Food sovereignty is a food system in which the people who produce, distribute, and consume food also control the mechanisms and policies of food production and distribution. This stands in contrast to the present corporate food regime, in which corporations and market institutions control the global food system. Food sovereignty emphasizes local food economies, sustainable food availability, and center culturally appropriate foods and practices. Changing climates and disrupted foodways
disproportionately impact indigenous populations and their access to
traditional food sources while contributing to higher rates of certain
diseases; for this reason, food sovereignty centers indigenous peoples.
These needs have been addressed in recent years by several international
organizations, including the United Nations,
with several countries adopting food sovereignty policies into law.
Critics of food sovereignty activism believe that the system is founded
on inaccurate baseline assumptions; disregards the origins of the
targeted problems; and is plagued by a lack of consensus for proposed
solutions.
Definition
The term "food sovereignty" was first coined in 1996 by members of Via Campesina, an international farmers' organisation, and later adopted by several international organisations, including the World Bank and United Nations. In 2007, the "Declaration of Nyéléni"
provided a definition which was adopted by 80 countries; in 2011 it was
further refined by countries in Europe. As of 2020, at least seven
countries had integrated food sovereignty into their constitutions and
laws.
History
Aligned somewhat with the tenets of the Slow Food
organization, the history of food sovereignty as a movement is
relatively young. However, the movement is gaining traction as more
countries take significant steps towards implementing food systems
that address inequities.
Global gatherings
At the 2007 Forum for Food Sovereignty in Sélingué, Mali, 500 delegates from more than 80 countries adopted the "Declaration of Nyéléni", which says in part:
Food sovereignty is the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable
methods, and their right to define their own food and agriculture
systems. It puts those who produce, distribute and consume food at the
heart of food systems and policies rather than the demands of markets
and corporations. It defends the interests and inclusion of the next
generation. It offers a strategy to resist and dismantle the current
corporate trade and food regime, and directions for food, farming,
pastoral and fisheries systems determined by local producers. Food
sovereignty prioritises local and national economies and markets and
empowers peasant and family farmer-driven agriculture, artisanal fishing,
pastoralist-led grazing, and food production, distribution and
consumption based on environmental, social and economic sustainability.
Issues
of food production, distribution and access are seldom apolitical or
without criticism. For example, the adoption of the Green Revolution
in countries across the globe has increased world food production but
has not "solved" the problem of world hunger. Food sovereignty advocates
argue this is because the movement did not address access to land or
distribution of economic power. Others argue that food sovereignty is
based on incorrect baseline assumptions around the role of subsistence
farming in government policy. Agrarian aspects of food sovereignty put
the movement in conflict with globalisation, industrialisation, and
urbanisation trends.
In September 2008, Ecuador
became the first country to enshrine food sovereignty in its
constitution. As of late 2008, a law is in the draft stages that is
expected to expand upon this constitutional provision by banning genetically modified organisms, protecting many areas of the country from extraction of non-renewable resources, and to discourage monoculture. The law as drafted will also protect biodiversity as collective intellectual property and recognize the Rights of Nature.
Since then Venezuela, Mali, Bolivia, Nepal and Senegal; and most recently Egypt (2014 Constitution) have integrated food sovereignty into their national constitutions or laws.
Indigenous food sovereignty
Global Issues
Climate
Climate
change is impacting the food security of indigenous communities as
well, including Pacific Islanders and those in the Circumpolar North,
due to rising sea levels or erosion.
Cuisine
Activists
claim that native food sovereignty is also appropriated as a cuisine
for mainstream dining because indigenous foods are framed to be
culturally authentic, desired by those outside of these communities.
Ingredients that are cultural staples, which are harder for these
populations to find, are displaced due to a greater demand for access
outside of indigenous populations.
Indigenous food sovereignty in the United States
Native
Americans have been directly impacted in their ability to acquire and
prepare their food and this disruption of traditional diets has resulted
in health problems, including diabetes and heart disease.
Indigenous food sovereignty activists in the United States assert that
the systematic displacement of indigenous communities has led to mass
food insecurity. Activist groups advocate for revitalization of
traditional practices, development of local food economies, the right to food, and seed sovereignty.
Indigenous people’s food sovereignty and food security are
closely related to their geographical location. Traditional indigenous
foodways in the United States are tied to the ancestral homelands of
Native American populations, especially for those with strong
subsistence traditions. For instance, it is taught among the Muckleshoot that “the land that provides the foods and medicines we need are a part of who we are."
The disruption of traditional foodways is described to be tied to
the disruption of the connection between traditional Native land and
their people, a change Rachel V. Vernon describes as being tied to
“racism, colonialism, and the loss of autonomy and power.”
Pre-colonial lands were expansive and thriving with traditional foods.
Because of disease and war, Native peoples in the early 20th century
were directly impacted in their ability to acquire and prepare their
food. In addition to this, relocation away from ancestral lands further
limited traditional foodways. Many indigenous people in the United
States now live in food deserts.
Due to inadequate or inhibited access to food, indigenous peoples
suffer disproportionately from food insecurity compared to the rest of
the US population.
At reservations, the “‘highly processed, high sugar, high fat, and
processed foods,’” further contributed to health issues in Native
populations, leading to indigenous peoples in the United States having
the highest rates of diabetes and heart disease in the nation.
In addition to this, a majority of Native peoples also live
off-reservation, and so are even further removed from traditional
foodways.
Because Native American nations are sovereign from the United
States, they receive little help in rehabilitating traditional foodways.
As defined by the National Congress of American Indians, tribal sovereignty
ensures that any decisions about the tribes with regard to their
property and citizens are made with their participation and consent.
The United States federal government recognizes Native American tribes
as separate governments, opposed to “special interest groups,
individuals, or ... other type of non-governmental entity.”
Activism
Native
Americans today fight for food sovereignty as a means to address
health, returning to culturally traditional foods for healing. Returning
to traditional eating is challenging, considering an extensive history
of relocation and cultural genocide. Many Native American histories of traditional culture foods have been lost or are now difficult to recreate.
Indigenous food sovereignty activists in the United States assert
that indigenous communities have been systematically displaced from
their traditional foodways, which has led to mass food insecurity. It is argued that the most effective way to achieve food security for indigenous groups is to increase their agency in food production.
Some activists also argue for food sovereignty as a means of healing
historical trauma and as a means of decolonizing their communities. In
the United States the Indigenous Food Systems Network and the Native
American Food Sovereignty Alliance work towards education and
policy-making concerned with food and farming security. Another group
focused on requiring food and energy sovereignty is the White Earth Anishnaabeg from Minnesota, who focus on a variety of foods, planting and harvesting them using traditional methods, a form of decolonization.
Such groups meet to establish policies for food sovereignty and to
develop their local food economies at summits such as the Diné
Bich’iiya’ Summit in Tsaile, Arizona, which focused on Navajo
traditional foods.
Indigenous food sovereignty activists also often advocate for seed sovereignty, and more generally for plant breeders’ rights.
Seed saving is important to indigenous communities in the United States
because it provides those communities with a stable food source and
holds cultural importance.
In addition, seed sovereignty advocates often argue that seed saving is
an important mechanism in creating agricultural systems that can adapt
to climate change.
Seed Sovereignty
Seed sovereignty can be defined as the right “to breed and exchange diverse open-sourced seeds." It is closely connected to food sovereignty, as seed sovereignty activists argue for the practice of seed saving partly as a means of increasing food security. These activists argue that seed saving allows for a closed food system that can help communities gain independence from major agricultural companies.
Seed sovereignty is distinct from food sovereignty in its emphasis on
seed saving specifically, rather than food systems in their entirety.
Seed sovereignty activists often argue for seed saving based on
environmental reasoning, not just food justice ones.
They argue that seed saving fills an important role of restoring
biodiversity to agriculture, and producing plant varieties that are more
resilient to change climatic conditions in light of climate change.
Food sovereignty versus food security
Food sovereignty was born in response to campaigners' disillusion with food security, the dominant global discourse on food provisioning and policy.
The latter emphasises access to adequate nutrition for all, which may
be provided by food from one's own country or from global imports. In
the name of efficiency and enhanced productivity, it has therefore
served to promote what has been termed the "corporate food regime": large-scale, industrialised corporate farming based on specialized production, land concentration and trade liberalisation.
Critics of the food security movement claim that its inattention to the
political economy of the corporate food regime blinds it to the adverse
effects of that regime, notably the widespread dispossession of small
producers and global ecological degradation.
Writing in Food First's Backgrounder, fall 2003, Peter Rosset argues that "food sovereignty goes beyond the concept of food security...
[Food security] means that... [everyone] must have the certainty of
having enough to eat each day[,] ... but says nothing about where that
food comes from or how it is produced."
