040617-HISTORY OF MEDICINE, Tarikh Al Tibb

Paper presented at the Malaysian Medical Students Conference held at Kuantan on 17^th June 2004 by Prof Dr Omar Hasan Kasule, Sr.

PRE-ISLAMIC ROOTS

The roots of modern medicine can be traced to ancient civilizations of Egypt, Babylon, China, India, Persia, Greece, and Rome. There were also contributions from traditional medicine of many societies including the Pre-Islamic Arabian peninsula.

The practice of embalming the dead gave Egyptians a lot of knowledge about anatomy. They also developed various medical and surgical modalities. The babylonians knew nasal tamponade for bleeding, cataract couching. They used blood-letting as a treatment. They knew circumcision and we learn from the sunnat that the great patriarch Ibrahim (PBUH) was circumcised.

The saying ‘seek knowledge even if as far away as China’ is well known all over the Muslim world. Muslims learned a lot from the Chinese. Ancient Chinese medicine was well developed. The Chinese developed acupuncture and castration of males who became eunuchs. Chang Chon-Ching, who lived in the 2^nd century M, was the most famous Chinese physician. He had famous medical writings and spread medical knowledge to Japan. In the 3^rd century M the Chinese surgeon Hua Chu wrote about physiology, anatomy, pathology, anesthetics. After him Huang wrote about acupuncture. Tao Hung Ching (454-536 M) used acupuncture and had interests in internal medicine, anatomy, children and women diseases, obstetrics, dietetics, and drugs. Chao Yuan Fang (550-630 M) wrote a medical encyclopedia. Sa’ad Ibn Abi Waqqaas the commander of the conquest of Qadisiyyat (13H) and the founder of the city of Kufa (18H) was sent by Othman Ibn Affan on a diplomatic mission to China 620-640 M and is reported to have lived in the Chinese city of Canton. Thereafter contacts between Muslims and Chinese increased. A Chinese physician came to Al Razi (d. 313 AH/925 M) and requested to study under him for 1 year. He learned Arabic and translated medical books into Chinese. Muslims were in contact with Chinese physicians who visited Central Asia such as Yuan Chwang 630-645 M and I Tsung 675-685 M.

Surgical knowledge in India was very advanced and many surgical instruments were developed. The following operations were carried out by Indian surgeons: tonsillectomy, amputation, tumor excision, hernia repair, repair of harelips, removal of bladder stones, couching cataracts, nose repair, ceserian section. Indians knew the washing and bandaging of wounds. Hyoscamus (Henbane) and cannabis indica were used as anesthetics. In some cases hypnosis was used as anesthesia. The period 6-12^th centuries M witnessed development of Indian medicine especially in the field of toxicology. Indian medicine reached Baghdad both directly and indirectly, through Persia. Muslims entered Sindh in 15H/637M led by the Omayyad military leader Muhammad Ibn al Qasim; a long period of contact with Indian medicine, trade and cultural exchange ensued. In the Abassid era the ruling Barmaki family were interested in Indian culture especially its medicine. Yahya bin Khalid al Barmaki, vizier of Harun al Rashiid, sent missions to India to learn its medical knowledge. He also invited Indian physicians to Baghdad. Some Indian medical texts were translated into Arabic in Baghdad. The physician Abi al hasan Ali Bin Sahal al Tabari in his book ‘Firdaus al Hikmat’ completed in 236H / 850M wrote about Indian medicine covering topics such as: importance of spiritual cures, treatment of metal disorders, importance of specialization, women diseases, obstetrics, internal medicine, dietary treatment, looking at the patient as one entity, diagnosis,  preventive medicine, anatomy, surgery, surgical instruments, and medical training. The Indian physician Kankah treated Harun al Rashiid and translated a book on poisons. The Indian physician Salih bin Baghlat was famous at the Abassid court. Urnda, Siddhayogar, and Ibn Dahn al Hindi were Indian physicians who served the Abassids and all worked at the Baghdad Hospital built in 187H/ 803M in the era of Harun al Rashid. Zantah was an Indian physician who wrote about poisons and their treatment. Ibn al Nadiim in his book ‘Al Fihrist’ mentioned Indian medical books that were translated into Arabic. Abubakr al Razi in his book ‘al Hawi’ depended a lot on Indian medical knowledge. Abi al Rayhan Muhammad bin Ahmad al Bairuni wrote about Indian medicine. He traveled in India and was very familiar with its people and culture.

Persian interest in Greek medicine was demonstrated when the King of Persia invited the famous Greek physician Hippocrates (460-377 BC) to help deal with diseases and epidemics in Persia. Hippocrates did not agree. When Alexander of Macedonia defeated Persia, he spread Hellenic civilization including its medicine. Greek knowledge was translated first into Persian then into Arabic. Hereafter many translations of medical works were made from Persian to Arabic especially at the time of the Abassids. Persian influence was very strong at the Abassid court in many areas including medicine.

Greek medical knowledge was picked up by the Romans and was spread in West Asia by the Byzantines. The famous Roman physician Galen closely followed Hippocrates. He in turn had a major impact on Byzantine medicine. Muslims learned a lot from Galen but also had access to other Greek sources. Complete reliance on Galen was not possible because Galen was selective in his copying from Hippocrates and other Greek physicians. Muslims played a big role in preserving early Greek medical knowledge, improving and enhancing it, and eventually passing it on to Europe during the renaissance. The Greek physician and father of European medicine, Hippocrates son of Heraclides (460-377 or 370 BC), introduced rational/scientific medicine. He introduced the theory of the 4 humors and the 4 elements of the body. The Hippocratic corpus consists of his writings and those of his students. Romans learned from the Greeks and developed advanced military hospitals called valetudinaria that were used to treat wounded soldiers on the battle-field. Three Roman physicians became famous: Celsus, Rofus, and Galen. Celsus described the cardinal signs of inflammation: rubor, tumor, calore, and dolore; provided  details of surgical procedures; and described ligation of blood vessels. He encouraged dissection. Rofus wrote 42 titles and made contributions to anatomy, surgery, and urinary tract disease. Claudius Galen (130-201 BC), a skilled Roman military surgeon, had great impact on Arab medicine. His writings were compiled by the Byzantines and were eventually translated into Arabic.

