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 collected recipes for eye medicines, listed all of the ingredients, and checked their

3 Lev distinguishes books from other genres of writing using eight features, as follows: 1) the text in medical books is usually longer than the text in prescriptions, letters and notebooks; 2) in most cases, pages are nicely laid out, with the text well set out and written—in clear, fine handwriting— in a professional style: the number of lines is fixed and the margins are straight; 3) the text is written on both sides of the paper and occasionally on bi-folia; 4) all fragments that are pages of the same book are the same size; 5) the text is written in a single hand and language; 6) the text is usually written in the same color ink throughout (apart from important words or headings, which in some cases are written in other colors); 7) occasionally, a keyword appears at the bottom of the page; 8) the text is arranged in book form, with volume, chapter and section headings. See Lev 2013, 494. 4 Prescriptions often begin with basmala and contain names of ingredients, listing quantities, methods of preparation, and occasionally methods of dosage. Quite often, the genizah prescriptions contain original recipes that are not found in the medical books. Thus, these texts are thought to be primary evidence of medicinal substances actually in use. See Lev and Chipman 2013. 5 There are a few extant letters in which ophthalmologists discuss patient symptoms and propose treatments (T-S 10J16.16 and T-S NS 327.93). In other letters, writers ask recipients to send them particular medicinal substances (T-S 12.364, T-S 13J26.4 and T-S Or. 1080 J78). See Ashur and Lev 2013, 9–35; Hoki 2015, 119–133. 6 It is apparent that some pharmacology books omit medical theory. Chipman has said that Kūhīn al-Aṭṭār, a Jewish pharmacist in Mamlūk Cairo, when writing his pharmacopoeia, intended to provide remedies, but did not offer theoretical explanations. It is true that this pharmacopoeia does not contain any theoretical explanations, but her claim that he thought that medical theory was not important, as long as the drugs were effective, is doubtful. See Chipman 2007, 266–267.

Vol. LII 2017 61 qualities and effects, as set out in authoritative medieval ophthalmologic texts. Finally, taking the characteristics of each ingredient into consideration, we examined whether or not these recipes exhibited theoretical consistency.

II. The Medical Fragments of the Cairo Genizah 1. The Notebooks of the Cairo Genizah Before taking up the main subject, let us explain several features of the genizah materials. In his recent paper, Lev argued that there was intermediate form between books and prescriptions. He called this form the “notebook.”7 Medieval Arabic medical books are basically huge volumes, designed to transmit and safeguard medical knowledge. They are not suitable for daily reference or prescription-making. On the other hand, the text found in notebooks is rather brief, consisting of recipes for compound medicines and quotations from medical books. Some prescription recipes may originally have appeared in notebooks, and been copied out as separate documents. Lev distinguishes notebooks from other kinds of documents by means of several characteristic features.8 We have multiple pieces of evidence to suggest that medieval physicians recognized the notebook format. For example, Ṣāʿid ibn al-Ḥasan (d. 1072), in his Fascination of Medicine (al- Tashwīq al-ṭibbī: hereafter, TṬ) advised physicians to frequently visit hospitals and put rare cases down in registers (dustūr), which were consulted by other hospital physicians (TṬ, 22b–23a). Mūsā ibn Maymūn (Maimonides d. 1204), in his Medical Aphorisms (Fuṣūl fī al-ṭibb: hereafter, FṬ), which consists mainly of quotations and paraphrased versions of other medical texts (and occasionally of his own experience), says “I chose these aphorisms just for myself, like notes (tadhkira)” (FṬ, 4). In this passage, he admits that this work is just like a set of notes, which are not meant for public consumption, but for his private use. Another well-known example involves al-Rāzī (d. 925), who left numerous memoranda that preserve his experience and reflections; these were posthumously compiled into a work called The Comprehensive Book on Medicine (Kitāb al- ḥāwī fī al-ṭibb). There was no commonly used Arabic word for the notebook. However, in all of these cases, medieval physicians appear to have recognized and acknowledged a form of writing that we would call note-taking. Their notebooks contain quotations from other medical books (as in the case of Mūsā ibn Maymūn), and knowledge drawn from experience (as in the cases of Ṣāʿid ibn al-Ḥasan and al-Rāzī). Some notebooks were intended for private use, while others were open to many practitioners. Of the notebooks preserved in the Cairo Genizah, most are not case history documents like

7 Lev identified 61 medical notebooks: 50 in the T-S collection, 9 in the Mosseri collection and 2 in the John Rylands University Library. This was about 3% of the total. See Lev 2013, 497. 8 1) The text in notebooks is longer than the text in prescriptions, and can include a few or many recipes. 2) On average, they are smaller than medical books; in many cases, parts of the fragments are written in different handwriting, sometimes using different kinds of ink. 3) The recipes in the notebooks have names and do not usually have basmala. The absence of basmala indicates that the recipes in notebooks were not intended to teach pharmacists how to prepare formulae. 4) Occasionally the overleaf is blank, and sometimes the verso is the inverse of the recto; in other cases, the content of the verso differs completely from that of the recto, even when they both deal with medicine. 5) Sometimes the content on one side is divided into two–four columns; in one case the recipes were crossed out. 7) In most cases, the text is scrawled in a vulgar style, while the arrangement of lines is usually sporadic and unfixed, with margins of various sizes. See Lev 2013, 499–500.

62 ORIENT Logic in Compound Drugs

The Comprehensive Book on Medicine, but memoranda that include recipes for various compound medicines, some of which must have been derived from experience.9 So far, twelve notebook fragments have been found that relate to ophthalmology: nine in the T-S collection (T-S K14.32; T-S K25.83; T-S Ar.39.228; T-S Ar.44.30; T-S NS 91.6; T-S AS 147.74; T-S AS 148.28; T-S AS 153.89; T-S AS 161.23), two in the Mosseri collection (I, 111; I, 113), and one in the John Rylands University Library (B 3591-1, 2). Most of the recipes have indications of use (for example, “a collyrium that removes thick leucoma” in T-S AS 147.74), while a few recipes only include the names of medicines, such as “a lead collyrium” (shiyāf ābār) in T-S AS 148.28 and T-S AS 153.89. The eye disease that most frequently appears in the notebooks is leucoma (bayāḍ), which is mentioned eight times.10 It is followed by conjunctivitis, a burning sensation (ḥarāra), and eruptions of the eyelids, each of which is mentioned four times. It is not clear whether this number reflects the actual frequency of these diseases in medieval Fusṭāṭ; there are only a few notebooks in comparison to the total number of medical fragments, and it is therefore difficult to construct a comprehensive view.

2. Popular Ophthalmology Books in Medieval Fusṭāṭ The most popular ophthalmology book in medieval Fusṭāṭ was undoubtedly Ophthalmologists’ Note (Tadhkirat al-kaḥḥāllīn: hereafter TK) by ʿAlī ibn ʿĪsā (d. 1010). According to the three catalogues mentioned above, more than fifty fragments of the manuscript have been identified. Moreover, the main content of TK was disseminated by another book, the less well known, Questions and Answers on the Ophthalmologic Arts (Masāʾil wa-ajwiba fī ʿilm ṣināʿat al-kuḥl: hereafter MI) by Dāniyāl ibn Shuʿyā.11 MI is a textbook for beginners, which rearranges the content of TK into a question-and-answer format similar to Ḥunayn ibn Isḥāq’s Questions on Medicine (Masāʾil fī al-ṭibb).12 We have identified nineteen fragments of MI, all of which are in the T-S collection.13 According to Goitein, some genizah fragments written during the eleventh century mention the family name Ben Shuʿyā, but Dāniyāl ibn Shuʿyā’s relationship with this family is not clear (Goitein 1978, 10). An Aleppine ophthalmologist, Khalīfa ibn abī al-Maḥāsin al-Ḥalabī (d. 1266) mentions Dāniyāl ibn Shuʿyā in his introduction of The Sufficient Book on Medicine (al-Kāfī fī al-kuḥl: hereafter KK) (KK, 31). It is clear that this textbook was written between the eleventh and mid-thirteenth centuries. Although fragments of Ḥunayn ibn Isḥāq’s Ten Essays on the Eye (ʿAshr maqālāt fī al-ʿayn: hereafter ʿAM) and Questions about the Eye (Masāʾil fī al-ʿayn), and ʿAmmār Mawṣilī’s Selected

