Adab aț-Ṭabīb is the title of a book on medical ethics and education written by the ninth-century physician Ishāq ibn ʻAlī al-Ruhāwī. This treatise, the title of which can be rendered in English as Practical Ethics of the Physician, is one of several important medieval Arabic sources that are at the core of Johann C. Bürgel’s magisterial work on medieval Arabic writings on medical ethics, medical education, and the position of the physician in society. The term Adab refers to notions of decency, ethics, and etiquette, and, as a specific genre in Arabic literature, it represents the linking of learning and knowledge for the purpose of providing guidance on appropriate human conduct in the professional and private realms. A substantial amount of writing from the classical era concerns Adab as it relates to the medical field, with al-Ruhāwī’s treatise being one of the most important contributions.
This text, long believed to be lost, was rediscovered in the mid-twentieth century. Bürgel’s Ärztliches Leben grew out of the author’s engagement with the mentioned and various other Arabic sources that formed the basis for his habilitation thesis in 1969. For this publication, Bürgel’s original habilitation thesis was revised by Fabian Käs, a research fellow at the Martin Buber Institute, University of Cologne, whose publications include Die Mineralien in der arabischen Pharmakognosie (Minerals in Arabic Pharmacognostic Literature).
Bürgel, today Professor Emeritus for Islamic Studies, chose the title of his book in reference to the term “Ärztliches Leben” (the life of the physician), coined by the eminent German medical historian Paul Diepgen to denote those areas of medical history that lie beyond the tracing of the development of medicine as a science, and comprise the conditions of the life of the physician and the sociological aspects of medical practice. To this, Bürgel added the term “Ärztliches Denken” (thoughts of the physician) in order to reflect that body of literature that deals with the epistemological aspects of medicine as well as the complex relationships between medicine and the fields of ethics, law, religion, philosophy, and the art of the state (pp. xii, 1). Accordingly, Bürgel’s Ärztliches Leben und Denken provides a useful and detailed overview of the position of the physician in medieval Arabic society, and its implications for medical practice, professional ethics, and medical education.
Bürgel has divided the book into four major parts, each one divided further into chapters and subchapters (and in a few places even further sub-sections, which at times makes it a little unwieldy). Part I, “Definitions and Limits,” deals, for the most part, with epistemological questions and the justification of medicine from a philosophical and religious perspective. Part II, “Medical Education,” offers a detailed account of the theoretical and practical education of physicians. Bürgel masterfully uses his sources to inform the reader of the medical curriculum, the places of education, and even examination questions. Part III, “Medical Practice,” deals with the ethical questions physicians encountered in the execution of their profession, the principles guiding their conduct towards patients, families, fellow physicians, and members of other related professional groups such as pharmacists. It also describes the supervision of medical practice by an appointed inspector, the muḥtasib. In Part IV, “Coordinates and Perspectives,” Bürgel discusses the complicated history of the reception of classical and Hellenistic thought by Islamic culture, arguing that not only medical knowledge itself, but also medical ethics and etiquette were deeply influenced by the incorporation of Greek thought into Islamic culture. In further chapters, he discusses what he terms the ‘Islamization of medicine,’ the position of Jewish and Christian physicians in society, and the decline of Arabic medicine. It is in this section that the author makes some sweeping statements that betray the book’s origin in the 1960s. This occurs, for example, when the author debates whether the reception of Greek culture and thought in Islamic culture may be characterized as a “last enormous, victorious lighting up of the Greek element, carried by Alexander into the Orient, where it was fighting with the Asiatic element, or as the sudden transfer of the Greek spark from the darkening Western world to the Orient that had just awoken to new life” (p. 387, translation my own).
But these occasional anachronisms should not detract from the book’s many merits. Throughout the work, Bürgel quotes short passages from his sources or paraphrases them in order to provide the reader as much as possible with the viewpoints of the various authors examined. This approach is one of the strengths of the book, even though it requires the reader to navigate different passages and chapters to gain a sense of a particular source in its entirety. The book provides a detailed description of the various sources (pp. xv-xxxvi), including chapter overviews for the most important works; instructions as to where to find relevant passages in the book; and a guide on existing editions of the relevant texts in Arabic, German, English, or French. This, in conjunction with the rich bibliography, makes the book highly valuable for scholars interested in the history of medical ethics in the Arabic world.
Besides al-Ruhāwī’s Practical Ethics Bürgel has incorporated a considerable number of other primary sources from the Arabic medieval period, many of which are made accessible for the first time in a European language (p. xiii). Among the most significant are: Ibn Hindū’s Miftah al-tibb (The Key to Medicine and a Guide for Students, C10), a philosophical introduction to medicine, written in a concise, highly polished style. Ibn-Hindū devoted an entire chapter to a rational justification of the art of healing, defending the validity of medicine and arguing against its detractors and those who maintained that it interfered with God’s will. Ṣā’id ibn al-Ḥasan’s at-Taswīq aṭ-ṭibbī (Encouragement to Medicine) similarly deals with ethical and deontological issues. The book also discusses medical errors, charlatans, and inept practitioners. Ibn Buṭlān’s Da’wat al-aṭibbā (Banquet of Physicians, C11) is a fictional narrative told with subtle irony from the perspective of a charlatan participating in the banquet, his inadequacies exposed in the course of the evening. Ibn Jumay’s Ar-Risāla aṣ-Salāḥīya (Treatise to Salah ad-Din on the Revival of the Art of Medicine, C12) contains a discussion of the then-widely perceived decline of medicine, its reasons, and possible solutions. Finally, Ibn abī Uṣaibi’a’s ‘Uyūn al-anbā’fī ṭabaqāt al-aṭibbā (News Sources about the Classes of Physicians, C13) supplies more than four hundred biographies of physicians.
In addition, the author draws from a variety of further medieval sources, among which two genres are of special interest: treatises on what Bürgel calls ‘prophetic medicine,’ and the so-called Ḥisba-literature. Prophetic medicine (aṭ-ṭibb an-nabawī) refers to a series of statements ascribed to the Prophet, on diseases and their treatments, that were collected over a period of time and developed into a particular genre. Some medieval writers viewed it as a counterpoint to the humoral system they had inherited from antiquity, and which was based on the Hippocratic and Galenic texts (ṭibb Buqrāṭ wa-Gālīnūs – pp. xxxiii, 423, 467). Bürgel – while acknowledging that this interpretation is somewhat controversial – holds that the authors of these treatises were mostly religious scholars and historians whose aim it was to promote prophetic medicine in direct competition to the scientific-secular system of humoralism (p. 424). Ḥisba-literature refers to the supervision of commercial affairs and various professions, among them that of the physician, by an official inspector, the muḥtasib, who was responsible for making sure that law and honest business practices were upheld. Bürgel analyzes two texts containing chapters that deal specifically with the supervision of medical practice. These works contain descriptions of examinations to ensure that physicians and other medical practitioners possessed the necessary knowledge to practice medicine (pp. 195-215). The volume also contains English summaries (pp. 461-467), but these are so short that they do not do the work justice.