570-1070: Arabs save medicine

As we study medicine it's essential to understand that one author, one physician, one scientists, cannot make accomplishments in medicine without the accumulated knowledge of all who came before him. Lacking such wisdom, no progress in medicine can be made. Stated another way, it would be impossible to hunt for cures without having prior knowledge of such cures.  

Lacking access to knowledge, every person must start from scratch, and by the time he passes away he'd learn no more than the men before him. Thanks to writings, and schools, one man can be taught all ancient wisdom in a few years. Instead of spending a lifetime relearning old wisdom, he can now study something new. He can think of, invent and discover new things.

When the last rung of the Roman Empire collapsed in 476 A.D., the west cast aside all such accumulated wisdom in favor of the Bible. This, perhaps with the help of the Black plague, helped send western civilization -- mainly Eastern Europe -- back to a primitive era where the only medicine was religion. All other knowledge, including medical knowledge, was the antithesis of the road to heaven.

During the same time western civilization was turning a blind eye to wisdom, Islamic nations were becoming united by Islamism under the name of Muhammad. By their new religion the Arabs, Muslims, ultimately gained control of Egypt, Syria, Persia, Northern Africa, Islands of Sicily, Rhodes, and Crete. They even gained control of Spain in 720.  (1, page 122)

Similar to Christians, Arabic civilization believed the Koran contained all necessary wisdom, with all other knowledge being "superfluous," proven by the destruction of Alexandrian libraries and schools during the Egyptian conquest. Yet it is believed that the people of this Arabic civilization, even though they had a newly created language, were so poorly educated they couldn't even read their own Koran. (1, page 122, 125)

This changed during the life of Mohamet, of whom, "according to Islam, was the last messenger of Allah." He lived from 570-632, according to dictionary.com. Mohamet wanted to inspire his people to read, and so he told his people he obtained his wisdom after inspiration from heaven. It was this encouragement that inspired the education of the Arabic civilization.  (1, page 124-125)

Mohamet told the story of how Gabriel came down from Heaven and said to him: (1, page 124)

Read -- added the angel -- in the name of God, the Creator.
He formed man by uniting the two sexes.
Read in the name of the adorable God.
He taught man the use of the pen.
He filled the soul with the light of science. (1, page 124)

So by the time Spain was conquered by the Arabs, learning was encouraged by Arabic leaders.  Ancient writings preserved in Egypt and Spain were transcribed to Arabic and studied by anyone eager to learn. 

Among the people driven from Rome in the 5th century were the Nestorians.  They were the followers of Nestorius (386-450) who was chosen to be Patriarch (Archbishop) of Constantinople by Emperor Theodosius II (401-450). He was consecrated in 428 and almost immediately started to make an impression.  In 430 he was condemned for heresy by a majority of his fellow bishops.  The condemnation was ratified by Theodosius and confirmed by Pope Sixtus III (died 440).  He retired to private life, although in 435 he was banished to the Oasis of Upper Egypt.  (3)(6, page 51)

His followers were allowed refuge in Persia. They established a school at Edessa in Mesopotamia, which was, according to historian Thomas Bradford, the "Athens of Syria.  It became the home of many scholars.  Many Greek and Latin works were translated into Syriac... Here on the Euphrates learning once more found a home.  A college and several schools were established." (6, page 51)

Bradford said the "Nestorians were given free exercise of their religion, and they were entrusted with the education of the children of the great Mohammedan families.  He said:

The Nestorians were the depositories of the old Greek medical knowledge. They revered the old names, and collected with great assiduity all the works on medical topics of all the former schools. Pupils hastened to their schools from all directions, and they were able to study practical medicine in a public hospital, probably the first institution of the kind... And this was the commencement of the great school of the future at Bagdhad. (2, page 51)

Speaking of Baghdad, another person who helped advance medicine in Persia was Almanzor (938-1002).  Bradford said Almanzor was responsible for the establishment of Baghdad and the establishment of the first Baghdad college.  He said: (2, page 57)

