BMJ  2005;331:1486-1487 (24 December), doi:10.1136/bmj.331.7531.1486

Editorial

How Islam changed medicine

Arab physicians and scholars laid the basis for medical practice in Europe

Islamic civilisation once extended from India in the east to the Atlantic Ocean in the west. Buildings in Andalusia such as the Alhambra in Granada, the Mezquita in Cordoba, and the Giralda in Seville are reminders of the architectural imprint this civilisation left on western Europe. Less well remembered, however, is the impact of Islamic civilisation on Western science, technology, and medicine between the years 800 and 1450.¹ As was argued this month at the Royal Institution, today's Western world might look very different without the legacy of Muslim scholars in Baghdad, Cairo, Cordoba, and elsewhere.²

As Islam spread out of the Arabian Peninsula into Syria, Egypt, and Iran it met long established civilisations and centres of learning. Arab scholars translated philosophical and scientific works from Greek, Syriac (the language of eastern Christian scholars), Pahlavi (the scholarly language of pre-Islamic Iran), and Sanskrit into Arabic. The process of translation reached its peak with the establishment of the "House of Wisdom" (Bait-ul-Hikma) by the Abbasid Caliph Al-Mamun in Baghdad in 830. It made Arabic the most important scientific language of the world for many centuries and preserved knowledge that might otherwise have been lost forever.

As well as assimilating and disseminating the knowledge of other cultures, Arab scholars made numerous important scientific and technological advances in mathematics, astronomy, chemistry, metallurgy, architecture, textiles, and agriculture. Techniques they developed—such as distillation, crystallisation, and the use of alcohol as an antiseptic—are still used.

Arab physicians and scholars also laid the basis for medical practice in Europe. Before the Islamic era, medical care was largely provided by priests in sanatoriums and annexes to temples. The main Arabian hospitals were centres of medical education and introduced many of the concepts and structures that we see in modern hospitals, such as separate wards for men and women, personal and institutional hygiene, medical records, and pharmacies.

Ibn Al-Nafis, a 13th century Arab physician, described the pulmonary circulation more than 300 years before William Harvey.³ Surgeon Abu Al-Qasim Al-Zahrawi wrote the Tasrif which, translated into Latin, became the leading medical text in European universities during the later Middle Ages. Al-Zahrawi was also a noted pathologist, describing hydrocephalus and other congenital diseases as well as developing new surgical technologies such as catgut sutures.^{4 5} Some describe Al-Razi (Rhazes), born in 865, as the greatest physician of the Islamic world. He wrote Kitab Al-Mansuri (Liber Almartsoris in Latin), a 10 volume treatise on Greek medicine,⁶ and also published on smallpox and measles: his texts continued to be reprinted well into the 19th century. The medical texts of Ibn Rushd (Averroes) were also widely used in European universities.

Ibn Sina (Avicenna) was known in the West as "the prince of physicians." His synthesis of Islamic medicine, al-Qanun fi'l tibb (The Canon of Medicine), was the final authority on medical matters in Europe for several centuries. Although Ibn Sina made advances in pharmacology and in clinical practice, his greatest contribution was probably in the philosophy of medicine. He created a system of medicine that today we would call holistic and in which physical and psychological factors, drugs, and diet were combined in treating patients.⁷

Eventually, the Islamic civilisation constructed by the Arabs went into decline. In the east, new powers rose: first the Mongols, who in 1258 devastated Baghdad, the greatest Arab city of its day, and later the Ottoman Turks, who brought large parts of the Arab world into their new empire from the 14th century onwards. Weakened by internal strife and civil conflict, most of the Islamic cities of Spain had been conquered by Christian armies by the 14th century. The last Islamic state in Spain, Granada, surrendered to the Spanish in 1492 and its ruler, Boabdil, was exiled to North Africa.⁸

The flow of technology and ideas from the Islamic world to the West slowed and, in the past 600 years, has reversed. Academics and politicians still debate the reasons for and consequences of this decline in Islamic science and technology. The legacy of Islamic civilisation, though, remains with us in making possible Europe's own scientific and cultural renaissance.⁹

Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP
(a.majeed{at}imperial.ac.uk)

---

Competing interests: None declared.

References

1. HRH Prince of Wales. Islam and the West: speech at Oxford Centre for Islamic Studies, 1993. www.princeofwales.gov.uk/speeches/religion_27101993.html (accessed 3 Dec 2005).
2. Drabu R, Nanji A, Greenfield S. Science and learning in Islam—a shared legacy. Royal Institution of Great Britian, London, 1 December 2005.
3. Soubani AO, Khan FA. The discovery of the pulmonary circulation revisited. www.kfshrc.edu.sa/annals/152/mh9422ar.html (accessed 3 Dec 2005).
4. Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment Neurosurg Rev 1999;22: 67-93.[Medline]
5. Al-Hassani STS. Thousand years of missing history. Manchester: Foundation for Science, Technology and Civilisation, 2004.
6. Van Alphen J, Aris A. Oriental medicine: an illustrated guide to the Asian arts of healing. London: Serindia, 2003.
7. Wear A, Geyer-Kordesch J, French R. Doctors and ethics: the historical setting of professional ethics. Rodopi: Amsterdam, 1993.
8. Fletcher R. Moorish Spain. London: Phoenix, 2001.
9. Bulliet R. The case for Islamo-Christian civilization. Irvington, NY: Columbia University Press, 2004.

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