This paper intends to explore the contribution of Islamic science to modern medicine. The paper’s argument can be summarised as follows: the advent of Islam created a knowledge-based society. This environment allowed for individual brilliance to shine. The cultured polymath in medieval Islamdom, whatever his personal beliefs, was given the academic space to pioneer many of the advances we take for granted in modern medicine.
The polymath did not however work locked away in the ivory towers of academia. There was an institutionalisation of healthcare which fostered education and training of these pioneers.
The paper will make allusion to the specific time periods where the Occident was able to benefit from the Orient. It was at the time of the Crusades where the Franks could develop an appreciation for the administration of hospitals, while the Renaissance saw the emergence of figures very much influenced by their earlier Islamic contemporaries.
The primitive medical practices of Arabia will be considered firstly. Then reference will be made to the advent of Islam and the medical implications that development entailed will be considered. Thereafter the paper identifies and deals with three separate locations in which the Islamic medical franchise thrived. The first centre was towards the east of the Islamic world in what is no modern day Iraq. It was here the brightest medical minds in Islamic history were produced, namely Rhazes (al-Razi) and Avicenna (Ibn Sina). Next, North Africa and the Central Islamic lands are considered. Here it was Ibn al-Nafis, who pre-empted Harvey’s discovery of circulation. Ibn Khaldun made strides in sociology while Avennathan (al-Haitham) advanced the field of ophthalmology. The last centre which the paper deals with is Islamic Spain, called Andalusia, which saw the rise of Albucasis (al-Zahrawi), Averroes (Ibn Rushd) and Ibn al-Baitar. They were responsible for significant advancements in the fields of dentistry, surgery and botany. The essay will then move onto a consideration of the institutionalisation of Islamic healthcare. It will be contrasted with its medieval counterpart in Christendom, as well as the modern equivalent.
The conclusion aims to bring the essay full circle back to looking at the topics dealt with as a whole. Hopefully, after the scene has been set one may appreciate the input of Islamic civilization into medicine. One should not underestimate the influence of Islamic thought on today’s medicine.
DEVELOPMENTS IN THE ERA OF THE ISLAMIC POLYMATH
The Greek fathers thought of medicine as more than just a functional discipline. Plato called it an art, while Paracelsus remarked “medicine is not only a science”. Modern medicine idealises uniformity – leading to Bynum’s definition of medicine as “a coherent structure of health beliefs” (1). Today, barring technical expertise and associated costs, medical practice is similar no matter what the location. Bynum’s evaluation is practical and thus it shall be used for the purposes of this essay.
This paper looks to examine the contribution of the Islamic civilization towards medicine. One may be surprised that the contribution of the Islamic world was so significant. The paper will begin by exploring the pre-Islamic era’s medical practices and then considering the shift in thinking that Islam brought about. From there, the three centres of learning, namely Persia, Egypt and Andalusia will be analysed. The Islamic academic world is distinctive in the study of intellectual history due to the number of polymaths that arose. The past greats engaged in the ‘art’ of medicine. With the disappearance of the polymath and the need for standardization, medicine would lose its spontaneous individual brilliance.
As with any science, medicine has evolved over the centuries. It has developed from a discipline founded and steeped very much in Greek culture to one of the Islamic natural sciences. It was from there that Europe emerged as a scientific power, pushing the discipline to its modern form.
Pormann believes that the term ‘Islamic’ best describes the culture that produced the medical advances in question. To be sure, there are issues with this label. Many of the greats such as Maimonides (1135-1204) or Hunayn b. Ishaq (808-873) were not Muslims. They were not all Arabs either. Yet the practitioners shared an environment steeped in an Islamic worldview. By the term Islamic medicine “we mean a certain society or framework which provides a backdrop in which people try to stay healthy” (2).
Days of Ignorance
Let us consider pre-Islamic Arabian custom. The pre-Islamic era was known as zamanat al-jahiliyyah – the period of ignorance . Sharif points out “Arabia at the birth of Islam… was a time torn by wars and family feuds. Ignorance was abysmal and education was not existent” (3). Tribal law governed, female infanticide was common and there are even reports of people marrying their own mothers. Medicine was “restricted to certain specialists – a conspicuous category of diviners, seers, befoulers and charm purveyors” (1). It was far behind the Greek practices that it was destined to equal because of its reliance on superstition and witchcraft .
