Abstract

Medicine in the classical Islamic world was basically shaped by three different traditions, sometimes interacting with each other: pre-Islamic Bedouin folklore; the so-called Prophetic medicine, the diagnosis and therapy of which was informed by the alleged practice of the Prophet Muljammad; and Hellenistic medicine. Prophetic medicine must have enjoyed a considerable share in everyday life, since a large number of compilations, all of them by traditionists, jurists, historians, rather than physicians, is extant in numerous manuscripts (and continues to be reprinted until today). However, far more productive and representative of medicine in Islam is the Hellenistic tradition, as it was standardized mainly by Galen (d. c. 216 CE), translated from Greek into Arabic and developed from the ninth century onwards. Arabic medical compendia which reflect this tradition in structure and contents are Abu Bakr al-RazI’s Comprehensive Book on

Treatises on ‘‘Prophetic medicine’’ emerged in the ninth century, flourished in the period of Sunni anti-Hellenistic traditionalism, the thirteenth and fourteenth centuries, and are quite popular today, as can be seen from numerous modern printings. Their authors were religious scholars rather than physicians. One of the earliest specimens of Prophetic medicine is the ninth-century Medicine of the Imams by al-Husayn b. Bistam b. Sabur and his brother, writing in Iran, which collects medical advice of the Prophet and of Shl'ite religious authorities, magical expedients, and prescriptions of compound drugs. Another example is the contemporaneous Summary on Medicine by the Andalusian Ibn Habib (d. around 853). From the heyday of this type of compilations, we have the works of the scholars of Hanball jurisprudence, Ibn al-JawzI (d. 1200), Ibn Qayyim al-Jawziyya (d. 1351), and ofal-Suyutl (d. 1505). The Medicine of the Prophet by the Damascene historian and Shafi'ite traditionist al-Dhahabl (d. 1348) again compiles medical sayings from religious authorities, but also from Greek medical authors such as Hippocrates, Galen, and Dioscurides along with Arabic authors in this tradition, for example, al-RazI and Avicenna. The peculiar fusion of this tradition and that of al-tibb al-nabawi (Prophetic medicine) is evident in a passage in the beginning ofthis work, which presupposes the Galenic definition of health as the right balance (Greek eukrasia, Arabic i ‘tidal) of the four humors and then goes on to attribute the progressively perfect balance to, first, man among the animals, then to the believers among the humans, the prophets, and so on, and finally the most perfect balance to the Prophet Muljammad. It is difficult to determine the exact share of Prophetic medicine in the medical care of the medieval Islamic world and to know the names of its practitioners, but, apart from the Hellenistic admixtures that one notes not only in al-Dhahabl’s book, the sheer bulk of works of this type, multiplied by a great number of manuscripts (and in modern times, printings), attests to the fact that Prophetic medicine coexisted with the Hellenistic tradition - as did popular magical medicine whose evidence consists not only of texts but also of amulets, talismans, magic squares, and magic-medicinal bowls. The pious fringe of Prophetic medicine, however, maintained that all human medical measures are to be considered as an impairment of God’s omnipotence and that care and cure should be limited to a healthy diet, simple medicines, prominently honey, and recitations and prayer.

