(Edited by Shahid Athar , M. D.)
Contributions Of Islam To Medicine
Ezzat Abouleish , M. D.
This paper is dedicated to those who contributed to the well being of
mankind and have done their best to make our journey on this planet more
pleasant; to all of them, irrespective of their race, religion or country of
Medicine, as it stands today, did not develop overnight. It is the culmination of efforts of millions of people, some we know and others we do not.
The flame of civilization, including medicine, started thousands of years
ago. The flame has been handed over from one generation to another, and
from one country to the other. Depending on who took the sacred responsibility of hosting it, sometimes it got brighter and sometimes it got dimmer.
However, it never died away, because if it did, it would have been too hard
to start all over again.
Between the ancient civilizations, namely the Egyptians, Greek, Roman,
Persian, Indian, and Chinese, and the Renaissance era in Europe, there was
a gap, commonly called "the dark ages", during which the flame was hosted,
not by the West, but by another culture and people called the Arabs or the
Moslems. The nomenclature, "the dark ages" reflects the civilization in
Europe between the 7th and 13th centuries, but by no means it expresses the
state of affairs in the Arab world or the Islamic Empire at that time when an
and science were as bright as the midday sun. That era, unjustifiably, has
been commonly neglected and overpassed, as if nothing happened. This
paper is an effort to elude to the important events which took place and the
significant physicians who lived during that period.
The Spread of Islam
In order to understand how medicine developed in the middle ages, we
have to look back at the history and find out the important things that
happened during the Seventh Century.
In 570 A.D., a man was born in a small city in the Arabian peninsula,
called Mecca (Haykal 1976), his name was Mohammed. In 610 A.D. he
declared a new religion, Islam. In 632 A.D., he died after uniting the Arab
tribes who had been torn by revenge, rivalry, and internal fights. Out of these
mostly illiterate nomadic people, he produced a strong nation that encountered and conquered, simultaneously, the two known empires at that time,
namely, the Persian and Byzantine Empires. In a man's life-time, the
Islamic Empire extended from the Atlantic Ocean on the West, to the
borders of China on the East. In 711 A.D., only 80 years after the death of
their prophet, the Arabs crossed to Europe to rule Spain for more than 700
years. In 732 A.D., they threatened Paris and their thrust was stopped at
Tours and Poiter (Eigeland 1976). In 831 A.D., the Moslems of North
Africa invaded Sicily and ruled it for 200 years. By 846 A.D., they
controlled the southern part of Italy and encountered Rome (Hitti 1977).
The hold of the Moslems over Italy remained so firm that Pope John VIII
(872-882 A.D.) deemed it prudent to pay tribute for two years (Hitti 1977)
In 869 A.D., the Arabs captured Malta (Ibn-Khaldun). In the tenth century,
from Italy and Spain, the Arabs extended their raids through the Alpine
passages into mid-Europe. In the Alps, there are a number of castles and
walls which tourists guides attribute to the invasion of the Moslems of
Sicily. In the southern part of Italy and in Sicily, a great civilization was
established and through which the torch of knowledge spread to Europe,
mainly through the University of Salerno in the southern part of Italy (Hitti
1977, Parente 1967).
The expansion of the Moslems in Europe was not limited to those from
North Africa and Spain. The Moslems, under the Ottoman Empire, invaded
Europe from the East. They occupied a good part of Middle Europe and
besieged Vienna twice, once during the reign of Sulayman 1 (1520-1566
A.D.) and the other during the reign of Mohammed IV (1648-1687 A.D.)
Islam and the Promotion of Culture and Science
As the Moslems challenged the civilized world at that time, they
preserved the cultures of the conquered countries. On the other hand, when
the Islamic Empire became weak, most of the Islamic contributions in art
and science were destroyed. This was done by the Mongols who, out of
barbarism, burnt Baghdad (1258 A.D.), and by the Spaniards, who out of
hatred, demolished most of the Arabic heritage in Spain. The difference
between the Arabs and these was the teachings of Islam which:
1. Stressed the importance and respect of learning. For example, the
first word revealed to the Moslems' prophet Mohammed was "Read". In
Mohammed's era, a captured enemy was freed if he paid a ransom or taught
ten Moslems writing and reading. In their holy book, the Qur'an, the
importance of knowledge has been repeatedly stressed as it says "Those
who know and those who do not are not equal." The prophet Mohammed
stressed learning by saying. "One hour of teaching is better than a night of
praying." One of the early princes, Khalid fbn Yazid (end of the 7th
century), gave up his treasure for the study of medicine and chemistry. He
studied medicine under John the Grammarian of Alexandria, and chemistry
under Merrinos the Greek (Haddad 1942). He also encouraged several
Greek and Coptic medical books to be translated into Arabic.
2. Forbade destruction. On conquering Mecca, the prophet Mohammed strongly stated that no homes, animals, or trees should be destroyed.
His followers abided with these principles when conquering other countries.
3. Encouraged cleanliness and personal hygiene. Islam instructed them
to approach God in their prayers five times a day with bodies and clothes
4. Developed in them the respect of authority and discipline. For
example, realizing the scourges and terror of plague, their prophet Mohammed (p.b.u.h.) decreed that "no man may enter or leave a town in which
plague broke out." And to make this law all the more binding and effective,
he promised the blessing of heaven to those who die of plague by stating that
if a man died of plague he would be considered a martyr (Haddad 1942).
Thus Mohammed (p.b.u.h.) laid for the Moslems the laws governing corden
and quarantine for the first time in history and made it work.
5. Tolerated other religions. The Islamic religion recognizes Christianity and Judaism and considers their followers to be people with holy books
like Moslems. Moreover, they candidly treated the Jews at an era when the
latter were persecuted in Europe. Dr. Jacob Minkin, a reputable Rabbi and
scholar says "It was Mohammadan Spain, the only land of freedom the Jews
knew in nearly a thousand years of their dispersion... While during the
Crusades, the armored Knights of the Cross spread death and devastation in
the Jewish communities of the countries through which they passed, Jews
were safe under the sign of the Crescent. They were not only safe in life and
possessions, but were given the opportunity to live their own lives and
develop a culture so unique and striking that it went down in history as the
'Golden Ages'. The Moors, the Muslim conquerors of Spain in 711, were
not religious fanatics. They were strong in their faith but generous with
regard to the religious convictions of others.... "The Ranaissance of Art in
Italy, says George A. Dorsey, has blinded us to the Renaissance of Science
in Spain, which fostered science, promoted culture, encouraged learning,
and set a premium on intellectual pursuits, no matter whether the intellect
was Moslem, Christian or Jew. Not since the days of Greece had the world
known such thirst for knowledge, such passion for learning, such spirit
shared by the prince and the courtien alike" (Minkin 1968).
The Arabs were assimilated by the vast new countries they reached.
From this marriage of genuine characters and righteousness with the ancient
and well established civilizations, a great new nation was born. It is difficult
to identify this new breed as Arabs, because although the language was
Arabic, all the scientists were not necessarily from the Arabian Peninsula.
It is also equally difficult to describe it as Islamic, because although the
majority of the scientists were Moslems, sponsored by Moslem rulers, and
governed by the Islamic law, yet some scientists were Christians or Jews,
especially at the early phase of the lslamic civilization: the translation
period to Arabic, and the decline part: the translation period to Latin and
Hebrew. Therefore, in this article, the adjectives Arabic or Islamic will be
used as synonyms.
