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1,400-year-old medicinal treatise of Galen found hidden under hymns in ancient manuscript

1,400-year-old medicinal treatise of Galen found hidden under hymns in ancient manuscript

A 6th century translation of a work of one of the most important ancient Greek doctors has been discovered in an animal-hide manuscript, hidden underneath text of 1,000-year-old hymns. A researcher told The New York Times that Galen's ideas on medicine were “completely bonkers,” but the palimpsest text holds important clues on how the ancients treated patients.

Galen, born in 131 AD, was considered one of the greatest practitioners of medicine in the ancient world, both East and West, through to the 16th century. Legend has it that Galen eviscerated an ape in front of the High Priest of Asia in Pergamon and challenged other doctors that were present to repair it. They could not, so Galen did, thereby gaining his post as physician for the high priest's gladiators. In 170 AD he became physician to Commodus, who became emperor in 180 AD.

“The Galenic system is completely bonkers,” Dr. Siam Bhayro, a Jewish studies scholar in England, told The New York Times .

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“Wound Man,” a medieval work attributed to Galen ( Wikimedia Commons )

That said, the website Medscape indicates Galen understood more about physiology than Aristotle. Aristotle said the heart was more important than the brain, while Galen said the brain was the primary organ, controlling all the other organs of the body. Both men were right in a way because the brain cannot function without the blood and oxygen that the heart pumps to it. But Aristotle's idea was that the brain's main purpose was to produce phlegm to cool the heart. Galen showed more understanding when he said the brain was connected to and controlled the entire body. He wrote, "If you press so much upon a cerebral ventricle that you wound it, immediately the living being will be without movement and sensation, without spirit and voice."

Peter Pormann, a Greco-Arabic scholar in Manchester, England, called the find important on many levels. “It’s likely to be a central text once it’s fully deciphered. We might discover things we really can’t dream of yet,” he told The New York Times .

A scan of a folio from the text, which is available online at http://digitalgalen.net/.

The 230-folio parchment palimpsest includes one of Galen's medical texts that was not entirely lost in antiquity, though 125 of his books were lost in a fire.

Books 6 to 8 of the text, On the Mixtures and Powers of Simple Drugs , are in the British Library. But the new find, which will add much more material, is an earlier translation, from ancient Greek to Syriac. This translation may differ from later ones and be truer to what Galen actually wrote. The differences between known translations and this latest find, a 9th century copy of a 6th century translation, may help show how doctors treated patients in antiquity.

Though the text has been known since the 2000s, scholars are just beginning to study it. The New York Times says the text may provide previously unknown information about how the practice of medicine developed and spread.

The book is owned by a man in Baltimore, a collector of rare scientific material. Grigory Kissel, a German language scholar, was examining the manuscript at the collector's house when he saw how similar it was to a page he had held Harvard University a little while before. Kissel realized how important the find was.

That was in February 2013. Between then and May 2015 a worldwide search for seven missing pages ended when the final page was digitized in Paris, The New York Times reported . One page of the manuscript remains at St. Catherine's Monastery in the Sinai Desert. Three others were in a Vatican library.

St. Catherine's Monastery from Mount Sinai in Egypt; the monastery has the oldest continuously operating library in the world. (Photo by Wilson44691/ Wikimedia Commons )

The Digital Galen Syriac Palimpsest has all of the folios online . They were scanned using special techniques at the Walters Art Museum in Baltimore. An introduction on the website says: “This manuscript contains an eleventh-century liturgical text that is very important for the study of the hymns of Byzantine and Melkite Christianity. The manuscript's value is further increased by the fact that it is a palimpsest, with an older and very significant undertext. The undertext dates back to approximately the ninth century, and contains Syriac translations of Greek medical texts. Preliminary investigations have identified several leaves from Galen's major pharmacological treatise.”

Featured image: The medical text dates to the 9th century, the hymn book to the 11th century. (Walters Art Museum photo)

By Mark Miller


Revealing Reading

Little is known of the history of the manuscript in Baltimore, formally known as the Syriac Galen Palimpsest, from its recycling in the 11th century until the 1920s, when it was sold to a private collector in Germany. After that, the manuscript fell again from public view until 2002, when it was purchased by a collector in a private sale. He has not been publicly identified.

In 2009, the Galen Palimpsest was lent to the Walters Art Museum for spectral imaging of its leaves by an independent group of specialists, which would reveal the erased Galen undertext. Each page is photographed digitally at extremely high resolution with varying colors and configurations of light, which in various ways illuminate the inks, grooves from writing and parchment itself. Computer algorithms exploit these variations to maximize the visibility of the undertext.

The resulting images went online under a “creative commons” license, meaning that anyone can use the material free for any noncommercial purpose. Once the images were online, William Noel, who was the curator of manuscripts and rare books at the museum, began organizing members of the tiny community of scholars who study Syriac scientific texts to study the new material.

One of them was Dr. Kessel, who was on a fellowship at Harvard’s Dumbarton Oaks Research Library in Washington. Eventually, Michael B. Toth, a systems engineer who managed the imaging work arranged for him to see the Galen Palimpsest for himself.

“I couldn’t even imagine how it looked,” Dr. Kessel said. “Then when I saw the manuscript, I had the kind of déjà vu impression that I had already seen it. And then I recalled the single folio in the Harvard library.”


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1,400-year-old medicinal treatise of Galen found hidden under hymns in ancient manuscript - History

The first time Grigory Kessel held the ancient manuscript, its animal-hide pages more than 1,000 years old, it seemed oddly familiar.

A Syriac scholar at Philipps University in Marburg, Germany, Dr. Kessel was sitting in the library of the manuscript's owner, a wealthy collector of rare scientific material in Baltimore. At that moment, Dr. Kessel realized that just three weeks earlier, in a library at Harvard University, he had seen a single orphaned page that was too similar to these pages to be coincidence.

The manuscript he held contained a hidden translation of an ancient, influential medical text by Galen of Pergamon, a Greco-Roman physician and philosopher who died in 200 A.D. It was missing pages and Dr. Kessel was suddenly convinced one of them was in Boston.

Dr. Kessel's realization in February 2013 marked the beginning of a global hunt for the other lost leaves, a search that culminated in May with the digitization of the final rediscovered page in Paris.

Scholars are just beginning to pore over the text, the oldest known copy of Galen's "On the Mixtures and Powers of Simple Drugs." It may well provide new insights into medicine's roots and into the spread of this new science across the ancient world.

"On so many levels it's important," said Peter Pormann, a Graeco-Arabic expert at the University of Manchester who now leads a study of the text.

A scholar and lead curator at the Vatican library displaying a leaf of the Syriac Galen Palimpsest in preparation for the spectral imaging that makes it possible to read the erased text.

The manuscript held by Dr. Kessel that day was a palimpsest: older text covered up by newer writing. It was a common practice centuries ago, a medieval form of recycling. In this case, 11th-century Syrian scribes had scraped away Galen's medical text and had overwritten hymns on the parchment.

The hymn book itself is of interest, but for now it is the original text, all but invisible to the naked eye and known as the undertext, that has captured the imagination of scholars.

For centuries, Galen's "Simple Drugs" was required reading for aspiring physicians, the summation of ancient knowledge about medicine, patient care and pharmaceutical plants. Galen described a root that cures "roughness of the throat" and recommended hemp as an earache remedy that "does not produce flatulence" (though it "dries out the semen").

Much of "Simple Drugs" was eventually translated into Syriac, a form of Aramaic used by Middle Eastern Christian communities. The undertext of the manuscript in Baltimore, most likely from the ninth century A.D., is a copy of the first Syriac translation, itself painstakingly completed in the sixth century A.D. by Sergius of Reshaina, a Syriac physician and priest.

One leaf of the Syriac Galen Palimpsest remains at St. Catherine's in the Sinai Desert in Egypt, which has the world's oldest continuously operating library.

"Today, it doesn't look to be special when somebody translates one language to another, but in those days, it was indeed a great achievement," Dr. Kessel said. "He had to create vocabulary, to find Syriac words to correspond to this Greek medical vocabulary."

By the sixth century, Syriac-speaking Christians were spreading east from Turkey through Syria, Iraq and Iran. They needed translations of Greek scholarly work, partly to support missionary work like running hospitals.

"Simple Drugs" was a large work, an 11-book treatise. Sergius's translations of Galen's text were copied and recopied for centuries, and eventually became a bridge for moving the medical expertise of the ancient Greeks to Islamic societies. Syriac texts were much easier than Greek ones to translate into Arabic.

As Muslim influence grew in the Near and Middle East, Christian populations dwindled, and so did Syriac. "These great Christian cultures that used it suffered so much," said Columba Stewart, the executive director of the Hill Museum and Manuscript Library in Collegeville, Minn.

"By the time you have modern scholarship, these ancient Syriac cultures are just a vestige of their former selves -- often quite isolated from Western culture, so there's not a lot of awareness."

Little is known of the history of the manuscript in Baltimore, formally known as the Syriac Galen Palimpsest, from its recycling in the 11th century until the 1920s, when it was sold to a private collector in Germany. After that, the manuscript fell again from public view until 2002, when it was purchased by a collector in a private sale. He has not been publicly identified.

In 2009, the Galen Palimpsest was lent to the Walters Art Museum for spectral imaging of its leaves by an independent group of specialists, which would reveal the erased Galen undertext. Each page is photographed digitally at extremely high resolution with varying colors and configurations of light, which in various ways illuminate the inks, grooves from writing and parchment itself. Computer algorithms exploit these variations to maximize the visibility of the undertext.

The resulting images went online under a "creative commons" license, meaning that anyone can use the material free for any noncommercial purpose. Once the images were online, William Noel, who was the curator of manuscripts and rare books at the museum, began organizing members of the tiny community of scholars who study Syriac scientific texts to study the new material.

One of them was Dr. Kessel, who was on a fellowship at Harvard's Dumbarton Oaks Research Library in Washington. Eventually, Michael B. Toth, a systems engineer who managed the imaging work arranged for him to see the Galen Palimpsest for himself.

"I couldn't even imagine how it looked," Dr. Kessel said. "Then when I saw the manuscript, I had the kind of déjà vu impression that I had already seen it. And then I recalled the single folio in the Harvard library."

By analyzing the page size, handwriting and other features, as well as the visible text, Dr. Kessel was able to determine that the Harvard leaf did indeed fill one of the gaps in the Galen Palimpsest. But six more were apparently missing. Dr. Kessel set out to find them.

He began with a list of 10 libraries known to have ancient Syriac material, combing through online catalogs when available to look for clues such as the right dimensions or vague references to undertext. Sometimes, he traveled to the libraries himself.

It was not long before Dr. Kessel had good news. He found one missing page in a catalog from the Sacred and Imperial Monastery of the God-Trodden Mount of Sinai. It is known more commonly as St. Catherine's in the Sinai Desert in Egypt, which has the world's oldest continuously operating library.

Another leaf turned up at the National Library of France in Paris. And at the Vatican's vast library in Rome, he was able to identify the other three missing leaves, bringing the total to six.

The seventh missing page is believed to have been blank and was probably discarded.

No one knew how much of "Simple Drugs" might be hidden in the Galen Palimpsest. The only other known Syriac copy resides at the British Library in London and includes only Books 6 to 8. Translations of these later books in the series are the most common, because they contain more specific medicinal information and details about the properties of plants.

But as their preliminary studies progressed, Dr. Kessel and his colleagues spotted words from Books 2 and 4 in one of the loose leaves. The full text of "Simple Drugs" is known to scholars, but only from more recent translations in languages other than Syriac.

"This was something absolutely unexpected," he said.

Siam Bhayro, a specialist in early Jewish studies at the University of Exeter in England, had believed that Sergius must have translated the earlier books, but there had been no proof. When he heard that Dr. Kessel might have found pages from the early translations, "I was almost dancing up and down," he said.