9 T-S NS 91.6 and T-S Ar.44.30 contain the phrase, “verified by experience” mujarrab( ) at the end of recipes. 10 I am writing another article on the treatment of leucoma; this topic is therefore outside the purview of this paper. 11 I consulted the text found in ms. Nuruosmaniye Kütüphanesi, 3576. 12 The question-and-answer textbooks were used in the medical school of Alexandria throughout antiquity, and then incorporated into Arabic medical education. In the Jewish community of Cairo, question-and-answer textbooks were popular pedagogical tools, not only in medical education, but also in Biblical and Halakhic education. See Pormann and Savage-Smith 2007, 68; Sklare 2007. 13 Isaacs referred to Dāniyāl ibn Shuʿyā as an author of a “commentary [on TK] in the form of questions and answers” and identified two fragments (T-S Ar.43.250 and T-S NS 305.117) as parts of MI. See Isaacs 1994, 43. I examined unidentified fragments and found some of them to be parts of MI: T-S Ar.39.344, T-S Ar.40.26, T-S Ar.40.35, T-S Ar.40.198, T-S Ar.43.173, T-S Ar.43.250, T-S Ar.44.8, T-S Ar.44.11, T-S Ar.44.31, T-S Ar.44.61, T-S Ar.44.85, T-S NS 222.38, T-S NS 222.42, T-S NS 305.117, T-S AS 176.383, T-S AS 180.76, T-S AS 181.84, T-S AS 181.186, T-S AS 181.195.

Vol. LII 2017 63 Essays on the Treatment of Eye Diseases (Kitāb al-muntakhab fī ʿilāj amrāḍ al-ʿayn) have also been identified, they are far fewer of these than of two works mentioned earlier. In addition, although there are many fragments of Ibn Sīnā’s QṬ, extant copies of the chapter on ophthalmology are scarce. Thus, TK and MI make up the largest group of Cairo Genizah ophthalmology books. We consequently regard ʿAlī ibn ʿĪsā’s teachings, transmitted through these two works, as the standard text for ophthalmologists in medieval Fusṭāṭ.

III. The Treatment of Conjunctivitis 1. Descriptions of Conjunctivitis Drawn from Ophthalmology Books In this section, we look at descriptions of conjunctivitis in TK, MI and other Arabic ophthalmology books likely to have been read by ophthalmologists in medieval Fusṭāṭ. According to TK, conjunctivitis is a hot swelling (waram) that affects the conjunctiva. It is divided into three types: the mildest type is caused by external factors (dust, smoke, oil and the sun’s heat), the second, more severe type is divided into two subcategories according to cause: the first of these is caused by one or a combination of the four residual humors (blood, phlegm, yellow bile, and black bile), sent to the conjunctiva by one of the aforementioned external causes, and the second is caused by residual humors triggered by internal causes, such as a weakness of the eye, an excess of residual humors in the brain, or various conditions of the vessels. The third and most severe type of conjunctivitis is caused by the same internal factors, but is accompanied by a swelling of the eyelid (TK, 160; MI, 56b–57a). After mentioning these pathological and diagnostic features, ʿAlī ibn ʿĪsā gives some general advice on how to expel the residual humors and how to control patients’ temperaments in everyday life, but this is not our present concern. Specific medications for eye disease are detailed below. The mildest type of conjunctivitis can be cured without any medication, as long as the external causes are removed. However, in severer cases, the residual humors can remain in the eye after the external or internal causes have been removed (TK, 160–161; MI, 56b–57a); for this reason, specific medicaments should be applied to the affected part. Medieval eye medicines were classified into several varieties, including kohl kuḥl( ), a refrigerant (barūd),14 and collyrium (shiyāf),15 in accordance with their methods of preparation. As several medieval ophthalmologists pointed out, the conspicuous feature of eye medicines is that they contained some kind of mineral. They mentioned two main reasons for this. First, all minerals have a dry quality and are therefore good for drying out purulent matter and stopping an inflow of humors ʿ( AM, 164). Second, eye medicines are expected to stay in the affected parts for a long time and must not dissolve quickly (ʿAM, 164–165). However, the eye is a sensitive organ, and minerals applied directly can damage it. For this reason, they are frequently mixed with softeners such as egg white (bayāḍ bayḍ), gum arabic (ṣamgh ʿarabī), milk (laban), sarcocolla (anzarūt) and tragacanth (kathīrāʾ) (TK, 163; ʿAM, 165–166). The key requirement for eye medicines is that they contain certain kinds of mineral and softener. However, this combination of ingredients does not appear in every recipe. Collyria 14 Kohl is a solid dry powder which is often used when there is a lot of dirt in the eye. A refrigerant is a kind of kohl that contains ingredients with a cold temperament. Kuḥl is a polysemous word, denoting two kinds of mineral: antimony (stibium, Sb) and galena (plumbum sulphidum, PbS). See Savage-Smith 1972, 98; Lev and Amar 2008, 190–192. 15 Collyria come in a salve form, used to treat various eye diseases.

64 ORIENT Logic in Compound Drugs usually contain a base of gum arabic or sarcocolla, but do not necessarily contain minerals.16 On the other hand, kohl comes in a powdery form, and does not always have a softener. As for the type of conjunctivitis caused by blood or yellow bile, it is cured with medicines that have suppressive and expulsive effects bi-mā( yaqmaʿu wa-yardaʿu).17 Medieval pharmacology books enumerated several kinds of medicinal effect (fiʿl) and explained their causes based on the temperaments (mizāj).18 The expulsive effect derives from cold; it contracts pores and prevent humors from flowing into the affected parts (QṬ, vol. 1, 234). By contrast, the word “to suppress” (yaqmaʿu) is an unusual term in the conventional classification of the medicinal effects. Presumably, the suppressive effect includes several derived from dryness, such as the astringent qābiḍ( ) and occlusive (musaddid) effects.19 Both suppressive and expulsive effects are thought to stop the inflow of humors. However,ʿ Alī ibn ʿĪsā draws attention to the danger of using cold substances, as these can delay the ripening of wounds and prevent matter from dissolving (TK, 166–167, 170). Ophthalmologists had to control the delicate balance between cold and heat: cold was required for both the expulsive and anesthetic effects, and heat was needed to ripen or dissolve matter.20 Thus, stopping the inflow of humors is primarily done using dryness, with ophthalmologists weighing the relative merits of heat or cold in particular situations. As to the type of conjunctivitis caused by phlegm, which is the cold humor, heat in particular is needed to ripen the humor (TK, 173; MI, 58a). Medieval ophthalmologists recorded several conjunctivitis remedies. We made a table of ingredients for all of the conjunctivitis medicines that are mentioned in popular ophthalmology and pharmacology books. We consulted four books: TK, QṬ, Ibn Tilmīdh’s pharmacopoeia (Aqrābādhīn: hereafter, AT),21 and Kūhīn al-ʿAṭṭār’s Manners of drugstores (Minhāj al-Dukkān: hereafter, MD).22 We collected all conjunctivitis remedies, and enumerated ingredients with their qualities and quantities.23 In this table, a cold and dry substance, for example, is written as “C, D.”24

