The History and Theory of Islamic Medicine

Review of Religions: December 20015 The author had the opportunity to review the history of Islamic medicine and was so fascinated that she compiled this article to chronicle the achievements of Muslims in the field of medicine. The article explores how Muslim scientists created the very fundamentals of modern medicine. Modern man, dependent as he is on the drugs of the chemist and the skills of the physician, on the reckoning of the computer and the predictions of the economic planner, owes more of a debt than he might suspect to the Islamic scientists of the Middle A g e s . Between the 9th and 14th centuries, Muslim chemists, physicians, astronomers, mathematicians, geographers and others not only kept alive the disciplines of Greek science, but extended their range, laying and strengthening the foundation on which much of modern science is built (Stewart, 1967). The topic of this essay is Islamic medicine, with an emphasis on its historical development, practice, theory and the influence of Islam on Islamic medicine. Historical Development Islamic science, from its very beginning, did not concern itself only with man’s physical environment, but included a pene- trating analysis of man as a spiritual being and of the society in which he dwelt. The first Muslim physician was a Companion of the Holy P r o p h e t( s a ), Haridth ibn-Kaladah, who had studied at Jundishapur(1). But despite this very early contact of Islam with the school of medicine, Arab Muslims did not pursue this field, and nearly all of the early physicians were either Christians, Jews or Persians. It was only after the establishment of Arabic as a major medical language, and the penetration of medicine and its knowledge into the texture of everyday life that Arab Muslims gradually became drawn to this subject. The History and Theory of Islamic Medicine by Mrs Samina Mian – Edmonton, India The History and Theory of Islamic Medicine Review of Religions: December 20016 In the beginning, the main target that drew the Islamic scholars was the capital city of Baghdad. There, the Caliph Mamun, who ruled the empire from 813 to 833, created the ‘House of Wi s d o m ’ – a famous centre of learning that included a library, a translation bureau and a school. Within seventy-five years after the establishment of the House of Wisdom, the greatest thoughts of the Greek and the other early people had been translated into A r a b i c . These translations included the chief philosophical books of A r i s t o t l e , some important works of Plato, and major studies by Euclid, Ptolemy, Archimedes and the celebrated Greek physicians Hippocrates, Dioscorides and Galen, as well as many important Persian and Indian scientific works(2). Hippocrates, known in Arabic as Buqrat, was recognized from the earliest period as the ‘Father of Greek medicine’. Numerous works by him were rendered into Arabic by the movement of translation, as described above. More of Galen’s works survived in Arabic than in Greek, and Muslims identified him as much with philosophy as with medicine(1). One of the foremost of the scholars at the House of Wisdom was Hunayn ibn-Ishaq. Hunayn studied medicine in Baghdad under a physician who had trained at the famous Persian medical school in Jundishapur, which was to have a profound influence on the develop- ment of Islamic medicine. Later, Hunayn was made in charge of the House of Wisdom by the Caliph, where he supervised all the translations. In addition to his translations, Hunayn also produced a large number of medical works of his own, among them the earliest known textbook on opthalmology(2). The great compilation and translation of knowledge, accom- plished by Hunayn and his colleagues did much to lay the groundwork of modern science, particularly in the field of medicine, as the works of these men were later translated into Latin and made their way into the West, primarily through Sicily and Spain. The basis for all Islamic science was the Greek belief that underlying the apparent chaos in the universe was a fundamental order. This order was said to be governed by universal laws that could be understood by human reason; once these laws were Review of Religions: December 2001 The History and Theory of Islamic Medicine 7 comprehended, all phenomena, no matter how unrelated they seemed, could readily be understood. Thus in an effort to understand the true nature of the universe, scholars pursued more than one branch of learning. The scientist-philosopher was not a narrow specialist, but was an expert in such varied fields as medicine, chemistry, astronomy, mathematics, logic, metaphysics, and even