1One of the enduring mysteries of comparative studies on Greek and Babylonian medicine is the fact that temple medicine only existed in Greece and not in Mesopotamia. This is surprising, not least because the thrust of all modern scholarship on Hippocratic medicine has been to reinforce the idea of ‘secularisation’ of Greek medicine in relation to that which came before. This is not meant to imply that Greeks were more atheistic or less atavistic than their neighbours, but simply that by mid first-millennium BCE, medicine was becoming more and more technical, moving away from divinities as causes of disease or their interference in the treatment of disease. The gods remained where they always had been, but science and medicine were progressing towards other kinds of explanations of the natural order, quite apart from arbitrary and random intrusions of gods and demons. What is often not recognised, however, is that the same tendencies can be found in Mesopotamia at roughly the same time. 1

2Nevertheless, when we take the long view of medical history from the early 2^nd millennium BCE onwards, in Mesopotamia and Egypt, we find strong associations with temples and temple cults. Priests and priesthoods had important roles to play, and the demarcation between religion-based magic and pharmacy-based medicine was sometimes rather blurred.2 The Babylonian ashipu or temple exorcist, for instance, was not only an expert in all matters magical, like his Persian counterpart, the magus, but the ashipu took an interest in medicine as well, and by the 5^th century BCE appears to have become a good all-rounder, in terms of his expertise, to the extent that the asû or physician almost disappears from our records; this reminds us of Herodotus’ famous remark that Babylonians had no doctors. This was not true, of course, but the Babylonian priesthood maintained a major role in medical practice.3 But did the priest practice his healing arts in the temple?

3We have relatively little evidence for any healing temples in Mesopotamia, except for that belonging to a healing goddess, Gula, which was a repository for numerous votive objects, usually consisting of clay models of a dog (associated with Gula as her totem) or of human body parts.4 On the surface, it might appear that Mesopotamian temple medicine functioned in the same manner as that of its neighbours, since the healing goddess Gula can be equated with Imhotep and Serapis in Egypt, Asklepius in Greece, and Eshmun in Phoenicia.5 However, there is no trace in the archaeological or literary record of anyone residing in a Gula Temple as part of a healing ritual. In fact, just the opposite, the usual scenario is for the priest to visit the patient at home and make a diagnosis,6 and for the physician to prepare and administer the drugs at the patient’s home. There does not appear to be any role for the temple in this process, which is somewhat surprising considering the central role that temples played within Babylonian urban life. Temples were the major industry of any Mesopotamian city, and certainly the chief employer, apart from the royal palace. Temples had a huge corvee of workers for temple fields, and temples themselves occupied a large part of the inner city with scores of temple guards, masons and carpenters, brewers and bakers, and of course, priests.7 The first millennium BCE temples were huge structures consisting of millions of bricks.8 The idea of a ziggurat was to construct an artificial mountain in a very flat landscape, to bring one closer to heaven and the gods, which turned out to be useful for the daily celestial observations leading to great advances in astronomy. Surrounding the temples were large courts, with an infrastructure for slaughtering large numbers of animals and afterwards distributing the sacrificial meat to temple functionaries and workers in the form of prebends.9 There is also a catch: these huge temples were not actually open to the public.10 In order to enter into the inner working parts of the temple, one had to be born (or perhaps adopted) into the right families with sacerdotal pedigrees.11 This may be one reason why Mesopotamian temples never functioned as clinics.

4Moreover, there was no Mesopotamian equivalent to the Asklepieion, where patients could go to spend the night, and where a patient’s dreams might determine the correct form of therapy for his or her particular illness. The Asklepieion priesthood was responsible for incubating the patient, or somehow inducing sleep which would produce the right sort of therapeutic dreams, and numerous inscriptions from Asklepieion-temples attest to the effectiveness of this practice. Babylonian priests never jumped onto this bandwagon.

5To understand the situation more clearly, imagine a Babylonian traveller visiting Greece. At his first view of the Parthenon in Athens, he probably would have thought the following: ‘nice stone work, I like the columns, and full marks for decorations. But where is everyone?’ The building itself is small in scale compared to what a Babylonian was used to, the buzzing activity of the sacrificial cults in spacious courtyards, which does not seem to be practical in a Greek temple setting. Greek and Babylonian temples certainly have some things in common, such as the presence of a divine idol within a sanctum sanctorum, but the Babylonian temple is what its name implies – a god’s house, a bīt ili. This is where the god lived, had his or her daily meals, slept in a bed, celebrated festivals, and occasionally left to go on journeys to visit another god in another temple. Temples were often temple complexes, a sort of condominium for several gods, which all shared the same cultic rites. To a visiting Babylonian, the typical Greek temple might have appeared as architecturally impressive but a trifle tranquil.

