Ibn al-Jazzar= Zad al-Musafir (Diseases and Their Treatment-Book review

Ibn al-Jazzar was a tenth-century Arab physician and member of a distinguished medical family in Qayrawan, the mediaeval capital of Tunisia. The present volume, one of seven written by Ibn al-Jazzar, provides a concise presentation of sex-related ailments, providing an illuminating snapshot of the development of medical science in the tenth century; it also provides insights for anyone interested in the view of sex and sexuality in Arab society in that period. By the early eleventh century, Zad al-Musafir had already been translated into Greek, and in the twelve century, into Latin and Hebrew. It was among the standard texts for medical instruction at Salerno, Montpellier, Bologne, Paris, and Oxford. Furthermore, Zad reflects the long-received wisdom from such classical figures of medicine and philosophy as Hypocrites, Aristotle, Rufus, Galen, Paul of Aegina, and Polemen. Zad comprises an introduction and twenty chapters, divided into sections dealing with the sexual ailments of men (chapters 1-8) and women (chs. 9-18), as well as sciatica (ch. 19), and gout (ch. 20). Translator-editor Gerrit Bos approached his task by means of philological comparison, collating the available extant manuscripts of Zad in Berlin, Dresden, Oxford’s Boodlian Huntington, Teheran-Malik, Copenhagen, the Wellcome Institute, and the Tarim al-Ahqaf Library. Ibn al-Jazzar’s approach to the aetiology of disease was based on Galen’s humoural theory, according to which the four basic fluids of blood, phlegm, black bile, and yellow bile determine, by their relative proportions in the body, determine a person’s physical and mental constitution. He furthermore embraced Galen’s allopathic principle of treatment, contraria contrariis curantur (opposites are cured by opposites). Galen also is the source of some of the specific remedies Ibn al-Jazzar recommends. Another of Ibn al-Jazzar’s important sources is Paul of Aegina, a seventh-century compiler of medical texts widely used in the Islamic world, where he was known as al-qawabili, The Obstetrician. In matters relating to pharmacology, Ibn al-Jazzar relies on several sources. When discussing simple drugs, he relies mainly on the first-century physician Dioscurides; when discussing compound drugs, he relies mainly on various Arab authorities. The few magical prescriptions Ibn al-Jazzar recommends appear to be based on the work Firdaws al-Hikma, by the ninth-century Arab physician al-Tabari. In the Introduction, Ibn al-Jazzar explains animal lust and the nature of sexual power. His source is Galen, whose ideas, in turn, may have been an adaptation of Aristotle’s views on sexuality, as something natural and necessary for the survival of species. In the original Arabic, Ibn al-Jazzar uses the term of Creator, which mean God created procreative organs. Chapter One deals with impotence and its treatment. Ibn al-Jazzar invokes Polemen, positing the importance of both the mind and the senses in engendering sexual 1 excitement. The author also describes the anatomy and physiology of the sexual organs. The chapter is mainly based on the writings of Galen. Ibn al-Jazzar goes on to discuss impotence, explaining erections as the product of two elements: the first, which man has in common with lower animals, is natural desire; the second, unique to man, is imagination. It is worth mentioning that imagination features prominently in Latin writings on coitus. According to Ibn al-Jazzar, the brain is the source of sperm cells. This idea, originally propounded by Plato, and espoused by the Arab medical writers al-Kindi and al- Tabari, was one of the three theories concerning the source of sperm widely accepted among the classical Greek thinkers. The second theory, propounded in the pseudo- Maimonidaic mediaeval treatise Ma’amar Razei ha-Hayyim ha-Miniyyim (Tract on the Secrets of Sexual Life), was that sperm originates in all parts of the body. The third theory was that sperm, like blood, is merely a residual product derived from food. In mediaeval Arabic medical literature, this last idea was propounded in K. al- Dhakhira, ascribed to Thabit ibn Qurra. Ibn al-Jazzar believed that the seat of lust is the liver, a view widely reflected in mediaeval Arab medical writings, including those of al-Tabari, al-Kindi, and ibn Sina. Ibn al-Jazzar describes the function of the testicles, contending that they impart power to the whole body; it is this power that causes males