The Greatest Benefit to Mankind

THE LEGACY OF GALEN

During a long fallow time of the intellect, some authors passed on the baton of medical learning. Oribasius (325–97), physician to Julian the Apostate, came from a wealthy family in Pergamon in Asia Minor (Galen’s hometown) and studied medicine at Alexandria. Three of his works became influential. The earliest comprised excerpts from the best medical authorities. Its four books described hygiene and diet; the properties of simple drugs and indications for use, and the body – its maladies and treatments from top to toe. What remains of it reveals broad reading and his respect for Galen and Rufus of Ephesus. He also wrote a shorter practical medical compendium for the traveller, and an even briefer summary. He was worried about the state of medicine, bemoaning (in a familiar way) the proliferation of quacks and the want of practical handbooks. Oribasius played an important role as mediator and synthesizer: he preserved excerpts from many authors otherwise lost, created a pattern for later digests, and shaped the package of Galenism that dominated later centuries. Having simplified, synthesized and publicized the master’s writings, his work was rehashed by others in the same mould – Aetius, Alexander of Tralles and Paul of Aegina – before being further systematized by the Arabs.

In North Africa, Caelius Aurelianus (c. 420) produced a large Latin nosographical handbook, De morbis acutis et chronicis [On Acute and Chronic Diseases]. A follower of the Methodist sect, he subscribed to the doctrine of stricture and laxity among atoms and pores: diseases were due either to excessive tension or relaxation. Fragments survive of a medical catechism, of parts of his Latin translation of Soranus’ Gynaecology, and of the eight books on Acute and Chronic Diseases.

The Greek physician Alexander of Tralles (sixth century) was best known for his Libri duodecim [Twelve Books on Medicine], popular in Latin, Greek and Arabic. After travelling in Greece, Italy, Spain and Gaul, he settled in Rome. He was the first European to champion the eastern laxative, rhubarb, later so prized, but was also keen on more exotic remedies, for example live beetles. Henbane, he taught, was effective only if held between the left thumb and index finger while the moon was in Pisces or Aquarius; and he advised epileptics to ‘take a nail of a wrecked ship, make it into a bracelet and set therein the bone of a stag’s heart taken from its body whilst alive; put it on the left arm; you will be astonished at the result.’ Over the next centuries, the rational medicine of antiquity went through a long process of being diluted, or rather spiced up, with more magic ingredients and more exotic recipes.

Slightly later, Paul of Aegina (fl. 640) studied and practised medicine in Alexandria. A Galenist, he wrote on gynaecology and poisons, but his only extant work is his medical encyclopaedia, Epitome medicae libri septem [Seven Books of Medicine]. It opens with pregnancy, the diseases of childhood and of old age, and then passes to diet and regimen. Illness is dealt with in Book II. Maladies affecting specific parts are next treated from top to toe. For mental illness he recommends gentle treatments, including music, but also alludes to satanic possession. Book IV is concerned with skin diseases, beginning with scabies and ‘elephantiasis’ (presumably a form of filariasis) and progressing to herpes, oedemas, cancers and ulcers. Discussion of conditions caused by noxious body humours is followed in Book V by a survey of external agents, principally poisons, with a brief appendix on impostors. Book VI deals with surgery, including an account of tracheotomy, and a final long book is taken up with drugs, including the use of colchicum for gout. As a practical introduction, his Epitome was esteemed by Islamic physicians.

Such writers as Oribasius and Paul of Aegina saw it as their job to stitch extracts from earlier writers into a compendium of teachings and remedies. Their encyclopaedias spread Galen’s influence far and wide; they also reveal emergent tensions between theory and practice. Galen’s insistence on the need for a doctor to understand philosophy was interpreted as a call for logic and book-learning. This encouraged a drift towards treating medicine in terms of set texts. Though Galen had laid down no canon, by AD 500 in Alexandria there was not only a syllabus of Hippocratic texts (those which Galen had followed) but an embryonic Galenic canon, which became known as the sixteen books, taught with commentaries and studied in a set order, beginning with On Sects and the Art of Medicine. Alexandrian scholars also summarized the sixteen books for ease of memory, thus imparting to Galenism a more dogmatic air. Just as Christ’s teachings were theologized by the Church, classical medicine was being given its own orthodoxy. Medicine was becoming a matter of great texts.

