Islamic Civilization

Defining Instances From Islamic Medicine

Islamic medicine, in both its theoretical aspects and practical applications had a highly innovative and original character, which sharply demarked it from its predecessors and contemporaries.

Observation  and experimentation played a central role in the Islamic scientific experience, and medicine was no exception. In stark contrast to the medical teachers of Europe, Islamic writers were practising physicians, who spoke from their own experience.[1] ‘He who studies the work of the Ancients gains the experience of their labours as if he had himself lived a thousand years . . . but all that is written in books is worth less than the eye of experience,’ wrote Al-Razi .[2] Only the first part would have appealed to European universities: practical experience was not part of the training for physicians in Europe, who could complete a medical degree without ever having set eyes on a patient.[3] A good instance of how observation demarcated Islamic from Greek medicine is an account by the Baghdadi doctor, Abd Al-Latif (1162-1231), who on a visit to Egypt , examined 200 skeletons, and wrote what follows:

‘Now the inspection of this portion of the bodies (the mandible) has convinced us that the bone of the mandible is single, that there is neither a joint nor a suture. We have repeated this observation a great many times on more than 200 heads…. We shall write on this subject a treatise in which we shall report what we have seen and compare it with what we learned in the books of Galen.

According to Galen, the sacrum and the coccyx are composed of six bones, for my part I have found that it is but a single bone…. With the exception of two cases only…. But in all I have found the bones firmly united.’[4]

We also learn from the medieval English scholar, Adelard of Bath (fl. early 12^th century), who was in the East during the first crusade (early 12^th century), of  ‘Arab masters’ and the old man of Tarsus who explained methods of dissection for the purpose of studying anatomy.[5] This attitude was also prevalent in the western realm of Islam, as Al-Zahrawi insisted that a thorough knowledge of anatomy was indispensable to success in surgical practice, a statement which, in his day, had the merit of novelty.[6] Centuries earlier, Al-Asmai (739-831) commented on anatomy, in his kitab al-Khail  (On the Horse), Kitab al-Wuhush (on Wild Animals), and most importantly on the making of man (Kitab khalk al-Insan), highlighting early Islamic knowledge of human anatomy.[7]

The same practical approach is adopted in relation to diseases. Muslim physicians recorded the subsequent course of the disease meticulously in order to check that their predictions had been correct, and this keeping of case histories was one of the greatest legacies of Islamic medicine.[8] Al-Razi  for instance, has left us thirty three accounts of his cases, and their scrutiny show how Muslim medicine relied primarily on practical experiment and observation.[9] Al-Razi’s approach was common to all Islamic medical scholars. Ibn Zuhr (b. ca.1091-94), for instance, was formed at the school of his father, and became an eminent practioner, with great medical experience, never relying on the Ancients’ legacy, but instead, submitting everything to experimentation.[10] He lays down experience as the sole guide to the physician, and shows himself as a man of independent observation, describing the operations for renal calculus and tracheotomy.[11] And, as Scott points out, the methods of the professors and writers who directed the policy of the Muslim hospitals owed their efficacy and success to their rigorously practical character, and no course of treatment was approved until it had been repeatedly tested.[12]

Investigation and observation were also obvious in the attitude towards contagious diseases, Ibn al-Khatib, a physician of Grenada , noting:

‘To those who say ‘‘How can we admit the possibility of infection while the religious law denies it?'' we reply that the existence of contagion is established by experience, investigation, the evidence of the senses and trustworthy reports. These facts constitute a sound argument. The fact of contagion becomes clear to the investigator who notices how he who establishes contact with the afflicted gets the disease, whereas he who is not in contact remains safe, and how transmission is effected through garments, vessels and earrings.'[13]

In this just cited instance, as in others of its pioneering aspects (some cited already), Islamic medicine was bound to come into conflict with the medicine of its predecessors. Al-Razi  has already been noted for his criticism of Hippocrates' Aphorisms.[14] Of Aristotle, this is what Al-Razi writes:

