Part 8

It was the Caliph Almansor and his immediate successor, Haroun Al-Raschid, who between them made Bagdad a centre of study. Students and professors came thither from all parts of the then civilised world, and the Caliphs welcomed, and indeed invited, both Christians and Jews to teach there. Hospitals were established in the city, and the first public pharmacies or dispensaries were provided in Bagdad by Haroun Al-Raschid. It is on record that in A.D. 807 envoys from that monarch came to the court of Charlemagne bringing gifts of balsams, nard, ointments, drugs, and medicines.

Arabic medicine was based on the works of Hippocrates and Galen, which were for the most part translated first into Syriac, and then into Arabic. It does not come within the scope of this work to narrate or estimate the advance in medicine which may be accredited to the Arabian writers and practitioners. Medical historians do not allow that they contributed much original service to either anatomy, physiology, pathology, or surgery; but it is admitted by every student that their maintenance of scholarship through the half dozen centuries during which Europe was sunk in the most abject ignorance and superstition entitles them to the gratitude of all who have lived since. The medicine of Avicenna was perhaps much the same as that of Galen. Both were accepted by the physicians of England, France, and Germany with the slavish deference which the long burial of the critical faculties had made inevitable, and which needed the vigorous abuse of Paracelsus to quicken into activity.

Whatever may have been the case with medicine it cannot be denied that the Arabs contributed largely to the development of its ministering arts, chemistry and pharmacy. The achievements attributed to Geber in the eighth century were probably not due to any single adept. Tradition assigned the glory to him and, likely enough, if such a chemist really lived and acquired fame, other investigators who followed him for a century or two adopted the pious fraud so frequently met with in other branches of study in the early centuries of our era of attributing theories or discoveries to some venerated teacher in order to assure for them immediate acceptance. However this may be, it is not the less established that the chemistry of Geber, or of Geber and others, was in fact the fruit of Arab industry and genius.

Our language indicates to some extent what Pharmacy owes to the Arabs. Alcohol, julep, syrup, sugar, alkermes, are Arabic names; the general employment in medicine of rhubarb, senna, camphor, manna, musk, nutmegs, cloves, bezoar stones, cassia, tamarinds, reached us through them. They first distilled rose water. They first established pharmacies, and from the time of Haroun Al-Raschid there is evidence that the Government controlled the quality and prices of the medicine sold in them. Sabor-Ebn-Sahel, president of the school of Dschondisabour, was the author of the earliest pharmacopœia, which was entitled “Krabadin”; and Hassan-Ali-Ebno-Talmid of Bagdad in the tenth century, and Avicenna (Al-Hussein-Ben-Abdallah-Ebn-Sina) in the eleventh century prepared collections of formulas which were used as pharmacopœias.

It was the Arabs who raised pharmacy to its proper dignity. We do not read of any noted pharmacists among them who were not physicians, but the latter were all keen students of the materia medica, and occupied themselves largely with pharmaceutical studies. But it is evident that there was a distinct profession of pharmacy. We read of Avicenna, for example, taking refuge with an apothecary at Hamdan, and there composing some of his famous works. Elsewhere a quotation from Rhazes gives some indication of the irregular practice of medicine which has prevailed in every country and among all nations; and Sprengel quotes some translated items from various Arabic authors which show that as early as the ninth century the Government sanctioned the book of pharmaceutical formulas, compiled by Sabor-Ebn-Sahel, director of the School of Dschondisabour, already mentioned. His work was frequently imitated in later times. The first London Pharmacopœia was professedly based largely on the Formulary of Mesuë.

There is also evidence that both in civil life and in the army the pharmacists were closely supervised. Their medicines were inspected, and the prices at which they were sold to the public were controlled by law.

The development and progress of medicine and its associated sciences among the Arabs may be very concisely sketched. The flight of Mohammed from Mecca to Medina, the Hejira as it is called, from which the Mohommedan era is dated, corresponds in our chronology with A.D. 622. The prophet died in 632. Contemporary with him lived a priest at Alexandria named Ahrun or Aaron, who compiled from Greek writers thirty books which he called the Pandects of Physic. These were translated into Syriac and Arabic about 683 by a Jew of Bassora named Maserdschawaih-Ebn-Dschaldschal. It is not in existence, and is only known by references to it made by Rhazes. The first allusion to small-pox known to history was contained in these Pandects. Serapion quotes a number of formulas which he says were invented by Ahrun. In 772 Almansor, the Caliph who founded the city of Bagdad, brought thither from Nishabur (Dschondisabour) in Persia, a famous Christian physician named George Baktischwah, who stayed for some time, and at the request of Almansor translated into Arabic certain books on Physic. He then returned to his own land, but his son was afterwards a physician in great favour with the two succeeding Caliphs, Almohdi and Haroun Al-Raschid. Freind states that when the elder Baktischwah returned to Persia Almansor presented him with 10,000 pieces of gold, and that Al-Raschid paid the younger Baktischwah an annual salary of 10,000 drachmas. The last-named ruler also brought to Bagdad the Nestorian Christian, Jahiah-Ebn-Masawaih, who, under the name of Mesuë the Elder, retained a reputation for his formulas even up to the publication of the London Pharmacopœia.

