Arabic Commentaries on the Hippocratic Aphorisms, vi.11: A Medieval Medical Debate on Phrenitis

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  • 1 Autonomous University of Barcelona
  • 2 Hiroshima University

This article surveys selected Arabic commentaries on the Hippocratic Aphorisms, Book Six, aphorism 11, documenting a five century-long debate on the disease known as phrenitis. We show how this debate springs from a variant transmission of the Hippocratic lemma. The variant reading, which appears in Ḥunayn ibn Isḥāq’s (d. 873) Arabic translation of the Aphorisms and of Galen’s (d. ca. 216) commentary on this text, clashed with Galenic theories on phrenitis. Arabic commentators formulated different theories in order to explain the problematic lemma, engaging with each other and refuting or embracing the views of earlier authors. We follow the evolution of this compelling debate on mental health and the body, paying special attention to the emergence of new ideas on phrenitis and its aetiology. We also formulate a hypothesis about the source of another variant reading of the lemma, as it appears in the commentary by Ibn Abī Ṣādiq (d. after 1068). We underscore how Arabic commentators progressively shifted their focus from the distinct aetiologies of melancholy and phrenitis to the symptoms in the affected part. We conclude that this shift in hermeneutic focus reflected an increased interest in understanding the two pathologies as mental illnesses sharing important characteristics. Finally, our article shows how medical commentaries were, for various and at times surprising reasons, venues for the re-elaboration of medical theories, as well as venues for polemic and self-promotion.

Abstract

This article surveys selected Arabic commentaries on the Hippocratic Aphorisms, Book Six, aphorism 11, documenting a five century-long debate on the disease known as phrenitis. We show how this debate springs from a variant transmission of the Hippocratic lemma. The variant reading, which appears in Ḥunayn ibn Isḥāq’s (d. 873) Arabic translation of the Aphorisms and of Galen’s (d. ca. 216) commentary on this text, clashed with Galenic theories on phrenitis. Arabic commentators formulated different theories in order to explain the problematic lemma, engaging with each other and refuting or embracing the views of earlier authors. We follow the evolution of this compelling debate on mental health and the body, paying special attention to the emergence of new ideas on phrenitis and its aetiology. We also formulate a hypothesis about the source of another variant reading of the lemma, as it appears in the commentary by Ibn Abī Ṣādiq (d. after 1068). We underscore how Arabic commentators progressively shifted their focus from the distinct aetiologies of melancholy and phrenitis to the symptoms in the affected part. We conclude that this shift in hermeneutic focus reflected an increased interest in understanding the two pathologies as mental illnesses sharing important characteristics. Finally, our article shows how medical commentaries were, for various and at times surprising reasons, venues for the re-elaboration of medical theories, as well as venues for polemic and self-promotion.

1. Introduction

Traditional scholarship has repeatedly questioned the value of commentaries, particularly of those produced after 1100, as a locus of innovation and development of medical theory.1 Recently, new interest in the commentary as an epistemic genre,2 along with newly available primary sources, are helping scholars to view the Arabic exegetical tradition as a venue for innovative theoretical debate. Pormann and Joose, in particular,3 have called attention on the manuscript tradition of the Arabic commentaries on the Hippocratic Aphorisms as a precious source of information about reception and textual criticism of Greek sources, Graeco-Arabic translation technique, methods of quotation, and exegetical procedures that contributed to the development of medical theory.4 The present article contributes to this ongoing process of rediscovery by presenting new evidence from the Arabic commentaries on the Hippocratic Aphorisms. This evidence testifies to the fact that Arabic commentators exerted innovative hermeneutical efforts as they explored the theoretical implications of the Hippocratic text. Under the strong influence of Galen, Arabic commentators on the Hippocratic Aphorisms developed ideas about the physiological origin of melancholy, expounded on its aetiology, diagnosis, and treatment, examined cases of mental pathologies arising from fever, intoxication, age and seasonal changes, and discussed how changes in the body can lead to recovery. Commentators engaged with each other, favouring some theories, dismissing others and proffering new interpretations of the source texts. The need to explain obscure or contradictory passages, in particular, gave rise to debates which in turn stimulated the development of further hermeneutical writing. One such debate is the object of the present paper.

In what follows, we will examine selected Arabic commentaries on Aphorisms vi.11, which, based on the Greek original, says the following: “Haemorrhoids appearing in melancholic and nephritic affections are favorable.” We will show how the Arabic version of this aphorism contains a variant reading of the Greek Hippocratic text, which reports phrenitis instead of the original nephritis of the Greek lemma. Hence, the version of Aphorisms, vi.11 that circulated among Arabic authors says: “Haemorrhoids appearing in melancholic and phrenitic affections are favorable.” The statement was recognised as problematic since it clashes with basic Galenic theories about phrenitis. According to Galen, phrenitis is caused by yellow bile,5 while melancholy is caused by black bile.6 Aetiologically linking melancholy and phrenitis and maintaining that both pathologies could be healed by the expulsion of thick blood through the haemorrhoids was difficult to rationalise, given the fact that the diseases have different causes. In what follows, we will see how the variant reading became the standard version of vi.11 among Arabic commentators, and how the latter reacted to the unusual statement contained in Ḥunayn’s translation.

2. Galen on Phrenitis

Before we begin our treatment of the Arabic debate on phrenitis, we must briefly introduce Galen’s description of the disease and its aetiology. Glenda McDonald summarises Galen’s treatment of phrenitis as follows. Galen defines phrenitis as a primary affection of the brain, characterised by fever, delirium and the plucking motion of the hands known as carphologia and crocydismos. He uses the irrational behaviours associated with phrenitis as evidence of the fact that the illness is located in the brain, the organ responsible for the authoritative faculties.7 For this disease to occur, yellow bile must move into a brain that is already inflammed. After this, concocted yellow bile causes delirium and visual disturbances and makes the patient feverish. When the delirium, fever and visual illusions take over, the patient is diagnosed as suffering from phrenitis.8

Galen thus identifies the aetiology of phrenitis with yellow bile moving into the brain when the latter is inflamed. However, Galen’s commentary on vi.11, in its Arabic version, states that the expulsion of black bile through openings in the haemorrhoids can cure both melancholy and phrenitis. It is, thus, only natural that Arabic commentators versed in Galenic theory would be puzzled by Aphorisms, vi.11: if phrenitis is caused by yellow bile, why would the expulsion of black bile be beneficial for this condition? What escaped those Arabic commentators is that the Arabic version they were working with was based on a different version of the Hippocratic lemma.

3. Ḥunayn ibn Isḥāq’s Arabic version of Galen’s Commentary on the Hippocratic Aphorisms

Islamic scholars received the text of the Hippocratic Aphorisms mainly through the Arabic lemmata standardised in Ḥunayn ibn Isḥāq’s Arabic version of Galen’s Commentary on the Hippocratic Aphorisms.9 Ḥunayn, the greatest translator of Greek medical works into Arabic, reported how he translated this commentary in his so-called Epistle (“Risāla”).10 Ḥunayn’s translation of Galen’s works reveals how he carefully rendered them into Arabic, strictly following Galen’s texts with recourse to his extensive study of Greek medical works. But in his Arabic lemma of Aphorisms, vi. 11 we find an interesting variant reading. The standard Greek Hippocratic lemma of vi.11 runs as follows:11

Τοῖσι μελαγχολικοῖσι καὶ τοῖσι νεφριτικοῖσιν αἱμορροΐδες ἐπιγενόμεναι ἀγαθόν.

Haemorrhoids appearing in those affected by melancholy and nephritis are favorable.

But Ḥunayn’s version is as follows:12

‮قال أبقراط‭:‬ أصحاب الوسواس السوداوي وأصحاب البرسام إذا حدثت بهم البواسير، كان ذلك دليلاً محموداً فيهم.‬‎

Hippocrates said: When haemorrhoids appear in patients with melancholy and patients of phrenitis (al-birsām), that is a favorable symptom for them.

