HISTORY OF MEDICINE
ARAB ROOTS OF EUROPEAN MEDICINE
David W. Tschanz,
MSPH, PhD
Wel knew he the olde Esculapus
And Deyscorides and eek Rufus
Olde Ypocras, Haly and Galeyn,
Serapion, Razi and Avycen,
Averrois, Damascien and Constantyn
, Bernard and Gatesden and Gilbertyn.
Hamad Medical Corporation, Doha-Qatar
In the "General Prologue" of The Canterbury
Tales, Geottrev Chaucer identifies the authorities
used by his "Doctour of Physic" in the six lines
quoted above. The list includes four Arab physicians:
Jesu Haky (Ibn Isa), Razi (Al-Razi, or Rhazes),
Avycen (Ibn Sina, or Avicenna) and Averrois (Ibn
Rushd or Averroes). These four did not make Chaucer's
list only to add an exotic flavor to his late-14th-century
poetry. Chaucer cited them because they were regarded
as among the great medical authorities of the
ancient world and the European Middle Ages, physicians
whose textbooks were used in European medical
schools, and would be for centuries to come.
First
collecting, then translating, then augmenting
and finally codifying the classical Greco-Roman
heritage that Europe had lost, Arab physicians
of the eighth to eleventh century laid the foundations
of the institutions and the science of modern
medicine.
After the collapse of the western
Roman empire in the fifth century, Europe lost
touch with much of its intellectual heritage.
Of Greek science, all that remained were Pliny's
Encyclopedia and Boethius's treatises on logic
and mathematics; the Latin library was so limited
that European theologians found it nearly impossible
to expand their knowledge of their own scriptures.
The center of Europe's new worldview became the
church, which exerted profound new influences
in medicine. Because Christianity emphasized compassion
and care for the sick, monastic orders ran hospitals,
which did not function as hospitals do today.
They were simply places to take seriously ill
people, where they were expected to either recover
or die as God willed. There were no learned physicians
to attend them, only kindly monks who dispensed
comfort and the sacraments, but not medicines.
Because the Christian church viewed care of the
soul as far more important than care of the body,
medical treatment and even physical cleanliness
were little valued, and mortification of the flesh
was seen as a sign of saintliness. In time, nearly
all Europeans came to look upon illness as a condition
caused by supernatural forces, which might take
the form of diabolical possession. Hence, cures
could only be effected by religious means. Every
malady had a patron saint to whom prayers were
directed by the patient, family, friends and the
community. Upper respiratory infections were warded
off by a blessing of the throat with crossed candles
on the feast of Saint Blaise. Saint Roch became
the patron of plague victims. Saint Nicaise was
the source of protection against smallpox. Kings,
regarded as divinely appointed, were believed
to be able to cure scrofula and skin diseases,
among other maladies, with the "royal touch."
With the study of disease and of patients neglected,
licensed medicine as an independent craft virtually
vanished. Those physicians who endured were mostly
connected with monasteries and abbeys. But even
for them, the generally accepted goal was less
to discover causes, or even to heal, than to study
the writings of other physicians and comment on
their work. In the middle of the seventh century,
the Catholic Church banned surgery by monks, because
it constituted a danger to their souls. Since
nearly all of the surgeons of that era were clerics,
the decree effectively ended the practice of surgery
in Europe.
Nine Greek physicians are named
and portrayed on one of the opening pages of an
Arabic medical manuscript written in the region
of Mosul, in present day Iraq, between 1220 and
1250. The text, an “antidotarium,” first outlines
the thought of the great second-century Greek
physician Galen on antidotes to snakebite, then
continues with an original discussion of a number
of other antidotes, their preparation, dosage
and method of use. Galen's portrait is at the
bottom.
At roughly the same time, another
civilization was rising in the east. The coming
of Islam, also in the seventh century led to a
hundred years of continuous geographical expansion
and an unprecedented era of ferment in all branches
of learning. The Arabs rapidly melded the various
cultures of the Islamic domain, and Arabic - the
language of the Qur'an - became the universal
language. By the 10th century, a single language
linked peoples from the Rann of Kutch to the south
of France, and Arabic became to the East what
Latin and Greek had been to the West - the language
of literature, the arts and sciences, and the
common tongue of the educated.
