Rufus of Ephesus (fl. c. a.d. 100) wrote a large body of works on a variety of medical topics.Footnote 2 Generally speaking, the Arabic tradition is particularly important for the reconstruction of much of his œuvre.Footnote 3 In the present article, I am going to present four new fragments of Rufus’ On Melancholy and a fragment from an otherwise unknown monograph On Preferring Fresh Poppies. These new fragments provide fascinating new insights into Rufus’ approach to recording case histories.
Rufus’ On Melancholy in two books was translated into Arabic some time in the ninth century. The Greek text and the Arabic translation have not come down to us in their entirety, but survive in later quotations in authors such as Aëtius of Amida (fl. c.500–550) and Abū Bakr Muḥammad ibn Zakariyāʾ al-Rāzī (d. c.925).Footnote 4 We have a few Latin fragments, based on the Arabic translation, and, as Fischer has shown, on the Greek text as well.Footnote 5 Moreover, a number of new Arabic fragments have come to light.Footnote 6 Rufus adhered to the idea of humoral pathology as developed in the Hippocratic treatise On the Nature of Man; and black bile, one of the four humours, obviously played a major role in his conception of melancholy. The new fragments collected here illustrate two facets of Rufus’ approach to medicine that have recently come into clearer focus: the dialogue with the patient,Footnote 7 and the relationship between physiological and psychic events.Footnote 8 The four new fragments presented here deal with the case of a patient who, owing to a bout of melancholy, does not feel pain, not even when the searing heat of a cautery iron burns his flesh.
The new fragments all come from Arabic commentaries on the Hippocratic Aphorisms. Footnote 9 Briefly, we have a dozen commentaries in Arabic on this text, dating from the eleventh to the fifteenth centuries a.d. It is a complex exegetical tradition in which later commentators often rely on earlier ones, although, naturally, they also criticize their predecessors and modify common sources. The four fragments illustrate one aspect of this tradition, namely how a quotation to which at least one commentator still had direct access in Arabic was reshaped and modified by later exegetes. Moreover, the later Arabic sources also provide secondary evidence for the textual state of the tradition.
Manfred Ullmann had already identified one fragment relating to this episode more than twenty years ago, and I subsequently included it in my collections of fragments from Rufus’ On Melancholy as F24.Footnote 10 It is taken from The Clear Guide on How to Treat Patients (al-Kitāb al-Wāḍiḥ al-dalīl fī mudāwāt al-ʿalīl) by Muḥammad ibn ʿAlī ibn ʿAbd Allāh al-Tawahhumī, an author about whom nothing is known, and runs as follows:Footnote 11
[1] Rufus said: ‘I cauterized someone who suffered from this ailment [melancholy] with a hot knife. [2] I put it onto one of the parts [of his body], but he [the patient] did not feel the fire. [3] He then said: ‘Increase your fire; it is cold’,Footnote 12 for the sensation had ceased. [4] There were many ulcers on his legs, since the blackness had reached the lower part of the body, because of the frequent motion of the legs.’
Three additional fragments all come from commentaries on aphorism 7.40, which runs as follows in Greek and Arabic:Footnote 13
ἢν ἡ γλῶσσα ἐξαίφνης ἀκρατὴς γένηται ἢ ἀπόπληκτόν τι τοῦ σώματος, μελαγχολικὸν τὸ τοιοῦτον.
قال أبقراط :متى عدم اللسان بغتة قوّته أو استرخى عضو من الأعضاء فالعلّة سوداوية.
Hippocrates said: when the tongue suddenly loses its power or a part of the body becomes limb (istarḫā), then the disease is melancholic.