6But how would an Asklepieion have appeared to a Babylonian? At first sight, it might have seemed more familiar, with its large courtyards and buildings and activities, but this impression may not have lasted for very long. To a Babylonian, the Asklepieion would not have appeared to be a straightforward temple. For one thing, the setting was wrong; instead of being in the centre of the city, the Asklepieion was either suburban, like in Pergamon, or rural, like in Cos. The functioning of the Asklepieion would have seemed strange to a Babylonian. The presence of a theatre and boutiques and libraries and dormitories for visitors would not have seemed very temple-like to someone accustomed to the imposing but sober Esagil at Babylon. Whatever the Asklepieion was to Greeks, no Babylonian would have considered it to be a temple, nor would a Babylonian have considered this to be ‘temple medicine,’ as we often refer to the Asklepieion. More shocking, even to a hellenized Babylonian, would have been the votive inscription in Epidaurus left by one Marcus Julius Apellas, who suffered from indigestion. Marcus reports that the god appeared in his dream to announce that he had been cured, but that it was still necessary for Marcus to pay his medical bills12. Mesopotamian priests may have been equally interested in remunerations, but any payment was always discretely described as a ‘donation’ for the gods in gratitude for healing. Marcus also reports that his healing was caused by the god’s touch, which is a common motif associated with Asklepius; a Babylonian would have probably appreciated the utility of a god’s touch, but as magic, not as medicine.

7Clearly the Greeks considered the Asklepieion to be a temple in which a specific brand of temple medicine was being practiced, which included practices which could be classified as magical. Magic represents something of a conundrum for scholars of Greek medicine, who usually rely upon the reassuring comments of the Hippocratic treatise on Sacred Disease: all other non-Hippocratic (meaning: non-rational) approaches to medicine can be attributed to either magoi, purifyers, vagabonds, and quacksalvers. This last term for quacksalver, alazones, is particularly surprising, since it is the Akkadian word aluzinnu for clown.13

8Medical histories have pointed to the fact that, in addition to the magical or dream-oriented treatments, regular drugs and phlebotomy were also prescribed in the Asklepieion, perhaps by physicians.14 Nevertheless, the use of magic in the Asklepieion reflects the larger problem, that Greek magic is relatively poorly documented, apart from defixiones, some binding spells, and mostly syncretistic and idiosyncratic Greek magical papyri from Egypt. The contrast with Mesopotamia is striking. One of the largest genres of Sumerian and Akkadian belles lettres consists of healing incantations and accompanying rituals, which are complimentary to medicine and diagnosis.15 Moreover, catalogues of incipits of medical, magical, and diagnostic works show that these are independent disciplines, all in the service of healing therapies.16 If we want to compare and contrast medicine and magic in Babylonian contexts, we have the means to do so: the magic is just as prominent and as well attested as the medicine. In the Greco-Roman milieu, this is not the case.

9The distribution of ancient sources affects how modern scholarship treats temple medicine. Edelstein’s chapter, for instance, on ‘Greek medicine in its relation to religion and magic’17 is a case in point: the argument is confused and often circular. According to Edelstein, doctors believed in Asklepius and his healing powers, although they refrained from prescribing magical cures, or what Edelstein terms ‘religious and magical medicine’ (ibid. 205); for this reason, they could not actually rule out temple medicine as illegitimate. Edelstein had a solution to get out of this conundrum: since Greek medicine often advised doctors not to engage with diseases which were incurable or untreatable, it would have been reasonable under such circumstances for doctors to recommend that terminal patients turn to temple medicine. This neat solution faces one serious objection: we have no examples of a physician claiming to be inadequate. In fact, we know the opposite from Aelius Aristides, whose doctors advised him against using temple medicine, although he refused to comply with their advice.18

