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Medicine
Ezzat Abouleish , M. D.
DEDICATION
This paper is
dedicated to those who contributed to the well being of mankind and
have done their best to make our journey on this planet more
pleasant; to all of them, irrespective of their race, religion or
country of origin.
Introduction
Medicine, as it
stands today, did not develop overnight. It is the culmination of
efforts of millions of people, some we know and others we do not.
The flame of civilization, including medicine, started thousands of
years ago. The flame has been handed over from one generation to
another, and from one country to the other. Depending on who took
the sacred responsibility of hosting it, sometimes it got brighter
and sometimes it got dimmer. However, it never died away, because if
it did, it would have been too hard to start all over
again.
Between the ancient
civilizations, namely the Egyptians, Greek, Roman, Persian, Indian,
and Chinese, and the Renaissance era in Europe, there was a gap,
commonly called "the dark ages", during which the flame was hosted,
not by the West, but by another culture and people called the Arabs
or the Moslems. The nomenclature, "the dark ages" reflects the
civilization in Europe between the 7th and 13th centuries, but by no
means it expresses the state of affairs in the Arab world or the
Islamic Empire at that time when an and science were as bright as
the midday sun. That era, unjustifiably, has been commonly neglected
and overpassed, as if nothing happened. This paper is an effort to
elude to the important events which took place and the significant
physicians who lived during that period.
The Spread of Islam
In order to
understand how medicine developed in the middle ages, we have to
look back at the history and find out the important things that
happened during the Seventh Century.
In 570 A.D., a man
was born in a small city in the Arabian peninsula, called Mecca
(Haykal 1976), his name was Mohammed. In 610 A.D. he declared a new
religion, Islam. In 632 A.D., he died after uniting the Arab tribes
who had been torn by revenge, rivalry, and internal fights. Out of
these mostly illiterate nomadic people, he produced a strong nation
that encountered and conquered, simultaneously, the two known
empires at that time, namely, the Persian and Byzantine
Empires.
In a man's
life-time, the Islamic Empire extended from the Atlantic Ocean on
the West, to the borders of China on the East. In 711 A.D., only 80
years after the death of their prophet, the Arabs crossed to Europe
to rule Spain for more than 700 years. In 732 A.D., they threatened
Paris and their thrust was stopped at Tours and Poiter (Eigeland
1976). In 831 A.D., the Moslems of North Africa invaded Sicily and
ruled it for 200 years. By 846 A.D., they controlled the southern
part of Italy and encountered Rome (Hitti 1977).
The hold of the
Moslems over Italy remained so firm that Pope John VIII (872-882
A.D.) deemed it prudent to pay tribute for two years (Hitti 1977) In
869 A.D., the Arabs captured Malta (Ibn-Khaldun). In the tenth
century, from Italy and Spain, the Arabs extended their raids
through the Alpine passages into mid-Europe. In the Alps, there are
a number of castles and walls which tourists guides attribute to the
invasion of the Moslems of Sicily. In the southern part of Italy and
in Sicily, a great civilization was established and through which
the torch of knowledge spread to Europe, mainly through the
University of Salerno in the southern part of Italy (Hitti 1977,
Parente 1967).
The expansion of
the Moslems in Europe was not limited to those from North Africa and
Spain. The Moslems, under the Ottoman Empire, invaded Europe from
the East. They occupied a good part of Middle Europe and besieged
Vienna twice, once during the reign of Sulayman 1 (1520-1566 A.D.)
and the other during the reign of Mohammed IV (1648-1687 A.D.)
(Hitti 1977).
Islam and the Promotion of Culture and Science
As the Moslems
challenged the civilized world at that time, they preserved the
cultures of the conquered countries. On the other hand, when the
Islamic Empire became weak, most of the Islamic contributions in art
and science were destroyed. This was done by the Mongols who, out of
barbarism, burnt Baghdad (1258 A.D.), and by the Spaniards, who out
of hatred, demolished most of the Arabic heritage in Spain. The
difference between the Arabs and these was the teachings of Islam
which:
1. Stressed the
importance and respect of learning. For example, the first word
revealed to the Moslems' prophet Mohammed was "Read". In Mohammed's
era, a captured enemy was freed if he paid a ransom or taught ten
Moslems writing and reading. In their holy book, the Qur'an, the
importance of knowledge has been repeatedly stressed as it says
"Those who know and those who do not are not equal." The prophet
Mohammed stressed learning by saying. "One hour of teaching is
better than a night of praying." One of the early princes, Khalid
fbn Yazid (end of the 7th century), gave up his treasure for the
study of medicine and chemistry. He studied medicine under John the
Grammarian of Alexandria, and chemistry under Merrinos the Greek
(Haddad 1942). He also encouraged several Greek and Coptic medical
books to be translated into Arabic.