The first extant exegete to mention Rufus when commenting on this aphorism is Ibn Abī Ṣādiq. He died after 1068 and was called the ‘second Hippocrates (Buqrāṭ al-ṯānī)’ owing to the fame of his Commentary on Hippocrates’ ‘Aphorisms’ (Šarḥ Fuṣūl Buqrāṭ), which survives in more than forty manuscripts.Footnote 14 He begins his commentary on this lemma with an explanation of the verb istarḫā, which here means ‘to lose sensation and movement (fuqdān al-ḥiss wa-l-ḥaraka)’. He then criticizes Galen for being wrong about the aetiology of this phenomenon: it is not caused by black bile or phlegm but by a hard swelling and bad mixture. Ibn Abī Ṣādiq then says (F24a)Footnote 15:
[1] وافهم أنّ الروح الحسّاس إذا خالطه البخار الغليظ السوداوي امتنع من النفوذ في آلات الحسّ [2] فيعرض الخدر والاسترخاء دفعة. [3] وقد حكى روفس أنّه شاهد ماليخوليا يزعم أنّه غير فاسد بالموت [4] لأنّه ليس يحسّ بالجوع والعطش ولا بالألم، [5] إذا ضرب. [6] قال: «فأحميت حديدة بالنار ووضعتها على ساعده. [7] فاحتملها زماناً طويلاً بقول: [8] ‹زِدني كَيّك، [9] فإنّ نارك باردة.› [10] ثمّ بعد الجهد الكبير لمّا رأى لحمه يحترق وشمّ رائحة القتار يسيراً، [11] انتبه على أنّ ما قاله كاذب.
[12] وأيضاً فإنّFootnote 16 السوداء لغلظها وأرضيتها تصلب العصب وتفعل فيه جسواً Footnote 17 [13] حسب ما تفعله في الورم المعروف بسقيروس. [14] فتمنع مسالك الروح النفساني من أن يعبرها الروح.
[1] Know that when the sensing pneuma (al-rūḥ al-ḥassās) is mixed with thick melancholic vapour, it is prevented from penetrating to the organs of sensation. [2] This then results in sudden numbness (ḫadar) and limpness (istirḫāʾ). [3] Rufus recounted that he witnessed that a melancholic believed that he was incorruptible by death, [4] because he did not feel hunger, nor thirst, nor pain, [5] when he was hit. [6] He [Rufus] said: ‘I heated a [cautery] iron in the fire and placed it on his forearm. [7] He bore it for a long time, saying: [8] “increase your cauterization, [9] for your fire is cold”. [10] Then, after a lot of effort, when he saw that his flesh was burning and smelled some odour of [flesh] being fried, [11] he realised that what he had said was false.’
[12] Also, because black bile is viscous and earthy, it hardens the nerves and produces hardness in them, [13] just as it does in the case of the swelling called skîros, [14] so that the pathways of the psychic pneuma are prevented from letting the pneuma pass through them.
This is by far the most complete version of our case history, and appears to contain some verbatim quotation from Rufus’ On Melancholy, here put in inverted commas (§§6–11). In particular, although sharing some material with the fragment in al-Tawahhumī (F24), it is longer and more detailed.
Two other, later commentators mention Rufus in the context of commenting on aphorism 7.40 as well, but these two shorter fragments appear to be based on Ibn Abī Ṣādiq rather than presenting an independent tradition. In fact, the first commentator, al-Sinǧārī, repeats quite a bit of Ibn Abī Ṣādiq verbatim, without, however, acknowledging his source (F24b):Footnote 18
[1] وقد حكى روفس أنّه شاهدFootnote 19 رجلاً به ماليخووليا، [2] وكان لا يحسّ بالألم ولا بالوجع ولا بالجوع ولا بالعطش. [3] قال فأحميت حديدة حتى طال زمانها في النارFootnote 20 ووضعتها على ساعده، [4] وهو يقول ‹زدنيFootnote 21 زدني .› [5] ثمّ بعد الجهد لمّاFootnote 22 <lacuna> أحسّ برائحة حريق جسمه
[6] والسوداء لغلظهاFootnote 23 والأرضية التي فيها تصلب العضو وتفعل فيه جسأة، [7] حسب ما تكون في الورم المعروف بسقروس، [8] فتمنع مسالك الروح النفساني من أن يعبّرهاFootnote 24 الروح.
