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Islamic Medicine: 1000 years ahead of its times
Ibrahim B. SYED, Ph.D*
* Clinical Professor of Medicine, University of Louisville School of Medicine, Louisville, KY 40292 and
President, Islamic Research Foundation International, Inc 7102 W. Shefford Lane Louisville, KY 40242-6462
e-mail:IRFI@INAME.COM
http://www.irfiweb.org


                                                            Summary
    Within a century after the death of Prophet Muhammad (peace be upon him) the Muslims not only conquered new lands, but also
became scientific innovators with originality and productivity. They hit the source ball of knowledge over the fence to Europe. By the
ninth century, Islamic medical practice had advanced from talisman and theology to hospitals with wards, doctors who had to pass
tests, and the use of technical terminology. Then, the Baghdad General Hospital incorporated innovations which sound amazingly
modern. The fountains cooled the air near the wards of those afflicted with fever; the insane were treated with gentleness; and at night
the pain of the restless was soothed by soft music and storytelling. The prince and pauper received identical attention; the destitute
upon discharge received five gold pieces to sustain them during convalescence. While Paris and London were places of mud streets
and hovels, Baghdad, Cairo and Cardboard had hospitals open to both male and female patients; staffed by attendants of both sexes.
These medical centers contained libraries, pharmacies, the system of interns, externs, and nurses. There were mobile clinics to reach
the totally disabled, the disadvantaged and those in remote areas. There were regulations to maintain quality control on drugs.
Pharmacists became licensed professionals and were pledged to follow the physician's prescriptions. Legal measures were taken to
prevent doctors from owning or holding stock in a pharmacy. The extent to which Islamic medicine advanced in the fields of medical
education, hospitals, bacteriology, medicine, anesthesia, surgery, pharmacy, ophthalmology, psychotherapy and psychosomatic dis-
eases are presented briefly.

Key Words; History of Medicine, Basic Sciences, Medical Education, Islamic Medicine




                     Introduction                                       The Islamic Empire for more than 1000 years
    Prophet Muhammad (peace be upon him) who is                      remained the most advanced and civilized nation in
ranked number one by Michael Hart', a Jewish schol-                  the world. This is because Islam stressed the impor-
ar, in his book The 100: The Most Influential Persons                tance and respect of learning, forbade destruction,
in History, was able to unite the Arab tribes who had                developed in Muslims the respect for authority and
been tom by revenge, rivalry, and internal fights, and               discipline, and tolerance for other religions. The
produced a strong nation acquired and ruled simulta-                 Muslims recognized excellence and hungering intel-
neously, the two known empires at that time, namely                  lectually, were avid for the wisdom of the world of
the Persian and Byzantine Empires. The Islamic                       Galen, Hippocrates, Rufus of Ephesus, Oribasius,
Empire extended from the Atlantic Ocean on the                       Discorides and Paul of Aegina. By the tenth century
West to the borders of China on the East. Only 80                    their zeal and enthusiasm for learning resulted in all
years after the death of their Prophet, the Muslims                  essential Greek medical writings being translated
crossed to Europe to rule Spain for more than 700                    into Arabic in Damascus, Cairo, and Baghdad. Arabic
years. The Muslims preserved the cultures of the con-                became the International Language of learning and
quered lands. However when the Islamic Empire                        diplomacy. The center of scientific knowledge and
became weak, most of the Islamic contributions in                    activity shifted eastward, and Baghdad emerged as
and science were destroyed. The Mongols bunt                         the capital of the scientific world. The Muslims
Baghdad (1258 A.D.) out of barbarism, and the                        became scientific innovators with originality and
Spaniards demolished most of the Islamic heritage in                 productivity. Islamic medicine is one of the most
Spain out of hatred.                                                 famous and best known facets of lslamic civilization,

2                                                                                                                      JISHIM 2002, 2
ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME                                                     Ýbrahim B. SYED


and in which the Muslims most excelled. The                              Training in Basic Sciences
Muslims were the great torchbearers of international           Only Jundi-Shapur or Baghdad had separate
scientific research. They hit the source ball of knowl-    schools for studying basic sciences. Candidates for
edge over the fence to Europe. In the words of             medical study received basic preparation from pri-
Campbell' "The European medical system is Arabian          vate tutors through private lectures and self study. In
not only in origin but also in its structure. The Arabs    Baghdad anatomy was taught by dissecting the apes,
are the intellectual forebears of the Europeans."          skeletal studies, and didactics. Other medical schools
    The aim of this paper is to prove that the Islamic     taught anatomy through lectures and illustrations.
Medicine was 1000 years ahead of its times. The            Alchemy was once of the prerequisites for admission
                                                           to medical school. The study of medicinal herbs and
paper covers areas such as medical education, hospi-
                                                           pharmacognosy rounded out the basic training. A
tals, bacteriology, medicine, anesthesia, surgery,
                                                           number of hospitals maintained gardens as a source
opthalmology, pharmacy, and psychotherapy.
                                                           of drugs for the patients and a means of instruction
                                                           for the students. Once the basic training was complet-
                 Medical Education                         ed the candidate was admitted as an apprentice to a
    In 636 A.D., the Persian City of Jundi-Shapur,         hospital where, at the beginning, he was assigned in
which originally meant beautiful garden, was con-          a large group to a young physician for indoctrination,
quered by the Muslims with its great university and        preliminary lectures, and familiarization with library
hospital intact. Later the Islamic medical schools         procedures and uses. During this preclinical period,
developed on the Jundi-Shapur pattern. Medical edu-        most of the lectures were on pharmacology and toxi-
cation was serious and systematic. Lectures and clin-      cology and the use of antidotes.
ical sessions included in teaching were based on the
apprentice system. The advice given by Ali ibnul-                           Clinical Training:
Abbas (Haly Abbas: -994 -A.D.) to medical students              The next step was to give the student full clinical
is as timely today as it was then'. "And of those things   training. During this period students were assigned in
which were incumbent on the student of this art            small groups to famous physicians and experienced
(medicine) are that he should constantly attend the        instructors, for ward rounds, discussions, lectures,
hospitals and sick houses; pay unremitting attention       and reviews. Early in this period therapeutics and
to the conditions and circumstances of their inti-         pathology were taught. There was a strong emphasis
mates, in company with the most astute professors of       on clinical instruction and some Muslim physicians
medicine, and inquire frequently as to the state of the    contributed brilliant observations that have stood the
patients and symptoms apparent in them, bearing in         test of time. As the students progressed in their stud-
mind what he has read about these variations, and          ies they were exposed more and more to the subjects
what they indicate of good or evil."                       of diagnosis and judgment. Clinical observation and
                                                           physical examination were stressed. Students (clini-
   Razi (Rhazes: 841-926 A.D.) advised the medical         cal clerks) were asked to examine a patient and make
students while they were seeing a patient to bear in       a diagnosis of the ailment. While performing physi-
mind the classic symptoms of a disease as given in text    cal examination, the students were asked to examine
books and compare them with what they found (6).           and report six major factors: the patients' actions,
   The ablest physicians such as Razi (Al-Rhazes),         excreta, the nature and location of pain, and swelling
Ibn Sina (Avicenna: 980-1037 A.D.) and Ibn Zuhr            and effuvia of the body. Also noted was color and feel
(Avenzoar: 116 A.D.) performed the duties of both          of the skin- whether hot, cool, moist, dry, flabby.
hospital directors and deans of medical schools at the     Yellowness in the whites of the eye (jaundice) and
same time. They studied patients and prepared them         whether or not the patient could bend his back (lung
for student presentation. Clinical reports of cases        disease) was also considered important (8).
were written and preserved for teaching'. Registers            After a period of ward instructions, students, were
were maintained.                                           assigned to outpatient areas. After examining the