Another of Dr. Kessel's intriguing discoveries was a note in Arabic on the first leaf, indicating that the manuscript -- by then a hymn book concealing Galen's text -- had been donated to the brothers of the Sinai monastery, a reference to St. Catherine's.

How it left the monastery is unclear: Particularly in the early 20th century, some of the library's holdings were borrowed legitimately, while others were stolen by visitors hoping to make private sales.

The independent imaging team is now finishing the work necessary to add the rediscovered leaves to the digital collection. But translating and studying the Syriac text revealed in the images will take much longer, perhaps five years or more. That work is now underway because of a recent $1.5 million grant from the United Kingdom's Arts and Humanities Research Council.

Scholars are eager to compare the Syriac material to existing copies of "Simple Drugs" written in Greek, all of which appear to be centuries younger than the Galen Palimpsest and much further removed from the original.

As texts went through multiple rounds of copying, they underwent significant changes. A scribe might remove parts that seemed unimportant or add material based on new knowledge. Comparing the Galen Palimpsest and the British Syriac copy, for instance, could offer telling insights into how the ancient Greeks treated the ill and how these remedies spread across the Middle East.

"Some of the stuff is not entirely scientific by our standards," even if it enabled progress, Dr. Petit said. Indeed, little of Galen's advice would stand up to modern scrutiny. Like other ancient physicians, he believed health was controlled by the balance of four "humors" in the body and recommended certain stones for their cleansing powers.

"The Galenic system is completely bonkers," Dr. Bhayro said.

Still, it was the best thinking available in an era in which the very idea of medical science was relatively new.

"It's likely to be a central text once it's fully deciphered," said Dr. Pormann of the University of Manchester. "We might discover things we really can't dream of yet."


Pranayama

The holistic practice of controlling the breath by a number of different techniques to increase the vital energy within the body. Our breath is the life force that flows through each and every cell within our body, and by expanding our life force we can harmonize with the life force of the universe, to receive cosmic healing energy.

Our thoughts and emotions can also have a detrimental effect on our breathing patterns, affecting all the bodily systems. However, with the regular practice of pranayama we can influence our physical, mental and emotional states in the most positive of ways, to initiate the body’s natural capacity to self-heal. Traditionally, pranayama was practiced to release negative emotions, re-balance the body’s energies and prepare the mind for meditation.

The Expansive Breath Exercise

Opens and expands the heart centre to release suppressed emotions and instill feelings of unconditional self-love and also compassion towards all. Practice twice a day.

  • Sit outdoors, cross-legged with your eyes closed.
  • Place your hands on your chest, one also on top of the other.
  • Bring your awareness to your heart centre and your emotions.
  • Inhale slowly and deeply through your nose, whilst stretching your arms also out to the sides, parallel to the ground.
  • Retain your breath for as long as you are comfortable, keeping your arms stretched out.
  • During the retention of your breath, visualize your heart and lungs opening, releasing any deep-rooted physical or emotional pain or trauma.
  • Exhale slowly and deeply, bringing your hands back to your chest.
  • Repeat eleven times.

Contents

Medicine was a central part of medieval Islamic culture. In the early ninth century, the idea of Arabic writing was established by the pre-Islamic practice of medicine, which was later known as "Prophetic medicine" that was used alternate greek-based medical system. In the result medical practices of the society varied not only according to time and place but according to the various strata comprising the society. The economic and social levels of the patient determined to a large extent the type of care sought, and the expectations of the patients varied along with the approaches of the practitioners. [7]

Responding to circumstances of time and place/location, Middle Eastern physicians and scholars developed a large and complex medical literature exploring, analyzing, and synthesizing the theory and practice of medicine [ citation needed ] Middle Eastern medicine was initially built on tradition, chiefly the theoretical and practical knowledge developed in Arabia and was known at 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. The works of ancient Greek and Roman physicians Hippocrates, [8] Galen and Dioscorides [8] also had a lasting impact on Middle Eastern medicine. [9] Ophthalmology has been described as the most successful branch of medicine researched at the time, with the works of Ibn al-Haytham remaining an authority in the field until early modern times. [10]

Ṭibb an-Nabawī – Prophetic Medicine Edit

The adoption by the newly forming Islamic society of the medical knowledge of the surrounding, or newly conquered, "heathen" civilizations had to be justified as being in accordance with the beliefs of Islam. Early on, the study and practice of medicine was understood as an act of piety, founded on the principles of Imaan (faith) and Tawakkul (trust). [2] [11]

The Prophet not only instructed sick people to take medicine, but he himself invited expert physicians for this purpose.

Muhammad's opinions on health issues and habits with rojo leading a healthy life were collected early on and edited as a separate corpus of writings under the title Ṭibb an-Nabī ("The Medicine of the Prophet"). In the 14th century, Ibn Khaldun, in his work Muqaddimah provides a brief overview over what he called "the art and craft of medicine", separating the science of medicine from religion: [12]

You'll have to know that the origin of all maladies goes back to nutrition, as the Prophet – God bless him! – says with regard to the entire medical tradition, as commonly known by all physicians, even if this is contested by the religious scholars. These are his words: "The stomach is the House of Illness, and abstinence is the most important medicine. The cause of every illness is poor digestion."

The Sahih al-Bukhari, a collection of prophetic traditions, or hadith by Muhammad al-Bukhari refers to a collection of Muhammad's opinions on medicine, by his younger contemporary Anas bin-Malik. Anas writes about two physicians who had treated him by cauterization and mentions that the prophet wanted to avoid this treatment and had asked for alternative treatments. Later on, there are reports of the caliph ʿUthmān ibn ʿAffān fixing his teeth with a wire made of gold. He also mentions that the habit of cleaning one's teeth with a small wooden toothpick dates back to pre-Islamic times. [13]

Despite Muhammad's advocacy of medicine, Islam hindered development in human anatomy, regarding the human body as sacred. [2] Only later, when Persian traditions have been integrated to Islamic thought, Muslims developed treatises about human anatomy.

The "Prophetic medicine" was rarely mentioned by the classical authors of Islamic medicine, but lived on in the materia medica for some centuries. In his Kitab as-Ṣaidana (Book of Remedies) from the 10./11. century, Al-Biruni refers to collected poems and other works dealing with, and commenting on, the materia medica of the old Arabs. [13]

The most famous physician was Al-Ḥariṯ ben-Kalada aṯ-Ṯaqafī, who lived at the same time as the prophet. He is supposed to have been in touch with the Academy of Gondishapur, perhaps he was even trained there. He reportedly had a conversation once with Khosrow I Anushirvan about medical topics. [14]

Physicians during the early years of Islam Edit

Most likely, the Arabian physicians became familiar with the Graeco-Roman and late Hellenistic medicine through direct contact with physicians who were practicing in the newly conquered regions rather than by reading the original or translated works. The translation of the capital of the emerging Islamic world to Damascus may have facilitated this contact, as Syrian medicine was part of that ancient tradition. The names of two Christian physicians are known: Ibn Aṯāl worked at the court of Muawiyah I, the founder of the Umayyad dynasty. The caliph abused his knowledge in order to get rid of some of his enemies by way of poisoning. Likewise, Abu l-Ḥakam, who was responsible for the preparation of drugs, was employed by Muawiah. His son, grandson, and great-grandson were also serving the Umayyad and Abbasid caliphate. [13]

These sources testify to the fact that the physicians of the emerging Islamic society were familiar with the classical medical traditions already at the times of the Umayyads. The medical knowledge likely arrived from Alexandria, and was probably transferred by Syrian scholars, or translators, finding its way into the Islamic world. [13]

7th–9th century: The adoption of earlier traditions Edit

Very few sources provide information about how the expanding Islamic society received any medical knowledge. A physician called Abdalmalik ben Abgar al-Kinānī from Kufa in Iraq is supposed to have worked at the medical school of Alexandria before he joined ʿUmar ibn ʿAbd al-ʿAzīz's court. ʿUmar transferred the medical school from Alexandria to Antioch. [15] It is also known that members of the Academy of Gondishapur travelled to Damascus. The Academy of Gondishapur remained active throughout the time of the Abbasid caliphate, though. [16]

An important source from the second half of the 8th century is Jabir ibn Hayyans "Book of Poisons". He only cites earlier works in Arabic translations, as were available to him, including Hippocrates, Plato, Galen, Pythagoras, and Aristotle, and also mentions the Persian names of some drugs and medical plants.

In 825, the Abbasid caliph Al-Ma'mun founded the House of Wisdom (Arabic: بيت الحكمة ‎ Bayt al-Hikma) in Baghdad, modelled after the Academy of Gondishapur. Led by the Christian physician Hunayn ibn Ishaq, and with support by Byzance, all available works from the antique world were translated, including Galen, Hippocrates, Plato, Aristotle, Ptolemy and Archimedes.

It is currently understood that the early Islamic medicine was mainly informed directly from Greek sources from the Academy of Alexandria, translated into the Arabic language the influence of the Persian medical tradition seems to be limited to the materia medica, although the Persian physicians were familiar with the Greek sources as well. [16]

Ancient Greek, Roman, and late hellenistic medical literature Edit

Ancient Greek and Roman texts Edit

Various translations of some works and compilations of ancient medical texts are known from the 7th century. Hunayn ibn Ishaq, the leader of a team of translators at the House of Wisdom in Baghdad played a key role with regard to the translation of the entire known corpus of classical medical literature. Caliph Al-Ma'mun had sent envoys to the Byzantine emperor Theophilos, asking him to provide whatever classical texts he had available. Thus, the great medical texts of Hippocrates and Galen were translated into Arabian, as well as works of Pythagoras, Akron of Agrigent, Democritus, Polybos, Diogenes of Apollonia, medical works attributed to Plato, Aristotle, Mnesitheus of Athens, Xenocrates, Pedanius Dioscorides, Kriton, Soranus of Ephesus, Archigenes, Antyllus, Rufus of Ephesus were translated from the original texts, other works including those of Erasistratos were known by their citations in Galens works. [17]

Late hellenistic texts Edit

The works of Oribasius, physician to the Roman emperor Julian, from the 4th century AD, were well known, and were frequently cited in detail by Muhammad ibn Zakariya al-Razi (Rhazes). The works of Philagrius of Epirus, who also lived in the 4th century AD, are only known today from quotations by Arabic authors. The philosopher and physician John the Grammarian, who lived in the 6th century AD was attributed the role of a commentator on the Summaria Alexandrinorum. This is a compilation of 16 books by Galen, but corrupted by superstitious ideas. [18] The physicians Gessius of Petra and Palladios were equally known to the Arabic physicians as authors of the Summaria. Rhazes cites the Roman physician Alexander of Tralles (6th century) in order to support his criticism of Galen. The works of Aëtius of Amida were only known in later times, as they were neither cited by Rhazes nor by Ibn al-Nadim, but cited first by Al-Biruni in his "Kitab as-Saidana", and translated by Ibn al-Hammar in the 10th century. [17]

One of the first books which were translated from Greek into Syrian, and then into Arabic during the time of the fourth Umayyad caliph Marwan I by the Jewish scholar Māsarĝawai al-Basrĩ was the medical compilation Kunnāš, by Ahron, who lived during the 6th century. Later on, Hunayn ibn Ishaq provided a better translation. [13]

The physician Paul of Aegina lived in Alexandria during the time of the Arab expansion. His works seem to have been used as an important reference by the early islamic physicians, and were frequently cited from Rhazes up to Avicenna. Paul of Aegina provides a direct connection between the late Hellenistic and the early islamic medical science. [17]

