LEGACY OF ARABIC MEDICINE Female Patients, Patrons and Practitioners In the medieval Islamic world

– Written by Peter E. Pormann, UK

Women constitute roughly half the FEMALE PATRONS increased the endowment of the hospital population. This is true now as it must Patronage played a powerful role in the founded by Badr al-Mu‘tadidi (d. 902), have been during the heyday of the Islamic provision of health services. In ‘Abbasid the commander-in-chief of the caliph al- medieval period. The sources from this times, caliphs, viziers and other high- Mu‘tadid (r. 892-902). time, however, whether medical writings, ranking officials sponsored the building histories or works of literature, were mostly of hospitals, the digging of wells and in The Mistress written by men, for men. Male doctors one case even the improvement of access The most powerful woman in ‘Abbasid sometimes even vilified women and put to medical services in prisons and remote times, however, was Shaghab, the mother them into the same category as charlatans, areas. It was not only men, however, who of the caliph al-Muqtadir (r. 908-32). Her the proverbial ‘medical others’. It is therefore financed these charitable activities. Women son became caliph at the tender age of not surprising that the woman’s voice only occasionally rose to some prominence in 13 and remained devoted to his mother reaches us faintly across the centuries. And the palaces of the powerful. For instance, throughout his life. She turned the harem yet, by combining a range of variegated Khayruzan (d. 789) and Zubayda (d. ca. into a separate female court that influenced sources, we can tell an interesting tale 831), mother and wife, respectively, of the the fate and fortunes of the empire. The of how women sponsored healthcare as caliph Harun al-Rashid (r. 787-809), had harem stewardess, installed by Shaghab, patrons, how they provided medical care wells and drinking fountains set up in mediated between the different parties in various roles and how they received Mecca and Medina. Shuja‘, the mother and kept the lines of communication open. treatment. of the caliph al-Mutawakkil (r. 847-61), Shaghab wielded such tremendous power

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Image: Double page from Mugiz al-Qanun, an Arabic medical text concerning a commentary on Ibn Sinia'sal-Qanun. Wellcome Library, London. Wellcome Images. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0.

that she was simply called the ‘Mistress’ (al- could not abide by the idea of a woman perceived biological limitations, some Sayyida). determining the affairs of the state. In the women such as Shaghab, the Mistress, rose The Mistress also enjoyed significant end she met with a cruel fate. After the to power and influence. Others practised income from land holdings that she death of her son she was imprisoned and medicine and offered medical care in obtained from her son, the caliph, and that tortured and died shortly after her release. various ways. she continued to buy up. As these holdings More generally speaking, physicians and increased, she required her own accounting philosophers in the medieval Islamic world WOMEN PRACTITIONERS office (diwan) to administer them. This regarded women as inferior, as did their If we peruse the histories of medicine wealth enabled her to embark on a vast Greek predecessors and their Christian written during the medieval Islamic period, programme of philanthropic works. She contemporaries. This can be exemplified by we find very few women. For instance, in his set up a number of pious endowments the view expressed by a 10th century author monumental history of physicians, called (awqaf), notably to help the poor during of a text on medical anthropology, called Essential Information about the Classes the pilgrimage to Mecca. One of these Abu Ja‘far Ahmad ibn Abi l-Ash‘ath (d. 970). of Physicians (‘Uyun al-anba’ fi tabaqat endowments funded a hospital that she He described women as the weaker gender, al-atibba’), Ibn Abi Usaybi‘a (d. 1270) only founded. At her behest, Sinan ibn Thabit (d. saying: mentions one female doctor (tabiba): the 931), a prominent intellectual and physician, “For the creator, great and exalted, did legendary Zaynab, physician of the Banu set up the ‘Hospital of the Mistress’ not intend women to have wisdom, nor to Awd tribe, who is said to have treated (Bimaristan al-Sayyida) in the area of John’s engage in arts, crafts and agriculture, nor ophthalmia. Even if women are largely Market (suq Yahya) on the bank of the River to protect the cities and the lives [of their absent from medical historiography, we Tigris in Baghdad. It opened its gates on inhabitants]. He only intended them for know about them from indirect sources. 14 June 918. The Mistress contributed to the purpose of procreation; therefore, their In pre-Islamic and early Islamic poetry, the physical well-being of the population mixture is most appropriate for reproduction we can find examples of female carers. through these acts of Islamic charity1. and procreation2.” One warrior boasts that he has left many Yet, even during her lifetime Shaghab Women were not, however, content opponents behind who are mortally was often vilified; the male elite simply with just producing babies. Despite their wounded and describes the scene of women

