The Eye and Eye Diseases from the Perspective of Ancient Babylonian and Biblical Sources: A Study of Selected Texts

The so-called Diagnostic Handbook is a compilation of the texts arranged by the Babylonian scientist Esagil-kin-apli in the middle of 11^th century [4]. This compilation, called ‘Symptoms’, contains more than 3000 diagnostics, which are distributed across 40 clay tablets with an average of around 80 entries each. Heeßel in his article Diagnostik in Babylonien und Assyrien presents an overview on the chapter from the Diagnostics Handbook (Tab. 1) [7].

Each tablet deals with symptoms in one part of the body, with seven tablets devoted to the head and only five to the rest of the body, which shows the importance of the signs and symptoms related to the head [7].

The people in ancient Babylonia differentiated following parts of the eye: the eyeball, the pupil, the shiny or green part of the eye, probably the skin of the eye, the iris, the eyelid, the eyelashes. The term tutelary eye goddess as part of the eye is also known, probably meaning pupil or eyelid. According to Ebeling, there is the same word meaning eye socket as well as a kind of ulcer [8].

Ancient Summer civilization used the word eye to mean the face, too. According to Ebeling, expression “sharp eye,” (i.e. visual acuity or sharpness of vision) was for the Babylonians a sign of a sharp mind [8]. In this way, Abd El Mohsen argues that the eye was not only an organ of vision, but, moreover, was considered a means of communication with the all-seeing god, i.e. symbol of life, but also death and destruction [9].

The notion physician is attested in the 3^rd millennium BCE in Mesopotamia. The medical prescriptions of the Ur period, on the other hand, seem to be the earliest evidence of medical practice. Even some Summerian prescriptions for eye complaints are known from this period of time (see Tab. 2) [4].

In Babylonia, however, illnesses were believed to be caused by evil spirits, ghosts and demons. Thus, for example, alu was the evil spirit causing blindness and three types of healers, diviners, exorcists, and physicians were dealing with it [10]. According to Biggs, therapeutic medicine and magical practices existed side-by-side and complemented each other rather than opposed each other [11]. The Mari Letters, a large archive of royal correspondence found near the modern Iraq border and written around 1800 BCE, contain information about treatments provided by both physicians (asûm) as well as exorcists, with diviners being important in determining the cause of the illness [5]. Thus, this act was important to eliminate the deeper cause of the illness, which lay in a discord in the relationship between man and his God [1]. Physicians, according to Geller, played a role only in medicine, and from the description of their roles it can be assumed that they dealt primarily with drugs and drug-related therapies [5].

While magical texts usually contain long incantations and short rituals, medical texts, on the other hand, contain long or large numbers of recipes (corresponding to the magical rituals) and short incantations [5]. The content of therapeutic texts is, as Biggs states, the purpose of the treatment, a list of ingredients, the method of treatment preparation, instructions for its administration, as well as an optimistic prognosis ‘he will recover’ [11]. Each particular section usually begins with the phrase, “If a man (suffers from) a certain illness, has certain symptoms, you prepare the following ingredients in the following way and administer it as follows,” i.e. act in accordance with a specific recipe [12]. Medical literature from Babylonia sounds very optimistic, in the sense that most medical remedies end with the statement that once the drugs are administered, the patient will get better or recover from his illness. In this connection, Geller states that these statements are hardly realistic, since diagnostic texts often give a prognosis, according to which the patient will die [5].

During the reign of the Babylonian king Hammurabi (about 1792-1750 BCE), a legal code called the Codex Hammurabi mentions particular health care concepts. These principles of managed care, carved in stone and written on many hundreds of clay tablets, recorded descriptions of illnesses associated with parts of the body, such as diseases of the ears, eyes, nose and throat, gallbladder problems, heart diseases, skin diseases, abscesses, disea ses affecting the lungs and chest, venereal diseases, rectal prolapse, constipation, but also plague, intoxication, fevers, tumors, and rheumatism [13].

Fig. 1

Babylonia at the time of Hammurabi https://en.wikipedia.org/wiki/Code_of_Hammurabi#/media/File:Hammurabi's_Babylonia_1.svg

The King Hammurabi in his Code replaced the priestly administration of justice with civil judges and provided certain protections for all classes in Babylonian society [14]. His edicts are rigorously structured in a grammatical style with a protasis, a proposition beginning with ‘if’, “If during a quarrel one man strike another and wound him, then he shall swear, ‘I did not injure him wittingly,’ and pay the physician (asûm);” (CH 206).