to be masculine and females feminine. Implicit in this view, originally propounded by Galen and widespread in the Middle Ages, is the assumption that women also have testicles, albeit smaller and less perfectly formed than men, namely the ovaries. The final part of Chapter One is devoted to aphrodisiacs. Ibn al-Jazzar recommends various foods and remedies, simple and compound, to increase the amount of one’s sperm, and to enhance one’s potency and sexual desire. Most of Ibn al-Jazzar’s recommendations feature in medical writings from ancient Greece through the Arab authorities mentioned above. Enhanced production of sperm is attributed to fresh meat, especially brain, egg yolk, pine nuts, and pepper. Chapter Two deals with priapism, a condition involving a swelling of the penis and constant erection. Ibn al-Jazzar’s views here derive from Galen and the early Byzantine medical writers. He prefaces his prescriptions for priapism with a reference to Galen’s dictum, contraria contrariis curantur, in this case, the avoidance of any stimulus to sexual desire. Thus, Ibn al-Jazzar recommends cold remedies and the avoidance of anything that induces flatulence. One such remedy is the chaste-tree’s seed, on which, according to Galen, the women of Athens would sleep during chief festivals, to be rid of sexual desire. Ibn al-Jazzar concludes with an explicit warning against hot food and drink. Chapter Three deals with the condition involving a constant, involuntary flow of sperm, referred to as ‘gonorrhoea’ (sayalan) in the ancient medical literature. Ibn al- Jazzar, like Galen, ascribes this affliction to either of two causes: a weakness in the seminal vesicles, in which case there is no erection; or a malady of the sperm themselves, in which case an erection can exist. 2 The treatment prescribed is a compound of cold [?] and various oils rubbed on the penis and loins. Chapter Four deals with nocturnal emissions (ihtilam), which Ibn al-Jazzar believes could have any of the following causes: 1. a surplus of sperm, which is common among young adults; 2. a feeling of closeness during sleep with the woman one loves; 3. imaginary intercourse during sleep with the woman one fancies. The treatments Ibn al-Jazzar recommends are: • eating cold foods; • rubbing cooling remedies on the thighs and penis; • rubbing the penis with camphor and rose oil; • sleeping on one’s side on a cold bed. Chapter Five deals with ulcers and tumours of the penis, and their treatment. In accordance with the humoural theory he subscribes to throughout his treatise, Ibn al- Jazzar contends that ulcers and tumours are caused by an excess of humours flowing to the penis from all other areas of the body. His prescribed remedies for moist ulcers and ulcers unaccompanied by tumours, are similar to those prescribed by Galen. Also, like Galen, Ibn al-Jazzar recommends plasters for tumours, pustules, and swelling of the penis. The subject of tumours is carried over into the Chapter Six, where testicular neoplasms and their treatment are discussed. Here too, in following the humoural analysis of disease, hot and cold tumours are believed to be caused by excessive amounts of hot and cold humours, respectively, reaching the testicles. Ibn al-Jazzar prescribes various dressings and plasters, some of them similar to those recommended by Galen. Chapter Seven treats various other afflictions of the testicles: vesicular ulcers, itching, open sores, and fissures. His therapeutic recommendations are derived from Galen, Oribasius, Paul of Aegina, and al-Tabari. In Chapter Eight, scrotal hernias are dealt with. Here, Ibn al-Jazzar prescribes treatments he developed himself, as well as treatments prescribed by Dioscurides and Sabur ibn-Sahl, a Christian physician from Gondeshapur who compiled a compendium of drugs widely used by apothecaries. Ibn al-Jazzar commences his discussion of women’s diseases in Chapter Nine, with amenorrhoea, the absence of the menses. Adhering to the Aristotelian-Galenic analysis of menstruation, Ibn al-Jazzar contends that women are naturally cold and moist.; as they lack the natural body heat to burn excess humours, they expel them by means of menstruation. Ibn al-Jazzar believes that this lack of natural body heat means that women are less perfect then men. The notion of the biological inferiority of women was widely prevalent in mediaeval medical literature, and often reinforced by data concerning putative feminine psychological and ethical inferiority. It is worth 3 