425 BIBLIOTHECA ORIENTALIS LXIX N° 5-6, september-december 2012 426 HOOFDARTIKEL MASKADUM AND OTHER ZOONOTIC DISEASES IN MEDICAL AND LITERARY AKKADIAN SOURCES NATHAN WASSERMAN The Hebrew University of Jerusalem I. Zoonotic diseases are infectious diseases due to etiological agents that pass from animals to humans, affecting both the humans and the animal.1) Their pathogens may be bacteria, viruses, parasites or prions, for which a wide variety of animals – wild, domesticated or peri-domesticated – serve as reservoir. The mode of transmission of the pathogens from the reservoir to the human host varies: infection through skin lesions, bites, inhalation of aerosols, contact with feces, or consumption of foodstuffs. Zoonotic diseases pose a persistent threat. In a recently published study 2) 335 occurrences of newly described zoonotic diseases were identified between the years 1940 and 2004 (including pathogens that crossed species for the first time, e.g. HIV). Seventy two percent of the studied zoonotic occurrences involved pathogens originating in wildlife (e.g. SARS in China). However, diseases whose reservoirs are domesticated and peri-domesticated animals prove to be no less of a problem. Populations in developing and developed countries who live in close proximity to animals and especially populations who raise livestock, risk exposure to zoonotic disease. The World Health Organization estimates that about 500 million people worldwide are likely to be in contact with such diseases, especially bovine tuberculosis, anthrax, and brucellosis.3) II. Turning to cuneiform sources,4) there is a small group of Old Babylonian medical incantations that list diseases which affect both humans and livestock. Two examples:5) Goetze 1955, 8–9 Text A: 1–12 (= SEAL 5.1.5.3) [The sikkatum-disease, fe]ver, the asûm-disease, ziqtum-disease, bad collapse, samagu-disease, samanu-disease, gergissudisease, Òennettum-disease, sweet simmu-disease ekketumdisease, risitum-disease, bloody feces, shivering, sagbanu-disease, and sassa†u-disease came down from the ziggurat of heaven, burned up the sheep, the lambs, caused the children on the shoulders of the nurse to be somber…6) 1 ) I wish to thank Prof. Hervé Bercovier, the faculty of medicine (microbiology and molecular genetics) at the Hebrew University of Jerusalem, for his readiness to discuss with me various problems pertaining to this research. This paper could not be completed without his help. The responsibility for the ideas expressed here is, needless to say, entirely my own. An early version of this paper was presented in July 2012, at the 58th Rencontre Assyriologique Internationale in Leiden. 2 ) Jones et al. 2008. 3 ) Palmer 2011. 4 ) Akkadian texts are referred to also by their respective numbers in the database Sources of Early Akkadian Literature (SEAL - http://www.seal. uni-leipzig.de/), run jointly by M. P. Streck and the author. 5 ) See also: Goetze 1955, 8–9 Text B (= SEAL 5.1.5.4); YOS 11, 8 (= SEAL 5.1.5.6). 6 ) [sí-ik-ka-tum i-s]a-tum / a-[su-ú-um z]i-iq-tum / mi-iq-tum Òé-nu / sa-ma-gu sa-ma-nu / ge-er-gi-su Òe-ni-tum / sí-mu ma-at-qum e-ke-tum / ri-si-tum ni-†ù / su-ru-pu-ú sa-ag-ba-nu / ù sa-sa-†ù / is-tu zi-qú-ra-at same-e ur-du-ni / úÌ-ta-mi-i† i-me-ri ka-lu-mi / uÌ-ta-di-<ru> Òú-Ìa-re-e i-na bu-ud ta-ri-tim… 427 MASKADUM AND OTHER ZOONOTIC DISEASES IN MEDICAL AND LITERARY AKKADIAN SOURCES 428 Cavigneaux 1994, 156–157: rev. 10’–14’ (= SEAL 5.1.5.5) The sikkatum-disease, fever, falling, sanudû-disease, asûmdisease, samanum-disease descended from the height(?) of heaven. Pox(?) has fallen down, fever had been ignited, has devoured the sheep, the lamb, and encircled(?) the child. The herd is gloomy…7) YOS 11, 69: rev9’–15’ (=SEAL 5.1.15.3) The whispering, the whispering-ones(f.). She (a milking cow?) has brought to me. The whispering, the whispering-ones. Oh my milking cows! Let me… let me… life! … cow(?), whispering-ones. Ningirim… cow(?), whispering-ones. Incantation