Overview
Islamic medicine was a genre of medical writing that was influenced by several different medical systems, including the traditional Arabian medicine of Muhammad's time, ancient Hellenistic medicine such as Unani, ancient Indian medicine such as Ayurveda, and the Sassanid medicine of the Academy of Gundishapur. Many early authors of Islamic medicine were usually clerics rather than physicians, and were known to have advocated the traditional medical practices of prophet Muhammad's time, such as those mentioned in the Qur'an and Hadith. For instance, therapy did not require a patient to undergo any surgical procedures at the time. From the 9th century, Hunayn ibn Ishaq translated a number of Galen's works into the Arabic language, followed by translations of the Sushruta and Charaka Samhitas and Pahlavi works from Gundishapur. Muslim physicians soon began making many of their own significant advances and contributions to the field of medicine, including the subjects of anatomy, bacteriology, microbiology, ophthalmology, pathology, pharmacology, pharmacy, physiology, surgery, and the pharmaceutical sciences.

Medicine was a central part of medieval Islamic culture. Responding to circumstances of time and place, Islamic physicians and scholars developed a large and complex medical literature exploring and synthesizing the theory and practice of medicine.[2] Islamic medicine was initially built on tradition, chiefly the theoretical and practical knowledge developed in Persia, Greece, Rome, and India. Galen and Hippocrates were pre-eminent authorities, as well as the Indian physicians Sushruta and Charaka, and the Hellenistic scholars in Alexandria. Islamic scholars translated their voluminous writings from Greek and Sanskrit into Arabic and then produced new medical knowledge based on those texts.[3] In order to make the Greek and Indian traditions more accessible, understandable, and teachable, Islamic scholars ordered and made more systematic the vast and sometimes inconsistent Greco-Roman and Indian medical knowledge by writing encyclopedias and summaries.[2] It was through Arabic translations that the West learned of Hellenic medicine, including the works of Galen and Hippocrates. Of equal if not of greater influence in Western Europe were systematic and comprehensive works such as Abu Ali ibn Sina's The Canon of Medicine, which were translated into Latin and then disseminated in manuscript and printed form throughout Europe. During the fifteenth and sixteenth centuries alone, The Canon of Medicine was published more than thirty-five times.[2]

Hospitals

Main article: Bimaristan

Muslim physicians set up some of the earliest dedicated hospitals. In the medieval Islamic world, hospitals were built in all major cities; in Cairo for example, the Qalawun Hospital could care for 8,000 patients, and a staff that included physicians, pharmacists, and nurses. One could also access a dispensary, and research facility that led to advances, which included the discovery of the contagious nature of diseases, and research into optics and the mechanisms of the eye. Muslim doctors were removing cataracts with hollow needles over 1000 years before Western physicians dared attempt such a task. Hospitals were built not only for the physically sick, but for the mentally sick also. One of the first ever psychiatric hospitals that cared for the mentally ill was built in Cairo. Hospitals later spread to Europe during the Crusades, inspired by the hospitals in the Middle East. The first hospital in Paris, Les Quinze-vingts, was founded by Louis IX after his return from the Crusade between 1254-1260.[4]

Hospitals in the Islamic world featured competency tests for doctors, drug purity regulations, nurses and interns, and advanced surgical procedures.[5] Hospitals were also created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients.[6]

Medical encyclopedias

The first encyclopedia of medicine in Arabic was Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah ("Paradise of Wisdom"), written in seven parts, c. 860.

Razi (Rhazes) wrote the Comprehensive Book of Medicine in the 9th century. The Large Comprehensive was the most sought after of all his compositions, in which Rhazes recorded clinical cases of his own experience and provided very useful recordings of various diseases. The Comprehensive Book of Medicine, with its introduction of measles and smallpox, was very influential in Europe.

Ali ibn Abbas al-Majusi (Haly Abbas)'s Kitab Kamil as-sina'a at-tibbiyya ("Complete Book of the Medical Art"), c. 980, became better known as the Kitab al-Maliki ("Royal Book", Latin: Liber regalis) in honour of its royal patron 'Adud al-Dawla. In twenty sections, ten of theory and ten of practice, it was more systematic and concise than Razi's Hawi, but more practical than Avicenna's Canon, by which it was superseded. With many interpolations and substitutions, it served as the basis for the Pantegni (c. 1087) of Constantinus Africanus, the founding text of the Schola Medica Salernitana in Salerno.[7]

Abu al-Qasim al-Zahrawi (Abulcasis), regarded as the father of modern surgery,[8] contributed greatly to the discipline of medical surgery with his Kitab al-Tasrif ("Book of Concessions"), a 30-volume medical encyclopedia published in 1000, which was later translated to Latin and used in European medical schools for centuries. He invented numerous surgical instruments and described them in his al-Tasrif.

