FUNDAMENTACIÓN DE LA METODOLOGÍA A UTILIZAR

Ottoman medicine and therapeutics are best understood as a system, inasmuch as they encompassed all of the health-promoting beliefs and actions, scientifi c knowledge, and skills of the members of the group that subscribed to the system.⁵ Seeing it as a system allows us to visualize Ottoman medicine as a superstructure, constructed of smaller building blocks of medical ideas and practices. This is to be expected in an empire as vast as the Ottoman, subject as it was to several climates and environments, and enriched by numerous cultural and scientifi c infl uences. The three building blocks, folkloristic popular medicine, religious medicine (“Prophetic medicine”), and mechanistic medicine based on humoralism had their own body of medical

knowl-edge, unique disease theory, and characteristic therapeutic techniques.

Each boasted a different set of credentials.

Popular medicine was sanctioned by custom, by a wide consensus from below, not by any religious, judicial or scientifi c authority. In the Ottoman empire, this medical folklore was in itself of many varieties, partly because of the Ottoman past, partly because of the Ottoman present. The Ottomans inherited shamanistic medical traditions from central Asia that Turkish tribes immigrating to the Middle East and Asia Minor brought with them. The Ottomans blended their Turkish past with other traditions that they encountered in their expansions, ranging from Hellenic Anatolia and the Christian Balkans to the local folklore in the Arab provinces. All these pasts functioned in a concrete present. The Ottoman Empire was made of several climate zones, each with its unique medical problems and fl ora and fauna from which medication was prepared. The medical illnesses riddling a port city like Tunis in North Africa and the medical steps to combat them were hardly the same as those of Baghdad in Iraq on the shores of the Tigris River, or Sofi a in the European hinterland.

Mechanistic medicine, based on humoralism inherited from Greek antiquity, is another medical tradition present in the Ottoman medical system. This tradition asserted its legitimacy by drawing on the scien-tifi c treatises of the sages of antiquity, the patronage of a Muslim urban elite, and the dominant role it played in the intellectual and literary discourses of famous medical fi gures. This medicine based itself on the physical and philosophical metatheory of the four elements. The human body was understood to correspond with this theory, as it is a microcosm of nature. The body consists therefore of four humors, or fl uids, the physiological building blocks of the body: blood (air), phlegm (water), black bile (earth), and yellow bile (fi re). In the case of illness, which is a state of imbalance in the body, it was up to the humoralist physician to diagnose which of the four humors was in excess or defi cient. The physician then proceeded to recommend a course of treatment, counteracting the offending humor by means of an opposite regimen. Excess in black bile, for example, known to be cold and dry, necessitates adding warmth and moisture artifi cially.⁶

Humoralism presented itself primarily as a preventive system.

Ideally, a patient consulted a doctor while healthy in order to ward off Illness. The humoral doctor was supposed to identify the particular humoral balance that made a specifi c individual healthy and instruct him or her how to maintain it. However, maintaining the appropriate balance was far from easy, as it was based on the integration of so many variables (the theme of integralism is the subject of the next

chapter). The physician had to advise the patient about the lifestyle in the broadest sense that matched his or her balance. Physicians were to consider all aspects of life—that is, everything from choosing a climate and topography to live in, to deciding on a profession (in the case of men), to organizing hours of rest and activity during the day, to fi xing a suitable food regimen, and much more. All these different aspects were part of the broad concept of “diet.” “Diet” comes from Greek, where diata means “regimen for life” rather than our narrower modern understanding of the food regimen, usually in the context of restriction of food in order to lose weight. In the humoral context, “diet” refers to the sex res non-naturales, the six nonnaturals, which include light and air, food and drink, work and rest, sleep and waking, excretions and secretions (which include also baths and sexual intercourse), and fi nally dispositions and states of the soul. (The naturals are tempera-ment, the humors, the faculties, and the pneuma, spirit.) Diet is thus

“the manner by which a man through his daily activity found himself in a lively and permanent relation with his surrounding world.”⁷ The six nonnaturals are a link with the body’s vital processes. The six non-naturals should be used quantitatively and qualitatively in the proper place and time and in the correct order. The “naturals” will thus be conserved in good condition and guarantee health.⁸

In Ottoman society, as well as in other early or premodern societies (Christian and Muslim alike), humoralism fi lled the niche of

“learned medicine” of its time. It enjoyed supremacy in urban com-munities, in the sultanic palaces, and among the wider Ottoman elite.