against the maskadum-disease. It is unlikely that all these ailments are zoonotic in nature, especially since most are found in other sources with no connection to animals.8) Mesopotamian medicine probably attributed these diseases both to men and livestock because it held that similar symptoms, whether in a human or animal, derived from the same disease. Whatever the cause of this dual attribution, it is important to note that ancient Mesopotamians were aware that diseases could affect humans as well as cows and sheep. This observation paves the way for what I believe to be an unambiguous case of a zoonotic disease mentioned in Akkadian sources: maskadum. This difficult incantation was treated by Cavigneaux and AlRawi12) and again by Streck and Wasserman.13) This is not the place to delve into its philological complexities. Suffice it to stress two points: first, line r.11’ proves unequivocally that maskadum affects cows, specifically milking cows – and not only humans; and second, that the word used for milking cow is not Akkadian: Ìalibatum is the pl. f. form of the substantivized adjective Ìalibum, meaning most probably “giving milk”. This otherwise unattested lemma derives from the West-Semitic verb Ìalabum, “to milk”, recorded only in Neo-Assyrian which borrowed it from Aramaic.14) YOS 11, 69 borrowed Ìalibatum from West-Semitic, which in the Old Babylonian period means Amorite.15) In post-Old Babylonian sources from the first millennium, maskadum appears mainly in incantations which make up part of the mussu’u-series, a magico-medical series of eight known tablets designed to treat various ailments whose main symptoms were joint and muscle pain.16) The main difference in the later incantations is the addition of a detailed list of pathological symptoms of the disease. This change exemplifies the tendency of magical texts in the first millennium towards medicalization of the earlier magical material, and attests to the growth of a specialized and systematic medical corpus. III. The disease called maskadum is mentioned in three Old Babylonian medical incantations, two of which bear close resemblance: A 663 = Collins 1999, 234–235: 8–15 (= SEAL 5.1.15.1) maskadum! maskadum! – not maskadum(!) (but) su’um (is its true name). It came down from heaven. In the pit is its location, in the track of the bull is its laying. It enters (with) the entering of the herds; it goes out (with) the going out of the herds. I have made you swear by (the name of) An and Antum: wherever you have grasped you will release!9) YOS 11, 14b:1–6 (= SEAL 5.1.15.2) maskadu[m!] mask]adum! – not maskadum (but) suÌûm (is its true name). In the street is its lair; in between the sheep is its location. It bites a wolf-bite; it attacks an Elamite-dog’s attack. It enters (with) the entering of the herds, it goes out (with) the going out of the herds. Go out maskadum before the flint razors of Gula will reach you!10) The third Old Babylonian maskadum-incantation is entirely different. It makes up part of YOS 11, 69, a multi-text tablet grouping four incantations of agricultural interest: the first incantation, in Sumerian, deals with field rodents. It is followed by an Akkadian ritual and Sumerian incantation against birds. The third incantation deals with maskadum, and the fourth combats onagers which threaten freshly winnowed barley.11) The short incantation against maskadum reads: STT II 136:iv3–1617) [Mussu’u VIII/l] = Böck 2007, 290– 292:153–166 suÌû is its name, maskadum its nickname. From the star of heaven it came down, indeed, it came down from the star of heaven. Half of snake’s venom, half of scorpion’s venom I (var.: it) took. It is boosted with venom, grasping…. Though having no mouth, it has teeth; though having no teeth it seizes the muscles. Though having no fingers, it seizes the groin. It is thin like a hair, unnoticed in the flesh. It seized the hip, shin, ankle, loins, back, and the tendon of the heel – all the muscles, the entire body…18) An almost identical incantation, also against maskadum, follows this one.19) Two mss., including the Sultan-Tepe text 12 ) Cavigneaux/Al-Rawi 2002, 10-11. ) SEAL 5.1.15.3. 