Ḥunayn’s translation reveals how he is reading “φρενιτικοῖσιν” (patients affected by phrenitis, al-birsām in Arabic) instead of “νεφριτικοῖσιν” (patients affected by nephritis). Before giving the translation of Galen’s commentary on this lemma, Ḥunayn adds his own commentary. In it, he justifies his choice of equivalent Arabic terms. He also reports the readings found in the Greek manuscript on which he bases his translation. Ḥunayn says:13

‮قال حنين‭:‬ إنّ الأطبّاء يعنون بالوسواس السوداوي اختلاط الذهن الذي يكون من المرّة السوداء من غير حمّى، واسمه باليونانية ماليخوليا. ويعنون بالبرسام حمّى تكون من ورم حارّ يعرض في أغشية الدماغ أو في الحجاب، ويعرض معها ضرورة اختلاط العقل، ويسمّونه باليونانية فرانيطس. ويعنون بالبواسير انفتاح أفواه العروق التي في المقعدة حتّى يجري منها الدم كما قد يعرض لكثير من الأصحّاء أن يجري منهم هذا الدم بأدوار من الزمان، واسم البواسير باليونانية امروايدس.‬‎

Ḥunayn said: Physicians mean by “melancholy” mental disorder caused by black bile without fever, and its term in Greek is mālīkhūlīyā. They mean by “phrenitis” (al-birsām) a fever from an inflammation occurring in the membranes of the brain or in the diaphragm, and mental disorder necessarily occurs with it. They call it in Greek frānīṭis. They mean by “haemorrhoids” openings in the mouths of the veins in the buttocks so that blood can flow from them, just as blood flows from many healthy persons periodically. The word haemorrhoids in Greek is imurūwaydis.

The above text confirms that Ḥunayn is reading φρενιτικοῖσιν, not νεφριτικοῖσιν. As Magdalene has noted, all the Greek manuscripts as well as commentaries transmitting the Hippocratic lemmata such as Galen’s, Stephanus’ (d. fl. 500–550) and Theophilus’ (d. 600–650), transmit the reading “νεφριτικοῖσιν.”14 Yet, as it is to be expected, the two terms were regularly miscopied by scribes.15

Ḥunayn’s comments hint at the fact that he himself realised that φρενιτικοῖσιν was a peculiar reading. Ḥunayn must have had a clear understanding of the different aetiologies of melancholy and phrenitis. Sensing the tension between the transmitted text before him and Galen’s other works, he felt the need to preface Galen’s commentary on this aphorism with his own remarks. What is being highlighted by Ḥunayn is the similarity between the symptoms of the two diseases.16 We conclude that the reading φρενιτικοῖσιν is not based on Ḥunayn’s misreading of νεφριτικοῖσιν, but on his Greek manuscript which contained this unusual reading.

The fact that Ḥunayn consistently reads φρεντικοῖσιν rather than νεφριτικοῖσιν is further attested to by his Arabic translation of the body of Galen’s commentary on this lemma the entire Greek text of which is the following:17

[1] Οὐ τῷ τῆς κενώσεως λόγῳ μόνον αἱμορροΐδες ἰῶνται τὰ τοιαῦτα τῶν παθῶν, [2] ἀλλὰ καὶ αὐτῇ τῇ ποιότητι τοῦ κενουμένου. [3] Παχὺ γὰρ εἰώθασιν αὗται κενοῦν αἷμα μεστὸν τοῦ μελαγχολικοῦ χυμοῦ, παραπλησίαν ἔχοντος ἐν αἵματι δύναμιν, οἵανπερ ἐν τοῖς οἴνοις ἡ τρύξ, [4] ὥστ’ οὐδὲν θαυμαστὸν καὶ μελαγχολίαν καὶ νεφρῖτιν ἰᾶσθαι διὰ τῶν αἱμορροΐδων, ἐκκενοῦν πεφυκυιῶν τὴν οἷον ἰλὺν τοῦ αἵματος.

[1] Haemorrhoids cure those who suffer from these illnesses not only by the way of purging, [2] but also by the quality of what is expelled. [3] In fact, these usually purge thick blood filled with melancholic humours, which in blood have a property very similar to the dregs in wine. [4] Hence, it is not surprising that both melancholy and nephritis are cured by the haemorrhoids, for they naturally purge what is turbid in the blood.

Now compare the above Greek text with Ḥunayn’s Arabic translation.18

‮قال جالينوس‭:‬ [‭1‬] إنّ البواسير ليس بطريق الاستفراغ فقط تشفي هذه الأمراض، [‭2‬] لكن قد تشفيها مع ذلك بكيفية الشيء الذي يستفرغ، [‭3‬] لانّ من شأن الدم الذي يستفرغ من البواسير أن يكون أسود مملوءاً من الخلط السوداوي الذي حكمه في الدم حكم الدردي في الخمر. [‭4‬] فليس هو إذاً بعجب أنّ يبرأ الوسواس والبرسام بالبواسير لأنّ من شأن البواسير أن يستفرغ ما هو من الدم بمنزلة العكر.‬‎

Galen said: [1] haemorrhoids not only cure these diseases by the way of purging, [2] but also cure them by the quality of the thing which is purged. [3] That is because the blood purged by haemorrhoids is naturally black and is full of the black bile whose relation to the blood is like the relation of dregs to wine. [4] Thus it is not surprising that melancholy and phrenitis are cured by haemorrhoids, since haemorrhoids naturally purge what is like dregs from blood.

In the text above Galen explains that both melancholy and nephritis are caused by “thick blood filled with melancholic humours.” For this reason, haemorrhoids facilitate the blood being expelled, resulting in recovery from both diseases. In his Greek commentary, Galen mentions “νεφρῖτιν” (nephritis) in [4], but Ḥunayn clearly reads it as phrenitis (al-birsām). These readings and his note show his conscious reading of φρενιτικοῖσιν in this lemma.

Ḥunayn’s Arabic translation of the Hippocratic Aphorisms became the standard text for medieval Islamic physicians, who often studied the text while having recourse to Galen’s commentary for clarification. Hence, Ḥunayn’s reading of the lemma—with phrenitis (al-birsām) standing in place of the original nephritis—became the standard reading in the medieval Islamic world. Yet, Ḥunayn’s version of the Aphorisms and Galen’s understanding of the text were not universally accepted. About a century after Ḥunayn, Rāzī cast doubt on Galen’s interpretation of this aphorism in Book of Doubts on Galen.

4. Rāzī’s (d. ca. 925) Doubts on Galen (al-Šukūk ʿalā Ǧālīnūs)

Abū Bakr Muḥammad ibn Zakarīyā al-Rāzī19 compiled his Book of Doubts on Galen (Kitāb al-šukūk ʿalā Ǧālīnūs) in order to expose the contradictions he encountered in Galen’s writings. The term šakk, “doubt,” conveys the principal purpose of Rāzī’s work. In it he discusses inconsistencies and errors in Galen’s medical and philosophical writings, undercutting Galen’s medical authority when his doctrines seemed to be unsubstantiated.20 In the introduction to the book, Rāzī preempts attacks he foresees coming for criticising Galen. Whilst admiting that he is reluctant to undertake this enterprise, he sees himself compelled to carry it out, given the frequent contradictions in Galen’s works, and the scholarly duty towards truth.21

As is to be expected, Rāzī does not overlook the inconsistency contained in the Arabic version of vi.11. Quoting from Ḥunayn’s translation of Galen’s commentary,22 Rāzī criticises Galen for coupling phrenitis and melancholy, two diseases having different aetiologies:23

‮المقالة السادسة، الفصل الذي فيه‭:‬ أصحاب الوسواس السوداوي وأصحاب السرسام إذا حدث بهم البواسير كان محموداً. قال جالينوس‭:‬ لمّا كان البواسير يستفرغ الدم العكر لم يكن بعجيب‭24‬ أن يبرئ الوسواس والسرسام. فأساء في ضمّه السرسام إلى الماليخوليا في هذا السبب فإنّ السرسام مرض حارّ ولا يكون من الدم الغليظ العكر بل من الرقيق الملتهب وأكثر‭25‬ ذلك يكون من الصفراء ويكون الورم الحادث منه في ناحية الدماغ حمرة لا فلغموني.‬‎

Book six, which contains the aphorism: “When haemorrhoids appear in patients of melancholy and patients of phrenitis, that is favorable.” Galen said: “Since haemorrhoids purge turbid blood, it is not surprising that melancholy and phrenitis are cured.” He made a mistake, bringing together phrenitis and melancholy in this case. That is because phrenitis is a hot disease caused not by thick blood, but rather by light inflamed blood. In most cases, it is caused by yellow bile, and the swelling that comes with it in the region of the brain is erysipelas, not flaġmūnī.

After quoting the Hippocratic lemma (in Ḥunayn’s version), Rāzī reports the excerpt from Galen’s commentary which contains the explanation of vi.11, to which he appends his own criticism. Rāzī engages directly with Galen, charging that he made a mistake in placing melancholy and phrenitis under a common cause.26 Rāzī’s refutation of Galen is based on a detailed scrutiny of the aetiology of phrenitis, and a partial account of its symptoms. His central argument against Galen is the following. Phrenitis is an affection of the brain tissues caused by light blood which has become inflamed because of the noxious activity of excess yellow bile. Given this aetiology, the expulsion of thick blood through the action of haemorrhoids should not be beneficial in cases of phrenitis, but only in cases of melancholy (the latter being caused by thick blood). It is noteworthy that Rāzī does not engage with Ḥunayn’s own commentary, nor does he contemplate a possible variant reading in the lemma or a mistake in the translation. By the same token, he does not attempt to provide a complete solution to the aporia, since Rāzī’s main objective in Doubts on Galen is to highlight contradictions between texts in the Galenic corpus. He may, then, have been satisfied with pointing out what he perceived to be Galen’s mistake.