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trying in vain to cure them. Another warrior lambasted women for their incompetence competent woman doctor. As these are very brags that he does not care that the wounds and tried to persuade his readers not to uncommon, if you are without one, then he inflicted make a female physician (asiya) consult them5. seek a eunuch doctor as a colleague or bring shudder. Moreover, in the Tradition of the Documents from later times, and a midwife experienced in women’s ailments Prophet, the Hadith and the Sunna, we find especially Egypt, also show that there were or a woman to whom you may give some occasional reports about female carers. In some female physicians (tabiba). In one case, instruction in this art. Have her with you and the entourage of the Prophet Muhammad, a papyrus preserves a letter by a mother bid her to do all that you instruct7.” women such as Umm Qatiya or Umm to her daughter with medical advice; the This quotation highlights not only the Sulaym provided medical care to his male mother writes: rarity of fully trained female surgeons, companions. Incidentally these instances “I had written to you, my beloved but also the woman’s experience in being then provided a precedent for medical daughter, a letter before this one and sent treated by a male doctor. Although we contact between men and women in the with it a paper [cone] containing a remedy mostly do not know the details of how Islamic legal tradition: provided that there for your stomach. Write to me that you have women treated other women and men, we was necessity (darura), men could examine received [it] and that my letter has reached possess more information about how male women intimately and vice versa3. you, that you have drunk it [sc. the remedy] practitioners treated female patients. Literature can also serve as a source. and benefited from it. Write to me, so that The mesopotamian judge and litterateur I can be in good spirits [again], for [at the FEMALE PATIENTS al-Tanukhi (d. 994) relates the episode of a moment] I am extremely worried about you. Examination by male physicians man who contracted a disease that resulted I ask God to grant me relief6.” Al-Razi wrote a letter to one of his in pustules on his leg. As the man is in This is a poignant testimony to the fact students in which he admonishes a young the countryside and no male physician is that many women, whether as mothers, protégé about to embark on a high-flying available, he consults an old woman who wives, aunts or neighbours, provided career that will lead him to the palaces of the uses magic to treat him (‘ajuz tarqi fi hadha). medical care to their family and relations. powerful. Al-Razi lays down some general The old woman not only uses magic, but The Christian physician Sa’id ibn al-Hasan guidelines as to how to behave at court, also applies a dressing made of myrtle and (d. 1072), however, deplored the fact that but also offers specific advice about how to oil to the affected spot. She enjoins her people generally sought the counsel of interact with female patients. He says: male patient to leave the dressing for three their female relatives and neighbours and “Know, my son, that the physician ought to days. He does as he is bidden and when he exclaimed that it is a wonder that anybody be gentle to people, preserve their confidences takes off the dressing, the pustules have got cured at all. Yet this is again evidence and guard their secrets, especially of those disappeared4. for the fact that it was women who often in whose service he is. Someone may suffer provided most of what modern historians of from a disease that he hides even from his Male views on women practitioners medicine call bodywork – the basic medical most intimate friends and family such as his Old women such as the one mentioned care needed in so many instances. father, mother or son. They keep it secret from by al-Tanukhi, were not always viewed with All in all, however, we have very these close connections, while they necessarily a favourable eye by their male competition. little information about these female share it with the doctor. If he treats one of the Different male authors lamented the fact practitioners. In Muslim Spain (al-Andalus), women, slave girls or slave boys, he ought to that patients often sought the advice of the great physician and surgeon al-Zahrawi keep his glance in check and not stray past such women in cases of medical problems. (fl. ca. 1000) complained about the difficulty the location of the disease. The doctor Galen For example, Abu Bakr Muhammad ibn caused by this lack of female doctors. When said in his testament to his students – and Zakariya’ al-Razi (d. 925) wrote a (now lost) discussing the surgical removal of bladder upon my life he was right – that one should treatise with the eloquent title: Epistle on stones, he says: surrender to God and avert one’s eyes from the reason why the ignorant physicians, the “The treatment is indeed difficult and is women endowed with beauty and good looks common people, and the women in the cities hindered by a number of things. […] You will and abstain from touching any part of their are more successful than men of learning in not find a woman who will expose herself to bodies. If he wants to treat them, he should treating certain diseases, and the physician’s a [male] doctor if she be modest or married. focus on the place of the proposed treatment excuse for this. Additionally, in his Treatise on […] You will not find a woman competent and not let his eyes wander to the rest of her the causes why most people turn away from in this art, particularly not in surgery. […] body8.” excellent physicians towards the worst ones, If necessity compels you to undertake this Al-Razi’s advice could not be clearer – only preserved in Hebrew, he repeatedly kind of case, you should take with you a the physician should avoid any indecent

