230 DENYSE ROCKEY and PENELOPE JOHNSTONE

because of its importance and accessibility. However, it is possible that other

extant writings of al-Razi, still in manuscript form in various parts of the world,
also contain remarks about speech. Unfortunately, no index has been compiled
for the Wur~i and time has not permitted a thorough search through this huge
work. He probably met with other impediments, and scattered references to such
conditions as the muteness following brain injury no doubt exist, as they do in the
Greek works from which al-Razi’s own reflections partly stem.

The most flourishing period of Islamic medicine was from the early 9th to the
mid- 13th Century. During this time the Caliphs’ capital, Baghdad, was also a
center for scientific and philosophical studies, and Arabic became the intellectual
language from the lndus, through North Africa, to Spain. The 9th Century was
the chief period of translation, when most of the notable Greek writings were
rendered into Arabic, often from a previous Syriac translation. This work was
carried out in Baghdad, where Hunain b. Ishay (Johannitius, 809-873 A.D.) was
the supervisor and main contributor. Thus, by the time al-Razi came to study
medicine, the works of most authorities were available in his native tongue.
Ah Bakr Zakariyya al-Razi, known to the west as Rhazes, was born c. 865
A.D. at Rayy, near modem Teheran, from which his name derives. Precise
details of his life are limited, but information and anecdotes, plus his own
sayings, are available in the standard Arabic biographies. The most quoted is that
of lbn Abi UsatbiCa (d. 1270 A.D. ), who also draws on earlier accounts. Razi is
said to have studied the usual subjects of the curriculum-including philosophy,
grammar, chemistry aird music -before taking up medicine around the age of 30.
when he came to Baghdad, his interest being aroused by visits to the
nd conversations with its chief pharmacist and physicians. So great was
*s diligence that he became the outstanding physician of his time, well
cserving the title +‘Galen of the Arabs. * +
his clinical work. teaching, and duties as superintendent of the
L-first at Rayy and later at Baghdad-he is said to have traveled widely,
become friend?y with the prince Mansur b. Ishaq, for whom he wrote one of
s best known works, Kit& &&nsuri. First-hand reports relate how Razi
id conduct his teaching sessions. Surrounded by a circle of senior students,
hind whom would be their juniors, he would summon a patient to relate his
azi would then go round the circle and find someone who could
prescribe; if none was able, he would supply the answer himself.
my assume that speech defectives demonstrated rather than described their
m but would have been spared any embarrassment, since all accounts
of F&i’s kindness and gentle manner. (Iskandar, 196 1, 1976; Meyerhof,
19=; pines. 1975; Ullmann, 1970).
ide his great learning, skill, and philanthropy, Razi was renowned for his
 MEDIEVAL ARABIC VIEWS ON SPEECH DISORDERS 231

penetrating insight and practical application of empirical knowledge. Indeed, he

can be said to have revived the Socratic art of clinical observation. It was this that
contributed to his originality, a notable example being his differentiation between
measles and smallpox. He also showed interest in children and his monograph,
Diseuses ofChildren, now available in English (Radbill, 197 l), has prompted
some to consider him the father of pediatrics (Major, 1954, I, p. 239). Surpris-
ingly, perhaps, this work contains no reference to speech defects.

al-Hawi

At the height of his medical career, Razi published the first four books of Kit&
d-Hard, a work still in manuscript, which was to be influential in shaping the
Qanun of Ibn Sina (Avicenna, 980-1037 A.D.). Completion of the work was cut
short by Razi ‘S premature death, and so students and colleagues edited his lecture
notes and compiled them into a book of the same name (Iskandar, 1967, 1975).
This served as a basic text for many years and was not entirely superseded by the
Qanun. During the Renaissance, its influence spread still further afield through a
Latin translation completed by Faraj b. Salim (Faragut) in 1279, under the title
Liher Continens, which is a literal rendering of “al-Hawi, ” meaning “com-
prehensive ” or “that which contains all. ” Also, not to be confused with ul-Jumi,
the recent Hyderabad publication is the first complete Arabic edition of this work
and amounts to more than 20 volumes. Though leaving much to be desired as a
work of critical scholarship, it is to be valued as containing the bulk of Razi’s
teachings as he would have presented them to students. He is said to have spent
many years on this compilation and hence L probably incorporates his accumu-
lated experiences in hospital and consultin room. The Hurt*i itself, never having
been revised by the master, betrays its un,, lished nature and thus is not entirely
characteristic of Razi’s work. However, it is an excellent example of the Arabic
method of selecting and arranging from the best sources available. As in many
writings of this type and period, diseases are classified roughly accordingly to
their position from “head to toe. ” There follows a description of general disor-
ders, fevers and plagues; a full pharmacopoeia; tables of terminology; weights
and measures; and finally an account of skin diseases.
Voice and speech impediments are treated in chapters concerning the head and
throat, and the latter are mentioned briefly as one of the symptoms of “phrenitls”
and “melancholy. ” The larynx was recognized as the site of hoarseness, which
was attributed to a variety of causes. including moisture, catarrh, ulceration of
the lung, and inhalation of cold air (3, pp. 157-Q’ . Most defects, however. were
attributed to various conditions of the tongue.