music and poetry. Starting in the 8th century, the Muslims gradually developed a more sophisticated approach to medicine, rather than the early desert superstitions of the Arabs. The main impetus came from the Persian medical school in Jundishapur, whose teachings were based primarily on the Greek practice of treating disease by rational methods. The contact between Jundishapur and the rulers of Islam began in 765 – not out of the search for universal truth, but due to a more urgent and personal reason – a chronic indigestion that plagued the founder of Baghdad. The chief physician of Jundishapur, Jurjis, who was a Christian, was invited to treat him. He succeeded, and was appointed as the court physician. Like Jurjis, most of Islam’s early practitioners were Persian-born, but they spoke and wrote Arabic, the language of scholarship during the Middle Ages. One of the most celebrated of these Eastern physicians was al-Razi, who lived from 865–925 CE. The finest physician of his age, he has been compared to Hippocrates for his originality in describing a disease. Razi (Latin – Rhazes) is said to have written more than two hundred books, ranging in subject matter from medicine and alchemy to theology and astronomy. About half of these books are on medicine, and include a well-known treatise on small pox. In his discussion of small pox, Razi was the first to differentiate a specific disease from among many eruptive fevers that assailed man. By giving the clinical symptoms of small pox, he enabled doctors to diagnose it correctly and to predict the course of the disease. He also recommended a treatment for the ailment. He urged gentle therapy, good diet and good nursing care, which meant about the same as it does today; rest, clean sur- roundings and keeping the patient comfortable. The History and Theory of Islamic Medicine Review of Religions: December 20018 While Razi knew nothing about bacteria which were not discovered until the early 17th century, he had an intuitive sense of the hygienic principles far ahead of medieval standards(2). He was once asked to choose the site for a new hospital in Baghdad. To do so, he suspended pieces of meat at various points around the city, and at the location where the meat petrified most slowly, he recommended building the hospital. The 10th and 11th centuries were the age of numerous medical author- ities of the highest rank. While al- Majusi was dominating the field of internal medicine in the East, Andalusia produced the first of its great medical figures – al-Fahrawi. He was the greatest of the Muslim surgeons and his Kitab al-Tarif (The Book of Concessions), which is a medical encyclopaedia, was a definitive guide for surgeons over the centuries. This was also the period of major works on opthalmology. Ali ibn Isa was the first person to propose the use of anesthesia for surgery. The most illustrious figure of this period and Islam’s most famous physician was Abu Ali ibn Sina, the ‘prince of physicians,’ the Av i c e n n a of Western scholastics and physicians, and one by whose name many people in the East call Islamic medicine to this day( 1 ). Born in Bukhara, he was self-taught in medicine and was already a famous physician by the age of eighteen. He lived from 980 to 1037 CE, and wrote some 170 books on p h i l o s o p h y, medicine, mathematics and anatomy, as well as poetry and religious work. Ibn Sina’s most renowned achievement was a l – Qanvn fil-tibb – the Cannon of M e d i c i n e, which was an encyclopaedia that dealt with virtually every phase of the treatment of disease. This is perhaps the most influential single work in the whole history of medicine, even including the writings of Hippocrates and G a l e n( 1 ). The encyclopaedia consists of five books which contain: • the general principles of medicine; • simple drugs; • disorders of internal and external organs of the body; • illnesses which affect the body in general; Review of Religions: December 2001 The History and Theory of Islamic Medicine 9 • and compound drugs. From the 12th to 17th century, the Cannon of Medicine served as the chief guide to medical science in European universities. Ibn Sina is now credited with such personal contributions as recognising the contagious nature of tuberculosis, and describing certain skin diseases and psychological disorders. Western historians consider Ibn Sina to be a great thinker who was instrumental in passing the Greek heritage to the West(3). After Ibn Sina, Islamic medicine gradually underwent a regional development while preserving its basic unity. In Iraq, Syria and adjacent lands, major cities like Cairo and Damascus became centres of attraction for