Chronicles and biographical dictionaries, two literary by- products of this social group, described ailments and explained death as stem-ming from changes in the humoral balance. This was also the medical system practiced in Ottoman hospitals.

Muslim religious medicine, the third medical tradition present in the Ottoman medical system, was similar in its contents to both popu-lar and humoral medicines, but its legitimacy lay elsewhere. Instead of relying on custom or learned treatises, Muslim believers accept religious medicine as originating from (and therefore sanctioned by) the sayings of the Prophet Muhammad. One aspect of Muhammad’s prophetic charisma and a source for divine blessing is the healing powers attributed to him. Although too few to constitute a complete medical system, the sayings in which Muhammad gave his (positive or negative) opinion on medical practices were the basis upon which Muslim scholars built from the ninth century onward. Hence this type of medicine is aptly known as “Prophetic medicine” (al-†ibb al-nabaw¥

in Arabic or tibb-i nebevi in Ottoman Turkish). Translations of Arabic

treatises on the subject into Ottoman Turkish, in addition to the com-position of original works in Turkish, attest to the popularity of this branch of religious knowledge among Ottoman Muslims.⁹

Popular medicine was transmitted orally, whereas humoralism and Prophetic medicine were both grounded in written traditions.

Moreover, humoralism and Prophetic medicine each had a unique written literary genre. Popular medicine emphasized techniques and results, not bookish learning and the accumulation of knowledge.

In addition to the different modes of legitimacy and theoretical and practical concepts of disease and health, each system had its own corps of specialist healers. The Ottomans might have been familiar with an example set in the K.utadg.

u Bilig.

(Knowledge That Brings Happiness), a political essay that, in an Islamic setting, describes an ideal monarchy. It was the fi rst long narrative poem in Turkic litera-ture, as well as the oldest monument of Turkic-Islamic literalitera-ture, and come from another Turkish-Muslim state of the eleventh century in central Asia, the Karakhanid realm. The author of the K.utadg.

u Bilig. differentiated between physicians (hekim), who cure with medications, and healers (esfuncu), whose expertise lay in healing illnesses (mainly mental) caused by demons and spirits (jinns).¹⁰

Muslim humoralism is theologically neutral in its attitude toward health and medicine (its adversaries in medieval Europe claimed it was even atheist and retained its pagan roots; some modern scholars describe it as rational and secular). Its physiological etiology did not judge the patients’ religious devotion or blame their misfortune on their sinfulness and infi delity.¹¹ Prophetic medicine, on the other hand, did have a pronounced ethical and theological worldview because of the ever-present monotheistic dilemma of divine justice. Suffering was promoted in intellectual circles as a purifying element, and therefore positive and desirable. Suffering was celebrated as a religious virtue, and illness was perceived as martyrdom, awarding the ill person with holiness and piety, and thus hastening his or her entrance into paradise. An example to this is the Prophetic saying “A believer will suffer no illness without God expiating his sins.”¹²

Despite all the differences, these three systems—folkloristic medi-cine, Prophetic medimedi-cine, and humoralism—were not autonomous or separate. People tended to adhere to only one of these three medical systems, but Ottoman medical subsystems could not afford to be exclusive. Moreover, in reality both healers and patients fused medi-cal ideas and practices, sometimes without consciously knowing this.

Such was the case when the source for a specifi c piece of knowledge or procedure was rooted in learned written medicine but after several

generations diffused orally to popular medicine, its “high” origin long forgotten.¹³ The three systems were not perceived as incompat-ible alternatives. Patients crossed from one sector to another in their search for proper—that is, effective—treatment.¹⁴

This reality brought about brutal competition among healers.