While a scholarly tradition maintained itself in the eastern Roman empire, promoting a somewhat stilted Galenism, learned medicine was languishing in the West, where erudite doctors almost disappeared. Schools dwindled and Latin became confined to the Church. Cassiodorus (c. 540–c. 583) advised his monks at Vivarium in southern Italy to tend the sick and trust in God, while recommending a few practical medical texts: ‘read above all the translations of the Herbarium of Dioscorides, which describes with surprising exactness the herbs of the field,’ together with some Latin Hippocrates, Galen’s Method of Healing, Caelius Aurelianus’ On Medicine, and a handful of others. But that amounted to a sparse diet, and such texts were largely practical. The Lorch Book of Medicine, written about 795 in a Benedictine abbey in Germany, similarly contains brief introductory texts on anatomy, the humours and prognostics, and ends with recipes and dietary advice. The range of learned medicine was shrinking.

Knowledge was also transmitted in the West through encyclopaedias like the Etymologiae of Isidore, archbishop of Seville (c. 560–636), a medieval bestseller. Writing amid the turmoil in Spain – Goths ruled the country while Arian heretics (those who denied that Jesus was divine in the same way as God the Father) were bickering with the pope – the young Isidore felt called upon to shore up classical culture. His Etymologiae (the name reflects his passionate interest in the origins of words) takes in theology as well as history, grammar, mathematics, law and virtually all other learning. The fourth book concerns medicine, drawing on late-classical compendia, including the works of Caelius Aurelianus.

Isidore served up a beginner’s guide to Greek science, philosophy and medicine. The physical world was explained in terms of the four qualities (hot, cold, wet, dry), and the four elements (earth, air, fire, and water). The body operated on a similar plan, ruled by the four humours (blood, choler, phlegm, melancholy). Disease in the microcosm was caused by humoral imbalance, and treatment had to restore that equilibrium allopathically by diet, regimen or drugs. The medical sections of his encyclopaedia abstracted learned medicine, but his very title highlighted the new focus of study: words not bodies. Semantics was the key to a cosmos created by the Divine Logos, an orientation symptomatic of the cloistering of learning in the Latin West during those times of which little evidence survives: the ‘Dark Ages’.

The Venerable Bede (c. 672–735) was the English Isidore, a man aware of the need to meld healing and holiness. Although their North-umberland lay on the outer rim of the civilized world, Bede and his monks possessed many medical writings. Indeed, England was unique in producing a medical literature in a non-Latin tongue, Anglo-Saxon. Knowledge of plant remedies was extensive, and the English healer (laece or leech) used chants and charms, predicated on the belief that certain diseases and bad luck were caused by darts shot by elves, while others involved a ‘great worm’, a term applied to snakes, insects, and dragons. Bald and Cild’s do-it-yourself Leechbook (AD 900) mirrors medical tracts common elsewhere in western Europe, simplifying Latin recipes by removing the more exotic ingredients and interweaving local remedies. Disease could be cured by prayers or by invoking saints’ names, by exorcism, or by transferring it to animals, plants or the soil. Christian amulets were prescribed, together with number magic (the Anglo-Saxons favoured nines). For paralysis, ‘scarify the neck after the setting of the sun and silently pour the blood into running water. After that, spit three times, then say: “Have thou this unheal and depart with it”.’

Anglo-Saxon medicine conveys the spirit of early medieval Europe. A basis of classical therapeutics endured, explained by a sprinkling of Greek theory. The emphasis, however, had shifted to practicalities: recipes, meteorological and astrological advice, tips for uroscopy and bleeding, all indicative of an unstable society where books and learning had grown precious. The torch of medicine had meanwhile moved from Galen’s Rome to the east.

