Interview with Professor Emilie Savage-Smith

Professor Emilie Savage-Smith expands in this remarkable interview on Islamic medicine of which she draws a lively picture. Beginning with a general survey of the conditions of its inception and development in an intercultural context, she mentions representative names and treatises, then the various fields of expertise are scrutinized and the different innovations this tradition brought are highlighted, from the classification of diseases, their treatment, the use of surgery, the improvement of medical instruments, the foundation of hospitals. The answers of the expert are informative on specific areas of medical care such as ophthalmology, mental illness, the development of a real industry of drugs, the various ways of healing, including the use of music in the treatment of emotional and mental stress. The exploitation of this treasure of medical knowledge in Europe until the 17th century is also reminded.

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We are happy to have Professor Emilie Savage-Smith who is a professor of the History of Islamic Science at the Faculty of Oriental Studies at the University of Oxford. Her specialities range in Islamic science, medicine and currently she is working on various projects at Oxford such as a new catalogue of Arabic manuscripts at the Boeding Library in Oxford dealing with Arabic manuscripts in medicine and related topics. She is also a senior projects researcher in a team of scholars translating and studying a newly-discovered Arabic cosmography, the Book of curiosities and has published (with a co-author) Medieval Islamic Medicine (Edinburgh University Press, 2007). Some of her other works just to give a brief idea is The Social History of Medicine from Oxford University Press in 2007. So we are very grateful to have you on the show and thank you for joining us Dr. Emilie.

Thank you very much for inviting me on to your programme.

It's a pleasure. If I can briefly begin with the first question. Why and at what stage in your career did you decide to study Arabic, and how did your interest in Islamic science develop?

Well, I began initially as a historian of science and medicine working primarily with ancient Greek and medieval European materials. But while I was working on my doctorate, which was in medicine at the University of Wisconsin in the United States, I saw a notice that the university was going to teach for the first time a course in Arabic, and of course it was through Arabic that I knew that these ideas so many of them had reached Europe. So I signed up for the class, and immediately found Arabic a fascinating language and then with more experience with it, I became very fascinated with the Arabic materials that I could read and relate to the science of medicine. After that, I was offered then a sizeable grant to continue on my doctorate if I used Arabic in my thesis, which I happily accepted to do. I then spent most of my working life looking at primarily medieval, but sometimes early modern, Islamic materials related to medicine and science.

Coming to the theme of today, which has to do with medicine and health, in terms of the early history of medicine, is it the case that based on your research that Arabic scholars did translate from the Greek scholars, or what is it the other way round, in terms of the research that you have done so far on this topic?

Well, certainly. During the early years of the Muslim expanding empire the scholars were very anxious to learn from the surrounding older cultures. New information that they could then incorporate and use in the emerging Islamic society, during the 9th century particularly, that would be the 2nd or the 3rd century of the Hijra or Muslim era, Arab scholars translated into Arabic a large number of Greek medical writings that had been composed in earlier centuries in the Greek speaking areas of what is now modern Turkey and Egypt. They also translated some Indians and Sanskrit treatises and some old Persian ones. All these then, particularly the Greek, but also the Indian and Persian, came to form what you might call a framework, an early framework, from which then the professional medical practice in the Islamic world developed. But it is important to keep in mind, I think, that Islamic culture did not simply provide custodial care, sort of taking care of this Greek medicine and transmitting it later to Europe, but rather the Islamic physicians just took that material and then developed a vast medical literature of their own that had many important innovations and changes. Then later, actually, this Arabic material which was mostly composed, say from the late 9th to the 12th century, this Arabic material was then later translated into Latin, and it was the Arabic medical literature that then provided late medieval Europe with the ideas and practices from which eventually early modern medicine arose.

Can you briefly mention some of the Muslim scholars who were pioneers in the field of medicine during their lives and the different fields upon which their contributions were made?

Well, there are so many, it is difficult to make a selection. First and foremost I think of the great figures would be a clinician, a clinical physician, whose name was Abu Bakr Muhammad Ibn Zakaria Al-Razi. He died about 925 CE. He was born in the city of Ray which at that time was a very important and vital commercial and intellectual centre, located today just south of Tehran. He headed hospitals in his native city of Ray and also in Baghdad, where he spent very much of his working life. Now what is fascinating is that we have preserved today over 900 case histories that were recorded by his students as he consulted with his patients. These are remarkable records for the history of medicine. He himself kept a large notebook which has been published and contains over 23 volumes. It is so large. These were the notes that he made throughout his working life, materials that he read in other people's medical writings, but also his cases and his constant attempts to find new therapies.

