Islamic medicine
Medicine played a prominent role in science and culture in the pre-modern Middle East. It arose as a formal discipline in the wake of an ambitious movement, in the ninth century, to translate Greek texts into Arabic, and prevailed for nearly a millennium thereafter.
Medical theory and the human body
Islamic theoretical formulations about the human body were founded on those of classical Greek philosophy and Graeco-Roman medicine, elaborated and developed by individual authors in the Arab Islamic tradition, not always in agreement with one another. In anatomical terms, the various parts and organs of the body were conceived of as comprising interrelated physical systems: skeletal, nervous, circulatory, and reproductive. The functions and activities attributed to these systems, however, and the connections drawn between them, often betrayed the limited extent to which empirical data could be collected and verified in the pre-modern age.
A good example is thinking on the circulatory system. Veins were identified as single-walled vessels that carried nourishment from the intestines to the liver, and then carried blood from the liver to feed the rest of the body. Arteries, on the other hand, were double-walled vessels carrying a finer kind of blood and pneuma, a sort of actualizing vapour, to the rest of the body. In this schema, circulation was entirely centrifugal: blood moved only outward from the heart and liver to the various parts of the body, where it was consumed for nourishment. Nothing travelled back to the heart and liver, which had constantly to replenish and renew the supply of blood outward to the rest of the body.
Arab-Islamic medicine, like Greek medicine before it, attributed key roles to certain major organs, each of which performed a specific vital function. The heart was the source of the ‘innate heat’ that sustains life. Body temperature was seen as a product of innate heat, the loss of which must invariably result in death. Anger was also a product of innate heat, which excitement and emotion agitated and caused to rise to the surface from the heart. The liver was the seat of the natural faculties of conception, growth, and procreation, which were carried throughout the body by the veins. A child was conceived, for example, when the procreative faculty carried to the uterus by the veins produced a fetus from the male sperm and the female menstrual blood. Bones grew because the faculty of growth was carried to them by the veins.
The brain was the seat of the psychical faculties — reason, imagination, thought, memory, and sense perception all had their origin here. The brain was also recognized as the source of voluntary movement: psychical pneuma passed through the nerves from the brain to the limb that was to move.
All of the above are part of what Islamic medicine called the ‘naturals’: the humours; the basic qualities of hot, cold, wet, and dry; personal temperament, and the faculties and pneumata — in sum, all that human beings really are. In addition, there were two other sets of factors that were deemed to affect the body, but that were not regarded as part of it. These were the ‘extra-naturals’ by which was meant illness and its symptoms, and the ‘non-naturals’ — six things external to the body, but vital to the preservation or restoration of health.
The doctrine of the non-naturals had been vital to Galen's system of medicine, and in Islamic medicine these were constantly stressed and elaborated. The first of the non-naturals was the consideration of air: good air encouraged and maintained good health, while corrupt air could throw the humours out of balance and cause illness. Epidemics, for example, were routinely attributed to bad or corrupt air.
The second was movement. Islamic medicine placed great stress on the role of exercise in maintaining health, and prescribed it in moderation as part of a recuperative routine. The third was eating and drinking: these were divided into categories of regular foodstuffs, foodstuffs with a remedial function, drugs, and poisons. Diet was a paramount consideration in both maintenance of health and recovery from illness. This category also covered matters of attire. One should dress warmly enough to maintain the innate heat, but not so excessively as to cause overheating.
Another of the non-naturals was sleep, along with wakefulness. Sleep was deemed to help digest food and mature humours, since it allowed innate heat to spread through the body. Wakefulness was also important, since too much sleep dulled the mind and could also cool the body.
The fifth non-natural was excretion and retention: this not only had to do with digestive function, including constipation and diarrhoea, but also covered intercourse and bathing. There was a voluminous literature on intercourse, which for many medical writers was linked to the quest for pleasure, since, as one author noted, most human beings and all animals engaged in intercourse for enjoyment and not for offspring. Again, the theme was moderation. Too much sex could weaken one's other faculties, it was warned, since blood was drawn away from other organs in order to produce new semen. Too little, however, could result in melancholy as vapours from retained semen reached the brain and disturbed it — the orientation toward male sexuality here is of course to be noted.
