202 • Debra A. Chase 



"most variegated clinical spectrum" (Arnold and Fasal 

 1973:40). The skin manifestations may be "macules, pa- 

 pules, nodules or all three" (Jopling 1984:20). They are mul- 

 tiple with bilateral symmetrical distribution. The face, arms, 

 buttocks and legs are principally involved. '^ 



The malady is further qualified by the relative clause be- 

 ginning in line 58 in which the reader is told: (1) that the 

 illness does not heal (with the denotation of "calm down." 

 "be appeased") (line 58), (2) that the doctor cannot find out 

 its fundamental nature (qerbiim) (lines 59-60), and (3) that it 

 is not relieved with bandages (denotation of nc'ihu = abate- 

 ment of illness (CAD N/1 147a]; D of /id/jw "to stanch, still, 

 allay" ICADN/1 149a)) (lines 60-61). The verbs pwid^M and 

 ndhii may suggest inflammation and perhaps pain (as does 

 the adjective marsam in line 57). I would suggest that if pain 

 is implied the text associates it with the skin lesions. In this 

 context it is significant that, particularly in the reactional 

 states of leprosy, there may be a fairly rapid change in skin 

 lesions. Note especially, in a severe Type 2 reaction, which 

 occurs almost exclusively in lepromatous leprosy, the lesions 

 become vesicular or bullous and break down (erythema nec- 

 roticans) (Jopling 1984:72 and plate 19). Fever, nerve pain, 

 periosteal pain, muscle pain, and joint pain may also occur 

 (Jopling 1984:73). The neuritis associated with leprosy 

 would be a source of pain; however, in one study 81% of 

 patients gave no significant history of pain or tenderness in 

 affected nerves (Fritschi 1987:173). Again note that unlike 

 tuberculoid leprosy, where pain may be present from the 

 earliest stages of the disease, in lepromatous leprosy, nerve 

 damage usually occurs late. 



The striking simile in line 63 underscores the victim's 

 helplessness, the futility of any efforts to overcome the ail- 

 ment: kima nisik mutim Id iimassahul "like the bite of death it 

 cannot be removed.''^ The image is palpable; the simmu. 

 asakku. miirsu is apparent on the offender's arms and legs, a 

 constant reminderof impending death, specified in lines 66- 

 67: adi napistasu ihellii/ "until his life is extinguished." 



Line 68: ana etlutisu Uddammam. The verb damdmu here 

 means "to moan, mourn." There is some debate over the 

 translation oi etlutisu. An etlu is a man, particularly a young, 

 able-bodied man (CAD E 407). The form in line 68 may be 

 interpreted as the nominative plural "men" and as such, the 

 passage has been translated "he will complain to his men" 

 (CAD E 409b; see also B 73a, D 60a). Such a translation, 

 however, is ill suited to the context. There is no previous 

 reference to the afflicted one's interactions with others and 

 certainly no meaningful referent for "his men." In light of the 

 context of affliction and general physical degradation, it is 

 preferable to read etiutu. "virility';''' thus, "may he con- 

 tinually moan about his virility." Such a reading is congruent 

 with the tangible imagery of the curse and, as the final blow, 

 acutely conveys the humiliation of the progressive debilita- 

 tion. 



The image here is certainly of physical breakdown; how- 

 ever, the reference may even be more specific and refer to 

 testicular atrophy. "Testicular involvement leading to impo- 

 tence, sterility and gynecomastia is well documented in lep- 

 romatous leprosy" (Pareek and Al-Nozha 1985:49). "* "Vary- 

 ing degrees of testicular atrophy are likely to occur, 

 particularly if the disease is neglected" (Jopling 1984:31). In 

 the earlier stages the individual is sexually potent but sterile. 

 Impotence and gynecomastia are later developments. Also in 

 Type 2 reaction the testes may become swollen and tender 

 with acute epididymo-orchitis (Jopling 1984:73).''' 



Although not diagnostically conclusive, the symptoms 

 may be interpreted as representative of lepromatous leprosy. 

 Clearly, a chronic skin disease involving numerous skin 

 lesions — specifically located on the arms and legs — is de- 

 scribed. The severity of the ailment is reinforced by the re- 

 petitive formulation of lines 55-57, the fact that its etiology 

 is unknown by the medical practitioner (as well as the fact 

 that it is inflicted by the "divine" doctor), and that surface 

 treatments are of no avail (Fritschi 1987:173).-'' There is an 

 implication that the disease is progressive in the simile, line 

 63, and more concretely, in the iterative verb form (Uddam- 

 mam Gtn damdmu) "he keeps on moaning (line 69) until his 

 life is extinguished" which points to a length of time between 

 recognition of the infection and its conclusion.-' The possi- 

 bility of peripheral nerve involvement, common in advanced 

 lepromatous disease, was alluded to previously. Although 

 little diagnostic emphasis can be placed on asakku in our text, 

 it is intriguing that the malady miqtu. from the root maqdtu 

 "to fall down," is associated with the goddess's persistent 

 simmu in another text.-- Finally, the reference to the loss of 

 virility (lines 68-69) may be interpreted as the testicular 

 damage that leads to atrophy characteristic of lepromatous 

 leprosy. 



End notes 



1 . A number of summaries on medicine in ancient Mesopotamia 

 are available: Labat 1953; Oppenheini 1962; Reiner 1964; Biggs 

 1969,1978. 



2. The most current proposal of which I am aware is that of 

 Kinnier Wilson (1982:354-357) who suggests that in an Old 

 Babylonian omen text published by Kocher and Oppenheim in 

 1957, \\\epusu "white spots." and niuidu perhaps, "nodules." on the 

 aftlicted man be interpreted as dimorphous leprosy. Although I 

 cannot offer another interpretation of the skin marks, it seems to 

 push the data too far to infer leprosy without further descriptive 

 material. 



3. Codex Hammurabi Epilogus R XXVllI .^-69 (Tafel 29). 

 Tablet and line numbers arc taken from the edition of Borger( 1963). 

 The normalizations and translations of the text are my own. 



4. See Haussig 1965:78 and Wcidner and von Sodcn 1971:695. 



5. See. for example, this epithet in the parallel curses: Borger 

 1970 (Kudunm SB kol. IV 5-6). 1967:109 (IV 3); King 1912:7 ii 

 29-31. 



Zagreb Paleopathology Symp. 1988 



