Stroke in Ancient Mesopotamia

Abstract

Introduction: More than 6000 years ago, the cradle of civilization, Mesopotamia, grew-up in what is known today as Iraq. The history of cerebrovascular diseases in Mesopotamia is insufficient to supply scholar needs. Therefore, the goal of this review is to highlight some remarkable points in the history of what we may coin as "stroke medicine" during the ancient Mesopotamian eras and to explore the knowledge and expertise of ancient healers. The neo-Sumerian period (2112-2004 BCE) documented, through clay tablets, many medical records about two kinds of medical specialists; the āšipu (exorcists) and the ašu (physician-priests).

Methods and findings: The information herein was gathered through literature review using online resources, such as NCBI, Google Scholar, PubMed, UCLA, and HİNARİ. Initially, most of the knowledge we have got was acquired mainly from two well-known transliterated cuneiform texts. Both tablets had clearly addressed stroke. One tablet, part of the "diagnostic" series is currently in the Louvre Museum in Paris, while the other one is in the British Museum in London and is part of the "therapeutic" series. The Mesopotamians had noticed and documented vascular disorders of the brain and some pertinent diseases. The ašu and the āšipu demonstrated an observational knowledge of anatomy and but no knowledge of the nervous system, the concept of pathology, or physiology as we call them today. Not all paralysis cases were viewed as a curse or an impact incurred by a supernatural deity. Physical treatment was mentioned to the patients. The familial occurrence of stroke was a well-known trait in that ancient period.

Conclusion: This descriptive review tells us that the history of stroke in the medical practice was well-encountered in the first half of the second millennium BCE and that physicians were keen observers to describe stroke presentation and prognosis.

Keywords: Mesopotamia; cerebrovascular disease; history of medicine; stroke.

Figure 1.. Tablet K.2418 of the “therapeutic” series. The tablet was fragmented and only the left half of it has survived. It contains 26 lines of Akkadian script about the medical treatment of stroke. Not on display. From the library of Ashurbanipal II at Kouyunjik (in modern-day Mosul Governorate, Iraq). Neo-Assyrian period, 7th century BCE. The British Museum, London. Photo ©Trustees of the British Museum. Used with kind permission, under CC BY-NC-SA 4.0 license.

Figure 2.. Gypsum bas-relief showing a dying lioness. The lioness was hit by two arrows, which appear to pierce the lower back. The animal roars and walks in agony, using her forelimbs and dragging the hindlimbs. She has paraparesis. The 3rd arrow hits the left shoulder. From the North Palace of Ashurbanipal II at Nineveh (in modern-day Mosul Governorate, Iraq). Neo-Assyrian period, circa 645-635 BCE. On display at the British Museum in London, Room 10a. Photo ©Osama Shukir Muhammed Amin.

Figure 3.. Gypsum bas-relief showing a dying lion. The animal’s lower back was hit by an arrow. The lion vomits blood and his hindlimbs are flaccid, indicating that he has paraparesis. Another arrow seems to hit the lion at the neck. From the North Palace of Ashurbanipal II at Nineveh (in modern-day Mosul Governorate, Iraq). Neo-Assyrian period, circa 645-635 BCE. On display at the British Museum in London, Room 10a. Photo ©Osama Shukir Muhammed Amin.