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In the history of medicine, Islamic medicine or Arabic medicine refers to medicine developed in the medieval Islamic civilization and written in Arabic, the lingua franca of the Islamic civilization. Despite these names, a significant number of scientists during this period were not Arab. Some consider the label "Arab-Islamic" as historically inaccurate, arguing that this label does not appreciate the rich diversity of Eastern scholars who have contributed to Islamic science in this era.[1] Latin translations of Arabic medical works had a significant influence on the development of modern medicine.
Overview
Islamic medicine was a genre of medical writing that was influenced by several different medical systems, including the traditional Arabian medicine of Muhammad's time, ancient Hellenistic medicine such as Unani, ancient Indian medicine such as Ayurveda, and the ancient Iranian Medicine of the Academy of Gundishapur. The works of ancient Greek and Roman physicians Hippocrates, Dioscorides, Soranus, Celsus and Galen had a lasting impact on Islamic medicine.[2][3][4]
Foundations
In Islamic tradition, the first Muslim physician is believed to have been Muhammad himself, as a significant number of hadiths concerning medicine are attributed to him. Several Sahaba are said to have been successfully treated of certain diseases by following the medical advice of Muhammad. The three methods of healing known to have been mentioned by him were honey, fire cupping, and cauterization, though he was generally opposed to the use of cauterization unless it "suits the ailment." According to Ibn Hajar al-Asqalani, Muhammad disliked this method due to it causing "pain and menace to a patient" since there was no anasthesia in his time.[5] Muhammad also appears to have been the first to suggest that there is always a cause and a cure for every disease,[5][6] according to several hadiths in the Sahih al-Bukhari, Sunan Abi Dawood and Al-Muwatta attributed to Muhammad, such as:
"There is no disease that Allah has created, except that He also has created its treatment."[7]
"Make use of medical treatment, for Allah has not made a disease without appointing a remedy for it, with the exception of one disease, namely old age."[8]
"Allah has sent down both the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically."[9]
"The one who sent down the disease sent down the remedy."[10]
"For every disease, Allah has given a cure."[6]
The belief that there is a cure for every disease encouraged early Muslims to engage in biomedical research and seek out a cure for every disease known to them.[6] Many early authors of Islamic medicine were usually clerics rather than physicians, and were known to have advocated the traditional medical practices of prophet Muhammad's time, such as those mentioned in the Qur'an and Hadith. For instance, therapy did not require a patient to undergo any surgical procedures at the time.
From the 9th century, Hunayn ibn Ishaq translated a number of Galen's works into the Arabic language, followed by translations of the Sushruta Samhita, Charaka Samhita, and Middle Persian works from Gundishapur. Muslim physicians soon began making many of their own significant advances and contributions to medicine, including the fields of allergology, anatomy, bacteriology, botany, dentistry, embryology, environmentalism, etiology, immunology, microbiology, obstetrics, ophthalmology, pathology, pediatrics, perinatology, physiology, psychiatry, psychology, pulsology and sphygmology, surgery, therapy, urology, zoology, and the pharmaceutical sciences such as pharmacy and pharmacology, among others.
Medicine was a central part of medieval Islamic culture. Responding to circumstances of time and place, Islamic physicians and scholars developed a large and complex medical literature exploring and synthesizing the theory and practice of medicine.[11] Islamic medicine was initially built on tradition, chiefly the theoretical and practical knowledge developed in Arabia, Persia, Greece, Rome, and India. Galen and Hippocrates were pre-eminent authorities, as well as the Indian physicians Sushruta and Charaka, and the Hellenistic scholars in Alexandria. Islamic scholars translated their voluminous writings from Greek and Sanskrit into Arabic and then produced new medical knowledge based on those texts.[12] In order to make the Greek and Indian traditions more accessible, understandable, and teachable, Islamic scholars ordered and made more systematic the vast and sometimes inconsistent Greco-Roman and Indian medical knowledge by writing encyclopedias and summaries.[11] It was through Arabic translations that the West learned of Hellenic medicine, including the works of Galen and Hippocrates. Of equal if not of greater influence in Western Europe were systematic and comprehensive works such as Avicenna's The Canon of Medicine, which were translated into Latin and then disseminated in manuscript and printed form throughout Europe. During the fifteenth and sixteenth centuries alone, The Canon of Medicine was published more than thirty-five times.[11]
Hospitals and Universities
Muslim physicians set up the earliest dedicated hospitals in the modern sense, known as Bimaristans, which were establishments where the ill were welcomed and cared for by qualified staff, and which were clearly distinguished from the ancient healing temples, sleep temples, hospices, asylums, lazarets and leper-houses which were more concerned with isolating the sick and the mad (insane) from society "rather than to offer them any way to a true cure."[13] These contrasted with hospitals in Christian Europe which were more concerned with prayer. The Bimaristan hospitals later functioned as the first public hospitals,[14] psychiatric hospitals[15] and diploma-granting medical universities.[16]
In the medieval Islamic world, hospitals were built in all major cities; in Cairo for example, the Qalawun Hospital could care for 8,000 patients with a staff that included physicians, pharmacists, and nurses. One could also access a dispensary, and research facility that led to advances, which included the discovery of the contagious nature of diseases, and research into optics and the mechanisms of the eye. Muslim doctors were removing cataracts with hollow needles over 1000 years before Western physicians dared attempt such a task. Hospitals were built not only for the physically sick, but for the mentally sick also. One of the first ever psychiatric hospitals that cared for the mentally ill was built in Cairo. Hospitals later spread to Europe during the Crusades, inspired by the hospitals in the Middle East. The first hospital in Paris, Les Quinze-vingts, was founded by Louis IX after his return from the Crusade between 1254-1260.[17]
Hospitals in the Islamic world featured competency tests for doctors, drug purity regulations, nurses and interns, and advanced surgical procedures.[18] Hospitals were also created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients.[19]
One of the features in medieval Muslim hospitals that distinguished them from their contemporaries and predecessors was their significantly higher standards of medical ethics. Hospitals in the Islamic world treated patients of all religions, ethnicities, and backgrounds, while the hospitals themselves often employed staff from Christian, Jewish and other minority backgrounds. Muslim doctors and physicians were expected to have obligations towards their patients, regardless of their wealth or backgrounds. The ethical standards of Muslim physicians was first laid down in the 9th century by Ishaq bin Ali Rahawi, who wrote the Adab al-Tabib (Conduct of a Physician), the first treatise dedicated to medical ethics. He regarded physicians as "guardians of souls and bodies", and wrote twenty chapters on various topics related to medical ethics.[20]
Another unique feature of medieval Muslim hospitals was the role of female staff, who were rarely employed in ancient and medieval healing temples elsewhere in the world. Medieval Muslim hospitals commonly employed female nurses, including nurses from as far as Sudan, a sign of great breakthrough. Muslim hospitals were also the first to employ female physicians, the most famous being two female physicians from the Banu Zuhr family who served the Almohad ruler Abu Yusuf Ya'qub al-Mansur in the 12th century.[21] Later in the 15th century, female surgeons were illustrated for the first time in Şerafeddin Sabuncuoğlu's Cerrahiyyetu'l-Haniyye (Imperial Surgery).[22]
Encyclopedias
The first encyclopedia of medicine in Arabic was Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah ("Paradise of Wisdom"), written in seven parts, c. 860. It was the first to deal with pediatrics and child development, as well as psychology and psychotherapy. In the fields of medicine and psychotherapy, the work was primarily influenced by Islamic thought and ancient Indian physicians such as Sushruta and Charaka. Unlike earlier physicians, however, al-Tabari emphasized strong ties between psychology and medicine, and the need of psychotherapy and counseling in the therapeutic treatment of patients.[23]
Muhammad ibn Zakarīya Rāzi (Rhazes) wrote the Comprehensive Book of Medicine in the 9th century. The Large Comprehensive was the most sought after of all his compositions, in which Rhazes recorded clinical cases of his own experience and provided very useful recordings of various diseases. The Comprehensive Book of Medicine, with its introduction of measles and smallpox, was very influential in Europe.
