Islamic Medicine

by

Husain F.Nagamia

Introduction

Considerable confusion exists in literature regarding the definition of 'Islamic Medicine'. This is mainly because each author that writes about 'Islamic Medicine' is actually writing about an aspect of Islamic Medicine. Thus the definition can vary depending upon the perspective. The context can be historical, cultural, scientific, pharmacological, therapeutic, religious or even a geo-political. In this monograph we shall be examining this body of knowledge mainly from its historical, scientific, therapeutic and application viewpoints.

The main source of all inspirational knowledge in Islam is 'The Holy Quran' . This book is considered by Muslims or followers of Islam to be the word of Allah or God, revealed by Him to the Prophet of Islam: Mohammed. A secondary source of a Muslims' inspiration is the 'Hadith or Sunna', which are the recorded and authenticated sayings and traditions of the Prophet of Islam: Mohammed.

As such not much medicine is mentioned in the Quran except for beneficial effects of some natural foods viz. honey and abstinence from intake of alcohol or other intoxicants proscribed on every Muslim, yet the Quran is the guiding spirit that every Muslim has to follow, including the physicians in treating their patient and the patients in handling their illness. However very early in the Islamic era, the Hadith literature had accumulated a number of sayings and traditions of the Prophet under a collection called the 'Prophetic Medicine'.

These edicts expounded on virtues of diet, natural remedies, and management of simple ailments like headache, fever, sore throat, conjunctivitis, etc. More importantly however injunctions were prescribed against contact with persons having a contagious disease for instance leprosy or entering or leaving an area of an epidemic or plague, thus helping to limit the disease. In addition a large number of traditions were collected under the title of 'Spiritual Medicine'. These were a collection of the verses of the Quran or prayers to the Almighty, which invoked blessings and which had to be recited when affliction was to be expurgated.

Prophetic Medicine

'Prophetic Medicine' although popular amongst the masses of Muslims because of its doctrinal and theological contents was considered by most Muslim historians and physicians as distinct from scientific and analytical Islamic Medicine. Ibn Khaldun (1332-1406 AD) a well known medieval Muslim jurist, historian, statesman in his 'Muqaddimah' states:

'The Bedouins in their culture, have a kind of medicine which they base primarily on experience restricted to a few patients only, and which they have inherited from their tribal leaders and old women. In some cases it is correct, but it is not founded on natural laws, nor is it tested against (scientific accounts) natural constitution (of peoples). Now the Arabs had a great deal of this type of Medicine before the advent of Islam and there were among them well known doctors like al-Harith ibn Kalada and others.

Their Medicine that has been transmitted in the Islamic religious works (as opposed to those works which were considered scientific works) belong to this genre. It is definitely no part of divine revelation (to the Prophet: Mohammed) but was something customarily practiced by the Arabs. This type of Medicine thus is included in his biographies, just as are other multitudinous of matters of sociological importance like the natural life and customs of the Arabs, but forms no part of religion of Islam to be practiced in the same way.'

Definition

Islamic Medicine in its true context, can thus be defined as a body of knowledge of Medicine that was inherited by the Muslims in the early phase of Islamic History (40-247 AH/661 -861 AD) from mostly Greek sources, but to which became added medical knowledge from, Persia, Syria, India and Byzantine. This knowledge was not only to become translated into Arabic, the literary and scientific lingua franca of the time, but was to be expounded, assimilated, exhaustively added to and subsequently codified, and 'islamicized'.

The Physicians of the times both Muslim and Non-muslim were then to add to this, their own observations and experimentation and convert it into a flourishing and practical science, thus helping in not only in curing the ailments of the masses, but increasing their standards of health. The effects of its domineering influence extending not only in the vast stretches of the Islamic lands, but also in all adjoining nations including Europe, Asia, China, and the Far East. The span was measurable not only for few centuries, but also perhaps for an entire millennium, 610 to 1610 AD.

During which time, Europe and rest of the extant civilized nations of the world were in grips of the 'dark ages'. It also to set the standards of hygiene, and preventative medicine and thus was responsible for the improvement of the general health of the masses. It was to hold sway until decadence finally set in, concomitant with the political decline of the Islamic nation. With the advent of Renaissance in Europe, at the beginning of the 17th Century AD, it was finally challenged by the new and emerging science of modern medicine, which was to finally replace it in most of the countries, including the countries of its birth!

