Medical ethics

Chapter 2

Muslim contribution in the evolution and development of medical Knowledge and expertise

2.1- Evolution of medical science

History of medicine is as old as human existence. Medical and health related issues remained a part of religious scriptures throughout history. It is interesting to note that the Muslim scholars of social science would also acquire the knowledge of medicine as part of their studies.  The manuscripts on medical science, with their origin in the medieval times, found in different parts of the world, bear testimony to the glorious past of the Muslims in medical science. In one of the libraries in Tashkent, Uzbekistan, several hundred ancient books have been stored on various aspects of medical sciences.  

One cannot help but look with admiration upon the way the Muslims handled their responsibility towards mankind. They not only preserved but also added to the achievements made earlier in medicine by others. They kept the flame of civilization burning and made it brighter before handing it over to Europe. Europe, in turn, passed it over to the United States of America and the cycle will probably continue in future. In order to combat the inferiority complex that plagues the Muslim Ummah, we must discover the contributions of the Muslims in fields such as natural science and medicine. This will encourage contemporary young Muslims to strive in the medical field and to think that major success is not beyond their reach. The very first verse of the Qur’an revealed to the prophet of Islam (SAS) in the night of power (Laylatul Qadr) in the month of Ramadan in 611 AD reads:                                    

“Read: In the name of thy lord who created man from a clot. Read: and Your Lord is the most generous who taught by the pen, Taught man that which he knew not." Qur’an- 96: 1-5. 

Names and contribution of all the great Muslim physicians, medical educationists and researchers are beyond the scope of this book. To emphasizes the fact that how ruthlessly Muslim input and contribution have not only been masked but also Muslim specialists in various fields of medical sciences were kept out of the history of medicine, following table briefly outlines the work of very few out of several hundred thousand torch bearers of Knowles during the period when rest of the world was not as enlightened as the Muslim world.
 

2.2- Following is the table which contains the names and achievements of some major Muslim physicians:  

1- Name-Arabic:    Jurjis ibn Bakhtishu  

Name- Latin:     Jibril Yuhanna ibn Masawayh 
Span of Life (A.D.):  700-800 
Specialty and Contribution:   Translation from Greek and Syrian   in to Arabic
Special Books:    Translation of works of Hippocrates,

                   Galen and Aristotle     

                                                                 

City - Country:   Baghdad

2- Name - Arabic:    Hunain Ibn Ishak 
Name - Latin 
Span of Life (A.D.):   826 - 882 
Specialty and Contribution:   Internal medicine, Epidemiology
Special Books:  On tib al batnia (internal medicine)

City - Country: Baghdad

 

3-Name Arabic    Al-Razi 

Name - Latin:     Razes 
Span of Life (A.D.):   841 - 926 (Ray-Tehran) 
Specialty and Contribution:   Internal Medicine, Epidemiology, Ophthalmology, Chemistry, Physics, and Philosophy etc.

Special Books:    Kitab Al-Mansuri (The Liber Al-Mansuris), Al-Murshid, Al-Hawi (Continents), Al-Gudari wa, Al-Gudari (de Peste or De Pestilentia)

City - Country:     Kharasan, Baghdad 
 

4- Name - Arabic:    Al-Zahrawi 

Name - Latin:     Abacuses (Bucasis Alzahravius) 
Span of Life (A.D.):    930 -1013 (al-Zahra-Cordova) 
Specialty and Contribution:   Surgery 
Special Books:   Al-Tasrif Liman Ajiz 'an al' Ta'lif 
City - Country:    Al-Andalus (Cordova) 
 

5- Name - Arabic:    Ibn-Sina 

Name - Latin:     Avicenna 
Span of Life (A.D.):   980 - 1037 (Bukhara) 
Specialty and Contribution:   Medical Encyclopedia,

Philosophy, Astronomy, Poetry

Special Books:    100 books Al-Qanun (over million words) 

City - Country:    Hamazan, Jurjan 
 
6- Name - Arabic:    Ibn-Rushd 
Name - Latin:     Averroes 
Span of Life (A.D.):   1126 - 1198 
Specialty and Contribution:   Philosophy, Medicine, Law 
Special Books:    Kitab Al-Kulliat 
City - Country:    Al-Andalus, Granada 

