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Logic in Compound Drugs According to Medieval Arabic Medical Books and the Cairo Genizah

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Logic in Compound Drugs According to Medieval Arabic Medical Books and the Cairo Genizah ORIENT, Volume 52, 2017, 59–78 Logic in Compound Drugs according to Medieval Arabic Medical Books and the Cairo Genizah Yu HOKI* This paper reveals the practice of compounding medicines from the perspective of medieval Arabic medical books and the Cairo Genizah, focusing on ophthalmology. Some researchers have argued that, due to the large number of new remedies added through experience and trade, physicians gradually became free from the classical four-quality theory. However, our study shows that a kind of logic can be discerned in compound medicines, and that this logic requires knowledge of the classical four-quality theory. The practical dimensions have been neglected because most Arabic materials do not say anything about it. Given this textual restriction, The Cairo Genizah is important for Arabic medical history, because it offers abundant information about medical practices. Among medical fragments of the Cairo Genizah, we focused on the specific genre, which we would call “notebooks.” The text found in notebooks is consisting of recipes for compound medicines. Quite often, the genizah notebooks contain original recipes that are not found in the medical books. These are thought to be clearer reflections of the actual practice in medieval Cairo. We took up treatments of conjunctivitis (ramad) and eruptions of the eyelids (jarab). Firstly, we explored several medical books, and summarized the descriptions that related to the treatments of these eye diseases. Secondly, turning to the genizah notebooks, we collected recipes for the eye medicines, listed all of the ingredients, and checked their qualities. Finally, taking the characteristics of each ingredient into consideration, we examined whether or not these recipes exhibited theoretical consistency. Through a close examination of these materials, we found that the ingredients in the notebook recipes are different from those in the medical books, although their temperaments fulfill the conditions required for particular treatments. The ophthalmologists might have recognized the required effects for certain eye diseases, and then chosen substances that met those requirements. Keywords: The Cairo Genizah, Arabic Medical History, Ophthalmology, ʿAlī ibn ʿĪsā, Dāniyāl ibn Shuʿyā I. Introduction This paper focuses on the practice of medieval Arabic ophthalmology from the perspective of medieval Arabic medical books and the Cairo Genizah. Most research on Arabic medical history has focused on the philological and theoretical subjects characteristic of Arabic literature, neglecting the practical dimensions of the field. This gap in the research record is partly due to some of the restrictions found in Arabic historical materials. Medieval physicians generally refrained from writing about individual cases, on grounds that they did not have universal validity.1 Some articles have explored the treatments prepared by physicians by examining the medieval * Ph.D. Candidate, Graduate School of Letters, Kyoto University © 2017 The Society for Near Eastern Studies in Japan Arabic medical books, most of which are case histories written by al-Rāzī (d. 925) (Meyerhof 1935, 321–356; Álvarez-Millán 2000, 293–306; Pormann 2011, 95–118). However, al-Rāzī was a rather exceptional physician, who kept detailed records of his own practice. Medical books were generally used to transmit theoretical knowledge and guidelines for treatment, not to document individual cases. Turning to other literary genres, we find two medical biographies: Ibn al-Qifṭī’s History of Sages (Tārīkh al-ḥukamāʾ) and Ibn Abī Uṣaybiʿa’s Important Reports of Physicians’ Biographies (ʿUyūn al-anbāʾ fī ṭabaqāt al-aṭibbāʾ). However, while these mention physicians’ careers, anecdota, and wroks, they do not provide a clear picture of actual treatments.2 It is therefore difficult to delve further into this subject while relying exclusively on medical books. Given these textual restrictions, we can appreciate the great value of the Cairo Genizah, which offers abundant information about medical practices. “Genizah (or bet genizah)” is a Hebrew word, meaning a repository of discarded written materials. There was a Jewish community in Fusṭāṭ (Old Cairo). The Jews in this city had several synagogues, one of which was called the Ben Ezra synagogue. In this building, one upper room was used as a genizah. The Jews of Fusṭāṭ were observing a religious directive that required used sacred books to be either deposited in a genizah or buried. This practice had been observed in many Jewish communities around the world since early times. However, in Fusṭāṭ in particular, thanks to an arid climate, a huge number of