Fig. 2

The Code of Hammurabi, King of Babylon The Code of Hammurabi, King of Babylon Chicago: University of Chicago Press, 1904 The Code of Hammurabi translated by L.W.King in The Avalon Project, Yale Law School, Lillian Goldman Lay Library, 2008.

The Code regulated the activities of the physicians even to the extent of setting conditions under which they could charge general surgery, eye surgery, fixing fractures, curing diseased muscles and other services a physician would normally perform. All social classes in the Babylonian society were covered by the health care system specifically identified in the 282 edicts of the Code [5]. The rates of payment were adjusted to the social status of the patient. The Codex’s scheduled fees were as follows:

CH 215 If a physician [asûm] makes a large incision with an operating knife and cure it, or if he opens a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.

CH 216 If the patient is a freed man, he receives five shekels.

CH 217 If he [the patient] be the slave of someone, his owner shall give the physician two shekels.¹²

Thus, Hammurabi’s Code mentions explicitly the practice of ophthalmology for the first time [15]. It is interesting that this Codex used a special fee scale according to social class to reimburse medical care services. Thus, the fee for a successful operation, which saves the eye of the noble patient from the upper class (awelum), should be ten shekels of silver, in the case of a free man from the middle class (mushkenum) five shekels, and only two shekels for the owner of the slave (wardum) [15]. It means that regardless of social class, access to medical care was unlimited. In the case of an unsuccessful operation leading to death of a noble man, the surgeon should have his hand cut off. In the case of a slave, the penalty was the payment of silver to the extent of half of his price.¹³ In this connection, Frank Joseph Goes points out, surgery was performed on a free man’s eye only when he was blind [16].

In the course of the history of treatment, there has been a partial differentiation between the surgeon, physician and even veterinarian. Probably another reason for its distinction was the custom of passing down knowledge of surgery from father to son and master to pupil [17]. According to Krause, physiology was unknown at this time and surgeons’ knowledge of anatomy was probably only elementary, leading to the assumption that they were incapable of performing complex operations [10, 17].

The medical texts from Mesopotamia, written mainly in the first millennium BCE, indicate that a physician compiled lists of diseases affecting the eye and various parts of the body, made a diagnosis, wrote and compiled prescriptions, and suggested treatments [11]. Recipes were carefully prepared. After the drugs were powdered by crushing or heating, they were made into tinctures, extracts or incorporated into oils or fats. Consequently, thus prepared fats were applied to bandage the eyes or forehead. A metal tube or reed was used to introduce the drug into the eye. A knife, made from copper or bronze, was used for operations on or about the eye [17].

The Code of Hammurabi provided a protection for all classes in society. Even individuals from conquered nations were covered by the Babylonian health care system [15]. In addition to the 15 texts that mentioned physicians, veterinarians, or barbers, there were about 20 others that dealt with injuries from fights such as an eye injury, a broken bone, a knocked-out tooth, a punch to the cheek, causing a miscarriage, or punching resulting in death. However, these texts do not mention health care services, but impose monetary fines or “eye for an eye” type of penalty [15]. The legal requirements of the ancient Near and Middle East regarding duties and responsibilities were reinforced in the form of the Mosaic Law in the kingdoms of ancient Israel and Judah as mentioned in biblical sources [18].

In the biblical sources, God is depicted as the living God whose power never ceases, whose care never ends, who acts on behalf of his people and overwhelms even the threat of death [18]. It means that divinity had the power to rule over life and death. Thus, the role of a healer or even a physician was very limited and not well known in the Hebrew Bible [19]. So, for instance, the king of Judah, Asa (910–870 BCE), died from a disease affecting his feet after seeking the help from physicians (2 Chronicles 16:12). Joseph calls physicians to embalm his father Israel (Gen 50:2). On the one hand, Job described his experience: “worthless physicians all of you” (Job 13:4), on the other hand, Jeremiah called for a physician (Jeremiah 8:22) [20].

For the biblical people of ancient times, life in God’s presence was life in its fullness providing prosperity, health and descendants. Consequently, any foreshortening of the human life span, reduction of its duration, its full potential, was considered a great evil for them [21].

