by Ehsan Masood
So, according to ibn-Sina, miracles must have a physical explanation. To take one example: most Muslims believe that the world will end one day and that when this happens, every member of the human race will return from the dead in a physical form, ready to be judged by God for their conduct during their lifetime. But ibn-Sina held that such bodily resurrection defies the laws of nature, and he thought that the day of judgement might take a different form to that traditionally taught in religion. He also doubted the traditional view of heaven and hell, in part because of his belief that matter cannot be everlasting – no fire can burn forever. And he thought that heaven and hell might take the form of a state of mind, instead of a physical space. The example he gave to support his theory was that of pain. He postulated that if it is possible to feel pain without experiencing pain in the physical sense – such as during a bad dream – it ought to be similarly possible to experience heaven or hell without physically travelling to a different place.
The surgeon of al-Andalus
Although many other Islamic physicians made their contributions to the progress of medicine, two other names that stand out are Abul-Qasim al-Zahrawi (Albucasis) and ibn al-Nafis. Although al-Zahrawi was born half a century earlier than ibn-Sina, their lives overlapped for 33 years until al-Zahrawi died in 1013. But they lived at different ends of the Islamic empire, thousands of miles apart – ibn-Sina mostly in Central Asia and Persia, and al-Zahwari far away in al-Andalus.
Al-Zahrawi was the greatest surgeon of Islamic times, and devoted his whole life to surgery. When the palace at Medinat al-Zahra near Cordoba was sacked in 1010, the great royal library was destroyed. So we know little of his life, and it may be that much of his work was lost, too. One book that we do know a lot about is called Kitab al-Tasrif li-man ’ajiza ’an al ta’lif. This can be translated as ‘Arrangement of Medical Knowledge for Someone Who Can’t Compile a Manual for Himself’. Fortunately, it is usually just known as Tasrif (‘Medical Knowledge’). It is essentially a practical manual comprising 30 volumes. The first is on general principles, the second is on diseases, symptoms and treatments, and volumes 3–29 are on pharmacology. The volume that has attracted most attention from historians, however, is volume 30, devoted to surgery.
Al-Zahrawi’s surgery
Volume 30 was translated into Latin by Gerard of Cremona (who was also ibn-Sina’s translator) in the 12th century, and it had a large influence on Western European surgery. Moreover, scholars are now discovering that it contains descriptions of relatively modern clinical techniques, such as ‘Kocher’s method’ for treating a dislocated shoulder and the ‘Walcher position’ for simplifying difficult labours.
This volume also properly illustrated a range of surgical instruments. Some of the instruments were already in use. Others were devices that he developed or perfected. These included a variety of forceps to aid childbirth, an ingenious scissor-like instrument for extracting tonsils without choking the patient, a concealed knife for cutting abscesses without alarming the patient, and all kinds of useful hooks and pincers.
Another key innovation attributed to him is the use of catgut for sutures in internal operations. Catgut has the remarkable property of not arousing any immune reaction in the body, yet staying strong until it dissolves naturally after a few weeks. That makes it perfect for sutures inside the body, allowing surgeons to make internal stitches, then close the opening knowing that the catgut stitches will dissolve once the wound is healed, so the body does not have to be reopened. The use of catgut is mentioned in Tasrif, and it has proved invaluable to surgeons ever since.
Doctor of the heart
Ibn al-Nafis was born in Damascus in 1213 but subsequently moved to Cairo, which by then had some of the most advanced hospitals in the Islamic world, including the al-Mansuri where ibn al-Nafis became head physician. He wrote a medical book which is believed to have made him very rich, and which replaced ibn-Sina’s Canon as the standard medical text in the Islamic world, though it had less impact in Europe. More significantly, he wrote commentaries on the work of Galen and ibn-Sina, correcting what he saw as some of their mistakes, for example on the pulse. But his real fame among historians in the West stems from a discovery made in 1924 that had some scholars rewriting medical history.
