"I invite you... to go back with me 1000 years to consider the fascinating history of the old Arabian ophthalmology which I have studied in the past five years." With these words Julius Hirschberg, addressing the American Medical Association in July 1905, presented the work of Muslim ophtalmologists. Inspired by the pionnering work of the eminent German expert, Dr Ibrahim Shaikh describes in brief in this well informed article the contributions of Al-Ghafiqi, Ibn al-Haytham, Salahuddin Ibn Yusuf, Kalifah of Aleppo, Zarrindast, and Ammar Al-Mosuli. He devotes a special interest to the first description of cataract operation by Al-Mosuli and its subsequent impact on the works of his followers.
Dr. Ibrahim Shaikh*
Figure 1: The earliest known medical description of the eye, from a 9th century work by Hunayn ibn Ishaq. This copy is dated of the 12th century (Source).
On 11-14th July 1905, Professor Julius Hirschberg (1843 – 1925), the renowned German eye ophthalmologist and medical historian, addressed the American Medical Association in California . The subject of his work was on "Arab Ophthalmologists". He began his lecture by saying: "I invite you... to go back with me 1000 years to consider the fascinating history of the Arabian Ophthalmology which I have studied in the past five years. Two questions at first must be addressed: What were the sources of information at the disposal of these Arab Ophthalmologists? What is the contribution of the Arabian work in ophthalmology?"
One of the outstanding classical works Memorial of Ophthalmology written by Ali Ibn Isa (1000 CE) was compiled from Greek sources, maily the Ten Treatises of the Eye of Galen and he added new knowledge. An eye specialist is known in Arabic as Al-Kahhal from the word Kuhl (kollyre). Hirschberg considered this work to be as important as the contribution of the Muslims to the Mosque of Cordoba (Spain). The textbook of Kalifah (written around 1260 CE) lists eighteen works on ophthalmology. In just 250 years, Muslims produced eighteen written works on ophthalmology. Whilst the Greek tradition, from Hippocrates to Paulus, spanning one thousand years, produced only five books on this subject. In all, there are some thirty ophthalmology textbooks produced by the Muslims. The most important of these were written by specialists and in fact fourteen still exist today. Hirschberg then went on to mention some of the more notable names and gave an account of their work.
Ali Ibn Isa
The most famous of all the occulists of Islam was born in Baghdad (Iraq). His work, Tashkiratul-Kahhalîn (Notebook of the Occulists), the best and most complete text book on diseases of the eye, was translated with commentary into German by Hirschberg and Lippert (1904) and into English by Casey Wood (1936). Ibn Isa's book was the most widely referred to textbook by later ophthalmologists. It was first translated into Persian and then into Latin and printed in Venice in 1497 CE. Famous contemporaries of Isa Ibn Ali were Ammar Ibn Ali Al-Mosuli (see below) and Abul Hasan Ahmed Ibn Muhammad Al-Tabari who, in his work Kitâb-ul Mu'âlaja 'l-Buqratiyya (Book of Hippocratic Treatment), says that he wrote a long treatise on diseases of the eye. Unfortunately this treatise is no longer available.
Ammar Ibn Ali Al-Mosuli
Figure 2: An Arabic manuscript titled Anatomy of the Eye, authored by al-Mutadibih (active ca. 1170-1199). This manuscript, dated ca. 1200CE, is kept at the Cairo National Library. (Source).
Ammar, from Mosul in Iraq, flourished around 1010 CE. He wrote a book entitled Kitâb al-Muntakhab fî 'ilâj al-'ayn (Book of Choices in the Treatment of Eye Diseases) and practiced mainly in Egypt. His book deals with anatomy, pathology and describes six case histories for cataract operation and a case of optic neuritis! Hirschberg writes that Ammar was "the most clever eye surgeon of the whole Arabian literature". Ammar discussed some 48-eye diseases in a short work of about 1500 words (one of the shortest works of its kind). This manuscript (No. 894) can be found in the Escorial Library near Madrid (Spain). Although shorter than the book of Isa Ibn Ali, it contains many more original remarks and observations. Until the 20th century, Ammar's work was only available in Arabic and a Hebrew translation made by Nathan the Jew in the 13th century. This work was translated into German by Professor Julius Hirschberg in 1905. Ammar was the inventor of the cataract operation by suction, using a fine hollow needle inserted through the limbus (where the cornea joins the conjunctiva). This was the best-performed operation of its time. This type of cataract operation among others is still carried out today. The operation of "couching", i.e. violent displacement of the lens, dates back to Babylonian times, but this had its obvious complications and risks. Ammar throughout his work, as a surgeon and researcher, never forgot that he was a Muslim first and scientist second. This is seen by his compassionate attitude towards his patients. On his travels he fulfilled his religious duties, visiting Medina and performing Hajj at Makkah.
