1842 Book Reviews

of family planning within Islam. These efforts are however confounded by ordinary people who describe themselves as having great love for children. Within this strongly patriarchal society, children are essential for social reproduction.

As Inhom tells us, the Arabic word used in Egypt to denote “family” usually means extended family; common usage of the term usra to denote “nuclear family” is relatively recent, coming from its adoption in family planning campaign material. An usra consists of husband, wife and children. A husband and wife are not an usra, and there is no word for couple. Those who marry and remain childless have no recognised existence; they are a social aberration.

Inhom’s book makes fascinating reading, because it gets behind the superficiality of RAP surveys, and avoids sweeping assumptions about women’s and men’s attitudes to children and families. As the author points out, we know little about the lives and feelings of real women in Middle Eastern societies, especially in relation to the poor. There are few studies of family life. This work is based on conversations with 100 infertile women and 90 fertile women attending Alexandria’s large public teaching hospital which is attended primarily by lower class woman. Individual stories are followed by analysis. Although the organisation of the book leads to some repetitiveness, it is readable and brings together the author’s primary data with a much wider appreciation of the relevant literature.

Notions of motherhood are, as the author points out, culturally constructed. In the case of Egypt, the key factors to consider are patriarchy, class, urbanism and religion-and these intertwine. In teasing out what is important, she paints a picture of social change. More women than ever are receiving education, and somewhat more are entering the workplace. With urbanisation, extended family systems are being eroded, though paradoxically the men may become more powerful in a situation where the husband is breadwinner and the wife consumer. In the countryside, women have access to crops, land and livestock; they can pursue crafts; they have access thus to income. In the town, the women are more dependent on their menfolk, while in turn the men, who have cash, who can buy a meal outside, are less dependent on them. Stripped of any productive role,

women are forced to focus more than ever on their reproductive role. Though patriarchy has always encouraged pronatalism, in today’s urban society the stakes have been raised.

The author suggests that population control programmes, while worthy in their aims, have served in recent years to create contradictions for poor women, by appearing to devalue the role of motherhood. The recent rise of Islamism, itself to be seen as perhaps a reaction to the breakdown of the patriarchal extended family, exploits this situation, Islamists have mounted a public attack on family planning. They see it as a threat to the Islamic ideal of the beauty of motherhood; as contradictory to the will of God and casting doubt on his ability to provide for all his children; the road to promiscuity and moral depravity, and lastly as disloyal to the Prophet who urged that the faithful should marry and multiply. Not unconnected with Islamism is the increasingly important nationalistic dimension to pronatalism, which sees the family planning movement as a Western conspiracy.

The focus of the book however, is on the plight of individuals who, in the face of this pronatalist trend, and with no organ&d support, have to live lonely lives with the disapproval of family and neighbours. Not all aspects of life are negative for every one; while mothers in law may give problems, the mothers of infertile women were found to be often a source of support and sympathy, as were, in some cases, husbands, sisters and neighbours. A sad picture emerges nevertheless, of women who embark on a search for children which takes them to quacks as well as reputable doctors, eats up all their savings and leads them to se.11 their jewellery, and ends only at menopause. One wonders whether this problem is taken seriously by the state health services, and what forms of community and health service support could be developed to help women through the difficult decisions they face in coping with their problems.

Nt&eld Institute for Health University of Leeds 71-75 Clarendon Road Lee& LS2 9PL U.K.

Carol Barker

Knowledge and the Sd~olarly Me&al TradItiona, edited by Don S. Bates. Cambridge University Press, 1995. 360 pp. US$64.95 (hardback, ISBN: 0 521 48071 X) and $24.95/UKE16.95 (paper, ISBN: 0 521 49975 5).

The cover of Knowledge and the Scholarly Medical Traditions is royal blue, offset by a small red and white woodcut. The contents are as rich and commanding as the cover is inviting. Much of the prose, by 15 authors from around the world, is beautiful and insightful. The chapters are arranged in three parts dealing respectively with ancient Gale&, Chinese, and Ayurvedic medical traditions. The similarities and differences of each are highlighted. The editor says the book, which originated from a workshop, aims to compare the ways in which ancient physicians learned and knew. In Ayurvedic and Chinese traditions, he says, knowledge is conveyed from master to disciple. A true practitioner is perceived as semi-divine and. inseparable for true knowledge. Galenic (Western) tradition turns instead to experience as a basis for knowledge. It centers on what is known in terms of methodology and other knowns. All three traditions, however, encompass degrees of both epistemology and of gnosticism; all have structural systems, and revere the past. The book reflects the authors’ diverse styles and interests.

Many intriguing quotes from ancient literature appear, .~ revealing unique aspects of ancient life.

Dean-Jone’s chapter describes the Galenic separation of women’s from men’s health, and contrasts this with Chinese traditions in which no separation occurred. Chinese doctors, records show, were not allowed to physically examine female patients. Galenic physicians, however, recorded accurate antomical obervations, negative opinions of patients historia (what others told them), but showed deference to midwives and to women’s “innate consciousness of their own bodies”. Citing contributions by midwives and physicians to Hippocratic writings, Dean-Jones argues that men’s lack of innate “consciousness” of the female body made women’s testimony of their own bodies indispensable to medicine. Thus ancient Hippocratic physicians came to rely on both autopsia (their own observations) and historia.

As universities became prevalent medicine gained intellectual respectability, says Garcia-Ballester in a chapter on health care in medieval Latin Galenism. He describes discrepancies faced by 13th century students; Schools of Arts (that were involved in medicine as in all things connected with human life) taught that philosophers investigate principles of health and illness, but doctors apply these principles to practice. Physicians of the 13th century

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came to see themselves as more useful than philosophers who sought truth. Medicine gained social justification and respectability, evidenced by its extensive geographic spread, Garcia-Ballester says. Other chapters on Galenism deal with epistemology in early Greek medicine (Lloyd), medical empiricism (Hankinson), scholarship and social context (Conrad), texts in medieval medicine (Wallis), and medicine in early modern England (Wear).

