Abstract
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The
resurgence of Islamic Civilization in the Near East in the 7th century
AD and its expansion to Persian Empire and Westward provided opportunities of
access Persian, Hellenic, and Roman writings in philosophy and medicine.
Based on their observations and experiences, Islamic physician-philosophers
expanded upon those writings and at times challenged them. Among these
physician-philosophers admiring and challenging Galen was Zakariya Razi
described as the greatest physician of Islam and Medieval Ages.
A
search of electronic and written materials about early Islamic Medicine was
carried out focusing on Persian physician-philosophers Zakariya Razi.
Abu
Bakr Mohammad Ibn Zakariya al-Razi, known in the West as Rhazes, was born in
865 AD in the ancient city of Rey, Near Tehran. A musician during his youth
he became an alchemist. He discovered alcohol and sulfuric acid. He
classified substances as plants, organic, and inorganic. At age 30, he
undertook the study of medicine. He was a prolific writer with more than 184
texts in medicine attributed to him with 40 of them currently available.
Among them are Kitab al-Mansoori, Kitab al-Hawi, and Kitab al -Judari wa
al-Hasabah. The latter is the first scientific description for the
recognition and differentiation of smallpox and measles. The Bulletin of the
World Health Organization of May 1970 pays tribute to Razi by stating “His
writings on smallpox and measles show originality and accuracy, and his essay
on infectious diseases was the first scientific treatise on the subject”.
Razi established qualifications and ethical standards for the practice of
medicine.
Zakariya
Razi was not only one of the most important Persian physician-philosophers of
his era ,but for centuries his writings became fundamental teaching texts in
European medical schools. Some important aspects of his contributions to
medicine are reviewed.
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Keywords: History of medicine · Iran ·
Razi
Introduction
rom
antiquity to the modern era, infectious diseases have played a significant role
in determining the course of human civilization. Written records and
paleopathologic evidence reveal the lasting impact of infectious diseases
caused by viruses, bacteria, spirochetes, and parasites have had on human
history. At the present time, the infectious diseases with the greatest impact
on humans in the developing countries are tuberculosis, malaria, and human
immunodeficiency virus (HIV), while sexually transmitted diseases, HIV, and
nosocomial infections are among the most significant in the industrialized
countries of the world.
A review of historical evidence strongly supports the
significance of two specific exanthemata in any number of epidemics described
in ancient civilizations. Descriptions resembling smallpox appear in the
earliest Egyptian, Indian, and Chinese writings.1 The mummy of
Pharaoh Ramses V reveals that an acute illness was the probable cause of his death
at age 40 in 1157 BC. The Pharaoh was described as having a striking rash of
yellowish blisters and pustules which closely resembles smallpox.1–3 Some
believe that the plague of Athens, starting in 430 BC, as described by
Thucydides, was probably due to the effects of a smallpox epidemic.4
Similar to smallpox, measles appears to have existed since antiquity. Like
smallpox, the origin of measles is not clear.4 Introduced by
colonizers to the New World, smallpox and measles caused epidemics with
devastating effects upon the immunologically naďve
native population. These two highly contagious diseases were difficult to
differentiate during the early stages as the skin rash and fever are common to
both.5 The first clear description and distinction between the two
diseases, the differential diagnosis and noting the complications of these
illnesses, was provided by the Persian alchemist-physician-philosopher Zakariya
Razi.6,7
Zakariya
Razi
Abu Bakr Mohammad Zakariya al-Razi (Persian Razi,
Latin Rhazes), a versatile physician-philosopher or Hakim, was born in 865 AD
in the the ancient city of Rey, a provincial capital of The Samanid Dynasty,
near the present city of Tehran, Iran. He died there in 925 AD, although some
scholars suggest he was born in 864 AD and died in 930 AD. He is best known for
his contributions to alchemy, medicine and philosophy, ethics in medicine, and
metaphysics and authored 184 books and treatise on these subjects. Razi was
well-versed in the ancient Greek language and he was an admirer and critic of
Galen. There is little information regarding Razi’s early life, but it is
written that he played lute in his youth and wrote an encyclopedia of music.8
Unable to make a comfortable living with music, he changed his interest to
alchemy. As a genuine chemist and physicist, he performed a great deal of
research and laid the foundation for scientific chemistry to replace alchemy,
having written several books and treatise in the field.9 He
discovered and purified alcohol (ethanol) and pioneered its use in medicine.
Also, he is credited with the discovery of sulfuric acid, the “work horse” of
modern chemistry and chemical engineering. The discovery of ammonium chloride
and other acids are also attributed to Razi. His achievements are particularly
important in the history of chemistry for his systematic classification of
chemical substances, chemical reactions, and the apparatus used in his
laboratory. In two important books, Kitab al-Asrar (The Book of
Secrets) and Sirr al-Asrar (The Secret of Secrets) he classified
matter into three categories as of plant, animal, and mineral origin. When
asked if he had obtained the knowledge of turning iron and copper into gold, he
replied with heretofore not described appreciation of the limits of scientific
chemistry: “I understand alchemy and I have been working on the characteristic
properties of metals for an extended time. However, it still has not turned
out to be evident to me, how one can transmute gold from copper. Despite the
research from the ancient scientists done over the past centuries, there has
been no answer. I very much doubt if it is possible.” However, he described the
techniques for making metal alloys. Twenty books and treatise in chemistry,
written in the Persian language (Farsi), are known to be the work of Razi.
