The Period of Islamic Rennaisance
The notable physicians during this period were as follows:
Bukhtishu family of Physicians. The oldest amongst these was Jibrail Bukhtishu who was the Chief Physician at the Hospital in Jundishapur. He came from a Christain family and was summoned to the court of Caliph Mamun (148AH/765 AD) when the latter fell ill. After having treated him successfully he was invited to stay in Baghdad and head a hospital there but he declined and returned to his native Jundishapur.(152 AH/769 AD) It was his son Jurjis Bukhtishu who was later invited by Caliph Harun-ul-Rashid to come to Baghdad to treat him (171AH/787 AD) and then offered to be the Chief Physician and head a hospital in Baghdad which he did till he died in 185 AH/801 AD).
Masawaih is another family of physicians associated with early Islamic History.During the reign of Caliph Harun-ul-Rashid the elder of the family migratd from Jundishapur t Baghdad and become a celebrated Ophthalmologist. He wrote the first Arabic treatise on ophthalmology. His son known to the west as Mesue Senior with real name of Yuhanna ibn Masawayh wrote several medical works in Arabic while translating other works from Greek.He is known for somewhat of a sarcastic temperament none the less commanded great repect becuase of his medical expertise.
Hunayn ibn Ishaq who was a student of ibn Masawayh became the greatest translator of Greek and Syriac medical texts during the 3rd century AH/9th century AD. He was responsible for masterly translations of Galen,Hippocrates, Aristotle into Arabic. He also improved the Arabic Medical lexicon giving it a rich technical medical language to express medical terninology and thus laid the foundations of the rich medical expression in Arabic language far superceeding the later translations from Arabic to Latin.He was himself an astute physician and wrote two original works on ophthalmology.
The credit of the first sytematic work on medicine during this era goes to a muslim physician Ali ibn Rabban al-Tabbari hailing from Persia but settling in Baghdad in the first half of the 3rd century AH/9th century AD. His work called 'Firdaws a--Hikma' or 'Paradise of Wisdom' contained extensive information from all extant sources including Greek, Syriac,Persian and Indian and contained an extensive treatment of Anatomy.
The Period of Islamic Epoch
The most famous and notable physican of this time and perhaps of the entire early Islamic era is no doubt Muhammad ibn Zakariyya al-Razi(born 251 AH/865 AD; died 312 AH/925 AD) called Rhazes by his Latinized name. Born in Rayy in northern Persia not much is known about his early life or his medical educartion. His fame starts with the establishment of a hospital in Baghdad of which he was the chief.
The story of how he picked the site of the Hospital when asked to select one, has become one of the classical legends of Islamic Medicine. He had pieces of meat hung in various quarters of the city and had them examined for putrefaction and reccomended the site where the meat had decayed the least as the most suitable site thus making him the first physician to infer indirectly the bacteriologic putrefaction of meat, and suggesting the environmental role that contaminated air plays in the spread of infection, predating by centuries the modern concept of air borne infection.
But besides this astute observation Al-Razi is known for numerous other original contributions to the Art and Science of Medicine. Although not the first to describe the diffeences between Small Pox and Chicken Pox and give an indepth description of measles in his famous work Kitab al Jadari wa'l-hsbah (Tretise on Small Pox and Measles) his was the one that became well known in the west because of frequent translations. He described allergy to roses in one of his classical cases. The famous Islamic hisrtorian and scientist al-Biruni has listed 56 medical works of al-Razi the most famous being al-Hawi or the Continens which is an Encyclolpedia of medical knowledge based on his personmal observations and experiences.
A scribed copy of this book was recently exhibnited by the National Library of Medicine in Bethesda, Maryland USA celebrating 900th Anniversary of its completion by an unknown sribe., and recorded as the third oldest Medical manuscrript preserved in the world today. A shorter medical textbook was dedicated to al-Mansur and hence called Kitab al-Mansuri.