Far more productive and prestigious than Prophetic medicine, and clearly better to evaluate in modern scholarship, were Hellenistic medicine and pharmacology, translated and appropriated from the early days of the 'Abbasid empire by the middle of the ninth century. It can safely be said that the whole of Greek medicine was translated into Arabic and was to dominate Islamic medicine - as well as long centuries of the Latin medical tradition. (For the translation movement, the role of the Alexandrian tradition in shaping the medical curriculum and the principal genres of medical literature, and the impact of ‘‘Galenism,’’ see the entry on Alexandrian Tradition into Arabic: Medicine in this volume.) One of the most obvious features of medical literature both in Late Antiquity and in classical Islam is the compendium, or encyclopedia, endeavoring to present all medical knowledge in systematic order. Two early specimens of such compendia are 'All b. Sahl Rabban al-Tabari’s (fl. c. 850) The Paradise of Wisdom, which predominantly uses Greek authors such as Hippocrates, Galen, Aristotle, Dioscurides, but appends an exposition of the system of Indian medicine (available through Persian and Arabic translations) and displays a characteristic mix of information also on natural philosophy, climate, astronomy/ astrology, magic, the human soul, and popular customs, and Abu Bakr Muliammad b. Zakariyya’ al-RazI’s (d. 925, or 935?) Comprehensive Book on Medicine (in medieval Latin translations Continens or Comprehensor), a large collection (compiled and roughly ordered a capite ad calcem posthumously by his students) of quotations from Galen and other authors and observations of his own. Another compendium by al-RazI, more systematized than the former, is his Book for al-Mansur, dedicated to the Samanid ruler AbU Salih: al-MansUr b. Ishraq in Rayy (south of today’s Tehran), where al-RazI directed a hospital. The two most famous medical encyclopedias in medieval Islam are 'All b. al-'Abbas al-MajUsl’s (around 980) Complete Book on the Medical Art (Latin: Liber regius, after another version of the Arabic title, Royal Book) and Avicenna’s (Ibn Sina, d. 1037) Canon of Medicine (Latin: Liber canonis). In accordance with the ancient classification, al-MajUsI divides medicine into theory (part 1) and practice (part 2); the first part dealing with the fundamental concepts of elements, humors, natures, faculties, anatomy, the natural and non-natural causes influencing the human body and soul, the doctrines of symptoms and diagnosis, pathology, the second part with hygienics and therapy. In his introduction, the author interestingly evaluates at length the works of his predecessors, duly praising Hippocrates and Galen, but critically noting the former’s terseness and the latter’s prolixity, and pointing out omission of entire medical disciplines and lack of systematic order in other Greek and Arabic works. The most famous medical encyclopedia in Arabic is certainly Avicenna’s Canon of Medicine, whose rigorous and sophisticated arrangement of material shows the author’s mastery of logic and philosophy in general and helped to dominate the medical theories in the Islamic world and later in Latin Europe. The Canon consists of five ‘‘books’’; the first covers much of what al-MajUsl’s Complete Book treats in its first part, the second book treats the simple medicinal substances (in alphabetical order), the third and fourth books basically deal with illnesses concerning only one part of the body and more than a single organ (like fevers), respectively, and the fifth book contains a formulary of compound substances. The systematic rigor of the Canon has necessitated various forms of vulgarization. Already the author himself published an epitome of its core material in didactic rhyme, and the list of subsequent commentaries, supra-commentaries, and summaries is indeed long. Perhaps the most influential commentator and epitomator of the Canon is Ibn al-Nafis (d. 1288) who, in the section on the anatomy of the heart, famously asserted, against Galen’s prevalent doctrine of a passage connecting the ventricles of the heart, that there is no such connection, visible or invisible, and that the blood in the right ventricle must arrive at the left one by way of the lungs - thus intimating, though not precisely formulating and proving, the model of the so-called ‘‘lesser’’ circulation. In the Islamic West, a noteworthy medical encyclopedia was compiled by Abu l-Qasim al-Zahrawl (d. soon after 1009), putting medical knowledge at the disposal of those unable to

Compile it for themselves. Besides chapters 1 and 2 on physiology and pathology, this compilation’s most extensive, and most famous and influential, part is the last chapter 30 on surgery, an art which, the author says, was largely obliterated on its way from Antiquity to Arabic medicine and is in need of a new anatomical foundation and accurate descriptions of operations such as cauterization, section, extraction, amputation, and the therapy of fractures and luxations. This chapter in particular had a considerable influence, through its translation by Gerard of Cremona, on anatomical and surgical literature of the Latin West down to the eighteenth century, as well as on early Ottoman medicine. Another interesting feature of this chapter is its abundant illustration with drawings of surgical instruments.

Notwithstanding the extensiveness and long afterlife of al-Zahrawl’s exposition (and some of his colleagues’ books, prominently the Foundation of the Art of Medicine by a student of Ibn al-Nafis, the Damascene Christian physician Ibn al-Quff, who died in 1286), it is a matter of debate whether the numerous and detailed surgical procedures described in the literature reflect real practice. From the lack of actual descriptions or realistic illustrations one may surmise that highly invasive operations, like surgically treating abdominal wounds or amputation, were performed very rarely, and the Caesarian section, during parturition or post-mortem, never. Surgical measures that are attested included - apart from minor measures such as bloodletting and cauterization, the latter used to seal bleeding wounds, but also to treat a great variety of complaints, including mental ones - removal of tumors and growths, treatment of wounds, such as extraction of arrows, excision of cysts, ligation, or sclero-tization of hemorrhoids, and of course circumcision.

