Barren Women

Front matter

Sara Verskin Barren Women

Islam - Thought, Culture, and Society

Volume 2

Contents

Why study the experiences of barren women? — 2 The importance of infertility as a phenomenon — 3 Studying infertility to shed light on related issues in Middle Eastern and Islamic history — 7

Methodological considerations and the nature of the sources — 8 Previous studies as methodological models — 8 The nature of the primary texts, and the promises, limitations, and pitfalls of studying intellectual history using sources spanning vast periods and topographies — 11 Parallels between communities separated by religion and time —— 15 Sources excluded from this study which merit further inquiry: fictional literature, magic, and pilgrimage literature — 16

Chapters and structure —— 19

Introduction to Part Il —— 117

The importance of the Greco-Roman medical tradition in Arabic

medicine —— 123

Greek antecedents to medieval gynecological concepts — 128 Moisture, menstruation, and health in Hippocratic texts — 128 Women's anatomy and the female contribution to the embryo — 131 Infertility and its treatment in Greek medicine —— 136

Etiology and treatment of female infertility in Arabo-Galenic

medicine —— 144 Infertility in the Firdaws al-hikma (Paradise of Wisdom) — 144 The intersection of infertility with other gynecological concerns —— 151 Menstrual retention and hysterical suffocation — 153

Childless couples and the assessment of each spouse’s fertility — 161 Acknowledgement of male-factor infertility — 161 The garlic test: A case study of recapitulated tradition and innovation — 164

5 Physicians, Midwives, and Female Patients — 175 Non-gynecological interactions between male medical professionals and female patients —— 177 Gynecological care and interactions between male physicians, female patients, and female intermediaries —— 185 Theory, practice, and women’s access to Arabo-Galenic medical knowledge — 198

Conclusion to Part Il: Medicine and Sexism —— 203

XIV —— Contents

Part Ill: Healing and Religious Vulnerability Introduction to Part III — 207

6 Religiously Classifying the Medical Marketplace of Ideas — 211 Intellectual eclecticism and the pursuit of medical knowledge — 211 Lack of classification of medicine in the hadīth collections — 215 Jurists on the “medicine of the physicians" —— 217 Jurists on resorting to folk medicine — 230

7 Heterodoxy and Healthcare Among Women — 237 Muslim female patients, male practitioners and the preservation of sexual boundaries — 242 Muslim female patients, non-Muslim female practitioners, and the preservation of sexual and intellectual boundaries — 245 Shielding Muslim women from heterodox gynosocial contexts —— 252 Ibn al-Hajj on women's networks of knowledge — 262 Heterodoxy and women's medicine — 268

Conclusion to Part Ill: A Tafsir about the First Woman's Fertility and Theological Vulnerability — 271

Epilogue: Infertility and the Study of Women's History — 276 Infertility and family law —— 277 Medieval gynecology and its significance — 280 The quest for conception: women's access to medical practitioners —— 281 Infertility and choice — 283

Bibliography — 285 Primary Sources and Translations —— 285

Index — 303

This study began with an assumption and a guestion. Assuming that producing children was the primary source of women’s value and women’s power in medieval Islamic societies, what happened when women failed to produce children? There were good reasons to make this first assumption. After all, anthropological and sociological accounts from many modern Middle Eastern communities describe the importance of motherhood for women and the anxiety surrounding infertility; and members of these modern communities often ascribe such values and anxieties to religion and to centuries-old tradition. Moreover, throughout the contemporary world, arguments in favor of “traditional” or “patriarchal” practices, as well as those rejecting them, have hinged upon the notion that the limitations placed on women exist to either confine them or support them in their role as producers and nurturers of children.’ Surely this was also true of the experiences of women in medieval Islamic societies? It raises the question of how those women who could not fulfill that role were treated.

From the start, it has also been clear that this line of reasoning is problematic. There are the definitional problems, such as what do we mean by “power,” when should communal practices be labeled “Islamic,” and what is the significance of the plural in the phrase “Islamic societies”? These concerns are real, but they represent a detour from the discussion at hand, not an actual contradiction or problematization of the supposition that motherhood was the primary role assigned to women, around which the traditional system, particularly as enshrined in Islamic law, was organized. Here, however, even a cursory knowledge of Islamic family law suggests a possibly fatal flaw with this argument: Islamic law barely mentions infertility and in no way overtly penalizes barren women.” Indeed, it makes rather little mention of maternity itself.* How then could it play

1 For some examples of the ambiguities of measures which serve to support and constrict women in their roles as producers of children, see Remke Kruk, “Pregnancy and Its Social Consequences In Mediaeval And Traditional Arab Society” Quaderni Di Studi Arabi 5/6 (1987):418 - 30.