Ali ibn Abbas al-Majusi (Haly Abbas)'s Kitab Kamil as-sina'a at-tibbiyya ("Complete Book of the Medical Art"), c. 980, became better known as the Kitab al-Maliki ("Royal Book", Latin: Liber regalis) in honour of its royal patron 'Adud al-Dawla. In twenty sections, ten of theory and ten of practice, it was more systematic and concise than Razi's Hawi, but more practical than Avicenna's Canon, by which it was superseded. With many interpolations and substitutions, it served as the basis for the Pantegni (c. 1087) of Constantinus Africanus, the founding text of the Schola Medica Salernitana in Salerno.[24]
Abu al-Qasim al-Zahrawi (Abulcasis), regarded as the father of modern surgery,[25] contributed greatly to the discipline of medical surgery with his Kitab al-Tasrif ("Book of Concessions"), a 30-volume medical encyclopedia published in 1000, which was later translated to Latin and used in European medical schools for centuries. He invented numerous surgical instruments and described them in his al-Tasrif.
Avicenna (Ibn Sina), a Hanbali and Mu'tazili philosopher and doctor in the early 11th century, was another influential figure. He is regarded as the father of modern medicine,[26] and one of the greatest thinkers and medical scholars in history. His medical encyclopedia, The Canon of Medicine (c. 1020), remained a standard textbook in Europe for centuries, up until the renewal of the Muslim tradition of scientific medicine. He also wrote The Book of Healing (actually a more general encyclopedia of science and philosophy), which became another popular textbook in Europe. Among other things, Avicenna's contributions to medicine include the introduction of systematic experimentation and quantification into the study of physiology,[27] the discovery of the contagious nature of infectious diseases, the introduction of quarantine to limit the spread of contagious diseases, the introduction of experimental medicine,[28] evidence-based medicine, clinical trials,[29] randomized controlled trials,[30][31] efficacy tests,[32][33] clinical pharmacology,[34] risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases,[35] the first descriptions on bacteria and viral organisms,[36][unreliable source?] the distinction of mediastinitis from pleurisy, the contagious nature of phthisis and tuberculosis, the distribution of diseases by water and soil, and the first careful descriptions of skin troubles, sexually transmitted diseases, perversions, and nervous ailments,[17] as well the use of ice to treat fevers, and the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences.[37]
Abū Rayhān al-Bīrūnī's Kitab-al-Saidana was an extensive medical encyclopedia which synthesized Islamic medicine with Indian medicine. His medical investigations included one of the earliest descriptions on Siamese twins.[38] Ibn Al-Thahabi (d. 1033) was famous for writing the first known alphabetical encyclopedia of medicine.
Ibn al-Nafis (1213-1288) wrote Al-Shamil fi al-Tibb (The Comprehensive Book on Medicine), a voluminous medical encyclopedia that was originally planned to comprise 300 volumes, but he was only able to complete 80 volumes as a result of his death in 1288. However, even in its incomplete state, the book is one of the largest known medical encyclopedias in history, though only a small portion of The Comprehensive Book on Medicine has survived. During his lifetime, The Comprehensive Book on Medicine had eventually replaced Ibn Sina's The Canon of Medicine as a medical authority in the medieval Islamic world. Arabic biographers from the 13th onwards considered Ibn al-Nafis the greatest physician in history, some referring to him as "the second Ibn Sina", and others considering him even greater than Ibn Sina.[39]
The last major medical encyclopedia from the Islamic world was Şerafeddin Sabuncuoğlu's surgical atlas, Cerrahiyyetu'l-Haniyye (Imperial Surgery). Though his work was mostly based on Abu al-Qasim al-Zahrawi's Al-Tasrif, he also introduced many innovations of his own.
Legacy
George Sarton, the father of the history of science, wrote in the Introduction to the History of Science:[17]
"Through their medical investigations they not merely widened the horizons of medicine, but enlarged humanistic concepts generally. [...] Thus it can hardly have been accidental that those researches should have led them that were inevitably beyond the reach of Greek masters. If it is regarded as symbolic that the most spectacular achievement of the mid-twentieth century is atomic fission and the nuclear bomb, likewise it would not seem fortuitous that the early Muslim's medical endeavor should have led to a discovery that was quite as revolutionary though possibly more beneficent."
"A philosophy of self-centredness, under whatever disguise, would be both incomprehensible and reprehensible to the Muslim mind. That mind was incapable of viewing man, whether in health or sickness as isolated from God, from fellow men, and from the world around him. It was probably inevitable that the Muslims should have discovered that disease need not be born within the patient himself but may reach from outside, in other words, that they should have been the first to establish clearly the existence of contagion."
"One of the most famous exponents of Muslim universalism and an eminent figure in Islamic learning was Ibn Sina, known in the West as Avicenna (981-1037). For a thousand years he has retained his original renown as one of the greatest thinkers and medical scholars in history. His most important medical works are the Qanun (Canon) and a treatise on Cardiac drugs. The 'Qanun fi-l-Tibb' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments."
Scientific method
Like in other fields of Islamic science, Muslim physicians and doctors developed the first scientific methods for the field of medicine. This included the introduction of mathematization, quantification, experimentation, experimental medicine,[28] evidence-based medicine, clinical trials,[40] dissection, animal testing,[37] human experimentation and postmortem autopsy by Muslim physicians, whilst hospitals in the Islamic world featured the first drug tests, drug purity regulations, and competency tests for doctors.[18]
Mathematization
In the 9th century, al-Kindi (Alkindus), in De Gradibus, demonstrated the application of mathematics and quantification to medicine, particularly in the field of pharmacology. This includes the development of a mathematical scale to quantify the strength of drugs, and a system that would allow a doctor to determine in advance the most critical days of a patient's illness, based on the phases of the Moon.[41]
Experimental method
In the 10th century, Razi (Rhazes) introduced controlled experiment and clinical observation into the field of medicine, and rejected several Galenic medical theories unverified by experimentation.[40] The earliest known medical experiment was carried out by Razi in order to find the most hygienic place to build a hospital. He hung pieces of meat in places throughout 10th century Baghdad and observed where the meat decomposed least quickly, and that was where he built the hospital. In his Comprehensive Book of Medicine, Razi recorded clinical cases of his own experience and provided very useful recordings of various diseases. In his Doubts about Galen, Razi was also the first to prove both Galen's theory of humorism and Aristotle's theory of classical elements false using experimentation.[42] He also introduced urinalysis and stool tests.[43]
Avicenna (Ibn Sina) is considered the father of modern medicine,[26] for his introduction of systematic experimentation and quantification into the study of physiology,[27] the introduction of experimental medicine,[28] clinical trials,[29] risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases,[35] in his medical encyclopedia, The Canon of Medicine (c. 1025), which was also the first book dealing with evidence-based medicine, randomized controlled trials,[30][31] and efficacy tests.[32][33]
According to Toby Huff and A. C. Crombie, the Canon contained "a set of rules that laid down the conditions for the experimental use and testing of drugs" which were "a precise guide for practical experimentation" in the process of "discovering and proving the effectiveness of medical substances."[40] Avicenna's emphasis on tested medicines laid the foundations for an experimental approach to pharmacology.[44] The Canon laid out the following rules and principles for testing the effectiveness of new drugs and medications, which still form the basis of clinical pharmacology[34] and modern clinical trials:[29]
- "The drug must be free from any extraneous accidental quality."
- "It must be used on a simple, not a composite, disease."
- "The drug must be tested with two contrary types of diseases, because sometimes a drug cures one disease by Its essential qualities and another by its accidental ones."
- "The quality of the drug must correspond to the strength of the disease. For example, there are some drugs whose heat is less than the coldness of certain diseases, so that they would have no effect on them."
- "The time of action must be observed, so that essence and accident are not confused."
- "The effect of the drug must be seen to occur constantly or in many cases, for if this did not happen, it was an accidental effect."
- "The experimentation must be done with the human body, for testing a drug on a lion or a horse might not prove anything about its effect on man."
