Medicine and Health

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Medicine and Health

Prophetic Foundations . Muslim medicine has an important theological basis. Both the Qur’an and the hadiths make many references to taking care of the body, which is a religious obligation for Muslims. An instrumental aspect of Islamic theology is the divinely ordained balance of life. Muslims are expected to protect that delicate balance, including care of their bodies, so they are able to perform religious duties and be valuable citizens. This concept was clearly put forth by the fifteenth-century Muslim physician Jalal al-Din al-Suyuti in his Tibb ul-Nabbi (Medicine of the Prophet):

It is obligatory upon every Muslim that he draw as close to the Almighty God as he can and that he put forth all his powers in attention to His commands and obedience to Him, and that he make the best use of his means and that he … [refrains] from what is forbidden and that he strive for what gives benefit to Mankind by the preservation of good health and the treatment of disease. For good health is essential for the performance of religious obligations and for the worship of God.

Public Health . Along with advances in health care came innovations in public health and hygiene. Medical schools were attached to teaching hospitals in cities such as Baghdad, Cairo, Damascus, and Cordoba. Medical facilities traditionally closed each night, but by the tenth century laws were passed to keep hospitals open twenty-four hours a day. Hospitals were also forbidden to turn away patients who were unable to pay. Eventually charitable foundations called waqfs were formed to support public institutions such as hospitals and schools. This money supported free medical care for all citizens. Muslim cities also maintained public baths to facilitate the fulfillment of religious duties related to personal hygiene. Muslims must perform a ritual washing five times per day before saying their obligatory prayers, and Muslim scholars realized early the links among clean water, public hygiene, and health.

Medical Theory . Muslim physicians used Greek, Chinese, and Indian medical theories as the bases from which to develop their own. Like the ancient Greeks, Muslims believed that a balanced body is a healthy body and did their best to maintain a delicate balance between the four humors: blood, phlegm, yellow bile, and black bile. As in Greek medical theory, the humors were linked between the four natures—hot, dry, cold, and humid—and the four elements—earth, water, air, and fire. Muslim scientists are considered the first medical scholars to understand the pathology of contagion, and as a result they created hospitals

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with separate wards for specific illnesses, so that people with contagious diseases could be kept away from others. Before this innovation in health care, a patient hospitalized for a broken leg might have been placed next to someone with the highly contagious bubonic plague.

Aids to Recovery . As early as the eighth century Muslims were aware of the connection between psychological well-being and physical health. In the tenth century, the renowned Adudi hospital in Baghdad offered soothing music, poetry, and the sound of running water as aids to recovery. Patients were also permitted to work in the herb gardens as a relaxing form of exercise. Eventually Muslim physicians developed a holistic form of treatment that involved a combination of diet management, herbal medication, isolation of communicable diseases, prayers, fresh air, exercise, healing scents, and reduction of stress. When patients were released, they were often given a small sum of money to facilitate their return to the community.

Folk Traditions . Arab-Muslim and Latin-Christian cultures both had a wealth of folk traditions, as well as religious faith, to draw on when confronted with illness. Often treatments combined remedies from several sources in search of anything that might offer relief to the afflicted. Like their European counterparts, Muslim physicians often turned to unscientific treatment methods. For instance, Islam developed in a region that had a strong tradition of believing in the power of the “evil eye.” Suyuti mentions it in his Tibb ul-Nabbi:

If any one of you is struck by the Evil Eye and asks for water in order to perform an ablution (ritual cleansing before prayer) then his request should be granted. And he who is struck by the Evil Eye will wash his face, his hands, his elbows and knees, and the tips of his feet, and what lies within his breeches. He will collect this water in a cup and pour it over the possessor of the Evil Eye. He will turn the cup upside down behind him on the ground. It is said that this pouring upon him will bury the effects and he will be cured by the permission of Almighty Allah.

Although some Muslims disagreed with the practice, astrology, numerology, protective charms, and amulets were also used in medieval times to ward off disease and the evil eye. These practices were particularly prevalent during the mid fourteenth century, when both the Muslim and Christian worlds were devastated by the rampant spread of bubonic plague, known as the Black Death. People seeking cures often made little distinction among religion, science, and superstition. Muslims often tried to protect themselves by wearing charms and rings that bore Arabic inscriptions, believing these letters had healing powers because the Qur’an was revealed in the Arabic language. Many believed they could protect themselves from illness or injury by wearing either an entire verse from the sacred text, or even a few letters.

