Sara Verskin Barren Women Islam – Thought, Culture, and Society

Volume 2 Sara Verskin Barren Women

Religion and Medicine in the Medieval Middle East Winner of the 2018 BRAIS – De Gruyter Prize in the Study of Islam and the Muslim World

An electronic version of this book is freely available, thanks to the support of libraries working with Knowledge Unlatched. KU is a collaborative initiative designed to make high quality books Open Access. More information about the initiative and links to the Open Access version can be found at www.knowledgeunlatched.org Knowledge Unlatched

The Open Access book is available at www.degruyter.com

ISBN 978-3-11-059567-3 e-ISBN (PDF) 978-3-11-059658-8 e-ISBN (EPUB) 978-3-11-059367-9 ISSN 2628-4286

This work is licensed under the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 Licence. For details go to http://creativecommons.org/licenses/by-nc-nd/4.0/.

Library of Congress Control Number: 2019957926

Bibliographic information published by the Deutsche Nationalbibliothek The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are available on the Internet at http://dnb.dnb.de.

© 2020 Sara Verskin, published by Walter de Gruyter GmbH, Berlin/Boston Cover image: © Calligraphy by Osman Özçay. With friendly permission. Printing and binding: CPI books GmbH, Leck www.degruyter.com Formymother and father

Acknowledgements

In the decade it has taken to produce Barren Women,Ihave been frequently struck by how,inweaving togetherthe elements of this project,Ikeep reaching for old threads Ifirst picked up long ago, handed to me by teachers and colleagues who at the time could not have known how much Iwould benefit from their knowledge and generosity.Itisapleasure to finally be able to offer them here some acknowledgement of their contributions to my scholarship. Barren Women is based on thedissertation Iwrote in theDepartment of NearEastern StudiesatPrincetonUniversity.Itcould nothavebeen written withoutthe guidance, patience,and good instinctsofmyadviser, Michael Cook. Iamdeeplygratefulfor hisunceasing supportfor this projectfrom start to finish. Iamequally grateful for the scholarlyculturehecultivatedin the department andinthe classesItook with him, from whichIstill continue to reap benefits longafter having left the institution.Hepromotedanenviron- ment of academic good will in whichseniorand juniorscholars respectfully solicited each other’shelpwith their research, generouslygaveeach other theirtimeand expertise, and publiclyacknowledged their intellectualdebts. Moreover,hetaughtmetoallow my scholarship to be defined by my sources, andtoallowthosesourcestoleadmeinnew directions,even when they directed me awayfrommyinitial areas of academic comfort.Asstudents in his courses, my classmatesand Ioften looked at eachother withexasperation andeven fearaswefound ourselvesdelving intobooks of numismaticsand ex- ploringSogdian etymology.But it wasthatexperience whichconvinced me that,whenmystudies took me in unexpected directions, it wasmyresponsibil- ityand my privilegetoacquirewhatever newknowledge Ineeded in orderto continue,and to do so withoutsacrificing precisionorseriousness.Somepeo- plecallthisapproach “interdisciplinary.” From ProfessorCook,Icame to think of it as amark of intellectual curiosity,playfulness,and tenacity. This book is also marked by the instruction Ireceivedfrom my otherteachers at Princeton University.Itwas in the stellar class on methodologies for studying the Middle East thatM.Şükrü Hanioğlu and Abraham Udovitch first introduced me to the complexities surrounding the study of women’shistory,and the debates Ifirst encountered there have stayedwith me. Hossein Modarressi taught me familylaw and guided me through my first serious researchproject on Islam- ic law, familyplanning,and the contested right to have children. Mark Cohen introduced me to the joys of Geniza research and the uses of cross-confessional social history.Iam grateful to all of them.

Prior to my arrival in Princeton, Ispent four formative and blissful years at the University of Chicago. In my first undergraduateyear,Ihappened to enroll in aBible course taught by the now late TikvaFrymer-Kensky,who introducedme both to the academic study of religious texts and to women’sparticular experiences of organized religion. The infectious enthusiasm of the late Farouk Mustafa drew me to Arabic studies. Fred Donner’sclassonMukhtaṣar al-Qudūrī served as my first introduction to Islamic law. But it wasWadad Kadi’scombination of tow- ering erudition, charisma,and remarkable kindness, that permanentlybrought me into the fold of Islamic studies and set me on my current path. Iamalso much indebted to Helma Dik and to agood portion of the faculty of the Classics department of the University of Chicago, who provided asecond intellectual home for me outside the field of Near Eastern languages and civilizations. They encouraged me to sit in on department workshops and colloquia, providing me with my first taste of the social experience of academic research. Iwould also like to thank John Craig for introducing me to the studyofsocial and economic history,and for teachingmehow to be creative in figuring out ways to “do” social history when sources are limited.Lastly, my gratitude goes to WendyOlmsted who, in addition to encouragingmetobecome an academic, cultivated an idyllic atmosphere of intellectual enterprise in her classes. Her remarkablydeftteach- ing of literature remains amodel which Iaspire to emulate. Several people were kind enough to read my dissertation and providerecom- mendationsfor reshapingitintoabook. Iwould particularly liketothank Eve Krakowski, Shaun Marmon, and AvnerGiladi for theirenthusiasm for the subject and fortheir thoroughand thoughtful critiquesand useful suggestions. Iwould also like to thankAndrasHamori and Monica Green for readingearly drafts of what would later become chapters 6and 7. Iamgratefultoall of them for theirencouragement, wisdom, and collegiality.Iwould alsoliketoacknowledge the membersofaremarkable online community of scholars of medieval medicine,MedMed,led by Monica Green.Ihave benefited from their expertise in countlessways. Of course,any errors in my work areareflection of no one else’sshortcomingsbut my own. In the course of my research Ihavegreatly benefited from the support of my colleagues,classmates,students,and theadministrators at my home institutions in the Near Eastern Studies department at Princeton and in the History depart- mentatRhode Island College. Iowe specialthankstothe manylibrarians who went aboveand beyond the callofduty to helpmealong my way, especially at PrincetonUniversity.Iwould also like to acknowledge the librarians at the Uni- versity of Minnesota, ColumbiaUniversity,Brown University,the University of Rhode Island, and Rhode Island College whohaveaided me, especiallythose Acknowledgements IX whopatientlyfilled my seeminglyinordinate number of interlibrary loanre- quests. The publication of this book would not have been possiblewithout the intellectual efforts and financial sponsorship of the BritishAssociation for Islamic Studies (BRAIS)and De Gruyter Publishers. Iamgrateful to the manyBRAIS members who welcomed my scholarship and who receivedmesowarmly when Iwas astranger in their midst.Iwould particularlylike to thank Omar An- chassi, AmiraBennison, Katrin Mittmann, Ayman Shihadeh, and Sophie Wa- genhofer. Iamalso grateful to the Knowledge Unlatched organization for providing open access to this book. WhenIfirst began my research, Iwas 23 yearsold and represented the youngest generation of my family. At the time, Ihad fourliving, beloved grandparents and great-grandparents, each of whom encouragedmywork in their own way. Now Ihaveonlyone grandparent still livingand Ihavethree children of my own, all of whom arenow old enoughtoread the wordsofthis book themselves, if not to fully understandtheirimport.Through it all,Ihavebenefited from my family’sunceasing dedication and enthusiasm for my productivity, as well as for my fertility.Inaddition to providingmewithlove, support,space, and timefor my work, my grandmother,brothers,father-in-law,and even afew moredistant relativeshaveall read chapters of this book.Never oncedid Ihear from themthat my work was boring, inaccessible,orawaste of energy. Their patience with,and confidence in, me and my work has buoyedmeupall this time. My husband, Alan, has been my classmate, research assistant,discussant, and editor for the past seventeen years. Sometimes collaborating,sometimes workingonparallel projects side-by-side, we have spent our professional lives reading, translating,writing,and teachingtogether.Aswonderful as he has been in the role of live-in colleague, Alan has been even better in the role of baby-daddy-with-academic-benefits. When Iwas exhausted by my pregnancies, or buffeted and overwhelmed by the activities of motherhood, he kept me teth- ered to my scholarlylife. And when Ihavebeen too engrossed in my work to respond to the demands of familyand household, he has absorbedthe impact of those demands himself. Forthis, and for all the joy and pleasure he bringsinto my life, Iamfilled with loveand gratitude. Daniel, Hannah, and Maya have alreadyproven to have inherited their father’ssweetness, humor, and inquisitiveness. Ithank them primarilyjust for being their lovable selves, but alsofor ushering me into the experience of motherhood and generation-building,giving me aparticipant’sperspective on the phenomena Istudy as aspectator. My parents read and commented upon every section of this book.Ashistor- ians in their own right,they taught me to lovethe people of the past,todesire to X Acknowledgements understand the broad contours of theirsocieties, and to seek out their individual stories whenever possible. My mother taught me to interview and to write, my father to explore and sincerelyappreciate the intellectual systems and moral cal- culus of people who hold aworldview different from mine. Moreover,just as they showed me the rewards of what would become my profession, my parents also showed me the delights offered by familyand the intellectual stimulationitcan provide. In honor of both those legacies,and in recognition of theirunstinting lovefor me, my husband, and our children, Idedicate this book to them. Contents

Studying Infertility in the Medieval Islamic World: Why and How 1 Why study the experiences of barren women? 2 The importanceofinfertility as aphenomenon 3 Studying infertility to shed light on related issues in Middle Eastern and Islamic history 7 Methodological considerations and the natureofthe sources 8 Previousstudies as methodological models 8 The nature of the primarytexts, and the promises, limitations, and pitfalls of studying intellectual historyusing sources spanning vast periods and topographies 11 Parallels between communities separated by religion and time 15 Sources excluded from this study which merit further inquiry: fictional literature, magic, andpilgrimageliterature 16 Chaptersand structure 19 Infertility as alocus forambiguity,uncertainty,and compromise 20

Part I: Infertility and Islamic Law Throughout the Life Cycle

Introduction to Part I 25

 Infertility and the Purposes of Marriage in Legal Theory 26 The childless marriages of the Prophet Muḥammad and the depiction of infertile spouses in the ḥadīth:two conflicting views 26 Mothers of the believers 26 Infertility in the ḥadīth 28 Infertility in the Islamic legal framework of sex and marriage, with comparisons to Christianity 31 Marriage annulment due to infertility and genital defects 35 Statements in favor of permitting khiyār (spouse’schoice to pursue annulment) in cases of infertility 39 Objections to including infertility among the grounds for annulment 41 Ḥanbalī views 41 Ḥanafī views 44 Shāfi‘ī views 45 Mālikī views 46 XII Contents

Genital defects, “female impotence,” and their relationto infertility 47 Acasefrom17th-century Catholic Spain at the intersection of early marriage, marriageannulment, genital defects, and infertility 53

 Law and Biology: Menstruation, Amenorrhea, and Legal Recognition of ReproductiveStatus 57 Menarche: the legal ramifications of the onset of menstruation 57 Hypothesizing average age at menarche and marriageand the fertility of young brides 58 Amenorrhea 67 ‘idda and irregular menstruation 69 The extended ‘idda as apotential burden on women 74 Acasestudy of irregular menstruation andthe laws of ‘idda 75 The extended ‘idda as apotential boon to women 80 Women’stestimony,privacy,and expertise 85

 IslamicLaw and the Prospects of Women Presumed to be Infertile 93 Marital prospects 93 Childlessness and inheritance 100 Death of the childlesswife 101 Death of the husband of the childlesswoman 105 Claiming inheritanceagainst malekin without the benefit of sons 107

Conclusion to Part I: The Intersection of Islamic Law and Women’s Biology 111 Contents XIII

Part II: Arabo-Galenic Gynecologyand the Treatment of Infertile Women

Introduction to Part II 117

 Gynecological TheoryinArabo-Galenic Medicine 123 The importanceofthe Greco-Roman medical tradition in Arabic medicine 123 Greek antecedents to medieval gynecological concepts 128 Moisture, menstruation, andhealth in Hippocratic texts 128 Women’sanatomy and the female contribution to the embryo 131 Infertility and its treatment in Greek medicine 136 Etiology and treatment of female infertility in Arabo-Galenic medicine 144 Infertility in the Firdaws al-ḥikma (Paradise of Wisdom) 144 The intersection of infertility with other gynecological concerns 151 Menstrual retention and hysterical suffocation 153 Childlesscouples and the assessment of each spouse’sfertility 161 Acknowledgement of male-factor infertility 161 The garlic test: Acasestudy of recapitulated tradition and innovation 164

 Physicians, Midwives, and Female Patients 175 Non-gynecologicalinteractions between male medical professionals and female patients 177 Gynecological care and interactions between male physicians, female patients, and female intermediaries 185 Theory, practice, and women’saccesstoArabo-Galenic medical knowledge 198

Conclusion to Part II: Medicine and Sexism 203 XIV Contents

Part III: Healing and Religious Vulnerability

Introduction to Part III 207

 Religiously Classifying the Medical Marketplace of Ideas 211 Intellectual eclecticism and the pursuit of medical knowledge 211 Lack of classification of medicine in the haḍ īth collections 215 Jurists on the “medicine of the physicians” 217 Jurists on resorting to folkmedicine 230

 Heterodoxy and HealthcareAmong Women 237 Muslim female patients,male practitioners and the preservation of sexual boundaries 242 Muslim female patients,non-Muslim female practitioners, andthe preservation of sexual and intellectual boundaries 245 Shielding Muslim women from heterodoxgynosocial contexts 252 Ibn al-Ḥ ājj on women’snetworks of knowledge 262 Heterodoxy and women’smedicine 268

Conclusion to Part III: ATafsīrabout the First Woman’sFertilityand Theological Vulnerability 271

Epilogue:Infertility and the Study of Women’sHistory 276 Infertility and family law 277 Medieval gynecologyand its significance 280 The quest for conception: women’saccesstomedical practitioners 281 Infertility and choice 283

Bibliography 285 PrimarySources and Translations 285 SecondaryScholarship 291

Index 303 Studying Infertility in the Medieval Islamic World: Why andHow

This studybegan with an assumption and aquestion. Assumingthatproducing children was the primary sourceofwomen’svalue and women’spower in medieval Islamic societies, what happened when women failed to produce children? There weregood reasons to make this first assumption. After all, anthropological and sociological accounts from manymodernMiddle Eastern communities describe the importance of motherhood for women and the anxiety surrounding infertility; and members of these modern communities oftenascribe such values and anxieties to religion and to centuries-old tradition. Moreover,throughout the contemporary world, arguments in favorof“traditional” or “patriarchal” practices,aswell as those rejecting them, have hinged upon the notion that the limitations placed on women exist to either confine them or support them in theirrole as producers and nurturers of children.¹ Surelythis was also true of the experiences of women in medieval Islamic societies?Itraises the question of how those women who could not fulfill that role were treated. From the start,ithas also been clear that this line of reasoningisproblem- atic. There are the definitional problems,such as what do we mean by “power,” when should communal practices be labeled “Islamic,” and what is the significance of the plural in the phrase “Islamic societies”?These concerns are real, but they represent adetour from the discussion at hand, not an actual contradic- tion or problematization of the supposition thatmotherhood was the primary role assigned to women, around which the traditional system, particularlyasen- shrined in Islamic law, wasorganized. Here, however,evenacursory knowledge of Islamic familylaw suggests apossiblyfatal flawwith this argument: Islamic lawbarelymentions infertility and in no wayovertlypenalizes barren women.² Indeed, it makes rather little mentionofmaternityitself.³ How then could it play

 Forsomeexamplesofthe ambiguities of measures which servetosupport andconstrict women in their rolesasproducers of children,see RemkeKruk, “Pregnancyand Its SocialCon- sequences In MediaevalAnd TraditionalArabSociety” Quaderni Di Studi Arabi 5/6 (1987):418 – 30.  The case of slave women represents somethingofanexception to this rule, as such women stood to gainsome legal protections if they bore their masters’ children. See Y. Mirza, “Remem- beringthe Umm al-Walad,” in Concubines and Courtesans:Women and SlaveryinIslamic History, ed. M. Gordon and K.A. Hain (Oxford: OxfordUniversity Press,2017), 297–337.  The most recentscholarship on motherhood in the medieval Islamic world, Kathryn Kueny’s Conceiving Identities:Maternity in Medieval Muslim Discourse and Practice (Albany: StateUniver- sity of New York Press, 2013), does not include anyextended discussion of Islamic law.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-002 2 Studying Infertility in the Medieval Islamic World: Why and How arole in shapingthe experiencesofinfertile women?Ultimately, it is the answer to this question which constitutes the subjectofthis book.

Why study the experiences of barren women?

Forstudents of medievalIslamic societies, the studyofbarren women offers two benefits. First,itilluminatesaphenomenon that is important in and of itself, as it was experienced by women in all eras and places,and with life-changingcon- sequences. Secondly, in exploring the factors thatshape the peculiar experience of infertility,weshed light on broader issues in Middle Eastern and Islamic history.Instudying reproduction, we gain insight into the interplaybetween the medicaland religious explanations of biological events and the significanceat- tributed to them. In studyingmedicalinterventions, we gain insight into the re- markablydiverse marketplaceofideas about health that existed in some medieval communities,and the anxieties some people felt as aresultofthe multiplicity of authorities and forms of knowledge.Wesee competition and anxiety expressed by religious authorities against medical authorities and practitioners of healingmagic, male medical practitioners against female ones, and male religious culture against femalereligious culture. In studying women’ssources of healthcare, we gain new insights into the meaningbehind regulations governing women’smodesty and social interactions. Finally, in studyingthe options available to childless women throughout their life cycles, we can fine-tune our understanding of some aspectsofthe institutions of Islamic marriage, divorce, and po- lygamyinwaysthat make us re-examine, and at times contradict,certain assumptions about patriarchy, paternity,motherhood, and women’svulnerabil- ity and empowerment within the Islamic legal system. The picture of patriarchythatemergesfrom this studyofinfertility is acom- plex and somewhat surprising one. While much ink has been spilled by others in describingpatriarchal attempts to exert male control over women’ssexual organs so as to ensurefathers’ confidenceintheir ownpaternity,this study shows the extent to which men depended upon and trusted women to individu- allymonitor and interpret theirown reproductive statuses. It alsoshows both the legal and medicalwillingness to tolerate, and even embrace, reproductive uncertainty and ambiguity.However,italsosuggests thatthe social constraints urged upon women were understood by manyjurists as existing for reasons beyond the need to guard against sexual and reproductive violations. Rather they werealso put in place to guard against the threat of religious and intellectual syncretism, a threat to which some jurists thoughtwomen were particularlyatrisk, and partic- Why study the experiences of barren women? 3 ularlysoduringtheir experiences of events connected with health, birth, and death.

The importanceofinfertility as aphenomenon

Writing in Tunis in the 1970s, the sociologist Abdelwahab Bouhdibaproduced a lengthy, dramatic, and damningdepiction of the importance of fertility and the prospect of sterility for women in what he termedcontemporary “Arabo-Muslim” society.⁴ His La Sexualité en Islam highlights the role playedbyIslamic legal norms in making the fate of women contingent upon their reproductive success. Because of the weakness of awoman’sposition as awife, awoman must seek safety through the institution of motherhood, he claims. Polygamy,divorce, and inheritance lawall conspiretopressurewomen into producing children, as ameans of obtaining loyalty,respect,care, and financial security in asystem which is otherwise lacking in thosethings.⁵ He concludes:

Havingchildren in the traditional Arabo-Muslim society is the fundamentalelement of security for awoman.Woebetide the sterile woman ...Motherhood,then, was aprotection. It was the onlysecurity for awoman – therewas practicallynoother ...So, giventhe “system” and the structures of the environment,the Arab womantries to increase her chances by havingasmanypregnancies as possible.Hencethat obsession with children – have children, morechildren and still morechildren!

Bouhdibaargues that even in TheThousand and OneNights,the classic story of the triumph of feminine brains over masculine brawn, what enables Shahrezad to survive is not her storytelling abilities,but rather her providing the king with three sons in the space of thirty-three months. “One of them walked, one of them crawled, and one was at the breast.”⁶ Other sociologists and ethnographers describingtheir findingsintwentieth- century Iran, Turkey,⁷ Palestine,⁸ Jordan,⁹ Egypt,¹⁰ and Morocco¹¹ have empha-

 A. Bouhdiba, Sexuality in Islam (London: Saqi Books, 2004), 215f.La Sexualité en Islam (Paris: Presses Universitaires de France, 1975), 263f.  Foranoverview of Islamic texts that refer to the honor duetomothers,see A. Giladi, Muslim Midwives: The Craft of Birthing in the Premodern Middle East (New York: Cambridge University Press, 2015), 37–56.  Bouhdiba, Sexuality in Islam, 216.  C. Delaney, The Seed and the Soil: Gender and Cosmology in TurkishVillage Society (Berkeley: University of CaliforniaPress, 1991), 59.Ofall the accounts of women’sexperiences in the Middle East that Ihavecomeacross,Delaney’splaces the least emphasis on the stresses caused by in- 4 Studying Infertility in the Medieval Islamic World: Why and How sized the role familial honor and social pressure playinshaping the experience of childless women, in addition to the fear of divorce. The French sociologist Paul Vieille, basedoninterviews with urban and rural women living in Iran in the 1960s, vividlydepicts the shameassociated with infertility and the pressure brought to bear in compellingyoung women to takemeasures to demonstrate their own fertility.

Aftermarriage all those whosurround ayoung wife await with anxiety the announcement of apregnancy. The event releases an anxiety;thenceforth the youngwife will be cherished by her husbandand her in-laws.If, on the contrary,thereisadelay, anxiety grows on all sides.The father of the young girl has givenaproduct for reproduction; he is discredited by his daughter who does not immediatelypromise achild. The husband’sfamily, on its side, has acquiredayoungwife to increase its descendants;ifher sterility continues,the husband loses interest in his wife and threatens to send her back or to take asecond wife. The household is constituted to procreate; sterility is abroken contract. The young wife whois, habituallyand without proof, taken to be responsible for the sterility of the couple, will do everythingtochange her state:pilgrimages, magic practices, potions,and so forth. If she does not succeed, she will have onlyadiminishedstatus,and her familywill feel dishonored by it. Social incitements to childbirth continue after the first birth. There are, notably, the uncertainties of the position of the wife in the household; the marriage is easilybroken by the will of the husband alone. Even if this does not happen in the countryside,¹² the op-

fertility and the anxiety to have children. Writingabout her fieldwork in aTurkish village in the early1980s,she also mentions that abortion is common, and quitedangerous for the mother. However,she does note that, “If achild is not producedwithin areasonable amount of time, the man is free to divorceortake asecondwife. Althoughpolygynyisforbidden in modern Turk- ish law, it sometimes occurs in villageswhere traditions of the Seriat (Islamic law) still operate. The system of beliefs implies that the marriage bond is less importantthan physiological paternity.” Ibid., 53.  H. Granqvist, MarriageConditions in aPalestinian Village, 1:117; 2:116,244–6, and idem, Child ProblemsAmong the Arabs (Södorström, 1950),76–7, 224. T. Canaan, “Unwritten Laws Affecting the Arab Woman of Palestine,” Journal of the Palestine Oriental Society 11 (1931), 175.  R. Antoun, “Social Organization and the Life Cycle in an Arab Village,” Ethnology 6.3 (1967), 302–3.  Ḥ . ʻAmmār, Growing up in an Egyptian village; Silwa, Province of Aswan (New York, Octagon Books, 1966), 94.S.Morsey, Gender,Sickness, and Healing in RuralEgypt (Boulder,CO: Westview Press, 1993), 48, 54,75. and “Sex Differences and Folk Illness,” in Women in the Muslim World,L. Beck and N. Keddie (Cambridge,Mass.: HarvardUniversity Press, 1978), 604–605.M.Inhorn, Infertility and patriarchy:the cultural politics of gender and family life in Egypt (Philadelphia: Uni- versity of Pennsylvania Press, 1996).  V. Maher, “Women and Social Change in Morocco,” in Women in the Muslim World,ed. Lois Beck and Nikki Keddie (Cambridge,Mass:HarvardUniversity Press,1978), 104.  ErikaFriedl’saccount of aremoteIranian mountain villageinthe 1970sand early1980s con- firms this: “There aren’tmanychildless couples in Deh Koh, and of the few not one ever split up, Why study the experiences of barrenwomen? 5

tion left to the husband to send back his wife easilyleads the latter to look for means to attach her to her home. Childrenare reputed to be “nails” that attach the wife to the home. Aftermarriage,women hasten to multiplythese ties which guaranteethem against repudiation. ...the group of women: they actively surround the young wife, initiateher,guide her through the first pregnancies,welcome the newborn,and combatsterility.Inthem are transmitted ancient popular practicesregarding magic, pharmacy, and medicine. They help the youngwives and exert aconsiderable pressureinfavor of fecundity.¹³

The effects of such pressurelead women to engageina“quest for conception,” memorablydepicted by Erika Friedl in Women of DehKoh,which includes a chapter portraying the experience of achildless young wife seeking aid in the wake of the Iranian Revolution,¹⁴ and by Marcia Inhorn, in her books The Quest for Conception: Gender,Infertility,and Egyptian Medical Traditions and In- fertility and Patriarchy:The Cultural Politics of Gender and Family Life in Egypt. In the course of such quests, infertile women seek assistance from ethnomedical practitioners, religious saints, and practitionersofbiomedicine. Astudy from modernEgypt shows that concerns about infertility,and the perception that pregnancyisnot occurringquicklyenough, account for more thanhalf of all women’smedical visits, whether to biomedical physicians or practitioners of in- digenous medicine.¹⁵ As depicted in modern accounts, in the course of this “quest for conception,” women encounter and navigate Islamic legal cultureincomplex ways. The delivery of medicalattention and care to women is potentiallyfraught as aresultofmodesty concerns. Moreover,medical systems and treatments,such as biomedical healing,humoral healing,magical healing, prayer,and pilgrimage rituals to attain saintlyblessing, baraka,are subjecttoreligious categorizations on the basis of theological orthodoxy and heresy.Whether aform of medicalintervention meets with approval or disapproval from religious authorities is not dependent on whether such interventions are “traditional,” validated by either

and no husband ever tookasecond wife because of his first wife’sbarrenness.Indeed after the first few rough yearsofcrushed expectations, attemptedcures, amulets and accusations,pilgrimages, travels to doctors, fights,sneers,and humiliating pity,and after hope has dimmed to afaint flicker deep in the couple’shearts, they tune in to each other as companions in misery and live morepeacefullyand leisurelythan most of their neighbors harassed by large families.” E. Friedl, Women of Deh Koh (London: Penguin Books,1991), 48.  P. Vieille, “FamilyAllianceand Sexual Politics,” in Women in the Muslim World,ed. Lois Beck and Nikki Keddie (Cambridge,Mass:HarvardUniversity Press,1978), 457.  Friedl, Women of Deh Koh, 47– 65.  H. Khattab, N. Younis, and H. Zurayk, Women, Reproduction, and Health in RuralEgypt (Cairo:American University in CairoPress, 1999), 65. 6 Studying Infertilityinthe Medieval Islamic World: Why and How historical precedent or indigeneity.Indeed, among some devout Muslims, centuries-old medicalsystems are viewed with more suspicion than the more recent biomedicine. As Inhorn writeswith respect to Egypt:

Interestingly,contemporary Islamists tend to condone most biomedical therapies as the creation of God – as being “God’smedicine.” Yet, it is trulyironic that onlymodern, Western- based biomedicine is deemed religiouslyacceptable, giventhe rich history of Yūnānī-inspired Islamic and prophetic medicineinEgypt.Asweshall see, manyofthe contemporary ethnomedical practices found in Egypt derive fromthese early, religiouslyacceptable medical traditions,which arenow viewed as unorthodoxbyIslamist elementsinEgyptian society.¹⁶

All of these characterizations of modernMuslim women’sexperiences highlight the importance of the Islamic legal tradition for understanding contemporary familial relations,genderroles,and attitudes toward medical treatment.¹⁷ And yet, duetothe paucity of scholarship,¹⁸ anthropologists have largely skipped over the medieval Islamic period when describing the significanceand consequences of infertility,reachinginstead for literature from the Greco-Roman or even Biblical periods.¹⁹ Where scholarshipabout the intersection of Islamic law, science, and gender exists, it has been very useful. Thus Basim Musallam’swork on the approaches of medieval Islamic physicians towards the “one-seed” and “two-seed theories” of conception, and the intertwined relationship between Islamic holytexts and those medical theories, has become the go-to text,almost the onlyone, for those wishing to provide some medieval Islamic context for contemporary conversations about the intersection of gender,medicine,and Islamic legal orthodoxy.²⁰ Still lacking,however,are studies of medieval interactions between male physicians and female patients, medieval attitudes toward the “quest for conception”

 M. Inhorn, Quest for Conception: Gender,Infertility,and Egyptian Medical Traditions (Phila- delphia: University of Pennsylvania Press, 1994), 94.  Inhorn, Infertility and Patriarchy, 26.  In an unusual dissertation, Egyptologist Nicole Hansen attempted to study5000 years worth of fertility rituals in Egypt,fromthe Old Kingdom to the present.The pre-colonial Islamic era is the most sparselysourcedperiod. N. Hansen, “Motherhood in the Mother of the World: continuity and change of reproductive concepts and practices in Egypt from ancient to modern times” (PhDdiss., University of Chicago,2006).  E.g., Taufik Canaan, “Unwritten Laws Affectingthe Arab Woman of Palestine,” 175, 203. R. Patai, Sex and Family in the Bible and the Middle East (New York: Doubleday, 1959), 76 – 84.  B. Musallam, “The Human EmbryoinArabic Scientific and Religious Thought,” in The Human Embryo:Aristotle and the Arabic and European Traditions. ed. G. R. Dunstan (Exeter: Uni- versity of ExeterPress, 1990), 32–46. Why study the experiences of barrenwomen? 7 and orthodoxand heretical forms of medical treatment,and the extent to which modernwomen’sexperiences of disempowerment or fear of disempowerment as aresultofinfertility wereshared by theirmedieval counterparts. Thisstudyrep- resents afirst foray,among what Ihope will be manyfuture ones, into filling those gaps in our knowledge.

Studying infertility to shed light on related issues in Middle Eastern and Islamichistory

The exploration of infertility has much to offer studentsofmedieval Islamic communities generally, well beyond specific information about barren women. Infertilityrepresents an extreme case in which awoman’smultiple roles as a mother,asapossessor and object of sexual desire, and as aconduit that binds families together (genealogicallyand financially) through marriage, are in direct conflict with each other.Byexamining this extreme case, we can gain insights into the relative significanceof, and tensions between, thoseroles. As otherscholars have demonstrated, analyzingthe ramifications of amar- ginal biological phenomenon and the rather specialized legal discourse sur- roundingitcan yield fruitful and clarifyinginsights about more common experiences and pervasive social structures.For example, Paula Sanders’sstudyof the treatment of hermaphrodites in medieval Islamic lawnot onlyprovides informationabout what hermaphrodites might have experienced, but alsoilluminates the process, purpose, and scope of gender differentiation in Islamic lawmore generally.²¹ The above-mentioned article by Basim Musallam,onmedieval embryology, not onlyexplains specific claims about genetics, but alsomakes a broader point,showing just how important scientific beliefs were in framing large branches of Islamic law, as it pertains to sexuality, contraception, and abortion.²² Moreover,heshows that existing Islamic texts and laws favored and promotedcertain scientific theories over others. My own studyofinfertility sheds light on ahost of issues surroundingthe physiology of pubescence, menstruation, and amenorrhea and their importance for understanding Islamic marriageand divorcelaw. Exploring infertility also drawsour attention to medieval medical treatment, both generallyand with regard to women specifically. Because infertility wasa

 P. Sanders, “Genderingthe Ungendered Body: Hermaphrodites in Medieval Islamic Law,” in Women in Middle Eastern History: Shifting Boundaries in Sex and Gender,ed. Nikki R. Keddie and Beth Baron(New Haven: Yale University Press, 1991), 74 – 95.  Musallam, “The Human EmbryoinArabic Scientificand Religious Thought,” 37–8, 42– 3. 8 Studying Infertility in the Medieval Islamic World: Why and How long-term problem, rather than an emergency, and because it was perceivedas an afflictionwhich could be attributed to multiple sources, in theory amedieval childless woman would have had ample time to seek an arrayoftreatment options, justasmodern childless women do today. And, just as they do today, the practitionersoffering treatment existed in an environment in which they competed for the exclusive trust of their patients, while their patientsoften availed themselvesofahybrid system for understanding what,precisely, waswrong with their bodies. An analysis of infertile women’streatment options therefore leads us to examine who was offering explanations and treatments for ill health, the relationship between patients and those offering them treatment,and the relationship between competingpractitioners. The information about competing practitionersfurther leadsustoconsider the question of the extent to which male authorities expected their views and writingsabout women’sbodies to reach and influencewomen themselves. Finally, studying infertility provides us with an opportunity to re-examine aspectsofIslamic lawwhich are regularlymentioned in medievaltexts,but which have been ignored or at times misinterpreted in modernscholarship. Forexample, agreat deal of attention has been paid to juristic concerns about interaction between women and unrelated men. However,little attention has been paid to the frequentlyexpressed medieval concerns about women interacting with their fellow women. Similarlyunderstudied are the frequent mentions of the legal outcomes of biologicallyunexpectedcircumstances – wiveswho are not old and yetdonot menstruate regularly, husbandsand wiveswho are in some wayimpotent and unable to engage in normal sexual activity,and women who claim to be pregnant with afetus for years on end. Studying infertility bringstothe fore and helps to contextualize the significance of these legal discussions.

Methodological considerationsand the nature of the sources

Previous studies as methodologicalmodels

At the end of his life, the historian of medicine Michael Dols, producedamag- num opus, Majnūn: TheMadman in Medieval Islamic Society with the objective of placing “the subjectofinsanity in its historicalcontext,toexamine its significance, not onlywithin the fields of medicine,theology, magic, and law, but also Methodological considerations and the natureofthe sources 9 within the social milieu of Islamic society.”²³ In his book,Dols traces the history of medicalthinking about the causes and treatments of mental illness in the Greek medicaltradition and the Arabic one, as well as in Jewish, Christian, and Islamic texts.Hegoes on to describe the institutions built to provide care for the mentally ill. He then addresses moral perceptions of the significance of madness,asdepicted by poets, mystics,and belle-lettrists.Finally, he explores the legal significance and consequences of insanity. In its ideal form, astudy of medievalinfertility would be structured using asimilar template. My own studyisfar more limited than Dols’sbook, focusingspecificallyonthe medical and legal discussions of the condition at hand. It is, however,writtenwith Dols’s scope in mind, bothinterms of the largerquestions it seeks to illuminate,and in terms of its handling of recondite sourcematerials. The similarities between infertility and madness are striking.The causes of both weresimultaneouslyattributed to both “natural” biological dysfunction and divine intervention, and the onsetofthe disease was difficulttopinpoint. Both posed long-term problems,and thereforethere was opportunityinthe course of asingle patient’slifetime to attempt multiple forms of treatment. Both affected not just the ill person themselves, but the families and communities that surrounded them. And for both, the historian lacks first-person narra- tivesofthe experiences of the unfortunate patients. In his introduction, Dols describes the ways in which the nature of the sources available shaped his project,its methodology, and its limitations; much of what he writes is also transferable to the studyofinfertility.Henotes thatthe paucity of descriptive resources necessitatespulling togethersources that come from awide rangeoflocations and times. This means that “the fragmentary nature of the sourcematerial makes it quite difficult to delineate the subtle changes in the beliefs and practices concerning insanity or,converselytoavoida static view of the subject.”²⁴ Moreover,inboththe medicaland legal literature, the depictions of mental disturbancesare “prescriptive rather than descriptive,”²⁵ meaningthat the depictions of the phenomenon in these texts are there to provide arationale for aparticular method of treatment,rather than a clinical description, and thereforemappingcontemporary diagnoses onto medieval medicaldescriptions requires making some interpretive assumptions.²⁶ The

 M. Dols, Majnūn: TheMadman in Medieval Islamic Society (Oxford: Clarendon Press,1992), vii.  Dols, Majnūn, 2.  Ibid., 1.  AmongDols’sassumptions are: (a) That mental illnesses found in medieval Islamic societies aresimilar to the ones recognized by modern medicine. (b)That based on biology,geography, 10 Studying Infertility in the Medieval Islamic World: Why and How medicaldata also does not lend itself to quantification at all. Most importantly, “nor are there, to my knowledge,any reliable personal records of the insane that would allow them to speak for themselves; the rarity of authentic voices robs this work of immediacy,comfortablydistancing us from what was often, surely, a painful reality.”²⁷ All of these methodological complications also pertain to the studyofthe treatment of barren women in the medieval Middle East.For Dols, these compli- cationsdonot preclude scholarlyanalysis.Hewrites, “What can be expected, however,isarelatively firm grasp of the interpretationsofirrationality, and ates- sellated picture of the madman in medieval society.”²⁸ This is also my task – to explore how infertility was understood and learn about the experiences of and attitudes towards infertile women from as manyperspectivesasare available to us. Discussions of infertility includeseveral uniquecomponents,not present in discussions of madness. Infertilityisone place wheresocial and religious expectations of gendered roles,scientific disputes about conception and reproduction, and familial dynamics, all intersect.For this reason, Ihavealso looked to Basim Musallam’s Sex and SocietyinIslam: Birth ControlBefore the Nineteenth Century as amodel for my own work. There Musallam uses the specific issue of contraception as an entry point into abroader analysis of Islamic attitudes generallytowardsexual activity and marriage. In doing so, he demonstrates

trade, and war,wecan assume that mental illness caused by tropical diseases,malnutrition, and narcotics caused mental illness to be widespread and to probablyincrease over time. (c) That certain sociological factors pertainingtothe segregation of minorities and women “mayhave produced agreaterincidenceofpsychoneuroses and personalitydisorders than would be found in modern Western society” (p.3n5). My assumptionsfor my own work aresimilar to (a) and (b), but have nothingcomparable to (c). Medieval infertility was duetothe same sorts of causes as modern infertility,though most likelythe prevalenceofeach particular cause was different (e.g. infertility or diminishedfertility due to malnutrition or anemia would have been moreprevalent in the past when morecommunities experienced periods of famine). In our own era, acommon cause of infertility is sexuallytransmitted infections. Some of these infections areknown to have existed in the past.For example the bacillus which causes gonorrhea,which was rampant in the pre-modern world, in particular is known to cause female infertility,eveninwomen whohavehad onlylimitedexposuretothe infection and who areotherwise asymptomatic. At the moment,thereisinsufficientscholarship to make an argument as to whether such infections weremoreorless prevalent in various medieval populations in the Middle East.For an example of what such scholarship might look like, consider a studywith respect to Japan.W.Johnston, “SexuallyTransmitted Diseases and Demographic Change in EarlyModern Japan.” East Asian Science, Technology,and Medicine 30 (2009):74 – 92.  Dols, Majnūn, 2  Dols, Majnūn, 2. Methodologicalconsiderations and the nature of the sources 11 how very large arole negative and positive evaluations of sexuality playedinde- fining the institution of marriage, in both the Christian and Islamic worlds,even though this might not be intuitivegiven that bothChristianity and Islam ulti- matelypermit sexual activity within the confines of marriage. Additionally, he shows how Islamic lawresponded to competing medicaltheories of conception and to the biological reality that contraceptiveswereknown to not always be reliable. His book also offers insights into how having children or avoiding childbirth were alternately understood as potentiallyboth desirable and undesirable from the point of view of women’swell-being.All of this stems from the discussion of contraception, which is to say, the voluntary decoupling of sexual relations from reproduction. My contribution to these topics stems from the study of the involuntary decoupling of sexual relations from reproduction.

The nature of the primarytexts, and the promises, limitations, and pitfallsof studying intellectualhistoryusing sources spanning vast periods and topographies

The scope, methodology, and precision of this studyhavebeen influenced by the sources currentlyavailable. None of the medieval sources upon which Idraw wereproducedbyMuslim women. As Kathryn Kuenynoted in her studyofma- ternity, “it is impossibletoassumethat [women’s] voices and contributions to Muslim discourse and practice,ifany,may be fullyuncovered.”²⁹ In recognition of the nature of the texts, the goal of this research is not to extract or “liberate” women’svoices from men’swritings, but rather to explore how certain men, be- longingtoparticularsectors of society,perceivedwomen’sexperiences, vulnerabilities, and choices. Most of my sources are medical encyclopedias, religious advice books, and legal manuals. From the medicaltexts,Ihave attempted to draw out informationabout the Arabo-Galenic gynecological heritage. Among the questions Iask are:what did physicians think it signified when awoman did not bear children?What did they think could have gone wrong?Were men blamed for infertility?Did gynecology serveasafield of discourse for reinforcing socially-approved genderroles?What sort of treatment options did physicians and pharmacists offer?How much contact did male medicalpractitioners have with femalepatientsand femalepractitioners?Did male physicians expect that their writingsongynecological issues

 Kueny, Conceiving Identities,3. 12 Studying Infertility in the Medieval Islamic World: Why and How would ever be read, known, or applied by women themselves? The answers to these questions are described in chapters four and five of this book. The bulk of this study is based on the writingsproduced by the fuqahā’,Mus- lim jurists.The genres Imake use of include theoretical lawcodes, fatwās (in which specific cases, whether theoretical or drawnfrom an individual life, are addressed by ajurist who clarifies the relevant points of lawfor the case at hand),booksofadvice and ethics based on Islamic sources (legal adab), ḥisba manuals (which instruct market inspectors how to go about ensuring public well-being), and anti-bid‘a literaturewhich decries “innovations” in social or religious life which are at odds with the author’sviews of Islamic orthodoxy. The jurists’ writingscontain atreasure troveofinformation and yetare also full of shortcomingsfrom the point of view of the social historian. The lawwas an institution which could potentiallytouch everyone, rich and poor,male and female, the educated and the uneducated – in away which perhaps the Arabo- Galenic medicaltradition did not.Evenbetter,intheir moralistic writings, the jurists reflect on the behaviors of people whom they feel they are unable to reach. Their writingsthus, in theory,provide awindow on to the livesofa broad swath of society.However,legal writings give us little information about those who werenot in legal conflict and did not fear potential future conflict. When childless couples and their extended families took care of each other, they had no reason to have encounters with the legal system. Because this studyutilizeslegal material, it necessarilyfocuses on areas of conflict,the assertion or curbing of (usuallymale) power,and the transactional trading of familial privileges. That does not mean, of course, that in the communities described marriages and families necessarilylacked harmonyorfunctioned on an entirely transactional basis. Even more overtlyinspirational moralistic literature, such as IbnMufliḥ’s al- Adābal-sharʻiyya,Ibn al-Jawzī’s Aḥkāmal-nisāʼ,orIbn al-Ḥājj’s Madkhal,which describes ideal behavior (while emphasizing the prevalence of misbehavior), tends to depict ideal marital life in terms of the assertion of ahusband’sresponsibility and noblesseoblige, which is requited by his wife’ssurrender of power to him. This too should not be taken as indicative of typicalfamilydynamics. In- deed, the authorsthemselvescomplain thatboth husbandsand wivesblithely ignore their advice on maritalrelationships.However,the unfortunate result is that this studydoes not and cannot address what are surelysome of the most salient features of the experience of infertility:love, pity,and companionship. Asecond significant shortcominginthe legal material Iuse is that,unlike court records, it is not locale and time specific. Legal manuals, and even fatwās and nawāzil,donot privilegethe accurate depiction of local and contemporary practices.The scholars who produced the legal analyses and moralistic literature Methodologicalconsiderations and the nature of the sources 13 upon which much of my research is basedwerealsonot primarilyconcerned with producing an accurate account of the prevalentbehavior or local customs found in their own communities.Rather they weremore concerned with categorizing various behaviors as commendable or reprehensible and establishingan intellectual pedigree for those categorizations. When it comes to legal matters that affect infertile women, the legal scholars do depict diversity,but generally with respect to intellectual strands and schools of thought,rather than with respect to locality and period. There are afew types of cases in which these authors do focus on changes over time or place. This occurs most prominentlywhen there is asignificant break between the views attributed to the ProphetMuḥammadhimself and the dominant position within asubsequent school of Islamic law. Forexample, on the issue of the desirability of women’sprayerinmosques the Islamic authorities frequentlyacknowledge that while the Prophet permitted attendance, they themselvesdiscourageitand justify that changeonthe grounds thatcontempo- rary women behave in adifferent (worse) fashion than the virtuous women of Medina.³⁰ The opposite situation is also attestedto, in which apreviouslydis- liked practice becomes widelypermitted. Forexample, al-Sarakhsī (d. ca. 490 A.H./1096 A.D., in Transoxania) writesthat in spite of ‘Ā’isha’scondem- nation of women who make use of bathhouses, “the correct position accordingto us is thatthereisnoproblem with having baths for either men or women because they have need of it,especiallyinour country.”³¹ References to changes over time and place also appear frequentlyinanti-innovation treatises,in which the author distinguishes between “the pure law” and the degenerate practices which he attributes to his own local community.Inthis literature, the diversity of practice is depicted as anovel occurrence, arecent deviation from apre- viouslyunivocal norm, rather thanaproduct of deeply-rooted multivocal traditions. Confirming whether the so-called “degenerate” practicesare common, rare, or entirelyhypotheticalisnot always possible.³² This bringsthe reader back to the concerns about the fraught use of the ad- jectives “medieval” and “Islamic” societies. The problems with such terms are

 M. H. Katz, Women in the Mosque: AHistoryofLegal Thoughtand Social Practice (New York: Columbia University Press,2014), 97.  Behnam Sadeghi, TheLogic of Law-Making in Islam: Women and Prayer in the Legal Tradition (Cambridge:Cambridge University Press,2013), 114.  E.g. In Ibnal-Ḥ ājj al-‘Abdarī’s Madkhal written in the early8th/14th century in Egypt,the author claims that Muslims women in Egypt,under the influence of their Christian and Jewish counterparts, have started observing “sabbaths” three days per week. Ibnal-Ḥ ājj al-‘Abdarī, Madkhal (Beirut: Dāral-Kutub al-‘Ilmiyya, 1995), 1/2:201–2. 14 StudyingInfertility in the Medieval Islamic World: Why and How manifest: they refer to communities separatedbyvast gaps in time and space, and which themselvesdrawonlocal traditions which mayvary considerably,tra- ditionsthat mayhavelittle relation to anyone notion of “Islam.” The texts Icite span from the 3rd/9th centuries through the 8th/14th centuries,and from Spain in the West,toIraqinthe East,and sometimes beyond. Can it be appropriate to write asweeping overview of atopic through the use of sources from such diverse populations?The question becomes even more challenging because discourses on Islamic lawand women are so often associated with attempts to depict the women of the Islamic worldasuniversally “subjugated” and in need of “liberation” at the hands of the “modern West.” In raising such concerns, Lila Abu-Lughod specificallycautions against writing in broad strokes.

Much of the best recentliteratureinMiddle East women’shistoryand anthropology can be conceivedofasworkingagainst universalizingdiscourses about patriarchy, Islam, and op- pression. Scholars have been seekingtospecify,toparticularize,and to ground in practice, place, class,and time the experiences of women and the dynamics of gender.³³

It is doubtless worthwhile to examine how infertile women experiencedIslamic lawinspecific communities;however,itwould be amistake to thereforecon- clude that our knowledge of history cannot benefit from engaging in “universal- izing discourses.” Broad discussions, such as those featured in Michael Dols’s Majnūn: the Madman in Medieval Islamic Society,Avner Giladi’s Children of Islam: Concepts of Childhood in Medieval Muslim Society and Basim Musallam’s Sex and Society in Islam: Birth ControlBefore the Nineteenth Century layout the contours of the intellectual landscape. They provide aframework which helps us to begin to answer what was important,what was axiomatic,what was conceivable,what was widespread,and what was controversial,evenif they maypotentiallymislead us as to relative frequency of different modes of dealing with anyparticularissue.Indeed, it is onlyinthe context of such a framework that we can hope to pinpoint and appreciate the extent to which local practices represent adeviation from, an alternative to, or arenegotiation of, the norms propounded by juristic writings. My choice to study “barren women in the medieval Islamic world” is thereforenot intended to elide over or ignore the significant differences between and within populations, but rather to engageinthe prerequisite work necessary for those differences to be recognized and appreciated.

 L. Abu-Lughod, “Feminist Longingsand Postcolonial Conditions,” in Remaking Women, Feminism and Modernity in the Middle East,ed. L. AbuLughod(Princeton:Princeton University Press, 1988), 22. Methodologicalconsiderations and the nature of the sources 15

Parallels between communities separated by religion and time

While the experiencesofmedieval Muslim women constitutethe main topic of study, Ialsocite parallels and divergences between medieval Islamic Middle Eastern communities and medievalChristian European ones, as well as between Muslim and non-Muslim communities in the Middle East.Myreasons for doing so are three-fold. First,thereare some forms of historical data available from certain communities in medieval Christian Europe which are currentlynot available from anymedieval Middle Eastern community.For example, scholars of Europe- an history have been able to start drawing conclusions about the ageatwhich women in certain medieval communities reached various stages of physical maturity,based on data from exhumed skeletons. Secondly, because medieval Christian and Jewishcommunities in the Middle East shared both medical beliefs and economic conditions with their Muslim peers, but had different legal options when it came to infertility,attimes it is easiertoparse the concerns motivating non-Muslim women’slegal strategies,and to thereby gain some sense of what mattered most to them.These are concerns which they mayhaveshared with their Muslim neighbors, and they thereforeshedlight on what mayhavebeen women’sconcerns more broadly, regardless of religious boundaries. Thirdly, it is worthwhile to note that manyofthose aspects of medieval women’sexperiences which modernegalitarian readers find most distasteful crossed confessional boundaries. In all threeofthe Abrahamic religions,women could be married off at very young ages. All three in some respect subordinated unmarried daughters to their fathers, and wivestotheir husbands.All three claimed that women’sbiological functions both determined and reflected their spiritual and social inferiority.This willcome as no surprise to even the most casual student of medieval history and theology. However,itbears repetition giventhe con- tentious history of people denigrating Islam by drawingattention to the “plight” of Muslim women. It is my hope that if Ican demonstrate the commonalities and peculiarities of the attitudes manifestedbythedifferent religious communities, honestassessments of women’scomparative vulnerabilities and sources of power in thosecommunities will not be viewed as aweapon to be wieldedin contemporaryideological battles. This studyalso makesextensive references to sources from other time periods, includingfrom the modernMiddle East.Inparticular,inthe tradition of such historians of medieval social history as S. D. Goitein and Avner Giladi, I draw on modern ethnographies.³⁴ Where Ihavelocated alegal or social strategy

 E.g. S. D. Goitein, AMediterranean Society:the JewishCommunities of the WorldasPortrayed 16 Studying Infertility in the Medieval Islamic World: Why and How that is employed by both modernwomen and medieval ones, Idrawattention to how modern women characterize their thought process in employing that strategy.For example, women in medieval and early-modern Islamic societies sometimes made the choice to forfeit the inheritance which was their legal due, without providinganexplanation for their doing so. Women living in twentieth- century societies also sometimes make this choice,but we have interviews with those women in which they offer explanations of the social purpose and motivations behind their individual choices.Thesemustnecessarilybeused with caution; they in no wayoffer proof of what motivated medieval women. But they can offer us perspectivesand analysis that are worth our consideration. Similarly,Ido not assume that the biological ideas espoused by rural Turkish women in Carol Delaney’s TheSeed and Soil or by urban lower-class Egyptian women in Inhorn’s TheQuest for Conception necessarilycoincide with the beliefs of Anatolian or Egyptian women from centuries ago. It would be highlyproblem- atic to assume that ethnographic accounts from Morocco, Egypt,Iraq, and Iran depict age-old social practices in thoserespective regions,and Idonot use them to project modern practicesback in time. But modernwomen’sexperiencesand perspectivesare not less valuable and thought-provoking for being ungeneraliz- able.

Sourcesexcluded from this study which meritfurther inquiry: fictionalliterature,magic, and pilgrimage literature

There are severalgenres is medieval literature which can perhaps provide us with insights into the topic at hand, but which have been excluded from this particular study. These include magical texts and artifacts, pilgrimageliterature and histories describing festival observances, and popularliterature. In afuture book, Iintend to examine these genres for evidence of women’sfertilityrituals. However,for the most part,Ihave excluded these genres from this work because of the methodological complications involved. Among these complications is the difficulty of evaluatingthe veracity of what are often vagueorunsympathetic de- scriptionsofwomen’sfertility rituals, written by men who view such rituals with disdain. Should we reject the outraged depictions of women’srituals that come from medieval moralists, on the grounds that outrageindicateslack of credibil- ity?Orshould we accept them at face value or,somehow,stake out amiddle

in the Documents of the Cairo Geniza (Los Angeles: University of California Press, 1978), 3:7. Gi- ladi, Muslim Midwives, 137. Methodologicalconsiderations and the natureofthe sources 17 ground?Evenmodernacademicand sympathetic observers of fertility rituals are often quite shocked by them, yetitwould be amistake to dismiss their descriptions altogether.³⁵ Determiningthe meaning of ritual performances is even more fraught, and it requires agreater degree of openness to speculation than the rest of this studydoes. Hence, it will be savedfor afuture one. The attractions and pitfalls of such speculation can be observed in Nicole Hansen’sdissertation, “Motherhoodinthe Mother of the World: Continuity and ChangeofReproductive Concepts and Practices in Egypt from Ancient to Modern Times.”³⁶ Other complications stem from the repetitions of tropes and the expectations of certain literaryconventions, which in turn make it moredifficult to explore fictional stories in search of clues to historical reality.However,certain celebrated stories maybeuseful in further illustrating concerns and phenomena regarding infertility which we also find in other genres.For example, the story of “Dalīla the Crafty” in OneThousand and OneNights,depicts infertile characters using elements thatwill appear over and over again in the legal literature too. Consider Dalīla’svictim Khātūn, the childless wife of awealthyemir.

The chief of the caliph’sofficers ...was married to abeautiful girl whomheloved. On their wedding night she made him swear to take no other wife and to spend no single night away from home. One day, when her husband went to the caliph’scourt,henoticed that each of the emirs was accompanied by one son or two, and then, when he went intothe baths and looked at his face in the mirror,hesaw that therewere morewhite than black hairs in his beard. He said to himself: ‘God took away your father and will He not provide you with ason?’ He was in an angry mood when he went back to his wife, and when she wished him agood evening,hesaid: ‘Get away fromme. From the daythat Ifirst sawyou nothing has gone right for me.’‘Whyisthis?’ she asked, and he said: ‘On our wedding night you made me swear to takenoother wife. TodayIsaw that every single emir had one or two sons.Ithoughtabout dyingwithout issue, and aman wholeavesnoheir will not be re-

 Auseful example of discomfort on the part of the anthropologist can be found in Inhorn’s description of her observations of afertility ritual at the tombofShaikh al-Khibari near Alexan- dria. Inhorn, Questfor Conception,228–231. Foranexample of an unsympatheticmedieval description of popular rituals,consider Ibnal-Ḥājj’sclaim that women hollow out bread, fill it with mouse dung,and eat it to facilitateeasy childbirth.Ibn al-Ḥājj, al-Madkhal,3/4:221.  Hansen, “Motherhood in the Mother of the World,” 41.Throughout her work, Hansen notes the similarities between aspectsofancient and current fertility rituals in Egypt.She notesthe similarity between circumambulation rituals,segregation of post-partum women, celebrations of week-old newborns,and the use of honey in medicines. However,without information as to whatthe women believethey areachievingthrough the use of these rituals it is virtuallyim- possible to tell whether we areseeinganinherited continuity,afaux-continuity (in which rituals which originated in the modern period arebackdated), or simplythe convergenceofpractices which arecommontomanysocieties. 18 Studying Infertility in the Medieval Islamic World: Why and How

membered, and Iamangry because youare barrenand cannot conceive by me.’ His wife invokedGod’sName against him and said; ‘Ihaveworn away mortars by poundingpow- ders and medicines, and the faultisnot mine but yours.You areaflat-nosed mule with wa- tery and infertile sperm that cannot inseminateand produce children.’‘Iamgoing on a journey,’ he told her, ‘and when Icome back Ishall take another wife.’‘It is God Who de- termines my fortune,’ she told him. He then let and each of them was sorry or having blamed the other ... Khatun [told Dalila] ‘on my wedding night Imade my husband swear that he would take no other wife. Then he looked at other men’sson and, in his longing for them, he accused me of beingbarren, while Itoldhim he was an infertile mule. He went off in afit of anger,promising to take another wife when he came back from his journey.Iam afraid that he will divorcemeand marry another,asheisaman of property with alarge income, and if he has sons by another wife it is they whowill take the wealth and the property instead of me.’‘Daughter,’ said Dalila, ‘don’tyou know about my master,Abu’l-Hamalat?³⁷ If anydebt- or goes to him as apilgrim, God will free him of his debt,and anybarrenwoman whovisits him will conceive.’ ...Khatun told her that sincethe dayofher wedding she had not left her house [not even] to offer condolences or congratulations.³⁸

As shallbeshown in the subsequent chapters, manyelements of this storycor- relatewith what we see in the medicaland legal literature. As part of his marriagecontract, the husband commits himself to monogamy, avery common stip- ulationinmedieval Islamic marriagecontracts.³⁹ The painofthe emir’s childlessness is deepenedbythe fact that he is also fatherless and stems from the sense thatnoone will remember him after his own death.Atthis point the husband blames the wife not onlyfor being barren, but for closing off the possibilityofasecond marriage, and he seeks to renegotiate this part of the contract.This too is attested to elsewhere. The wife in turn blames her husband for their childlessness. The belief that infertility could stem from either husbands or wivesisalso well-attested to in medieval medicalliterature. The wife’sconcern that her husband’schildren by another wife would eventuallyappropriate her share of his estate is also reflectedinthe legal sources. Andfinally, the wife’s remark thatshe has been constrained from seeking atreatment for her infertility at the handsofaholyman because she is so virtuous that she does not leave the

 The name is apun, referringtoboth pregnant women and debtors.  M. Lyons (translator), TheArabian Nights: Tales of 1,001 Nights Volume 2 (Penguin Classics: New York, 2010), 804.  K. Ali, “Marriage in Classical Islamic Jurisprudence: ASurvey of Doctrines,” in Frank Vogel and Asifa Quraishi, ed., TheIslamic Marriage Contract (Cambridge:HarvardUniversityPress, 2009) 23–25.A.Sonbol, “Shari‘ Court RecordsAnd Fiqh As Sources Of Women’sHistory,” Reli- gion &Literature,42(2010) 238. Goitein, Mediterranean Society,3:149–50. Chaptersand structure 19 house even for women’ssocial activities, such as wedding celebrations and the paying of condolencecalls, is alsodescribed in the jurists’ writings.

Chaptersand structure

Part Iofthis book explores the ways in which Islamic lawcould influencethe experiencesofinfertile and childless women over the course of alifetime, ex- cludingthe experience of medicalintervention. The first chapter examines the significanceoffertilityasitisdepicted in the earlyIslamic non-legal religious sources, particularlyinthe sīra and the ḥadīth,and explores the contrast between those textsand legal discussions of the role of fertilityinmarriage. The second chapter explores aspects of the reproductive life cycle thatwerethe subject of agreat deal of legal thought, includingadolescent maturity,menarche, amenorrhea, and menopause. It shows how legal expectations of the reproductive cycle wereinsome ways at odds with the biological realities of many women. This, in turn, confused legal expectations about who was and was not likelytobeinfertile,pregnant,orpotentiallypregnant.The chapter further explores the prospects and the mechanisms of divorceand remarriage,and how reproductive dysfunctions complicated those procedures. Chapter 3concludes this section with an exploration of the marital prospects of childless women and how childlessness affects the application of Islamic inheritance laws. The second part of this book examines the perspectiveswecan gain on in- fertilityfrom the Arabo-Galenic gynecological tradition. Chapter 4describes the gynecological theory found in medieval medicaltextsand its relationship to the Greek medical tradition which it references.Thischoice of topic is basedonthe fact that the Arabic medical textsexplored here explicitlyclaim Greek physicians as their primary authorities and, as will be shown in Part III, this had significance from the point of view of certain Islamic jurists.Chapter 5discusses gender segregation, modesty concerns, medicalinteractions between the sexes, and the extent to which it was possible for gynecologicalideas contained in medical books to have ever made areal impact on women’smedicalcare. It aims to shed light on aquestion which has garnered attention from other scholars of the history of science and genderand society:whether specificallyIslamic religious attitudes towardwomen’sroles and towards gender-based separation are reflected in the Arabic medicalwritingsabout women’sbodies. The final part addresses attitudes towardmedicaltreatment found in the writingsofcertain medieval jurists.Chapter 6examines juristic depictions of the relationship between Arabo-Galenic medicine, the “medicine of the Proph- et,” and folk medicine.Itargues that some jurists wereconcernedbythe intel- 20 Studying Infertility in the Medieval Islamic World: Why and How lectualhybridity found in the medieval medical scene. They believed that people’sdesire for healingpotentiallyled them to leveragesupernatural forces other thanGod’s, or to esteem as infallible truth pronouncements other than the Islamic revelation, or to put their trust in and offer their intimacy to non- Muslims. Chapter 7argues that these same juristswereevenmore concerned about the potential for heterodoxy among women patients, particularlythose seeking medicaland ritual aid in dealingwith significant moments in the life cycle and reproductive cycle.Iarguethat the jurists’ stated preferences when it comes to who provides medical care to Muslim women demonstrate aconcern with more than just modesty and the sexual dangers of female-male contact. Rather,they are motivated by aconcern about intellectual influence, the dangers of female-female contact,and the rise of what they believetobeagulf between Muslim women’sculture, particularlyasitrelates to biologyand the management of life cycle events, and the culturepropagated by the jurists.

Infertility as alocus forambiguity,uncertainty, and compromise

Among the most salient aspects of infertility is the wayinwhich it foregrounds the uncertainty that people oftenlived with, on abiological, social, legal, and theological level. With regard to diagnosis,therewas apronounced resistance across the medieval Islamic world to legallyorsocially labelingeither femalein- fertilityormale sterility as apermanent condition. One could not legallylabel one’sspouse as infertile in the wayone could, for example, label them as lep- rous.One could not be certain that aperson who did not reproducewhile they wereyoung would also fail to reproducewhile they wereold. Indeed, as we shall see, even more obvious labels pertinenttoreproduction, such as that of yā’isa (the post-menopausal woman) wereoften not conferred upon women until very old age. The significance of diagnostic uncertainty is also readilyap- parent when we analyze how,inboth the medical and legal realms,the symptoms of pregnancyand infertility wereconflated. So too werethe therapies intended to promoteconception and those intended to promoteabortion or contraception. This resulted in both legal and medical ambiguity and hencecon- fusion, but that ambiguity alsoprovided potentiallyvulnerable women with room to maneuver in their ownperceivedself-interest,both legallyand medically. There wasalso uncertainty about the marital consequences of infertility.In manyMuslim communities,infertility could potentiallyprecipitatepolygamy, divorce, remarriage,social disconnection, or disinheritance, but it did not have to. Infertility as alocus forambiguity,uncertainty,and compromise 21

These uncertainties also provided abroad rangeofopportunities for individuals to exercise choice,and to be influenced by the choicesoftheir spouses and familymembers. This provided aflexibilitywhich was not present to the sameextent in societies dominated by Jewish or Christian views of marriage. There was atremendous amount of debate, ambivalence, and compromise surroundinghealing itself, particularlyfor women. Whatconstitutes effective medicine and what quackery?When does the pursuit of health constitutethe reasonable exploitation of the cures set on earth by the beneficent God,and when does it suggest alack of trust in thatGod?Towhom should femalepatients turn for guidance? To male or female practitioners? To Muslims or non-Muslims? How much of aconcern should avoiding physical immodesty be when seeking gynecological care? How much concern should there be to avoid heterodoxy,su- perstition, and dependency on those foreign to the household or to the religious community?The literature Ihavepieced together suggests that male physicians interacted with femalepatients and had few compunctions in doing so, yetthere is also evidence that this interaction was viewed as suboptimal. Not onlywere interactions between male practitionersand female patients fraught, so also wereinteractions between femalepractitioners and their femalepatients, espe- ciallybut not exclusivelywhen the healers werenon-Muslims. Finally, this studyhighlights the multiple legal areas,pertaining specifically to women, in which there appears to be asignificant tension between legal theory and social practice in manylocales and time periods. These areas include: female socializing and ritual practices in gender-segregated settings, the role of women in transferring and preservingproperty between generations and families, the publicdemonstration of menstrual status, and the extent of interactions between menand women in medicalsettings. Thistension is profoundlyimpor- tant when attemptingtounderstand the ways in which Islamic lawhelped to shape the experiences of Muslim women, and when considering the malleability of religious discourse about gender and familyroles. It has often been assumed that medieval Islamic lawpromoted aframework which placed intense pressure on women to have children and encouraged dissatisfaction with those who could not.Upon closer examination, however,wesee that this pressureand dissatisfaction was not aone-waystreet.Islamic lawdid not condemn barren women, but rather had adisparatelynegative impact on them. Such disparate impact,combined with the fierceculturaldesire for children, placed astrain on religious norms. It spurred individual women, their families, their medical practitioners, and their religious leaders to develop exceptions,reinterpretations,stratagems, and compromises in their negotiation of Islam.

Part I: Infertility and Islamic Law Throughoutthe LifeCycle

Introduction to Part I

‘Ā’isha said: Iasked the Prophet, 'What person has the greatest claim over awoman?’ He said, ‘Herhusband.’ Isaid, ‘What person has the greatest claim over aman?’ He said, ‘His mother.’⁴⁰

Classical Islamic lawdoes not grant infertility aparticular legal status.⁴¹ Apre- pubescent girl, avirgin, apregnant woman, abreastfeeding woman, and an old woman all have special laws attached to their situation, but neither infertility nor childlessness is alegal category.Nevertheless,inavariety of areas,Islamic lawhad potentiallydistinct consequences for medieval infertile women, in part because infertility often correlated with other physical and social conditions, such as irregular menstruation, which in turn had legal implications. These laws did not targetinfertile women and,indeed, infertility rarelyentered into Is- lamic legal discourse. Each area of the lawwas its own unit,defined by its own set of scriptural bases (nuṣūṣ)and its own principles (maqāṣid), onto which one can map individual cases. As aresult, they are rarelyconsidered together as con- tiguous topographical features thatcombine to form alegal landscape which an individual person, such as an infertile woman, might traverse over the course of alifetime. This section attemptstolay out justsuch agrand landscape by piecing the discreteunits together.

 Al-Haythamī (d. 807/1405), Majma‘ al-zawā’id (Beirut: Dāral-Kutub al-‘Ilmiyya, 2001), 4:405.  Onlyinthe modernperiod arethere exceptions.See Aharon Layish, Marriage,Divorce, and Succession in the Druze Family (Leiden: Brill, 1982), 205and Vardit Rispler-Chaim, “Ḥasan Murād Mannā:Childbearing and the Rights of aWife,” Islamic Law and Society 2(1995), 92.The article refers to a fatwā which can be found in Ḥasan Murad Mannā, Fatāwā wa-tawjīhāt (Cairo: Dāral- Ṣafwa, 1990), 201–2.

The childlessmarriages of the Prophet Muḥammad and the depiction of infertile spouses in the ḥadīth: two conflicting views

Some Islamic laws concerning women are traditionallyconsidered to have been derivedfrom the Prophet Muḥammad’sfamilylife. These include laws pertaining to seclusion and veiling,adoption and kinship, sexual etiquette and negotiation within polygamous marriages, the procedurefor dealingwith accusations of maritalinfidelity,and others. Women’sformsofpurification from menses in preparation for prayer are also traced backtothe practicesofthe Prophet’s own family.⁴² The tradition of permitting young girls to playwith dolls is based on ‘Ā’isha’s(d. 58/678⁴³)childhood in the Prophet’shome.⁴⁴ Somehave attributed the willingness to allow Muslim women to participate in the transmission of ḥadīth to the precedent of the Prophet’swives and daughters transmitting them.⁴⁵ However,not all aspectsofthe Prophet’shousehold became precedents for deriving Islamic law. Forexample, the number of the Prophet’ssimultaneous marriages is held to be exceptional rather thanparadigmatic for the Islamic laws of marriage.⁴⁶ With this in mind, the question arises as to whether Islamic legal attitudes towardinfertility have anyrelation to the Prophet Muḥammad’spersonal example.

Mothers of the believers

Most of the Prophet Muḥammad’smarriages werechildless but there is aremark- ablyscant recordofpeople commentingonthat fact.Onlytwo of Muḥammad’s

 M. H. Katz, Body of the Text (Albany: SUNY Press, 2002), 85, 97.A.Sayeed, Women and the TransmissionofReligious Knowledge in Islam (Cambridge:Cambridge University Press,2013), 30.  Here as elsewhere, Islamic calendar dates(A.H.) arefollowed by Christian ones (A.D.).  Al-Bukhārī (d. 256/870), Ṣaḥīḥ al-Bukhārī (Vaduz, Liechtenstein: Thesaurus Islamicus Foun- dation, 2000), 78 (adab):81 =no. 6130.  This toohad its limits,astherewere those whobelieved that the Prophet’swives represented the exception rather than the rule. Sayeed, Women and the Transmission of Religious Knowledge in Islam,63ff.  Katz, Body of the Text,73.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-004 The childless marriages of the Prophet Muḥammad 27 manymarriages and liaisons resulted in children and, of the children he did produce, no son survivedchildhood and onlyone daughter,Fāṭima (d. 11/633), survivedher father.⁴⁷ Muḥammadisreported to have impregnated two women, his first wife Khadīja (d. 619) and Māriyyathe Copt (d. 16/637).⁴⁸ Some of the other women with whom he had sexual relations did have children from previous husbands, but not from him. With the exception of ‘Ā’isha, all of his wiveshad been previouslymarried, although some of those marriages wereofshort duration and during timesofwar.Intotal, approximatelyhalf of the wivesand concubines associated with Muḥammad had no children at all, or thereare conflicting reports about them.⁴⁹ In part,this can be attributed to the unusual patterns of fertilitythat occur in asociety with highrates of divorce, prematuredeath, and warfare.⁵⁰ Forall of these reasons,itisdifficult to determine the exactrea- son for the high number of childless unions in Muḥammad’sfamily. The Prophet Muḥammad does not appear to have devalued his childless marriages, quite the contrary.With some exceptions, his wiveswereheld in highesteem in their own lifetimesand in the subsequent generations. Although awell-known ḥadīth has the Prophet praising his late wife Khadīja to his beloved but jealous wife ‘Ā’isha on the grounds that Khadīja gave him children, there is otherwise but little mention of childlessness as asourceofstrain in his mar-

 In additiontohis descendants throughFāṭima, Muḥammad also had two grandchildren from his daughter Zaynaband one from his daughter Ruqayya. The marriage between the Proph- et’sdaughter UmmKulthūmand ‘Uthmānwas childless.Zaynab’sson ‘Alī died young while her daughter Umāma survivedintoadulthood and married ‘Alī ibn Abī Ṭālib, after the death of her aunt Fāṭima. She bore him ason, Hilāl. Muḥammad’sgrandson, fromthe union between his daughter Ruqayyaand ‘Uthmān, died in childhood. The household thus remained small. Ibn Sa‘d(d. 230/845), al-Ṭabaqātal-kubrā (Beirut: DārIḥyaʼ al-Turāth al-ʻArabī,1996) 8:252–262. On Muḥammad’schildren, see IbnQayyim al-Jawziyya(d. 751/1350), Zādal-maʻādfīhady khayr al-ʻibād (Beirut: Muʼassasat al-Risāla, 1998), 1:101.  Thereare some traditions in which ‘Ā’isha is said to have told Muḥammad that Māriya’sson Ibrāhīmwas not his.Some Shī‘ī commentaries on Q. 24:11, e.g. Tafsīral-Qummī saythat the verse refers to this incident.Al-Qummī, Tafsīral-Qummī (Qum: Muʼassasat al-Imāmal-Mahdī, 2014)2:702.  These are ‘Ā’isha, Ḥafṣa, Zaynabbt. Khazayma, Zaynabbt. Jaḥsh, Juwayriyya, Ṣafiyya, May- mūna, and Rayḥāna.  Thereisalarge bodyofscholarlyliteratureabout the extent to which polygyny, as it is prac- ticedinthe twentieth century,itself reducesthe fertility of women in such marriagesincompar- ison to women in monogamous marriages. The correlation between depressed fertility in polygynous families is sometimesattributed to chemical-biological factors and sometimes to socio- economic factors,while other scholars denythat there is asignificant correlation at all. See K. Effah, “AReformulation of the Polygyny-Fertility Hypothesis,” Journal of ComparativeFamily Studies 30 (1999), 381–408. 28 1Infertilityand the Purposes of MarriageinLegalTheory riages.⁵¹ While there are manytraditions which reportdiscussions between Abū Bakr and his daughter ‘Ā’isha, and ‘Umar and his daughter Ḥafṣa(d. 45/665), regarding their relationships with Muḥammad, Ihavenot found one thataddress- es their childlessness.⁵² Similarly,there is no record of Muḥammad’swives or enemies overtlyaccusing the Prophet himself of diminished fertility.⁵³ Some modernfeminist Muslims have pointed to the example of Muḥammad’swives, revered in the Islamic tradition as the “mothersofthe believers,” as icons demonstratingthe value of childless women⁵⁴ although, to my knowledge,nomedi- eval sourcemakes this positive connection.⁵⁵

Infertility in the ḥadīth

In spite of the Prophet’spersonal example, many ḥadīthsassociated with Muḥammadand ‘Umar (d. 23/644), father of Muḥammad’schildless wife Ḥafṣa, referencefertility as an essentialtrait to seek out in aspouse. Fertility is correlated with several other desirable traits, includingvirginityand amiabil- ity.Other ḥadīthssuggest that even when an infertile woman is otherwise desirable, her inability to conceive disqualifies her as aprospective spouse. The following are some of Muḥammadand ‘Umar’sstatements about infertile women.

 E.g. Al-Bukhārī, Ṣaḥīḥ al-Bukhārī, 63 (manākib al-ansār):20 =no. 3818. Another exception occurs in atradition where ‘Ā’isha says of Māriya Umm Ibrāhīm: “Then God grantedhim a child throughher and kept us from havingone.” IbnSa‘d, Ṭabaqāt, 8:213. One could also per- hapsinterpret the followingpassage from IbnSa‘d’sbiographyof‘Ā’isha, apassage which is immediatelypreceded by discussions of the consummation of her marriage,asarequest for a child: “Isaid to him, ‘OMessengerofGod, women are supposed have a kunya, so give me a kunya.’ He said, ‘Take on as your kunya your son ‘Abdallāh,’” i.e. her nephew’sname. Ibn Sa‘d, Ṭabaqāt, 8:274, 275. See D. Spellberg, Politics,Gender and the Islamic Past (New York: Co- lumbia University Press, 1994), 41.  E.g. al-Bukhārī (d. 256/870), Ṣaḥīḥ al-Bukhārī,46(bab al-maẓālim):25 =no. 2468.  The one time Muḥammad’sfertility is addressed is in a ḥadīth in which he argues that he has proof that he is not the anti-Christ (dajjāl). Muḥammad says that whereas the anti-Christ is infertile and cannot sire children, he (Muḥammad) has sired children. Muslim ibn al-Ḥajjāj(d. 261/ 875), Ṣaḥīḥ Muslim (Beirut: DārIḥyā ʼ al-Turāth al-ʻArabī), 4:1783 =no. 2927.  See, for example,A.Chaudhry, “Unlikely Motherhood in the Qur’ān: Oncofertility as Devo- tion” in Oncofertility:Reflections from the Humanities and Social Sciences, ed. T. K.Woodruff et al. (New York: Springer,2010), 287–94.  See Kueny, Conceiving Identities:Maternity in Medieval Discourse and Practice,110 –14. Kuenyshows that even those medieval commentators whohad positive attitudes toward ‘Ā’isha still noted her infertility as an imperfection. The childless marriages of the Prophet Muḥammad 29

Ma‘qil b. Yasār(d. 59/679 in Baṣra)said: Aman came to the Prophet and said “Ihavefound anoble and beautiful woman, but she is infertile. Should Imarry her?” He said: “No.” Then he came to him asecond time and he [again]forbade him. Then he came to him athirdtime and [the Prophet] said: “Marry amiable, fertile women so that I[God] maymakeyou abun- dant amongthe nations.”⁵⁶

From IbnJurayj(d. 150/767 in Mecca): Aman came to the Prophet and said: “OMessenger of God, Ihaveacousin who is the most noble-minded of women but she is barren.” The MessengerofGod said: “Do not marry her.” Then he said. “Marryingafertile black woman is better than marryingafair woman whoisinfertile. Itaughtyou that amiscarried fetus whoisthe offspringofMuslims is told: ‘Enter Paradise!’ He remains, full of indigna- tion, at the gate of Paradise and says: ‘Iwill not enter paradise until my parents do.’ So he is told: ‘Then enter Paradise, by the grace of the mercy of God.’”⁵⁷

From Anas b. Malik (d. 91/709 in Baṣra): [The Prophet] said, “Marry amiable,fertile women and multiply, for Iwill make great the number of prophets amongyou on the DayofRes- urrection. Bewareofthe barrenwoman, for [one married to]her is like aman ensconced at the topofawell, whowaters his land daily, but whose land does not bloom,the stream [of water] is not absorbed.⁵⁸

Abū Dāwūdsaid: ‘Umar said: “Amat in the house is betterthan awoman whodoes not produce children.”⁵⁹

The attitude manifested in these statements is summarized in Abū Ḥāmid al- Ghazālī’s(d. 505/1111) Iḥyā ‘ulūmal-dīn.

 Abū Dāwūd(d.275/889), Sunan (Riyadh: Maktabal-Maʻārif lil-Nashr,1996), 311–12 = no. 2050,al-Nasā’ī (d. 303/915), Sunan (Riyadh :Maktabal-Maʻārif lil-Nashr,1996), 499 = no. 3227.  ‘Abdal-Mālik ibn Ḥabīb(d. 238/852), Kitābadab al-nisā’ al-mawsūmbi-kitābal-ghāya wa’l- nihāya (Paris:Dāral-Gharb al-Islāmī,1992),152.This statement indicates that the cousininques- tion is unable to conceive and the Prophet responds that she is useless,evenincomparison to a lowly wife. He says that conception is itself useful even if no live baby results,sincethe fetus can compel God to allow his parents into heaven. In so doing, the Prophet differentiates between a woman whoisunable to conceive and awoman whoisunable to carry afetus to term, even though in almost all other places in Arabic and Islamic literature, the diagnosis of infertility encompasses both conditions.See, for example, al-Shaybānī’s(d. 189/804) commentary on Q. 19:5 in which he glosses the word “barren woman” (‘āqir)saying, “she does not menstruate, does not getpregnant,and does not give birth.” Muḥ ammad ibn al-Ḥ asan al-Shaybā nī, Nahj al-bayān ʻan kashfmaʻānīal-Qurʼān (Tehran: Nashr al-Hādī,1998) 3:303.  Ibn Ḥabīb, Kitābadab al-nisā’ al-mawsūmbi-kitābal-ghāya wa’l-nihāya,152– 3. Thereare manyversions of this ḥadīth which do not include the final sentenceorwhich have adifferent conclusion, see al-Bayhaqī (d. 458/1066), al-Sunan al-kubrā (Beirut: Dāral-Kutub al-‘Ilmiyya, 2003), 7:131.  Abū Dāwūd, Sunan,589 =no. 3922. 30 1Infertility and the Purposes of MarriageinLegalTheory

The secondpurpose [of havingchildren] is endearingoneself to the MessengerofGod and pleasinghim by increasingthat which he takes pride in. Forthe MessengerofGod stated this explicitly, and everythingwhich is said of ‘Umarclearlyindicates an emphasis on the obligation of procreation. Forhemarried alot and said, “Imarry for procreation.” In the akhbār regarding the disparagement of the barrenwoman (madhammat al-mar’aal- ‘aqīm)itisreported that he, peace be upon him,⁶⁰ said “Amat in the corner of the house is betterthan awoman whoisinfertile.” He also said, “The best of your women arethose whoare fertile and amiable (al-wulūdal-wudūd). He also said, “Afertile black woman is betterthan afair woman whodoes not producechildren.”⁶¹ This indicates that procreation is asuperior virtue of marriage [in comparison to the virtue of]tamingsex- ual excess, sincefair women aremoresuitable for securing chastity,lowering one’sgaze, and curbingdesire.⁶²

All of the above ḥadīthspoint to atradition of forbidding, discouraging, and dis- daining marriage to infertile women. It should be noted, however,that fertility is certainlynot the only, or even the most common, virtue attributed to agood prospective wife. Other ḥadīthsinstruct men to seek out wiveswho are, among other things, believers, modest,beautiful, well-born, thrifty,wealthy, appreciative,and soft spoken.⁶³ Among the most commonlymentioned, highly-prized attribute is that of virginity, which willbediscussed below. We thus have Muḥammad’spersonal legacyofcontracting and remainingin non-procreative marriages standing in contrast to the statements attributed to him and to ‘Umar,father of the celebratedbut childless Ḥafṣa, that disparage and forbid such marriages. These negative statements are frequentlyfound in adab al-nisā’ (etiquetteorreligious guidance pertainingtowomen) literature, but theirlegal potential never seems to have been exploited in the formulation of Sunnī familylaw.Instead, the ḥadīth most oftencited in legal literature con- cerninginfertility pertains to asterile man:

[Reported from] IbnSīrīn: ‘Umar b. al-Khaṭṭābsent aman on atax collecting mission, and he married awoman. But he was infertile (‘aqīm), and when he was brought before ‘Umar

 Ihaveincluded the benediction here as thereissome disagreement as to whetheral-Ghazālī attributes this statement to ‘Umar or to Muḥammad himself. This formulation would indicate that the Prophet himself is meant,however the statement is elsewhere attributed to ‘Umar.It is possible that the benedictionwas inserted by alater copyist,rather than by al-Ghazālī himself.  See al-Ṭabarānī (d. 360/971), al-Mu‘jam al-kabīr (Cairo: Maktabat Ibn Taymiyya, 1983), 19:416 and Ibn Ḥibbān(d. 354/965), al-Majrūḥīnmin al-muḥaddithīn (Aleppo:Dāral-Wa‘y, 1975), 2:111.  Al-Ghazālī, Iḥyā ‘ulūmal-dīn (Cairo: Mu’assasat al-Ḥ alabī,1967), 2:26.  See AmālQarā mī, al-Ikhtilāffīal-thaqāfa al-ʻarabīya al-islāmīya (Beirut: Dāral-Madāral-Is- lāmī,2007), 37. Infertility in the Islamic legal framework of sex and marriage 31

this was mentioned to him and he said. “Did youinform her that youare infertile?” He said, “No.” [‘Umar] said, “Then divorceher and inform her,then give her the choice.”⁶⁴

Although this ḥadīth is often citedinlegal manuals, in discussions of laws pertaining to marital defects, it is usually immediatelycircumscribed or circumvented so as to limit or negateits impact,aswill be explainedlater in this chapter. In order to appreciate the significanceofthe radical divergencebetween Is- lamic lawonthe one hand, and the adab al-nisā’ literature culled from these ḥa- dīthsonthe other hand, it is worth examining the consequences of infertility in other religions.

Infertility in the Islamic legal framework of sex and marriage, with comparisonstoChristianity

In Sex and Society in Islam: Birth ControlBefore the Nineteenth Century,Basim Musallam began his studyofIslamic attitudes toward contraception by highlightingthe contrasts between Christian and Islamic premises regarding sexuality and its role in marriage. It would serveuswelltoreiterate these contrasts when considering attitudes toward infertility.Musallam noted the following elements of Islamic sexual morality:marriagecould be polygynous,and legitimate sexual intercourse could be had not onlywith wives, but alsowith concubines. Marriagewas not viewed as anecessarilypermanent relationship because divorcewas easy to obtain and could occur at anypoint.Finally, maritalsexual intercourse was based on the right to sexual fulfilment; it needed no procreative justification, and therefore contraception and abortion weretolerated.⁶⁵ Musallam contrastedthese features of Islamic thought with Christianity’sre- pressive approach to sexual intercourse, except as aprerequisite for reproduction, and Christianity’sdedication to the idea of permanent,monogamous marriages. Lookingatthese same features with respect to infertility and marriage law, one can see that,inaChristian framework, one of the tragedies of childlessness was its seeming permanence and the remarkably few options that were available to achildless Christian couple, due to the restrictions on divorceand

 The ḥadīth is found in asection on marriage to an impotent man, but the ḥadīth text is ambiguous as to whether this is so in the case in question. Logically, it is doubtful that the man is impotent because the issue seems to hinge upon the question of disclosure rather than consummation. Sa‘īdb.Manṣūr(d. 227/843), Sunan (Bombay: Dāral-Salafiyya, 1982) 2:81= no: 2021.  B. Musallam, Sex and Society in Islam: Birth Control Before the Nineteenth Century (Cam- bridge:Cambridge University Press, 1983), 11. 32 1Infertility and the Purposes of MarriageinLegalTheory remarriage.⁶⁶ In some cases the childless couple might be able to enter areligious order,orpossiblyremarry following the death of one of the spouses, or retroactively annul their marriageonthe basis of either impediments or consan- guinity,but otherwise they were unlikelytoexperienceachangeintheir maritalstatus. They could not hope to procreatewith someone else or to leave amarriagethatwas marred by childlessness. Thus the late-7th-century East Sy- rian bishop of Fārs, Īšōʿbōkt,noted that many people think that the Christian ban on divorceisharsh, especiallyincases where, “because of sterility or sickness … awoman is unable to sleep with her husband, [and] he remains deprived of sons.” Īšōʿbōkt acknowledgedthe sentiment but highlighted that the law’sse- verity was at least egalitarian. For “when aman is taken holdbysimilar infirm- ities, awife is compelled to bear this affliction.”⁶⁷ Infertilitythus accentuated the inherent rigidity of Christian concepts of marriage, as understood in most Chris- tian communities.⁶⁸ By contrast, duetothe very same factors thatMusallam out- lines, in Islamic societies much of the tragedyassociated with childlessness was the very fluidity and precariousness of the childless woman’ssituation. Infertility highlighted the inherent flexibility, and henceuncertainty,embedded in Islamic marriages. Twofactors in Islamic familylaw playedaparticularlysignificant role in shapingthe legal position of infertile couples:easilyobtainable divorceand the acceptability of polygamy. Because infertility was acknowledgedtohavemul- tiple potential causes, includingsexual dissatisfaction and incompatibility (as will be seen in chapter four), spouses in childless marriagescould hope that a different pairing would be more fruitful. The fact thathusbands werelegally able to divorcetheir wivesfor anyornocause,solong as they had the financial and social wherewithal to do so, meant that achildless wife could hope that her husband would divorceher.For then she would be freetomarry someone else with whom she could conceive.Achildless wife in that samesituation, however,

 ThereisahistoryofCatholics criticizingMiddle Eastern Christians for practicingbigamyin order to obtain achild, in spiteoftheir own religious precepts. Foranexample involvingpolyg- amydue to childlessness (after the death of an onlychild) see A. Jaussen, Coutumes des Arabes au paysdeMoab (Paris:V.Lecoffre, 1908), 15–16.See also, J. P. Thompson, Photographic Views of Egypt, Past and Present (Boston: J. P. Jewett,1856), 139.  L. Weitz, “Syriac Christians in the Medieval Islamic World: Law, Family, and Society,” (Ph.D. Dissertation: Princeton University,2013), 258. Cf.V. Garver, “Childbearing and Infancyinthe Car- olingian World,” Journal of the History of Sexuality 21 (2012), 214.  Historians of the medieval Catholic church in Europe have notedthat manyofthe restrictions on the dissolution of marriage became formalized and enforcedinaprocess which began onlyinthe eleventh century and continued through the thirteenth. R. M. Karras, Sexuality in Medieval Europe: Doing Unto Others (New York: Routledge,2005), 62,68. Infertility in the Islamic legal framework of sex and marriage 33 could just as easilyfear that her husband would divorceher and marry another woman, leaving his childlessdivorcée without long-term support. The existenceofthe institution of polygamysimilarlymeant that achildless wife could hope that her husband would not divorceher,but would rather keep her and supplement her with amorefertile spouse.⁶⁹ In this way, polygamycould blunt the impact of the religious duty to produce children, for aman could hope to fulfil that requirement through some of his marriages and not through others.⁷⁰ This, of course, was true of the Prophet Muḥammad himself. Equally, a childless wife could fear that her husband would not sether freebut would instead have her supplanted with amore fertile wife with whom she would be in (losing) competition. In addition to divorceand polygamy – institutions explicitlyenshrined in Is- lamic law – athird factor had asubstantial role in defining the legal experience of infertile women in theirmarriages, which Iwill call the legal distaste for neb- ulousness.The Sunnī framework for marriageismarked by specific points in the timeline of amarriage.Atthe beginning of amarriagethese includethe transfer- al of the dower,the transferalofthe bride to the groom’scustody, and the act of consummation. At the dissolution of amarriage, defining points occur when a husband pronounces aformula of repudiation, when awife renounces adebt owed her or returns aproperty to her husband, the death of the spouse, the menstrual cycles marking the ‘idda waitingperiod in which both spouses still have financial claims upon each other,and the end of the ‘idda when the ties between them have been severed. However,the realization that amarriagewilllikelynot yield children does not occur as alegal assumption at anyparticularpoint in an Islamic marriage. Legal sources point this out frequently, particularlywhen citing the above-mentioned ḥadīth about the ‘Umar’s “sterile” tax-collector and de- nying that he could be labeled as such. By contrast,inthe Rabbinic Jewish tradition,the ten-year anniversary of the marriagemarks apoint at which the marriageitself is considered sterile, and there are attendant legal consequences including, theoretically, legally-mandated divorce.⁷¹

 See A. Bouhdiba, La Sexualité en Islam, 263. This is not to saythat polygamywas the pre- dominant form of marriage.  Muḥammad b. Muḥammad al-Ḥaṭṭāb, Mawāhib al-jalīl (Beirut: Dāral-Fikr,1992),3:404.  Mishna Yevamot 6:6, andBabylonianTalmud, Yevamot,65b-66a. SeeJ.Baskin, “Rabbinic Re- flectionsonthe BarrenWife,” HarvardTheological Review 82 (1989),101– 14.Thistheoretical re- quirementwas likely notoftenpracticedassuch. Cf.Yevamot 64a. However, thereissomeevi- dencethatitcould be broughttobearonpractical matters when thewifewantedtoobtaina divorcefromareluctant husband. Alegal question wasaddressed to HaiBen Sherira (939– 1038), thegaonofthe YeshivaofPumbedita in Iraq: “Regarding onewho haslived with his 34 1Infertility and the Purposes of MarriageinLegalTheory

No medieval Islamic legal school has abinding test for either male or female fertility, and some medieval jurists note the particular difficulty of establishing the fertility of asexuallyinexperienced woman.⁷² Forexample, in commenting on the ḥadīth, “Marry amiable and fertile women,” earlyShī‘ite writers explain that one predicts the fertility of avirgin based on the fertilityofher kinswomen.⁷³ This is summarized in the Jawāhir al-kalām:

wife forten years, whichare notcontinuous, andwho wasintermittentlyinadifferentcityand intermittently with her, andbywhomshe hasnot hadchildren, is he obligatedtodivorce her when sheasksfor adivorce,and to give herher ketubbawhenshe claims “[I want achild]to be asupport formyhandand an axetoburyme”?Ordoesthere need to be tenyears in whichhecontinuouslylived in thesamecitywithher?” Judeo-ArabicfragmentinFriedman, Jew- ishPolygynyinthe Middle Ages,169 ff.The requirementisalsocited in casesbrought by medieval Jewish plaintiffhusbands, whowantedtouse it to override theclauses in theirmarriagecontracts whichstipulated that if they were marryasecond wife,theywould divorcethe firstand payher themoney duetoher in her ketubba andtoreturnher trousseau. Thesehusbandswantedtoeither engage in bigamy or to divorcetheir wiveswithout penalty. Theargumentwas that theclausewas invalidifitnecessitatedthemviolatingthe Biblicalcommandment to be fruitful andmultiply. See, forexample,Shimonb.Tsemah Duran(d. 1444 in Algiers), Seferha-Tashbets (Lemberg:Uri Zeʼev Salat, 1891),§94–95.Inthose places wherethe “BanofRabbenuGershom,” the11th-century prohibition on both polygamy andunwanteddivorce,was enforced thereweremedievalattemptsto override it in casesofinfertility. In response,the late 12th/early 13th-century German rabbi, Eliezer b.Yoel ha-Levi(Ravyah)wrote that Jewish communitiesnolongerevenpromote divorceincases of infertility, letalone usethe commandmentofbeing fruitful to override thepolygamyban.Henotes that this is dueinparttothe prevalence of infertility: “We arenot at libertytowaive theBan of the illustriousRabbenu Gershom, forthere aresomanyunhealthy andbarrenwomen,yet no one openshis mouthtocomplain.” TranslationfromE.Westreich, “InfertilityasGroundfor Polygamy in Jewish LawinItaly:Interactionamong LegalTraditionsatthe time of theRenaissance,” in Olir – Osservatoriodelle libertàedistituzionireligiose 2(2003), 12.  ‘Abdal-KarīmZaydān, al-Mufaṣṣal fī aḥkāmal-marʾawa’l-bayt al-Muslim fī al-sharīʻaal-Is- lāmīya (Beirut: Muʾassasat al-Risāla, 1994) 6:51.  Thereare manymoreshī‘īḥadīthsattributed to both Muḥammad and ‘Alī disparagingmar- riagetoinfertile women, as well as providingadvice on how to promotefertility.Interestingly, amongthe modernDruze community which banned polygamyamillennium agobut which does permit divorce, these ḥadīthshaveformed the basis for some significant legaldisagree- ments.A.Layish writes: “...the Druze Court of Beirut held that proven barrenness of the wife was a shar‘ī ground for divorce, without the husband beingliable (as to the financial consequences), on the strengthoftwo religious-legal rules which provided that ‘the supreme purpose of marriage is the production of offspring’ and ‘abarren wife should be avoided.’ Amajor- ity of the Lebanese Druze Supreme Court of Appeal also held, in one case in which the wife’s barrenness had been provedbymedical documents,that the question of offspringwas of great importance in amarriage;the husband might invoke barrenness as aground for dissolution because he has alegitimateright to children ‘for the preservation of the name and contin- uanceofthe memory [of the family] and the retention of the familyproperty by the agnates in accordancewith established tradition’;the court decided by amajority of votesthat the husband Marriageannulment due to infertility and genitaldefects 35

It is said that the combination of [fertility] and virginity occurs in one whoisnot tooyoung nor menopausal, and whohas nothinginher temperament which indicates atendency to barrenness,such as absenceofmenstruation. Isay,the primary wayofknowingwhether a virgin is fertile is referring to [the reproductive historyof] her kinswomen, her mothers and sisters.⁷⁴

Asimilar concept of gauging the fertilityofvirgins based on their kinswomen is found in some late-medieval Sunnī sources such as the Asnā al-maṭālib fī sharḥ Rawḍ al-ṭālib and the Kashshāfal-qinā’,but none of these suggests that thereexists aspecific or formal means of implementing this concept.⁷⁵

Marriageannulment due to infertility and genital defects

To what extent did Islamic legal theory acknowledge and privilegethe desire for children as particularlyimportant in amarriage? Andtowhat extent did it treat the frustration of not being able to reproduceasany different from anyother form of marital disappointment?Wecan begin to answer these questions by examining the sparse legal discussions of whether the prospect of childlessness due to aspouse’sinfertility can serveasabasis for either ahusband or awife to ask that their marriagebeannulled, on the grounds that their spouse’sinfertility constitutes adefect that cheatsthe fertile spouse of amarital right.Wecan also examine legal discussions about injuries to aperson’sreproductive organs. Within these discussions are debates about whether the lawallows someone to be designated as infertile, whether either spouse has alegal right to expectre- production from amarriage, the sexual rights of spouses to each other and the extent to which thosesexual rights can be disentangled from reproductive rights, and the extent to which the loss of one’sown reproductive capacities con-

might divorcethe wife without this beingregarded as arbitrary repudiation entitlingher to compensation. On the other hand, the minority of the court held that sterility of the wife (or husband) was not asecular or religious-legal ground for divorcebecause it did not constitute non-fulfilment of amarital duty the fulfilment of which depends on the will; in fact,inthe particular case in question, the wife had done all she could: she had undergone prolonged medical treatment to become fertile.” Layish, Marriage,Divorce, and Succession in the Druze Family,205.  Al-Najafī (d. 1266/1855), Jawāhir al-kalāmfīsharḥ Sharāʾiʻ al-Islām (Beirut: Muʾassasat al- Murtaḍā al-ʻĀlamiyya, 1992),10:360.  Zakarīyā ibn Muḥammad al-Anṣārī (d. 926/1520), Asnā al-maṭālib fī sharḥ Rawḍ al-ṭālib (Bei- rut: Dāral-Kutub al-‘Ilmiyya, 2000), Chapter14, no:263. Al-Bahūtī (d. 1051/1641), Kashshāfal- qinā’ (Beirut: Dāral-Fikr,1982) 5:9. 36 1Infertility and the Purposes of MarriageinLegal Theory stitutes an injury and aharm deserving of acompensation over-and-abovethe loss of one’scapacities for sexual intercourse and pleasure. The concept of marital defects and annulment can onlybeunderstood in the context of the two farmorecommon ways of ending amarriageinIslamic law. These means of dissolving amarriageare: ṭalāq (male-initiatedrepudiation) and khul‘ (in which the wife buysherself out of the marriage). UnlikeinChristian ec- clesiasticallaw,there was no Islamic legal case in which annulment was the onlyoption acouple had for ending amarriage. In all cases ahusband could legallychoose to end amarriagevia ṭalāq rather than annulment,since male-initiated divorcedid not requireany grounds whatsoever.And awife could seek out a khul‘ arrangement to end her marriage, although her power was circumscribed to agreater extent thanher husband’s. Annulment was thus alesser-used means of ending amarriage, one subsetofwhich is known as tafrīqlil-‘ayb (separation due to defect).⁷⁶ This form of annulment is significant for our purposes because medieval discussions about which defects oughttoserveasgrounds for annulment provide insights into what jurists believed werethe minimum expectations of marriage, and sometimes these discussions suggest when legal un- derstandings conflicted with other social or culturalexpectations. Annulment was established by the pronouncement of ajudge,rather than the couple. While its use was not common, since it could be invoked in only very few circumstances,there wereparticularcases in which annulment had practical advantagesoverthe more usual forms of divorce. Repudiation, ṭalāq, was ahusband’sprivilegethat had few intrinsic limits but did burden him with potentiallyheavy financial obligations. These included the support due to the wife duringthe ‘idda (the waitingperiod that follows adivorce, usually calculated as threemenstrual periods),the repayment of the delayed, outstanding portion of the mahr (i.e. the dower paid by the groom to the bride as part of a marriagecontract,often in an initial and alaterinstallment) and, in some communities, the giving of a mut‘a,a“divorcegift.” However,ifthe marriageended through khul‘ rather than ṭalāq,the wife, with her husband’sconsent,bought herself out of the marriagebyeither forfeiting the money the husband already owed her or otherwise compensating her husband. From ahusband’sperspective,akhul‘ divorcehad some financial advantagesand it is thought,for thatreason, that khul‘ was acommon form of marriagedissolution. The existenceofthis wife-initiated form of divorcewas potentiallyempoweringtoawife, but it also created aperverse incentive that could harmher.Itcould motivateahusband

 Other grounds for annulment included the discovery that the marriage was illicit,e.g.due to incestuous kinship or to awife’sprevious marriage havingnever properlyended. Marriageannulment due to infertility and genitaldefects 37 not to offer ṭalāq even if the marriagewas an unhappy one because,ifthe husband could pressurehis wife into officiallyinitiating the end of the marriage, he stood to save himself money.⁷⁷ Thus, while the costs of ṭalāq often served as a measure of protection against unwanted divorce, and khul‘ oftenserved as a means for awoman to assert her independence,these factors also set up an opportunity for potential exploitation.⁷⁸ These concerns made annulment apoten- tiallyuseful waytoend the marriage. From the perspective of ahusband, if he could obtain an annulment,hecould potentiallyavoid paying for the maintenance of his formerwife duringthe ‘idda waitingperiod that followed adivorce.⁷⁹ He could also avoid paying adivorcegift⁸⁰ and possibly(although not usually)hecould alsoavoid paying the delayedportion of the mahr.⁸¹ From

 Rapoport, Marriage, Money,and Divorce,72.  E.g. Ibn Rushd al-jadd was askedabout aman whoconsummated marriage with his virgin wife and then, for the next eleven months, “harmed her” in away which insults women, which IbnRushd understands to mean that he did not have sexual relations with her sincethe consummation. The wife “cannot stand him” and the man refuses to divorceher unless she giveshim everythingshe owns.Ibn Rushd tells the court to warn the man that he has one year to have relations with his wife and if he does not by the end of that time, the court will end the marriage by decree and the wife will owe the husband nothing. IbnRushd, Fatāwā Ibn Rushd,1:185.A similar form of extortion is mentioned in another fatwā,but in that case the wife capitulates to the demand and then sues afterward.Ibid., 2:952. Cf. al-Wansharīsī, al-Mi‘yāral-mu‘rib, 4:141. The Shāfi‘ī jurist Ḥ usayn ibn Muḥ ammad al-Marwarrū dhī (d. 462/1069) responds to a case where awoman whose husband never paid the mahr initiates a khul‘ divorce, payinga sum twice as much as the mahr to getout of the marriage.She then attempts to have the mar- riageretroactively annulled so as to recuperate the money she paid, but the jurist rules against her.See al-Marwarrū dhī, Fatāwā al-qāḍī Ḥ usayn ibn Muḥammad al-Marwarrūdhī (Amman: Dār al-Fatḥ ,2010), 325. F. Zarinebaf-Shahr writingabout Ḥanafī courtcases in 17th-century Ottoman Istanbul writes that “often, in order to retainthe mehr, men forced their wivestoinitiatedivorce” and provides examples of ex-wives (successfully) attemptingtoretroactively sue for the exploitation. F. Zarinebaf-Shahr, “Women, Law, and Imperial JusticeinOttoman Istanbul in the Late Seventeenth Century” in Women, the Family,and Divorce Laws in Islamic History,ed. Amira El Azhary Sonbol (Syracuse: Syracuse University Press, 1996), 92.  Al-Haytamī, Tuḥfatal-muḥtājfīsharḥ al-minhāj in Ḥawāshī al-Sharawānī wa-Ibn-Qāsim al- ʻAbbādī ʻalā tuḥfatal-muḥ tājbi-sharḥ al-minhājli-Ibn Ḥ ajar al-Haytamī (Beirut: DārIḥyā’al-Tur- āth al-‘Arabī,1988), 8:229.  Mut‘a. This was not always apractical component of Islamic divorce. See Y. Rapoport, “Ma- trimonial Gifts in EarlyIslamic Egypt,” Islamic Law and Society 7.1(2000), 18–21 and D. Little, “AFourteenth-Century Jerusalem Court Record of aDivorceHearing: ACase Study” in Mamluks and Ottomans: Studies in Honour of Michael Winter,ed. D.J. Wasserstein and A. Ayalon(London: Routledge,2006), 66–85.  Consider,for example, the above-mentioned case from the Druze Court of Beirut in Layish, Marriage, Divorce and Succession in the Druze Family,205.See also Ibn Ḥazm, al-Muḥalla (Cairo: Idāratal-Ṭibā‘aal-Munīriyya, 1928), 10:112–114, which discusses partial restitution of the ṣadāq 38 1Infertility and the Purposes of MarriageinLegalTheory the perspective of awife seeking to end her marriage,akey advantage of an annulment over other types of marriagedissolution was that she could use it to circumvent ahusband who was reluctant to set her free, or who was trying to pressure her into afinanciallyexploitative khul‘ divorce.⁸² Jurists identified onlyafew defects which could serveaslegitimate grounds for annulment. Some jurists drew an analogybetween marriagecontracts and sales contracts and argued thatthe same (or similar)circumstances that would nullify asale would alsonullify amarriage. Others maintainedthat onlythosespecific circumstances mentioned in ḥadīthsabout marriageannulment could justify such astep. However,regardless of which avenue the jurists pursued,there was amarked tendencytolimit the extent to which spousalde- fects could serveasgrounds for annulment.This tendency is remarked upon by the Cordoban jurist and philosopher IbnRushd (d. 595/1198) who explained that while contracts of sale and contracts of marriageare similar up until the point of the consummation of the marriage, there are significant differences when defects are found after consummation. Moreover,hewrote, whereas in asale anydefect maybegrounds to rescind the contract, there exists a “unanimity of the Muslims on the point that not every defect can lead to the nullification of marriage.”⁸³ The physical and physiological defects most commonlyrecognizedasgrounds for annulment wereleprosy,elephantiasis, insanity and, most importantlyfor our purposes, missing or abnormal genital organs. In the premodern period almostall Sunnī legal discussions of whether infertility is adefect – one which constitutes grounds for the non-sterile spouse to have the marriagenullified – have auniform conclusion thatextends across the legal schools: femaleinfertility is not considered to be such acondition.⁸⁴ There is slightlymore debate as to whether that is true for infertile husbands married to potentiallyfertile wives, with IbnTaymiyya(d. 728/1328) representing

to the husband. The 5th/11th-century Shāfi‘ī jurist al-Marwarrū dhī rules that under particular circumstances the husband would not paythe mahr. Al-Marwarrū dhī, Fatāwā, 323.  The Mālikī treatise al-Nawādir wa’l-ziyādāt includes achapteronhusbands whobecome awareofadefect in their ex-wives followingaṭalāq divorceand attempt to retroactively convert it intoanannulment,and on wiveswho become awareofadefect in their ex-husbands following a khul’ divorceand attempttodothe same thing. IbnAbīZayd al-Qayrawānī, Kitābal-Nawādir wa’l-ziyādāt 4:36.  IbnRushd, Bidāyatal-mujtahid (Cairo: Dāral-Salām, 1995), 3:1348. Translation from Imran Ahsan Khan Nyazee, TheDistinguished Jurist’sPrimer:ATranslation of BidāyatAl-Mujtahid (Reading: Garnet,2000), 2:59.  al-Buhūtī, Sharḥ muntahā al-irādāt (Beirut: Dār ‘Ālam al-Kutub, 1993), 2:678. Marriageannulment due to infertility and genital defects 39 the minority medieval opinion that awoman mayhavealegal right to procreative sex.⁸⁵

Statements in favor of permitting khiyār (spouse’schoice to pursue annulment) in cases of infertility

Arguments in favorofincludinginfertility among the list of defects permitting a spouse to exercisethe choice (khiyār)tohavethe marriageannulled are quite rare in Sunnī legal literature. The above-mentioned instruction from ‘Umar b. al-Khaṭṭābtothe sterile man to “informher,then give her the choice” is widely cited, but it is then almost uniformly circumvented using the argument that it is impossible to determine with certainty that aman reallyissterile. Among the exceptions to this rule is Ḥasan al-Baṣrī (d. 110/728), who is reported to have held the view that infertility in either spouse is grounds for annulment if the non-infertile spouse so desires.His opinion is cited by the Ḥanbalī jurist Ibn Qudāma (d. 620/1223)asfollows, “If one [spouse] has found the other to be sterile, [the non-sterile spouse] is giventhe choice.”⁸⁶ The Shāfi‘ī jurist al-Māwardī (d. 450/1058) statesthatthere is an opinion within the school that awoman has aright to khiyār in the case of ahusband who is able to have intercourse, but who lacks testicles, “because he is missing something without which therecannot be offspring.”⁸⁷ While it is common among jurists to view genital defects as alegitimate reason for annulment on the grounds that such defects interfere with sexual intercourse, al-Māwardī’s phrasing,which emphasizes offspringrather than intercourse, is unusual. IbnTaymiyyamakesanovel argument for consideringinfertility,atleast male infertility,asgrounds for annulment.Rather than rooting the argument in definitions of defect,hedraws alegal analogybetween sterility and contraception: “If ahusband is proven to be sterile, we rule by analogythat the woman has [the right of]choice, since she has aright to achild. It is for this reason that we sayone cannot practice coitus interruptus with afree woman with-

 This generalization about the literatureisalso confirmed in Vardit Rispler-Chaim, “Ḥasan MurādMannā:Childbearing and the Rights of aWife,” 95–6. However,in1995, aSaudi muftī,citing ‘Umar’sstatement about the ‘aqīm, ruled that the wife of an infertile man could have her marriage annulled on the grounds that women marry for the purpose of havingchildren. V. Rispler-Chaim, Disability in Islamic Law (Dordrecht: Springer,2010), 61.  IbnQudāma, al-Mughnī, 10:59.  al-Māwardī, Kitābal-ḥāwī al-kabīr (Beirut: Dar al-Kutub al-‘Ilmiyya, 1999) 9:340. 40 1Infertilityand the Purposes of MarriageinLegalTheory out her permission.”⁸⁸ IbnTaymiyya’sargument is basedonthe premise that there is aconsensus (withinthe Ḥanbalī school) that it is not permitted for a man to practice coitus interruptus without his wife’sconsent.Building upon this premise, he argues that the reason that unilateral coitus interruptus is not permittedisbecause afreewoman has aright to achild, and contraception would violate that right.Since ahusband’ssterilitywould also violate that right,logicallyittoo maynot be imposed upon awife without her consent. IbnTaymiyya’sargument is not unproblematic; other juristswho also believe that aman has to obtain his wife’sconsent before practicing withdrawal arguethat the legal right being violatedisher right “that he ejaculate in her when having sexual relations with her,”⁸⁹ but that is aright to sexual fulfilment rather thanaright to procreative sex. IbnTaymiyya’sunderstanding of the legal rights underlying the laws of consent and coitus interruptus is unusual but not unique. It is also found in the writing of the Ḥanafī jurist al-Kāsānī.The latter says that it is disliked for coitus interruptus to be practiced without the woman’s consent, “because sex culminatinginejaculation is the wayofgetting achild, and she has aright to achild.”⁹⁰ Within IbnTaymiyya’sown school, Ibn Qudāma agrees with him with regardtocontraception though not with regard to actual sterility.I.e.awife has aright to demand procreative sex rather than coitus interruptus,because she maywant achild, but he does not extend that logic so as to support the notion that awife maydemandanannulmentof her marriagetoasterile man. IbnQayyim al-Jawziyya, IbnTaymiyya’sdisciple, provides along and detailed list of defects which are grounds for khiyār and that list does not explicitly include infertility.However,hemakes an unusual argument that could be read as implicitly in favorofviewing infertility as adefect.After concluding his list he writes:

It is preposteroustolimit defects to two,six, seven, or eight to the exclusion of those which areinferred from them or areequivalent to them, such as the blind, the mute, the deaf and the woman whose hands and legs have been amputated either one or both. ...The Commander of the Faithful, ‘Umar b. al-Khaṭṭāb, told someone who had married a woman despitenot beingable to sire children: “Inform her that youare sterile and give her the choice.” What would he [‘Umar] sayabout defects which for her arecomplete, rather than partial?The analogy is this: that for every defect which repels the other spouse – and as aresultofwhich mercyand benevolence, which aregoals of marriage, cannot be

 IbnTaymiyya, Fatāwā al-kubrā,5:464.  Aḥmad b. Muḥammad al-Ṭahāwī, Sharḥ ma‘ānī al-āthār (Beirut: ʻĀlam al-Kutub, 1994), 2:30 –31.  Al-Kāsānī, Badā’i‘ al-ṣanā’i‘ (Beirut: Dāral-Kutub al-’Ilmiyya, 1986), 2:334. Marriageannulmentdue to infertility and genital defects 41

attained – khiyār is mandated. This is inferred from [the lawof] sales,justasthe conditions which arestipulated in marriagesare based on the fulfilment of the conditions of sales.God and His Prophet did not subject one whoismisled and deceivedtothe one whomisled and deceived them.⁹¹

Ibnal-Qayyim seems to be using the example of male sterility as the initial premise in an aminori ad maius argument,i.e.if‘Umar mandates khiyār in the caseof sterility which is a “partial” defect,all the more so must khiyār be mandated in cases of a “complete” defect,such as blindness, muteness, etc. However,no- wheredoes he explicitlystate or provethe initial “minor” premise implied here; he does not include sterility in the formal list of defects which have scriptural standing.Instead, he argues that there are manydefects in addition to scriptural ones which could contravene the goals of marriage and thus may serveasgrounds for annulment,and sterility falls into at least one thosecatego- ries.

