LEGACY OF ARABIC MEDICINE Ibn Zuhr The turbaned doctor of Seville

– Written by David W. Tschanz, USA

Perhaps the best way to introduce him is “This is my only jug” whined the man, “I start with a story: can’t.” In 1120 a Muslim doctor was en route to “And that thing bulging out there,” see his patient, the Almoravid ruler of Seville. sternly replied the doctor pointing to the He has earned On the side of the road he saw an emaciated man’s midsection, “Is your only stomach. man holding a water jug. The man’s belly It is easier to find a new jug than a new undisputed was swollen and he was in obvious distress. stomach.” claim to the title “Are you sick?” the doctor asked the man. The man continued to protest, but one of The patient nodded. Ibn Zuhr’s servants picked up a stone and ‘The Father of “What have you been eating?” smashed the jug. A dead frog flowed out “Only a few crusts of bread and the water with the foul water. Experimental from this jug.” “My friend,” the doctor said to the “Bread won’t hurt you,” said the doctor. patient, “look what you have been drinking. Surgery’ “It could be the water. Where are you getting That frog would have taken you with him. it?” Here, take this coin and go buy a new jug.” “From the well in town.” When the doctor passed by a few days Ibn Zuhr pondered a moment. “The well later he saw the man sitting along the side is clean. It must be the jug. Break it and find of the road. His stomach had shrunken, he a new one.” had gained weight and his colour was back.

90 Image: Chirurgical Operation, Turkish manuscript, 15th Century (Public Domain).

Seeing the doctor, the main heaped praise Cairo, he began his medical practice and toppled the world’s largest empire had on him. training under his father, Abu’l-Ala Zuhr destroyed its libraries, using the scrolls to (d. 1131). In addition to being a leading fuel the fires that cooked their meat, turning BACKGROUND physician of the era, Abu’l-Ala was a vizier Europe’s intellectual heritage into ashes. Ibn Zuhr, the physician who observed, to the Almoravids, then in control of Seville. In post-Roman Europe, the Christian deduced and cured the man was born in Ibn Zuhr became their physician as well. Church redefined medicine and science in Seville in 1091 CE, and named Abu Marwan During his life, Muslim medical practice a profound and inhibiting way. Illness, the Abd al-Malik. At the time of his birth no one was the most advanced in the world Church insisted, was due to supernatural questioned that he would become a doctor. and driven to constantly improve by the forces, as a punishment for sin, or as It was, after all, a family tradition. Prophet’s oft-quoted hadith that for every diabolical possession, hence the only cure The Banu Zuhr (from where he got illness and condition God had created a cure, for sickness and disease was by religious the nickname Ibn Zuhr, later Latinised to and the role of the physician was to find it. means. Every malady was assigned a patron Avenzoar by European scholars) had already By contrast, medical knowledge in saint to whom prayers for a cure were produced two generations of physicians, Christian Europe was mired in a stygian directed by the patient, his family, friends and would produce five more. Ibn Zuhr abyss. Compared to their Muslim and the community. outshone them all, becoming one of the counterparts, European physicians were The Church opposed anything that greatest physicians – some historians say witch doctors, bereft of knowledge and saved the body but risked the soul. Bathing the greatest – of the Islamic world. He also hampered by a cultural mindset that was condemned as a prideful, immoral earned undisputed claim to the title ‘The disdained their work as a challenge to act. Basic hygienic principles were lost. Father of Experimental Surgery’. Divine Will. The pope banned surgery, because it was a After graduating from the University of The intellectual life of the West was danger to the surgeons’ chance for salvation. Cordoba, and a brief stay in Baghdad and in shambles. The barbarian hordes that Hellenistic style doctors were replaced by