‘References are to the volume and page number of the Hyderabad edition of the Htrwi. Where
direct quot.ations are given, the line number is also indicated. The corresponding section on the Voice
in the Liber Continens is to be found in Vol. I, Book 3 of the 1506 edition (Bodleian Library no.
231 DENYSE ROCKEY and PENELOPE JOHNSTONE

In main, Razi’s encyclopedia follows the teachings in Firduus al-Hikma,

batten by al-Tabari (c. 850 A.D.). This author, however, is more concerned
ith philosophical reflections and, aside from his comments on voice, discusses
h impediments in relation to the lips, teeth, and nostrils (Siddiqi, 1928). By
C, Razi focuses on the tongue and it is from his discussion of this organ
most of our information is drawn. Though this is a comparatively short
ion, it is significant that he should attend to speech at all, since the subject
frequently overlooked by physicians of his standing in the West until more
ent eentwies, and what references do appear rarely amount to more than one

is chapter on the tongue, speech, and related subjects, Razi draws on a

of authorities, distinguishing his own contribution by the word li
inions are listed in turn and he lets each authority speak for himself.
ly there is little interpretation or attempt to relate one extract to another,
omments may have been given at the time and not committed to paper.
on toCAli b. R,abban al-Tabari (c. 810-855 A.D.), he makes mention of
ic writers: Ibn Masawaih of Jundeshapur (c. 777-857 A.D.), Yuhanna
yun (Serapion, d.c. 8’73 A.D.) and Masarjawaih, also referred to as
i, who lived at the end of the 8th or early 9th century at Basra, Iraq. The
urces of influence on the rise of Islamic intellectualism are also evident.
nce is made to its Greek and Alexandrian heritage through the works of
SW-90 A-D.), Ahrun (c. 610-641 A.D.) and Paulus of Aegina
A.D.): to Syria through the 8th Century writer SemCon de Taibuta; and
ia through the Caraka-Samhita compendium. Thus the Hawi is well named
ws USa condensed account of thinking on speech disorders until that time.

T’ague and Speech Impediments

ologically, the tongue has long been associated with speech, the Gothic
e Latin lingrra being two instances. Similarly in Arabic, Zisan, the
rd for tongue, also denotes “language” as in the famous dictio-
/?UZFZaf-%rab. While there is reason to differentiate tonglde from language,
Standish between the spoken and more general form, as in phrases like
and ‘dead language q” the basis for this distinction is not
l

nt. Consequently, early writers, hardly suspecting the intricacies of

physiology, looked to the tongue both as thk. chief organ of speech
rce of its principal defects.

tn Vol. I, Book 6, Tracts 1 and 2 of the 1509 edition (Bodleian Library no. Lister E
conesponding to the translations that follow on the Tongue are to be found in
8, Book 7; and in the 1509 edition, Vol. I, Book 7, Tract 1. The former version
of the Had except for one small passage that does not appear in the Arabic, but
a=anged so that symptoms, etiology, and diagnosis are presented first, and
 MEDIEVAL ARABIC VIEWS ON SPEECH DISORDERS 233