Medicine was the first of the Greek sciences to
be studied in depth by Islamic scholars. After
Plato's Academy was closed in 529, some of its
scholars found refuge at the university at Jundishahpur,
the old Sassanid capital of Persia, which had
also sheltered excommunicated Nestorian Christian
scholars - among them physicians - in 431. Persia
became part of the Islamic world in 636, and Arab
rulers supported the medical school at Jundishahpur
and for the next 200 years, Jundishapur was the
greatest center of medical teaching in the Islamic
world. There, Islamic physicians first familiarized
themselves with the works of Hippocrates, Galen,
and other Greek physicians. At the same time,
they were also exposed to the medical knowledge
of Byzantium, Persia, India, and China.
Recognizing the importance of translating Greek
works into Arabic to make them more widely available,
the Abbasid caliphs Harun al-Rashid (786-809)
and his son, al-Ma'mun (813-833) established a
translation bureau in Baghdad, the Bayt al-Hikmah,
or House of Wisdom, and sent embassies to collect
Greek scientific works in the Byzantine Empire.
This ushered in the first era in Islamic medicine,
whose effects we feel today: the period of translation
and compilation.
The most important of the translators was Hunayn
ibn Ishaq al-'Ibadi (809-73), who was reputed
to have been paid for his manuscripts by an equal
weight of gold. He and his team of translators
rendered the entire body of Greek medical texts,
including all the works of Galen, Oribasius, Paul
of Aegin, Hippocrates and the Materia Medica of
Dioscorides, into Arabic by the end of the ninth
century. These translations established the foundations
of a uniquely Arab medicine.
Muslim medical practice largely accepted Galen's
premise of humors, which held that the human body
was made up of the same four elements that comprise
the world: earth, air, fire, and water. These
elements could be mixed in various proportions,
and the differing mixtures gave rise to the different
temperaments and "humors." When the body's humors
were correctly balanced, a person was healthy.
Sickness was due not to supernatural forces but
to humoral imbalance, and such imbalance could
be corrected by the doctor's healing arts.
Muslim physicians therefore came to look upon
medicine as the science by which the dispositions
of the human body could be discerned, and to see
its
Nine Greek physicians are named
and portrayed on one of the opening pages of an
Arabic medical manuscript written in the region
of Mosul, in present day Iraq, between 1220 and
1250. The text, an “antidotarium,” first outlines
the thought of the great second-century Greek
physician Galen on antidotes to snakebite, then
continues with an original discussion of a number
of other antidotes, their preparation, dosage
and method of use. Galen's portrait is at the
bottom.
Scientific knowledge that originated
in India, China and the Hellenistic world was
sought out by Arab and Muslim scholars and then
translated, refined, synthesized and augmented
at different centers of learning, starting at
Jundishahpur in Persia around the sixth century
- even before the coming of Islam - and then moving
to Baghdad, Cairo, and finally Toledo, and Cordoba,
from where the knowledge spread to Western Europe.
The patronage of the caliphs made considerable
resources available for this work.
goal as the preservation of health
and, if health should be lost, assistance in recovering
it. They viewed themselves as practitioners of
the dual art of healing and the maintenance of
health.
Even before the period of translation closed,
advances were made in other health-related fields.
Harun al-Rashid established the first hospital,
in the modern sense of the term, at Baghdad about
805. Within a decade or two, 34 more hospitals
had sprung up throughout the Islamic world, and
the number grew each year.
These hospitals, or bimaristans, bore little resemblance
to their European counterparts. The sick saw the
bimaristan as a place where they could be treated
and perhaps cured by physicians, and the physicians
saw the bimaristan as an institution devoted to
the the promotion of health, the cure of disease,
and the expansion and dissemination of medical
knowledge. Medical schools and libraries were
attached to the larger hospitals, and senior physicians
taught students, who were in turn expected to
apply in the men's and women's wards what they
had learned in the lecture hall. Hospitals set
examinations for their students, and issued diplomas.
By the 11th century, there were even traveling
clinics, staffed by the hospitals, that brought
medical care to those too distant or too sick
to come to the hospitals themselves. The bimaristan
was, in short, the cradle of Arab medicine and
the prototype upon which the modem hospital is
based.
Like the hospital, the institution of the pharmacy,
too, was an Islamic development. Islam teaches
that "God has provided a remedy for every illness,"
and that Muslims should search for those remedies
and use them with skill and compassion. One of
the first pharmacological treatises was composed
by Jabir ibn Hayyan (ca. 776), who is considered
the father of Arab alchemy. The Arab pharmacopoeia
of the time was extensive, and gave descriptions
of the geographical origin, physical properties
and methods of application of everything found
useful in the cure of disease.