Mesuë is noted for his opposition to the violent purgative medicines which the Greek and Roman physicians had made common, and he had much to do with the popularisation, if not with the introduction of, senna, cassia, tamarinds, sebestens, myrabolans, and jujube. He modified the effects of certain remedies by judicious combinations, as, for example, by giving violet root and lemon juice with scammony. He gave pine bark and decoction of hyssop as emetics, and recommended the pancreas of the hare as a styptic in diarrhœa.

A disciple of Mesuë’s, Ebn-Izak, added greatly to the medical resources of the Arabs by translations of the works of Hippocrates, Galen, Pliny, Paul of Egineta, and other Greek authors.

Abu-Moussah-Dschafar-Al-Soli, commonly called Geber, the equivalent of his middle name, is supposed to have lived in the eighth century. It has already been remarked that the chemical discoveries attributed to this philosopher were probably the achievements of many workers, and were afterwards collected and passed on to posterity as his alone. From him are dated the introduction into science, to be adopted later in medicine, of corrosive sublimate, of red precipitate, of nitric and nitro-muriatic acids, and of nitrate of silver.

These chemical discoveries must have been made within the hundred years from 750 to 850, because Rhazes, who wrote in the latter half of the ninth century, mentions them. Geber has been supposed to have claimed to have discovered the philosopher’s stone, and to have made the universal medicine. But it is not at all certain that he contemplated medicine at all. His language is highly figurative, and probably when he says his gold had cured six lepers he meant only that he had, or thought he had, extracted gold from six baser metals.

Rhazes, whose Europeanised name is the modification of Arrasi, which was the final member of a long series of Eastern patronymics, was of Persian birth, and commenced his studies in that country with music and astronomy. When he was thirty he removed to Bagdad, and it was not until then that he took up the sciences of chemistry and medicine. Subsequently he was made director of the hospital of Bagdad, and his lectures on the medical art were attended by students from many countries. His principal work was entitled Hhawi, which has been translated Continent, apparently because it was supposed to contain all there was to know about medicine. The style of this treatise is that of notes without method, and it is certain that it could not have been written entirely by Rhazes, as authorities are named who did not live until after he had died. The theory is that Rhazes left a quantity of notes of his lectures and cases, and that some of his disciples afterwards published them with additions, but without much editing.

Among the methods of treatment for which Rhazes is responsible may be mentioned that of phthisis, with milk and sugar; of high fever, with cold water; of weakness of the stomach and of the digestive organs, with cold water and buttermilk; and he advises sufferers from melancholia to play chess. He states that fever is not itself a disease, but an effort of nature to cast out a disease. He was particularly careful in the use of purgatives, which he said were apt to occasion irritation of the intestinal canal, and in dysentery he relied usually on fruits, rice, and farinaceous food, though in severe cases he ordered quicklime, arsenic, and opium. In Freind’s History of Medicine (1727) a translation of some comments of Rhazes on the impostors of his day shows better than the citations already given how just and, it may be said, modern were the ideas of this practitioner of more than a thousand years ago. It may be added that Freind is not very complimentary to Rhazes generally. I append an abbreviation of this interesting notice of the quackery of the ninth century.

There are so many little arts used by mountebanks and pretenders to physic that an entire treatise, had I mind to write one, would not contain them. Their impudence is equal to their guilt in tormenting persons in their last hours. Some of them profess to cure the falling sickness (epilepsy) by making an issue at the back of the head in form of a cross, and pretending to take something out of the opening which they held all the time in their hands. Others give out that they will draw snakes out of their patients’ noses; this they seem to do by putting an iron probe up the nostril until the blood comes. Then they draw out an artificial worm, made of liver. Other tricks are to remove white specks from the eye, to draw water from the ear, worms from the teeth, stones from the bladder, or phlegm from various parts of the body, always having concealed the substance in their hands which they pretend to extract. Another performance is to collect the evil humours of the body into one place by rubbing that part with winter cherries until they cause an inflammation. Then they apply some oil to heal the place. Some assure their patients they have swallowed glass. To prove this they tickle the throat with a feather to induce vomiting, when some particles of glass are ejected which were put there by the feather. No wise man ought to trust his life in their hands, nor take any of their medicines which have proved fatal to many.