Food sovereignty includes support for smallholders and for collectively
owned farms, fisheries, etc., rather than industrializing these sectors
in a minimally regulated global economy. In another publication, Food
First describes "food sovereignty" as "a platform for rural
revitalization at a global level based on equitable distribution of farmland and water, farmer control over seeds, and productive small-scale farms supplying consumers with healthy, locally grown food."
Food sovereignty has also been compared to Food justice,
which focuses more on race and class inequities and their relation to
food, whereas food sovereignty refers more so to agency over food
production systems.
Criticisms of the Green Revolution
The Green Revolution, which refers to developments in plant breeding between the 1960s and 1980s that improved yields from major cereal
crops, is upheld by some proponents of food security as a success story
in increasing crop yields and combating world hunger. The policy
focused primarily in research, development and transfer of agricultural
technology, such as hybrid seeds and fertilisers, through massive private and public investment that went into transforming agriculture in a number of countries, starting in Mexico and India.
However, many in the food sovereignty movement are critical of the
green revolution and accuse those who advocate it as following too much
of a Western culturetechnocratic program that is out of touch with the needs of majority of small producers and peasants.
While the green revolution may have produced more food, world hunger continues because it did not address the problems of access. Food sovereignty advocates argue that the green revolution failed to alter the highly concentrated distribution of economic power, particularly access to land and purchasing power.
Critics also argue that the green revolution’s increased use of
herbicides caused widespread environmental destruction and reduced
biodiversity in many areas.
Academic perspectives
Food Regime theory
It is in its capacity as a social movement that food regime analysts are interested in food sovereignty. With its Marxist
influences, food regime theorists are interested in how moments of
crisis within a particular food regime are expressive of the dialectical
tension that animates movement between such configurations (i.e.,
periods of transition). According to leading theorist Philip McMichael,
food regimes are always characterized by contradictory forces.
Consolidation of a regime does not so much resolve as it does contain,
or else strategically accommodate, these tensions.
According to McMichael, a "world agriculture" under the WTO Agreement on Agriculture
("food from nowhere") represents one pole of the "central
contradiction" of the present regime. He is interested in the food
sovereignty movement's potential to escalate the tension between this
and its opposing pole, the agroecology-based localism ("food from somewhere") advocated by various grassroots food movements.
Offering slightly different conclusions, recent work by Harriet
Friedmann suggests that "food from somewhere" is already being co-opted
under an emergent "corporate-environmental" regime (cf. Campbell 2009).
Criticisms
Wrong baseline assumptions
Some
scholars argue that the Food Sovereignty movement follows wrong
baseline assumptions, citing that small-scale farming is not necessarily
a freely chosen lifestyle and farmers in least developed and highly
developed countries do not face the same challenges. These critics claim
the Food Sovereignty movement may be right about the mistakes of neoliberal economic ideology, but it is silent about the fact that many famines actually occurred under socialist and communist regimes that pursued the goal of food self-sufficiency (cf. Aerni 2011).
Political-jurisdictional model
There is a lack of consensus within the food sovereignty movement regarding the political or jurisdictional community at which its calls for democratisation and renewed "agrarian citizenship" are directed. In public statements, the food sovereignty movement
urges strong action from both national governments and local communities
(in the vein of the indigenous rights movement, Community-Based Natural Resource Management (CBNRM) . Elsewhere it has also appealed to global civil society to act as a check against abuses by national and supranational governing bodies.
Those who take a radically critical view on state sovereignty
would argue against the possibility that national sovereignty can be
reconciled with that of local communities (see also the debate about multiculturalism and indigenous autonomy in Mexico).
Crisis of the peasantry?
In
its strong reassertion of rural and peasant identities, the food
sovereignty movement has been read as a challenge to modernist
narratives of inexorable urbanisation, industrialisation of agriculture, and de-peasantisation. However, as part of ongoing debates over the contemporary relevance of agrarianism in classical Marxism,
Henry Bernstein is critical of these accounts. He claims that such
analyses tend to present the agrarian population as a unified, singular
and world-historical social category, failing to account for:
a population's vast internal social differentiation (North/South, gender and class positionalities);
the conservative, cultural survivalist tendencies of a movement that
has emerged as part of a backlash against the perceived homogenising
forces of globalisation (Boyer discusses whether food sovereignty is a counter or anti-development narrative) Berstein claims that these accounts cannot escape a certain agrarian populism (or agrarianism). For a response to Bernstein, see McMichael (2009).
Medieval Islamic physicians largely retained their authority until the rise of medicine as a part of the natural sciences, beginning with the Age of Enlightenment,
nearly six hundred years after their textbooks were opened by many
people. Aspects of their writings remain of interest to physicians even
today.
Overview
Medicine
was a central part of medieval Islamic culture. This period was called
the Golden Age of Islam and lasted from the eighth century to the
fourteenth century.
The economic and social levels of the patient determined to a large
extent the type of care sought, and the expectations of the patients
varied along with the approaches of the practitioners.
Responding to circumstances of time and place/location, Islamic
physicians and scholars developed a large and complex medical literature
exploring, analyzing, and synthesizing the theory and practice of
medicine Islamic medicine was initially built on tradition, chiefly the theoretical and practical knowledge developed in Arabia and was known at Muhammad's time, ancient Hellenistic medicine such as Unani, ancient Indian medicine such as Ayurveda, and the ancient Iranian Medicine of the Academy of Gundishapur. The works of ancient Greek and Roman physicians Hippocrates,Galen and Dioscorides also had a lasting impact on Middle Eastern medicine.
Intellectual thirst, open-mindness, and vigor were at an all time high
in this era. In the Golden Age of Islam, the knowledge by anicent
culture were brought together brought together scientist and scholars
allowing the work of Arabic scientist to be the most advanced. Ophthalmology has been described as the most successful branch of medicine researched at the time, with the works of Ibn al-Haytham remaining an authority in the field until early modern times.
Origins and sources
16th century manuscript of the Al-Tibb al-Nabawi (Treatise on Prophetic Medicine) created for Ottoman emperor Suleiman the Magnificent
Ṭibb an-Nabawī – Prophetic Medicine
The
adoption by the newly forming Islamic society of the medical knowledge
of the surrounding, or newly conquered, "heathen" civilizations had to
be justified as being in accordance with the beliefs of Islam. Early on,
the study and practice of medicine was understood as an act of piety,
founded on the principles of Imaan (faith) and Tawakkul (trust).
The Prophet not only instructed sick people to take medicine, but he himself invited expert physicians for this purpose.
— As-Suyuti’s Medicine of the Prophet p.125
Muhammad's
opinions on health issues and habits with rojo leading a healthy life
were collected early on and edited as a separate corpus of writings
under the title Ṭibb an-Nabī ("The Medicine of the Prophet"). In the 14th century, Ibn Khaldun, in his work Muqaddimah
provides a brief overview over what he called "the art and craft of
medicine", separating the science of medicine from religion:
You'll have to know that the origin
of all maladies goes back to nutrition, as the Prophet – God bless him!
– says with regard to the entire medical tradition, as commonly known
by all physicians, even if this is contested by the religious scholars.
These are his words: "The stomach is the House of Illness, and
abstinence is the most important medicine. The cause of every illness is
poor digestion."
— Ibn Khaldūn, Muqaddima, V, 18
The Sahih al-Bukhari, a collection of prophetic traditions, or hadith by Muhammad al-Bukhari
refers to a collection of Muhammad's opinions on medicine, by his
younger contemporary Anas bin-Malik. Anas writes about two physicians
who had treated him by cauterization
and mentions that the prophet wanted to avoid this treatment and had
asked for alternative treatments. Later on, there are reports of the caliphʿUthmān ibn ʿAffān
fixing his teeth with a wire made of gold. He also mentions that the
habit of cleaning one's teeth with a small wooden toothpick dates back
to pre-Islamic times.
Despite Muhammad's advocacy of medicine, Islam hindered development in human anatomy, regarding the human body as sacred. Only later, when Persian traditions have been integrated to Islamic thought, Muslims developed treatises about human anatomy.
The "Prophetic medicine" was rarely mentioned by the classical authors of Islamic medicine, but lived on in the materia medica for some centuries. In his Kitab as-Ṣaidana (Book of Remedies) from the 10./11. century, Al-Biruni refers to collected poems and other works dealing with, and commenting on, the materia medica of the old Arabs.
The most famous physician was Al-Ḥariṯ ben-Kalada aṯ-Ṯaqafī, who
lived at the same time as the prophet. He is supposed to have been in
touch with the Academy of Gondishapur, perhaps he was even trained there. He reportedly had a conversation once with Khosrow I Anushirvan about medical topics.