658 behaviour when dealing with female as she is now well. This episode not after delivery. In one case, the placenta patients. He justifies this injunction with a only highlights the shame that female did not come out during birth, in two reference to Galen (d. ca. 217), the great Greek patients could feel when examined by others the patients suffered from excessive doctor. male practitioners, but also the problems bleeding and in another there was reduced Al-Razi observed that patients perceive that the latter faced when doing so: they menstruation. An excess of menstruation some diseases as so shameful that they do had to avoid any hint of impropriety, for or the absence thereof occurs quite often. not even talk about them with their closest otherwise they would have incurred the One patient had fits of raving madness family. Al-Tanukhi relates a story that can censure of the woman and her family9. like an epileptic during her periods of illustrate this point. Once, the daughter menstruation and another had secreted of a high-ranking official suffered from a Case histories mostly watery blood. In a few cases, women pain in her private parts. This pain worsens A major source of how actual women sensed that their menses moved up in their over time. At first, she tells no-one, but as were treated is al-Razi’s case histories as body. One woman is reported as having an things get worse, her father notices that they are preserved in his Book of Experience illness during pregnancy, whereas another something is wrong and she confides in (Kitab al-Tajarib). From them, it would suffered from constipation, leading to a him. He too does not immediately seek appear that women routinely consulted pain that goes up from the belly to the medical help and only turns to a (male) male physicians. Here we find some back. Finally, in one case, a woman had an physician when his daughter is at ‘death’s general topics where more case histories ulcerous swelling in her womb. door’. The physician then first talks with of women than of men are related – in One issue that preoccupies patients the girl, taking her history. Through the case of headaches and migraine, for then and now is fertility. Al-Razi discussed clever deduction in a Sherlock Holmes- instance, he lists 11 female and 10 male it in his Doubts about Galen. Basically, like fashion, he discovers that the reason patients and their complaints. One chapter Galen thought that only women could be for her pain is a tick. The physician asked on ailments of the womb exclusively deals responsible for infertility. Al-Razi disagrees the father to allow him to see the spot with women, listing 26 cases. Sometimes, with Galen’s opinion: and examine it. After some hesitation he women complained about burning, pain “This is not true… I have seen many such consents to the examination, given the or roughness in their private parts or men [suffering from infertility] who changed dire circumstances. The physician has the about discharges (e.g. yellow liquid or women often out of a desire to procreate, girl pinned down and removes the tick. just a liquid). A number of times, women but that was of no use to them. One of them She then asks that he leave immediately, consulted al-Razi because of complications bought slave girls according to my advice,

it was women who often provided most of what modern historians of medicine call bodywork – the basic medical care needed in so many instances

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so that they would be opposite to him in the criticism of men. Likewise, as providers had access to elite male practitioners such mixture. I had a indefatigable neighbour of healthcare, the medical elite sometimes as al-Razi. They obviously felt shame when with a warm and moist mixture. He went to viewed them with an unfavourable eye intimate examinations became necessary, great lengths in changing slave girls, but to and resented the competition. This difficult yet even these were occasionally carried no avail10.” situation was not unique to the world of out by male physicians. The literature also This passage is interesting for a number Islam. After all, Galen developed a medical suggests that women consulted al-Razi and of reasons. It shows al-Razi critically anthropology that partly explained women’s his colleagues in cases of female conditions engaging with Galen, but it also offers inferiority by their sexual organs, and doctors such as those relating to menstruation and an interesting vignette of elite social life. – among them Ibn Abi Ash‘ath – adopted childbirth, and the same could be said for Owing to his experience, al-Razi knows these and other misogynistic Greek ideas in questions about lactation. Yet women also that some men are infertile, no matter who their conception of women. Moreover, the provided advice in medical matters to other their partners are. The Galenic concept of segregation of women could lead to a limited women, both orally (as one can deduce from opposite mixtures, however, makes rich access to (male) medical care, as their bodies comparative anthropological studies) and in men hope to be able to find a slave girl with were controlled by men. writing. In this way, a complex picture of the whom they could have a baby. This somewhat bleak picture should not place of women in the medical marketplace detract from the fact that it was women who emerges in the medieval Islamic world. CONCLUSIONS provided the majority of bodywork – they Although marginalised, they could occupy Women faced significant difficulties as cared for the members of their family in such a prominent position that male doctors patrons and practitioners. When they rose to case of illness and some could offer efficient became quite alarmed by their female power like the Mistress Shaghab, they incurred cures to the wider public. Many women also competition.