10It would be interesting to know what a typical Babylonian visitor to Greece would have made of the god Asklepius, who was a relative late-comer to the divine pantheon, at least by Babylonian standards. For Homer, Hesiod, and Pindar, Asklepius was a hero, but not yet a god (Edelstein – Edelstein 1945: II 1). In any case, Babylonians at around 600 BCE were not in the habit of elevating their heroes to divine status; earlier kings had formally become deified, but this practice had been obsolete for nearly two millennia. Moreover, the Greek explanation – that the physician Asklepius first lived as a mortal and later died and was resurrected as a god – would not have impressed a Babylonian audience. Their problem would not relate to resurrection and promotion to divine office, but with status and recognition. Babylonian society was essentially bureaucratic in its orientation; this means that the office is more important than the individual. There were no famous healers and charismatic physicians in the Orient, whose fame was widespread. Being a healer in Mesopotamia was a job, and in any case, the power to heal was either endowed by gods or resulted from prescribing the proper drugs. And finally, Babylonians did have a healing goddess who was divine patron to physicians, named Gula, and she is referred to as a master physician, but not as the inventor of medicine. In fact, medical incantations warn the patient to hurry up and get well before Gula arrives with her scalpel in hand, which can only mean terrifying and painful surgical procedures ahead.19

11But what about the matter of incubation? The idea itself seems plausible, that through the power of suggestion, a patient dreams about some sort of healing remedy, and the entire process could be a useful way of having the patient accept treatments which would have been unpleasant, painful, or even dangerous. Negative consequences of treatment would be attributed to the gods rather than to the healers, but any positive outcome would belong to the temple and its functionaries. The system is so attractive, in fact, that one cannot but wonder why Babylonians did not adopt it for themselves. Nevertheless, a cynical approach to incubation is hardly justified, based on the large amount of evidence from Greek sources with positive views of incubation and Asklepieion-based therapy in general.

12The cult of Asklepius was widely popular. Galen himself claimed to be saved by Asklepius, who advised him not to accompany Marcus Aurelius to war.20 The appeal of this cult can be seen from the medical diaries of Aelius Aristides, whose graphic descriptions make for gripping reading, of how he survived his doctors by following the Asklepieion advice of bathing in a freezing river.21 The Hippocratic treatise, Regimen Four, provides a therapeutic framework for dreams as diagnostic tools,22 which is lacking from Mesopotamian omen and medical literature. Babylonians, on the other hand were keenly interested in the mantic properties of dreams and kept a detailed Dreambook of dream topics which could be judged as being favourable or unfavourable, but these were never applied to medicine specifically.23 However, the distinction in Artemidorus’ Dreambook between descriptive and mantic dreams, enupnia and oneiroi, is not shared by the extensive Babylonian dream oracle compendium. The simple question is: why is there no serious Babylonian interest in medical incubation?

13The answer, from a Mesopotamian perspective, resides in the role of dreams within the entire theory and practice of divination, which took many different forms. Take extispicy, for instance: examining the entrails of domestic animals for clues forecasting future events. The most important organs for this purpose were the liver and lungs, and a huge literature detailing omens derived from these organs has come down to us on cuneiform tablets.24 The idea, at least in earlier periods, appears to be that gods left messages inscribed on these organs which one could learn to read, given the proper technical training. As time went on, the messages became more and more complex and the techniques of extispicy eventually overshadowed the role of the gods in all this. The emphasis was on posing the right sort of binary question and computing a host of binary positive and negative indicators to come up with a correct yes or no answer. This was an expensive form of forecasting, which only the king or wealthy patrons could afford, since it involved examining the liver and lungs or two animals, to check the results. Luckily, cheaper forms of forecasting were also available, such as interpreting omens from rising smoke or patterns made by oil on water, somewhat akin to reading tea leaves today. All these omens have something in common: they are provoked. Even Cicero noticed this.25 These are not the kinds of unprovoked omens which occur by chance, such as an earthquake, a scorpion or snake appearing in the house, or even a lunar eclipse (known as Šumma ālu-omens, see Freedman 1998-2017). Eventually, much of this forecasting was superseded by astrology, which required no expensive outlay of cash but at the same time could render very exact results, based on precise mathematical calculations.

14But what about dreams? In Mesopotamian terms, dreams usually remained unprovoked omens which happen by chance. Incubation as a means of inducing dreams, like producing omens by examining a sheep’s liver, was normally not an option. One could not simply convert one system to another, to make unprovoked omens into provoked omens. There was no mechanism within Mesopotamian divinatory science for this kind of general paradigm shift. At the same time, the Akkadian Dreambook, which catalogues numerous dreams and offers a verdict as to whether they are positive or negative in terms of results, has many parallels with the text of Artemidorus. Here is a sample passage from the Akkadian Dreambook:

DIŠ kap-pi GAR-ma RI.RI-aš-ma ina KI GUB-ma ZI-a NU ZU-e SUHUŠ.BI NU GI.NA ina an-ni SUHUŠ GI.NA
If (one dreams that) he has wings and flies and lands but is not able to rise again, that his footing is not correct, (but) in this case his footing is correct.26

15Compare this with Artemidorus:

Most inauspicious and unlucky of all are dreams in which one wants to fly but is unable or those in which he is flying with one’s head facing the ground and one’s feet facing the sky.27

16The similarities speak for themselves.

