Visitors to London this autumn might well decide to take a detour from their regular itineraries to visit the hushed splendour of the Royal College of Physicians near the city's Regent's Park, where a small but fascinating exhibition of manuscripts, books and documents relating to Islamic medicine will be on display until 25 October. Focussing on the medicine practiced across the Arab and Islamic world during the mediaeval period, the exhibition nevertheless also extends its view to the modernisation of medical practice in the late 19th century. While most of the treatments recommended may seem outlandish to visitors today, according to the exhibition's curator, British scholar Peter Pormann, many of them were seen as authoritative in Europe until at least the 18th century, being widely taught in medical schools and universities. While few of these treatments would actually have worked, Pormann bravely argues that some of them at least could have had at least some therapeutic benefit to patients. Islamic medicine originates in the classical world, as do Islamic philosophy and Islamic science more generally, and, like them, it is part of the inheritance of the ancient Greek and Roman world that was shared by European Christian and Arab and Islamic civilisation. Mediaeval Islamic medicine, like the medicine practiced at the same time in Europe, was based on that practiced in classical antiquity, with the result that it shared the same philosophical outlook and similar therapeutic procedures. The common denominator for both mediaeval Islamic and mediaeval European medicine lay in the works of the classical writer Galen, whose works on medicine, extending to some 440 titles, were written in the second century CE. These works systematised the medicine of the ancient Greek and Roman world, notably the theory of the four “humours” — blood, phlegm, yellow bile and black bile — whose imbalance was believed to be responsible for disease. The role of the physician was to restore these humours to healthy equilibrium by prescribing either drug-based therapies or by carrying out more radical surgical interventions such as blood-letting. The London exhibition starts by examining the legacy of Galen's works to Islamic medicine, focussing in particular on their translation into Arabic from the 9th century onwards. Teams of translators drawn from across the Islamic world gathered in Baghdad to work on translating the philosophical, scientific, medical, and, to a lesser extent, literary, texts of the classical Greek and Roman world into Arabic under the patronage of the Abbasid caliphs in a concerted effort of absorption and rediscovery that Pormann compares to the humanism of the Italian Renaissance. Among these texts were the works of Galen, and modern readers are particularly fortunate, Pormann writes, in being able to trace this process through in detail since one of the most important of these translators, the 9th century polymath Hunayn Ibn Ishaq, left a record of his translation practice in an epistle (risala) on the subject. Hunayn may have acquired his knowledge of Greek from an extended stay in Alexandria, and he certainly achieved an astonishing degree of fluency. According to his epistle, he translated 100 works by Galen into either Syriac or Arabic, and in order to acquire the Greek texts he had to travel extensively in Syria, Palestine and Egypt, comparing the manuscripts he acquired on such journeys to establish the best originals. Writing in the exhibition catalogue, Pormann says that Hunayn's work is important not only because it made a large number of texts by Galen available in Arabic, but also because it established new standards for translation. Arabic equivalents were found for Greek technical terms, eliminating the need for paraphrase or transliteration, and authoritative versions of Galen's ideas were established from often corrupt Greek manuscripts. The exhibition contains two items that illustrate the contributions made by Hunayn and the other early Arab translators to translation practice and the transmission of the classical inheritance. The first of these, a copy of Hunayn's Arabic translation of Galen's book On Simple Drugs, is of “incredible importance”, Pormann writes, since “it is the only Galenic text for which we can compare an older and a newer Arabic translation.” The second, a French translation of the Arabic translation of Galen's Anatomical Procedures, shows the use made of Hunayn's translations by later scholars. Only the first eight books of this work survive in Greek, the remaining seven surviving only in mediaeval Arabic translation. Study of the latter can help in the reconstruction of the lost Greek original. A section of the exhibition is dedicated to the 11th century philosopher Ibn Sina (Avicenna), a towering figure not just in medicine but also across the natural sciences and demanding comparison with Aristotle as a result of his encyclopaedic conception of philosophy. The focus is on the Canon of Medicine, a medical encyclopaedia that brought together the state of play at the time of its composition and later served as the basis for centuries of medical teaching both in the Arab and Islamic world and in Europe. The first translation of the Canon of Medicine into Latin was made in the 12th century, and, according to Pormann, it was still being consulted well into the 18th century. The exhibition contains a 12th century Arabic manuscript of the work and a 14th century Latin translation. It also contains