The Greek-speaking multi-national Byzantine empire, with its capital at Constantinople in West Asia, lasted over 1000 years after the fall of Rome and acted as a bridge to transfer Greek knowledge to West Asia and North Africa. The Byzantines compiled Greek knowledge from Hellenic and Roman books. The University of Alexandria was the center of this activity. It continued functioning after the Muslim conquest of 642M and lasted until 719M. Johns Philoponus, the grammarian, was an Egyptian scholar in Alexandria who met Amre bin al ‘Aas. He wrote commentaries on the books of Aristotle and Galen. Palladius and Asclepius wrote commentaries on Hippocrate’s writings in the 6^th century M. Paulinus, an expert in women diseases and obstetrics, was another Byzantine physician in Alexandria.

Medical knowledge in the Arabian peninsular before Islam was the folk medicine found in all human communities. We know a lot about the nature of this medicine from the many authentic hadiths on Tibb al nabawi. The prophet’s medicine was in most cases the medicine practised in Hejaz at that time. Pre-Islamic Arabs used cupping, hijamat; cautery, kayy, and branding with fire, wasm. They used a wide variety of herbal medicine. Among medical practitioners in the pre-Islamic era were: Ibn Huzeem, Nadr Ibn Harith, and Ramtha al Tamiimi. The harsh environment, isolation in the desert, the nomadic Bedouin life, and general illiteracy explain the low level of medical knowledge among Arabs before Islam. They sometimes confused medical practice with sorcery and magic.

MEDICINE IN THE EARLY ISLAMIC PERIOD (0 – 132 H)

Overview: The period under review covers the era of the Prophet (-13H to 10H), the era of the 4 rightly-guided khulafa, khulafa al rashdiin (10-40H), the Omayyad era (41-132H), and entry into Andalusia (starting 94H). The prophet;s teachings gave a big impetus to medicine. He taught that there were two branches of knowledge: ‘ilm al abdaan & ilm al adyaan. He taught that the body had rights and had to be cared for. He also taught that the intestine was the abode of disease and prevention was the head of all medicine. He taught a lot about personal and environmental hygiene. He practiced medicine and urged his companions to seek cures for their diseases. The start of rapid medical advance was in the Omayyad period. Translations of medical texts into Arabic started under the Omayyads. Prince Khalid Ibn Yazid rewarded translators lavishly.

Rufaidah bint Sa'ad, the nurse: is generally recognized as the first Muslim nurse. Rufaidat's full name was Rufaidat bint Sa'ad of the bani Aslam tribe of the Khazraj tribal confederation in Madinah. She was born in Yathrib before the migration of the Prophet Muhammad (PBUH). She was among the first people in Madina to accept Islam and was one of the Ansar women who welcomed the Prophet on arrival in Madina. Rufaidah's father was a physician. She learned medical care by working as his assistant. Her history illustrates all the attributes expected of a good nurse. She was kind and empathetic. She was a capable leader and organizer able to mobilize and get others to produce good work. She had clinical skills that she shared with the other nurses whom she trained and worked with. She did not confine her nursing to the clinical situation. She went out to the community and tried to solve the social problems that lead to disease. She was a public health nurse and a social worker. When the Islamic state was well established in Madina, Rufaidah devoted herself to nursing the Muslim sick. In peace time she set up a tent outside the Prophet's mosque in Madina where she nursed the sick. During war she led groups of volunteer nurses who went to the battle-field and treated the casualties. She participated in the battles of Badr, Uhud, Khandaq, Khaibar, and others. Rufaidah's field hospital tent became very famous during the battles. At the battle of the trench, ghazwat al khandaq, Rufaidah set up her hospital tent at the battle-field. The prophet Muhammad instructed that Sa'ad bin Ma'adh who had been injured in battle be moved to the tent. Rufaidah nursed him and carefully removed the arrow from his forearm and achieved hemostasis. The prophet visited Sa'ad in the hospital tent several times. Rufaidah had trained a group of women companions as nurses. When the Prophet's army was getting ready to go to the battle of Khaibar, Rufaidah and the group of volunteer nurses went to the Prophet Muhammad (PBUH). They asked him for permission "Oh messenger of Allah, we want to go out with you to the battle and treat the injured and help Muslims as much as we can". The Prophet gave them permission to go. The nurse volunteers did such a good job that the Prophet assigned a share of the booty to Rufaidah. Her share was equivalent to that of soldiers who had actually fought. Rufaidah's contribution was not confined only to nursing the injured. She was involved in social work in the community. She came to the assistance of every Muslim in need: the poor, the orphans, or the handicapped. She looked after the orphans, nursed them, and taught them. Rufaidah had a kind and empathetic personality that soothed the patients in addition to the medical care that she provided.

