Mary Flowers Braswell
 

Author's Note: From my earliest exposure to the Middle Ages, I have been intrigued by Thomas Garbaty's article on "The Summoner's Occupational Disease" (Medical History 7 [1963]: 348-58). The meticulous research and the close reading of texts-both "literary" and medical -are characteristic of Tom's work throughout, as is his ability to bring one discipline to bear so perceptibly on another . The following essay is my modest tribute to what I have learned from him...
 
 

The manuscript, at first, meant nothing to me. I could not read Hebrew, was ignorant of early medicine, and unaware, not only of the culture and the context of the Al'Mansuri, but also of Rhazes himself. Even the subject - therapeutics - and the English title: "Diseases from Head to Foot," left me indifferent. As a Professor of the Middle Ages, however, I was continuously searching for some real Medieval artifact to show my students. Aware that the Reynolds Library held a few early manuscripts and incunabula, I scheduled a field trip for the class and literally stumbled onto MS 5087, crumbling in its box. My students were exhilarated, but I was depressed; visions of the Al'Mansuri corroding into powder seemed all too real to me: one more medieval artifact, gone. Fortunately, however, the library had a new and energetic staff. Persuaded of the manuscript's potential significance, they arranged for its evaluation and restoration and sent it immediately to the Northeast Document Conservation Center at Andover, Massachusetts.
 

This re-examination of the Manuscript proved to be a mixed blessing for me. On the one hand, the Reynolds learned that it owned a document on which no value could be placed: one of only three extant copies of Rhazes' work on therapeutics (the only one with a title page and preface); one of the most popular textbooks for students and physicians during the Middle Ages. On the other hand, the Manuscript, now in a sealed glass case in the middle of the Reading Room, was the subject of much media adoration. And because I had "come across the manuscript while browsing through the stacks" - a blatant distortion of the truth, but a wonderful story-I was presumed to be an expert and was inevitably pressed for interviews and photographs, alongside a book I couldn't read and did not understand. Desperate for help, I appealed to Chaucer, and in his own inimitably ambiguous way, he responded.
 

The Doctor of Physic in the General Prologue knew about Rhazes; Chaucer tells us so in line 432 of the General Prologue. In the list of medical Authorities this pilgrim knew "wel," the name "Rhazes" (spelled "Razis") appears, along with the more celebrated Hypocrates, Galen, Averroes, and Avicenna. Just who was Rhases that Chaucer would place him in such company? And what did the Physician know? This paper is a struggle to find answers.
 

Abu Bakr Muhammad ibn Zakariya al-Razi (c. 850-923) was a leading figure in the field of medieval medicine. Most of his reputed 250 works are not extant; others remain untranslated and uncalendared in such European libraries as the Bodleian and the Bibliotheque Nationale. A musician, a physicist, and an alchemist, he is noted for the simplicity of his methods and for his keen sense of scrutiny. He is believed to have pioneered the methods of differential diagnosis and clinical observation. The author of the fourteenth-century version of the Arabic Fihrist remarks on his clinic:

I once asked an old man of the town of Ray about Ar-Razi's clinic. He said that Ar-Razi was a serious old man with a large, drooping head who seated his pupils in rows according to their grades and attainments. It was Ar-Razi's [sic] custom to call first upon the lower class to examine a patient when he reported to the clinic. If this class failed to diagnose the patient's ailment he was handed over to the next higher class, and only after the malady had eluded the knowledge of all the disciplines did it come to the master's attention.¹
 

Rhazes's patients were thus examined and evaluated from a variety of perspectives. Such a stratified method of diagnosis is still used today in the West for medical teaching.
 

Razes's concern for precise descriptions is demonstrated by his surviving case histories, thirty-three of which were published and translated in 1935 from his magnum opus, the Continens. Although these have occasioned little interest among the medical profession - and none at all among literary scholars-they provide a cast of characters that should not be lost to us, one deliberately shaped and organized by professions and infirmities. There was, for example: a "long-bearded cotton-merchant [who] suffered from chronic pain in his stomach"; the son of the "gold smith" who had a "lachrymal fistula" (a swelling in the tear gland); "our neighbor, the cloth merchant from the Street of Lucerne [who] suffered from epileptic fits from his childhood; he was slim"; "a bookseller, named Nazif, [who was an] epileptic by his face as I saw that his Jugular veins were full, his face red and puffy. He was stout, with red eyes and of plethoric condition" (Meyerhof, ff). Rhazes observes, prescribes, and evaluates. And his patients thrive: "It was only a few days before he was able to move both his legs"; "all the people who were near her wondered at this astonishing fact that her eye was saved"; an obese individual "was completely restored and his body began simultaneously to lose flesh." These characters are made vivid to us by Rhazes's penetrating eye.²
 

Rhazes's unusual attentiveness to medical detail resulted in his famous treatise on "Smallpox and Measles," where, for the first time the one disease was distinguished from the other. Both ailments involved fever, pain in the back, itching in the nose, and terrors in the sleep. The inflicted could expect a "pricking" of the body, inflamed facial color, and a "vehement redness in both cheeks" and eyes. The voice would be hoarse, the breath dry, and the spittle thick. But there are differences in the two disorders, Rhases notes:
 

The inquietude, nausea and anxiety are more frequent in the measles than in the smallpox; while on the other hand, the pain in the back is more peculiar to the smallpox than to the measles.
 