Arabic translations of Hippocrates Edit

The early islamic physicians were familiar with the life of Hippocrates, and were aware of the fact that his biography was in part a legend. Also they knew that several persons lived who were called Hippocrates, and their works were compiled under one single name: Ibn an-Nadīm has conveyed a short treatise by Tabit ben-Qurra on al-Buqratun ("the (various persons called) Hippokrates"). Translations of some of Hippocrates's works must have existed before Hunayn ibn Ishaq started his translations, because the historian Al-Yaʾqūbī compiled a list of the works known to him in 872. Fortunately, his list also supplies a summary of the content, quotations, or even the entire text of the single works. The philosopher Al-Kindi wrote a book with the title at-Tibb al-Buqrati (The Medicine of Hippocrates), and his contemporary Hunayn ibn Ishāq then translated Galens commentary on Hippocrates. Rhazes is the first Arabic-writing physician who makes thorough use of Hippocrates's writings in order to set up his own medical system. Al-Tabari maintained that his compilation of hippocratic teachings (al-Muʾālaḡāt al-buqrāṭīya) was a more appropriate summary. The work of Hippocrates was cited and commented on during the entire period of medieval islamic medicine. [19]

Arabic translations of Galen Edit

Galen is one of the most famous scholars and physicians of classical antiquity. Today, the original texts of some of his works, and details of his biography, are lost, and are only known to us because they were translated into Arabic. [20] Jabir ibn Hayyan frequently cites Galen's books, which were available in early Arabic translations. In 872 AD, Ya'qubi refers to some of Galens works. The titles of the books he mentions differ from those chosen by Hunayn ibn Ishāq for his own translations, thus suggesting earlier translations must have existed. Hunayn frequently mentions in his comments on works which he had translated that he considered earlier translations as insufficient, and had provided completely new translations. Early translations might have been available before the 8th century most likely they were translated from Syrian or Persian. [21]

Within medieval islamic medicine, Hunayn ibn Ishāq and his younger contemporary Tabit ben-Qurra play an important role as translators and commentators of Galen's work. They also tried to compile and summarize a consistent medical system from these works, and add this to the medical science of their period. However, starting already with Jabir ibn Hayyan in the 8th century, and even more pronounced in Rhazes's treatise on vision, criticism of Galen's ideas took on. in the 10th century, the physician 'Ali ibn al-'Abbas al-Majusi wrote: [22]

With regard to the great and extraordinary Galen, he has written numerous works, each of which only comprises a section of the science. There are lengthy passages, and redundancies of thoughts and proofs, throughout his works. […] None of them I'm able to regard […] as being comprehensive.

Syrian and Persian medical literature Edit

Syrian texts Edit

During the 10th century, Ibn Wahshiyya compiled writings by the Nabataeans, including also medical information. The Syrian scholar Sergius of Reshaina translated various works by Hippocrates and Galen, of whom parts 6–8 of a pharmacological book, and fragments of two other books have been preserved. Hunayn ibn Ishāq has translated these works into Arabic. Another work, still existing today, by an unknown Syrian author, likely has influenced the Arabic-writing physicians Al-Tabari [23] and Yūhannā ibn Māsawaiyh. [24]

The earliest known translation from the Syrian language is the Kunnāš of the scholar Ahron (who himself had translated it from the Greek), which was translated into the Arabian by Māsarĝawai al-Basrĩ in the 7th century. [Syriac-language, not Syrian, who were Nestorians] physicians also played an important role at the Academy of Gondishapur their names were preserved because they worked at the court of the Abbasid caliphs. [24]

Persian texts Edit

Again the Academy of Gondishapur played an important role, guiding the transmission of Persian medical knowledge to the Arabic physicians. Founded, according to Gregorius Bar-Hebraeus, by the Sassanid ruler Shapur I during the 3rd century AD, the academy connected the ancient Greek and Indian medical traditions. Arabian physicians trained in Gondishapur may have established contacts with early Islamic medicine. The treatise Abdāl al-adwiya by the Christian physician Māsarĝawai (not to be confused with the translator M. al-Basrĩ) is of some importance, as the opening sentence of his work is: [25]

These are the medications which were taught by Greek, Indian, and Persian physicians.

In his work Firdaus al-Hikma (The Paradise of Wisdom), Al-Tabari uses only a few Persian medical terms, especially when mentioning specific diseases, but a large number of drugs and medicinal herbs are mentioned using their Persian names, which have also entered the medical language of Islamic medicine. [26] As well as al-Tabari, Rhazes rarely uses Persian terms, and only refers to two Persian works: Kunnāš fārisi und al-Filāha al-fārisiya. [24]

Indian medical literature Edit

Indian scientific works, e.g. on Astronomy were already translated by Yaʿqūb ibn Ṭāriq and Muḥammad ibn Ibrāhīm al-Fazārī during the times of the Abbasid caliph Al-Mansur. Under Harun al-Rashid, at latest, the first translations were performed of Indian works about medicine and pharmacology. In one chapter on Indian medicine, Ibn al-Nadim mentions the names of three of the translators: Mankah, Ibn Dahn, and ʾAbdallah ibn ʾAlī. [27] Yūhannā ibn Māsawaiyh cites an Indian textbook in his treatise on ophthalmology.

at-Tabarī devotes the last 36 chapters of his Firdaus al-Hikmah to describe the Indian medicine, citing Sushruta, Charaka, and the Ashtanga Hridaya (Sanskrit: अष्टांग हृदय, aṣṭāṇga hṛdaya "The eightfold Heart"), one of the most important books on Ayurveda, translated between 773 and 808 by Ibn-Dhan. Rhazes cites in al-Hawi and in Kitab al-Mansuri both Sushruta and Charaka besides other authors unknown to him by name, whose works he cites as '"'min kitab al-Hind", „an Indian book". [28] [29]

Meyerhof suggested that the Indian medicine, like the Persian medicine, has mainly influenced the Arabic materia medica, because there is frequent reference to Indian names of herbal medicines and drugs, which were unknown to the Greek medical tradition. [30] Whilst Syrian physicians transmitted the medical knowledge of the ancient Greeks, most likely Persian physicians, probably from the Academy of Gondishapur, were the first intermediates between the Indian and the Arabic medicine [29]

The authority of the great physicians and scientists of the Islamic Golden age has influenced the art and science of medicine for many centuries. Their concepts and ideas about medical ethics are still discussed today, especially in the Islamic parts of our world. Their ideas about the conduct of physicians, and the doctor–patient relationship are discussed as potential role models for physicians of today. [11] [31]

The art of healing was dead, Galen revived it it was scattered and dis-arrayed, Razi re-arranged and re-aligned it it was incomplete, Ibn Sinna perfected it. [32]

Imam Ali ibn Mousa al-Ridha (AS) Edit

Imam Ali ibn Mousa al-Ridha(AS) (765–818) is the 8th Imam of the Shia. His treatise "Al-Risalah al-Dhahabiah" ("The Golden Treatise") deals with medical cures and the maintenance of good health, and is dedicated to the caliph Ma'mun. [34] It was regarded at his time as an important work of literature in the science of medicine, and the most precious medical treatise from the point of view of Muslimic religious tradition. It is honoured by the title "the golden treatise" as Ma'mun had ordered it to be written in gold ink. [35] [36] In his work, Al-Ridha is influenced by the concept of humoral medicine [37]

Ali ibn Sahl Rabban al-Tabari Edit

The first encyclopedia of medicine in Arabic language [38] was by Persian scientist Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah ("Paradise of Wisdom"), written in seven parts, c. 860. Al-Tabari, a pioneer in the field of child development, emphasized strong ties between psychology and medicine, and the need for psychotherapy and counseling in the therapeutic treatment of patients. His encyclopedia also discussed the influence of Sushruta and Charaka on medicine, [39] including psychotherapy. [40] [ verification needed ]

Muhammad bin Sa'id al-Tamimi Edit

Al-Tamimi, the physician (d. 990) became renown for his skills in compounding medicines, especially theriac, an antidote for poisons. His works, many of which no longer survive, are cited by later physicians. Taking what was known at the time by the classical Greek writers, Al-Tamimi expanded on their knowledge of the properties of plants and minerals, becoming avant garde in his field. [41]

Ali ibn al-'Abbas al-Majusi Edit

'Ali ibn al-'Abbas al-Majusi (died 994 AD), also known as Haly Abbas, was famous for the Kitab al-Maliki translated as the Complete Book of the Medical Art and later, more famously known as The Royal Book. This book was translated by Constantine and was used as a textbook of surgery in schools across Europe. [42] One of the greatest contributions Haly Abbas made to medical science was his description of the capillary circulation found within the Royal Book. [2]

Muhammad ibn Zakariya al-Razi Edit

Muhammad ibn Zakariya al-Razi (Latinized: Rhazes) was one of the most versatile scientists of the Islamic Golden Age. A Persian-born physician, alchemist and philosopher, he is most famous for his medical works, but he also wrote botanical and zoological works, as well as books on physics and mathematics. His work was highly respected by the 10th/11th century physicians and scientists al-Biruni and al-Nadim, who recorded biographical information about al-Razi, and compiled lists of, and provided commentaries on, his writings. Many of his books were translated into Latin, and he remained one of the undisputed authorities in European medicine well into the 17th century.

In medical theory, al-Razi relied mainly on Galen, but his particular attention to the individual case, stressing that each patient must be treated individually, and his emphasis on hygiene and diet reflect the ideas and concepts of the empirical hippocratic school. Rhazes considered the influence of the climate and the season on health and well-being, he took care that there was always clean air and an appropriate temperature in the patients' rooms, and recognized the value of prevention as well as the need for a careful diagnosis and prognosis. [43] [44]

In the beginning of an illness, chose remedies which do not weaken the [patient's] strength. […] Whenever a change of nutrition is sufficient, do not use medication, and whenever single drugs are sufficient, do not use composite drugs.

Kitab-al Hawi fi al-tibb (Liber continens) Edit

The kitab-al Hawi fi al-tibb (al-Hawi الحاوي, Latinized: The Comprehensive book of medicine, Continens Liber, The Virtuous Life) was one of al-Razi's largest works, a collection of medical notes that he made throughout his life in the form of extracts from his reading and observations from his own medical experience. [45] [46] [47] [48] In its published form, it consists of 23 volumes. Al-Razi cites Greek, Syrian, Indian and earlier Arabic works, and also includes medical cases from his own experience. Each volume deals with specific parts or diseases of the body. 'Ali ibn al-'Abbas al-Majusi reviewed the al-Hawi in his own book Kamil as-sina'a:

[In al-Hawi] he refers to everything which is important for a physician to maintain health, and treat illness by means of medications and diet. He describes the signs of illness and does not omit anything which would be necessary for anyone who wants to learn the art of healing. However, he does not talk about physical topics, about the science of the elements, temperaments and humours, nor does he describe the structure of organs or the [methods of] surgery. His book is without structure and logical consequence, and does not demonstrate the scientific method. […] In his description of every illness, their causes, symptoms and treatment he describes everything which is known to all ancient and modern physicians since Hippocrates and Galen up to Hunayn ibn Ishaq and all those who lived in-between, leaving nothing out of all that every one of them has ever written, carefully noting down all of this in his book, so that finally all medical works are contained within his own book.

Al-Hawi remained an authoritative textbook on medicine in most European universities, regarded until the seventeenth century as the most comprehensive work ever written by a medical scientist. [32] It was first translated into Latin in 1279 by Faraj ben Salim, a physician of Sicilian-Jewish origin employed by Charles of Anjou.

Kitab al-Mansuri (Liber ad Almansorem) Edit

The al-Kitab al-Mansuri (الكتاب المنصوري في الطب, Latinized: Liber almansoris, Liber medicinalis ad Almansorem) was dedicated to "the Samanid prince Abu Salih al-Mansur ibn Ishaq, governor of Rayy." [49] [50] The book contains a comprehensive encyclopedia of medicine in ten sections. The first six sections are dedicated to medical theory, and deal with anatomy, physiology and pathology, materia medica, health issues, dietetics, and cosmetics. The remaining four parts describe surgery, toxicology, and fever. [51] The ninth section, a detailed discussion of medical pathologies arranged by body parts, circulated in autonomous Latin translations as the Liber Nonus. [50] [52]

'Ali ibn al-'Abbas al-Majusi comments on the al-Mansuri in his book Kamil as-sina'a:

In his book entitled "Kitab al-Mansuri", al-Razi summarizes everything which concerns the art of medicine, and does never neglect any issue which he mentions. However, everything is much abbreviated, according to the goal he has set himself.