One of the earliest physicians known to have performed human dissection and postmortem autopsy in his medical experiments was Ibn Zuhr (Avenzoar),[45] who introduced the experimental method into surgery,[46] for which he is considered the father of experimental surgery.[47] There were a number of other early practitioners of human dissection and autopsy at the time,[48] including Ibn Tufail,[49] Saladin's physicians al-Shayzari[48] and Ibn Jumay, Abd-el-latif,[50] and Ibn al-Nafis.[51]
The experimental method was introduced into botany, materia medica and the agricultural sciences in the 13th century by the Andalusian-Arab botanist Abu al-Abbas al-Nabati, the teacher of Ibn al-Baitar. Al-Nabati introduced empirical techniques in the testing, description and identification of numerous materia medica, and he separated unverified reports from those supported by actual tests and observations.[40]
Peer review
The first documented description of a peer review process is found in the Ethics of the Physician written by Ishaq bin Ali al-Rahwi (854–931) of al-Raha, Syria, who describes the first medical peer review process. His work, as well as later Arabic medical manuals, state that a visiting physician must always make duplicate notes of a patient's condition on every visit. When the patient was cured or had died, the notes of the physician were examined by a local medical council of other physicians, who would review the practising physician's notes to decide whether his/her performance have met the required standards of medical care. If their reviews were negative, the practicing physician could face a lawsuit from a maltreated patient.[52]
Anatomy and Physiology
In anatomy and physiology, the first physician to refute Galen's theory of humorism was Muhammad ibn Zakarīya Rāzi (Rhazes) in his Doubts about Galen in the 10th century. He criticized Galen's theory that the body possessed four separate "humors" (liquid substances), whose balance are the key to health and a natural body-temperature. Razi was the first to prove this theory wrong using an experiment. He carried out an experiment which would upset this system by inserting a liquid with a different temperature into the body resulting in an increase or decrease of bodily heat, which resembled the temperature of that particular fluid. Razi noted particularly that a warm drink would heat up the body to a degree much higher than its own natural temperature, thus the drink would trigger a response from the body, rather than transferring only its own warmth or coldness to it. This line of criticism was the first comprehensive experimental refutation of Galen's theory of humours and Aristotle's theory of the four classical elements on which it was grounded. Razi's own chemical experiments suggested other qualities of matter, such as "oiliness" and "sulfurousness", or inflammability and salinity, which were not readily explained by the traditional fire, water, earth and air division of elements.[42]
Experimental anatomy and physiology
The contributions of Avicenna to physiology include the introduction of systematic experimentation and quantification into the study of physiology in The Canon of Medicine (c. 1020).[27] The contributions of Ibn al-Haytham (Alhacen) to anatomy and physiology include many improvements in our understanding of the process of visual perception in his Book of Optics, published in 1021.[37] Other innovations introduced by Muslim physicians to the field of physiology by this time include the use of animal testing[37] and human dissection.[48]
Ibn Zuhr (Avenzoar) (1091-1161) was one of the earliest physicians known to have carried out human dissection and postmortem autopsy. He proved that the skin disease scabies was caused by a parasite, a discovery which upset the theory of humorism supported by Hippocrates and Galen. The removal of the parasite from the patient's body did not involve purging, bleeding, or any other traditional treatments associated with the four humours.[45]
In the 12th century, Saladin's physicians al-Shayzari[48] and Ibn Jumay were also among the earliest to undertake human dissection, and they made explicit appeals for other physicians to do so as well. During a famine in Egypt in 1200, Abd-el-latif observed and examined a large number of skeletons, and he discovered that Galen was incorrect regarding the formation of the bones of the lower jaw and sacrum.[50]
Circulatory anatomy and physiology
Ibn al-Nafis, the father of circulatory physiology,[53] was another early proponent of human dissection.[51] In 1242, he was the first to describe the pulmonary circulation,[54] coronary circulation,[55] and capillary circulation,[56] which form the basis of the circulatory system, for which he is considered the one of the greatest physiologists in history.[57] The first European descriptions of the pulmonary circulation came several centuries later, by Michael Servetus in 1553 and William Harvey in 1628. Ibn al-Nafis also described the earliest concept of metabolism,[58] and developed new Nafisian systems of anatomy, physiology and psychology to replace the Avicennian and Galenic doctrines, while discrediting many of their erroneous theories on the four humours, pulsation,[59] bones, muscles, intestines, sensory organs, bilious canals, esophagus, stomach, and the anatomy of almost every other part of the human body.[51]
The Arab physician Ibn al-Lubudi (1210-1267), also from Damascus, wrote the Collection of discussions relative to fifty psychological and medical questions, in which he rejects the theory of four humours supported by Galen and Hippocrates, discovers that the body and its preservation depend exclusively upon blood, rejects Galen's idea that women can produce sperm, and discovers that the movement of arteries are not dependent upon the movement of the heart, that the heart is the first organ to form in a fetus' body (rather than the brain as claimed by Hippocrates), and that the bones forming the skull can grow into tumors. He also advises that in cases of extreme fever, a patient should not be released from hospital.[60]
In the 15th century, the Tashrih al-badan (Anatomy of the body) written by Mansur ibn Ilyas contained comprehensive diagrams of the body's structural, nervous and circulatory systems.[61]
Pulsology and sphygmology
Muslim physicians were pioneers in pulsology and sphygmology. In ancient times, Galen as well as Chinese physicians erroneously believed that there was a unique type of pulse for every organ of the body and for every disease.[62] Galen also erroneously believed that "every part of an artery pulsates simultaneously" and that the motion of the pulse was due to natural motions (the arteries expanding and contracting naturally) as opposed to forced motions (the heart causing the arteries to either expand or contract).[63] The first correct explanations of pulsation were given by Muslim physicians.
Avicenna was a pioneer of sphygmology after he refined Galen's theory of the pulse and discovered the following in The Canon of Medicine:[62]
"Every beat of the pulse comprises two movements and two pauses. Thus, expansion : pause : contraction : pause. [...] The pulse is a movement in the heart and arteries ... which takes the form of alternate expansion and contraction."
Avicenna also pioneered the modern approach of examining the pulse through the examination of the wrist, which is still practiced in modern times. His reasons for choosing the wrist as the ideal location is due to it being easily available and the patient not needing to be distressed at the exposure of his/her body. The Latin translation of his Canon also laid the foundations for the later invention of the sphygmograph.[64]
Ibn al-Nafis, in his Commentary on Anatomy in Avicenna's Canon, completely rejected the Galenic theory of pulsation after his discovery of the pulmonary circulation. He developed his own Nafisian theory of pulsation after discovering that pulsation is a result of both natural and forced motions, and that the "forced motion must be the contraction of the arteries caused by the expansion of the heart, and the natural motion must be the expansion of the arteries." He notes that the "arteries and the heart do not expand and contract at the same time, but rather the one contracts while the other expands" and vice versa. He also recognized that the purpose of the pulse is to help disperse the blood from the heart to the rest of the body. Ibn al-Nafis briefly summarizes his new theory of pulsation:[63]
"The primary purpose of the expansion and contraction of the heart is to absorb the cool air and expel the wastes of the spirit and the warm air; however, the ventricle of the heart is wide. Moreover, when it expands it is not possible for it to absorb air until it is full, for that would then ruin the temperament of the spirit, its substance and texture, as well as the temperament of the heart. Thus, the heart is necessarily forced to complete its fill by absorbing the spirit."
Epidemiology, Etiology, Pathology
In etiology and epidemiology, Muslim physicians were responsible for the discovery of infectious disease and the immune system, advances in pathology, and early hypotheses related to bacteriology and microbiology.[37] Their discovery of contagious disease in particular is considered revolutionary and is one of the most important discoveries in medicine.[17] The earliest ideas on contagion can be traced back to several hadiths attributed to Muhammad in the 7th century, who is said to have understood the contagious nature of leprosy, mange, and sexually transmitted disease.[65] These early ideas on contagion arose from the generally sympathetic attitude of Muslim physicians towards lepers (who were often seen in a negative light in other ancient and medieval societies) which can be traced back through hadiths attributed to Muhammad and to the following advice given in the Qur'an:[66]
"There is no fault in the blind, and there is no fault in the lame, and there is no fault in the sick."
