Iranian Journal of Pharmaceutical Research (2008), 7 (2): 93-99 Copyright © 2008 by School of Pharmacy Received: January 2008 Shaheed Beheshti University of Medical Sciences and Health Services Accepted: February 2008

Review Article

History of Medical Sciences in

Jalal Pourahmad*

Faculty of Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

The practice and study of medicine in Persia has a long and prolific history. The was combined by different medical traditions from , Egypt, India, China and Greece for more than 4000 years and merged to form what became the nucleus and foundation of medical practice in the European countries in the 13th century. The Iranian academic centers like Jundishapur University (3rd century AD) were a breeding ground for the union among great scientists from different civilizations. These centers successfully followed their predecessors’ theories and greatly extended their scientific research through history. Iranian physicians during the glorious Islamic civilization had a tremendous share in the progress of medical sciences. The excellent clinical observations and physical examinations and writings of Iranian scientists such as Rhazes (Al-Razi, 865-925 AD), Haly Abbas (Ali ibn- al Abbas-al Majusi, died 994 AD), (Abou Ali Sina, 980-1037) and Jurjan (Osmail ibn al-Husayn al-Jurjani, 110 AD) influenced all fields of medicine The new era of medicine in Iran begins with establishment of Dar-ul-funoon in 1851, which was the only center for modern medical education before the establishment of Tehran University. Following the establishment of the Tehran university school of medicine in 1934 and the return of Iranian graduates from the medical schools in Europe, much progress was made in the development and availability of trained manpower and specialized faculties in medicine. After the Islamic revolution by the growing spirit of independence inspired by the Iranian government the number of medical schools and medical students increased more than 10 times. For the 1st time in recent modern history the Iranian medical universities started to offer post-graduate specialized degrees in basic, clinical and engineering sciences.

Medical sciences including pharmacy has of a medical practitioner from Neo-Assyrian a long history in Middle and Near East and period, as well as Middle Assyrian and Middle goes back to the ancientArchive Mesopotamian period Babylonian of textsSID have been published. The vast (Beginning with 3000 BC). There are majority of these tablets are prescriptions, but many cuneiform tablets from cities as ancient as there are a few series of tablets that have been (2500 BC), the city of Prophet Abraham labeled “treatises”. One of the oldest and the (PBUH). The bulk of the tablets that do largest collections is known as “Treatise of mention medical practices have survived from Medical Diagnosis and Prognoses.” The text the library of Asshurbanipal at (668 consists of 40 tablets collected and studied BC) . So far 660 medical tablets from by the French scholar R. Labat (1). Although this library and 420 tablets from the library the oldest surviving copy of this treatise dates to around 1600 BC, the information * Corresponding author: contained in the text is an amalgamation of E-mail: [email protected] several centuries of Mesopotamian medical