This treatise of Rhazes's was translated into multiple languages, and served as a guide and a format, well into the eighteenth century, for diagnosing diseases of the skin.
 

And finally, for our purposes here, Rhazes's treatise "Upon the Circumstances Which turn the Head of Most Men from the Reputable Physicians," sets out clear ethical standards for the medical profession:
 

The physician should desire the cure of the patient more than his fee, he should also prefer the treatment of the poor to that of the rich, he should be thorough in his instructions and prodigal in benefiting the public.
 

Rhazes's "Al-Mansuri" contains a scathing commentary on medical quacks and charlatans: individuals who inserted frogs, worms, and other objects into their patients' bodies and then pretended to take them out; "doctors" who sucked water out of the victim's ear (which they had actually put in from a tube in their mouths). In the name of healing, such "physicians" performed magic "tricks": drawing snakes and lizards from patients' noses, or curing distemper by collecting all the "floating humors of the body to one place by rubbing [that place] with winter-cherries." Scrutinize your physicians, Rhazes warns his audience: "No wise men ought to trust their [own] lives in their hands, nor take any more of their medicines, which have proved fatal to so many." (Sadi, p. 70). With that caveat in mind, let us return to Chaucer.
 

Chaucer's Doctor of Physic knew Rhazes "wel," but what exactly did the Doctor know? The listing of medical authorities with whom this pilgrim was familiar is, in some ways, formulaic, like enumerations of spices or of wicked wives. Rhazes is sometimes included, sometimes not. Dante apparently places Rhazes in Hell 's first circle, as "him who made the Great Commentary " (presumably the Continens). Juan de Meun lists Rhazes as one of the physicians who fell into Death's snare (i.e., even doctors die), along with Hippocrates, Galen, and Avicenna. But Chaucer's use is different: Rhazes is attached to the Physician - a part of the Physician's very being - the portrait of a man who was also grounded in "surgerye." Because we are expected to understand the allusion, it is in the contemporary surgical manuals that we may find out what the Physician knew.
 

Information on Rhazes is relatively "set" in such manuals; thus, we do not have to try to determine which works the Physician would actually have read. For the purposes of this paper I am drawing here from "cirurgies" of Lanfranc and of Guy de Chauliac.³ Rhazes is generally quoted first on a physician's appearance, obviously working from the theory that a better-looking doctor would be a better doctor. He should be comely, Rhazes says, "wel proporcyonede" and with a "temperate" complexion. Otherwise, he could not have "gode maners," by which is presumably meant both a good character and an appropriate behavior. About the patient, Rhazes notes that a wounded man - particularly if he be wounded in the head - should abstain from drinking wine. His wound should be carefully cleansed so that new flesh can develop, and then he should be treated with a medicinal herb, such as that made from daisies. Razis recommends an ointment so that a man shall "have more hair than he has," or dye it "yellow" or "white," or keep the ends from splitting. A sharp, bitter powder, placed on the pelottis will cause an individual to purge fleume - a directive which is followed by a recipe.

Itchy skin, whether dry or moist, can be cured by various of Rhases's ointments; specific recipes follow. Rhazes is quoted on joint pain, on gout, and on severe "opthalmia," where the eyes are red and burning but there is no swelling. Rhazes recommends taking milk from a woman who has nourished a baby girl and making eye salve from it. This information and more, presumably the Physician knew "wel."
 

But what did Chaucer know? Apparently, a considerable amount. I am not suggesting that the poet numbered among his "sixty bokys, olde and newe" copies of the Al-Mansura or the Continens, and he is much more frequent in his references to Galen and to Hippocrates (the latter sometimes used as a synonym for "doctor") than to the Arabic physician. But I do believe that Chaucer was careful in his inclusion of Rhazes in the Physician's portrait, and knowing something about Rhazes helps us to know something about the medical knowledge the Physician carried about in his head, both heightening and expanding this character.
 

A knowledge of the surgical manuals is, in fact, crucial to the understanding of this pilgrim, much more so than the stripped-down versions of doctors in Estates Satires which were originally taken from these medical works. The explanations of surgery, astronomy, natural magic, humors, Authorities, dietary habits, and personal demeanor that fill their pages is what Chaucer's pilgrim is made of. And knowing the proper sources allows us to know the Doctor of Physic in a distinctive way.
 