Other early nurses: The following nurses became famous for their nursing work both in war and peace during the time of the prophet: Rufaidat bint Ka’ab al Aslamiyyat; Amiinat Bint Qays al Ghifariyyat; Umm ‘Atiyyah al Anasariyyat; Nusaibat Bint Ka’ab al Maziniyyat & her family; Zainab from the tribe of Bani Awd an expert in diseases and surgery of the eye. History has recorded names of women who worked with Rufaidah: Umm Ammara, Aminah, Umm Ayman, Safiyat, Umm Sulaim, and Hind. Umm Ammara is also known as Nusaibat bint Ka'ab bin Amru bin 'Awf bin Mabdhool bin 'Amru bin Ghanam bin Mazin bin al Najjar al Ansariyat. She was the mother Abdullah and Habiib, the sons of Bani Zayd bin 'Asim. Nusaibat was assisted by her husband and her children in her nursing work. She participated in the covenants of 'Aqabat and Ridhwan. She was at the battle of Uhud with her husband and her son. She was also at the battle against Musailamah in Yamamah. She was injured 12 times in this battle, her hand was cut off, and she eventually died as a result of her wounds. She had gone to the battle of Uhud to nurse the fighters and provide them with water and when the battle turned against Muslims she took a sword and fought defending the Prophet. Amiinat bint Qays was reported to have helped in preapring Safiyat for her wedding to the Prophet (PBUH). Umm 'Atiyyah al Ansariyat al Khadfidhat treated women in Madina.

Physicians: Among the physicians of this era were: al Harith Bin Kaldat,  Rufa’at bin Yathri,  Ibn Athaal,  Thiyadhuuq,  Abd al Malik Bin Sa’ied bin Hayyaan bin Abjar al Kinani , Abu al Hakam al Dimashqi,  Wahb bin Minyat (d. 112H /732M), and Ibn Juraih al Raahib (d. 130H). Abu Omar Bin Salal al Harith Bin Kaldat (d. 734M) of the tribe of Thaqaf from Taif was praised by the prophet as the best Arab physician of his day. The prophet ordered Sa’ad bin Abi Waqqaas to consult al Harith. His mother was an aunt, khaalat, of the prophet. Al Harith studied medicine in Khuristan in Persia and became famous as a physician in Persia. He then returned to Taif and entered Islam and lived until the Omayyad era. He used to advise people to take preventive measures against disease. On his death his work was inherited by al Nadhar bin al Harith. Rufa’at bin Yathri Abu Ramthat al Tamiimi lived at the time of the prophet and met him. Ibn Athaal, a Christian physician at the court of Mu’awiyah bin Abi Sufyan and an expert in medicines and poisons, was suspected in the death of many prominent people. Thiyadhuuq, said to have been a physician to the Omayyad governor Hajjaaj bin Yusuf, wrote a book with special interest on the relation between the patient and the physician and also wrote on dietary advice. Abd al Malik Bin Sa’ied bin Hayyaan bin Abjar al Kinani was a physician of the Khalifah Omar Ibn Abd al Aziiz (99-101 H) and had a famous saying: ‘leave the medicine alone as long as you can withstand the disease, d’i al dawaa ma ihtamala badanuka al ddaau’. Abu al Hakam al Dimashqi was a Christian physician with specialization in therapeutics and was physician to the second Omayyad Khalifah, Yazid Ibn Abi Sufyan. ‘Aailat Ibn Hakam al Dimashqi was a Christian physician for the Omayyad rulers. His son Abu al Hasan ‘Isa bin Hakam bin Abi al Hakam was also a physician and authored a medical book. Wahb bin Minyat (d. 112H /732M)  knew Greek physiology and believed that a person has 360 organs.

MEDICINE IN THE ABASSID PERIOD (132 H – 656H / 749 – 1258M)

ACHIEVEMENTS

This era was a time of translation and advancement in medical knowledge and technology. This was made possible by the general conditions of peace that pax Islamica had established allowing movement of people and ideas across the expanse of a large empire. The political leaders encouraged as well as patronized learning and science. They bought books and imported scientific brains. Al Ma ‘amun established Bayt al Hikmat which undertook translations of Greek knowledge. Hunain Ibn Ishaaq (808-873 M), one of the most famous translators, translated from Syriac to Arabic assisted by his son Ishaaq and his daughter’s son, Hubaysh al A’am, and Isa bin Yahya. They were joined in the translation project by Istafan bin Basil, Qusta bin Luuqa, and Thabit bin Qurrat al Harraani. The translators gave priority to books of Galen over those of Hippocrates; however the ideas of the latter were included in the writings of the former. They translated other books in pharmacy and medicine by Greek and Byzantine authors. Unfortunately they also translated books on magic and sorcery which created confusion in Muslim medicine later. The age of translation was soon followed by the age of innovation; Muslims were no longer passive consumers of knowledge; they started adding to it and enriching it. The process of translation strengthened Arabic as a language of science. The translators had to arabize many technical terms, ta’ariib al mustalahaat. Greek tenets and ideas were islamized for example translators would use alternative words in the place of pig and alcohol.

During the early abassid era, many measures of public health significance were undertaken. The abassid Minister Ali Ibn Isa asked the court physician Sinaan Ibn Thabit to organize regular visiting of prisons by medical officers. The first hospital was built by Harun al Rashiid in Baghdad. Khalifah al Mansur instructed his physician Isa bin Yusuf to examine all physicians to determine those who were competent; those who were successful were allowed to continue their work and the unqualified were expelled. Sinaan examined physicians in 319H.