14 ) AHw 309b takes Ìalabum as a denominative of West-Semitic noun Ìala/ib, “milk”. 15 ) So already Cavigneaux/Al-Rawi 2002, 11. 16 ) A similar incantation is found in CT 23, 2-4 // CT 23, 5-14 (cf. Böck 2007, 312), not belonging to the mussu’u-series: “sû is its name, maskadum its nickname. From the stars of heaven it came down. It seized, the paralysis, the entire body of the young man. It seized (his) hip, shin, ankle, loins, back and the tendon of the heel. Illustrious, all-knowing AsalluÌi cast over it an incantation that exorcizes all. Just as day and night are separated so let the disease be separated from his body!” 17 ) Text E in Böck’s sigla. For other mss. of this incantation, see Böck 2007, 290-292. 18 ) suÌû sumsu maskadu kinûssu / istu kakkab samami urda urdamma istu kakkab samami / misil imti sa Òerri misil imti sa zuqiqipi imassa alqi (var. ilqi) / uttur imta atar Òibit … / pâ la sakin sakin sinni / sinni la sakin Òabit ser’ani / ubanati la sakin Òabit kappalti / kima sarti qatan la edû ina pagri / iÒbat gissa kinÒi u kiÒalla / qablu rapasta u sasalli / napÌar ser’ani gimir kala pagri… 19 ) VIII/m, according to Böck’s (2007, 293) nomenclature. 13 7 ) sí-ka-tum i-sa-tum mí-iq-tum sa-an-a-du-um a?-su? ù sa-ma-nu-um / i-na zu-qú-ra-an sa-me-e ur-da-ma / im-qú-ut sí-ka-tum in-na-pí-iÌ i-sa?t[um] / <i?>-ta-KU-ul i-ma-ra ka-lu!-ma-am / ù Òú-Ìa-ra-am i-li-im?-mi? / qú-tu-úr bu-lu-um la i-ta-WI [ú] […]. 8 ) On zoonotic diseases in cuneiform texts, see Stol (forthcoming). 9 ) ma-as-ka-du-um ma-as-ka-du-um ú-la ma-as-ka!-du!-um! (Text: ma-as-ra) su-ú-um / is-tu sa-mi ur-da-am / i-na si-it-pi-im ma-an-za-zu-su / i-na ki-bi-is al-pi-i-im ma-a-a-al-su / e-re-eb bu-li-im i-ru-ab wa-Òi bu-liim iÒ-Òí / ú-ta-mi-ka AN ù An-tum a-sar ta-aÒ-ba-tu / lu tu-wa-sa!-ar tu.en. ni.in.nu.ri / Òí-i ma-as-ka-du-<um> [zi] su Ìu ur. 10 ) [m]a-as-ka-du-[um ma-as-k]a-du-um ú-ul ma-as-ka-du-um su-Ìu-úum / i-na s[u-li]-im! na-ar-ba-Òu-su i-na {ma-an-za-as-sú} i-me-ri m[a-anz]a-zu-su / na-sa-ak ba-ar-ba-ri-um i-na-as-sa-ak sa-Ìa-a† kal-bi-im e-lam[i] [i-sa]-Ìi-i† / e-re-eb bu-lim i-ru-u[b w]a-Òe-e bu-lim uÒ-Òi / [Ò]i-i ma-as-[ka]-[du]-[um] [la]-a-ma ik-su-du-ka Òú-ur-ru na-ag-la-b[u (sa) d] Gu-la / t[u6].én.é.nu.[ri]. 11 ) On this tablet see George 1999; Wasserman 1999. 429 BIBLIOTHECA ORIENTALIS LXIX N° 5-6, september-december 2012 just quoted, insert the remark about the connection of the disease to livestock which is known from the Old Babylonian sources: STT II 136:iv1920) [Mussu’u VIII/m] = Böck 2007, 293: 170 In the track of the bull is its lair, in the track of the sheep is its location.21) So, what can be said about the main characteristics of maskadum, based on the texts available so far? • The most important piece of data is that maskadum is a disease that is directly connected to the presence of ruminant animals (cows and sheep) – the disease “come and goes” with them. In other words, the vectors of the disease are small and large cattle. • However, its exact etiology, or origin, was unknown to the ancient healers – the texts mention a celestial origin. • There is a confusion regarding its lexical identification – the disease has two names: maskadum and suÌû/sû.22) • Its symptoms were severe pain – “wolf bite” in Old Babylonian sources; “scorpion’s/snake’s venom” in later sources. The pain is located in the loins, back, hips, shins, etc. – so in post-Old Babylonian sources. • The disease affects humans and also milking cows. • The antidote to maskadum is first by magical means (incantations), but surgical treatment is also hinted at – an Old Babylonian text mentions “the razors of Gula”. Later texts refer to the technique of rubbing (mussu’u) and mention magical amulets. IV. The next step in the discussion deals with the conceptualization of maskadum in Antiquity. I propose that maskadum was defined early in the second millennium, in a social milieu of herd-raising people, more precisely by the Amorites. The word maskadum itself is an import from Amorite, based on the MAPRAS nominal pattern.23) The root √skd, from which maskadum must derive, is not productive in Akkadian.24) Only the lexeme sakadu is found once in the synonym list Malku=sarru, proving that this root is non-native in Akkadian. The word sakadu is equated with qitrudu, “heroic”,25) fitting well into its section in the synonym list which covers the sematic field of rulers, warfare, and strength.26) It is therefore likely that the basic meaning of maskadum was “the strong/violent (disease)”, a secondary concretization of an abstract term. The proposal that maskadum is an Amorite loanword in Akkadian explains the unusual remark “suÌû is its name, maskadum its nickname” which opens all the maskadum incantations, Old Babylonian and post-Old Babylonian 20 ) Text E in Böck’s sigla. Text A (= BM 45483+) reads probably the same. 21 ) ina kibsi alpi narbassu ina kibsi immeri manzassu. 22 ) This disease is equated in lexical texts with other diseases besides maskadum, see CAD S/3, 417b. 23 ) Streck 2000, 335 §5.43 (see also §5.46). This nominal pattern is, of course, not unknown in Akkadian. 24 ) The root √skd exists in Arabic lexicographical texts, meaning “to give something, to present something”. Rules of phonetic changes between different Semitic languages exclude, however, the possibility that it is a cognate of Akkadian √skd, since /s/ in Arabic corresponds to /s/ or /s/ in Akkadian. The hypothetical Arabic cognate root *√†kd, which would be a natural cognate of Amorite √skd, is unknown. 25 ) Malku=Sarru I:32: Hrusa 2010, 32 (see CAD S/1, 113b). 26 ) Hrusa 2010, 10. 430 alike. Evidently, Babylonian medical tradition retained the memory that this disease is foreign in origin, appending to it a local Akkadian name.27) The suggestion that maskadum originated in an early pastoral setting clarifies the use of the Amorite adjective Ìalibatum, “milking cows” in the Old Babylonian incantation YOS 11, 69, and explains why the original connection of the disease to sheep and cows began to disappear in post-Old Babylonian incantations: in later periods, which no longer relied on a semi-nomadic pastoral economy, the comment “in the track of the bull is its lair, in the track of the sheep is its location” seemed unclear and non-essential. V. Based on the evidence presented so far, I wish to propose a modern candidate for the ancient maskadum disease, namely brucellosis. Brucellosis is one of the most common zoonotic diseases. It is endemic in the Mediterranean basin, in the Balkans, in the area of the Persian Gulf, and other neighboring countries. In 1751 Cleghorn, a British army surgeon stationed on the island of Minorca, described cases of chronic, relapsing febrile illness which is probably the first modern description of this disease. In 1861 Marston, a British military doctor serving in Malta, described his own infection in this disease. But it was David Bruce, also a British army surgeon stationed in Malta, who, in 1887, isolated from human spleens the pathogen of the disease– the bacteria brucella, named after him.28) 29) Different species of brucella are known, the three main ones being Brucella abortus, causing miscarriage in cattle; Brucella melitensis, affecting goats; and Brucella suis, typically affecting domestic pigs.30) In domestic animals brucellosis produces genitourinary infections leading to lower milk production and abortions, with significant financial repercussions. It commonly affects humans as well.31) Humans contract brucellosis through ingestion of unpasteurized milk and dairy products, by contact with infected meat and by accidental