www.SID.ir Pourahmad J / IJPR (2008), 7 (2): 93-99 knowledge. The diagnostic treatise is organized substances used for medicinal purposes. Drugs in head to toe order with separate subsections which were taken internally included; mercury, covering convulsive disorders, gynecology and antimony, arsenic and sulfur. Animal fats were pediatrics. To the non-specialist they sound like also prescribed. All were basically the same as magic and sorcery. However, the descriptions Babylonian medicine and prescriptions (3, 4). of diseases demonstrate accurate observation At one point Darius ordered a representative skills. Virtually all expected diseases exist, to return to Egypt in order to restore the they are described and cover neurology, fevers, department of the ruined house of life dealing worms and flukes, venereal disease and skin with medicine; “ While his majesty was in lesions. The medical texts are essentially he ordered me (Udjahorresne) to return to Egypt. rational, and some of the treatments (such as I gave them every useful thing and all their excessive bleeding) are essentially the same instruments indicated by the writings, as they as modern treatments for the same condition had been before. His majesty did this because he (2-4). knew the virtue of this art to make every sick The first major Iranian dynasty,Achaemenid man recover” (5). or Hakhamaneshian (550 BC), promoted The subsequent Seleucid (selukian) and the development of culture and science Parthian (Ashkanian) dynasties followed the extensively. The great scholars such as same trends with more Greek influence science the philosopher Heraclitus of Ephesus, the and art due to massive presence of Greeks in the Babylonian astronomer Kidinnu and even the area. However the flourishing of science and historian Herodotus were Persian subjects. The technology happened in the Sassanian period ancient cultures of the Egyptians, Babylonians, with major centers of learning and the famous Elamites, and others continued to exist and university Jundaishapur (6, 7). The Sassanian develop. Babylonian Physicians were all over king, Anoshirvan is mentioned by many the territories and served all people including historians and biographers to have been a major . Xenophon relates that when the Greek promoter of all sciences including philosophy soldiers who served under Cyrus the younger and medicine. In a Pahlavi text (Karnamag) he is passed through the territory of Babylonia, they quoted the following; “We have made inquiries found sufficient number of Physicians even in about the rules of the inhabitants of the Roman the villages to treat the wounded warriors. Texts Empire and the Indian states. We have never describe how physicians used medicine, prayers rejected anybody because of their different and magic. They would often model images of religion or origin. We have not jealously kept evil spirits out of clay and shatter them, in order away from them what we affirm. And at the same to restore the invalid to health. time we have not disdained to learn what they Achaemenid made Babylon one of their stand for. For it is a fact that to have knowledge major capitals and extensively used the texts at of the truth and of sciences and to study them is the temple libraries. The library and museum at the highest thing with which a king can adorn the Persepolis was build to rival the Babylonian himself. And the most disgraceful thing for archives famousArchive in the ancient world. Greek ofkings is toSID disdain learning and be ashamed of and Egyptian physicians were invited to join exploring the sciences. He who does not learn is the Achaemenid court and served the royal not wise” (8). household. Persians also adopted the tradition of Greek Philosophers Syriac speaking paying the physicians according to the rank and Christians and Nestorian Christians fleeing gender. The archives at Persepolis indicate that persecution by Byzantine rulers were received physicians and midwives who delivered boys by Anoshirvan and were commissioned to were paid double the amount they got when the translate Greek and Syriac texts into Pahlavi. baby delivered was a girl. The records do not Paul the Persian dedicated Works of logic to the indicate severe punishments if the sick person king. The Greek philosopher Priscianus Lydus died, as was the case under (3, 4). wrote a book in response to the king’s questions Texts also show lists of plants, herbs and other on a number of subjects in Aristotelian physics,