a commentary on Ibn Sina's work by the 13th century writer Ibn Al-Nafis, which, Pormann says, contains “perhaps the most-quoted example of innovation” in Arab and Islamic medicine. In his commentary on the Canon, Ibn Al-Nafis described pulmonary circulation, arguing that “since there is no passage between” the two ventricles of the heart, the blood must pass through the lungs to be mixed with air. While this was not exactly a description of the circulation of the blood, later put forward by the English scientist William Harvey in the 17th century, it nevertheless marked a significant conceptual innovation. A further section of the exhibition focuses on the work of the 10th century physician and philosopher Al-Razi (Rhazes), born near modern Tehran, writing in Arabic and Persian, and author of the al-kitab al-mansuri, a medical handbook later translated into Latin in the 12th century, and a treatise on smallpox and measles. Al-Razi's book Doubts about Galen (kitab al-sukuk ala galinus) takes up the cudgels against Galen on numerous points, Pormann says, showing that Al-Razi was a keen clinician. This practical bent is underlined by his massive works the kitab al-hawi fi al-tibb (the comprehensive book) and the kitab al-gama al-kabir (the great compendium), which contain case histories and clinical notes. Pormann says that these works bear witness to Al-Razi's empirical instincts, his hospital work helping him to compare numerous cases of the same disease and arrive at therapeutic conclusions. Among the works exhibited here are copies of Al-Razi's book Curing within the Hour, an intriguing work that lists conditions that can be cured within an hour of their development and including some types of headache, toothache and tinnitus, and a Latin translation of Al-Razi's treatise on smallpox and measles, which, Pormann says, “represents an important example of medical progress in the area of differential diagnosis”. Al-Razi was also interested in the social settings of medical practice, apparently producing works on topics as various as “the reasons why people prefer inferior physicians” and “why ignorant physicians, common folk and women in cities are more successful than scientists in treating certain diseases,” along with his clinical works. In his introduction to the scholarly catalogue accompanying the exhibition, Pormann has interesting things to say about the origins and character of Islamic medicine and the translation of Arabic medical texts into European languages. He also writes on medical training in the mediaeval Arab and Islamic world, with would-be physicians being tested according to the instructions given in Hunayn Ibn Ishaq's On the Examination of the Physician (fi mihnat al-tabib) on the corpus produced by authors such as Ibn Sina and Al-Razi, for example, though “the canon of testable knowledge was largely based on Greek texts in Arabic translation.” Special consideration is given to the institution of the Islamic hospital, which, uniquely in the period, enjoyed financial security as a result of the system of religious foundations (awqaf) that supported it and brought together therapy, research and teaching. Pormann says that it was the establishment of such hospitals that helped to give rise to a medical profession and supported the kind of research found in the works of Al-Razi. At the end of this enjoyable and thought-provoking exhibition visitors may find themselves wondering how innovative Islamic medicine might be thought to be, and, a not unrelated question, how far any of the treatments recommended by these mediaeval Arab authors would have worked in restoring health or curing illness. Pormann has high praise for the “dynamism of medical thought and practice in the mediaeval Islamic world”. But did this dynamism mark an advance over classical Greek or Roman medicine? And, no less importantly, did it lead to any therapeutic benefits? Writing on mediaeval Islamic pharmacology, Pormann says that “one should not be too quick to judge whether or not an ancient therapy was beneficial or not. In the literature, we often find physicians and other medical practitioners commenting on the positive effect of their therapeutic measures; it is hard to imagine that they all lied or were mistaken.” But is it really so hard to imagine that they were all mistaken? In the absence of any veridical theory of disease, these early physicians relying instead on the Greek theory of humours, one might find it hard to imagine instead that any of the potions they administered to their patients would have had anything other than accidental benefit. Favoured practices such as cupping and bloodletting would have done little more than irritate or exhaust patients, and it seems more than likely that they would have led directly to infection (cupping involves the placing of a heated cup next to the skin). Pormann gives an example of one compound drug taken from a compendium by the 10th century writer Al-Kaskari that runs as follows: “Take Persian marjoram, Nabatean marjoram, cumin from Kirman, bishop's weed seed, cleansed celery seed, galls, pomegranate peels, inner oak bark, and opium, and of each one part. Crush, sieve through a hair sieve, then put it back in the mortar. Then afterwards add the opium to it and pound it lightly… Only take a little of it, as it has a somewhat strong effect.” As he goes on to note, the only active ingredient here is opium, and that could have had an, at best, unpredictable and not necessarily therapeutic effect.
