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114-528: Like a number of other healing goddesses, Ninkarrak was described as a divine physician . She shared her role in the Mesopotamian pantheon with deities such as Gula , Ninisina , Nintinugga , and Bau . Dogs frequently are found associated with Ninkarrak and are interpreted as a symbol for her as well as for multiple other divine physician goddesses. While she was sometimes identified with other similar deities, certain traits were unique to her. Together with

228-484: A hieroglyphic Luwian inscription from Carchemish , which asks the goddess' dogs to devour anyone who damages the inscribed monument. The identification of Nikarawa with Ninkarrak has a long history in modern scholarship. Ignace Gelb already proposed it in his translation of the Carchemish inscription in 1938. That translation has been challenged in a recent publication by Sylvia Hutter-Braunsar, although as of 2022,

342-474: A "College of Physicians and Surgeons". All American states have an agency that is usually called the "Medical Board", although there are alternate names such as "Board of Medicine", "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts" or some other variation. After graduating from a first-professional school, physicians who wish to practice in the US usually take standardized exams, such as

456-500: A DPM degree. After residency, one to two years of fellowship programs are available in plastic surgery, foot and ankle reconstructive surgery, sports medicine, and wound care. Podiatry residencies and/ or fellowships are not accredited by the ACGME . The overall scope of podiatric practice varies from state to state and is not similar to that of physicians holding an MD or DO degree. DPM is also available at one Canadian university, namely

570-469: A Sumerian theonym, although this argument is not accepted by Sibbing-Plantholt as convincing evidence. Westenholz argued that the name was of foreign origin (much like these of Tishpak or the Dilmunite deities Inzak and Meskilak ) and the addition of the sign NIN was meant to make it resemble Sumerian theonyms, which often started with this sign (examples include Ningirsu and Ninisina ). This view

684-456: A basic medical qualification, and up to another nine years to become a specialist. In most jurisdictions, physicians (in either sense of the word) need government permission to practice. Such permission is intended to promote public safety, and often to protect government spending, as medical care is commonly subsidized by national governments. In some jurisdictions such as in Singapore , it

798-721: A beneficial effect on their health and lifestyle. According to a study of male physicians in the United States, life expectancy is slightly higher for physicians (73 years for white and 69 years for black) than lawyers or many other highly educated professionals. Causes of death which are less likely to occur in physicians than the general population include respiratory disease (including pneumonia , pneumoconioses , COPD , but excluding emphysema and other chronic airway obstruction ), alcohol-related deaths, rectosigmoid and anal cancers , and bacterial diseases. Physicians do experience exposure to occupational hazards , and there

912-495: A canal named after her. While she is overall sparsely attested in sources from the Mesopotamian heartland before the end of the Old Babylonian period, sporadic references to her are also known from the southernmost cities, notably Larsa and Uruk . However, in the latter case the only evidence is a letter with the formula "just as I do not turn my back on Ninkarrak, I do not turn my back on you", which might only reflect

1026-421: A cow, and a duck) as well as nine Egyptian -style scarabs , all of which likely were intended as an offering to Ninkarrak or a were a temple deposit. Archaeologists found a number of small bronze figurines of dogs inside the temple as well. Further excavations additionally uncovered a ceremonial axe and a scimitar with a devotional inscription mentioning Ninkarrak, both made out of bronze . Early occupation of

1140-518: A curse formula from the reign of Naram-Sin of Akkad . The Babylonian king Hammurabi invoked Ninkarrak in a curse formula on one of his steles , calling her the "goddess who promotes my cause at the Ekur temple" and imploring her to punish anyone who damages the monuments with diseases "which a physician cannot diagnose". References were often made to Ninkarrak's dogs, which were regarded as fearsome. She can be identified on seals from Sippar through

1254-558: A feeling of decreased personal achievement, and others. A study by the Agency for Healthcare Research and Quality reported that time pressure was the greatest cause of burnout; a survey from the American Medical Association reported that more than half of all respondents chose "too many bureaucratic tasks" as the leading cause of burnout. Medical education and career pathways for doctors vary considerably across

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1368-512: A medical environment around the beginning of the 21st century led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the Centers for Disease Control and Prevention , as many as 1,000 people were subject to accidental needle sticks and lacerations each day in the United States while providing medical care. Additionally, surgeons can expect to suffer hundreds of such injuries over

1482-519: A number of deities known from sources from various ancient cities located in modern Syria bear names that originally came from an unknown language predating the era of predominance of speakers of Semitic languages and Hurrian in the region. The proposed category of "Syrian substratum" deities includes a number of deities for the most part first attested in Ebla: Kura , Barama , Hadabal , Adamma , Išḫara , Aštabi , as well as Kubaba . Dagan ,

1596-442: A number of other goddesses, including Ninkarrak, but also Bau, Ninsun , Nanshe , Ninigizibara , and more. At the same time, each section appears to preserve information about the original character of the goddess mentioned in it. The one dedicated to Ninkarrak does not describe her abilities as a healer, but rather highlights her high status. In a version of the literary text Great Revolt against Narām-Sîn from Mari , Ninkarrak

