Lectures on history of medicine

Great scientists of East – Ar-Razi, Al-Farabi,

Al-Biruni, Abu Ali Ibn Cina
The Islamic World rose to primacy in medical science with such thinkers as Ar- Razi (Rhazes), Al-Farabi, Al-Biruni, Ibn Sina (Avicenna).

Abu Bakr Muhammad Ibn Zakariya Ar-Razi (known in the west as Rhazes) was the greatest physician of Islam and the Medieval Ages. He remained up to the XVII c. the undisputable authority of medicine.

Ar-Razi was born at Ray near modern Tehran in 850. It is said that early in his life al-Razi was interested in singing and music besides other professions. Because of his eagerness for knowledge, he became more interested in the study of alchemy and chemistry, philosophy, logic, mathematics and physics. It was the field of medicine that he spent most of his life, practicing it, studying and writing about it. Due to his fame in medicine he was appointed head of the physicians of the Ray Hospital, and later put in charge of the Baghdad main Hospital during the reign of the Adhud-Daulah.

An interesting episode of Al-Razi's remarkable method of choosing the right spot for the Baghdad main hospital is described as follows. When Adhud Daulah asked Al-Razi to build a hospital, he had pieces of fresh meat placed at various parts of the city of Baghdad. Some time later, he checked each piece to find out which one was less rotten than the others, and he chose the spot of the least rotten pieces of meat a site for the hospital.

The greatest medical work of Ar-Razi, and perhaps the most extensive ever written by a medical man, is al-Hawi, i.e., the "Comprehensive Book," which includes indeed Greek, Syrian, and early Arabic medical knowledge in their entirety. Throughout his life Ar-Razi must have collected extracts from all the books available to him on medicine. In his last years, he combined these with his medical experience into an enormous twenty five volume medical encyclopedia. Al-Rhazi was the first to distinguish between smallpox and measles. Rhazes became the first physician to systematically use alcohol, cotton in his practice as a physician.

Abu Nasir Muhammad ibn Tarkhan ibn Uzlagh al-Farabi, Al -Farabi (870 – 950) was the great scientist – encyclopedists , philosopher who introduced Plato and Aristotle to Muslim philosophy. He was born in Farab in Asia Minor (modern Otrar) He was schooled in the towns of Farab and Bukhara, before continuing his studies of Greek philosophy in Hanan and Baghdad. Al –Farabi knew 70 languages and traveled widely throughout the Arabian kingdoms of Persia, Egypt, and Asia Minor.

He made great contributions to astronomy, logic, music, mathematics, sociology and ethics, philosophy and justice, medicine and psychology.

Al-Farabi had great influence on science and philosophy for several centuries, and was widely regarded to be second only to Aristotle in knowledge (alluded to by his title of "the Second Teacher"). He got title of “The Second teacher” in Baghdad, political and cultural centre of that time.

He was author of more than 200 philosophical works. Treatises about medicine were “About organs of human body”, “About soul”, “About objection Galen in occasion of its disagreements with Aristotle concerning to organs of human body”, “About Diseases of gastrointestinal tract and other diseases”. In his treatment of the human soul, al-Farabi draws on a basic Aristotelian outline, which is informed by the commentaries of later Greek thinkers. He says it is composed of four faculties: The appetitive (the desire for, or aversion to an object of sense), the sensitive (the perception by the senses of corporeal substances), the imaginative (the faculty which retains images of sensible objects after they have been perceived, and then separates and combines them for a number of ends), and the rational, which is the faculty of intellection. It is the last of these which is unique to human beings and distinguishes them from plants and animals. It is also the only part of the soul to survive the death of the body.

Al-Farabi's treatise “Meanings of the Intellect” dealt with music therapy, where he discussed the therapeutic effects of music on the soul.

He died in Damascus in 950 at the age of 80. Al-Farabi's work greatly influenced the Islamic philosophers who followed him. Al-Farabi was world man, he brought together and systematized achievements of Arabian, Persian, Greek, Indian and his own Turks culture.

Al-Biruni (973-1048) was astronomer, geographer, ethnographer and historian. He knew Greek, Arabian, Syrian, and Sanskrit languages. He worked in Kat, capital of Horesmshah’s state. Al – Biruni wrote fundamental works devoted to pharmacology, astronomy, medicine such as “Chronology”, “Pharmacology”, “Mineralogy”, “Pharmacognosy”.

“Pharmacgnosy” was one manuscript which discovered in 1927 in Brucc and valuable monument in East.

