Greece to Islam: The Transmission of Medical Knowledge
This essay addresses the question ‘Islamic scholars added little to the sum of medical knowledge: they simply passed on Greek medical ideas to later generations.’ Do you agree with this statement?
In this day and age we receive knowledge in a variety of forms that we take for granted, radio television, books, newspapers, the Internet etc.. Most of the time we don’t even think about how this information reaches us, how and where it is published, how journalists translate the technical language for the understanding of the layman, or how the knowledge is translated into other languages and disseminated around the world. The transmission of knowledge is a complex business, and was a much slower and more involved process before the age of mass communication. What actually happened in the past? How did information/knowledge travel in the days before radio, television, the internet etc.? One might assume that in the pre mass communication days that information/knowledge travelled neither very far nor very fast. However, around a thousand years ago ideas about the workings of the body, and disease, made an amazing journey from Ancient Greece, via the Middle East, to Europe. This migration of ideas was promulgated through the written word, texts which were translated from Greek into Arabic, and later into Latin. I plan to explore this journey, this migration of medical theories/knowledge, to begin to understand why these texts were so important, why they were translated, and whether or not the canon of medical knowledge contained within them was in any way changed, developed or extended during this migration. The starting point has to be a basic understanding of medicine in the Greek world. Between the fifth century BC and the third century AD many scholars/practitioners formulated theories about the ways in which the body works - the most influential of which was promulgated by Hippocrates (Wiki 1). These Hippocratic theories were much expanded by later scholars, the most important of whom was Galen of Pergamum 129-210AD (Wiki 2). These ‘Hellenistic’ ideas spread East into the lands conquered by Alexander, parts of the modern day Middle East, including Syria and Egypt, and even to the borders of India.
The Greek understanding of the workings of the body and disease was very different from our modern understanding of such things. Today we know all about the way in which the skeleton houses the many different organs that perform the daily functions that keep us alive, and how they sometimes break down with all of the attendant consequences. We are used to thinking of diseases affecting different parts of the body - we suffer from headaches, we have a heart attack or a stroke. Whilst Ancient Greek practitioners had knowledge of anatomy, they did not have our understanding of how disease affected the individual parts, they believed that the most important constituents of the body were fluids, or humours. This humoral theory came about from observation and reason - the application of natural philosophy - applied to the four humours, blood, yellow bile, black bile and phlegm. The observation that when someone was ill the body expelled liquids, in the form of vomiting, diarrhoea, a runny nose etc. led to the reasoning that the humours were no longer in balance, hence the illness. They also reasoned that the humours related to the four fundamental elements, earth, air, fire and water, leading to the notion of hot, cold, wet or dry humours. This led to the thinking that a healthy body was one in which the humours were in balance. Hippocrates thought that this balance depended on various factors, and was easily disrupted by a bad diet, lack of exercise, too much exercise, overwork, the varying seasons etc.
if there be rains in autumn; if the winter be mild, neither very tepid nor unseasonably cold, and if in spring the rains be seasonable, and so also in summer, the year is likely to prove healthy. But if the winter be dry and northerly, and the spring showery and southerly, the summer will necessarily be of a febrile character, and give rise to ophthalmies and dysenteries. For when suffocating heat sets in all of a sudden, while the earth is moistened by the vernal showers, and by the south wind, the heat is necessarily doubled from the earth, which is thus soaked by rain and heated by a burning sun, while, at the same time, men’s bellies are not in an orderly state, nor the brain properly dried; for it is impossible, after such a spring, but that the body and its flesh must be loaded with humors, so that very acute fevers will attack all, but especially those of a phlegmatic constitution
Hippocrates, c.400BC
Hippocrates linked certain diseases to the seasons, for example spring weather caused an increase in blood flow leading to a predisposition to people suffering from fevers. This is just a short and very basic understanding of the Greek ideas of humoral medicine, not the subject of this essay, but necessary for the basis of it. The key characteristic being that it was a systematic approach, humours explain both health and disease following a logical set of rules, and a rational approach in the realisation that most diseases are of natural rather than supernatural origin.
From the seventh century AD Greek theories of humoral medicine spread further afield, and came to be adopted in the Islamic world. A dynamic, dominant culture flourished from the early seventh century under the prophet Muhammad, and his followers. Most of the Middle East was unified under Muslim rulers by the end of the seventh century, with Egypt, north-west Africa, Iran and parts of Spain by the eighth century. This was a period of great economic growth. Islamic rulers, their courtiers and traders became wealthy and powerful. Towns and cities expanded, and the capital of the Islamic world was relocated from Damascus to Baghdad, which became a cultural melting pot attracting traders and scholars from across the world. Not only did these military conquests spread the Arabic language across vast areas of the planet, but it also brought Islamic scholars into direct contact with the Hellenistic world, Greek ideas and the Greek language. Between the eighth and eleventh centuries huge numbers of Greek texts, works on mathematics, philosophy and medicine, were translated into Arabic. Extremely large numbers of medical manuscripts were translated, especially those of Hippocrates and Galen. Many scholars worked on translations, perhaps the most famous being Hunyan ibn Ishaq (Wiki 3), who, with a band of helpers, translated over a hundred works by Galen, as well as other texts by Greek authors, notably Hippocrates and Rufus of Ephesus (Wiki 4). These translations covered the range of medical knowledge of the time - the functions of the body, specific diseases, drugs and medical treatments.