1710-418: A physician, in the broad sense). In Commonwealth countries, specialist pediatricians and geriatricians are also described as specialist physicians who have sub-specialized by age of patient rather than by organ system. Around the world, the combined term "physician and surgeon" is used to describe either a general practitioner or any medical practitioner irrespective of specialty. This usage still shows

1824-476: A plastic handle with an extensible blade (like a utility knife ) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile. Alternatives to scalpels in surgical applications include electrocautery and lasers . Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey. Skulls from

1938-619: A professor of internal medicine . Hence, in the 16th century, physic meant roughly what internal medicine does now. Currently, a specialist physician in the United States may be described as an internist . Another term, hospitalist , was introduced in 1996, to describe US specialists in internal medicine who work largely or exclusively in hospitals. Such 'hospitalists' now make up about 19% of all US general internists , who are often called general physicians in Commonwealth countries. This original use, as distinct from surgeon,

2052-406: A retractable scalpel. The French used an amphismela in the 1700s. South African scientists showed that a blunt scalpel caused sharp cuts if the blade was subjected to ultrasound. Applications might be in energy-saving paper cutting. In the palmar grip , also called the "dinner knife" grip, the handle is held with the second through fourth fingers and secured along the base of the thumb, with

2166-623: A sealed deposit dated to the Old Babylonian period . The excavation made it possible to date the artifacts with relative accuracy as certain features evident in them are not attested before 1650-1640 BCE (the reign of the Fifteenth Dynasty of Egypt ). The hieroglyphs inscribed on them are regarded as "poorly executed and sometimes misunderstood", indicating Levantine, rather than Egyptian, origin, with similar ones being known from Byblos , Sidon , and Ugarit . In documents from

2280-455: A significant cultural content, including conventional western medicine. Ayurveda , Unani medicine , and homeopathy are popular types of alternative medicine. Some commentators have argued that physicians have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes. Indeed, in most western nations relatively few physicians smoke, and their professional knowledge does appear to have

2394-483: A small and extremely sharp bladed instrument used for surgery , anatomical dissection , podiatry and various handicrafts . A lancet is a double-edged scalpel. Scalpel blades are usually made of hardened and tempered steel , stainless steel , or high carbon steel ; in addition, titanium , ceramic , diamond and even obsidian knives are not uncommon. For example, when performing surgery under MRI guidance, steel blades are unusable (the blades would be drawn to

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2508-529: A specialist in surgery ). This meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons . This term is at least nine hundred years old in English: physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter Oxford English Dictionary , third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi

2622-593: A specific figure depicted, and on a single seal . Neo-Babylonian king Nebuchadnezzar II , who reigned from 605 to 562 BCE, apparently was devoted to Ninkarrak and rebuilt the Eulla. Eight copies of an inscription commemorating this event are presently known. The king states that he was tasked by Marduk with repairing it, and describes its previous state in the following terms: "the temple had not been kept in good repair, so that its ground plan had become obliterated and its outlines unrecognizable, covered with dust, (which)

2736-428: A standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as Aditya Dispomed , Aspen Surgical and Southmedic . A few companies have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges

2850-482: A three- or four-year degree, often in science) are usually four or five years in length. Hence, gaining a basic medical degree may typically take from five to eight years, depending on jurisdiction and university. Following the completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full registration is granted, typically one or two years. This may be referred to as an " internship ", as

2964-529: A variety of care and are therefore also referred to as general practitioners . Family medicine grew out of the general practitioner movement of the 1960s in response to the growing specialization in medicine that was seen as threatening to the doctor-patient relationship and continuity of care. In the United States, the American Podiatric Medical Association (APMA) defines podiatrists as physicians and surgeons who treat

3078-401: Is evidence-based medicine . Within conventional medicine, most physicians still pay heed to their ancient traditions: The critical sense and sceptical attitude of the citation of medicine from the shackles of priestcraft and of caste; secondly , the conception of medicine as an art based on accurate observation, and as a science, an integral part of the science of man and of nature; thirdly ,

3192-423: Is a health professional who practices medicine , which is concerned with promoting, maintaining or restoring health through the study , diagnosis , prognosis and treatment of disease , injury , and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities —or they may assume responsibility for

3306-467: Is a well-known aphorism that "doctors make the worst patients". Causes of death that are shown to be higher in the physician population include suicide among doctors and self-inflicted injury , drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease. Physicians are also prone to occupational burnout . This manifests as a long-term stress reaction characterized by poorer quality of care towards patients, emotional exhaustion,

3420-533: Is also accepted by Alfonso Archi, who notes that identification of the Eblaite Ninkar with a minor Sumerian goddess of daylight would make it difficult to explain why devotion to her is relatively common, for example among women of the royal house. Irene Sibbing-Plantholt also presumes Ninkarrak was worshiped in Ebla. It is possible that Ninkarrak, under the name Nikarawa ( ni-ka+ra/i-wa/i-sa 2 ), appears in

