In no department of scientific investigation was the genius of Arabian culture more signally displayed than in the noble profession of medicine. In ancient Arabia, disease was supposed to be an indication of the anger of God, which it was the peculiar province of the sorcerer to remove. The erroneous ideas of morbific conditions common to nations in their intellectual infancy, among the primitive Arabs, conspicuous for their ignorance, were even more pronounced than was characteristic of other races not less barbarous. It was a long step from the fetichism of the Desert to the sacrificial ceremonies of Rome and the Asclepiads of Greece, yet all were of a similar character, though the latter represented the origin of the medical science of antiquity. Temperance was at once the precaution and the remedy of the abstemious Bedouin. Mohammed diligently inculcated the doctrine that the stomach was the seat of all diseases, and fasting their cure.
The beneficent art which has for its object the alleviation of human suffering was in the seventh century degraded to the vilest purposes of the priest and the charlatan. The writings of the celebrated Greek practitioners, lost in the universal destruction of learning consequent upon barbarian supremacy or hidden in the seclusion of the cloister, had been forgotten. The reputation of the medical school of Alexandria, whose methods had wrought such miracles in the advancement of science, was, in the minds of the more intelligent, but an indistinct and doubtful tradition; to the ignorant it was wholly unknown. Then, and for centuries afterwards, throughout Christendom, medicine was closely allied with sorcery and imposture, partly astrological, partly mystical, but never scientific. The supernatural] character with which ecclesiastical shrewdness and cunning had invested it,—the accepted principle that disease was punishment inflicted for the commission of sin,—a principle which, strange to say, has still its advocates even in our enlightened age,—rendered all progress impossible. Maladies were largely attributed to the influence of spirits or to the possession of devils, to be exorcised by prayer, holy water, the application of relics, the invocation of saints. The superstitions inherited from Pagan antiquity, and of incalculable potency in their action upon the minds of the multitude, were a source of great revenue to the clergy. Among the vast number of holy men whose names fill the pages of the Roman Catholic calendar there were many individuals whose intercession was considered especially efficacious in the treatment of certain diseases. The policy of the Church, which lost no opportunity of impressing the fancy of its votaries, even went so far as to expel from the constellations of the zodiac the familiar forms of the ancients, and to substitute in their stead representations of cenobites and martyrs, the piety of whose lives, often of questionable authenticity, had obtained for them the honor of canonization. The identification of the treatment of disease with religious ceremonial, and indirectly with celestial interference, conferred upon the priesthood a new and formidable weapon of spiritual power. Their influence, already great at the bedside of the sick and the dying, soon became paramount. To the weight which their ecclesiastical functions imposed, they added the dictatorial manner which is essential to the successful ministrations of the physician. They collected enormous fees. They disposed of estates. Often, in the very presence of death, they engaged in unseemly disputes over the division of the spoil. They forced the afflicted to the most humiliating compliances. Profoundly ignorant of the nature of disease and its cure, they supplied their glaring deficiencies by the employment of every resource of imposture known to their calling. By aspersions and the exhibition of the Host they cast out demons. They removed pain with the sovereign virtues of relics. Chronic affections were treated by protracted prayer and vicarious penance. Pilgrimages to sacred localities, supplemented by frequent and generous contributions, were also of notable efficacy. The waters of certain wells and springs under the patronage of a saint, and which had been the scenes of well-attested miracles, were classed among the most popular therapeutic agents. The gift of healing, especially efficacious in cases of goitre and scrofula, with which royal personages were supposed to be endowed, was another of the delusions in which mediæval times were so remarkably prolific. This singular idea, probably of British origin, can be traced to the reign of Edward the Confessor, and was not discarded until the accession of the House of Brunswick. Its institution was undoubtedly ecclesiastical; the repetition of a religious formula accompanied the touch of the sovereign; and the practice of the ceremony at Pentecost was always a source of much edification to the multitude, and of substantial profit to the religious establishment under whose auspices it happened to be conducted.