5. Ibn Abī Ṣādiq (d. after 1068)27

The task of making sense of the Arabic lemma of Aphorisms, vi.11 and of Galen’s commentary, as well as of formulating a hypothesis about its complicated transmission history was undertaken a century after Rāzī by Ibn Abī Ṣādiq, sometimes called “the second Hippocrates.”28 Ibn Abī Ṣādiq authored one of the earliest commentaries on the Hippocratic Aphorisms. As shown by many extant manuscripts of it, his commentary was influential, and later commentators on the Aphorisms frequently utilised it. He also authored a rebuttal to Rāzī’s Doubts on Galen entitled Resolving Rāzī’s Doubts (Ḥall šukūk al-Rāzī), which was aimed at solving or partly dispelling the force of the the aporias collected by Rāzī in Doubts on Galen. The nature of the work is polemical as it aims at restoring Galen’s authority in the face of Rāzī’s criticisms. Resolving Rāzī’s Doubts is now lost, but Ibn Abī Ṣādiq quotes it in his commentary on the Aphorisms.

In his commentary on Aphorisms, vi. 11, Ibn Abī Ṣādiq uses the following lemma:29

‮أصحاب الوسواس السوداوي وأصحاب السرسام إذا حدث فيهم البواسير كان ذلك دليلاً محموداً فيهم.‬‎

The text is clearly taken from Ḥunayn’s version, though in this version we find sirsām for phrenitis instead of birsām in Ḥunayn’s.30 In his comments on this aphorism, Ibn Abī Ṣādiq begins by paraphrasing Galen’s commentary. He, then, refers to Rāzī’s doubts about Galen’s interpretation. Finally, he tries to dispel the tension between Rāzī and Galen by citing another translation of vi.11.31

‮التفسير‭:‬ ذكر جالينوس في تفسيره هذا الفصل أنّ استفراغ دم البواسير ينفع الماليخوليا والسرسام لأنّ الدم العكر يستفرغ به. وناقضه الرازي قائلاً بأنّ السرسام لا يكون من الدم الغليظ بل من الدم الرقيق الملتهب وأكثر ذلك يكون من الصفراء، فكيف ينفع منه خروج دم البواسير؟. وقد قلنا في حلّنا شكوكه إنّ الدم الملتهب الذي هو مادّة السرسام يحرق سريعاً حتّى قد يصير الوجه والرأس من المبرسمين أسود فينتفع صاحبه باستفراغ دم البواسير. وأيضاً فإنّ الطبيعة إذا فتحت أفواه العروق في البواسير ودفع الدم الفضلي إليها مالت الموادّ بأجمعها إلى تلك الناحية فينفع صاحب السرسام بذلك.‬‎

Commentary: Galen mentions in his commentary on this aphorism that the purging the blood of the haemorrhoids is beneficial to melancholy and phrenitis, because the turbid blood is purged with it. Rāzī disagreed with him, saying “phrenitis is not caused by thick blood, but rather by light, inflamed blood, and in most cases this is caused by yellow bile. So how should purging blood from haemorrhoids be beneficial?” We have stated in resolving his doubts [about Galen’s interpretation of vi.11] that inflamed blood, namely, the sickly matter of phrenitis, burns rapidly so that the face and head of the patients of phrenitis (al-mubarsamīna)32 turn black, so the patient benefits from the purging of the blood of the haemorrhoids.33 Moreover, when Nature opens the mouths of the haemorrhoids and surplus blood is pushed towards them, they cause all matter to flow in that direction. The patient of phrenitis benefits from this as a consequence.

Having recourse to Resolving Rāzī’s Doubts, Ibn Abī Ṣādiq resists Rāzī’s objection to Galen’s commentary. Although he agrees with Rāzī’s opinion that phrenitis is caused by light blood, he explains that 1) haemorrhoids can cure the black colour of the patient’s face and head by purging the black bile; and 2) haemorrhoids cause all sickly matter to flow out including light blood. For these reasons, he concludes that the purging of the blood of the haemorrhoids is still beneficial for the phrenitic patient.

Moreover, after defending this Hippocratic lemma against Rāzī, Ibn Abī Ṣādiq attempts to dispel some of the tension between the two great medical authorities by mentioning another Arabic translation of this aphorism.34

‮ووجدت في نقل مجهول بدل أصحاب السرسام وجع الكلية. وجملة الفصل هكذا من كان به مرض من المرّة السوداء ووجع في كليته فتبع ذلك انفجار دم بواسير فهو خير. فإن كان الناسخ الأوّل سها فنقل السرسام في الدستور بدل وجع الكلّية فإنّ من البيّن أنّ أوجاع الكليتين على الأكثر يكون من كيموس غليظ وخروج الدم من البواسير يستفرغ أمثال هذه الكيموسات.‬‎

In an anonymous translation I found “kidney pain” instead of “patients with phrenitis.” The whole lemma [in this translation] is as follows: “when a person has a disease caused by black bile and has pain in the kidneys and that is followed by the eruption of the blood of haemorrhoids, that is beneficial.” So if the first copyist [of Ḥunayn’s lemma] was careless, and he copied “phrenitis” in the exemplar instead of “kidney pain,” it is then evident that pains in the kidneys are in most cases caused by thick humours, and blood flowing from haemorrhoids purges this kind of humour.

In this last part, Ibn Abī Ṣādiq mentions another Arabic version of this lemma, which is a literal translation of the standard Greek Hippocratic lemma of vi.11 containing nephritis. Given that the wording of this version is completely different from Ḥunayn’s, Ibn Abī Ṣādiq obviously refers to another Arabic translation of the Hippocratic lemmata. A promising candidate for his source is another version of the Hippocratic Aphorisms attributed to al-Biṭrīq (fl. the end of the eighth century), father of the translator Yaḥyā ibn al-Biṭrīq.35 In addition, this text is partially transmitted in the Arabic commentary on the Hippocratic Aphorisms wrongly attributed to Palladius (fl. mid-5th–6th century) and in the Book of History (Kitāb al-Taʾrīḫ) by al-Yaʿqūbī (fl. second half of ninth century).36 Unfortunately, vi.11 is not extant in either source. The case of lemma Aphorisms vi. 23, however, may provide some insight into the source.

The standard Greek Hippocratic lemma of Aphorisms vi. 23 reads as follows:37

Ἢν φόβος ἢ δυσθυμίη πολὺν χρόνον ἔχουσα διατελῇ, μελαγχολικὸν τὸ τοιοῦτον.

If fear or despondency lasts for a long time, it is melancholic.

Ḥunayn translates this lemma, as follows:38

‮من دام به التفزّع وخبث النفس زماناً طويلاً فعلّته سوداوية.‬‎

If fear and despondency last in a person for a long time, his disease is melancholic.

Al-Yaʿqūbī’s History transmits this lemma as follows:39

‮من أصابه فزع أو خبث نفس زماناً كثيراً دائماً فذلك يصير إلى المرّة السوداء‬‎

If a person suffers from fear or despondency40 for a long time, that becomes black bile [that is, melancholy].

Comparing the two versions shows that while Ḥunayn translates “melancholic (μελαγχολικὸν)” into “melancholic (sawdāwīya),” preserving thereby the Greek adjectival form, al-Biṭrīq translates it with a noun phrase “black bile (al-mirra al-sawdāʾ).” This very feature appears in the version of Aphorisms, vi.11 quoted in the body of Ibn Abī Ṣādiq’s commentary on vi. 11. Here, too, the adjective “μελαγχολικός (melancholic)” is translated as “a disease caused by black bile (maraḍun mina l-mirrati s-sawdāʾi),” using the noun “black bile (al-mirra al-sawdāʾ),” whereas Ḥunayn uses a specific term, al-waswās al-sawdāwī, to translate melancholy.41 This similarity suggests that Ibn Abī Ṣādiq may be quoting al-Biṭrīq’s version of vi.11 in his commentary.

In the final part of the commentary, Ibn Abī Ṣādiq seems to be contemplating the possibility that whilst the original text of Ḥunayn’s Arabic lemma did in fact contain nephritis instead of phrenitis, subsequent manuscripts were corrupted by the first scribe’s carelessness, who allegedly wrote “phrenitis (sirsām)” instead of “pain of the kidneys (waǧaʿ al-kulya).” Ibn Abī Ṣādiq concludes that the alternative reading “kidney pain,” if accepted, solves the problem of the peculiar reading “phrenitis” in Galen’s commentary. In fact, haemorrhoids cure affections of the kidneys (such as nephritis) because they purge thick humours.

