In many regions across the medieval Islamic world, male physicians decided what medicine (ṭibb) was and who practiced it. This authority resulted in a gendered hierarchy of medicine and has encouraged historians to move beyond the male physicians in their studies of premodern medical practice. For example, several scholars have commented on this passage, written by Ṣā’id ibn al-Ḥasan around 1072 CE in his book Making Medicine Interesting (al-Tashwīq al-Ṭibbī):
Sometimes patients are cured without knowledge of the cause of illness, its diagnosis, or its cure. …This is hardly surprising, when patients surrender their lives, their very souls, to devious old women (al-‘ajā’iz al-khurafāt)! Not a single person falls sick without his whole household becoming doctors, either his wife or his mother or his aunt, either a relation or a neighbor. He accepts her most expensive cures, consumes the most unpleasant of her preparations, and obeys her commands more than he would a physician’s. He believes that this woman, despite her lack of intelligence (‘aql), has more knowledge and sound judgment than a physician.1
The vitriol of the male physician Ṣā’id ibn al-Ḥasan towards women healers suggests a possible antagonism between skilled women and doctors in the medieval Islamic world. Some historians say this passage is evidence that “female practitioners …constituted potentially powerful competition for their male counterparts.” In Avner Giladi’s history of midwives, we learn that while male physicians rarely mention women practitioners in their erudite medical texts, some of them worked together on gynecological and obstetrical cases. A few physicians in al-Andalus seem to have held skilled midwives in high regard. But physicians seem less charitable towards women who did not know their place in and around the birthing room; ibn al-Ḥasan is not alone in his harsh criticism. But why did he target old women specifically? Historians of gender and sexuality in the Islamic world have shown how age and gender are mutually constitutive—for example, through the figure of the amrad (beautiful “male” youth). Might the old woman also present a distinct example of this phenomenon?
Many of the intriguing contributions to this forum on “the old women of Nishapur” focus on how these women are said to believe. In this essay, I turn to the question of how old women are presumed to know. As Rula Abisaab shows, proper faith and knowledge were intimately connected for male scholars in the medieval Islamic world. Whether one should aspire to, or merely settle for, the faith of the old women of Nishapur is a question that became imbricated in major religious debates, as Kausar Bukhari explains. Men described the faith of women as pure, naïve, intrinsic, embodied, unstudied, and uniquely experiential: essentializing representations that were wielded in sectarian polemics, Adam Bursi shows. Setrag Manoukian’s formulation for the old women, “sensing without realizing,” resonates with how historians have identified the physician (ṭabīb) with prestigious theoretical medicine and the possibly illiterate midwife and practitioner (mutaṭabbib) with experiential and practical knowledge along the lines of epistêmê and technê.
Discussions of embodiment and corporeality in the premodern Islamic world have largely focused on religious texts—the works of Sufi authors in particular, as with studies by Scott Kugle and Shahzad Bashir. They demonstrate how embodied ways of knowing and somatic practices were differently constitutive of sainthood, miraculous and political power, and gender, especially masculinities. Scholars have yet to pull medical texts into this theoretical arena, with some recent notable exceptions. Male physicians of all religions in the medieval Islamic world also had embodied and experiential ways of knowing that were mutually constitutive with scientific masculinities. While male physicians emphasized their own book learning in autobiographical writings, they also relied on experiential knowledge rooted in expert sense perception. But despite its importance, experiential knowledge without theoretical study was considered insufficient in healers of any gender. This was part of the purported boundary between the physician and the other.
What were old women presumed to know about medicine, and why was it always old women? Alongside the trope of ignorant quacks, older women’s expertise emerged as a trope in the genre of erotology, or ‘ilm al-bāh. Erotological treatises were incredibly popular—in Arabic, Persian, Ottoman Turkish, and other languages—though many treatises have yet to be edited or studied. They were structured differently by a range of authors from jurists to doctors to litterateurs, each text a different combination of literary, medical, magical, and prophetic content. As Pernilla Myrne traces the topos of “women as erotic experts and advisers” from the tenth century onwards, she highlights the continuous popularity of stories about a mother, an experienced erotic expert, advising her daughter and future son-in-law with tales from her own life. Some versions of this story are pornographic even as they include medical information about health and pleasure. While generations of male authors perceived an older woman who is also a mother as the appropriate figure to share experiential knowledge about (androcentric) sexual pleasure with readers, no comparable trope appears in more formal medical texts authored by physicians. The woman expert’s senior status in this trope suggests that it is through experience (tajriba) that her erotic expertise is honed.
