Medical Sciences in the Islamic Civilization

The medical sciences and related fields have enjoyed great peaks in achievement through Muslim scholarship, which raised both standards of practice and the status of the physician. This article delves into the vast history of Muslim contribution in medicine, while also shedding light on lesser known scholars.

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FSTC Research Team*

Table of contents

1. Origins of Islamic Medical Tradition
2. Two Famous Physicians: Ali Ibn 'Abbas and Ibn al-Quff
3. Al-Zahrawi the Genius Surgeon
4. Eye Diseases and their Treatments
5. Dentistry
6. Other Aspects of Islamic Medicine
7. Medical Institutions: Hospitals
8. Concluding Words on Islamic Medicine

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1. Origins of Islamic Medical Tradition

Islamic medicine goes back to the time of the Prophet Muhammad, and it received its impetus from both his encouragement and example. Hareth Ibn Kelda was an Arab established at Mecca, and from him the Prophet obtained something more than the rudiments of medicine, an accomplishment which contributed greatly to his success [1]. The Prophet attended the sick, gave consultations, and imparted his learning to his wives, and crucially, he recognized the paramount importance of hygiene, and inculcated its maxims upon every occasion [2]. "God has not caused a single disease to descend upon men without providing a remedy," "Diet is the principle of cure, and intemperance the source of all physical ills," were some of the aphoristical sayings whose truth he constantly impressed upon his followers [3].

Following his example, his companions and early Caliphs gave great support to medical learning, teaching and practice, and by the high Middle Ages, Islamic medicine was ripe with accomplishments. Some such achievements are outlined by Campbell:

"The Arabians raised the dignity of the medical profession from that of menial calling to the rank of one of the learned professions; they were the first to introduce systematically arranged illustrations in their medical writings, and also gave us their system of numbering which has all but replaced the cumbersome Roman numerals. They also developed the science of chemistry as applied to medicine, and considerably improved the art of dispensing by the introduction of such elegant preparations as rose and orange water. To the Arabians we owe the introduction of the idea of the legal control of qualifying examinations for admission to the medical profession, and though the idea of establishing hospitals did not originate with them, they were responsible for the establishment of a large number of these institutions [4]."

Figure 1a-c: Three pages from Al-Juz' al-thalith min kitab al-Hawi fi al-tibb (The third part of the comprehensive book on medicine) by Abu Bakr Muhammad ibn Zakariya al-Razi (ca. 865-ca. 925). (Source).

Durant makes another excellent summary of Islamic medical achievements, which is abridged here [5]. The Muslims, he says "established the first apothecary shops and dispensaries, founded the first medieval school of pharmacy, and wrote great treatises on pharmacology. Muslim physicians were enthusiastic advocates of the bath, especially in fevers and in the form of the steam bath. Their directions for the treatment of smallpox and measles could scarcely be bettered today. Anesthesia by inhalation was practiced in some surgical operations…. No man could legally practice medicine without passing an examination and receiving a state diploma; druggists, barbers, and orthopedists were likewise subject to state regulation and inspection. The physician-vizier Ali ibn Isa organized a staff of doctors to go from place to place to tend the sick; certain physicians made daily visits to jails; there was an especially humane treatment of the insane [6]."

"The Arabs," in the words of Scott, "were the first to perform the important operation of lithotomy and to reduce old dislocations. They knew how to ligature the arteries four centuries before Ambrose Pare. They used hooks for the extraction of polypi. They made frequent and intelligent use of counter-irritants. The seton is their invention. The application of leeches in apoplexy was a common incident in their practice. They were familiar with the effects of caustics and acids as escharotics. They substituted refrigerants for tonics in certain affections of the nerve-centres. They understood the value of cold water in arresting hemorrhage. They originated the modern method of bandaging. The treatment of slow fevers, like typhoid, by baths of low temperature, was frequently employed by them; it was recommended by Razes nine hundred years before its announcement to the present generation as a new and remarkable discovery. To Ibn Zuhr medical science owes the operation of tracheotomy and the original description of pericarditis. Abulcasis, in explaining lithotomy, advises the section used by surgeons ever since he wrote, in the 10th century. Nor had the advantages derived from anaesthesia escaped the notice of these profound and ingenious observers. They suggest the administration, in decoction, of darnel—the Lolium Temulentum— and other plants of narcotic properties, until complete loss of consciousness and sensation is obtained, to facilitate the performance of severe operations. Even the results of microbial infection appear to have been recognized by them, although its cause remained unknown. Nor in that early day was the care of animals neglected, and the name of Abu Bakr Ibn Badr has descended to posterity as that of a famous veterinary surgeon [7]."

Muslim science and medicine in particular, were so much more advanced in comparison to Western Christian counterpart. The 12th century Muslim historian, Usama Ibn Munquidh, relates an anecdote on the authority of Guillaume de Bures, with whom he travelled from acres to Tiberias: "There was with us in our country,' said Guillaume, "a very doughty knight, who fell ill and was at the point of death. As last resource we applied to a Christian priest of great authority and entrusted the patient to him saying, ‘Come with us to examine such and such a knight.' he agreed and set off with us. Our belief was that he had only to lay hands upon him to cure him. As soon as the priest saw the patient, he said, ‘bring me wax.' We brought him some, and he softened it and made (two plugs) like the joints of a finger, each of which he thrust into one of the patient's nostrils; whereupon he expired. ‘He is dead,' we exclaimed. `Yes,' replied the priest; ‘he was suffering, and I plugged his nostrils so that he might die and be at peace! [8]"

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Figure 2: Page from the Latin translation of Isagoge Johannitii in Tegni Galeni, a medical book by Hunayn ibn Ishaq (ca. 809-873). (Source).

Usama also narrates the following incidents, which are contained in his Kitab al-i'tibar [9]. Usama's account tells of the crudities of Western treatment [10]. The writer's uncle, a Muslim Prince, had sent a doctor to a Frankish neighbour at the latter's request. When the doctor returned after a surprisingly short period, he had a remarkable tale to tell. They brought before me, he said, a knight in whose leg an abscess had grown; and a woman afflicted with imbecility. To the knight I applied a small poultice until the abscess opened and became well; and the woman I put on a diet and made her humour wet. Then a Frankish physician came to them and said, "This man knows nothing about treating them." He then said to the knight "Which wouldst thou prefer, living with one leg or dying with two?" The latter replied "Living with one leg". The physician said "Bring me a strong knight and a sharp axe." A knight came with the axe. And I was standing by. Then the physician laid the leg of the patient on a block of wood and bade the knight strike his leg with the axe and chop it off at one blow. Accordingly he struck it - while I was looking on - one blow, but the leg was not severed. He dealt another blow, upon which the marrow of the leg flowed out and the patient died on the spot. He then examined the woman and said, "This is a woman in whose head there is a devil which has possessed her. Shave off her hair." Accordingly they shaved it off and the woman began once more to eat their ordinary diet-garlic and mustard. Her imbecility took a turn for the worse. The physician then said 'The devil has penetrated through her head.' He therefore took a razor, made a deep cruciform incision on it, peeled off the skin at the middle of the incision until the bone of the skull was exposed and rubbed it with salt. The woman also expired instantly. Thereupon I asked them whether my services were needed any longer, and when they replied in the negative I returned home, having learned of their medicine what I knew not before [11].

Scott, further observes in relation to such contrast, that "Five centuries after the Moorish physicians of Spain had treated disease by the rational principles of medicine, surgery, and hygiene, Europe still adhered to the archaic conceptions of barbaric ignorance; to the belief that all illness was a manifestation of divine displeasure; to the possession by evil spirits; to the delusive expedients of priestly artifice,—the exhibition of relics, the muttering of texts, the performance of exorcisms [12]."

These treatments contrast sharply with the Muslim, professional, and above all humane, approach. ‘Heroic' treatment was adopted only where milder means had proved unsuccessful, and whenever possible, the curative powers of nature were allowed full exercise; and a change of climate, especially in pulmonary affections, was one of the principal resources of the Moorish physicians [13]. Al-Zahrawi, for instance, demonstrates his humanity and psychological insight when talking about phlebotomy, venesection, or, in plain English, bleeding, a practice of which doctors used to be inordinately fond:

"Let him endeavour on that day to have his mind free from all such spiritual afflictions as anxiety, anger, or fear. There should also be in the place where he is sitting such things as are customary for men to enjoy, such as perfumes, aromatics, and music, and the like [14]."