16 See Savage-Smith 1980, 148. Gum arabic and sarcocolla were also contained in other kinds of compound medicines such as catapasm (safūf) and pill (ḥabb). See Chipman 2010, 185–279. 17 TK, 163; MI, 57b. According to MI, conjunctivitis is cured using medicines with expulsive and preventive effects bi-( mā yardaʿu wa-yamnaʿu). “Prevent (yamnaʿu)” is not a usual term in the classification; it appears to correspond with the word “suppress” in TK. 18 Temperament was divided into two types: the first and the second temperaments. The former denotes qualities of one substance, derived from a combination of the four elements; the latter is qualities obtained through a mixture of substances that have the first temperaments, such as compound medicines. Most medicinal effects are correlated with particular temperaments. See QṬ, vol. 1, 223. Concerning medicinal effects, see ʿAM, 164–170; TK, 47–54; MI, 41b–42b; QṬ, vol. 1, 232–236. 19 The astringent effect stimulates parts of organs and contracts them. The occlusive effect occludes the vessels and pores. See QṬ, vol. 1, 235. 20 TK, 172; MI, 57a–58b. The ripening and dissolving effects are derived from heat. Ḥunayn mentions that medicinal effects derived from heat are necessary to ripen the humor. Seeʿ AM, 180. 21 Ibn Tilmīdh (d. 1165) is a Nestorian Christian physician in Baghdad. See AT, 7–19. 22 MD was written in the year 1260 in Cairo, by Kūhīn al-ʿAṭṭār. This book became a standard for Cairene pharmacists. See Chipman, 2010. 23 d = dirham = 3.125 gram, m = mithqāl = 4.68 gram, u = ūqiya = 33.85 gram, dāniq = 0.52 gram (Lev and Chipman 2012, 22). As far as the Cairo Genizah is concerned, there seem to have been no agreement on a relationship between quality degrees and quantities. A few physicians, such as al-Kindī and Ibn Rushd, tried to establish methods of calculation of quality degrees, involving quantities. However, it is not likely that their methods were disseminated in medieval Fusṭāṭ, given that their extant manuscripts of the Cairo Genizah are scarce. We therefore, in this case, do not decide that qualities of compound medicines were calculated through a mere multiplication of quantities. It might be reasonable to assume that medieval physicians simply thought that a larger quantity of medicinal substances bring about stronger effects. Concerning the relationship between qualities and quantities, see Sylla 1971, 17–20.

Vol. LII 2017 65 This survey is limited to eye medicines clearly said by the writers to be effective for conjunctivitis. We have also included recipes used to treat an eye disease called redness of the eye (ḥumra), because redness of the eye is, according to Ḥunayn ibn Isḥāq, a specific type of conjunctivitis that is caused by excessively hot blood (ʿAM, 174).

Table 1: Ingredients of Conjunctivitis Remedies according to the Four Medical Books

Names of Recipes Ingredients TK bariyūmā collyrium cadmia (H, D) × 3d, burnt copper (H, D) × 3d, horn poppy (C, D) × 2d, acacia (C, D) × (shiyāf bariyūmā) 1d, opium (C, D) × 1d, rain water (C, M) ointment for conjunctivitis and lentil (C, D (TK). H, D (QṬ)), sandalwood (C2, D2), rose (C, D), camphor (C3, D3), swelling (ṭilāʾ nāfiʿ li-l- endive (C, D) ramad wa-l-waram) ointment for aloe (H, D), horn poppy (C, D), lycium (H, D), saffron (H, D), opium (C, D), acacia (C, conjunctivitis and D), Armenian clay (D), red sandalwood (C, D), nightshade water (C, D) swelling 2 ointment for hot conjunctivitis and severe pain (nāfiʿ li-l-ramad rose (C, D), peel of pomegranate (C, D), lentil (C, D (TK). H, D (QṬ)) al-ḥārr wa-l-ḍarabān al-shadīd) small powder of zinc (dharra ṣaghīra min al- zinc (C, D), watar (C, M) tūtiyā al-murabbā) white collyrium (shiyāf ceruse (C, D) × 8d, gum arabic (C, D) × 4d, opium (C, D) × 1d, tragacanth (C, D) × 1d, abyaḍ) egg white (C, D) white collyrium of ceruse (C, D) × 8d, sarcocolla (H, D) × 1d, milk (C (TK). H (QṬ)), tragacanth (C, D) × sarcocolla 1d, opium (C, D) × 1d, gum arabic (C, D) × 4d, rain water (C, M) QṬ ceruse (C, D) × 48m, cadmia (D) × 24m, Indian lycium (H, D) × 5m, sour grape (C, airy collyrium (shiyāf D) × 5m, opium (C, D) × 5m, white pepper (H, D) × 6m, balm oil (H, D) × 8m, gum hawāʾī) arabic (C, D) × 6m, cinnamon (H, D) × 16m, rain water (C, M) collyrium which is used stone of ShJTWS (D?) × 8m, frankincense (H, D) × 7m, burnt copper (H, D) × 8m, before taking a bath opium (C, D) × 8m, gum arabic (C, D) × 8m, myrrh (H, D) × 4m, wine (H, D), egg (shiyāf yustaʿmalu qabla white (C, D) al-ḥamām) aloe (H, D) × 8m, burnt copper (H, D) × 16m, opium (C, D) × 16m, gum arabic (C, D) collyrium which is used × 16m, myrrh (H, D) × 12m, saffron (H, D) × 8m, cadmia (H, D) × 4m, frankincense before taking a bath 2 (H, D) × 3m, wine (H, D), egg white (C, D) Erasistrats’ medicine burnt copper (H, D) × 2m, myrrh (H, D) × 1m, burnt vitriol (H, D) × 1m, pepper (H, (dawāʾ Arasisṭurāṭus) D) × 1/3m, saffron (H, D) × 0.5m, wine (H, D) × 9u, grape juice (C, D) × 4.5u

24 H = heat, C = cold, M = moist, D = dry. Information about the qualities is taken from TK and QṬ. In medieval Arabic pharmacology, the strength of the four qualities was usually ranked using four degrees. Both works agree on the basic temperaments of most medicinal substances, although they frequently differ on their degrees. Therefore, we wrote only the basic temperaments. MI has the abbreviated contents of TK. See TK, 347–386; MI, 84a–86b; QṬ, vol. 1, 243–470.

66 ORIENT Logic in Compound Drugs

Names of Recipes Ingredients medicine for severe horn poppy (C, D) × 48d, saffron (H, D) × 24d, opium (C, D) × 12d, FYLZHRJ (H, D) conjunctivitis (dawāʾ × 6d, henbane (C, D) × 6d, rose (C, D) × 40d, gum arabic (C, D) × 48d, rain water (C, yanfaʿu min al-ramad M), melilot oil (H, D), milk (C (TK), H (QṬ)), egg white (C, D) al-shadīd) rose collyrium (shiyāf fresh rose (C, D) × 72m, burnt cadmia (H, D) × 24m, saffron (H, D) × 6m, opium (C, wardī) or greatest D) × 3m, antimony (C, D) × 3m, copper (H, D) × 2m, spikenard (H, D) × 2m, myrrh collyrium (shiyāf akbar) (H, D) × 4m, verdigris (H, D) × 2m, gum arabic (C, D) × 24m, rain water (C, M) AT kingly remedy (al- sarcocolla (H, D), milk (C), starch (C, D), white sugar (H, M) malkāyā or al-malikī) mild red collyrium gum arabic (C, D), tragacanth (C, D), starch (C, D), ceruse (C, D), burnt copper (H, D), (shiyāf aḥmar layyin) haematite (C, D), Indian rue (H, D) ceruse (C, D) × 8, argentic slag (H, D) × 4, gum arabic (C, D) × 4, hematite (C, D) × 4, rosy remedy (wardī) opium (C, D) × 1, mace (?) × 1, burnt copper (H, D) × 1, saffron (H, D) × 1, camphor (C, D) white collyrium (shiyāf gum arabic (C, D) × 2d, tragacanth (C, D) × 2d, starch (C, D) × 2d, ceruse (C, D) × 5d, abyaḍ) opium (C, D) × 0.5d, egg white (C, D), rain water (C, M) yellow powder (dharūr sarcocolla (H, D) × 5d, horn poppy (C, D) × 2d, aloe (H, D) × 0.5d, rose seed (C, D) × aṣfar) 0.5d, saffron (H, D) × 0.5d, opium (C, D) × 4d MD Indian boxthorn (H, D) × 7d, zinc (C, D) × 7d, swallow-wort (H, D) × 2d, barberry boxthorn collyrium bark (?) × 2d, sarcocolla (H, D) × 2d, starch (C, D) × 2d, gum arabic (C, D) × 2d, (ashyāf khawlān) verdigris (H, D) × 2d, water (C, M) Indian boxthorn (H2, D2) × 7d, zinc (C, D) × 5d, barberry bark (?) × 1m, sarcocolla boxthorn collyrium 2 (H, D) × 1m, ceruse (C, D) × 1d, starch (C, D) × 1d, verdigris (H, D) × 1d, water (C, M) camphor refrigerant zinc (C, D) × 5d, camphor (C, D) (barūd kāfūrī) great aqrāmāṭīqūn horn poppy oil (C, D) × 2d, aloe (H, D) × 0.5d, rose seed (C, D) × 0.5d, saffron (H, D) medicine (ṣanʿat × 0.5d, sarcocolla (H, D) × 5d, opium (C, D) × 2 dāniq aqrāmāṭīqūn akbar) great yellow powder sarcocolla (H, D) × 5d, horn poppy (C, D) × 2d, aloe (H, D) × 0.5d, rose seed (C, D) × (dharūr aṣfar kabīr) 0.5d, saffron (H, D) × 0.5d opium (C, D) × 2dāniq Ḥatīk’s collyrium (ashyāf burnt copper (H, D) × 20d, gum arabic (C, D) × 5d, acacia (C, D) × 5d, spikenard (H, Ḥatīkī) D) × 3.5d, saffron (H, D) × 3.5d, opium (C, D) × 3.5d kingly kohl (kuḥl al- sarcocolla mixed with milk (H, D) × 10d, KShMYZJ (H, D) × 1m, starch (C, D) × 3d, malkāyā) sugar (H, M) × 3d gum arabic (C, D) × 3d, starch (C, D) × 3d, tragacanth (C, D) × 3d, ceruse (C, D) × 3d, mild red collyrium burnt copper (H, D) × 3d, haematite (C, D) × 3d, Indian spikenard (H, D) × 3d, saffron (ashyāf aḥmar layyin) (H, D) × 0.5d, pearl (C, D) × 1d, coral (C, D) × 1d, wine (H, D), fennel oil (H, D) mild yellow collyrium horn poppy (C, D) × 24d, saffron (H, D) × 12d, sarcocolla (H, D) × 12d, tragacanth (C, (ashyāf aṣfar layyin) D) × 12d, opium (C, D) × 7d, starch (C, D) × 7d, castor (H, D) × 3d new collyrium (ashyāfa gum arabic (C, D) × 1.5d, long pepper (H, D) × 1d, ginger (H, D) × 1m, boxthorn (H, jadīda) D) × 2m, zinc (C, D) × 5d, yellow myrobalan (C, D) × 2.5d powder used by Egyptian physicians (dharūr ākhar sarcocolla mixed with milk (H, D) × 10d, KShMYZJ (H, D) × 3d yastaʿmiluhu al-aṭibbāʾ bi-Miṣr)