Ibn Abī Ṣādiq’s commentary displays an array of remarkable features.42 On the one hand, Ibn Abī Ṣādiq tries to harmonise Ḥunayn’s Arabic version of vi.11 with what Ibn Abī Ṣādiq knew what Galen says about phrenitis and nephritis in his other medical writings. On the other hand, he defends Galen’s commentary against Rāzī’s criticism by explaining that haemorrhoids purge all kind of humours. Hence, haemorrhoids are beneficial even in diseases caused by light humours such as phrenitis. On the other hand, Ibn Abī Ṣādiq seems to suspect that there is a mistake in Ḥunayn’s translation. Consequently, he provides another translation which restores the original reading and salvages Galen’s comment. Thus, his defense of Galen’s commentary is completed by saying that if nephritis is the original reading the meaning of Galen’s comment is straightforward.

As already stated, Ibn Abī Ṣādiq’s commentary became very popular and later commentators on the Aphorisms utilised it frequently. It is not surprising that his efforts to explain this variant lemma would have strong repercussions in the later tradition.

6. al-Sinǧārī (12th Century)43

The lifetime of ʿAlī ibn Abī Ṭāhir al-Ṭabīb al-Sinǧārī is still open to debate. He appears to be the author of a collection of the Hippocratic lemmata as well as of a commentary on the Aphorisms entitled Making It Easy to Reach an Explanation of Hippocrates’ Aphorisms (Kitāb taysīr al-wuṣūl ilā tafsīr al-fuṣūl li-Abuqrāṭ).44 In the introduction to this commentary, Sinǧārī states that he wrote it with the purpose of making the Aphorisms more accessible to the students of his day.45 His purpose is reflected by the synthetic features of his commentary on vi.11, which gives the impression that Sinǧārī attempted to condense in his relatively short text as much information on melancholy and phrenitis as possible.46

‮قال الشارح‭:‬ الوسواس السوداوي سببه احتراق الدم ولهذا قال أبقراط فقد يعرض في الربيع الوسواس السوداوي لأنّ الربيع يولّد الدم فإذا كان دماً غليظاً عكراً على حسب مزاج المتولّد فيه والسرسام أيضاً، فتولّده من الدم لأنّه ورم حارّ حادث في الدماغ. فإن كان الدم لطيفاً رقيقاً كان منه السرسام، فإن كان غليظاً كما تقدّم كان منه الوسواس. فإذا قويت الطبيعة أرسلت نيل الفضلة الدموية من أعالي البدن إلى أسافله فقلّ تصاعد الأبخرة المتصاعدة عنها وبرأ المرضان بسبب اندفاع المادّة.‬‎

The commentator said: the cause of melancholy is the burning of blood. For this reason Hippocrates says: “Melancholy happens in the spring,” because spring generates blood. So if it is thick, turbid blood that is in accordance with the mixture of the person in whom it [the blood, sc. al-damm] is generated (al-mutawallid fīhi) and with phrenitis as well, it [phrenitis] is generated by blood because it is a hot swelling occurring in the brain. If the blood is light, phrenitis comes from it; if the blood is thick, as mentioned beforehand, melancholy comes from it. When Nature is strong, it pushes surplus blood it receives from the higher parts of the body to the lower parts, so that the rising of vapours ascending from it decreases, and the two illnesses are cured because the disease matter gushes out.

Sinǧārī’s commentary is partly derivative and partly original. It is derivative in its central argument, which relies heavily on Ibn Abī Ṣādiq. Sinǧārī’s wording closely follows that of Ibn Abī Ṣādiq. Nature attempts to eliminate surplus blood by pushing the blood away from the inflamed part, downward. Surplus blood is then expelled through openings in the veins created by the haemorrhoids. Finally, the surplus blood along with rest of the sickly matter leaves the body through the pores. On the other hand, Sinǧārī’s commentary is original in that it is the first Arabic commentary on vi.11 to mention vapours rising to the brain as a common cause of melancholy and phrenitis. In this common aetiology, extrapolated from Hippocratic-Galenic theory,47 we see a further effort to rehabilitate Galen’s association of the two diseases.

The main point of interest in Sinǧārī’s commentary is the hermeneutic shift in the core issue; namely, the mechanism by which haemorrhoids are supposed to cure both melancholy and phrenitis. At this juncture, we should recall that Galen argued that haemorrhoids cure melancholy and nephritis by expelling thick blood, which causes both diseases. On the other hand, Sinǧārī states that when surplus blood, either thick or light, is present in the body, Nature will attempt to push it downwards. When this movement happens, vapours cease to rise to the brain and both melancholy and phrenitis are cured. Sinǧārī’s text still keeps the expulsion of blood as a concurrent cause in the healing process, but we see that his hermeneutic focus has shifted from “the quality of what is expelled” (that is, the thick blood, in Galen’s view) to the movement of surplus blood downwards, and the consequent cessation of noxious vapours. The implications of Sinǧārī’s commentary are multiple. On the one hand, he relies heavily on the local movement of matter, already identified by Ibn Abī Ṣādiq, as the key mechanism for curing phrenitis and melancholy. On the other hand, he highlights other elements shared by the two pathologies, such as rising vapours, whose activity in the brain is the direct cause of delirium.

Sinǧārī’s hermeneutical approach, with its focus on movement and the cessation of the rising of vapours to the brain, was to be increasingly popular among later commentators some of whom turned away from Galen’s idea of expelling disease matter in favour of the idea of the disease matter moving downwards as a way of explaining the problematic lemma. This is an important point, in that we see that Arabic commentators realised that the argument that uses expulsion of surplus blood to justify both the healing of melancholy and phrenitis was open to criticism. The Arabic tradition was clearly not comfortable with such an explanation, and it shifted progressively to a new approach to the whole question, one that recast the discussion in terms of “local movement” rather than “expulsion.” According to this theory, haemorrhoids draw down surplus blood as well as any disease matter in the vessels in the body. Hence, disease matter of all kinds is dislodged from the head, curing both melancholy and phrenitis. The theory nicely accounts for why haemorrhoids have the ability to cure any affection caused by sickly matter in the brain. It also is important to underscore how Galen’s emphasis on “the quality of what is expelled,” namely black bile, is lost in this new way of speaking about phrenitis and haemorrhoids. A further step towards the overshadowing Galen’s original theory of expulsion was to be taken by the 13th century commentator Ibn al-Nafīs.

7. Ibn al-Nafīs (d. 1288)48

While brevity is a recurring feature of Ibn al-Nafīs’s overall commentary,49 his hasty treatment of Aphorisms, vi.11 speaks to the historical development of the debate on phrenitis in the medieval Arabic commentary tradition on this aphorism. Clearly, Ibn al-Nafīs did not feel the need to give a detailed account of the aetiology of melancholy and phrenitis, nor to explain in detail why local movement of the sickly matter was beneficial in both pathologies, as previous commentators had done. This is likely due to the fact that his audience was already familiar with the theory of movement of disease matter. We know that Ibn al-Nafīs had access to Ibn Abī Ṣādiq, with whom he engaged in his own commentary.50 Ibn Abī Ṣādiq’s influence on Ibn al-Nafīs is also apparent in his commentary on vi.11. The following text constitutes Ibn al-Nafīs’ entire commentary on vi.11.51

‮إنّما كان كذلك لدلالة هذه البواسير على انتقال مادّة المرض إلى جهتها ويلزم شفاء ذلك المرض.‬‎

It is this way because these haemorrhoids are the sign that the disease matter moves in their direction, from which the cure of the illness follows.

Ibn al-Nafīs evidently does not feel the need to expound the aetiology of phrenitis. Instead he refers to the argument that says that healing is brought about by the local movement of sickly matter (intiqāl al-mādda). It is striking that he does not mention the need for matter to be expelled. We thus observe a further development in the hermeneutics of vi.11. The original theory of expulsion of melancholic blood as beneficial for melancholy and phrenitis, as found in Ḥunayn’s text, is absent. Ibn al-Nafīs is satisfied with saying that the transfer of sickly matter from the head to the perianal area cures both illnesses. Ibn al-Nafīs seems to deliberately omit the expulsion of matter and the aetiologies of melancholy and phrenitis from his commentary, relying instead on the argument of the “local movement” of disese matter to justifying Hippocrates’ statement. This is an important hermeneutic shift in the commentary tradition on vi.11 since the main treatment mechanism in Galen’s commentary, namely, the expulsion of “melancholic” blood, has disappeared.

