Doctor in Exile
Musa ibn Maymun (Latinized to Maimonides) was a Renaissance man before there was a Renaissance. He too was born in Cordoba, just 12 years after Ibn Rushd, to a family that had produced eight generations of scholars. The towering genius of his era, a Jew living in a Muslim world, his achievements covered law, philosophy and medicine. At an early age, he developed an interest in science and philosophy. In addition to reading the works of Muslim scholars, he also read those of the Greek philosophers made accessible through Arabic translations. His great work on Jewish law was written in Arabic using the Hebrew alphabet, and as a religious scholar he opposed the mingling of religion and medicine. He was the only intellectual of the Middle Ages who truly personified the confluence of four cultures: Greco-Roman, Arab, Jewish and European.
|nathan benn / alamy
|This bronze bust of
Maimonides is in Cordoba, where he was born.
When he was 10 years old, the less-than-tolerant Almohads conquered Cordoba. They offered the city's Jews and Christians the choice of conversion to Islam, exile or death. Maimonides's family chose exile, and they eventually settled near Cairo. When family tragedy reduced them to penury, he took up the practice of medicine.
Maimonides wrote 10 known medical works in Arabic. They describe, among much else, conditions including asthma, diabetes, hepatitis and pneumonia. They emphasize moderation and a healthy lifestyle. A doctor, he wrote, must be knowledgeable in many disciplines, treat the whole patient and not just the disease, heal both the body and the soul, and must himself be imbued with human and spiritual values, the foremost of which is compassion.
Throughout his medical works Maimonides often challenged what he called Galen's "arrogant presumption" when it differed from his own experiences, leading to one of his key contributions: the idea that, in medicine, personal empirical experience trumps written authority. Nonetheless, his passion for order and learning led him to abridge the Roman physician's massive literary output to a single book of key extracts that a physician could carry in his pocket. Though he was also a Talmudic rabbi, when it came to the understanding of disease, Maimonides was what today we would call a "natural scientist"-a strict empiricist-and he strove to clearly divorce medicine from religion. At a time when magic, superstition and astrology were all widespread in medical practice, his writings contain no references to these, nor to Talmudic medicine. That which is correct, he argued, is that which works.
Maimonides taught that individuals should look after their own health by avoiding bad habits and seeking medical attention promptly when ill. "One's attention," he wrote, "should first focus on the maintenance of natural [body] warmth, before anything else. That which best insures this is [the performance of] moderate physical exercise, which is good both for the body and soul." He then goes on to prescribe a daily regimen of walking for elderly patients, something with a distinctly modern ring to it. He also discusses the benefits of massage and touch as a means of stimulating the innate "heat" of the body, insofar as it rejuvenates the body naturally.
He recognized furthermore the medical benefits of positive thinking, leading to an early form of psychosomatic medicine. Whether certain amulets or trinkets were anathema to his rational world view was unimportant compared to the needs of the patient. If they made the patient feel better, he wrote, then having them present was best "lest the mind of the patient be too greatly disturbed."
Secrets of the Heart
By the time Ala al-Din Abu al-Hassan Ali ibn Abi-Hazm al-Qurashi al Dimashqi -far more easily known as Ibn al-Nafis-was born in 1213 in Damascus, the intellectual center of the Islamic world had become Ayyubid-ruled Cairo. While in his early 20's, Ibn al-Nafis moved there and eventually became chief physician at the 8000-bed
|behzad / musee d'histoire
de la medicine / archives charmet / bridgeman art library
gouache illustration depicting Ibn al-Nafis is titled "Discovery of
the 'Small Circulation'"-the movement of blood from the right
ventricle of the heart to the lungs and back to the left atrium. It
was Ibn al-Nafis who first correctly described the interaction of the
heart and lungs in circulation and oxygenation of blood.
At 29, he published the Sharh Tashrih al-Qanun Ibn Sina (Commentary on Anatomy in the Canon of Ibn Sina). The book described a number of his anatomical discoveries, including the earliest explanation of the pulmonary circulation of blood.
Ibn al-Nafis went on to show that the wall between the right and left ventricles of the heart is solid and without pores, thus disproving Galen's teaching that the blood passes directly from the right to the left side of the heart. Ibn al-Nafis then correctly stated that the blood must pass from the right ventricle to the lungs, where its lighter parts filter into the pulmonary vein to mix with air and then to the left atrium and finally onward to the rest of the body. It was the first time anyone was able to explain how air entered the blood.
|musee atger / giraudon
/ bridgeman art library (detail)
|In a 14th-century
French version of al-Zahrawi's Arrangement of Medical Knowledge,
a sick man and a crippled man are presented to a doctor. Al-Zahrawi's
compendium was used in Europe till the late 16th century.
Ibn al-Nafis also hinted at the existence of capillary circulation, arguing "there must be small communications or pores [manafidh] between the pulmonary artery and vein." Though his hypothesis was limited to blood transit in the lungs, it would be confirmed for the entire body 400 years later when Marcello Malpighi described the action of capillaries. Moreover, after the 14th century, Ibn al-Nafis's discovery was lost, and it was not until 1924, when Egyptian physician Muhyo al-Deen Altawi found a copy of the Commentary in Berlin's Prussian State Library, that the full extent of Ibn al-Nafis's work was understood-showing that it was he, and not William Harvey some four centuries later, who had discovered the circulatory system.
Unfortunately, Ibn al-Nafis's fall into undeserved obscurity was not unique or even particularly unusual. Over those medieval centuries Muslim physicians by the tens of thousands, the great and the ordinary, lived and worked mostly outside centers of medical science. While they toiled, small groups of Christian and Jewish scholars also labored, filling for a coming era the roles of translators and disseminators that their Muslim predecessors had once filled for al-Ma'mun in Baghdad. Many were located along the porous, shifting, multicultural frontier with Spain where Toledo, Barcelona and Segovia offered them support; others gathered in the cities of France, Italy and Sicily that were touched by Islam. They too became cultural bridges, returning to a reawakening West both the intellectual foundations it had foregone nearly a millennium earlier and a rich legacy of discovery upon which today's western medicine is founded.
The physicians who produced this legacy of discovery in the Muslim world devised techniques and further unraveled enduring mysteries of the human body and mind. They established hospitals and the professions of surgery, medicine and pharmacy, invented surgical instruments and applied empirical methods to test hypotheses. They separated religion from science and opened a door for women. Many of their precepts of personal health, diet and hygiene are common sense today. Perhaps most important of all, they re-taught European physicians that sickness is only a deviation from health, and that the role of medicine is to cure disease.
If any of this seems too easily self-evident to us, that is because progress turns yesterday's discoveries into today's everyday knowledge.
||David W. Tschanz
(dwt1121_at_gmail_com) holds advanced degrees in history and epidemiology and has worked for Saudi Aramco in Dhahran since 1989. He writes primarily about history, medicine and technology. The second edition of his book Petra: A Brief History will be published in March.
This article appeared on pages 34-39 of the January/February 2011 print edition of Saudi Aramco World.
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