MEDICINE IN THE KINGDOM OF ARAGON IN THE EARLY FOURTEENTH CENTURY
In September 1301 the king of Aragon, James II, wrote urgently to his treasurer commanding him to get the royal "Librum medicine vocatum Avicenne" out of pawn. As he explained in a second letter in March 1302, he had allowed his favorite surgeon, Berengar de Riaria, to pawn the volume with a Barcelona merchant for 500 sueldos, but now he found a "valda necessarium" and had to have it back. Five hundred sueldos was an enormous amount the price of fifty meters of Persian cloth, of a good mule or of a ppor horse and not even the royal treasury always found such sums easy to produce. The king had to repeat his order for the book's redemption for months to come. This volume on which the king placed so much store can only have been Avicenna's Canon, the great medical encyclopedia of Ibn Sina translated into Latin by Gerard of Cremona in the twelfth century; from the 1230's on it was increasingly cited by Latin medical writers, and in the fourteenth century it was coming to replace the old Articella as the heart of the European medical curriculum. In 1302, as James sought frantically to get his book back, Avicenna was becoming recognized as the greatest medical authority since Galen. The next year, in July 1303, the king ordered that Berengar de Riaria be given 250 sueldos more to buy another volume of Avicenna "ad opus sui" - this time, perhaps, the Cantica (Urjuza fi 't-tibb) that Ermengol Blasi had translated in 1283.
Ten years later the king again demonstrated his interest in having the best of Islamic Medicine made available in his kingdom. In November 1313 he commanded his treasurer to pay 1000 sueldos to Jahuda Bonsenyor for translating from Arabic into the vernacular (Catalan) "a certain book of medicine called 'halcahahuy"'. Jahuda Bonsenyor, son of Astruch, had since 1294 been responsible for preparing all Arabic-language documents and contracts drawn up in Barcelona; he was also a physician (metge), and a friend of the king's own physician, Joan Amell. The title given to the medical work he was to translate for the king, 'halcahahuy', is probably a transliteration of the nisba of Abu'l-Qasim al-Zahrawi, known to the West as Abulcasis. Only a few sections of Abulcasis' great medical encyclopedia, al-Tasrif had been translated in James' day, even into Latin: the Surgery by Gerard of Cremona in the twelfth century, the pharmacology (as' Liber servitoris") by Simon of Genoa and Abraham Judeus at the very end of the thirteenth. What portion Jahuda was expected to translate for the king we cannot tell; Cardoner has supposed that Bonsenyor translated only a small part of the Tasrif, probably the section dealing with bloodletting, but the huge sum with which the translator was to be rewarded twice as much as the Avicenna had been pawned for suggests that he may have translated a major portion of the work. Unfortunately, the Catalan version is not known to exist today.
King James, who so obviously appreciated the importance and value of Islamic Medicine had to do what he could to encourage its spread in his kingdom because at this moment early in fourteenth century it was apparently not easily accessible there to Christian physicians. When the king established the first University in his realms, in Lerida in 1300, he brought in Guillem de Bezoers, a master from outside (probably from the medical faculty of Montpellier in France), to lecture on medicine. Guillem soon found that the medical books available in Lerida were defective and would have to be emended by systematically checking them against texts written in the Arabic language. At his request, the king commanded in 1302 that:
Because certain Arabic medical books belonging to Jews in our realms are needed to correct these medical texts…we command that whatever medical works written in Arabic are needed by this master (Guillem) should be turned over to him by those Jews until he has had them translated or has used them to correct the other texts.
Unfortunately, the school did not prosper; it closed briefly between 1305 and 1310, and Guillem left Spain to serve the Popes in Avignon. Islamic medical writings remained difficult for Christians to come by. It was the academically trained physician who best appreciated the importance of the Islamic scientific tradition, and throughout the first decades of the fourteenth century there were still few such academic physicians in the kingdom of Aragon. Lerida began again to train students after 1310, but it had only one teacher of medicine and probably not many more students at any one time. Even in the largest cities the market for medical writings was limited. When master Gonsalbo Pere of Barcelona drew up his will in 1334, he instructed his executors that since books on his science ("ars sive sciencia") would find no buyers, his library should not be sold in that city but should be shipped as a whole to Montpellier, where the presence of an, important medical school would ensure better prices.
By this time Montpellier had wholly adopted Greek and Islamic Medicine as the basis for its curriculum, and the principal agent of this change was undoubtedly Arnald of Villanova, who for the last twenty years of his life was the preferred physician of James II. Arnald could read Arabic, and his first appearance in the historical record is in Barcelona, in 1282, as the translator of Hunain Ibn Ishaq's Arabic version of Galen's short work On tremor; his translation is in general a faithful and quite competent one.
Two other translations from Arabic to Latin can also be attributed to Arnald, a translation of Abu 'I-Salt's K. al-adwiya al-mufrada and another of Avicenna's K. al-adwiya Arnald, a translation of Abu 'I-Salt's K. al-adwiya al-mufrada and another of Avicenna's K. al-adwiya al-qalbiya (under the title De viribus cordis) -the Avicenna, like the Galen, prepared in Barcelona. During the 1290's Arnald had left Aragon to teach medicine at Montpellier, and after he returned to James's lands he was charged with advising Pope Clement V on the best pattern for medical education at his former school. At Arnald's recommendation, Clement issued new regulations in 1309 that required all bachelors of medicine to possess (teneantur) the works either of Avicenna or of Rhazes, Isaac, and Constantine -the last -named undoubtedly including the Pantegni pf 'Ali Ibn al-Abbas. When Arnald died in 1311, the inventory of his belongings included works of Rhazes and Isaac in Latin translations, as well as eight codices written in Arabic script one of them a work on anatomy, with figures, another a Synonoma, perhaps the work of Yuhanna ibn Sarafyun.
Arnald was not unique in James's realms as a translator of Arabic medicine for a Latin- reading audience: as we have seen, Ermengol Blasi - Arnald's nephew! -was responsible for translating Avicenna's Cantica in 1283. A generation or so later, Berengar Eymerich of Valencia (another physician trained at Montpellier) prepared a Latin version of the dietary sections of Abu 'I-Qasim's Tasrif. Nor was Arnald unique as an educated Christian physician able to read such works in the original language: when master Joan, physician of Barcelona, died in 1302, his estate included "decem libros Sarracenicos de fisica", which his executors then turned over to another physician, Matheu de Suria. And certainly Arnald was not unusual in possessing books on Islamic Medicine in his personal library: Bernat Serra's possessions in 1338 included the Viaticum of ibn al-Jazzar, the K. al-Mansur of Rhazes, and the Surgery of Abu 'I-Qasim. Bernat was himself a surgeon, and Christian surgeons tended to depend less on book-learning than did physicians; that a surgeon should have owned such works makes plain that he fully recognized their importance. I think we may conclude that by the 1330's the value of Islamic Medicine was fully acknowledged by the ablest and best-trained Christian physicians in Aragon, and by those patients -like the king -who could afford their services.
In search since 1977 through the Aragonesarchives I have drawn up a list of medical practitioners of all sorts -not only physicians and surgeons, but the less important apothecaries and barbers as well. I have 810 names of practitioners on my list for the period 1285-1335: 689 are Christians the great majority, as you would expect; 108 are Jews; and only 12 are Muslims. Who were these practitioners in Aragon, and what role did they play in communicating Islamic medical science to the Latin West?
One might expect or hope to find learned physicians or surgeons, celebrated for their knowledge and rewarded for their skill; but the reality is quite different. Eight of the thirteen were barbers, with only a limited medical role and no sign of special skills. Almost all the others were described as surgeons, but there is no reason to think they had illustrious careers.
Indeed, the kings themselves interested as they were in the best of medical care -were still unable to locate trustworthy and capable Islamic physicians. There is no record that James II was ever treated by a Muslim, though certainly he regularly consulted certain learned Jewish practitioners, as did Alfonso III. A Saracen surgeon, who turns up suddenly in 1332 in response to a summons by the ailing Alfonso, was apparently unsatisfactory, for she never appears again; another royal surgeon is mentioned the next year, who was evidently no more successful and likewise is thereafter absent from the record. Incidentally, both these surgeons were women, which again suggests that learned practitioners (who would surely have been men) were hard for even the king to find. In his final illness, in 1335, Alfonso was treated exclusively by (male) Christian physicians, many of them university-trained and one of them, master Jordan of Turre, brought in especially from Montpellier.