According to al-Biruni, as noted by Nayernouri,9
Razi stopped his studies in alchemy because the chemical experiments caused him
an eye-disease. At age 30, Razi began his medical and philosophical studies
under Ali Ibn Rabban al-Tabari, a physician-philosopher from the ancient city
of Merv in western Iran. Nayernouri9 disputes the accuracy of
al-Tabari as Razi’s mentor in medicine. He states that Razi may have utilized
al-Tabari’s texts in medicine since al-Tabari may have died prior to Razi’s
birth. Razi gained practical experience as the director of the Royal Hospital
at Rey. Another of his teachers of medicine was the well-known physician Ali Ibn
Sahl (a Jewish convert to Islam, belonging to the famous medical school of
Tabaristan or Hyrcania). Soon he surpassed his teachers in medical knowledge
and practice. Later, by invitation of the Islamic ruler he became the head of
Muqtadari Hospital for a long time. It has been written that the same Caliph
asked Razi to build a hospital, but before doing so, Razi put fresh pieces of
meat in various places in the city of Baghdad, Iraq. Some time later, he
checked each piece of meat to find the least spoiled one and chose that place
as the site for the hospital. Because of his high reputation as a
physician-philosopher and teacher, students flocked to him from all over the
Islamic territories. In his book entitled Shukuk ‘ala Jalinus (Doubt about
Galen), he praised Galen’s commendable contribution to medicine. However, he
rejected Galen’s claim of the superiority of the Greek language and many of his
medical views since Galen’s description of some diseases did not agree with his
own clinical observations, i.e., the run of fever. In some cases Razi believed
that his clinical experience exceeded that of Galen. Further, he rejected
Socrates and Aristotle’s thoughts about the dichotomy of mind-body and
pioneered the concept of mental health and self-esteem as being essential to a
patient’s welfare. The “sound mind, healthy body” connection prompted him to
communicate frequently with his patients on a personal rather than the
patronizing level which was characteristic for that time. He encouraged them
to heed his advice as a path to their recovery and bolstered their fortitude
and determination to resist the illness resulting in a speedy recovery. In his
book about spiritual medicine, Razi presented ethical views of the
physician-scientist. He discussed the significance of improving the spiritual
quality of patients. Kasymov10 suggests that Razi’s spiritual
medicine is seen as synonymous to the notion of “medical ethics.” Razi’s
medical views were influenced by Hippocrates and Galen. In his theories, Razi
was a Galenist; but in practice, he apparently was guided more by the
principles of Hippocrates but his erudition was broad and deep, and he
demonstrated considerable originality.11,12
Razi combined psychological methods and physiologic
explanations. He used psychotherapy in a primitive but dynamic fashion.12 He
set clear standards for the professional practice of physicians. He was a
tireless and prolific author in medicine. About 40 of his medical books and
treatise are still extant in the libraries and museums of Iran, Britain,
France, India, and the Library of Congress of the United States (a Latin
translation). George Sarton in his Introduction to the History of Science14
wrote that Razi was the greatest physician of Islam and the Medieval
Ages. The May 1970 Bulletin of the World Health Organization, paid special
tribute to Razi stating “His writings on smallpox and measles show originality
and accuracy, and his essay on infectious diseases was the first scientific
treatise on the subject.” Razi was a pioneer in many areas of medicine
particularly in the fields of pediatrics and infectious diseases.15
He wrote an immense medical encyclopedia, a
comprehensive book on medicine called Kitab al-Hawi fi al-Tibb (Liber
Continens) consisting of 23 volumes containing many extracts from
Greek and Hindu authors and clinical observations of his own. A compendium to
this book was the Book of Experience or Casebook, a collection of case
histories recorded by some of his students and issued posthumously. This book
was translated into Latin in 1279 under the title of Liber Continens by Faraj Ibn
Salem (known in Europe as Farraguth) a physician of Sicilian-Jewish origin
employed by Charles of Anjou, to translate medical works. Even more influential
in Europe was Razi’s book of medicine, a short general textbook in ten chapters
based largely on Greek science and entitled Kitab al- Mansuri (Liber Almansoris)
which he dedicated in 903 to the Samanid prince Abu Salih al-Mansur Ibn Ishaq,
Governor of Rey.15 This treatise was subsequently translated into
Latin in Toledo, Spain, by Geraldo di Cremona in 13th century AD. A
third and extremely influential treatise was Razi’s Kitab al-Judari wa
al-Hasbah (De variolis et morbiliis) was translated in 18th
century into Latin and English.16 The last book related to smallpox
and measles and in it Razi makes a number of prescient observations, not
described previously. Among these observations, he writes “Smallpox appears
when the blood boils and infected, resulting in vapors being expelled. Thus,
juvenile blood (which looks like wet extracts appearing on the skin) in being
