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General Overview

• Important medieval Islamic physicians
• `Razis' the great clinician of the early 10th century
• `Avicen', or Avicenna as other Europeans called him, referring to Ibn Sina whose early 11th-century medical encyclopedia was as important in Europe as it was in the Middle East.
• Arabic medical literature of the 9th to 12th centuries, through Latin translations, provided late medieval Europe with ideas and practices from which early modern medicine eventually arose.
• Arabic Physicians were influenced heavily by the earlier Greek teachings. They mingled that with some Persian, Indian, and Arab elements.
• Communications over such a vast area during the course of several centuries were, as would be expected, neither uniform nor very swift, and the dispersion of ideas and texts from one region to another was uneven.
• The general health of the Islamic community was influenced by many factors:
• the dietary and fasting laws and the general rules for hygiene and burial of the different religious communities
• the climatic conditions (desert, marsh, mountain and littoral communities)
• the different living conditions of nomadic, rural, and urban populations
• local economic factors and agricultural successes or failures
• population migration and travel
• the injuries and diseases attendant upon army camps and battles
• the incidence of plague and other epidemics as well as the occurrence of endemic conditions such as trachoma and other eye diseases.
• Another important factor in the medical care given is the economic and social status of the patient
• The medical profession in general transcended the barriers of religion

GREEK and other ancient influences

• Early in the 9th century, there was established in Baghdad a foundation called the House of Wisdom (Bayt al-Hikmah), which had its own library. Its purpose was to promote the translation of scientific texts.
• The most famous of the translators was Hunayn ibn Ishaq al-`Ibadi, a Christian originally from southern Iraq who also knew Greek and Arabic.
• He was the author of many medical tracts and a physician to the caliph al-Mutawakkil
• He translated nearly all the Greek medical books known at that time, half of the Aristotelian writings as well as commentaries, various mathematical treatises, and even the Septuagint.
• Accuracy and sensitivity were hallmarks of his translating style.
• Through these translations a continuity of ideas was maintained between Roman and Byzantine practices and Islamic medicine.
• The writings of Hippocrates as well as other Greek physicians were translated around this time.
• Knowledge of medicinal substances was based initially upon the illustrated treatise on materia medica written in Greek by Dioscorides in the 1st century.
• Several Arabic translations and revisions of his treatise were undertaken in 9th-century BaghdadSpain and later.

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• The Greek legacy underlying al-Razi's work: Galen and Hippocrates
• The Islamic physicians drew on the studies of Galen, and Hippocrates, among other great Greek physicians.
• Ancient Greek medicine had accepted the importance of open intellectual inquiry and of medical pluralism
• Galen on the other hand, coming much later as synthesizer and simplifier, had picked up only certain threads from the ancient Greek medical past, and by so doing he had all but closed the door of intellectual inquiry.
• Galen, as systemizer and simplifier had worked within a complex paradigm that posited a balanced constitution as equivalent to good health, and an unbalanced constitution as equivalent to some sort of disease condition. Galen was also very much aware of the need to keep the medical profession in being by providing it with fee-paying patrons/clients. Accordingly, he had argued that each individual client had his/her own particular balance: this balance gradually changed as the client progressed from childhood to youth to adulthood and on to old-age. Within this schema, the role of a physician was to understand the particular characteristics of his client and (for a fee) to prescribe a proper regimen for him to follow.
• Galen's paradigm also posited the division of the theory of medicine into three parts. These were the theory of the "natural" causes of disease as a deviation from the normal, the theory of "causes" and the theory of "signs."
• NATURAL CAUSES OF DISEASE
• There were seven "natural" things: the four elements (earth, air, fire, water): complexions (nine in number, a combination of hot and cold, wet and dry); the four humors (phlegm, yellow bile, black bile and blood); the four members (the brain, the heart, the liver, the testicles - two in number but counted as one); the three forces; the two actions (i.e. unconscious digestive processes and conscious movement); the three spirits; the three types of sickness.
• In addition, there were the six "non-naturals." The first five, according to Galen, were climate, motion and rest, diet, sleeping patterns, evacuation and sexuality; the sixth consisted of afflictions of the soul. Even a quick scan of this listing of categories of things and forces (each of which had a complex meaning) will convince the reader that for Galen and his followers "medicine" was really a branch of philosophy: only a well-educated specialist could begin to understand it.