The Advent of Islam
The advent of Islam revolutionized the Arab approach to knowledge. Muhammad, the Prophet of Islam was himself illiterate when he claimed to have seen an angel instructing him to ‘Read!’ Prophetic wisdom would spur intellectual curiosity – a famous saying (hadith) of the Prophet is “Seek ye knowledge, even if it be in China!” The Qu’ran further instructed believers to make study of nature. This provided religious motivation for the study of natural science. The foundation was established for the oncoming intellectual giants. Sharif points out that the “Arabs were fired with the zeal for knowledge” (3).
The book of al-Bukhari , a book of the sayings of the Prophet, contains the views of the Prophet regarding medicine . One tradition runs: “Healing is in three things: A gulp of honey, cupping and branding with fire (cauterizing). But I forbid my followers to use branding with fire (cauterizing)” (5). At that time, presumably these were the three principal techniques of healing. Nonetheless, the branding of fire was banned because of the pain it entailed. Sabri reasons that Muhammad “understood the use and value of medical arts; he recommended the practice of the medical arts” (6). Sharif documents that records show that al-Harith b. Kaladah was the “only know physician in the Prophet’s time” (2). He was trained at Jundishapur and under the orders of the Prophet he travelled to Persia twice to “engage in a dialogue of medicine” (1).
Persia & Iraq
Baghdad produced the first of the Islamic polymaths. A key reason for this was the fact that it was here where Greek to Arabic translations were undertaken. The aforementioned Hunayn b. Ishaq’s numerous translations of Greek works into Arabic, under Caliphal patronage, introduced Greek medicine to the Islamic world .
Newly found Greek wisdom was fervently admired by Baghdad’s physicians. Perhaps the most famous was al-Razi (854 -925?). His success is reflected by the fact that his works were “translated into several European languages”. Indeed, it is claimed his devotion to study in general led to his eyesight being impaired causing him to turn to medicine when looking for a cure (7). His assimilated notes led to Al-Hawa fi al-tibb (The All Inclusive Work on Medicine). However, his most celebrated work was his treatise, On Smallpox and Measles. Pormann highlights al-Razi’s skills for his case notes, use of the placebo effect and use of control groups. Although common today, these were all pioneering at his time (2). Sabri observes “Rhazes emphasises the importance of the doctor/patient relationship: the healing art” (6) . Al-Razi was not just a physician but also the real intellect behind Baghdad hospital commissioned by the Caliph, Harun al-Rashid. Additionally, he was also the chief physician of the hospital in his hometown of Rayy. Unfortunately as his medical prowess attracted attention, al-Razi came into conflict with the governing powers. Bynum (1) tells us on one occasion:
“Al-Razi proposed that in certain diseases a physician could eliminate within an hour symptoms which had been building up for days and months. This was met with amazement and disbelief among the assembled company”
Somewhat inevitably, his talents aroused jealousies leading to his downfall.
Al-Razi was eclipsed by Ibn Sina (980-1037). Born in Persia, he was self-educated in medicine by sixteen and claimed to have learnt everything he knew by the age of eighteen. His first appointment was to the Emir. After that, he constantly was relocating himself to serve different individuals in ever-changing circumstances . Sharif argues that “from the twelfth to the seventeenth century al-Razi and Ibn Sina were considered superior even to Hippocrates and Galen” (3). Interestingly both are considered outside the pale of orthodox Islam: Ibn Sina for his novel philosophy and al-Razi for his denial of Muhammad. Whatever his philosophical views, his medical expertise was to become the stuff of Muslim folklore: Inglis notes the opinion that “Avicenna was the equal of Aristotle” (8) . Though Ibn Sina’s medical work was all encompassing, one particular fascinating feature was his work on psychology. Sabri regards his achievements on brain localization as foreshadowing the twentieth century (6); in addition, he “analysed for the first time pathological and psychological phenomena”. A classical narrative regarding Ibn Sina is dictated by Inglis:
“There was a Prince suffering from delusion that he was a cow and Avicenna came in the capacity of a butcher. Examining the cow…Ibn Sina came to the conclusion he must be fattened. The prince… began to eat and gradually as he regained his strength the delusion disappeared”
Inglis notes that it was “not until a millennium later that Freudian psychoanalysts were to rediscover the technique of entering the psychotic’s fantasy, in order to provide a bridge for him to return to reality”. He adds that the “Qanun represented the early flowering of psychotherapy under the Caliphate” (8). Indeed it was this Canon of Medicine, a medical encyclopaedia that was his greatest contribution to natural science.