Historical Background

In order to understand the milieu in which Islamic medicine was born, one has to understand the salient events in the advent of Islam and a few events just preceding the Islamic era. Arabia which was a large area covered mostly by an arid desert that was roamed by nomadic tribes of Bedouins. Certain communities had been established where the trade routes intersected and water was available. Mecca was along the Yaman- Damascus trade route. It was considered a holy city and a sanctuary. The Kaaba or house of worship was replete with idols of different gods each representing a tribe or community.

These Bedouins had their own tribal moral or ethical codes of conduct and idolatry was in practice. Blood feuds were common and attacking caravans along trade routes was a way of life. Sacrifices were often offered to appease the gods and burying of live female children was common practice. Family feuds were common and settling scores in order to uphold tribal honor led to frequent bloody encounters in which many people were killed.

Women and children were treated as 'chattels' or private possessions and became the property of the winner. This era of Arabia is frequently referred by Muslims as 'Jahilliya' or age of ignorance. Islam was not only to bring dramatic changes in the religious practices of these warring nomadic tribes but also unite them into an unprecedented social and cultural nation that very quickly was to develop into a strong political entity, with its own system of administration, justice, and military power, all under one leadership.

The first leader of the Islamic State was no doubt the Prophet of Islam, Mohammed but then his four successors called the 'Pious Caliphs' were to quickly consolidated and expand the nation. Within one hundred years of coming into existence, the Islamic empire had spread from Spain in the west, to China in the east, and encompassed in its midst, the whole of northern Africa ,Egypt, Syria, Palestine, Transjordan ,Central Asia and parts of western India. Later it was to be even carried further by the Muslim merchants to the shores of the far east including the Malaysian peninsula, the islands of the East Indies and Indonesia.

In its early era and for several centuries, the Islamic empire was centrally governed by a leader or 'Caliph' and administered by provincial governors. The first four Caliphs were elected democratically but the later the Caliphate became dynastic. Later still a western Caliphate was established in Spain. In later history the Islamic Nation was to break up into various kingdoms, as the provincial rulers become more autonomous and independent of the center and was ultimately to be overrun by the Sejluk Turks who were the forerunners of the Ottoman empire.

It was during the early Caliphates of the 'Ummayads' and the 'Abbasids' that the maximum development of Islamic Medicine took place. It was also during this time and under the patronage of these Caliphs that the great physicians both muslim and non-muslim thrived, accumulated the wealth of medical knowledge and cultivated a system of medicine that was to be later called 'Islamic Medicine'.

The early era of Islamic Medicine and the School of medicine at Jundishapur:

Jundishapur or 'Gondeshapur' was a city in Khuzistan founded by a Sasnid emperor Shapur I (241-272 AD) before the advent of ISLAM.It was to settle Greek prisoners, hence the name 'Wandew Shapur' or 'acquired by Shapur.' In present day western Persia the site is marked by the ruins of Shahbad near the city of Ahwaz. The town was taken by Muslims during the caliphate of Hadrat Umar, by Abu Musa Al-Ashari in (17 AH/738 AD ). At this time it already had a well established Hospital and Medical school.

Many Syrians took refuge in the city when Antioch was captured by Shapur I. In fact the latter nicknamed the city 'Vehaz-Andevi Shapur' or 'Shapur is better than Antioch.' The closing of the Nestorian School of Edessa by Emperor Zeno in 489 AD led to the Nestorians fleeing from there and seeking refuge in Jundishapur under patronage of Shapur II, which got an academic boost as a result.

The Greek influence was already predominant in Jundishapur when the closing of the Athenian school in 529 AD by order of the Byzantine emperor Justinian drove many learned Greek physicians to this town. A University with a medical school and a hospital were established by Khusraw Anushirwan the wise (531-579 AD) where the Greeco-Syriac medicine blossomed. To this was added medical knowledge from India brought by the physician vizier of Anushirwan called 'Burzuyah.'

On his return the latter brought back from India the famous 'Fables of Bidpai', several Indian Physicians, details of Indian Medical Texts and a Pahlavi translation of the 'Kalila and Dimma.' Khusraw was even presented a translation of Aristotleian Logic and philosophy. Thus at the time of the Islamic invasion the school of Jundishapur was well established and had become renowned as a medical center of Greek, Syriac and Indian learning.