One of the first lines of inquiry centered on the tongue’s shape and mobility.
Since antiquity, it has been realized that this organ served both taste and articula-
tion, and Aristot!e was able to elaborate its latter role through his new science of
comparative anatomy. The human tongue, he believed, was best adapted to
speech because its breadth and softness conferred great malleability (492b30;
660a23). Even amongst birds, the best talkers were those with the broadest
tongues, since these had the facility of also becoming pointed (66Oa33). Razi
appears to have accepted this view, though he cites Masarjawaih as his authority.
This Jewish physician held that a finely pointed tongue, like a bird’s, was best for
speech (3, p. 208). But inherent mobility was of little value if the organ had no
freedom of action. Aristotle had noted that the tongue was useless for speech in
those animals where it was tied down, and an analogy was not hard to find in
humans.
If lingual flexibility was fundamental to speech, it was logical to explain
pathology in terms of some restriction to movement. This could arise from
sources that were either extrinsic or intrinsic. Razi begins with the former and,
quoting from Galen, states unequivocally:

The more forwardly placed the band, or frcnum, beneath the tongut’. the more dlfticult %pccch
becomes, and vice versa (3. p. 207, 1.6):

He then observes certain intrinsic causec, of speech impediment. Now appartntly

quoting Masarjawaih, he says:

A man with a large tongue. being unable to manif ‘stc it and cnunclatc the Icttcrs, uill
stumble in his speech )~;ruttJ.3 Vl’ith a \~-q broad tongue hr’ uill speak tndistrnctl~ )tilA(411).
But if his tongue is small and too short to reach the points of artxulation, hc uill mis-
pronounce certain letters [drhqh]. This resembles the condition of coung bo>$ ~41th trhorf
torlgues, who, however, lose the defe<t once they mature. ( 3. p. 208, 1.71.

Here we have a crude distinction between three tvpes II of impediment. and a

rudimentary appreciation of developmental delay. Little more could be expected,
since the role of the nervous system was extremely obscure. Aristotle had placed
thinking in the heart and supposed that the brain, through its phlegm. acted solely
as a cooling agent. Galen, who contributed much to neurology, was of a drfferC:nt
mind. Having observed that voice was inhibited after severa’nce of the recunent

‘Cf. Paulus /@ineta, Book VI, sect. xxix (Adams, i844-47).

3Throughout this paper, we have generally used the word nearest to the infinitive in Arz’oic, the
verbal base (past tense). However, in direct quotations and problematic passages, we frave given the
form of the word as it appears in the Hawi. This may be:
Verbal Base: lakina iathigha ratta fa’fa’a
Verbal Noun: lukna luthgha rutta fa’fa’(t)
Adjective: alkan althagh arratt fa’fa’
Roots: l-k-n l-th-gh r-t-t
 DENYSE ROCKEY and PENELOPE JOHNSTONE

al nerve, he concluded that the stimulus must originate in the central

s system (Major, 1954, pp. 191, 196). This was a step towards dis-
tinguishing impediments of the central and peripheral systems. Little further
however, was made in differential diagnosis over the following cen-
Nazi was still drawing upon Galen on this point:

impeded, one must investigate whether or not the brain is also involved, for
will be an accompanying disturbance of sensory perception (hawass] . If not,
must examine the body of the tongue either for tremor, flaccidity or rigidity, which
e restricted its movement, or for moisture, thickness and swelling, which may have
itheavy43.p, 211, 1.15).