Medicine Before Islam
In order to comprehend the contributions of Arabs to medicine,we must
have in our minds a picture of the condition of medicine before they arrived
to the scene. Generally speaking, two elements are required for medical
Manpower and hospitals
A. Manpower before Islam:
There were medical centers in different parts of the world which were
later either under control of the Arabs or in touch with them. For example,
in Syria, medicine was advanced and was greatly influenced by the
Byzantine civilization which affected also the economic and administrative
systems (Hammameh 1962). From the fifth century on, the Greek was the
language of learning in Syria. The knowledge of the Arabs of the Greek
civilization was mainly through the Syrian scholars who translated it into
Arabic. In Egypt, Alexandria was another center for culture. The Arabs got
in touch with both the ancient Egyptian and Greek civilizations through the
Egyptian scholars. In Persia, there was a medical school in a city called
Jundi-Shapur in which medicine was highly developed. The Abbasi
Caliphs during the 8th century encouraged the Persian physicians to
translate into Arabic the medical knowledge therein, to build medical
centers in Baghdad, the capital of their empire, and to run newly built
hospitals. With further expansion east, the Arabs through contacts with
India and China, brought ideas and methods, not only in medicine, but also
in mathematics, chemistry, philosophy, etc.
B. Hospitals Before Islam:
Hospitals as we know them now probably were not present. True, there
were places for the sick to stay, but these were mainly temples or annexes
to temples that were run by priests. Gods were supposed to play a major role
in the art of healing. For example, the Goddess Toueris was the Egyptian
symbol of fecundity and protectress of the pregnant and parturient. She was
shown as a standing pregnant hippopotamus carrying the hicroglyph
meaning protection in one paw, and the sign of life in the other. Small
figures of Toucris were popular as amulets (Speert 1973). In those days,
sanctuary, prayers, inactation, and hypnosis were integral parts of the
Characteristic Features of Hospitals in the Islamic Civilization
During the Islamic civilization, hospitals had much developed and
attained specific characteristics:
1. Secular: Hospitals served all peoples irrespective of color, religion,
or background. They were run by the government rather than by the church,
and their Directors were commonly physicians assisted by persons who had
no religious color. In hospitals, physicians of all faiths worked together with
one aim in common: the well-being of patients.
2. Separate wards: Patients of different sexes occupied separate wards.
Also different diseases especially infectious ones, were allocated different
3. Separate nurses: Male nurses were to take care of male patients, and
4. Baths and water supplies: Praying five times a day is an important
pillar of Islam. Sick or healthy, it is an Islamic obligation; of course physical
performance depends on one's health, even he can pray while laying in bed.
Before praying, washing of face, head, hands, and feet must be done, if
possible. For certain conditions, a bath is obligatory. Therefore, these
hospitals had to provide the patients and employees with plentiful water
supply and with bathing facilities.
5. Practicing physicians: Only qualified physicians were allowed by
law to practice medicine. In 931 A.D., the Caliph Al-Mugtadir from the
Abbasid dynasty, ordered the Chief Court-Physician Sinan Ibn-Thabit to
screen the 860 physicians-of Baghdad, and only those qualified were
granted license to practice (Hamarneh 1962). The counterpart of Ibn-
Tbabit, Abu-Osman Sai'd Ibn-Yaqub was ordered to do the same in
Damascus, Mecca, and Medina. The latter two cities were in need for such
an act because of hundreds of thousands of pilgrims visiting them every
year. This was to prevent taking advantage of these pilgrims and to curb the
spread of diseases among them.
6. Rather medical schools: The hospital was not only a place for treating
patients, but also for educating medical students, interchanging medical
knowledge, and developing medicine as a whole. To the main hospitals,
there were attached expensive libraries containing the most up-to-date
books, auditoria for meetings and lectures, and housing for students and
7.Proper records of patients: For the first time in history, these
hospitals kept records of patients and their medical care.
8. Pharmacy: During the Islamic era, the science and the profession of
pharmacy had developed to an outstanding degree. The Arabic materia
medica became so rich and new drugs and compounds were introduced
because the Muslims had contact with almost all the known world at that
time, either through control or trade. Their ships sailed to China and the
Philippines, and their convoys made trades with black Africa, Europe and
Asia. Chemistry became an advanced science, and there were means and
need for a specialization called pharmacy.
Thus, the main Arabian hospitals were models for medieval hospitals
built later in Europe. They were rather medical schools to which those
seeking advanced medical knowledge, from the East or West, attended.
The Reasons for the High Standard of Islamic Hospitals
In the Islamic Empire, the hospitals attained a golden era unsurpassed
in previous history. The reasons behind such a high standard include:
1. Being part of a civilization as a whole:The people were prosperous;
thus, they were capable of taking care of their health and of seeking the best
available treatment. Also, lslam stresses the necessity of seeking treatment
of every disease; the Prophet says "For every disease, God created a cure."
The required sciences for good medical care were at a high standard e.g. the
Arabs were advanced in chemistry, mathematics, administration, pharmacy, medicine, etc. They gave the world the system of numbering which
have replaced the cumbersome Roman numerals. The world owes to them
the knowledge of the following chemical reactions, namely sublimation,
precipitation, filtration, distillation, etc. The great Arab chemist Jabir Ibn-
Hayan discovered sulphuric and nitric acids. According to Webster Dictionary, the words sugar, alcohol, alkali, syrup, coffee, cotton, all are Arabic
words. Fielding H. Garrison, the author of the well-known work on the
"History of Medicine" said: "...The Saracens themselves were the originators not only of algebra, chemistry, and geology, but of many of the so-
called improvements or refinements of civilization, such as street lamps,
window-panes, firework, stringed instruments, cultivated fruits, perfumes,
spices, etc... "
2. High prestige of physicians: The physicians in this era earned a high
prestige. Although anyone, irrespective of his social status, can study
medicine, yet the route was long and tedious. He had to finish Islamic
studies, philosophy, astronomy, art, chemistry, etc. before being accepted
as a medical student. Therefore, the physician was a cultured person who
had wisdom and knowledge. In fact, the Arabic translation of a physician
is "Hakim" which means sage. In the 9th and 10th century, the Court-
Physician was in the protocol ahead of the Chief-Justice. Many eminent
physicians, as we will discuss later, showed enough talent, social knowledge, political capabilities, and wisdom to be appointed by the Caliphs as
prime ministers (Visiers). Owing to the high prestige and connections of
physicians, generous funds for hospitals were easily obtained.
3. Rulers' involvement in public services: The Caliphs of the Islamic
empire built magnificent hospitals for one or more of the following reasons:
a. Religion: Their religion stated that money spent on charity is a good
investment for Judgment Day.
b. Eternity: The Pharoahs of Ancient Egypt sought eternity by building pyramids, the rulers of Islam sought the same thing by building
mosques, hospitals, and schools carrying their names.
c. Politics: To show their people that they cared, and were interested
in them, the rulers built hospitals.
Whatever the motive of the ruler, the population benefited and good
hospitals were erected.
4. Adequate financing to run the hospitals:The rulers set aside generous
funds to run these hospitals. Also the philanthropists gave generously, thus
following their religious beliefs and imitating their rulers. In Islam, there is
a special system called Al-Waqf. A person can donate part or all of this
wealth to charity. The government takes care of such a donation, and its
revenues help to maintain and build mosques, hospitals, and schools.