The process of translation from Greek to Arabic was a complex one, especially given that it often proved difficult to find a complete text of a medical work in some cases. Many of these texts existed as manuscripts, and were scattered in libraries throughout the Middle East and Egypt, and most of them had been copied and recopied by hand for hundreds of years. Given the lengthy process of translation, even for specialist scribes and copyists it took a long time to translate/copy a manuscript. Unsurprisingly practitioners didn’t always want to pay for the copying of a whole text, and may just commission a scribe to reproduce some parts of an original, or even ask for extracts from several manuscripts to be brought together in one book. The fact that pages could go missing, even be destroyed, resulted in the problem that texts could exist in many different forms. Very few people were able to translate from the Greek - once the language of scholars throughout the Hellenic and Roman worlds, but in decline - to Arabic. Syriac speaking Christians dominated the translation process as they possessed the rare combination of necessary language skills. Hunyan and his collaborators were well placed to translate as they had a good knowledge of Greek, they came from a culture in which many Greek texts had been translated into Syriac. The Syriac and Arabic languages being closely related made it a quite simple task to translate the one into the other.
That is not to say that they didn’t encounter problems, particularly in translating medical texts. When translating medical texts it is particularly important to ensure that information about diseases, drugs etc. are accurately transmitted. Translators found ways around the problem of where there was no Arabic word for particular Greek words using the process of transliteration to produce new Arabic words. This process involves translating the letters of one alphabet into another - in this case from Greek to Arabic - to produce the new words. For example, the Greek word ‘lethargos’ became ‘litharghus’. Some terms were translated by the use of similar words, the Greek term of epilepsy, known to the Greeks as ‘the sacred disease’ because it was believed to be sent by the gods, became ‘al-marad al-ilahi’ (‘the divine disease’) in Arabic. Even though Islamic scholars endeavoured to produce the best translations possible it was inevitable that errors would creep in, especially when unfamiliar terms were being repeatedly copied. Even so the Islamic scholars developed their translation skills becoming much more sophisticated with the passage of time. Whilst the translators went to great lengths to ensure that their translations were accurate, some changes were inevitable due to religious differences. References to the Greek gods were routinely replaced with Allah, and remedies requiring the use of alcohol or any product derived from pigs (both of which are forbidden in the Qur’an) were not included in the Islamic pharmacy.
The interesting question is about why Islamic scholars devoted so much time to the translation of Greek medical texts. The temptation is to say that it was because there was no medicine practised in the Islamic world, and that these theories of medicine were needed. But, there is evidence that there were many remedies for various ailments in the pre-eighth century Islamic world. The practitioners were able to treat many common ailments with cures that had, probably, been arrived at through the process of trial and error. The translations gave practitioners access to much more sophisticated systems, such as the theories of humoral medicine. Previously Islamic remedies had been based on the use of plants and animal products such as urine and milk. Other common methods were bloodletting and simple surgical procedures to deal with wounds and the lancing of boils etc.. Given that some illnesses were thought to have a supernatural origin magic was also employed in the form of charms or amulets worn to either cure or prevent ailments caused by malicious spirits - commonly called ‘jinns’ or ‘the evil eye’.
Until the middle of the twentieth century the accepted thinking among historians was that Islamic translators were simply passing on Greek theories of medicine to later generations, but making very few innovations/developments of their own. This has since been proven to be quite wrong. Unquestionably Islamic authors did not attempt to revise the theories of humoral medicine, after all these theories explained all aspects of bodily function in a systematic way. It can be argued that it would be difficult to understand how one part of the theory could be changed without requiring serious revisions of all of the other parts. The translations, mentioned above, provided the foundation for a distinct culture of Islamic medicine, a foundation which continued and built upon Greek theories. These theories were held in such high esteem that translators faithfully translated the names of plants, animals or minerals that were not to be found in Arab speaking lands. In a work on poisons the names of snakes were translated, even though no patient of an Islamic practitioner would be likely to suffer a bite from one, this rendered advice on how to treat such snake bites quite useless.
The adoption of Greek medical theory across the Islamic world - from Spain to the borders of India - made it possible for practitioners to develop new ideas and observations within this established framework. Islamic practitioners added new treatments, where the pharmacopeia (Wiki 5) by Dioscorides (Wiki 6) listed 850 drugs, Islamic pharmacopeias listed over 3000 items including new medicines such as camphor, musk and senna. Such new medicines and drugs were sold in special shops - what today I guess we would call a pharmacy. New drugs, that were not used in Greek medicine, were developed and adapted into the humoral system by categorising them by their qualities - such as whether they were hot, wet, cold or drying. From the humoral qualities practitioners could easily work out how to use these new medicines/drugs. Not only did Islamic pharmacists develop new medicines/drugs, they also developed new techniques, such as filtration, distillation and other chemical techniques, to purify and combine them. Various texts show that where Greek authors laid emphasis on diet and lifestyle changes to treat diseases Islamic scholars placed a greater emphasis on drugs. Records of the treatment of patients by Abu Bakr Muhammad ibn Zakariyya al-Razi (Rhazes in Latin) (Wiki 7) seem to suggest that he used a limited number of tried and tested drugs in most cases.
