By Peter E Pormann
The Lancet, Vol 373 (2009)
Introduction: A woman “who spoke confusedly”, laughed excessively, and “was red in her face” came to see the famous clinician al-Rāzī (died c 925), a hospital director both in his native Rayy (near modern Teheran) and Baghdad. He diagnosed her as suﬀering from melancholy (mālinkhūliyā), a disease akin to madness (junūn) and caused by an excess of black bile. He ordered his female patient to have her blood let at the median cubital vein, and to take a decoction of epithyme. The outcome of the treatment is not recorded, but al-Rāzī declared it to be sound (salīm). This case history offers us a rare glance of such an encounter; in general, most of our sources are silent about female patients and practitioners in the medieval Islamic world, so that it is diﬃcult to tell their story. Yet, as they constituted roughly half the population, we may rightly ask how they experienced disease and accessed health care. In the theoretical literature, women appear mostly in two contexts, that of disorders specific to women; and that of disease that affect women differently from men. An example of the latter is again melancholy, believed to occur more rarely, but also more severely, in women.
Diseases specifically aﬀecting women that are discussed in medieval Arabic literature largely concern the reproductive organs, complications before and after childbirth, lactation, and child-rearing. Instances of gynaecological disorders include uterine cancer, inﬂammations of the womb, and the retention of menses. Menstruation ﬁgures prominently in the literature, as blood—one of the four humours next to yellow bile, black bile, and phlegm—was believed to have a direct impact on the bodily balance. Physicians also discussed another gynaecological condition: during uterine suﬀocation (ikhtināq al-rahim), called hysterikê pníx in Greek (whence we get our “hysteria”), they believed the womb moves inside the body, and thus impairs certain physical and mental functions. Physicians thought lack of sexual intercourse was one of the possible causes for this condition; for the womb, in want of semen, wanders through the body. Therefore, young women, who do not yet engage in sexual intercourse, as well as widows, were particularly prone to the disease.