Philosophy-RAG-demo/transcriptions/HoP 127 - Peter E Pormann on Medicine in the Islamic World.txt

 Hi, I'm Peter Adamson and you're listening to the History of Philosophy podcast brought to you with the support of King's College London and the Leverhulme Trust, online at www.historyoffilosophy.net. Today's episode will be an interview about philosophy and medicine in the Islamic world with Peter E. Poorman, who is Professor of Classics and Greco-Arabic studies at the University of Manchester. Hi Peter. Hi Peter. Thanks for coming on. Perhaps we can start by talking about the sources of medicine in the Islamic world. Would it be fair to say that the situation is similar to philosophy and that the main sources are Greek? Indeed they are. So the two big authorities, the two names that are mentioned over and over again in the Islamic tradition are on the one hand Hippocrates and on the other Galen. But then there are some lesser known physicians such as Rufus of Ephesus who dies around the year 100 and then there is for instance Paul of Aegina, a seventh-entry physician who worked in Alexandria and presumably because of his name hailed from the island of Aegina which is just opposite Athens or Piraeus. But generally speaking when it comes to the medical tradition, humoral pathology, the idea that blood, phlegm, yellow bile and black bile when in balance create health and when in imbalance create disease, this humoral pathology, this idea basically dominates the Islamic tradition and that's a Greek idea which we first find in the Treatise on the Nature of Men by Hippocrates which was then adopted, so that's the fifth-entry BC, which was then adopted by Galen, the physician who lives roughly from 1 to 9 till 216 AD and this physician Galen wrote a commentary on it and he adopted and adapted that humoral pathology and that's the cornerstone of medicine as it developed in the Islamic world. I suppose that most of the medical authors who are working in Arabic are at the mercy of the translators, I mean not Hunan and Nisak who is one of the most important translators of medical works into Arabic, but most medical authors would have just had to work with the Arabic versions that were given to them by the translators. Yeah that's correct, I mean it's not entirely correct for the ninth-entry so we have somebody called Attabari who probably knew Syriac, there's somebody called Ibn Sarabiyyun in the late ninth-entry who writes in Syriac and then is translated into Arabic, so some people would have had a notion or a knowledge of Syriac because they're Christians or some people would have a notion or some knowledge of Greek, although for the vast majority and certainly the most important figures that is true, so the people of whom we know and whom we admire, kind of the luminaries of the Arabic medical traditions, people like Ar-rezi, Ibn Sina, Avicenna and others, they totally relied on the translations. And even the Arabic technical terminology that's used in medical works is to some extent based on Greek technical terminology just like in philosophy? Yes and no, so basically there were three procedures or three ways in which the Greek vocabulary was adapted and adopted, so the first is just to translate one term with another, so the concept of mixture, you know kras is in Greek, it's very important, so how are the humors, these four humors mixed, now that's called mizaj in Arabic, that's an Arabic term, maybe has also a cognate in Syriac, but I mean like it's a good Arabic word. So other terms then are translated as what we call calques or loan translations, for instance there's a disease called alopecia, alopecia, you know the disease literally of the fox alopex, which is basically a loss of hair, which you Peter might be familiar with, and now this disease alopecia is then translated into Arabic as da'athalab, so literally the disease of the fox, so alopecia, kind of the fox disease in Greek becomes the disease of the fox in Arabic, that's a loan translation, and for this obviously the Greek word structure is important, and then sometimes we have just transliteration, take prunites, you know a brain fever, a disease which is sometimes nowadays associated with meningitis, that is often just transliterated, pharanites, and that's a procedure which also occurs, but in all these three cases, whether it's just you know like replacing a Greek word with an Arabic word, or finding a loan translation, or just transliterating the word, the Greek concepts are important that are behind that. To what extent do you think we're being misled by the fact that mostly what we've got access to here is these very learned texts which are grounded in this translation movement, I mean on the ground was a lot of the medical care that people were actually receiving, was it actually influenced by Greek medicine, or is this more like a literary tradition? Well it is both, so on the one hand you have a massive translation movement in the 9th century about which you talked in an earlier episode, and that obviously, so these translations, these texts are very important, but on the other hand you have a tradition on the ground, so even in pre-Islamic and early Islamic poetry you find certain Greek technical terms mentioned, now that doesn't depend on a learned tradition, that's just because the Arabs lived in close contact with the Greeks or with the Byzantines and took certain ideas and concepts over from them, so it's not just one channel, you know, so the practice is important and the theory is important, but what did not happen is just that the text got translated and then all of a sudden some Arab author first reads them and then kind of applies the principles, you know like there is a tradition, there are physicians for instance, Christian