Another source of funds and an important pillar of Islam is alms-giving
(2 1/2% of property value). Collected alms goes to the state treasury which
takes care of charitable organizations. Very few hospitals in the Islamic era
were private. Thus, patients fees constituted an unimportant source of
The capital of the Islamic empire kept changing from one dynasty to the
other. In each capital, an important medical center developed. Thus, by the
end of the 13th century, there were many medical centers spread throughout
the Arab world. Space does not allow the description of all the hospitals
built throughout these centuries. We, therefore, chose some of the important
ones which will be described according to the region where they were
1. In El-Sham
El-Sham at that time included what is known now as Syria, Lebanon,
Jordan, and Palestine, Damascus and Jerusalem were the important cities.
a. In Damascus: The first known hospital in Islam was built in
Damascus in 706 A.D. by the Umayyad Caliph, Al-Walid (Hamarneh 1962). The most important hospital built in Damascus in the
middle ages was named Al-Nuri Hospital, after King Nur Al-Din
Zinki, in 1 156. This hospital was built during the Crusade Wars to
fulfill a need for a well-equipped and well-staffed hospital. It turned
out to be not only a first class hospital, but also a first class medical
school. The king donated to the hospital a whole library rich in
medical books. It is important to understand why books were
expensive and limited in number in the middle ages. This was
because they were hand-written as printing was not used until the
middle of the fifteenth century. The hospital adopted medical
records, probably the first first in history. From its medical school, many
eminent physicians graduated, an example is Ibn Al-Nafis, the
scholar who discovered the pulmonary circulation as will be
discussed. The hospital served the people for seven centuries and
parts of it still exist.
b. In Jerusalem: In 1055 A.D., the Crusaders built Saint John Hospital. By the end of the eleventh century, it grew to such an extent to
include a hospital, a palace for knights, and a convent for the
nursing sisters. The medical activities of the hospital were tremendous because of the large number of daily admissions of patients,
pilgrims, and wounded soldiers. After the liberation of Jerusalem
by Salah Al-Din in 1187 A.D., the hospital name was changed into
Al-Salahani Hopital. He expanded the hospital which continued to
serve the people until its destruction by an earthquake in 1458 A.D.
2. In Iraq and Persia:
In 750 A.D., Baghdad was built to be the capital of the Abbasid dynasty
by the Calip Abu-Gaifar Al- Mansur. In 766 A.D., he assigned the dean of
the medical school of Jindi Shapur, Judis Ibn-Babtishu', to be the Court-
Physician and to establish hospitals proportionate to the glory and prosperity of Baghdad.
When Harun Al-Rashid followed (786-809 A.D.), he ordered the
grandson of Ibn-Bahtishu and his Court-Physician, Jibril, to build a special
hospital named Baghdad Hospital. This hospital developed into an important medic center.
One of its chiefs was Al-Razi, the eminent Internist.
In 918 A.D., the Caliph Al-Mugtadir built two hospitals in Baghdad.
One was on the east side of the city which he named Al-Sayyidah Hospital,
after his mother. The other was on the west side which he named, Al-
Mugtadiri Hospital, after himself.
Another important hospital was named Al-Adudi Hospital. It was built
in 981 A.D. after King Adud Al-Dawlah. It was the most magnificent
hospital built in Baghdad before modern time. The Caliph wanted to outdo
his predecessors. It was furnished with the best equipment and supplies
known at the time. It had interns, residents, and 24 consultants attending its
professional activities. Haly Abbas, who wrote the famous book "Liber
Regius (Al-Malaki)", was one of the staff. It was destroyed in 1258 when
the Mongols, led by Holagu the grandson of Ghingiz Khan, invaded
3. In Egypt:
In 872 A.D., Ahmed Ibn-Tulun built a hospital called Al-Fusta
Hospital in the City Al-Fustat which is now in old Cairo. It served the
growing Cairo population for six centuries. It was divided into separate
wards. On admission, the patients were given special apparel while their
clothes, money, and valuables were stored until the time of their discharge.
In 1284 A.D., King Al-Mansur Qalawun built an important hospital
named Al-MansuriHospital . The story behind its construction is interesting. King Al-Mansur Qalawun was an officer in the Arabian army fighting
the Crusaders. While in the Holy Land, he fell sick and was admitted to Al-
Nuri Hospital. On recovery, he vowed that if he ever became the ruler of
Egypt, he would build a great hospital in Cairo even more magnificent than
Al-Nuri Hospital for, the sick. poor, and rich alike. At the dedication
ceremony, he asked for a cup of wine from the pharmacy. After drinking it
he declared that by taking that portion as a medication, he was signifying
that the hospital was serving all people. from the king to the least of his
subjects (Hamarneh 1962).
e. It was the best hospital built then as reported by the contemporary
historians such as Ibn-Battota and El-Kalkashandi. It had different sections
for different diseases. Music therapy was used as a line of treatment for
psychiatric patients. It served 4,000 patients daily. The patient's stay in the
hospital was free moreover on his discharge, the patient was given food
and money for compensation for being out of work during his hospital stay.
Al-Mansuri Hospital has served Cairo for seven centuries since it has been
built. It is now used for ophthalmology and called Mustashfa Qalawun. Its
ancient door is preserved in the Islamic Museum of Cairo.
4. In North Africa (Al-Maghrib Al-Arabi):
a. Tunisia: In 830 A.D., Prince Ziyadat Allah I, built Al-Qayrawan
Hospital in a district of the Qayrawan city called Al-Dimnah. Subsequently
all hospitals in Tunisia were called Dimnah instead of Bimaristan as they
were called in the East, which is a Persian word meaning a hospital. The
Qayrawan Hospital was characterized by spacious separate wards waiting
rooms for visitors and patients, and female nurses from Sudan, an event
representing the first use of nursing in Arabic history. The hospital also
included a chapel for prayers.
b. Morocco: In 1190 A.D., the king Al-Mansur Ya'qub Ibn-Yusuf,
built a hospital in the capital city, Marakesh, named it the Marakesh
Hospital. It was a huge hospital beautifully landscaped with fruit trees and
flowers. Water was brought by aqueducts to all sections. Patients were
provided with special apparel: one for winter and another for summer. The
pharmacy was taken care of by specialists called the Sayadlah. There was
an expensive private section where a patient was charged what is equivalent
to $ 1501 day. One thousand years ago, this fee was quite expensive.
5. Al-Andalus (Spain):
In 1366 A.D., Prince Muhammed Ibn-Yusuf Ibn Nasr, built the
Granada Hospital in the city of Granada which had expanded to half a
million population. The hospital represented the beauty of the Arabic
architecture in Spain and served the people until the fall of Granada in 1492
Method of Therapy in Islamic Medicine
The patients were treated through a scheme starting with physiotherapy and diet; if this failed, drugs were used, and at last, surgery would be
resorted to. The physiotherapy included exercises and water baths. The
Arabs had an elaborate system of dieting and were aware of food deficiencies. Proper nutrition was an important item of treatment.
Drugs were divided into two groups: simple and compound drugs. They
were aware of the interaction between drugs; thus, they used simple drugs
first. If these failed, compound drugs were used which are made from two
or more compounds. If these conservative measures failed, surgery was
Medical Ethics in Islam
The medical profession was a well respected specialty and its Ieaders
kept it this way by laying down proper ethics. Al-Tabari, the chief physician
in 970 A.D., described the Islamic code of ethics as follows (Hamamch
1971, Levy 1967):
I. Personal characters of the physician:
The Physician ought to be modest, virtuous, merciful, and un addicted
to liquor. He should wear clean clothes, be dignified, and have well-
groomed hair and beard. He should not join the ungodly and scaffers, nor
sit at their table. He should select his company to be persons of good
reputation. He should be careful of what he says and should not hesitate to
ask forgiveness if he has made an error. He should be forgiving and never
seek revenge. He should be friendly and peacemaker. He should not make
jokes or laugh at the improper time or place.
II. His obligation towards patients:
He should avoid predicting whether a patient will live or die, only God
(Allah) knows. He ought not loose his temper when his patient keeps asking
questions, but should answer gently and compassionately. He should treat
alike the rich and the poor, the master and the servant, the powerful and the
powerless, the elite and the illiterate. God will reward him if he helps the
needy. The physician should not be late for his rounds or his house calls. He
should be punctual and reliable. He should not wrangle about his fees. If the
patient is very ill or in an emergency, he should be thankful, no matter how
much he is paid. He should not give drugs to a pregnant woman for an
abortion unless necessary for the mother's health. If the physician prescribes a drug orally, he should make sure that the patient understands the
name correctly, in case he would ask for the wrong drug and get worse
instead of better. He should be decent towards women and should not
divulge the secrets of his patients.
