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EAST MEETS WEST
A PANORAMA OF ARABIAN MEDICINE
Rudyard Kipling is often quoted as having said, "East is East, and West is West and never the twain shall meet..". In what follows, I will try to question that dictum, not literally, though this is possible through application of linguistic analysis, not topologically, though this is probable through the use of spherical trigonometry rather than plane geometry but historically through a very brief survey of Arabian medicine.
The history of Arabian medicine can be conveniently divided into three phases, characterised briefly as :
1 .Phase I: Greek into Arabic
2. Phase II: Arabic
3. Phase 111: Arabic into Latin
Phase I was the period of translation of Greek scientific and philosophical works into Arabic. This started in the eighth century A.D. when Islam covered nearly two
thirds of the known world, and contacts with the West were already established through Byzantium, Spain, and Sicily. The Khalifs at Baghdad became aware of what was to be learned from Greek science, and in the reign of al-Ma'mun an institution was founded for this purpose, "The House of Wisdom". The first translations were made from Syriac, the language of the Nestorian Christian physicians of Jundi-Shapur. These Nestorian Christians were forced to abandon their Byzantine homeland because of controversies over dogma. Originally, the principal seat of Nestorian scholars was the theological school at Edessa (Urfa), which had developed into a Syriac-language centre of Greek philosophy; this institute of higher learning eventually was ordered closed by Emperor Zeno (491 A.D.). In the year 489, the Nestorieans had migrated practically in a body to Persia, where they found refuge and employment under the Sassanid rulers. At the time, Jundi-Shapur, now Shahabad, was the metropolis of Khuzestan Province, in southern Persia, not far from Susa, the ancient capital of the Land of Elam. There, the Sassanids had established an academy and a teaching hospital, one of the oldest (if not actually the oldest) in the world. Among the most distinguished physicians at Jundi-Shapur were the Bukht Yishu's, a dynasty of doctors whose members were summoned to Baghdad at least from time to time, where they served as the personal physicians to the Abbasid Khalifs. They were active in this capacity for over two hundred years, their motto being "Safer under the khalif's turban than under the Pope's cloak". In the course of time, however, translations came to be made directly from Greek into Arabic. The most famous of all the translators was Hunayn Ibn-Is'haq, a Nestorian Christian who became court physician to the Khalif al-Mutawakkil. He and his team translated a large number of medical works of Hippocrates and Galen, as well as philosophical works by Plato and Aristotle and mathematical works of Euclid and Archimedes. Hospitals and medical schools flourished during that period, first in Baghdad and later in the main provincial cities. One of the greatest was the Mansuri hospital in Cairo, said to have had accommodation for 8000 people. "This hospital was lavishly appointed. Not merely were male and female patients separated, but there were separate wards for different categories such as fevers, ophthalmia, dysentery and surgical cases. Besides a number of surgeons and physicians, some of whom were specialists, there were attendants of both sexes, a large administrative staff, a dispensary, store-rooms, a mosque, a library and facilities for lecturing". The founders of these hospitals were khalifs and other wealthy men such as Viziers who gave a large sum of money as an endowment; the income from this was then used to pay the staff. Medical service was free. We also hear of doctors making medical rounds in prisons, and of arrangements for a traveling clinic and dispensary to visit the village of lower Iraq. In the medical schools attached to the hospitals, the study of medical theory through the standard texts of Galen and others was combined with clinical instruction. In the curriculum, Greek science and philosophy were also included, and graduates were usually well-versed in more than one field. The history of Arabian medicine abounds in polymaths.
After the first period of translation, when the chief works of Galen and Hippocrates were made available in Arabic, the Christians lost their monopoly of medicine, and several Muslims reached such a stature in medical science that they stood far above their immediate predecessors and were roughly on a level with the greatest of the Greeks. They achieved this by combining vast theoretical knowledge with acute clinical observation and a critical sense. Here, it will be possible to mention only few of the most famous, but it is worth noting the fact that for the five centuries from 800 to 1300 A.D. Arabic medical writings have been preserved from the pens of over 70 authors, mostly Muslims but including a few Christians and Jews. .
