[Downloaded free from http://www.urologyannals.com on Wednesday, October 05, 2011, IP: 41.239.121.203] || Click here to download free Android application for this journal Review Article Experimental medicine 1000 years ago Rabie E. Abdel-Halim King Saud University College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia Abstract Little is known about the state of experimentation in the field of medicine during the Medieval Islamic era. With few exceptions, most of the contemporary sources on history of medicine propagate the idea that the roots of experimental medicine in its modern form, including clinical trials and drug-potency studies, first started during the European Renaissance in the 16th to the 18th centuries. This study is part of an ongoing multidisciplinary primary-source investigation of the original Arabic works of 11 Islamic medical scholars who lived and practiced between the 9th and the 13th centuries. The study critically evaluated and documented their contributions to the development of the scientific method and experimental medicine during that medieval Islamic era in several areas including critical appraisal of previous knowledge, clinical observations and case reports, clinical therapeutic trials, drug potency trials, experimentation on animals, dissection and dissection experiments as well as postmortem examinations. In each of the above-mentioned areas, significant contributions were made during the Medieval Islamic era from as early as the ninth century AD. Key Words: Experimental method, experimental surgery, history of medicine Address for correspondence: Prof. Rabie E. Abdel-Halim, 90 Heathfield Rd, Liverpool, Merseyside, L15 9HA, UK. E-mail: [email protected] Received: 24.01.2011, Accepted: 24.01.2011 INTRODUCTION not a conception properly applicable to Antiquity and the Middle Ages.[6] Since the beginning of recorded history, those who tried to heal have sought truth and predictability in their encounters METHODS with the sick and injured. However, little is known about the state of experimentation in the field of medicine during The present work is part of an ongoing multidisciplinary the Medieval Islamic era. With few exceptions, most of the primary-source study of the published medical works of 11 contemporary sources on history of medicine propagate Islamic medical scholars who lived and practiced between the th th the idea that the roots of experimental science as well as 9 and the 13 centuries. The study critically evaluated their experimental medicine in its modern form, including clinical contributions to the progress of various surgical and medical trials and drug-potency studies, first started during the subspecialties. Their original works were compared with those European Renaissance in the 16th to the 18th centuries.[1-5] It of their predecessors and with those who came after them. Their is, thus, commonly believed that the contemporary scientific influence on Medieval Europe and European Renaissance was methodology based on observation and experimentation is traced, evaluated, and documented. Access this article online In this article the focus will be on the findings related to the Quick Response Code: scientific method and experimental medicine during that Website: medieval Islamic Era. www.urologyannals.com RESULTS AND DISCUSSION DOI: 10.4103/0974-7796.82168 I. Critical appraisal of previous knowledge One of the important features of medicine and other sciences Urology Annals | May - Aug 2011 | Vol 3 | Issue 2 55 [Downloaded free from http://www.urologyannals.com on Wednesday, October 05, 2011, IP: 41.239.121.203] || Click here to download free Android application for this journal Abdel-Halim: Experimental medicine 1000 years ago during the medieval Islamic era was that it developed in a logical tried by him. In such instances, he usually states that he has to and scientific way starting first with a thorough review of the verify the validity of the mentioned drug actions. literature. Islamic scholars critically appraised the translated heritage of previous civilizations rejecting what is superfluous He was also the first to doubt the belief, prevalent among the and accepting only what proved to be true in the light of their ancients that breaking of a bladder stone inside the bladder own observations, experience and experimentation; a mode of during or before its removal endangers the patient’s life.[13] In analysis that constitutes the basis of scientific research. his book Al-Hawi, after citing that Antylus, the second century Greek scholar adhered to that belief, Al-Razi commented, This mental attitude of being critical in their appraisal of the “This is to be looked into, God willing”.