Vol. LII 2017 67 Names of Recipes Ingredients auric slag (C, D), copper scoria (H, D), cadmia (H, D), honey (H, D), gum arabic (C, qāqiyās collyrium D) × 12d, burnt copper (H, D) × 12d, saffron (H, D) × 12d, opium (C, D) × 4m, myrrh (ashyāf al-qāqiyās) (H, D) × 4m, haematite (C, D) × 4m, Indian spikenard (H, D) × 4m, rose seed (C, D) × 4m, white pepper (H, D) × 24, wine (H, D), fennel oil (H, D) sandalwood (C, D) × 5d, rose seed (C, D) × 12d, gum arabic (C, D) × 3d, tragacanth rose collyrium (shiyāf (C, D) × 3d, Indian boxthorn (H, D) × 3d, aloe (H, D) × 3d, horn poppy (C, D) × 3d, ward) saffron (H, D) × 1d, opium (C, D) × 1d, rose water (C, M) rose (C, D) × 72m, cadmia (D) × 6m, antimony (C, D) × 6m, copper scoria (H, D) seventy-collyrium (ashyāf × 6m, burnt copper (H, D) × 6m, saffron (H2, D1) × 6m, myrrh (H2, D1) × 6m, sabʿīnī) spikenard (H1, D2) × 6m, haematite (C, D) × 6m, ceruse (C, D) × 6m, gum arabic (C, D) × 24m small yellow powder sarcocolla mixed with milk (H, D) × 10d, aloe (H, D) × 2d, horn poppy (C, D) × 2d (dharūr aṣfar ṣaghīr) small yellow powder 2 sarcocolla (H, D) × 6d, horn poppy (C, D) × 3d, aloe (H, D) × 2d acacia (C, D) × 10d, gum arabic (C, D) × 10d, burnt copper (H, D) × 10d, copper spikenard collyrium scoria (H, D) × 10d, Indian spikenard (H, D) × 3d, saffron (H, D) × 1.5d, opium (C, D) (shiyāf sunbul) × 1d, rain water (C, M) zinc (C, D) × 10d, saffron (H, D) × 10d, ginger (H, D) × 5d, yellow myrobalan (C, verjuice refrigerant D) × 5d, long pepper (H, D) × 2d, swallow-wort (H, D) × 2d, Indian salt (H, D) × 1d, (barūd al-ḥiṣrim) verjuice (C, D) white collyrium (shiyāf ceruse (C, D) × 8d, gum arabic (C, D) × 4d, tragacanth (C, D) × 4d, starch (C, D) × 4d, abyaḍ) sarcocolla (H, D) × 2d, opium (C, D) × 1d, , egg white (C, D) white powder (dharūr sarcocolla (H, D) × 5d, sal ammoniac (H, D) × 2d, white sugar (H, M) × 1d, gum abyaḍ) arabic (C, D) × 1d

Each physician draws and chooses from a diverse range of medicinal substances; nevertheless, there are typical features, as shown in this table. First, the recipes include several types of mineral (antimony, Armenian clay, burnt copper, cadmia, ceruse, hematite, salt, vitriol, and zinc) and softener (egg white, gum arabic, milk, myrrh, sarcocolla, starch, and tragacanth). No one mineral is mentioned very frequently, but the ratio of minerals to other ingredients is much higher than in compound medicines designed to treat diseases other than eye diseases.25 Second, dryness is a common feature of most medicinal substances. These recipes seem intended to stop the inflow of humors mainly through the use of dryness. By contrast, the four books differ in balance between heat and cold. Heat predominates over cold in QṬ and MD, whereas the reverse is the case in TK and AT. We can assume that heat and cold were used for different purposes. As an example of cold eye medicines, we would like to focus on an eye medicine recommended by several physicians: white collyrium (shiyāf abyaḍ).26 White collyrium is one of the most popular collyria, found in most medieval Arabic ophthalmology and pharmacology books. Although all of the books cite slightly different recipes, they agree that its main ingredients are ceruse, gum arabic, and tragacanth, and that it is an effective treatment for hot conjunctivitis.27 According to ʿAlī ibn 25 The percentage of minerals in these medicines is 16%. Minerals are occasionally used for skin diseases, but syrups and pills rarely contain them. See the materia medica in AT and Chipman 2010. 26 There is evidence that white collyrium was used in medieval Fusṭāṭ. In one of the letters of the Cairo Genizah (T-S 10J16.16), two ophthalmologists are discussing treatments for a patient who suffers with conjunctivitis, a corneal ulcer (qarḥ), and an eruption of the eyelid. One ophthalmologist suggests that white collyrium should be used to treat the conjunctivitis, but he does not include a recipe (Ashur and Lev 2013, 9–35; Hoki 2015, 119–133). 27 There are various versions of a white collyrium. See AT, 128; AQ, 239–240.

68 ORIENT Logic in Compound Drugs

ʿĪsā, it has an anesthetic effect; Ibn Sīnā says that it has a drying and expulsive effect (TK, 167; QṬ, vol. 2, 118, 121). Thus, the qualities of white collyrium incline toward cold and dry. Most of the collyria in TK and AT are intended to treat hot conjunctivitis: accordingly their recipes incline toward cold. We can also find several medicines whose temperaments incline toward heat, such as Erasistrats’ medicine and two versions of collyrium which is used before taking a bath in QṬ, boxthorn collyrium, small yellow powder, and verjuice refrigerant in MD. These writers say that these medicines are used to treat old conjunctivitis (ramad ʿatīq) or remnants of conjunctivitis (baqāyā al-ramad) (QṬ, vol. 3, 415, 416; MD, 135, 144). According to MI, new conjunctivitis needs to be cured using medicines with expulsive and preventive effects. By contrast, old one should be cured using medicines with a dissolving effect, which derives from heat (MI, 57b–57a). This is probably because the inflow of residual humors has stopped at the later phase, and humors that stay in the eye need to be dissolved. QṬ and MD contain many conjunctivitis remedies of this type; therefore, the temperaments of the recipes in these books incline to heat.

