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A Babylonian treatise on epilepsy

Trans. by J. V. Kinnier Wilson and E. H. Reynolds

Medical History, 1990, 34: 185-198.

• Læs Wilson & Reynolds fulde analyse af teksten: Texts and documents. Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. [pdf]
• Se også: Bardia Tajerbashi & Christoph Friedrich: Zur Geschichte der Therapie der Epilepsie. Eine der ältesten bekannten Krankheiten Pharmazie in unserer Zeit, Volume 36, Issue 4, 2007 (p 254-261). [pdf]

OBVERSE

I TEMPORAL ASPECTS OF EPILEPSY

1. If epilepsy falls once upon a person [or falls many] times, [it is (as the result of) possession] by a demon or a departed spirit.

a. One symptom entries

2. [If an epilepsy demon has fallen once(?) upon him and] his eyes are red and yellow (from suffusion or ecchymosis)-hand of ardat Lili.

3. [Ifan epilepsy demon has fallen once(?) upon him] and he cries, "It is he again!", an encircling bennu-demon [1] has possessed him. His life will be spared.

4. [If an epilepsy demon falls from time to time upon him and] he has a fit two or three times during the day, if he is flushed in the morning and pale in the evening, it is miqtu.

5. [If an epilepsy demon falls many times upon him], possessing him two or three times during the day and the condition has become chronic, [2] he will die [3] in a state of epilepsy.

b. Longer entries with prognosis

6. [If an epilepsy demon falls many times upon him, and on] a given day [ 4] he seven times pursues and possesses him, his life will be spared. If he should fall upon him eight times his life may not be spared.

7. [If an epilepsy demon falls many times] upon him, and for one year when he falls (the patient) has the fit at the (same) precise time, the situation is critical. Miqtu draws closest to a man at midday and it is then most serious for him.

8. [Ifan epilepsy] demon falls (many times) upon him and on a given day [ 4] he seven times pursues him and he has a fit with loss of consciousness, and if when (the demon) has let him go he ..... , [5] -hand of the departed spirit of a murderer. He will die.

9-10. [If an] epilepsy demon falls again and again upon him, his eyes are suffused with blood-R: and he blinks his eyes;-if his lower (var.: his upper) cheek areas twitch [6] and his hands and feet are extended; if when the exorcist comes to see him hope is perishing [7] that he will ever regain consciousness,[8] -hand of the ghost of a murderer. (He will die).

II GELASTIC EPILEPSY

11. [If at the] time of his epilepsy he laughs loudly for a long time, his legs-R: "his hands and legs"-being continuously flexed and extended,-hand of Lilû.

III MAJOR SEIZURES' AND DIURNAL EPILEPSY

a. Paired entries

12. [If at the time] ofhis fit he loses consciousness and foam comes from his mouth, it is miqtu.

13. [If at the time] of his fit he loses consciousness and his arms and legs bend round to the same side as his neck, it is miqtu.

14. If at the time ofhis fit ..... takes hold of him and foam comes from his mouth, an (unfulfilled) vow made by his father has seized him. He (the child) will die.

15. If at the time of his fit after it has taken hold of him foam comes from his mouth,-hand of Lilû.

16. If at the end [9] of his fit when his limbs become relaxed again his bowels are sometimes seized and he has a motion, it is "hand of ghost" (nocturnal epilepsy).

17-18. If at the end of his fit his limbs become paralysed, he is dazed (or, dizzy), [10] his abdomen is "wasted" (sc., as of one in need of food) and he returns everything which is put into his mouth .......-hand of a ghost who has died in a mass killing. He will die.

19-22. If at the end of his fit his limbs become paralysed, (the demon) "pouring out" upon him so much that he loses control (of his functions); if when he thus "pours out" upon him his eyes are red and his face expressionless; [ 11] if his šer' ānu-vessels (mod.: "arteries") pulsate at a quickened rate and he cnes [12] although the tips of his fingers and toes remain cold; if when the exorcist asks the sick person to repeat (a prayer) he repeats what he says to him, but after (the demon) has let him go he does not know what he said,-hand of Lilŭa-la'bi. [13]

23. If before [14] his fit a half of his body is "heavy" for him and pricks him, and afterwards he has a fit with loss of consciousness and he loses control (of his functions), it is miqtu. At midday it will be most serious for him.

24-25. If before his fit he suffers from frontal headaches and is emotionally upset, and afterwards he ... [ . . ] his hands and feet, (and) rolls from side to side (on the ground) without deviation (of the eyes) or foam(ing at the mouth), it is a fall-R: due to emotional shock, or "hand of Ishtar". He will recover.

26. If when he has his fit (the fallen person) is looking sideways [ 15] or the whites of his eyes deviate to the side, and blood flows from his mouth, for female (patients) it is Lilû, and for male, Lilītu.