Objectionstoincluding infertility among the grounds for annulment

There are threedifferent,frequentlymentioned objections to includinginfertility as grounds for annulment: first,the (disputable) claim thatitisnot mentioned in anyrevealedtext (naṣṣ)asgrounds for annulment,and onlythose specifically revealed grounds are acceptable. Second, that logicallythe onlyacceptable grounds for annulmentare ones that bar sexual intercourse and infertility does not do that. Andthird, that it is impossible to know for certain whether someone is sterile and so no one, particularlynoman, can be labeled as such.

Ḥanbalī views Of all the legal schools, the Ḥanbalīspermit marriagenullification for the most diverse set of reasons. They grant the choice to pursue annulmenttoboth husbands and wivesofspouses who suffer from insanity,leprosy,and elephantiasis; to wivesofimpotent⁹² or castrated men or those without functioning testicles;⁹³

 IbnQayyim al-Jawziyya,Zādal-ma‘ād,5:182.  Thereissome disagreement among Ḥanbalīsregarding the man whoisabletoconsummate the marriageoncebut then becomes impotent,see Spectorsky, Chapters on Marriage and Di- vorce,113.The two opinions areeither that the wife has no grounds to annul the marriage,or that the husband is givenone year to provehimself able to have intercourse. If he does not have sexual intercourse in that time, thereappears to be ajudiciallymandated ṭalāq: the wife is giventhe full dowerand must then begin her ‘idda period. 42 1Infertilityand the Purposes of MarriageinLegalTheory and to husbands of women who suffer from ‘afl, qarn, fatq, or baḥr,which referto abnormalities of the female genitals.⁹⁴ Such genital abnormalities will be addressed later in this chapter.Ibn Qayyim al-Jawziyya describes the contrast between the schools of lawthus:

Dāwūd(d. 270/884), Ibn Ḥazm (d. 456/1064), and those whoagree with them saythat there is no nullification at all.⁹⁵ Abū Ḥanīfa says that thereisnonullification except for castration and impotence. Al-Shāfi‘ī and Mālik say: insanity,leprosy,elephantiasis,⁹⁶ vaginal blockage, castration, and impotenceare bases for annulment. ImāmAḥmad [ibn Ḥanbal] added to [al-Shāfi‘ī and Mālik’sgrounds for annulment]: also if the woman has been rup- turedsuch that [the flesh] between the two orifices has been torn. Accordingtohis colleagues: also if thereisaputrescence of the vagina and the mouth,⁹⁷ or if the openings for urine and semen in the vagina have been torn, or if there is an oozing wound in them, as well as hemorrhoids and fistulae. [They also include the conditions of] istiḥāḍa (constant menstruation), leakingofurine and such, lack of testicles,tuberculosis of the testicles, and waj’,i.e.one whose testicles arecrushed, and if either [spouse] is a khuntha (in- tersex) in appearance.⁹⁸

In the Ḥanbalī school, this list of defects is arrivedatthrough the logic of sales/ returns and the logic of the goals of marriage,rather than being understood sim- plyasamatter of divine decree.⁹⁹ As to whether this list is an exhaustive one, there exists adifferenceofopinionbetween IbnQayyim al-Jawziyya and IbnTay- miyyaonthe one side, and IbnQudāma on the other.Ibn al-Qayyim argues that these grounds for annulmentare examples illustrating ageneral principle that, when the purpose of marriageisitself thwarted, the non-defective spouse may choose to end the marriage through annulment.Thus, in his view,there could be grounds beyond these examples. By contrast,Ibn Qudāma usesthe same

 Manṣūrb.Yūnus al-Buhūtī, Sharḥ muntahā al-irādāt, 2:676.  IbnQudāma, al-Mughnī,6:651 and al-Buhūtī, Sharḥ muntahā al-irādāt,3:86.  These jurists areassociated with the Ẓāhirī school of Islamic law. IbnQayyim al-Jawziyya quotes Ibn Ḥazm’stongue-in-cheek argument that if the marriage contract describesthe wife as healthy, and she is found to have anymedical problem whatsoever,includinginfertility,he has technicallynot married her at all but rather some theoreticallyhealthyperson. He does not have the option of remaining married or dissolvingthe marriage because they arenot spouses. Ibn Ḥazm, al-Muḥallā (Beirut: Maktabal-tijārī lil-tibā‘a, 1969) 1:115.  See Rispler-Chaim, Disability in Islamic Law,64, and R. Shaham. TheExpert Witness in Islam- ic Courts (Chicago:University of Chicago Press, 2010), 42.  Thereseems to be some disagreement in the commentary tradition as to whether this is the literalmouth or the vaginal orificeorboth.  IbnQayyim al-Jawziyya,Zādal-ma‘ād, 5:165.  This is the argument in the Mughnī,inthe Zādal-ma‘ād,and Sharḥ muntahā al-irādāt. Marriageannulment due to infertility and genital defects 43 starting point (that the above-listed defects are based on the logic of threats to the purpose of marriage) to come to the opposite conclusion:

Anydefect outside of these does not thwart the purpose of the marriage bond, which is sexual intercourse, as opposed to the various defects which are included in these. If one was to say, “leprosy and skin lesions do not thwart sexual intercourse,” we would say: “in fact it does thwart it,because it producesanaversion which altogether prevents him from ap- proaching, for he fears that he and his offspringwill contract it.” So too, one is afraidof an attack from amadman, and that serves as apalpable barrier [tointercourse].¹⁰⁰

IbnQudāma’sargument assumesthat the purpose of marriageissexual intercourse, and that all the canonical grounds listed for khiyār are in fact related to the ability to engagetointercourse. In IbnQudāma’sview,thereisnoother purpose of marriagewhich, if thwarted, could be addressed through annulment. Since infertile people maystill engage in sexual intercourse, infertility cannot be considered to be among the conditions that thwart the purpose of marriageand thus cannot serveasthe basis for annulment. In asimilar vein, al-Buhūtī (d. 1051/1641) argues that infertility should be rejected from the list of legal defects because it does not preclude sexual enjoy- ment.Hewrites:

Regarding defects other than those previouslymentioned, none of these aregrounds for either one of the spouses to exercise khiyār. Forexample, one-eyedness, lameness,lacking ahand or afoot,blindness,muteness,deafness,baldness, or one of them beinginfertile or menopausal [none of these mayserveasgrounds for nullification] ...because none of these prevent sexual pleasureorthreaten to infect [the other spouse].¹⁰¹

Adifferent objection raised within the Ḥanbalī school against infertility being included among grounds for nullifying amarriageisthatitisimpossibletoprove for certain that someone is infertile.Inspite of the tradition in which ‘Umar instructs asterile man to divorcehis wife and give her the choice of whether or not to re-enter the marriage, IbnQudāma says that it is impossibletocategorically state that someone will never produce children.

We do not know of anyscholar whodisagrees with [the view that infertility should not count] other than Ḥasan [al-Baṣrī]who said, “If one found the other to be infertile, they give them achoice.” Aḥmad [Ibn Ḥanbal] tendedtoexplain his words saying, “Perhaps his wife would likeachild.” But this is at the beginningofthe marriage,soonwhat basis could it be nullified when [infertility] itself cannot be proven?One might proveit

 IbnQudāma, al-Mughnī,10:56.  al-Buhūtī, Sharḥ muntahā al-irādāt,2:678. 44 1Infertilityand the Purposes of MarriageinLegalTheory

on the basis of menopause but,onthe other hand, it is known that thereare men whodo not produce offspringwhenthey areyoung,but then have offspringwhenthey areold.¹⁰²

In summary,thereisaminorityopinionwithin the Ḥanbalī school thatadiag- nosis of infertility,oratleast male infertility,can serveasgrounds for annulling marriage. However,the majority view is that infertility in either husbands or wivescannot be used in this way. However,among thoseespousingsuch a view,there is adisagreementastowhether infertility is excluded on the grounds that it is irrelevant since it does not preclude engaging in sexual relations, or whether it is excluded because one cannot actuallylabel aspouse as infertile in the first place.

Ḥanafī views Of the four main Sunnī legal schools, the Ḥanafī one has the most restricted definition of maritaldefects. Ḥanafī discussions of ‘ayb (defect) and faskh (nullification)are uniqueinthat awife’sdefects are never grounds for nullification. In- stead, ahusband has onlyone optionfor ending his marriage: traditional divorce. Awife, by contrast,may be able to have her marriageannulledifher husband is defective.However,ahusband’sdefectiveness is determined solely on the basis of whether he has ever succeeded in penetrating his wife anytime duringthe marriage. No other aspectsofhis physical or mental state enter into the matter.The position is summarized by al-Kāsānī (d. 587/1191).

With regardtothe circumstances in which [a wife is entitled to] achoice[to have her marriagenullified]: the first and foremost consideration is whetherhehas had intercourse with this woman in this marriage.Tosuch an extent is this the case that,ifhehad intercourse with her onlyonce, then the choicetoexercise that right has been passed up and no longer exists.¹⁰³

If the husband lacks apenis, the nullification can takeplace immediately. If a woman claims thather husband is impotent,the husband mayhaveuptoone year to attempt to penetrate his wife after the complaint is broughttothe court’s attention.¹⁰⁴ If awoman finds herself married to aman whose testicles have been

 IbnQudāma, al-Mughnī,10:59 – 60.  Al-Kāsānī, Badā’i‘ al-ṣanā’i‘,2:325.Zaydān, al-Mufaṣṣal fī aḥkāmal-marʾawa’l-bayt al-Mus- lim fī al-sharīʻaal-Islāmiyya, 9:24.  In al-Fatāwā al-sirājiyya the textspecifies that this is alunar year,eleven days shorter than asolar year.al-Ū shī,Sirājal-DīnAbū Muḥ ammad ʻAlī ibn ʻUthmān, al-Fatāwā al-sirājiyya (Le- nasia, South Africa:Dāral-ʻulū mZakariyyā,2011), 205. Marriageannulment due to infertility and genital defects 45 severed but who retains apenis (khaṣiyy)the case is treated as one of impotence, on the grounds that such aman mayyet achieve an erection and penetrate his wife. This last scenario is significant because it allows us to differentiatebetween sterility and impotence. The man without functioning testicles is (in the jurists’ view) necessarilypermanentlysterile but not necessarilypermanentlyimpotent. If he is able to overcome his impotence and penetrate his wife, he possesses no legal defect.The fact that he is still sterile has no legal consequence. Even though Ḥanafī juristsoften rule that awife has aright to insist upon sex that is not curtailedbycoitus interruptus,they do not make the argument that she has aright procreation. Usually, it appears that jurists understand “her right to obligate him to ejaculate into her”¹⁰⁵ as aright to intercourse itself, nothing more. Al-Kāsānī,bycontrast argues that awife’srights are not limited to sex. She has aright to the kind of sex thatwould allow her to conceive. “It is disliked for ahusband to engagein‘azl (coitus interruptus) with his free wife without her consent,because sex culminating in ejaculation is the wayofgetting achild, and she has aright to achild. With ‘azl,the [conception of a] child is thwarted and thereforeher right is thwarted.”¹⁰⁶ However,evenifher husband ignores her prerogatives by practicing non-procreative sex, his behavior is categorized as either permittedordisliked – it is not forbidden and it certainlydoes not serveasgrounds for nullifying amarriage. Moreover,al-Kāsānī never takes the next logical step IbnTaymiyyaarticulates;that is to say, he does not arguethat awoman maychoose to requestanannulment of amarriagetoaster- ile husband.

Shāfi‘ī views Al-Shāfi‘ī argues that aman cannot know for certain that he is sterile. He therefore denies thatthe frequently-mentioned case of the sterile man being ordered to give his wife ameans to exit the marriagehas anypractical application.

If he married her and said, ‘Iaminfertile,’ or he said nothingabout it until the contract had been completed and then he acknowledgedit, she would still not have achoice. That is because he himself cannot know that he is infertile until he dies, because aman maybe slow to have achild when he is young and yethewill have progenywhenheisold. She does not have aright to choose on the basis of progeny. This is because the right to choose is reservedfor loss of the ability to have sex, not the loss of the ability to have progeny.”¹⁰⁷

 Al-Ṭahāwī, Sharḥ ma‘ānī al-āthār,3:30 – 31.  Al-Kāsānī, Badā’i‘ al-ṣanā’i‘ 2:334.  Al-Shāfi‘ī,Kitābal-umm (Beirut: Dāral-Ma‘rifa, 1990), 5:43. 46 1Infertility and the Purposes of MarriageinLegal Theory

This view thatone cannot consider infertility as adefect because one can never be sure that it will not eventuallybeovercome is echoed by subsequent Shāfi‘ī jurists such as al-Māwardī,who explicitlyextends the argument to the reverse case, when it is the wife who is accused of infertility.Al-Māwardī articulates this position in the context of adiscussion about awife who suffers from ifḍā’,arupture in the genitals which can cause infertility.Hewrites regarding this injury: “Because he can have completeintercourse – even if she is infertile and cannot have offspring, or even if he, the husband, is sterile and cannot beget children – there is no khiyār for either one of them because this [sterility] is spec- ulative,and perhaps it will end.”¹⁰⁸ The same conclusion, that neither rupture nor infertility constitutes grounds for annulment,isalso articulated by al- Nawawī.¹⁰⁹ While this idea that infertility is not adefect because it cannot be proven is repeated frequently, Shāfi‘īsalso refutethe claim that awoman has aright to offspring.Thisisconsistent with the madhhab’sview of ahusband’sdecision to engage in coitus interruptus without the wife’spermission.¹¹⁰ With the exceptionof al-Shīrāzī (d. 476/1083), the Shāfi‘īspermit ahusband to engageinthis contraceptive practice regardless of his wife’sconsent,because she has aright to sexual intercourse, not to progeny.

Mālikī views The majority Mālikī position regardingwhat constitutes grounds for annulment is similar to the Ḥanbalī one, with some minor distinctions with respect to specific kinds of defects,such as leprosy and formsofmale castration.¹¹¹ There is, however,some disagreement as to whether awoman can ever exercise khiyār after the consummation of amarriage. The topic of female infertility specifically is barelyconsidered in Mālikī texts. In IbnAbīZayd al-Qayrawānī’s(d. 386/996) al-Nawādir wa’l-ziyādāt,the matterisdispensed with in one sentence: “As for one who is deceivedbyaninfertile woman who cannot give birth, or a woman who is deceivedbyasterile man, neither one of them has a[legal] argu-

 Al-Māwardī, Al-Ḥāwī, 9:341.  Al-Nawawī, Rawḍat al-ṭālibīnwa-‘umdatal-muftīyīn (Beirut: al-Maktabal-Islāmī,1991), 7:178.  Al-Nawawī (d. 676/1227), exceptionally, disapprovesof‘azl even with awife’sconsent. Abdel Rahim Omran, Family Planning in the Legacy of Islam (Routledge:New York, 1992),159 ff.  Khalīlibn Isḥāqal-Jundī, Mukhtaṣar (Cairo: Dāral-Ḥadīth, 2005), 1:102and al-Qarāfī, al- Dhakhīra (Beirut: Dāral-Gharb al-Islāmī,1994), 4:419 – 20. Marriageannulmentdue to infertility and genital defects 47 ment.”¹¹² Male infertility receivesslightlymore attention elsewhere. In the Ma- wāhib al-jalīl,inthe context of adiscussion of men’sresponsibilities when seeking aspouse, the Libyan jurist al-Ḥaṭṭāb(d. 954/1547) writes about the extent to which aprospective husband has an obligation to disclose to his prospective spouse his ownproclivities toward asceticism with respect to fasting and to sex, especiallyiffasting leadstodiminished sexual capacities or to adiminished ability to earn aliving.Turning specificallytothe question of procreation, al-Ḥaṭ- ṭābwrites that aman oughttodisclose in advancethathewill not or cannot engage in marital sexual relations,but he has no responsibility of disclosure if he simplybelieves himself to be infertile. The first two situations, i.e. sexual asceticism and diminishedearning capacity,are deemed to be harmful to the wife and to jeopardize their marriage, but the prospect of childlessness is not so deemed.¹¹³

Genitaldefects, “female impotence,” and their relation to infertility

We have seen thatwhile the jurists consider the possibility thataperson might wish to annul their marriagetoaninfertile spouse, for the most part they ulti- matelyreject the legality of doing so. However,with the exceptionofthe Ḥanafīs (who reject altogether the notion of husbands annulling marriages on the basis of defects) most jurists do recognize acategory of legal defect which is related to femaleinfertility.They recognize defects to women’ssexual and reproductive organs as constituting grounds for annulment. Such defects are described using the following vocabulary: a) ‘afl: Apiece of flesh inside the vagina,resemblingaman’sscrotal hernia. This maycorrespond to the biomedicaldiagnosis of avaginal prolapse. b) qarn: Atissue or bone that blocks the vagina. This maycorrespond to the biomedical diagnosisofavaginal septum. c) ratq: Usuallythis is described as apiece of flesh partiallyorfullyblocking the opening of the vagina, thereby rendering it so narrow thatapenis can penetrate onlywith difficulty or not at all. This seems to correspond to the biomedical diagnosisofanimperforate hymen. It is also sometimes described as apiece of flesh within the cervix which partiallyorfullyblocks

 al-Qayrawānī, al-Nawādir wa’l-ziyādāt,532.  al-Ḥaṭṭāb,Mawāhib al-jalīl 3:404. 48 1Infertilityand the Purposes of MarriageinLegalTheory

off the uterus.This growth within the cervix maycorrespond to anumber of modernbiomedical diagnoses.¹¹⁴ d) ifḍā’ or fatq: Rupture. This is described in the legal literatureasaholeorfis- tula in the flesh dividing two organs, either the vagina and the rectum,orthe vagina and the bladder,such that they are no longer completelyseparated.

The first three femalesexual defects are all treated in the legal literatureasbeing similar.Ibn Qudāma suggests that ‘afl, qarn,and ratq be understood as nearly synonymous.¹¹⁵ They all refer to avaginal passagetoo narrow for normal forms of sexual intercourse duetosome blockage.From amedieval standpoint, unlike the male sexual defects (castration and impotence), all four of these female “defects” are adjacent to the traits considered to be desirable in women. The intacthymen is itself understood as an obstruction and as the very symbol of virginity. Similarly,inmedievaldictionaries, afḍā means both to deflower a virgin and to “make the woman’stwo orifices[the rectum and the vagina] one.”¹¹⁶ Accordingtosome Egyptian jurists, ratq was alsoknown as apotential complication associated with femalecircumcision, aritual which those jurists generallyviewed in apositive light and which was often performedwhen a girl wasonthe cusp of marriage.¹¹⁷ Forexample, the Cairene Mālikī jurist al- Qarāfī (d. 684/1285) cites the Sicilian jurist IbnYūnus (d. 451/1061), citing the Alexandrian jurist Muḥammad ibn al-Mawwāz(d. 281/894), discussing marriage annulment in cases “wherethe imperforate hymen is causedbycircumcision” (al-ratq min al-khitān).¹¹⁸ In Arabo-Galenic medicalliterature, all of the first three conditions were thoughttobecurable, unlikethe non-sexual medicaldefects that weregrounds for annulment,such as insanity or leprosy.¹¹⁹ Forexample, the 4th/10th-century

 al-Rāzī, al-Ḥāwī fī al-ṭibb (Beirut: Dar al-Kutub al-‘Ilmiyya, 2000) vol. 3, book 9:16.  IbnQudāma, Mughnī, 10:56.  Lane, Arabic-EnglishLexicon,s.v. f-ḍ-ā. Cf. Al-Fayyūmī, Al-Miṣbāḥ al-munīrfīGharībal- Sharḥ al-kabīr,s.v. f-ḍ-ā. Al-Fayyūmī states that it can also refer to arupturewhich unifies the vagina with the urethra.  J. Berkey, “Circumcision Circumscribed:Female Excision and Cultural Accommodationin the Medieval near East, International Journal of Middle East Studies 28.1(1996), 30.  Al-Qarāfī, al-Dhakhīra,4:421.Also cited in IbnAbīZayd al-Qayrawānī, Kitābal-Nawādir wa’l-ziyādāt,4:529.Some modernmedical journals have also notedthat female circumcision can cause imperforate hymen as well as makingitmoredifficulttoidentify and moredangerous to treat.E.g.M.Alsammani, “Imperforate Hymen Complicated with Genital Mutilation:ACase Report,” Journal of Clinical Case Reports, 2(2012), 107.  The Mukhtaṣar Khalīl also mentions this, but does not seem to attach anysignificant legal consequencetothis fact.Khalīlibn Isḥaq al-Jundī, Mukhtaṣar,1:103.The relative ease or difficul- Marriageannulment due to infertility and genitaldefects 49

Andalusian physician and surgeon al-Zahrāwī describes ratq as potentiallycausing retention of the menses or making intercourse, conception, and delivery difficult,and then he details methods for curing it.Al-Rāzī,writing in 3rd/9th-century Iraq and Iran, describes much the same thing.Such well-known authorities as Galen, Celsus, Paul of Aegina, al-Majūsī and IbnSīnāall wroteonthe subject.¹²⁰ To cure ratq,writes al-Zahrāwī,one should instruct amidwife to break through the barrier using either aprobe or her fingers or,inextreme cases, ascalpel. Al- Rāzī suggests the physician use aprobe. Unfortunately, this procedurecould very well cause the fourth genital defect which, in some schools, could serveasgrounds for annulment.This defect is known as ifḍā’ or fatq,rupture. Outside of legal literature, both terms have a broad spectrum of meaning,with fatq alsoincludingnon-feminine-specific medical conditions such as hernias,and ifḍā’ also referringtothe defloration of a virgin.¹²¹ However,both the terms ifḍā’ and fatq,when used in legal discussions of marital defects and injuries,seem to be used interchangeablyand refer not to defloration, but to severe injury,usuallyinthe context of rape or earlymarriage. Forexample, the Ḥanbalī jurist IbnQudāma glosses the word fatq saying:

ty of treatingeach of these conditions is discussed by Muḥ ammad ibn ʻAbdal-Bāqī al-Zurqāni (d. 1099/1710) in his commentary on the Mukhtaṣar. Al-Zurqāni, Sharḥ al-Zurqānī ʻalá Mukhtaṣar Sayyidī Khalīl (Beirut: Dāral-Kutub al-ʻIlmiyya, 2002), 3:421.  M. S. Spinkand G. L. Lewis, AlbucasisonSurgery andInstruments (Berkeley:Universityof CaliforniaPress,1973),458–59.InIbn Sīnā, Qānūnfīal-ṭibb (Būlāq: al-Maṭba‘aal-Āmira,1878) 2:594=kitāb III: fann 21: maqāla 4: faṣlfīal-rutqā’. Al-Rāzī, al-Ḥāwī fī al-ṭibb vol. 3, bk.9:16. TheMālikī jurist Asbaghibn al-Faraj in Ṣa‘īd(d. 225/840), also mentions thepossibility of curing the ratq. Citedinal-Qayrawānī, Kitābal-nawādirwa’l-ziyādāt,4:529.There it mentions thetreat- ment taking anywhere betweenseveralmonthsand up to ayear. Cf.al-Majusī, Kāmil, 488.  In medical literature,futuq can refer to avariety of injuries in which the muscular wall of a bodilycavity is split or perforated or compromised, such that somethingoutside protrudes through it,e.g.ahernia. It can also mean somethingthat was closed or narrow and has been split open. Forexample, when clouds in the sky areparted or split asunder so that the sun shines through.With regard to awoman, the Lisānal-‘arab defines fatqā’ as “awoman with awidened vagina, the oppositeofaratqā’.” But the same dictionary also includes the definition that appears in legal literatureathat is: fatqā’ “awoman whose two exits [vagina and rectum] have become one.” Ifḍā’ tooseems to have awider spectrum of meaningoutside legal writings,includingdefloration of avirgin. The definition in the Lisānal-‘arab that corresponds to medieval legal usage is this: “Awoman who is mufḍā: one whose twoexits have be- comeconnected ...asaresult of coitus.” 50 1Infertility and the Purposes of MarriageinLegalTheory

He said, regarding one whohas sexual relations with his minor wife¹²² and ruptures her,he owes one-thirdofthe diyya. [I.e. he must payone thirdofthe sum he would payfor manslaughter.] Meaningoffatq (rupture): aperforation of [the barrier] between the passages for urine and semen. And it is also said: instead, it means aperforation of [the barrier] between the vagina and rectum. But that [second definition] is unlikely, because it is unlikelythat the wall between the twospaces would be eliminated throughsex, for this wall is strong and tough.¹²³

The term ifḍā’ when used in ḥadīth and legal literature with reference to compensation for injury or genital defects alsoseems to refertoasimilarlysevere condition with disastrous repercussions.¹²⁴ In an early ḥadīth collection the injury is described as one that mayresultinaninability to maintain apregnancy or retain urinary and fecalcontinence.

Zayd b. Thābit said, “Regarding awoman whose husbandruptured her: If fertility and both forms of continenceare retained, athird of the diyya [is owed] for it.Iffertility and both forms of continence arenot retained, afull diyya [is owed] for it.¹²⁵

The full diyya,or“bloodwit,” refers to the amount of compensation owed to a victim’sfamilyincase of manslaughter.Compensation for non-fatal injuries is calculatedasafraction of the diyya and is paid to the living victim.

Regarding aman whowas spurned by awoman. He then ruptured her. ‘Umar imposed the ḥadd punishment upon him and [further] penalized him with asum of one thirdofher diyya.¹²⁶

 Medieval Islamic legal sources mention the dangers of intercourse, but not of childbirth,for young brides.Bycontrast,Jewish lawinthe lateantique and medieval period seems to takeinto account the dangers of birth, but not of intercourse, for youngbrides.Henceitmandates the use of contraceptivesfor intercourse (but not abstinence) with girls.B.T.Yevamot 12b. Some Ḥanafī jurists also mention the concern that women giveninmarriage be robust enough to “toleratethe pain of circumcision,” e.g. Ibn Nujaym (d. 970/1563) in his Baḥral-ra’īq and Maḥ mū dibn Aḥ mad al-Marghīnānī,(d. 1220) in his Muḥīṭ al-burhānī fī al-fiqhal-Nuʻmānī (Beirut: DārIḥyāʼ al-Turāth al-ʻArabī,2003), 3:163.  IbnQudāma, al-Mughnī, 12:169–70.  It is possible that asomewhat less violent but similar injury is beingdescribedinal-Wan- sharīsī, Mi‘yāral-mu‘rib 3:234–5. It tells of aman who, in the course of consummatingmarriage to his virgin bride, did something which made her wet the bed, and she continues to do so night- ly.Hewishes to return her to her father,who refuses on the grounds that she had no such condition before.  ‘Abdal-Razzāq, Muṣannaf (Beirut: Dāral-Kutub al-ʻIlmiyya, 2000), 9:262=no. 17667.  Musannaf IbnAbīShayba #27325. Marriageannulment due to infertility and genitaldefects 51

Al-Ṣādiq was asked about aman who came upon agirl and ruptured her such that since then she excreted in this organ. She could not give birth.¹²⁷

He beat awoman and ruptured her (afḍāhā): meaning, he made the orificefromwhere her urine comes out and the orificewhere her menses come out one; or [the orifices of]her menses and excrement one. This coitus was likeabeating. Regardless of whether this is an unrelated woman whofights against it,orawife whom he tears up during coitus,if she is renderedincontinent by it [he pays apenalty].¹²⁸

Regarding ifḍā’ (rupture), which is when the barrier between where the penis enters and where the urine exits is punctured ...heisabletohavecomplete intercourse, even if she is infertile and cannot have offspring.¹²⁹

There is no khiyār as aresult of either him or her beingsterile,nor for her being mufḍā’. Ifḍā’ is the elimination of that which is between where the urine exits and where the penis enters.¹³⁰

These descriptions of injuries most closelyresemble the conditions known in modernbiomedicine as vesico-vaginal fistulae and recto-vaginalfistulae, in which there is ahole in the tissue separatingeither the vagina from the urinary tract,orthe vagina from the rectum, such that excreta leak into the vagina. In modernmedical literature, gynecological fistulaeare most often discussed as acommon obstetrical complication in the developing world, particularly among women whose bodies are too underdeveloped to healthilydeliverchil- dren.¹³¹ It is less frequentlyassociated with sexual trauma in modernmedicallit- erature,¹³² although it has receivedsome attention from advocacy groups publi- cizing the problem of wartime rape.¹³³ Until the advent of modern surgery,

 Muḥammad al-Najafī, Jawāhir al-kalām,15:450.  Ibn ʻĀ bidīn, Radd al-muḥ tār ʻalā al-Durr al-mukhtār (Beirut: Dāral-Kutub, 1994), 10:221.  al-Māwardī, Kitābal-ḥāwī al-kabīr,9:341.  Al-Nawawī, Rawḍat al-ṭālibīn, 7:176.  Forinformation about vesico-vaginal fistulae and recto-vaginal fistulae, see L. Wall, “Dead Mothers and Injured Wives: The Social Context of Maternal Morbidity and Mortality among the Hausa of Northern Nigeria,” Studies in Family Planning 29 (1998), 341–59.  Foranexception, see: M. Muleta and G. Williams, “Postcoital Injuries Treated at the Addis Ababa Fistula Hospital, 1991–97,” Lancet 354,no. 9195 (1999), 2051–2and A. M. Abasiattai et al., “Vaginal Injuries DuringCoitus in Calabar: A10Year Review,” Nigerian Postgraduate Medical Journal 12.2 (2005), 12:140 – 4.  E.g., A. Longombe et al., “Fistula and Traumatic Genital Injury from Sexual Violenceina Conflict SettinginEastern Congo:Case Studies,” ReproductiveHealth Matters 16.31 (2008), 132–14. 52 1Infertility and the Purposes of MarriageinLegal Theory fistulaewerelargely incurable, always debilitating, but usuallynon-fatal.¹³⁴ In the 11th/17th-century Durr al-mukhtār and in its 12th/18th-century commentary, the condition is described as being so severe as to make the possibility of sexual intercourse so remotethat rules of gender segregation between unrelated members of the opposite sex maynolonger apply. It has been argued that ifḍā’ and fatq sometimes refer to fourth-degree perinealtearing, which is when the skin and muscle between the vagina and anal sphincter,and the sphincter itself, are torn, usuallyinthe course of childbirth.¹³⁵ In modernmedicaldiagnosis, the most salient feature of such injuries is fecal incontinence. Unlikethese modern diagnoses,however,the injuries known as ifḍā’ and fatq are described by medievaljurists as being the result of sexual intercourse, not of childbirth. Ifḍā’ is also aterm used in the legal literature to indicate rape.¹³⁶ Some legal works also mention that ifḍā’ can occur by means of an instrument, such as a stone or tool, but even so it is still understood as asexual act.¹³⁷ All four of the genital-related defects mentioned in the legal sources corre- late very stronglywith physical immaturity.Moreover,the interventions used to attempt to cure these defects could lead to long-term infertility.I.e.treating awoman who has the defect of having anarrow or obstructed vaginal passage (ratq)may lead to awoman becomingafatqā’ whose vaginal wall has been damaged resulting in afistula.Intriguingly,there is some evidence from Catholic Spainthat such genital defects wereconsidered to be aform of “female impotence,” and thataccusations of this sort of female impotencesometimes served as alegal cover for accusations of infertility since, in Catholicism too, impotence was grounds for annulment whereas infertility wasnot.Thismay or maynot be true in the Islamic context,given thatinIslam there were more avenues available for ending amarriage.

 On the social effects of fistulae in amoderncommunity see A. I. Islam and A. Begum, “A Psycho-Social StudyonGenito-Urinary Fistula.” BangladeshMedical Research Council Bulle- tin 18.2 (1992):82– 94  Hina Azam translatesthe injury,inthe contextofviolent sexual assault, as “perineal tear- ing.” However perinealtearingisaterm with awide valence (i.e. the injury can be superficial or moreserious) but it is primarilyused in regardtothe relatively minor injuries to the surfaceof the bodythat often coincide with healthychildbirth, whereas in the contextofmedieval Islamic claims for damages, it refers to an injury that primary effects internal organsand that mayresult in multiple forms of incontinence. H. Azam, Sexual Violation in Islamic Law (New York: Cam- bridge University Press, 2015), 100.  Forthe use of the term to indicaterapesee, D. Serrano, “Rape in Maliki Legal Doctrine and Practice,” Hawwa 5(2007), 166–207, esp. 167. .  E.g. Al-Kāsānī, Badā’i‘ al-ṣanā’i‘ (Beirut: Dāral-Kutub al-‘Ilmiyya, 2003), 10:445 – 6. Marriageannulment due to infertility and genitaldefects 53

Acasefrom17th-centuryCatholic Spain at the intersection of early marriage, marriage annulment, genitaldefects, and infertility

The multi-layered connections between infertility and accusations of female genital defects are dramaticallyillustrated in acourt casefrom 17th-centuryCatholic Spain. In this case, the husband seeks to end his marriageonthe grounds that his wife is incapable of sexual intercourse due to genital defects.Asthe case un- folds, it becomes clear that he is in fact concernedabout his wife’sinfertility,and that her infertility was itself the final consequence of aseries of events stemming from his marriage to aphysicallyimmature girl who, it seems, was not initially acknowledgedtobesoyoung.Manyofthe social concerns and actionsdescribed here echo the technicallanguageand seemingly obscure medicalsituations found in Islamic legal texts and flesh them out.Atthe sametime, we must keep in mind the obviously divergent legal and social attitudes toward divorce in the Christian and Islamic worlds. The following summary of the case is derivedfrom the original scholarship of EdwardBehrend-Martínez.¹³⁸ Magdalena Fernández de Valasco Sáenz’shus- band Pedro brought her to the court of Calahorrain1697 to enter aplea for annulment on the charge of her impotence. Pedro’slawyeralleged that the previously-marriedfather-of-three had found thathis sixteen-year old bride’s vagina was too narrow “for reception of the material thatserves for the preservation of the species.”¹³⁹ He complained to her natal familyand her mother then attempted “to open and/or expand [Magdalena’s] vagina using hands and instruments.”¹⁴⁰ This, however,did not remedythe problem so Pedro turned to the courttoput an end to the marriage. In court,Pedro’slawyercomplained that Magdalena was incapable of conceiving.The judge ordered an expert medicalexamination which concluded that Magdalena was small and had not yetreached menarche. It also found that Magdalena’sgenitals had been forced open by an instrument,leaving her mutilatedand sterile. Magdalena’slawyeraccused Pedro of injuringher by having intercourse with her when she was of “such atender age.”¹⁴¹ The lawyer then said she onlyneeded time to sexuallymature and then she would be able to con-

 See E. Behrend-Martínez, “Female Sexual PotencyinaSpanish Church Court,1673 – 1735,” Law and HistoryReview 24.2 (2006), 297–330. Also, E. Behrend-Marti´nez, Unfit for Marriage:Im- potent Spouses On Trial In the Basque Region of Spain, 1650–1750 (Reno:University of Nevada Press, 2007), 71– 73.Ihave not studied the primary sourcesintheir original languages.  Behrend-Martínez, “Female Sexual PotencyinaSpanish ChurchCourt,1673 – 1735,” 318.  Behrend-Marti´nez, Unfit for Marriage,72.  Behrend-Martínez, “Female Sexual PotencyinaSpanish ChurchCourt,1673 – 1735,” 318. 54 1Infertility and the Purposes of MarriageinLegal Theory summate the marriageand produce children. The lawyer said thatthis had also happened in his own family.¹⁴² Asecond medical examination was ordered which found that Magdalena was not sixteen yearsold,but “about twelve.” The court declared Magdalena impotent and annulled the marriage. As with Sunnī law, in Spanish lawinfertility wasnot considered to be grounds for annulment,however,the inability to consummatethe marriage due to genital defects did constitutesuch grounds.Canon lawacknowledged “female impotence” as grounds for annulment beginning in the twelfth century.¹⁴³ Definitions of femaleimpotenceinthe Catholic context closelyresembled Islam- ic discussions of legal defects pertaining to women’sgenitals, particularlyas both focus on purportedvaginal blockages.¹⁴⁴ Forexample, Gratian’s Decretals described threetypesoffemaleimpotence: anarrow vagina,ablocked vagina, or atumor which has closed the entrance to the uterus.¹⁴⁵ Chargesoffemale im- potenceweresometimes brought to court onlyafter several years of marriage, indicating thatthe problem experienced by the couple was one which took years to surface, and thus was not likelytobeaproblem in actuallyconsummat- ing the marriage,¹⁴⁶ and sometimes these lawsuits, ostensiblyabout the charge

 The scenario in which at first awoman is labeled as impotent (impossible to penetrate), and then later on is abletohavenormal sexual relations,isdealtwith in the lawcodeSieta Par- ditas. Las Siete Partidas,tr. Samuel Parsons Scott (Chicago:The Comparative LawBureauofThe American BarAssociation, 1931) 4:914. This condition seems to be one which resolvesitself with the passage of time.  Behrend-Martínez, “Female Sexual PotencyinaSpanish ChurchCourt,1673 – 1735,” 316.  P. Darmon, TrialbyImpotence:Virilityand MarriageinPre-Revolutionary France (London: Ho- garthPress,1985),16. In the12th-13th centuriesA.D.there appearstohavebeensomeintellectual tensionbetween thedesireofCatholicreligious authoritiestoencourage thosestuck in marriages with an impotent partnertolive “as brotherand sister,” andtheir reasoningthatannulment would preventmorelicentiousforms of behavior (i.e.alternativeforms of sexualbehaviorbetween spouses, or adultery.) This brieflyculminatedadecision by Pope CelestineIV, whosepapacylasted forlessthan3weeksof1241, to issueadecree whichallowed ahusband,whose wife’sgenitals were toonarrow, “both to keep herinhis houseand to remarry.” Darmon, TrialbyImpotence, 65.There is no evidence that such permission to engage in bigamy waseverlegally implemented. Formoreonthe religio-legalproblems associated with such conditions see, C. S. Pinheiro, “The MedicalSources in theChaptersabout SterilityofRodrigo de Castro’s De universa mulierum medicina,” in GayleDavis andTraceyLoughran, The Palgrave Handbook of InfertilityInHistory:Ap- proaches, Contexts andPerspectives (London: Palgrave Macmillan, 2017), 302.  Corpus iuris canonici Lib. 4, Tit.15, Cap.1“De frigidis et maleficiatis,etimpotentia coeun- di.”  This is nottosuggest that chargesoffemaleimpotencenever occurredtowards thebeginning of amarriage. In fact, they seem to have oftenbeenleveled in response to chargesofmaleimpo- tence. In part,thiscan be attributed to canonlaw,which wouldhavepermitted thenon-impotent spouse in an annulled marriage to remarry, butwould have forbiddenthe otherspousefromdoing Marriageannulment due to infertility and genitaldefects 55 of female impotence, were focused on the ability to become pregnant¹⁴⁷ Behrend- Martinez writes:

Regardless of canon law, however,which did not allow for annulments based on sterility, one of the rhetorical concerns that the prosecution expressed in this case was that Magda- lena was useless for the propagation of the species.Again, court rhetoric conflated female potencywith fertility.Her vagina “could [not] permit the introduction of the material that serves for reproduction.” After beingmutilated by either her mother or husband, Magdale- na’sdefect was probablynolonger whether she could have sex or not but whether she could bear children. Therefore,the concern for the lack of sexual “potency” was specifically anxiety over reproductive capacity:she could not give Pedroany morechildrenthan he alreadyhad. The ability of an individual to reproduce was an issue in impotencecases,eventhough sterility was not an allowable cause for annulment under the law. The fact that sterility could not be directlyconsideredwas clear to the court and prosecutors;therewerenoan- nulment cases in which sterility was the central plea and very few mentioned it at all, but this did not prevent sterility frombecomingafundamental trial issue.¹⁴⁸

Such cases demonstrate the connection between legal discussions of theoretical vaginal blockagesand the practical desire to dissolve marriages to barren women. In Magdalena’scase, the accused wife reallydoes seem to be physicallyunable to consummatethe marriage. The testimonies suggest that this might be because she is very young.Inaddition to being small, she is premenarchal, and it seems that she, her parents, or her husband or perhaps all of them are either ig-

so.However,thisphenomenonalsooccurdamong Jews.Thusinacase addressed to Bezalel b. Avrahamal-Ashkenazi, a16th-centuryrabbi born in Jerusalemand educated in Egypt,weare informed that “Reuven waswed to Dina,but wasunabletohavenormalintercourse with her. He went around saying that shewas sealed closed andneededtobeopenedwithalancet, while herrelatives went around saying that Reuven wasimpotent. When thetwo engagedinfights [the community?]soughttocorrect/rebuke thewoman butdid notsucceed.And so Reuven initiated Jewish courtproceedings andbrought womenwithexpertise in this matteraswitnesses,but nonethelessthe woman’srelatives wouldnot give in to thelaw.Instead,theywenttothe gentile lawand removedfromReuven’spossessionthe trousseauand allthe gifts, andthentheycon- vinced himtodivorce her – accordingtothe testimonyofwidespread knowledgecomingfrom thosewho know of theoutrage done to Reuven.” Ashkenazi, She’elot u-teshuvot Rabenu Betsalel Ashkenazi (New York:Feldman,1955), folio31, question 15.Cf. T. Rosenand U. Kfir, “What Does a Father Want?: An UnpublishedPoemand ItsIntertexts,” in StudiesinArabicand Hebrew Lettersin HonorofRaymond P. Scheindlin,ed. J. Decter andM.Rand(Piscataway,NJ: GorgiasPress,2007), 129–53.Pp. 136– 137include thecaseofatwelve-year-oldJewishbride whoisbrutalizedbyboth herimpotent younghusbandand herparents forher perceivedsexualfaults.  Behrend-Martínez, “Female Sexual PotencyinaSpanish Church Court,1673 – 1735,” 317.  Ibid., 319–320. 56 1Infertilityand the Purposes of MarriageinLegalTheory norant,orpretending to be ignorant,ofher true age. In attemptingtoconsum- mate the marriage, either her husband or her mother,and possiblyher medical examiner,injureand mangle her internal sex organs,thus renderingher infertile as well. In this case, therefore, female infertility is both the central fear motivating concerns about femalesexual impotence, and it is also the product of attempts to curethat impotence. “Impotence” is in turn aresult of, or at least highly correlated to, marriageconsummation at an earlyage,atopic we shall return to in the next chapter. How much of this is relevant to an Islamic legal context?Several key aspects of the situation have parallels in the pre-modern Islamic world. As we shall see, Magdalena’sage and pre-menarchal status at the time of marriageare similar to ages commonlyfound in the Islamic world. The disputes surrounding the need for patience for the youngwife’sphysical immaturity are found in the Islamic context as well. The physical defect of which she is accusedalso has parallels found throughout Islamic legal theoretical literature about genital defects. So too do the interventionsembarked upon by the mother,interventionswhich cause further damagetothe girl’ssexual organs.The description of the damage to Magdalena’ssexual organs and fertilitybythese efforts also seems to match the condition of ratq as described in medievalIslamic texts.What is not clear, however,iswhether we should read medieval Islamic allegations of femalegen- ital defects in light of this Catholiclegal stratagem: i.e. thoseallegations of genital defects existed to provide legal cover for dealing with what was primarily a fertilitycomplaint.The argument in opposition to such areadingisthataMus- lim husband did not need such astrategy, since he had the option of divorcing his wife. The argument in favorofsuch areading is that some Muslim husbands and some Muslim wives, or their families, clearlydid want to end their marriages via annulment rather than by divorce. They attempted to do so by arguingretro- actively that the wife was not in aposition to marry,either because she had a genital defect,orbecause she had been married off when she was aminor in an improper fashion, or because she had not yetcompleted her ‘idda (waiting period) from aprevious marriage.¹⁴⁹ We thus see that,while the juristsalmost never granted official recognition of the notion that infertility itself constitutes abasis for ending amarriage, they did recognize as legitimate grounds for annulment physical defects that werehighlycorrelated with infertility.

 E.g. al-Wansharīsī, al-Mi‘yāral-Mu‘rib, 3:48–9, 245, 266. 2Law andBiology: Menstruation, Amenorrhea, andLegal Recognition of Reproductive Status

Certain aspects of Islamic marital lawhad the potential to exacerbate or mitigate tensions surrounding fertility.Aspreviouslymentioned, this was true of Islamic legal tolerance for both polygamyand divorce. However,there wereadditional concepts which helpedtoshape the experience of infertility.The legal significance attachedtomenarche, menstruation,pregnancy, amenorrhea, and menopause alsoplayedaconsequential role. So toodid the legal dependence on, and distaste for,the mediating role playedbymidwivesand other expertsinfemale gynecology. In this chapter,wewill examine medievallegal assumptions about what constitutes child-bearingage,the legal ramificationsattachedtoawoman’s menstrual cyclesand their interruption, and how,counter-intuitively,social and legal flexibility regarding the length of gestation sometimes helped to protect and empower women who did not conceive at all.

Menarche: the legal ramificationsofthe onset of menstruation

The onset of menstruation was socially and legallysignificant in anumber of ways that intersected with fertilityand infertility.First,menarche triggered an ex- pectationoffertility, i.e. the legal system operated under the assumption that, immediatelyfollowing the onset of menarche, awoman was likelyfertile and experiencing regular menstrual cycles. In post-menarchal adolescents,irregular menstruation was considered adefect,rather than normal.¹⁵⁰ However,from a biomedical standpoint,itiscommon now,and likelywas even more common in the past,for menarche to be followed by ayear or several years of irregular menstrual cycles, manyofwhich maybeanovulatory.There is little textual evidence from anymedievalpopulation in the Islamic world that thereexisted an awareness of the modern scientificnotion of adolescent subfecundity.(However, there is some evidence from the learned medical literaturethat women wereconsidered to reach the ageofpeak fertility at alater point than menarche.) The ear-

 The 18th-century scholar Ibn ‘Ābidīnsays, regardingthe purchasingofaslave woman, that agirl whoisbetween 15 and 17,and has not yetmenstruated, is considered defective,sincelack of menstruation is indicative of disease. He then says that if she menstruates, but onlyevery 6 months,that too is adefect for which she can be returned to the seller.Ibn ‘Ābidīn(d. 1252/1836), Ḥ āshiyat Radd al-muḥtār (Riyadh: ‘Ālam al-Kutub, 2003), 7:179.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-005 58 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status lier women married,therefore, the more likelyitwould be that an extended period of time would elapse before they would getpregnant.Impatience with such an extended timeframe could potentiallyhavenegative,evendisastrous,consequences,both medicaland legal. Apost-menarchal girl who was not pregnant might experience adesire or pressuretoimplement measures to cure her infertility,measures which themselvescould damageher sexual organs. The expectation of fertility meant that menarche also had the legal consequence of requiringpost-menarchal divorcées and widows to experience three menstrual periods before remarrying,soastoestablish that they werenot pregnant with their former husbands’ offspring.When women did not experience regular menstruation, it complicated theirdivorceand remarriageprocedures, sometimestothe detriment of the women themselvesand sometimes benefiting them. Menarche was also consequential because it demarcated the end of legal minor-hood and the beginning of legal adulthood.¹⁵¹ Minor girls who werevir- gins could be legallymarried and consummatetheir marriages but,inthose cases wherethey had been giveninmarriagebytheir guardian other than their father,once they reached menarche they potentiallyhad alimited window of time to choose to unilaterallyend their marriages.¹⁵² Unmarried minors who werenot virgins (having been married and then either divorced or widowed all before reachingmenarche) had to wait until legal majority to choose to remarry.This is significant for social historians because the women in this particular legal situation had reason to appear in court and thus to generate legal texts from which we can gather some information about the ageand experiences of these adolescents.

Hypothesizing average age at menarche and marriage and the fertility of young brides

There was, and in some parts of the non-academic worldstill is, an incorrect presumption thatNorth African and Asian girls mature and experience menarche at

 Qarāmī, al-Ikhtilāffīal-thaqāfa al-ʻarabīyahal-islāmīya, 328. Mahmoud Yazbak “Minor Mar- riages and Khiyāral-Bulūgh in Ottoman Palestine:ANote on Women’sStrategies in aPatriarchal Society,” Islamic Law and Society 9.3(2002), 386–409.  If agirl was married off as aminor by anyone other than her father,then she could poten- tiallyexercise the choice to unilaterallyend her marriage if she declared her desire to do so during the window of time between reachingmenarche and engaginginpost-menarchal sexual relations with her husband. Menarche: the legal ramifications of the onset of menstruation 59 earlier ages thanEuropean girls.¹⁵³ There was also apresumption that, in pre- moderntimes, the onsetofadolescenceoccurred even earlier thanitdoes today. In an attempt to counteract such assumptions, Harald Motzki argued in 1985that it was wrong to think that in the medieval Middle East (he specifically refers to 1st/7th-century Arabia, but also to later centuries and to abroader geo- graphic region as well) females normallyreached sexual maturity between age “nine to tenyears,” and instead he suggested that “the averagewas ...for a girl, twelve to thirteen years, which corresponds approximately with modern Eu- ropean standards.”¹⁵⁴ However,Motzki’ssuggested agerangedoes not seem to be corroborated by either medieval textsormodernphysical anthropology. In fact,late‐antique, medieval, and Ottoman textssuggest that the averageage of menarche was somewhat later than Motzki’ssuggested ageof12–13 years, with theoretical literature rarely if ever suggesting an averageage of menarche younger than 14 years, and individual anecdotes referencing later ages. More- over,studies of physical anthropology from other times and places suggest (though not definitively)amuch later averageage of menarche thanwhat Motzki and other historians of the medieval Islamic world have assumed. The medieval jurists understood menarche as beingone of the ultimatesigns of femalelegal physical maturity (bulūgh). The otherindicators were: iḥtilām (wet dreams), pubichairs, pregnancy, and reaching apreset agethreshold for the onsetofadulthood.¹⁵⁵ The minimum agefor bulūgh in agirl was generally accepted to be nine years, and that was also legallyconsidered to be the lowest

 Thereissome evidencethat the idea that “oriental” women livinginhot climates reach puberty earlier than do European women is itself an “orientalist” fantasy in the EdwardSaid- ian sense. Such claims wereadvanced by such noted18th-century scientists as Boerhaave and Haller,and wererefuted in the nineteenth and twentieth centuries.See K. Bojlén and M.W. Bent- zon, “The InfluenceofClimateand Nutrition on AgeatMenarche: AHistorical Review and a Modern Hypothesis,” Human Biology 40 (1968), 69.20th-century scientific evidenceabout the roleclimateplays in menstruation suggests that either climatedoes not have much effect at all, or womeninnorthern climes menstruate earlier,possiblydue to vitamin-D deficiency, and those livingcloser to the equator tend to menstruate later. L. Zacharias and R. Wurtman, “AgeatMenarche: Genetic and Environmental Influences,” New England Journal of Medicine 280(1969), 868–75.  H. Motzki, “Geschlechtsreife und Legitimation zur Zeugung im frühen Islam” in Ges- chlechtsreife und Legitimation zur Zeugung ed. Ernst Wilhelm Müller (Freiburg/Munich: Karl Alber GmbH, 1985), 493. My translation.  Forreferences to the application of maximum-agerulings,see L. Peirce, Morality Tales:Law and Gender in the Ottoman Court of Aintab (Berkeley:University of California Press, 2003), 151. 60 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status possibleage at which agirl can menstruate.¹⁵⁶ As for the ages at which women would be considered adults in the absenceofphysicalsigns of maturity,17isthe most commonlymentioned number,with individual jurists setting the agebe- tween 15 and 19 years.¹⁵⁷ Such legal texts do not,however,implythatthis number is meant to reflect an expectedoraverage ageofmenarche. Several Roman and Byzantine physicians suggest that menarche and the onset of puberty begin at the ageof14, with some noting that “the best time for conception is about the eighteenthorthe twentieth year.”¹⁵⁸ The Tunisian physicain Ibnal-Jazzāral- Qayrawā nī (d. 369/980) also cites the ageof14, though he says menarche can occur as earlyasage 12.Both the physician Abū Bakr al-Rāzī (d. 311/923)and IbnSīnāmention that it dangerous for girls youngerthan15toexperience childbirth due to their small size, but otherwise they do not mention an expected age of menarche. We have some anecdotalinformationabout menarche from Ottomancourt casesinwhich womenexercisetheir khiyāral-bulūgh (their choice to unilaterally annultheir marriage immediatelyuponreachingmenarche, if they hadbeenmarried offasminorsbyguardians otherthantheirfathers). In astudy of courtrecords dating from 1600 –1623 in theAnatolian city of Kayseri, Ronald Jenningsfinds re- cordsinwhich womenwho hadbeenmarried as infantsconfirm,now that they were no longer minors,thattheyacceptthe marriagesarrangedfor them and arenot exercising theirright of annulment. Ages areoften notmentioned, but wheretheyare,the ageislistedas“more than 15 yearsold.”¹⁵⁹ In hisstudy of khiyāral-bulūgh in late-Ottoman Palestine,Mahmoud Yazbak citesthe following informationabout ages.In1871, agirl is married at 13,and reachesmenarche at theage of 14;inanother a14yearold whohas notreached menarche is married off. In 1911 agirlwho is “more than 14 yearsold” testifiesthatshe hasjustreached

 IbnQudāma (d. 620/1223), al-Mughnī (Cairo:Maktabat al-Qāhira, 1968) 7:461. Al-Ḥaṣkafī (d.1088/1677), Durr al-mukhtār in Hāshiyat Radd al-Muḥtār ‘alā al-Durr al-mukhtār (Cairo: Muṣ- ṭafa al-Ḥalabī,1966) 3:507.  The 10th/16th-century Ottoman chef mufti Ebussuud Efendi considered children of both sexes to be of ageassoon they demonstrated physical signs of maturity. “In the absenceof such signs,females wereconsideredtocome of ageatseventeen.” L. Peirce, “Seniority,Sexual- ity,and Social Order: the Vocabulary of Gender in EarlyModern Ottoman Society,” in Women in the Ottoman Empire, ed. Madeline C. Zilfi (Leiden: Brill, 1997), 185. See also al-Mawsūʻah al-Fiq- hīyah (Kuwait: Dawlat al-Kuwayt, Wizāratal-Awqāfwa-al-Shuʼū nal-Islāmīyah, 1987) 8:192and Qarāmī, al-Ikhtilāffīal-thaqāfa al-ʻarabīya al-islāmīya, 329.  Aetius of Amida, The Gynaecology and Obstetrics of the VIth century,tr. James Ricci(Phil- adelphia:Blakiston, 1950), 19.  R.C. Jennings, “Women in Early17th Century Ottoman Judicial Records:The Sharia Court of Anatolian Kayseri,” Journal of the Economic and Social Historyofthe Orient 18 (1975), 78. Menarche: the legal ramifications of the onset of menstruation 61 menarche. In 1884,agirl whois15and stillaminorcomes to courthavingbeen promised as an infant to twodifferent peoplewho nowseektoconsummatethe marriage.Yazbakdoesnot mentionany case of agirl claiming to have reachedmenarche priortothe ageof14. It should also be noted, however, that theabove-mentioned casesall come from severalcenturies afterthe medieval period and, forrea- sons that will be explored below, Iargue that medieval living conditions would have likely meantthatthe average ageofmenarchewould have been laterthan thosementioned in theOttoman period in thesamelocales.Inany case,tomy knowledge, nowhereinthe Middle East in anyera of pre-20th-century historydo we find evidence to suggestwomen commonly reachedmenarche priortothe ageof14. Modern medical anthropology and European osteological historical records maygiveusmore insight to the experience of women in the medieval Middle East.Studies of adolescence in living women from geneticallysimilar but eco- nomicallydivergent populations have found thatnutrition plays asignificant role in determining the durationofadolescenceand the onsetofmenarche. In developing countries,higher socio-economic status, higher caloricintake and, in particular, access to protein and fat from animal products, correlates with earlier menstruation, while underprivileged statuses, low caloric intake, and general malnourishment are associatedwith more prolongedpuberty and latermen- struation.¹⁶⁰ Thus, in the late-20th century,there is onlymoderate variation between the mean ageofmenarche of middle-class girls in European urban cen- ters and their middle-class counterparts in Middle East and North African cities. The mean ageranges between 12.2 years and 13.4 years.¹⁶¹ By contrast,the ageof menarche ranges far more among those from varyingeconomic backgrounds within the sameregion. Forexample, a1982 studycomparingwealthyurban adolescents in Kenyawith their impoverishedrural peers showed that,onaver- age, rural girls experiencedmenarche more thantwo yearslater than wealthy girls.¹⁶² Urban well-nourishedgirls reached menarche at the median ageof 13.2 years, while their rural counterparts did so at the ageof15.3years. Similarly, in a1998 study from India, well-off girls experiencedmenarche at amedian age

 The reasonfor this correlation is not entirelyclear,and the data is not clear-cut.See R. Sprinkle, “The MissingPolitics and Unsettled Scienceofthe Trend towardEarlier Puberty,” Pol- itics and the Life Sciences 20.1 (March 2001), 43 – 66.  J. M. Tanner, Fetus Into Man: Physical Growth from Conception to Maturity (Cambridge:Har- vardUniversity Press,1990), 146.  H. Kulin et al., “The Effect of Chronic Childhood Malnutrition on Pubertal Growth and De- velopment,” American Journal of Clinical Nutrition 36 (1982),527–36.The article cites similar results fromstudies of adolescents in the United States and in India. 62 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status of 12.1 years, while underprivileged ones did so at 15.4 years.¹⁶³ In Western populations, wherethere are historicalstatistics available, the meanage of menarche has fallen dramaticallyeveninthe past century,byabout threeyears.¹⁶⁴ A similar decline of averageage of menarche is currentlybeing seen in populations in developing West African countries such as Gambia, Senegal, and Mali, where that agehas declined from more than 16 years to less than 15 years in fewer than three decades.¹⁶⁵ Turningtothe medieval period, to my knowledge thereare no studies of the physical maturity of adolescent humanremains from anywhere in themedieval Middle East.However,inthe past decade,there hasbeenagreatdealofosteolog- ical studyofmedievaland ancientEuropeanskeletons,especiallyinEngland and Italy, andthere arealsosomestudies comparingdiets in medieval European and Middle Easternpopulations. StudiesofsomeindividualEuropeancommunities suggestthatprior to theBlack Deathgirls beganpuberty (i.e.breastdevelopment andgrowthspurts) at thesametimeastheydid in the20th century, butmenarche (which occurs afterpeakheightvelocityhas been reachedand thegrowthspurt hasbegun to decelerate)occurredlater, andthe maturationand growth process occurred over amuchlonger timeframe.

The ages at which individuals reached puberty,orachieved full adultmaturity,weresignif- icantlydifferent from those of modern people ...Inadverse conditions, juvenile growth can continue up to the mid-20s ...Measurement of the length of the femoral shaft in children fromBarton suggests that they lacked the growth spurt that is indicative of puberty, from which we can infer that puberty was not experienced until the later teens...The skeletal evidencesuggests that youngadults continued to grow intotheir early20s,rather than reachingfull physical maturity in their late teens. This has implications for our understanding of the livesofyoung medieval men and women. The ageofmenarche is assumedto have been around15years on the basis of medical texts from across medievalEurope ... however,the ageofmenarche is determined principallybynutrition. It is likelythat the poor nutrition experienced by young women in medieval Yorkshireand Lincolnshire would have delayedthe onset of menarche until their late teens. In modern societies menarche is usuallyfollowed by up to threeyears of adolescent infertility.”¹⁶⁶

 A.S Parent et.al. “The timingofnormal puberty and the agelimits of sexual precocity:variations around the world, secular trends,and changesafter migration.” EndocrineReviews 24 5 (2003):673.  S. Scott and J. Duncan, Demography and Nutrition: EvidencefromHistorical and Contem- porary Populations (Oxford: Wilson &Sons,2008), 95.  S. Prentice et al. “Evidencefor aDownwardSecular TrendinAge of Menarche in aRural Gambian population,” Annals of Human Biology 37 (2010), 717.  R. Gilchrist, Medieval Life: Archaeology and the Life Course (Woodbridge:Boydell Press, 2012), 41– 2. Menarche: the legal ramifications of the onset of menstruation 63

Adolescent infertility is causedbyirregular menstrual cycles, of which manymay be anovulatory.Inmodern populations, the laterthe onset of menarche for an individual female, the longer the post-menarchal length of time for her menstrual cyclestobecome regular.Thus agirl who begins menstruating relatively late in her teen years will likelyexperience alonger post-menarchal period in which she is less prone to becomingpregnant.Itisnot currentlyknown how to evaluate whether this correlation between late menarche and longer subfecundity held true for medieval populations. The most comprehensive attempt to chartadolescent development in amedieval population comes from astudyoffour urban cemeteries in England with corpses from the years 900 to 1550,one with “highstatus” occupants and the rest with “low status” occupants.With atotal of 994 skeletons of people aged 10 –25,Mary Lewis and Fiona Shapland analyzedthe stages and ages of pubertal growth. Their sample indicatedthat there is amismatch between what the medieval European legal and literarysources implyabout the agemenarche, and the osteological record. Iwould arguethat the sameislikelytrue in the Middle Eastern context. Lewis and Shapland’sanalysis shows that adolescents began puberty at a similar agetomodern children at around 10 –12 years, but the onsetofmenarche in girls was delayedbyuptothreeyears, occurringaround 15 for most in the studysample and 17 years for females living in London.¹⁶⁷ Modern European males usuallycompletetheir maturation by 16–18 years; medievalmales took longer with the deceleration stageofthe growth spurt extendingaslate as 21 years.

This period of physical and sexual development is at odds with medieval canon law, where the legal ageatwhich boysand girls could consent to marriage was 14 and 12 years,respec- tively.This encompasses atime when both would have experienced the onset of puberty, but predates the period in which the majority of females would have been fertile (c.15–16 years). In practice,itseems males and females in 13th to 15th-century England married between 18 and 23 years ...with urban females marryingslightlylater ...¹⁶⁸

While there are no direct studies of skeletons in the medieval Middle East to comparewith these findings, there have been some studies of medieval Middle Eastern diets. It maybehypothesized, based on evidence from medievalEurope, that nutritionalfactors had asignificant effect on the maturation process for

 According to this study, 86%offemales reached menarche when they were15years old.  M. Lewisetal, “On the Threshold of Adulthood: ANew Approach for the Use of Maturation Indicators to Assess Puberty in Adolescents fromMedieval England,” Journal of Human Biology 28 (2016), 48–56. 64 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status

Middle Easterners just as they did for Europeans.Evidence from Iraq, Syria, and Egypt in the middle ages, both before and after the Black Death,suggests that – while there weresignificant differences in the specific diets of these populations, as compared to each other and as compared to the diets of those in Western and Southern Europe – certain nutritionalelements werelargely the same. Thusthe content of bread differed quite substantiallybetween the Middle East and Eu- rope, but the high proportion of bread in the diet and in the budgets of most of the population did not.Prior to the Black Death, the price of meat,aswell as othersources of fat and protein wassohighastobenormallyprohibitive for the workingpoor of Iraq, Syria and Egypt.¹⁶⁹ (However,poultry was available.) In comparison to their European counterparts, the lower and middle classes of Egypt are thought to have consumed asimilar amount of calories, but less meat.

The highcost of meat (mutton) in the Near East explains that the specializedworkers (and probablyalso the small merchants) in the Near East had to allot one-fourth or even one- thirdoftheir income for it through all periods of the Middle Ages. In Southern and Western Europe the expenses for meat wererelatively smaller.The nutritive value of the food which the workingclasses could affordwas very small both in the Moslem East and in the Latin West.But sinceapparentlyuntil the Black Death, meat in Europe was much cheaper,the lower strata of the population had moreproteins and lipids.¹⁷⁰

Therehas been an interestinghypothesisbased on skeletal evidence from England that children therehad somewhat differentdietsfromtheir parents, andthatthese dietsconsisted of even less meat. This wouldinfactbeinkeeping with Galenic humoralprinciplesofthe appropriatediet forthe ages of man.¹⁷¹ WhilesuchGa-

 A. Sabra,Poverty and Charity in Medieval Islam: Mamluk Egypt, 1250–1517 (Cambridge: Cambridge University Press, 2000), 121–3and E. Ashtor, “The Diet of Salaried Classes in The Medieval Near East,” Journal of Asian History 4(1970), 11. Ashtorestimates that in 11th-century (A.D.) Egypt,anadultmale “worker” with afamilycould affordtobuy approximately1100 calories worth of food for himself, of which only41grams came fromprotein and 15 grams came from fats. By the 15th century,this had increased greatlyto1900 calories,82grams of protein, and 45 grams of fat.  Ashtor, “The Diet of Salaried Classes,” 20.  Gilchrist, Medieval Life,52: “The nutritional risk to children mayhavebeen further exacer- bated by medieval childcarepractices. Isotopic analysis of skeletal remains fromWharram Percy showed alowerlevel of nitrogen for children aged between four to eight years, in comparison with older children and adults.This result was interpreted as indicatingthat children in this age group were fed adiet which was moreplant-based, with alower proportion of marine foods and meat or animal-based products ...Inother words,medieval childcarepractices mayhavespe- Menarche: the legal ramifications of the onset of menstruation 65 lenicdieteticprinciplesare mentionedinmedical literaturefromthe medieval Arabworld,there is no evidence to either confirmordenythatsuchprinciplesre- flectedorinfluencedcommonpractice. Whileitisnot yetpossibletodrawdefinitiveconclusions aboutthe average ageofmenarche in anyparticularmedieval Middle Easterncommunity,comparisons to modern populationsand to medieval populationselsewhere in the worldstronglysuggest that in theMiddleEast, as in Europe,the averageage of menarche wasmorelikelytobe15or16years or later, ratherthanthe 12–13 year agesuggested by previous historians. How did ageatmenarche relatetoage at marriage? We have no statistically- rich records available from anyMiddle Eastern community prior to the 19th century.The earliest census known to me which attemptstoaccount for all women in the population comes from Egypt,inagovernment studyconduct- ed between 1846–1848. In his analysis of that census,focusing on Cairo, Phil- ippe Fargues noted that the ages of women at the time of marriagewererecorded onlyinone district,that of Old Cairo. There “the averageage of women upon their first marriageis13.8years, compared to 20.3 years for men.” Among women between the ages of 10 –14,almost half (49.1 %) had alreadymarried. Forwomen between the ages of 15–19,89% had ever been married. Kenneth Cuno, in his analysis of the census,noted that women younger than15were much lesslikelytobemarried in rural areas and, when they were, they tended to come from wealthier households.¹⁷² As for the pre-modern period, what anecdotal evidence we have suggests that it was not uncommon for women to marry at an earlyage.Yossef Rapoport attempted to make some statistical inferences about marriagepatterns in Mam- luk Cairo on the basis of the women mentioned in al-Sakhāwī’s Ḍaw’ al-lāmi‘ in which the 9th/15th-centurywriter chronicled the livesof500 women. On the subject of the averageage of first marriagefor women, Rapoport wrote:

The majority of girls weremarried off in their earlyormid-teens ...Sitt al-‘Arab married Abū Shāma when she was fourteen. Rābi‘ah the daughter of the scholar Ibn Ḥajar al-‘As- qalānī,first married at the ageoffifteen, and his granddaughter married at the ageofsix- teen. Some married earlier.Al-Sakhāwī married an eleven-year old girl. Al-Maqrīzī’smother

cificallydenied children the foods rich in B12 which would have protectedthem from megalo- blastic anaemia.”  See P. Fargues, “The Stages of the FamilyLife Cycle in Cairo at the End of the Reignof Muḥammad ‘Alī,According to the 1848 Census,” Harvard Middle Eastern and Islamic Review 5(2000), 12 and 33.K.Cuno, Modernizing Marriage: Family,Ideology,and Law in Nineteenth- and Early Twentieth-CenturyEgypt (Syracuse: Syracuse University Press, 2015), 66.The census is currentlybeingdigitized by Mohamed Saleh. 66 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status

first married when she was twelve.Orphan girls wereusuallymarried off while still minors, between ten and twelve.But it should be notedthat some women weremarried at an older age. The historian al-Birzālī’sdaughter first married when she was nineteen. The virgin bride of Ibn Ḥajar was eighteen.¹⁷³

Evidence from Jewishcommunities of Egypt indicatessimilar marriagepatterns.¹⁷⁴ Womencould experience their first marriageaslate as their late teens or as earlyastheir pre-teens, with marriageinthe earlyteens occurringfrequent- ly.Itisamistake to assume thatthoseagescorrespond with either menarche or the level of physical maturity one would expect from awoman of the sameage in the modern Middle East.¹⁷⁵ Based on the aboveconsiderations, it seems thatfirst

 Y. Rapoport, Marriage,Money,and Divorce in Medieval Islamic Society (Cambridge:Cam- bridge University Press, 2005), 38–9.  Child marriage within the Middle Eastern Jewish community is the subject of some schol- arlydebatebetween S. D. Goitein, M. Friedman, A. Grossman and R. Lamdan, with Lamdan and Grossman arguing that child marriage was so frequent as to be nearlythe norm, and Goitein claimingthat it was very rare.Thereappears to be little disagreement that 14 – 15 years was a common agefor marriage,and the debatecenters on just how frequent marriageswere to girls aged 10 to 12 or younger. The agerangesuggestedbythe Genizasources and medieval Jew- ish responsa literatureseems similar to the one represented in the Muslim Mamluk sources.R. Lamdan, “Child Marriage in Jewish Society in the Eastern Mediterranean duringthe Sixteenth Century,” Mediterranean Historical Review 11(1996), 37–59.Cf. T. Meacham, “Marriage of Minor Girls in Jewish Law: ALegal and Historical Overview,” in JewishLegal Writings by Women,ed. by M. D. Halpern and Ch. Safrai (Jerusalem:UrimPublications, 1998), 27.Eve Kra- kowski has argued that because Jewish marriagesconsist of twostages, kiddushin and nisu’in, which in the Geniza period were often separated by asubstantial period of time, and because the timingofnisu’in is often not specified within the Geniza documents,thereare fewer recorded incidents of consummated minor marriage than previouslythought. E. Krakowski, Coming of Age in Medieval Egypt (Princeton:Princeton University Press, 2018), 123.  On the subject of whether Islamic lawpermits marriage tominors,there seems to be some confusion in English-languagenon-scholarlypublicationswhich sometimes cite al-Nawawī (d. 676/1277) as sayingthat it is forbidden to consummateamarriage beforemenarche. This claim seems to be based on a1914English translation of al-Nawawī’s Minhāj. The English text by E. C. Howard is as follows: “Afather can dispose as he pleases of the hand of his daughter, without askingher consent,whatever her agemay be, provided she is still avirgin. It is, however,alwayscommendable to consult her as to her future husband; and her formal consent to the marriage is necessary if she has alreadylost her virginity.Whereafather disposes of his daughter’shand during her minority,she cannot be deliveredtoher husband beforeshe attains puberty.” Minhaj et Talibin: AManual of MuhammadanLaw according to the SchoolofShafii,tr. E. C. Howard (London: W. Thacker &Co., 1914), 284. Amoreliteraltranslation of the Arabic text reads, “Afather can marry off his virgin [daughter], whether aminor or an adult,without her consent; but it is commendable that he consultwith her.Hecannot marry off anon-virgin [daughter] except with her consent; so if she is aminor she is not married off until she reaches Amenorrhea 67 marriages for manymedieval Muslim, Jewish,and Christian women in the medieval Middle East would have occurred at atime when the woman wasunlikelyto be either fertile or experiencing menstrual regularity,due to physical immaturity.

Amenorrhea

The literaryevidence of the widespread practice of mid-teenagemarriage. coupled with skeletal evidence that mid-teens wereoftennot as physicallydevel- oped as theyare at the present day, has anumber of ramifications for understanding fertility. The first is that it must have been common in women’sfirst marriages for them to not experience regular menstruation at all, due to being pre-menarchal or to experiencing the irregular and anovulatory menses associated with post-menarchal adolescence.¹⁷⁶ If and when awoman became fertile, it would also have been common for her not to experience regular menstruation due to pregnancyand lactation. This is, to some extent,borne out by evidence from fatwās, in which women who have born multiple children and are not old, testify thatthey have not experienced regular menstrual cyclesinyears, or indeed ever in the course of their marriage.¹⁷⁷ Regular menstrual cyclesare of supreme importance in Islamic divorcelaw, because they are usedtodetermine the ‘idda,the mandatory period which must elapse after afirst marriagehas dissolvedbefore asecond marriage can legally take place. The ‘idda is significant in that awoman maynot remarry until it is completed, ought not to leave the lodging provided to her by her formerhusband, and duringthat time her formerhusband has both financial obligations to her as well as sexual rights over her (if the divorceisnot atriple, final one). The ‘idda period for adivorced woman is determined to last either for

puberty.” As his commentators explain, he means that anon-virgin must give consent to be married, and she is legallycapable of consent onlyonceshe has reached menarche, therefore the non-virgin minor cannot remarry until that point.Al-Nawawī, Minhājal-ṭālibīn (Beirut: Dāral- Minhāj, 2005), 375 – 6. On medieval legal attempts to define the minimum physical requirements for consummation, see Kecia Ali, Marriage and SlaveryinEarly Islam (Cambridge:HarvardUni- versity Press,2010), 76 and Yazbak, “Minor Marriagesand Khiyāral-Bulūgh in Ottoman Pales- tine: ANote on Women’sStrategies in aPatriarchal Society.”  See, for example, al-Fatāwa al-hindiyya (Būlāq: al-Maṭba‘aal-Kubrā al-Amīriyya, 1892), 1:531: “Aminor woman whose husband has divorced her,and threemonths minus one day has elapsed, and whothen menstruates once, but does not menstruatethree times – her ‘idda has not been fulfilled.”  See, for example,Ibn Taymiyya, Majmū‘ fatāwa (Medina: Majma‘ al-Malik Fahd li-Ṭibā‘at al-Muṣḥaf al-Sharīf, 2004), 34:23. 68 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status three menstrual cycles or three months, depending on her menstrual status. If she is pregnant at the time of the divorce, the ‘idda lasts until she givesbirth. If awoman is of reproductive agebut has irregular or absent menstrual cycles, the ‘idda maybeprolongedfar longer thanthe usual three months. It is not uncommon for legal discussions of ‘idda to consider such prolongedperiods, although to my knowledge such cases have not been studied systematicallyin the secondary literature. Because the legal system was basedonthe assumption thatwomen who reach menarche menstruate regularlyand are thus potentiallyfertile, the circumstances of pregnancyand infertility looked identical to each otherfrom the legal standpoint,since either maycorrelatewith disrupted menstrual cycles! This meant that at the end of amarriageaninfertile woman who failed to regularly menstruate could be tied to her ex-husband in much the same wayasa woman who was pregnant at the time of her divorce. Her ‘idda could be extreme- ly protracted. This is oddlythe mirror imageofthe medical situation in which the use of fertility drugs and abortifacients, i.e. tools of “menstrual regulation,” also looked profoundlysimilar.(As will be shown in the next chapter,lack of menstrual bleeding could be taken as amedicalindication thatthe woman was al- readyinthe earlystages of pregnancy,i.e.experiencing amissed period. Or, lack of menstrual bleeding could be amedical indication that the woman was not experiencing normal, healthyreproductive cycles and thus could not conceive until menstruation was restored. Drugs thatproduced menstrual bleeding could thus either be construed as producing an abortion in apregnant woman or as jump-starting amenstrual cycle in abarren woman. Somedrugs and treatments which weresupposed to resultinthe expulsion of blood from the uterus, in one context appear as abortifacients, and in another appear as fertility agents.) Amenorrhea was thus associated with bothfertility and infertility,and it seems to have thrown awrench into the legal system bent on establishingpater- nity and sexual belonging. Foramenorrhea legallyindicatedthatawoman’s bodycould have been impregnated by arelationship with aprevious man, even as it indicated an inability to become newlypregnant.This problem is directlyand repeatedlyattested to in fatwā literature.Women who were not menstruating regularlycould find it difficult to completetheir ‘idda and so could not permanentlysever old marital ties and establish new ones. A “positive” flip-side to this problem also existed: in some legal schools adivorced woman who could claim amenorrhea(aclaim which was difficult to legallydispute) could argue that she was,infact,pregnant and thus arguethat her ex-husband still owed her support or,ifthe ex-husband was deceased, inheritance. In this situation, presentingamenorrhea as indicative of pregnancy, rather than infertility,was ‘ idda and irregular menstruation 69 aviable strategyfor an infertile woman who wished to retain alegal and financial relationship with her formerhusband.

‘idda and irregular menstruation

Legal literaturerarelymakes explicit reference to women who are experiencing infertility.After all, infertility cannot be legallyproven. However,thereare many references to women who are experiencing amenorrhea and irregular menstruation. These references are found in the context of legal discussions of divorceand widowhood, since such conditions affected the length of the ‘idda period. Given that the symptoms of amenorrheaand irregular menstrual periods in women of reproductive agecorrelatestrongly with infertility and diminished fertility, it is worth delving into these discussions of the legal experiencesofnon-menstruating women in order to shedlight on the legal landscape for infertile women.¹⁷⁸ The length of the ‘idda period for divorcées is usually counted as threemenstrual cycles.¹⁷⁹ However,for women who are post-menopausal (āyisāt), or who are minors who have not yetbegun menstruating,the ‘idda is calculated as three lunar months.¹⁸⁰ From alegal perspective,awoman is considered to have reached menopause onlyonce she has met two requirements: she has both ceased to menstruate and has reached acertain minimum age. The Fatāwā al- hindiyya notes thatevenifawoman who has met those criteria and has therefore observed an ‘idda based on months laterappears to menstruate, then “the portion of her ‘idda which has elapsed is canceled and she must recommenceby calculatingher ‘idda by menstrual cycles.”¹⁸¹ The minimum agerequired to be considered past the ageofmenstruation is set between 50 and 62 years old

 It is, of course, impossible to obtain statistics about the relative predominanceofvarious causes of female infertility in different medievalcontexts. However,research in MENA countries in the past 20 years suggests that tubal problems currentlyaccount for between 26%and 42 %of female infertility,whereas pituitary,ovarian, and uterine disorders accounted for the remainder. Irregular menstruation is not usuallyasymptom of tubal blockages, but it is asymptom of the other kinds of disorders.Inother words, if infertile medieval women in the Middle East suffered infertility from the same causes as do modern Middle Eastern women, between 58%and 74 %of would have also potentiallyexperienced irregular menstruation.See G. I. Serour et al., “Infertil- ity:AHealth Problem in the Muslim World” Population Sciences 10 (1991), 41– 58.  By comparison, the waitingperiod in Jewish lawisthreemonths,not menstrual cycles, regardless of the circumstances. Mishna Yevamot 4:10.  If aminor is divorced, and during her three-month-long ‘idda she menstruates for the first time, her ‘idda begins anew,and is counted by menstrual cycles.  ShaykhNiẓām, al-Fatāwā al-hindiyya,1:526–7. 70 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status and varies both between and within legal schools.¹⁸² Among the Mālikīsthe minimum ageofmenopause is setateither 50,or“one should ask women who are between the ages [of 50 and 70]about the blood which flows from women. If they saythere is no menstruation at her age, she counts using months.”¹⁸³ Most Shāfi‘ī authorities consider the minimum ageofmenopause to be 62 years, with al-Qalyūbī also citing opinions in favorofage 50 and age60. The minimum ageofmenopause is amatter of dispute among Ḥanafīs. Both 50 and 55 years are cited in the Durr al-mukhtār.¹⁸⁴ Of course,inmanymedievalcommunities, precisebirthdateswentunrecord- ed forordinarypeople, andthusthere maynot have been apractical opportunity to verify that awoman was, forexample,49ratherthan50years old. Nevertheless, awoman whowas said to be 49 andwho hadnot menstruatedrecentlywould not, in theory, have been labeledmenopausalbymostscholars, with theexception of Ibn Taymiyya andhis disciple Ibn Qayyimal-Jawziyya.¹⁸⁵ That this couldbeaprac- ticalproblem even forsomerelativelyolder womenissuggested in apassagefrom the Masā’il of Ibn Ḥanbaltransmitted by Ibn Hāni’ (d.275/888).

Iasked Abū ‘Abdallāh[Ibn Ḥanbal] about aforty-year-old woman who married aman and remained with him for threeyears without menstruatingorseeingany form of blood. Then the husband divorced her,and her ‘idda from this first marriagewas determined to be three months,upon which she married another husband. She remained with him for four years, moreorless,and did not menstruate. Howshould her ‘idda be determined,now that she has been divorced again?¹⁸⁶

 Similar ages arealso found in medieval European literature. See D. W. Amundsen and C. J. Diers, “The AgeofMenopause in Medieval Europe,” Human Biology 45 (1973), 605–612.  Aḥmad ibn Muhammad al-Dardīr,al-Sharḥ al-saghīr in Bulghat al-sālik li-Aqrabal-masālik ilā madhhab al-ImāmMālik (Cairo: Muṣṭafa al-Bābī al-Ḥalabī,1952) 1:497.  Al-Ḥaṣkafī, Durr al-mukhtār in Hāshiyat Radd al-muḥtār ‘alā al-Durr al-mukhtār, 2:606  Their explanation hinges upon the rootmeaningofthe yā’isa,which is the word used for post-menopausal women but which literallymeans “hopeless” or “without expectationsorpros- pects” in some particular regard. Ibnal-Qayyim explains. “IbnTaymiyyasaid: Menopause is different for different women, and there is no cut-off point to applytowomen. The intention of the verse is that each woman is without prospects with respect to herself. Formenopause is the op- positeofexpectation, so when awomanbecomes without prospect of menstruating, and she does not expect it,then she is menopausal, even if she is forty years old or thereabouts,though another woman will not be without prospect of menstruatingevenifshe is fifty years old ...” IbnQayyim al-Jawziyya, Zādal-maʻād,5:583.  Ibn Ḥanbal, Masā’il al-ImāmAḥmad bin Ḥanbal riwāyatIsḥaq ibn Ibrāhīmibn Hāni’ al- Nayṣābūrī (Beirut: al-Maktabal-Islāmī,1979), 207. Parallel cases can be found in IbnTaymiyya, Fatāwā, 34:19. Similar situations arementioned brieflyinthe Fatāwā al-hindiyya,1:528. ‘idda and irregular menstruation 71

In this instance, the divorcée is now in her forties, and has not menstruated in at least seven years. After her first divorce, three years prior,she waited three months before remarrying.Ifshe could be legallyconsidered post-menopausal, those three months would have been sufficient to finalize her first divorce, and she could go through the same proceduretofinalize her second divorce. But Ibn Ḥanbal does not accord her that legal designation for either her first divorceor her second. Instead he cites several different opinions.

There is disagreement.There arethose whosay that her ‘idda fromthe first [husband] should have been one year,such is the opinion of ‘Umar. But Ibrāhīmsays, “If she has ever menstruated, even if onlyonce, then the ‘idda must be according to menstrual cycles and will last forever until she menstruates [again]. But IbnMas‘ūdsays: in the case of ‘Alqama’swife,¹⁸⁷ whofell ill and menstruated [only] twice and then died, ‘Alqama inherited from her.The rulingof‘Umar b. al-Khaṭṭāb was that if she does not know what has made her stop [menstruating], e.g. sickness or breastfeeding, she should wait 12 months,and then remarry. Abū ‘Abdallāh[Ibn Ḥanbal] said: My opinion is that they should be separated, that is, she and the husbandwho divorced her last,and then her ‘idda from the first [husband] should be set at 12 months,and afterwards the ‘idda fromthe second husband should be set at one year.

The first two opinions conflict with each other. In Ibrāhīm’sview,inthe absence of menstruation such awoman must wait twelve months between marriages. In IbnMas‘ūd’sview,inthis situation she must wait threemenstrual cycles regardless of how much time must elapse for that to occur.The third opinion, Ibn Ḥan- bal’s, suggests that Ibrāhīm’sapproach is correct under some circumstances, while IbnMas‘ūd’sapproach is correct under others. Atwelve-monthwaitingpe- riod is appropriate if menstrual cycles have stopped for no discernable reason, but if the amenorrheacan be attributed to aparticular trigger, then the waiting period must be counted accordingtomenstrual cycles regardless of how much time elapses.Ultimately, Ibn Ḥanbal concludes that the woman must now ob- servetwo years’ worth of waiting,one year for each divorce. Most later Ḥanbalī jurists takethe position thatifawoman stops menstruating for reasons unknown, her ‘idda is set at twelve months. This timeframe is usually explained as the combination of anine-month-longwaiting period to establish lack of pregnancy, at which point the lack of menstruation is attributed to menopause,followed by the three-month-longwait of apost-menopausal woman. However,under certain circumstances the delayincompletingthe ‘idda could be longer thanone year.This occurs when the onsetofamenorrheacorre-

 The story of 'A lqama ibn Qays is explained on p. 72. 72 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status sponds to aknown condition such as lactation or sickness, even possiblymental illness due to distress.Under such circumstances the woman must wait until her menses recommence or until she reaches the ageofmenopause, and onlyatthat point mayshe begin calculating the three-month-long ‘idda.¹⁸⁸ On this point, early Ḥanbalī scholars refertoacase wherethe circumstancecausing the amenorrhea is “known” and,asaresult, the ‘idda is prolongedindefinitely, or until those circumstances change. The case is astory about ‘Alqama (d. 62/681), a companion of the Prophet. ‘Alqama divorced his wife whereupon she became ill and stopped menstruating.Seventeen months later,she died.Inthat case IbnMas‘ūd, another companion of the Prophet,ruled that ‘Alqama inherited from her,thus indicating that she died while still within her ‘idda period, proving that the ‘idda can last for more than ayear.¹⁸⁹ There is adebate as to what motivated IbnMas‘ūd’sruling.Ibn Ḥanbal’sson ‘Abdallāh(d. 290/903) seems to understand the story to mean thatsince amenorrhea coincided with ‘Alqama’s wife having fallen ill, one could hope that menstruation would resume once the illnessended, and hence the ‘idda could last as long as the triggering illness and for three menstrual cycles thereafter.¹⁹⁰ Others interpreted the ruling in adifferent light,saying that the reason that the woman was still considered to be in her ‘idda nearlyayear and ahalf after her divorcewas because IbnMas‘ūd thoughtpregnancycould last for two years:

Isḥāq¹⁹¹ said ...The meaningofthe ruling about ‘Alqama and his wife’sillness is that Ibn Mas‘ūdfavored the opinion that pregnancycould last two years, as ‘Ā’isha said: “Achild does not remain in the wombmorethan two years.”¹⁹²

Those who attributed to IbnMas‘ūdthe logic that,although gestation is usually nine months long,itispossible for it to last up to two years, and hence the ‘idda can last thatlong,also argued that under all circumstances of amenorrhea, once the two years have passed and it is clear that thereisnopregnancy, the divorcée can remarry immediately, without needing to undergo the three-month-long

 Ibid., 7:465.  Al-Sarakhsī,aḤanafī,would later use the story to illustrate apoint about the rights of a husband to revoke adivorceevenduringaprolonged ‘idda. Al-Sarakhsī (490/1096), al-Mabsūṭ (Beirut: Dāral-Kutub al-‘Ilmiyya, 1993) 6:19.  Susan Spectorsky, Chapters on Marriage and Divorce (Austin: University of Texas Press, 1993), 133.  Isḥāqb.Manṣūral-Kawsaj(d. 251/865).  Aḥmad ibn Muhammad al-Dardīr(d. 1201/1786), Sharḥ al-kabīr ‘alā Mukhtasar Khalīl in Ḥā- shiyat al-Dasūqī ‘alā al-Sharḥ al-kabīr (Beirut: Dāral-Fikr,n.d.) 2:471. ‘idda and irregular menstruation 73 waiting period of the post-menopausal woman.¹⁹³ The notionthatgestation could last so long will be addressed laterinthis chapter. Ḥanafīsand most Shāfi‘īstakeavery different position on the question of how awoman experiencing amenorrheacompletes adivorce, aposition which largely side-steps the question of whether the woman is possiblypregnant.In- stead they maintain that awoman remains in her ‘idda until such time as she had bled three times or reached the minimum agerequired to be legallyconsidered post-menopausal. Once she reaches menopause,her ‘idda is calculated as lasting threemonths, at the end of which she is free to marry.Intheory,such laws would mean that an ‘idda could lastmanyyears indeed.¹⁹⁴ Interestingly,although the view that anon-menstruating woman must remain in her ‘idda until old ageisendorsed in the Durr al-mukhtār,the Ḥanafī author also suggests that it would be prudent in such asituation to direct awoman to aMālikī judge, so that she maycompleteher ‘idda in asingle year.¹⁹⁵ And in the Radd al-muḥtār Ibn ‘Ābidīnquotes al-Zāhidī (d. 658/1260) as saying that one fellow Ḥanafī jurist issued a fatwā basedonthe view of Mālik on this matter “because of need.”¹⁹⁶ Mālikīsfollow the nine-months-plus-three-months formula if menstruation seems to have ceased entirely.However,ifmenstruation occurs intermittently, the waiting period maybelonger.

If the woman who is waitingfor ayear menstruates during that year,evenifitisonthe last dayofthat year,then she must wait again for asecond menses,oruntil the end of [another] year.When the year ends without her menses appearing, her ‘idda is over.But if her menses do appear within that year,evenifitisonthe last day, she must wait for athirdmenses,or acomplete “white” year in which thereisnoblood, if she is free. If she is aslave,she stops at the second year.¹⁹⁷

Such asituation, in which menstruation is highlyinfrequent,could theoretically delayadivorcée’sremarriagefor up to threeyears.

 IbnQudāma, al-Mughnī,7:463.Ibn Ḥanbal, Masāʼil al-ImāmAḥmad ibn Ḥ anbal wa-Isḥāq ibn Rāhwayh (Medina:ʻImādat al-Baḥ th al-ʻIlmī,2004), 4:1705–1707.Atranslation of the latter can be found in Spectorsky, Chapters on Marriage and Divorce,189  al-Ū shī,Sirājal-DīnAbū Muḥ ammad ʻAlī ibn ʻUthmān, Al-Fatāwā’ al-Sirājīya (Lenasia, South Africa: Dāral-ʻulū mZakariyyā 2011), 232.  Ibid., 3:508;and al-Kāsānī (d. 587/1191), Baḍā’i‘ al-ṣanā’i‘,2:195.The adoption of Mālikī practice in regardtothis issue would be enshrined in the Ottoman “LawofFamilyRights” in 1917. See N. J. Coulson, AHistoryofIslamic Law (Edinburgh:EdinburghUniversity Press, 1964), 192.  Ibn ʻĀ bidīn, Ḥ āshiyat Radd al-muḥtār,5:186.  Aḥmad ibn Muhammad al-Dardīr(d. 1201/1786), Sharḥ al-kabīr ‘alā Mukhtasar Khalīl in Ḥā- shiyat al-Dasūqī ‘alā al-Sharḥ al-kabīr (Beirut: Dāral-Fikr,n.d.) 2:471. 74 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status

The extended ‘idda as apotential burden on women

Fatwās, particularlythoseofIbn Taymiyya, shed some light on the negative con- sequencesoflong ‘idda periods from the point of view of women seeking to end amarriage. (For the usefulnessofthe extended ‘idda to women see the section below.) In one fatwā,Ibn Taymiyyaaddresses the caseofayoung,married woman who seems to have stopped menstruating altogether, with no indication of when or if she will begin menstruating again. Her husband decides to divorce her.The petitioner asks: “Is the ‘idda for her divorcemeasured by months or must she wait until she reaches the ageofmenopause?” IbnTaymiyyaresponds by highlightingthe plight of awoman stuck in this situation.

If it is possible that her menses will return, and it is possible that they will not return,then she should wait one year and marry,as‘Umar b. al-Khaṭṭābruled regarding the woman whose menses had stopped without her knowingwhathad stopped them. She waits one year,and that is the common view,for example the view of Mālik and al-Shāfi‘ī.Asfor one whosaysthat she must be of the ageofmenopause, that is avery weakview,with so much harm in it as to be unparalleled in the law. Foritkeeps her from marriageat the very time of her need of it and would onlypermit [marriage]toher onceshe no longer needs it [i.e. in her old age].¹⁹⁸

In another fatwā,Ibn Taymiyyareiteratesthe samelogic and explicitlycharacter- izes it as maṣlaḥa (arrivedatonthe basis of the public interest). In this case, a woman’ssecond husband has divorced her upon realizingthatshe had menstruated onlyonce duringher ‘idda following her divorcefrom her first husband.In an effort to remarry her second husband,the wife then declares that she has reached menopause. As part of his answer,Ibn Taymiyyaconcludes with an attack on the Ḥanafī view.

According to [Abū Ḥanīfa] awoman in this precarious situation would remain in her ‘idda until she grewold and reached the ageofmenopause, even though accordingtotheir opinion she would have to remain unmarrieduntil 50 or 60.But that would be such ahardship as to be an exception to the law, and so the maṣlaḥa of the Muslims abolishes it.¹⁹⁹

IbnTaymiyya’s fatwāsalso include aresponsetoacase about awoman in her ‘idda whose menses are “delayed” as aresultofbreastfeeding and who resorts

 IbnTaymiyya, Majmū‘ Fatāwā,34:20.  Ibid., 34:17. ‘idda and irregular menstruation 75 to drugs in order to bring on menstruation. He notes thatsuch menstruation does indeedqualify,sothat the woman can be freetoremarry.²⁰⁰

Acasestudy of irregular menstruation and the laws of ‘idda If IbnTaymiyya’s fatwāsseem relatively clear-cut,afatwā attributed to the Mālikī Qāḍī ‘Iyāḍ (d. 544/1149) demonstrates the complicated nature of calculating the ‘idda and the significant resulting problems that an irregularlymenstruating woman could have in enteringand leaving amarriage. It alsoforegrounds the role of husbands and of other women in mediating an individual woman’sen- counter with the law. The case begins as follows:

When [Muḥammad b. Aḥmad] married his wife Fāṭima bt.Muḥammad (known as IbnNaj- jūma), he learned²⁰¹ that she had acondition which delayedher blood. It concerned him that he might have contracted his marriage with her beforethe completion of her ‘idda fol- lowingher husband’s, ‘Alī b. Muḥammad’s, divorcefromher.Muḥammad thereforeques- tioned and interrogated her,and informed her about what was requiredofher,whereupon she acknowledgedtohim that her blood had onlycome twice sinceher divorcefrom ‘Alī, and that she was ignorant of [the requirements]. Muḥammad withdrew from her and consulted with some trusted men of learning, whoinstructed him to divorceher,for she is not permitted to him. He thereforeseparated fromher ...²⁰²

The istiftā begins with Muḥammad realizingthathis wife is not menstruating as expected. This, he realizes, mayhavebeen the caseprior to the marriage and he gets her to acknowledge that,infact,she had menstruated onlytwice since her divorceafter her previous marriage. He tells her “what was required of her.” She says that she was ignorant of the requirement.Hedivorces her,apparentlysur- prised by her confession. The judge is then told that Muḥammad, even before his marriage, was aware of the possibility thatthe requirementsof‘idda werenot being fulfilled. During his courtship, he had requested of amale intermediary,who in turn requested of his wife, that she educatethe potential fiancée about the rules of ‘idda.

 Ibid., 34:19.  Lit. “it was revealed to him.” This is the version that appears in al-Wansharīsī, al-Miʻyār. The version that appears in IbnRushd’s Fatāwā says “to her.”  IbnRushd, Fatāwā Ibn Rushd (Beirut: Dāral-Gharb al-Islāmī,1987), 2:1085–7and Aḥmad ibn Yaḥyā al-Wansharīsī, al-Miʻyāral-muʻrib wa’l-jāmiʻ al-mughrib ʻan fatāwā ahl Ifrīqiyawaʾl-An- dalus waʾl-Maghrib (Rabat: Wizāratal-Awqāfwaʾl-Shu’ūnal-Islāmiyyalil-Mamlakaal-Maghri- biyya, 1981) 3:401–3. 76 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status

Muḥammad testified ...that he had addressed Ḥājj Ḥaḍḍūr...to propose marriage between himself and Fāṭima b. Muḥammad b. Najjūma, and Muḥammad said to him: “Tell her to fear almighty God, her Lord, and to wait by herself until her ‘idda is completed. In- form her that if she is of the sort whosees blood, then [she must do so] three times.Ifshe does not see [blood], then [the ‘idda]isthree full months.She is not permitted to marry or to become engageduntil after what Itold you.Warn her against doing what she did with the Fāsī who proposed to her,whenshe decided to contract the marriage with him prior to the end of her ‘idda.” ...UmmQāsim, the wife of Ḥājj Ḥaḍḍūr, met with Fāṭima b. Muḥammad IbnNajjūma to inform her of all that Muḥammad b. Aḥmad mentioned above. [Umm Qāsim said that] she said all of this and informed her of it,and that Fāṭima told her that her ‘idda had been completed, and that she had seen blood threetimes sinceher divorcefromher first husband.

This passageshows that that before his engagement Muḥammad had warned Fā- ṭima (via intermediaries) to keep to herself and not to do what she did in the past,which was to become engaged to aman (the Fāsī,who mayormay not have been her previous husband ‘Alī)before she had completed her ‘idda. It seems that Fāṭima has ahistory of attemptingtoenter into marriages before she has completed her ‘idda. Throughout this history Fāṭima is frequentlyinformed by others about the laws of ‘idda and yetshe maintains that she was ignorant of what she is supposed to do.

...The husband seeks to take back the dower,but the woman is keepingit. She claims ignorance, but the husbandhas female witnesses sayingthat they informedher of what he said verbatim, and that the matter had been clarified to her during her ‘idda from the first husband, which incidentally,according to one of them, was the second time [they had done so?]. The husband says that with this clarification,thereisnopossibilityof her beingignorant ...

