The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter
ran through such concerns as anatomy, physiology and materia medica, while the last four dealt with clinical matters: diagnosis, therapy, surgery and pathology, discussing diseases from head to foot. His separate work, al-Tibb al-ruhani [Spiritual Physic] handled diseases of the soul within a discussion of philosophy. Having won fame in Rayy, al-Razi went to Baghdad to take charge of its new al-Mu’tadidi Hospital. He spent his declining years in Rayy suffering from glaucoma, before becoming blind.
Al-Razi developed a medical philosophy. In the first chapter (‘On the Excellence and Praise of Reason’) of al-Tibb al-ruhani, he asserted that reason (al-’aql) was the ultimate authority which ‘should govern, and not be governed; should control, and not be controlled; should lead, and not be led’. He condemned slavish authority, devoting a large book, Fi’l-Shukuk ’ala Jalinus [Doubts about Galen], to criticism of precepts in Galen, beginning with al-Burhan [Demonstration], and ending with his large work, Fi’l-Nabd [On the Pulse]. In his introduction to Fi’l-Shukuk, he nevertheless declared himself Galen’s disciple; but since the art of healing was a form of philosophy, it could neither renounce criticism nor benefit from worshipping the dead. Extolling the progress of scientific knowledge, he wrote in Fi Mihnat al-tabib [On Examining Physicians and on Appointing Them] that ‘he who studies the works of the Ancients, gains the experience of their labour as if he himself had lived thousands of years spent on investigation.’ Nevertheless ‘all that is written in books is worth much less than the experience of a wise doctor.’
Al-Razi’s best-known work, al-Hawi fi’l-tibb [Continens, or Comprehensive Book of Medicine], was a commonplace book of detailed notes and transcribed bits of texts, beginning with diseases of the head and working down. Devoted to specific subjects, these files were gradually filled with jottings; the result was a kind of filing system, organized by subject though lacking overall form. Al-Razi incorporated case histories from earlier sources, notably Galen, but he also registered his own cases, recording the patient’s name, age, sex and occupation. Clinical observations of his own illnesses are also preserved: notes on how he had treated throat inflammation by gargling with strong vinegar; elsewhere he wrote about his swollen right testicle (emetics helped recovery). From these notes, al-Razi took the material for books such as al-Qulani [Cholic] and al-Jadari wa’l-hasba [Smallpox and Measles]. Hitherto all exanthemata (infections causing rashes) had tended to be lumped together; al-Razi was the first to distinguish them as separate diseases: ‘The physical signs of measles are nearly the same as those of smallpox, but nausea and inflammation are more severe, though the pains in the back are less. The rash of measles usually appears at once, but the rash of smallpox spot after spot.’ It is intriguing to find measles regarded as the more severe.
Al-Razi had many asides on medical practice: noblemen, he judged, echoing Galen, were entitled to special consideration in prescribing; for them unpleasant tasting drugs should be made palatable. But he did not neglect the poor, for whom he wrote his Man la yahduruh al-tabib [Who has no Physician to Attend Him]. Khawass al-ashya’ [Properties of Things] included the role of alchemy in medicine and the secret recipes and remedies of nature. Experience must be the touchstone of truth:
since many wicked people tell lies with regard to such properties, and we do not possess decisive means to distinguish the truth of rightful men from the false testimony of liars – save only actual experience – it will be useful not to leave these claims scattered but to collect and write them all. We shall not accept any property as authentic unless it has been examined and tried.
Al-Razi won renown, and his medical works later enjoyed ascendancy in the Latin West. In 1279 al-Hawi fi’l-tibb was Latinized under the title of Continens by the Sicilian Jew Faraj ibn Salim (Farragut), and printed five times between 1488 and 1542. His al-Mansuri fi’l-tibb [Liber ad Almansorem] and his al-Tibb al-muluki [Liber regius] were also popular. His work was in turn mentioned by Abu Rayhan ibn Ahmad al-Biruni (Al-Biruni, 973–c. 1050), who wrote on a variety of subjects: astronomy and astrology, mathematics, geography, history, philosophy and religion, mechanics, mineralogy and medicine. As well as editing al-Razi, he translated much of Galen’s otherwise lost Commentary on the Hippocratic Oath.