As an example that we have in one instance, he recorded what is essentially the earliest clinical trial that is known in medical history. What happened was that he encountered a group of patients that had the early symptoms of meningitis, and he divided the patients into two groups: one he treated with a therapy that in his day was used which was blood letting (we don't do that today); and the other group he withheld all treatment from it. He found that the group that he treated did not develop the really severe form of meningitis, while the others all did and died. Now we don't accept blood letting of course as a method of treatment today, but the idea of determining what your therapy would be by setting up this kind of trial, clinical trial if you want, is completely remarkable. And you can see that he is struggling throughout all these notes, constantly challenging what people before his day said, how they were treating diseases, and he is wanting to find new and better methods.

Then he also wrote a treatise which he dedicated to a governor of Ray in 903 called The book of medicine dedicated to Mansur [Al-Mansuri fi al-tibb]. This was translated into Latin in the 12th century and it became one of the most important and widely read medical manuals in Europe. That's one example. Another example of course would be Ibn Sina who was known in Europe as Avicenna. He was born in central Asia about 980 and died about 1037 and he travelled extensively in the Eastern part of the Islamic lands. He was known, and still is known, as one of the great philosophers of medieval Islam but also one of the great physicians, primarily because he composed a very large medical encyclopaedia which was called The Canon of Medicine, in which he brought together all the knowledge of his day that had any bearing on the treatment of diseases, and also the drug therapy for use in those diseases. It was in turn translated also into Latin and was used well in Europe as a textbook until the 17th century. It is actually still used in unani medicine today.

Another scholar which comes to mind is Ibn al-Nafis on pulmonary circulation and developing that theory. Can you briefly elaborate on this?

Ibn al-Nafis worked in Damascus and also sometimes in Cairo in the 13th century. What he proposed in a treatise that he wrote in his commentary on Ibn Sina's Canon really challenged some of the anatomical and physiological theories that had been current up until his time. In particular, he described what is technically known as pulmonary transit. Some people call it as the pulmonary circulation, which is a revision of the notion of the blood flow and, in this case, he is saying that the blood from the right ventricle of the heart must go through the lungs before reaching the left ventricles of the heart, whereas prior to his work, it was thought that it went just directly from one ventricle, one portion of heart, to the other part of the heart and did not go to the lungs. This is actually quite an important idea and a real challenge to the anatomical authorities that he had inherited in his work. Indeed he described this roughly 300 years ago before anyone in Europe. It would appear actually that they got the idea from him, probably from a Latin translation of his work.

Having now mentioned the scholars, the next question that comes to mind is that of what kind of advancements did these scholars make in the field of medical instruments that are used in medical labs today for dealing with patient's concerns?

Well, a remarkable number of instruments that we would use today were devised at quite an early period in Islamic culture. In particular, there was a writer who worked in Muslim Spain around the year 1000. His name was Abu al-Qassim Al-Zahrawi, and he wrote an illustrated treatise on surgery. That is important because it is the first treatise ever to be illustrated with the instruments for surgery. He had hundreds of illustrations of instruments, and many of these were of his invention. For example, he designed an obstetrical forceps. Now, mind you, they were not for use in live birth, as we tend to use them today, but they were used for extracting a dead foetus. But still, it was a remarkable invention.

I think the most genius device that he came up with was an instrument to be used during a tonsillectomy. It was a scissor-like instrument that could remove the swollen tonsil and hold the gland so that the patient wouldn't choke on it, and it was held for removal and after that of course the patient would gurgle with water. Also, he was very much concerned with the patient not being frightened by surgery, and he devised what he called a concealed knife, a hidden knife. Basically what it is. It is a blade between two curved plates, and the blade could be sort of extended or withdrawn at will, and the patient wouldn't see the blade and not realise until it was too late that he was going to be cut with this knife. He devised several sizes of this and highly recommended it so that the patient would not be frightened, which I think is a lovely idea. He also devised different ways of bandaging broken arms similar to a cast today but setting cloth, bandages in egg white and a form of plaster, actually many very substantial innovations.