The husband seeks to annul his marriageand retrievethe dower he gave to his wife, on the grounds that by not menstruating three times since her previous marriageshe had not completed her divorceand thus was not free to marry. He further claims that the woman must have lied in saying that she was free to marry,since multiple people had provided instruction to her about how the laws of ‘idda work. Thejurist disagrees, however,sayingthatshe maywell have thought she had fulfilledher ‘idda obligations, and that if she is willing to issue asworn oaththatthat was her state of mind, she maykeep the dower likeany other divorcee. ‘idda and irregular menstruation 77

The answer:

...Ithas not been confirmed what the Ḥājjī’swife said to/about²⁰³ her:i.e.whether – when [the Ḥājjī’swife] informed her that the ‘idda is threemenses,and warned her against mar- ryingbeforeits completion – [Fāṭima] then said that her ‘idda had been completedand that she has seen blood three times sinceher divorcefromher first husband. My view is that since

[a] she denies that she was informed that the ‘idda is three menses,and she was not informed of that,and

[b]she married onlybecause she thoughther ‘idda from her first husband had been completed, and

[c] sinceshe denies this within the limits of the law

she is not required to returnany part of the dower to him. But if she refuses to swear [that this was the stateofher marriage], she does not receive from him anythingexceptthe price of her vulva,²⁰⁴ and the rest returns to him ...

Everyone involved in the caseassumesthatFāṭima must be confused about the rules of ‘idda,atleast initially. Her husband-to-be assumes that Fāṭima must be warned to keep to herself until she menstruates threetimes, and that she needed to be enlightened by Ḥājj Ḥaḍḍūr. Umm Qāsim makes the sameassumption. The other women affirm that they explained everything to her not once, but twice. Finally, the muftī seems to agree that thereisroom for ignorance here. There seems to be something trulycomplicated about the lawof‘idda in this case such thatitwould make sense for the men and women involved to checkand double-check the situation. In David Powers’sanalysis of this case, he maintains that Fāṭima’sfailureto complywith the laws of ‘idda is motivated by selfishness, and that her claim of ignorance of those laws is obviously false.However,the most plausible wayof accounting for the actions of all the people mentioned in the legal document is to takeseriously the fact that Fāṭima’smenstrual cycles were infrequent (“her blood was delayed”). This means that when Muḥammadinstructed her, by wayofḤājj Ḥaḍḍūrand Umm Qāsim that “if she is of the sort who sees blood, then [she must do so] three times; if she does not see [blood], then [the ‘idda]isthree full months,” Fāṭima’sstatus really was potentiallyambiguous. The complicated nature of the situation seems to steminpart of from the legal dichotomydifferentiatingbetween those who menstruate and those who

 Thereare anumber of textual variants among the manuscripts in this section. It might say “to her” or “about her.”  On the use of this phrase see Kecia Ali, Marriage and SlaveryinEarly Islam, 151. 78 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status do not.(The languageofthe instructionsissued here is mostlyQur’ānic. It is possible, of course,that this languageisused for official purposesinthe legal document but does not reflect the actual wording used to instruct the woman.) Fāṭima believed she fell into the category of those who do not menstruate, and so she thoughther ‘idda ought to be calculated as three months long.The point of contention between the parties to the lawsuit is not whether Fāṭima knew that she was not allowed to marry duringher ‘idda. She was not ignorant of that. She says that “she onlymarried someone thinking that her ‘idda from her first husband had been completed” but,she claims, she never said that she had “seen blood three times” and did not know thatshe had to.The point of contention is whether Fāṭima knew that she still fell into the category of the menstruating woman, regardless of her lack of regular menstrual cycles. This, accordingtoFā- ṭima and Qādī ‘Iyāḍ,she could plausiblyclaim not to know.She did not know that awoman with oligomenorrhea such as herself had to see blood three times, rather than simplywait the three months. Muḥammadand the other witnesses, for their part,testify that they explained the laws of ‘idda manytimes and thatshe must thus have known that she was in the category of women who must calculate their ‘idda by menstrual cycles. Fāṭima’ssituation appears to have been further complicated by the semi- public and semi-privatenature of menstruation, at least in this particularcom- munity.This attitude towardmenstruation can be inferred from details from the fatwā. Prior to the marriage, it seems that Fāṭima was publiclyknown to have a menstrual problem – hence the women’srepeated counselingofher regarding the laws of ‘idda and Muḥammad’swarning that he knows about her and the Fāsī.²⁰⁵ So, in this community,there is apublic dimension to menstruation. But there is also aprivatedimension to menstruation, hence the public’signo- rance of the fact thatFāṭima had menstruated onlytwice since her most recent divorce. The public aspect of menstruation might have been somewhat obscured by the legal requirement thatawoman remainathome duringher ‘idda period. Muḥammad’smessagetoFāṭima at the time of the proposal includes the caution to keep to herself,indicating that this theoretical requirement was expected (by

 One could makethe argument that the public knew nothingabout her menses at the time of the Fāsī relationship, and that they knew she had not completedher ‘idda simplybecause not enough time had elapsed, e.g. she had been divorced onlyone or twomonths prior.However,if that werethe case, then Muḥammad’sconcerns would have been allayedwith the passage of time. Givenhis concerned behavior at the time of his own engagement,one would have to arguethat Muḥammad and the women’sconcerns shifted from countingtime to counting menses, and it just so happened Fāṭima had amenstrual problem too.This strikes me as aplausible, if not the most likely, scenario. ‘idda and irregular menstruation 79 at least some) in this community to be put into practice. This would account for the fact that no one is sure how manytimes Fāṭima menstruated until she supplies the information herself. So, at the time of her relationship with the Fāsī,Fāṭima was known to have a menstrual problem, but for some reason at the time of Muḥammad’smarriage both the femalewitnesses and Muḥammadbelieved that the danger waspast and, perhaps,sodid Fāṭima. There are at least two scenarios in which this could happen. Perhaps at the time of her engagement to the Fāsī,Fāṭima had not experiencedmenstruation at all, or had onlymenstruated once and then stopped, and so the public imageofFāṭima was as someone experiencing amenorrhea. Once she menstruated again, it was mistakenlybelieved that she was now having regular cycles. Onlyonce Muḥammad and Fāṭima had been married for awhile did it become clear that this was not the case. Alternatively,atthe time of her engagement to the Fāsī,Fāṭima had menstruated twice, and so the public imageofFāṭima was of aperson who had regular, though long,cycles. By the time Muḥammadproposed, he and the women thoughtthat asufficient interval had elapsed for her to have completed threecy- cles, and so they then did their duediligenceand weresatisfied whenshe af- firmed thatshe had completed her ‘idda. Meanwhile, Fāṭima believed that since she wasnolonger seeing blood she simplyhad to wait threemoremonths. Onlyonce she was married did it become clear to Muḥammad that his wife did not have predictable menses. In either case the misunderstanding,deliberate or feigned, came to light onlyonce the husband realized his wife menstruates only intermittentlyinstead of having cycles and he chose to ask her how manytimes she had menstruatedprior to her marriage. In his article about this case, David Powers concludes that it showcases a woman craftilyusing faux-naiveté to manipulate the judicial system.²⁰⁶ However,

 D. Powers, “Women and Divorceinthe Islamic West: Three Cases,” Hawwa 1(2003), 29–45. Powers’ analysis leavesout the vital pieceofinformationthat the wife has delayedmenses.He argues, “Clearlyknowledgeable about the rules of marriage and divorce, Fāṭima manipulated these rules, apparentlyfor the purpose of liningher pockets with dīnārs and dirhams.She used her knowledge of the lawtodeceive not one but two husbands,insuccession. Ironically, she defended her action with the claim – surelydisingenuous – that she was ignorant of the law. The strategyappears to have worked.” He also suggests that,inaddition to beingmotivated by greed, “Fāṭima mayhavehad other motives, e.g., to extricateherself from amarriage that had been forcedupon her by her marriage guardian, fear of pregnancy, or hatredofmen.” Powers’ onlyevidencefor his claim that Fāṭima is “clearlyknowledgeable” is that she appears to avoid losing the lawsuit.Thereisnoevidencethat she wanted either divorce. If her purpose was to avoid marriage to this husbandortoavoid pregnancy in general, it seems that by merely disclos- ing her menstrual state she could have avoided both. 80 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status amore straightforward analysis of the fatwā – especiallywhen read together with the laws of menopause and with IbnTaymiyya’s fatwās – suggests that the confusion, miscommunication, and frustrations experienced by Fāṭima and Muḥammad make sense within the context of the application of the laws of ‘idda for those with disrupted menstrual cycles. Moreover,since infertile women often experience such menstrual disruptions, infertile women would have been more likelythan others to suffer from this frustrating legal situation, making it more difficult for them to conclude adivorceand to initiate aremar- riage.

The extended ‘idda as apotential boon to women

Medieval jurists, especiallyMālikī ones (as well as 19th-century French colonial administrators and 20th-century anthropologists) alsorecognizedthatthe extended ‘idda could potentiallybebeneficial both to divorcées and to widows. This is so in situations when the formerwife uses her extended ‘idda to retain the rights due to her from her former husband. Twowritingsfrom the Andalusian jurist IbnRushd al-Jadd (d. 520/1126) illustrate this point.The first is a fatwā he writes in response to the case of awoman whose husband divorced her.Aslegal- ly required, she livedinher former husband’shouse duringher ‘idda. Aftersome time, whenthe “‘idda for one such as her ended,” the former husband attempted to evict her from the house, at which point she declared that she was pregnant, and her former husband claimed thatshe was lying.

IbnRushd receivedaquery from Badajozabout awoman whose husband divorced her,and she observed her ‘idda in the house in which she had been divorced. The ‘idda for one such as her ended and the husband, wantingtoremoveher from his house, told her that her ‘idda had alreadyended. She declared that she was pregnant,in[the house], while her husband claimed she was lyingand he wishes her to be examined by women. Must she swear that she suspects she is pregnant or not? Answer: Ihavepondered the question and lingered over it.Ifshe declaredthis after four months or so, she is to be believed without an oath. If she declared this after six months or so, she is believed so long as she swears. There is disagreement if she declared this near to the end of the year,and some saythat she should be believed so long as she swears, while others saythat she is not to be believed unless therewas ahint of this previously. But if she declaresthis after the year has ended she is not to be believed unless the women examine her and corroboratewhat she declared.²⁰⁷

 IbnRushd, Fatāwā, 3:1278 – 79,also in al-Wansharīsī, al-Mi‘yāral-mu‘rib,4:482. ‘idda and irregular menstruation 81

Here, the divorced woman argues thatshe is still in her ‘idda by virtue of sus- pecting that she is pregnant,and as aresult she stillhas aright to lodgings paid for by her former husband. Her formerhusband deniesthat thereisreason to believethatshe is pregnant and wishes the matter to be settled by femaleex- perts, while the court considers whether she should be forced to swear an oath in order to be believed. Nowhereineither the question or the answer is it explicitly stated what indications the woman has thatshe is pregnant.Most likelyitisthe absenceofmenses but,particularlyinNorth Africa, menstruation wasstill considered compatible with pregnancy.²⁰⁸ In his book of jurisprudence al-Bayānwa’l-taḥṣīl the samejurist,Ibn Rushd, addresses another set of (hypothetical) scenarios,inwhich awoman is divorced and her former husband dies some unspecified time later.She then seeks to inherit from him as awidow,onthe grounds thatshe never menstruated afterher divorce.²⁰⁹ The jurist is asked to consider the following situations, “in regards to aman who divorces his wife while she is [a] breastfeeding or [b]not breastfeeding,and then he dies. She claims thatshe has not menstruated and is seeking a share of the inheritance [i.e. the share normallydue to awidow].” Since we are studying the potential legal options of infertile women we shall focus on his response to the situation in which the ex-wife/would-be widow claims to be experiencing amenorrhea unconnected with breastfeeding. IbnRushd begins by citing the opinion of the Andalusian jurist al-‘Utbī (d. 255/869). “He said, regarding awoman who is not breastfeeding:she is believed until one year has elapsed, whether or not she mentioned [her lack of menstruation] before, but she must swear to it – unless there is arumor thatshe has al- readymenstruated three times.” IbnRushd explains that this means that if her divorcehas occurred within the past year,and she is willing to swear that in that time she has not menstruated, then she is believed and hence inherits as a widow would. He then addresses the situation if more than ayearhas elapsed since the divorce. If “she then seeks the inheritance, allegingthat her ‘idda has not ended due to therebeing asensation present in her womb,” then she is not believed until women examine her and corroborate her statement.HereIbn Rushd explic- itlyconnects the reason for the extended ‘idda to the notion that the woman might yetbepregnant.Citing another authority,hesaysthat if the examining

 E.g. al-Wansharīsī, al-Mi‘yāral-mu‘rib, 4:524.  IbnRushd, al-Bayānwa’l-taḥṣīl (Beirut: Dāral-Gharb al-Islāmī,1984) 5:419. 82 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status women do find “suspected” pregnancy,²¹⁰ she mayremaininthe lodgingspro- vided for her ‘idda for up to five years. If, afterfiveyears, she still claims to feel pregnant and to not be menstruating she is no longer believed. From the divorced woman’spoint of view,that means she can potentiallyobtain for herself up to five years of housing, if her lack of menstruationcan be interpreted as pregnancyrather than infertility. IbnRushd then mentions adebate as to whether her former husband had to be aware, priortohis death, thatshe was not menstruating (and thus that they werenot fullydivorced). He seems to subscribe to the opinion that the husband’s knowledge is not requisite. However,healso mentions other opinions. He cites the opinion of Damascene Mālikī jurist Ibnal-Mawwāz(d. 281/894) who rules that she can onlyinherit if her formerhusband wasaware duringhis lifetime that she had not menstruated yet. He further mentions an alternative construction of the relevant timeline:ifher claim comes onlyfour months into the divorce, she is believed without swearing to it.After six months she is believed onlywith an oath. And if she claims “not to have completed threemenses due to delayedmenstruation,” but that claim emergesonlyafter ayear or two has elapsed, and her husband is alreadydead, she is not believed. He concludes that in asituation wherethe woman’sclaim or oath will not suffice, she should be examined by otherwomen, who mayprovide expert testimony.²¹¹ The practical upshot of IbnRushd’sdiscussion is that if awoman makes it known that she has not menstruated since her divorce, then she mayclaim the benefitsdue to apregnant woman withoutany external corroboration, though she mayneed to swear an oath as to her status. It is not clear whether this oath is about onlyher lack of menstruation or alsoher “sensation” of pregnancy, or whether those are considered to be one and the same. If her claim to be experiencing amenorrhea or pregnancyismade late in the ‘idda process, it is not rejected outright as impossible, but rather it is subjectedtoahigher standard of proof. The more expedientlytimed the woman’sclaims are,the higher the burden of proof required to substantiate them. That proof, however,need not be the eventual birth of achild, but rather testimonyfrom expert women that the ex- wife exhibitssome symptoms of pregnancy.

 The languageused herefor suspicion of pregnancyismustarāba and rība. This idiom is also used elsewhereinIbn Rushd’swritings in regard to awoman whoclaims to be pregnant while her ex-husbanddenies it.E.g.al-Wansharīsī, al-Mi‘yāral-mu‘rib,4:482. The term also appears in the Mi‘yār in at least one placewhere it is not attributed to IbnRushd. See al-Mi‘yāral- mu‘rib, 4:524and 5:56.  IbnRushd, al-Bayānwa’l-taḥṣīl,5:419–20. ‘idda and irregular menstruation 83

ParticularlyinNorth Africa, the testimonyofmidwivescould have enough forcetocompel aman to financiallysupport his ex-wife for years, if the testimony supported the claim thatthe ex-wife was experiencing aprolongedpregnan- cy.InMoroccan lore, afetus could go into astate of hibernation in which the mother can feelits presencebut it does not grow until it “wakes up” or is “awak- ened.” This hibernating gestation can last for up to five years. Midwiveswerere- sponsiblefor diagnosing this condition, known as the “sleeping fetus,” rāqid, and their help was also sought in “awakening” the rāqid and so that normal pregnancycould “resume.” The rāqid is well known within secular scholarship of Islamic lawasaninstrument for protecting the reputation of women who birth children at inconvenient moments, moments that would indicate thatthey con- ceivedwhen they were unmarried or their husbands werenot present to impreg- nate them. However,the notion of rāqid protected not onlywomen with awk- wardly-timed pregnancies,but alsowomen who did not appeartobepregnant at all. Multiple medieval fatwāswhich reference extended gestations do not refer to situations in which the paternity and circumstances of the conception of ababyare suspect,but rather to asituation in which awoman claims to be pregnant despite not yetproducing ababy.²¹² Until recently,²¹³ the rāqid was understood by Europeans workinginMoroccoasprimarilyacopingmech- anism for infertile women.²¹⁴ In referencetolate 19th and early20th-century Mo- rocco, Ellen Amster writes:

The raqid preventedunilateral divorce(ṭalāq), because according to the Qur’an, aman cannot divorceapregnant wife beforeshe givesbirth, after which he owes her two years of maintenancefor breast-feeding. Adivorced woman could thus receive up to five years of maintenancebyclaimingaraqid pregnancy, and awidow could delaythe division of her husband’ssuccession by declaringherself pregnant at his funeral; anychild born within the five-year delayperiod would consequentlyinherit.Shari‘aand Berber customary courts left the diagnosis of the raqid to the woman herself, her mother,oramidwife ... In the Moroccoofthe twentieth century,French physicians wereincredulous that shari‘a judgescould believesuch a “physiologicalabsurdity.” Doctors sawthe raqid as awoman’s

 E.g. al-Wansharīsī, al-Mi‘yāral-mu‘rib,3:224–25.  By the late-twentieth century,ithad re-emergedasawayofcoping with the pregnancies of North African women whose husbands werelivinginEurope as migrant workers.  F. Legey, TheFolkloreofMorocco,tr. Lucy Holtz. (London: Unwin, 1935), 105–106: “Abarren woman will never admit her sterility.She believes that she has conceived, and that her pregnancy is delayedbyaspell ...she imagines that she was pregnant,and the child fell asleep ...she then abandons herself to certain practices in order to wakeitup...It is also thought that if this magic medicinedoes not wake up the child, it will facilitateits expulsion, and that the woman will then conceive normally.” 84 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status

ruse to avoid divorce, and Dr.Delanoe commented wryly, “Every sterile woman claims to have [sleepingchild.]”²¹⁵

Amster goes on to show that French doctors and the French legal system were seen as instrumental in upholding the prerogativesofliving ex-husbands and the kin of deceased ex-husbands,who denied that their ex-wives and ex-in- laws were pregnant.Bycontrast,the courts based upon sharī‘a and customary lawwereperceivedasbeing more protective of the rights of such women, and especiallytheirright to lodging during the ‘idda. Similarly, Noel Coulson has noted that in modern Egypt too, effortstoreform the legal code along more Euro- pean lines included provisions to protect ex-husbands from the demands of an extended ‘idda on the basis of long gestations.²¹⁶ It should be noted that while the concept of the sleeping fetus is most com- monlyassociatedwith Morocco, the notionthat afetus could gestate beyond one year is found in sources from Medina and is acknowledgedbynot onlythe Mālikī school, but also by the other threeSunnī schools, with the Hanafīshaving the most narrowly defined limits of possiblegestation, setting it at two years and other schools mentioningfour,five, and seven year limits.²¹⁷ Sometimeseven longer gestations are mentioned. In aremarkable account of his familylife, a learned Cairene named Burhānal-DīnIbrāhīmal-Biqā‘ī (d. 885/1480) describes the nine-year-longpregnancyofhis concubine, Ḥasbiya Allāh, with his much- anticipated child. He mentions thatarivalwife and some acquaintances scoff at the concubine’sclaim, but al-Biqā‘ī asserts that his experience has the support of bothmedical authors and female midwiveswho have periodicallyexamined the “pregnant” woman.²¹⁸

 E. Amster, Medicine and the Saints (Austin: University of Texas Press, 2013), 167–8.  Coulson, AHistoryofIslamic Law,176.  See al-Sarakhsī, al-Mabsūṭ. 4:45.Ibn Rushd the grandson (Averroes) takes exception to the notion of longgestations.Hewrites, “They disagreed about the longest period of pregnancy through which the father can be associated with the child. Mālik said that it is five years, while some of his disciples said it is seven. Al-Shāfi‘ī said that it is four years. The Kūfīssaid it is two years. Muḥammad ibn al-Ḥakamsaid it is ayear.Dāwūdsaid it is six months.This counting is based on practiceand experience. The opinions of Ibn ‘Abdal-Ḥakamand the Ẓā- hirites arecloser to the normal. The rule should be based upon what is normal,not upon what is rare, which would, perhaps, be impossible.” Translation fromImran Ahsan Khan Nya- zee, TheDistinguished Jurist’sPrimer:ATranslation of Bidāyatal-Mujtahid (Reading: Garnet, 2000), 2:433.  al-Biqā‘ī, Iẓhāral-ʻaṣrli-asrārahl al-ʻaṣr (Riyadh:n.p., 1993) 3:43 – 4. Here both the “mother” and the “father” appear to be motivated in part by animus towardone of his wivesand her child. See. L. Guo, “Tales of aMedieval Cairene Harem: Domestic Life in al- Biqā‘ī’sAutobiographical Women’stestimony,privacy,and expertise 85

Women’stestimony, privacy,and expertise

One strikingaspect of references to women’sreproductive statuses is the extent to which they could remain private, unknown to anyone but the woman herself, at least in some communities.Thisissomewhat surprising giventhe close quar- ters in which people lived, the significance of menarche for women’slegal and ritual identities, and the importance of purification after menstruation for all kinds of ritual activities. Despite the public significance of menstruation, all of the above-mentioned legal cases and hypothetical questions indicate that,in manyplaces,itwas possible for no one but the woman herself to be aware whether she was currentlyexperiencing regular menstrual cycles.²¹⁹ Thusthe biological fact of menarche and menstruation or lack thereof was, in some places, aprivate matter,such that an individual woman might exercise some control over the timing of its becomingasocial fact. Forexample, al-Mi‘yāral-mu‘rib,the famous collection of North African and Andalusian fatwāscompiled by al-Wansharīsī (d. 914/1508), includes manycases wherenoone but agirl herself is aware whether she has reached menarche.²²⁰ It also includes several cases in which ahusband is surprised to find thathis new wife is physicallyimmature,and this is particularlytrue in the caseoffatherless brides.²²¹ Sometimesthis in and of itself causesalegal problem,²²² but in other cases we hear of it onlybecause it is invokedaspart of alegal counterclaim,

Chronicle,” Mamluk Studies Review 9(2005), 111. Interestingly, in addition to experiencing food cravings, ḤasbiyaAllāh’smain form of signaling her pregnant status is by attempting and failing to complete the Ramaḍānfast.Al-Biqā‘ī notesher attempts to fast and her becoming overcome by dizziness by noon, despiteher self-care. Al-Biqā‘ī further mentions that after failingtofast during Ramaḍānfor two years in arow,the woman made up the fasts over the course of another two months,asreligiouslyrequired, and both he and she engagedinother forms of expiation for her failuretofast.Itmay be worth investigating whether prematurelybreakingthe fast was con- sideredtobeaquintessential form of intentionallyorinadvertentlyrevealingapregnancy, in the waythat avoiding alcohol in social situations or vomitingunexpectedlyisinAmerican culture.  Cf. M. H. Katz, “ScholarlyAuthority and Women’sAuthority in the Islamic LawofMenstrual Purity,” in F. Kashani-Sabetand B. Wenger,ed., Gender in Judaism and Islam: Common Lives, Un- common Heritage (New York: New York University Press, 2014), 85 – 87;93.  E.g., al-Wansharīsī, al-Mi‘yāral-mu‘rib,3:245;3:266.  Forasummary of the legal ramifications of marryingoff fatherless brides see Yazbak “Minor Marriagesand Khiyāral-Bulūgh in Ottoman Palestine,” 392–3. Forananalysisofjuristic opinions pertainingtominor marriage moregenerallysee Nū ral-Dīn ‘AbdAllāhibn Ḥ umayyid al-Sā limī, Īḍ āḥ al-bayānfīnikāḥ al-ṣibyān: aḥkāmtazwījal-ṣighār (Beirut: al-Dāral-ʻArabiyya lil- ʻUlū m, 2006).  E.g. IbnRushd, Fatāwā, 294.al-Marwarrū dhī, Fatāwā, 323, 335. al-Nawawī, Rawḍat al- ṭālibīn, 246. 86 2Menstruation, Amenorrhea, and Legal Recognition of Reproductive Status rather than because it is at the heart of alegal dispute. Forexample, afatherless girl with aseemingly unscrupulous uncle is married off “when she was not even close to maturity” and dies in thatstate.²²³ Herrelativessue for her estate on the grounds of her minority,and her husband sues on the grounds that he thought she was mature. Sometimes the bride herself seems to be pretending to be more physicallymature than she is, and at other timesthe husband disputes with the bride’sfamilyand claims that she is in fact mature enough to enduresexual relations, while they claim that she is not.²²⁴ We even have acaseinwhich both occur:afatherless girl being raised by her kin is married off and then, at the point of consummation, she tells her husband that she has not reached puberty (bulūgh), and he divorces her on the spot.Helaterregrets his decision because she is in dire need, but he is told she cannot remarry until she can provepuberty. Then the girl announces that she has reached pubertyand officiallyproves to some unspecified powers-that-be that she shows breast-budding,which is a sign of maturity. The couple then remarry but at around the time of consummation she begins to “hate” her husband, and then tells him that she has not,in fact,reached puberty and flees. He denies her claim of immaturity.Both sides then each bringanexpert woman (bayyina), who offer competing expert opinions about whether the girl shows signs of breast-budding.²²⁵ All this suggests that these physical characteristics wereoftennot amatter of public knowledge until such time as alegal dispute arose and progressed to the point whereexpert witnesses wererequired, and that even at this point physical characteristics were subjecttointerpretation and manipulation. It should be noted here thatnumerous fatwāsinal-Wansharīsī’s al-Mi‘yāral- mu‘rib indicate that while afather could marry off avirgin daughter who had not yetreached menarche, the jurists and Maghribi/Andalusi society in general were scrupulous about waiting to marry off afatherless girl until she either reached menarche or displayedsome other sign of pubescence. (Some Mālikī sources specificallylist not menarche, but rather being physicallytall enough to birth achild, as the minimum developmental requirement for avirgin orphan girl to marry.²²⁶) Fatwāsfurther demonstrate that at times these measures protected girls from exploitation and sexual trauma and, as we have seen, at othertimes orphan girls deliberately tried to circumvent these measuresand pretend to be older in order to marry and thereby save themselvesfrom deprivation.

 al-Wansharīsī, al-Mi‘yāral-mu‘rib,3:96 – 7.  Ibid., 3:8 – 9.  Ibid., 3:48–9.  IbnAbīZayd al-Qayrawānī, Kitābal-nawādir wa’l-ziyādāt (Beirut: Dāral-Gharb al-Islāmī, 1999), 4:398. Women’stestimony,privacy,and expertise 87

Avariation on this theme of strategic manipulation of menarchal status is alluded to in a9th/15th-century slave-buyingguide by an Egyptian Ḥanafī jurist. Obviously, the book is written with the interests of amale slaveowner in mind, and thus it maynot be possibletotake at face value its account of slave women’s motivations. Nonetheless it is worth noting the book’sclaim thatafemale slave might engageinstrategic misrepresentation of her menstrual statusfor legal purposes. “If aslave girl declares that she is not mature, do not trust her statement in this regard, whether it is [a claim to be] younger or older.For aslave girlmight have entered puberty while subject to a[previous male owner] but has concealed it duetoher desire for achild, so thatshe might be freed from the bondageof slavery.Manyslave girls pretend to be infertile to deceive their owners.Therefore, whoever wishes to sell aslave girl should displayher for sale onlywhile she is menstruating.”²²⁷ The implication here seems to be that aslave woman might se- cretlyhope to conceive,because aslave who is impregnated by her owner is entitled to certain privileges. Accordingtomost jurists such awoman, known as an umm al-walad (motherofachild), can never be sold away from her young child. The child is the property of her owner/the child’sfather and, if the enslaved mother is sold to adifferent owner,the sale is nullified according to most legal authorities. Moreover,there developed earlyoninSunnī legal history aconsensus that,upon the death of the owner,both mother and child would go free and the child would inherit from the father.For this reason, the author of the slave-manualsuggests that aslave woman might resort to trickery to become an umm al-walad. The woman might pretend she is tooyoung to getpregnant so as to “entrap” her new owner into impregnatingher and to thereby improve her legal status. The slaveownerwould have sexual relations with her thinking that he does not risk begetting achild because his slave is either too immature or is otherwise infertile.Orshe could trick someone in the slave market,bybeing alreadypregnant but concealing her pregnancyatthe point of being re-sold, knowing that once she is sold and reveals she has been impregnated by her former owner,she is no longer legallysubject to the new owner.²²⁸ Other slave-buy-

 Maḥmūdb.Aḥmad al-ʿAyntābī, al-Qawl al-sadīdfīikhtiyāral-imā’ wa’l-ābīd (Beirut: Mu’assasat al-Risāla, 1996), 38.  The laws governingthe positionand rights of the umm al-walad, the slave who had birthed her master’schild, weresubject to agreat deal of dispute, particularlyinthe earlier periods of Islamic legal development.See Mirza, “Remembering the Umm al-Walad.” See also G. Lydon, and B. Hall, “ExcavatingArabic Sourcesfor the History of Slavery in Western Africa,” in African Voices on Slavery and the Slave Trade,ed. A. Bellagamba et.al., (Cambridge:Cambridge Univer- sity Press, 2016), 24.See also, S. Marmon, “Domestic Slavery in the Mamluk Empire: aPrelimi- 88 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status ing manuals, one from 5th/11th-century Iraq and another from 6th/12th-century Spainalso mention misrepresentations of menstrual status, but emphasize the slave-dealers’ role in promotingtrickery,rather than attributing it to the enslaved women’sown designs.²²⁹ Menstruation or lack thereof in the wake of adivorceordeath also seems to have been alargely individual matter in manycommunities,such that the woman held the discretionary power to choose when to make others in her community aware of the end of her ‘idda.²³⁰ We have seen an example of this phenomenon in the case of the woman whose husband divorced her afterrealizing that she had not menstruated thrice after her previous divorce. All those involved besides the woman herself wereunaware of how manytimes she had menstruated, though they suspected thatthere was aproblem. Judith Tucker comes to a similar conclusion in her analysis of menstrual status in 17th-century Damascus. She mentions acase thatcame before a Ḥanafī judge in which awife claimed to have menstruatedthreetimesbefore enteringher second marriage, while her second husband accused her of lying.The judge affirmedthat her oath in this matter is accepted and the marriageisvalid. Tucker writes: “Awoman wasem- powered, within the limits of the feasible, to define her own waiting period, and it was her word, not that of her husband or others, that determined whenthe waiting period ended. Awoman who was known to have irregular menstrual periods, for example, could also testify to the completion of threemenstrual cycles, and her testimonywould be accepted, so long as areasonable period of time had passed.”²³¹ The writingsbyIbn Rushd about whether to believeclaims about the presenceofasleeping fetus alsoindicate that,atleast for the first few months, a woman’swordwas believed without anyexternal check. Midwivesand similar experts do appear to have arole in this system, but it seems that their presencewas not always thought desirable or welcome in the initial stages of adispute. Such attitudes are particularlyprominent among jurist

nary Sketch,” in Slavery in the Islamic Middle East, ed. S. Marmon (Princeton, Markus Wiener Pub, 1999), 1–24.  IbnBuṭlān, Risāla fī shirā al-raqīqwa-taqlībal-ʻabīd,inNawādir al-makhṭūtāt editedby ʻAbdal-SalāmHārū ninNawādir al-makhṭūtāt 4(Cairo: Lajnat al-taʼlīfwa’l-tarjama wa’l-nashr, 1954),383. And al-Saqatī, Fī adābal-ḥisba = Un manuel hispaniquedeHisba (Paris:Leroux, 1931), 52.  The means by which such public signaling occurs seems to varyconsiderably.Aninterest- ing example of such signaling throughthe performance of aceremonial bath can be found in a 20th-century fatwā from Timbuktu. See M. Mathee, “Women’sAgencyinMuslim Marriage: FatwāsfromTimbuktu,” Journal for Islamic Studies 31 (2011), 91.  J. Tucker, In the Houseofthe Law:Gender and Islamic Law in Ottoman Syria and Palestine (Berkeley:University of CaliforniaPress, 2003), 170. Women’stestimony,privacy,and expertise 89 in North Africa and Spain. There is mention of midwivesbeing summonedto confirm the presenceofgenital defects and injuries to the genitals, as well as female claims of male impotence,but this was not uncontroversial. Particularlyin the Mālikī school, modesty concerns complicated the assertion of sexual defects. The Mālikī school is unusual in thatatleast some jurists thought that proving the existence of awife’ssexual defects by means of direct examination might cause more harmthan benefit to the husband.²³² Forexample, al-Wanshārīsī quotes aquestion posed to the Cordovan judge IbnDhakwān(d. 451/1059) about aman who accuses his wife of suffering from the defect known as ratq. The judge consults with the Cordovan muftī Ibn ‘Attāb(d. 462/1069) who responds that,inaccordancewith the legal opinion advanced by Saḥnūn (d. 240/854), the woman should be examined by other women. However,he notes thathis fellow Cordovan muftī Ibnal-Qaṭṭān(d. 460/1068) rules that other women should not be examining her,onmodesty grounds.²³³ This is consistent with Mālikī views of modesty regulationsinother contexts too, which se- verelylimit the ability of anyone apart from the spouse to legallyexamine a woman’svagina. (Oddly,however,Mālik is said to have called for arather public test of male impotence,which would preservethe man’smodesty but not that of his sexual partner.Inthis case, the man’spenis is daubed with saffron and he is secluded with his partner. Then twowomen examine her vagina for traces of the saffron.²³⁴) In addition to concerns about modesty,there wereother objectionstothe testimonies of expert women. Some jurists expressed reservations not with ex- aminationper se, but rather in regards to investing midwiveswith too manysi- multaneous roles.For example, as Ron Shaham has explored in his book on expert witnesses, IbnSahl (d. 486/1093), aCordovan jurist and judge,objected to midwivesbeing responsible for examining sold slave women, looking for defects that might annul the sale. He objected on the grounds that such apractice effec- tivelymade the midwife “awitness,aphysician, and ajurisconsult (muftiyyah)at

 al-Qarāfī, al-Dhakhīra,4:422.  al-Wansharīsī, al-Mi‘yāral-mu‘rib, 3:132. The oppositeattitude is displayedinal-Mi‘yāral- mu‘rib,3:139.Delfina Serrano mentions that while female slaveswho were victims of rape might be examined by midwives, “thereisadisagreement in the case of the free woman: Ibn al-Mawwaz and IbnHabibtransmitted from Mālik that the woman, regardless of her status, must be examined by agroup of women in order to determine if she has been deflowered. Ac- cording to Ashhab, the free woman is not subject to this exam.” D. Serrano, “Legal Practiceinan Andalusī-Maghribī Sourcefromthe Twelfth Century CE: The Madhāhib al-ḥukkāmfīnawāzil al- aḥkām,” Islamic Law and Society 7(2000), 201.  Al-Qayrawānī, al-Nawādir wa’l-ziyādāt,538. 90 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status the same time.”²³⁵ When it came to issues of paternity,there was ageneral reluctance to accept femaletestimonythat could not be corroboratedbyaman, on the grounds thatwomen’stestimonywas insufficient in most criminalcases.²³⁶ On occasion we hear of midwivestestifying that adivorcée or widow is pregnant but who are then shown to be lying or mistaken.²³⁷ Hereissuch acase from North Africa:

Sīdī ‘Abdallāhal-‘Abdūsī [d. 849/1445inthe region of Fez] was asked aboutawoman whose husband had died, and she said she was pregnant.Some midwivesknowledgeable about such matters probed her womb and said it was indeed inhabited. She remained like that for longer than the period of the ‘idda,i.e.the ‘idda of the widow.²³⁸ Later she wanted to marry [again] and her case was broughttothe qāḍī al-Haṣan. She said that her womb showed no indication of that which she had previouslydeclared, and that she had menstruated twice in one month. The qāḍī orderedthe knowledgeable midwivestoprobe her womb and they said, “To us,nothingwhich we previouslysaw appears to be in her womb now.” Then the qāḍī ordereditbetestified to, and [some males] testified to what the woman and the midwiveshad said. She then married, consummated the marriage,and remained with her husband for about six months.Then she said, “Iappear to be pregnant and it is from my deceased husband.” Herhusband hit her and divorced her via khul‘,and she remained so for about one month. Then the husband took her back, and she remained another eleven months and then gave birth. She said, “he is the offspringofmyfirst husband.” It was said to her, “did younot then marry while youwere pregnant?” She said, “Ifeared for myself and for my money,whenthe Arab whoaskedmetomarry him, because it is their custom to marry awoman to gether money.” Then some of the people said to her husband: “Make her swear that the child is that of the first (husband) and leave her and her child, even if it is your son.” So he made her swear and divorced her via khul‘ and reconciled(?) with the

 Shaham, TheExpert Witness in Islamic Courts, 96.  Giladi, Muslim Midwives: TheCraft of Birthing in the Premodern Middle East,113–132. In a Jewish istiftā’ fromeleventh-century Iraq addressed to Hayy Gaon, ahusband beingsued for di- vorcevoices his disdain for midwivesthis way: “What does our master, the Head of the Yeshiva, sayinthe matter of aman whomarried avirgin and livedwith her for about twoyears,and afterwards she broughthim to court sayingthat he is impotent.She claims that she is still avirgin, while he says, ‘Ipenetratedher and defloweredher [lit: Ibroughtout the blood of virginity] at the time of the wedding.’ She denies it and says, “Bringwomen whoare midwivestometocheck me, and they shall find that Iamavirgin.’ He says, ‘She hates me and has set her sights on another man. Idonot consider the wordsofmidwives, and they cannot be trusted to the extent that they would make me lose, such that Iwould have to payout the ketubah. Forthis is like witnessing, and women areunfit for witnessing.’” My translation of the medieval Hebrew translation of an onlypartiallyextant Judeo-Arabic original. Hebrew in Otsar ha-ge’onim ed. B. Lewin (Jerusalem: Hebrew University,1928), 7:148. Discussion and Arabic fragment in M. Friedman, Ribui nashim be-Yisrael =JewishPolygynyinthe Middle Ages JewishPolygyny in the Middle Ages (Jerusalem:Mossad Bialik, 1986), 169ff.  Shaham, TheExpert Witness in Islamic Courts,88.  Four months and tendays. Women’stestimony,privacy,and expertise 91

child. Afterthis some of the people said to him, “the child is yours,notwithstanding the woman’svow.” So now he seeks his son, but the relativesofthe dead [first husband] are preventinghim, saying “he is the son of our dead brother.” Clarify for us to whom the son belongs.²³⁹

This case hints at several complicatingfactors which, withoutmore detail, we cannot entirelyconfirm. Yetcertain elements are clear: soon after becomingwid- owed, the widow decided that it was in her interest to be considered bound via pregnancytoher deceased husband. But then, at some laterdate (at least four and one-half months into her widowhood) she decided to marry again, at which point she no longer claimedtobepregnant.Six months into the second marriage, which was at least 11 months after the death of the first husband, the wife announced that she was gestating the first husband’schild. This led to a khul‘ divorce, resulting in amonth-longseparation, followed by areconciliation. This pregnancyclaim was not soon followed by the actual birth of achild. Rather,achild was finallyborn 11 months afterthe reconciliation, and thus at least 22 months (if not much later)after the death of the first husband. Through- out this saga, the midwives’ testimonies confirmed the wife’sown claims about the matter.And, throughout most of this timespan, the woman clearly wished to be perceivedaspregnant,though it took her quite some time to actuallybirth a child. Herreasons for wanting to be perceivedaspregnant were, ironically, to avoid the entanglementsofanew marriage. Initiallyshe dissuaded suitors by claiming to be pregnant by her deceased husband, but then decided she had best remarry.Ifher statement about fearing for own safety is to be believed, she remarried because she thoughtitwould protect her from the advances of other suitors whom she perceivedasbeing athreat.Yet she clearlyhad mixed feelingsabout her second marriage, persuading her husband to divorceher, twice, by claiming to be pregnant with another man’schild. Herethe impetus for claiming to be pregnant and extendingher ‘idda seems to be primarily that it gave her the spacetobepracticallyindependent,byvirtue of tying her to adead husband rather than aliving one. This complex relationship between biological realities,legal definitionsof biological phenomena, and marriageand divorcepractices, meantthat cultural practices influenced expectations of fertility, and thatwomen could reframe their biological state to gain legal advantage.Sometimeslegal and cultural factors created an expectation of fertility,evenwhen biologypointed towardlikelysub- fecundity or infertility.Such was the case when women experienced earlyfirst marriages, or when they experienceddivorcesomewhat earlyorlate in life.

 al-Wansharīsī, al-Mi‘yāral-Mu‘rib,4:54– 5. 92 2Menstruation, Amenorrhea, and LegalRecognition of Reproductive Status

When the distinctions in the legal system weredifficult to applytothese nuanced biological realities experiencedbysubfertile and infertile women, it could be asourceofconfusion and frustration. On the other hand,the legal system and the community oftenplaced agreat deal of trust in women, such that they had the opportunityand flexibilitytorepresent their reproductive status in ways that enhanced theirlegal position. 3Islamic Law and the ProspectsofWomen Presumed to be Infertile

Marital prospects

On occasion, legal works provide us some insight into the marital prospects of women who had acquiredareputation for being infertile.For example, in his commentary on Tuḥfatal-muhtājfīsharḥ al-minhāj the 19th-century Shāfi‘ī scholar al-Shirwānī,reflects on the comparisons and contrasts between atheoretical post-menopausal woman and atheoretical sterile woman “whom aman who alreadyhad offspring decided to marry.”²⁴⁰ While al-Shirwānī is alate scholar, the familydynamic he alludes to is probablynot limited to his time and place. The infertile woman seems to be someonewho has experiencedprevious marriages, but who is nonetheless able to attract aproposal from aman who is content with her infertility because he alreadyhas offspring.Inthe household of aman who alreadyhas as manychildren or heirs as he desires,and who does not wish to have more, it makes sense that an infertile wife might well find asuitable home. However,al-Shirwānī goes on to saywhile at first it mayseem that an infertile woman is “like amenopausal woman, since she does not conceive,for pregnancyisnotapossibility for her,ordinarily” he then argues the contrary, saying that an infertile woman’scase is different “since thereisapossibility that she mayyet become pregnant and her lack of pregnancyduringher previous marriages was due to acause other than infertility.” He opts for the latter interpretation, saying that since one can never be sure thatshe reallyisinfertile, she cannot be comparedtoamenopausal woman. There always remains ahope or fear thatabarrenwoman mayyet provefertile. This description of the possibilities and uncertainties surroundingaseem- ingly infertile woman on her second marriage bears quite astrongresemblance to the depiction of achildless widow contemplating her future in Women of Deh Koh,Erika Friedl’sfictionalized anthropological account of life in arural village in Iran in the 1970sand early1980s. There she describes amiddle-aged childless widow weighing the possibility of remarriage.

She had been around along time, yetshe was not old. Therewereseveral middle-agedwid- owers in the village, acoupleofthem even eligible relatives. But perceptive as she was,she appreciatedtheir problems very well. Foraman whostill wanted children she was abad

 al-Shirwānī, Tuḥfatal-muhtājfīsharḥ al-minhājwa-ḥawāshī al-Shirwānī wa’l-‘Ibādī (Cairo: Maktaba al-tijāriyyaal-kubra bi-Miṣr, 1983), 8:78.

risk, even if therewas atacit understandingthat her barrenness probably had been dueto [her latehusband]’sinadequacyand not hers. Foraman with grown sons,onthe other hand, she was not old enough;there was still just achanceshe might have children, which would obviouslynot be in the interest of the older children. Against the opposition of his sons,anolder man had little chancetotake ayoungish wife.²⁴¹

As described by Friedl, infertile women could potentiallybedesirable as spouses, since some husbands would not want more children than they alreadyhad from aprevious marriage.However,asboth Friedl’saccount and statements such as the one by al-Shirwānī attest,infertility wassomething thatpeople believed could not be determined with certainty.(This, despite the fact thatmedical literaturefrequentlydescribes tests to diagnose fertilityand infertility.) In modernethnographic literature,inaddition to unmarriageability,another,much-feared consequence of infertility is polygyny. Conversely, apologists for polygynypoint out that the institution protects infertile women from the prospect of divorce, and that it is asignificant argument in favorofpolygyny.²⁴² How then was polygynyasaconsequenceofinfertility viewed in the medieval world? The idea thatpolygamymay protect infertile women can be found in ḥadīth literature. A ḥadīth tells the story of asixty-year-old convert to Islam,Nawfal b. Mu‘āwiya, who had five wivespriortohis conversion. Once he joins the Prophet, he learns that Islam limits him to onlyfour wives, and he must divorceone. The woman whom he is forced to abandon is his elderly, barren wife. Here, the lim- itation placed on polygamy(onlyfour wives) proves negative for the barren woman, whereas she was betteroff duringthe eraofmoreexpansivepolygamy. Commentaries on Q. 4:128alsopoint to the notion that polygamyisgood for barren wives. The Qur’ānic verse reads in part, “If awoman fears contempt on the part of her husband, or abandonment,itisnosin to them if they come to terms of agreement between them, for agreement is best.” The verse was understood as referringtothe practice of allowing awife to cede to her co-wife the marital rights originallyallotted to herself so as to avoid being divorced. The Prophet’s wife Sawda, who ceded her conjugal rights to ‘Ā’isha to avoid divorce, is often cited in Qur’ānic commentaries as an example of this sort of trade off. Al- Ṭabarī (d. 310/923), in commentingonthis verse, givesother examples of

 Friedl, Women of Deh Koh,32.  Foradiscussionofthe modern defenses of the institutionofpolygamy, see S. Rank, “Po- lygamyand Religious Polemics in the LateOttoman Empire: Fatma Âliye and Mahmud Es’ad’s Ta’addüd-i Zevcât’aZeyl” Cihannüma: Tarih ve CoğrafyaAraştırmaları Dergisi 1/2(Dec. 2015), 61– 79. Maritalprospects 95 women who might find themselvesmaking this calculation. He writes, “If a woman has grown old, or does not give birth, and the husband wantsto marry someone else, he can come to her and say, ‘Iwant to marry awoman who is younger than you, so that she maybirth children for me, and Iwill award her days and maintenance,’ then, if she is satisfiedwith that,hewill not divorceher ...”Thus, in al-Ṭabarī’sview,aninfertile woman might find herself making the choice to either accept divorceortoaccept apolygamous mar- riageinwhich the sexual rights due to her are ceded to another wife. Herepolygamyisexplicitlyassociated with inequality,and the infertile wife who consents to it does so for fear of the alternative.Divorce, in this case, seems to be viewed as aworse prospect thanpolygamy. However,marriagecontracts often suggest the opposite and indicate that in general awoman would prefer to be divorced thantobeinapolygamous marriage. There is an abundance of medievalmarriagecontracts stipulating that aman who engages in polygamy maybecompelled to divorcehis first wife, which implies thatmanypeople considered divorcetobeabetter prospect than sharing ahusband.²⁴³ Other marriage contracts suggest amore flexible attitude towardpolygamy. Forexample, acom- monlydiscussed stipulation in amarriagecontractwas that the first wife, rather than be automaticallydivorced in the event of asecond marriage,instead be giventhe power to divorcethe second wife on her husband’sbehalf.²⁴⁴ (Such marriageconditions are usually rejected by the jurists, except by the Ḥanba- līs.²⁴⁵)Thesesorts of conditionsraise the question of whether infertility was a factor thatchanged the normalcalculus and, if so, how.Among the three prospects of divorce, monogamous childlessness,and polygamy, which represented the worst casescenario for barren women and which the best?Tothe extent that women’sfamilies werewary of polygamy, and all evidence from marriage contracts indicates thatmanywere, what was it about polygamythat they object-

 E.g. A. Sonbol, “AHistory of Marriage Contracts in Egypt.” In TheIslamic Marriage Con- tract,ed. Frank Vogeland Asifa Quraishi (Cambridge:HarvardUniversity Press,2009), 102–5. See also, Ali, “Marriage in Classical Islamic Jurisprudence,” 25 and 44n263 – 4and Rapoport, Marriage, Money,and Divorce,69, 74.Aversion of this clause is mentioned and permitted by Ibn Ḥanbal in the Masā’il ibn Ḥanbal of Isḥāqb.Manṣūral-Kawsaj.Ibn Ḥanbal, Masāʼil al- ImāmAḥmad ibn Ḥ anbal wa-Isḥ āqibn Rāhwayh), 4:1682.  This is sometimes known as the “Qayrawānclause,” though it was morewidespread than the name implies. See Dalenda Largue` che,Monogamie en Islam :l’exception kairouanaise (Man- ouba: Centredepublication universitaire, 2011). E.g. Ibnal-‘Aṭṭār, Kitābal-Wathāʼiq wa’l-sijillāt =Formulario notarial Hispano-Arabe (Madrid: Majma‘ al-Muwaththiqīnal-Majrīṭī,1983), 7. See also, A. Sonbol, “AHistory of Marriage Contracts in Egypt.”  Kashshāfal-qinā 5:134.4:1682. 96 3Islamic Law and the Prospects of Women PresumedtobeInfertile ed to?What did barren women in polygamous marriages fear most,and what would make the prospect of polygamymore palatable? Jewishdocuments from the Cairo Geniza, as well as some rabbinic legal responsa from the Geonim of Iraq, suggest some intriguing answers to the question of the circumstances under which an infertile woman facing the prospect of either divorceofpolygamymight prefer one or the other.Jewishrabbinic family lawasitwas practiced in the medieval Middle East,inboth its Palestinian and Babylonian forms, had manyparallels with Islamic family law. Minormar- riagewas permitted, as was divorce. As was true among Muslims, among Jews divorcewas accompanied by the payment of the delayedportion of the dower and with adivorce gift.Jews of the Middle East,like their Muslim counterparts, often wrote “monogamyclauses”²⁴⁶ into their marriagecontracts stipulating that aman cannot take asecond wife or maidservant without his wife’spermission – the violationofwhich would triggerthe wife’sright to forceadivorce.²⁴⁷ One of the differences between Jewishlaw and Islamic law, however,was thatdivorce was more often discouraged and more cumbersome to effect,²⁴⁸ and polygamy was more strongly discouraged among Jews in much of the Arab world.²⁴⁹ Anoth-

 In an unusual example of such aclause from the 11th century,inamarriage agreement in which one of the parties is aman whocomes fromRamle in Palestine (where Jewish polygamy seems to have been almost entirelyabsent),itseems to saythat the husband promises to live monogamouslyorelse to payafine, except if the wife does not become pregnant.Unfortunately, the documentisbadlypreserved at preciselythis spot.Friedman, Ribui nashim be-Yisrael 56.The designation for this CairoGeniza documentisENA NS 18.27.  Forexamples see, Friedman, Ribui Nashim be-Yisrael 63 – 65, 71– 73.For an example of a divorcesettlement which actuallycitesthis clause as the reason for the divorce, see pp.74 – 78.The settlement’slack of mention of childrenimplies that the marriage is childless. Forexamplesofmarriage contracts in which the violationofmonogamyresults in the imposi- tion of afine, rather than adivorce, see ibid. 67– 71,73–4.  This is not to suggest that divorcewas rarelypracticedrather,asGoitein shows, “[i]n the Geniza world, divorcewas disapprovedbut abundantlypracticed.” Goitein, Mediterranean Soci- ety,3:260.However,unlikeIslamic divorces, which in theory could comeinto effect through speech, even by an ill-considered slip of the tongue, Jewish divorces did not comeinto effect except through the delivery of acourt-drawn-up document.  Ibid., 147– 8, 150.AmongJewish communities in the Islamic world attitudes towardpolyg- amyseem to have varied somewhat,with the Jews of Palestine seeminglynot practicingpolyg- amyatall in either the Islamic era or in lateantiquity,while the Jews of both Christian and Mus- lim Spain seem to have practiced it until relatively late. In the documents and literary works from the Cairo Geniza, there aremanyanti-polygamyclauses, suggestingthat polygamywas a practical concern for Egyptian Jewish women. Polygamy amongthe Jews of Iraq in lateantiquity and the earlyIslamic eraseems to have been associated with travel, and bears some resem- blancetothe Shī‘ite institution of mut‘a (temporary marriage). In Spain and particularlyin Egypt,polygamyseems to have been strongly associated with travelaswell, with different Maritalprospects 97 er differencewas that rabbinic lawstronglyencouraged, or even compelled, couples who had not producedchildren in the first ten years of marriagetodi- vorce.²⁵⁰ Because continuingchildless marriages, divorce, and polygamywere all actively discouraged among Jews, some questions addressed to rabbinic authorities about divorceand polygamydescribeindetail the emotional, economic, and legal trade-offs thatchildlessJewishcouples had to negotiate. These same trade-offs might very well also have applied to the petitioners’ Muslim counterparts. Several documents from the Cairo Geniza are quite detailed in their descriptions of what childless women had to gain and fear from polygamous marriages. A12th-centurydocument depicts acouple drawing up anew ketubba (marriage contract) to govern their marriage, after the original contractthathad governed the first yearsoftheir marriagewas lost.The new document reflects achangein their circumstances.The husband’sperspective is described thus: “Iask to marry awoman in addition to her,for Ihavenot had anyoffspringfrom her.Iwish to see offspring in front of me, as is obligated upon us by Moses our Teacher, by being fruitful and multiplying,and in order that there be aremembrance of me, and my name and the name of my fathers willnot be cut off.” The woman agrees to her husband marryingasecond wife if the following conditions are observed:

I[the husband] agreed, and promised to follow all the conditions she chose, namely: Iwill takenothingout of her apartment which is currentlyinit, including furniture and dishes ...

wiveslivingindifferent regions of the world, rather than with the simultaneous maintenanceof two households in close proximity.See Friedman, Ribui nashim be-Yisrael,88–92;205–240.Po- lygamywas also highlyassociated with spousal abandonment in the course of travel, to such an extent that Maimonidesissued aban prohibitingany local Jewish woman frommarryingafor- eign Jewunless he could provethat he was single, and simultaneouslymandatingthat anyfor- eign Jewish man whohad married locallyand planned to travel abroad againwas to deposit a divorcedocument to be deliveredifhedid not return within apredetermined time of one, two,or threeyears.Maimonides, Teshuvot ha-Rambam (Jerusalem: Mikitse Nirdamim, 1960), 624=#347.  Initiallythis rule also extended to allegations of male impotence, but by the 16th century therewere anumber of Jewish authorities of Spanish descent livinginEgypt,Palestine,and Is- tanbul writinginfavor of compellingdivorces in cases of alleged impotenceafter substantially shorter periods of time. R. Weinstein, “Impotenceand the Preservation of the Familyinthe Jew- ish Community of Italyinthe EarlyModern Period” (Hebrew) in Sexuality and the Family in His- tory = Eros, erusin, ve-isurim: miniyut u-mishpaḥah ba-historiyah,ed. I. Bartal and I. Gafni (Jer- usalem: Merkaz Zalman Shazar le-toldot Yisrael, 1998), 163. Cf. Babylonian Talmud, Yevamot 64b, which suggests that twoand ahalf years is amoreappropriatelength of time to see if a marriage can yield children. 98 3Islamic Law and the Prospects of Women Presumed to be Infertile

No curse will ever be placed on her,neither alight curse nor agrave one, not even an oath, and not by means of magic. And that in everythingIspend on [the two wives] and in everythingthat Iamtobuy to maintain them, Iwill not give preference to one over the other in anyofthese regards. But if thereis[document torn] and she asks to be divorced, then Iwill be bound to pay her the 100 dinars of delayeddower and for [document torn] another 100 dinars.” ²⁵¹

The woman in this document is hedging her bet.She conditionallyagrees to her husband taking asecond wife but expressesafear that the husband might be tempted to reduce her ownmaterial standard of living.She also is fearful lest the new wife attempt to curse her or use magic against her.Elsewhereinthe document,she promises not to curse the new wife or anychildren she might have.(The potential for rivalry and cursing in such circumstances is dramatized in astory in the Thousand and OneNights,inwhich aman marries his cousin “a girl of twelve,who reached womanhood onlyafterward” who for thirty years bore no children. The man then takes amistress,who bears him ason. Thechild- less wife then spitefullycurses her rivaland the child, turning them into acow and calf to be slaughtered.²⁵²)The new document further stipulates that if the barren wife has reason to regret opening the marriagetoasecond wife, her husband willagree to divorceher and paythe remainder of her delayeddower and divorcegift. Avery similar document from al-Maḥalla, Egypt,from the year 1141,describes in minute detail an agreement between aJewish apothecary,Sa‘adya, and his wife, Na‘ama, whom it seems he threatened with divorcebefore reconcil- ing with her.

The Elder Sa‘adya said to us: Iamsick of my life and have swornabindingoath to get[re‐] married. Ihavealreadyreached an agreement with my spouse,²⁵³ my current wife Na‘ama bt.AbūNaṣr, that she will permit me to marry another woman. Ihad alreadyofferedher dower to her and to separate from her,but she did not choose this. Rather,Ibound myself to the conditions that she asked of me. They are: That Inot promotethe woman Imarry over her,rather Iwill be equitable with the two of them, with regardtosleepingarrangements,spending,and maintenance. Iwill not give preferencetothe other over her in anymatter; rather,sleeping, night by night,onregular days,Sabbaths,and holidays,will be split equallybetween the two of them. So too with regardtospendingand maintenance.

 Friedman, Ribui nashim be-Yisrael,177.  H. Haddawy, TheArabian Nights (New York: Norton, 1990) 22. One mayperhapsalso see parallels with the story of Abraham’schildless wife Sarah and her ill-treatment of Hagar/Hājar.  Lit: “with my tent.” Forthis locution see Goitein, Mediterranean Society (Berkeley:Univer- sity of CaliforniaPress,1999), 3:160 –1. Marital prospects 99

And if Iamblessed with offspringfromthe wife Ishall marry,beitmale of female – onceIdie the [son or daughter] shall not do anythingagainst my wife Na‘ama bt.AbūNaṣr, nor will anyone else be empoweredbyhim to takeher to court or to utter anykind of curse or oath against her,for Ihavealreadymade her loyaltomeand to all of my heirs after me, in her words, in her house, and in her marriage document,inregards to everything...²⁵⁴ And at anytime while Iamstill alive,havingmarried [a second wife], should my first wife become distressed by her life with me, Iwill be obligated to payher the entirety of her delayeddowerand will divorceher,and Iwill not impede her.And if Idonot payher delayeddower,the courtwill have the right to sell off the followinghousehold furnishings in order to payher the delayeddower,²⁵⁵ and Iwill payher both the remainder of her dower and her alimony, and this is the list of furnishings ...²⁵⁶

In this document the woman indicates that she tooisconcernedboth about her standard of living and about potentiallyincurring acurse from the new wife, but here the division of time and sexual rights is alsomentioned as afactor.Addi- tionally,the document anticipates the end-of-life conflicts between the childless widow and the rest of the familyand attempts to headoff apotential lawsuit between the twosides. Athird document similarly describes the reconciliation of a man and his barren wife who initiallyasked to be divorced. As part of their reconciliation he promises that his wife will be provided with adecent burial.²⁵⁷

 S. D. Goitein explains that, “in reality,this agreement [to paythe delayeddower] frequently proved to be unenforceable simplybecause the husband was unable to acquire the means for the payments guaranteed. Consequently, when the end of life approached, we find settlements made in which the amount of the latemarriage gift to be paid was reduced, sometimestohalf the original amount or even less.The reductions involved concessions of on the husband’sside, usuallythe granting to the wife the status of ‘trustworthiness,” ...protected her from being troubled by heirs and courtswith demands to renderaccount of anyproperty of her husband held by her.” Goitein, Mediterranean Society,3:251 and 254–58 describe the difficulty awidow might have in acquiringher duefromthe latehusband’sother heirs.  Friedman’s Ribui nashim be-Yisrael includes an odd example of what appears to be some sort of settlement,inwhich ahusband pays his first wife the delayeddower and transfers her trousseauentirelytoher custodyimmediatelyprior to marryingasecondwife, but the document does not explicitlysay that he is divorcing her.Perhaps this represents aprecautionary step similar to the above-describedenumeration of the property which would be transferred in the event of adivorce. The document dates from 1130.The documentisBodl MS Heb.B11, fol. 3, in Friedman, Ribui nashim be-Yisrael,80–81. Asimilar documentfromthe same decade appears on p.119 but,inthis document,itseems that the first wife had forcedher husband (also her cousin) to divorcehis second wife, but is now agreeing to allow him to remarry his divorcee, on condition that the first wife receive her delayeddower in advanceincase she has trouble collectingitlater.  Friedman, Ribui nashim be-Yisrael, 185.  Ibid, 194. 100 3Islamic Law and the Prospects of Women Presumed to be Infertile

These stipulations implythatfor some childless women agood polygamous marriagewas seen as abetter alternative thandivorce, and divorcewas abetter alternative compared to an unhappy polygamous marriage. In order to establish agood polygamous marriage, the contracts include the conditionsthat (a) the current wife not be forced to give up her current standard of living;(b) the husband treat his wivesequitablywith respect to sexual arrangementsand financial support;(c) the current wife not suffer abuse from the new wife; and (d) the current wife will be giventhe means to support herself after the husband’sdeath, with no attempts to withhold the money owed to her.One of the documents goes so far as to specify which valuables will be sold by the court in the event that the familyofthe deceased attempts to thwart the childless widow from collecting her money from the estate. Interestingly,none of these documents attempt to define arelationship between the childless wife and anypotential child producedbythe new spouse, other than to restrain hostilities between them. In no wayispolygamypresented as asurrogateform of motherhood or as potentiallyexpanding the circle of relations for the barren woman. Of course,inmanyIslamic and Jewish communities,the practice of polygamy was either limited or practicallynon-existent.²⁵⁸ Forexample, Leslie Peirce notes that polygynyisnot mentioned at all in the court documents of the Ana- tolian town of Aintab, in the earlymodernperiod, even among childless families.²⁵⁹ Presumably, remainingmonogamous in achildless marriage must have been apractical option for many, if for no other reason than the potentially highfinancial and social costs of divorce. Of course, in such cases, legal literature can offer us few insights, since there was no reason for the relationship to receive scrutinyfrom the court.The experiences of childlessspouses who re- mainedmarried to each other did not draw the law’sattention until such time as one spouse died and the other became apotential heir to the inheritance.

Childlessnessand inheritance

Up to this point,wehaveexamined the implications of infertility for those at- temptingtocontractordissolve amarriage. However,infertility was also signifi-

 Forabrief discussionofthe highcostsassociated with polygamyinearlymodern Aleppo, and the court recordswhich attest to this cost see A. Marcus, TheMiddle East on the Eve of Mod- ernity:Aleppo in the Eighteenth Century (New York: Columbia University Press, 1989), 199–200, 368. He notes,however,that infertility was consideredanexceptional circumstance, in response to which polygamywas potentiallyacceptable even amongJews.  Peirce, Morality Tales:Law and Gender in the Ottoman Court of Aintab,150. Childlessness and inheritance 101 cant after the death of one of the spouses, since childlessness had asubstantial impact on the rules of inheritance. Furthermore, the prospect of future inheritance had the potential to influencefamilydynamics while both spouses were still living.Women’schildlessness had consequences in three different inheritance situations: (a) When amarried,childless woman died, leaving behind aliving husband and her natal familyasheirs. (If her parents have also died,then the inheritance distribution takesonadded complications.²⁶⁰) (b)When amarried, childless woman was widowed, thereby inheriting aportion of her husband’slegacywithout the legal possibility of her share return- ingback to her husband’sbloodline.The legacywould thus be transferred from her husband’sbloodline to that of her own birth family. (c) When achildless woman wasdue to inherit or to collect from the estate of a relative by birth but had no husband or son to represent her interests during the legal proceedings.

The ability of women to take holdofproperty in their lifetimes, and their ability to pass on property to theirown heirs upon their deaths, were intimatelycon- nected. Medieval Islamic lawinnoway distinguished between infertile and fertile women regardingtheir rights to inherit,benefit from, and manage their own property.But it did distinguish between women who had children and thosewho werechildless when it came to theirrights to pass along property to their heirs. The resultwas that achildless woman, who passed away before her husband, effectively handed over to her husband’sfamily half of the property givento her by her natal family,with no chance of it going to her natal family’sdescend- ants. Achildless woman who survivedher husband handed over up to aquarter of her husband’sproperty to her own natal family. This created potential incen- tivestopostpone or impedechildless women from gainingaccess to property duringtheir lifetimes.

Death of the childlesswife

In Sunnī legal theory,when achildless woman dies leaving onlyahusband and members of her birth familyasheirs, the husband receivesfifty percent of her

 The situation of aperson whodies without livingancestors or descendants to inherit from them is known as kalāla,acomplicated topicthat is beyond the scopeofthis book. 102 3Islamic Law and the Prospects of Women Presumed to be Infertile estate.²⁶¹ In those societies in which awoman’sestate might include asubstantial bridal trousseauaswell as other property,this could represent asignificant financial loss for her birth family. One wayofmitigatingfears of this sort of situation was to marry awoman to her paternal cousin who, for inheritance purposes, was alsoamember of her natal family.²⁶² Another waywas to either pass off the woman’spossessions (whichshe had receivedfrom her birth family) as life-time gifts which, upon her death, would revert back to her birth family, or to call into question the woman’smarriageitself. Such scenarios are mentioned in some istiftāsaddressed to IbnTaymiyya.

He was askedabout amaturewoman whodied, leavingafather,amother,and ahusband, and whose father then took possession of her trousseau, leavingnothingtoher heirs ... He was askedabout awoman whodied, leavingahusband and her two parents,and whose father then took hold of her possessions, sayingthat she was aminor.Does her husband inherit from her?²⁶³

Yossef Rapoport has analyzed Mamluk-era attemptsbysome women’sfamilies to take back the trousseaufollowing her death if she produced no children.²⁶⁴ Such families would either add clauses to the marriagecontractwhich would finalize the transfer of the trousseaufrom parents to daughter onlyonce she gave birth, or they would engageinlegal proceedingstodefine her trousseauasatempo- rary gift.²⁶⁵ Maya Shatzmiller notes that there was apractice in Muslim Spain

 Based on Qur’ān4:12.  “The structural means to prevent property passingout of the familyisthe marriageofpa- ternal first cousins.Insuch amarriage,the husband inherits from the wife in two capacities:asa husband he is aQur’ānic heir,who, in the absenceofchildren, takesone-half of her estate(by the side of children he takesonlyone-quarter but thereisnodanger then of the property passing out of the family), and as an agnatic relative he takes the residue.” A. Layish, “The Mālikī Family “Waqf” accordingtoWills and “Waqfiyyāt,” Bulletin of the SchoolofOriental and African Studies, 46 (1983), 28.  Taqī al-DīnIbn Taymiyya, Fatāwā al-Nisā’,ed. IbrāhīmMuḥammad al-Jamal (Cairo: Makta- bat al-Qur’ān, 1987), 195,203.Referenced in Rapoport, Marriage, Money,and Divorce, 17.The translation is mine.  Rapoport, Marriage, Money,and Divorce,17.  Rapoport notesthat since,inJewish law, the bride’sfamilywould not inherit from her if she had awidower,thereexist both Karaite and Rabbanitecontracts fromMamluk Cairo which have asimilar stipulation.ShragaAbramson notesthat the stipulationthat half of the estateofa childless wife return to her birth familycan be found in the Jerusalem Talmud and was amatter of frequent debate. It was enshrined in lawinthe widelypublicizedthirteenth-century takkanah (decree) of Toledo, but apparentlyitwas slightlydifferent in its Arabic and Hebrew versions, which circulated simultaneously. Abramson, “On the Takkanah of Tuletula (Toledo) Regarding the Husband’sInheritance of his Wife’sEstate,” Zion 60 (1995), 201–224. Foranexample of this Childlessnessand inheritance 103 of fathersmaintaining ownership over property ostensiblygiven to their daughters until one to seven years into the marriage.²⁶⁶ Al-Wansharīsī’s Mi‘yār has several such cases,²⁶⁷ includingacase of amother and step-fathersuing their widower son-in-lawtorecover their late daughter’strousseauafter she died. The widower launches acountersuit for the weddingexpenses. It is not at all clear how much time had elapsed since the wedding.²⁶⁸ Multiple istiftāsand stipulations in marriage contracts indicate that childlessness was commonlyunderstood by parents of the bride to represent an exception which prevented the marriagefrom being fullyrealized. Parents with such views strategized to interrupt the transfer of property from the wife’s natal family to the husband and his heirs. Judith Tucker notes that in Ottoman Palestinethe jurists accepted the popular notion that the property givento women at the time of their marriagewas alife-time loan which would return to her parents if she died.²⁶⁹ It is possiblethatthe husbandsofinfertile women also viewed theirmarriages as not fullyrealized, giventhatthereare manyinstances of awidower suing his deceased wife’sfamilyfor the return of his weddingexpenses; however,itisalso possiblethat this was simplyalegal tactic rather than an expression of social values. In alater historical context,that of early-modern Ottoman Anatolia, the association between the production of children and awoman’sachievement of status as an autonomous adultand householder with property of her own, was both physicallymanifested and embeddedinlanguageitself. Leslie Peirce describes how,inthe town of Aintab, wivesdid not gettheir ownresidences until they birthed their first child:

clause in an 11th-century marriage contract found in the CairoGeniza see T.S. 13 J6.33, in Fried- man, Ribui nashim be-Yisrael,68–71.For an analysisofthe prevalenceofsuch stipulationsin marriage contracts found in the Cairo Geniza see EveKrakowski, Coming of Age in Medieval Egypt (Princeton: Princeton University Press,2018), 246–251. Judith Olszowy-Schlangerhas identified sixteen Karaite marriagecontracts which stipulatethat if awoman dies childless her possessions revert back to natal family, thus preserving their property,but the husbandis also absolvedofpayingthe delayedportion of the dower.J.Olszowy-Schlanger, Karaite Marriage Documents From the Cairo Geniza:Legal Tradition and Community Life In Mediaeval Egypt and Palestine (Leiden: Brill, 1998), 241–4.  M. Shatzmiller, “Women and PropertyRights in Al-Andalus and the Maghrib:Social Patterns and Legal Discourse,” Islamic Law and Society 2(1995), 229–30.  Al-Wansharīsī, al-Mi’yāral-Mu‘rib,3:97, 221. 9:150.Cf. 4Ibn al-‘Aṭṭār, Kitābal-Wathāʼiq wa’l- sijillāt,339.  Al-Wansharīsī, al-Mi‘yāral-Mu‘rib,3:92 and 9:127–8.  Tucker, In the House of the Law,56. 104 3Islamic Law and the Prospects of Women Presumed to be Infertile

It was generally[the gelin,new bride], not the young husband, whomade the spatial tran- sition intomarriage by movinginto the household of his parents (the term gelin derived from the verb gelmek, “to come” ...)The word emphasized that the young bride had as yetnoidentity except as an affiliatetoher husband’sfamily ...The female adult,incontrast – the avert or hatun – acquired her identity fromthe establishmentofher own household unit with the birth of children. This event was often accompanied by aphysical move into aseparate residence ...household-as-residencewas seen as afundamental constitu- ent of full adulthood. This convergenceofhousehold and the production of children reflects the widespread view of parenthood as critical in establishingfull personhood in the community.More than marriage itself, childbearingand child-rearing transformedmen and women into sociallymatureadults. There was,however,agender disparity in this signaling of adulthood, as the existenceoftwo labels for the married woman – new bride and female adult – suggests.Itwas the female member of the marital pair – the bearer of the child – whose changingstatus marked the inception of the new household. Correspondingly, it was she whoexperienced greater pressure to bear children.²⁷⁰

In those communities in which the full-fledgedacknowledgement of awoman’s marriageand her right to pass property on to her heirs was subject to the birth of children, the prospect of childlessness had the potential to shape her familial life duringher lifetime. Rapoport notes that parental attemptstostall the transfer of property sometimes meant that the younger generation had to taketheir parents to court.Hewrites, regardingthe Mamluk period, “The vast majorityofdisputes over dowrieswereintergenerational rather thanconjugal. In the legal literature the question is almostnever usurpation of the dowry by the husband, but rather the parents’ attempt to revoke the gift.”²⁷¹ Mathieu Tiller mentionsasimilar pat- tern in his analysis of Adab al-qāḍī written by the 3rd/9th-century Ḥanafī jurist al- Khaṣṣāf.²⁷² In thosecommunities wherethis practice of delayedorrevocable forms of dowry prevailed, such an arrangement might have compounded the frustrations of achildless marriage.When the financial benefitsaccruingfrom marriageonly legally “took hold” once amarriageproved stable as evidenced by the presence of children, lack of children would have further contributed to lack of financial autonomyand hence to marital instability.Ihavefound at least one source which uses the phrase, “the time it takes to produce two children from two pregnancies,” as aproverbial idiom for establishing that amarriageoriginallycon-

 L. Peirce, Morality Tales:Law and Gender in the Ottoman Court of Aintab,149–150.  Rapoport, Marriage, Money,and Divorce, 18.  M. Tillier, “Women beforethe Qāḍī under the Abbasids,” Islamic Law and Society 16 (2009), 282. Childlessnessand inheritance 105 tracted under questionable circumstances now has the longevity to be thought of as valid.²⁷³

Death of the husband of the childlesswoman

In amonogamous marriage, awoman with no descendants whose husband had died would theoretically receive one quarter of her husband’sproperty in addition to anydeferred dower still owed to her,accordingtoall Sunnī schools of law.²⁷⁴ (AccordingtoTwelverShī‘ites she would not inheritatall.²⁷⁵)Ifshe was part of apolygynous but childlessfamily, that quarter would be divided equallybetween all widows. Thus if there werethree wives, each would receive one twelfth of the estate. If aman died leaving one or morewidows and at least one son (e.g. from adifferent marriage), his widow(s)would receive atotal of one eighth of the estate. In all of the abovecases, the property inheritedby anychildless widow would effectivelyberemoved from her husband’sbloodline because, when she died, all of her heirs would be from her natal family. ²⁷⁶ The same cannot be said of awidow who has children with the deceased, since their mutualchildren would bring the greater part of their mothers’ portion backinto the paternal bloodline once they inherit from her.²⁷⁷

 Al-Dasūqī, Ḥāshiyyat al-Dasūqī ‘alā al-Sharḥ al-Kabīr (Beirut: Dāral-Fikr,n.d.),2:224.  Based on Q4:12.  Shī‘ī legalliterature which deals with recompense of injuries demonstrates arecognition of the financial loss associated with infertility.The Shī‘aawardawoman the full diyya in compensation if aman injures her in such away as to cause her to prematurely lose her ability to men- struatethus renderingher barren. Sunnī schools do not usuallyawardcompensation for the loss of fertility,but onlyfor damage to abodypart.Ibn Bābawayh al-Qūmmī (d. 381/992) Manlāyaḥ- ḍuruhu al-faqīh, § 5334.  Interestingly,according to Marcia Inhorn’sstudies of infertility in contemporary Egypt, those infertile womenwho were married to their cousins sometimes consideredthemselvesto be in amuch betterposition and to have happier marriagesrelative to other infertile women whoweremarried to “strangers.” M. Inhorn, Infertility and Patriarchy (Philadelphia: University of Pennsylvania Press, 1996), 130.Inhorn does not,however,mention issues of inheritancein anyofher work.  The complicated nature of the partition of the property of childless men sets the stagefor a riddle told in the fifteenth maqāma of al-Ḥarīrī (d. 516/1122):aman dies whose onlylivingheirs arehis full-brother and his widow,who herself has afull brother.Underwhatcircumstance would the widow’sbrother legallycometoinherit all of the property other than his sister’s and disinherit the deceased’sbrother?See al-Ḥarīrī and F. Steingass, TheAssemblies of al-Ḥ arīrī; Student’sedition of the Arabic text; with Englishnotes,grammatical,critical, and historical (Lon- don: Sampson Low, Marston &Co. 1897), 112. 106 3Islamic Law and the Prospects of Women PresumedtobeInfertile

The awareness of conflictinginterests between the widow and the rest of the deceased husband’srelativescould lead the husband, the wife, or the other rel- ativestoattempt to circumvent shar‘ī inheritance laws through the establishment of waqfs(endowments), death-bed divorce²⁷⁸ or,onoccasion, the discovery of a rāqid i.e. “sleeping fetus.” Somescholars arguethat waqf endowments served in some communities as ameans of disinheriting women, although that view has come under agreat deal of scholarlycriticism, and others have argued that en- dowmentstendedtosupplement rather than detract from women’sshares of inherited wealth.²⁷⁹ Sometimes a waqf seems to have been put in place to safe- guard the inheritance of existing children before anew marriagewas embarked upon. Forexample, acase in al-Wansharīsī’sal-Mi‘yāral-mu‘rib describes aman with two young children who, prior to marrying anew wife, creates an endowment for the benefit of his children. The new marriagelasts twelve years before the death of the husband and appears to be childless.²⁸⁰ In this case, the widow takes control of the endowment for several years before her step-son, at the ageoftwenty-one, is finallyabletotake control of it himself. At thatpoint,she has trouble extricating her delayeddower from her late husband’sestate due to its beingtied up in the endowment.

 If the husband weretodivorcehis wife irrevocably, just beforehis death, she would not inherit anyshareofthe estate, thereby preservingmoremoney for the husband’sother heirs. Rapoport, Marriage, Money and Divorce,87. The legality of such ameasureisamatter of dispute. There aremanyexamples of medieval istiftāswhich describe deathbed divorcebut,unfortunately,such documents rarely describe whothe husbands’ heirs arewho arecompetingwith the (ex‐)widow.For example none of the fatwāsinal-Wansharīsī’s al-Mi‘yāral-mu‘rib specify who the competingheirs are. See volume 4:87– 8. Modern fatwāswhich address the deathbed divorce of childless women do specify the competingheirs,perhaps because there arefewer of them than there would have been in pre-modern periods e.g. ‘AllāmNaṣār, “Fatwā – January 19, 1952,” in Fatāwā dāral-iftā’ al-miṣriyya (Cairo:Wizāratal-Awqāf, 1980), 5:114. The phenomenon of disinheriting childless widows through deathbeddivorceisalso mentioned by modern women’srights advocates, particularlyinPakistan. Report of the Pakistan’sWomen’sRights Commis- sion,1976quoted in “Some Facts and Figures About Women’sSituation In Pakistan,” Manushi 12 (1982):5.There,there have been some efforts to ameliorate the position of childless women by allowinghusbands to transfer property to them during their lifetimes,with the property revert- ing back to the husband (if he is alive)orhis family(if he is deceased) after the wife’sdeath. These efforts have often failed to succeed on the grounds that they aredifficulttojustify within the Islamic legal system.L. Carroll, “Life Interests and Inter-Generational Transfer of Property Avoidingthe LawofSuccession,” Islamic Law and Society 8(2001), 271.  P. Hennigan, TheBirth of aLegal Institution:The Formationofthe Waqf in Third-Century A.H. Ḥanafī Legal Discourse (Leiden: Brill, 2004), xvi.  Wansharīsī, Mi‘yāral-mu‘rib 7:261. Childlessness and inheritance 107

On occasion, particularlyinthe Mālikī madhhab,weread about heretofore childless women who have been widowed for years and are able to disrupt the inheritance system by giving birth to a rāqid who then inherits aportion of his deceased father’sestate. Al-Wansharīsī describes jurists trading increasinglyout- landish stories,such as this one:

Awoman came to us whose husband had died while her womb was occupied by achild. Then, after seven years, she brought forth the child. The aforementioned man had left other children and [this new child] inherited along with them, once they sawhis resemblanceto their father.They acknowledged him and did not denyittohim.²⁸¹

Despite its farfetched nature, the case is important in terms of demonstratingthe protracted impact of childlessness and fertilityonthe inheritance system. Occasionally, we also hear of oldage with the impending prospect of inheritance as atime for spouses to demonstrate care for each other regardless of their fertilityfailures. In the Kitābal-Umm,al-Shāfi‘ī relates the story of the daughter of Ḥafṣ ibn al-Mughīra.Her first husband ʻAbdallāhb.AbūRabī‘a, divorced her, prompting ‘Umar b. al-Khaṭṭābtomarry her.But ‘Umar found out prior to con- summating the marriagethat she was infertile and could not bear children, and so he divorced her too. She remained single for several more years, long enough for ‘Umar to die and sometime into the caliphate of ‘Uthmān. Then her first husband, ʻAbdallāh, remarried her when he fell ill so that she toocould inherit from him along with his other wives, because “there wasakinship between them.”²⁸² Herethe kinship is likelyboth emotional and biological.

Claiming inheritance against male kinwithout the benefit of sons

In addition to inheriting from her husband and children, awoman alsoinherited from her birth relatives: her parents,and sometimes her siblingsand paternal grandparents.²⁸³ Islamic inheritance law, by recognizingadaughter’sand sister’s right to inherit property from her birth family, and to keep her finances separate

 Ibid. 4:492.  Al-Shāfi‘ī, Kitābal-umm 4:108. The storyisalso told in ‘Abdal-Razzāq’s Muṣannaf,#11132.  Throughout the Islamic world, customary lawwas often at odds with the sharī‘a’sinsis- tenceonawarding women shares in inheritance. Rapoport, Marriage, Money and Divorce in Me- dieval Islamic Society, 20.See also, Annaliese Moors, “Inheritance: Contemporary Practice,” in Encyclopedia of Women in the Islamic Cultures,ed. Suad Joseph (Leiden: Brill, 2003–2007), 2:300 and Y. Tobi, “InheritanceRights of Jewish Women and Moslem Women In Yemen,” Pro- ceedings of the Seminar for Arabian Studies 24 (1994), 201–8. 108 3Islamic Law and the Prospects of Women Presumed to be Infertile from her husband’s, provided awoman with ameasure of autonomybut also placed awoman in apotentiallyawkwardposition in which her financial interests did not entirelycoincide with those of either her birth family or her husband’sfamily. The person whose financial interests most closelymirrored her own was her son. The mother of ayoung son could become the guardian of his share of his father’sinheritance, should her husband choose to appoint her to that position. It was in her interest to protect her son’sshare of the property from her husband’skin and business partners. Later,anadultson could po- tentiallybeinaposition to protect his mother’sshare of her birth-family’sproperty,since it was in his interest to do so. Awoman’smale kin from her natal familywereoftenher de factoprotec- tors²⁸⁴ and representativesinlegal proceedings,²⁸⁵ but when it came to inheritance from the estates of her birth relatives, her share competed with those of her brothers and uncles.²⁸⁶ Thus her usual representativeshad financial interests which weredirectlyopposed to her own. By contrast,inthe person of her son, she would have amale familymember who could effectively represent her because his financial interests coincided with hers, as he would inheritfrom her but would not inherit from her male relatives.²⁸⁷ Such representation, however, would not be available to achildless woman. There are at least three known ways in which women dealt with the threat of being deprivedoftheir inheritance. They could sue theirfellow heirs for their in-

 On the highstatus of the bond between brothers and sisters see Goitein, Mediterranean So- ciety,3:21– 24.For acontemporary anthropological perspective on the relationship between brothers and their widowed childless sister,see Friedl, Women of Deh Koh,26–46.  “With regardtowomen and inheritance, the evidencesuggests that women receivedtheir inheritanceshares but probablywerenot present at the division of the estate. Idonot know if it was acommon practice for husbands to represent their wivesorfor male relativestorepresent unmarriedwomen, and Idonot know if women in fact receivedtheir inheritances, although I strongly suspect that this was the case. The fatwāsindicatethat females were dependent on male relativesfor the receipt of their shares ...”M. Shatzmiller, “Women and Property Rights in Al-Andalus and the Maghrib: Social Patterns and Legal Discourse” Islamic Law and Society 2 (1995), 241.  Zarinebaf-Shahr,writingabout seventeenth-century Ottoman Istanbul, notesthat alarge percentage of women’scourt petitions wereabout inheritanceand property disputes: “Inheri- tancedisagreements occurredamongmembers of all economic strata, but mostlyamongmem- bers of the middle class,wherewomen were left dependent on male relativesfor the protection of their property rights.Zarinebaf-Shahr, “Women, Law, and Imperial JusticeinOttoman Istan- bul in the Late Seventeenth Century,” in Women, the Family,and Divorce Laws in Islamic History, ed. Amira El Azhary Sonbol (Syracuse: Syracuse University Press, 1996), 87 ff.  Ottoman-eracourt recordsshow mothers on occasion suingtheir adultsons for their one- eighth shareofthe husband’sestate. Childlessnessand inheritance 109 heritance in court,they could sue for their inheritance from people who had boughttheir expropriatedproperty from the rival heirs, or they could choose to forfeit their property.Inpractice,inappears that in some places the latter two werequite common. Forexample, in 16th-century Ottoman Anatolia, according to Leslie Peirce, alarge percentageofwomen’scourt appearances revolved around inheritance disputes.But the defendants in these cases were not women’srival heirs to the familyestate. “Women’srights,” writes Peirce, “werein- fringed by avariety of male relatives – stepfather,uncle, even father,and, most frequently, brothers.” In such cases, rather than suing theirown relatives directly, women instead suedthose to whom their relativeshad sold the share of the property which “should” have gone to the sister or daughter.Peirce writes: “Female suits ...werebroughtdirectlyagainst the current owner and not against the male relative who had sold the land.The court’sinterest was to defend the women’sclaims; it did not concern itself with prosecutingthe wrongful seller or compensatingthe loser.”²⁸⁸ Thesameprocess is described by Ronald Jennings, who examined early17th-century court records from the Anatolian city of Kayseri.²⁸⁹ The roundabout nature of such legal behavior suggests that women did not think it was in their own interest to attempt to formallysue their own male relatives. Modern anthropological research in Palestine, Jordan,Pakistan, Bangla- desh, and India suggests that, in those contemporary societies, women sometimes view forfeiting their inheritencerights (tanāzul)asagood strategyfor securing their relationship with their brothers,arelationship which bringsboth material and social benefits.²⁹⁰ Thisisparticularlytrue of childless women, as is explained in this analysis of familydynamics in an Arab villageinthe newly-formed state of Israel:

While women legallyhavethe right to inherit (The Koran, iv,13), no woman with abrother will demand her shareofthe property.Inbrief, awoman is always jurallyand emotionally connected to her father’shousehold and his patrilineage.Attimes of difficulty,quarrels,or maltreatment in her husband’shousehold, as ayoung widow or as achildless older one, she requires the security of the house of her paternal relatives.Without such protection, and without her own kin to defend her rights,awoman is easilyexploited. She will not risk in-

 L. Peirce, Morality Tales:Law and Gender in the Ottoman Court of Aintab,213.  R.C. Jennings, “Women in Early17th Century Ottoman Judicial Records:The Sharia Court of Anatolian Kayseri” Journal of the Economic and Social Historyofthe Orient 18 (1975), 67.  Widows sometime forfeit their rights to their husband’swealth as well, in order to benefit her son and to acquire his loyalty.However there is no perceivedbenefit accruingtothe widow in cases where the widow is childless.S.Sait and H. Lim, Land, law and Islam: property and human rights in the Muslim world (New York: Zed Books, 2006), 123. 110 3Islamic Law and the Prospects of Women PresumedtobeInfertile

curringthe anger of her brotherbyrequestingproperty and thereby reducinghis share. Should she do so, she would be cut off from his household.²⁹¹

In asummary of these studies of women’sforfeiture of property,Siraj Sait and Hilary Lim write:

It is an interestingexample of ‘God proposes,Man disposes’ where pragmatic or socio-cultural considerations alter the impact of Shari‘arules, even though they take effect after the Shari‘aformula is implemented. While gender rights advocatesare justifiablyconcerned over women beingforced to renouncetheir limited property rights,the reality maybefar morecomplex. It maybeachoiceoverempowerment through property or throughen- hanced familysupport.²⁹²

Based on these insights, we can see how achildless woman might have been both particularlyvulnerable and empowered by her situation. By virtueofnot having anyone whose financial interests coincided with hers, she had few natu- ralallies when it came to matters of inheritance. Unlikewomen who had children, however,childless women could relinquishtheir share to their brothers, and thereby seek to win from them the support which they would have received from their children.

 H. Rosenfeld, “Processes of Structural Change within the Arab Village Extended Family,” American Anthropologist 60 (1958), 1130.  Sait and Lim, Land, law and Islam: property and human rights in the Muslim world,121. Conclusion to Part I: The Intersection of Islamic Lawand Women’sBiology

Islamic lawrarelypenalizes barren women or delegitimizes childless marriages. This is the casedespite the fact that ḥadīths dating from the first centuries of Islam decry such marriages, and despite the economic and social problems that accompanied childlessness. Indeed, in Islamic legal theory women could not even be categoricallylabeled as infertile from the time they reached menarche until they reached old age. Yetthis presumption of fertilitydid not always match up with either biological likelihood or sociallyconstructed diagnoses. This is not to saythatIslamic lawwas irrelevant to the experiencesofmedieval Muslim women, nor am Isuggesting thatlegal theory represents the “true” place of women in Islamic societies. Rather,Iwould arguethat it is the mismatch between Islamic legal theory,legal practice, biology, and other sources of cultural expectations that had the greatest impact in defining the situations in which medieval barren women found themselves. This mismatch is evident on multiple fronts.Eventhough in ḥadīth-based advice literature,the legal-philosophical literature, and in the more theoretical sections of legal handbooksthereare frequent mentionsofthe idea that reproduction is one of the primary goals of marriage(maqāṣid al-nikāḥ), this goal did not shape the development of laws of marriage. To aremarkable extent,itwas a different goal of marriage, that of sexual pleasure, that shaped the law.²⁹³ It was women’sroles as possessors of femalesexual desire and as objects of male sexual desire that defined their place when contracting amarriage. Awoman’sdesire for sexual satisfaction, her utilityasasexual object,and her defectiveness if she becomes sexuallyunavailable to her husband, had far greater legal consequences than her desire for children, her utility as aproducerofchildren, and her defectiveness if she was infertile. Forthis reason, the lower agelimit of marriagewas set not at the point whenawoman would likelyproduce children, but rather at the point whenshe became capable of engaginginsexual intercourse. Similarly,afree woman could demand completesexual intercourse rather than coitus interruptus (usually) not on the grounds of her right to achild, but rather on the grounds of her right to sexual satisfaction. Forboth sexes, it was not in-

 Judith Tucker makes much the same point,with an emphasis on aslightlylater historical context. J. Tucker, “Muftīsand Matrimony: Islamic Lawand GenderinOttoman Syriaand Pales- tine,” Islamic Law and Society,1.3 (1994), 272.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-007 112 Conclusion to Part I: TheIntersectionofIslamic Lawand Women’sBiology fertility, but rather impotence, which served as legal grounds for marriageannulment. We see amismatch between lawand biologyinthe laws pertaining to the ‘idda period, the ostensible legal purpose of which was to clarify that awomb is not “occupied” by the offspringofaprevious husband. However,the ‘idda was measured via menstrual cycles, an imperfect proxy for reproductive capacity.Further muddying the situation was the biological possibility of oligomenorrhea and amenorrhea, which proved disruptivetothe legal function of the ’idda period. Moreover,the belief in multi-year-longpregnancies, abelief acknowl- edgedboth in lawand in society at large,added another dimension to concepts of infertility,reproductive availability,and paternity.Finally, the seemingly straightforward biological facts of menarche, menstruation, conception and pregnancywerecomplicated by women’sabilitiesto“shape” these facts by con- cealingthem or swearing to their occurrence. We see amismatch between the legal and social expectations of the role women oughttoplayinconveying and enjoying the benefits of familial wealth. All women, both fertile and infertile, had the legal right to inherit and thereby the ability to divert wealth from their birth families, and this was asourceoffrus- tration which prompted legal intrigue. Forinfertile women, the frustrations were all the more palpable because even as theydiverted wealth to other families, they did not produce multi-generational networks with them. Katherine Kueny, in her work on motherhood in Islamic thought,suggests that this incapacity was further magnified by the infertile woman’sinability to create kinship ties through breastfeeding.

Women whohavenoinfant to breastfeed cannot create an expandednetwork of blood ties with their own children or others amongtheir familyorthe community of believers. With- out the ability to establish such an expansive network of familial relations,few will inherit from them. In the absenceofoffspring, the wealth of the familymust be transferredlater- allyrather than linearly, asecondary provision put forth in the Qur’ānthat stifles ahusband’sGod-givenright to sow his own legacy among futuregenerations. Unmoored, barren women areleft adrift in aworld organized around kinship ties.²⁹⁴

Finally, therewas ablatant mismatch between legal and social attitudes towards polygamy, and infertility further complexified the situation. In Islamic legal theory,ahusband could engage in polygamywithout reproach and with an expectation thatall wiveswould receive equal treatment.However,ingeneral practice, women, their families, and their communities frequentlywent out of their wayto

 Kueny, Conceiving Identities,158. Conclusion to Part I: TheIntersectionofIslamic Lawand Women’sBiology 113 protect women from the perceivedevils of polygamy. Infertility,however,was an exception to that generalization.Itwas often acceptable for men in otherwise monogamoussocieties to engageinpolygamysoastobeable to maintain arelationship with abarren wife, while attemptingtononetheless produce offspring. Women who weregiven the choice between polygamyand divorcemight even view polygamyasthe better option. The resultofall these mismatches was that the Islamic legal context provided infertile women and their families with adizzying array of paths, rather than narrow dictates,within which they could maneuver and strategize. It is certainly the case that there were women whose childlessness rendered them particularly weak and in need of protection,and it is also truethatasaresultofnot recog- nizing infertility as asourceofparticularsocial vulnerability,the legal system had no impetus to put in place safeguards to protect their interests. We also see, however,that therewerewomen who could exploit the flexibility provided by the discrepancies highlighted here so as to secure their own well-being.

Part II: Arabo-Galenic Gynecologyand the Treatment of Infertile Women

Introduction to Part II

Medieval gynecology as an intellectual field was shaped by male scientists’ lack of direct access to women’sreproductive organs,anobstacle rooted in female anatomyitself, in addition to cultural values of modesty.The internal and hence physicallyinaccessible nature of women’sreproductive organs meant that anyscientist would have to make some inferences when attemptingto help people have children. The scientisthad to infer what contribution mothers make to their offspring, giventhat there is no visible maternal equivalent to the father’ssemen. He had to infer what conditions made it likelythat coitus would resultinconception, giventhatnot all sexual encounters produce apregnancy. He had to infer what the earlysigns were thatconception had takenplace, given that the embryomust be growingfor some time before it is large enough to be detected through quickeningormaternal showing.Hehad to infer the reason behind the well-observedphenomenon thatpregnant women do not tend to menstruate, and lactating women often do not either.Hehad to infer the causes of miscarriage, giventhat the triggers of earlycontractions resulting in the prema- ture expulsion of still-growing fetuses are not obvious, and the same is true of the causes of intrauterine fetal death. He also had to infer the sources of breastmilk and its relationship to pregnancy. There wereadditional, related questions that ancientand medievalscien- tists asked which maynot seem intuitive to us but which do derive from univer- sallyobservable phenomena. Among these were: whydowomen usually menstruate? Giventhat most women experience menstruation,what does it signify if awoman does not,ordoes not do so regularly? If menstruation is natural and healthy,islack of menstruation asymptom, or perhaps acause, of ill health? What makes it impossible for women to “self-pollinate” giventhat they obviously contributetothe make-up of the child (as indicated by hereditary similarity) and have the capacity to grow and nourish the fetus in theirwombs?Dowomen manifest aphysical indication of sexual desire and arousal, as men do in the form of erections?Dowomen experience impotence,asmen do?Would awoman who is not aroused during aparticularsexual encounter be unlikelytoget pregnant, just as aman who experiences erectile dysfunction during asexual encounter is unlikelytoimpregnate? Conversely, if awoman does conceive,does that indicate she was aroused at the time of conception and was thus awillingsexual partner? What makes an embryodevelop as male or female, at what stage does sexual differentiation occur,and can one influencethatbodilyprocess, in the sameway thatone can influencethe shape of one’sbodythrough eating and exercise? Is amale fetus an indication that its male parent has astronger

“seed,” i.e. amore powerful hereditary influence; and is afemale fetus the product of astronger,more influential female parent?And finally – giventhat the womb during pregnancyobviously expands, causes pain, compresses other organs such as the bladder and stomach, pulsessoviolently(in the form of contractions) as to be able to expel the fetus, and then shrinks postpartum – does the womb do such thingswhen it is not occupied by apregnancy? Infertilitywas aparticularlycomplicated gynecological issue because it was linked to theories of conception and embryonic development, and these theories carried significancebeyond the realmofmedicine. Manyofthe scientists, philosophers, and theologians who articulated aconception theory did not do so pri- marilyfor the purpose of describingwhere babies come from, but rather to describe the relationships between Creator and creation, soul and body, form and matter.Insuch descriptions, these binary relationships were mapped onto the male and femalecontributions to the embryoand,inevitably, it was the female contribution which constituted the junior or less sophisticatedpartner in the relationship. Somescientists also embraced more egalitarian-seeming theories of conception, not due to acommitment to the principle of genderequality, but rather due to its seeming consonance with Islamic religious textsand law, as well as empirical observations about heredity.²⁹⁵ In some ways,the significanceofconception theory beyond the purelymed- ical realm is analogous to the significanceattached to the motions of the planets and celestialbodies, beyond the realmofphysical astronomy. The cosmos hinted at truths about God Himself, His creation, His providence, His sovereignty,and the truths containedinHis own book,the Qur’ān. But astronomical truths were also practicallyimportant.They helpedpeople to orient themselvestoward Mecca; and, to the extent thatpeople put stock in the idea that the movements of the planets and stars impacted human life, astronomical insights wereper- ceivedasbeing practicallyuseful.²⁹⁶ Similarly, articulating the correct theory of conception mattered bothbecause it was ametaphor or metonym for larger philosophical truths, and because it had apractical value. In addition to the philosophical and theological ramificationsthat influenced medicalthinking about fertility and infertility,there were more mundane concerns as well. The treatment of infertility potentiallycalled for sexually-charg- ed and immodest interactions. Medicaldiagnosisand treatment of infertility involved conversations about sexual technique, the physical examination of the

 Musallam, “The Human EmbryoinArabic Scientific and Religious Thought,” 37.  On the prominent roleofastronomyinmedicine, see P. Pormann and E. Savage-Smith, Me- dieval Islamic Medicine (Washington,DC: GeorgetownUniversity Press,2007), 154–156. IntroductiontoPart II 119 genitals, the application of pessaries(suppositories) in the vagina and ointments within the uterus,vaginal fumigation, and the consumption of sexuallysugges- tive foods and substances.Italso possiblyinvolvedmedicalized forms of genital rubbing or surgicalcorrection of genital abnormalities.²⁹⁷ The confluence of these complications raises some interesting questions. How was infertility understood by the physicians of the medievalIslamic world?Towhat extent did their beliefs about women’sbodies differ from the beliefs held by those physicians of antique and late-antique periods whom the medieval physicians esteemed?Did broader philosophical attitudes about female inferiority and social constructions of femininevirtueshaveanimpact on how infertility was understood and treated?Most importantly, is there evidence that the theory and treatments espoused by classically-trainedmale physicians had anypractical applications for femalepatients?Was masculine discourse about gynecologymerelyanintellectual exercise, which was neither informed by nor could hope to impact the secluded world of women?Or, perhaps, was the world of women and gynecological care not nearlyassecluded and segregated as some have assumed? The role and significance of gynecologyinthe medicalliterature produced by medieval Islamic civilization has been the subject of some debate. The great historian of Islamic science,Manfred Ullmann, devotes onlyfour para- graphs of his Die Medizin im Islam to discussing medieval gynecologyinthe Is- lamic world, describing it as essentiallyunderdevelopedasaresultofmedieval physicians having nothing to do with gynecological care.²⁹⁸ Ullmann makes a two-fold claim: book-learned male physicians did not invest in the studyofgy- necology,and the reason they did not do so was because onlymidwives, who lacked all access to Arabo-Galenic medicaltheory,had the opportunitytotreat gynecological conditions. Ullmannissomewhat obscure in his attribution of the sourceofthis “underdevelopment,” suggesting it might be due to “morality codes” or to some other aspect of culture, which he ambiguouslyterms “tradition.” In anycase, in Ullmann’sview,learned gynecologymust have been a moot and underdeveloped discipline, because all medicallylearned people weremen, and gendersegregation made gynecologyanexclusively femaledo- main. Men could not tread or have an impact in this domain, and so they took no interest in it.

 IbnSīnā,Qānūnfīal-ṭibb 2:590=Kitāb 3: fann 21: maqāla 4: faṣlfīal-rutqā’. al-Majūsī, al- Kāmil,2:488. al-Rāzī, al-Ḥāwī fī al-ṭibb vol. 3, bk. 9:16.  Ullmann, Medizin im Islam, 250. 120 Introduction to Part II

By contrast, in her book Conceiving Identities:Maternity in Medieval Muslim Discourse and Practice,Kathryn Kuenycharacterizes medieval gynecology as an arena for the assertionofmale dominance and control over the incompetent bodies of women, specificallysoastowrest the power of reproduction from them. She writes:

[T]he rhetoric and discourse appropriated by medieval Muslim physicians and scholars [cast] the female bodyasthe passive,moredependent sex that must be controlled and dominated by men ...tokeephazards at bay, medieval physicians assert knowledge of, or controlover, every stage of the reproductive act by surveying and circumscribing the female body, and by workingtocure anyproblem within it that might interferewith man’sdesireto replicatehimself ...Assumingthe role of custodian and surveillant of women’sbodies, male medical scholars and physicians,likethe Qur’ānic God, claim both the knowledge and power to generate life.²⁹⁹ Giventheir near-obsessive interest in concocting ways to prevent miscarriages, it is evident Muslim physicians believeinmost cases that God does not destine the fetus to die but rather that women do not takeproper caution for or care of what they are carrying, or that women’sbodies aresimplynot wellequipped for the task. Because women often failed to bringapregnancytofruition, men needed to be that much morevigilant in protecting the fetus from female ignorance,carelessness,orweakness,orindevisingwaystoovercome the female body’sinherent deficiencies.Asaresultoftheir concern, elite scholars rendered women incapable of caringfor their own bodies.³⁰⁰

Whereas Ullmann submits thatgynecology was neglected by male physicians because it wasnot within men’spurview, since thatwhich was out of sight also wasout of mind, Kuenymakes acontradictory claim. She depicts physicians as attemptingtoartificiallyinsert themselvesinto an area in which one would naturallyexpectwomen to be independent,competent,and dominant. Physi- cians did so for the purposesofasserting women’spassivity,incompetence, and need for male aid.Kuenyalsoclaims that theirdepictions of the functioning of the uterus artificiallyuse physiological notions to promotereligious notions of chastity.³⁰¹ The following two chapters argueinopposition to bothKueny’sand Ull- mann’scharacterizations of medieval gynecology. Both characterizations over- emphasize the power and explanatory value of certain culturaltendencies.Nei- ther adesire to use medicine as atool of subjugation, nor acommitment to modesty and gendersegregation account for the wayinfertility is discussed in medievalmedicalwritings. Medical discourse on infertility reflects neither lack

 Kueny, Conceiving Identities, 53.  Kueny, Conceiving Identities, 71.  Kueny, Conceiving Identities, 68. IntroductiontoPart II 121 of interest,nor an assumption of custodianship or surveillance of women’sbodies, nor an intellectual assault on women’svirtue or reproductive competence. The answers that Arabo-Galenic physicians offered to genuinelyperplexing questions about reproduction and female physiology were similar to thosepro- vided by theirGreco-Roman predecessors. However,the Arabic writers modified the Greek medicaltradition in twointeresting directions. First,Arabicdepictions of the role of the female bodyinthe reproductive process weresomewhat more egalitarian and less socially coercive than Hippocratic and Galenic – and espe- ciallyAristotelian – depictions. Second, there was an attenuation of the links between physiologicaltheories, diagnostics,and therapeutics when it comes to gynecology,although this was also true to alesser degreealreadyinGalen’sown time. Even when certain beliefs about anatomyand conception werejettisoned, nevertheless diagnoses,tests,and therapeutic measures,which had been based on the abandoned theories, continued to be propounded. Thus in many cases, practical aspects of gynecologicalcare remained constant even as underlying theory varied. Sometimesthe converse was true as well, and adiagnosis re- mainedconstant while the measures taken to respond to it varied considerably. Of course, incongruity between therapeutics and etiologyisnot unique to the medievalcontext.Consider that bloodletting remained astaple of European and Americanmedicalpractice for two centuries after William Harvey proved that blood circulatedand so the bodywas unlikelytohaveasuperfluity of blood. Or,tooffer amore modern example, recall that American parents, who theoreticallyknow that “the common cold” is avirus, stillfrequentlywarn their children not to go outside in winter with wet hair or an insufficiently heavy coat,lest feelingcold cause them to “catch acold.” The flexible relationship between etiology, diagnostics, and therapeutics meant that,despite the fact that scientists fiercelydebated and held diverse opinions about embryology,³⁰² thosedebates did not result in correspondingly divergent sets of practical recommendations within the gynecological literature. Rather,wesee the repetition of arelatively narrow setofpractical recommendations which often had “ecumenical” value, easilyintegratedinto diverse and conflictingscientificworldviews and appropriate to awide rangeofgynecolog- ical needs.