BAKHTISHU’U FAMILY OF PHYSICIANS

The family of Bakhtishu’u made many contributions to the early growth of medicine. Jurjis bin Bakhtishu’u al Jandishapuri was a Syrian physician brought to treat the khalifah, al Mansur, in Baghdad. He cured the khalifah and returned to his hometown after 4 years. His place at the capital was taken by his son Bakhtyuush who later became a physician for Harun al Rashiid. Bakhtyuush was followed by his son Jibril bin Bakhtyuush who authored medical books. They were followed by others from the same family serving the rulers. The family served at the court for several generations and attained positions of influence, power, and wealth. Al Hakiim Yahya bin Bakhtyuush al Jandishapuri translated from Greek and Syriac to Arabic and died in Baghdad in 300H. Abu Sa’id Obaydullah bin Jibril from the family of Bakhtyuush wrote several books: nawadir al masail, manaqib al attibba (completed in 423H), al taharat wa wujuubiha, tadhkirat al haadhir wa zaad al musaafir, and rawdhat tibbiyyat.

THE MASAWAYH FAMILY OF PHYSICIANS

The family of Masawayh made many contributions to medicine. Masawayh was a pharmacist who had two sons: Daud and Yahya. Daud became famous as a physician eloquent in Persian, Syriac, and a little Arabic. Abi Zakariyah Yohanna Ibn Masawayh (777-857 M), a physician to several abassid rulers (Al Ma amun, al Mu’tasim, al Waathiq, al Mutawakkil) and teacher of Hunain Ibn Ishaaq, was commissioned together with his sons by Harun al al Rashid to translate ancient Greekn medical books. The Khalifah al Ma amuun made him head of the Bayt al Hikmat.  He was supervisor of the hospital in Baghdad and was the first person to establish a faculty of medicine. He wrote many books on fevers, nutrition, headache, and sterility in women that were translated in Europe. One of his famous publications was a book ‘kitaab al kamala wa tamaam’ that covered several diseases. He was so interested in dissection that he had a special room for that purpose and had apes brought to him from Nubia in Africa.

OTHER PHYSICIANS

Abu al Hasan Ali Bin Sahl Rabn Al Tabari, a physician to two abassid khulafa, was born a Christian in Persia in 810M. He embraced Islam at the hands of al Mu ‘tasim and died in Baghdad after 227H / 831M. He first lived in Tabarstan and moved to Baghdad in about 297H. He authored Firdaus al Hikmat, dedicated to al Mutawakkil and published in 850M, an encyclopedic work on medicine, philosophy, zoology, and astronomy greatly influenced by the writings of Hippocrates, Aristotle and Galen. The end of the book was a description of Indian medicine. Abu Yusuf Ya’aqub bin Ishaq bin Salih bin Ismail bin Muhammad bin al Ash’ath al Kindi the philosopher of the Arabs wrote a book on mental health titled ‘al Hiilat li Dafu’I al Ahzaan’ as well as other medical books. Qusta bin Luuqa al Ba’alabakki, born a Christian in 830M and died in 912M, was a contemporary of al Kindi. He translated many books into Arabic and wrote books on physiology and psychology. Mankah was an Indian who translated books into Arabic from Sanskrit including a treatise on poisons by the Indian physician Sanqah.

Thabit bin Qurrat al Harraani translated many medical books. Hunain Ibn Ishaq al Ibaadi aka Johanitius (194-260H / 810-873M) was a Christian who knew Syriac, Greek, and Arabic. He studied in Basra, Baghdad, Syria, and Byzantine. He translated Greek medical books including writings of Hippocrates and Galen. His work was continued after his death by his nephew Hubaish. He in addition wrote some books of his own the most famous being kitaab al aghdhiyat, al masail fi al tibb li al muta’alimiin, kitaab al madkhal fi al tibb, kitaab al maqqqlaat al asharat fi al saidalat. Ali Ibn Abbaas al Majuusi, a native of Ahwaaz from a Zoroastian family who died in 982 or 995M, authored a book on treatment of disease with single remedies, adwiyat mufradat, and another book on medicine called Kaamil al Sina’at al Tibiyyat that became famous after that as al Maliki and was translated into Latin and used as a reference in Europe. He was the first to explain that the fetus is expelled by the contractions of the uterus.

Ibn Abi Usaybi’ah was born in Syria and practiced medicine in Cairo. His major contribution was writing bibliographies of all physicians before him. Ibn al Quffi, whose full name was Amin al Dawlah Ibn al Faraj Muwafiq al Ddiin Ya'qub Ibn Ishaq Ibn al Quffi al Malaki al Karki, was born in 630H/1233M and died in 685H/1286M. He wrote a surgical manual ' al 'umdat fi sina'at al jarahat'. Dhia Al Addin Abdullah Ahmad Bin Al Baitar was born towards the end of the 12^th century and died in 1248M. He traveled widely. His most famous book was al Jamiu li Mufradaat al Adwiyat wa al Aghdhiyat. Abu Ibrahim Zain al Ddiin Ismail bin al Hassan bin Muhammad al Husayni al Alawi al Jarjaani (d. 531H / 1137M) authored three books in the Persian language: al Tadhkirat al Ashrafiyat fi al Sina’at al Tibiyyat, al Ajwibat al Tibiyyat wa al Mabahith al ‘Alaniyat, and Zubdat al Tabiib. Muwafaq Al Adiin Abd Al Latiif Bin Yusuf Al Baghdadi (b. 1162M d. 1231M) travelled to Cairo and Damascus. He started teaching medicine in Damascus in 1207 CE. Jurjus Bin Jibrail; Ibn Radhwan Al Masri; Alau al Ddiin Ali bin Abi al Hazm; Ali Bin Abbas Al Tusi.

MEDICINE IN THE LATER ABASSID ERA (659 – 923H / 1261-1517M)

Following the Tatar invasion and destruction of the capital of the khilafat in Baghdad, the Muslim world went into a period of decline. Medicine and medical knowledge also declined.