ISLAM

The eastern Mediterranean experienced turmoil of its own. Prolonged warfare between the Byzantine (Roman) and Persian empires caused chaos; within Byzantium, ethnic tensions between Greeks, Semites, Persians, Armenians and Slavs were exacerbated by vitriolic doctrinal splits amongst Christian sects. The heroic military efforts of Justinian (r. 524–65) to recover the western Roman Empire and his ruinous building ambitions caused further upheaval. The appearance of bubonic plague in 541 heralded two hundred years of devastating outbreaks. The Greek heritage grew less assured. Learned medicine continued in large cities, especially Alexandria, but most doctors were increasingly working in isolation, and religion assumed a dominant role in everyday life. The scene was set for Islam.

Muhammad (570–632) was a member of the tribe of Quraysh who ruled Mecca. He began life as a poor orphan but rose to become a wealthy merchant. When he was about forty, he received a call, and the Qur’an (Koran) was revealed to him in visions. He gradually assumed the mantle of the last of the prophets in a long line beginning with Adam and Noah. In 622 an assassination plot against the Muslims in Mecca led him to flee to Medina where he commanded a growing following.

By the time of his death, practically all of Arabia had been won over for Islam, and a century later his adherents had conquered half of Byzantine Asia, all of Persia, Egypt, the Maghreb (North Africa) and Spain, where Cordova became capital of the western caliphate, the Baghdad of the West, the source of Hispano – Arabian culture, together with Seville and Toledo, which peaked in the twelfth century, and later still Granada. Unlike Christianity, Islam was not a proselytizing faith which saw itself as superseding earlier ones, and the Qur’an granted Christians and Jews special status as ‘People of the Book’ (ahl al-Kitab), adherents of the other scripture-based faiths. Before the papacy launched the Crusades, Christians, Jews, Muslims and others rubbed along well together. What brought some unity to the Arab empire was not religion but a common language.

The pre-Islamic Near and Middle East possessed a popular medicine akin to that of the Mediterranean. Materia medica included plants and herbs familiar to Greek medicine, though certain remedies were distinct. Truffle juice was applied to eye disorders, clarified butter was used against fever, dates were prescribed for children’s maladies, while camel’s urine toned up the system. Cupping, cautery and leeches were employed for blood-letting; wounds were disinfected with alkali-rich saltwort, and ashes were applied to stanch bleeding. Knowledge of internal organs was meagre, and surgery was basic.

Interwoven with these practices were animist beliefs. Ill health was widely attributed to spirits. To restore well-being, the sick had to outwit them or recruit the protection of superior magical powers. The forces responsible for ill health were the jinn and the evil eye (al-’ayn), a glance believed to harm those upon whom it fell. The jinn (plural :jinni, whence genie) was a lesser spirit interfering with human beings; one could see, bargain with and even kill jinni, and they could bring good luck as well as bad. Healthwise, however, their activity was harmful, and they were held particularly to blame for fevers, madness and children’s diseases.

Avoidance of sickness thus demanded practical and magical precautions to ward off evil spirits. There were incantations against ailments like leg ulcers and night-blindness, and charms guaranteed a safe delivery for pregnant women. Popular observances countered unwelcome visitations from spirits: thus a boy suffering from a blistered lip would beg for food and then toss any offerings to the dogs; as the blister had originally been attracted by his eating food, it would be drawn to the scraps and so transferred to the dogs. Practical medicine was everyone’s business, but those who, like bleeders and cuppers, possessed particular skills were paid for their services, while the magical side of traditional medicine was performed by diviners, seers and charmers.