If different types of healers offered the patients—their clients—more or less the same therapeutics, and none could boast superior success rates, healers could not single themselves out and justify the high level of fi nancial rewards they expected. Humoral doctors, for example, could not necessarily demand (and get) the fi nancial premium they believed befi tted their long process of training and their theoreti-cal knowledge. They wished to strengthen their position as carriers of classical (and superior) tradition, in contrast to the “charlatans”

who could offer no more than harmful superstitions. Their guildlike organizations in the bigger cities were used, among other things, to bring pressure on the Ottoman authorities to remove their com-petitors. Humoral physicians could not (or refused to) recognize the medical logic behind their competitors’ practice, especially when the similarities were great. They claimed, for instance, that these medical procedures were benefi cial to the patient only when they were the ones implementing them.¹⁵

Three examples will suffi ce to illustrate the considerable over-lap, even ambiguity, in knowledge and technology. The fi rst is phle-botomy, a therapeutic technique used by all three medical systems.

Phlebotomy was one of the most frequently used therapeutic and prophylactic treatments for many centuries in the Middle East, as well as in Europe. Humoralism adopted bloodletting as a means to relieve the body from surplus humors that upset the balance in the body (and hence corrupted it). Manuals guided the doctor in words, and sometimes also in pictures, as to when to draw blood, how much to draw, and what body part to draw from. The decision depended on the patient’s age and constitution, the season of the year, the weather, and the time of day.¹⁶ Phlebotomy was popular also in folkloristic medicine, sometimes to the extent that people practiced it on them-selves. Certainly, phlebotomy was used also when people were not ill as a preventive measure to keep one’s health. Even the Prophet Muhammad is reported to have allowed it, whereas other popular forms of treatment, like cauterization, were forbidden.¹⁷

The dialogue between the three subsystems was not restricted to the therapeutic side of medicine. One evidence is that they all would touch the patient as a diagnostic tool to grasp his or her inner patho-logical problems. Another is that they shared sources for knowledge

or “truth”; all would draw on authorities and theories usually con-nected with rival systems.

Direct physical contact between physician and patient, even their being in the same room together, was not trivial (in contrast to today, when we expect to be touched by the doctor when he or she examines us, and regard it a basic condition of sound medical practice). Medi-eval biographical dictionaries celebrate the supernatural abilities of some famous physicians, who correctly diagnosed a medical problem of someone not in their immediate presence. We can fi nd fantastic anecdotes about doctors commenting to their companions upon seeing someone on the street in passing that the person in question was sure to die in the next day or two; and lo and behold—that is exactly what happened! Moving from literary embellishments to humoral medical writings, we can fi nd that in addition to pulse reading, there were other highly respected and much practiced diagnostic methods, like scrutinizing urine (uroscopy), which could of course be done when not in the presence of the patient. Therefore, it is worth noting that both humoralism and Prophetic medicine assigned importance to the doctor’s touching the patient. A humoralist doctor would feel the pulse at the wrist (Chinese medicine, of course, emphasizes pulse taking, too). According to Prophetic sayings, Muhammad laid his hands on the body of ill persons to discern what ailed them. Various versions pinpoint different body parts, either the forehead or the upper chest between the nipples.¹⁸ The body part designated for touching may be different, but the reasons behind diagnosis by touch were similar.

Medical authors did not refer to reasons other than the medical/physi-cal, but there is a psychological meaning as well, of which they may have not been consciously aware. Touching established an intimate physical connection between doctor and patient. From the latter’s point of view, the healer assumed responsibility for the situation at the moment of touching, and the healing process started.

Maybe most surprising is to fi nd medical writers quoting the “great names” associated with rival medical theories as authorities. It is not at all trivial to read Muslim scholars who, while discussing Prophetic medicine, connect medicine with the divine relying on Galen, the Greek pagan, as a source for unearthing the mysteries of health and disease.

Pagan Galenism (and the fi gure of Galen himself) indeed underwent a process of depaganization in order to be adopted by a monotheistic Muslim society.¹⁹ But this is a basic characteristic of Prophetic medi-cine. It did not mean to discard humoral Galenism as such; far from it. Authors on religious medicine even accepted pre-Muslim authorities in addition to more obvious Muslim ones, like Ibn Sina and others.

They did, however, position them—Muslim and non-Muslims alike—as authorities inferior to the divine legitimacy of Prophetic medicine. It was a confrontation of authorities, not of contents.