All the scholars rejoiced, and dreamed of a new Alexandria. Bagdad, the home of the caliphs, the city of the Arabian Nights, city of magnificance, and capital of the Saracens, was situated on the west bank of the Tigris river. In the old days its population was about 2,000,000. It is said that the caliph Almanzor was attacked by a dangerous disease, and sent for a physician who had been of the Nestorian school. Being restored to health by this physician, the caliph learned the value of the healing art, and became a patron of knowledge. Almanzor now made his new and beautiful city the home of the arts and sciences. He invited all the philosophers to visit him, no matter of what religion. It was not long before the cultivators of mathematics, astronomy, medicine and general literature abounded at the court of Almanzor. A medical college was established; there were public hospitals and laboratories for the benefit of students. So great was the culture of the medical faculty that power was given to it to examine all persons who intended to devote themselves to the study of medicine. So great was the number of professors and students who flocked to that centre of learning that at one time it contained six thousand professors and students. Almanzor enriched his new city with a great number of works on medicine, astronomy and philosophy, which he caused to be translated from the Greek. He had the works of Aristotle, Galen and Ptolemy translated, and these labors were continued by his successors.  (2, page 57-58)

Learned scholars banished from Europe in the 6th century were allowed to take refuge in Persia.  They were allowed to continue their studies and even set up schools where they became teachers.  When Arabs conquered Persia in the 7th century, ancient writings were transcribed and taught to Arabic scholars, who absorbed the wisdom eagerly, paying special attention to the works of Aristotle and Galen. To facilitate teaching they even set up hospitals.  (1, page 123)

The importance of education was appreciated so much that a school of medicine was set up in Baghdad. V. J. Fourgeaud said in 1864:

"So Great was the estimation in which their learning and skill were held, that, notwithstanding the intolerant spirit of Mohammedans, they were permitted the free excess of their religion, and were entrusted with the classical instruction of those of the Moslemin whose education was most cared for.  Aristotle, Pliney, Theophrastus, Dioscorides, Galen, and other element authors (were translated to Syriac, Hebrew and Arabic)." (1, page 124)

Before this time the medical profession was open to all who chose to participate in it.  The Arabs passed laws requiring a diploma from a medical school.  Greek and Roman physicians gathered their own herbs and medicinal supplies from grocers and created their own internal remedies.  The Arabs were the first to create a separate profession, the druggist, who was responsible for creating and preparing medicine. (1, page 124)

The pharmacy profession was established.  They created rules for preparing drugs, which was an advancement to the old system where each physician had his own cook book of medicinal recipes.  The first pharmacopoeia (book of drugs) was created.  (1, page 123)

The Arabs also conquered Spain, and it became the most prosperous county in the world.  Of this, Fourgeaud said:

"Agriculture, commerce, manufacturers, wealth and population are represented to have flourished to such a degree... that, in reading accounts left by historians, as suspicion of oriental exaggeration is often forced upon the  mind.  It is not, therefore, surprising that, in speaking of the Arabs, the Spaniards of that time are represented as saying: 'They have taken our land, but they have covered it with gold.'" (1, page 128)

While other countries in Europe were on the decline, Spain became the "literary and scientific sceptre."  Seventy libraries were opened in Cordova, The medical schools were so great people came from all over the world to be educated.  Even Christian princes in need of medical help traveled there and trusted their lives to the Arabic physicians.  (1, page 128)

With the treasures of the ancient world available to the conquerors of Persia, they were now thrust to the "head of the scientific world."  (1, page 124)

Such was the way for the next 500 years, until this prosperous Arab world came to a halt.  They were driven from Spain by Ferdinand and Isabella, and they then sunk back into the world of ignorance. (1, page 128)

Since the fall of Arabian medicine sometime during the end of the 13th century, "Arabia has been in mental darkness and superstition,"  said historian Thomas Bradford in 1898.  While eastern civilization moved into a dark ages of medicine, western civilization moved out of theirs. (2, page 77)

So we can honestly say that we owe true thanks to the Arabs of the middle ages for saving medical wisdom.  They borrowed medical knowledge from the ancient world, improved upon it, and returned it to the western world of which it came.

References:

1. Fourgeaud, V.J, "Historical Sketches: Medicine among the Arabs: XXI, Intnroduction," Pacific medical and surgical journal, vol. 7, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Francisco, Thompson and Company, pages 122-130
2. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
3. "The Heresiarch," Catholic Encyclopedia, http://www.newadvent.org/cathen/10755a.htm, accessed 10/29/13

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1-1619: Jews, Arabs and Latins practice tracheotomies (and mouth to mouth breathing)

Chances are early tracheotomies were performed with no anaesthetics.  I write this not that I know this for sure, although I would imagine the procedure was generally performed as a last ditch effort to try to save a life of a person who was otherwise suffocating and was probably going to die if nothing was done.