The great philosopher and doctor Ibn Sina (also known as Avicenna in the western world) was another influential figure. His The Canon of Medicine, sometimes considered the most famous book in the history of medicine, remained a standard text in Europe up until its Age of Enlightenment and the renewal of the Islamic tradition of scientific medicine.

He was born in Persia around 980 in Afshana, in Bukhara province, his mother's home, a small city now part of Uzbekistan.

About 100 treatises were ascribed to Ibn Sina. Some of them are tracts of a few pages, there are works extending through several volumes. The best-known among them, and that to which Ibn Sina owed his European reputation, is his 5-volume “The Canon of Medicine”, which was a standard medical text in Europe and the Islamic world up until the XVIII c. The book is known for its introduction of systematic experimentation and quantification into the study of physiology, the discovery of contagious diseases and sexually transmitted diseases, the introduction of quarantine to limit the spread of infectious diseases, the introduction of experimental medicine, clinical trials, neuropsychiatry, risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases, and hypothesized the existence of microorganisms. It classifies and describes diseases, and outlines their assumed causes. Hygiene, simple and complex medicines, and functions of parts of the body are also covered. In this, Ibn Sīnā is credited as being the first to correctly document the anatomy of the human eye, along with descriptions of eye afflictions such as cataracts. It asserts that tuberculosis was contagious, which was later disputed by Europeans, but turned out to be true. It also describes the symptoms and complications of diabetes. Both forms of facial paralysis were described in-depth. “The Canon of Medicine” was the first book dealing with experimental medicine, evidence-based medicine, randomized controlled trials, and efficacy tests, and it laid out the following rules and principles for testing the effectiveness of new drugs and medications, which still form the basis of clinical pharmacology and modern clinical trials:

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."
   

First book contained medicine definition, anatomical and general knowledge, health and treatment of diseases. Second book was devoted to simple drugs and its action. Third book was about pathology and therapy, description of some diseases and ways of its treatment. Surgery and fever were described in fourth book. There were compound medicinal substances and antidote in fifth book.

“The Canon of Medicine” became the text book for medical education in the schools of Europe. Scientists of Arabian Caliphates and Asia Minor influenced on development of medicine in all world.

Medicine in Western Europe

In 476 the last Roman emperor Romul Augustul was decrowned. This date designated the downfall of slave owning epoch in Europe and beginning of new epoch – feudalism.

Church was the main institution in feudal epoch. Christian church was unified till the middle of XIc., then it was broken up into west (Catholic) and east (Orthodox) in 1054.

First hospitals (co-called God’s houses) were attached to monasteries in Western Europe. God’s houses appeared in Lion (VI c.) and Paris (VII c.) then hospital of Saint Bartholomew in London (XII c.). Monks cultivated medical plants, made room for its keeping. Connecting of religion and medicine put the brakes on the scientific thought.

In the Middle Ages medicine was dominated by the ideas of Galen and the theory of the four humours. Medieval scholiasts forget his many experimental achievements in anatomy and physiology while weak points of his study about pneuma, supernatural powers was rise to religious dogma and it became standard of scholastic medicine. It aroused galenism – corrupt, one-sided understanding of Galen’s study.

Furthermore outside many towns were leper 'hospitals' (really just hostels as nothing could be done for the patients). Leprosy was a dreadful skin disease. Anyone who caught it was an outcast. They had to wear clothes that covered their whole body. They also had to ring a bell or a wooden clacker to warn people they were coming. Fortunately leprosy grew less common in the XV c. and it died out in Britain in the XVI c. In the The Middle Ages only monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals. However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath.

The Black Death (bubonic plague with pulmonary infection), originating in Eastern Asia, passed through India to Asia Minor, Arabia, Egypt, Northern Africa, and directly to Europe by the Black Sea. In Europe the epidemic began in 1346, and spread first of all in the maritime cities of Italy (especially Genoa) and Sicily, in 1347 it appeared in Constantinople, Cyprus, Greece, Malta, Sardinia and Corsica, and, towards the end of the year, at Marseilles; in 1348 in Spain, Southern France (Avignon), Paris, the Netherlands, Italy, Southern England and London, Scbleswig-Holstein and Norway, and in December, in Dalmatia and Jutland; in 1349 in the Austrian Alpine countries, Vienna, and Poland; in 1350 in Russia, where in 1353 the last traces disappeared on the shores of the Black Sea. First quarantines were introduced in seaports of Italy in 1348.

In the XIII c. a new type of craftsmen emerged in towns. He (or she because not all were male) was the barber-surgeon. They cut hair, they pulled teeth and they performed simple operations such as amputations and setting broken bones.