8. Ibn al-Quff (1233–1286)52

Abū al-Faraǧ ibn Yaʿqūb ibn Isḥāq Ibn al-Quff al-Karakī was a student of Ibn Abī Uṣaybiʿa’s, the latter of whom concludes his history of physicians with an entry on Ibn al-Quff. Ibn Abī Uṣaybiʿa also speaks about Ibn al-Quff’s father in glowing terms. The latter served as a professional scribe and was highly praised by Ibn Abī Uṣaybiʿa for his ability to memorise poetry, his deep knowledge of the Arabic language and his impeccable style in writing.53 He wanted his son to master medicine and entrusted him to the instruction of Ibn Abī Uṣaybiʿa and other distinguished physicians, such as Naǧm al-Dīn ibn al-Minfāḥ (d. 1256 or 1258),54 himself the author of a commentary on the Aphorisms. Ibn al-Quff clearly benefited from the education afforded him under his father’s supervision. His keen interest in philological and lexicographical issues in his commentary is also noteworthy. Ibn al-Quff’s commentary, entitled Book on the Elements for the Commentary on the Aphorisms (Kitāb al-wuṣūl fī šarḥ al-fuṣūl), is by far the longest of the Arabic commentaries on the Aphorisms.55 In the introduction, Ibn al-Quff explains that someone approached him, requesting that he compose a commentary on the Aphorisms. The petitioner appears to have been especially keen to have Ibn al-Quff respond to the statements made by Rāzī about the Aphorisms.56 The introduction, thus, reveals how Ibn al-Quff intended to compose a work that would engage with earlier commentaries. Its length suggests that he also aimed at composing the most exhaustive commentary on the Aphorisms. One of the manuscripts reports that he completed the commentary at the beginning of Muḥarram, 681 H (April 1282 AD), just four years before his death.57

Ibn al-Quff organised his commentary in enquiries (mabāḥiṯ).58 Regarding the phrenitis debate, we are mainly concerned with Ibn al-Quff’s second enquiry, which runs as follows.59

‮البحث الثاني‭:‬ مراده بالوسواس السوداوي على ما ذكره حنين هو تغيّر الظنون والفكر عن الحالة الطبيعية إلى الفساد وإلى الخوف وهو المعروف بالماليخوليا والسرسام وهو المسمّى باليونانية فرانيطس وهو عبارة عن ورم أحد حجابي الدماغ أو جرمه على ما عرفت ويلزمه اختلاط العقل. وقد جاء في بعض النسخ عوض السرسام البرسام وهو خطأ فإنّ كلام أبقراط في أمراض الرأس والبرسام من أمراض الصدر. وأصحاب هذه العلل إذا حدث لهم البواسير انتفعوا بها من وجهين‭:‬ أحدهما من جهة عكس المادة وميلها إلى خلاف الوجع، وثانيهما من جهة استفراغ مادّتهما. وقوله كان ذلك دليلاً محموداً فيهم لأنّ حدوث البواسير ليس هو دليل محموداً فيمن لم يلزمه ذلك. قال الرازي رحمة الله عليه السرسام لا يكون عن الدم الغليظ المستفرغ بالبواسير بل حدوثه في الأكثر عن موادّ لطيفة صفراوية أو دم رقيق. وإذا كان كذلك، فكيف يجوز أن يقال إنّ البواسير نافعة في ذلك؟ قلنا‭:‬ الأمر وإن كان كذلك لكنّ السرسام يلزمه احتراق الموادّ بسبب قوّة الحرارة فمتى انحدرت هذه المادة إلى أسفل، انتفع صاحبه بخروجها. وأيضاً فإنّ تلك الموادّ وإن كانت لطيفة فإنّها تخرج بطريق الاستتباع. ومع هذا جميعه فإنّ عكس الموادّ إلى خلاف الجهة نافع جدًّا منذر بزوال المرض المخالف.‬‎

The second enquiry: according to what Ḥunayn says, by melancholy (al-waswās al-sawdāwī) he [Hippocrates] means the changing of opinions and thoughts from their natural state to a corrupted state and fear. It is also known as “mālīḫūliyā.” Phrenitis (sirsām) is called “frānīṭīs” in Greek. It is an expression for the swelling of one of the two membranes of the brain or its body, according to what you have learned. It is necessarily accompanied by confusion of the mind. In some of the manuscripts “birsām” is found instead of “sirsām.” This is a mistake, however, since Hippocrates is speaking about the illnesses of the head, whereas birsām belongs to the illnesses of the chest. If patients with these illnesses get haemorrhoids, they benefit from them in two ways. The first is that they reverse the matter and push it in the direction opposite to the pain. The second is that [the patient benefits] from purging the disease matter. And he says: “That is a favorable symptom for them,” because haemorrhoids occurring is not a favorable indication for those who are not affected by that. Rāzī, God have mercy upon him, said: “Phrenitis is not caused by the thick blood purged by the haemorrhoids, but in most cases it is caused by light yellow matter [that is, the yellow bile] or by light blood.” But if it is so, how is it admissible to say that haemorrhoids are beneficial in that [case]? We say: “Even if the case is this way, phrenitis is, nevertheless, caused by the burning of matter due to the power of the heat. When this matter descends towards the lower parts, the patient benefits from its expulsion. Also, if the disease matter is light, they [the disease matter and blood] exit, one following the other. For all these reasons, the disease matter reversing in the opposite direction is extremely beneficial, and it gives notice that the opposing disease will disappear.”

Ibn al-Quff’s engagement with the source texts is noteworthy. He describes phrenitis, citing Ḥunayn’s definition directly. He says it is a swelling of “one of the meninges, or the whole brain.” The swelling causes the mind to be in a state of confusion. Ibn al-Quff also makes a compelling philological remark, which can be only summarily addressed here. Some manuscripts, he says, report the term birsām for phrenitis, which is a mistake in Ibn al-Quff’s view. The correct term, according to the Persian etymology cited by Ibn al-Quff, is sirsām, a compound word from sar, head, and sām, inflammation. Analogously, birsām indicates an inflammation of the chest because bar in Persian means chest and sām means inflammation.60 In accordance with his commentary’s aims, Ibn al-Quff also engages in the debate on phrenitis initiated by Rāzī. What is more, he frames the issues at stake in a way that recalls Ibn Abī Ṣādiq. It is striking, however, that Ibn al-Quff does not credit Ibn Abī Ṣādiq explicitly. A close comparison of the two commentaries reveals similarities.

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Ibn al-Quff adopts aspects of Ibn Abī Ṣādiq’s commentary without a properly crediting him. This is unusual, for Ibn al-Quff tends to quote his sources carefully and to engage with them directly.61 To account for this, we can speculate that Ibn Abī Ṣādiq’s commentary was so well-known that it did not need citation. On the other hand, the verb qulnā (meaning, we said) points to the fact that Ibn al-Quff may have chosen to report Ibn Abī Ṣādiq’s solution as if it was his own. This suspicion is reinforced when we consider that Ibn al-Quff does not fail to mention Rāzī and his Doubts on Galen. It would be logical, then, to subsequently quote Ibn Abī Ṣādiq’s response to Rāzī. Instead, Ibn al-Quff reports Ibn Abī Ṣādiq’s theory as if it was his own. This gives us an important insight into the strategies that Ibn al-Quff deploys in his commentary. By strategically choosing which authors to quote and which not, Ibn al-Quff uses his commentary to enhance his authority. This fact points to other roles that medieval Arabic medical commentaries played. They served as venues for exegesis, polemic but also for self-promotion.

8. Conclusion

In the first part of the article, we have seen how Ḥunayn’s variant transmission of Aphorisms, Book Six, aphorism 11 led Rāzī to criticise Galen’s interpretation of it. More than a century later, Ibn Abī Ṣādiq engaged with Rāzī in an attempt to reconcile the aphorism with Hippocratic and Galenic medical theory and to defend Galen’s interpretation. Remarkably, the theory of local motion of disease matter, first propounded by Ibn Abī Ṣādiq as an explanation for this aphorism and used against Rāzī in Galen’s defense, seems to have been precipitated by the fact that he had access to the earlier Arabic translation of the Aphorisms. Later commentators were satisfied with adopting his approach, progressively distancing themselves from Galen’s theory of expulsion, preferring instead to focus on the local movement of the disease matter to explain Hippocrates’ words. Hence, an important strand in the Arabic tradition gradually departed from Galen’s explanation of the text. The trend was reversed by Ibn al-Quff, who used Ibn Abī Ṣādiq’s ideas but also mentioned Galen’s theory of expulsion.

