As a general reference to healing practices, medicine has a long and complex history in the ancient Near East. It is useful to think of healing practices as part of a healthcare system that includes, but is not limited to, beliefs about the causes of illness, the options available to patients, and the role of governments in healthcare.

Public hygiene, which refers broadly to the organized efforts of a community to promote health and prevent disease, is also part of any healthcare system. Brief synopses are provided here of the healthcare systems in the major geocultural areas of the Near East (see below) from earliest times to the Early Islamic period (c. 1250 CE).

Prehistory.

Little is known about the treatment of illness during the Paleolithic, the first period of human material culture, which ended approximately between 20000 and 16000 BCE in the Near East. By the end of the period, it is speculated, humans practiced therapeutic rituals and may have recognized the medicinal value of some plants. At Shanidar I (c. 45000 BCE), a rock-shelter in Iraq, the skeleton of a “Neanderthal” adult male suggests that he had received substantial care from his community because he had lived for years with osteoarthritis and other serious injuries. [See Shanidar Cave.]

In the Neolithic (c. 8500–4300 BCE) period, the domestication of animals introduced some new pools of diseases into human populations. Thus, bovine tuberculosis may have become more prevalent in human beings after cattle began to be kept for milk and food. Human tuberculosis is reflected in skeletal material from Egypt and Bab edh-Dhra῾ (Jordan) as early as the fourth millennium.

Some researchers conclude, on the basis of comparisons in dental attrition (among other features), that hunter-gatherers (e.g., Natufians at el-Wad, Jordan) in some Epipaleolithic cultures (c. 19000–8000 BCE) were generally healthier than agriculturalists at places such as Jericho and Tell Abu Hureyra, a large settlement in northern Syria. Yet, some studies of the Levant estimate the average life-span in the Neolithic at thirty-four years, compared to thirty years in the Epipaleolithic period. At Çatal Höyük, a large Neolithic town in Anatolia, skeletal remains of some individuals were estimated to be more than sixty years old. [See Çatal Höyük.]

Because many diseases need relatively high population densities in order to thrive, a number of diseases that were insignificant in hunter-gatherer bands became significant with the rise of urbanization. Other serious threats to public health in most cities of the ancient Near East probably included the unequal distribution of food and the contamination of food and water supplies by the inadequate disposal of human and animal wastes. Increases in trade, military expeditions, and migration helped to spread diseases among populations.

The frequency of enamel hypoplasia (thin enamel) and other skeletal features in the urban populations of the Early Bronze Age (c. 3300–2300 BCE) in the Levant may indeed indicate a decline in health status relative to the Epipaleolithic and Neolithic. High rates of hypoplasia are also found at Azor (near Tel Aviv) and elsewhere in the Chalcolithic period (4300–3300 BCE).

Throughout all prehistoric periods the family was probably the main caretaker for the ill. The appearance of survivable surgical procedures on the skull (trephination) is already evident in the Pre-Pottery Neolithic at Jericho (c. 8500–6000 BCE). The reasons for trephination are still unclear, but if it is a medical procedure, it may be one of the earliest representatives of the development of specialized healing crafts. The most effective treatment, however, was probably simple rest.

A discussion of the major geocultural areas in the Near East follows for the periods prior to the Islamic conquest in the eighth century CE. We shall proceed alphabetically: Anatolia, Cyprus and the Aegean, Egypt, Mesopotamia, and Syria-Palestine.

Anatolia.

By the Neolithic period various groups had already built impressive towns (e.g., Çatal Höyük) in Anatolia. It is the Hittites, a group of Indo-European speakers, who are perhaps the best-known residents of the region, especially in the Late Bronze Age. The Hittite healthcare system is difficult to reconstruct because sources are very fragmentary. However, extant sources show that Hittite medicine included Luwian and Hurrian traditions. Many of the best-known Hittite medical texts are translations or adaptations of Mesopotamian models. [See Hittites; Luwians.]

