Medical Practices, Middle East
Medical Practices, Middle East
The medical practices of the Middle East have a long history of interchange with the West. In the late medieval world a massive transfer of medical and scientific knowledge took place from the Arab-Islamic world to western Europe, while in the modern colonial period western European states medicalized many of the new states of the Middle East. Prior to the nineteenth century most of these places had not been constituted as countries, and much recent work in the history of medicine has concentrated on the imperial use of medicine as a form of repression and cultural subjugation in the creation of nation-states. Almost all of the Middle East—which is seen here as stretching from Morocco in North Africa to Iran—was occupied at some point in the nineteenth or twentieth centuries by imperial, primarily French and British, powers.
While the cultures of the Middle East evidently possessed distinct local medical practices, from the eighth century c.e. onward they all shared a medical culture that was based on three interlinking medical systems, whose composition varied from place to place and over time: Graeco-Arabic medicine, Qu'ranic medicine, and what Kathleen Malone O'Connor refers to as "vernacular medicine."
In the Medieval period Arabs and Persians were enthusiastic translators of Greek scientific knowledge. The term Graeco-Arabic medicine refers to the combination of Galenic and Hippocratic medical knowledge with indigenous Arabian medical beliefs, some of which were borrowed from Indian Ayurveda and other Eastern forms of medicine. Scientific learning was prized and promoted by the state in the Islamic world, which led classic Islamic physician-scholars, such as Ibn Rāzi, Ibn Sina, and Ibn Rushd, to refine and develop Greek medicine. Great emphasis was placed on diet, public health, and the connection between physical and spiritual well-being. This ethical approach to health fused with the growing field of Qu'ranic medicine, which advocated an approach to welfare that drew on the Qu'ran and the hadith (sayings) of Prophet Mohammed. In some cases this could involve the use of amulets inscribed with Qu'ranic verses, tinctures formulated from Qu'ranic ink, and prayer, but it also shared a belief in astrological medicine that was present in Graeco-Arabic healing. These treatments were supplemented by "vernacular medicine," which was primarily based upon pre-Islamic herbalism, and the science of pharmacology, which was very well developed in the medieval Arab-Islamic world.
Each of these forms of medicine shared an approach to health that stressed the importance of collective and individual efforts to prevent the spread of sickness, both through public health initiatives (such as hospitals) and the encouragement of righteous living. Arab-Islamic medicine was therefore profoundly holistic and it possessed a strong moral dimension, which is evinced in medieval literatures on medical ethics that discuss notions of justice, such as the question of whether it is acceptable for a doctor to charge for his services.
Many of the techniques and ideas of Arab-Islamic medicine were transferred to western Europe, often through Iberia, in an uncoordinated program of translation that transferred the knowledge generated by the "Golden Age" of Islamic science (1200 to 1600 c.e.). Texts such as Ibn Sina's Canon of Medicine became standard medical reference works across Europe, while the holistic ethos of Arab-Islamic medicine deeply influenced some European centers of medical learning, such as Montpellier. By the eighteenth century, however, western Europeans were confident that they had themselves developed a superior medical system. Known as scientific medicine, this was characterized by the emphasis on medicine's curative potential, often through surgical procedures, and was associated with Montpellier's great French rival, the Paris school of medicine.
Most Western colonists had little conception that the countries they occupied in the Middle East possessed complex medical cultures, let alone forms of medicine that had in fact played a formative role in the development of European scientific medicine. This European medicine was seen as a tool of progress that would reawaken the "primitive" cultures of the Middle East, and in most imperial ventures doctors played a large part in both establishing safe living conditions for the servants of the imperial state and in offering medical services that aimed to win over local populations. This process reached its apogee with the so-called médecins aventuriers in Morocco, who Maréchal Lyautey declared would "form the front-line of colonialism. In each settlement I will establish a native clinic…. Little by little, the gifts of civilisation will calm desires for independence" (Bidwell 1973, p. 16).
In neighboring Algeria, French doctors had played a large part in forging an Algerian state, often representing the only nonmilitary French authority with which Algerians came into contact. The French state promised Algerians a national health-service network that went beyond even the state's responsibility for medical provision in France, but budgetary constraints eventually led to Western medical knowledge being dispersed by competing groups of military, mission, and private doctors. The failure of this promise of universal healthcare, best seen in the tiny numbers of Algerians trained in medical professions, and the hostility of many Algerians toward drugs and vaccinations, which seemed to have little effect against the epidemics and plagues that ravaged the country, led to a disillusionment with Western medicine that was also apparent elsewhere in the Arab-Islamic world. A similarly nuanced approach to the reception of Western medical systems has been observed by Khaled Fahmy in his study of the development of a School of Midwifery in 1830s Cairo. Fahmy demonstrates how such training institutions represented both an extension of socioeconomic opportunity for Egyptian women and the means by which the modern state could gain greater oversight and control of its population. There were, however, states, such as Sudan, where Western medicine was seen in a more benign light, in part through the concerted efforts to recruit local doctors and to solve local problems.
Recent studies of eighteenth-and nineteenth-century Ottoman, Egyptian, and Persian medicine (see Murphey, Sonbol, Ebrahimnejad) have stressed the need to understand the medicalization of the Middle East as a complex process, in which both local and Western parties borrowed from each other, and where there were strong lines of continuity from traditional medical practices. This was especially evident in the case of medical education, where hospital-based training drew on the traditions of the maristans (traditional Middle Eastern hospitals) (Sonbol 1991, p. 6). Such education did, however, introduce novel notions of specialization, for whereas traditional Egyptian practitioners had often acted as doctors and herbalists, the Western system of distinctions between pharmacists, surgeons, and physicians became the regional norm (Sonbol 1991, pp. 44-45). With regard to Iran, Hormoz Ebrahimnejad goes so far as to assert that "the embryo of modernization in nineteenth-century Iran resided in the institutionalization of traditional medicine" (2004, p. 11).
Further illustration of this complex relationship comes in Daniel Panzac's work on the plague in this period. While plagues had been eradicated from western Europe by the eighteenth century, they continued to occur periodically throughout the Middle East. Panzac shows that the management of plagues in the Ottoman Empire was not only a central focus of the gradually more hierarchical exchange of medical knowledge between West and East, but also a major impetus for the establishment of international systems of disease management (in the form of quarantines and cordons sanitaires) that were forerunners of twentieth-century international health institutions.
On gaining independence all new states in the Middle East based their new, national medical systems on administrative models borrowed from the West. These systems were, however, much better resourced than had been the case in the colonial period, and in all of the Middle East there have been dramatic improvements in mortality rates and the near eradication of previously endemic diseases such as bilharzia and malaria. From 1950 to 1990, life expectancy rose from 41.8 years to 62.1 years in North Africa and from 45.2 to 66.3 years in West Asia, through a combination of improved nutrition, childhood immunization programs, improved water supplies, and increasing literacy (Barlow 1999, p. 3). As any visitor to a souk anywhere in the Middle East will see, Western, allopathic medicine exists alongside a continuing belief in traditional medical practices, such as herbalism, in a synthesis that precedes the contemporary West's interest in integrating scientific and complementary systems of medicine.
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