PROPHETIC MEDICINE

• A genre of medical writing called “al-tibb al-nabawi”
• Authors were clerics – some more religiously inclined than others
• Advocated the medicine available in Muhammad’s day
• Acceptable to the religiously orthodox
• Therapy consisted of diet and simple drugs (especially honey), bloodletting, and cautery, but no surgery.
• Other topics included fevers, leprosy, plague, poisonous bites, protection from night-flying insects, protection against the evil eye, rules for coitus, theories of embryology, proper conduct of physicians, and treatment of minor illnesses such as headaches, nosebleed, cough and colic.
• It was prohibited to drink wine or use soporific drugs as medicaments.
• The treatises also provided numerous prayers and pious invocations to be used by the devout patient, with the occasional amulet and talisman, and they were particularly popular in the 13th to 15th centuries, with some still available today in modern printings.

Abu Bakr Muhammad ibn Zakariya' al-Razi (Rhazes)

• A physician learned in philosophy as well as music and alchemy.
• The most sought after of all his compositions was The Comprehensive Book on Medicine (Kitab al-Hawi fi al-tibb) -- a large private notebook or commonplace book into which he placed extracts from earlier authors regarding diseases and therapy and also recorded clinical cases of his own experience.
• Arranged by disease
• Meticulous about citing his sources
• The clinical cases, while not unique, are the most numerous and varied in the Islamic medieval medical literature.
• Known as Rhazes in Europe
• The Comprehensive Book on Medicine was translated to Latin in 1279
• It became one of the most widely read medieval medical manuals in Europe, and the ninth chapter, on therapeutics, frequently circulated by itself under the title Liber nonus ad Almansorem. In the Renaissance many editions of it were printed with commentaries by the prominent physicians of the day, such as Andreas Vesalius.
• Book on Smallpox and Measles - Kitab fi al-jadari wa-al-hasbah – was translated in the 18^th Century
• Among al-Razi's smaller medical tracts were treatises on colic, on stones in the kidney and bladder, diabetes, and a cornucopia of other things.
• Al-Razi displayed a primary interest in therapeutics, lacking the concern of later writers for refining the classification of symptoms. He was not in such awe of Galen that he refrained from correcting him, but his criticism was in the areas of logic and clinical applications.

IMPORTANT MEDICAL WRITERS

• `Ali ibn al-`Abbas al-Majusi (d. 994/384 H) was born into a Zoroastrian family from the Iranian city of Ahwaz about the time of al-Razi's death. Al-Majusi practiced medicine in Baghdad and served as physician to the ruler `Adud al-Dawlah, founder of the `Adudi hospital in Baghdad.
• He wrote The Complete Book Of The Medical Art
• He divided his encyclopedia into two large books, one on theoretical principles and the other on practical aspects.
• Abu `Ali al-Husayn ibn `Abd Allah ibn Sina, known to Europe as Avicenna. He was born in 980 (370 H) in Central Asia and traveled widely in the eastern Islamic lands, composing nearly 270 different treatises. When he died in 1037 (428 H) he was known as one of the greatest philosophers in Islam, and in medicine was so highly regarded that he was compared to Galen.
• Wrote The Cannon of Medicine
• The large comprehensive Arabic encyclopedia rivaled the popularity of al-Majusi's compendium and in many quarters surpassed it.
• He divided his treatise into 5 books
• general medical principles
• materia medica
• diseases occurring in a particular part of the body
• diseases not specific to one bodily part (such as fevers)
• a formulary giving recipes for compound remedies
• Ibn Sina in general excelled in logical assessment of a condition and the comparison of symptoms.
• Analgesics (mukhaddirat) abate the pain, he says, because they destroy the sensation of that part, which they accomplish either through hypercooling or by means of a toxic property. Of the analgesics, the most powerful he considered to be opium, and then mandrake, two varieties of poppy, henbane, hemlock, the soporific black nightshade, and lettuce seeds; he also included cold water and ice among the analgesics
• No need for extreme measures to relieve pain – concerned with massage, the application of hot compresses, the use of a hot-water bottle…

Book Designs

• It was through the written word that formal medical knowledge was transmitted from one generation of physicians to another and from one region to another.
• The arts of the written book were highly developed at this time in the Arab world.
• In the Islamic world, nearly all manuscripts were written on paper, which was in plentiful supply in the Middle East by the 9th century.
• Printing, on the other hand, came relatively recently to the Middle East (essentially not until the 19th century). Only by hiring a scribe to prepare a copy by hand, or copying it himself, could a physician possess his own copy of a book.
• The calligraphic skills of the scribe or specialist illuminator were applied to presentation copies of treatises on every subject, including scientific and medical books. In contrast to the illuminated initials used in Western manuscripts which draw the attention to one focal point on the page, in Islamic manuscripts the entire text itself is part of the design
• Human anatomy was a topic to receive the attention of illustrators.
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SPECIALIZED LITERATURE

