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York, George K. III MD

Accidental Historian

Neurologists are often called upon to determine whether a patient's symptoms are those of epilepsy. When the patient repeatedly falls to the ground convulsing, the diagnosis is relatively easy. Symptoms like laughing or running are trickier. Most often, a laborious and somewhat repetitive history of the symptoms will reveal the truth of the matter. Accidental historians know that it was ever thus. The oldest extant reference to epilepsy is a guide to the symptoms of epilepsy for the Babylonian practitioner.

The Babylonians had a collection of 40 cuneiform tablets called Sakkiku, which might be translated as “All Diseases.” This series of tablets describes various manifestations of disease. Archaeologists have unearthed two copies of an edited version of Sakkiku, which dates from the seventh century BCE. The original version has not survived, but is estimated to date from 1050 BCE. The twenty-fifth tablet of this Babylonian medical text is devoted to the manifestations of miqtu, the Babylonian term for “the falling disease.” We owe to J.V. Kinnier Wilson, son of S.A. Kinnier Wilson, and E.H. Reynolds the English translation of the cuneiform tablet (see Medical History 1990;34:185–198).

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The Babylonian tract on epilepsy, like many Egyptian medical texts, has a formal structure in which particular manifestations are followed by a prognosis. For example, the unknown author or authors of Sakkiku say that if a person has a single seizure, he will live, but if he has two or three spells a day, he will die. A patient who has a seizure and never regains consciousness will also die. The text tells the astute Babylonian physician that if a person loses consciousness and foams at the mouth, it is miqtu.

According to the text, these conditions also might describe miqtu: The patient falls asleep during the day and his fingers twitch, he has paralysis and dizziness, he cries out, foams at the mouth, and turns his head to the left.

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The Babylonians believed that demons and ghosts, which could possess a person temporarily, caused illnesses such as epilepsy. Supernatural creatures were believed to cause the various manifestations of miqtu. In the Babylonian language the verb “to seize” also carries a meaning “to possess,” and this word was applied to epilepsy. Thus, the demon Lilu, his slave-girl Lili, and his wife Lilitu would possess people, causing their epilepsy.

The Babylonian text says that if a person laughs loudly while his limbs are being flexed and extended, it is the hand of Lilu. A curious feature of this family of demons is that they are childless. As a result of their envy, they had a particular interest in possessing children, explaining the frequent occurrence of childhood epilepsy.

The Babylonians had different terms for diurnal and nocturnal epilepsy, and they attributed nocturnal spells to ghosts. They claimed that exclusively nocturnal spells featuring headaches, hissing in the ears, deafness and abdominal distension show the hand of a ghost. It also attributed multiple seizures in a single day to the ghost of a departed murderer, adding that those with this illness will surely die.



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Disease treatments were discussed in a separate group of cuneiform tablets, which were not a part of the Sakkiku. However, examination of therapeutic texts shows that Babylonian practitioners used both supernatural invocations and more practical remedies. Priests and exorcists attended to the sick, treating them with prayers and incantations. Other healers used medicines, ointments, enemas, and amulets. The Babylonians lacked the conception of natural causation of disease, an idea that the Greeks would introduce. Nevertheless, they observed their patients carefully and categorized illness in a way that makes sense three millennia later.

Physicians are often called upon to put a name to an illness, with the implication that doing so tells us more about it. Modern science makes this more likely, but we should recognize that this was not always so. Accidental historians will feel an affinity with the Babylonian practitioners who pronounced the diagnosis of miqtu. Making a diagnosis of epilepsy can be tricky, but it leads to treatment that works, at least to some degree. In the end we might not know much about the illness, despite having successfully diagnosed and treated it. Even so, the patients are grateful.

©2005 American Academy of Neurology