The last of the non-naturals was psychical states, illustrating how mental function was integrated into the physical and how it was recognized that this could have a decisive impact on one's physical well-being. Medical works cautioned that tendencies to be overly suspicious, fearful, angry, shy, or morose had to be regulated, as they could throw the body out of balance and produce illness. Conversely, psychical states could be controlled by reason.
The doctrine of the non-naturals highlights the themes of moderation and balance that dominated medieval Islamic thinking on the healthy body. Health itself was defined as a natural state of balance that was specific to oneself; there was no universal paradigm — variety was what made people individuals. In order to treat patients successfully, the physician had to be able to recognize the temperaments and natural states of each individual.
A special problem was posed by the female body. Islamic medicine usually regarded the female body in terms of gynaecology and obstetrics, and chapters on women's health and illness more often than not discussed nothing else. Diagnosis and therapy made major assumptions about the female body that reflected the more general views of a society dominated by men. Following the Greeks, Islamic medicine held that women were too cold in temperament to produce sperm, and too weak to grow proper male genitalia. They possessed weaker constitutions than men, became ill more quickly, and could not bear medications in the same way that men could. They were also inclined to emotional extremes and hysteria.
Diagnosis and therapy: practical aspects of the medical body
It is important to bear in mind that in medieval Islamic times the medical body (as conceived of in medical theory and practice) was in important ways something apart from the human body. Medicine as an intellectual discipline dealt with subjects such as health, illness, and healing as theoretical abstracts; aspiring physicians learned these, for the most part from books and often with little or no experience with actual cases, but then eventually had to apply them to human beings, where the ideas they had absorbed (e.g. the actions of humours) were not immediately visible or evident.
Assessment of an ailing patient's condition involved questioning the victim and relatives and associates who might have important information, and examining the patient's body. In both of these areas certain sensitivities had to be overcome. Nakedness, for example, was religiously disapproved, and there was a pronounced emphasis on individual privacy and modesty.
In examining a patient the physician devoted considerable attention to personal constitution and temperament — that is, to determining where along the continuum the patient's natural state of health might be. Physical signs were also examined; the physician sought to determine whether the patient was hot, or sweaty, or pale or flushed in the face, and so forth. Manual manipulation and palpation were likewise employed to check for broken bones, determine if internal organs were overly hard or soft, or identify the location and status of tumours and swellings.
Over and above all these other diagnostic techniques, however, physicians relied on examination of pulse and urine. There was a voluminous literature on the pulse, largely inspired by Galen (130-210 ad), whose works on the subject, as on so many others, had been translated into Arabic in early Islamic times and promoted to a position of practically unassailable authority. The pulse was assessed not only in terms of whether it was weak or strong, slow or fast, regular or irregular, but also, for example, whether it was large or small and hard or soft. From such examination, physicians considered that they could identify problems ranging from jaundice to dropsy, diphtheria, pregnancy, and anxiety.
Again, there was an extensive literature on the urine, inspired and defined by the works of Galen. Urine was subjected to minute discussion and classification. Great importance was attached to its colour: varying shades of yellow, colourless, or tinged with green, red, or black. Thinness or viscosity, odour, ‘touch’, clarity, foaminess, and probably taste, were all considered. Sediment in urine was broken down into numerous categories: sandy, greasy, flaky, hair-like, ash-like, and so forth. These properties revealed much about a patient's state of health. Mental dysfunction, for example, produced blond urine with a wine-like foam; red urine was regarded with alarm and taken as a sign that death was probably near; black urine was associated with liver problems and at the beginning of an illness it meant certain death; viscous cloudy urine meant that a headache was imminent.
Despite the impression in the medical literature of close contact between doctor and patient, there is clear evidence that the physical presence of the patient was not deemed absolutely necessary for an accurate diagnosis. A family member with no medical background could describe a relative's illness, or bring a written account or a urine sample to the doctor, who would identify the problem and prescribe a therapy without direct recourse to the patient. One may conclude that the medieval physicians were supremely confident in their theoretical constructs and diagnostic techniques.
The theoretical dimension of Galenic medicine was decisively systematized by Avicenna (d. 1037), and its practical side was advanced in various areas (such as pharmacology, ophthalmology, and surgery). However, as an explanation for physical dysfunction it comprised a closed system already able to account for every problem. Divergence from the views of Galen was exceptional.
For all their confidence in their system, physicians were acutely aware of its limitations; this expressed itself not only in a widespread feeling that physicians would never be able to command all that the great Galen had known, but also in an emphasis on public health and preventive medicine as opposed to therapeutics.