Arab pharmacists, or saydalani, introduced a large
number of new drugs to clinical practice, including
senna, camphor, sandalwood, musk, myrrh, cassia,
tamarind, nutmeg, cloves, aconite, ambergris,
and mercury. The saydalani also developed syrups
and juleps - the words came from Arabic and Persian,
respectively - and pleasant solvents such as rose
water and orange-blossom water as means of administering
drugs. They were familiar with the anesthetic
effects of Indian hemp and henbane, both when
taken in liquids and inhaled.
By the time of al-Ma'mun's caliphate, pharmacy
was a profession practiced by highly skilled specialists.
Pharmacists were required to pass
An anatomy lesson at the medical
school at Montpellier - one of Europe's earliest
- from Chauliac's 1363 Drande Chirurgie. (Photo
source: ART RESOURCE/MUSEE ATGER)
examinations and be licensed, and
were then monitored by the state. At the start
of the ninth century, the first private apothecary
shops opened in Baghdad. Pharmaceutical preparations
were manufactured and distributed commercially,
then dispensed by physicians and pharmacists in
a variety of forms: ointments, pills, elixirs,
confections, tinctures, suppositories, and inhalants.
The blossoming of original thought in Arab medicine
began as the ninth century drew to a close. The
first major work appeared when Abu Bakr Muhammad
ibn Zakariya Al-Razi (ca. 841-926) turned his
attention to medicine.
Al-Razi, known to the West as Rhazes,
was born in Persia in the town of Rayy, near Tehran.
After a youth spent as a musician, mathematician
and alchemist, Al-Razi went to Baghdad to take
up the study of medicine at the age of 40. Completing
his studies, he returned to Rayy and assumed the
directorship of its hospital. His reputation grew
rapidly and within a few years he was selected
to be the director of a new hospital to be built
in Baghdad. He approached the question of where
to put the new facility by hanging pieces of meat
in various sections of the city and checking the
rate at which they spoiled. He then ordered the
hospital built at the site where the meat showed
the least putrefaction.
Al-Razi is regarded as Islamic medicine's greatest
clinician and its most original thinker. A prolific
writer, he turned out some 237 books, about half
of which dealt with medicine. His treatise, The
Diseases of Children, has led some historians
to regard him as the father of pediatrics. He
was the first to identify hay fever and its cause.
His work on kidney stones is still considered
a classic. In addition, he was instrumental in
the introduction of mercurial ointments
Between the 10th century and
the Renaissance, European hospitals like the one
above, from an undated Italian manuscript, were
increasingly modeled on the Arab bimaristan.(Photo
source: ART RESOURCE / ISSOGNE CASTLE)
to treat scabies. Al-Razi advocated
reliance on observation rather than on received
authority. He was a strong proponent of experimental
medicine and the beneficial use of previously
tested medicinal plants and other drugs. A leader
in the fight against quacks and charlatans - and
author of a book exposing their methods - he called
for high professional standards for practitioners.
He also insisted on continuing education for already
licensed physicians. Al-Razi was the first to
emphasize the value of mutual trust and consultation
among skilled physicians in the treatment of patients,
a rare practice at that time.
Following his term as hospital director in Baghdad,
he returned to Rayy where he taught the healing
arts in the local hospital, and he continued to
write. His first major work was a 10-part treatise
entitled Al-Kitab al Mansuri, so called after
the ruler of Rayy, Mansur ibn Ishaq. In it, he
discussed such varied subjects as general medical
theories and definitions; diet and drugs and their
effect on the human body; mother and child care,
skin disease, oral hygiene, climatology and the
effect of the environment on health; epidemiology
and toxicology.
Al-Razi also prepared AI Judari wa al Hasbah,
the first treatise ever written on smallpox and
measles. In a masterful demonstration of clinical
observation, Al-Razi became the first to distinguish
the two diseases from each other. At the same
time, he provided still valid guidelines for the
sound treatment of both.
Al-Razi's most esteemed work was a medical encyclopedia
in 25 books, AI Kitab al Hawi, or The Comprehensive
Work, the Liber Continens of al-Razi's later Latin
translators. Al-Razi spent a lifetime collecting
data for the book, which he intended as a summary
of all the medical knowledge of his time, augmented
by his own experience and observations. In AI
Hawi, Al-Razi emphasized the need for physicians
to pay careful attention to what the patients'
histories told them, rather than merely
The Anatomy of the Human Body.
Persian notations detail the human muscle system
in Mansur ibn Ilyas's late-14th century Tashrih-I
Badan-I Insan.
consulting the authorities of the
past. In a series of diagnosed case histories
entitled "Illustrative Accounts of Patients",
Al-Razi demonstrated this important tenet. One
patient, who lived in a malarial district, suffered
from intermittent chills and fever that had been
diagnosed as malaria, but nonetheless seemed incurable.
Al-Razi was asked to examine him. Upon noting
pus in the urine, he diagnosed an infected kidney,
and he treated the patient successfully with diuretics.
Al-Razi's clinical skill was matched by his understanding
of human nature, particularly as demonstrated
in the attitudes of patients. In a series of short
monographs on the doctor-patient relationship,
he described principles that are still taught
a millennium later: Doctors and patients need
to establish a mutual bond of trust. He wrote;
"Positive comments from doctors encourage patients,
make them feel better and speed their recovery"
and, he warned, "changing from one doctor to another
wastes patients' health, wealth and time."
Not long after Al-Razi's death,
Ibn Sina (980-1037) was born in Bukhara in what
today is Uzbekistan. Later translators Latinized
his name to Avicenna. It is hard to describe Ibn
Sina in anything other than superlatives. He was
to the Arab world what Aristotle was to Greece,
Leonardo da Vinci to the
Surgical instruments are shown
in detail in a 13th century translation of The
Method, a 30-part medical text written by Islam’s
greatest medieval surgeon, Abu al-Qasim, who practiced
in 10th century Cordoba.
Renaissance, and Goethe to Germany.
His preeminene embraced not only medicine, but
also the fields of philosophy, science, music,
poetry, and statecraft. His contemporaries called
him "the prince of physicians."
Ibn Sina's life was in fact the stuff of legend.
The son of a tax collector, he was so precocious
that he had completely memorized the Qur'an by
age 10. Then he studied law, mathematics, physics,
and philosophy. Confronted by a difficult problem
in Aristotle's Metaphysics, Ibn Sina re-read the
book 40 times in his successful search for a solution.
At the age 16, he turned to the study of medicine,
which he said he found "not difficult." By the
time he was 18, his fame as a physician was so
great that he was summoned to treat the Samanid
prince Nuh ibn Mansur. His success with that patient
won him access to the Samanid royal library, one
of the greatest of Bukhara's many storehouses
of learning. At the age of 20, Ibn Sina was appointed
court physician and twice served as vizier to
Shams al-Dawlah, the Buyid prince of Hamadan in
western Persia. His remaining years were crowded
with adventure and hard work, yet he somehow found
time to write 20 books on theology, metaphysics
astronomy, philology and poetry and 20 more on
medicine – including Kitab al-Shifa' or The Book
of Healing, a medical and philosophical encyclopedia.
An early-15th century Persian
copy of the opening page of Book Four of Ibn Sina's
[Avicenna] 11th century Canon of Medicine, which
remained in the syllabi of European medical schools
well into the 19th century.
An illustration in The Surgeon's
Tract, an Ottoman text written by Sharaf al-Din
in about 1465, indicates where on the scalp incisions
should be made.
Ibn Sina's supreme work, however,
is the monumental Al-Qanun fi al-Tibb, "The Canon
of Medicine." Over one million words long, it
was nothing less than a codification of all existing
medical knowledge. Summarizing the Hippocratic
and Galenic traditions, describing Syro-Arab and
Indo-Persian practice and including notes on his
own observations, Ibn Sina strove to fit each
bit of anatomy, physiology, diagnosis and treatment
into its proper niche.
The Canon stressed the importance of diet and
the influence of climate and environment on health.
It included discussions of rabies, hydrocele,
breast cancer, tumors, labor, and poisons and
their treatment. Ibn Sina differentiated meningitis
from the meningismus of other acute diseases;
and described chronic nephritis, facial paralysis,
ulcer of the stomach and the various types of
hepatitis and their causes. He also expounded
the dilation and contraction of the pupils and
their diagnostic value. He described the six motor
muscles of the eye and discussed the functions
of the tear ducts. In addition, he noted the contagious
nature of some diseases, which he attributed to
"traces" left in the air by a sick person.
