The poetics of affliction in the Poem of the Righteous Sufferer allow us to gaze on the body as a layered subjectsubseque of medical knowledge.

Inscribed on clay tablets, the cuneiform Ludlul bēl nēmeqi (The Poem of the Righteous Sufferer) tells an ancient illness narrative of a sick person. A literary poem of both ancient and modern renown, the poem’s famous theme is suffering, and every element of the poem contributes. From the 42-line hymn to Marduk that opens the work to the account of Marduk’s healing that finally comes late on the third tablet, most of the rest of the poem tells the tale of Šubši-mešrê-Šakkan (Shubshi-meshre-Shakkan), the sick person at the center of the poem. That tale largely consists in poetics of affliction, broadly conceived.

As a famous work, most modern thinkers have been interested in Ludlul as a traditional wisdom poem about theodicy — that is, as a meditation on the problems of evil and human suffering. But in the last 20-25 years, ANE scholars have deciphered and studied hundreds of under-known Akkadian medical texts — warranting a second look at the kind of ancient wisdom Ludlul represents.

More recently, attention has shifted to Ludlul’s numerous affinities with the writings, practices, and knowledge of Babylonian exorcists. The exorcists are the most high profile medical scholars in the first millennium known to us. We have a lot of data, especially about their written corpus, from the curriculum described in the Exorcist Manual [KAR 44] to numerous cuneiform tablets that bear exorcist scribal signatures and postscripts. This notably circumscribed collection of writings achieved authoritative status among elite, royal medical practitioners in the first millennium. As J. Cale Johnson suggests,

In Mesopotamia, I would like to suggest, the medical discipline was thoroughly professional and indeed fully institutionalized: would-be ‘physicians’ were expected to have mastered a fixed corpus of both written and oral tradition, and the written materials were quasi-official standardized compendia. When the ruler chose his royal physicians, they would invariably have been drawn from the most accomplished members of these quasi-official institutions (J. Cale Johnson, 291).

Ludlul itself is not mentioned in the Exorcist Manual, and extant copies of Ludlul lack an exorcist scribal signature. But as Alan Lenzi argues and summarizes in his excellent new book, Ludlul’s worldview, vocabulary, rituals, and genres are reflective of exorcist knowledge:

“The experiences as described in the poem provide insight into the worldview and concerns of the ancient scholars among whom the poem’s author was counted, likely from the ranks of the exorcists. The protagonist’s experience with divine revelation sheds light on those scholars’ divinatory worldview. The anatomical and pathological vocabulary used to describe his suffering compares well to the vocabulary in exorcism texts. The ritual failures he experiences reflect the poem’s institutional agenda. And the structure and language of his first person account shows intertextual connections with incantation prayers, a genre distinctive to exorcism. The poem’s subsequent incorporation into various scribal curricula and tablet collections demonstrates the poem’s cultural stature among first-millennium scribes, who wrote a commentary on Ludlul and used the text in the creation of others.”

A work richly engaged in medical knowledge, Ludlul enjoyed an active manuscript life across the first millennium and is essential to any modern study of ancient medical literature. [A note: below, I refer to the standard Babylonian Poem of the Righteous Sufferer (Ludlul bēl nēmeqi) — I largely quote the English translations of Oshima (2014/2021) with additional consultation of the more recent Lenzi (2023).]

A Word about Ludlul’s Professional Medical Discourses

Ludlul is an original Mesopotamian blend. It combines well attested poetics about pious sufferers with the similarly well attested medical discourses of elite exorcist writings. It is worth spending a moment thinking about this admixture to better understand the literary framing of exorcist medical knowledge. Along those lines, we should consider the broader conventions engaged by the work, like the poetics of complaint, the righteous sufferer motif, and formal medical terminology. Were I to write a longer discussion here — I would turn to Lenzi’s book and to Oshima’s discussion introducing his critical text of Ludlul. And I would especially like to highlight the valuable models and approaches of modern medical anthropologists to something they have long called “the illness narrative” (orig., Kleinman). Similarly applicable to oral and written media, an illness narrative consists in people’s accounts and stories about their illness experience. We can expect to hear about a wide spectrum of topics, issues, and experiences — only some of which are engaged with medical terminology or concepts. In modern examples, most illness narratives do not include many formal medical terms or concepts in their accounts of pain, changed circumstances, shifting social support systems, etc. Indeed, these latter features of Ludlul are crucial to any “rich description” (Geertz) of Ludlul’s illness narrative. Any longer version of my attempt here to understand the “layers of the body” in Ludlul would need to consider those analyses.

Caveats aside, professional exorcism is one of the social contexts and domains of knowledge engaged by Ludlul’s illness narrative. Hence, what I provide below can be understood as contributing to that analysis.

Body Parts in Ludlul and Exorcist Medical Texts

A notable feature of Ludlul, especially when viewed through the lens of professional exorcist medicine, is the poem’s repeated attention to afflicted body parts. By my count, there are seven body scans across the three tablets of the poem which I will present and analyze below. But it is important to situate this attention to body parts in the context of exorcist medical culture. Indeed, the body acquired new significance in the first millennium as a subject of epistemological, conceptual, practical, and even scribal practices.

During the same time period that Ludlul was popular, an innovative and influential exorcist text was widely circulated and highly prized — called Sakikkū/SA.GIG (the Diagnostic Handbook). Modern study of its 40 tablets has richly illuminated the importance of the head to foot body scan. On twelve tablets towards the beginning of the work, traditional medical language, phrases, and whole lines, known from countless Akkadian and Sumerian medical texts, are presented in a new scribal format. As each sequential tablet moves down the body, observable ‘signs’ and symptoms are gathered in 100s of short–medium length entries, guiding the medical professional towards diagnosis and prognosis. In most ancient text catalogues, Sakikkū is to be followed by the 27 tablets of Alamdimmû, a physiognomic omen series which also opens with twelve tablets listing corporeal signs by body part from head to foot. In a remarkable statement about body parts, the exorcist scribe of both texts includes what John Z. Wee dubs “Esagil-kīn-apli’s Manifesto” in one of his text catalogues. The statement refers to Sakikku’s scan down the body, listing symptoms and diagnoses by body part, which he says are “held together like a new weave.” He goes on to describe Sakikku as “a compilation of (forms of) sickness and (forms of) distress” (Finkel/1988, reprinted in Wee. See also Couto-Ferreira).

Esagil-kīn-apli’s emphasis on his method of unraveling and rearranging older textual material according to new themes of organization” (Wee, Phenomena in Writing, 256) is a principle that does double duty in DH — because there is a parallel/complimentary/analogous unraveling and rearranging of symptomatic body parts in the diagnostic entries. [TO DO — Say more about that-XXX]

To return to the body parts in Ludlul, as I indicated above, there are seven body scans across the three tablets of the poem. Six of those seven scans are poetically threaded through descriptions of Šubši-mešrê-Šakkan’s affliction. The seventh body scan explicitly structures the account of Marduk’s healing. It would be hard to deny that body parts are a central feature of the work. They may even be crucial to the organizational logic of Ludlul as a literary work, given statements like “Esagil-kīn-apli’s Manifesto” that establishes a relationship between threading symptomatic body parts together and reweaving traditional texts, both of which characterized exorcist practice.

Ludlul’s seven body scans are a particularly rich source of information on the afflicted body — and they allow me to explore my topic for today: the West Asian body as a layered object of ancient medical knowledge.