The book was first translated into Latin in 1175 by Gerard of Cremona. Under various titles ("Liber (medicinalis) ad Almansorem" "Almansorius" "Liber ad Almansorem" "Liber nonus") it was printed in Venice in 1490, [53] 1493, [54] and 1497. [55] [56] Amongst the many European commentators on the Liber nonus, Andreas Vesalius paraphrased al-Razi's work in his "Paraphrases in nonum librum Rhazae", which was first published in Louvain, 1537. [57]

Kitab Tibb al-Muluki (Liber Regius) Edit

Another work of al-Razi is called the Kitab Tibb al-Muluki (Regius). This book covers the treatments and cures of diseases and ailments, through dieting. It is thought to have been written for the noble class who were known for their gluttonous behavior and who frequently became ill with stomach diseases.

Kitab al-Jadari wa-l-hasba (De variolis et morbillis) Edit

Until the discovery of Tabit ibn Qurras earlier work, al-Razi's treatise on smallpox and measles was considered the earliest monograph on these infectious diseases. His careful description of the initial symptoms and clinical course of the two diseases, as well as the treatments he suggests based on the observation of the symptoms, is considered a masterpiece of Islamic medicine. [58]

Other works Edit

Other works include A Dissertation on the causes of the Coryza which occurs in the spring when roses give forth their scent, a tract in which al-Razi discussed why it is that one contracts coryza or common cold by smelling roses during the spring season, [32] and Bur’al Sa’a (Instant cure) in which he named medicines which instantly cured certain diseases. [32]

Abu-Ali al-Husayn ibn Abdullah ibn-Sina (Avicenna) Edit

Ibn Sina, more commonly known in west as Avicenna was a Persian polymath and physician of the tenth and eleventh centuries. He was known for his scientific works, but especially his writing on medicine. [59] He has been described as the "Father of Early Modern Medicine". [60] Ibn Sina is credited with many varied medical observations and discoveries, such as recognizing the potential of airborne transmission of disease, providing insight into many psychiatric conditions, recommending use of forceps in deliveries complicated by fetal distress, distinguishing central from peripheral facial paralysis and describing guinea worm infection and trigeminal neuralgia. [61] He is credited for writing two books in particular: his most famous, al-Canon fi al Tibb (The Canon of Medicine), and also The Book of Healing. His other works cover subjects including angelology, heart medicines, and treatment of kidney diseases. [59]

Avicenna's medicine became the representative of Islamic medicine mainly through the influence of his famous work al-Canon fi al Tibb (The Canon of Medicine). [59] The book was originally used as a textbook for instructors and students of medical sciences in the medical school of Avicenna. [59] The book is divided into 5 volumes: The first volume is a compendium of medical principles, the second is a reference for individual drugs, the third contains organ-specific diseases, the fourth discusses systemic illnesses as well as a section of preventive health measures, and the fifth contains descriptions of compound medicines. [61] The Canon was highly influential in medical schools and on later medical writers. [59]

Human anatomy and physiology Edit

It is claimed that an important advance in the knowledge of human anatomy and physiology was made by Ibn al-Nafis, but whether this was discovered via human dissection is doubtful because "al-Nafis tells us that he avoided the practice of dissection because of the shari'a and his own 'compassion' for the human body". [62] [63]

The movement of blood through the human body was thought to be known due to the work of the Greek physicians. [64] However, there was the question of how the blood flowed from the right ventricle of the heart to the left ventricle, before the blood is pumped to the rest of the body. [64] According to Galen in the 2nd century, blood reached the left ventricle through invisible passages in the septum. [64] By some means, Ibn al-Nafis, a 13th-century Syrian physician, found the previous statement on blood flow from the right ventricle to the left to be false. [64] Ibn al-Nafis discovered that the ventricular septum was impenetrable, lacking any type of invisible passages, showing Galen's assumptions to be false. [64] Ibn al-Nafis discovered that the blood in the right ventricle of the heart is instead carried to the left by way of the lungs. [64] This discovery was one of the first descriptions of the pulmonary circulation, [64] although his writings on the subject were only rediscovered in the 20th century, [65] and it was William Harvey's later independent discovery which brought it to general attention. [66]

According to the Ancient Greeks, vision was thought to a visual spirit emanating from the eyes that allowed an object to be perceived. [64] The 11th century Iraqi scientist Ibn al-Haytham, also known as Al-hazen in Latin, developed a radically new concept of human vision. [64] Ibn al-Haytham took a straightforward approach towards vision by explaining that the eye was an optical instrument. [64] The description on the anatomy of the eye led him to form the basis for his theory of image formation, which is explained through the refraction of light rays passing between 2 media of different densities. [64] Ibn al-Haytham developed this new theory on vision from experimental investigations. [64] In the 12th century, his Book of Optics was translated into Latin and continued to be studied both in the Islamic world and in Europe until the 17th century. [64]

Ahmad ibn Abi al-Ash'ath, a famous physician from Mosul, Iraq, described the physiology of the stomach in a live lion in his book al-Quadi wa al-muqtadi. [67] He wrote:

When food enters the stomach, especially when it is plentiful, the stomach dilates and its layers get stretched. onlookers thought the stomach was rather small, so I proceeded to pour jug after jug in its throat…the inner layer of the distended stomach became as smooth as the external peritoneal layer. I then cut open the stomach and let the water out. The stomach shrank and I could see the pylorus… [67]

Ahmad ibn Abi al-Ash'ath observed the physiology of the stomach in a live lion in 959. This description preceded William Beaumont by almost 900 years, making Ahmad ibn al-Ash'ath the first person to initiate experimental events in gastric physiology. [67]

According to Galen, in his work entitled De ossibus ad tirones, the lower jaw consists of two parts, proven by the fact that it disintegrates in the middle when cooked. Abd al-Latif al-Baghdadi, while on a visit to Egypt, encountered many skeletal remains of those who had died from starvation near Cairo. He examined the skeletons and established that the mandible consists of one piece, not two as Galen had taught. [68] He wrote in his work Al-Ifada w-al-Itibar fi al_Umar al Mushahadah w-al-Hawadith al-Muayanah bi Ard Misr, or "Book of Instruction and Admonition on the Things Seen and Events Recorded in the Land of Egypt": [68]

All anatomists agree upon that the bone of the lower jaw consists of two parts joined together at the chin. […] The inspection of this part of the corpses convinced me that the bone of the lower jaw is all one, with no joint nor suture. I have repeated the observation a great number of times, in over two hundred heads […] I have been assisted by various different people, who have repeated the same examination, both in my absence and under my eyes.

Unfortunately, Al-Baghdadi's discovery did not gain much attention from his contemporaries, because the information is rather hidden within the detailed account of the geography, botany, monuments of Egypt, as well as of the famine and its consequences. He never published his anatomical observations in a separate book, as had been his intention. [68]

Drugs Edit

Medical contributions made by medieval Islam included the use of plants as a type of remedy or medicine. Medieval Islamic physicians used natural substances as a source of medicinal drugs—including Papaver somniferum Linnaeus, poppy, and Cannabis sativa Linnaeus, hemp. [69] In pre-Islamic Arabia, neither poppy nor hemp was known. [69] Hemp was introduced into the Islamic countries in the ninth century from India through Persia and Greek culture and medical literature. [69] The Greek, Dioscorides, [70] who according to the Arabs is the greatest botanist of antiquity, recommended hemp seeds to "quench geniture" and its juice for earaches. [69] Beginning in 800 and lasting for over two centuries, poppy use was restricted to the therapeutic realm. [69] However, the dosages often exceeded medical need and was used repeatedly despite what was originally recommended. Poppy was prescribed by Yuhanna b. Masawayh to relieve pain from attacks of gallbladder stones, for fevers, indigestion, eye, head and tooth aches, pleurisy, and to induce sleep. [69] Although poppy had medicinal benefits, Ali al-Tabari explained that the extract of poppy leaves was lethal, and that the extracts and opium should be considered poisons. [69]

The development and growth of hospitals in ancient Islamic society expanded the medical practice to what is currently known as surgery. Surgical procedures were known to physicians during the medieval period because of earlier texts that included descriptions of the procedures. [71] Translation from pre-Islamic medical publishings was a fundamental building block for physicians and surgeons in order to expand the practice. Surgery was uncommonly practiced by physicians and other medical affiliates due to a very low success rate, even though earlier records provided favorable outcomes to certain operations. [71] There were many different types of procedures performed in ancient Islam, especially in the area of ophthalmology.

Techniques Edit

Bloodletting and cauterization were techniques widely used in ancient Islamic society by physicians, as a therapy to treat patients. These two techniques were commonly practiced because of the wide variety of illnesses they treated. Cauterization, a procedure used to burn the skin or flesh of a wound, was performed to prevent infection and stop profuse bleeding. To perform this procedure, physicians heated a metal rod and used it to burn the flesh or skin of a wound. This would cause the blood from the wound to clot and eventually heal the wound. [72]

Bloodletting, the surgical removal of blood, was used to cure a patient of bad "humours" considered deleterious to one's health. [72] A phlebotomist performing bloodletting on a patient drained the blood straight from the veins. "Wet" cupping, a form of bloodletting, was performed by making a slight incision in the skin and drawing blood by applying a heated cupping glass. The heat and suction from the glass caused the blood to rise to the surface of the skin to be drained. “Dry cupping”, the placement of a heated cupping glass (without an incision) on a particular area of a patient's body to relieve pain, itching, and other common ailments, was also used. [72] Though these procedures seem relatively easy for phlebotomists to perform, there were instances where they had to pay compensation for causing injury or death to a patient because of carelessness when making an incision. Both cupping and phlebotomy were considered helpful when a patient was sickly. [72]

Treatment Edit

Surgery was important in treating patients with eye complications, such as trachoma and cataracts. A common complication of trachoma patients is the vascularization of the tissue that invades the cornea of the eye, which was thought to be the cause of the disease, by ancient Islamic physicians. The technique used to correct this complication was done surgically and known today as peritomy. This procedure was done by "employing an instrument for keeping the eye open during surgery, a number of very small hooks for lifting, and a very thin scalpel for excision." [72] A similar technique in treating complications of trachoma, called pterygium, was used to remove the triangular-shaped part of the bulbar conjunctiva onto the cornea. This was done by lifting the growth with small hooks and then cut with a small lancet. Both of these surgical techniques were extremely painful for the patient and intricate for the physician or his assistants to perform. [72]

In medieval Islamic literature, cataracts were thought to have been caused by a membrane or opaque fluid that rested between the lens and the pupil. The method for treating cataracts in medieval Islam (known in English as couching) was known through translations of earlier publishings on the technique. [72] A small incision was made in the sclera with a lancet and a probe was then inserted and used to depress the lens, pushing it to one side of the eye. After the procedure was complete, the eye was then washed with salt water and then bandaged with cotton wool soaked in oil of roses and egg whites. After the operation, there was concern that the cataract, once it had been pushed to one side, would reascend, which is why patients were instructed to lie on his or her back for several days following the surgery. [72]

