Medicine in Iran

Profession, Practice and Politics, 1800-1925

H. Ebrahimnejad

• Publisher: Palgrave Macmillan
• Year: 2013
• Print ISBN: 9780230341029
• eBook ISBN: 9781137052889
• Topic: History
• Subtopic: Middle Eastern History
• Index: History

This book traces how medicine in modern Iran was both theoretically and institutionally transformed in the 19th and 20th centuries. It explores the process by which local physicians, in a non-colonial context, assimilated the emerging "modern medicine" and the institutional devices that accommodated this transition.

CHAPTER 1

The State of Medical Theory and Practice in Nineteenth-Century Iran

Background and Origin

Before the introduction of modern schools in the nineteenth century, medical education in Iran had not changed since the Middle Ages. The sources students read included Hippocrates’ Aphorisms (Fosul Buqrât); Summaria Alexandrinorum (Jawâme

eskandarâniyeen, the summary of Galen’s works); Râzi’s The Continent (al-Hâwi); Majusi’s The Kâmel al-Senâ

a (the perfect art of medicine); Avicenna’s Canon of Medicine (al-Qânûn fi’l Tibb), and various commentaries on the Canon, such as those by Ibn Nafis and Qutb al-Din-e Shirâzi; Abu-Sahl-e Masihi’s The Mâ’a; Samarqandi’s Asbâb and (Qazvini’s) al-Hâwi al-Saghir (the Lesser Continent); Seyyed Esmâ

il-e Jorjâni’s Zakhira (Treasure); and Hakim Mo’men’s Tohfa, the last two written in Persian.¹

There was no institution of higher education in medicine before 1851, when the first state-funded school of Dâr al-Fonun (Polytechnic) was created in Tehran. Elements of humoral theory were taught at madrasa (Islamic college) alongside the other natural sciences, but medicine as a speciality at a higher level could be studied only by motivated individuals, either as a fellow to a private master or independently.² Most of the physicians we will refer to in this book, for instance, undertook their studies privately, with a master (often a relative) or independently, following self-taught masters like Ebn-e Sina (Avicenna).³ This situation continued even after the establishment of the Dâr al-Fonun, not least because this school was not extended beyond Tehran and Tabriz. Medical graduates were too few and their knowledge of modern medicine too imperfect to change the landscape.

Abdollâh Mostowfi called them “semidoctors” (doctor-che) as opposed to doctors who had completed their studies in Europe. According to Mostowfi, these “semidoctors,” with the exception of those skilled in surgery, were not popular or respected, and the most famous doctors were the traditional hakimbâshi, whose knowledge was based on Hakim Mo’men’s Tohfa, Avicenna’s Qânun, and Râzi’s Bor’ al-sâ

a (recovery in one hour), and who, in addition, had drugs from the Makhzan al-advieh (of

Aqili).⁴ John Gilmour, who reported on the state of medicine in 1924, a period when traditional education was not yet a forgotten practice, stated:

Formerly it was the custom for the older and more renowned Persian doctors to take an assistant or assistants. … . Later, the assistants were allowed to be present while the master examined and treated their patients. They copied the prescriptions ordered for the different maladies. They learned the signs and symptoms of diseases. After two or three years of this training, the teacher presented his pupils with certificates stating that they were competent to practice medicine.⁵

The ejâzeh-nâmeh (or license) issued by Galenico-Islamic physicians specified the book or text, such as Chaghmini’s Commentary (on Avicenna’s Canon), or al-Majusi’s Kâmel al-Senâ

a, that a student had read and studied with his master. With the introduction of a modern curriculum, the certificate mentioned only the names of the masters and the subject matter studied, such as physiology, surgery, ophthalmology, and materia medica. In a letter dated 17 Jamâdi II 1326 Hejira (July 17, 1908), an anonymous author states that, after studying medicine under Mirzâ Mohammad

Ali Tabib (one of the distinguished physicians of Kâshân), Mirzâ Hossein Khân-e Kâshâni “has also been present in my classes, and has assimilated a high level of medical knowledge with enthusiasm … and therefore he should be trusted as a skilled physician by patients.”⁶ With the establishment of modern hospitals, hospital practice was also added to indicate practical skills.⁷