 Fordiscussions of such debates see Musallam, “The Human EmbryoinArabic Scientific and Religious Thought.” Also N. Fancy, “Womb Heat versus Sperm Heat: Hippocrates against Galen and IbnSīnāin Ibnal-Nafīs’sCommentaries,” Oriens 45 (2017), 150 –175and U. Weisser, Zeugung,Vererbung,und pränatale Entwicklung in der arabisch-islamischen Mittelalters (Erlan- gen: HanneloreLüling, 1983). 122 Introduction to Part II

Did the gynecological theories or advice found in medieval medicalwritings have anypractical import?Would educated male physicians have advised women patients regardingtheir gynecological ailments and, even if they had, would women have been inclined to payany attention to their book-learned knowledge?The extant literature we have suggests that,insome communities at least,the answer to boththese questions is “yes.” At the very least,the situation is much more ambiguous than Ullmann assumes.³⁰³ Medical writingsoften depict male physicians as having close interactions with theirfemale patients. They consistentlyshow thatphysicians thought they ought to be involved in medicalcare and worked with midwives who mediated their interactions with female patients, and thatatother times male physicians interacted with female patients directly, includinginthe management of gynecological matters.Moreover, the extant medicaltextswehavesuggest that medieval writers assumedthat the knowledge they and their readerspossessed would be utilized by real female patients.

 It should be noted that until recentlyhistorians of European medicine also assumed that in Christendom, prior to the earlymodern period, male physicians had little to do with childbirth or the treatment of gynecological conditions. This view has been challengedand undermined in recent years, particularlybyMonica Green. See M. Green, Making Women’sMedicine Masculine: TheRise of Male Authority in Pre-Modern Gynaecology (Oxford: OxfordUniversityPress,2008), particularlypp. 36–45 for the earlier period. Also, M. Green, “Caringfor Gendered Bodies,” in OxfordHandbook of Medieval Women and Gender,ed. Judith Bennett and Ruth Mazo Karras (Oxford: OxfordUniversity Press, 2013), 345–61. 4Gynecological TheoryinArabo-Galenic Medicine

The importanceofthe Greco-Roman medical tradition in Arabic medicine

In his Shukūk ‘alā Jālīnūs (Doubts About Galen) the famouslyindependent physician Abū Bakr Muḥammad ibn Zakarīyā al-Rāzī (d. 311/923), known as Rhazes in the Latin tradition, writes:

Galen says, “One whounderstandswhatissaid in this section knows whatrenders men sterile and women infertile: that is, aman who has abalanced temperament is always fertile, but one who lacks balancewill be fertile if he so happens to be coupled with his op- positeinhumoral temperament.” This is not true, for Ihaveseen manymen such as this, cycling through women, hopingtoreproduce, and it is of no use to them. One of them would buy slave girls accordingtoour guidancetohim, and Ievaluated their humoral com- patibility with him.³⁰⁴ Ialso had aneighbor,whose warm and moist temperament could pass for that of acamel, whoexpended great efforts in his cyclingthroughslave girls, but it was of no use to him – even though Galen says that this sort of temperament is stron- gest with respect to reproduction.³⁰⁵

Al-Rāzī’sobservations remind us of some peculiaraspects of infertility as an “illness.” First,itwas ongoing,and therefore apatient usually had the time to make avariety of attempts to fix the problem. This was not true of othertypesofail- ments such as acute diseases or injuries.However,infertility was anomalous among other long-term conditionssuch as chronic pain, or diminishedeyesight, in thatthere was astrongpossibility that it could be resolved. Like fevers and other acute conditions, infertility could pass, whether duetoeffective intervention or despite neglect or harmful medical treatment.Ifitresolvedand the former sufferer did produce children, having had ample time to attempt avariety of treatments,attributing the sourceofhealing was amatter open to interpreta-

 The Christian physician, Isḥāqibn ‘Alī al-Ruhāwī (d. 931A.D.), wholived in northwestern Iraq, seems to allude to the practiceofphysicians choosingsexual partners for their patients when he writes, “It is of value to distinguish between skillful shrewd practitioners and those whoimitatethem. Youmay see these twoclasses when they come intoacity and plan to show what they claim about their work with various arts.Some of them butter up the sultan of that country with electuaries and in selectingwomen who are pretty and act well, which they claim have [health] value.” This translation of al-Ruhāwī’s Adab al-ṭabīb is fromMartin Levey, “Medical Ethics of Medieval Islam with Special ReferencetoAl-Ruhāwī’s ‘Practical Ethics of the Physician,’” Transactionsofthe American Philosophical Society 57 (1967), 90.  al-Rāzī, KitābShukūk ‘alā Jālīnūs (Tehran: Muʾassasah-ʾiMuṭālaʻāt-iIslāmī,Dānishgāh-i Tihrān, 1993), 79.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-009 124 4Gynecological TheoryinArabo-Galenic Medicine tion. Moreover,unlike most other types of long-term medical conditions,there was aclear line differentiating between success and the lack thereof in treating infertility.Inthe management and alleviation of pain, or even diminished eye- sight,the patient’ssubjective perceptions dictated the extent to which acourse of treatment was deemed successful. Not so for the treatment of infertility.When successfultreatment was markedbythe arrival of achild, one could make an empirical argument,oratleast an anecdotal one, demonstrating the failureof aparticularexplanatory theory and course of treatment,which is precisely what al-Rāzī does. Al-Rāzī’sattack on Galen’sstatements about fertility respond to amedical culturewhich proudlydescribed its theories as an intellectual inheritance from the Greco-Roman world. Hippocrates (fl. c. 5th century B.C.), Aristotle (fl. c. 4th century B.C.), Dioscorides (fl. c. 1st century A.D.), Galen (d. c. 216A.D.), Paul of Aegina (fl. c. 7th century A.D.) and manyothers are cited as authorities in the medieval Arabic gynecological literature. Most of the gynecological beliefs described belowentered into the Arabic medical corpus through the mediation of Galen and later figures such as Stephanus of Athens, Aetius of Amida, and Paul of Aegina.³⁰⁶ It is not my intention to explore here the translation and reception history of individual Greek or Roman medicaltexts,ortotrace the routethrough which they weretransmitted to the Arabic-writing world, since others have alreadydone so.³⁰⁷ Instead, this chapter explores the substance of

 Forthe importance of Galen in shapingthe Arabic reception of Hippocratic texts,see M. Ullmann, Die Medizin im Islam (Leiden: Brill, 1970), 35–62;N.Fancy, “Womb Heat versus Sperm Heat: Hippocratesagainst Galen and IbnSīnāin Ibnal-Nafīs’sCommentaries,” Oriens 45 (2017), 150 –175; and P. Pormann, “The Hippocratic Aphorisms in the Arabic Medical Tradi- tion,” Aspetar 2(2013), 412– 415.  Thereare several scholarlyworks which describe the transmission of Greco-Roman gynecology to the medieval Islamic world and to Latin Europe. Max Meyerhof and Dimitri Joannides produced threeshort monographs on the subject in the 1930s.D.Joannides, Esquisse de la gy- nécologieetdel’obstétrique chez les égyptiens et les grecs (Cairo, 1934); idem, La gynécologie et l’obstétrique chez Avicenne (Ibn Sina) et leurs rapports avec celles des grecs (Cairo, 1938); and idem, La gynécologieetobstétrique de Paul d’Egine et son influence sur la médecine arabe (Cairo, 1940). Ursula Weisser wrote an importantstudyofmedieval Arabic understandingsof the physiology of reproduction and heredity Zeugung,Vererbung,und pränatale Entwicklung in der arabisch-islamischen Mittelalters. Monica Green’s “The TransmissionofAncient Theories of Female Physiology and Disease Through the EarlyMiddle Ages” (Ph.D.Dissertation: Princeton University,1985) provides the best overview of the history of the translation movement with respect to gynecology.Itincludes an appendix with useful flowcharts depictingthe translation movement with regard to individual gynecological texts on pp. 235–238. Forarecent philologi- cally-oriented analysis of the transmission, reception, and exegesis of Hippocratic aphorisms pertainingtogynecologysee Rosalind Batten, “The Arabic Commentaries On The Hippocratic The importanceofthe Greco-Romanmedical tradition in Arabic medicine 125

Arabic medical writingsabout the causes and treatments of infertility and related gynecological issues. This book uses “Arabo-Galenic medicine” as an infelicitous shorthand for a complex intellectual heritage as we know it from acertain set of highlyinfluen- tial texts which routinely refer to each other.These texts are all written in Arabic, though manyofthe texts’ authors werealso steeped in other linguistic traditions. Some of these textsreflectavariety of sources of local and global medicalknowledge,especiallyIndian medicine and particularlyIndian pharmacy,although this influenceand inspiration is sometimes acknowledgedonlyinvagueorano- nymizing terms by our authors. Most often, the medievalauthorsexplicitlysit- uate their own thinkingand contributions to the medicalfield in the context of Greek thought, especiallyasmediated by Galen and Galen’sdisciples. They buttress theirarguments by citing either texts translated from the original Greek and Syriac into Arabic, or by engagingwith other original Arabic texts which also situate themselveswithin the sameintellectual heritage. As depicted by the medievalArabo-Galenic authors themselves, the ancient theorists who exerted the most influenceontheir own framework for understanding gynecologywereHippocrates,Aristotle, and Galen.³⁰⁸ Whereas in the medievalLatin world Soranus’s(fl. c. 100 A.D.) famed Gynecology was continu- ouslyincirculation, thereislittle evidence thatitwas ever translated into Ara- bic. However,some of Soranus’ gynecological thought became known to the Ara- bic world through Paul of Aegina(d. c. 690A.D.).³⁰⁹ The gynecological sections of manyofthe Byzantine medical encyclopedias, which werelater transmitted to the Arabic world, also draw heavilyonSoranus’ treatments. The extant Hippocratic treatises relatingtogynecologyare Diseases of Women (I &II), Diseases of Young Girls, On Barrenness, Generation and Nature of the Child, Nature of Women, Seven-month Child, Eight-Month Child, Superfeta- tion and Excision of the Embryo. AccordingtoManfred Ullmann, onlytwo of the more minor works on gynecology, Superfetation and Diseases of Young Girls,are known to have been translated into Arabic in the medieval period, as was Hip-

Aphorisms:Arabic Learned MedicalDiscourse On Women’sBodies (9th-15th Cent.)” (Ph.D.Dis- sertation: University of Manchester,2018). Scholarlydiscussions aboutwhich Greek gynecological works wereavailable in Arabic versions has heavilyreliedonthe work of Manfred Ullmann. Ullmann’s Die Medizin im Islam is available in an accessible English summary: Islamic Medicine (Edinburgh:Edinburgh University Press, 1978).  Weisser, Zeugung,Vererbung,und pränatale Entwicklung, 53.  Ullmann, Islamic Medicine,11, 14,15and Peter Pormann, TheOriental Tradition of Paul of Aegina’sPragmateia (Leiden: Brill, 2004). 126 4Gynecological Theory in Arabo-Galenic Medicine pocrates’ Aphorisms, which also includes gynecological material.³¹⁰ On Genera- tion and Natureofthe Child also exists in amodified form in Arabic as Kitāb al-ajinna li-Buqrāṭ.³¹¹ Abook attributed to Hippocrates called Kitābawjā’ al- nisā’,i.e. “Diseases of Women,” is found in listsofbooks but,accordingtoUll- mann, there is no evidence thatitwas ever extant in Arabic.³¹² However, Super- fetation has abroader gynecological scope than its title implies, corresponds closelywith Diseases of Women I,and contains some passages which are identical to thosefound in On Barrenness. Of all of these, Hippocrates’ Aphorisms is the most frequentlycited text in the medieval Arabic medical literature pertaining to infertility. Medieval gynecology, like otherbranches of medicine,was heavilyinflu- enced by Galenic thought.³¹³ The authority of Galen was so respected that amedieval physician might resort to ta’wīl (scriptural reinterpretation) in order to explain away his errors by arguingthat his teachingshad merelybeen misunderstood. Johann Christoph Bürgelnotes the following example of such esteem:

‘Abdal-Laṭīfal-Baghdādī discoveredthat the lower jawbone of the human bodywas not,as Galen had thought, composed of twoparts, but that it was asingle sutureless bone. This famous Egyptian scholar made his discovery in the course of osteological studies in an ancient cemetery in the northwest of Cairo – but not until he had investigated morethan two thousand skulls did he realize that he had come across an error in Galen’steaching. In his account of this experienceheexpressed the conviction – which, self-evident as it mayseem to us,was abold statement in those times – that the evidenceofthe perception of our senses deserved moreconfidencethat the teachings of Galen;³¹⁴ though havingsaid so,

 Green, “The Transmission of Ancient Theories of Female Physiology and Disease Through the EarlyMiddle Ages,” 79 and Ullmann, Die Medizin im Islam,29.  Commenting on the relationship between the two texts, the modern editors of Kitābal-ajinna li-Buqrāṭ write: “The text,aspreserved ...shows amixtureoftranslation,paraphrase, and comment ...inmanycases the distinctionsbetween expanded translation, paraphrase and re- statement areblurred.” M. C. Lyons and J. N. Mattock, Kitābal-ajinna li-Buqrāṭ (Cambridge:Pem- brokeArabic Texts,1978), ii.  M. Ullmann, “Zwei spätantikeKommentarezuder hippokratischen Schrift ‘De morbis muliebribus’” Medizinhistorisches Journal 12 (1977), 245–262; M. Green, “The Transmission of An- cient Theories of Female Physiologyand Disease through the earlyMiddle Ages,” 74.  Green, “The Transmission of Ancient Theories of Female Physiology,” 235–7.  Al-Baghdādī’sclaims to originality werebynomeans well-received. See N. Peter Joosse, ThePhysician as aRebellious Intellectual: TheBookofthe TwoPieces of Advice or Kitābal-Na- ṣīḥatayn by ‘Abdal-Laṭīfibn Yūsuf al-Baghdādī (Frankfurt am Main: Peter LangEdition,2014). The biographer Ibnal-Qiftī’sentry about him is both personallyand professionallyscathing. It concludes, “In 628, it occurredtohim to traveltoIraqand to makethe ḥajj pilgrimage.He fell sick in Baghdad and began to treat himself with his own medicine, and died – just as The importanceofthe Greco-Romanmedical tradition in Arabic medicine 127

he added, typicallyenough that there might be found an interpretation of the words in question which would free Galen from the charge of error.³¹⁵

Asomewhat less diffident attitude can be found in the above-quoted Shukūk ‘alā Jālīnūs (Doubts About Galen) in which al-Rāzī anticipates thathis criticism of Galen, and in particular of his humoral theory,will itself be met with consterna- tion. Using terminology that is deliberatelyreminiscent of Islamic jurisprudential language, al-Rāzī compares the stance of his critics, who believeheshould have amore reverential attitude towardGalen, to jurists bound by taqlīd. Taqlīd refers to the intellectual posture of ajurist who imitates or conforms to his predecessors’ conclusions, rather thanrevisiting the premises on which they are based, due to his belief thatheisboundbyhis predecessors’ authority.Al-Rāzī instead calls on his fellow scientists to emulate the sunna,the exemplary tradition, of the great philosophers of old. His languageechoes the religious value of emulating the sunna of the Prophet Muḥammad.

As for those whocensuremeand call me ignorant for havingproduced this Book of Doubts – Idonot call them philosophers. They have turned their backs on the tradition (sunna)of the philosophers.They have taken up the tradition of ignorant upstarts,throughimitation (taqlīd), refrainingfromraisingany objection against it.Aristotle says: ‘Plato and the Truth areatodds,and both arefriends to me – but the Truth is afriend dearer still than Plato.’³¹⁶

Al-Rāzī’scriticisms of Galen’stheories wereindeed alarming enough to inspire some of the great figures of medieval medicine such as IbnAbīṢādiq al- Nīsābūrī (d. after462/1068), IbnZuhr (Avenzoar, d. 557/1162) and Moses Maimo- nides (d. c. 1204) to write refutations of them. IbnZuhr accounted for this failing in al-Rāzī by claiming that either al-Rāzī did not author the book at all, or he wrotehis book when he was an adolescent tooyoungtounderstand Galen, or

God had wished – in the year 629. His books weresold in Aleppo. Ihappened upon some of them, and they wereofthe degree of inferioritywhich is furthest removed fromperfection. God save us from the enticement of pretentiousness!” Ibnal-Qiftī, Inbāhal-ruwāt ʿalā anbāh al-nuḥāt,ed. Muḥammad Ibrāhīm(Cairo: Dāral-Kutub al-Miṣriyya, 1950),2:196.Translation by A. Verskin, “AMuslim-Jewish Friendship in the Medieval Mediterranean: ʿAlī Ibnal-Qifṭī’sBi- ographyofRabbi Yūsuf Ibn Shamʿūn,” in TheIdea of the Mediterranean, ed. Mario Mignone (Stony Brook: Forum Italicum Publishing,2017), 189.  J. C. Bürgel, “Secular and Religious Features of Medieval Arabic Medicine,” in Asian Med- ical Systems:AComparative Study,ed. Charles Leslie (Berkeley:University of California Press, 1976), 45 – 6. The anecdotecomesfrom ‘Abdal-Laṭīfal-Baghdādī, Kitābal-Ifāda wa’l-i‘tibār (Lon- don: Allen and Unwin, 1965), 176and 272–6.  al-Rāzī, KitābShukūk ‘alā Jālīnūs,2.The English translationisslightlymodified from apassage in M. Mohaghegh’safterwardtothe book. 128 4Gynecological TheoryinArabo-Galenic Medicine else he produced it as an old man whose great mind had become addled by exposure to arsenic and sulfur in the course of his alchemicalstudies.³¹⁷ This reverential attitude towardGalen is significant not onlyfor comprehending gynecologyand embryologyinmedieval learned medicine, but also for understanding the ambivalenceand the criticisms leveled by some juristsagainst the culture of Arabo-Galenic medicine.Such attitudes will be explored in chapter 6.

Greek antecedentstomedieval gynecologicalconcepts

Moisture, menstruation, and health in Hippocratic texts

In their gynecological statements the Arabo-Galenic physicians explicitlydrew on Hippocratic theory and practice,despite lacking direct access to some of the major Hippocratic gynecologicaltexts. Hippocratic medical theory characterized women’shealth, and the differencebetween women and men, through the lens of polar opposites:dry and moist,right and left,hot and cold, etc.³¹⁸ Hippo- cratic gynecology in particular associated women with moisture,while Aristote- lian and Galenic gynecologyplaced emphasis on characterizingwomen as colder than men. These opposites recur throughout Arabo-Galenic gynecological writings, with masculinity associatedwith heat,³¹⁹ dryness and the right side, and femininity associatedwith cold, moisture and the left side.³²⁰ The most obviousevidence of women’s “moisture” was menstruation, but the characterization was not localizedtothe uterus,rather it defined women’s entire physiology.AccordingtoHippocratic gynecology,women are moist because theirsofter, porous flesh retains fluid more thandoes the less-porous flesh of men.³²¹ Menrid themselvesofwhat excess fluid they have through per-

 Mohaghegh, KitābShukūk ‘alā Jālīnūs, 112.  On the internal consistencyofthe gynecological works and their relation to the rest of the Hippocratic corpussee, A. E. Hanson, “Continuity and Change:Three Case Studies in Hippocrat- ic Gynecological Therapy and Theory,” in S. Pomeroy Women’sHistoryand Ancient History (Chapel Hill: University of North Carolina Press, 1991), 76 – 7.  Thereissome inconsistencyinthe Hippocratic texts with regardtoheat. Diseases of Women I says that “awoman has hotter blood, and because of this she is hotter than aman,” while in Regimen for Health it says “Females,incliningmoretowater, grow fromfoods, drinks and pur- suits that arecold,moist and gentle. Males,incliningtofire, grow fromfoods and regimen that aredry and warm.”  Weisser, Zeugung,Vererbung,und pränatale Entwicklung, 275.  Text in A. E. Hanson, “Hippocrates: Diseases of Women 1,” Signs 1(1975), 572. Greek antecedents to medieval gynecologicalconcepts 129 spiration. Women, however,must do so through menstruation, pregnancy(in which case menstrual blood nourishesthe fetus) or lactation.³²² Whereas biomedical gynecologyunderstands menses as merelythe shed lin- ing of the uterus,the Hippocratics understood the menses as alarge quantity of excess fluid which filled the uterus to capacity before being evacuatedthrough menstrual bleeding.They estimated that ahealthywoman dischargesapproxi- matelyone pint of blood each cycle, about seven or eight times as much as is estimatedinstudies of twentieth-centurywomen.³²³ The process through which all this fluid was evacuatedcould easilybeimpeded, so they thought, leading to abuild-up of “retained menses.” If the “retainedmenses” werenot evacuated, the uterus would become overfull, thereby causing pain and serious disease. The entire extant fragment of the Hippocratic treatise Diseases of Young Girls is devoted to describingthe dangers risked by women whose excess moisture is not givenaproper outlet.

Afterwards blood is gatheredinto their wombs for evacuation. Yet, when the mouth of the exit is not opened and moreblood flows in duetotheir nourishment and the increase of their body, then the blood, not havingawaytoflow out,rushes from the quantity towards the heart and the diaphragm. When these parts arefilled, the heart becomes numb;then lethargy seizes them after the numbness,then after the lethargy,madness seizes them ... When these things occur in this way, the younggirl is mad fromthe intensity of the inflammation; she turns murderous from the putrefaction; she feels fears and terrors from the darkness.From the pressure around the heart,these young girls long for nooses. Their spirit,distraught and sorelytroubled by the foulness of their blood, attracts bad things,but names somethingelse even fearful things.They command the younggirl to wander about,tocast herself into wells,and to hangherself, as if these actions were preferable and completely useful. Even when without visions,acertain pleasureexists,asaresultof which she longsfor death, as if somethinggood ... Release from this comeswheneverthereisnoimpediment for the flowingout of the blood. Iurge, then, that whenever younggirls suffer this kind of maladythey should marry as quicklyaspossible. If they become pregnant,they become healthy. If not,either at the same moment as puberty,oralittle later,she will be caught by this sickness,ifnot by another one. Among those women whohave regular intercourse with aman, the barren suffer these things.³²⁴

 Green, “The Transmission of ancient theories of female physiology,” 16.  L. Dean-Jones, “Menstrual Bleedingaccording to the Hippocratics and Aristotle,” Transac- tions of the American PhilologicalAssociation 119 (1974), 181.  Ann Ellis Hanson and Rebecca Flemming “Hippocrates’‘PeriPartheniôn’ (Diseasesof YoungGirls): Text and Translation,” Early Science and Medicine 3(1998), 251–252. My emphasis. 130 4Gynecological Theory in Arabo-Galenic Medicine

In this text,lack of regular menstruation is depicted not as menstrual absence but rather as menstrual retention,i.e.menstrual blood exists, but it is locked in and needstobereleased or else it will overfill and damagethe rest of the body. That release is best obtained through marriageand sexual intercourse. Sex- ual intercourse is itself credited with providinganoutlet for menses. (There is some disagreement among classicists as to whether the Hippocratics thought of defloration as breakingahymenal seal or stopper which then allows the menses to flow out,orwhether sexual intercourse was thought to dilate the veins and the cervix, thereby providing awider channelfor the exiting menses.³²⁵)Thus irregular or absent menstruation is not understood as indicative of agirl being tooyoung to have reached full physical maturity,ortoo young to be married, but rather lack of marriageisdepicted as barring her from reaching full physical health, thereby causing disease. Moreover,anevenbetteroutlet for excess menses is pregnancy and lactation,since menses nourish the fetus, and excess blood is the rawingredient that when “cooked” is transmuted into breastmilk. If pregnancyand birth are particularlysalubrious then, by extension, those who are married but barren are particularlyatrisk of ill health. The Hippocratic gynecologicaltreatisesare thus premised on the notion that women who have reached puberty are subject to diseases if they are not regularly menstruating,pregnant,ornursing. Not onlyare menstruating,pregnant,and nursing women considered to be healthy,but Hippocratic medicine claims that women who have givenbirth are subject to less pain while menstruating and less severe disease.³²⁶ Such an understanding assumesthat sexual intercourse and childbirth are necessary for women in order to avoid illness. Con- versely, virgins, non-fertile women, and unattached widows are depicted as physicallyatrisk. In this system, barren women are in adisadvantageous position not simplybecause they cannot produce children, but because they are thoughttobesufferingfrom injurious disease, one which mayevenlead to de- rangement and apropensity toward violence.

 L. Dean-Jones, L. Dean-Jones, Women’sBodies in ClassicalGreekScience (Clarendon Press: Oxford, 1994), 50.  Ibid., 19.Cf. Diseases of Women I, 572and Diseases of Young Girls. The latter is in Ann Ellis Hanson and Rebecca Flemming “Hippocrates’‘Peri Partheniôn’ (Diseases of YoungGirls): Text and Translation,” Early Science and Medicine 3(1998), 251. Greekantecedents to medieval gynecological concepts 131

Women’sanatomy and the female contributiontothe embryo

Three anatomicallyerroneous but significant assumptions with respect to female anatomywerepassed from the Hippocratics to Galen and onward into Arabic medicalliterature. The first of these was the assumption that in ahealthy woman there is adirect passagebetween the mouth, uterus, and vagina.Further- more, 5th-century B.C. Greek anatomical thought implied that the uterus has olfactory capabilities, and thus amedical practitionercan attract or repel the uterus upwards or downwardswithin the bodybyintroducing attractive or repellant substances to it via the vagina or mouth. Later Greek and Arabo-Galenic physicians rejected entirelythe idea that the uterus can sense odor or moveinre- sponse to it,yet the application of the samesorts of odorous substances continued to playasignificant role in antique and medieval gynecology. Furthermore, Hippocratic gynecologyassumedthatawoman’sfertilitydependedonher having an unobstructed channel between vagina, uterus,and nose.Ablocked passagewas understood as indicative of ill-healthand sterility.Avariety of medieval diagnostic practices continued to be predicatedupon the existenceofthis pas- sagebut,asweshall see, medieval writers develop this line of thoughtinnew and divergent ways. The second anatomical error was the idea thatthe human uterus is “bipar- tite”³²⁷ i.e. thatthe uterus is composed of twosymmetrical cavities, aleft one and aright one (as is true in the case of some animals).³²⁸ This assumption was used to explain whymale and femalefetusesdevelop differentlyinutero. It continued to holdswayinGalenic and later Arabic medicine despite the fact that,through reports of dissections, and possiblyfrom internal examinations, Galen himself wasaware thatthe uterus did not have twocavities.³²⁹ Me-

 Modern biomedicine treats the bicornuate uterusasarare and serious medical condition. A somewhat morecommoncondition is the “uterine septum” in which apartition bifurcates an otherwise normally-shaped uterus. This condition often causes miscarriage.  The anatomists of Alexandria, Egypt,who performed dissections, correctly describedthe shape of the uterus. However,this information was not integrated intolater gynecologicaltheory.Alexandria seems to be the onlyplaceinthe ancient Greco-Roman world whereweknow that dissection was performed. It seems it was toleratedtherefromthe thirdcentury B.C. until the second century A.D.LudwigEdelstein, Ancient Medicine (Baltimore:Johns Hopkins Press, 1967), 256.  Galen, De Uteri Dissectione,chap. 3, translated in Charles Mayo Goss, “On the Anatomyof Uterus,” TheAnatomical Record 144(1962),77–83. 132 4Gynecological TheoryinArabo-Galenic Medicine dieval medicine referenced the left and rights “sides” of the uterus in discussions surroundingfertility and pregnancytests,aswell as fetal development.³³⁰ The third error layinthe belief that therewas apassageconnectingthe uterus to the breasts.The explanatory value of this passagewas that it meant that changes in the breasts could be usedtomonitor changes in the uterus,particu- larlyduringpregnancy. DrawingonHippocrates’ Aphorisms 5:37–38, al-Rāzī writes, “If she was pregnant and her breasts suddenlyshrivel, then she has experienced amiscarriage. Andifshe was pregnant with twins and one of her breasts shrivels, she has miscarried the [fetus] which is on that side. The signs of conception, whether it is amale or afemale: males are on the right side [of the uterus] and females are on the left side, and it is onlyrarely otherwise.”³³¹ The connection between breasts and uterus also held out the possibilityoftreat- ing uterine ailments by means of the more accessible bodypart,for example by applying cupping glasses under the breasts and drawing blood from theretopre- vent excessive blood loss duringmenstruation.³³² The passagebetween the uterus and the breasts was also useful for explaining lactational amenorrhea – it stood to reason that nursing women might not menstruate because their “excess” blood, which would otherwise be evacuated by menstruation,had been transformed into breastmilk. Finally, the existence of the connection between the breasts and the uterus suggested abiological relationship between the babies wet-nursed by women and those birthed by them, arelationship thatfit in well with Islamic concepts of milk-siblinghood, which created legal ties of close kinship between awetnurse and the nursing child.³³³ Notablymissing from the gynecological teachings of Hippocrates and Aris- totle is an awareness of the existenceofthe ovaries.Although ovaries are large enough to be visible without modern technology,itisthought that their ex- istenceonlybecame widelyknown in the Greco-Roman scientificworld in the 3rd century B.C. thanks to Herophilus,eventhough others in the Mediterranean world had long been using ovariotomyinanimals(and sometimes in women)

 Forbeliefs about the divided uterus see Weisser, Zeugung,Vererbung,und pränatale En- twicklung, 275.  al-Rāzī, al-Ḥāwī fī al-ṭibb vol. 3, bk. 9:75.This closelyfollows Aphorisms 5:37–38.  Ibnal-Jazzāral-Qayrawānī and Gerrit Bos, Ibn al-JazzāronSexual Diseases and Their Treat- ment: acritical edition, Englishtranslation and introductionofBook6of Zādal-musāfir wa-qūtal- ḥ āḍ ir (London, KeganPaulInternational, 1997), 149(Arabic), 272(English.) Cf.  Giladi, Infants, Parents and WetNurses: Medieval Islamic Views on Breastfeedingand their Social Implications,119. Greek antecedents to medieval gynecological concepts 133 as ameans of sterilization.³³⁴ The physicians of late antiquity and the medieval world, by contrast,werevery much aware of the existenceofovaries and sur- mised that they werethe femaleequivalent of testicles.However human ova, the existence of which continued to be amatter of debate until the 18th century since they are almost toosmall to see with the naked eye, are entirelymissing from both ancient and medieval gynecology. The lack of adetectable equivalent to semen raised the question of whether women produce agamete, “seed,” as men do. The Hippocratic gynecological treatises did not explicitlylay out atheory of reproduction.³³⁵ They were, however,clearlybased on atwo-seed understanding of conception. In Hippocratic texts, semen constitutes the male seed. Women also secreteseed into their womb, whereitencounters semen. The “female seed” is alsoafluid, just as semen is; and this fluid is secreted duringsexual arousal, just as semen is. As Leslie Dean-Jones writes,this is not asubstance which the physicians claimed to have directlyobserved. Rather, “the female seed was not necessarilyavisible secretion as aman’swas; it was postulated because of its explanatory value in ahypothesis, not because it had been empir- icallyobserved ...the femaleseed is by nature emitted into the womb. It only appears outside the womb if the womb is open contrary to nature.”³³⁶ Aristotle argued against the notion thatwomen produce seed as men do. In- stead, he posited thatmenstrual blood is itself the femalecontribution to the embryo. He compared the semen and the menses to acarpenter and ablock of wood. The menses are amaterial to which the semen provides the form. When the semen acts on the menses, it thereby creates something new,anembryo, just as the carpenter acts upon the wood to create abed.³³⁷ This is known as the one-seed theory of generation. Aristotle offered anumber of arguments against the idea that women produce agamete. He claimedthat women lack the “vitalheat” necessary to concoct seed, that pre-pubescent boys resemble women and since the former cannotbring about conception the lattercannot either,and that women could not possiblybesecretingseed because they are al- readysecreting something else, namelymenses. Among the arguments that have greatest implications for the treatment of childless women was his claim that male seed is secreted onlywherethere is sexual pleasure and arousal, yet women getpregnant even when sexual intercourse is unwanted. This was

 A. Preus, “Galen’sCriticism of Aristotle’sConception Theory,” Journal of the HistoryofBi- ology 10 (1977), 67.  Dean-Jones, Women’sBodies in ClassicalGreek Science,154.  Dean-Jones, Women’sBodies,156.  Aristotle, Generation of Animals, 1, 18–22. 134 4Gynecological TheoryinArabo-Galenic Medicine proof to him that whatever it is that women are contributingtothe embryo, it is not seed, for they make that contribution with or withoutpleasure. This assertion thatwomen can conceive regardless of whether they are sex- uallyaroused potentiallyhad both quite negative and positive ramifications for the social treatment of women. Those physicians who, unlike Aristotle, subscri- bed to the two-seed theory of conception, encouraged men to become attuned to their wives’ sexual desires so as to increase the likelihood of the woman secret- ing seed, resulting in conception.³³⁸ On the other hand, in accordancewith the two-seed theory,when awoman did become pregnant,the fact that conception occurred was evidence that the woman was awilling participant in the sexual act.Authorssuch as Soranus and al-Rāzī claimed that conception is possible onlywhen women ejaculate,³³⁹ thus indicating thatimpregnated women are willing sexual partners even in cases of purported rape.³⁴⁰ Their view alsoimplied that awoman’ssterility can be blamed on her sexual frigidity.Bycontrast,Aris- totle’sposition de-incentivized paying attention to women’ssexual desires,since they are unimportant from the perspective of reproduction. However,italso supported the notion thatconception can occur without impugning the virtuous intent of asexuallyassaulted woman. It also absolvedinfertile women of the charge that their reproductive failureisattributable to alack of sexual ardor for their husbands.The great adherent of Aristotelian thoughtamong the medieval physicians,the philosopher IbnRushd (Averroes), drew aconnection between Aristotle’sassertion and listeningtowomen’sclaims. “Aristotle has argued that awoman can getpregnant without ever experiencing emission.Itoo have pursuedthis matter by observation and found it to be true ...Ihave also asked women about it,and they tell me the same. That is, theyoften become pregnant without experiencing pleasure.”³⁴¹ Five hundred years after Aristotle, Galen drew upon the discovery of ovaries and on Aristotle’sown work to criticize Aristotle’sreproductive theories. Accord-

 See al-Rāzī, al-Ḥāwī fī al-ṭibb, vol. 3, bk. 9:66.Ibn Sīnā, Qānūnfīṭibb, 2:550 = Kitāb III: Fann 20: maqāla 1: fasl fī ‘udhr al-ṭabībfīmāyu‘allim min al-taldhīdh. Al-Baladī, Tadbīral-ḥabālā’, 10. Weisser, Zeugung, Vererbung,und pränatale Entwicklung, 152. Cf. Aetius of Amida, “Sterile and useless (inane) arethose women whoare forced to have coitus against their will. Forlovepre- sides over (is essential for)conception; and women in loveconceive very often.” Aetius of Amida, The Gynaecology and Obstetrics of the VIth century,tr. James Ricci (Philadelphia: Blakis- ton, 1950), 36.  Rāzī, al-Ḥ āwī,9:58.  Soranus, Gynecology 36–7.  Muḥammad ibn Aḥmad ibn Rushd, Kulliyātfīal-ṭibb (Morocco: Maʻhad al-JinirālFrankū , Lajnat al-Abḥ ā th al-ʻArabīya al-Isbānīya,1939), 30.Translation from Musallam, Sex and Society in Islam,64. Greekantecedents to medieval gynecological concepts 135 ing to Galen, Aristotle was correct in claiming that women lack the quantities of vital heat found in men, but that inequality of heat accounts for whymale and femalereproductive organs are fundamentally similar (as ovaries and testes are) rather than categoricallydifferent.AccordingtoGalen, heat pushes the genitals of male fetusesoutward, whereas relative cold keepsthe genitals of femalefetus- es inside. Whatemergesfrom this theory is aconceptualization of female anat- omynot as entirely different from male anatomy, but rather as the mirror of it. Galen writes:

All the parts,then, that men have,women have too,the differencebetween them lyingin onlyone thing, which must be kept in mind throughout the discussion, namely, that in women the parts arewithin [the body], whereas in men they areoutside ...Consider first whichever ones youplease, turn outwardthe woman’s, turn inward, so to speak and fold double the man’s, and youwill find them the same in both in every respect. Then think first,please, of the man’sturned in and extendinginward between the rectum and the bladder. If this should happen, the scrotum would necessarilytake the placeofthe uteri, with the testes lyingoutside, next to it on either side; the penis of the male would become the neck of the cavity that had been formed; and the skin at the end of the penis,now called the prepuce,would become the female pudendum [the vagina] itself. Think too, please, of the converse, the uterusturned outwardand projecting.Would not the testes [the ovaries] then necessarilybeinside it?Would it not contain them likeascrotum? Would not the neck [the cervix], hithertoconcealedinside the perineum but now pendent,bemade intothe male member?And would not the female pudendum, beingaskin-likegrowth upon this neck, be changedintothe part called the prepuce? It is also clear that in consequence the position of the arteries,veins,and spermatic vessels [the ductus deferentesand Fallo- pian tubes] would be changedtoo.Infact,you could not find asingle male part left over that had not simplychangedits position; for the parts that are inside in woman areoutside in man.³⁴²

AccordingtoGalen, the heat possessed by menmakes their bodies efficientlyuse up all of theirnutrients through normal masculine activity.Due to women’sdi- minished heat “the femaleisless perfect than the male ...for if among animals the warm one is the more active,acolder animal would be less perfect thana warmer.”³⁴³ Thisimperfection creates an inefficiency that keeps women from using up all their nutrients and givesthem an excess which can be used to nur- ture the fetus, whereas men in their efficiency cannot do so. In this model, the menses are both araw material from which the fetus will be fashioned and the nutrient for the fetus, but they are not the femalegamete. The female gamete

 Galen, On the Usefulnessofthe Parts of the Body,2:628–9.  Galen, On the Usefulnessofthe Parts of the Body,2:628. 136 4GynecologicalTheoryinArabo-GalenicMedicine is aseed like the male seed, but thinner and colder and therefore less impactful. It is produced in the female testes (ovaries) and transmittedfrom them to the uterus through tubes that are analogous to the seminal vesicle.Galen claims to have observed this femalesperm. From his descriptions, it seems he is referringtoa mucus discharge in the uterus.³⁴⁴ This Galenic concept of the male and female genitals as inside-out versions of each other is reiterated by the medieval physicians of the Islamic world,³⁴⁵ as are modified versions of his two-seed theory.³⁴⁶

Infertility and its treatment in Greek medicine

Both the Hippocratics and Aristotle recognized that acouple’slack of children maybedue to infertility stemmingfrom either partner, male or female, or both.³⁴⁷ However,inthose authors’ works,male infertility was not fullymedical- ized in the sense that the physician might want to look for it,diagnose it and suggest acourse of action to correct it.AsRebecca Flemming writes:

[References in Aristotle to male infertility]are all essentiallytheoretical, about causes not cures (though GA 747a3–22 provides diagnostic advice); and the first does not even refer to specific explanationsfor male infertility.Similarly, the few explicit Hippocratic engage- ments with male reproductive failure (the Scythians in Airs WatersPlaces 21,³⁴⁸ and the

 M. Boylan, “Galen’sConception Theory,” Journal of the HistoryofBiology 19 (1986), 62.  Cf. Ibn Sīnā, Qānūnfīal-ṭibb,2:555–6=kitāb III: fann 21: maqāla 1: faṣlfītashrīḥ al-raḥim. IbnZuhr, Kitābal-taysīr (Rabat: Akādīmiyyat al-Mamlakaal-Maghribiyya, 1991), 340.al-Majūsī, Kāmil al-ṣinā‘afīal-ṭibb (Cairo:al-Maṭbaʻah al-Kubrā al-ʻĀ mira, 1877), 1:123. ‘Alī ibn Sahl Rabbān al-Ṭabarī, Firdaws al-ḥikma, 34.  B. Musallam, “The Human EmbryoinArabic Scientific and Religious Thought,” in The Human Embryo:Aristotle and the Arabic and European Traditions,ed. G. R. Dunstan (Exeter: Uni- versity of ExeterPress, 1990), 33 – 4.  R. Flemming, “The Invention of Infertility in the Classical Greek World: Medicine,Divinity, and Gender,” Bulletin of the HistoryofMedicine 87 (2013), 571.  The Scythians aresaid to have sterilized men by cuttinganervebehind the ear and thereby disruptingthe productionofsemen, which was thoughttooccurinitiallyinthe spinal column. Interestingly,this notion made its waynot onlyinto the medical commentary tradition, but also in the ḥisba tradition. In his manual for market inspectors,the 6/12th-century muḥtasib al-Shay- zarī,who practiced somewhereinthe Syria/Palestine /Egypt region, writes that one should not permit phlebotomists to bleed the veins behind the ears because that causes sterility.Hesays thereisadebateregarding whether cuttinginto the vein behind one ear onlyhas asterilizing effect. Kitābnihāyatal-rutba fi ṭalab al-ḥisba lil-Shayzarī (Cairo: Lajnat al-ta’līfwa’l-tarjama wa’l-nashr, 1946), 92. Greekantecedents to medieval gynecological concepts 137

enigmatic Aphorisms 5:63³⁴⁹)are never followed up therapeutically. All these authors are, of course, deeplycommitted to the importanceofthe male contribution to generation; but its dysfunction seems not to be medicalized.³⁵⁰

While these texts acknowledge the reality of male infertility,they have little to sayabout how to diagnose it and provide no information about how to remedy it.Inpart,this can be attributed to the perception that the easiest waytodeal with aman’sseeming lack of fertility is to have him attempt to reproduce with another woman. In Generation of Animals,Aristotle writes that one can test whether aman’ssemen is fertile by placing it in avessel with water and seeing if it sinkstothe bottom (in which case it is) or floats to the surface (in which case it is not).³⁵¹ However,healso writes, “in knowing the causes [of sterility] on the husband’ssidethere are various signs to be taken, but taking those thatare mostlyeasier, let him be observed to have intercourse with other women and to generate.”³⁵² Although this attitude is laterechoed in the Qānūn of IbnSīnā (d. 427/1037) as well as in al-Majūsī’s(d. 384/994) Kāmil al-ṣinā‘aal-ṭibbiyya with some modifications, medieval Arabic texts devote somewhat more attention to male infertility thandid Greek ones.³⁵³ By contrast,femalefertility and infertility is the subject of agreat deal of medicaldiagnostic, prognostic, and therapeutic interest in ancientmedicine.Re- markably, of the 1500 pharmacological recipes found in the Hippocratic corpus, 80%are gynecological and found in treatises devoted to women’sfertility.³⁵⁴ The

 The aphorism is “[V:62] Women whohavethe uterus cold and dense (compact?) do not conceive;and those also who have the uterus humid, do not conceive,for the semen is extinguish- ed, and in women whose uterusisvery dry,and very hot,the semen is lost from the want of food; but women whose uterus is in an intermediatestatebetween these temperaments prove fertile. [V:63] And in like manner with respect to males;for either,owing to the laxity of the body, the pneuma is dissipated outwardly, so as not to propel the semen, or,owingtoits density, the fluid (semen?) does not pass outwardly; or,owing to coldness, it is not heatedsoastocollect in its proper place(seminal vessels?), or,owing to its heat,the very same thing happens.” Trans- lation by Francis Adams.  R. Flemming, “The Invention of Infertility in the Classical Greek World: Medicine,Divinity, and Gender,” n. 23.  Aristotle, Generation of Animals II 7:747a, 3–7. Cf. IbnSīnā,al-Ḥayawān XVI=volume 8of al-Shifā’ (Cairo: al-Hayʼaal-Miṣ rīya al-ʻĀ mma lil-Taʼlīf, 1970), 2:409 Cf. Weisser, Zeugung,Verer- bung,und pränataleEntwicklung,152.  Aristotle, HistoryofAnimals VolVII-X,Tr. D. M. Balme (Cambridge:LoebSeries,Harvard University Press, 1991), 636b11.  al-Majūsī, Kāmil al-ṣinā‘afīal-ṭibb,2:467.  L. Totelin, Hippocratic Recipes:Oraland Written Transmission of Pharmacological Knowl- edgeinFifth- and Fourth-centuryGreece (Boston: Brill, 2008), 2, 197. 138 4Gynecological TheoryinArabo-Galenic Medicine

Hippocratic treatisesalso include dozens of tests to diagnose fertility or lack thereof. These textsdescribemanycausesoffemaleinfertility,which maybe categorized as follows: (1) The inability of semen to pass into the uterus duetoanarrowness or block- ageinthe passagebetween the vagina and the cervix, or due to the abnormal shape or position of the uterus.The blockage maybeattributed to the retention of “old” menses which have coagulated, having failed to be fully evacuated. (2)The inability of the uterus to retain the male semen, and the subsequent “slipping out” of the semen due to either the failureofthe uterus to “close” over the cervix or to an unhealthysmoothness and slipperiness in the uterus. This slipperiness maybecaused by an excess of moisture,coagulated blood, or ulcers. (3) An excess or deficiency of heat or moistureinthe uterus which “overcooks” or “dries out” the seed. (4) Dyskrasia, i.e. an overall humoral imbalance in the woman’sbody.³⁵⁵

Despite having avery different understanding of how reproduction occurs,both Aristotle’sand Galen’sdescriptions of the potential causes of female infertility are quite similar to the Hippocratic ones, and Aristotle seems to draw heavily upon the Hippocratic treatise On Barrenness.³⁵⁶ Aristotle describes the problem of the smooth, slipperyuterus,deficient moisture in the uterus, and general humoral imbalance.³⁵⁷ Galen explains thatmenstrual blood helps provide the uterus with texture, and lack thereof causes the uterus to be tooslippery to retain the semen.³⁵⁸ These all enter into the medieval medicalliterature as well. On Barrenness also mentions diagnostic measures for establishing infertility based on physical touch. “If the mouth of awoman’suterus or its neck becomes hard, this will be recognizedwhenshe palpates with afinger,and also if her uterus is turned aside towardher hip. When the case is such, do not give anysharp suppository – for if the mouth of the uterus ulcerates after becominginflamed, there is agreat danger that barrenness will result.”³⁵⁹ Note that,inthis phrasing,

 Hippocrates, Diseases of Women I, §11, Cf. Galen, On Hippocrates’ On the NatureofMan, §47–49.  A. Preus, “Biomedical Techniques for InfluencingHuman Reproduction in the Fourth Cen- tury B.C.,” Arethusa 8(1975), 246.  Aristotle, HistoryofAnimals VII.2–3(582–3). Cf. Galen, On Hippocrates’ On the Natureof Man, §48.  Galen, On the Anatomy of the Uterus, 81 (chapter10).  Hippocrates, On Barrenness §230.Translation by Paul Potter. Hippocrates Vol. X, 367. Greek antecedents to medieval gynecologicalconcepts 139 it appears that the femalepatient herself conducts the intimate examination to find out whether the cervix is hard.While it seems that this informationismeant to be communicated to the medicalpractitioner,itisnot the practitioner himself who conducts the manualexamination. Similarly, in On Barrenness the medical practitioner is instructed to preparesitz-bathsand pessaries for the patient,to layout blankets for her,and to make sure she does not burn herself, but it is the patient herself who inserts the pessary.³⁶⁰ On Barrenness mentions several categoriesoftreatments for thosediagnosed with infertility:eating certain foods the utilityofwhich is not always explained, clearing the passagebetween vagina and mouth by means of sitz-baths, pessaries, and fumigations, or introducing probes to changethe width of the vagina; or changingthe textureorenvironmental qualities of the uterus by inserting “fer- tilizing” substances or using probes.Some of the ingredients in Hippocratic fertility recipes are known to have been attached to specific qualities, for example boiled foods werethoughttomake the bodymore soft and moist,red wine to make it dryer and harder,etc. Other ingredients were associated with purgation and excretion: puppy and octopus meat,for example, werebelieved to have a laxative effect.³⁶¹ In On Barrenness,botheating boiledpuppies and fumigating with them are recommended for removingblockagesinthe passagetothe uterus.³⁶² Other fertilityingredients are thosefound in perfumes, which werethem- selvescloselyassociated with sexual stimulation and intercourse in Greek antiquity.³⁶³ These includefrankincense, myrrh, cinnamon,cassia and styrax,³⁶⁴ all of which alsoplayaprominent role in the medieval period. Castoreum (a substance extracted from the glands of beaverforeskins) had asimilar use and was associated almostexclusively with “women’smedicine.”³⁶⁵ KnowninPersian and

 Ibid., §221.  Hippocratic Recipes,198.  Hippocrates, On Barrenness §218 and 230.  Totelin explains “Perfumes playedanimportantroleinsexual preliminaries in ancient Greece, and in Assembly Women,Blepyrus plaintively asks his wife οὐχὶ βινεῖται γυνὴ κἄνευ μύρου;(Can’tawoman fuck without perfume?). Perfumes appear frequentlyinthe Hippocratic gynaecological recipes ...[many] pessaries in the Hippocratic collections of recipes, [had] to be dipped in perfume before beingapplied. This act of dippingapessary in scented oil maybethe equivalent of anointingthe genitalia and other parts of the bodybeforesexual intercourse; it serves as apreliminary to penetration. The perfume that is most commonlyused in the Hippo- cratic recipes to facilitatethe insertion of apessary is roseoil. This again might not be acoin- cidence; ῥόδον (rose)was aslangterm for the female genitalia throughout antiquity.” Hippocrat- ic Recipes,204.  Totelin, Hippocratic Recipes,150  Ibid., 161. 140 4Gynecological TheoryinArabo-Galenic Medicine

Arabic literature as jundbādastar,castoreum continued to be particularlyassoci- ated with the treatment of uterine problems from ancient Greek antiquity through the modern period. (Itcontinued to be used in the West until the early20th century to treat spasms and hysteria and to inducelabor after intrauterine fetal death.³⁶⁶)Others ingredients are associated with fertilitydue to their having shapes or names reminiscent of sexual organs,such as stag horns, figs, radishes, myrtle, squirting cucumber,and gourds.Weknow how they were viewed because manyofthe Hippocratic ingredients alsoappear in ancient plays whereitisclear they have sexual connotations. Not all of these ingredients continued to have sexual association in later periods. Thisistrue of celery,for example, which in the ancient Greek comedies represents femalesexual organs, or barley and pennyroyal which connoted pubic hair.(Of all these ingredients, onlypennyroyal is currentlyknown to have chemical effectsofpharmacological value. The essentialoil of pennyroyal is lethallytoxic and was used as an emmenagogue and abortifacient until the early20th century. It also has muscularand hallucinogenic effects.) Other ingredients werebelieved to open the uterus and expel what it retained, whether menstrual blood which needed to be purged or adead fetus which needed to be forced out.The drugs associated with this purgation included pennyroyal, silphium, squirting cucumber, and gourds.³⁶⁷ In medieval texts, the squirting cucumber in particularbecame associated with these functions.³⁶⁸ It is alsoknown as wild cucumber,orecballium elateri- um,orinArabicasqiththā’ al-ḥimār, qiththā’ barrī or ‘alqām.³⁶⁹ Of course, in the Arabic texts,the repertoire of materia medica is significantlyexpanded.

 Michael J. O’Dowd, TheHistoryofMedicationsfor Women: materia medica woman (New York: Parthenon Pub. Group, 2001), 88–89.  Totelin, Hippocratic Recipes,214 – 19.  It appears,for example in Ibnal-Jazzāral-Qayrawā nī’s Ṭibb al-fuqarā’ as an abortifacient in his chapter “On Treatment of Diseases of the Uterus,MenstrualRetention, and BringingDown the Fetus,” and in his Zādal-musāfir in threeplaces (emmenagogue, abortifacient,and ingredi- ent in atreatment for gout). Ibnal-Jazzāral-Qayrawānī, Ṭibb al-fuqarā’ wa’l-masākīn (Tehran: Muʼassasah-ʼiMuṭālaʻāt-iIslāmī,Dānishgāh-i Tihrān, 1996), 158. Ibnal-Jazzāral-Qayrawānī and G. Bos, Ibn al-JazzāronSexual Diseases and Their Treatment: acritical edition, Englishtrans- lation and introduction of Book 6ofZādal-musāfir wa-qūtal-ḥ āḍ ir (London, KeganPaulInterna- tional, 1997), 141, 195,235.  See Dioscorides and T.A. Osbaldeston, Dioscorides De Materia Medica: aNew EnglishTrans- lation (Johannesburg:IBIDIS, 2000), 707(Bk 4:155). Ibnal-Jazzār, Ibn al-JazzāronSexual Diseas- es and Their Treatment,291.According to John Riddle, modern medical testing has confirmed the contraceptive but not the abortive qualities of the squirtingcucumber.J.Riddle, Contracep- tion and Abortion fromthe Ancient Worldtothe Renaissance (Cambridge:HarvardUniversity Press, 1992),54. Greekantecedents to medieval gynecological concepts 141

Lack of menstruation is also acknowledgedinancient and medieval texts as either an underlying cause or asign of infertility.These textsoften depict amenorrhea as aform of constipation, rather than menstrual absence.The woman produces menses, but the blood is retained by the uterus rather than evacuated from it,which results in infertility because the male semen is either physically blocked from reachingthe uterus,orbecause the retained menses have con- gealed or rotted resulting in atoxic uterine environment.The first step, therefore, to promotingfertility is to supplyanemmenagogue to “bringdown” the retained menstrual blood from the uterus. Alarge number of the gynecological recipes, both ones associatedwith fertility and ones thought to be contraceptives, are described as promotingthis menstrual “regularity.” In the medieval period, the association of bleeding (in the form of menses) with the return of fecundity to barren women is so strong that virtuallyall medieval commentaries on the Qur’ān, and likewise Tales of the Prophets, describe the restoration of fertility to the barren wivesofAbraham and Zechariah in terms of the sudden onset of menstruation.³⁷⁰ Importantly, whereas todaya“missed period” is the classic first indication of pregnancy, the Greek physicians (and, it seems, later physicians as well) did not seem to view disrupted menstruation in quite the samemanner, even though they werewell aware that amenorrhea is asymptom of pregnancy.³⁷¹ This means that when anon-menstruating woman was givenanemmenagogue or un- derwent asurgical proceduretotriggeramenstrual cycle in the hopesofher get- ting pregnant,itispossible that the resulting blood was in fact an abortion. One method of treatinginfertility was the insertion of wood, lead, or tin probes through the vagina and into the uterus.³⁷² Hippocrates suggests this form of treatment to cure amenorrhea and initiate amenstrual cycle and thus afertility cycle,towiden the vagina or dislodgeablockage in the uterus,orto changethe textureofthe uterus and make it lesssmooth and thereby enable it to retain semen more easily. We have encountered the use of such aprobe in chapter 1, in the caseofMagdalena from 17th-century Catholic Spain. If con-

 E.g., IbnKathīr, Qiṣaṣ al-anbiyā’, glosses Q. 21:90, which refers to God fixing Zakariyyā’s wife for him, and explains that it means that previouslyshe did not menstruateand then God made her do so. Cf. al-Shaybānī and IbnKathīr’s Tafsīr on Q. 21:90and Ibnal-Jawzī’s Ibnal-Jawzī’s Zādal-masīrfī‘ilm al-tafsīr on Q. 11:70.  H. King, Hippocrates’ Woman: Reading the Female Body in Ancient Greece, 32 and Rebecca Flemming, Medicine and the Making of Roman Women: Gender,Nature, and Authority from Celsus to Galen (New York: OxfordUniversity Press, 2000), 162. Cf. Hippocrates’ On Barrenness §215.Al- though see Aphorisms IV:61.  Hippocrates, Superfetation, §29; On Barrenness, §217,221,228,238, 244. 142 4Gynecological Theory in Arabo-GalenicMedicine ducted earlyinapregnancy, before the existenceofthe pregnancywas evident to the woman, such probingwould certainlyhavecaused an abortion, which would have looked like the onset of menstruation.³⁷³ The probe could also cause further damagetothe internal organs, thereby creatingevenmoreimpedi- ments to fertility. In Arabo-Galenic medicine,probes or hooks (ṣināra)appearin the context of treating ratq, the condition in which the vagina is toonarrow or is blocked by excess tissue. Throughout Greek medicalliterature, and subsequently, there are substances and even surgical techniquesthatare mentioned both as abortifacients and as means for promotingfertility. It could be argued that this is simply duetothe fact that manysubstances,such as wine, honey or frankincense, had multiple medicaluses or werethoughttobepanaceas.However,certain substances such as wormwood, pennyroyal, and fenugreek werenot simply general pana- ceas but rather seem to have maintainedmillennia-long reputations as “women’sdrugs.” From abiomedical point of view,the conflation of abortifacients with fertility agents has apeculiarlogic. Both first-trimester miscarriages and the beginning of the reproductive cycle (in the form of menstruation) are characterized by vaginal bleeding.Moreover,amenorrheamay be either asymptom of pregnancyorasymptom of hormonaldisruption associated with infertility.³⁷⁴ Therefore, atreatment which resulted in vaginal bleeding mayhaveinduced either menstruation, or hemorrhage, or fetal death or uterine contractions so as to cause an abortion. Moreover,because the fetus is so small in the earlystages of pregnancy, the different phenomena would have been difficult to distinguish. Therefore, it seems likelythat sometimes when women thoughtthey weretaking substances to begin amenstrual period so as to promotefertility, in fact they wereprematurelyending an undiagnosed pregnancy. There were, of course diagnostic tools for determiningwhether awoman is alreadypregnant.For example, On Barrenness offers the following test: “Grind redocher and anise very fine, dissolve in water,give(sc. to drink), and let the woman sleep. If colic comes on around her navel, she is pregnant: if this does not happen, she is not.”³⁷⁵ The same test,but with hydromel instead of ocher,isproposed in Hippocrates’

 A. Preus, “Biomedical Techniques for InfluencingHuman Reproduction in the Fourth Cen- tury B.C.,” 249.  Etienne vandeWalle et al., Regulating Menstruation:Beliefs,Practices,Interpretations (Chi- cago, University of Chicago Press, 2001). This book explores the notion that discussion of the medical goal of “regulating” menstruation, in manycultures and periods throughout the world, has served as adevicefor communicatinginformationabout abortifacients.  Hippocrates, On Barrenness, §215.TranslationbyPaulPotter. Hippocrates Vol. X, (Cam- bridge,MA: HarvardUniversity Press,2012), 341. Greek antecedents to medieval gynecological concepts 143

Aphorisms 5:41.This diagnostic tool alsoappears frequentlyinmedieval manuals, together with explanations as to whythe test is effective (these explanations are not present in the Hippocratic treatise).³⁷⁶ Throughout antiquity and into the medieval period, the treatment of infertility related in some respects to the medicaltheories surroundingconception and femaleanatomybut did not altogether accord with them, since treatments were premised on ideas that stood apart from the theory.For example, diagnostic interest in menstrual blood and therapeutics intended to alter the qualities of menstrual blood remained aconstant of medieval treatments of infertility,even though the significance of menstruationtothe reproductive process was amatter of intense dispute and subject to diverse medical opinions. The importance of introducing pleasant smells into the uterus,for the sake of improvingormaintain- ing reproductive health, remained constant,evenafter the medical community had come to the consensus that the uterus cannot moveand does not have the olfactory capability to be attracted or repelledbyodors. The disjuncturebe- tween conception theory and therapeutic practice can alsobeseen in attitudes towardmale infertility,for though it was theoreticallyacknowledgedthat men could be the sourceofinfertility,itwas never fullyembraced therapeutically. Moreover,therapeutic techniques werenot limited to or grounded in conception theory.Wesee this, for example, in the emphasis on the use of sexuallysugges- tive ingredients to promotereproductive health. Allofthis indicates that while treatment techniques could find justification in prevailing scientific theory, they were not dependent upon it.

 E.g. ‘Alī ibn Sahl Rabbānal-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,38and al-Rāzī, al-Ḥāwī fī al-ṭibb vol. 3, bk. 9:51.InafascinatingLatin account, De Secretis Mulierum of Psudeo-Albertus Magnus (latethirteenth-century), the author describes this test as beingsurreptitiouslyadmin- istered, as ameans of uncoveringthe truth when awoman would otherwise wish to the conceal whether or not she is pregnant.Hewarns that “some women, however,are so clever and so awareofthe trick that they refuse to tell the truth.” H.R.Lemay, Women’sSecrets: ATranslation of Pseudo-Albertus Magnus’s “De Secretis Mulierum” with Commentaries (Albany: StateUniversity of New York Press, 1992),125. 144 4Gynecological Theory in Arabo-GalenicMedicine

Etiologyand treatment of female infertility in Arabo-Galenic medicine

Infertility in the Firdaws al-ḥikma (Paradise of Wisdom)

What follows is an analysis of the discussion of infertility found in the Firdaws al-ḥikma (Paradise of Wisdom),written around the year 236/850bythe physician ‘Alī ibn Sahl Rabbānal-Ṭabarī,aSyriac Christian convert to Islam who livedin Persia and Iraq. The relevant sections of the Firdaws al-ḥikma have the advant- ageofbeing both comparatively succinct and representative of the sorts of discussions of infertility found in manysubsequent Arabo-Galenic medical works. Al-Ṭabarī begins his discussion of diseasesofthe uterus with the following list of gynecological concerns.

Amongthe greatestofmaladiesafflictingthe uterus areinfertility,the slippingout of the seed, the miscarriage of the fetus, uterine suffocation, hemorrhageofmenstrual blood, retention of menstrual blood, tumors,and dyscrasia.³⁷⁷ Forifthereisanexcessofheat the seed is burned. An excess of cold freezes it.Ifthereisanexcessofmoisture, or the ability to hold on³⁷⁸ to the seed is weakened, the seed slips out.Ifthereisanexcess of dryness it desiccatesand dries up the seed.³⁷⁹

Al-Ṭabarī’slist begins with infertility,and then proceedstoenumerate avariety of concerns ending with dyscrasia which, as he explains, leads to the “seed”– either the gametes or embryo – failing to thrive.Inthis list al-Ṭabarī seems to categorize infertility as both an illness in and of itself, and as asymptom and consequenceofother conditions.Hedoes not fullydifferentiatebetween causal factors for infertility,etiological types of infertility,and comorbidities associated with infertility.These topics are all discussed together. Al-Ṭabarī begins by explaining the danger an adverse environment poses to the “seed.” Like aliteral plant-seed, the human seed can onlythrive in environments with appropriate levels of warmth and moisture. Al-Ṭabarī does not specify whether “seed” refers to the embryoitself or to the male or female gametes

 Cf. al-Majūsī, al-Kāmil,1:388 and Weisser, Zeugung,Vererbung,und pränatale Entwicklung, 158.  misāka =holdingin, retention. Ihaveavoided translatingthe word as retention onlybecause in this particular contextitwould be confused with iḥtibāsal-dam,retention of the (menstrual) blood. Misāka was also the word used in the legal texts to refertourinary and fecal continence.  al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,273.Cf. IbnSīnā,Qānūnfīal-ṭibb, 2:562=kitāb III: fann 21: maqāla 1: faṣlfīdalā’il al-bard fī al-raḥim. Etiology and treatment of female infertility in Arabo-Galenic medicine 145 prior to conception. Indeed, his guidance is not constructed upon aparticular understanding of what constitutes the female contribution to the embryoorof the stages of embryonic development.Rather,his guidance is based both on humoral notionsofachieving balance, and on analogical inferences about what conditions cause plant seeds to thrive or die. The emphasis on the harmful effects of excessive heat,cold, moisture, and dryness is found in virtuallyall subsequent discussions of the pathologies of the uterus in Arabo-Galenic medicine. Such conditions are largely depicted as cura- ble, through fumigations and foodstuffs meant to restore the correct balance of heat and moisture.³⁸⁰ Sometimes these foodstuffs are described as directlyim- pacting heat,and there are “warming” foods or “cooling” ones. At other times the treatments are meant to aid in the production of one of the four humors: blood (characterized by heat and moisture), phlegm(cold and moisture), yellow bile (heat and dryness), or black bile (cold and dryness). Excessive heatand cold in the uterus,inadditiontocreatinganinhospitable environment for the seed, are also depicted as potential impediments to conception because they affect the quantity and viscosity of menstrual blood. Menstrual blood that is too thin or thick does not flow out properly, and thus becomes stuck in the uterus or clogsblood vessels.³⁸¹ This old blood can impedepregnancyby coagulating into abarrier near the cervix, thereby preventing semen from reaching the uterus,orbycoatingthe wall of the uterus thereby making it too slippery to retain the embryo, or by rottingand producing noxious fumes which poison the uterine environment.Infertility duetothis menstrual retention is treated by ingesting drugs,applying pessaries, and using fumigation techniques, the purposes of which are to make the blood flow out more easilyand evacuate from the womb. Al-Ṭabarī explains that excessive moistureand other conditions can also cause infertility by making the uterus too smooth for the seed to adhere within the womb. He writes, “Among the thingsthatprevent conception are conditions in the uterus itself,such as ulcers,stiffness, excessive coarseness,orviscous phlegm. These make it slippery such thatitcannot retain the seed in it.”³⁸² The concern that conditions within the uterus could make it physicallyunable to keep either semen or the embryofrom slipping out is found throughout both Greek and Arabic texts.When this slipperiness is attributed to excessive moisture, it can be corrected by having the woman take measures to bring

 al-Ṭabarī, Firdaws al-ḥikma, 40.  Cf. Ibn al-Jazzār, Ibn al-JazzāronSexual Diseases and Their Treatment, 263.  al-Ṭabarī, Firdaws al-ḥikma, 274. 146 4Gynecological Theory in Arabo-Galenic Medicine about “dryness.”³⁸³ Such measures include ingested pills and decoctions,compresses,enemas, pessaries, and fumigations meant to absorb or draw out excess moisture. Therecipes for these pessaries and fumigations, particularlyasde- scribed by IbnSīnā,oftencombine one or two dozen ingredients.³⁸⁴ Slipperiness can also be attributed to an unreceptive texture in the uterinewall, aresultofthe scarring over of previouslyhealed ulcers and abscesses. While ulcers,tumors, and wounds to the uterine wall are considered to be treatable by medieval authors, the infertility that mayresultfrom them is usually not.³⁸⁵ Al-Ṭabarī continues his description of thingsthat cause infertility by listing conditions that block the semen’spath to the uterus.

Also, blood or afleshygrowth which blocks the path [to the uterus], the uterus disappear- ing from its place,³⁸⁶ or excessive fat in the part of the diaphragm nearest to the intes- tines.³⁸⁷

These conditions are treated by diet,topromotefat loss, as well as surgery to removegrowths in the vaginal canal.³⁸⁸ Al-Ṭabarī’sdiscussion of infertility also addresses the problem of miscarriage. In some respects,the failuretoconceive and the failuretosustain apregnancy are not entirelydifferentiated, especiallywhen conception failureisattrib- uted to the uterus failingtoretain seed. Conflation between miscarriageand this kind sourceofinfertility is typical of some othermedieval discussions as well, particularlyinthe Qānūn.³⁸⁹ Kuenycharacterizes these discussions as physicians’“near-obsessive interest in concocting ways to prevent miscarriage” based on their belief in women’scarelessness and inadequacy.This interpretation is amistake. The physicians do not pathologize healthypregnancies so much as they elide over the distinction between awoman failingtoconceive because the semen or embryoslipsout of her uterus rather than embedding in it, and awoman failing to carry to term whenthe fetus detaches from the uterus and “falls out.” In discussing the prevention of miscarriage, the authors are providing therapeutic advice to treat what is, in theirview, avariant form of infertility.

 Al-Baladī, Tadbīral-ḥ abālā’, 28–29.  E.g. IbnSīnā,Qānūnfīal-ṭibb, 2:577–8=kitāb III: fann 21: maqāla 2: faṣlfīḥuqna jayyida  IbnSīnā,Qānūnfīal-ṭibb, 2:565=kitāb III: fann 21: maqāla 1: al-tadbīrwa’l-‘ilāj  I.e. uterine prolapse. Cf. Ibnal-Jazzār, Ibn al-JazzāronSexual Diseases and Their Treatment, 177.  al-Ṭabarī, Firdaws al-ḥikma, 274.  al-Zahrāwī, Albucasis on Surgeryand Instruments,457.  Cf. Ibn Sīnā, Qānūnfīal-ṭibb, 2:577 = kitāb III: fann 21: maqāla 2: faṣlfīḥafẓ al-janīn Etiology and treatment of female infertility in Arabo-Galenic medicine 147

Al-Ṭabarī views miscarriageprimarilyasthe dislodging of the embryofrom the uterus.Childlessness which is aresult of miscarriageorthe inability to retain the embryoistreated by shielding the pregnant woman from physical or psychological experiencesormalevolent forces which can cause her to moveinaway which might jolt the embryo. At various timesinthe pregnancy, the connection between the embryoand the uterus is seen as particularlyfragile.

Miscarriagecan also resultfromexcessive cold or indigestion, or grief, or acoarse wind, or an excess of phlegm in the veins of the uterus, or from ajump from aheighttothe ground, or ablow,orastrong jolt.³⁹⁰

Elsewhereinthe Firdaws al-ḥikma,al-Ṭabarī explains:

[Miscarriagemay resultfrom] diarrhea,orablow to her breast,orfromasevere shock or fright,orbecause she hears an alarmingnoise, or duetoexhaustion or severe misfortune or because she approaches things which by their naturesabort the fetus.Amongstones and the likethereare those which protect the fetus and those which eject it fromthe womb, whether it is alive or dead. Youwill find this in its own chapter...Hippocratessays, “Preg- nant women, if they need treatment should receive treatment in the fourth through seventh month, but not beforeorafter that.” The reason for his statement is that duringthe first month the fetus is akin to aweakfruit which can be dislodgedbyaslight wind or movement,but in the eighth month it is akin to ripe fruit which is not dislodgedbyaslight wind or movement.³⁹¹

Here, al-Ṭabarī lists avariety of direct and indirect causesofmiscarriage.³⁹² Drawing on an imageand timeline found in Hippocrates, he notes that,inthe early stages of pregnancy, the fetus is attached like an “unripe fruit” which can thus be easilydislodged. Listed among the misfortunes which can cause a miscarriageare bodyblows and emotional blows. It is not entirelyclear from these passages whether the emotional blows are dangerous because psychological distress itself triggers the miscarriage, or whether the physiological assumption is that,when enduringpsychological distress,the internal organs physically moveorshudder,and it is this movement which physicallydislodgesthe embryo. Note that here diarrheaisthoughttobeabletocause amiscarriage, and

 al-Ṭabarī, Firdaws al-ḥikma, 274.  al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,39–40.Cf. Ḥunayn ibn Isḥāq, Kitābal-mawlūdīn (Baghdad:Majma’ al-Lugha al-Siryāniyya, 1978), 38. Ibn al-Jazzār, Ibn al-JazzāronSexual Diseas- es and Their Treatment, 285–6and al-Rāzī, al-Ḥāwī fī al-ṭibb, vol. 3, bk 9:49–50 and al-Baladī, Tadbīral-ḥabālā’, 15–16.  Cf. Soranus, Soranus’sGynecology 45 – 46,which has avery similar list. 148 4Gynecological Theory in Arabo-GalenicMedicine it is not uncommon for bowel movements to be associated with anguish or strongemotional responses.³⁹³ In the middle of this passageabout the physical and psychological triggers of miscarriage, al-Ṭabarī includes adescription of stones and plants which, without being ingested, can also triggermiscarriageorprotect women from miscar- rying.

The head of the hospital of Jundīshāpūrinformedmethat there is, amongafamilyinthe village of Ahwaz,³⁹⁴ astone which protects the fetus if it is tied to the pregnant woman. Moreover,wehaveheard that,according to the son of areveredChristian woman in Rayy,ifthis pregnant woman with this stone inadvertentlyencounters another pregnant woman, the one whodoes not have the stonewith her will miscarry.Daylamite women inform me that this protective stone is widelyavailable in Jīlān. Dioscorides mentionsaplant called the fawflāfīqūs (=qawqlāqimūs? =cyclamen?), which resembles the bindweed leaf. According to his information, it is athorn which is placed on wounds ...ifthis leaf is af- fixed to awoman whoisnot pregnant,she then conceives. But,ifapregnant woman glan- cesatit,then she miscarries. Pregnant womenmust be careful duringthe eighth month because if they miscarry thereisarisk they will die, and should thereforeavoid acute ex- haustion, poor food, excessive washing, and sneezing.³⁹⁵

In his description of these stones and plants that can exert power on women’s bodies withoutbeing ingested, al-Ṭabarī cites as authorities female informants and male intermediaries for femaleinformants. He mentions aphysician at the famoushospital of Jundīshāpūr, who himself refers to the folk knowledge of people in the surrounding villages. He also cites the son of an unknown Chris- tian woman, and then refers to some Daylamitewomen with whom he appears to have had direct contact.Each of these informants refers to astone or plant that affects women who encounter it.The stone serves as asort of shield, not only protecting pregnant women from miscarriageand deflecting the threat posed by other pregnant women, but making the threat rebound upon the woman lacking the stone.

 Cf. Ibid., 38: “Forthe seed is evacuated through fright,sorrow,sudden joy and, generally, by severe mental upset; through vigorousexercise, forceddetention of the breath, coughing, sneezing, blows,and falls, especiallythose on the hips;byliftingheavy weights,leaping,sitting on hard sedan chairs,bythe administration of drugs,bythe applicationofpungent substances and sternutatives; through want,indigestion, drunkenness,vomiting, diarrhea; by aflow of blood fromthe nose, from hemorrhoids or other places; throughrelaxation due to some heating agent,through marked fevers, rigors,cramps and, in general, everythinginducing aforcible movement by which miscarriage maybeproduced.”  I.e., near the hospital in Jundīshāpūr.  Al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,39–40. Etiology and treatment of female infertility in Arabo-Galenic medicine 149

As Manfred Ullmann notes,interest in the healing properties of stones,magical cures, and “sympathetic” cures is not divorced from “rational” medicine in Arabo-Galenic writings, but is it more prevalent in gynecology than in other areas of medicine.³⁹⁶ It is not surprising,therefore, that the one magic square depicted in the entire Firdaws al-ḥikma is to be found in the section on childbirth.³⁹⁷ (This is an earlyArabic example of the ancient 3x3buduh square, with the numerals in the rows and columns adding up to 15,and the numbers 2, 4, 6, and 8atthe corners.³⁹⁸)Ibn Sīnā too mentions manynon-rationalrem- edies for gynecological problems.³⁹⁹ Treatments involving the ingestion of the reproductive powers of animalsare particularlycommon in the medieval (as well as ancient) gynecological literature. Forexample, IbnSīnāsuggests that awoman experiencing infertility drink elephant urine at the time of coitus.⁴⁰⁰ The 7th/13th-century Egyptian guide to pharmacy, Minhājal-dukkān,describes using an enema made of rabbit rennet for hasteningconception,⁴⁰¹ an ingredientwhich does not appear in other recipes in the book, but which is alsorecommended for fertilitypurposes in Di- oscorides’ Materia Medica.⁴⁰² Similarly, a5th/11th-century book of pharmacy made by the physicians in the ‘Aḍudī hospitalinBaghdad, based on the pharmacological work of physician SābūrIbn Sahl (d. 255/869), explains that “if awoman drinks some of the testicle and the rennet of ahare, she will be blessed with amale child.”⁴⁰³ Treatments of infertility sometimesalsoreflectthe influenceofparticular conception theories. The “two-seed” theory of conception, which posited that women secreteasemen-likeseed, implied atherapeutic corollary:toincrease

 Ullmann, Islamic Medicine, 109 and Medizin im Islam, 253.  al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb, 281.  On the history of the buduh magicsquare, includingits obstetrical uses see, V. Porter,L. Saif, and E. Savage-Smith “Amulets,Magic, and Talismans” in Companion to Islamic Art and Ar- chitecture (Wiley-Blackwell, 2017), 538.  IbnSīnā,Qānūnfīal-ṭibb, 2:566 = kitāb III: fann 21: maqāla 1: al-tadbīrwa’l-‘ilāj.  IbnSīnā,Qānūnfīal-ṭibb, 2:566 = kitāb III: fann 21: maqāla 1: al-tadbīrwa’l-‘ilāj.  L. Chipman, TheWorld of Pharmacy and Pharmacists in Mamluk Cairo (Leiden: Brill, 2010), 262. Al-Rāzī toorecommends it for the same purpose. Al-Ḥāwī, 9:58. Cf. al-Majūsī, al-Kāmil, 2:436.  This is one of onlythree ingredients which Dioscorides recommends to aid conception, but it is also acontraceptive.Hewrites that rabbit rennet “aids conception, but if drunk after menstruation, it causes barrenness.” Translation from J. Riddle, Goddesses,Elixirs, and Witches: Plants and Sexuality throughout Human History (New York: Palgrave Macmillan, 2010), 69.  IbnSahl and O. Kahl, SābūrIbn Sahl’sDispensatoryinthe Recension of the ʿAḍudī Hospital (Leiden: Brill, 2009), 210. 150 4Gynecological TheoryinArabo-Galenic Medicine the likelihood of conception, women oughttobestimulatedsoastosecrete more seed, and thereforehusbands should make efforts to become more satisfying lov- ers. IbnSīnāadvises:

There is no shame for the physician if he speaks about enlargingthe penis,narrowingthe entrance, and female sexual pleasure, because these two things occasion the production of offspring. Often, asmall penis becomes aconcern because the woman cannot be pleasured by it and so she does not ejaculate. Sinceshe does not ejaculate thereisnochild. It may also become aconcern because it might alienatehis wife and she might seek someone other than him. Likewise, if she is not narrow,her husband will not satisfy her and she toowill not satisfy her husband, and this must all be offset.Similarly, sexual pleasureen- couragesquick ejaculation, and in most cases of women whose ejaculation is delayed, and whoare left with their desireunsatisfied, there is no offspring.⁴⁰⁴

In this wayIbn Sīnā argues that aphysician mayneed to discuss sexual matters or recommend sexuallyenhancing alterations, in order to protect against infertility,aswell as concupiscence. The second theory of conception is sometimes called the “seed and soil” model. Accordingtothis theory,male sperm constitutes the onlyormain gamete, and the role of the femalebodyistoserveasaspace to grow and nourish the embryo. This imageisfound in the Greek tradition, includinginHippocratic writings, and seems to have coexisted with the two-seed theory of conception. This same is true in Ayurvedic texts such as the Charaka Samhita.⁴⁰⁵ The two co- exist in the Islamic tradition as well. An example of reproductive organs being compared to atilled field can be the found in the Qur’ān, in apassagefrequently cited in legal discussions of intercourse. “Your women are atillagefor you; so come unto your tillageasyou wish” (Q.2:223). Asimilar imageisevoked by the ḥadīth,cited previously, “Beware of the barren woman, for one married to her is like aman ensconced at the topofawell, who waters his land daily, but whose land does not bloom, the stream [of water] is not absorbed.⁴⁰⁶ The classicistAnn Ellis Hanson has argued that this “seed and soil” model is also reflected in the practice of treatinginfertile women with fertilizer-likesub- stances.Such methods of treatment are prevalent in Greek medicine and are closelyassociated with gynecology. Forexample, the following recipe comes from the Hippocratic text, Diseases of WomenI:

 IbnSīnā,Qānūnfīal-ṭibb, 2:549–50 = Kitāb III: Fann 20: maqāla 1: faṣlfī‘udhr al-ṭabībfī māyu‘allim min al-taldhīdh.  P. Râyand H.N.Gupta. CarakaSamhita;AScientific Synopsis (New Delhi: NationalInstitute of Sciences of India, 1965), 7–8.  Ibn Ḥabīb, Kitābadab al-nisā’ al-mawsūmbi-kitābal-ghāya wa’l-nihāya,152–3. Etiology and treatment of female infertility in Arabo-Galenic medicine 151

If the mouth is closed, let her applyfig juice until it opens;and let her wash herself immediatelywith water. And crush hawk’sexcrement in sweet wine and give to drink whilst she is fasting, and let her immediatelysleep with her husband. Or,whenever the menses arestopping, crush excrement of the Egyptian goose in roseperfume, and anoint the vagina and let her sleep with her husband.⁴⁰⁷

The fig juicehas symbolic associationswith fertility and the excrement usedin this recipe has literaluse as agricultural fertilizer.Inthe Hippocracticcorpus, mention of dreckapotheke (“dungtherapy”)islimited to gynecological texts.⁴⁰⁸ In Arabic texts, the use of dungisnot limited exclusively to gynecological and fertility-related matters,but it is particularlypronounced in those areas.

The intersectionofinfertility with othergynecologicalconcerns

Female infertility is depicted in medieval medicaltextsasthe potential consequence, or byproduct,ofseveral other gynecological conditions and concerns, concerns which are also of great interest to physicians for reasons other than infertility. As aresult, discussions of infertility alsoveer off into several other distinct,but intersecting,medicalareas.These includethe ascertainment of fetal sex and development,diagnosis of menstrual retentionand uterinesuffocation, and assessment of male and female reproductive history and prospects. An example of these intersectingdiscussions can be seen in the continuation of apassagefrom the Firdaws al-ḥikma on the damageinflicted on the seed by excessive heat and cold. Al-Ṭabarī writes:

Hippocratessays, if the breasts of pregnant women shrivel, they miscarry.Ifone breast shrivels,she miscarries the fetus which is on the side of the shriveled breast.Ifthe color of the womanisgood, that indicates that the fetus is male. If her color is ugly it indicates that the fetus is female.⁴⁰⁹ The reason for [Hippocrates’]statement is that the male is warm and the female is cold,and warmth improves coloring whereas cold makesituglier and greener.⁴¹⁰

Herewesee the influenceofthe Hippocratic notion of the connection between the breasts and the bifurcated uterus,onto which has been mapped the Aristo- telian concept thatthe male fetus is warmer (thereby providinghealthier color-

 This translation is from Hippocratic Recipes,213.  Ibid., 212.  Hippocrates, Aphorisms,V.38.  al-Ṭabarī, Firdaws al-ḥikma, 37.Cf. al-Baladī, Tadbīral-ḥabālā,18. 152 4GynecologicalTheory in Arabo-Galenic Medicine ing) and the femaleiscolder (producingasicklycolor in the mother). The discussion of infertility and the proper environment for the seed moves into adiscussion of miscarriagewhich is intermixed with adiscussion of fetal sexdiagnosis. Conception, pregnancy, and sex differencesare all part of the samecontinuum of concerns and even the same continuum of diagnosis.Wesee this even among physicians with substantial disagreements as to the causes of sexvariation,⁴¹¹ and even among those who express skepticism about the connection between heat and gender. Thiscontinuum of infertility and fetal sex diagnoses is articulated by al-Rāzī,accompanied by his characteristic caveats. In his experience, manymen and women do not conform to humoral type.

Signs of conception: Apollonius said: if the menses areretained without fever or trembling or shortness [of breath]then she is pregnant.For menses which areretained duetoillness present with the above[symptoms], but if the uterus shows no [sign of illness] then she is indeed pregnant.Ifshe is pregnant with amale, then her color is good; if with afemale then her colorispallid in comparison to her usual color prior to conception, for the female is colder while the male is warmer.This is so onlyingeneral, for it is possible for someone pregnant with afemale [fetus] to improveher regimen after conception thus improvingher color, and the oppositeispossible too.There aremanyother signs of amale [fetus], such as havingmanyand forceful movements.These signs are also onlygeneral ones,for if she is carryingavery weakmale or atremendouslystrong femaleone it is possible that [the female fetus’s] movements will be greaterand moreforceful. [Galen?] said: the fetus cannot be cold unless both the sperm of the man and the uterusofthe mother arecold at the same time. But as for me [al-Rāzī], Iconsider this to be ridiculous because it arbitrarilyassigns categories for nature’sactions ...but we have indeed seen manywomen with humoral temperaments that arewarmer than are those of manymen. This indicates masculinity and femininity are not determined by warmth but rather by predominanceofone type [of seed].⁴¹²

Al-Rāzī combines into asingle discussion what might seem to the modern reader to be entirelyseparate topics: recognizingand differentiatingbetween amenorrhea due to pregnancyand amenorrhea duetoillness, differentiatingbetween healthypregnancyand unhealthy pregnancy, and differentiatingbetween pregnancy with amale fetus from pregnancywith afemalefetus.

 See S. Gadelrab, “Discourses on Sex Differences in Medieval ScholarlyIslamic Thought,” Journal of the HistoryofMedicine and Allied Sciences 66 (2011), 40 –81 and N. Fancy, “Womb Heat versus Sperm Heat: Hippocratesagainst Galen and IbnSīnāin Ibnal-Nafīs’sCommenta- ries,” 150 –175.  al-Rāzī, al-Ḥāwī fī al-ṭibb, vol. 3, bk. 9:50 –1. Cf. Al-Baladī, Tadbīral-ḥ abālā’, 20. Etiology and treatment of female infertility in Arabo-Galenic medicine 153

Menstrual retention and hysterical suffocation

Menstruation and the qualities of menstrual blood occupy acentral role in medieval discussions of both fertility in particular,and women’shealth in general. With regard to fertility, the significanceofmenstruation is two-fold. First,menstrual blood itself is understood to be either afemalegameteorthe sourceof nourishment for afetus. Insufficient menstrual blood can also mean that the bodylacks nourishment for the fetus.⁴¹³ Second, menstrual blood is also understood as potentiallyblocking conception or renderingthe environment of the uterus noxious if it is not flushed out correctlyand regularly. Infertilityisnot,however,the onlyproblematic consequenceofirregular menstruation. Rather,the medieval physicians continue the tradition of emphasizing the importance of menstruation to women’sgeneral health. They also continue to warn of the danger of retained menses and the disease known as “uterine suffocation.” However,whereas Hippocratic descriptions of these illnesses pathologize the bodies of women who are not fulfilling the sociallyexpected roles of marrying and producing children, and the treatments of these diseases appear to coerce women into fulfilling socially-approved roles,this is less true in medievalArabo-Galenic discussions of these conditions. 5th-centuryB.C.Greek texts describeuterine suffocation, also known as “hysterical suffocation,” or “the wandering womb,” as adisease in which the uterus expands or moves and in so doing displaces or crushes awoman’sother vital organs,potentiallycausing avariety of dire symptoms,includinginsanity,epi- leptic-like fits and deathlyfaints.⁴¹⁴ The phenomenonisfamouslydescribed in Plato’s Timaeus:

The seed [semen in males] havinglife, and becomingendowed with respiration, produces in that part in which it respiresalively desire of emission, and thus creates in us the loveof procreation. Wherefore also in men the organ of generation becoming rebellious and mas- terful, like an animal disobedienttoreason,and maddened with the stingoflust,seeks to gainabsolute sway;and the same is the case with the so-called womb or matrix of women; the animal within them is desirousofprocreatingchildren, and when remainingunfruitful long beyond its proper time, gets discontented and angry, and wanderinginevery direction through the body, closes up the passages of the breath, and, by obstructingrespiration,

 IbnSīnā,Qānūnfīal-ṭibb, 2:567–71 = kitāb III: fann 21: maqāla 1.  The phenomenon of the “wandering womb” has receivedagreat deal of scholarlyatten- tion. See, for example,C.Faraone, “The Rise of the Demon Womb in Greco-Roman Antiquity,” in M. Parcaand A. Tzanetou (eds.), Finding Persephone: Women’sRituals in the Ancient Mediter- ranean (Bloomington: Indiana University Press, 2007), 224–37;and S. Gilman et al., Hysteria Be- yond Freud (Berkeley:University of California Press, 1993). 154 4GynecologicalTheory in Arabo-Galenic Medicine

drivesthem to extremity,causingall varieties of disease, until at length the desireand love of the man and the woman, bringingthem together and as it wereplucking the fruit from the tree, sow in the womb, as in afield, animals unseen by reason of their smallness and without form; these againare separated and matured within; they arethen finallybrought out into the light,and thus the generation of animals is completed.⁴¹⁵

This description of sexual reproduction attributes to the uterus an independent “lust” equivalent to the “disobedient” lust subsisting in the male genitals. But the uterus diverges from its male counterpart by attacking its “host” when it is discontented by lack of children. It wanders up into the woman’sbodythereby suffocating her.Inaneffort to pacify it,man and woman engageinsexual intercourse. Implicit in this physiology is amessagethat women who do not engage in sexual intercourse and reproduction put themselvesinmortal danger. The Hippocratic treatise Diseases of Women I, describes hysterical suffocation thus:

When the womb is near the liverand the abdomen and when it is suffocating, the woman turns up the whites of her eyes and becomes chilled; some women become livid. She grinds her teeth and saliva flows out of her mouth. These women resemble those whosuffer from Herakles’ disease.⁴¹⁶ If the womb lingers near the liverand the abdomen, the woman dies of the suffocation.⁴¹⁷

The ultimatecure for hysterical suffocation is pregnancy, which weighs down the womb and keepsitfrom moving into other parts of the body. Sexual intercourse also helps because the moisture and weight provided by semen anchor the womb in place. Alternatively,sweet smelling substances can be applied to the vagina to “lure” the “animal” uterus down to its proper place, and foul-smelling substances can be applied to the nose to repelthe uterus away from the upper bodycavities. Thislast treatment is basedonthe previouslymentioned premise that the mouth, uterus,and vagina are all part of one continuous channel. In Aristotle’sthought and in later Greek and Romanmedicine, uterine suffocation continues to be an accepted diagnosis despite the widespread acknowledgement thatthe uterus is anchored in place by ligaments and so cannot

 Timaeus 91b-d.Translation by B. Jowett.Galen’ssynopsis of the Timaeus was available in Arabic and there mayhavebeen other sourcesaswell. On the Arabic reception of the Timaeus, see A. Das, “Galen and the Arabic traditions of Plato’sTimaeus” (Ph.D.thesis:UniversityofWar- wick, 2013). Forthe reception of this specific passage see also, Weisser, Zeugung,Vererbung,und pränatale Entwicklung, 146 – 7.  I.e., epilepsy.  Translation in A. E. Hanson, “Hippocrates: ‘Diseases of Women 1,’” §10. Etiology and treatment of female infertility in Arabo-Galenic medicine 155 moveinto the regions occupied by other organs.⁴¹⁸ Such knowledge was confirmed by human dissections undertaken in Alexandria in the generations after Aristotle’sdeath.⁴¹⁹ By the second century,Soranus and Galen are well aware that the uterus is moored in place by tissue connectingittoother organs with the resultthat it cannot wander.Soranus rejects the notion thatthe uterus can moveupward and mocksthe idea thatthe uterus possesses olfactory capabilities. But he does not reject the existenceofthe disease thatwas thoughttobe caused by the womb’swandering,claiming instead that inflamed ligaments pull the uterus in the wrongdirection, thereby triggering the symptoms known as uterine suffocation. Moreover,although he entirelyrejects the notion that the uterus is an animal-likebeing with asense of smell, he still prescribes the sameuse of smells as therapy,onthe grounds that they make the uterus contract.⁴²⁰ Galen too objectstothe idea that the uterus can wander upward and yethe too takesfor granted the existenceofthe condition described as uterine suffocation.⁴²¹ He says thatitoccurs when retained menses and female seed rot,which in turn causes congestion in the blood vessels enteringthe uterus, which in turn distends the adjacent ligaments, which in turn pulls on the uterus such that the uterus rises, expands, or twists. Furthermore, the rottingofthe retained menses creates anoxious fluid which poisons and chills the woman’swhole body, thereby causing the severe symptoms.Heattributes this disease particularlytowid- ows and prescribes odor therapy as well as measures to “release” the build-up of female “semen.”⁴²² Moreover,although as an anatomist Galen waswell aware of the impossibility of hysterical suffocation, as atherapist he, as Monica Green puts it, “displayedhis medicalconservatism by retaining the odoriferous therapy even though,with his new etiology, it would have lost anysemblance of arational basis.”⁴²³ Galen prescribes the use of both cupping and the application of strong smelling substancestothe mouth and vagina to treat awoman whose

 Aristotle, Generation of Animals 720a, 12–14,denies the wanderingwombphenomenon. Aristotle, History of Animals 582b, 22–6, nonetheless says that an empty womb can rise upwards and cause suffocation.  C. Faraone, “Magical and Medical Approaches to the WanderingWomb in the Ancient Greek World.” ClassicalAntiquity 30 (2011):6.  H. King, Hippocrates’ Woman: Reading the Female Body in Ancient Greece (London: Rout- ledge,1998), 231.  Galen, On the Usefulness of the Parts of the Body,tr. MargaretTallmadge May(Ithaca: Cor- nell University Press,1968), 2:653.  See Green, ‘The TransmissionofAncient TheoriesofFemale Physiology and Disease’ 48. Also Helen King, ‘Galen and the widow:towards ahistoryoftherapeuticmasturbation in ancient gynaecology.’ EuGeStA: Journal on Gender Studies in Antiquity 1(2011): 205–235.  Green, “The Transmission of Ancient Theories of Female Physiology,” 50. 156 4Gynecological TheoryinArabo-Galenic Medicine

“uterus rises or experiencesdeviations.” Likethe Hippocratics, he appears to subscribe to the notion that sweet smells attract the uterus to its proper place and fetid smells repel it from its current abnormalplace. We thus see in Soranus’ and Galen’swritingsthatthe anatomical premise has changed drastically, since they know the uterus cannot sense smell, nor is it free to float about,much less to roam about the bodylike an animal desiring to satisfy its cravings. But the symptomologyofthe illness previouslythoughttobecaused by the uterus moving does not change, onlyits etiology. Moreover,eventhough the etiology changes, the therapies,includingodor therapy,donot change. In medieval Arabic texts,the causes and cures for ikhtināqal-raḥim (uterine suffocation/strangulation) are subtlyreinterpreted in significant ways.Whereas in the Hippocratic texts bothmenstrual retentionand hysterical suffocation are described as resulting from aperson’sstatus as avirgin, widow,orbarren woman, over time, particularlyinthe Byzantine and Islamic periods, these con- ditionsbecome attributed to awider variety of causes, and suggested treatments varied just as widely. Al-Ṭabarī writes:

Retention of menses maybedue to heat,dryness,severefatigue, or nosebleed because this diminishesthe blood, or [it mayoccur in] one who is fat for her blood departs duetoher fat,orbecause the veins of her womb arenarrow, or from arupture. As aresult of retention of the menses or lack of coitus, theremay occurvapors, asthma, damage to the liverand stomach, heart palpitations,vile thoughts,headache,uterine suffocation,inability to conceive, abscess,and dropsy,because when the [uterus] retains the menstrual blood, [the blood] will coagulateinitsveins and disperse its vapors intothe entirebody, thereby causing these maladies.⁴²⁴ Sometimesthe uterus is stretched by atumor or coagulated, sticky superfluities,such that it inclines to one side and is thereforelackinginheight or width. Sometimesthe uterus rises upwards towards the diaphragm thereby causing suffocation, and it overcomes the womansuch that she maylose consciousness.Inwhich case, a wool flake should be placed on her nose so as to learn whether she is alive or dead. If the wool moves, then she is alive.The cause of this is either an excess of coitusorthe lack of it.For,ifthereismuch seed it might rot and become likeapoison, and sometimes it spreads and so the diaphragm convulses and the woman suffocates ...Sometimesan itch accompanied by swelling also occurs in the uterusdue to the intensity of desire for sexual intercourse, just as in amale thereisanitch and swellingdue to desire.⁴²⁵

Much of al-Ṭabarī’sabovedescription has Greek antecedents. We see the Galenic assimilation of uterine suffocation into the framework of retainedmenses. The use of aflake of wool to ascertain whether awoman is still breathing, having lost consciousness as aresultofauterine ailment,comesfrom an anecdote

 Cf. Bos, Ibn al-JazzāronSexual Diseases and Their Treatment, 264.  al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,273 – 5. Etiology and treatment of female infertility in Arabo-Galenic medicine 157 found in several different Galenic texts.Itisalso found in Aetius of Amida’sgy- necological treatise.⁴²⁶ In some versions the woman is described as alongtime widow,but al-Ṭabarī makes no reference to the marital status of the unconscious woman here.⁴²⁷ As in the Timaeus,the uterusisdepicted as swellingwith sexual desire, comparable to male tumescence. Like Galen, al-Ṭabarī describes excessive female seed as needingtoberemoved, or exorcised. Menstrual blood needs to be exorcised as well, and he does not clearly differentiatebetween menses and seed. The menses or seed can potentiallyendanger awoman if they are not evacuatedand instead coagulate and rot.When it putrefies it makes the uterus uninhabitable for anyembryoand sends vapors or fumes throughout the rest of the body, especiallyupwards towards the head. This retained menstrual blood or seed mayindeed be attributedtoawoman’sfailure to engageinsexual relations with aman, but al-Ṭabarī also suggests it can be attributed to the woman engagingintoo much sexual activity.(The notion that sexual excess causes hysterical suffocation can alsobefound in the works of pre-Islamic authors as well, such as Paul of Aegina and Aetius, who writes that it is most prevalent among lascivious women and thosewho make use of contraceptive drugs.⁴²⁸)Furthermore, al-Ṭabarī also believes that these maladies can alsobeattributed to ahost of other problems,some psycho-social (such as shock or depression) and others more physical, such as cold or hemorrhoids.⁴²⁹ The extent to which these conditions are associated with unattached women varies somewhat in medieval medical texts.Ibn al-Jazzār, like al-Ṭabarī,con- flates hysterical suffocation (which he very much associates with sexual deprivation) with menstrual retention, which he does not particularlyassociate with sexual deprivation. He writes:

[Hysterical suffocation] occurs [toawoman] by reason of asurplus and corruption of her sperm when she is withheld from sexual intercourse. Forthen the sperm increases,corrupts and becomes likeapoison. This happens mostlytowidows,especiallywhen they have

 Aetius of Amida, TheGynaecologyand Obstetrics of the VIth century,70.  The story of Galen’suse of wool to test whether asexually-deprivedwidow has fainted or died is found in several sources,including Galen, On the Usefulness of the Parts,K.VIII, 414– 15. It appears to have entered intothe Arabic corpus via Paul of Aegina, appearing in al-Rāzī,Ibn al- Jazzār, and IbnSīnā’sworks. Forinterpretations of this anecdotesee Helen King, ‘Galen and the widow:towards ahistory of therapeutic masturbation in ancient gynaecology.’ EuGeStA: Journal on Gender Studies in Antiquity 1(2011), 205–235.  S. Gilman et al., Hysteria Beyond Freud. (Berkeley:University of California Press, 1993), 47.  Cf. al-Rāzī, al- Ḥāwī fī al-ṭibb, 9:37.Cf. IbnSīnā,Qānūnfīal-ṭibb, 2:600 = kitāb III: fann 21: maqāla 4:‘alāmāt (ikhtināqal-raḥim). 158 4GynecologicalTheory in Arabo-Galenic Medicine

givenbirth to manychildren. It can also happen to women when they have reached sexual maturity without knowingany man. Forwhen the sperm has collected in them, they need its emission just likemen, which is anatural act.But when the woman does not have a man, the sperm is collected in her and acoldvapour arises fromittothe respiratory diaphragm because of its connection to the uterus.This causes asthma, and because the diaphragm is connectedwith the throat and with the places of [origin] of the voicesuffocation occurs to her,aswehaveexplained. This disease can also be caused by retention of the menstruation, for when the retained menstrual blood and the sperm collectinthem, the disease called “hysterical suffocation” occurs to them with extreme force, especiallyinau- tumn or in winter.⁴³⁰

Herehysterical suffocation is identifiedasparticularlyprevalent among unat- tachedwomen, not because the uterus is searchingfor reproduction, but because bothsexes requiresexual release in order to be healthy,lest “cold vapors” arise from the retained male and femalesperm.⁴³¹ It can alsooccur due to the lack of evacuation of the menses.⁴³² The diseases at hand are more prevalent among adultvirgins and widows, according to Ibnal-Jazzār, but despite many pages of detailedinstructions as to how to alleviate the problem, neither he nor al-Ṭabarī recommend that the problem be fixed through marriage. This is also true of Paul of Aegina and Aetius of Amida’streatment of the subject.⁴³³ In otherwords, hysterical suffocation and menstrual retentionare diagnoses that no longer necessarilyservetopathologize unattached women. This is alsosomewhat true of al-Rāzī’spronouncementsonthe topic. Theex- ception can be found in his treatise dedicated to enumerating the medicalvir- tues of sexual activity,inwhich he describes it as apotential curefor hysterical suffocation.⁴³⁴ He alsoquotesother people’sopinions about the medical value of intercourse for treating these conditions.Inhis Ḥāwī,helists adozen different authorities, citing boththeirdescriptions of hysterical suffocation and their cures for it,and among them he cites the opinions of older authorities who do recommend marriagefor curing the malady. There he quotes Hippocrates as saying “if she does not have ahusband then one marriesher off quickly”⁴³⁵ and “this suffocation does not occur to pregnant women. Thereforemy[recommendation] is

 Bos, Ibn al-JazzāronSexual Diseases and Their Treatment,274 – 275. Bos’ translation.  Cf. Ibn al-Quff.  See also Ibn Sīnā, Qānūnfīal-ṭibb 2:589 = Kitāb 3: fann 21: maqāla 3: faṣlfīa‘rāḍ[iḥtibāsal- ṭamth]  See Green, “The Transmission if Ancient Theories of Female Physiology and Disease,” 106.  Peter E. Pormann. “Al-Rāzī (d. 925) on the Benefits of Sex: AClinician Caught between Phi- losophyand Medicine.” Oyegentlemen: Arabic studies on scienceand literaryculture,inhonour of Remke Kruk 2(2007), 124  al-Rāzī, al-Ḥāwī,9:43. Etiology and treatment of female infertility in Arabo-Galenic medicine 159 that it is treated with what bringsdown the blood and thins out the semen, or with much sexual intercourse ...If she becomes pregnant,the situation is ob- viated altogether,for the womb is weighed down and moves back and is made moist.”⁴³⁶ He alsocites al-Masīḥ’scommentary on Diseases of Young Girls, “When awoman maturestothe point of menstruation and is avirgin, blood is diverted towardher uterus ...and it causes something likeinsanityinher. If that has happened, it [?] should be removed and then one should marry her off, for if she becomes pregnant she will become healthy.”⁴³⁷ Both IbnSīnāand al-Majūsī explicitlyrecommend marriageifthe patient is avirgin. Al-Majūsī writes, “If the woman is avirgin, then she must marry.Ifshe rarelyengages in intercourse, she should do so. Forintercourse voids the semen which is retainedinits passages and unblocks the blockage which was caused by it[’sretention]and,insodoing,makes it cease, God willing.”⁴³⁸ If the cause of hysterical suffocation is found to be “retention of semen,” IbnSīnārecommends marriageasone possible cure. Note thatthe assumption in this case is that the woman is not currentlyengaginginsexual relations because she is unmarried. Thus it appears that the “semen” in this caseisfemale semen, which has not found an outlet.

