Download PDF | Helena M. Paavilainen - Medieval Pharmacotherapy Continuity and Change_ Case Studies from Ibn Sina and Some of His Late Medieval Commentarors - 2009.
817 Pages
INTRODUCTION
Preliminary Remarks e subject of this study is medical drug therapy in medieval times and the interplay of tradition and innovation that characterize its development. In order to appreciate that development, which began with literate Arabic1 medicine and led to Latin medical scholasticism, we will concentrate on a few diseases2 and follow their treatment methods, starting from an Arabic medical encyclopedia of the th century, proceeding through a number of Arabic and some Latin commentaries, and concluding in the th century. In this way we aim to trace both the continuity and the development of the theory and practice of medieval drug therapy, trying to discover any possible patterns that might have inßuenced the choice of the drugs in therapy, especially why certain drugs were preferred above others.
is in turn also demands examining in detail the causes and the manifestations of each of the symptoms/syndromes treated and the possible interconnections between these, the given therapeutic theory and the recommended medicaments, establishing the degree of coherence between the dierent parts of the system.e scope of the study is limited to literary medicine based on the Galenic tradition, especially its drug therapy; this excludes medical folklore and magic on the one hand, and physiotherapy, venesection, and exercise on the other. e starting point is the assumption that the authors of most of these texts were practicing doctors and therefore combined both the theoretical and the practical knowledge of their time.
In the early chapters we will explore the theoretical background, against which we will then consider the selected diseases and their therapy. In the Þrst chapter we will follow the spread of the Greek medical tradition throughout the area of Arab cultural inßuence to the Latin West and give a short overview of both its theory and practice as found in the texts of the medieval Arab writers. In the second chapter we will look more closely at the particular authors whose texts we shall be discussing; while the third chapter will delineate the methods used.
the following three chapters, the main body of the work, then discuss three medical conditions: nosebleed, cough and diabetes, as they appear in the medieval medical literature, especially from the therapeutic point of view. e hypotheses to be tested here are that ) Medieval disease and therapy descriptions are internally coherent, and, ) If so, the historical continuity of the use of a drug and its popularity in the therapeutic recommendations of a single medical author correlate both with each other and with other relevant aspects of the medical system, and 3) these correlations occur according to clear patterns, showing that the choice of the drugs was rational. e conclusions drawn about the validity of the hypotheses will be shown in the Þnal chapter. e transliteration of Arabic words follows the system used by the Library of Congress. In the case of Arabic names, the deÞnite article alhas not been capitalized, unless it appears at the beginning of a sentence. Bracketed [ ] material in the translations indicates additions made to the English text for the purpose of intelligibility.
.. Research Material3 In this book we will concentrate on the type of medicine which was practiced by doctors from the highest to the middle level of the professional scale—literate practitioners, from whose ranks arose also the greatest medical authors of the time, especially the encyclopedists. For material, we have chosen a medieval Arabic medical encyclopedia—Ibn S¯ına’s ¯ Kitab al-Q ¯ an¯ un¯ —and Þve of its commentaries. Commentary literature helps in pursuing a given subject matter and following its development over the centuries, while keeping track both of additions to medical lore over time (i.e., new herbs, prescriptions or theories) and of that which has been omitted from the lore of earlier centuries.
Two epitomes (or abstracts) will be discussed, in addition to one commentary on an epitome, one fully-ßedged commentary discussing the whole text in detail, and one more glossary-type commentary. Since the epitome genre necessitates drastic condensation, examination of the epitome should clarify which drugs the author really considers to be the most necessary, and possibly, why. e full scholastic commentary genre, on the other hand, oers the author the possibility of adding as many innovations as he wants. By comparing these two versions of the texts, it should be possible to determine which were the core drugs (those used by most doctors) amongst all those in the range of drugs used in the Middle Ages for the treatment of a particular disease.4 Ibn S¯ına’s (–) ¯ 5 great medical encyclopedia Kitab al-Q ¯ an¯ un¯ f¯ı al-. tibb was studied in the original Arabic version printed in Beirut (Bayrut [sine anno], reprint of B ¯ ul ¯ aq H.) and compared with the ¯ Latin translation by Gerard of Cremona (Liber Canonis Avicenne, Venetiis, ). K. al-Qan¯ un¯ is part of the living medical tradition in the Middle East, and thus we considered it appropriate to use the text actually still in use today.6 e commentaries we have used are Mujaz al-Q ¯ an¯ un¯ by Ibn al-Naf¯ıs (d. ),7 Qan¯ unja f ¯ ¯ı al-. tibb by al-Jaghm¯ın¯ı (d. –)8 with its anonymous supracommentary, and the commentaries by Gentile da Foligno (d. )9 and Jacques Despars (d. )10 in Tertius Canonis Avicenne, Venice, 1505.