In 1924, a manuscript from ibn al-Nafis’ Commentary on Anatomy in Avicenna’s Canon, dating from 1242, was discovered in the Prussian State Library in Berlin. Galen (and later ibn-Sina) believed that blood seeped through from one side of the heart to the other through little holes in the septum that divided the sides. On examining many hearts, both alone and with witnesses, ibn al-Nafis could find no signs of such holes at all. He asserted instead that blood in the right ventricle of the heart must reach the left ventricle through the lungs alone, and not through small passages as Galen had maintained. Ibn al-Nafis had discovered what today we call pulmonary transit, or the lesser circulation.
Some writers and historians believe that ibn al-Nafis had in fact discovered the circulation of the blood. Others, such as medical historians Emilie Savage-Smith of Oxford University and Peter Pormann of Warwick University, say that discovering pulmonary transit is not quite the same thing as demonstrating the continuous circulation of blood, which William Harvey did in 1628. This could be because ibn al-Nafis’s description was uni-directional – it did not include the notion that blood returns from the left venticle to the right ventricle.
Ibn al-Nafis was, in many ways, part of the last generation of groundbreaking medical scientists in medieval Islam.
Ibn-Sina’s critics
Ibn-Sina and other doctors of the period were very much experimentalists. They would play with different treatments and if something didn’t work, they were happy to discard it and try an alternative method.
But theirs was not the only medical system in use at the time. Shortly after the time of ibn-Sina, Sufism began to take root, and Sufi ideas became more popular in Islamic territories. Sufism – in all its forms – has much to say on health and wellbeing, as well as the protection of the environment. One of its ideas is that asceticism (the suppression of worldly desires, shunning wealth and living on modest means) is both a route to good health and a way of pleasing God.
The proponents of such an approach to wellbeing included Abu Hamid al-Ghazali, an influential Sufi scholar and theologian from the 12th century. However, al-Ghazali was also critical of ibn-Sina and wrote a book called The Incoherence of the Philosophers. In this book, he took issue with what he considered to be the hubris of science and philosophy in their claims to be able to explain the natural world, which in al-Ghazali’s opinion denied a space for God.
In one of his writings criticising ibn-Sina’s attempts to produce a unified theory of the mind-body relationship, al-Ghazali wrote:
Yet these philosophers … they take the view that the equal balance of the temperament has great influence in constituting the powers of animals. They hold that even intellectual power in man is dependent on the temperament; so that as temperament is corrupted, intellect is also corrupted and ceases to exist. Further, when a thing ceases to exist, it is unthinkable in their opinion that the non-existent should return to existence. Thus it is their view that the soul dies and does not return to life – and they deny the future life – heaven, hell, resurrection and judgement. There does not remain, they hold, any reward for obedience or any punishment for sin.
(The Faith and Practice of al-Ghazali, Oneworld, 2000)
The Prophet’s Medicine
At the same time, yet another medical tradition, known as the Prophet’s Medicine, also began to emerge, and has since grown into a global industry. In today’s Muslim world, the Prophet’s Medicine is every bit as popular as the herbal medicine of ibn-Sina, so much so that in the countries of south Asia (as well as among Muslims in countries such as Britain), the two systems have either merged, or are regarded by patients as being one and the same.
We know a good deal about the Prophet’s Medicine, thanks to a 14th
-century manual that is still in print to this day. It is called Medicine of the Prophet, and its author was a scholar of religion from Damascus named ibn-Qayyim al-Jawziyya. He belonged to the same Islamic tradition as Ahmad ibn-Hanbal, the Baghdad jurist from the 9th century who was tortured by his caliph for refusing to sign up to state-sponsored rationalism. This is known as the Hanbali school, which is still popular today in Saudi Arabia and forms the basis of the country’s culture and laws.
The Hanbali school took a dim view of both experimental medicine and the Sufism of al-Ghazali. The arguments against Sufism were powerfully made: for example, ibn-Qayyim could not understand how God would look kindly on a Muslim who intentionally makes himself and his family destitute and thus dependent on others for charity. If anything, ibn-Qayyim believed that such extreme poverty was more likely to lead people away from religion than to make them better Muslims. Similarly, ibn-Qayyim also saw experimental medicine as an inferior system because it was often uncertain and open to being improved or superseded by the next discovery.