What is even more fascinating are some of the new instruments that were devised for treating eye diseases and in particular cataracts. A physician who worked in Egypt, although he was originally from Mosul in Iraq, wrote a treatise that covered about 43 eye ailments and that included cataracts. Now cataracts were a very common cause of blindness at this time, as indeed they are today. And traditionally, by which I mean going back for many hundreds of years, initially in India, cataracts were treated by inserting a small needle into the white part of the eye and pushing the clouded lens down so that it is out of the way of the field vision, but it is not a very good way to do it, but helped. Now what Amar proposed was to use a thicker needle because it is hollow and try to remove, to suck out, the lens which obviously have to be softer and remove it. He claimed much success with this technique. Interestingly enough, however, there is a another ophtalmologist who worked in Egypt in the early 14th century about 1320 who said you could still get the instrument that Amar had devised, that he tested and said they did not work. So you have already controversy as to whether or not they actually functioned, but the fact that they tried it and actually came up with the idea of doing it, this I think is quite remarkable.

You touched on this whole field of the instruments the scholars made. The next question that comes to mind is on the issue of diseases. What kind of diseases did the scholars find cures for during their times? Some of the symptoms that comes to mind is small pox, measles and whether any vaccinations were developed by these scholars to deal with these kinds of problems?

Yes, we had the first actual descriptions of small pox and measles from the late 9th- early 10th century of Al-Razi, who wrote the first treatise on it actually which clearly described the conditions and laying out treatment for it. Now, he did not devise the ways of preventing you from getting small pox and measles, but the care that he gave, particularly the concern for the eyes, again, which is a very serious, was concerned particularly with measles. His care was very reasonable and probably relatively effective. As an aside, he also wrote the first treatise we have in medical history on hay fever and developed again some very sensible ways of handling hay fever. Again you can say that it is not a cure, but we do not have a cure today of hay fever, but it was a very sensible way of handling what was a new condition.

Probably the most spectacular evidence of the innovation of treating diseases is again in the philological literature. The 12th and 13th centuries, particularly in Egypt and Syria, saw some remarkable treatises written on eye diseases and new ways of handling those, and particularly the treatment of cataracts, as I have already mentioned, but also trachoma, which was also another major cause of blindness. In the Middle East they developed some excellent methods of both surgically and with mild form of drug therapy treating and controlling those conditions. It is quite remarkable. And in fact, for one complication of trachoma they used surgical method of treating that was used in Europe until the end of the First World War. Now we use quite a different technique but it is quite remarkable. Now as far as vaccinations are concerned, that does not really come in to anybody's thinking until the 18th century, and we know that certainly by 1720 there were people, particularly in rural areas in Turkey, who were using a kind of simple form of inoculation, technically known as varialation against small pox. This was observed in 1720 by the wife of the British ambassador to the Turkish court, Lady Mary Montague. She wrote back to her friends in England describing this procedure that she had observed in Turkey, and she was very instrumental in getting it introduced into England and then that procedure was developed. It was changed and extended and it became the technique that we now call vaccination.

Can you touch on the contribution Muslim scholars may have made in the field of herbal medicine. Fields like botany come to mind and just general remedies that are available because it is an alternative kind of medicine which is available today in the market. In places like India, you get a lot of different medication coming through the alternative method, rather than the complimentary method or the traditional method which we are aware of here in mainstream Europe.

Interestingly enough, however, when you look at the earlier period of Islam in medicine, they would not have made a distinction of herbal and medications in general. For all the treatises that we have until the end of the 18th century are going to be treatises that include both herbs and mineral substances, which are actually very important. Now, to return back more to herbs, Muslim physicians in the early medieval Islamic period hugely expanded the number of pharmaceutical materials. They were available to societies, and these included a lot of new substances obviously including camphor, for example, which is a substance that is still used today very much. Musk, sinna, which you will find in herbal preparation for constipation, and the mirobilons which are used very much in India and unani medicine today. Those were all new introductions into the store -you might say- of medicinal substances. They also extended the use of herbs that were perhaps known, or in fact were known, to earlier peoples but they used them in different ways, e.g. wormwood which is a species of artinesia. It is of great interest to pharmaceutical companies today, because it is being seen as the major source of treatment for malaria today. And yet medieval Islamic physicians were using it to treat the disease of the liver and spleen, and of course malaria indeed involves the spleen. They used it for other things too, such as an antidote for opium poisoning.