This eventually led to the theory of contagious disease, which was fully understood by Avicenna in the 11th century. By then, the pathology of contagion had been fully understood, and as a result, hospitals were created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients who do not have any contagious diseases.[19] In The Canon of Medicine (1020), Avicenna discovered the contagious nature of infectious diseases such as phthisis and tuberculosis, the distribution of diseases by water and soil, and fully understood the contagious nature of sexually transmitted diseases.[17] In epidemiology, he introduced the method of quarantine as a means of limiting the spread of contagious diseases,[29] and introduced the method of risk factor analysis and the idea of a syndrome in the diagnosis of specific diseases.[35]
In order to find the most hygienic place to build a hospital, Muhammad ibn Zakariya ar-Razi (Rhazes) carried out an experiment where he hung pieces of meat in places throughout 10th century Baghdad and observed where the meat decomposed least quickly. Razi also wrote the Comprehensive Book of Medicine in the 9th century. The Large Comprehensive was the most sought after of all his compositions, in which Razi recorded clinical cases of his own experience and provided very useful recordings of various diseases, as well as the discovery of measles and smallpox. The Large Comprehensive also criticized the views of Galen, after Razi had observed many clinical cases which did not follow Galen's descriptions of fevers. For example, he stated that Galen's descriptions of urinary ailments were inaccurate as he had only seen three cases, while Razi had studied hundreds of such cases in hospitals of Baghdad and Rayy.[67] Chickenpox was also first indentified by Razi, who clearly distinguished it from smallpox and measles.[68] The Comprehensive Book of Medicine, especially with its introduction of measles, smallpox and chickenpox, was very influential in Europe.
Ibn Zuhr (Avenzoar) was the first physician to provide a real scientific etiology for the inflammatory diseases of the ear, and the first to clearly discuss the causes of stridor.[69] He also gave the first accurate descriptions on neurological diseases, including meningitis, intracranial thrombophlebitis, and mediastinal germ cell tumors. Averroes suggested the existence of Parkinson's disease and attributed photoreceptor properties to the retina. Maimonides wrote about neuropsychiatric disorders and described rabies and belladonna intoxication.[25]
Allergology and immunology
The study of allergology and immunology originate from the Islamic world.[37] Muhammad ibn Zakarīya Rāzi (Rhazes) was responsible for discovering "allergic asthma", and was the first physician known to have written articles on allergy and the immune system. In the Sense of Smelling, he explains the occurrence of rhinitis after smelling a rose during the Spring. In the Article on the Reason Why Abou Zayd Balkhi Suffers from Rhinitis When Smelling Roses in Spring, he dicusses seasonal rhinitis, which is the same as allergic asthma or hay fever. Al-Razi was the first to realize that fever is a natural defense mechanism, the body's way of fighting disease.
The distinction between smallpox and measles also dates back to al-Razi. The medical procedure of inoculation was practiced in the medieval Islamic world in order to treat smallpox. This was later followed by the first smallpox vaccine in the form of cowpox, invented in Turkey in the early 18th century.[70]
Hematology and heredity
In hematology, Abu al-Qasim al-Zahrawi (Abulcasis) wrote the first description on haemophilia, a hereditary genetic disorder, in his Al-Tasrif, in which he wrote of an Andalusian family whose males died of bleeding after minor injuries.[71]
Microorganisms
Muslim physicians speculated on the existence of bacteria and microorganisms, though these early theories were not proven or observed until the 17th century, when investigations into microbiology were only made possible with the invention of the microscope. These early ideas did, however, influence Girolamo Fracastoro.
Avicenna hypothesized that bodily secretion is contaminated by foul foreign earthly bodies before being infected.[15][36]
When the Black Death bubonic plague reached al-Andalus in the 14th century, Ibn Khatima hypothesized that infectious diseases are caused by small "minute bodies" which enter the human body and cause disease. Another 14th century Andalusian physician, Ibn al-Khatib (1313-1374), wrote a treatise called On the Plague, in which he stated:[15]
"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 infection 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 affected through garments, vessels and earrings."
Parasitology
In parasitology, Ibn Zuhr, through his dissections, was able to prove that the skin disease scabies was caused by a parasite, a discovery which upset the theory of humorism supported by Hippocrates, Galen and Avicenna. The removal of the parasite from the patient's body did not involve purging, bleeding, or any other traditional treatments associated with the four humours.[45]
Dentistry
Dental surgery
Muslim dentists were pioneers in dentistry, particularly dental surgery and dental restoration. The earliest medical text to deal with dental surgery in detail was the Al-Tasrif by Abulcasis. He gave detailed methods for the successful replantation of dislodged teeth.[72]
Dental restoration
Another 10th century Arab dentist, Abu Gaafar Amed ibn Ibrahim ibn abi Halid al-Gazzar, from North Africa, described methods of dental restoration in his Kitab Zad al-Musafir wa qut al-Hadir (Provision for the traveler and nutrition for the sedentary), which was later translated into Latin as Viaticum by Constantine the African in Salerno. He provided the earliest treatment for dental caries:[73]
Al-Gazzar also recommended arsenic compound in his prescription for holes in the teeth, as well as against dental caries, loosening, and relaxing of the nerves as a result of too many fluids.[74]
Avicenna dedicated many chapters of The Canon of Medicine to dentistry, particularly dental restoration. Influenced by al-Gazzar, he provided his own treatment for dental caries, stating that carious teeth should be filled with cypress, grass, mastix, myrrh, or styrax, among others, with gallnut, yellow sulfur, pepper, camphor, and with drugs for pain relief, like arsenic or wolf’s milk. He further stated that arsenic boiled in oil should be dripped into the carious defect.[74]
Both Avicenna and al-Gazzar, however, believed that dental caries were caused by "tooth worms" like what the ancients believed. This was proven false in 1200 by another Muslim physician named Gaubari in his Book of the Elite concerning the unmasking of mysteries and tearing of veils which dedicated a chapter to dentistry. He was the first to reject the idea of caries being caused by tooth worms, and he stated that tooth worms in fact do not even exist. The theory of the tooth worm was thus no longer accepted in the Islamic medical community from the 13th century onwards.[74]
Obstetrics
Perinatology
Muslim physicians made many advances in obstetrics, especially perinatology. In ancient times, Greek and Hellenistic writers such as Hippocrates, Galen, Ptolemy and Paul of Aegina erroneously believed that uterine contractions were only an indication of the onset of childbirth and that the fetus would subsequently swim its way out of the womb and birth canal. In the 10th century, Ali ibn Abbas al-Majusi proved this theory false as he discovered that uterine contractions are in fact the cause of delivery of the fetus. Abu al-Qasim al-Zahrawi offered advice to midwives on childbirth and complex obstetrics in his Al-Tasrif (1000) and made a number of advances in the field. He pioneered the method of episiotomy for the delivery of obstructed labour, and he introduced the required surgical instruments for this operation. Caesarean sections were described in detail by Ferdowsi in his Shahnameh (1010) and by al-Biruni in his Al-Athar al-Baliyah.[75]
Embryology
- Further information: The relation between Islam and science: Embryology
Embryology was discussed to some extent in early Islamic literature, including the Qur'an and the Hadith literature (see The relation between Islam and science for more details).
Ibn al-Nafis criticized previous Aristotelian, Galenic and Avicennian explanations of embryology and proceeds to develop his own theories on embryology and generation. He believed that when a male and female semen mix, and when they create a mixed matter that has an appropriate temperament to receive an animal or human soul, God issues a soul to this matter, which then develops into an embryo that grows and generates organs.[76] He further writes:
"Galen believes that each of the two semen has in it the active faculty to fashion and the passive faculty to be fashioned, however the active faculty is stronger in the male semen while the passive in the female semen. The investigators amongst the falasifa believe that the male semen only has the active faculty, while the female only has the passive faculty. ... As for our opinion on this, and God knows best, neither of the two semen has in it an active faculty to fashion."[77]
He then shows that once the male semen and female semen are brought together in the womb, the female semen quenches the hot fire of the male semen through its own cool and wet nature.[78]
The Arab physician Ibn al-Quff (1233-1305), a student of Ibn al-Nafis, described embryology and perinatology more accurately in his Al-Jami:
"The formation of a foam stage in the first 6 to 7 days, which in 13 to 16 days, is gradually transformed into a clot and in 28 to 30 days into a small chunk of meat. In 38 to 40 days, the head appears separate from the shoulders and limbs. The brain and heart followed by the liver are formed before other organs. The fetus takes its food from the mother in order to grow and to replenish what it discards or loses ... There are three membranes covering and protecting the fetus, of which the first connects arteries and veins with those in the mothers womb through the umbilical cord. The veins pass food for the nourishment of the fetus, while the arteries transmit air. By the end of seven months, all organs are complete ... After delivery, the baby's umbilical cord is cut at a distance of four fingers breadth from the body, and is tied with fine, soft woolen twine. The area of the cut is covered with a filament moistened in olive oil over which a styptic to prevent bleeding is sprinkled ... After delivery, the baby is nursed by his mother whose milk is the best. Then the midwife puts the baby to sleep in a darkened quiet room... Nursing the baby is performed two to three times daily. Before nursing, the mother's breast should be squeezed out two or three times to get rid of the milk near the nipple."[75]
Pharmaceutical sciences
Al-Kindi was a renowned 9th century Arab doctor who wrote many books on the subject of medicine. His most important work in the field was De Gradibus, in which he demonstrated the application of mathematics to medicine, particularly in the field of pharmacology. This includes the development of a mathematical scale to quantify the strength of drugs, and a system that would allow a doctor to determine in advance the most critical days of a patient's illness, based on the phases of the Moon.[41]
In his Comprehensive Book of Medicine, Razi (Rhazes) recorded clinical cases of his own experience and provided very useful recordings of various diseases. The Comprehensive Book of Medicine, with its introduction of measles and smallpox, was very influential in Europe. Razi also carried out an experiment in order to find the most hygienic place to build a hospital. He hung pieces of meat in places throughout 10th century Baghdad and observed where the meat decomposed least quickly, and that was where he built his hospital.