Zarrindast (Gold Hand)
Abu Ruh Muhammad Ibn Mansur Bin Abdullah, otherwise known as Al-Jurjani, an excellent surgeon from Persia who flourished around 1088 C.E., wrote a book, entitled Nûr-ul-'Uyûn (The Light of the Eyes). The book, much of which is original, was written during the reign of Sultan Malikshah and consists of ten chapters. In the seventh chapter he describes some 30-eye operations including 3 types of cataract operation. He also deals with anatomy and physiology of the eye and eye diseases. One chapter is devoted to eye diseases which can be seen such as cataract, trachoma, scleral and corneal diseases and problems of the eyelids. Another chapter deals with diseases that lie hidden (the signs are exhibited in the eye and vision but the cause may be elsewhere) i.e. third nerve paralysis, blood disorders, toxicity etc. The book mentions curable and incurable diseases and gives methods of treatment. A large section is about surgery of the eye. There is a section on drugs employed by the occulists.
Figure 3: A figure depicting a Muslim physician during a treatment. Serefeddin Sabuncuoglu, Cerrahat al-Haniyye, Millet Library, Ali Emiri Tip, p. 79.
Another name mentioned by Hirschberg in his address to the American Medical Association (1905) was Abu Muttarif from Seville (Spain) who flourished around the 11th century. Besides being an eye specialist he was also a Wazîr (minister). Unfortunately, his work is entirely lost.
Muhammad Ibn Qassoum Ibn Aslam Al-Ghafiqi, simply known as Al-Ghafiqi (died 1165 CE), also from Spain, wrote a book in the 12th century called Al-Murshid fî 'l-Kuhl (The Right Guide in Ophthalmology). The book is not just confined to the eye but gives details of the head and diseases of the brain. Al-Ghafiqi used Ammar's treatise as a reference for his work. Today a tourist visiting Cordoba can see the commemorating bust of Muhammad Al-Ghafiqi, a tribute paid from the people of Cordoba to an outstanding Muslim eye specialist. The bust with full Arab Ammama can be seen in the quadrangle of a municipal hospital in Cordoba, Spain. It was erected in 1965 to commemorate the eight hundredth anniversary of his death.
Kalifah of Aleppo
Kalifah Ibn Al-Mahasin of Allepo (Syria), who flourished around 1260 CE, wrote a book of 564 pages in which he describes and gives drawings of various surgical instruments including 36 instruments for eye surgery. He also discusses the visual pathways between the eye and the brain. He also writes about twelve kinds of cataract operations. The term for cataract in Arabic is Al-Mâ' Nazul 'Ayn. Mâ' means water or water descending onto the eye, i.e. water accumulates in the lens and it becomes "soggy" thus making it cloudy. This cloudiness is sucked out by the use of hollow needle, thus the cataract is removed and the patient is once again able to see.
Salahuddin Ibn Yusuf from Hammah (Syria) wrote in 1290 CE a book called The Light of the Eyes in which he discussed new work on the optical theory of vision. He also quoted many extracts from Ammar's treatise. He did work on the eye from a more general medical point of view, as did other notable physicians such as Az-Zahrawi, Ibn Zuhr and Ibn Rushd.
Figure 5: The Result of Thinking about the Cure of Eye Diseases (Natijat al-fikar fi `ilaj amrad al-basar) written in Cairo by Fath al-Din al-Qaysi (d. 1259/657 H). Copy finished by unnamed scribe on 16 November 1501 (5 Jumada I 907 H). © The National Library of Medicine, Bethesda, Maryland, MS A48, fols. 7b-8a. (Source).
Ibn al-Haytham, born in 965 CE, was the first to explain that all vision was made possible because of refraction of light rays. The work of Ibn al-Haytham was repeated and expanded upon by the Persian mathematician Kamal al-Din l-Farisi (died 1320 CE) who observed the path of rays of light in the interior of a glass sphere in order to examine the refraction of sunlight in rain drops. This led him to an explanation of the genesis of primary and secondary rainbows.
"From 800-1300 C.E. the World of Islam produced not less than 60 renowned Eye Specialists or Occulists, authors of textbooks and producers of monographs in Ophthalmology. Meanwhile in Europe prior to the 12th century an Occulist was unheard of." Professor J. Hirschberg told this to an enthralled audience at the American Medical Association. It was not until the 18th century that the method of removal of cataract by a hollow needle was employed in Europe.
The Muslims produced many original works on the anatomy of the eye. Their studies were, however, limited because they carried out their observations only on animal eyes. The dissection of any part of the human body was considered disrespectful in principle. These works give us the oldest pictures of the anatomy of the eye.
Figure 6: A commentary on the Mujiz or Concise Book of Ibn al-Nafis, called The Key to the Mujiz and composed in Arabic by al-Aqsara'i, who died in 1370 (771H). The copy was completed in October of 1407 (Jumada I 810 H). © The National Library of Medicine, Bethesda, Maryland, MS A67, fol. 167b showing a schematic diagram of the visual system. (Source).