The evidence from the Arabic commentaries on Aphorisms, vi.11 reveals that their authors sought to nuance the definition and understanding of phrenitis, particularly regarding the disease’s aetiology. Commentators added details about its aetiology, semiotics and seeking common elements between phrenitis and melancholy. Ibn Abī Ṣādiq underscores the fact that phrenetic patients display the symptom of having a dark or black complexion. Sīnǧārī points out that the vapours rising to the brain are involved in bringing about phrenitis. Ibn al-Nafīs’ commentary focuses exclusively on the “local movement” of sickly matter away from the brain as a therapeutic mechanism curing both diseases. A compelling aspect of this process is that there is increasing recognition of the fact that phrenitis and melancholy are related pathologies. For, notwithstanding their different aetiologies, both lead to mental derangement and affect the brain. Hence, the commentators’ focus on the local movement of sickly matter is paralleled by a conceptualisation of phrenitis and melancholy as mental illnesses.

We have observed that the Arabic tradition progressively distanced itself from the original Galenic text, in a trajectory that can be roughly periodised as follows.

  1. 1)Ḥunayn ibn Isḥāq’s translation (9th c.);
  2. 2)Rāzī’s Doubts on Galen (9th–10th c.);
  3. 3)Ibn Abī Ṣādiq, al-Sinǧārī’s and Ibn al-Nafīs (11th–13th c.);
  4. 4)New inquiries of Ibn al-Quff (13th c.).

These sources are a veritable palimpsest, displaying the many intertextual aspects of the Arabic commentaries. They show how influential Arabic commentators devised new strategies to solve the aporia produced by a miscopied Greek manuscript. Others reworked previous literature into their own commentaries, adding and subtracting material from the source texts. The debate examined in this article reveals yet another important aspect of commentary practice: by discussing and refuting previous commentaries, some Arabic commentators displayed their medical and philological skills, perhaps even seeking to increase their personal prestige as scholar-physicians among their peers.62

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Overwien, Oliver. “The Paradigmatic Translator and His Method: Ḥunayn ibn Isḥāq’s Translation of the Hippocratic Aphorisms from Greek via Syriac into Arabic.” Intellectual History of the Islamicate World 3 (2015): 158–87.

Pomata, Gianna. “The Medical Case Narrative: Distant Reading of an Epistemic Genre.” Literature and Medicine 32 (2014): 1–23.

Pomata, Gianna. “Observation Rising: Birth of an Epistemic Genre, ca. 1500–1650.” In Histories of Scientific Observation, edited by Lorraine Daston and Elizabeth Lunbeck, 45–80. Chicago: University of Chicago Press, 2011.

Peter E. Pormann, “Theory and Practice in the Early Hospitals in Baghdad—Al-Kaskarī on Rabies and Melancholy.” Zeitschrift für Geschichte der Arabisch-Islamischen Wissenschaften 15 (2003): 197–248.

Pormann, Peter E. and N. Peter Joosse. “Commentaries on the Hippocratic Aphorisms in the Arabic Tradition: The Example of Melancholy.” In Epidemics in Context: Greek Commentaries on Hippocrates in the Arabic Tradition, edited by Peter E. Pormann, 211–49. Berlin: De Gruyter, 2012.

Pormann, Peter E., et al. “The Enigma of Arabic and Hebrew Palladius.” Journal of the Intellectual History of the Islamicate World 5.3 (2017): 252–310 (in press).

Ragab, Ahmed. The Medieval Islamic Hospital: Medicine, Religion and Charity. Cambridge: Cambridge University Press, 2015.

al-Rāzī, Abū Bakr Muḥammad ibn Zakariyyā. Kitāb al-Šukuk alā Ǧālīnūs. Edited by Mahdī Muḥaqqiq. Tehran: International Institute of Islamic Thought and Civilization, 1993.

al-Rāzī, Abū Bakr Muḥammad ibn Zakariyyā. Kitāb al-Šukuk li-l-Rāzī. Edited by Muṣṭafā Labīb ʿAbd al-Ġanī. Cairo: Dār al-kutub wa-l-wathāʾiq al-qawmīya, 2005.

Savage-Smith, Emilie. A New Catalogue of the Arabic Medical Manuscripts in the Bodleian Library, University of Oxford Volume I: Medicine. Oxford: Oxford University Press, 2011.

al-Sinǧārī, Ṭāhir ibn Ibrāhīm. Tartīb (Tabwīb) fuṣūl Abuqrāṭ. Edited by ARABCOMMAPH. The University of Manchester, 2012–2017. doi: http://dx.doi.org/10.3927/52132532.

Tytler, John. The Aphorisms of Hippocrates. Calcutta: Education Press for Committee of Public Instruction, 1832.

Ullmann, Manfred. Die Medizin im Islam. Leiden: Brill, 1970.

Ullmann, Manfred. Islamic Medicine. Edinburgh University Press, 1978.

Ullmann, Manfred. Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts. Wiesbaden: Harrassowitz, 2002.

Ullmann, Manfred. Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts: Supplement, Band I: AO. Wiesbaden: Herrassowitz Verlag, 2006.

1

This attitude towards medical commentary is criticised in Nahyan Fancy, “Medical Commentaries: A Preliminary Examination,” Oriens 41 (2013): 525–45, 525–7.

2

On “epistemic genre” see, Gianna Pomata, “The Medical Case Narrative: Distant Reading of an Epistemic Genre,” Literature and Medicine 32 (2014): 1–23; Gianna Pomata, “Observation Rising: Birth of an Epistemic Genre, ca. 1500–1650,” in Histories of Scientific Observation, eds. Lorraine Daston and Elizabeth Lunbeck (Chicago: University of Chicago Press, 2011), 45–80.

3

Peter E. Pormann and N. Peter Joosse, “Commentaries on the Hippocratic Aphorisms in the Arabic Tradition: The Example of Melancholy,” in Epidemics in Context: Greek Commentaries on Hippocrates in the Arabic Tradition, ed. Peter E. Pormann (Berlin: De Gruyter, 2012), 211–49.

4

See also Carsten Schliwski, “Moses Ben Maimon, Šarḥ Fuṣūl Abuqrāṭ, der Kommentar des Maimonides zu den Aphorismen des Hippokrates. Kritische Edition des arabischen Textes mit Einführung und Übersetzung” (PhD diss., University of Köln, 2007).

5

From Galen’s commentary on the Hippocratic Aphorisms. Galen, Galeni opera omnia, ed. Karl G. Kühn, (Leipzig: Libraria Car. Cnoblochii, 1829), 18a:21.

6

This view is stated in Galen’s On the Causes of Symptoms 2.7.2 (Galen, Galeni opera omnia, 7:202) and On the Affected Parts 3.9 (Galen, Galeni opera omnia, 8:178).

7

Based on Galen’s On the Affected Parts 3.7 (Galen, Galeni opera omnia, 8:166–7). This text is discussed in in Glenda C. McDonald, “Concepts and Treatment of Phrenitis in Ancient Medicine” (PhD diss., Newcastle University, 2009), 139.

8

Ibid., 145.

9

On Ḥunayn’s translation of this commentary, see Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 217–9. We rely on the following five manuscripts: Madrid, Escurial, MS árabe 789, copied ca. 13th century (henceforth, E5); Madrid, Escurial, MS árabe 790, copied 1209 AD (henceforth, E6); Madrid, Escurial, MS árabe 791, copied 1101 AD (henceforth, E7); Paris, Bibliothèque nationale de France, MS 2837 fonds arabe, copied 1227 AD (henceforth P1); and Yale, Arabic MS suppl. 87, copied 1691 AD (henceforth YA). Moreover, we also occasionally refer to the (rather defective) edition of Ḥunayn’s Arabic lemmata by John Tytler, The Aphorisms of Hippocrates (Calcutta: Education Press for Committee of Public Instruction, 1832).

10

See Ḥunayn ibn Isḥāq, Ḥunayn ibn Isḥāq on His Galen Translations, ed. John C. Lamoreaux (Provo: Brigham Young University Press, 2016), 94–7. Gotthelf Bergsträsser, “Ḥunayn ibn Isḥāq: Über die syrischen und arabischen Galen-Übersetzungen,” Abhandlungen für die Kunde des Morgenlandes 17 (1925), 40 (1st series), ll. 6–14 (no. 88), 32–3 (2nd series, German translation). For analysis of this passage, see Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 217. On this work, see Oliver Overwien, “The Paradigmatic Translator and His Method: Ḥunayn ibn Isḥāq’s Translation of the Hippocratic Aphorisms from Greek via Syriac into Arabic,” Intellectual History of the Islamicate World 3 (2015): 158–87, 161–3.

11

Caroline Magdelaine, “Histoire du texte et édition critique, traduite et commentée, des Aphorismes d’ Hippocrate” (PhD diss. Université de Paris-Sorbonne), 2:450–1. Since the Aphorisms became very popular, the Greek text of this work displays numerous variants in its textual transmission. To clarify the original Hippocratic statements as far as we can, when we quote a lemma of the Aphorisms, we use a critically edited text of it, called “standard Greek Hippocratic lemma,” namely the text edited by Magdelaine.