2 The case of slave women represents something of an exception to this rule, as such women stood to gain some legal protections if they bore their masters’ children. See Y. Mirza, “Remembering the Umm al-Walad," in Concubines and Courtesans: Women and Slavery in Islamic History, ed. M. Gordon and K.A. Hain (Oxford: Oxford University Press, 2017), 297-337.

3 The most recent scholarship on motherhood in the medieval Islamic world, Kathryn Kueny's Conceiving Identities: Maternity in Medieval Muslim Discourse and Practice (Albany: State University of New York Press, 2013), does not include any extended discussion of Islamic law.

8 OpenAccess. O 2020 Sara Verskin, published by De Gruyter. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. https://doi.org/10.1515/9783110596588-002 a role in shaping the experiences of infertile women? Ultimately, it is the answer to this question which constitutes the subject of this book.

Why study the experiences of barren women?

For students of medieval Islamic societies, the study of barren women offers two benefits. First, it illuminates a phenomenon that is important in and of itself, as it was experienced by women in all eras and places, and with life-changing consequences. Secondly, in exploring the factors that shape the peculiar experience of infertility, we shed light on broader issues in Middle Eastern and Islamic history. In studying reproduction, we gain insight into the interplay between the medical and religious explanations of biological events and the significance attributed to them. In studying medical interventions, we gain insight into the remarkably diverse marketplace of ideas about health that existed in some medieval communities, and the anxieties some people felt as a result of the multiplicity of authorities and forms of knowledge. We see competition and anxiety expressed by religious authorities against medical authorities and practitioners of healing magic, male medical practitioners against female ones, and male religious culture against female religious culture. In studying women's sources of healthcare, we gain new insights into the meaning behind regulations governing women's modesty and social interactions. Finally, in studying the options available to childless women throughout their life cycles, we can fine-tune our understanding of some aspects of the institutions of Islamic marriage, divorce, and polygamy in ways that make us re-examine, and at times contradict, certain assumptions about patriarchy, paternity, motherhood, and women’s vulnerability and empowerment within the Islamic legal system.

The picture of patriarchy that emerges from this study of infertility is a complex and somewhat surprising one. While much ink has been spilled by others in describing patriarchal attempts to exert male control over women’s sexual organs so as to ensure fathers’ confidence in their own paternity, this study shows the extent to which men depended upon and trusted women to individually monitor and interpret their own reproductive statuses. It also shows both the legal and medical willingness to tolerate, and even embrace, reproductive uncertainty and ambiguity. However, it also suggests that the social constraints urged upon women were understood by many jurists as existing for reasons beyond the need to guard against sexual and reproductive violations. Rather they were also put in place to guard against the threat of religious and intellectual syncretism, a threat to which some jurists thought women were particularly at risk, and partic-

Why study the experiences of barren women? — 3 ularly so during their experiences of events connected with health, birth, and death.

The importance of infertility as a phenomenon

Writing in Tunis in the 1970s, the sociologist Abdelwahab Bouhdiba produced a lengthy, dramatic, and damning depiction of the importance of fertility and the prospect of sterility for women in what he termed contemporary “Arabo-Muslim” society.* His La Sexualité en Islam highlights the role played by Islamic legal norms in making the fate of women contingent upon their reproductive success. Because of the weakness of a woman’s position as a wife, a woman must seek safety through the institution of motherhood, he claims. Polygamy, divorce, and inheritance law all conspire to pressure women into producing children, as a means of obtaining loyalty, respect, care, and financial security in a system which is otherwise lacking in those things.” He concludes:

Having children in the traditional Arabo-Muslim society is the fundamental element of security for a woman. Woe betide the sterile woman . . . Motherhood, then, was a protection. It was the only security for a woman - there was practically no other... So, given the “system” and the structures of the environment, the Arab woman tries to increase her chances by having as many pregnancies as possible. Hence that obsession with children — have children, more children and still more children!

Bouhdiba argues that even in The Thousand and One Nights, the classic story of the triumph of feminine brains over masculine brawn, what enables Shahrezad to survive is not her storytelling abilities, but rather her providing the king with three sons in the space of thirty-three months. “One of them walked, one of them crawled, and one was at the breast.”*

Other sociologists and ethnographers describing their findings in twentieth-century Iran, Turkey,’ Palestine,’ Jordan,’ Egypt,’° and Morocco" have empha-

4 A. Bouhdiba, Sexuality in Islam (London: Saqi Books, 2004), 215 f. La Sexualité en Islam (Paris: Presses Universitaires de France, 1975), 263f.