Side by side with clerical impostors, another class of practitioners, equally ignorant and scarcely less dangerous, preyed upon the superstitious and credulous of mediæval society. These were the charlatans who posed as astrologers, alchemists, magicians. Their encroachments upon the territory of the Church, and the suspicious methods they employed, necessitated a certain degree of concealment and secrecy, but their haunts were well known to their victims. They professed to consult the appearance of the heavens, the motions of the planets, the recurrence of eclipses, the apparition of comets and meteors, in the compounding of medicines and the treatment of distempers. Celestial phenomena were thus regarded as of the highest importance in the determination of symptoms and the administration of remedies. The curative virtues of plants were entirely dependent on the position of the star under which they were gathered. A correspondence of qualities was presumed to exist between objects having the same color or form, an idea possibly as old as man himself. Hence were derived the imaginary aphrodisiacal virtues of the mandrake, and the alleged properties of red and white substances as calorifacients and refrigerants. The occupations of these pretenders, usually confined to the fleecing of their dupes, were, however, not always so innocuous. They were eminently skilled in the composition of love-philters and poisons, whose secret administration is believed to have more than once changed the succession of certain of the royal houses of Europe. The criminal history of the Middle Ages is not more remarkable for the nefarious deeds of these fraudulent practitioners than for the immunity which the possession of dangerous secrets enabled them to enjoy.
To the ministrations of these two classes—that of the ecclesiastic and that of the charlatan—was the health of Christian Europe thus committed for many centuries. A striking similarity characterized the proceedings of both. Each employed mummeries, exorcisms, incantations. Each professed to believe in the efficacy of amulets. One invoked the intercession of the saints; the other was credited with holding nightly intercourse with the spirits of the infernal world. Both, by the alleged exercise of supernatural affiliation, wielded great power, and lived in luxury at the expense of those whom they habitually deluded. While each considered the other as encroaching on his peculiar domain and an object of suspicion, a community of sentiment between them generally prevented any serious outbreak of hostility. The favor and protection of the prince was equally accorded to these two appendages of the court. One was the keeper of the royal conscience; the other was valued as an unscrupulous and ever available instrument of secret vengeance. Both at times exercised the important functions of physician. Unfortunate, indeed, was the invalid dependent upon such inadequate resources. For him there was no prospect of substantial relief; no system of intelligent treatment; no remedies but incense, relics, and the mysterious formulas of imposture; no prophylactic but the talisman; no diagnosis but the consultation of the stars; no prescription but the Pater and the Ave. In the estimation of the populace, the calling of the physician was identical with that of the necromancer. In the advice of the priest the greater confidence was reposed, his connection with the Church investing his opinions with a divine, even an infallible, sanction. When failure resulted, as was often the case, it was not attributed to inexperience and ignorance, but to neglect to propitiate the saints and the Virgin. The commonest rules of hygiene, upon which are absolutely dependent the health of communities, were habitually ignored. The streets were open sewers. The court-yards steamed with miasmatic vapors engendered by decaying garbage. Into most houses the purifying rays of the sun could never penetrate. Floors and walls alike were grimy with filth. Linen and cotton garments worn next the skin, and which contribute so much to personal comfort and cleanliness, were unknown; the Arabs, by whom they were invented, had not yet introduced them to the knowledge of Europe. The supply of water, everywhere contaminated, became a prolific source of infection. Public baths did not exist; a profane luxury of the Pagan and the Saracen, their use was contrary to the traditions of Christianity; the Gospels contain no general precepts for ablution; and its practice was abhorrent to the meditative simplicity of clerical and monastic life. The universal existence of these pathogenic conditions is alone sufficient to account for the rapid diffusion and frightful mortality of contagious diseases. Leprosy had under the filthy habits and promiscuous intercourse of the populations of the Middle Ages assumed a character of extraordinary virulence. France, at that time certainly not the least civilized country of Europe, furnishes a suggestive instance of the prevalence and disastrous effects of this incurable disorder. From the eleventh to the fourteenth century, there was not a village—scarcely a hamlet—without its lazar-house; the streets of great cities swarmed with leprous beggars in every stage of loathsome deformity; and in 1250 there were known to be two thousand leper-asylums in that kingdom,—there were nineteen thousand in Europe. The result of the disregard of sanitary precautions, and the deplorable lack of medical knowledge, is also established by the fatality of great epidemics, previously mentioned. Such was the awful penalty entailed by hatred of learning, personal neglect, and public indifference to the laws of health, conditions sedulously maintained by the policy of the papal system, whose ministers collected immense revenues from shrines, relics, amulets, and the endless paraphernalia of superstition, and discouraged, by all the insidious arts of their profession, every rational method for the prevention and treatment of disease.