 
7- Name - Arabic:    Ibn-Maimon 

Name - Latin:     Maimonides 
Span of Life (A.D.):   1135 - 1208 (Granada) 
Specialty and Contribution:   Philosophy, Translations- Hebrew,

Latin, Poisons, Hygiene   and Public Health 
Special Books:    Al-Tadbir El-Sihhi, Moushid El-Hairan 
City - Country:    Cairo (Saladdin's physician) 

 
8- Name - Arabic:    Ibn-Al-Nafis 

Name - Latin: 
Span of Life (A.D.):    1208 - 1288 (Damascus) 
Specialty and Contribution:   Pulmonary circ., Blood supply to the heart 
Special Books:    Sharah Tashrih al Qanun, Al-Mujaz 
City - Country:    Damascus, Cairo 

2.3- The foundation of the Muslims’ achievements in science and medicine- Verses of the Holy Qur’an and Traditions of the Holy Prophet:

"And they shall say had we but listened or used reason, we would not be among the inmates of the burning fire." Qur’an-  67 :10.                                                        

"Are those who have knowledge and those who have no knowledge alike? Only the men of understanding are mindful”

“And whosoever brings the truth and believes therein, such are the dutiful." Surah Al Qur’an- 39:33

 

“Every Muslim man's and every Muslim woman's prayer should be: "My Lord! Enrich me with knowledge." Qur’an-  20 : 114.  

The following traditions of the Prophet PBUH supplement the foregoing teachings of the Qur’an in the following way:  

1. "The acquisition of knowledge is compulsory for every Muslim, whether male or female." 

2. "The ink of the scholar is more sacred than the blood of the martyr." 

3. "Seek knowledge from the cradle to the grave.“

4. "God has revealed to me, 'whoever walks in the pursuit of knowledge I facilitate for him the way to heaven.” 

5. "The best form of worship is the pursuit of knowledge."  

6. “Scholars should endeavor to spread knowledge and provide education to people who have been deprived of it. For, where knowledge is hidden it disappears.” 

7. Some one asked the prophet PUH “Who is the biggest scholar?" He replied: “He who is constantly trying to learn from others, for a scholar is very hungry for more knowledge."

8. "Seek for knowledge and wisdom, for whatever the vessel from which it flows, you will never be the loser.

9. "Thinking deep for one hour (with sincerity) is better than 70 years of (mechanical) worship."

10. "Worship without knowledge, has no goodness in it and knowledge without understanding has no goodness in it. And the recitation of the Qur’an, which is not thoughtful, has no goodness in it."

11. "To listen to the words of the learned and to instill unto others the lessons of science is better than religious exercises."

2.4- Interpretation of the above-mentioned sources:                                                                                                                               

Knowledge of medicine is one of the most famous and best-known facets of Islamic civilization, and in which Muslims most excelled. Muslims were the great torchbearers of international scientific research. Some of the best and most eloquent praises of science ever written came from the pens of Muslim scientists who considered their work as an act of worship, instrumental in winning Allah’s pleasure. The same motives led to the establishment of al-Azhar (800 AD) the first university in the world. They hit the “Source ball of knowledge" over the fence to Europe.

Muslim physicians were the first to criticize ancient medical theories and practices. Al-Razi devoted an entire book as a critique of Galen's anatomy. The works of Paracelsus are insignificant compared to the vast volumes of medical writings and original findings accomplished by the medical giants of Islam.

In the words of Campbell, "the European medical system is Arabian not only in origin but also in its structure. The Arabs are the intellectual forbearers of the Europeans." In fact the Muslims are directly responsible for the European renaissance. At the apex of its glory around the tenth century Cortuba (Qurtabah), the capital of Muslim Spain, had pavements, street lighting, three hundred public baths, parks, palaces, one hundred thousand houses and seventy libraries. There were close to half a million books in a single library whereas the whole of France contained much less than this figure. There were 100 hospitals in Qurtabah city alone.  

The Muslim physicians performed complicated eye surgery 600 years earlier than the Europeans. They developed differential and integral mathematics. They discovered the force of gravity, blood circulation, laws of motion, and even developed the theory of evolution and taught it in their universities. 

