Month: March 2012

ninth-century physician Bakhtishu saves man with bird-shit medicine

Ancient Mesopotamian, Egyptian, Indian, Talmudic, Greek, and Roman physicians agreed that animal excrement has valuable medical uses.  Herophilus, founder of the great medical school in Alexandria early in the third-century BGC, introduced camel dung and camel urine into Greek medicine.  The hugely influential Greek physician Galen used pigeon dung in wound dressings.[1]  Not merely a curiosity of primitive cultures, medical use of excrement (dreckapotheke), like blood-letting, existed within well-developed, scholarly medical knowledge.

In ninth-century Baghdad, Bakhtīshū`, of the illustrious Bakhtīshū` family of Abbasid royal physicians, turned to mixed bird droppings in a medical emergency.  A fat, wealthy man took medicine and then greatly over-ate, despite Bakhtīshū`’s order not to do so.  The fat man’s belly swelled even further, and his breathing became heavy.  He appeared to be on the brink of death.  The man was quickly hoisted onto a camel and carried to Bakhtīshū`’s house:

All this happened on a very sultry day, and Bakhtīshū` was hot and bothered, standing outside his house.  He asked about the man’s condition and was informed of the whole story.  Bakhtīshū` had more than two hundred birds in his house — cuckoos, hoopoes, white birds and the like.  They had a large drinking pool full of water, which was now heated by the sun, and the birds had left their droppings in it. The physician called for coarse salt and ordered it to be thrown into the pool and dissolved in the water.  He then ordered a funnel and made the man drink it all, while he was still unconscious.  He told us to stay away from him, and indeed he evacuated abundantly from the upper and lower parts.  He became so weak that it was necessary to sustain him with perfume and francolin dung. But, after several days, to our great astonishment, he recovered.  Having asked Bakhtīshū` about his case, he told me: ‘I was thinking his case over and realized that if we should use a medicine he would be dead by the time it was all prepared and administered.  Now, we treat people afflicted by severe colic with pigeon dung and salt.  The birds’ drinking pool, heated in the sun and full of dung, was exactly what he needed, and this was the fastest way it could be administered.  So I treated him thus, and by the grace of God it worked.[2]

Bakhtīshū` was recognized to possess extensive medical learning.  He reasoned carefully in this case.  There’s no arguing with his success, either in becoming a wealthy personal physician to the Abbasid Caliph Al-Mutawakkil or in this particular case.  But kids, don’t try this yourself with your family’s bird-bath.  You shouldn’t presume upon the grace of God.

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Notes:

[1] Von Staden (1989) p. 18.  Galen recommended the use of pigeon dung in his work, De compositione medicamentorum per genera, 3.6.

[2] Recounted in Ibn Abi Usaibia’s History of Physicians (HP), pp. 275-6.

References:

HP: Ibn Abi Usaybi’ah, Ahmad ibn al-Qasim. English translation of History of Physicians (4 v.) Translated by Lothar Kopf. 1971. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 294.  Online transcription.

Von Staden, Heinrich. 1989. Herophilus: the art of medicine in early Alexandria: edition, translation, and essays. Cambridge: Cambridge University Press.

non-profits' distribution of management expenses

At the recent DC Data Dive, GuideStar put out for analysis some IRS financial data for non-profit organizations.  The non-profits are identified only by an ID number, topic of work, and geographic scope. The question for the data dive was: “What financial data may be predictive of an organization’s defunct status in two years?”  Volunteer data analysts went at that question with various data analysis and modeling strategies.

The financial data for the non-profits includes expense data partitioned into the categories program services, management, fundraising, and payments to affiliates.  A rudimentary means for evaluating non-profits is to look at management, fundraising, or overhead expense ratios.  The meaningfulness of those ratios depends on accounting distinctions between expenses.  Is formulating plans to expand a program a management expense or a program expense?  Is reviewing a program a management expense or a program expense?  The answers to these sorts of accounting questions aren’t obvious, but the answers clearly affect expense ratios.  Moreover, accounting, like everything else, responds to incentives.  Since non-profits are commonly measured on expense ratios, innovative accounting is likely to favor lower expense ratios.

Analysis of digit distributions can provide insight into data-generating processes.  Across orders of magnitude, numbers that are the outcomes of exponential growth processes, or are choices from uncorrelated probability distributions, have first-digit distributions that follow Benford’s Law. Numbers that human or industry conventions select are less likely to follow Benford’s Law.  Does the digit distribution of non-profits’ management expenses follow Benford’s Law?