If the cause of the [hysterical suffocation] is retention of the semen, then it is necessary to getstarted on marriage.Untilthat time, she should engage in exercise and [makeuse of] those thingswhich dry out the semen, such as rue, mint ...asinthe [aforementioned] recipe. The midwife must insert her hand in the vagina and rub it with oil of lilyornard or laurel, and massage the entrance to the vagina, and she should massage the entrance to the uterusagreat deal. [The patient] must be givenboth pleasureand pain, so that it will be likethe experience of sexual intercourse.⁴³⁹

Although IbnSīnāencourages marriage to cure hysterical suffocation, unlikein the Hippocratic texts,marriage is not recommended for the purpose of curing the woman’swandering womb by weighing it down with pregnancyorwith male

 Ibid., 9:44.  Ibid., 9:45.This is ‘Īsā b. Ḥakam al-Dimashqī,known as al-Masīḥ.Ibn Abī ‘Uṣaybi‘asayshe livedduring the time of Harūnal-Rashīd. IbnAbī‘Uṣaybi‘adoes not mention him havingwritten this treatise. He is referredtoextensively by al-Baladī in Tadbīral-ḥ abālā’.  al-Majūsī, al-Kāmil,2:438–9.  IbnSīnā,Qānūnfīal-ṭibb 2:602=Kitāb 3: Fann 21: maqāla 4: faṣlfīal-mu‘ālajāt. Cf. Ibn Sīnā, Qānūnfīal-ṭibb, 2:599=Kitāb III: fann 21: maqāla 4: faṣlfīikhtināqal-raḥim. The phrase is reminiscent of Galen’s On the Affected Places. Forananalysis of the history of the interpretation of this passageinmodern scholarship see H. King, “Galen and the widow:towards ahistory of therapeutic masturbation in ancient gynaecology.” EuGeStA:Journal on Gender Studies in An- tiquity 1(2011), 203–235. 160 4Gynecological TheoryinArabo-GalenicMedicine semen. Rather,itisrecommended to give her the opportunitytorid herself of her own pent-up femalesemen. The alternative he offers appears to be medical masturbation as ameans of evacuating female semen in much the same waythat men do. (Some of the languagehere, includingthe reference to “pleasure and pain” is reminiscent of the languageofGalen and the widow.) In other medieval texts,the potential causes of menstrual retention and hysterical suffocation are so numerous and varied that the diagnoses no longer function as ameans of reinforcing particular gender roles.Rather the diagnoses serveasanintermediary step, providing arational basis for linking almost any precipitatingfactor with atreatment which promises cleansing,purgation, relax- ation, or release. Ibnal-Jazzār, for example, writesthat retained menses can be caused by nosebleeds, hemorrhoids, excessive fat,exercise, sorrow,fear,anxiety, and anger.The symptoms of menstrual retention are similarlynon-specific. It can manifest in the form of emaciation, nausea, fever,and lack of sexual appetite.⁴⁴⁰ As for treatment options, Ibnal-Jazzārrecommends several different ways to evacuate or exorcise the retained blood,fumigation beingthe preferred technique. Other therapies include pessaries, back and foot massage, rubbing the genitals (performed by amidwife),⁴⁴¹ bleeding,and cupping.⁴⁴²All of these techniques involvethe creation of intimate and sensory-rich experiences,the purpose of which is to effect aform of release and relief by breakingdown and ex- pelling whatever is frustrating the normalmenstrual and reproductive cycle. One can see the cross-overappeal of such adiagnosis.Itcan be understood in strictlybiological terms – the blood is being blocked in the uterus and, as a result, is undergoing anaturalprocess of decayand so it must be evacuated and the uterus cleaned of the rot by meansofincense burning and intimate touch to break down or removethe decay. But it can justaseasilyfit into world- views thatposit thatawoman can be inhabited by amalevolent force, aghost twin, or an evil eye, which must be released, drivenout,orexorcised so that the bodycan resume its normal functions, possiblybymeans of rituals involving strongscents and intimate touch. Christopher Faraone has demonstratedthat,in the Roman and Byzantine worlds,therewas agreat deal of intellectual compat- ibility of medicalunderstandings of the wandering womb and magical concepts exhibited in material culture. Amulets and magical recipe books have been found from the first,second, and fourth centuries (the most recent,from

 Bos, Ibn al-Jazzār,263 – 4.  IbnSīnāmakes the same suggestion, op.cit. al-Rāzī does so as well and quotes previous authorities for doing so in al-Ḥāwī fī al-ṭibb, 9:38, 40 and 44.al-Majūsī also writes that the mid- wivesdothis, see al-Kāmil,2:428.  Bos, Ibn al-Jazzār,275.Cf. al-Rāzī, al-Ḥāwī, 41 and 44. Childless couples and the assessment of eachspouse’sfertility 161

UpperEgypt) which abjure the womb itself to stayinplace, and both of these accord with the demonic exorcism practices of the time.⁴⁴³ It maybeargued that echoes of this notion can be seen in modern Egyptian fertilityrituals as described by Marcia Inhorn and others.⁴⁴⁴

Childlesscouples and the assessment of each spouse’s fertility

Acknowledgement of male-factor infertility

Throughout the Arabo-Galenic medical corpus,male-factor infertility,female- factor infertility,and “incompatibility” between the humoral temperaments of acouple are all recognized as potential reasons for awoman to fail to become pregnant.Male infertility receivessomewhat more attention in the Arabic tradition than in the Greek, though still not nearlytothe extent of femaleinfertility. Male infertility is generallyattributed to one of threefailings: humoral imbalance, producing toolittle sperm, and erectile difficulties.Some authorsalso claim that male infertility can be caused by defective sperm or by aproblem with the angle of the penis such thatitcannot project semen “in astraight line.”⁴⁴⁵ However,the inability on the part of the man to produce offspring is rarelyclassified as adisease to be treated in and of itself in medical encyclopedias. Rather,male infertility is addressed as asubsection of discussions about undesirable sexual performance. Often male infertility is conflated with impotence, small penis size, and lack of sexual prowess. The is less true in Ibn Sīnā’s Qānūn where, in several places,male and female infertility are described in similar terms and addressed at the sametime.⁴⁴⁶ There the terminologyfor male and femalefertility-related difficulties is so similar that it is sometimes difficult to tell which partnerisunder discussion. IbnSīnārepeatedlyuses the term

 Faraone, “Magical and Medical Approaches to the WanderingWomb in the Ancient Greek World.” 19–22.  M. Inhorn, Quest for Conception, xxiii; R. Natvig, “Liminal Rites and Female Symbolism in the Egyptian Zar Possession Cult,” Numen 35 (1988), 57–68;and J. Boddy, Wombs and Alien Spi- rits: Women, Men,and the ZarCult in Northern Sudan (Madison:University of Wisconsin Press, 1986).  Ṭabarī, Firdaws al-ḥikma,37–38. Cf. Philip J. vander Eijk, Diocles of Carystus. (Leiden: Brill, 2001), 1:87– 91 and 2:93 – 97.  IbnSīnā,Qānūnfīal-ṭibb, 2:562=kitāb III: fann 21: maqāla 1: faṣlfīdalā’il al-yabūsa. 162 4Gynecological Theory in Arabo-Galenic Medicine manī to refer to bothmen’sand women’s “sperm,”⁴⁴⁷ by which he meansmale semen and, it seems, femaleejaculate.Another,unusual expression of egalitarianism with respect to male and femaleinfertility can be found in al-Majūsī’s brief discussion of the topic. While other physicians prescribe surgical treatments for femaleinfertility,inhis Kāmil al-Majūsī does the samewith respect to male infertility: “If instead [his infertility]isdue to ablockage within the vesi- cles of the penis, then he must be treated by unblocking that blockage by using a blade, which we will discuss in the chapter on surgery.”⁴⁴⁸ One reason the diagnosis of sterility and fertility in men receivedcompara- tivelylittle attentioninmedicaltexts is duetothe fact that menwho wantedto provethemselvesfertile even if they failed to conceive with theirspouses had ample opportunity to do so, whereas women did not.Inasociety wheredivorce, polygamy, and concubinagewereoptions, aman could potentiallyhavemultiple sexual partners, and thus multiple opportunities to attempt to procreate. Ibn Sīnā makes apoint similar to Aristotle’sabout the inegalitarianism of medicine in this regard: while ahusband maybemedicallyadvised to have sexual relations with another woman, such is not the casewith respect to awife. He writes:

Regarding the infertile [woman] and sterile [man] by nature:aperson with ahumoral temperament contrary to that of his partner needs to replace them. As for aperson with ashort penis,there is no remedy. Similarly, [thereisnoremedyfor] awoman whose orificefor menstruatinghas become plugged up as aresult of ulcers which have sincehealed over and become slippery.Regarding awoman who needs to replace her husband, the physician is not in apositiontohelp her.But regarding the rest of the cases, there are[treatments].⁴⁴⁹

In other words, for husbands with a “incompatible” sexual partner, aphysician might medicallyadvise him to take on anew one. (Wehaveencountered physicians offering help in choosing sexual partners for their male patients in al-Rāzī, KitābShukūk ‘alā Jālīnūs,and his contemporary al-Ruhāwī mentions something similar.⁴⁵⁰)Itissocially unacceptable for physicians to offer such advice to women who are having difficulty conceiving with theirhusbands.Like Aristotle and IbnSīnā,al-Majūsī too suggests thataman’sapparent sterility might simply be due to incompatibility,and so it is appropriate for the physician to recommend that the man attempt to procreate with someone new.

 IbnSīnā,Qānūnfīal-ṭibb, 2:562=kitāb III: fann 21: maqāla 1: faṣlfīal-‘uqr wa-‘usr al-ḥabl  al-Majūsī, Kāmil al-ṣinā‘afīal-ṭibb,2:437.  IbnSīnā,Qānūnfīal-ṭibb, 2:565=kitāb III:fann 21: maqāla 1: al-tadbīrwa’l-‘ilāj. My italics.  E.g. al-Rāzī, KitābShukūk ‘alā Jālīnūs,79and al-Ruhāwī’s Adab al-ṭabīb, in Levey, ‘Medical Ethics of Medieval Islam,’ 90. Childless couples and the assessment of eachspouse’sfertility 163

If lack of conception is due to the husband, and that is due to his sperm havinglittle com- patibility with some women, then he must switch women so that he mayencounterwhat will be compatible with the humoral temperament of his sperm.⁴⁵¹

Since medieval authorsacknowledge that childlessness could be aresultofei- ther incompatibility or adifficulty subsisting in either the man or woman, natu- rallythe medicalliterature includes many tests of assessingindividual fertility and infertility.Sometests assess both partners simultaneously, while others test onlythe woman for fertility. In the Arabic medicalcorpus these diagnostic measures appeartobeemployed onlyafter awoman has failed to conceive, rather than to distinguish fertile from infertile women prior to marriage. To my knowledge,these textsdonot suggest astandard amount of time that should elapse before medicalattention is sought. One commonlydescribed means of establishingwhether the male or female partnerinasexual relationship is responsible for that union’schildlessness is by examining the qualities of their urine. Al-Ṭabarī writes:

If the woman does not producechildren, and youwant to know whether that is duetothe woman or duetothe man, then takesome of the man’surine and sprinkle it on agrowing lettuceroot, and sprinkle the urine of the woman on another lettuceroot.⁴⁵² The next day whichever root is found to have dried up, then that seed is the corrupt one.⁴⁵³ Or takesome of both their seeds and put them [this likelyrefers to the lettuceupon which each has uri- nated] in avessel in which thereiswater,and whichever of the seeds floats to the surfaceof the water, that is the one in which there is infertility and corruption. Or takesome peas, lentils and beans,and plant them in the ground, and have woman urinateonthem for two days.Ifany of them germinateasaresult, then she can conceive.And if not,then she cannot.⁴⁵⁴

Such urine tests seem to be common across awide variety of cultures and appear in ancient medical and magical texts throughout the Mediterranean world.⁴⁵⁵ In-

 al-Majūsī, Kāmil al-ṣinā‘afīal-ṭibb,2:437.  Cf. IbnSīnā,Qānūnfīal-ṭibb, 2:564 = Kitāb III: Fann 21: maqāla 1: faṣlfīal-‘alāmāt [‘alāmāt al-‘uqr].  Likethe garlictest,this toowill become atoolfor diagnosingvirginity (though onlyonthe part of women). E.g., whereas in the Greek textsthis is either apregnancy or afertility test, in the Sefer ahavat nashim the author maintains “The sagesofGreece do this experiment: the girl must urinateovermarshmallowsinthe evening, and bringthem in the morning; if they are still fresh she is modest and good, if not,she is not.” Caballero-Navas, Book of Women’sLove,142.  al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,38.  Foranattempt to drawadirect connection between ancient Egyptian versions of this test and latemedievalEgyptian versions,see A. Bayoumi, “Survivances Egyptiennes,” Bulletin de la Socie´te´ royale de ge´ographie d’E´ gypte 19 (1937): 279–287. 164 4Gynecological Theory in Arabo-Galenic Medicine terestingly,what is tested is not the parents’ gametes, but rather abroader quality of being nurturing versus poisonous that subsists even in urine.Such atest is particularlyadaptable because it does not requirethat one subscribe to anyparticular theory about what constitutes the femalecontribution to the embryo.

The garlic test: Acasestudy of recapitulated tradition and innovation

Among the manyprocedures for diagnosing fertilityisone that stands out both for its longevity and for the perspective it can offer us on the transmission and reinterpretation of ancient medical heritages. The test appears in awide variety of medievalArabic-languageliterarygenres,includingmedicalcompendia, obstetrical treatises,erotica, slave-buyingguides, and encyclopedias. It also appears in other languages and eras, spanning three continents and 3000 years. It can be found in some of the oldest Egyptian medical papyri, Hippocratic gynecological treatises,the writingsofthe Roman and Byzantine physicians, the Babylonian Talmud, and in medieval Hebrew and Latin texts up through the earlymodern period. The procedureappears in anumber of variations within the Hippocratic corpus.

If awoman does not conceive, and youwish to ascertain whether she can conceive,having wrapped her up in blankets, fumigatebelow,and if it appears that the scent passes through the bodytothe nostrils and mouth, know that of herself she is not unfruitful.⁴⁵⁶

Test for fertility:boil ahead of garlicand applyittothe uterus; on the next dayhavethe woman examine herself by palpatingwith afinger; and if her mouth smells,the sign is positive.Ifnot,make another application. Test for fertility:enclose alittle oil of bitter almonds in apieceofwool, applyit[as a vaginal suppository], and see what the woman’smouth smells of.⁴⁵⁷

Applyasuppository of alittle oil of bitteralmonds wrapped in wool: then at dawn examine whether the suppository has givenoff an odor throughthe woman’smouth: if it has,she will become pregnant,but otherwise not ...Another:thoroughly clean ahead of garlic, snip it off, and applyasasuppository against the uterus:onthe followingday,see whether it has givenoff an odor through the woman’smouth: if it has,she will become pregnant, but otherwise not.⁴⁵⁸

 Hippocrates, Aphorisms 5:59.Translation by Francis Adams.Slightlymodified.  Hippocrates, NatureofWoman,§96.Translation by Paul Potter. Hippocrates Vol. X (Cam- bridge,MA: HarvardUniversity Press,2012), 303.  Hippocrates On Barrenness,§214. Translation by Paul Potter. Hippocrates Vol. X, 339 – 40. Childless couples and the assessment of eachspouse’sfertility 165

In each of these iterations of the test astronglysmelling substance is inserted into the woman’svagina. If the odor penetrates from the woman’svagina up through her mouth it means that she can indeed conceive,and therefore she should not be blamed for acouple’slack of conception. Moreover,another Hip- pocratic treatise, Superfetation,describing arather different version of the test, mentionsthat if one weretoadministerittoacurrentlypregnant woman the smell would not penetrate.⁴⁵⁹ Very similar tests can also be found in two, much older,Egyptian medical papyri. Nearlyacentury agoErik Iversen identifiedthe similarities between the Hippocratic passages and the CarlsbergVIII papyrus (likelydating from the 13th century B.C. but possiblyreflectinga19th-century B.C. text) and the Kahun medical papyrus #28(dating from c. 1800 B.C.). Iversen viewed them as evidence of the direct influenceofEgyptian medicine on Greek medicine. The Egyptian texts read:

To determine whowill and whowill not , youshould then cause the bulb of an onion to spend the night in her flesh until dawn. If the odor appears in her mouth, she will bear . If , she will never ...⁴⁶⁰

Another method.Leave overnightacloveofgarlicmoistened (with ...)in the body(i.e. in the vagina). If yousmell garlic on her breath,she will give birth (normally). If youcannot smell it,she will not give birth normally, and this will always be the case.⁴⁶¹

The two tests described in the Egyptian texts are indeed similar to each other and to the Hippocratic ones – acloveofonion or garlic is placed in the woman’s vagina, she sleeps on it overnight,and the next dayshe is inspected to see if the smell is exhaled from her mouth – but the condition being tested in the second instance is somewhat ambiguous. It maybeaform of fertilitytest⁴⁶² or it maybe, as Jacques Jouanna understands it,atest to predict whether acurrentlyexisting pregnancywill eventuallybefollowed with healthybirth.⁴⁶³ If it is atest of the

 Hippocrates, Superfetation §25.  Papyrus Carlsberg8.4=Kahun Medical Papyrus 28.Quoted in Totelin, Hippocratic Recipes, 181. Iversen’stranscription of the papyrus appears in E. Iversen, “Papyrus CarlsbergVIII with some remarks on the Egyptian origin of some popular birth prognoses,” Det. Kgl. Danske Viden- skabernes Selskab. Historisk-filologiske Meddelelser XXVI (1939), 21–22.  J. Jouanna, Greek Medicine from Hippocrates to Galen (Leiden: Brill, 2012), 5.  Strouhal, Evžen, BřetislavVachala, and Hana Vymazalova´. TheMedicine of the Ancient Egyptians. 1, Surgery, Gynecology,Obstetrics,and Pediatrics. 162Strouhal, Evžen, BřetislavVacha- la, and Hana Vymazalova´. TheMedicine of the Ancient Egyptians. Vol. 1,Surgery,Gynecology,Ob- stetrics,and Pediatrics (Cairo:American University in CairoPress, 2014)162  He concludes, contra Iversen, “Thus it is difficulttospeak of direct influence.” Ibid., 5–6. 166 4Gynecological TheoryinArabo-Galenic Medicine health of apregnancy, then it reflects an understanding of femaleanatomythat is somewhat at odds with the one found in the Hippocratic gynecologicaltext Superfetation,which claims thatapregnant woman should not be permeable to smells from substances inserted into the vagina. However,inboth the Egyp- tian and Greek version of the garlic test,anunblocked passageisadesirable finding indicating the fertility of the woman or the health of her current pregnancy,while obstruction is indicative of ill-health. Between the Hippocratic period and the dawn of Islam,the procedurecon- tinued to be described in medical literature as afertility test.Inhis Gynecology, Soranus attests that it was usedbyhis predecessors Diocles, Euenor,and Eury- phon, though he himself does not subscribe to the underlying physiology behind the test since he believes that thatitcan provide afalse negative test for infertility.⁴⁶⁴ (These misgivingsare suppressed in later texts thatclaim Soranus as an authority.For example, the 6th-centuryByzantine physician Aetius of Amida appears to suggest thatSoranus subscribes to the efficacy of the test.⁴⁶⁵)Galen, unlikeSoranus, does not directlychallengethe reliability of the garlic test.Instead, in his commentary on Aphorisms 5.59,heoverlays the test with ahumoral significance.⁴⁶⁶ According to Galen, if the odor does not perme- ate up to the woman’smouth it means that the womb and the pathways in the bodyare clogged, and they are cloggeddue to an excess of cold or moisture. This cloggedstate can be rectified by introducing hot,cold, moist,ordry substances to changethe humoral balance, thereby restoringfertility.Galen therebymain- tains the test but offers amodified interpretationastohow it works.The same is true of Stephanus of Athens’s(fl. late-6th/early-7th-century) line of reasoning in his lectures on Aphorisms. Stephanus seems to onlyhalf-heartedlysubscribe to the science underlying the test.Hedoes not refer to asingle physical channel which must remain unblocked but rather to amoregeneralizedsense of healthy sympathyand communication by means of “the veins, arteries and nerves.” Nonetheless,heunderstands the test to be meaningful.⁴⁶⁷ Despite these differencesinexplaining whythe test works,until the 3rd/ 9th century there does not seem to be anysubstantial changeinthe understanding of what the garlic test demonstrates:the transferofthe smell of garlic from

 Soranus, Gynecology,33–4.  Aetius of Amida, The Gynaecology and Obstetrics of the VIth century,tr. James Ricci(Phil- adelphia:Blakiston, 1950), 19.  Galen, and K.G. Kü hn. Clavdii Galeni OperaOmnia. (Lipsiae: prostat in officina libraria C. Cnoblochii, 1821–1833), 17:857.  Stephanus,and Leendert Gerrit Westerink, CommentaryOnHippocrates’ Aphorisms (Berlin: Akademie-Verlag,1985) 160 –161. Childless couples and the assessment of eachspouse’sfertility 167 the vagina to the mouth indicatesthat awoman will be able to conceive.(There is one possible exception, mentioned in two places in the Talmud, which will be addressed below.⁴⁶⁸)Thischanges with the medieval iterations of the garlic test. In the Firdaws al-ḥikma,al-Ṭabarī extensivelyand accurately quotes the Hip- pocratic textsupuntil he reaches the garlic test:

[Hippocrates] also said, “If youwant to know if awoman will conceive or not,then sit her on apierced chair,cover her with arobe,and fumigateher from beneath with costus or sandarac, or aloeswood, and if youfind the smell⁴⁶⁹ of the incense [emerging] fromher nostrils,then she will conceive.Ifnot,then she will not conceive.⁴⁷⁰ The reason for [Hippo- crates’]statement is that if the smell does not emerge from the nose, that is indicative that the body’spassagesand the uterusare damaged. He also said that if awoman drinks mixed honey [hydromel] beforesleepingnot having eaten, and then she experiences colic around her middle, then she is pregnant.⁴⁷¹ And if not,then she is not.The reason for this statement of his is that the uterus, if it is occupied with aseed, is closed up. Mixed honey provokesbloatingand if the wombisclosed up, the passage for the wind is narrowed, and this bloatingisretained in the [womb] thereby provoking colic. Another person said awoman should placegarlicinher vagina and sleep on it,and if the next daythereisasmell of garlicthen she is pregnant.And if not,then there is no pregnancyinher.⁴⁷²

Most of this passageistaken almostverbatim from Hippocratic textsand Galen’s commentary on the Aphorisms. However,inthe lastsentence, there is asignificant departure from the older texts.Inthe Firdaws al-ḥikma,the incense-based

 See Talmud Bavli Ketubot 10b and Talmud Bavli, Yevamot 60b.  Alternatively: “if the smell is found.”  Cf. Hippocrates’ Aphorisms 5:59: “If awoman does not conceive and wishes to ascertain whether she can conceive,havingwrapped her up in blankets, fumigatebelow and, if it appears that the scent passes throughthe bodytothe nostrils and mouth, know that of herself she is not unfruitful.” Translation by Francis Adams.  Cf. Hippocrates’ Aphorisms 5:41: “If youwish to ascertain if awoman be with child, give her mixed honey to drink when she is goingtosleep, and has not takensupper,and if she be seized with colic in the belly, she is with child, but otherwise she is not pregnant.” Translation, slightly modified, fromFrancis Adams.Cf. al-Rāzī, al-Ḥāwī fī al-ṭibb,vol. 3, bk 9:50.  al-Ṭabarī, Firdaws al-ḥikma fī al-ṭibb,37–38. Siggel translates this intoGerman as “so kann sie empfangen...so kann sie nicht empfangen,” i.e., she can conceive. Giventhe context of the paragraph,and the grammar of the sentence,Ido not think an unmodified readingofthe Arabic supports this interpretation. From the context, it appears that this is atest of pregnancy, not a test of potential fertility.See A. Siggel, “Gynäkologie, Embryologie und Frauenhygiene ausdem Paradies der Weisheit über die Medizin des Abū al-Ḥasan ‘Alī b. Sahl Rabbānat-Ṭabarī,” Quellen und Studien zur Geschichte Naturwissenschaften und der Medizin 8(1941), 238.Weisser appears to read al-Ṭabarī’ssentenceasIdo, see Weisser, Zeugung, Vererbung,und pränatale Entwicklung, 159. 168 4Gynecological Theory in Arabo-Galenic Medicine version of the procedurediagnoses fertility,but that is not the casewhen the test is done with garlic. Instead, al-Ṭabarī describes it as atest of whether or not conception has occurred. It is apregnancytest.Al-Ṭabarī does not seem to feel the need to explain whythe emergenceofthe garlic smell from the mouth of a woman is evidence of her pregnancy. It does not necessarilyfollow from the initial concept (whichhehas not discarded) of fertility being dependent on unblocked passages. It does, however,accord with ancient Egyptian texts,and it makes sense if we understand his logic to be that the smell of the garlic on her breath constitutes adesirable outcome irrespective of whether one is testing for fertility or pregnancy. In Arabic medical texts dating from the next threecenturies, we continue to find this proceduredescribed as atest either for fertilityorfor pregnancyorboth, with three different interpretations of what the outcome of the test means. These interpretations are (1) the presenceofthe scent in her mouth is indicative of fertility,(2) it is indicative of pregnancy, or (3) it is indicative of lack of current pregnancy.Inthe 4th/10th century,the garlic-as-fertility-test is mentioned by al-Rāzī⁴⁷³ in Iraq in his al-Ḥāwī fī al-ṭibb,and by Aḥmad al-Baladī in Egypt in his obstetrical text.⁴⁷⁴ By contrast,anobstetrical text produced in Spain duringthe same period by ‘Arībb.Sa‘īdal-Qurṭubī describes the garlic-based version of the procedure as apregnancytest and the incense-based version as afertilitytest,just as al-Ṭabarī does. Al-Qurṭubī writes, “if the next daythe scent of the garlic emergesfrom the nose,itisasign of conception. If it does not do so, then she is not pregnant.”⁴⁷⁵ This is particularlycurious because, in the paragraph im- mediatelypreceding this one, al-Qurṭubī says thatasign of pregnancyisthatthe mouth of the uterus is closed over.Intheory,such aclosing of the cervix would interrupt the passagebetween the vagina and the mouth. One would thus expect that the transfer of the garlic odor from vagina to mouth would be an indication that the cervix was stillopen and that pregnancyhad not occurred. However,al- Qurṭubī does not appear to be consistent in this regard. IbnSīnā’sQānūndescribes the garlic test twice, once as atest for fertilityor lack thereof, and once as atest for pregnancyorlack thereof but,unlike al- Ṭabarī and al-Qurṭubī,his anatomical theory remains consistent and accords more closelywith Hippocratic thought. In his section on the signs of infertility IbnSīnā,like the Hippocratics, writes thatthe presenceofthe smell indicates

 Cf. Al-Rāzī, al-Ḥāwī fī al-ṭibb, vol. 3, book 9:52.  Al-Baladī, Tadbīral-ḥ abālā’, 18.  ‘Arībibn Sa‘īdal-Qurṭubī, Kitābkhalq al-janīnwa-tadbīral-ḥabālā wa’l-mawlūdīn = La livre de la génération du foetus et le traitement des femmes enceintes et des nouveau-nés (Algiers:Li- brairie Ferraris, 1956),28. Childless couples and the assessment of each spouse’sfertility 169 an unobstructed path and hence aprospect of fertility.⁴⁷⁶ The test then appears three pages later as apregnancytest,but the pregnancyisproven absent by the smell of garlic in awoman’smouth. He writes:

Conception can be diagnosed throughtests.Amongthem is havingthe woman drink two waqītas of Sara-check beforesleep, or similarlymixed rainwater, and then seeingwhether thereiscolic or not,because in conjunction these cause retention and bloatinginthe in- testines.Physicians areconvinced by this, and it is apositive test, except for those women whoare alreadyaccustomed to drinkingthis.Another [test]: she should submit to afast for aday and then in the eveningbewrapped in robesand fumigate herself on apierced chair with acone of incense. If the fumes and smell emerge from her mouth and nose, then thereisnoconception in her.Asimilar negative test is takinggarlic, sleeping on it,and [seeing] if the smell and taste of it is in her mouth or not.⁴⁷⁷

Herethe anatomical premise is maintained, i.e. the premise that normallythe path from the vagina to the uterus to the mouth is unobstructed, and the exis- tenceofanobstruction indicates that either the cervix has closed,asoccurs during pregnancy, or there is something in the uterus causing ablockage,i.e.a fetus. What has changed is thatfinding the path to be unobstructed is no longer necessarilyadesirable outcome. Thepresenceofgarlic in the mouth is an indication thatpregnancyhas failed to be achieved. In slave-buyingguides, the procedureappears as apregnancytest, but with two opposing interpretations. In the Risāla fī shirā al-raqīqwa-taqlībal-ʻabīd by the 5th/11th-century Baghdadi Christian physician IbnBuṭlān, the author writes about women being sold as slaves. The slave dealer attempts to conceal the fact thatthey are pregnant by displaying fake menstrual blood.

What conceals pregnancy: the slaverprovides the slave woman with fake blood to display, made from resinand dragon’sblood⁴⁷⁸ – if she cannot obtain the blood of animals. To verify the existenceofapregnancyand its health: This knowledge can be obtained by placingbeneath the woman incense such as ambergris, and preventing[the smell] from exitingfromthe sides or openings in her robes. If the smell issues from her mouth, then she is not pregnant.And the opposite[is true too].⁴⁷⁹

 IbnSīnā,Qānūnfīal-ṭibb 2:564 =kitāb III: fann 21: maqāla 1: faṣlfīal-‘alāmāt [‘alāmātal- ‘uqr].  IbnSīnā,Qānūnfīal-ṭibb 2:567=kitāb III: fann 21: maqāla 1: faṣlfī‘alāmātal-ḥabl wa- aḥkāmihi.  I.e. ared dye made from plant resin or cinnabar.  IbnBuṭlān, Risāla fī shirā al-raqīqwa-taqlībal-ʻabīd,383. Iamgrateful to Dr.Hannah Bark- er for drawingmyattention to this passageand the subsequent one. 170 4Gynecological TheoryinArabo-Galenic Medicine

This accords with IbnSīnā’sview.Morethan acentury later and on adifferent continent,Ibn Buṭlān’sadvice appears again, in al-Andalus,inamarket-inspector’smanual by al-Saqatī from c. 606/1210. Much of al-Saqatī’sadviceinthe sur- roundingpassages is aprecis of IbnBuṭlān’sadvice, except for his interpretation of this test: he understands it as having the opposite meaningfrom the one attributed to it by his source.

They [masculine plural] conceal pregnancybydisplayingfakeblood, manufactured from resinand dragon’sblood, if no animal blood is obtainable. One can become informed [male singular] about the pregnancyofawoman by placingbelow her incense or ambergris and preventingitfrom exitingvia her sleeves or garments.Ifthe smell issues from her mouth, then she is pregnant.And if it does not,then she is not pregnant.⁴⁸⁰

It is noteworthythat the two Andalusians,al-Saqatī (the 6th/12th-century author of the market inspector’smanual) and al-Qurṭubī (the 4th/10th-century author of the obstetrical treatise) interpret the test in the sameway,i.e.that the permeation of the smell is apositive sign of pregnancy. By the 7th/13th-century,weencounter anew iteration of the test with another set of permutations about its interpretation.Inhis Kitāb ʻajāʼib al-makhlūqāt wa’l-ḥayawānātwa-gharāʼib al-mawjūdāt (Book of The WondersofCreation and the Peculiarities of Beings) the Persiancosmographer al-Qazwīnī (d. 682/ 1283)explains the test as follows. “If youwant to know whether awoman is a virgin or anon-virgin then mix thinlysliced garlic with honey and tell her to carry it [in her vagina], and then wait two hours. If the odor of the garlic can be smelled from her mouth then she is avirgin, if not then she is anon-virgin.”⁴⁸¹ Hereonce again the permeation of the smell is positive sign, but now it does not indicate fertility, or pregnancy,but rather virginity. Such an interpretation might seem counterintuitive,given that discussions of femalevirginity tend to presuppose the existenceofaphysical barrier in the form of ahymen. We might assume that the garlic test could more logically test for virginity by determininghymenal intactness. Under such circumstances, afindingofagarlic smell in awoman’smouth oughttobeindicative of the loss of virginity,whereas the lack of smell would indicate that the hymenal obstruction is still in place. Indeed, that is preciselywhat we find in an Egyptian encyclopedia producedone generation later.The author,Shihābal-DīnAhmad al-Nu-

 Al-Saqatī, Fī adābal-ḥisba = Un manuelhispaniquedeHisba,52.  Al-Qazwīnī, ʻAjāʼib al-makhlūqātwa-al-ḥayawānātwa-gharāʼib al-mawjūdāt (Beirut: Muʼas- sasat al-Aʻlamī li’l-Maṭbū ʻāt, 2000), 231. Childless couples and the assessment of eachspouse’sfertility 171 wayrī (d. 733/1333)writesthatthe procedurecan be used as avirginitytest, as a pregnancytest,and as afertilitytest.

Ḥunayn ibn Isḥāqsaid⁴⁸²:Ifyou want to know if awoman is avirgin or non-virgin have her take peeled garlic and insert it and carry it in her vagina overnight. When she wakesuplet her breath out, and if the smell of the garlic is in her mouth then sheisanon-virgin. Butif[the smell] is not presentinher mouth then sheisavirgin. So too one mayrecognize her pregnancy: if the smell of garlicispresent then she is not pregnant,and if it is not present then she is pregnant. If youwant to find out the stateofwoman, whether she mayyet become pregnant or not,then have her take rolled birthwort and crush it with the gall of acow,then have her keep it in overnight. If the next morning its smell is found in her mouth, then shemay become pregnant. Andifnot, then sheisinfertile.⁴⁸³

Thus, accordingtoal-Nuwayrī,anobstruction indicates either virginityorpreg- nancy or sterility,whereas the presenceofasmell indicatessexual experience, lack of pregnancy, or fertility.The same virginity test,inslightlydifferent words and without the attributiontoIbn Isḥāqisalso found in the therapeutic work Kanz al-ikhtiṣāṣ by ʻIzz al-Dīnibn Aydamar al-Jaldakī,an8th/14th-century Persianalchemist and physician who traveled as far as Yemen and North Africa. This samepassage(withoutthe attribution to Ḥunayn ibn Isḥāq) is also quoted in Raḥma fī al-ṭibb wa’l-ḥikma,bythe famed Islamic scholar Jalālal-Dīnal- Suyūṭī (d. 911/1505), in the context of achapter on restoringvirginitytothe non-virgin. The description of the garlic test is immediatelyfollowed by several recipes for pessaries that restore virginity.⁴⁸⁴ Such formulations, in which both virginity and pregnancyare proven by a lack of smell, continued to be repeated in later Middle Eastern literature. But this is not to suggest that the older interpretations of the garlic test wereaban- doned.The famous book of erotic medicine by IbnKamal Pasha (d. 941/1534) Rujūʻ al-shaykh ila ṣibāh (The Return of the Old Man to His Youth) describes the garlic-based version of the test as ameans of establishingpregnancy and recommends the incense version of the test to establish fertility and infertility.Ibn Kamal Pasha’sinterpretation of the garlic test is similar to thatofal-Ṭabarī,al- Qurṭubī,and al-Saqatī:ifthe scent of garlic permeates to her mouth then she is pregnant.

 Ihavebeen unable to locate this quotation in the works of Ḥunayn ibn Isḥāq.  al-Nuwayrī, Nihāyatal-arab fī funūnal-adab (Beirut: Dāral-Kutub al-‘Ilmiyya, 2004), 12:129. Italics are mine.  Jalālal-Dīnal-Suyūṭī, Kitābal-Raḥma fī al- ṭibb wa’l-ḥikma (Beirut: Dāral-Arqam, 2011), 182 (chapter 136). 172 4GynecologicalTheory in Arabo-GalenicMedicine

Beyond the Islamic world too, the garlic test was the subject of these permutations, with new ones introduced. Aparticularlyinteresting version can be found in a13th-century Hebrew gynecological text from southern Europe called Sefer ahavat nashim (The Book of Women’sLove). The book recommends fumi- gatingthe uterus and, “if the smoke reachesher mouth and is bitter,she is not avirgin; if it does not,she is avirgin. Youcould do the sametoabarren woman: if the smoke goes up to her mouth and is bitter,you will know that she is barren; if not,she is closed and not barren.”⁴⁸⁵ This too is immediately followed by virginity-restoration recipes.Atthis point,itseems that the communication of smells from the vagina up to the mouth has become attached to undesirable results, i.e. lack of virginity,and so, by association, it becomes attached to another undesirable outcome, i.e. infertility.So, in this case, the test has the exactopposite diagnostic value of the one articulated in the Hippocratic texts,despite sharing the same gynecologicalpremises. The history of the garlic test has much to teach us about the nature of medieval learned gynecology. First,the garlic test is an example of an idea whose origins are ambiguous. Itsmedieval versions clearlyreference Greek formulations, but the underlying concept mayalsobeindigenous to parts of the Middle East,present before the translation movement of the early ‘Abbasid period. After all, the garlic test is found even in ancient Egypt,whereitwas connected with pregnancyrather than fertility. Second, the garlic test suggestssome degree of correlation between “book medicine” and medicalpractice. The very fact that the usesattributed to the garlic test vary,but do so all within one specific theoretical framework, suggests thatthe garlic test was an actual procedure, not merelyanintellectual exercise. By contrast, unvaried and non-specific descriptions of procedures are indicative of their having never been actuallyimplement- ed, as Emilie Savage-Smith has argued in referencetoother medicalproce- dures.⁴⁸⁶ The garlic test also serves to remind us of the basic problems and solutions available to the would-be medieval gynecologist.The basic problem was that women’sgenitals wereinternal and hidden, and thus it wasdifficult to know whether all was well or if something was wrong with respect to fertility,pregnancy,orvirginity.One solution to this problem was to positthat one can discover what is happeninginside the bodybysupposing thatthe internal organs are

 Caballero-Navas, Book of Women’sLove,142.Onthe history and derivation of medieval Jew- ish gynecological texts see R. Barkaï, Les infortunesdeDinah, le livre de la génération: La gyné- cologie juiveauMoyen âge (Paris:Cerf, 1991).  Emilie Savage-Smith, “The PracticeofSurgery in Islamic Lands:Mythand Reality,” Social HistoryofMedicine 13 (2000), 307–321. Childless couples and the assessment of each spouse’sfertility 173 connected to the outside, visible world and by mappingwhat is happeningatthe entries and exits of the body. The garlic test,and the fumigations too, thus function like an x-rayorsonogram.The modern physician learns about that which is in the bodybybombardingthe bodywith electro-magnetic radiation or sound- wavesand creates apicture basedupon what penetrates the bodyand what does not.The medieval physician did so using scents. The garlictest is also significant because it highlights the connections between the diagnosis of women’sbodies, blame, and social control. The test in- vites us to think about certain gynecological practicesasnot merelymedicaldi- agnostic tools but rather as women’srituals. The garlic test is aperformance, or ordeal, whose specific meaningissubject to interpretive variation, but whose purpose remains constant.Inall its permutations it has aconsistent goal: to sci- entificallyuncover the “facts” about awoman’ssexual past or her reproductive future, facts which in the present are always in doubt. The test is predicated on the notion thather unknown past and futureare possibletodiscover because they leave atangible mark on her present body. We might thereforebeinclined to view infertility testing, like virginity testing,asatool of patriarchal intimida- tion. It threatens women by perpetuatingthe notion that their bodies can be checked to if they are fit or defective.However,thereisanother wayofinterpret- ing such tests. In some of the Hebrew and Arabic versions of the procedureasvirginity test, the procedureisimmediatelyfollowed by advice about how to restore or fake virginity.Inthese contexts, therefore, the garlic test is one of aset of toolstobe utilizedbyawoman to avert blame from herself. The utilityofsuch atest as ameans of defending awoman and restoring her to her husband’sgood graces is illustrated dramaticallyinaversion found in Babylonian Talmud,from apassagelikelyoriginatinginthe 3rd-century. This version uses not garlic, or incense, but the fumes from abarrel of wine. The test appears in aone of aseries of anecdotes, in each of which agroom after the wedding comes before arabbi and voices his suspicions that his bride was not a virgin. In each case the rabbitowhom the groom bringshis concern provides either atheoretical explanation or an empirical test which would account for the lack of appearance of virginity despite the bride being avirgin at the time of consummation. Each anecdoteconcludes with arecommendation to the groom that he consider himself fortunate and “go enjoy she whom youhaveac- quired.”

Aman came beforeRabban Gamliel the son of Rabbi [Yehudah Ha-Nasi] and said to him: My master,Iengagedinintercourse and did not find blood. She [the bride] said to him: My master,Iam still avirgin. 174 4Gynecological TheoryinArabo-Galenic Medicine

[Rabban Gamliel] said to them: Bringmetwo maidservants,one avirgin and one a non-virgin. They broughtthem to him and he seated them on the openingofacask of wine. The scent of the [wine] waftedthrough the non-virgin but the scent of it did not waft throughthe virgin. He then seated the [wife] on the cask, and the scent of it did not waft through. [Rabban Gamliel] said to the [husband]: Go enjoy she whom youhave acquired. Whydid [Rabban Gamliel] not just initiallyexamine [the bride] by this [method]? Be- cause he had heardof[the theory] but had never seen it in practice.And he thoughtthat perhaps it is not certain, and it is not proper to subject Jewish women to indignities need- lessly.⁴⁸⁷

This story depicts the test as undignified but ultimatelyuseful in supporting the woman’sclaims. In the Aphorisms too, the fertilitytest is depicted as ameans of provingthat acouple’schildlessness is not the woman’sfault,and Stephanus of Athens suggests that its purpose is to coerce the husband rather than the wife. In other words, the test might not have been wielded primarilyasaweapon against women. Rather it might have been adefensive tool, by means of which awoman could attempt to exonerate herself from accusations of fault,and blunt the force of aman’sdistrust,by“scientifically” assuaging his doubts. Thegarlic test,like virginity restoration, might well have offered women ashield to fend off patriarchal judgementand condemnation.

 Talmud Bavli Ketubot 10b. 5Physicians, Midwives, and Female Patients

When drawingonArabic medical texts in an attempt to shedlight on how women experienced infertility,wemust ask the question: did the ideas articulated in these texts ever have apractical impact on the waymedieval infertile women weretreated or how they perceivedtheir infertility?Afterall, what we have are theories and practices described in books, in aworld in which the vast majority of women werenot taught to read. While some biographical dic- tionariesinclude accounts of individual women who did master aparticular bodyoforalorwritten texts (such as ḥadīth literature, or poetry), we have no such account in the realm of medicine. Therefore, Arabo-Galenic gynecology could have practical implications onlyifmale participantsinthis literate medical cultureshared this culture with femalemedical practitioners or communicated theirideas directlytofemalepatients. One might well assume,asManfred Ull- mann does, that neither of these thingscould occur,onthe grounds thatwomen would have lacked interest in male opinions about femalebodies, or on the grounds thatmodesty concerns made such interactions taboo. The extant sources,however,donot buttress such assumptions, and instead point at avery different state of affairs. As acaveattoher ownscholarship on ancient gynecological theories, Monica Greenwrites:

[T]he transmission of ancient traditions must be understood as aprimarilyintellectual and literary phenomenon. In all of the cultures discussed ...literacylevels were so low that a textual medium of knowledge would ipso factohavebeen inaccessible to the vast majority of people. Hencethe reader should not assume (nor have Imeant to imply) that the medical practices describedherewere necessarilythose most regularlyperformed when awoman complained of anyillness.Nor,additionally, can we always be surethat the theories expounded in medical literaturereflect the attitudes of the contemporary society at large.⁴⁸⁸

The same caveats maybeapplied to the communities under discussion in this study. When it comes to medieval Middle Eastern societies, we currentlyhave no wayofobjectively assessing the relative frequency of women receiving gynecological care that was influenced by the Arabo-Galenic literarytradition, as opposed to care guided by familial or local medicallore, or care predicated on religious intervention or the manipulation of supernatural forces. (The intellectual ramifications of these forms of healing are explored from the perspective of certain Islamic jurists in the next chapter.) What we do have,instead, are manytan-

 Green, “The Transmission of Ancient Theories of Female Physiology,” 7.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-010 176 5Physicians, Midwives, and Female Patients talizing remarks that shed light on the feasibility of women receiving gynecological care in the Arabo-Galenic medical tradition. In the regions and time-period from which thereisextant literature(which maywellnot be representative of the majority of communities), that literature depicts environments in which male physicians interact with femalepatients, though women appear in onlyarelatively small percentageofthe individual cases mentioned.⁴⁸⁹ Literary works,books of medical ethics,biographical dic- tionariesdetailing the exploits of physicians,guides to inspectors policing the marketplace, and works of religious preachingand public moralitydescribeava- riety of professional interactions between male physicians and femalepatients. They refertomedical consultations and to women submittingtheir urine to male physicians for uroscopy,just as their male counterparts do.⁴⁹⁰ Male phlebotomists are depicted as bleeding women. Male physicians examine women in the course of making house calls, take their pulse,⁴⁹¹ and at times engagein

 E.g., Abū Bakr Muḥ ammad ibn Zakarīyā al-Rāzī, Kitābal-tajārib:maʻadirāsa fī manhajal- baḥ th al-ʻilmī ʻinda al-Rāzī (Alexandria: Dāral-Wafāʼ li-Dunyā al-Ṭ ibāʻawa’l-Nashr,2006), 247– 252. The other two known clinical experiencecasebooks are al-Majālis fī al-ṭibb by Abū Ja‘far Aḥmad b. ‘Īsā al-Hāshimī (fl. 5th/11th-century) and Kitābal-Mujarrabāt by IbnZuhr,both from Spain.  In Ibnal-Ruhāwī’s Adab al-ṭabīb thereare several anecdotes about women submittingtheir urine for uroscopy, particularlyinorder to determine pregnancyand fetal sex. See M. Levey, “Medical Ethics of Medieval Islam with Special ReferencetoAl-Ruhāwī’s ‘Practical Ethics of the Physician,” 74 – 75.  Consider this anecdotefromal-Ghazālī’s Iḥyā ‘ulūmal-dīn: “Someone complained to a physician about his wife beinginfertile and not bearingany children. The physician felt her pulse and said: ‘No need to worry about infertility treatment,for youare goingtodie in forty days,asisindicated by your pulse.’ The woman was overcome with fear and lost all appetite for life; she took out her money,divided it and bequeathed it.She remained without eating and drinking,but the [allotted] time passed without her dying. The husband went to the physician and said: ‘She did not die.’ He replied: ‘Iknow that.Havesex with her now,and she will give birth.’ The husband retorted: ‘Howso?’ The physician explained: ‘Isaw that she was over- weight, and that fat had collected at the orificeofthe womb. Moreover,Iknew that she would onlylose weightifshe wereafraid of dying, so Iput this fear into her.Thus she lost weight,and the obstacle against conception has disappeared.’” Translation (modified) from Peter Pormann’s text studyhandout, “Female Patients,Patronsand Practitioners in 10th and 11th-Century Bagh- dad: An Unheard Voice?” InstituteofIslamic Studies at McGill University,Montreal, May4, 2007.Inanother textfromthe same period called Daʻwat al-aṭibbāʼ,the Christian physician IbnButlāncomplains that people have absurd and scientificallyimpossible expectations of physicians, and he lists as an example of such expections, the notion that aphysician should be abletodistinguish abarrenfromafruitful woman by feelingher pulse. See. F. Rosenthal, “The Defense of Medicine In The Medieval Muslim World,” Bulletin of the HistoryofMedicine 43 (1969):529. Non-gynecological interactions 177 more intimate formsoftouch. Medical texts also recommend surgeries to be conducted on women, includingontheir genitals and in obstetrical situations. As for the role occupied by female medicalproviders in the ecosystem of learned gynecology,the situation is remarkably ambiguous, not onlywhencomparing across communities,but even when considering the writingsofindividual authors.

Non-gynecologicalinteractionsbetween male medical professionalsand female patients

Descriptions of market activity from 6th –7th /12th –13th-century Islamic Spain, Egypt,and Syria portray physicians,pharmacists, surgeons, bonesetters and as- sorted other medicalpersonnelhaving storefronts in the market or in similar set- tingsinwhich women werepresent.⁴⁹² At least some of the medicalcare provided in these settingsclearlyreflects the Arabo-Galenic medical tradition. These descriptions come from books of ḥisba,guides for market inspectors whose job it was to prevent fraudand physical and moral pollution in the market and other public places.Concerns about the potential for sexual exploitation of women, and scandalous behavior on the part of women, feature prominently in this genre of literature. However,medical practitioners are not particularly scrutinizedinthis regard. Ḥisba manuals indicate that,atleast in some communities,itwas acceptable for male medicalpractitioners to touch female clients. Forexample, according to a6th/13th-century Syrian ḥisba manualbyal-Shayzarī,male phlebotomists perform cupping on women’sthighs to bring down the menses, apractice which is also recommendedinthe theoretical medicalliterature.⁴⁹³ Similarly,amanual by Ibnal-Ukhuwwa, written in 7th/14th Mamluk Egypt,describes male phlebotomists bleeding women, with no mention of modesty-based concerns in doing so. This is the case despite the fact that the author mentions regulations basedon

 See S. Hamarneh, “Origin and Functions of the ḤisbahSystem in Islam and ItsImpact on the Health Professions,” Sudhoffs Archiv fürGeschichte der Medizin und der Naturwissenschaften 48 (1964), 157–63 and M. Meyerhof, “La surveillancedes professions médicales et paramédicales chez les Arabes,” Bulletin de l’Institut d’Égypte 26 (1944), 119–34.Chipman, TheWorld of Phar- macy and Pharmacists in MamlūkCairo,70. See Abū’l-Munā al-Mūhīnal-‘Aṭṭār, Minhājal-dukkān wa-dustūral-ayān (Beirut: Dāral-Manāhil, 1992),16; Ibnal-Ukhūwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba,54–59; ʻIbn ʻAbdū nal-Tujibī and E. Le´vi-Provençal, Se´ville Musulmane Au De´ but Du XIIe Sie`cle: Le Traite´ D’ibn Abdun Sur La Vie Urbaine Et Les Corps De Me´tiers (Paris: G. P. Maisonneuve,1947), §139–40.  al-Shayzarī, KitābNihāyatal-rutba fī ṭalab al-ḥisba, 96.See IbnSīnā,Qānūnfīal-ṭibb 2:589 = Kitāb 3: fann 21: maqāla 3: faṣlfīal-mu‘ālajāt. 178 5Physicians, Midwives, and Female Patients modesty concerns in other,non-medical situations. Moreover,when addressing phlebotomists, Ibnal-Ukhuwwa mentionsothercaveats, but none of these reflect concerns about modesty or sexual taboos.

No slave must be bled without the owner’spermission, nor aminor without that of his guardian, nor apregnant woman, nor one menstruating.Bleedingmust not be performed except in apublic place, nor with anybut asharp instrument, nor when he [the operator] is in astate of mental agitation. The muḥtasib must exact apromise and abond from them that in tenspecified casesthey will not bleed except after consultationwithphysicians ...⁴⁹⁴

Herewesee menstruation and pregnancy treated as counterindications for bleeding,not as taboo subjects thwarting male medicalinquiry and involvement. Indeed, Ibnal-Ukhuwwa later specificallymentionsthe usefulness of bleeding the saphenous vein to provoke menstruation. (Healsomentions counter-indications with respect to male reproduction. He prohibits phlebotomists from cutting or bleeding the veins behind the ears, for fear that it will inducemale sterility. Al-Shayzarī includes aslightlylonger discussion of this notion, which also appears in the Hippocratic treatise Airs,Waters, Places.⁴⁹⁵) Ibnal-Ukhuwwaalsoinstructs the inspector to ensure that the phlebotomist is prepared to conduct circumcisions, on both males and females.

The phlebotomist should carry with him instruments for circumcision (consistingofarazor and scissors), for it is adutyincumbent upon both men and women. To this the generality of men of learningagree. Abū Ḥanīfa called it arecommended practice, but not acompul- sory duty.For the male, it consists in abscission of the prepuce hidingthe glans penis,for the female in cuttingthe skin over the vagina and abovethe urethra. It is apracticecom- pulsory upon men and women, who must carry it out on themselvesand on their children. If it is neglected, the imam must enforce its beingcarried out.⁴⁹⁶

That phlebotomists weretaskedwith circumcision can be attributed to their having the requisitesharp tools in theirpossession. A13th-century Egyptian shadow playtitled, al-Ṣāni‘a, “The Female Practitioner,” features awoman, probablya gypsy,asthe titular character,and she is depicted bearing asatchel, lances,cupping glasses,and needles with which she fulfills her roles as phlebotomist,tat- tooer,circumciser,and fortune-teller.⁴⁹⁷ While femalephlebotomists are not

 Ibnal-Ukhūwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 54.Levy’stranslation.  Al-Shayzarī, KitābNihāyatal-rutba fī ṭalab al-ḥisba, 92  Ibnal-Ukhuwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 56.Levy’stranslation.  P. E. Kahle, “AGypsy Woman in Egypt in the Thirteenth Century A.D.” Journal of the Gypsy Lore Society,thirdseries,29(1950):11–15. Non-gynecological interactions 179 mentioned in Ibnal-Ukhuwwa’stext,they were ofteninvolvedinfemalecircum- cisions in Egypt.⁴⁹⁸ Furthermore, in legal literature thereisahistory jurists en- couragingphysicians to teach women to perform circumcisions and other medical procedures in order to avoid subjecting women to amale gaze.⁴⁹⁹ However, in Ibnal-Ukhuwwa’smanual, the description of how to conduct femalecircum- cisions uses masculine grammatical forms for the practitioner.⁵⁰⁰ In addition to hisba manuals, medicaltexts tooalso give the impression that male practitioners performcircumcisions and genital excisions on women. The 4th/10th-century physicians IbnSīnāand al-Zahrāwī,both writing in contexts wherefemale circumcision was not acommon practice (in Iraq and Spain re- spectively)describe in their medical texts how amale physician should go about performing clitorectomies when the clitoris is abnormallylarge.Ibn Sīnā,for his part,expresses some skepticism regardingwhether such acondition actuallyexists and, if it does,whether it cannot be better managed without surgery.⁵⁰¹ Al-Zahrāwī does not mention such doubts but,following quite closely Paul of Aegina’sdescription of the procedureinhis book on surgery,writes “You[masculine]must grasp the clitoris with your hand or with ahook and cut it off. Do not cut toodeeply...and as for afleshygrowth growinginthe cervix and filling it ...you should cut this too, just as youcut off the clitoris.”⁵⁰² Al-Zahrāwī is quite clear that it is amale physician performing the operation, and that the surgery entails touchingthe genitals. One could make the argument that al-Zahrāwī does not consider the clitoris to be femalegenitalia,and that the medicalscenario is thus not considered gynecological or sexuallyfraught.(He refers to the operation as cutting aclitoris which is so large as to look “de- formed” and “erect like aman’s” penis). His chapter describing the procedure (chapter 71)precedesthe chapters on gynecological surgery but immediatelyfol- lows the chapter on treatinghermaphrodites (chapter 70)and on the mechanics of male castration (chapter 69), which in turn is preceded by chapters on male genitalia.This sortoforganization mayimplyaview that the uncircumcised girl constitutes astageonamasculine-to-feminine continuum,which moves from males, to castrated men, to hermaphrodites,touncircumcised girls, to

 Berkey, “Circumcision Circumscribed: Female Excision and Cultural Accommodation in the Medieval Near East,” 20.  Ibn ʻĀ bidīn, Ḥ āshiyat Radd al-muḥ tār,9:533.  Ibnal-Ukhuwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 164 in the Arabic.  IbnSīnā,Qānūnfīal-ṭibb, 2:603=kitāb III: fann 22: maqāla 1, faṣlfīal-laḥmal-zā’id wa-ṭūl il-baẓr.  al-Zahrāwī, Albucasis on Surgeryand Instruments,457.Cf. Paul of Aegina and Francis Adams, TheSeven BooksofPaulus Ægineta (London: Sydenham Society,1844), 2:381. 180 5Physicians, Midwives, and Female Patients full-fledgedwomen. The chapter in question is taken verbatim from Paul of Ae- gina’sbook on surgery,which maintains the samechapter order.⁵⁰³ It could perhaps be argued thatphlebotomists and surgeons are distinct from physicians,and thus are not elite enough to be considered athreat to sexual respectability nor sufficientlytheoreticallytrained as to be able to communi- cate Arabo-Galenic medicaltheory and practice to their patients. However,we also hearofphysicians treating women and conversing with them about both medicaland non-medical topics.This appears to be the case both in the households of the nobility,wheremodesty constraints were usually greatest, as well as in less elite households in avariety of places and periods. Numerous tales recounted by IbnAbīUṣaybī‘ainhis biographical dictionary of physicians, Kitāb ‘Uyūnal-anbā’ fī ṭabaqātal-aṭibbā’,reference relationships and alliances between male physicians and female patientsinthe royal household. Some of these relationships are described as occurringatadistance and through intermediaries, such as the one between Khayzurān, the mother of the famed ‘Abbasid caliphs al-Hādī and Hārūnal-Rashīd, and the physician Abū Quraysh. But there are also numerous mentions of physicians visitingthe women’squarters. Forex- ample,the Samaritan physician and vizier to the Ayyubids Muhadhdhab al-Dīn Yūsuf ibn Abī Sa‘īd(d. 624/1227), served as the personal physician to boththe male and female members of the royal household. In one story about him a friend of his, ajudge,fell out of favoratcourt and asked Muhadhdhab al-Dīn to advocate for him. In an effort to help, the physician turned to his allies in the harem:

Seriat al-Malik al-‘Adil, the mother of al-Malik al-Sālih ibn al-Malik, was unwell at that time. She was of Turkish origin, an intelligent,pious and good woman, very kind and generous. When the Doctor Muhadhdhabal-Dīncame to see her in the harem, he acquainted her with the case of the judge,his troubles and the unjust treatment meted out to him ...The chief eunuch supported Muhadhdhab’srequest.But Seriat said: “How can Idoanythingfor the judge,orevenmention him to the Sultan? Icannot,because he will ask: ‘What makes you speak about the judge,and how is it that youknow him?’ If he were,say,adoctor whovisits us fromtime to time, or amerchant who sells us cloth, it would be possible for me to talk and intervene; but as it is, Ican do nothing.”⁵⁰⁴

 Paul of Aegina and Francis Adams, TheSevenBooks of Paulus Ægineta (London: Sydenham Society,1844), 2:381. Cf. IbnSīnā,Qānūnfīal-ṭibb, 2:603 = kitāb III: fann 22: maqāla 1, faṣlfīal- laḥmal-zā’id wa-ṭūlil-baẓr in which IbnSīnādescribesthe same surgery,but says thereisdis- agreement as to whether this condition even exists and whetherornot it can be managedwith- out surgery.  Translation from L. Kopf, Livesofthe Physicians http://www.tertullian.org/fathers/ibn_abi_ usaibia_03.htm, p. 905.Ibn Abī Uṣ aybī‘a, ʻUyūnal-anbāʾ fī ṭabaqātal-aṭibbāʾ (Beirut: DārMak- taba al-Ḥayāt, 1965), 730. Non-gynecological interactions 181

The woman and the physician then concoctaschemewhich ultimatelysucceeds. From this passage, it is evident that not onlydoes the physician visit the noblewomen, but that he occupies one of the few professions that are perceivedas having legitimate business in the harem. The noblewoman says it would seem suspiciousfor her to be aware of the political fortunes of ajudge and to intervene on his behalf, but it would not be inappropriate for her to be seen to do so on behalf of aphysician or cloth merchant.The story indicates that in this noblewoman’sparticular community there are opportunities for educated physicians to converse with women without violating social norms. Other anecdotes recounted by IbnAbīUṣaybī‘asuggest that physicians who personally attended the women of noble households mayhavebeen in highly sensitivepositions that occasioned some awkwardness, but such obstacles werenot insurmountable. The story is told of Sa‘īdibn Tufīl(d. 279/892),an Egyptian physician to the famed founder of the Tuluniddynasty Aḥmad ibn Ṭūlūn, and his accidental protegee in the medicalarts, Hāshim.

When Sa‘īdibn Tufīlfirst associated with Aḥmad, he had ahirelingofugly appearance, called Hāshim, who, together with his father,workedwith flax. He tendedSa‘īd’smule and kept watch on it when Sa‘īdentered the house of Aḥmad ibn Tūlūn. Sa‘īdoccasionally had him pound drugs at his house when he took him home with him, and blow upon the fire over the concoctions. Sa‘īdibn Tufīlhad ason of handsome appearance, endowed with intelligenceand asound knowledge of medicine. At the beginningoftheir acquaintance- ship, Aḥmad ibn Tūlūninstructed Sa‘īdtofind aphysician for his womenfolk, who would reside at the court during Sa‘īd’sabsence. Said Sa‘īd: ‘Ihaveason whom Ihave taught and made proficient.’ Said Aḥmad: ‘Present him to me.’ When he was introduced, Aḥmad, seeingahandsomeyouth, possessed of all good qualities,commentedtoSa‘īd: ‘He is not suitable to servethe women; for them Ineed aperson of great knowledge, but ugly appearance.’ Sa‘īdwas reluctant to have astranger attend the women, for fear that he might disagreeand clash with him. He therefore took Hāshim, providedhim with adira’a[aloose outer garment] and slippers and appointed him to the women ... ‘Umar askedSa‘īd: ‘In what position did youinstall Hāshim?’ Sa‘īdreplied: ‘In the serviceofthe women, for the Emir wanted aperson of unprepossessing appearance.’ Said ‘Umar: ‘An ugly person with asound education, fittingthe post,could surelyhave been found among the sons of physicians. Youhavedisgraced the profession ...’

From this account it would seem that,inthe Tulunid court,women wereseen by trained male physicians, but it was aposition appropriate to ajunior person, though stillaperson old enough to be potentiallysexuallyappealing.The ideal physician under such acircumstancewas someone well-educated but not physicallyattractive.The story continues with Hāshim’sgreat success among the noblewomen, who then personallymake the introductions between their trusted physician and the sultan himself. 182 5Physicians, Midwives, and Female Patients

Hāshim acquired such highprestigeamongthe women that they preferredhim even to Sa‘īd, for he preparedmedicines which had abeneficialeffect on them as regards fatness, pregnancy, the complexion and the growth of hair.When Aḥmad ibn Tūlūn’sailment became very severe and the physicians assembled in his presenceevery morning, Mi’at Alī, the mother of Abū’l-Ashā’ir,said: “Alarge crowdofphysicians has assembled, but Hāshim is not amongthem. By Allāh, OmyLord, none of them is his equal.” Aḥmad said to her: “Have him come to me secretly, so that Imay talk to him.” She secretlybrought him to Ahmad after encouraginghim to speak.⁵⁰⁵

As the narrator tells it,the women in this case are happy to draw on the expertise of the male physician, even when it comes to feminine matters such as fertility. There are manysuch accounts in IbnAbīUṣaybī‘a’swork, includingmen- tions of privatemeetingsbetween physician and female patient.⁵⁰⁶ Rarelyare modesty measures mentioned in these circumstances.Aninteresting exception to this rule can be seen in IbnAbīUṣaybī‘a’sanecdoteabout the 7th/13th-century court physician in Cairo, Rashīdal-DīnAbūḤulayqa. IbnAbīUṣaybī‘arecounts a story about Rashīdal-Dīn’sskill. In the story, the physician engagesintaking the pulsesofall the sick women in the sultan’shousehold, whom he cannot see because they are hiddenbehind ascreen. The sultan himself decides to hide behind the screen togetherwith the women and extends his own arm out in turn. The physician recognizes, by the precise measure of the pulse, that it is in fact that of the ruler,and not of anyone else.⁵⁰⁷ The storyisinteresting because, in mentioningthe screen, it suggests that aphysician might interact with and even touch apatient without being able to physicallysee her.However, such measures are not mentioned anywhereelse in the biographical dictionary, despite manystories of interactions with femalepatients. It could well be that the screen is amere literarydevice, meant to show off (as it clearlydoes) the physician’sprowess, or else it represents aparticularstringencyunique to the femalemembers of the royal household in that particularera.⁵⁰⁸ Other genres of literature, less focused on enhancing the reputations of individual physicians,also mention male physicians treatingfemale patients and otherwise interactingwith women of the household. Afascinating,ifproblemat-

 Translation from Kopf, Lives of the Physicians, 688. IbnAbīUṣ aybi‘a, ʻUyūnal-anbāʾ fī ṭa- baqātal-aṭibbāʾ,543.  IbnAbīUṣ aybi‘a, ʻUyūnal-anbāʾ fī ṭabaqātal-aṭibbāʾ,637.  IbnAbīUṣ aybi‘a, ʻUyūnal-anbāʾ fī ṭabaqātal-aṭibbāʾ,592.  In her discussion of Ottoman medicine, Miri Shefer-Mossensohn explores how women of the highestrank had morelimited access to medical care than those of less exaltedsocial position, as aresult of the demands of modesty.M.Shefer-Mossensohn, Ottoman Medicine: Healing and Medical Institutions, 1500–1700 (Albany: SUNY Press, 2009), 130 –1. Non-gynecological interactions 183

ic, sourceofmedical practice is atreatise written by the Cairene jurist Ibnal-Ḥ ājj al-‘Abdarī (d. 737/1336), in which he castigates his owncommunity for what he believes are the manymoral degradations of his age. (This treatise will be examined in more detail in the subsequent chapters.) Among the manyreprehensible behaviors he condemns is his fellow Egyptian Muslims’ choiceswhen seeking medicalcare. He is particularlyupset with Muslims who summon non-Muslim physicians instead of Muslim ones to tend to members of their household. In his treatise, he lays out manyreasons whysuch conduct is unseemly, one of which focuses on women:

Even if nothinghappens except that the infidel describes aMuslim’swife or daughter to someone else ...it would be toomuch for Islamic protective jealousy (al-ghayraal-islām- iyya), even if it werenot forbidden in the noble Law,⁵⁰⁹ God forbid. If someone were to say: ‘But the jurists have permitted uncoveringnakedness before aphysician whetherthe patient is aman or awoman!’ the response is that this is the case onlywhenthereisane- cessity,and thereisnonecessity that calls for inviting an infidel when there exists aMuslim physician.⁵¹⁰

The central argument in this passageisanattack on medicalinteractions that cross the religious divide, not ones that cross the gender divide. However,the argument implies that both Ibnal-Ḥājj and his hypothetical interlocutor assume that amale physician is expected to see femalepatients. Moreover,from the interlocutor’sstatement “but the jurists have permitted uncovering nakedness before aphysician whether the patient is aman or awoman,” we can inferthat this environment is one in which asignificant portion of the population assumes that,inamedical context,femalenudityisunproblematic. Indeed, the religiously zealous Ibnal-Ḥ ājj does not dispute this point,rather he argues that such mixed-gender interactions are onlypermittedifitisamatter of necessity,and there are no medical occasions which requireaninteraction that crosses the boundaries of bothgenderand faith.⁵¹¹ The formerisadmittedlynecessary and acceptable; the latter,heargues, should not be.

 I.e. Even if the readerweretodenyhis previous stated arguments showingthat choosing non-Muslimphysicians contravenes the sharia, aMuslim man should still disdain such behavior on the grounds of ghayra, appropriatesexual possessiveness.  Ibnal-Ḥ ājj, al-Madkhal. 3/4:318.  Thereisagreat deal of both primarysourcesand scholarlyliteratureabout interreligious medical mixinginthe Mediterranean, from the late antique erathrough the end of the middle ages and beyond. It is not uncommon to find Jewish, Christian,and Islamic texts that condemn such mixingwhile at the same time confirmingits prevalence. See chapter 6. 184 5Physicians, Midwives, and Female Patients

Evidence of the communication of medicalknowledge across the genderdivide can be found in avariety of texts that expressconcern that physicians or pharmacists (both are mentioned) mayteach women which drugs are abortifacients, or mayfurnish women with the drugs.The concern is either that women mayinturn use them on themselvesorsurreptitiouslypoison another woman out of spite.Some books, including ḥisba manuals, specificallytie this concern to the need to uphold the Hippocratic Oath.⁵¹² Adetailed warning about such communications can be found in amedical ethics treatise by the 3rd/9th-century Baghdadi Christian physician Isḥāqb.‘Alī al-Ruhāwī:

If youare understanding,Ofriend, youhavethe advice of the great Hippocrates. He said that youmust not mind the impatience of awoman whom yousee distressed and afflicted duetoher gestation, and not pity her or give her aremedytomake her fetus fall. Whoever does so has no fear of God. There is no reason to kill the fetus. On the contrary,itisnecessary to raise it for this brings with it aworthyremuneration. As to abad mother,donot show anycompassion for her,sothat her shame will cause the improvement of manyother women. Bewareofgivingthings [i.e. abortifacients] like these; they areprescribed onlyifyou fear the death of the pregnant woman or the fetus. There is no difference whether youadminister the drugoryou sell it.Beforedecidingon the drugtreatment,itisessential that youreadthe book of Hippocrates in regardtohis oaths to carry out his word. Youmust adheretohis oaths and go along with his beliefs from which the oaths arederivedsincethese belongtothe art of medicine. These must be observed under all conditions.⁵¹³ ...Together with beingconcerned about the sellers and storekeepers of the remedies which we have presented, the physician must warn the drugmerchant not to give women drugs which make the fetus fall and menstruation flow without his permission.⁵¹⁴

These exhortations against providing abortifacients indicate that physicians communicated directlywith women about matters related to pregnancy. One could possiblyread these texts about avoiding abortifacients as simply repeating traditionalwisdom, rather than reflecting actual medicalpractice but,atleast in al-Ruhāwī’scase, the details suggest asubstantial degree of immediacy. He cau- tions the physician that his “pity” and “compassion” when he sees a “distressed,”“afflicted,” and “shamed” pregnant woman should not movehim to help her procureanabortion. This, in my view,suggests that al-Ruhāwī is speak- ing from experience, either his own or thatofhis fellow physicians.

 Al-Shayzarī,98. TheMa‘ālim al-qurba fī aḥkāmal-ḥisba,167 in Arabic text. Also in Ibn Bassām, Nihāya al-rutba fī ṭalab al-ḥisba (Beirut: Dāral-Kutub al-ʻIlmiyya, 2003), 340.  Translation in Martin Levey, “Medical Ethics,” 56.  Ibid., 62.Levey’stranslation with some significant emendation. Gynecological care and interactions 185

To be sure, depictions of charlatans, mountebanks,and disreputable physicians describe them as being on even more familiar terms with women thanis proper.Thus Saladin’sphysician IbnJumay‘ complains that deceptive physicians reach clientele by “gainingthe favoroftheir wivesthrough suitable and alluring drugs,like aphrodisiacs, medicaments for conceiving,fatteningand hair-growing by making common cause with the femalebath-attendants, hairdressers and midwives, in order that they should talk about them and praise their won- derful medicalskill.”⁵¹⁵ Herethe charge against charlatans is not so much immodesty as playing to the female crowdand consummatenetworkingby means of cultivatingrelationships with women who are in para-medical professions. This bringsustothe question: what sort of relationship did male physicians have with midwives, and did men playagynecological role with or without midwivesasintermediaries?

Gynecological care and interactionsbetween male physicians, female patients, and female intermediaries

In spite of the above-mentioned references to interactions between male physicians and femalepatients, there is much evidence to suggest that,inthe societies from which our texts derive,itwas taboo for male physicians to view or touch women’sgenitals, or at least some women considered the matter in that light.We see this primarily in literary anecdotes.InIbn Abī Uṣaybī‘a’sbiographical dictionary,the story is told of Jibrā’īlibn Bukhtīshū’ ibn Jūrjīs, who cures a woman of paralysis during an examination simply by bending his head down and extendinghis hand toward her skirt as though he intended to lift it,thereby awakeningthe woman’sself-protective instincts.⁵¹⁶ In al-Faraj ba‘dal-shidda,al- Tanūkhī tells the story of awealthyyoung woman in the countryside who attempts to conceal aterrible pain and discharge in her vagina.Her father,upon finallydiscovering that she is sick and on death’sdoor,sends for medical care.

Isent for Yazīdthe Urinanalyst and consulted him. “Would youforgive me,” Yazīdasked, “if Imake asuggestion?Ican issue no prescription unless Iamallowedtosee the site of the complaint and palpateitwith my own hands, and ask the woman questions as to how the disorder mayhavearisen.” Hercondition was

 IbnJumay‘, al-Maqāla as-Ṣalāḣ ̣iya = Treatise to Ṣalāḥ ad-Dīnonthe revival of the art of medicine by Ibn Jumayʻ:edited and translated by HartmutFähndrich (Marburg: KommissionsverlagF. Steiner,1983).  IbnAbīUṣ aybi‘a, ʻUyūnal-anbāʾ fī ṭabaqātal-aṭibbāʾ, 188. 186 5Physicians, Midwives, and Female Patients

now so serious,indeed desperate, that Iconsented; but after he had examinedher exter- nallyand found the siteofthe pain, his questions went on for so long and had so little to do with her illness that Ifelt temptedtolay violent hands on him. However,Ireminded myself of the good character that he bore,and contained myself with difficulty.

The father’simpatience with Yazīd, and his need to calm himself by reminding himself of Yazīd’sgood character,does not appeartostemfrom his concern that the manistouchinghis daughter,but rather that the man is asking her seemingly pointless questions insteadofhelping her.

At last he said: ‘Have someone hold the girl down.’ Igavethe order;hethrust his hand intoher vagina; she screamed, then fainted; blood spurted out,and he withdrew his hand, displayingacreature smaller than adung-beetle, which he tossed aside. The girl immediatelysat up, crying: ‘Papa!You must send this man out of my room,for Iamwell again.’⁵¹⁷

The story goes on to explain thatthe sourceofthe trouble was atick, contracted while tending cattle. Both stories,about the paralysis and the tick, suggest that modest femalepatientsmight be reluctant to have male physicians see or touch their genitals, but that doctors themselvesdonot have compunctions in this regard. Illness, whereitispresent,suspends the dictates of modesty.The restoration of such dictates,and deferencetowomen’spreferences,isthe marker that the medical emergency is over,having been resolvedthrough the cleverness of the physician. Aless celebratory and more mundane expressionofwomen refusing to seek out treatment offered by male physicians can be seen in the famous Sevillian physician IbnZuhr’saccount of having in his youth once come across a woman with aprolapsed uterus,who had not sought male medicalcare for it. He laments:

Know that when Iwas ayouth Isaw awoman to whom this had happened, and her uterus was likeabracelet which was showingthrough her vagina. It had been that wayfor along time. Idonot know what happened to her.Had this been recent,the physician would have been able to undo the injury,God permitting.”⁵¹⁸

 al-Tanūkhī, Farajba‘dal-shidda (Beirut: DārSādir,1978), 4:215. TranslationinJulia Bray, Writing and Representation in Medieval Islam (London: Routledge,2006), 225.  Abū Marwān ‘Abdal-Malik ibn Zuhr, Kitābal-taysīrfīal-mudāwāhwa’l-tadbīr (Damascus: Dāral-Fikr,1983), 308–309. Gynecological care and interactions 187

The most explicit description of how sexual propriety factors into medicalcare appears at the beginning of achapter in the Surgery of al-Zahrāwī,who practiced in Cordoba in the 4th/10th-century.The chapter describes an operation to remove bladder stones.The operation required amedicalpractitioner to insert his finger either into the anus (if the patient was amale or avirgin female), or into the vagina, to feel for the stone and, using both the inserted finger and an external hand to press down on the bladder, to manipulate the stone to alocation near the groin. The practitioner would then make an incision to surgicallycut the stone out.Hewrites:

It is uncommon for awoman to have astone. But if it should happen to awoman the treatment is indeed difficultand hindered by anumber of things.One is that the woman maybe avirgin. Another is that youwill not find awoman whowill expose herself to a(male) doc- torifshe is chasteorhas close male relatives(lātujid imra’atubīḥ nafsahā lil-ṭabībidhā kānat ‘afīfa aw dhawātal-maḥārim).⁵¹⁹ Athirdisthat youwill not find awoman competent in this art,particularlynot in surgery.Then afourth is that the placefor cuttingupon the stone in awoman is along wayfromwhere the stonelies,sothe incision has to be deep, which is dangerous.Ifnecessity compels youtothis kind of case, youshould take with you acompetent womandoctor (imra’aṭabība muḥsina). As these arevery uncommon, if you arewithout one then seek chaste/eunuch doctor as acolleague (fa-uṭlub ṭabīban ‘afīfan rafīqan),⁵²⁰ or bringamidwife experienced in women’sailments or awoman to whom youmay give some instructioninthis art (imra’atushīrfīhādhihi al-ṣinā‘aba‘ḍ al- ishāra). Have her with youand bid her do all that youenjoin; first of all, in searching for the stone. If she perceivesthat the woman is avirgin she should pass her finger into the anus and palpatefor the stone. If she finds it and keeps her finger on it,then bid her cut down upon it.But if the patient be not avirgin bid the midwife pass her finger into the vulva and palpatefor the stone, after she has placed her left hand upon the bladder and applied agood pressure.Ifshe finds the stone she should graduallypush it down from the outlet of the bladder as far as she can until it reaches the bottom of the pelvis. Then she should cut down upon it from about the middle of the pudenda near the root of the hip on whichever side she can convenientlyfeel it; she must keep her finger on the stone, pressing from below.The incision should start by beingsmall; then let her introduce asound into the small incision, and when she finds the stone then she will enlarge the incision until she knows that it is big enough for the exit of the stone.

 Spink and Lewis translate “dhawātal-maḥārim” as “married” rather than “havingclose male relatives.”  The Arabic word describingthis doctor is “‘afīf” i.e. “chaste,” which is not the usual term for aeunuch, though ‘Afīfseems to have been commonlyused as apersonal name giventoeu- nuchs.However,given the context, Ithink Lewis and Spink’sinterpretation of ‘afīf as eunuch is plausible. 188 5Physicians, Midwives, and Female Patients

...Ifyou arehindered by ahemorrhage...after some days,when the acute hemor- rhagehas subsided and suppuration has set in, returntoyour operating until youget the stone out.⁵²¹

From this description, which is the clearest one we have,itseems that al-Zahrāwī would ideallyteam up with speciallytrainedeunuchs and women and direct them as they performed examinations and surgeries on women. It should be noted here thatwhile most of the content of this chapter is taken verbatim from the Byzantine physician Aetius of Amida’sencyclopedia,⁵²² all of the passages about midwives, eunuchs, assistants, virgins and chastity seem to be original to al-Zahrāwī.⁵²³ This suggests that these original additions reflect al-Zahrā- wī’sown place and time. (I have been unable to find anyothermention of eunuch physicians in medieval Arabic literary or documentary sources, however they are known to have attendednuns in Byzantium.⁵²⁴)Interestingly,headmits that thereare few opportunities for aphysician to practice this particular surgery.Such admissions are not present in most of his other descriptions of performing operations on women, which would implythat he views those other operations as practical, rather than rare-to-the-point-of-being-theoretical. He connects the rarity of bladder-stone removal surgery specificallytothe sensibil- ities of respectable women, rather than to anyreluctanceonthe part of the physician, or to external policing.Furthermore,his mention of the possibility of teamingupwith women doctors as well as midwivesand the physician’s own femaletrainees, suggests that he views it as not impossible for awoman to receive some degree of instruction, such that she is conversantwith the medical worldview of male practitioners of Arabo-Galenic medicine,evenifsuch a woman is ararity.Bycomparison, writing in the samecentury but on the other side of the Muslim world, IbnSīnādiscusses the sameoperation, but makes no mention of afemalepractitionerorofparticularmodesty concerns, de-

 al-Zahrāwī, Albucasis on Surgery and Instruments,M.S.Spink and G. L. Lewis (Berkeley: University of California Press,1973), Book 30,Chapter61, 420 – 423. The translation is amodified version of Spink and Lewis’s.  Spink and Lewis note the correspondencebetween the two works,but not the discrepancies.Otherwise, they uncharacteristicallychoose to not comment on the chapteratall, on the grounds that it “needs no note.” Ibid., 420.  Cf. Aetius of Amida, TheGynaecology and Obstetrics of the VI Century,chapterXCIX,105.  Kathryn M. Ringrose, ThePerfect Servant: Eunuchs and the Social Construction of Gender in Byzantium (Chicago:University of Chicago Press, 2003), 83. Gynecological care and interactions 189 spite his detailed explanations and warningsabout the operation and its permutations.⁵²⁵ Another description of the same procedure, from 7th/13th-century Syria,provides us with asimilar account of women’sreluctance to undergo bladder-stone removal surgery but seems to takeitasagiventhat the surgery would have to be performedbyawoman. The physician Ibnal-Quffwrites:

When stones occur in the bladder of women, their treatment is complicated by five factors: one of them is that the woman might be avirgin, and so thereisnopath for insertingthe finger in the vagina so as to find the stone. Second: few women comeforwardtoundergo said treatment,due to the pain of the incision. Third,wedonot find awoman whowill permit herself such surgical treatment because they areovercome by bashfulness.Fourth: because the location of the stone is further in them and requiresadeeper incision, and that is dangerous. Fifth, she maybepregnant thereisaconcern that the incision will injure the fetus ...But,ifyou want [or:she wants⁵²⁶]toattempt to removeit, then seek an expert, intelligent midwife, and order her to do everythingthat yousay ...⁵²⁷

He does not implythatsuch “expert,intelligent” midwivesare rare, as al- Zahrāwī does, nor that it is acceptable for aman to engageinthe surgery,as IbnSīnādoes. We thus see adiversity of attitudes toward the proper division of labor between male and femalepractitioners with respect to this procedure. It is not clear whythis procedureinparticular should serveasthecontext for Ibnal-Quff’selaborations on women’s “bashfulness” and al-Zahrāwī’selaborations on allaying modesty concerns.The most likelyexplanation seems to be that – since there was along history of offering different methods for removingstones based upon whether the patient was aman, virgin woman, or non-virgin woman – it mayhaveseemed particularlyappropriatetobuild off of thatdiscussion to tangentiallyaddress how patients’ social identities affect their medicalcare. We have remarkablyfew references to either the existenceoforthe training of the “competent woman doctor” whom al-Zahrāwī mentions as beingsorare. Certainly, the feminine noun “ṭabība” i.e. “doctoress” exists, but in the pre-Otto- man period it does not seem to refer to awoman trained in Arabo-Galenic med-

 IbnSīnā,Qānūnfīal-ṭibb, 2:510=kitāb III: fann 19: maqāla 1: faṣlfīal-tadbīr [re: ḥiṣātal- muthāna].  The verb used here is ambiguous and can be read as asecond-person masculine or thirdperson feminine form.  Abū al-Faraj ibn Yaʻqū bIbn al-Quff, Kitābal-ʻUmda fī al-jirāḥa (Hyderabad: Majlis Dāʼirat al-Maʻārif al-ʻUthmāniyya, 1937) 2:210–11. 190 5Physicians, Midwives, and Female Patients icine.⁵²⁸ Morecommon are references to women ophthalmologists.The most expansive account of women receiving training from aphysician in the Arabo-Ga- lenic tradition can be found in IbnAbīUṣ aybi‘a’sdescription of the multiple generations of the IbnZuhr physician-dynasty that flourished in Spain. He writes that the sister and niece of al-Ḥ afīdAbūBakr ibn Zuhr (d. 596/1199) “were knowledgeable in the art of medicine and treatment,and they had much experience in matters pertaining to the treatment of women. Andthe two of them would attend the women of al-Manṣ ūrand no one would deliverthe children of al-Manṣ ūrand his household except for al-Ḥ afīd’ssister Rufayda, or her daughter when her mother died.”⁵²⁹ IbnAbīUṣ aybi‘aalso claims thatthe caliph’svizier had both IbnZuhr and his niece assassinated, an indication that both occupied positions of power.Weknow little else about these female physicians, not even the name of the assassinatedwoman. It is reasonable to surmise that the phenomenon of female relativesofphysicians practicing gynecological and obstetrical medicine themselves occurred with some frequency, but there are few extant references to such individuals.⁵³⁰ This is not to suggest that women who provided care wereararity.There is little reason to doubt that women in general, as part of theirroleasmothers, wives, sisters,daughters,cooks,and producers and consumers of local knowledge of plants, stones,and magic provided much of the day-to-day care for sick people in both the Middle East and in Europe up until the modern period.⁵³¹ However,there is no extant record of female medicalproviders studying medicalbooks or being trained in the Arabo- Galenic medical tradition.⁵³²

 S. D. Goitein writes that the word ṭabība occurs several times in the documents of the Cairo Geniza, but he believes these refer to women fromlowerstrata of society,not classicallytrained physicians. See Goitein, Mediterranean Society, I:127–8.  Translation from Kopf, Lives of the Physicians,664.Ibn Abī Uṣ aybi‘a, ʻUyūnal-anbāʾ fī ṭa- baqātal-aṭibbāʾ,524.  These few areidentified in Giladi, Muslim Midwives, 70 – 71.The biographical details are quitescant.Inthe Ottoman period we hear of an unnamed daughter of the chief physician of the Manṣ ūrī hospital in Cairo, whoherself inherited his position after his death in 1036/1626.  Savage-Smith and Pormann, Medieval Islamic Medicine, 103.  Muḥammad b. Ibrāhīmal-Jazarī’s(d. 738/1338) biographical dictionaryincludes areference to aCairene woman named UmmKhayr Khadīja bint al-imāmFakhr al-Dīnal-Nawzari (d. 733/ 1333)who both knew how to writeand, in her old age, served as amidwife to the sultan’swife. However,her writingseems to be connected to her religious scholarship, not to anymedical knowledge she might have.Apart fromher serving as amidwife, thereisnoindication that she has access to anysort of medical scholarship. Al-Jazarī, Ta’rīkh ḥawādith al-zamānwa-an- bā’ihi wa-wafayaātal-akābir wa’l-a’yānmin abnā’ihi (Beirut: al-Maktabaal-‘Aṣriyya, 1998) 3:701. Gynecological care and interactions 191

Although the “competent woman doctor” is so rarelymentioned in medical literature, the figureofthe midwife appears much more frequently, sometimes as asubordinateand informant,and sometimes more as acolleague. Descriptions of the extent of physicians’ dependency upon midwivesvaryconsiderably in the medicalliterature. While there are manyreferences to cooperation between midwivesand physicians in the medicalcompendia, it is just as common for texts not to indicate the presenceofanintermediary at all, even in gynecological situations. It should be noted here that it is oftendifficult to discern which tasks are performedbythe male physician, which by female attendant(s) or midwives, and which by the patient herself.Inpart this is due to the frequent use of passive verb formsinthese texts.The matter is further complicated by the fact that it is often grammaticallyunclear whether the active indicative verbs in Arabic medical manuals are intended to be read as second-person masculine forms or thirdperson feminineforms.⁵³³ Imperativeverb forms, however,make the gender of the practitioner somewhat clearer. Unsurprisingly,interactions between midwivesand physicians frequently appear in discussions of childbirth complications.Once again, the most detailed description of such cooperation is found in al-Zahrāwī’stext,inhis chapter on handling difficult childbirth. The chapter seems to indicate that the male physician has visual access to the laboringwoman. However,the physical interventions in the delivery are conducted by the midwife.

The midwife must have wisdom and dexterity and be skilled in all these cases and beware of failures and mistakes. Ishall explain the technique in these modes of delivery so that she [or: youmasculine]may be instructed and maybeacquainted with them all. When the fetus comes out by the vertex in the normal manner and yetthe delivery is with great difficulty for the woman and yousee that her strength is exhausted, then make her sit on aseat and order the women to take hold of her and foment her womb in ade- coction of fenugreek in bland oils.Then the midwife should take between two fingers alittle scalpel and makeanincision in the fetal membrane or open it with the finger nail, to allow the contained waters to flow out; and put pressure upon the woman’sabdomen until the fetus comes down ...⁵³⁴

As the chapter continues,however,inadditiontousing gender-ambiguous verbs al-Zahrāwī alsobegins using masculine imperatives for actions that require intimate contact with the woman in labor,such as “place [ḍa‘ =masculine imper-

 Weisser makes this same point,see Zeugung,Vererbung,und pränatale Entwicklung, 56–59.  al-Zahrāwī, Albucasis on Surgeryand Instruments,468–471. The translation is that of Spink with some additionstoshow grammar.Moresubstantial emendation occurs in the secondpara- graph. 192 5Physicians, Midwives, and Female Patients ative]the woman upon aplatform...and shake [masculine imperative] the plat- form.” If the baby emergesfeet first,hewrites “return [masculine imperative]the fetus bit by bit [into the uterus] until youhaveplaced it in anaturalposition.” He suggests that, if all else fails, the physician should make acompound and “anoint [masculine imperative]with it the vagina of the woman and her lower abdomen” and later “press [masculine imperative]gentlyupon her abdomen.”⁵³⁵ The chapter thus leavesthe reader with an imageofboth male and femalepractitioners engagedingynecological practice, at least duringmedicalemergen- cies.⁵³⁶ In another,remarkable depiction of cooperation during an emergency obstetrical operation, al-Zahrāwī explains how to make and use aspeculum for opening the womb to extract astillborn fetus.⁵³⁷ He then writes:

When youwish to open the womb with this [speculum], makethe woman sit on acouch with her legs hanging down, parted; then introduce the two projections [of the speculum] into the orificeofthe wombwhile youhold [masculine] the end of the instrumentlower down between her thighs; then open your hand in the same wayasyou would with forceps, to the extent to which youwish to open the womb, so as to allow the midwife to see what she desires.⁵³⁸

Interestingly,this depiction of the interaction between the physician and midwife does not make clear the hierarchyofroles.One could well read this as the male medicalpractitionersupporting the more expert midwife. The division of labor and extent of cooperation between midwivesand male physicians is more ambiguous in IbnSīnā’sQānūn. IbnSīnāmentions the role of midwivesasinformantsquite often, both in emergency and in non-emergency situations. Forexample, he mentions soliciting information from amidwife in the case of an abnormallypositioneduterus.

 Ibid., 471.  This can also be seen in Hippocratic and other Greek texts.AsLeslie Dean-Jones notes, “thereisadivision of labor within asingle case.” Dean-Jones, “Autopsia, Historia, and What Women Know:The Authority of Women in Hippocratic Gynecology,” in Knowledge and the Schol- arly Medical Traditions,ed. Donald George Bates (Cambridge:Cambridge University Press, 1995), 55.  Forafascinating discussionofhow fetal-extraction procedures in medieval Arabic texts wereunderstood and reinterpreted by early-modern European physicians in light of their own innovations in forceps-assisted delivery see H. King, Midwifery, Obstetrics and the Rise of Gynae- cology:The Uses of aSixteenth-CenturyCompendium (London: Routledge,2017), 142.  al-Zahrāwī, Albucasis on Surgery and Instruments,486–9. Spink’stranslation with my clar- ifications in brackets. Gynecological careand interactions 193

Chapteronthe declination and distortion of the womb:itispossible for the uterus to in- cline towards one of the woman’ssides,such that the mouth of the uterus is no longer aligned with the path throughwhich the semen flows to it ...The midwivesknow the direction of the inclination by feelingwith their fingers, and they will know whether it is due to rigidity or laxness ...⁵³⁹

Even as he describes midwivestaking the role of genital touching, IbnSīnā claims that he is directlyinvolvedinpatient care, and that he is giving instructions to the midwife and patient. In other places,Ibn Sīnā givesthe impression thatthe male physician personally oversees and administers gynecological treatment withoutthe mediation of another woman. Forexample, as part of his description of amethod for extracting the placenta after birth, when it has not alreadyemerged, he instructs the physician: “Use substances to inducesneezing ...once the mouth of the womb dilates,then youinsert your hand and extract” the placenta.⁵⁴⁰ The in- structionsinthis sentenceare grammaticallyunambiguous, addressing amale in the second person, and directinghim to introduce his hand into the birthing woman’suterus. IbnSīnāsimilarlydepicts the male physician as directlyinvolvedinthe delivery process in his description of abortionprocedures and the extraction of a stillborn baby after an arduous labor.

The management of miscarriage and expellingthe dead fetus:Atcertain times,abortion maybenecessary,amongthem: when the pregnant woman is asmall girl whomone fears will die fromchildbirth. Also when there is alesion within the womband extra flesh which makesthe exit too small for the baby and it is killed. Also when the fetus has died within the womb of the pregnant woman. Know that if the woman has experienced four days of difficultlabor,then the fetus is alreadydead, so busy yourself [masculine] with the life the mother,and do not busy yourself with the life of the fetus, rather strive [masculine] to expel it.[This] abortion is brought about by means of movements or by means of drugs.The drugs can do so either by killingthe fetus, or by forcefullybring- ing down menstruation ...⁵⁴¹

From this description, it seems as though IbnSīnāexpects the physician to be personally ministering to the laboringwoman and extracting the deceased baby himself. There is no mention of amidwife throughout this passage.

 See IbnSīnā,Qānūnfīal-ṭibb, 2:596= kitāb III: fann 21: maqāla 4: faṣlfīmīlānal-rahīm.  IbnSīnā,Qānūnfīal-ṭibb, 2:580 = kitāb III: fann 21: maqāla 2: fī ikhrājal-mashīma  IbnSīnā,Qānūnfīal-ṭibb, 2:578=kitāb III: fann 21: maqāla 2: tadbīral-isqāṭ wa-ikhrājal- janīnal-mayit. 194 5Physicians, Midwives, and Female Patients

Compare IbnSīnā’sdiscussion of adifficult labor abovewith another surgical passageabout expellingadead fetus, for which he assigns amuchlargerrole to intermediaries. He describes the midwife as engaged in the grizzlybusiness of drawingout the fetus by meansofhooks poked into its body. He attributesthis technique to “the ancients,” thereby implying that such aprocedurewas in his own time atheoretical one, rather than one commonlypracticed.

The [pregnant] woman must layonthe bed on her back, with her head tilted downwardand her thighs raised. Then women, or aservant,grasp her on either side. If these [people]are not present,then tie [masculine] her chest to the bed with knots so that her bodywill not be pulled down when it is stretched. Then the midwife opens that which is coveringthe neck of the uterus,anoints her left hand with oil, brings her fingers together lengthwise, and inserts them into the mouth of the uterusand dilates it with them. More oil is added, and she ascertains whether it is necessary to insert hooks with which the fetus maybedrawn out, and the places which arebest for insertingthe hooks.These places, in afetus which is pre- sentinghead-first,are the eyes, the mouth, the nape...⁵⁴²

He goes on to describe the piercing process, and then how to modify that process when the fetus presents feet first,anoperation which involves not one hook but two. What is odd about the descriptions of these twoprocedures for dealing with abortion and obstructed labor is that the first one, featuringamale physician giving his patient expulsive drugs,isquite feasible in terms of medieval medical technique, but the presenceofamale medicalpractitionerdoes not conform to our expectations of medieval births. By contrast, the second procedurefeatures a femalemedicalpractitioner practicing obstetrics,which seems more true-to-life, but it also describes asurgicaltechnique which most likelywas never implemented.⁵⁴³ This discrepancy suggests that we should not view the presenceof amidwife in amedical text as correlated with the sensitivity of aparticularmed- ical problem or as correlated with the feasibility of aparticularform of treatment. Midwivesare also depicted as workinginconjunction with male physicians in non-emergency situations which requireinserting fingers into the patient’s body. Ibnal-Jazzār, writing in 4th/10th-centuryQayrawān, dealsextensively with gynecology, explaining diagnostic measures and offering avariety of pessaries, pills, and fumigation techniques for treatingwomen’sgenitals. In thosechapters, he mentions the presenceofamidwife onlytwice, once in connection with the treatment of hysterical suffocation, and the other time whendiscussing the diag-

 IbnSīnā,Qānūnfīal-ṭibb, 2:576=kitāb III: fann 21: maqāla 2: faṣlfītadbīrli-ba’ḍ al- qudamā’ fī ikhrājal-janīnal-mayit.  Savage-Smith, “The PracticeofSurgery in Islamic Lands,” 315. Gynecological care and interactions 195 nosis of uterine tumors. In both cases he indicates that he is “instructing” the midwife.

We should tell the midwife to rub gentlythe orificeofthe uterusfromthe inside and outside with one of the oils we have mentioned.⁵⁴⁴

To diagnose the presenceofatumor,hewrites:

If the tumor occurs in the front part of the uterus, it is followed by aheavy pain in the vagina with retention of urine, and if it occurs in the orificeofthe uterus, it is followed by pain in the naveland stomach, and if the midwife inserts her finger,she finds the orificeofthe uterus closed and hard.⁵⁴⁵

Elsewhereinthe same text,Ibn al-Jazzārdescribes treatingaprolapsed uterus with poultices, but he does not mention amidwife. However,the verbs are ambiguous, and can be read as either referringtoamale physician bindingthe groin in apoultice or as apoulticebeing bound around the siteofthe injury, with the gender of the practitioner unstated.⁵⁴⁶ In al-Majūsī’s al-Kāmil al-ṣinā‘afīal-ṭibb,110 chapters of which are devoted to surgery,heexplicitlystates thatitisthe midwife who performssurgeries to treat rutqa (the condition mentioned in the previous chapter in which the vagina is too narrow or obstructed). She is also the practitioner who excises obstruc- tions in the uterus arising from previous ulceration.⁵⁴⁷ Sometimes different works by the same author offer conflictingunderstand- ingsofstandard practice. This can be seen in al-Rāzī’sworks.Some of them contain references to dependence on midwivesasintermediaries, while otherbooks covering the same material have no such references. The following gynecological passages in al-Rāzī’s Ḥ āwī,for example, implydirect contact between male physicians and femalepatients. The verbs directed at the physician here are all masculine singular imperatives.

The placenta: if youwant to expel the placenta, dose her with asternutatory drugthen hold [sing.masc. imperative]her nostrils and mouth, for in such asituation the bellywill stretch and tighten, which facilitates the expulsion [of the placenta].⁵⁴⁸

 Ibnal-Jazzār, Ibn al-JazzāronSexual Diseases and Their Treatment,275.  Ibid., 277.  Ibid., 179.  al-Majūsī, al-Kāmil,488.  Formoreonthe roleofsneezinginexpellingthe fetus see Batten, “The Arabic Commen- taries On The Hippocratic Aphorisms,” 140 – 178. 196 5Physicians, Midwives, and Female Patients

On fibroids: He said: Place [masculine imperative]amirror under the woman so that you maysee the thing as it reallyis. If there is intense pain present,have[masculine imperative] her sit on alaxative concoction ...⁵⁴⁹

To treat rutqa,whetheritiscongenital or as aresult of ahealed-overwound: Open [masculine imperative]the vagina of the woman and youshall find that the openingofthe vagina is coveredbysomethingresembling amuscle. This is if the flesh is in the vagina. (If it is in the cervix, then thereisnothingtoworry about until the girl reaches [the onset of]menstruation, but then [menstruation] might be retained and not flow,and she will as aresult experienceintense pain and quicklydie if she is not treated; and this is because all the blood returns to her bodyand rotsand suffocates it) ...but this flesh, when it grows in the openingofthe vagina, makes it impossible for aman to have intercourse with her, and she cannot menstruateeither and she cannot conceive.Ifitisinthe cervix then she can have intercourse but she will not conceive. It maybethat this flesh entirelyblocks the [entrancetowomb] and it maybethat thereisasmall openingfromwhich menses mayexit,and it maybethat such a[patient] does conceive but both she and the fetus die when there is no wayfor it to come out.

Other passages describe the physician relaying to the midwife that he needscer- tain information:

If yousee retention of the menses ...tell the midwife to touch the cervix and if it is closed without beingrigid it is asign of pregnancy.⁵⁵⁰ The signsofpregnancy: the closingupofthe mouth of the uterus. The mouth of the uterus closes when it is occupied and when thereare tumorsinit. The difference between them is that the tumor is accompanied by stiffness while the closing[of the uterus] dueto its beingoccupied is not accompanied by stiffness,but rather it is in anatural state. The midwife should insert her finger to ascertain it.This is one of greatest signsfromthe uterus when it is shut.⁵⁵¹

The Ḥāwī consists of agreat number of quotations from other writers which have not been edited and synthesized, and so it is entirelypossiblethat none of the abovepassages reflectscommon practice in al-Rāzī’sown society. Other works by al-Rāzī more clearlyreflect aunified authorial voice, and we might turn to these to learn about the gendered division of labor in gynecological care. In al-Rāzī’s Man lā yahḍ uruhu al-ṭabīb he does not mention midwivesatall. As for al-Rāzī’s Manṣūrī fī al-ṭibb,the modern editor of the onlytwentieth-century printed edition writesinafootnotethat he has chosen to emendthe text to limit cross-genderinteraction:

 Al-Rāzī, al-Ḥ āwī,15.  Al-Rāzī, al-Ḥ āwī,9:49. Cf. Al-Baladī, Tadbīral-ḥ abālā’, 33.  Ibid. 51. Gynecological care and interactions 197

[glossingthe phrase “he givestothe (female) patient”] “It is so in all versions.⁵⁵² In these chapters which address women and those diseases of the menses and of the uterus which befall them, the author writes as though speakingabout amale [practitioner]. Hence “he givestothe patient,”“he administers,”“he inserts,”“he feeds,” etc.We have tried to correct all of the wordswithout pointingout every mistakeinthe footnotes.⁵⁵³

In other words, the modern editor chose to emend the text by changingthe active masculine verbs, originallyattributed to male physicians,topassive or feminine forms, some of which implythatthe patientperformsthese actions on her own, and others implying the presenceofasecond woman acting as amedicalinter- mediary.Inthis footnote, the editor notes that because there were so manysuch “problematic” references to the male practitioner,hefelt it too cumbersome to draw attention to them all. The editor clearlydoubts thatthe medicalcare mentioned by al-Rāzī could have been provided by aman. The omissions of references to female intermediaries and practitioners wherewemight expect to find them has been catalogued by AvnerGiladi, in his book, Muslim Midwives. He notes that “the midwife is altogether – or almost totally – ignored” in the major works by Thābit b. Qurra, al-Ṭabarī,al-Majūsī,Ibn Zuhr,and Ibnal-Nafīs.⁵⁵⁴ In omitting them, the authors instead appear to be addressing, at least grammatically, male practitioners. Regardless of whether authors of medicals works include references to mid- wivesornot,theyall depict alandscape in which male physicians interact with femalepatients, includingthose with gynecological problems.Theyexpectmale physicians to be in aposition to communicatewith their female patients about drugs and sell them directlytothem. They indicate thatmale physicians are present in the same room as their female patients and clients, able to speak to them, to look at and touch their patients’ bodies to the extent thatthey could feelthe pulse,assess the visual appearance of the patient,hold the patient’snose and mouth, and set up fumigations. The respectability of genital touchingisless clear.There are severalreferen- ces to the notion that women werereluctant to have male physicianssee or touch their genitals. However,all of the references to this reluctance suggest that it stems from patient preference rather than medicalethics.Al-Zahrāwī and Ibn Sīnā refertomale involvement duringemergency obstetric situations, involvement which appears to include manipulating the emerging baby,while other passages from the sameworks assign those tasks to the midwife.

 I.e. All manuscripts use amasculine verb.  al-Rāzī, al-Manṣūrī fī al-ṭibb,448..  Giladi, Muslim Midwives, 73 – 4. 198 5Physicians, Midwives, and Female Patients

Both theoretical medical compendia and ḥisba manuals corroborate one another in providingthe impression that male medicalprofessionals sometimes provide clitorectomies,and male phlebotomists bleed women, and yetwedo not see acodeofprofessional ethics attachedtothosepractices.These textspro- vide no guidance about how to touchpatients while avoiding accusations of impropriety.One could well take this data point to mean thatsuch touchingrarely happened in actual dailyexperience. (Itcould, perhaps,beargued that such tasks are considered menialones in some societies, and so are unlikelytobeper- formedbymen with extensive medicaleducations and less likelytoreceive the attention of ethicists.) If we were to argue, however,that these services wererare- ly offered by men of anyclass, and that in reality these services weresegregated by gender, then we would be forced to argueagainst the extant textual record. In other words, while we do not have all the textual evidence we would expect from asociety in which male practitionersfrequentlytreat femalepatientsinways that involvetouching, nonetheless we have too much evidence to be ignored that such interactions werecommon, and we have very little evidence to the contrary. As for the extent to which midwivesserved as intermediaries, multiple sources depict physicians in non-emergency situations asking midwivestoconduct examinations and relayinformation to them about how the cervix feels. The implication is that midwivesare workinginthe capacity of assistantsand informants to the physician. Whether it was standard procedureinany particularcom- munity for male physicians to have formal professional relationships with midwivesisdifficult to say. Ḥisba manuals and medicalethics treatises do not mention them. However,the reference to charlatans cultivatingrelationships with midwivessuggests that perhaps midwivesreferred theirpatientstophysi- cians or otherwise engaged male physicians as consultants. Moreover,one could arguethat,justasmidwiveswereknown to serveasmedical informants for the court system, they could have just as easilyserved as informants for physicians.From this evidence, it appears that at least some male physicians wereworkinginclose enough proximitywith midwivesand female patients to be able to share medicalknowledge.

Theory, practice, and women’saccess to Arabo-Galenic medical knowledge

The portions of Arabo-Galenic texts pertainingtothe treatment of women fre- quentlyprovide detailed instructions to male physicians and are written as though such men are directlyand physicallyinvolvedingynecologicaland ob- Theory, practice, and women’saccesstoArabo-Galenic medical knowledge 199 stetrical care. Does this mean that manymedievalwomen likelyweretaught the Arabo-Galenic system for understandinginfertility and participatedinthat understanding, or was their intellectual experience likelyuninformed by such theories?There are three possibleinterpretations of the practical significanceof Arabo-Galenic gynecologicalwritings. (1) The purpose of the textsistopass along entirelytheoretical medicalknowledge to physicians.The authorsare not concernedabout the practice and implementation of these instructions, rather this information exists onlybecause of the medieval propensity toward theoretical thoroughness in encyclopedias. (2)These texts’ instructions werein- tended to have practical value and to be implemented by female medical practitioners. The authors believed their instructions would be read by or otherwise or- allyconveyedtowomen who would implement them in gender-segregated settings. Where masculine languageisusedtodescribe practitioners, it is merely agrammatical or literaryconvention and is irrelevant to the meaningofthe text. Or (3) the texts’ instructions have practical value and were intended to be implemented by male physicians with the help of female assistantsorinformants. Each of these explanations is plausible but problematic.⁵⁵⁵ One could indeed make the argument that the instructions in these texts werenever intended to be applied to the care of patients, and so Arabo-Galenic medicalwritingscan tell us nothing about the kind of medicaladviceand treatment infertile women received. If so, this would not be unique to infertile women; much of medieval medical writing is thought to bear little relation to the practice of medicine.This seems to be particularlytrue of surgical medicine.⁵⁵⁶ Cesarean sections (includingpost-mortem ones) are the classic example of aprocedurewhich is repeatedlydiscussed in medieval Arabic literature but which is not believed to have actually been attempted. The descriptions are too inaccurate and vagueand the illustrations reflect hagiographic literary topoi – they are not medical diagrams. Emilie Savage-Smith quotes the 8th/ 14th-century Egyptian oculist al-Shādhilī in support of this argument.