2. The Ingredients Used in Conjunctivitis Remedies according to the Cairo Genizah Turning now to the Cairo Genizah, we found five recipes (four for conjunctivitis and one for redness of the eye) to be relevant to our survey: one in T-S K25.83, one in T-S NS 91.6, and three in I, 113 (Mosseri). The following are translations of the relevant sections.

Recipe I (T-S K25.83, recto; Isaacs 1994, 5) 8. Kohl for hotness and a burning sensation 9. of the eye, conjunctivitis, redness and ulcer. Take 10. […] and saffron (zaʿfarān) of the same weight (wazn wazn), two of haematite (shādanj),28 and eight each of ceruse (asbīdāj) 11. and gum arabic. 12. Knead with water, make them into tiny tablets, dry them in 13. […] and take them to […] 14. […] Apply it. It is effective if God wills. Temperaments: saffron (H, D), haematite (C, D), ceruse (C, D), gum arabic (C, D), water (C, M)

Recipe II (T-S NS 91.6, verso; Niessen and Lev 2008, 141) 9. Prescription for conjunctivitis, pannus, other hidden [diseases], and strengthening visual light. 10. For any type of eye pain, conjunctivitis, redness, or damage when the blood vessels of the eye contract: Indian zinc (tūtiyā Hindī), yellow myrobalan (halīlaj aṣfar) 11. 5, maḥmūdī zinc (tūtiyā maḥmūdī),29 three pieces of zinc. Grind each piece. Dissolve two bunches of turmeric (ʿurūq)

28 There is no mention of the unit. 29 Unidentified.

Vol. LII 2017 69 12. in pure water, sprinkle it over the [ground] medicine in the vessel. Heat them until […] Then, apply it to 13. the eye. There is a cause verified by experience. Temperaments: Indian zinc (C, D), yellow myrobalan (C, D), maḥmūdī zinc (C, D), turmeric (H, D)

Recipe III (I, 113, recto; Lev 2011: 126) 16. Red refrigerant for tears (damʿa) and redness: Take one ūqiya of haematite 17. 1 part (juzʾ) each of clove and saffron. Grind them into fine pieces, sieve them with silk 18. and apply it. It will remove tears and redness. Effective. Temperaments: haematite (C, D), clove (H, D), saffron (H, D)

Recipe IV (I, 113, recto; Lev 2011: 126) 22. Kohl for severe conjunctivitis: Take 3 dirham of gum arabic, 2 dirham of sarcocolla, 23. 5 dirham each of saffron, castor (jūndbīdastar) and water, and 1 dirham of opium (afyūn). Grind them, sieve them 24. Crush […] with water, 4 dirham of each of them. 2 dirham each of pearl (lūlū) and sepiolite (zabad baḥr) 25. 5 dirham of white sugar (sukkar ṭabarzad) and 1 dirham of opium. Grind them, sieve them, crush them and make them soft. Then apply it. Temperaments: gum arabic (C, D), sarcocolla (H, D), saffron (H, D), castor (H, D), water (C, M), opium (C, D), pearl (C, D), sepiolite (H, D), white sugar (H, D)

Recipe V (I, 113, recto; Lev 2011: 126) 43. Indian collyrium for conjunctivitis, eruptions of eyelids and punnus: Take […] mithqāl each of yellow myrobalans, 44. belleric myrobalans (balaylaj), emblic myrobalans (amlaj), Indian zinc, and […] Temperaments: yellow myrobalan (C, D), belleric myrobalan (C, D), emblic myrobalan (H, D), Indian zinc (C, D)

The remarkable point is that these recipes clearly show originality when it comes to ingredients and their indications for uses. No three notebooks have content that is identical to the edited texts of medical books.30 To be sure, there must have been unknown versions of manuscripts and unknown ophthalmology books; however, it is not reasonable to assume that all of the recipes necessarily come from medical books. In a few notebook recipes (for example, T-S NS 91.6 and T-S Ar.44.30), the phrase, “verified by experience” mujarrab( ) is added at the end of a recipe. This word suggests that those particular recipes were not derived from books, but from someone’s experience. Although some recipes did originate from books, there is also a possibility that the

30 In addition to the aforementioned books, we also consulted the following: al-Kindī’s Aqrābādhīn (hereafter, KA), al- Samarqandī’s Aqrābādhīn al-Qalānisī (hereafter, AQ), and Ibn abī al-Bayān’s Dustūr al-bīmāristānī (Sbath 1932), and found that these books do not contain the identical content.

70 ORIENT Logic in Compound Drugs writers did not copy them out verbatim. They could have changed unfamiliar ingredients to favorite ones.31 Consequently, the recipes in the notebooks can be regarded as clearer reflections of actual practice in medieval Fusṭāṭ than the recipes in medical books. Although the recipes in the notebooks contain unique substances, they also include the typical features of conjunctivitis remedies. Firstly, dryness is a common characteristic of most ingredients. These five recipes contain more cold substances than hot ones, but some recipes incline to heat; accordingly, we can assume that heat and cold were used for different purposes. Recipes I, II, and V are presumably intended to alleviate pain or a hot sensation because they contain more cold ingredients than hot ones. By contrast, recipe III and IV incline toward heat; accordingly they seem intended to ripen the humors. Secondly, the two main ingredients: minerals (ceruse, haematite, Indian zinc, maḥmūdī zinc, sepiolite) and softeners (gum arabic and sarcocolla) are frequently mentioned. However, an examination of each recipe reveals that each composition is different. Recipe I and IV contain both of the main ingredients, while Recipes II, III, and V have minerals, but do not contain any softeners (at least in the legible portion of the text). It is not strange that recipe III does not contain softeners because it is a kind of kohl. We see these recipes as adhering to the conventional format for conjunctivitis remedies. This research shows that the preference for certain substances in the Cairo Genizah differs from that found in the medical books. Four substances are mentioned exclusively in the notebooks: clove, turmeric, and two kinds of myrobalan. Myrobalan is particularly remarkable because it appears five times in the notebooks, whereas only MD mentions it no more than two times. Medical uses of the myrobalan fruit had been popular in India and China since early times, whereas ancient Greek physicians never mentioned it (Levey 1966, 342). Myrobalan is the most frequently mentioned medicinal substance in the genizah prescriptions and drug lists (Amar and Lev 2007, 528). It was used not only for eye medicines, but also in electuaries (as in a recipe found in Or. 1081 J39) and syrups (T-S 13J6.14) used to treat various other ailments. Various kinds of myrobalan are mentioned in the Cairo Genizah, for example, black myrobalan (halīlaj aswad),32 Indian myrobalan (halīlaj hindī),33 and Chebulic myrobalan (halīlaj kābulī) (T-S Ar.43.338). Most of the species are native to tropical Africa and Asia (Zohary 1978, 459), and the medical markets of Fusṭāṭ depended on imports of most species, obtained through Indian Ocean trade.34 Cloves were also cultivated in Tropical Asia and imported through Indian Ocean trade (Goitein 1971, 153–154; Zohary 1978, 455). Another remarkable case is saffron, the fourth most frequently mentioned substance in the Cairo Genizah (Amar and Lev 2007, 528). According to the genizah notebooks as well as to the Arabic medical books, saffron was used for various medical purposes.35 It was cultivated in al- Andalus, Damascus, Isfahan and Afghanistan, and exported to Cairo and other cities (Amar and 31 According to Chipman’s study on MD, Kūhīn al-Aṭṭār attributes several recipes to earlier physicians, but he did not copy them verbatim. See Chipman, 2010, 18–46. 32 One prescription for an electuary contains black myrobalan (T-S Ar.43.338). 33 One prescription for an electuary contains Indian myrobalan (T-S Ar.30.65). 34 For example, in a court document (ENA 4020), two brothers claim to share the trade in myrobalans with India. See Goitein 1971, 288. 35 One prescription for an electuary contains saffron (T-S Ar.34.305).

Vol. LII 2017 71 Lev 2007, 530–531). The micro phenomenon of locally prepared eye medicines was premised on wide-area trade.