[14] literature did help the medieval Islamic scholars, not only in checking the validity of the previous knowledge but also in Ibn Sina (Avicenna, 980–1037 AD) basically followed the adding original new contributions. They were ready to test methodical, analytical line originated by Al-Razi in all his by experiment what they got in theory, and to tabulate and works. Here is just an example from the section on simple systematize their findings to produce original scientific work. drugs in his famous Kitab Al-Qanun Fi Al-Tib (The Canon Their works are full of statements to this effect. of Medicine): "{Bladder stone}: The critical appraisal of knowledge even if it came from famous Some people stated that the stone formed in the urinary bladder authorities was obvious in the Medieval Islamic era as early as if [prepared as medication and] drunk by a patient suffering the 9th century. An example is shown in the statement by Al- from the same condition, will dissolve [his] bladder stones. And Razi (Rhazes, 865–925) in the opening section to his book this is among the medicines I do not approve .”[15] on diet therapy Manafie Al-Aghdhiyah wa Dafei Madarrihah [Figure 1] translated as follows: The same scientific method of reliance on direct observation, “...I decided to author a complete and wide-ranging book on experience, and experimentation is also evident in works of all how to keep away the side effects (harm) of nutrients. I decided the other Islamic medical scholars subject of this study. For an to make the book more self-explanatory and comprehensive example, in his book Sharh Tashrih Al-Qanun (Commentary than the work compiled by the honorable Galen. That is because on the Anatomy of the Canon), the 13th century Ibn Al-Nafis Galen in his book on the same topic overlooked, went wrong (1210–1288), stated that,“…However as regard the function and failed to cover the subject fully in many areas..” [7] of organs, we rely only on what is dictated by investigative observations and accurate research; not caring whether it Al-Razi’s reliance on his own observation, experience, and conformed with, or differed from, the opinions of those who experimentation is also quite obvious in all sections of his came before us.”[16] encyclopedic work Al-Hawi (Liber Continens)[8] as well as in [9-11] other works. He even authored a separate treatise titled II. Clinical observation and case reports Kitab Al-Shukuk Ala Galinus (Doubts About Galen) in which A new rational approach to the care of patients was also he discussed various points of contradiction he had with Galen’s developed by Al-Razi early in the ninth century. His rational medical views.[12] approach was based on recording, interpreting and classifying his clinical and experimental observations. This original This scientific critical attitude is also evident in Al-Razi’s practice approach established the methodology of clinical medicine as frequently seen in his Al-Hawi book when commenting on and differential diagnosis and made a lasting impact on Islamic drugs described by predecessors, or by contemporaries, but not medicine. In contrast to the lack of recorded case histories in the tenth-century Latin tradition, Al-Razi’s medical practice as a clinician is attested by hundreds of case histories. Scholars who came after Al-Razi like Ibn Sina, Al-Zahrawi (Albucasis, 936–1013), Ibn Zuhr (Avenzoar, 1091–1162), Muhadhdhab Al-Deen Al-Baghdadi (1117–1213), and Ibn Al-Nafis continued to follow and enrich his pioneering school giving prime importance to clinical observations and differential diagnosis. They all were keen on recording and classifying their clinical experience in the form of case histories, reports of medical Figure 1: Part of page 2 of Al-Razi’s book on diet therapy Manafie al- [17-19] Aghdhiyah wa Dafei Madharrihah[7] with added underlining to highlight experiences, and a wide variety of clinical accounts. This is in relevant text agreement with Cumston who described the Islamic physicians 56 Urology Annals | May - Aug 2011 | Vol 3 | Issue 2 [Downloaded free from http://www.urologyannals.com on Wednesday, October 05, 2011, IP: 41.239.121.203] || Click here to download free Android application for this journal Abdel-Halim: Experimental medicine 1000 years ago as keen observers who excelled in diagnosis and prognosis opinions [on laxatives and how to counteract its side effects]. with their description of symptoms showing a precision and Hence, they may compose a refutation for that purpose. an originality that could be only obtained by direct study of Then I will challenge them to one [contest]: let them utilize the disease.[20] the medicines I mentioned in the same way I prescribed and utilize it in a different way. Then, the effects and side effects III. Clinical therapeutic trials of each method are to be recorded. Certainly the experiment Deliberate case-control experiments designed to assess, upon will either validate or invalidate my opinion whether I was then patients, the value of therapeutic procedures are an essential alive or dead.”[ 22] feature of modern medicine. It is, therefore, interesting to find out that Al-Razi, more than one thousand years ago planned, Ibn Zuhr, then, elaborated on how experimentation is far carried out and reported the findings of such an experiment.