There is a very human touch in al-Zahrawi's gruesome description of the treatment of nasal polyps. He explains how you deal with them, with hook and scalpel, then tells what must be done if the polyp is in the upper part of the ethmoid bone where your instruments cannot reach. In this case you must take a linen thread, rather thick, which may knotted; the idea is to get the thread into the nose, with the other end coming out of the mouth then, using the thread as a saw, you saw the polyp off. Now how do you get the thread into that position? Al-Zahrawi's directions are firm; he obviously was not going to put up with any nonsense from patients:

"Let the patient contrive to get one end of the thread into his nose with a probe or anything he can. Let him make a full inspiration until it reaches the cartilage and comes out through the throat. Boys at school often do this sort of thing; it is quite easy for anyone who wishes [15]."

Al-Zahrawi is one of the many Muslim physician scholars that marked the medieval Islamic period. Some such names and their accomplishments ought to be cited before other accomplishments of Muslim medicine are looked at.

2. Two Famous Physicians: Ali Ibn 'Abbas and Ibn al-Quff

It is worthless going through all Islamic physicians, some sources such as the web-site Muslimheritage.com having already devoted large space to many such physicians. Here, there won't be much on the scholars who have already been widely written about in the web-site already cited, and also in literature as a whole, scholars such as Ibn Sina, Al-Razi, Ibn Al-Nafis, etc, but on other scholars such as Al-Majussi, Ibn al-Quff, Al-Tabari (the medical scholar), who have not benefited of much focus, but whose contributions to the subject have been crucial.

Haly Abbas, as he is best known in medical histories, whose real name is Ali ibn-al-Abbas al-Majusi, was born in Ahwaz (died in Shiraz in 994/5). He studied medicine under Abu Mahir Musa ibn Yusuf ibn Sayyar in Shiraz and referred to him in grateful terms more than once [16]. Later Ali Abbas was court physician to the great patron of medicine, Azud al-Dawlah, in Shiraz, before he went to Baghdad, and later built the famous Azudi Hospital in that city [17]. But before going to Baghdad he had built a fine hospital in Shiraz, where Ali ibn Abbas was the physician [18].

Ali ibn Abbas was not a prolific writer, in fact his only book, named in Arabic, Kitab al-Maliki, the Royal Book, or in Latin, Liber Regius, made up for the paucity of his writings; Browne calls, the Liber Regius as "the most accessible and most readable of the great Arabic Systems of Medicine [19]." Ali ibn Abbas, who according to Haskins was "one of the outstanding Arabic writers", had planned his al-Malaki (or Regalis Dispositio) as a comprehensive treatise on medicine, intermediate between Al-Razi's two works: the enormous al-Hawi (The Comprehensive Book) and the concise Liber medicinalis [20]. This book (of which a copy is preserved in the National Library of Medicine at Bethesda) is very well systematised and organised [21]. The Arabic text consists of 400,000 words and is divided into 20 discourses, each divided into numerous chapters, of which the first ten deal with the theory, and the second ten with the practice of medicine; the nineteenth discourse, containing 110 chapters, is devoted entirely to surgery [22]. The work is divided into two basic volumes of ten chapters each, one volume covering theory, the other practice. The first volume deals with historical sources, anatomy, faculties, the six primaeval functions, classifications and causations of disease, symptoms and diagnosis, urine, sputum, saliva and pulse as an aid to diagnosis, external or visible manifestations of disease, and internal diseases like fever, headache, epilepsy, and warning signs of death or recovery [23]. The second volume deals with hygiene, dietetics, cosmetics, therapy with simple drugs, therapy for fevers and diseases of organs; that is respiration, digestion, reproduction etc. There is a chapter on surgery, orthopaedics, and finally treatment by compound medicaments [24].

The introductory part of the book, the first three chapters of the first discourse, was devoted to a review of the earlier authorities in medicine. Ali Abbas found Hippocrates too concise and Galen too diffuse, al-Razi's al-Hawi too discursive and badly organised, and his al-Mansruri too concise [25]. Ali Abbas then discusses his own writing of the Liber Regius, in which he adopts a middle ground between prolixity and undue conciseness. This he shows by his description of pleurisy. He begins with the definition of the condition and its cause; then he gives the four essential symptoms of the lesion - fever, cough, chest pain and dyspnoea; then he discusses the prognosis and finally the treatment [26]. At the end of the chapter he puts under emphasis the importance of the training a physician should follow:

"And of those things which are incumbent on the student of this art are that he should constantly attend the hospitals and sick-houses; pay unremitting attention to the conditions and circumstances of their inmates, in company with the most acute professors of Medicine; and enquire frequently as to the state of the patients and the symptoms apparent in them, bearing in mind what he has read about these variations, and what they indicate of good or evil. If he does this, he will reach a high degree in this art. Therefore it behoves him who desires to be an accomplished physician to follow closely these injunctions, to form his character in accordance with what we have mentioned therein, and not to neglect them. If he does this, his treatment of the sick will be successful; people will have confidence in him and be favorably disposed towards him, and he will win their affection and respect and a good reputation; nor withal will he lack profit and advantage from them. And God Most High knoweth best [27]."

Browne calls attention to an important discussion in the Liber Regius that gives the first intimation of a capillary circulation. This passage, which occurs in the chapter treating of the Animal Virtues or Vital Functions, deals chiefly with the two opposite movements of expansion and contraction, which in the heart and arteries constitute diastole and systole, and the respiratory movements of inspiration and expiration. These movements are compared to those of bellows, except that they are produced by internal, not by external, forces; and it is supposed by the writer that the heart draws air from the lungs to mix with the blood for the elaboration of the vital spirit, just as the lungs inhale it from without, and that the vaporised vitiated air is expelled by the reverse process [28]. Then he goes on to say:

"And you must know that during the diastole such of the pulsating vessels (i.e. the arteries) as are near the heart draw in air and sublimated blood from the heart by compulsion of vacuum, because during the systole they are emptied of blood and air, but during diastole the blood and air return and fill them. Such of them as are near the skin draw air from the outer atmosphere; while such as are intermediate in position between the heart and the skin have the property of drawing from the non pulsating vessels (i.e. the veins) the finest and most subtle of the blood. This is because in the non-pulsating vessels (i.e. the veins) are pores communicating with the pulsating vessels (i.e. the arteries). The proof of this is that when an artery is cut, all the blood which is in the veins also is evacuated [29]."

In Salerno, Italy, and under Constantine the African's versions (Constantine was the Tunisian born scholar) was made the translation of Ali Abbas al-Majusti's Kitab al-Malaki. Thus from Al-Qayrawan north to Europe arose "a generation of prominent medical teachers [30]." Stephen of Antioch, for instance, a Pisan, trained apparently in the school of Salerno in Sicily, followed his countrymen to Antioch (Syria). There, he translated in 1127 the medical writings of Ali Ibn Abbas and planned further versions from the Arabic [31]. Stephen's translation of the Liber Regalis is found in numerous manuscripts and two early editions printed at Venice in 1492 and at Lyons in 1523 [32]. The book (like most Muslim works of the sort) includes the usual two parts: Theoretica and Practica (theory and practice), each in ten books. The Theoretica had previously been translated into Latin under the title Pantegni by Constantine the African, whilst the second half, Practica, was translated partly by both him, and his pupil John ‘the Saracen' and a Pisan physician named Rusticus during the great expedition against Majorca in 1114 [33]. Stephen notes in the preface that when he came upon Ali's book in Arabic, he found there was no complete Latin version, while what Constantine had translated suffered from omissions and transpositions, which prompted him to prepare an entirely new version [34].

Figure 3: View of Kitab al-Malaki (Royal book) of Ali ibn al-‘Abbas al-Majusi (fl. 940-980), known as Haly Abbas, which exerted a strong influence on the Western universities. Dedicated to a Prince of Shiraz, this well-organized compendium of medical theory and practice purported to contain everything a physician needed to know for proceeding with treatment. (Source).

Ibn al-Quff, born in Karak (Jordan, 1233; d. Damascus, 1286), was involved in medicine, physiology, natural sciences, and philosophy. Ibn al-Quff's father, Muwaffaq al-Din Yaqub, was a Christian Arab (an adherent of the Imperial Orthodox Church), who held an important governmental position under the Ayyubids in Karak. These facts are reflected in his cognomens al-Masihi (the Christian) and al-Karaki. When Muwaffaq al-Din was promoted to the position of a secretary-scribe of the high court, the family moved to Sarkhad in Syria. There Muwaffaq al-Din met and formed a close friendship with the physician-historian Ibn Abi Usaybiah (1203-1270) [35], who spoke of him as "a learned scholar, unequaled scribe in the elegance and perfection of his handwriting, a man of letters, a competent historian, and a pleasant companion, witty and respectable [36]."