Ibn Firnas of Islamic Spain invented, constructed and tested a flying machine in the 800's A.D. Roger Bacon learned of flying machines from Arabic references to Ibn Firnas' machine. The latter's invention antedates Bacon by 500 years and Da Vinci by some 700 years. The Muslim scholars learned of the art of fine glass production from Syrian artisans during the 9th and 10th centuries.  

The Muslim ideal was, it goes without saying, not visual beauty but God in His plentitude; that is Allah with all His manifestations, the stars and the heavens, the earth and all nature. The Muslim ideal is thus infinite. But in dealing with the infinite as conceived by the Muslims, we cannot limit ourselves to the space alone but must equally consider time.  

Science is the most momentous contribution of Islamic civilization to the modern world; but its fruits were slow in ripening. Not until long after Moorish culture had sunk back into darkness did the giant, which it had given birth, to rise in his might.  Although there is not a single aspect of European growth in which the decisive influence of   Islamic culture is not traceable, nowhere is it as clear and momentous as in the genesis of that power which constitutes the permanent distinctive force of the modern world and the supreme source of its victory-- natural science and the scientific spirit.  

A variety of mechanical clocks were produced by Spanish Muslim engineers, both large and small, and this knowledge was transmitted to Europe through Latin translations of Islamic books on mechanics. These clocks were weight-driven. Designs and illustrations of epi-cyclic and segmental gears were provided. One such clock included a mercury escapement. The latter type was directly copied by Europeans during the 15th century. In addition, during the 9th century, Ibn Firnas of Islamic Spain, according to Will Durant, invented a watch-like device which kept accurate time. The Muslims also constructed a variety of highly accurate astronomical clocks for use in their observatories.  

The pendulum was discovered by Ibn Yunus al-Masri during the 10th century, who was the first to study and document its oscillatory motion. Its value for use in clocks was introduced by Muslim physicists during the 15th century   

2.5- Major scientific breakthrough in the Muslim world 

The Muslim scholars placed scientific pursuits on a sound foundation comprising systematic relationship between observation, hypothesis and verification. Most of the foundations of recent advances had been laid down in Muslim Spain, Iraq and Egypt!  

 

"The first mathematical step from the Greek conception of a static universe to the Islamic one of a dynamic universe was proponed by al-Khwarizmi (780-850), the founder of modern algebra.  Khwarizmi’s algebraic symbols enhanced the purely arithmetical character of numbers as finite magnitudes by demonstrating their possibilities as elements of infinite manipulations and investigations of properties and relations. In Greek mathematics, the numbers could expand only by the laborious process of addition and multiplication.

So we might say that the advance from arithmetic to algebra implies a step from being to 'becoming' from the Greek universe to the living universe of Islam. The importance of Khwarizmi's algebra was recognized, in the twelfth century, by the west, when Girard of Cremona translated his theses into Latin. Until the sixteenth century, this version was used in European universities as the principal mathematical text book.   

Their medical investigations not only widened the horizons of medicine but also enlarged humanistic concepts generally. Once again, they brought this about because of their over-riding spiritual convictions. Thus, it can hardly have been accidental that those researches should have led them that were inevitably beyond the reach of Greek masters.

It was probably inevitable that the Muslims should have discovered that disease need not be born within the patient himself but may reach from outside, in other words, that they should have been the first to establish clearly the existence of contagion.  

In 1454, Gutenberg developed the most sophisticated printing press of the middle ages. However, movable brass type was in use in Islamic Spain 100 years prior and that is where the west's first printing devices were made.  

We have reasons to believe that when, during the crusades, Europe at last began to establish hospitals it was inspired by the Arabs of the near East. The first hospital in Paris, Les Quinze-vingt, was founded by Louis IX after his return from the crusade 1254-1260." (300 years after the establishment of hospitals in Qurtabah).  

We find in  Jabir’s writings remarkably sound views on methods of chemical research-- a theory on the geologic formation of metals (the six metals differ essentially because of different proportions of sulphur and mercury in them) preparation of various substances (e.g., basic lead carbonates, arsenic and antimony from their sulphides)."  

A great deal of geographical as well as historical & scientific knowledge is contained in the thirty volume Meadows of Gold and Mines of Gems by one of the leading Muslim historian, al Mas'udi, of the tenth century. "Besides the translation of Greek works and their extracts, the translators made manuals of which one form that of the 'pandects,' is typical of the period of Arabic learning. These are recapitulations of the whole medicine, discussing the affections of the body, systematically beginning at the head and working down to the feet."  
 

