LEGACY OF MEDICINE Medieval Islamic Pharmacy Development of a science and a profession

– Written by David W. Tschanz, USA

No one knows when the first medicine various effects; natural history more than lost, especially in the field of health. Medical was made in the hopes of curing an illness, ‘pharmacy’ as we understand it today. practitioners were driven by a hadith of the only that it was so long ago the answer By the start of the 7th century CE, Europe Prophet: is lost in the mists of prehistory. What is and much of the Near East was mired “Allah never inflicts a disease unless he known is that the development of medicines in a morass of intellectual stagnation. makes a cure for it” pharmaceuticals has continued without The ravages of the barbarian hordes had This placed the responsibility for interruption, though with many fits and destroyed the libraries and irreplaceable discovering these cures and restoring health starts, since then. manuscripts collected over the centuries. on the skills and development of medical In the pre-Islamic West and Middle East The achievements of a thousand years of practitioners. early medicine was primarily a fusion of Hellenistic civilization in the arts, sciences Greek, Indian, Persian and later Roman and humanities were erased in a paroxysm THE RISE OF PHARMACY STUDIES attention that had slowly progressed over of destruction. Within a century of the death of the the better part of a millennia. Texts on By mid-century the rise of and Prophet, a systematic approach to the medications were common but most of its hallmark thirst for knowledge and study of poisons and some drugs was being these materia medica were simply lists openness to discovery began the saving and undertaken at the Umayyad court. Snake of various plants and minerals and their eventual expansion of what Europe had and dog bites as well as the ill effects of

616 Cordoba

Kairouan Damascus Isfahan Kufa Fustat

Medina

Mecca

Above: Map showing the geographical reach of the Umayyad Caliphate. Based upon the work of Gabagool via Wikimedia Commons. scorpions and spiders and other animals Yazid’s son, Khalid bin Yazid (d. 704), was celery, leek, sesame, rocket, olives, mustard were a cause of great concern, while the interested in alchemy, and so he employed and lichen. Important gums such as poisonous properties of various minerals the services of Greek philosophers who were frankincense and acacia were used. Animal and plants, such as aconite, mandrake living in Egypt. He rewarded them lavishly, products included: hair, blood, egg white, and black hellebore were exploited. and they translated Greek and Egyptian milk and sour milk, honey and dung. and Dioscorides were considered ancient books on chemistry, medicine and the stars. ‘Lab equipment’ consisted of pots, pans, authorities on the subject, and many A contemporary of Khalid was the Jabir Ibn tubes, retorts, alembics, crucibles and var- spurious treatises on the subject were Hayan (Geber), who promoted alchemy as ious distilling apparatus, covering platters, attributed to them. Numerous Islamic a profession laying early foundations for ceramic jars, tumblers, mortars and pestles writers discussed poisons and particularly chemical and biochemical research though (often made of glass or metals), tripods, theriacs, the antidotes for poisons. for reasons other than pharmacy. scales and medicinal bottles. The range and Sudden death was not an uncommon scope of alchemical operations included occurrence in royal courts and was SCIENTIFIC ALCHEMY AS FOUNDATION distillation, sublimation, evaporation, often, usually erroneously, attributed to The role of scientific alchemy cannot be pulverisation, washing, straining, cooking, poison. Not surprisingly, fear of poisoning over-emphasised. The trend, approach and calcination and condensation (thickening of convinced Umayyad leaders of the need to type of information circulated in 9th century liquid compounds). study them, detect them and cure them. As Arabic alchemical manuals represent some The key names in scientific alchemy a result much of early Islamic pharmacy of the best work in this field. The careful during the early Abbasid period were was done by alchemists working in methodology they developed would serve Abu al-Fa’id Ohun-Nun (d. 861) of Egypt toxicology. all fields, including pharmacy. and Ibn Wahshiyyah (fl. ca. 900) who The first of these was Ibn Uthal, the In the process of experimenting in the wrote on a variety of topics including Christian physician to the first Umayyad making of amalgamations and elixir, several alchemy, toxicology, magic and astrology. caliph, Mu’awiyah. He was a noted important mineral and chemical substances Rational alchemical activities, however, alchemist and had conducted a systematic were used such as sal ammoniac, vitriols, reached a climax in the works of ar-Razi, a study of antidotes and poisons. A number of sulphur, arsenic, common salt, quicklime, contemporary of Ibn Wahshiyah, and a far suspicious deaths at court led to his eventual malachite, manganese, marcasite, natron, more original writer. Ar-Razi’s works are of execution. Another Christian physician- impure sodium borate and vinegar. much higher calibre both in their relevance pharmacist, Abu al-Hakam al-Dimashqi, Among simples of botanical origin they to alchemy, as well as to pharmacy and served the second Umayyad caliph, Yazid. used fennel, saffron, pomegranate rinds, medicine.