The inadequate disposal of waste was probably a major public health problem, especially in urban areas. Concern with public health may be partly responsible for the clay pipes and drainage channels found at Boğazköy, Alaca Höyük, and other LB cities. Some of the wealthier households in Boğazköy and other cities were apparently equipped with toilets. [See Boğazköy.]

Illnesses mentioned in Hittite texts include disorders of the eyes, mouth, throat, and intestines. There are reports of illnesses afflicting King Šuppiluliuma (who died in about 1335 BCE of a plague brought back by his soldiers after a campaign in Syria) and King Ḫattušili III (c. 1278 BCE). The Plague Prayers of Muršili II (c. 1335–1308 BCE), which refer to an unidentified epidemic lasting some twenty years, recognize that diseases could affect the socioeconomic stability of an entire empire.

For Hittites, illnesses could be caused by numerous factors, including the sins of past generations. Evil and illness could resemble physical substances that needed to be removed by washing and other methods. Known therapeutic rituals emphasize an analogy between ritual actions, especially the act of speaking itself, and the effects on an illness. Many gods and goddesses (e.g., Išḫara, Šaušga, Kamrušepa) could be healers. There are no known Hittite temples that were used as sanitoria, but prayers and divinatory rituals related to illness may have been performed at temples.

Hittite physicians are already attested in the Old Hittite period (c. 1700–1500 BCE), and at least some probably were pupils of Assyrian healers. The materia medica included various plants and minerals. Hittite kings, like many sovereigns in the Near East, attempted to maintain a reliable and efficient organization of healers. Various texts also attest to the importance of female midwives and healers/diviners, some of whom had their own organizations. Hittite letters also mention the importation of professional healers from Egypt and Mesopotamia, especially in the fourteen–thirteenth centuries BCE. The general population, however, probably consulted a variety of folk practitioners who were not organized.

Cyprus and the Aegean.

Although it is difficult to determine the earliest instances of healing activities in the Aegean area, some scholars argue that female figurines on Cyprus indicate the possible existence of fertility therapy by the Chalcolithic period (c. 3800–2500 BCE). Various Middle and Late Minoan period sites (e.g., Mt. Jouktas, Traostalos) on Crete have produced figurines of body parts that may have been associated with healing cults.

According to Vassos Karageorghis (Cyprus, London, 1982), medical activities may be detected in at least some LB temples at Kition on Cyprus. [See Kition.] At Mycenae, skeletal remains show that in the fourteen-thirteenth centuries BCE the elite were probably better fed and healthier than the general population.

Greeks generally believed that illness could be sent by a large number of deities who also could heal. Such deities included Apollo, whose arrows could cause epidemics (à la Resheph in the Levant), and Artemis, the goddess of women. The most famous healing god, Asclepius, who had the dog and serpent as emblems, was regarded as the patron of all physicians. Unlike most other gods, Asclepius rarely sent illness.

By the late first millennium BCE there is ample textual and archaeological evidence for the use of asclepieia (temples of Asclepius) as healing centers, particularly in Athens, Cos, Pergamon, and Epidauros. Patients usually were believed to be healed in a night's stay at the asclepieion. Figurines of afflicted (or healed) body parts were left in these temples. Probable scalpels and other surgical instruments have been discovered at the asclepieion in Pergamon.

City-states invested in the care of the chronically ill by building asclepieia and other healing temples. Community investments in asclepieia in Athens and Rome may be linked to local epidemics in 429 BCE and 292 BCE, respectively. Patients, especially wealthy ones, also supported the temple with thanksgiving offerings and other donations.

Hierarchies in healing options are attested in some Greek texts. For example, patients might first attempt to pray to a god at home. If that did not bring relief, a local physician might be consulted. If the latter was unsuccessful, the patient might go to the asclepieion. Comparable therapeutic hierarchies were probably used in most areas of the ancient Near East.

By the third century BCE, Hippocrates and other figures are credited with developing the first systems of “rational” medicine. For example, the Hippocratic treatise “On Airs, Waters, and Places” links climate and environment, not gods, with illness. Yet, such natural explanations can be found alongside supernatural ones in asclepieia. The Roman Empire helped to spread Greek concepts of healthcare throughout the Near East.