Al-Razi is often referred to as the father of Islamic medicine, and probably not without good reason. He was the first practitioner to chronicle the symptoms and causes of smallpox, and to make the differentiation between it and measles, along with other observations
Al-Razi was apparently the first to attribute hay fever to the smell of roses at springtime in his manual on coryza (rhinitis). Stones of the kidney and bladder, small pox and measles were some of the specific diseases on which he wrote extensively. He also described the valves of the heart.
Lakhtakia, 2014
Although such ideas and observations were relatively new Al-Razi based them on the humoral theory of the body and disease, using the theory to explain why people only caught smallpox once. Being a disease that was predominantly caught by children he theorised that smallpox was caused by impure blood in children from birth, and that at some point the blood started to ferment. He thought that the body would then begin to expel this bad matter which would appear as spots on the skin. His reasoning was that once the bad blood had been expelled the individual could not catch smallpox again. His reasoning that someone could only catch smallpox once was right is some respects, we now know that once an individual has been exposed to smallpox the body builds an immunity to the virus.
The second renowned Islamic scholar was Ibn Sina (Wiki 8) (Avicenna in Latin) was a prolific writer covering a wide range of topics, philosophy, religion, medicine, astronomy and natural sciences. One of his most famous works was Qanun fil Tibb, the Canon of Medicine (Wiki 9) which remained the authoritative text for centuries setting the standards for medieval medicine and was the standard textbook throughout eighteenth century Europe. The Canon is a massive work comprising of five volumes which contain around a million words. Book one contains the knowledge required to practice medicine – medical theory, the causes of diseases, hygiene, treatments and surgery. Book two deals with simple drugs, ands those substances that could be used as remedies. Book three concentrates on a comprehensive account of diseases of individual parts of the body, starting with those which affect the head and moving down the body, ending with those that affect the feet. Book four deals with diseases which affect the body as a whole, such as fevers. Book five covers compound drugs and their usage. Though a very long work it became a very practical and comprehensive book of reference for the practitioner who wished to know more about any particular ailment and its treatment. In this way scholars such as Al-Razi and Ibn Sina brought a more systematic approach to Greek theories, presenting them in a far more coherent way, at the same time extending the knowledge of diseases, and the usage of new drugs.
The eleventh century saw a further migration of medical knowledge as texts were further translated from Arabic and Greek into Latin and spread across Europe. There are many similarities, and some marked differences, in these migrations. There is the context in which the movements took place. Just as the Islamic scholars came into contact with Greek ideas during the expansion of Islamic rule, so to the reconquest of part of Europe brought Christians into contact with Islamic ideas. From the eleventh century parts of Spain, Southern Italy, Sardinia and Sicily which had been under Islamic rule were conquered/reconquered. Strangely the Crusades seem to have had no major impact on the exchange of knowledge between the Middle East and Europe. Translations, into Latin, of many works across many subjects were made in these contact areas, particularly in Toledo, Puglia and Palermo. The practical reasons for this was that there were large numbers of Muslim and Jewish scholars with a good knowledge of Arabic and Hebrew, along with Christian scholars. Clerics and administrators with their knowledge of Latin. Just as in Baghdad centuries before these Muslims, Jews and Christians pooled their combined knowledge of languages to produce accurate translations of Greek texts.
However, as previously discussed, having access to such a plethora of texts does not explain why scholars would take the time and trouble to translate them from Arabic into Latin. It can be argued that similar social and political factors to those that drove the move to translation in the Middle East were also at work in medieval Europe. The whole region was experiencing a period of economic growth with increasing population, expanding towns and cities and flourishing trade. Alongside this the number of schools and universities was growing to supply a new generation of skilled workers for literate occupations, including medicine. There was a growing interest in intellectual matters, bringing with it a strong desire to rediscover Greek knowledge, Arabic philosophy and science. In this context there was a social elite - princes, clerics, practitioners etc - who were prepared to pay scholars to make translations of Arabic texts on medicine, mathematics and science.
European translators, like Islamic scholars before them, faced the same problems of translation, often there were no Latin words for Arabic terms. So they used the same techniques as a solution to the problem, and resorted to transliteration, as had Islamic scholars before them when translating from Greek to Arabic. Also as Islamic scholars had changed gods to Allah, Christian translators removed all references to Allah, and put a particular Christian gloss on the understanding of the four humours and linked them to the four evangelists Matthew, Mark, Luke and John. Inevitably translation from Arabic to Latin, and the devising of new terms for diseases and drugs, led to confusions and inaccuracies - as we have already seen was the case in translating from Greek to Arabic. Also this problem was exacerbated by errors which crept in due to the repeated copying of manuscripts. The illustrations of surgical instruments in Arabic texts originally were accurate representations of the devices, but copyists did not understand the devices, or their functions, and made them a basis for decoration of the texts, thus rendering the drawings totally useless as a record of the instruments used. However there are two striking differences between such translations into Arabic, and from Arabic to Latin. First European scholars were privilege to a richer medical tradition that there Islamic counterparts had been. European scholars translated Arabic translations of Greek authors - notably Galen - and some texts written in Greek. Second, where Islamic scholars seem to have worked relentlessly at their translations in Europe the translations were done in a series of stages.