However doctors looked down on barber-surgeons because they did manual work. Therefore they were regarded as inferior to doctors who did not.

In the late XI c. a medical school was founded in Salerno in Italy. In the XII c. another was founded at Montpellier. In the XIII c. more universities were founded at Bologna, Padua, Neapol, Oxford, Paris and etc. Furthermore many students studied medicine in European universities. Medicine became a profession again. But it had dogmatic features.

Bologna has stained incomparable glory from the fact that Mondino de Liucci (about 1275-1326), the reviver of anatomy, taught there. There, for the first time since the Alexandrian period (nearly 1500 years), he dissected a human corpse, and wrote a treatise on anatomy based upon personal observation - a work which, for nearly two and a half centuries, remained the official textbook of the universities. Although Mondino's work which appeared in 1316, contains many defects and errors, if nevertheless marked an advance and incited men to further investigation. Text book on surgery by Guy de Chauliac (XIV c.) was wide spread in Western Europe.

Medicine of medieval Europe developed in difficult and negative conditions. Nevertheless in depths future medicine of Renaissance became generated.

Medicine development during the period of Renaissance

Medicine of the Renaissance era in Europe was from around 1400 to around 1750. The Renaissance marked a change of direction for medical knowledge and practice following the stagnation of medieval medicine in the preceding period. A rebirth of interest in the pursuit of new knowledge and scientific enquiry began, similar to that found in ancient Greek medicine. The known world expanded for Europeans, as they discovered the Americas and explored the continents of Asia and Africa, making contact with new peoples and civilizations. New medicinal plants and treatments were brought back to Europe and new technologies such as the microscope emerged, influencing medical development. The spirit of discovery encouraged scientific research that overturned the traditional practices of the Middle Ages, which had been based on the classical teachings of Egypt, Greece, and Rome.

During the XVIc. there were some improvements in medicine. However it remained basically the same as in the Middle Ages. Medicine was still dominated by the theory of the four humours.

From the time of Mondino, anatomy had been diligently cultivated at the universities, especially in Italy. Anatomy made special progress because of the artists. Thus Raphael Sanzio (1488-1520) already makes use of the human skeleton when making his sketches, so as to give his figures the proper posture. We possess numerous anatomical descriptions and sketches by Leonardo Da Vinci . Leonardo Da Vinci (1452-1519) dissected some human bodies and made accurate drawings of what he saw. The great Michelangelo (1475-1564) left sketches of the muscles and in 1495, in the monastery of Santo Spirito at Florence, made studies for a picture of the Crucified with cadavers as models.

Big influence on development of natural science had activity of English philosopher F. Beckon (1561 – 1626) – forefather of English materialism and modern experimental science.

René Descartes (1596-1650) was a highly influential French philosopher, mathematician, scientist, and writer. He made sketches of reflex arch, divided nerves into centripetal and centrifugal. He considered that all life movement subordinated to laws of mechanics.

In 1478 a book by the Roman doctor Celsus was printed. (The printing press made all books including medical ones much cheaper). The book by Celsus quickly became a standard textbook. However in the early 16th century a man named Theophrastus von Hohenheim called himself Paracelsus (meaning "equal to or greater than Celsus", a Roman encyclopedist from the first century known for his tract on medicine). Theophrastus Aureolus Bombastus von Hohenheim (1493-1541), was born in Einsiedeln, Switzerland. He denounced all medical teaching not based on experiment and experience. However traditional ideas held sway for long afterwards.

In 1506 he went to the University of Basle; from Trithemius he learned chemistry and metallurgy in the smelting houses at Schwaz (Tyrol), and he visited the principal universities of Italy and France. In 1526 he became town physician of Basle, and could as such give lectures. His first appearance is characteristic of him. He publicly burned the works of Avicenna and Galen and showed respect only to the "Aphorisms" of Hippocrates. He was the first to give lectures in the German language. But as early as 1528, he was compelled, on account of the hostility he evoked, to leave Basle secretly. After this he travelled through various countries working constantly at his numerous writings, until death overtook him at Salzburg in 1541.

He considered illnesses were abnormity of organism, i.e. simple chemical violation of balance, and chemical remedies and means could help to restore the balance. Human is created from earth and he consists from incombustible and refractory substances: sulfur, mercury, and salt (chemical theory of Paracelsus). Main task of chemistry was making drugs, he thought. He used many chemical drugs for treatment. His popular expressions were: “All is poison and all is medicine. Only one doze makes substance either poison or medicine”, “Theory of doctor is experiment. Nobody can be doctor without science and experiment”.