Initially the rise of Islam posed no threat to this traditional lore. The Qur’an has almost nothing to say about medicine, apart from advice to the faithful to wash for prayer and praise for the healing powers of honey. Scripture accepted the jinn, and Islam raised no objection to the indigenous medicine of conquered provinces; formal learning, including medicine, continued in the (Christian) Jacobite and Nestorian monasteries of Syria and Mesopotamia.

The seventh and eighth centuries, however, brought the transformation of Islam from a simple monotheistic creed to a formal faith, laying down theological orthodoxy. Popular medicine became mired in controversy because of its animistic bent, and many traditional practices were condemned. Conflict was sharpened by the fact that, in the centuries after the Prophet’s death (632), discussion of issues tended to be dominated by claims that Muhammad or his companions must have pronounced on the matter. Such pious dicta grew into a distinct corpus called hadith, the sayings of the Prophet. Old-style healers also began to claim Muhammad’s support: traditions alleged to be from the Prophet told, for example, that ‘the evil eye is real’; that there was medicinal power in his saliva; and that the water of the well of Zamzam in Mecca had healing properties. Being God’s word, the Qur’an too must have great powers. Hence, to assist a woman in labour, certain verses should be written on a slate, cleaned off, and the water given her to drink. The parallels with Christian healing are plain.

As Islam developed, traditional medicine was called into question. One major dilemma was plague. Early views had attributed epidemics to the jinn. This explanation was displaced by beliefs setting pestilence within the monotheistic framework of an Allah who was the ordainer of all things (including disease), yet was just and merciful. Though with the growth of Islam, many folkloric practices were attacked, medicine itself was not called into question, since Islam taught that ‘God sends down no malady without also sending down with it a cure.’

It is often held that a distinctive Arab – Islamic medicine dates from the time of the Prophet and stems from a hospital (bimaristan: Persian for house for the sick) and academy at Jundishapur, near Susa in southern Persia. Jundishapur was certainly a meeting-place for Arab, Greek, Syriac and Jewish intellectuals, but there is no evidence that any medical academy existed there. Only in the early ninth century did Arab – Islamic learned medicine take shape. The first phase of this revival lay in a major translation movement, arising during the reign of Harun al-Rashid (r. 786–809) and gaining impetus in the caliphate of his son, al-Ma’mum (r. 813–33). It was stimulated by a socioeconomic atmosphere favourable to the pursuit of scholarship, a perceived need among both Muslims and Christians for access in Arabic to ancient medicine, and the ready availability of the relevant texts.

Crucial in this ‘age of translations’ was the establishment in Baghdad, capital of the Islamic empire under the Abbasid caliphs, of the Bayt al-Hikma (832), a centre where scholars assembled texts and translated into Arabic a broad range of non-Islamic works. The initial translation work was dominated by Christians, thanks to their skills in Greek and Syriac. The main figure was Hunayn ibn Ishaq (d. 873), later known in the West as Johannitius, a Nestorian Christian from the southern Iraqi town of al-Hira. Hunayn, who travelled to the Byzantine empire in search of Galenic treatises and was said to wander the streets of Baghdad reciting Homer in Greek, was amazingly prolific. With his pupils, he translated 129 works of Galen into Arabic (and others into Syriac), providing the Arabic world with more Galenic texts than survive today in Greek.

Encouraged by official patronage, the translation drive proceeded rapidly. Hundreds of Greek texts were rendered into accurate and elegant Arabic; works in Syriac and Sanskrit were also translated, reflecting the cosmopolitanism of ninth-century Baghdad. The impact was enormous, not least in view of the hundreds of ancient texts saved in Arabic for posterity. The favoured author was Galen, and he thereby became the father figure for Arabic medicine. Even the Hippocratic Corpus was known primarily through his commentaries.

