Since ancient times animals, their parts, and their products have constituted part of the inventory of medicinal substances used in various cultures. This phenomenon is marked by both a broad geographical distribution and very deep historical origins. As some authors have shown, animal-based medicines have been utilised since antiquity 12.

Testimony to the medical use of animals began to appear with the invention of writing, and is found in archives, papyruses, and other early written historical sources dealing with medicine. Data have been found on such usages in ancient civilisations, such as Egypt and Mesopotamia, which left their mark on the various societies that later arose in the Levant.

Historical sources of ancient Egypt mention the medicinal uses of substances derived from animals, for example, cattle milk, bee honey, lizard blood, ox organs, swallow's liver, bat limbs, ambergris from the sperm whale, and the glands of the musk deer 3456.

Archives of several civilisations of ancient Mesopotamia, mainly the Assyrian and the Babylonian, contain descriptions of fish oil, beeswax and honey, mongoose blood, turtle shell, goat's skin, gazelle, deer and sheep sinew, bird excrement, and animal fat 78910.

In ancient China, among many other substances of animal origin, the glands of the musk deer were used 1112. In India, the Hindu religion has used five products of the cow for purification since ancient times 13.

Classical medical literature also indicates animals as remedies. In the 5^th–4^th centuries BCE Hippocrates 14 included among many other animal substances the use of cattle milk, chicken's eggs, mammals' horns and sea sponge 15. About 10% of the substances mentioned in Dioscorides's (1^st century CE) materia medica 14 were body parts and products of animals 1617. Such uses on a smaller scale were common in the Byzantine empire 18.

The Jewish sources, mainly the Mishna (1^st–3^rd centuries CE) and the Talmud (4^th – 5^th centuries CE), that is, the literature of the Jewish Sages, mention several animals and their medical uses: honey was used to treat bulimia and goat's milk to cure coughing. Snakes, human urine, pearl, mammals' glands, and several other substances were used for different medical conditions 19.

The neo-Aramaic medical tradition, which evolved in the Near East during the Byzantine period, conserving classical medical knowledge, made great medical use of animals 2021. This knowledge was conveyed farther and translated, becoming an important part of the new Arab medical and pharmaceutical profession (7^th century CE).

Arabic medieval literature offers ample information about animals in general and their medical uses in particular. The 'medicine of the prophets' (tibb al-nabawi) indicates intensive medicinal use of chicken eggs, cattle cheese, and bee honey 2223, for medicinal uses of foodstuff were common in the Middle Ages, as they still are in folk medicine 24. Early Muslim physicians such as the 9^th-century al-Tabari 14 and al-Kindi 14 describe the medical uses of several animals, in Iraq and Iran, such as bear, beaver testicles, camel, cattle fat, coral, crab, dog, fish stone, horse, lizard, medical skink, mouse, pearl, pigeon, rabbit, rhino and goat horns, scorpion, snake, squid, turtle, and wolf, and animal products such as honey, wax, milk, and eggs. Together these comprise about 7% of all medicinal substances 2526. More information on such uses can be found in general encyclopaedias such as that of the 13^th-century al-Qazwini 142728. al-Damiri, the 14^th-century Muslim zoologist 14, describes in his lexicon hundreds of animals 29, tens of which were used for remedies 30.

The accounts of travellers during the Middle Ages are an additional source of information about animals used for medicinal purposes. For example, Geoffrey of Unseefe (12^th century) described the use of theriac against various kinds of insect bites, while Jacques de Vitry (12^th–13^th centuries) describes the beaver, which "bites off its own testicles with its teeth and throws them to the pursuing hunters" who make use of them for medicinal purposes. Jacques de Vitry mentions a pharmacist in Acre who raised various animals and used their excrement to prepare medications. Felix Fabri (15^th century) described the hunting of the adder, which provided one of the components for theriac. Thomas Shaw (18^th century) tells of the striped lizard found on the coast of Syria and used for the arousal of sexual desire 31.

Many of the animals which were mentioned before are also used in present-day traditional medicine. For instance, in Iraq twelve kinds of animals are described as medicinal sources, including sea sponge, cow, camel, bee, fish, squid, sheep, nacre, and silkworm, and they constitute 5% of all the substances mentioned 32. A survey conducted in Syria during the 1970s found that 2–8% of the substances in the possession of medicine vendors in the markets were of animal origin 3334. A survey of traditional materia medica in use in the markets of Israel recorded 20 substances of animal origin 35. Similar data are derived from surveys conducted in Jordan 36.

In Pakistan, for instance, 31 substances were listed (animal parts and products), constituting 9% of all the medicinal substances in the inventory of traditional medicines. Examination and research show that these substances are similar to those used as remedies throughout human history, irrespective of geographical borders, and include: sea sponge, bee honey and beeswax, squid, medical skink, lizard, silkworm, crab, spider, amber, pearl, nacre, hedgehog, and earthworm 373839.

A study on the use of medicinal substances in the Levant during the Middle Ages found that 9.5% of all the medicinal substances were of animal origin 40. The primary purpose of some animal products, which were used as remedies, was food. The study also examined the reciprocal relationship of substances such as milk, cheese, and honey as food products and their use as medicinal remedies 24.

The importance of animal parts in the history of pharmacy in general has been studied since the beginning of the 20^th century 41; other works deal with groups of animals and their uses in medicine, for example, marine animals 42.

The present study takes a new approach to the use of animals in medicine in the medieval (10^th–16^th century) and early Ottoman (16^th–18^th century) Levant (the Land of Israel and parts of present-day Syria, Lebanon, and Jordan, defined by the Muslims in the Middle Ages as Bilad al-Sham).

Literature (primary as well as secondary) consisting of tens of diverse historical sources was screened to shed light on the medicinal uses of materials of animal origin from the 10^th to the 18^th century. The main sources are presented in table 1.

The information presented in Table 2 is the result of a survey of literature on the medicinal substances of Bilad al-Sham (the Levant) from the 10^th to the end of the 18^th century 4072. The criteria were: (1) the animal or product is mentioned in a book on medicine or pharmacy treating the Levant or one of its cities or geographical zones. (2) It is mentioned in a source regarding trading in it in the area; and we possess other historical sources dealing with its medicinal applications in the Levant. (3) The substance is mentioned in general literature regarding its medicinal use.

Several animals and their products were disregarded since they were used by quacks or for mystical medicinal uses: these are subjects for different research, although the two fields are not always fully distinguished 67.

Finding the substances of animal origin in the literature was tough work, but identifying them according to their medieval names, written in many dialects, or by their nicknames was even harder, mainly because no drawings or paintings were available. Therefore, exact scientific identification was not always accomplished.

The means of identification included all old and new dictionaries, lexicons, zoology books, and scientific keys.

The sources noted in the table are those in which the substance is said to be used in the Levant. However, the medicinal uses of the substances in the medieval period were collected from other sources as well, mainly medical books of the same period 272846647374. The information presented in the table is limited, so conflicting identifications, detailed descriptions, a full list of sources, or a complete list of uses are not given.

The accumulated data set out in table 2 attest to a remarkably wide range of medicinal uses of animals and their parts in the medieval and Ottoman Levant. Recent historical surveys located and identified 286 medicinal materials, of which 81.8% are of plant origin, 5.2% of minerals, 3.5% of other materials, and 9.5% of animal origin 4075. Recent ethnopharmacological surveys conducted at shops and with vendors of traditional medicine in Israel 35 and Jordan 36 reveal that similar materials are in use in the same geographical area until present day.

Tables 2 contains forty-eight animal extracts and products. These can be divided into three different groups: