We have many stories of medieval physicians who treated kings and rulers – these were elite and famous doctors. But what about those who took care of ordinary people and are less known to history? A very unique account from the thirteenth century tells us about one physician and the problems he faced.
Our physician is Ibrāhīm ibn Yuḥannā al-Wajīh al-Qalyūbī, who lived in Cairo during the second half of the thirteenth century. He wrote a treatise called Naṣīḥat al-muḥibb fī dhamm al-takassub bi-l-ṭibb (Advice to the passionate [student] admonishing against making a living with medicine) in which he tries to warn people from pursuing a career in medicine. A recent article by Ignacio Sánchez, a Senior Research Fellow at the University of Warwick explores this treatise and what it reveals about the life of a physician.
There are a lot of revealing personal anecdotes in this treatise, and al-Qalyūbī finds many problems in his life – he is overworked, underpaid, has no time for anything else, and his patients don’t listen to him. He complains about his competition but also is worried that his work is damaging his religious faith. It is a bitter look back upon his career.
Al-Qalyūbī would work from a little shop in the markets of medieval Cairo, where the families of patients would come looking to hire him. They would bring him back to their homes so he could check on the patient and try to diagnose their ailment. Those people would come at all times to find him, even if it was during prayers or sleeping in the middle of the night. Having to do this wasn’t just an inconvenience for al-Qalyūbī – there were times when the physician would be brought to strange places in the darker corners of the city, and here he feared that he might be robbed or killed. The latter did happen to one of his colleagues, Najm al-Dīn, who was murdered by a woman he had come to help.
The patients and their families might come seeking his help, but many times they did not follow his prescriptions. Al-Qalyūbī says that he often got into arguments with women who were taking care of their relatives, or who also worked in the medical field as midwives or wet nurses. Our physician felt that everyone should listen to him because he had studied medicine, but that was not the case. Sánchez relates one of the anecdotes:
Al-Qalyūbī complains that the patients’ relatives very often ask him to consult with experienced old women and reach an agreement with her about the treatment. In one of these cases he says ironically that he will embroider something for her in return, and when a woman argues that men do not know about that, he replies: “And how does a woman know about medicine? If you have doubts about my claiming to know something that is easy just because I am a man, why should we believe your claim to know anything about the most difficult and hidden things, because you are a woman?”
This argument did not seem to impress the relatives of the patient, who replied: “Things are not like that. Embroidering is an art (ṣināʿa), but medicine is only discourse (kalām). Anyone who reads about it with application can learn it.” For them and, if we judge by the tone of these anecdotes, perhaps for many other contemporaries of al-Qalyūbī, the tangible medical skills that women learned through practice seemed to be more valuable than the bookish knowledge of physicians.
Al-Qalyūbī did not like this, but it was something he had to accept in his profession. He finds that there were other ways he was disrespected.
Al-Qalyūbī complains about having been mockingly asked about the inspection of his patients’ urine and faeces, and often receiving vials with false urine samples. People also joke about the physician’s inspection of genitals when treating sexual diseases, and even imitate him and touch his genitals to make fun of him.
Another thing that bothered al-Qalyūbī very much was that most physicians in Cairo were Jewish, while he was one of the few Muslims who worked in this profession. Sometimes even his patients just assumed he was Jewish. It was another source of frustration for al-Qalyūbī as he felt Jewish doctors had unfair advantages. He usually describes them in a stereotypical fashion and is upset that the people of his city, including his fellow Muslims, often preferred to be treated by Jewish physicians.
While the long hours, many competitors, and no one listening to him were bad enough, al-Qalyūbī even feared that being a physician was bad for his soul. He acknowledges that many of his fellow Muslims assumed he had little faith because he was a man of science. Al-Qalyūbī writes how “even if [the physicians] would pray, fast, and give alms, even if they would fly in the sky and walk on water, there would still be doubts in people’s souls about their commitment to Islam, or as to whether they have any religion at all.”
Al-Qalyūbī believed he was doing good work but also acknowledged that the nature of his work, in which he would see his patients suffer and die, could lead one away from his faith:
When a physician commits his first mistake, he is terrified and cowardly afraid of practising medicine. But he needs to make a living through this art, and, when he makes a second mistake, he is not as perturbed as he was by the first one. The third one has even less effect. Then he eventually develops a thick skin, his heart hardens, and he becomes used to it just like the dead-washer [grows accustomed to his work]. In the end, he dispels the anguish from his soul by denying the hereafter and the final reckoning.
Ignacio Sánchez does note that we should be somewhat weary of accepting everything that al-Qalyūbī tells us in his treatise. His bitterness could lead him to exaggerate or even lie about things that he saw or heard. After all his work is aimed to convince others (or perhaps his own younger self) not to become physicians. Despite this, one can learn much about what it was like to be a medieval physician. Sánchez writes that
…Naṣīḥat al-muḥibb is, above all, a window onto the hidden world of medieval street physicians. Al-Qalyūbī’s deprecation of medical practice is a unique testimony, and a biased one at that. But he had to support his arguments with evidence; thus, even if he exaggerates when building his case, his treatise contains invaluable referential information that contradicts the idealised image of the physician transmitted by historians of medicine.
The article, “Why Muslims Shouldn’t Practice Medicine: The Autobiographical Account of a Frustrated Physician, Ibrāhīm al-Qalyūbī (fl. second half of seventh/thirteenth century),” by Ignacio Sánchez, appears in the journal Medieval Worlds. Click here to read it.
You can learn more about Ignacio Sánchez and his work through his Academia.edu page.
Top Image: A physician depicted in an Arabic manuscript of Dioscorides’ De materia medica from 1229 – Wikimedia Commons