JISHIM 2002, 2                                                                                                   3
Ýbrahim B. SYED                                               ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME


patients they reported their findings to the instructors.    who practiced the art of healing. In the first year of the
After discussion, treatment was decided on and pre-          decree more than 860 were examined in Baghdad
scribed. Patients who were too ill were admitted as          alone. From that time on, licensing examinations were
inpatients. The keeping of records for every patient         required and administered in various places.
was the responsibility of the students.                      Licensing Boards were set up under a government
                                                             official called Muhtasib or inspector general . The
                     Curriculum                              Muhtasib also inspected weights and measures of
    There was a difference in the clinical curriculum        traders and pharmacists. Pharmacists were employed
of different medical schools in their courses; howev-        as inspectors to inspect drugs and maintain quality
er the mainstay was usually internal medicine.               control of drugs sold in a pharmacy or apothecary.
Emphasis was placed on clarity and brevity in                What the present Food and Drug Administration
describing a disease and the separation of each enti-        (FDA) is doing in America today was done in Islamic
ty. Until the time of Ibn Sina the description of            Medicine 1000 years ago. The chief physician gave
meningitis was confused with acute infection accom-          oral and practical examinations, and if the young
panied by delirium. Ibn Sina described the symptoms          physician was successful, the Muhtasib administered
of meningitis with such clarity and brevity that there       the Hippocratic oath and issued a license. After 1000
is very little that can be added after I 000 years (6).      years licensing of physicians has been implemented in
Surgery was also included in the curriculum. After           the West, particularly in America by the State
completing courses, some students specialized under          Licensing Board in Medicine. For specialists we have
famous specialists. Some others specialized while in         American Board of Medical Specialities such as in
clinical training. According to Elgood (9) many sur-         Medicine, Surgery, Radiology, etc. European medical
gical procedures such as amputation, excision of             schools followed the pattern set by the Islamic med-
varicose veins and hemorrhoids were required                 ical schools and even in the early nineteenth century,
knowledge. Orthopedics was widely taught, and the            students at the Sorbonne could not graduate without
use of plaster of Paris for casts after reduction of frac-   reading Ibn Sina's Qanun (Cannon). According to
tures was routinely shown to students. This method           Razi a physician had to satisfy two condition for
of treating fractures was rediscovered in the West in        selection: firstly, he was to be fully conversant with
1852. Although ophthalmology was practiced widely,           the new and the old medical literature and secondly,
it was not taught regularly in medical schools.              he must have worked in a hospital as house physician.
Apprenticeship to an eye doctor was the preferred
way of specializing in ophthalmology. Surgical treat-
                                                                                   Hospitals
ment of cataract was very common. Obstetrics was
left to midwives. Medical practitioners consulted                 The development of efficient hospitals was an
among themselves and with specialists. Ibn Sina and          outstanding contribution of Islamic medicine (7).
Razi both widely practiced and taught psychotherapy.         Hospitals served all citizens free without any regard
After completing the training, the medical graduate          to their color, religion, sex, age or social status. The
was not ready to enter practice, until he passed the         hospitals were run by government and the directors
licensure examination. It is important to note that          of hospitals were physicians.
there existed a Scientific Association which had been            Hospitals and separate wards for male patients
formed in the hospital of Mayyafariqin to discuss the        and female patients. Each ward was furnished with a
conditions and diseases of the patients.                     nursing staff and porters of the sex of the patients to
                                                             be treated therein. Different diseases such as fever,
              Licensing of Physicians                        wounds, infections, mania, eye conditions, cold dis-
     In Baghdad in 931 A.D. Caliph Al-Muqtadir               eases, diarrhea, and female disorders were allocated
learned that a patient had died as the result of a physi-    different wards. Convalescents had separate sections
cian's error. There upon he ordered his chief physi-         within them. Hospitals provided patients with unlim-
cian, Sinan-ibn Thabit bin Qurrah to examine all those       ited water supply and with bathing facilities. Only

4                                                                                                       JISHIM 2002, 2
ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME                                                     Ýbrahim B. SYED


qualified and licensed physicians were allowed by         supplies known at the time. It had interns, residents,
law to practice medicine. The hospitals were teaching     and 24 consultants attending its professional activi-
hospitals educating medical students. They had hous-      ties, An Abbasid minister, Ali ibn Isa, requested the
ing for students and house-staff. They contained phar-    court physician, Sinan ibn Thabit, to organize regular
macies dispensing free drugs to patients. Hospitals had   visiting of prisons by medical officers (14). At a time
their own conference room and expensive libraries         when Paris and London were places of mud streets
containing the most up-to-date books. According to        and hovels, Baghdad, Cairo, and Cordova had hospi-
Haddad, the library of the Tulum Hospital which was       tals which incorporated innovations which sound
founded in Cairo in 872 A.D. (1100 years ago) had         amazingly modern. It was chiefly in the humaneness
100,000 books. Universities, cities and hospitals         of patient care, however, that the hospitals of Islam
acquired large libraries (Mustansiriyya University in     excelled. Near the wards of those afflicted with fever,
Baghdad contained 80,000 volumes; the library of          fountains cooled the air; the insane were treated with
Cordova 600,000 volumes; that of Cairo 2,000,000          gentleness; and at night music and storytelling
and that of Tripoli 3,000,000 books), physicians had      soothed the patients.
their own extensive personal book collections, at a           The Bimaristans (hospitals) were of two types -
time when printing was unknown and book editing           the fixed and the mobile. The mobile hospitals were
was done by skilled and specialized scribes putting in    transported upon beasts of burden and were erected
long hours of manual labour.                              from time to time as required. The physicians in the
                                                          mobile clinics were of the same standing as those
   For the first time in history, these hospitals kept
                                                          who served the fixed hospitals. Similar moving hos-
records of patients and their medical care.
                                                          pitals accompanied the armies in the field. The field
   From the point of view of treatment the hospital       hospitals were well equipped with medicaments,
was divided into an out- patient department and an        instruments, tents and a staff of doctors, nurses, and
inpatient department. The system of the in-patient        orderlies. The traveling clinics served the totally dis-
department differed only slightly from that of today.     abled, the disadvantaged and those in remote areas.
At Tulun Hospital, on admission the patients were         These hospitals were also used by prisoners, and by
given special apparel while their clothes, money, and     the general public, particularly in times of epidemics.
valuables were stored until the time of their dis-
charge. On discharge, each patient - received five                           Bacteriology
gold pieces to support himself until he could return to       Al-Razi was asked to choose a site for a new hos-
work.                                                     pital when he came to Baghdad. First he deduced
    The hospital and medical school at Damascus had       which was the most hygienic area by observing
elegant rooms and an extensive library. Healthy peo-      where the fresh pieces of meat he had hung in vari-
ple are said to have feigned illness in order to enjoy    ous parts of the city decomposed least quickly.
its cuisine. There was a separate hospital in                 Ibn Sina stated explicitly that the bodily secretion
Damascus for lepers, while, in Europe, even six cen-      is contaminated by foul foreign earthly body before
turies later, condemned lepers were burned to death       getting the infection. Ibn Khatima stated that man is
by royal decree.                                          surrounded by minute bodies which enter the human
    The Qayrawan Hospital (built in 830 A.D. in           system and cause disease.
Tunisia) was characterized by spacious separate              In the middle of the fourteenth century "black
wards, waiting rooms for visitors and patients, and       death" was ravaging Europe and before which
female nurses from Sudan, an event representing the       Christians stood helpless, considering it an act of God.
first use of nursing in Arabic history. The hospital
                                                              At that time Ibn al Khatib of Granada composed a
also provided facilities for performing prayers.
                                                          treatise in the defense of the theory of infection in the
  The Al-Adudi Hospital (built in 981 A.D. in             following way: To those who say, "How can we
Baghdad) was furnished with die best equipment and        admit the possibility of infection while the religious

