Practice versus Theory: Medieval Materia Medica according to the Cairo Genizah

Abstract

Much information on medicine and the use of materia medica in the medieval period exists, but it is mainly based on the vast medical literature of that period both in the East and the West. Such books composed in the Arab world cover various subjects: medical theories and doctrines, the maintenance of good health (regimen sanitatis)1 or preventive medicine, different diseases and ailments, and qualities of medicinal substances,2 pharmacopoeias listing remedies and how to make them,3 and materia medica—medicinal substances, their different names and medical uses.4 Most of these books were written by qualified and learned physicians and pharmacists, are well organized, and were meant for teaching as well as references for theory and practice.5 Each author presents the optimal materia medica that should be used (to the best of his extensive knowledge) out of a very large inventory of medicinal substances from all over the Old World. Little in-depth research seems to have been conducted with the aim of exploring what may have taken place in medieval medical practice in the East.6 However, an exception lies in the recent studies of both Graeco-Roman and original Islamic records of medical case histories, namely those written by al-Rāzī (d. 930) in his Kitāb al-Ḥāwī.7 Each physician used the medical knowledge he acquired from his teachers and the medical literature of his time; however, many of the books had been written centuries earlier, often in other parts of the world, and were later translated and copied many times in different geographical locations.8 Other books were written by court physicians, commissioned by the local ruler, especially in the Ayyubid period.9 Authors of such theoretical books were never limited in choosing the materia medica: for example, Maimonides counselled the sultan al-Afḍal (d. 1225) to supply the court pharmacy with the best substances possible.10 In contrast, practitioners who had to treat people from the lower socio-economic strata had to prescribe formulas based on the substances they knew and could rely on, and which were available in the vicinity and were stocked by pharmacists. Even then, the availability of the substances was not guaranteed, and sometimes practitioners had to prescribe a substitute formula based on the less expensive and tried and trusted substances at hand.11 In reality, the practical inventory of materia medica was thus smaller than the theoretical inventory, which was based upon the books that physicians had in their possession. It was only logical that some medicines and medicinal substances were used more often than others, according to price, availability, practitioners’ choices, and even local medical trends. The main goal of this study was to learn about the practical medicinal uses of various substances by the members of the Jewish community of Cairo as a reflection of the Mediterranean Arab world as a whole. We were able to do this thanks to the Cairo Jewish community’s unique habit, based on religious law, of gathering all written documents and keeping them in the attic of their synagogue. These are the Genizah collections, whose survival is also linked to the dry climate of Old Cairo, which contributed much to the preservation of the fragments for more than a thousand years. The Genizah collections, especially the Taylor-Schechter Collection at Cambridge University Library, which include, inter alia, various medical documents, provide a golden opportunity to assess the quantities of both the practical and theoretical inventories of the Genizah people, and to display the gap between the two. Moreover, we would like to probe the commercial cycle of physicians, patients, herbalists, pharmacists, merchants, local markets, and international trade in the areas under Islamic rule and cultural/scientific influence. This being our objective, what can we learn about the practical uses of materia medica? How can we discover the main diseases that afflicted people in the communities under study? And finally, what were the most frequently prescribed medicines and medicinal substances in eastern medieval society?