Abu Ali ibn Sina (Avicenna), a Mu'tazili philosopher and doctor in the early 11th century, was another influential figure. He is regarded as the father of modern medicine,[9] and one of the greatest thinkers and medical scholars in history. His medical encyclopedia, The Canon of Medicine (c. 1020), remained a standard textbook in Europe for centuries, up until the renewal of the Muslim tradition of scientific medicine. He also wrote The Book of Healing (actually a more general encyclopedia of science and philosophy), which became another popular textbook in Europe. Among other things, Avicenna's contributions to medicine include the introduction of systematic experimentation and quantification into the study of physiology,[10] the discovery of the contagious nature of infectious diseases, the introduction of quarantine to limit the spread of contagious diseases, the introduction of experimental medicine, evidence-based medicine, clinical trials,[11] randomized controlled trials,[12][13] efficacy tests,[14][15] and clinical pharmacology,[16] the first descriptions on bacteria and viral organisms,[17] the distinction of mediastinitis from pleurisy, the contagious nature of phthisis and tuberculosis, the distribution of diseases by water and soil, and the first careful descriptions of skin troubles, sexually transmitted diseases, perversions, and nervous ailments,[4] as well the use of ice to treat fevers, and the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences.[18]

Abu Rayhan al-Biruni's Kitab-al-Saidana was an extensive medical encyclopedia which synthesized Islamic medicine with Indian medicine. His medical investigations included one of the earliest descriptions on Siamese twins.[19]

Medical ethics
Main article: Bimaristan

One of the features in medieval Muslim hospitals that distinguished them from their contemporaries was their higher standards of medical ethics. Hospitals in the Islamic world treated patients of all religions, ethnicities, and backgrounds, while the hospitals themselves often employed staff from Christian, Jewish and other minority backgrounds. Muslim doctors and physicians were expected to have obligations towards their patients, regardless of their wealth or backgrounds. The ethical standards of Muslim physicians was first laid down in the 9th century by Ishaq bin Ali Rahawi, who wrote the Adab al-Tabib (Conduct of a Physician), the first treatise dedicated to medical ethics. He regarded physicians as "guardians of souls and bodies", and wrote twenty chapters on various topics related to medical ethics, including:[20]

• What the physician must avoid and beware of
  
• The manners of visitors
  
• The care of remedies by the physician
  
• The dignity of the medical profession
  
• The examination of physicians
  
• The removal of corruption among physicians

On a professional level, Razi (Rhazes) introduced many practical, progressive, medical and psychological ideas in the 10th century. He attacked charlatans and fake doctors who roamed the cities and countryside selling their nostrums and 'cures'. At the same time, he warned that even highly educated doctors did not have the answers to all medical problems and could not cure all sicknesses or heal every disease, which was humanly speaking impossible. To become more useful in their services and truer to their calling, Razi advised practitioners to keep up with advanced knowledge by continually studying medical books and exposing themselves to new information. He made a distinction between curable and incurable diseases. Pertaining to the latter, he commented that in the case of advanced cases of cancer and leprosy the physician should not be blamed when he could not cure them. To add a humorous note, Razi felt great pity for physicians who took care for the well being of princes, nobility, and women, because they did not obey the doctor's orders to restrict their diet or get medical treatment, thus making it most difficult being their physician. He also wrote the following on medical ethics:

"The doctor's aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose mortiferous remedies."[20]

Peer review

The first documented description of a peer review process is found in the Ethics of the Physician written by Ishaq bin Ali al-Rahwi (854-931) of al-Raha, Syria, who describes the first medical peer review process. His work, as well as later Arabic medical manuals, state that a visiting physician must always make duplicate notes of a patient's condition on every visit. When the patient was cured or had died, the notes of the physician were examined by a local medical council of other physicians, who would review the practising physician's notes to decide whether his/her performance have met the required standards of medical care. If their reviews were negative, the practicing physician could face a lawsuit from a maltreated patient.[21]