JISHIM 2002, 2                                                                                                   5
Ýbrahim B. SYED                                               ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME


law denies it?" We reply that the existence of conta-            Abu al-Qasim Khalaf Ibn Abbas Al-Zahrawi
gion is established by experience, investigation, the        (930-1013 A.D.) known to the West as Abulcasis,
evidence of the senses and trustworthy reports. These        Bucasis or Alzahravius is considered to be the most
facts constitute a sound argument. The fact of infec-        famous surgeon in Islamic medicine. In his book Al-
tion becomes clear to the investigator who notices           Tasrif, he described hemophilia for the first time in
how he who establishes contact with the afflicted gets       medical history. The book contains the description
the disease, whereas he who is not in contact remains        and illustration of about 200 surgical instruments
safe, and how transmission is effected through gar-          many of which were devised by Zahrawi himself. In
ments, vessels and earrings.                                 it Zahrawi stresses the importance of the study of
    Al-Razi wrote the first medical description of           Anatomy as a fundamental prerequisite to surgery.
smallpox and measles - two important infectious dis-         He advocates the reimplantation of a fallen tooth and
eases. He described the clinical difference between          the use of dental prosthesis carved from cow's bone,
the two diseases so vividly that nothing since has           an improvement over the wooden dentures worn by
been added. Ibn Sina suggested the communicable              the first President of America George Washington
nature of tuberculosis. He is said to have been the          seven centuries later. Zahrawi appears to be the first
first to describe the preparation and properties of sul-     surgeon in history to use cotton (Arabic word) in sur-
phuric acid and alcohol. His recommendation of wine          gical dressings in the control of hemorrhage, as
as the best dressing for wounds was very popular in          padding in the splinting of fractures, as a vaginal
medieval practice. However Razi was the first to use         padding in fractures of the pubis and in dentistry. He
silk sutures and alcohol for hemostatis. He was the          introduced the method for the removal of kidney
first to use alcohol as an antiseptic.                       stones by cutting into the urinary bladder. He was the
                                                             first to teach the lithotomy position for vaginal oper-
                     Anesthesia                              ations. He described tracheotomy, distinguished
   Ibn Sina originated the idea of the use of oral anes-     between goiter and cancer of the thyroid, and
thetics. He recognized opium as the most powerful            explained his invention of a cauterizing iron which he
mukhadir (an intoxicant or drug). Less powerful anes-        also used to control bleeding. His description of vari-
thetics known were mandragora, poppy, hemlock,               cose veins stripping, even after ten centuries, is
hyoscyamus, deadly nightshade (belladonna), lettuce          almost like modern surgery. In orthopedic surgery he
seed, and snow or ice cold water. The Arabs invented         introduced what is called today Kocher's method of
the soporific sponge which was the precursor of              reduction of shoulder dislocation and patelectomy,
modem anesthesia. It was a sponge soaked with aro-           1,000 years before Brooke reintroduced it in 1937.
matics and narcotics and held to the patient's nostrils.        Ibn Sina's description of the surgical treatment of
    The use of anesthesia was one of the reasons for         cancer holds true even today after 1,000 years. He
the rise of surgery in the Islamic world to the level of     says the excision must be wide and bold; all veins
an honourable speciality, while in Europe, surgery           running to the tumor must be included in the amputa-
was belittled and practiced by barbers and quacks.           tion. Even if this is not sufficient, then the area affect-
The Council of Tours in 1163 A.D. declared Surgery           ed should be cauterized.
is to be abandoned by the schools of medicine and by             The surgeons of Islam practiced three types of sur-
all decent physicians." Burton stated that "anesthetics      gery: vascular, general, and orthopedic, Ophthalmic
have been used in surgery throughout the East for            surgery was a speciality which was quite distinct both
centuries before ether and chloroform became the
                                                             from medicine and surgery. They freely opened the
fashion in civilized West."
                                                             abdomen and drained the peritoneal cavity in the
                                                             approved modern style. The first colostomy opera-
                       Surgery                               tion was attributed to an unnamed surgeon of Shiraz.
    Al-Razi is attributed to be the first to use the seton   Liver abscesses were treated by puncture and explo-
in surgery and animal gut for sutures.                       ration.

6                                                                                                        JISHIM 2002, 2
ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME                                                    Ýbrahim B. SYED


   Surgeons all over the world practice today unknow-                       Ophthalmology
ingly several surgical procedures that Zahrawi intro-           The doctors of Islam exhibited a high degree of
duced 1,000 years ago.                                     proficiency and certainly were foremost in the treat-
                                                           ment of eye diseases. Words such as retina and
                     Medicine                              cataract are of Arabic origin. In ophthalmology and
   The most brilliant contribution was made by Al-         optics lbn al Haytham (965-1039 A.D.) known to the
Razi who differentiated between smallpox and               West as Alhazen wrote the Optical Thesaurus from
measles, two diseases that were hitherto thought to be     which such worthies as Roger Bacon, Leonardo da
one single disease. He is credited with many contri-       Vinci and Johannes Kepler drew theories for their
                                                           own writings. In his Thesaurus he showed that light
butions, which include being the first to describe true
                                                           falls on the retina in the same manner as it falls on a
distillation, glass retorts and luting, corrosive subli-
                                                           surface in a darkened room through a small aperture,
mate, arsenic, copper sulfate, iron sulphate, saltpeter,
                                                           thus conclusively proving that vision happens when
and borax in the treatment of disease . He introduced
                                                           light rays pass from objects towards the eye and not
mercury compounds as purgatives (after testing them
                                                           from the eye towards the objects as thought by the
on monkeys); mercurial ointments and lead oint-            Greeks. He presents experiments for testing the
ment." His interest in urology focused on problems         angles of incidence and reflection, and a theoretical
involving urination, venereal disease, renal abscess,      proposal for magnifying lens (made in Italy three
and renal and vesical calculi. He described hay-fever      centuries later). He also taught that the image made
or allergic rhinitis.                                      on the retina is conveyed along the optic nerve to the
   Some of the Arab contributions include the dis-         brain. Razi was the first to recognize the reaction of
covery of itch mite of scabies (Ibn Zuhr), anthrax,        the pupil to light and Ibn Sina was the first to
ankylostoma and the guinea worm by Ibn Sina and            describe the exact number of extrinsic muscles of the
sleeping sickness by Qalqashandy. They described           eyeball, namely six. The greatest contribution of
abscess of the mediastinum. They understood tuber-         Islamic medicine in practical ophthalmology was in
                                                           the matter of cataract. The most significant develop-
culosis and pericarditis.
                                                           ment in the extraction of cataract was developed by
   Al Ash'ath demonstrated gastric physiology by           Ammar bin Ali of Mosul, who introduced a hollow
pouring water into the mouth of an anesthetized lion       metallic needle through the sclerotic and extracted
and showed the distensibility and movements of the         the lens by suction. Europe rediscovered this in the
stomach, preceding Beaumont by about 1,000 years.          nineteenth century.
Abu Shal al- Masihi explained that the absorption of
food takes place more through the intestines than the                        Pharmacology
stomach. Ibn Zuhr introduced artificial feeding either         Pharmacology took roots in Islam during the ninth
by gastric tube or by nutrient enema. Using the stom-      century. Yuhanna bin Masawayh (777-857 A.D.)
ach tube the Arab physicians performed gastric             started scientific and systematic applications of ther-
lavage in case of poisoning. Ibn Al-Nafis was the first    apeutics at the Abbasids capital. His students Hunayn
to discover pulmonary circulation.                         bin Ishaq al-lbadi (809-874 A.D.) and his associates
   Ibn Sina in his masterpiece Al-Quanun (Canon),          established solid foundations of Arabic medicine and
containing over a million words, described complete        therapeutics in the ninth century. In his book al-
studies of physiology, pathology and hygiene. He           Masail Hunayn outlined methods for confirming the
specifically discoursed upon breast cancer, poisons,       pharmacological effectiveness of drugs by experi-
diseases of the skin, rabies, insomnia, childbirth and     menting with them on humans. He also explained the
the use of obstetrical forceps, meningitis, amnesia,       importance of prognosis and diagnosis of diseases for
stomach ulcers, tuberculosis as a contagious disease,      better and more effective treatment.
facial tics, phlebotomy, tumors, kidney diseases and          Pharmacy became an independent and separate
geriatric care. He defined love as a mental disease.       profession from medicine and alchemy. With the wild

