The Case History in Medieval Islamic Medical Literature: Tajārib and Mujarrabāt as Source
By Cristina Álvarez Millán
Medical History, Vol.54:2 (2010)
Introduction: Knowledge of medieval Islamic medical practice has traditionally been based on the analysis of learned treatises. However, a comparison of the therapeutic advice advocated in formal treatises with treatments prescribed to patients has shown that the appeal to theory was to a large extent neglected in practice and, therefore, that theoretical works are not a reliable account of reality. From this perspective, case histories may prove to be an invaluable source for medical historians studying medical practice in medieval Islam. Yet, case histories—as well as prescriptions for actual patients, clinical observations, and medical anecdotes—are, none the less, literary sources, and we may well stumble on the same stone twice as we did when studying theoretical treatises regardless of literary and social contexts. The purpose of this paper is mainly to question whether the varying categories of clinical accounts can be treated as reliable guides to medieval Islamic clinical practice. The question of whether medieval Islamic medical authors deliberately followed a particular style of clinical account common among ancient Greco-Roman patterns, and whether they deployed case histories to illustrate the practice of medicine or to build up their reputation in the medical market-place, has been addressed elsewhere. A comparison of case histories by Abū Bakr Muammad b. Zakarīyā’ al-Rāzī (d. 313/925) with Greco-Roman models showed that this particular Islamic physician used the case history as a tool for medical instruction rather than for self-promotion. However, the question of whether al-Rāzī’s clinical accounts were representative within medieval Islamic medical literature remains open. As demonstrated below, an analysis of a wider range of sources shows that medieval Islamic medical writers certainly used scientific rhetoric for self-representation as well as persuasive strategies for self-promotion like those found in Galen’s case histories. Consequently, the use of literary devices to stress features other than the interpretation of symptoms, prognosis and therapy raises the issue mentioned above: do medieval Islamic case histories serve as documentary evidence of actual medical practice? With the aid of a wider scope of materials than those by al-Rāzī, I shall attempt to draw attention to the dangers of reading case histories—like theoretical treatises—too literally, and to explore the historical value of clinical records in assessing a particular physician’s everyday practice.
In order to provide as broad a picture as possible of the clinical account in medieval Islamic medical literature, I have divided this paper into three parts. The first section provides an overview of collections of case histories and medical experiences as a literary genre. In the second, case histories taken from different medieval Islamic authors will show the various purposes of clinical accounts. As far as the details of practice are concerned, I will let case histories speak for themselves, focusing instead on their wording and style, and their literary or social contexts so as to ascertain the author’s agenda. In the third section, I shall analyse case histories attributed to the well-known Islamic physician Ibn Sīnā, known in the western medical tradition as Avicenna (d. 428/1037). A study of his recorded clinical experience will show that his medical theory and practice operated in different spheres, suggesting that our present consideration of his excellence as a clinician is supported by historical assumptions rather than by a critical analysis of sources.