. Research Method12 e research concentrates on four main questions: . Traditionalism vs. Empiricism, Continuity vs. Change13 Medical historiography oen creates the impression that most early pharmacological writings are the result of mindless copying activity based on excessive reverence for tradition, with no evidence of criticism or possibility for change.14 On the other hand, research studies conducted by Martin Levey and John Riddle stress, respectively, the unobtrusive character of change in medieval medicine through omissions and additions and rationality as a factor impelling change.15 However, at this stage we are not asking the question why changes occurred but simply whether they did occur and to what extent. How much traditional material and how much innovation do the commentaries contain? . e Practical Relationship between Pharmaceutical eory and Practice Here we study Þrst the internal coherence of Ibn S¯ına’s description of ¯ the causes, symptoms and consequences of a particular syndrome and the general theoretical guidelines for therapy, and then the relationship between his pharmacological theory and his practical therapeutic choice of drugs. Ibn S¯ına’s pharmacological theory should dictate the general ¯ type of remedy. We will examine whether this was actually the case or whether the choice of drugs was based on a dierent system in practice. . Other Factors Inßuencing the Choice of Drugs by Ibn S¯ına and his ¯ Followers Here we will examine the inßuence of Ibn S¯ına’s drug preferences on the ¯ choices of the commentators following him, the possible cause for the need of innovations, and the inßuence of other factors. . Possible Implications Here we will examine the practical conclusions drawn from the relationship of the entire therapeutic system to the objective physical reality. e diseases—or symptoms—of which the treatments are to be studied are nosebleed, cough and diabetes. Nosebleed is an easy-to-observe symptom, with simple theoretical explanation in Kitab al-Q ¯ an¯ un¯ . erefore, we chose its treatment as the model through which we will show the details of the method. Cough represents a far more complicated complex of symptoms, the medieval treatment and etiologic understanding of which was not, however, very distant from our present understanding. Diabetes, on the other hand, was understood in medieval medicine in a radically dierent manner from the way in which we understand it now, thus oering us a realistic example of the challenges connected with medieval pharmacological information. Common to all these symptoms and diseases is the fact that they form unities that can also be understood and treated by modern Western bioscience. None of the main topics of this book—the continuation of medical prescription tradition from the Arabic to the Latin commentary literature,16 the internal coherence of the medical system as seen in individual diseases, and the factors inßuencing the choice of the drugs—have yet been extensively studied.
e method used includes the following steps: Stage . Describing the Disease (causes, symptoms, consequences) We will describe the disease—or the symptom—as set out in K. alQan¯ un¯ , giving its causes, symptoms and possible consequences, together with their interconnections.
Stage : Describing the Disease’s Treatment in eory Here we describe the theoretical basis of the drug treatment of a certain disease or symptom, addressing the following questions: What medicinal qualities were recommended, and what qualities did a drug need to have in order to be recommended for therapy of the speciÞc symptom/syndrome?17 What were the eects the healer sought?18 Stage : Describing the Practical Treatment Here we will give the prescriptions and drug recommendations laid out by Ibn S¯ına for the disease in question. ¯ Stage : Tallying the Frequency with which Dierent Drugs Appear in Prescriptions Here we will count how many times each simple drug appears in the prescriptions, thus concluding which of the simple drugs were Ibn S¯ına’s ¯ favorites. Stage : Comparing the Simple Drugs and their Qualities According to Book II of K. al-Qan¯ un¯ Here we will compare the therapeutic qualities of the simple drugs recommended for a particular disease in Book II of K. al-Qan¯ un¯ , together with the list of therapeutic qualities which Ibn S¯ına gave as necessary for ¯ the treatment in his description of the disease’s treatment in theory (Stage ).
Our intention is to investigate the connection between the choice of drugs and their therapeutic qualities—i.e., to connect theory and practice and to examine how far the theory inßuenced the practical choice of the drug. Stage : Repeating Stages – Using the Various Commentaries Here we describe the same symptoms/syndromes as they appear in the two Arabic commentaries, the Arabic supracommentary and the two Latin commentaries according to Stages through . ese commentaries are then compared with K. al-Qan¯ un¯ . Stage : Considering Other Rationales behind Ibn S¯ına’s Drug Choices ¯ At this point we move from the perspective of a medieval doctor to that of the modern scholar and seek to evaluate other possible reasons behind the choice of the simple drugs recommended by Ibn S¯ına for the disease ¯ in question. Stage : Seeking Correspondence between the Dierent Variables Connected with the Choice of the Drugs Here we try to see exactly how the factors possibly connected with the choice of drugs inßuenced this choice, both in K. al-Qan¯ un¯ and in the commentaries, and if they form any regular patterns. e purpose is to Þnd out which criteria are most relevant for the fourth main question addressed here—the possible implications of the research. Stage : Conclusions Here we will discuss the results of Stages –.
this method has its drawbacks, most of which are connected with the nature of the data. Not all Þelds have yet been studied, and even those researched have not all been examined to the same depth. e identiÞcation of medieval drug names is oen dubious. Diagnoses based on ancient descriptions of syndromes are rarely fully conclusive. e descriptions of both therapy and simple drugs by Ibn S¯ına and the com- ¯ mentators are oen partial and quite unsystematic. erefore one of the key concepts of the method is cumulative evidence: acknowledging that while the data are not—and cannot be—perfect, the sheer weight of evidence can still validate the results.
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