is question of weight or turgidity, leading to a weak and unwieldy

at attracted most discussion. And as these symptoms could be ex-
conveniently by the prevailing medical philosophy, there was no
~~~~~1~~ in accounting for most speech defects in a similar fashion.
from mechanical impediments, the Arabs saw no reason to depart from
ion31 Hellenic explanation of sickness in terms of an imbalance amongst
humors-yellow and black bile, phlegm, arid blood. In due course, these
n not as isolated organic fluids but in relation to the Greek cosmological
onceived of four basic and opposing qualities-hot, cold, wet,
ination of any two being the basis of the four elements-
water. These could be linked further to temperament, anatom-
e seasons. Hence “cold” and “wet” were associated with a
matic disposition, the brain and winter. (Browne, 1921, pp. 115425;
llah. 1946, pp. 76-85; iMajor, 1954, pp. 192- 193). A schematic represen-
of this theory, which remained popular in Europe until very recent cen-
is given in Figure 1.
the basis of this system, diseases were correlated with certain times of the
terized by black bile being more common in autumn, and so
not appear to be until mi;;: modem times, however, that stuttering
explicitly linked to climatic changes.
upation with physical causes meant that the psychological aspects
disorders were largely overlooked, but there was some crude attempt to
m with persunality types, t-hemselves a reflection of the humoral theory.
ad found stuttering (ischnophonia) more prevalent amongst melan-
use their imagination outstripped their physical capabilities
- This latter point was taken up by others including Razi who,
that it was mispronunciation (lurhgha) to which melancholies

Book ill, Chap. viii and Book IV, Chap. iii (Kiihn, 1824).
aide, one sf the disputed works.
 MEDIEVAL ARABIC VIEWS ON SPEECH DISORDERS 235

WINTER
I
brain
I
phlegm
I
phlegmatic
I
WATER

spleen heart
I I
--black bile - EARTH AIR -- blood - SPRING
i -I-
melancholjc sanguine

lilver
I
yellow bile
I----
choleric
I

Fig. I The relationships between the climate, elements, organs. humors, and tempera-
tures according to the Greek scientific system.

were liable, their other symptoms variously indicating moisture of the brain, or
the predominance of black humor (1, p. 73). In his section on the tongue,
however, Razi is principally concerned with it physical condition.
Even today, the tongue’s appearance is t;, en as a guide to the state of health.
For Razi, some humoral imbalance would z revealed through its taste. color.
temperature and size. Quoting various authorities, he gives signs of how the
humors are involved in the appearance and feel of the tongue. One writer ac-
counts for all the four humors and their effects: if the tongue is of red. black. or
yellow color, with excessive dryness, this is caused by heat; paleness and Pack of
sensation stem from coldness; flaccidity, much dampness. enlargement. and
heaviness are from moisture; contraction and dcssication are signs of dryness (3.
y. 209). Another writer speaks of dnness being manifcstcd ht. constriction.
smallness, and tremor. All these conditions could disturb the actio Of the
tongue, and thus impede speech in their several days.
2 DENYSE ROCKEY and PENELOPE JOHNSTONE

nt in young deaf boys (3, p. 210). Razi makes of speech in this

km. but if the welling coincided with a defe(ct, it is likely that a causal
ould have been deduced.
n for heaviness was excessive phlegm, linked with speech
rso~s. The lingual clumsiness of deaf people attempting to
mi&t have created the impression of an enlarged tongue, but the order of
ence seems to have been inverte:d, with deafness perhaps thought to
r than originate the muteness:

awaih) said: those who are dumb have large tongues which do not move easily
tbs. When the tongue is large, tlhe substance from which the ear and its
ed is weak, and so the person is deaf. ( 3 p . 208, 1.4).

nship between deafness and dumbness had eluded the An-

although their common etymological root, KM/I, indicates
were connected. Neither here, nor in his section on the
s Razi elaborate upon hearrng and speech. From this passage, one
was confused about their association, which is hard
l&z, a nonmedical writer born almost a century earlier, explicitly
a3 dumbness is a consequence of never having heard sound, and he
n the degrees of deafness and speech impediment (Pellat , 1969).
(fa’fa’aj, one fact was asserted: “a woman does not
rs a rudimentary descriptilon of two of the disorder’s
1 syntfptorns:fluency, once the initial block is overcome, plus its fluctua-
umstance. But his account of the former is less clear than
8j.8 and he is content to cite the subjective evidence of one

had difficulty in producing a sound to begin speaking, but once he had

is tongue was wondetilly loosened. This [the man believed] was due to
ction in his throat . _ _he said: “I am troubled by stopping of the voice when
controversy. or declaiming. * But when he was conversing about more
l