Continuing into the early eleventh century, the translation movement revived learned medicine, made Arabic a tongue for original scholarship, and gave Islamic culture access to a galaxy of learning. The early translators also launched an original medical literature of their own. Hunayn authored essays on ophthalmology, known as his Kitab al-’ashr maqalat fi l-’ayn [Book of the Ten Treatises on the Eye]. His Medical Questions and Answers, a student text book, adopted the threefold scheme of discussing first the natural organisation of the body, then neutral factors, and finally unnatural (or contra-natural) disease – a handling reproduced by all Arabic writers in the Galenic tradition. By the late ninth century medical men had access to a stock of ancient texts in superior Arabic translations and an expanding corpus of original scholarship glossing Greek works.

This in turn created a need for fresh syntheses, leading to the supreme achievement of Arab – Islamic medicine, the medical compendia. The first was the Firdaws al-hikma [Paradise of Wisdom] by ’Ali ibn Rabban al-Tabari (c. 850), in which the author, an Islamic convert, sought to collect a summa of medical erudition worthy for presentation to the Caliph al-Mutawakkil. His sources were Arabic and Persian translations of ancient classics, and his citations included not only Hippocrates, Galen and Dioscorides but Persian and Indian writers (this Indian element was soon, however, eclipsed by the Greek tradition).

Persia produced one of the greatest Muslim physicians and philosophers, Muhammad ibn Zakariya al-Razi, known in the West as Rhazes (865–925), author of some 200 treatises. In his youth (anecdotes tell us) al-Razi studied and practised medicine at the bimaristan of Baghdad. He later returned to Rayy, near Teheran, as head of its hospital, at the invitation of Persia’s ruler, Mansur ibn Ishaq; al-Razi dedicated to him Al-Kitab al-mansuri fi’l-tibb [The Mansurian Book of Medicine], a manual in ten books. The first six ran through such concerns as anatomy, physiology and materia medica, while the last four dealt with clinical matters: diagnosis, therapy, surgery and pathology, discussing diseases from head to foot. His separate work, al-Tibb al-ruhani [Spiritual Physic] handled diseases of the soul within a discussion of philosophy. Having won fame in Rayy, al-Razi went to Baghdad to take charge of its new al-Mu’tadidi Hospital. He spent his declining years in Rayy suffering from glaucoma, before becoming blind.

Al-Razi developed a medical philosophy. In the first chapter (‘On the Excellence and Praise of Reason’) of al-Tibb al-ruhani, he asserted that reason (al-’aql) was the ultimate authority which ‘should govern, and not be governed; should control, and not be controlled; should lead, and not be led’. He condemned slavish authority, devoting a large book, Fi’l-Shukuk ’ala Jalinus [Doubts about Galen], to criticism of precepts in Galen, beginning with al-Burhan [Demonstration], and ending with his large work, Fi’l-Nabd [On the Pulse]. In his introduction to Fi’l-Shukuk, he nevertheless declared himself Galen’s disciple; but since the art of healing was a form of philosophy, it could neither renounce criticism nor benefit from worshipping the dead. Extolling the progress of scientific knowledge, he wrote in Fi Mihnat al-tabib [On Examining Physicians and on Appointing Them] that ‘he who studies the works of the Ancients, gains the experience of their labour as if he himself had lived thousands of years spent on investigation.’ Nevertheless ‘all that is written in books is worth much less than the experience of a wise doctor.’

Al-Razi’s best-known work, al-Hawi fi’l-tibb [Continens, or Comprehensive Book of Medicine], was a commonplace book of detailed notes and transcribed bits of texts, beginning with diseases of the head and working down. Devoted to specific subjects, these files were gradually filled with jottings; the result was a kind of filing system, organized by subject though lacking overall form. Al-Razi incorporated case histories from earlier sources, notably Galen, but he also registered his own cases, recording the patient’s name, age, sex and occupation. Clinical observations of his own illnesses are also preserved: notes on how he had treated throat inflammation by gargling with strong vinegar; elsewhere he wrote about his swollen right testicle (emetics helped recovery). From these notes, al-Razi took the material for books such as al-Qulani [Cholic] and al-Jadari wa’l-hasba [Smallpox and Measles]. Hitherto all exanthemata (infections causing rashes) had tended to be lumped together; al-Razi was the first to distinguish them as separate diseases: ‘The physical signs of measles are nearly the same as those of smallpox, but nausea and inflammation are more severe, though the pains in the back are less. The rash of measles usually appears at once, but the rash of smallpox spot after spot.’ It is intriguing to find measles regarded as the more severe.