Upon the father's request, Ibn Abi Usaybiah agreed to teach young Ibn al-Quff the healing art. The tutor was soon impressed by the brilliance and aptitude for learning of his new student. He also found him fond of reading biographies of illustrious sages, and inclined to quiet, thoughtful meditations. Ibn Abi Usaybi'ah began to teach young Ibn al-Quff with the assistance of preliminary and fundamental texts on the healing art, such as the Masa'il (an introduction to medicine) of Hunayn ibn Ishaq, and the Aphorisms and the Prognosis of the Hippocratic corpus in the Arabic version as rendered also by Hunayn ibn Ishaq. Through the study of leading manuals, such as those by al-Razi, Ibn al-Quff was instructed by Ibn Abi Usaybiah in the classification and treatment of diseases, and their causes and symptoms [37].

Later, Ibn al-Quff's father was transferred to the high court in Damascus, and the family moved to the Syrian capital. Here, Ibn al-Quff studied metaphysics, philosophy, medicine, natural sciences, and mathematics. He was then appointed an army physician-surgeon at the citadel of Ajiun in Jordan, where he stayed for several years. After his fame had spread, he was transferred to Damascus, where until his death at the age of fifty-two, he taught medicine and performed his professional duties among the soldiers stationed at the citadel [38].

Despite his absorbing responsibilities as physician-surgeon for the Mamluk army, Ibn al-Quff was also a prolific author. Ibn al-Quff's main works are a medical compendium, Kitab jami' al-gharad fi hifd al-Sihha wadaf al-marad (Compendium of What One Should Know to Preserve One's Health and Avoid Disease), and a treatise on surgery, Kitab al-umda fi sinaat al-jiraha (The Pillar of Surgery) [39]. The second of these works is divided into two parts, theory and practice, each of which contains ten chapters [40]. The first part begins with an elaborate anatomical introduction, then deals with pathology, and a classification of diseases [41]. In chapter 19 the author explains four methods of circumcision, and a new method of lithotomy applicable to women [42]. In Kitab al-Umda, Ibn al-Quff also describes the vital connection between the arteries and veins and the passage of life-giving blood and pneuma from the former to the latter; a reference to the capillaries made nearly four centuries before the work of Malpighi, who benefited from the use of the microscope [43]. Ibn al-Quff also explains the function of the cardiac valves, their number, and the direction in which they open and close. He also appealed for all the Arab lands to standardise the weights and measures used in pharmacy and medicine [44].

Ibn al-Quff also wrote an elaborate commentary on Hippocrates' Aphorisms, Kitab al-usul fi sharb al-fusul, which is extant; and commentaries on the Qanun and the Kitab al-isharat of Ibn Sina, which are lost. Various other medical works are ascribed to him [45]. His Jami al-Gharad on embryology, child growth, diet and drug therapy, the preservation of health, and physiognomy contains original approaches and ideas. For example, he theorised on the genesis of the embryo and the stages it passes through in its growth, especially the appearance of a foam like cluster after the sixth day of fertilisation, and on the early formation of the embryo after the twelfth day. He spoke of how "the head distinctly emerges as separate from the shoulders . . . and that the brain is the first major organ to develop [46]." Also found are his instructions on what should be done to the infant at birth and thereafter, which are of great historical interest [47].

Finally, from the eastern side of Islam is al-Tabari, not the historian, but the medical scholar. At this juncture, too, there appeared an encyclopaedic work, Ali Tabari's Paradise of Wisdom, which gave an overall picture of the position of Arab men of learning. The son of a doctor of Tabaristan, Ali Tabari came to Baghdad, and eventually, at the age of seventy, was there converted to Islam [48]. At that advanced age he produced an apologetic which was well above the ordinary. His major work is a series of observations on the most diverse subjects, the documentary sources of which are Greek and Indian. From preliminary philosophic discussions the book moves on to embryology and a consideration of the health value of different kinds of food and drink. A quick survey of the number of muscles, nerves, and veins is then followed by a review of tastes, smells, and colours, and methods of treatment based on pharmacology and toxicology [49]. Next came a chapter on a subject new in Muslim medical literature: a study of climates, waters, and seasons in relation to health. Then, an outline of cosmography and astronomy, followed by an essay on the utility of medicine, with a summary of Indian medicine. A final section deals with general pathology, diseases of the head, heart, and intestines, nervous diseases, and fevers. The work was in many respects ahead of its time. It is interesting to note the order of diagnostic procedure laid down: the appearance and nature of the affected part, signs of palpitation, any disturbance of function, difficulty of evacuation, possible secondary effects, and lastly, the interrogation of the patient [50].

The accomplishments of the Muslim scholars on medicine in the Iberian Peninsula have been largely seen on MuslimHeritage.com to warrant any more space. All that is necessary here is this briefest outline by Scott who sums up their accomplishments. No names in the long catalogue of Muslim genius, Scott holds, stand higher than those of Abulcasis (Al-Zahrawi), the originator of modern surgery, ; than Ibn Zuhr (Avenzoar), whose family was prominent for three hundred years in the medical annals of Muslim Spain; than Averroes, whose great professional attainments have been obscured by his pre-eminent reputation as a natural philosopher. Arib Ibn Said al-Khatib, whose works exceeded a thousand in number, composed treatises on gynecology and obstetrics, and was the author of the Calendar of Cordova, a wonderful compilation of medical truths, surgical maxims, astronomical and agricultural knowledge. Ibn Wafid, of Toledo, who lived in the 10th century, and whose extraordinary abilities made him conspicuous among hundreds of eminent contemporaries, consumed twenty years in the preparation of his work on the general practice of medicine. Ibn-Zuhr was the first to discover that scabies was produced by a diminutive parasite, and to prescribe sulphur as a remedy. The treatise of Mohammed Ibn Qassum on diseases of the eye occupied six hundred pages; that of Mohammed al-Temini on hernia and tumors nearly four hundred. Daoud-al-Agrebi wrote on fumigations, collyriums, hemostatics; he recommends the administration of narcotics in lithotomy, in the incision of abscesses, and in emasculation for the production of eunuchs. Saladin-Ibn-Yusuf published a book on the anatomy of the eye and the theories of vision [51].

3. Al-Zahrawi the Genius Surgeon

The scientific and logical methods inaugurated by the Caliphs of the East were perfected in the medical colleges of Muslim Spain. The study of anatomy attained a development previously unknown to the traditions and experience of the profession. From the contemplation of bone-heaps in the cemeteries the student advanced to the performance of autopsies; to the determination, by actual survey, of the location and offices of the internal organs; to the vivisection of quadrupeds and criminals [52]. In etiology, pathology, therapeutics, great progress was made [53].

Surgery, whose practice had entailed reproach rather than distinction upon its Professors, was, by the removal of the prejudice attaching to anatomical demonstration, relieved of the obloquy with which it was generally regarded; a blind reverence for precedent and authority was not recognised by the practitioners of the Hispano-Muslim school [54]. They inculcated the paramount importance of a competent knowledge of the functions of the organs of the human body, which they well knew could only be obtained from the practice of dissection. They advised great caution in all operations, and every new theory was subjected to severe and exhaustive tests [55]. Their works were elucidated by the introduction into the text of drawings of instruments adapted to the removal of the morbid conditions described; and science is indebted to the Spanish Muslems for this innovation, now an essential part of all treatises on surgery [56].

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Figure 4: Detail from the Latin version of Haly Abbas's Liber Totius Medicine Necessaria (1523). (Source).

Perhaps the most famous physician and surgeon of the Umayyad age in Spain was Abul-Qasim Khalaf ibn Abbas al- Zahrawi, known to the West as Albucasis (A.H.318/A.D. 930 to A.H. 403/A.D. 1013). He gained great fame as a physician, and wrote a major compendium of extant medical knowledge entitled Tasrif, known in Latin as Liber Servitoris, which comprises thirty volumes [57]. The initial volumes dealt with general principles, the elements and the physiology of humours, and the rest dealt with the systematic treatment of diseases, from the head to the feet. The last volume is perhaps the most important in that it deals with all aspects of surgery [58]. Al-Zahrawi's al-Tasrif, includes many surgical instruments, which Al-Zahrawi devised and constructed, and a number of surgical procedures [59]. It was the first textbook of surgery with illustrations of the instruments used ever to be published [60]. He explains with the aid of drawings the use of such instruments, and surgical operations in great detail [61]. He then shows what a practical man he is by adding:

"Now I have arranged this Book on cauterisation by chapters, set in order from the head to the foot, to make it easier for the seeker to find what he wants." And that is the system he follows in the other two Books [62]. It gained such great fame that it became the standard textbook of surgery in important universities in Christian Europe, and was widely read. Al-Zahrawi emphasised that knowledge of anatomy and physiology was essential prior to undertaking any surgery [63].

"Before practicing surgery, he [the surgeon] should gain knowledge of anatomy and the function of organs so that he will understand their shape, connections and borders. He should become thoroughly familiar with nerves, muscles, bones, arteries and veins. If one does not comprehend the anatomy and physiology one can commit a mistake which will result in the death of the patient. I have seen someone incise into a swelling in the neck thinking it was an abscess, when it was an aneurysm, and the patient dying on the spot [64]."