In any data analysis, understanding the data is fundamental.  The non-profit dataset consists of multiple years of observations for many non-profit organizations.  Time-series data for a single organization is generated differently from cross-sectional data for a set of organizations.  Nonetheless, I combine these two different data types to get a sufficiently large sample to analyze the non-profits by topic.  The analysis thus conflates data generation within and across organizations.

Preliminary review of the data suggested that management expenses for organizations serving “At-Risk Youth” and “People with Disabilities” provide an interesting comparison.  Both types of organizations serve individuals.  Their shares of reviewer-identified “top” organizations are relatively close.  Both have about 900 management expense figures in the dataset.  Thus distribution tests for these two groups have considerable and roughly comparable power.  Kernel density plots show that the management expense distributions for each group are similar and have much probability density across more than two orders of magnitude.  Hence fitting their first-digit distributions to Benford’s Law seems reasonable.

Despite organizational and statistical similarities, the first-digit distributions for “At-Risk Youth” and “People with Disabilities” management expenses differ significantly.  Management expenses for “At-Risk Youth” organizations are strongly inconsistent with Benford’s Law.  Management expenses for “People with Disabilities” organizations show no evidence of being inconsistent with Benford’s Law.  What accounts for that difference?

A quantile-quantile (Q-Q) plot of management expenses (plotted in base-10 logarithms) indicates that the distributions differ most in their tails.  Nonetheless, if the digit-distribution test is applied only to management expenses greater than $10,000 and less than $10,000,000, the results still differ significantly.  Across that subset of management expenses, the p-values for log-likelihoods for Benford Law are 0.0039 and 0.0601 for “At-Risk Youth” and “People with Disabilities” organizations, respectively.  The Q-Q plot over that range displays a undulation apparently associated with the different digit distributions.  Management expenses for “At Risk Youth”, combined across organizations and over time, appear to be more conventional and less naturally selected than those for “People with Disabilities.”

Natural selection, for numbers, organizations, and organisms, is generally associated with increased fitness.  I thus tentatively predict that organizations serving “People with Disabilities” are more effective and less likely to go defunct than those serving “At-Risk Youth.”

All the data used in the above analysis are publicly available.  Do your own analysis to evaluate my prediction and to formulate your own predictions.

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Analysis note:  Digit distributions were tested using Ben Jann’s Digdis Stata module from the Statistical Software Components (ssc) archive. Benford’s Law log-likelihood ratio p-values for all the topics are available in this summary table.  Organizations serving at-risk youth and people with disabilities average about 9 years of management-expense figures per organization.  The figures are mainly from 1998 to 2008.

The original dataset is available here (Excel file).  Here’s some data documentation.  Here’s a tab-separated text version of the dataset, with area and topic created from the original cause field.

Asaph brought professional medicine into ancient Jewish life

Law was a problem for Jewish physicians 1500 years ago.  Jewish law describes God punishing those who do not follow God’s commandments.  God’s punishments include physical sickness:

The LORD will smite you with consumption, and with fever, inflammation, and fiery heat, and with drought, and with blasting, and with mildew; they shall pursue you until you perish. … The LORD will smite you with the boils of Egypt, and with the ulcers and the scurvy and the itch, of which you cannot be healed. … The LORD will smite you on the knees and on the legs with grievous boils of which you cannot be healed, from the sole of your foot to the crown of your head.[1]

Jewish law does not state that those who are sick did not follow God’s commandments.  Other causes of sickness could also exist.  Nonetheless, the brotherly malice that got Joseph carried off to Egypt also tends to cause sickness to be interpreted as God’s punishment.[2] That reduces demand for physicians’ healing services.

Politics was also a problem.  Jewish law describes the sick going to priests for diagnosis.[3]  Establishing non-priestly medical services would entail delicate professional politics.  Moreover, the most authoritative medical knowledge in the Mediterranean world 1500 years ago was Greek medical knowledge.  Greek medical knowledge was transmitted throughout the Roman Empire via the works of Hippocrates and Galen.  It was associated with worship of strange gods and a wide range of practices not in accordance with Jewish law.  Greeks and Jews fought bitterly in Alexandria, a center of Greek medical learning.  A Talmudic injunction declared: “Cursed be the man who would breed swine, and cursed be the man who would teach his son Greek wisdom.”[4]  How could a Jewish physician benefit from Greek medical knowledge?

