The Development of Arab Medicine During the Eighth through Thirteenth Centuries

Overview

During the Middle Ages, Arabic medicine developed and filled a major gap left by the fifth-century collapse of the Roman empire in the West. At first Islamic physicians sought to preserve knowledge by collecting, then translating, the classical Greco-Roman medicine that Europe had lost. Then they began adding information from other cultures, giving their own comments and interpretations. Arab physicians laid the foundations of modern medicine as well as that of important medical institutions.

Background

After the collapse of the Roman empire, very little knowledge of Greek medical science was available in the West. The Church became the center of society and greatly influenced the development, or stagnation, of medicine in the West. The Church made no pretense of its mission, which was to minister to the soul and not to the body. Monastic orders ran hospitals, but they were places for the seriously ill, and people were expected to recover or die as God willed. No medicines were given, nor did physicians attend to them. Without studying disease, and with the physical health of people considered relatively unimportant, medicine as a craft vanished. In the middle of the seventh century the Catholic church banned surgery by monks.

The Eastern empire at Byzantium experienced turmoil in the form of ethnic tensions and bitter splits among Christian sects. The Greek heritage weakened and declined, though medical learning was perpetuated in centers like Alexandria in North Africa.

At about this time a different development was occurring on the Arabian peninsula. In this region a tribal society rife with injustice, promiscuity, and disease was transformed with the rise if Islamic religion. The teachings of the prophet Muhammad, born at Mecca in 570, united the scattered tribes of Bedouins under one set of rules. Through Mohammed the concepts and practices of health became incorporated in the general body of Islamic religious teachings. Muhammad was concerned with the health of his followers and even wrote about treatment of many conditions, such as leprosy and smallpox. In the seventh and eighth centuries the Islamic empire spread eastward to the Indus River, west along the Mediterranean coasts of Africa, and north to the Pyrenees in western Europe.

During the Umayyad dynasty (660-750), which was based in Damascus, translations of ancient medical works began. Prince Khalid bin Yazid had a passion for medicine and alchemy and instructed Greek scholars in Egypt to translate Greco-Egyptian medical literature into Arabic. In addition, after Plato's Academy was closed in 529, some of the scholars moved to the University of Jundishahpur in the old capital of Persia. This city also became home to excommunicated Nestorian Christian physicians. When Persia became part of the Islamic empire in 636, the Arab rulers supported the medical school and for the next 200 years it was one of the greatest centers of medical learning in the Islamic world. Under the Umayyads, the Hispanic Muslim area of Cordoba, Seville, and Granada also became great centers of learning, which later peaked in the twelfth century.

In around 750, political rule of the Muslim world passed into an era known as the Abbasid period. In 754 Abu Jafar al Manser founded Baghdad on the banks of the Tigris River in the fertile area of Iraq. The climate was ideal, and there was an absence of mosquitoes. In 750 the empire divided into the Eastern Caliphate, with Baghdad as the capital, and the Western Caliphate, with Cordoba, Spain, as capital. The Muslims had conquered the eastern Byzantium empire. At first the Arabs were indifferent to the learning of their infidel subjects, but gradually grew to appreciate it. In around the middle of the eighth century they began to undertake Arabic translations of Persian, Hindu, and especially Greek scientific, medical, and philosophical works. Most translations were made by Syrian-Christian and Sabian scholars.

The Muslim world developed an attitude of relative tolerance for Jews and Christians; as Islam was considered a superior religion by its adherents, Muslims did not make proselytizing a priority and these groups got along very well in that region. It was not until the papacy launched the Crusades to drive the Muslims out of the Holy Land that hostilities developed.

Impact

Medicine was the first of the ancient Greek sciences to be revived and studied. The Abbasid caliph Harun al-Rashid (786-809) and his son al-Mamun (813-833) recognized the importance of translating Greek works into Arabic and established a translation bureau, called the Bayt-al-Hikmah or House of Wisdom, in Baghdad. They sent people throughout the old Greek empire to collect scientific works. Islamic physicians studied the works of Hippocrates (460-377 b.c.), Galen (130-200), and other Greek physicians. At the same time, they gathered the knowledge of Byzantium, Persia, India, and China. This ushered in the first era of Islamic medicine—the period of translation and compilation.