III. His obligation towards the community:
The physician should speak no evil of reputable men of the community
or be critical of any one's religious belief.
IV. His obligations towards his colleagues:
The physician should speak well of his acquaintances and colleagues.
He should not honor himself by shaming others. If another physician has
been called to treat his patient, the family doctor should not criticize his
colleague even if the diagnosis and the recommendations of the latter differ
from his own. However, be has the obligation to explain what each point of
view may lead to since his duty is to counsel the patient as best as he can.
He must warn him that combining different types of therapy may be
dangerous because the actions of different drugs may be incompatible and
V. His obligations towards his assistants:
If his subordinate does wrong, the physician should not rebuke him in front of others, but privately and cordially.
Medicine in Islam passed through three stages:
I. The first stage is the stage of translation of foreign sources into
Arabic. It extended mainly during the seventh and eighth centuries.
II. The second stage is the stage of excellence and genuine contribution in which the Islamic physicians were the leaders and the
source of new chapters to medicine. This stage extended during
the ninth through the thirteenth centuries.
III. The third stage is the stage of decline where medicine, as well as
other branches of science, became stagnant and deteriorated. The
stage started mainly after the thirteenth century.
During the first stage, Syrian and Persian scholars did a marvelous job
by translating honestly the ancient literature from Greek and Syriac in
Arabic. Thcy translated different branches of science including philosophy
astrology, and medicine. The works of Hippocratcs (460-370 BC), Aristototle
(384-322 BC), and Galen (131-210 A.D.) were among those translated
From Arabic, the classic Greek literature was translated into Latin, then into
Greek because most of the original scripts were lost and the only source was
the Arabic translation. If the Arabs did only one thing, namely, preserving
the ancient literature and handing it honestly to Europe, that would have
been a sufficient contribution in itself. The Moslem rulers encouraged
translation, e.g. Khalif Al-Mamun Al-Abbassi paid the translator the
weight of his translation in gold (Haddad 1942). Among the eminent
physicians who took part in the first stage were Jurjis lbn-Bakhtisliu, his
grandson Jibril, Yuhanna Ibn-Masawaya, and Hunain Ibn-Ishak; most of
them were Christians, yet they were respected and well treated by the
It is said, rightly or wrongly, that the history of a nation is the sum total
of the history of a few of its individuals. Ths is particularly true in the
history of medicine during the Arab period. In every stage of its development we find men of outstanding repute, the sum total of whose efforts has
constituted this magnificent chapter. It is impossible to give an account of
all the important physicians of Islwn. We thus are going to discuss some of
those who were known to Medieval Europe and whose books affected its
thinking and practice for centuries (Table 1), I chose an internist, Al-Razi
(Razes); a surgeon, Al-Zahrawi (Abulcasis); the physician-philosopher of
Islam, Ibn-Sina (Avicenna); the philosopher-physician of Islam, Ibn-Rushd
(Averroes); a pioneer in physiology, Ibn-Al-Nafis; and a Jewish Arab, Ibn-
His full name is Abu-Bakr Mohammaed Ibn-Zakaria Al-Razi, known
to the Western World as Razes. He was born in Ray, a suburb of Tehran, the
capital of modern Persia (Profile of Iran 1977, Sarton 1950). He first studied
music which was his main interest in his early life. He was a skillful player
on the lute. He then studied philosophy, and later medicine. But he was a
better physician than a philosopher ,
He first became the Court-Physician of Prince Abu Saleh Al-Mansur,
the ruler of Khorosan. Then he moved to Baghdad where he became the
Chief Physician of the Baghdad Hospital and the Court-Physician of the
Caliph. He had a good basis of physics and chemistry as well as medicine.
He published several books which were translated into Latin, French,
Italian, Hebrew, and Greek. One of his main books is "Al-Mansuri" (Liber
Al-Mansofis) which he dedicated to his patron Prince Al-Mansur. It was
composed of ten treatises and included all aspects of health and disease. He
defined medicine as "the art concerned in preserving healthy bodies, in
combating disease, and in restoring health to the sick." He thus showed the
three aspects of medicine namely, public health, preventive medicine, and
treatment of specific diseases. he listed seven principles for the preservation
1. Moderation and balance in motion and rest.
2. Moderation in eating and drinking.
3. Elimination of superfluities.
4. Improvement and regulation of dwelling places.
5. Avoidance of excessive evil happenings before they become uncontrollable.
6. Maintenance of harmony in ambitions and resolutions.
7. Acquisition of reticence through possession of good habits including exercise.
He also published another book called "Al-Murshid". In it, he emphasized the important lines of therapy that we mentioned earlier. He described
the different types of fever including continuous, relapsing, and hectic. He
stated that fever can be a symptom of a disease or a disease in itself. He introduced mercury as a therapeutic drug for the first time in history, which was later adopted in Europe. He realized that a man normally does not want
to get sick, and he wants to recover as soon as possible. However, if a patient
does not have the will or the desire to get well, the physician's hands are tied
and cannot help him. He stressed the continued medical education of the
physician. He advised him to record his own observations. He encouraged
him to meet with other physicians to discuss medical problems. He
recommended that the physicians should try solving these problems rather
than depending on others for finding solutions.
Another book written by Al-Razi was named "Al-Hawi", which means
the complete text. It was composed of 22 volumes. It was one of the main
text books in the medical school in Paris, especially its 9th volume on
He wrote a treatise on measles and smallpox called "de Peste or de
Pestilentia" which was translated to Latin in 1565 A.D. It is a masterpiece
in clinical medicine (Browne 1962). It describes the clinical difference
between the two diseases so vividly that nothing since has been added (Keys
(ABULCASIS, BUCASIS, ALZAHRAVIUS)
His full name is Abu-Al-Qasim Khalaf Ibn'Abbas Al-Zahrawi. He had
been known in the Western World as Abulcasis, Bucasis or Alzahravius. He
is the famous surgeon of the Arabs. In 930 A.D., he was born in Al-Zahra,
a suburb of Cordova. He attended the University of Cordova which had been
established for one and a half centuries. At that time Cordova had a
population of one million (Hitti 1977). It was the magnificent capital of Al-
Andalus where culture and science were at their peak in Europe. In military
power the Moslems also reached their zenith, not only in Spain but also
throughout Europe after King Abdel-Rahman III defeated the Spanish
kings of Navarre, Castile, and Leon at the north in 997 A.D.
Al-Zahrawi became an eminent surgeon. lie was appointed as the
Court-Physician of King Abdel-Rahman III. He spent a productive life in
Practicing medicine, especialy in surgery and medical writings. He died at
the age of 83.
He wrote mainly four books. One of them is "Al-Tastif Liman Ajiz'an
Al-Ta'lif' which is the best medieval surgical encyclopedia. It was used in
Europe until the 17th century. He stressed the importance of basic sciences:
"... Before practicing, one should be familiar with the science of anatomy
and the functions of organs so that he will understand them, recognize their
shape, understand their connections, and know their borders. Also he
should know the bones, nerves, and muscles, their numbers, their origin and
insertions, the arteries and the veins, their start and end. These anatomical
and physiological bases are important, and as said by Hippocrates: 'These
are many physicians by title and a few by practice.' ... If one does not
comprehend the anatomy and physiology, he may commit a mistake that
can kill the patient. I have seen someone, who pretended to be a surgeon,
incised an aneurysm in the neck of a woman , mistaking it for an abscess.The
woman bled to death."
