Ibn al-Jazzar on medicine for the poor and destitute.

• Author: Bos, Gerrit

INTRODUCTION

ABU JA FAR AHMAD B. ABI KHALID B. AL-JAZZAR, a physician who was born and who practiced in Qayrawan in the tenth century, is the author of a number of medical works, the most famous of which is his Zad almusafir wa-qut al-hadir (Provisions for the Traveller and the Nourishment of the Settled).(1) This influential medical compendium in seven parts is for the most part still in manuscript. Only the sixth part, on sexual diseases, and a section of the seventh part, on fevers, are in the process of being printed in critical editions and with English translations.(2) In addition to this medical compendium, Ibn al-Jazzar composed some minor treatises. One, entitled Risala fi 'l-nisyan wa- ilajihi (On Forgetfulness and its Treatment), was published recently.(3) Another, virtually unnoticed until now, is his Tibb alfuqara wa 'l-masakin (Medicine for the Poor and Destitute). This text is extant in a number of manuscripts,(4) and in an edition prepared by S. Kataya which I have not seen.(5) In this article I will give an analysis of this treatise based on MS Gotha A 2034, fols. 1-26a.(6) I will discuss the particular literary genre to which it belongs, its main characteristics, and the differences and similarities it subtends with respect to related genres.

THE LITERARY GENRE OF THE TIBB AL-FUQARA

Apart from the introduction and epilogue, about which I will speak later, the Tibb al-fuqara is basically a list of remedies for the different diseases a capite ad calcem. According to this structure, fol. 1b starts with recipes for headache and fol. 25b ends with a recipe for podagra, or gout. Almost no attention whatever is paid to the causes or symptoms of the disease. The .Tibb al-fuqara thus belongs to a special literary genre called "medicine for the poor," which was pursued by several Arab Muslim doctors during the Middle Ages and is closely related to a collection of texts called "treatise [on the treatment] of him who is not called upon by the physician (K, man la yahduruhu al-tabib).(7) Al-Razi (865-923), known best for his K. al-.Hawi (Liber continens), was apparently active in both genres, for he is the author of a monograph also entitled K. man la yahduruhu al-tabib,(8) and according to Ibn Abi Usaybi a, he also composed a monograph entitled Tibb al-fuqara.(9) The thirteenth-century doctor Ibn al-Nafis, who described for the first time the lesser or pulmonary circulation of the blood, composed a monograph bearing the same title, which, according to Sezgin, is basically an extract from al-Razi's K. al-Hawi.(10)

In the Latin West, a text entitled Liber pauperum and attributed to Constantine the African (tenth century) is possibly a translation of Ibn al-Jazzar's monograph.(11) Peter of Spain (thirteenth century), a doctor and philosopher who became pope under the name John XXI, composed a Thesaurus pauperum.(12) Works with a similar title are attributed to Arnau de Villanova, Gerard de Solo, and Bernard de Gordon. A treatise ascribed to a Friar Randolf who lived in the thirteenth century is explicitly intended as a guide to those who would "help poor folk that fall into sickness and do not have the knowledge to help themselves or the ability to hire physicians." There is, as Kieckhefer remarks, evidence that Dominicans and Franciscans provided medical care especially for those who could not afford professional physicians.(13) In eighteenth-century England, hundreds of books composed for the medical information of the layman came on the market, many of them going through multiple editions. One of them is called The Poor Man's Medicine Chest.(14) In France, different texts were published from the seventeenth to the nineteenth century dealing with the treatment and surgery of the poor. One of the most popular was Dom Nicolas Alexandre's La medecine et la chirurgie des pauvres, qui contiennent des remedes choisies, faciles a preparer & sans depense, pour la plupart des maladies internes & externes qui attaquent le corps humain, first published in Paris in 1714 and reprinted repeatedly.(15) Yet another text with a similar title but different content, which was widely distributed in different versions and very popular in France during the nineteenth century, is the Medecin des pauvres. It is basically a collection of prayers invoking God, Christ, Mary, or one of the saints for the healing of a wide variety of ailments. These prayers are sometimes very old, some of them going back to the early Middle Ages.(16)