The Black Death . The devastating plague that struck the Muslim world and Europe in the mid fourteenth century sparked an important exchange of medical knowledge between the Muslim empire and Latin Christendom. Contemporary comments describing the plague and how people tried to deal with it reveal much about the time and how sometimes, in their effort to avoid the plague, people did things that probably increased their exposure to the highly contagious disease. The Moroccan traveling scholar Ibn Battuta (1304 - circa 1378) described how the people of Damascus tried to deal with the plague:

The people fasted for three successive days, the last of which was a Thursday. At the end of this period the amirs, sharifs, qadis, Doctors of the Law, and all other classes of the people in their several degrees, assembled in the Great Mosque, until it was filled to overflowing with them, and

spent Thursday night there in prayers and liturgies and supplications. Then, after performing the dawn prayer, they all went out together on foot carrying Qur’ans in their hands; the amirs too, barefooted. The entire population of the city joined in the exodus, male and female, small and large. The Jews went out with their Book of the Law and the Christians with their Gospel, their women and children with them; the whole concourse of them in tears and humble supplications, imploring the favor of God through His Books and His Prophets.

In fourteenth-century Germany and Flanders the Christian flagellants—who went from village to village flogging themselves in an attempt to end the plague by penance for the sins of mankind—probably spread the plague through every village they visited. The many efforts to combat the plague throughout Europe and the Middle East combined common sense (such as quarantining victims) with superstition. Another “protective measure” that was instrumental in spreading the plague was fleeing the disease by leaving a city where the plague had struck and going to a place that was so far disease free. Ibn Battuta always seemed to be just one step ahead of the plague, but others were not so lucky, and their behavior proved deadly to people they encountered in their flight. One of the most effective treatments developed by Muslim physicians was to open and drain the “bubos” (boils) and then soak the area with vinegar and oil of roses. People were also told to keep their homes clean and to avoid the “miasma” (bad air) of crowded places. Finally, they were told to turn to the Qur’an for help.

Medical Exchange During the Crusades . The Crusades (1095-1271) offered an opportunity for an exchange of medical knowledge between European physicians and those of the Middle East. Most of the time the sharing of medical procedures was a positive experience, but sometimes cultural prejudices prevented European doctors from learning from their more-advanced Middle Eastern counterparts. A journal entry by Usamah ibn Munqidh (1095-1188), a prominent Muslim living in Syria, tells the story of a European Christian doctor and Syrian Arab physician:

One day, the Frankish [French] governor of Munaytra, in the Lebanese mountains, wrote to my uncle the sultan, asking him to send a physician to treat several urgent cases. My uncle selected one of our Christian doctors, a man named Thabit. He was gone for just a few days, and then returned home. We were all very curious to know how he had been able to cure the patients so quickly, and we besieged him with questions. Thabit answered: “They brought before me a knight who had an abscess on his leg and a woman suffering from consumption [excessive fatigue and general poor health]. I made a plaster for the knight, and the swelling opened and improved. For the woman I prescribed a diet to revive her constitution. But a Frankish doctor then arrived and objected, This man does not know how to care for them.’ And, addressing the knight, he asked him, Which do you prefer, to live with one leg or die with two?’ When the patient answered that he preferred to live with just one leg, the physician ordered, ‘Bring me a strong knight with a well-sharpened battle axe.’ The knight and the axe soon arrived. The Frankish doctor placed the man’s leg on a chopping block, telling the new arrival, ‘Strike a sharp blow to cut cleanly.’ Before my very eyes, the man struck an initial blow, but then, since the leg was still attached, he struck a second time. The marrow of the leg spurted out and the wounded man died that very instant. As for the woman, the Frankish doctor examined her and said, ‘She has a demon in her head who has fallen in love with her. Cut her hair.’ They cut her hair. The woman then began to eat their food again, with its garlic and mustard, which aggravated the consumption. Their doctor affirmed, ‘The devil himself must have entered her head.’ Then, grasping a razor, he cut an incision in the shape of a cross, exposed the bone of the skull, and rubbed it with salt. The woman expired on the spot. I then asked, ‘Have you any further need of me?’ They said no, and I returned home, having learned much that I had never known about the medicine of the Franj (French).