Heller stated that Al-Zahrawi described the ligature of arteries long
before Ambrose Pare (Khairallah 1942). Al-Zahrawi also used cautery to
control bleeding. He used wax and alcohol to stop bleeding from the skull
during cranial surgery. Sprengel said that Al-Zahrawi was the first to teach
the lithotomy position for vaginal operations (Khairallah 1942). Al-Zahrawi also described the tracheotomy operation and performed it as an
emergency on one of his servants. He was the first to write on orthodontia.
He showed evidence of great experience from details of clinical picture and
surgical procedures e.g. his description of varicose veins stripping, even
after ten centuries, is almost like modern surgery (Al-Okbi 1971): "... Have
the leg shaved if it is much hairy. The patient gets a bath and his leg is kept
in hot water until it becomes red and the veins dilate; or he exercises
vigorously. Incise the skin opposite the varicose vein longitudinally either
at the ankle or at the knee. Keep the skin opened by hooks. Expose, dissect,
and separate the vein. Introducc a spatula underneath it. When the vein is
elevated above the skin level, hang it with a blunt rounded hook. Repeat the
procedure about three fingers from the previous site and hang the vein with
another hook as previously done. Repeat the procedure at as many sites
along the varicose vein as necessary. At the ankle, ligate and strip it by
pulling it from the incision just above. When it reaches there, repeat at the
higher incision until all of it is stripped. Ligate the vein and then excise it.
If difficulty is encountered in pulling it, ligate its terminal part with a string
and pass it under the spatula and dissect it further. Pull gently and avoid its
tearing because if it does, it becomes difficult to strip all of it and can cause
harm to the patient. When you have stripped it all, put alcohol spanges at the
sites of the skin incisions and take care of the incisions until they heal. If the
varicose vein is tortuous, you have to incise the skin more frequently, at each
change of direction. Dissect it and hang it with the hooks and strip it as
previously described. Do not tear the vein or injure it. If this happens, it
becomes difficult to strip it. The hooks used should be blunt, eyeless, and
rounded, otherwise it can injure the vein".
He also wrote about fracture of the skull (Al-Okbi 197 1): "... The types
of skull fractures are numerous, their shapes are different, and their causes
are many. For example, some skull fractures are due to a blow by a sword
that splits the whole skull and reaches the dura, the same as the ax does to
the wood, therefore it is called axial fracture. Sometimes the sword does not
split the skull completely, it is thus called incomplete axial fracture. Such
a fracture can be small or big. Another type is comminuted fracture Which
can be due to a hit by a stone or a fall on a stone; and this fracture can reach
the dura or only be limited to the outer part of the bone. This fracture can
also be small or big. A third type is the hairy type of skull fracture which is
so tiny and linear like a hair. A fourth type is the depressed fracture which
occurs due to a fail or a blow so the bone is depressed like a brass jar when
hit by a blunt instrument. This usually happens when the bone is soft as
children. The types of these fractures are diagnosed by examining the wound,
removing the debris and contused pan of the scalp, exposing the skull, and
feeling it by the spatulas. The hairy fracture is difficult to discover and can
be diagnosed by exposing the skull, and smearing it with ink; the linear
fracture thus appears stained." In the treatment of fractures of the skull, Al-
Zahrawi wrote: "... If the patient shows serious signs such as high fever,
repeated vomiting, exophthalmos, convulsions, and coma, do not touch him
because he is probably going to die. Otherwise, treat him as follows: first
shave the patient's head. In comminuted depressed fractures, these pieces
of bone should be removed as will be explained. If in the process of the
patient's examination or during surgery bleeding occurs, it can be controlled by pressure using towels soaked in alcohol and by wax. Then after
control of the bleeding, the small pieces of bone are removed using special
forceps . To remove the depressed fracture, first, make
trephines in the healthy bone around it. These trephine instruments should
not penetrate beyond the skull into the soft tissues underneath, thus they are
called non penetrating trephines. They have a rounded ring in their proximal
end to prevent them from penetrating beyond certain depths. You should
have a number of these trephines that can stop at different depths depending
on the thickness of the skull. Connect the holes in the skull
using special saws. First, use a fine small saw, then larger
ones. These should be sharp and made of steel. Avoid cutting the dura by
the trephine or saw. Once the depressed bone is freed, remove it gently, then
smoothen the edges of the skull by special instruments.
Wash with alcohol and treat the wound with packs soaked with ointment."
Al-Zahrawi described many dental operations such as dental extractions, fixation, re implantation, and artificial teeth. He described referred
tooth pain and cautioned the physician against removal of the healthy tooth
to which pain is referred. He used gold threads to fix teeth because other
metals would tarnish and cause a reaction. Chapter 6 of his book was all
devoted to foreign bodies of the ear and their treatment. He also devoted one
whole chapter to mid wifery, giving tips to midwives, and describing the
problems of difficult labor and obstetrical manoeuvre. He recommended
decompression of the fetal head for obstructed labor and described the
instruments used. He described the management of liver abscess by treating
it into two stages (Khairallah 1942). The first stage was to allow adhesions
around it and to close it from the peritoneal cavity. The second stage was to
incise it. ..."If the procedure is done in one stage, the pus may spread to the
whole abdomen and the patient may die." He described a total of 200
surgical and dental instruments most of them were original (Fig. 3). He said
"... Choose your instruments carefully beforehand according to the operation. However, you should design other devices if needed." Thus he
encouraged the physician to be innovative.
During the time of Al-Zahrawi, surgery in the Islamic world became a
respected specialty practiced by reputable physicians. On the contrary in
Europe, surgery was belittled and practiced by barbers and butchers. In
1163 A.D., the Council of Tours declared the following resolution "Surgery
is to be abandoned by the schools of medicine and by all decent physicians."
Ibn-Sina's full name is Abu-Ali Husayn lbn-Abdullah lbn-Sina, and his
titles were Al-Shaykh Al-Rais (The chief Master) or Al-Muallim Al-Thani
(The Second Teacher), second to Aristotle (Browne 1962). He is known in
the Western World as Avicenna.
In 980 A.D. Avicenna was born in Bukhara which is now part of Russia
and known as Uzben. By the age of 10, he was already proficient in the
Qur'an and Arabic classics. By the age of 16, he finished Islamic law
studies, geometry, anatomy, logic and philosophy. His metaphysics were
influenced by an earlier philosopher in Islam, Al-Farabi. By the age of 18,
he completed the study of medicine. Soon after, he became the Prime
Minister (the Visier) and Court-Physician of Prince Nuli-Ibn-Mansur, the
Samanid Ruler of Bukbara. The prince was impressed by the intelligence
and endurance of his Visier and opened for him the royal library which was
unique in its literary richness. Ibn-Sina wrote his first book at the age of 21.
Then he became Visier of Ali ibn Maimun, the ruler of Khawarazm or
Khiva. But he ultimately fled to avoid being kidnapped by the Sultan
Mohammed El-Ghazin. Ironically, fate played an important role in the life
of Avicenna who was a master in planning. The ruler of Hainadan, the
southern part of Persia, who was called Amir Shwnsu'd-Dawla, had renal
colic. Ibn-Sina treated the Amir's colic. The latter was very pleased and
appointed Ibn-Sina, not only his Court-Physician but also his Visier.
Avicenna was a proud and arrogant man. This created enemies leading to
a mutiny of the military leaders against him resulting in his dismissal and
imprisonment. Fortunately, the Amir got renal colic once more and no one
could relieve his pain. He thus summoned back Avicenna who cured him.
The Amir apologized to Avicenna and reinstated him.
Avicenna's life during this time was extraordinarily strenuous. All the
day he was busy with the Amir's services. The great part of the night was
passed in lecturing and writing his books, with intervals of wine-drinking,
music, and minstrelsy. After many vicissitudes, worn out by hard work and
hard living, Avicenna died and was buried in Hamadan, Persia, in 1037
A.D. at a comparatively early age of 57. In his last illness, he treated himself
unsuccessfully, so that it was said by his detractors that neither could his
physics save his body nor his metaphysics save his soul (Browne 1962).