The Canon of Medicine was a “medical Bible for a longer period than any other work”, says Ahmad (7). The rationale for giving it such admiration is stated by Sabri: “The Canon was a mammoth undertaking, a careful classification and systemization of all the medical knowledge known to Arabs in the eleventh century” (6). Translations have ranged from Latin to Chinese showing its success – Inglis states that “the Qanun was to become a standard textbook in many European medical schools, where it held its place until the seventeenth century” (8).
North Africa, Egypt & Syria
Persia provided plenty of scholars and they lit the torch that was destined to now burn further afield. The intellectual focus was centred at Cairo because it was a lively city, to which many intellectuals ventured to for knowledge.
Let us first consider a sociologist of great repute. Ibn Khaldun (1332–1406) spent the majority of his life in North Africa after his birth in Andalusia and played crucial role in the formulation of social sciences . These, of course, can be considered within our remit if one recalls Bynum’s definition of medicine being a “coherent structure of health beliefs” (1). Scrutinizing social trends and community developments is essential for epidemiology and associated fields – a topic we will return to when considering the development of the Islamic hospital. Enan mentions that “Ibn Khaldun was the first man to study the social phenomena, to understand and explain the events of history and to deduce them from social laws, in such a wonderful scientific manner”. In Ighathat al-Umma bi Kashf al-Ghumma, Ibn Khaldun expressed the “short account of the misfortunes of the high cost of living and the scarcity of water”. Ibn Khaldun’s theories were later “treated by Machiavelli…Adam Smith, Vico, Montesquieu and Auguste Comte”; highlighting the lasting influence of his ideas. Unfortunately, the Berber himself was overlooked and has “remained in oblivion for centuries (9). Nevertheless, he was instrumental in the birth of sociology and the way he treated his art should be considered alongside the internal workings of healthcare services.
Another notable authority was the Iraqi born al-Haitham (965-1039), who migrated to Egypt . Seemingly, he never practised as a physician. Despite this, his tracts on ophthalmology were revolutionary. He taught that “impressions made upon the retina were conveyed along the optic nerve to the brain forming visual images on symmetrical portions of both retinas” (3). He is well known for rectifying Ptolemy’s accepted idea that “the eye sends out visual rays to the object of vision” (7). Sabri specifically points to where he demonstrated for the first time that the rays of light come from the external object to the eye and not from the eye itself impinging on external things” (6). Ahmad is of the opinion that “the influence of Alhazen’s Thesaurus Opticae may be traced to the optics written by Roger Bacon” (7). His study on the eye earnt him recognition as, perhaps, “the greatest student of optics of all times” (3)
Cairo was a bustling, cultural metropolis. Ibn al-Nafis was born in Syria, educated in Damascus and eventually journeyed to Cairo . Although Ibn al-Nafis accomplished various things , he is best associated for his correct adjustment of the Galenic view of circulation. Galen held the opinion that blood in the right side of the heart passed through invisible pores into the left side and was then distributed into the body. Ibn al-Nafis corrected this by stating that the “blood must pass from the right ventricle to the left ventricle by the way of the lungs” (10). This itself is extremely significant . Ibn al-Nafis held himself to be prevented from dissection by his faith and in a somewhat impressive, intellectual feat, deduced thus by means of logic . In addition to describing the pulmonary circulation, he also accurately depicted the coronary circulation – Sharif states that it was Ibn al-Nafis who recognised that “blood which is in the right side of the heart nourishes the heart”” (3).
Muslim Spain was known as Andalusia. S. Sharif records that Muslims were invited by the native people and Count Julian to “rescue their homeland from the cruelties of the Spanish kings” (11). After conquering Spain, tremendous advancement was made in technical knowledge. One city was exceptional – Inglis (8) tells us:
“Cordova shone with public lamps; Europe was dirty, Cordova built a thousand baths; Europe was covered with vermin, Cordova changed its garments daily; and with its fifty hospitals, not to mention its seventy public libraries, Cordova held an attraction for the aspiring doctor”
Al-Zahrawi (936-1013) hailed from this city and remained unsurpassed in his field of surgery and dentistry for many years . Ahmad attributes to him the invention of certain surgical instruments (7). One of his most famed was a medical compendium titled al-Tasrif. It contained “such new ideas as cauterization of wounds, crushing stone inside the bladder and dissection…deals with obstetrics and the surgery of the eyes” (3). Sabri believes “this work greatly helped to lay the foundation of surgery” (6).