We possess written accounts of various procedures which cannot be performed nowadays because thereisnoone whohas actuallyseen them performed;anexample is the instrument designed to cut up adead fetus in the wombinorder to save the mother’slife. There aremanysuch procedures:they aredescribed in books,but in our own time [i.e. the four-

 Foranexploration of these issues in the medieval European contextsee, M. Green, Making Women’sMedicine Masculine: the Rise of MaleAuthority in Pre-Modern Gynaecology (Oxford: Ox- fordUniversity Press,2008).  Savage-Smith, “The PracticeofSurgery in Islamic Lands,” 307–321. 200 5Physicians, Midwives,and Female Patients

teenth century] we have never seen anyone perform them because the practical knowledge has been lost,and nothingremains but the written accounts.⁵⁵⁷

Al-Shādhilī appears to be referringtothe procedures IbnSīnāmentioned, which called for physician-midwifecooperation. Other surgicaland cauterization procedures for removingbladder stones and tumors and treating hemorrhoids wereindeed implemented, accordingto Savage-Smith. This conclusion is basedonthe fact thatthe instruments and in- structionsprovided in the medieval literature were bothtechnicallypossibleto implement and werelikelyeffective.Both medicaltexts and ḥisba manuals suggest that, at least in some placesand periods, such surgeries wereperformed on women as well as men. Thisisnot to saythatnowomen would have compunctions about undergoing such procedures, but rather that such adegree of interaction between the genders wasnot unthinkable. Descriptions of medievalArabic non-surgical treatments of gynecological problems,and particularlyofinfertility due to amenorrhea, are dynamic, extensive,and detailed. There are literallydozens of recipesfor oral pills, pessaries, and incense intended to draw down the menses and restart the reproductive cycle. This is alsotrue of treatments intended to restore humoral balance to the uterus.Occasionally, the author will conclude arecipe with the claim that he has tested it and can confirm its effectiveness. Someofthese recipes which appear in medicalcompendia also appear in pharmacy books such as the Minhāj al-dukkān. Taken together, such evidence indicates thatauthors did not view this part of their texts as unrelated to the practice of medicine. Afew trace references within these recipes indicate that the author thinks women might have access not onlytomale physicians, but to his text itself. These references all occur in recipes for contraceptives and abortifacients. Ibn al-Jazzārwrites: “When Iwas reading the works of the ancient [physicians] who speak about the forces and helpful and harmful effects of the simple drugs,Ifound that they mention drugs which corrupt the sperm in the uterus and prevent conception, and drugs which kill the fetus and expel it from the womb. Itherefore decided to mention the caseofthese drugs in this chapter,

 Ibid., 315.Cf. Chapter 66 of al-Zahrāwī’ssurgery,inwhich he describeshow to operateon “flatulent hernia,” also known as pneumatocele. He writes, “Ihavenot seen anyone pluck up enough courage to attempt the operative treatment of this kind of rupture, though the ancients said it oughttobedone in the same wayashernia with varicocele,namely...”al-Zahrāwī, Al- bucasis on Surgery and Instruments,447. Theory, practice, and women’saccesstoArabo-Galenic medical knowledge 201 so thatthey will be known and so that women would beware of using them.”⁵⁵⁸ In his Kāmil al-ṣinā‘aal-ṭibbiyya,al-Majūsī writes:

As to medicineswhich preventconception, although they should notbementioned to prevent theiruse by womeninwhomthere is no good,itisnecessary sometimestoprescribe them to thosewomen whohaveasmalluterus, or thosewho have adisease which, in the case of pregnancy, maycause thewoman deathinchildbirth. Except forwomen in such pre- dicaments, thephysiciansshouldnot prescribe[these]medicines.Also, he should notpre- scribe medicineswhich causethe menses to flow,ormedicines whichexpel thedead fetus, except to womenhecan trust, becauseall thesemedicines kill thefetus andexpelit.⁵⁵⁹

Ibnal-Jazzār’sstatement implies that what he writes eventuallyreaches women. Al-Majūsī’sstatement is somewhat moreambiguous. His phrase “they should not be mentioned” could mean that although it is safe to write about abortifacients for a(male) readership, the drugs should not be spoken of lest it reach the ears of women. Nevertheless, the participation of at least some women in the authors’ community of knowledge is assumed. As to whether women shared the physicians’ understandingofhumoral medicine – and their beliefs about the role of heat, cold, moisture, and dryness – it seems that thatwas in and of itself amatter of debate, at least in some loca- tions. IbnAbī‘Uṣaybī‘awrites:

Ihaveitonthe authority of the sageRashīdal-DīnAbūSa‘īdibn Ya‘qūbthe Christian that Abū al-Hasan Sa‘īdibn Hibat Allāhwas in charge of treating the sick at the hospital. One day, when in the lunaticwardinorder to inspect and treat the inmates, awoman approached him and askedhis adviceconcerning the treatment of her son. When he replied: “You should urge him to take cooling and moistening foods,” one of the inmatesofthe lunatic wardmocked him, saying: “Youhad better give that prescription to one of your pupils,who has had some experienceofmedicine and knows some of its rules.Astothis woman, what does she know about cooling and moistening things?You should have recommended her somethingspecific that she might readilyuse.”⁵⁶⁰

This story,which is set in 5th/10th-centuryBaghdad, highlights the opinion that women could not participate in medicaldiscourse in even the most basic way. Women could not even be expectedtoknow what constitutes a “cooling” or “moistening” food.From the inmate’spoint of view,women might accept particular prescriptions offered by physicians,but they have no notion of how such

 Translation from G. Bos in Ibnal-Jazzār, Ibn al-JazzāronSexual Diseases,290.  Translation from B. Musallam, Sex and Society in Islam,70.  Translation from Kopf, Livesofthe Physicians,480.Ibn Abī Uṣ aybi‘a, ʻUyūnal-anbāʾ fī ṭa- baqātal-aṭibbāʾ, 342–3. 202 5Physicians, Midwives,and Female Patients prescriptions are arrivedat. Al-Ruhāwī too, writing in the previous century, claims that among the common people there is disagreement even about the ax- ioms upon which all Galenic fertility medicine is based. He complains “There is also awidespread stupidity among the people that in certain illnesses they may be their ownphysicians.They believe...that women are hotter thanmen ...”⁵⁶¹ Such statements indicate that therewerealternative systems available to women for understanding physiology.Indeed, there is agreat deal of medical writing in which male physicians complain that they do not command the respect from patients which they deserve,thatthe masses are ignorant of what de- cent medicinelooks like, and that they are taken in by pseudo-doctors who do not understand basic science.Chapter 6will explore this topic further.However, it would be amistake to conclude that either the genderdivide or the existence of popularalternatives to the Galenic medical system precluded the gynecological portions of Arabo-Galenic texts from having an audience or an impact on women’smedical care.

 Translation in Martin Levey, “Medical Ethics,” 97. Conclusion to Part II: Medicineand Sexism

Forthe optimistic student of history,the studyofgynecologyappears to offer insights into the social construction of gender. That is to say, theories of the health and illness of women’sreproductive organs often correspond to sociallyencour- aged and discouraged behavior,aswehaveseen in the Hippocratic depiction of menstrual retention and the wandering womb. Physicians’ descriptions of women’sbodies explicitlyorimplicitly trace the boundaries of women’slives and buttress the confines placed on them, often justifying women’sinferior and dependent social positions. Medicine is thereforeamirror for much deeper social constructs,orsoahistorian might hope. Unfortunately, however,medieval Ara- bic gynecology flies in the face of this hope and defies anysuch attempts to tor- ture it into such theoreticallyneat paradigms. In manyways, the Arabic side of the Greco-Arabic gynecological tradition appears to be remarkablyegalitarian. The theories it articulates with regard to anatomy, sexual lust,conception theory,embryology, hysterical suffocation, and obstetrical care are no more,and oftenmuch less, socially coercive in their implications for women than are the theories articulated by its classical predecessors. We also see this in the increased attention paid to male infertility. In part,the medical tradition is egalitarian preciselybecause it focuses on deriving information about hidden female anatomyand physiology by extendingtoit conclusions extrapolated from male anatomyand physiology. Contra Kueny’sthesis, the approach to fertilityand pregnancyfound in medieval Arabic medical literature does not attempt to minimize women’sconfi- dence in theirbodies. Rather it attempts to make their bodies comprehensible and more predictable through the use of analogies, correspondences,diagnostic rituals, and rational deductions.Extant evidence suggests that medieval women wereeager for interventions to improvethe likelihood of producing children, and for predictive information. We see this in the trulyremarkable number of gynecological recipes available, from Hippocratic times through the middle ages; and, as mentioned in the introduction, even in modern Egypt about half of all visits by women to medicalprofessionals are occasioned by concerns about fertility. Obviously, from abiomedical perspective,manyofthe assumptions medieval physicians made about women’sphysiologyand the causes of infertility were incorrect.Itisalso true that many of these assumptions could flourish due to the social fact that women’sgenitals weredifficult to view as aresultofcultural mores,religiouslyderived or otherwise. However,itisalsothe case that lack of knowledge about women’sreproductive organs was duetoabiological, objec-

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-011 204 Conclusion to Part II: Medicine and Sexism tive fact: that women’sgenitals and gametes weredifficult to view by virtue of being internal. While apious medieval scholarmight view this happy conver- gence as evidence of God’sintelligent design, the modern scholarmustbe wary,lest it lead us into the temptation to over-interpret physicians’ writings as motivated by culturalmalevolence rather thanbythe scientific desire to supplement incompletedata with logical inferences. Part III: Healing and ReligiousVulnerability

Introduction to Part III

Illness and medicaltreatment presented patients with choices and trade-offs that had social and theological significance.Asick person could potentiallyin- teract with manyvarieties of practitioners and healing systems, especiallyifthey livedinone of the urban settingsfrom which most of our sources derive,and if theirs was along-term condition such as infertility.They could turn to physicians whose conceptsofillness and healing derivedfrom academic medicine, or to those offering remedies based upon local knowledge,ortothoseoffering “Pro- phetic medicine” based upon the medicalstatements contained in the ḥadīth. They could direct prayers for healing towardGod, or they could requestinterven- tion from saints and holypeople, or they could turn to practitionersoffering healing through the invocation and manipulationofspirits and demonic forces. They could try all these methods in combination or serially. Alternatively,they could resign themselvestothe dictates of Divine Providence and choose non-intervention. In the eyes of manyreligious thinkers,all of these interventions involved entrustingoneself to apractitioner. It meant sharing experiences with, and being guided by,aparticularauthority figure, one who thereby exercised acertain degreeofinfluenceoverthe patient.Italso entailed some degree of intellectual submission, or leap of faith, or even an open-minded flirtation with a particularepistemological system. There is along history of jurists engagingindiscussions about the relationship between medical teachings and revealed religion. Somejurists, particularly (but not exclusively)those operating in Mamluk-era Egypt and Syria voiced strongopinionsabout the religious implications of the pursuitofhealing among such varied offerings. These jurists depicted medical treatment as religiously fraught because it could lead to aMuslim putting trust in an authority outside of Islamic authorities, or attributingpower to forces other thanGod and trying to command thoseforces. The solution, proposed by thosewho saw this as problem, was to Islamicize aspects of medical knowledge and treatment as much as possible. When the patient was not onlyaMuslim, but also awoman, particularlya Muslim woman with reproductive needs, the value of Islamicizing the culture surroundingmedicine presented apotential conflict with the value placed on avoiding improper interactions between men and women. The conflict was multi-layered. One layerconcerned the general premise found in legal hand- books thatitisbest to minimize medicalinteractions between those who are of different religions and different genders. This, of course, led to the question: is it better for afemale Muslim patient to receive treatment from amale Muslim

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-012 208 IntroductiontoPart III medicalpractitionerorfrom afemalenon-Muslim practitioner?The former has the advantage of being Muslim, but the latter has the advantage of beingofthe same sex. What matters more? Asecond layerofconcern was the potential affin- ity between Muslim and non-Muslim women, particularlyinobstetrical settings. If anon-Muslim woman could be admitted into the presenceofaMuslim woman who was not fullyclothed, wouldn’tthat implythat the non-Muslim woman was part of her intimate circle, like afamily-member or likeher fellow Muslim women?And what if the non-Muslim woman conveyedinformation about her Muslim patient to non-Muslim men?What if the non-Muslim woman conveyed heretical ideas from the non-Islamic community to her Muslim patient?Athird layerofconcern had to do with the specterofgroups of Muslim women transmitting amongst themselvesbeliefs and practices that contravened the teachings promulgated by male authoritative interpreters of Islam,i.e.the jurists.What if women – who had fewer opportunities thandid men to interact with and receive guidance from male Islamic authorities – instead turned to each other for instruction and guidance when dealingwith issues of birth, life, and death? What would theirreligious experience looklike? What effect would it have on the religion of their male familymembers? These concerns about the confluence of medicine, religion, and gender surface in avariety of literature produced by the ‘ulamā’,the scholars of Islamic law. In legal compendia and in ḥadīth and ḥadīth commentaries they appear in chapters devoted to theology, the practice of visiting graves, formsofmedical treatment,the propriety of visitingpublic baths, rules of modesty,interactions with non-Muslims, the trustworthiness of witnesses, and marital rights pertaining to awife’sdesire to maintain contact with her birth familyand pertainingto ahusband’sresponsibility to provide appropriatelodging and good treatment. Religio-medical concerns alsoappear in booksofḥisba,i.e.market inspectors’ manuals, agenre mentioned in chapter 5. These issues are also discussed in books of religious guidance pertainingtowomen, which consist largely of ḥadīths and anecdotes about prominent figures in Islamic history,aswell as statements of legal principles. Examples of this genre include Ibn Ḥabīb’s(d. 238/852) Adab al-nisā’,the volume devoted to women and marriageinal-Ghazā- lī’s(d. 505/1111) Iḥyā ‘ulūmal-dīn,and books written by Ibn Ḥanbal (d. 241/855), Ibnal-Jawzī (d. 597/1201), and Ibnal-ʻAṭṭā r(d. 724/1324) which are all titled Aḥkāmal-nisā’. Religious reflections on medicine also appear in books of “Pro- phetic medicine” i.e. medicaladvice treatisesbasedprimarilyonḥadīthscon- taining medicinal recommendations, such as al-Tīfāshī’s(d. 561/1253), al-Shifā fī al-ṭibb al-musnad ʻan al-sayyid al-Muṣṭafā,Ibn Qayyim al-Jawziyya’s(d. 751/ Introduction to Part III 209

1350)al-Ṭ ibb al-nabawī,⁵⁶³ al-Dhahabī’s(d. 748/1348) book by the same name, Shams al-Dīnibn Ṭ ūlūn’s(d. 953/1546) al-Manhal al-rawī fī al-ṭibb al-nabawī, and the extensive portion of IbnMufliḥ ’s(d. 763/1361) al-Ādābal-shar‘iyya that is devoted to health. IbnMufliḥ ’sbook also falls into another category of juristic literaturewhich covers medicine and women’sissues extensively:anti-bid‘a literature. This is agenre characterized by denunciations of “innovation” (bid‘a), i.e. practices which the author believes depart from “pure Islam.” Much of this literaturedescribes, to use amodern phrase, how contemporary society is going to hell in ahandbasket.Ibn al-Ḥ ājj al-‘Abdarī’s(d. 737/1336) Madkhal is aprime example of this sortofliterature, as is IbnTaymiyya’s(d. 728/1328) Iqti- ḍ āʾ al-ṣirāṭ al-mustaqīm. Although some of this literatureiswritten in amore personal and dramatic style than is typical of faṭwāsorlegal compendia, the legal upshot of the jurists’ arguments in these texts usuallydoes reflect the samejudgmentsthat are found in their legal schools’ more authoritative and influential books. Theauthors en- courageand discouragethe samebehavior which their madhhab encourages and discourages, and rarely do they forbid that which their madhhab discourages or permits (with some exceptions thatwillbediscussed below).However,incom- parisontomost canonicallyauthoritative manuals of law, some examples of this literaturearticulate in more detail the authors’ own views of the social settings and intellectual underpinningsofthe legal rulingsfound in the canon, i.e. their personal understanding of the motivations and anxieties that underlie common legal positions. The jurists who advocate for the Islamicization of the medical experience indicate that they feel embattled. The tone of much of theirwritingsisovertly preachyand exhortative in style; it is the voice of dissent rather thanofcoercive power.Evenasanti-bid‘a texts, treatisesabout women, and market-inspector manuals promulgatearather restrictive notion of what should be considered religiously and sociallyacceptable, they testify to the widespread practice of the very activities which they condemn.⁵⁶⁴ This literature depicts the quest for healing as aform of exploration, for both men and women. When awoman exploredthe avenuesavailable to help her overcome infertility,the intellectual territory she had to negotiate in the course of her exploration was contoured not onlybyattitudes towardsexual propriety, but alsobyconcerns about heterodoxy.Suchconcerns about heterodoxy are im-

 The book is an excerpt from Ibn Qayyim al-Jawziyya’s Zādal-ma‘ād.  H. Lutfi, “Mannersand Customs of Fourteenth-Century Cairene Women: Female Anarchy versus Male Shar‘iOrder in Muslim Prescriptive Treatises,” in Women in Middle Eastern History, ed. Nikki Keddie and Beth Baron(New Haven: Yale University Press, 1993), 102. 210 Introduction to Part III portant for understanding the jurists’ attitudes not justtowardwomen’sgyneco- logical activities, but also toward women’sother gatheringsconnected with the life cycle.These attitudes and legal positions were not marginal even if, when it comes to women’sconduct, in some places and times they might have been “more honored in the breach than in the observance.” Afterall, calls for restrictions on women’sreligious excursions and public presenceoccasionallyresulted in the enforcement of highlyrestrictivepublicpolicies,⁵⁶⁵ especiallyduring stressful periods such as times of plague.⁵⁶⁶ Furthermore, even when dramatic “crackdowns” werenot in force, theoretical articulations of religious ideals still exerted power.AsAhmed Ragab puts it:

The degree of the commitment to the canonical text or its canonized interpretations varied greatlythroughhistory.However,the religious ideal was never seen as an unattainable model but rather apossible alternative and adesirable goal. Muslims were demanded to seek closeness to these traditions,which covered much of the dailylife. They were in constant internal socio-cognitive debatebetween the desiredand the livedorbetween the ideal and the daily. Although it is naive to takethese views and commandments as indicators of how people livedtheir lives, it is equallynaive to discredit them as important sources for understanding the dailylife of the inhabitants of the medieval Middle East and their social and intellectual constructs.⁵⁶⁷

“The religious ideal” constructed in these textspotentiallyintersected at several different points with an infertile Muslim woman’ssearch for healing.First,atthe nexus between medicalscience and theology, magic, and prayer; second, where medicalneed conflicted with religious modesty regulations; and third, at the point wherethe jurists regulated (or tried to regulate)awoman’ssocial network, the network from which she derivedher worldview,includingher beliefs and knowledge about the causes of her infertility and her optionsfor reversing it.

 Forexample, in MamlūkCairo, we know of at least six separate occasions when the government issued proclamations just beforethe ‘īdholidays prohibiting women from visingholy tombs at Qarāfa and Ṣaḥrā’.Evidentlywhatever success the proclamations enjoyed wereshort- lived. See T. Ohtoshi, “The Manners,Customs,and Mentality of Pilgrims to the Egyptian City of the Dead: 1100 –1500 A. D.” Orient 29 (1993), 30.  Lutfi, “Mannersand Customs of Fourteenth-Century Cairene Women,” 101.  A. Ragab, “Epistemic Authority of Women in the Medieval Middle East,” HAWWA 8(2010), 183. 6Religiously Classifying theMedical Marketplace of Ideas

Intellectualeclecticismand the pursuit of medical knowledge

Writing in the 8th/14th-century,the Syrian Ḥanbalī jurist IbnMufliḥ differentiated between the pious and impious patient as follows:

If aperson engagesinmedical treatment with the intention of following sunna-approved treatments and cares for his bodywhich God has bestowed upon him with the best care – that constitutes faith and prosperity.But if he fears in his heart – if Satan whispers to him that if he does not receive treatment then he mayperish, and Satan deludes him into believingthat without him he would die, and with such amotivation he engages in medical treatment – then he is an infidel.⁵⁶⁸

In IbnMufliḥ’sanalysis,impiety in medicine is amanifestation of fear: fear that adhering to God’sdictates will not lead to the desired outcome and that health can onlybeobtainedbycultivatingrelations with an external power.That external power is characterized as Satanic. It is this reliance upon an externalpower that transforms treatment from an act of faith into an act of infidelity. Juristic discussions about the status of medicine in Islam developedaround asmall set of ḥadīthsattributed to the Prophet.Among the most frequentlymentioned is the Prophetic statement that “God did not senddown anydisease without also sending down its cure.”⁵⁶⁹ This was interpreted to mean that the sharī‘a either permits or recommends engaginginmedical intervention. Another frequentlycited ḥadīth refers to the Prophet’streatment of his own health.

‘Ā’isha said: “When the Prophet of God’sillnesses became great,both Arab and non-Arab physicians would give him prescriptions and we would treat him.”⁵⁷⁰

This reportwas cited as proof that there is nothing impious about treating illnesses. Another version of the same report has ‘Ā’isha explaining that she herself acquiredher knowledge of medicine from these physicians in the process of

 IbnMufliḥ , Ādāb,2:335.  Al-Bukhārī, Ṣaḥīḥ al-Bukhārī, 76 (ṭibb):1, no. 5378.  Aḥ mad ibn Ḥ anbal (d. 241/855), Musnad Ibn Ḥ anbal (Cairo: Dāral-Maʻārif, 1951), 6:67.Mu- ḥammad b. Aḥmad al-Dhahabī (d. 748/1348), al-Ṭ ibb al-nabawī (Beirut: DārIḥyāal-‘Ulūm, 1990), 224. Muḥammad ibn Mufliḥ (d. 763/1361), al-Ādābal-shar‘iyya (Beirut: Mu’assasat al-Risāla, 1996), 2:335. Aḥ mad ibn Yū suf al-Tīfāshī (d. 561/1253), al-Shifā fī al-ṭibb al-musnad ʻan al-sayyid al-Muṣṭafā (Beirut: Dāral-Maʻrifa, 1988), 203.

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-013 212 6Religiously Classifyingthe MedicalMarketplace of Ideas caring for her husband. The “non-Arab” physicians with whom Muḥammad consulted seem to have been understood as specificallynon-Muslimphysicians,as this ḥadīth wasoftenfollowed immediatelybyastatement that aMuslim may indeedconsultadhimmī physician, but he should exercise caution when doing so.⁵⁷¹ Forexample, in his al-Ṭ ibb al-nabawī al-Dhahabī quotes this fragment of the ḥadīth and then glosses it using statements by IbnḤanbalabout heeding the advice of dhimmī physicians.

“When the Prophet of God’sillnesses became great,both Arab and non-Arab physicians.” Aḥmad [ibn Ḥ anbal] said: it is permissibletodefer to aphysician from the ahl al-dhimma when he prescribes permitted treatments.But his directivesmust not be listened to when he prescribes forbidden treatments,such as alcohol, etc.Similarly, his directivesare not listened to with regardtobreakingfast instead of fasting, prayingwhile sitting[instead of prostrating] etc. Regarding such directives, they arenot to be accepted unless received from physicians whoare pious Muslims.Aḥmad is also quoted as dislikingmixed or con- cocted medicines produced by the ahl al-dhimma. He said, according to the recension of Aḥmad b. al-Ḥasan, “It is disliked to drink apolytheist’smedicines.” Al-Marūzī said, “Aḥmad commanded me not to buy for him prescriptionsfromaChristian. He said it was because [the Christian]could not be trusted not to mix into it somethingforbidden, such as poisonsorritual impurities, while maintaining it to be healthful.”⁵⁷²

Thus, drawingonthis precedentset by the Prophet Muḥammad, the ‘ulamā’ formedaconsensus that seeking medicaltreatment was permissible,but they also understood the same ḥadīth as depicting afraught social reality:illness compels people to put themselvesinthe hands of diverse, even non-Muslim, practitioners. Some ḥadīthsattributedtothe Prophet wereinterpreted as highlighting the negative aspects of medical intervention:

70,000 of my people will enterparadise without areckoning: those whodid not have them- selvescharmed (lā yastarqūn), did not consult auguries,did not have themselvescauter- ized, and whoentrusted themselvestoGod.⁵⁷³

This ḥadīth was understood as implying the preferability of trusting in God’s providencetomedical intervention generally, not just with respect to these

 The explicit identification of the non-Arabswith infidels appears in ʻAbdal-Ḥ ayyibn ʻAbd al-Kabīral-Kattānī’s, Niẓāmal-ḥukūma al-nabawiyyaal-musamma al-tarātībal-idāriyya (Beirut: Dāral-Arqam, 1996), 353. This,ofcourse, makes historical sense as well, giventhat therewere very few non-Arab Muslims during the lifetime of the Prophet.  al-Dhahabī, al-Ṭ ibb al-nabawī,2:224  Muslim, Ṣaḥīḥ Muslim, 1:198, no. 218. Cf. al-Bukhārī, Ṣaḥīḥ al-Bukhārī,76(ṭibb):17,no. 5705. Intellectual eclecticism and the pursuit of medical knowledge 213

three specific activities. Acommonlyquoted anecdote has Aḥ mad ibn Ḥ anbal re- citing this ḥadīth when praising sick people who choose not to inform aphysician about their illness and instead decidetoforgo treatment.⁵⁷⁴ However even IbnḤanbal is depicted as viewing treatment is legitimate, saying “healing is a concession [rukhṣa], and refraining from it is on ahigher level.”⁵⁷⁵ Other jurists portray medical intervention in amorepositive light.Both the Shāfi‘ī and Ḥanafī legal schools view medicaltreatment as preferable to non-treatment,asdoes the influential Ḥanbalī jurist Ibnal-Jawzī.Mālik is said to have takenthe position that “engaging in [medicaltreatment] and refraining from it are equal ... there is nothing wrongwith engaginginmedical treatment and there is nothing wronginrefraining from it.”⁵⁷⁶ Even those jurists who were wary of medicine,such as IbnḤanbal, did not condemn medicine as necessarilysinful,onlypotentiallyso. There were, indeed, people who argued that medicine is inherentlyimpious as it betraysadesire to thwart God’sdesigns,but in juristic literature we most often hear of the existence of this view from those who consider it to be pernicious and feelobliged to refute it.For example, in his 8th/14th-century ḥisba manualfrom Egypt,Ibn al-Ukhuwwa argues in favorofraising the profile of medicine as anecessary and noble profession. As part of thatargument he quotes a ḥadīth:

Abū Hurayrasaid: One day, one of the men of the Anṣār, acompanion of the Prophet,was wounded. The Prophet summoned two physicians whowere in Medina and instructed them to treat him. The twosaid, “OMessengerofGod, we used to treat and thwart [bodilyharm] during the jāhiliyya. But then Islam came, and isn’tIslam tawakkul [entrustingoneself to God]?” He said, “treat him, for He whosent down diseases also sent down their treatments.” Then the two attending him treated him, and he recovered.⁵⁷⁷

 IbnMufliḥ , Ādāb,2:333,al-Dhahabī, al-Ṭ ibb al-nabawī,2:221.Cyril Elgood, “Tibb-ul-Nabbi or Medicine of the Prophet,Being aTranslationofTwo Works of the Same Name. I: The Ṭibb-ul- Nabbi of al-Suyūṭī.II: The Ṭibb-ul-Nabbi of Mahmud bin Mohamedal-Chaghayni, together with Introduction, Notesand aGlossary” Osiris 14 (1962),125.Elgood ascribes this anonymous treatise to the 9th/15th-century Shafi‘ī scholar al-Suyūṭī,but due to the fact that one manuscript of it includes an owner’sdate from 783/1391,and another manuscript found in the Bodleian library lists the author as al-Dhahabī,the current scholarlyconsensus is that the treatise is likelyal- Dhahabī’s. See, Emilie Savage-Smith, “Islamic MedicalMedical Manuscripts at the NationalLi- brary of Medicine,” Nlm.nih.gov. https://www.nlm.nih.gov/hmd/arabic/prophetic_med2.html (accessedAugust 21,2018).  IbnMufliḥ , Ādāb,2:333.  IbnMufliḥ , Ādāb,2:334.  Ibnal-Ukhuwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 166–7inArabic. 214 6ReligiouslyClassifying theMedical MarketplaceofIdeas

The notion that undergoingmedical treatment reveals alack of tawakkul,trust in God, seems to have been afeature of some Sufi thought.⁵⁷⁸ This sort of argument is raised and denouncedinseveral different medicaltexts.The Persian physician IbnAbūal-Faraj ibn Hindū,writing in the early5th/11th-century, articulatesacom- mon counter-argument:

Those whofear that acknowledgingthe existenceofmedicine means infringingupon God’s determination of man’sfate (qadā’)ought to stop eatingwhenthey arehungry and drinking when they arethirsty.God mayvery wellhavedestined them to perish fromhungerand thirst.Thus,ifthey eat and drink, they infringe upon God’sdetermination of fate. They end up by substituting their wish for His wish.⁵⁷⁹

Several belle-lettrist texts alsofeature debatesalong similar lines for and against the use of medicine,some of whose arguments are obviouslyfacetious and exaggerated.⁵⁸⁰ The jurists do not tend to object to medical interference per se. Rather,some jurists,particularlythe ones writing in the Fatimid and Mamluk eras, make the claim that the religious identity of practitioners, the medical theory underlying treatment,and the ingredients used in treatment,all have religious consequences.For this reason, such jurists are interested in categorizing medicalintervention accordingtosourceofillness, type of treatment,practitioner of treatment, and the spiritual state of the patient.They frequentlyuse terminology which dis- tinguishesbetween “natural” (ṭabī‘ī)and “magical” (siḥrī)sources of illness,⁵⁸¹ contrasts “physical” (ṭabī‘ī or “pertaining to the abdān”)and “spiritual” (ilāhī or “pertaining to dīn”)treatments,⁵⁸² and they compare “the medicine of the physicians” to “the medicine of the Prophet” and to “the medicine of itinerants and old women.” These jurists claim thatthe patient’sattribution of the source of their illness, their choice of cure, and their choice of medicalpractitionerre- flects upon their religious status, which in turn influences the outcome of their treatment.

 N. Fancy, Science and Religion in Mamluk Egypt: Ibn al-Nafīs, PulmonaryTransit, and Bodily Resurrection (London: Routledge,2013), 68. On this topic see B. Reinert, Die Lehrevom tawakkul in der klassischen Sufik (Berlin: de Gruyter,1968).  F. Rosenthal, “The Defense of Medicine In The Medieval Muslim World,” 523.  Ibid.  Shams al-Dīnibn Ṭ ūlūn(d. 953/1546), al-Manhal al-rawī fī al-ṭibb al-nabawī (Hyderabad: Anwāral-Maʻārif, 1987), 352.  IbnQayyim al-Jawziyya, al-Ṭ ibb al-nabawī (Beirut: Dāral-Fikr =DārIḥyāal-Kutub al-‘Ara- biyya, 1957), 17. Lack of classification of medicine in the haḍ īth collections 215

Lack of classification of medicine in the ḥadīth collections

Twocategoriesofphysical illnesses are recognized in ḥadīth literature: (1) those caused by humans utilizing occultpractices,which include sorcery (siḥr)and the evil eye(al-‘ayn),⁵⁸³ and (2)thosecausedbyDivine will and nature. Alarge variety of treatments are recognized as potentiallyeffective though not all are permitted or recommended. Thesetreatments includethe intervention of physicians, sorcerers,astrologers, and prophets;the use of foodstuffs, bloodletting, cupping,cauterization, drugs,alchemy, clysters,individual prayer,ablutions, bathing,incantations using the Qur’ān(ruqya),⁵⁸⁴ amulets(tamā’im),⁵⁸⁵ sooth- saying,and other forms of magic. The chapters on medicine in the ḥadīth collections do not provide arigid methodologyfor thinking about the etiologyofill- ness or what constitutes medicalattention. Rather the ḥadīthsprovide an eclectic catalog of “thingsthat might help” people, with hygiene, diet,and particular foodstuffs extolled aboveall others. The ḥadīthsalso comment on therapies, indicating that the Prophet praised cupping and disliked cauterization.⁵⁸⁶ The disapproval of cauterization does not seem to be based on anyparticular theological concern, rather it is depicted as atreatment of last resort.⁵⁸⁷ Many ḥadīthsdepict the prophylactic usefulnessofreciting specific Qur’ānic verses. The Prophet recited some of these togetherwith blowing,spitting or hand-motions, and he praised his companions when they used Qur’ānic verses to perform healing incantations.⁵⁸⁸ Other ḥadīthscondemn resortingtoincantations, auguries, and astrology,orsay that it would be best not to use them.⁵⁸⁹ These condemnations, however,donot tend to dismiss these actions as useless, nor do they demonstrate aclear-cut differentiation between different spheres of medical knowledge,i.e.inthe ḥadīth collections there is no “high medicine” or “low medicine” clearlydefined along the lines of etiology, source, or the social class of its practitioners. There is no sense that illnesses of natural origin ought to be treated by “natural” medicine,orthat supernatural illnesses must be foughtbyoccultmeans. Incantations are effective against scorpions, scabs,

 E.g. Ṣaḥīḥ al-Ṭirmidhī, 2:27.  E.g. Musnad ibn Hanbal, 3:421. Ṣaḥīḥ Muslim 2:223.  See IbnMufliḥ , Ādāb,3:64–69  al-Bukhārī, Ṣaḥīḥ al-Bukhārī, 76 (ṭibb):4, no. 5683.  IbnMufliḥ , Ādāb,2:334;Elgood, “Tibb-ul-Nabbi or Medicine of the Prophet,” Osiris 14 (1962),144.  IbnQayyim al-Jawziyya, al-Ṭ ibb al-Nabawī,144;al-Bukhārī, Ṣaḥīḥ al-Bukhārī, 76 (ṭibb):32, no. 5735.  Ibnal-Jawzī, Aḥ kāmal-nisā’ (Kuwait: Maktabat dārIbn Qutayba, 1989), 97– 100. 216 6ReligiouslyClassifyingthe MedicalMarketplace of Ideas and ulcers.⁵⁹⁰ Breakfasting on seven dates shields one from the effects of both poisons and witchcraft for the rest of the day.⁵⁹¹ The roots t-b-ḅ and ‘-l-j, “treat” are both used in the ḥadīth in describe healing apatient either by means of natural medicine or through magic or incantations. Both are also used to describe apatient physicallyaffected by malicious sorcery.Wesee t-b-ḅ used as asynonym for s-ḥ-r, “bewitchment” in the following ḥadīth from Ṣaḥīḥ al-Bukhārī.

‘Ā’īsha said: The MessengerofGod had been bewitched (suḥira)such that he thoughthe had had sexual relations with his wives, but he had not done so. Sufyānsaid: this is a most severeform of sorcery,ifthat is so. Then [The Prophet] said: ‘Ā’īsha, know that God has informedmeabout what Iinquired of Him. Twomen came to me, and one of them sat by my head and the other by my feet.The one at my head said to the other, what ails this man?Hesaid, he is bewitched (maṭbūb). [The first] said, “whobewitched him (man ṭabbahu)?”⁵⁹²

Another ḥadīth uses ‘-l-j in referencetosome sortoftaboo magic to arouse ahusband’sardor.

From Khālid b. Ma‘dān: awoman came to the MessengerofGod and said, ‘OMessengerof God, do youlook wellupon my producingsomethingtomake [myhusband] loveme?’ He said, ‘Fieupon you, fie upon you! What youhavesaid is heinous!’ Then he had her expel- led and orderedwaterand spilled it on the spot where she had been. Later the Messengerof God learned that the woman had become devout and her situation had improved. From IbnMas‘ūd: He said, Ivisited ‘Ā’isha, mother of the faithful, with my mother and she had women whowere coming to her with questions.Awoman came to her and said, “O mother of the faithful, mayawoman pitch her tent?” She said, “There is nothingwrong in it.” Then the woman left,and the women said to [‘Ā’isha], “Do youknow what she wanted, Omother of the faithful?” She said, “What do youmean?” They said, “She wanted to treat (tu‘ālija)her husband! ‘Ā’isha said, “Bring her back to me.” So they brought her back and she said to her, “Fieupon you” and she forbade her.Then she said, “Saltinfire,saltinfire, expel her from me and wash her traces with water and lotus leaves.”⁵⁹³

 Cyril Elgood, “Tibb-ul-Nabbi or Medicine of the Prophet,” 154.  Cyril Elgood, “Tibb-ul-Nabbi or Medicine of the Prophet,” 138.  Al-Bukhārī, Ṣaḥīḥ al-Bukhārī, 76 (ṭibb):49 no. #5765.Al-Khaṭṭābī comments, “Maṭbūb means bewitched (masḥūr)and ṭibb means sorcery (saḥr).” Al-Khaṭṭābī, Aʻlāmal-Ḥ adīth fī sharḥ Ṣaḥīḥ al-Bukhārī (Mecca: Jā miʻat Umm al-Qurā,Maʻhad al-Buḥ ū th al-ʻIlmīyah wa-Iḥ yāʼ al-Turāth al-Is- lāmī,Markaz Iḥ yāʼ al-Turāth al-Islāmī,1988), 1499.Cf. IbnMufliḥ , Ādāb, 3:84 on the various meaningofṭibb.  IbnHabīb, Kitābadab al-nisā’,230 –32. Jurists on the “medicine of the physicians” 217

In both of these cases, terms which have medical significance are usedtorefer not just to magic, but to “offensive” magic rather than “defensive” magic. The root ‘-l-j in particularseems to have used in connection with awife’sinterference with her husband’snatural affectionsand libido.Thus, there does not seem to be an entirelyseparate vocabulary to distinguish between providingmedical care, healing potions, and offensivesorcery. The word ṭabīb however,may refer exclusively to apractitioner of medicine. Forwhile the root t-b-ḅ is used with regard to magic, the word ṭabīb does not seem to be so utilized. The historian of Islamic medicine LawrenceConrad writes that this is itself amarker of the Islamic era.

“Should one go the doctor (ṭabīb)?”,one sayingofthe Prophet has aman ask Muḥ ammad; and the answeristhat he should, for “God sends down no maladywithout also sending down with it acure”.Inthis account,transmitted in manyvariant forms and one of the most widespread of medical sayings from the Prophet,asharp distinction was now drawn between the old-style ṭabīb,the master of spells and charms,and adifferent kind of ṭabīb whosearches out the curesprovided by God, the giverofall things.⁵⁹⁴

Medieval jurist IbnQayyimal-Jawziyya notes that while the root t-b-ḅ can refer to magic in some literature,itdoes not when used in legal contexts.⁵⁹⁵

Juristsonthe “medicine of the physicians”

The lack of systematic differentiation in the ḥadīth collections does not carry over into the works on medicine produced by the ‘ulamā’,that is to say, the books of Prophetic medicine, the chapters on medicine in legal manuals, and the legal adab treatises, even though all of these draw heavilyonthe ḥadīths. Rather,the literature producedbythe jurists,like the medical literature produced by the doctors in the Arabo-Galenic tradition, depicts medical practice as bifurcated between high medicine as practiced by the physicians,and low medicine as practicedbyignoramuses, charlatans, and old women. The jurists consistentlyuse the term ṭabīb as an umbrella term for avariety of medicalprofessionals,none of whom are associatedwith the occult. As Ibn Qayyim al-Jawziyya explains, in interpreting ḥadīthsabout a ṭabīb,one must understand the term to apply to:

 L. Conrad, The Western Medical Tradition:800 BC to AD 1800 (New York: Cambridge Uni- versity Press, 1995), 98.  IbnQayyim al-Jawziyya, al-Ṭ ibb al-nabawī,107– 9. 218 6Religiously Classifyingthe MedicalMarketplace of Ideas

...all those whocarry out treatment either through general prescriptions or the practice of aspecializedmethod of healers.Ifheuses akoḥ lstick he is an oculist; if ascalpel and ointments,heisasurgeon; if aknife, acircumciser;anincisinginstrument,aphleboto- mist; cuppingglasses and asharp knife, acupper.Heisknown by his bonesetting equip- ment and his bandagesifabonesetter;byhis irons and fire if acauteriser;byhis waterskin- bag if one whoadministers clysters.⁵⁹⁶

The one professional who is not mentioned in this list is the pharmacist.How- ever,the physicians’ pharmacological activities greatlyconcern the jurists and so it seems thatweshould understand the term ṭabīb as also referring to pharmacists when used in the texts producedbythe ‘ulamā’. This literature depicts physicians as aclasswhich shares abodyofintellec- tual precepts: they venerate Galen, they do not believeinany form of treatment other than “natural” medicine;⁵⁹⁷ however,they do believethat khawāṣṣ exert real impact.The term khawāṣṣ (literally: special properties) is used generally in Arabic literature to refertoavariety of beliefs about the healing powers of stones,metals, bones, and even letters and numbers.⁵⁹⁸ However,when the jurists write about the physicians’ use of khawāṣṣ,they seem to be referringto the use of stones or metalswhich can cause physical effects, even from adis- tance, by means of magnetism or “sympathy.” Their effects are not supernatural, but they cannot be explainedbymeans of logic.⁵⁹⁹ Their properties and uses are known through empirical experience. The existence of this category of treatment in the highmedicaltradition becomes importanttothose jurists seeking to situate Prophetic medicinewithin that tradition. In polemical literaturebythe proponents of the Prophet medicaltradition, the proponents of “physicians’ medicine” are accused of attacking Islam and Prophetic medicine on the grounds that (a) Islam has no medicalteaching, (b) to the extent thatIslam has amedicalteachingitisderivativefrom, and subject to, Greek medicine, and (c) Prophetic medicine is wronginascribing to the evil eyeand sorcery the power to cause physical damageand in attributing real cu- rative power to incantations. The juristsdonot reject the “medicine of the physicians” as untrue, or in and of itself religiouslysuspect.Indeed, the Greek medicalheritageisfrequently

 IbnQayyim al-Jawziyya, al-Ṭ ibb al-Nabawī,112.Translation fromPenelope Johnstone, Med- icine of the Prophet (Cambridge:Islamic Texts Society,1998), 107.  IbnṬūlūn, al-Manhal al-rawī,352.  IbnQayyim al-Jawziyyasaysthat the number seven possesses special healingproperties but that Hippocrates and Galen and the other physicians are unawareofthem. IbnQayyim al-Jawziyya, al-Ṭ ibb,79.  IbnQayyim al-Jawziyya, al-Ṭ ibb,134. Jurists on the “medicine of the physicians” 219 quoted and implicitlyreferenced in all of the books of Prophetic medicine which include the authors’ own voices,such as those by IbnQayyim al-Jawziyya, al- Dhahabī,Ibn Ṭūlūn, and al-Suyūṭī,and they frequentlymention physicians in the Arabo-Galenic tradition. However,these authors are concerned about the relationship of medicalscience to religious science.This is both atheoretical question about the categories of knowledge and epistemology, and apractical question about whether one must entrust one’sbodilywell-beingand one’sspiritual well-being to the same authorities or to different ones. It is common in the texts written by the jurists about medicine to cite al- Shāfi‘ī as saying: “Knowledge is of two kinds: the knowledge of religions (adyān)isjurisprudence and the knowledge of bodies (abdān)ismedicine.”⁶⁰⁰ The implication is that religious knowledge and medicalknowledge are separate, that medicalknowledge is not asubset of religious knowledge,and that it is incumbent on the Muslim community to produce experts in both sciences. Nonetheless,itisimportant to at least some of the ‘ulamā’ to establish that Islam itself provides both kindsofknowledge.Anoft-quotedstory has aChris- tian physician remarking thatIslam has no medical teaching.The Muslim re- spondent cites Qur’ān7:31 “eat and drink and do not be extravagant; Truly, He loves not the extravagant”⁶⁰¹ and comments, “God has combined all of medicine into half of averse of our book.” The Christian is suitablyimpressed and replies: “Your scripture and your prophet have left no medicine for Galen,” i.e. thereis nothing more for Galen to add to Islamic medical knowledge.⁶⁰² The jurists are under no illusions about the shortcomingsofsuch aretort.Rather they make several separate and sometimes competing arguments about the existenceand relevance of Islam’scontribution to medicalknowledge. One argument is thatwhile Islam does not provide its own medical theory,it does provide knowledge of specific cures based on the empirical evidence of experience (tajārib). Moreover,this specific knowledge is not simply acquired through happenstance, but rather is derivedfrom the Prophet Muḥ ammad’sper-

 Al-Bayhaqī, Manāqib al-Shāfiʻī (Cairo: Maktabat Dāral-Turāth, 1971)2:114.Ibn Mufliḥ , al- Ādābal-shar‘iyya (Beirut: Mu’assasat al-Risāla, 1996), 2:335. In the Biḥāral-anwār,this statement is attributed to the Prophet Muḥammad. Al-Majlisī, Biḥāral-anwār (Beirut: Muʾassasat al-Wafā’, 1983) 1:220.  Translation fromAlan Jones, TheQur’ān (Exeter: E. J. W. Gibb Memorial Trust,2007), 150.  IbnMufliḥ , Ādāb, 2:340;Ibn al-Ḥ ājj, al-Madkhal, 3/4:324and Ibnal-Jawzī, Zādal-masīrfī ‘ilm al-tafsīr (Beirut: Dāral-Fikr,1987) 3:128; Jamālal-Dīnal-Surramurrī,(d. 776/1374) Shifā’ al- ālāmfīṭibb ahl al-Islām. See Bürgel, “Secular and Religious Features of Medieval Arabic Med- icine,” 57. 220 6Religiously Classifyingthe MedicalMarketplace of Ideas

fect knowledge.Ibn Ṭ ūlūn(d. 953/1546) quotesAbūSulayman al-Khaṭṭābī (d. c. 388/998) as making this point:

Know that medicineisoftwo kinds:rational medicine (al-ṭibb al-qiyāsī)which is Greek and which people use in most lands,and the medicineofthe Arabsand the Indians,which is empiricalmedicine (ṭibb al-tajārib). Most of what the Prophet established is in accordance with what the Arabsestablished, except that which he specifiedasderivingfromprophetic knowledge by means of revelation and that transcends everythingwhich physicians understand and the doctors know.Everythingwhich he did or said is on the highest level of cor- rectness,for God kept him from sayinganythingbut truth and from doing anythingbut rightly.⁶⁰³

The jurists seek to bolster the argument that Muḥ ammadwas medicallyknowl- edgeable by showing where ḥadīthscorrespond to specific Arabo-Galenic principles and to so-called “Greek” pharmacological knowledge.⁶⁰⁴ They are, however, aware thatthis too presents alogical and theological pitfall. The Egyptian Mālikī scholarIbn al-Ḥ ājj addresses this issue with regard to the Prophetic statement that “the black seed (al-ḥabba al-sawdā’)isacure for all thingsexceptdeath.”⁶⁰⁵

One of the ‘ulamā’ said that the physicians saythe black seed is beneficial for treating only seventeen diseases.He[the ‘alim]claimed that this ḥadīth is subject to that.[i.e. The ḥa- dīth’sclaim that the black seed is acure-all is true onlytothe extent that it overlaps with the findings of the physicians.] He [the ‘alim]said: “And so, anyone whowants to use it should ask the physicians about it and if they inform him that it is beneficial for that particular disease he uses it,and if not he does not,orhowever [the physician] says.” But Abū Muḥ ammad⁶⁰⁶ [one of Ibnal-Ḥ ājj’steachers] rejected that saying: “God forbid that Ishould in so doing say ‘the possessor of perfect light reportedsomething,but we will subject it to the opinion of the possessors of shadows.’”

 IbnṬūlūn, al-Manhal al-rawī,10. The quotation appears in Al-Khaṭṭābī, Aʻlāmal-ḥ adīth fī sharḥ Ṣaḥīḥ al-Bukhārī, 2107– 8.  In Elgood’stranslationofal-Dhahabī,this occurs on pages 54,55and 66 (in which two ḥa- dīthsare compared with the Hippocratic Oath), 61,7176, 78,79, 83,86, 92,95, 97– 8, 98, 103,108, 109,112, 114–5, 136,138, 139,166 and 171(in which Prophetic embryology is compared to Hippo- cratic embryology). Although much of Near Eastern pharmacological knowledgecame fromfar- ther East,inthe Ṭ ibb al-nabawī books,onlysourcessuch as Hippocrates, Galen, Dioscorides, and Ibn Sīnā are cited.  This ḥadīth,although widelycited, is problematic because the spiceinquestion required ‘translation’ intomedievalparlance. Thereisadebateastowhether the black seed referstocor- iander or cumin. Al-Dhahabī offers both translationsand prefers the first.Ibn al-Ḥ ājj says it is the second, see Ibnal-Ḥ ājj, al-Madkhal,3/4:322.  This is Abū Muhammad ‘Abdallāhibn Sa’dibn Abī Jamra al-Andalūsī (d. 675/1300), whois citedrepeatedly in the Madkhal and was one of Ibnal-Ḥ ājj’steachers.Like Ibnal-Ḥājj, he mi- grated fromthe Maghrib /Andalus region to Egypt. Jurists on the “medicine of the physicians” 221

It was said to [Abū Muḥ ammad]: “So whatthen is the connection between what the Prophet reported and what the physicians say?” He said, “The answer is two-fold. First: the black seed is beneficial for all diseases,asthe Prophet reported, for he sawwith the perfect light which God had granted him and bestowed upon him, and he sawthat it is beneficial for all diseases.The people of medicinesaw in the shadows their own thoughts and did not know morethan seventeen. Alternatively:indeed, the black seed was beneficial for seventeen diseases as the physicians said, but then God made it beneficial for this People (umma)for all of the diseases,just as [this umma]has been distinguished with special qualities from other peoples in beinghonored with the Prophet.” This statement of his is clearlyevident.But it all goes back to the intention (niyya)of the sick person in dealingwith this. Forthe principle is that everythingwhich proceeds from the Lawgiver is tied to the acceptance [of it] and the strength of faith. Therefore, the endeavorwill succeed in proportion to the intention, and the possessor of [the intention] will triumph in his objective.⁶⁰⁷

Abū Muḥ ammadrejects the notion that, in order to make practical use of Pro- phetic medicine, it needs to be evaluated on the basis of whether it accords with physicians’ medicine. Instead he offers two contradictory alternativesfor understanding the relationship between the twoforms of medicaladvice. Either there is one medicaltruth to which the Prophet has full access and the physicians have limited access,orthere are twodifferent medical truths, one which is true for Muslims and one which is true for all others. Ibnal-Ḥ ājj’scomment (“the endeavor will succeed in proportion to the intention”)further elaborates upon the second concept: the more pious one is, the “more Muslim” one is, the more one is subject to the rules of one medicalreality over another. This concept of multiple medical realities appears often, particularlyinIbn al-Qayyim’s al-Ṭ ibb al-nabawī.

When the heart turns towardthe Lord of the Worlds,the Creatorofboth illness and medicine, the One whoregulates natureand disposes of it as He wishes,[the patient] responds to other medicines,different from those which pertain to one whose heart is turned away and far from Him.⁶⁰⁸

Similarly,hewrites:

This [particular practice] is somethingwhich the physician’streatments do not include, nor can anyone benefit from it whodenies it,orridicules it,ordoubts it,orwho carries it out as an experiment without believingthat it will benefit him. If thereexist in nature khawāṣṣ – whose causes the physicians cannot explain to us,but which they consider to have special

 Ibnal-Ḥ ājj, al-Madkhal, 3/4:323.  IbnQayyim al-Jawziyya, al-Ṭ ibb, 7. Translation from Penelope Johnstone, Medicine of the Prophet, 9. Translation slightlymodified. 222 6Religiously Classifyingthe MedicalMarketplace of Ideas

qualities which render them exceptions to natural rules – so what if their heresy and ignorance makes them deny al-khawāṣsal-shar‘iyya?⁶⁰⁹

The claim in these statements is that the choice of treatment which aperson makes,and the degreeofenthusiasm about that treatment,isareflection upon thatperson’slevel of faith. Moreover,that person’slevel of faith influences the degree to which atreatment can be effective.The implication of such aview is thatwhen apatientchooses aphysician she puts faith in that physician and becomes affiliated with the worldview he offers. If she is cured by him it is, at least in part,atestament to her conviction. Conversely, if she chooses an alternative healing system, and fails to be healed, thattoo reflects upon her faith. This conception of healing makes “the medicine of the physicians” religiously problematic for another reason: the physicians are stereotypicallyassociated with Christian-Jewish-Hellenic impiety.The jurists are deeplyconcernedabout, but paradoxicallyperpetuate, the perception that non-Muslims constituteeither the majority of physicians,orthe most popular physicians among Muslim patients. Often the juristsattribute this to Muslims having ceded the domain of medicine to non-Muslims. This stereotypeispromulgated in several different genres,overalong period of time, in avariety of regions.For example, in books of Prophetic medicine al-Shāfi‘ī (who livedinthe 2nd/8th century) is cited as being “grieved to see how much Muslims had lost of this science. Often he used to say: They have lost one third of human knowledge and have allowed themselvestobereplacedbyJews and Christians. He also usedtosay: Verilythe People of the Book have now conquered and surpassed us in this sublime Art.”⁶¹⁰ Similarly, centuries later in his ḥisba manualIbn al-Ukhuwwa claims:

[The practice of medicine] is acommunal obligation, and yetamongMuslims no one fulfills it.Manyatown has no physician except amember of the people of dhimma,whose legal testimonywith regard to matters pertainingtophysicians or medical sciencecannot be le- gallyaccepted. We see no [Muslim] occupyinghimself with it; and instead everyone flocks to the studyoffiqh,and moreparticularlythat portion of it givenovertodisputes and liti- giousness ...How could religion permit aperson to occupy himself with acommunal obligation that the community is alreadyfulfilling, and to neglect an obligation that no one is fulfilling? Isn’tthis dueonlytomedicine not beingdirectlyconducive to obtainingpositions as judgesand in government,through which aperson can promotehimself over his peers

 IbnQayyim al-Jawziyya, al-Ṭ ibb, 134.  Elgood, “Tibb-ul-Nabbi,” 128. Cf. IbnṬūlūn, al-Manhal al-rawī,6:“Al-Shāfi‘ī used to lament the medicine which the Muslims have lost,saying: ‘They have lost athird of knowledge and con- signed it the Jews and Christians.” Al-Dhahabī, al-Ṭ ibb al-nabawī,228. Jurists on the “medicine of the physicians” 223

and rule over his enemies?But alas,knowledge of religion has been obliterated.God is the onlyhelp and upon Him we must depend to rescue us from this madness which infuriates the Merciful One and amuses Satan.⁶¹¹

Ibnal-Ukhuwwablames the supposed preponderance of dhimmis among physicians on the supposedlyneglectful attitude of learned Muslims. In another ḥisba manual, from the 6th/12th century, the Sevillian jurist Ibn ʻAbdū narticulatesadif- ferent permutation of al-Shāfi‘ī’sfear of the loss of what was originally “Muslim” medicalknowledge.Hewrites:

Scientific books should not be sold to Jews or Christians,except those pertainingtotheir own religion. Forthey translate books of scienceand attributethem to their coreligionists and bishops, when the books areauthoredbyMuslims.And it is best not to permit aJewish or Christian physician to attend and treat Muslims,for they do not bear Muslims goodwill. They maytreat onlytheir coreligionists;for if aperson does not bear Muslims goodwill, how can he be entrusted with their lives?⁶¹²

Herenon-Muslims are also associatedwith medicine, but not due to Muslim neglect of the science but rather due to non-Muslims translating books authored by Muslims, thereby acquiring an undeserved reputation for scientific achievement. Even outside of legal literature, Muslim physicians are alsodepicted as having trouble competing for patients, or at least such is the stereotype. In his Kitāb al-bukhalā’,al-Jāḥ iẓ (d. 255/869) famouslydepicts amiserlyMuslim physician pleading thatbusiness is bad for him, even duringaperiod of plague, due to his difficulty in attracting patients. The physician says:

Forone thing, they know Ihappen to be aMuslim and folk held the belief beforeIbegan to practice medicine, no indeed even beforeIwas born, that Muslims are not successful in medicine. Then my name is Asad and it oughttohavebeen Ṣ alīb, Jibrā’īl, Yuḥ annā and Bīrā.Mysurname is Abū’l-Ḥ ārith and it ought to have been Abū ‘Īsā,AbūZakariyyā and Abū Ibrāhīm. Iwearashouldermantle of white cotton and my shouldermantle oughtto be black silk. My pronunciation is an Arab pronunciation and my dialect ought to have that of the people of Jundī Sābār.⁶¹³

 Ibnal-Ukhuwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 166 in Arabic.  al-Tujibī and E. Le´vi-Provençal, Se´ville Musulmane Au De´but Du XIIe Sie`cle: Le Traite´ D’ibn Abdun Sur La Vie Urbaine Et Les CorpsDeMe´tiers,57inArabic. Cf. al-Saffārīnī, Ghidhāʼ al-albāb li-sharḥ Manẓūmat al-ādāb (Beirut: Dāral-Kutub al-‘Ilmiyya, 1996), 2:12.  Translated by R. B. Serjeant, TheBook of Misers (London: Garnet &Ithaca Press, 2000), 86. He means that if had atraditionallyChristianname or Persian appearance, rather than aMuslim or Arab appearance,hewould attract morepatients. 224 6Religiously Classifyingthe MedicalMarketplace of Ideas

Kitābal-bukhalā’ is abook of satire, ridiculing this fictional Arab Muslim physician for comingupwith unconvincing excusesfor his miserliness. So we might guess that in fact people were assumed not to care about the Christian and non- Arab traits which the miserclaims patients value. But jurists writing in avariety of periods and contextsalso allegeinall seriousness that there is apreference for dhimmī doctors among some Muslims.⁶¹⁴ Ibnal-Ḥ ājj, writing in early8th/ 14th-century Cairo, givesseveral reasons for this. First,the dhimmīshavearepu- tation for being more knowledgeable and have better medical ijāzas(certifica- tions). As aresult,accordingtoIbn al-Ḥ ājj,eventhose Muslims who mistrust dhimmīssometimes choose to deal with their ambivalent attitude towards them by consulting first a dhimmī and then double-checking with aMuslim physician.

Some people areontheir guard regarding what Ihavesaid [about the malevolenceofthe non-Muslimdoctor] and they retainaMuslim doctor and aChristian or aJewish doctor and relaywhatthe infidel recommended to the Muslim.⁶¹⁵ This tooisunseemly.⁶¹⁶

There is some indication thatone of the reasons aMuslim might turn to anon- Muslim physician is thatthere are distinct disadvantagestobeing treated by someone from one’sown community.Ibn al-Ḥ ājj urgesMuslim doctors to make themselvesattractive to Muslim patients by keepingthe privateinforma- tion they learn from patients visitingtheir house out of circulation in the mosque. He alsotells them aMuslim physician must be especiallycompassionate with patientswhile at the sametime forcefullyremindingthem that they must not consultanyone less pious than he.

When aphysician wishes to leave his home for the mosque,hemust make the intentions (niyyāt)that were previouslymentioned [in the chapteron] the behavior of an ‘ālim when he leaveshis house for the mosque. Forknowledge (‘ilm)isinfact of twokinds:the knowledge of religions and the knowledge of bodies.Each of them, if performed with the correct intention, is among the greatest acts of worship, and God enters intoits practice and there is no substitutefor it in the world. [The physician] should intend in doingsotoembodythe pure sunna in his doctoring, and to promotethat which provides assistancetohis Muslim brothers, removesdistress from them, and supports them in the face of calamities and misfortunes.Heshould make the intention of hidingthe nakedness of his Muslim brothers and not disclose anythingexcept that which the lawdemands to be disclosed. Forthis reason

 Moshe Perlmann, “The Position of Jewish Physicians in Medieval Muslim Countries,” Israel Oriental Studies 2(1972), 315–19.  However,Ibn Mufliḥ mentions two Ḥ anbalīswho do just that and he does not reprove them, see IbnMufliḥ , Ādābal-shar‘iyya,2:428.  Ibnal-Ḥ ājj, al-Madkhal,3/4:318. Jurists on the “medicine of the physicians” 225

the sick person, and whoever is responsible for him, arecommanded not to resort to anyone except someone whoembodies these characteristics. [The physician] must intend to be compassionatetoward them ...and he should urge upon the sick person and his guardian that they should not resort to anydoctor except one whomay be describedasreligious, upright,and trustworthy.⁶¹⁷

This is followed by descriptions of the elaborate pains that aMuslim doctor must take to avoid exposing his patients’ secrets either when his patients are visiting him in his house or when he sees them on non-medical occasions,such as in the mosque: “Forthe patient might have illnesses which he does not want to expose to anyone, especiallythe ‘ulamā’.”⁶¹⁸ At the same time, Ibnal-Ḥ ājj reminds the physician thathemust himself investigate the intimate details of apatient’sfamilylife in order to provide the patient with the best treatment,evenwhen such details reveal unseemlybehavior.⁶¹⁹ Such instructionssuggest that some Muslim patients might have deliberately avoided Muslim physicians preciselybecause seeing adoctor within their own community might increase the risk of exposure and embarrassment. These risks wereprobablyall the weightier since many maladies were thought to result from specific misbehavior.⁶²⁰ Moreover,Muslim medicalpractitionerscould be called upon to provide legal testimony, while non-Muslim practitionerscould not.Furthermore, there is some evidence from biographical dictionaries of the Mamluk period thatthe 7th/13th-centurywitnessed a “decline of the philosopher-physician and the rise of the faqīh-physician” in the Mamluk world.⁶²¹ Per- haps this toowas asourceofconcern for potential Muslim patients. If the Mus- lim physician and the ‘ālim wereone and the same, and apatient wanted to keep embarrassing informationfrom the ‘ālim,itwould provide an incentive to the patient to seek medicalcare from anon-Muslim.

 Ibnal-Ḥ ājj, Madkhal, 3/4:335.  Ibnal-Ḥ ājj, Madkhal, 3/4:336.  Ibnal-Ḥ ājj approvingly quotes acase where an astutedoctor suspects that his patient’sfather was not his actual one. He summons the patient’smother for aprivatemeaning “with no thirdperson present” and tellsher that the onlyway to save her son’slife is to reveal to the physician the identity of the true father.The mother says she was impregnated by apassingBed- ouin man. The physician is then able to cure the son usingBedouin medicine. Ibnal-Ḥ ājj, Madkhal,3/4:339.  Forexample, it was commonlythoughtthat birth defects were aresultofaberrant sexual positions.Kathryn Kueny, “The Birth of Cain: Reproduction, Maternal Responsibility,and Moral CharacterinEarlyIslamic Exegesis,” HistoryofReligions 48 (2008), 121.  LeighChipman, TheWorld of Pharmacy and Pharmacists in MamlūkCairo (Boston: Brill Academic Publishers, 2009), 127. 226 6Religiously Classifyingthe MedicalMarketplace of Ideas

Perhaps unsurprisingly,medieval Christian and Jewish authorities sometimes expressed asimilar fear that the faithful prefer to turn to outsiders for medicalattention. Some Jewishauthors claimed that their co-religionist consider Muslims and Christians to have abettermedicaltradition and condemned this practice by invoking aTalmudic statement saying that Jews mayentrusttheir wealth to anon-Jew, but not their bodies.⁶²² Meanwhile church authorities in Crusader kingdoms promulgated decrees banning LatinChristians from consulting with physicians from other religions.They expressedconcern that Latin Christians denigrate the medicalauthorities from theirown religious community and prefer Muslim, Jewish, Samaritan, and Syrian Christian practitioners.⁶²³ When jurists argued against such cross-confessional treatment,what were they afraid would happen?Ibn al-Ḥ ājj listsmanynegative consequences to pa- tronizingnon-Muslim doctors:⁶²⁴ it takes work away from Muslims, it puts Mus- lims at physical risk from the malevolence of Jewish doctors,⁶²⁵ and it normalizes relationships with Jews and Christians which should not be normalized and may resultinproselytizing. The notion that cross-confessional medicine either serves as atestament of normalization, or causes normalization, of cross-confessional relationships and trust is supported not onlybyliterary condemnations of such activities, but also in documentary evidence. Forexample, in the Cairo Geniza we find aletter of recommendation, from 7th/13th-century Cairo and written in Arabic script,testifying to the competence and good character of aJewishphysician named Abū al- Ḥasan ibn Abū Sahl ibn Ibrāhīm. The letter is written in the name of witnesses who identify themselvesas“free, honourable and good Muslim men.” The letter explains that “since someone has requested them, they have responded by reg- isteringtheir testimonytowhat they know of his trustworthiness, reliability,pro- bity,expertise, uprightness and knowledge.” They testify that the physician “is a man of honor ...trustworthyinthe profession thathepractices,reliable, on account to his devotion to his religion ...inholding session in street stalls and in having freedom of access to the housesofpeople and the dwellingsofthose

 G. Bos, “On Editingand TranslatingMedieval Hebrew Medical Texts,” JewishQuarterly Re- view 89 (1998), 102–103.  B. Kedar, “Jews and Samaritans in the CrusadingKingdom of Jerusalem,” Tarbiz 53 (1984), 397, 404.  Ibnal-Ḥ ājj, Madkhal, 3/4:316–21.  Ibnal-Ḥ ājj, Madkhal, 3/4:318. In this rather colorful section, Ibnal-Ḥ ājj describesthe dis- gruntled mindset and plottingofthe Jewish doctor and does not mention Christians.Cf. Perl- mann, “The Position of Jewish Physicians in Medieval Muslim Countries,” 317. Jurists on the “medicine of the physicians” 227 whom he treats. They have not known him to exhibit anything but charity,pro- bity,trustworthiness, reliability and integrity.”⁶²⁶ Those who objected to Muslims frequenting non-Muslim medical practitioners had additional concerns beyond social issues. The inability of non-Muslims to offer medical testimonyincourt was also asourceofanxiety.But the most tangible problem posed by cross-confessional medicine,and the one which is most frequentlycited in Prophetic medicine treatises as well as books of religious preachingsuch as those by IbnMufliḥ and Ibnal-Ḥājj,isthat non-Muslim doctors might recommend treatments which are at odds with Islamic law, such as sitting insteadofprostratingoneself in prayer and not participating in Ram- aḍ ānfasts.⁶²⁷ Another commonlymentioned concern is that anon-Muslim physician might offer amedicine which includes impure substances which are either rituallyunclean (i.e. najāsāt)ordeliberatelypoisonous.⁶²⁸ Forthis reason jurists who dealt with the issue of non-Muslim physicians treatingMuslim patients wrotethatitiseither forbidden or disliked to ingest acompound druggiven by anon-Muslim physician, unless aMuslim has verified its individual compo- nents. Even more worrisome was the possibility that anon-Muslimdoctor might be quick to recommend ingesting alcohol.While the utilityand legality of the use of alcohol in medicine was amatter of some dispute,⁶²⁹ the Prophetic medical literatureadamantlyforbids it.However,al-Dhahabī’sextensive protestations against therapeutic alcohol stronglysuggest that manyMuslims thoughtitprop- er to view medicalsituations as an exception to the general prohibition:

 CairoGeniza document T-SNS305.115,editedand translatedbyGeoffrey Khan. G. Khan, Arabic Legal and AdministrativeDocuments in the CambridgeGenizah Collections (Cambridge: Cambridge University Press,1993), 247–50.  Elgood, “Tibb-ul-Nabbi,” 126.  Usually, concern about najāsāt is associated with Christian physicians and malevolence with Jewish ones. Aḥ mad ibn Ḥ anbal is quoted as associating both with Christians,and his opinion is cited in IbnMufliḥ , Ādāb,2:428 and al-Dhahabī in Elgood, “Tibb-ul-Nabbi,” 127. Cf. al-Dhahabī, Ṭ ibb,224,where the focus is also on Christians.Incontrast,Ibn al-Ḥ ājj focuses on Jewish physicians,claimingthat Jews,bymonopolizing the professions of physician, oculist, and accountant,attempt to master Muslims’ bodies and worldlygoods. Ibnal-Ḥ ājj, Madkhal, 3/ 4:320.Aview that does not distinguish between Christiansand Jews is found in Muḥ ammad b. Aḥ mad b. Sālim al-Saffārīnī al-Ḥ anbalī’s(d. 1188/1774) statement is his book of adab: “It is reprehensible for us to entrust one of (the ahl al-kitāb)with preservingour bodies by means of medicine because they areour enemies.How can we entrust someone whoisour enemywith our souls?” al-Saffārīnī, Ghidhāʼ al-albābli-sharḥ Manẓūmat al-ādāb (Beirut: Dāral-Kutub al-‘Il- miyya, 1996), 2:12.  Forasummaryofthe controversy,see al-Mawsūʻaal-fiqhiyya (Kuwait: Wizāratal-Awqāf wa’l-Shu’ū nal-Islāmiyya, 2004), 5:27–8. 228 6Religiously Classifyingthe MedicalMarketplace of Ideas

Another tradition says that the Prophet was asked about wine, whetheritcould be used as amedicine. And he replied: Wine is not amedicine. This is atradition related by Abū Dāwūdand al-Tirmidhī ... Ṭāriq ibn Suwayd relates:Isaid to the Prophet that we grewgrapes and pressed out the juiceand drank it.And he said: Do not do so. So Iwent back to him and said: I curethe sick with it.And he replied: Verilythat is not healing: it is producing adisease. This sayingisrelated by Muslim, Abū Dāwūd, and al-Tirmidhī and it is areliableand accurate tradition. Said al-Khaṭṭābī:Call it adisease, for in the drinkingofthe juiceofthe grapethereis somewhat of sin. And indeed it is quitetrue that thereisnoadvantage tobegained from wine. The enquirer when he enquired alreadyknew that it contained sin. But he was en- quiringabout its natural advantages. But the Prophet disclaimed them and rejected these too.And God knoweth all things. It is evident that wine is aremedy for some diseases.Yet the Prophet transferred it from the boundariesofthis World to the boundaries of the Next World and from aconsideration of the natural to aconsideration of the lawful. Some one else has remarked that God in His glory deprivedwine of all its uses when He disallowed it.And God is all-knowing. ⁶³⁰

Despite the diversity of opinionsfound in otherbooks written by the ‘ulamā’ about medical uses of alcohol, the proponents of Prophetic medicine stake out the position thatalthough alcohol mayindeed have healing properties,nevertheless those properties should not be taken into consideration. Proponents of Prophetic medicine, despite their protests against some aspects of the culture of “the physicians,” tend to portray Prophetic medicine, not as aset of stringencies or restrictions, but rather as asourceofadditional and better alternativestoArabo-Galenic medicine.They appeal directlytothe in- stinct towardmedical experimentation, urging Muslim patientstoexperiment with Islam and to give it achance to help them meet their medical needs. Ibn Qayyim al-Jawziyya in particular makes this appeal repeatedly. Forexample, he quotes a ḥadīth in which the Prophet uses qusṭ (costus) to curepleurisy.In exasperation the jurist writes:

Itsbenefit for one whohas pleurisy is hidden from ignorant physicians,sothey denyit. But if that ignorant one heardthat this statement comesfromGalen, he would accord it the status of a[holy]text ...Now we have alreadysaid that the medicine of the physicians, relative to the medicineofthe prophets,ismorelackingthan the medicine of itinerants and old women relative to the medicine of the physicians;⁶³¹ and that there is agreater gapbetween whathas been encountered through revelation and what has been encoun-

 Elgood, “Tibb-ul-Nabbi,” 80.  Asimilar phrase can be found in Jamālal-Dīnal-Surramurrī’s(d. 776/1374) Shifā’ al-ālāmfī ṭibb ahl al-Islām. p.2 of manuscript. Jurists on the “medicine of the physicians” 229

tered through empiricismand logic, than between the dimwit and the keen man. But if those ignorant ones were to find adrugwritten down by one of the Jewish, Christian, or polytheistic physicians,they would receive it welcomingly and warmly, and would not hes- itate to try it.⁶³²

Ibnal-Qayyim argues that physicians place so much trust in the authority of Galen that theyreceive his opinions as holywrit.Similarly,hecomplains that when anon-Muslim physician makes arecommendation people are willing to try it.But since the Prophet made the recommendation, the physicians and the people dismiss it. Ibnal-Qayyim’sexasperation with the unwillingness of some people to recognize “ true” medical knowledge mirrors the tone of the medicalwritingsofthe physicians themselves, who alsocomplain that potential patientsare likelytoso- licit help from the wrong sort of authorities. The physician al-Rāzī producedtwo treatises on this topic, one titled, Epistle on the Reason Whythe IgnorantPhysi- cians, the Common People, and the Women in the Cities Are MoreSuccessful than Men of Learning in Treating certain Diseases and the Physician’sExcuse for This and the other titled, On the Causes WhyMost People Turn away From Excellent Physicians towards the WorstOnes.⁶³³ The Christian physician Ṣ ā‘id ibn al- Ḥ asan (d. after 464/1072) wrote:

Howamazingisthis [that patients arecuredatall], consideringthat they hand over their livestosenile old women!⁶³⁴ Formost people, at the onset of illness, use as their physicians either their wives, mothers or aunts,orsome [other] member of their familyorone of their neighbors.He[the patient] acquiesces to whatever extravagant measureshe might order,

 IbnQayyim al-Jawziyya, al-Ṭ ibb al-nabawī, 274.  Pormann and Savage-Smith, Medieval Islamic Medicine,90. Neither work is extant in Ara- bic. However,the second one exists in medieval Hebrewtranslation. M. Steinschneider, “Wis- senschaft und Charlatanerie unterden Arabern im neunten Jahrhundert,” Virchows Archiv (1866) 36:570 – 86 and 37:560 –65;reprinted in Beiträgezur Geschichte der arabisch-islamischen Medizin (Frankfurt: Institut für Geschichte der arabisch-islamischen Wissenschaften, 1987), 2:39–61.  The image of the “old woman” dispenserofmedical knowledge in medieval Arabo-Islamic medical and religious literatureisnot quiteequivalent to the one found in the literatureofme- dieval Christian Europe. The latter seems to invest her with moredemonic power, more “savage” piety,and moreignorance.See Jole Agrimi and Chiara Crisciani, “Savoir médical et anthropologie religieuse: Lesreprésentationsetles fonctions de la vetula (XIIIe-XVesiècle),” Annales. Économies, Sociétés,Civilisations 48 (1993), 1292. Acomparative studyofthe depiction of the “active” old woman in medieval Middle Eastern and European literaturewould be awelcomead- dition to the field of women’shistory.See, for example, the first chapter of Shihābal-DīnAḥmad al-Tīfāshī’sdepictions of old women in Nuzhat al-albābfī-mā lā yūjad fī kitāb. 230 6Religiously Classifyingthe MedicalMarketplaceofIdeas

consumes whatevershe preparesfor him, and listens to what she says and obeysher com- mands morethan he obeysthe physician.⁶³⁵

The physicians who write about the medicine of “the ignorant,”“the common people,” and “old women” appear to be referringwhat we would call “folk medicine.” In spite of its lowlyassociations, folk medicine alsoreceivesthe attention of the jurists,just as “highmedicine” does.

Juristsonresorting to folk medicine

Both the jurists and the physicians indicate thatitisquite common for apatient to seek treatment in theirown home, often from the women of the household. Peter Pormann suggests that “women probablyprovided much medical care for members of bothsexes, even if the elite male physicians took adim view about theiractivities.”⁶³⁶ Rarelyare such activities described with anydetail, and it is difficult to determine the full scope of the activities Ibnal-Qayyim refers to when writing disparaginglyabout the “medicine of itinerantsand old women” and setting it in contrast to the “medicine of the physicians.” Ibnal-Ḥ ājj, acontemporary of Ibnal-Qayyim, offers some unusuallydetailed descriptions. He claims that women practitionersview the inversion of aspectsofcorrect behavior as aform of treatment.⁶³⁷ Forexample midwivesmake use of reviled substances for the purposes of easing difficultlabor and protecting the newborn.

 Translation by Peter Pormann in Pormann, “The Art of Medicine:Female Patients and Prac- titioners in Medieval Islam,” 1598–99. Ṣā‘id ibn al-Ḥ asan, At-Tašwīqaṭ-ṭibbī des Ṣā‘id ibn al- Ḥ asan,ed. OttoSpies (Bonn: Selbstverlag des Orientalischen Seminars der Universitat Bonn, 1968), fol. 27b.  Pormann, “The Art of Medicine,” 1599.  The performanceofprohibited and unnatural acts is thoughttoaid in gaining controlover demons.Ibn al-Nadīmwrites that this is particularlytrue in Egypt,which he calls “the Babylon of the magicians.” Dols, Majnūn: the Madman in Medieval Islamic Society,265.Thereare many references to such beliefs in modern ethnographies as well, especiallyinEdwardWestermarck’s descriptionsofearlytwentieth-century Morocco. Forexample,hedescribeshow infertile women in several different tribes eat the flesh or drink the urine of male puppies to become pregnant with male offspring.Westermarck, Ritual and Belief in Morocco (London: Macmillan, 1926), 1:585. He also describeshow “the jnūn help people to practice witchcraft ...Aperson whofor this purpose wants to summon aJewish jinn does all sorts of disgusting and forbidden things.He eats his own excrements,and dirties his clothes with them; drinks his own urine if thirsty, and sprinkles his clothes with it; puts his right slipper on his left foot and his left slipper on his right foot,and wears all his clothes with the inside out; makes an ablution with urine, and prayswith his face turned in the wrongdirection, that is, not toward Mecca. He writes Jurists on resorting to folk medicine 231

Forthe midwivesinour time arerarelycareful about avoidingimpurities. The midwife comes in contact with the parturition blood and other impurities and then touches the newborn and his clothes – all without washingoff the impuritieswith purewater. This is not permitted, yetsome of the midwiveslet the newborn suck on their [the midwives’]fingers which have been in contactwith impuritiesand claim that it is healthyfor this and that,but this is all alie and falsehood and contrary to the pure sunna ...Some of them, when childbirth is difficultfor the woman, take out the center of aloaf of bread and put mouse-dung inside it and they have her eat it until it is all gone. They explain this with the claim that this will ease the birth for her.This is without adoubt stupidity,for [the Prophet] is known to have said: God, Great and Sublime, does not grant healingbymeans of somethingwhich is forbidden.⁶³⁸

Other jurists,when describingthe care of children and the care of women in the midst of childbirth, caution against the folk-practice of manipulating objects and texts to uncover informationortobend supernatural powers to the will of the practitioner in order to effect healing.⁶³⁹ The jurists alsodescribe women turning to the services of men who heal bodilyinjuries,orpossiblyinflict them, by means of the written word. Forexam- ple, Ibnal-Ukhuwwa(acontemporary of Ibnal-Qayyim and Ibnal-Ḥ ājj) writesin his ḥisba manual about the services offered by astrologers and letter-writers. Among the services they provide, in additiontoreadinghoroscopes and writing correspondence, is magical control over sickness:

They must be constrained fromengaginginsorcery.They must not writefor anyperson any spirit-magic such as love-sickness,agitation, hemorrhage,ophthalmia, tongue-tie, etc.For doing witchcraft is forbidden, and when aperson is found to be doing it,rebuke him so as to deter others ...When one of them is found violatingthese restrictions and writingwhat is forbidden, the muḥtasib must removehim and chastise him, and if he returns,rebuke him again.⁶⁴⁰

Ibnal-Ukhuwwafurther says that “most of those who frequent them are women.” Forthis reason, rather thanmarginalizing the presenceofthese practitioners, Ibnal-Ukhuwwainstructs the market inspector to insist that astrologers

on apaper the name of the jinn he wants to summon inside a jedwal,inaccordancewith the instructions he gets fromabook on asubject; burns the papertogether with some coriander seed, and in burningitrecitesthe name of the jinn and some passages from the Koranwith the word Allāhand other holywords exchangedfor šitan;and continues this recitation until the jinn comes.” Ibid., 1:360.  Ibnal-Ḥājj, al-Madkhal,3/4:221.  E.g. al-Saffārīnī, Ghidhāʼ al-albāb,22; Ibn Mufliḥ , Ādāb,3:66; and Ibnal-Jawzī, Aḥ kāmal- nisā’,99.  Ibnal-Ukhuwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 183–84 in Arabic. 232 6Religiously Classifyingthe MedicalMarketplaceofIdeas and letter-writers sit in the middle of the highway,rather than in isolated alleys or indoors. The public placement of the letter-writers makes it easier to monitor those men who loiter near them for the purpose of making contact with members of the opposite sex. In spite of its supposed prevalence,the ‘ulamā’ do not accord folk medicine the samerespect that they accord the medicine of the physicians,and so they have less need to define its precise relationship to the Islamic system of knowledge.Inhighmedicine, the great physicians such as Galen represent an alternative sourceofauthority to the Prophet Muḥ ammad. This is not the case with folk medicine.Yet folk medicine presents achallengeofits own to Islam.Instead of representing an alternative to Muḥ ammad’stherapeutic knowledge,itrepresents an alternative to God’spower over the world itself and an alternative to the notion thatIslamic ritual as propounded by the ‘ulamā’ is the best waytodefend oneself from the dangers posed by the world. The problem with the use of sorcery and the eating of unclean foods is explained by IbnMufliḥ.People “believethat these are modes of treatment and healing,when in fact they resultinpolytheism (shirk), because people attempt to repel the fates which have been set down for them, and they request[beings] other than God to repel the suffering which He himself ordained.”⁶⁴¹ One modern scholar, in characterizingthe views of IbnQayyim al-Jawziyya,frames the theological problem thus: “[Ibn Qayyim al-Jawziyya views] the occultic sciencesasso manypantheistic demons eating away at Islam’sspiritual innards, whereGod’s undivided omnipotencewas parceled out to stars and birds,and elementalna- ture was chargedwith atransmutational potencythat appearedtobeself-sus- tained.”⁶⁴² In the face of this shirk,the juristshavetwo options: either to ban all magical practices or to find ameansofaccommodating them in an Islamic framework. The problem with banning them is that much of the ḥadīth literature supports the idea that supernatural forces influencehealthand that the Prophet’scom- panions made use of incantations and talismans and other elements found in folk medicine.⁶⁴³ Thereforealmost all jurists instead find ways of Islamicizing the magical impetus. Texts and images thatare not in Arabic,orare not understood, are prohibited, as is the invocation of beingsother than God.⁶⁴⁴ But it is

 IbnMufliḥ , Ādāb,3:66, citingthe opinion of Ibnal-Athīrfromthe Nihāya.  John W. Livingston, “Scienceand the Occult in the ThinkingofIbn Qayyim al-Jawziyya” Journal of the American Oriental Society 112 (1992),600.  Forsome examples,see IbnQayyim al-Jawziyya, Ṭ ibb,127–46,276 – 79 and al-Dhahabī’s al- Ṭ ibb al-nabawī, 276–7.  IbnMufliḥ, al-Ādābal-shar‘iyya, 2:334. Jurists on resorting to folkmedicine 233 acceptable and encouraged to recite Qur’ānic verses, to write them down on bowls and paper in mystical patterns,and to perform rituals with such objects for medicinal or prophylactic purposes. Some authorities even instruct non-Mus- lim medicalpractitioners(who treat Muslims)toreciteQur’ānic verses in their healing rituals, despite the general opposition to non-Islamic use of the Qur’ān.⁶⁴⁵ Forexample, in the Muwạ tṭa,Mālik b. Anas reports an interaction between the first caliph, Abū Bakr,and his daughter ‘Ā’isha, the Prophet’swidow. “Abū Bakr al-Ṣ iddīqvisited ‘Ā’isha while she had a[health] complaint and aJew- ish woman wasrecitinganincantation over her.AbūBakr said, ‘Recite an incan- tation over her using the Book of God.’” On the basis of this reportal-Shāfi‘ī rules that non-Muslims can use Qur’ānic-based incantations when treatingaMus- lim.⁶⁴⁶ Several examples of Islamicized incantationsand talismans for childbirth purposes can be found in Prophetic medicine books and otherliterature produced by jurists. Muḥ ammadibn Aḥ mad al-Saffārīnī’s(d. 1188/1774) descriptions list previouslyknown talismans⁶⁴⁷ but also include the occasional diagram⁶⁴⁸:

ImāmAḥmad said: Forawoman experiencingdifficultchildbirth one writes on abowlor somethingclean, “In the name of God the Benevolent the Merciful, there is no godbut God, the Compassionate the Noble, the Sublime God, the Master of the Throne, the Great,praise be to God the Master of the Worlds: ‘On the daythey see it,itwill be as if they had tarried onlyfor an evening or its forenoon.’ (Qur’ān79:46⁶⁴⁹) ‘On the daywhen they see what they have been promised, it will seem to them as they had lingeredfor onlyanhour of asingle day. Aproclamation.’ (Qur’ān46:35)”.Then she should drink fromitand anoint her bosom with what remains. Aḥ mad, mayGod be pleased with him, reported: These wordscome fromIbn ‘Abbās, mayGod be pleased with them both, and Ibnal-Sunnī cited it in ‘Amal al-yawm wa’l- layla.⁶⁵⁰ And from al-Dīnawarī’s Kitābal-Mujālasa ...“Jesus son of Mary encounteredacow whose child was stuck in her belly. She said: ‘Oword of God, call upon God to deliverme.’

 A.S. Tritton, Caliphs and their Non-Muslim Subjects (London: F. Cass,1970), 8.  Malik b. Anas, al-Muwạ tṭa,50(al-‘ayn):4no. 11. Al-Shāfi‘ī, Kitābal-umm,7:241.  These two prescriptions areidentical to the ones found in IbnQayyim al-Jawziyya, Ṭ ibb, 277. Arecipe fragment from thirteenth-century Quṣayralso uses Qur’ān84, see Li Guo, Com- merce, Culture, and Community in aRed Sea Port in the Thirteenth Century (Leiden: Brill, 2004), 311. The fragmentsays: “Forawomanwho wants to [. ..]achild.” Guo understands this recipe to be afertility charm, but it seems morelikelytomethat it is acharm to be used during labor.  al-Saffārīnī, Ghidhāʼ al-albāb,2:23.  Translations of the Qur’ānic passagesare from Alan Jones, The Qur’ān,556.  Abū Bakr Aḥ mad ibn Muḥ ammad al-Dīnawarī,known as Ibn al-Sunnī (d. 364/974), Kitāb ‘amal al-yawm wa’l-layla (Beirut: Mu’assasat al-Kutub al-Thaqāfiyya, 1988). 234 6Religiously Classifyingthe MedicalMarketplaceofIdeas

He said: ‘OYou who creates soul from soul and bringsout soul from soul, deliverher.’ And she cast out what was in her belly.’” When the woman’schildbirth is difficult, this should be written for her.⁶⁵¹ Al-Tatā’ī al-Mālikī mentions the followinginhis commentary on the prefaceofthe Mukhtaṣar:⁶⁵² One of the people of knowledge whowrotethis verse and tied it to a woman experiencing difficultchildbirth set it in this form. Ihaveseen in one collection that it is supposed to be tied to her left thighand this is the diagram of the placement of the verse.⁶⁵³

When the heavenissplit asunder And listens to her Lordasshe must When the earth is spread out And casts out what is in her and is empty (Q :–)

He derivedfor him, in order to honor him, part of His name. Thus the Lord of the Throne is called Maḥmūd, and this one Muḥammad (*Ḥ assānibn Thābit)

It is easy to appreciate the aptness of the Qur’ānic verse used in this talisman. Its description of the physical contortions of heavenand earth on judgmentday is readilyapplicable to the contortions of childbirth, and the feminine languageap- plied to the heavens is easilytransferable to the laboringwoman. The purpose of the poetic verse by Ḥ assānibn Thābit praising the Prophet Muḥ ammadissome- what less clear.One possibility,however,isthat the poem at the center of the talismanisthere to replaceapicture of asupernatural being.Thus atextual invocation of Muḥ ammadsubstitutesfor aphysicaldepiction and invocation of a spirit.

 Abū Bakr al-Dīnawarī (d. 333/944), al-Mujālasa wa-jawāhir al-‘ilm (Frankfurt am Main: Ver- öffentlichungen des Institutes fürGeschichteder arabisch-islamischen Wissenschaften, 1986), no. 1996.  Muḥ ammad b. Ibrāhīmb.Khalīlal-Tatā’ī al-Mālikī (d. 942/1535).  The translation of the poetic verse by Ḥ assānibn Thābit is fromAnnemarie Schimmel, And Muhammad is His Messenger: the veneration of the Prophet in Islamic piety (Chapel Hill: Univer- sity of North Carolina Press, 1985), 106. Jurists on resorting to folk medicine 235

There is ageneral consensus among the jurists thatthe use of textsinamu- lets and healing rituals is acceptable, so long as the texts are derived from Islam- ic scripture. Ibnal-Ḥ ājj, however,encourages people to reciteelaborate prayers in conjunction with the use of Qur’ānic verses, prayers which explicitlydistance magical rituals from the trappings of polytheism. Hereisone such prayer:

Write, “OGod, Youare the giveroflife and death, Youare the Creator and youare the Maker,and Yousend tribulation and Yougivedispensation, and Youare the Healer ... OGod, Iask Youwith Your beautiful names and Your supreme attributes, OYou in whose hands lie tribulation and dispensation and healingand treatment,Iask Youwith the miraculous [verses] of Your Prophet Muḥ ammad ...thereisnoharm except Your harm and no benefit except Your benefit ...and no wrongdoingcommitted by man can getpast You, and no jinn can be fortified with acharm by means of Your perfect speech which they cannot getpast,nor can anysin by man or jinn. Iask You...to heal him and to pardon him and to rebound what afflicts him upon his enemies.” The waytouse [this prayer] is to writeitinsaffron on aclean vessel or paper, then to wash the bowlin water or dissolve the paperinwater,and then to drink the watercompletely. Then he should placehis hands in the remainingmoistureinthe bowland use them to wipe as much of his bodyashecan.⁶⁵⁴

The actions prescribed by Ibnal-Ḥ ājj in this passagehaveall the hallmarks of magical healing.The incantationiswritten on amedicine bowl using aspecific ink and the patientingests and anoints himself with the “substance” of the text. The purpose of ingesting asubstance and anointing the bodywith it is to change something about the bodyinorder to healit. The purpose of performinganin- cantationistoexert control over asupernatural being and to compel it to act in one’sfavor.However,this prayer is atheological declaration which subverts the implied meaningofthe ritual. It deniesthat people can changeand heal their own bodies⁶⁵⁵ and it deniesthat God can be compelled to do the bidding of the one performing the enchantment.Inthis wayIbn al-Ḥ ājj preserves the physical content of magical medicine while Islamicizing its verbal content. When the jurists consider the question of how aMuslim ought to go about obtaining medical treatment,they evaluate medicaloptions in relative terms. Fewthingsare absolutelyforbidden or commanded, but they urge Muslim patients to choose between better and worse options. What makesaparticular treatment better or worse is not just the objectivepractice of the treatment, but rather which authorities and epistemological systems the patient acknowl-

 Ibnal-Ḥ ājj, al-Madkhal,3/4:327–8.  This languagecloselyresembles the languagebycertain mutakallimūn in subordinating medicinetoDivine will and occasionalism.See, for example, ‘Abdal-Jabbāral-Hamadhānī’s Tathbītdalā’il al-nubūwa (Cairo: Dāral-Muṣ ṭafā,2006) 2:615–16. 236 6ReligiouslyClassifying theMedical MarketplaceofIdeas edgesinchoosing that treatment.What is important to the jurists is that medical knowledge is acquired, and medicaltreatment is practiced, through an Islamic conduit.However,when the patient is aMuslim woman, the concern to Islami- cize the culturesurroundingmedicine runs up against the value placed on gender separation. This creates aconflict of values for the jurists. 7Heterodoxy and HealthcareAmong Women

The jurists who viewed the choice of medicalpractitioner as religiouslyand so- ciallyfraught did not seek to ban religiouslyproblematic practitioners. When seeking medicalassistance they gave preference to medical practitioners from some demographics over others, but they valued the preservation of life and health more. Indeed, it was preciselybecause life and healthweresovalued that there wasahighdegree of tolerance for inter-cultural interactions in medical situations, and so therewas also increased opportunity for problematic interactions.We have seen evidence of such tolerance in practice in ḥisba manuals, belles-lettres,and documents from the CairoGeniza. And we have seen theoretical tolerance in the example of the Prophet Muḥammadand his companions turning to bothAraband non-Arab doctors,and Muslim and non-Muslimpracti- tioners, duringtheir illness. Respect for medicalskill did not,however,preclude jurists from considering better and worse identitiesfor medical care providers.Rather,they discussed and calculatedwhom it was more or less preferable for apatienttoturn to for medicalattention. Forfemalepatients, this calculation came with added complications, and the treatment of infertile women came with even more. Modesty- based restrictions weremost easilyrelaxed in cases of life-threatening emergency and old age – two situations which did not usuallyapplytowomen battling infertility.Infertility involved neither extreme pain nor imminent death and thus did not constituteanobviousmedical emergencyaccordingtoIslamic law.⁶⁵⁶

 Theseare thestandards used by theḤanafī school to determineifthere is amedical necessity whichmakes it permissiblefor Muslimstohavetheir sexual organs examined by membersof theoppositesex.See Ibn ʻĀ bidīn(d. 1252/1836), Ḥ āshiyat Radd al-muḥtār (Cairo:al-Bābī al-Ḥ alabī, 1966), 6:371. TheḤanafī jurist ‘AbdAllāhb.Maḥ mū dal-Mawṣ ilī (d.683/1284) saysthatthe same circumstanceswhich permit aMuslimtodrink wine andeat theflesh of pigs also applyinjudging when it is permissiblefor awoman to be examined by amalephysician.al-Mawṣ ilī, al-Ikhtiyārli- taʻlīlal-Mukhtār (Beirut:Dāral-Risāla al-ʻĀ lamiyya, 2009), 4:108. Ihavefound no specific medie- valreference to infertilityasanemergency,but aprominent modern Shāfi‘ī jurist,Nūḥ‘Alī Salmān al-Quḍāh(d. 2010)the former GrandMufti of Jordan,has said that infertilitydoesindeedconsti- tute an extenuatingmedical circumstance andwrites, “Necessarytreatment ...includes gyneco- logicalexaminationsfor womenwithfertility problems,which arepermissible.” N. Keller, The Re- liance of theTraveller:aClassicManualofIslamic Sacred Law (Chicago:Sunna Books,1991),514. By contrast aSaudi muftī,Shaykh ‘AbdAllāhal-Jibrīn, specifically says that infertilityisnot amedical emergencyand hencerequiresthe assistance of afemalephysician.See al-Muslimūn (March 1, 1991), 8, referred to in Vardit Rispler-Chaim, IslamicMedical Ethics in theTwentiethCentury (Lei- den: Brill, 1993), 63.Inasimilar fatwā,al-Jibrīnadvises ahusbandthatitisimpermissible forhim

Moreover,moreoften than not,infertility must have been along-term problem in away thatalife-threateningdisease was not.Ifaninitial attempt at acure proved unsuccessful, an infertile patient would have had the time and motiva- tion to look further afield and seek another practitioner or system of healing for amore effective treatment.Lastly, midwifery and medicine pertaining to the genitals was subject to special religious restrictions on interactions between Muslim women and non-Muslim women. In determiningwho should theoreticallybethe person to provide medical attention to afemale patient,the jurists placed avalue both on maintaining boundaries between members of the opposite sex and in promotingMuslim practitioners. As is true of the discussion about medicine generally(described in chapter 6) texts about women’smedicalcare speak lessofcommanded and forbidden medical practitioners and more about preferable and undesirable options. Most often, juristic preferencefor medical practitioners was expressed in terms of general dicta: “aMuslim before anon-Muslim” and “awoman before aman” should examine afemale Muslim patient.⁶⁵⁷ I.e. afemaleMuslim practitioner was the most favoredhealthcareprovider for aMuslim woman, and a male non-Muslim was the most unfavorable provider.But what did the jurists want to happen when the choice was less clear-cut? The Shāfi‘ī jurists in particularare interested in teasingout the relative weight of the various factors that go into choosing apractitioner,doing so in their commentaries on al-Nawawī’s(d. 676/1278) Minhājal-ṭālibīn,which states that men can treat women, and women can treat men, “provided that there is no woman to treat the woman or man to treat the man. And thereshould be no dhimmī while aMuslim is available.”⁶⁵⁸ The SyrianShāfi‘ī jurist Shihābal- Dīnal-Adhra‘ī (d. 783/1381) for example, teaches that an infidel woman is preferable to aMuslim man and that under most circumstances she is preferable to akinsman (maḥram)when it comes to viewing aMuslim woman’sbody. How- ever,incases wherethe practitionermust examine the woman’sgenitals, rather than anon-Muslim female practitioner,al-Adhra‘ī givespreferencetoany kind of “quasi-kin” (naḥ wmaḥram), aterm which appears to refer to slaves, eunuchs,

to presenthis wife to amalephysician forthe purposes of diagnosing andrelieving female infertility. ‘Abdal-‘AzīzIbn Bāzetal., Fatāwā Islamiyya (Riyadh: Darussalam,2001),140.  al-Shirbīnī, Mughnī al-muḥ tāj,3:133. ʻAbdal-Hamīdal-Shirwānī, Ḥ awāshī al-Shirwānī wa- Ibn Qāsim al-ʻAbbādī ʻalā Tuḥ fatal-muḥ tājbi-sharḥ al-Minhājli-Ibn Ḥ ajar al-Haytamī (Beirut: Dāral-Kutub al-‘Ilmiyya, 1996), 9:39–40.  Jalālal-Dīnibn Aḥ mad al-Maḥ allī (d. 864/1459), Kanz al-rāghibīnsharḥ Minhājal-ṭālibīn. 7Heterodoxy and Healthcare Among Women 239 and young boys who are not yetpubescent.⁶⁵⁹ He further designates aeunuch as preferable to apubescent boy (murāhiq), who in Shāfi‘ī jurisprudence is described as an older boy who is still aminor although developed enough to be capable of narrating to others what he sees.⁶⁶⁰ However al-Adhra‘ī concludes that he prefers “the most skilled person – even if he is of the opposite gender and religion” to other practitioners.⁶⁶¹ Al-Adhra‘ī’sfinal conclusion favors skill aboveall but still takes into consideration gender,religion, and kinship. He also differentiates between general medicalcare and care involving viewing the genitals. In the latter case he claims that anon-Muslim woman providing genital-related care is more problematic than having certain males provide medical care. Al-Adhra‘ī’ssystem has some gaps; he does not explain preciselyhow he sit- uates non-Muslim kinsmen and male quasi-kin in this system. The Shāfi‘ī jurist al-Bulqīnī (d. 805/1403) describes more clearlythe following order of preference in seeking out medicalcare for afemaleMuslim patient:

Afemale Muslim, then aMuslim boy whoisnot pubescent (ghayr murāhiq), then one who is pubescent (murāhiq), then an infidel non-pubescent boy,then apubescent one, then an infidel woman, then aMuslim maḥram (kinsman), then an infidel maḥram,then anon-kin Muslim man, then an infidel one.⁶⁶²

The jurist Shihābal-Dīnal-Qalyūbī’s(d. 1079/1659) order of preference adds another layer, taking into account the notion of kinswomen, and differentiating between them and afemale practitioner who is not closelyrelated to the patient. Al-Qalyūbī writes:

ForaMuslim woman (patient) aMuslim female kinswoman (maḥram)takesprecedence, then aMuslim female non-maḥram,then aMuslim boy whoisnot pubescent,then a dhimmī non-pubescent boy,then an adult male Muslim maḥram,then an adult male infidel maḥram,then aMuslim eunuch, then an infidel eunuch, then a dhimmī female maḥram, then a dhimmī female non-maḥram,then aMuslim pubescent boy,then anon-Muslim pubescent boy,then an adult non-maḥ ramMuslim, then an adultnon-maḥ raminfidel. The goal is to give precedencetomembers of the same gender over others,and to maḥrams

 ʻAbdal-Hamīdal-Shirwānī, Ḥ awāshī al-Shirwānī wa-Ibn Qāsim al-ʻAbbādī ʻalā Tuḥ fatal- muḥ tājbi-sharḥ al-Minhājli-Ibn Ḥ ajar al-Haytamī (Beirut: Dāral-Kutub al-‘Ilmiyya, 1996), 9:40.  E. Alschech, “Out of Sight and Therefore Out of Mind: EarlySunnī Islamic Modesty Regu- lations and the Creation of Spheres of Privacy,” Journal of Near Eastern Studies 66 (2007):282.  al-Adhra‘ī’sopinion appears in IbnḤajar al-Haytamī’s(d. 973/1567) commentary on al-Na- wawi’s Minhājal-ṭālibīn known as Tuḥ fatal-muḥ tājbi-sharḥ al-Minhāj. See al-Shirwānī, Ḥ awāshī al-Shirwānī,9:40  al-Shirwānī, Ḥ awāshī al-Shirwānī,9:40. 240 7Heterodoxy and HealthcareAmong Women

over others,and to those who have rights to see moreoverothers.[And of these criteria] one whopossesses the same gender takesprecedence, then maḥram status,and then the same religion.⁶⁶³

The modern commentator ʻAbdal-Ḥ amīdal-Shirwānī analyzes al-Bulqīnī’slist with some concern and surprise, since some of it clashes with general modesty regulations.

[In al-Bulqīnī’slist] the Muslim pubescent boy takes precedenceoverthe infidel non-pubescent boy,despitethe former beinglike anon-kinsman⁶⁶⁴ compared to the latter,since a [non-pubescent boy] is usuallytreated as a maḥram⁶⁶⁵ or likean‘adim (mental deficient)! [I.e. al-Shirwānī finds it odd that amale older boy,who is usuallytreatedasaforeign male when it comestonudity,ispreferable to an infidel youngerboy whoisusuallytreated as not possessingsexual awareness.] As for the infidel pubescentboy takingprecedencetothe infidel woman: whathehas chosen follows the rulinginthe Minhāj. [I.e. al-Shirwānī iden- tifies this as in keepingwith the legal tradition.] He discriminates between the Muslim and the infidel maḥram even though they areequal in terms of viewing[akinswoman]. And he considers apubescent boy,whether Muslim or infidel, to takeprecedenceoveramaḥram, whether Muslim or infidel, even though the former is likeanon-kinsman ...Wouldn’tthe infidel woman takeprecedenceoverthe pubescent boy,beheaMuslim or an infidel?For a pubescent boy is likeanadult when it comes to [the legality of his] gaze, whileaninfidel woman has [the legalright] to gaze upon what is exposed in the course of dailylife ...⁶⁶⁶

Below is avisual representationofal-Bulqīnī’sand al-Qalyūbī’slists, with the parenthetical information basedonal-Shirwānī’scomments.

 Shihābal-Dīnal-Qalyūbī, Hāshiyatā al-Imāmayn al-muḥaqqiqayn al-mudaqqiqaynal- Shaykh Shihābal-Dīnal-Qalyūbī wa’l-Shaykh ʻUmayra ʻalā sharḥ Jalālal-Dīnal-Mahallī ʻalā Min- hājal-ṭālibīn (Beirut: Dāral-Kutub al-‘Ilmiyya),3:322.  Thereare two views within the Shāfi‘ī school about the status of a murāhiq: one is that in his presenceawoman should cover herself to the same extent as she would in the presenceofa kinsman. The other,which al-Nawawī prefers, is that he is to be consideredlike an adultnon- kinsman, and she must coverherself accordingly,see al-Nawawī, Rawḍat al-ṭālibīn, 7:22. and al- Shirwānī, Ḥ awāshī al-Shirwānī, 9:30.  al-Mawsūʻaal-fiqhiyya,31:52.  Al-Shirwānī, Ḥ awāshī al-Shirwānī,9:40. 7Heterodoxy and HealthcareAmong Women 241

Al-Bulqīnī’sorder of preference Female Kin Muslim

.Muslim woman Yes Either Yes .Muslim young boy n/a (Yes) Yes .Muslim older boy (No) No Yes .Non-Muslim young boy n/a (Yes) No .Non-Muslim older boy (No) No No .Non-Muslim woman Yes No No .Muslim kinsmanNoYes Yes .Non-Muslim kinsmanNoYes No .Muslim non-kinsmanNoNoYes .Non-Muslim non-kinsman No No No

al-Qalyūbī’sorderofpreference Female Kin Muslim

.Muslim kinswoman Yes YesYes .Muslim non-kinswoman Yes No Yes .Muslim younger boy n/a QuasiYes .Non-Muslim younger boy n/a QuasiNo .Muslim adult kinsmanNoYes Yes .Non-Muslim adult kinsman No YesNo .Muslim eunuch Ambiguous QuasiYes .Non-Muslim eunuch Ambiguous QuasiNo .Non-Muslim kinswoman Yes YesNo .Non-Muslim non-kinswoman Yes No No .Muslim older boy (No) No Yes .Non-Muslim older boy (No) No No .Muslim adult non-kinsman No No Yes .Non-Muslim adult non-kinsman No No No

Manyaspectsofthese ordersofpreference mayatfirst seem counterintuitive. Both jurists prefer that anon-Muslim male child or anon-Muslim eunuch serveinagynecologicalcapacity rather than anon-Muslim woman. Al-Qalyubī even prefers thatanon-Muslim adultkinsman serverather thananon-Muslim woman, meaning thateventhough neither are Muslim, the male relative is preferable to the non-related woman! In these lists neither gender, nor kinship, nor religious status take absolute precedence in determining the most appropriate medicalsupport for aMuslim woman. It is clear that amale, non-Muslim, non-kinsman is the least appropriate person for aMuslim woman to interact with. But once that case is excluded, we have examples of gender trumpingkinship (a Muslim non-kinswoman is preferable to amale kinsman), but also of kinship trumping gender (al-Qalyūbī prefers a kinsman to anon-Muslim woman, and both jurists prefer ayoungboy – who is a 242 7Heterodoxy and HealthcareAmong Women quasi-kin – to anon-Muslim woman). Usuallygendertrumps religion (a non- Muslim woman is preferable to an adultMuslim non-kinsman), but sometimes religion trumps gender (al-Bulqīnī prefers aMuslim older boy to anon-Muslim woman). Kinship can trumpreligion (a non-Muslimkinsman is preferable to Muslim non-kinsman), and sometimes religion trumpskinship (for al-Bulqīnī aMuslim older boy – who usually has the status of anon-kinsman when it comes to issuesofnudity – is preferable to anon-Muslim youngboy – whose status is usually that of someone who triggers few or no nudity restrictions at all). Most interestingly,bothjurists are less inclined to resort to non-Muslim women than to non-Muslim boys and eunuchs.⁶⁶⁷ What accounts for these complicated orders of preference and what do they mean?Inmaking these lists, the Shāfi‘ī jurists are engaging in atheoretical intellectual exercise of limited influence. But this exercise does not exist in avacuum, rather it drawsonawide-rangingand much-quoted bodyoftextsand discussions about Muslim women’smedical and intellectual interactions with men, with non-Muslimwomen, and with their fellow Muslim women. Such discussions are the topic of this chapter.