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www.SID.ir History of Medical Sciences in Iran theory of the soul, meteorology and biology. Chinese Herbal medicine and religion. The The Sassanian religious text, Dinkard shows books were kept at the university and the royal familiarity with all these topics, especially libraries and Greek medicine based on works by Aristotelian physics. It is apparent from the text Hippocrates and dominated the discipline that ’s famous article “On Coming to (11). be and Passing away” was well known by the The later Muslim historians refer to the compilers of Dinkard. Becoming, decay and Sassanian Imperial library as the House of transformation, the three fundamental concepts Knowledge (Bayt al Hikmat). The library in the article, had been mentioned and discussed. functioned as both a place where accounts of Pahlavi texts also indicate that the doctors Iranian history and literature were transcribed were paid according to the rank of the patient. and preserved. At the same time it was a place Books in medicine, astronomy, Almagest (by where qualified hired translators, bookbinders Ptolemy), Aristotle’s Organon and a number of and others worked to preserve, purchase, copy, texts in crafts and skills were translated from illustrate, write and translate books. It was Greek. Syrian Christians in particular played a such texts that made their way into the Islamic significant part in communicating Greek sciences period. Many books in sciences and philosophy and knowledge to the Persians (9, 10). were translated by the Persians, Greeks, Syriac The famous university and the hospital at and Aramaic-speaking scholars into and Jundaishapur built earlier reached its peak at eventually made their way into Muslim Spain Anoshirvan’s time. The Muslim historian Qifiti and Western Europe. Persia and Byzantium (12/13th century AD) in his book ‘History dominated the area before . The later was of Learned Men’ quotes the following; “In a continuation of the Eastern Roman Empire the twentieth year of the reign of Khosrow II and the seat of Greco-Roman art, culture and (Anoshirvan) the physicians of Jundaishapur civilization. Alexandria and assembled for a scientific symposium by order were major centers of intellectual activities with of the king. Their debates were recorded. theaters, libraries and universities. In addition to This memorable session took place under the major cities like Alexandria Constantinople and presidency of Jibril Durustabad, the physician in , intellectuals and scientists moved ordinary to Khosrow, in the presence of Sufista’i and carried ideas from in the west, and his colleagues, together with Yuhanna and a through Nisbis and () to Marv and large number of other medical men” (11). Jundaishapur in Western Persia (11). It is likely that the medical teaching resembled The conquest of Islam in united those at Alexandria with some influence from east and west, improved trade and boasted . This hospital and the medical center book publishing by introducing advanced paper were to become the model on which all-later making techniques from China. However, major Islamic Medical Schools and hospitals were to be cities and libraries were destroyed. Arabic built. Earlier Muslim historians such as Maqdisi eventually became the universal language of (10th century) mentioned the medical school in the empire and forced conversions into Islam Khuzistan and namedArchive its famous associates and threatened of national SID identities and local cultures. practitioners. The famous writer and translator, The Imperial library at was lost; the Burzoyeh who translated the Indian book of whole city was totally destroyed and never rose fables the Panchatantra (later, Kalileh va- again. The destruction of such major libraries Demneh) for Anoshirvan, was also a well-known with the rise of Arabic language made it clear physician from (10). The first recorded to the scholars and intellectuals that all pre- Muslim Physician Harith bin Kalada had studied Islamic knowledge and national identities were at Jundaishapur Medical School. In Jundaishapur in danger of total destruction and they had to Greek, Indian and Persian scientific traditions be preserved. Massive and heroic efforts were were assimilated. Indian scientific material in made and the result was the formation of a astronomy, astrology, mathematics and medicine dynamic and significant translation movement were also translated into Pahlavi along with for almost two hundred years, till the 10th

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www.SID.ir Pourahmad J / IJPR (2008), 7 (2): 93-99 century. The movement started in he had pieces of meat hung in various quarters in Umayyad (Umavian) times, and flourished of the city and watched their putrefaction and in Abbasid (Abbasian) (754 AD). All chose the site where the putrefaction was the major surviving Greek, Syriac, Persian and slowest and the least. At its inception it had Indian texts were translated into Arabic and Neo- 24 physicians on staff, including specialists Persian. Pre-Abbasid translations from Pahlavi categorized as Physiologists, oculists, surgeons included major religious, literary, scientific and and bonesetters. Various historians have historical texts. Nawbakht, the court astrologer mentioned that the hospital was ‘like a great and his son Abu Sahl and other colleagues, castle’ with water supply from the Tigris and all Farazi and Tabari and many others sponsored appurtenances of Royal Palaces (11, 13-16). by the Barmakid (Barmakian) family (the Medicine remained dominated by the chief ministers to the early Abbasids who were Greek tradition, the first to rid the science from murdered later) translated and promoted Pahlavi supernatural powers and spirits. Around 450 texts into Arabic and Neo-Persian. They were BC, the Italian-born Greek natural philosopher all Iranians and aimed to incorporate Sassanian and physician Alcmaeon began forwarding culture into Abbasid ideology and guarantee the the new theory that disease was caused by a continuity of the Iranian heritage. Christian and fundamental imbalance in the body between Jewish learned families of Sassanian Persia, such certain opposed qualities, such as heat and as Bukhtishu and Hunyan families, were also cold (sardi/garmi), or wetness and dryness great translators of Syriac, Greek, Pahlavi and (tari/khoshki). This theory was picked up and other texts into Arabic. Both families had served elaborated by Hippocrates (460-377 BC) who at Jundaishapur University, for generations completely disregarded the presumption of the and were instrumental in founding the Adudi spiritual causes of disease. He proposed that Hospital and Medical School in Baghdad (11, health resulted from the equal influence of four 12). bodily “humours” that was analogous to the four The Nestorian physician, Jabrail ibn Bakhtishu elements of Greek physics (earth, water, air and was the head of the Jundaishapur University, fire). Blood, phlegm, and two kinds of bile were when he was called to Baghdad in 148 AD as the associated with four major organs; heart, brain, court physician to Caliph al-Mansur. He liver and spleen; and with the four seasons was later charged with building the first hospital and the four ages of man: childhood, youth, (Bimarestan or Maristan) in the city based on maturity and old age. Deviations from perfect the Syro-Persian model already established at balance among the four produced diseases. Jundaishapur. He went back to Iran but many Therapies consisted of attempting to restrain the members of his family served the Abbasids for overactive humour while encouraging the others. a long time. Five centuries latter the great Greek physician, Baghdad, a suburb of Ctesiphon was built in Galen (130-200AD), concluded that blood 762 by al-Mansur. The Royal library at Baghdad was manufactured in the liver from material was based on the Sassanian model and was also provided by the stomach. He also posited two called the houseArchive of knowledge (Bayt al-Hikmat) ofother systems SID of essential fluid. One originated and like the Persian royal library became a in the heart and was carried by the arteries. center of learning and attracted scientists and The other, ‘anima’ (soul or the life principle), intellectuals alike and many of its’ directors proceeded from the brain by way of the nerve were either Iranian or from Iranian descent. tracts. Though none are correct, nevertheless, Baghdad itself became hire to the Alexandrian Galen’s meticulous anatomical studies and and Persian scientific traditions and thought. logical method provided a point of departure for The ‘Adudi’ hospital was built under the the development of modern medicine. Once this instructions of the great Iranian Physician Razi Greek heritage and knowledge was translated (Latin Rhazes, he was from Ray) and resembled into Arabic, it became universal and replaced the great hospital in Jundaishapur. It is said that most of the older traditions and schools. Greek, in order to select the best site for the hospital Persian, Arab and Indian scholars refined the

