Archive for the ‘Hippocrates’ Category

On cancer, from a Garšūnī medical text   2 comments

Siddhartha Mukherjeeh’s Emperor of Maladies: A Biography of Cancer (New York, 2010), a 500-plus page popular level survey of cancer in human history, with the bulk of the period covered being the last hundred years or so, thanks especially to the substantial advancements achieved in that time, has received wide acclaim. One service the work performs is that it informs a general readership that cancer is nothing new. I’d like to point here to a recent identification of a short passage on cancer in an Arabic (Garšūnī) manuscript from Mardin, but before I do that, it will be worthwhile to highlight, without going into any great detail, some resources in Greek and Arabic that touch on cancer. (Jacob Wolff  — see the full reference below — at the beginning of the 20th century traced the history of the disease; I’ll not be surprised if there’s something comparable that is more recent, but I don’t know it offhand.)

The Ebers papyrus, in (hieratic) Egyptian, dated to the 16th century BCE, refers to a kind of tumor thought to have been cancer, but it’s not until much later that we get a name for cancer that sticks. Hippocrates (c. 450-c. 380 BCE) is given credit for naming the disease “crab” (καρκίνος = Latin cancer, Syriac sarṭānā, Arabic saraṭān). (Incidentally, this is one of many cases where English medical convention has opted for Greek or Latin words taken over wholesale instead of translations of those terms; German, by contrast, has Krebs.) A few centuries later, Galen (130-200 CE), too, discusses cancer (and other tumors). The Galenic emphasis and contribution for cancer is that it is caused by black bile. Some centuries after Galen, we have a focused description of cancer by Paul of Aegina (7th cent. CE) in his Medical Epitome (cf. also the passage on cancers in the womb from Ibn Sarābiyūn based on Paul in P. Pormann, Paul of Aegina, 27-28). I have collected a number of other notable passages, but I refer to just a few here. Photios in the 9th century had the following to say of cancer in his Lexicon (κ p. 132), “καρκίνος is a sensation [or “misfortune”] occurring in bodies, which is now called καρκίνωμα; it is often found.” The Suda s.v. is similar, as also Hesychios, Lex. κ no. 832; see Paul of Aegina, Epit. 6.45 for a longer description, and Oribasios, Coll. Med. 45.11.4.1, quoting Xenophon (medicus), for some different types of cancer occurring in different parts of the body. The term καρκίνωμα is defined in the Definitiones medicae wrongly attributed to Galen (Kühn, vol. 19, 430.6 and 443.5). Again in another work of a pseudo-Galen we see that καρκινώματα are especially common in female breasts (Introductio, Kühn, vol. 14, 779.8-9, cf. 786.8; see also Hipp. Epid. 5.1.101).

As is well known, Syriac scholars spent considerable efforts poring over and translating Greek scientific works, and in the ninth century some of them — Ḥunayn b. Isḥāq is the most famous — played the unimaginably important role of further translating some of such texts into Arabic, sometimes from Syriac, sometimes directly from Greek. There are in Ḥunayn b. Isḥāq’s Risāla on the translations of Galen’s works into Syriac and Arabic (ed. Bergsträsser, 1925) three references of possible relevance: on Galen’s Ad Glauconem de medendi methodo libri IIDe tumoribus praeter naturam, and De atra bile. The Risāla, a new edition of which with English translation by John Lamoreaux is thankfully soon to appear, is a well-known resource for our knowledge of Greek medical literature in both Syriac and Arabic. This work is well known as a resource for the history of Arabic medical literature, but it bears underlining that many of the translations Ḥunayn refers to are Syriac; even if these are not all known to have survived, it is at least a boon to our Syriac literary knowledge to know that such and such a Galenic text did exist in that language. In the second book of Ad Glauconem, Ḥunayn tells us (p. 7, ll. 10-11), Galen “describes the indicators of tumors and their treatments” (ويصف في المقالة الثانية دلائل الاورام ومداواتها); this term (waram pl. awrām) does not, however, necessarily mean a cancerous tumor. This work had been translated into Syriac by Sergius of Rēšʿainā († 536) — at a time, Ḥunayn says, when he was somewhat accomplished in translation but he was not yet at the peak of his skill — before Ḥunayn himself translated it into Syriac and then into Arabic for different patrons (p. 7, ll. 12-16: وقد كان سبقني الى ترحمة هذا الكتاب سرجس الى السريانيّة وقد كان قوويّ بعض القوّة في الترجمة ولم يبلغ غياته ثم ترجمته بعد الى السريانيّة لسلمويه…ثمّ ترجمته في هذا الايام الى العربيّة لابي جعفر محمّد بن موسى). The other two books (nos. 57 and 68 in the Risāla), which I do not quote here due to space, are discussed on p. 31.4-9, and p. 32.14-16. The medical bio-bibliographer Ibn Abī Uṣaybiʿa hardly mentions cancer: the only place I know of is at the end of ch. 8 (p. 255 in the Beirut ed. before me) for a physician called Al-Sāhir (“the sleepless”), also known as Yūsuf the Priest, and even there the reference to the disease is somewhat tangential:

 وقال عبيد الله بن جبرائيل عنه إنّه كان به سرطان في مقدم رأسه وكان يمنعه من النوم فلقب بالساهر من اجل مرضه قال وصنف كناشا يذكر فيه ادوية الامراض وذكر في كناشه اشياء تدلّ على أنّه كان به هذا المرض

ʿUbayd Allāh b. Jibrāʾīl said of him that he had cancer on his forehead and that it would prevent him from sleeping, and so he was nicknamed Al-Sāhir because of his disease. He also said that he had put together a compendium [kunnāš] in which he mentions the remedies of diseases, and he mentioned in his book certain things indicating that he did in fact have this disease.