A page of Al-Zahrawi’s illustration of surgical instruments (12: removed for copyright purposes)
The academic’s innovative nature helped introduce ideas suited for those times. However, he was most proficient in dentistry. His pioneering character mean that he was the “first to describe innumerable ideas and gadgets” (8) in the discipline. Ahmad observes that “his book is illustrated with dental instruments…he discussed oval deformities, dental arches and the formation of tartar”. He could “set an artificial tooth in place of a diseased one” (7). In the mould of a traditional polymath he did not feel constrained by specialisation – his works talked of “midwifery, cooking…and psychology” (1).
Another Cordovan (1126-1198) was Ibn Rushd . Early in life he was an apprentice to Ibn Tufayl. He succeeded him as physician to Abu Yakub Yusuf, the reigning Caliph at the time. Ibn Rushd is better known for his contribution to philosophy and judicial thinking. Nevertheless an empirical rational worldview was vital to his work. His Kitab al Kulliyat fi al-Tibb (The Complete Book of Medicine) has been called a “veritable encyclopaedia of medicine”. There were several Latin editions and the books was “translated twice in Hebrew” (3). It is worth remembering that a critically acclaimed work can have its success determined by the number of languages it appears in. Numerous compendiums were materializing at different times and they constantly were being reworked, re-edited, commented on and improved upon. Information was constantly being collated together to enhance medical knowledge of that time. Ibn Rushd’s controversial character “got him into trouble with Moslem fanatics when they came into power” (8). Al-Mansur banished him based on theological grounds . This echoes back to the times of al-Razi. It is an unfortunate truth that political affairs at times can dictate the products of science. This is poignant because “Averroes promised to be even more remarkable” than his contemporaries (8).
Finally, let us consider Ibn al-Baitar (1197-1248). As a botanist his discoveries provided advances in pharmacology. He is known for describing more than one thousand and four hundred drugs (12). Sari notes that “Ibn Baytar introduced 300 new drugs” (3). Ahmad utilizing Ibn al-Baitar’s Kitab al-Jami fi Adwiya al-Mufrada (The Encyclopaedia of Chique Medicines) calls him “greatest botanist of Islam and of the middle ages whose writings prepared the round for the development of botanical science during the modern times” (7). He was the first scientist to investigate the cure for cancer with any success. The Islamic school inherited the four tumours theory in regarding to diseases . In those times it was believed “the cause of cancer is black bile”. Hindiba was believed to help because it “cooled down the combustion of bile” (13). Although the theory itself is flawed, it is extremely probable that Ibn al-Baitar was aware what he had stumbled onto . His discovery was momentous and the European Patent Office patented Hindiba as a method for treating neoplasia in 1997 (14). It is incredible to believe that over a thousand years ago, he gave as an anti-cancer treatment. He was devoted his life to his work – he traversed Arabia, Damascus, Syria, North Africa and Constantinople to assemble his meticulous anthology .
The Muslims left Spain after much infighting and were pushed out by the Christian powers in 1492. When considering the evolution of Europe, the mark left on Spain is apparent – indeed the advances of Muslim academics were to provide the spark for the Renaissance in Europe (3). As the Muslims sailed out of Spain, many of the Jewish intellectuals opted to flee carrying the discoveries of Islam into Europe. Scholars from Leonardo da Vinci to Machiavelli were to be influenced by the academic output of the Islamic world.
The Development of Hospitals
It is the medieval Western hospital of Christendom that is the direct parent of its modern counterpart. Jones tells us that “hospitals have been in an existence since the medieval period…for people undertaking Christian pilgrimages”. However, certain charity hospitals, such as Guys (1725) and Middlesex (1746) were for the “poor, homeless and sick”. He (14) proposes that there has been “some continuous historical process of evolution” because:
“The function of hospitals began to change in early 19th Century. These social changes combined with specialist scientific knowledge led to the development of what would be modern hospital medicine”
This gives one an authentic context of Bynum’s ‘modern medicine’. The reason he suggests is that the change in function has come from “a change in character of disease from acute to chronic illness”, “growth of middle class” and the “formation of NHS after the NHS ACT in 1946” (15).