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www.SID.ir History of Medical Sciences in Iran assimilated ideas and by the 12th century slow genre of physicians produced Encyclopedias of progress was made toward understanding the medical knowledge based on observation and organic cause of diseases. The brilliant Iranian experience. The main topics included anatomy, scientist Raze (845-925 AD) distilled alcohol classification and causation of diseases, and clearly distinguished smallpox from measles symptoms and diagnosis. Urine, sputum, (11-13, 15, 16). saliva and pulse were observed and used to aid The celebrated Iranian physician and diagnosis. External or visible manifestations philosopher, Abu Ali Sina (Avicenna, 980- of diseases and internal symptoms like fever, 1037), wrote 100 books in many subjects headache etc were listed and studied. Therapy including his most famous compendium, Canon with drugs and herbs were used to improve the of Medicine. His magnum opus is one of the patient’s conditions (11). Female practitioners classics of medicine ever written. He extensively and nurses that existed before Islam remained studied herbal medicine from China, India and for a while but soon lost their position and only Persia. Avicenna like his predecessor Farabi midwives continued and most had no proper (another well known Iranian) was an outspoken training (11-13). empiricist and insisted that all theories must be The flourishing of sciences and the translation confirmed by experience. He argued against the movement did not last long for a number of blind acceptance of any authority and improved reasons, including foreign military attacks. distillation techniques. Alchemists tried to The sciences, including medicine, were foreign convert one substance into another in order imports as far as many were concerned and to make gold. In the process they uncovered met with opposition from various quarters. From a host of medicinal compounds and improved the time when the translation movement began to distillation and sublimation techniques. Another the end of the Islamic , these sciences major Greek tradition based on theories of were either frowned upon or openly attacked by and Euclid on light, opened the way to the practitioners of indigenous religious and Arabic science of optics. Human eye became the focus disciplines. Aristotelian logic was rejected of study and major advances were made and and the adherents of the religious tradition of eye care was improved. The Jewish Physician Kalam had no use for Neo-platonic doctrines Masawayh practicing at Jundaishapur joined of the followers of Greek philosophy. The the medical school at Baghdad at the invitation ‘foreign sciences’, which included mathematics, of Caliph Harun-ul-Rashid and wrote a detailed astronomy, medicine, alchemy and astrology book on Ophthalmology. Masawayh family were generally felt by religious people to produced three more prominent physicians with constitute a serious threat to religious beliefs and the most famous, Yuhanna ibn Masawayh, who values of religious life. The influential religious wrote prolifically and 42 works are attributed to thinker al-Ghazali (he died in 1111 AD) wrote a him. Another great Jewish physician who had popular refutation of philosophy and repeatedly served at Jundaishapur was Hunain ibn Ishaq. He warned against exposing Muslims to potentially translated the entire collection of Greek medical misleading rational sciences and practices (11, works, including GalenArchive and Hippocrates. His 15-17). of SID original contributions included 10 works on The Hanbali jurist Ibn Taymiyya (in the ophthalmology. He was appointed the director year 1328) and later his ideological follower of the royal library by Caliph al Mutawakkil. Mohammad Ibn Abd-al-Wahhab (founder of Tabbari, another major physician, migrated wahhabi sect in 1744) launched a passionate and from Persia to Baghdad in the first half of the 9th uncompromising attack on Greek logic. There century AD. His major work, called “Paradise were defenders as well like Ibn Hazm who of Wisdom”, contained extensive information maintained a literalist view of Islamic law, but from all extant sources including Greek, Syriac, did not openly attack Greek tradition. The other Persian and Indian and contained an extensive was al-Kindi (870 AD), an Arab aristocrat, who treatment of Anatomy (11-13). supported the Greek scientific tradition which in Like their Greek predecessors, the new his time was identified mainly with non-Muslims