Egypt.

Egyptian medical texts were among the first discovered and published by modern Near Eastern archaeologists. The Ebers papyrus (c. 1550 BCE), which contains a general collection of remedies, was published in 1875. Mummies from Egypt began to be studied medically as early as 1820. The thousands of skeletons from Egypt provide examples of various illnesses, including mandibular abscesses, skeletal deformities, and likely cases of tuberculosis.

Private tombs, especially in the Old Kingdom (c. 2575–2134 BCE), depict people with dwarfism, scoliosis, and other physical deformities. Some scholars argue that excavated human remains reflect a life expectancy of forty-fifty years and high infant mortality, regardless of social level.

Herodotus speaks of the scrupulous personal hygiene of the Egyptians, but Egypt probably suffered from poor public sanitation. Latrines existed in at least some upper-class households (and even in some second dynasty tombs, c. 2700 BCE), but excavations at Tell el-Amarna and elsewhere indicate that even some of the most luxurious homes were surrounded by heaps of garbage and open sewers.

Although the Ebers papyrus and other texts reflect the notion that irregularities in the system of vessels that carried air and fluids within the body could cause illness, Egyptians believed that illness could be sent and/or cured by a large number of deities, including Heket, Hathor, Imhotep, Isis, and Sekhmet (“the lady of pestilence”). Some temples specialized in healing, a notable example being the sanitorium established in the Ptolemaic period (304–30 BCE) at Deir el-Baḥari on the site of the “birthing temple” (where royal women gave birth) of Queen Hatshepsut (1473–1458 BCE).

Medical professions and skills may have developed quite early in Egypt. Probable dentists (known as “toothers”) appear in about 3000 BCE. One of the earliest known physicians, Hesy Re of the third dynasty (c. 2600 BCE), is described as the “chief of the dentists and physicians” to the pyramid builders in a wooden panel found in his tomb at Saqqara. Two bodies from tombs from the fifth dynasty (c. 2465–2323 BCE) attest to the setting of fractured limbs by means of splints and bandages.

Scholars usually identify the swnw, attested in the main medical papyri and in other texts, as the principal type of healing practitioner. The Edwin Smith papyrus indicates that medical examinations were simple, direct, and meant to determine, among other things, whether patients would benefit from treatment. Most treatments probably used incantations along with drugs and physical procedures. In some periods, Egyptian practitioners were valuable commodities exported to Anatolia and other lands of the Near East.

In at least some periods the state seems to have invested in medical care in order to ensure the maintenance of a healthy labor force. Some records noted illness-related absences from state projects, and physicians (e.g., Hesy Re) were assigned to particular groups of laborers. Of course such investments probably varied with time and circumstance. For the majority of Egyptians, however, healthcare was probably provided by folk healers and administered in the home.

Mesopotamia.

As elsewhere in the Near East, healing practices in Mesopotamia probably predate writing. Mesopotamian healers are mentioned in texts by the middle of the third millennium. As indicated by the earliest attested collection of medical prescriptions (Ur III period, c. 2050 BCE), the development of writing created new systems of collecting, storing, and distributing medical information.

Diagnostic manuals, letters, and other types of texts speak of the threats to public health posed by dirty water, urban epidemics, and famine (see Martinez, 1990). Some texts speak of taboos against contacting persons with certain skin diseases. Malaria and other diseases probably posed constant problems for people living near canals or near areas with poor water drainage. Eye ailments, impotence, and digestive problems are among the most frequent problems mentioned in Akkadian texts.

Medicine

MEDICINE. Figure 1. Figurine from Isin of a patient and dog. This may depict a ritual mentioned in texts in which a dog, associated with Gula, is touched by the patient for medicinal purposes. (Courtesy H. Avalos)

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Marduk, Ea, and Ishtar were among the deities consulted for illness. Recent excavations at Isin and Nippur have renewed attention on the importance of Gula (Ninisina), a healing goddess associated with dogs (see figure 1). Dogs probably had a role in Gula's therapeutic rituals, and a dog cemetery, dated to about 1000 BCE, is associated with her temple at Isin. Although no known Mesopotamian temple functions as a large sanitorium, various temples (e.g., the temple of Gula at Isin in various periods) may have stored medical information, and priests may have performed therapeutic and diagnostic rituals in them.

