History of liver anatomy: Mesopotamian liver clay models

Abstract

A common method of divination in antiquity was the inspection of sacrificed animals. The liver was the single organ which summarized the custom of predicting the future among the Babylonians, Etruscans, Greeks and Romans.1 The liver was considered the site of the soul, the vital organ and the central place of all forms of mental and emotional activity. It was not until much later that the heart began to serve this function in these civilizations. The association between divination and anatomy came from the interest of the priests in locating the souls of men and animals. Therefore, theologians of antiquity became the first students of human and comparative anatomy. The Babylonian rituals of divination can be dated to the earliest period of Babylonian history, about 3000 years before the birth of Christ. It can therefore be stated that the study of anatomy began in that period, with the detailed analysis of the sheep liver. Although Mesopotamian clay liver models are part of the history of liver anatomy, few have survived to the present. Model ME92668, held at the Middle East Department of the British Museum, dates back to 2000BC (Figs 1,​,22). Figure 1 Visceral surface of the clay model Figure 2 Diafragmatic surface of the clay model Priests recognized that although the basic configuration of organs of the same type remained, two livers never looked the same. Prediction of the future was therefore based on specific findings of the liver surface. These priests developed sheep liver clay models that were used to instruct those aspiring to the priesthood. Through the study of Babylonian writing, several terms in this model were translated and many were later incorporated to current anatomical terminology. The right and left lobes were designated as ‘right and left wings of the liver’. The gallbladder fossa was called ‘the river edge of the liver’ and the umbilical fissure, ‘River of the liver’ or ‘gate of the palace.’ The caudate lobe was appropriately identified as the ‘middle of the liver’ and its processes described as papillary and pyramidal (caudate) of the ‘finger of the liver’ and ‘fruit’ or ‘lower’, respectively. The gallbladder was given the name ‘bitter part’. The hepatic duct was known as ‘output’ and the common bile duct as ‘the junction’. As might be expected, the porta hepatis was called ‘the gate’. In addition, the subsidiary hepatic ducts were specifically named ‘branches’ and the portal triads represented as ‘holes’, ‘passages’ or ‘weapons’. Because liver surgeons use surface anatomical landmarks on the liver to help perform procedures, ancient liver clay models should be considered part of the history of liver anatomy and surgery. Furthermore, modern liver anatomical terminology2 has its roots in the nomenclature used by Babylonians.