Old-Time Makers of Medicine — Ch. 5 Great Arabian Physicians, part 1/2

GREAT ARABIAN PHYSICIANS

In order to understand the place of the Arabs in medicine and in science, a few words as to the rise of this people to political power, and then to the cultivation of literature and of science, are necessary.

We hear of the Arabs as hireling soldiers fighting for others during the centuries just after Christ, and especially in connection with the story of the famous Queen Zenobia at Palmyra.

After the destruction of this city we hear nothing more of them until the time of Mohammed.

During these six and a half centuries there is little question of education of any kind among them except that at the end of the sixth century, the Persian King Chosroes I, who was much interested in medicine, encouraged the medical school in Djondisabour, in Arabistan, founded at the end of the fifth century by the Nestorian Christians, who continued as the teachers there until it became one of the most important schools of the East.

It was here that the first Arab physicians were trained, and here that the Christian physicians who practised medicine among the Arabs were educated.

Among the Arabs themselves, before the time of Mohammed, there had been very little interest in medicine.

Gurlt notes that even the physician of the Prophet himself was, according to tradition, a Christian.

Mohammed's immediate successors were not interested in education, and their people mainly turned to Christian and Jewish physicians for whatever medical treatment they needed.

When the Caliphs came to be rulers of the Mohammedan Empire, they took special pains to encourage the study of philosophy and medicine; though dissection was forbidden by the Koran, most of the other medical sciences, and especially botany and all the therapeutic arts, were seriously cultivated.

Until the coming of Mohammed, the Arabs had been wandering tribes, getting some fame as hireling soldiers, but now, under the influence of a feeling of community in religion, and led by the military genius of some of Mohammed's successors, whose soldiers were inspired by the religious feelings of the sect, they made great conquests.

The Mohammedan Empire extended from India to Spain within a century after Mohammed's death.

Carthage was taken and destroyed, Constantinople was threatened.

In 661, scarcely forty years after the _hegira_ or flight of Mohammed, from which good Mohammedans date their era, the capital was transferred from Medina to Damascus, to be transferred from here to Bagdad just about a century later, where it remained until the Mongols made an end of the Abbasside rulers about the middle of the thirteenth century.

At the beginning the followers of Mohammed were opposed to knowledge and education of all kinds.

Mohammed himself had but little.

According to tradition, he could not read or write.

The story told with regard to the Caliph Omar and the great library of Alexandria, seems to have a foundation in reality, though such legends usually are not to be taken literally.

Certainly it represents the traditional view as to the attitude of the earlier Moslem rulers to education.

Omar was asked what should be done with the more than two million volumes.

He said that the books in it either agreed with the Koran, or they did not.

If they agreed with it they were quite useless.

If they did not, they were pernicious.

In either case, they should be done away with, because there was an element of danger in them.

Accordingly, the precious volumes that had been accumulating for nearly ten centuries, served, it is said, to heat the baths of Alexandria for some six months--probably the most precious fuel ever used.

Fortunately for posterity, the edict was not quite as universal in its application as the story would indicate, and exceptions were made for books of science.

In the course of their conquests, however, the Mohammedan Arabs captured the Greek cities of Asia Minor.

They were brought closely in contact with Greek culture, Greek literature, and Greek thought.

As has always been the case, captive Greece took its captors captive.

What happened to the Romans earlier came to pass also among the Arabs.

Inspired by Greek philosophy, science, and literature, they became ardent devotees of science and the arts.

While not inventing or discovering anything new, like the Romans they carried on the old.

Damascus, Basra, Bagdad, Bokhara, Samarcand all became centres of culture and of education.

Large sums were paid for Greek manuscripts, and for translations from them.

Under the famous Harun al-Raschid, at the end of the eighth century, whose name is better known to us than that of any others, because of the stories of his wandering by night among his people in order to see if justice were done, three hundred scholars were sent at the cost of the Caliph to the various parts of the world in order to bring back treasures of science, and especially of geography and medicine.