One of the important translators was Hunayin ibn Ishaq (808-873), known in the Latin West as Johannitius. A profound scholar of Greek, he went to Baghdad to study medicine and soon became recognized for his great ability as a translator after translating a work by Galen. He was sent by al-Mamum to Byzantium to obtain manuscripts and to work on translations of the great Greek philosophers and physicians, such as Hippocrates, Galen, and Dioscorides (40-90). He made long journeys into Mesopotamia, Syria, Palestine, and Egypt to find the manuscripts. He strove to render the Greek text as clearly as possible and was impatient with poor translations. His methods are still used in modern philology.

Hunayin's medical works were divided into three areas: translations of ancient texts, summaries and paraphrases of these texts, and original treatises. He and his pupils translated 129 works of Galen into Arabic. Since Hunayin preferred Galen, he provided the Arabic world with more translations of Galenic texts than are available today in Greek.

Islamic medicine largely accepted Galen's humoral theory, by which he proposed that the human body was made up of the four elements that comprise the world—earth, air, fire, and water. When these elements were mixed in various proportions, the differing mixtures gave rise to different temperaments or "humors." When the humors were in perfect balance, the body was healthy; when the humors were out of balance the person would be ill, and this must be corrected by the doctor's healing arts. Thus, physicians viewed it as their task to preserve health if possible and then to heal if necessary.

During this period of translation, advances were made in other fields. Hospitals, or bimaristans, were established where the sick could be treated and health promoted. Medical schools and libraries were attached to hospitals, and the hospitals gave examinations and diplomas. There were traveling clinics that would go to places inaccessible to the hospitals. The Islamic hospital was the prototype of the modern teaching hospital today. Also, pharmacies were developed. The Arab alchemist Jabir ibn Hayyan (721-815) is considered the father of pharmacy. A large number of new drugs were introduced into practice. The first private apothecary shop opened in Baghdad at the start of the ninth century. Spain had a favorable climate and diverse array of flora, which aided in the development of botanical medicine. Ibn al-Baytar, born in Malaga in 1197, worked in southern Spain on different plants and wrote a commentary on Dioscorides. In general, Hispanic Islam had a high level of medical practice and surgery.

As the ninth century drew to a close, the first major Arabic medical work was produced by Abu Bakr Muhammad ibn Zakariya' ar-Razi (865-923), known in the West as Rhazes. Rhazes is regarded as Islamic medicine's greatest practitioner and original thinker. Some have dubbed him the father of pediatrics because of his treatise on the diseases of children. He wrote a medical encyclopedia consisting of 25 books.

Rhazes also knew the importance of the doctor-patient relationship. He developed a philosophy of medicine that asserted the primacy of reason and condemned slavery to authority in medicine. He later became one of the most respected medical scholars in the West and his notebook of medical writings, the Kitab al-Hawi (Comprehensive book), was translated into Latin in 1279 under the title Continens.

Not long after Rhazes' death, another great physician, Ibn Sina (980-1037), known in the West as Avicenna, was born. Some have said that Avicenna was to the Arab world what Aristotle (384-322 b.c.) was to ancient Greece, Leonardo da Vinci (1452-1519) to the Renaissance, and Johann Wolfgang von Goethe (1749-1832) to Germany. Avicenna's major work, the Canon of Medicine, was used as a standard reference until into the nineteenth century.

During the tenth century, Arab texts began to be translated into Latin. Europeans began to see the intellectual riches of the Arabs and were inspired to seek out their own heritage. Galen and Hippocrates returned to the West by way of the Arab medical classics. Salerno, at the cross-roads of East and West, became one of the first great centers of medical scholarship in Europe.

The development of Arab science reached its high point in the tenth and eleventh centuries, and, after some sporadic and short-lived but important revivals in the thirteenth and fourteenth centuries, came to a virtual halt by the end of the fifteenth century.

Despite the fact that humors and miasmas have been displaced by other theories, the medicine of Islam made great contributions to techniques of diagnosis, knowledge of preventive health, and the use of quarantine to limit the spread of disease. The Islamic world proved an essential source for the European rediscovery of "lost" Greek medical knowledge and the promotion of scientific observation and experimentation in the West, where such fundamental precepts of medical practice had been abandoned.

EVELYN B. KELLY