Muslim female patients, male practitionersand the preservation of sexual boundaries

The Shāfi‘ī,Ḥanafī,⁶⁶⁸ and Ḥ anbalī⁶⁶⁹ schools of lawall permit amale physician to view and touchawoman’sgenitals if there are no alternative medicalpractitioners available. By comparison, the Mālikī school uniformlyprohibits male physicians from doing so.⁶⁷⁰ Non-Mālikī discussions about who ought to attend

 Ihavebeen unable to find references to eunuch physicians. However,anArabic CairoGen- iza document from the 6–7th /12–13th centuries contains aquestion to a mufti about the appro- priateness of havingatrusted Jewish eye-doctor “whohas no beard” visitingthe household of Muslims,specificallythe ḥaram. It is possible that the physician’sbeardlessness is mentioned to signify that he is not quiteaman, and is perhaps ayouth. Cairo Geniza document Or.1080.15.62 in Khan, Arabic Legal and AdministrativeDocuments in the CambridgeGenizah Collections,296.  Fatāwā al-hindiyya (Būlāq: al-Maṭba‘aal-Kubrā al-Amīriyya, 1892),5:330.  IbnQudāma (d. 620/1223), al-Mughnī (Cairo: Maktabat al-Qāhira, 1968), 7:101 and Abū Yaʻlā ibn al-Farrā’ (d. 458/1066), al-Jāmi‘ al-ṣaghīr (Riyadh: DārAṭlas,2000), 398. In the Kashshāfal- qinā‘: “Adoctor mayview and touch whatever it is necessary for him to view and touch,evenher genitals and inside her,because this is amatter of obvious need, even if he is anon-Muslim.” Manṣ ū ribn Yū nus ibn Idrīsal-Buhū tī, Kashshāfal-qinā‘ (Beirut: Dāral-Fikr,1982),5:13.  Aḥ mad Muḥ ammad Kan‘ān, al-Mawsūʻaal-ṭibbiyyaal-fiqhiyya (Beirut: Dāral-Nafā’is, 2000), 748. The Mālikī jurist al-Nafrāwī (d. 1125/1714), writes that it is preferable for amale doctor The preservation of sexual boundaries 243 asick woman speak of an order of preference or precedence givenwhich medical practitionersare immediatelyavailable. These texts presume apressingmedical necessity or emergency,orelse alegal need to establish female virginity or pubescence.⁶⁷¹ One exception is al-Nawawī (d. 676/1278)who explicitlyallows male practitionerstoview the bodies of femalepatientsunder non-emergencycircum- stances,such as for the purposes of medicaleducation. He writes, “whereitis forbidden to look it is alsoforbidden to touch, but both are permittedfor bleeding,cupping and treating.Isay, looking is also permittedfor teaching and for testifying.”⁶⁷² Otherwise,amedical necessitywhich would theoreticallyallow amale physician to view the genitals of afemale patient is usually defined as having the samehighbar that would permit aMuslim to drink wine or eat the flesh of pigs, or it is defined as occurringwhen aperson is in extreme physical pain or in mortal danger.⁶⁷³ Even as most jurists permit male practitionerstotreat femalepatientsin medicalsituations wheresuch interaction is a “necessity,” they still describe male practitioners attending femalepatients as an unfortunate,necessary evil. They express aconcern about the sexual invasiveness of aman’sgaze, describing it as weighingmore heavilyonafemale patient than afemalepractitioner’s gaze does.⁶⁷⁴ The possibilityofthe development of an illicit sexual relationship is not generallymentioned as aconcern, since it is understood that afamily memberwill also be present in the room,rather it is the gaze that constitutes aform of harm in and of itself.

to operate by havingawoman look at the genitals and describe them to him, since “Ithink no one says that aman’sviewingawoman’sgenitals is permissible ...Ifthat which is witnessed is… in the area of her back or bellyorsomewhere else outside of her genitals,noone but women maywitness it,and for aman to view it is not permissibleevenifthe woman wishes it.But if it is in her genitals and the womanissurethat thereisaninjury,thereshould be women to look at her genitals and their testimonyisaccepted. He [the doctor] should follow Khalīl’sdirection and comewith two womentowitness for him from two viewpoints.” Aḥ mad b. Ghunaym al-Nafrāwī, al-Fawākih al-dawānī (Cairo: Muṣ ṭafā al-Bābī al-Ḥalabī,1955), 2:367.  Muṣ ṭafā al-Suyūṭī (d. 1243/1827), the Ḥ anbalī,also mentions in this contextthat ahand-am- putator mayalso view the bodyofhis “patient.” al-Suyūṭī, Maṭālib ūlī al-nuhā fī sharḥ ghāyatal- muntahā (Damascus:al-Maktabal-Islāmī,1961), 5:15.  Al-Nawawī, Minhājal-ṭalibīn in al-Shirbīnī (d. 977/1570), Mughnī al-muḥ tājilāma‘rifat maʻānī alfāẓ al-Minhāj (Cairo: Maṭbaʻat Muṣ ṭafā al-Bābī al-Ḥ alabī,1958), 3:132.  ‘AbdAllāhb.Maḥ mū dal-Mawṣ ilī (d. 683/1284), aḤanafī,saysthe necessity in this case is the same as the necessities which makeitpermissibletodrink wine and eat the flesh of pigs(al- Mawṣ ilī, Al-Ikhtiyārli-taʻlīlal-Mukhtār,4:108). Ibn ‘Ābidīnsaysthe school agrees that amale physician can treat afemale patient’sgenitalia onlyifshe is in unbearable pain or might die. Ibn ʻĀ bidīn, Ḥ āshiyat Radd al-muḥ tār,9:533.Cf. Fatāwā al-Hindiyya,5:330.  al-Shirbīnī, Mughnī al-muḥ tāj,3:133. 244 7Heterodoxy and HealthcareAmong Women

The jurists also worry that an inappropriate medical practitioner might compromise his or her patient’smodesty by describing her bodytoathird party. Such apossibility is mentioned particularlywith regard to non-Muslim practitioners, both men and women, who are not sharī‘a-bound to guard the privacy of their patients. We have alreadyseen an impassioned declaration of this concern in apassagebyIbn al-Ḥ ājj:

The sixth reason[whyitisunacceptable for anon-Muslimdoctor to treat aMuslim even if a Muslim doctor serves as asecond physician] is that it is detestable and abominable if the patient is aMuslim woman, because the infidel is the enemyofGod, and he would enjoy viewingher and palpatingher.Ithas alreadybeen said that aMuslim woman is not permitted to reveal anypart of her bodytoaChristian woman or Jewish woman. If this is true regarding awoman, how much moresoregarding aman?For aMuslim woman would need to reveal some of her bodysothat [the physician] could see the part that hurts,and this would be welcomedbyanenemyofGod and an enemyofhis Prophet ... Even if nothinghappens except that the infidel describes to someone aMuslim’swife or daughter or [demonstrates] some other kind of their manyreprehensible tendencies,it would be toomuch for Islamic protective jealousy (ghayra), even if it were not forbidden in the noble Law, God forbid. If someone weretosay: “But the ‘ulamā’ have permitted uncoveringnakedness before aphysician whether the patient is aman or awoman!” the response is that this is the case when thereisanecessity,and thereisnonecessity that calls for inviting an infidel when thereexists aMuslim physician.⁶⁷⁵

Ibnal-Ḥ ājj makes anumber of arguments in this passage. The first is that anon- Muslim male physician constitutes arisk because he maytake sexual pleasure in viewing and touchingaMuslim woman. However,evenifanon-Muslim physician does not himself directlyengageinthis behavior,there is afear he will describe his patient to someone else, which would be intolerable. He alsoclaims that aMuslim woman is forbidden from revealing anypart of her bodyto even anon-Muslim woman, atrain of thought that will be discussed below. The central argument in this passageisthus an attack on Muslim/non-Muslim medicalinteraction, not on male/femaleinteraction. It is preciselybecause male doctors are assumedtotreat women that Ibnal-Ḥ ājj sees it as important that thosedoctors be Muslim. Ibnal-Ḥ ājj is not suggesting thatmost of his fellow Muslim Cairenes see the world as he does, or practice as he would wish them to. Indeed, Ibnal-Ḥ ājj himself admits that manyofhis fellow Muslims see it as per- fectlyIslamicallyjustifiable for both non-Muslim male physicians and female practitionerstoview and treat femaleMuslim patients. Rather,heargues against his fellow Muslims who view illness as an occasion which makesitacceptable to cross the boundaries of both confession and gender.

 Ibnal-Ḥ ājj, al-Madkhal,3/4:318. The preservation of sexual and intellectual boundaries 245

Ibnal-Ḥ ājj is not,however,alone voice operating on the margins of Islamic thought. In chapter 6wediscussed others who held similar views regardingnon- Muslim physicians,i.e.male practitioners. The legal position of the non-Muslim femalemedical practitioner who treats Muslim femalepatientsismore complex. Three different legal factors come into play, and it is this complexity that accounts for the odd ordersofpreference articulated by al-Qalyubī and others. The first legal factor relatestonudity, specificallytorules about the extent to which Muslim women must cover themselvesinthe presenceofnon-Muslim women. The second factor is the general legal principle that “necessity makes permitted” the setting aside of nudity prohibitions.Childbirth is considered to be such anecessity.The third legal factor is one we have not yetexamined, and thatisthe tradition established by the companions of the Prophet that spe- cificallyprohibits aMuslim woman from allowing anon-Muslim woman to see her genitals and serveasher midwife duringchildbirth.⁶⁷⁶ As we shallsee, in the interplayofthese three factors,modesty restrictions basedonsexual threats are intertwined with modesty restrictions based on culturalthreats.

Muslim female patients, non-Muslim female practitioners, and thepreservation of sexualand intellectualboundaries

The extent to which aMuslim woman should be willingtoexpose herself to the gaze of anon-Muslim woman is amatter of some debate among the medieval jurists.While Islamic jurisprudence regardingnudity and modesty does not differentiatebetween Muslim and non-Muslim male viewers with regard to the male Muslim body, nudityand modesty between women is another matter.Juristic debates about Muslim women’smodesty with respect to non-Muslim women take as their starting point varyinginterpretations of Qur’ān24:31.

Saytothe believingwomen, that they cast down their eyes and guard their private parts, and reveal not their adornment ...save to their husbands,ortheir fathers,ortheir husbands’ fathers,ortheir sons,ortheir husbands’ sons,ortheir brothers, or their brothers’ sons,ortheir sisters’ sons, or their women,orwhat their right hands own, or such men as attend them, not havingsexual desire,orchildren whohavenot yetattained knowledge of women’sprivateparts ...⁶⁷⁷

 IbnKathīr, Tafsīral-Qur’ānal-‘aẓīm (Riyadh:DārṬayba lil-Nashr wa’l-Tawzī‘,1997), 6:48.  Q. 24:31. Translation from A. J. Arberry, TheKoran Interpreted (London: Allen &Unwin, 1955). The italics aremine. 246 7Heterodoxyand HealthcareAmong Women

The phrase “or their women” is interpreted in twowaysbythe medieval jurists. One interpretation deemphasizes the possessive “their” and understands the verse to mean that aMuslim woman is exempted from covering herself in the presenceofwomen in general, just as she is exempt from covering herself in the presenceofmale family and household members. In accordancewith this interpretation, some jurists permit anon-Muslim woman to view the same parts of the bodythat aMuslim woman mayview.The other interpretation understands “their” (which is grammaticallyathird person plural feminine possessive adjective) as meaning “thoseaffiliatedwith” aMuslim woman. Among pro- ponentsofthis interpretation, the phrase “their women” refers to Muslim women’sfemaleco-religionists, since it would be wrongtosuggest affiliation with non-Muslim women. Thus women who are non-Muslims are refusedadmis- sion into aMuslim woman’ssphere of intimates. Both interpretationsofthe verse can be found among Ḥanbalīs, beginning with Ibn Ḥanbalhimself. Both are attributed to him in the Aḥkāmal-nisā’.

Muḥammad b. ‘Alī told me that al-Athram told him that Abū ‘Abdallāh[Ibn Ḥanbal] said: Some people areofthe opinion that she should not removeher head cover (khimār)inthe presenceofaJewish or Christian woman, for [the non-Muslim woman] is not one of “their women.” But Iamofthe opinion onlythat neither aJewish woman nor aChristian woman, nor anyone else who is not her fellow [Muslim] woman mayview her genitals,nor maythey be amidwife to her when she givesbirth. But as to viewing[just] her hair,itisnot aproblem. Muḥammad b. Abī Hārūnnarrated from Isḥāqbin Ibrāhīmwho said: Iasked Abū ‘Ab- dallāh[ibn Ḥanbal] if aMuslim woman mayexpose her head in the presenceofdhimmī women. He said, “She is not permitted to expose her head to dhimmī women, because God said ‘or their women.’” [Isḥāqbin Ibrāhīm] also said: IheardAbūAbdallāh, when askedabout this verse “or their women” say, “The women of the People of the Book – whether Jewish or Christian – maynot be midwivesfor aMuslim woman and maynot view her.”⁶⁷⁸

Accordingtoal-Athram, Ibn Ḥanbal does not,ingeneral, object to non-Muslim women viewing aMuslim woman. However,midwifery and viewing the genitals represent an exceptionand an extra stringency.AccordingtoIsḥāqb.Ibrāhīm, Ibn Ḥanbal objectstonon-Muslim women viewing even aMuslim woman’s hair,and of course they cannot serveasmidwivestoher. In the Mughnī,Ibn Qudāma (d. 620/1223)continues to articulate both positions, ascribingthem bothtoIbn Ḥ anbal, but advocatesfor the less restrictive

 Ibn Ḥanbal, Aḥkāmal-nisā’‘an al-imāmAbī‘AbdallāhAḥmad ibn Muḥammad ibn Ḥanbal, riwāya Abī Bakr al-Khilāl (Beirut: Muʼassasat al-Rayyānlil-Ṭ ibāʻawa’l-Nashr,2002),38. The preservation of sexualand intellectualboundaries 247 view,meaning thataMuslim woman need not cover herself in the presenceof women generally, whether Muslim or non-Muslim. However,evenwhereIbn Ḥ anbal and IbnQudāma take the less restrictive position and saythatwith re- gardtonudityand sexuality there is no difference between Muslims and non- Muslims, they make an exception with regard to anon-Muslim woman viewing aMuslim woman’sgenitals, particularlyinthecontext of servingasamidwife duringabirth.⁶⁷⁹

The rule of awoman with awoman is the same as aman with aman. Thereisnodifference between two Muslim women and aMuslim woman with a dhimmī woman, just as there is no difference between two Muslim men and aMuslim man with a dhimmī man concerning viewing. Aḥ mad [ibn Ḥanbal] said “some people rule that [a Muslim woman] maynot removeher clothinginthe presenceofaJewish or Christian woman, but Irule that [a non- Muslim woman] onlycannot look at her genitals and cannot serveasher midwife when she givesbirth.” However,Aḥmad also has another view:that aMuslim woman cannot remove her head-cover(khimār)inthe presenceofadhimmī woman and cannot enter abathhouse together with her.And that is the position of Makḥ ūland Sulaymānb.Mūsāon His statement “or their women.” The first positionstemsfrom[the fact] that Jewish and other female infidels would visit with the Prophet’swives and they did not cover themselves, and he did not command them to coverthemselves...For veiling between men and women happens for areason that is not present between aMuslim and anon-Muslim woman. So it is not necessary to impose veiling between them, just like between aMuslim and a dhimmī man, for veilingismade necessary where thereare explicit texts or analogy,and neither of these arepresent.Asregards His statement, “or their women” the likelyintention is “all women.”⁶⁸⁰

Among medieval jurists,the Ḥ anbalīsgenerallytakethe position thatanon- Muslim woman is no different from aMuslim woman with respect to nudity, i.e. the laws are parallel to thosepertainingtonudity and modesty between men, meaning that onlythe area of the bodybetween the naveland knees must be concealed.⁶⁸¹ By contrast, most Mālikīs⁶⁸² and Shāfi‘īs(with the promi-

 However,one nineteenth-century Ḥ anbalī source does saythat,ifnecessary (not explained), anon-Muslim midwife is permitted to deliverachild. al-Suyūṭī, Maṭālib ūlī al-nuhā, 5:15.  IbnQudāma, al-Mughnī,7:105–106.  E.g. IbnQudāma, IbnMunjī,and IbnTaymiyya. The influential theologians al-Ghazālī (Shāfi‘ī)and Ibn ‘Arabī (Malikī)hold the same view.Alshech, “Notions of PrivacyinClassical Sunni Islamic Thought,” 164.  Al-Khurashi, Ḥ āshiyat al-Khurashī ʻalā’ Mukhtaṣar Khalīl (Dāral-Kutub al-ʻIlmīyah,2015) 1:46.Al-Dasūqī (d. 1230/1815), Ḥ āshiyat al-Dasūqī ʻalā al-Sharḥ al-kabīr (Cairo:Dāral-Iḥ yāʼ al- Kutub al-ʻArabiyya, n.d.), 1:344.However,Ibn ‘Arabī (d. 543/1148) citesboth opinions in his com- 248 7Heterodoxy and HealthcareAmong Women

nent exception of al-Ghazālī⁶⁸³), and some Ḥ anafīs⁶⁸⁴ require aMuslim woman in the presenceofanon-Muslim woman to cover herself to much the same extent that she would in front of astrangeman, with the possible exception thatshe can reveal whatever is necessary to go about her dailybusiness.Inthis view, while aMuslim woman mayreveal everythingthat is not between her knees and naveltoother Muslim women, she mayreveal onlyher face and palms to non-Muslim women. Other Ḥ anafīstake aposition midwaybetween these two poles by placing non-Muslimfemaleviewers in the same category as kinsmen, rather than the same category as foreign men, with the result that aMuslim woman mayreveal more of her bodyintheirpresence. However,midwifery and similar situations in which another person must look at aMuslim woman’s genitals represent aspecial case accordingtomedieval jurists from across the legal schools. One of the reasons articulatedfor being wary of non-Muslim women viewing Muslim ones is the fear thatthey might describeMuslim women to theirhusbands. This explanation is usually ascribed to ‘AbdallāhIbn ‘Abbās(d. 68/687) and is presented in its fullest forminIbn Kathīr’s(d. 774/1373) commentary on the above-mentioned Qur’ānic verse.

His statement “or their women” means she maydisplayher ornaments to Muslim womenas well, but not to the women of the dhimma,lest they describe them to their husbands. This is aconcern with regardtoall women, but moresowith regardtodhimmī women because no restriction stops them from doing so, while aMuslim woman is taught that this is forbidden and she is kept from doing so. Forthe MessengerofGod said, “awoman should not touch a woman and describe her to her husband as though he himself could see her” ...Ḥārith b. Qays reported, “The Commander of the Faithful ‘Umar b. al-Khaṭṭābwrote to Abū ‘Ubayda, ‘It has been broughttomyattention that some Muslim women arefrequentingbathhouses together with polytheistic women. Now,itisnot permitted for awoman whobelieves in God and the Last Daytohaveher nakedness seen by anyone but her co-religionists’” ...Ibn ‘Abbāssaid, “‘Or their women’ referstoMuslim women, and she must not show the Jewish or Christian woman her throat, earring, or sash, or that which onlyamaḥram maysee” ... Mujāhid said, “AMuslim woman should not removeher head-coveringwhile with apoly- theistic woman” ...Both Makḥ ūland ‘Ubāda b. Nusayy disliked havingChristian,Jewish, or Magian women serveasmidwivestoaMuslim woman ...Ibn ‘Aṭ ā’ narrated from his

mentary on Qur’ān24:31 and prefers the reading that all women are the same in this regard. Ibn al-‘Arabī, Aḥ kāmal-Qur’ān (Beirut: Dāral-Kutub al-‘Ilmiyya, 1991), 3:385.  Al-Ghazālī, al-Wasīṭ fī al-madhhab (Cairo: Dāral-Salām, 1997), 5:30.Referred to in E. Al- shech, “Notions of Privacy in Classical Sunni Islamic Thought” (Ph.D.Dissertation: Princeton University,2004), 164.  Al-Ḥaṣkafī (d. 1088/1677) in Ibn ‘Ābīdīn, Ḥ āshiyat Radd al-muḥ tār ‘alā al-Durr al-mukhtār (Beirut: Dāral-Fikr,1992),6:371. The preservation of sexual and intellectual boundaries 249

father.⁶⁸⁵ “When the companions of the Prophet first came to Jerusalem, Jewish and Chris- tian women would serveasmidwivestotheir wives. And this,iftrue, was duetothe exi- gencies of the circumstance, or it was atribulation.”⁶⁸⁶

IbnKathīrinterprets the phrase “or their women” to meanthat non-Muslim women are excluded from intimate access to Muslim women, and initiallyhe claims that the purpose of such exclusion is not to preserveMuslim women from the gaze of non-Muslim women themselves, but rather from men’s “vicar- ious” gazes. However,the earlyIslamic authorities he citestoshow that Muslim women should not fraternize with non-Muslim women do not mention fear of male gazes.Rather he citesaseries of prohibitions which purport to date to the time of the Islamic conquest of Jerusalem under ‘Umar,⁶⁸⁷ which was not the first time when Muslim women encountered non-Muslim ones, but was the first time when they did so while outnumbered and residinginaforeign environment.These prohibitions restricted Muslim women from frequenting bathhouses with non-Muslim women, exposing their bodies to them, and receiving gynecological services from them. The underlying motive is not articulatedaspart of the narrativeabout the choice to prohibit such contact. The fear that anon-Muslim woman (who lacks proper Islamic instruction) would describe aMuslim woman to her husband does not sufficientlyexplain whythis prohibition is attributed to the period of the conquests rather than to the lifetime of the Prophet.Nor does it explain whythe earlyIslamic authorities and all of the schools of lawdesignatechildbirth as creating aspecial impedi- ment to non-Muslim women interactingwith Muslim ones. After all, medical need usually occasions waiving modesty restrictions, rather than imposing more confiningones. If non-Muslim and Muslim women are essentiallyequal vis-à-vis nudity, as the Ḥ anbalīsclaim, whydoes childbirth make it licit for a Muslim woman to view her fellow woman’sgenitals but illicitfor anon-Muslim to do so?If, as the Shāfi‘īs(and the Mālikīsand Ḥ anafīs) say, anon-Muslim woman is arisk because she might describeaMuslim woman, whythen does al-Bulqīnī’sorder of precedence give preferencetoboth Muslim and non-Muslim male children, whether younger or older,overanon-Muslim woman?After all, when it comes to legal discussions of nakedness,the defining characteristic of

 Also in IbnAbīḤātim al-Rāzī (d. 327/938), Tafsīral-Qur’ānal-‘aẓim li-Ibn Abī Ḥātim (Mecca: Maktabat NizārMuṣṭafā al-Bāz, 1997), 8:2577.  IbnKathīr,Tafsīral-Qur’ānal-‘aẓīm, 6:47– 48.  One version of this reportsaysthat the ‘Umar in question is the caliph ‘Umar II, that is, ‘Umar b. ‘Abdal-‘Azīz, and the person he tasks with the enforcement of this lawisAbūBakr b. ‘Amr b. Ḥ azm. Ibnal-Jawzī, Aḥ kāmal-nisā’,30. 250 7Heterodoxy and Healthcare Among Women children is that they are able, and have atendency, to describewhat they see.⁶⁸⁸ Indeed, if they could not describewhat they see they could not possiblybeold enough to provide emergency medicalattention. Moreover if the concern is thata non-Muslim woman might describe aMuslim woman, whydoes al-Bulqīnī rule that it is preferable to employ an infidel pubescent boy who is as able to engage in descriptions as awoman is, who similarlyhas no Islamic-based compunctions about doing so, and who is himself considered to possess aform of sexual desire?⁶⁸⁹ These seeming inconsistenciessuggest that the fear that aman might vi- cariouslyexperience aMuslim woman’sexposed bodyisnot the central issue, or at least not the onlyconcern, governing either earlyprohibitions on non-Muslim midwifery or later Shāfi‘ī jurists’ orders of preference for medical care. Instead, it makes sense to view restrictions on Muslim women being attended by non-Muslim midwivesand frequenting bathhouses with them not as a product of concernsabout privacyand sexual violation, but rather as an expression of concerns about the intellectual intimacy occasioned by bathhouse at- tendanceand midwifery itself. These two activities have more in common than just the element of nudity.When awoman visited the bathhouse, it was likely that she wasinastate that had religious, biological, and social significance. The sameistrue of the occasions when awoman required amidwife. Abirthing room served as the locus for the woman’stransition to motherhood, the baby’s entrance into the world and,oftenenough,the departure of either mother or baby from this world to the next.Abathhouse served as the locus for an unwed woman’stransitioninto marriage, awife’stransition into motherhood, and amenstruating woman’stransition from an impure to apure state. Thus both the bathhouse and the birthing room wereplaces associatedwith liminality. These states of liminalitywerethought to be dangerous and to renderwomen especiallyvulnerable to attacksbydemons and the evil eye, as well as the physical dangers posed by childbirth.⁶⁹⁰ Awoman did not deal with these dangers

 See Eli Alshech, “NotionsofPrivacy,” 162–63.  This seems to have confused later Shāfi‘ī jurists as well, hence al-Qalyūbī does not give preferencetothe pubescent boy over the non-Muslim woman. However,hestill givespreferences to the non-Muslim eunuch over anon-Muslim female maḥram,eventhough Shāfi‘ī jurists do believethat eunuchs experience lust and engageinaform of sexual relations.Alshech, “Notionsof Privacy,” 168.  Works written by medievalmen saythat women went to the bathhouse in connection with life-cycle events,and both documentary and literary evidencedemonstrateawidelyheld belief that women werevulnerable at these times.These works do not explain preciselywhat medieval women said or did to protect or heal themselves. However,there aremanydescriptions by modern anthropologists of contemporary women’scultures and their concepts of magic and liminality with the bathhouse as the locus and the midwife as the authority for the transmission and The preservationofsexual and intellectual boundaries 251 alone, rather she was coached through them by friends, older women, and others who werethought to have knowledge and expertise. Bathhouses and birthing rooms werethus places where women dealt with anxieties about vital aspects of their lives. Therefore, the bathhouse and the birthing room wereprime loci for the transmission of inherited cultureand knowledge,and the expression of authoritative wisdom and power.Itmakes sense then thatthe jurists sought to restrict interactions between Muslim and non-Muslim women in such contexts for fear that non-Muslim women would propagateculture and knowledge that ran counter to the teachingsofIslam.⁶⁹¹

performance of that culture. See A. Cuffel, “PolemicizingWomen’sBathing among Medieval and EarlyModern Muslims and Christians, TheNatureand Function of Water,Baths,Bathing,and Hy- giene from Antiquity through the Renaissance,ed. C. Kosso and A. Scott (Leiden: Brill, 2009). C. M. Obermeyer, “Pluralism and Pragmatism: Knowledge and PracticeofBirth in Morocco,” Med- ical AnthropologyQuarterly 14 (2000), 186–87 and E. S. Drower, “Women and Taboo in Iraq,” Iraq 5(1938), 116–17.Onthe significanceofliminal ritesand the linguistic connections between women’slife-cycle events, see R. Natvig, “Liminal Rites and Female Symbolism in the Egyptian Zar Possession Cult,” Numen 35 (1988), 64–66.  One Moroccan anthropologist compares the roleofthe bathhouse to mobile-phones,in terms of their importance as the main source of communication and informationfor women, es- peciallyones whootherwise do not leave their homes.S.Graiouid, “Communication and the So- cial Production of Space: the Hammam, the Public Sphere and Moroccan Women,” Journal of North African Studies 9(2004), 1, 105 and 107. ErikaFriedl, writingabout Iran, notes that bathhouse is where women “exchangednews,discussed problems,and politicked. This was also where the most privateofall entities,the body, was revealed to public scrutiny: pregnancies in- variablywere first noted here,and if awoman could conceal elsewherethat she had been beat- en, in the bath her bruises told the tale and her condition became public.” E. Friedl, “The Dy- namics of Women’sSpheres of Action in Rural Iran,” in Women in Middle Eastern History,214. Another anthropologist,writingabout Morocco, describes the bathhouse in asimilar way: “It is one of the rare places where [women] meet women whodonot belongtotheir qurāb or ‘close ones’,that is, the circle of friends,relatives, and neighbours with whomthey interact on adaily basis.Hereawoman is likelytopick up news that would not have reached her ears within the close surroundings of her ‘dārwadarb’,the house and the alley where she lives. In the public bath she has the opportunity to extend her personalnetwork beyond the women in her imme- diatesurroundings.The scars and tattoos on the nearlynaked bodies of the bathingwomentell details of their personalhistories without words.This creates an atmosphere of temporary intimacy that mayencourageawoman to pour out her heart to anywoman whohappens to sit next to her.Sharingpersonal problems with astranger whohas no access to her own social network has the additional advantage that she does not have to be afraidthat her confidentialities will leak out to her ‘close ones’ in the form of gossip that could have repercussions on her reputation. In this way, the weeklyvisit to the public bath serves as an ‘escape’ from the familyprivacy that envelopes women most of the other days in the week.” Marjo Buitelaar, “Public Baths as Private Places,” in Women and Islamization,ed. Karin Askand Marit Tjomsland (Oxford: Berg, 1998), 114. 252 7Heterodoxyand HealthcareAmong Women

Shielding Muslim women from heterodoxgynosocialcontexts

The argument thatmedieval Islamic jurists feared thatMuslim women would learn false beliefs through theircontacts with non-Muslimsisnot anew one.⁶⁹² However,itseems to go unnoticed thatthe anxiety expressed by some ‘ulamā’ about Muslim women meeting with non-Muslim women also extends to occasions whereMuslim women meet with each other,particularlyinthe context of life-cycle marking occasions.These occasionsincludeweddingfeasts, funerals and mourning ceremonies, and sickbed visits, as well as publicbathhouse attendance. There are numerous examples in ḥadīthsand juristic literature of these activities being considered as aset and stronglycondemned. Manyofthese condemnations are voiced in acurious way: it is not onlyMuslim women who engage in these activities against their husbands’ will who are disparaged, but rather men who permit their wivestoengageinthese activities are condemned as well. Forexample, a ḥadīth attributed to ‘Alī in the Shī‘ite legal compendium Daʻāʼim al-Islām by Qāḍī Nuʻmān(d. 363/974) quotes him as saying:

“He whocomplies with the wishes of his wife in four things,God will hurl him into the Fire.” He was asked, “What is this compliance, OCommander of the Faithful?”‘Alī said, “The demand to attend marriage feasts (‘urusāt), to join mourningsessions (niyāḥāt), to go visitingthe sick (‘iyādāt)and to visit bathhouses (ḥammāmāt).”⁶⁹³

Similar statements can be found in Sunnī religious guidance about women.⁶⁹⁴ IbnḤabīb’s(d. 238/853) Adab al-nisā’ attributes the following statement to the Prophet,inwhich the husband is blamed for not preventing his wife from engaging in these activities.

 Alexandra Cuffel writes about this issue in two of her articles: “PolemicizingWomen’s Bathing amongMedieval and EarlyModern Muslims and Christians,” citedabove, and “From PracticetoPolemic: Shared Saints and Festivals as ‘Women’sReligion’ in the Medieval Mediter- ranean,” BSOAS 68 (2005), 401–19.  Translation by Asaf A. A. Fyzee, Pillars of Islam (New York: OxfordUniversityPress, 2004), 2:201. Slightlymodified.  Cf. Birgivi (d. 981/1573) whowrites that awoman “should not be sent to be with non-relatives...nor to their houses or weddings, nor to the public bath, nor to visit the sick if they are not intimaterelatives.” M. Zilfi, Women and Slaveryinthe Late Ottoman Empire: TheDesign of Difference (New York: Cambridge University Press,2010), 56.See also Cuno, Modernizing Mar- riage: Family,Ideology,and Law in Nineteenth- and Early Twentieth-CenturyEgypt,91. Shielding Muslim women from heterodoxgynosocial contexts 253

[The Prophet Muḥammad] said: There arefour things for which, if he complies with his wife in them, God throwsaman intothe Fire: thin clothing, bathhouses,mourningsessions,and weddings.⁶⁹⁵

Ibnal-Jawzī’s(d. 597/1201) Aḥkāmal-nisā’ alsocondemns women for visiting the sick and attending funerals, claiming that even if her familydoes not recognize these as problematic, Satan certainlydoes.

ʻAbdallāh[b. Mas‘ūd] said: Women arenakedness,sokeepthem at home. When awoman goes out intothe street her familysaystoher, “Where areyou going?” She responds, “Iam visitingthe sick” and “Iamfollowingafuneral procession.” But Satan never lets up on her ...and awoman can never supplicatebeforeGod as well as she could by staying in her house and worshippingGod there.⁶⁹⁶

In the Ḥ anafī manualoflaw, al-Baḥral-rā’iq, IbnNujaym(d. 969/1561) differentiates between excursionsoutside the home that awife has aright to make regardless of her husband’swishes, excursions awife can make so long as she has her husband’spermission, and excursions she maynot make even if her husband does permit them and for which both are considered blameworthy.

[A Muslim wife] can go out to visit her parents and maḥārim,and it is right for her to go out to her parents every weekwith or without [her husband’s] permission, and to visit her maḥārim onceeach year with or without his permission. As for going out to visit familybe- yond this, she can do so with his permission ...Hemay permit her to go out to visit her parents and to paycondolence and sick calls to them, and to visit her maḥārim and to mourn them. As for other occasions,thereare seven circumstances under which aman is allowed to permit her to go out: [1] to visit her parents,[2] to paysick calls to them, and [3] to mourn them or either one of them; [4] to visit maḥārim,[5] if she is amidwife or [6] awasher or [7] has some other legitimatereasontogoout with or without his permission, and ḥajj is one of these. But excluding these, he should not permit her to visit outsiders,pay them sick calls,and attend wedding celebrations,and she should not go out.Ifhedoes permit it and she goes out,they both areatfault.She should also be preventedfromgoingtothe bathhouse.⁶⁹⁷

All of these statements about bathhouses, weddings,sick visits, and mourning observances suggest that these are activities to which ahusband or otherfamily membermight well have no objection.The activities do not appear to be neces-

 IbnḤabīb, Kitābadab al-nisā’, 295  Ibnal-Jawzī, Aḥ kāmal-nisā’, 54.  Zayn al-Dīnb.IbrāhīmIbn Nujaym al-Miṣrī (d. 970/1563), Baḥral-rā’iq sharḥ kanz al-daqā’iq (Quetta: al-Maktaba al-Mājidiyya, 1983), 3:195. 254 7Heterodoxyand HealthcareAmong Women sarilyassociated with femalelicentiousness. Ibnal-Jawzī indicates that when a women wantsapersuasive excuse to go out she says, “Iamvisiting the sick, I am following afuneral procession,” showing that not onlydomale familymembers tend to condone such behavior,but they view it as the best reason for a woman to be out of the house. Similarly,the threat of hellfire leveled against husbands who do not curb their wives’ participation in such excursions suggests that these are not activities that ahusband would necessarilyview as indecent or infringingupon his rights or interests. If they were, therewould be less of aneed to threaten husbands and disallow them from exercisingtheirown discretion on this matter, because their own self-interest would be enough. What then makes these activities objectionable, in the eyes of the jurists? Whywould husbands be depicted as not necessarilysharing the same concerns as the jurists,and whywould women engageinsuch activities anyway?Before offering my own answer to these questions, it is worth exploring two explanations that Ibelieveare insufficient in answeringthem. The first insufficient ex- planationisthat the condemnation of bathhouses, sick visits, mourning rites, and weddings has little to do with the activities themselvesbut rather has more to do with upholdinghusbands’ rights to keep their wivesathome wherethey are sexuallyaccessible. The second insufficientexplanation is that participation in the above-mentioned events is condemned onlybecause these events provide cover for mixed-gender interactions and lascivious behavior. Both of these explanations consider the condemned activities with afocus onlyonmen’saccesstowomen for the purposes of sex, male sexual jealousy, and the desire to control or regulate women’sbodies. In contrast to these explanations, Iwould arguethat juristic concern regardingthese activities are about women’saccess to their fellow women for the purposesofconversation, ortho- doxtheological “jealousy,” and the desire to control or regulate women’sintel- lectualexperiences. It is true that legal treatment of women’s khurūj,i.e.exits or excursionsfrom the home, in general is predicated on notions of husbands’ sexual rights.Among the contractualprerogativesand responsibilities between husband and wife in Islamic thought is the husband’sright to initiate sexual intercourse whenever he wishes (undermost circumstances)and for thatreason he has aright to control his wife’smobility outside the home, lest her excursions make her sexually unavailable.⁶⁹⁸ (She in turn has the right to demand he provide aproper home.) Thus, one important topic of legal discussions about women’sexcursionsisthe mediationbetween the opposing preferences of ahusband and awife when the

 Ali, “Marriage in Classical Islamic Jurisprudence,” 12. Shielding Muslim women from heterodoxgynosocial contexts 255 latter wishestoleave and the former wishes for her to remain. The juristsidentify which excursions awife has aright to insist upon despite his objections, and which excursions ahusband has aright to curtail if he so desires.For example, in the passagejust quoted from al-Baḥral-rā’iq,Ibn Nujaym writes thatawife has aright to see her parents at least once weekly, and her other relativesat least once every year,regardless of the preferences of her husband.Beyond that,ahusband can determine whether to allow the parents into his home and whether to permit or forbid more frequent contact,onthe grounds that he has both aright to determine who enters his homeand has the right to insist his wife remainathome whereshe will be available to him. In adjudicating such instances,the jurists consider the clash between the desires of the twoop- posite parties, the husband and the wife, with the husband most often empowered to make the choice about whether to retain or forgo his wife’spresence. However,aswehaveseen, with regardtocertain types of activities, i.e. bathhouse attendance, weddings,mourning rituals, and sick visits, the husband’s prerogativesare not at issue and he is condemned if he permits his wife to leave for such purposes. IbnNujaymdoes not sayexplicitly why ahusband is not permittedtoallow his wife to leave the house to participateinburials, go to bathhouses, etc. It is true that thereare manycustoms associated with these activities which the jurists condemn, such as inappropriatelyexcessive mourning rituals, the playing of musicalinstruments, and gender mixing.But,when husbands are instructed not to permit their wivestoattend weddingsand othersocial occasions,often there is no claim thatitisonlyparticular secondary circumstances which make it impermissible for women to attend such functions. Forexample, regarding funeral processions, the Andalusian Mālikī jurist, ‘Abdal-Malik ibn Ḥ abīb writes explicitly, “Women are not permitted to follow funerals even if thereare no wailers.”⁶⁹⁹ Asimilar statement from another of IbnḤabīb’swritings, Kitāb al-wāḍiḥamin al-sunan w’al-fiqh is quotedinthe 4th/10th-century ḥisba manual of IbnAbd al-Ra‘ūf, who depicts it as applicable law. “Womenare forbidden to assemble to mourn the dead, whether in secret or in public, even when the mourning is not accompanied at all by funereal songs.”⁷⁰⁰ By stating that even private (rather than public) mourning assemblies are forbidden for women, and even ones thatdonot involvesinging, the author makes explicit

 IbnḤabīb, Kitābadab al-nisā’, 238.  E. Lévi-Provençal, Trois Traités Hispaniques De Hisba:Texte Arabe (Cairo: Publications De L’institut Français D’archéologie Orientale Du Caire, 1955), 77.See. R. Arié, “Traduction annotée et commentéedes traitésdeḥisba d’Ibn ‘AbdAl-Ra’ūfetde‘Umar al-Garsīfī,” Hespéris Tamuda 1 (1960), 24. 256 7Heterodoxy and HealthcareAmong Women that his objectionstosuch activities are not based solelyonancillary concerns, such as the potential for women to make aspectacle of themselvesinpublic. Regarding the drawbacks of bathhouse attendance, the most obvious objection is to the ancillary nudity involved. But this does not fullyaccount for the negative attitude towardwomen’sbathhouse use. There is even aweak ḥadīth which claims that wereone to removenudityaltogether from the bathhouse experience, one could still not make it acceptable for women:

It is reported that ‘Ā’isha asked the MessengerofGod about the bathhouse and he said, “Farbeitfromme[to go to]bathhouses. And there is nothinggood in bathhousesfor women.” She said, “OMessengerofGod, they enter it wearing aloincloth.” He said, “No, not even if they were to enter it wearingaloincloth and asleeved shirt and a head-covering. Fornowoman removesher head-coveringanywhereother than her husband’shouse without removingthe curtain between herself and her God.”⁷⁰¹

Many ḥadīths, more commonlyaccepted as authentic by medieval scholars, permit men to use publicbaths, so long as they wear aloincloth, but still forbid women altogether from frequenting them.⁷⁰² Others ḥadīthsforbid women from attending bathhouses unless they are sick and need to enter for birth or post-partum purposes.⁷⁰³ The extensive record of authorities condemningthese activities is matched by an equallyextensive recordofwomen insistingonengaginginthem and finding them meaningful. Forexample, al-Wansharīsī’s al-Mi’yāral-Mu‘rib contains the following query addressed to a3rd/9th-century Cordoban jurist,depicting women’sdevotion to mourning rituals.

Yaḥyā⁷⁰⁴ was asked: What if aman dies, and his mother or his sister or his wife go out to the grave, and with them arewomen whoare their neighbors?What about awoman whose husband or child has died, and some of her relativesmakeahabit of visitinghis grave every Fridayorso? What if she weeps loudly, or the women join her in loud cries? Should they be forcedback and forbidden to go out?And if they areforbidden, but then go back to doingit, should [the men] beat them?...

 “This was reported by al-Ṭ abarānī in the al-Awsaṭ as one of ‘AbdAllāhb.Lahī‘a’sreports.” Al-Haytamī, Majma‘ al-Zawā’id,1:278. Cf. al-Ṭ abarānī (d.360/971), al-Mu‘jam al-awsaṭ (Cairo: Dār al-Ḥ aramayn, 1995) 3:321. It so happens that thereare several reports fromIbn Lahī‘awhich are especiallyrestrictive with regardtowomen, and al-Ṭ abarānī does not consider him to be fully trustworthy,  IbnMājah, Sunan, 33 (adab):94 =no. 3749.  IbnMājah, Sunan, 33 (adab):93 =no. 3748.  I.e. Yaḥyā b. Yaḥyā al-Laythī (d. 234/848). Shielding Muslim women from heterodoxgynosocial contexts 257

He said: Women should not go to gravestoseek mercy for their children or husbands at all.⁷⁰⁵

From the question, we can see thatthe women are assumed to be going to the cemetery for actual death rituals, rather than using the cemetery as apretext for amore frivolous outing.Wecan see also that this is awomen’scommunal activity.Ittakes place among female relativesand neighbors, and it does not seem to be avenue wheremen suspect sexuallycompromising behavior is likely to occur.Itisthe actual ritual content being performed by groups of women that concerns the men. Moreover,wesee thatthe men think thatthese rituals and communal outingsare so important to women, that theywill risk male wrath in order to engageinthem. The bathhouse was similarlyimportant for women. While for men it served as avenue for physical cleaning and routine physical maintenance – bathhouses retained male barber-surgeons, cuppers, phlebotomists, and masseurs for the use of their male patrons but not their female ones⁷⁰⁶ – for women they were also stronglyassociatedwith physical and spiritual cleansing from the impurities associated with menstruation, defloration, birth, and postpartumhealing and with the lifecycle events surrounding these changes. Modern ethnographies and the fragmentary evidence we have from medieval sources suggest that the bathhouse was alsothe site for pre-nuptial instruction, fertility rites, and gynecological treatment.Thiswas true for Christians and Jews, as well as Muslims. Muslim (as well as Christian⁷⁰⁷)religious figures decried women attending the bathhouse but felt the need to make an exception for women experiencing illness, pregnancyand post-partum recovery.Many ḥadīthstothis effect are quoted in IbnḤabīb’s Adab al-nisā’:

From ‘AbdAllāhb.‘Amr b. al-‘Āṣ regarding the MessengerofGod: He said, “Youwill con- quer the land of the foreigners and in it youwill find buildings called bathhouses.Men should not enterthem except with aloincloth, and prohibit your women from them except those whoare post-partumorwho are sick.” From Umm Kalthūmwho said, “Ivisited the bathhouse with ‘Ā’isha and said to her, ‘Didn’tyou used to despise the bathhouse?’ She said, ‘Iamsick, and it is permittedtoasick

 Al-Wansharīsī, al-Mi’yāral-Mu‘rib 6:419 – 20  J. Sourdel-Thomine, “Ḥammām,” in Encyclopaedia of Islam,2nd ed., ed. P. Bearman et al. (Leiden: Brill, 1960), 3:139–44.  A. Cuffel, “PolemicizingWomen’sBathingamongMedieval and EarlyModern Muslims and Christians, TheNatureand Function of Water,Baths,Bathing,and Hygiene from Antiquity through the Renaissance,ed. Cynthia Kosso and Anne Scott (Leiden: Brill, 2009), 174n.10. 258 7Heterodoxyand HealthcareAmong Women

woman.’ That was when she was sufferingfromskin disease, so Icoveredher in henna from head to toe.”⁷⁰⁸

Bathhouse attendance, henna applications, maritaland fertility rites and instruction,and midwifery went hand in hand. Brides usedtovisit the bathhouse twice, in preparation for marriageand immediatelyfollowing the consummation of marriage.⁷⁰⁹ The second visit immediatelypreceded “the night of henna.” Some late legal works mention in passing that on these occasions the bride would be accompanied by amidwife. Forexample, Ibn ‘Ābidīn(d. 1252/1836) writes:

It is understood amongthe people in our time that avirgin receivesextra things in addition to the mahr (dower). Amongthem arethings to be givenbeforeconsummation such as money for the naqsh⁷¹⁰ and the bathhouse,for agarment called the “lifāfatal-kitāb,” and for other garments which the husband givestoher and which the bride’sfamily givesthe midwife and the bathhouse attendant and other such women. Also among them arethings to be paid after consummation, likethe wrap and the slippers and the checkered cloth, and the bath clothes.These arecustomary and understood and fall in the category of customary law.⁷¹¹

Modern anthropological texts about bathhouse use among 20th-century Muslim communities in the Maghreb, Egypt,and Iraq describe how,evenwhen women visit the bathhouse without aprofessional midwife in attendance, they often have adesignated companion who is entrusted with performinghealing and prophylactic rites.⁷¹² They alsoshow thatthe bride’sattendant(s) who bathe and cover her with henna are the women who instruct her about consum- mating her marriage.⁷¹³

 IbnḤabīb, Kitābadab al-nisā’, 234–35.  Sourdel-Thomine, “Ḥammām.”  Literally: Inscribing(with black ink)usuallyappliedtothe skin but sometimestoeggsas well. The naqsh ceremonyiscurrentlymost commonlyassociated with wedding ritual in Moroc- co and Yemen. Ibn ‘Ābidīnlived primarilyinDamascus.  E.g., Ibn ‘Ābidīn, Ḥ āshiyat Radd al-Muḥtār,4:272.  R. Natvig, “Liminal Rites and Female Symbolism,” 64.For an Iraqi example see E. S. Drow- er, “Woman and Taboo in Iraq,” 106.  In one description of aweddinginGiza, Egypt in the 1920s, the author (a teacher in are- formatory school) translates the term balāna as village midwife. She describes how the bathhouse attendant/midwife on the wedding night “mocked [the bridegroom] loudlyfor not beingaman, seized his hand and, wrappingalarge pieceofstifflystarched butter-muslin roundhis first and second finger, draggedhim towards the bride ...the bridegroom then, with the assistanceofthe belana,proceeded to break the hymen with his two fingers.” E. E. Per- kins, “Marriage CeremonyinLower Egypt,” Man 32 (1932), 64.E.W.Lane describes the midwife Shielding Muslim women from heterodoxgynosocial contexts 259

The significant religious role and religio-medical role attached to the other women accompanying awoman to the bathhouse is also alluded to in medieval Jewishtexts.In12th-century Egypt,Maimonidesand nine of his Rabbanite colleagues publish an edict condemning “the majority” of Egyptian Jewish women for what the Rabbaniteauthorities consider to be aheretical Karaite practice:when the menstruating woman (niddah)goes to the ritual bath (mikveh)topurify herself, instead of submerging herself in the water by herself,she seeks purification from other women.

[M]ost of the women relyoncomplete heresy,amatter not spoken by God, and it is this: the niddah takesawoman whoisnot a niddah to sprinkle her with waterthat she supposes is pure; the niddah thinks that if she should sprinkle herself, she will not be purified and will not be permissibletoher husband. This activity is called by them [the women] “sprin- kling.”⁷¹⁴

In otherwords, women in an impure state go to the ritual bath with other women and insist the water purifies by virtueofbeing sprinkledbyareligiouslypure, fellow woman. That not onlyinvests women with religious importance but also means that women must go to the bathhouse even when theyare not impure, in order to provide this religious service for each other.Jewish sources from other communities also attest to women beingaccompanied to the mikveh regularlybymidwivesprior to pregnancysoastopromotefertility. Somemedi- eval Jewish texts describeitasamatter of course that midwivesaccompanyJew- ish women to ritual baths on amonthlybasis, although the evidence of this comes from European Jewish communities.⁷¹⁵

and bathhouse attendant as twoseparate individuals whoboth have paid roles in the marriage ceremony. The bathhouse attendant participates in the wedding night,see Lane, An Account of the Manners and Customs of the Modern Egyptians (New York: The American University of Cairo Press, 2003), 163and 171. In apassagewhich Lane wroteinLatinbut whichwas expurgated, he describes the same breaking-of-the-hymen ceremony, see Jason Thompson, “Small Latin and Less Greek:Expurgated PassagesfromEdwardWilliam Lane’s An Account of the Manners and Customs of the Modern Egyptians,” Quaderni di Studi Arabi 1(2006), 13.  Translation by Shaye Cohen. S. Cohen, “Purity,Piety,and Polemic: Medieval Rabbinic De- nunciationsof’Incorrect’ Purification Practices,” in R. Wasserfall, ed. Women and Water:Men- struation In JewishLife and Law.(Hanover,NH: University Press of New England [for] Brandeis University Press, 1999) 91.  Forexample, in Jewish communities in medieval Europe, “midwivesaccompanied women on their monthlyvisits to the ritual bath and were expected to help promotefertility.” E. Baum- garten, Mothersand Children:JewishFamily Life in Medieval Europe (Princeton:PrincetonUni- versity Press,2004), 31. A12th-century Ashkenazi Jewish text translatedbyBaumgarten assumes that universallywomen performtheir monthlyablutions accompanied by another woman whois 260 7Heterodoxyand HealthcareAmong Women

Bathhouses, cemeteries,sickbeds, and weddingswerethus sites of intellectual, religious activity for women. One of the most dramatic portrayals of Muslim women’shunger for these communal religious occasions can be found in Ibn Ḥabīb’s Adab al-nisā,inaremarkable dialogue imagined to have taken place between the Prophet Muḥammadand Asmā’ bint Yazīd, acompanion of the Proph- et famous for her initiative,piety,transmission of ḥadīth,and participation in battles.

The MessengerofGod was sittingwith acrowdofhis companions when he encountered a woman of the Anṣārnamed Asmā’.She greetedhim and then said, “OMessengerofGod, I am the messengerofthose who arebehind me – agroupofMuslim women – all of whom speak with my voice and are of my opinion! God sent youtoall people, to men and to women, and we trusted youand followed youand we believed whatwas revealed to you! Then God favoredyou – the community of men – over women, with manifold advantages, and bestowed upon youFridaycommunal prayerand the acts of congregating,visiting the sick, followingfuneral processions,the ḥajj,and ‘umra after the ḥajj. And He sin- gledyou out for greaterfavors than this – with frontier mobilization (ribāṭ)and jihād in the path of God. But what about us – the community of women?Weare confined and curtained off, the fosters of your offspring, the climax of your desire, and the foundations of your homes.Weraise your children for you. We weaveyour clothingfor you, and we let no one else but youintoyour beds.Istherenorewardfor us,OMessengerofGod?” The Prophet turned to his companions and said, “Have youeverheard anythinglike this woman’sspeech?’ They said, ‘No! By the One whosent youwith prophecy, OMessenger of God. We have not seen among women one with so far-reachingamind and such adeep question as this.” Then he facedher and said to her, “Owoman, go and be instructed and instruct the women of your quarter,and all those women, Anṣārand Muhājirīn, that youencounter, and all Muslim women: if one of youisagood spouse to her husband, and he is pleased with youfor one hour of the day, it is equal to jīhād and ribāṭ and ḥajj and ‘umra and fol- lowingafuneral and visiting the sick, and communal prayer – that is the meritorious deed of awoman.”⁷¹⁶

In this text,itismen who attain religious merit through communal prayer,pilgrimage, visiting the sick, burying the dead, and fighting together on behalf of Islam.Women are imagined to envy men not for their social power or dominance, but rather because they have religious duties which require congregation,

theretopromoteher fertility.The textsaysthat in atown wherewomen areparticularlyfertile, it is because the midwiveswho accompanythem to the ritual bath arebenevolent,whereas in a town where thereare few successful births,itisbecause the midwiveswho accompany women to the bath arenot enhancingfertility but rather spreading infertility through witchcraft. Ibid., 47.  Ibn Ḥabīb, Kitābadab al-nisā,264–5. Shielding Muslim women from heterodoxgynosocial contexts 261 and the activities they do in community with one another are religiouslyvalued. Such communal, religiously-valuable activities, in Ibn Ḥabīb’stelling,iswhat Muslim women want for themselves. That other male authorities toorecognize this desire among Muslim women, and recognize the fulfillment offered by the activitiesthey are trying to steer women away from, is also suggested by the fact that often their condemnations of these excursions are immediatelyfollowed in legal texts by asuggestion that husbands provide women with ameans of attaining religious learning from men. Consider the continuation of the above-quoted passageinal-Baḥral-rā’iq.

...heshould not permit her to visit outsiders,pay them sick calls,and attend wedding celebrations,and she should not go out.But if he does permit it and she goes out,they both areatfault.She should be prevented from going to the bathhouse. If she wishes to go out to attend alearningsession without her husband’sapproval, she cannot do so. If she [has alegal issue], and her husband asks the ‘ālim on her behalf and conveys [the information]toher,she is not allowed to go out; however if he is not in a position to go ask himself, she is allowed [to go ask the ‘ālim]evenwithout her husband’s approval. If she does not have anyparticular [legal] concern but she wants to go out to the learningcircle to learn about issues havingtodowith ablutions and prayer, if the husband can memorize the issues and recount them to her,hecan prevent her [from attending herself]. If he cannot memorize them, it preferable for him to allow her [toattend] sometimes; although if he does not allow it,thereisnothingtobedone and she is not permitted to go out so long as she has no particular [legal] concern.⁷¹⁷

Compare this passagetoaḥadīth in which ‘Ā’isha urgeswomen to refrain from going to the bathhouses in separate but complementary appeals to husbands and wives. She concludes with acommand to men: “Oyou men, whoever among youbelieves in God and the Last Daywill never send[his wife] to the bathhouse. Men are in charge of (qawwamūn ‘alā)women (Qur’ān4:34), so guard your women and do not bring blame upon yourself, and teach them the Qur’ānand command them to exalt God all daylong,and do not invite them to leave their houses.”⁷¹⁸ It seems from the formulation in this ḥadīth and in the Baḥral-rā’iq thatthe authorities in these texts are proposingthat wives, instead of attendingbath- houses, weddings, funerals, and sick beds, oughttolearn Islam from their husbands or,failing that, from the ‘ulamā’ themselves. In other words, they think that the two activities are both meansoffulfilling the sameneed,and one

 IbnNujaym, Baḥral-rā’iq sharḥ kanz al-daqā’iq, 3:195.Cf. Abū Yaḥ yā Zakariyyaal-Anṣ ārī (d 926/1520), Asnā’ al-maṭālib (Beirut: Dāral-Kutub al-‘Ilmiyya, 2001), 7:469–70.  IbnḤabīb, Kitābadab al-nisā’, 235. 262 7Heterodoxyand HealthcareAmong Women means is impious whereas the other is pious. The correlation between the two kinds of activitiesisrarelyexplained explicitly. Here the 8th/14th-century Cairene jurist Ibnal-Ḥ ājj is the welcome exception.

Ibn al-Ḥ ājj on women’snetworks of knowledge

Ibnal-Ḥ ājj famously⁷¹⁹ writes in his Madkhal, “Awoman should take [but] three excursions out in her lifetime: out to the house of her husband when she is given to him, out when her parents die, and out to her own grave.”⁷²⁰ However,inthe same book he writes, “If awoman has ahusband he is required to teach her,if she is ignorant of the law. If he does not,she should ask him to do so. If he does not do so, she should ask to leave [the house]toacquireknowledge.Ifhedoes not permit her to leave,she should do so without his permission.”⁷²¹ He explic- itlysaysthat “an ‘ālim must prevent his family[i.e. wives] from female socializing.”⁷²² Immediatelyfollowing this statement,however,hemakes an exception. He says that it is right for awoman who has been taught lawbyher husband to meet with groups of women who have no access to knowledge from men in their own household and to teach them Islamic lawwhich pertains to them. He writes that at such an assemblyone must be wary lest the gathering becomes aforum for

...any corrupt practices which women do when they gather together.Sincemost of their gatherings arenot without talk of those deplorable practices with which they have grown up and which have found aplaceintheir hearts as though they were religious rites... The practices which some of them hold to – which have become deeplyingrained in their hearts, and which have become so through women’stalk and throughtalk with those men whoindulge women (for anyone whowitnesses and is silent is like one whopartici- pates) – include the deplorable practiceofdesignating some of the days of the year and days of the week, such that every dayhas its particular activities which cannot be done on anyother day. They regardanyone whodisagrees with them [fem.] on this matter as por- tendingevil and they attributetohim ignorance (jahl)and lack of knowledge.⁷²³

Ibnal-Ḥ ājj claims that women’sgatheringsare sites for the promulgation of afemale religious culture, completewith “religious rites” and their own evaluations

 See Huda Lutfi, “Manners and Customs of Fourteenth-Century Cairene Women,” 99–121.  Ibnal-Ḥ ājj, al-Madkhal,1/2:177.  Ibid., 1/2:199.  Ibid., 1/2:198.  Ibid., 1/2:199–200. Shielding Muslim women from heterodoxgynosocial contexts 263

of knowledge and ignorance. In other places in the Madkhal,Ibn al-Ḥ ājj claims that women have their own parallel religious system. He refers to khilāf (differences of opinion) among women about how to calculate the duration of menstruation and how to purify oneself, and he claims that all their opinionsare contrary to the laws of the sharī‘a,which they would know if they learned from men instead of from each other.⁷²⁴ He says Muslim women have elaborate rules for observing the Sabbath (on Fridays,Saturdays, and Sundays) and annual holiday rituals to bring good luck for the following year.⁷²⁵ They alsohaveaslew of rituals surrounding childbirth. It is in the context of his description of midwifery and the culture surroundingchildbirth that Ibnal-Ḥ ājj makesthe remarkable observation that this impious femalereligion is the natural resultofgender segregation.

Men have moredirect contact with the ‘ulamā’ than womendo, for women are secluded (muḥ tajibāt)and as aresultthey generallygrowupinignorance(jahl). Because of their re- moteness fromknowledge and from knowledgeable people,they generallytake up many deplorable practices and rarely do they avoid that which the pure sharī‘a opposes.⁷²⁶

He spells out the problem: the ideal of ḥijāb isolates women from men, as it should. However men, in the form of the ‘ulamā’ and their students, are the transmitters of “pure” Islam,asare the books of the ‘ulamā’.⁷²⁷ As aresultof their isolation from both the society of men and from Islamic religious knowledge,women turn to the companyofother women and to the knowledge they have to offer.Thuswomen’s jahl (ignorance) is the direct consequence of ḥijāb. Ibnal-Ḥ ājj’ssolution for fixing this deplorable state of affairs is to discour- ageeach woman from the companyand religion of her fellow women, and to replace this with greater access to one man, i.e. her husband, and to her husband’scorrect religious culture. Ibnal-Ḥ ājj repeatedlydescribes women as engagingininnovation and syncretism but,rather than connectingittointrinsic intellectual and moral weakness on their part,⁷²⁸ he usuallyattributes it to lack of male interest in sharing ‘ilm (knowledge)with women and with conversing with them generally.

 Ibid., 1/2:154–5.  Ibid., 1/2:201–2.  Ibid., 3/4:220.  Ibid., 1/2:155.Cf. Katz, Women in the Mosque: AHistoryofLegal Thought and Social Practice, 5.  On the attributionofintellectual weakness to women, see KarenBauer, “‘Traditional’ Exe- gesis of Q4:34,” ComparativeIslamic Studies 2(2006), 129–142. Huda Lutfi, in apreviouslycited article, notesthat Ibnal-Ḥ ājj also mentionsthe infamous ḥadīth statingthat “women arelacking 264 7Heterodoxyand HealthcareAmong Women

It is disgusting in awould-be-‘ālim or an ‘ālim,whose wife is askedabout somethingreli- gious which women need, for her not to have knowledge of it,while he is supposed to be responsible for her.This is one of the most disgustingthings,and it is most contemptible when he is supposed to be an example to be followed.⁷²⁹ It is incumbent upon him to make agreat effort to teachhis family[i.e. wives] ...for women generallywill learn the laws which applytothem. So if they areignorant about somethingwhich is required of them, then that is due to the concealment of knowledge.⁷³⁰

He writeshumorouslythat if aman is so devoted to his ownacquisition of religious knowledge that he cannot make time to communicateknowledge to his wife, then the honestthing for him to do is to not interact with his wife in anyway whatsoever.

He devotes himself to learningand leavesnoroom for anythingelse – and good for him – so he busies himself with what is in front of him and does not become sidetracked.Itissaid about the qāḍ ī ‘Abdal-Wahhāb: when he came to Cairohegot married and livedwith his wife for years and then he died. Herfamilywanted to marry her off, and she said to them “marry me off as avirgin.” They said to her, “How?You livedfor years with him.” She said, “The first night he came to me and prayedtwo rak‘as and then sat and lookedinhis books and did not raise his head. And he did that for several days.Soone dayIgotupand got dressed and adorned myself and flirted beforehim. Then he raised his head, looked, smiled, and then took the pen which was in his hand and drew it across my face, and so destroyed my adornment.Then he bent his head down in his book and never againlifted it again until he went to join his Lord.” So anyone whohas such sublime determination, let him proceed in his footsteps. The ‘ulamā’ say, “One who seeks knowledge needs six things which he cannot do without,and if he lacks anyone of them his knowledge is commensuratelylacking. They are: eager determination, piercing intellect,patience, sustenance, aguidingshaykh, and long life.” So if he wishes to relax, how can he make the intention of doing so while exemplifyingthe sunna,as[the Prophet] said, “Relax your hearts from time to time?” He intended by this that one should introduce gaiety to one’sfamily[i.e. wives] by attendingtothem [fem. pl.] and talkingwith them [fem. pl]. It is incumbent upon

in intelligenceand religion.” Ibnal-Ḥ ājj invokesthe ḥadīth three times.Inthe first instance, he explains that although women arepermitted to wearsilk, men arenot.The reason for this is that women aredeficient and men are perfect,sowhat need have men to add to their own perfection. In the other twoinstances, he argues that men have allowed women to determine the laws per- tainingtothemselvesand have accepted women’sauthority with regardtolaw,eventhough women makeupthe laws themselvesrather than relyonthe norms expounded by the jurists. He reminds husbands that male religion is correct and female faux-religionisincorrect,sohus- bands should evangelize women. Ibn al-Ḥ ājj, al-Madkhal,1/2:107,174,and 3/4:312–3.  Ibid., 1/2:356.  Ibid., 1/2:358. Shielding Muslim women from heterodoxgynosocial contexts 265

him to be with his familyand his children as one of them and not abovethem. Imean by this that he should be friendlyand agreeable with them.⁷³¹

He then goes on to describe how Muḥ ammad socialized with and taught his wives. He emphasizes communication bothinthe sense of the Prophet and his familyenjoying each other’sconversation, and in the sense of the Prophet taking an interest in molding his wives’ beliefs and teachinghis wiveshow to go about their activities. The communication of learning from husband to wife is not necessarilyas pleasant as his descriptions of the Prophet’shousehold suggests. Elsewhere Ibnal-Ḥ ājj cites approvingly the example of his teacher’sattitude towardhis own wife.

IheardmymasterAbūMuḥ ammad say, “When Igot married Itold my wife: do not move and do not speak awordinmyabsence, rather set it aside until Icome back, for Iamre- sponsible for your behavior in its entirety.Iwas responsible for myself alone, but now Iam responsible for myself and for you, and so Imust fulfill ten prayers [i.e. the five dailypray- ers requiredoftwo people] and similarlyfor all of the obligations and so toofor every virtue which Iamaccountable for,” etc., such that he exaggerated to her saying, “if youmovethe jugfromone placetoanother,inform me of it.” He said, “[I did] that for fear that she would do somethingthinkingthat no religious lawapplied to it when in fact therewas one that did, and she continued to inform me about everythingshe did.”⁷³²

Ibnal-Ḥ ājj urgeshusbands to be extremelycontrolling over their wives’ domestic activities – awife should not even move ajar in her homewithout her husband’s input.But this control has apurpose beyond the mere displayofpower and sub- missiveness. Itspurpose is to create asituation whereawife asks her husband for religious instruction and he supplies it to her.This situation is the pious alternative to awoman seeking guidance from her fellow women, as Ibnal-Ḥ ājj indicatesinhis discussion of washing (ghusl).

He should instruct [hiswife] also about what happens if the [menstrual]blood persists and continues beyond its usual course and then stops. The laws of this arediscussed in the books of jurisprudence. Also, if it persists and does not stop, then she is a mustaḥāḍ a and he must instruct her regarding [i.e. warn her against] whatsome [women] do: when one of them stops menstruating,she goes out to the bathhouse and washesthere, not knowingthe laws of washingand what they require of her and instead she just cleans her bodyand nothingmore. Now,ifshe prays havingwashed in this manner,her prayers arenot correct. And it is not permitted for her husband to have intercourse with her if she

 Ibid., 1/2:358–59.  Ibid., 1/2:152. 266 7Heterodoxy and HealthcareAmong Women

does not,after menstruating, wash herself with a ghuslal-shar‘ī (religiouslycorrect washing), because thereisnointention (niyya)present in [her actions]. So it is obligatory for him to teach her the laws of this. If she does formulate the intention, her washingiscorrectand so prayer,intercourse, and everythingwhich was forbidden to her during her state of menstruation becomes lawful to her,irrespective of whetherthis was beforethe filthceasedor after,contrary to what some [women] do – in [thinking] that the washingconsists of going into the bath and cleaningoneself there,without an intention – due to their ignoranceof the laws in this regard. He should also instruct them regarding this innovation (bid‘a)which some women do in declaringthings unlawful, in that they believethat awoman is not purified until she puts her hand in her vagina and cleans inside it,and that if she does not do this she is not consideredtohavewashed ...and the cause of this is lack of learningand lack of understanding of the ḥadīthsofthe MessengerofGod.⁷³³

Ibnal-Ḥ ājj repeatedly, throughout the Madkhal encourages husbands to commu- nicate with theirwives, to become more involved in women’srituals, and to offer asubstitute for the advice of other women. He is so insistent that men involve themselvesand even direct traditionallyfemalespheres of activity that he tells husbands (and, to alesser extent,other responsible males if no husband is present) to involvethemselvesinmidwives’ traditionaldomains. He even goes so far as to instruct husbands to converse with midwives(who are presumablyunrelat- ed to them) so thatmidwivescan receive male, Islamic instruction:

It is incumbent upon the guardian [of the newborn], and certainlywithin his rights,toask the midwife how she receivesthe newborn. Forthe midwivesinour time arerarelycareful about avoidingimpurities, and the midwife comes in contact with the parturition blood and other impurities and then touches the newborn and his clothes – all without washingoff the impurities with purewater. This is not permitted, still some of the midwiveslet the newborn suck on their [the midwives’]fingers which have been in contact with impurities and claim that it is healthyfor this and that.But this is all utterlyfalse and contrary to the pure sunna ... But if the guardian were to ask about these things,such corrupt practiceswould be discontinued,then he could instruct her as to what precautions against impuritiesshe must take for her part and for the newborn’s. If she is alreadyknowledgeable about this, welland good. If she is not knowledgeable, then she will learn the laws of this as aresult of his questioningofher about them. Even so, most [midwives] have grown up practicing abominable customs which lead to the altogether forbidden practices previouslymentioned.⁷³⁴

In spite of his claim that midwiveswill welcome such instructionand adopt masculine, “Islamic” childbirth practices in place of their own customs,Ibn al-Ḥ ājj is

 Ibid., 1/2:155.  Ibid., 3/4:221. Shielding Muslim women from heterodoxgynosocial contexts 267 not impervious to other ways women mayviewsuch interference. He prefaces his demand that husbands involvethemselvesinevents leading up to and following childbirth with the warning: “Itisincumbent on the guardian of the newborn not to defer to [midwives], neither to their opinions nor to theirpractices, even if they become angry or disdainful, or his interference with them leadsto them quitting and goingaway.”⁷³⁵ Ibnal-Ḥ ajjcomes to the conclusion that husbands need to oversee and instruct midwivesbecause it is the logical endpoint to his claim that husbands should be the primary providers of knowledge and social context to their wives. He claims this role for husbands because the alternativestoitare for women to acquireinformationand culture either by violating the rules of gender segregation and interacting with non-kinsmen, which is abhorrent because of the sexual indecencyofsuch behavior,orbyturning to other women, which is abhorrent because these other women promulgatetheir own culturewhich he believes consists of athin veneer of misunderstood Islamic practiceswhich are undergirded by Christian /Jewish /pre-Islamic beliefs.⁷³⁶ The reason that women’scultureissoun-Islamic, he says,isthat women are kept from Islamic knowledge and ritual practice by virtue of the dictates of gender segregation (which he approves of whole-heartedly) and because of male Muslims’ neglect

 Ibid., 3/4: 220.  Forabrief overview of these practices,see the above-mentioned article by Huda Lutfi. In at least one passage, Ibnal-Ḥ ājj mayactuallybeconflating Muslim women with non-Muslim women. He writes, “He must not allow his wife to enter the bathhouse, sincenowadays it consists of corrupt religion and deplorable practices. Forour ‘ulamā’ disagreed regarding awoman with awoman: is it categorized likethe lawofaman with aman? Or like the law of aman with a non-kinswoman? Or like aman with a maḥram woman?But they (fem.) have dispensed with all of this and have violated general consensus by enteringbathhouses stark naked. Even if we grant that awoman may[choose to]concealwhatisbetween her naveland her knees,they (fem.) reproveher,sayingthingsthey must not,until she removes her covering. Then this is compounded with another forbidden thing, and that is aJewish or Christian woman, who is not permitted to see the bodyofafree Muslim woman. But in the bathhouse, Muslim, Christian, and Jewish women gettogether,exposed to each other’snakedness. So how can one allow his wife to enterit?” Ibnal-Ḥ ājj, al-Madkhal,1/2:352.What is remarkable about this passage is that he claims that some ‘ulamā’ argued that twoMuslim womenare allowed to see no more of each other than an unrelated man and woman. Iamnot surethat anyjurist formallyargues this with respect to Muslim women. Rather,some arguethis with respect to aMuslim woman beingviewed by anon-Muslimwoman. It is almost aconsensus amongthe jurists that the laws regarding viewingnakedness arefor “a(Muslim) woman with a(Muslim) woman” like “aman with aman.” See al-Mawsū‘aal-fiqhiyya,40:359–60. 268 7Heterodoxyand HealthcareAmong Women and lack of interestinthe intellectual livesoftheir womenfolk, for which he cas- tigatesthem repeatedly.⁷³⁷ When Ibnal-Ḥ ājj expresses an anxiety that women are turning to other women in times that are pregnant with religious significance, and so are placing their trust in Muslim women and learning from them rather than from the ‘ulamā’,are his views representative of other jurists?Wecannot know for certain, since other jurists do not explain their motivations so explicitly. However,Ibn al- Ḥ ājj’sformal legal recommendations, which are basedupon this anxiety,are indeed widespread in juristic literature. The Madkhal is typical in exhorting husbands to limit their wives’ participationinthe gatheringssurrounding birth, sickness, marriage, and death, even when men are not particularlybothered by their wives’ activities and even when women are quite insistent on engaginginsuch activities. The Madkhal is alsoinkeepingwith other traditions of encouraging men to provide theirwives with some sortofaccess to Islam as interpreted by the ‘ulamā’.

Heterodoxy and women’smedicine

In summary,there is astrain of medieval juristic thought thatseeks to regulate who Muslim women entrusttheir bodies to, who maybecounted among their intimates,and who maybepermitted to take on authority roles in moments of existential significance.This regulation is not aimed justatpreservingmodesty and avoiding sexual violation, as has sometimes been assumed. Rather,such regulationreflects concerns about intellectual influenceand susceptibility. These concerns parallel the jurists’ anxieties about male Muslim medicalpa- tients seeking healing.Aswesaw in the previous chapter,evenfor male Muslim patientstherewas aconcern thatthe pursuit of healthcould be religiously com- promising, since it meant entrustingoneself to potentiallynon-Islamic authori-

 In an article about atwentieth-century Palestinianbedouin tribe, Lila Abu-Lughod describes how the facts of male-femalesocial segregation in that particular tribe createasituation where there is an autonomous female society,whose conversations men arenot privy to,and which considers itself authoritative and responsible for bringingupyoungwomen and inculcat- ing them with culture and knowledge.When men involvethemselves, or women involvemen, in the women’sspherethey areresentedfor doing so. In this society,husbands mayhavelittle con- versation with their own wives. Abu-Lughod reports, “even when they arenot working, men and women rarely socialize together.Indeed, my host’ssenior wife confessed to me that beforeIhad cometolive with them and to spend time chattingwith my host in her room,she had never spent an entireeveninginhis company.” Abu-Lughod, “ACommunity of Secrets: The Separate World of Bedouin Women,” Signs 10 (1985), 640. Heterodoxy and women’smedicine 269 ties and epistemologies preciselywhen health concerns could make people fearful and thus intellectuallyvulnerable. The jurists were indeedconcernedabout women patients’ modesty with respect to male physicians,but they werealso concernedabout non-Muslim female medicalpractitioners, and even about Muslim female ones. Just as some jurists did not want Muslim men developing an intimacywith non-Muslimphysi- cians for fear that it would normalize relations with non-Muslims, subvert trust in God and in revelation, and lead to the patient ingesting forbidden substances and being lax in their religious obligations, so toothose samejurists did not want Muslim women developing an intimacy with non-Muslim women such that they consider them to be among “their” women, did not want them engaging in “innovation,” and did not want them ingesting forbidden substances and being lax about impurity.Inmyopinion, it is this concern that motivates the Shāfi‘ī jurists’ preferencetohaveboys provide medicalcare, even non-Muslim ones, rather than women: women are more likelytobeintimate with other women and thus susceptible to imbibing aworldview from them. Women in gynecological and obstetrical situations are less likelytoidentify with boys in this way. Hencethe objections to anon-Muslim midwife are not basedsolely on fears of sexual access and the dangers of male-female contact.Rather,they are also based on concerns regarding intellectual access and the dangers of female-female contact.The non-Muslim midwife is problematic because she communi- cates an un-Islamic cultureinamoment of spiritual significanceand intellectual vulnerability. This is not aproblem associatedstrictlywith non-Muslim practitioners. Some jurists are alsoconcernedabout the potential for Muslim women to have an “un-Islamic” influence upon each other,due to the gulf between Muslim women’scultureand the male, Islamic culture propagated by the jurists themselves. The jurists routinely, though with very little explanation, encouragehus- bands to restrict their wivesfrom interactingwith other women, bothMuslim and non-Muslim, in avariety of important venues for the communication of culture, communal knowledge,and healing rituals. Interestingly,inthe same contexts wherethey curtail wives’ accesstothe main forums for exchanges between women, the juristsencouragehusbands to talk to their wivesand to expose them to the Islamic culture promulgated by the ‘ulamā’,ideallybyteachingtheirwives their own knowledge or by relaying to them the ‘ulamā’sanswers to particular questions or discourses from the majālis al-‘ilm (learning circles) or,failing that,byallowing theirwives to ask questions and to attend the majālis al-‘ilm themselves. Ibnal-Ḥ ājj al-‘Abdarī,exceptionally, provides amotivation for such legal guidelines. He says thatdue to gender segregation and male lack of interest, 270 7Heterodoxyand HealthcareAmong Women

Muslim women have little access to male ‘ulamā’ and consequentlyhavelittle access to authentic Islam,and so they instead perpetuate ignorance and polytheism amongst themselves. Therefore, says Ibnal-Ḥ ājj, husbands are encouraged to limit the transmission of women’s(non-Islamic) cultureand to instead pro- mote an Islamic culture wherethe husband serves as the conduit for orthodox, male knowledge and instruction. Ibnal-Ḥ ājj then takesthis to the logical conclusion: since medicine ought to be Islamicized, and even Muslim women are per- petuators of non-Islamic culture, then husbands too should be involved in obstetrical care. Conclusion to Part III: ATafsīrabout the First Woman’sFertility andTheological Vulnerability

Treatingillnesswas,for the most part,deemed compatible with Islamic theological orthodoxy.But the desperation brought on by illness, the lack of consensus about how to understand illness, the frequent failureofmedical treatments, and the “faith” and power dynamics implied in the relationship between patient and practitioner invested sickness and healingwith theological repercussions which potentiallyskewed toward heterodoxy in one form or another.Women, who were physicallyseparated from the authorized interpreters of Islam,and who were deemed by some to be mentally deficient in religious matters,weredepicted as in even greater danger in this regard. Thejurists’ interpretation of the field of medicine, when augmented with concerns about the religious ignorance and heterodoxy of Muslim women, and coupled with concerns about the physi- callyintimate nature of medicalintervention, could put Muslim women seeking gynecological care in aparticularlyuncomfortable position. Moreover,for young women who weremothers and aspiring mothers, it might have been even more difficult to make adistinctionbetween medical and religious practice and authority,since medicalcare focusingonfertilityand menstruation wasinter- twined with women’ssocial roles and theirritual purity.Physical robustness, sickness, and death, i.e. “medicalissues” werelikelytohavebeen aconstant concern in their religious lives – in the form of menstruation, pregnancy, miscarriage, birth, stillbirth, breastfeeding and infant mortality. All of these themes are encapsulated in astory told about the first woman, Eve, and her involvement with the Devil, Iblīs. The story appears in manydiffer- ent iterations.⁷³⁸ The following are the versions recounted in al-Ṭ abarī’s(d. 310/ 923) history:

(1) According to ...Samurab.Jundab: None of Eve’schildren survived. Therefore, she vowed that if one of her children were to survive,she would call him ‘Abdal-Ḥ ārith [al-Ḥ ār- ith beingone of Satan’snames.] When achild of hers survived, she called him ‘Abdal-Ḥ ār- ith. That was due to Satan’sinspiration.

(2) According to ...Ibn ‘Abbās: Evewould give birth to Adam’schildren and make them worship God, callingthem ‘Abdallāh, ‘Ubaydallāh, and the like. But then they would

 These sourcesare referredtoinanarticle by D. A. Spellberg, although she interprets the implicationsofthe story differently. Spellberg, “Writingthe Unwritten Life of the Islamic Eve: Menstruation and the DemonizationofMotherhood,” International Journal of Middle Eastern Studies 28 (1996), 305–24.

die. Now Iblīscame to her and to Adam and said: Were youtogivethem other names,they would survive.So, when she gave birth to amale child for Adam, they called him ‘Abdal- Ḥ ārith. In this context, God revealed His word(Q. 7:190) from “It is He Who created youfrom asingle soul” until “the two set up for Him associates in connection with what He had giventhem” to the end of the verse.

(3) Accordingto...Sa‘īdb.Jubayr: When Evebecame heavy with her first pregnancy,Satan came to her beforeshe gave birth, and said: Eve, what is that in your womb?She said: Ido not know.Heasked: Wherewill it come out,fromyour nose, your eye, or your ear?She againreplied: Idonot know.Hesaid: Don’tyou think, if it comes out healthy, youshould obey me in whatever Icommand you? When she said: Yes, he said: Call him ‘Abdal-Ḥ ārith! Iblīs – MayGod curse him! – was called al-Ḥ ārith. She agreed. Afterwards, she said to Adam: Someone came to me in my sleep and told me such and such. Adam said: That is Satan. Bewareofhim, for he is our enemywho droveusout of Paradise. Then Iblīs – MayGod curse him! – came to her againand repeated what he had said before, and she agreed. When she gave birth to the child, God brought him out healthy. Yet, she called him ‘Abdal-Ḥ ārith. This is [meant by] God’sword: “They set up for Him associates in connection with what he had giventhem” to “And God is aboveyour associating [others with him].”

(4) When [Sa‘īdb.Jubayr] was asked whether Adam associated [others with God], he replied: God forbid that Ishould assume Adam did that! However,when Evewas heavy with child, Iblīscame and said to her:Wherewill this one come out,fromyour nose, your eye, or your mouth?Hethereby caused her to despair [because she did not know and was afraid of what was going to happen]. Then he said: Don’tyou think that,when it comes out perfectlyformed – Ibn Wakī‘ said that IbnFuḍ ayladded: without harming or killingyou – youshould obey me? When she agreed, he said: Call him ‘Abdal-Ḥ ārith, and she did. Jarīradded: So Adam’sassociating [others with God] was onlyinthe name.

(5) So she – meaningEve – gave birth to aboy.Iblīscame to her and said: Call (plural) him my servant (‘abdī)! If youdon’t, Ishall kill him. Adam said to him: Iobeyed you[once before], and youcaused me to be drivenout of Paradise. So he refused to obey him and called the child ‘Abdal-Raḥman “Servant of the MercifulOne.” Satan – MayGod curse him! – gained power over the boy and killed him. Evebore another child, and when she gave birth to it,Satan said: Call him my servant! If youdon’t, Ishall kill him. Adam said to him [again]: Iobeyed you[once before], and youcaused me to be drivenout of Paradise. So he refused to obey him and called the boy Ṣāliḥ,and Satan killed him. The third time around, Iblīssaid to Adam and Eve: If you(pl.) want to overcome me, call him ‘Abdal- Ḥ ārith. Iblīs’sname was al-Ḥ ārith. He was called Iblīswhen he was bedeviled (ublisa) – became confused. This [is meant by God’sword] where He says: “They set up for him associates in connection with what He had giventhem”–meaninginconnection with the names.”⁷³⁹

 Franz Rosenthal, Historyofal-Ṭabarī:General Introduction and From the Creation to the Flood (Albany: SUNY Press,1989), 320 –2. Arabic: al-Ṭ abarī, Tā rīkh al-rusul wa’l-mulūk (Leiden: Brill, 1879), 1:149 – 51. Conclusion to Part III 273

Eveisquite literallyhell-bent on producing aviable son. In versions (1), (2), and (5), her desperation stems from the fact that she has alreadyexperienced either pregnancyloss or infant death,⁷⁴⁰ despite the fact that (in versions 2and 5) she had shown her devotion to the trueGod by naming her children as His servants. In versions (3) and (4) her desperation stems from her fears, prior to her first birth, about how childbirth works.Any audience of the story would recognize the fear that the thing in her bodymight emerge from her facial orificesasex- tremelynaïve, although some might empathize with her ignorance about the physiology of birth and her inability to know what preciselyisinhabitingher body.⁷⁴¹ To amedieval audience,however,her fear that either her child or she herself might not survive the ordeal is perfectlysensible. In these respects, Eve’sconcern to ensure her own in health, the healthofher child, and her success in giving “birth to amale child for Adam,” is reflective of the concerns of medievalwives generally. In versions (2)and (5), Adam and Evefind thattheirchoice to name their child “the Servant of God,” i.e. to show their dedication to true religion, does not result in health – their children die anyway.Inresponse, either Eveor both parents call their child “the Servant of the Devil.” This proves to be an effective course of action, for their children are healthy. The texts are of two opinions as to whythis happened. In versions (1) and (2), the children dedicated to God die for no apparent reason. No foul playismentioned but God simply does not choose to keep them alive.SoEve shopsaround for another sourceofhealth and settles on invoking Satan. In version (3), the child dedicated to Satan sur- vivesdue to God’sefforts, not Satan’s, although Evegives credit to Satan. In version (4) too, Evegives credit to Satan, but it is unclear whether this is deservedor not.Inversion (5), the children dedicated to God are killed by Satan, while the one dedicated to Satan liveson. The children’sill-healthisthus not aresultof nature or Divine negligence, as Satan himself provides the disease. Adam and Eveare perfectlyaware thatSatan is the cause of their troubles,yet they choose to throw in their lotwith him because he is ultimatelymoreeffective than God is

 It is not clear fromal-Ṭ abarī’saccount when the death takes place. In IbnḤanbal’saccount, which he traces to Samura ibn Jundab, Satan seems to kill the fetus in utero. Aḥ mad ibn Ḥ anbal, Musnad (Cairo:n.p., 1895), 5:11.  In IbnSa‘d’sversion of the story,Satan appears in disguise to Eveduring one of her later pregnancies and tellsher that unlikeinher previous (successful pregnancies), this fetus is mis- formed likeananimal, and she panics. He says he will heal the fetus if the child is named for him. Ibn Sa‘d, Ṭabaqāt, 1:14.Amedieval audience, livinginaperiod when endogamyand malnutrition werecommon, mayhavebeen particularlyreceptive to Eve’sterror about her fetus’ birth-defects. 274 Conclusion to Part III when it comes to securing their child’shealth. Remarkably, in all versions of the anecdotethe decision to dedicate the child to Satan is depicted as aperfectlylog- ical and effective course of action,ifbirthing successfullyisthe ultimategoal.⁷⁴² In this story Satan is afigure who has the power to protect,who can understand thingswhich Eveisataloss to explain, who poses athreat which neces- sitates propitiation,and who offers aplausible alternative after afirst attempt proves to be ineffective. In these respects,Satan is similar to boththe “high” physicians and the “low” medical practitioners, and to their respective medical systems, as depicted by thosejurists who consider them athreat.The jurists warn that these medicalpractitionersand systems mayindeed be effective, and they mayindeed offer knowledge which Islam seemingly lacks. Thejurists also warn that sometimes malicious physicians in fact cause the illnesses which they purport to cure. And they recognize that Muslims turn to non-Islamic medicine because when people are sick they will turn to anyone and everyone. Even the Prophet,whenhewas sick, turned to both Muslims and non-Muslims for help. In the story of Eveand her quest for healthy children, turning to Satan to keep her child healthyisone and the same thing as dedicating her child to Satan. There is no ultimatedifferencebetween the realm of abdān (bodies) and the realm of dīn (religion), except that God is seemingly less effective in the formerthaninthe latter.Itisnot entirelyclear whether Eveisaware that the individual she ultimatelyentrustsher health to is Satan. In version (5), she definitelyisaware, but in versions (1), (2)and (4), Eveis“inspired” or instructed by someone whom she mayormay not recognize,tochangeher child’s name to ‘Abdal-Ḥ ārith, but it is not at all clear that Eveisaware that al-Ḥ ārith is Satan’sname.⁷⁴³ In version (3), Eveseems to be unaware until Adam explains that al-Ḥ ārith refers to the Devil. However,evenwith this information in hand she dedicates her son to al-Ḥ ārith thinking thatitwas he who caused her to give birth to ahealthychild. In this respect too, Eve’srelationship with Satan reflects the jurists’ concerns about patient-provider relations. Patients maynot realize thatwhat they are doing constitutes shirk,and even once they do realize it they maynolonger be concerned. In Eve’scase, in version (3), she is rendered especiallyvulnerable because she, unlike her husband Adam,does not have direct knowledge about Satan’sidentity and about who does and does not constitute “the enemy.” This too reflects the view held by jurists such as Ibnal-Ḥ ājj

 The one exception is IbnSa‘d’sversion in which ‘Abdal-Ḥ ārith dies.  In IbnSa‘d’sversion, it is explicitlystated that Satan cleverlyrefers to himself as al-Ḥ ārith so that Evewill not recognize him. Conclusion to Part III 275 that awoman, unlikeher husband, does not have direct knowledge about what constitutes correct religious practice and hence has trouble identifying its opposite. Denise Spellbergunderstandsthe abovestoryaspromoting “the demonization of motherhood.” This is aplausible interpretation but,ifso, the story does so in avery strangemanner. Whereas Eve’sother sin, the eating of the fruit of the forbidden tree and the “cutting” of the tree, is characterized as resulting from stupidity,appetite, or the desire to violate the divine order by acquiringimmor- tality,this sin is characterized as the resultofEve’sdesire to achievewhat is not onlypossible but also desirable for her as awife – she would liketoproduce children for her husband. The story thus does not demonize motherhood so much as it depicts the ferociousness of mothers’ dedicationtotheir own fertility. They will turn to God to produce children but,ifthat fails, they willturn else- wheretoo. Epilogue:Infertility andthe Study of Women’s History

To study barrenness is to studythe history of women’sstruggles in adistilled form.Infertilewomen encounteredthe same expectations, were subject to the same restrictions,lookedtothe same forms of support,and engagedinthe same religious practicesasdid fertilewomen; but theconstraints and opportunities that accompaniedwomanhoodhad repercussions that were potentiallymore weighty for them.Bystudyingthe factors which particularlyinformedthe livesof barrenwomen,wealsoilluminateimportant swathsofwomen’sexperiences moregenerally.The purpose of this book, therefore, has beentoestablish a framework for inquiryintomedieval barren women’sexperiences, onethatcan helporient us as we try to identifywhat was at stake for thesewomen,what pos- sibilitieswereavailable to them,and howwomen invested their energies. This book has examined three bodies of evidence which can informusabout the experience of femaleinfertility:Islamic legal discussions pertaining to women’sreproductive capacities,Arabo-Galenic medical texts, and religious works preachingabout medicalpractitionersand healing practices.These threefoci reflect the aspectsofwomen’sinfertility which had the most to do with men and, more specifically, the aspects of women’sinfertility which were most subjectto the influenceexerted by exclusively male institutions. The choice to attempt to understand women’sexperiences through such masculine lenses might have in- itiallystruck readersofthis studyasodd, even frustrating.This methodology, however,has its strengths. Among my primaryreasons for studying women’shistory in this wayismy desire to answer questions thatare important to my own 21st-century community without mischaracterizingwhat was important to the older communities Istudy. Ihaveattempted to produce an analysis which speaks to issues of patriarchy, the construction of gender,feminine ritual, and women’sempowerment,and to shed light on these concerns in away which respects and preserves the modes of thought, the genre expectations, and the authorial intent behind these medieval texts.Ofall the sources we have available, the books produced by the juristsand the physicians are best-suited to this task because these genres are better understood by historians thanare other written sources (for the moment at least), and because they exist in great abundance and have attracted agreat deal of schol- arlyattention. My hope is that by rootingmyexploration in these texts,the medieval people who are at the center of this endeavorwould recognize the individual topics of discussion in this book as familiar ones, though they might be

OpenAccess. ©2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative CommonsAttribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-016 Infertility and family law 277 surprised by the juxtaposition of those individual topics or the weight attributed to them. This studydeals in generalizations and possibilities. Ihope some students of women’shistory will find the generalizations useful for alerting them to phenomena they would have otherwise failed to notice and for helping them to make sense of their own explorations into the livesofindividuals and individual communities.Ihope still others will come forward with counter-examples to my arguments, and with modifications and improvementsupon my theories. The studyofwomen’ssocial history in the medieval Middle East is still at its early stages, and we have agreat deal of work to do to begin to do justicetothe experiences of those women.

Infertility and family law

Certain underappreciated aspects of marital lawand social practice had adispa- rate impact on barren women. Forexample, we have seen that first marriages for medievalwomen frequentlytook place at an agewhen women were likelyto have been developmentallysub-fecund. This has consequences for understanding infertility,but it also has consequences for understanding women’shistory more broadly. With regard to infertility,the implications of earlymarriages are, first,that women maywell have come to be viewed as infertile much earlier in their lifetimes than they would today, and consequentlywould have experienced the pressuretofind acure earlyon. Such cures could themselvesexacer- bate fertility problems or createones wherenone existed. Asecond implication of earlymarriageisthat,inthe worst circumstances,coitus could itself resultin damagetoagirl’sreproductive organs. Such situations are mentioned in Islamic legal manuals and some fatwā collections,though Isurmise thattheywererare. However,evenwhen earlymarriagedid not have these severe medical consequences,the phenomenon mayinformour understandingofcertain marriagedy- namics. If manywomen did not completethe pubertyprocess until they werein their early20s, then wivesintheir mid-teens likelyappeared to be physically more child-likethan they do today, and thus more likelytobeviewed as in need of protection, tutelage,and supervision. It is perhaps then no wonder that,for first marriages, brides weregiven little autonomy,⁷⁴⁴ and their preferences commanded relatively little respect; but,when they became matrons,moth-

 See K. Ali, Marriage and Slavery in Islam,33. 278 Epilogue: Infertility and the Study of Women’sHistory ers-in-law, widows, or divorcées, they seem to have acquired much more authority.⁷⁴⁵ With regard to Islamic law, infertility highlights medieval ambivalenceto- ward the institutions of divorceand polygamy. In some instances,divorce seems to have been viewed as running counter to the barren wife’sinterests, and this made the option of acceptingpolygamyasameans of avoiding divorce sometimespalatable. Sometimes infertile women who were subject to the threat of divorcewould attempt to shield themselvesfrom its effects by insisting that they wereinfactpregnant,orhad not menstruated, and thus they could continue to be attachedtotheirformer husband for an extended period of time. On the other hand,wealso hear of women attemptingtohasten divorceproceedingsso that they could find new husbands,and sometimes having trouble doing so because they were not menstruatingregularly. While menstrual irregularity and unusual claims of pregnancyhad special implications for infertile women, they also have much to teach us about women’s experiencesmore broadly. Uncertainty surroundingmenstruation and conception highlights the extent in which women had some degree of privacy and ability to choose how to present their bodies. We have seen that,inbiological matters which werelegallysignificant for marriageand divorce, women in arangeof societies seem to have been in aposition to conceal, reveal, or define their own status before society at large and before theirhusbands.Wehaveencountered newlywed husbands who seem to be surprised to find that theirwives are younger than expectedorare not menstruating regularly. We have seen husbands and wivesresortingtothe competingtestimonies of midwivestoestablish the wife’s level of maturation or pregnancystatus. We have seen wivesand midwives expe- dientlychanging their testimonyabout pregnancystatus.Women themselvestes- tify about whether or not they have menstruated or felt signs of pregnancy. They even testify as to whether the father of their fetus is alongdead husband rather than aliving one. This has implications for our understandingofhow women managed the intrusion of society at large into intimate matters that wereconsidered to be of public religious and legal concern, such as the preservation of clear-cut lines of paternity.The dependence upon women’stestimonysuggests that,despite the scrutinyand restrictions attached to women’sreproductive roles,inmanycommunities women did have opportunities for privacy. This

 Cf. Goitein, Mediterranean Society, 3:162–4. Foranilluminating anthropological discussion of how assessments of awoman’scompetencechange over the course of her lifetime within a rural Egyptian villagesee Morsey, Gender,Sickness, and Healing in Rural Egypt: Ethnography in Historical Context,52–4. Infertility and family law 279 means that women could sometimes not onlyfashion their own responses to external pressures on them,but could alsoexert apractical pressure of their own. We see this, for example, with the woman who claimedtobecarryingher long dead husband’schild, even when she remarried.⁷⁴⁶ Due to her testimony, her deceased husband’srelativesconsider her child to be one of their own kin. In this way, women weresometimes invested with acertain trust and acapacity for defining their ownpublic status. The studyofchildlessness also highlights conflictingattitudes towards women’sinheritance rights and, morefundamentally, toward their familial affiliation. Amarried woman waspart of two families, the one she was born into and the one she married into, and she transferred wealth between them.⁷⁴⁷ She re- ceivedwealth from her birth familyvia her dowry and through her inheritance. If she had children at the time of her death and she predeceased her other heirs, her father and her mother would inheritone sixth each, and the rest would be inheritedbyher husband and children. Thus, two thirds would be lost to the birth family. If she had no children, her birth familywould lose half, and that would include half of her trousseau, items which had sentimental as well as monetary value, and which would pass into the hands of the husband and his family. If, on the other hand, awoman was predeceased by her husband, then she would inherit from him an eighth of his wealth if he had achild, and aquarter of his wealth if they werechildless, thereby depriving the other heirs from his familyofit. In theory,such laws meant that married women always represented the removal of asignificant amount of wealth from one of their two families, but childless married women represented an often greater loss with fewer tangible benefits. We see that when married childless women predeceased their husbands, the women’sbirth families pursuedaggressive legal measures to prevent such losses. Meanwhile, childless widows wereatrisk of being disinheritedin favoroftheirhusbands’ blood relatives.⁷⁴⁸

 al-Wansharīsī, al-Mi‘yāral-Mu‘rib,4:54– 5.  By contrast,her husband belongedtothe familyinwhich he was born, and their son would be part of his father’sfamilytoo. This form of association is visible in avariety of settings,but it is most easilyseen in the Islamic inheritancelawspertainingtograndchildren. The son of ason belongedtohis father’sand paternal grandfather’slineage,and he could potentiallyinherit from his paternal grandfather and paternal uncles.But the son of adaughter did not belong to his maternal grandfather’slineage,and could not inherit from anyofhis maternal relatives other than from his mother herself.  E.g. The story of Khātūnand Dalīla in Alif Layla or Book of the Thousand Nights and One Night, W. H. Macnaghten (Calcutta, 1839), 3:418. 280 Epilogue: Infertility and the Study of Women’sHistory

Medieval gynecologyand itssignificance

Medieval Arabo-Galenic gynecologyhighlights the complicated relationship between scientific and religious understandingsofanatomyand reproduction. Some of the theories put forth in medicalbooks matched religious beliefs and correlated with legal and practical norms. Forexample, as Basim Musallam has shown, the two-seed understanding of conception was ascientific theory particularlyfavored by IbnSīnāand his physician-jurist successorssuch as IbnQayyim al-Jawziyya. It also matched up with aparticular ḥadīth ascribed to the Prophet Muḥammad, and correlated with alegal and practical willingness to make use of contraception.⁷⁴⁹ Similarly, the notion thatbreastmilk wasmade from menstrual blood accorded well with Islamic notions of kinship via breastmilk. Thisconcept was retainedevenasacompeting notionthat milk was a product of semen was alsowidelybelieved.⁷⁵⁰ Not all biological ideas that had religious importance wereechoed in Arabo- Galenic gynecological literature, however.And not all gynecological knowledge had an impact on religious thought.The concept of the “sleeping fetus” was not integratedinto Arabo-Galenic gynecology. Nor,for thatmatter,was religious interest in virginity. In the opposite direction, scientific tests of fertility werenever integratedinto Islamic legal thought. Similarly,medicaltheorization about genderdifferencesdid not necessarily mirror social attitudes towardsgender relations.Sherry SayedGadelrab,for example,published asubstantial article on medicaldepictions of the anatomical differences between the genders.⁷⁵¹ Gadelrab’sarticle takes up the question of whether the physicians of the medieval Islamic world viewed women’sanato- mies and hencequalities as essentiallydefective versions of men’sbodies and qualities, or whether (to borrowaslightlymore modernturn of phrase, which is not Gadelrab’s) “men are from Mars and women are from Venus,” i.e. two opposite species.⁷⁵² When analyzingIbn Sīnā’swork, she noted that in his Qānūn,a work focused on medicaltreatment,hedepicts male and female genitalia as

 A. Giladi, Infants, Parents and WetNurses: Medieval Islamic Views on Breastfeeding and Their Social Implications,60.  Ibid. 21,26, 80.  S. Gadelrab, “Discourses on Sex Differences in Medieval ScholarlyIslamic Thought,” Jour- nal of the HistoryofMedicine and Allied Sciences 66 (2011), 40 –81. Cf. A. Ragab, “One, Two, or ManySexes: Sex Differentiation in Medieval Islamicate Medical Thought” Journal of the History of Sexuality,24(2015), 428 – 454.  The question relates to the thesis articulated in Thomas Laqueur’s Making Sex:Body and Gender from the Greeks to Freud (Cambridge:HarvardUniversity Press, 1990). The quest forconception: women’saccesstomedical practitioners 281 near equivalents,which weretobetreated based on shared premises about bod- ilyhealth, from the point of view of the physician. However,inhis book on nature, the Kitābal-ḥayawān,Ibn Sīnā depicted masculine and feminine natureas “more divergent behaviorallyinhuman beingsthan in anyother animal,ashas been noticed by the natural philosophers.”⁷⁵³ Thus, IbnSīnācould holdthe view that men and women are completelydifferent and unequal (with women com- paring unfavorablytomen) and could identify that inequality as rooted in anatomyand physiology,while simultaneouslyarguingthat,anatomically, men’sand women’sreproductive organs werelargely equivalents.Inother words, even among people who held “chauvinistic” views of women, that chauvinism did not extend into every scientificarea involving gender, and even among people who held egalitarian views regarding menand women’sreproductive organs, that did not translate into asocial egalitarianism.

The quest forconception: women’saccess to medical practitioners

In areassessment of Ullmann’sclaim that there werenoopportunities for theo- reticallytrainedphysicians to applytheir gynecological knowledge duetogender segregation, this book has argued that the preponderance of the evidence available to us suggests otherwise.Medical works, ḥisba manuals, literaryanecdotes, and anti-bid‘a literature all indicate thattrained male practitionersdid treat women in avariety of medical situations, including intimate ones which involved direct observation of the patient,taking her pulse, bleeding and cupping her,discussingcontraceptivesand abortifacients, and operatinginthe areaof the groin. There is little reason to doubt that such interactions werecommon- place in manyparts of the Middle East.Asfor the propriety of medicalsituations which involvedviewing and touchingwomen’sgenitals and performing surgery on them, the textual evidence is more varied. Such interactions are described in medicalmanuals, sometimes with amidwife taking on an explicitly-defined role as intermediary and sometimes not.Midwivesseem to be particularlylikelytobe mentioned in situations which involved the practitioner introducing ahand or finger into the vagina. However,multiple sources suggest it was thought appropriate for men to engageinclitorectomies,⁷⁵⁴ even though in modern contextsthe

 Gadelrab, 26.citing IbnSīnā,Kitābal-ḥayawān.  Al-Zahrāwī, Albucasis on Surgeryand Instruments,457 and Ibnal-Ukhuwwa, TheMa‘ālim al-qurba fī aḥkāmal-ḥisba, 56. 282 Epilogue: Infertility and the Study of Women’sHistory practice is largely associated with femalepractitioners.⁷⁵⁵ Men are alsodescribed as workingcollegiallywith women practitioners in heroic interventions for obstructed labor and childbirth. Someofthe procedures described, however, werelikelytheoretical possibilities only, rather thanpractical ones. Thisiscer- tainlythe case with regardtocesarean sections, and probablywith regard to perinatal dismemberment,but in other cases the practicability of suggested treatments which involvemen in the birthing room is more ambiguous. Legal and moralistic writingsauthored by jurists provide adifferent perspective,one which complements the view we getfrom medicalwritings. Their policing of boundaries highlights the prevalence of the opposite phenomenon.

If someone weretosay: “But the ‘ulamā’ have permitted uncoveringnakedness beforea physician whether the patient is aman or awoman!” the response is that this is the case when thereisanecessity,and thereisnonecessity that calls for inviting an infidel when thereexists aMuslim physician.⁷⁵⁶

In this passage, it is clear that in 8th/14th-century Cairo thereisanexpectation that the male physician, regardless of religious affiliation, would view and touch his femalepatient in the course of providingmedicalattention. It is also clear that there are those in Ibnal-Ḥājj’saudience who commonlyassert that jurists have no objection to uncovering nakedness (though Ibnal-Ḥājj does not mentioned whether this includes genitals) before amedicalpractitioner regardlessofgenderorreligion. Against this backdrop, Ibnal-Ḥājj argues thatMuslim women should not be revealing themselveseventonon-Muslim women, let alone to non-Muslimmen. In response to those who raise the argument that the impropriety associated with nakedness does not pertain to medical situations, he argues that the impropriety is still there if awoman is exposed to anon-Muslim, male or female, when she has the opportunity to be seen by aMuslim practitioner. As we have seen, Ibnal- Ḥājj’slegal positions on this matter are not uniquetohim. There wasalong tradition,stemmingfrom certain ḥadīthsattributed to the time of ‘Umar’sconquest of Jerusalem, of forbidding Muslim women from exposing themselvestonon- Muslim women. When it came to the practical ranking of preferred medical practitioners, there is adebate among the jurists as to the relative distastefulness of exposing Muslim women to femalenon-Muslim medical practitionersasop- posed to male Muslim ones.

