The Arab World

Another route of transmission of Hippocratic ideas to the West was through the Arab world. The most obvious contact between medical systems took place after the Arabs took Alexandria in A.D . 642, possibly while Paul of Aegina was there; the medical school at Alexandria continued to exist until around A.D . 719, probably still using Greek as its language of instruction.^[246] The great age of translation began in the ninth century; Greek manuscripts were taken as booty in conquest, and

those translating them into Arabic—sometimes through the medium of Syriac—enjoyed royal patronage. From this time onward, versions of Hippocratic texts, based on several manuscripts, were produced; the most famous early translator was Hunain ibn Ishaq al-'Ibadi—known to the West as Johannitius—the Christian son of a druggist, who was also responsible for translating works by Galen, Oribasius, and Paul of Aegina. Hunain also listed all the works of Galen that had been translated into Arabic or Syriac by about A.D . 800; these included such key works in the hysteria tradition as On the Affected Parts, On Difficulty in Breathing , and the commentary on the Aphorisms , from which the Hippocratic Aphorisms themselves were excerpted and then transmitted separately.^[247] There thus exists a striking contrast between East and West in the ninth century; as R. J. Durling puts it, "Whereas European knowledge of Galen was limited to a few Galenic works, and those either unimportant or clearly spurious, Arabic translations of almost all his writings were made." Something similar occurs with regard to much of the Hippocratic corpus; in contrast to the Latin West, where emphasis was placed on translating those texts of immediate practical value, the Arabic translators did not neglect the more theoretical and speculative treatises, so that the "Arabic Hippocrates" is more complete than the "Latin Hippocrates."^[248] This does not, however, apply to Hippocratic gynecology; neither Diseases of Women nor Nature of Woman was translated into Arabic, although two Byzantine commentaries on Diseases of Women 1.1-11 were in circulation in the Arab world before the eleventh century, together with Byzantine medical encyclopedias.^[249]

The main means by which Greco-Roman ideas were transmitted was through the compilation of new encyclopedic works. The Firdaws al hikma (Paradise of Wisdom) of 'Ali ibn Rabban at-Tabari (810-861) was completed in 850 and includes approximately 120 quotations from the Hippocratic corpus, and a large amount of Galenic material, together with extracts from other Greek and Islamic writers such as Aristotle and Hunain.^[250] At-Tabari believes that the essential wetness of woman leads to menstrual loss; retained moisture sinks to the lowest part of the body and then comes out, "just as in a tree the excess moisture comes out as gum."^[251] In his section on uterine disorders, he includes suffocation of the womb. He writes, "Sometimes, through damming-up of menstrual blood and lack of sexual intercourse, vapours develop." He explains that the retained blood becomes thick, and produces vapors that then affect the whole body, causing such symptoms as painful breathing, palpitations, head pain, and suffocation of the womb.

A further discussion of suffocation occurs in the context of womb

movement. The womb can lean to one side, but sometimes it actually rises up until it reaches the diaphragm, causing suffocation. "Then the woman loses consciousness, with the result that her breath is stopped. Then one puts a bit of wool under her nostrils in order to see whether she is alive or dead." The cause here is not menstrual blood, but accumulated seed; if there is an "excess, lack or absence" of intercourse, seed will accumulate in the womb, rot, and become poisonous and thick. The womb then moves to the diaphragm and the woman suffocates.^[252]

Thus womb movement was readily combined with a Galenic etiology of retained seed or menses, but to this mixture at-Tabari added the explanatory device of vapors. Where Greco-Roman writers employed the concept of sympathy to account for the effects of the womb on other parts of the body, writers in the Arab world also used vapors; as we shall see, this development entered the western hysteria tradition when texts were translated from Arabic to Latin from the eleventh century onward.

The next writer from the Arab world who should be considered here is Muhammad ibn-Zakariyya' ar-Razi (Rhazes), whose Kitab al-Hawi , a twenty-four-volume collection of excerpts from Greek, Arabic, and Indian writers known in Latin as the Continens , was written around A.D . 900.^[253] Also translated into Latin was his Kitab al-Mansori , which includes a chapter on uterine suffocation. Here Rhazes gives a basically Galenic account of the condition, including retained menses and seed, the patient falling down as though dead, and scent therapy; he includes the recommendation that a midwife should rub the mouth of the womb with a well-oiled finger. He does not say that the womb moves, although he describes a sensation "as if something is pulled up."^[254]

The work of 'Ali ibn al-'Abbas al-Majusi, known in Europe as Haly Abbas, was produced in the tenth century A.D . It too combines Hippocratic etiologies with a predominantly Galenic approach, often read through the eyes of Paul/Aetius; but al-Majusi plays down the membranes anchoring the womb, claiming instead that the womb can move around the body. He includes both sympathy and vapors. He explains that suffocation of the womb is a very dangerous condition because sympathy leads to the vital organs, the brain and heart, being affected. If a woman does not have intercourse, a large quantity of seed will collect and will "stifle and extinguish the innate heat." Retained menstrual blood has similar effects.^[255]