2. Forbade
destruction. On conquering Mecca, the prophet Mohammed strongly
stated that no homes, animals, or trees should be destroyed. His
followers abided with these principles when conquering other
countries.
3. Encouraged
cleanliness and personal hygiene. Islam instructed them to approach
God in their prayers five times a day with bodies and clothes
spotlessly clean.
4. Developed in
them the respect of authority and discipline. For example, realizing
the scourges and terror of plague, their prophet Mohammed (p.b.u.h.)
decreed that "no man may enter or leave a town in which plague broke
out." And to make this law all the more binding and effective, he
promised the blessing of heaven to those who die of plague by
stating that if a man died of plague he would be considered a martyr
(Haddad 1942). Thus Mohammed (p.b.u.h.) laid for the Moslems the
laws governing corden and quarantine for the first time in history
and made it work.
5. Tolerated other
religions. The Islamic religion recognizes Christianity and Judaism
and considers their followers to be people with holy books like
Moslems. Moreover, they candidly treated the Jews at an era when the
latter were persecuted in Europe. Dr. Jacob Minkin, a reputable
Rabbi and scholar says "It was Mohammadan Spain, the only land of
freedom the Jews knew in nearly a thousand years of their
dispersion...
While during the
Crusades, the armored Knights of the Cross spread death and
devastation in the Jewish communities of the countries through which
they passed, Jews were safe under the sign of the Crescent. They
were not only safe in life and possessions, but were given the
opportunity to live their own lives and develop a culture so unique
and striking that it went down in history as the 'Golden Ages'. The
Moors, the Muslim conquerors of Spain in 711, were not religious
fanatics. They were strong in their faith but generous with regard
to the religious convictions of others....
"The Ranaissance of
Art in Italy, says George A. Dorsey, has blinded us to the
Renaissance of Science in Spain, which fostered science, promoted
culture, encouraged learning, and set a premium on intellectual
pursuits, no matter whether the intellect was Moslem, Christian or
Jew. Not since the days of Greece had the world known such thirst
for knowledge, such passion for learning, such spirit shared by the
prince and the courtien alike" (Minkin 1968).
The Arabs were
assimilated by the vast new countries they reached. From this
marriage of genuine characters and righteousness with the ancient
and well established civilizations, a great new nation was born. It
is difficult to identify this new breed as Arabs, because although
the language was Arabic, all the scientists were not necessarily
from the Arabian Peninsula. It is also equally difficult to describe
it as Islamic, because although the majority of the scientists were
Moslems, sponsored by Moslem rulers, and governed by the Islamic
law, yet some scientists were Christians or Jews, especially at the
early phase of the lslamic civilization: the translation period to
Arabic, and the decline part: the translation period to Latin and
Hebrew. Therefore, in this article, the adjectives Arabic or Islamic
will be used as synonyms.
Medicine Before Islam
In order to
comprehend the contributions of Arabs to medicine,we must have in
our minds a picture of the condition of medicine before they arrived
to the scene. Generally speaking, two elements are required for
medical practice:
Manpower and hospitals
A. Manpower before
Islam:
There were medical
centers in different parts of the world which were later either
under control of the Arabs or in touch with them. For example, in
Syria, medicine was advanced and was greatly influenced by the
Byzantine civilization which affected also the economic and
administrative systems (Hammameh 1962). From the fifth century on,
the Greek was the language of learning in Syria. The knowledge of
the Arabs of the Greek civilization was mainly through the Syrian
scholars who translated it into Arabic.
In Egypt,
Alexandria was another center for culture. The Arabs got in touch
with both the ancient Egyptian and Greek civilizations through the
Egyptian scholars. In Persia, there was a medical school in a city
called Jundi-Shapur in which medicine was highly developed. The
Abbasi Caliphs during the 8th century encouraged the Persian
physicians to translate into Arabic the medical knowledge therein,
to build medical centers in Baghdad, the capital of their empire,
and to run newly built hospitals. With further expansion east, the
Arabs through contacts with India and China, brought ideas and
methods, not only in medicine, but also in mathematics, chemistry,
philosophy, etc.