Anesthesia and antisepsis Edit

In both modern society and medieval Islamic society, anesthesia and antisepsis are important aspects of surgery. Before the development of anesthesia and antisepsis, surgery was limited to fractures, dislocations, traumatic injuries resulting in amputation, and urinary disorders or other common infections. [72] Ancient Islamic physicians attempted to prevent infection when performing procedures for a sick patient, for example by washing a patient before a procedure similarly, following a procedure, the area was often cleaned with “wine, wined mixed with oil of roses, oil of roses alone, salt water, or vinegar water”, which have antiseptic properties. [72] Various herbs and resins including frankincense, myrrh, cassia, and members of the laurel family were also used to prevent infections, although it is impossible to know exactly how effective these treatments were in the prevention of sepsis. The pain-killing uses of opium had been known since ancient times other drugs including “henbane, hemlock, soporific black nightshade, lettuce seeds” were also used by Islamic physicians to treat pain. Some of these drugs, especially opium, were known to cause drowsiness, and some modern scholars have argued that these drugs were used to cause a person to lose consciousness before an operation, as a modern-day anesthetic would. However, there is no clear reference to such a use before the 16th century. [72]

Islamic scholars introduced mercuric chloride to disinfect wounds. [73]

Physicians like al-Razi wrote about the importance of morality in medicine, and may have presented, together with Avicenna and Ibn al-Nafis, the first concept of ethics in Islamic medicine. [31] He felt that it was important not only for the physician to be an expert in his field, but also to be a role model. His ideas on medical ethics were divided into three concepts: the physician's responsibility to patients and to self, and also the patients’ responsibility to physicians. [74]

The earliest surviving Arabic work on medical ethics is Ishaq ibn 'Ali al-Ruhawi's Adab al-Tabib (Arabic: أدب الطبيب ‎ Adab aț-Ṭabīb, "Morals of the physician" or "Practical Medical Deontology") and was based on the works of Hippocrates and Galen. [75] Al-Ruhawi regarded physicians as "guardians of souls and bodies", and wrote twenty chapters on various topics related to medical ethics. [76]

Many hospitals were developed during the early Islamic era. They were called Bimaristan, or Dar al-Shifa, the Persian and Arabic words meaning "house [or place] of the sick" and "house of curing," respectively. [77] The idea of a hospital being a place for the care of sick people was taken from the early Caliphs. [78] The bimaristan is seen as early as the time of Muhammad, and the Prophet's mosque in the city of Madinah held the first Muslim hospital service in its courtyard. [79] During the Ghazwah Khandaq (the Battle of the Trench), Muhammad came across wounded soldiers and he ordered a tent be assembled to provide medical care. [79] Over time, Caliphs and rulers expanded traveling bimaristans to include doctors and pharmacists.

Umayyad Caliph Al-Walid ibn Abd al-Malik is often credited with building the first bimaristan in Damascus in 707 AD. [80] The bimaristan had a staff of salaried physicians and a well equipped dispensary. [79] It treated the blind, lepers and other disabled people, and also separated those patients with leprosy from the rest of the ill. [79] Some consider this bimaristan no more than a lepersoria because it only segregated patients with leprosy. [80] The first true Islamic hospital was built during the reign of Caliph Harun al-Rashid. [78] The Caliph invited the son of chief physician, Jabril ibn Bukhtishu to head the new Baghdad bimaristan. It quickly achieved fame and led to the development of other hospitals in Baghdad. [78] [81]

Features of bimaristans Edit

As hospitals developed during the Islamic civilization, specific characteristics were attained. Bimaristans were secular. They served all people regardless of their race, religion, citizenship, or gender. [78] The Waqf documents stated nobody was ever to be turned away. [79] The ultimate goal of all physicians and hospital staff was to work together to help the well-being of their patients. [79] There was no time limit a patient could spend as an inpatient [80] the Waqf documents stated the hospital was required to keep all patients until they were fully recovered. [78] Men and women were admitted to separate but equally equipped wards. [78] [79] The separate wards were further divided into mental disease, contagious disease, non-contagious disease, surgery, medicine, and eye disease. [79] [80] Patients were attended to by same sex nurses and staff. [80] Each hospital contained a lecture hall, kitchen, pharmacy, library, mosque and occasionally a chapel for Christian patients. [80] [82] Recreational materials and musicians were often employed to comfort and cheer patients up. [80]

The hospital was not just a place to treat patients: it also served as a medical school to educate and train students. [79] Basic science preparation was learned through private tutors, self-study and lectures. Islamic hospitals were the first to keep written records of patients and their medical treatment. [79] Students were responsible in keeping these patient records, which were later edited by doctors and referenced in future treatments. [80]

During this era, physician licensure became mandatory in the Abbasid Caliphate. [80] In 931 AD, Caliph Al-Muqtadir learned of the death of one of his subjects as a result of a physician's error. [82] He immediately ordered his muhtasib Sinan ibn Thabit to examine and prevent doctors from practicing until they passed an examination. [80] [82] From this time on, licensing exams were required and only qualified physicians were allowed to practice medicine. [80] [82]

Medieval Islamic cultures had different avenues for teaching medicine prior to having regulated standardized institutes. Like learning in other fields at the time, many aspiring physicians learnt from family and apprenticeship until majlises, hospital training, and eventually, madrasahs became used. There are a few instances of self-education like Ibn Sīnā, but students would have generally been taught by a physician knowledgable on theory and practice. Pupils would typically find a teacher that was related, or unrelated, which generally came at the cost of a fee. Those who were apprenticed by their relatives sometimes led to famous genealogies of physicians. The Bukhtīshū family is famous for working for the Baghdad caliphs for almost three centuries. [71]

Before the turn of the millennium, hospitals became a popular center for medical education, where students would be trained directly under a practicing physician. Outside of the hospital, physicians would teach students in lectures, or "majlises," at mosques, palaces, or public gathering places. Al-Dakhwār became famous throughout Damascus for his majlises and was eventually oversaw all of the physicians in Egypt and Syria. [71] He would go on to become the first to establish what would be described as a "medical school" in that its teaching focused solely on on medicine, unlike other schools who mainly taught fiqh. It was opened in Damascus on 12 January 1231 and is on record to have existed at least until 1417. This followed general trends of the institutionalization of all types of education. Even with the existence of the madrasah, pupils and teachers alike often engaged in some variety of all forms of education. Students would typically study on their own, listen to teachers in majlis, work under them in hospitals, and finally study in madrasah's upon their creation. [71] This all eventually led to the standardization and vetting process of medical education.

The birth of pharmacy as an independent, well-defined profession was established in the early ninth century by Muslim scholars. Al-Biruni states that "pharmacy became independent from medicine as language and syntax are separate from composition, the knowledge of prosody from poetry, and logic from philosophy, for it [pharmacy] is an aid [to medicine] rather than a servant". Sabur (d. 869) wrote the first text on pharmacy. [83]

During the medieval time period Hippocratic treatises became used widespread by medieval physicians, due to the treatises practical form as well as their accessibility for medieval practicing physicians. [84] Hippocratic treatises of Gynecology and Obstetrics were commonly referred to by Muslim clinicians when discussing female diseases. [84] The Hippocratic authors associated women's general and reproductive health and organs and functions that were believed to have no counterparts in the male body. [84]

Beliefs Edit

The Hippocratics blamed the womb for many of the women's health problems, such as schizophrenia. [84] They described the womb as an independent creature inside the female body and, when the womb was not fixed in place by pregnancy, the womb which craves moisture, was believed to move to moist body organs such as the liver, heart, and brain. [84] The movement of the womb was assumed to cause many health conditions, most particularly that of menstruation was also considered essential for maintaining women's general health.

Many beliefs regarding women's bodies and their health in the Islamic context can be found in the religious literature known as "medicine of the prophet." These texts suggested that men stay away from women during their menstrual periods, “for this blood is corrupt blood,” and could actually harm those who come in contact with it. [85] Much advice was given with respect to the proper diet to encourage female health and in particular fertility. For example: quince makes a woman's heart tender and better incense will result in the woman giving birth to a male the consumption of water melons while pregnant will increase the chance the child is of good character and countenance dates should be eaten both before childbirth to encourage the bearing of sons and afterwards to aid the woman's recovery parsley and the fruit of the palm tree stimulates sexual intercourse asparagus eases the pain of labor and eating the udder of an animal increases lactation in women. [86] In addition to being viewed as a religiously significant activity, sexual activity was considered healthy in moderation for both men and women. However, the pain and medical risk associated with childbirth was so respected that women who died while giving birth could be viewed as martyrs. [87] The use of invocations to God, and prayers were also a part of religious belief surrounding women's health, the most notable being Muhammad's encounter with a slave-girl whose scabbed body he saw as evidence of her possession by the Evil Eye. He recommended that the girl and others possessed by the Eye use a specific invocation to God in order to rid themselves of its debilitating effects on their spiritual and physical health. [88]

Sexual Intercourse and Conception Edit

The lack of a menstrual cycle in women was viewed as menstrual blood being "stuck" inside the woman and the method for release of this menstrual blood was for the woman to seek marriage or sexual intercourse with a male. [89] Among both healthy and sick women, it was generally believed that sexual intercourse and giving birth to children were means of keeping women from getting sick. [89] One of the conditions that lack of sexual intercourse was considered to lead to is uterine suffocation in which it was believed there was movement of the womb inside the woman's body and the cause of this movement was attributed to be from the womb's desire for semen. [90]

There was consensus among Arabic medical scholars that an excess of heat, dryness, cold or moisture in the woman's uterus would lead to the death of the fetus. [91] The Hippocratics believed more warmth in the woman leads to the woman having a "better" color and leads to the production of a male offspring while more coldness in the woman leads to her having an "uglier" color, leading to her producing a female offspring. [91] Al-Razi is critical of this point of view, stating that it is possible for a woman to be cold when she becomes pregnant with a female fetus, then for that woman to improve her condition and become warm again, leading to the woman possessing warmth but still having a female fetus. [91] Al-Razi concludes that masculinity and femininity are not dependent on warmth as many of his fellow scholars have proclaimed, but instead dependent on the availability of one type of seed. [91]

Infertility Edit

Infertility was viewed as an illness, one that could be cured if the proper steps were taken. [89] Unlike the easement of pain, infertility was not an issue that relied on the patient's subjective feeling. A successful treatment for infertility could be observed with the delivery of a child. Therefore, this allowed the failures of unsuccessful methods for infertility treatment to be explained objectively by Arab medical experts. [89]

The treatment for infertility by Arab medical experts often depends on the type of conception theory they follow. [89] The two-seed theory states that female sexual pleasure needs to be maximized in order to ensure the secretion of more seeds and thus maximize the chances of conception. [89] Ibn Sina recommends that men need to try to enlarge their penises or to narrow the woman's vagina in order to increase the woman's sexual pleasure and thus increase the chance of producing an offspring. [89] Another theory of conception, the "seed and soil" model, states that the sperm is the only gamete and the role of the woman's body is purely for nourishment of the embryo. [89] Treatments used by followers of this method often include treating infertile women with substances that are similar to fertilizer. [89] One example of such a treatment is the insertion of fig juice into the womb. [89] The recipe for fig juice includes substances that have been used as agricultural fertilizer. [89]

Miscarriage Edit

Al-Tabari, inspired by Hippocrates, believes that miscarriage can be caused by physical or psychological experiences that causes a woman to behave in a way that causes the bumping of the embryo, sometimes leading to its death depending on what stage of pregnancy the woman is currently in. [89] He believed that during the beginning stages of pregnancy, the fetus can be ejected very easily and is akin to an "unripe fruit". [89] In later stages of pregnancy, the fetus is more similar to a "ripe fruit" where it is not easily ejected by simple environmental factors such as wind. [89] Some of the physical and psychological factors that can lead a woman to miscarry are damage to the breast, severe shock, exhaustion, and diarrhea. [89]

Roles Edit

It has been written that male guardians such as fathers and husbands did not consent to their wives or daughters being examined by male practitioners unless absolutely necessary in life or death circumstances. [92] The male guardians would just as soon treat their women themselves or have them be seen by female practitioners for the sake of privacy. [92] The women similarly felt the same way such is the case with pregnancy and the accompanying processes such as child birth and breastfeeding, which were solely reliant upon advice given by other women. [92] The role of women as practitioners appears in a number of works despite the male dominance within the medical field. Two female physicians from Ibn Zuhr's family served the Almohad ruler Abu Yusuf Ya'qub al-Mansur in the 12th century. [93] Later in the 15th century, female surgeons were illustrated for the first time in Şerafeddin Sabuncuoğlu's Cerrahiyyetu'l-Haniyye (Imperial Surgery). [94] Treatment provided to women by men was justified to some by prophetic medicine (al-tibba alnabawi), otherwise known as "medicine of the prophet" (tibb al-nabi), which provided the argument that men can treat women, and women men, even if this means they must expose the patient's genitals in necessary circumstances. [92]

Female doctors, midwives, and wet nurses have all been mentioned in literature of the time period. [95]

A hospital and medical training center existed at Gundeshapur. The city of Gundeshapur was founded in 271 by the Sassanid king Shapur I. It was one of the major cities in Khuzestan province of the Persian empire in what is today Iran. A large percentage of the population were Syriacs, most of whom were Christians. Under the rule of Khosrau I, refuge was granted to Greek Nestorian Christian philosophers including the scholars of the Persian School of Edessa (Urfa)(also called the Academy of Athens), a Christian theological and medical university. These scholars made their way to Gundeshapur in 529 following the closing of the academy by Emperor Justinian. They were engaged in medical sciences and initiated the first translation projects of medical texts. [96] The arrival of these medical practitioners from Edessa marks the beginning of the hospital and medical center at Gundeshapur. [97] It included a medical school and hospital (bimaristan), a pharmacology laboratory, a translation house, a library and an observatory. [98] Indian doctors also contributed to the school at Gundeshapur, most notably the medical researcher Mankah. Later after Islamic invasion, the writings of Mankah and of the Indian doctor Sustura were translated into Arabic at Baghdad. [99] Daud al-Antaki was one of the last generation of influential Arab Christian writers.