The first phase of translation took place during the eleventh century, and was centred on the monastery at Monte Cassino and the monk Constantine Africanus (Wiki 10). He was responsible for the translations of works by both Arabic and Greek authors, including a number of texts by Galen. He also translated Kitab Kamil al-sina ah al tibbiyah (Wiki 11) by Ali ibn al-abbas al- Majusi (Wiki 12).The title of this book translates into English as The Complete Book of the Medical Art, and was Pantegni in Latin - meaning The Universal Art. When translated from the Arabic many Islamic authors were turned into the Latin form, hence Ali ibn al-abbas al- Majusi became Haly Abbas. Among the translations by Constantine were works by Ibn al-Jazzar (Wiki 13) and Hunyan ibn Ishaq. The second phase of translation was during the twelfth century, and is associated with Gerard of Cremona (Wiki 14) working in Toledo (Wiki 15). Whereas Constantine had focused his efforts on works of medical theory Gerard and his assistants concentrated on compendia by Islamic authors. Works such as al-Razi’s Kitab al-mansuri fi l-tibb (The Mansurian book of Medicine), Ibn Sina’s Canon, and surgical sections from Abu al-Qasim’s (known in Europe as Albucasis) (Wiki 16) Al-Tasrif. A century later there translations from the original Greek and Arabic were carried out when the remaining important works by Galen, al-Razi and Ibn Rushd (Known as Averroes) (Wiki 17) were translated.
Later in medieval Europe these texts went through a further period of translation when they were translated from Latin into vernacular languages. During the medieval period only highly educated people spoke and read Latin, whilst everyone else spoke vernacular languages (sometimes dialects) - the language spoken by the native people of a particular area/country. As literacy increased many more people could read the vernacular than could read Latin, therefore translation into the vernacular brought these texts to a much wider readership. The result being that practitioners began not only to translate these Latin texts, but also began to write their own texts in the vernacular languages. A further transformation came with the invention of printing in the mid fifteenth century, making it so much easier, and cheaper, to produce books, books that began to circulate in ever greater numbers.
In conclusion, Greek theories of medicine later enhanced by Islamic scholars, and followed by European scholars, remained the fundamental understanding of bodily function, disease and therapy right up to the eighteenth century. Humoral theories were not a set of static ideas, but were a foundation providing a flexible set of tools to explain aspects of health and disease. These theories, when adopted into new cultures, were repeatedly refreshed and revised by new practitioners. This constant revision and enhancement gives the lie to the idea that Islamic scholars simply took Greek medicine and ‘passed it on’, they were responsible for a whole range of ways in which the Greek theories were extended and improved upon. Scholars like Al-Razi, Ibn-Sina, and Ibn Al-Nafis not only to adopted Greek theories, but also to extended them through their own philosophical studies and their own experiments. Their understanding, and adoption, of Greek theories of humoral medicine led to a largely forgotten renaissance in medical culture. This ‘renaissance’ led such scholars to create a strong culture of medicine which spread across Europe, ranging from Baghdad to Toledo, with the Islamic incursions, a culture that came to us through later translations into Latin. These Latin translations formed the basis of medical thinking in the seventeenth century, and thus have been developed further with more modern techniques. So, while it would be easy to take the given statement at face value it is not difficult to discover enough facts to enable one to disagree with it, and to highlight the reality of a widely forgotten and neglected Islamic renaissance.
Sources
Wiki 1 - https://en.wikipedia.org/wiki/Hippocrates
Wiki 2 - https://en.wikipedia.org/wiki/Galen
Hippocrates, c.400BC, On Airs, Waters, and Places, https://ebooks.adelaide.edu.au/h/hippocrates/airs/index.html
Wiki 3 - https://en.wikipedia.org/wiki/Hunayn_ibn_Ishaq
Wiki 4 - https://en.wikipedia.org/wiki/Rufus_of_Ephesus
Wiki 5 - https://en.wikipedia.org/wiki/De_Materia_Medica
Wiki 6 - https://en.wikipedia.org/wiki/Pedanius_Dioscorides
Wiki 7 - https://en.wikipedia.org/wiki/Muhammad_ibn_Zakariya_al-Razi
Ritu Lakhtakia, 2014, A Trio of Exemplars of Medieval Islamic Medicine: Al-Razi, Avicenna and Ibn Al-Nafis, https://www.ncbi.nlm.nih.gov/pubmed/25364546/
Wiki 8 - https://en.wikipedia.org/wiki/Avicenna
Wiki 9 - https://en.wikipedia.org/wiki/The_Canon_of_Medicine
Wiki 10 - https://en.wikipedia.org/wiki/Constantine_the_African
Wiki 11 - https://en.wikipedia.org/wiki/The_Complete_Book_of_the_Medical_Art
Wiki 12 - https://en.wikipedia.org/wiki/%27Ali_ibn_al-%27Abbas_al-Majusi
Wiki 13 - https://en.wikipedia.org/wiki/Ibn_al-Jazzar
Wiki 14 - https://en.wikipedia.org/wiki/Gerard_of_Cremona
Wiki 15 - https://en.wikipedia.org/wiki/Toledo,_Spain
Wiki 16 - https://en.wikipedia.org/wiki/Al-Zahrawi
Wiki 17 - https://en.wikipedia.org/wiki/Averroes