A surgical discipline of remarkable variety and innovation was developed in ophthalmology; in fact, the works on the anatomy of the eye and the therapy of eye diseases can be seen as a distinct branch of Arabic medical literature. Already in the ninth century the famous translator from Greek into Arabic and medical author in his own right, Hunayn b. Isljaq, and his teacher Ibn Masawayh wrote influential ophthalmological works, advancing beyond their Greek forerunners (Galen, Oribasius, Paul of Aegina, et al.). 'All b. 'Isa (d. after 1010) is the author of a highly regarded Memorandum for Oculists, which systematically treats 130 eye diseases with their symptoms, causes, and therapies. A close contemporary of his was 'Ammar al-Mawsill whose Book of Selection on the Treatment of Eye Diseases was dedicated to the Fatimid sultan al-Hakim and presents less than half of 'All’s inventory of disorders, but contains a number of original observations and measures, for example, actual reports on six operations on a cataract, including his invention of a metallic hollow needle used to suck the cataract from the eye, and on the examination of the pupil’s reaction to light incidence before operating a cataract. Other authors describe an operation to treat corneal vascularization, a complication of trachoma, which is called peritomy today and which involved the use of hooks to keep the eye open during surgery and of a thin scalpel for excision.

Another flourishing field of Arabic medical literature and practice was pharmacology. As for Arabic authors Galen was the chief authority in general medicine, so was Dioscurides (d. around 90) the leading author on materia medica, whose work was translated into Syriac and Arabic at a very early stage and was repeatedly commented upon by authors such as Ibn Juljul (d. after 994) and Ibn al-Baytar (d. 1248). The latter composed also a work on ‘‘simple’’ drugs and their use against illnesses a capite ad calcem, and thirdly, the most famous compilation ofphar-macognosy and dietetics, based on his own observations and excerpts from over 250 works and describing, in alphabetical order, more than 1400 medicaments, the Comprehensive Book on Simple Drugs and Foodstuffs. In pharmacology, one may say that Arabic writers excelled over their Greek forerunners, because their wider geographical horizons introduced them to a vast variety of new plants and drugs, and because of their descriptive sophistication and not least their keen interest in linguistic and terminological matters.

Medical attendance in the medieval Arab and Iranian world depended, like any other public service, on the economic and political situation in a given place and period. Urban settlements were privileged over rural areas, and political centers offered more opportunity to claim and dispense medical treatment than provincial towns. Principally, doctors could operate in their own office, or visiting the patient in his own house, or in the streets and on the markets, or in a hospital. Administering treatment in a public place was the business of popular practitioners - bone-setters, cuppers, quacks pretending to heal eye and tooth complaints, and often was the object of control by the official inspector of the market (multtasib). Hospitals, on the other hand, are a manifestation of a continuous respectable concern of Muslim society with public welfare. Generally, the foundation of hospitals was due to the initiative of the ruler and the high officials surrounding him and was part of their aim - often in the initial phases of new dynasties which wanted to manifest their profile and splendor - to further the public weal by establishing religious and secular institutions - in addition to hospitals, schools, libraries, fountains, rest houses for travelers, etc. The origin of hospitals in the Islamic realm is not quite clear; the hospital in seventh-century Sasanian Gondeshapur was already famous in the seventh century, and the Christian Bokhtishu' family of physicians, summoned from there by the 'Abbasid Caliph al-Mansur (d. 775) to the court in Baghdad, may have been instrumental in importing this institution (the term h'imaristan is of Persian origin) and, generally, a Christian concern for public charity. At any rate, in the classical period of Islam every major city had one or more hospitals: Baghdad (since the first half of the tenth century, prominently the 'Adudi hospital, founded in 982), Damascus (the Nuri hospital around 1150), Cairo (the Manstirl hospital, founded in 1284), as well as in Iran and al-Andalus. A full-fledged hospital consisted ofan outpatient clinic and an infirmary and housed departments for the specialists - surgeons, oculists, pharmacists -, an asylum for the insane, a home for elderly patients without a family, and a lecture yard and library for medical education.