Physicians during the early years of Islam
Most likely, the Arabian physicians became familiar with the Graeco-Roman and late Hellenistic
medicine through direct contact with physicians who were practicing in
the newly conquered regions rather than by reading the original or
translated works. The translation of the capital of the emerging Islamic
world to Damascus
may have facilitated this contact, as Syrian medicine was part of that
ancient tradition. The names of two Christian physicians are known: Ibn
Aṯāl worked at the court of Muawiyah I, the founder of the Umayyad dynasty.
The caliph abused his knowledge in order to get rid of some of his
enemies by way of poisoning. Likewise, Abu l-Ḥakam, who was responsible
for the preparation of drugs, was employed by Muawiah. His son,
grandson, and great-grandson were also serving the Umayyad and Abbasid caliphate.
These sources testify to the fact that the physicians of the
emerging Islamic society were familiar with the classical medical
traditions already at the times of the Umayyads. The medical knowledge
likely arrived from Alexandria, and was probably transferred by Syrian scholars, or translators, finding its way into the Islamic world.
7th–9th century: The adoption of earlier traditions
Very few sources provide information about how the expanding Islamic
society received any medical knowledge. A physician called Abdalmalik
ben Abgar al-Kinānī from Kufa in Iraq is supposed to have worked at the medical school of Alexandria before he joined ʿUmar ibn ʿAbd al-ʿAzīz's court. ʿUmar transferred the medical school from Alexandria to Antioch. It is also known that members of the Academy of Gondishapur travelled to Damascus. The Academy of Gondishapur remained active throughout the time of the Abbasid caliphate, though.
An important source from the second half of the 8th century is Jabir ibn Hayyans "Book of Poisons". He only cites earlier works in Arabic translations, as were available to him, including Hippocrates, Plato, Galen, Pythagoras, and Aristotle, and also mentions the Persian names of some drugs and medical plants.
It is currently understood that the early Islamic medicine was mainly informed directly from Greek sources from the Academy of Alexandria,
translated into the Arabic language; the influence of the Persian
medical tradition seems to be limited to the materia medica, although
the Persian physicians were familiar with the Greek sources as well.
Ancient Greek, Roman, and late hellenistic medical literature
The works of Oribasius, physician to the Roman emperor Julian, from the 4th century AD, were well known, and were frequently cited in detail by Muhammad ibn Zakariya al-Razi (Rhazes). The works of Philagrius of Epirus, who also lived in the 4th century AD, are only known today from quotations by Arabic authors. The philosopher and physician John the Grammarian, who lived in the 6th century AD was attributed the role of a commentator on the Summaria Alexandrinorum. This is a compilation of 16 books by Galen, but corrupted by superstitious ideas. The physicians Gessius of Petra and Palladios were equally known to the Arabic physicians as authors of the Summaria. Rhazes cites the Roman physician Alexander of Tralles (6th century) in order to support his criticism of Galen. The works of Aëtius of Amida were only known in later times, as they were neither cited by Rhazes nor by Ibn al-Nadim, but cited first by Al-Biruni in his "Kitab as-Saidana", and translated by Ibn al-Hammar in the 10th century.
One of the first books which were translated from Greek into
Syrian, and then into Arabic during the time of the fourth Umayyad
caliph Marwan I by the Jewish scholar Māsarĝawai al-Basrĩ was the medical compilation Kunnāš, by Ahron, who lived during the 6th century. Later on, Hunayn ibn Ishaq provided a better translation.
The physician Paul of Aegina lived in Alexandria during the time of the Arab expansion.
His works seem to have been used as an important reference by the early
Islamic physicians, and were frequently cited from Rhazes up to Avicenna. Paul of Aegina provides a direct connection between the late Hellenistic and the early Islamic medical science.
Arabic translations of Hippocrates
The early Islamic physicians were familiar with the life of Hippocrates,
and were aware of the fact that his biography was in part a legend.
Also they knew that several persons lived who were called Hippocrates,
and their works were compiled under one single name: Ibn an-Nadīm has conveyed a short treatise by Tabit ben-Qurra on al-Buqratun ("the (various persons called) Hippokrates"). Translations of some of Hippocrates's works must have existed before Hunayn ibn Ishaq
started his translations, because the historian Al-Yaʾqūbī compiled a
list of the works known to him in 872. Fortunately, his list also
supplies a summary of the content, quotations, or even the entire text
of the single works. The philosopher Al-Kindi wrote a book with the title at-Tibb al-Buqrati (The Medicine of Hippocrates), and his contemporary Hunayn ibn Ishāq then translated Galens commentary on Hippocrates.
Rhazes is the first Arabic-writing physician who makes thorough use of
Hippocrates's writings in order to set up his own medical system. Al-Tabari maintained that his compilation of hippocratic teachings (al-Muʾālaḡāt al-buqrāṭīya)
was a more appropriate summary. The work of Hippocrates was cited and
commented on during the entire period of medieval Islamic medicine.
Arabic translations of Galen
Galen is one of the most famous scholars and physicians of classical antiquity.
Today, the original texts of some of his works, and details of his
biography, are lost, and are only known to us because they were
translated into Arabic. Jabir ibn Hayyan frequently cites Galen's books, which were available in early Arabic translations. In 872 AD, Ya'qubi
refers to some of Galens works. The titles of the books he mentions
differ from those chosen by Hunayn ibn Ishāq for his own translations,
thus suggesting earlier translations must have existed. Hunayn
frequently mentions in his comments on works which he had translated
that he considered earlier translations as insufficient, and had
provided completely new translations. Early translations might have been
available before the 8th century; most likely they were translated from
Syrian or Persian.
Within medieval Islamic medicine, Hunayn ibn Ishāq and his
younger contemporary Tabit ben-Qurra play an important role as
translators and commentators of Galen's work. They also tried to compile
and summarize a consistent medical system from these works, and add
this to the medical science of their period. However, starting already
with Jabir ibn Hayyan in the 8th century, and even more pronounced in
Rhazes's treatise on vision, criticism of Galen's ideas took on. in the
10th century, the physician 'Ali ibn al-'Abbas al-Majusi wrote:
With regard to the great and
extraordinary Galen, he has written numerous works, each of which only
comprises a section of the science. There are lengthy passages, and
redundancies of thoughts and proofs, throughout his works. […] None of
them I'm able to regard […] as being comprehensive.
— al-Majusi, 10th century
Syrian and Persian medical literature
Syrian texts
During the 10th century, Ibn Wahshiyya compiled writings by the Nabataeans, including also medical information. The Syrian scholar Sergius of Reshaina
translated various works by Hippocrates and Galen, of whom parts 6–8 of
a pharmacological book, and fragments of two other books have been
preserved. Hunayn ibn Ishāq has translated these works into Arabic.
Another work, still existing today, by an unknown Syrian author, likely
has influenced the Arabic-writing physicians Al-Tabari and Yūhannā ibn Māsawaiyh.
The earliest known translation from the Syrian language is the Kunnāš
of the scholar Ahron (who himself had translated it from the Greek),
which was translated into the Arabian by Māsarĝawai al-Basrĩ in the 7th
century. [Syriac-language, not Syrian, who were Nestorians] physicians
also played an important role at the Academy of Gondishapur; their names were preserved because they worked at the court of the Abbasid caliphs.
Persian texts
Again the Academy of Gondishapur
played an important role, guiding the transmission of Persian medical
knowledge to the Arabic physicians. Founded, according to Gregorius Bar-Hebraeus, by the Sassanid ruler Shapur I during the 3rd century AD, the academy connected the ancient Greek and Indian medical traditions. Arabian physicians trained in Gondishapur may have established contacts with early Islamic medicine. The treatise Abdāl al-adwiya
by the Christian physician Māsarĝawai (not to be confused with the
translator M. al-Basrĩ) is of some importance, as the opening sentence
of his work is:
These are the medications which were taught by Greek, Indian, and Persian physicians.
— Māsarĝawai, Abdāl al-adwiya
In his work Firdaus al-Hikma (The Paradise of Wisdom), Al-Tabari
uses only a few Persian medical terms, especially when mentioning
specific diseases, but a large number of drugs and medicinal herbs are
mentioned using their Persian names, which have also entered the medical
language of Islamic medicine. As well as al-Tabari, Rhazes rarely uses Persian terms, and only refers to two Persian works: Kunnāš fārisi und al-Filāha al-fārisiya.
at-Tabarī devotes the last 36 chapters of his Firdaus al-Hikmah to describe the Indian medicine, citing Sushruta, Charaka, and the Ashtanga Hridaya (Sanskrit: अष्टांग हृदय, aṣṭāṇga hṛdaya;
"The eightfold Heart"), one of the most important books on Ayurveda,
translated between 773 and 808 by Ibn-Dhan. Rhazes cites in al-Hawi and in Kitab al-Mansuri both Sushruta and Charaka besides other authors unknown to him by name, whose works he cites as "min kitab al-Hind", „an Indian book".
