SOME MESOPOTAMIAN MEDICINE

FOR A GREEK HEADACHE

JOANN SCURLOCK

To an unrecognized extent, Hellenistic Greek phi-

losopher-scientists tapped the rich resources represented by the scientific traditions
of the lands conquered by Alexander. Not only is this interesting as a subject in its
own right, but the recognition of the ancient Mesopotamian sources from which
Classical authors drew inspiration, however indirectly, can in some cases serve to
rescue from obscurity passages that have defied previous attempts at understand-
ing. In what follows, we will briefly outline a few examples of this Ex Oriente Lux
that, it is hoped, Marten will enjoy.
As I have argued in my “Esagil-kin-apli” (Scurlock 2004) the Hippocratic diag-
nostic category phrenitis (Internal Affections 48) has resisted identification largely
through ignorance of texts relating to the ancient Mesopotamian diagnostic cate-
gory “hand” of ghost. In addition, ancient Mesopotamian ghosts were believed to
cause a variety of headaches, including ophthalmologic migraine as well as certain
types of seizures, references that seem to have reached Classical authors and whose
citation by the latter out of their original context has caused similar confusion
among modern scholars not versed in ancient Mesopotamian texts.
In an article by Clifford Rose in Cephalalgia 1995, it is argued that Aretaeus of
Cappadocia was the first to distinguish among different types of headaches. Long
before Aretaeus, however, ancient Mesopotamian physicians had devised separate
herbal treatments for ordinary headaches, severe (tension) headaches accompa-
nied by pain in the neck muscles, and pulsating one-sided (migraine) headaches
with bloodshot and tearing eyes.
The preservation of the observations of Aretaeus’s predecessors is fortunate
since it enables us to correct Rose, who accuses Aretaeus of mistaking meningitis for
migraine. Actually, ancient physicians clearly distinguished the fatal variety of cepha-
laea from headaches accompanying fevers, such as meningitis. The latter were
referred to by a separate term, cephalalgia.

195
196 JOANN SCURLOCK

If the head is suddenly seized with pain from a temporary cause, even if
it should endure for several days, the disease is called cephalalgia.1
In some cases, the headache is acute and is accompanied by fever; in these
cases the leading physicians of the sects give it the special name cephalalgia.
In other cases the disease is chronic and unaccompanied by fever … This
form of the disease the ancients call cephalaea. 2
Without help from Mesopotamia, however, little more could be said since Are-
taeus gives no further description of his fatal headaches other than to mention that
they were severe and protracted. In addition to cases of what could be encephalitis
or meningitis, ancient Mesopotamian physicians described fatal afebrile head-
aches, which are good candidates for Aretaeus’s fatal variety of cephalaea as follows.
DIfi SAG.KI-Íú DIB-su-ma TA dUTU.fiÚ.A EN EN.NUN UD.ZAL.LI ur-rak ú-Íam-Íá
GAM3
If his temple afflicts him and it lasts from sunset till the morning watch
(var. it keeps him awake all night), he will die.

DIfi Íi-bit SAG.DU-Íú paˇ-rat [GAM]4

If the seam of his head (feels like it) is open, he will die.

[Íi-bit] SAG.DU-Íú paˇ-rat Úfi : SAG.DU-Íú TAG.MEfi5

[The seam] of his head (feels like it) is open, he will die. (That means) his
head continually hurts him intensely.

DIfi SAG.KI-Íú DIB-su-ma KI.MIN SA SAG.KI-Íú ma-gal ZI.MEfi UGU SAG.DU-Íú

DU8 fiU GIDIM7 GAM6
If his temple afflicts him so that ditto (he continually cries out), his tempo-
ral blood vessels (feel like they) are pulsating greatly (and) the seam of his
head (feels like it is) open, “hand” of ghost; he will die.

DIfi SAG.KI-Íú DIB-su-ma KI.MIN SA SAG.KI-Íú ma-gal ZI.MEfi u e-li SAG.DU-Íú

Óa-biÍ GAM7

1 Aretaeus the Cappadocian, On Chronic Diseases I.2.

2 Soranus of Ephesus, apud Caelius Aurelianus, Chronic Diseases I.1.6.
3 DPS IV B obv. 12 = TDP 34:12; cf. BAM 482 iv 46'//AMT 19/1 iv! 29'.
4 DPS III A obv. 24//C obv. 15 = TDP 20:15.
5 STT 403:22 (commentary).
6 DPS IV B obv. 8//D 8 = TDP 32:8; cf. BAM 482 iv 49'//AMT 19/1 iv! 32'–33'.
7 DPS IV B obv. 9//D 9 = TDP 32:9.
SOME MESOPOTAMIAN MEDICINE FOR A GREEK HEADACHE 197

If his temple afflicts him so that ditto (he continually cries out), his tempo-
ral blood vessels (feel like they) are pulsating greatly (and) the upper part
of his head (feels like it was) broken in pieces, he will die.