physicians who practice medicine, who draw on these texts and who are then imitated, so one thing which is very important is the curriculum at Alexandria in late antiquity, that is more or less adopted wholesale in Baghdad in the 9th century, so there's on the one hand transfer of knowledge, but on the other hand then there is innovation and there are new ideas that stem from or that are built on this fundament, on this basis of Greek human pathology. That's actually the next thing I was going to ask you, what sorts of innovations or discoveries were made in the Arabic medical tradition? Well there are numerous innovations and that's first and foremost a very important point. I'd just like to give you a few examples from different areas, so for instance the first anatomical illustrations of the muscles of the eye which we have occur in an Arab manuscript in Hunayd ibn Ishaq's text, the Ten Treatises on the Eye, so there you find the first illustration of, you know like an anatomical illustration, so you know perhaps they're Greek antecedents and we don't have them, but for us as far as we know this is the first manuscript where we see it, it's by the way Cairo Tiptai Maud 100, so it's nowadays kept in Cairo in the National Library there, so that's one thing, you know illustration, anatomy, another thing is the discovery of new diseases or the differentiation between diseases about which people did not know beforehand, so Hunayd ibn Ishaq, the translator and physician who dies in the 870s for instance, describes in his work on eye diseases a condition called panus nowadays, P-A-N-N-U-S, sabal in Arabic and it's basically an overgrowth over the eye and this is a condition which was not known or which we do not find in Greek sources and which for the first time is described in this text, so new diseases are discovered or Ar-Razi, Abu Bakr Muhammad ibn Zakariya Ar-Razi who dies in 925 roughly distinguishes between smallpox and measles for the first time, a distinction not made in earlier Greek sources, so you know new diseases are described but also new therapies are found, so obviously the Greek recipes you know like a very important Galen and Dioscorides, an author who lived in the first century AD. You mean drug recipes for medicines? Medicines yes, so again Dioscorides in the in the first century AD and Galen in the second century AD write on simple drugs, write work on simple drugs and Galen also on compound drugs, so many many recipes, a lot of information how individual medical substances, the so-called simple's work you know and that is translated into but it's not just people just take the recipe and don't do anything with it, so the recipes are further developed, it's like a cook who can't you know who can't refuse the temptation to innovate when he sees a recipe, similarly in like a lot of recipes are altered and also a lot of drugs come in from the east for the first time. The last innovation which I'd like to mention is the hospital, obviously there were Byzantine hospitals but when we come to the Arabic world, the ninth and tenth century, these institutions are much more sophisticated, they have teaching, they have research, they are secure in law, they have elite medicine practice there, so the best physicians practice in hospitals and some of them at least are you know like not confessional, so Christian Jews and Muslims equally practice there as physicians and come there as patients, so also on the social level there's a lot of innovation. Right, so the next time one of us is in hospital then we should give thanks to the Arabic medical tradition. Well I mean we could say that some of these innovations foreshadow modern developments but it's always difficult, one should always resist the temptation to find the present in the past. Well said, nice aphorism to go along with the epocrates' aphorisms. One disease you've worked on quite a bit is a disease that was recognized in the ancient tradition but the understanding of it was developed further in the Arabic tradition and this is melancholy, can you tell us a bit about that because I think it's philosophically interesting. Yes, so melancholy is a disease which has different manifestations and melancholy or the word the Greek word melina huile from which melancholy is derived actually means black bile, so melancholy is the disease of the black bile and the different types of this disease and the Greek physician who was really the most influential for the subsequent tradition is Rufus of Ephesus whom I mentioned earlier who lived around the year 100 AD and he wrote a treatise on melancholy and he distinguishes for instance between innate melancholy and acquired melancholy. Some people are just melancholic by character or by disposition but they have too much black bile and they have certain tendencies and some people acquired and the disease manifests in different ways. I mean nowadays when we say somebody's a melancholic it just means you know he has the blues you know so he's sad or whatever but melancholy in those days was really a form of madness so you have delusions so for some people thought they are made of parchment and they're you know like they're so dry that you know if somebody touches them they're brittle other thought they were made of porcelain and they could be you know crushed and crumble other people thought that they that Atlas who holds the world on his arms could get tired and then the the sky would fall or the world would crumble and they were afraid of that there's a famous case of an astronomer who thought that some thought they were cocks you know like basically chicken and cried like chicken and flap their wings like chicken so some became aggressive and would attack people other became despondent