3534-482: Is also supported by Sibbing-Plantholt, who concludes that the Sumerian appearance of the name "could (...) have been carefully created by scholars who attempted to give the goddess a meaningful position within the religious framework". Westenholz proposed that Ninkarrak might have originally been one of the deities whose names belong to a proposed substratum , originally proposed by Alfonso Archi. It has been argued that

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3648-607: Is attributed to both Išḫara and Ninkarrak in their respective sections of the deity list An = Anum . In addition to Ninkarrak, multiple other healing goddesses belonged to the Mesopotamian pantheon , among them Ninisina (from Isin ), Nintinugga (from Nippur ), Gula (possibly originally from Umma ), and Bau . While they formed an interconnected network, and could be treated as equivalents or conflated, all of them were initially separate from each other. The differences among individual deities were particularly pronounced in

3762-469: Is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on the jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or more years after commencing basic medical training—five to eight years at university to obtain

3876-546: Is common for physicians to inflate their qualifications with the title "Dr" in correspondence or namecards, even if their qualifications are limited to a basic (e.g., bachelor level) degree. In other countries such as Germany , only physicians holding an academic doctorate may call themselves doctor – on the other hand, the European Research Council has decided that the German medical doctorate does not meet

3990-553: Is common in most of the world including the United Kingdom and other Commonwealth countries (such as Australia , Bangladesh , India , New Zealand , Pakistan , South Africa , Sri Lanka , and Zimbabwe ), as well as in places as diverse as Brazil , Hong Kong , Indonesia , Japan , Ireland , and Taiwan . In such places, the more general English terms doctor or medical practitioner are prevalent, describing any practitioner of medicine (whom an American would likely call

4104-428: Is considerably more than for conventional surgical blades. There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than

4218-440: Is generally accepted that the point of origin for Ninkarrak should be considered uncertain in the light of available evidence. Joan Goodnick Westenholz proposed that the name "Ninkar" attested in texts from Ebla , stand for Ninkarrak rather than the similarly named, but more obscure southern Mesopotamian goddess of daylight. Occasional shortening of Ninkarrak's name to "Ninkar" is known from Mesopotamian sources as well. This theory

4332-850: Is it so greet difference betwixe a cirugian and a physician." Henry VIII granted a charter to the London Royal College of Physicians in 1518. It was not until 1540 that he granted the Company of Barber-Surgeons (ancestor of the Royal College of Surgeons ) its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge . Newer universities would probably describe such an academic as

4446-468: Is known too. Irene Sibbing-Plantholt points out that parallels may be drawn between the roles of Ninkarrak and the rainbow goddess Manzat in treaties. In a hymn dedicated to Nanaya , this goddess compares herself to Ninkarrak. Multiple sources attest the existence of a connection between Ninkarrak and Išḫara , a goddess first attested in sources from Ebla , later worshiped by various cultures of Mesopotamia, as well as by Hurrians and Hittites. She

4560-563: Is larger than a #3. #5 handles are also common, and are round, with a patterning to ensure a non-slip grip. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle. The following table of blades is incomplete and some blades listed may work with handles not specified here. A lancet has a double-edged blade and a pointed end for making small incisions or drainage punctures. Graphical and model-making scalpels tend to have round handles, with textured grips (either knurled metal or soft plastic). The blade

4674-460: Is likely derived from NIN.IN, used to represent the name of another goddess of medicine, Ninisina , although according to Antoine Cavigneaux and Manfred Krebernik, a second and less likely possibility is that it was based on a connection with the term indub , " embankment ." The deity list An = Anum also gives Ninekisiga, possibly to be understood as "lady of the house of funerary offerings ," as an alternate name of Ninkarrak. The etymology of

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4788-399: Is mentioned in association with the coronation of Ipḫur-Kiši, although in another copy Gula appears instead, and the temple present in the same passage, Esabad, belonged to Ninisina. A degree of interchangeability between Ninkarrak and Ninisina and between Ninkarrak and Gula is attested in sources from Sippar , as attested variable writing of both toponyms and theophoric names (for example,

4902-469: Is not attested before the Old Babylonian period . The worship of Ninkarrak is well attested in sources from Sippar , although it is not certain whether she was present in the local pantheon before the Old Babylonian period or, whether she only was introduced there during the reign of Immerum, perhaps from the Diyala area. A temple dedicated to her already existed there in the Old Babylonian period. It bore

5016-457: Is often termed biomedicine by medical anthropologists . Biomedicine "formulates the human body and disease in a culturally distinctive pattern", and is a world view learnt by medical students. Within this tradition, the medical model is a term for the complete "set of procedures in which all doctors are trained", including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional physicians,

