Rhazes
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
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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.