many people died from this disease so it's a huge huge spectrum of symptoms which come under melancholy which is kind of a kind of madness and it is caused by an axis of black bile and there are various ways and I won't go into all the details but melancholy is interesting because it really poses the question how does my bodily constitution influence my mental capacities so right which is obviously a matter of great importance to philosophers as well as the doctors yes and that brings us to someone you've mentioned who actually I talked about on the last episode of the podcast is Razi yes and he was both a doctor and a philosopher and I would say is unusual in that we have quite a lot of medical writings of his some philosophical writing so along with Avicenna he's a thinker for whom we have both sides represented to what extent would you say that his medical output is in tension with his philosophical output well I mean let's take for instance the topic of sexual intercourse you know obviously we all want to stay healthy and we all want to stay happy or happiness is a philosophical goal whereas health is a medical goal in some of his philosophical works for instance you know his philosophical way of life you know Razi advocates that sex is bad for you and under no circumstances should you engage in or seek sexual pleasure obviously he stands in a long philosophical tradition I mean even epicureans were wary of sex but certainly the Stoics were and others were too they just said you know like don't seek the pleasures of the flesh because they are transient and they might go away or they might last only four short period of time or they might give you grief you know try to find pleasure in things which are longer lasting so this is a position which has become nearly commonplace by late antiquity and which are Razi adopts in his philosophical works but when it comes to medicine and he writes a number of manuals I mean he writes two manuals on sexual intercourse he has a more nuanced position he says for some people sex is actually good and that can have medical benefits for instance in order to combat melancholy you know sex and entertainment too and wine drinking wine in moderation are things that are advocated in order to overcome melancholy and he recognizes that and so his philosophical position is very strict this medical position is very nuanced and I always thought there is this wonderful phrase where he says for some people sexual intercourse is actually beneficial I always thought that he was thinking of himself as being in that category but of course I'm speculating wouldn't be surprised another area where I think his medical output is interesting philosophically is what he has to say about methodology and in general I suppose that one of the more obvious places to look for philosophically interesting aspects of medicine in Greek in Latin and in Arabic is when they start talking about how doctors go about discovering new remedies identifying diseases and so on yeah what is Razi have to say about that oh a very very interesting figure in that that area so obviously you're right in saying that nowadays we still debate how can we discover drugs you know now we have double-blind trials and we have a huge you know literature and a lot of thought is going into the question how do we know that a drug works we think of the placebo effect you know how can we exclude that and so on so forth obviously what happens in in the ninth and tenth entry what happens with our eyes is not quite as sophisticated but there's a fundamental debate about how to arrive at the right treatment already in Greek times Galen writes on the sex for beginners Galen again in the second century AD is a different kind of sex so this is not on sex for beginners sex for beginners and lest I pronounce this incorrectly and he says that there are basically two important sects there's a third one the method is but they don't need to the concern us here there the empiricist to say let's do what works you know if we see that a drug works we don't have to ask why or what the inner bodily functions are it's too complicated we will never be able to ascertain that so let's do what works and then the rationalists and they say okay let's think about how the body works the humus fonts and other things and then because we understand how the body works we will be able to to find the right treatment now this is a debate of which are as it was aware and to which he contributes so he obviously knows about empiricists and rationalist and he like Galen adopts a middle ground he says you know empiricism alone certainly will not help us but nor would just book learning without you know using other principles help us so he occupies a middle ground like Galen and there are things in which he's very innovative for for instance when talking about phrenitis brain fever mentioned earlier during when I talked about translations when dealing with this condition he said that once he tried to bleed to phlebotomize likes to bleed one group of player patients and they did not contract the disease and then he left another group of patients deliberately and did not bleed them so we have the notion of a control group which we really find for the first time in our Razi obviously they're not randomized controlled trials as we have them nowadays but that's a quite a sophisticated way of doing things at another time he talks about statistics he talks about large chords of patients so in different ways so to speak he finds means to he finds ways to refine that that theory about medical epistemology which he in he inherits from the Greeks and there to hit innovates one thing that makes clear these kinds of examples is that Razi was really a medical practitioner he saw