IV. Treatment for Eruptions of the Eyelids 1. Descriptions of the Disease according to the Ophthalmology Books Next, let’s consider the medical books’ descriptions of eruptions of the eyelids. According to TK and MI, eruptions are caused by salty moisture, exposure to sunlight or smoke, and unsuitable treatments for conjunctivitis. They are usually classified into four degrees of acuteness, but the treatment plan is basically same for all degrees. First, the residual humors should be expelled using phlebotomy and purgative medicines; then collyria with irritant properties (ḥidda) should be applied. When treating very mild eruptions, mildly irritating medicines such as red collyrium (shiyāf aḥmar) should be applied. Severer forms of the condition can be cured by using more irritating medicines, such as collyrium made of verdigris (zinjār) (TK, 76–77; MI, 45b–47a). “Irritation” (ḥidda) is an unusual term in the conventional classification of the medicinal effects. This effect presumably includes several effects derived from heat or dryness, because TK and MI recommend verdigris and wine, whose temperaments are hot and dry. According to Ibn Sīnā, the required treatment for eruptions involves medicines with a scraping effect (muḥakkik), which is derived from heat. Scraping medicines were thought to draw hot humors to the pores and irritate the skin (QṬ, vol. 1, 234). In modern medicine, this kind of effect would probably be called a counter irritant. On the other hand, Ḥunayn ibn Isḥāq says that eruptions can be removed using medicines with an astringent effect, which is based on dryness (ʿAM, 188). Thus, medicines for eruptions of the eyelids can be both hot and dry. The following table lists the ingredients used in remedies for eruptions which are mentioned in medical books.

Table 2: Ingredients of Remedies for Eruptions of the Eyelids according to the Four Medical Books

Names of Recipes Ingredients TK pepper (H, D) × 5d, Chinese ginger (H, D) × 5d, yellow myrobalan (C, D) × 5d, black basilic remedy myrobalan (C, D) × 5d, aloe (H, D) × 1d, sepiolite (H, D) × 6d, red lead (H, D) × 5d, (bāsilīqūn) cassia (H, D) × 4d, camphor (C, D) × 4d, sal ammoniac (H, D) × 1d dust-color powder zinc (C, D) × 10d, haematite (C, D) × 10d, white sugar (H, M) × 5d (dharūr aghbar) green collyrium (shiyāf verdigris (H, D) × 3d, cadmia (H, D) × 2d, ammoniacum (H, D) × 2d, gum arabic (C, akhḍar) D) × 2d, ceruse (C, D) × 2d, rue (H, D) yellow powder (dharūr sarcocolla (H, D) × 2d, horn poppy (C, D) × 1d aṣfar) QṬ Apollonius’ collyrium burnt haematite (C, D) × 32m, burnt copper (H, D) × 16m, stone of ShJTWS (D?) × (shiyāf Abūlūniyūs) 32m, verdigris (H, D) × 16m, opium (C, D) × 3m cadmia (H, D) × 6m, burnt yellow vitriol (H, D) × 4m, gum arabic (C, D) × 16m, rain Apollonius’ collyrium 2 watar (C, M)

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Names of Recipes Ingredients Erasistratus’ medicine See Table 1 fāqīṭūn kohl (kuḥl cadmia (H, D) × 8m, burnt copper (H, D) × 8m, antimony (C, D) × 8m fāqīṭūn) yellow collyrium (shiyāf cadmia (H, D) × 80m, yellow vitriol (H, D) × 40m, rain water (C, M) aṣfar) AT argentic slag (H, D) × 10d, sepiolite (H, D) × 10d, burnt copper (H, D) × 5d, ceruse basilic remedy (C, D) × 2d, salt (H, D) × 2d, sal ammoniac (H, D) × 2d, germander (H, D) × 2d, black pepper (H, D) × 2d, long pepper (H, D) × 2d, clove (H, D) × 1d, usnea (D) × 1d gum arabic (C, D) × 4d, auric slag (H, D) × 4d, ceruse (C, D) × 4d, verdigris (H, D) × dīzaj collyrium (ashyāf 2d, myrrh (H, D) × 0.25d, opium (C, D) × 0.25d, castor (H, D) × 0.25d, lycium (H, D) al-dīzaj) × 0.25d, galbanum (H, D) × 0.25d, leek oil (H, D), rue oil (H,D), wine (H, D) dust-color powder Kirman zinc (C, D) × 1, burnt caltrop(H, D) × 1, sugar (H, M) × 0.25 (aghbar) green collyrium (ashyāf ceruse (C, D) × 2d, ammoniacum (H, D) × 2d, gum arabic (C, D) × 2d, starch (C, D) × akhḍar) 1d, verdigris(H, D) × 2d, rue oil (H, D) burnt copper (H, D) × 8d, copper scoria (H, D) × 8d, aloe (H, D) × 4d, salt (H, D) × 2d, Indian refrigerant (barūd Armenian borax (H, D) × 2d, pepper (H, D) × 2d, ginger (H, D) × 2d, vitriol (H, D) × hindī) 2d, glass-slag (H, D) × 1d, white mustard (H, D) × 1d, frankincense (H, D) × 1d, wine vinegar (H, D?) haematite (C, D) × 12d, gum arabic (C, D) × 10d, opium (C, D) × 6d, aloe (H, D) × 6d, irritant red collyrium verdigris (H, D) × 6d, myrrh (H, D) × 0.5d, saffron (H, D) × 0.5d, dragon’s blood (H, (ashyāf aḥmar ḥādd) D) × 2d, water (C, M) powder effective for itch and trachoma (dharūr aloe (H, D), lycium (H, D), yellow myrobalan (C, D), horn poppy (C, D) yanfaʿu al-ḥikka wa-l- jarab) MD antimony (C, D) × 10d, zinc (C, D) × 10d, copper scoria (H, D) × 10d, haematite (C, ashen kohl (kuḥl ramādī) D) × 10d, swallow-wort (H, D) × 3d argentic slag (H, D) × 10d, sepiolite (H, D) × 10d, burnt copper (H, D) × 2.5d, ceruse basilic kohl (kuḥl al- (C, D) × 2.5d, salt (H, D) × 2.5d, sal ammoniac (H, D) × 2.5d, germander (H, D) × bāsilīqūn) 2.5d, black pepper (H, D) × 2.5d, long pepper (H, D) × 2.5d, clove (H, D) × 1d, usnea (D) × 1d boxthorn collyrium See Table 1 boxthorn collyrium 2 See Table 1 Dhikrī’s collyrium argentic slag (H, D) × 3.5d, gum arabic (C, D) × 3.5d, ceruse (C, D) × 3.5d, verdigris (ashyāf Dhikrī) or green (H, D) × 5d, rue oil (H, D), ammoniacum (H, D) × 2d collyrium (khaḍrāʾ) Dhikrī’s [green] verdigris (H, D) × 5d, ceruse (C, D) × 2d, ammoniacum (H, D) × 3d, rue oil (H, D) collyrium 2 Dhikrī’s [green] verdigris (H, D) × 3d, cadmia (H, D) × 2d, gum arabic (C, D) × 2d, ceruse (C, D) × 3d, collyrium 3 tragacanth (C, D) × 2.5d, camphor (C, D) × 0.5d, rue (H, D) gum arabic (C, D) × 6d, argentic slag (H, D) × 6d, auric slag (H, D) × 6d, ceruse (C, dīzaj collyrium (ashyāf D) × 6d, verdigris (H, D) × 6d, burnt copper (H, D) × 6d, haematite (C, D) × 6d, Indian al-dīzaj) spikenard (H, D) × 6d, myrrh (H, D) × 2d, opium (C, D) × 2d, castor (H, D) × 2d, boxthorn (H, D) × 2d, rue oil (H, D), galbanum (H, D) × 1m