The solution, in his eyes, was a system of medicine based on medical references found in the Qur’an itself, and many more that appeared in biographical works on the life of Muhammad. Of divine origin, these would be less open to challenge and change than any alternative. At the core of the Prophet’s Medicine is the idea that the Qur’an, being God’s word, can also be regarded as the final word in healthcare and in healing.
The Prophet’s Medicine, however, also has a strong folk-healing dimension to it. For example, it includes the idea that good (or bad) health is linked to the motion of the planets and can therefore be affected by astrology; and that evil spirits, or black magic, also have the power to make people fall ill. Also in this tradition is the idea that deviation from religion is a potential cause of disease: in other words that illness might be a test, or a punishment from God for poor behaviour. In such cases, a doctor’s prescription might also include instructions to perform special prayers, fasting or charitable giving.
Plagued by controversies
One of the best-known examples from history of the differences between the experimental approach to medicine and that of the Prophet’s Medicine is in the treatment of plague. According to ibn-Qayyim, the Prophet Muhammad is believed to have said the following about plague: ‘Plague is punishment sent on those who disobey God. Do not enter a land where you hear of plague. And do not flee if it breaks out in your own land.’ In addition, he is also reported to have said: ‘Plague is martyrdom for every Muslim.’
The authenticity of these reports is open to question. However, for ibn-Qayyim, the message is clear: if you get the plague, you need to stay where you are. Similarly, ‘plague is martyrdom’ could be taken to mean that there is little or no point in trying to treat the disease. Referring to experimentalists such as ibn-Sina, ibn-Qayyim said in his book: ‘The physicians have nothing whereby to repel these illnesses and their causes, any more than they have anything to explain them.’ Later, he added: ‘Have complete trust and confidence in God and to endure patience and accept with contentment His decrees.’
In spite of their radically different approaches to healthcare, the Prophet’s Medicine and experimental medicine eventually began to merge in the Islamic world. This development holds important lessons for how new knowledge is absorbed in Islamic countries in the present day.
9
Astronomy:
The Structured Heaven
Have they not looked at the heaven above them – how We structured it and adorned it and how it has no rifts?
The Qur’an
In few places is the night sky such a jewelbox of stars as above Arabia, the birthplace of Islam. The desert air often ensures good visibility, and for trading caravans travelling at night to avoid the heat of the day, the stars must have been familiar guides in a featureless landscape long before the coming of the Prophet Muhammad. It may be, then, that the Arabic names of so many of our stars – Aldebaran, Rigel, Formalhaut, Betelgeuse, Deneb, Altair and many more – come from these ancient days. The coming of Islam gave astronomy an exalted status and ensured that these names have survived to become the names astronomers use even today.
There were many reasons for the prominence of astronomy in Islam, besides natural curiosity and the desire for knowledge. Travel across a vast empire, encompassing large areas of sea and desert, called for navigational aids which only the stars could provide. And astrology – which in older Arabic was the same word as astronomy – still attracted caliphs with its power to predict, despite the objections of many theologians. The rise of the Abbasids, for instance, brought some of the ancient Persian Zoroastrian tradition of astrology right into the heart of Islam, and each Abbasid caliph had his own personal astrologer from the Naubakht dynasty. Many patrons also called on astronomers to give them astrological ‘inside information’, and many historians say that the pursuit of astrology was a key reason for the development of observatories.
Astronomical demands
At least three Islamic teachings had implications for astronomy. First of all, Muslims were told to pray daily at five specific times – sunset, late evening, dawn, soon after midday and late afternoon. In the days before alarm clocks, this was by no means as easy as it sounds. The only way to be sure when to pray would be to observe the angle above the horizon of the sun or the stars in the sky. And if it was important to do it at precisely the correct time, then the more accurately that could be calculated, the better. It took a concerted effort by astronomers to work out how to do this in such a way that the appointed time had not passed before one had calculated it.