In a separate section on treatment, he retains the Hippocratic scent therapy, but explains its success partly in terms of vapors. Bad smells administered to the nose rise to the brain, "warming, dissolving and diluting the cold vapors," but also driving the womb back down.^[256] For

al-Majusi, the womb is "more or less an independent living being," yearning for conception, annoyed by bad smells and leaning toward pleasant smells. Plato's description of the womb as an animal desiring conception was known to the Arab world through Galen.^[257] Al-Majusi also recommends sexual intercourse as a cure, especially for virgins, whose strong desire for sex and thick menstrual blood predisposes them to the condition.^[258] In the absence of this, he repeats the Galenic therapy of instructing a midwife to rub sweet-smelling oils on the mouth of the womb, and states explicitly that this has the same effect as intercourse, in warming and thinning the seed, so that it can drain away and the woman can "find peace."^[259]

Also working in the tenth century was Ibn al-Jazzar, whose main work was the Kitab Zad al-Musafir in seven books. This was a particularly important source for medieval European medicine; it was translated into Latin, Greek, and Hebrew, and is known in Latin as the Viaticum .^[260] Book 6, chapter 11, describes suffocation of the womb; the condition begins with loss of appetite and the chilling of the body, which is attributed to corruption of retained seed, particularly in widows and young girls of marriageable age. From the seed a fumus —a smoke, or vapor—rises to the diaphragm, because the diaphragm and womb are connected; then, since further connections exist between the diaphragm and the throat and vocal chords, suffocation ensues. similar problems may result from retained menses, and scent therapy and the application of fragrant oils to the mouth of the womb are recommended. Repeated here is a version of the story given in Galen of the woman who lay as dead but was known to be alive by the presence of innate heat; here, however, Galen rather than Empedocles becomes its hero!^[261]

Finally, Ibn Sing (Avicenna), born in A.D . 980, included discussions of hysterical suffocation in his Qanun (the Canon ); translated into Latin by Gerard of Cremona in twelfth-century Toledo, this influential text was printed thirty-six times in the fifteenth and sixteenth centuries.^[262] He devotes four successive chapters to the condition, its signs and cures, and the preferred regimen for sufferers. He bases his description on Galen as interpreted by Aetius, favoring sympathy (communitas ) over vapors, and including the test for life with a piece of wool and the story of the widow; cures include phlebotomy and the rubbing of scented oil into the vulva, while the regimen includes the use of foul-smelling substances at the nose and sweet scents at the vagina.^[263]

Thus it can be seen that the distinctively Hippocratic features of womb movement, scent therapy, and the therapeutic value of sexual intercourse survived even in the directly contradictory environments of

Galenic theory and Islamic culture. Despite the rejection of the moving womb by both Soranus and Galen, it soon returned to the fore in the explanations of hysterical suffocation given by writers and compilers in both East and West. In the Arabic world, Soranus's Gynecology may not have been translated, so his attack on the theory of the mobile womb may have remained unknown;^[264] as for Galen, although he explicitly rejects Plato's womb-as-animal theory in On the Affected Parts , he implicitly accepts it in To Glaucon , thus leaving the matter open for future commentators. Such elements of the hysteria tradition as the wool test for life and the story of the widow and the midwife, retained by the Byzantine encyclopedists, continue to survive in Arabic medicine; the story of the woman raised from apparent death by Empedocles is found in Ibn al-Jazzar but plays a minor role, perhaps because the short reference to it in Galen is insufficient for its reconstruction.

In terms of the most likely victims for the condition, it is of interest that Galen's preference for widows is ignored; virgins become a prime target. This is not a return to Hippocratic etiology since, as I have argued above, the Hippocratic hysteria texts rarely give a particular target population for womb movement; furthermore, when a particular group is specified, this tends to be the childless in general (since their flesh is not "broken down"), older women not having intercourse, or young widows. The Hippocratic text that may be at the root of this interest in virgins is one that was available in the Arab world, since it is cited twice by Rhazes: the Diseases of Young Girls .^[265] This is a short and vivid description of a condition that arises not from womb movement, but instead from retention of menstrual, or possibly menarcheal, blood. The target population consists of parthenoi —meaning young girls, unmarried women, and/or virgins—who are "ripe for marriage" but remain unmarried. Their blood is described as being plentiful due to "food and the growth of the body." If "the orifice of exit" is closed, the blood that has moved to the womb ready to leave the body will travel instead to the heart and diaphragm, causing visions, loss of reason, and a desire to commit suicide by hanging. The author states that he orders girls with this condition to marry as quickly as possible; if they become pregnant, they will be cured. I would suggest that this text, retrospectively diagnosed as hysteria by several writers during this century, lies behind al-Majusi's interest in the thick blood of a virgin and in intercourse as a cure, as well as explaining Ibn al-Jazzar's target population of girls of marriageable age.^[266]

Finally, in these writers, a new explanatory device is used to account for the effects of the womb on other parts of the body: vapors. Yet the

concept of sympathy continues to exist, sometimes—as in Ibn al-Jazzar—involving very precise connections between particular organs of the body.