The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter
of his death, practically all of Arabia had been won over for Islam, and a century later his adherents had conquered half of Byzantine Asia, all of Persia, Egypt, the Maghreb (North Africa) and Spain, where Cordova became capital of the western caliphate, the Baghdad of the West, the source of Hispano – Arabian culture, together with Seville and Toledo, which peaked in the twelfth century, and later still Granada. Unlike Christianity, Islam was not a proselytizing faith which saw itself as superseding earlier ones, and the Qur’an granted Christians and Jews special status as ‘People of the Book’ (ahl al-Kitab), adherents of the other scripture-based faiths. Before the papacy launched the Crusades, Christians, Jews, Muslims and others rubbed along well together. What brought some unity to the Arab empire was not religion but a common language.
The pre-Islamic Near and Middle East possessed a popular medicine akin to that of the Mediterranean. Materia medica included plants and herbs familiar to Greek medicine, though certain remedies were distinct. Truffle juice was applied to eye disorders, clarified butter was used against fever, dates were prescribed for children’s maladies, while camel’s urine toned up the system. Cupping, cautery and leeches were employed for blood-letting; wounds were disinfected with alkali-rich saltwort, and ashes were applied to stanch bleeding. Knowledge of internal organs was meagre, and surgery was basic.
Interwoven with these practices were animist beliefs. Ill health was widely attributed to spirits. To restore well-being, the sick had to outwit them or recruit the protection of superior magical powers. The forces responsible for ill health were the jinn and the evil eye (al-’ayn), a glance believed to harm those upon whom it fell. The jinn (plural :jinni, whence genie) was a lesser spirit interfering with human beings; one could see, bargain with and even kill jinni, and they could bring good luck as well as bad. Healthwise, however, their activity was harmful, and they were held particularly to blame for fevers, madness and children’s diseases.
Avoidance of sickness thus demanded practical and magical precautions to ward off evil spirits. There were incantations against ailments like leg ulcers and night-blindness, and charms guaranteed a safe delivery for pregnant women. Popular observances countered unwelcome visitations from spirits: thus a boy suffering from a blistered lip would beg for food and then toss any offerings to the dogs; as the blister had originally been attracted by his eating food, it would be drawn to the scraps and so transferred to the dogs. Practical medicine was everyone’s business, but those who, like bleeders and cuppers, possessed particular skills were paid for their services, while the magical side of traditional medicine was performed by diviners, seers and charmers.
Initially the rise of Islam posed no threat to this traditional lore. The Qur’an has almost nothing to say about medicine, apart from advice to the faithful to wash for prayer and praise for the healing powers of honey. Scripture accepted the jinn, and Islam raised no objection to the indigenous medicine of conquered provinces; formal learning, including medicine, continued in the (Christian) Jacobite and Nestorian monasteries of Syria and Mesopotamia.
The seventh and eighth centuries, however, brought the transformation of Islam from a simple monotheistic creed to a formal faith, laying down theological orthodoxy. Popular medicine became mired in controversy because of its animistic bent, and many traditional practices were condemned. Conflict was sharpened by the fact that, in the centuries after the Prophet’s death (632), discussion of issues tended to be dominated by claims that Muhammad or his companions must have pronounced on the matter. Such pious dicta grew into a distinct corpus called hadith, the sayings of the Prophet. Old-style healers also began to claim Muhammad’s support: traditions alleged to be from the Prophet told, for example, that ‘the evil eye is real’; that there was medicinal power in his saliva; and that the water of the well of Zamzam in Mecca had healing properties. Being God’s word, the Qur’an too must have great powers. Hence, to assist a woman in labour, certain verses should be written on a slate, cleaned off, and the water given her to drink. The parallels with Christian healing are plain.
As Islam developed, traditional medicine was called into question. One major dilemma was plague. Early views had attributed epidemics to the jinn. This explanation was displaced by beliefs setting pestilence within the monotheistic framework of an Allah who was the ordainer of all things (including disease), yet was just and merciful. Though with the growth of Islam, many folkloric practices were attacked, medicine itself was not called into question, since Islam taught that ‘God sends down no malady without also sending down with it a cure.’