Arab Medicine . By the twelfth century, however, many European physicians were enthusiastically studying works by Arab medical authorities such as al-Razi (865-925), known in the West as Rhazes, and Ibn Sina (980-1037), well known to European scholars as Avi-cenna. When asked to choose the location for a new hospital in Baghdad, al-Razi hung large pieces of raw meat on poles in various sections of the city. After a few days, he determined the site by finding the place where the meat had rotted the least. He concluded that the circulation of the air must be best at that site, which would make it a good place for treating sick people. In his medical texts he put forth new ideas about the need to improve the mental health of patients in order to cure their diseases. He was also one of the earliest physicians to see pediatrics as a separate field of medical research. Until this time, people tended to view children as “small adults” and ignored their different psychological and physical needs. Al-Razi’s Kitab al-Mansuri (Book of Mansur) describes diseases and treatments in a systematic and scientific way. He kept careful clinical records and instructed his readers on how to diagnose and cure diseases. The philosopher-physician Ibn Sina’s enormous Qanun fi’l-tibb (Canon of Medicine) listed every disease known at that time and their cures. He also included a pharmacopoeia in which he described medicinal plants and other remedies in detail. In the twelfth century Ibn Sina’s Qanun was translated into Latin by Gerard of Cremona. Thought to be the most widely read medical text in the world, it served as the primary medical text of European universities until the seventeenth century. In his study of the nervous system, Ibn Sina concluded that muscles move through impulses sent through the nerves and also noted that some organs, such as the liver and the kidney, do not have any nerves inside them but are surrounded by nerves in their outer layer. Ibn Sina’s Kitab al-shifa (Book of Healing) is not a medical text: instead it covers a wide variety of scientific fields and focuses on explaining how science and theology together could solve the great mysteries of life.

Surgery and Anatomy . An area in which Muslim physicians excelled was surgery. Ibn Sina’s detailed descriptions of the structure of the human eye and how the heart valves let blood enter the heart as the heart contracts are obviously the observations of a physician who performed many surgical procedures. An entire chapter of al-Razi’s Kitab al-Mansuri is devoted to surgical procedures. In this chapter he was the first physician to write about spinal cord injuries and how a patient could be paralyzed if the connection between the nerves and the brain was severed. Arab physicians were also the first scholars to describe the four chambers of the heart and how the valves kept the blood flowing in one direction. They were also the first to use inhalation anesthesia by putting a sponge soaked in narcotics over the face of the patient during surgery. They eventually created sedatives that enabled them to perform major surgery, and they invented more than two hundred surgical instruments. Medieval Muslim surgeons used hollow needles and suction to remove cataracts from their patients’ eyes—a procedure that was revived in 1846 by a French doctor. Muslim scholars also wrote books on how the eyes, optic nerves, and brain give people sight. (Earlier scientists thought that beings saw by sending rays out of their eyes, rather than by receiving light rays through the eyes and transmitting them to the brain.) After performing surgery, Muslim physicians sewed their patients up with sutures (stitches) made of animal guts or silk. As early as the tenth century, to lower the risk of postsurgical infection, they had created a new antiseptic called al-kohl (alcohol) using a distillation process invented by Arab chemists. Once surgery was completed, patients entered a recovery ward, where they received continued medical care while listening to prayers, poetry, and music.

Al-Zahrawi . In his Kitab al-Tasrif (Encyclopedia of Surgery and Instruments), Abu al-Qasim al-Zahrawi (known in the West as Albucasis), an eleventh-century surgeon from Andalusia (Muslim Spain), wrote a clear description of the pulmonary circulatory system as well as the “lesser circulation” of smaller vessels. He also described surgical procedures he had invented—including dissecting organs, removing stones from the bladder, and cauterizing wounds—and was the first physician to identify hemophilia as a disease. Skilled at oral surgery and dentistry as well, he explained how to make artificial teeth from animal bones. After the twelfth century, when Gerard of Cremona translated al-Zahrawi’s medical text into Latin, the thirty-volume work revolutionized European medicine. In addition to its instructions on how to perform surgery, the text included diagrams of the surgical instruments that al-Zahrawi had invented and detailed descriptions of human anatomy. A large portion of this work was dedicated to the description of how to prepare and use duhn, the oil or “essence” of various plant and animal matter—such as roses, balsam, almonds, chick peas, chamomile, eggs, snakes, and flying ants. These remedies were administered for ailments such as inflamed eyes, bladder infections, chest colds, skin rashes, tumors, and asthma. In fact, al-Zahrawi offered a treatment for virtually all known diseases.