IV NOCTURNAL EPILEPSY

27. If his seizure (or, possession) always takes place in the evening, it is the seizure of a ghost (nocturnal epilepsy).

a. Two symptom entries

28. If ditto, he has a feeling of distention in his epigastrium and "his legs are lifted up" (i.e., he sits motionless(?)),-seizure by a ghost.

29. If ditto, he has a feeling of distention in his abdomen and is restless until the middle of the night (sc., when "relieved" by his fit),-seizure by a ghost.

30. If ditto, his eyes become cloudy and his ears hiss,-seizure by a ghost.

b. One symptom entries

31. If ditto, and his ears hiss,-seizure by a ghost.

32. If ditto, and his ears (or, hearing) become "paralysed",-seizure by a ghost.

33. If ditto, and his forehead aches,-seizure by a ghost.

34. If ditto, and at the time of his possession he is hot and from the evening watch until the middle watch he remains awake (waiting) for him,-seizure by a ghost.

35. If ditto, and at the time of his possession he cries, "It is he again!",-hand of ardat Lilî.

V CHRONIC EPILEPSY

One symptom entries

36. If the possessing demon has been possessing him again and again, and as a result of his possession his eyes become red and yellow (from suffusion or ecchymosis), -hand of ardat Lilî.

37. If the possessing demon has been possessing him again and again, and as a result of his possessions his hands and feet become yellow (or, pale),-hand of Lilû.

38. If the possessing demon has been possessing him again and again, and as a result of his possessions he is constantly wiping clean his hands and face, the ghost of a person who died in water has possessed him. At midday it will be most serious for him. R: A demon from the river has smitten him.

VI TYPES AND VARIETIES OF THE POSSESSION

39-40. If the possessing demon ...... and at the time of his fit he clenches his hands as (tightly as) though rigor (or, rigor mortis?) had seized him, and, with legs extended, is greatly convulsed; if then the seizure abates and he begins to regain consciousness, [16] -hand of the e'ēlu-demon.

41-43. If the possessing demon possesses him many times during the middle watch of the night, and at the time of his possession his hands and feet are cold, he is much "darkened" (and unresponsive?), keeps (involuntarily) opening and shutting his mouth, is brown and yellow as to the eyes and ......-hand of ardat Lilî. It may go on for some time, but he will die. R: For female (patients) it is Lilû, for male, Lilītu.

44-45. If (the demon) possesses him during his sleep, and, while he is still conscious, [16] continues to "pour out" upon him until he loses consciousness; if when they rouse him he is in a state of fear, [ 17] -R: (or), if at the time of his being roused he is in a state of confu[sion],-hand of Lilû ...... Lilītu. In either case he will recover.

46. If his possessing demon begins to possess him in the late afternoon, and at the time of his possession he has ..... [18] his forehead and his eyes oppress him and he has internal (or, stomach) pains,-hand of ghost.

REVERSE

1-3. If at the time of his possession, while he is sitting down, his (left) eye [ 19] moves to the side, a lip puckers, saliva flows from his mouth, and his hand, leg and trunk on the left side jerk (or, twitch) like a (newly)-slaughtered sheep, it is miqtu. If at the time of the possession his mind is consciously aware, (the demon) can be driven out; if at the time of the possession his mind is not so aware, (the demon) cannot be driven out.

Paired entries

4-6. If at the time of his possession he cries, "my heart, my heart!"; if he blinks his eyes, has hot flushes, rubs (involuntarily) the tip of his nose and the tips of his fingers and toes are cold; if you try to get the sick person to speak and he does not answer,-hand of Lilû.

7-9. If at the time of his possession he cries, "my heart, my heart!"; if he blinks his eyes, has hot flushes, rubs (involuntarily) the tip of his nose and the tips of his fingers and toes are cold; if he remains conscious [16] but when you try to speak with him he acts strangely (or, like a strange person),-hand of Lilû-la'bi.

VII PRE-POSSESSION SYMPTOMS

10-11. If by day a sleep pours over him and his fingers and toes begin to twitch, it is miqtu. It may take hold of him in fallow ground or in the corner (of a house).

12. If his limbs jerk or move erratically and he has spells of dizziness, [20] it is miqtu. At midday it will be most serious for him.

13. If his limbs are "paralysed" (sic) and/or prick him and he has spells of dizziness, it is miqtu. At midday it will be most serious for him.

VIII POST-POSSESSION SYMPTOMS

14-15. If when his limbs become at rest again like those of a healthy person he blinks and begins to regain consciousness, [16] and when you try to speak with him he acts strangely (or, like a strange person),-hand of Lilû (or) of a messenger of his god.