lots of patients he worked in hospitals and looking ahead to another philosopher who I haven't covered yet but I think we should discuss because he's so important in the history of Islamic medicine is Avicenna some people have thought that Avicenna unlike Razi wasn't particularly involved with medical practice but really was more of a book learning figure in the history of medicine very important as a transmitter of ideas about medicine but maybe not someone who actually had a lot of hands-on practice with patients to what extent do you think that that is true well I mean Avicenna was first and foremost a philosopher and a great intellect but I don't think I don't believe in these either-or scenarios you know like just because he was mainly in like so let's say his canon of medicine is mainly in like a book in which he condenses previous Greek and Arabic medical theory and arranges it very intelligently so that's for me also an area of innovation you like the arrangement of knowledge by division by the principle of division in a very very interesting way but that doesn't preclude that he had some medical experience so there are some 30 times in his Canon where he says you know I tried this or I you know you confirmed this by experience or whatever and they are like some stories in various sources in his biography but also in the later text talking about his life which confirmed that he was a practicing physician and I don't think that we have any I mean that there's any doubt that he practiced some medicine you know it probably wasn't what he did most of the time but he certainly had to practical experience now in his autobiography he boasts that at the age of 16 he had already meant mastered all of medicine it was a very easy subject and so on and so forth that is rhetoric and that's a philosophical stance and there's external evidence which shows that he actually learned from other earlier physicians later in life so I think I personally think and I have argued this in print in one of your forthcoming books that Avicenna is both a great theoretician but also has practiced medicine there's no doubt about it so actually maybe we could even say that he's sort of the reverse of Razi Razi is basically a doctor but also does some philosophy I've assigned as basically a philosopher but also does some medical practice well I think you say this because most of our Razi philosophical writings are lost I mean it is true to a certain extent but Razi was labeled as indeed an apostate all you know like an unbeliever and the later tradition wasn't very kind to his philosophical writings so I think if we had more we would appreciate his philosophy more but generally speaking I think that's that's right while we're on the topic of Avicenna I wanted to come back to something you mentioned earlier which is that in this tradition it's common to think about psychological states as being somehow dependent on states of the body and one area where this arises is that Avicenna associates various psychological faculties things like imagination so on with organs of the body and in particular the brain so could you say a little bit about that well I mean Avicenna has this theory of the five inner senses so each sense you know in outside sense like side to each outside faculty of sensation that corresponds in like something in the brain and it is situated in the brain and it's a difficult topic because again in his medical work in his philosophical works he formulates that theory slightly differently but what is clear is that he situates these faculties inside the brain and so that he tries to come to some understanding of how the I mean how the interface so to speak between the soul or the mental faculties and the physical faculties of sensation work and I think that his his take on this is actually quite a bit of a departure from what happened before because like the common sense for instance was already found in Aristotle but what he makes of it and the way he describes it is and how he links it to the five the five outer senses to the five in the senses is innovative but that's probably something you know more about than I do so you should actually maybe I'll talk about it more when I get to Avicenna and I'm talking about his psychology before we end I just wanted to give you a chance to say more generally where is the state of research into this whole field I mean is it in its infancy or is there a lot still to be done researching Islamic medicine well we stand on the shoulders of giants of course so they are the generation of my teachers have produced a wonderful and brilliant work I mean convention Manfred Ullmann Emily Savage Smith Remkrit Kreck and others but in my generation we are very few and you know like I'm in my early 40s now and there's not well I shouldn't say this man he looks younger but in any case but you'd like there are fairly few people I mean if you think of a major figure like Avicenna you know his canon of medicine is full of interesting philosophical things his medicine you know like he's the most important the most influential medical author and he's there are very few studies done by people who work with the Arabic sources and do something you know kind of who are trained in the history of medicine so the state is really on some level in its infancy and we certainly need more people to move into it okay well if anyone out there in the audience is tempted then they can give professor Foreman a call for now I'll just thank him very much for coming on the show thank you thanks for having me and please join me next time when I'll start to look at philosophy in the 10th century in the context of the Baghdad school of Aristotelian philosophers next time on the history of philosophy without any gaps