In the 10th century, Abu al-Mansur al-Muwaffak mentions for the first time some chemical facts to distinguish certain medicines.[79]
Clinical pharmacology
Avicenna's contribution to pharmacology and the pharmaceutical sciences in The Canon of Medicine (1020s) include the introduction of systematic experimentation and quantification into pharmacology and the study of physiology,[27] the introduction of clinical pharmacology,[34] experimental medicine,[28] evidence-based medicine, clinical trials,[29] randomized controlled trials,[30][31] efficacy tests,[32][33] the experimental use and testing of drugs, a precise guide for practical experimentation in the process of discovering and proving the effectiveness of medical substances,[40] and the first careful descriptions of skin troubles, sexually transmitted diseases, perversions, and nervous ailments,[17] as well the use of ice to treat fevers, and the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences.[37] The Canon laid out the following rules and principles for testing the effectiveness of new drugs and medications, which still form the basis of clinical pharmacology[34] and modern clinical trials:[29]
- "The drug must be free from any extraneous accidental quality."
- "It must be used on a simple, not a composite, disease."
- "The drug must be tested with two contrary types of diseases, because sometimes a drug cures one disease by Its essential qualities and another by its accidental ones."
- "The quality of the drug must correspond to the strength of the disease. For example, there are some drugs whose heat is less than the coldness of certain diseases, so that they would have no effect on them."
- "The time of action must be observed, so that essence and accident are not confused."
- "The effect of the drug must be seen to occur constantly or in many cases, for if this did not happen, it was an accidental effect."
- "The experimentation must be done with the human body, for testing a drug on a lion or a horse might not prove anything about its effect on man."
Pharmacy
In the field of pharmacy, the first drugstores were opened by Muslim pharmacists in Baghdad in 754,[80] while the first apothecary shops were also founded by Muslim practitioners.[81]
The advances made in the Middle East by Muslim chemists in botany and chemistry led Muslim physicians to substantially develop pharmacology. Muhammad ibn Zakarīya Rāzi (Rhazes) (865-915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Shapur ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoeia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973-1050) wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah (The Book of Drugs), where he gave detailed knowledge of the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Ibn Sina (Avicenna), too, described no less than 700 preparations, their properties, mode of action and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008-1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by `Mesue' the younger, and the Medicamentis simplicibus by `Abenguefit'. Peter of Abano (1250-1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. For the story, he also mentions the distillation of sea-water for drinking.[82]
Analgesics, antiemetics, antipyretics, diuretics
In the medieval Islamic world, Arabic physicians discovered the diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic (pain killing) and antipyretic properties of medical cannabis, specifically cannabis sativa, and used it extensively as medication from the 8th to 18th centuries.[83]
Antiseptics
Razi (10th century) used mercurial compounds as topical antiseptics. From the 10th century, Muslim physicians and surgeons were applying purified alcohol to wounds as an antiseptic agent. Surgeons in Islamic Spain utilized special methods for maintaining antisepsis prior to and during surgery. They also originated specific protocols for maintaining hygiene during the post-operative period. Their success rate was so high that dignitaries throughout Europe came to Córdoba, Spain, to be treated at what was comparably the "Mayo Clinic" of the Middle Ages.[84]
Medical and therapeutic drugs
Razi, Avicenna, al-Kindi, Ibn Rushd, Abu al-Qasim, Ibn Zuhr, Ibn al-Baitar, Ibn Al-Jazzar, Ibn Juljul, Ibn al-Quff, Ibn an-Nafs, al-Biruni, Ibn Sahl and hundreds of other Muslim physicians developed drug therapy and medicinal drugs for the treatment of specific symptoms and diseases. The word "drug" is derived from Arabic[citation needed]. Their use of practical experience and careful observation was extensive.[84]
Chemotherapeutical drugs were first developed in the Muslim world. Muslim physicians used a variety of specific substances to destroy microbes. They applied sulfur topically specifically to kill the scabies mite.[84]
Abulcasis developed a variety of medications, which he described in the cosmetics chapter of Al-Tasrif (c. 1000). For epilepsy and seizures, he invented medications called Ghawali and Lafayfe. For the relief and treatment of common colds, he invented Muthallaathat, which was prepared from camphor, musk and honey, similar to Vicks Vapour Rub, a modern topical cream. Abulcasis also invented nasal sprays and hand cream, and developed effective mouth washes.[85]
Medicinal alcohol
Numerous Muslim chemists produced medicinal-grade alcohol through distillation as early as the 10th century and manufactured on a large scale the first distillation devices for use in chemistry. They used alcohol as a solvent and antiseptic.[84]
Surgery
Abu al-Qasim al-Zahrawi (Abulcasis), regarded as the father of modern surgery,[25] contributed greatly to the discipline of medical surgery with his Kitab al-Tasrif (Book of Concessions or The Method of Medicine), a 30-volume medical encyclopedia published in 1000, which was later translated to Latin and used in European medical schools for centuries. His influential al-Tasrif introduced his famous collection of over 200 surgical instruments. Many of these instruments were never used before by any previous surgeons. Hamidan, for example, listed at least twenty six innovative surgical instruments that were not known before Abulcasis. The surgical instruments he invented include the first instruments unique to women,[37] as well as the surgical uses of catgut and forceps, the ligature, surgical needle, scalpel, curette, retractor, surgical spoon, sound, surgical hook, surgical rod, specula,[86] bone saw,[70] and plaster.[87] His work also included anatomical descriptions and sections on orthopaedic surgery and ophthalmology.[88] The influence of the Al-Tasrif eventually led to the decline of the barber surgeons who were prevalent before his time, and they were instead replaced by physician-surgeons in the Islamic world.
Ibn al-Haytham (Alhacen) made important advances in eye surgery, as he studied and correctly explained the process of sight and visual perception for the first time in his Book of Optics, published in 1021.[37] Avicenna was the first to describe the surgical procedure of intubation in order to facilitate breathing, and he also described the "soporific sponge", an anasthetic imbued with aromatics and narcotics, which was to be placed under a patient's nose during surgical operations. He also described the first known surgical treatment for cancer, stating that the excision should be radical and that all diseased tissue should be removed, including the use of amputation or the removal of veins running in the direction of the tumor.[71] Ammar ibn Ali al-Mawsili is also notable for inventing the injection syringe and hypodermic needle for the extraction of cataracts in the first successful cataract surgery.[89][90]
Ibn al-Nafis dedicated a volume of The Comprehensive Book on Medicine to surgery. He described three stages of a surgical operation. The first stage is the pre-operation period which he calls the "time of presentation" when the surgeon carries out a diagnosis on the affected area of the patient's body. The second stage is the actual operation which he calls the "time of operative treatment" when the surgeon repairs the affected organs of the patient. The third stage is the post-operation period which he calls the "time of preservation" when the patient needs to take care of himself and be taken care of by nurses and doctors until he recovers.[91] The Comprehensive Book on Medicine was also the earliest book dealing with the decubitus of a patient.[92]
Anesthesiology
General anesthesia and general anesthetics were pioneered by Muslim anesthesiologists, who were the first to utilize oral as well as inhalant anesthetics. In Islamic Spain, Abu al-Qasim and Ibn Zuhr, among other Muslim surgeons, performed hundreds of surgeries under inhalant anesthesia with the use of narcotic-soaked sponges which were placed over the face. Muslim physicians also introduced the anesthetic value of opium derivatives during the Middle Ages. Laudanum was also used as an anaesthetic.Ibn Sina (Avicenna) wrote about its medical uses in his works, which later influenced the works of Paracelsus. Sigrid Hunke wrote:[84][93]
"The science of medicine has gained a great and extremely important discovery and that is the use of general anaesthetics for surgical operations, and how unique, efficient, and merciful for those who tried it the Muslim anaesthetic was. It was quite different from the drinks the Indians, Romans and Greeks were forcing their patients to have for relief of pain. There had been some allegations to credit this discovery to an Italian or to an Alexandrian, but the truth is and history proves that, the art of using the anaesthetic sponge is a pure Muslim technique, which was not known before. The sponge used to be dipped and left in a mixture prepared from cannabis, opium, hyoscyamus and a plant called Zoan."