The Arabic medical compendium culminated in two works of the tenth and eleventh centuries. ’Ali ibn al’-Abbas al-Majusi (Haly Abbas, d. late tenth century) was a native of al-Ahwaz in southern Persia, but little is known about his life. Following al-Razi’s example, he divided his Kamil al-sina’a al-tibbiya [The Complete Medical Art] into two sections, on theoretical and on practical medicine, each including ten treatises on specialized topics, and his introduction surveyed the development of medicine up to his own times. Well-organized, practical, and devoting greater attention than al-Razi to anatomy and surgery, it secured al-Majusi’s medical reputation, winning a place second only to Ibn Sina’s Qanun.
The talents of Abu Ali al-Husayn ibn ’Abdallah ibn Sina (Avicenna, 980–1037) were evident from early youth. A Persian tax-collector’s son, he could, it is piously recorded, recite the Qur’an at the age of ten and was practising medicine by sixteen. If somewhat mythologized, Ibn Sina represents the pinnacle of the Galenic ideal of the philosopher – physician in Islam: he was the first scholar to create a complete philosophical synthesis in Arabic.
In a wandering life driven by burning intellectual curiosity, Ibn Sina held positions as a jurist, a teacher of philosophy, an administrator, and as physician to various courts. His autobiography boasts that his writing was done on horseback during military campaigns, in hiding, in prison and even after drinking bouts. The outcome was two hundred and seventy tides which include two monumental encyclopaedias, one on science (Kitab al-Shifa) and one on medicine (Kitab al-Qanun).
The Kitab al-Qanun [Canon, or The Medical Code] arranges in its million words the whole of medical science: the legacies of Hippocrates, Galen, Dioscorides and the late Alexandrian physicians, enriched by the works of Arab predecessors. It consists of five books arranged by subject, with subdivisions and summaries. Book I deals with general principles, starting with the theory of the elements, humours and temperaments and moving on to anatomy, physiology, hygiene, aetiology, symptoms and treatment of diseases. Book II is on materia medica, describing the physical properties of simple drugs, and how to collect and preserve them (a separate section lists 760 drugs alphabetically). Book III deals with specific diseases, classified from head to heel, together with the aetiology, symptoms, diagnosis, prognosis and treatment of each. Anatomy is also discussed. Book IV is concerned with diseases, such as fevers, affecting the whole body; it also covers ulcers, abscesses, swellings, pustules, fractures and injuries, as well as poisons, and there is even a section on anorexia and obesity. Book V describes compound drugs – theriacs, electuaries, emetics, pessaries, liniments, and so on – together with their medicinal uses.
In addition to the Canon, Ibn Sina wrote about forty works on medical subjects. The best known is Urjuza fi’l-tibb [A Medical Poem], a summary of the principles of medicine in verse as a mnemonic aid to students. But it was the Qanun that became the authoritative text on medicine for centuries, both in Islam, where it remains influential, and in Latin Christendom, earning him such tides as the ‘Galen of Islam’. His pre-eminent standing in the Latin West is symbolized by Dante’s ennobling him between Hippocrates and Galen.
Critics have alleged that al-Razi’s and Ibn Sina’s work stifled independent thought. Certainly the Canon was taught and annotated, but some of the commentaries were highly critical, notably that of the Andalusian physician, Ibn Rushd (Averroës, 1126–98). Criticism of its anatomy section also gave rise to the description by Ibn al-Nafis (d. 1288) of the pulmonary (lesser) circulation, nearly three hundred years before Servetus and Realdo Colombo (see below).
All these great compendia originated in Persia, but texts were also produced elsewhere, including the work of Abu’l-Qasim Khalaf ibn Abbas al-Zahrawi (Albucasis, 936–1013). Born in Cordova, al-Zahrawi was author of a medical compendium entitled Al-Tasrif li-man ’ajaza ’an al-ta’lif [The Recourse of Him Who Cannot Compose (a Medical Work of His Own)]. Some 1500 pages in length, and divided into thirty treatises, it offers information on topics elsewhere neglected, including surgery,