In this day and age we receive knowledge in a variety of forms that we take for granted, radio television, books, newspapers, the Internet etc.. Most of the time we don’t even think about how this information reaches us, how and where it is published, how journalists translate the technical language for the understanding of the layman, or how the knowledge is translated into other languages and disseminated around the world. The transmission of knowledge is a complex business, and was a much slower and more involved process before the age of mass communication. What actually happened in the past? How did information/knowledge travel in the days before radio, television, the internet etc.? One might assume that in the pre mass communication days that information/knowledge travelled neither very far nor very fast. However, around a thousand years ago ideas about the workings of the body, and disease, made an amazing journey from Ancient Greece, via the Middle East, to Europe. This migration of ideas was promulgated through the written word, texts which were translated from Greek into Arabic, and later into Latin. I plan to explore this journey, this migration of medical theories/knowledge, to begin to understand why these texts were so important, why they were translated, and whether or not the canon of medical knowledge contained within them was in any way changed, developed or extended during this migration. The starting point has to be a basic understanding of medicine in the Greek world. Between the fifth century BC and the third century AD many scholars/practitioners formulated theories about the ways in which the body works - the most influential of which was promulgated by Hippocrates (Wiki 1). These Hippocratic theories were much expanded by later scholars, the most important of whom was Galen of Pergamum 129-210AD (Wiki 2). These ‘Hellenistic’ ideas spread East into the lands conquered by Alexander, parts of the modern day Middle East, including Syria and Egypt, and even to the borders of India.
The Greek understanding of the workings of the body and disease was very different from our modern understanding of such things. Today we know all about the way in which the skeleton houses the many different organs that perform the daily functions that keep us alive, and how they sometimes break down with all of the attendant consequences. We are used to thinking of diseases affecting different parts of the body - we suffer from headaches, we have a heart attack or a stroke. Whilst Ancient Greek practitioners had knowledge of anatomy, they did not have our understanding of how disease affected the individual parts, they believed that the most important constituents of the body were fluids, or humours. This humoral theory came about from observation and reason - the application of natural philosophy - applied to the four humours, blood, yellow bile, black bile and phlegm. The observation that when someone was ill the body expelled liquids, in the form of vomiting, diarrhoea, a runny nose etc. led to the reasoning that the humours were no longer in balance, hence the illness. They also reasoned that the humours related to the four fundamental elements, earth, air, fire and water, leading to the notion of hot, cold, wet or dry humours. This led to the thinking that a healthy body was one in which the humours were in balance. Hippocrates thought that this balance depended on various factors, and was easily disrupted by a bad diet, lack of exercise, too much exercise, overwork, the varying seasons etc.
if there be rains in autumn; if the winter be mild, neither very tepid nor unseasonably cold, and if in spring the rains be seasonable, and so also in summer, the year is likely to prove healthy. But if the winter be dry and northerly, and the spring showery and southerly, the summer will necessarily be of a febrile character, and give rise to ophthalmies and dysenteries. For when suffocating heat sets in all of a sudden, while the earth is moistened by the vernal showers, and by the south wind, the heat is necessarily doubled from the earth, which is thus soaked by rain and heated by a burning sun, while, at the same time, men’s bellies are not in an orderly state, nor the brain properly dried; for it is impossible, after such a spring, but that the body and its flesh must be loaded with humors, so that very acute fevers will attack all, but especially those of a phlegmatic constitution
Hippocrates, c.400BC
Hippocrates linked certain diseases to the seasons, for example spring weather caused an increase in blood flow leading to a predisposition to people suffering from fevers. This is just a short and very basic understanding of the Greek ideas of humoral medicine, not the subject of this essay, but necessary for the basis of it. The key characteristic being that it was a systematic approach, humours explain both health and disease following a logical set of rules, and a rational approach in the realisation that most diseases are of natural rather than supernatural origin.
From the seventh century AD Greek theories of humoral medicine spread further afield, and came to be adopted in the Islamic world. A dynamic, dominant culture flourished from the early seventh century under the prophet Muhammad, and his followers. Most of the Middle East was unified under Muslim rulers by the end of the seventh century, with Egypt, north-west Africa, Iran and parts of Spain by the eighth century. This was a period of great economic growth. Islamic rulers, their courtiers and traders became wealthy and powerful. Towns and cities expanded, and the capital of the Islamic world was relocated from Damascus to Baghdad, which became a cultural melting pot attracting traders and scholars from across the world. Not only did these military conquests spread the Arabic language across vast areas of the planet, but it also brought Islamic scholars into direct contact with the Hellenistic world, Greek ideas and the Greek language. Between the eighth and eleventh centuries huge numbers of Greek texts, works on mathematics, philosophy and medicine, were translated into Arabic. Extremely large numbers of medical manuscripts were translated, especially those of Hippocrates and Galen. Many scholars worked on translations, perhaps the most famous being Hunyan ibn Ishaq (Wiki 3), who, with a band of helpers, translated over a hundred works by Galen, as well as other texts by Greek authors, notably Hippocrates and Rufus of Ephesus (Wiki 4). These translations covered the range of medical knowledge of the time - the functions of the body, specific diseases, drugs and medical treatments.