Id begin to speak without difficulty. (3, p. 207, 1. 1 l).y

ba meaning **muscle. but it is extremely unlikely that Razi was referring

l l

pam. as elucidation of the middle ear structures only began in the West
can it be assumed that he was alluding to the nerve as this word, %.sub
was nat used for musde. although it did stand for “sinew“ or “tendon. ‘*
sion over this word and it is difficult to know at what point anatomists
from tendons _
also a disputed work.
on he Vbe @econd book), frequently quoted by Razi.
 MEDIEVAL ARABIC VIEWS ON SPEECH DIS0RDBG.S 237

He also mentions Masarjawaih’s opinion that stuttering (@Ifa’a) I can arise from (

moisture at the root of the tongue:

If, or when, the condition becomes exaggerated, the breath is trapped and the heat then
engendered serves to free the tongue, after the fashion of singers and the like, who have to
perform for a long time. (3, p. 208, 1.2).i”

This . notion that warmth generates

. freedom of movement harks back to Aristotle
(903”8- 13, 90Sa16- 19, 90Sb29-38) and iinticipates Bacon, who wrote in
Svlva Sylvarum:

Divers . . . do Stut. The cause may be (in most) the Refrigeration of the Tongue. whereby it is
less apt to move. and therefore we see, that Naturals[” j do generally Stut: And we see, that in
those that Stut, if they drink wine moderately, they S :ut less. because it heatel h: And so we
see, that they that Stut, do Stut more in the first offer to speak, than in continuance; because
the Tongue is, by motion, somewhat heated. (1670, Cent. IV, 386).

Bacon goes on to assert that dryness may. less frequently, be the problem. for:

many stutter, we find, are very choleric men; choler inducing dryness in the tcbneue. (ibid. I

Heat and dryness had also been alluded to by Huarte in his E.~r~~zirz~~tic~~
&WVI’.~
Wits ( 1594), where it is suggested that heat XI long as it does not bring on
immoderate dryness, facilitates imagination nd speech? The idea that speech
impediments might be associated with immc :rate dryness perhaps derives ulti-
mately from Hippocrates, who connected certain speech defects with baldness,
considered to be a sign of aridity (Epici. II, 5).13 The humoral theory was well
suited to provide an interpretation of the connection between nervousness and a
parched mouth, which is now well attested, but writers in this tradition failed to
take up the point. Razi, for example, though acknowledging the co-ltxistence of

‘“This is a tentative translation. The word rendered “exaggerated *’ may mean strong or serious.
Masarjawaih seems to indicate that holding in the breath generates warmth, which then “releases”
the tongue.
“Bacon was probably referring to the mentally retarded. The word “natural” was often applied to
simpletons, the belief being that they were in some way pure and uncontaminated by the Fail. Various
spellings and emphases are used in the different editions of this book, which first appeared in 1626.
12We are grateful to Jeffrey Wollock for drawing our attention to this passage and also for pointing
out that the association of dryness with speech defects in Hippocrates’ Epidemic~s (II, 5). gave rise to
a controversy in the Renaissance. Readers are referred to him for further information on this subject.
13Not one of the genuine works.
 DENYSE ROCKEY and PENELOPE JOHNSTONE

ss an$ speech inhibition, relates this neither to stuttering nor nervousness,

scusses it only in connection with a feverish statei
The c,nIy other type of unusual speech mentioned in this passage is that of
m, who were supposedly not malpronouncers (alrhagkr) of the letter R.
is not entirely clear, but it should be remembered that to the
those &ys “foreigner” was almost synonymous with “Persian,‘* it origi-
feting to those who were incomprehensible because they could not speak
It is significant. however. that Razi does not use the word a/tin, which
Itkeappropriate if he were commenting upon their foreign accent and
atins their facility with R vis-a-vis other sounds, such as TH, that were
for them. Instead,, he uses althagh, which suggests that he is
ing foreigners with his own countrymen, Sony of whom use a deviant R
and uncharacteristic of foreigners. Since the apical trill was the accepted
Semaan, 1968), we may assume that this provided no barrier
ners. but that various corruptions were to be found amongst the Arabs
ves. probably on account of speech defect rather than dialect, as Razi
ntmducing the word hzhja into the discussion, nor does he mention local
is likely that the distinction between defective and dialectal R
ot clearly drawn, and, indeed, it is still being questioned today
ern and English parallel to Razi ‘s assertion is hard to find.
not susceptible to the W for R defect, noticeable among some
rs. but neither arc they adept at pronouncing the English R, and
if?culty with this sound contributes to the accent of their speech.
er, writing in 1882, points to an instance in Germany where the
rilled R tended to become corrupted, except in German-speaking
opulation or adjoining Slavic speaking areas, where the