Medicine

MEDICINE. Figure 2. A panel of an Assyrian bronze plaquette, probably showing a healing ritual. Note the figure on the couch and healers, perhaps asipus dressed in fish-garb, attending to him. (Musée du Louvre/Antiquités Orientales)

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Many Assyriologists have followed Edith K. Ritter (1965) in positing two main healing specialists in Mesopotamia, the āšipu and the asû (see figure 2). In this scheme, the former uses magical means while the latter does not. An alternative view argues that both professions operated within a framework that assumed magical causation. The distinction was rooted in the simple distribution of labor in the healthcare system—namely, the asû specialized in the direct application of herbs and bandages and the āšipu in contacting and appeasing the divine beings deemed responsible for the illness.

Intensive therapeutic labor resulted, in part, from polytheism itself. For example, a single illness might require the assembly of paraphernalia, plants, and incantation texts for each of the numerous supernatural beings that might be entreated or repelled. Complex therapeutic rituals could even leave kings waiting days without the desired treatment. Diagnostic manuals may have helped to set labor priorities by identifying patients who were expected to die regardless of therapy.

Patients chose consultants on the basis of availability, economics, and a host of other factors. Kings could affect the distribution of physicians by monopolizing their services or sending them to other lands. Kings and town officials could also help to manage the distribution of materia medica.

Some Mesopotamian laws reveal the state's efforts to set prices for medical services and malpractice (e.g., laws 215–221 of the Code of Hammurabi). Extant laws and contracts also show that the state attempted to place the responsibility for long-term healthcare on the families of the afflicted. In fact, care at home was prevalent throughout the history of Mesopotamia.

Persia.

The healthcare systems in ancient Iran, especially in the Achaemenid period (550–332 BCE), are among the most difficult to reconstruct. Excavations of Persian palaces and houses in Persepolis, Susa, Pasargadae, and elsewhere indicate that Persians probably encountered the same urban health problems found elsewhere in the Near East.

Because Old Persian texts are few, the usual sources for the study of Persian medicine include Greek authors and the Videvdad, a Zoroastrian sacred text whose composition is dated by some scholars to within the Arsacid period (224 BCE–224 CE).

Zoroastrianism is a monolatrous religion popularized during the Achaemenid, Parthian/Arsacid, and Sasanian (224–652 CE) periods in Iran. In general, Zoroastrianism ascribed good and evil to two primordial principles: Angra-Mainyu, the principle of evil, is credited with creating thousands of diseases, while Ahuramazda is credited with creating healing substances, including homa (“wine”).

The Videvdad outlines elaborate codes of purity that viewed physiological processes such as birth, menstruation, and death as generators of impurity that could be transmitted by touch. This theology apparently led to the use of elaborate rituals to purify those afflicted by illness. Various diseases, including chronic skin ailments, rendered the patient an outcast in society.

The Videvdad mentions at least three types of healing specialists (herbalists, surgeons, and incantation priests). The same work notes procedures meant to certify physicians and outlines fees for various medical services. The medical school founded in the Sasanian period at Gundaishapur (Iran) foreshadowed Islamic hospitals and medical schools.

It is difficult to judge the extent to which Zoroastrian monolatry and purity laws were applied in the Achaemenid period. An Old Persian text does indicate that Xerxes I (485–465 BCE) destroyed the temples of “false gods,” a policy that presumably would restrict the options for patients if such gods were healing deities. Yet, Greek reports indicate that Achaemenid kings valued or preferred Greek and Egyptian physicians. Interest in public health reportedly prompted Darius (522–486 BCE) to subsidize the medical professions in Egypt and elsewhere.

