The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

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СКАЧАТЬ (or contra-natural) disease – a handling reproduced by all Arabic writers in the Galenic tradition. By the late ninth century medical men had access to a stock of ancient texts in superior Arabic translations and an expanding corpus of original scholarship glossing Greek works.

      This in turn created a need for fresh syntheses, leading to the supreme achievement of Arab – Islamic medicine, the medical compendia. The first was the Firdaws al-hikma [Paradise of Wisdom] by ’Ali ibn Rabban al-Tabari (c. 850), in which the author, an Islamic convert, sought to collect a summa of medical erudition worthy for presentation to the Caliph al-Mutawakkil. His sources were Arabic and Persian translations of ancient classics, and his citations included not only Hippocrates, Galen and Dioscorides but Persian and Indian writers (this Indian element was soon, however, eclipsed by the Greek tradition).

      Persia produced one of the greatest Muslim physicians and philosophers, Muhammad ibn Zakariya al-Razi, known in the West as Rhazes (865–925), author of some 200 treatises. In his youth (anecdotes tell us) al-Razi studied and practised medicine at the bimaristan of Baghdad. He later returned to Rayy, near Teheran, as head of its hospital, at the invitation of Persia’s ruler, Mansur ibn Ishaq; al-Razi dedicated to him Al-Kitab al-mansuri fi’l-tibb [The Mansurian Book of Medicine], a manual in ten books. The first six ran through such concerns as anatomy, physiology and materia medica, while the last four dealt with clinical matters: diagnosis, therapy, surgery and pathology, discussing diseases from head to foot. His separate work, al-Tibb al-ruhani [Spiritual Physic] handled diseases of the soul within a discussion of philosophy. Having won fame in Rayy, al-Razi went to Baghdad to take charge of its new al-Mu’tadidi Hospital. He spent his declining years in Rayy suffering from glaucoma, before becoming blind.

      Al-Razi developed a medical philosophy. In the first chapter (‘On the Excellence and Praise of Reason’) of al-Tibb al-ruhani, he asserted that reason (al-’aql) was the ultimate authority which ‘should govern, and not be governed; should control, and not be controlled; should lead, and not be led’. He condemned slavish authority, devoting a large book, Fi’l-Shukuk ’ala Jalinus [Doubts about Galen], to criticism of precepts in Galen, beginning with al-Burhan [Demonstration], and ending with his large work, Fi’l-Nabd [On the Pulse]. In his introduction to Fi’l-Shukuk, he nevertheless declared himself Galen’s disciple; but since the art of healing was a form of philosophy, it could neither renounce criticism nor benefit from worshipping the dead. Extolling the progress of scientific knowledge, he wrote in Fi Mihnat al-tabib [On Examining Physicians and on Appointing Them] that ‘he who studies the works of the Ancients, gains the experience of their labour as if he himself had lived thousands of years spent on investigation.’ Nevertheless ‘all that is written in books is worth much less than the experience of a wise doctor.’

      Al-Razi’s best-known work, al-Hawi fi’l-tibb [Continens, or Comprehensive Book of Medicine], was a commonplace book of detailed notes and transcribed bits of texts, beginning with diseases of the head and working down. Devoted to specific subjects, these files were gradually filled with jottings; the result was a kind of filing system, organized by subject though lacking overall form. Al-Razi incorporated case histories from earlier sources, notably Galen, but he also registered his own cases, recording the patient’s name, age, sex and occupation. Clinical observations of his own illnesses are also preserved: notes on how he had treated throat inflammation by gargling with strong vinegar; elsewhere he wrote about his swollen right testicle (emetics helped recovery). From these notes, al-Razi took the material for books such as al-Qulani [Cholic] and al-Jadari wa’l-hasba [Smallpox and Measles]. Hitherto all exanthemata (infections causing rashes) had tended to be lumped together; al-Razi was the first to distinguish them as separate diseases: ‘The physical signs of measles are nearly the same as those of smallpox, but nausea and inflammation are more severe, though the pains in the back are less. The rash of measles usually appears at once, but the rash of smallpox spot after spot.’ It is intriguing to find measles regarded as the more severe.

