Origins: A Cure for the Common Cold?

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In the “General Prologue” of The Canterbury Tales, Geoffrey Chaucer identifies the authorities used by his “Doctour of Physic.” The list includes four Arab physicians: Jesu Haly (Ibn ’Isa), Razi (Al-Razi, or Rhazes), Avycen (Ibn Sina, or Avicenna) and Averrois (Ibn Rushd, or Averroes).

These four did not make Chaucer’s list only to add an exotic flavor to his late-14th-century poetry. Chaucer cited them because they were the great medical authorities of the ancient world—physicians whose textbooks were being used in European medical schools and would continue to be used for centuries to come.

After the collapse of the Western Roman Empire in the fifth century, much of Europe’s intellectual heritage was lost. Of Greek science, all that remained were Pliny’s Natural History (first century C.E.), some elements of Galen (second century C.E.) and Boethius’s treatises on logic and mathematics (early sixth century C.E.).

Medicine as a science independent of religion virtually vanished. In the seventh century, the Catholic Church banned surgery by monks, largely because of the use of cadavers for scientific dissection. Since nearly all of the surgeons of that era were clerics, the decree virtually ended the practice of surgery in Europe.

Also in the seventh century, Islam was emerging in the East. The Arabs rapidly melded the various cultures of the Islamic domain, precipitating a period of geographical expansion and ferment in all branches of learning. Arabic, the language of the Koran, became the universal language throughout most of the countries bordering the Mediterranean. By the tenth century, Arabic became to the East what Latin and Greek had been to the West—the language of literature and of the arts and sciences as 007well as the common tongue of the educated.

Medicine was one of the main Greek sciences to be studied in depth by Islamic scholars. After Plato’s Academy in Athens was closed in 529 C.E., some of its scholars found refuge at the university in Jundishahpur, the old Sassanid capital of Persia, which had also sheltered excommunicated Nestorian Christian scholars—among them physicians—in 431. Persia became part of the Islamic world in 636, and Arab rulers supported the medical school at Jundishahpur. For the next 200 years it was the greatest center of medical teaching in the ancient world.

Jundishahpur’s physicians familiarized themselves with the works of Greek physicians. They were also exposed to the medical knowledge of Byzantium, Persia, India and China.

Recognizing the importance of translating Greek works into Arabic to make them more widely available, the Abbasid caliphs Harun al-Rashid (786–809) and his son, al-Ma’mun (813–833), established a translation bureau in Baghdad, the Bayt al-Hikmah, or House of Wisdom, and sent emissaries to collect Greek scientific works in the Byzantine Empire. The most important of the translators was Hunayn ibn Ishaq al-’Ibadi (809–873), who was reputed to have been paid for his manuscripts by an equal weight of gold. By the end of the ninth century, he and his team had translated numerous Greek medical texts, including works attributed to Hippocrates (c. 460–377 B.C.E.), Dioscordes’s Materia Medica (first century C.E.), Galen and Oribasius (c. 320–400 C.E.), into Arabic.

Advances were also made in other health-related fields. Harun al-Rashid established a hospital (or bimaristan) at Baghdad around 805. Within a decade or two, 34 more hospitals had sprung up throughout the Islamic world, and the number grew each year.

The bimaristan provided the prototype upon which our modern hospitals are based. Medical schools and libraries were attached to the larger hospitals, and senior physicians taught students, who in turn were expected to apply in the hospitals’ wards what they had learned in the lecture hall. Hospitals set examinations for their students and issued diplomas. By the 11th century, there were even traveling clinics, staffed by the hospitals, that brought medical care to those patients too distant or too sick to come to the hospital.

Arab scholars also invented the institution of the pharmacy, following the Islamic precept that “God has provided a remedy for every illness.” They introduced a large number of new drugs to clinical practice, including senna, camphor, sandalwood, musk, myrrh, cassia, tamarind, nutmeg, cloves, aconite, ambergris and mercury. These ancient pharmacists, or saydalani, also developed syrups and juleps—these words come from Arabic and Persian, respectively—and pleasant solvents like rose water and orange-blossom water for administering drugs. They were familiar with the anesthetic effects of Indian hemp, which is related to marijuana, and henbane.

At the start of the ninth 008century, the first private apothecary shops opened in Baghdad. Pharmacists were required to pass examinations and be licensed, and they were then monitored by the state. Pharmaceutical preparations were manufactured and distributed commercially, then dispensed by physicians and pharmacists in a variety of forms—ointments, pills, elixirs, confections, tinctures, suppositories and inhalants.

The first major medical text appeared when Abu Bakr Muhammad ibn Zakariya Al-Razi (c. 841–926), known to the West as Rhazes, turned his attention to medicine.

Born in Persia near the modern city of Tehran, Al-Razi spent his youth as a musician, mathematician and alchemist. At the age of 40, he went to Baghdad to study medicine. After completing his studies, he became director of the hospital in the small town where he was born. His reputation grew rapidly; within a few years he was selected to be the director of a new hospital to be built in Baghdad. To determine where the hospital should be located, Al-Razi applied experimental principles: He hung pieces of fresh meat in various sections of the city and observed the rate at which they spoiled. He then ordered the hospital built at the site where the meat showed the least putrefaction.

