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The most distinguished of the Arabian physicians was the man whose

rather lengthy Arabian name, beginning with Abu Bekr Mohammed, finished

with el-Razi, and who has hence been usually referred to in the history

of medicine as Rhazes. He was born about 850 at Raj, in the Province of

Chorasan in Persia. He seems to have had a liberal early education in

philosophy and in philology and literature. He did not take up medicine

> until later in life, and, according to tradition, supported himself as a

singer until he was thirty years of age. Then he devoted himself to

medical studies with the ardor and the success so often noted in those

whose opportunity to study medicine has been delayed. His studies were

made at Bagdad, where Ibn Zein el-Taberi was his teacher. He returned to

his native town and was for some time the head of the hospital there.

Later he was called by the Sultan to Bagdad to take charge of the

renovated and enlarged hospital of the capital. His medical career,

then, is not unlike that of many another successful physician,

especially of the modern time. At Bagdad he had abundant opportunities

for study, and the ambition to make medicine as well as to make money

and gain fame.

His studies in science were all founded on Aristotle. Though he was

called the Galen of his time, and looked up to the Greek physician as

his master, even the authority of Galen did not override that of the

Stagirite in his estimation. One of his aphorisms is said to have been,

If Galen and Aristotle are of one mind on a subject, then surely their

opinion is true. When they differ, however, it is extremely difficult

for the scholar to decide which opinion should be accepted. He drew

many pupils to Bagdad, and, when one knows his teaching, this is not

surprising. Some of his aphorisms are very practical. While the

expressions just quoted with regard to Galen and Aristotle might seem to

indicate that Rhazes was absolutely wedded to authority, there is

another well-known maxim of his which shows how much he thought of the

value of experience and observation. Truth in medicine, he said, is a

goal which cannot be absolutely reached, and the art of healing, as it

is described in books, is far beneath the practical experience of a

skilful, thoughtful physician. Some of his other medical aphorisms are

worth noting. At the beginning of a disease choose such remedies as

will not lessen the patient's strength. When you can heal by diet,

prescribe no other remedy, and, where simple remedies suffice, do not

take complicated ones.

Rhazes knew well the value of the influence of mind over body even in

serious organic disease, and even though death seemed impending. One of

his aphorisms is: Physicians ought to console their patients even if

the signs of impending death seem to be present. For the bodies of men

are dependent on their spirits. He considered that the most valuable

thing for the physician to do was to increase the patient's natural

vitality. Hence his advice: In treating a patient, let your first

thought be to strengthen his natural vitality. If you strengthen that,

you remove ever so many ills without more ado. If you weaken it,

however, by the remedies that you use you always work harm. The simpler

the means by which the patient's cure can be brought about, the better

in his opinion. He insists again and again on diet rather than

artificial remedies. It is good for the physician that he should be

able to cure disease by means of diet, if possible, rather than by means

of medicine. Another of his aphorisms seems worth while quoting: The

patient who consults a great many physicians is likely to have a very

confused state of mind.

Some idea of Rhazes' strenuous activity as a writer on medical subjects

may be obtained from the fact that thirty-six of his works are still

extant, and there are nearly two hundred others of which only the

titles have been preserved. Some of these are doubtless the works of

pupils and students of succeeding generations, published under his name

to attract attention. His principal work is Continens, or

Comprehensor, which owes its title to the fact that it was meant to

contain the whole practice of medicine and surgery. It includes

references to the writings of all previous distinguished medical

writers, from Hippocrates to Honein Ben Ishac, also known as

Johannitius, a Christian Arabian physician, one of Rhazes' teachers. The

most frequently quoted of these authorities are Galen, Oribasius,

Aetius, and Paul of AEgina. The work, however, is not made up entirely of

quotations, but contains many observations made by the author himself.

Gurlt says that the foundation of the theoretic medicine of Rhazes is

the system of Galen, while in practice he seems to cling more to the

aphorisms of Hippocrates. He has many practical points which show that

he thought for himself. For instance, in wounds of the abdomen, if the

intestines are extruded and cannot be replaced, he suggests the

suspension of the patient by his hands and feet in a bath in order to

facilitate their return. If they do not go back readily, compresses

dipped in warm wine should be used. Cancer he declares to be almost

incurable. He has much to say about the bites of animals and their

tendency to be poisonous, knew rabies very well, and knew also that the

bites of men might have similar serious consequences.