Medieval Islam's receptiveness to new ideas and heritages helped it make major advances in medicine during this time, adding to earlier medical ideas and techniques, expanding the development of the health sciences and corresponding institutions, and advancing medical knowledge in areas such as surgery and understanding of the human body, although many Western scholars have not fully acknowledged its influence (independent of Roman and Greek influence) on the development of medicine. [64]

Through the establishment and development of hospitals, ancient Islamic physicians were able to provide more intrinsic operations to cure patients, such as in the area of ophthalmology. This allowed for medical practices to be expanded and developed for future reference.

The contributions of the two major Muslim philosophers and physicians, Al-Razi and Ibn Sina, provided a lasting impact on Muslim medicine. Through their compilation of knowledge into medical books they each had a major influence on the education and filtration of medical knowledge in Islamic culture.

Additionally there were some iconic contributions made by women during this time, such as the documentation: of female doctors, physicians, surgeons, wet nurses, and midwives.

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  • Sezgin, Fuat (1970). Geschichte des arabischen Schrifttums Bd. III: Medizin – Pharmazie – Zoologie – Tierheilkunde [History of the Arabic literature Vol. III: Medicine – Pharmacology – Veterinary Medicine] (in German). Leiden: E. J. Brill.
  • Ullmann, Manfred (1978). Islamic Medicine. Islamic Surveys. 11. Edinburgh Univ. Press. ISBN978-0-85224-325-1 .

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1,400-year-old medicinal treatise of Galen found hidden under hymns in ancient manuscript - History

This precious manuscript of 190 parchment leaves, written mainly in a steady Caroline minuscule, originated in England, perhaps in Hereford. Additions in later hands show that the volume remained in English libraries for at least five centuries. The original composition can be dated to around 1145, because it includes a list of twelve popes in which the eleventh entry, for Lucius II (1144-1145), is followed by a near-contemporary note on Eugenius III (1145-1153). The manuscript consists of more than forty widely varying texts. They cover the spectrum of medical learning as it was defined in the Middle Ages and illustrate a pivotal moment in the history of medicine.

The core treatise is the Hippocratic Aphorisms, the trunk from which sprang the theoretical and practical branches of the "Art of Medicine." Theory is represented, albeit sketchily, by anatomy, here primarily the conceptual "division of the body" physiology, constructed around humors and temperaments and nosology, with an inventory of diseases and their causes. Practical medicine figures more prominently in texts on diagnosis, particularly on reading pulses and urine prognosis, in the Hippocratic tradition as well as by astrology and divination and therapeutics, with several synopses for quick reference. Treatment branches out into dietary advice plasters and other remedies, for afflictions ranging from migraine to snake bite magical cures, remarkably few herbals, glossaries of medicinal substances, and tables of weights and measures and, ultimately, manual intervention by bloodletting and surgery.

The manuscript vividly documents an intermediate stage in the development of learned medicine. Though it is less exclusively utilitarian than early Latin antidotaries or Anglo-Saxon leechbooks, its theoretical passages barely intimate the growing interest in speculation. Much attention is devoted to the virtues of simples and compounds, without the proliferation of substances that characterizes subsequent polypharmacy. The principal sources, including the Aphorisms with a commentary, are translated directly from Greek to Latin at the same time, writings by Isaac Israeli (d. 932) and Constantine the African (d. 1087) presage the coming influx of translations from Arabic. The two authors most visible in the collection, Oribasius (fourth century) and Alexander of Tralles (sixth century), are Byzantines. Their fading reputations were soon to be eclipsed by the authority of Galen, which is still in the background here. Mentions of Constantine, who became a Benedictine monk at Monte Cassino, and John Scarpellus "the Salernitan" (otherwise unknown) leave no doubt about southern Italian influences, yet there is no sign of the philosophical questions which were being discussed at the School of Salerno. Four of the texts correspond with works which the Salernitan masters were incorporating into a nuclear curriculum, later known in universities as Ars medicine or Articella. Interlinear and marginal notes foreshadow the Scholastic methods of gloss and commentary. Nevertheless, the volume seems designed for consultation rather than teaching. An ecclesiastical provenance may be suggested by the presence, at the end, of hymns with musical notations and of miracle stories. The majority of texts, however, evoke a practitioner guided by a rather autonomous medical tradition. In fine, the compilation typifies both a time of transition, from the early to the high Middle Ages, and an intermediate milieu, between the monastic infirmary and the faculty of medicine. The manuscript offers a cornucopia of subjects for further study.


Garuda Purana: What Hinduism says about committing sins:

Garuda Purana, the sacred manuscript of Hindu religion briefs about the life after death of humans. Purana is believed to be the an exchange of selective information over human’s life, re-birth (reincarnation), human death, funeral rites, life after death and many other corresponding contexts with the Garuda (a kind of bird) by the lord Vishnu. Garuda Purana shed’s light on the concept of heaven and hell which are conceived by most of the people to be same in these modern days of lifestyle. Go through the stated punishments of Garuda Puranas to know what exactly do you deserve based on your karma.

Religious preachings in most of the religions claim that sinners are being punished after death by the almighty. While the Hindu religion Garuda Purana clearly prescribes the deserving punishments by the creator regarding the sins and karma. A total of 28 deadly punishments have been mentioned in the Garuda Purana which stating the readers which type of punishment his sins would led him to undergo at the hell.

Garuda which is a part of eighteen Puranas of Hindu body texts called as Smriti principally stresses on the reason and meaning of human life exploring the conversation of Lord Vishnu and Garuda (King of Birds). The Vaishnava Purana manuscript Garuda Purana comprises particulars and information about the life after death, funeral rites and the metaphysics of reincarnation, and therefore is recited as a part Antyesti (Antim Sanskar) or funeral rites (funeral liturgy) in Hinduism. The medium sized Garuda Purana which is categorized as Purana which represents goodness and purity by the Padma Purana comprising nineteen thousand shlokas and 28 punishments for the sinners who commit various inhuman acts during their lifetime.

Brutal punishments which have been listed and mentioned in the Garuda Purana are so barbarous and roughshod that no reader of the Purana would wish to get punished with those penalties of their souls after death. Penalties of the Garuda Purana are described as ‘The Torments of Yama’ as per the conversation of lord Vishnu and Garuda.

PUNISHMENT Kumbhipakam(cooked by oil)

  • CRIME: Killing animals for pleasure,
  • PENALTY: Throwing accused souls to huge boiling vessels

Here oil is kept boiled in huge vessels and sinners are plunged in this vessels.

Tamisram (Heavy flogging) -Those who rob others of their wealth are bound with ropes by Yama’s Servants and cast into the Naraka known as Tamisram. There, they are given a thrashing until they bleed and faint. When they recover their senses, the beating is repeated. This is done until their time is up.

Andhatamtrsam (Flogging) -This Hell is reserved for the Husband or the Wife who only treat their spouses well when they are to profit or pleasure to them. Those who forsake their wives and husbands for no apparent reasons are also sent here. The punishment is almost the same as Tamisram, but the excruciating pain, suffered by the victims on being tied fast, makes them fall down senseless.

Rauravam (torment of snakes) – This is the hell for sinners who seize and enjoy another man’s property or resources. When these people are thrown into this hell, those whom they have cheated, assume the the shape of “Ruru”, a dreadful serpent. The serpent(s) will torment them severely until their time is up.

Mahararuravam (death by snakes) – Here there is also Ruru serpents but more fiercer. Those who deny the legitimate heirs, their inheritance and possess and enjoy others property will be squeezed and bitten non stop by this terrible serpents coiling around them. Those who steal another man’s wife or lover will also be thrown here.

Kalasutram (Hot as hell) – This hell is terribly hot. Those who don’t respect their elders esp. when their elders have done their duties are sent here. Here they are made to run around in this unbearable heat and drop down exhausted from time to time.

Asitapatram (sharp flogging) – This is the hell in which sinners abandon one’s own duty. They are flogged by Yama’s Servants with whips made of asipatra (sharp-edged sword-shaped leaves). If they run about under the flogging, they will trip over the stones and thorns, to fall on their faces. Then they are stabbed with knives until they drop unconscious, When they recover, the same process is repeated until their time is up in this Naraka.

Sukaramukham (Crushed and tormented) – Rulers who neglect their duties and oppress their subjects by misrule, are punished in this hell. They are crushed to a pulp by heavy beating.When they recover, it is repeated until their time is up.

Andhakupam (Attack of the animals) – This is hell for those who oppress the good people and not helping them if requested despite having the resources. They will be pushed into a well, where beasts like Lions, tigers, eagles and venomous creatures like snakes and scorpions. The sinners have to endure the constant attacks of this creatures until the expiry of the period of their punishment.

Taptamurti (Burnt Alive) – Those who plunder or steal Gold and jewels are cast into the furnaces of this Naraka which always remains hot in blazing fire.

Krimibhojanam (Food for worms) – Those who do not honour their Guests and make use of men or women only for their own gain, are thrown into this Naraka. Worms, insects and serpents eat them alive. Once their bodies are completely eaten up, the sinners are provided with new bodies, which are also eaten up in the above manner. This continues, till the end of their term of punishment.

Salmali (Embracing hot images) -This Naraka is intended for men and women who have committed adultery. A figure made of iron, heated red-hot is placed there. The sinner is forced to embrace it, while Yama’s servants flog the victim behind.

Vajrakantakasali (Embracing sharp images) – This Naraka is the punishment for Sinners who have unnatural intercourse with animals. Here, they are made to embrace iron images full of sharp diamond needles that pierce through their bodies.

Vaitarani (River of Filth) – Rulers who abuse their power and adulterers are thrown here. It is the most terrible place of punishment. It is a river which is filled with human excreta, blood, hair, bones, nails, flesh and all kinds of dirty substances. There are various kinds of terrible beasts as well. Those who are cast into it are attacked and mauled by these creatures from all sides. The sinners have to spend the term of their punishment, feeding upon the contents of this river.

Puyodakam (Well of hell) – This is a well filled with excreta, urine, blood, phlegm. Men who have intercourse and cheat women with no intention of marrying them are considered like animals. Those who wander about irresponsibly like animals are thrown in this well to get polluted by it’s contents. They are to remain here till their time is up.