5130-404: Is otherwise unattested. A difference between them has been identified based on curse formulas, where only Ninkarrak was invoked to bring incurable diseases. In Mari, Kakka, seemingly a local healing goddess, was associated with Ninkarrak, but also with Ninshubur . This local goddess is regarded as distinct from Kakka , the sukkal of Anshar , who is known from the deity list An = Anum (where

5244-455: Is partly from their extensive training requirements, and also because of their occupation's special ethical and legal duties. The term traditionally used by physicians to describe a person seeking their help is the word patient (although one who visits a physician for a routine check-up may also be so described). This word patient is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from

5358-512: Is the result of history and is often confusing. These meanings and variations are explained below. In the United States and Canada, the term physician describes all medical practitioners holding a professional medical degree. The American Medical Association , established in 1847, as well as the American Osteopathic Association , founded in 1897, both currently use the term physician to describe members. However,

5472-533: Is the text known as, Ninisina's Journey to Nippur . In the late hymn to Ninisina, Ninkarrak appears as one of her names, described as be-let rik-si up-ša 2 -še-e , "lady of bandages (and) magical actions". Irene Sibbing-Plantholt notes that a difference between the respective characters of Ninkarrak and Ninisina is, that the former was not typically described as motherly, in contrast with the latter who was. A syncretistic hymn to Gula composed at some point between 1400 BCE and 700 BCE by Bulluṭsa-rabi equates her with

5586-407: Is usually flat and straight, allowing it to be run easily against a straightedge to produce straight cuts. There are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for wood carving , cutting leather and heavy fabric. Rising awareness of the dangers of sharps in

5700-619: The Reallexikon der Assyriologie und Vorderasiatischen Archäologie . Ninkarrak was commonly associated with both Gula and Ninisina, who were interchangeable to a degree. An association between her and the latter of these two goddesses is first attested in the Ur III period . In bilingual texts, Ninkarrak often appears in the Akkadian version, while Ninisina - in Sumerian . One example

5814-521: The Université du Québec à Trois-Rivières ; students are typically required to complete an internship in New York prior to obtaining their professional degree. The World Directory of Medical Schools does not list US or Canadian schools of podiatric medicine as medical schools and only lists US-granted MD, DO, and Canadian MD programs as medical schools for the respective regions. Many countries in

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5928-551: The American College of Physicians or the Royal College of Physicians in the United Kingdom, and such hard-won membership is itself a mark of status. While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms of traditional medicine and alternative medicine continue to espouse vitalism in various guises: "As long as life had its own secret properties, it

6042-492: The American College of Physicians , established in 1915, does not: its title uses physician in its original sense. The vast majority of physicians trained in the United States have a Doctor of Medicine degree, and use the initials M.D. A smaller number attend osteopathic medical schools and have a Doctor of Osteopathic Medicine degree and use the initials D.O. The World Directory of Medical Schools lists both MD and DO granting schools as medical schools located in

6156-525: The Latin word patiens , the present participle of the deponent verb , patior , meaning 'I am suffering', and akin to the Greek verb πάσχειν ( romanized : paschein , lit. to suffer) and its cognate noun πάθος ( pathos , suffering). Physicians in the original, narrow sense (specialist physicians or internists, see above) are commonly members or fellows of professional organizations, such as

6270-536: The Old Assyrian period Ninkarrak is the only healing goddess attested, and a reference to the property of a temple dedicated to her is known. Later Assyrian sources mentioning her include the Tākultu text, listing deities greeted by the king during a long ritual and a number of hymns from Assur , although she was not a major goddess in this area in the first millennium BCE. In the kingdom of Apum , also located in

6384-739: The USMLE for a Doctor in Medicine. Most countries have some method of officially recognizing specialist qualifications in all branches of medicine, including internal medicine. Sometimes, this aims to promote public safety by restricting the use of hazardous treatments. Other reasons for regulating specialists may include standardization of recognition for hospital employment and restriction on which practitioners are entitled to receive higher insurance payments for specialist services. The issue of medical errors , drug abuse, and other issues in physician professional behavior received significant attention across

6498-551: The "foundation" years in the UK, or as "conditional registration". Some jurisdictions, including the United States, require residencies for practice. Medical practitioners hold a medical degree specific to the university from which they graduated. This degree qualifies the medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for an internship or conditional registration. Specialty training

6612-401: The 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used. The handle of medical scalpels come in several basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle

6726-588: The Needle Stick Prevention Act, which requires hospitals to minimize the risk of pathogen transmission through needle or scalpel-related accidents. There are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, DeRoyal , Jai Surgicals, Swann Morton , and PenBlade are more intuitive to use due to their similarities to

6840-558: The Order of Physicians to practice medicine. In some countries, including the United Kingdom and Ireland, the profession largely regulates itself, with the government affirming the regulating body's authority. The best-known example of this is probably the General Medical Council of Britain. In all countries, the regulating authorities will revoke permission to practice in cases of malpractice or serious misconduct. In

