History of Medicine from Ancient Greece to the Classical World of Islam. lecturer: Dr Peter E Pormann. Week 10: Medicine in the Middle Ages I

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1 History of Medicine from Ancient Greece to the Classical World of Islam lecturer: Dr Peter E Pormann Week 10: Medicine in the Middle Ages I The Islamic Tradition Primary Sources F. Rosenthal, The Classical Heritage in Islam, The Islamic world series (London: Routledge, 1992) Secondary Sources Peter E. Pormann, E. Savage-Smith, Medieval Islamic Medicine (Edinburgh, EUP, 2007); classmark: R P6 Peter E. Pormann (ed.), Islamic Medical and Scientific Tradition, Critical Concepts in Islamic Studies, 4 vols (Routledge: London, 2011) L. I. Conrad et al., The Western Medical Tradition (Cambridge, CUP: 1995), chapter 4 (Conrad, The Arab-Islamic Medical Tradition ); classmark: R 131.W3 Peter E. Pormann, The Oriental Tradition of Paul of Aegina s Pragmateia (Leiden: Brill, 2004); classmark: R126.P6

2 Peter E Pormann Medical Epistemology in the Arabic Tradition 1 Handout Medical Epistemology in the Arabic Tradition T 1 Martin Edwards, Keywords in the History of Medicine: Evidence, Lancet 363 (2004), 1657 Medical practice has been evidence-based since antiquity. What has changed is our understanding of what constitutes evidence. T 2 T 3 Al-Rāzī, Risāla ʾilā Baʿḍ Talāmiḏihī (Letter to One of his Students), ed. ʿAbd al-laṭīf Muḥammad al-ʿabd, Aḫlāq aṭ-ṭabīb (The Ethics of the Physician) (Cairo: Maktabat Dār al-turāṯ, 1977), 77 8 Leave aside what confuses common idiots, namely [the idea] that one can hit on [the right treatment] by experience [taǧriba] without any reference to [scientific] knowledge [ʿilm]. For such a thing does not exist, even if one were the oldest person, because the benefit which one derives from an appropriate treatment [in such a case] is merely the result of good luck. The highest degree of those who do not refer to knowledge about the principles of the art are those who look things up in books. They take treatments from them, but do not know that what one finds in books are not things to be used exactly like that, but rather propositions [maqālāt] put there so as to follow them and learn the medical art from them. Even if the only thing written about the topic of experience were what Galen had said, I would still prevent those who consult me about the art of medicine from being treated by experience. The wise teacher Hippocrates barred it as well when he began [his book of Aphorisms] by saying: Life is short, the art is long, the [right] time is fleeting, and experience dangerous. 1 By my life, he was right in saying this. And I certainly prohibit experience in the medical art. Ar-Rāzī, Al-Kitāb al-manṣūrī fī l-ṭibb (Book for al-manṣūr on Medicine), ed. Ḥāzim al- Ṣiddīqī al-bakrī (Kuwait: Maʿhad al-maḫṭūṭāt al-ʿarabīya, 1987), 368; previously edited and translated by Iskandar, A Study of ar-rāzī s Medical Writings, i. 306, ii. 107 I do not think that pure mercury causes much damage. When one drinks it, however, it does cause a lot of pain in the stomach and the bowels. It is secreted in its [original] form, especially if the patient moves. I, myself, have administered it to an ape in my possession. I observed exactly the symptoms which I have just mentioned. T 4 Al-Rāzī, Comprehensive, xv. 121, line , line 3 (1) I say: the distinguishing features preceding burning fevers [al-fuṣūl al-muqaddima li-l-ḥummā al-muḥriqa] are severe and continuous thirst, heat, and burning. (2) According to what I have seen 1. Aph Littré, 4: 458, lines 1-4 ( Ὁ βίος βραχύς, ἡ δὲ τέχνη μακρή, ὁ δὲ καιρὸς ὀξύς, ἡ δὲ πεῖρα σφαλερή ). See Franz Rosenthal, Life Is Short, the Art Is Long : Arabic Commentaries on the First Hippocratic Aphorism, Bulletin of the History of Medicine 40 (1966),

