Obesity-Related Female Infertility in Medieval Persian Manuscripts

Abstract

Dear Editor,Obesity and its related disorders are becoming a worldwidepublichealthconcern contributingtoincreased morbidity andmortality rates [1]. Obese women, in addition to their similarcomorbiditiestomen,havefertility-relateddisorders,whichisa less emphasized aspect of obesity [ 2]. Hypotheses on asso-ciation between obesity and female infertility entered themedical literatureintheearly twentieth century [3].However,recognition of this association dates back to the earlier centu-ries.Inarecenthistoricalnote,LevibenGershon(1288–1344CE), a French rabbi, was suggested as the first to have de-scribed the relationbetween obesity and female infertility [4].Based on the historical evidence, we believe that the associa-tion between obesity and female infertility was known to theGreek and Persian physicians much earlier than thought.Hippocrates (ca. 460–370 BCE) seems to be the first tounderstand that obesity might lead to infertility [5]. Althoughobesity and related complications were subjects of interest intheGreekandByzantineeras,theassociationbetweenobesityand female infertility was not clearly described inthe medicalmanuscripts of these periods [6, 7].The Islamic Golden Age (ca. 750–1257 CE), throughwhich European science during the Middle Ages developed,coincided with the appearance of prominent physicians suchas Rhazes (ca. 865–925 CE), Haly Abbas (930–994 CE),Albucasis (936–1013 CE), and Avicenna (981–1037 CE) [8,9].DespitetheArabiclanguagesovereigntyoverthescientificliterature of this era, some renowned scholars of this period,e.g., Akhawayni Bukhari (?–983 CE) and Hakim Jorjani(1042–1137 CE), compiled their medical treatises in Persian.Likewise, more well-known medical books of the medievalPersia such as Rhazes’ Liber Continens, Avicenna’s TheCanon of Medicine, andHalyAbbas’TheRoyalBook,whichwere all written in Persian language, were not neglected insubsequent centuries. Particular emphasis of their descendantstomakenumerouscopies of their extant manuscripts as wellastreasuring the medical curricula of the medieval Persian andEuropean schools with these masterpieces might highlighttremendous influence of the Persian medical compilationson the medicine of their times [ 9–11].Akhawayni Bukhari (Fig. 1)lived andpracticed medicinein Bukhara (now in Uzbekistan). Being the student of astudent of Rhazes, Akhawayni collected his 20-year medicalexperiences in the Hidayat al-Mutaallemin fi al-Tibb(Learner’s Guide to Medicine)[11]. Written in new Persianbefore 983–984 CE, the Hidayat was compiled in a “lightand simple” style for Akhawayni’s son and other students ofmedicine at the Samanid period (819–999 CE) [12]. Thesecond part of the book on different medical issues roughlya pedibus usque ad caput contains a chapter on the “uteruspains” in which Akhawayni describes female obesity as apredisposing factor to infertility: “…each organ in the body