Meyerhof suggested that the Indian medicine, like the Persian medicine, has mainly influenced the Arabic materia medica,
because there is frequent reference to Indian names of herbal medicines
and drugs, which were unknown to the Greek medical tradition.
Whilst Syrian physicians transmitted the medical knowledge of the
ancient Greeks, most likely Persian physicians, probably from the
Academy of Gondishapur, were the first intermediates between the Indian
and the Arabic medicine.
Approach to Medicine
Medicine in the Medieval Islamic World was often directly related to horticulture. Fruits and vegetables
were related to health and well being, although they were seen as
having different properties than what modern medicine says now.
The use of the humoral theory is also a large part of medicine in this
period, shaping the diagnosis and treatments for patients.This kind of
medicine was largely holistic, focused on on schedule, environment, and diet.
As a result, medicine was very individualistic as every person who
sought medical help would receive different advice dependent not only on
their ailment, but also according to their lifestyle. There was still
some connection between treatments however, as medicine was largely
based on humoral theory which meant that each person needed to be
treated according to whether or not their humors were hot, cold,
melancholic, or choleric.
Horticulture
The
use of plants in medicine was quite common in this era with most plants
being used in medicine being associated with both some benefits and
consequences for use as well as certain situations in which they should
be used. This was due to the association between certain plants with hot or cold properties, i.e "cool as a cucumber" or a hot pepper.
Thus, hot ailments such as a fever should be addressed by consuming a
cucumber and a cool ailment such as a significant amount of phlegm
should be treated with the pepper.
Physicians and scientists
The
authority of the great physicians and scientists of the Islamic Golden
age has influenced the art and science of medicine for many centuries.
Their concepts and ideas about medical ethics are still discussed today,
especially in the Islamic parts of our world. Their ideas about the
conduct of physicians, and the doctor–patient relationship are discussed as potential role models for physicians of today.
The art of healing was dead, Galen
revived it; it was scattered and dis-arrayed, Razi re-arranged and
re-aligned it; it was incomplete, Ibn Sinna perfected it.
Imam Ali ibn Mousa al-Ridha (AS) (765–818) is the 8th Imam of the Shia. His treatise "Al-Risalah al-Dhahabiah" ("The Golden Treatise") deals with medical cures and the maintenance of good health, and is dedicated to the caliph Ma'mun.
It was regarded at his time as an important work of literature in the
science of medicine, and the most precious medical treatise from the
point of view of Muslimic religious tradition. It is honoured by the
title "the golden treatise" as Ma'mun had ordered it to be written in
gold ink. In his work, Al-Ridha is influenced by the concept of humoral medicine.
Ali ibn Sahl Rabban al-Tabari
The first encyclopedia of medicine in Arabic language was by Persian scientist Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah ("Paradise of Wisdom"),
written in seven parts, c. 860 dedicated to Caliph al-Mutawakkil. His
encyclopedia was influenced by Greek sources, Hippocrates, Galen,
Aristotle, and Dioscurides. Al-Tabari, a pioneer in the field of child development, emphasized strong ties between psychology and medicine, and the need for psychotherapy and counseling in the therapeutic treatment of patients. His encyclopedia also discussed the influence of Sushruta and Charaka on medicine, including psychotherapy.
Muhammad bin Sa'id al-Tamimi
Al-Tamimi, the physician (d. 990) became renown for his skills in compounding medicines, especially theriac,
an antidote for poisons. His works, many of which no longer survive,
are cited by later physicians. Taking what was known at the time by the
classical Greek writers, Al-Tamimi expanded on their knowledge of the
properties of plants and minerals, becoming avant garde in his field.
Ali ibn al-'Abbas al-Majusi
'Ali ibn al-'Abbas al-Majusi (died 994 AD), also known as Haly Abbas, was famous for the Kitab al-Maliki translated as the Complete Book of the Medical Art and later, more famously known as The Royal Book.
Considered one of the great classical works of Islamic medicine, it was
free of magical and astrological ideas and thought to represent
Galenism of Arabic medicine in the purest form. This book was translated
by Constantine and was used as a textbook of surgery in schools across
Europe. The Royal Book has maintained the same level of fame as Avicenna's Canon
throughout the Middle Ages and into modern time. One of the greatest
contributions Haly Abbas made to medical science was his description of
the capillary circulation found within the Royal Book.
Muhammad ibn Zakariya al-Razi
Top image: Folio from the "Liber continens" by Al-Razi Bottom image:"Liber continens", translated by Gerard of Cremona, second half of the 13th century
Muhammad ibn Zakariya al-Razi
(Latinized: Rhazes) (born 865) was one of the most versatile scientists
of the Islamic Golden Age. A Persian-born physician, alchemist and
philosopher, he is most famous for his medical works, but he also wrote
botanical and zoological works, as well as books on physics and
mathematics. His work was highly respected by the 10th/11th century
physicians and scientists al-Biruni and al-Nadim,
who recorded biographical information about al-Razi, and compiled lists
of, and provided commentaries on, his writings. Many of his books were
translated into Latin, and he remained one of the undisputed authorities
in European medicine well into the 17th century.
In medical theory, al-Razi relied mainly on Galen,
but his particular attention to the individual case, stressing that
each patient must be treated individually, and his emphasis on hygiene
and diet reflect the ideas and concepts of the empirical hippocratic
school. Rhazes considered the influence of the climate and the season
on health and well-being, he took care that there was always clean air
and an appropriate temperature in the patients' rooms, and recognized
the value of prevention as well as the need for a careful diagnosis and
prognosis.
In the beginning of an illness,
chose remedies which do not weaken the [patient's] strength. […]
Whenever a change of nutrition is sufficient, do not use medication, and
whenever single drugs are sufficient, do not use composite drugs.
— Al-Razi
Kitab-al Hawi fi al-tibb (Liber continens)
The kitab-al Hawi fi al-tibb (al-Hawiالحاوي, Latinized: The Comprehensive book of medicine, Continens Liber, The Virtuous Life)
was one of al-Razi's largest works, a collection of medical notes that
he made throughout his life in the form of extracts from his reading and
observations from his own medical experience.
In its published form, it consists of 23 volumes. Al-Razi cites Greek,
Syrian, Indian and earlier Arabic works, and also includes medical cases
from his own experience. Each volume deals with specific parts or
diseases of the body. 'Ali ibn al-'Abbas al-Majusi reviewed the al-Hawi in his own book Kamil as-sina'a:
[In al-Hawi] he refers to
everything which is important for a physician to maintain health, and
treat illness by means of medications and diet. He describes the signs
of illness and does not omit anything which would be necessary for
anyone who wants to learn the art of healing. However, he does not talk
about physical topics, about the science of the elements, temperaments
and humours, nor does he describe the structure of organs or the
[methods of] surgery. His book is without structure and logical
consequence, and does not demonstrate the scientific method. […] In his
description of every illness, their causes, symptoms and treatment he
describes everything which is known to all ancient and modern physicians
since Hippocrates and Galen up to Hunayn ibn Ishaq
and all those who lived in-between, leaving nothing out of all that
every one of them has ever written, carefully noting down all of this in
his book, so that finally all medical works are contained within his
own book.
— al-Majusi, Kamil as-sina'a, transl. Leclerc, Vol. I, p. 386–387
Al-Hawi remained an authoritative textbook on medicine in most European universities, regarded until the seventeenth century as the most comprehensive work ever written by a medical scientist. It was first translated into Latin in 1279 by Faraj ben Salim, a physician of Sicilian-Jewish origin employed by Charles of Anjou.
The al-Kitab al-Mansuri (الكتاب المنصوري في الطب, Latinized: Liber almansoris, Liber medicinalis ad Almansorem) was dedicated to "the Samanid prince Abu Salih al-Mansur ibn Ishaq, governor of Rayy."
The book contains a comprehensive encyclopedia of medicine in ten
sections. The first six sections are dedicated to medical theory, and
deal with anatomy, physiology and pathology, materia medica, health
issues, dietetics, and cosmetics. The remaining four parts describe
surgery, toxicology, and fever.
The ninth section, a detailed discussion of medical pathologies
arranged by body parts, circulated in autonomous Latin translations as
the Liber Nonus.
In his book entitled "Kitab
al-Mansuri", al-Razi summarizes everything which concerns the art of
medicine, and does never neglect any issue which he mentions. However,
everything is much abbreviated, according to the goal he has set
himself.
— al-Majusi, Kamil as-sina'a, transl. Leclerc, Vol. I, p. 386
The book was first translated into Latin in 1175 by Gerard of Cremona.