This knowledge had intermingled to create a highly acclaimed and state of the art Medical school and hospital. After the advent of Islamic rule the University continued to thrive. In fact the first recorded Muslim Physician Harith bin Kalada, who was a contemporary of the Prophet acquired his medical knowledge at medical school and hospital at Jundishapur.

It is likely that the medical teaching at Jundishapur was modeled after the teaching at Alexandria with some influence from Antioch but it is important to note that 'the treatment was based entirely on scientific analysis, in true Hippocratic tradition', rather than a mix-up with superstition and rituals as was the case in Greek 'asclepieia' and Byzantine 'nosocomia'.

This hospital and Medical Center was to become the model on which all later Islamic Medical Scools and Hospitals were to be built .The School none the less thrived during the Ummayid caliphate and Sergius of Rasul'ayn translated medical and philosophical works of both Hippocrates and Galen into Syriac.These were later to be translated into Arabic casting an everlasting imprint onto all the future of Islamic Medicine.

It was during the Abbasid Caliphate that Caliph al-Mansur the founder of the city of Baghdad invited the then head of the Jundishapur School to treat him. This physician was Jirjis Bukhtyishu, a Christian whose name meant 'Jesus has saved'. He treated the Caliph successfully and got appointed to the court. He however did not stay permanently in Baghdad returning to Jundishapur before his death, but the migration to Baghdad had begun. Thus his son Jibrail Bukhtishu established practice in the city and became a prominent physician.

Another family that migrated from Jundishapur to Baghdad was the family of Masawayh who went at the invitation of Caliph Harun-ul-Rashid and became a famous Ophthalmologist. Most famous amongst his three sons who were physicians was Yuhanna ibn Masawayh (Mesue Senior). He wrote prolifically and 42 works are attributed to him. By this time second half of 2nd century after hijra (8th century AD) the fame of Baghdad began to rise as also the political power of the caliphate. Many hospitals and medical centers were established and tremendous intellectual activity was recorded. This culminated into the period of Islamic Renaissance and the golden era of Islamic Medicine of which description is given under a separate section.

The resources for development of Islamic Medicine: The Bait-ul-Hikma or 'The House of Wisdom':

'Bait-ul-Hikma' or House of Wisdom was founded in 214 AH 830 AD by the Caliph Al-Mamun an Abbasid Caliph. Ibn Al Nadim, who was the son of a bookseller and whose famous catalogue of books 'Firhist of Nadim' tells us of many of the Books of his time, relates this story of the Caliph: Aristotle appeared in the dream of the learned Caliph and told him that there was no conflict between reason and revelation. The Caliph thus set about searching for books and manuscripts of the ancient Greek philosophers and scientists. He sent an emissary to the Byzantine Emperor to get all the scientific manuscripts that were apparently stored in an old and dilapidated building. After initially turning him down the emperor granted him his request. Among the emissaries sent to select the works was the first director of the house of wisdom Salman, who was the one that led the delegation.

.Others in it were al Hajjaj Ibn Matar, Ibn al Batrik.They brought back with them many Greek scientific works and manuscripts. Translations of all of these was immediately started.However the translation of the medical works of the Greeks had started earlier during the reign of Caliph Harun al Rashid, with the building of the first hospital under the Caliph's patronage.

Ibn Nadim lists 57 Translators associated with he House of Wisdom. The one's who formed the first delegation to the Byzantine King have already been named. Other famous ones are as follows:

1. al Hajjaj ibn Yusuf ibn Matar completed translation of Euclid's elements. Other Greek authors including Aristotle, Archimedes, Pythogras, Theodesius, Jerash, Apollonius, Theon and Menelaus all were translated.

2. Muhammad ibn Mujsa al-Khwarizimi born in Khiva systematically explored arithmetic and al-gebra. The latter derived its name from his discourse: 'Kitab al-Jabr wa al-Muqabla.' Algebra was derived from the second letter and meant 'bone setting' a graphic description of operations on solving quadrantic equations.

3. The knowledge of geometry flourished and with it architecture and design. Ibn Khaldun was later to describe geometry as a science that 'enlightens the intelligence of man and cultivates rational thinking.'

4. Mamun's court astronomer was Musa ibn Shakir. His three sons Muhammad, Ahmad and al-Hassan devoted their lives to the search of knowledge. They exemplified the Prophetic traditions and dicta: 'Seek learning even if it be in China.' 'The search for knowledge is obligatory on every Muslim.' 'The ink of scholars is worth more than the blood of martyrs.'

