Although Baghdad
Of the physicians who worked
in Baghdad Tehran
Al-Razi was a musician and a
money-changer until his thirties, when he began to study medicine in Baghdad
The largest and most
important of al-Razi’s medical works is Kitab al-Hawi fi al-tibb (The
comprehensive book of medicine), a collection of medical notes that
al-Razi made throughout his life in the form of extracts from everything he had
read, as well as observations from his own medical experience. Translated into
Latin in the 13th century, Kitab al-Hawi was repeatedly printed in Europe during the 15th and 16th centuries under the title Liber Continens.
Printed as it was when
printing was new, al-Razi’s writings had a major influence on the development
of medical practice in Europe .
The Kitab al-Hawi is
an enormous work: in its published form it consists of 23 volumes, two of which
are further divided into two lengthy parts. Each volume deals with specific
parts or diseases of the body, although the groupings of ailments are often
idiosyncratic. The volume that includes gout, for example, also covers diseases
related to large and small worms in the abdomen, piles, hunchback, varicose
veins and elephantiasis. Amongst these massive files of working notes are to be
found the occasional case history, as well as a glimpse of al-Razi as a
practising clinician (a collection of over 900 case histories recorded by some
of his students and issued posthumously exists under the titleThe Book of Experience or Casebook).
Some of al-Razi's ideas have
parallels with ideas today. For example, he suggests that “The physician, even
though he has his doubts, must always make the patient believe that he will
recover, for the state of the body is linked to the state of the mind.” He
cautioned against unnecessary use of drugs, and particularly polypharmacy: “If
the physician is able to treat with nutrients, not medication, then he has
succeeded. If, however, he must use medication, then it should be simple
remedies and not compound ones.” Unlike the polypharmacy promoted by some other
Islamic authors in the 9th century, al-Razi rarely recommends compound
remedies, and when he does, these have few ingredients.
All the leading physicians
of Baghdad
The inflammation of joints
associated with gout might explain why ancient Greek physicians described the
condition under various names, which they appear to have applied to gout and
rheumatism alike. Al-Razi gives four recipes for "gout and the
joints" in Kitab al-Hawi. All of these are pastes
or dressings to be applied to the painful areas with, in one instance, a damp
piece of paper or cloth to keep the medication moist. Opium occurs in all of
them, henbane in one and hemlock in two - one of which also has mandrake. A
paste that al-Razi describes as good contains equal parts of opium and liquid
storax (Liquidambar orientalis).
Three of al-Razi’s four
remedies for "gout and the joints" include colchicum, which had been
used for treating gout since at least the second millennium BC. Indeed, its
active ingredient, colchicine, is still used to treat acute attacks of the
condition today.
Where gout
is accompanied by high fever, the recipe contains seeds that cause diuresis
without giving out much heat, such as those of white colchicum, water melon and
cucumber. These, in equal parts, are mixed with one third of a part of opium,
and an oral dose of four dirhams (12g) of the mixture with the same amount of
sugar is analgesic and effective within the hour.
Where
there is no high fever, the ingredients, in an oral remedy, are: colchicum,
opium, borax, colocynth, ammi, aristolochia, and mountain thyme.
One of the two recipes
illustrates a common feature of al-Razi’s writings: he makes clear that he was
not prepared simply to accept what he read, but wished to reserve judgement
about the effects of medicines until he had investigated them personally.
I have
heard amazing accounts, amongst which is the following: the physician of .....
prescribed for gout a potion prepared with two mithqals (4.5g) of colchicum,
half a dirham (1.5g) of opium and three dirhams (9g) of sugar. The drug is said
to be effective within the hour, but I need to verify this.
Al-Razi’s willingness to
test the validity of therapeutic claims and theories in practice is illustrated
in another passage in Kitab al-Hawi, identified by Emilie
Savage-Smith (1996). He recognised the symptom complex that heralded the onset
of meningitis - dullness and pain in the head and neck, the avoidance of bright
light (photophobia), insomnia and exhaustion - and wondered how best to treat
these patients:
When the
dullness (thiqal) and the pain in the head and neck continue for three and four
and five days or more, and the vision shuns light, and watering of the eyes is
abundant, yawning and stretching are great, insomnia is severe, and extreme
exhaustion occurs, then the patient after that will progress to meningitis
(sirsâm) … If the dullness in the head is greater than the pain, and there is
no insomnia, but rather sleep, then the fever will abate, but the throbbing
will be immense but not frequent and he will progress into a stupor
(lîthûrghas). So when you see these symptoms, then proceed with bloodletting.
For I once saved one group [of patients] by it, while I intentionally neglected
[to bleed] another group. By doing that, I wished to reach a conclusion (ra’y).
And so all of these [latter] contracted meningitis.
Although we would be
unlikely to recommend bloodletting for patients with the prodromal symptoms of
meningitis today on the basis of this evidence, al-Razi’s approach to refining
his treatment reflects a way of thinking about one of the principles to be
observed in drawing inferences about the effects of treatments, namely, the
need for comparison.