History of Medicine
Islamic Culture and the Medical Arts
The Great Systematizers
Although the Hawi by al-Razi is an extraordinary collection of medical observations and extracts, it was not without its critics. `Ali ibn al-`Abbas al-Majusi (d. 994/384 H) was born into a Zoroastrian family from the Iranian city of Ahwaz about the time of al-Razi's death. Al-Majusi practiced medicine in Baghdad and served as physician to the ruler `Adud al-Dawlah, founder of the `Adudi hospital in Baghdad. It was to him that al-Majusi dedicated his only treatise, The Complete Book of the Medical Art (Kitab Kamil al-sina`ah al-tibbiyah), also called The Royal Book (al-Kitab al-Malaki). It is one of the most comprehensive and well-organized compendia in early medical literature. In Europe the treatise was known as Liber regius or Pantegni and the author as Haly Abbas.
Al-Majusi began his influential Arabic encyclopedia with a critical survey of his sources, which included Hippocrates and Galen as well as al-Razi. While commending al-Razi's medical epitome dedicated to Mansur, al-Majusi criticized the Comprehensive Book on Medicine, the Hawi, for being too long (the modern printed version is incomplete at 23 volumes) and not well organized, since it had been intended as an aide-memoire and general medical record for al-Razi's own private use. Al-Majusi stated that the Hawi was so enormous that few could afford copies of it, and that in fact he knew of only two people who owned a copy, "both of whom were people of culture, learning, and wealth."
Al-Majusi then proceeded himself to produce a model of organization and systematization. He divided his encyclopedia into two large books, one on theoretical principles and the other on practical aspects. Each book had 10 chapters, with divisions and subdivisions under these, typical of the elaborate organizational format of medieval Arabic writings. The chapters of the first book cover the following topics:
- historical sources and the general principles of elements and humors;
- anatomy of the homogeneous parts (bones, bloodvessels, cartilage, membranes, hair, etc.);
- anatomy of the heterogeneous parts (brain, eyes, nose, lungs, heart, kidney, etc.);
- the three faculties (natural, animal, and psychical), causes of death, and sense perception;
- the six `non-naturals', being air and winds, movement and rest, eating and drinking, sleeping and waking, evacuation and retention (including bathing and coitus), and emotions;
- classification and causes of diseases;
- symptoms of diseases and diagnosis from pulse, urine, fevers, sputum, saliva, and perspiration;
- visible external diseases, including fevers, tumors, superficial conditions (smallpox, leprosy, scabies, lice, etc.), wounds and lesions, animal and insect bites and stings, and poisons;
- causes and symptoms of internal afflictions (headache, epilepsy, eye diseases, digestive disorders, etc.);
- warning signs of the onset of diseases, of severe and lengthy illness, of death, or recovery, and of the crisis of a disease.
The Complete Book of the Medical Art (Kitab Kamil al-sina`ah al-tibbiyah) by `Ali ibn al-`Abbas al-Majusi (d. 994/384 H). The copy was finished on 15 May 1208 (7 Dhu al-Qa`dah 604 H) by the Christian scribe Tawma ibn Yusuf ibn Sarkis al-Masihi, who copied it for Mahmud ibn Zaki al-Ruqiy al-Shihabi. Shortly afterward it became the property of `Atiyah a Jewish physician of Damascus.
NLM MS A26.1, fol. 33a,
open to the chapter on the eye condition pterygium (zafarah).
The second book had 10 chapters on the following topics:
- the general principles of hygiene, dietetics, cosmetics, and therapy;
- therapy with simple drugs;
- the treatment of fevers and swellings;
- treatment of skin diseases and burns, bites, and poisons;
- therapy for diseases of the head, eyes, ears, nose, and mouth;
- therapy for diseases of the respiratory organs;
- therapy for diseases of the digestive organs;
- therapy for diseases of the genitalia and reproductive organs;
- surgery, including bloodletting, cautery, the setting of fractures and dislocations, and surgery of the parts of the body in order from top to bottom; and
- recipes for compound medicaments.
A contemporary of al-Majusi, but working independently in the far western Islamic lands, was Abu al-Qasim Khalaf ibn al-`Abbas al-Zahrawi, latinized as Albucasis, who worked in Cordoba sometime during the reign of the Spanish Umayyad ruler `Abd al-Rahman III al-Nasir from 912 to 961 (300-350 H). Al-Zahrawi also composed a major synthesis of medical knowledge available in his day, Kitab al-Tasrif li-man `ajiza `an al-ta'lif, a title rather difficult to translate but meaning the arrangement of medical knowledge for one who is not able to compile a book for himself. Of the 30 books making up the Tasrif, the first was concerned with general principles (elements, humors, temperaments, anatomy), while the second, much larger than any of the other books, was concerned with symptoms and treatments of 325 diseases discussed in sequence from head to foot. Except for the last book, all the rest are rather short and are concerned with some aspect of pharmacology or diet. The final book was devoted to surgery and was very influential, often circulating by itself apart from the rest of the encyclopedia.
Of all Islamic physicians, the best known name is that of Abu `Ali al-Husayn ibn `Abd Allah ibn Sina, known to Europe as Avicenna. He was born in 980 (370 H) in Central Asia and traveled widely in the eastern Islamic lands, composing nearly 270 different treatises. When he died in 1037 (428 H) he was known as one of the greatest philosophers in Islam, and in medicine was so highly regarded that he was compared to Galen.