Vol. LII 2017 73 Names of Recipes Ingredients dust-color kohl (kuḥl haematite (C, D) × 11d, zinc (C, D) × 11d, white sugar (H, M) × 5d, pearl (C, D) aghbar) haematite (C, D) × 4d, burnt copper (H, D) × 4d, argentic slag (H, D) × 4d, Indian salt (H, D) × 4d, Armenian borax (H, D) × 4d, verdigris (H, D) × 4d, white pepper (H, D) × eye-brightening kohl 3d, black pepper (H, D) × 3d, sepiolite (H, D) × 3d, long pepper (H, D) × 4.5d, aloe (H, (kuḥl al-rawshanāyā) D) × 4.5d, spikenard (H, D) × 4.5d, clove (H, D) × 4.5d, ginger (H, D) × 2d, belleric myrobalan (C, D) × 2d, saffron (H, D) × 1d, starch (C, D) × 1d green collyrium (ashyāf ceruse (C, D) × 3d, gum arabic (C, D) × 3d, ammoniacum (H, D) × 3d, starch (C, D) × akhḍar) 3d, verdigris (H, D) × 3d, rue oil (H, D) Ḥatīk’s collyrium See Table 1 burnt copper (H, D) × 8d, copper scoria (H, D) × 8d, aloe (H, D) × 4d, salt (H, D) × 2d, Indian refrigerant (barūd Armenian borax (H, D) × 2d, pepper (H, D) × 2d, ginger (H, D) × 2d, vitriol (H, D) × hindī) 2d, glass-slag (H, D) × 1d, white mustard (H, D) × 1d, wine vinegar (H, D?) haematite (C, D) × 12d, gum arabic (C, D) × 10d, verdigris (H, D) × 5d, yellow vitriol irritant red collyrium (H, D) × 5d, opium (C, D) × 2d, viper’s blood (?) × 2d, aloe (H, D) × 2d, myrrh (H, D) (ashyāf aḥmar ḥādd) × 1d, saffron (H, D) × 1d wine (H, D) mild red collyrium See Table 1 new collyrium See Table 1 qāqiyās collyrium See Table 1 haematite (C, D) × 12d, gum arabic (C, D) × 6d, verdigris (H, D) × 6d, burnt copper ṭarkhmāṭīqān collyrium (H, D) × 4d, yellow vitriol (H, D) × 4d, opium (C, D) × 2d, saffron (H, D) × 7d, wine (ashyāf ṭarkhmāṭīqān) (H, D) auric slag (H, D) × 4d, black pepper (H, D) × 4d, opium (C, D) × 4d, borax (H, D) × ṭarkhmāṭīqān collyrium 2 4d, indigo (?) × 2d, arsenic (H, D) × 2d, gum arabic (C, D) × 8d, horn poppy (C, D) × 8d, sarcocolla (H, D) × 1d, salt (H, D) × 1d, wine (H, D), fennel oil (H, D) haematite (C, D) × 12d, gum arabic (C, D) × 20d, yellow vitriol (H, D) × 4d, verdigris ṭarkhmāṭīqān collyrium 3 (H, D) × 4d, burnt copper (H, D) × 4d, opium (C, D) × 1d, saffron (H, D) × 1d, fennel oil (H, D), wine (H, D) verjuice refrigerant See Table 1

Although there is a diverse range of medicinal substances to choose from, these recipes also show the typical features of medicines for eruptions. First, most of the ingredients are dry, and the ratio of heat to cold is higher than in conjunctivitis remedies. Hot ingredients are mentioned about twice as frequently as cold ingredients in each of the books. This is because eruptions are treated mainly through the use of irritant medicines of a hot or dry temperament, while remedies for conjunctivitis use heat and cold for different purposes. Second, the two main categories of ingredients are frequently included. These are minerals (antimony, argentic slag, Armenian borax, auric slag, burnt copper, cadmia, ceruse, copper scoria, glass-slag, haematite, iron scoria, red lead, salt, verdigris, vitriol, yellow vitriol, and zinc) and softeners (ammoniacum, gum arabic, myrrh, sarcocolla, starch, and tragacanth).

2. The Ingredients Used in Eruption Remedies according to the Cairo Genizah Four recipes are identified as remedies for eruptions of the eyelids: one in the T-S collection (T-S AS 147.74; Isaacs 1994, 79) and three in the Mosseri collection (I, 113). The following are translations of the relevant parts.

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Recipe I (T-S AS 147.74, verso) 10. Red collyrium effective 11. for pannus and eruptions of the eyelids. Its recipe: Take 12. 1 dirham of haematite, 1 dirham of burnt galingale (wājj muḥarraq), 13. 1 dirham of burnt copper (rāsukht), half a [dirham] of myrrh (murr), half a [dirham] of saffron, 14. and half a [dirham] of pepper (fulful). Make them into a collyrium and apply it. Temperaments: haematite (C, D), burnt galingale (H, D), burnt copper (H, D), myrrh (H, D), saffron (H, D), pepper (H, D)

Recipe II (I, 113, recto) 18. Kohl for leucoma and eruptions of the eyelids 19. Take 2 mithqāl of burnt copper, 1 mithqāl each of vitriol (zāj), ceruse, myrrh, saffron, and oak gall (ʿafṣ) 20. Grind them, […] copper. Grind and sieve them, and crush them with […] 21. and honey (ʿasal). Then, mix them with the collyrium. Dry it. Temperaments: burnt copper (H, D), vitriol (H, D), ceruse (C, D), myrrh (H, D), saffron (H, D), oak gall (C, D), honey (H, D)

Recipe III (I, 113, recto) 39. Refrigerant kohl made of antimony 40. for eruptions of the eyelids and leucoma: Take […] dirham of haematite, 2 mithqāl of Armenian borax, 2 mithqāl of rice (abrīnj), 41. 2 mithqāl of verdigris, 1 mithqāl of aloe, 1 mithqāl of white pepper, 1 mithqāl of haematite. 42. Grind all of the haematite and the other substances, sieve them and crush them, 43. and apply them. Temperaments: haematite (C, D), Armenian borax (H, D), rice (H, D), verdigris (H, D), aloe (H, D), white pepper (H, D)

Recipe IV (I, 113, recto: the same recipe as recipe VI above) Temperaments: yellow myrobalan (C, D), belleric myrobalan (C, D), emblic myrobalan (H, D), Indian zinc (C, D)

These recipes have unique combinations of ingredients and descriptions of their efficacies, which cannot be found in the medical books.36 Nevertheless, most of the recipes in the notebooks fulfill the two main conditions for any remedy used to treat eruptions. First, most of the ingredients are hot and dry. Compared with the conjunctivitis remedies found in the notebooks, these medicines are composed of many more hot ingredients than cold ones; moreover, they contain several extremely hot ingredients (verdigris, vitriol and white pepper). As for recipe IV, the final

36 These notebook recipes are not identical with texts of KA, AQ, and Sbath 1932.

Vol. LII 2017 75 piece of text is missing, but the original version could have inclined toward cold. It is likely to be a conjunctivitis remedy, but not an eruption remedy. Second, all recipes include several minerals (Armenian borax, burnt copper, haematite, Indian zinc, verdigris, and vitriol), and recipes I and II contain softeners (myrrh and honey). Recipe III is called “kohl,” and it is therefore not surprising that it does not contain a softener. According to Ibn Sīnā, the scraping effect is reinforced by thorns or solidity of a substance (QṬ, vol. 1, 234). Thus, by leaving out the softeners, recipe III was particularly designed to irritate the skin. It might not be statistically valid to judge this group of recipes based on only four examples, but we were limited to these materials. As far as the four recipes are concerned, excepting recipe IV, all fulfill the theoretically required conditions.