Al-Zahrawi describes instruments designed and constructed by him, and their use. Here he tells of the tonsil-guillotine, and first describes a tongue-depressor made of gold or silver and slender like a knife:

"And when the tongue is depressed with its help, the tumour will be made manifest to you. Take a hook, fix it in one tonsil and pull it forward as far as it will go, but be careful not to pull any of the mucosa away with it. Then cut it with an instrument of this form; it is like scissors except that its extremities are curved, the beak of each meeting the other, and very sharp. It should be made of Indian iron or Damascus steel [65]."

Figure 5a-b: Page of Yuhanna Ibn Masawayh's (d. 857-858) Liber de simplicibus (13th-14th centuries). Treasured in the Middle Ages as a sort of "physician's desk reference," this work on simples and their applications has a remarkable number of decorative initial letters. (Source).

He also gives what may be the first description of a true syringe. He calls it zarraqah, "shooter" projector:

"It is made of silver or ivory, hollow, with a long fine tube, fine as a probe; entirely hollow except for the end, which is solid with three holes in it: two on one side and one on the other. The hollow part containing the plunger (al-midfa) is exactly of a size to be enclosed by it so that any liquid is drawn up with it when you pull it up; and when you press it down it is driven in a jet, as is done by the projector whereby naphtha is thrown in naval battles [66]."

Having described the use of the packing-stitch for suturing wounds, he says:

"With this stitch I once sewed up a wound that a man got in the belly. He had been wounded with a knife; the opening of the wound was more than a span long, and by that time there protruded some two spans length of his mid-gut… The wound healed in about a fortnight, and I treated him until he was better; he lived for many years after, carrying on as usual. The verdict of the doctors had been that he could not be healed [67]."

Some operations described by him are carried out even today in the manner he described almost one thousand years ago [68]. These include operations on varicose veins, the reduction of skull fractures, dental extractions, and the forceps delivery of a dead foetus, to mention just a few [69].

There is more than a touch of pride too when he explains the importance of knowledge of anatomy:

"He who is not skilled in anatomy is bound to fall into error that is destructive of life. I have seen many laying claim to this knowledge and boasting of it, but having neither knowledge nor experience [70]."

He gives several grisly examples, including this:

`I saw another doctor who had a regular salary from one of the high officers of our country for medical treatment. A black slave of the officer's suffered a fracture of the leg near the heel, together with a wound. The doctor rushed in, in his ignorance, and bound up the fracture over the wound, very tightly, not allowing the wound to breathe. Eventually the slave's leg and foot swelled and he was close to death. I was called in and made haste to loosen the bandage, but gangrene had already taken hold and it continued to extend until he perished [71]."

Figure 6a-b: Two pages from volume 30 of the book of medicine and surgery Al-Tasrif by Abu-l-Qasim al-Zahrawi (Abulcasis), as preserved in a manuscript in The Institute of Manuscripts of Azerbaijan National Academy of Sciences in Baku. (Source a) - (Source b).

But he also records at least one instance where he was wrong and not another doctor but the patient was right:

"What I am going to tell you is exactly what happened to a certain man's foot. He had a blackening of the foot, with a burning like fire. When he saw the disease spreading in the limb, he hastened to amputate it himself, at the joint, and he got better. After a very long time had passed, the very same kind of disease arose in the forefinger of his hand. He came to me and I attempted to suppress the superfluity with remedies applied to the hand. But it was not to be suppressed and began to spread to the second finger and eventually to the whole hand. He urged me to cut off his hand but I did not wish to do so . . . for his strength was declining. When he despaired of me, he went back to his own country, and I then heard that he had gone and cut off his hand and had got well [72]."

In conclusion, as Nagamia notes, surgery in the Muslim world was raised by al-Zahrawi to the level of a high science at a time when in the Christian West, the Council of Tours declared, in 1163, "Surgery is to be abandoned by all schools of medicine and by all decent physicians [73]."

4. Eye Diseases and their Treatments

The treatment of the eye received more attention from the Muslims than any other branch of the profession [74]. From the very early stages, ophthalmology and eye surgery received focused attention, and Islamic ophthalmology is reckoned by many to be of the highest order [75] with Muslim oculists as the most accomplished operators [76]. One reason, possibly, for the advance of the science was its high incidence amongst the population, and the fact that Muslim eye surgeons were able to use freely available eyes [77]; the heat and dryness of the climate being favourable to ophthalmic affections and affording the surgeon varied and incessant practice [78]. Nearly every medical compodium covers some aspect of eye diseases, although the best is by monographs solely devoted to the subject [79]. They enumerate nine different forms of cataract, which they treated by couching and by puncture. Their needles were both round and triangular; some were hollow and made of glass [80].

This advance produced a number of outstanding scholars and works.

By far, one of the earliest scholars in the field was Ali Ibn Issa (Jesu haly) (d.1010), from Baghdad. His Tadkiratul-Kahhaleen (Notebook of the Oculist) is the second oldest complete text extant in Arabic on the eyes, and is based on older texts as well as personal experience [81]. The book is in three parts, the first, devoted to anatomy, the second to the external diseases of the eye, and the third part to internal diseases of the eye which are not visible upon inspection [82]. We are interested in the third part which includes general ophthalmological medicine. He describes the effects of 143 drugs [83].

Here follow a couple of recipes from Issa's book.

"Prescription for a collyrium which sharpens and strengthens the sight. Take equal parts of sagapenum resin, opopanax resin, saltstone, verdigris, white pepper, asafetida, balsam oil, gall of a bull, long pepper, and ginger. The number of drugs is ten. These are kneaded with fennel juice after which it is finely pulverised. The eye is rubbed with it."

Further, "when you dissolve a little opopanax resin in basil juice, it is useful when it is rubbed in the eye. Or one may take the juice of green, unripe pomegranates, it is cooked down to its half, then honey is added, and then it is left for 20 days in the sun; it is rubbed on to sharpen the sight [84]."

Issa's book was the most widely referred to text book by later ophthalmologists. First translated into Persian and then into Latin and printed in Venice in 1497, his work was used as a text book in Europe till the 18th century [85]. It was translated with commentary into German by Hirschberg and Lippert (1904), as already noted, and into English by Casey Wood (1936).

Figure 7a-b: Two pages from the original manuscript of Al-Tasrif depicting surgical instruments. © Institute of Manuscripts of Azerbaijan National Academy of Sciences in Baku (Source a) – (Source b).

Famous contemporaries of Isa Ibn Ali was Al-Mosuli from Mosul in Iraq. His Kitab-ul Muntakhab fi Ilaj-ul Ayn (Book of Choices in the Treatment of Eye Diseases) discusses forty eight diseases. The translation of this work has been accomplished in German, and it highlights many of the accomplishments of al-Mosuli [86].In the following are recipes by Al-Mosuli to heal eye disorders and diseases. Al-Mosuli states:

"In the treatment of ulcers, the best for treatment is the following collyrium. It effects healing and allows natural flesh to grow there so that, after the cure, no spot remains in the eye. Watch that when the ulcer is treated with anything else. The eye must be bound from the beginning of the ailment."

Prescription for lead collyrium for ulcers:

"Take 8 dirhams each of gold colored calamine, white lead and burnt copper, 4 dirhams of burnt lead, 30 dirhams of antimony sulfide, 8 dirhams each of strong gum arabic and tragacanth, 1 dirham each of myrrh and opium, and 5 dirhams of incense. These drugs are put together, pulverised, sieved, and kneaded with potable water. Small cakes are made of them which are dried in the shade, then used.

Watch that when using a mineral drug which has not been properly pulverised for the remedy which is used in ulcers it should not prick the eye. Be careful in the same way with other remedies. I myself have treated ulcers with this remedy all my life. It is the best."

"If a small spot remains, then prepare a calamine collyrium so that no other be used. Prescription [of the calamine collyrium]: Five dirhams of white lead, 2 dirhams each of gum and tragacanth and 1 dirham each of opium and silver colored calamine are gathered, pulverised and sieved, and kneaded with rainwater and egg white. A collyrium is prepared from it and some rubbed with milk when it is needed and dripped into the eye [87]."

In discussing the treatment of a cataract, Al-Mosuli presents four detailed cases and an instrument of his own design, a hollow needle to remove cataract by suction, inserted through the limbus (where the cornea joins the conjunctiva). Until the 20th century, this work was only available in Arabic and a Hebrew translation of the 13th century. The German translation is recent and is by J. Hirschberg (1905).