5. The works of these learned men or 'Sons of Musa" were exceptionally creative. They wrote on: celestial mechanics, the atom, the origins of earth, Ptolemic universe, the properties of the ellipse, Planes and spheres, The knowledge of geometry served in practice to create canals, bridges and architectural designs.

6. Muhammad ibn Musa on one of his travels met Thabit ibn Qurra. The latter was master in three languages. Greek, Syraic and Arabic and soon got appointed to become the court astrologer to Caliph al-Mutadid. He was invaluable addition to the House of Wisdom. In 70 original works he wrote on every conceivable subject including mathematics, astronomy astrology, ethics, mechanics, physics, philosophy, and published commentaries on Euclid, Ptolemy, and other Greek thinkers and philosophers.

7. The two sons of Thabit ibn Qurra also became famous. Sinan was a famous physician in Baghdad. He was director of several hospitals and was court physician to three successive caliphs. His son Ibrahim also became a prominent scientist. He invented sundials and wrote a special treatise on this subject on this subject.

8. The greatest medical mind in the House of Wisdom was Hunain ibn Ishaq. Born in Hira Hunain was the son of an apothecary. He soon translated entire collection of Greek medical works including Galen, Hippocrates. Hunain was an extremely gifted and talented translator. From being just a literal translator he tended to be more scientific and duly interpreted the original text by cross reference, annotation and citing glossaries. His original contributions included 10 works on ophthalmology which were extremely systematic. He rose to the highest honor by being appointed the director of the House of Wisdom by Caliph al Mutawakkil.

9. Qusta ibn Luqa was another accomplished translator and scholar. He has 40 original contributions to his credit. He wrote on diverse subjects such as 'mirrors, hairs, fans, winds, logic, geometry and astronomy to name a few.

10. Yuhanna ibn Masawaih (Mesuse senior) was an early director of the House of Wisdom. He served under four caliphs. Al Mamun, al-Mutassim, al-Wathik and al-Mutawakkil. He wrote about medical especially gynecological problems.

11. The effect of the House of wisdom was tremendous. Islamic Science, philosophy, art and architecture all felt its effects. Agriculture, Government, prosperity and economic wealth were the benefactors. It ultimately was responsible to produce figures like Al-Kindi, Al-Farabi, some of the greatest thinkers, scientists and philosophers of Islam. Also some of the greatest Islamic Physicians had available to them all the knowledge of ancient Greece, Syria, India and Persia available to them and in turn they contributed by their astute observation and originality. The giants of Islamic Medicine and their achievements are described elsewhere.

Hospitals during the Islamic era

The idea of a hospital as an institutional place for the caring of the sick has not been recorded in antiqiuty. There were sanatoria and 'travel lodges' that were attached to temples where the sick were attended to by attendant priests. Most of the therapy in these sanatoria consisted of prayers and sacrifices to the gods of healing especially to Aaescalapius. Cures that ocured were thought to result from divine interventions.

A large number of hospitals were developed early during the Islamic era.They were to be called 'Bimaristan' or 'Maristan'. The idea of a hospital as a place where sick could get attention was totally adopted by the early Caliphs. The first hospital is creditied to Caliph Al-Walid I an Ummayad Caliph (86-96 AH 705-715 AD), by some it was however considered no more than a leprosoria because it allowed the seggregation of lepers from others. It did have on staff 'salaried doctors' to attend the sick.

The first true Islamic hospital was built during the reign of Caliph Harun-ul-Rashid (170-193 AH 786-809 AD). Having heard of the famous medical institution at Jundishapur already described above the Caliph invited the son of the chief physician, Jibrail Bakhtishu to come to Baghdad and head the new 'bimaristan' which he did.It rapidly achieved fame and led quickly to developments of other hospitals in Baghdad.

One of these the 'Audidi' hospital was to be built under the instructions of the great Islamic Physician Al-Razi. It is said that in order to select the best site for the hospital he had pieces of meat hung in various quartters of the city and watched their putrefaction and advised the Caliph to site the hospital where the putrefaction was the slowest and the least ! At its inception it had 24 physicians on staff including specialists categorized as Physiologists, oculists, surgeons and bonesetters. When Djubair visitied Baghdad in 580 AH/ 1184 AD he recorded that this hospital was 'like a great castle' with water supply from the tigris and all appurtenances of Royal Palaces.