Besides these and other original contributions of which most have all been published and some survive to this day al-Razi devoted a lot of his time to teaching, bedside medicine and attending to the royalty and court.The impact of these publications on Islamic Medicine was tremendous. His books became an invaluable additon to the armamentarium of a medical student of the time and remained standard texts until the appearance much later of texts by al-Majusi (see below) and by ibn Sina :'Qanun fil Tibb''The Canon of Medicine' of which description will be given later.
In the 4th century of Hijra, 10th century AD another Islamic physician gained prominence in Baghdad. His name al-Majusi or Haly Abbas to the west (d 384 AH/994 AD). He became the director of the Adud-dawlah Hospital .It was to its founder that al-Majusi dedicated his medical work entitled Kitab Kamil al Sina al-Tibbiyah' or ' The complete book of the Medical Art ' also called 'al-Kitab al-Maliki' or 'The Royal Book'. This book (of which again a copy is preserved in the NLM at Bathesda) is very well systematized and organized. Divided into two basic volumes one covers theory and the other practical aspects. Each of these has 10 Chapters.
The first volume deals with historical sources,anatomy, faculties,six primeval functions, classification and causation of disease, symptoms and diagnosis, urine, sputum, saliva and pulse as an aid to diagnosis, external or visible manifesttions of disease and internal diseases like fever, headache epilepsy and warning signs of death or recovery. The second volume deals with hygine, dietics, cosmetics. Therapy with simple drugs. Therapy for fevers and diseases of organs viz of respiration, digestion, reproduction etc. There is a chapter on surgery, orthopedics, and finally treatment by compound medicaments.
About the 2nd century AH/ 8th century AD a great center of knowledge learning and culture had been developing in the western part of the Islamic empire. This was in Spain or 'Andalusia'as it was called by the Arabs.Spain had been invaded and conquered by the Muslims in 93 AH/714 AD. When the Ummayad dynasty ended in Baghdad the last of Ummayad princes had escaped to Spain where they established a greart dynasty called the Western Caliphate. The rulers of this dynasty laid the foundation of the muslim rule of Spain that was to last for seven centuries. The epoch of this period was to come during the reign of Amir Abdar-Rahman Al-Dakhil in 138 AH/756 AD.
During his reign Cardoba also called 'Qurtuba' became a great center of International learning. A great library containing more than a million volumes was estasblished. Sciences flourished and great men of learning and physicians worked under the Royal patronage. Later this center was to shift to Granada, under the patronage of the great Ummayad ruler Abd al-Rahman III al-Nasir (300-350 AH/912-961 AD). Perhaps the most famous physician and surgeon of the era was 'Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi' known to the west as Albucasis (318 AH/930 AD to 403 AH/1013 AD). He gained great fame as a physician. He wrote a major compendium of extant medical knowledge called 'Tasrif'.
It comprised of thirty volumes.The initial volumes dealt with general principles, elements and physiology of humors and the rest deal with systematic treatment of diseases from head to foot. The last volume is perhaps the most important in that it deals with all aspects of Surgery. It was the first textbook of Surgery with illustration of instruments used in Surgery to be ever published. It gained such greart fame that it became the standard testbook of surgery in prestigious universities in the west and was most widely read.He emphasised that knowledge of Anatomy and physiology was essential prior to undertaking any surgery: '
Before practicing surgery one should gain knowledge of anatomy and the function of organs so that he will understand their shape, connections and borders.He should become thoroughly familiar with nerves muscles bones arteries and veins.If one does not comprehend the anatomy and physiology one can commit a mistake which will result in the death of the patient. I have seen someone incise into a swelling in the neck thinking it was an abscess, when it was an aneurysm and the patient dying on the spot.'
