The Greatest Benefit to Mankind. Roy Porter

neglected, including surgery, midwifery and child-rearing, and detailed accounts of bleeding, cupping and cautery. Treatise 30, the most celebrated, deals with surgery, describing operations for the stone, cauterization of wounds, sutures, obstetrical and dental procedures, setting fractures and dislocations, procedures for opening abscesses and eye surgery, to say nothing of 200 illustrations of medical and dental instruments, many of which he designed himself. This surgical treatise won enormous acclaim in the Latin West.

      Albucasis gave a definitive account of cautery, which was central to Arabic surgical practice, being used to open abscesses, burn skin tumours and haemorrhoids, cleanse wounds, and stanch blood flow. Like bloodletting, it was also performed in the treatment of internal diseases, and Albucasis advised the cauterizing iron for almost every ailment, including epilepsy, stroke and melancholy. Apart from him, it is unlikely that the Arabic surgical authors ever practised surgery themselves.

      Also Spanish-born was Abu-l-Walid Muhammad ibn Ahmad ibn Muhammad ibn Rushd (d. 1198), latinized as Averroës. Physician, philosopher and jurist, Ibn Rushd is known in the West for his classic commentaries on Aristotle. Coming from a long line of lawyers, he served as a judge in Cordova and Seville and also as physician to the ruling Almohad family – though he later came under attack for his views, leading to exile and the burning of his philosophical works. His major medical text is the encyclopaedic al-Kulliyat [The Book of General Principles], written between 1153 and 1169. Consisting of seven books dealing with anatomy, health, pathology, symptoms, dietetics and drugs, hygiene and therapeutics, it was conceived as a companion to al-Taisir, written by his colleague, Ibn Zuhr (Avenzoar, c. 1091–1162), which dealt with specific diseases. Together they constituted a comprehensive medical treatise, becoming familiar in the West through their Hebrew and Latin translations [Colliget], and printed together in Venice in 1482. On physiological issues he preferred Aristotelian explanations over Galen’s, but he was not a slavish follower, and both the Colliget and the Commentaries show independent thinking.

      Rabbi Moshe ben Maimun (1135–1204: Moses Maimonides or Abu ’Imran ibn ’Ubdaidalla Musa ibn Maimun) was another scholar who testifies to the intellectual pre-eminence of Spain at this time. The ascendancy of a fanatic Muslim ruling group forced the Jewish Maimonides, like Averroës, to flee Cordova in 1148, and he spent the next ten years in exile. In 1158, he settled in Fez, but moved on a few years later to Cairo where he stayed until his death. His medical practice earned him celebrity; in 1174 he was appointed court physician to Saladin, sultan of Egypt and Syria, and he became the head of the Jewish community in Egypt.

      Paralleling the Islamic intellectuals of his day, Maimonides was a polymath, combining philosophy, logic, theology, astronomy and medicine. Apart from his major fourteen-volume religious work, the Mishneh Torah, which is in Hebrew, his books were written in Arabic. His ten medical works, all surviving, mostly in Arabic but some only in Hebrew translation, include the Extracts from Galen, a collection of Galen’s writings, and a Commentary on the Hippocratic Aphorisms. His Medical Aphorisms is of particular interest because of its criticism of Galen for preferring Aristotelian over biblical cosmology. He emphasized the duties of physicians: ‘may I never see in the patient anything but a fellow creature in pain.’

      There are various treatises on individual topics (on haemorrhoids, asthma, poisons and their antidotes, and so forth), but Maimonides’ most famous medical book was his Regimen of Health – short, much reproduced, often translated, and full of solid advice:

      How can a person heal his intestines if they are slightly constipated? If he is a young boy, he should eat salty foods, cooked and spiced with olive oil, fish brine and salt, without bread, every morning; or he should drink the liquid of boiled spinach or cabbage in olive oil and fish brine and salt. If he is an old man, he should drink honey mixed with warm water in the morning and wait approximately four hours, and then he should eat his meal. He should do this for one day or three or four days if it is necessary, until his intestines soften.

      While not adding anything original to Graeco – Arabic medicine, Maimonides’ considerable literary output earned him respect, and, like other contemporaries, he was widely cited by leading European authorities such as Henri de Mondeville, Arnald of Villanova and Guy de Chauliac.

      An original aspect of Arab – Islamic medicine was its contribution to pharmacology. The lands overrun by Arab warriors yielded an abundance of plants, animals and minerals; hence, whereas Dioscorides’ materia medica had included less than a thousand plants, animals and minerals, that of Ibn al-Baytar (d. 1248) astonishingly listed over 3000 items, including 800 botanical drugs, 145 mineral drugs, and 130 animal drugs. The medical formulary of al-Kindi (Yaqub ibn-Ishaq al-Kindi, c. 800–870) served as a source for Arabic treatises on pharmacology, botany, zoology and mineralogy. His writings contained many Persian, Indian or Oriental drugs unknown to the Greeks, including camphor, cassia, senna, nutmegs and mace, tamarind and manna.

      In the eleventh century, al-Biruni described more than a thousand simples in his Kitab al-Saydanah fi al Tibb [Book of Pharmacy in the Healing Art]. The Minhaj al-Dukkan via Dustur al-’yan [Handbook for the Apothecary Shop], written in Cairo in 1259 by the Jewish pharmacist Abu al-Muna Kohen al-’Attar, was much more than a mere formulary of the materia medica. Intended to provide instruction for his son, it included drug synonyms, recipes for syrups, remedies to aid digestion, fumigations and liniments and pharmaceutical weights – and also covered the duties and shop practices of the pharmacist.

      The word ‘drug’ is of Arabic origin, as are alcohol (it then referred to a sulphurous powder), alkali, syrup, sugar, jujube and spinach; and many new drugs were introduced by the Arabs – benzoin, camphor, myrrh, musk, laudanum, naphtha, senna and alcohol. From the time of the ‘father’ of Arabic alchemy, Jabir ibn Hayyan (Jebir or Geber), who lived in the tenth century, they developed the alchemical techniques of crystallization, filtration, distillation and sublimation, alongside investigations into the properties of things contained in a ‘secrets of nature’ tradition paralleling that in the West. They created the first pharmacies, which also served as rendezvous for the exchange and discussion of information.

      Overall, the value of Arab contributions to medicine lies not in their novelty but in the thoroughness with which they preserved and systematized existing knowledge. Great effort was devoted to its dissemination and medical texts were repeatedly copied. Over 5000 medical manuscripts in Arabic, Turkish, and Persian survive in libraries in Turkey alone, with more than fifty copies of Ibn Sina’s Qanun, and still more transcripts of the many later commentaries on it. And though the era of the great Arabic medical compendia ended with the Qanun, such works long continued as foci of scholarly attention, commentaries in turn becoming the bases for super-commentaries, such as that of ’Ala’ al-Din ibn al-Nafis (1200–88).

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

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

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