Finally, the main cause inciting me to pen this post: I have recently discovered two copies — Church of the Forty Martyrs, Mardin, 555(2) and 556, the former very incomplete and less accurate in comparison with the latter—of a medical text in Garšūnī manuscripts, both undated but perhaps of the 16th or 17th century. This anonymous work consists of a catalog of illnesses with their descriptions and treatments. Each section generally consists of these four (rubricated) headings: al-maraḍ (the disease), al-sabab (its cause), al-ʿarḍ (its presentation, manifestation), al-tadbīr (its regulation, steps to be taken against it). At this point I have no further data to identify the text, whether for author, date, or possible other manuscripts, but I welcome any additional information. Here are just a few lines from this work on cancer. In this section — no. 56 in 556, but no. 55 in 555(2) — cancer is grouped with dubayla (a stomach disease) and kumna (black cataract), and the ailments are each discussed in turn.

With the parts on these other illnesses omitted, the text reads (ms. no. 556 with some variants from 555(2) in brackets):

Al-sabab. Wa-l-saraṭān ḫilṭ sawdāwī ḥādiṯ bi-l-qarnī [bi-l-qarānī, om. ḥādiṯ].

Al-ʿarḍ. Wa-ʿalāmat al-saraṭān ṣalābat al-ʿayn wa-tamaddud ʿurūqihā.

Al-tadbīr. Wa-ammā al-saraṭān lā burū lahu [lā budd wa-lahu] ġayr an al-ṭabīb yajtahidu fī taskīn alamihi wa-taḫfīf aḏīyatihi bi-stifrāġ al-badan wa-bi-l-aġdiya [om. wa-] al-muʿtadila wa-bi-an yaḍaʿa ʿalá l-ʿayn ṣufrat al-bayḍ maḍrūba maʿa kaṯīra wa-bi-laban al-nisā wa-bayāḍ al-bayḍ maʿa šay yasīr min [maʿa] iklīl al-malik fa-iḏā sakana al-wajaʿ fa-yajibu an yukḥala al-ʿayn bi-l-tūtiyā [om. -l-] wa-l-šādanaj [wa-l-sādanaj] wa-l-luʾluʾ wa-l-našā taduqq [yaduqq] al-adwiya wa-tanḫul [wa-yanḫul] wa-yattaḫiḏ kuḥlan wa-yaktaḥil bihi.

And here is an admittedly rough translation:

The cause: Cancer is black bile occurring on the side of the head.

Its manifestation: The mark of cancer is a hardening of the eye and the stretching out of its veins.

Its regulation: As for cancer, there is no recovery for it, even though the physician may make efforts to placate the patient’s suffering and to reduce his pain by evacuating the body, by balanced nutrition, or by putting the well-beaten yellow of an egg with women’s milk and egg-white with a little melilot on the eye. If the pain lessens, then it is necessary that zinc, lentil-stone, pearls, and starch be applied to the eye. Crush the medicinal ingredients and strain them; let the patient take it and apply it to his eye.

The remark, “there is no recovery for it,” a prognosis unfortunately still all too true for many, is reminiscent of other remarks about cancer in ancient and medieval medical literature. The command in the Egyptian Ebers papyrus has “do nothing against it”. More generally, Hippocrates in Aphorisms 7.87 counsels, “Diseases that medicines don’t heal, the knife heals; those that the knife doesn’t heal, fire heals; those that fire doesn’t heal we have to consider incurable” (Ὁκόσα φάρμακα οὐκ ἰῆται, σίδηρος ἰῆται· ὅσα σίδηρος οὐκ ἰῆται, πῦρ ἰῆται· ὅσα δὲ πῦρ οὐκ ἰῆται, ταῦτα χρὴ νομίζειν ἀνίατα), and in 6.38 (6.37 in the Syriac version) he recommends leaving “hidden cancers” (κρυπτοὶ καρκίνοι) untreated, since treating them will only cause a quick death, and presumably the cancer itself will still kill the patient, just not as quickly. See P. Pormann and E. Savage-Smith, Medieval Islamic Medicine 130 for a similarly bleak prognosis from 14th-century Spain.

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Suplementary note: I don’t know the source of the sentence, but H. Fähnrich (in his chapter in A. Harris, ed., Indigenous Languages of the Caucasus, vol. 1, p. 202) cites in Georgian the line ძუძუსა ჩემსა მჯდომი მაზის “a cancer is on my breast.”

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Bibliography

Peter Pormann, The Oriental Tradition of Paul of Aegina’s Pragmateia (Leiden, 2004).

——– and Emilie Savage-Smith, Medieval Islamic Medicine (Washington, D.C., 2007).

Jacob Wolff, Die Lehre von der Krebskrankheit. Four volumes. Gustav Fischer: Jena, 1907. In English see The Science of Cancerous Disease from Earliest Times to the Present, trans. Barbara Ayoub.

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