many physicians with the building of new hospitals in the 12th century. Ibn Nafis, p h i l o s o p h e r, theologian and physician, was entitled the second Ibn Sina, while working both in Cairo and Damascus. Although Ibn Nafis has been celebrated through- out the Islamic world, including Persia and India, since his death in 1288, it was only in 1924 that an Egyptian doctor, Muhyi al-Din al- Tatawi, discovered that centuries before Columbo and Servetus, Ibn Nafis had explained correctly the circulation of blood. This was one of the most important discoveries in the history of medicine, and made the name of Ibn Nafis celebrated in the West as the real predecessor of William Harvey rather than Columbo and Servetus, who had been credited until then with the discovery of minor circulation. In Maghrib, between the 11th and 12th centuries, Ibn Fuhr composed The Book Facilitating the Study of Therapy and Diet, which is among the most celebrated products of Islamic medicine in Andalusia. A Spanish physician, ibn-Rushd (Latin – Averroes) wrote on medicine, philosophy, law and astronomy. His talent was varied enough that he served not only as a chief physician, but also as a judge in Seville and Cordoba. In addition, Ibn Rushd is known as one of the foremost interpreters of Aristotle. A n o t h e r Spanish born Jewish physician who influenced western ways was Ibn Maymum, who served as a court physician to the Sultan of Egypt and Syria in the 12th century. His medical works include the commentaries on Galen and Hippocrates, as well as his own The History and Theory of Islamic Medicine Review of Religions: December 200110 observations, primarily related to diet and personal hygiene. A f t e r these celebrated figures, medicine gradually declined in Andalusia, but survived in Morocco, where it continues in certain quarters to this day. In Persia and India, most of the medical history was dominated by the works of Ibn Sina. In the 12th c e n t u r y, there appeared the first extensive medical encyclopaedia in Persia modelled upon the Cannon by a l – J u r J a n i( 1 ). He is perhaps responsible for the perpetuation of the medical teachings of Ibn-Sina during the later centuries. After the Mongol invasion, there was great cultural and scientific exchange between Islam and China. From the reign of Nadir Shah onward, modern European medicine was introduced into Persia. T h i s process accelerated with the establishment of a new university Dar al-Fanun in Tehran during the Qajar period, where modern medicine was taught. In Persia, as in Egypt, Turkey and other lands of Western Islam, the traditional system has continued, although to a lesser extent(1). The history of Islamic medicine in India is inseparable from that of Persia because of the flow of a large number of Persian physicians to India in the 15th and 18th centuries, as well as the use of Persian as the primary scientific language, especially in medicine. It was after the Eighteenth century that Muslim and Hindu physicians from India itself came to the fore to continue the cultivation of Islamic medicine. It is in India, Pakistan, and Bangladesh that Islamic medicine is most alive today(1). Medical activity in the Turkish part of the Ottoman world was closely related to that of Persia until the 15th century. From the 17th century onward, the influence of European medicine began to make itself felt in Tu r k e y, and by the Nineteenth century, there had been a nearly total replacement of traditional medicine by the modern European system in this part of the Islamic world. Islam and Islamic Medicine The principles of Islamic medicine are deeply rooted in Islamic tradition, although this medicine itself came into being as a result of the integration by Muslims of several older traditions of medicine, Review of Religions: December 2001 The History and Theory of Islamic Medicine 11 of which most important was the Greek. Islam directs the faithful to seek knowledge of the natural world, and inspiration in it: the world is the work of God. In Islam, both the ends and means of an individual’s actions must be halal (allowed). Therefore, the whole of Islamic medicine is also related to Islam through the injunctions contained in the Qur’an and the Hadith, concerning health and various questions related in one way or another to medicine. The aspects of Divine Law con- cerning personal hygiene, dietary habits, ablutions, and many other elements affecting the body are again related to medicine. As a practical guide to health, the Qur’an makes some explicit instructions – for example, the importance of bathing is emphasised and it is included in great detail in the preparation for