DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus. 2007, 27: 369-425.
Carmen Peña, Fernando Girón. La prevención de la enfermedad en la España
bajomedieval, Granada, Universidad, 2006, 549 pp. ISBN: 84-338-3920-9.
There are few books currently available on the prevention of illness in medieval medicine
that are as substantial and informative as this one. Its authors are long-established
and respected authorities in this field. They have the added advantage that one is an
Arabist and the other a medical doctor, which allows them a wider vision, given that
they approach their objectives from complementary perspectives.
The work in question is very thorough and clearly the result of years of dedication.
It combines sources of diverse origins, with texts that often present a complex
interpretation but are treated with scientific rigour and, most importantly, touch on
aspects that are under-represented in current historiography.
The reason for this under-representation is that the prevention of illness, in antiquity
and the medieval world, did not receive the same attention from doctors as
actual illnesses, their causes, progression and treatment. However, the great medical
writers always reserved a chapter of their work, even in small treatises dedicated to
their patrons, for discussion of the factors that affected patients on a daily basis and
exerted a significant influence on their health.
The book takes three groups of sources as references. The first constitutes contributions
by classical authors, mainly Hippocrates and Galen. The second refers to Arabic
authors —or Jews who wrote in Arabic— with contributions by Avicenna, al-Razi and
al-Mayusi from the East and by Avenzoar, Averroes, Maimónides and Ibn al-Jatib from
Andalusia Andalusians. The third group acknowledges the debt owed to the Christian
and Jewish doctors who inherited this knowledge and translated it into Latin or Castilian
for the benefit of the Christian world. Pedro Hispano, Arnau de Vilanova, Juan de
Aviñón, Alonso Chirino and the anonymous author of the Medicina castellana regia are
included among these sources. The book also cites other authors of equal standing
but who made a lesser contribution to this study, such as the Andalusians al-Zahrawi,
‘Arib ibn Sa’id and al-Arbuli.
Peña and Girón do not limit themselves to the task of gathering information but
rather subject it to a detailed analysis, raising various thought-provoking questions that
lead to specific hypotheses. The book is, in summary, a combination of contributions
from different writers, their analysis by the authors and their conclusions.
The work itself is divided into three parts, sub-divided in turn into chapters.
They are preceded by a useful «Note to the Reader» in which the authors set out the
reasons that inspired them to develop this study. They go on to cite their sources and
their corresponding geographical areas, as well as their individual contribution to and
influence on the object of study.
In Part One, they address the preventative tradition, dating back to antiquity, which
has been crystallised in writings on health at different times and in different cultures,
paying special attention to the treatises cited in this work. Throughout these pages
we encounter references to measures for preventing disease, with specific mention
of patients’ food and drink intake, habitat, sleep and wakefulness, physical exercise,
retention and excretion, and emotions. They follow the factors in patients’ daily life that
influence their treatment by the doctor, e.g., their age, sex, constitution and habits, as
well as the seasons of the year and climate. Completing this part is a description of
texts emanating from classical Greek, Byzantine, Latin, eastern Islamic, and Andalusian
sources and from scholastic medicine in general, as well as references to the works of
Avenzoar, Averroes, Maimónides, Pedro Hispano, Arnau de Vilanova, Ibn al-Jatib, Juan
de Aviñón and Alonso Chirino.
Part Two is dedicated to the preventive resources used in the preservation of health,
which are divided into three groups. The first concerns the day-to-day surroundings of
patients: their location, air, clothing and adornment; the towns, streets, gardens and
houses; the orientation of their possessions and furnishings and the ambience created;
the materials and colours used for clothes, and their jewellery. The second group
is dedicated to the measures to be taken in the event of epidemics, and the third is
concerned with sleep, wakefulness and the emotions.
Part Three, the most extensive section of the book, deals with the direct actions
of the doctor to preserve the health of the patient through the relationship between
the intake and excretion of patients. Two categories can be established. One category
concentrates on prevention via the individual patient’s food and drink and their positive
or negative influence on the organism, as well as on the role of food in achieving
specific results. Each type of food is defined by its nature, i.e., hot, cold, dry or humid,
which is then matched to the nature of the patient. Some foods, prohibited by religion,
were omitted from scientific texts. The other category concerns the actions needed
to regulate the evacuation of residues in the body as a means of maintaining health.
Among these actions is physical exercise, including rest, massage and bathing. This
topic reveals the greatest differences in opinion between the Christian doctors on one
hand and the Islamic and Jewish doctors on the other. There are also references to
bloodletting, cupping, purgatives, vomiting, enemas and diuretics. This part ends with
a chapter dedicated to sexual relationships as another form of evacuation.
The work is accompanied by an extensive critical bibliography, which the authors
number by chapters. It is completed by the historical jources consulted and a glossary
of place names, concepts, diseases, treatments, and proper names.
The quantity and range of the contributions to medieval medical knowledge contained
in this book, some of which challenge existing preconceptions, result in a splendid
work that is highly attractive to any type of reader, not only specialists in the subject.
It is a well-rounded study, based on solid research into medical theory and practice,
which illustrates the impact of these theories on people’s daily lives in the cultural and
religious mix of medieval Spain. Furthermore, by placing the dietetics of medieval Spain
in the wider context of Islamic medicine, this book will be of lasting value. Consequently,
the book makes a major contribution to our understanding of the prevention of illness,
a previously neglected area of research. The authors are to be sincerely congratulated,
as are the bodies that made this publication possible, notably the Wellcome Trust, with
support from the British Academy and Granada University Press.
Camilo Álvarez de Morales
Escuela de Estudios Árabes (CSIC, Granada)