Avicenna wrote I00 treatises, 21 of them were major of which 16 were
in medicine. He wrote in philosophy, medicine, named Al-Qanon fi Al-
Tibb (Canon of Medicine). It was an encyclopedia containing more than one
million words. It was composed of 5 volumes:
Volume I- described the principles and theories of medicine.
Volume II- contained the simple drugs arranged alphabetically.
Volume III- described localized diseases of the body from the head to the
Volume IV- was addressed to generalized diseases of the body e.g. fevers.
Volume V- explained compound drungs.
The Canon contained all medical knowledge up to the 1Oth century. It
was translated to many languages and was the reference for medical schools
in Europe up to the 17th century. Although the Canon was a great book, it
overshadowed the important works prior to it by Al-Razi and Al-Zahrawi,
and subsequent to it by Ibn-Al-Nafis and Ali Ibn-Abbas, Halle Abbas,
Avicenna wrote Arabic and Persian poems.The last of his Arabic poem,
which is considered a classical beauty, describes the descent of the Soul into
the Body from the Higher Sphere which is its home (Browne 1962).
Avicenna is considered a great philosopher, and his writings affected
the thinkers and influenced many of those who appeared after him. He was
a unique phenomenon, not only because of this encyclopedic accomplishments in medicine, but also because of the versatility of his genius. He has
been compared in this respect with Aristotle, Leonardo da Vinci, and Goethe. (Keys 1971).
Ibn-Rashid, or Averroes as known in Europe, was born in Granada in
1126 A.D. He studied philosophy, medicine and law. He was
appointed as a judge in Seville in 1169 A.D. where he stayed in office for
a quarter of a century. He was affected by Aristotle on whom he wrote
important commentaries (Black 1970, Al-A'sar 1972). In these interpretations he asserted that the human soul is not independent, but shares a
universal mind. This belief caused a great controversy and was later
declared heretical by both the Moslems and Christians alike because it
contradicted the doctrine of personal immortality.
He was admired by the Jews of Spain who spread Ws philosophy into
Europe especially into Italy and France after they were forced out of Spain.
His followers interpreted some of his writings to mean that there are two
kinds of truth, a philosophical and a religious truth. This implied a
separation of reason and faith and influenced philosophical and theological
speculation for many centuries. Because of his bold ideas, he was dismissed
from his work and sent to Morocco where he was kept in prison till he died
on December 12, 1198. his important contribution to medicine was "Al-
Kulliyat fi Al-Tibb" (Colliyet). It was a summary of the medical science at
that time and composed of seven parts. He wrote another book, "Al-Taisir"
on practical medicine. It consisted of useful excerpts and a clinical description of diseases including serous pericarditis and mediastinal abscens. He
personally suffered from the latter disease and left very careful records of
his own symptoms. The book is not known in Arabic, but there are several
Latin editions (Haddad 1942). Ibn-Rushd was another example of the
cultured Arabic physician.
In 1135, Musa Ibn-Maimon (Moses Maimonides) was born in Cordova,
Spain (Minlcin 1968). His father was a Rabbi and had a great
influence of Moses in his interests and future achievements. During that
period, the Jews had a golden era in Spain. Minkin (1968), a renowned
scholar and an eminent Rabbi wrote "It was Mohammedan Spain, the only
land the Jews knew in nearly a thousand years of their dispersion, which
made the genius of Moses Maimonides possible."
In1160 A.D., Moscs emigrated to North Africa to the city of Fas where
be studied medicine. In 1165 A.D., he left to Palestine. However, he was
dissatisfied with the cultural atmosphere. Therefore, he went to Egypt
where he stayed until he died in 1204 A.D. He was buried in Teberias,
Maimonides first started his career as the Rabbi of the jewish Comniunity of El-Fostat city, the capital of Egypt at that time and part of old Cairo
now. Later on in life, he practiced medicine. He became an eminent and
respected physician. He served both Kings Salah-El-Din (Saladin) and his
elder son Sultan Al-Malik Al-Afdel during his short reign (1198-1200
A.D.). He had the confidence of both. During Salali-El-Din war with King
Richard, the Lion-Hearted, the latter fell sick. Although those two kings
were at war, they had respect and admiration of each other. Saladin sent Ibn-
Maimon to Richard to treat him. After being, cured. Rictiard asked Ibn-
Maimon to join his court. But the latter politely declined and preferred to
stay with Saladin (Minkin 1968).
Ibn-Maimon's impact on the Jewish religion is very important. He
wrote classical work in the Jewish religion including codification of the
Jewish laws (Black and Roth 1970). Hc also wrote in philosophy. His book,
"Dalalat Al-Hai'ran" (The Guide of the Perplexed) is an important achievement which was welcomed not only by those of the Jewish faith but also by
Moslems and Christians alike. He was affected by his contemporary Ibn-
Rushd, and by Aristotl'e, but he tried to unite logic and faith. He wrote his
book in Arabic. He did not live long enough to see the Hebrew translation
of his book which would have given him a great satisfaction.
In medicine Ibn-Maimon did two important things: First, be translated
many Arabic books into Hebrew which were than translated into Latin and
other European languages. An example of these books is the Canon of
Avicenna. Second, be wrote a few books of his own. One of them is "Magala
fl Tadbir Al-Sihha" (Regimen Sanitatis) which stressed proper diet, personal hygiene, and moderation in the pleasures of life. It was in the form of
letters to the Sultan Al-Afdel. The other was "Kitab" Al-Fusal fi Al-Tibb"
(Fisul Musa). This was a collection of 1,500 aphorisms extracted from
Galen writings together with forty-two critical remarks. Moses also wrote
a book on poisons and their antidotes (Al-A'sar 1971).
When he died, the Jewish Community in Egypt built a synagogue
named after him. Some Jews, up-till-now, stay overnight in this synagogue
in hope of receiving healing through the spirit of this great physician
1208 - 1288 A.D.
In 1208 A.D., Ala'El-Deen Ibn-El-Nafis was born in a small town near
Damascus called Kersh (Fig. 7) (Ibrahim 1971). He learned medicine and
philosophy in Damascus and spent most of his life in Cairo. He was a
physician, a linguist, a philosopher, and a historian. He was the first chief
of Al-Mansuri Hospital in Cairo and the dean of the School of Medicine in
During this era, the medical profession together with other branches of
science were passing a crisis. The Mongol Tartar invasion and destruction
of Baghdad in 1258 A.D. caused an injury to the Islamic civilization from
which it never recovered. It destroyed forever the Caliphate, symbolic unity
of the Arabian Empire, and the preeminence of Baghdad as a center for
learning. Also during that period Islamic culture was declining in Spain. It
was then Cairo and Damascus the centers for education and medical
prestige. There, the medical profession was characterized by the freedom of
discussion and expression of opinion, something that was very new in
medicine and not known to Europe until the 17th century when introduced
to England by Sedenbam (Ibrahim 1971).
Ibn-El-Nafis was a dedicated person. He used to start his day after dawn
prayers by making rounds at the hospital, followed by case discussions with
students and colleagues, then hospital administration. His evenings were
spent reading, writing and discussing medicine and philosophy with frequent scholar guests at his home in El-Hussein District in Old Cairo. His
house was an example of beautiful Arabic architecture, made of marble with
a fountain in the central hall.