[1] Rufus recounted that he witnessed a man suffering from melancholy [2] and he did not feel pain, nor ache, nor hunger, nor thirst. [3] He [Rufus] said: ‘I heated a [cautery] iron in the fire for a long time, and put it on his forearm; [4] he was saying: “increase [it], increase [it]”. [5] Then, after a lot of effort, when he sensed the odour of the body being burnt … <lacuna>’.
[6] … and black bile, because it is viscous and earthy, which hardens the part of the body and produces hardness in them, [7] just as it does in the case of the swelling called skîros, [8] so that the pathways of the psychic pneuma are prevented from letting the pneuma pass through them.
Whereas al-Sinǧārī follows Ibn Abī Ṣādiq quite closely in §§1–5 (corresponding to F24a §§3–7), he quotes him verbatim but without acknowledgment in §§6–8. Between §§5 and 6, some text must have fallen out, as the comparison between the two authors clearly shows.
Al-Sīwāsī, an author of the early fourteenth century, also appears to rely on Ibn Abī Ṣādiq, although he provides merely a brief summary (F24c):Footnote 25
[1] وقد يكون لأن الخلط السوداوي غلّظFootnote 26 الروح النفساني في الدماغ وكدّره [2] بحيث يمتنع من النفوذ في المجاري [3] أو إن نفذ لغلظه لا تعمل قواه أفعالها. [4] والذي يكون بغتة هو هذا السبب، [5] لأن سائر الأسباب لا يكون إلّا بالتدريج. [6] وهذا كما حكينا عن روفس أنّه شاهد مجنوناً لم يحس بالحرق.
[1] It [loss of sensation] can also be caused by the melancholic humour making the psychic pneuma viscous and dark, [2] so that it is prevented from penetrating through the passageways; [3] or even if it penetrates, its faculties do not carry out their functions, because it is viscous. [4] What happens suddenly is due to the cause, [5] since the other causes only occur gradually. [6] This is as we have reported here on Rufus’ authority, who witnessed that a madman did not feel being burnt.
Paragraphs 1–2 correspond to F24b §§1–2, whereas §§3–5 contain different material, partially summarizing information in Ibn Abī Ṣādiq and Galen. The whole Rufus episode gets reduced to one short sentence (§6).
Finally, we find a fragment in some of the manuscripts preserving Ibn Abī Ṣādiq's commentary. The context is his commentary on aphorism 2.6:Footnote 27
ὁκόσοι, πονέοντές τι τοῦ σώματος, τὰ πολλὰ τῶν πόνων μὴ αἰσθάνονται, τούτοισιν ἡ γνώμη νοσεῖ.
قال أبقراط :من يوجعه شيء من بدنه ولا يحسّ بوجعه في أكثر حالاته فعقله مختلط.
Hippocrates said: ‘Those who suffer pain in some part of their body without feeling it in most cases, have a confused mind.’
There are two different commentaries on this aphorism. In the majority of the manuscripts, Ibn Abī Ṣādiq explains this aphorism at some length by linking the faculty of intellection (al-qūwa al-ʿaqlīya) to the faculty of sensation (al-qūwa al-ḥassāsa), as both are located in the same place, namely the brain. Let us call this version the main one. Yet, in one manuscript (CB1), we find an alternate version after the main version which is introduced as follows: ‘The writer of the original [manuscript] mentioned that during collation he found another commentary on this aphorism in a different manuscript (Ḏakara kātibu l-aṣli annahū waǧada fī nusḫati ġayri l-aṣli waqta l-muqābalati šarḥan āḫara li-hāḏā l-faṣli.)'Footnote 28 Then follows the Hippocratic lemma and a full commentary, introduced by the word ‘commentary (al-tafsīr)’. This alternate version is also preserved in another manuscript (S2), which lacks the main version.Footnote 29 That these two versions circulated is probably due to the fact that Ibn Abī Ṣādiq revised his commentary.Footnote 30 In this alternate commentary on 2.6, he linked this aphorism to melancholy, and especially to melancholic vapours rising to the brain. He also mentions religious melancholics who are too absorbed to feel pain. At the end of his commentary on this lemma, Ibn Abī Ṣādiq states (F24d):Footnote 31
[1] وذلك أن الأرواح النفسانيّة إذا غلظت وتكدّرت فيهم بالأبخرة الغليظة السوداويّة، امتنعت من النفوذ إلى الأعضاء على ما ينبغي. [2] فلا يحسّون بأوجاع كثيرة تعرض لهم. [3] فقد ذكر روفس الكبير أنّ واحدًاFootnote 32 من أصحاب المالنخوليا لم يكن يحسّ بما ينخس من بدنه أو يرض، [4] وأنّه كُوِي في ساعده، فلم يصدق بالكي إلا أن احترق منه شيء صالح.
