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SUMMARY. Medicine and disease in medieval Islam have thus far been approached
through theoretical medical treatises, on the assumption that learned medical texts are a
transparent account of reality. A question yet to be sufficiently explored is the extent to
which the ideas and theoretical principles they contain were actually carried out in practice.
This paper deals with the description of diseases occurring in a tenth-century Casebook
Not many years ago, a well-known historian of classical medicine wrote that 'at
certain times and places doctors appear to have depended upon literacy for the
improvement of their craft, the better organisation of its teaching, and the raising
of their own professional status. Yet the historian . . . is still left with the question of
the extent to which practice was modified by this literary activity.'1 This statement
is particularly appropriate to medieval Islamic medicine, since the practical aspect
of medieval Islamic medical care has thus far been approached and described
through its prolific theoretical writings, on the assumption that learned medical
texts are a transparent account of reality. Yet, while much ink has run on paper
about the achievements and practical dimension of medieval Islamic medicine as
depicted in academic treatises, case histories—the source more likely to give us a
hint of what learned medical practice actually involved in medieval Islam—have
until recently been largely neglected.
Case histories, reports of medical experiences, and a wide variety of clinical
accounts which defy precise categorization are valuable instruments for medical
historians to study medicine and disease at a particular period. The earliest extant case
histories appear around the fifth to fourth century BC, in the seven books of Epidemics
within the Hippocratic Corpus. Around the second half of the first century AD, Rums
of Ephesus left a collection of clinical accounts which have been preserved only in
* Universidad Complutense de Madrid.
' I. M. Lonie, 'Literacy and the Development of Hippocratic Medicine', in F. Lasserre and P.
M u d r y (eds.), Formes depensee dans la collection Hippocratique (Geneva, 1983), p. 145.
Arabic.2 In the second century AD, Galen included a number of case histories in
some of his works and also wrote a book in which he collected and described his
major clinical cases.3 No further case histories beyond these ancient clinical accounts
seem to have survived from Europe until the thirteenth century, when the Latin
tradition began to develop the medical genre of consilia.
In contrast to tenth-century Europe, from where no case histories appear to
have been preserved, the tenth-century Islamic tradition presents a rich body of
materials, from both eastern and western regions of the Islamic world. In this
paper, I will focus on clinical accounts recorded by the well-known physician Abu
Bakr Muhammad ibn Zakarlya' al-Razi , who died in AD 925. He was director of
straightforward manner in which they are presented suggest the daily conditions
encountered by a physician, Razi's Casebook actually constitutes an exceptionally
impartial source for studying medical practice. Moreover, it reflects Razi's actual
practice as opposed to his formal medical writings, which present theories and
ideas that may not always have been implemented. What then is the Casebook's
picture of medicine and disease in the Middle East in the tenth century? Does it
match the image represented in the theoretical medical literature?
The clinical accounts in Razi's Casebook are divided into thirty-one sections,
dealing with the parts of the body from the head downward, including several
chapters on specific conditions, such as dropsy, colic, fevers, or skin disorders, and
11
Ibid., fols. 2a-2b.
12
Ibid., fol. 68a.
13
Ibid., fols. 8a-9b.
14
Ibid., fols. lOb-lla.
Tenth-century Case Histories from the Islamic Middle East 297
regarding some conditions leads them to consider, for instance, diabetes as a disease
related to the kidneys, while some psychological affections are taken to be heart
conditions, and a breast disorder such as the following one is included in the
chapter devoted to chest conditions:
A woman presented whose breasts had become dark and one of which was hard, as though
it were a movable and protruding growth. He [Razi] said: 'This is a serious matter, since it
feels hot and isflushed;this heat is overpowering her and has unbalanced the humours. One
must draw the conclusion that the tumour is a cancer, but the cancer does not protrude, for
otherwise it could be extirpated.' He prescribed that she take one tnithqal of shabyar [a
soporific electuary] every night, that she wash and then anoint [the tumour] with oil of
sesame or violet. Diet—anything that moistens and soothes.15
15
Ibid.,fol.49a.
298 Cristina Alvarez-Milldn
and a woman who after delivering a child with profuse bleeding had a normal
menstruation and then bloodletting, as a consequence of which she was affected by
unsteadiness (khiffah), anxiety, and diarrhoea.
There is a section in the Casebook devoted to patients who have fallen down
while riding an animal or in the hammam—that is, steam bath—but none of them
presents any broken bones. Scattered throughout the work, we also find several
cases of cancer (saratan) affecting the eye, the stomach, the face, the back of the
neck, and one affecting the leg. Hernia (fatq) was apparently not a sufficiently
interesting or frequent occurrence to deserve a particular section. Five patients
complaining of other disorders, however, are said to suffer from that condition. In
16
Ibid., fols. 64a and 66b-67a respectively.
17
Ibid., fol. 63b.
18
Ibid., fol. 67b and 73b-74a.
19
It is interesting to note that no case involving rabies or bites by poisonous snakes or insects is
recorded in Razi's Casebook.
Tenth-century Case Histories from the Islamic Middle East 299
kidney and bladder disorders and on sexual intercourse', there is only one case of a
man who had lost his sexual appetite (faqad al-bah) and wanted a drug to cure it.