On this subject of the cataract, Al-Zahrawi tells us, in the course of some of the more horrendous operations, to give the patient a rest from time to time, for instance in couching for cataracts. The method is to insert the couching needle, miqdah, into the white of the eye and press the point down. The illustration shows the needle as broadening out from the tip, like a spatula. He goes on, and this is an interesting sidelight on the difficulties in the way of the transmission of information before the days of journals and international congresses:

"I have heard that a certain Iraqi has said that in Iraq he makes a hollow needle, miqdah manfud, by which the humour is sucked out. In our land I have never seen anyone do it in this fashion, nor have I read of it in any of the books of the Ancients; perhaps it is a new invention [88]."

Syria produced a number of eminent writers in the field. Salah al-Din wrote Kitab Nur al-uyun wa-Jami al-Funun (Light of the Eyes..), which is most particularly interesting in its mention of all preceding authorities and their works, including Ali.b. Isa, Ammar, Ibn Jazla...

Khalifa al-Halabi (mid 13th) of Aleppo, wrote his Kitab al-Kafi fi al-Kuhl (Book on the Adequacy in Ophtalmology) in which he mentions eighteen major ophtalmological texts. His work is very practical too, with very good descriptions of cataract operations, the instruments used, and also the steps to be taken after the operation [89].

Al-Mahasin (13th century) also of Aleppo, is the author of a large work of 564 pages in which he describes and gives drawings of various surgical instruments including 36 instruments for eye surgery.

Completing this list of an otherwise longer one, are Al-Ghafiqi and Ibn Sina. Al-Ghafiqi (d. 1165), from Spain, wrote Al-Murshid fil Kuhl (The Right Guide in Ophthalmology). The book is not just confined to the eye but also gives details of the head and diseases of the brain. In the Kitdb al-murshid fi 'l-kuhl, al-Ghafiqi describes treatment for pustules of the eyelid, which is of interest when considered together with his great work on simple drugs [90]. Throughout this text on ophthalmology, the author is well oriented toward the use of drugs, both internally and externally. Al-Ghafiqi informs us that hard and small pustules appear especially on the eyelids of adolescents and young girls. They originate from a thick vapor. He gives the treatment:

`It is necessary to approach the eyes with two droppers. From one, there comes out very hot water in which has been boiled dill, camomile, and melilot. Then, the eyelid is coated with juice of wild cucumber or take finely powdered Yemenite alum. Then take after that terebinth gum; put it in a small fire and pour alum in it. Finally, put it on the pustules to extirpate them. Take some natron and gum arabic in equal parts. Pulverise them with a palm branch and apply. If that does it, it is good. If not, then open the cephalic veins [91]."

As for Ibn Sina, whilst his Qanun had more than thirty Latin editions since the 16th century, its section dealing with ophtalmology has been the subject of special study on the part of modern medicine [92].

5. Dentistry

With regard to teeth and their treatment, these vary from their hygiene to the operations relating to them.

With regard to dental hygiene, the Muslims innovated with the miswak, certainly the first cleansing tooth-brush in history [93]. Gustav Nachtigal, the famous 19th century traveller and explorer of the Sahara and Sudan, relates that the women of Wadai, a region in the Sudan, rarely go out without their toothbrushes in the corner of their mouths [94]. These toothbrushes are, as he says, prepared from the wood of the siwäk (Salvadora portico L.) which has been made fibrous at the end, and as soon as they sit down they use these brushes diligently [95]. Reporting in an article in 1915 the information of Max Meyerhof, an ophthalmologist who had practiced for many years in Cairo, Wiedemann declares that the Nubians always carry with them a wooden stick of about 15 to 20 cm, called siwak, to which they probably owe their shiny white teeth [96]. It is not something only common to these Nubians, but widespread amongst Muslims, and even nowadays some Muslims belonging to a religious movement called Jamaat al-Tabligh can often be seen wearing the siwak in their breast pockets, which they use on every suitable occasion [97]. In this way, all these Muslims follow the example of the Prophet who according to the Hadith, was a fervent supporter of its use [98]. The siwak was, according to him, a purgative for the mouth and a pleasure for Allah. When the Prophet came into his house, he first of all used the siwak. When he woke during the night, he cleansed his mouth with it, then washed himself and prayed [99]. The extent to which the use of the siwak in the Muslim mind is associated with the Prophet may be illustrated by the fact that the tree from which the siwak was prepared was called siwak al-nabi or "siwak of the Prophet" in Algeria [100].

Figure 8a-b: Front views of two Islamic hospitals: The bimaristan of Nur al-Din in Damascus, founded in 1154, and the Complex of Sultan al-Mansur Qalawun (Mausoleum, Madrasa and Hospital) in Cairo, founded in 1285 . (Source a) - (Source b).

The kind of wood recommended for the preparation of the toothbrush called siwak or miswak [101] is that of the arak tree. Abu Hanifa al-Dinawari, for instance, states that this tree is best known for the preparation of the miswak from its roots, branches and suru [102]. Nachtigal informs us that this kind of wood has the quality of making the breadth of the women of wadai sweet smelling [103]. Wiedemann states that the toothbrush used in Egypt is exclusively prepared from this wood [104], whilst al-Dinawari lists a number of other kinds of trees [105].

Al-Washsha (d. 936) in his kitab al-muwashsha, and handbook for good manners and etiquette is a good window on the subject [106]. He formulates certain rules for its proper use:

`For the cleaning of the teeth with the miswak definite times of the day and places have been prescribed. One should not use it at improper times nor should one go beyond the times fixed for it. One may use it in the morning and evening, during the afternoon, before daybreak and after prayer. It is also permitted to use the miswak on an empty stomach, before going to sleep and during the daytime when fasting. Fine, well-educated people are not allowed to use the siwak in certain places as, for instance, in the toilet, in the bath, in the middle of the street, and among many people. None of them cleans his teeth when standing, reclining upon his side, or lying down. Neither does he clean them when everyone is looking at him, or when he is speaking. To use the siwak on the toilet and in the bath belongs to the bad habits of the low and common people for such an abuse weakens the gums and worsens the breath of the mouth. Well-educated, respectable and fine people never behave in that way [107]."

A century or so earlier, Hunayn B. Ishaq (809-873) wrote a work on dentistry, kitab hifz al-Asnan wa al-litha (On the Preservation of the Teeth and Gums) which is till in manuscript form [108]. Fragments, however, are cited by al-Razi in his al-Hawi (Liber Continens) [109]. Quoting Hunayn, he remarks:

`and if anyone wants his teeth and gums to stay healthy… they should beware of pieces of food left between the teeth, and clean their teeth painstakingly without unsettling them and without wounding the gums. And excessive use of the toothpick (idman al-Khilal) and playing with it wounds the gums [110]."

Hunayn also warns against too much use of the miswak, for it ends up weakening the teeth and make them go rotten [111]. It is obvious that Hunayn treated patients who suffered from diseases of the teeth caused by an excessive use of toothbrush and toothpick, whilst he recognises their wholesome effect when used moderately [112].

Muslim dentistry had another aspect, the surgical aspects. Here are one or two examples from Al-Zahrawi's contribution to such an aspect of dentistry:

`When, in extracting a tooth, the broken-off root remains behind, you should apply cotton-wool soaked in butter for one or two days to soften it, then insert the tongs with stork-billed jaws. The points should be made like a file or rasp on the inside. If this does not work, dig down over the root and remove all the flesh, then insert the instrument resembling a small crowbar (‘atala). If the root comes out, well and good; if not, try the other instruments here depicted [113].

image alt text

Figure 9: Medical prescription issued by the director of the Bimaristan Qalawun dating from the 9th century H/15th century CE, Mamluk period. © Museum of Islamic Art in Cairo. (Source).

After describing and illustrating a whole series of picks and probes - with triangular points, forked, hooked - he says:

"You should know that dental instruments are very numerous, as are the other instruments, almost countless. And the experienced worker with a knowledge of his craft may devise fresh instruments as his work on actual cases suggests them to him. For there are certain ailments for which the Ancients did not mention any instrument, because of the variety of their types [114]."

He describes how to cut down projecting teeth, prefacing his remarks with "When teeth grow in other than their natural place, the appearance is very bad, especially when it occurs in women or slaves." His account of how to secure loose teeth (292) is particularly interesting:

"When the front teeth are loosened by some blow or fall and the patient cannot bite his food lest they fall out, and you have tried, unsuccessfully, treating them with styptics, the technique is to bind the teeth with gold or silver wire. Gold is the better, for silver oxidizes and corrodes after some days, but gold remains for ever in its state [115]."

The wire should be of moderate thickness, in keeping with the distance between the teeth. Take the wire and run it doubled between two sound teeth then, with the two ends of the wire, weave between the loose teeth, one or several, until you bring your weaving to a sound tooth on the other side. Then repeat the weaving, back to the side where you began; tighten it gently and judiciously till they do not move at all. Then cut off the ends of wire, bring them together and twist them with forceps and hide them between a sound tooth and a loose tooth so as not to hurt the tongue. But if it comes undone or breaks, bind them with another wire; so may he have the use of them all his life [116].