It is impossible to give any adequate idea of the thoroughly practical

character of Rhazes' medical writing in a few lines, but it may suffice

to say that there is scarcely any feature of modern medicine and surgery

that he does not touch, and oftener than not his touch is sure and

rational and frequently much better than the advice of successors long

after him in the same matters. An example or two will suffice to

illustrate this. In the treatment of nasal polyps he says that whenever

drug treatment of these is not successful, they should be removed with a

snare made of hair. For fall of the uvula he suggests gargles, but when

these fail he advises resection and cauterization. Among the affections

of the tongue he numbers abscess, fissure, ulcer, cancer, ranula,

shortening of the ligaments, hypertrophy, erythema of the mucous

membrane, and inflammatory swelling. In general his treatment of the

upper respiratory tract is much farther advanced than we might think

possible at this time. He advises tracheotomy whenever there is great

difficulty of respiration, and describes how it should be done. After

the dyspnea has passed the edges of the wound should be brought together

with sutures. It is not surprising, then, to find that the treatment of

fractures and luxations is eminently practical, and, indeed, on any

subject that he touches he throws practical light.

In the introduction to his edition of the works of Ambroise Pare,

Malgaigne says that the first reference to a metal band in connection

with trusses is to be found in Rhazes. Hernia was, of course, one of the

serious ailments that, because of its superficial character, was rather

well understood, and so it is not surprising to find that much of our

modern treatment of it was anticipated. The manipulations for taxis, the

use of a warm bath for the relaxation of the patient by means of heat

and by putting the head and feet higher than the abdomen while in the

bath, and the employment of various kinds of trusses to prevent

strangulation of the hernia recur over and over again, in the authors of

the Middle Ages. Many of the suggestions are to be found in the early

Greek authors, but subsequent writers give a certain personal expression

to them which shows how much they had learned by personal observation in

the employment of various methods.

Pagel, in Puschmann's Handbook of the History of Medicine, declares

that Rhazes' most important work for pure medicine is his monograph on

smallpox. Its principal value is due to the fact that, though he has

consulted old authorities carefully, his discussion of the disease is

founded almost entirely on his own experience. His description of the

various stages of the disease, of the forms of the eruption, and of the

differential diagnosis, is very accurate. He compares the course of the

fever with that of other fevers, and brings out exactly what constitutes

the disease. His suggestions as to prognosis are excellent. Those cases,

he declares, are particularly serious in which the eruption takes on a

dark, or greenish, or violet color. The prognosis is also unfavorable

for those cases which, having considerable fever, have only a slight

amount of rash. His treatment of the disease in young persons was by

venesection and cool douches. Cold water and acid drinks should be

administered freely, so that sweat and other excretions may carry off

poisonous materials. Care must be taken to watch the pulse, the

breathing, the appearance of the feet, the evacuations from the bowels,

and to modify therapy in accordance with these indications. The eruption

is to be encouraged by external warmth and special care must be taken

with regard to complications in the eyes, the ears, the nose, the mouth,

and the pharynx.

A fact that will, perhaps, give the best idea to modern readers of the

place of Rhazes in the history of medicine is that Vesalius considered

it worth his while to make a translation of his principal work.

Unfortunately that translation has not come down to us. When Vesalius,

pestered by the controversies that had come upon him because of his

venturing to make his observations for himself, accepted the post of

physician to the Emperor Charles V, he burnt a number of his

manuscripts. Among these were his translation of Rhazes and some

annotations on Galen, which, as he says himself, had grown into a huge

volume. The Galenists were bitterly decrying his refusal to accept Galen

on many points, and both of these works would have added fuel to the

flame of controversy. He deemed it wiser, then, not to give any further

opportunities for rancorous criticism, and, feeling presumably that in

his new and important post it was not worth while to bother further over

the matter, he burnt them. He tells the reason in his letters to Joachin

Roelant: When I was about to leave Italy to go to Court, since a number

of the physicians whom you know had made the worst kind of censure of

my books, both to the Emperor himself, and to other rulers, I burned

all the manuscripts that were left, although I had never suffered a

moment under the displeasure of the Emperor because of these complaints,

and in spite of the fact that a number of friends who were present urged

me not to destroy them.

Vesalius' translation of Rhazes was probably undertaken because he

recognized in him a kindred spirit of original investigation and

inquiry, whose work, because it was many centuries old, would command

the weight of an authority and at the same time help in the controversy

over Galenic questions. This, of itself, would be quite enough to make

the reputation of Rhazes, even if we did not know from the writings

themselves and from the admiration of many distinguished men as well as

the incentive that his works have so often proved to original

observation, that he is an important link in the chain of observers in

medicine, who, though we would naturally expect them to be so frequent,

are really so rare.