So you have a really huge expansion of both the number of herbal remedies available and also the way in which they are being used to treat different diseases. May I also mention that one of the most important, or certainly very important, contributions to the pharmaceutics was the introduction by Muslim physicians of cotton, that is scarcely ever mentioned, but in fact cotton of course is a vital importance for bandaging and [medical] dressings. It was unknown until Muslim physicians applied it, first by learning about the plant and secondly, a part of using cotton as a surgical dressing.

Did Muslim women play a role in the field of medicine and general advancements in this area?

Well, in terms of the society at large, women were probably the major providers of health care for the society, because they looked after the medical needs of the children of course, saw to their husbands and extended members of the family. We do however know that there were woman who were acting as professional physicians outside of their families. Unfortunately the historical sources simply do not give us their names. The closest we have come to have a name is the fact that there were two women who were part of a five-generation family of physicians who worked in Muslim Spain. The family is known as the Ibn Zuhr family, and we know that there were two women in that family who served in the household of the ruler of the day, roughly from around 1180 to 1190 or so. But we do not actually know their names. We do know however from some other sources that there were a number of acting women physicians, simply because some of the established male physicians, such as Al-Razi, whom I have already mentioned, would complain that their patients would turn to women physicians when the cure that he had given was not working very well. So we have a number of complaints from male physicians that female physicians were poaching their patients. And we have some legal documents from the early 10th century about a disputed fee over the services of a female physician, but she is not named actually in the document.

Can you touch on the reason as to why these women were not mentioned in the sources. Is it linked to the society and perceptions at that time?

Well, we can speculate as to why they were not mentioned. We do not actually know. In general, the women tend not to be named. Why? Possibly because the documents were actually written by men who don't choose to give the women's names. It is very annoying to historians today not to have the women's names there, but they are clearly practising and we know that there were a lot of female occulists who treated eye disease. Again the male physicians are upset about these women cutting into their practice.

Another area that comes to mind, especially in this field of medicine, is this idea of hospitals. Did Muslim scholars have a role to play in the construction and development of hospitals during that time?

Well, yes indeed. In fact, I think the establishment of hospitals was one of the really great achievements of medieval Islamic society. There were some what were called poor relief facilities which were offered by some Christian monasteries, but the medieval Islamic hospitals had features that we would easily recognize today in a modern hospital, and this is a great achievement actually. The earliest ones were built in Baghdad around the 9th century, and in fact by the end of the 9th century, there were five hospitals in Baghdad alone. In Egypt, I believe, the earliest hospital was built about 872 in the south west quarter of what is now Cairo, it is called today Ibn Tulun. But the 12th and 13th centuries saw the rise of even more elaborate hospitals, and fortunately we have more information about them, sometimes floor plans and documentation, whereas for the early hospitals we lack obviously a great deal of documentation for them. But by the 12th and 13th centuries, the hospitals, the Islamic hospitals, were urban structures, institutions, largely circular institutions, and they were open most of them to all, that is male and female, civilian and military, adult and child, rich and poor, and they had specialist wards just as we would have today. They would have a special area for surgery, another ward for eye complaints. Those were always put in a separate section, and another ward for gastro-intestinal complaints, and of course separate wards for men and women, and separate people attending the male and female wards.

Another point to make, and I think this is very important, is that these were the very first teaching hospitals on record. That is, formally trained physicians were at these great hospitals and they made regular rounds. We have information on how many times a day they made the rounds, and they actually taught medicine at the bed side to their students there. This is a very important innovation in the history of medicine again.

If we come to today's day and age, we have this whole idea of this waiting list in the NHS. How did the system operate during that time in terms of dealing with patients? Was it as patients came into the hospitals that they would be dealt with or was there some kind of system whereby you had to wait for your turn to be treated?