Headaches may be a symptom of severe neurological disorders, particularly

tumors, abscesses, ruptured cerebral aneurysms, and cranial trauma. All these were
probably meant to be included in Aretaeus’s category of fatal headache. The last
three Mesopotamian references above are particularly suggestive of ruptured cere-
bral aneurysms because of their severity—they are often described by modern
patients as the worst headache possible.
Another form of headache first described by ancient Mesopotamian physi-
cians is what we call ophthalmologic migraine.
e-nu-ma IGI-Íú bu-ur-‰a id-da-nag-ga-la fiU.G[IDIM.MA…] ÿanaŸ [T]I-Íú …8
When his eyes continually see flashes, “hand” of gh[ost (or) …], to cure
him…
9
DIfi NA ina IGI.MEfi-Íú bir-‰i x[…] GIDIM Óur-ba-ti mu-u[Í-…]
If a person [sees] flashes in his eyes […] a ro[ving(?)] ghost of the wastes
[afflicts him] …

Also attributed to ghosts, but separately described, were severe dizziness and
ringing in the ears. Put together with a few further observations, the result was Sora-
nus of Ephesus’ masterful description of what he terms “scotoma.”
Those who have the disease experience a sudden darkening10 and blot-
ting-out of the vision, with such dizziness that they think everything is
moving about them. They see before their eyes sparks (which the Greeks
call marmarygae) like the flashes that come from the spots of shining
marble, meeting the eyes from every direction, no matter which way they
turn them. Again, in this disease the head and eyes feel weighted down;
though the patient wishes to sit down, he fears to move for he thinks every-
thing is giving way or falling about him. There is ringing in the ears, sweat-
ing of the upper parts of the body, or a sudden fall followed by swift
arising. And the disease is aggravated if the patient watches the flow of a

8 BAM 516 i 2–3; cf. AMT 85/2:12.

9 AMT 85/2: 4–5.
10 It was this “darkening” (Greek scotos) that gave “scotoma” its name (Soranus of Ephesus,
Chronic Diseases I.2.51). Rose states (p. 3) that Avicena’s term for headache is “from the Persian
sar did.” It seems more probable, however, that it is instead a direct translation of scotos using the
Arabic word for black, sowda.
198 JOANN SCURLOCK

river from a high point or gazes at a rotating potter’s wheel or does

anything when bending forward or hears a loud noise.11
Aretaeus’s description of “scotoma” (On Chronic Diseases I.3) is much less ele-
gant and foregrounds the dizziness and ringing in the ears, although the sparkles of
light in the eyes are still mentioned. In addition, Aretaeus speaks of “scotoma” as
“the commencement of other affections—of mania, melancholy or epilepsy,” a
judgment with which Soranus concurs.
Scotoma … frequently attacks … those who drink wine to excess … In
addition, it gives warning of epilepsy to come (saepe futuram denuntiat
epilepsiam).12
Unfortunately for ancient physicians, this association of “scotoma” with “epi-
lepsy” led Clifford Rose to argue that “since he (Soranus) considered it (‘scotoma’)
to be a precursor to an epileptic attack (he) must therefore have meant simply a
dizzy spell.” As is clear from his detailed description, the full syndrome of what Sor-
anus is calling “epilepsy,” said generally to occur or commence after drunkenness
( Chronic Diseases I.4.61), involves not only ophthalmologic migraine (his
“scotoma”) but also odd cravings, troubled dreams, an unsettled mind with a ten-
dency to anger, and forgetfulness.
Those who are on the verge of an attack of epilepsy show symptoms in
common with those of other diseases originating in the membrane of the
brain. … Certain objects may appear as if dangling before the eyes, like
the sparking points in marble … or spiders’ webs or thin clouds or small
winged animals, such as gnats. And patients see sparks flashing or rings
of fire spinning before their eyes … There are also the following symp-
toms: stiffness of the throat, constant precordial distention, yawning,
sneezing, flow of saliva, distaste for food or else an uncontrolled desire for
it, continued wakefulness or else excessive and unprofitable sleep, trou-
bled dreams, difficulty in digesting food, tentigo without any apparent
reason, frequent desire for venery, sometimes an effusion of semen during
sleep … mind unsettled and troubled, a tendency to become angry for no
good reason, forgetfulness of what has just recently taken place, and a
susceptibility to anything that blurs the vision.13
The described symptoms are characteristic of another of the syndromes attrib-
uted by ancient Mesopotamian physicians to the attack of unhappy ghosts, namely