Ibn Sina's magnum opus by which he was known East and West is the Kitab al-Qanun fi al-tibb or Canon of Medicine. It was composed over a lengthy period of time as he moved westward from Gurgan, in northern Iran, where it was begun, to Rayy and then to Hamadan even further southwest, where he completed it. The large comprehensive Arabic encyclopedia rivaled the popularity of al-Majusi's compendium and in many quarters surpassed it. He divided his treatise into 5 books, the first concerned with general medical principles, the second with materia medica, the third with diseases occurring in a particular part of the body, the fourth on diseases not specific to one bodily part (such as fevers), with the final book containing a formulary giving recipes for compound remedies. The Canon was known to Europeans through the Latin translations of Gerard of Cremona and Andrea Alpago and remained in use in medical schools at Louvain and Montpellier until the 17th century. Complete manuscript copies, in either the Arabic original or in Latin, are exceedingly rare, no doubt due to the enormous length of the entire work. The National Library of Medicine is fortunate to have a carefully executed complete copy probably made at the beginning of the 15th century, with illuminated headings opening each of the 5 books.
The Canon of Medicine (Kitab al-Qanun fi al-tibb) by Ibn Sina (d. 1037/428 H).
A rare complete copy made in Iran probably at the beginning of the 15th century.
NLM MS A53, fol. 368b, the illuminated opening of the 4th book
Ibn Sina in general excelled in logical assessment of a condition and the comparison of symptoms. A conservative but balanced approach to general therapeutics can be seen in his discussion of the means of relieving pain. Analgesics (mukhaddirat) abate the pain, he says, because they destroy the sensation of that part, which they accomplish either through hypercooling or by means of a toxic property. Of the analgesics, the most powerful he considered to be opium, and then mandrake, two varieties of poppy, henbane, hemlock, the soporific black nightshade, and lettuce seeds; he also included cold water and ice among the analgesics. The physician must be careful to determine the cause of the pain and to make certain that it is not due merely to an external cause, such as heat or cold, or an incorrect arrangement of the pillow, or a poor bed, or a fall during drunkenness. Often, he says, there is no need for strong measures, for bathing and sound sleep are sufficient. He recognized the importance of sleep for alleviating pain and stressed that, as analgesics might be harmful, they should be prepared in the mildest possible way. The physician needs to determine which is more harmful to the patient, the pain or the possible dangers of the analgesia.
Ibn Sina was also concerned with other means of relieving pain, such as massage, the application of hot compresses, the use of a hot-water bottle, pleasurable music, or compelling work. What is equally interesting is what is not stated by Ibn Sina: There is no mention of the use of wine, though wine is used for other purposes elsewhere in the Canon, nor is there any mention of the use of analgesics or soporifics during an operation.
Among Ibn Sina's smaller medical writings were a popular didactic poem on medicine, a treatise on cardiac drugs concerned with the physiology and pathology of the heart and how they are influenced by emotions and with the simple remedies for regulating heart beat, treatises on diagnosis from respiration and pulse, on colic, on intermittent fevers, on diabetes, and on hygiene and regimen.
The Canon of Medicine by Ibn Sina was not, however, greeted everywhere with praise. In Spain the physician Ibn Zuhr (d. 1131 (525 H), father of the more eminent Ibn Zuhr known in Latin as Avenzoar, wrote a treatise criticizing parts of Ibn Sina's book on materia medica, that is, the second book of the Canon. When a merchant from Iraq brought Ibn Zuhr a copy, he examined it but then rejected it and would not put it in his library, but rather cut off its margins and used them to write prescriptions for his patients. Our source of information on Ibn Zuhr's opinion of Ibn Sina is Hibat Allah ibn Jumay` al-Isra'ili, who was physician to Saladin in Egypt (ruled 1169-1193/564-589 H). From this account it seems that it was about a century before the Canon became available in Cordoba after it was completed in Hamadan. Since this Ibn Zuhr was the first of a five-generation family of prominent Andalusian physicians, the question arises whether Islamic medicine in Spain followed the direction of this patriarch of medical families and developed with less dependence upon the ideas of Ibn Sina.
Comprehensive attempts at collecting and systematizing (as well as updating with personal observation) the fragmentary and unorganized Greco-Roman medical literature that had been translated into Arabic were enormously successful in producing a coherent and orderly medical system. The medicine of the day was so brilliantly clarified by these compendia (especially those by al-Majusi and Ibn Sina), and such order and consistency was brought to it, that a sense of perfection and hence stultifying authority resulted. The sheer size of these encyclopedias tended to emphasize their authoritative nature. In the case of Ibn Sina, even the title Qanun, meaning `canon' or `codes of law', contributed to this view.
Ibn al-Nafis's 13th-century treatise The Concise Book (Kitab Mujiz) which epitomized the Canon of Ibn Sina. The undated copy, written in a fine professional hand with an illuminated heading and opening text in cloud bands, was probably produced in Iran or India in the 17th to 18th century.
NLM MS A44.1, fol. 1b
By the 12th century an awareness set in that these compendia were too large to be really useful for ready reference. Consequently, epitomes of the Qanun were produced to make the ideas more quickly accessible, and commentaries were written to clarify the contents. The most popular of all the epitomes of the Qanun was that called Kitab al-Mujiz or The Concise Book. It was written in Syria by Ibn al-Nafis (d. 1288/687 H), known to his contemporaries as `Ala' al-Din `Ali ibn al-Hazm al-Qurashi. He was an authority on religious law as well as a prolific writer of medical tracts and a specialist in treating eye diseases. This epitome by Ibn al-Nafis in turn generated many commentaries that expanded on particular points.