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clerics convinced the role of the physician of which may have died in infancy) and a It is also the most readable of all of Ibn was not to heal, but to study the writings of daughter. Zuhr’s writings. He was clearly influenced by other physicians and pen commentaries on the simplicity of his incarceration, and the their work. RETURN TO FAVOUR spontaneity of Berber life with its elements In 1147, the Almohads (Al-Muwahadun), of miracle-working and folk remedies. It also EARLY CAREER under ‘Abd al-Mu’min, conquered Seville shows the value of composing a book based Ibn Zuhr was the first Muslim scientist to and Ibn Zuhr returned as the new ruler’s on personal experience and knowledge devote himself solely to medicine and made personal physician and devoted himself as opposed to merely summarising and several major discoveries and breakthroughs to medical practice and teaching until his conveying the work of others. carefully chronicled in his books, only three death in 1161. In the book, Ibn Zuhr makes several of which survive. The lost works include a Shortly after his release from prison al- recommendations regarding diet. For treatise on cosmetics, a treatise on leprosy Mu’min requested he prepare a general example, he argues that food intake should and a memorial addressed to his son on medical handbook for laymen and the be determined according to the season. what to do in the treatment of diseases and court. Ibn Zuhr, who mentions he didn’t “Since digestion in winter is stronger, the the use of laxatives. have access to his book, produced the Kitab amount of food should be greater; and The first of the surviving texts, Kitab al-Aghthiya (Book of Foods) which describes since it is colder and more humid, the foods al-Iqtisad fi Islah al-Anfus wa al-Ajsad different types of food and drugs and their should be hotter and drier”. (Book of the Middle Course concerning the effects on health as well as the importance A significant portion of the book is taken Reformation of Souls and the Bodies) was of hygiene. up with a discussion of the nutritional value completed in 1121 and dedicated to the Almoravid prince Ibrahim ibn Yusuf ibn Image: This 15th- Tashifin. The book, written for laymen, gives century Italian a summary of diseases, therapeutics and illustration depicts the presentation hygiene. The introduction is a long treatise of a work by Ibn on the relation between psychology and Zuhr of Seville, health. The main text consists of seven translated into Latin sections (divided into 15 iqtisad) that relate by John of Capua. to diseases of: 1. The tongue and mouth. 2. The eyes. 3. Ears, nose, scalp and face. 4. Neck, brain, arms, armpits and fingers. 5. Buttocks. 6. Scabies, furuncles and tumours. 7. Acute conditions including fevers, chills, myopathies and oedemas. It appears his intention was to discuss the ailments of internal organs, including the brain, heart, lungs and kidney in a future book that was never written. This book is interesting but as one commentator has said, it is a first work and its real value is in comparison to Ibn Zuhr’s later works Around 1131, possibly at the death of his father, he fell out of favour of with the Almoravid ruler, Ali bin Yusuf bin Tashufin, and fled to Africa. He was, however, apprehended and jailed in Marrakesh for the next 16 years. While in prison he met a woman who with whom he had children, though we do not know her name and whether she was his sole wife or one of several wives. During this imprisonment he became the father of two sons (the first

92 of various foods and their preparation. Ibn A number of Latin texts, written in conditions effecting anatomic sites from the Zuhr favours ordinary, fermented wheat Montpellier, France, under the title Regimina top of the head to the upper abdomen. Book bread cooked over the tannur, an earthen sanitatis, followed the format and content of II covers the rest of the body. oven in the shape of a dome. He praises the book. The text made a deep impression Each ailment is described and then the value of mutton and lamb, which he on Maimonides who frequently quoted it. followed by recipes, consisting mostly of considers the most humid and delicious. The themes of the book are as timeless herbal medications used as laxatives for Beef is dismissed as an inferior meat. He also as its recommendations. It is not a stretch to the evacuation of superfluous humours, discusses wild animals, finding gazelle easy say that if it were put in a modern format ointments and dietary restrictions. A to eat, lions and leopards too tough whereas and the language modernised, the Kitab number of medications derived from snakes and locusts are acceptable in dire al-Aghthiya would be a useful manual minerals or animals are included. Following emergencies. The most delicious game food for persons looking for a sensible diet and Galen’s teachings, Ibn Zuhr recommends he says is porcupine, “in moderation”. practical guidelines for a healthy lifestyle – bloodletting in instances ranging from There is an entire section on ‘Simple just as it was 10 centuries ago. ringworm to more serious conditions such Medications with Special (meaning His last book, Kitab al-Taisir fi al-Mudawat as penetrating head wounds, empyema and occult) Properties of Objects’. These include wa al-Tadbir (Book of Simplificationsome fevers. somewhat arcane and exotic preparations concerning Therapeutics and Diet), was Ibn Zuhr includes detailed case reports, such as grains of emerald, bezoars and written at the request of his student and such as the one paraphrased at the burned river crabs. Also recommended are intellectual opponent Ibn Rushd (Averroes) beginning of this article, to illustrate his practices such as the daily viewing of olive in approximately 1155 CE. Ibn Zuhr was points, describing the ailment, deducing the trees and the drinking of water poured over then in his 60s. His goal was to combine the cause and applying a cure. molten iron or gold, or of water in which old tradition of compendium writing with In a breakthrough he proved that copper has been washed. Perhaps a bit some theoretical and scientific medicine. scabies was caused by the itch mite sheepishly, Ibn Zuhr defends their inclusion The main body of Taysir is divided into (Scabies sarcoptes). This simple discovery on the grounds Galen used them as well. two books and formulary of medicinal completely disproved the erroneous but The book also offers guidelines on general preparations as an appendix. The first two long-standing and much-revered theory of hygiene and best healthy practices regarding books are arranged “from head to heel” four humours supported by Hippocrates, sleep, exercise, dwellings, grooming, according to a long-established tradition Galen and Avicenna. When he showed that bathing, pregnancy and childcare. dating back to ancient Egypt. Book I covers curing the disease was by removal of the