The process of translation from Greek to Arabic was a complex one, especially given that it often proved difficult to find a complete text of a medical work in some cases. Many of these texts existed as manuscripts, and were scattered in libraries throughout the Middle East and Egypt, and most of them had been copied and recopied by hand for hundreds of years. Given the lengthy process of translation, even for specialist scribes and copyists it took a long time to translate/copy a manuscript. Unsurprisingly practitioners didn’t always want to pay for the copying of a whole text, and may just commission a scribe to reproduce some parts of an original, or even ask for extracts from several manuscripts to be brought together in one book. The fact that pages could go missing, even be destroyed, resulted in the problem that texts could exist in many different forms. Very few people were able to translate from the Greek - once the language of scholars throughout the Hellenic and Roman worlds, but in decline - to Arabic. Syriac speaking Christians dominated the translation process as they possessed the rare combination of necessary language skills. Hunyan and his collaborators were well placed to translate as they had a good knowledge of Greek, they came from a culture in which many Greek texts had been translated into Syriac. The Syriac and Arabic languages being closely related made it a quite simple task to translate the one into the other.
That is not to say that they didn’t encounter problems, particularly in translating medical texts. When translating medical texts it is particularly important to ensure that information about diseases, drugs etc. are accurately transmitted. Translators found ways around the problem of where there was no Arabic word for particular Greek words using the process of transliteration to produce new Arabic words. This process involves translating the letters of one alphabet into another - in this case from Greek to Arabic - to produce the new words. For example, the Greek word ‘lethargos’ became ‘litharghus’. Some terms were translated by the use of similar words, the Greek term of epilepsy, known to the Greeks as ‘the sacred disease’ because it was believed to be sent by the gods, became ‘al-marad al-ilahi’ (‘the divine disease’) in Arabic. Even though Islamic scholars endeavoured to produce the best translations possible it was inevitable that errors would creep in, especially when unfamiliar terms were being repeatedly copied. Even so the Islamic scholars developed their translation skills becoming much more sophisticated with the passage of time. Whilst the translators went to great lengths to ensure that their translations were accurate, some changes were inevitable due to religious differences. References to the Greek gods were routinely replaced with Allah, and remedies requiring the use of alcohol or any product derived from pigs (both of which are forbidden in the Qur’an) were not included in the Islamic pharmacy.
The interesting question is about why Islamic scholars devoted so much time to the translation of Greek medical texts. The temptation is to say that it was because there was no medicine practised in the Islamic world, and that these theories of medicine were needed. But, there is evidence that there were many remedies for various ailments in the pre-eighth century Islamic world. The practitioners were able to treat many common ailments with cures that had, probably, been arrived at through the process of trial and error. The translations gave practitioners access to much more sophisticated systems, such as the theories of humoral medicine. Previously Islamic remedies had been based on the use of plants and animal products such as urine and milk. Other common methods were bloodletting and simple surgical procedures to deal with wounds and the lancing of boils etc.. Given that some illnesses were thought to have a supernatural origin magic was also employed in the form of charms or amulets worn to either cure or prevent ailments caused by malicious spirits - commonly called ‘jinns’ or ‘the evil eye’.
Until the middle of the twentieth century the accepted thinking among historians was that Islamic translators were simply passing on Greek theories of medicine to later generations, but making very few innovations/developments of their own. This has since been proven to be quite wrong. Unquestionably Islamic authors did not attempt to revise the theories of humoral medicine, after all these theories explained all aspects of bodily function in a systematic way. It can be argued that it would be difficult to understand how one part of the theory could be changed without requiring serious revisions of all of the other parts. The translations, mentioned above, provided the foundation for a distinct culture of Islamic medicine, a foundation which continued and built upon Greek theories. These theories were held in such high esteem that translators faithfully translated the names of plants, animals or minerals that were not to be found in Arab speaking lands. In a work on poisons the names of snakes were translated, even though no patient of an Islamic practitioner would be likely to suffer a bite from one, this rendered advice on how to treat such snake bites quite useless.
The adoption of Greek medical theory across the Islamic world - from Spain to the borders of India - made it possible for practitioners to develop new ideas and observations within this established framework. Islamic practitioners added new treatments, where the pharmacopeia (Wiki 5) by Dioscorides (Wiki 6) listed 850 drugs, Islamic pharmacopeias listed over 3000 items including new medicines such as camphor, musk and senna. Such new medicines and drugs were sold in special shops - what today I guess we would call a pharmacy. New drugs, that were not used in Greek medicine, were developed and adapted into the humoral system by categorising them by their qualities - such as whether they were hot, wet, cold or drying. From the humoral qualities practitioners could easily work out how to use these new medicines/drugs. Not only did Islamic pharmacists develop new medicines/drugs, they also developed new techniques, such as filtration, distillation and other chemical techniques, to purify and combine them. Various texts show that where Greek authors laid emphasis on diet and lifestyle changes to treat diseases Islamic scholars placed a greater emphasis on drugs. Records of the treatment of patients by Abu Bakr Muhammad ibn Zakariyya al-Razi (Rhazes in Latin) (Wiki 7) seem to suggest that he used a limited number of tried and tested drugs in most cases.