Al-Razi had many asides on medical practice: noblemen, he judged, echoing Galen, were entitled to special consideration in prescribing; for them unpleasant tasting drugs should be made palatable. But he did not neglect the poor, for whom he wrote his Man la yahduruh al-tabib [Who has no Physician to Attend Him]. Khawass al-ashya’ [Properties of Things] included the role of alchemy in medicine and the secret recipes and remedies of nature. Experience must be the touchstone of truth:

since many wicked people tell lies with regard to such properties, and we do not possess decisive means to distinguish the truth of rightful men from the false testimony of liars – save only actual experience – it will be useful not to leave these claims scattered but to collect and write them all. We shall not accept any property as authentic unless it has been examined and tried.

Al-Razi won renown, and his medical works later enjoyed ascendancy in the Latin West. In 1279 al-Hawi fi’l-tibb was Latinized under the title of Continens by the Sicilian Jew Faraj ibn Salim (Farragut), and printed five times between 1488 and 1542. His al-Mansuri fi’l-tibb [Liber ad Almansorem] and his al-Tibb al-muluki [Liber regius] were also popular. His work was in turn mentioned by Abu Rayhan ibn Ahmad al-Biruni (Al-Biruni, 973–c. 1050), who wrote on a variety of subjects: astronomy and astrology, mathematics, geography, history, philosophy and religion, mechanics, mineralogy and medicine. As well as editing al-Razi, he translated much of Galen’s otherwise lost Commentary on the Hippocratic Oath.

The Arabic medical compendium culminated in two works of the tenth and eleventh centuries. ’Ali ibn al’-Abbas al-Majusi (Haly Abbas, d. late tenth century) was a native of al-Ahwaz in southern Persia, but little is known about his life. Following al-Razi’s example, he divided his Kamil al-sina’a al-tibbiya [The Complete Medical Art] into two sections, on theoretical and on practical medicine, each including ten treatises on specialized topics, and his introduction surveyed the development of medicine up to his own times. Well-organized, practical, and devoting greater attention than al-Razi to anatomy and surgery, it secured al-Majusi’s medical reputation, winning a place second only to Ibn Sina’s Qanun.

The talents of Abu Ali al-Husayn ibn ’Abdallah ibn Sina (Avicenna, 980–1037) were evident from early youth. A Persian tax-collector’s son, he could, it is piously recorded, recite the Qur’an at the age of ten and was practising medicine by sixteen. If somewhat mythologized, Ibn Sina represents the pinnacle of the Galenic ideal of the philosopher – physician in Islam: he was the first scholar to create a complete philosophical synthesis in Arabic.

In a wandering life driven by burning intellectual curiosity, Ibn Sina held positions as a jurist, a teacher of philosophy, an administrator, and as physician to various courts. His autobiography boasts that his writing was done on horseback during military campaigns, in hiding, in prison and even after drinking bouts. The outcome was two hundred and seventy tides which include two monumental encyclopaedias, one on science (Kitab al-Shifa) and one on medicine (Kitab al-Qanun).

The Kitab al-Qanun [Canon, or The Medical Code] arranges in its million words the whole of medical science: the legacies of Hippocrates, Galen, Dioscorides and the late Alexandrian physicians, enriched by the works of Arab predecessors. It consists of five books arranged by subject, with subdivisions and summaries. Book I deals with general principles, starting with the theory of the elements, humours and temperaments and moving on to anatomy, physiology, hygiene, aetiology, symptoms and treatment of diseases. Book II is on materia medica, describing the physical properties of simple drugs, and how to collect and preserve them (a separate section lists 760 drugs alphabetically). Book III deals with specific diseases, classified from head to heel, together with the aetiology, symptoms, diagnosis, prognosis and treatment of each. Anatomy is also discussed. Book IV is concerned with diseases, such as fevers, affecting the whole body; it also covers ulcers, abscesses, swellings, pustules, fractures and injuries, as well as poisons, and there is even a section on anorexia and obesity. Book V describes compound drugs – theriacs, electuaries, emetics, pessaries, liniments, and so on – together with their medicinal uses.

