Islamic medicine

Medicine of the Arab-speaking world (Spain, North Africa, Arabia, Turkey, and Persia, now Iran) from the foundation of Islam in the early 7th century to the beginning of the European Renaissance in the 15th century. Following the end of the Roman Empire in AD 476 Europe was plunged into the Dark Ages, a period of regression and lost knowledge, while medicine flourished in the Middle East. Medical advances were aided by the strong central governments of the Arab empires, the importance placed on helping the sick by Islam, and the preservation in Arabic of medical texts by Galen, Hippocrates, and other classical Greek and Roman theorists, that had either been lost or remained unread in Europe.

Medical heritage In 431 the Syrian ecclesiastic Nestorius, Christian patriarch of Constantinople, was deposed for asserting that Mary was only mother to the human nature of Jesus. Expelled from the city, he moved to Persia (modern Iran), taking with him a collection of texts that included the works of Galen and Hippocrates. Nestorius' followers translated his library into Arabic, giving the Arab-speaking world access to a large fund of classical theory and knowledge. The books were available in Baghdad, capital of the Muslim Abbasid dynasty, who led the largest and foremost Islamic empire from the 8th to the 13th centuries. Muslim scholars who gathered in Baghdad used the Arabic translations of classical texts as a source of medical knowledge. Universities and libraries were established, with two of the greatest being in Baghdad and the Egyptian city of Cairo. Both contained hundreds of thousands of books.

Health system One of the obligatory rules of the Koran, the sacred book of Islam, is that the rich must care for the poor, and the healthy must look after the sick. This tenet encouraged the wealthy and powerful to provide hospitals and public health systems. Baghdad (now the capital of Iraq) had its first hospital by 850, and more than 60 had been founded by the 11th century. London, although already an important trading centre in the same era, did not have a proper hospital until the 11th century. Cities in the Muslim world often had public baths, sewers, and paved streets. Baghdad had over a thousand public baths, and the Spanish city of Córdoba had 900.

Medical practice Doctors in Islamic hospitals were trained according to the ideas of Hippocrates, including his technique of clinical observation that focused on recording the symptoms and course of an illness. The anatomical works of Galen were also used. From 931 all medical students in Baghdad had to take examinations to qualify to be a doctor, and be licensed before they could work. Patients were kept in separate wards according to their illnesses, and provided with trained nurses and clean water. Patients were often given money after they were discharged to ensure that they could take time off work to recover.

Medical and anatomical knowledge Doctors in the Muslim world mainly followed the ideas of Hippocrates and Galen without question. Their main sources were translations of works taken from Constantinople by Nestorius and his followers in the 5th century, and Greek texts collected for the Abbasid court in Baghdad by Joannitius, Hunayn ibn Ishaq al Ibadi, a Nestorian Christian and Arabic translator who travelled in Greece in the 9th century. The works of the classical theorists were revered as a source of perfect knowledge and instruction, so Galen's ideas regarding anatomy, including his errors, remained unchallenged as facts for many centuries.

Islamic law forbade dissection, and this prevented doctors from discovering the errors of Galen or making new discoveries. Some surgeons, however, made small advances in anatomical knowledge through applying Hippocrates' system of clinical observation to their work, while others, such as the 12th-century Spanish Muslim surgeon Avenzoar, also made discoveries through limited postmortem dissections.

As the knowledge of Arab medicine increased, the findings of a few doctors began to challenge the ideas of Hippocrates and Galen. When Avenzoar proved that the skin disease scabies was caused by a parasite, the discovery upset Hippocrates' theory of humours and Galen's treatment by opposites. Removing the parasite from the patient did not involve purging, bleeding, or any of the other traditional treatments associated with the four humours. Galen's belief that blood flowed from one side of the heart to the other through holes in its septum (dividing wall) was overturned by the Syrian physician Ibn an-Nafis, who correctly described pulmonary circulation (the passage of blood from one side of the heart to the other through the lungs) despite the ban on dissection. His work, however, was lost and did not reach Europe until 1924; discovery of the anatomy of the heart and pulmonary circulation was only made in Europe in the 16th century following the work of Andreas Vesalius and Matteo Realdo Colombo.

Despite the beginning of doubts about Galen's ideas, they remained extremely powerful across the medieval Muslim world. In general, although Islamic medicine kept the ideas of the ancient world alive during this period, it did not develop anatomical knowledge to any greater heights than had been reached in the Roman era.

Another source of medical knowledge in the Arab world came from the trade links established with India and Persia. Trading offered access to other medical traditions as well as new ingredients for medicines.

Individuals Rhazes, a Persian doctor practising in Baghdad in the 9th and early 10th centuries, is considered the greatest physician in the Arab world. A follower of the Hippocratic technique of clinical observation, Rhazes recorded the difference between measles and smallpox many centuries before such discoveries were made in Europe. Rhazes's ideas spread through other doctors who trained in his hospital, and through his many writings, such as al-Hawi/The Comprehensive Book, which were available to medical scholars through the great Arab libraries in Baghdad and other cities. The texts were also translated into Latin, and became important sources for European medical students up to the 18th century.

Another important physician was Avicenna (Arabic Ibn Sina), a doctor to the rulers of Baghdad in the early 11th century. He was also regarded as the greatest philosopher in the medieval Muslim world. Avicenna produced a complete system of medicine, the al-Qanun/Medical Canon, which incorporated the theories of Hippocrates, Aristotle, and Galen, and his own ideas and new observations. His work spread across the Islamic world and reached Europe through trade links and the Crusades. Translation of the Canon by European scholars played a crucial part in Europe's rediscovery of the ideas of Galen and Hippocrates in the Middle Ages. It remained a standard medical text used in European universities throughout the Renaissance, and was still in use in the early 18th century, seven centuries after publication.

The Spanish Muslim physician and surgeon Abulcasis, working in the 10th and early 11th centuries, wrote an encyclopedia of medical knowledge al-Tasrīf li man ajaz an-il-talif/An aid for the man who can't read big books (completed about AD 1000) that included instructions on when and how to operate on patients, the first independent book to do so. He encouraged surgeons to use the Hippocratic technique of clinical observation to decide when it was appropriate to perform surgery. Abulcasis gave instructions for surgery on the bladder and the amputation of limbs. He also gave advice on treating broken or dislocated bones and joints. Abulucasis and other surgeons were hindered by the ban on dissection, but were still able to make progress by recording cases and testing out new techniques on their patients. Once their work was recorded their ideas spread through the great libraries, hospitals, and universities of the Muslim world.

Impact of Islamic medicine The importance of Islamic medicine during this period lies in its preservation of the texts of classical scholars, lost to Europe following the fall of the Roman Empire, and its creation of new sources of medical knowledge in the books written by doctors such as Avicenna and Rhazes. While Europe underwent a period of regression in many areas during the Dark Ages and early medieval period, the Muslim world continued to grow in power, organization, and knowledge. As contact increased between the Christian and Muslim civilizations, ideas known in the classical worlds of Greek and Rome returned to Europe. Without the preservation of the works of Galen and Hippocrates in the Arab-speaking world, medical knowledge in Europe may have remained in the Dark Ages for much longer. The Muslim world kept the public health practices of the Romans alive, when European public health had ceased to function. It also improved hospital technology and practice at a time when such institutions had almost disappeared across Europe. Fundamental change was prevented by the religious ban on dissection that existed until the 14th century in the Muslim world. Even after 1300 only limited dissection was possible, and it was difficult to challenge the theories of Galen, or to make new discoveries. Islam acted as a positive and negative force on medicine, much as Christianity did in the Dark Ages and Middle Ages in Europe.