It is an interesting historical reflection that the Japanese and Chinese are doing the same thing now.

The Arabs were very much taken by the philosophy of Aristotle, and it became the foundation of all their education.

Greek thought, as always, inspired its students to higher things.

Soon everywhere in the dominions of the Caliphs, philosophy, science, art, literature, and education nourished.

Medicine was taken up with the other sciences and cultivated assiduously.

Freind, in his "Historia Medicinae," says that the writings of the old Greeks which treated of medicine were saved from destruction with the other books at Alexandria, for the desire of health did not have less strength among the Arabs than among other nations.

Since these books taught them how to preserve health, and were not otherwise contrary to the laws of the Prophet, that served to bring about their preservation.

Freind also calls attention to the fact that grammars and books which treated of the science of language were likewise saved from destruction.

Besides the library, the Arabs, after their conquest of Alexandria in the eighth century, came under the influence of the university still in existence there.

In the West, in Spain, the Arabs enjoyed the same advantages as regards contact with culture and education as their conquest of the Eastern cities and Alexandria brought them in the East.

While it is not generally realized, Spain was, as we have pointed out, the province of the Roman Empire in the West that advanced most in culture before the breaking up of the Empire.

The Silver Age of Latin literature owes all of its geniuses to Spain.

Lucan, the Senecas, Martial, Quintilian, are all Spaniards.

Spain itself was a most flourishing province, and under the Spanish Caesars, from the end of the first to about the end of the second century, increased rapidly in population.

Spain was the leader in these prosperous times, and the tradition of culture maintained itself.

When Spain became Christian the first great Christian poet, Prudentius, born about the middle of the fourth century, came from there.

He has been called the Horace and Virgil of the Christians.

The coming down of the barbarians from the North disturbed Spain's prosperity and the peace and culture of her inhabitants, but it should not be forgotten that the first medieval popularization of science, a sort of encyclopedia of knowledge, the first of its kind after that of Pliny in the classical period, came from St. Isidore of Seville, a Spanish bishop.

There has been considerable tendency to insist that Spanish culture and intellectuality owe nearly all to the presence of the Moors in Spain.

This can only be urged, however, by those who know nothing at all of the Spanish Caesars, the place of Spain in the history of the Roman Empire, and the continuance of the culture that then reached a climax of expression during succeeding centuries.

On the contrary, the Moors who came to Spain owe most of their tendency to devote themselves to culture and education to the state of affairs existent in Spain when they came.

There is no doubt that they raised standards of education and of culture above the level to which they had sunk under the weight of the invading barbarians from the North, and Spain owes much to the wise ruling and devotion to the intellectual life of her Moorish invaders.

All the factors, however, must be taken together in order to appreciate properly the conditions which developed under the Arabs in both the East and the West.

The Arabs invented little that was new in science or philosophy;

they merely carried on older traditions.

It is for that that the modern time owes them a great debt of gratitude.

RHAZES

The most distinguished of the Arabian physicians was the man whose rather lengthy Arabian name, beginning with Abu Bekr Mohammed, finished with el-Razi, and who has hence been usually referred to in the history of medicine as Rhazes.

He was born about 850 at Raj, in the Province of Chorasan in Persia.

He seems to have had a liberal early education in philosophy and in philology and literature.

He did not take up medicine until later in life, and, according to tradition, supported himself as a singer until he was thirty years of age.

Then he devoted himself to medical studies with the ardor and the success so often noted in those whose opportunity to study medicine has been delayed.

His studies were made at Bagdad, where Ibn Zein el-Taberi was his teacher.

He returned to his native town and was for some time the head of the hospital there.

Later he was called by the Sultan to Bagdad to take charge of the renovated and enlarged hospital of the capital.

His medical career, then, is not unlike that of many another successful physician, especially of the modern time.

At Bagdad he had abundant opportunities for study, and the ambition to make medicine as well as to make money and gain fame.

His studies in science were all founded on Aristotle.

