Ibn Khaldūn (1332–1406 CE), the renowned historian, philosopher, and sociologist, did not write extensively about medicine in the same way that figures like Ibn Sīnā (Avicenna) or al-Rāzī (Rhazes) did. However,Ibn Khaldun discussed medicine, nursing, and midwifery more directly in the context of “livelihoods” (al-maʿāsh) or professions, as part of his broader exploration of human society, economics, and civilization.
Medicine as a Craft and Empirical Science #
In his analysis of various professions and crafts, Ibn Khaldūn places medicine among the sciences that develop in tandem with the rise of urban civilization. He notes that medicine initially emerges as a folk tradition—rooted in inherited customs, local remedies, and empirical practices passed down orally among nomadic and rural peoples. In early stages of society, medical knowledge is informal, practiced by elders, tribal leaders, or women with experiential knowledge. However, as society becomes more complex, medicine evolves into a formalized profession. This transformation reflects Ibn Khaldūn’s core belief that knowledge systems mature through a process of social refinement and increasing specialization.
Importantly, Ibn Khaldūn distinguishes medicine from purely theoretical sciences. While it had been traditionally grouped with philosophical disciplines due to its theoretical underpinnings in Greco-Arabic science (notably Hippocratic and Galenic thought), he underscores that medicine is in fact primarily empirical. It is governed by observation, trial and error, and adaptation to local climates, diets, and social practices. This emphasis anticipates later scientific developments that prioritize evidence-based practice over abstract speculation.
Nursing and Midwifery #
Among the professions associated with caregiving, Ibn Khaldūn makes special note of nursing (ḥiḍāna) and midwifery (qābila), situating them within the realm of necessary and respectable urban occupations. He recognizes these practices as largely female-driven, but far from marginal: they are vital to the functioning of family life, child-rearing, and the maintenance of health in society.
Nursing #
Nursing, in his account, is a craft grounded in human need, not theoretical sophistication. It involves knowledge of caregiving acquired through observation and repetition, primarily within domestic and communal settings. While it does not possess the intellectual status of formal medicine, Ibn Khaldūn treats it with respect as a form of skilled labor essential to the well-being of individuals and the continuity of the household.
Midwifery #
Midwifery, likewise, is presented as a profession of deep practical knowledge. Midwives, though excluded from the formal philosophical and medical institutions of their time, serve as indispensable experts in childbirth and women’s health. Their craft is portrayed as both economic and communal—part of the web of specialization that arises in cities where demand for such services creates a niche profession. Ibn Khaldūn acknowledges the empirical competence of midwives, who often surpass theoretical physicians in practical outcomes related to birth and maternal care.
A unifying theme in Ibn Khaldūn’s treatment of all these roles is that they are products of urbanization and social complexity. In his theory of ʿumrān (urbanism), as societies grow more stable and populous, the division of labor becomes more refined. Professions emerge to meet specific needs, and individuals develop expertise in narrower, more specialized domains. Medicine, nursing, and midwifery—while differing in status, training, and social prestige—are all expressions of this increasing differentiation of labor.
Moreover, Ibn Khaldūn’s sociological framing allows us to see these health-related professions not simply as personal vocations, but as structural necessities: each reflects a response to collective human needs, rooted in a particular stage of social development. His discussion anticipates many modern ideas about the sociology of health, gendered labor, and the professionalization of care work.
Though Ibn Khaldūn did not write a medical textbook, his observations in the Muqaddimah offer a surprisingly rich and modern view of health professions. He recognizes medicine as a craft that evolves through empirical inquiry; he legitimizes nursing and midwifery as practical, experience-based, and socially necessary professions; and he embeds them all within a broader vision of society’s progression from simplicity to complexity. In doing so, he affirms that the health of individuals—and of civilizations—is shaped not only by science, but by culture, economy, and the interdependence of professions.
Ibn Khaldun On Medicine #
(From al-Muqaddima, section on economic life (maʿāsh))
The ṣinā`a of medicine (al-ṭibb) is needed in cities and countries and not in rural areas. It is necessary in cities and settled countries given the widely known benefits of such a ṣinā`a. The mission of it is the preservation of health among those who are healthy, and the repulsion of illness among those who are ill using medical treatment so that they are cured of their diseases.
It should be known that the origin of all illnesses is in foods (aghdhiya), as stated by the Prophet Muhammad, may God’s peace and blessing be with him: “The stomach is the locus of disease; dieting is the chief treatment; and the origin of every disease is indigestion.”
The meaning of “the stomach is the locus of disease” is obvious (ẓāhir).
As for the statement, “Dieting is the chief treatment,” the word “ḥimya” refers to hunger—which is, in a sense, protection against food. It follows, then, that hunger is the greatest medicine, the origin of all medicines. As for the statement, “the origin of every disease is indigestion,” the meaning of “al-barda” is the introduction of new food to the food already in the stomach before it has been digested.
The explanation of this statement is this: God created the human being (al-insān). God preserved life of the human being by food. The human being would consume the food by eating it; then flood it with digestive and extractive forces until it becomes fluid-blood suitable for consumption by the various parts of the body, be it flesh or bones. The fluid nutrients are then picked up by the growth cells, which transform it into flesh and bones.
Digestion (haḍm), then, means the boiling of food using the instinctive heat (al-ḥarāra al-gharīziyya), one step after another, until the food becomes, literally, part of the body. In other words, when the food enters the mouth, it is masticated by the jaws. After that, the heat of the mouth will affect it, boiling it slightly and converting its structure a bit. This can be observed when a morsel of food is taken and chewed well; its taste will be different from when it was a morsel when it first enters the mouth.