Scientific method

Like in other fields of science, Muslim physicians and doctors developed the first scientific methods for the field of medicine. This included the introduction of experimentation, quantification, experimental medicine, evidence-based medicine, clinical trials, dissection, animal testing,[18] human experimentation and postmortem autopsy by Muslim physicians, whilst hospitals in the Islamic world featured the first drug tests, drug purity regulations, and competency tests for doctors.[5]

In the 9th century, al-Kindi (Alkindus), in De Gradibus, demonstrated the application of mathematics to medicine, particularly in the field of pharmacology. This includes the development of a mathematical scale to quantify the strength of drugs, and a system that would allow a doctor to determine in advance the most critical days of a patient's illness, based on the phases of the Moon.[22]

In the 10th century, Razi (Rhazes) introduced controlled experiment and clinical observation into the field of medicine, and rejected medical theories unverified by experimentation.[23] The first known medical experiment was carried out by Razi in order to find the most hygienic place to build a hospital. He hung pieces of meat in places throughout 10th century Baghdad and observed where the meat decomposed least quickly, and that was where he built the hospital. In his Comprehensive Book of Medicine, Razi recorded clinical cases of his own experience and provided very useful recordings of various diseases. In his Doubts about Galen, Razi was also the first to prove both Galen's theory of humorism and Aristotle's theory of classical elements false using experimentation.[24] He also introduced urinalysis and stool tests.[25]

Avicenna (Ibn Sina) is considered the father of modern medicine,[9] for his introduction of systematic experimentation and quantification into the study of physiology,[10] the introduction of experimental medicine and clinical trials,[11] the experimental use and testing of drugs, and a precise guide for practical experimentation in the process of discovering and proving the effectiveness of medical substances,[23] in his medical encyclopedia, The Canon of Medicine (c. 1020), which was the first book dealing with experimental medicine, evidence-based medicine, randomized controlled trials,[12][13] and efficacy tests,[14] [15] and it laid out the following rules and principles for testing the effectiveness of new drugs and medications, which still form the basis of clinical pharmacology[16] and modern clinical trials:[11]

1. "The drug must be free from any extraneous accidental quality."
2. "It must be used on a simple, not a composite, disease."
3. "The drug must be tested with two contrary types of diseases, because sometimes a drug cures one disease by Its essential qualities and another by its accidental ones."
4. "The quality of the drug must correspond to the strength of the disease. For example, there are some drugs whose heat is less than the coldness of certain diseases, so that they would have no effect on them."
5. "The time of action must be observed, so that essence and accident are not confused."
6. "The effect of the drug must be seen to occur constantly or in many cases, for if this did not happen, it was an accidental effect."

7. "The experimentation must be done with the human body, for testing a drug on a lion or a horse might not prove anything about its effect on man."

The first physicians known to have performed human autopsies and postmortem dissections were Ibn Zuhr (Avenzoar),[26] Saladin's physician Ibn Jumay, Abd-el-latif,[27] and Ibn al-Nafis.[28]

Legacy

George Sarton, the father of the history of science, wrote in the Introduction to the History of Science:[4]

"Through their medical investigations they not merely widened the horizons of medicine, but enlarged humanistic concepts generally. [...] Thus it can hardly have been accidental that those researches should have led them that were inevitably beyond the reach of Greek masters. If it is regarded as symbolic that the most spectacular achievement of the mid-twentieth century is atomic fission and the nuclear bomb, likewise it would not seem fortuitous that the early Muslim's medical endeavor should have led to a discovery that was quite as revolutionary though possibly more beneficent."

"A philosophy of self-centredness, under whatever disguise, would be both incomprehensible and reprehensible to the Muslim mind. That mind was incapable of viewing man, whether in health or sickness as isolated from God, from fellow men, and from the world around him. It was probably inevitable that the Muslims should have discovered that disease need not be born within the patient himself but may reach from outside, in other words, that they should have been the first to establish clearly the existence of contagion."

"One of the most famous exponents of Muslim universalism and an eminent figure in Islamic learning was Ibn Sina, known in the West as Avicenna (981-1037). For a thousand years he has retained his original renown as one of the greatest thinkers and medical scholars in history. His most important medical works are the Qanun (Canon) and a treatise on Cardiac drugs. The 'Qanun fi-l-Tibb' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments."

"We have reason to believe that when, during the crusades, Europe at last began to establish hospitals, they were inspired by the Arabs of near East.... The first hospital in Paris, Les Quinze-vingt, was founded by Louis IX after his return from the crusade 1254-1260."

Fields

An Arabic manuscript, dated 1200 CE, titled Anatomy of the Eye, authored by al-Mutadibih.

