managing patients: physicians serving early Islamic rulers

Physicians were highly influential figures in rulers’ courts in the early Islamic world.  Physicians offered rulers not only treatment for specific ailments and sicknesses, but also ongoing advice about what to eat, where to live, and what activities to pursue.  The early-ninth-century caliph al-Mu`tasim declared:

My physician Salmawayhi is greater in my eyes than the chief judge, as the latter decides about my money, while the former decides about my person, and my life is dearer to me than my money and possessions.[1]

As a trusted personal adviser to al-Mu`tasim, the physician Salmawayhi gained broad powers encompassing those of a judge and vizier:

One can find in the state registers the decrees of al-Mu`tasim in judicial and other matters, all in Salmawayhi’s handwriting, as well as all the orders to the princes and commanders in matters of government and attendance at the Caliph’s court.[2]

Other physicians were less successful in managing their relationship with their ruler-patient.  Consider Daniel the Physician.  He served the eleventh-century Syrian ruler Mu’izz al-Dawlah.  That physician-patient relationship worked out badly for the physician:

Mu’izz al-Dawlah inquired of Daniel, “Do you not maintain that quinces, when eaten before a meal, cause constipation, and when eaten after a meal, have a purging effect?” “Yes, indeed,” replied Daniel.  Whereupon Mu‘izz al-Dawlah said: “As for myself, when I eat them after a meal, they make me costive.” When Daniel answered: “This is not a normal reaction,” Mu‘izz al-Dawlāh punched him in the chest and said: “Get up and learn how to behave in the service of rulers, then you may come back.”  Daniel left, spitting blood. In this condition, he lived on for a short time but then died.[3]

The physician al-Hasan ibn Zairak also suffered serving ninth-century Egyptian ruler Emir Ahmad ibn Tulūn:

Ahmad ibn Tulūn called al-Hasan ibn Zairak and said to him: “I think that the medicine you gave me today was not the proper one.” Ibn Zairak replied: “The Emir, may Allāh lend him support, should order all the physicians of Fustat to assemble at his residence each morning and decide unanimously what the Emir should take. I have administered nothing to you but medicines which were prepared by a person you trust and which are designed to strengthen the retentive powers of your stomach as well as your liver.” Said Ahmad: “By Allāh, if you do not succeed in your treatment, I am determined to have your head cut off. You are merely experimenting on the sick, but can do no real good.” Al-Hasan ibn Zairak left the Emir’s presence trembling. He was a very old man. His liver became inflamed as a result of anxiety and fear and because, owing to his troubled state, he neither ate nor slept. A profuse diarrhea set in, he was overcome with chagrin, and eventually his mind became disturbed and he talked deliriously about Ahmad ibn Tulūn’s ailment. He died the next day.[4]

Ibn Abi Usaybi’ah, who recorded these incidents in his thirteenth-century history of physicians, also preserved a large number of aphorisms from his eminent uncle.  Ibn Abi Usaybi’ah’s uncle was a physician who served rulers and apparently accumulated considerable wealth.  He seems, however, to have cherished the ideal of being a monkish scholar.  Among his aphorisms are:

Avoid the rulers of this world and you will spare yourself the company of evil men.

Whoever is able to live contentedly in accordance with his needs and instead sells his soul to another, spurred by the desire for the luxuries of life, is the stupidest of fools.

If it is possible to live apart from people with the minimum of needs, this is the best situation.[5]

These aphorisms probably draw upon literary platitudes of ascetic scholarship.  At the same time, weariness and frustration surely could occur in a physician’s relationships with his ruler-patients.

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Notes:

[1] HP p. 316.

[2] HP p. 315.

[3] HP. p. 455.  Mu‘izz al-Dawlah was a ruler in Aleppo about 1047 when Ibn Butlān visited that city.  HP p. 464.

[4] HP p. 685.  In attempting to strengthen the retentive powers of Ahmad’s stomach and strengthen his liver, ibn Zairak suffered profuse diarrhea and an inflamed liver.  This transference of ailments from patient to physician suggests that this story was a courtly construction of some literary sophistication.  It probably also generally reflects ibn Zairak’s difficulties serving Ahmad.

[5] HP pp. 918, 925 (#57), 926 (#68).  Ibn Abi Usaybi’ah’s uncle was Rashid al-Dīn `Ālī ibn Khalīfa.  He was born in Aleppo in 1183.  At the young age of 25, he began serving the Sultan al-Malik al-Mu`azzam as a physician.  He died young at age 38.   Ibn Abi Usaybi’ah apparently greatly admired his uncle.

Reference:

HP: Ibn Abi Usaybi’ah, Ahmad ibn al-Qasim. English translation of History of Physicians (4 v.) Translated by Lothar Kopf. 1971. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 294Online transcription.

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