Some operations described by him are carried out even today in the manner he described them almost 1000 years ago!.These would include operations on varicose veins, reduction of skull fractures,dental extractions , forceps delivery for a dead fetus to mention just a few. Surgery was raised to a high level of science by him, at a time when the Council of Tours in Europe declared in 1163 AD:'Surgery is to be abondoned by all schools of medicine and by all decent physicians'
However the greatest physician of the Islamic era was Avicenna or Ibn Sina his full name being:'Abu Ali al-Husayn ibn Abdallah ibn Sina'. Some historians of medicine acclaim him to be the greatest physcian that has ever lived . That is because ibn Sina was not only a physician par excellence but his knowledge and wisdom extended to many other branches of science and culture including philosophy, metaphysics, logic, and religion.As a result of his great wisdom, he has been awarded the titles: al-Shaykh al-Rais (The chief master) and al-Muallim al-Thani (the second philosopher after Aristotle)..
Ibn Sina was indeed a prodigy. At the age of 10 he had memorized the whole Quran.By age of 16 he had mastered all extant sciences that appealed to him including mathematics, geometry, islamic law,logic, philosophy and metaphysicis. By age 18 he taught himself all that was to learn in medicine. Born in city of Bokhara in what is now central Asia in the year 370 AH/980 AD he rapidly rose in ranks and became the vizier (prime minister) and court physician of the Samanid ruler of BukharaPrince Nuh ibn-Mansur.The Royal Library was opened to him and this enlarged the knowledge of Avicenna to new dimensions.
He began writing his first book at age 21. In all, in the short span of 30 years of wrting this man had written over a 100 books of which 16 were on medicine. His magnum opus is one of the classics of medicine ever written.The Canon of medicine as it became known in the west was written with the title of 'Kitab al-Qanun fi al-Tibb'. This voluminous compendium of medical knowledge rivalled one written earlier by al-Razi and al-Majusi and indeed surpassed both of these in the content and originality.It was composed of five volumes: Volume I contained the general principles Volume II Simple drugs Volume III Sytematic description of diseses from head to foot Volume IV general maladies viz fevers and Volume V Compound drugs.
The Canon was translated into Latin by Gerard of Cremora and Andrea Alpago and remained the standard textbook of medicine in Louvain and Montpellier until the 17th Century. A complete copy is in the archives of National Library of Medicine in Bethesda, Maryland.. The effects of the systematic collection of hitherto unorganized Greco-Roman medicine and adding to it by personal observation and experimentation of these physician brought medicine to a new pinnacles of practice.
Writes Prof Emile Savasge Smith, professor of history at the Welcome Library of Meidicine in a monograph that accompanied an exhibition of the oldest Arabic manuscripts in collection at the National Library of Meidicne:
'The medicine of the day was so brilliantly clarified by these compendia (especially those of Ibn sina and al-Majusi) and such order and consistency weas brought to it that a sense of perfectioin and hence stultifying authority resulted.'
The Basic Sciences in Islamic Medicine
Contarary to popular belief, basic Sciences were were highly developed in Islamic Sciences. For instance Oriental historians of Medicine have erroneously emphasised that science of anatomy, during the Islamic era was rudimentary ,and did not progress much further than the discoveries already made and desribed by the Greeks or 'the ancients'. It was popularly held that the Islamic physicians did not challenge the anatomic concepts of the 'ancients'. Secondary to the religious proscription of dissection and thus lacking in their own observations they relied heavily on observations of Galen, Aristotle, Paul of Agaeia and other Greek sources.
However after recent discoveries of manuscripts by an Egyptian Physician Mohiuddin al-Tatawi, that had been hetherto unsrutinized, it has become evident that Islamic Physicians not only possesed excellent knowlege of anatomy but they added some challenging new concepts that were revolutionary to the then understanding of anatomical concepts laid down by the 'ancients'.
The example that has now become well known is that of the discovery of the lesser or pulmanary circulation by Ibn Nafis( d 687 AH/1288 AD) Until then the credit of the discovery of the lesser circulation was given to Servetus and Colombo, who discribed it in much similar terms as Ibn Nafis only two hundred years later. The description given of the pulmonary circulation by Ibn Nafis challenged the fundamental concept held by Galen.