It is often held that a distinctive Arab – Islamic medicine dates from the time of the Prophet and stems from a hospital (bimaristan: Persian for house for the sick) and academy at Jundishapur, near Susa in southern Persia. Jundishapur was certainly a meeting-place for Arab, Greek, Syriac and Jewish intellectuals, but there is no evidence that any medical academy existed there. Only in the early ninth century did Arab – Islamic learned medicine take shape. The first phase of this revival lay in a major translation movement, arising during the reign of Harun al-Rashid (r. 786–809) and gaining impetus in the caliphate of his son, al-Ma’mum (r. 813–33). It was stimulated by a socioeconomic atmosphere favourable to the pursuit of scholarship, a perceived need among both Muslims and Christians for access in Arabic to ancient medicine, and the ready availability of the relevant texts.
Crucial in this ‘age of translations’ was the establishment in Baghdad, capital of the Islamic empire under the Abbasid caliphs, of the Bayt al-Hikma (832), a centre where scholars assembled texts and translated into Arabic a broad range of non-Islamic works. The initial translation work was dominated by Christians, thanks to their skills in Greek and Syriac. The main figure was Hunayn ibn Ishaq (d. 873), later known in the West as Johannitius, a Nestorian Christian from the southern Iraqi town of al-Hira. Hunayn, who travelled to the Byzantine empire in search of Galenic treatises and was said to wander the streets of Baghdad reciting Homer in Greek, was amazingly prolific. With his pupils, he translated 129 works of Galen into Arabic (and others into Syriac), providing the Arabic world with more Galenic texts than survive today in Greek.
Encouraged by official patronage, the translation drive proceeded rapidly. Hundreds of Greek texts were rendered into accurate and elegant Arabic; works in Syriac and Sanskrit were also translated, reflecting the cosmopolitanism of ninth-century Baghdad. The impact was enormous, not least in view of the hundreds of ancient texts saved in Arabic for posterity. The favoured author was Galen, and he thereby became the father figure for Arabic medicine. Even the Hippocratic Corpus was known primarily through his commentaries.
Continuing into the early eleventh century, the translation movement revived learned medicine, made Arabic a tongue for original scholarship, and gave Islamic culture access to a galaxy of learning. The early translators also launched an original medical literature of their own. Hunayn authored essays on ophthalmology, known as his Kitab al-’ashr maqalat fi l-’ayn [Book of the Ten Treatises on the Eye]. His Medical Questions and Answers, a student text book, adopted the threefold scheme of discussing first the natural organisation of the body, then neutral factors, and finally unnatural (or contra-natural) disease – a handling reproduced by all Arabic writers in the Galenic tradition. By the late ninth century medical men had access to a stock of ancient texts in superior Arabic translations and an expanding corpus of original scholarship glossing Greek works.
This in turn created a need for fresh syntheses, leading to the supreme achievement of Arab – Islamic medicine, the medical compendia. The first was the Firdaws al-hikma [Paradise of Wisdom] by ’Ali ibn Rabban al-Tabari (c. 850), in which the author, an Islamic convert, sought to collect a summa of medical erudition worthy for presentation to the Caliph al-Mutawakkil. His sources were Arabic and Persian translations of ancient classics, and his citations included not only Hippocrates, Galen and Dioscorides but Persian and Indian writers (this Indian element was soon, however, eclipsed by the Greek tradition).
Persia produced one of the greatest Muslim physicians and philosophers, Muhammad ibn Zakariya al-Razi, known in the West as Rhazes (865–925), author of some 200 treatises. In his youth (anecdotes tell us) al-Razi studied and practised medicine at the bimaristan of Baghdad. He later returned to Rayy, near Teheran, as head of its hospital, at the invitation of Persia’s ruler, Mansur ibn Ishaq; al-Razi dedicated to him