5 For an overview of Islamic texts that refer to the honor due to mothers, see A. Giladi, Muslim Midwives: The Craft of Birthing in the Premodern Middle East (New York: Cambridge University Press, 2015), 37-56.

6 Bouhdiba, Sexuality in Islam, 216.

7 C. Delaney, The Seed and the Soil: Gender and Cosmology in Turkish Village Society (Berkeley: University of California Press, 1991), 59. Of all the accounts of women’s experiences in the Middle East that I have come across, Delaney’s places the least emphasis on the stresses caused by insized the role familial honor and social pressure play in shaping the experience of childless women, in addition to the fear of divorce. The French sociologist Paul Vieille, based on interviews with urban and rural women living in Iran in the 1960s, vividly depicts the shame associated with infertility and the pressure brought to bear in compelling young women to take measures to demonstrate their own fertility.

After marriage all those who surround a young wife await with anxiety the announcement of a pregnancy. The event releases an anxiety; thenceforth the young wife will be cherished by her husband and her in-laws. If, on the contrary, there is a delay, anxiety grows on all sides. The father of the young girl has given a product for reproduction; he is discredited by his daughter who does not immediately promise a child. The husband's family, on its side, has acquired a young wife to increase its descendants; if her sterility continues, the husband loses interest in his wife and threatens to send her back or to take a second wife. The household is constituted to procreate; sterility is a broken contract. The young wife who is, habitually and without proof, taken to be responsible for the sterility of the couple, will do everything to change her state: pilgrimages, magic practices, potions, and so forth. If she does not succeed, she will have only a diminished status, and her family will feel dishonored by it.

Social incitements to childbirth continue after the first birth. There are, notably, the uncertainties of the position of the wife in the household; the marriage is easily broken by the will of the husband alone. Even if this does not happen in the countryside," the opfertility and the anxiety to have children. Writing about her fieldwork in a Turkish village in the early 1980s, she also mentions that abortion is common, and quite dangerous for the mother. However, she does note that, “If a child is not produced within a reasonable amount of time, the man is free to divorce or take a second wife. Although polygyny is forbidden in modern Turkish law, it sometimes occurs in villages where traditions of the Seriat (Islamic law) still operate. The system of beliefs implies that the marriage bond is less important than physiological paternity." Ibid., 53.

8 H. Granqvist, Marriage Conditions in a Palestinian Village, 1:117; 2:116, 244— 6, and idem, Child Problems Among the Arabs (Sódorstróm, 1950), 76 — 7, 224. T. Canaan, “Unwritten Laws Affecting the Arab Woman of Palestine," Journal of the Palestine Oriental Society 11 (1931), 175.

9 R. Antoun, “Social Organization and the Life Cycle in an Arab Village," Ethnology 6.3 (1967), 302-3.

10 H. ‘Ammar, Growing up in an Egyptian village; Silwa, Province of Aswan (New York, Octagon Books, 1966), 94. S. Morsey, Gender, Sickness, and Healing in Rural Egypt (Boulder, CO: Westview Press, 1993), 48, 54, 75. and “Sex Differences and Folk Illness,” in Women in the Muslim World, L. Beck and N. Keddie (Cambridge, Mass.: Harvard University Press, 1978), 604—605. M. Inhorn, Infertility and patriarchy: the cultural politics of gender and family life in Egypt (Philadelphia: University of Pennsylvania Press, 1996).

11 V. Maher, *Women and Social Change in Morocco," in Women in the Muslim World, ed. Lois Beck and Nikki Keddie (Cambridge, Mass: Harvard University Press, 1978), 104.

12 Erika Friedl’s account of a remote Iranian mountain village in the 1970s and early 1980s confirms this: “There aren't many childless couples in Deh Koh, and of the few not one ever split up,

Why study the experiences of barren women? — 5 tion left to the husband to send back his wife easily leads the latter to look for means to attach her to her home. Children are reputed to be “nails” that attach the wife to the home. After marriage, women hasten to multiply these ties which guarantee them against repudiation.

. .. the group of women: they actively surround the young wife, initiate her, guide her through the first pregnancies, welcome the newborn, and combat sterility. In them are transmitted ancient popular practices regarding magic, pharmacy, and medicine. They help the young wives and exert a considerable pressure in favor of fecundity.”

