Hajar A. Hajar AL BinAli, MD, FACC*

 It took man centuries and millennia to build our present medical knowledge that we all take for granted. Medicine is the most respected and the oldest profession on earth. It had and still has a profound impact on human life and comfort. It is important for both physicians and lay people to review the ancient roots of modern medicine.
 Some readers may consider the title, Arabian Gulf: Cradle of Medicine, provocative.
 It should not be. 
The reason I refer to the Arabian Gulf as the cradle of medicine is that the Gulf (Fig.1) is the region where human civilization began. 
There is no disagreement among historians that the north of the Gulf was the site of early civilization in human history.
 The first human settlement was far south of present Iraq, which is now covered by the Gulf sea after the melting of the Ice Age (1). 
Historians agree that the Sumerians in the north of the Gulf, which is actually the south of present Iraq, were the first civilized people.
Samuel

Fig.1. The Arabian Gul

Kramer, a well known authority on Sumerian history, chose a dramatic title to one of his books: History Begins at Sumer (2).
The word civilization is related to urban settlement and cities, and derives from Latin civitas (city). So civilization means "city-dwellers".
Archaeological discoveries have proven the existence of prehistoric societies from 58000 – 3000 BC. The Sumerian culture has been dated from 3000 BC in the city of UR. This coincides with the invention of writing by the Sumerians, which is the beginning of history. Prehistory is time before the invention of writing.
Some primitive societies still practice medicine exactly as they were carried out over thousands of years. Examples of such practices are witchcraft, exorcism, cautery, and blood letting. Most of Arabian Gulf traditional medicine that is still practiced on a limited scale are inherited from the Mesopotamians. In fact, some of the Babylonian heritage are preserved not only by the Arabs but also by non-Arab Moslems (see table 1). Islam did not forbid all pre-Islamic traditions.

  The causes of Illness in Arabian Gulf traditional medicine were thought to be due to ginii, demons and witchcraft. The Gulf Arabs believed that disease is punishment by God for sins. These beliefs are, no doubt, Babylonian in origin. For thousands of years the Gulf Arabs believed in the
bad eye as a cause of disease. The bad eye concept as a cause of disease is so prevalent, especially among the older generation of our society, that it is unlikely to vanish for years to come. The bad eye concept is well-explained by the Babylonians. They believed that a spirit may enter a person’s body, and it may leave through his eye, without his attention or knowledge, to possess another person when the former looks at the latter, the victim.
We frequently use the term Babylonian to indicate not only the Babylonian era, when Babylon was the capital of Mesopotamia, but also the entire history of Mesopotamia from its Sumerian origins to the Assyrian period, just as when we say Egyptian, we refer to the whole period of Pharaonic history.
The Babylonian achieved great progress in mathematics, astronomy and a variety of first inventions in history. It is beyond the scope of this article to discuss other than their medical history. Table 2 lists some of their scientific achievements.
 

Disease forms have remained essentially the same throughout the millennia. There is no doubt that before there were humans there was disease. But unfortunately, proof of the existence of diseases in prehistory can not be traced except through bones. Flesh decays fast and no traces of it could be found for analysis. Archaeologists have unearthed the skeleton of an individual dated 60,000 years ago in Shanidar cave, north Iraq. The skeleton was given the name Shanidar I, after the cave in which it was found. Shanidar I had multiple traumatic injuries, healed fractures and degenerative bone disease. He could not have survived such deadly injuries alone without someone caring and providing food for him (3). His story proves the existence of "humane" care in early societies.
Trepanned skulls have also been found dating as early as 5000 BC in Mesopotamia.
The reasons for such practice is still speculative and explanations have ranged from treatment for epilepsy, headache, to venting for increased intracranial pressure; or an avenue for the devil to exit!
  

Since the Sumerians are credited with the earliest human civilization, it is not surprising that excavations in that region reveal the existence of a Sumerian physician seal as early as 3000 BC. That seal is the earliest proof of the existence of physicians during that era (Fig 2).

Fig. 2. Physician cylinder seal. The inscription reads:
“O god Edinmugi, vizier of the god Gir, who attends mother animals when they drop their young! Urlugaledina the doctor is your servant.”

Besides the invention of the wheel and writing, the Sumerians are also credited for the preparation of drugs and cosmetics and brewing of barley beer.
An article in the American Journal of Cardiologystated, "Writing on a baked clay tablet a physician recommended the addition of potassium nitrate to a number of medical cures" (4).
The practice of medicine was not restricted to male physicians only. There is a single mention of a woman physician in an old Babylonian text from Larsa (5).
They even had veterinarians and they called them, "healers of beef and ass."

Fig. 3. Oldest known Sumerian medical book. 2200 B.C.
  

The oldest medical text was written by a Sumerian physician in the 3rd millennium BC on a clay tablet (Fig 3). This medical text is now in the University of Philadelphia Museum (6). Most Babylonian medicine came from the botanical world. Their favorite mineral preparation was sodium chloride and potassium nitrate.
Clay tablets have been found mentioning liver, eye, respiratory diseases, fever and gonorrhea. They showed some knowledge of night blindness, otitis media, renal calculus, stroke and scabies. (7).
The Babylonians administered drugs in every possible way short of injections: mixtures, potions, inhalation, ointment, liniment, enemas and suppositories. (6).
Limited physical examination was carried out by the Babylonians. The temperature of the skin was tested in several parts of his body, the rhythms of the pulse was apparently recognized. 
The discoloration of the skin and the color of the urine was noted. (5).
  