Well, you ask an excellent question and regrettably we don't have that kind of information. The one type of information we are completely lacking is how many patients came in per day, per year, how long did they stay, and what the recovery rate was. In other words we are missing that kind of data. We know how many physicians there were, we know how many beds there were, we know what kind of wards there were, we know that they would have a library, we know that they would have a teaching area, that there would be a pharmacy, but what we don't know is how the patients actually got there, were they referred by their doctor, did they walk in off the street. It is generally said that a very wealthy person would probably not have used the hospitals, unless under the most extraordinary circumstances, say, when they were travelling and away from home, otherwise a very wealthy person would probably have the physician would be brought to him, if he was a ruler or someone like that.

Another famous hospital which I have read about is the Al-Nuri hospital in Damascus. Can you maybe touch on this?

Well yes, it was a remarkable hospital. It is comparable to another one which was called Mansuri Hospital in Cairo. The Al-Nuri hospital was built by Nureddin Ibn-Zhengi who died about 1174, and he build a very large complex hospital with all the features that I have mentioned, specialised wards and teaching areas and so on. The reason why it is so famous is: first we have a lot of documentation about it; secondly it was still used as a hospital right into the middle of the 19th century. We actually have diagrams and so on of its use then and it is partially still standing today. It has now been converted into a museum of the history of medicine and science, and very well worth a visit, should you be in Damascus.

Moving to the next topic related to hospitals is the topic of pharmacy. What role did Muslim scholars have in the field of pharmacy in terms of like today, obviously we can visit pharmacies and pick up a range of medicines via prescription, for just any kind of treatment we may be suffering from. Were there any pharmacies in the Islamic era, whereby Muslim scholars may have constructed such a system whereby people can just visit and pick up any medicines they may need for their ailments or diseases?

Oh, absolutely!! Again, as early as the 9th century, we know that there were pharmacies that we might call public pharmacies, they were mostly located in the market areas, and here a person could go and get the kinds of medicaments they needed, like compound remedies. Physicians would also send their recipes to be given to a patient and the patient would take it to the pharmacy and have it filled like we would today. There were also hospital pharmacies, and we know again from the late 9th century that the hospital pharmacies would have what we would call today an outpatient area, so a patient would go to a pharmacy in a hospital and also ask for a drug and then of course the pharmacy in a hospital would also prepare the drug for the patient in the hospital.

We even have preserved today texts of what we call formularies, which are books with recipes for these drugs, and they were again written very early from the 9th century on for use in these hospital pharmacies. We have others that were directed more towards what we might call a public pharmacy, and we have from the middle of the 13th century even a treatise written by a Jewish physician working in Cairo called Cohen who wrote a treatise not only on how to stock all of these drugs and how to make the recipes that we need, but also actually how to manage and run one, that is how you handle the accounts, what kind of staff you need for it and so on.

Some of the names of scholars which I came across in this field were Al-Kindi in the 9th century and Al-Biruni in the 11th century. Who may have contributed to this idea of pharmacies. Maybe you can elaborate on that a bit.

Well both figures you mentioned, Al-Kindi in the 9th century and Al-Biruni in the 11th, were important in terms of what you might call the theory of drugs, that is they wrote both of them rather possessively on how you classify a given drug, that is a drug would be classified in terms of its action, whether it was drying or moistening or heating something or would cool something, and then you would grade each drug on a range of say 1 to 4 or 1 to 6, in terms of the intensity of its action. And they developed different ways of classifying drugs so that a person who wants to make a recipe would know. Or if you wanted to treat a certain disease, you look for a drug that had a particular action and intensity and use it. Neither one, Al-Kindi nor Al-Biruni, ever ran a pharmacy so they are not at the practical end. They are sort of at the theoretical end, analysing the drugs that would be used in a pharmacy.

How and through what process was this immense knowledge translated into other languages and introduced into Europe eventually? I mean, what were the stages upon which this transmission took place?