The Muslim scholars studied, collected and described plants that might have some utilitarian purpose, whether in agriculture or in medicine. These excellent tendencies, without equivalent in Christendom, continued during the first half of the thirteenth century by an admirable group of four botanists.

One of these, Ibn al-Baitar, compiled the most elaborate Arabic work on the subject (Botany) which was, in fact, the most important for the whole period extending from Dioscorides down to the sixteenth century. It was a true encyclopedia on the subject, incorporating the whole Greek and Arabic experience."  

'Abd al-Malik ibn Quraib Al asmai (739-831) was a pious Arab who wrote some valuable books on human anatomy. Al-Jawaliqi who flourished in the first half of the twelfth century and 'Abd al-Mumin who flourished in the second half of the thirteenth century in Egypt, wrote treatises on horses.  

The greatest zoologist amongst the Arabs was al-Damiri (1405) of Egypt whose book on animal life, 'Hayat al-Hayawan' has been translated into English by A.S.G. Jayakar (London 1906, 1908)." 

The concept of the finite nature of matter was first introduced by Antione Lavoisier during the 18th century. He discovered that, although matter may change its form or shape, its mass always remains the same. Thus, for instance, if water is heated to steam, if salt is dissolved in water or if a piece of wood is burned to ashes, the total mass remains unchanged.  

The fact is that the principles of this discovery were elaborated centuries before by al-Biruni (d. 1050). Lavoisier was a disciple of the Muslim chemists and physicists and referred to their books frequently. Trigonometry was developed to a level of modern perfection by Muslim scholars. The credit must be given to al-Battani. The words describing the basic functions of this science, sine, cosine and tangent, are all derived from Arabic terms. Thus, original contributions by the Greeks in trigonometry were minimal.  

Muslim mathematicians were the first to utilize decimals instead of fractions on a large scale. Al-Kashi's book, key to arithmetic, was written at the beginning of the 15th century and was the stimulus for the systematic application of decimals to whole numbers and fractions thereof. It is highly probable that Stevin imported the idea to Europe from Al-Kashi's work.  

Muslim mathematicians, the inventors of algebra, introduced the concept of using letters for unknown variables in equations as early as 9th century A.D. Through this system, they solved a variety of complex equations, including quadratic and cubic equations. They used symbols to develop and perfect the binomial theorem. Muslim mathematicians introduced negative numbers for use in a variety of arithmetic functions at least 400 years prior to Cardano. Muslim mathematicians invented logarithms and produced logarithmic tables several centuries earlier. Such tables were common in the Islamic world as early as the 13th century.  

Muslim astronomers made numerous improvements upon Ptolemy's findings as early as the 9th century. They were the first astronomers to dispute his archaic ideas. In their critique of the Greeks, the Muslim scholars synthesized proof that the sun is the center of the solar system and that the orbits of the earth and other planets might be elliptical. They produced hundreds of highly accurate astronomical tables and star charts. Many of their calculations are so precise that they are regarded as contemporary. The Alphonsine Tables are little more than copies of works on astronomy transmitted to Europe via Islamic Spain, i.e. the Toledo Tables.  

Research by Reinuad and Fave has clearly shown that gunpowder was formulated initially by Muslim chemists. Further, these historians claim that the Muslims developed the first fire-arms. Notably, Muslim armies used grenades and other weapons in their defense of Algericus against the Franks during the 14th century. Jean Mathes indicates that the Muslim rulers had stock-piles of grenades, rifles, crude cannons, incendiary devices, sulfur bombs and pistols decades before such devices were used in Europe. The first mention that has been made of cannon was in an Arabic text around 1300 A.D. Roger bacon learned of the formula for gunpowder from Latin translations of Arabic books.  

Muslim geographers and navigators learned of the magnetic needle, possibly from the Chinese, and were the first to use magnetic needles in navigation. They invented the compass and passed the knowledge of its use in navigation to the west. European navigators relied on Muslim pilots and their instruments when exploring unknown territories. Gustav le bon claims that the magnetic needle and compass were entirely invented by the Muslims and that the Chinese had little to do with it. Neckam, as well as the Chinese, probably learned of it from Muslim traders. It is noteworthy that the Chinese improved their navigational expertise after they began interacting with the Muslims during the 8th century.  