JISHIM 2002, 2                                                                                                  7
Ýbrahim B. SYED                                              ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME


sprouting of apothecary shops, regulations became           a dynamic fashion. Razi was once called in to treat a
necessary and imposed to maintain quality control.          famous caliph who had severe arthritis. He advised a
“The Arabian apothecary shops were regularly                hot bath, and while the caliph was bathing, Razi
inspected by a syndic (Muhtasib) who threatened the         threatened him with a knife, proclaiming he was
merchants with humiliating corporal punishments if          going to kill him. This deliberate provocation
they adulterated drugs." As early as the days of al-        increased the natural caloric which thus gained suffi-
Mamun and al-Mutasim pharmacists had to pass                cient strength to dissolve the already softened
examinations to become licensed professionals and           humours, as a result the caliph got up from his knees
were pledged to follow the physician's prescriptions.       in the bath and ran after Razi. One woman who suf-
Also by this decree, restrictive measures were legal-       fered from such severe cramps in her joints that she
ly placed upon doctors, preventing them from own-           was unable to rise was cured by a physician who lift-
ing or holding stock in a pharmacy.                         ed her skirt, thus putting her to shame. "A flush of
    Methods of extracting and preparing medicines           heat was produced within her which dissolved the
                                                            rheumatic humour."
were brought to a high art, and their techniques of dis-
tillation, crystallization, solution, sublimation, reduc-      The Arabs brought a refreshing spirit of dispas-
tion and calcination became the essential processes of      sionate clarity into psychiatry. They were free from
pharmacy and chemistry. With the help of these tech-        the demonological theories which swept over the
niques, the Saydalanis (pharmacists) introduced new         Christian world and were therefore able to make clear
drugs such as camphor, senna, sandalwood, rhubarb,          cut clinical observations on the mentally ill.
musk, myrrh, cassia, tamarind, nutmeg, alum, aloes,            Najab ud din Muhammad'", a contemporary of
cloves, coconut, nuxvomica, cubebs, aconite, amber-         Razi, left many excellent descriptions of various
gris and mercury. The important role of the Muslims         mental diseases. His carefully compiled observation
in developing modern pharmacy and chemistry is              on actual patients made up the most complete classi-
memorialized in the significant number of current           fication of mental diseases theretofore known."
pharmaceutical and chemical terms derived from              Najab described agitated depression, obsessional
Arabic: drug, alkali, alcohol, aldehydes, alembic, and      types of neurosis, Nafkhae Malikholia (combined pri-
elixir among others, not to mention syrups and juleps.      apism and sexual impotence) Kutrib (a form of per-
They invented flavorings extracts made of rose water,       secutory psychosis), Dual-Kulb (a form of mania).
orange blossom water, orange and lemon peel, traga-
canth and other attractive ingredients. Space does not          Ibn Sina recognized 'physiological psychology' in
permit me to list the contributions to pharmacology         treating illnesses involving emotions. From the clini-
and therapeutics, made by Razi, Zahrawi, Biruni, Ibn        cal perspective Ibn Sina developed a system for asso-
Butlan, and Tamimi.                                         ciating changes in the pulse rate with inner feelings
                                                            which has been viewed as anticipating the word asso-
                                                            ciation test of Jung. He is said to have treated a terri-
                  Psychotherapy                             bly ill patient by feeling the patient's pulse and recit-
    From freckle lotion to psychotherapy- such was          ing aloud to him the names of provinces, districts,
the range of treatment practiced by the physicians of       towns, streets, and people. By noticing how the
Islam. Though freckles continue to sprinkle the skin        patient's pulse quickened when names were men-
of 20th century man, in the realm of psychosomatic          tioned Ibn Sina deduced that the patient was in love
disorders both al-Razi and Ibn Sina achieved dramat-        with a girl whose home Ibn Sina was able to locate by
ic results, antedating Freud and Jung by a thousand         the digital examination. The man took Ibn Sina's
years. When Razi was appointed physician-in-chief to        advice, married the girl, and recovered from his ill-
the Baghdad Hospital, he made it the, first hospital to     ness.
have a ward exclusively devoted to the mentally ill.
                                                               It is not surprising to know that at Fez, Morocco,
   Razi combined psychological methods and physi-           an asylum for the mentally ill had been built early in
ological explanations, and he used psychotherapy in         the 8th century, and insane, asylums were built by the

8                                                                                                     JISHIM 2002, 2
ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME                                                                    Ýbrahim B. SYED


Arabs also in Baghdad in 705 A.D., in Cairo in 800                5.    Browne E.G., "Arabian Medicine",Cambridge University
A.D., and in Damascus and Aleppo in 1270 A.D. In                        M.Sirajud- din and Sons, Publishers, Lahore, 1962, pp. 5-16.
addition to baths, drugs, kind and benevolent treat-              6.    Podgomy G., N. Carolina Med. J. 27, 197-208, (1966).
ment given to the mentally ill, musico-therapy and                7.    Lyons A.S. and Petruccelli, R.J., "Medicine - An Illustrated
                                                                        History", H.N. Abrams Inc., Publishers, New York, 1978,
occupational therapy were also employed. These                          pp. 295-317.
therapies were highly developed. Special choirs and               8.    Garrison F.H., "History of Medicine". 4th edition, W.B.
live music bands were brought daily to entertain the                    Saunders Co., Philadelphia, 1929, p. 134.
patients by providing singing and musical perform-                9.    Elgood G., "A Medical History of Persia", Cambridge
ances and comic performers as well.                                     University Press, Cambridge, 195 1, pp. 278-301.
                                                                  10.   Wasty H.N., "Muslim Contribution to Medicine", M.
                                                                        Sirajuddin and Sons, Publishers, Lahore, 1962, pp. 5-16.
                      Conclusion                                  11.   Hamarneh S., Sudhoffs Archiv fur Geschichte der medizin
    1,000 years ago lslamic medicine was the most                       und der Naturwissenschaften, 48, 159-173.
advanced in the world at that time. Even after ten cen-           12.   Abouleish E., J. Islamic Med. Asso., lo(3, 4), 28-45, (1979).
turies, the achievements of Islamic medicine look                 13.   Haddad F.S., Leb. Med. J. 26, 331-346, 1979).
amazingly modern. 1,000 years ago the Muslims were                14.   Shahine Y.A., "The Arab Contribution to Medicine",
the great torchbearers of international scientific                      Longman for the University of Essex, London, 1971, p. 10.
research. Every student and professional from each                15.   Miller B., Mankind, 6(8), 8-40, (1980).
country outside the Islamic Empire, aspired, yearned,             16.   "Aspects of Muslim Civilization". Pakistan Branch of
                                                                        Oxford University Press, Lahore, 1961, pp. 53.
a dreamed to go to the lslamic universities to learn, to
                                                                  17.   Keys T.E., Wakim K.G., Mayo Clinic Proceedings of the
work, to live and to lead a comfortable life in an afflu-               Staff Meeting, 28, 423-437, (1953).
ent and most advanced and civilized society. Today, in            18.   Siddiqi M., "Studies in Arabic and Persian Medical
this twentieth century, the United States of America                    Literature", Calcutta Univcrsity, Calcutta, 1959, p. XX.
has achieved such a position. The pendulum can                    19.   Burton L., "1001 Nights (Six Volumes)", 1886.
swing back. Fortunately Allah has given a bounty to               20.   Hitti P., "The Arabs: A Short History", Henry Regnery,
many Islamic countries - an income over 100 billion                     Chicago, 1943,P.143.
dollars per year. Hence Islamic countries have the                21.   Castiglioni A., "A History of Medicine", E. Krumbhaar
                                                                        (trans.), Alfred A.Knopf, New York, 1958, p. 268.
opportunity and resources to make Islamic science
                                                                  22.   Singer C. and Underwood A.A., "A Short History of
and medicine number one in the world, once again.                       Medicine", 2nd edn. Oxford University Press, New York,
                                                                        1962, p. 76.
                    REFERENCES                                    23.   Khairallah A.A., Ann. Med. Hist. 34, 409-415
1.   Hart M.H., "The 100: A Rankin of the Most Influential        24.   Al-Oakbi, Hospital Med. Prac., Cairo, 1, 14-29, (1971).
     Persons in History.", Hart Publishing Co., New York, 1978.   25.   Haddad F.S., "XXI International Congress of the History of
2.   Nasr S.H., "Science and Civilization in Islam." New                Medicine" (Sienna 1968, Sep. 22) 1970, pp. 1600 -1607.
     American Library, Inc., New York, 1968, pp. 184-229.         26.   Bender G.A., "Great Moments in Medicine". Parke-Davis,
3.   Salam A., IAEA Bulletin, 22(2), 81-83, (1980).                     Detroit, 1961, p. 68-74.
4.   Campbell D., "Arabian Medicine", Vol. 1, Paul, Trench,       27.   Fisher G., Ann. Anat, Surg., 6, 217-217, (1882).
     Trubner and Co. LTD., London, 1926.                          28. Whitehead E.D. and Bush R.B., Invest, Urology, 5,