Cataract surgery
- See Ophthalmology
Dental surgery
- See Dentistry
Experimental surgery
Ibn Zuhr (Avenzoar) is considered the father of experimental surgery,[47] for introducing the experimental method into surgery in his Al-Taisir.[46] He was the first to employ animal testing in order to experiment with surgical procedures before applying them to human patients.[46] He also performed the first dissections and postmortem autopsies on humans as well as animals.[45]
Eye surgery
Neurosurgery
Tracheotomy
The surgical procedure of tracheotomy was invented by Ibn Zuhr (Avenzoar) in the 12th century.[94]
Surgical instruments
Adhesive bandage and Plaster
Abu al-Qasim al-Zahrawi (Abulcasis), in his Al-Tasrif (1000), invented the modern plaster and adhesive bandage, which are still used in hospitals throughout the world.[87] The use of plasters for fractures became a standard practice for Arab physicians, though this practice was not widely adopted in Europe until the 19th century.[71]
Catgut and Forceps
Abu al-Qasim's use of catgut for internal stitching is still practised in modern surgery. The catgut appears to be the only natural substance capable of dissolving and is acceptable by the body.
Abu al-Qasim also invented the forceps for extracting a dead fetus, as illustrated in the Al-Tasrif.[95]
Cauter and Ligature
A special medical instrument called a cauter, used for the cauterization of arteries, was first described by Abu al-Qasim in his Kitab al-Tasrif.[96]
In the Al-Tasrif, Abu al-Qasim also introduced the use of ligature for the arteries in lieu of cauterization.[97]
Cotton dressing and Surgical needle
Al-Zahrawi was the first surgeon to make use of cotton (which itself is derived from the Arabic word qutn) as a medical dressing for controlling hemorrhage.[71]
The surgical needle was invented and described by Abu al-Qasim in his Al-Tasrif.[94]
Injection syringe and hypodermic needle
The Iraqi surgeon Ammar ibn Ali al-Mawsili invented the first hollow hypodermic needle and injection syringe in circa 1000 using a hollow glass tube and suction to extract and remove cataracts from a patient's eye during a cataract surgery.[98]
Other instruments
Other surgical instruments invented by Abu al-Qasim and first described in his Al-Tasrif (1000) include the scalpel, curette, retractor, surgical spoon, sound, surgical hook, surgical rod, and specula,[86] as well as the bone saw.[70]
Therapy
Aromatherapy
Steam distillation was invented by Avicenna in the early 11th century for the purpose of producing essential oils, giving rise to aromatherapy. As a result, he is regarded as a pioneer of aromatherapy.[99]
Cancer therapy
In cancer therapy, Avicenna described the first known treatments for cancer in The Canon of Medicine; one was a surgical method involving amputation or removal of veins,[71] and the other was a herbal compound drug named "Hindiba", which Ibn al-Baitar later identified as having "anticancer" properties and which could also treat other tumors and neoplastic disorders.[100] After recognizing its usefulness in treating neoplastic disorders, Hindiba was patented in 1997 by Nil Sari, Hanzade Dogan, and John K. Snyder.[101]
Avicenna's Canon also described the first known surgical treatment for cancer, stating that the excision should be radical and that all diseased tissue should be removed, including the use of amputation or the removal of veins running in the direction of the tumor.[71]
Chemotherapy
Chemotherapy was pioneered by al-Razi (Rhazes) in the 10th century, when he introduced the use of chemical substances and drugs as forms of medication. These chemicals included vitriol, copper, mercuric and arsenic salts, sal ammoniac, gold scoria, chalk, clay, coral, pearl, tar, bitumen and alcohol.[102]
Chromotherapy
Avicenna, who viewed colour to be of vital importance in diagnosis and treatment, made significant contributions to chromotherapy in The Canon of Medicine. He wrote that "Color is an observable symptom of disease" and also developed a chart that related colour to the temperature and physical condition of the body. He further discussed the properties of colours for healing and was "the first to establish that the wrong colour suggested for therapy would elicit no response in specific diseases." As an example, "he observed that a person with a nosebleed should not gaze at things of a brilliant red color and should not be exposed to red light because this would stimulate the sanguineous humor, whereas blue would soothe it and reduce blood flow."[103]
Hirudotherapy
Hirudotherapy, the use of medicinal leech for medical purposes, was introduced by Avicenna in The Canon of Medicine (1020s). He considered the application of leech to be more useful than cupping in "letting off the blood from deeper parts of the body." He also introduced the use of leech as treatment for skin disease. Leech therapy became a popular method in medieval Europe due to the influence of his Canon. A more modern use for medicinal leech was introduced by Abd-el-latif in the 12th century, who wrote that leech could be used for cleaning the tissues after surgical operations. He did, however, understand that there is a risk over using leech, and advised patients that leech need to be cleaned before being used and that the dirt or dust "clinging to a leech should be wiped off" before application. He further writes that after the leech has sucked out the blood, salt should be "sprinkled on the affected part of the human body."[104]
Pharmacotherapy
Physiotherapy
Muslim physicians developed a method of therapy that began with diet and physiotherapy; if this didn't work for the patient, then prescriptions for drugs and medication were given; and if this didn't work, then they resorted to surgery. The physiotherapy prescribed by Muslim physicians usually included physical exercise and bathing. Muslim Arab physicians developed an elaborate system of dieting, in which there was an awareness of food deficiencies, and proper nutrition was an important item of treatment. Medical drugs were divided into two groups: simple and compound drugs. As they were aware of the interaction between drugs, they used simple drugs first; if these failed, then compound drugs were used which are made from two or more compounds; and if these conservative methods failed, then surgery was undertaken as a last resort.[75]
Psychotherapy
Phytotherapy
In phytotherapy, Avicenna introduced the medicinal use of Taxus baccata L. in The Canon of Medicine. He named this herbal drug as "Zarnab" and used it as a cardiac remedy. This was the first known use of a calcium channel blocker drug, which were not used in the Western world until the 1960s.[105]
Urology
Muslim physicians from the Islamic world made many advances in the field of urology. Muhammad ibn Zakarīya Rāzi introduced the methods of urinalysis and stool testing,[43] while other physicians dealt with the medical management and treatment of kidney stones, inflammations, infections, and sexual dysfunction. They pioneered advanced surgical approaches to the treatment of bladder stones as well as penile and scrotal problems, using techniques that are still used by modern physicians. They were also the first to produce tested drugs for the treatment of many urological disorders.[106]
Lithotomy
In lithotomy, Abulcasis performed the first successful extraction of bladder and kidney stones from the urinary bladder using a new instrument he invented—a lithotomy scalpel with two sharp cutting edges—and a new technique he invented—perineal cystolithotomy—which allowed him to crush a large stone inside the bladder before its removal, significantly decreasing the death rates previously caused by earlier attempts at this operation by the ancients.[107]
Sexual health
In sexual health, Muslim physicians and pharmacists identified the issues of sexual dysfunction and erectile dysfunction. They developed several methods of therapy for this issue, including the single drug method where a drug is prescribed, and a "combination method of either a drug or food." These drugs were also occasionally used for recreational drug use to improve male sexuality in general by those who did not suffer from sexual dysfunctions. Most of these drugs were oral medication, though a few patients were also treated through topical and transurethral means. Sexual dysfunctions were being treated with tested drugs in the Islamic world since the 9th century until the 16th century by a number of Muslim physicians and pharmacists, including al-Razi, Thabit bin Qurra, Ibn Al-Jazzar, Avicenna (The Canon of Medicine), Averroes, Ibn al-Baitar, and Ibn al-Nafis (The Comprehensive Book on Medicine).[108]
Other medieval contributions
Other medical contributions first introduced by Muslim physicians include the discovery of the immune system, the introduction of microbiology, the use of animal testing, and the combination of medicine with other sciences (including agriculture, botany, chemistry, and pharmacology),[37] as well as the first drugstores in Baghdad (754), the distinction between medicine and pharmacy in the 12th century, and the discovery of at least 2,000 medicinal substances.[80] Other medical advances came in the fields of pharmacology and pharmacy,[61] and in the following fields of the biomedical sciences:
Botany and environmental science
