PRE-20TH CENTURY HISTORY: Public Health in Qâjâr Iran

Article excerpt

Public Health in Qâjâr Iran, by Willem Floor. Washington, DC: Mage, 2004. 270 pages. $50 paper.

The history of medicine in Iran has usually focused on the medieval period and its renowned physicians such as Râzi and Avicenna. Historiographical literature for modern Iran does not go beyond some articles or chapters of books, although there are far more available sources for the modern period compared with previous centuries. Willem Floor's Public Health in Qâjâr Iran is the first attempt to fill this gap by providing a general history of medicine in Qâjâr Iran (1797-1925), and despite its somehow restrictive title, addresses various issues such as diseases, therapeutics, folk as well as learned medicine, medical institutions, theories and practices, the modernization process and so forth.

Floor's interest in the history of medicine and public health stems from his research on the social history of Iran, about which he has written extensively. The book is mainly based on contemporary published materials, such as Western travel accounts, Persian diaries and state journals. The extensive linguistic ability of the author has allowed him to roam widely and to provide the reader with data from sources in not less than seven different languages. The information in these sources on everyday life such as clothing, techniques of washing, housing, animal husbandry, the treatment of the mentally ill and their place in the society, etc., are extremely rare in the medical manuscripts, which are mostly concerned with theoretical issues. Bloodletting, for instance, is systematically advised in medical manuscripts but they do not provide a real picture of this practice in the society.

Public Health in Qâjâr Iran is organized in six chapters. After a short introduction, as the first chapter, the second chapter discusses the "main diseases" that prevailed in 19th-century Iran such as various epidemic, endemic or generative diseases, including "women diseases," and psychic disorders. However, the sources do not talk about diseases systematically. Nor do they talk about diseases from a medical viewpoint, but rather from a lay perspective. As a result, the information they provide is not entirely accurate; moreover, the disease list they furnish is rather arbitrary. The chapter reflects this shortcoming to the extent that some diseases are discussed in fewer than two lines while the others occupy up to five pages. Diarrhea, for example, is mentioned under the section of "women diseases" (p. 52), rather than being discussed under "intestinal diseases" (p. 31).

A century of modern life with at least basic hygienic facilities separates us from the urban or rural communities of 19th-century Iran to the extent that we have hardly any clear idea about the environmental health problems of that time. The third chapter on "public hygiene" provides a striking picture of the unhygienic conditions of the population. This chapter helps us to appreciate better the extent to which the effects of the epidemics were amplified by the absence of "public health" measures and to understand better the phenomenon of under-population in Qâjâr Iran.

Chapters 4 and 5 constitute the core of the volume in that they examine the two pillars of the medical system: medical knowledge and medical institutions. The medical knowledge is divided into Galenic medicine, folk medicine, and Prophetic medicine. However, the terminology used to elaborate on this classification (pp. 68 ff) is rather puzzling and does not stand historiographical or theoretical analysis. Medicine of the Prophet, for instance, considered by Floor as a distinct medical system, was rather folk medicine, sanctioned by being attributed to the Prophet. Likewise, the term tebb-e sonnati, literally "traditional medicine," is a modern term to designate learned medical literature based on Avicennian and Galenic theories and does not signify folk medicine, as Floor believes. It was not before the second part of the 19th Century that the term tebb-e qadim (old medicine) emerged to distinguish Galenico-Avicennian medicine from tebb-e jadid (modern medicine), which had been introduced from Europe. Finally, the term "Islamic medicine" is the creation of modern historiography coined by Western scholars but subsequently welcomed by Muslim physicians eager to have the medicine of their own.

Floor's book has the merit of underlining the importance of non-official, folk, and faith-healing medical practice compared to Galenico-Islamic or learned medicine, insofar as the former provided the major medical services while the latter was expensive and rarely available (p. 8). Nevertheless, it is not right to say that Galenico-Islamic medicine was "marginal," of "little importance" or "relegated to the dustbin of the history" in 19th Century Iran (pp. 233-35). Galenico-Avicennian medicine was not institutionalized to the point of creating a professional group distinguished from other healers. But not only was it practiced by both learned and rank and file physicians, it also pervaded folk and Prophetic medicine and through them it was involved in providing medical service. Furthermore, due to its monopoly on medical education, "Galenico-Avicennian" medicine provided the major intellectual tools for translation and transmission of modern medicine. Moreover, how could Galenico-Avicennian medicine be considered marginal while, according to the author himself, its practitioners enjoyed high social and even political status (p. 103)?

The importance of a medical system cannot be measured only by its availability, but also by its place in the power relationship within the occupational group. Likewise, tangible distinctions between various ranks of physicians or surgeons were possible within the framework of this power relationship, but not on the basis of scientific knowledge or skill, at least as far as 19th-century Iran is concerned. This the reviewer underlined in his article "Theory and Practice" (History of Science, 2000, p. 172) and not, as quoted by Floor (p. 78), that there was no distinction between physician, surgeon, ophthalmologist, druggist and so forth.

The last chapter deals with medical modernization. Floor privileges the role of the Europeans in the medical modernization and tends to overlook the internal dynamics. It is in the light of this view that, for example, rather than delving into the translated texts of Western sources and finding their strategy and approach, he criticizes the translations as erroneous (pp. 175-176). However faulty these translations might be for us, for the physicians of that period they were the only possible way to come within reach of modern medicine. Despite his Eurocentric approach, Floor maintains a critical stance towards the European sources. For example, he comments that Western observers who reproved the unhygienic nature of Muslim ritual washing, had failed to understand that "Moslem law does not refer to biological or chemical purity or cleanliness of water, but rather its ritualistic aspect of purification" (p. 60). The question of public health, chosen by the author for the title of the book, is dealt with in the last chapter. Public health measures along modern lines were indeed taken more systematically during the last two decades of the Qâjâr period and as the author mentioned, these measures took a particular dimension and strength under the Constitutional Assembly (majlis).

Floor's initial project was an article but the snowball effect of the broad research resulted in this volume. However, the reader is left with the impression that it was completed hastily. Although medical historiography on modern Iran is badly in need of new scholarly research, one would have preferred that the author had spent more time revising the text in order to remove various misspellings and to provide a more complete index.

Despite these minor reservations as well as some problems with its conclusions, mentioned above, Public Health in Qâjâr Iran, achieves a valuable task of shedding light onto the darkness of the medical history of modern Iran. It is a welcome introduction and a useful textbook for students of history as well as for the public at large.

[Author Affiliation]

Hormoz Ebrahimnejad, Wellcome Trust Centre for the History of Medicine, University College of London, United Kingdom

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