He established introduced a training course so surgeons were fully qualified before being allowed to perform operations independently

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parasite from the patient’s body and did have eaten 10 grapes and you will go they were largely limited to obstetrics, they not involve purging, bleeding or any other 10 times to evacuate the bowels”. The began a tradition that became common in traditional treatments associated with the Almohad Caliph asked him the reason every Muslim society to the present – the four humours, he sent a shudder through of this; he informed him of it. Then it acceptance of women as medical doctors. the medical world that unshackled it from happened as he said. ‘Abd al-M’umin By contrast, the USA did not graduate its blind subservience to ancient, but incorrect became calm and was healed, and first female physician until 1849, England in ideas. As a result, he is sometimes called the so [Ibn Zuhr’s] reputation and rank 1870 and Scotland in 1894. ‘Father of Parasitology’. increased. Ibn Zuhr’s only adult son, Abu Bakr, He wrote about ways to avoid became a successful physician, but was developing kidney stones through diet SURGERY more famous among his contemporaries and lifestyle to avoid painful and difficult While Az-Zahrawi, a fellow Andalusian, as a man of letters and a poet. He also repair in future years. He gave the first is considered the ‘Father of Surgery’ because served the Almohad caliphs Abu Yaqub accurate descriptions of neurological of the impressive body of knowledge, Yussuf al-Mansur, and then Al-Nassir. A disorders, including meningitis, intracranial instruments and techniques he had devised group of envious dignitaries wrote a letter thrombophlebitis and mediastinal and developed a century earlier, Ibn Zuhr to Al-Mansur in which they made serious tumours, and made contributions to did one better: in Taysir he introduces allegations against Abu Bakr but al-Mansur modern neuropharmacology. He also gave and confirms the use of the experimental had the accusers imprisoned. Unfortunately clinical descriptions of intestinal phthisis, method into surgery. he, as well as Ibn Zuhr’s daughter the inflammation of the middle ear and Using animals as his subjects, Ibn Zuhr midwife, were poisoned by an envious vizier pericarditis. proved the safety of a tracheotomy on a in Marrakesh in 1199. His description ‘On Verrucae that Occur goat by performing one. He also performed Abu Bakr’s son, Abu Muhammad in the Stomach’, which deals with an postmortems on sheep in the course of his ‘Abdallah ibn al-Hafid, became a successful emaciated Berber who evacuates a tumour clinical research on treatment of ulcerating physician in the Almohad service. He was the size of an apple in his stools, represents diseases of the lungs and represented a poisoned around 1205, and was buried in the first detailed report of a cancer of the further step in the development of the Seville near his ancestors. He left two sons colon. experimental school started by Al-Razi who lived in Seville; the youngest, Abu Al- In Taysir, he was the first to explain how (Rhazes) of Baghdad in the 9th century ‘Ala’ Muhammad, was also a physician and to provide direct feeding using a tube of who gave monkeys doses of mercury to test the 6th generation of physicians in direct silver or tin through the gullet and rectum it as a drug for human use. Ibn Zuhr is the descent in the Ibn Zuhr family. In the 1240s in the cases where normal feeding was first physician known to have carried out Seville was in Spanish hands and all Muslim not possible i.e. parenteral feeding. He human dissection and postmortem autopsy scholarship in the city effectively ended, also recommended the use of a fine sound to confirm his understanding of surgical including the Banu Zuhr medical dynasty. tipped with a small diamond for breaking techniques. Curiously he will deny this, Ibn Zuhr’s works were translated into up urethral stones. though there is no other way he could have Latin by scholars living along the Christian- He also showed extreme skill in had the detailed knowledge he presents Islamic border in Europe, particularly at understanding the psychology of patients. without it. Montpellier, Toledo, Salerno and Padua. Ibn Abi Usaybia wrote about one incident: Ibn Zuhr also established surgery as Hebrew translations appeared in the mid- The Almohad Caliph ‘Abd al-Mu’min an independent field of medicine by 12th century. The Taysir’s Latin version, Liber needed to have a laxative drug, and he introducing a training course designed Teisir, was usually paired with the Colliget, detested to drink the purgative drugs. specifically for future surgeons so that they the Latin translation of Ibn Rushd’s largely [Ibn Zuhr] acted by subtle means, he were fully qualified before being allowed to theoretical Kitab al-kulliyat. went to a grapevine of his garden, perform operations independently, and for The Cairo-based Jewish physician and irrigated it with water containing defining the roles of a general practitioner Maimonides quoted extensively from Ibn the purgative drugs, macerated or and a surgeon in the treatment of a surgical Zuhr and considered him “unique in his age boiled. When the grapevine took the condition. He also drew the lines at which and one of the great sages”. strength of the laxative drugs, and the a physician should stop during his general His books remained popular in Europe grapes appeared with these strengths, management of a surgical condition, a as late as the advent of the 18th century he ordered the Almohad Caliph to major step in the evolution of general and their emphasis on observation and be on a diet, and then brought him a surgery as a specialty of its own. experimentation greatly influenced the grape and indicated him of eating it. Eastern and Western medical sciences for The Caliph had a good opinion of [Ibn LEGACY several centuries, laying the seeds for his Zuhr]. When he ate it in his presence, Ibn Zuhr would see to it that two of intellectual heir, Paracelsus. The latter’s he said to him: “Oh, Commander of his female relatives, his daughter and critique of scholastic methods in medicine the faithful, it is sufficient for you to granddaughter, went into medicine. Though and the uncritical copy of the teachings of