noting, however, that the medical writer Soranus took issue with the idea of a supposed feminine constitutional inferiority deriving from moisture and cold. All in all, Ibn al-Jazzar’s proposed aetiology reflects a highly formalised Galenic, humoural analysis. Yet Ibn al-Jazzar also offers additional possible causes of amenorrhoea: psychological stress, anxiety, continuous sorrow, anger, and fear. Ibn al-Jazzar believes the symptoms of amenorrhoea are: lack of appetite, nausea, and a craving for harmful things to eat, including charcoal and dirt. Here too, he follows adheres to Galen. Chapter Ten deals with excessive bleeding during menstruation (hypermenorrhoea). Ibn al-Jazzar’s highly schematic exposition of the ailment’s aetiology in Galenic and humoural. Among the main causes of hypermenorrhoea, according to this approach, is low quality blood, which takes on different hues, depending on whether it is sharp, bitter, or heavy with mucous. Ibn al-Jazzar recommends a variety of decoctions, electuaries, pills, pessaries, and powders. Chapter Eleven is devoted to hysterical suffocation. Its symptoms are: lack of appetite, coldness, fainting spells, weak pulse, and occasionally convulsive contractions. Two categories of women are at particular risk: widows and virgins. Among the recommended treatments are: • message • sniffing various ingredients with a disagreeable odour • sternutatories • fumigation • cupping glasses • suffumigation • fragrant drugs. Chapter Twelve focuses on uteral tumours. The humoural aetiology Ibn al-Jazzar posits ascribes neoplasms of the uterus to an excess of either yellow bile or coarse black bile. Possible non-humoural causes Ibn al-Jazzar mentions are: coarse winds, injuries, and amenorrhoea. The treatments Ibn al-Jazzar recommends include: • bleeding the patient from the basilic or median cubital vein • decoctions • plasters • poultices • suppositories • compresses and sitz baths with boiled nard (for hot tumours). 4 As authorities for some of his prescribed treatments, Ibn al-Jazzar invokes Galen, Dioscurides, and Paul of Aegina. Chapter Thirteen deals with uteral ulcers. Ibn al-Jazzar’s causes and symptoms are both based on the writings of Paul of Aegina. The treatments Ibn al-Jazzar proposes include: • drugs, both simple and compound • decoctions • suppositories • special diet • sitz baths. Ibn al-Jazzar concludes with instructions for the making of two types of suppositories recommended by Dioscurides. One type, consisting of meal made of fenugreek seed mixed with goose fat, was used to treat hardness and obstruction of the uterus. The second type, made of fig soup mixed with egg yolk, was used to treat ulcers and amenorrhoea. The central topic of Chapter Fourteen is uteral prolapse. Ibn al-Jazzar believes that prolapse of the uterus results from an excess of moisture, which causes a relaxation of the uteral ligaments; continuous sitting on cold surfaces; bathing in cold water; and a difficult childbirth. Among Ibn al-Jazzar’s prescribed treatments are: • sleeping on one’s back, with knees together and the lower legs apart • linen bandages • ointments • sitz baths • rubbing of cow dung on vagina • fumigation with foetid odours • rubbing oils on vagina. Some of these treatments are based on the writings of Soranus, Paul of Aegina, and Dioscurides. In Chapter Fifteen, Ibn al-Jazzar proposes a healthy regimen for pregnant women. Such a regimen includes the application of ointments and poultices to strengthen the umbilical chord. For the final stages of pregnancy, bathing, ointments, and relaxing foods are what a woman needs. Ibn al-Jazzar recommends that when a pregnant woman craves for what is injurious, such as clay or charcoal, she should be given roasted chickpeas, while fragrant poultices are applied to her stomach. Several of Ibn al-Jazzar’s recommendations are derived from Galen and Soranus. 