Well, there were two primary areas through which this Islamic medicine and all its complexities reached and influenced Europe. One was the area of southern Italy the other is Spain, and in both of those places there were for several centuries large multi-lingual communities so these provided points of contact between Europe and the Islamic Middle East where you could find people who could translate from one language to the other. And there were two areas where the medical treatises were particularly translated. One was in Italy at the monastery at Monte Casino in the second half of the 11th century about 1080 CE, and the translations there were done by a man we call Constantine the African, who actually came from Qayrawan in North Africa, and so he could do both Latin into Arabic and Arabic into Latin. The other which ended up being a larger translation project was carried out in Spain in the following century, roughly about 1180 CE, by several scholars who worked in Toledo. One, Gerard of Cremona actually translated 68 different medical and scientific works from Arabic into Latin during his lifetime. Then there were some other places too, there were some translators, like Steven of Antioch working in Syria and Filders of Tripoli who also worked in Sicily. They did some translations, not as many as these other places but some translations are in Syria at the time of the Crusades. So those were the main points, but there were actually some translations that continued on even in the 16th and 17th centuries, and some European medics would hire a translator to translate from Arabic into Latin a treatise that he had learned about that was not available to him.

I think this does kind of answer my next question related to this area, that is some of these mainland European thinkers and scholars may not have been fluent in Arabic, so how did they go about translating Arabic into their respective languages? I think you just mentioned they probably hired people to do that.

Yes. Sometimes we know they will name two or three people that are helping them in their translation. Now some of the major translators like Gerard that I mentioned working in Toledo clearly knew both languages fairly well, both Arabic and Latin, but he would also on occasion would have another person working with him, who would do an early version, you might say, that he would work again just as you have people today who are bilingual, so there were people in earlier centuries who were bilingual and could do that kind of translation.

Another book that I came across was "The Book of Water." Can you maybe touch on this?

Well, that's an example of a treatise, despite its name, it is actually rather a general medical treatise that was translated quiet early from Arabic into Latin, but to be honest it didn't have as much influence upon European medicine as some of the ones that were translated a little bit later.

Gray's anatomy?

Well, Gray's anatomy of course is the famous anatomical reference work that all physicians today know and use. I think it would not be right to say you could find certainly medieval Islamic anatomy in that, but it represents the culmination of increased knowledge of human anatomy over centuries and of course at various points there have been important points of input in terms of anatomical knowledge. One of them being the Ibn al- Nafis' description of the pulmonary transit. Now that has never been discredited, but you will find it will not necessarily be called pulmonary transit today, but anyway it will be there in Gray's anatomy, as will also another Muslim physician observed much more closely the bones in what we call the sacrum, which is the lower back and he made some very good observations about those and about the jaw bone, the structure of the jaw bone and that has now gotten into the anatomical literature and is of course to be reflected in as one some points in Gray's anatomy today.

Judging from your vast research into this area, is there any practices introduced by Muslim scholars at that time which maybe are not being used today which you feel maybe could be used in the field of medicine to maybe improve things in this field, or is it a case that there are so many advancements through modern techniques and facilities that it is very difficult to correlate it back to that era and find techniques to probably use today?

Well, in fact I think there is increased interest in certain techniques of medieval Islamic medicine and there certainly should be, and that is I think the emphasis that Islamic physicians in the earlier period placed upon non interventionist techniques. That is, a Muslim physician in the medieval period only would resort to drugs and invasive procedures when it was absolutely necessary. Their first approach to treating any condition was to adjust the diet, to look at exercise, to change the quality of the air. They were very concerned about how pure the air was and the housing conditions. To look at, they had a very curious term for these, they called them the "six non naturals;" but these were features that were around a person they could control, they weren't part of a basic physiology that they couldn't control. So you could control your diet, you could control the air around you, you could control the amount of sleep you got, you could control the amount of exercise you get. They included bathing in this, and this was the point at which they always began treatment for someone, first you look at that. Now, obviously, if you are suddenly wounded in battle that means they are going to begin by looking at the wound, but if you come in with an ordinary illness, the approach is to look first at these elements around you, and begin the treatment with that, then only if those techniques do not work do you go to drugs and their saying was "you began first with simple drugs", just not a compound kind of fancy medication like we tend to give everyone today but a basic drug. Now it wasn't necessarily herbal, I mean you could have other things. You begin with that, if that didn't work then you would move to a compound remedy and then finally the very last resort was a kind of surgery. So basically what they had is what today we would call a holistic approach. I think we could look much more at that than we are doing today. We are in my view of course far frpù that, there are many aspects of modern medicine that I think have gone far, that could use correction.

