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.

Foundations

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, 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.^[2] Muhammad also appears to have been the first to suggest the contagious nature of leprosy, mange and sexually transmitted disease;^[3] and that there is always a cause and a cure for every disease,^[2][4] according to several hadiths in the Sahih al-Bukhari, Sunan Abi Dawood and Al-Muwatta attributed to Muhammad, such as:

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.^[4] 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.^[5] 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.^[6] 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.^[5] 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.^[5]

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, assylums, lazarets and leper-houses which were more concerned with isolating the sick and the mad from society "rather than to offer them any way to a true cure."^[7] The Bimaristan hospitals later functioned as the first public hospitals,^[8] psychiatric hospitals^[9] and diploma-granting medical universities.^[10]

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, and 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.^[11]

Hospitals in the Islamic world featured competency tests for doctors, drug purity regulations, nurses and interns, and advanced surgical procedures.^[12] Hospitals were also created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients.^[13]

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.^[14]

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.^[15] Later in the 15th century, female surgeons were illustrated for the first time in ?erafeddin Sabuncuo?lu's Cerrahiyyetu'l-Haniyye (Imperial Surgery).^[16]

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.^[17]

Muhammad ibn Zakar?ya R?zi (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.^[18]

Abu al-Qasim al-Zahrawi (Abulcasis), regarded as the father of modern surgery,^[19] 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,^[20] 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,^[21] 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,^[22] evidence-based medicine, clinical trials,^[23] randomized controlled trials,^[24][25] efficacy tests,^[26][27] clinical pharmacology,^[28] risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases,^[29] the first descriptions on bacteria and viral organisms,^[30] 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,^[11] 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.^[31]

Ab? Rayh?n al-B?r?n?'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.^[32] 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.^[33]

The last major medical encyclopedia from the Islamic world was ?erafeddin Sabuncuo?lu'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:^[11]

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,^[22] evidence-based medicine, clinical trials,^[34] dissection, animal testing,^[31] 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.^[12]

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.^[35]

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.^[34] 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.^[36] He also introduced urinalysis and stool tests.^[37]

Avicenna, considered the father of modern medicine, introduced experimental medicine and systematic experimentation and quantification in physiology, discovered the contagious nature of diseases, and described many medical treatments, including anesthetics and medical and therapeutic drugs, in The Canon of Medicine.

Avicenna (Ibn Sina) is considered the father of modern medicine,^[20] for his introduction of systematic experimentation and quantification into the study of physiology,^[21] the introduction of experimental medicine,^[22] clinical trials,^[23] risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases,^[29] in his medical encyclopedia, The Canon of Medicine (c. 1025), which was also the first book dealing with evidence-based medicine, randomized controlled trials,^[24][25] and efficacy tests.^[26][27]

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."^[34] Avicenna's emphasis on tested medicines laid the foundations for an experimental approach to pharmacology.^[38] 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^[28] and modern clinical trials:^[23]

1. "The drug must be free from any extraneous accidental quality."
2. "It must be used on a simple, not a composite, disease."
3. "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."
4. "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."
5. "The time of action must be observed, so that essence and accident are not confused."
6. "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."
7. "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),^[39] who introduced the experimental method into surgery,^[40] for which he is considered the father of experimental surgery.^[41] There were a number of other early practitioners of human dissection and autopsy at the time,^[42] including Ibn Tufail,^[43] Saladin's physicians al-Shayzari^[42] and Ibn Jumay, Abd-el-latif,^[44] and Ibn al-Nafis.^[45]

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.^[34]

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.^[46]

Anatomy and Physiology

In anatomy and physiology, the first physician to refute Galen's theory of humorism was Muhammad ibn Zakar?ya R?zi (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.^[36]

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).^[21] The contributions of Ibn al-Haytham (Alhacen) to anatomy and physiology include his correct explanation of the process of sight and visual perception for the first time in his Book of Optics, published in 1021.^[31] Other innovations introduced by Muslim physicians to the field of physiology by this time include the use of animal testing^[31] and human dissection.^[42]

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.^[39]

In the 12th century, Saladin's physicians al-Shayzari^[42] 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.^[44]

The opening page of a medical work by Ibn al-Nafis, the father of the circulatory physiology. This is probably a copy made in India during the 17th or 18th centuries.