5 Chapter Sixteen deals with the subject of difficult childbirth. The causes according to Ibn al-Jazzar are similar to those enumerated in the pseudo-Galenic Definitiones Medicae, and include: • worry • narrowness of the uteral passage • obesity • very young pregnancies. The means Ibn al-Jazzar recommends for dealing with difficult childbirth include: • bathing in water containing fenugreek, marshmallow’s seeds, linseed and peeled barley. • rubbing of thighs and abdomen with sesame oil and jasmine oil. • massage of sides and waist, and rub with oil. • drugs such as oxymel (sakanjabin). • wine with pounded mint • sneezing. Ibn al-Jazzar also recommends the magic means of hanging a dry stone or cyclamen on the woman’s thighs. Chapter Seventeen covers the topics of contraception and abortion. Ibn al-Jazzar’s attitude towards these matters may be described as neutral: he offers lists of both fertility drugs and magic contraceptives. Such neutrality is in conformity with Islam; the use of contraceptives and abortifacients as means of birth control has been practised in Islamic society, and is sanctioned by Islamic law. That this had, in fact, been the attitude of Islam is born out in discussions of contraception and abortion in various categories of literature in Islamic cultures: medical, legal, erotic, and popular. It is reasonable to infer that Ibn al-Jazzar’s prescription of magical contraceptives reflects a social reality wherein such contraceptives were the only ones the poor could afford; ‘normal’, particularly compound, drugs were very expensive. Ibn al-Jazzar includes a warning that contraceptives and abortifacients should only be used when medical justification exists: when childbirth posed a danger to a woman’s life, or in the case of a diseased or malfunctioning uterus. There are the two main justifications for Arab physicians to use birth control means. Ibn al-Jazzar provides a list of contraceptives and abortifacients. These include, for women, putting alum in the vagina, to prevent insemination or to expel the foetus. For men, he recommends a contraceptive juice of mint, savin, cyclamen, lupine, birth wort, cinnamon, and castoreum. Chapter Eighteen deals with the extraction of the placenta from the uterus after childbirth. The means Ibn al-Jazzar recommends include: • sneezing induced by sniffing soapwort, with the mouth and nostrils shut 6 • drinking any of several compound drugs, among them water with marshmallow ashes, which serve as emetics • licking saffron. Chapter Nineteen covers an affliction he terms ‘sciatica’, which affects the hip joint. According to Ibn al-Jazzar, sciatica is caused by a viscous, mucous-like humour that settles in the socket of the hip-bone. The symptoms are, amongst the elderly, pain and heaviness of the hip, or mainly amongst young men, severe pain; a constant, heavy throbbing; a burning sensation; and inflammation. Both the causes and symptoms Ibn al-Jazzar mentions are apparently derived from Paul of Aegina. Among the treatments Ibn al-Jazzar recommends for sciatica caused by hot humours are: bleeding, purgatives, enemas, cold food, and cold ointments. The patient is further admonished to adhere to a special regimen of moderate eating and drinking, and abstention from sex. Gout, another affliction of the joints, is the subject of Chapter Twenty. It is a heavy hurting pain occuring to the feet. Ibn al-Jazzar, as Paul of Aegina before him, bases his aetiology of the disease on bad humours and weakness of the joints. Ibn al-Jazzar believes such weakness is caused by a restful, easy life, and immoderate eating and drinking. When such an unhealthy regimen is accompanied by frequent sexual intercourse, the inevitable result is gout; frequent intercourse is harmful both to the nerves, which have been corrupted already by easy living, and to the joints, which become hot and attract superfluous humours. According to Ibn al-Jazzar, three types of people do not suffer from gout: • eunuchs • young boys • women. Neither eunuchs nor young boys engage in sexual intercourse, and while women do engage in it, it is less physically taxing on them, and they furthermore expel bodily superfluities during menstruation. The treatments recommended by Ibn al-Jazzar include: • evacuation of the harmful superfluities, both hot and cold, with various herbs and pills extract from such as colchicum, sagepenum, myrobalan, pepper, asafetida, leek, and oil of jasmine. • eating foods that are quickly digested • physical exercises. 7 Comments: This work done by translated and edited by Gerrit Bos is a useful reference for institutions, colleges and individuals that focus on the history of Islamic medicine. It is a unique masterpiece, with rich references and different languages. I have however ....But this work, lack of certain things: 1. Page 39, line 3 (Ibn al-Jazzar text): ashrata, instead of ‘ashrata . 2. More details and explanation about Cimolian earth (pages: 256, 257, 286). 3. Page 286, written Cimolean earth. 4. Page 224, line 1383 the Arabic text: al-harif, instead of al-kharif. 5. Latin names of plants (at least an index ).