Chaucer employs a number of medical terms in his works, many of them esoteric; all of them carefully placed. Ralph Elliott notes that, within the Doctor's portrait, Chaucer uses the words "cordial," meaning "medicine for the heart," and "digestible" (easy on the stomach) for the first time in recorded history, although these words might not have been new in the oral tradition. The words "drogges" for drugs and "letuaries," for medicinal mixtures (both in l. 426 of the pilgrim portrait) are "quite rare"⁴ (Elliott, p. 307). The first use of the word "patient" to mean "person receiving medical treatment" is found in the Troilus (307); Pertelote lectures at length on laxatives; and Canacee makes special salves to cure her hawk. Chaucer characterizes with medical symptoms: with humors, yes, but also with the Cook's mormal, the Summoner's "fire-red" face, the Pardoner's lack of hair. And how much more is there in his texts that the first audience would have known but we do not? What exactly did Chaucer mean when, in the House of Fame, he speaks of "clerkes"
 

which konne wel

All this magic naturel,

That craftely do their ententes

To make, in certeyn ascendentes

Ymages, lo, thrugh which magik

To make a man been hool or syk

(Book III, 1265-1270)
 

Do these "clerkes" cure with legitimate drugs? Or do they "craftely" pull lizards out of noses? There may be much more here for mining.
 

While much of Chaucer's medical knowledge would have been "in the air," we must not preclude the possibility that he did his research and did it thoroughly. Chaucer scholars, so attuned to belletristic sources (Ovid, Dante, and the like) are less sensitive to literary sources from other disciplines when Chaucer uses them - and he uses them often. In a forthcoming book on Chaucer's "Legal Fiction,"⁵ I have argued that the poet read records and tracts from law, and that he used them in innovative, poetic ways. I suggest that the plot for the "Shipman's Tale" originated from a customary law on loaning money, and that the frame of the Canterbury Tales owes much to ordinances from the Manor Courts. Chaucer saw genre in laws: bills, complaints, quitclaims, milling ordinances, and writs thread throughout his works. And although medical manuals per se are beyond the scope of this present study, they contained genres as well. Medical students at Oxford studied logic and grammar along with "cergurie and physics," so it is not surprising to find that textbooks written for them contain "descriptios" (i.e., Razes' "diseases from head to foot"), enumerated portrayals of "sick" people who become the "ugly" people of medieval romance, echoes of saints' lives with their miraculous cures, and heroic stories of "good" doctors who performed heroically. The correlations are striking.
 

I still cannot read Reynolds MS 5087, but I am totally engaged with it now. The fifteenth-century Hebrew translation of a Latin text on disease written by a Persian physician of the tenth century is a wealth of history and knowledge--of early medicine, certainly, but also, unexpectedly, of Chaucer.

1. L. M. Sadi, “The Millennium of Ar-Razi (Rhazes, 850-932 A. D.?),” Annals of  Medical History n.s.7 (1935): 62.

2. For these descriptions and others, see Max Meyerhof, “Thirty-Three Clinical Observations by Rhazes (circa 900 A.D.), Isis, 23 (1935): 321-72.

3. See  Lanfrank’s “Science of cirgurie,” part I, ed. Robert von Fleischhacker (Millwood, N. Y.:  Kraus Reprint Co., 1975) and The Middle English Translations of Guy de Chauliac’s Treatise on “apostemes,” Book II of The Great Surgery, ed. BjÅrn Wallner (Lund, Sweden:  Lund University Press, 1988-1989).

4. Ralph W. V. Elliot, Chaucer’s English  (London:  AndrJ Deutsch Limited, 1974), pp. 305-09.

5.  Chaucer’s “Legal Fiction”:  Reading the Records (London and Toronto:  Associated  University Presses, 2001).  For studies on the Shipman’s Tale and the General Prologue (cited below), see, respectively, “Chaucer’s ‘Queinte Termes of Lawe’: A Legal view of the Shipman’s Tale,”  ChauR 22 (1988):  295-304, and “Chaucer’s ‘Court Baron’:  Law and The Canterbury Tales,” Studies in the Age of Chaucer 16 (1994):  29-44.
 
 
 
 
 
 

Copyright ©2000 by Mary Flowers Braswell
 

An image of the Rhazes manuscript:
Scroll down to paragraph three and click on "Ninth Book of the Al'Mansuri,"
with thanks to University of Alabama archivist Mike Flannery

Mary Flowers Braswell, Professor of English at the University of Alabama, Birmingham, is the author of the forthcoming Chaucer's Legal Fictions, and The Medieval Sinner, as well as numerous articles, essays and reviews. She edited Ywain and Gawain and Sir Perceval of Galles for the Middle English Text Series, and co-edited The Arthurian Tradition: Essays in Convergence (University of Alabama Press, 1983).