praying. The result is that there is always a link between Islamic medicine and the teachings of Islam, and whatever historians may say of the Greek, Syrian, Indian or old Persian origins of the medical idea or practice, Islamic medicine has always been seen by Muslims as closely related to religion. Some jurists have pointed out that of the ‘foreign’ sciences, only medicine was studied by even one or two of the companions of the Holy P r o p h e t( s a ), and that medical practices which would lead to the regaining of the health of body and soul were encouraged from the earliest period of Islam(1). Within the Islamic world, what survives of the traditional medicine today is closely associated with the actual practice of religion by the majority of people. The Practice of Islamic Medicine Islamic civilisation created certain institutions and norms closely related to its own general structure in order to make the teachings and practice of medicine possible. G r a d u a l l y, the figure of the physician, originally of Christian or Jewish background, became Islamic and there came into being the Islamic figure of the hakim – who was at once physician and philosopher, as well as a master of most of the other traditional sciences. Most of the clinical aspects, as well as surgery and pharmacology were taught in hospitals to which usually a medical school was added. T h e teaching and the practice of Islamic The History and Theory of Islamic Medicine Review of Religions: December 200112 medicine are inseparable from the institution of the hospital, which at its height contained in addition to words, major libraries, lecture halls and other facilities necessary for the training of medical students. To this d a y, the only remnants of larg e – scale hospitals and dispensaries where Islamic medicine is practised are to be found in the Indian subcontinent, some of the examples being the Osmania hospital in Hyderabad, Deccan, and the Hamdard Institutes of Dehli and Karachi. The practice of Islamic medicine has always been closely connected with the dispensaries and c h e m i s t ’s shops. The traditional druggist has knowledge of various drugs, especially herbs, which comprise most of the traditional m e d i c a m e n t s. Also significant for its medical uses is the traditional bath (hammam), which is found in one form or another throughout the Islamic world. Muslim physicians have used the traditional bath for all kinds of uses including overcoming headaches. These baths continue to fulfill medical as well as religious and hygienic functions. The Theory of Islamic Medicine The theory of Islamic medicine is related to the whole of Islamic metaphysics, cosmology and philo- sophy. Islamic physicians saw the body of man as an extension of his soul and closely related to both the spirit and the soul ( 1 ). Moreover, Islamic medicine was especially concerned with the interpretations and interrelation of cosmic forces, and the effect of these forces upon man. Muslim physicians also remained fully aware of the sympathy between all orders of existence, and the mutual actions and reaction of one creature upon another. They therefore visualised man to be related both inwardly through the soul and the spirit, and outwardly through the grades of micro-cosmic hierarchy of the Principles of Cosmic manifestation. Muslims reject the idea of original sin, and therefore, the concept that disease and suffering have resulted from the original sin is contrary to the basic Islamic belief that men are born free ( 4 ). Muslim physicians believe in the spirit which is the subtle body standing intermediate between the physical body and the force of life which comes from the world above. Muslim physicians Review of Religions: December 2001 The History and Theory of Islamic Medicine 13 also believed that six external factors are essential and must be present to guarantee the health of the patient(1). These factors are air, food, bodily rest and movement, sleep, emotional rest, and excretion and retention. The four humours, that is blood, phlegm, yellow bile and black bile form the foundation of animal activity, and the body of all animals, including man, is comprised of them. The traditional physician sought to restore the health of the patient not only by examining internal problems but by studying all the external factors so as to discover the one or several causes which had disrupted the harmony of humours within the body and with the environment. These causes could range from having eaten the wrong food to emotional strain. Health then, as considered by Muslim physicians, is a question of living in harmony with oneself and with the environment, taking