  Numerous gods and goddesses controlled health and disease.
  Disease was punishment for sin.
  When gods retract their protection, man falls prey to disease-bearing devils 
     and ghosts,  which swarmed around Mesopotamia.
  Illness was essentially a moral and ethical defect, a black mark, a condemnation. 
     Such an ailment called for a moral cure.
 Treatment: mostly magical and religious.

There were, in ancient Iraq, true physicians who believed in the supernatural origin of most diseases, but who also recognized the causative action of natural agents such as dust, dirt, food or drink and even contagion.
  

The Babylonian had their own medical and philosophical beliefs. The following are some of their enduring beliefs (6):

1. The heart is the seat of the mind.
2. The liver is the seat of emotion.
3. The stomach is the seat of courage.
4. The uterus is the seat of kindness.

These beliefs survived throughout thousands of years. They still exist, not only in Arab culture, but also in many cultures around the world. In Muslim and Christian Holy Scriptures, the heart was the center of thoughts. The concept that the heart is the center of love is almost universal. Some ancient Arab poets associated both the heart and the liver with love. In the West, people still say, "he has guts", when they mean courage. Most people are not aware that the origin of such terminology goes back to the ancient Babylonians.
  

2. Ashipumade the diagnosis and prognosis. It was assumed that the patient's fate
   depended largely on his findings. His task was to perform the rites required for driving
   out an evil spirit from the body and for reconciling the patient with his god.
   If the disease was obvious, it was the work of a certain devil and no further diagnosis
   was necessary!
   In more complicated cases, the priest recited a long list of possible sins to the patient,
   hoping that he might be able to choose from them the sin that had caused his disease.
   If both methods failed, divination entered the scene (7).

3. Asu was the real physician. He was neither a priest nor a witch-doctor, but a
   professional man belonging to the upper middle class of the Assyro-Babylonian
   society.  He had spent years at school learning the basic sciences of his time. 
   He provided rational medicine. In later periods however, the asu was superceded 
   by the ashipu (5).
   We have learned how an asu looked like from a humorous Babylonian story, The 
  
a physician (asu): clean-shaven and carrying the two insignia of his calling – a libation
   (alcohol) jar and a censer(incense burner)(5).  
   I n other descriptions, he carried a bag of herbs.
  

The Babylonians were very skilled in treating tooth abscess. Historians mention that an Egyptian king sent for a Babylonian dentist to treat his tooth abscess when his Egyptian dentist failed. They described their methods of treatment using herbs and oil to massage the gum so vigorously 

Fig. 4. Ceremonial beaker with double-headed snake dedicated to Ningishzida, god of healing. c. 2000 B.C

The Epic of Gilgamesh is the most famous of the Babylonian myths and is considered the father of epic literature. Gilgamesh sought immortality that was granted only to the gods. The snake ate the plant of immortality and shed its skin. The shedding of the skin was a sign that the snake possessed the power of regeneration and rejuvenation, hence the snake in the epic of Gilgamesh may have been the origin of its association in medicine. Ninazu, "Lord of Physicians", was an important healing deity and the emblem of his son, Ningishzida, was a double-headed snake (9). A double-headed snake ceremonial beaker (Fig 5) is another proof that the link between the snake and medicine is of the Babylonian origin before the Greeks adapted the concept.
  

Both the Mesopotamian and Egyptian lands witnessed fruitful exchange of medicine with Europe over thousands of years. First, Mesopotamian medicine was transmitted in part to the Greeks, and together with Egyptian medicine, it paved the way for the great Hippocratic reform of the fifth century B.C. Then, during the rise of the Arab Empire (8th -10th century), Greek medicine was translated to Arabic. The Arabs preserved Greek medicine when most of the original works was lost from Europe. The Arabs improved on Greek medicine as well as made new discoveries over several centuries. In the 13th and 14th century Greco-Arab medicine was transferred to Europe again from Arab capitals such as Cordoba in Andalusia, Spain and Baghdad in Iraq.
It is true that not only medicine but human civilization started north of the Arabian Gulf, but neither medicine nor civilization belongs to one nation on earth. Nations as well as civilizations borrowed from each other medicine, science, arts, and technology over centuries of human development. Fortunately for us, in the field of medicine, the same trend is continuing in the medical sciences. No country has monopoly on medical science today. With the present vast publications and fast communications via the internet, medicine is becoming a global science. In fact the whole world is becoming a village in a small planet in our universe.

Medical history shows us the evolution of medicine, how medical therapies come and go, and how useful procedures become not so useful. Some of us may laugh at the diagnostic and therapeutic methods used by the ancient Babylonians. But to be fair we should credit the Babylonians and ancient Egyptians for starting the foundations of medicine with their trial and error. Through such trial and error, they laid down the foundations of medicine upon which this field progressed. 
They deserve our admiration.
Modern medicine with its scientific theories has its roots in the "old" theories of the past. Many of today's medical facts and theories sprang out from yesterday's myths and errors. Today's truth might also become tomorrow's myth.