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www.SID.ir Pourahmad J / IJPR (2008), 7 (2): 93-99 and non-Arabs. Though the rational sciences first faculty and soon more modern universities remained for a while but at the end they lost followed in other parts of the country. In 1936 specially after the conquest and destruction of for the first time 12 women were admitted into Baghdad by the Mongols (1258AD). Medicine Tehran University. They entered all faculties, along with other sciences was soon to be forgotten included was Dr. Frough Kia who later joined and once again magic, superstition and prayers the faculty of medicine. The medical schools with rudimentary medicine replaced the brilliant were built on European models and staffed with scientific traditions. Magicians, sooth-sawyers, qualified educated practitioners and physicians. exorcists and self-trained herbalists replaced Nursing schools were followed and new modern qualified and trained medical practitioners and hospitals built throughout the country. In the the concept of hospitals faded from the memory. 1970’s foreign doctors were employed mainly Religious leaders fiercely opposed anatomy and from India and were sent into rural clinics. The no new knowledge emerged till the advent of medical schools at the major universities enjoyed modern medicine and importation of European a high standard and graduates of these universities medical knowledge into the Muslim countries in had no problems continuing postgraduate studies the 19th century (11, 15-17). in any of the major medical schools in Europe or The second half of the 19th century is the North America (18). beginning of major political and ideological After the Islamic revolution and establishment transformations in Iran and the start of of Islamic Republic of Iran by late Imam modernization processes. Modern sciences Khomeini in 1979, the population of Iran had and western ideas of democracy civil society nearly doubled in less than 2 decades, while by enlightenment human rights and emancipation the growing spirit of independence inspired by of women were introduced through translation the Iranian government the number of universities of European texts into Persian. The Armenians and university students increased more than 10 of Isfahan for their exclusive use imported the times. For the first time in recent modern history, first printing machine in 1641. However the the Iranian universities started to offer post- first printing machine in Persian started work in graduate specialized degrees in basic, clinical and Tabriz in 1813 and the book industry was changed engineering sciences. All the foreign doctors and forever. The first modern school Dar ul Fonoun medics in rural clinics were replaced by young (the Institute of technology) started work in 1851 Iranian medical graduates. More than 800 Ph. with a few European instructors and texts were D. degrees have been awarded in basic sciences translated from a number of European languages only in the past 10 years (19). Despite the great to introduce Iranian pupils to modern sciences. difficulties that the Iranian scientists have been Educated Iranians joined and in no time tens of facing for more than 28 years (as a consequence books in Geography, Engineering, Medicine, of a social revolution, 8 years of a destructive Military, Biology, Mathematics and other war imposed by Iraq, excessive brain drain, disciplines were translated. In 1925, there were discriminatory practices by some international only 253 general practitioners who were trained journals in publishing the Iranian articles, and in Dar-ul-FunoonArchive college of medicine and 652 ofunfair sanctionsSID imposed by the industrialized Hakims who had gained experience of medicine, countries), Iran’s science is still thriving and the and were practicing throughout the country. current number of yearly scientific publications The modernization movement resulted in the exceeds 2000 (19). When normalized with constitutional revolution (1906). Iranian students respect to the number of researchers and the were sent to Europe with government sponsorship research budget, the Iranian scientists seem and the first modern doctors were educated in to outperform most of their counterparts in Europe. For the first time since Sassanian period the advanced industrialized nations. The a major University with different faculties was main reasons for this are: total engagement in built. In 1934 a new legislation was passed and a truncated research activities (basic or applied) budget was allocated to build the first University leading solely to pure publications and the lack in Tehran. The medical School at Tehran was the of infrastructure for developmental research

