This is an excerpt from Transactions of the American Philosophical
Society, Vol. 57, Part 3, 1967. "Medical Ethics of Medieval Islam with
Special Reference to Al-Ruhawi's Practical Ethics of the Physician",
translated by Martin Levey. Permission for printing of excerpts from TAPA
has been obtained.
Ishaq ibn Ali Al-Ruhawi lived around 1200 A.D. and was born in Ruha, a city in northwestern Iraq, today known as Urfa. His book, called "Adab Al-Tabib, the Conduct of a Physician", is a classic in the annals of medical ethics. We shall continue to print excerpts of this classic in future issues.
We say that it is necessary for the physician, after he expends (his
efforts) in what has been mentioned in the pursuit of science, that he do his
best every day to cleanse whatever issues forth from the orifices of his body
as his nostrils, eyes, nose, etc., and to wash them with water. Excesses
should not be in evidence in these openings; this occurs with excessive
eating, drinking, and harmful use of these. Therefore, for this reason, the
most beneficial method to purify the senses and to cleanse them is the
improvement of food and drink.
Further, the physician is obliged to frequent assemblages of the virtuous, learned, and men of letters amenable to him. It is not polite for him to expectorate, yawn, stretch himself, and to do similar things. All these and those like them are caused by being sated with food and drink. The physician must avoid them and whatever fills the head. After that, he must take care of his mouth by means of a toothpick and tooth medicine to polish the teeth and to perfume the breath and strengthen the gums of the teeth. This is done by means of schoenanth, cyperus, and others similar. He chews aloewood a little at a time to perfume the gums of his teeth and to strengthen his stomach and brain. Mastix and similar (gums) are also like it. For this reason, Galen said, "There was a man who had a bad odor in his mouth; he took care of it to the extent that it decreased by vomiting, purging, and drinking the remedies which improve it, Then, every day he put in his mouth cardamom, sometimes cinnamon, and sometimes other odoriferous substances. After he did this, he could not leave his house."
Then it is necessary that the follow this by examining the odors of his other bodily organs. That which is bad is removed by an opposite odor as tutty for the odor of the armpit, and aromatics which subdue unpleasant smells.
He must also investigate any excess in his organs not needed for the body as excessive nails, too much hair on his head and face, etc. He removes them.
After these, the physician must take care of his clothes, keeping two facts in mind. One is that they must be useful and soft and warming in winter, and thin and soft in summer. The second is that they must be (garments) of beauty when he is near people of his status. The physician to the king has need of more clothes than does one who serves the public.
The physician must guard all his five senses and not use them except for a beneficial purpose and to repel harm. If he speaks, he must talk of science and knowledge, and no foul word must be heard from him. He must be cautious in his use of words especially in the assemblage of kings and chiefs. He does not ask (anything) except what helps his problem, and he does not answer except when he is queried.
In the same way, he must guard his sight, not beholding anything vile which may be injurious, if it is not necessary. This is true even as a boy. He must try always to look at the books of his art and at the code of his divine law since the books on divine law determine morals and encourage good works, and the books of his art help him to acquire knowledge.
It is essential that the physician take care of his hearing, trying not to talk with illiterates nor to listen to statements of the wicked and those of the sects with evil opinions. This is possible when he does not sit in company with those who do these things, and if he does not mingle with or speak to them, as far as possible. If possible, discussion with a virtuous one (is desirable); otherwise to sit down (alone) in study is the greatest of friendship.
He must be careful in guarding the rest of his senses by keeping away evil smells and corrupted odors from the brain, or the factors which corrupt his body. He should try to improve the air of his dwelling and his office. This possible by not being close to that which corrupts the air such as a copper, smeltery, the furnace of a bathhouse, a place where corrupted water accumulates, a tanning yard, and the like.
Then, the physician must divide his day and night times according to his needs and practice. He should try to choose the time of sleeping so as to be at a minimum and only in that amount of need. This is because sleep is like death, and deeds are accomplished only in wakefulness. For this reason, the period of wakefulness must be longer than that of sleep. An example of this, is that his actions must be according to schedule, is that the first of the acts of a rational one after rising, from his sleep and cleansing of his body and the organs of the senses, in accordance with the preceding statement, is prayer. This is because thanks giving to the Benefactor, acknowledgement of His unity, and humility before Him (is due) since He is the origin of all good, the Almighty, the doer of what is necessary in reason and divine law. He justifies withdrawal from vice and pure sin by cleansing the heart. And he answers prayers and gives to all the beloved. For this reason, the first act is prayer, also (it is) the last act of the evening.
Then the physician turns from prayer to the reading of the book of his religion since it orders him to do good. Then he turns to the reading of the books of medicine according to the order of the ancients. Then when it comes to visiting, the sick, he prays again saying the morning prayers asking the exalted and hallowed God to help him prosper in his success with his patients. He then goes out with good intentions to his patients who have been exposed to many sort of disagreeably matters and their eyes are sleepless from the depth of (their) calamity. He praises God for bestowing so much on him and asks his help for their recovery so that when he comes to the patient, asks about the symptoms, and diagnoses his case, he soothes his mind and promises him recovery and health.
If the patient and the one who serves him understand, then the physician describes the remedies to them and allows them to go on with the therapy If it is not understood, then he must, with his own hands, undertake the treatment that is necessary; he (i.e. the physician) does not explain anything to (the patient). In maintaining silence as to the diagnosis for one who would not understand, in case of error, it is better for the patient and for the physician. After he has completed the visit to his patient he must return to the above mentioned office to treat any of the patients and to understand the problems.
Here. I have not described how it is necessary to query the patients, nor how the patients must behave, nor how to serve them since I have set apart separate chapters for each of these. They will come later by the help of God.
The physician must better his relationship to and endure the distress of the patients. He must pay attention to any statement heard from them. No matter what the circumstances, he must acquire information from anywhere or anything which may prove beneficial to the recovery of the patient. The physician must not discourage any complaints of the patient or display of his distress since these symptoms which occur may be important in the diagnosis of the illness. The physician must show mercy; this is not possible except by the fear of God. If the physician has these traits, then he speaks only the truth and does good for all the people.
When he has attended to the needs of the people, then he pays attention to bodily matters by bathing, eating and drinking. These are done in proportion according to what is best for him in quantity and quality, and according to the time and place. If he must eat with others, he does not ape them in eating and drinking but he organizes all the natural things according to what is essential and in the amount of what is needed, not according to taste. He teaches the correct way to others in this. He masticates well what he eats and sips what he drinks. It is best for the physician that he not sit down to drink wine in company since by this he loses time and his status is lowered. He must also beware of frequent association and mingling with young men since this would not free him from the illiterate and insensitive. It is not proper for the physician to contend with women in pulling so as not to be held in contempt by the people and chiefs. It is not correct for the physician to cam property by trade since that holds him back from science. It is not in his best interests for the physician to occupy himself with play and playthings so that he may not become weak-minded and silly. Flattery is not fitting for the physician since it is of the morals of the crowd. Envy is not good for the physician since it causes him to fall from his position.
This, which has been described, is necessary for the improvement of the physician's body just as I described, in an earlier chapter, the improvement of his soul. What I have mentioned in this chapter regarding the affairs of the body is sufficient for those who have intelligence and are acquainted with the literature.