Muslims developed a scientific approach to botany and agriculture based on three major elements; sophisticated systems of crop rotation, highly developed irrigation techniques, and the introduction of a large variety of crops which were studied and catalogued according to the season, type of land and amount of water they require. Numerous encyclopaedias on botany were produced, with highly accurate precision and details.[109] Al-Dinawari (828-896) is considered the founder of Arabic botany for his Book of Plants, in which he described at least 637 plants and discussed plant evolution from its birth to its death, describing the phases of plant growth and the production of flowers and fruit.[110]
In the early 13th century, the Andalusian-Arabian biologist Abu al-Abbas al-Nabati developed an early scientific method for botany, introducing empirical and experimental techniques in the testing, description and identification of numerous materia medica, and separating unverified reports from those supported by actual tests and observations.[111] His student Ibn al-Baitar published the Kitab al-Jami fi al-Adwiya al-Mufrada, which is considered one of the greatest botanical compilations in history, and was a botanical authority for centuries. It contains details on at least 1,400 different plants, foods, and drugs, 300 of which were his own original discoveries. The Kitab al-Jami fi al-Adwiya al-Mufrada was also influential in Europe after it was translated into Latin in 1758.[112][113]
The earliest known treatises dealing with environmentalism and environmental science, especially pollution, were Arabic treatises written by al-Kindi, Qusta ibn Luqa, al-Razi, Ibn Al-Jazzar, al-Tamimi, al-Masihi, Avicenna, Ali ibn Ridwan, Ibn Jumay, Isaac Israeli ben Solomon, Abd-el-latif, Ibn al-Quff, and Ibn al-Nafis. Their works covered a number of subjects related to pollution such as air pollution, water pollution, soil contamination, municipal solid waste mishandling, and environmental impact assessments of certain localities.[114] Cordoba, al-Andalus also had the first waste containers and waste disposal facilities for litter collection.[115]
Child development and pediatrics
Ali ibn Sahl Rabban al-Tabari was a pioneer of pediatrics and the field of child development, which he discussed in his Firdous al-Hikmah.[23]
His student Muhammad ibn Zakarīya Rāzi (Rhazes) is considered the father of pediatrics for writing The Diseases of Children, the first book to deal with pediatrics as an independent field of medicine.[29]
Endocrinology
In endocrinology, Avicenna (980-1037) provided a detailed account on diabetes mellitus in The Canon of Medicine, "describing the abnormal appetite and the collapse of sexual functions and he documented the sweet taste of diabetic urine." Like Aretaeus of Cappadocia before him, Avicenna recognized a primary and secondary diabetes. He also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. Avicenna also "described diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank (1745-1821) who first differentiated between diabetes mellitus and diabetes insipidus.[116]
In the 12th century, Zayn al-Din al-Jurjani provided the first description of Graves' disease after noting the association of goitre and exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time.[117][118] Al-Jurjani also established an association between goitre and palpitation.[119]
] Gerontology and geriatrics
Avicenna's The Canon of Medicine was the first book to offer instruction for the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna wrote that "old folk need plenty of sleep. Time spent on the couch should be liberal—more than is legitimate for adults." He wrote that after waking up, the body should be anointed with oil "to stimulate the sensitive faculties". Regarding exercise, he recommended walking or horse-riding. He stated:[120]
"The factors to consider in regard to exercise in old people are the various bodily states of different persons; the sequels likely to arise from their ailments; and their previous habits as regards exercise."
He said that if the body is healthy, it can perform attempered exercises, but if one part of the body is infirm, "then that part should not be exercised until after the rest", and that exercises are not to be strictly graduated "as if the body were to be strengthened". The Canon recognized four periods of life: the period of growth, prime of life, period of elderly decline (from forty to sixty), and decrepit age. He states that during the last period, "there is hardness of their bones, roughness of the skin, and the long time since they produced semen, blood and vaporal breath". However, he agreed with Galen that the earth element is more prominent in the aged and decrepit than in other periods. Avicenna did not agree with the concept of infirmity, however, stating:[120]
"There is no need to assert that there are three states of the human body—sickness, health and a state which is neither health nor disease. The first two cover everything."
Thesis III of the Canon discussed the diet suitable for old people. Avicenna wrote that they should be given food in small amounts at a time and that they can have two to three meals a day, divided up according to the digestive powers and general condition of the old person in question. He also recommended fruits, such as figs and prunes. He also stated:[121]
"Some laudable nutrition may be allowed at bedtime, [but] robust old folk may have a more liberal supper, as long as they avoid any gross aliment... all hot, sharp or dessicative foods, such as dishes made with vinegar, salt, hot aromatics, seasonings and pickles. [Milk is good for the aged, being] nutritious and humectant in nature. [Yet] articles of food with a laxative action are most appropriate for the elderly."
The famous Arabic physician Ibn Al-Jazzar Al-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh[122] or Teb al-Mashaikh wa hefz sehatahom.[123] He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory, entitled Kitab al-Nissian wa Toroq Taqwiati Adhakira,[124][125][126] and a treatise on causes of mortality entitled Rissala Fi Asbab al-Wafah.[122] Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness (Risalah al-Shafiyah fi adwiyat al-nisyan).[127]
Ophthalmology
Of all the branches of Islamic medicine, ophthalmology was one of the foremost. The specialized instruments used in their operations ran into scores. Innovations such as the “injection syringe”, invented by the Iraqi physician Ammar ibn Ali of Mosul, which was used for the extraction by suction of soft cataracts, were quite common. In cataract surgery, Ammar ibn Ali attempted the earliest extraction of cataracts using suction. He introduced a hollow metallic syringe hypodermic needle through the sclerotic and successfully extracted the cataracts through suction.[89][90]
Ibn al-Haytham (Alhacen) made important contributions to ophthalmology and eye surgery, as he studied and correctly explained the process of sight and visual perception for the first time in his Book of Optics, published in 1021.[37] He was also the first to hint at the retina being involved in the process of image formation.[128]
Ibn al-Nafis, in The Polished Book on Experimental Ophthalmology, discovered that the muscle behind the eyeball does not support the ophthalmic nerve, that they do not get in contact with it, and that the optic nerves transect but do not get in touch with each other. He also discovered many new treatments for glaucoma and the weakness of vision in one eye when the other eye is affected by disease.[129]
Psychiatry and psychology
The first psychiatric hospitals and insane asylums were built in the Islamic world as early as the 8th century. The first psychiatric hospitals were built by Arab Muslims in Baghdad in 705, Fes in the early 8th century, and Cairo in 800. Other famous psychiatric hospitals were built in Damascus and Aleppo in 1270.[130] Unlike medieval Christian physicians who relied on demonological explanations for mental illness, medieval Muslim physicians relied mostly on clinical psychiatry and clinical observations on mentally ill patients. They made significant advances to psychiatry and were the first to provide psychotherapy and moral treatment for mentally ill patients, in addition to other new forms of treatment such as baths, drug medication, music therapy and occupational therapy.[89]
The concepts of mental health and "mental hygiene" were introduced by the Muslim physician Ahmed ibn Sahl al-Balkhi (850-934). In his Masalih al-Abdan wa al-Anfus (Sustenance for Body and Soul), he was the first to successfully discuss diseases related to both the body and the mind, and argued that "if the nafs [psyche] gets sick, the body may also find no joy in life and may eventually develop a physical illness."[131] Al-Balkhi was also a pioneer of psychotherapy, psychophysiology and psychosomatic medicine. He recognized that the body and the soul can be healthy or sick, or "balanced or imbalanced", and that mental illness can have both psychological and/or physiological causes. He wrote that imbalance of the body can result in fever, headaches and other physical illnesses, while imbalance of the soul can result in anger, anxiety, sadness and other mental symptoms. He recognized two types of depression: one caused by known reasons such as loss or failure, which can be treated psychologically; and the other caused by unknown reasons possibly caused by physiological reasons, which can be treated through physical medicine.[131]