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Isalmic Caliphates:

632 – 661 Rashidun Caliphate 750 – 1258 Abbasid Caliphate

661 – 750 Umayyad Caliphate

Above: Timeline of the Islamic Caliphates.

All of these techniques and methodolo- Qusta ibn Luqa and Mankah the Indian, As was the case in Europe and America gies as well as the attention to methodology who translated from Sanskrit into Arabic, up to modern times, many prominent and experimentation were essential to the and translated a treatise on poisons written physicians in Islam, prepared the necessary development of pharmacy as a science and by the Indian physician Shanaq, were also medications for their patients. Al-Majusi, not a hit and miss exercise. leading figures in this crucial period. az-Zahrawi and Ibn Sina (d. 1037) are good examples, but exceptions. For the typical THE ABBASIDS PHARMACY AS A PROFESSION medical professional, the role of educated The 9th century marked the beginning While Islamic scholars did not invent pharmacists in the medical field and in of the Golden Age of Islamic learning and the idea of medications, they did develop society could not be ignored and was, in fact just as Muslim scholars began to make pharmacy as a separate, co-equal profession , welcomed. Arabic pharmacy (saydanah) progress in the physical sciences, so too did requiring skilled practitioners with their was recognised as a profession and school they learn, master and expand the arts of own training, licensing and standards. of thought separate from medicine, just medicine and the science of pharmacy. The prolific intellectual ferment that as grammar is separate from the art of This early rise and development of fired the Baghdad schools, support at the composition, prose from poetry, and so professional pharmacy in Islam – more than highest levels of government and a craving forth. Its practitioners were recognised as 4 centuries before such development took for intellectual pursuits paved the way for possessing essential skills in a profession place in Europe – was the result of three greater achievement in the next 400 years. meeting high standards. major occurrences: Manuals on materia medica and books of By the beginning of the 9th century 1. the great increase in the demand for instructions circulated in large numbers Baghdad, the centre of learning at the time, drugs and their availability on the throughout the Islamic World and using the saw a rapid expansion of the number of market, methods of alchemy to formulate medicines privately owned pharmacy shops, a trend 2. professional maturity and and experiments. that quickly spread to the suburbs and then 3. an unprecedented intellectual curiosity. Methods of extracting and preparing to other Muslim cities. Initially these were of scientific books into Arabic medicines were brought to a high art unregulated and managed by personnel of had already begun under the short-lived and their techniques of distillation, inconsistent quality, but all that changed. Umayyad Caliphate. It exploded under the crystallisation, solution, sublimation, One of the finest definitions of the Abbasids whose caliphs searched the world reduction and calcination became the pharmacist, his role and his profession, was for books and manuscripts above all else. essential processes of pharmacy and given by Abu ar-Rayhan al-Biruni (d.1048). , was probably the chemistry. In his work as-Saydanah fit-Tibb, al-Biruni greatest translator in Arab history. He had With the help of these techniques, the defined the pharmacist “as the professional a superlative knowledge of Syriac, Greek saydalanis (pharmacists) introduced new who is specialised in the collection of all and Arabic, and carried out a large number drugs such as camphor, senna, sandalwood, drugs, choosing the very best of each simple of from Greek scientific and rhubarb, musk, myrrh, cassia, tamarind, or compound, and in the preparation of philosophical manuscripts into Arabic, nutmeg, alum, aloes, cloves, coconut, good remedies from them following the for which he was paid their weight in nuxvomica, cubebs, aconite, ambergris and most accurate methods and techniques as gold. These included most of the works of mercury. recommended by experts in the healing Hippocrates and Galen. After his death, They further introduced hemp and arts.” This description varies only slightly work was continued by his pupils and by henbane as anaesthetics, and established from the modern one. his nephew Hubaish. Thabit ibn Qurrah, the monopoly on the dispensation of Pharmacy students were trained in a who wrote on a variety of medical topics ointments, pills, elixirs, confections, combination of classroom exercise coupled as well as on philosophy and astronomy; tinctures, suppositories and inhalants. with day-to-day practical experiences with