Under various titles ("Liber (medicinalis) ad Almansorem";
"Almansorius"; "Liber ad Almansorem"; "Liber nonus") it was printed in Venice in 1490, 1493, and 1497. Amongst the many European commentators on the Liber nonus, Andreas Vesalius paraphrased al-Razi's work in his "Paraphrases in nonum librum Rhazae", which was first published in Louvain, 1537.
Kitab Tibb al-Muluki (Liber Regius)
Another work of al-Razi is called the Kitab Tibb al-Muluki (Regius).
This book covers the treatments and cures of diseases and ailments,
through dieting. It is thought to have been written for the noble class
who were known for their gluttonous behavior and who frequently became
ill with stomach diseases.
Kitab al-Jadari wa-l-hasba (De variolis et morbillis)
Until the discovery of Tabit ibn Qurras earlier work, al-Razi's treatise on smallpox and measles
was considered the earliest monograph on these infectious diseases. His
careful description of the initial symptoms and clinical course of the
two diseases, as well as the treatments he suggests based on the
observation of the symptoms, is considered a masterpiece of Islamic
medicine.
Other works
Other works include A Dissertation on the causes of the Coryza which occurs in the spring when roses give forth their scent,
a tract in which al-Razi discussed why it is that one contracts coryza
or common cold by smelling roses during the spring season, and Bur’al Sa’a (Instant cure) in which he named medicines which instantly cured certain diseases.
Abu-Ali al-Husayn ibn Abdullah ibn-Sina (Avicenna)
Top image: One of the oldest existing copies of The Canon of Medicine by Avicenna, c. 1030 Bottom image: The Canon of Medicine, printed in Venice 1595
Ibn Sina, more commonly known in west as Avicenna
was a Persian polymath and physician of the tenth and eleventh
centuries. He was known for his scientific works, but especially his
writing on medicine. He has been described as the "Father of Early Modern Medicine".
Ibn Sina is credited with many varied medical observations and
discoveries, such as recognizing the potential of airborne transmission
of disease, providing insight into many psychiatric conditions,
recommending use of forceps in deliveries complicated by fetal distress, distinguishing central from peripheral facial paralysis and describing guinea worm infection and trigeminal neuralgia. He is credited for writing two books in particular: his most famous, al-Canon fi al Tibb (The Canon of Medicine), and also The Book of Healing. His other works cover subjects including angelology, heart medicines, and treatment of kidney diseases.
Avicenna's medicine became the representative of Islamic medicine mainly through the influence of his famous work al-Canon fi al Tibb (The Canon of Medicine). The book was originally used as a textbook for instructors and students of medical sciences in the medical school of Avicenna.
The book is divided into 5 volumes:
The first volume is a compendium of medical principles, the second is a
reference for individual drugs, the third contains organ-specific
diseases, the fourth discusses systemic illnesses as well as a section
of preventive health measures, and the fifth contains descriptions of
compound medicines. The Canon was highly influential in medical schools and on later medical writers.
Ibn Buṭlān - Yawānīs al-Mukhtār ibn al-Ḥasan ibn ʿAbdūn al-Baghdādī (Ibn Butlan)
Ibn Buṭlān, otherwise known as Yawānīs al-Mukhtār ibn al-Ḥasan ibn ʿAbdūn al-Baghdādī, was an Arab physician who was active in Baghdad during the Islamic Golden Age. He is known as an author of the Taqwim al-Sihhah (The Maintenance of Health تقويم الصحة), in the West, best known under its Latinized translation, Tacuinum Sanitatis (sometimes Taccuinum Sanitatis).
The work treated matters of hygiene, dietetics, and exercise.
It emphasized the benefits of regular attention to the personal
physical and mental well-being. The continued popularity and publication
of his book into the sixteenth century is thought to be demonstration
of the influence that Arabic culture had on early modern Europe.
His other work include a books such as:
Taqwim al-Sihha (تقويم الصحة)
Da'avat al-ateba'
Al-maqalat al-Mokhtarat fi tadbir al-amrad al-a'rezat al-aksar bel taghziat Ma'loofat
Resalat fi shari al-raghigh va taghlib al-bai'd
Maqalat fi an al-foroj ahar men al-farkh
Al-maqalat al-mesriat fi monaghezat Ali Ibn Ridwan
Maqal fi al-qorban al-moqadas (مقال في القربان المقدس)
Medical contributions
Human anatomy and physiology
Mansur ibn Ilyas: Anatomy of the human body (تشريح بدن انسان, Tashrīḥ-i badan-i insān), c. 1450, U.S. National Library of Medicine.
It is claimed that an important advance in the knowledge of human anatomy and physiology was made by Ibn al-Nafis,
but whether this was discovered via human dissection is doubtful
because "al-Nafis tells us that he avoided the practice of dissection
because of the shari'a and his own 'compassion' for the human body".
The movement of blood through the human body was thought to be known due to the work of the Greek physicians.
However, there was the question of how the blood flowed from the right
ventricle of the heart to the left ventricle, before the blood is pumped
to the rest of the body. According to Galen in the 2nd century, blood reached the left ventricle through invisible passages in the septum.
By some means, Ibn al-Nafis, a 13th-century Syrian physician, found the
previous statement on blood flow from the right ventricle to the left
to be false.
Ibn al-Nafis discovered that the ventricular septum was impenetrable,
lacking any type of invisible passages, showing Galen's assumptions to
be false. Ibn al-Nafis discovered that the blood in the right ventricle of the heart is instead carried to the left by way of the lungs. This discovery was one of the first descriptions of the pulmonary circulation, although his writings on the subject were only rediscovered in the 20th century, and it was William Harvey's later independent discovery which brought it to general attention.
According to the Ancient Greeks, vision was thought to a visual spirit emanating from the eyes that allowed an object to be perceived. The 11th century Iraqi scientist Ibn al-Haytham, also known as Al-hazen in Latin, developed a radically new concept of human vision. Ibn al-Haytham took a straightforward approach towards vision by explaining that the eye was an optical instrument.
The description on the anatomy of the eye led him to form the basis for
his theory of image formation, which is explained through the
refraction of light rays passing between 2 media of different densities. Ibn al-Haytham developed this new theory on vision from experimental investigations. In the 12th century, his Book of Optics was translated into Latin and continued to be studied both in the Islamic world and in Europe until the 17th century.
Ahmad ibn Abi al-Ash'ath, a famous physician from Mosul, Iraq,
described the physiology of the stomach in a live lion in his book al-Quadi wa al-muqtadi. He wrote:
When food enters the stomach,
especially when it is plentiful, the stomach dilates and its layers get
stretched...onlookers thought the stomach was rather small, so I
proceeded to pour jug after jug in its throat…the inner layer of the
distended stomach became as smooth as the external peritoneal layer. I
then cut open the stomach and let the water out. The stomach shrank and
I could see the pylorus…
Ahmad ibn Abi al-Ash'ath observed the physiology of the stomach in a live lion in 959. This description preceded William Beaumont by almost 900 years, making Ahmad ibn al-Ash'ath the first person to initiate experimental events in gastric physiology.
According to Galen, in his work entitled De ossibus ad tirones, the lower jaw consists of two parts, proven by the fact that it disintegrates in the middle when cooked. Abd al-Latif al-Baghdadi, while on a visit to Egypt, encountered many skeletal remains of those who had died from starvation near Cairo. He examined the skeletons and established that the mandible consists of one piece, not two as Galen had taught. He wrote in his work Al-Ifada w-al-Itibar fi al_Umar al Mushahadah w-al-Hawadith al-Muayanah bi Ard Misr, or "Book of Instruction and Admonition on the Things Seen and Events Recorded in the Land of Egypt":
All anatomists agree upon that the
bone of the lower jaw consists of two parts joined together at the chin.
[…] The inspection of this part of the corpses convinced me that the
bone of the lower jaw is all one, with no joint nor suture. I have
repeated the observation a great number of times, in over two hundred
heads […] I have been assisted by various different people, who have
repeated the same examination, both in my absence and under my eyes.
— Abd al-Latif al-Baghdadi, Relation from Egypt, c. 1200 AD
Unfortunately, Al-Baghdadi's discovery did not gain much attention
from his contemporaries, because the information is rather hidden within
the detailed account of the geography, botany, monuments of Egypt, as
well as of the famine and its consequences. He never published his
anatomical observations in a separate book, as had been his intention.