MEDICINE IN ANDALUSIA:

Medical knowledge spread in Europe from Andalusia. The famous Andalusian physicians were: Urayb bin Salad al Katib, Abu Zakariyyah Yahya Ibn Ishaq, Abul al Qasim al Zahrawi, Ibn Abayya, Ibn Tufail, Ibn Rushd, Ibn Zuhr, Ibn Khatimah, Ibn al khatib. Abu Omran Musa bin Maimoon al Qurtubi al Andalusi aka Maimoinides (529-605H / 1135-1209M) was a Jew born in Qurtuba in Andalusia in the year 1135M  who migrated to and settled in Egypt. He and his son, al Afdhal, after him became physicians to to Salah al Ddiin al Ayubi. He wrote the following books: dalaalat al hairiin, maqalat fi al sumuum, and al taharuz min al adwiyat al qattaalat. His most fampous book was al fusuul fi al tibb, aphorisms, that was extracted from writings of Galen.

MEDICINE IN THE MAGHREB:

Medical knowledge in the maghreb was an extension of the Andalusian medical knowledge.

MUSLIM CONTRIBUTIONS TO MEDICINE

BASIC MEDICAL SCIENCES

Anatomy: Muslims largely dependec on the writings of Galen. They however made their own observations and corrected many mistakes made by Galen. The main contributors were: Ibn Masawayh, Ibn Abi al Ash’th, al Majusi, Ibn Habal, Ali Ibn Abbas, Ibn Sina, Ibn al Quffi, Ibn al Nafiis, Ibn Ruhd, Abdul Lateef Baghdadi, Zakariyyah Ibn Muhammad Ibn Muhammad al Cazweeny d. 683 AH). Al Razi encouraged dissection and study of physiology. Al Zahrawi insisted on knowledge of anatomy before any surgery. 

Physiology: Muslim physiological knowledge was influenced a lot by the Greek theories of the 4 elements, al asqaat: hot, cold, wet, and dry; the 4 humors, al alkhlaat: blood, phlegm, yellow bile, and black bile; the 9 temparaments, al mizaaj: 1 balanced and 8 out of balance; the pneumata, al arwaah: ruh tabi’I, ruh hayawaani, and ruh nafsaani. They also described the faculties, al quwaa: natural faculties, quwa tabi’iyat, animal faculties, quwa haiwaniyyat, psychic faculties, quwa nafsaniyyat; and procreative faculties, quwa al insaal. These Greek ideas had one very important and true concept, the idea of balance which is the forerunner of the modern physiological concept of homeostasis. Most of the details were however found by later research to be untrue and were discarded. The heart and circulation were described by Muslims as a mechanical pump. Ideas of food digestion were also known.

MEDICAL DISCIPLINES

Infectious diseases: Al Razi was aware of air-borne infection when he made an experiment to determine the site of a new hospital in Baghdad by putting meat in the air and waiting to see the site where it putrfied soonest. Al Razi in his book, Kitaab al judri wa al hisbat described the symptoms of smallpox and measles. The concept of contagion waa known as early as the time of the prophet. Al Majuusi described contagious diseases like leprosy, elephantiasis, phrenitis, and trachoma. Ibn al Khatib and Ibn Khatimat described the symptoms of plague. Ibn Khatima had mentioned minute bodies causing disease in the 14^th century CE.

Public health: the following wrote about public health: Qusta bin Luuqa, Ishaaq bin Omran, Ibn al Jazzaar, Ibn Sina, Fakhr al Ddiin al Razi, and Ibn al Quffi.

Blood circulation:  Ibn Nafees al Nafees described pulmonary circulation centuries before its ‘discovery’ by William Harvey.

Psychiatry: depression melancholia was related to organic factors. It was also realized that it could be caused solely by psychological factors. The symptoms of depression were described very well.

Metabolic/endocrine diseases: The symptoms of diabetes mellitus were described well. Urine examination was a very advanced art.

Allergy: Al Razi described rhinitis due to plant exposure centuries before similar descriptions by Europeans.

Dietetics: Muslims knew that diet is a method of treatment. The following wrote on diets: Hunain Ibn Ishaaq, Muhammad bin Zakariyyah al Razi, and Ibn Zuhr.

PHARMACEUTICALS

Muslims knew both simple and compound drugs. Among those who wrote about drugs were: Abu daud Sulaiman bin Hasan al Andalusi known as Ibn Juljul in the 4^th century H / 10^th century M; Ibn al Jazzaar, Ibn al Raihan al Biruni, Abi Obaid al Bakri, Ibn Baja al Idrisi, and Abd al Latif al Baghdadi.

SURGICAL DISCIPLINES

Ophthalmology: (Ibn Hytham d. 1040 AD, Hunain Ibn Ishaq, Al Razi, Ibn Sina, Al Zahrawi, Ali Ibn Isa, Ibn al Rushd, Abu al Qasim Ammar). Ibm Hytham (965-1040 CE) in his book 'Kitaab al Manadhir' disproved the extromission theories of Euclid and Ptolmey and instead advocated an intromission view. He described the optic pathways and the point-to-point projection of the visual world into the  brain. He described how eye movements helped in visual perception. He also realised that several processes were involved in conscious visual experience. Jurjani (5^th century H) wrote about ophthalmology in his book 'Nur al ‘Uyuun'. Al Zahrawi described many extra-ocular operations. Al Zahrawi described the posterior displacement of the lens in cataracts. He also discovered many instruments such as: hooks, eye speculum, conjuctival scissors for removal of panus, perforator and depressing needles for cataract surgery. Al Razi recommended tearing the capsule of the lens if it cannot be displaced and Ibn Sina described various needles that can be used for this. Ali Ibn Isa was another ophthalmologist who wrote the book 'Tadhkirat al Kahaliin'. Both Al Razi and Ibn Sina described a procedure for operative decompression of glaucoma.