B. Hospitals Before
Islam:
Hospitals as we
know them now probably were not present. True, there were places for
the sick to stay, but these were mainly temples or annexes to
temples that were run by priests. Gods were supposed to play a major
role in the art of healing. For example, the Goddess Toueris was the
Egyptian symbol of fecundity and protectress of the pregnant and
parturient. She was shown as a standing pregnant hippopotamus
carrying the hicroglyph meaning protection in one paw, and the sign
of life in the other. Small figures of Toucris were popular as
amulets (Speert 1973). In those days, sanctuary, prayers,
inactation, and hypnosis were integral parts of the
therapy.
Characteristic Features of Hospitals in the Islamic
Civilization
During the Islamic
civilization, hospitals had much developed and attained specific
characteristics:
1. Secular:
Hospitals served all peoples irrespective of color, religion, or
background. They were run by the government rather than by the
church, and their Directors were commonly physicians assisted by
persons who had no religious color. In hospitals, physicians of all
faiths worked together with one aim in common: the well-being of
patients.
2. Separate wards:
Patients of different sexes occupied separate wards. Also different
diseases especially infectious ones, were allocated different
wards.
3. Separate nurses:
Male nurses were to take care of male patients, and vice
versa.
4. Baths and water
supplies: Praying five times a day is an important pillar of Islam.
Sick or healthy, it is an Islamic obligation; of course physical
performance depends on one's health, even he can pray while laying
in bed. Before praying, washing of face, head, hands, and feet must
be done, if possible. For certain conditions, a bath is obligatory.
Therefore, these hospitals had to provide the patients and employees
with plentiful water supply and with bathing
facilities.
5. Practicing
physicians: Only qualified physicians were allowed by law to
practice medicine. In 931 A.D., the Caliph Al-Mugtadir from the
Abbasid dynasty, ordered the Chief Court-Physician Sinan Ibn-Thabit
to screen the 860 physicians-of Baghdad, and only those qualified
were granted license to practice (Hamarneh 1962). The counterpart of
Ibn- Tbabit, Abu-Osman Sai'd Ibn-Yaqub was ordered to do the same in
Damascus, Mecca, and Medina. The latter two cities were in need for
such an act because of hundreds of thousands of pilgrims visiting
them every year. This was to prevent taking advantage of these
pilgrims and to curb the spread of diseases among
them.
6. Rather medical
schools: The hospital was not only a place for treating patients,
but also for educating medical students, interchanging medical
knowledge, and developing medicine as a whole. To the main
hospitals, there were attached expensive libraries containing the
most up-to-date books, auditoria for meetings and lectures, and
housing for students and house-staff.
7.Proper records of
patients: For the first time in history, these hospitals kept
records of patients and their medical care.
8. Pharmacy: During
the Islamic era, the science and the profession of pharmacy had
developed to an outstanding degree. The Arabic materia medica became
so rich and new drugs and compounds were introduced because the
Muslims had contact with almost all the known world at that time,
either through control or trade. Their ships sailed to China and the
Philippines, and their convoys made trades with black Africa, Europe
and Asia. Chemistry became an advanced science, and there were means
and need for a specialization called pharmacy.
Thus, the main
Arabian hospitals were models for medieval hospitals built later in
Europe. They were rather medical schools to which those seeking
advanced medical knowledge, from the East or West,
attended.
The Reasons for the High Standard of Islamic
Hospitals
In the Islamic
Empire, the hospitals attained a golden era unsurpassed in previous
history. The reasons behind such a high standard
include:
1. Being part of a
civilization as a whole:The people were prosperous; thus, they were
capable of taking care of their health and of seeking the best
available treatment. Also, lslam stresses the necessity of seeking
treatment of every disease; the Prophet says "For every disease, God
created a cure." The required sciences for good medical care were at
a high standard e.g. the Arabs were advanced in chemistry,
mathematics, administration, pharmacy, medicine, etc. They gave the
world the system of numbering which have replaced the cumbersome
Roman numerals.
The world owes to
them the knowledge of the following chemical reactions, namely
sublimation, precipitation, filtration, distillation, etc. The great