In addition to the Canon, Ibn Sina wrote about forty works on medical subjects. The best known is Urjuza fi’l-tibb [A Medical Poem], a summary of the principles of medicine in verse as a mnemonic aid to students. But it was the Qanun that became the authoritative text on medicine for centuries, both in Islam, where it remains influential, and in Latin Christendom, earning him such tides as the ‘Galen of Islam’. His pre-eminent standing in the Latin West is symbolized by Dante’s ennobling him between Hippocrates and Galen.

Critics have alleged that al-Razi’s and Ibn Sina’s work stifled independent thought. Certainly the Canon was taught and annotated, but some of the commentaries were highly critical, notably that of the Andalusian physician, Ibn Rushd (Averroës, 1126–98). Criticism of its anatomy section also gave rise to the description by Ibn al-Nafis (d. 1288) of the pulmonary (lesser) circulation, nearly three hundred years before Servetus and Realdo Colombo (see below).

All these great compendia originated in Persia, but texts were also produced elsewhere, including the work of Abu’l-Qasim Khalaf ibn Abbas al-Zahrawi (Albucasis, 936–1013). Born in Cordova, al-Zahrawi was author of a medical compendium entitled Al-Tasrif li-man ’ajaza ’an al-ta’lif [The Recourse of Him Who Cannot Compose (a Medical Work of His Own)]. Some 1500 pages in length, and divided into thirty treatises, it offers information on topics elsewhere neglected, including surgery, midwifery and child-rearing, and detailed accounts of bleeding, cupping and cautery. Treatise 30, the most celebrated, deals with surgery, describing operations for the stone, cauterization of wounds, sutures, obstetrical and dental procedures, setting fractures and dislocations, procedures for opening abscesses and eye surgery, to say nothing of 200 illustrations of medical and dental instruments, many of which he designed himself. This surgical treatise won enormous acclaim in the Latin West.

Albucasis gave a definitive account of cautery, which was central to Arabic surgical practice, being used to open abscesses, burn skin tumours and haemorrhoids, cleanse wounds, and stanch blood flow. Like bloodletting, it was also performed in the treatment of internal diseases, and Albucasis advised the cauterizing iron for almost every ailment, including epilepsy, stroke and melancholy. Apart from him, it is unlikely that the Arabic surgical authors ever practised surgery themselves.

Also Spanish-born was Abu-l-Walid Muhammad ibn Ahmad ibn Muhammad ibn Rushd (d. 1198), latinized as Averroës. Physician, philosopher and jurist, Ibn Rushd is known in the West for his classic commentaries on Aristotle. Coming from a long line of lawyers, he served as a judge in Cordova and Seville and also as physician to the ruling Almohad family – though he later came under attack for his views, leading to exile and the burning of his philosophical works. His major medical text is the encyclopaedic al-Kulliyat [The Book of General Principles], written between 1153 and 1169. Consisting of seven books dealing with anatomy, health, pathology, symptoms, dietetics and drugs, hygiene and therapeutics, it was conceived as a companion to al-Taisir, written by his colleague, Ibn Zuhr (Avenzoar, c. 1091–1162), which dealt with specific diseases. Together they constituted a comprehensive medical treatise, becoming familiar in the West through their Hebrew and Latin translations [Colliget], and printed together in Venice in 1482. On physiological issues he preferred Aristotelian explanations over Galen’s, but he was not a slavish follower, and both the Colliget and the Commentaries show independent thinking.