In the history of mankind, there are persons whose importance is
revealed with the flight of time and their truth glows with the passage of
centuries; Ibn-El-Nafis is one of those. He wrote many books, ten of them
in medicine and a special one in philosophy. In the latter book "Fadel Ibn-
Natik", he tried to present the counter point of the philosophical view of
Avicenna expressed in his book "Hai Ibn-Yakzan". He was an authority in
theology on which he wrote several books, e.g. "The complete Message of
the Prophet" and "Al-Ragol Al-Kamel" (The Perfect Man) supporting
unitarianism. Ibn-El-Nafis had an important character, not being a follower
but a scholar. This was evident in his writings whether in philosophy or
In medicine he wrote many books, two of them are "Mujaz Al-Qanun"
which means the "Summary of the Canon". In these two books which were
based on avicenna's writings, he criticized the short comings of Avicenna's
book and of Galen's views and added to them. That is why he was named
by some as Avicenna the Second. For example be wrote "... We have relied
chiefly on his (Galen) teachings, except in a few details which we think are
wrong and were not given after a thorough investigation. In describing the
function of the organs, we have depended on careful investigation, observation, and honest study, regardless of whether or not these fit with the
teachings and theories of those who have preceded us."
Ibn-El-Nafis added lights to the physiology of the circulation. In the
ancient history, Erasistratus of the Alexandria Scbool (310 B.C. - 250 B.C.)
believed that blood was contained only in the eight side of the circulation,
namely the veins and the fight side of the heart. The left side of the
circulation, namely the left side of the heart and the arteries were supposed
to contain air because arteries were found empty when an animal was
sacrificed, hence the name "arteria".
When Galen came (131 - 210 A.D.), he described blood to pass from the
right side of the heart to the left side through minute openings in the septum
of the heart, then it mixed with air from the lungs, and sequently distributed
to the whole body. For centuries this was the prevalent belief and no one,
including the Arab physicians and their eminent writer Avicenna, could
dare to challenge this sacred view. Ibn-El-Nafis did. Five times he stated in
unmistakable terms that "... the blood from the right chamber of the heart
must arrive at the left chamber, but there is no direct pathway between them.
The thick septum of the heart is not perforated and does not have visible
pores as some people thought or invisible pores as Galen thought. The blood
from the right chamber must flow through the vena arteriosa (pulmonary
artery) to the lungs, spread through its substance, he mingled with air, pass
through the arteria venosa (Pulmonary vein) to reach the left chamber of the
heart... " (Salem 1968). In describing the anatomy of the lung Ibn-El-Nafis
stated: "The lung is composed of. first, the bronchi: second, the branches of
the arteria a venosa; and third, the branches of the vena arteriosa; all of these
are connected by loose porous flesh ... The need of the lung for the vena
arteriosa is to transport to it the blood that has been thinned and warmed in
the heart, so that what seeps through the pores of the branches of this vessel
into the alveoli of the lung may mix with what is of air therein and combine
with it ... and the mixture is carried to the left cavity of the heart by the
arteria venosa" (Haddad 1936).
Ibn-El-Nafis also made other contributions in the circulation. Avicenna,
following Galen's description of the anatomy, stated that the human heart
has three ventricles. Ibn-El-Nafis rejected that as he said "...And his
statement ((Avicenna's) that the heart has three ventricles is not correct, as
the heart has only tow ventricles..." He was also the first to describe the
coronary circulation as he wrote "...Again, his statement (Avicenna's) that
the blood in the right side is to nourish the heart is not true at all, for the
nourishment of the heart is from the blood that goes through the vessels that
permeate the body of the heart... "
Three centuries after the discovery of the pulmonary circulation by Ibn-
El-Nafis, others, such as Michael Servetus, Realdus Colombus, Carlo
Ruini, Andrea Cesalpino, and Francois Rabelais, claimed the same thing
(Mayerhof 1935). There is a strong suspicion that these authors obtained
their knowledge from the Arabic literature which was available at that time
to the European investigators without giving credit to Ibn-El-Nafis (Keys
1971, Haddad 1942). It is considered to be more than a coincidence that
Servetus would discover the pulmonary circulation, and also to write a
book, similar to that of Ibn-El-Nafis, on Unitarianism. Servetus was burnt
with his book, "Restitutio Christianismi" in Geneva in October 1553 at the
order of Calvin because he was considered heretic.
THE ARABS AND OPHTHALMOLOGY
The Arabs were much interested in ophthalmology. In the ninth
century, Hunayn Ibn-Ishak (Joannitius) translated to Arabic the Greek
literature on the eye. As mentioned before, Al-Razi described the changes
in the caliber of the eye produced by relaxation and contraction of the iris.
He also described the cataract operation.
In 1050 A.D. at Baghdad, Ali Ibn-Isa (Jesu Haly) wrote the classic book
on ophthalmology, Tathkirat Al-Kahhalin (A Note for the Oculists). As
stated by Cunistan (1921), it is the oldest book in its original language on
diseases of the eye. In a clear and logical style, the author described
trachoma, conjunctivitis, and cataract, and prescribed treatment (Keys
Avicenna described the six extrinsic muscles of the eyeball.
In the thirteenth century, Ibn Abu-Al-Kawafer wrote a book on therapeutic ophthalmology entitled "Natigat-El-Fikr fi Ilag Amrad El-Bassar"
(Conclusions from Expelience on Treatment of Diseases of the Eye).
According to Kahil (1929) is one of several textbooks of ophthalmology
considered to be superior to any written in Europe up to the eighteenth
ARABS AND ANESTHESIA
Being an obstetric anesthesiologist, I feel obligated to write a little more
on the contributions of the Arabs to both anesthesia and obstetrics.
First, in anesthesia, the Arabs described in detail the pharmacology of
important narcotics such as opium and other central nervous system
depressants such as hyoscyamus and hashish (Khairallal 1942). Burton
(1886 A.D.) stated that "anesthetics have been used in surgery throughout
the East for centuries before ether and chloroform became the fashion in the
civilized West. In a Treatise on the Canon of Medicine by Gruner it is stated
by Avicenna under the article 8l4 ANESTHETICS:"If it is desirable to get
a person unconscious quickly, without him being harmed, add sweet
smelling moss to the wine, or lignum aloes. If it is desirable to procure a
deeply unconscious state, so as to able the pain to be borne which is involved
in painful applications to a member. place darnel-water into the wine, or
administer fumitory, opiuium, hyoscyamus (half dram doses of each); nutmeg, crude aloes-wood (4 grains of each). Add this to the wine, and take as
much as is necessary for the purpose. Or. boil black hyoscyamus in water,
with mandragore bark, until it becomes red. Add this to the wine."
The Arabs also introduced "the Soporific Sponge" which was commonly used for anesthesia in the middle ages. The sponge was soaked with
aromatics and narcotics to be sucked and then held under the nostril to
provide anesthesia prior to surgery (Keys 1971).
Avicenna wrote more than 1,000 years ago about the effect of pain on
ventilation: "Pain dissipates the bodily strength and interferes with the
normal functions of the organs. The respiratory organs are inhibited from
drawing in air, and consequently the act of breathing is interfered with, and
the respiration becomes intermittent, rapid, or altogether unnatural in
rhythm" (Gruner 1930).
ARABS AND OBSTETRICS
Hynayn Ibn-Ishak (Joannitius, 809-873 A.D.) translated the work of the
Greek pioneer in obstetrics, Paul of Aegina, into Arabic. Hunayn also
translated to the Arabic world most of the work of Hippocrates, Galen, and
Ptolemy. Moreover, he was a gifted physician and philosopher. Ali Ibn-Al-
Abas Al-Majusi (Halle Abbas) who died in 994 A.D. was the first to
describe in his book "Al-Kitab Al-Malaki" (The Royal Book) that the
uterine contractions are the cause of delivery of the fetus (Keys 1971).
Before him, it was thought that the uterine contractions were only as
indication of the onset of labor; subsequently the fetus would swim its way
out of the womb and birth canal.