The Canon also included a description of some
760 medicinal plants and the drugs that could
be derived from them. At the same time Ibn Sina
laid out the basic rules of clinical drug trials,
principles that are still followed today. (side
bar Testing New Medicines) Not surprisingly, The
Canon rapidly became the standard medical reference
work of the Islamic world. Nizami-i Arudi of Samarkand
spoke for generations of physicians when he wrote,
in the early 12th century, "From him who manages
the first volume [of The Canon], nothing will
be hidden concerning the general theory and principles
of medicine." The Canon was used as a reference,
a teaching guide and a medical textbook until
well into the 19th century, longer than any other
medical work.
During the 10th century, when Arab
astronomical texts were first translated in Catalonia,
Europe began to reap the intellectual riches of
the Arabs and, in so doing, to seek out its own
classical heritage. The medical works of Galen
and Hippocrates returned to the West by way of
the Middle East and North Africa, recovered through
Latin translations of what had become the Arab
medical classics. Through the intellectual ferment
of the Islamic present, Europe recovered some
of its past.
The two main translators of classical material
from Arabic into Latin were Constantinus (also
known as Leo) Africanus (1020-1087), who worked
at Salerno and in the cloister of Monte Cassino,
and Gerard of Cremona (1140-1187), who worked
in Toledo. It was no accident that both translators
lived in the Arab-Christian transition zone, where
the two cultures fructified each other. And it
was no coincidence that Salerno, Europe’s first
great medical faculty of the
In this illustration from 1320,
a lecturer reads from a book labeled “Avicenum,”
the Latin form of Idn Sina's name, while an assistant
prepares a compound with mortar and pestle.
When this mural of a pharmacy
was painted in late 15th century Italy, more than
600 years had passed since the first private apothecary
opened in Baghdad. At the Benedictine monastery
at Monte Cassino in the 10th century, the Middle
Eastern traveler Leo Africanus translated Arab
medical texts and supervised a hospital run on
Arab principles.
Middle Ages, was close to Arab Sicily,
nor that the second, Montpellier, was founded
in 1221 in southern France, near the Andalusian
border. Ibn Sina's Canon made its first appearance
in Europe by the end of the 12th century, and
its impact was dramatic. Copied and recopied,
it quickly became the standard European medical
reference work. In the last 30 years of the 15th
century, just before the European invention of
printing, it was issued in 16 editions; in the
century that followed more than 20 further editions
were printed. From the 12th to the 17th century,
its Materia Medica was the pharmacopoeia of Europe,
and as late as 1537 The Canon was still a required
textbook at the University of Vienna.
Translations of Al-Razi's Al-Kitab Al Hawi and
other works followed rapidly. Printed while printing
was still in its infancy, all of Al-Razi's works
gained widespread acceptance. The ninth book of
Al-Kitab al-Mansuri ("Concerning Diseases from
the Head to the Foot") remained part of the medical
curriculum at the University of Tubingen until
the end of the 15th century.
Contemporary Europeans regarded Ibn Sina and Al-Razi
as the greatest authorities on medical matters,
and portraits of both men still adorn the great
hall of the School of Medicine at the University
of Paris. In The Inferno, Dante placed Ibn Sina
side by side with antiquity's two greatest physicians,
Hippocrates and Galen. Roger Bacon consulted Ibn
Sina to further his own inquiries into vision.
But it was not only Al-Razi and Ibn Sina who influenced
Europe. Translations of more than 400 Arab authors,
writing on such varied topics as ophthalmology,
surgery, pharmaceuticals, child care and public
health, deeply influenced the rebirth of European
science.
Despite their belief in now superseded
theories such as humors and miasmas, the medicine
of Ibn Sina, Al Razi and their contemporaries
is the basis of much of what we take for granted
today.
It was those Arab physicians who made accurate
diagnoses of plague, diphtheria, leprosy, rabies,
diabetes, gout, cancer, and epilepsy. Ibn Sina's
theory of infection by "traces" led to the introduction
of quarantine as a means of limiting the spread
of infectious diseases. Arab doctors laid down
the principles of clinical investigation and drug
trials, and they uncovered the secret of sight.
They mastered operations for hernia and cataract,
filled teeth with gold leaf and prescribed spectacles
for defective eyesight. And they passed on rules
of health, diet and hygiene that are still largely
valid today.
Thus, not only did the Islamic world provide a
slender but ultimately successful line of transmission
for the medical knowledge of ancient Greece and
the Hellenic world, but it also corrected and
enormously expanded that knowledge before passing
it on to a Europe that had abandoned observation,
experimentation and the very concept of earthly
progress centuries before.
Physicians of different languages and religions
had cooperated in building a sturdy structure
whose outlines are still visible in the medical
practices of our own time.
ARAMCO WORLD 1997
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