JISHIM 2002, 2                                                                                                                     9

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Islamic medicine ahead of its time

  • 1. Islamic Medicine: 1000 years ahead of its times Ibrahim B. SYED, Ph.D* * Clinical Professor of Medicine, University of Louisville School of Medicine, Louisville, KY 40292 and President, Islamic Research Foundation International, Inc 7102 W. Shefford Lane Louisville, KY 40242-6462 e-mail:IRFI@INAME.COM http://www.irfiweb.org Summary Within a century after the death of Prophet Muhammad (peace be upon him) the Muslims not only conquered new lands, but also became scientific innovators with originality and productivity. They hit the source ball of knowledge over the fence to Europe. By the ninth century, Islamic medical practice had advanced from talisman and theology to hospitals with wards, doctors who had to pass tests, and the use of technical terminology. Then, the Baghdad General Hospital incorporated innovations which sound amazingly modern. The fountains cooled the air near the wards of those afflicted with fever; the insane were treated with gentleness; and at night the pain of the restless was soothed by soft music and storytelling. The prince and pauper received identical attention; the destitute upon discharge received five gold pieces to sustain them during convalescence. While Paris and London were places of mud streets and hovels, Baghdad, Cairo and Cardboard had hospitals open to both male and female patients; staffed by attendants of both sexes. These medical centers contained libraries, pharmacies, the system of interns, externs, and nurses. There were mobile clinics to reach the totally disabled, the disadvantaged and those in remote areas. There were regulations to maintain quality control on drugs. Pharmacists became licensed professionals and were pledged to follow the physician's prescriptions. Legal measures were taken to prevent doctors from owning or holding stock in a pharmacy. The extent to which Islamic medicine advanced in the fields of medical education, hospitals, bacteriology, medicine, anesthesia, surgery, pharmacy, ophthalmology, psychotherapy and psychosomatic dis- eases are presented briefly. Key Words; History of Medicine, Basic Sciences, Medical Education, Islamic Medicine Introduction The Islamic Empire for more than 1000 years Prophet Muhammad (peace be upon him) who is remained the most advanced and civilized nation in ranked number one by Michael Hart', a Jewish schol- the world. This is because Islam stressed the impor- ar, in his book The 100: The Most Influential Persons tance and respect of learning, forbade destruction, in History, was able to unite the Arab tribes who had developed in Muslims the respect for authority and been tom by revenge, rivalry, and internal fights, and discipline, and tolerance for other religions. The produced a strong nation acquired and ruled simulta- Muslims recognized excellence and hungering intel- neously, the two known empires at that time, namely lectually, were avid for the wisdom of the world of the Persian and Byzantine Empires. The Islamic Galen, Hippocrates, Rufus of Ephesus, Oribasius, Empire extended from the Atlantic Ocean on the Discorides and Paul of Aegina. By the tenth century West to the borders of China on the East. Only 80 their zeal and enthusiasm for learning resulted in all years after the death of their Prophet, the Muslims essential Greek medical writings being translated crossed to Europe to rule Spain for more than 700 into Arabic in Damascus, Cairo, and Baghdad. Arabic years. The Muslims preserved the cultures of the con- became the International Language of learning and quered lands. However when the Islamic Empire diplomacy. The center of scientific knowledge and became weak, most of the Islamic contributions in activity shifted eastward, and Baghdad emerged as and science were destroyed. The Mongols bunt the capital of the scientific world. The Muslims Baghdad (1258 A.D.) out of barbarism, and the became scientific innovators with originality and Spaniards demolished most of the Islamic heritage in productivity. Islamic medicine is one of the most Spain out of hatred. famous and best known facets of lslamic civilization, 2 JISHIM 2002, 2
  • 2. ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME Ýbrahim B. SYED and in which the Muslims most excelled. The Training in Basic Sciences Muslims were the great torchbearers of international Only Jundi-Shapur or Baghdad had separate scientific research. They hit the source ball of knowl- schools for studying basic sciences. Candidates for edge over the fence to Europe. In the words of medical study received basic preparation from pri- Campbell' "The European medical system is Arabian vate tutors through private lectures and self study. In not only in origin but also in its structure. The Arabs Baghdad anatomy was taught by dissecting the apes, are the intellectual forebears of the Europeans." skeletal studies, and didactics. Other medical schools The aim of this paper is to prove that the Islamic taught anatomy through lectures and illustrations. Medicine was 1000 years ahead of its times. The Alchemy was once of the prerequisites for admission to medical school. The study of medicinal herbs and paper covers areas such as medical education, hospi- pharmacognosy rounded out the basic training. A tals, bacteriology, medicine, anesthesia, surgery, number of hospitals maintained gardens as a source opthalmology, pharmacy, and psychotherapy. of drugs for the patients and a means of instruction for the students. Once the basic training was complet- Medical Education ed the candidate was admitted as an apprentice to a In 636 A.D., the Persian City of Jundi-Shapur, hospital where, at the beginning, he was assigned in which originally meant beautiful garden, was con- a large group to a young physician for indoctrination, quered by the Muslims with its great university and preliminary lectures, and familiarization with library hospital intact. Later the Islamic medical schools procedures and uses. During this preclinical period, developed on the Jundi-Shapur pattern. Medical edu- most of the lectures were on pharmacology and toxi- cation was serious and systematic. Lectures and clin- cology and the use of antidotes. ical sessions included in teaching were based on the apprentice system. The advice given by Ali ibnul- Clinical Training: Abbas (Haly Abbas: -994 -A.D.) to medical students The next step was to give the student full clinical is as timely today as it was then'. "And of those things training. During this period students were assigned in which were incumbent on the student of this art small groups to famous physicians and experienced (medicine) are that he should constantly attend the instructors, for ward rounds, discussions, lectures, hospitals and sick houses; pay unremitting attention and reviews. Early in this period therapeutics and to the conditions and circumstances of their inti- pathology were taught. There was a strong emphasis mates, in company with the most astute professors of on clinical instruction and some Muslim physicians medicine, and inquire frequently as to the state of the contributed brilliant observations that have stood the patients and symptoms apparent in them, bearing in test of time. As the students progressed in their stud- mind what he has read about these variations, and ies they were exposed more and more to the subjects what they indicate of good or evil." of diagnosis and judgment. Clinical observation and physical examination were stressed. Students (clini- Razi (Rhazes: 841-926 A.D.) advised the medical cal clerks) were asked to examine a patient and make students while they were seeing a patient to bear in a diagnosis of the ailment. While performing physi- mind the classic symptoms of a disease as given in text cal examination, the students were asked to examine books and compare them with what they found (6). and report six major factors: the patients' actions, The ablest physicians such as Razi (Al-Rhazes), excreta, the nature and location of pain, and swelling Ibn Sina (Avicenna: 980-1037 A.D.) and Ibn Zuhr and effuvia of the body. Also noted was color and feel (Avenzoar: 116 A.D.) performed the duties of both of the skin- whether hot, cool, moist, dry, flabby. hospital directors and deans of medical schools at the Yellowness in the whites of the eye (jaundice) and same time. They studied patients and prepared them whether or not the patient could bend his back (lung for student presentation. Clinical reports of cases disease) was also considered important (8). were written and preserved for teaching'. Registers After a period of ward instructions, students, were were maintained. assigned to outpatient areas. After examining the JISHIM 2002, 2 3