A good example is Jalål al-D¥n al-Suy¨†¥ (d. 1505), the famous Egyptian scholar, one of the most famous fi gures in premodern Islamic history. Al-Suy¨†¥ enjoyed a great reputation as a scholar, and an aura of godliness surrounded him even during his lifetime. According to the medieval Egyptian chronicler Ibn Iyås (d. 1524), on his death al-Suy¨†¥’s standing reached its zenith: his clothes were bought as if they were relics!²⁰ A versatile writer, known usually for his religious scholarly work (mostly hadith, the sayings of the Prophet, and Qur’anic studies), he was active also in the fi eld of medicine. His treatise Al-manhaj al-saw¥ wal-manhal al-raw¥ f¥ al-†ibb al-nabaw¥ (The Proper Road and the Thirst-quenching Spring of Prophetic Medicine), is—as its title indicates—a discussion of medicine as formed by, and legitimized by, the sayings of the Prophet Muhammad.²¹ This treatise and others by al-Suy¨†¥ enjoyed a wide reputation. Before he reached the age of thirty, his works were sought after in the Middle East and later in the entire Muslim world; they circulated from India to North Africa.

In the framework of our discussion here, it should be noted that two manuscripts of Al-manhaj al-saw¥ were kept at the libraries of Topkapı, the Ottoman imperial palace.²² Al-Suy¨†¥’s text, which is devoted to Muslim Prophetic medicine, reminds the reader very much of Greek Galenic theory. His treatise on Prophetic medicine takes the form of a Galenic book. It starts with medical theory and then goes on to discuss principles of treatment based on this theory. The contents of the text are infl uenced by Galenism. The constitution of man is explained by al-Suy¨†¥ as being made up of the four elements, and he included putrefi ed air (miasma), food and drink, and physical and emotional factors on his list of causes of disease. These are the accepted etio-logical agents in the humoral tradition. At the same time, al-Suy¨†¥

composed this medical treatise as a Muslim scholar, not a Galenic humoral physician. Al-Suy¨†¥ begins his work with an exposition of the four humors as a report in the fi rst person by God describing his creation of the world and humanity. In other works he discusses his belief in the curative powers of words (whether written, recited, or worn) from the Qur’an or God’s names. He also acknowledged the evil eye and the jinn as etiological agents. Al-Suy¨†¥ fused medicine with faith, God, and worship, and placed humoralism in a divinely ordained world.

Al-Suy¨†¥ is by no means unique, although some writers on Prophetic medicine composed their treatises to resemble religious

texts, relying more exclusively in contents and format on the sayings of the Prophet Muhammad without attempting to assume a medical or scientifi c aura. Al-Suy¨†¥’s work is an example of a mature stage in the development of Prophetic medicine from the late Mamluk period.

It came into being when Muslim scholars did not stop at collecting medical-related sayings related to the Prophet Muhammad, or as they had in earlier stages. Rather, they went on to compose comprehensive medical works, based on hadith but explained in the light of Galenic medicine. The scholars’ aim was not to build a new Muslim medical system, confronting the existing systems, from non-Islamic origins.

Instead, they wished to legitimize medicine in the eyes of Muslim scholars, making it relevant to a Muslim world view centered on complete faith in God. Medicine—in effect repeating humoralism in its physiology and etiology—was portrayed as an integral part of a devout Muslim lifestyle, and was even a religious obligation accord-ing to some legal scholars.²³

On the other side of the spectrum of medical writing, humoral writers themselves supplied religious authority to their Galenic argu-ments. Take Zeyn al-Din al-Abidin b. Halil as an example. He devoted his work in Ottoman turkish on diet entitled Shifa’-ı al-feva’id (The Advantages of Health) to Murad IV (reigned 1623–40). The treatise outlines different types of dishes and beverages according to their humoral attributes (cold, warm, moist, and dry). The author explains how these attributes, combined with different cooking methods and the exact timing of a dish during a meal affect one’s inner balance.

Zeyn al-Din al-Abidin grouped his discussions into seventeen head-ings ranging from water for drinking to pulse, meat, poultry, desert and mountain game, and sea and lake fi sh, and he fi nishes with fresh

Zeyn al-Din al-Abidin grouped his discussions into seventeen head-ings ranging from water for drinking to pulse, meat, poultry, desert and mountain game, and sea and lake fi sh, and he fi nishes with fresh