Science and Islam_A History_Icon Science

by Ehsan Masood

  Yet there is no doubt that these ghastly events had a deep and lasting effect on Muslim consciousness. The success of Islam and the towering intellectual achievements of the early years had seemed to confirm that God was on the side of Muslims. It was this self-belief – this conviction that the world was theirs to explore, to know – that enabled Islamic-era scientists to accomplish so much. The trauma of the destruction of Baghdad and so much else undermined that self-belief. And although there were still many individual scientific triumphs to come, many more important accomplishments in the field of knowledge, there was perhaps never the same drive and energy coming from every level of society, from the caliph down, that there had been in the first seven centuries of Islam.

  Footnote

  1 Nizam al-Mulk (1018–92) is one of the most fascinating figures in medieval Islam. He was the advisor for the first two Seljuk sultans and acquired a reputation as an effective administrator of a huge empire to match the Barmakids – wise, prudent, resourceful and successful, and a devout Muslim. But he also created a legacy of efficient civil service which was to become a hallmark of later Turkish Islamic governments. He wrote down many of his ideas on how things should be run in a famous book called Seyasat-nameh (The Book of Government; or Rules for Kings). More importantly, he founded the Nizamiyah system of colleges.

  Part II

  Branches of Learning

  8

  The Best Gift From God

  The best gift from God is good health. Everyone should reach that goal by preserving it for now and in the future.

  Saying of the Prophet Muhammad on health

  In few areas did science, community benefit and religious duty come so closely and productively together in early Islam as they did in medicine.

  The Prophet Muhammad frequently emphasised the importance of good health and healthy eating. He also encouraged people to seek medical treatment, and is reported to have said: ‘Make use of medical treatment, for God has not made a disease without appointing a remedy for it, with the exception of one disease – old age.’ And by his emphasis on charitable works, one of Islam’s foundational pillars, he encouraged doctors to provide care for the sick, and the wealthy to pay for it.

  There were practical reasons for promoting medical science, too, of course, in the new empire. Battle wounds were all too common, for example, as were diseases of the digestive system and infections – transmitted, much as happens today, by the movement of people across borders, and into the new Islamic cities such as Baghdad. Yet empires had needed medical science before and had not provided it. What perhaps made Islam different at the time was the willingness of richer people to pay for healthcare, whether for religious, social or political reasons. Also important was the sense of religious duty that drew many people into the medical profession – as well as the excitement of the search for knowledge and the prospect of a lucrative career.

  Of course, there were many charlatan doctors and quacks, but there were also several dedicated physicians. Some were at the very cutting edge of research and practice. Others just did the best they could with the tools at their disposal. The combined result is that the peoples of the Islamic empires perhaps had medical care which was as good as, if not better than, that of any empire that had gone before.

  It would be inappropriate to compare the range and effectiveness of medical treatments in earlier times to what we have in the modern world. Nor did the Islamic world create the first hospitals. However, hospitals were advanced for their day, and doctors of the Islamic era often provided effective treatments. What is also clear is that the medicine that originated in Islamic times penetrated deep into Europe in the following centuries, perhaps more so than any other Islamic science. A whole range of books by physicians and surgeons such as Hunayn ibn-Ishaq, ibn-Sina and al-Zahrawi were in widespread use in the universities of Europe for many centuries. Their popularity only waned after the main basis of their theories, the idea of the four humours, was superseded by the germ theory of disease.

  The Greek legacy

  At the start of the Islamic era, various traditions of medicine were in use in addition to those of Arabia and, together, they served the growing cities of the empire. At Gundeshapur in Sassanian Persia, for instance, Persians and Nestorian Christian refugees from the Byzantine empire had founded a respected medical school. Some of these physicians moved to Damascus and Baghdad to establish elite medical dynasties there. But the biggest influence by far was Hellenistic – the medicine of the Greeks, which today is still practised in large parts of South Asia, and is known by the name Unani, which means ‘Greek’.

  Ancient Greek medical ideas became central to mainstream Islamic medicine, and when the translation movement got under way, there was a rush to translate as much of the work of the great Greek medical authorities as possible into Arabic.

  One of the prize Greek medical sources was De Materia Medica, written in the 1st century by a Greek surgeon serving in the Roman army called Dioscorides. Dioscorides’ book became the main source on drugs and on the herbs from which they could be extracted. But the most influential by far of the Greek physicians who worked for Rome was Galen, whose voluminous writings covered the entire field of medicine and provided a complete background in theory and practice for any physician.

  Born in Pergamon in Turkey, Galen went to Rome as a young man, where his skills as a physician soon found him in the service of the emperor, and where he gained a reputation that made him the greatest authority in Western medicine for nearly 1,300 years.

  As he was not allowed to dissect human bodies, Galen learned about anatomy from gladiators’ wounds and by dissecting apes, sheep, pigs, goats and even elephants. In this way, he learned about the nervous system, and invented a complete system of treatment that remained the standard until just a few centuries ago. Not overtaxed with modesty, he was aware of his huge influence, writing: ‘I have done as much for medicine as Trajan did for the Roman empire when he built roads and bridges. It is I, and I alone, who have revealed the true path of medicine. It must be admitted that Hippocrates already staked out this path … but I have made it passable.’