transformed into richer blood, having the color of mature wine. At this stage,
smallpox shows up essentially as bubbles found in wine-as blisters. This
disease can also occur at other times-meaning not only during childhood. The
best thing to do during this first stage is to keep away from it otherwise this
disease might turn into an epidemic.” Also, Razi noted the illness was
transmitted from person to person. His explanation of why survivors of
smallpox do not develop the disease a second time is the first theory of
acquired immunity.17 In differentiating smallpox from measles in his
book of al-Judari wa al-Hasbah, Razi wrote “The eruption of the smallpox is
preceded by a continued fever, pain in the back, itching in the nose, and
terrors in the sleep. These are the more peculiar symptoms to approach,
especially a pain in the back with fever; then also a pricking which the
patient feels all over his body; a fullness of the face, which at times comes
and goes; an infectious color, and vehement redness in both cheeks; a redness
of both eyes, heaviness of the whole body; great uneasiness, the symptoms of
which are stretching and yawning; pain in the throat and chest, with slight
difficulty in breathing and cough; a dryness of breath, thick spittle and
hoarseness of the voice; pain and heaviness of the inquietude, nausea and
anxiety; (with this difference that the inquietude, nausea, and anxiety are
more frequent in the measles than in the smallpox; while on the other hand, the
pain in the back is more peculiar to the smallpox than to the measles) heat of
the whole body; and an inflamed colon, and shining redness, especially an
intense redness of the gums.”
Other
medical contributions
Razi was the first to note the pupillary reaction to
light. He wrote “In the middle of the iris appears a hole which contracts when
the light is strong but dilates in obscurity.”18 He described the
operation for cataract also and stated, “I have split the lower part of the
pupil and have led the cataract outward”.19
He was the first physician to fully detail the definitive
manifestations of gonorrhea.20 He was the first to describe spina
bifida in The Liber Continens. In this book, he discussed infantile
convulsions.21 He described hydrocephalus as congenital or acquired
postnatally as well as describing microcephaly. The latter he considered to be
incurable. Razi is known for having described allergic rhinitis in an article
on the reason prince Abou Zayd Balkhi suffered from rhinitis when smelling
roses in spring. He was the first to realize that fever is a natural defense
mechanism, the body’s way of fighting disease. In his writings, Razi
differentiated rheumatism from gout. He did animal experimentations with new
drugs, noting their effects and toxicity before administering them to his
patients. A volume of Kitab al-Hawi fi al-Tibb is dedicated to
pharmacology. Indeed pharmacy can trace much of its historical foundations to
singular achievements of Razi. His birthday of August 27 has been adopted as
the Pharmacology Day in Iran.
Conclusion
With the rise of Islam in the 7th century
AD and the establishment of the Eastern Caliphate (Abbassid) in the eighth
century AD in Baghdad, there was a migration of physician-philosophers from the
Academy of Gondishapur in Persia to Baghdad, initiating the coming of the
“Islamic Golden Age”. Among the pillars of the Golden Age of Islamic Medicine
was the Persian alchemist-physician-philosopher Zakariya Razi. From various
sources of medical literature cited in this paper, one can summarize the
character and the accomplishments of Zakariya Razi as follows: He wrote the
first treatise on pediatrics, the Practica Puerorum.21 He
was a rationalist, extremely confident in the power of reason, free from every
kind of prejudice, and daring in the expression of his thoughts. He was described
as outstanding in generosity and always willing to treat and help the poor. He
was the most appealing healer of his age from a modern vantage point. Students
and practitioners thronged to his lectures, as apparently he was a brilliant
bedside teacher. A man of his time, he revered learning and based his knowledge
on the books of authorities. But, he was an independent thinker and not afraid
to rely on his own observations when they contradicted the past. He counseled
others saying “All that is written in books is worth much less than the
experience of a wise doctor.”
Razi’s fame rested on clear-cut clinical descriptions
of illness, original observations, and a pragmatic approach to treatment. He
gave the first accurate descriptions of smallpox and measles, advised proper
food in preference to drugs in treatment, and recommended simple rather than
complex remedies. Despite the large fees and honors he received, his generosity
to the less fortunate left him poor at the time of his death. For several centuries,
his books together with those of Avicenna’s Canon of Medicine were used as the
primary texts in major medical schools in Europe. Many countries have issued
commemorative stamps in Razi’s honor. His portrait hangs in the hall of School
of Medicine in Paris.
References
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DR. Smallpox: ten years gone. Am J
Public Health. 1988; 78: 1589 – 1595.
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15 April,
1998)
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