6954-515: The US state-level depend upon continuing education to maintain competence. Through the utilization of the National Practitioner Data Bank , Federation of State Medical Boards ' disciplinary report, and American Medical Association Physician Profile Service, the 67 State Medical Boards continually self-report any adverse/disciplinary actions taken against a licensed physician in order that the other Medical Boards in which

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7068-609: The United States. After completion of medical school , physicians complete a residency in the specialty in which they will practice. Subspecialties require the completion of a fellowship after residency. Both MD and DO physicians participate in the National Resident Matching Program (NRMP) and attend ACGME -accredited residencies and fellowships across all medical specialties to obtain licensure. All boards of certification now require that physicians demonstrate, by examination, continuing mastery of

7182-479: The art or craft of the profession. Both the role of the physician and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are some common elements, such as medical ethics requiring that physicians show consideration, compassion, and benevolence for their patients . Around the world, the term physician refers to a specialist in internal medicine or one of its many sub-specialties (especially as opposed to

7296-447: The ceremonial name Eulla, "house of rejoicing". The temple might have owned property in the city, as indicated by a reference to a field of Ninkarrak. A year name of Buntaḫtun-ila, a local ruler of Sippar contemporary with Sumulael , states that he brought a lilissu drum to her temple. A gate and a district of the city also were named after her. She also occurs in theophoric names, such as Puzur-Ninkarrak and Ṣilli-Ninkarrak. One bearer of

7410-536: The core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years. Primary care physicians guide patients in preventing disease and detecting health problems early while they are still treatable. They are divided into two types: family medicine doctors and internal medicine doctors. Family doctors, or family physicians, are trained to care for patients of any age, while internists are trained to care for adults. Family doctors receive training in

7524-482: The course of their career. Scalpel blade injuries were among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries made up 7 percent to 8 percent of all sharps injuries in 2001. "Scalpel Safety" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury. Safety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as

7638-528: The developing world have the problem of too few physicians. In 2015, the Association of American Medical Colleges warned that the US will face a doctor shortage of as many as 90,000 by 2025. Within Western culture and over recent centuries, medicine has become increasingly based on scientific reductionism and materialism . This style of medicine is now dominant throughout the industrialized world, and

7752-515: The distribution of evidence of her cult they serve as an indication that even if partially syncretised , individual Mesopotamian goddesses of medicine had distinct origins. It is possible that Ninkarrak only developed into a healing goddess due to already being associated with disease in curse formulas, in which she appears frequently as early as in the Akkadian Empire . In the context of those texts she could be paired with Išḫara . While

7866-525: The exception of a single bilingual text, Ninkarrak was never associated with the daughter of Ninisina, Gunura . The deity list An = Anum equates the goddess NIN -ĝaʾuga (reading of the first sign uncertain, with ereš and égi both being possibilities), the wife of the god Lugalabba , with Ninkarrak, although in the Emesal Vocabulary she corresponds to Gula instead, and a text where in different copies her name alternates with Ninmug 's

7980-507: The foot, ankle, and associated structures of the leg. Podiatrists undergo training with the Doctor of Podiatric Medicine (DPM) degree. The American Medical Association (AMA), however, advocates for the definition of a physician as "an individual possessing degree of either a Doctor of Medicine or Doctor of Osteopathic Medicine ." In the US, podiatrists are required to complete three to four years of podiatry residency upon graduating with

8094-688: The former Kakka appears in Ninkarrak's section) and from the later myth, Enuma Elish . The oldest certain attestation of Ninkarrak occurs in the treaty between Naram-Sin of Akkad and an Elamite ruler . According to Daniel T. Potts, she is one of the four deities from the Sumero-Akkadian pantheon mentioned in it, the other four being Ninurta , Ilaba , Išḫara , and Manzat , while the remaining twenty six are Elamite and include, among others, Inshushinak , Humban , Hutran , Pinikir , and Simut . Her inclusion might indicate that she belonged to

8208-527: The formula "May Ninkarrak bandage you with her gentle hands". Her other area of expertise was believed to be exorcisms . As attested for the first time in texts from the Old Assyrian period , she could be invoked to ward off the demon Lamashtu , which is also attested for Ninisina and might indicate that healing goddesses were viewed as guardians of pregnant women, as well as mothers and newborns, who are demographic groups particularly endangered by this creature according to Mesopotamian beliefs. Notably Ninkarrak

8322-472: The formula also invokes Damu . Both of them are mentioned in an incantation against the demon Lamashtu from the same city as well, in this case following the pair Ea and Asalluḫi . A copy of the Adapa myth from Amarna , presumably a part of a scribal school curriculum, mentions Ninkarrak. Physician A physician , medical practitioner ( British English ), medical doctor , or simply doctor

8436-400: The harbour", in their proposal a to be understood as synonym of "prostitute". Irene Sibbing-Plantholt notes that past popularity of this proposal relied on the presumption that goddesses were connected to supposed practices of " temple prostitution ." Joan Goodnick Westenholz rejected this view due to lack of a connection to Ninkarrak's sphere of activity. Douglas Frayne suggested that the name