With few exceptions, most medieval sources used by physicians in the nineteenth century were in Arabic. On his arrival in Iran in 1893, Dr. Schneider reported that the principal medical texts, translated into Persian and used by physicians, were those of Râzi.⁸ It is not clear to what extent Arabic sources were used, but it was recommended that skilled doctors should read these sources in Arabic rather than in translation.⁹ Writing medical treatises in Arabic or claiming to be conversant with Arabic was commonplace among the learned physicians in the Qâjâr period. Mirzâ Mohammad-Taqi Shirâzi Malek al-Atebbâ (d. ca.1873) wrote four books in Arabic.¹⁰ Mohammad-Kâzem-e Rashti Filsuf al-Dowleh (d.1905) used to show off his Arabic knowledge, although he did not write in Arabic.¹¹ Reading or writing in Arabic was a sign of a high level of theoretical knowledge, which distinguished learned physicians from the rank and file. However, contrary to Gilmour’s claim that “medical works were always written in Arabic,”¹² it does not seem that Arabic medical texts constituted the bulk of medical literature in nineteenth-century Iran. Although the ideal language remained Arabic, even the physicians who were able to read and write in Arabic wrote mostly in Persian. A number of treatises were prompted by the occurrence of epidemics, such as wabâ (cholera) and tâ

un, while others included advice on preserving health, the qualities of food and drugs (based on humoral theories), and the Six Non-naturals (Setta Zaruriya).¹³ It would be surprising had medical literature on such popular topics been written in Arabic, as it would have, otherwise, limited its audience by excluding those who were able to read Persian but not Arabic.¹⁴

Following Galen’s theory that “only he is a perfect physician, who is at the same time a philosopher,”¹⁵ physicians in Iran at the end of the nineteenth century liked to flaunt their “qualification in philosophy, which they deemed indistinguishable from that of medicine”¹⁶ so as to distinguish themselves as “professional.” These learned philosopher-doctors (hakim) were rare, because few could afford, either intellectually or materially, to pursue the study of both medicine and allied sciences such as philosophy, astrology, mathematics, geography, and geometry.¹⁷ The “rank and file” doctors to whom patients had recourse were many, however, whether surgeons, ophthalmologists (kahhâl), female healers, barbers, or dervish (mendicant Islamic monks),¹⁸ as they were cheaper and more accessible. Nevertheless, no clear-cut theoretical distinction between “learned” medicine and folk and faith healing can be drawn. We find learned physicians advising magic and faith healing in their books.¹⁹ This attitude was similar to that of nineteenth-century Western physicians, who, as Jacques Leonard noted, observed modesty toward magic medicine (cure through pilgrimage) because the popularity of this practice expressed the impotence of their own therapies.²⁰ Criticisms by learned physicians targeted quacks or utterly unskilled doctors but not faith healers.²¹ This combination of science and religion and/or magic was also observed in practice. During the cholera epidemic of 1904, when modern medicine was already well established, all public health measures were taken and medical instructions for the prevention and treatment of cholera were distributed, while at the same time, the population gathered in the mosques, under the guidance of the ulama, who after some discussion on the conditions of health and treatment, prayed to God for the healing of the sick and for the epidemic to cease. The population was receptive to modern scientific solutions as well as to religion and faith healing.²²

In the same way that faith healing and magic could be found in learned (or rational) medical texts, humoral theories based on Greek rational medicine percolated through all forms of healing methods and knowledge. In a treatise on plague (Mehnat al-tâ

un), the author refers to classical authors who set out four causes for the occurrence of cholera and plague: (a) the gas contained in the earth that bursts out through cracks, fouls the air, and the foul air produces choleric diseases; (b) the state of planetary constellations; (c) corrupted matter and water in the environment that pollutes the air—in support of this third cause, the source quotes Galen as saying that in India, following a great fight, the disintegration of cadavers and their subsequent putrefaction produced plague and cholera; (d) God’s will to punish his creatures who have committed sin. What proves this to be divine punishment is that physicians are unable to prevent or cure it unless God takes pity on his creatures and sends a remedy.²³ The author acknowledges the importance of divergent opinions and theories without concern for their contradictions, apparently seeing them as complementary. Furthermore, following the theory that “in the face of Destiny a physician is helpless” nineteenth-century physicians in Iran recognized their inability²⁴ and saw their recourse to irrational medicines as entirely legitimate as well as practical.

At the end of the nineteenth century, most physicians dressed like the ulama, indicating that they were knowledgeable in divine science as well as in medicine.²⁵ Likewise, religious scholars (mojtaheds, literally “those who practiced ejtehâd,” interpreting the Koran and the sunna (the traditions of the Prophet) to reach legal decisions on various aspects of everyday life) also studied medicine to enable them to issue opinions on health and medical cases related to the practice of religion. In addition to learned mojtaheds, dervishes, who were more available in the market, practiced freely the dogma that all diseases were divided into hot, cold, humid, and dry.²⁶ If the study or practice of medicine by religious scholars was justified for legal reasons, the study of almost all other “sciences,” including jurisprudence and religion, was recommended for medical purposes. A physician needed to master ten “necessary” sciences and these were jurisprudence and the traditi...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Illustrations
• Preface
• Introduction
• 1 The State of Medical Theory and Practice in Nineteenth-Century Iran
• 2 The Physicians and Their Encounter with Western Medicine
• 3 The Reform Movement and Medical Institutionalization
• 4 Medical Transition under the Constitution
• Conclusion
• Notes
• Bibliography
• Author Index
• Subject Index