618 drugs. Trainees became familiar with the shapes, physical properties, and kinds of drugs. Under decrees by the caliphs al-Mamun and al-Mutasim pharmacists had to pass examinations to become licensed professionals and were pledged to follow the physician’s prescriptions, though most medical scholars, including Biruni, believed a pharmacist should be able to substitute or to discard one drug for another if it made pharmacological sense. To avoid conflict of interest and assure that no cover-ups occurred, doctors were prevented from owning or holding stock in a pharmacy or apothecary shop. Pharmacists and their shops were periodically inspected by a government appointed official al-Muhtasib and his aides. The Muhtasib checked to see that the medicines were mixed properly (to prevent dilution of the medicines) and that the jars containing the medicines were kept clean. When the inspector caught a druggist not abiding by the rules, the druggist was fined Image: De Materia Medica of Dioscorides, an image from an Arabic-translated manuscript from De Materia Medica, a Greek text written by Dioscorides (Public Domain). heavily or suffered more severe punishment, such as a beating of the soles of his feet. Hospitals had their own dispensaries, the Abbasid regime, which was usually trend that accelerated form the 9th century attached to manufacturing laboratories, occupied by the most outstanding physician onwards. Not surprisingly, early knowledge where syrups, electuaries, ointments of the Islamic world. Another post, that of medicinal substances was based initially and other pharmaceutical preparations of Chief Pharmacist, was also created to on the approximately 500 substances were prepared on a relatively large scale. head the department which supervised described by the Greek Dioscorides in his The hospital was run by a non-medical the preparation of drugs. One of the most treatise on materia medica. administrator. He was assisted by a Chief famous holders of the position was Zia Ibn The Nestorian physician, Yuhanna Medical Officer (Mutwalli or Dean) who Baytar, the great botanist and herbalist who bin Masawayh (ca777-857), a second was a physician. The other member of the occupied this post in 1266. generation pharmacist, penned an early hospitals troika was the Shaikh Saydalani treatise on therapeutic plants, listing who served as Chief Pharmacist and DEVELOPMENT OF PHARMACEUTICAL about 30 aromatics including their overseer of the dispensary. LITERATURE physical properties, methods of detecting The government post of Inspector- The preparation and use of medicinal adulteration and their pharmacological General of Hospitals was created during drugs had its own specialised literature, a effects. He recommended using medicinal

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plants to build up a natural resistance to comes from Kabul aloes from Socotra and of opium or henbane causes sleep and also diseases. aromatic spices from India. death. A younger colleague, Abu Hasan ‘Ali He recommended glass or ceramic The first known medical formulary b. Sahl Rabban at- Tabari (b. 808) said that storage vessels for liquid (wet) drugs was prepared by al-Aqrabadhin Sabur the therapeutic value of each drug needed special small jars for eye liquid salves bin. Sahl (d. 869). Sabur’s formulary-type to be reconciled with the particular disease lead containers for fatty substances. For compendium is unique in its organisation and urged physicians not to simply provide the treatment of ulcerated wounds, he and purposely written as a guidebook the routine remedy. He identified the best prescribed an ointment made of juniper- for pharmacists, whether for use in their source for several components stating, for gum, fat, butter and pitch. In addition, he own private drugstores or in hospital example, that the finest black myrobalan warned that one mithqal (about 4 grams) pharmacies. The book included medical recipes stating the methods and techniques of compounding these remedies, their pharmacological actions, the dosages given of each and the means of administration. The formulas are organised by the type of preparation to which they belong i.e. tablets, powders, ointments, electuaries or syrups. Later formularies composed as larger independent collections of recipes followed this model and some were written for specific use in hospitals. In addition to these early works, virtually every medical practitioner wrote a treatise on medicaments. Medical encyclopaedias usually had one chapter on materia medica and another on recipes for compound remedies, for example, Razi’s al-Hawi mentions 829 drugs. Pharmacological drugs were classified into simple and compound drugs, mufraddat and murakkabat. The effects of these were detailed and documented in the literature with a high degree of accuracy and completeness. The largest and most popular of materia medica manuals was that by Ibn al-Baytar, who was born in Malaga in the kingdom of Granada towards the end of the 12th century and became `Chief of Botanists’ in Cairo in the first half of the 13th century. His Arabic treatise, The Comprehensive Book on Materia Medica and Foodstuffs (Kitab al-Jami` li-mufradat al-adwiyah wa- al-aghdhiyah), was an alphabetical guide to over 1400 simples taken from his own observations as well as from 150 written sources that he names. Al-Baytar’s manual formed the basis of many subsequent manuals on medicinal substances, including that written in the 18th century by Muhammad Husayn ibn Muhammad Hadi al-`Aqili al-`Alavi, a Image: Man Bitten by Mad Dog, an image from an Arabic-translated manuscript from De practitioner in India and grandson of a well- Materia Medica, a Greek text written by Dioscorides (Public Domain). known Indian practitioner.