Some scholars argue that it was only in the Sasanian period that Zoroastrianism became a state religion. If so, it is only speculation that the state encouraged the removal of various types of patients from society and restricted therapeutic options, insofar as not all deities were seen as legitimate. While the persecution of Christians is attested in the Sasanian period, however, Christianity and many other religions survived and retained their healing traditions.

Syria-Palestine.

The trephinated skulls found at Jericho from the Neolithic period and the implantation of a bronze wire in a tooth found at ῾Ein-Ziq, a small Nabatean fortress in Israel's northern Negev desert in the Hellenistic era, attest to the long existence of specialized medical consultants in Syria-Palestine. Liver models found at LB Hazor and Megiddo may have been used in medical consultations or in hepatoscopy. The Amarna tablets (fourteenth century BCE) mention epidemics and the traffic of physicians in Canaanite royal courts.

As in most areas of the Near East, the inadequate disposal of garbage and human waste was a threat to public health in Syria-Palestine. City-states (e.g., Gibeon) in areas where rainfall was poor had to construct cisterns, which were vulnerable to contamination. By the Middle or Late Bronze Ages, parts of various cities (Jericho, Tell Beit Mirsim) apparently had drains, some of which may have carried sewage. Recent excavations in Jerusalem have recovered toilet seats, one of which was found in a separate cubicle in a house dated to about 586 BCE. However, it is not certain how widespread such amenities were in the city at the time.

Although there are many textual references to washing and related hygienic activities (Gn. 18:4; Ps. 60:8), it is likely that personal hygiene was generally poor in the absence of abundant water supplies. In the Bible, bathing was sometimes seen as a significant event (Ru. 3:3).

As in many areas of the ancient Near East, insect infestation was probably a significant problem in Syria-Palestine. Incense may have been useful in repelling some insects, and ivory and wooden combs found at various sites from various periods (e.g., at LB Megiddo) may have effectively removed lice. Shaving the body and covering it with oil also may have combatted lice and other ectoparasites. [See Incense.]

Archaeoparasitologists recently established the likely existence of certain intestinal diseases (e.g., tapeworm and whipworm infections) in ancient Israel, but the precise identification of most diseases in the Bible has been notoriously difficult, especially in cases of epidemics (Nm. 25; 1 Sm. 5:6–12). Nonetheless, biblical stories recognize that epidemics can alter the course of history (e.g., the plagues on Egypt in Ex. 7–10), and many plagues are viewed as the result of Israel's contact with outside groups (e.g., Midianites in Nm. 25).

The condition usually translated as “leprosy” (Heb., ṣāra῾at) receives the most attention in the Bible (Lv. 13–14), but it does not have a simple modern equivalent because it probably encompassed a large variety of diseases, especially those manifesting chronic discoloration of the skin. Infertility was viewed as an illness that diminished the social status of the afflicted woman (Gn. 30:1–20).

As the Kirta epic and other Ugaritic texts indicate, El, the supreme god at Ugarit, was concerned with healing, especially infertility. In Tyre, Sidon, and other Phoenician city-states of the early first millennium BCE, Eshmun, who was sometimes identified with the Greek Asclepius, was a healing god whose temples may have provided therapeutic services. Many gods in the ancient Near East, including Yah-weh and Resheph, were gods of disease and healing.

The Hebrew Bible has at least two principal explanations for illness. Deuteronomy 28 affirms that health (Heb., šālōm) encompasses a physical state associated with the fulfillment of covenantal stipulations that are fully disclosed to the members of the society. Illness stems from the violation of those stipulations, and therapy includes reviewing one's actions in light of the covenant. The Book of Job offers a contrasting, yet complementary, view arguing that illness may be rooted in divine plans that may not be disclosed to the patient at all—and not in the transgression of published rules. The patient must trust that God's undisclosed reasons are just.

Perhaps the most distinctive feature of the Israelite healthcare system depicted in the canonical texts is the division of the patient's consultative options into legitimate and illegitimate. This dichotomy is partly the result of monolatry, insofar as illness and healing rest ultimately upon Yahweh's control (Jb. 5:18) and non-Yahwistic options are prohibited.