s was minimized and consequently the articulation of R became more

me modem speech pathologists have supposed that Aristotle attrib-

stuttering to tongue-tie, this is not the case (660a26-27). The latter he
ted with speech designated trndos, as opposed to pspllus and is-
23-25). This distinction is most clear in Hellenic writings and
that it was adopted by the Arabs, since they used the roughly equiva-
fdzighu, lakina, andjbIfa’rr. While Razi was more wedded to medi-
Aristotle, whom he does not mention in this passage, he

one of Galen’s “accidental ’ or *unnatural ** causes, which Mercunalis introduces

l l

reconcile the fact that the same speech defects had been attributed to two opposing
wz moisture aud dryness. SM Hieronymous Mercurialis, Treatise on fhe Diseases q!f
- translated by Woliock t 1977).
supplied by Jeffrey Wollock. Other more convoluted interpretations could
which would turn partly on the definition of ahhugh, but the above seems
 MEDIEVAL ARABIC VIEWS ON SPEECH DISORDERS 239

nevertheless seems to follow the Aristotelian rather than Galenic diagnostic

distinctions. I6
T1~u1o.s and lathz’gha refer principally to malpronunciation of R or S, bui
possibly cover any simple articulatory problem. These words are sometimes
translated as ‘ ‘lisp, ’ ’ but as this term now often specifically denotes a rh for s
substitution, we have avoided it. The idea underlying lathigha is that the tongue is
hampered from reaching the proper articulatory position, and it implies an imped-
iment rather than a dialectal deviation.
The connotation of psellos and hkirzcr is rather more obscure but probably
relates to a more widespread blurring of speech. Lukirw was also used to describe
the accelLt-of foreigners and so may also embrace unusual voice quality and
intonation patterns. The Greeks certainly named the speech of some defectives
‘after foreigners (barhcrralalicr), but lakinn does not have such a strong sense of
impediment, as does hthighu.
Ischnophonos and fa ‘J&z denote stuttering, the latter apparently being an
onomatopoeic word, as is tarntarn. I7 Medieval Arabs were evidently particularly
impressed by the prevalence of the fa sound in stuttering speech. Nazi also used
the further term rutta, which is not well attested but connotes some kind of
stumbling or hesitant speech. 18 These categories appear to have had theoretical
rather than practical importance, however, since there is no indication that they
had any significant influence on provoking specific forms of treatment.

‘Treatment

The Greek principle for remedying disturbahces, whether from bad habits or
illness, was to induce the opposite state. Applied to bodily ailments, this in-
volved attempting to bring the fluids back into harmony by chilling the fever.
reducing excessive moisture, and so on. There was general agreement that this
might be done through medicines, gargles. purges, emetics, cautery,
phlebotomy, friction, and compresses, but each physician was given scope for

‘“Galen’s use of pscllos for a defective s, though ap;??rently onomatopoeic. appears to be idiosyn-
l:ratic(WYWollock in Mercurialis, 1977, p. 128, ~2). It would be interesting to compare Farallel
texts to ascertain precisely how Greek writers were rendered into Arabic during the 9th Century.
Many of these works are still in manuscript form.
*‘Van Riper ( 197 1, p. 5) gives one Arabic word for stuttering as _vrrfnmtum, which is the present
tense of tumrmn. It indicates a prevalence of the ra syllable in speech. For onomatopoeic words
denoting stuttering in other languages, see Wingate, 1976, p. 40. (Onomatopoeia was also said to be
the origin of hottentot, supposedly one of “a whole nation of stammerers. ” The argument for and
against the case was put by Fry, Wedgewood, and Watermeyer in 1866.)
IsVan RiperalsOgivesrattat as an Arabicword for stuttering. This is derived from the verb rtlttu,
the precise meaning of which is unclear.
240 DENYSE ROCKEY and PENELOPE JOHNSTONE

originality through advocating more precise methods or drugs. For instance,

whereas one doctor would suggest that the inhibition of speech in fevers was best
treated by soured milk upon the head, message of the cervical vertebrae, and
embrocation. others found compresses to this region helpful for tremor and
thickness.
With thespread of the Islamic Empire, the Arabs came into contact with many
new substances from Persia, India, and the Far East, such as myrrh, musk,
cloves, and nutmeg, which made welcome additions to their pharmacopeia. In
his chapter on the tongue, Razi mentions no less than 80 drugs, variously com-
bined in different prescriptions. Few, if any, were specific to the tongue, but
formed part of the pharmacists’ stock-in-trade. Though mainly herbal in origin,
there were some of mineral or animal provenance. Nowadays, it is difficult to see
how many of these ingredients could be therapeutically justified, but their pre-
scription was reasonable, given the tenents of humoral theory. Drugs with de-