There were, however, medicines that could have taken the edge off, such as opium.  Opium is an opiate that is one of the oldest known medicines known to man.  It is described in some of the earliest writings shared among the medical community.  So if the opportunity presented itself, this or some other medicine could have been taken to ease pain and suffering.

The ancient Jews, after the birth of Christ (around the years 1-650 A.D.) were known to perform surgeries when prayer, magic and natural remedies did not work.  When they did resort to surgeries, they did have certain herbs that were perhaps mixed into a drink that was used as a sleeping draught. (1, page 62)

The Jews were nomads, which means they traveled to many places in search of a home.  They spent time among the ancient Mesopotamians and Egyptians, and in the process they picked up a lot of knowledge about medicine.  Perhaps among the medical procedures they learned about from either of these places was the operation later to be called tracheotomy by the Greeks.  As they traveled they may also have educated other civilizations of the procedure.  This was one of the ways medical knowledge traveled through time.

Renouard explains that "the Arabs, and the Latins of the Middle Ages, had so little anatomical knowledge that they very much exaggerated the dangers of the operation, and, without condemning it absolutely in theory, abstained from its practice." (2, page 449)

Although this was not always the case.

Paulus Aegineta (625-690), as was noted earlier, performed the procedure with regularity, and described the procedure pretty much as Antyllus had several hundred years earlier.  (5, page 521) The operation was not regularly practiced until the 16th century, yet most of what was written was a reproduction of what Antyllus wrote on the subject.

Rhazes (865-925), Mesue (777-857), and Avicenna (980-1037) do not mention the methods of the procedure, but recommend it as a last option in cases of "angina strangulans." (3, page 199)  Avecenna did, however, describe "intubating the trachea using 'a cannula of gold or silver.'" (4pages 222-228) 

In the 12th century Arabian physicians Avenzoar and Albacasis were among the few physicians who dared to perform tracheotomies, although prior to them the procedure was rarely performed. Avenzoar (Ibn Zuhr), who was the most renowned physician and surgeon after Avicenna,  noted experiments of the procedure on goats, although he recommended it not be done unless the physician had knowledge of anatomy.  (3, page 198)  (6, pages 70-71)

Of course anatomical knowledge was rarely obtained by physicians mainly because autopsies were rarely performed, and when they were it must have been an unwholesome event.  Historian Fielding Hudson Garrison, in his 1922 history of medicine, explains that bodies were probably stolen, and both the grave robber and the autopsy performer would have risked an untimely death if caught.  There were a few books describing anatomy, although chances were good the descriptions were from animal dissections: pigs, dogs, apes, etc. (1, page 415)

The Surgeon Lanfranchi of Milan (1250-1306), Garrison explains,  was a surgeon at the School of Salerno in Northern Italy who may have been the first physician to mention intubation.  He became involved in the "squabbles of Guelphs and Ghibellines and was exiled.  He arrived in Paris in 1295, where he introduced the French to Italian medicine.  So it's highly likely the French also had knowledge to the technique of intubation.  (1, page 144)

Renouard continues:  "Anthony Benivieni, a physician of Florence, who lived at the end of the fifteenth century, saved the life of a patient by opening the trachea, and giving issue to the pus of an abscess that was formed within it. This is the first account we have of a tracheotomy, after an interruption of twelve hundred years; but its author does not state the manner in which he performed it, and it does not appear that he employed this method in other cases." (2, page 449)

Along with tracheostomies, mouth to mouth breathing also is mentioned in the fifteenth century.  It was documented to have been performed in Italy to revive newborn infants stunned at birth and not breathing on their own. This would have been a major effort on the part of the caregivers to save the life of a newborn infant stunned at birth who otherwise would have had no chance at life.  (5 need reference)

Fabricius d’Aquapendente (1537-1619), Renouard said, "is the first among moderns who gives a detailed description of this operation. He proves that it may be executed without injury to any other important organ; and that by it, we may often save a patient from impending death. The invention of the canula has been attributed to him, which has usually been left for some time in the artificial opening thus made. (2, pages 448-449)

In 1596 Sanatorius became the first to use a trocar to insert a cannula into the stoma, "and left a canula in the opening for three days."  Fabricius ab Aquapendente, in order to prevent the cannula from falling into the airway, added a cannula with wings.  Later later his pupil, Casserius, "made a very important improvement in introducing a canula with a curve corresponding to the arc of the quadrant, and he also tied in position the canula with tape.  The improvement in the shape of the instrument, however, was soon lost sight of, and the straight tube long remained in use." (5, page 521)

So knowledge of how to create an airway made it's way through the dark ages of medicine in the west, and the bright ages of medicine in the east.  Now it would make it's way to the Renaissance, where improved anatomical wisdom would help speed up the advancement of medical wisdom.