  • 3. Ýbrahim B. SYED ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME patients they reported their findings to the instructors. who practiced the art of healing. In the first year of the After discussion, treatment was decided on and pre- decree more than 860 were examined in Baghdad scribed. Patients who were too ill were admitted as alone. From that time on, licensing examinations were inpatients. The keeping of records for every patient required and administered in various places. was the responsibility of the students. Licensing Boards were set up under a government official called Muhtasib or inspector general . The Curriculum Muhtasib also inspected weights and measures of There was a difference in the clinical curriculum traders and pharmacists. Pharmacists were employed of different medical schools in their courses; howev- as inspectors to inspect drugs and maintain quality er the mainstay was usually internal medicine. control of drugs sold in a pharmacy or apothecary. Emphasis was placed on clarity and brevity in What the present Food and Drug Administration describing a disease and the separation of each enti- (FDA) is doing in America today was done in Islamic ty. Until the time of Ibn Sina the description of Medicine 1000 years ago. The chief physician gave meningitis was confused with acute infection accom- oral and practical examinations, and if the young panied by delirium. Ibn Sina described the symptoms physician was successful, the Muhtasib administered of meningitis with such clarity and brevity that there the Hippocratic oath and issued a license. After 1000 is very little that can be added after I 000 years (6). years licensing of physicians has been implemented in Surgery was also included in the curriculum. After the West, particularly in America by the State completing courses, some students specialized under Licensing Board in Medicine. For specialists we have famous specialists. Some others specialized while in American Board of Medical Specialities such as in clinical training. According to Elgood (9) many sur- Medicine, Surgery, Radiology, etc. European medical gical procedures such as amputation, excision of schools followed the pattern set by the Islamic med- varicose veins and hemorrhoids were required ical schools and even in the early nineteenth century, knowledge. Orthopedics was widely taught, and the students at the Sorbonne could not graduate without use of plaster of Paris for casts after reduction of frac- reading Ibn Sina's Qanun (Cannon). According to tures was routinely shown to students. This method Razi a physician had to satisfy two condition for of treating fractures was rediscovered in the West in selection: firstly, he was to be fully conversant with 1852. Although ophthalmology was practiced widely, the new and the old medical literature and secondly, it was not taught regularly in medical schools. he must have worked in a hospital as house physician. Apprenticeship to an eye doctor was the preferred way of specializing in ophthalmology. Surgical treat- Hospitals ment of cataract was very common. Obstetrics was left to midwives. Medical practitioners consulted The development of efficient hospitals was an among themselves and with specialists. Ibn Sina and outstanding contribution of Islamic medicine (7). Razi both widely practiced and taught psychotherapy. Hospitals served all citizens free without any regard After completing the training, the medical graduate to their color, religion, sex, age or social status. The was not ready to enter practice, until he passed the hospitals were run by government and the directors licensure examination. It is important to note that of hospitals were physicians. there existed a Scientific Association which had been Hospitals and separate wards for male patients formed in the hospital of Mayyafariqin to discuss the and female patients. Each ward was furnished with a conditions and diseases of the patients. nursing staff and porters of the sex of the patients to be treated therein. Different diseases such as fever, Licensing of Physicians wounds, infections, mania, eye conditions, cold dis- In Baghdad in 931 A.D. Caliph Al-Muqtadir eases, diarrhea, and female disorders were allocated learned that a patient had died as the result of a physi- different wards. Convalescents had separate sections cian's error. There upon he ordered his chief physi- within them. Hospitals provided patients with unlim- cian, Sinan-ibn Thabit bin Qurrah to examine all those ited water supply and with bathing facilities. Only 4 JISHIM 2002, 2
  • 4. ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME Ýbrahim B. SYED qualified and licensed physicians were allowed by supplies known at the time. It had interns, residents, law to practice medicine. The hospitals were teaching and 24 consultants attending its professional activi- hospitals educating medical students. They had hous- ties, An Abbasid minister, Ali ibn Isa, requested the ing for students and house-staff. They contained phar- court physician, Sinan ibn Thabit, to organize regular macies dispensing free drugs to patients. Hospitals had visiting of prisons by medical officers (14). At a time their own conference room and expensive libraries when Paris and London were places of mud streets containing the most up-to-date books. According to and hovels, Baghdad, Cairo, and Cordova had hospi- Haddad, the library of the Tulum Hospital which was tals which incorporated innovations which sound founded in Cairo in 872 A.D. (1100 years ago) had amazingly modern. It was chiefly in the humaneness 100,000 books. Universities, cities and hospitals of patient care, however, that the hospitals of Islam acquired large libraries (Mustansiriyya University in excelled. Near the wards of those afflicted with fever, Baghdad contained 80,000 volumes; the library of fountains cooled the air; the insane were treated with Cordova 600,000 volumes; that of Cairo 2,000,000 gentleness; and at night music and storytelling and that of Tripoli 3,000,000 books), physicians had soothed the patients. their own extensive personal book collections, at a The Bimaristans (hospitals) were of two types - time when printing was unknown and book editing the fixed and the mobile. The mobile hospitals were was done by skilled and specialized scribes putting in transported upon beasts of burden and were erected long hours of manual labour. from time to time as required. The physicians in the mobile clinics were of the same standing as those For the first time in history, these hospitals kept who served the fixed hospitals. Similar moving hos- records of patients and their medical care. pitals accompanied the armies in the field. The field From the point of view of treatment the hospital hospitals were well equipped with medicaments, was divided into an out- patient department and an instruments, tents and a staff of doctors, nurses, and inpatient department. The system of the in-patient orderlies. The traveling clinics served the totally dis- department differed only slightly from that of today. abled, the disadvantaged and those in remote areas. At Tulun Hospital, on admission the patients were These hospitals were also used by prisoners, and by given special apparel while their clothes, money, and the general public, particularly in times of epidemics. valuables were stored until the time of their dis- charge. On discharge, each patient - received five Bacteriology gold pieces to support himself until he could return to Al-Razi was asked to choose a site for a new hos- work. pital when he came to Baghdad. First he deduced The hospital and medical school at Damascus had which was the most hygienic area by observing elegant rooms and an extensive library. Healthy peo- where the fresh pieces of meat he had hung in vari- ple are said to have feigned illness in order to enjoy ous parts of the city decomposed least quickly. its cuisine. There was a separate hospital in Ibn Sina stated explicitly that the bodily secretion Damascus for lepers, while, in Europe, even six cen- is contaminated by foul foreign earthly body before turies later, condemned lepers were burned to death getting the infection. Ibn Khatima stated that man is by royal decree. surrounded by minute bodies which enter the human The Qayrawan Hospital (built in 830 A.D. in system and cause disease. Tunisia) was characterized by spacious separate In the middle of the fourteenth century "black wards, waiting rooms for visitors and patients, and death" was ravaging Europe and before which female nurses from Sudan, an event representing the Christians stood helpless, considering it an act of God. first use of nursing in Arabic history. The hospital At that time Ibn al Khatib of Granada composed a also provided facilities for performing prayers. treatise in the defense of the theory of infection in the The Al-Adudi Hospital (built in 981 A.D. in following way: To those who say, "How can we Baghdad) was furnished with die best equipment and admit the possibility of infection while the religious JISHIM 2002, 2 5