‘We observe that you endow nature with the same attributes as living beings: choice, knowledge and wisdom, because you claim that nature acts always with wisdom and fitness; that it aims towards a goal, that it does nothing aimlessly, creating the eye of an embryo so that the child might see… that it sets all things in their right places, organising them perfectly, forming the foetus in the womb and then guiding its development most delicately towards perfection; also that it governs man, lends him health, dispels his diseases, since as Hippocrates has said, nature is the physician of all our ills. And yet, you say that nature is inanimate and without life…. Without capacity of choice, without knowledge, which is an evident contradiction and a manifest absurdity.’[15]

In Kitab Al-shukuk al Jalinus (Doubts on Galen,) a work considered lost in its original, but found by Kraus,[16] Al-Razi  refutes Galen substantially.[17] Al-Razi says:

‘Indeed, it is painful for me to oppose the one (Galen) who, amongst all men, has gifted me with goodness and has been most helpful, and by whom I was guided, and whom I followed... However the art of medicine is a philosophy, which does not include acquiescing to what the leaders (of school) say: no blind acceptance of their opinion, nor favourable treatment (of which they will benefit), no renouncing either to a profound examination of what they hold.’[18]

Every other Muslim medical writer was also critical of Galen.[19] Al-Madjusi (d. 994) in Kitab al-Malaki is very critical of Hippocrates, whom he finds too concise, and therefore sometimes obscure; of Galen, finding him too verbose, and of Paul of Aegina who was neglectful of surgery and anatomy.[20] Ibn al-Nafis reconstructed the theory of the lesser circulation of the blood exactly in refutation of Galen.[21] Al-Biruni , for his part, blamed Galen for his excessive credulity when he reports the story of the snake queen whose sight or hiss caused immediate death: ‘I should like to know,’ al-Biruni asks, ‘who could have told Galen about her habitat and qualities, if all who looked at her died.’[22]

Al-Zahrawi (d. 1013) is also extremely critical of Greek surgery, whose deficiencies he highlights repeatedly. He refutes Greek surgical methods and techniques, such as in the repair of fractured ribs, the methods of stretching the belly of the patient and pushing the fracture; or that a cupping vessel should be applied to the place; or that wounds with fracture be bandaged (which can cause death by ulceration or defluxion.)[23] He remarks with regard to cauterisation, for instance:

‘The Ancients have stated that cauterisation with gold is more effective than with iron. They said that on account of the temperateness of gold and its noble character. They also stated that the site of cauterisation does not become purulent, but that is not absolutely so, for I myself have experience of that and have found that it happens in some cases and not in others. Cauterisation with gold is indeed better and more successful than with iron, as they say, except that when you are heating the gold cautery in the fire, because of its redness you cannot be sure when it has reached the desired temperature. In addition to this, gold cools very quickly, and if you overheat it it melts in the fire, heats and runs, and you will find yourself in difficulties. Therefore in our opinion cauterisation is swifter and more successful with iron.’[24]

Islamic practice was also fundamentally at odds with contemporary Western medical practice. Muslims were pioneering in the treatment of many health problems, such as that of the insane, who benefited from great care, a consideration they little found in Western Christendom.[25] The treatment of the mentally ill in Islam was, indeed, more humane than that seen in Europe until the 19^th century.[26] Indeed, in every respect, Western medical practice, until quite recently, lagged behind the Islamic, and the contrast was considerably sharper in medieval times. At the time, whilst in Islam we find an extraordinary outburst of secular medical learning, involving not just Muslims, but also Jews and Christians, under the Islamic state, as this chapter amply highlights, in medieval Western Christendom this was not the case. Russell even claims that the Church retarded the progress of medical science,[27] the early Christians going as far as denying to physicians the power of healing, and the view was that many diseases were sent as punishments for sin.[28]

