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

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СКАЧАТЬ the era of the great Arabic medical compendia ended with the Qanun, such works long continued as foci of scholarly attention, commentaries in turn becoming the bases for super-commentaries, such as that of ’Ala’ al-Din ibn al-Nafis (1200–88).

      Growing up in Damascus, Ibn al-Nafis studied at the famous Nuri hospital there. As with so many Arabic physicians, his interests were wide: medicine, logic, grammar and theology; he also wrote numerous commentaries on Hippocrates and Ibn Sina. His Mujiz al-Qanun, an epitome of Ibn Sina’s Canon, was vastly popular, but the work for which he is best known today is the commentary on the anatomy of Ibn Sina, the Sharh Tashrih al-Qanun, since one passage contains the first description of the pulmonary circulation.

      Contrary to the Galenic description of the passage of blood from the right ventricle directly through ‘invisible pores’ to the left ventricle, Ibn al-Nafis states that no blood could pass through the interventricular septum, ‘the substance of the heart there being impermeable … therefore, the blood must pass only through the lungs’. He thus proposed for the first time the pulmonary circuit of the blood:

      This is the right cavity of the two cavities of the heart. When the blood in this cavity has become thin, it must be transferred into the left cavity, where the pneuma is generated. But there is no passage between these two cavities; the substance of the heart there seems impermeable. It neither contains a visible passage, as some people have thought, nor does it contain an invisible passage which would permit the passage of blood, as Galen thought.… It must, therefore, be that when the blood has become thin, it is passed into the arterial vein [pulmonary artery] to the lung, in order to be dispersed inside the substance of the lung, and to mix with the air. The finest parts of the lung are then strained, passing into the venous artery [pulmonary vein] reaching the left of the two cavities of the heart.

      His description, however, seems to have fallen into obscurity. A similar description of the pulmonary circuit appeared in 1553 by the Spaniard Michael Servetus, and then in 1559 by the Italian, Realdo Colombo, but there is no evidence that either had access to his work.

      HEALTH CARE

      What of health care in general in Islam? Damascus and Cairo were no dirtier or cleaner than Naples, Paris, or any other pre-modern cities. Livestock was kept at home, waste left in the streets, and epidemics wrought havoc. Medieval sources frequently refer to ‘pestilence’, sometimes smallpox, though the greatest scourge was bubonic plague, which devastated the region in wave after wave between 541 and 749, returning as the Black Death in 1347–9. Cairo, the world’s second largest city with half a million people, lost half its population.

      To serve the sick, a range of medical practitioners and services was on offer. The formative period was marked by the predominance of Christian doctors, with lesser numbers of Jews and pagans. Many physicians had several occupations, and sidelines in trade were common. Healing remained more flexible and unregulated than in Christendom: there were no licensing requirements, no fixed curricula or sites for learning medicine, and no laws defining the profession. Islamic society tolerated a spectrum of practitioners and remedies, partly because popular lore was upheld by custom and the approval of the Prophet. In any case, learned medicine was often unavailable in the countryside, and within the cities it was beyond most people’s pockets.

      There were various ways to prepare for a medical career. Some doctors were self-taught, like Ibn Sina. Others underwent formal study under a teacher. Muslims sometimes taught in mosques, and hospitals were natural places for instruction, since patients were to hand and many hospitals had libraries. Teaching methods and curricula varied according to the master, though instruction often focused on the key Galenic works. Mathematics and logic were also studied, and the novice had an array of manuals, later supplemented by the cribs generated around Ibn Sina’s Qanun. Textual mastery was paramount; texts were usually read aloud and learnt by heart, and classwork meant sitting with a mentor who posed questions and glossed obscurities. Anatomy was not taught in a hands-on manner, since dissection was abhorrent to Muslim sensibilities: the dead were believed to feel pain, and dissection was desecration. Clinical experience was obtained in hospitals: physicians used patients to illustrate maladies and problems to students who trailed them on their rounds. Pupils probably shouldered certain basic duties, such as venesection.

      Physicians had certain public duties to fulfil, some quite bureaucratic. Doctors were frequently called upon to make official statements – for example, when a leper was seeking public assistance. Jewish physicians were often leaders of their communities, and Muslims found themselves in administrative positions such as army physician or hospital medical superintendent.

      The hospital, though not part of a wider ‘health policy’, was a centre of Islamic medical practice. These institutions (the greatest were in Baghdad, Damascus, Cairo and Cordova) were initially inspired by the precedent of sick-relief services offered at Christian monasteries, although the Islamic hospital became a more elaborate medical institution. The first was apparently founded in Baghdad around 805 on the initiative of Harun al-Rashid, and this was followed by others. The movement spread to Persia, and by the twelfth century a hospital graced every large Islamic town; thirty-four have been identified in Muslim cities from Spain to Moghul India. One of the best known was built in Cairo in 1283 by al-Mansur Qalawun, who dedicated it to all who needed care – rich and poor, old and young, male and female, of all faiths. It had special wards for physical and mental diseases, a surgery, pharmacy, dispensary, library and lecture rooms, and a chapel for Christians as well as a mosque; it was still in use when Napoleon invaded Egypt.

      Separate hospitals for the insane were also set up. The Qur’an required humane care of the mad, and the first institutions created primarily for mental cases appeared in Muslim lands. Called maristans, these had a good reputation, and European travellers marvelled at the humanity shown to the insane. The Islamic tradition had some impact, the first European mental hospitals being built in former Muslim Spain, beginning with Granada in 1365.

      Nevertheless, the role of hospitals in medieval Islam should not be exaggerated. They were a drop in the ocean for the vast size of the populations they had to serve, and their true function lay in highlighting ideals of compassion and bringing together the activities of the medical profession.

      With Cordoba falling to the Christians in 1236 and Baghdad sacked by the Mongols in 1258, Arab civilization was beginning to decline after 1300. The Ottoman Turks who dominated the Levant in the succeeding centuries did not inspire new intellectual glories. Nevertheless, the medical system described flourished in the Muslim world until the nineteenth century, when it gradually receded before the tide of modern western medicine. It continues in India and Pakistan as Yunani medicine.

CHAPTER V THE MEDIEVAL WEST

      BARBARIAN INVASIONS, the collapse of the western Roman empire, and the rise of warrior fiefdoms spelt catastrophe for civilization and its amenities – including the teaching and practice of learned medicine. City life collapsed in Europe into a landscape dominated by castles and cathedrals, with literate men and women confined to monastic cloisters. The medical thread was, however, unbroken, even if it frayed and threatened to snap. Through what are known as the Dark Ages medical manuscripts were at least preserved, copied and studied within the sanctuaries provided by abbeys and cathedral schools. The medicine they kept alive was, however, but a shadow of its brilliance in Galen’s day: a basic survival kit when book-learning itself was under threat.

      The revival of formal medicine took place centuries later in the backward West than in the Islamic world – not until around 1100, emerging first in Salerno in southern Italy, thirty miles south of Naples and seventy miles from the glorious Benedictine monastery of Monte Cassino. And it had to be imported and replanted.

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