[1] For when psychic pneumas become viscous and turbid in them [sc. the patients] because of thick melancholic vapours, they are prevented from penetrating to the parts of the body as they should. [2] Then they do not sense many pains that befall them. [3] The great Rufus mentioned that one of those suffering from melancholy did not feel it when one pricked or prodded his body. [4] He [the patient] was cauterized at his forearm, but he did not believe that he was cauterized until a healthy part of his [body] burned.
This constitutes a shorter paraphrase of the longer version given by Ibn Abī Ṣādiq when commenting on aphorism 7.40 (F24b). Now that we have seen the various versions of this episode, we can draw some conclusions.
When one combines the four new fragments with the previously known F24, they offer quite a bit of new information. Clearly, F24a presents the fullest account, and we therefore have to assume that Ibn Abī Ṣādiq had either access to Rufus’ On Melancholy in Arabic translation or an intermediary source. There is still a small chance that this intermediary source could have been the Important Chapters on the Medicine of the Masters (Al-Fuṣūl al-Muhimma fī ṭibb al-ʾAʾimma) by Sarābiyūn ibn Ibrāhīm (who can be dated to the eleventh century or later; not to be confused with Yuḥannā ibn Sarābiyūn).Footnote 33 It contains Rufus’ Case Notes and, since these Case Notes are not complete, Ibn Abī Ṣādiq could presumably draw on the lost part here. It is more likely, though, that he draws on Rufus of Ephesus’ On Melancholy.
We clearly see Rufus here talking about a specific case, an actual patient whom he treated. The patient labours under the illusion that he is immortal (F24a §3); he does not feel hunger and thirst (F24a §4), nor pain when he is beaten (F24a §§4–5). The most striking consequence of this, however, is the fact that even when cauterized the patient does not feel anything. He even asks to be cauterized more. Only the smell of his burning flesh alerts him to the fact that he is being burnt (F24a §§10–11). Moreover, his legs have ulcers, because the melancholic humour has descended there (F24 §4). The new fragments, and especially F24a, thus give us a more vivid and detailed picture of Rufus’ melancholic patient who could not feel pain.
Moreover, the fragments illustrate nicely how a passage from an ancient author of great authority such as Rufus of Ephesus went through numerous mutations. The following scenario appears to be the most likely. When Ibn Abī Ṣādiq first commented on aphorism 2.6, he was not yet aware of Rufus’ report of the melancholic not feeling pain. By the time he reached aphorism 7.40, he had sight of Rufus’ On Melancholy, or possibly an intermediary source citing this episode. When Ibn Abī Ṣādiq then revised his commentary at a later stage, he included this episode in his new commentary on aphorism 2.6. None of the subsequent commentators mentions it in the context of 2.6, which goes to show that the earlier version circulated much more widely and had a greater influence. It is from this earlier version that two later commentators drew when providing their explanation of 7.40. The older al-Sinǧārī quotes Ibn Abī Ṣādiq at times verbatim, although without acknowledgment. The younger al-Sīwāsī merely gives a short summary of the episode, taken most likely again from the earlier version of Ibn Abī Ṣādiq's commentary. Despite the vagaries of the transmission of Rufus’ thought, the Arabic commentaries on the Aphorisms clearly constitute a rich source for otherwise lost Greek ideas. What is more, this source is now freely available under a creative commons licence, so that anybody can draw from it.