Rhazes writes of aqua vitæ, but it is now accepted that he only means a kind of wine. The distillation of wine was not practised till a century after him. Mercury in the form of ointment and corrosive sublimate were applied by him externally, the latter for itch; yellow and red arsenic and sulphates of iron and copper were also among his external remedies. Borax (which he called tenker), saltpetre, red coral, various precious stones, and oil of ants, are included among the internal remedies which he advises.

The Arab author who acquired by far the greatest fame in Western lands, and who, indeed, shared with Galen the unquestioning obedience of myriads of medical practitioners throughout Europe until Paracelsus shook his authority five hundred years after his death, was Al-Hussein-Abou-Ali-Ben-Abdallah-Ebn-Sina, which picturesque name loses its Eastern atmosphere in the transmutation of its two concluding phrases into Avicenna. This famous man was born at Bokhara in 980; at twelve years of age he knew the Koran by heart; at sixteen he was a skilful physician; at eighteen he operated on the Caliph Nuhh with such brilliant success that his fame was established. In the course of a varied life he was at one time a Vizier, and soon afterwards in prison for being concerned in some sedition. He escaped from prison and lived for a long time concealed in the house of a friendly apothecary, where he wrote a large part of his voluminous “Canon.” He spent the later years of his life at Ispahan, where he was in great favour with the Caliph Ola-Oddaula, and he died at Hamdan in 1038 in the fifty-eighth year of his age. He had led an irregular life, and it was said of him that all his philosophy failed to make him moral, and all his knowledge of medicine left him unable to take care of his own health.

Competent critics who have studied the medical teaching of Avicenna have not been able to discover wherein its merits have justified the high esteem to which it attained. The explanation appears to be that what Avicenna lacked in originality he made up in method. The main body of his “Canon” is a judicious selection from the Greek and Latin physicians, and from Rhazes and other of his Arabic predecessors. He wrote a great deal on drugs and remedies, but it has been found impossible to identify many of the substances of his Materia Medica, as in many cases the names he gives evidently do not apply to those given by Serapion, Rhazes, and other writers. He often prescribed camphor, and alluded to several different kinds; a solution of manna was a favourite medicine with him; he regarded corrosive sublimate as the most deadly of all poisons, but used it externally; iron he had three names for, probably different compounds; he had great faith in gold, silver, and precious stones; it was probably he who introduced the silvering and gilding of pills, but his object was not to make them more pleasant to take, but to add to their medicinal effect.

Serapion the younger, and Mesuë the younger, who both lived soon after the time of Avicenna, were principally writers on Materia Medica, from whose works later authors borrowed freely.

The subsequent Arab authorities of particular note came from among the Western Saracens. Albucasis of Cordova, Avenzoar of Seville, and Averrhoes of Cordova, who are all believed to have flourished in the twelfth century, were the most celebrated. Albucasis was a great surgeon and describes the operations of his period with wonderful clearness and intelligence. Avenzoar was a physician who interested himself largely in pharmacy. He was reputed to have lived to the age of 135 and to have accumulated experience from his 20th year to the day of his death. Averrhoes knew Avenzoar personally, but was younger. He was a philosopher and somewhat of a freethinker who interested himself in medical matters. We are naturally more concerned with Avenzoar than with the others.

It is evident from the books left by Avenzoar, whose full name was Abdel-Malek-Abou-Merwan-Ebn-Zohr, that in his time the practices of medicine, surgery, and pharmacy were quite distinct in Spain, and he apologises to the higher branch of the profession for his interest in those practices which were usually left to their servants. But he states that from his youth he took delight in studying how to make syrups and electuaries, and a strong desire to know the operation of medicines and how to combine them and to extract their virtues. He writes about poisons and antidotes; has a chapter on the oil alquimesci, which Freind renders oil of eggs, and Sprengel calls oil of dates. Avenzoar says his father brought it from the East, and that it was a marvellous lithontryptic. He tells how mastic corrects scammony, and sweet almonds colocynth. He is the earliest writer to refer to the medicinal virtues of the bezoar stones. He gives a different account of the origin of these stones from that of other authors. The best, he says, comes from the East and is got from the eyes of stags. The stags eat serpents to make them strong, and at once to prevent any injury their instinct impels them to run into streams and stand in the water up to their necks. They do not drink any water. If they did they would die immediately; but standing in the stream gradually reduces the force of the poison, and then a liquor exudes by the eyelids which coagulates and forms a stone which may grow to the size of a chestnut, which ultimately falls off. According to another Arab author, Abdalanarack, the bezoar stone acquired such a celebrity in Spain that a palace in Cordova was given in exchange for one.