Najab ud-din Muhammad (10th century) described a number of mental diseases in detail. He made many careful observations of mentally ill patients and compiled them in a book which "made up the most complete classification of mental diseases theretofore known." The mental illnesses first described by Najab include agitated depression, neurosis, priapism and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).[89] Symptoms resembling schizophrenia were also reported in later Arabic medical literature.[132]
Muhammad ibn Zakarīya Rāzi (Rhazes) and al-Balkhi were the first known physicians to study psychotherapy. Razi in particular made significant advances in psychiatry in his landmark texts El-Mansuri and Al-Hawi in the 10th century, which presented definitions, symptoms and treatments for problems related to mental health and mental illness. He also ran the psychiatric ward of a Baghdad hospital. Such institutions could not exist in Europe at the time because of fear of demonic possessions.[89]
In al-Andalus, Abu al-Qasim (Abulcasis), the father of modern surgery, developed material and technical designs which are still used in neurosurgery. Ibn Zuhr (Avenzoar) gave the first accurate descriptions on neurological disorders, including meningitis, intracranial thrombophlebitis, and mediastinal germ cell tumors, and made contributions to modern neuropharmacology. Averroes suggested the existence of Parkinson's disease and attributed photoreceptor properties to the retina. Maimonides wrote about neuropsychiatric disorders and described rabies and belladonna intoxication.[25]
Ibn al-Haytham is considered by some to be the founder of experimental psychology and psychophysics,[133] for his pioneering work on the psychology of visual perception in the Book of Optics.[134] In Book III of the Book of Optics, Ibn al-Haytham was the first scientist to argue that vision occurs in the brain, rather than the eyes. He pointed out that personal experience has an effect on what people see and how they see, and that vision and perception are subjective.[134] Along with al-Kindi and Ibn al-Haytham, al-Biruni was also a pioneer of experimental psychology, as he was the first to empirically describe the concept of reaction time.[135]
Avicenna was a pioneer of psychophysiology and psychosomatic medicine. He recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as an anticipation of the word association test attributed to Carl Jung.[89] Avicenna was also a pioneer of neuropsychiatry. He first described numerous neuropsychiatric conditions, including hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.[136]
Rheumatology
In rheumatology, Muhammad ibn Zakarīya Rāzi reported a psychotherapeutic case study from a contemporary 10th century Muslim physician who treated a woman suffering from severe cramps in her joints which made her unable to rise. The physician cured who by lifting her skirt, putting her to shame. He wrote: "A flush of heat was produced within her which dissolved the rheumatic humour."[89]
Zoology
- Further information: Early Islamic philosophy: Evolution
In the zoology field of biology, Muslim biologists developed theories on evolution and natural selection which were widely taught in medieval Islamic schools. John William Draper, a contemporary of Charles Darwin, considered the "Mohammedan theory of evolution" to be developed "much farther than we are disposed to do, extending them even to inorganic or mineral things." According to al-Khazini, ideas on evolution were widespread among "common people" in the Islamic world by the 12th century.[137]
The first Muslim biologist to develop a theory on evolution was al-Jahiz (781-869). He wrote on the effects of the environment on the likelihood of an animal to survive, and he first described the struggle for existence and an early form of natural selection.[138][139] Al-Jahiz was also the first to discuss food chains,[140] and was also an early adherent of environmental determinism, arguing that the environment can determine the physical characteristics of the inhabitants of a certain community and that the origins of different human skin colors is the result of the environment.[141]
Ibn al-Haytham wrote a book in which he argued for evolutionism (although not natural selection), and numerous other Islamic scholars and scientists, such as Ibn Miskawayh, the Brethren of Purity, al-Khazini, Abū Rayhān al-Bīrūnī, Nasir al-Din Tusi, and Ibn Khaldun, discussed and developed these ideas. Translated into Latin, these works began to appear in the West after the Renaissance and appear to have had an impact on Western science.
Ibn Miskawayh's al-Fawz al-Asghar and the Brethren of Purity's Encyclopedia of the Brethren of Purity (The Epistles of Ikhwan al-Safa) expressed evolutionary ideas on how species evolved from matter, into vapor, and then water, then minerals, then plants, then animals, then apes, and then humans.[142]
Modern contributions
After the 15th century, there were very few medical contributions from Muslim scientists until the 20th and 21st centuries, when Pakistani, Turkish, Iranian, Saudi Arabian, Yemeni, Malaysian and American Muslim scientists made significant contributions to modern medicine and biomedical research.
Pharmacology and natural products chemistry
In the 20th century, Salimuzzaman Siddiqui was a leading Pakistani scientist in natural products chemistry. He is the pioneer in extracting chemical compounds from the Neem and Rauwolfia, and is also known for isolating novel chemical compunds from various other flora in the Indian subcontinent. As the director of H.E.J. Research Institute of Chemistry, he carried out extensive research with a team of scientists on pharmacology of various plants to extract a number of chemical substances of medicinal importance.[143]
Dermatology and neurology
Behçet's disease is named after Hulusi Behçet (1889-1948), the Turkish dermatologist and scientist who first recognized the syndrome in one of his patients in 1924 and reported his research on the disease in Journal of Skin and Venereal Diseases in 1936.[144][145]
In 1991, Saudi medical researchers discovered "neuro-Behcet's disease",[146] a neurological involvement in Behcet's disease, considered one of the most devastating manifestations of the disease as described by Egyptian Scientist Sahar Saleem.[147] In 1989, Saudi neurologists also discovered "neurobrucellosis", a neurological involvement in brucellosis.[146]
Diabetes and hematology
Iranian scientist Samuel Rahbar was a pioneer in hematology and the understanding of diabetes. In 1969, he discovered glycosylated hemoglobin (HbA1C), a form of hemoglobin used primarily to identify plasma glucose concentration over time. He was also the first to describe its increase in diabetes.[148]
Medical technology
Iranian physician and engineer Toffy Musivand invented a variety of medical technology, including the artificial cardiac pump as treatment for heart failure, "remote power transfer for implantable medical devices, remote patient monitoring (telemedicine), biofluid dynamics to reduce/eliminate thrombosis in blood conducting devices, patient care simulation centre, detection devices and methods for detection, in situ sterilization, medical devices (failure analysis and regulatory process), and medical sensors."[149]
Internal medicine, pathology, rheumatology
Dr. Muhammad B. Yunus is a Muslim American physician who practices internal medicine and rheumatology.[150] In 1981, he published the "first controlled study of the clinical characteristics" of the fibromyalgia syndrome, for which he is regarded as "the father of our modern view of fibromyalgia."[151] His work was the "first controlled clinical study" of fibromyalgia "with validation of known symptoms and tender points" and he also proposed "the first data-based criteria." In 1984, he proposed the important concept that the fibromyalgia syndrome and other similar conditions are interconnected. He showed serotonergic and norepinephric drugs to be effective in 1986, published criteria for fibromyalgia in 1990, and developed neurohormonal mechanisms with central sensitization in the 1990s.[152]
He also made important advances in the understanding of the chronic fatigue syndromes in general, the biopsychosocial model, medical sociology, neurology, psychosocial development, and neurochemical pathology.[153] His "biopsychosocial perspective" of fibromyalgia and other chronic fatigue syndromes is the "only way to synthesize the disparate contributions of such variables as genes and adverse childhood experiences, life stress and distress, posttraumatic stress disorder, mood disorders, self-efficacy for pain control, catastrophizing, coping style, and social support into the evolving picture of central nervous system dysfunction vis-a-vis chronic pain and fatigue."[151]
Biomedical research in space
In 2007, Malaysian scientist Sheikh Muszaphar Shukor, who is both an astronaut and orthopedic surgeon, became the first to perform biomedical research in outer space. His medical experiments on board the International Space Station were related to the characteristics and growth of liver cancer and leukemia cells, and the crystallisation of various proteins and microbes in space.[154] His experiments relating to liver cancer, leukemia cells and microbes will benefit general science and medical research, while his experiments relating to the crystallisation of proteins, lipases in this case, will directly benefit local Malaysian industries.[155]
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