In fact it suggested that there existed a pulmonary capillary bed where the blood was 'purified ' before being brought back to the heart by the pulmonary artery, thus predating the discovery of pulmonary capillaries long afterwards, following the discovery of the microscope by Anthony Von Luwenheek.. It has to be noted that it has been documented that Ibn Masawaih or 'Masseuse Senior' his latinized name had with the special permission of the Caliph built a house on ther banks of the river Tigris where he dissected apes, to learn their anatomy and extrapolated the information to human anatomy.
That the knowlege of anatomy was pre-requisite for the surgeon has been emphasized by Al-Zahrawi in the surgical section of his book 'Tasrif' where he writes in the introduction:
'Now this is the reason why there is no skilful operator in our day: the art of medicine is long and it is necessary for its exponent, before he exercises it , to be trained in anatomy as Galen has described it, so that he may be fully acquainted with the uses, forms, temparament of the limbs; also how they are jointed, and how they may be seperated, that he should understand fully also the bones, tendons and muscles, their numbers and their attachments; and also the blood vessels both the arteries and the veins, with their relations. And so Hippocrates said: ' Though many are docotors in name, few in reality, particularly on the surgical side.'
As regards the physiological concepts embodied in the Islamic Medicine they were based on the Hippocratic and Galenic concepts of elements natrures and humors. The theory expounded being that harmony in the body prevails when all the humors are in proper balance and it is their imbalance that creates disease.
Under this principle then, disease is a state of imbalance of humours and needs the restoraion of balance, to bring the organism back to its normal healthy state. Under modern medicine such a concept would be unacceptable or at least untenable; because in modern medicine causation of disease is related to etilogical agents or factors. However it was Claud Bernard's concept of the 'milleu interior' which can in modern terms be compared to the Jabirean concept of innate harmony as exponded by Islamic medicine.
In order to further exemplify the factors affecting this balance the theory of Islamic Medicine expounds the concept of elements and temperaments. Basic elements are broken into: earth , fire, air and water and each of these is given a temperament: viz earth is dry and cold; water is humid and cold; fire hot and dry heat, air is humid and hot. Even further each of the four essential body fluids like blood, phlegm, yellow bile and black bile are assigned a respective temperament. Each dietary food, medicine or climatic environment can thus then modify or temper the humors of the body and it is an interplay of these that can restore health from sickness or cause the sickness to worsen.
Such a theory was understandably ill undeerstood and even laughed at and ridiculed by the scietists of the west. Yet the same scientists have now begun to look at the human organism from different insights. To give an example: until recently the theoritical basis of Accupuncture would not have been acceptable to any physician trained by principles of western or modern medicine and yet today this is being looked at with new insight and accepted because the application have shown practical results which would otherwise be unexplainable by modern principles of anatomy and physiology.For a further exposition of the theories of Islamic Medicine the reader is directed to read an exposition by O.C. Gruner and a desertation on the subject by Hakim Mohammed Said.
More importantly however it was the fundamental belief of a Muslim Physician that the organic body alone cannot manifest life being innate and devoid of a life force. That it was the instillation of this life force or 'Ruh' which give its vibrance and vitality of spirit.Thus without the 'ruh' no function of the body is possible. It is the 'Ruh' which descends from the Almighty to mix with the anatomic and physioogic body to make a complete human being.It is thus essential when treating a diseased state to take into consideratioin the 'Ruh' or the Soul, a concept totoally alien to the followers of Modern Medicine.
Pharmacy, Pharmacognosy, Materia Medica and Therapeutics
One of the greatest sciences that had a great impetus on Islamic medicine was the development of pharmacy and phamacognosy. Chemistry or 'Alchemia' had been studied by most Islamic Physicians and scholars. This study was furthered by concomitant development of techniques to refine drugs, medications and extracts by process of distillation, sublimation, crystallization. Druggists or Attarin became commonplace in Islamic lands and their proliferation ultimately required the institution of licensing of pharmacists and druggists.