3 Peter E Pormann Medical Epistemology in the Arabic Tradition 2 by way of experience [taǧriba] and what I have seen in this book, regarding constant fevers: (3) If he [the patient] suffers from heaviness [ṯiqal] and pain in the head and neck lasting for two, three, four, five days or more; and he avoids to look [directly] into the light, whilst tears flow; and he often yawns and stretches his body, having severe insomnia; and he perceives a feeling of extreme exhaustion, then the patient will progress to brain fever [sirsām, corresponding to Greek phrenîtis]. (4) He becomes daring [fa-yuqdimu] like a drunkard, not paying any attention to food or drink, until the crisis supervenes. (5) If, however, the heaviness in the head is greater than the pain, and there is no insomnia, but rather sleep, and the fever abates, with the pulse being broad and not quick, then he will progress to lethargy [lītharġus, λήθαργος]. (6) So when you see these symptoms, resort to bloodletting. (7) For I once saved one group [of patients] by it [bloodletting], whilst I intentionally left another group, so as to remove the doubt from my opinion through this [astabriʾu bi-ḏālika raʾyī]. (8) Consequently all of these [latter] contracted brain fever. T 5 Ar-Rāzī, Comprehensive Book [MS Arundel. Or. 14, fol. 283a, lines 15 17; ed. in Albert Z. Iskandar, Ar-Rāzī, the Clinical Physician, in: Islamic Medical and Scientific Tradition, ed. Pormann I say [lī]: According to what I have seen [written] by Galen, and also experience [taǧriba]. Onion juice, when applied as an ointment to the penis acts as a contraceptive. When one can endure its water, it aborts foetuses with great force. T 6 Ar-Rāzī, Comprehensive Book [MS Arundel. Or. 14, fol. 285a, lines 3 5; ed. in Iskandar, Ar-Rāzī, the Clinical Physician ] I say [lī]: Experience [taǧriba]. There was a woman who was in excruciating labour [tuṭlaqu] for a number of days. Then she was given two dirham saffron to drink, after which she gave birth immediately. I tried this [ǧarrabtu hāḏā] repeatedly, and it was like that. T 7 Ar-Rāzī, Hidden Properties of Things (Ḫawāṣṣ al-ʾašyāʾ) [Cairo, Dār al-kutub wa-lwaṯaʾiq al-miṣrīya, MS Ṭibb 141, fol. 119b, lines 4 9; ed. in Iskandar, Ar-Rāzī, the Clinical Physician ] We should not leave out something we hope may be beneficial simply because some people do not know about it or are opposed to it. If they were people who form an opinion, and then verify and scrutinise it, they ought to have endeavoured not to deny something for which they have no evidence [burhān] that it does not work. For evidence stating that an hidden property is like this or that is not more necessary than the [evidence] stating that a hidden property is not like this or that. If in this whole matter there were only this one hidden property, it would still be necessary to verify and scrutinise it rather then rejecting something for which there is no evidence to reject it, and to leave it postponed until it is correctly established through evidence [ʾilā ʾan yaṣiḥḥa biburhānin].