94 Image: Scene from the Story of Bayad and Riyâd (Public Domain). the old Fathers of Medicine such as Ibn Sina Further Reading and Ibn Rushd owes much to Ibn Zuhr and 1. Azar H. The Sage of Seville: Ibn Zuhr, His Legacy of Muslim Scientists, Thinkers, and was a major step a more dynamic approach Time, and His Medical Legacy. American Artists. Washington: National Geographic to medicine University in Cairo, Cairo 2008. 2007. Ibn Zuhr was not merely a keen observer 2. Campbell DC. Arabian Medicine and its 6. Osler W. The Evolution of Modern of patients and a dispenser of remedies. Influence on the Middle Ages. Reprint: Medicine: A Series of Lectures Delivered His narratives are candid recollections Philo Press, Amsterdam, 1974: p. XI-XV. at Yale University on the Silliman and views on a variety of subjects and of 3. Millán CA. Ibn Zuhr. In: Glick TF, Livesey Foundation in April 1913. New Haven: his society. His medical recipes could be Yale University Press, London: Humphrey compared to current forms of alternative SJ, Wallis F. Medieval Science, Technology, and Medicine: An Encyclopedia. Milford, Oxford University Press 1921. medicine. His holistic approach to medicine (Routledge Encyclopedias of the Middle and his spontaneous vignettes make him Ages). New York: Routledge, 2005. one of the most refreshing physicians of any age. Against a modern culture of often 4. Menocal MR. The Ornament of the World: impersonal, bureaucratised and costly How Muslims, Jews, and Christians David W. Tschanz Ph.D. healthcare, Ibn Zuhr’s role as a caring, Created a Culture of Tolerance in Medieval Independent Scholar, formerly with genuine hakim (healer-teacher) to his Spain. New York: Back Bay Books 2002. Saudi Aramco Medical Services patients continues to inspire. 5. Morgan M. Lost History: The Enduring USA

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