8550-603: The high moral ideals, expressed in that most "memorable of human documents" (Gomperz), the Hippocratic oath ; and fourthly , the conception and realization of medicine as the profession of a cultivated gentleman. In this Western tradition, physicians are considered to be members of a learned profession , and enjoy high social status , often combined with expectations of a high and stable income and job security . However, medical practitioners often work long and inflexible hours, with shifts at unsociable times. Their high status

8664-451: The husband of other medicine goddesses. They appear together on two seals from the Old Babylonian period . Anu was consistently regarded as Ninkarrak's father while her mother was Urash , which indicates that her parentage was understood to be identical to that of Ninisina , another healing goddess. The son of the latter goddess, Damu , was sometimes said to be Ninkarrak's child instead. They appear together in incantations . However, with

8778-572: The identification of Nikarawa as an alternate spelling of Ninkarrak's name is still regarded as plausible. Ninkarrak was regarded as a healing goddess and functioned as a divine physician. Evidence from deity lists such as An = Anum indicates that theologians perceived her as the default Akkadian goddess of medicine. Šurpu addresses her as the "great doctoress"( azugallatu ). Mesopotamian goddesses associated with medicine were portrayed as surgeons in literary texts, cleaning wounds and applying bandages. One healing incantation invokes Ninkarrak with

8892-489: The index finger and thumb. Surgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (sometimes just for a single, small cut). The handle is also known as a "B.P. handle", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented

9006-402: The index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts. In the pencil grip , best used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle, the scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of

9120-837: The international standards of a PhD research degree. Among the English-speaking countries, this process is known either as licensure as in the United States, or as registration in the United Kingdom , other Commonwealth countries, and Ireland . Synonyms in use elsewhere include colegiación in Spain , ishi menkyo in Japan , autorisasjon in Norway , Approbation in Germany , and άδεια εργασίας in Greece. In France , Italy and Portugal , civilian physicians must be members of

9234-574: The large English-speaking federations ( United States , Canada , Australia ), the licensing or registration of medical practitioners is done at a state or provincial level, or nationally as in New Zealand. Australian states usually have a "Medical Board", which has now been replaced by the Australian Health Practitioner Regulation Agency (AHPRA) in most states, while Canadian provinces usually have

9348-547: The latter is known only from Girsu , while Irene Sibbing-Plantholt maintains a more cautious approach, and concludes that it remains uncertain which goddess is meant in early sources such as the Abu Salabikh deity list. Other certain early attestations have been identified in incantations, inscriptions, theophoric names, and toponyms from the Old Akkadian and Ur III periods , although in deity lists, Ninkarrak's name

9462-520: The latter name was a scribe during the reign of Hammurabi of Babylon . In sources from Middle Babylonian Sippar, her name occurs only on a single kudurru (boundary stone) inscription, which states that if anyone will transgress the listed regulations, Ninkarrak will "take away his seed". Attestations from the Kassite and Middle Babylonian periods are infrequent overall: her name is only mentioned on three kudurru , never in clear association with

9576-473: The link between the deities was based on their shared origin in what is modern Syria, while Irene Sibbing-Plantholt refers more broadly to both of them as being worshiped in the "Western and Eastern fringes of Mesopotamia" and identifies that as the cause. She also proposes that since Ninkarrak was associated with dogs and Išḫara with either snakes or scorpions , they might have been perceived as complementary deities, due to their animal symbols. The name Meme

9690-557: The magnets and would also cause image artifacts ). Historically, the preferred material for surgical scalpels was silver . Scalpel blades are also offered by some manufacturers with a zirconium nitride–coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut. Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have

9804-603: The main deity of the upper Euphrates area, is regarded as a "substratum" deity in some recent studies too due to the implausibility of various proposed etymologies of his name. According to Westenholz's proposal, the area where Ninkarrak was originally worshiped "could be in the Habur river basin, one side of the triangle formed by the Habur river ending at Terqa and the other side by the Tigris river ending at Akkad ". However, it

9918-403: The north of Mesopotamia in the upper Khabur valley , she was one of the deities invoked in oath formulas in treaties, and a statue of her might have been present during related ceremonies. However, Klaas R. Veenhof argues that it cannot be said for sure whether Ninkarrak appears in documents from this kingdom as a local deity or whether she belonged instead to the pantheon of the other signatory of

10032-471: The original meaning of physician and preserves the old difference between a physician, as a practitioner of physic , and a surgeon. The term may be used by state medical boards in the United States, and by equivalent bodies in Canadian provinces, to describe any medical practitioner. In modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively. This

10146-591: The personal devotion of the author or the professional community he belonged to, and as such, does not necessarily confirm that she belonged to the local pantheon. A goddess known from texts from Ebla who might correspond to Ninkarrak, Ninkar, appears in one of the offering lists, following Resheph of Hadani and his spouse Adamma . An offering of a mace to her is also attested, although Alfonso Archi considers it to be unusual. Attestations of Ninkarrak are known from sources from both Emar and Ugarit in modern Syria and according to Joan Goodnick Westenholz, might support