Medieval Western medical practice was quite primitive, some of its common methods of treatment for practically every ailment being bleeding by leeches or at times by the use of the knife, even in the case of warriors weakened from loss of blood.[29] The contrast with Islam was visible in the East during the crusades, where Frankish and Muslim practice came head to head as seen through a number of instances narrated by Usama Ibn Munqidh, such as the Franks carrying out unnecessary amputations leading to the death of patients, applying salt on open wounds, etc.[30] And whilst Muslim writers such as Ibn Zuhr of Seville  wrote against astrology and medical mysticism,[31] in Western Christendom, magic charms and curious drugs were prescribed, and so was the drinking of urine for its supposedly beneficial qualities.[32]

Even greater contrast between Islamic and Western Christian medicine applies to the invocation of saints. For each disease, in Western Christendom, Draper notes, there was a saint; thus, a man with sore eyes must invoke St. Clara, but if it were an inflammation elsewhere he must turn to St Anthony, whilst an ague would demand the assistance of St. Pernel.[33] Guthrie offers a good outline of such healing saints, such as St Dymphna for insanity, St Roch for the plague, St Blasius the throat, St Bernardine the lungs, St Apolonia the teeth, St Lawrence the back, and so on and so forth.[34] For the propitiating of these celestial beings it was necessary that fees should be paid, and thus the practice of religious medicine became a great source of profit.[35] Islam, on the other hand, as Daniel correctly points out, shuns and combats beliefs in saints, relics and miracles,[36] and the contrasting approach to this question by the two cultures came to a head in the crusade period. The Muslims became aware at first hand of crusader practices, and how relics were eagerly demanded from the Holy land, including remains of St.Thaddeus, and the mythical King Abgar, from Edessa.[37] In the 13^th century, relics came from West to East. The arm of St Philip was sent to Acre in 1268 from Florence,[38] where it had been adored for sixty years; and English soldiers were protected, in King Richard’s time, by a ‘a certain writing hanging from the neck,’[39] better than the coat of mail, or thick pourpoint beneath.[40] In the same 13^th century, pilgrims also visited Sardenai near Damascus  by special treaty with the Muslims to obtain the oil which flowed from the breast of the miraculous picture of the Virgin, painted on wood; and Tortosa with its portrait of the Virgin.[41] Such practices drove one of the chief ‘Orthodox’ Islamic thinkers, Ibn Taymiyya (1263-1328), to castigate the Christian clergy for their hypocrisy, and above all their charlatanism.[42]  He said:

‘They (the Christians) put kohl in water moving with a very slight movement, which then flowed slowly so that it ran down the picture of the virgin and came out of her eyes. People thought it was tears.’[43]

There is also recourse to saints and marabouts for healing and much else in most modern Islamic societies even today. Watts has looked at some of these manifestations.[44] In many parts of the Muslim world, he points out, most occult practices date from pre-Islamic times, and are relics of the Persian, Ptolemaic and Romano Coptic times.[45] In Egypt , for instance, barren women walked seven times counter clockwise around the exterior walls of a Coptic Church.[46] In that country, Egypt, and under strict Sunni Islam, Watts correctly notes, saints are not recognised as they are seen as primitive Christian invention.[47]  On top of this pre-Islamic factor, the general decline, which set on the Islamic land, and which will be discussed in the final part of this work pushed aside rational practice and brought about behaviours, which mirrored that Islamic decline. It is also, without doubt, Western colonisation, in its systematic efforts to unseat Islam, which promoted such practices as adoration of saints, so-called marabout shrines, and the likes. Dr Bodichon, one of the French theorist of colonisation of Algeria (1830-1962), for instance, held that:

‘It matters little that France in her political conduct goes beyond the limits of common morality at times; the essential thing is that she establishes a lasting colony and that, later, she brings European civilisation to these barbaric countries…… (including through) corruption and disorganisation.’[48]

Orthodox Islam, as can be seen in recent Islamic revivals, such as in Algeria in the 1980s, banned and fought a considerable number of such practices, which the French had encouraged during the colonial period.[49] In Egypt , resort to saints, Watts insists,  was, and is not sanctioned by the teachers of the Law and Theology of Al-Azhar.[50] Indeed, no mufti or imam did or does anywhere else in the Sunni Islamic world, because it is simply, fundamentally at odds with the so called Orthodox-Sunni Islam.