Because it was accessible and inexpensive, prayer to Yahweh was probably a patient's most common legitimate option. Petitions and thanksgiving prayers uttered from the viewpoint of the patient are attested in the Bible (Ps. 38; Is. 38:10–20). Other treatments mentioned in the Bible include “mandrakes” for infertility (Gn. 30:14), “bandages” (Ez. 30:21), and “balsam” from Gilead (Jer. 46:11). The last text shows awareness of the importance of Gilead in the production of medicinal substances consumed in Egypt.

Illegitimate options, which were probably widely used by Israelites, included consultants designated as rōpĕ'îm (2 Chr. 16:12), non-Yahwistic temples (2 Kgs. 1:2–4), and probably a large variety of “sorcerers” (Dt. 18:10–12). Female figurines found throughout monarchic Israel, especially in domestic contexts, may have been involved in fertility rituals. The largest known dog cemetery in the ancient world, recently uncovered at Ashkelon, may be associated with a healing cult of the Persian period. [See Ashkelon.]

The foremost legitimate consultants in the canonical texts are commonly designated prophets, and they were often in fierce competition with “illegitimate” consultants. Stories of healing miracles (e.g., 2 Kgs. 4:8) may reflect an effort to promote prophets as the legitimate consultants. Their function was to provide prognoses (2 Kgs. 8:8) and intercede on behalf of the patient (2 Kgs. 5:11). Unlike some of the principal healing consultants in other Near Eastern societies, the efficacy of Israelite prophets resided more in their relationship with god than in technical expertise. The demise of the prophetic office in the early Second Temple period probably led to the wide legitimation of the rōpě'îm (cf. Sir. 38). Midwives (Ex. 1:15–21) may actually have been the most common healthcare consultants, especially for pregnant women.

Another accepted option for some illnesses, particularly in the preexilic period, was the Temple. In 1 Samuel, Hannah visited the temple at Shiloh to help reverse her infertility. (2 Kings 18:4 indicates that prior to Hezekiah the bronze serpent made by Moses as a therapeutic device (Nm. 21:6–9) was involved in acceptable therapeutic rituals in the Temple in Jerusalem. Bronze serpents have been found in temples (e.g., the asclepieion at Pergamon) and are known to have been used for therapy during the first millennium BCE. Bronze serpents, such as those found in or near shrines at LB Timna῾, Tel Mevorakh, and Hazor, may have been involved in therapeutic rituals, but other functions cannot be excluded.

The Priestly code, which may be viewed as an extensive manual on public health that centralizes in the priesthood the power to define illness and health for an entire state, severely restricted access to the Temple for the chronically ill (e.g., lepers in Lv. 13–14; cf. 2 Sm. 5:8 on the blind and the lame) because of fear of “impurity.”

The theology of impurity, as a system of social boundaries, could serve to remove socioeconomically burdensome populations, and especially the chronically ill, from society. “Leprosy” alone probably encompassed a wide variety of patients. In effect, the Priestly code minimizes state responsibility for the chronically ill, leaving the eradication of illness for the future (Ez. 47:12; cf. Is. 35:5–6).

Thanksgiving or “well-being” offerings (Lv. 7:11–36) after an illness were probably always acceptable and economically advantageous for the Temple. Offerings after an illness also may have served as public notice of the readmission of previously ostracized patients to the society (Lv. 14:1–32).

Relative to the Priestly code, the community responsible for the Dead Sea Scrolls added to the list of illnesses excluded from the normal community and expanded the restrictions for “leprosy,” the blind, and the lame (IQSa II.4–9). Socioeconomic reasons, as well as the fear of magical contamination, may be responsible for such increased restrictions.

Perhaps the most significant consequence of the Priestly code was the growth of chronically ill populations with little access to the Temple. Because Jesus and his disciples appear to target these populations (Mt. 10:8; Mk. 14:3), early Christianity may be seen, in part, as a critique of the priestly healthcare system. In early Christianity illness may be caused by numerous demonic entities who are not always acting at Yahweh's command (Mt. 15:22; Lk. 11:14), and not necessarily by the violation of covenant stipulations (Jn. 9:2). Emphasizing that the cure for illness may be found in this world, early Christianity preserved many older Hebrew traditions regarding miraculous healings (Acts 5:16, 9:34) and collective health (Jas. 5:16), although the influence of Hellenistic healing cults (e.g., the Asclepius cult) also may be seen.