After one or two teeth have fallen out, they may be restored to their place and bound in as instructed, and become permanent. Sometimes a piece of ox-bone may be carved and made into the shape of a tooth. . . and fastened as we have said, and it will last and he will get long service from it [117].

6. Other Aspects of Islamic Medicine

Hygiene and prevention played major roles in Islamic medicine. It was a cardinal principle of Islamic pathology that overtaxing the digestive organs was the cause of a multitude of disorders [118]. The abstentious and temperate habits which characterised the 1ife of the desert were impressively inculcated by the Qur'an and the entire body of Muslem tradition [119].

Muslims also adopted other techniques for healing, such as cautery as seen here with al-Zahrawi with the following instances. He refers to the common saying that the cautery is the end of medicine, "al-kayy akhir al-tibb." Which is true, he says, but not in the way they mean:

"For they believe that after the cautery no treatment. . . will help. It means precisely the opposite: after various treatments have been applied. . . then last of all we apply cauterisation and this proves effective, whence the saying that the cautery is the end of medicine; not in the sense in which it is held by the laity and many ignorant doctors [120]."

So he prescribes cauterisation for headache, epilepsy, incipient hunchback, cataract - not on the eye itself but on the middle of the head and on the temple - warts, dropsy, diarrhoea, and almost anything you can think of [121].

On incising a tumour of the liver, he says:

". . . Mark the place of the swelling with ink, then heat in the fire the cautery that resembles a probe, and make one cauterisation until the whole thickness of the skin is burnt through, finishing up at the capsule so that all the purulent matter comes out. Then apply the treatment for wounds. But in my opinion it would be better to pass it by [122]."

The text of his treatise does not make it clear but an illustration in the manuscripts does, that what he calls the cautery resembling a probe is in fact a trocar together with a cannula, a tube through which it passes so as not to hurt the patient more than necessary: this seems to be original with Al-Zahrawi [123].

For some ailments he advises cauterisation with various caustic materials, not with the actual cautery. One such is non-chronic migraine:

"Take one clove of garlic, peel it and cut both ends off. Then cut open the site of the pain in the temple with a broad scalpel till there is room to contain the clove under the skin, then introduce it under the skin till it is completely hidden. Then bind up the wound tightly and leave for 15 hours, then unbind it, remove the garlic and leave the wound open for two or three days; then apply cotton wool soaked in butter until it suppurates. Then dress with ointment until it heals [124]."

In general, however, he prefers the cautery:

"You should know, my sons, that . . . fire is a simple substance having no action except upon the part cauterised; nor does it do more than slightly hurt any adjacent part. But the effect of cauterisation with caustic may spread to parts at a distance. Fire, on the other hand . . . has no such effect unless it is overdone [125]."

Nevertheless he does not rush blindly on, brandishing his cautery. Here is what he says about cauterisation for cancer (al- kayy fil-saratan: I, 28, p. 151):

"When the cancer is in its initial stage, burn all round it with the circular cautery. Some doctors have said it may be cauterised with one extensive cauterisation in the middle. This hardly seems right to me, for I should expect it to ulcerate out, which I have seen several times [126]."

Even in that remote age there were specialists who wrote with signal ability on the morbid anatomy of the different portions of the body [127]. Affections of the eye, obstetrics, eruptive fevers, were exhaustively treated, the book of Al-Razi on the diseases of children being the first on that topic known to exist [128]. The various topical applications used at present by the profession—such as unguents, plasters, counter-irritants, and pomades—originated in Muslim Spain [129]. Al-Zahrawi, once more, played a great part in this. In the 19th volume of Al-Tasrif by al-Zahrawi, a chapter was devoted completely to cosmetics, and is the first original Muslim work in cosmetology. He described the care and beautification of hair, skin, teeth and other parts of the body, perfumes, scented aromatics and incense. He includes under-arm deodorants, hair removing sticks and hand lotions. Towards the medicaments, he recommend Ghawali and Lafayfe for epileptic fits and Muthallaathat, prepared from camphor, musk and honey, in fact very much like Vicks Vapour Rub, for the treatment of cold relief. Other utilities which we tend to consider as part of the 20th century but which were present in Muslim Spain and which are described by Al-Zahrawi include nasal sprays, mouth washes and hand creams [130].

One difficulty unlikely to confront most modern doctors appears in Al-Zahrawi's Book II, Chapter 61 (421), on extracting a stone from females.

"It is very uncommon for women to have stones, but if it should happen the treatment is indeed difficult and is hindered by a number of things. One is that the woman may be a virgin. Another is that you will not find a woman who will expose herself to a male doctor if she be chaste or married. A third is that you will not find a woman competent in this art, particularly not in surgery. If necessity compels you, you should take with you a competent woman doctor. As these are scarce (qalil), if you are without one, then seek a eunuch doctor as a colleague, or bring a midwife or a woman to whom you may give some instruction in this art. Have her with you and bid her do all that you tell her to do [131]."

7. Medical Institutions: Hospitals

Writing on Muslim hospitals, Scott says:

"In the polished capitals of Damascus and Cairo numbers of splendidly appointed medical institutions—colleges, hospitals, dispensaries, laboratories—arose. The services of the most distinguished physicians were gratuitously rendered to the inmates of the hospitals. The hygienic arrangements of the latter were, in many respects, superior even to those dictated by the spirit of modern scientific progress. They were larger, better arranged, and more commodious. Purity of air was assured by a system of thorough ventilation. There were fountains everywhere,—in the courts, in the halls, in the gardens. Wards placed under the direction of competent specialists were appointed for the treatment and study of every disease. Insane patients were prescribed for like the others, and had their attendants, their baths, and their amusements. For them, as well as for the unfortunate victim of insomnia and the convalescent, there were the diverting mirth of the story-teller and the soothing powers of music [132]."

We know of thirty-four hospitals established in Islam in this period. The most famous hospital in Islam was founded in Damascus in 706; in 978 it had a staff of twenty-four physicians. Medical instruction was given chiefly at the hospitals [133]. Early were hospitals constructed in the land of Islam, the work of both Tulunids of Egypt and Aghlabids of Tunisia. The Aghlabid ruler, Ziyadat Allah I (817-838), built a hospital in the city in 830, one of the most pioneering of its genre, called ad-Dimnah hospital, being built in ad-Dimnah quarter near the great mosque of al-Qayrawan [134]. The hospital of Ibn Tulun established at al-Fustat in 872 was situated between the mosque of Ibn-Tulun and the hill of al-Gareh, in one of the most heavily populated quarters of Fustat. In both construction and management it absorbed vast resources; and also included a library of 100,000 books [135]. Its financing came chiefly from the bazaar and from other waqfs; the patients were given a special garment and beds, and were served meals and medications; physicians attended to the patients every day; and every Friday Ibn-Tulun visited the hospital, inspected the supplies, conferred with the physicians and visited the patients [136].

Figure 10: Pages 270-271 from an 18th century edition of Rhazes' treatise on smallpox and measles: Maqāla fī al-jadarī wa al-hasbah (De variolis et morbillis), in Arabic and with a Latin translation by Salomon Negri, a Melkite priest from Damascus. Glasgow University Library Special Collections Department, MS Hunter 133. (Source).

By the 12th century, the hospital in Islam had reached very advanced standards. Thus, in Damascus the largest hospital built in 1156 by Nur al-Din Zangi: The Al-Nuri Hospital, was placed under the direction of the physician al-Bahili. It was well supplied with food and medication, and had a well stocked library for teaching [137]. Ibn Jubayr admired, most particularly, the way in which the administrator of the hospital kept a register of patients [138], probably the earliest of its kind [139]. In Morocco, in 1190, Al-Mansur Ya'qub Ibn Yusuf built a hospital in Marrakech in a spacious area surrounded by fruit trees, flowers, herbs, and vegetables [140]. `Water, the historian al-Marrakuchi said, "was brought in aqueducts to all its sections, besides four pools in the centre thereof, of which one was built of white marble." The daily endowment was thirty golden Dinars for the purchase of food supplies, un-stocked medication, and unpredicted expenses. Physicians cared for the sick and prescribed diet and medications, while appointed pharmacists specialised in the compounding and preparing of drugs. Here too, patients were provided with special apparel for the summer and winter seasons. In Cairo, in 1285, Sultan Qalawun began the construction of al-Mansuri Hospital; the largest of all. It attended 4000 patients daily, had different wards catering for diverse diseases, and even applied music therapy on mentally ill patients [141]. Al-Mansuri hospital is described by Durant:

"Within a spacious quadrangular enclosure four buildings rose around a courtyard adorned with arcades and cooled with fountains and brooks. There were separate wards for diverse diseases and for convalescents; laboratories, a dispensary, out-patient clinics, diet kitchens, baths, a library, a chapel, a lecture hall, and particularly pleasant accommodations for the insane. Treatment was given gratis to men and women, rich and poor, slave and free; and a sum of money was dispersed to each convalescent on his departure, so that he need not at once return to work. The sleepless were provided with soft music, professional story-tellers, and perhaps books of history [142]."