Muslim geographers produced untold volumes of books on the geography of Africa, Asia, India, china and the Indies during the 8th through 15th centuries. These writings included the world's first geographical encyclopedias, almanacs and road maps. Ibn Battutah's 14th century masterpieces provide a detailed view of the geography of the ancient world. The Muslim geographers of the 10th through 15th centuries far exceeded the output by Europeans regarding the geography of these regions well into the 18th century. The crusades led to the destruction of educational institutions, their scholars and books. They brought nothing substantive regarding geography to the western world.  

A variety of Muslim chemists, including al-Razi, al-Jabar, al-Biruni and al-Kindi, performed scientific experiments in chemistry some 700 years prior to Boyle. Durant writes that the Muslims introduced the experimental method to this science. Humboldt regards the Muslims as the founders of Chemistry 

Al-Bairuni (d. 1050) was the world's first great experimenter. He wrote over 200 books, many of which discuss his precise experiments. His literary output in the sciences amounts to some 13,000 pages, far exceeding that written by Galileo or, for that matter, Galileo and Newton combined.  

Ibn Zuhr correctly described the nature of pleurisy, tuberculosis and pericarditis. Az-Zahrawi accurately documented the pathology of hydrocephalus and other congenital diseases. Ibn al-Quff and Ibn an-Nafs gave good descriptions of the diseases of circulation. Other Muslim surgeons gave the first accurate descriptions of certain malignancies, including cancer of the stomach, bowel and esophagus. Modern anesthesia was discovered, mastered and perfected by Muslim anesthetists 900 years before the advent of Davy and Wells. They utilized oral as well as inhalant anesthetics.  

Six hundred years prior to Long, Islamic Spain's Az-Zahrawi and Ibn Zuhr, among other Muslim surgeons, performed hundreds of surgeries under inhalation anesthesia with the use of narcotic-soaked sponges which were placed over the face.

Muslim physicians introduced the anesthetic value of opium derivatives during the middle ages. Opium was originally used as an anesthetic agent by the Greeks. Paracelus was a scholar of Ibn Sina's works from which it is almost sure that he derived this idea.  

Muslim physicians used a variety of specific substances to destroy microbes. They applied sulfur topically specifically to kill the scabies mite. Ar-Razi (10th century) used mercurial compounds as topical antiseptics. 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.  

As early as 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.  

The concept of quarantine was first introduced in the 7th century A.D. by the Prophet Muhammad, who wisely warned against entering or leaving a region suffering from plague. As early as the 10th century, Muslim physicians formulated the use of isolation wards for individuals suffering with communicable diseases.

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 Cordova, Spain, to be treated at what was comparably the "Mayo Clinic" of the Middle Ages. During the 14th century Ibn Baytar wrote a monumental pharmacopoeia listing some 1400 different drugs. Hundreds of other pharmacopeias were published during the Islamic era. It is likely that the German work is an offshoot of that by Ibn Baytar, which was widely circulated in Europe.  

 

In the 10th century, Islam's AL-Razi wrote an in-depth treatise on the venous system, accurately describing the function of the veins and their valves. Ibn an-Nafs and Ibn al-Quff (13th century) provided full documentation that the blood circulates and correctly described the physiology of the heart and the function of its valves 300 years before Harvey.  

William Harvey was a graduate of Italy's famous Padua University at a time when the majority of its curriculum was based upon Ibn Sina's and ar-Razi's textbooks. According to the eminent scholar of Arab history, Phillip Hitti, the Muslims, not the Greeks or Europeans, wrote the first "modern" pharmacopoeia. The science of pharmacology was originated by Muslim physicians during the 9th century.  

Ar-Razi, Ibn Sina, al-Kindi, Ibn Rushd, az-Zahrawi, Ibn Zuhr, and Ibn Baytar, Ibn al-Jazzar, Ibn Juljul, Ibn al-Quff, Ibn an-Nafs, al-Biruni, Ibn Sahl and hundreds of other Muslim physicians mastered the science of drug therapy for the treatment of specific symptoms and diseases. In fact, this concept was entirely their invention. The word "drug" is derived from Arabic. Their use of practical experience and careful observation was extensive.