Anesthesiology: Al Zahrawi performed many of his operations under anesthesia: opium or mandragora.

Obstetrics: Al Baladi (circa 380 H) wrote a complete discourse on midwifery called ' Kitaab Tadbir al Habala'. Al Zahrawi described normal and abnormal presentations and described instruments for craniotomy to deliver a dead fetus in case of obstruction. He also developed a vaginal speculum.

General surgery: The main contributors were: Ibn Zuhr, al Shirazi, Ibn Dhahabi, and al Zahrawi. The book al Tasrif By Al Zahrawi took 30 years to compile in 30 volumes. The last volume deals with surgery and is one fifth of the whole book. The volume on surgery is divided into three sections: (a) cauterization in 56 chapters (b) incisions, perforations, wounds & wound healing in 93 chapters (c) bones setting and joints in 36 chapters. The book contains anatomical details. It covered all branches of surgery. The book was used as a standard text in Europe and was translated into Latin in the 12^th century M. Al Zahrawi performed thyroidectomy in 952 M. Al Razi was the first to use gut sutures for intestinal repair. Al Zahrawi is also reported to have used catgut and cotton sutures. Al Zahrawi recognized pain as a symptom and not a disease. Among operations performed by Al Zahrawi and described in his writings were: tracheostomy as an elective procedure and bandaging techniques. Al Zahrawi has 11 inventions credited to his name such as use of the syringe for bladder irrigation, the vaginal speculum, and plaster for bone setting. Al Jurjani (d. 1136 M) described the relation between goiter and exophthalmos

Traumatology & orthopedics: Al Zahrawi and al Quff described treatment of bone and joint trauma. Zahrawi wrote about osteomyelitis, amputations, and osteotomies for un-united fractures. He cautioned against above-knee and above-elbow amputations.

Wound treatment: The main contributors were: Ibn Sina, Al Zahrawi, Ibn Rushd, and Al Razi. Al Zahrawi taught the following methods of arresting hemorrhage: digital pressure, tourniquet, sponges, cauterization, hypothermia, ligation of bleeding vessels by sutures of thread. He also advised against tight bandaging. Al Zahrawi emphasied the imoortance of cleanliness in would treatment. Ibn Sina mentioned dry dressing. Al Zahrawi wrote about the drainage of abscesses describing in detail the site and shape of the incision, packing of the wound, excision of the skin edges, use of slow decompression of large cavities, dependent and counter drainage.  

Urology: Al Zahrawi described bladder irrigation. He also developed original methods of lithotromy for impacted stones. He introduced a fine drill into the urethra and was rotated gently to break up the stone into small pieces that could be washed away by the urine. He also wrote about using a bladder sound to locate bladder calculi, control of post-operative hemorrhage, and removal of clots from the bladder.

Gastro-enterology: Al Zahrawi used stomach tubes. He described paracentesis for ascites and intra-peritoneal abscesses. He mentioned use of trocar and cannula to drain liver abscesses. He also described the use a heated cautery to open liver abscesses. Ibn Zuhr (1113-1162 M) was the first to describe in detail the distinction between gastric ulcer and gastric malignancy. Ibn Sina wrote about colitis and its management by diet, drugs, and enema. Abu Imran Musa bin Maymun (1135-1204 M) wrote about hemorrhoids and the role of diet and surgery in their treatment. Mohammad bin Mahmood Al-Qusum (circa 1525 M) in his book ' Zad al Masir fi 'Ilaj Bawasir' wrote about treatment of piles. Ibn al Quff wrote about complications of hemorrhoidectomy and post-operative anal stricture. Al Zahrawi originated cauterization treatment of fistula-in-ano and was aware of the complications of this treatment.

Plastic surgery: Al Zahrawi described the cauterization treatment of harelip. He wrote that the edges must be freshened first before cautery.

Ear , Nose, and Throat: Al Zahrawi discovered the guillotine method of tonsillectomy as well as the complications of the operation. He described the tumors of the tonsil. Among discoveries attributed to al Zahrawi are: use of special osteotomies for nasal operations and polypectomy, use of a marine sponge with an attached string for removal of foreign bodied from the throat, removal of foreign bodies from ears, treatment of nasopharyngeal tumors by repeated excision and cauterization.

Dentistry: Ibn al Quff described making artificial teeth from bone. A Zahrawi described several dental operations: wiring of loose teeth, extraction of roots of broken teeth and broken pieces of the mandible by use of special forceps.

Thermal and chemical cauterization for syphilitic lesions were described by Ibn Sina

Tumors: The main contributor was Abdul Malik Ibn Zuhr (d. 484 H). Al Zahrawi and Ibn Sina recommended wide excision including healthy tissue in removal of tumors. Use of cautery and drugs in treatment of tumors was also described. 

Neuro-surgery: Both al Zahrawi and Ibn Quff described in detail the various intra-cranial and extra-cranial hemorrhages due to arrow wounds and their respective treatments. Al Zahrawi described symptoms and signs of skull fracture. He also described the depressed fracture in children and recommended treatment by removal of a bone. In cranial operations, the drill may accidentally perfotate the delicate intra-cranial structure; Al Zahrawi developed an instrument to prevent this accidental penetration. Al Zahrawi's craniotomy operations were remarkably like modern ones; using burr holes with a linking cut between them allowing to raise part of the cranial vault. Al Zahrawi described paralysis due to injury of the spinal cord. Haly Abbas described several types pof fractures: simple, comminuted, displaced, and hairline. Ibn Sina classified fractures of the skull into two types: closed fractures and open fractures. He described treatment of skull wounds by relieving hematomas or removing pieces of bone that could hurt the brain. Al Baghdadi described the depression fracture found in children. He also described meningoceles that remained after skull surgery and appeared during coughing. Samarkandi described treatment of brain edema following skull trauma and its relief using dehydration, venesection, and enema.

