Medicine

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MEDICINE

Medicine has been an integral part of Islamic intellectual life and social institutions from the time of the Prophet. This brief description will touch on the diverse origins of medical knowledge in Islam; the development of hospitals, medical practice, and medical knowledge during the Islamic "Golden Age" (the latter half of the seventh century through the thirteenth century c.e.); the role of the Islamic world in protecting, elaborating, and reintroducing Hellenic medicine to Europe after the Dark Ages; and contemporary issues including the development of Islamic medical organizations dedicated to the assertion and protection of the religious context of the practice of medicine.

Medicine in the Time of the Prophet

The tribes that inhabited what is now Saudi Arabia at the time of the prophet Muhammad had a great deal of traditional medicine. As medical thinking and knowledge became explanatory and inductive with the parallel development of scientific thought in general, much of this traditional knowledge was preserved and some of it expressed in religious thinking. At the same time, distinct medical traditions were well developed in India, Persia, China, and Greece. Early Islamic medicine drew upon all of these traditions. The Qur?an itself contains limited specific medical text, although there is important guidance in prescribing breastfeeding as the right of every child, in proscribing intoxicants and the meat of certain animals, and in commentary on the beneficial health effects of some natural foods. However, the hadith (authenticated sayings and deeds of the Prophet) and its interpretations contain rich and detailed material on preventive and curative medicine, dietetics, and spiritual health. Early in the Islamic tradition these sources were collected and eventually became known as al-Tibb al-Nabawi (Medicine of the Prophet, or Prophetic Medicine). These collections remained distinct from the Persian, Indian, and Greek sources that early Islamic physicians drew upon, although they interacted with these traditions through their work. The best-known version is that of Ibn Qayyim al-Jawziyya, writing in Damascus in the late eleventh century c.e. Translated into many languages and widely accessible to Muslims the world over, the Medicine of the Prophet forms the rationale for many aspects of everyday Muslim life in terms of health protection and promotion—for example, injunctions against overeating; prescriptions for the spiritual and psychological care of the bereaved and traumatized; encouragement of moderation in all things; and much specific instruction on everyday food, drink, rest, and sexual behavior.

The Development of Islamic Medicine

The schisms within European Christianity in the fourth and fifth centuries c.e. paved the way for a shift of focus outside Europe for development of the profession. When Nestorius, the Patriarch of Byzantium, and his followers were forced out of Europe a large pool of intellectuals moved to the Middle East, many to Jund-e Shapur, a city in what is now southwestern Iran that was already home to a thriving intellectual community including Syrians, Persians, and Jews and where a medical school was well established. When Justinian I (527–565 c.e.) expelled "heathen philosophers" from Athens, the Hellenic medical tradition based on Galen and others was transplanted to the fertile soil of Jund-e Shapur where it thrived amid a community of scholars who translated the Greek medical works into Arabic either directly or through translations into Syriac. Manuscripts from other regions including India and China were also translated and when Islam expanded into Egypt, Greek manuscripts from Alexandria also became available. A short time before, the Persians had been conquered by Muslim armies under the first caliph, giving the Muslims access to Jund-e Shapur.

In 765 c.e., an eminent Christian physician who headed the medical school at Jund-e Shapur, Jurjis Bukhtishu, was invited to Baghdad by the caliph al-Mansur to treat him. He did this successfully, and was appointed to the court. Although he returned to Jund-e Shapur, his son migrated to Baghdad and set up a successful medical practice. Other prominent medical men and their offspring soon joined an emigration to Baghdad, which became a medical focal point with many hospitals and medical centers and a great deal of scientific and intellectual activity of all sorts, most of which drew on Greek intellectual tradition. That the medical experts of Jund-e Shapur and later of Baghdad were accomplished linguists who opened the Islamic empire to knowledge from the rest of the world and made Arabic the primary language of the time for documentation in medicine, science, philosophy, and many other fields.

During the several centuries that followed, hospitals and medical schools were established and thrived throughout the Islamic world, with the largest and most notable in Damascus, Cairo, and Cordoba. These facilities established traditions of treatment free of charge to the patient and acceptance of all in need of treatment without regard to means, religion, age, or gender. The development, enrichment, and encyclopedic documentation of medicine in the Islamic world of the time was led by a series of individuals, some of whom were true "Renaissance men" of their times. The guidance of several of these (al-Razi, al-Zaharwi, Ibn Sina) will be briefly mentioned, but they are among many other eminent contributors to medicine from this period.

Abu Bakr Mohammed ibn Zakariyya al-Razi (known as Rhazes in the West) was born near what is now Tehran in middle of the seventh century c.e. Al-Razi was accomplished in many spheres, and came to the study of medicine relatively late in life after a visit to Baghdad and a hospital there, which he later directed. There are many stories about al-Razi's skill as a practitioner. One famous account addresses his knack for environmental health. The story goes that he was asked at some time during his career to choose the location for a new hospital in Baghdad. He did this by observing fresh meat hanging in various parts of the city and choosing the area based on where the meat took the longest to spoil. He was a diligent teacher, a skilled diagnostician, and a prolific writer. His written works number in the hundreds. The largest, which is a huge compilation of case studies and notes edited and published by al-Razi's students after his death, has been called al-Hawa (the Continent); a thirteenth-century Latin translation was entitled Continens. This work summarized essentially all of the medical writings preceding al-Razi's time as well as his own observations. His most famous piece was a much shorter monograph in which he distinguished smallpox, chicken pox, and measles; this work translated to Latin was called de Pestilentia and formed the basis for much future work on these highly contagious diseases.

