“If an infant’s body (has) a lukewarm temperature, his head has fever, he feeds at the breast and then drools a lot, his teeth are coming out. He may suffer for 14 or 20 days, but he will get well.”
This description of the teething process comes from a 3,000-year-old medical handbook from ancient Assyria and Babylonia. The Babylonian Diagnostic Handbook, known by the name of Sakikkū, is one of the most impressive intellectual achievements of the ancient world.
More than three millennia before the stethoscope, before bacteria, before Hippocrates — there was the Sakikkū. This monumental Babylonian diagnostic handbook was carved in cuneiform wedges on 40 tablets, with remarkably accurate descriptions for conditions ranging from gastrointestinal issues to strokes. Yet these ancient physicians didn’t blame the human body. They blamed the gods.
Disease and Demons
For the ancient Assyrians and Babylonians, disease was a complex and often terrifying affair. Medicine blended physiology into the fabric of their religious and magical worldview. When you got sick, it wasn’t a pathogen or your biology acting up. Instead, it was a punishment from the gods, a malicious attack by demons, or the result of witchcraft. Your health was intrinsically linked to your relationship with the divine. Any sin could anger a god or draw a demon’s attention to you.
This supernatural understanding of disease shaped their approach to diagnosis and treatment. In Babylonia, there were two types of healthcare professionals. The asû was the practical healer. He would mix potions and bandage wounds. Asû had excellent knowledge of herbs and poultices and was a surprisingly regulated profession. In the famous Code of Hammurabi, the oldest complete legal text, there are fees and penalties for malpractice.
Meanwhile, the āšipu, by contrast, was a scholar-priest. He was the one who diagnosed. It was the āšipu who would visit the patient’s home to perform the diagnosis, and the Sakikkū was his primary reference manual. The āšipu’s job was to identify both the illness and the supernatural instigator for it. It could have been a god angry over a broken oath or a demon lurking near the home. Each required a different ritual response. Diagnosis meant deciphering the will of the gods.
In Babylon, medicine was metaphysics.
Yet despite this spiritual approach, the medical texts are remarkably precise and well-structured.
A Diagnostic Matrix
The Sakikkū doesn’t have just a single author. It was a collection, compiled and refined, passed down through generations. Yet, the final, authoritative form seems to be connected with a scholar called Esagil-kin-apli. He was the chief scholar to the Babylonian king Adad-apla-iddina, who reigned from approximately 1067 to 1046 BCE.
However, many scribes, editors, and scholars worked on it. The goal was to create an exhaustive catalog of information, a “Wikipedia” of disease at the time. Mesopotamian cultures loved to classify and structure information, and this was a quintessential example.
The primary intellectual tool for this undertaking was the list — a format that allowed for the exhaustive cataloging and systematic permutation of information. The text’s intricate organization, from its grand 40-tablet framework down to the formulaic language of each individual omen, reveals a highly organized and logically coherent system.
Everything had a point. Even the number 40 is connected to the god Ea (known as Enki in Sumerian), the deity of wisdom, magic, and craftsmanship. They were grounding their medical manual firmly in the divine.
From there, the Sakikkū is divided into six chapters. It starts with a guide on how to approach the house of a sick person and look out for omens. Do you encounter a pig on your way? That could be an omen for diagnosis. The second chapter instructs on how to inspect the diseased. The third chapter is on infectious diseases, while the fourth is on neurological syndromes including epilepsy, seizures, strokes, ghosts, and gods. The other chapters deal with skin lesions, fever, women, and infants.
The highly structured and formulaic nature of the Sakikkū reveals its function as more than just a reference manual; it was a cognitive technology. Faced with the chaotic and terrifying reality of disease, the Mesopotamian scholar used the text to impose order and create a sense of intellectual control.
But at the heart of the Sakikkū lies a consistent “if-then” structure.
If X, then Y
Each entry begins with an observed symptom (“if”) and concludes with a corresponding interpretation or outcome (“then”). This formula (“If the patient’s face is pale, then the hand of the ghost is upon him”) is applied to the human body with almost clinical precision. What makes this structure so remarkable is not just its clarity but its ambition. It aimed to transform medicine into a predictive science, capable of decoding divine will through empirical observation. By systematically analyzing all the relevant signs (body part, side, color, or severity) the Sakikkū generates a diagnostic matrix, seeking to account for every possible variation of illness. Although it was based in the divine, it imposed a rational framework with stunning analytical rigor.
For instance, “If the patient’s face contains sweat”, the texts read “the hand of the god Šamaš is upon him; he will recover.” The god Šamaš (read Shamash) was believed to see everything that happens in the world and was therefore responsible for justice and protection of travelers. “If one side of his body is limp,” then “it is the hand of the demon Šulak.” Šulak was the demon of the privy and lurked in bathrooms. He caused several diseases, including palsy or stroke, which were diagnosed here.
The prognosis was less optimistic for epilepsy. “If [the epilepsy] demon falls upon him and on a given day he seven times pursues him…”, the patient was not expected to recover.
A few signs came not from the patients themselves, but rather from the world. “If a multi-colored pig is seen on the way to the patient’s house,” then “the patient has dropsy [edema].” It was a rational system, in a way; just one with very irrational premises.
Lost and Rediscovered
The Sakikkū’s resurrection is a story almost as improbable as the text itself.
For nearly two millennia, the knowledge contained within its 40 tablets lay dormant, buried under the sands of modern-day Iraq. In the 1850s, British archaeologists uncovered the royal library of King Ashurbanipal in Nineveh. Fires from the city’s violent destruction had baked its clay tablets into ceramic, preserving them for over 2,500 years.
Among them were copies of Sakikkū — handwritten in Akkadian cuneiform, some already over a millennium old when they were filed away. Scholars like René Labat and Irving Finkel would spend lifetimes piecing them together. Others compared them to modern neurology.
But the more archaeologists looked at the texts, what emerged was not superstition. It was a coherent, systematic worldview.
It’s easy to dismiss the Sakikkū as magical thinking. But that’s a misunderstanding of its intent. It was not irrational — it was other-rational. The Sakikkū observed symptoms with precision. It built taxonomies, permutations, and classification systems. The diagnostic sequence “from head to foot” mirrors the empirical drive seen in Hippocratic texts, but predates them by centuries.
The difference was not in method. It was in metaphysics.
Babylonian medicine didn’t separate the physical from the divine. The body was a canvas. The gods, the dead, the unseen could smear this canvas and cause diseases; this was part of the diagnosis.
In a world without penicillin and X-rays, people sought more than just random evidence and diagnoses; they sought structure. They attempted to build a systematic classification of what causes ailments. Sure, it was a classification based on their world understanding at the time, but it was an ordered system nonetheless.
Even more than the medical conclusions themselves, this approach of ordering things is perhaps all the more impressive. In the end, they got quite a few things right medically, as well. After all, if your baby’s teething, it’s unpleasant and the baby may get feverish, but at the end of the day, they’ll be fine.