10260-399: The physician holds or is applying for a medical license will be properly notified so that corrective, reciprocal action can be taken against the offending physician. In Europe, as of 2009 the health systems are governed according to various national laws, and can also vary according to regional differences similar to the United States. Scalpel A scalpel , lancet , or bistoury is

10374-530: The presence of these animals. A dog statuette was found during excavations of her temple in Terqa . However, according to Sibbing-Plantholt it is not certain whether Ninkarrak's connection with dogs necessarily reflects her role as a healing deity, and might instead reflect the liminal character of dogs in Mesopotamian beliefs. Ninkarrak was usually not paired with any male deities, although sometimes she appears in association with Pabilsag , who could also function as

10488-425: The proposals can be accepted with certainty, and she agrees with the view that the variable orthography and apparent lack of connection between the meaning of the sign "KAR" and Ninkarrak's character might indicate that her name did not originate in Sumerian. Westenholz, who also voiced support for this view, pointed out Ninkarrak's name is absent from glossaries of dialectical emesal forms, which would be expected for

10602-400: The provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice . Medical practice properly requires both a detailed knowledge of the academic disciplines , such as anatomy and physiology , underlying diseases , and their treatment, which is the science of medicine, and a decent competence in its applied practice, which is

10716-470: The same man appears as "Puzur-Ninkarrak" in one document and as "Puzur-Gula" in another). According to Barbara Böck it is possible that large-scale migration from Isin was responsible for this phenomenon. Irene Sibbing-Plantholt notes that since Ninkarrak was worshiped there for longer than the other two goddesses, who are much more sparsely attested, their names were likely treated as her " cognomina " locally. Equally close connection between Ninkarrak and Gula

10830-624: The same time and place show signs of brain surgery. Ancient Egyptians made incisions for embalming with scalpels of sharpened obsidian , a material that is still in use. The first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC. The amphismela was an anatomical knife-edged on both sides. The term comes from the Greek αμφι ( utrinque , "on both sides"), and μελιζω ( inside , "I cut"). Ancient Romans used more than 150 different surgical instruments, including scalpels. 10th century Arab-Spanish surgeon Albucasis invented

10944-575: The sphere of cult , in contrast with theology. In the Weidner list , Ninkarrak, Gula, and Ninisina occur separately from each other, which indicates they were viewed as separate from each other at the time of its composition. However, as noted by Joan Goodnick Westenholz, the study of Ninkarrak as an independent deity was nonetheless neglected in Assyriology in the past, with no dedicated studies published between 1918 and 2010, and no separate entry in

11058-507: The standard spelling of Ninkarrak's name is nin -kar-ra-ak , it is not attested before the second millennium BCE, and the orthography shows a degree of variety in cuneiform texts. Spellings from the Ur III period include nin-kar 7 and nin-kar-ra , while in texts from the Old Babylonian period , forms such as nin-kar , nin-kar-ra , nin-kar-ak , nin-ni-ka-ra-ak , nin-kar-ak , nin-ḫar-ra (from Mari), and possibly nin-ḫar-ra-ak and nin-kar 2 may be found. In Ugarit , her name

11172-414: The state pantheon of the Akkadian Empire , although it is also possible her inclusion depended instead, on the presence of her cult in areas bordering with Elam. A number of further possible early references are uncertain, as it is not clear when the writing nin-kar refers to Ninkarrak and when to the goddess of daylight, Ninkar, who was regarded as analogous to Aya . Joan Goodnick Westenholz argued that

11286-414: The structure has been dated to roughly the same period as the reigns of three kings of Terqa: However, the temple remained in use later as well. and archaeologists speculate that the temple was remodeled multiple times. The scarabs from the temple of Ninkarrak are considered a find of particular achaeoloigcal importance, as they represent the easternmost known location where such objects have been found in

11400-410: The theonym, Ninkarrak, is unknown. Early Assyriologist Knut Tallqvist understood it as a topographical name, "Lady ( Nin ) of Karrak". William W. Hallo , expanding on this proposal, suggested that it might have been derived from the name of the city of Larak , which would require a hypothetical form Lakrak to be in use at some point, eventually leading to the spelling Karrak, although this suggestion

11514-453: The theory that she originated in the northwest of Mesopotamia. In Emar, she had no temple and does not appear in theophoric names. A curse formula invokes her alongside Išḫara and implores both of them to react if anyone damages the rest of the text by destroying "his seed and his name". In Ugarit, she is mentioned in a medical formula against eye disease written in Akkadian . It is presumed to have Babylonian origin. In addition to Ninkarrak,

11628-665: The treaty. A temple of Ninkarrak was located somewhere in the proximity of the Diyala River , although its ceremonial name and precise location are unknown. It is known that she was worshiped in Shaduppum , where a festival involving offerings of sesame oil was held in her honor, in Išḫali, where she is attested in incantations, and in Nuzi , where she appears in the theophoric names (Ninkarrak-ummī and Ninkarrak-ṣillī). Ninkarrak also