Several centuries later, the dual influence of al-Zahrawi in the West and Ibn Sina in the East were pivotal. Abu 'l-Qasim al-Zahrawi lived from about 930 to 1013 c.e. and was known as the "greatest surgeon of Islam." Zahrawi lived in the western caliphate, near Cordoba, and attended the University of Cordoba. He is most famous for his command of analgesia and anesthesia, utilizing opium and other natural narcotics and depressants, and the theory and practice of surgery. He invented many surgical instruments and wrote what is no doubt the first textbook of surgery. Although ignored throughout most of the eastern part of the Islamic world at the time, his influence on Europe was very significant.

Ibn Sina (known as Avicenna in the West) lived just a bit later (980–1037 c.e.). He was born in Persia in what is now Isfahan, Iran. Like many medical men of his time, he was an intellectual in a complete sense, writing on philosophy, music, military strategy, mathematics, and other subjects as well as medicine. His greatest medical work was the Qanun fi altibb, a five-volume treatise based on Greek knowledge and including Ayurvedic writings from India, some Chinese medicine, and other available sources. The Qanun included discussions of almost all ailments imaginable, as well as health promotion focusing on diet, the environment, and climate; it also included a huge materia medica including many medicinal plants and the drugs that could be derived from them. His theory of infection by "traces," together with the Prophet's earlier injunction to avoid travel to or from places in which plague was present, led to the introduction of quarantine as a means of limiting the spread of infectious diseases. Although he also wrote in his native Persian, Ibn Sina's medical works were penned in Arabic, which faciliated the reintroduction of scientific medicine in Europe as the Dark Ages gave way to the European Renaissance. This process paralleled a period of decline in Islamic influence and hegemony.

The Re-Introduction of Medical Science to Europe

The Arabic text of Ibn Sina's Qanun was published in Rome in 1593, and was one of the first Arabic books to be printed. The entire text had been translated into Latin two centuries earlier. This encyclopedic work soon became the preeminent medical text in Europe and was depended upon for four hundred years by the major medical schools on the continent. It was published in no less than sixteen editions, in Milan, Padua, and Venice throughout the 1400s and 1500s; the last edition for textbook use was published in 1658. Ibn Sina's writings, and the antecedent Islamic works on which he drew, thus formed the route by which the Arabic repository of Hellenic medicine, greatly expanded and enriched, was reintroduced to Europe. The subsequent major scientific advancements that came with Claude Bernard's (quite compatible) theory of the internal milieu, van Leewenhoek's discovery of the microscope, and other advances quickly pushed medicine to a secular, empirical basis and the importance of the contributions of the Arabic texts was largely forgotten.

Medicine in Contemporary Islam

Today, the infrastructure and content of medicine as it is practiced in the Islamic world is compatible with and even formed in the image of European and other Western models. Ironically, the only part of the world in which the corpus of (largely Greek) theory that constituted the medical knowledge of early Islamic history is still taught is in South Asia, where there are schools and licensure for practitioners of "Tibb Unani" ("Greek Medicine"). In most of the Muslim world, however, medical education and practice is largely consistent with that in the West, with a structure of specialties, supervisory responsibility and liability, curricula, and requirements for continuing medical education for practitioners. However, the last several decades have seen a movement toward development of consciously Muslim perspectives in medicine.

A notable recent change has been the reentry of women into medicine throughout the Muslim world. There has never been a prohibition on female physicians, nor on the treatment of patients of either gender by a male or female doctor. Aside from the doctrine that "necessity overrides prohibition," the hadith states clearly that treatment should depend solely on the needs of the patient and the capability of the doctor. Indeed, the precedent for female doctors was set by the Prophet's own entirely female medical corps that accompanied his armies into battle. As medicine became an intellectual pursuit requiring literacy and education, skills that were the province of men in most Muslim societies, the profession became almost entirely male. As education has more recently included women, they have moved back into medicine without formal barriers and with enthusiasm.

Recently there has been particularly active dialogue and introspection around issues of bioethics and the conduct of the Muslim medical practitioner in the religious context. Noteable in this context is the Islamic Organization for Medical Sciences (IOMS) (<http://www.islamset.com>), established in 1984 in Kuwait with an objective of serving the entire Muslim world. In its brief history IOMS has held multiple conferences on the heritage of Islam in medicine, established a World Health Organization Collaborating Research Center focused on traditional medicinal plants, and published a number of works focusing on ethical issues including Muslim definitions of the beginning and end of life, the use of newer reproductive technologies, care of the aged, and, recently, the impact of globalization on health and health care in the Islamic world. An Islamic Oath of the Doctor was developed by an IOMS conference, and is now widely published and used.

An early anatomical drawing appears in the volume two color insert.