I think Prince Charles last year mentioned something in those lines that maybe even contemporary medical practitioner should be looking at the holistic approach even alternatives, like traditional methods and complementing them with today's practices.

Yes, I agree completely. I think I don't always like the term alternative medicines, simply because I think this what we might call holistic approach that should be brought into the main stream medicines rather than making it seem as if that is just an alternative, a curious way to do it. What I would like to see is the medical professions try and incorporate this kind of approach into the mainstream medicine.

Another area that comes to mind today which many medical practitioners comment on is that mental health is going to be an issue which is going to affect a lot of people in today's western societies. Were there any innovations by Muslim scholars in the way they dealt with these symptoms? Was there such a thing as mental health in that age?

Well, there was, they were very concerned about different forms of mental and emotional illness. They had of course sometimes curious terms about depression, melancholia, fear, excessive fear and violence. There was a great deal of concern for them, and again they would approach it in somewhat the same way, particularly with mental illness. They felt that the first thing you needed to do was to look at the environment that person lived in and to make the changes in both the physical and the emotional environment. And they were great believers in the use of music for example. We have evidence that even in hospitals, musicians would be brought in at regular times to assist, particularly in wards where you have people who were emotionally and mentally distressed.

Did that have a positive impact in terms of curing the problems?

We would like to think it did, then again you see we lack information on the patients in the hospitals, we simply don't know what happened to those patients, but many of the approaches we are coming to realize today are very sound. Music can be a good therapy, they were reading poetry, reading the Quran, reciting the Quran of course. They would suggest different ways to a person, sort of using their mind or becoming more tranquil in their mind. Many recommendations of turning to the Quran and occasionally other writers for consolation and there were various ways and recommendations for handling grief. So they were very concerned about it and many of the methods that they recommended are very reasonable ones actually.

For example in the UK, there are provisions under the Mental Health Act where you could be sanctioned if you are classed as a risk to society. Was there such a system then whereby such individuals would be put in a hospital ward maybe if it was deemed that they would be such a grave risk to society? How did the Muslim scholars deal with such kind of concerns if somebody was really mentally ill?

There were wards for just the mentally ill in hospitals; in fact that is again an innovation of Muslim medicine, and we know that this practice continued on in many of the hospitals. You could be also placed in it against your will. The family had to go a Qadi (Judge) and present the case for a person being placed in such a ward when they appeared to be a danger to themselves or for whatever reason society felt that they needed to be placed there. So, yes, they did have forced containment in mental wards.

Do you have any observations you wish to make on this whole theme of the Muslim scholars' contribution towards the field of medicine?

Well, there is one thing I would like to stress actually when looking at the material that we have from the pre-modern Muslim world and medical care, and that is that there is a remarkable intellectual open mindedness in this early Islamic period. The physicians were receptive to the new ideas which included the heritage from the pre-Islamic world, all which they studied with a great deal of respect. Also non Muslim scientists and physicians, Christians and Jews in particular but also others, pagans you might say, played quite an important role in the scientific and medical communities. And when the topic was medicine particularly, Muslims very frequently taught Christians and Jews and Christians and Jews were very often teachers of Muslims, and they didn't seem to make any difference what their religious belief was, in terms of who wrote a treatise. So people who were Muslims would read treatises written by either Christians and Jews and the other way round. So it was really an open, non dogmatic, quite vibrant atmosphere, which I think encouraged people to engage in debate, shared ideas and to really seek knowledge by asking questions and examining the evidence and then applying that to developing a system of medical care and provision as well to the hospitals , that was absolutely remarkable.

At the beginning I did mention a few publications which you are working on, is there any impending publications or works which by yourself or other authors which we can look forward to reading at this stage?

Well for people who are interested in this particular topic, I must recommend the book, it's out on paperback, called Medieval Islamic Medicine and it just came out about a few months ago and is available to the Edinburgh university press in the UK. There you will find many of the ideas, many more than I've been able to discuss here, discussed in further detail and illustrated. And we hope the book is addressed to a more general public and so I would like to recommend that. I wrote it together with a former student of mine, now an established scholar in his own right and between the two of us I think we've been able to put into quite a bit of material that has not been published or known before.

Thank you very much for participating in this interview.

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