11 Soranus of Ephesus, apud Caelius Aurelianus, Chronic Diseases I.2.51–52.

12 Soranus of Ephesus, apud Caelius Aurelianus, Chronic Diseases I.2.51.
13 Soranus of Ephesus, apud Caelius Aurelianus, Chronic Diseases I.4.62–64.
SOME MESOPOTAMIAN MEDICINE FOR A GREEK HEADACHE 199

alcoholism. Drinking alcohol on an empty stomach can induce hypoglycemia, pro-

ducing sweating, tremor, tachycardia, anxiety and hunger, as described in the fol-
lowing reference.
DIfi ZI.IR fiUB.fiUB-su mim-ma Íá im-ma-ru ú-‰al-la UB.NIGIN.NA-Íú KÚM u IR
u4-mi-Íam-ma TUKU-Íi a-zu-za-a bi-bil fiÀ ma-dam-ma TUKU.MEfi EN u-bal-
lu-niÍ-Íú fiÀ i-Óa-Óu U4 u-ba-lu-niÍ-Íú IGI.BAR-ma la i-lem fiU GIDIM7 Íá ina A
14
SÌG-[i‰]
If worry continually afflicts him (and) he makes supplication to whatever
he sees, his limbs are hot and he sweats every day, he has a big appetite at
unpredictable times, (and) until they bring him what he wants he vomits,
(but) when they bring it to him he looks at it and doesn’t eat it, “hand”
of a ghost who was struck in the water.

The neurological disease called Wernicke-Korsakoff syndrome is caused by

thiamine deficiency brought on by chronic alcoholism. Its findings include confu-
sion, amnesia, paralysis of the muscles for eye movement (ophthalmoplegia), stag-
gering gait (ataxia), and abnormal eye movements (nystagmus), as described in the
following reference.
DIfi NA KAfi.SAG NAG-ma SAG.DU-su DIB.DIB-su INIM.MEfi-Íú im-ta-na-áÍ-Íi ina
DUG4.DUG4-Íú ú-pa-áÍ-Íaˇ ˇè-en-Íú la ‰a-bit NA BI IGIII-Íú GUB-za ana TI-Íú
15
…
If a person drinks fine beer and as a result his head continually afflicts him,
he continually forgets his words and slurs them when speaking, he is not
in full possession of his faculties, and that person’s eyes stand still, to cure
him …

A more serious consequence of excessive alcohol intake is delirium tremens

(DTs), which the following reference appears to describe.

DIfi tu-gu-un-Íú ú-zaq-qat-su GEfiTUII-Íú GÙ.DÉ.MEfi S∞G SU-Íú GUB.GUB-az kal

LÚ.AD6-Íú GIN7 kal-ma-tum i-ba-Íú-ú i-nam-muÍ u fiU-su ub-bal-ma la i-ba-
áÍ-Íú : la ig-gi-ig fiU GIDIM7 UD.DA LÚ GIN7 GIfiN∞G.GIDRU Íá d30 GÌRII-Íú fiU
16
GIDIM7
If (the skin under) his headband stings him, his ears roar, the hair of his
head continually seems to stand on end, his whole body crawls as if there

14 DPS XXVII:29–31 (AOAT 43.299–300).

15 BAM 575 iii 51–52//BAM 59:21–24.
16 DPS XXVII:32–34 (AOAT 43.300).
200 JOANN SCURLOCK

were lice but when he brings his hand up there is nothing to scratch,
“hand” of ghost ‰¤tu (dehydration); (if) the person (bends and stretches
out) his feet as in the scepter of Sîn, “hand” of ghost.

The “scepter of Sîn” in the reference above is also mentioned in connection

with ghosts in the following, very similar references. One of these is drawn from the
diagnostic series and the other appears in a therapeutic text, with accompanying
treatment.

DIfi GIfiN∞G.GIDRU Ía d30 GAR-su-ma GÌR-Íú i-kap-pap u i-tar-ra-a‰ i-ram-mu-

um u Ú° ina KA-Íú DU-ak fiU GIDIM7 mur-tap-pi-du ina EDIN DIB-su17
If the scepter of Sîn has been placed on him so that he bends and stretches
out his foot, he drones and saliva flows from his mouth, “hand” of a ghost
roving in the steppe afflicts him.

