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The importance of correct diagnosis looms large in both ancient and modern medicine .Itguidestherapyandpatientmanagement,andcanbethefoundationforapproaches to preventive measures. Prognosis is an allied skill that can require as much medical knowledge and intuition. The art of prognosis in the modern era, however, gets less recognition and attention, even though it can be important to the mental and emotional well-being of the patient and his or her family. In ancient Mesopotamia, prognosis had a significant impact on therapy. When the case was considered to be hopeless,1 the ams hipu did not continue therapy, as do modern physicians .2 This seems less strange when we realize that the ams hipu’s treatments consisted not merely of medicine but also of what we consider “magic” and that continuing therapy could potentially have meant engaging in expensive sacrifices and elaborate magical rituals when it was certain that the patient was going to die. We should also remember that the ancient Mesopotamians had many medicines that were not hallmarked for specific diseases but designed instead to alleviate specific symptoms (such as pain). Any of these treatments could have been applied to terminal cases without violation of the “no treatment” rule.3 This “no-treatment” rule has interesting implications when the “signs and symptoms” and prognoses listed in the ancient Mesopotamian diagnostic/prognostic handbook are put back into their original context. At first glance, there is a superficial resemblance between ancient Mesopotamian diagnostic and prognostic texts and omens. In both cases, there was an enumeration of “signs” derived from observations of everyday life followed by a positive or negative prediction, and in both cases there was a treatment or ritual to be performed in order to avoid death or disaster. chapter 20 Prognostics If his mouth is warm, he will get well; if his mouth is [cold, he will die]. —DPS VII A obv. 29 = TDP 62:29 If what a person observed while walking in the street (or what the amshipu observed on his way to the patient as is outlined in the first two tablets of the diagnostic/prognostic handbook ) contained a favorable omen (“his house will prosper”; “the patient will live”), all was well, and the pedestrian or ams hipu needed to do nothing in order to benefit. If, however, the observation was of something ill-omened (“his house will be scattered”; “the patient will die”), the pedestrian or amshipu was well advised to perform a special type of apotropaic magic ritual called a NAM.BÚR.BI in order to avert the portended evil. Due to the rule that forbade the ams hipu from treating hopeless cases, however, observations taken at the patient’s bedside (Tablets III to LX of the diagnostic/prognostic handbook )operatedbyacompletelycontraryprinciple;itwaspreciselythosemedical“signsand symptoms” with a favorable prognosis (“he will get well”) that received treatment, magical or otherwise. As if to underline this difference, the verbal tenses used to describe patients’ signs and symptoms in Tablets III to LX of the diagnostic and prognostic handbook are the same as those used in the therapeutic texts and are different from those used in Tablets I to II and in the omen literature generally.4 This inverted relationship between ancient Mesopotamian medicine and ancient Mesopotamianomensismostclearlyevidentinthosemedicalconditionsthatwerealsoconsidered ominous (i.e., they had both a prediction for the future and a prognosis). Although one might expect a treatable ailment to have a good prediction and vice versa, there are some quite dramatic examples of bad predictions attached to treatable conditions and of good predictions paired with “he will die” or at least with “he will die unless you treat him right away.” 20.1 [DISHinaMU].{3}.KÁMSHUB-suAD-s húDINGIRTUKU-shiLÚ.TURBIinaMUBIÚSH ana ZI-hri . . . (DPS XXIX:25 [AOAT 43.320]) **[If] (spawn of SHulpaea) falls on him [in] the third5 [year], his father will obtain a personal god; that infant will die in the same year; to remove it . . . In short, the condition was potentially fatal but a good omen for the victim’s father. By contrast, a ringing left ear was treatable but nonetheless portended ill for the patient after cure. 20.2 DISHGESHTU 15-shú GÙ.GÙ-si DIN (DPS VIII 8a = TDP 68:8a) **If his left ear continually rings, he will get well. 20.3 DISH NA GESHTU ZAG-s hú GÙ.GÙ-si me-si-ru DIB-su (BAM 155 ii 5⬘//Labat, RSO 32.112 iii 10⬘; cf. BAM 506:8⬘; DPS VIII 10a = TDP 68...

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