• Large numbers of treatises were devoted to the diagnosis and treatment of a specific disease or to diseases affecting a particular part of the body. For example …
• Forgetfulness
• Poisonous bites
• Hemorrhoids
• Particular classes of potential patients were also the subject of a number of treatises. For example
  
• The poor and the destitute
• Travelers

OPHTHALMOLOGY AND SURGERY

• Blindness was one of the leading causes of disability throughout the Islamic Empire, which is why ophthalmology was a huge emphasis
• considerable advancement in knowledge over that in the Greco-Roman treatises preserved today
• 9th century the physician-translator Hunayn ibn Ishaq wrote monographs on ophthalmology, including the influential Ten Treatises on the Eye
• Untreated cataract result in blindness
• `Ammar ibn `Ali al-Mawsili
• He insisted he could cure a cataract by sticking in a hollow needle and sucking it out
• Generally accepted method – Couching
• Success rate 4/10
• pushing the lens of the eye out of the way by inserting into the eye a needle or probe through the edge of the cornea
• Infection and glaucoma were the major causes for failure
• trachoma, the major cause of blindness
• treated by averting the eyelid and scraping the interior with a selection of scrapers
• they developed
• Surgery
• Surgical chapter from the 10th-century medical encyclopedia composed in Spain by al-Zahrawi.
• Al-Zahrawi divided his discourse on surgery into three parts: on cautery, on incisions and bloodletting, and on bone setting
• included in it copious illustrations and descriptions of instruments
• In the 13th century, Ibn al-Quff, composed a specialized surgical manual - omitted all ophthalmologic procedures because he considered these the province of a specialist.
• Nearly all the other general discussions of surgery did include some ophthalmologic practices, though not with the detail and thoroughness evident in the monographs devoted solely to ophthalmology.

ANATOMY

• The anatomical sections of the Canon of Medicine by Ibn Sina assembled by an anonymous compiler into one volume
• Knowledge of anatomy in medieval Islam was firmly based on the anatomical writings by the 2nd-century Greek physician Galen.

PHARMACEUTICS AND ALCHEMY

• In the field of materia medica and its applications, Islamic writers surpassed their earlier models because of their broader geographic horizons brought them into contact with drugs unknown to earlier peoples, such as camphor, musk, sal ammoniac, and senna. In later Arabic works, medicines were used that came from as far as China, Southeast Asia, the Himalayas, southern India, and Africa.
• Initially based upon the approximately 500 substances described in the 1st century AD by Dioscorides in his Greek treatise on materia medica.
• Medical encyclopedias usually had one chapter on materia medica and another on recipes for compound remedies
• The topic of poisons was of great interest in both antiquity and the medieval world and it also generated its own literature.
• Many of the techniques employed in drug production were also part of the realm of alchemy.
• The Arabic word al-kimiya, from which we derive the word alchemy, was used for both chemistry and alchemy, and no clear distinction was made between the two activities.
• As the equipment and processes of alchemy developed -- with its methods of evaporation, filtration, sublimation, crystallization, and distillation -- they came to influence pharmacy and medical chemistry.

HOSPITALS

• The hospital was one of the great achievements of medieval Islamic society.
• In Islam there was generally a moral imperative to treat all the ill regardless of their financial status.
• The hospitals were largely secular institutions, many of them open to all, male and female, civilian and military, adult and child, rich and poor, Muslims and non-Muslims. They tended to be large, urban structures.
• Of the great Syro-Egyptian hospitals of the 12th and 13th centuries, we possess a considerable amount of information.
• There was a separate hall for women patients and areas reserved for the treatment of conditions prevalent in the area -- eye ailments, gastrointestinal complaints (especially dysentery and diarrhoea), and fevers. There was also an area for surgical cases and a special ward for the mentally ill.
• Hospitals in Islamic lands were financed from the revenues of pious bequests called waqfs. Wealthy men, and especially rulers, donated property as endowments, whose revenue went toward building and maintaining the institution.
• Part of the state budget also went toward the maintenance of a hospital.

Bibliography

"Islamic Culture and the Medical Arts." National Library of Medicine - National Institutes of Health. Web. 29 Nov. 2009. <http://www.nlm.nih.gov/exhibition/islamic_medical/islamic_00.html#toc>.

Sheldon Watts, Disease and Medicine in World History (New York: Routledge, 2003) iii, Questia,

Reynoldson, Fiona. Medicine Through Time (Heinemann Secondary History Project). New York: Heinemann Educational, 2003. Print.