The original work of the Arabs includes the introduction of terms such as Eyeball, Conjunctiva, Cornea, Uvea and Retina. Muslims also did operations on diseases of the lids such as Trachoma, a hardening of the inside of the lid. Glaucoma (an increase in the intra-ocular pressure of the eye) under the name of "Headache of the pupil" was first described by an Arab. However, the greatest single contribution in ophthalmology by the Arabs was in the matter of cataracts.
According to the Journal of the American Medical Association (1935) there is, in the Vatican Library, a unique manuscript ascribed to Ibn Nafis (died in 1288 CE) entitled Kitâb al-Muhazzab fî Tibb al-‘Ayn (A Book of Corrections in the Medicine of the Eye). It contains a description of the eyes of animals and a discussion on the varieties and colours of the human eye.
In the 12th century, Gerard of Cremona, the famous translator into Latin of scientific and medical Arabic works, spent 40 years of his life (1147-1187 CE) in Toledo (Spain) translating the work of Muslims including the works of Ar-Razi and Ibn Sina. This fact has been attributed on a Spanish postal stamp. Arab physicians have been in the forefront of the effort to prevent blindness since 1000 C.E, when Ar-Razi became the first doctor to describe the reflex action of the pupil. At about the same time, Ammar Bin Ali Al-Mosuli invented the technique of suction removal of cataracts by the use of a hollow needle ."
Professor J Hirschberg concluded his address to the American Medical Association with these words:
"During this total darkness in medieval Europe they (the Arab Muslims) lighted and fed the lamps of our science (ophthalmology) - from the Guadalquivir (in Spain) to the Nile (in Egypt) and to the river Oxus (in Russia). They were the only masters of ophthalmology in medieval Europe."
So we can see from Hirschberg's work that the Muslim ophthalmologists of the 10th-13th centuries were many hundreds of years ahead of their time.
References and further reading
- Biró I., "In memory of Julius Hirschberg", Orv Hetil, Aug 8, 1976; 117(32):1953-4 (in Hungarian).
- Halit Oguz, "Ophthalmic chapters of serefeddin Sabuncuoglu's illustrated surgical book (Cerrahiyyetü'l Haniyye) in the 15th century, Annals of Ophthalmology, Humana Press Inc., vol. 38, No. 1, 2006.
- Hamarneh, and Sonnedecker, Glenn, A Pharmaceutical View of A. al-Zahrawi, Leiden, Brill, 1963,
- Hirschberg, Julius, Geschichte der Augenheikunde" 1899-1919, 9 vols., 4700 pp. Originally published as vols. XII-XV (1899-1918) of the 2nd ed. of the Handbuch der gesammten Augenheilkunde, edited by Graefe & Saemisch. English translation: History of Ophtalmology, translated by Frederick C. Blodi. Bonn : J.P. Wayenborgh, 1982-. See vol. 2: vol. 2: The Middle Ages; the sixteenth and seventeenth centuries.
- Koelbing H. M., "Julius Hirschberg (1843-1925), ophthalmologist and medical historian", (in German), Klin Monatsbl Augenheilkd. 1976 Jan;168(1):103-8.
- Said, Hakim Mohammed, "Various tools used by Albucasis", Photograph showing 8 assorted tools used by Albucasis. In: Life and Works of Al-Zahrawi. Printed by Hamdard.
- Snyder C., "Julius Hirschberg, the neglected historian of ophthalmology., Am J Ophthalmol., May 1981; 91(5): 664-76.
- Spink, M.S., and Lewis, G.L., Albucasis On Surgery and Instruments. London: Wellcome Institute for the History of Medicine, 1973, pp. 21-36.
- Vernet, J. & Samsó, J. et al. 1992. El Legado cientifico andalusi. Madrid: Ministerio de Cultura. Exhibition Catalogue with a video in Spanish.
 See H. M. Koelbing, "Julius Hirschberg (1843-1925), ophthalmologist and medical historian", Klin Monatsbl Augenheilkd, 1976, 168(1):103-8. Julius Hirschberg of Berlin was one of the most brilliant ophthalmologists of his time. As a surgeon and as the editor of the Centralblatt für praktische Augenheilkunde" (1877-1919) he enjoyed a world-wide reputation. As a historian of ophthalmology, his greatest achievement was the famous History of Ophtalmology, written in German: Geschichte der Augenheikunde, 1899-1919, 9 vols., 4700 pp. He covered in it the history of ophtalmolgy from the ancient Egyptians down to 1900. He hit upon the history of ophtalmology in Muslim heritage in volume 2: vol. 2: The Middle Ages; the sixteenth and seventeenth centuries. See the English translation of the whole encyclopedia by by Frederick C. Blodi et al., The history of ophthalmology. Bonn : J.P. Wayenborgh, 1982-.
 Optometry Today, publication of the Association of Optometrists, England, March 28, 1987.
*Dr, Retired, Fellow Manchester Medical Society, University of Manchester, Manchester, UK.