‘The Important Influence of Baghdad on the Development of Western Medicine’

By the ninth century, Islamic medical practice began to advance beyond the theories of the ancient Greeks and the people of Mesopotamia became interested in developing the theories of Galen, Hippocrates, and Paul of Aegina. By the tenth century, many of the teachings of essential Greek medical text were translated into Arabic in Baghdad. As the Islamic Empire grew and extended its borders from Spain to China, Arabic became the international language of learning and diplomacy. Western doctors first learned of Greek medicine, including the works of Hippocrates and Galen, by reading Arabic translations. Indeed, Baghdad emerged as the capital of the scientific world. They introduced hospital wards and examinations for young doctors. They also introduced psychiatry as a field of medicine when the Christian world was still being influenced by demons and devils causing mental illness. Najab ud din Muhammad, a contemporary of Razi, even attempted to classify mental diseases into psychosis and neurosis, a classification that still exists today. These included kutrib (a form of persecutory psychosis), and dual-kulb (a form of mania). The Islamic world produced the first skilled, pharmacists, who made their own medicines and worked closely with physicians. Baghdad introduced regulations on the sale and quality of drugs, and licenced pharmacists and even prevented doctors from owning or holding stock in a pharmacy. They developed methods of extracting medicines, including crystallization, solution, sublimation, and reduction to introduce new drugs such as senna, sandalwood, musk, myrrh, and nuxvomica. The words drug, alkali, alcohol, aldehydes, alembic, and elixir all come from this period. In Baghdad Medical School, doctors learned anatomy by dissecting apes, skeletal studies, while other schools only taught anatomy through illustrations and lectures.

Abu Bakr Muhammad ibn Zakariyya al-Razi, (854 CE – 925 CE)

Surgery was also included in the Baghdad curriculum many surgical procedures such as amputation, excision of varicose veins and haemorrhoids were required knowledge. Orthopaedics was also widely taught to use plaster of Paris for casts in the reduction of fractures. Interestingly, this method of treating fractures was only rediscovered in the West in 1852. Ophthalmology was practiced in Baghdad, and it should be remembered that medical words such as retina and cataract are of Arabic origin. lbn al Haytham (965-1039 A.D.) wrote that vision happens when light rays pass from objects towards the eye and not from the eye towards the objects as thought by the Greeks. He also taught that the image made on the retina is conveyed along the optic nerve to the brain. The Persian physician, chemist, alchemist, philosopher, and scholar al-Razi lived from 865 to 925 C.E. Al-Razi moved to Baghdad where he became the Chief Physician of the Baghdad Hospital and the Court-Physician of the Caliph. He was the first to distinguish measles from smallpox, and he discovered the chemical kerosene and several other compounds. Abu Bakr Muhammad ibn Zakariyya al-Razi, (854 CE – 925 CE), was a Persian polymath, physician, alchemist, philosopher, and important figure in the history of medicine. He became the chief physician of the Baghdad and Rayy hospitals. Razi was the first to recognize the reaction of the pupil to light and introduced mercury as a therapeutic drug for the first time in history, which was later adopted in Europe. Al-Razi is attributed to be the first to use animal gut for sutures. He is credited with many contributions, which include being the first to describe true distillation, corrosive sublimate, arsenic, copper sulphate, iron sulphate, saltpetre, and borax in the treatment of disease. as mentioned, he introduced mercury compounds as purgatives (after testing them on monkeys); mercurial ointments and lead ointment.”. His interest in urology focused on problems involving urination, venereal disease, renal abscess, and renal and vesical calculi.

Abu Alī al-Husayn ibn Abd Allah ibn Sina (c. 980, Afshana near Bukhara– 1037, Hamadan, Iran)

He described hay fever or allergic rhinitis. He wrote “The Diseases of Children,” likely the first text to distinguish paediatrics as a separate field of medicine and pioneered ophthalmology. Records show, he was the first doctor to write about immunology and allergy. Ibn Sina, who many Europeans referred to as Avicenna, was also Persian. He had many skills and professions, and he wrote nearly five hundred books and articles, of which at least half still exist today. Among his contributions to medieval medicine were “The Book of Healing,” an expansive scientific encyclopaedia, and “The Canon of Medicine,” which became essential reading at several medical schools around the world. Students at the Sorbonne could not graduate without reading Ibn Sina’s Qanun (Cannon). Ibn Sina was the first to describe the exact number of extrinsic muscles of the eyeball. A method of extracting cataracts was developed by Ammar bin Ali of Mosul, who introduced a hollow metallic needle through the sclerotic and extracted the lens by suction. This was not done in Europe until the nineteenth century. The new Al-Adudi hospital in Baghdad was built in 981 A.D. and had interns, residents, and 24 consultants. An Abbasid minister, Ali ibn Isa, requested the court physician, Sinan ibn Thabit, to organise regular visiting of prisons by medical officers. Abu al-Qasim Khalaf ibn al-Abbas al-Zahrawi al-Ansari, popularly known as Al-Zahrawi was an Arab Muslim physician, surgeon and chemist who lived in Al-Andalus. Considered the greatest surgeon of the Middle Ages, he has been described as the father of surgery. He introduced cotton (Arabic word) in surgical dressings to control haemorrhage, as padding in the splinting of fractures, and taught the lithotomy position for vaginal operations. He demonstrated the difference between goitre and thyroid cancer and stripped varicose veins.

