Leprosy in the Epilogue to the Code of Hammurapi? • 201 



50. May Ninkarak, 



51. the daughter of Anum, 



52. who speaks 



53. my well-being 



54. in Ekur, 



65. cause to break out 

 64. on his limbs, 



55. a serious illness, 



56. an evil affliction, 



57. a grievous sore 



58. which does not heal, 



59. whose nature the doctor 



60. cannot find out, 



62. which he cannot soothe 



61. with bandages, 



63. (which) like the bite of death cannot be removed, 



66. so that until his life 



67. is extinguished, 



69. he keeps on moaning 



68. about his virility. 



The translation of the curse is straightforward and presents 

 few difficulties for the philologist. In lines 50-54 Ninkarak is 

 identified as the malefactor. Ninkarak, equated with Gula 

 and Nin-Isina, all healing goddesses,'* is the daughter of 

 Anum, the supreme god of heaven. She is the great physi- 

 cian, azugallalu rabitu,^ who confers life and revives from 

 death. ^ Her role as a divine healer makes her eminently suita- 

 ble as the perpetrator of an incurable affliction and she is 

 frequently summoned for this role in the cur.se formulae of 

 certain inscriptions.^ The curse, set forward in lines 55-69, 

 details the nature of the disease. The discussion that follows 

 includes comments on the range of meaning of the Akkadian 

 diction, together with brief literary critical notes, and the 

 signs and symptoms of leprosy that appear in the text. 



Leprosy is a chronic infection caused by Mycobacterium 

 leprae which primarily attacks the peripheral nerves and der- 

 mis.** The clinical manifestations vary widely depending 

 upon the immunological response of the host. Variations of 

 the disease range from tuberculoid leprosy to lepromatous 

 leprosy. Specific diagnostic criteria have been established for 

 these forms, although most individuals will present some- 

 where along the spectrum between the two poles. Knowledge 

 of the clinical aspects of leprosy provides data relevant to an 

 understanding of Ninkarak's curse. 



Line 55: mur^am kabtam "a serious illness," literally, "heavy 

 illness." mursii is used generally of physical ailments and 

 with a qualifier (often part of the body) for specific illnesses 

 (CAD M/2 224-227).9 



Line 56: asakkam lemnam "an evil (in the sense of "danger- 

 ous," "bad") affliction." According to CAD All 'ilS-'ill, 

 asakku is both a demon and the diseases it causes. As 

 Ninkarak is the subject, the one inflicting the ailment, it is 

 clear that another personality is not involved; but the nature 

 of the ailment (other than evil) cannot be further specified. 

 The figurative aspect of the description is underscored by the 

 fact that the term is not found in medical texts (CAD All 

 326b). It is noteworthy that Jacobsen (1946:147) interpreted 

 the Sumerian A-sag literally as "the one who smites the arm." 

 Although it has been suggested that this interpretation is 

 "probably a popular etymology" (CAD All 326b), the asso- 

 ciation with binding, laming, crippling, or paralysis is partic- 

 ularly suggestive with respect to the diagnosis of leproma- 

 tous leprosy in which, in the advanced stage, "peripheral 

 nerve disease leads to widespread neuropathic deformities" 

 (Stein et al. 1983:1423).'° A more secure reference in this 

 context is the mention of miqtu "incurable paralyzation (?)" 

 that is attributed to Gula in a similar curse. ' ' 



Without treatment "fibrosis of nerves is an inevitable end- 

 result of lepromatous leprosy . . . causing bilateral 'glove 

 and stocking' anaesthesia" (Jopling 1984:17). Edema of the 

 legs, an early symptom of lepromatous leprosy, might be 

 applicable here, but the parallel reference to miqiu would 

 suggest a more serious disease process. Furthermore, such 

 edema usually precedes the classical skin lesions (Jopling 

 1984: 19), and in this text, emphasis is clearly placed on skin 

 changes. Because of this emphasis, I am inclined to suggest 

 that the text portrays lepromatous leprosy in which the physi- 

 cal signs in the skin are likely to be noticed first and evidence 

 of damage to nerves occurs late (Jopling 1984:21).'- 



Line 57: simmam marsam "serious (grievous) sore/skin erup- 

 tion." The synonymous parallelism of these three lines poet- 

 ically emphasizes the severity of the malady." The final 

 description, simmam marsam. provides the most diagnostic 

 information. 



There are many types of simmu: The deities Sin and Enlil 

 are described as putting every kind of simmu in the land 

 (AA/r84,4 ii 9 and 1 1 cited from CAD S 277b-278a). Fbrthe 

 most part, simmu appears to be associated with the skin (also 

 eye) where it may break out (wasii), appear (basu). or heal 

 (baldtu) (GIG as simmu). It may be infectious (ARM 10 

 130:3,14), and it may be treated with medications or ban- 

 dages (CAD S 276-278). '•* 



In this passage from the epilogue Ninkarak is called upon 

 to "bring out" the simmu. cause it to "come forth," (perhaps 

 "erupt") (S of wa.)u, line 65) on the limbs of the offender. 

 Note that the skin lesions of lepromatous leprosy present a 



Zagreb Paleopathology Symp. 1988 