If the modern hospital can be traced to the institution of Western Christendom, where did the medieval Western hospital come from? The Crusades may have led to a face-off between the West and the East with resentment which lingers up to now, but it also meant that the Occident could observe the Orient. Sharif remarks that “the Arabs were not the first to build hospitals but they were certainly the first to improve them” (3). The government had a crucial role to play in this because they had to “maintain high standards in the public hospitals” (16). Indeed, the better hospitals had “streams of running water, pools and small groves of trees where patients could relax” (1). Sharif (3) adds that:
“The furniture, bedding and clothing at the Mansuri hospital Cairo, rivalled in their luxury and perfection those that adorned places of the Caliphs. Sometimes were musicians and singers were brought in”
In addition to the luxury of these environments, the healthcare extended beyond the hospital. Sharif notes there was also care in the penal system – ““physicians looked after prisoners” . He adds “first aid stations were established near mosques where large numbers congregated”; additionally, “small hospitals for the blind and lepers were built during the Umayyad period (3). Despite all the amenities, the focus remained on its standard purposes – the administration was well handled for there were “in-patient and out-patient departments” (1) and there was “a registered pharmacy attached to every large hospital”. The operation was not run ad hoc: There were “several books were written on hospitals and hospital management” (3).
Healthcare, of course, entails a tremendous amount of administration – a fact which the Islamic hospitals had to take account of. Quddusi (17) writes that in the caliphal reign (634-644) of Umar b. Khattab:
“Free hospitals were established and pensions sanctioned for the unemployed persons. Widows, invalid and physically handicapped persons were provided with suitable financial assistance”
In the major cities, the healthcare facilities were good – the hospitals “at Baghdad, Damascus and Cairo were the best known at the time”. Sharif also tells us that “in Andalusia there were over fifty hospitals in Cordova alone, besides those at Granada, Seville and Toledo” (3). Bynum elucidates that “efforts were also made to extend medical care to rural areas…small towns and large villages all seem to have had at least one, formal physician” (1). There then was a concerted effort to make healthcare accessible to all. Nevertheless, one must admit that it is only the modern nation state, as developed in the West which has successfully advanced the target of 100% coverage.
Institutions are all well and good but they need trained professionals working in them for them to be effective. According to Pormann, there were two main methods of education. The first was self-teaching while the second was being taught by the physicians themselves (2). Bynum says “Ibn Sina and Ibn Ridwan (988-1061) both claimed to be self taught” (1) – the former because he found medicine easy whilst, Ibn Ridwan was too poor to afford an education. The latter method, under a physician, was fairly common. It may have involved a respected physician signing off a student’s textbook when he had mastered that text . This type of education would have been complemented by facilities – Sharif contributes by stating that “every large hospital possessed a library of its own” (3). Within the hospital “the precinct included kitchen and pharmacy facilities, a bath, a library and lecture rooms”. The complex system of medical education could be compared with today’s because “clinical experience was available in hospitals”. Bynum specifies that “students would assume basic duties…and advanced students would undertake preliminary examinations” The students knowledge was enhanced by the doctors “regularly making rounds” and using “patient and library facilities to teach their students” (1).
Just as today the GMC monitors the etiquette of practitioners, in the Islamic world there was a similar scheme. Hodgson tells us that “the caliphal administration provided for the examination of physicians” (16). Bynum (1) gives an example of this:
“In 931 word reached the caliph in Baghdad one of the common folk had died at the hands of an incompetent doctor, so the ruler ordered that only physicians who had been examined should practise medicine”
No functioning health system could free its practitioners from the need for culpability.
Though Islamic culture brought much to medicine; its contribution remains “heavily understudied” (2). Sharif comments “a bare one percent” of the Islamic works have “been salvaged so far because of Mongol hordes and fanaticism of European conquerors” (3). The destruction of books, however, is not the only reason for our lack of knowledge. The modern Arabs disinterest in history has means that dozens of libraries across the Middle East house hundreds of unstudied manuscripts.
It was the Islamic polymath, a man who mastered several disciplines and thrived in the institutions of the literate, who was the crucial component for the advances in sociology, botany, pharmacology, ophthalmology, surgery, anatomy and pathology to name just a few. Should we then lament the loss of this polymath in today’s medicine? I do not believe so. Standardization has meant conformity, which is essential for efficient treatment. Nevertheless, we would be ill-advised to forget the cultured Islamic polymath. One can genuinely approve of Brifault, when he said “science owes a great deal to Arab culture” (5). Even Dante, who in his notorious Inferno cast Muhammad in the lowest fire of hell, said that:
“William Harvey will say 600 years after his death to his friend Aubrey; ‘Go to the fountainhead and read Aristotle, Cicero and Avicenna”
Many thanks must be given to Tarek Al-Yousaf for helping research and structure the article.
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