In the Orient, on the other hand, great progress had early been made in the various branches of the healing art. The number of Arab physicians was prodigious. An entire volume of the biographical work of Abu-Osaibah is taken up with their names. In the city of Bagdad, at one time during the eleventh century, there were nearly nine hundred. The Nestorian school of Djondisabour had already, in the sixth century, sent forth many eminent practitioners. Some of these, in search of more extensive knowledge, travelled in India; at least one of them, Harets-Ibn-Keladah, an Arab, established himself at Mecca. From him Mohammed, who was his friend, obtained something more than the rudiments of medicine, an accomplishment which contributed greatly to his success. The Prophet attended the sick, gave consultations, and imparted his learning to his wives. He recognized the paramount importance of hygiene, and inculcated its maxims upon every occasion. “God has not caused a single disease to descend upon men without providing a remedy,” “Diet is the principle of cure, and intemperance the source of all physical ills,” were some of the aphoristical sayings whose truth he constantly impressed upon his followers. The renowned Khalif Al-Mamun was the first Moslem prince to impart a decided impulse to the study of scientific medicine. To Bagdad, his capital, which he had named the City of Peace, he attracted, by the promise of magnificent rewards, the chief professors of the medical school of Djondisabour. The fact that they were Christians was in the eyes of that great monarch no impediment to their employment or promotion. Under their intelligent direction colleges and dispensaries were established. The first hospital of which history makes mention was founded at Bagdad. The world was diligently explored for medical treatises of every description. The Greek authors were rendered into Arabic by a body of translators especially employed for that purpose. The vast importance of this intellectual movement, guided by the spirit of scientific inquiry whose conclusions were based on results obtained by observation and experiment, is disclosed by the great minds it produced and through the influence it exerted on other nations.
In medicine, as in all other sciences, the Spanish Arabs enjoyed peculiar advantages. The accumulated wisdom of the Alexandrian School was theirs by right of conquest. The learning, the inventions, and the methods of the great colleges of Djondisabour, of Bagdad, of Cairo, of Damascus, were theirs by appropriation or inheritance. Many of the most accomplished scholars of those institutions established a residence in the Peninsula, and enriched with their knowledge the already gigantic stock of scientific facts, the result of years of study and experiment by the brightest minds in the most highly intellectual and cultivated society of Europe. Neither national nor religious prejudice proscribed the fruits produced by the labors of the philosophical observer. The contributions of the skeptic, the Christian, the Jew, and the Worshipper of Fire were received with the same respect and rewarded with the same liberality as were those of the orthodox Moslem. The enterprising surgeons and pharmacists of Moorish Spain travelled, studied, and pursued their investigations in every country which promised a profitable return to their industry or their researches. The academies of the Peninsula were illumined by the genius and the erudition of such great writers and operators as the Bakhtichous, Masués, and Serapions, the Nestorian pioneers of medicine and surgery; Honein-Ibn-Ishak, Albategnius, Abu-Yusuf-al-Kendi, Tsabit-Ibn-Korra, Ibn-Bothan, Ibn-Sina, Abu-Bekr-Mohammed, of Persia; Ibn-al-Heitsam, Al-Hazen, Abul-Mena-Ibn-Naso, of Egypt; Ibn-al-Mathran, Ibn-al-Dakhnar, Ibn-Khalifa, Abd-al-Atif, Djimal-al-Dire, of Syria; Ibn-al-Djezzar, Constantine Africanus, and Edrisi, of Barbary. These names, famous in the annals of the profession, and gathered from every quarter of the Mohammedan world, are equalled if not surpassed in renown by those of Moorish Spain. The schools in the empire of Islam, already celebrated, were also rendered doubly illustrious by many other distinguished scholars of scarcely inferior ability, whose talents and discoveries produced a revolution in the practice of every department of medical science. All of the institutions where it was taught were not public. Many were established by practising physicians, who had also their private hospitals. The sons adopted the profession of their fathers for many consecutive generations, and added to the learning obtained by example and experience the natural advantages derived from the hereditary transmission of genius and skill.
The khalifs often attended the lectures of eminent practitioners, and always bestowed upon them the most substantial marks of their favor. Capable of the exercise of every public employment, the court physician was often raised to the post of vizier. Many accumulated immense fortunes. Djabril-Ibn-Bakhtichou left ninety million drachmas; Al-Mamum gave Honein for every volume he translated from the Greek its weight in gold.