Asaph’s Book of Medicines shows Jewish physicians working to make professional medicine acceptable within ancient Jewish life.  Asaph’s book aligns with the will of God medical knowledge and physicians’ healing services.  In Asaph’s book, the physician serves God and the patient.  Moreover, Asaph’s book uses Jewish wisdom to encourage Jewish physicians to study leading medical knowledge, i.e. Greek medical knowledge.  Asaph’s book constructs the Jewish physician as a fully professional physician, but distinctively Jewish and obedient to Jewish law.[5]

Asaph’s book begins with an account of the origin of medical knowledge.  This account states two causes of sickness among Noah’s children and grandchildren in the time after the deluge.  The first cause of sickness, “spirits of the bastards,” is the evil-doing other that the deluge failed to wash away completely.[6] The second cause of sickness, “human transgression and their sinful ways,” refers to God’s punishment as described in Jewish law.  Asaph thus makes clear that sickness is not just God punishing a person for disobedience.[7]

God, who Jewish scripture describes as kind and merciful, gave Noah medical knowledge.  When Noah’s children and grandchildren told Noah of their suffering in sickness, Noah was sympathetically distressed.  He sanctified his house, approached the altar and offered sacrifices, and prayed and beseeched God for relief.  God responded by giving the righteous Noah knowledge of medical healing.  Noah recorded that knowledge in a book of medicines.  Noah’s book  was the origin of medical knowledge for all peoples: “the ancient wise men copied from this book and wrote many books, each one in his own language.”

With this account of the origin of medical knowledge, Asaph’s Book of Medicines provides sound Jewish credentials for all foreign medical knowledge.  Greek medicine could claim an ancient lineage to Asclepius and Hippocrates.  However, in Jewish understanding, there is no God but the Lord, and no surviving human line can predate Noah.  Moreover, since God gave Noah medical knowledge, medical knowledge is within Jewish law.[8]

Asaph’s book includes a medical oath that largely encompasses the substance of the Hippocratic Oath.  Under the Hippocratic Oath, the physician swears to serve patients and “keep them from harm and injustice.”  Asaph’s Oath forbids the physician from approaching the patient with a haughty or vindictive spirit or harming the patient.  Both the Hippocratic Oath and Asaph’s Oath restrict surgery, require respect for patient privacy, forbid professional sexual abuse, forbid deadly drugs, and restrict abortion.  Both restrict the extent of medical fees.  In these practical aspects of ancient medical practice, Asaph’s Oath follows the Hippocratic Oath.[9]

Asaph, however, rewrites the Hippocratic Oath to create a professional covenant suitable for Jewish physicians.  The Hippocratic Oath is a declaration of the oath-taking physician.  It begins with the oath-taker declaring:

I swear by Apollo Physician and Asclepius and Hygeiea and Panaceia and all the god and goddesses, making them my witnesses, that I will fulfill according to my ability and judgement….

Such an oath would be abhorrent to a Jew.  Asaph’s Oath is structured as commandments that teachers speak to pupils and as an affirming response from the pupils.  The pupil-physicians respond to Asaph’s Oath’s commandments:

We will do all that you exhorted and ordered us to do, for it is a commandment of the Torah, and we must do it with all our heart, with all our soul and with all our might.

While gods are merely witnesses in the Hippocratic Oath, Asaph’s Oath makes God a central figure in its commands:

Now put your trust in the Lord, your God, who is a true God, a living God, for it is He who kills and makes alive, who wounds and heals, who teaches men knowledge and also to profit, who wounds with justice and righteousness, and who heals with pity and compassion.

The Hippocratic Oath concludes with a conditional petition:

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Asaph’s Oath concludes with an imperative to please God and be righteous:

keep His {God’s} orders and commandments and follow all His ways, in order to please Him, and to be pure, true and upright.

The Hippocratic Oath and Asaph’s Oath thus differ starkly not in professional practice but in the structure of ethical life.[10]

Asaph’s Book of Medicines aligns Greek medical knowledge with Jewish wisdom.  Jewish wisdom characteristically divides humanity into two polar categories — the wicked in contrast to the righteous, the wise in contrast to the foolish.  Thus the Book of Proverbs declares:

  • The wise woman builds her house, but the foolish tears it down with her own hands.
  • Whoever walks with the wise becomes wise, but the companion of fools suffers harm.
  • It is the wisdom of the clever to understand where they go, but the folly of fools misleads.[11]

Asaph’s book contrasts the wise and the foolish physician:

A wise physician studies and understands the traditional wisdom concerning the diseases and the pains in all the bones, and the cure according to the medical ethics of the ancient physicians and according to their scientific knowledge. The foolish physician who cures disregarding the medical ethics causes more damage to the body than the disease itself.