All these institutions were supported by the government, and placed under the supervision of the court physician, the head of his profession, who was held to a strict accountability for their proper management [143]. For this important and responsible employment belief in Islam was by no means essential; honesty, skill, and industry were the sole recommendations to imperial favor, and the medical advisers of the Successors of the Prophet were frequently Christians and Jews [144]. In all hospitals registers of cases were opened and preserved, and far more importance was attached to the observations made at the bedside of the patient than to the information obtained by the perusal of books [145].

Likewise, Muslim Spain also shined thanks to its hospital institutions. The hospital service of that country has received little attention from historians, but it is highly improbable that, in the general advance of civilisation, this important auxiliary to medicine should have been at all neglected [146]. It is a singular fact that the only detailed notice of a Moorish hospital in the Peninsula is of that of Algeziras, which was founded in the 12th century, but there are reports that many public institutions of this kind existed at one time at Cordova [147]. The Hispano-Muslim practitioners held consultations at the bedside of the patient; some, employed by the government, visited the sick of remote localities at regular intervals; for the poor there was generous attendance and treatment [148].

In many of the hospitals prescribed lectures were given in the large hall of the hospital. These consisted of the reading of a medical manuscript by the so-called "Reading out Physician," for these texts in manuscript form were scarce and seldom owned by the medical student [149]. Following the reading, the chief physician or surgeon asked and answered questions of the students. Bedside teaching was considered the most important part of the training [150]. The students in groups followed the attending physician or surgeon in his ward rounds; the more advanced students observed the doctor, later in the day, taking the history and making an examination of the patients, and prescribed for them in the Out-Patient Department of the hospital. The exact time for training the medical students must have varied at different times and places [151].

8. Concluding Words on Islamic Medicine

It is worth ending this outline by stressing the role of Islamic medicine and its impact. Al-Razi's Kitab al-Hawvi (Comprehensive Book), for instance, covered in twenty volumes every branch of medicine. Translated into Latin as Liber continens, it was probably the most highly respected and frequently used medical textbook in the Western world for several centuries; it was one of the nine books that composed the whole library of the medical faculty at the University of Paris in 1395 [152].

Another concluding point is how Muslim scholars viewed their profession, and how they regarded their social milieu. Al Zahrawi, as a scrap of information in the form of a note by the scribe of the Veliuddin manuscript (fol. 228b), written 250 years after his death, says:

"I have been told that he was extremely ascetic; that half of his work every day he did without fee, as charity, and that he wrote this compendium over a period of forty years [153]."

And best to conclude this outline on Muslim medicine with these words from al-Zahrawi to his "sons" (his students):

"Show then caution and care for yourselves, and gentleness and perseverance for your patients. Take the best road that leads to health and a happy outcome. Purify yourselves of anything which you fear may cause doubt as to your religious life and your worldly life, for this will perpetuate your good name and will elevate your fortunes in this world and the next [154]."

Footnotes

[1] S.P. Scott, History of the Moorish Empire, Philadelphia: The Lippiuncot Company, 3 vols.; vol. 3, p. 505.

[2] Ibidem.

[3] Ibidem.

[4] D. Campbell, Arabian Medicine and its Influence on the Middle Ages, Amsterdam: Philo Press, 1926 (reprinted 1974), p. xiii.

[5] W. Durant, The Age of Faith, New York: Simon and Shuster, 1950, pp. 245-246.

[6] Ibidem.

[7] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, pp. 514-5.

[8] E. G. Browne, Arabian Medicine (1921), reprint Cambridge University Press, 1962 (Gryphon Books, 2001), p. 70.

[9] G. Sarton, Introduction to the History of Science, Williams and Wilkins Company, 1950, vol. 2, p. 447.

[10] W. Montgomery Watt, The Influence of Islam on Medieval Europe, Edinburgh, 1972, p. 65; C. Hillenbrand, The Crusades, Islamic Perspectives, Edinburgh University Press, 1999. p. 352.

[11] In W. Montgomery Watt, The Influence of Islam on Medieval Europe, op. cit., p. 65. See also: Medieval Sourcebook: Usmah Ibn Munqidh (1095-1188): Autobiography, excerpts on the Franks.

[12] S. P. Scott, History of the Moorish Empire, op. cit., vol. 3. p. 522.

[13] Ibid, p. 513.

[14] G. Lewis, "The Surgery of Albucasis", Islamic Culture, vol. 73, 1999, pp. 21-36; p. 28.

[15] G. Lewis, "The Surgery of Albucasis", op. cit., pp. 35-36.

[16] A. Whipple, The Role of the Nestorians and Muslims in the History of Medicine, Ann Arbor, Michigan: University Microfilms International (1980), Microfilm xerography, 1977, 1980, p. 41.

[17] Ibidem.

[18] Cyril. A. Elgood, A Medical History of Persia and the Eastern Caliphate. From the Earliest Times until the Year A.D. 1932, Cambridge, 1951, p. 155 ff.

[19] P. K. Hitti, History of the Arabs, London: MacMillan, 1970, p. 54.

[20] C. H. Haskins, Studies in Medieval Culture, Oxford, 1929 (reprint New York: Frederick Ungar, 1965), p. 131.

[21] H.F. Nagamia, "An Introduction to the History of Islamic Medicine", Islamic Culture, vol. 73, 1999, pp. 1-19; p. 11.

[22] A. Whipple, The Role of the Nestorians and Muslims in the History of Medicine, op. cit., p. 41.

[23] H. F. Nagamia, "An Introduction to the History of Islamic Medicine", op. cit., p. 11.

[24] Ibidem.

[25] A. Whipple, The Role of the Nestorians and Muslims in the History of Medicine, op. cit., p. 41.

[26] P. K. Hitti, History of the Arabs, op. cit., p. 56.

[27] Ibidem.

[28] E. G. Browne, Arabian Medicine, op. cit., p. 123.

[29] Ibid, p. 124.

[30] Max Meyerhof, "Science and Medicine", in The Legacy of Islam, eds. Sir Thomas Arnold and Alfred Guillaume (Oxford: The Clarendon Press, 1931), p. 351.

[31] C.H. Haskins, Studies in Medieval Culture, op. cit., p. 131.

[32] Ibidem.

[33] Ibidem.

[34] Ibidem.

[35] Ibn abi Usaybi'a, 'Uyun al-anba' fi tabaqat al-atibba, ed. by August Müller, Konigsberg, 1884.

[36] S.K. Hamarneh, "Ibn Al-Quff", Dictionary of the Middle Ages, edited by Joseph Strayer. New York: Charles Scribner's Sons, 1989-, 12 vols.; vol. 11, p. 238.

[37] Ibidem.

[38] Ibidem.

[39] Antoine Barthélémy Clot (Clot bey), Note sur la fréquence des calculs visicaux en Egypte et sur la méthode employée par les chirurgiens arabes pour en faire l'extraction (28 pp., Marseilles 1830); E. Wiedemann, "Beschreibung von Schiangen bei Ibn Qaff", Beiträge 50, Sitzungsberichte der phys. med. Sozietat (Erlangen), vol. 48, 1918, pp. 61-64.

[40] G. Sarton, Introduction to the History of Science, op. cit., vol. 2, p. 1099.

[41] Ibidem.

[42] Ibidem.

[43] S. K. Hamarneh, "Ibn Al-Quff", op. cit., p. 238.

[44] Ibidem.

[45] G. Sarton, Introduction to the History of Science, op. cit., vol. 2, p. 1099.

[46] S. K. Hamarneh, "Ibn Al-Quff", op. cit.,pp. 238-239.

[47] Ibidem.

[48] G. Wiet, V. Elisseeff, P. Wolff, and J. Naudu, History of Mankind, vol 3: The Great Medieval Civilisations (translated from the French). George Allen & Unwin /UNESCO, 1975, p. 645.

[49] Ibidem.

[50] Ibidem.

[51] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, p. 512.

[52] Ibid, pp. 512-513.

[53] Ibidem.

[54] Ibid p. 513.

[55] Ibidem.

[56] Ibidem.

[57] H.F. Nagamia, "An Introduction to the History of Islamic Medicine", op. cit., p. 12.

[58] Ibidem.

[59] Derived from M.S. Spink and G. Lewis, "The Surgery of Albucasis", op. cit.

[60] H.F. Nagamia, "An Introduction to the History of Islamic Medicine", op. cit., p.12.