Despite the fact that medicine and its practitioners enjoyed such a high status in Muslim societies - to be judged by the social eminence and high salary of the top-rank physicians and the impressive endowment of the large hospitals - we have numerous examples of invectives against the professional failings of the physician as an individual and against the pretensions of medicine as a discipline. The rich deontological branch of Arabic medical literature, basing itself on the professional ethics and example of Hippocrates and on the programmatic treatise by Galen, “That the Best Physician is Also a Philosopher” is full of lamentations over the present state of the art. Physicians are blamed as arrogant, incompetent, and, more often than not, greedy for money. A small essay by one 'Abdalwadud (late eleventh/early twelfth century) on “The Blameworthiness of Making Money by the Craft of Medicine” presents a number of examples of the decline of medicine: prescription of, and trade with, expensive drugs regardless of the specific climate and humoral disposition of the patient, conflict between worldly power and the physician’s professional ethics, lack of cooperation between colleagues, where a complex diagnosis would call for more than one specialist, and plain practical and theoretical ignorance. 'Abdalwaduid’s main argument is that incompetence and love of money are two sides of the same coin and that practicing medicine merely with regard to making money perverts the idea of this noble art. Other noteworthy works on the physician’s professional ethics are Isltaq b. 'Ali al-Ruhawi’s (probably working in the second half of the ninth century) The Ethics (Arabic adab) of the Physician, 'Allb. Ridwan’s (d. 1068) treatises The Useful Book on How to Teach the Art of Medicine, On the Path to Happiness by Medicine, and The High Rank/Dignity (Arabic sharaf) of Medicine, and Sa'id b. al-Hasan’s (writing in 1072) Arousing the Desire for Medicine. These programmatic monographs are complemented by handbooks for the examination of the student of medicine (al-Razi’s On Examining and Appointing the Physician contains several quotations from Galen’s corresponding work) and for the control of the physician practicing in public by the muJi tasib, and by polemical treatises exposing the tricks of medical charlatans, as contained in al-Jawbarl’s (around 1240) Book of Selection on Disclosing Secrets and Lifting Veils.

Both the claims of medicine to constitute a ‘‘noble art,’’ founded on philosophical authority, and the lamentations over its shortcomings and present decline have their roots in Late Antiquity. In its Athenian phase, philosophy had enjoyed the eminent status of a religion for intellectuals and in Alexandrian scholarship a central position as art (Greek techne) and as science (episteme), which furnishes the other sciences with their principles (medicine, according to Ammonius son of Hermias, receiving from philosophy its system of elements). In later Alexandrian scholarship, beginning with the fifth century, philosophy as an academic career lost its basis; whereas rhetors, grammarians, particularly physicians after their examination found a flourishing job market, philosophy graduates had to look for openings in rhetoric, teaching grammar, and not least in medicine: many of the sixth and seventh-century Alexandrian commentators on Aristotle’s works worked as doctors - a lucrative profession, which drew the jealousy of the few advocates of ‘‘pure’’ philosophy and which, in turn, explains the remarkable self-image of medicine as a philosophical discipline. In Arabic medicine, this characteristic persisted: all medical encyclopedias and many monographs on special subjects display their theoretical basis at length and organize their subject matter in strict hierarchy; even the ‘‘practical part’’ ofthese works obeys the - highly speculative - theory of humoral pathology, and references to Aristotelian logic and natural science and Galenic ethics are ubiquitous. As in Alexandria (and in Byzantium) the philosopher-physician was a prominent figure in Islam: al-Razi, Ibn al-Tayyib (a commentator on works by Aristotle, Hippocrateis, and Galen, who was a physician at the 'Adudiyya hospital in Baghdad and d. in 1043), Avicenna, and Ibn Rushd (Averroes, d. 1198) are well-known examples. On the other hand, representatives of ‘‘pure’’ philosophy have disputed the philosophical aspirations of medicine. Al-Farabi (d. 950), a scholar working in Baghdad and disdaining any financial gain from a non-philosophical practice and refusing any public position, did not include medicine in his Enumeration of the Sciences, doubted Galen’s competence in logic, and granted only a limited validity to the generalia of medicine, the doctrine of the human organism, and the theory of health and illness as subjects of the natural sciences. In his preface to a short Epistle on Medicine, al-FarabI defined medicine as a “productive craft, which is not concerned with treating its obJects as intelligibilia for the soul, as in (philosophical) reflection, but to produce effects on the objects and to provide them with qualities and other accidentia’.’ Medicine is, al-FarabI implies, not concerned with the human soul and is not a science (Arabic 'ilm, Greek episteme). Comparable to the fields of agriculture or rhetoric, medicine is concerned with the particular and the contingent, not the general and logically demonstrable, and it leads to ‘‘opinions,’’ not to ‘‘certainty.’’

See also: > Abu Bakr al-RazI, Muljammad ibn Zakarlya’ (Rhazes) > Alexandrian Tradition into Arabic: Medicine

>  Aristotle, Arabic > al-FarabI, Abu Nasr > Galen, Arabic

>  Ibn Rushd, Muhammad ibn Ahmad al-Hafid (Averroes)

>  Ibn SIna, Abu 'AlI (Avicenna) > Ibn al-Tayyib > MedIcine and Philosophy > Translations from Greek into Arabic