  Yet although Galen did study anatomy, the fact is that his anatomical knowledge came as much from animals as humans, and he did make basic errors. Such was his status, though, that a thousand years later many physicians – including those from the Islamic era – would insist that if Galen said it, it must be true, even if it contradicted the evidence of their own eyes.

  Updating Galen

  Not all of the Islamic medical scientists, though, were quite so reverential. When early-9th-century scholars like Hunayn ibn-Ishaq made the first translations of Galen into Arabic, these quickly became authoritative works on the subject. Yet despite Galen’s status, ibn-Ishaq’s readers began to wonder if Galen was always right about everything. Maybe even the great Greek medic had made mistakes.

  We have already seen how Hunayn made a number of important updates to Galen’s version of the anatomy of the eye. The first big challenge to Galen, however, came from a Persian medic called al-Razi (Rhazes in Latin) about half a century later.

  Al-Razi, by all accounts, was never one to do things the conventional way. Born in the city of Rayy in 865, he apparently started out as a lute player. Very soon, though, he took up alchemy until, according to some sources, an experiment that went wrong damaged his eyesight. The story continues that after going for medical treatment for his eyes, he decided to take up medicine himself. It may be that he thought he could do a better job than the doctors who were treating him. If so, he was proved right. After excelling in training in Baghdad, he returned to Rayy as director of the city’s hospital, where his lectures attracted many students and even patients. For a while, he was also director of the main hospital in Baghdad.

  Al-Razi’s dilemma

  Something of al-Razi’s character is revealed in the titles of books he wrote such as On The Fact That Even The Most Skillful of Physicians Cannot Heal All Diseases
and Why People Prefer Quacks and Charlatans to Skilled Physicians. Like most major scholars of the age, he was a polymath, writing books on a range of disciplines from astronomy to natural history, but it was his medical work that sealed his place in history.

  Al-Razi’s innovations are a roll-call of the breadth of medical practice. He identified and described smallpox and measles, and his book on these two diseases was influential up until the 19th century. He also wrote one of the most important and comprehensive books about clinical practice which was called, in typically straightforward fashion, al-Hawy, which means Comprehensive Book. It ran to 23 volumes and was an encyclopedia of Greek, Syriac, Persian, Indian and even Chinese medicine. And he discovered that fever is part of the body’s defences.

  Just as he had challenged his tutors as a student, al-Razi was also prepared to challenge the great Galen, writing, in his book Doubts about Galen, ‘It grieves me to oppose and criticise the man, Galen, from whose sea of knowledge I have drawn much indeed … Although this reverence and appreciation will and should not prevent me from doubting, as I did, what is erroneous in his theories.’

  Historians argue over whether al-Razi was criticising just details in Galen, or whether he was concerned about Galen’s entire system. At the heart of Galen’s system was the idea, dating back to the time of Hippocrates in the 4th century BC, that good health required a balance between four kinds of body fluid, called humours. The humours were blood, phlegm, yellow bile and black bile. Each corresponded to one of the four elements of which the Greeks believed that everything is made – air, water, fire and earth – and with one of four qualities: warm and moist, cold and moist, warm and dry, and cold and dry. They also corresponded to four natural temperaments that people could have: sanguine, phlegmatic, choleric and melancholic.

  The idea was that people fell ill when the four fluids somehow got out of balance. So the way to treat illnesses, logically enough, was to restore balance using a combination of diet and herbal drugs, as well as various invasive methods. For example, when someone went to the doctor complaining of fever or headache, if it was thought to be due to an excess of blood, then it was treated by letting some of the excess out of the body – simply by either cutting an artery and collecting the blood in a bowl, or pressing a small cup over a cut and letting the blood flow out into it. Bloodletting, or phlebotomy, remained a common treatment worldwide until the 1800s. Millions of patients through the ages, including George Washington, went through the ordeal of bleeding. Many actually died from loss of blood, but the treatment persisted. Bloodletting is still used by some cultures today.

  Galen on trial

  Al-Razi decided to conduct a trial to see if bloodletting worked as a treatment for meningitis. Two things are interesting about this trial. The first is the fact that he was not prepared just to accept Galen’s idea as it stood, but wanted to put it to a proper test. The second thing is the methodology he used, which gives us an insight into his thinking. In his hospital he let one group of meningitis patients go untreated; but he treated another group by bloodletting in the normal way. Interestingly, the results of the trial supported Galen’s view that bloodletting was an effective treatment – although few would accept that particular finding today.

  In Doubts about Galen, al-Razi also seems to question the theory behind Galen’s basic system. He asks if it is really true that giving a patient a hot drink would raise their body temperature even higher than that of the drink, as the theory of humours would seem to imply. It takes only a simple test, of course, to show that this is not true. If it is not, al-Razi suggests, there must be other control mechanisms in the body that the humours do not explain, but it is unclear how far he went with such ideas.