inhalation of aerosols containing Brucella.32) The World Health Organization reports that there are half a million new cases of brucellosis in humans every year, a figure which some consider an underestimate.33) Most sufferers of brucellosis live in close proximity to livestock: shepherds, veterinarians and workers in the meat industry.34) Antibiotic treatment is the first-line therapy recommended by the World Health Organization.35) It is important to stress that humanto-human transmission is extremely rare in brucellosis, and animals serve as the sole reservoir of the pathogen.36) More 27 ) maskadum is also equaled with sassa†u in Malku=Sarru IV:51: = Hrusa 2010, 95 (see CAD S/2, 175a). 28 ) Purcell et al. 2007, 186; Nicoletti 2002, 5; Shuttleworth 1979, 72–73. 29 ) There is, however, a controversy about who should be credited for linking brucellosis to goat milk (Vassallo 1996). 30 ) Ortner et al. 1981, 138. 31 ) Doganay and Aygen 2003, 173. 32 ) Assad 2012, 189-190. 33 ) Assad 2012, 189-190. 34 ) Bouza 2002, 81-82. 35 ) Alp/Doganay 2008, 575. 36 ) Ortner et al. 1981, 139: “… the spread of brucellosis between humans is very rare…”. The disease may pass between humans through sperm or through milk, from a mother to child (see Vandercam et al. 1990: “…proof of person-to-person sexual transmission [of brucellosis] is lacking, despite evidence from isolated case reports suggesting this may occur”). 431 MASKADUM AND OTHER ZOONOTIC DISEASES IN MEDICAL AND LITERARY AKKADIAN SOURCES than a century after its first assured description, no major country has been able to eradicate brucellosis,37) and it is still a widespread disease (with possible application in biological warfare).38) Clinically speaking, brucellosis in humans presents a very heterogeneous spectrum of symptoms, a fact which makes it difficult to diagnose. Clinical manifestations of acute brucellosis include recurring undulant fevers that may persist for weeks, malaise, sweats, non-inflammatory joint pain, lower back pain and headaches. When chronic, brucellosis involves inflammation of the vertebra, sometimes with neurologic impairment; pain and restricted movement in the hips, knees, shoulders, wrists, and ankles; genitourinary, gastrointestinal and hematologic complications are also recorded.39) This set of symptoms clearly matches the list of symptoms found in the maskadumincantations in the mussu’u-series: “It seized the hip, shin, ankle, loins, back, and the tendon of the heel – all the muscles, the entire body”. Brucellosis has mainly inner-body effects, like changes in the spine, prevertebral abscess,40) and enlarged liver,41) but in some cases the disease can be noticed on the exterior, showing rupture of blood vessels in the limbs,42) and large cysts – both in humans and in animals (see Figs. 1, 2).43) These external features could perhaps be treated in surgical way in Antiquity, 44) as reflected in the threat found in one of the Old Babylonian incantations “go out maskadum before the flint razors of Gula will reach you!”. Finally, skeletal involvement in chronic brucellosis is not uncommon and can be archaeologically detected.45) 46) An Early Bronze case of brucellosis was reported in Jericho.47) Other cases of brucellosis dating back to c. 3100 Fig. 1: Lumbar cyst caused by brucellosis (Raptis et al. 2005, 82) 432 Fig. 2: Hygroma (inflamed cyst with fluids) in sheep caused by brucellosis (Ramadan 1991) B.C. were found in Jordan and in Bahrain.48) An earlier case of brucellosis was found in a Chalcolithic site in Spain,49) and it was even suggested that a hominin skeleton of Australopithecus africanus shows signs of brucellosis.50) Recently, a team from Michigan State University succeeded in extracting ancient DNA from a skeleton in Albania, proving the molecular existence of brucellosis in Medieval Europe.51) There is no doubt that brucellosis has accompanied human society at least since the domestication of