One of the largest hospitals ever built was the Mansuri Hospital in Cairo it was completed in 1248 by the orders of the Mameluke ruler of Egypt, Mansur Qalaun. It was most elaborate. It had a total capacity of 8000 people ! The annual income from endowments alone was One million dirhams.

Men and women were admitted to separate wards. Irrespective of race religion and creed or citizenship (as specifically stated in the Waqf documents) nobody was ever turned away .There was no limit to the time the patient was treated as an inpatient ! (what a contrast from present HMO's !). There were separate wards for men and women and medicine, surgery, fevers and eye diseases had separate wards. It had its own pharmacy, library and lecture halls. It had a mosque for Muslim patients as well a chapel for Christian patients!

The Waqf document specifically stated: 'The hospital shall keep all patients, men and women until they are completely recovered. All costs are to be borne by the hospital whether the people come from afar or near, whether they are residents or foreigners, strong or weak, low or high, rich or poor, employed or unemployed, blind or sigted, physically or mentally ill, learned or illiterate. There are no conditions of consideration and payment; none is objected to or even indirectly hinted at for non-payment. The entire service is through the magnificence of Allah, the generous one.'

As to the physical conditions of these hospitals especially those established by princes, rulers and viziers it can be stated that some of these were luxurious and were actual palaces that had been converted to hospitals. Even contemporary Europe could not boast of a single hospital that came close to the facilities that were provided in these intitutions. Some of them especially in Baghdad, Egypt and Syria had furnishings were similar to those in the palaces.Most of theser being under the patronage of the viziers, sultans and caliphs were no doubt inspired by the Islamic teaching of the welfare of the poor and needy. The Quran tells us:

'You shall not attend to virtue unless you spend for the welfare of the poor from the choicest part of your wealth' (3,92) and again: 'O you who believe spend (for the poor) from the worthiest part of what you have earned and what your crop yields, and do not give away from its unworthy parts- such that you yourselves will not take until you examine the quality minutely- and know that Allah is not in your need and all praise belongs to Him.' (2,267).

As to the salaries of Physicians here is some information from authentic sources. The annual income of Jibrail ibn Bakitshu who was the Chief of Staff at a Baghdad hospital during the reign of Mamun ArRashid (d c.e 833/218 A.H.) as recorded by his own secretary was 4.9 million dirhams. His son also a doctor lived in a house in Baghdad that was air-conditioned by ice in summer and heated by charcoal in winter ! A resident by comparison who was supposed to be on duty for two days and two nights a week, was paid 300 dirhams a month. (Remind you of Denton Cooley and his fellows ?).

The great physicians of Islamic Medicine

The era of Islamic Medicine produced some very famous and notable physicians.These physicians were not only responsible to get all the existing information on Medicine of the time together but add to this knowledge by their own astute observations, experimentation and skills. Many of them were skilled in medical writing and produced encyclopedic works which became standard texts and reference works for centuries.

With the coming of European Rennaicanse they formed the basis on which the european authors gained insight into the medicine of the 'ancients' or early greek authors whose works weree only preserved in Arabic. In addition many re-discoveries took place which had already been recorded by the Islamic physicians but hitherto had been unknown until recently uncovered. The classical example of the discovery of Pulmonary circulation originally given to Servetus was found to have been succintly describned by Ibn Nafis an Islamic Physician who lived centuries earlier.

Ibn Nafis repudiated the earlier concepts held by Galen and described the lesser circulation so succinctly that nothing more could be added until Malphigi could describe the alveoli and the pulmonary cappillaries with the asdvent of the microscope discovered by Anthony Von Luwenheek in mid 19th Century.Some of them form the basis of instruction of students of Tibb and Hikma the traditional Islamic Medicine practiced in the subcontinent of India and Pakistan, even today under the banner of Tibb or Unani Meidicne.! It would be out of scope for us in this chapter to describe the accomplishments of each of these physicians, however we will proceed with giving you the salient accomplishments of some of the most notable amongst them. For sake of classsifiction the historic periods of the Islamic Physicians can be divided into three parts:

1. The period of Islamic Rennaisance: From the beginning of Islam to the end of the Abbasid dynasty.

2. The period of Islamic Epoch: When all sciences including Medicine reached the pinnacle of development under the Islamic patronage.

3. The period of decline: during which the knowlege of Islamic Medicine was translated into european languages and became the basis of further development and discoveries and ultimately led to basis for the development of Modern Medicine.