17Furthermore, we possess dream rituals intended to make clients have favourable rather than bad dreams, as well as counter-charms to deal with the portents engendered by bad dreams. There are also examples of incantations and rituals to induce a dream to help the subject 'see an omen-verdict' or an 'oracular decision'. Here is an example:

Incantation rubric: (It is the text) to make an oracular decision. Its ritual: You take large barley. A youth who has not
known a woman cleanses himself on an auspicious day. He grinds (the barley). During the night, on the roof, before Ursa major, the youth ignites a brazier of juniper and this upuntu-flour.
(Then) he stands outside (the ritual area). You recite this (above) incantation three times before Ursa major.
You libate pure water. You will see an oracular decision.28

18These Akkadian rituals have two different but interesting rubrics:

Incantation rubric: (It is the text) to see an oracular decision.
Incantation rubric: It is (the text) to make a bad dream favourable.29

19Even though this ritual occurs within dream rituals, it is not actually incubation, but a ritual taking place under specific stars. There is no clear evidence for actual dream incubation, nor is any actual information given away regarding the contents of the oracle itself. We will never know what the dream had to say. A similar procedure appears in unpublished Babylon tablets from roughly 500 BCE edited by Irving Finkel from the British Museum, which record incantations to induce mantic dreams:

Incantation: Mamu, god of dreams, messenger of the great gods,
He who delivers their cry, are you, he who carries their words, are you.
Do you grant me a vision!
Let me see a dream of good import! Let the dream I am about to see [bode well!]30

20Once again, no clues about the kind of vision and whether this might be related to personal health.

21But we do have some important information from another source, from a small group of texts known to Assyriologists as ‘oracle questions’, such as this one from Babylon also from the around 500 BCE, which means roughly contemporary with Greek temple medicine. The oracle question concerns the need for medical attention:

Shamash, great lord whom I am asking, answer me with a reliable ‘Yes’! (I am) So-and-so, son of So-and-so, who is now sick with asû-disease....
Within this day should So-and-so determine and resolve to seek out So-and-so, a capable physician, and should he (the physician) come before him (the suppliant, and) perform all he knows regarding treatments? (or reveal) his prognosis (and) medical skill? So that the bitterness of illness and what he (the suppliant) has eaten is uprooted and driven from his body? 31

22Here is a clear example of an oracle, but as we can see, the usual binary pattern appears even when asking for a direct answer from a god, without any mechanistic interference of divinatory rituals, slaughtering of animals, or observation of tell-tale signs. The oracle does not ask for a remedy to treat the illness or purge the body from harmful substances, but whether the suppliant should seek out a certain doctor who has the requisite skills to do the job. Yes or no. This is the chief pattern for all Mesopotamian divination.

23We also have dreams mentioned within therapy, such as the following medical incantation against the ill effects of witchcraft, which includes numerous mental and physical symptoms of distress. The patient complains of dizziness, ringing in his ears, stiff neck, paralysis, pain in hips and knees, and depression, and then he says the following:

Lying asleep, I see, in my dreams (my) god and [(my) goddess], ghosts, dead people, living people, people I know (and) people I do not know. The dream I see I cannot remember and I cannot hold on to it.32

24Dreams, in this case, designate the problem rather than the solution, and this is typical for Mesopotamian medicine, which does not normally use dreams as a form of therapy.

25This brings us back to our opening question, to the counterintuitive proposition that one might have expected Hippocratic physicians to have regarded temple medicine as the brainchild of magoi, charlatans, and Orientals. Instead, we find temple medicine to have achieved respectability and legitimacy, and even working in cooperation with physicians. We can only guess at why Babylonian physicians did not follow the Greek model, which could have easily been accommodated by Akkadian dream omens, rituals, incantations, and oracles. All the necessary components were in place. The answer may simply lie within the inherent conservatism of Babylonian science, which managed to adapt to the new forecasting techne of astrology but was generally unwillingly to accept dreams as provoked omens. For this reason and others, a Babylonian visiting an Asklepieon would not have recognised its incubation-based therapies or leisure facilities as anything else but foreign and unfamiliar.