sheep, goats and cows c. 10,000 BP, or perhaps much earlier.52) It is unlikely, therefore, that the disease was unknown to a society whose livelihood was based on pastoralism, such as that of Early and Middle Bronze Age Amorites. VI. As we have seen, first millennium Mesopotamian medical texts considered maskadum to be a disease which attacks the entire body, affecting in particular joints and muscles.53) Thus, if the hypothesis presented here is correct and modern brucellosis can be identified, at least generally, with maskadum, then ancient Mesopotamian healers referred mainly to the musculoskeletal symptoms of brucellosis in their understanding of the disease. Other flu-like symptoms of brucellosis, especially undulant fevers and headaches, were probably not recognized the Babylonians as maskadum, and were attributed to other diseases. Interestingly, one late Babylonian text from Uruk, which lists different diseases according to their source organ (“from the heart”, “from the lung”, “from the kidney” etc.), places maskadum in the category “from the mouth”.54) In addition, two entries in hemerological manuals warn against eating certain kinds of meat on certain days, lest the person get maskadum: “(on a certain day) he must not eat pork, lest 37 ) Nicoletti 2002, 8. ) Purcell 2007. 39 ) Andriopoulos 2005. 40 ) Alp/Doganay 2008, 575; Al-Nakshabandi 2010. 41 ) Al-Nakshabandi 2010. 42 ) Heydari et al. 2005. 43 ) Raptis et al. 2005. 44 ) As they are treated today, see Ramadan 1991. 45 ) D’anastasio 2011; Ortner et al. 1981, 138–141; Ortner 2003, 215. 46 ) For possible confusion with signs of tuberculosis see Ortner et al.1981, 140; Mutolo et al. 2012. 47 ) Brothwell 1965. 38 48 ) Ortner/Frohlich 2007; Rashidi et al. 2001. ) Etxeberria 1994; Curate 2006. 50 ) D’anastasio 2009. 51 ) Mutolo et al. 2012. 52 ) Dunne et al. 2012; D’anastasio 2009. As well as Rashidi 2011 (ref. courtesy J. Eidem) – a study which I did not have the possibility to consult while writing this paper. 53 ) Thompson (1936, 190) took maskadum to be “rheumatism or similar” (see also JRAS 1937, 430; AfO 11, 339, n. 18). 54 ) SpTU 1, 43: 15. 49 433 BIBLIOTHECA ORIENTALIS LXIX N° 5-6, september-december 2012 maskadum will seize him”,55) and “he must not eat beef, lest maskadum will befall him”.56) These references may indicate that ancient Mesopotamian experts in magic and medicine suspected that maskadum could be brought on by eating meat products. VII. To sum up, I propose that: • Mesopotamian medicine knew about zoonotic diseases, diseases that affect both humans and animals. • One disease in particular, maskadum, was identified as being dependent on livestock. • The most likely candidate for this particular zoonotic disease is brucellosis which was endemic and widespread in the Levant and Mesopotamia in ancient times and still today. The question as to how ancient Mesopotamians found out that some diseases required an animal host is not easily answered, especially since modern medicine arrived at this conclusion only fairly recently. And yet, the ancient texts are clear on this. One should not overlook the fact that another zoonotic disease was well known in ancient times: rabies. Brucellosis could have been recognized as another zoonotic disease because of its transmission from sheep and cattle to humans, and almost never from human to human. It is not beyond the realm of possibility that some observer made an empirical induction that connected the immediate presence of livestock with the appearance of the disease. The appearance of similar external cysts in both humans and animals sick with brucellosis could also spark the idea that this disease ties humans to livestock. VIII. I wish to end this paper with a methodological caveat, serving as my own advocatus diaboli. Unlike material substances, geographical locations, or cosmological events – diseases are not non-changing objective entities. They are cultural