The wise physicians cured according to the four elements of the body and knew the power of the roots and pharmaceutical compounds, mixing them with each other according to their coldness, heat, humidity and dryness. Each organ was cured according to the power of the element dominating it. If a physician does not follow the instructions given in the book, he cause damage or maims the body, or transforms the disease into other diseases by curing only the symptoms of the disease. The pains of the patient are changed until he is on the verge of death. Furthermore, the foolish physician so tortures the patient until the latter prefers to die rather than to live with such a maimed body.[12]

Despite its unpoetic, prolix form, the wisdom of Asaph teaches an unmistakable lesson.  The wise Jewish physician embraces Greek medical knowledge.[13]

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Notes:

[1] Deuteronomy 28:22,27, 35.  See also Leviticus 26:16 and Numbers 12:10-11.

[2] On Joseph getting carried off to Egypt, see Genesis 37:1-28.

[3] E.g. Leviticus 13-14.

[4] Bab Kamma 82b.  See also Sotah 49b and Menahot 54b. In English, Epstein (1935).  Cited from Newmyer(1993) p. 107.

[5] For background on Asaph’s Book of Medicines, see Lieber (1984).  Lieber suggests that Asaph’s book was written in tenth-century southern Italy.  Muntner favors a sixth-century date.  Some material included within the book may be more ancient writings.  Asaph’s book is probably the oldest surviving medical text written in Hebrew.

[6] Within the Genesis narrative, the “spirits of the bastards” are Nephilim.  See Genesis 6:1-4.  However, the specific term “spirits of the bastards” suggests lack of legal relation to God the Father, the God of Abraham, Isaac, and Jacob.  It thus associates the pagan other with a cause of sickness.

[7] For the English translation of Asaph’s origin of medicine quoted above, see Himmelfarb (1994) pp. 129-30. Asaph’s Book of Medicine elsewhere affirms that physicians cannot cure all sicknesses and in particular they cannot heal sickness caused by immoral acts:

In spite of our vast experience and our deep medical investigations, we know that the physician cannot cure all the diseases; only some patients will be healed.  Even the diseases that are cured are cured with God’s help.  Many people die out of being immoral.  They pass away in sloth and feebleness since they have not behaved according to religion while being healthy.  The behavior results in disease.  When they were sick, they did not consult wise physicians; this was ordained by God.  Therefore, they die on account of having been immoral, as they walked blindly in their ways, headed towards bloody acts and did not resist temptation.

Trans. Muntner & Rosner (1971) pp. 235-36 (para. 438). The reasoning here emphasizes (wise) physicians’ professional merit.  Asaph’s account of the origin of medicine is closely related to the Book of Jubilees, 10:1-14.  The Book of Jubilees dates to about 150 BGC.  Segal (2007), pp. 170-4, argues that Asaph’s account depends on the Jubilees’ tradition.  In any case, Asaph’s account does not seem to have been translated into Hebrew, i.e. it transmits an original Hebrew-language source.

[8] The account in the Book of Jubilees more clearly explains why the “spirits of the bastards” continue to cause sickness not related to a person’s evil-doing: “they {the spirits of the bastards} would not walk in uprightness, nor strive in righteousness” (Charles translation) or “they {the spirits of the bastards} would neither conduct themselves properly nor fight fairly” (VanderKam translation).  Asaph’s account leaves that effect as a rather obvious interpretation, following directly from the first mention of the spirits of the bastards attacking Noah’s children.  Cf. Segal (2007) p. 171-2, n. 8.  Ibn Abi Usaibia’s History of Physicians, written in thirteenth-century Damascus, provides some evidence of a Jewish claim to the origins of medicine.  After reviewing claims for Greek or Egyptian origins, ibn Abi Usaibia notes:

There are still other opinions variously ascribing the invention of medicine to the Chaldeans, the magicians of Yemen, Babylonia or Persia, the Indians, the Slavs, the Cretans, to whom the Epithymon is referred, or the people of Mount Sinai. (HP p. 6)

The “people of Mount Sinai” are plausibly Jews, with the suggestion that different Jewish sects existed.  Ibn Abi Usaibia also notes:

Some Jews claim that God, the Mighty and Exalted, sent the Book of Healings down from heaven to Moses, peace be upon him. (HP p. 14)

This tradition of “some Jews,” evidently recorded by an Islamic author, may be an alternative tradition to that of the Book of Medicines given to Noah, or a mis-transmission of that tradition.  In addition, ibn Abi Usaibia reports:

One of the Israelite savants claims that the discoverer of medicine was Jubal, the son of Lamech, the son of Methuselah. (HP p. 15)

Kopf’s note to this statement observes, “The Arabic spelling of the names points to oral tradition ….”  Evidently by the thirteenth century a variety of Jewish traditions existed concerning the origins of medicine.