Though he was called the Galen of his time, and looked up to the Greek physician as his master, even the authority of Galen did not override that of the Stagirite in his estimation.

One of his aphorisms is said to have been, "If Galen and Aristotle are of one mind on a subject, then surely their opinion is true.

When they differ, however, it is extremely difficult for the scholar to decide which opinion should be accepted."

He drew many pupils to Bagdad, and, when one knows his teaching, this is not surprising.

Some of his aphorisms are very practical.

While the expressions just quoted with regard to Galen and Aristotle might seem to indicate that Rhazes was absolutely wedded to authority, there is another well-known maxim of his which shows how much he thought of the value of experience and observation.

"Truth in medicine," he said, "is a goal which cannot be absolutely reached, and the art of healing, as it is described in books, is far beneath the practical experience of a skilful, thoughtful physician."

Some of his other medical aphorisms are worth noting.

"At the beginning of a disease choose such remedies as will not lessen the patient's strength."

"When you can heal by diet, prescribe no other remedy, and, where simple remedies suffice, do not take complicated ones."

Rhazes knew well the value of the influence of mind over body even in serious organic disease, and even though death seemed impending.

One of his aphorisms is: "Physicians ought to console their patients even if the signs of impending death seem to be present.

For the bodies of men are dependent on their spirits."

He considered that the most valuable thing for the physician to do was to increase the patient's natural vitality.

Hence his advice: "In treating a patient, let your first thought be to strengthen his natural vitality.

If you strengthen that, you remove ever so many ills without more ado.

If you weaken it, however, by the remedies that you use you always work harm."

The simpler the means by which the patient's cure can be brought about, the better in his opinion.

He insists again and again on diet rather than artificial remedies.

"It is good for the physician that he should be able to cure disease by means of diet, if possible, rather than by means of medicine."

Another of his aphorisms seems worth while quoting: "The patient who consults a great many physicians is likely to have a very confused state of mind."

Some idea of Rhazes' strenuous activity as a writer on medical subjects may be obtained from the fact that thirty-six of his works are still extant, and there are nearly two hundred others of which only the titles have been preserved.

Some of these are doubtless the works of pupils and students of succeeding generations, published under his name to attract attention.

His principal work is "Continens," or "Comprehensor," which owes its title to the fact that it was meant to contain the whole practice of medicine and surgery.

It includes references to the writings of all previous distinguished medical writers, from Hippocrates to Honein Ben Ishac, also known as Johannitius, a Christian Arabian physician, one of Rhazes' teachers.

The most frequently quoted of these authorities are Galen, Oribasius, Aetius, and Paul of AEgina.

The work, however, is not made up entirely of quotations, but contains many observations made by the author himself.

Gurlt says that the foundation of the theoretic medicine of Rhazes is the system of Galen, while in practice he seems to cling more to the aphorisms of Hippocrates.

He has many practical points which show that he thought for himself.

For instance, in wounds of the abdomen, if the intestines are extruded and cannot be replaced, he suggests the suspension of the patient by his hands and feet in a bath in order to facilitate their return.

If they do not go back readily, compresses dipped in warm wine should be used.

Cancer he declares to be almost incurable.

He has much to say about the bites of animals and their tendency to be poisonous, knew rabies very well, and knew also that the bites of men might have similar serious consequences.

It is impossible to give any adequate idea of the thoroughly practical character of Rhazes' medical writing in a few lines, but it may suffice to say that there is scarcely any feature of modern medicine and surgery that he does not touch, and oftener than not his touch is sure and rational and frequently much better than the advice of successors long after him in the same matters.

An example or two will suffice to illustrate this.

In the treatment of nasal polyps he says that whenever drug treatment of these is not successful, they should be removed with a snare made of hair.

For fall of the uvula he suggests gargles, but when these fail he advises resection and cauterization.

Among the affections of the tongue he numbers abscess, fissure, ulcer, cancer, ranula, shortening of the ligaments, hypertrophy, erythema of the mucous membrane, and inflammatory swelling.