[DIfi GIG] LÚ GIN7 GIfiGIDRU Ía dEN.ZU GAR-Íum-ma G[ÌR]-Íú i-kap-pap u i-tar-

ra-a‰ i-ra-am-mu-um u ÿru-’u-túŸ [ina] ÿKA-ÍúŸ DU-ak GIDIM mur-tap-pi-
du ina EDIN DIB-su …18
[If] the person’s [illness] sets upon him like the scepter of Sîn so that he
bends his ÿfootŸ and then stretches (it) out, (and if) he drones and saliva
flows [from] his mouth, a ghost roving in the steppe afflicts him …

What appears to be described in the above texts are seizures of the grand mal type.
Seizure disorders often occur within twenty-four hours after the cessation of drink-
ing. Interesting in view of the association of the “scepter of Sîn” with both delirium
tremens and grand mal seizures is the fact that about a third of the patients with
alcohol-induced seizure disorders progress to develop delirium tremens.
In short, comparison between Soranus’s account and ancient Mesopotamian
descriptions reveal that what Soranus is calling “epilepsy” in this context is not the
full range of seizure activity covered by the Ancient Mesopotamian term for epi-
lepsy, AN.TA.fiUB.BA, but only what was termed the “scepter of Sîn,” that is, what we
now refer to as withdrawal seizures. Given this context, Soranus is not to be dunned
for his alleged inability to recognize a headache and instead praised for having
made the observation that ophthalmologic migraine is “common in those who
drink wine to excess and gives warning of withdrawal seizures to come.”
Epilepsy was known to the Greeks as the Sacred Disease due, as Soranus notes
(Chronic Diseases I.4.60), to the fact that many believed it to be caused by divine
agency. Of significance, then, in view of the attribution by ancient Mesopotamian

17 DPS XXVII:35–36 (AOAT 43.300).

18 BAM 385 i 15'–17'//BAM 471 ii 21'–22'.
SOME MESOPOTAMIAN MEDICINE FOR A GREEK HEADACHE 201

physicians of alcoholic withdrawal seizures to the “scepter of the moon-god Sîn” is

the fact that Aretaeus connects this specific form of epilepsy to the moon: “for it is
supposed that it is an infliction on persons who have sinned against the moon and
hence some have called it the Sacred Disease.”19
Also probably of ultimate ancient Mesopotamian origin is the notion, found in
Plutarch and Aristotle (apud Stol 1993: 126), that the moon-god was responsible
for producing infantile spasms. Ancient Mesopotamian physicians described
infants having seizures as “jerking,” “trembling,” or having “confusional states.”
The texts below indicate that the infant recovered and, therefore, fit the definition
of benign infantile seizures.

DIfi LÚ.TUR ig-da-na-al-lut u LÙ.LÙ fiU d30 AL.TI 20

If an infant continually jerks and is restless, “hand” of Sîn; he should
recover.

DIfi LÚ.TUR KÚM NU TUKU IGIII-Íú bal-‰a fiUII-Íú u GÌRII-Íú i-ra-’u-ba fiU d30 DIN 21
If an infant does not have a fever, his eyes are dilated (and) his hands and
his feet tremble, “hand” of Sîn; he should recover.

Unfortunately, the introduction by the Greeks of “natural causes” whereby it

became the moon (rather than the moon-god) that was involved led inevitably to
much pseudo-scientific nonsense on the subject of phases of the moon, moonlight,
and eventually magnetic forces allegedly producing seizures.22 Also characteristic
of Classical science was a method—foreign to ancient Mesopotamia—of generat-
ing treatments solely on the basis of the physician’s diagnosis. It was this that led so-
called physicians to treat seizures by burning the patient’s head, perforating his
skull with a bow drill, and cutting the arteries behind his ears (Temkin 1945: 76–
77). None of these defects should be laid at the door of ancient Mesopotamia. As
with other aspects of ancient Greek medicine, however, with the help of cuneiform
sources, it is possible to extract the essentially sound core from the overburden of
theoretical elaboration and to rescue some ancient Greek diagnoses for science.23

19 Aretaeus the Cappadocian, On Chronic Diseases I.4. Interesting in this context is the extent
to which “magical” treatments for “epilepsy” in the Classical world included not only substances
associated in one way or another with the moon but also with ghosts including the bones of the
dead (Temkin, 1945:10–15, 22–23).
‘20 DPS XL A 35 = TDP 220:35.
21 DPS XL A 120 = TDP 230:120)(6).
22 For further references, see Stol, 1993: 121–125, 127.
23 For more examples, the reader is referred to Scurlock, 2004.
202 JOANN SCURLOCK

BIBLIOGRAPHY
Aretaeus the Cappadocian, 1856. The Extant Works of Aretaeus the Cappadocian, trans. F.
Adams, London.
Caelius Aurelianus, 1950. On Acute Diseases and On Chronic Diseases, ed. I. Drabkin,
Chicago.
Rose, C. 1995. “The History of Migraine from Mesopotamian to Medieval Times,” Cepha-
lalgia 19, 1–3.
Scurlock, J. 2004. “From Esagil-kin-apli to Hippocrates,” Le Journal des Médicines Cunéi-
formes 3, 10–30.
Stol, M. 1993. Epilepsy in Babylonia, Cuneiform Mongraphs 2, Groningen.
Temkin, O. 1945. The Falling Sickness. Baltimore.