12

Galen, Tafsīr Ǧālīnūs li-fuṣūl Abuqrāṭ, trans. Ḥunayn ibn Isḥāq, ed. Taro Mimura (The University of Manchester, 2012–2017), doi: http://dx.doi.org/10.3927/51931843. E5, fol. 52b; E6, fol. 43b; E7, fols. 116a–116b; P1, fol. 107a; YA, fol. 151a; Tytler, Aphorisms, 54.

13

E5, fols. 52b–53a; E6, fol. 43b; E7, fol. 116b; P1, fols. 107a–107b; YA, fol. 151a.

14

Magdalene, “Histoire du texte,” 2:450.

15

Ibid., 3:668–9.

16

We owe this point to the anonymous referee.

17

Galen, Galeni opera omnia, 18a:21.

18

Galen, Tafsīr Ǧālīnūs li-fuṣūl Abuqrāṭ, ed. Mimura. E5, fol. 53a; E6, fols. 43b–44a; E7, fol. 116b; P1, fol. 107b; YA, fol. 151a.

19

For a brief biography of Rāzī, see Ullmann, Islamic Medicine (Edinburgh: Edinburgh University Press, 1978), 43–4.

20

In his introductory article to his edition of Doubts on Galen, Muḥaqqiq suggests to equate the term šakk (pl. šukūk) with the Greek aporia; Mahdī Muḥaqqiq, introduction to al-Rāzī, Šukuk ʿalā Ǧālīnūs, 108 [sic] (2nd series). Manfred Ullmann, Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts: Supplement, Band I: AO (Wiesbaden: Herrassowitz Verlag, 2006), 152. Additionally, see the entry for “απορεω [sic]”/“‮شك‬‎,” in Glossarium Graeco-Arabicum: A Lexicon of the Mediaeval Arabic Translations from the Greek, Berlin-Brandenburg Academy of Science (last accessed 20 December, 2016, http://telota.bbaw.de/glossga/filecards.php?id=177735). We are thankful to Dr. Matteo Martelli and to Dr. Sonja Brentjes for their help on this note.

21

Abū Bakr Muḥammad ibn Zakarīyā al-Rāzī, Kitāb al-Šukūk li-l-Rāzī, ed. Muṣṭafā L. ʿAbd al-Ġānī (Cairo: Dār al-kutub wa al-waṯāʾiq al-qawmīya, 2005), 39–44.

22

Incidentally, it should be noted that one of the present authors has found the reading birsām to be widespread in the extant manuscripts of Ḥunayn’s version of the Aphorisms. On the other hand, the spelling sirsām appears in the great majority of the Arabic commentaries after Ḥunayn, as early as at the time when Rāzī wrote. On the reasons behind the progressive forsaking of birsām in favour of sirsām, see Nicola Carpentieri, “On the Meaning of Birsām and Sirsām: A Survey of the Arabic Commentaries on the Hippocratic Aphorisms,” Mélanges d’ institut Dominicain d’ études orientales du Caire 32).

23

Rāzī, Kitāb al-Šukūk li-l-Rāzī, 201–2; Rāzī, Kitāb al-Šukūk ʿalā Ǧālīnūs, 59 (1st series). Variant readings are recorded in the apparatus.

24

‮بعجيب‬‎] ʿAbd al-Ġānī: ‮تعجب‬‎ Muḥaqqiq.

25

‮وأكثر‬‎] add. ‮من‬‎ ʿAbd al-Ġānī.

26

One may read this wording as Rāzī’s distinctive critical approach, already underscored by Iskandar, see Albert Z. Iskandar, “Ar-Rāzī, the Clinical Physician,” in Islamic Medical and Scientific Tradition, ed. Peter E. Pormann (London: Routledge, 2011), 1:216–7.

27

Manfred Ullmann, Die Medizin im Islam (Leiden: Brill, 1970), 160. For a recent discussion of his impact on 13th century medicine, see Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion and Charity (Cambridge: Cambridge University Press, 2015), 154–5. Ragab concludes that Ibn Abī Uṣaybiʿa was not not well-informed about Ibn Abī Ṣādiq and “failed to acquire sufficient information” about his life. Ibn Abī Uṣaybiʿa, ʿUyūn al-anbāʾ fī ṭabaqāt al-aṭibbāʾ, ed. Augustus Müller (Königsberg: self-published, 1884 [reprinted Westmead, UK: Gregg International Publishing, 1972]), 2:14. See also Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 221–5.

28

Ullmann, Medizin, 160.

29

Ibn Abī Ṣādiq, Šarḥ fuṣūl Abuqrāṭ, ed. ARABCOMMAPH (The University of Manchester, 2012–2017), doi: http://dx.doi.org/10.3927/51932337. This edition is based on the following two Arabic manuscripts: Dublin, Chester Beatty, MS Ar. 3802 (copied in 1281; henceforth CB1); Istanbul Beyazid Devlet Kütüphanesi, MS Veliyeddin Efendi 2508 (copied in 1067; henceforth V1). CB1, fol. 167b; V1, fols. 68a–68b.

30

See n. 22.

31

Ibn Abī Ṣādiq, Šarḥ fuṣūl Abuqrāṭ, ed. ARABCOMMAPH. CB1, fols. 167b–8a; V1, fol. 68b.

32

This wording mubarsam may suggests that Ibn Abī Ṣādiq uses the words sirsām and birsām synonymously to refer to phrenitis.

33

Meaning that haemorrhoids can purge the black bile causing the black colour in the patient’s face and head to disappear.

34

Ibn Abī Ṣādiq, Šarḥ fuṣūl Abuqrāṭ, ed. ARABCOMMAPH. CB1, fols. 168a; V1, fol. 68b.

35

Ullmann, Medizin, 326. Ullmann, introduction to Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts (Wiesbaden: Harrassowitz, 2002), 15–53.

36

On this version, see Hinrich Biesterfeldt, “Palladius on the Hippocratic Aphorisms,” in The Libraries of the Neoplatonists, ed. Cristina D’Ancona (Leiden: Boston: Brill, 2007), 385–97. Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 215–216. On the problem of Palladius’ authorship of the commentary, see Peter E. Pormann, et al., “The Enigma of Arabic and Hebrew Palladius,” Journal of the Intellectual History of the Islamicate World 5.3 (2017): 252–310.

37

Magdelaine, “Histoire du texte,” 2:453.

38

Galen, Tafsīr Ǧālīnūs li-fuṣūl Abuqrāṭ, ed. Mimura. E5, fol. 55b; E6, fol. 48a; E7, fol. 120a; P1, fol. 111a; YA, fol. 155b; Tytler, Aphorisms, 54.

39

Martijn T. Houtsma, Ibn Wadhih qui dicitur al-Jaʿqūbī Historiae (Leiden: Brill, 1883), 1:114.

40

Remarkably, Ḥunayn and al-Biṭrīq translated δυσθυμίη with ḫubṯu nafsin, although we do not know who coined the term ḫubṯu nafsin for this Greek word, due to the few witnesses on Arabic translation of Greek medical works composed before Ḥunayn. To our knowledge, this particular collocation does not appear in the original or supplementary volumes of Ullmann’s Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts.

41

For a comparison of al-Biṭrīq’s and Ḥunayn’s translation techniques, see Ullmann, Wörterbuch zu den griechisch-arabischen Übersetzungen, 41–8.

42

We record our gratitude to the anonymous referee for eliciting these remarks.

43

Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 225–6. Emilie Savage-Smith, A New Catalogue of the Arabic Medical Manuscripts in the Bodleian Library, University of Oxford Volume I: Medicine (Oxford: Oxford University Press, 2011), 13–4 [Entry 4].

44

Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 225–6.

45

Ibid., 227.

46

Ṭāhir ibn Ibrāhīm al-Sinǧārī, Tartīb (Tabwīb) fuṣūl Abuqrāṭ, ed. ARABCOMMAPH (The University of Manchester, 2012–2017), doi: http://dx.doi.org/10.3927/52132532. This edition is based on the following manuscripts: Istanbul, Beyazid Devlet Kütüphanesi Veliyeddin Efendi MS 2474 (undated, henceforth V2) fol. 142a; Aleppo, Fondation Salem, MS Ar. 1037 (undated, henceforth G) fol. 104a; MS London, Wellcome Library, MS Or. 43 (undated, henceforth W) fol. 63a.

47

See McDonald, “Concepts and Treatment of Phrenitis,” 92, 106.