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www.SID.ir History of Medical Sciences in Iran activities leading to new technologies. The Institute, Mumbai (2000) 278-86 average impact factor of the papers in various (8) Frye RN. The Political under the Sasanians. In: Yarshater E. (ed.) The Cambridge fields of basic sciences seems quite satisfactory, History of Iran. Vol. 3: The Seleucid, Parthian and considering the difficult conditions the Iranian Sasanid Periods. Cambridge University Press, London scientists are working under. Should the research (1985) 116-180 budgets and conditions improve and the unfair (9) Fichtner H. Man and Cosmos in Ancient Iran. Serie sanctions currently imposed by the world politics Orientale Roma 91, Rome (2001) (10) de Blois F. Burzôy’s Voyage to India and the Origin be eliminated, a far better contribution to the of the Book of Kalilah wa Dimna. Oxford University world science can be expected. Press, London (1990) (11) Arnold T and Guilaume A. (eds.) The Legacy of Islam. References Oxford University Press, London (1960) (12) Nasr SH. Science and Civilization in Islam. 2nd ed. (1) Labat R. Traité Akkadien de Diagnostics et Pronostics Islamic Texts Society, Cambridge (1987) Médicaux. Brill, Leiden (1951) (13) Pourahmad J. Renowned physicians and pharmacists (2) Briffault R. The Making of Humanity. Macmillan Co., in the shiny Islamic era. Hakim (1997) 1: 17-23 London (1938) (14) Toynbee A. A Study of History. Oxford University (3) Sarton G. Introduction to the History of Science. Press, London (1951) Williams & Wilkins, Baltimore (1948) (15) Singer CJ. (ed.) Studies in the History and Method of (4) Sarton G. A Guide to the History of Science. The Science. Vol 2, Clarendon Press, Oxford (1921) Ronald Press Co., New York (1952) 171-173 Singer C and Underwood EA. A Short History of (5) van der Spek RJ. Darius III, and (16) Medicine. 2nd ed. Clarendon Press, Oxford (1962) Babylonian scholarship. In: Achaemenid History XIII. (17) Shaw GB. The Genuine Islam. Vol 1, Singapore Brill, Leiden (2003) 289-346 (1936) (6) Fichtner H. Un te‚ moin du syncre‚ tisme mazde‚ en (18) Amirazodi H. History of Pharmacy Education in Iran tardif: le traite‚ pehlevi des ‘Se‚ lections de Zâdspram, [dissertation]. Tehran, Shaheed Beheshti University Transition Periods in Iranian History. Studia Iranica, (M. C.) (1996) Cahier 5 (1987) 59-72 (19) Mehrdad M, Heydari A, Sarbolouki M and Etemad (7) Fichtner H. On the notion of Good Measure (paymân) S. Basic science in the Islamic Republic of Iran. and other related philosophical concepts from the Scientometrics (2006) 61:79-80 Dênkard III, Third International Congress Proceedings This article is available online at http://www.ijpr-online.com (6th to 9th January 2000), K. R. Cama Oriental

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