Al-Zahrawi in his hospital in Cordoba

Al-Zahrawi introduced what is called today Kocher’s method of reduction of shoulder dislocation and patellectomy to orthopaedic surgery, 1,000 years before Brooke reintroduced it in 1937. He described tracheotomy, orthodontia and described the different types of fracture before the introduction of X Rays. In the rest of the Islamic world, the Iranian ibn Sina (Avicenna 980-1037 A.D) suggested the communicable nature of tuberculosis long before the infectious nature of the pathogen was discovered. Ibn Sina originated the idea of the use of oral anaesthetics and he recognised opium as the most powerful mukhadir (an intoxicant or drug). He also used less powerful anaesthetics such as mandragora, poppy, hemlock, hyoscyamus, deadly nightshade (belladonna), lettuce seed, and snow or ice-cold water. However, the turning point in the great age of Islam’s contribution to medicine came when a confederation of nomadic tribes led by Genghis Khan, first conquered China, and then spread out to attack the rest of the Muslim Empire. In 1258, Hulagu Khan invaded Baghdad and destroyed the ancient systems of irrigation with such extensive devastation that even today agricultural recovery in this nation is still incomplete. While in Baghdad, Hulagu made a pyramid of the skulls of Baghdad’s scholars, religious leaders, and poets, and he deliberately destroyed what remained of Iraq’s canal headworks. The medical knowledge of centuries was swept away, and Mesopotamia became a neglected frontier province ruled from the Mongol capital of Tabriz in Iran. In 1380, another Turko-Mongol confederation was organised by Tamerlane the Great, who claimed descent from Genghis Khan. They swept down on Baghdad again destroyed the hospitals and burnt the libraries with their irreplaceable works. It is said that the waters of the Tigris ran blue with the ink of the medical and scientific works destroyed by these barbarians. The result was to wipe out much of the priceless cultural, scientific, and medical legacy that Muslim scholars had been preserving and enlarging for some five hundred years.

Siege of Bagdad (1258)

In 1401, he sacked Baghdad and massacred many thousands of its inhabitants. His rule virtually extinguished Islamic dominance of medicine and Baghdad, long a centre of trade suffered severe economic depression. The medico-social innovations of the Baghdad scholars totally disintegrated. To make matters worse, the southern province of Basra, which had been a key transit point for seaborne commerce was circumvented after the Portuguese discovered a shorter route around the Cape of Good Hope. By the end of the Mongol period, the medical knowledge of the people of Mesopotamia had shifted from the urban-based Abbasid culture to the tribes of the river valleys, where it has remained well into the twentieth century

Extract above is taken from Dr Patrick Treacy's book 'The Living History of Medicine' soon to be published in 2022

Dr. Treacy was awarded the ‘Top Aesthetic Practitioner in the World 2019’ in Las Vegas. He won the ‘Doctor of the Year’ UK & Ireland (Las Vegas 2019) and (London 2018). He is recognised as one of the most influential aesthetic practitioners in the world being named amongst the ‘Ultimate 100 Global Aesthetic Leaders’ (2019, 2018, 2017). His research has strongly influenced this specialist area where he has developed global protocols relating to dermal filler complications and wound healing, as well as pioneering techniques for HIV facial lipodystrophy facial end prostheses and radiosurgery venous thermocoagulation.?

Dr Patrick Treacy working as a doctor in Baghdad before the Gulf War

'Taking advantage of the temporary lull, I retreated along the outside courtyard to my bedroom in the doctor’s residence. Patients’ relatives were sitting under the palm trees, chatting, and smoking below the bright stars of the Baghdad night. A few soldiers with Russian AK-47 assault rifles slung loosely from their shoulders stood by the perimeter walls. There was no sign of any of the soldier’s family members within the compound.

I found it difficult to get to sleep knowing that I could be called at any moment, and for a long while, I lay and listened to the crickets singing in the long grass outside. From time to time, a muezzin on a minaret wailed into a microphone and probably woke the sleeping city. I had just managed to get a few hours of sleep before the phone rang again. It was twenty to eight in the morning, and there was a cardiac arrest in intensive care.

As I struggled to put my clothes on, I heard the cardiac beeper of my colleague sounding in the room next door. I wondered which of the patients had crashed and decided it was probably one of the little girls again. I ran out the door, pulling on my white coat, and narrowly missing a pair of veiled Muslim women who were walking along the path.

A group of nurses were returning from an all-night party in one of the blocks and watched me running across the courtyard. Their early morning revelry was changed to concern as they watched my sprint. I took a shortcut, jumping over some shrubs to reach the door of the unit, and arrived on the ward out of breath'

Extract in italics above is taken from Dr Patrick Treacy's book 'The Needle and The Damage Done' published by Austin McCauley in April 2021

The Needle and the Damage Done | Book | Austin Macauley Publishers