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Conclusion In many of the previous books and articles on the subject of ancient Mesopotamian medicine , little credit has been given to the medical knowledge and skills of these early physicians .Althoughtherolesofvirusesandbacteriawereplayedbygods/goddesses,ghosts,and demons, it does not follow that diagnosis was “irrational” and treatment “pure magic.” The problem presented by the divine language of what we still call medical signs and symptoms was to determine which combinations of animal products, minerals, and plants and which recitations were effective for which medical problems. To answer this question, the ancestor of the amshipu began by carefully observing his patients and deriving a vocabulary to describe their signs and symptoms so that any treatments that might subsequently be devised could be applied consistently, past successes reproduced, and repetition of past failures avoided. Gradually, it was noted which individual signs and symptoms tended to occur together, and these were grouped into syndromes. Only after the process of gathering information was more or less complete did the ancient Mesopotamian physician attempt to assign syndromes to causal agents. In other words, he did not ask “What combinations of signs and symptoms would these gods/goddesses cause?” but “Which of these gods/goddesses, if any, would cause this combination of signs and symptoms?” This pattern of nomenclature is analogous to the use of syndromes in modernmedicinewiththeexceptionthatthemodernphysicianhastheluxuryofbeingbetter able to correct his classification system by reference to invisible causal agents identified by laboratory analysis. Thereweremagicalrituals,buttheywereintendedasasupplementto,andnotareplacement for, treatment with medicines and surgery. Medicines were evaluated by clinical trials, although not as rigorously controlled as in current practice. There is no evidence that Mesopotamian physicians constructed improbable and untested theoretical principles to explain illnesses, as did too many premodern physicians. Instead, they evaluated possible causes pragmatically, and systematically tested plants and minerals for useful therapies. That ancient Mesopotamians should have produced a sophisticated medical system should come as no surprise. They also invented the potter’s wheel and chariots, refined irrigation to an art, and developed the first architectural arch, the first written language, a system of measurement of time still employed by us today, as well as a sophisticated system of mathematics and astronomy. The practice of medicine in ancient Mesopotamia had an organization that is similar to that of modern medicine. A team approach to patient care was evident, with the amshipu primarily responsible for diagnosis, and the asû for collecting and compounding the components of medicines. The amshipu followed a logical and organized process in describing and recording diseases. The diagnostic/prognostic handbook included all areas of medicine, listing them in head-to-toe order with special sections for pediatrics, obstetrics and gynecology , and neurology. Some recurring combinations of signs and symptoms were considered to be syndromes much as is the current practice. The exact process that was used to train physicians is unknown, but the medical literature certainly played a vital role. The organization of the diagnostic/prognostic handbook makes it clear that the object was not merely to describe specific diseases or syndromes but to function as medical textbooks do in the present era. There were series of references that compared varying presentations of the same disease and contrasted them with different diseases that may have some overlapping signs and symptoms. Also included were entries that attempted to explain the etiology of specific diseases. It seems likely that experienced senior physicians would have been preceptors to physicians-in-training. The amshipu used the same general approach to the work-up of patients that is currently practiced. He obtained medical histories from the patient and family members that established past exposure to contagious diseases, important geographical and travel information , and any familial diseases. Physical examinations were performed thoroughly, and described with an extensive medical vocabulary that indicates the importance that physicians placed on these observations in understanding the disease process. The amshipu used touch, sound, sight, and smell as he pushed, prodded, felt, sniffed, and looked at his patients. Breathing patterns, pulse rates at many body sites, temperature, the smell of wounds and urine, and the feel of muscles, joints, and abdomen were all important factors in reaching a correct diagnosis. In addition to direct physical findings, the ancient Mesopotamian physician also devised clinical diagnostic tests, some of which are still in use today. It is also clear from the descriptions of chronic diseases that the amshipu often followed his patients for long periods of time. The a mshipu also played a significant role in preventing diseases...

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