620 THE RULES OF CLINICAL TRIALS SUMMARY Further Reading In any field of human endeavour he A series of Islamic scholars, physicians, 1. Hadzovic S. Pharmacy and the Great turned his attention to, Ibn Sina () , authors and an army of unsung Contribution of Arab-Islam ic Science to was like a force of nature. In the area of plain folk played a critical role in the its Development. Med Arch 1997; 51: 47-50. pharmacy he made many contributions, development of pharmacy as a science and 2. Kamal H. Encyclopedia of Islamic including describing 760 drugs and their as a separate profession. Medicine. Cairo: General Egyptian Book uses. His most lasting in the field of Islamic scholars laid down a legacy Organization 1975. pharmacy was his development of rules for that reflects itself in every prescription testing the effectiveness of a new drug or that is filled, every license that is granted, 3. Levey M. Early Arabic Pharmacology. medication. These principles still form the every elixir, syrup and medicament that is Leiden: EJ Brill 1973. basis of modern clinical drug trials. created, used or tested. It is memorialised 4. Savage-Smith E. Islamic Culture and the in the significant number of current Medical Arts. Bethesda: National Library 1. The drug must be free from any pharmaceutical and chemical terms derived of Medicine 1994. extraneous accidental quality. from Arabic: drug, alkali, alcohol, aldehydes, 5. Tschanz DW. The Arab Roots of European 2. It must be used on a simple, not a alembic and elixir among others, not to Medicine. In: Aramco World, May-June composite, disease. mention syrups and juleps. They invented 1997. 3. The drug must be tested with two flavourings extracts made of rose water, contrary types of diseases, because orange blossom water, orange and lemon sometimes a drug cures one disease by peel, tragacanth and other attractive its essential qualities and another by its ingredients. David W. Tschanz Ph.D. accidental ones. The Muslims’ introduction of regulation Independent Scholar, formerly with 4. The quality of the drug must correspond ensured that all doctors and pharmacists Saudi Aramco Medical Services to the strength of the disease. For were qualified and that they did not USA example, there are some drugs whose cheat their patients when it came to drug heat is less than the coldness of certain composition actions which doubtlessly diseases, so that they would have no saved countless lives that would have been effect on them. lost due to incompetence and assured 5. The time of action must be observed, professional standards unmatched for so that essence and action are not centuries. confused. If what these men did seems to be a 6. The effect of the drug must be seen to simple and obvious thing to us now, it is only occur constantly or in many cases, for if because the obvious is yesterday’s discovery. this did not happen, it was an accidental effect. Parts of this paper are based on a peer- 7. The experimentation must be done with reviewed published manuscript: the human body, for testing a drug on a Tschanz DW. A short history of Islamic lion or a horse might not prove anything pharmacy. Journal of ISHIM 2003. about its effect on man. http://www.ishim.net/ishimj/3/03.pdf

Fear of poisoning convinced Umayyad leaders of the need to study them, detect them and cure them

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