  No-one really followed up al-Razi’s doubts about the entire system of humours, though, and it was another thousand years before it was seriously challenged. However, in the South Asian Unani school of herbal medicine, it is still used as a basis of medical treatment by a majority of people in countries such as Bangladesh, India and Pakistan. This is partly because modern healthcare is still unaffordable in these regions.

  Ibn-Sina

  Nevertheless, a few Islamic physicians gradually began to chip away at the edifice of Greek medicine, even as many more used it with dedication and, as Peter Pormann of Warwick University suggests, with some success. However, life for physicians was never quite so encouraging or so supportive as it had been in the early centuries of the Abbasid caliphates. By the time the next great figure in Islamic medicine, ibn-Sina (Avicenna), was born in 980, the empire was no longer under the control of a single caliph. The result was that ibn-Sina spent much of his colourful, varied life moving around trying to find a medical position that would pay him decently and give him the time to carry on with his other scholarly work.

  Born near Bukhara in present-day Uzbekistan, ibn-Sina was something of a prodigy. By the age of ten, he knew not just the Qur’an but much Arabic poetry by heart, and by the age of sixteen had become a physician. Ibn-Sina proved his competence early on when he successfully treated the Samanid ruler of the eastern Islamic caliphate for a potentially life-threatening diarrhoeal infection. As reward, he was given access to the royal library at Bukhara, and certainly took advantage of it. His skill as a physician became almost legendary, even though the turbulent politics of the time kept him permanently unsettled, either stuck as a teacher or obliged to put himself at the whims of some prince or caliph.

  Ibn-Sina managed to become one of the most famous philosophers, mathematicians and astronomers of his time, and wrote books on a range of scientific topics, a vast encyclopedia (one of the first ever written) and even poetry, including, perhaps, this verse in Omar Khayyam’s Rubaiyat which is attributed to him, with its clear astrological symbolism and reference to his life’s work:

  Up from Earth’s Centre through the Seventh Gate I rose

  And on the Throne of Saturn sate

  And many a knot unravelled by the Road

  But not the master-knot of Human Fate.

  The Canon of Medicine

  Ibn-Sina made a number of key astronomical observations, devised a scale to help make readings more precise, and made a string of contributions to physics, such as identifying different forms of energy – heat, light and mechanical – and the idea of force. He also noted that if light consists of a stream of particles, then its speed will be finite. The mathematical technique of ‘casting out of nines’, used to verify squares and cubes, is also attributed to ibn-Sina, among others. And he is believed to have suggested the fundamental geological idea of superposition – the concept that in rock layers, the youngest layers are highest – that would not be properly formulated until the 17th century.

  Yet his fame, above all, is based on his book al-Qann fi al-Tibb (The Canon of Medicine). Consisting of 1 million words, this multi-volume book surveyed medical knowledge from ancient times to the present day. Its comprehensive, systematic approach meant that it became the reference for Arabic- and Persian-speaking doctors, and once it was translated into Latin it became one of the standard textbooks in Europe for six centuries, with some 60 editions being published between 1500 and 1674, according to the historian Nancy Siraisi.

  Besides bringing together existing knowledge, the Canon contained many of ibn-Sina’s own insights. He recognised, for instance, that tuberculosis is contagious; that diseases can spread through soil and water; and that a person’s emotions can affect the state of their physical health. He also realised that nerves transmit pain and signals for muscle contraction. The Canon also contained a description of 760 drugs, and so became an important medical manual too.

  Unlike al-Razi, though, ibn-Sina does not seem to have questioned the basic idea of humours. Indeed, it is possible that the clarity and care that was displayed in his work helped the concept to survive for longer than it might otherwise have done. But what he did do was give medicine a stronger evidence base for learning and moving forward, which has been the hallmark of the best m
edical practice ever since. Moreover, his Canon clearly laid out principles and procedures for testing new drugs.

  There is no doubt that ibn-Sina was a proud, perhaps even arrogant and difficult man. Unfortunately, his absolute certainty that he was right (as he often was), along with his tendency to dismiss his critics as idiots, offended many, including his political patrons. This quality caused him to make some rather bold claims regarding the relationship of science to religion, and it meant that he would one day be charged with heresy.

  Nature’s laws

  Like the scientist that he was, ibn-Sina firmly believed that there are laws of nature which cannot be violated. He believed that all physical phenomena have a known cause – an idea which also characterised his approach to medicine. This meant that he found it hard to envisage supernatural events such as healing miracles and bodily resurrection. For the mass of believers, miracles are an example of an active God bending the rules in order to prove the truths of religion to sceptics. But ibn-Sina believed that this does not happen. Early Islam did not seem to need miracles, and it is debatable if the Prophet Muhammad performed them. But by the 11th century, miracles were firmly established in Islamic theology as a route to gaining converts and supporters.

  Ibn-Sina believed that there exists a single set of principles that can explain the nature of the physical universe, the reason for its creation, and the relationship between mind and body, and he made it his life’s work to find connections between these apparently different fields, and ultimately to discover a theory of everything. This was an ambitious scheme, but then ibn-Sina, according to Yahya Michot of the Hartford Seminary in Connecticut, was always supremely confident of his abilities, and believed that God had deliberately made him brighter than the average individual.