According to Suesmann Muntner,(17) the genre of "medicine for the poor" originated with Asaf Judaeus, an ancient Jewish physician whose exact dates are uncertain, and who is the author of a medical compendium entitled Sefer refu ot (Book of Medicines).(18) The introduction to a special section of this work which is devoted to medicine for the poor states: "This is the beginning of the remedies for the poor so that they may be cured for free, for all these remedies can be found everywhere at any moment, and Asaf beseeched his students to treat the poor with these remedies for free with loving kindness and magnanimity."(19) The therapy recommended by Asaf in this section does not include magical remedies, but consists only of simple, natural ones. The interest taken in Jewish circles in this particular form of medicine can also be understood from the Hebrew translations of works dealing with this subject. Ibn al-Jazzar's monograph was translated by Hayyim Ben Judah Ibn Musa (1380?-1460), a biblical commentator and physician born in Bejar, near Salamanca, Spain, and known for his professional ability in the service of kings and nobles for about forty years.(20) In the introduction, the translator remarks that he decided to translate this work because, although small in size, it is great in quality, a conclusion reached by him after he had tested several of the remedies recommended in it.(21) Peter of Spain's Thesaurus pauperum was translated three times: 1) Ozar ha- aniyim; 2) a compendium with the same title; 3) Ozar ha-dallim, a translation prepared by Todros Moses Bondoa in 1394.(22)

The awareness of the special needs of the sick and poor, from which the literary genre of "medicine for the poor" originated, can be found in ancient Jewish sources. The Essenes, the ancient Jewish sect that flourished between the second century B.C. and the end of the first century A.D., treated the sick who were unable to pay anything (i.e., the poor) from public funds.(23) The rabbinic precept of "visiting the sick" (bikkur holm) concerns both rich and poor. Merely visiting, though, is not enough to truly fulfill this mizwah (religious obligation); one ought to provide for the poor person's physical needs (to cure him), his emotional needs (to cheer him up), and his material needs (to bring him medicine and food without payment when he is poor).(24) According to a tale recorded in the Talmud, R. Abba, the cupper, had a "place out of the public gaze" where his patients could deposit whatever they could afford, so the penniless were not embarrassed.(25) A deontological treatise entitled Sefer musar ha-rofe im, attributed to Isaac Israeli, the teacher of Ibn al-Jazzar, urges the physician to be "especially concerned with visiting and treating the poor, for you cannot assume a more rewarding work."(26) Judah he-Hasid, the twelfth-century German moralist, declared: "If a poor man and a rich man fall ill at the same time, and many go to the rich man to pay him honor, go thou to the poor man, even if the rich man is a scholar."(27) Judah ibn Tibbon, the famous twelfth-century translator and physician, declared in his last will and testament: "My son, let thy countenance shine upon the sons of man, visit their sick and let thy tongue be a cure to them; and if thou receivest payment from the rich, attend gratuitously upon the poor; and the Lord will requite thee, and give thee thy reward."(28) In the seventeenth century Jacob Zahalon of Rome urged that doctors "not accept a fee from the poor nor from relatives and close friends."(29) Material preserved in the Geniza informs us about the actual establishment of pious foundations for the purchase of medicines for the poor. Physicians treated indigent patients without exacting fees, if the physicians could be reached by them. Both Maimonides and his great-great-grandson David II gave medical advice and help to poor persons with whom they had dealings in their capacity as heads of their Jewish communities.(30) A letter from the Geniza informs us about a Christian army surgeon treating a Jewish woman who had suffered injuries in an accident, without taking an honorarium.(31)

It seems that such awareness of the special needs of the sick and poor was lacking in ancient Greek Hippocratic medicine,(32) since it was intended for an aristocratic clientele. When the author of the Precepts recommends that a physician should not be overly insistent about fees, since this is troubling to an ill person, his major concern is the practical advantage of an openly moral stance.(33) He stresses, as Vivian Nutton puts it, "the benefits to be gained by acting ethically."(34) The Hippocratic Oath does not show any particular concern for the poorer classes. And although the various deontological treatises enjoin the physician to be sincere, upright, honest, and fair when treating patients, he should nevertheless not look like a poor person in the way he dresses, since his patients would have no confidence in such a physician. But Galen was certainly aware of the special needs of the poor and sick, an awareness betraying itself especially in his pharmacological writings.(35) Nor is it true, as Newmyer maintains, that he was a physician of the upper layers of Roman society only.(36) According to a recent study, 13.2% of a provisional group of 174 patients treated by Galen belonged to the lower classes, including slaves.(37) A prominent theme in Galen's writings is his diatribe against the...