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History of Medicine in the Cairo Genizah Project

Physical health and well-being have engaged the minds of people from time immemorial. Indeed, much historical evidence on medicine and healing has been gleaned from prehistoric excavations and archeological sites, records found on ancient papyri and clay tablets, and letters and books written on parchment and paper.  Such testimony provides important insight into the practices of physicians, herbalists, and pharmacists, those afflicted by illness, descriptions of diseases and various forms of treatment. Generally speaking, the written material provides information regarding the theoretical knowledge of medicine, while the archeological evidence, albeit limited, offers a glimpse into the practical prescriptions.
History of Scholarship
The discovery of the Cairo Geniza over a century ago supplied information on almost every aspect of life of not only Jews, but also Muslims and Christians of Medieval Egypt and the Mediterranean Basin. Moreover, the Genizah shed new light on various segments of the population, offering glimpses into the worlds of the middle and lower classes.
Since their discovery, scholars from a variety of disciplines have made use of Geniza fragments on an array of topics. Medical issues, however, tended to be researched sporadically or secondary to other subjects. Nevertheless, a  number of scholars have dealt with medical matters, including Albert Dietrich, who in his work on the Merchants’ Letters, mentions medical documents, along with Colin Baker, Paul Fenton,  Mark Cohen, Esti Dvorjetski, and, especially, Haskell Isaacs. Shlomo Goitein devoted a chapter in his seminal work 'A Mediterranean Society’ to medicine in the Genizah and published an article on the subject in 1963. A number of times, in fact, Goitein noted a specific medical topic and encouraged further research, calling for a dissertation and thorough investigation. Haskell D Isaacs, with the assistance of Colin F Baker, likewise published an important work in 1994 on medieval medicine after surveying over 1600 documents found at the Genizah, entitled Medical and para-medical manuscripts in the Cambridge Genizah collections.
Since 2003, there has been renewed interest in the history of medicine at the Genizah, drawing historians of medicine and biology, scholars of Middle Eastern studies, and linguists. They have yielded a wealth of studies further contributing to our knowledge of the history of Medieval Arabic medicine.
The first stages of research focused on restoring the inventory of medical texts that were used by the community of the Genizah. In order to accomplish this, Efraim Lev and Zohar Amar re-examined the fragments catalogued by Isaacs, along with dozens of new fragments newly identified as medical from Cambridge as well as other Geniza collections. Re-examining the fragments has resulted in different outcomes. There are hundreds of documents which bear witness to practical prescriptions- along with guidelines for their use in hundreds of works written by physicians and pharmacists. In total, Lev and Amar identified 278 fragments, which they describe in their book (2008) and numerous articles (2006, 2007, 2008).
Within a short amount of time, the project has led to the understanding that different groups of documents describe different information. Thus, there are prescriptions written by physicians after seeing a patient, which include a recipe (formula) compiled by a pharmacist. The most important and interesting information is undoubtedly to be found in the prescriptions; they reflect the medical reality that existed in Cairo, which at times corresponds with information found in books. What emerges from the prescriptions in particular is their originality. Unlike books, which are usually copied from classical or contemporary medical sources, the prescriptions are clear-cut primary evidence of the medicinal substances used, the medical conditions that afflicted the members of the community, and the ways they were treated.
In the next stage, the various groups of documents were examined in depth by Lev and Leigh Chipman (2008, 2011), in order to understand the function of medical texts and the knowledge which they reflect. To that end, 140 medical prescriptions written in Arabic, Judeo-Arabic, as well as a number in Hebrew and Persian-Hebrew have been examined. This has in turn resulted in the publication of a number of articles devoted to linguistic aspects of the language employed by doctors (Geva-Kleinberger and Lev, 2009)  and their commercial and economic implications (Amar and Lev 2007). Seventy prescriptions have been examined in depth, shedding light on the pharmacies of Medieval Cairo and its neighboring cities of the East (Lev, 2007).
A number of medical letters and prescriptions were also dealt with at length by Ashur and Lev (2013), some of which were authored by Maimonides and his contemporaries. Many of these letters represent two-way communication and medical responsa between physician and patient and fellow physicians. The medical prescriptions, in contrast, represent how physicians and pharmacists communicated through the patient.
There are still further documents that did not readily conform to the above studies, such as prescriptions, texts which combine theoretical and practical material or different languages and a large number of manuscripts. Some of the material and prescriptions have likewise been deleted. After thorough investigation, it has become evident that these texts represent medical notebooks and hence a new genre that was previously unknown.  These notebooks may be regarded as an in-between stage in the transference of medical knowledge, from the practical to the theoretical and vice versa. The most recent article on this topic was published by Lev (2013).
Another area of research is locating and identifying medical and pharmaceutical books found in the Geniza composed primarily in Arabic, Judeo-Arabic, and Hebrew. Dozens of works have been identified over the past decade by the research team, namely Lev (2013), Lev and Chipman (2006, 2007, 2008), Serry and Lev (2010), and Niessen and Lev (2008). Many of the books identified are in fact the oldest known manuscripts of the works in question, a number of articles have therefore been devoted to them.
In tandem to these studies, medical documents from two major archival collections- the Manchester Rylands Genizah collection and the collection found most recently at Cambridge- were likewise studied, identified, catalogued, and published (Lev and Smithuis, 2013 and Lev 2011).

 Research has been supported for the past decade by St. John College at Cambridge University, where Prof. Lev was invited as a visiting scholar as well as the Taylor-Schechter Cairo Genizah Research Unit at the Cambridge University Library headed formerly by Prof. Stefan Reif and currently, Dr Ben Outhwaite. The Norman Bleehen foundation likewise enabled Prof. Lev extended periods of research at Cambridge.
In Process
To date, the centre conducts research under the direction of Efraim Lev, who focuses on the social-economic history of Jewish healthcare-providers (i.e. physicians and pharmacists) in Muslim lands from the medieval period. In this scholarly framework, the biographies of hundreds of Jewish caregivers have been reconstructed through genizah documents as well as contemporaneous Arabic texts. The information gleaned from personal letters, legal documents, lists of patrons from the community, and various other documents allows us to paint a picture albeit incomplete regarding each. The hundreds of biographies, however, enables us to reconstruct a fascinating picture regarding the social standing of healthcare-providers, their methods of work, their economic status, their familial ties, additional forms of employment, etc. This information has been concentrated in a Wiki platform that will be open to the public upon the completion of the research, thus enabling the collaboration of other scholars, students and the wider community.
Future Programs
In the next stage, the project will continue to reconstruct the medical library of healthcare professionals of the Genizah. More than 1,500 fragments of medical books that have been found at the genizah have further aided in identifying books. Examining the different works, genres, and authors enables the reconstruction of theoretical medical knowledge that Medieval health professionals in Muslim lands- both Jewish and not- had at their disposal. Such research will also utilize book lists that were found at the Genizah that mention the medical texts that the Jewish intellectual elite had on their shelves, were ordered by copyists, or were in the possession of physicians.