It is necessary to stress that in ancient biblical sources there is not such a distinction between life and death as it is known today, when people wish to escape death and live as long as possible in this world, trying to follow some special medical or surgical treatment. This is especially visible in the ancient passages of the Old Testament, where death is seen as a natural part of the natural order of creation (Gen 3:19) [18, 21]. First of all, the one who brings help for physical ailments is God who “heals all your diseases” (Psalm 103:3). There are many examples of prayers of thanksgiving for healed diseases in the Old Testament (cf. Psalm 107). Even the healing of eye diseases, as the psalmist says, comes from God “the Lord gives sight to the blind” (Palm 146:8). The prophets and angels also successful heal those suffering from eye diseases as they did for all the sick in general.

The Bible does not mention a single instance of a priest having performed the functions of a physician. It cannot also be assumed that the doctors were allowed to perform autopsies, and in fact there is never any mention of such things in the ancient biblical sources. The Prophets, however, practiced occasionally also healings, i.e. the prophet Isaiah cured King Hezekiah of an inflammation by applying a plaster made of figs (2 Kings 20:7) [22]. Although a number of medicinal plants are mentioned in biblical texts, most of them were also known from medical practices in Ancient Egypt and/or Mesopotamia [22, 23].

Copper and its compounds were probably used by the Hebrews to treat diseased eyes. On the one hand, copper is mentioned several times in the old biblical texts (cf. Gen 4:22; Lev 26:19), on the other hand, the ophthalmologists of the Greeks and Romans used it frequently too. And as mentioned above, a copper knife used for operations on or about the eye was also known in ancient Mesopotamian texts [4].

Biblical texts provide many references to vision decline and eye disease, intertwining physical conditions with spiritual consequences. These themes reflect the importance of sight, both literally and metaphorically, in understanding health and divine intervention. The biblical narratives related to the vision also highlight the broader human experience of seeking healing and understanding.

The word for ‘eye’ in Hebrew, ayin, is derived from the word stem ayn, which is translated as ‘spring’ (Genesis 16:7). Based on the belief that the eye was like a spring, the mechanism by which brain injury was thought to cause blindness was believed to be overflow of fluid from the brain to the eye. This corresponds to the Hippocratic theory that all diseases are related to the balance of humors or fluids [25].

Due to advancing age, the eyes became naturally dim, as in the case of Eli who was 98 years old when his eyes were so dim that he was not able to see (1 Sam 4:15, cf. 1 Kings 14:4). The harmful effects of excessive crying are also recorded in biblical sources and tearbottles were regularly used, as found in ancient sepulchers (cf. Psalm 56:8) [26]. Exophthalmos is also mentioned in the Hebrew Bible and attributed to high living standard, “their eyes bulge with abundance” (Psalm 73:7) and bloodshot eyes are due to excessive drinking of wine (Prov 23:29-31.33) [27]. When Jacob announces the future to his sons, he says of Judah, alluding to its wine-growing and animal husbandry: “His eyes will be darker [cloudy] than wine” (Gen 49:12). The same clouding of the eyes after drinking wine occurs in the Proverbs of Solomon. Here the question: “Who has redness [clouding] of the eyes?” is answered: “Those who linger long at the wine. Those who go in search of mixed wine” (Prov 23:30).

Redness and burning sensation of the eyes, ophthalmia was said to accompany fever “that shall consume the eyes” (Leviticus 26:16) [26]. The eyeball (bulbus oculi) is known to be partially covered by the conjunctiva, whose diseases are among the most common of the eye (e.g. conjunctivitis). The biblical sources mention, among other things, conjunctival hyperemia. In the passage “As vinegar to the teeth and smoke to the eyes” (Prov 10:26), for instance, there is a hint pointing toward the subjective symptom of conjunctival hyperemia as burning and biting sensation. The cause, however, is said to be the smoke, which is harmful to the eyes. Another medical problem connected with vision is corneal staining. As with chemical burns, a corneal stain can also be caused by a burn (2 Kings 25:6-7). The plague prediction “their eyes will rot in their sockets” (Zech. 14:12) is known, indicating chemical or radiation damage [22].

Healthy eyes are valued with great respect in biblical sources, which is also expressed by certain religious and ritual regulations of ancient Judaism. For example, priests must not be blind, they must not have a bald spot on their head or corneal spots (Lev 21:5.18.20).