The two tropes discussed above—including the vitriolic and erotic ends to which male authors deployed them—may overshadow the ways authors recognized women as particular kinds of knowers. Sometimes, the knowledge and magic shared between women had to be disciplined, as Adam Bursi shows in his contribution to this forum. Sara Verskin explores the anxieties of ulema about illicit and inappropriate female knowledge shared in homosocial spaces like the birthing room. Similarly, physicians’ descriptions of working in tandem with midwives were meant to bring their practice out from behind closed doors and under the direction and authority of a physician. Consider this famous passage by the Cordoban physician al-Zahrāwī (d. 1013) about treating bladder stones in women:
If necessity compels you to this kind of case, you should take with you a good woman doctor. As these are very uncommon, if you are without one then seek out a chaste doctor as a colleague, or bring a midwife experienced in women’s ailments, or a woman to whom you may give some instruction in this art. Have her with you and bid her to do all that you command. First, in searching for the stone…bid the midwife to pass her finger into the vulva and palpate for the stone, after she has placed her left hand upon the bladder and applied good pressure. If she finds the stone she should gradually push it down from the outlet of the bladder as far as she can until it reaches the bottom of the pelvis. Then she should cut towards it from about the middle of the pudenda near the root of the hip on whichever side she can conveniently feel it; she must keep her finger on the stone, pressing from below.2
Here, women knowers emerge not as tropes but as subordinate coworkers. The skills al-Zahrāwī expected of a midwife were expert indeed, relying on her trained sense perception, skilled manipulation, bedside manner, and comfort with surgical equipment.
Physicians’ reliance on midwives was just one example of the people of all genders who enabled a physician’s practice. Most physicians did not forage, dry, and store their own drugs, and some left drug preparation to pharmacists entirely. Those who prepared their own remedies likely relied on trained laborers to mash, mix, boil, distill, etc. Patients in need of cupping, massage, and other bodywork were sometimes referred to same-gender specialists and barbers like those operating in hammams, or public baths. And, of course, there were those who kept the hammam fires burning to heat and cool bodies, a major therapeutic method in humoral medicine. Manuals of market inspection and the rare documents of the Cairo Geniza offer these glimpses into the world of pharmacists, perfumers, traders and foragers, in Egypt at least.
But working with an archive of men’s writing so full of silences, absent a single surviving medical text by a woman, what can we know of women’s knowledge—especially what was taught and practiced beyond the text? Several historians, like Sara Verskin and Avner Giladi mentioned above, set out to study women’s medical knowledge and practice but wrote largely about men’s anxieties and discourses about women’s knowledge. Those are the textual sources we have, and they limit what we can know. These scholars’ analyses of masculinist themes in medical and legal texts are insightful and valuable. But the desire of some scholars to know the women of a thousand years ago has led them to support their claims with citations to anthropological studies of the modern Middle East, without any discussion of this method.
By contrast, historian Taylor Moore offers a fresh and compelling analysis of anthropological writings, magical objects, archival documents, and the writings of male physicians to argue for the importance of old women as producers of knowledge. In her dissertation, Superstitious women: Race, magic, and medicine in Egypt (1875-1950), Moore underscores the historical contingency of the “political and spiritual economy of healing” of Upper Egyptian and Black African women who settled in Egypt’s urban centers after the failure of Egypt’s imperial expansion into East Africa and the nominal abolition of slavery in 1877. Her method of “superstitious reading” foregrounds women as “critical producers of knowledge” entangled in the internationalization of social sciences in the interwar period. At the least, her work should caution historians away from uncritically projecting women’s practices recorded by anthropologists onto the premodern past.
Perhaps our field is still haunted by that fierce colonial ghost: the idea of a stagnant, unchanging East. The trope of the faith and knowledge of old women may help protect historians against such hungry ghosts by reminding us to first question our own “archival desires” to recover or recuperate what is lost. Do we seek to “restore” the silent and marginalized as full, speaking subjects to assuage our own discomforts? And yet, we do know there were wise old women in this period. By “thinking with” the old women of premodern Islam, rather than trying to study their knowledge-practices, we may arrive at a critical vantage point on medicine in the past as well as in our own lives. The figure of the wise old woman makes the gendered hierarchies of formal medical practice more starkly visible. She reminds us that the others of biomedical physicians continue to be marked by identity—race, class, gender—as well as the epistemic boundaries of modern science.
The word I have translated here as “devious” is written in the 1996 Maktab al-Tarbiyya al-‘Arabī li-‘l-Duwal al-Khalīj edition as khurafāt, an unusual form I have not found in Arabic lexicographical texts. If the word is related to khurāfa (untrue and clever speech), I think “devious” may be more appropriate than “senile,” as others have translated it. Taylor Moore offers a detailed study of how wise women’s knowledge was understood as khurāfa (superstition) by some people in modern Egypt (see below).↩
I have adapted this translation from Sara Verskin’s Barren Women. Previous translations of this passage by Spink and Lewis have included “eunuch” or “chaste” as a possible translation of the word ‘afīf. The versions of this text I have accessed do not support the Spink and Lewis reading. However, eunuchs played prominent roles in many medieval Islamic contexts, non-binary sex categories were acknowledged by legal and medical writings, and sex was understood beyond a binary. Certain people of nonbinary sex could well have assisted physicians in al-Zahrāwī’s time. See: Shireen Hamza, https://jhiblog.org/2020/07/01/islamic-history-and-medicine-in-trans-muslim-lives/↩