Drugs
Inscribed pestle and mortar for grinding drugs. Khrusan, late 12th or early 13th century
Medical contributions made by medieval Islam included the use of
plants as a type of remedy or medicine. Medieval Islamic physicians
used natural substances as a source of medicinal drugs—including Papaver somniferum Linnaeus, poppy, and Cannabis sativa Linnaeus, hemp. In pre-Islamic Arabia, neither poppy nor hemp was known. Hemp was introduced into the Islamic countries in the ninth century from India through Persia and Greek culture and medical literature. The Greek, Dioscorides,
who according to the Arabs is the greatest botanist of antiquity,
recommended hemp seeds to "quench geniture" and its juice for earaches.
Ali al-Ruhawi believed that a physician must be a bontanist and
understand pharamacological characteristics of the various morphological
parts. Beginning in 800 and lasting for over two centuries, poppy use
was restricted to the therapeutic realm.
However, the dosages often exceeded medical need and was used
repeatedly despite what was originally recommended. Poppy was
prescribed by Yuhanna b. Masawayh to relieve pain from attacks of gallbladder stones, for fevers, indigestion, eye, head and tooth aches, pleurisy, and to induce sleep.
Although poppy had medicinal benefits, Ali al-Tabari explained that the
extract of poppy leaves was lethal, and that the extracts and opium should be considered poisons.
Surgery
The
development and growth of hospitals in ancient Islamic society expanded
the medical practice to what is currently known as surgery. Surgical
procedures were known to physicians during the medieval period because
of earlier texts that included descriptions of the procedures.
Translation from pre-Islamic medical publishings was a fundamental
building block for physicians and surgeons in order to expand the
practice. Surgery was uncommonly practiced by physicians and other
medical affiliates due to a very low success rate, even though earlier
records provided favorable outcomes to certain operations. There were many different types of procedures performed in ancient Islam, especially in the area of ophthalmology.
Techniques
Bloodletting and cauterization
were techniques widely used in ancient Islamic society by physicians,
as a therapy to treat patients. These two techniques were commonly
practiced because of the wide variety of illnesses they treated.
Cauterization, a procedure used to burn the skin or flesh of a wound,
was performed to prevent infection and stop profuse bleeding. To
perform this procedure, physicians heated a metal rod and used it to
burn the flesh or skin of a wound. This would cause the blood from the
wound to clot and eventually heal the wound.
Bloodletting, the surgical removal of blood, was used to cure a patient of bad "humours" considered deleterious to one's health. A phlebotomist performing bloodletting on a patient drained the blood straight from the veins. "Wet" cupping,
a form of bloodletting, was performed by making a slight incision in
the skin and drawing blood by applying a heated cupping glass. The heat
and suction from the glass caused the blood to rise to the surface of
the skin to be drained. “Dry cupping”, the placement of a heated cupping
glass (without an incision) on a particular area of a patient's body to
relieve pain, itching, and other common ailments, was also used.
Though these procedures seem relatively easy for phlebotomists to
perform, there were instances where they had to pay compensation for
causing injury or death to a patient because of carelessness when making
an incision. Both cupping and phlebotomy were considered helpful when a patient was sickly.
Treatment
Surgery was important in treating patients with eye complications, such as trachoma and cataracts. A common complication of trachoma patients is the vascularization of the tissue that invades the cornea
of the eye, which was thought to be the cause of the disease, by
ancient Islamic physicians. The technique used to correct this
complication was done surgically and known today as peritomy.
This procedure was done by "employing an instrument for keeping the eye
open during surgery, a number of very small hooks for lifting, and a
very thin scalpel for excision." A similar technique in treating complications of trachoma, called pterygium, was used to remove the triangular-shaped part of the bulbar conjunctiva
onto the cornea. This was done by lifting the growth with small hooks
and then cut with a small lancet. Both of these surgical techniques were
extremely painful for the patient and intricate for the physician or
his assistants to perform.
In medieval Islamic literature, cataracts were thought to have
been caused by a membrane or opaque fluid that rested between the lens
and the pupil. The method for treating cataracts in medieval Islam
(known in English as couching) was known through translations of earlier publishings on the technique. A small incision was made in the sclera
with a lancet and a probe was then inserted and used to depress the
lens, pushing it to one side of the eye. After the procedure was
complete, the eye was then washed with salt water and then bandaged with
cotton wool soaked in oil of roses and egg whites. After the operation,
there was concern that the cataract, once it had been pushed to one
side, would reascend, which is why patients were instructed to lie on
his or her back for several days following the surgery.
Anesthesia and antisepsis
In both modern society and medieval Islamic society, anesthesia and antisepsis
are important aspects of surgery. Before the development of anesthesia
and antisepsis, surgery was limited to fractures, dislocations,
traumatic injuries resulting in amputation, and urinary disorders or
other common infections.
Ancient Islamic physicians attempted to prevent infection when
performing procedures for a sick patient, for example by washing a
patient before a procedure; similarly, following a procedure, the area
was often cleaned with “wine, wine mixed with oil of roses, oil of roses
alone, salt water, or vinegar water”, which have antiseptic properties.
Various herbs and resins including frankincense, myrrh, cassia, and
members of the laurel family were also used to prevent infections,
although it is impossible to know exactly how effective these treatments
were in the prevention of sepsis. The pain-killing uses of opium had
been known since ancient times; other drugs including “henbane, hemlock,
soporific black nightshade, lettuce seeds” were also used by Islamic
physicians to treat pain. Some of these drugs, especially opium, were
known to cause drowsiness, and some modern scholars have argued that
these drugs were used to cause a person to lose consciousness before an
operation, as a modern-day anesthetic would. However, there is no clear
reference to such a use before the 16th century.
Physicians like al-Razi wrote about the importance of morality in medicine, and may have presented, together with Avicenna and Ibn al-Nafis, the first concept of ethics or "pratical philosophy" in Islamic medicine. Al-Razi wote his treatise "Kitab al-tibb al-ruhani" also known as "Book on Spritual Physick" on popular ethics. He
felt that it was important not only for the physician to be an expert
in his field, but also to be a role model. His ideas on medical ethics
were divided into three concepts: the physician's responsibility to
patients and to self, and also the patients’ responsibility to
physicians.
The earliest surviving Arabic work on medical ethics is Ishaq ibn 'Ali al-Ruhawi's Adab al-Tabib (Arabic: أدب الطبيبAdab aț-Ṭabīb, "Morals of the physician" or "Practical Medical Deontology") and was based on the works of Hippocrates and Galen. Although, it should be mentioned that unlike Hippocartes, Galen did not propose a definite medical ethic code. Morals of the physician
was al-Ruhawi's introductory comment to elevate the practice of
medicine in order to aid the ill and enlist the help of God in his
support.
He quotes Hippocrates that the medical arts involve three factors: the
illness, the patient, and the physician. The book consisted of twenty
chapters on various topics related to medical ethics.
In the first chapter of his book, al-Ruhawi declared that the truth is
more important for physicians who follow rational ethics and the medical
injunctions.Al-Ruhawi
regarded physicians as "guardians of souls and bodies", and insisted
them to use proper medical etiquette for strong medical ethics and not
to ignore theoretical overtones. In pre-Islamic times, there were
problems of a lack of part of an element of struggle and conflict to
resolve ethical diffculites. Al-Ruhawi helped bridge this gap.
Hospital Building ("darüşşifa") of Divriği Great Mosque, Seljuq period, 13th century, Turkey
Many hospitals were developed during the early Islamic era. They were called Bimaristan, or Dar al-Shifa, the Persian and Arabic words meaning "house [or place] of the sick" and "house of curing," respectively. The idea of a hospital being a place for the care of sick people was taken from the early Caliphs. The bimaristan is seen as early as the time of Muhammad, and the Prophet's mosque in the city of Madinah held the first Muslim hospital service in its courtyard. During the Ghazwah Khandaq (the Battle of the Trench), Muhammad came across wounded soldiers and he ordered a tent be assembled to provide medical care. Over time, Caliphs and rulers expanded traveling bimaristans to include doctors and pharmacists.
Umayyad Caliph Al-Walid ibn Abd al-Malik is often credited with building the first bimaristan in Damascus in 707 AD. The bimaristan had a staff of salaried physicians and a well equipped dispensary. It treated the blind, lepers and other disabled people, and also separated those patients with leprosy from the rest of the ill. Some consider this bimaristan no more than a lepersoria because it only segregated patients with leprosy. The first true Islamic hospital was built during the reign of Caliph Harun al-Rashid (A.D 786-809). The Caliph invited the son of chief physician, Jabril ibn Bukhtishu to head the new Baghdad bimaristan. It quickly achieved fame and led to the development of other hospitals in Baghdad.
As hospitals developed during the Islamic civilization, specific
characteristics were attained. Bimaristans were secular. They served all
people regardless of their race, religion, citizenship, or gender. The Waqf documents stated nobody was ever to be turned away. The ultimate goal of all physicians and hospital staff was to work together to help the well-being of their patients. There was no time limit a patient could spend as an inpatient; the Waqf documents stated the hospital was required to keep all patients until they were fully recovered. Men and women were admitted to separate but equally equipped wards.
