Explanatory models for the functioning and malfunctioning of the heart provide the cultural framework for focusing the attention of individuals on heart beat, for labeling some conditions as disease symptoms, and for establishing causal links between irregularities in heart beat and specified personal and sociai conditions. The explanatory models in popular medicine in Maragheh for the functioning of the heart are drawn primarily from the Galenic paradigm. The precise function of the heart was debated over the centuries by Greek physicians and anatomists, by Islamic scholars and doctors, and later by Europeans. 7 But while certain aspects of the model provoked debate, the general framework for understanding the heart was unchallenged: the heart is at once a central physiological organ (related to innate heat, nutrition, and distribution of the blood) and an organ of emotional functioning (or the seat of the vital soul) in man.
It would be inappropriate to fully describe the classical view here, b ut in both Greek and Islamic science the theory of the heart is based in cosmology. Man is a Microcosm of the greater Universe, which consists of an ontological hierarchy from the sublunary realm (of generation and decay), the cosmic spheres, and the intelligible world of pure form.8 All levels of the ontological hierarchy are represented in man. The liver is the seat of the natural faculty and the baser human appetites; its primary physiological function is the transformation of (raw) food into (cooked) blood. The brain is the seat of the rational faculty, which enables man to relate to the intelligible order. The vital or animal faculty resides in the heart; it provides the 'innate heat' and 'vital breath' (pneuma or nafs ) to the body and is the seat of the emotions, particularly fear and anger ("because they coincide with the expansion and contraction of breath" - Ibn Sina 1930:118). The primary physiological function of the heart is not
circulation, of course, but the provision of heat necessary for life and the transformation of breath into the pneuma , which vitalizes the body. If the heart fails in these functions, particularly if it loses its strength as the source of innate heat, weakness and death may result. But for many diseases known in modern medicine to be heart diseases, Galen believed heart problems to be secondary rather than primary. Galen also believed that anger and grief may cause heart pain because they lead to excessive heat , and that fear and fright may cause the heart to leap and to register irregular pulse. But he does not (to my knowledge) describe the syndrome of mild palpitations and heart sensations which is called in Maragheh 'heart distress.'