Circulatory anatomy and physiology

Ibn al-Nafis, the father of circulatory physiology,^[47] was another early proponent of human dissection.^[45] In 1242, he was the first to describe the pulmonary circulation,^[48] coronary circulation,^[49] and capillary circulation,^[50] which form the basis of the circulatory system, for which he is considered the one of the greatest physiologists in history.^[51] 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,^[52] 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,^[53] bones, muscles, intestines, sensory organs, bilious canals, esophagus, stomach, and the anatomy of almost every other part of the human body.^[45]

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.^[54]

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.^[55]

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.^[56] 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).^[57] 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:^[56]

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.^[58]

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:^[59]

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.^[31] Their discovery of contagious disease in particular is considered revolutionary and is one of the most important discoveries in medicine.^[11] 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.^[3] 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:^[60]

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.^[61] 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.^[11] In epidemiology, he introduced the method of quarantine as a means of limiting the spread of contagious diseases,^[23] and introduced the method of risk factor analysis and the idea of a syndrome in the diagnosis of specific diseases.^[29]

In order to find the most hygienic place to build a hospital, Muhammad ibn Zakar?ya R?zi (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.^[62] The Comprehensive Book of Medicine, especially with its introduction of measles and smallpox, 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.^[63] 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.^[19]

Allergology and immunology

The study of allergology and immunology originate from the Islamic world.^[31] Muhammad ibn Zakar?ya R?zi (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.^[64]

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.^[65]

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.^[9][30]

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:^[9]

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.^[39]

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.^[66]

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:^[67]

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.^[68]

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.^[68]

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.^[68]

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 fetal craniotomy 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.^[69]

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.^[70] He further writes:

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.^[71]

The Arab physician Ibn al-Quff (1233-1305), a student of Ibn al-Nafis, described embryology and perinatology more accurately in his Al-Jami:

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.^[35]

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.^[72]

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,^[21] the introduction of clinical pharmacology,^[28] experimental medicine,^[22] evidence-based medicine, clinical trials,^[23] randomized controlled trials,^[24][25] efficacy tests,^[26][27] 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,^[34] and the first careful descriptions of skin troubles, sexually transmitted diseases, perversions, and nervous ailments,^[11] 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.^[31] 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^[28] and modern clinical trials:^[23]

1. "The drug must be free from any extraneous accidental quality."
2. "It must be used on a simple, not a composite, disease."
3. "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."
4. "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."
5. "The time of action must be observed, so that essence and accident are not confused."
6. "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."
7. "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,^[73] while the first apothecary shops were also founded by Muslim practitioners.^[74]

The advances made in the Middle East by Muslim chemists in botany and chemistry led Muslim physicians to substantially develop pharmacology. Muhammad ibn Zakar?ya R?zi (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.^[75]

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.^[76]

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.^[77]

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. Their use of practical experience and careful observation was extensive.^[77]

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.^[77]

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.^[78]

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.^[77]

Surgery

Abu al-Qasim al-Zahrawi (Abulcasis), regarded as the father of modern surgery,^[19] 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,^[31] 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,^[79] bone saw,^[64] and plaster.^[80] His work also included anatomical descriptions and sections on orthopaedic surgery and ophthalmology.^[81] 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.^[31] 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.^[65] 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.^[82][83]

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 acutal 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.^[84] The Comprehensive Book on Medicine was also the earliest book dealing with the decubitus of a patient.^[85]

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. Ibn Sina (Avicenna) wrote about its medical uses in his works, which later influenced the works of Paracelsus. Sigrid Hunke wrote:^[77][86]

Cataract surgery

See Ophthalmology

Dental surgery

See Dentistry

Experimental surgery

Ibn Zuhr (Avenzoar) is considered the father of experimental surgery,^[41] for introducing the experimental method into surgery in his Al-Taisir.^[40] He was the first to employ animal testing in order to experiment with surgical procedures before applying them to human patients.^[40] He also performed the first dissections and postmortem autopsies on humans as well as animals.^[39]

Eye surgery

Neurosurgery

Tracheotomy

The surgical procedure of tracheotomy was invented by Ibn Zuhr (Avenzoar) in the 12th century.^[87]

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.^[80] 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.^[65]

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.^[88]

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.^[89]

In the Al-Tasrif, Abu al-Qasim also introduced the use of ligature for the arteries in lieu of cauterization.^[90]

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.^[65]

The surgical needle was invented and described by