Ar-Razi, known to the West as Rhazes, was born in 865 at Rayy near Tehran, and died at Baghdad between 923 and 932. He was the first head of the first hospital founded in Baghdad. He was a voluminous writer on all the scientific and philosophical subjects then studied, and over fifty of his works are still extant. One of the best known is a treatise "On Smallpox and Measles", which has been translated into Latin, Greek, French and English. His greatest work was al-Hawi, "The Continents" or "Comprehensive Book", which was an encyclopedia of all medical science up to that time, and had to be completed by his disciples after his death. For each disease he gave the views of Greek, Syrian, Indian, Persian and Arabic authors, and then added notes on his clinical observations and expressed a final opinion. Rhazes was a keen observer and a critical thinker. Here is one of his case histories in which he relates his initial confusion, how he arrived at the correct diagnosis, and, retrospectively, some sort of self-criticism.
"Abdalla Ibn Sawada used to suffer from attacks of mixed fever which overtook him sometimes every six days, sometimes like a tertian, quartan or quotidian. They were preceded by a slight rigor, and micturition was very frequent. 1 gave it as my opinion that either these attacks of fever would turn into quartan, or that there was an abscess of the kidney. Only a short while elapsed before the patient passed pus in his urine; I informed him that these feverish attacks would not recur, and so it was. The only thing that prevented me initially from giving it as my definite opinion that the patient was suffering from an abscess of the kidney was that he had previously suffered from tertian and other types of fevers. Moreover, the patient did not complain to me of heaviness in his loin, and I had neglected to ask him about this. The frequency of micturition should have strengthened my suspicion of a kidney abscess. It is, therefore, our duty to avoid lack of solicitude with the utmost possible care-if Allah will!".
In addition to his extensive knowledge and vast experience, Rhazes always urged for high ethical standards in the profession. Many of this aphorisms are still relevant: "Doctors are nominally many, virtually few", "Ignorant doctors are killers", "Don't treat with drugs what you can treat with diet, and don't treat with compound drugs what you can treat with simple ones", "Those who consult many doctors are likely to fall in the errors of every one of them".
Although the excellence of Rhazes' book was widely recognised, some felt that it was too lengthy a work, and about half a century later a Persian physician set out to produce an equally comprehensive but less bulky encyclopedia. The man was al-Majusi, known to the West as Haly Abbas, and the book was "The Complete Art of Medicine" or alternatively "Al-Kunnash al-Malaki". It was one of the earliest medical books to be translated into Latin and proved popular, being chiefly referred to as "Liber regius".
Probably the most outstanding writer on medicine in Arabic was Ibn-Sina or Avicenna (d. 1037). Like ar-Razi, he wrote many subjects, and is accounted to have been greater as a philosophthan as a physician. Nevertheless, his vast "Canon of Medicine" is rightly acclaimed as the "culmination and masterpiece of Arabic systematization" (Meyerhof). It was translated into Latin in the twelfth century, and continued to dominate the teaching of medicine in Europe until the end of the sixteenth century at least. There were sixteen editions of it in the fifteenth century, one being in Hebrew, twenty editions in the sixteenth century, and several more in the seventeenth.
There were also innumerable commentaries on it in Arabic, Latin,Hebrew and the vernaculars. One distinguished commentator on Avicenna was Ibn an-Nafis, who practiced in Cairo and was the first to describe the lesser or pulmonary circulation of the blood.
Islamic was not restricted to anyone region of the Islamic empire, but was widely spread wherever Islam was strong. Scholars traveled far afield to have personal contact with the most celebrated teachers. Though Umayyad and Moorish Spain did not recognize the Abbasid Khalif in Baghdad, it remained in cultural contact with the Islamic East. From Spain, it was easy to travel to intellectual centers like Medina, Damascus and Baghdad. Important books found their way to Spain within a few years of their publication in the East, while the scholars and writers of Islamic Spain made notable contributions to Arabic literature and learning. In medicine the most original writer was Abul-Qasim az-Zahrawi (d. after 1009), known in Latin as Abul- casis. His writing on surgery and surgical instruments, many of which he invented and illustrated in his books, is the outstanding Arabic contribution to this aspect of medicine. Several of the philosophers of Spain were also competent physicians. In addition to Ibn-Rushd or Averroes, the greatest commentator on Aristotle, there may be named Ibn-Zuhr or Avensoar of Seville and the Jewish scholar Ibn-Maimon or Mainlonides (d. 1024), who studied in Spain though he eventually became court-physician to Saladin in Egypt. Mention should also be made of Ibn-al-Baytar of Malaga, who was primarily a pharmacologist, but made valuable contributions to botany. In the related fields of alchemy and optics the experiments of Jabir Ibn-Hayyan, of al-Biruni and of Ibn al-Haytham are well known.