fragments, totaling up to 250,000, were preserved in good condition. Some of these were written during the Ottoman era, but the majority date from between 1000–1260 CE (Reif 2000, 1–22). The Jews of Fusṭāṭ made it their custom to place a range of different documents in the genizah; for this reason, the Cairo Genizah contains not only sacred books, but also secular documents, including letters, contracts, administrative documents, and secular science books. We have identified about 2,040 medical documents, most of which were written between 1000 and 1260 CE. The importance of the Cairo Genizah for Arabic medical history was pointed out first by Dietrich (1954) and later by Goitein (1963; 1971, 240–272). Isaacs (1994) has compiled a catalogue of medical documents in the Taylor-Schechter (T-S) Genizah Collection at the Cambridge University Library, the world’s largest collection. Recently, catalogues of the Mosseri Genizah Collection and the Rylands Genizah Collection have also been drawn up (Lev 2011; Lev and Smithuis 2013). As Isaacs did not classify these documents systematically, Lev divided them into the following five genres: books,3 notebooks (Lev 2013), prescriptions,4 lists of drugs (Lev and Amar 2007), and correspondence.5 By examining these materials, Lev and other scholars were able to elucidate various issues involving the practical dimensions of medicine. These included the trade in medicinal substances (Amar and Lev 2007), the actual use of medicinal substances (Lev 1 According to Ibn Sīnā’s Qanon of Medicine (al-Qānūn fī al-ṭibb: hereafter QṬ), medical knowledge is divided into two parts: theoretical and practical knowledge. The former is knowledge of the principles of medicine (uṣūl al-ṭibb), while the latter is knowledge of how to practice medicine (kayfiyyat mubāshara). Both have status as forms of knowledge (ʿilm). On the other hand, case histories and concrete examples of practice are not regarded as knowledge; consequently, they are excluded from the purview of medical books. Concerning the epistemological framework of medicine, see QṬ, vol. 1, 3; Gutas 2003, 145–162. 2 Indeed, there are several reports of the diagnoses and treatments offered by physicians, but we cannot know whether they are descriptions of facts or popular anecdotes, as can be seen in other books. Such anecdotes may reflect the facts, but they are not reliable enough to use as source materials for an in-depth study of medical practice. 60 ORIENT Logic in Compound Drugs and Amar 2008), and recipes for compound drugs (Lev and Chipman 2013). There is still much room for further research. Among various aspects of medical practice, this study focuses on the preparation of compound medicines (adwiya murakkaba). Levey (1973, 130) argued that, due to the large number of new remedies added through wide-ranging trade, physicians gradually became free from the classical four-quality theory. This argument may be the natural consequence of reading pharmacology books, some of which avoid any discussion of medical theory or of the interactions between pharmacological practice and theory.6 However, based on this claim, one might imagine that the actual preparation of compound medicines mainly depended on experience or custom, which did not always reflect medical theory. This veiw is highly controversial. We are still not sure to what extent medieval physicians were adhering to medical theory in some pharmacology books, and in actual practice. In this article, we suggest that, through a close examination of medieval Arabic medical books and the Cairo Genizah, researchers can discern a kind of logic in the practice of compounding medicines. This logic requires knowledge of the classical four-quality theory. It is important to observe the internal consistency of the recipes, despite their apparent diversity, because only thus can we avoid reducing the basis of compounding to mere experience and custom, and gain a profound understanding of how physicians thought about and implemented their medical practice. One of the subjects we focus on is ophthalmology, and especially the treatment of conjunctivitis (ramad) and eruptions of the eyelid (jarab). Eye diseases are presumed to have been among the most common complaints in medieval Fusṭāṭ, owing to the hot climate (Sandford-Smith 1990). A quick look at Isaacs’ catalogue soon reveals that quite a number of documents are related to ophthalmology. In order to investigate its practical aspects, we focus on the specific genre of the medical fragment—the equivalent of the modern-day notebooks. We conducted our research using the following process. Firstly, we explored several medical books, which could have been read by ophthalmologists in Fusṭāṭ between the eleventh and mid-thirteenth centuries; we summarized the descriptions they contained that related to eye diseases. Secondly, turning to the genizah notebooks, we
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