Anatomy and physiology

In anatomy and physiology, the first physician to refute Galen's theory of humorism was Razi (Rhazes) in his Doubts about Galen in the 10th century. He criticized Galen's theory that the body possessed four separate "humors" (liquid substances), whose balance are the key to health and a natural body-temperature. Razi was the first to prove this theory wrong using an experimental method. He carried out an experiment which would upset this system by inserting a liquid with a different temperature into the body resulting in an increase or decrease of bodily heat, which resembled the temperature of that particular fluid. Razi noted particularly that a warm drink would heat up the body to a degree much higher than its own natural temperature, thus the drink would trigger a response from the body, rather than transferring only its own warmth or coldness to it. This line of criticism was the first comprehensive experimental refutation of Galen's theory of humours and Aristotle's theory of the four classical elements on which it was grounded. Razi's own chemical experiments suggested other qualities of matter, such as "oiliness" and "sulfurousness", or inflammability and salinity, which were not readily explained by the traditional fire, water, earth and air division of elements.[24]

The contributions of Avicenna to physiology include the introduction of systematic experimentation and quantification into the study of physiology in The Canon of Medicine (c. 1020).[10] The contributions of Ibn al-Haytham (Alhacen) to anatomy and physiology include his correct explanation of the process of sight and visual perception for the first time in his Book of Optics, published in 1021.[18] Other innovations introduced by Muslim physicians to the field of physiology by this time include the use of animal testing.[18]

Ibn Zuhr (Avenzoar) (1091-1161) was the first physician known to have made human postmortem dissections and autopsies. He proved that the skin disease scabies was caused by a parasite, a discovery which upset the theory of humorism supported by Hippocrates and Galen. The removal of the parasite from the patient's body did not involve purging, bleeding, or any other traditional treatments associated with the four humours.[26]

In the 12th century, Saladin's physician Ibn Jumay was also one the first to undertake human postmortem dissections, and he made an explicit appeal for other physicians to do so as well. During a famine in Egypt in 1200, Abd-el-latif observed and examined a large number of skeletons, and he discovered that Galen was incorrect regarding the formation of the bones of the lower jaw and sacrum.[27]

In 1242, Ibn al-Nafis was the first to describe human blood circulation and pulmonary circulation,[28] for which he is considered the father of the theory of circulation.[29] This discovery would be rediscovered, or perhaps merely demonstrated, by William Harvey in 1628, who was previously credited for this discovery in Western history.

The Arab physician Ibn al-Lubudi (1210-1267), also from Damascus, wrote the Collection of discussions relative to fifty psychological and medical questions, in which he rejects the theory of four humours supported by Galen and Hippocrates, discovers that the body and its preservation depend exclusively upon blood, rejects Galen's idea that women can produce sperm, and discovers that the movement of arteries are not dependant upon the movement of the heart, that the heart is the first organ to form in a fetus' body (rather than the brain as claimed by Hippocrates), and that the bones forming the skull can grow into tumors. He also advises that in cases of extreme fever, a patient should not be released from hospital.[30]

In the 15th century, the Tashrih al-badan (Anatomy of the body) written by Mansur ibn Ilyas contained comprehensive diagrams of the body's structural, nervous and circulatory systems.[31]

