Gynaecology

by Aileen Das Published on: 29th December 2021

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As in early modern Europe, most people in medieval Islamicate society received medical care from female family members. Contemporary male doctors viewed these women, who acted as nurses and midwives, as stiff competition, and so reviled them in medical literature...

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Note of the Editor: This article, “Gynaecology” written by Aileen Das, is Chapter Eight, Pages 86-95, extracted from the book “1001 Cures: Contributions in Medicine & Healthcare from Muslim Civilisation” editor Peter Pormann, published by the Foundation for Science, Technology and Civilisation, UK. The content of this chapter is relevant to the current pandemic environment around the world.

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While female healers were an important source of primary healthcare in the medieval world, there are very few references to female doctors (singular, ṭabība) in Arabic biographical and medical literature. Moreover, no medical text by a female physician survives – if they even existed. The historian Ibn Abī Uṣaybiʿa (d. 1270) identifies a woman named Zaynab, who was associated with the southern Arabian Banū Awd tribe, as one of the famous doctors working around the time of the advent of Islam (see ed. Müller 1882, vol. 1, p. 123, lines 13–17; Pormann 2014, 657). Nonetheless, reports about Zaynab and her skills as an oculist seem suspicious, because tenth-century biographers such as Ibn al-Nadīm (fl. 987) and Ibn Ǧulǧul (d. c. 994) do not mention her in their lists of renowned pre-Islamic doctors. According to the surgeon Abū al-Qāsim al-Zahrāwī (fl. c. 1000), female physicians were rare in Muslim Spain, and their assistance in the treatment of virgins and modest women was highly desired.

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Figure 1. A physician takes the pulse of a young girl. While female healers were an important source of primary healthcare in the medieval world, there are very few references to female doctors (singular, ṭabība) in Arabic biographical and medical literature. Moreover, no medical text by a female physician survives – if they even existed.

In a chapter ‘On the extraction of stones from a woman’ in his medical encyclopaedia, al-Zahrāwī instructs the reader to bring along a competent female doctor when his patient refuses to be attended by a man; failing to find such a qualified woman, he recommends a eunuch or midwife instead (eds Spink/Lewis, London 1973, 420–1; see also Pormann/Savage-Smith 2007, 104). Despite theologians appealing to ḥadīth and sunna traditions to sanction the medical treatment of female patients by male doctors and vice versa, many women were still hesitant to expose themselves (and their genitalia) to men outside their family. Male physicians also seemed concerned to maintain a level of decorum when examining their female patients, for al-Rāzī advises one of his students to avoid looking at the bodies of beautiful women by restricting their gaze to the afflicted part (Pormann 2014, 658–9)…

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Figure 2. Surgical instruments for extracting a dead foetus taken from al-Zahrāwī’s Surgery. It would appear that the obstetrical operations outlined in medieval medical texts might represent a kind of relic of ancient theory rather than contemporaneous practice. Like al-Zahrāwī, most doctors probably employed less invasive means, such as the use of pharmaceuticals, for these difficult procedures.

Gynaecology does not appear to have developed as an independent textual field in the medieval Islamic world. That is to say, only a small number of medical treatises take women’s health as one of their principal concerns: for example, Ibn al-Ǧazzār’s (895–979) The Care of Children and their Management (Siyāsat al-ṣibyān wa-tadbīruhum), ʿArīb ibn Saʿd’s (c. 912–80) Book on the Generation of the Foetus and the Treatment of Pregnant Women and Newborns (Kitāb ḫalq al-ǧanīn wa-tadbīr al-ḥabālā wa-al-mawlūdīn), al-Baladī’s (fl. c. 970s) Book on the Regimen of Pregnant Women and Children (K. Tadbīr al-ḥabāla wa-al-atfāl), and Abū al-Ḥasan Saʿīd Ḥibat Allāh’s (1045–1101) Treatise on the Creation of Man (Maqāla fī ḫalq al-insān) (Green 2003, 359). As the above titles indicate, these texts treat subjects relating to obstetrics and pediatrics. Drawing heavily on ancient Graeco-Roman literature, they also address theories about reproduction and embryology.

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Figure 3. A woman giving birth attended by other women, possibly midwives.

The question regarding female, as opposed to male contributions to generation, was a major point of contention between followers of Aristotle and Galen. In On Semen, Galen argued against the Aristotelian view that women supplied only the matter of their menstrual blood to the formation of the foetus, while men furnished their semen. Rather, he advanced a two-seed theory, according to which both men and women contribute semen (ed. De Lacy 1992, 145–61; on Galen’s criticism of Aristotle’s theory of reproduction, see van der Eijk 2009, 277–9). It should be noted that what we now call ovaries were believed by Galen to be female testicles that produced a fluid similar to male semen. Less controversial topics covered in these books include discussions about the diet of pregnant and lactating women, criteria for selecting wet nurses, and the appropriate age for weaning…

Many medical encyclopaedias, which examine diseases from top to toe, contain gynaecological chapters as well. Al-Zahrāwī composed several chapters in his The Arrangement of Medical Knowledge for One Who is Not Able to Compile a Book for Himself (Kitāb al-Taṣrīf li-man ʿaǧiza ʿan al-taʾlīf) that offer instructions for dealing with complicated deliveries and the extraction of dead foetuses. Although these chapters are addressed to midwives, al-Zahrāwī appends some case histories that demonstrate his own familiarity with obstetrical problems…

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