[9] Pines (1975) pp. 2-4, 6-7, provides an English translation of Asaph’s Oath and Hippocrates’ Oath.  It provides the text for all the subsequent quotes above from those oaths.  I have made minor adaptations to Pines’ text.  Arabic translations of Hippocrates Oath also called it Hippocrates Covenant.  See Rosenthal (1956) p. 54.  Thus oath and covenant did not conceptually distinguish Hippocrates’ text and Asaph’s text in their reception history.

[10] Asaph integrates within his Book of Medicines quotes from the Torah, e.g. Deuteronomy 6:5 (part of the Shema).  In his literary essay The Contemplative Life, Jewish philosopher Philo of Alexandria explicitly describes the Jewish Therapeutic symposium in contrast to the classical Greek symposium.  For relevant discussion, see Niehoff (2010). Asaph’s Book of Medicine is a practical rather than literary work.  Both works, however, emphasize a distinctive Jewish identity within the Hellenistic world.

[11] Proverbs 14:1, 13:20, 14:8.  For similar first-century Jewish-Christian wisdom, see Matthew 7:24-27, 25:1-12.

[12] Trans. Muntner & Rosner (1971) pp. 270-1, largely repeated pp. 20-1.  That translation uses “silly” rather than “foolish.”  I’ve substituted “foolish” above because it’s within the same semantic range and is contextually more appropriate.  That text contains four wise/silly couplets.

[13] Asaph’s Book of Medicines does just that.  It includes a translation of Hippocrates’ Aphorisms, embraces Greek humoral medical theory, shows knowledge of Galenic medicine, and includes many medical prescriptions from Dioscorides.  See Newmyer (1993), which calls Asaph “an enlightened student of Greco-Roman pharmaceutics” (p. 119).  Newmyer also observes that Asaph is a pious Jew and that his selection and presentation of medicines reflects distinctively Jewish concern for the poor and aging (pp. 117-9).  Lieber (1984), p. 249, observes:

Among Jewish medical works in Hebrew and Arabic the Book of Medicines is unique in trying to establish Jewish roots in its particular field.  Yet, as has been seen, it in no way denies the validity of pagan Greek concepts.  On the contrary, it produces Jewish and even Biblical credentials for their use.

References:

Epstein, Isidore. 1935. The Babylonian Talmud. London: Soncino Press.

Himmelfarb, Martha. 1994. “Some Echoes of Jubilees in Medieval Hebrew Literature.”  Pp. 115-41 in Reeves, John C. 1994. Tracing the threads: studies in the vitality of Jewish pseudepigrapha. Atlanta, Ga: Scholars Press.

HP: Ibn Abi Usaybi’ah, Ahmad ibn al-Qasim. English translation of History of Physicians (4 v.) Translated by Lothar Kopf. 1971. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 294.  Online transcription.

Lieber, Elinor. 1984. “Asaf’s “Book of Medicines”: A Hebrew Encyclopedia of Greek and Jewish Medicine, Possibly Compiled in Byzantium on an Indian Model”. Dumbarton Oaks Papers. 38: 233-249.

Muntner, Sussman, and Fred Rosner, trans. & ed. 1971.  The Book of Medicine of Asaph the Physician: Commentary (vol. 1) and translated text (vol. 2).  Document 06-501-N-L, Prepared under the Special Foreign Currency Program of the U.S. National Library of Medicine and U.S. National Institutes of Health, Public Heath Service, U.S. Department of Health, Education, and Welfare, Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 294.

Newmyer, Stephen. 1993. “Asaph the Jew and Greco-Roman pharmaceutics.”  Pp. 107-120 in Jacob, Irene, and Walter Jacob. 1993. The Healing past: pharmaceuticals in the biblical and rabbinic world. Leiden: E.J. Brill.

Niehoff, Maren R. 2010. “The symposium of Philo’s Therapeutae: Displaying Jewish Identity in an Increasingly Roman World.”  Greek, Roman, and Byzantine Studies. 50 (1): 95-116.

Pines, Shlomo. 1975. The oath of Asaph the physician and Yoḥanan ben Zabda: its relation to the Hippocratic Oath and the Doctrina Duarum Viarum of the Didachē. Jerusalem: Israel Academy of Sciences and Humanities.

Rosenthal, Franz. 1956. “An ancient commentary on the Hippocratic Oath.”  Bulletin of the History of Medicine. 30(1): 52-87.

Segal, Michael. 2007. The book of Jubilees: rewritten Bible, redaction, ideology and theology. Leiden: Brill.

VanderKam, James C. 1989. The Book of Jubilees. Lovanii: E. Peeters.