[61] Derived from M.S. Spink and G. Lewis, "The Surgery of Albucasis", op. cit.

[62] G. Lewis, "The Surgery of Albucasis", op. cit., p. 26.

[63] H.F. Nagamia, "An Introduction to the History of Islamic Medicine", op. cit., p. 12.

[64] Ibidem.

[65] G. Lewis, "The Surgery of Albucasis", op. cit., p. 32.

[66] Ibid, pp. 32-33.

[67] Ibid, p. 35.

[68] H.F. Nagamia, "An Introduction to the History of Islamic Medicine", op. cit., p. 12.

[69] Ibidem.

[70] G. Lewis, "The Surgery of Albucasis", op. cit., p. 34.

[71] Ibidem.

[72] Ibid, p. 35.

[73] H.F. Nagamia, "An Introduction to the History of Islamic Medicine", op. cit., p.12.

[74] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, pp. 513-514.

[75] G.M. Wickens, for example, qualify it as "outstanding": see G. M. Wickens, "The Middle East as a world centre of science and medicine", in Introduction to Islamic Civilisation, edited by R.M. Savory, Cambridge: Cambridge University Press, 1976; pp 111-118; p. 116.

[76] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, pp. 513-514.

[77] G.M Wickens, "The Middle East as a world centre of science and medicine", op. cit., p. 116.

[78] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, pp. 513-514.

[79] E. Savage Smith, "Medicine", in Encyclopedia of the History of Arabic Science, edited by R. Rashed, London: Routledge, 1996, vol. 3, pp. 903-962; p. 948.

[80] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, pp. 513-514.

[81] M. Levey, Early Arabic pharmacology: An Introduction Based on Ancient and Medieval Sources, Leiden: Brill, 1978 (reprint 1997), p. 128.

[82] C. A. Elgood, A Medical History of Persia and the Eastern Caliphate, op. cit. p. 141.

[83] M. Levey, Early Arabic pharmacology, op. cit., p. 128.

[84] Ibidem.

[85] W. Durant, The Age of Faith, op. cit., pp. 245-246.

[86] J. Hirscliberg, J. Lippert, and E. Mittwoch, Die arabischen Augenarzte nach den Quellen Bearbeitet, Leipzig, 1905, part II.

[87] These recipes are found in M. Levey, Early Arabic pharmacology, op. cit., pp. 127-128.

[88] G. Lewis, "The Surgery of Albucasis", op. cit., p. 28.

[89] M. Levey, Early Arabic pharmacology, op. cit., p. 129.

[90] Ibid, p. 128.

[91] J. Hirschberg and J. Lippert (Leipzig, 1904), Part I, p. 273; Al-Ghafiqi, Kitdb al-murshid fi ‘l-kuhl, Arabic text published by Sayyid al-Sharafi, Hyderabad, 1964.

[92] F. Gabrieli, "The Transmission of learning and literary influences to Western Europe", in The Cambridge History of Islam, vol 2, edited by P.M. Holt, A.K. S. Lambton and B. Lewis, Cambridge University Press, 1970, pp. 851-89; p. 862.

[93] See the excellent article by G. Bos, "The Miswak: An Aspect of Dental Care in Islam", in Medical History, vol. 37, 1993, pp. 68-79.

[94] G. Nachtigal, Sahara and Sudan, Leipzig, 1889; reprint Graz: Akademische Verlagsantast, 1967, vol 3, p. 261.

[95] G. Bos, "The Miswak", op. cit., pp. 68-79; p. 68.

[96] E. Wiedemann, "Zanarzliches bei den Muslimen", Aufsatze zur arabischen wissenschats-geschichte, Heidelsheim-New York, 1970, vol. 2, p. 181.

[97] G. Bos, "The Miswak", op. cit., p. 68.

[98] See J. Wensinck, A Handbook of early Mohammedan Tradition, alphabetically arranged, Leiden: Brill, 1927, p. 280.

[99] Al-Bukhari, Kitab al-Adhan, Bab 8.

[100] E. Wiedemann, "Zanarzliches bei den Muslimen", op. cit., p. 182.

[101] R. Dozy, Supplément aux dictionaries arabes, 2nd edition, 2 vols. Leiden/Paris: 1927, vol. 1, p. 707.

[102] Abu Hanifa al-Dinawari, Kitab al-Nabat, edited by B. Lewis. Wiesbaden: Franz Steiner Verlag, 1974, p. 225.

[103] G. Nachtigal, Sahara and Sudan, op. cit., vol 3, p. 261.

[104] E. Wiedemann, "Zanarzliches bei den Muslimen", op. cit., p. 181.

[105] See G. Bos, "The Miswak", op. cit., p. 70.

[106] Abu Tayyib al-Washsha, Kitab al-Muwashsha, ed. R.E. Brunnow, Leiden: Brill, 1886; German translation by D. Bellman (Leipzig, 1984).

[107] Abu Tayyib al-Washsha, Kitab al-Muwashsha, op. cit., pp. 141-142; German translation by D. Bellman, op. cit., pp. 101-102.

[108] See M.Ulmann, Die Medizin in Islam, Leiden, 1970, pp. 115-119.

[109] Al-Razi, Kitab al-Hawi (Hydrebad: Osmania Oriental Publication Bureau), 1952-1974, 23 vols.

[110] Ibid, vol. 3, pp. 107-108.

[111] G. Bos, "The Miswak", op. cit., p. 75.

[112] Ibid, p. 76.

[113] G. Lewis, "The Surgery of Albucasis", op. cit., p. 31.

[114] Ibidem.

[115] Ibidem.

[116] Ibid, pp. 31-32.

[117] Ibid, p. 32.

[118] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, p. 511.

[119] Ibidem.

[120] G. Lewis, "The Surgery of Albucasis", op. cit., p. 26.

[121] Ibid, p. 26.

[122] Ibid, p. 27.

[123] Ibid, p. 27.

[124] Ibid, p. 27.

[125] Ibid, p. 27.

[126] Ibid, p. 27.

[127] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, p. 507.

[128] Ibid, p. 508.

[129] Ibid, p. 516.

[130] Mainly derived from S.K Hamarneh and G. Sonnedecker, A Pharmaceutical View of Albucassis Al-Zahrawi in Moorish Spain, Leiden, 1963; and M. Levey, Early Arabic pharmacology, op. cit.

[131] G. Lewis, "The Surgery of Albucasis", op. cit., pp. 29-30.

[132] S. P. Scott, History of the Moorish Empire, op. cit., vol. 3, p. 508.

[133] W. Durant, The Age of Faith, op. cit., pp. 245-246.

[134] S. K. Hamarneh, Health Sciences in Early Islam, Noor Foundation and Zahra Publications, Texas, 1983, p. 102.

[135] F.S. Haddad, in I.B. Syyed, "Medicine and Medical Education in Islamic History", in Islamic Perspectives, edited by S. Athar, pp. 45-56; p. 48.

[136] A. Issa Bey, Histoire des hopitaux en Islam, Beirut: Dar ar ra'id al-'arabi, 1981, pp. 112-115.

[137] S. K. Hamarneh, Health Sciences in Early Islam, op. cit., p. 100.

[138] Ibn Jubayr, Al-Rihla. The Travels of Ibn Jubayr, translated by R. J. C. Broadhurst, Jonathan Cape, 1952, pp 283-4.

[139] S. K. Hamarneh, Health Sciences, op. cit., p. 100.

[140] Abd al-Wahid al-Marrakushi, Al-Mu'jib fi talkhis akhbar al-Maghrib, edited by R. Dozy (Leiden, 1881), pp. 208-10 (quoted in S. K. Hamarneh, Health Sciences, op. cit., p. 103).

[141] F. S. Haddad in I.B. Syyed, "Medicine and Medical Education", op. cit., p. 48.

[142] W. Durant, The Age of Faith, op. cit., pp. 330-331.

[143] S.P. Scott, History of the Moorish Empire, op. cit., vol. 3, pp. 508-509.

[144] Ibidem.

[145] Ibidem.

[146] Ibid, p. 516.

[147] Ibidem.

[148] Ibidem.

[149] A. Whipple, The Role of the Nestorians and Muslims in the History of Medicine, op. cit., p. 59.

[150] Ibidem.

[151] Ibid, pp. 59-60.

[152] W. Durant, The Age of Faith, op. cit., pp. 245-246.

[153] G. Lewis, "The Surgery of Albucasis", op. cit., p. 33.

[154] Ibid, p. 36.

*The members of the FSTC Research Team comprises of Mohammed Abattouy, Salim Al-Hassani, Mohammed El-Gomati, Sali Shahsivari, Salim Ayduz, Savas Konur, Cem Nizamoglu, Anne-Maria Brennan, Maurice Coles, Amar Nazir and Margaret Morris.

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