 Berkey, “Circumcision Circumscribed: Female Excision and Cultural Accommodation in the Medieval Near East,” 20.  Ibnal-Ḥ ājj, al-Madkhal,3/4:318. Infertility and choice 283

The objection to non-Muslim practitioners was not basedexclusively on concerns of sexual impropriety.(Theconcerns extended to male non-Muslim practitioners and their male patients, and even to nominallyMuslim practitioners who wereoverlyworshipful of the Greek medicaltradition and dismissive of the Pro- phetic pronouncements on medicine.) Rather,inaddition to the issue of sexual exposure, the objectionswerealso based on concerns about the intellectual and spiritual influencehealers have over their patients. This is not to suggest that there is aconcerted trend in fiqh itself to legislate restrictions on seeking treatment from those practicing Arabo-Galenic medicine.There is no such legal tradition.But there is ahistory of such sentiments being expressed in the adab literature produced by jurists,who seem to be casting themselvesinthe role of embattled scolds. The objections to subjecting oneself to the intellectual and spiritual influence of those who offer asystem of belief and asystem of authoritativeness outside of the orthodoxIslamic one, had particular implications for women. These implications are most clearlyarticulated by Ibnal-Ḥājj,but Ibnal-Ḥājj is certainly operating within along-standing strand of religious discourse. Ibnal-Ḥājj argues not onlythat non-Muslim women pose an intellectual threat to Muslim women and lead them astray (and through them also their husbands and families) by encouragingthe adoption of syncretistic practices, but also that Muslim women can pose this threat as well. This is not entirely the fault of Muslim women or aresult of their inborn spiritual deficiencies. Rather,Ibn al-Ḥājj argues, because Muslim women are secluded from most Muslim men, they do not have sufficientaccess to the teachers of orthodoxIslam (what he refers to as “the pure Law”)who are themselvesmen. The result,heclaims, is that there is areligious vacuum among women, avacuum which creates aspace for women to construct and perpetuate theirown religious ritual. This ritual cen- ters upon the life cycles and matters of menstruation, sex, birth, sickness, and death.

Infertility and choice

Thelegal, biological,scientific, andreligious concepts describedinthisbookcon- stitute gravitational poles whichexerted sometimes overtand sometimessubtle pressureonthe environments in whichinfertilewomen found themselves. These forcesdid notall exert pressure in the same direction. Forexample,the legalten- dency to definethe requisitesofmarriage as based on sexualrightsand responsi- bilitiesran afoul of thosesocialpressureswhich accorded agreaterroletothe reproductive elementofmarriage.The desirability of marryingfertilewomen 284 Epilogue: Infertility and the Study of Women’sHistory competed with the desirability of marryingvirgins,some of whom were tooyoung to be able to show signsoffertility. In thewakeofwidowhood or divorce, thepres- surestoensurelineage by monitoring women’smenstrual cycles were hampered by thebiologicalfactthatmenstrualcyclesare inexact proxies forreproductivestatus. Moreover,the tendency to seclude women from men, and women from societyat largeduringthe ‘idda period, made monitoringmenstrual cycles difficultorunfea- sible. Thepressure exertedbyIslamic lawtoinclude womenasheirs to family property competed with the roles women necessarily played as liaisons to other families. Thetendencytoconcentrate both scientificknowledge andreligiousau- thority in the hands of men, and to thereby make womendependent on menfor medicaland religious guidance, ranupagainst modesty restrictions, restrictions whichpulledwomen towardsturningtoother womenfor medicaland religious guidance,muchtothe chagrinofmaleauthorities. All this means that there was arangeofwaysinwhich abarren woman could experience infertility,and there was arangeofwaysinwhich people could choose to treat barren women, in both the medical and social senses of “treat.” However,manyofthose choiceswould have been fraught and unstable. Acouple or ahusband could choose to remain childless and monogamous, but in such asituation the inheritance system would create conflicts between the couple and theirin-laws, and possiblywith their own birth families. Awoman could choose to seek treatment for her barrennessatthe hands of either Galenic medicalpractitioners, or practitionersoffolk medicine,orofmagic, or through the intercessions of holypersons – but none of those options would necessarily come without condemnation on the grounds of either sexual impropriety or heterodoxy.Thisrangeofchoices,and the instability of those choices,takes on greater dramatic significance when we consider that infertility was often alife- long condition, the ramificationsofwhich changed as husbands and wivespro- gressed into middle and old age. Those choicesonce made could be revisited again and again over the course of manyyears. Thus, the experience of infertility was adynamic one, subjectboth to forces beyond anyone’scontrol and subject to the individual choices and maneuveringsofwomen, theirhusbands,their medicalpractitioners, and their extended families. Bibliography

PrimarySourcesand Translations

‘Abd al-Razzāqb.Hammām. Muṣannaf. 12 vols. Beirut: Dāral-Kutub al-ʻIlmiyya,2000. Abū DāwūdSulaymānIbn al-Ash‘ath. Sunan. Riyadh: Maktab al-Maʻārif lil-Nashr,1996. Aetius of Amida. The Gynaecologyand Obstetrics of the VI century,tr. James Ricci. Philadelphia: Blakiston, 1950. Alif Layla or Book of the Thousand Nights and One Night,ed. W. H. Macnaghten, 4vols. Calcutta, 1839. English Translation: RichardBurton. The Book of aThousand Nights and aNight, 10 vols. Benares: Kamashastra Society, 1885. al-Anṣārī,Zakarīyā ibn Muḥammad. Asnā al-maṭalib̄ fī sharḥ Rawḍ al-ṭalib.̄ 9vols. Beirut:Dār al-Kutub al-‘Ilmiyya, 2000. Arberry, A. J. The KoranInterpreted. London: Allen &Unwin, 1955. Aristotle. Generation of Animals. Tr.A.L. Peck. Cambridge: Loeb Series, HarvardUniversity Press, 1943. Aristotle. History of Animals VolVII-X. Tr.D.M.Balme. Cambridge: Loeb Series, Harvard UniversityPress, 1991. al-‘Aṭṭār, Abū’l-Munā al-Mūhīn. Minhājal-dukkānwa-dustūral-ayān. Beirut: Dāral-Manāhil, 1992. al-ʿAyntābī,Maḥmūdb.Aḥmad. al-Qawl al-sadīdfīikhtiyāral-imā’ wa’l-ābīd. Beirut: Mu’assasatal-Risāla, 1996. al-ʻAẓ īmābādī,Muḥ ammad Shams al-Ḥ aqq. ʻAwn al-maʻbuds̄ harḥ SunanAbīDawū d.̄ 2vols. Beirut: DārIbn Ḥazm, 2005. al-Baghdādī, ‘Abd al-Laṭīf. Kitābal-Ifāda wa’l-i‘tibār. London: Allenand Unwin, 1965. al-Baladī,Abūal-ʻAbbāsAḥmad ibn Muḥ ammad. Tadbīral-habạ l̄ ā wa’l-atfạ lwā ’l-sibyạ n.̄ Beirut: Dāral-Kutubal-‘Ilmiyya, 2004. al-Bayhaqī,Aḥmadb.al-Ḥusayn. al-Sunanal-kubrā. Beirut: Dāral-Kutub al-‘Ilmiyya, 2003. al-Bayhaqī,Aḥmadb.al-Ḥusayn. Manaqib̄ al-Shafī ʻī. 2vols. Cairo: Maktabat Dāral-Turāth, 1971. al-Biqā‘ī,Burhānal-DīnIbrāhīm. Izhạ rā l-ʻasrḷ i-asrarā hl al-ʻasṛ ,3vols. Riyadh: n.p., 1993. al-Buhūtī,Manṣūrb.Yūnus. Kashshāfal-qinā’. 6vols. Beirut: Dāral-Fikr,1982. al-Buhūtī,Manṣūrb.Yūnus. Sharḥ muntahā al-irādāt. 3vols. Beirut: Dār ‘ālam al-Kutub, 1993 al-Bukhārī,Muḥammadibn Ismāʿīl. Ṣahị̄ ḥ al-Bukhārī. Vaduz, Liechtenstein: Thesaurus IslamicusFoundation, 2000. al-Dardīr, Aḥmadibn Muhammad. Sharḥ al-kabīr ‘alā Mukhtasar Khalīl in Ḥāshiyat al-Dasūqī ‘alā al-Sharḥ al-kabīr. 4vols. Beirut: Dāral-Fikr,n.d. al-Dasūqī,Muḥammadibn Aḥmad. Ḥāshīyat al-Dasūqī ‘alā al-Sharḥ al-kabīr. 4vols. Beirut: Dāral-fikr,n.d. al-Dhahabī,Muḥammad b. Aḥmad. al-Tibḅ al-nabawī. Beirut:DārIḥyāal-‘Ulūm, 1990. al-Dīnawarī,AbūBakr. al-Mujālasa wa-jawāhir al-‘ilm. Frankfurt am Main: Veröffentlichungen des Institutes fürGeschichte der arabisch-islamischen Wissenschaften,1986. Dioscorides and T.A. Osbaldeston. Dioscorides De Materia Medica: aNew English Translation. Johannesburg: IBIDIS, 2000. Duran, Shimon b. Tsemah. Sefer ha-Tashbets. Lemberg:Uri Zeʼev Salat, 1891.

al-Fayyūmī,Aḥmad ibn Muḥammad. al-Miṣbāḥ al-munīrfīGharībal-Sharḥ al-kabīr. Beirut: Dāral-Kutubal-ʻIlmiyyah, 1978. Galen. De Usu Partium. Translated by Margaret TallmadgeMay. On the Usefulness of the Parts. 2vols. Ithaca: CornellUniversity Press,1968. Galen. On the Anatomyofthe Uterus. Translated by Charles MayoGoss. “On the Anatomy of the Uterus.” The Anatomical Record 144 (1962): 77–83. Galen. On Hippocrates’ On the NatureofMan. tr.W.J.Lewis and J.A.Beach. https://www.ucl. ac.uk/~ucgajpd/medicina%20antiqua/tr_GNatHom.html (accessed July 1, 2017.) al-Ghazālī,AbūḤāmid. Iḥyā ‘ulumā l-dīn. 5vols. Cairo: Mu’assasatal-Ḥ alabī,1967. al-Ghazālī,AbūḤāmid. al-Wasīt ̣ fī al-madhhab. 7vols. Cairo: Dāral-Salām, 1997. al-Hamadhānī, ‘Abd al-Jabbār. Tathbītdalā’il al-nubuwwa. Cairo: Dāral-Muṣ ṭafā,2006. al-Ḥarīrī and F. Steingass. The Assemblies of al-Ḥarīrī;Student’sedition of the Arabic text; with Englishnotes, grammatical, critical, and historical. London: Sampson Low,Marston &Co. 1897. al-Ḥaṣkafī,Muḥammad ibn ʻAlī. Durr al-mukhtār. In Hāshiyat Radd al-Muḥtār ‘alā al-Durral- mukhtār. 8vols. Cairo: Muṣṭafaal-Ḥalabī,1966. al-Ḥaṭṭāb, Muḥammadb.Muḥammad. Mawāhib al-jalīl. 6vols. Beirut: Dāral-Fikr,1992. al-Haythamī,Nūral-Dīn ʻAlī ibn Abī Bakr. Majma‘ al-zawā’id.10vols. Beirut:Dāral-Kutub al- ‘Ilmiyya, 2001. Hippocrates. De Morbis Mulierum. TranslatedbyAnn Ellis Hanson. “Hippocrates: ‘Diseases of Women 1.’” Signs 1(1975):567–584. Hippocrates. De Virginum Morbis. Translated by Ann Ellis Hanson and Rebecca Flemming. “Hippocrates’‘PeriPartheniôn’ (Diseases of YoungGirls): Text and Translation.” Early Science and Medicine 3(1998): 241–252. Hippocrates. Genuine Works of Hippocrates. Tr.Francis Adams. London: The Sydenham Society,1849. Hippocrates. Hippocrates Vol. X. Tr.Paul Potter.Cambridge, MA: Harvard UniversityPress, 2012. Ibn ‘Abd al-Ra’ūfand E. Lévi-Provençal. Trois Traités Hispaniques De Hisba: Texte Arabe. Cairo: Publications De L’institut FrançaisD’archéologie Orientale Du Caire, 1955. Ibn ‘Abd al-Ra’ūfand Rachel Arié. “Traduction annotée et commentéedes traités de ḥisba d’Ibn ‘Abd Al-Ra’ūfetde‘Umar al-Garsīfī.” Hespéris Tamuda 1(1960), 5–38. Ibn ʻAbdūnal-Tujibī and E. Le´vi-Provençal, Se´ville Musulmane Au De´but Du XIIe Sie`cle: Le Traite´ D’ibn Abdun Sur La VieUrbaine Et LesCorps De Me´tiers. Paris:G.P.Maisonneuve, 1947. Ibn ‘Ābidīn, MuḥammadAmīnb.ʻUmar. HāshiyatRadd al-Muḥtār ‘alā al-Durr al-mukhtār. 8 vols. Cairo: Muṣṭafa al-Ḥalabī,1966. 14 vols. Riyadh: ‘Ālam al-Kutub, 2003. Ibn Abī Shaybah, Abū Bakr ʻAbdallāhb.Muḥammad. Muṣannaf fī al-aḥādīth waʾl-āthār. Jedda: Dāral-Qiblah lil-Nashr waʾl-Tawzīʻ,2006. Ibn Abī Uṣaybīʻa, Aḥmadibn al-Qāsim, ʻUyūnal-anbāʼ fī ṭabaqātal-aṭibbāʼ. Beirut: Dār Maktabat al-Ḥayāt, 1965. Partial English translation availableonline: L. Kopf. Lives of the Physicians. http:// www.tertullian.org/fathers/ibn_abi_usaibia_03.htm Ibn Abī Zayd al-Qayrawānī,AbūMuḥammad ʻAbd Allāh. al-Nawādir wa’l-ziyādāt ʻalā mā fī al- mudawwanah min ghayrihā min al-ummahāt,ed. ʻAbd al-Fattāḥ Muḥammadal-Ḥulw.15 vols. Beirut: Dāral-Gharb al-Islāmī,1999. PrimarySources and Translations 287

Ibn al-ʻArabī,Muḥammad ibn ʻAbdallāh. Aḥkāmal-Qurʾān,2vols. Beirut:Dāral-Kutub al- ‘Ilmiyya, 1991. Ibn al-‘Aṭṭār, Muḥammad ibn Aḥmad. Kitābal-Wathāʼiq wa’l-sijillāt (Formulario notarial Hispano-Arabe), ed. Ch.Gendrónand F. Corriente. Madrid: Majma‘ al-Muwaththiqīnal- Majrīṭī,1983. Ibn Bābawayh, Muḥammadb.ʻAlī. Man lā yaḥḍuruhu al-faqīh. Mashhad: al-Majmaʻ,1988. Ibn al-Barrāj, ʻAbd al-ʻAzīzibn Niḥrīr. al-Muhadhdhab,2vols. Qom: Mūʼassasat al-Nashr al- Islāmī,1986. Ibn Bassām, Nihāya al-rutba fī ṭalab al-ḥisba. Beirut:Dāral-kutubal-ʻilmiyya, 2003. Ibn Bāz, ‘Abd al-‘Azīzetal. Fatāwā Islamiyya. Riyadh:Darussalam, 2001. Ibn Ezra, Abraham. Sefer Hanisyonot =The Book of Medical Experiences Attributed to Abraham Ibn Ezra: Medical Theory,Rational and Magical Therapy:AStudy In Medievalism,ed. J. Leibowitz and S. Marcus. Jerusalem: Magnes Press, 1984. Ibn Ḥabīb, ‘Abd al-Mālik. Kitābadab al-nisā’ al-mawsūmbi-kitābal-ghāya wa’l-nihāya. Paris: Dāral-Gharb al-Islāmī,1992. Ibn Ḥajaral-Haytamī,Aḥmad ibn Muḥammad. Tuḥfat al-muḥtājfīsharḥ al-minhājinḤawāshī al-Sharawānī wa-Ibn-Qasim̄ al-ʻAbbad̄ ī ʻalā tuhfaṭ al-muhtạ jb̄ i-sharḥ al-minhajl̄ i-Ibn Ḥajar al-Haytamī. 13 vols. Beirut: DārIḥyā’al-Turāth al-‘Arabī,1988. Ibn al-Ḥ ājj, Muḥammadb.Muḥammad. al-Madkhal. 4vols. Beirut: Dāral-Kutub al-‘Ilmiyya, 1995. Ibn Ḥanbal, Aḥmad. Musnad. 11 vols. Beirut: ‘Ālam al-Kutub, 1998 and Cairo: Dāral-Maʻārif, 1951. Ibn Ḥanbal, Aḥmad. Masā’il al-ImāmAḥmadbin Ḥanbal riwāyat Isḥaq ibn Ibrāhīmibn Hāni’ al-Nayṣābūrī.Beirut: al-Maktab al-Islāmī,1979. Ibn Ḥanbal, Aḥmad. Masaʼ̄ il al-ImamAh̄ maḍ ibn Ḥanbal wa-Ishạ qī bn Rahwayh.̄ 10 vols. Medina: ʻImādat al-Baḥ th al-ʻIlmī,2004. Ibn Ḥanbal, Aḥmad. Aḥkāmal-nisā’‘an al-imāmAbī‘AbdallāhAḥmad ibn Muḥammad ibn Ḥanbal, riwāya Abī Bakr al-Khilāl. Beirut: Muʼassasatal-Rayyānlil-Ṭ ibāʻawa’l-Nashr, 2002. Ibn Ḥazm, ‘Alī ibn Aḥmad. al-Muḥalla. 11 vols. Cairo: Idāratal-Ṭibā‘aal-Munīriyya, 1928 and Beirut: Maktab al-tijārī lil-tibā‘a, 1969. Ibn Ḥibbān, Muḥammad. al-Majrūḥīnmin al-muḥaddithīn. Aleppo: Dāral-Wa‘y, 1975. Ibn Isḥāq, Ḥunayn. Kitābal-mawlūdīn. Baghdad: Majma’ al-Lughaal-Siryāniyya, 1978. Ibn Isḥāqal-Jundī,Khalīl. Mukhtaṣar. Cairo: Dāral-Ḥadīth, 2005. Ibn al-Jawzī,Abūal-Faraj ʻAbd al-Raḥmānibn ʻAlī. Ahḳ āmal-nisā’. Kuwait: Maktabat DārIbn Qutayba, 1989. Ibn al-Jawzī,Abūal-Faraj ʻAbd al-Raḥmānibn ʻAlī. Zādal-masīrfī‘ilm al-tafsīr. 8vols. Beirut: Dāral-Fikr,1987. Ibn al-Jazzāral-Qayrawānī. Ṭibb al-fuqarā’ wa’l-masākīn. Tehran: Muʼassasah-ʼiMuṭālaʻāt-i Islāmī,Dānishgāh-i Tihrān, 1996. Ibn al-Jazzāral-Qayrawānī and Gerrit Bos. Ibn al-JazzāronSexual Diseasesand Their Treatment: acritical edition, English translation and introduction of Book 6ofZadā l- musafir̄ wa-qutā l-hạ d̄ ir.̣ London, KeganPaulInternational,1997. Ibn Jumay‘. al-Maqāla as-Saḷ āḣiyạ =Treatise to Saḷ āḥ ad-Dīnonthe revival of the art of medicine by Ibn Jumayʻ:edited and translated by HartmutFähndrich. Marburg: Kommissionsverlag F. Steiner,1983. 288 Bibliography

Ibn Kathīr, Ismāʻīlibn ʻUmar. Tafsīral-Qur’ānal-‘azị̄ m,8vols. Riyadh:DārṬayba lil-nashr wa’l-tawzī‘,1997. Ibn Kathīr, Ismāʻīlibn ʻUmar. Qiṣaṣ al-anbiyāʼ. Damascus: DārIbn Kathīr, 1992. Ibn Mājah,Muḥammadibn Yazīd. Sunan. 5vols. Riyadh: Maktab Maʻārif lil-Nashr,1996. Ibn Manṣūr, Sa‘īd. Sunan. 3vols. Bombay: Dāral-Salafiyya, 1982. Ibn Mufliḥ ,Muḥammad. al-Ādābal-shar‘iyya. 3vols. Beirut: Mu’assasatal-Risāla, 1996. Ibn al-Naqīband Noah Keller, The Relianceofthe Traveller: AClassic Manual of Islamic SacredLaw by Ahmadibn Naqib al-Misri. Chicago: Sunna Books, 1991. Ibn Nujaym, Zayn al-Dīnb.Ibrāhīm. Bahrạ l-rā’iq sharḥ kanz al-daqa’̄ iq.9vols. Quetta: al- Maktaba al-Mājidiyya, 1983. Ibn al-Quff,Abū al-Faraj ibn Yaʻqūb. Kitābal-ʻUmda fī al-jirāha.̣ 2vols. Hyderabad: Majlis Dāʼirat al-Maʻārif al-ʻUthmāniyya,1937. Ibn Qayyim al-Jawziyya, Muḥammad. al-Tibyānfīaqsāmal-Qur’ān. Cairo: n.p., 1933. Ibn Qayyim al-Jawziyya, Muḥammad. Zādal-maʻādfīhadykhayr al-ʻibād. 6vols. Beirut: Muʼassasatal-Risāla, 1998. Ibn Qayyim al-Jawziyya, Muḥammad. al-Tibḅ al-nabawī. Beirut: Dāral-Fikr =DārIḥyāal-Kutub al-‘Arabiyya, 1957.English translation: Medicine of the Prophet. tr.Penelope Johnstone. Cambridge: Islamic Texts Society,1998. Ibn al-Qiftī, ʻAlī ibn Yūsuf. Inbāhal-ruwāt ʿalā anbāhal-nuḥāt,ed. Muḥammad Ibrāhīm. Cairo: Dāral-Kutub al-Miṣriyya, 1950. Ibn Qudāma,Muwaffaqal-Dīn ʻAbd Allāhibn Aḥmad. al-Mughnī. 10 vols. Cairo: Maktabat al- Qāhira, 1968. Ibn Rushd, Muḥammad b. Aḥmad (al-jadd). al-Bayānwa’l-taḥṣīlwa’l-sharḥ wa’l-tawjīhwa’l- ta‘līlfīmasā’il al-mustakhraja,ed. Muḥammad Ḥajjī.20vols. Beirut:Dāral-Gharb al- Islamī,1984. Ibn Rushd, Muḥammad b. Aḥmad (al-jadd). Fatāwā Ibn Rushd. 3vols. Beirut: Dāral-Gharb al- Islāmī,1987. Ibn Rushd, Muḥammad b. Aḥmad (Averroes). Bidāyat al-mujtahid. 2vols. Cairo: Dāral-Salām, 1995. English translation: The Distinguished Jurist’sPrimer: ATranslation of Bidāyat Al- Mujtahid,tr. Imran AhsanKhanNyazee. 2vols. Reading: Garnet, 2000. Ibn Rushd, Muḥammad b. Aḥmad (Averroes). Kulliyātfīal-ṭibb. Morocco:Maʻhadal-Jinirāl Frankū,Lajnat al-Abḥ āth al-ʻArabīya al-Isbānīya, 1939. Ibn Sa‘d, Muḥammad. al-Ṭabaqātal-kubrā,8volsin4.Beirut: DārIḥyaʼ al-Turāth al-ʻArabī, 1996. Ibn Sahland Oliver Kahl. SābūrIbn Sahl’sDispensatory in the Recension of the ʿAḍudī Hospital. Leiden: Brill, 2009. Ibn Sīnā. al-Qānūnfīal-ṭibb.3vols. Būlāq: al-Maṭba‘aal-Āmira,1878. Ibn Sīnā. al-Shifā’. 4vols. Cairo: al-Hayʼaal-Miṣ rīya al-ʻĀ mmalil-Taʼlīf, 1970. Ibn al-Sunnī,Aḥmad b. Muḥammad. Kitāb ‘amal al-yawm wa’l-layla. Beirut: Mu’assasatal- Kutubal-Thaqāfiyya, 1988. Ibn Taymiyya, Taqī al-Dīn, Fatāwā al-nisā’. Cairo: Maktabat al-Qur’ān, 1987. Ibn Taymiyya, Taqī al-Dīn. Majmū‘ fatāwā. 37 vols. Medina: Majma‘ al-Malik Fahd li-Ṭibā‘at al- Muṣḥaf al-Sharīf, 2004. Ibn al-Ukhuwwaand R. Levy. The Ma‘ālim al-qurbafīaḥkāmal-ḥisba of Ḍiyā’ al-DīnM.b.M al-Qurashī al-Shafi‘ī known as ibn al-Ukhuwwa. London: CambridgeUniversity Press, 1938. Primary Sources and Translations 289

Ibn Ṭ ūlūn, Shams al-Dīn. al-Manhal al-rawī fī al-tibḅ al-nabawī. Hyderabad: Anwāral-Maʻārif, 1987. Ibn Zuhr, ʻAbd al-Malik ibn Abī al-ʻAlāʼ. Kitābal-taysīr. Rabat: Akādīmīyat al-Mamlakaal- Maghribiyya, 1991. Al-Jāḥiẓ. Kitābal-Bukhalā’. English translation: The Book of Misers,tr. R. B. Serjeant. London: Garnet &Ithaca Press, 2000. Al-Jazarī,Muḥammadb.Ibrāhīm. Ta’rīkh ḥawādith al-zamānwa-anbā’ihi wa-wafayaātal- akābir wa’l-a’yānmin abnā’ihi.3vols. Beirut: al-Maktaba al-‘Aṣriyya, 1998. Jones, Alan. The Qur’ān. Exeter: E. J. W. GibbMemorialTrust, 2007. al-Kāsānī,AbūBakr ibn Masʻūd. Badā’i‘ al-sanạ ʼ̄ iʻ.7vols. Beirut:Dāral-Kutubal-’Ilmiyya, 1986. al-Khaṭṭābī,AbūSulayman. Aʻlāmal-Ḥ adīth fī sharḥ Ṣ aḥ īḥ al-Bukhārī.Mecca: Jāmiʻat Umm al-Qurā,Maʻhadal-Buḥ ūth al-ʻIlmiyyah wa-Iḥ yāʼ al-Turā th al-Islāmī,Markaz Iḥ yāʼ al- Turā th al-Islāmī,1988. Lemay, H. R. Women’sSecrets: ATranslation of Pseudo-Albertus Magnus’s “De Secretis Mulierum” with Commentaries. Albany: StateUniversity of New York Press, 1992. Lyons, M. C. and J. N. Mattock. Kitābal-ajinna li-Buqrāṭ. Cambridge: Pembroke Arabic Texts, 1978. Maimonides, Moses. Teshuvotha-Rambam. 3vols. Jerusalem: Mikitse Nirdamim, 1957. al-Majlisī. Biḥāral-anwār. 44 vols. Beirut: Muʾassasatal-Wafā’,1983. al-Majūsī, ʻAlī ibn al-ʻAbbās. al-Kāmil al-ṣinā‘afīal-ṭibb,2vols. Cairo: al-Maṭbaʻah al-Kubrā al-ʻĀ mira,1877. Mālik b. Anas. al-Muwaṭṭa’,ed. ʻAbd al-MajīdTurkī.Beirut: Dāral-Gharb al-Islāmī,1999. Mannā, Ḥasan Murad. Fatāwā wa-tawjīhāt. Cairo: Dāral-Ṣafwa, 1990. al-Marghīnānī,Maḥ mūdibn Aḥ mad. Muhị̄ t ̣ al-burhan̄ ī fī al-fiqh al-Nuʻman̄ ī. 9vols. Beirut: DārIḥyā ʼ al-Turā th al-ʻArabī,2003. al-Marwarrūdhī,Ḥusayn ibn Muḥ ammadibn Aḥ mad. Fatawā ̄ al-qad̄ ị̄ Ḥusayn ibn Muhammaḍ al-Marwarrudh̄ ī. Amman: Dāral-Fatḥ ,2010. al-Māwardī. Kitābal-ḥāwī al-kabīr. 19 vols. Beirut:Dar al-Kutub al-‘Ilmiyya, 1999. al-Mawṣ ilī, ‘Abdallāhb.Maḥ mūd. al-Ikhtiyārli-taʻlīlal-Mukhtār. 5vols. Beirut: Dāral-Risāla al-ʻĀ lamiyya, 2009. Muslim ibn al-Ḥajjāj. Ṣahị̄ ḥ Muslim. 5vols. Beirut: DārIḥyāʼ al-Turā th al-ʻArabī,1955. al-Nafrāwī,Aḥmad b. Ghunaym. al-Fawakih̄ al-dawan̄ ī. 2vols. Cairo: Muṣ ṭafā al-Bābī al- Ḥalabī,1955. al-Najafī,Muḥammad Ḥasan ibn Bāqir. Jawāhir al-kalāmfīsharḥ Sharāʾiʻ al-Islam̄ ,15vols. Beirut: Muʾassasat al-Murtaḍā al-ʻĀlamiyya, 1992. al-Nasā’ī,Aḥmad ibn Shuʻayb. Sunan. Riyadh:Maktab al-Maʻārif lil-Nashr,1996. Naṣār, ‘Allām. “Fatwā – January19, 1952.” In Fatāwā dāral-iftā’ al-miṣriyya. Cairo: Wizārat al-Awqāf, 1980. al-Nawawī,Muḥyīal-Dīn. Minhājal-ṭālibīn. Beirut: Dāral-Minhāj, 2005. English translation: Minhaj et Talibin: AManual of Muhammadan Lawaccording to the School of Shafii,tr. E. C. Howard. London: W. Thacker &Co., 1914. al-Nawawī,Muḥyīal-Dīn. Rawḍat al-ṭālibīnwa-‘umdat al-muftīyīn. 8vols. Beirut: al-Maktab al-Islāmī,1991. Nuʻmānibn Muḥammad and A. A. Fyzee. Pillars of Islam,2vols. New York: Oxford University Press, 2004 290 Bibliography

al-Nuwayrī,Shihābal-DīnAḥmadibn ʻAbd al-Wahhāb. Nihāyat al-arab fī funūnal-adab. Beirut: Dāral-kutubal-‘ilmiyya, 2004. Niẓām. al-Fatāwa al-hindiyya,6vols. Būlāq: al-Maṭba‘aal-Kubrā al-Amīriyya, 1892. Paul of Aeginaand Francis Adams. The Seven Books of Paulus Ægineta. 3vols. London: SydenhamSociety, 1844. al-Qalyūbī,Shihābal-DīnAḥmad ibn Aḥmad. Qalyūbī wa-ʻUmayrah: hāshiyatā al-imāmayn al- muḥaqqiqayn al-mudaqqiqayn al-ShaykhShihābal-Dīnal-Qalyūbī wa’l-Shaykh ʻUmayrah ʻalá Sharḥ Jalālal-Dīnal-Maḥallī ʻalá Minhājal-ṭālibīnlil-ShaykhMuḥyīal-Dīn al-Nawawī fī fiqh madhhab al-Imāmal-Shāfiʻī. 4vols. Cairo: DārIḥyāʼal-Kutubal- ʻArabiyyah,1960. al-Qarāfī,Shihābal-DīnAḥmadb.Idrīs. al-Dhakhīrah. 15 vols. Beirut: Dāral-Gharb al-Islāmī, 1994. al-Qazwīnī,Zakarīyā ibn Muḥ ammad. ʻAjaʼ̄ ib al-makhluqā tw̄ a-al-hayawạ nā tw̄ a-gharaʼ̄ ib al- mawjudā t.̄ Beirut: Muʼassasatal-Aʻlamī lil-Maṭbūʻāt, 2000. al-Qummī, ʻAlī ibn Ibrāhīm. Tafsīral-Qummī. 3vols. Qum:Muʼassasatal-Imāmal-Mahdī, 2014. al-Qurṭubī, ‘Arībibn Sa‘īd. Kitābkhalq al-janīnwa-tadbīral-ḥabālā wa’l-mawlūdīn=La livre de la génération du foetus et le traitementdes femmesenceintes et des nouveau-nés. Algiers: Librairie Ferraris, 1956. al-Rāzī,Muḥammad ibn Zakarīyā. al-Ḥāwī fī al-ṭibb. Beirut: Dar al-kutub al-‘ilmiyya, 2000. al-Rāzī,Muḥammad ibn Zakarīyā. KitābShukūk ‘alā Jālīnūs. Tehran: Muʾassasah-ʾiMuṭālaʻāt-i Islāmī,Dānishgāh-i Tihrān, 1993. al-Rāzī,Muḥammad ibn Zakarīyā. Kitābal-tajārib: maʻadirasā fī manhaj al-bahtḥ al-ʻilmī ʻinda al-Raz̄ ī. Alexandria: Dāral-Wafāʼ li-Dunyā al-Ṭ ibāʻawa’l-Nashr,2006. al-Rāzī,Muḥammad ibn Zakarīyā. al-Mansụ̄ rī fī al-tibb.̣ Kuwait: Maʻhad al-makhṭūṭātal- ʻarabīya, 1987. al-Rāzī, ʻAbd al-Raḥmānibn Abī Ḥātim. Tafsīral-Qur’ānal-‘aẓim li-ibn abī Ḥātim. 8vols. Mecca: Maktabat NizārMuṣṭafā al-Bāz, 1997. al-Saffārīnī,Muḥammad b. Aḥmad b. Sālim. Ghidhaʼ̄ al-albabl̄ i-sharḥ Manzụ mat̄ al-adā b.̄ 2 vols. Beirut: Dāral-Kutubal-‘Ilmiyya, 1996. Ṣā‘id ibn al-Ḥ asan. At-Tašwīqaṭ-ṭibbī des Ṣā‘id ibn al-Ḥasan,ed. Otto Spies. Bonn: Selbstverlag des Orientalischen Seminarsder Universitat Bonn, 1968. al-Sarakhsī,Muḥammadibn Aḥmad. al-Mabsūṭ. 30 vols. Beirut:Dāral-Kutub al-‘Ilmiyya, 1993. al-Shāfi‘ī,Muḥammadibn Idrīs. Kitābal-umm.8vols. (Beirut: Dāral-Ma‘rifa, 1990). al-Shayzarī, ʻAbd al-Raḥ mānibn Naṣ r. Kitābnihāyat al-rutbafiṭalab al-ḥisba lil-Shayzarī. Cairo: Lajnat al-ta’līfwa’l-tarjamawa’l-nashr,1946. al-Shirbīnī,Muḥ ammadb.Aḥmad. Mughnī al-muhtạ jil̄ āma‘rifat maʻan̄ ī alfaz̄ ̣ al-Minhaj.̄ 6 vols. Cairo: Maṭbaʻat Muṣ ṭafā al-Bābī al-Ḥ alabī,1958. al-Shirwānī, ʻAbd al-Ḥamīd. Ḥawāshī tuḥfat al-muhtājbīsharḥ al-Minhāj. 10 vols. Cairo: Maktaba al-tijāriyyaal-kubra bi-Miṣr, 1938 and Beirut: Dāral-Kutubal-‘Ilmiyya, 1996. LasSiete Partidas,tr. Samuel ParsonsScott. Chicago: The ComparativeLaw Bureau of The American BarAssociation, 1931. Soranus, and Oswei Temkin. Soranus’sGynecology. Baltimore: Johns Hopkins University Press, 1956. SecondaryScholarship 291

Stephanus, and Leendert Gerrit Westerink. CommentaryOnHippocrates’ Aphorisms.Berlin: Akademie-Verlag, 1985. al-Suyūṭī,Jalālal-Dīn. Kitābal-Raḥma fī al-ṭibb wa’l-ḥikma. Beirut: Dāral-Arqam, 2011. al-Suyūṭī,Muṣṭafā ibn Saʿd. Maṭālib ūlī al-nuhā fī sharḥ ghāyat al-muntahā, 6vols. Damascus: al-Maktab al-Islāmī,1961. al-Ṭabarānī,Aḥmad. al-Mu‘jam al-kabīr. 25 vols. Cairo: Maktabat Ibn Taymiyya, 1983. al-Ṭabarānī,Aḥmad. al-Mu‘jam al-awsat.̣ 10 vols. Cairo: Dāral-Ḥ aramayn,1995. al-Ṭabarī,AbūJa‘far. Tar̄ īkh al-rusul wa’l-muluk.̄ Leiden: Brill, 1879. English translation: Franz Rosenthal. History of al-Tabaṛ ī:General Introduction and From the Creation to the Flood. Albany: SUNY Press, 1989. al-Ṭabarī, ‘Alī ibn SahlRabbān. Firdaws al-ḥikma fī al-ṭibb. Berlin: Maṭbaʿat Āftāb, 1928. al-Ṭahāwī,Aḥmadb.Muḥammad. Sharḥ ma‘ānī al-āthār. 4vols. Beirut: ʻĀlam al-Kutub, 1994. al-Tīfāshī,Aḥmad ibn Yū suf. al-Shifā fī al-tibḅ al-musnad ʻan al-sayyid al-Musṭ af̣ ā. Beirut:Dār al-Maʻrifa, 1988. al-Tirmidhī,Muḥammadb.ʿĪsā.Ṣaḥīḥal-Tīrmidhī. 13 vols. Cairo: Maṭbaʿah al-Miṣriyyabiʾl- Azhar,1934. al-Ū shī,Sirājal-DīnAbū Muḥ ammad ʻAlī ibn ʻUthmān, al-Fatawā ’̄ al-Sirajiyya.̄ Lenasia, South Africa:Dāral-ʻulūmZakariyyā,2011. al-Wansharīsī,Aḥmad ibn Yaḥyā. al-Miʻyāral-muʻrib wa’l-jāmiʻ al-mughrib ʻan fatāwā ahl Ifrīqiya waʾl-Andalus waʾl-Maghrib. 13 vols. Rabat: Wizāratal-Awqāfwaʾl-Shu’ūnal- Islāmiyya lil-Mamlakaal-Maghribiyya, 1981. al-Zahrāwī,Abū al-Qāsim Khalafibn ʻAbbāsand M.S. Spinkand G. L. Lewis,Albucasis on Surgery and Instruments:ADefinitive Edition of the Arabic Text with English Translation and Commentary. Berkeley: University of California Press,1973. al-Zurqāni, Muḥ ammad ibn ʻAbd al-Bāqī. Sharḥ al-Zurqānī ʻalá Mukhtaṣar Sayyidī Khalīl. Beirut: Dāral-Kutubal-ʻIlmiyya, 2002.

SecondaryScholarship

Abasiattai, A. M. et al. “Vaginal Injuries During Coitus in Calabar: A10-year Review.” Nigerian Postgraduate Medical Journal 12.2 (2005): 140–4. Abramson, Shraga. “On the Takkanah of Tuletula (Toledo) Regarding the Husband’s Inheritance of his Wife’sEstate.” Zion 60 (1995): 201–224. Abu-Lughod, Lila. “ACommunity of Secrets: The SeparateWorld of Bedouin Women.” Signs 10 (1985): 637–659. Abu-Lughod, Lila. “Feminist Longings and Postcolonial Conditions.” In Remaking Women, Feminismand Modernity in the MiddleEast,ed. L. Abu-Lughod, 3–32. Princeton: PrincetonUniversity Press,1988. Agrimi, Jole and ChiaraCrisciani, “Savoir médical et anthropologie religieuse: Les représentations et les fonctions de la vetula (XIIIe-XVesiècle).” Annales 48 (1993), 1281–308. Ali, Kecia. Marriage and Slavery in EarlyIslam. Cambridge: Harvard UniversityPress, 2010. Ali, Kecia. “MarriageinClassical Islamic Jurisprudence: ASurvey of Doctrines.” In The Islamic Marriage Contract,ed. FrankVogel and AsifaQuraishi, 23–25. Cambridge: Harvard UniversityPress, 2008. 292 Bibliography

Ali, Kecia. Sexual Ethics &Islam. Oxford:Oneworld Publications, 2006. Alsammani, Mohamed Al-Khatim. “ImperforateHymen Complicatedwith Genital Mutilation: A Case Report,” Journal of Clinical Case Reports 2(2012): 107. Alshech, Eli. “Notions of Privacy in Classical Sunnī Islamic Thought.” Ph.D.Dissertation: PrincetonUniversity,2004. Alshech, Eli. “Out of Sight and Therefore Out of Mind: Early Sunnī Islamic Modesty Regulations and the Creation of Spheres of Privacy.” Journal of Near Eastern Studies 66 (2007): 267–90. ʻAmmār, Ḥ ā mid. Growing up in an Egyptian village; Silwa, ProvinceofAswan. New York, OctagonBooks, 1966. Amster,Ellen. Medicine and the Saints. Austin: University of TexasPress, 2013. Amundsen, Darrel W. and CarolJeanDiers. “The Age of MenopauseinMedieval Europe.” Human Biology 45 (1973): 605–612. Anonymous, “Some Facts and Figures About Women’sSituation In Pakistan,” Manushi 12 (1982): 5. Antoun, Richard. “On the Modesty of Women in Arab Muslim Villages: AStudy in the Accommodation of Traditions.” American Anthropologist 70 (1968): 671–697. Antoun, Richard. “SocialOrganization and the Life CycleinanArabVillage,” Ethnology 6 (1967): 294–308. Ashtor,Eliyahu. “The Diet of Salaried Classes in The Medieval NearEast.” Journal of Asian History 4(1970): 1–24. Azam, Hina. Sexual Violation in Islamic Law. New York: CambridgeUniversityPress, 2015. Barkaï, Ron. LesinfortunesdeDinah, le livredelagénération: La gynécologie juive au Moyen âge. Paris: Cerf, 1991. Baskin, Judith. “Rabbinic Reflections on the Barren Wife.” HarvardTheological Review 82 (1989): 101–14. Batten, Rosalind. “The Arabic Commentaries On The Hippocratic Aphorisms: Arabic Learned Medical Discourse On Women’sBodies (9th-15th Cent.).” Ph.D.Dissertation:University of Manchester,2018. Bauer,Karen. “‘Traditional’ ExegesisofQ.4:34.” Comparative Islamic Studies 2(2006): 129–142. Baumgarten, Elisheva. Mothers and Children: JewishFamilyLife in Medieval Europe. Princeton: Princeton University Press,2004. Bayoumi, Abbas. “Survivances Egyptiennes.” Bulletin de la Socie´te´ royale de ge´ographie d’E´ gypte 19 (1937): 279–287. Behrend-Martínez, Edward. “Female Sexual PotencyinaSpanish Church Court, 1673–1735.” Lawand History Review 24.2 (2006): 297–330. Behrend-Martínez, Edward. Unfit for Marriage: ImpotentSpouses On Trial In the Basque Region of Spain, 1650–1750. Reno: UniversityofNevadaPress, 2007. Berkey,Jonathan. “Circumcision Circumscribed: Female Excisionand Cultural Accommodation in the Medieval nearEast.” International Journal of Middle EastStudies 28.1 (1996): 19–38. Boddy,Janice. Wombs and AlienSpirits: Women, Men, and the Zar Cult in NorthernSudan. Madison: University of WisconsinPress,1986. Bojlén, K. and M.W. Bentzon. “The InfluenceofClimate and Nutrition on AgeatMenarche: A Historical Review and aModern Hypothesis.” Human Biology 40 (1968): 69–85. SecondaryScholarship 293

Bos, Gerrit. “On Editing and Translating Medieval Hebrew Medical Texts.” JewishQuarterly Review 89 (1998): 101–122. Bouhdiba, Abdelwahab. La Sexualité en Islam. Paris: PressesUniversitaires de France, 1975. English translation: Sexuality in Islam. London: Saqi Books, 2004. Boylan, Michael. “The Galenic and Hippocratic Challenges to Aristotle’sConception Theory.” Journal of the History of Biology 18 (1984): 83–112. Boylan, Michael. “Galen’sConception Theory.” Journal of the History of Biology 19 (1986): 62. Cohen, Shaye J. D. “Purity,Piety,and Polemic: Medieval Rabbinic Denunciations of “Incorrect” Purification Practices.” In Women and Water: Menstruation in JewishLife and Law, ed. R. Wasserfall, 82–100. Hanover,NH: BrandeisUniversityPress, 1999. Buitelaar,Marjo. “Public Baths as PrivatePlaces.” In KarinAsk and Marit Tjomsland, Women and Islamization,103–124. Oxford: Berg, 1998. Bürgel,Johann Christoph. “Secular and Religious Features of Medieval Arabic Medicine.” In Asian Medical Systems: AComparative Study,ed. Charles Leslie, 44–62. Berkeley: UniversityofCalifornia Press, 1976. Caballero-Navas, Carmen. The Book of Women’sLoveand JewishMedieval Medical Literature on Women =Sefer Ahavat Nashim. New York: Kegan Paul,2004. Canaan, Taufiq. “Unwritten Laws Affecting the Arab WomanofPalestine.” Journal of the Palestine Oriental Society 11 (1931): 172–203. Carroll, Lucy. “LifeInterests and Intergenerational TransferofProperty Avoiding the Law of Succession.” Islamic Lawand Society 8(2001): 245–286. Chaudhry, Ayesha S. “Unlikely Motherhood in the Qur’ān: Oncofertility as Devotion.” In Oncofertility: Reflections from the Humanities and Social Sciences,ed. T. K. Woodruff et al., 287–94. New York: Springer,2010. Chipman, Leigh. The World of Pharmacy and Pharmacists in Mamluk Cairo. Leiden:Brill, 2010. Colin, Joël. L’enfantendormi dans le ventredesame`re:e´tude ethnolinguistique et juridique d’une croyanceauMaghreb. Perpignan: Centre d’e´tudes et de recherches juritiques sur les espaces me´diterrane´en et africain francophones (CERJEMAF), 1998. Conrad, Lawrence. The WesternMedical Tradition: 800 BC to AD 1800. New York: Cambridge UniversityPress, 1995. Coulson, Noel J. AHistory of Islamic Law. Edinburgh: Edinburgh UniversityPress, 1964. Cuffel, Alexandra. “From Practice to Polemic: Shared Saints and Festivals as ‘Women’s Religion’ in the Medieval Mediterranean.” Bulletin of the School of Oriental and African Studies 68 (2005): 401–19. Cuffel, Alexandra. “Polemicizing Women’sBathing among Medieval and Early Modern Muslims and Christians.” In The Natureand FunctionofWater,Baths, Bathing, and Hygiene from Antiquity through the Renaissance,ed. Cynthia Kossoand Anne Scott 171–188. Leiden:Brill, 2009. Cuno, Kenneth M. Modernizing Marriage: Family, Ideology, and LawinNineteenth- and Early Twentieth-CenturyEgypt. Syracuse: Syracuse University Press,2015. Darmon, Pierre. Trial by Impotence: Virility and Marriage in Pre-Revolutionary France. London: HogarthPress, 1985. Das,Aileen. “Galen and the Arabic traditions of Plato’sTimaeus.” Ph.D.thesis: Universityof Warwick, 2013. 294 Bibliography

Dean-Jones, Leslie. “Menstrual Bleeding according to the Hippocraticsand Aristotle.” Transactions of the American Philological Association 119 (1974): 177–191. Dean-Jones, Leslie. Women’sBodies in Classical Greek Science. Clarendon Press: Oxford, 1994. Delaney,Carol. The Seed and the Soil: Gender and CosmologyinTurkish VillageSociety. Berkeley: University of California Press, 1991. Dols, Michael. Majnūn: the MadmaninMedieval Islamic Society. New York: OxfordUniversity Press, 1992. Drower,E.S.“Women and Taboo in Iraq.” Iraq 5(1938): 105–117. Edelstein, Ludwig. AncientMedicine. Baltimore: Johns Hopkins Press, 1967. Effah, Kofi. “AReformulation of the Polygyny-Fertility Hypothesis.” Journal of Comparative FamilyStudies 30 (1999): 381–408. Elgood, Cyril. “Tibb-ul-Nabbi or Medicine of the Prophet, Being aTranslation of TwoWorks of the Same Name. I: The Ṭibb-ul-Nabbi of al-Suyūṭī.II: The Ṭibb-ul-Nabbi of Mahmud bin Mohamed al-Chaghayni, together withIntroduction,Notes and aGlossary.” Osiris 14 (1962): 33–192. Fancy,Nahyan. Scienceand Religion in Mamluk Egypt: Ibn al-Nafīs, Pulmonary Transit, and BodilyResurrection. London: Routledge, 2013. Fancy,Nahyan. “Womb Heat versus Sperm Heat: Hippocrates against Galen and Ibn Sīnā in Ibn al-Nafīs’sCommentaries.” Oriens 45 (2017): 150–175. Faraone, Christopher. “Magical and Medical Approaches to the Wandering Womb in the Ancient Greek World.” Classical Antiquity 30 (2011): 1–32. Faraone, Christopher. “The Riseofthe Demon Womb in Greco-RomanAntiquity.” In Finding Persephone: Women’sRituals in the AncientMediterranean,ed. M. Parcaand A. Tzanetou, 224–37.Bloomington: IndianaUniversityPress, 2007. Fargues,Philippe. “The Stages of the Family LifeCycle in Cairoatthe End of the Reign of Muḥammad ‘Alī,According to the 1848 Census.” Harvard MiddleEastern and Islamic Review 5(2000): 1–39. Flemming, Rebecca. “The Invention of Infertility in the Classical Greek World: Medicine, Divinity,and Gender.” Bulletin of the History of Medicine 87 (2013): 565–590. Flemming, Rebecca. Medicine and the Making of Roman Women: Gender,Nature, and Authority from CelsustoGalen. New York: Oxford UniversityPress, 2000. Friedl, Erika. “The DynamicsofWomen’sSpheres of Action in RuralIran.” In Women in Middle Eastern History: Shifting Boundaries in Sex and Gender,eds N. R. Keddie and B. Baron, 195–214. New Haven: Yale University Press, 1991. Friedl, Erika. Women of Deh Koh. London: Penguin Books, 1991. Friedman, Mordechai. Ribui nashim be-Yisrael =JewishPolygynyinthe Middle Ages. Jerusalem: Mossad Bialik, 1986. Gadelrab, SherrySayed. “Discourses on Sex Differences in Medieval Scholarly Islamic Thought.” Journal of the History of Medicine and Allied Sciences 66 (2011): 40–81. Garver,Valerie. “Childbearing and Infancy in the Carolingian World.” Journal of the History of Sexuality 21 (2012): 208–244. Giladi, Avner. Infants,Parents and WetNurses: Medieval Islamic Views on Breastfeeding and their Social Implications. Leiden: Brill, 1999. Giladi, Avner. Muslim Midwives: The Craft of Birthing in the PremodernMiddle East. New York: CambridgeUniversity Press,2015. SecondaryScholarship 295

Gilchrist, Roberta. Medieval Life: Archaeologyand the Life Course. Woodbridge: Boydell Press, 2012. Gilman, Sander et al. Hysteria Beyond Freud. Berkeley: UniversityofCalifornia Press, 1993. Goitein, S. D. Mediterranean Society. 6vols. Berkeley: UniversityofCalifornia Press, 1999. Good, Mary-Jo Delvecchio. “Of Blood and Babies: The RelationshipofPopular Islamic PhysiologytoFertility.” Social Science &Medicine 14 (1980): 147–156. Graiouid, Said. “Communication and the SocialProduction of Space: the Hammam, the Public Sphereand Moroccan Women.” Journal of North African Studies 9(2004): 104–130. Granqvist, Hilma. ChildProblems Among the Arabs. Helsingfors:Södorström, 1950. Granqvist, Hilma. Marriage Conditions in aPalestinian Village. 2vols. Helsingfors: Akademische buchhandlung,1931–1935. Green, Monica. “The Transmission of Ancient Theories of Female Physiologyand Disease Through the Early Middle Ages.” Ph.D.Dissertation:Princeton University,1985. Green, Monica. Making Women’sMedicine Masculine:The Rise of Male Authority in Pre- Modern Gynaecology. Oxford: Oxford University Press,2008. Green, Monica. “Caring forGenderedBodies.” In OxfordHandbook of MedievalWomen and Gender,ed. Judith Bennett and Ruth MazoKarras,345–61. Oxford: OxfordUniversity Press, 2013. Guo, Li. Commerce, Culture, and Community in aRed Sea Port in the Thirteenth Century. Leiden: Brill, 2004. Guo, Li. “Tales of aMedieval Cairene Harem: Domestic Life in al-Biqā‘ī’sAutobiographical Chronicle,” Mamluk StudiesReview 9(2005): 101–121. al-Hājirī,SārahShāfī. al-Ahkạ mā l-muttasilạ bi’l-ʻuqm wa’l-injabw̄ a-manʻ al-hamḷ fī al-fiqh al-Islam̄ ī. Beirut:Dāral-Bashāʼir al-Islāmīya, 2013. Hamarneh, Sami. “Origin and Functions of the Ḥisbah System in Islam and Its Impact on the Health Professions.” Sudhoffs Archiv für Geschichte der Medizin und der Naturwissenschaften 48 (1964): 157–173. Hansen, Nicole Bernadette. “MotherhoodintheMother of the World: Continuity and Change of Reproductive Concepts and Practices in Egypt from Ancient to Modern Times.” Ph.D. dissertation:UniversityofChicago, 2006. Hanson, Ann Ellis. “Continuity and Change:Three Case Studies in Hippocratic Gynecological Therapy and Theory.” In Women’sHistory and Ancient History,ed. S. Pomeroy, 73–110. Chapel Hill: UniversityofNorth Carolina Press, 1991. Hennigan, Peter. The Birth of aLegal Institution: The Formation of the Waqf in Third-Century A.H. Ḥanafī Legal Discourse. Leiden: Brill, 2004. Inhorn, Marcia. Infertility and Patriarchy: The Cultural Politics of Gender and FamilyLife in Egypt. Philadelphia:University of Pennsylvania Press, 1996. Inhorn, Marcia. Questfor Conception: Gender,Infertility,and Egyptian Medical Traditions. Philadelphia: University of Pennsylvania Press, 1994. Iversen, Erik. “Papyrus CarlsbergVIII with some remarksonthe Egyptian origin of some popular birthprognoses.” Det.Kongelige. Danske Videnskabernes Selskab. Historisk- filologiske Meddelelser 26 (1939): 1–31. Jauanna, Jacques. Greek Medicine fromHippocrates to Galen. Leiden: Brill, 2012. Jaussen, Antonin. Coutumes des Arabes au pays de Moab. Paris: V. Lecoffre, 1908. 296 Bibliography

Jennings, RonaldC.“Women in Early 17th CenturyOttomanJudicial Records: The Sharia Court of Anatolian Kayseri.” Journal of the Economic and Social History of the Orient 18 (1975): 53–114. Johnston, William. “Sexually Transmitted Diseases and Demographic ChangeinEarly Modern Japan.” EastAsian Science,Technology,and Medicine 30 (2009): 74 – 92. Joannides, Dimitri. Esquisse de la gynécologie et de l’obstétrique chez les égyptiens et les grecs. Cairo, 1934. Joannides, Dimitri. La gynécologie et l’obstétrique chez Avicenne (Ibn Sina) et leurs rapports avec celles des grecs. Cairo, 1938. Joannides, Dimitri. La gynécologie et obstétrique de Pauld’Egine et son influencesur la médecine arabe. Cairo, 1940. Joosse, Peter. The Physician as aRebellious Intellectual: The Book of the TwoPiecesofAdvice or Kitābal-Naṣīḥatayn by ‘Abdal-Laṭīfibn Yūsufal-Baghdādī. Frankfurt am Main: Peter Lang Edition, 2014. Kahle, Paul. “AGypsy WomaninEgypt in the Thirteenth Century A.D.” Journal of the Gypsy Lore Society,third series, 29 (1950): 11–15. Kan‘ān, Aḥ mad Muḥ ammad. al-Mawsu‘̄ aal-tibbiyyạ al-fiqhiyya. Beirut: Dāral-Nafā’is, 2000. Karras, RuthMazo. Sexuality in Medieval Europe:Doing UntoOthers. New York: Routledge, 2005. Katz, Marion Holmes. Bodyofthe Text. Albany: SUNY Press,2002. Katz, Marion Holmes. “Scholarly Authority and Women’sAuthority in the Islamic Law of Menstrual Purity.” In Gender in Judaismand Islam: Common Lives, Uncommon Heritage, ed. Firoozeh Kashani-Sabet and Beth S. Wenger, 73–104. New York: NYU Press, 2014. Katz, Marion Holmes. Women in the Mosque: AHistory of Legal Thoughtand Social Practice. New York: Columbia UniversityPress, 2014. Kedar,Benjamin Z. “Jews and Samaritans in the Crusading Kingdom of Jerusalem.” Tarbiz 53 (1984), 387–408. Khan, Geoffrey. Arabic Legal and Administrative Documents in the Cambridge Genizah Collections. Cambridge: CambridgeUniversity Press, 1993. Khattab, Hind et al. Women, Reproduction, and Health in Rural Egypt. Cairo: American UniversityinCairo Press,1999. King, Helen. Hippocrates’ Woman: Reading the Female BodyinAncientGreece. London: Routledge, 1998. King, Helen. “Galen and the widow: towards ahistoryoftherapeutic masturbation in ancient gynaecology.” EuGeStA: Journal on Gender Studies in Antiquity 1(2011), 205–235. Krakowski, Eve. Coming of Age in Medieval Egypt. Princeton: PrincetonUniversity Press, 2018. Kruk, Remke. “Pregnancy and Its Social Consequences In Mediaeval And Traditional Arab Society.” Quaderni Di Studi Arabi 5/6 (1987): 418–30. Kueny,Kathryn. Conceiving Identities: Maternity in Medieval Discourse and Practice. Albany: State UniversityofNew York Press, 2013. Kueny,Kathryn. “The Birth of Cain: Reproduction, Maternal Responsibility,and Moral Character in Early Islamic Exegesis.” History of Religions 48 (2008): 110–129. Kulin, H. et al. “The Effect of Chronic Childhood Malnutrition on PubertalGrowth and Development.” American Journal of Clinical Nutrition 36 (1982): 527–36. SecondaryScholarship 297

Largue`che, Dalenda. Monogamie en Islam: l’exception kairouanaise. Manouba: Centre de publication universitaire,2011. Lamdan, Ruth. “Child MarriageinJewish Societyinthe Eastern Mediterranean during the Sixteenth Century.” Mediterranean Historical Review 11 (1996): 37–59. Lane, Edward W. An Account of the Manners and Customs of the Modern Egyptians. New York: The American UniversityofCairoPress,2003. Lane, Edward W. Arabic-English Lexicon. 8vols. London: Williams and Norgate, 1893. Laqueur, Thomas. Making Sex: Bodyand Gender fromthe Greeks to Freud. Cambridge: HarvardUniversityPress, 1990. Layish,Aharon. “The Mālikī Family “Waqf” according to Wills and “Waqfiyyāt.” Bulletin of the School of Oriental and African Studies 46 (1983): 1–32. Layish,Aharon. Marriage, Divorce,and Succession in the Druze Family. Leiden: Brill, 1982. Legey, Françoise. The Folklore of Morocco,tr. Lucy Hotz. London: Unwin, 1935. Levey,Martin. “Medical EthicsofMedieval Islam withSpecial ReferencetoAl-Ruhāwī’s ‘Practical Ethicsofthe Physician’.” Transactions of the American Philosophical Society 57.3 (1967): 1–100. Lewin, Benjamin. Otsar ha-ge’onim. Jerusalem: Hebrew University,1928. Lewis, M., F. Shapland and R. Watts. “On the Threshold of Adulthood: ANew Approach for the Use of Maturation Indicators to Assess PubertyinAdolescents from Medieval England.” Journal of Human Biology 28 (2016): 48–56. Little, Donald P. “AFourteenth-CenturyJerusalem Court Record of aDivorce Hearing: ACase Study.” In Mamluksand Ottomans: Studies in Honour of Michael Winter,ed. D. J. Wasserstein and A. Ayalon, 66–85. London: Routledge, 2006. Livingston, John W. “Science and the Occult in the Thinking of Ibn Qayyim al-Jawziyya.” Journal of the American Oriental Society 112 (1992): 598–610. Longombe, AhukaOna et al. “Fistula and Traumatic Genital Injury from Sexual Violenceina Conflict Setting in Eastern Congo: Case Studies.” Reproductive Health Matters 16.31 (2008): 132–141. Lutfi, Huda. “Mannersand Customs of Fourteenth-CenturyCairene Women: Female Anarchy versus Male Shar‘iOrder in Muslim PrescriptiveTreatises,” 99–121. In Women in Middle Eastern History,ed. NikkiKeddie and Beth Baron. New Haven: Yale UniversityPress, 1993. Lydon, Ghislaine and Bruce S. Hall. “Excavating Arabic Sources forthe History of Slaveryin Western Africa,” 15–49. In African Voices on Slaveryand the SlaveTrade,ed. Alice Bellagamba,SandraE.Greene, and Martin A. Klein. Cambridge: CambridgeUniversity Press, 2016. Maher,Vanessa. “Women and Social ChangeinMorocco.” In Women in the Muslim World, ed. L. Beck and N. Keddie, 100–123. Cambridge: Harvard UniversityPress, 1978. Marcus, Abraham. The Middle Eastonthe EveofModernity: Aleppo in the Eighteenth Century. New York: Columbia UniversityPress, 1989. Marmon, Shaun. “Domestic Slaveryinthe Mamluk Empire: aPreliminarySketch.” In Slavery in the Islamic Middle East,ed. Shaun Marmon, 1–24. Princeton: Markus Wiener Pub., 1999. Mathee, Mohamed. “Women’sAgency in Muslim Marriage: FatwāsfromTimbuktu.” Journal for Islamic Studies 31 (2011), 75–95. 298 Bibliography

Meacham, Tirzah. “MarriageofMinor Girls in JewishLaw: ALegaland Historical Overview.” In JewishLegal Writings by Women,ed. M. D. Halpern and Ch.Safrai, 23–37.Jerusalem: Urim Publications, 1998. Meyerhof, Max. “La surveillancedes professions médicales et paramédicales chez les Arabes.” Bulletin de l’Institut d’Égypte 26 (1944): 119–34. Mirza, Younus. “Remembering the Umm al-Walad.” In Concubines and Courtesans: Women and slavery in Islamic History,ed. M. Gordon and K.A.Hain, 297–337.Oxford: Oxford UniversityPress, 2017. Moors, Annaliese. “Inheritance: ContemporaryPractice.” In Encyclopedia of Women in the Islamic Cultures,ed. Suad Joseph, 2: 299–302. Leiden: Brill, 2003–2007. Morsey,Soheir A. Gender,Sickness, and Healing in Rural Egypt. Boulder,CO: Westview Press, 1993. Morsey,Soheir A. “Sex Differences and Folk Illness.” In Women in the Muslim World,ed. L. Beck and N. Keddie, 599–616. Cambridge: Harvard UniversityPress, 1978. Motzki, Harald. “Geschlechtsreife undLegitimation zurZeugung im frühen Islam.” In Geschlechtsreife und Legitimation zur Zeugung, ed. Ernst Wilhelm Müller,479–550. Freiburg/Munich: Karl Alber GmbH, 1985. Muleta, M. and G. Williams. “Postcoital Injuries Treatedatthe AddisAbaba Fistula Hospital, 1991–97.” Lancet 354(1999):2051–2. Musallam, Basim. “The Human Embryo in Arabic Scientific and Religious Thought.” In The Human Embryo: Aristotle and the Arabic and European Traditions,ed. G. R. Dunstan, 32–46. Exeter: University of Exeter Press, 1990. Musallam, Basim. Sex and Society in Islam: Birth Control Beforethe Nineteenth Century. Cambridge: CambridgeUniversity Press, 1983. Natvig, Richard. “Liminal Rites and Female Symbolism in the Egyptian ZarPossession Cult,” Numen 35 (1988): 57–68. Obermeyer,Carla Makhlouf. “Pluralismand Pragmatism:Knowledgeand Practice of Birth in Morocco.” Medical Anthropology Quarterly 14 (2000): 180–201. O’Dowd, Michael J. The History of Medications for Women: Materia Medica Woman. New York: Parthenon Publishing Group, 2001. Ohtoshi, Tetsuya. “The manners, customs, and mentality of pilgrims to the Egyptian cityof the dead:1100–1500 AD.” Orient 29 (1993): 19–44. Olszowy-Schlanger,Judith. Karaite Marriage DocumentsFromthe CairoGeniza: Legal Tradition and Community Life In Mediaeval Egypt and Palestine. Leiden: Brill, 1998. Omran, Abdel Rahim. FamilyPlanning in the Legacy of Islam. Routledge: New York, 1992. Parent,A.S.et. al. “The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration.” Endocrine Reviews 24.5 (2003): 668–93. Patai, Raphael. Sex and Familyinthe Bible and the Middle East. New York: Doubleday,1959. Peirce, Leslie. Morality Tales: Lawand Gender in the Ottoman Court of Aintab. Berkeley: UniversityofCalifornia Press, 2003. Peirce, Leslie. “Seniority,Sexuality,and SocialOrder: the VocabularyofGender in Early Modern OttomanSociety.” In Women in the Ottoman Empire,ed. MadelineC.Zilfi. Leiden: Brill, 1997. Perkins, E. E. “MarriageCeremony in Lower Egypt.” Man 32 (1932): 63–66. SecondaryScholarship 299

Perlmann,Moshe. “The PositionofJewish Physicians in Medieval Muslim Countries.” Israel Oriental Studies 2(1972), 315–19. Pinheiro, CristinaSantos. “The Medical Sources in the Chaptersabout Sterility of Rodrigode Castro’sDeuniversa mulierummedicina.” In The PalgraveHandbook of Infertility In History: Approaches, Contextsand Perspectives, ed. Gayle Davis and Tracey Loughran. London: Palgrave Macmillan, 2017. Pormann, Peter. The Oriental Tradition of Paul of Aegina’sPragmateia. Leiden: Brill, 2004. Pormann, Peter. “Female Patients, Patrons and Practitionersin10th and 11th-Century Baghdad: An UnheardVoice?” Montreal, InstituteofIslamic Studies at McGillUniversity, May 4, 2007. Pormann, Peter. “The Art of Medicine: Female Patients and PractitionersinMedieval Islam,” Lancet 373 (2009): 1598–9. Pormann, Peter. “The Hippocratic Aphorisms in the Arabic Medical Tradition.” Aspetar 2 (2013): 412–415. Pormann, Peter and Emilie Savage-Smith. Medieval Islamic Medicine. Washington,D.C.: Georgetown UniversityPress, 2007. Porter,Venetia, LianaSaif,and Emilie Savage-Smith, “Amulets, Magic, and Talismans.” In Companion to Islamic Art and Architecture. Wiley-Blackwell, 2017. Powers, David. “Women and Divorceinthe Islamic West: Three Cases.” Hawwa 1(2003): 29–45. Prentice,S.etal. “Evidence for aDownwardSecular TrendinAge of Menarche in aRural Gambian population.” Annals of Human Biology 37 (2010): 717–721. Preus, Anthony. “Biomedical Techniques forInfluencing Human Reproduction in the Fourth Century B.C.” Arethusa 8(1975): 237–63. Preus, Anthony. “Galen’sCriticism of Aristotle’sConception Theory.” Journal of the History of Biology 10 (1977): 65–85. Qarāmī,Amāl. al-Ikhtilaff̄ īal-thaqafā al-ʻarabīya al-islam̄ īya. Beirut: Dāral-Madāral-Islāmī, 2007. Ragab, Ahmed. “Epistemic Authority of Women in the Medieval Middle East.” Hawwa 8 (2010): 181–216. Ragab, Ahmed. “One, Two, or Many Sexes: Sex Differentiation in Medieval IslamicateMedical Thought.” Journal of the History of Sexuality 24 (2015): 428–454. Rank,Scott. “Polygamy and Religious Polemicsinthe Late OttomanEmpire: FatmaÂliye and Mahmud Es’ad’sTa’addüd-i Zevcât’aZeyl.” Cihannüma: Tarih ve CoğrafyaAraştırmaları Dergisi 1/2 (2015): 61–79. Rapoport, Yossef. “Matrimonial Gifts in Early Islamic Egypt.” Islamic Lawand Society 7.1 (2000): 1–36. Rapoport, Yossef. Marriage, Money,and Divorce in Medieval Islamic Society. Cambridge: CambridgeUniversityPress, 2005. Rây, P. and H.N. Gupta. Caraka Samhita; AScientific Synopsis. New Delhi: National Institute of Sciences of India, 196. Reinert, Benedikt. Die Lehrevom tawakkul in der klassischen Sufik. Berlin: de Gruyter, 1968. Riddle, John. Contraception and Abortion from the AncientWorld to the Renaissance. Cambridge: Harvard University Press,1992. Riddle, John. Goddesses, Elixirs,and Witches: Plants and Sexuality throughout Human History.New York: Palgrave Macmillan, 2010. 300 Bibliography

Ringrose, Kathryn M. The Perfect Servant: Eunuchs and the Social Construction of Gender in Byzantium. Chicago: UniversityofChicago Press, 2003. Rispler-Chaim, Vardit. Islamic Medieval Ethics in the Twentieth Century. Leiden: Brill, 1993. Rispler-Chaim, Vardit. “Ḥasan MurādMannā:Childbearing and the Rights of aWife.” Islamic Law and Society 2(1995): 92–99. Rispler-Chaim, Vardit. Disability in Islamic Law. Dordrecht: Springer,2010. Rosenfeld,H.“ProcessesofStructuralChangewithin the Arab Village Extended Family.” American Anthropologist 60 (1958): 1127–1139. Rosen, Tova and Uriah Kfir. “What Does aFather Want?: An Unpublished Poem and Its Intertexts.” In Studies in Arabic and Hebrew Letters in Honor of Raymond P. Scheindlin, ed. Jonathan Decter and Michael Rand, 129–53. Piscataway,NJ: Gorgias Press, 2007. Rosenthal, Franz. “The Defense of Medicine in the Medieval Muslim World.” Bulletin of the History of Medicine 43 (1969): 519 – 32. Sabra, Adam. Poverty and Charity in Medieval Islam: Mamluk Egypt, 1250–1517. Cambridge: CambridgeUniversityPress, 2000. Sadeghi, Behnam. The Logic of Law-Making in Islam: Women and Prayerinthe Legal Tradition. Cambridge: CambridgeUniversity Press, 2013. Sait, Siraj and HilaryLim. Land, Lawand Islam: Property and Human Rights in the Muslim World. New York: ZedBooks, 2006. al-Sālimī,Nūral-Dīn ‘Abd Allāhibn Ḥ umayyid. Īdạ h̄ ̣ al-bayanf̄ īnikah̄ ̣ al-sibyạ n:̄ ahkạ mt̄ azwīj al-sighạ r.̄ Beirut: al-Dāral-ʻArabiyyalil-ʻUlūm, 2006. Sanders, Paula. “Gendering the Ungendered Body: Hermaphrodites in Medieval Islamic Law.” In Women in MiddleEasternHistory: Shifting Boundaries in Sex and Gender,ed. NikkiR. Keddie and Beth Baron, 74 – 95. New Haven: Yale University Press,1991. Savage-Smith, Emilie. “The Practice of SurgeryinIslamic Lands: Myth and Reality.” Social History of Medicine 13 (2000): 307–321. Savage-Smith, Emilie. “Islamic Medical Medical Manuscripts at the National Libraryof Medicine,” Nlm.nih.gov.https://www.nlm.nih.gov/hmd/arabic/prophetic_med2.html (accessed August 21, 2018). Sayeed, Asma. Women and the Transmission of Religious Knowledge in Islam. Cambridge: CambridgeUniversityPress, 2013. Schimmel,Annemarie. And Muhammad is His Messenger: The Veneration of the Prophet in Islamic Piety. Chapel Hill: University of North CarolinaPress,1985. Scott, S. and J. Duncan. Demographyand Nutrition: Evidence from Historical and ContemporaryPopulations. Oxford:Wilson &Sons, 2008. Serour,G.I.etal. “Infertility: AHealth Problem in the Muslim World.” Population Sciences 10 (1991): 41–58. Serrano, Delfina. “LegalPractice in an Andalusī-Maghribī Sourcefrom the Twelfth CenturyCE: The Madhāhib al-ḥukkāmfīnawāzil al-aḥkām.” Islamic Law and Society 7(2000): 187–234. Serrano, Delfina. “Rape in Mālikī LegalDoctrine and Practice.” Hawwa 5(2007): 166–207 Shaham,Ron. The Expert Witness in Islamic Courts. Chicago: UniversityofChicago Press, 2010. Shatzmiller,Maya. “Women and Property Rights in Al-Andalus and the Maghrib: Social Patterns and Legal Discourse.” Islamic Law and Society 2(1995), 219–57. SecondaryScholarship 301

Shefer-Mossensohn, Miri. Ottoman Medicine: Healing and Medical Institutions, 1500–1700. Albany: SUNY Press, 2009. Siggel, Alfred. “Gynäkologie, Embryologie undFrauenhygiene aus dem Paradies der Weisheit über die Medizin des Abū al-Ḥasan ‘Alī b. SahlRabbānat-Ṭabarī.” Quellen und Studien zur Geschichte Naturwissenschaften und der Medizin 8(1941): 216–272. Sohrabvand, Farnaz et al. “Comparison of Hysterosalpingography and Avicenna’sMethod for Evaluation of Tubal Patency.” Traditional and Integrative Medicine 1(2016): 90–95. Sonbol, AmiraEl-Azhary. “AHistoryofMarriageContractsinEgypt.” In The Islamic Marriage Contract,ed. FrankVogel and AsifaQuraishi, 87–122. Cambridge: HarvardUniversity Press, 2008. Sonbol, AmiraEl-Azhary. “Shari‘ Court RecordsAnd Fiqh As Sources Of Women’sHistory.” Religion &Literature 42 (2010): 229–246. Sourdel-Thomine, J. “Ḥammām.” In Encyclopaedia of Islam,2nd ed., ed. P. Bearman et al. Leiden: Brill, 1960. Spectorsky, Susan. Chapters on Marriage and Divorce. Austin: UniversityofTexas Press, 1993. Spellberg, Denise. Politics, Gender and the Islamic Past. New York: Columbia University Press, 1994. Spellberg, Denise. “Writing the Unwritten Life of the Islamic Eve: Menstruation and the Demonization of Motherhood.” International Journal of Middle Eastern Studies 28 (1996): 305–24. Sprinkle, Robert. “The Missing Politics and Unsettled Scienceofthe TrendtowardEarlier Puberty.” Politics and the Life Sciences 20.1 (2001): 43–66. Steinschneider,Moritz. “Wissenschaft und Charlatanerie unter den Arabern im neunten Jahrhundert.” Virchows Archiv 36 (1866): 570–86 and 37: 560–65. Tanner,James M. Fetus Into Man: Physical Growth from Conception to Maturity. Cambridge: HarvardUniversityPress, 1990. Thompson, Jason. “Small Latin and LessGreek:Expurgated Passages from EdwardWilliam Lane’sAnAccount of the Manners and Customs of the Modern Egyptians.” Quaderni di Studi Arabi 1(2006): 7–28. Thompson, Joseph Parrish. Photographic Views of Egypt, Pastand Present. Boston: J. P. Jewett, 1856. Tillier,Mathieu. “Women before the Qāḍī under the Abbasids.” Islamic Law and Society 16 (2009): 280–301. Tobi, Yosef. “Inheritance Rights of Jewish Women and Moslem Women in Yemen.” Proceedings of the Seminarfor Arabian Studies 24 (1994): 201–208. Totelin, Laurence. Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-centuryGreece. Boston: Brill, 2008. Tritton, A. S. Caliphs and their Non-Muslim Subjects. London: F. Cass,1970. Tucker,Judith E. “Muftīsand Matrimony: Islamic Law and Gender in OttomanSyria and Palestine.” Islamic Lawand Society 1.3 (1994): 265–300. Tucker,Judith E. In the House of the Law: Gender and Islamic LawinOttoman Syria and Palestine. Berkeley: UniversityofCalifornia Press, 2003. Ullmann, Manfred. Die Medizin im Islam. Leiden: Brill, 1970. Ullmann, Manfred. “Zwei spätantikeKommentare zu der hippokratischen Schrift ‘De morbis muliebribus.’” Medizinhistorisches Journal 12 (1977): 245–262. 302 Bibliography

Ullmann, Manfred. Islamic Medicine. Edinburgh: Edinburgh UniversityPress, 1978. vandeWalle, Etienne et al. RegulatingMenstruation: beliefs, practices, interpretations. Chicago, UniversityofChicago Press, 2001. vander Eijk, Philip J. Diocles of Carystus.Leiden: Brill, 2001. Verskin, Alan. “AMuslim-JewishFriendship in the Medieval Mediterranean: ʿAlī Ibn al-Qifṭī’s Biography of Rabbi Yūsuf Ibn Shamʿūn.” In The Idea of the Mediterranean,ed. Mario Mignone, 184–199. Stony Brook: ForumItalicumPublishing, 2017. Wall, L. L. “Dead Mothersand Injured Wives:The Social Context of Maternal Morbidity and Mortality among the HausaofNorthern Nigeria.” Studies in FamilyPlanning 29 (1998): 341–59. Weisser,Ursula. Zeugung,Vererbung, und pränatale Entwicklung in der arabisch-islamischen Mittelalters. Erlangen: Hannelore Lüling, 1983. Vieille, Paul. “Family Allianceand Sexual Politics.” In Women in the Muslim World,ed. Lois Beck and NikkiKeddie, 451– 472. Cambridge, Mass: Harvard University Press, 1978. VomBruck, Gabriele. “ElusiveBodies: The Politics of Aesthetics among Yemeni EliteWomen.” Signs 23 (1997): 175–214. Weinstein, Roni “Impotence and the Preservation of the Family in the JewishCommunity of Italy in the Early Modern Period” (Hebrew). In Sexuality and the FamilyinHistory =Eros, erusin, ve-isurim: miniyut u-mishpachah ba-historiyah, ed. I. Bartal and I. Gafni Jerusalem: MerkazZalman Shazar le-toldot Yisrael, 1998. Weitz, Lev. “Syriac Christians in the Medieval Islamic World: Law,Family,and Society,” Ph.D. Dissertation: PrincetonUniversity, 2013. Westermarck,Edward. Ritual and Belief in Morocco. 2vols. London: Macmillan, 1926. Westreich, E. “Infertility as Groundfor Polygamy in JewishLaw in Italy: Interaction among LegalTraditions at the time of the Renaissance.” Olir – Osservatorio delle libertà ed istituzioni religiose 2(2003): 1–28. Wizāratal-Awqāfwa’l-Shuʾūnal-Islāmiyya, Dawlat al-Kuwayt. al-Mawsuʻ̄ aal-fiqhiyya. 45 vols. Kuwait: Wizāratal-Awqāfwa’l-Shu’ūnal-Islāmiyya, 2004. Yazbak, Mahmoud. “Minor Marriages and Khiyāral-Bulūgh in Ottoman Palestine: ANote on Women’sStrategies in aPatriarchal Society.” Islamic Lawand Society 9.3 (2002): 386–409. Zacharias, L. and R. Wurtman. “AgeatMenarche: Genetic and Environmental Influences.” New England Journal of Medicine 280 (1969): 868–75. Zarinebaf-Shahr,Fariba. “Women, Law,and Imperial JusticeinOttomanIstanbul in the Late Seventeenth Century.” In Women, the Family, and Divorce Laws in Islamic History,ed. AmiraElAzhary Sonbol, 81–95. Syracuse: Syracuse University Press, 1996. Zaydān, ‘Abd al-Karīm. al-Mufasṣ aḷ fī ahkạ mā l-marʾawa’l-bayt al-Muslim fī al-sharīʻaal- Islamiyya.̄ 11 vols. Beirut: Muʾassasatal-Risāla, 1994. Zilfi, Madeline C. Women and Slavery in the Late Ottoman Empire:The Design of Difference. New York: CambridgeUniversityPress, 2010. Index

Abdallāhibn Ḥanbal (d. 290/903) 72 Breastmilkand breastfeeding 3, 25, 67,71, Abortion 4, 7, 20, 31, 68, 140–143, 184, 74,81, 83, 112, 117,129f.,132, 151, 280 193f.,200f.,281 Buhūtī,Manṣūribn Yūnus (d. 1051/1641) Abū Bakr al-Ṣ iddīq(d. 13/634) 28, 233 38, 42f. Abū Ḥanīfa (d. 150/767) 42, 74,178 Bulqīnī,AbūḤafṣ ʻUmar ibn Raslān(d. 805/ Abu-Lughod, Lila 14, 268 1403) 239–242, 249f. Adhra‘ī (d. 783/1381) 238f. Burial and mourning practices 208, 252– Aetius of Amida (fl. late5th/early 6th century 257 A.D.)60, 124, 134, 157f.,166, 188 ‘Ā’isha bint Abī Bakr (d. 58/678) 13, Cauterization 200, 212, 215, 218 25–28, 72, 94, 211, 216, 233, 256f.,261 Cemeteries, see Burial and mourning practi- Alcohol and wine 139, 142, 151, 173, 212, ces 227f.,237,243 Charlatans 185, 198, 217 ‘Alī ibn Abī Ṭalib (d. 40/661) 27,34, 252 Chastity30, 120,187,254 ‘Alqamaibn Qays(d. 62/681) 71f. – see also Virginity Amenorrhea, see Menstruation: amenorr- Child and perinatal mortality 27,29, 193, hea 256, 271–275 Amster,Ellen 83f. Childbirth Amulets, see Magical healing and the occult – dangers and injuries 52, 60,193, 201, and curses 271–274 Annulment, see Divorce: annulment on the – difficult labor 191–194, 231 basis of physicaldefects – health benefits 130 Arabian Nights, see Thousand and One – magical and medical practices149, 191– Nights,The 194, 231, 233f. ‘Arībibn Sa‘d, see al-Qurṭubī, ‘Arībibn – modesty and socialintimacy 245–257, Sa‘īd 263, 265–268, 282 Aristotle (d. 322 B.C.) 6, 121, 124f.,127– Chipman, Leigh 225 129, 132–138, 151, 154f.,162 Christians and Christianity 9, 15 Ashtor,Eliyahu 64 – as medical authorities 148, 212, 219, Asmā’ bint Yazīd(d. ca.64/680) 260 222–227,229, 244 Astrologyand astronomy 118, 215, 231 – dissolution of marriageamong 31f., ‘azl, see Contraception 53–56 – midwifery and bathing 244, 246–248, Baghdādī, ‘Abd al-Laṭīf(d. 629/1231) 126f. 257,267 Bathhouses and bathing 13, 17,88, 185, Circumcisionand clitorectomy 48, 50, 208, 215, 247–267 178f.,198, 218, 281f. Behrend-Martínez, Edward53–55 Coitus interruptus, see Contraception Bid‘a (innovation) 12, 209, 266, 281 Conception, theories of 6, 10 f.,117f.,133f., Biqā‘ī,Burhānal-DīnIbrāhīm(d. 885/1480) 136f.,143, 149–152, 203 84f. Contraception 7, 10f.,20, 31, 39f.,45f., 50, Birth defects 225, 272f. 111, 140f.,149, 157,200, 208, 281 Bleeding, see Cupping and phlebotomy Coulson, Noel 84 Bouhdiba, Abdelwahab3,33

Cupping and phlebotomy 132, 136, 155, Fertility testing (men and women)34f., 94, 160, 176–180,198, 215, 218, 243, 257, 121, 132, 137f.,163–174 281 Fetal sex diagnosis 151f.,176 Curses98f., 216, 231 Financialconcerns, see Inheritance;Lawsuits; Mahr (dower payment from husband to Dāwūdal-Ẓ āhirī (d. 270/884)42, 84 wife); Trousseaux Death, see Burial and mourning practices; Fistula 42, 46, 48–52 Divorce: deathbed;Infant and perinatal Flemming, Rebecca 136f. mortality; Inheritance Friedl, Erika 4f., 93f.,108, 251 Dhahabī,Muḥammad b. Aḥmad(d. 748/ 1348) 209, 211–213, 219f.,222, 227, Gadelrab, SherrySayed 280f. 232 Galen (d. ca.216 A.D.)49, 121, 123–128, Dioscorides (d. ca.90A.D.) 124, 140,148f., 131, 134–136, 138, 152, 154–157,160, 220 166f, 218–220, 228f.,232 Divorce Garlic 164–174 – among Christians and Jews 31–34, Genital defects (legal) 31, 35–56, 89, 111, 53–56, 90,96–100 142 – annulmentonthe basis of physicaldef- Geniza(Cairo) 66, 96–100, 190, 226f.,242 ects 31, 34–36, 38–56 Ghazālī,AbūḤāmid (d. 505/1111) 29f.,176, – deathbed 106f. 208, 247f. – khul‘ (wife-initiated divorce) 36–38, 90f. Giladi, Avner 14–16, 190, 197 – non-menstruating women 7, 53–56, 58, God and piety 6, 18, 20f.,29, 41, 118, 120, 67–75, 80–83, 86–88 141, 184, 204,207,211–214, 217,219– – ṭalāq (husband-initiated repudiation) 3f., 224, 231–233, 235, 244, 248, 252f., 18, 20,27, 31–33, 36f.,44, 56, 75–80, 260f.,269, 271–275 83, 94f.,106f.,113, 162, 278, 284 Green, Monica122, 124, 155, 175 – see also ‘idda;Pregnancy: rāqid Diyya (bloodwit) and compensation forinju- Ḥadīth 19, 26–31, 33f.,38, 50, 94, 111, ries 50f.,105 150,175, 207f.,211–213, 215–217,220, Dols, Michael 8–10,14 228, 232, 252, 256f.,260f.,263, 266, 280,282 Egypt, Ancient 131, 168, 172 Ḥafṣabint ‘Umar (d. 45/665) 27f, 30 – see also Modern Middle Eastern communi- Ḥ anafī legal school ties – contraception 40,45 Embryo 6f., 117f.,121, 131–136, 144–147, –dissolution of marriage37, 42, 44–45,47 150,203, 220 –inheritance104 Eunuchs 180,187f.,238–242, 250 – marriageand domestic life50, 52, 253, Eve(Ḥawwā’)271–275 255, 261 Examinations (of medical patients) 53–56, – medical and modesty matters213, 237, 80–82, 84, 89, 118, 131, 139, 164, 174, 243 176, 185–188, 237f. – menstruation, ‘idda,and pregnancy 70, 72–74,84, 88 Fargues,Philippe 65 – see also Abū Ḥanīfa, Ibn ‘Ābidīn; Ibn Nu- Fasting 47,85, 151, 169, 212, 227 jaym; Kāsānī Fāṭimabint Muḥammad (d. 11/633) 27 Ḥ anbalī legal school Fatwās12, 25, 37f.,40, 67–70, 73–80, – contraception 40 83–86, 106–108, 237 – dissolution of marriage39, 41–45,95 Index 305

– marriageand domestic life49, 95, 102 Ibn Abī Zayd al-Qayrawānī (d. 386/996) 38, – medical and modesty matters211–213, 46, 48, 86 224, 227,242f.,246f. Ibn ʻĀ bidīn, MuḥammadAmīnb.‘Umar (d. – menstruation, ‘idda,and pregnancy 67, 1252/1836) 51,57, 73, 179, 237,243, 70–74,80 258 –see also Ibn Ḥanbal; Ibn al-Jawzī,Ibn Mu- Ibn al-ʻAṭṭār, ‘Alā’ al-Dīn ‘Alī ibn Ibrāhīm(d. fliḥ;Ibn Qayyim al-Jawziyya; Ibn Qudā- 724/1324)208 ma;Saffārīnī;Ibn Taymiyya Ibn al-Ḥ ājj al-‘Abdarī (d. 737/1336) 12f.,17, Hansen, Nicole6,17 183, 209, 219–221, 224–227,230f., Ḥasan al-Baṣrī (d. 110/728) 39 235, 244f.,262–270,274,282 Ḥ assānibn Thābit (fl. mid-1st/7th century) Ibn al-Ḥ asan, Ṣ ā‘id (d. after 464/1072) 234 229f. Ḥaṭṭāb, Muḥammad(d. 954/1547) 33, 47 Ibn al-Jawzī (d. 597/1201)12, 141, 208, 213, Henna258 215, 219, 231, 249, 253f. Hippocrates (d. c. 370 B.C.) and Hippocratic Ibn al-Jazzāral-Qayrawānī (d. 369/980) 60, texts 132, 140,145 – 147,157f.,160,194f., – fertility,infertility,and pregnancy 129– 200f. 131, 136–143, 147f.,151,164–168, 172, Ibn al-Mawwāz, Muḥammad(d. 281/894) 178 48, 82 – hysterical suffocation 129, 153–155, Ibn al-Nafīs(d. 687/1288) 197 158f.,203 Ibn al-Quff (d. 685/1286) 189 – marriage121, 129f.,153, 158f.,203 Ibn al-Ukhuwwa (d. 729/1329)177–179, – menstruation and retention of menses 213, 222f.,231 128–130,203 Ibn Buṭlān(d. 1066/458) 88, 169f.,176 – reproductive theories 132f.,147 Ibn Ḥabīb, ‘Abd al-Malik (d. 238/852) 29, – transmission and reinterpretation 124– 150,208, 216, 252f.,255, 257f.,260f. 126, 132, 136, 164–168, 172, 218, 220 Ibn Ḥanbal, Aḥmad (d. 241/855) 42f., Hippocratic oath 184, 220 70–73, 95, 208, 212f.,246f. Ḥisba manuals formarketinspectors 12, Ibn Ḥazm, ‘Alī ibn Aḥmad(d. 456/1064) 37, 88, 136, 170,176–179, 184, 198, 200, 42 208f.,213, 222f.,231, 237,255, 281 Ibn Hindū,Abūal-Faraj (d. 410/1019) 214 Humoral temperaments 35, 123, 128, 133, Ibn Jumay‘ (d. 594/1198) 185 135, 137f.,144f.,151f.,156, 161–163, Ibn Kamal Pasha (d. 941/1534) 171 201 Ibn Kathīr(d. 774/1373) 141, 245, 248f. Ḥunayn ibn Isḥāq(d. 260/873) 147,171 Ibn Mufliḥ ,Muḥammad (d. 763/1361) 12, Hysterical suffocation 129, 144, 151, 153– 209, 211, 213, 219, 224, 227,231f. 160, 194, 196, 203 Ibn Nujaym (d. 970/1563) 50, 253, 255, 261 Ibn Qayyim al-Jawziyya(d. 751/1350) Iblīs, see Satan 40–42, 70, 208f.,214f.,217–219, Ibn ‘Abbās(d. 68/687) 233, 248, 271 221f.,228–233, 280 Ibn ʻAbdūn, Muḥammad ibn Aḥmad (d. early Ibn Qudāma (d. 620/1223) 39f.,42–44, 6th/12th century) 177,223 48–50,60, 73, 242, 246f. Ibn Abī Ṣādiq al-Nīsābūrī (d. after 462/ Ibn Rushd, Abū al-WalīdMuḥammad (al-Jadd, 1068) 127 d. 520/1126)37, 75, 80–82, 85, 88 Ibn Abī Uṣaybī‘a(d. 668/1270)180–182, Ibn Rushd, Muḥammad(Averroes,d.595/ 185, 190, 201 1198) 38, 84, 134 306 Index

Ibn Sahl, Abū al-Aṣbagh ‘Isā (d. 486/1093) – jinn 230 89 – marriageage 50, 66f. Ibn Sīnā (d. 427/1037) 49, 60,119, 134, – medical patients 9, 226 136f.,144, 146, 149f.,153, 157–163, – medical practitioners164, 222–224, 168–170,177,179f.,188f.,192–194, 226f.,229, 242, 244, 247–249 200,280f. – polygamy34, 96–100 Ibn Taymiyya(d. 728/1328)38–40, 42, 45, – sabbath 13, 98, 263 67,70, 74 f.,80, 102, 209 – virginity tests 172, 174 Ibn Tufīl, Sa‘īd(d. 279/892) 181f. Jouanna, Jacques 165 Ibn Ṭūlūn, Aḥmad (d. 270/884)181f. Jundīshāpūr148, 223 Ibn Ṭ ūlūn, Shams al-Dīn(d. 953/1546) 209, 214, 218–220, 222 Kāsānī, ‘Alā’ al-Dīn(d. 587/1191) 40,44f., Ibn Zuhrfamily of physicians 127,136, 176, 52, 73 186, 190,197 Khadīja bint Khuwaylid (d. 619 A.D.)27 ‘idda (waiting period following end of amar- Khaṭṭābī,AbūSulayman(d. ca.388/998) riage) 33, 36f.,41, 56, 67–85, 88, 216, 220,228 90f.,112, 284 Khawāsṣ ̣ (items withspecial healing proper- Impotence 8, 31, 41f.,44f., 48, 52–56, ties) 147,149, 218, 221f. 89f.,97, 112, 117,161 Khayzurān, mother of caliphs al-Hādī and Informants and intermediaries Hārūnal-Rashīd180 – legal contexts 57,75f., 86, 89–91 Khurūj (excursions) and religious educational – medical 148, 180, 185, 191–195, 197– opportunities forwomen 253–265 199, 243, 281 Kueny,Kathryn1,11, 112, 120,146, 203 Inheritance 16, 19f.,68, 71f.,81–83, 87. 100–110,112, 279, 284 Legaltestimony 55, 60, 76–79, 82–91, Inhorn, Marcia 5f., 16f.,105, 161 222, 225–227,243, 278f. Injuries to the reproductiveorgans 35, 46, Lewis, Mary63 49–56, 58, 89, 105, 142 Lim, Hilary110 Innovation, see Bid‘a Lithotomy 187–189, 200 Insanity, see Madness Iversen, Erik 165 Madness8–10,38, 41f.,129, 153, 159 ‘Iyāḍ,Qāḍī(d. 544/1149) 75, 78 Magical healing and the occult 4f., 16, 83, 98, 163, 190, 210,214, 216f.,230,250 Jāḥ iẓ (d. 255/869) 223 – amulets 5, 160, 215, 23–235 Jaldakī, ʻIzz al-Dīnibn Aydamar (d. 743/ – objections to 216, 232, 235 1342) 171 – ruqya 215, 233 Jennings, Ronald 109 – squares 149 Jesus 233 – stones 147–149, 218 Jews and Judaism – written word231, 233, 235 – bathing and mikveh 246–248, 257,259, Mahr (dower payment from husband to 267 wife) 33, 36–38, 41, 76f.,96, 98f., – divorce15, 33f.,55, 69, 90,96–100 103, 105f.,258 – engaging in ruqya (healing using Qur’ānic Maimonides, Moses (d. 1204A.D) 97,127, verses) 233 259 – inheritance102 Majūsī (d. 384/994) 49, 119, 136f.,144, – interactions with Muslim women 244, 149, 159f.,162f.,195, 197,201 246–249, 267 Index 307

Mālik ibn Anas(d. 179/795) 42, 74,84, 213, – menopause 20, 44, 57,69–74,80, 93 233 – physiology 57,59, 61–68, 128–131, 153– Mālikī legal school 161 – dissolution of marriage38, 42, 46–48 – purification 26, 85, 259, 263, 266 – marriageand domestic life86, 255 – retention 49, 129, 140f.,152–161, 196 – medical and modesty matters48f., 52, Midwives 89, 213, 233f.,242, 247,249 – interactions with male medical practitio- – menstruation, ‘idda,and pregnancy 70, ners49, 119, 122, 159f.,175–200, 281 73–75, 78, 80,82, 84, 107 – practices 231, 258–260,263, 266f. – see also Ibn Abī Zayd al-Qayrawānī;Ibn – providinglegal testimony 57,83–91, 278 Ḥabīb; Ibn al-Ḥ ājj; Ibn al-Mawwāz; Ibn – non-Muslim238, 245–252, 269 Rushd; Ibn Sahl; ‘Iyāḍ,Qāḍī;Mālik ibn Minorsand youths Anas;Saḥnūn; Wansharīsī – boys 63, 133, 178, 186, 239–242, 250, Māriyyathe Copt (d. 16/637) 27 269 Markets 87,136, 170,177,209, 231f. – girls 26, 50, 53–63, 65–67,69, 85–87, Marriage4,18, 25f.,31, 35, 37,41, 53f., 96, 98, 102, 123, 125, 129f.,159, 179, 58, 65–67,72f., 77,85, 88, 95, 102– 193, 196, 277 104, 106f.,252, 254, 258, 277 Miscarriage29, 117,120,132, 142, 144, – companionship between spouses 12, 107, 146–148, 151f,193, 271 264–266 Modern Middle Easterncommunities – desirable attributes in aspouse 28–31 – Egyptian 3–6, 16f.,32, 65, 84, 105, 161, – disclosure of prospective harm to the other 258 spouse 31, 39f.,47 – Iranian 3–5, 93f.,251 –legal minorsand physicalmaturity – Iraqi 251, 258 53–56, 58–63, 65–67,85 – Jordanian 3, 109, 237 –medically recommended 129f.,153, 158f. – Lebanese 34 – remarriage20, 32, 54, 58, 67,71–80,86, – Moroccan 3f., 16, 83, 230, 251, 258 90f.,107 – Pakistani 106, 109 – see also Contraception; Divorce; ‘idda; – Palestinian 3f., 58, 60,109, 268 Mahr;Minors – Saudi 39, 237 Marwarrūdhī,Ḥusayn ibn Muḥammad(d. – Tunisian 3 462/1069) 37f.,85 – Turkish3f.,16 Māwardī (d. 450/1058) 39, 46, 51 Modesty,clothing, and nudity 13, 17,88, Medicine of the prophet see Prophetic medi- 180,185, 185–187,208, 213, 215, 237– cine 243, 247–267 Medicines and pharmacy 139f.,142f.,146, Motzki, Harald 59 148f.,169, 212, 224, 227,231 Mourning rituals, see Burial and mourning – see also Abortion practices Menarche, see Menstruation: menarche Muḥammad(Prophet) 13, 26–31, 211–213, Menopause, see Menstruation: menopause 215–217,219–221, 228, 232, 234f.,237, Menstruation 253, 260,264f.,274 – amenorrheaand irregular 8, 25, 57–58, – see also Prophetic medicine 67–84 Musallam, Basim 6f., 10,14, 31f.,134, 201, – fertility 29, 35, 49, 68, 141 280 – legal significance 25, 33, 36, 51,57–58, 66–81, 85f. Najāsāt (impuresubstances) 212, 227, – menarche 53, 57–68, 85f.,112 230f.,257,266, 269 308 Index

Nawawī,Muḥyīal-Dīn(d. 676/1227) 46, 51, Puberty 7, 59–67,86–87.129f, 239–243, 66f.,85, 238, 240,243 250, 277 Non-Muslims – see also Menstruation; Minors – see Christians and Christianity; Jews and Pulse-taking 176, 182, 197,281 Judaism Nuʻmān, Qāḍī (d. 363/974) 252 Qalyūbī,Shihābal-Dīn(d. 1079/1659) 70, Nutrition 10,59, 61–65, 146, 215 239–241, 250 Nuwayrī,Shihābal-DīnAhmad (d. 733/ Qarāfī,Shihābal-Dīn(d. 684/1285) 46, 48, 1333) 170f. 89 Qazwīnī (d. 682/1283) 170 Oaths 17f.,76f., 80–82, 88. 90,98f., 112 Qur’ān27, 78, 83, 94, 112, 118, 120,141, Orphans 66, 85f. 215, 219, 233–235, 245, 248, 261 Ovaries 132–136 Qurṭubī, ‘Arībibn Sa‘īd(d. ca. 370/980) 168, 170f. Parents, relationship with married daugh- ters55, 102–104, 107,253–255, 261 Ragab, Ahmed 210 Paternity 2, 4, 68, 83, 90,112, 278 Ramadan, see Fasting Paul of Aegina 49, 124f.,157f.,179f. Rapoport, Yossef 65f.,95, 102, 104, 106f. Peirce, Leslie 60, 103f.,109 Rāqid (sleeping fetus), see Pregnancy Pessaries 119, 139, 145f.,160, 171, 194, Rāzī,AbūBakr Muḥammad ibn Zakarīyā (Rha- 200 zes)(d. 311/923) 48f.,60, 119, 123f., Pharmacists 11, 149, 177,184, 218, 225 127,132, 134, 143, 147,149, 152, 157f., – see also Medicines and pharmacy 160, 162, 167f.,176, 195–197,229, 249 Phlebotomy, see Cupping and phlebotomy Ruhāwī,Isḥāqibn ‘Alī (fl. 3rd/9th century) Pleasureand sexual arousal 123, 162, 176, 184, 202 – among boys and eunuchs 245, 250 Ruqya 215, 233 – as aprerequisitefor conception 117,133, 140,150,156, 161 Saffārīnī,Muḥ ammadibn Aḥ mad(d. 1188/ – as amedical need 117,123, 130,150,154, 1774) 223, 227,231, 233 203 Saḥnūn(d. 240/854) 89 – as apurpose of marriageand marital Sait, Siraj 110 right 36f.,39f., 43, 95, 111 Sakhāwī,Shams al-Dīn(d. 831/1428) 65 Poisons184, 212, 216, 227 Saqatī,Muḥ ammad(d. 7th/13th century) 88, Polygamy 2–4, 20, 26f.,32–34, 57, 170f. 94–97,100, 105, 112f.,162, 278 Sarakhsī,Muḥammadibn Aḥmad(d. ca.490/ Pormann, Peter 176, 229f. 1096) 13, 72, 84 Powers, David 77,79 Satan 211, 223, 253, 271–274 Pregnancy Savage-Smith, Emilie 172, 199f.,213 – enslaved women 1, 84–89 Semen 117,133, 136–138, 141, 145f.,149, – legal claims 68, 80–84, 90–92, 112 153–155, 159, 161, 193, 280 – rāqid (sleeping fetus) 72, 83–84, 90f, – in women 149, 155, 159f.,161 106f.,112 Shādhilī, Ṣadaqah ibn Ibrāhīm(fl. 8th/14th – tests 132, 168–171 century)199f. – see also Childbirth Shāfi‘ī legal school Privacy 78, 85, 224f.,239, 244, 247f.,251 – dissolution of marriage37–39, 42, 45f. Prophetic medicine 6, 19, 207f.,213–219, – marriageand domestic life45f., 93, 107 221f.,227f.,233 Index 309

– medical care and knowledge 213, 219, Trousseaux 34, 55, 99, 102f.,279 237–242, 249f.,269 Tucker,Judith 88, 103, 111 – menstruation, ‘idda,and pregnancy 70, 73f.,84 Ullmann, Manfred 119f.,122, 124–126, –see also Adhra’ī;Bulqīnī;Ghazālī;Mar- 149, 175, 281 warrūdhī;Māwardī;Nawawī;Qalyūbī; ‘Umar ibn al-Khaṭṭāb(d. 23/644) 28–33, Shirwānī,Suyūṭī 39–43, 50, 71, 74,107,248f.,282 Shāfi‘ī,Muḥammad ibn Idrīs(d. 804/820) Umm al-walad, see Slavery and slaves 42, 45, 74,84, 107,219, 222f.,233 Urine inspection163f.,176, 185 Shaham,Ron 89f. ‘Utbī,Muḥ ammadibn Aḥ mad (d. 255/869) Shapland, Fiona63 81 Shatzmiller,Maya 102f.,108 Shī‘ite thought 34, 96, 105, 252 Vieille, Paul 4f. Shīrāzī,AbūIsḥāq(d. 476/1083) 46 Violence50–52 Shirk (polytheism) 232, 274 Virginity28, 30,34f., 48–50, 58, 66f.,86, – see also God and piety 90,130,156, 158f.,163, 170–174, 187– Shirwānī, ʻAbd al-Ḥ amīd(d. 1301/1884) 189, 243, 258, 280 240 Visiting the sick 252–257,260f.,268 Slaveryand slaves 1, 57,73, 87–89, 123, 169, 178, 238 Wansharīsī,Aḥmadibn Yaḥyā (d. 914/1508) Soranus of Ephesus (d. 2nd century A.D.) 37,50, 56, 75, 80–83, 85f.,89, 91, 103, 125, 134, 155f.,166 106f.,256f.,279 Spellberg, Denise 28, 271, 275 Waqf endowments 102, 106 StephanusofAthens (d. 7th centuryA.D.) Weddings 19, 90, 103, 173, 252–255, 258– 124, 166, 174 261 Sterility (in men) 47,54, 161 Wetnurses, see Breastmilkand breastfee- Surgery 49, 146, 165, 172, 179, 187f.,191f., ding 194, 199f.,281 Widows and widowers58, 69, 80f.,83, Suyūṭī,Jalālal-Dīn(d. 911/1505) 171, 213, 90–93, 99–103, 105–109, 130,155– 219, 247 160, 279, 284 Witnesses, see Legaltestimony Ṭabarī,AbūJa‘far(d. 310/923) 94f.,271– 273 Yazbak, Mahmoud 60f. Ṭabarī, ‘Alī ibn SahlRabban (fl. c. 246/850) 136, 143–149, 151, 156–158, 163, 167f., Zāhidī,Najm al-Dīn(d. 658/1260) 73 171, 197 Zahrāwī,Abū al-Qāsim Khalaf ibn ʻAbbās(d. Thousand and One Nights,The 3, 17,98 ca.400/1013)49, 146, 179, 187–189, 191f.,197,200,281