constructs whose definition alters with time, reflecting shifting cultural paradigms. According to the humoral theory of Hippocrates, melancholia had its somatic basis in an excess of black bile. For Albrecht Dürer the same disease had a spiritual, religious and psychological basis. Today Melancholia is mainly metaphorical and modern medical literature refers to its characteristic set of behavior as depression and bipolar disorder. In greater parts of western society, hysteria and homosexuality are not currently considered somatic diseases, although they were until a few decades ago. And just as diseases disappear, new diseases appear. Internet Addiction Disorder (IAD) is now accepted as a medical condition which covers a variety of impulse-control problems, as Cybersex Addiction, Net Compulsion, Information Overload, and Computer Addiction.57) Before 1912, when the Swiss psychiatrist Paul Eugen Bleuler invented it, autism simply did not exist, but it is now the “hidden epidemic”.58) Briefly, the notion that a modern equivalent can be found for each and every ancient disease is naïve, if not actually wrong. 55 ) ser saÌî la ikkal maskadum iÒabbassu (5R 48 v:33, cited in CAD M/1, 368a). 56 ) ser alpi la ikkal maskadum ibassisu (Iraq 23, 90:14, cited in CAD M/1, 368a). 57 ) http://www.helpguide.org/mental/internet_cybersex_addiction.htm 58 ) http://www.msnbc.msn.com/id/6844737/ns/health-mental_health/ 434 Can one safely say that Hansen’s disease is the Biblical leprosy? Is it methodologically right to search for modern equivalents to sassa†um, rapadum, sanadum, gergissum, sagbanum, or garasum – or any other of the many diseases mentioned in Mesopotamian sources? The answer to these questions is certainly not positive – but it is not entirely negative either. Ancient physicians had their own system of classification of natural phenomena and their own way of conceptualizing somatic and mental disorders. At the same time, however, human physiognomy has not significantly changed since the Middle Bronze Age and the bacteria which surround us today also surrounded the Babylonians, to similar effect. So what ancient disorders may be identified today? Some modern diseases, like Down Syndrome or Tay-Sachs, though displaying clear pathological signs, cannot, in principle, be inferred from ancient texts since it is impossible to relate their symptoms to one single disease without knowing their etiology in genetic abnormalities – totally unknown of course in Antiquity. There is a good chance that diseases arising from a traumatic event – rabies for example, which herald an immediate or fatal response, can be identified in ancient texts. It is also possible to identify diseases whose symptoms and mode of transmission are easily discernable, like rubella (but then, would it be possible to distinguish in the ancient sources between rubella, measles, or chickenpox – all highly contagious diseases whose symptoms are similar? Hardly). Diseases which affect a specific organ – like the eye in glaucoma and in cataracts, or the mouth in cleft lip and cleft palate, have a better chance of being identified in modern terms than systemic diseases which affect the entire body with a multitude of symptoms, like diabetes. Some diseases which appear in a well-defined circumstances, like Sudden infant death syndrome (SIDS) may also be identified. Diseases typical to a region, like hyperthermia (sun heat) can be detected. Brucellosis – an endemic and common disease with acute and even fatal results, whose mode of transmission is unique but understood by pre-modern medicine – meets more than one of the above conditions, allowing us, I suggest, to identify it with the ancient maskadum. References Al-Nakshabandi, N. A. (2012). “The Spectrum of Imaging Findings of Brucellosis: A Pictorial Essay.” Canadian Association of Radiologists Journal 63(1): 5-11. Alp, E. and M. 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