RUFUS’ ON PREFERRING FRESH POPPIES
The Hippocratic Treatments (al-Muʿālaǧāt al-Buqrāṭīya) by the tenth-century author al-Ṭabarī is another prominent source for quotations from ancient authors, not least from Rufus’ On Melancholy.Footnote 34 It contains a chapter (5.15) ‘On earache brought about by warm winds settling in the ears, and causing pain and tension’, in which we find the following interesting quotation:Footnote 35
[1] وذكر روفس في مقالته في فضل الخشخاس الرطب فقال: [2] «دخلت بستاناً، [3] وأكلت من بقايا رطب الهلياث ومن بُسْر السكر. [4] فأويت إلىFootnote 36 فَيْءِ شجرة ونمت. [5] فلمّا انتبهت ولم أشك إلا وأن الحية قد لسعت أذني، وقمتFootnote 37 كالهائم. [6] فوجدت في البستان بقايا خشخاش رطب، [7] لأن زمانه قد كان ذهب. [8] فأكلت منه الكثيرFootnote 38 [9] ونزلت في الماء البارد. [10] فسكن الوجع بعد ساعة، [11] حتى كأنه لم يكن. [12] وقمت مجلسا كثيرا. [13] فعلمت أن الخشخاش نفعنيFootnote 39 كثيرا، [14] وأن الماء البارد برد الأذنين من خارج [15] وعدل المزاج الذي كان قد احتد، [16] وقويت الطبيعة بقوة البدن، [17] فدفعت ذلك عن المعدة والأمعاء. [18] واجتماع هذه الأسباب أزال تلك العلة. [19] وأنها كانت بخارات حادة ارتفعت من معدتي إلى الرأس. [20] فتولد ذلك من أكلي الرطب الكثير.
[1] In his treatise On Preferring Fresh Poppies, Rufus gave the following account: [2] ‘I entered a garden [3] and ate the remnants of fresh figs [raṭb al-hilayāṯ] and sweet figs [busr al-sukkar]. [4] I then repaired to the shade of a tree and slept. [5] When I awoke and I had no complaint other than that a snake had bit my ear, I rose like a madman. [6] I found remnants of fresh poppies in the garden, [7] because their season had just passed. [8] I ate a lot of them [9] and descended into cold water. [10] The pain subsided after a short while, [11] to the point that it nearly completely disappeared. [12] I frequently repeated these sessions. [13] Then I knew that the poppy had been greatly beneficial for me, [14] and that the cold water had cooled the ears from the outside [15] and improved the mixture that had become too sharp, [16] so that the nature was strengthened by the body being strong. [17] Then it [nature] pushed this [sc. the poppy] away from the stomach and the intestines. [18] The confluence of these causes removed this disease. [19] [I also learnt] that sharp vapours had risen from my stomach to the head. [20] They were generated by my having eaten a lot of fresh [figs].
The context is this: al-Ṭabarī had just described a number of recipes against warm winds (riyāḥ ḥārra) nestling in the ear, saying that, ‘if fresh poppies are in season, they are the most useful thing to eat for this disease, by providing a relief against these vapours (in kāna awānu hāḏā l-ḫašḫāši l-raṭbi fa-akluhū min anfaʿi l-ašyāʾi li-hāḏihi l-ʿillati wa tusakkinu hāḏihi l-buḫārāti)’. Then follows our fragment and afterwards further recipes of things to be introduced into the ear. In other words, the quotation is well framed and appears to be verbatim.