4 Peter E Pormann Medical Epistemology in the Arabic Tradition 3 T 8 ʿAbd al-laṭīf al-baghdādī ( ), Book of the Two Pieces of Advice (Kitāb al- Naṣīḥatayn) [Bursa, MS Hüseyin Çelebi 823 fol. 67a, line 10 68a, line 5; ed. and tr. in Joosse, Pormann, Decline and Decadence in Iraq and Syria after the Age of Avicenna? ] He [Galen] complained about the methodist sect and the empiricist sect. Even though they all generally fall short and are deficient, they have useful rules [ḍawābiṭ] and principles [faḍāʾil], which it is best to acquire and learn, especially those of the empiricists. Galen reported many of their procedures in his On Compound Drugs according to Places [Mayāmir] and On Compound Drugs according to Types [Qāṭāǧānis; katà génē]. 2 Our contemporaries do not belong to any of the three sects which he [Galen] defined in his book On the Sects [for Beginners], but rather rely on luck and chance [al-baḫt wa-l-ittifāq] like a blind man shooting [an arrow] without knowing in which direction the target is. The sects of the methodists and empiricists know the direction of the target, but shoot [the arrow] without first examining its [the target s] specific position. The masters of reason [the rationalists] know the direction and examine the position of the target, directing their arrow there in the most perfect and correct fashion. The empiricists examine certain aspects of the target, such as its shadow, so that they deserve to hit the mark. The people of our time, however, do not examine the target, nor its direction, and one is therefore surprised not by their making a mistake, but by their getting things right, whereas one is surprised by the mistake of the rationalists, and not their getting things right. For the latter get things mostly right and essentially right at that [wa-bi-ḏ-ḏāti], whilst making mistakes only rarely and accidentally [bi-l- ʿaraḍi]. But these spongers [al-mustarziqa] rarely get things right, and only accidentally, whilst mostly making mistakes, and essentially at that. We add the following as an explanation through an example which we posit. Take a man who suffers from fever. A physician of each of the sects comes to him. The methodist aims at loosening him [the patient] insofar as the fever arose out of stricture [iḫtināq, corresponding to stégnōsis]. The empiricist says: I have observed [raṣadtu] many times people suffering from such a fever. I resorted to blood-letting, and extracted such-and-such a quantity of blood until he [the patient] fainted. Yet afterwards he [the patient] recovered from his fever in one go. The rationalists will make the fever into a genus [ǧins], divide it by its essential differences [fuṣūl ḏātīya] into three species [ʾanwāʿ]. He [the rationalist] then looks at the fever of this man [to determine] of which of the three [species] it is. He determines that it is a fever which has [disease] matter [al-ḥummā ḏāt al-mādda]. Then he divides this fever into its species according to the [disease] matter, and determines that it [the fever] is bloody. He divides the bloody [fever] into the pure [al-ḫāliṣa] and the mixed [al-mašūba], and finds that it is pure. He divides the pure [bloody fever] further into that which has putrefied, and that which has begun to boil, and finds that it is that which has begun to boil. Then he considers the location, the age, the present time, the habit, the past regimen, and other things of a nature to change the diagnosis [al-ḥukm]. From all these collected facts he derives a picture of the necessary regimen. Then he lets the blood [of 2. Galen s work On Compound Drugs According to Places (Περὶ συνθέσεως φαρμάκων τῶν κατὰ τόπους, de compositione medicamentorum secundum locos) was known under its Syriac title Mayāmir (literally treatises ), whilst his On Compound Drugs According to Types (Περὶ συνθέσεως φαρμάκων τῶν κατὰ γένη, de compositione medicamentorum secundum genera) was known under the end of its Greek title according to types (katà génē) in its Arabised form; see Manfred Ullmann, Die Medizin im Islam, Handbuch der Orientalistik, I Abt., Erg. vi. 1 (Leiden: Brill, 1970), pp. 48 9; Sezgin, Medizin (n. 29), pp

5 Peter E Pormann Medical Epistemology in the Arabic Tradition 4 the patient] until he faints. I wished I knew who of these three physicians more accurately gets things right, and errs less frequently. Yet no intelligent man can choose anyone other than the rationalist, judging him to be skilful and wishing him victory and success [al-ẓafar wa-l-falāḥ]. Further literature: Peter E. Pormann, Medical Methodology and Hospital Practice: The Case of Tenth-century Baghdad, in: P. Adamson (ed.), In the Age of al-farabi: Arabic Philosophy in the 4th/ 10th Century, Warburg Institute Colloquia 12 (London: Warburg Institute, 2008), , (ed.), Islamic Medical and Scientific Tradition, Critical Concepts in Islamic Studies, 4 vols (Routledge: London, 2010)w N. Peter Joosse, Peter E Pormann, Decline and Decadence in Iraq and Syria after the Age of Avicenna? ʿAbd al-laṭīf al-baghdādī ( ) between Myth and History, Bulletin of the History of Medicine, 84.2 (May 2010) [in press]