      Al-Razi had many asides on medical practice: noblemen, he judged, echoing Galen, were entitled to special consideration in prescribing; for them unpleasant tasting drugs should be made palatable. But he did not neglect the poor, for whom he wrote his Man la yahduruh al-tabib [Who has no Physician to Attend Him]. Khawass al-ashya’ [Properties of Things] included the role of alchemy in medicine and the secret recipes and remedies of nature. Experience must be the touchstone of truth:

      since many wicked people tell lies with regard to such properties, and we do not possess decisive means to distinguish the truth of rightful men from the false testimony of liars – save only actual experience – it will be useful not to leave these claims scattered but to collect and write them all. We shall not accept any property as authentic unless it has been examined and tried.

      Al-Razi won renown, and his medical works later enjoyed ascendancy in the Latin West. In 1279 al-Hawi fi’l-tibb was Latinized under the title of Continens by the Sicilian Jew Faraj ibn Salim (Farragut), and printed five times between 1488 and 1542. His al-Mansuri fi’l-tibb [Liber ad Almansorem] and his al-Tibb al-muluki [Liber regius] were also popular. His work was in turn mentioned by Abu Rayhan ibn Ahmad al-Biruni (Al-Biruni, 973–c. 1050), who wrote on a variety of subjects: astronomy and astrology, mathematics, geography, history, philosophy and religion, mechanics, mineralogy and medicine. As well as editing al-Razi, he translated much of Galen’s otherwise lost Commentary on the Hippocratic Oath.

      The Arabic medical compendium culminated in two works of the tenth and eleventh centuries. ’Ali ibn al’-Abbas al-Majusi (Haly Abbas, d. late tenth century) was a native of al-Ahwaz in southern Persia, but little is known about his life. Following al-Razi’s example, he divided his Kamil al-sina’a al-tibbiya [The Complete Medical Art] into two sections, on theoretical and on practical medicine, each including ten treatises on specialized topics, and his introduction surveyed the development of medicine up to his own times. Well-organized, practical, and devoting greater attention than al-Razi to anatomy and surgery, it secured al-Majusi’s medical reputation, winning a place second only to Ibn Sina’s Qanun.

      The talents of Abu Ali al-Husayn ibn ’Abdallah ibn Sina (Avicenna, 980–1037) were evident from early youth. A Persian tax-collector’s son, he could, it is piously recorded, recite the Qur’an at the age of ten and was practising medicine by sixteen. If somewhat mythologized, Ibn Sina represents the pinnacle of the Galenic ideal of the philosopher – physician in Islam: he was the first scholar to create a complete philosophical synthesis in Arabic.

      In a wandering life driven by burning intellectual curiosity, Ibn Sina held positions as a jurist, a teacher of philosophy, an administrator, and as physician to various courts. His autobiography boasts that his writing was done on horseback during military campaigns, in hiding, in prison and even after drinking bouts. The outcome was two hundred and seventy tides which include two monumental encyclopaedias, one on science (Kitab al-Shifa) and one on medicine (Kitab al-Qanun).

      The Kitab al-Qanun [Canon, or The Medical Code] arranges in its million words the whole of medical science: the legacies of Hippocrates, Galen, Dioscorides and the late Alexandrian physicians, enriched by the works of Arab predecessors. It consists of five books arranged by subject, with subdivisions and summaries. Book I deals with general principles, starting with the theory of the elements, humours and temperaments and moving on to anatomy, physiology, hygiene, aetiology, symptoms and treatment of diseases. Book II is on materia medica, describing the physical properties of simple drugs, and how to collect and preserve them (a separate section lists 760 drugs alphabetically). Book III deals with specific diseases, classified from head to heel, together with the aetiology, symptoms, diagnosis, prognosis and treatment of each. Anatomy is also discussed. Book IV is concerned with diseases, such as fevers, affecting the whole body; it also covers ulcers, abscesses, swellings, pustules, fractures and injuries, as well as poisons, and there is even a section on anorexia and obesity. Book V describes СКАЧАТЬ