In the Roman Empire, famous therapeutic baths were constructed or enlarged. Near the Sea of Galilee, the large thermal bath complex that thrived from the second century to the end of the first millennium CE at Ḥammath-Gader is explicitly associated in inscriptions with therapy and may have been used by Romans, Christians, Jews, and Muslims. [See Ḥammath-Gader.] A mass grave near the Jordan River apparently contains the remains of sick visitors in search of healing (c. 614 CE) in the famous waters (see 2 Kgs. 5). Ritual bath installations called miqva'ot (sg., miqveh), dating from the Second Commonwealth onward, have been uncovered in many Jewish communities (e.g., the Jewish Quarter in Jerusalem, Masada), but they probably were not used for ordinary therapeutic reasons. [See Ritual Baths.]

In the Byzantine period, and especially under the empress Eudocia (d. 460), various leprosaria were founded in the Judean Desert (e.g., at the Monastery of Theodosius). These leprosaria may reflect the state's attempt to channel populations of chronically ill patients to peripheral areas of the empire rather than simply to the outskirts or to special areas of major cities. In sum, prior to the rise of Islam, Syria-Palestine and most of the Near East already had a wide array of healthcare systems and facilities deriving from Greek, Roman, Jewish, Christian, Persian, and Arab traditions.

Islamic Period.

Because Islam encompassed most of the geographic areas under discussion, the Islamic period merits a unified treatment. Between the ninth and fourteenth centuries CE, many of the most important works in medicine by Jews, Christians, Zoroastrians, and Muslims were written in Arabic, a language spread by Islam. Arabic medical texts are abundant, so that archaeology is not the primary source of information about healthcare in Islamic countries.

Little is known of the healthcare systems of the pre-Islamic cultures (e.g., Midianites, Nabateans) associated with the northwestern Arabian Peninsula, the homeland of Islam. It is possible to speculate that some diseases (e.g., malaria) were insignificant in arid regions. Analogies with healing practices elsewhere in the Near East probably existed (e.g., prayer; the use of special consultants). Jews and Christians lived in northwestern Arabia at the time of Islam's rise in the seventh century and presumably had their own healing traditions.

Some scholars argue that Islamic medicine was essentially Greek medicine. Others argue that while the Greek traditions are obvious, Islam synthesized various traditions and made new contributions. The famed Ibn Khaldun (1332–1406), in his Muqaddimah, acknowledges that Islam inherited a body of nonrevealed medical tradition from the bedouins, Sasanians, and other sources.

Under the word salām, the Qur'an speaks of the broad well-being of a person. Sickness encompassed the whole organism rather than just the soul or the body. Greek influence, however, helped to maintain the soul/body dualism in many Islamic traditions. Thus, Ibn Sina (980–1037), whose Canon was, for hundreds of years in the West and the East, one of the most authoritative medical textbooks, thought that the mind could heal or sicken the body.

As a monotheistic religion, Islam resulted in a dichotomous healthcare system insofar as patients could not use options sponsored by gods other than Allah. Although natural causes for illness seem to be recognized, ultimately illness and health are created by Allah's will and purposes. Prevention of illness was an essential component of Islamic medical practice, and a proper diet, which excluded pork, was seen as perhaps the most essential factor in maintaining good health.

The major traditions of Islam (e.g., Sunni, Shi῾ah) developed some distinctive notions of treatment. For example, some scholars argue that Sunni tradition encourages patients to seek treatment at any time, whereas Shi῾i tradition encourages them to seek treatment only if the illness becomes unbearable. While major traditions prohibit the use of alcohol, other traditions (e.g., the Hanafi school) prohibit only intoxication.