Al-Razi is often referred to as the father of Islamic medicine, and probably not without good reason. He was the first practitioner to chronicle the symptoms and causes of smallpox, and to make the differentiation between it and measles, along with other observations
Al-Razi was apparently the first to attribute hay fever to the smell of roses at springtime in his manual on coryza (rhinitis). Stones of the kidney and bladder, small pox and measles were some of the specific diseases on which he wrote extensively. He also described the valves of the heart.
Lakhtakia, 2014
Although such ideas and observations were relatively new Al-Razi based them on the humoral theory of the body and disease, using the theory to explain why people only caught smallpox once. Being a disease that was predominantly caught by children he theorised that smallpox was caused by impure blood in children from birth, and that at some point the blood started to ferment. He thought that the body would then begin to expel this bad matter which would appear as spots on the skin. His reasoning was that once the bad blood had been expelled the individual could not catch smallpox again. His reasoning that someone could only catch smallpox once was right is some respects, we now know that once an individual has been exposed to smallpox the body builds an immunity to the virus.
The second renowned Islamic scholar was Ibn Sina (Wiki 8) (Avicenna in Latin) was a prolific writer covering a wide range of topics, philosophy, religion, medicine, astronomy and natural sciences. One of his most famous works was Qanun fil Tibb, the Canon of Medicine (Wiki 9) which remained the authoritative text for centuries setting the standards for medieval medicine and was the standard textbook throughout eighteenth century Europe. The Canon is a massive work comprising of five volumes which contain around a million words. Book one contains the knowledge required to practice medicine – medical theory, the causes of diseases, hygiene, treatments and surgery. Book two deals with simple drugs, ands those substances that could be used as remedies. Book three concentrates on a comprehensive account of diseases of individual parts of the body, starting with those which affect the head and moving down the body, ending with those that affect the feet. Book four deals with diseases which affect the body as a whole, such as fevers. Book five covers compound drugs and their usage. Though a very long work it became a very practical and comprehensive book of reference for the practitioner who wished to know more about any particular ailment and its treatment. In this way scholars such as Al-Razi and Ibn Sina brought a more systematic approach to Greek theories, presenting them in a far more coherent way, at the same time extending the knowledge of diseases, and the usage of new drugs.
The eleventh century saw a further migration of medical knowledge as texts were further translated from Arabic and Greek into Latin and spread across Europe. There are many similarities, and some marked differences, in these migrations. There is the context in which the movements took place. Just as the Islamic scholars came into contact with Greek ideas during the expansion of Islamic rule, so to the reconquest of part of Europe brought Christians into contact with Islamic ideas. From the eleventh century parts of Spain, Southern Italy, Sardinia and Sicily which had been under Islamic rule were conquered/reconquered. Strangely the Crusades seem to have had no major impact on the exchange of knowledge between the Middle East and Europe. Translations, into Latin, of many works across many subjects were made in these contact areas, particularly in Toledo, Puglia and Palermo. The practical reasons for this was that there were large numbers of Muslim and Jewish scholars with a good knowledge of Arabic and Hebrew, along with Christian scholars. Clerics and administrators with their knowledge of Latin. Just as in Baghdad centuries before these Muslims, Jews and Christians pooled their combined knowledge of languages to produce accurate translations of Greek texts.
However, as previously discussed, having access to such a plethora of texts does not explain why scholars would take the time and trouble to translate them from Arabic into Latin. It can be argued that similar social and political factors to those that drove the move to translation in the Middle East were also at work in medieval Europe. The whole region was experiencing a period of economic growth with increasing population, expanding towns and cities and flourishing trade. Alongside this the number of schools and universities was growing to supply a new generation of skilled workers for literate occupations, including medicine. There was a growing interest in intellectual matters, bringing with it a strong desire to rediscover Greek knowledge, Arabic philosophy and science. In this context there was a social elite - princes, clerics, practitioners etc - who were prepared to pay scholars to make translations of Arabic texts on medicine, mathematics and science.
European translators, like Islamic scholars before them, faced the same problems of translation, often there were no Latin words for Arabic terms. So they used the same techniques as a solution to the problem, and resorted to transliteration, as had Islamic scholars before them when translating from Greek to Arabic. Also as Islamic scholars had changed gods to Allah, Christian translators removed all references to Allah, and put a particular Christian gloss on the understanding of the four humours and linked them to the four evangelists Matthew, Mark, Luke and John. Inevitably translation from Arabic to Latin, and the devising of new terms for diseases and drugs, led to confusions and inaccuracies - as we have already seen was the case in translating from Greek to Arabic. Also this problem was exacerbated by errors which crept in due to the repeated copying of manuscripts. The illustrations of surgical instruments in Arabic texts originally were accurate representations of the devices, but copyists did not understand the devices, or their functions, and made them a basis for decoration of the texts, thus rendering the drawings totally useless as a record of the instruments used. However there are two striking differences between such translations into Arabic, and from Arabic to Latin. First European scholars were privilege to a richer medical tradition that there Islamic counterparts had been. European scholars translated Arabic translations of Greek authors - notably Galen - and some texts written in Greek. Second, where Islamic scholars seem to have worked relentlessly at their translations in Europe the translations were done in a series of stages.