The separate wards were further divided into mental disease, contagious
disease, non-contagious disease, surgery, medicine, and eye disease. Patients were attended to by same sex nurses and staff. Each hospital contained a lecture hall, kitchen, pharmacy, library, mosque and occasionally a chapel for Christian patients. Recreational materials and musicians were often employed to comfort and cheer patients up.
The hospital was not just a place to treat patients: it also served as a medical school to educate and train students.
Basic science preparation was learned through private tutors,
self-study and lectures. Islamic hospitals were the first to keep
written records of patients and their medical treatment.
Students were responsible in keeping these patient records, which were
later edited by doctors and referenced in future treatments.
During this era, physician licensure became mandatory in the Abbasid Caliphate. In 931 AD, Caliph Al-Muqtadir learned of the death of one of his subjects as a result of a physician's error. He immediately ordered his muhtasibSinan ibn Thabit to examine and prevent doctors from practicing until they passed an examination. From this time on, licensing exams were required and only qualified physicians were allowed to practice medicine.
Medical Education
Medieval
Islamic cultures had different avenues for teaching medicine prior to
having regulated standardized institutes. Like learning in other fields
at the time, many aspiring physicians learnt from family and
apprenticeship until majlises, hospital training, and eventually,
madrasahs became used. There are a few instances of self-education like
Ibn Sīnā, but students would have generally been taught by a physician
knowledgable on theory and practice. Pupils would typically find a
teacher that was related, or unrelated, which generally came at the cost
of a fee. Those who were apprenticed by their relatives sometimes led
to famous genealogies of physicians. The Bukhtīshū family is famous for working for the Baghdad caliphs for almost three centuries.
Before the turn of the millennium, hospitals became a popular
center for medical education, where students would be trained directly
under a practicing physician. Outside of the hospital, physicians would
teach students in lectures, or "majlises," at mosques, palaces, or
public gathering places. Al-Dakhwār became famous throughout Damascus for his majlises and was eventually oversaw all of the physicians in Egypt and Syria.
He would go on to become the first to establish what would be described
as a "medical school" in that its teaching focused solely on on
medicine, unlike other schools who mainly taught fiqh. It was opened in
Damascus on 12 January 1231 and is on record to have existed at least
until 1417. This followed general trends of the institutionalization of
all types of education. Even with the existence of the madrasah, pupils
and teachers alike often engaged in some variety of all forms of
education. Students would typically study on their own, listen to
teachers in majlis, work under them in hospitals, and finally study in
madrasah's upon their creation. This all eventually led to the standardization and vetting process of medical education.
Pharmacy
The birth of pharmacy
as an independent, well-defined profession was established in the early
ninth century by Muslim scholars. Islamic pharmacological tradition was
a result of Mesopotamian intellectual centers that supported the
exchange of ideas. Indian and far east influences made their way into
Mesopotamia by trade routes. Mesopotamia encompasses most of present day
Iraq, which later became the Sasanian empire. Persians preserved Greek
ideas that trickled down into Islamic pharmacology. Pharmacology in
Islmaicate empires was characterized by all substances applied to the
human body. Drugs, foods, beverages, cosmetics, and perfumes were all
used for their medicinal properties. Drugs consisted of plant-derived
substances that originated in various regions of Asia. Pharmacological
agents were employed as treatments based on their effectiveness at
maintaining the human body's equilibrium. The Greek physician
Hippocrates is credited for categorizing sickness as an imbalance of the
abstract qualities cold, hot, dry, and moist. A diet was proscribed as
treatment for the imbalance to restore equilibrium.
Al-Biruni
states that "pharmacy became independent from medicine as language and
syntax are separate from composition, the knowledge of prosody from
poetry, and logic from philosophy, for it [pharmacy] is an aid [to
medicine] rather than a servant". Sabur Ibn Sahl was a physician (d.
869) who wrote the first text on pharmacy in his book Aqrabadhin al-Kabir. Heavily influenced by Dioscorides, it is believed that his book was written some believe it was written after Dioscorides' Materia Medica.
The acclaimed Greek herbalist Dioscorides worked alongside Greek
physician Galen to categorize pharmacological agents. The Andalusian
physician Ibn Juljul systematized substances from India, Southeast Asia,
or Indian ocean lands. The categorizing of substances was further
organized based on their transmission into the Islamicate empire. The
origins consisted of Greek, Indian, or Iranian origination. The
knowledge of the substances' medicinal properties were result of
pre-Islamic Sasanian empire and the pyro-Persian culture that emphasized
pharmacological pursuits. Islamicate pharmacy achieved the
implementation of a systematic method of identifying substances based
off of their medicinal attributes. In addition, Sabur also wrote three
other books A Refutation of Hunayn's Book on the Difference Between Diet and the Laxative Medicine; A Treatise on Sleep and Wakefulness; and Subsitution of one Drug for Another. Although his works was not enforced by the government authorities, they was widely accepted in the medical circles. The branch of pharmacology was a result of continuity and expansion of pre-existing civilizations.
During the medieval time period Hippocratic treatises became used
widespread by medieval physicians, due to the treatises practical form
as well as their accessibility for medieval practicing physicians. Hippocratic treatises of Gynecology and Obstetrics were commonly referred to by Muslim clinicians when discussing female diseases.
The Hippocratic authors associated women's general and reproductive
health and organs and functions that were believed to have no
counterparts in the male body.
Beliefs
The Hippocratics blamed the womb for many of the women's health problems, such as schizophrenia.
They described the womb as an independent creature inside the female
body; and, when the womb was not fixed in place by pregnancy, the womb
which craves moisture, was believed to move to moist body organs such as
the liver, heart, and brain.
The movement of the womb was assumed to cause many health conditions,
most particularly that of menstruation was also considered essential for
maintaining women's general health.
Many beliefs regarding women's bodies and their health in the
Islamic context can be found in the religious literature known as
"medicine of the prophet." These texts suggested that men stay away
from women during their menstrual periods, “for this blood is corrupt
blood,” and could actually harm those who come in contact with it.
Much advice was given with respect to the proper diet to encourage
female health and in particular fertility. For example: quince makes a
woman's heart tender and better; incense will result in the woman giving
birth to a male; the consumption of water melons while pregnant will
increase the chance the child is of good character and countenance;
dates should be eaten both before childbirth to encourage the bearing of
sons and afterwards to aid the woman's recovery; parsley and the fruit
of the palm tree stimulates sexual intercourse; asparagus eases the pain
of labor; and eating the udder of an animal increases lactation in
women.
In addition to being viewed as a religiously significant activity,
sexual activity was considered healthy in moderation for both men and
women. However, the pain and medical risk associated with childbirth
was so respected that women who died while giving birth could be viewed
as martyrs.
The use of invocations to God, and prayers were also a part of
religious belief surrounding women's health, the most notable being
Muhammad's encounter with a slave-girl whose scabbed body he saw as
evidence of her possession by the Evil Eye. He recommended that the
girl and others possessed by the Eye use a specific invocation to God in
order to rid themselves of its debilitating effects on their spiritual
and physical health.
Sexual Intercourse and Conception
The lack of a menstrual cycle
in women was viewed as menstrual blood being "stuck" inside the woman
and the method for release of this menstrual blood was for the woman to
seek marriage or sexual intercourse with a male.
Among both healthy and sick women, it was generally believed that
sexual intercourse and giving birth to children were means of keeping
women from getting sick.
One of the conditions that lack of sexual intercourse was considered to
lead to is uterine suffocation in which it was believed there was
movement of the womb inside the woman's body and the cause of this
movement was attributed to be from the womb's desire for semen.
There was consensus among Arabic medical scholars that an excess
of heat, dryness, cold or moisture in the woman's uterus would lead to
the death of the fetus.
The Hippocratics believed more warmth in the woman leads to the woman
having a "better" color and leads to the production of a male offspring
while more coldness in the woman leads to her having an "uglier" color,
leading to her producing a female offspring.
Al-Razi is critical of this point of view, stating that it is possible
for a woman to be cold when she becomes pregnant with a female fetus,
then for that woman to improve her condition and become warm again,
leading to the woman possessing warmth but still having a female fetus.
Al-Razi concludes that masculinity and femininity are not dependent on
warmth as many of his fellow scholars have proclaimed, but instead
dependent on the availability of one type of seed.
Infertility
Infertility was viewed as an illness, one that could be cured if the proper steps were taken.
Unlike the easement of pain, infertility was not an issue that relied
on the patient's subjective feeling. A successful treatment for
infertility could be observed with the delivery of a child.
