Modern Researcher Unearths Ancient Prescriptions from the Cairo Genizah

Centuries before the show Hoarders, the Jews of Cairo saved 300,000 manuscript fragments over a nearly 1,000-year period in the geniza, or storeroom, of a synagogue.  It turns out that the Cairo Geniza is actually a treasure trove, in this case, of medieval medical information.  Prof. Efraim Lev rummages daily through the attic of Near Eastern history, uncovering lost prescriptions and shedding light on modern medicine.

Lev, of the University of Haifa, first came across the Geniza while studying medieval medicine, recognizing its potential to “learn about the practical and theoretical medicine of the Mediterranean.”

After a year in Cambridge combing through fragments, he’d uncovered 140 prescriptions from the vast pile.  They reveal a lot about a typical doctor’s visit 1000 years ago.

Doctors’ visits took longer, for one thing.  Physicians “didn’t have a time limit of seven minutes per patient.  They did a serious physical check; conversation was not just about the symptoms.”  Finally, the physician would decide what the problem was and write a prescription.

Either the patient or a family member would go to a pharmacist to compound the prescription.  Since each prescription was prepared individually, it was usually discarded afterwards.  “But the Jews threw it away into the Geniza with all the other documents.”

It’s lucky for us that they did.  Most of what we know about Arabic medicine comes from books, says Lev.  “But books deal with theory, and from the Geniza prescriptions, we know how they prescribed, and what kind of materials they were using.”

אפרים לב באתר היסטורי / Prof. Efraim Lev at historic site

Very few prescriptions were written by the books.  “This is the beautiful thing about it.  The prescription was according to the age, to the gender, to the season, to many other things… They would take a prescription from the book and make it perfect for this patient.”

What would a typical prescription include?

“They used a lot of purges, to solve all kinds of problems,” says Lev.  “In many prescriptions, sugar was involved, because you get energy from the sugar.  Licorice was used a lot, and aloe vera for skin diseases.  They used many of the spices that we know today, that were brought from India and from Sri Lanka and so on, pepper and saffron.  All kinds of fruits and mace, even cinnamon.”

Modern researchers, Lev says, have found that most of these traditional materials have active medicinal ingredients.

If either the patient, the doctor or the pharmacist were Muslim, the prescription would be written in Arabic.  If all three were Jewish, it would be written in Judeo-Arabic, in Hebrew characters.

In either language, prescriptions bore elaborate blessings at the top and bottom, such as the Arabic “bismillah,” “by the grace of God,” or the Hebrew equivalent.  “God was involved in every prescription… with the same phrases, benedictions, they all believe in one God.”

Most materials in the Geniza date from the 11th to the 13th century, when Cairo ruled a bustling global economy.

“Cairo was the capital of the Muslim empire… the economic capital , the political capital.  That’s why the Jews came to live there and to work.”  With them came knowledge from every part of the ancient world.  “The Jews were connected, they had family ties and business ties with Jewish communities around the world at the time:  north Africa, Tunisia… Asia Minor, Iraq, Israel, Syria.”

Today, more than a century after much of the Geniza was brought to Cambridge by Rabbi Solomon Schechter, most of its treasures are still uncatalogued.  Lev’s current passion is taking 1500 fragments of medical books and reconstructing as much of the medical knowledge of the period as possible.  “It’s like a time capsule,” he says.

Perhaps the biggest mystery about the Geniza is why it was collected in the first place.

“We don’t know the reason.  They were collecting every piece of paper, vellum, anything that something was written on.  It didn’t matter what language, or whether it was religious or secular.”  Its disorganization suggests that nobody intended to create an archive.

But for Lev, the reasons aren’t as important as the outcome.  “It’s great for historians… for learning about every aspect of life, very personal things.  If you wanted to get divorced, you’d need to tell the beit din [rabbinical court] exactly what’s going on in your bedroom.  It’s all written down with names and so on.

“That’s why the Geniza is so interesting.  It tells us about the lives of real people, not just the rich and famous, as usually happens in history.”

Through the Geniza, modern physicians, too, can learn from their medieval counterparts.  “In complementary medicine, they do it: they talk with the patient, they touch him, they get more information.  This personal way of treating people is something that we should go back to.”