into full consideration of what one eats and drinks. It is then through diet, medicament, exercise or other factors to re-establish the harmony which is synonymous with health. Branches of Islamic Medicine D i fferent branches of Islamic medicine are anatomy and physi- o l o g y, internal medicine, surg e r y, o p t h a l m o l o g y, and hygiene and public health. I will consider hygiene and public health in more detail because of the fact that Islamic medicine is concerned more with the prevention of illness than with its cure. The emphasis upon personal hygiene and cleanliness in Islam is a direct effect of the teachings of Islam. Ritual cleanliness requires Muslims to wash themselves regu- l a r l y. Dietary habits of Muslims, which include not only abstention from alcoholic drinks and pork, but also fasting, eating less than one’s full appetite and eating slowly, may have a direct medical effect. Diet has a more prominent role in Islamic medicine than it does in modern medicine. The Muslims considered the kind of food and the manner in which it is consumed to be so directly connected to health, that the effect of diet was considered by them as being perhaps more powerful than that even of drugs on both health and illness. It is also interesting that the Holy Prophet(sa) stressed the use of a toothbrush The History and Theory of Islamic Medicine Review of Religions: December 200114 (miswak) and never neglected its use personally. Therefore, the Islamic belief is that sickness comes from unhygienic living, and is not a punishment for sin(4). The aspects of Islamic medicine concerning hygiene and public health include the religious teachings, and purely medical ones inherited through millennia of experience and science. Islamic Medicine Today The continuous weakening of traditional medicine before the onslaught of the spread of modern Western medicine in the last two centuries is seen in most parts of the Islamic world. As a result, today, except for the sub-continent of India where traditional Islamic medicine and pharmacology continue on both the intellectual and popular level, in Persia, Iraq, Syria and Egypt – only a few branches such as pharma- cology and certain dietary habits continue, while the medical schools have become completely dominated by Western medicine. Because of the rumours in the Western world about the short- comings of Western medicine and especially pharmacology, new interest is being shown in the use of herbs as medicaments. As a result, a greater attention is being paid to Islamic medicine. Many Muslim governments are trying to provide medical coverage for all of their citizens, but both the rapid rise in population and the cost of training the physicians in the Western type of medical school make such a programme impossible. Moreover, medical care has become much worse in certain areas where the old hakims have died out without anyone taking their place. Therefore, there has been a conscious effort in certain countries, such as Persia, to bring back traditional medicine in combination with certain programmes for the spread of rural medicine. As revealed at the International Conference on Islamic Medicine in Kuwait (1981), medical school curricula should emphasize that medicine is ‘worship’, both as an approach to Belief by contemplating on the Signs of God, as well as from the applied aspect by helping man in distress. Moreover, the medical school curricula should comprise the teachings and the study of the ‘Islamic Code of Medical Ethics’. In conclusion, it can be said that Islamic medicine is fully alive in Review of Religions: December 2001 The History and Theory of Islamic Medicine 15 Pakistan and Bangladesh and among the Muslims of India, and only partly alive in the rest of the Islamic world. Islamic medicine is still able to teach a great deal in fields as far apart as pharmacology and psychosomatic medicine to a humanity that has divorced the soul from the body. Bibliography 1. N a s r, Seyyed Hossein. 1976. Islamic Science: An Illustrated Study. World of Islam Festival, Publishing Company Ltd. p.273. 2. Stewart, Desmond. 1967. ‘Early Islam’. Ti m e I n c o r p o r a t e d, New Yo r k . p.192. 3. S a r d a r, Fiauddin. East-We s t discord over the Prince of Scholars. New Scientist. August 1981, p.395. 4. Barton, Richard Thomas. 1958. Religious Doctrines and Medical Practice. Charles C. Thomas publishers USA. p.94. 5. Walgate, Robert. 1981. ‘Islamic Science: Radicals A g r e e ’ . Nature: 293 (8). p.418. 6. Hakim Mohammad Said. 1981. The International Conference on Islamic Medicine. Medical Times June 1981. 16 (1). pp 47- 50. Published by Hamdard Foundation, Pakistan.