Therefore, this allowed the failures of unsuccessful methods for
infertility treatment to be explained objectively by Arab medical
experts.
The treatment for infertility by Arab medical experts often depends on the type of conception theory they follow.
The two-seed theory states that female sexual pleasure needs to be
maximized in order to ensure the secretion of more seeds and thus
maximize the chances of conception. Ibn Sina recommends that men need to try to enlarge their penises or to narrow the woman's vagina in order to increase the woman's sexual pleasure and thus increase the chance of producing an offspring. Another theory of conception, the "seed and soil" model, states that the sperm is the only gamete and the role of the woman's body is purely for nourishment of the embryo. Treatments used by followers of this method often include treating infertile women with substances that are similar to fertilizer. One example of such a treatment is the insertion of fig juice into the womb. The recipe for fig juice includes substances that have been used as agricultural fertilizer.
Miscarriage
Al-Tabari, inspired by Hippocrates, believes that miscarriage
can be caused by physical or psychological experiences that causes a
woman to behave in a way that causes the bumping of the embryo,
sometimes leading to its death depending on what stage of pregnancy the
woman is currently in.
He believed that during the beginning stages of pregnancy, the fetus
can be ejected very easily and is akin to an "unripe fruit".
In later stages of pregnancy, the fetus is more similar to a "ripe
fruit" where it is not easily ejected by simple environmental factors
such as wind.
Some of the physical and psychological factors that can lead a woman to
miscarry are damage to the breast, severe shock, exhaustion, and diarrhea.
Contraception
While
the belief that carrying children and childbirth was very important and
healing part of the Islamic culture, many medical scholars also
recognize the importance of population control, primarily through contraceptives and abortion.
The use of contraceptives and abortion as opposed to abstinence, in
terms of population control, was preferred due to the belief in the
tremendous healing properties brought by sexual intercourse.
The topic of contraceptives and abortion had been very controversial
throughout the western world; however, in the Islamic culture, due to
the ties between women's reproductive health and one's overall
well-being, medieval Muslim physicians devoted time and research into
recording and testing different theories in this field.
Prior to the development and research into safe contraceptives in order to prevent pregnancy, the concept of 'inducedmiscarriages'
grew popular. This was the act of intentionally causing a miscarriage
in the very early stages of pregnancy, though medical journals outlined a
variety of methods, this was usually achieved through the consumption
of plant derived substances.
Medical journals and other literature from this time show an extensive
and detailled list of a variety of different drugs and plant derived
substances that supposedly have abortifacient
qualities. Many of these substances were later laboratory tested and
found to be correctly identified in their ability to induce a
miscarriage. While some of these early texts did recommend a woman get
an abortion during early stages, it was clear that it was a dangerous
and potentially fatal procedure for the mother, causing a greater
reliance on the safer alternative techniques and substances these texts
also provided.
Further development in this field led to the introduction of
contraceptives that would prevent one's need to induce a miscarriage.
Many religious scholars and medieval physicians of the time agreed on the importance of contraceptive alternatives due to the legal rights of women. This was due to the belief that "early withdrawal impinged upon [the woman's] rights ... to enjoy full satisfaction".
Commencing more research into possible contraceptives. The data from
this research made its way into the previously mentioned medical
journals, already containing a list of abortifacients, providing a great
variety of drugs and other prescribed substances for use as a
contraceptive. The lists of drugs and other substances in these journals became widely accessible to be utilized by the public.
The great availability and accessibility of these medical texts
and the depth of research shown by the data shows that contraceptives
and abortions, surgical or not, were frequently sought after by women of
this time.
While there may be a variety of reasons women would require these
resources, whether connected to population control or personal reasons,
it is clear that the Islamic culture not only incorporated, but brought
about positive connotations in regards to women's reproductive health.
During a period in which men dominated medicine, the almost immediate
inclusion of women's reproductive health in medical texts, along with a
variety of different techniques and contraceptive substances, long
before the development of 'the pill', reinforces the cultural belief that men and women were to be viewed as equals, in regards to sexual health.
Roles
It has been
written that male guardians such as fathers and husbands did not
consent to their wives or daughters being examined by male practitioners
unless absolutely necessary in life or death circumstances.
The male guardians would just as soon treat their women themselves or
have them be seen by female practitioners for the sake of privacy.
The women similarly felt the same way; such is the case with pregnancy
and the accompanying processes such as child birth and breastfeeding,
which were solely reliant upon advice given by other women.
The role of women as practitioners appears in a number of works despite
the male dominance within the medical field. Two female physicians from
Ibn Zuhr's family served the Almohad ruler Abu Yusuf Ya'qub al-Mansur in the 12th century. Later in the 15th century, female surgeons were illustrated for the first time in Şerafeddin Sabuncuoğlu's Cerrahiyyetu'l-Haniyye (Imperial Surgery). Treatment provided to women by men was justified to some by prophetic medicine
(al-tibba alnabawi), otherwise known as "medicine of the prophet" (tibb
al-nabi), which provided the argument that men can treat women, and
women men, even if this means they must expose the patient's genitals in
necessary circumstances.
Female doctors, midwives, and wet nurses have all been mentioned in literature of the time period.
A hospital and medical training center existed at Gundeshapur. The city of Gundeshapur was founded in 271 by the Sassanid king Shapur I. It was one of the major cities in Khuzestan province of the Persian empire in what is today Iran. A large percentage of the population were Syriacs, most of whom were Christians. Under the rule of Khosrau I, refuge was granted to GreekNestorian Christian philosophers including the scholars of the Persian School of Edessa (Urfa)(also called the Academy of Athens), a Christian
theological and medical university. These scholars made their way to
Gundeshapur in 529 following the closing of the academy by Emperor
Justinian. They were engaged in medical sciences and initiated the first
translation projects of medical texts. The arrival of these medical practitioners from Edessa marks the beginning of the hospital and medical center at Gundeshapur.
It included a medical school and hospital (bimaristan), a pharmacology
laboratory, a translation house, a library and an observatory.
Indian doctors also contributed to the school at Gundeshapur, most
notably the medical researcher Mankah. Later after Islamic invasion, the
writings of Mankah and of the Indian doctor Sustura were translated
into Arabic at Baghdad. Daud al-Antaki was one of the last generation of influential Arab Christian writers.
The cooperation that occurred during the Abbasid empire in 750
A.D rested on the engagement between Nestorian Christians from the
Byzantine empire and the Abbasid ruling elite. Nestorian christians from
the Byzantine empire escaped persecution and opposition to scientific
advancements to receive financial support from the ruling elite of the
Byzantine empire. The Greek texts of Galen were introduced by Christians
and translated into Arabic for Islamic scholars and physicians to make
commentaries. With the emerging combined civilizations, the caliphs of
the Abbasid empire were eager to gain knowledge from the pre-existing
societies. The Byzantine empire depicted a modernized society that
engaged in medical and pharmacological pursuits. The less oppressive
Islamic view of Greek secular knowledge promoted the cooperation between
Nestorian Christians and the Islamic empire. The
Abbasid caliph al-Ma’mun was credited for promoting the translation of
Greek texts, which accelerated the solidification of medicine in the
Islamicate empires. The cooperation from the Nestorian Christians was
enabled by the lack of conflict associated with the subject of medicine.
Christians and Muslims were able to collaborate without religious
conflicts arising. Greek and Syriac texts were translated into Arabic as
the Hellenic period of scientific pursuit transitioned into the Islamic
empire. One of the most acclaimed translators of the Islamicate empires
was a Nestorian Christian, Hunnayn b. Ishaq, who was well versed in
Syriac, Greek, Arabic, and medical training. Hunnayn’s translations were
mainly works of the Greek physician Galen. Ultimately, Hunnayn is
credited for establishing a successful systematic method of translation
for scientific texts.
Legacy
Medieval
Islam's receptiveness to new ideas and heritages helped it make major
advances in medicine during this time, adding to earlier medical ideas
and techniques, expanding the development of the health sciences and
corresponding institutions, and advancing medical knowledge in areas
such as surgery and understanding of the human body, although many
Western scholars have not fully acknowledged its influence (independent
of Roman and Greek influence) on the development of medicine.
Through the establishment and development of hospitals, ancient
Islamic physicians were able to provide more intrinsic operations to
cure patients, such as in the area of ophthalmology. This allowed for
medical practices to be expanded and developed for future reference.
The contributions of the two major Muslim philosophers and physicians, Al-Razi and Ibn Sina,
provided a lasting impact on Muslim medicine. Through their compilation
of knowledge into medical books they each had a major influence on the
education and filtration of medical knowledge in Islamic culture.
Additionally there were some iconic contributions made by women
during this time, such as the documentation: of female doctors,
physicians, surgeons, wet nurses, and midwives.