The effects of such pressure lead women to engage in a “quest for conception,” memorably depicted by Erika Friedl in Women of Deh Koh, which includes a chapter portraying the experience of a childless young wife seeking aid in the wake of the Iranian Revolution,“ and by Marcia Inhorn, in her books The Quest for Conception: Gender, Infertility, and Egyptian Medical Traditions and Infertility and Patriarchy: The Cultural Politics of Gender and Family Life in Egypt. In the course of such quests, infertile women seek assistance from ethnomedical practitioners, religious saints, and practitioners of biomedicine. A study from modern Egypt shows that concerns about infertility, and the perception that pregnancy is not occurring quickly enough, account for more than half of all women’s medical visits, whether to biomedical physicians or practitioners of indigenous medicine.”

As depicted in modern accounts, in the course of this “quest for conception,” women encounter and navigate Islamic legal culture in complex ways. The delivery of medical attention and care to women is potentially fraught as a result of modesty concerns. Moreover, medical systems and treatments, such as biomedical healing, humoral healing, magical healing, prayer, and pilgrimage rituals to attain saintly blessing, baraka, are subject to religious categorizations on the basis of theological orthodoxy and heresy. Whether a form of medical intervention meets with approval or disapproval from religious authorities is not dependent on whether such interventions are “traditional,” validated by either and no husband ever took a second wife because of his first wife’s barrenness. Indeed after the first few rough years of crushed expectations, attempted cures, amulets and accusations, pilgrimages, travels to doctors, fights, sneers, and humiliating pity, and after hope has dimmed to a faint flicker deep in the couple’s hearts, they tune in to each other as companions in misery and live more peacefully and leisurely than most of their neighbors harassed by large families.” E. Friedl, Women of Deh Koh (London: Penguin Books, 1991), 48.

13 P. Vieille, “Family Alliance and Sexual Politics,” in Women in the Muslim World, ed. Lois Beck and Nikki Keddie (Cambridge, Mass: Harvard University Press, 1978), 457.

14 Friedl, Women of Deh Koh, 47-65.

15 H. Khattab, N. Younis, and H. Zurayk, Women, Reproduction, and Health in Rural Egypt (Cairo: American University in Cairo Press, 1999), 65.

historical precedent or indigeneity. Indeed, among some devout Muslims, centuries-old medical systems are viewed with more suspicion than the more recent biomedicine. As Inhorn writes with respect to Egypt:

Interestingly, contemporary Islamists tend to condone most biomedical therapies as the creation of God - as being "God's medicine." Yet, it is truly ironic that only modern, Westernbased biomedicine is deemed religiously acceptable, given the rich history of Yūnānī-inspired Islamic and prophetic medicine in Egypt. As we shall see, many of the contemporary ethnomedical practices found in Egypt derive from these early, religiously acceptable medical traditions, which are now viewed as unorthodox by Islamist elements in Egyptian society.'*

All of these characterizations of modern Muslim women’s experiences highlight the importance of the Islamic legal tradition for understanding contemporary familial relations, gender roles, and attitudes toward medical treatment." And yet, due to the paucity of scholarship,'* anthropologists have largely skipped over the medieval Islamic period when describing the significance and consequences of infertility, reaching instead for literature from the Greco-Roman or even Biblical periods.'?

Where scholarship about the intersection of Islamic law, science, and gender exists, it has been very useful. Thus Basim Musallam’s work on the approaches of medieval Islamic physicians towards the *one-seed" and “two-seed theories" of conception, and the intertwined relationship between Islamic holy texts and those medical theories, has become the go-to text, almost the only one, for those wishing to provide some medieval Islamic context for contemporary conversations about the intersection of gender, medicine, and Islamic legal orthodoxy.”° Still lacking, however, are studies of medieval interactions between male physicians and female patients, medieval attitudes toward the “quest for conception”

16 M. Inhorn, Quest for Conception: Gender, Infertility, and Egyptian Medical Traditions (Philadelphia: University of Pennsylvania Press, 1994), 94.

17 Inhorn, Infertility and Patriarchy, 26.

18 In an unusual dissertation, Egyptologist Nicole Hansen attempted to study 5000 years worth of fertility rituals in Egypt, from the Old Kingdom to the present. The pre-colonial Islamic era is the most sparsely sourced period. N. Hansen, “Motherhood in the Mother of the World: continuity and change of reproductive concepts and practices in Egypt from ancient to modern times” (PhD diss., University of Chicago, 2006).