This sense of limitation was nowhere more evident than in the field of surgery. This was highly developed in Islamic times, in terms of both instrumentation and technique, and procedures of great delicacy — such as repair of inguinal hernia and cataract surgery — were successfully performed. But the range of surgical expertise dealt largely with the surface of the body: for example cautery, bloodletting, and draining boils and abscesses. More problematic were matters requiring invasion of the body cavity. After injuries exposing internal organs, the physician might do whatever he could to repair the damage, clean the exposed parts, and close the wound. But this was done with little hope of success, and the risk of fatal infection — of which the true causes were then of course unknown — was simply too great to allow exploratory or remedial surgery on the physician's own initiative.
The limited use to which knowledge of internal anatomy could be put, combined with the overarching authority of the results already achieved by Galen, and social sensitivities over treatment of the dead, dictated that there was little interest in autopsy or dissection. The diagrams of the ‘Five-Figure Set’, a collection of anatomical drawings which appeared in Islam for the first time in manuscripts of a Persian surgical text written in 1396, seem not to reflect any special attention to internal anatomy. They are paralleled by similar drawings in medieval Western texts and probably originate with late antique models taken up from Greek texts translated in early Islamic times but since lost. There are occasional references to dissection of apes and efforts to confirm or test Galenic anatomy, but as the prospects for applying such knowledge remained so bleak, these explorations were doomed to remain sporadic and of little practical importance.
Developments in modern times
The efforts of Islamic regimes to cope with the challenge of the West included major programmes of modernization in medicine. Egypt, invaded by Napoleon in 1798, was the scene of pioneering developments under the energetic leadership of Muhammad Ali, and it was there, in the early decades of the nineteenth century, that the first real, modern medical schools and hospitals in the Islamic world were established. Since then, Western bio-medicine has everywhere come to prevail as the authoritative interpretation of the medical body.
The adoption of modern Western medical science and technology on a massive scale has had a dramatic impact. Infant and child mortality have dropped sharply, and life expectancy has risen considerably. Prestigious medical centres in national capitals successfully perform complex and costly operations (e.g. heart transplants) ; but such institutions are largely irrelevant to the vast majority of the population of the country, who often live far from the capital, and suffer most from basic problems of poor public health. The goals and priorities of medicine have thus been areas of particularly vigorous discussion.
There have also been activities on other fronts. Books promoting the practical and herbal remedies of the so-called ‘medicine of the Prophet’ have proliferated, and enjoy a brisk market, and there has also been a marked revival in the role of healers who use religious spells and incantations to exorcize demons and spirits from the body. There are also healers who attract patients for consultations with spirits, whom only the healer can see or hear and who recommend therapies and predict the outcome of serious cases. Dabbling in communications with the spirit world, however, is disapproved — often vehemently — as blasphemy, by some religious authorities. Still, the magical interpretation of problems concerning the body is clearly on the rise, and not just among the poor or in rural areas.
There has also been a marked trend toward the promotion or revival of Galenism as a formal medical system. In India and Pakistan, where it never declined so precipitously as it did in the Arab world, it survives under the name Unani Tibb (‘Greek medicine’) and is officially sanctioned and supported by government.
In the Arab lands, the dialogue between Western and traditional views of medicine and the body takes the form of debate over properly Islamic medical ethics. A vast array of subjects is covered. Medical issues concerning sex and reproduction, such as sex change operations, AIDS, menstruation, abortion, masturbation, artificial insemination, sperm banks, and cosmetic surgery, have provoked great interest and heated debate, as also have euthanasia and post-mortem examination.
Implicit in all these debates, as in discussions involving the body in other fields of endeavour, is an effort to maintain the social and religious norms of Islam in the face of challenges posed by foreign structures of science and technology based on other assumptions.
— Lawrence I. Conrad
Bibliography
- Conrad, L. I. (1995). The Arab-Islamic medical tradition. In L. I. Conrad et al. The Western medical tradition: 800 bc to ad 1800. Cambridge University Press.
- Rispler-Chain, V. (1993). Islamic medical ethics in the twentieth century. Brill, Leiden.
- Rosenthal, F. (1990). Science and medicine in Islam. Variorum, Aldershot.
- Ullmann, M. (1978). Islamic medicine. Edinburgh University Press
See also Galen; heart; humours; Islam and the body; medicine; pulse.