Most of the deliveries were performed by midwives at home. For
complicated obstetrics Al-Zahrawi offered advice to midwives as mentioned before, used fetal craniotomy for delivery of obstructed labor, and
introduced the required instruments. The operation of cesarean section was
described in 1010 in the Book of Kings by Abul Kasim Al-Firdaws (Speert 1973). It described cesarean section practiced on
R'uda'ba, the mother of King Rustam at his birth. Another reference for
cesarean section is written by Al-Biruni in his book, Al-Athar Al-Baliiyah
dated 1307 A.D. (Hitti 1977) as shown in figure 9 which is preserved in the
library of the University of Edingurgh (Hitti 1977).
Ibn-Al-Quff (1233-1305) is another physician who contributed to perinatology. He was born in Jordan (Hamameh 1971). In his book "Al-Jami",
he presented original observations on embryology. He spoke of "... the
formation of a foam stage in the first 6 to 7 days, which in 13 to 16 days, is
gradually transformed into a clot and in 28 to 30 days into a small chunk of
meat. In 38 to 40 days, the head appears separate from the shoulders and
limbs. The brain and heart followed by the liver are formed before other
organs. The fetus takes its food from the mother in order to grow and to
replenish what it discards or loses ... There are three membranes covering
and protecting the fetus, of which the first connects arteries and veins with
those in the mothers womb through the umbilical cord. The veins pass food
for the nourishment of the fetus, while the arteries transmit air. By the end
of seven months, all organs are complete ... After delivery, the baby's
umbilical cord is cut at a distance of four fingers breadth from the body, and
is tied with fine, soft woolen twine. The area of the cut is covered with a
filament moistened in olive oil over which a styptic to prevent bleeding is
sprinkled ... After delivery, the baby is nursed by his mother whose milk is
the best. Then the midwife puts the baby to sleep in a darkened quiet room...
Nursing the baby is performed two to three times daily. Before nursing, the
mother's breast should be squeezed out two or three times to get rid of the
milk near the nipple". These findings of Ibn-Al-Quff, appear basic and
fundamental, but seven hundred years ago, they were new and different.
One cannot help but look with admiration upon the way the Muslims
handled their responsibility towards mankind. They not only preserved, but
also added to earlier achievements in medicine. They have fostered the
flame of civilization, made it brighter, and handed it over to Europe in the
best possible condition. Europe, in turn, passed it to the United States of
America, and the cycle continues.
TABLE 1. THE MAIN ISLAMIC PHYSICIANS
Name - Arabic: Jurjis ibn Bakhtishu Jibril Yuhanna ibn Masawayh
Name - latin:
Span of Life (A.D.): 700 - 800
Speciality and Contribution: Translation from Greek and Syriac into Arabic
Special Books:Translation of works of Hippocrates, Galen and Aristotle
City - Country: Baghdad
Name - Arabic: Hunain Ibn Ishak
Name - latin:
Span of Life (A.D.): 826 - 882
Speciality and Contribution:
City - Country:
Name - Arabic: Al-Razi
Name - latin: Razes
Span of Life (A.D.): 841 - 926 (Ray-Tehran)
Speciality and Contribution: Internal Medicine, Epidemiology, Ophthalmology, Chemistry, Physics, Philosophy
Special Books: Kitab Al-Mansuri (The Liber Al-Mansuris), Al-Murshid, Al-Hawi (Continents), Al-Gudari wa, Al-Gudari (de Peste or de Pestilentia)
City - Country: Kharasan, Baghdad
Name - Arabic: Al-Zahrawi
Name - latin: Abulcasis (Bucasis Alzahravius)
Span of Life (A.D.): 930 -1013 (al-Zahra-Cordova)
Speciality and Contribution: Surgery
Special Books: al-Tasrif Liman Ajiz 'an al' Ta'lif
City - Country: Al-Andalus (Cordova)
Name - Arabic: Ibn-Sina
Name - latin: Avicenna
Span of Life (A.D.): 980 - 1037 (Bukhara)
Speciality and Contribution: Medical Encyclopedia, Philosophy, Astronomy, Poetry
Special Books: 100 books Al-Qanun (over million words)
City - Country: Hamazan, Jurjan
Name - Arabic: Ibn-Rushd
Name - latin: Averroes
Span of Life (A.D.): 1126 - 1198
Speciality and Contribution: Philosophy, Medicine, Law
Special Books: Kitab Al-Kulliat
City - Country: Al-Andalus, Granada
Name - Arabic: Ibn-Maimon
Name - latin: Maimonides
Span of Life (A.D.): 1135 - 1208 (Granada)
Speciality and Contribution: Philosophy, Translations- Hebrew, Latin, Poisons, Hygiene and Public Health
Special Books: Al-Tadbir El-Sihhi, Moushid El-Hairan
City - Country: Cairo (Saladdin's physician)
Name - Arabic: Ibn-Al-Nafis
Name - latin:
Span of Life (A.D.): 1208 - 1288 (Damascus)
Speciality and Contribution: Pulmonary circ., Blood supply to the heart
Special Books: Sharah Tashrih al Qanun, Al-Mujaz
City - Country: Damascus, Cairo
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BLAC, M: Averroes, Merit Students Encyclopedia Vol. 2, 476, Crowell-Collier Educational Co. 1970.
BROAWE, E.G.: Arabian Medicine: Cambridge at the University
BURTON, L. edition of 1001 Nights (Six volumes). 1886.
CAWBELL, DAVID: Arabian Medicine and its influence on the
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CUSTON, C.G.: A Brief Historical Summary of the Treatment of
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GRUNER, O.C.: A treatise on the Canon of Medicine of Avicenna,
Incorporating a Translation of the First Book, London, Luzac & Co. 1930.
HADDAD S.I. and KHAIRALLAH A.A.: A forgotten Chapter in the
History of the Circulation of the Blood. Arinuals of Surgery 104: 1-8, 1936.
HADDAD, S.I.: Arabian Contribution to Medicine. Anna Med. Hist.
HAMARNEH S: The Physician and the Health Profcssions in Medeival
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HAMARNEH, S.: Development of Hospitals in Islam. J. History of
Med. and Allied Sciences 17: 366-84, 1962.
HAYKAL, M.H.: The life of Mohammed, 8th edition, North American
Trust Publications-, 1976.
HITTI, P.K.: History of the Arabs, 10th Edition, St. Martin's Press,
New York, 602-614, 1977.
IBN-KHALDUN, VOL. IV, P. 201.
IBRAHIM, S.: Lights on History of Sciencc: Ibn-El-Nafis, Hospital
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KAHIL, N.: Une ophthalmologic Arabe par un practici en due Caire du
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KEYS, T.E., WAKIM, K.G.: Contributions of the Arabs to Medicine
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KHAIRALLAH, A. A.: Arabic Contributions to Anatomy and Surgery: Ann. Med. Hist. 3:4 409-15, 1942.
LEVY, M.: Medical Ethics of Medieval Islam with Special Reference
to Al-Ruhawis, "Practical Ethics of the Physican". May 19067, Vol. 57
MEYERHOF, M.: Ibn-El-Nafis (Xlllth Cent) and His. Theory of the
Lesser Circulation. Isis 23: 100-120, 1935.
MIN-KIN, J.S.: The World of Moses maimonides: Thomas Yoseloff
Inc. New York, 1968.
PARENTE, P. The Medical School of Salemo in the Regimen of Health
of the Medical School of Salcmo. N.Y. Vantage Press, 1967, pp. 15-20.
Profile of Iran. Health Care in Iran. May 1977, 2536, Vol. 11, No. 5.
SALEM, R.A.: Discovery of the Pulmonary Circulatioii by an Arab in
the 13th century. Anesthesia & Analgesia... Current Researches, 47: 587-
SARTON, G.: Introduction of the history of Science. Vol. I Baltimore,
Camegic Inst. of Wash. 1950.
SPEERT, H.: Iconographia Gyneatrica and Obstetrics. Philadelphia:
T.A. Davis Co. 1973.