Pharmacological drugs were classified into simple and compound drugs, 'the mufraddat and the murakkabat'. The effects of these were detailed and documented. The earliest Islamic works on pharmacognosy were written before translation of the Greek works of Dioscorides. Titles such as 'Treatise on the power of drugs their beneficial and their ill effects' and then again The Power of simple drugs' were written in the third and fourth century AH/ ninth century AD. Most medical texts contained chapters on the use of both these types of remedies, thus Razi's al-Hawi mentions 829 drugs.
Materia Medica and texts containing compendia of drugs their effects appears frequently during the era of Islamic Medicine. Notable amongst these is the contribution of Abu Bakr ibn Samghun of Cardoba on 'The Comprehensive book on views of the Ancients as well as the Moderns on Simple Drugs' Ibn Juljul made a commentary of drugs and plants described by Dioscordes and added a number of newer ones. Al-Zahrawi's Tasrif mentioned earlier in reference to its surgical volume also had a section on plants and drugs.
The second book of the Canon is devoted to the discussion of simple drugs and the powers and qualities being listed in charts. One of the most authoritative book on drugs was written by famous scholar and philosopher al-Biruni entitled 'The Book on drugs' which contains a huge compendium of drugs, their actions and their equivalent names in several languages.
Even today perhaps the most extensive pharmacotherapy especially as related to plant medicinal and herbal preparations can be attributed to modern day Islamic or Tibbi Medicine and finds great favor in the Indian subcontinent often being as popular as western or synthetic medicine.
In fact western pharmaceutical companies have often 'invaded' into this domain, the classical example being of the extract of 'Ruwalfia Serpentina' a root that yielded a potent anti-hypertensive which was a very popular remedy for hypertension in the sixties and which had been known to the Hakims for several centuries before being exploited by the west. No doubt in this pharmacopoeia there are other drugs equally effective in other diseases that need to be scientifically analyzed by random studies and double blind clinical trials for their effectiveness!
Contemporary Practice of Islamic Medicine
Islamic Medicine continues to be practiced in many of the Islamic countries today. However western traditional modern medicine has replaced the core of the health care systems in most of these countries. The only countries where it has to some degree enjoyed an official status is the Indian Subcontinent. The three main countries of the Indian subcontinent are India, Pakistan and Bangladesh. Thus in India there have been established medical schools where 'Tibb or Unani' medicine (translated as Natural medicine or Greek medicine) continues to be taught. These schools give their students a formal diploma in 'Tibb or Unani' medicine; which enables their students to be licensed practitioner of 'Tibb or Unani' medicine.
These students are instructed in 'Unani' concepts of medicine. They then utilize this knowledge and therapeutics in their practice. Their certification, licensing and supervision is controlled by the Indian Medical Council. In India both in rural and urban communities one finds practitioners of 'Unani or Tibbi' medicine. In Pakistan in the middle sixties the government under the then President Muhammed Ayub Khan ordered the official registration and licensing of the traditional Hakims (much to the chagrin of practitioners of modern medicine)! Tibb also enjoys favor of public popularity in other countries including Afghanistan, Malaysia and countries in the Middle East. In the latter it has recently had a resurgence in practitioners.
Conclusion
The greatest challenge of Islamic Medicine is not in its practice, therapeutics or application but in adaptation to modern day needs. Thus it is my belief that the fundamental challenge is not the way in which Islamic Medicine is practiced but the way in which it is defined. Somewhere in the late 16th century and 17th century a dichotomy developed between Islamic medicine and Modern or western medicine. This dichotomy was mainly related to the development of one civilization and concomitant decline of another, a cycle that is an ongoing fact of history. This upsurge of one, and slide of another civilization is no doubt an ongoing phenomena that has its effect on the great cultures of mankind.
To say that one system of medicine is superior to another is akin to committing the folly of labeling one antibiotic superior to another. Although one of them may have been discovered earlier and one later each antibiotic continues to play its role in a given ailment. The challenge then would be to study and define the interrelationships between these and precisely define when one is more useful than another. Exactly the same would apply to these two different systems of medicine. The roles of each of these needs to be defined, each needs to be studied in depth and in the light of each others progress, and each needs to be supplemented so that humanity can benefit from the good of each.