16. If when his limbs become at rest again like those of a healthy person his mouth is seized so that he cannot speak,-hand of the ghost of a murderer. R: hand of the ghost of a person burned to death in a fire.

17. If when his limbs become at rest again like those of a healthy person he remains silent and does not eat anything,-hand of the ghost of a murderer; alternatively, hand of the ghost of a person burned to death in a fire.

IX THE EPILEPTIC CRY

18. If he cries "u'āyi!" or utters a sound (like an animal), saliva flows from his mouth and his neck is pressed down to the left, it is miqtu.

X FEAR AND CONFUSION IN POST-ICTAL OR OTHER STATES

Entries arranged in groups of three

19-20. If he keeps going into and out of (his house) or getting into and out of his clothes .. or talks unintelligibly a great deal, does not any more eat his bread and beer rations and does not go to bed,-hand of Ishtar .....

21. If ditto, and (additionally, the demon) makes his eyeballs to protrude, a demon bent on killing him is standing at the head of his bed. He will die.

22. If he has panic attacks (or, becomes more and more fearful) and (the demon) causes his eyeballs to protrude, a demon bent on killing him is standing at the head of his bed. He will die.

23-24. If, in a state of fear, he keeps getting up and sitting down, (or) if he mutters unintelligibly a great deal and becomes more and more restless,-for a female (patient) it is Lilû, for a male, Lilītu. In either case he/she will recover.

25. If during (or, between) his illnesses he is sometimes fearful and sometimes elated, on one occasion it will be ardat Lilî on another it could be Bennu. [21]

26. If he is sometimes fearful and sometimes restless in his bedroom,-hand of "Urtilli" (= ardat Lilî?). He will recover.

27-28. If a death-wail sounds forth for him and (at each wail) he himself responds to it, saying as the wail sounds forth, "Who are you" (sc., "O dying one, that men are wailing for?"),-a . . . muttillu-demon [22] has affected him or become involved with him. When he stands at the head of his bed, he will die.

29. If a death-wail sounds forth for him and (at each wail) he himself responds to it, rising and falling onto his knees, a demon from the desert has possessed him.

30-31. If a death-wail sounds forth for him, and as each wail sounds forth he himself responds to it, rising to his feet or trying to get up and falling back again or getting up and falling to his knees, he will be saved from (the effects of) his illness. A wandering demon has possessed him.

NOTES

[1]    On this demon cf. also below, rev. 25. From Akk. lexical and omen texts, bennu, as both a disease and the demon causing it, appears to have a meaning either close or complementary to that of miqtu and the terms are often found together.

[2]    The text is here read as i-ri-ik īrik-ma, the verbs being from arāku, "to be long (of time)".

[3]    GAM = imat is read on the Babylonian tablet, the Assyrian text being emended accordingly to *i-*mat.

[4]    Lit.: "on that day".

[5]    A difficult verb edēpu with life-threatening implications is here involved but the precise meaning is not clear.

[6]    On the variant reading at this point, cf. further in the Commentary, under obv. 9.

[7]    Hypothetical translation. An unusual verb and form is involved at this point.

[8]    Lit., "look at the person who is holding him", cf. above, p. 187.

[9]    Lit.,, "at the time of", as also in the two entries following.

[10]    A difficult compound expression in Akk. lies behind this translation, which adheres to the traditional interpretation "to be dizzy", or, "to have dizzy spells" (or, "vertigo"), as substantiated by the dictionaries. Cf. also rev. 12.

[11]    As it stands the text reads: "if his eyes are 'bound' and his face red", but "R" follows this with the word suhhuru, "to turn round", or "to be turned round", and the translation interprets this instruction as meaning that the position of the verbs in the two phrases should be interchanged.

[12]    Possibly an indication of the young age of the patient.

[13]    Cf. also rev. 9, below. The most suitable translation is "hand of Lilû-of-the-fevers", which would mean that Lilû himself might bring fever or the like to the bedside of the young epileptic.

[14]    Lit., "at the time of", as also in the entry following. Cf. above, note 9.

[15]    Lit., "to his hands", meaning to his right- and left-hand sides. A similar phrase occurs in TDP 88, 5: "if he keeps looking (anxiously) from side to side".

[16]    Lit., "looks at the person who is holding him", cf. note 8 and the reference cited.

[17]    The same observation as at the end of the sentence regarding the recovery of the patient is inserted in the text at this point, and has been omitted as anticipatory.

[18]    Text not understood. A new expression appears to be involved at this point, possibly having some connection with speech.

[19]    The inserted word "left" has been added from the indication of left side involvement mentioned lower down in the entry.

[20]    On this rendering cf. above, obv. 17 with note 10.

[21]    If correctly understood, a new grammatical construction is involved in this line.

[22]    Emended text, following a suggestion of M. Stol.