Various Muslim states encouraged heavy investment in public health. For example, a rare, if not unprecedented, healthcare policy was promulgated in Iraq by Walid I (705–715), who reportedly provided stipends and attendants for lepers. In the early tenth century in Iraq special teams were established to visit prisons, and mobile dispensaries brought healthcare to the countryside, where doctors were scarce. The management of lepers during the Umayyad caliphate (755–1031) in Córdoba (Spain) included their segregation in “the suburb of the sick” (Ar., Rabaḍ al-marḍā). Endowments (Ar., waqf), often by wealthy individuals, for hospitals were generally encouraged.

The most famous general hospitals emerged during the ῾Abbasid caliphate (750–1257), especially in Baghdad, Mecca, and Damascus. There were also some hospitals for mental patients. The administrators and medical personnel of the first hospitals were often Nestorian Christians, who translated medical texts from Greek into Arabic (sometimes via Syriac). The principal doctors, who were also teachers, reportedly made rounds within the hospital and visited the court daily. The hospital founded in the twelfth century in Damascus reportedly kept detailed patient records. It also had protocols to separate patients who would be admitted from those who would be sent home after receiving treatment. In general, the Islamic period presents perhaps the best documented examples of how monotheistic societies integrated a variety of approaches to healthcare.

Synthesis.

The advance of “civilization,” and of urbanization in particular, posed new challenges to human health. Challenges included managing chronically ill populations, determining the level of state investment in public health, and maintaining a supply of consultants and medications, especially for the elite. Ancient governments recognized that epidemics could hasten the demise of an entire city or empire. The parallel and overlapping healthcare systems in the Near East provided a variety of responses to these challenges. In fact, many of the basic problems and responses pertaining to healthcare (e.g., level of state investment, regulation of medical fees) were first articulated in the ancient Near East.

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MEDICINE. Figure 3. Synopsis of the Mesopotamian health care system. (Courtesy H. Avalos)

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Many aspects of a healthcare system are related to a culture's basic religious framework. Polytheistic systems (e.g., in Mesopotamia, Anatolia, and Egypt) allowed a broader range of alternatives for patients than monolatrous ones (see figure 3). Yet, the large number of gods that could be appeased or repelled could also lead to complex rituals that denied speedy attention even for the elite.

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MEDICINE. Figure 4. System of consultation options reported in the biblical texts. (Courtesy H. Avalos)

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The development or imposition of monolatry tended to bifurcate a healthcare system into legitimate and illegitimate options. Although monolatrous systems (e.g., in Israel and Islam) could simplify the search for a healing deity, other factors could render the therapeutic process as variegated and complex as in polytheism (see figure 4).

Most healthcare systems had a variety of options that were probably arranged hierarchically, depending, in part, on the patient's needs and means. Prayer was probably one of the first, and most economical, options chosen by patients in all systems. Care at home was probably the preferred and most common option, even in cultures that centralized and localized healthcare to some extent (e.g., asclepieia; Islamic hospitals).

It is difficult to evaluate one healthcare system as better than another because precise data are lacking with which to measure their effectiveness. Some institutions meant to cure may actually have spread diseases by concentrating sick people in small spaces (e.g., asclepieia). The best medical technology (e.g., scalpels, forceps, dental drills, and splints) may have helped only simple problems (e.g., extraction of lodged weapons). In general, in most cultures, trauma (from accidents, strife), malnutrition, and disease maintained life expectancy to under forty years from the Paleolithic to the Early Islamic period.

Much of the information preserved in archaeological and textual sources pertains to the urban and literate segments of Near Eastern cultures; however, as is the case in many modern nonwestern cultures, the majority of patients lived outside of cities and had as healing consultants midwives and other types of folk healers who were illiterate—and thus did not document their practices.

Nonetheless, archaeology still has much to contribute to what can be known of ancient and modern healthcare. More importantly, by focusing on healthcare as a system that interacts with theology, politics, economics, and the environment, new questions can be posed about the textual and archaeological data already available.

[See also Paleopathology; Personal Hygiene. In addition to the sites cross-referenced above, many others mentioned are also the subject of independent entries.]

Bibliography

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Hector Ignacio Avalos