  • 5. Ýbrahim B. SYED ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME law denies it?" We reply that the existence of conta- Abu al-Qasim Khalaf Ibn Abbas Al-Zahrawi gion is established by experience, investigation, the (930-1013 A.D.) known to the West as Abulcasis, evidence of the senses and trustworthy reports. These Bucasis or Alzahravius is considered to be the most facts constitute a sound argument. The fact of infec- famous surgeon in Islamic medicine. In his book Al- tion becomes clear to the investigator who notices Tasrif, he described hemophilia for the first time in how he who establishes contact with the afflicted gets medical history. The book contains the description the disease, whereas he who is not in contact remains and illustration of about 200 surgical instruments safe, and how transmission is effected through gar- many of which were devised by Zahrawi himself. In ments, vessels and earrings. it Zahrawi stresses the importance of the study of Al-Razi wrote the first medical description of Anatomy as a fundamental prerequisite to surgery. smallpox and measles - two important infectious dis- He advocates the reimplantation of a fallen tooth and eases. He described the clinical difference between the use of dental prosthesis carved from cow's bone, the two diseases so vividly that nothing since has an improvement over the wooden dentures worn by been added. Ibn Sina suggested the communicable the first President of America George Washington nature of tuberculosis. He is said to have been the seven centuries later. Zahrawi appears to be the first first to describe the preparation and properties of sul- surgeon in history to use cotton (Arabic word) in sur- phuric acid and alcohol. His recommendation of wine gical dressings in the control of hemorrhage, as as the best dressing for wounds was very popular in padding in the splinting of fractures, as a vaginal medieval practice. However Razi was the first to use padding in fractures of the pubis and in dentistry. He silk sutures and alcohol for hemostatis. He was the introduced the method for the removal of kidney first to use alcohol as an antiseptic. stones by cutting into the urinary bladder. He was the first to teach the lithotomy position for vaginal oper- Anesthesia ations. He described tracheotomy, distinguished Ibn Sina originated the idea of the use of oral anes- between goiter and cancer of the thyroid, and thetics. He recognized opium as the most powerful explained his invention of a cauterizing iron which he mukhadir (an intoxicant or drug). Less powerful anes- also used to control bleeding. His description of vari- thetics known were mandragora, poppy, hemlock, cose veins stripping, even after ten centuries, is hyoscyamus, deadly nightshade (belladonna), lettuce almost like modern surgery. In orthopedic surgery he seed, and snow or ice cold water. The Arabs invented introduced what is called today Kocher's method of the soporific sponge which was the precursor of reduction of shoulder dislocation and patelectomy, modem anesthesia. It was a sponge soaked with aro- 1,000 years before Brooke reintroduced it in 1937. matics and narcotics and held to the patient's nostrils. Ibn Sina's description of the surgical treatment of The use of anesthesia was one of the reasons for cancer holds true even today after 1,000 years. He the rise of surgery in the Islamic world to the level of says the excision must be wide and bold; all veins an honourable speciality, while in Europe, surgery running to the tumor must be included in the amputa- was belittled and practiced by barbers and quacks. tion. Even if this is not sufficient, then the area affect- The Council of Tours in 1163 A.D. declared Surgery ed should be cauterized. is to be abandoned by the schools of medicine and by The surgeons of Islam practiced three types of sur- all decent physicians." Burton stated that "anesthetics gery: vascular, general, and orthopedic, Ophthalmic have been used in surgery throughout the East for surgery was a speciality which was quite distinct both centuries before ether and chloroform became the from medicine and surgery. They freely opened the fashion in civilized West." abdomen and drained the peritoneal cavity in the approved modern style. The first colostomy opera- Surgery tion was attributed to an unnamed surgeon of Shiraz. Al-Razi is attributed to be the first to use the seton Liver abscesses were treated by puncture and explo- in surgery and animal gut for sutures. ration. 6 JISHIM 2002, 2
  • 6. ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME Ýbrahim B. SYED Surgeons all over the world practice today unknow- Ophthalmology ingly several surgical procedures that Zahrawi intro- The doctors of Islam exhibited a high degree of duced 1,000 years ago. proficiency and certainly were foremost in the treat- ment of eye diseases. Words such as retina and Medicine cataract are of Arabic origin. In ophthalmology and The most brilliant contribution was made by Al- optics lbn al Haytham (965-1039 A.D.) known to the Razi who differentiated between smallpox and West as Alhazen wrote the Optical Thesaurus from measles, two diseases that were hitherto thought to be which such worthies as Roger Bacon, Leonardo da one single disease. He is credited with many contri- Vinci and Johannes Kepler drew theories for their own writings. In his Thesaurus he showed that light butions, which include being the first to describe true falls on the retina in the same manner as it falls on a distillation, glass retorts and luting, corrosive subli- surface in a darkened room through a small aperture, mate, arsenic, copper sulfate, iron sulphate, saltpeter, thus conclusively proving that vision happens when and borax in the treatment of disease . He introduced light rays pass from objects towards the eye and not mercury compounds as purgatives (after testing them from the eye towards the objects as thought by the on monkeys); mercurial ointments and lead oint- Greeks. He presents experiments for testing the ment." His interest in urology focused on problems angles of incidence and reflection, and a theoretical involving urination, venereal disease, renal abscess, proposal for magnifying lens (made in Italy three and renal and vesical calculi. He described hay-fever centuries later). He also taught that the image made or allergic rhinitis. on the retina is conveyed along the optic nerve to the Some of the Arab contributions include the dis- brain. Razi was the first to recognize the reaction of covery of itch mite of scabies (Ibn Zuhr), anthrax, the pupil to light and Ibn Sina was the first to ankylostoma and the guinea worm by Ibn Sina and describe the exact number of extrinsic muscles of the sleeping sickness by Qalqashandy. They described eyeball, namely six. The greatest contribution of abscess of the mediastinum. They understood tuber- Islamic medicine in practical ophthalmology was in the matter of cataract. The most significant develop- culosis and pericarditis. ment in the extraction of cataract was developed by Al Ash'ath demonstrated gastric physiology by Ammar bin Ali of Mosul, who introduced a hollow pouring water into the mouth of an anesthetized lion metallic needle through the sclerotic and extracted and showed the distensibility and movements of the the lens by suction. Europe rediscovered this in the stomach, preceding Beaumont by about 1,000 years. nineteenth century. Abu Shal al- Masihi explained that the absorption of food takes place more through the intestines than the Pharmacology stomach. Ibn Zuhr introduced artificial feeding either Pharmacology took roots in Islam during the ninth by gastric tube or by nutrient enema. Using the stom- century. Yuhanna bin Masawayh (777-857 A.D.) ach tube the Arab physicians performed gastric started scientific and systematic applications of ther- lavage in case of poisoning. Ibn Al-Nafis was the first apeutics at the Abbasids capital. His students Hunayn to discover pulmonary circulation. bin Ishaq al-lbadi (809-874 A.D.) and his associates Ibn Sina in his masterpiece Al-Quanun (Canon), established solid foundations of Arabic medicine and containing over a million words, described complete therapeutics in the ninth century. In his book al- studies of physiology, pathology and hygiene. He Masail Hunayn outlined methods for confirming the specifically discoursed upon breast cancer, poisons, pharmacological effectiveness of drugs by experi- diseases of the skin, rabies, insomnia, childbirth and menting with them on humans. He also explained the the use of obstetrical forceps, meningitis, amnesia, importance of prognosis and diagnosis of diseases for stomach ulcers, tuberculosis as a contagious disease, better and more effective treatment. facial tics, phlebotomy, tumors, kidney diseases and Pharmacy became an independent and separate geriatric care. He defined love as a mental disease. profession from medicine and alchemy. With the wild JISHIM 2002, 2 7