Further Reading Feminine: Women in Arab Sources. Tabib (The Ethics of the Physician). Cairo: 1. Peter E. Pormann. Islamic Hospitals in the London, New York: I. B. Tauris 2002. p.129- Maktabat Dar al-Turath 1977. p.27-29. Time of al-Muqtadir. Ed John Nawas In: 148, on p. 140-41. 9. Julia Bray. The Physical World and the Abbasid Studies II: Occasional Papers of 5. Peter E. Pormann. The Physician and Writer’s Eye: al-Tanukhi and Medicine. the School of ‘Abbasid Studies, Leuven, 28 the Other: Images of the Charlatan in In Bray ed. Muslim Horizons: Writing June - 1 July 2004. Orientalia Lovaniensia Medieval Islam. Bulletin of the History of and Representation in Medieval Islam. Analecta 177 (Leuven; Dudley, Mass: Medicine 79 (2005), 189-227, reprinted in London: Routledge 2006. p.215-250, on Peeters: 2010). p.337-82. Reprinted in Pormann, Islamic Medical and Scientific p. 224-6; reprinted in Pormann, Islamic Islamic Medical and Scientific Tradition, Tradition, ii. 203-39. Medical and Scientific Tradition, i.343-80, on p.353-355. Critical Concepts in Islamic Studies. 6. Ed. Yusuf Raghib, Marchands d’étoffes du London: Routledge 2011. i. 136-78. Fayyoum au IIIe/IXe siècle d’après leurs 10. Ed. ‘Abd al-Gani, Mustafa Labib, Kitab 2. Oxford, Bodleian Library, MS Hunt. 534, archives (actes et lettres), Supplément al-Shukuk li-l-Razi (t. 320 h. / 932 m.) ‘ala fol. 402a, lines 6-8; see Remke Kruk, aux Annales islamologiques: cahier nos. kalam fadil al-’atibba’ Jalinus fi l-kutub ‘Ibn abi-l-Ash‘ath’s Kitab al-hayawan: 2, 5, 14, 16, 5 vols (Cairo: Institut français allati nusibat ilayhi (Cairo, Dar al-Kutub a Scientific Approach to Anthropology, d’archéologie orientale, 1982-96), vol. 2, nº wa-al-Watha’iq al-Qawmiya, al-Idara Dietetics and Zoological systematics’, 28, lines 3-5; see Joel. L. Kraemer, ‘Women al-Markaziya li-l-Marakiz al-‘Ilmiya, Zeitschrift für Geschichte der arabisch- Speak for Themselves’, The Cambridge Markaz Tahqiq. islamischen Wissenschaften, 14 (2001), Genizah Collections: Their Contents 119-68; reprinted in Pormann, Islamic and Significance, Cambridge University Medical and Scientific Tradition, ii. 342- Library Genizah Series 1. Cambridge: 384. Cambridge University Press 2002. p.178- Peter Pormann M.A., M.Phil., D.Phil., 3. Peter E. Pormann. Islamic Medicine 216. F.R.A.S. Crosspollinated: A Multilingual and 7. Albucasis On Surgery and Instruments. A Multiconfessional Maze. In: AA Akasoy, Definitive Edition of the Arabic Text with Director of the John Rylands Research JE Montgomery, PE Pormann eds. Islamic English Translation and Commentary. MS Institute and Professor of Classics and Graeco-Arabic Studies Crosspollinations: Interactions in the Spink, GL Lewis eds. Berkeley/Los Angeles: Medieval Middle East. Oxford: Oxbow University of California Press 1973. p.420- School of Arts, Languages and Cultures 2007. p.76-91. 21 (translation slightly modified). University of Manchester 4. Nadia Maria Al-Cheikh. Women’s 8. Al-Razi, Risala ila Ba‘d Talamidhihi Manchester, UK History: A Study of al-Tanukhi. In: M (Letter to One of his Students), ed. ‘Abd Contact: peter.pormann@manchester. Marín, R Deguilhem eds. Writing the al-Latif Muhammad al-‘Abd, Akhlaq al- ac.uk

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