Andreas Vesalius (1514 – 1564), studied at Louvain, Montpellier and Paris, then became imperial field-surgeon. His eagerness to learn went so far that he stole corpses from the gallows to work on at night in his room. He soon became convinced of the weakness and falsity of the anatomy of Galen. His anatomical demonstrations on the cadaver, which he performed in several cities and which attracted attention, soon earned him a call to Padua where he had recently graduated and where, with some interruptions, he taught from 1539 to 1546. His chief work, “On the Workings of the Human Body” or "De corporis humani fabrica libri vii", which appeared at Basle in 1543, brought him great fame. Vesalius is the founder of scientific anatomy and of the technique of modern dissection. The work emphasized the priority of dissection and what has come to be called the "anatomical" view of the body — seeing human internal functioning as an essentially corporeal structure filled with organs arranged in three-dimensional space. It contained accurate diagrams of a human body. Unfortunately, he himself destroyed a part of his manuscripts on learning that his enemies intended to submit his work to ecclesiastical censure. While engaged on a pilgrimage, he received word in Jerusalem of his reappointment as professor in Padua, but he was shipwrecked in Zant and died there in great need on 15 October, 1564.

In the XVIc. – the beginning of XVII c. there were many doctors-anatomists: Fallopii, Eustacchi, Bottalo, Fabricio, etc. Their names introduced in anatomical terms.

Galen's theory, according to which the left heart and the arteries contained air, the blood being generated in the liver, had long been regarded as improbable, but in spite of every effort no one had as yet discovered the truth about circulation. The solution of this problem, which brought about complete fall of Galen's system and a revolution in physiology, came from the English physician William Harvey of Folkstone (1578-1657). His work is “Anatomical research about heart and blood in animals”. Harvey's discovery published in 1628, that the heart is the centre of the circulation of the blood must return to the heart, at first received scant notice and was even directly opposed by Galen's adherents; but further investigation soon made truth victorious.

A new field of investigation was opened by the invention of the microscope (the end of the XVIc.), by which Marcello Malpighi (1628-1694) discovered the smaller blood-vessels and the blood corpuscles. From Harvey's time starts a series of important anatomists and physiologist. In 1658 Jan Swammerdan first observed red blood corpuscles. Then in 1665 Robert Hooke was the first person to describe cells in his book “Micrographia”.

Finally in 1683 Antoine van Leeuwenhock (1632-1723) observed microorganisms. He made more than 200 microscopes, which increased to 270 times. However he did not realize microorganisms caused disease.

Girolamo Fracastoro (1478  1553) was an Italian physician, scholar (in mathematics, geography and astronomy), poet and atomist.

In 1546 he proposed that epidemic diseases are caused by transferable tiny particles or "spores" that could transmit infection by direct or indirect contact or even without contact over long distances. In his writing, the "spores" of disease may refer to chemicals rather than to any living entities. His book (De contagione - "On Contagion") also gave the first description for typhus. The name for syphilis is derived from Fracastoro's 1530 epic poem in three books, Syphilis sive morbus gallicus ("Syphilis or The French Disease"), about a shepherd named Syphilus. The poem suggests using mercury and "guaiaco" as a cure. The collected works of Fracastoro appeared for the first time in 1555.

Doctor Montano (1489 – 1552) resumed clinical study in Padua University.

The activity of the physician was mainly to assist "nature". Hermann Boerhave (1668-1738), the most famous practitioner of his time, who in 1720 became clinical professor at Leyden. He tried to explain most physiological processes as purely mechanical.

The French field-surgeon Ambroise Paré (1510 -1590) was famous for a marked change in the treatment of gunshot wounds and arterial hemorrhage. He abandoned the Arabic method of work with a red-hot knife, declared that supposedly poisoned gunshot wounds were simple contused wounds, and proceeded to bandage them without using hot oil. He was the first to employ the ligature in the case of arterial hemorrhage. He improved technology of amputation, herniotomy and tracheotomy. Pare also designed artificial limbs.

European doctors contributed in the field of stomatology. Italian doctor Chigovanni Archoli propagandized ten rules on teeth care after meal. Since XVc. in England the barber-surgeon cut hair and pulled teeth. The Chinese invented the toothbrush. (It was first mentioned in 1498). Toothbrushes arrived in Europe in the XVII c. In the late XVII c. they became popular with the wealthy in England.

The Middle Ages made great contribution into cultural history of mankind. It was not only earlier bourgeois culture of Italian Renaissance and humanistic world outlook in Western Europe of XVI c., but also Byzantine music and icon painting, Hellenistic novel, Arabian medicine and many other heritages. Cultural horizon became extend. World unity was more notable.