  • 7. Ýbrahim B. SYED ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME sprouting of apothecary shops, regulations became a dynamic fashion. Razi was once called in to treat a necessary and imposed to maintain quality control. famous caliph who had severe arthritis. He advised a “The Arabian apothecary shops were regularly hot bath, and while the caliph was bathing, Razi inspected by a syndic (Muhtasib) who threatened the threatened him with a knife, proclaiming he was merchants with humiliating corporal punishments if going to kill him. This deliberate provocation they adulterated drugs." As early as the days of al- increased the natural caloric which thus gained suffi- Mamun and al-Mutasim pharmacists had to pass cient strength to dissolve the already softened examinations to become licensed professionals and humours, as a result the caliph got up from his knees were pledged to follow the physician's prescriptions. in the bath and ran after Razi. One woman who suf- Also by this decree, restrictive measures were legal- fered from such severe cramps in her joints that she ly placed upon doctors, preventing them from own- was unable to rise was cured by a physician who lift- ing or holding stock in a pharmacy. ed her skirt, thus putting her to shame. "A flush of Methods of extracting and preparing medicines heat was produced within her which dissolved the rheumatic humour." were brought to a high art, and their techniques of dis- tillation, crystallization, solution, sublimation, reduc- The Arabs brought a refreshing spirit of dispas- tion and calcination became the essential processes of sionate clarity into psychiatry. They were free from pharmacy and chemistry. With the help of these tech- the demonological theories which swept over the niques, the Saydalanis (pharmacists) introduced new Christian world and were therefore able to make clear drugs such as camphor, senna, sandalwood, rhubarb, cut clinical observations on the mentally ill. musk, myrrh, cassia, tamarind, nutmeg, alum, aloes, Najab ud din Muhammad'", a contemporary of cloves, coconut, nuxvomica, cubebs, aconite, amber- Razi, left many excellent descriptions of various gris and mercury. The important role of the Muslims mental diseases. His carefully compiled observation in developing modern pharmacy and chemistry is on actual patients made up the most complete classi- memorialized in the significant number of current fication of mental diseases theretofore known." pharmaceutical and chemical terms derived from Najab described agitated depression, obsessional Arabic: drug, alkali, alcohol, aldehydes, alembic, and types of neurosis, Nafkhae Malikholia (combined pri- elixir among others, not to mention syrups and juleps. apism and sexual impotence) Kutrib (a form of per- They invented flavorings extracts made of rose water, secutory psychosis), Dual-Kulb (a form of mania). orange blossom water, orange and lemon peel, traga- canth and other attractive ingredients. Space does not Ibn Sina recognized 'physiological psychology' in permit me to list the contributions to pharmacology treating illnesses involving emotions. From the clini- and therapeutics, made by Razi, Zahrawi, Biruni, Ibn cal perspective Ibn Sina developed a system for asso- Butlan, and Tamimi. ciating changes in the pulse rate with inner feelings which has been viewed as anticipating the word asso- ciation test of Jung. He is said to have treated a terri- Psychotherapy bly ill patient by feeling the patient's pulse and recit- From freckle lotion to psychotherapy- such was ing aloud to him the names of provinces, districts, the range of treatment practiced by the physicians of towns, streets, and people. By noticing how the Islam. Though freckles continue to sprinkle the skin patient's pulse quickened when names were men- of 20th century man, in the realm of psychosomatic tioned Ibn Sina deduced that the patient was in love disorders both al-Razi and Ibn Sina achieved dramat- with a girl whose home Ibn Sina was able to locate by ic results, antedating Freud and Jung by a thousand the digital examination. The man took Ibn Sina's years. When Razi was appointed physician-in-chief to advice, married the girl, and recovered from his ill- the Baghdad Hospital, he made it the, first hospital to ness. have a ward exclusively devoted to the mentally ill. It is not surprising to know that at Fez, Morocco, Razi combined psychological methods and physi- an asylum for the mentally ill had been built early in ological explanations, and he used psychotherapy in the 8th century, and insane, asylums were built by the 8 JISHIM 2002, 2
  • 8. ISLAMIC MEDICINE: 1000 YEARS AHEAD OF ITS TIME Ýbrahim B. SYED Arabs also in Baghdad in 705 A.D., in Cairo in 800 5. Browne E.G., "Arabian Medicine",Cambridge University A.D., and in Damascus and Aleppo in 1270 A.D. In M.Sirajud- din and Sons, Publishers, Lahore, 1962, pp. 5-16. addition to baths, drugs, kind and benevolent treat- 6. Podgomy G., N. Carolina Med. J. 27, 197-208, (1966). ment given to the mentally ill, musico-therapy and 7. Lyons A.S. and Petruccelli, R.J., "Medicine - An Illustrated History", H.N. Abrams Inc., Publishers, New York, 1978, occupational therapy were also employed. These pp. 295-317. therapies were highly developed. Special choirs and 8. Garrison F.H., "History of Medicine". 4th edition, W.B. live music bands were brought daily to entertain the Saunders Co., Philadelphia, 1929, p. 134. patients by providing singing and musical perform- 9. Elgood G., "A Medical History of Persia", Cambridge ances and comic performers as well. University Press, Cambridge, 195 1, pp. 278-301. 10. Wasty H.N., "Muslim Contribution to Medicine", M. Sirajuddin and Sons, Publishers, Lahore, 1962, pp. 5-16. Conclusion 11. Hamarneh S., Sudhoffs Archiv fur Geschichte der medizin 1,000 years ago lslamic medicine was the most und der Naturwissenschaften, 48, 159-173. advanced in the world at that time. Even after ten cen- 12. Abouleish E., J. Islamic Med. Asso., lo(3, 4), 28-45, (1979). turies, the achievements of Islamic medicine look 13. Haddad F.S., Leb. Med. J. 26, 331-346, 1979). amazingly modern. 1,000 years ago the Muslims were 14. Shahine Y.A., "The Arab Contribution to Medicine", the great torchbearers of international scientific Longman for the University of Essex, London, 1971, p. 10. research. Every student and professional from each 15. Miller B., Mankind, 6(8), 8-40, (1980). country outside the Islamic Empire, aspired, yearned, 16. "Aspects of Muslim Civilization". Pakistan Branch of Oxford University Press, Lahore, 1961, pp. 53. a dreamed to go to the lslamic universities to learn, to 17. Keys T.E., Wakim K.G., Mayo Clinic Proceedings of the work, to live and to lead a comfortable life in an afflu- Staff Meeting, 28, 423-437, (1953). ent and most advanced and civilized society. Today, in 18. Siddiqi M., "Studies in Arabic and Persian Medical this twentieth century, the United States of America Literature", Calcutta Univcrsity, Calcutta, 1959, p. XX. has achieved such a position. The pendulum can 19. Burton L., "1001 Nights (Six Volumes)", 1886. swing back. Fortunately Allah has given a bounty to 20. Hitti P., "The Arabs: A Short History", Henry Regnery, many Islamic countries - an income over 100 billion Chicago, 1943,P.143. dollars per year. Hence Islamic countries have the 21. Castiglioni A., "A History of Medicine", E. Krumbhaar (trans.), Alfred A.Knopf, New York, 1958, p. 268. opportunity and resources to make Islamic science 22. Singer C. and Underwood A.A., "A Short History of and medicine number one in the world, once again. Medicine", 2nd edn. Oxford University Press, New York, 1962, p. 76. REFERENCES 23. Khairallah A.A., Ann. Med. Hist. 34, 409-415 1. Hart M.H., "The 100: A Rankin of the Most Influential 24. Al-Oakbi, Hospital Med. Prac., Cairo, 1, 14-29, (1971). Persons in History.", Hart Publishing Co., New York, 1978. 25. Haddad F.S., "XXI International Congress of the History of 2. Nasr S.H., "Science and Civilization in Islam." New Medicine" (Sienna 1968, Sep. 22) 1970, pp. 1600 -1607. American Library, Inc., New York, 1968, pp. 184-229. 26. Bender G.A., "Great Moments in Medicine". Parke-Davis, 3. Salam A., IAEA Bulletin, 22(2), 81-83, (1980). Detroit, 1961, p. 68-74. 4. Campbell D., "Arabian Medicine", Vol. 1, Paul, Trench, 27. Fisher G., Ann. Anat, Surg., 6, 217-217, (1882). Trubner and Co. LTD., London, 1926. 28. Whitehead E.D. and Bush R.B., Invest, Urology, 5, JISHIM 2002, 2 9