In general his treatment of the upper respiratory tract is much farther advanced than we might think possible at this time.

He advises tracheotomy whenever there is great difficulty of respiration, and describes how it should be done.

After the dyspnea has passed the edges of the wound should be brought together with sutures.

It is not surprising, then, to find that the treatment of fractures and luxations is eminently practical, and, indeed, on any subject that he touches he throws practical light.

In the introduction to his edition of the works of Ambroise Pare, Malgaigne says that the first reference to a metal band in connection with trusses is to be found in Rhazes.

Hernia was, of course, one of the serious ailments that, because of its superficial character, was rather well understood, and so it is not surprising to find that much of our modern treatment of it was anticipated.

The manipulations for taxis, the use of a warm bath for the relaxation of the patient by means of heat and by putting the head and feet higher than the abdomen while in the bath, and the employment of various kinds of trusses to prevent strangulation of the hernia recur over and over again, in the authors of the Middle Ages.

Many of the suggestions are to be found in the early Greek authors, but subsequent writers give a certain personal expression to them which shows how much they had learned by personal observation in the employment of various methods.

Pagel, in Puschmann's "Handbook of the History of Medicine," declares that Rhazes' most important work for pure medicine is his monograph on smallpox.

Its principal value is due to the fact that, though he has consulted old authorities carefully, his discussion of the disease is founded almost entirely on his own experience.

His description of the various stages of the disease, of the forms of the eruption, and of the differential diagnosis, is very accurate.

He compares the course of the fever with that of other fevers, and brings out exactly what constitutes the disease.

His suggestions as to prognosis are excellent.

Those cases, he declares, are particularly serious in which the eruption takes on a dark, or greenish, or violet color.

The prognosis is also unfavorable for those cases which, having considerable fever, have only a slight amount of rash.

His treatment of the disease in young persons was by venesection and cool douches.

Cold water and acid drinks should be administered freely, so that sweat and other excretions may carry off poisonous materials.

Care must be taken to watch the pulse, the breathing, the appearance of the feet, the evacuations from the bowels, and to modify therapy in accordance with these indications.

The eruption is to be encouraged by external warmth and special care must be taken with regard to complications in the eyes, the ears, the nose, the mouth, and the pharynx.

A fact that will, perhaps, give the best idea to modern readers of the place of Rhazes in the history of medicine is that Vesalius considered it worth his while to make a translation of his principal work.

Unfortunately that translation has not come down to us.

When Vesalius, pestered by the controversies that had come upon him because of his venturing to make his observations for himself, accepted the post of physician to the Emperor Charles V, he burnt a number of his manuscripts.

Among these were his translation of Rhazes and some annotations on Galen, which, as he says himself, had grown into a huge volume.

The Galenists were bitterly decrying his refusal to accept Galen on many points, and both of these works would have added fuel to the flame of controversy.

He deemed it wiser, then, not to give any further opportunities for rancorous criticism, and, feeling presumably that in his new and important post it was not worth while to bother further over the matter, he burnt them.

He tells the reason in his letters to Joachin Roelant: "When I was about to leave Italy to go to Court, since a number of the physicians whom you know had made the worst kind of censure of my books, both to the Emperor himself, and to other rulers, I burned all the manuscripts that were left, although I had never suffered a moment under the displeasure of the Emperor because of these complaints, and in spite of the fact that a number of friends who were present urged me not to destroy them."

Vesalius' translation of Rhazes was probably undertaken because he recognized in him a kindred spirit of original investigation and inquiry, whose work, because it was many centuries old, would command the weight of an authority and at the same time help in the controversy over Galenic questions.

This, of itself, would be quite enough to make the reputation of Rhazes, even if we did not know from the writings themselves and from the admiration of many distinguished men as well as the incentive that his works have so often proved to original observation, that he is an important link in the chain of observers in medicine, who, though we would naturally expect them to be so frequent, are really so rare.