Pain in the joints is the next most numerous category, represented by about
50 cases. Most of these complaints are accompanied by other symptoms such as
constipation or diarrhoea, headache, fever, nausea, trembling of the hand, and
difficulty in breathing. The chapter also includes one case of sciatica (irq al-nisa')
and four cases of gout {niqris). Interestingly, in the title of this section the Medina
worm or Guinea worm (al-'irq al-madarii) is mentioned.20 This is a worm 50—70 cm
long that lives in the subcutaneous tissue of human beings. On maturity, the head
of the female breaks through the skin (usually of the lower leg) and discharges
26
Abu Bakr M u h a m m a d ibn Zakariya" al-Razi, Al-Taqsim wa-al-tashjjr: Taqaslm al-'ilal, edition and
French translation b y S. M . H a m m a m i (Aleppo, 1992), p p . 106—35.
27
Abu Bakr M u h a m m a d ibn Zakariyaf al-Razi, Kitab al-Mansun, Escorial, Real Biblioteca del
Monasterio, Arabic M S . 858, fols. 116b-120a.
28
See 'All ibn 'Isa al-Kahhal, Memorandum Book of a Tenth-Century Oculist, trans. C . A. W o o d
(Chicago, 1936).
29
A c o m p o u n d purgative remedy in w h i c h drugs o f a bitter taste are mixed w i t h aromatic drugs,
the main ingredients b e i n g aloe and c i n n a m o n ; see M . Levey, Early Arabic Pharmacology (Leiden,
1973), pp. 85-6.
Tenth-century Case Histories from the Islamic Middle East 303
combination of hiera with quqaya,30 and tryphera.31 Given the range of ophthalmic
conditions in Razl's Casebook, the variation of treatment from one patient to
another is actually quite small, for therapy seems to have been concentrated on
evacuation by means of venesection and/or cupping, and the use of purgatives,
light diet, bathing, and a rather small number of both simple and compound drugs.
Since it was argued that the proper treatment of all disease required the expulsion
of the humour at fault, these methods constituted the first line of treatment for
every type of disease.
The general characteristics of ophthalmic therapy apply to the entire Casebook. It
should also be noted that no surgery is recorded amongst Razi's case histories.
suffers a chronic (atJq) trachoma. A similar pattern occurs with regard to pannus,
which in theory must be removed surgically, while in practice is treated only with
compound drugs. Table 1 summarizes the therapies for trachoma and pannus that
are advocated in the two theoretical treatises, Kitab al-Taqsim wa-al-tashjir and Kitab
al-Mansurl, as compared with the therapies actually practised by RazI and recorded
in Kitab al-Tajarib.
For pterygium, in both his Kitab al-Taqsim and Kitab al-Mansurl, RazI
TABLE 1. A comparison of the therapies recommended and the therapies actually practised by Abu Bakr
Muhammad ibn Zakariya al-Razi
TRACHOMA
1 'red' collyrium 1 'red' collyrium 1 'red' and 'green' collyria,
regular application
2 'green' collyrium 2 'green' collyrium 2 venesection
3 egg white (at night) 3 venesection 3 purging
4 oil of rose (at night) 4 purging 4 steam-bath (hammam)
5 steam-bath (hammam), 5 steam-bath (hammam) 5 avoidance of certain
the next day foods
CHRONIC TRACHOMA
1 venesection (cephalic) 1 venesection 1 scraping
2 cupping 2 scraping, with tabarzad
sugar and a wardah
3 decoction of myrobalan 3 rinse with vinegar
(every two weeks)
4 eversion of eyelid and 4 application of chewed
rubbing with 'red' and cumin the next day
'green' collyria
5 no sleep with full stomach 5 yellow ophthalmic powder
(dhanir)
6 diet of prunes, apricots, 6 'red' and 'green' collyria
andjulep
TRACHOMA WITH PANNUS LIGHT PANNUS:
1 venesection (cephalic), 1 'red' and 'green' 1 excision
twice a month collyria
2 purging with myrobalan 2 basiTiqun coUyrium
and hiera
3 gargling with oxymel
and mustard 3 nirsana collyrium
4 sneezing 4 hot collyria
5 eversion and rubbing of 5 purging
eyelid with 'green' collyrium
6 washing with hot water 6 steam-bath, regular visits
7 a compound drug applied
to the eyes and temples
8 no sleeping with full THICK PANNUS:
stomach 1 excision, lifting
with needles and hooks
9 avoidance of heavy foods and cutting with scissors
10 another compound 2 application of cumin
remedy, applied at night water and yellow ophthalmic
powder
11 steam-bath (next day)
Tenth-century Case Histories from the Islamic Middle East 305
perhaps for the better organization of his teaching. Moreover, it is clear that Razi's
clinical accounts depict medicine and disease in a very different manner from that
of the theoretical treatises. The extent to which theory modified the overall
intuitive spontaneity of Razi's treatments is difficult to assess, but it appears to have
played a relatively minor role. What is certain, however, is that the analysis of case
histories enables new questions to be raised, old problems to be reformulated, and
theoretical writings to be interpreted from new standpoints.
Acknowledgements