Note:  Spelling within quotes is that of the original author

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
2. Renouard, Pierre-Vincent, "History of medicine: from its origin to the nineteenth century,"
3. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203  (referenced to page 198-9)
4. Szmuk, Peter, eet al, "A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age," Intensive Care Medicine, 2008, 34, pages 222-228
5. Mackenzie, Morrell, "Diseases of the throat and nose, Volume I, 1880, Philadelphia, Presley Blakiston
6. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

2000 B.C.: Chaldeans introduce physicians to Babylon

Chaldeans introduced astronomy/ medicine to ancient Mesopotamians?

Various groups of people continued to emigrate into Mesopotamia even as the Sumerian civilization was fading. Among these were the Syrians, Babylonians, Hebrews, Phoenicians, Akkadians and Arabs. Some of these matured to form villages, towns, cities, empires and even civilizations. Yet it was another group of people who had the greatest impact on medicine: the Chaldeans (Chaldees). (Baas page 25)

No one knows when they emigrated into the area, although many speculate they came from the north. The Hebrew Bible says they came from the "extremities of the earth," which may be Armenia, Cephenin, and Arrapachitis. Job mentions gold, and Jeremiah the iron of the north. It's also believed they left their homeland (and nobody knows why) over a century before they landed in Babylonia and Persia, or "before they besieged Jerusalem." (Asiatic Journal, page 36-37)

As time went by they were assimilated into Babylonian and Persian society to the point that they were often referred to as Babylonians and Persians, as opposed to Chaldeans. (Asiatic Journal, page 36-37) 

The dominant element of their way of life "consisted of servants to the deity," (Baas, page 25) and they are even referred to in the Bible as the "Magi" or the "Wise men," or "haruspices."  (Asiatic Journal, page 37)(Baas, page 25)

Magi or wise men were magicians, priests who were proficient in all the knowledge of the universe.  They specialized in mythology, religion, and medicine.  They were, perhaps, the most well educated people among society, and they were, in essence, magicians.

Haruspices, according to Britanicca.com, refers to the study of organs, such as the liver, and astronomical phenomenon, such as thunderstorms, lightning, alignment of stars, planets, comets, etc.  This was all done for the purpose of divination, or predicting the future.

The Chaldeans were known for their knowledge of mathematics, astronomy, astrology, interpretations of dreams, and medicine. Some referred to them simply as "skygazers."

Perhaps by gazing at the stars they developed the first calendars based on the phases of the moon.  Perhaps they are the ones who introduced Babylonians and Persians to a numerical system based on the number 60.  This system included the 360 degree circle, 60 seconds in a minute, 60 minutes in an hour, and so forth. They are also sometimes credited as helping the Babylonians advance mathematics, astronomy, astrology and medicine. 

Henry Sigerist, in his 1922 history of medicine, said that ancient societies did not study the sky because they were interested in the alignment of the planets, stars, comets, etc. What they were interested in was interpreting the words of the gods, and this alignment, so they thought, was how the gods communicated. It was the job of the Chaldean priests, and later the Babylonian priests, to interpret astrological signs. (Sigerist, page 392)

Or, as William Osler wrote in his history of medicine:

A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that “declare the glory of God,” reflect, as in a mirror, the Microcosm, the daily life of man on earth. (Osler, page 24)

As they themselves were, their knowledge and culture were assimilated into Babylonian culture, and this is how medicine evolved into a science of divination through astrology and hepatoscopy in ancient Babylonia, or so it is believed. (Baas, page 25)(Sigerist, 392)

Actually, not only were the Chaldean Priest known for their astrology and hepatoscopy, they were also known for their herbal remedies and incantations. In fact, it was probably due to the Chaldean Priests that the Babylonians became well known for their poisons. (Baas, ?)

Babylonian medicine was initially referred to as poison because it was used for its poisonous effects, which sometimes included killing people who were not wanted.  It was this effect, some believe, that gave Babylonian medicine, at least initially, a bad name.  Perhaps for this reason most physicians were seen as bad people, and for this reason they worked behind the scenes.

Perhaps this was among the reasons that when the Greek historian Herodotus traveled through Mesopotamia, he wrote that "they have no physicians."  Various historians have noted ample evidence that there were, especially after the assimilation of the Chaldeans.

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