HOSPITALS

The Persian word bimaristan was used to refer to hospitals and is literally translated as the house of the sick. The first hospital in Islam was the hospital tent that the prophet ordered erected in the mosque of Madina during the battle of the confederates and Rufaidat used it to treat the wounded. The complete bimaristan was established in 88H for the lepers and the blind by the Omayyad Khalifat al Waliid bin ‘Abd al Malik. There were general bimaristans as well as specialized ones for prisons and schools. There were bimaristans for isolating patients who mad or those with chronic diseases like leprosy. The army has mobile bimaristans.

Hospitals were built in Baghdad, Cairo, Andalusia, and Damascus. Bimaristan al Adudi al Kabir was opened in Baghdad in 982 M. Bimaristan al Nuri al Kabir was established in Cairo in 160 M. The Salahi and Mansuri hospitals were built in Cairo and the Nuri hospital was built in Damascus. Muslim hospitals had separate sections for each type of disease. They had gardens. Fans were used to cool the hospital. Cleanliness was observed by workers in all areas of the hospital especially the kitchen and the pharmacy. Daily clinical rounds were carried out. Patients were given some money on discharge.

MEDICAL COLLEGES

Mosques were first used for medical education for example Omar bin al Mansur (d. 824H) taught medicine at the Tulinid mosque, al jami’u al taaluuni, in Egypt. Abu Ja’afar al Mansur established Bayt al Hikmat in Baghdad that had become by the time of Ma amuun a research center in which medical books were translated. Among schools of medicine was the school of Abu Bakar bin Fuwruk al Asbahani (d. 406H). The Wazir Nidhaam al Mulk (408-486H) established medical schools in Iraq and Khurraasaan. Medical schools were also established at bimaristans such as the school of the al Muqtadiri Bimaristan in Baghdad established in 306H. Out of concern for proper medical education, Khalifah al Muqtadiri ordered in 319H that nobody would be allowed to practice medicine unless examined by Sinan bin Thaabit bin Qurra.

MAJOR WRITINGS by MUSLIM PHYSICIANS

Al Qanun Fi Al Tibb was written by Abu Abdullah Ali Al Hussein Bin Abdullah Ibn Siina. Al Hawi was written by Muhammad Ibn Zakariyyah Al Razi, Kitaab Al Manadhir was written by Ibn Haytham. Al Tasrif was written by Al Zahrawi. The book al Tasrif that took 30 years to compile is in 30 volumes. The last volume deals with surgery and is one fifth of the whole book. The volume on surgery is divided into three sections: (a) cauterization with 56 chapters (b) incisions, perforations, wounds & wound healing 93 chapters (c) bones setting and joints 36 chapters. The book contains anatomical details. It covered all branches of surgery. The book was used as a standard text in Europe and was translated into Latin in the 12^th century CE. Al Kafi was written by Abu Nasr Ibn Al Ayn Zarbi. Al Umdat Fi Sinat Al Jarahat was written by Abu Al Farag Ibn Al Kufi (1233-1286 M). The book consists of 20 maqalas of which maqala 17 is devoted to traumatology while maqala 19 discusses surgical problems and their treatment from head to foot. Al Jirahat Al Kaniya was written by Sharaf Al Dddiin Ali. Kamil Al Sinaet Al Tibiyyat was written by Ali Ibn Abbas. Kitaab Al Kulliyaat was written by By Ibn Rushd. Kitaab Zad Al Musafir Wa Quut Al Hadhir was written by Abu Yafar Ahmad Ibn Ibrahim Ibn Abi Hadir Al Jazzan. The Ten Articles On The Eye  was written by Hasan Ibn Ishaq. A Manual For The Oculist was written by Ali Ibn Isa. Al Taysir Li Man Ajaza ‘An Taliif was written by Abu Al Qasim Al Zahrawi. Kitab Al Shamil was written by Ibn Nafiis. Kitaab al Dhakhiirat was written by Ismail al Jarjani in Persian.

DECLINE and RENAISSANCE

TRANSFER OF MEDICAL KNOWLEDGE TO EUROPE

While Muslim medicine was flourishing in West Asia, Europe was in the ignorance and decline of its middle ages. There were three routes of knowledge transfer from the Muslim world to Europe: through Italy, through Andalusia, and by the crusaders. Constatine Africanus (d. 1087 CE) translated the most important medical books from Arabic into Latin. This gave new life to the Salerno (Italy) school of medicine. After him more books were translated. Many medical texts that had been lost in Europe were rediscovered thanks to the translations made by Muslims. Books by Hunain Ibn Ishaaq, al Razi, Al Zahrawi, Ibn Sina, and Ibn Zuhr were translated into Latin and were used in Europe as texts for many years. Europeans came to study at Muslim institutions in Andalusia and took back the knowledge to Europe. Crusaders in the Near East found themselves in a more advanced Muslim civilization and took back many ideas with them to Europe.