Moses Maimonides, the most famous Jewish scholar and theologian of the middle ages, must be mentioned among the exponents of Arab pharmacy. He was born at Cordova in 1139, and studied medicine under Averrhoes, but when he was twenty-five the then Mohammedan ruler of Spain required him to be converted or quit the kingdom. Maimonides therefore went to Cairo, and became physician to Saladin, the well-known hero of Crusade wars, who was then Sultan of Egypt. Among his duties he had to superintend the preparation of theriaca and mithridatium for the Court. The drugs for these compounds, Maimonides says, had to be brought from the East and the West at great expenditure of time and money. Consequently, “the illustrious Kadi Fakhil,” (who was apparently one of Saladin’s ministers), “whose days may God prolong, ordered the most humble of his servants in 595 (A.D. 1198) to compose a treatise, small, and showing what ought to be done immediately for a person bitten by a venomous animal.” The treatise which Maimonides composed, in obedience to this order, he called “Fakhiliteh.” This small popular manual reflects in general the pharmacy of Spain and is of no particular interest. The author considers that for all kinds of poisons and venoms the most efficacious antidote is an emerald, laid on the stomach or held in the mouth; and he notes the virtues of theriaca, mithridatium, and of bezoar. But the Kadi was thinking of poor people, and therefore more ordinary remedies were also named. A pigeon killed and cut in two pieces might be applied to painful wounds, but if this was not available warm vinegar with flour and olive oil might be substituted. Vomiting must be excited, and to destroy the virus a mixture of asafœtida, sulphur, salt, onions, mint, orange-pips, and the excrement of pigeons, ducks, or goats, compounded with honey and taken in wine, was recommended. The wisdom of Rhazes, of Avenzoar, and of other great authorities was also drawn from.

VII

FROM THE ARABS TO THE EUROPEANS

“Mediciners, like the medicines which they employ, are often useful, though the one were by birth and manners the vilest of humanity, as the others are in many cases extracted from the basest materials. Men may use the assistance of pagans and infidels in their need, and there is reason to think that one cause of their being permitted to remain on earth is that they might minister to the convenience of true Christians.”--The Archbishop of Tyre in Sir Walter Scott’s _Talisman_.

It would require a very long chapter and would be outside the scope of this work to attempt to trace in any detail the manner in which the ancient wisdom and science of the Greek and Latin authors, which was so marvellously preserved by the iconoclastic Arabs, was transferred, when their passion for study and research began to fail, to European nations. It has been alleged that the Crusades served to bring the attainments of the Eastern Saracens to the knowledge of the West through learning picked up by the physicians and others who accompanied the Christian armies against the Mohammedans.

But there is no evidence and not much probability that Europeans acquired any Eastern science of value through the Crusades. Indirectly medicine ultimately profited greatly by the commerce which these marvellous wars opened up between the East and the West, and the diseases which were spread as the consequence of the intimate association of the unwholesome hordes from all the nations concerned, resulted in the establishment of thousands of hospitals all over Europe. The provision of homes for the sick was far more common among the Mohammedans than among the Christians of that period. Activity of thought was stimulated, and medical science must have shared in the effects of spirit of inquiry. Some historians have supposed that the infusion of astrological superstitions into the teaching and practice of medicine was largely traceable to the communion with the East in these Holy Wars: but this idea is not supported by anything that we know of the Arab doctors. “I have not found the union of astrology with medicine taught by any writer of that nation,” says Sprengel; and his authority is very great. On the other hand the philosophers and theologians of that age were only too eager to seize upon anything mystic, and plenty of materials for their speculations were found in the Greek and Latin manuscripts handed down to them. Superstitions entered into the mental furniture of the age much more directly from Rome and Alexandria than from Bagdad.

That the Arabs of the East could have taught their Christian foes much useful knowledge cannot be doubted. The letter from the Patriarch of Jerusalem to Alfred the Great (see page 131), for example, is proof of the pharmaceutical superiority of the Syrians over the Saxons at that time.

M. Berthelot has shown by abundant evidence in his “History of Alchemy” that the Latin works dealing with chemistry of the thirteenth, fourteenth, and fifteenth centuries which were very numerous in Christendom, were almost exclusively drawn from Arabic sources. Such chemical learning as the Arabs had collected from Greek writers, as well as that which they had added from their own investigations, in this way found its way back to the heirs of the original owners as they may be called.

We read likewise of Constantine the African, who, about the year 1050, came to Salerno after a long residence in the East, and gave to the medical school of that city the translations he had made from Arab authors. But, notwithstanding these evidences of Eastern culture, it is certain that the actual introduction of pharmacy into the Northern European countries is much more largely due to the Spanish Mohammedans. In the Middle Ages poor Arabs and Jews who had studied medicine in the schools of Cordova and Seville tramped through France and Germany, selling their remedies, and teaching many things to the monks and priests who, in spite of repeated papal edicts forbidding them to sell medicines, did in fact cultivate all branches of the art of healing, including many superstitions. The edicts themselves are evidence that they sold their services to those who could afford to pay for them.