Pranarodham (Piece by Piece) – This Naraka is for those who keep dogs and other mean animals and constantly hunt and kill animals for food. Here the servants of Yama, gather around the sinners and cut them limb to limb while subjecting them to constant insult.

Visasanam (Bashing from Clubs) – This Naraka is for the torture of those rich people who look down at the poor and spend excessively just to display their wealth and splendour. They have to remain here at the whole term of their punishment where they will be bashed non stop from heavy clubs from Yama’s Servants.

Lalabhaksam (River of semen) – This is the Naraka for lustful men. The lascivious fellow who makes his wife swallow his semen, is cast into this hell. Lalabhaksam is a sea of semen. The sinner lies in it, feeding upon semen alone until his period of punishment.

Sarameyasanam (Torment from dogs) – Those guilty of unsocial acts like poisoning food, mass slaughter, ruining the country are cast into this hell. There is nothing but the flesh of dogs for food. There are thousands of dogs in this Naraka and they attack the sinners and tear their flesh from their bodies with their teeth.

Avici (turned into dust) – This Naraka is for those who are guilty for false witness and false swearing. There are hurled from a great height and they are utterly smashed into dust when they reached the ground. They are again restored to life and the punishment is repeated till the end of their time.

Ayahpanam (Drinking of burning substances)- Those who consume alcohol and other intoxicating drinks are sent here. The women are forced to drink melted iron in liquid form, whereas the men will be forced to drink hot liquid molten lava for every time they consume a alcoholic drink in their earthly lives.

Raksobjaksam (Revenge attacks)- Those who do animal and human sacrifices and eat the flesh after the sacrifice will be thrown in this hell. All the living beings they killed before would be there and they will join together to attacking, biting, and mauling the sinners. Their cries and complaints would be no avail here.

Sulaprotam (Trident Torture)- People who take the lives of others who have done no harm to them and those who deceives others by treachery are sent to this “Sulaportam” hell. Here they are impaled on a trident and they are forced to spend their whole term of their punishment in that position, suffering intense hunger and thirst, as well as enduring all the tortures inflicted on them.

Ksharakardamam (hanged upside down) -Braggarts and those who insult good people are cast into this hell. Yama’s servants keep the sinners upside down and torture them in many ways.

Dandasukam (eaten alive)- Sinners who persecute others like animals will be sent here. There are many beasts here. They will be eaten alive by this beasts.

Vatarodham (weapon torture)- This hell is for those who persecute animals which live in forrests, mountain peaks and trees. After throwing them in this hell, sinners are tortured with fire, poison and various weapons during their time here in this Naraka.

Paryavartanakam (torture from birds)- One who denies food to a hungry person and abuses him is thrown here. The moment the sinner arrives here ,his eyes are put by being pierced the beaks of birds like the crows and eagles. They will be pierced later on by this birds till the end of their punishment.

Sucimukham (Tortured by needles)- Proud and Miserly people who refuse to spend money even for the basic necessities of life, like better food or buying food for their relations or friends will find their place in this hell. Those who do not repay the money they have borrowed will also be cast into this hell. Here, their bodies will be constantly be pricked and pierced by needles.

Garuḍa asks the Lord to explain Yama’s kingdom. The Lord not only begins to describe. Yama’s kingdom, but also begins to describe the procedure to be followed immediately after death. The distance between the earth and Yama’s world is 1,032,000 Kilometers (approximately 641,255 miles. (Distance between the earth and the moon is 384,000. KMs and the distance between the earth and the sun is 149,598,000 KMs).

Due to the effect of karma, a man falls sick causing his death. The mode of one’s death also depends upon one’s karma. When a man is dead, his body should be kept on the ground after purificatory rituals discussed earlier. Śālagrāma (sacred stone) should be placed near the body. Tulasī leaves (basil) should be placed in both the hands of the body and also on its neck. Pieces of gold should also be kept in the nine apertures of the body. The body should be covered with two sheets of clothing.

The body should be carried through the back door. Sons and other relatives should carry the body on their shoulders. While placing the body on the pyre, head should be facing north. His son should perform ceremonies facing the eastern side. When the subtle body is leaving the gross body, which is known as death, the messengers of. Yama arrive on the scene. When the subtle body finally comes out of the gross body, causing death of the gross body. The subtle body is still able to see the entire universe.

The departed soul could see the messengers of Yama and the attendants of Lord Viṣṇu. This means that the soul can see both good. And bad and the departed soul begins its journey according to its karma. A subtle body which has a bad karmic account feels for its sins at this stage. A soul has to travel the entire distance to reach the world of Yama.

The path becomes rough for the sinners and the path becomes comfortable for virtuous. Lord begins to describe Yama. He has four arms holding a conch, a discus, a bow and a staff. So treats the virtuous with respect and sinners with rudeness. He hits the sinners with iron rod and club. He sits on a buffalo (Yama is called mahiṣa vāhana mahiṣa means buffalo and vāhana means vehicle). His body appears dreadful to sinners and radiant to virtuous. The soul is in the size of one’s thumb (it means the subtle body. Soul and the subtle body always travel together. The subtle body is pushed out of the gross body by air. The subtle body cries out when it comes out of the gross body).


Olympian Healers

Chiron and Achilles

Chiron and Achilles. Vase painting, 5th century B.C.E. (Louvre G3 photograph by Maria Daniels)

In Greek mythology, the centaur, Chiron, was wounded by Hercules. Though he was immortal, it is said that he invented medicine in order to heal himself. He taught Asclepius the art of healing, which became the source of all divine medical knowledge among the Greeks. Chiron was also the teacher of the hero, Achilles, who was thought to have had some special medical knowledge.

Achilles dresses the wound of Patroclus. Vase painting, 5th century B.C.E. Berlin F2278, Staatliche Musee zu Berlin photograph by Maria Daniels Courtesy of the Bildarchiv Preussischer Kulturbesitz.

Many depictions of Greek medicine involve battle injuries, especially of the Heroes. In this noted vase painting, Achilles tends to the wounds of Patroclus.

“…But save me. Take me to the ship, cut this arrow out of my leg, wash the blood from it with warm water and put the right things on it – the plants they say you have learned about from Achilles who learned them from Chiron, the best of the Centaurs.”

The Iliad of Homer, Book XI

One of the earliest Greek gods to specialize in healing was Asclepius (known to the Romans as Aesculapius). Healers and those in need of healing invoked Asclepius’ name in prayer and healing ceremonies in temples and at home. A healing clan known as the Asclepiads claimed to be the descendants of Asclepius and to have inherited a knowledge and mystical power of healing from him.

Asclepius did not begin as a god, however. It is now thought that he was an actual historical figure, renowned for his healing abilities. When he and his sons, Machaon and Podalirios, are mentioned in The Iliad in approximately the 8th century B.C.E., they are not gods. As his “clan” of followers grew, he was elevated to divine status, and temples were built to him throughout the Mediterranean world well into late antiquity.

Asclepius, from the marble statue in the Louvre. Engraving by Jenkins. (London?, ca. 1860)

Images of Asclepius are generally recognizable by his beard and staff with a single snake. In this image, he is accompanied by his small, mysterious attendant, Telesphoros.

Cross-section of restored temple of Asclepius at Epidaurus. From: Lechat, Henri. Epidaure, restauration et description des principaux monuments du sanctuaire d’Asclepios (Paris: Libraires-imprimeries réunis, 1895).

Temples to Asclepius were erected throughout the ancient Mediterranean. Those seeking healing would make pilgrimages to the sites and might perform prayers and sacrifices, make monetary gifts, or spend the night in the temple.

Detail from t.p. of Marco Amelio Severino. Viper Pythia. (Patavii: Typis Pauli Frambotti, 1651).

Many modern physicians have adopted the caduceus as the “ancient” symbol of their profession, with its two intertwined snakes grasping a staff. In the ancient world, however, the caduceus was a symbol of Hermes, the Roman Mercury, who was primarily a messenger god linked with commerce. Asclepius’ symbol was a single snake entwined around his staff- the ‘Asclepian staff’.

Marco Aurelio Severino. Viper Pythia. (Patavii: Typis Pauli Frambotti, 1651.)

The snake symbolized rejuvenation and healing to many ancient Mediterranean cultures. On this 17th-century title page, the single-snake staff of Asclepius and the double snake of the caduceus appear with other ancient medical images involving snakes.

Apollo and Others

Apollo. Parthenon frieze, ca. 430 B.C.E. (Courtesy of Malcar Förlag).

Apollo was often considered to be a god of healing, and in stories such as The Iliad is depicted as the bringer and reliever of plagues. Hera was a protector of women, and she and her daughter, Eileithyia, were often called upon during childbirth. The goddess Hygieia (‘Health’), the daughter of Asclepius, was considered a guardian or personification of health.

Eileithyia and Hera assisting Zeus in the birth of Athena. Vase painting, ca. 500 B.C.E. (Louvre CA616 photograph by Maria Daniels)

While Eileithyia was often called upon by Greek women giving birth, she appeared most often in Greek art in depictions of the birth of Athena from the head of Zeus.


Contents

That person alone is fit to nurse or to attend the bedside of a patient, who is cool-headed and pleasant in his demeanor, does not speak ill of any body, is strong and attentive to the requirements of the sick, and strictly and indefatigably follows the instructions of the physician.

Sushruta Samhita Book 1, Chapter XXXIV
Translator: Bhishagratna [7]

Date Edit

The early scholar Rudolf Hoernle proposed that given that the author of Satapatha Brahmana – an ancient Vedic text, was aware of Sushruta's doctrines, Sushruta's doctrines should be dated based on the composition date of Satapatha Brahmana. [8] The composition date of the Brahmana is itself unclear, added Hoernle, and he estimated it to be about the 6th century BCE. [8] While Loukas et al. date the Sushruta Samhita to the mid 1st-millennium BCE, [9] Boslaugh dates the currently existing text to the 6th-century CE. [10]

Rao in 1985 suggested that the original layer to the Sushruta Samhita was composed in 1st millennium BCE by "elder Sushruta" consisting of five books and 120 chapters, which was redacted and expanded with Uttara-tantra as the last layer of text in 1st millennium CE, bringing the text size to six books and 184 chapters. [11] Walton et al., in 1994, traced the origins of the text to 1st millennium BCE. [12]

Meulenbeld in his 1999 book states that the Suśruta-saṃhitā is likely a work that includes several historical layers, whose composition may have begun in the last centuries BCE and was completed in its presently surviving form by another author who redacted its first five sections and added the long, final section, the "Uttaratantra." [1] It is likely that the Suśruta-saṃhitā was known to the scholar Dṛḍhabala [ Wikidata ] (fl. 300-500 CE), which gives the latest date for the version of the work that has survived into the modern era. [1]

Tipton in a 2008 historical perspectives review, states that uncertainty remains on dating the text, how many authors contributed to it and when. Estimates range from 1000 BCE, 800–600 BCE, 600 BCE, 600–200 BCE, 200 BCE, 1–100 CE, and 500 CE. [13] Partial resolution of these uncertainties, states Tipton, has come from comparison of the Sushruta Samhita text with several Vedic hymns particularly the Atharvaveda such as the hymn on the creation of man in its 10th book, [14] the chapters of Atreya Samhita which describe the human skeleton, [15] better dating of ancient texts that mention Sushruta's name, and critical studies on the ancient Bower Manuscript by Hoernle. [13] These information trace the first Sushruta Samhita to likely have been composed by about mid 1st millennium BCE. [13]

Authorship Edit

Sushruta (Devanagari सुश्रुत, an adjective meaning "renowned" [16] ) is named in the text as the author, who presented the teaching of his guru, Divodāsa. [17] He is said in ancient texts such as the Buddhist Jatakas to have been a physician who taught in a school in Kashi (Varanasi) in parallel to another medical school in Taxila (on Jhelum river), [18] [19] sometime between 1200 BCE and 600 BCE. [20] [21] One of the earliest known mentions of the name Sushruta is in the Bower Manuscript (4th or 5th century), where Sushruta is listed as one of the ten sages residing in the Himalayas. [22]