DECLINE OF MUSLIM MEDICINE

Following the golden era of medicine in the first abassid state, there was general decline in medicine. Isolated efforts continued but the rapid growth of the earlier times did not exist. The decline of Muslim medicine was inevitable even on methodologic grounds. Pre-Islamic bedoin medicine was empirical learning from trial and error. The Qur’anic methodological revolution would have turned it into a progressive evidence-based medical system. The interlude of Greek medicine that relied a lot on philosophical discourse and not practical observation delayed the growth of evidence-based empirical medicine among Muslims. The golden era of Muslim medicine during the early abassid period was due to a combination of translated Greek medical knowledge with the addition of empirical observations by Muslims. However Greek ideas became predominant and squeezed out the empirical and inductive approach taught by the Qur’an. This dealt a death to further development of Muslim medicine.

GROWTH OF EUROPEAN MEDICINE

Post-renaissance: The growth of medical knowledge post-renaissance was phenomenal. We shall use surgery as an example. The renaissance witnessed rapid progress in surgical knowledge and practice. Leonardo da Vinci (1452-1519 M) dissected and described human bodies. Andreas Vesalius (1513-1564 M) dissected bodies and published De Humani Corporis Fabrica Libri Setem which corrected many anatomical mistakes. Ambrose Pare (1510-1590 M) was an army surgeon who stopped use of hot oil to treat gunshot wounds, invented surgical instruments, used ligatures instead of cauterisation of blood vessels in amputations, developed artificial limbs, and invented surgical instruments. Jean Baptiste Denis carried out the first successful blood transfusion in 1667 M using blood from a lamb. Obstetric forceps were developed by Peter Chamberlain in England in 1630 M. Santorio Santorio (1561-1636 M) developed the thermometer and measured body weight. Milliam Harvey (1578-1657 CE) rediscovered blood circulation that had been described centuries before by the Muslim physician Ibn Nafis. Marcello Malphigi (1628-1694 M) described capillary circulation. Athansius Kircher (1602-1680 M) and Anton Van Leewenhook (1632-1723 M) described micro-organisms seen under the microscope. Fransesco redi (1626-1697 M) disproved the theory of spontaneous generation. 

18^th-19^th Centuries M: Daniel Fahrenheit (1686-1736 M) developed the mercury thermometer. Stephen Hales (1677-1761 M) was the first to measure blood pressure. William Hunter (1718-1783 M) and his brother John Hunter (1728-1793 M) dissected bodies and taught anatomy and surgery. Rene TH Laennec (1781-1826 M) discovered the stethiscope. Claude Benard (1813-1878 M) introduced the scientific method in medicine. Herman Von Helmholtz (1821-1894 M) invented the ophthalmoscope. Joseph Priestly discovered nitrous oxide in 1776 M and it was later used as an anesthetic in operative surgery. Ignas Semmelweiss (1818-1865 M) insisted on hand-washing in obstetric practice to prevent spread of infection. Oliver Wendell Holmes (1809-1894 M) also wrote treatises on infections. Louis Pasteur (1822-1895 M) laid the foundations of modern bacteriology but Robert Koch (1843-1910 M) is considered the father of this discipline. William Roengten (1845-1922 M) discovered x-rays in 1895 M. Madame Curie and her husband Peter discovered radium and its ability to destroy malignant cells in 1898 M.

20^th century: Paul Erlich (1854-1915 M) discovered Salvarsan in 1910 M. Alexander Fleming (1881-1955 M) discovered penicillin in 1929 M. In 1901 M Karl Landsteiner discovered blood grouping. In 1948 M Dr Papanicoulus discovered the PAP smear.

TRANSFER OF EUROPEAN MEDICINE TO THE MUSLIM WORLD

Eurpean powers started controlling large tracts of Muslim land in the 19^th century M and introduced European medicine. In 1828M a European medical school was established at Abu Za’abel in Egypt and was transferred to Cairo in 1837M. A medical school was established in Teheran in 1850M. Robert Koch and Louis Pasteur came to Cairo in 1884M to investigate the cholera epidemic. A medical school was established in Istanbul at about the same time.

RENAISSANCE OF MUSLIM MEDICINE

Muslim renaissance in Medicine started with the commencement of the new hijra century 1400 H/1980M. Medicine in the ummat is passing through a period of renaissance. There is pride in the past and a determination to excel in the present. This renaissance is manifesting as seminars, conferences, memorial buildings, books, and publications dealing with Islamic medicine. Islamic Medical Associations have been set up and are operating in the US, S Africa, Pakistan, Egypt, Sudan, and Jordan. Among their activities are: journals, bulletins, conventions, research, direct care services, medicolegal fatwas, advocacy, Islamic clinics and hospitals. There is research on remedies in tibb nabawi and traditional medicine, clinical trials of the use of honey in treatment (diarrhoea, ocular disease, and bladder schistosomiasis), chemical analysis of nigella sativa seed. experimental study of Qur’anic facts on menstrual hygiene, immunological and physiological properties of habba sauda by Dr Ahmad el Kadhi. immunological and physiological impact of tilawat al qur’an. use of dermatoglyphics to study hereditary disease. herbal drugs for intestinal infestations, analysis of herbal remedies mentioned by early physicians for pharmacological activity. Clinical trials of ancient remedies were undertyaken. In the practical arena Islamic relief agencies: medical services in war and devasted areas, medical services for the poor, medical services and dawa. Medico-legal fatwas: medico-fiqhi committees at Rabitat al ‘Aalam al Islami, Organization of the Islamic Conference, the Islamic Hospital in Jordan. Intenational Conferences on Islamic Medicine: Kuwait: 1980, 1982, USA, S. Africa, Egypt, Malaysia, and Pakistan.

The contemporary Islamic renaissance in medicine is expressing itself in many forms. One of them is the Islamization of medicine. The Islamization process of the 15^th century will have to avoid the mistakes of the Islamization process of the 3^rd century. A major lesson learned from the earlier Islamization experience was how Greek ideas stifled further medical development in the ummat.