19 E.g., Taufik Canaan, “Unwritten Laws Affecting the Arab Woman of Palestine,” 175, 203. R. Patai, Sex and Family in the Bible and the Middle East (New York: Doubleday, 1959), 76-84. 20 B. Musallam, “The Human Embryo in Arabic Scientific and Religious Thought,” in The Human Embryo: Aristotle and the Arabic and European Traditions. ed. G. R. Dunstan (Exeter: University of Exeter Press, 1990), 32—46.

Why study the experiences of barren women? — 7 and orthodox and heretical forms of medical treatment, and the extent to which modern women’s experiences of disempowerment or fear of disempowerment as a result of infertility were shared by their medieval counterparts. This study represents a first foray, among what I hope will be many future ones, into filling those gaps in our knowledge.

Studying infertility to shed light on related issues in Middle Eastern and Islamic history

The exploration of infertility has much to offer students of medieval Islamic communities generally, well beyond specific information about barren women. Infertility represents an extreme case in which a woman’s multiple roles as a mother, as a possessor and object of sexual desire, and as a conduit that binds families together (genealogically and financially) through marriage, are in direct conflict with each other. By examining this extreme case, we can gain insights into the relative significance of, and tensions between, those roles.

As other scholars have demonstrated, analyzing the ramifications of a marginal biological phenomenon and the rather specialized legal discourse surrounding it can yield fruitful and clarifying insights about more common experiences and pervasive social structures. For example, Paula Sanders’s study of the treatment of hermaphrodites in medieval Islamic law not only provides information about what hermaphrodites might have experienced, but also illuminates the process, purpose, and scope of gender differentiation in Islamic law more generally." The above-mentioned article by Basim Musallam, on medieval embryology, not only explains specific claims about genetics, but also makes a broader point, showing just how important scientific beliefs were in framing large branches of Islamic law, as it pertains to sexuality, contraception, and abortion.” Moreover, he shows that existing Islamic texts and laws favored and promoted certain scientific theories over others. My own study of infertility sheds light on a host of issues surrounding the physiology of pubescence, menstruation, and amenorrhea and their importance for understanding Islamic marriage and divorce law.

Exploring infertility also draws our attention to medieval medical treatment, both generally and with regard to women specifically. Because infertility was a

21 P. Sanders, “Gendering the Ungendered Body: Hermaphrodites in Medieval Islamic Law,” in Women in Middle Eastern History: Shifting Boundaries in Sex and Gender, ed. Nikki R. Keddie and Beth Baron (New Haven: Yale University Press, 1991), 74—95.

22 Musallam, “The Human Embryo in Arabic Scientific and Religious Thought,” 37-8, 42-3.

long-term problem, rather than an emergency, and because it was perceived as an affliction which could be attributed to multiple sources, in theory a medieval childless woman would have had ample time to seek an array of treatment options, just as modern childless women do today. And, just as they do today, the practitioners offering treatment existed in an environment in which they competed for the exclusive trust of their patients, while their patients often availed themselves of a hybrid system for understanding what, precisely, was wrong with their bodies. An analysis of infertile women’s treatment options therefore leads us to examine who was offering explanations and treatments for ill health, the relationship between patients and those offering them treatment, and the relationship between competing practitioners. The information about competing practitioners further leads us to consider the question of the extent to which male authorities expected their views and writings about women’s bodies to reach and influence women themselves.

Finally, studying infertility provides us with an opportunity to re-examine aspects of Islamic law which are regularly mentioned in medieval texts, but which have been ignored or at times misinterpreted in modern scholarship. For example, a great deal of attention has been paid to juristic concerns about interaction between women and unrelated men. However, little attention has been paid to the frequently expressed medieval concerns about women interacting with their fellow women. Similarly understudied are the frequent mentions of the legal outcomes of biologically unexpected circumstances — wives who are not old and yet do not menstruate regularly, husbands and wives who are in some way impotent and unable to engage in normal sexual activity, and women who claim to be pregnant with a fetus for years on end. Studying infertility brings to the fore and helps to contextualize the significance of these legal discussions.