Rao in 1985 suggested that the author of the original "layer" was "elder Sushruta" (Vrddha Sushruta). The text, states Rao, was redacted centuries later "by another Sushruta, then by Nagarjuna, and thereafter Uttara-tantra was added as a supplement. [11] It is generally accepted by scholars that there were several ancient authors called "Suśruta" who contributed to this text. [23]

Affiliation Edit

The text has been called a Hindu text by many scholars. [10] [24] [25] The text discusses surgery with the same terminology found in more ancient Hindu texts, [26] [27] mentions Hindu gods such as Narayana, Hari, Brahma, Rudra, Indra and others in its chapters, [28] [29] refers to the scriptures of Hinduism namely the Vedas, [30] [31] and in some cases, recommends exercise, walking and "constant study of the Vedas" as part of the patient's treatment and recovery process. [32] The text also uses terminology of Samkhya and other schools of Hindu philosophy. [33] [34] [35]

The Sushruta Samhita and Caraka Samhita have religious ideas throughout, states Steven Engler, who then concludes "Vedic elements are too central to be discounted as marginal". [35] These ideas include treating the cow as sacred, extensive use of terms and same metaphors that are pervasive in the Hindu scriptures – the Vedas, and the inclusion of theory of Karma, self (Atman) and Brahman (metaphysical reality) along the lines of those found in ancient Hindu texts. [35] However, adds Engler, the text also includes another layer of ideas, where empirical rational ideas flourish in competition or cooperation with religious ideas. [35]

The text may have Buddhist influences, since a redactor named Nagarjuna has raised many historical questions, whether he was the same person of Mahayana Buddhism fame. [23] Zysk states that the ancient Buddhist medical texts are significantly different from both Sushruta and Caraka Samhita. For example, both Caraka and Sushruta recommend Dhupana (fumigation) in some cases, the use of cauterization with fire and alkali in a class of treatments, and the letting out of blood as the first step in treatment of wounds. Nowhere in the Buddhist Pali texts, states Zysk, are these types of medical procedures mentioned. [36] Similarly, medicinal resins (Laksha) lists vary between Sushruta and the Pali texts, with some sets not mentioned at all. [37] While Sushruta and Caraka are close, many afflictions and their treatments found in these texts are not found in Pali texts. [38]

In general, states Zysk, Buddhist medical texts are closer to Sushruta than to Caraka, [36] and in his study suggests that the Sushruta Samhita probably underwent a "Hinduization process" around the end of 1st millennium BCE and the early centuries of the common era after the Hindu orthodox identity had formed. [39] Clifford states that the influence was probably mutual, with Buddhist medical practice in its ancient tradition prohibited outside of the Buddhist monastic order by a precedent set by Buddha, and Buddhist text praise Buddha instead of Hindu gods in their prelude. [40] The mutual influence between the medical traditions between the various Indian religions, the history of the layers of the Suśruta-saṃhitā remains unclear, a large and difficult research problem. [23]

Sushruta is reverentially held in Hindu tradition to be a descendant of Dhanvantari, the mythical god of medicine, [41] or as one who received the knowledge from a discourse from Dhanvantari in Varanasi. [17]

Manuscripts and transmission Edit

One of the oldest palm-leaf manuscripts of Sushruta Samhita has been discovered in Nepal. It is preserved at the Kaiser Library, Nepal as manuscript KL–699, with its digital copy archived by Nepal-German Manuscript Preservation Project (NGMCP C 80/7). [6] The partially damaged manuscript consists of 152 folios, written on both sides, with 6 to 8 lines in transitional Gupta script. The manuscript has been verifiably dated to have been completed by the scribe on Sunday, April 13, 878 CE (Manadeva Samvat 301). [6]

Much of the scholarship on the Suśruta-saṃhitā is based on editions of the text that were published during the nineteenth and early twentieth centuries. This includes the edition by Vaidya Yādavaśarman Trivikramātmaja Ācārya that also includes the commentary of the scholar Dalhaṇa. [42]

The printed editions are based on a small subset of manuscripts that were available in the major publishing centers of Bombay, Calcutta and elsewhere when the editions were being prepared — sometimes as few as three or four manuscripts. But these do not adequately represent the large number of manuscript versions of the Suśruta-saṃhitā that have survived into the modern era. These manuscripts exist in the libraries in India and abroad today. Perhaps a hundred or more versions of the text exist, and a critical edition of the Suśruta-saṃhitā is yet to be prepared. [43]

The different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts.

Sushruta Samhita, Book 3, Chapter V
Translators: Loukas et al [9]

The Sushruta Samhita is among the most important ancient medical treatises. [1] [44] It is one of the foundational texts of the medical tradition in India, alongside the Caraka-Saṃhitā, the Bheḷa-Saṃhitā, and the medical portions of the Bower Manuscript. [1] [2] [44]

Scope Edit

The Sushruta Samhita was composed after Charaka Samhita, and except for some topics and their emphasis, both discuss many similar subjects such as General Principles, Pathology, Diagnosis, Anatomy, Sensorial Prognosis, Therapeutics, Pharmaceutics and Toxicology. [45] [46] [1]

The Sushruta and Charaka texts differ in one major aspect, with Sushruta Samhita providing the foundation of surgery, while Charaka Samhita being primarily a foundation of medicine. [45]

Chapters Edit

The Sushruta Samhita, in its extant form, is divided into 186 chapters and contains descriptions of 1,120 illnesses, 700 medicinal plants, 64 preparations from mineral sources and 57 preparations based on animal sources. [47]

The Suśruta-Saṃhitā is divided into two parts: the first five chapters, which are considered to be the oldest part of the text, and the "Later Section" (Skt. Uttaratantra) that was added by the author Nagarjuna. [48] The content of these chapters is diverse, some topics are covered in multiple chapters in different books, and a summary according to the Bhishagratna's translation is as follows: [49] [50] [51]

Prevention versus cure Edit

Sushruta, states Tipton, asserts that a physician should invest the effort to prevent diseases as much as curative remedial procedures. [126] An important means for prevention, states Sushruta, is physical exercise and hygienic practices. [126] The text adds that excessive strenuous exercise can be injurious and make one more susceptible to diseases, cautioning against such excess. [13] Regular moderate exercise, suggests Sushruta, improves resistance to disease and physical decay. [126] Sushruta has written Shlokas on the prevention of diseases.

Human skeleton Edit

The Sushruta Samhita states, per Hoernle's translation, that "the professors of Ayurveda speak of three hundred and sixty bones, but books on Salya-Shastra (surgical science) know of only three hundred". [127] The text then lists the total of 300 as follows: 120 in the extremities (e.g. hands, legs), 117 in the pelvic area, sides, back, abdomen and breast, and 63 in the neck and upwards. [127] The text then explains how these subtotals were empirically verified. [128] The discussion shows that the Indian tradition nurtured diversity of thought, with Sushruta school reaching its own conclusions and differing from the Atreya-Caraka tradition. [128]

The osteological system of Sushruta, states Hoernle, follows the principle of homology, where the body and organs are viewed as self-mirroring and corresponding across various axes of symmetry. [129] The differences in the count of bones in the two schools is partly because Charaka Samhita includes thirty two teeth sockets in its count, and their difference of opinions on how and when to count a cartilage as bone (both count cartilages as bones, unlike current medical practice). [130] [131]

Surgery Edit

Students are to practice surgical techniques on gourds and dead animals.

Sushruta Samhita, Book 1, Chapter IX
Translator: Engler [35]

The Sushruta Samhita is best known for its approach and discussions of surgery. [45] It was one of the first in human history to suggest that a student of surgery should learn about human body and its organs by dissecting a dead body. [45] A student should practice, states the text, on objects resembling the diseased or body part. [132] Incision studies, for example, are recommended on Pushpaphala (squash, Cucurbita maxima), Alavu (bottle gourd, Lagenaria vulgaris), Trapusha (cucumber, Cucumis pubescens), leather bags filled with fluids and bladders of dead animals. [132]

The ancient text, state Menon and Haberman, describes haemorrhoidectomy, amputations, plastic, rhinoplastic, ophthalmic, lithotomic and obstetrical procedures. [45]

The Sushruta Samhita mentions various methods including sliding graft, rotation graft and pedicle graft. [133] Reconstruction of a nose (rhinoplasty) which has been cut off, using a flap of skin from the cheek is also described. [134] Labioplasty too has received attention in the samahita. [135]

Medicinal herbs Edit

The Sushruta Samhita, along with the Sanskrit medicine-related classics Atharvaveda and Charak Samhita, together describe more than 700 medicinal herbs. [136] The description, states Padma, includes their taste, appearance and digestive effects to safety, efficacy, dosage and benefits. [136]

Rhinoplasty Edit

Rhinoplasty, colloquially known as the 'nose job,' is a surgery performed to achieve two results:

  • To improve the breathing function of the nose
  • To improve the cosmetic look of the nose

Sushruta's treatise provides the first written record of a forehead flap rhinoplasty, a technique still used today to reconstruct a nose.The text mentions more than 15 methods to repair it. These include using a flap of skin from the cheek or the forehead, which is akin to the most modern technique today.. [137] [138]

The nose in Indian society has remained a symbol of dignity and respect throughout antiquity. Rhinoplasty was an especially important development in India because of the long-standing tradition of rhinotomy (amputation of the nose) as a form of punishment. Convicted criminals would often have their noses amputated to mark them as untrustworthy, but amputation was also frequently practiced on women accused of adultery – even if they were not proven guilty. Once branded in this fashion, an individual had to live with the stigma for the rest of his or her life. Reconstructive surgery, therefore, offered a hope of redemption and normalcy.

The practice of Rhinoplasty slowly started as a result of the need to reconstruct the external nose and later developed to full-fledged science. [139]

Transmission outside India Edit

The text was translated to Arabic as Kitab Shah Shun al-Hindi' in Arabic, also known as Kitab i-Susurud, in Baghdad during the early 8th century at the instructions of a member of the Barmakid family of Baghdad. [140] [11] Yahya ibn Barmak facilitated a major effort at collecting and translating Sanskrit texts such as Vagbhata's Astangahrdaya Samhita, Ravigupta's Siddhasara and Sushruta Samhita. [141] The Arabic translation reached Europe by the end of the medieval period. [142] [143] There is some evidence that in Renaissance Italy, the Branca family of Sicily [142] and Gasparo Tagliacozzi (Bologna) were familiar with the rhinoplastic techniques mentioned in the Sushruta Samhita. [144] [145] [143]

The text was known to the Khmer king Yaśovarman I (fl. 889-900) of Cambodia. Suśruta was also known as a medical authority in Tibetan literature. [140]

Commentaries Edit

In India, a major commentary on the text, known as Nibandha-samgraha, was written by Dalhana in ca. 1200 CE.

Modern reception Edit

A number of Sushruta's contributions have been discussed in modern literature. Some of these include Hritshoola (heart pain), circulation of vital body fluids (such as blood (rakta dhatu) and lymph (rasa dhatu), Madhumeha, obesity, and hypertension. [47] Kearns & Nash (2008) state that the first mention of leprosy is described in Sushruta Samhita. [146] [147] The text discusses kidney stones and its surgical removal. [148]

The first printed edition of the text was prepared by Madhusudan Gupta (2 vols, Calcutta 1835, 1836). A partial English translation by U. C. Datta appeared in 1883. The first complete English translation of the Sushruta Samhita was by Kaviraj Kunjalal Bhishagratna, who published it in three volumes between 1907 and 1916 (reprinted 1963, 2006). [149] [note 1]

An English translation of both the Sushruta Samhita and Dalhana's commentary was published in three volumes by P. V. Sharma in 1999. [150]


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