Because there is so little evidence of the presence of Islamic practitioners in Aragon, there is understandably little that can be said about the nature of their practice. In only one case do we find any evidence of the sort of treatment carried out by a Muslim practitioner of the kingdom. In December 1311 the king commanded that an investigation be launched against Ali de Lucera, a "Saracen" of Daroca, on the ground that
When the late Menga Menguez of Daroca was suffering with pains in the head, you promised to cure her of this illness so that you could extort money from the said Menga and her son Bartholomew; and that acting diabolically you made the said Menga wear seals (?caractes) and did other wicked things, because of which she is said to have died.
The king had pursued the investigation to keep his subjects from diabolic beliefs, rather than to punish medical malpractice per se, and in any case he agreed in April 1313 that Ali (who had hastily left Daroca after the investigation began) would not be harassed any further by the charge. But one feature of the original accusation bears the ring of truth, namely that Ali was treating illness with seals, and this superstitious remedy is far removed from the wholly unmaterialistic intervention recommended by Islamic medical authorities like Rhazes or Avicenna -the latter, for example, variously prescribing ointments and embrocations, remedies to be taken internally, and bleeding from veins in the head as treatments for headache.
Let us consider once again -but in more detail -the level of health manpower in the realms of the Aragonese kings in the fourteenth century.
The total population of the kingdom at this time was perhaps 800,000 -slightly over half a million in Catalonia, 100,000 in Aragon, 150,000 in Valencia. Muslims made up almost two-thirds of the population of Valencia, Jews only 5% or so; in Aragon the Muslim population may have been 25-30%, the Jews only 10%. Yet in just these two parts of the kingdom we find five times as many Jewish practitioners as Muslims. We must conclude, I think, that there were disproportionately few Muslim physicians of any sort in the Aragonese lands, and that those who were to be found there lacked the familiarity with their medical heritage that their Jewish and even Christian counterparts possessed -it was a Barcelona Jew, after all, Jahuda Bonsenyor, to whom the king had to turn for a translation of the work of al-Zahrawi. Why should this have been so?
The probable answer to this question is furnished by the biography of an Islamic surgeon born in Spain in the late thirteenth century: Muhammad al-Shafra. Al-Shafra's birth place was Crevillente, a Muslim enclave surrounded by Christian Spain -Valencia to the north and Murcia to the south -which maintained an independent existence until 1318. Born perhaps about 1280, al-Shafra studied surgery, not with a Muslim master, but with a Christian, "master Bernat"; he criticized the Muslim surgery of his day as having become the province of mere empirics. At about the time that Crevillente was absorbed into the Valencia of James II, in 1318, al-Shafra moved south to the Muslim kingdom of Granada; later he shifted to Algeciras, and when it too was reconquered by Christians, in 1344, he moved across the straits of Gibralter to Fez. In his repeated moves from Christian territory he was doing what most other members of the learned professions in Islamic Spain seem to have done: so long as there were Muslim lands with wealthy patrons to the south, it was more to a Muslim physician's advantage to sell his services there.
This should not be taken to prove active Christian repression or expulsion of the Muslim population of the northern kingdoms. In fact, while there were certainly severe restrictions imposed on Muslim life in the Aragonese realms, it still seemed attractive enough there that some Muslim physicians migrated into them -like Faraig, a surgeon who moved to Daroca in Aragon from Agreda (in Castile) with his family and household in the 1320's. However, Granada and North Africa were far more attractive to the able, the learned, and the ambitious, with the result that Muslim medicine in Christian Aragon was soon represented by poorly educated or empirically trained practitioners. It has been customary to see this flight of Muslim learning from Christian territories in Spain as a phenomenon continuing until relatively late, but the figures I have quoted suggest that the exodus was already largely accomplished by the early fourteenth century.
Yet even though Muslim practitioners seem to have been scarce in Aragon, their intellectual heritage -Islamic Medicine- had firmly established itself there by 1350. We have observed the first ages of this in the early years of the fourteenth century, as learned Christian physicians and their patients show an increasing conviction that it is in Islamic authors like Ibn Sina and Abu '1- Qasim that the highest medical wisdom is to be found, and as medieval universities like Montpellier make the writings of such men an integral part of the medical curriculum. The process culminates in the 1330's, when in Catalonia and Valencia alike an academic background, or at least a thorough familiarity with the Greco-Arabic medical literature, is made a formal requirement for anyone wishing to practice medicine in these realms; and the supremacy of the medical tradition developed and transmitted by Islam would continue to be acknowledged in the kingdom of Aragon for the remainder of the Middle Ages and Renaissance.