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Civilized Medicine
Fifty men and women had just been blown to pieces on
London’s underground, and television screens all over the world were
covered with blood. In Australia, finding myself wheeled into hospital for
surgery under images of the Virgin and Child, with portraits on the wall
of the women who founded the Sisters of Charity and the Sisters of Mercy,
I wondered why the ministry of Christ should contrast so violently with
the sword of Islam.
A week later I transferred to a Jewish hospital for
rehabilitation. In the foyer there was a stained-glass mural of “medicine
through the ages” that showed Hippocrates, the rabbi and physician
Maimonedes, a tutorial class in Renaissance anatomy, and in its final
panel the decoding of the human genome. Again, you couldn’t help thinking
how lucky we are to belong to Judaeo-Christian civilization and not
another.
The anthropologically informed know (or at least should
know) that religious systems ethically centered on universal peace and
love, instead of territorial tribal defence and survival, are
comparatively rare in human history. They will also know (or at least
should know) how the iconography of Christianity, with its appeal to
suffering and compassion (Calvary) and of maternal care (Mary and Jesus),
differs from the fierce warlike totems of primitive cults.
Looking back into the past we can be eternally grateful
that both Christianity and Judaism provided intellectual frameworks loose
enough, in the post-medieval epoch, to allow the emergence of a secular
science that freed itself of priestly control, and went on to build the
edifice of medical knowledge today. In the hospitals where I was fortunate
enough to be treated, the ethical and technical strands of our
civilization are powerfully intertwined. Not all peoples have been as
lucky as we have been—or as unlucky as the Arabs
have been. The edifice of western medicine is unique. We must all make
sure its high standards are maintained.
Multicultural staff
An Australian hospital today is a multicultural affair.
The national shortage of both nursing staff and doctors ensures that a
relatively high proportion come from overseas. That this presents serious
challenges for the maintenance of standards and the safety of patients is
undeniable, and an extreme and disturbing example of what can happen
(though much too idiosyncratic to be typical) is discussed this month in “Doctor
Death” at SPIKED.
But it also presents opportunities, and the Australian
Medical Association may well be correct when it says that our hospitals
couldn’t survive without large numbers of recruits from outside. Leading
these seem to be nurses from Ireland: their bustling good humor and
practicality make them welcome wherever they go. Others come from various
parts of Asia, and the nurse I encountered who most embodied the old
professional firm-but-friendly style was from Sri Lanka. She combined
attractive British vocal noises with a disarming hint of Zsa Zsa Gabor,
having somewhere acquired “dahlink” as a universal greeting. “How are you
today dahlink?” “Have you had your medication dahlink?” “Have your bowels
opened today dahlink?” Charming.
Mention of the old nursing style reminds one that it
required a certain distinctive personality—and a strong and uncompromising
personality too. In the past, the successful nurse had a lot of
no-nonsense assertiveness about her, while the Sisters and Matrons of
yesteryear could not only silence their more obstreperous patients, they
could discipline specialists too.
It was just an impression, but it seemed to me that
today’s Australian recruits had a personality profile more quiet, subdued,
and humbly amenable—in other words predisposed to take
bottom-of-the-social-ladder bedpan work without question or complaint.
While their vocational commitment is beyond question, do they have the
strength to impose themselves and endure?
Medicine and civilization
Is it right to invidiously contrast the
Judaeo-Christian contribution to western civilization with that of Islam?
And especially Islam’s contribution to modern medicine? A recent book
reviewed in the July 29 Times Literary Supplement has the title The
Case for Islamo-Christian Civilization, its author arguing that “Islam
and the West are historical twins whose resemblance did not cease when
their paths diverged.”
Intended perhaps more as a provocation than a serious
thesis, it appears to lean heavily on what Jews and Christians and Muslims
shared theologically and doctrinally 1500 years ago. I haven’t read the
book, and I must say Islamo-Christian Civilization sounds unconvincing to
me. But if we bear its argument in mind, perhaps there is something to be
learnt from the curious history of Islamic medicine all the same.