Such was the glory of Arab civilization at its zenith. In his book "The Influence of Islam on Medieval Europe", W .Montgomery Watt, Professor Emeritus of Arabic at Edinburgh, concludes his survey of Arab achievements in science and philosophy with the following remark, which I quote fully: "When one becomes aware of the full extent of Arab experimenting, Arab thinking and Arab writing, one sees that without the Arabs European science and philosophy would not have been developed when they did. The Arabs were no mere transmitters of Greek thought, but genuine bearers, who kept alive the disciplines they had been taught and extended their range. When about the year 1100, Europeans became seriously interested in the science and philosophy of their Saracen enemies, these disciplines were at their zenith; and the Europeans had to learn all they could from the Arabs before they themselves could make further advances".
It was in the twelfth century that European scholars interested in science and philosophy came to appreciate how much they had to learn from the Arabs, and set about studying Arabic works in these disciplines and translating the chief of them into Latin. The earliest name in this third phase, the phase of Arabic into Latin, is that of Constantine the African, a merchant dealing in drugs and travailing between Tunisia and Southern Italy. On a visit to Salerno, where the oldest school of medicine in Europe was established, he realized how backward the school was, and decided to go and study medicine in the Islamic world. On his return to Europe, where he spent the final part of his life at the Benedictine monastery of Monte Cassino, he translated into Latin the medical works he had studied; among these was the "Liber regius" of al-Majusi. Another great translator was Gerard of Cremona, an Italian who came to Toledo and worked there for many years. To him are ascribed about a hundred translations. A third name is that of Michael Scot, who died in 1236, probably in Scotland. He travelled widely to Toledo, Bologna, Rome, and finally settled at the Sicilian court of Frederick II. This monarch, like his I grandfather Roger II (both of whom have been called "the two baptized sultans of Sicily"), was personally interested in the various branches of Arab science, and it was for him that Michael translated many of the works of Avicenna and Averroes.
It should be pointed out that the attitude of medieval Europe to the Arabs contained two contrasting elements, deep fear on the one hand, and on the other admiration coupled with an acknowledgment of superiority. The fear was considerably allayed by military victories, the Reconquista in Spain and the Crusades in the East. But the admiration and dependence on Arab science and culture continued for several centuries. "There is a well-known description of the crudities of European treatment by an Arab writer of the Crusading period, Usama Ibn. Munqidh. The writer's uncle, a Muslim prince, had sent a doctor to a Frankish neighbor at the letter's request. When the doctor returned after a surprisingly short period, he had a remarkable tale to tell. He had to treat a knight and a woman. The knight had an abscess of the leg, to which the Arab doctor applied a poultice to bring it to a head; the abscess burst and began to drain satisfactorily. The woman suffered from what is called "dryness" , though the precise nature of this condition is not clear. The Arab ordered a strict regimen, including abundant fresh vegetables. At this point, a Frankish doctor came on the scene. He asked the knight whether he preferred to live with one leg or die with two. The knight gave the obvious answer, and the doctor made him stretch out his leg on a block of wood while a strong man tried to cut off the affected part with a sharp axe. The first stroke failed to sever the limb. The second caused the marrow to flow out, and the man died almost at once.
The treatment of the woman was even worse. The Frankish doctor declared that a demon had possessed her, and that her hair must be cut off. This was done, and the woman went back to her diet of garlic and mustard. The "dryness" increased and the doctor ascribed this to the fact that the demon had entered into her head.. He then made a cross-shaped incision, pulled the skin apart until the skull was exposed, and rubbed in salt. The woman died at once. Thereupon the Arab asked the people whether they had any further need of him, got a negative answer and returned home".
Practical experience of Saracen medicine stimulted the Crusaders to establish new hospitals and medical schools in addition to the old ones at Salerno and Montpellier, but these still fell below Arab standards in such matters as having separate wards for infectious diseases, or full-time resident physicians. Another Arab practice-clinical instruction to students in a hospital-was not copied in Europe until about 1550. Rhazes' "Continens" and Avicenna's "Canon" remained the standard texts for European medicine through the fifteenth and sixteenth centuries.
In conclusion, I hope I have proven my point. It is really unfortunate that of Kipling's ballad, only the first line is usually quoted. Let me now recite it more fully:
"Oh, East is East, and West is West and never the twain shall meet, Till Earth and Sky stand presently at God's great Judgment Seat; But there is, neither East nor West, Border, nor Breed nor Birth, when two strong men stand face to face, though they come from the ends of the Earth".
A feeling of discouragement when you slip up is a sure sign that you put your faith in deeds. -Ibn 'Ata'llah