V. Conclusion In this study, we have shown that a certain logic can be found in the recipes of the genizah notebooks, as well as of the four medical books. It would be reasonable to assume that medieval ophthalmologists shared a definite body of knowledge concerning medicinal substances. Below, we would like to reconstruct their way of thinking, as it was applied to medical practice. Before we discuss this subject, let us grasp the point of a pharmacological argument about a kind of medicinal effect that cannot be explained in terms of the four qualities, i.e., the specific properties (khāṣṣa). We have focused only on medicinal effects based on the four qualities, but many medieval physicians discussed the causes of those irregular effects. According to Ibn Sīnā, the cause of a specific property can be attributed to its specific form (ṣūra nawʿiyya), which is an immaterial factor, superadded to a suitable mixture of matter. This immaterial cause creates the specific property, while the mixture of matter is only preparation for receiving the form. He insists that a certain proportion of the mixture cannot be changed to the specific form. On the other hand, Ibn Rushd, who criticized Ibn Sīnā’s theory of the specific properties, claimed that interaction of the four qualities was sufficient to explain all unpredictable effects. Accordingly, he did not admit the existence of immaterial formal causality (Hoki 2014). Although the theories of these two thinkers differ, they agree that there are some effects that cannot be explained by the mere combination of qualities. Such effects are, so to speak, emergent qualities. As far as the Cairo Genizah notebooks are concerned, there is no way of judging whether the ophthalmologists compounded eye medicines in order to bring out a specific property. It is more likely that they regarded each ingredient as an example of a combination of the four qualities, and therefore substitutable. Our study shows that the ingredients in the notebooks are different from those in the medical books, although their temperaments do fulfill the conditions required for particular treatments. The ophthalmologists might have recognized the required medicinal effects for certain eye diseases, and then chosen medicinal substances that met those requirements. Admittedly, these data do not rule out the possibility that some ophthalmologists believed that compound medicines have specific properties, and thus cannot be changed, as Ibn Sīnā said. However, it is more likely that the ophthalmologists modified their recipes, taking the temperaments into consideration. If so, the ophthalmologists must have had three types of knowledge: knowledge of the

76 ORIENT Logic in Compound Drugs treatment for certain eye diseases, knowledge of the temperament of each medicinal substance, and knowledge of basic structures of compound drugs, namely, the combinations of minerals and softeners. At first sight, the ophthalmologists seem to have invented original recipes at will, but actually, these three types of knowledge limited their choices to some extent. Earlier researchers have focused more on practicality and experiential knowledge in Arabic pharmacology, however, those kinds of knowledge could not have changed as a result of practice or experience. This conclusion is also true for the four Arabic medical books. In addition, thousands of medicinal substances are mentioned in Arabic pharmacological and botanical books. However, according to the prescriptions of the Cairo Genizah, only about 120 were in common use (Lev and Amar, 2008), and so the range of choices possible in practice was more limited than the range available in theory. The argument that physicians became free from theory because of the huge number of available medicinal substances should therefore be reconsidered. According to the Cairo Genizah, ophthalmologists seem to have replaced medicinal substances and invented original recipes within the limitations of medical theory and the availability of medicinal substances. The demands of their role must have made it necessary to preserve knowledge. Ophthalmologists had to consult documents, especially, to establish the temperament of each medicinal substance. The extant genizah fragments suggest that their main sources were TK and MI. The final chapters of these two works are devoted to a materia medica section, in which many medicinal substances are listed and their qualities and effects described. Notebooks and drug lists also can preserve this kind of knowledge. By examining these materials, we will be able to clarify how the ophthalmologists recognized individual substances.

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Vol. LII 2017 77 Goitein, S. D. 1983: The Yemenites, Jerusalem. Gutas, D. 2003: “Medical Theory and Scientific Method in the Age of Avicenna,” in D. C. Reisman and A. H. al-Rahim (eds.), Before and after Avicenna: Proceedings of the First Conference of the Avicenna Study Group, Leiden, 145–162. KK = Khalīfa ibn abī al-Maḥāsin al-Ḥalabī, al-Kāfī fī al-kuḥl, ed. by M. Ẓ. al-Wafāʾī and M. R. Qalʿajī, Bayrūt, 1995. Hoki, Y. 2014: “Ibn Rushd’s Criticism of the Theory of the Inherence of the Specific Property (khāṣṣa) in Medicine,” Bulletin of the Society for Near Eastern Studies in Japan 57/1, 33–48 (in Japanese with an English summary). Hoki, Y. 2015: “Treatment of Eye diseases in Cairo Genizah,” Journal of History of Science Japan 54, 119–133 (in Japanese with an English summary). Isaacs, H. D. (with the assistance of C. F. Baker) 1994: Medical and Para-medical Manuscripts in the Cambridge Genizah Collections, Cambridge. Lev, E. 2011: “A Catalogue of the Medical and Para-medical Manuscripts in the Mosseri Genizah Collection, together with Several Unpublished Examples (X. 37; I. 124.2),” Journal of Jewish Studies 62, 121–145. Lev, E. 2013: “Mediators between Theoretical and Practical Medieval Knowledge: Medical Notebooks from the Cairo Genizah and their Significance,” Medical History 57, 487–515. Lev, E., and E. Amar 2007: “Practice versus Theory: Medieval Materia Medica according to the Cairo Genizah,” Medical History 51, 507–526. Lev, E., and Z. Amar 2008: Practical Materia Medica of the Medieval Eastern Mediterranean according to the Cairo Genizah Leiden, 2008. Lev, E., and L. Chipman 2013: Medical Prescriptions in the Cambridge Genizah Collections: Practical Medicine and Pharmacology in Medieval Egypt, Leiden. Lev, E., and R. Smithuis 2013: “A Preliminary Catalogue of the Medical and Para-medical Manuscripts in the Rylands Genizah Collection: Together with the Partial Edition of Two Medical Fragments (B 3239 and A 589),” in R. Smithuis and P. S. Alexander (eds.), From Cairo to Manchester: Studies in the Rylands Genizah Fragments, Oxford, 157–196. Levey, M. 1973: Early Arabic Pharmacology: An Introduction Based on Ancient and Medieval Sources, Leiden. Meyerhof, M. 1935: “Thirty-three Clinical Observations by Rhazes (c. 900 AD),” Isis 23, 321–356. MI = Dāniyāl ibn Shuʿyā, Masāʾil wa-ajwiba fī ʿilm ṣināʿat al-kuḥl, MS. Nuruosmaniye Kütüphanesi, 3576. MD = Kūhīn al-ʿAṭṭār, Minhāj al-dukkān wa-dustūr al-aʿyān fī aʿmāl wa-tarākīb al-adwiya al-nāfiʿa li-l-abdān, ed. by Ḥ. ʿĀṣī, Bayrūt, 1992. Niessen, F., and E. Lev 2008: “Addenda to Isaacs’s Catalogue of the Medical and Para-medical Manuscripts in the Cambridge Genizah Collection together with the Edition of Two Medical Documents T-S12.33 and T-S NS 297.56,” Hebrew Union College Annual 77, 131–165. Pormann, P. E. 2011: “Medical Methodology and Hospital Practice: The Case of Fourth-/Tenth-century Baghdad” in P. Adamson (ed.), In the Age of al-Fārābī: Arabic Philosophy in the Fourth-Tenth Century London, 95–118. Pormann, P. E., and E. Savage-Smith 2007: Medieval Islamic Medicine, Edinburgh. QṬ = Ibn Sīnā, al-Qānūn fī al-ṭibb, vols. 1–3, Bayrūt, n.d. Reif, S. C. 2000: A Jewish Archive from Old Cairo: The History of Cambridge University’s Genizah Collection, Richmond. Sandford-Smith, J. 1990: Eye Diseases in Hot Climates, Oxford. Savage-Smith, E. 1972: “Drug Therapy in Trachoma and Its Sequelae as Presented by Ibn al-Nafīs,” Pharmacy in History 14/3, 95–110. Savage-Smith, E. 1980: “Ibn al-Nafīs’s Perfected Book on Ophthalmology and His Treatment of Trachoma and Its Sequelae,” Journal for the History of Arabic Science 4, 147–204. Sbath, P. 1932: “Le formulaire des hôpitaux d’Ibn abil Bayan, médecin du bimaristan annacery au Caire au XIIIe siècle,” Bullétin de l’Institut d’Égypte 15, 9–78. Sklare, D. 2007: “Scriptural Questions: Early Texts in Judaeo-Arabic,” in M. Bar-Asher et al. (eds.), A Word Fitly Spoken: Studies in Mediaeval Exegesis of the Hebrew Bible and the Qurʾan: Presented to Haggai Ben-Shammai, Jerusalem, 205–231 (in Hebrew). Sylla, E. 1971: “Medieval Quantifications of Qualities: The ‘Merton School’,”Archive for History of Exact Science 8, 9–39. TK = ʿAlī ibn ʿĪsā, Tadhkirat al-kaḥḥāllīn ed. by M. Q. al-Sharafī, Ḥaydarʾābād, 1964. TṬ = Ṣāʿid ibn al-Ḥasan, Das Buch At-Tašwīq aṭ-Ṭibbī des Ṣāʿid ibn al-Ḥasan: Ein arabisches Adab-Werk über die Bildung des Arztes, ed. by O. Spies, Bonn, 1968. Zohary, M. 1978: The Plant World: Morphology, Taxonomy, Evolution, Biology, Jerusalem.

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