Today one of the most striking features of eastern
dependence on western knowledge is the spectacle of thousands of nurses
and doctors imported into the Gulf states over the last fifty years,
simply because traditional Arab cultures have neither the educated
personnel, nor the social foundation of sexual equality, nor the
scientific knowledge, nor the political will to correct any of these
deficiencies, which would enable them to independently provide the medical
services that outsiders offer.
Was it any different in the past? How old is this
pattern of dependence? If there were original thinkers in the region
hundreds of years ago, do we find a continuous scientific development from
one thinker to the next? Can we see an evolving tradition of medical
thought leading steadily to the present day? Or will the closed and
dogmatic nature of Islamic culture mean that new thought, when it occurs,
is not assimilated, is soon lost sight of, and is then forgotten? A light
comes on in the darkness; goes out; and disappears.
Medical knowledge as sacred text
It seems that there have been variations on “western
nurses in the Gulf states” for a very long time. Writing about the period
before the 17th century, Bernard Lewis notes on the one hand
that very few travellers went from East to West to learn, and on the other
that very few eastern people had any knowledge of western languages. The
movement of both people and ideas was therefore almost entirely from West
to East, usually individuals belonging to members of religious minorities
such as non-Catholic Christians, Greeks, or Armenians—groups the Ottoman
Turks considered reliable:
Minority doctors with Western training also played an
increasing role in the practice of medicine. Arabic, Persian, and Turkish
scientific writings of the period show some limited acquaintance with
Western medicine and Western geography, both needed for practical reasons,
but no awareness of Western history or culture. (Bernard Lewis, What
Went Wrong? p37)
The way Islam dealt with the new disease of syphilis
was typical. It came to the attention of eastern scholars early on, and
“was reported in a Persian medical work by an author who died in 1510.” So
fixed, rigid, complete, and unchanging was the body of Islamic medical
knowledge, however, that syphilis might never have been discussed at all
had it not originated outside the Ottoman Empire.
Because it was new, came from Europe, and was not
already incorporated into a never-to-be-questioned sacred text, “it was
therefore acceptable to translate European writings on the diagnosis and
treatment of this disease.” A collection of writings on syphilis were
translated and presented to the Sultan in 1655. Yet the book consisted
entirely of 100-year-old European works. “Knowledge was something to be
acquired, stored, if necessary bought, rather than grown or developed.”
(Ibid. p39.) Little has changed.
The circulation of the blood
Then there’s the intriguing story of the circulation of
the blood, and of a pioneering Syrian physician called Ibn al-Nafis. Lewis
notes that the discovery of the circulation of the blood is “normally
credited to the English physician William Harvey, whose epoch-making
Essay on the Motion of the Heart and Blood was published in 1628 and
transformed both the theory and practice of medicine.” (Ibid. p79.)
Harvey’s discovery built on the earlier work of a
Spanish physician, Michael Servetus, 1511-1553, whose discovery of the
lesser or pulmonary circulation of the blood was published in 1553, the
same year as his death. But the really interesting thing is that still
earlier, as Lewis tells the story, a 13th-century Syrian
physician named Ibn al-Nafis “set forth his theory of the circulation of
the blood in terms very similar to those later used by Servetus and
adopted by Harvey”. Lewis thinks it likely that Servetus knew of the
Syrian’s work.
So here was a striking innovation in medicine, in
Syria, in the 13th century. What happened next? Ibn al-Nafis
died childless at about the age of 80, leaving his estate and his library
to a Cairo hospital. “His book and his theory remained unknown”, writes
Bernard Lewis, “and had no effect on the practice of medicine.” (Ibid.
p80.) By which Lewis means of course that it had no effect on the theory
and practice of medicine in the Islamic world. Ibn al-Nafis may well have
influenced Michael Servetus however.
It is all very strange. This willing dependence on
Western science and technique, this preparedness to beg, buy, borrow, or
steal, combined with a stubborn resistance to social and political
modernization, is a pattern going back hundreds of years.
September 2005
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