First, we ought to note that al-Ṭabarī quotes from Rufus’ ‘treatise [maqālatihī] On Preferring Fresh Poppies’. This suggests that at least al-Ṭabarī thought that Rufus had written such a work and was now quoting from it. Yet, to date, such a title has not come to light in connection with Rufus of Ephesus. Therefore, there is the possibility that the quotation actually derives from Rufus’ large work On Foodstuffs (Περὶ διαίτης), of which a large number of fragments survive.Footnote 40 One of these fragments does deal with poppy and comes from Muḥammad ibn Zakarīyāʾ al-Rāzī’s Comprehensive Book (al-Kitāb al-Ḥāwī), a notoriously difficult source, because he often paraphrases and distorts his predecessors, sometimes beyond recognition, although he also has verbatim quotations.Footnote 41 It runs as follows:Footnote 42
[1] روفس قال: [2] الخشخاش عاقل للطبع، [3] وخاصة الأسود والبستاني منه، [4] ويسمى مروريا؛ [5] يؤكل وينوم باعتدال: [6] والذي يسيل بزره [7] ويسمى «السيال»، [8] فليس يؤكل بل هو كالدواء، [9] والأسود البزر شديد البرد . والمستطيل البزر يخدر؛ [11] ومنه يصنع الأفيون. [12] والمقرن ينقي ويقطع [13] حتى أن طبيخه نافع من وجع الكبد [14] وورقه وزهره ينقيان القروح الوسخة جدا وينزعان أثر الكي. [15] وأما الإرَقليFootnote 43، [16] ويسمى الزبدي أيضا، [17] فإن بزره يسهل الخام [18] ويشفي من البلغم.
[1] Rufus said: [2] poppies bind nature, [3] especially the black and domestic varieties, [4] called ‘passing [murūrī]’; [5] it is eaten and induces moderate sleep. [6] The variety which has seeds provoking ‘flowing’ [diarrhoea], [7] called ‘the flowing’ [al-sayyāl], [8] is not eaten but used like a drug. [9] The variety that has black seeds is extremely cold. [10] The variety that has long seeds has a numbing effect; [11] it is used to make opium. [12] Horned [poppy] cleanses und cuts, [13] so that its decoction is useful against the pain of the liver; [14] its leaves and flowers greatly cleanse impure ulcers and remove cautery scars. [15] The Herculean variety, [16] also called foam-like [that is, μήκων ἀφρώδης], [17] has seeds which ease raw [matter] [18] and cure phlegm.
The information provided here about the ‘Herculean variety’ (§§ 15–18), for instance, is a somewhat loose quote from Galen's On Simple Drugs 7.15 (ed. Kühn 12.74, line 17 – 12.75, line 2): μήκων ἡρακλεία, καλεῖται δὲ καὶ ἀφρώδης …. καθαρτικὸν δ’ ἔχει φλέγματος τὸ σπέρμα. It is impossible to decide at this stage whether al-Rāzī is drawing here on Galen rather than on Rufus; whether Galen incorporated information found in Rufus; or whether there is a common source.
Be that as it may, let us return to the fragment from the Hippocratic Treatments. It constitutes a first-person account of an injury: Rufus was bitten by a snake whilst napping in a garden after having eaten some figs. He finds relief from the severe pain by eating fresh poppy and immersing himself in old water, a procedure which he repeated frequently. Rufus draws the conclusion that the combination of fresh poppy consumption and cold water brought about the easing of the pain. He ends with a remark about sharp vapours that move from the stomach to the brain, owing to what he had previously eaten. We can only speculate how this first-person account fits within a treatise on preferring fresh poppies, about which we know nothing else. The first-person account of this episode fits well with Rufus’ tendency to speak in his own voice.Footnote 44 Poppy seed and opium were used both in antiquity and in the medieval Islamic world, and Rufus’ treatise appears to be part of this tradition.Footnote 45 This is the first fragment from this treatise by Rufus; it can only be hoped that more fragments, whether in Greek, Arabic or Latin, will come to light and round out our picture of this perceptive and influential clinician.