Fascinating accounts of life and knowledge in ancient China appear in the section on Chinese medicine. Sivin quotes early Chinese doctors and teachers like Ch'un-yu I, ca 100 BC who wrote in response to imperial edicts seeking doctors who could treat effectively. Authors recorded what illnesses they had cured, what books they owned, and how they had acquired their knowledge. Sivin describes a typical transmission from master to disciple; the disciple reads but his master refuses to teach him, advising him to let his thoughts mature. After repeated appeals, the master gives in and teaches, perpetuating veneration of seemingly divine founders and knowledge. In the sociopolitical context of ancient China medical knowledge was semi-divine, while in the West it relied on scientific theory.

Kuriyama contrasts Chinese and Western "ways of seeing". He examines the relation of visual observation and knowledge to understanding of the body. Kuriyama notes analogies in Chinese medicine between humans and plants; wisdom rooted in the heart gives rise to expression that may appear luminous and pure in the face. Visual diagnosis of facial hues was believed to reflect the health of the whole person. The study of facial hues may have arisen from the mystical association with colors and fascination with facial expressions, he says.

Bray's chapter on amenorrhea in imperial China quotes ancient physicians' accounts of women's health and makes stimulating reading. The sexes were conceived in terms of degree of shared yin and yang qualities; women's health wasn't different from men's. Reliance on visual diagnosis, and the perception that women's health was akin to men's compensated for the denied opportunity to physically examine female patients. Physicians generally believed they understood female disorders like amenorrhea, which, representing interruption of a central bodily cycle, was considered dangerous.

Farquhar presents engaging excerpts from recent Chinese biographies to examine a genre of medical writing that emerged after the Cultural Revolution, during which all doctors practiced, published, and taught anonymously for the collective national benefit. After the 1980s, the demand for selfless service waned. The Quarterly Bulletin of Shandong College of Traditional Chinese Medicine (TCM) then published a series of autobiographical essays ("Paths of Renowned Senior Chinese Doctors") to recognize the personal and professional sacrifices individual physicians were forced to make during the Cultural Revolution. Farquhar's chapter explores the use of personal story- telling in medical history, and raises concerns about the Westernization of TCM today.

Trawick's chapter on Western perceptions of Chinese and Ayurvedic traditions grew from teaching. To impress something lasting on each ethnically diverse undergraduate, she says, academicians must relate their stories to a general

Reviews 1843

audience. Her chapter does this, explaining Chinese and Ayurvedic traditions. Both, she says, maintain that bodily processes are invariant, that nothing is random, and hold that diseases and misfortune result from infractions of the rules but are correctable with procedures based on rules. The emphasis is perceived by Westerners to be subjective and physiological, rather than objective and anatomical. Chinese medicine focuses on the concept of wind which illustrates breath and the changing balance of yin and yang. The Ayurvedic medical tradition mirrors the social caste system, Trawick says, and is inseparable from religious and cultural traditions. She relates Ayurvedic customs to their medical classification system based on types of land (wet/dark/low or dry/light/high). Meats and foods from different lands are thus believed to influence consumer health in different ways. Origins, derivations, and births are emphasized:

From food in the stomach, blood is derived, with feces as a waste product. From blood, flesh is derived, with urine as a waste product. From flesh, fat is derived, with perspiration as a waste p roduc t . . , each deriva- tive substance is considered purer and "harder" than its precusor . . . . As with liberation of the soul from the body, we find the derivation of a pure male essence from its mixed female substrate.

Zimmermann's chapter notes similarities between Sanskrit and Galenic texts, and discusses the validity of comparing the two. Cohen's chapter describes the episte- mological carnival of Asian medicine reminding us, the editor says, that academicians presume to study scholarship using scholarly methods, try to produce knowledge about knowers and the known, but remain only bodies trying to transcend our local selves. In a closing commentary, Finkelstein says comparing bodies of knowledge (as the authors attempt to do " . . . is flimsy, very unsafe, very uncertain . . . . But comparisons somehow do take p lace . . . they have some value." Another commentator, Young, insightfully points out that while the book deals with knowns and texts, " . . . people and sicknesses are likely to traverse traditions".

Much of the book provides enjoyable reading for those like myself who haven't studied epistemology. It seems a useful reference for scholars who have, also for those interested in cultural traditions. It could serve as a graduate text. Chapters on women's health are valuable feminist sources. The book may appeal to less learned readers, as well as to academicians of all disciplines for whom it offers a meaningful historic context in which to see their individual lives, so inherently linked to learning and knowledge. As Bates says, the book reflects the tension of "the here and now from which there is no escape, and the transcendent knowing through which we strive, however imperfectly, to understand and accommodate the other".

St. George's University School of Medicine Anatomical Sciences PO Box 7 St. George's Grenada, West Indies

Cheryl Cox

London Monitor No. 3: The G~de to Health Services in the Capital, edited by Sean Boyle. King's Fund Publishing, London, 1996. 95 pp., £9.95.

Within London's health services are some of the mightiest of institutions, weightiest of opinions and most sensitive of issues. Services in London have evolved in a way that has promoted medicine that is specialist,

technological and dominated by teaching and research. By contrast, London has some of the greatest problems in the structure of primary and community services. Five years ago the Tomlinson report [I] set out to re-shape the pattern of health services in London with rationalis- ation and merger of various teaching and specialist centres and renewed investment in primary and community care.