The first phase of translation took place during the eleventh century, and was centred on the monastery at Monte Cassino and the monk Constantine Africanus (Wiki 10). He was responsible for the translations of works by both Arabic and Greek authors, including a number of texts by Galen. He also translated Kitab Kamil al-sina ah al tibbiyah (Wiki 11) by Ali ibn al-abbas al- Majusi (Wiki 12).The title of this book translates into English as The Complete Book of the Medical Art, and was Pantegni in Latin - meaning The Universal Art. When translated from the Arabic many Islamic authors were turned into the Latin form, hence Ali ibn al-abbas al- Majusi became Haly Abbas. Among the translations by Constantine were works by Ibn al-Jazzar (Wiki 13) and Hunyan ibn Ishaq. The second phase of translation was during the twelfth century, and is associated with Gerard of Cremona (Wiki 14) working in Toledo (Wiki 15). Whereas Constantine had focused his efforts on works of medical theory Gerard and his assistants concentrated on compendia by Islamic authors. Works such as al-Razi’s Kitab al-mansuri fi l-tibb (The Mansurian book of Medicine), Ibn Sina’s Canon, and surgical sections from Abu al-Qasim’s (known in Europe as Albucasis) (Wiki 16) Al-Tasrif. A century later there translations from the original Greek and Arabic were carried out when the remaining important works by Galen, al-Razi and Ibn Rushd (Known as Averroes) (Wiki 17) were translated.
Later in medieval Europe these texts went through a further period of translation when they were translated from Latin into vernacular languages. During the medieval period only highly educated people spoke and read Latin, whilst everyone else spoke vernacular languages (sometimes dialects) - the language spoken by the native people of a particular area/country. As literacy increased many more people could read the vernacular than could read Latin, therefore translation into the vernacular brought these texts to a much wider readership. The result being that practitioners began not only to translate these Latin texts, but also began to write their own texts in the vernacular languages. A further transformation came with the invention of printing in the mid fifteenth century, making it so much easier, and cheaper, to produce books, books that began to circulate in ever greater numbers.
In conclusion, Greek theories of medicine later enhanced by Islamic scholars, and followed by European scholars, remained the fundamental understanding of bodily function, disease and therapy right up to the eighteenth century. Humoral theories were not a set of static ideas, but were a foundation providing a flexible set of tools to explain aspects of health and disease. These theories, when adopted into new cultures, were repeatedly refreshed and revised by new practitioners. This constant revision and enhancement gives the lie to the idea that Islamic scholars simply took Greek medicine and ‘passed it on’, they were responsible for a whole range of ways in which the Greek theories were extended and improved upon. Scholars like Al-Razi, Ibn-Sina, and Ibn Al-Nafis not only to adopted Greek theories, but also to extended them through their own philosophical studies and their own experiments. Their understanding, and adoption, of Greek theories of humoral medicine led to a largely forgotten renaissance in medical culture. This ‘renaissance’ led such scholars to create a strong culture of medicine which spread across Europe, ranging from Baghdad to Toledo, with the Islamic incursions, a culture that came to us through later translations into Latin. These Latin translations formed the basis of medical thinking in the seventeenth century, and thus have been developed further with more modern techniques. So, while it would be easy to take the given statement at face value it is not difficult to discover enough facts to enable one to disagree with it, and to highlight the reality of a widely forgotten and neglected Islamic renaissance.
Sources
Wiki 1 - https://en.wikipedia.org/wiki/Hippocrates
Wiki 2 - https://en.wikipedia.org/wiki/Galen
Hippocrates, c.400BC, On Airs, Waters, and Places, https://ebooks.adelaide.edu.au/h/hippocrates/airs/index.html
Wiki 3 - https://en.wikipedia.org/wiki/Hunayn_ibn_Ishaq
Wiki 4 - https://en.wikipedia.org/wiki/Rufus_of_Ephesus
Wiki 5 - https://en.wikipedia.org/wiki/De_Materia_Medica
Wiki 6 - https://en.wikipedia.org/wiki/Pedanius_Dioscorides
Wiki 7 - https://en.wikipedia.org/wiki/Muhammad_ibn_Zakariya_al-Razi
Ritu Lakhtakia, 2014, A Trio of Exemplars of Medieval Islamic Medicine: Al-Razi, Avicenna and Ibn Al-Nafis, https://www.ncbi.nlm.nih.gov/pubmed/25364546/
Wiki 8 - https://en.wikipedia.org/wiki/Avicenna
Wiki 9 - https://en.wikipedia.org/wiki/The_Canon_of_Medicine
Wiki 10 - https://en.wikipedia.org/wiki/Constantine_the_African
Wiki 11 - https://en.wikipedia.org/wiki/The_Complete_Book_of_the_Medical_Art
Wiki 12 - https://en.wikipedia.org/wiki/%27Ali_ibn_al-%27Abbas_al-Majusi
Wiki 13 - https://en.wikipedia.org/wiki/Ibn_al-Jazzar
Wiki 14 - https://en.wikipedia.org/wiki/Gerard_of_Cremona
Wiki 15 - https://en.wikipedia.org/wiki/Toledo,_Spain
Wiki 16 - https://en.wikipedia.org/wiki/Al-Zahrawi
Wiki 17 - https://en.wikipedia.org/wiki/Averroes
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