11742-476: The world, in particular following a critical 2000 report which "arguably launched" the patient-safety movement. In the US, as of 2006 there were few organizations that systematically monitored performance. In the US, only the Department of Veterans Affairs randomly drug tests physicians, in contrast to drug testing practices for other professions that have a major impact on public welfare. Licensing boards at

11856-439: The world. In all developed countries, entry-level medical education programs are tertiary -level courses , undertaken at a medical school attached to a university . Depending on jurisdiction and university, entry may follow directly from secondary school or require pre-requisite undergraduate education . The former commonly takes five or six years to complete. Programs that require previous undergraduate education (typically

11970-431: Was a phonetic Akkadian rendering of Sumerian nin-gir-ak , "Lady of the scalpel " (with ak being a genitive ending), although this view is generally considered implausible. Sibbing-Plantholt proposes the derivation from nin-kara 2 , "Lady of the mourning cloth", which according to her would fit Ninkarrak's " liminality ," although in her survey of past scholarship on the matter, she ultimately concludes that none of

12084-427: Was based on finds that include a tablet with a list of offerings that starts with her name (most likely used as a point of reference by priests maintaining it), as well as seals mentioning her, and other epigraphic evidence. Among the items excavated were 6637 beads made out of a variety of materials ( agate , carnelian , gypsum , hematite , lapis lazuli , and rock crystal ), including some shaped as animals (a frog,

12198-565: Was believed to be capable of both inflicting and, if placated, curing illnesses, but she also functioned as a love goddess and was associated with the underworld and by extension with the goddess Allani . Examples of texts that mention Išḫara together with Ninkarrak include an Old Assyrian treaty, offering lists from Sippar and Mari, and especially, in curse formulas. Additionally, both appear in Naram-Sin's treaty with Elam , although not next to each other. Joan Goodnick Westenholz presumed that

12312-435: Was evaluated critically by Manfred Krebernik. Thorkild Jacobsen suggested derivation from the genitive form of the Sumerian word kar (" harbor ", " quay ") in the 1970s. This view is also accepted by a number of other researchers. Maurice Lambert in the 1950s and Piotr Steinkeller in the 1990s both suggested that Ninkarrak's name was an allusion to prostitution , arguing it can be translated roughly as "the one who 'does'

12426-612: Was no longer named together with the sanctuaries of the gods, (whose) regular offerings were cut off, they ceased to be mentioned, the cereal offerings were discontinued". He also built temples dedicated to Ninkarrak in Borsippa and Babylon . The latter, Ehursagsikilla, "house, pure mountain", survived as late as the Parthian period . A number of sources refer to it as a temple of Gula instead. Andrew R. George refers to it as belonging to "Gula-Ninkarrak" and tentatively proposes that it

12540-457: Was not described as a divine midwife , however. Ninkarrak was also invoked in curses. In this capacity, she was implored to inflict various diseases upon potential transgressors, which led Jan Assmann to refer to her as the "goddess of maladies". Irene Sibbing-Plantholt goes as far as suggesting that Ninkarrak might have been primarily a curse deity, and only acquired an association with healing as an extension of this role. She already appears in

12654-757: Was possible to have sciences and medicines based on those properties". The US National Center for Complementary and Alternative Medicine (NCCAM) classifies complementary and alternative medicine therapies into five categories or domains, including: alternative medical systems, or complete systems of therapy and practice; mind-body interventions, or techniques designed to facilitate the mind's effect on bodily functions and symptoms; biologically based systems including herbalism ; and manipulative and body-based methods such as chiropractic and massage therapy. In considering these alternate traditions that differ from biomedicine (see above), medical anthropologists emphasize that all ways of thinking about health and disease have

12768-602: Was the same house of worship as the Egalmah. Joan Goodnick Westenholz describes the temple in Borsippa in similar terms. Ninkarrak was also present in the pantheon of the middle Euphrates area. In Mari , she appears in a list of deities and offerings to them from the reign of Zimri-Lim and in therapeutic incantations. She was particularly strongly associated with nearby Terqa . A temple excavated in that city has been identified as one dedicated to Ninkarrak. The identification

12882-510: Was worshiped in locations more closely related to the cults of other healing goddesses: she had a small chapel in Nippur (where the main healing goddess was Nintinugga ) and she is also present in a small number of personal names from Nippur. It also is possible that she was worshiped at a site in Isin . A year name of one of the kings from the dynasty of Isin , Suen-magir , mentions the digging of

12996-540: Was written as ni-ka-rak x (rik 2 ) , while in an incantation from Alalakh a damaged name has been restored tentatively as ne-ni-ka-ra-ak . Two further spellings, nin-kar 2 -ra-ak(-a) 2 and nin-ka-rak appear in Neo-Babylonian sources, despite the standard spelling being generally employed consistently through the Middle Babylonian period . A logographic writing of the name, NIN.IN.DUB,

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