ssicative powers were recommended to reduce moisture, with mustard, pepper,
ginger, and even cabbage juice being frequently lauded for their astringent prop-
erties. One cure for tardy speech was rubbing the tongue’s surface with an
infusion of pyrethrum, barks of frankincense, staphisagria, pepper, and cas-
toreum. For this same defect, another authority suggested massage with vinegar,
honey, and Darani salt, pIus lingual exercise. Other nonmedical treatment for
children with speech delay was that they be talked to and “encouraged to an-
swer” or “chocked” into talking, the physician persisting until the child in
desperation -oak “refuge in speech” (3, pp. 208, 2 12). This seems to indicate an
awareness that some defects were not physical. Indeed, Razi was famed for his
’ 'psychlrrogical l ’ approach, several centuries ahead of what is generally sup-
sed to be the beginnings of psychosomatic medicine. One anecdote is recorded
how. when all physical remedies had failed, he cured the rheumatism of Amir
Mansur by provoking his ire, a risky tactic with so powerful a patient (Browne,
11921,pp. 82-83).
Mhoulgh Razi does not mention any speech defect consequent to large pro-
es, it is worth noting his treatment, as some form of verbal impedi-
2ht WE, pro’bably part of the clinical picture. These particular cases rarely
responded to purgatives or emetics and so Razi drew attention to a remedy from
This eratailed adding sour fruit to the d\et in order to “awaken” the
the tongue and thereby disscPlve excessive phlegm. If this
ff&:tirve in shrinking the tissues and t: uabling them to lie within the
tR, it PH,buld‘Lnave been &sin
infinitely more pleasant treatment than the leeches,
and bridles enployed during subsequent centuries in
u h hi:; excelh~nt review of this med’cal and speech problem, Pierre
these procedures ~ff;errfailed, causing some doctois to
OBM~%ZT cJ!dermeth&s, such a!$ G&n’s (A& pf,b. ~1.
,8) 9 v,hich (entailed wl*apping
e !h doth soaked i11lettuce juice. Tl+ r-ernedy was also recom*;nended
 MEDIEVAL ARABIC VIEWS ON SPEECH DISORDERS 241

by Razi in a subsequent section (3, p. 238), and later it similarly found favor with
Riverius (1668, pp. 123-124).
Razi had a particular interest in chemistry and played a key role in introducing
doctors to mercurial ointments, but this was not wholly at the expense of surgery.
By the 9th Century, cutting the frenum was a well-tried procedure, the only point
in question being the technique used. Hooks were preferable to hot irons, but
whatever the method, the blood should not be “agitated.” Similar caution was
advocated for phlebotomy, often necessary in cases of “frog’ ’ (3, pp. 2 1O-2 11).
Razi warned that the procedure was not without risk, due to swollen sublingual
vessels, a warning which al-Zahrawi (Albucasis or Abu’l-Qasim, d. 1013) had
cause to reaffirm a century later (Spink and Lewis, 1973). In view of the deaths
from hemorrhage that followed’ lingual surgery for stuttering during the 19th
Century, such caution is particularly impressive. Further, though given to caut-
ery, Razi appears to have found no place for it with speech defects originating in
the tongue.
In addition to drugs and surgery, the beginnings of didactic treatment for
stutterers is also discernible. The patient cited earlier had evidently been “bur-
dened with medicines, ” but Galen’s treatment was different and evidently more
helpful, since he paid attention to the activity of the chest (3, p. 207). I9 Thus, it
appears that Razi was transmitting instruction on how to breathe. This w&staken
up by Avicenna and more recent European therapists, and is probably the advice
most often spontaneously profeerred to stutterers by lay people in modern times.

Concluding Comments

Razi was a key figure in preserving Hellenic cience and transmitting it to the
West. His main contribution to speech parholog, was in selecting and presenting
the best ideas of his predecessors and contemporaries, recommending only such
advice as he himself had tested. Despite this, it is usually Avicenna whose name
is quoted by those post-Renaissance writers who have been interested in Islamic
ideas on speech. Like other heirs to the humoral theory, Razi was unable to step
outside its conceptual framework and so was prevented from making any sig-
nificant advance in the etiology and treatment of speech defects. He concentrated
chiefly on the tongue and presumed that the co-existence of an abnormal appear-
ance with a verbal impediment indicated a causal relationship. The modern
reader can only be surprised that two such conditions coincided sufficiently often

‘“This is another involved passage due to the copious use of the root q-b-d. Literally. the patient is
advised to restrict or “grasp his chest, *’ possibly with his hands. It might be advising the patient to
“take hold” of himself, possibly through waiting and thinking before speaking. but a more likely
interpretation is that he should hold his breath before beginning to speak.
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