Al-Razi turned out some 237 books, about half of which dealt with medicine. His treatise The Diseases of Children has led some historians to regard him as the father of pediatrics. He was the first to identify the cause of hay fever. His work on kidney stones is still considered a classic. In Al-Judari wa al Hasbah, Al-Razi demonstrated that smallpox and measles are different diseases—and he provided still-valid guidelines for the treatment of both afflictions.

His most esteemed work was a medical encyclopedia in 25 volumes, Al-Kitab al-Hawi (The Comprehensive Work), called the Liber Continens by later Latin translators. Al-Razi spent a lifetime collecting data for the book, which he intended as a summary of all the medical knowledge of his time, augmented by his own clinical observations. He emphasizes the need for physicians to pay careful attention to what the patients’ histories tell them, rather than merely consulting earlier authorities. In a series of case studies, Al-Razi demonstrates this tenet. One patient, who lived in a malarial district, suffered from intermittent chills and fever that had been diagnosed as malaria. Al-Razi was asked to examine him. Upon noting pus in the 009urine, he diagnosed an infected kidney, and he treated the patient successfully with diuretics.

Not long after Al-Razi’s death, Abu ’Ali al-Husayn ibn ’Abd Allah ibn Sina (980–1037) was born in Bukhara, in what today is Uzbekistan. Later translators Latinized his name to Avicenna. He was to the Arab world what Aristotle was to Greece, Leonardo da Vinci to the Renaissance and Goethe to Germany.

The son of a tax collector, Ibn Sina was so precocious that he had completely memorized the Koran by age 10. Then he studied law, mathematics, physics and philosophy. At 16 he turned to the study of medicine, which he found “not difficult.” By 18, his fame as a physician was so great that he was summoned to treat the Samanid prince Nuh ibn Mansur. His success with that patient won him access to the Samanid royal library, one of the greatest of Bukhara’s many storehouses of learning.

At 20, Ibn Sina was appointed court physician to Shams a-Dawlah, the Buyid prince of Hamadan, in western Persia. His remaining years were crowded with travel, adventure and much hard work, yet he also found time to write 20 books on theology, metaphysics, astronomy, philology and poetry, along with 20 more on medicine.

His supreme work is the Al-Qanun fi al-Tibb, or Canon of Medicine, which codified existing medical knowledge. Summarizing the work of Hippocrates, Galen, Syro-Arab physicians, and Indo-Persian scholars, as well as his own observations, Ibn Sina strove to fit each bit of anatomy, physiology, diagnosis and treatment into its proper niche.

The Canon stresses the importance of diet and the influence of climate and environment on health. It includes discussions of rabies, breast cancer, tumors, labor and poisons. Ibn Sina describes chronic nephritis, facial paralysis, ulcer of the stomach and the various types of hepatitis and their causes. He expounds on the dilation and contraction of the pupils and their diagnostic value, lists the six motor muscles of the eye and explains the functions of the tear ducts. He also warns of the contagious nature of some diseases, which he attributes to “traces” left in the air by a sick person.

Ibn Sina’s Canon made its first appearance in Europe by the end of the 12th century, and its impact was dramatic. Copied and recopied, it quickly became the standard European medical reference work. In the last 30 years of the 15th century, just before the European invention of printing, it was issued in 16 editions; in the century that followed more than 20 further editions were printed. As late as 1537 The Canon was still a required textbook at the University of Vienna. From the 12th to the 17th century, it provided Europe with its pharmacopoeia.

Contemporary Europeans regarded Ibn Sina and Al-Razi as the greatest authorities on medical matters, and portraits of both men still adorn the great hall of the School of Medicine at the University of Paris. In Dante’s Inferno, Ibn Sina sits side by side with antiquity’s two greatest physicians, Hippocrates and Galen.

These and other Arab physicians made accurate diagnoses of plague, diphtheria, leprosy, rabies, diabetes, gout, cancer and epilepsy. Ibn Sina’s theory of infection by “traces” led to the introduction of quarantine as a means of limiting the spread of infectious diseases. Arab doctors mastered operations for hernia and cataract, filled teeth with gold leaf and prescribed spectacles for defective eyesight. And they passed on rules of health, diet and hygiene that are still largely valid today.

In the “General Prologue” of The Canterbury Tales, Geoffrey Chaucer identifies the authorities used by his “Doctour of Physic.” The list includes four Arab physicians: Jesu Haly (Ibn ’Isa), Razi (Al-Razi, or Rhazes), Avycen (Ibn Sina, or Avicenna) and Averrois (Ibn Rushd, or Averroes). These four did not make Chaucer’s list only to add an exotic flavor to his late-14th-century poetry. Chaucer cited them because they were the great medical authorities of the ancient world—physicians whose textbooks were being used in European medical schools and would continue to be used for centuries to come. After the collapse of the […]