The same happens in the stomach: The heat of the stomach cooks it until it becomes chyme (kaymus), which is the extract of the boiled food (maṭbūkh), which is sent to the liver; the remaining residue in the bowels will be sent out through the two orifices.
The heat of the liver, then, cooks down the chyme, until it becomes fresh blood (daman `abīṭan) that is covered by a foam, which is the yellow bile (al-ṣafrā’). Some dry parts, known as the black bile residue (al-sawdā’), would settle. The coarse parts, known as the phlegm (al-balgham) are not sufficiently cooked by these natural acids (al-ḥarr al-gharīzī). The liver then sends all of it into the veins and arteries. There, the natural enzymes (al-hāl al-gharīzī) start to cook them—turning them into pure blood, which converts into hot and humid steam that sustains the animal spirit (al-rūḥ al-ḥayawānī), and from which the growth cells would pick its fill, turning it into flesh, and its coarse parts into bones. Then, the body excretes the excesses that are not needed in the form of different particles including sweat, saliva, mucus, and tears. This is the form of nutrients and their transformation from energy (quwwa) into events in the form of generated flesh. It should be clear then that the origin of diseases, or most of the diseases, is fevers (al-ḥummiyyāt). The cause of it is that natural acid (al-ḥarr al-gharīzī) may fail to finish cooking in every stage of the digestive track, causing some of the food to remain uncooked. This in turn can be caused by excess food in the stomach that would overwhelm the natural acid. Or it could be caused by adding more food in the stomach before it is able to finish cooking the food already there. In this case, the natural acid would busy itself in cooking the new arrival, leaving the first food uncooked. Or the natural acid may spread itself thin cooking both foods at the same time, failing to cook parts of both. The stomach would, nonetheless, pass the food in such a condition, making the heat of the liver incapable of cooking it, too. It is possible that some unprocessed food remains in the liver. Yet, the liver would pass all, including the unprocessed food, to the veins as is. When the body has extracted its needs, it sends the excess along with other leftovers in the form of excreted sweat, tears, and saliva, if it can. However, the body may fail to clear all of it, leaving some in the veins, liver, and stomach; this accumulation would increase over time.
Since every humid substance that is not cooked and processed would rot, the rotten food would contaminate other unprocessed food; and this is called mixture (al-khild). All rotten foods would generate strange heat, and when it occurs in the human body, it will be called fever (al-ḥummā).
One can experiment with this by leaving food out until it becomes rotten. It is the same phenomenon with animal dung, and how it emits heat and how it takes its course.
This is the meaning of fevers (al-ḥummiyyāt) in the human body, which is the chief disease and the origins of all of them as explained in the tradition (Hadith).
The treatment of fevers consists of cutting off food from the ill person for a determined number of weeks and eating only appropriate foods until he heals.
In the case of good health, the same procedure (fasting) serves as a preventive treatment for this and other illnesses and the reference for this is in the Hadith.
In some cases, the food contamination could affect a specific organ. In this case, the organ might become ill, causing injuries to the body localized in the main organs or other organs. When an organ is diseased, its disease may transfer to effect energies that it enables. This summarizes all the diseases (amrāḍ). And the origins of these diseases, generally, are found in foods and the knowledge of all these matters is with the medical doctor (al-ṭabīb).
These diseases are more likely to strike city and country dwellers because of the abundance of foods, the diversity in their living ways, their lack of reliance on a single kind of food, and the absence of set times for meals. These people, urban dwellers, often mix their meals to include spices, vegetables, and fruits—dry and moist—when they process and cook their meals. They do not limit themselves to one or a few types. We have documented cases in which the cooked meals of just one day consisted of forty types including plant and animal, making for a very strange temper. It is possible that it is too strange to agree with the body and its organs and parts.
Moreover, the air in cities becomes foul due to its contact with rotten steam rising from the large amounts of trash. This is important because the air energizes the spirits (munashshita li-‘l-arwāḥ) and such energy strengthens the natural acids and enzymes needed for digestion.
Furthermore, sporting activities are missing in city living, for city dwellers are sedentary; thereby exercising does not take anything from them and leaves no effects on them. Consequently, the occurrence of illness is frequent in the city and urban regions, making their need to this ṣinā`a (medicine) proportional to the rate of illness and sickness.
Whereas people who live in rural areas and whose foods are generally little, and who are likely to go hungry due to the scarcity of grains (al-ḥubūb); they become accustomed to hunger to the extent some would think that it is an acquired trait because of how persistent it is amongst them. Spices are few or non-existent. Therefore, cooking using herbs and fruits would require the luxury of city-living, from which they are disconnected. Instead, they eat simple meals, removed from other mixes, and make its temper closer to matching the temper of the body (al-badan).
The air in which rural dwellers live, too, is less contaminated due to limited steam and foulness associated with living closely to each other. Or, rural dwellers live may live in different air all together when they live apart from each other or move around.
Sports (al-riyāḍa) are common among rural dwellers because of their frequent movements riding horses, hunting, or doing any other task. These exercising activities aid in digestion and improve the breakdown of eaten foods. Adding one food to another in the stomach also would not occur, which would enhance their temper and protect them from diseases—making their need for medicine limited. As a result, medical doctors do not exist in the countryside, as a general observation. The non-existence of medical doctors is due to the lack of need: Were medical doctors needed, they would have existed, because the doctor would be able to make a living in the countryside and thus reside there; but that is not the case. “Thus is God’s Sunna (System) among his created people; and one cannot find an alternative to God’s Sunna.”