The mathematical method of telling the time at night, for instance, is to work out the unknown sides or angles of a vast triangle between the earth and the sky, from the known sides and angles. At one corner of the triangle is a particular star. At another is the north celestial pole – the point in the sky about which all the stars rotate. The third is the zenith, the highest point to which the star rises during the night. Working this out pushed astronomical calculation and the related mathematics of trigonometry to new levels. It also helped to drive innovations in the astrolabe, a device for computing angles developed in Greece. After suitable modifications, telling the time on a starry night eventually became easier.
Standing towards Mecca
Second, Muslims are expected to pray towards the Ka’bah in Mecca. This direction is called the qibla, and many astronomers and mathematicians worked hard at getting the qibla right. This is a surprisingly tricky problem because, as the surface of the earth is curved, it is necessary to work out a particular direction across a curved surface. (Interestingly, there was never any question in the Islamic world at this time about the earth not being round.) This is complex spherical geometry, and also demands very accurate observations of the reference points in the night sky – since even the tiniest error could throw the calculations out.
Third, the Islamic calendar consists of twelve lunar months in a year. Each lunar month starts with the moon’s first visible crescent. Predicting exactly when that crescent will appear presented early Muslim astronomers with a real challenge. The peoples of pre-Islamic Arabia used a mixed lunar/solar calendar, in which eleven days would be added to the 354 days of a lunar year to bring it in line with a solar year. This process is called intercalation; however, it is forbidden in the Qur’an, which is why Islam uses a lunar calendar to this day.
As the ability to tell the time accurately was useful in so many ways, most mosques employed an official time-keeper or muwaqqit to help the faithful pray as directed, and on time. Muwaqqits were competent astronomers, and so thousands of them across the empire were keeping records of planetary motion, which they added to the growing body of increasingly accurate tables that were produced throughout the Islamic era. Some historians, such as David King, have begun to explore religious astronomy in medieval Islam, and realised that there was a whole other dimension, barely yet appreciated, concerned with matters suc
h as the alignment of mosques and other buildings.
Clearly, the early Arabic-speaking Muslims had a long heritage of their own astronomical observations to help them, but from the beginning of the Abbasid era they also worked closely with astrologers and astronomers from Persia. When astrologers like the Naubakhts and the Persian Jewish Masha’allah ibn-Athar (Messahala) came to Baghdad, they brought with them tables called zij, which showed the positions of the sun, moon, planets and stars, compiled over many centuries.
Faith in the stars
At the same time, the Islamic empire’s rulers were happy to pay for the necessary infrastructure of astronomy, such as observatories and astronomical instruments. They took a strong interest in the activities of the institutions they funded, and got to know the leading astronomers of the day on a personal level. A few of them were also practising astronomers.
Such interest helped to ensure that one of Islam’s seminal contributions to modern science has been in the patronage and development of observatories. The first of these were built in 9th-century Baghdad and 10th-century Cairo, though the latter remained incomplete. In later centuries, these would be eclipsed by bigger and better ones in Istanbul, Maragha, and Samarkand in modern-day Uzbekistan. In the majority of these examples – and in many more – the observatories would contain specialised instruments such as quadrants, armillary spheres and astrolabes.
Islam’s observatories were usually paid for from the private funds of rulers such as al-Mamun in Baghdad and al-Hakim in Cairo. In addition, the relationship between a ruler and his chief astronomer was often close – rather like a head of government and his or her chief scientist today. For example, the scientist Hassan ibn al-Haitham worked in Fatimid Cairo during the 11th century under the ruler al-Hakim; ibn al-Shatir worked as the chief astronomer and timekeeper in Damascus’ largest mosque during the 14th century; ibn-Sina worked in 11th- century Central Asia under a number of different rulers; and Nasir al-Din al-Tusi, who directed the Maragha observatory, worked directly for the ruler Helagu Khan – he is believed to have accompanied Helagu during the latter’s assault and sacking of Baghdad. Finally, one of the largest observatories was the Samarkand, established in the 15th century by the governor Ulugh Beg, who was a keen amateur scientist.