References

1. ^ Behrooz Broumand, The contribution of Iranian scientists to world civilization, Arch Iranian Med 2006; 9 (3): 288 – 290.
2. ^ a b c National Library of Medicine digital archives.
3. ^ Hakeem Abdul Hameed, Exchanges between India and Central Asia in the field of Medicine
4. ^ a b c d e f George Sarton, Introduction to the History of Science. (cf. Dr. A. Zahoor and Dr. Z. Haq (1997), Quotations From Famous Historians of Science, Cyberistan.
5. ^ a b Michael Woods, Islam, once at forefront of science, fell by wayside, Post-Gazette National Bureau, Sunday, April 11, 2004.
6. ^ Medicine And Health, "Rise and Spread of Islam 622-1500: Science, Technology, Health", World Eras, Thomson Gale.
7. ^ Charles S. F. Burnett, Danielle Jacquart (eds.), Constantine the African and 'Ali Ibn Al-'Abbas Al-Magusi: The Pantegni and Related Texts. Leiden: Brill, 1995. ISBN 9004100148
8. ^ a b Martin-Araguz, A.; Bustamante-Martinez, C.; Fernandez-Armayor, Ajo V.; Moreno-Martinez, J. M. (2002). "Neuroscience in al-Andalus and its influence on medieval scholastic medicine", Revista de neurologia 34 (9), p. 877-892.
9. ^ a b Cas Lek Cesk (1980). "The father of medicine, Avicenna, in our science and culture: Abu Ali ibn Sina (980-1037)", Becka J. 119 (1), p. 17-23.
0. ^ a b c d Katharine Park (March 1990). "Avicenna in Renaissance Italy: The Canon and Medical Teaching in Italian Universities after 1500 by Nancy G. Siraisi", The Journal of Modern History 62 (1), p. 169-170.
1. ^ a b c d e f David W. Tschanz, MSPH, PhD (August 2003). "Arab Roots of European Medicine", Heart Views 4 (2).
2. ^ a b c Jonathan D. Eldredge (2003), "The Randomised Controlled Trial design: unrecognized opportunities for health sciences librarianship", Health Information and Libraries Journal 20, p. 34–44 [36].
3. ^ a b c Bernard S. Bloom, Aurelia Retbi, Sandrine Dahan, Egon Jonsson (2000), "Evaluation Of Randomized Controlled Trials On Complementary And Alternative Medicine", International Journal of Technology Assessment in Health Care 16 (1), p. 13–21 [19].
4. ^ a b c D. Craig Brater and Walter J. Daly (2000), "Clinical pharmacology in the Middle Ages: Principles that presage the 21st century", Clinical Pharmacology & Therapeutics 67 (5), p. 447-450 [449].
5. ^ a b c Walter J. Daly and D. Craig Brater (2000), "Medieval contributions to the search for truth in clinical medicine", Perspectives in Biology and Medicine 43 (4), p. 530–540 [536], Johns Hopkins University Press.
6. ^ a b c D. Craig Brater and Walter J. Daly (2000), "Clinical pharmacology in the Middle Ages: Principles that presage the 21st century", Clinical Pharmacology & Therapeutics 67 (5), p. 447-450 [448].
7. ^ a b The Canon of Medicine, The American Institute of Unani Medicine, 2003.
8. ^ a b c d e f g h i j Bashar Saad, Hassan Azaizeh, Omar Said (October 2005). "Tradition and Perspectives of Arab Herbal Medicine: A Review", Evidence-based Complementary and Alternative Medicine 2 (4), p. 475-479 [476]. Oxford University Press.
9. ^ Dr. A. Zahoor (1997), Abu Raihan Muhammad al-Biruni, Hasanuddin University.
0. ^ a b Islamic Science, the Scholar and Ethics, Foundation for Science Technology and Civilisation.
1. ^ Ray Spier (2002), "The history of the peer-review process", Trends in Biotechnology 20 (8), p. 357-358 [357].
2. ^ a b Felix Klein-Frank (2001), Al-Kindi, in Oliver Leaman and Hossein Nasr, History of Islamic Philosophy, p. 172. Routledge, London.
3. ^ a b Toby E. Huff (2003), The Rise of Early Modern Science: Islam, China, and the West, p. 218. Cambridge University Press, ISBN 0521529948.
4. ^ a b G. Stolyarov II (2002), "Rhazes: The Thinking Western Physician", The Rational Argumentator, Issue VI.
5. ^ Rafik Berjak and Muzaffar Iqbal, "Ibn Sina—Al-Biruni correspondence", Islam & Science, December 2003.
6. ^ a b Islamic medicine, Hutchinson Encyclopedia.
7. ^ a b Emilie Savage-Smith (1996), "Medicine", in Roshdi Rashed, ed., Encyclopedia of the History of Arabic Science, Vol. 3, p. 903-962 [951-952]. Routledge, London and New York.
8. ^ a b S. A. Al-Dabbagh (1978). "Ibn Al-Nafis and the pulmonary circulation", The Lancet 1, p. 1148.
9. ^ Chairman's Reflections (2004), "Traditional Medicine Among Gulf Arabs, Part II: Blood-letting", Heart Views 5 (2), p. 74-85 [80].
0. ^ L. Leclerc (1876), Histoire de la medecine Arabe, vol. 2, p. 161, Paris. (cf. Salah Zaimeche, The Scholars of Aleppo: Al Mahassin, Al Urdi, Al-Lubudi, Al-Halabi, Foundation for Science Technology and Civilisation)
1. ^ a b H. R. Turner (1997), Science in Medieval Islam: An Illustrated Introduction, p. 136-138. University of Texas Press, Austin.