48

See Max Meyerhof and Joseph Schacht, introduction to Ibn al-Nafīs, al-Risāla al-Kāmilīya fī al-sīra al-nabawīya (The Theologus autodidactus of Ibn al-Nafīs), eds. Joseph Schacht and Max Meyerhof (Oxford: Clarendon Press, 1968), 1–28. Nahyan Fancy, Science and Religion in Mamluk Egypt: Ibn al-Nafīs, Pulmonary Transit and Bodily Resurrection (London: Routledge, 2013). Ullmann, Medizin, 172–6. On his commentary, see Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 233. Albert Z. Iskander, “Ibn al-Nafīs, ʿAlāʾ al-Dīn Abū ʿl-Ḥasan ʿAlī ibn Abī ʿl-Ḥazm al-Qurashī (or al-Qarashī),” in Dictionary of Scientific Biography, ed. Charles Gillispie (New York: Scribner, 1974), 9:602–6.

49

Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 235.

50

Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion and Charity (Cambridge: Cambridge University Press, 2015), 155.

51

Ibn al-Nafīs, Šarḥ fuṣūl Abuqrāṭ, ed. Sherif Masry et al. (The University of Manchester, 2012–2017), doi: http://dx.doi.org/10.3927/52065834. The following manuscripts have been consulted. Gotha, Landesbibliothek MS 1898 (undated, henceforth Th2) fol. 147b; Wetzstein II, MS 1183 (1235 H./1819, henceforth B3) fol. 102a. We also refer to Ibn al-Nafīs, Šarḥ fuṣūl Abuqrāṭ, ed. by Yūsuf Zaydān (Cairo: al-Dār al-miṣriyya al-lubnāniyya, 1991), 433.

52

Ullmann, Medizin, 16–7. Sami Hamarneh, The physician, Therapist, and Surgeon, Ibn al-Quff (1233–1286): An Introductory Survey of His Time, Life, and Works (Cairo: Atlas Press, 1974). Ibn Abī Uṣaybiʿ, ʿUyūn al-anbāʾ, 2:273–4.

53

Ibn Abī Uṣaybiʿa, ʿUyūn al-anbāʾ, 2:273–4.

54

Ibid.

55

Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 235.

56

Abū al-Faraǧ Yaʿqūb Ibn al-Quff, Kitāb al-wuṣūl fī šarḥ al-fuṣūl, ed. ARABCOMMAPH (The University of Manchester, 2012–2017), doi: http://dx.doi.org/10.3927/52132236. This edition is based on the following manuscripts. Yeni Camii MS 919, (730 H/1329, henceforth Y) fol. 1b; London, British Library, MS Or. 1348, (787 H /1385 henceforth L5) fol. 1b.

57

Ibid.

58

Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 236.

59

Ibn al-Quff, Kitāb al-wuṣūl fī šarḥ al-fuṣūl, ed. ARABCOMMAPH. Y, fol. 284b; L5, fol. 157a.

60

See n. 23.

61

Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 236.

62

We are indebted to our colleagues on the ARABCOMMAPH team at the University of Manchester for their work on the primary sources quoted, as well as their invaluable advice: Peter E. Pormann and Samuel Barry, Rosalind Batten, Elaine van Dalen, Kamran I. Karimullah, Emily Selove, Aileen Das, Sherif Masry and Hammood Obaid.

  • 3

    Peter E. Pormann and N. Peter Joosse, “Commentaries on the Hippocratic Aphorisms in the Arabic Tradition: The Example of Melancholy,” in Epidemics in Context: Greek Commentaries on Hippocrates in the Arabic Tradition, ed. Peter E. Pormann (Berlin: De Gruyter, 2012), 211–49.

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  • 8

    Ibid., 145.

  • 23

    Rāzī, Kitāb al-Šukūk li-l-Rāzī, 201–2; Rāzī, Kitāb al-Šukūk ʿalā Ǧālīnūs, 59 (1st series). Variant readings are recorded in the apparatus.

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  • 27

    Manfred Ullmann, Die Medizin im Islam (Leiden: Brill, 1970), 160. For a recent discussion of his impact on 13th century medicine, see Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion and Charity (Cambridge: Cambridge University Press, 2015), 154–5. Ragab concludes that Ibn Abī Uṣaybiʿa was not not well-informed about Ibn Abī Ṣādiq and “failed to acquire sufficient information” about his life. Ibn Abī Uṣaybiʿa, ʿUyūn al-anbāʾ fī ṭabaqāt al-aṭibbāʾ, ed. Augustus Müller (Königsberg: self-published, 1884 [reprinted Westmead, UK: Gregg International Publishing, 1972]), 2:14. See also Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 221–5.

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  • 28

    Ullmann, Medizin, 160.

  • 35

    Ullmann, Medizin, 326. Ullmann, introduction to Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts (Wiesbaden: Harrassowitz, 2002), 15–53.

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  • 39

    Martijn T. Houtsma, Ibn Wadhih qui dicitur al-Jaʿqūbī Historiae (Leiden: Brill, 1883), 1:114.

  • 43

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 225–6. Emilie Savage-Smith, A New Catalogue of the Arabic Medical Manuscripts in the Bodleian Library, University of Oxford Volume I: Medicine (Oxford: Oxford University Press, 2011), 13–4 [Entry 4].

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  • 44

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 225–6.

  • 45

    Ibid., 227.

  • 47

    See McDonald, “Concepts and Treatment of Phrenitis,” 92, 106.

  • 49

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 235.

  • 50

    Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion and Charity (Cambridge: Cambridge University Press, 2015), 155.

  • 52

    Ullmann, Medizin, 16–7. Sami Hamarneh, The physician, Therapist, and Surgeon, Ibn al-Quff (1233–1286): An Introductory Survey of His Time, Life, and Works (Cairo: Atlas Press, 1974). Ibn Abī Uṣaybiʿ, ʿUyūn al-anbāʾ, 2:273–4.

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  • 53

    Ibn Abī Uṣaybiʿa, ʿUyūn al-anbāʾ, 2:273–4.

  • 61

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 236.

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  • 3

    Peter E. Pormann and N. Peter Joosse, “Commentaries on the Hippocratic Aphorisms in the Arabic Tradition: The Example of Melancholy,” in Epidemics in Context: Greek Commentaries on Hippocrates in the Arabic Tradition, ed. Peter E. Pormann (Berlin: De Gruyter, 2012), 211–49.

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  • 8

    Ibid., 145.

  • 23

    Rāzī, Kitāb al-Šukūk li-l-Rāzī, 201–2; Rāzī, Kitāb al-Šukūk ʿalā Ǧālīnūs, 59 (1st series). Variant readings are recorded in the apparatus.

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  • 27

    Manfred Ullmann, Die Medizin im Islam (Leiden: Brill, 1970), 160. For a recent discussion of his impact on 13th century medicine, see Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion and Charity (Cambridge: Cambridge University Press, 2015), 154–5. Ragab concludes that Ibn Abī Uṣaybiʿa was not not well-informed about Ibn Abī Ṣādiq and “failed to acquire sufficient information” about his life. Ibn Abī Uṣaybiʿa, ʿUyūn al-anbāʾ fī ṭabaqāt al-aṭibbāʾ, ed. Augustus Müller (Königsberg: self-published, 1884 [reprinted Westmead, UK: Gregg International Publishing, 1972]), 2:14. See also Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 221–5.

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  • 28

    Ullmann, Medizin, 160.

  • 35

    Ullmann, Medizin, 326. Ullmann, introduction to Wörterbuch zu den griechisch-arabischen Übersetzungen des 9. Jahrhunderts (Wiesbaden: Harrassowitz, 2002), 15–53.

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  • 39

    Martijn T. Houtsma, Ibn Wadhih qui dicitur al-Jaʿqūbī Historiae (Leiden: Brill, 1883), 1:114.

  • 43

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 225–6. Emilie Savage-Smith, A New Catalogue of the Arabic Medical Manuscripts in the Bodleian Library, University of Oxford Volume I: Medicine (Oxford: Oxford University Press, 2011), 13–4 [Entry 4].

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  • 44

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 225–6.

  • 45

    Ibid., 227.

  • 47

    See McDonald, “Concepts and Treatment of Phrenitis,” 92, 106.

  • 49

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 235.

  • 50

    Ahmed Ragab, The Medieval Islamic Hospital: Medicine, Religion and Charity (Cambridge: Cambridge University Press, 2015), 155.

  • 52

    Ullmann, Medizin, 16–7. Sami Hamarneh, The physician, Therapist, and Surgeon, Ibn al-Quff (1233–1286): An Introductory Survey of His Time, Life, and Works (Cairo: Atlas Press, 1974). Ibn Abī Uṣaybiʿ, ʿUyūn al-anbāʾ, 2:273–4.

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  • 53

    Ibn Abī Uṣaybiʿa, ʿUyūn al-anbāʾ, 2:273–4.

  • 61

    Pormann and Joosse, “Commentaries on the Hippocratic Aphorisms,” 236.

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