Methodological considerations and the nature of the sources Previous studies as methodological models

At the end of his life, the historian of medicine Michael Dols, produced a magnum opus, Majniin: The Madman in Medieval Islamic Society with the objective of placing “the subject of insanity in its historical context, to examine its significance, not only within the fields of medicine, theology, magic, and law, but also within the social milieu of Islamic society."? In his book, Dols traces the history of medical thinking about the causes and treatments of mental illness in the Greek medical tradition and the Arabic one, as well as in Jewish, Christian, and Islamic texts. He goes on to describe the institutions built to provide care for the mentally ill. He then addresses moral perceptions of the significance of madness, as depicted by poets, mystics, and belle-lettrists. Finally, he explores the legal significance and consequences of insanity. In its ideal form, a study of medieval infertility would be structured using a similar template. My own study is far more limited than Dols’s book, focusing specifically on the medical and legal discussions of the condition at hand. It is, however, written with Dols’s scope in mind, both in terms of the larger questions it seeks to illuminate, and in terms of its handling of recondite source materials.

The similarities between infertility and madness are striking. The causes of both were simultaneously attributed to both “natural” biological dysfunction and divine intervention, and the onset of the disease was difficult to pinpoint. Both posed long-term problems, and therefore there was opportunity in the course of a single patient’s lifetime to attempt multiple forms of treatment. Both affected not just the ill person themselves, but the families and communities that surrounded them. And for both, the historian lacks first-person narratives of the experiences of the unfortunate patients.

In his introduction, Dols describes the ways in which the nature of the sources available shaped his project, its methodology, and its limitations; much of what he writes is also transferable to the study of infertility. He notes that the paucity of descriptive resources necessitates pulling together sources that come from a wide range of locations and times. This means that “the fragmentary nature of the source material makes it quite difficult to delineate the subtle changes in the beliefs and practices concerning insanity or, conversely to avoid a static view of the subject.””* Moreover, in both the medical and legal literature, the depictions of mental disturbances are “prescriptive rather than descriptive,” meaning that the depictions of the phenomenon in these texts are there to provide a rationale for a particular method of treatment, rather than a clinical description, and therefore mapping contemporary diagnoses onto medieval medical descriptions requires making some interpretive assumptions.** The

23 M. Dols, Majniin: The Madman in Medieval Islamic Society (Oxford: Clarendon Press, 1992), vii.

24 Dols, Majnūn, 2.

26 Among Dols’s assumptions are: (a) That mental illnesses found in medieval Islamic societies are similar to the ones recognized by modern medicine. (b) That based on biology, geography, medical data also does not lend itself to quantification at all. Most importantly, “nor are there, to my knowledge, any reliable personal records of the insane that would allow them to speak for themselves; the rarity of authentic voices robs this work of immediacy, comfortably distancing us from what was often, surely, a painful reality."?

All of these methodological complications also pertain to the study of the treatment of barren women in the medieval Middle East. For Dols, these complications do not preclude scholarly analysis. He writes, *What can be expected, however, is a relatively firm grasp of the interpretations of irrationality, and a tessellated picture of the madman in medieval society.”** This is also my task — to explore how infertility was understood and learn about the experiences of and attitudes towards infertile women from as many perspectives as are available to us.

Discussions of infertility include several unique components, not present in discussions of madness. Infertility is one place where social and religious expectations of gendered roles, scientific disputes about conception and reproduction, and familial dynamics, all intersect. For this reason, I have also looked to Basim Musallam's Sex and Society in Islam: Birth Control Before the Nineteenth Century as a model for my own work. There Musallam uses the specific issue of contraception as an entry point into a broader analysis of Islamic attitudes generally toward sexual activity and marriage. In doing so, he demonstrates trade, and war, we can assume that mental illness caused by tropical diseases, malnutrition, and narcotics caused mental illness to be widespread and to probably increase over time. (c) That certain sociological factors pertaining to the segregation of minorities and women “may have produced a greater incidence of psychoneuroses and personality disorders than would be found in modern Western society" (p.3n5). My assumptions for my own work are similar to (a) and (b), but have nothing comparable to (c). Medieval infertility was due to the same sorts of causes as modern infertility, though most likely the prevalence of each particular cause was different (e.g. infertility or diminished fertility due to malnutrition or anemia would have been more prevalent in the past when more communities experienced periods of famine). In our own era, a common cause of infertility is sexually transmitted infections. Some of these infections are known to have existed in the past. For example the bacillus which causes gonorrhea, which was rampant in the pre-modern world, in particular is known to cause female infertility, even in women who have had only limited exposure to the infection and who are otherwise asymptomatic. At the moment, there is insufficient scholarship to make an argument as to whether such infections were more or less prevalent in various medieval populations in the Middle East. For an example of what such scholarship might look like, consider a study with respect to Japan. W. Johnston, “Sexually Transmitted Diseases and Demographic Change in Early Modern Japan.” East Asian Science, Technology, and Medicine 30 (2009):74— 92. 27 Dols, Majnün, 2