The versatility of many of these learned men is one of the marvels of the educational system under which their talents were developed. Their medical knowledge was often the least conspicuous of their intellectual accomplishments. They were famous mathematicians, astronomers, metaphysicians, grammarians, botanists. Some left hundreds of works on the different sciences. Even in that remote age there were specialists who wrote with signal ability on the morbid anatomy of the different portions of the body. Affections of the eye, obstetrics, eruptive fevers, were exhaustively treated. The book of Rhazes on the diseases of children is the first on that topic known to exist. Medical encyclopædias were common. The number of translators produced by the school of Bagdad alone exceeded one hundred. The multiplication of copies of Greek medical and philosophical works by this means, and their consequent wide distribution, preserved them from the fate encountered by so many other memorials of Attic genius. The salutary example of the Abbaside khalifs was not lost upon the Moslem princes of Syria and Egypt. In the polished capitals of Damascus and Cairo numbers of splendidly appointed medical institutions—colleges, hospitals, dispensaries, laboratories—arose. The services of the most distinguished physicians were gratuitously rendered to the inmates of the hospitals. The hygienic arrangements of the latter were, in many respects, superior even to those dictated by the spirit of modern scientific progress. They were larger, better arranged, and more commodious. Purity of air was assured by a system of thorough ventilation. There were fountains everywhere,—in the courts, in the halls, in the gardens. Wards placed under the direction of competent specialists were appointed for the treatment and study of every disease. Insane patients were prescribed for like the others, and had their attendants, their baths, and their amusements. For them, as well as for the unfortunate victim of insomnia and the convalescent, there were the diverting mirth of the story-teller and the soothing powers of music. When a patient was discharged as cured from the Moristan of Cairo, founded in the tenth century, and the most luxuriously equipped hospital of ancient or modern times,—where cooling waters rippled by the bedside of the sick, and their senses were refreshed by the sight and odors of beds of flowers,—he received five pieces of gold, to provide for his necessities until his strength was completely restored. These institutions were supported by the government, and placed under the supervision of the court physician, the head of his profession, who was held to a strict accountability for their proper management. For this important and responsible employment belief in Islamism was by no means essential; honesty, skill, and industry were the sole recommendations to imperial favor, and the medical advisers of the Successors of the Prophet were frequently Christians and Jews. In all hospitals registers of cases were opened and preserved, and far more importance was attached to the observations made at the bedside of the patient than to the information obtained by the perusal of books.
The fame of the medical colleges of the Orient spread rapidly throughout the world, and attracted the ambitious of every creed,—Christian, Hebrew, Mohammedan. In the eleventh century there were more than six thousand students of medicine in the schools of Bagdad. The methods of the professors and writers who directed the policy of these institutions owed their efficacy and success to their severely practical character. No course of treatment was approved until it had been repeatedly tested. Rhazes boasted that his knowledge had been acquired in hospitals and not from libraries. It was the leading principle of the practice of Ibn-Zohr that the resources of nature, if properly directed, are generally sufficient to cure disease. Abulcasis insisted that a thorough knowledge of anatomy was indispensable to success in surgical practice, a statement which, in his day, had the merit of novelty. The original principles of science transmitted from the great Greek physicians were again promulgated for the benefit of mankind, after having been divested of the mass of superstition and imposture with which they had long been encumbered. Almost every disease incident to humanity was treated by the Arab practitioner. Ophthalmia, endemic in countries subjected to the incessant glare of a tropical sun, received particular attention. The Moorish surgeons describe eleven different operations for cataract. Smallpox and leprosy were the subject of protracted and exhaustive investigation. There were specialists for affections of the nerves and the brain, and of the pectoral organs; for complaints resulting from physical excesses; for the various forms of insanity. Considerations of delicacy and the jealous prejudice resulting from the life of the harem debarred the physician from the application of the principles of gynæcology, and the practice of obstetrics was relinquished to women. Surgery, whose practice now implies the possession of the highest degree of professional skill, was for ages among the Arabs considered of inferior importance, and was abandoned to barbers and charlatans. The Mohammedan doctrine that the soul remained with the body for a certain time after dissolution was a serious obstacle to the acquisition of anatomical knowledge, vital to the success of the operator. This feeling was intensified by an idea prevalent among the rabble that handling a corpse was a source of frightful, nay, even of ineffaceable, pollution. The same impediments to the study of anatomy also existed in Christian Europe under the rules of the Church. One of the most heinous offences of the Emperor Frederick II. was that he encouraged dissections, a practice which, as it violated the sacred tabernacle of the soul and, according to ecclesiastical precept, might cause serious embarrassment on the day of the General Resurrection, had been rigidly proscribed by the policy of Rome.
The Arabs attached the greatest importance to hygienic precautions for the prevention as well as for the cure of disease. It was a cardinal principle of their pathology that overtaxing the digestive organs was the cause of a multitude of disorders. The abstemious and temperate habits which characterized the life of the Desert were impressively inculcated by the Koran and the entire body of Moslem tradition. Their observance was constantly suggested by the familiar use of amusing and pertinent aphorisms and proverbial phrases, such, for instance, as, “The worst things that an old man can have are a young wife and a good cook.”