A SHORT HISTORY OF

NEUROLOGY
The Arab & Muslim Contribution
500-1516 A.D

Regional and 21st International Conference

of Alzheimer's Disease 28th Sep -1st Oct
2005

Ashraf Kurdi FRCP (G) FRCP (London)

Amman, JORDAN
Introduction
• The language of science at the time was Arabic.

• Many scientists and physicians throughout the Muslim

Empire taught and wrote in Arabic.

• Many scientists were born all over the Muslim Empire

from Central Asia to Andalusia with various ethnic and
religious backgrounds, but what united all of them
was the Arabic language which they all used in their
work. The political and cultural stability coupled with
religious tolerance was paramount in allowing their
work to flourish.

• One should not restrict the term of Arab Medicine to

those born in what is now an "Arab" country, but think
more globally without ethnic, religious or social2
Introduction ...

• In the history of Arab medicine, we can easily

identify several consecutive periods:
– Pre-Islamic and early Islamic medicine from 500 - 750
A.D, the end of the Umayyad caliphate in Damascus.

– The expansion of Arab medicine started when the Arabs

conquered Syria, Mesopotamia, Persia and Egypt and
came in contact with an established medical science and
tradition. This period coincided with the rise of the
Abassid caliphate from 750 - 900 A.D, and the expansion
of translation from the Greco-Roman medicine into
Arabic with addition of personal commentaries and
experiences to the original text.

3
Introduction ...

– The flourishing period of pure Arab medicine, which

started during the Abassid Caliphate around 900 A.D and
spanned through to the Andalusian era up to 1300 AD.

– The fourth period from 1300 - 1516 AD. This was

exemplified by the reverse wave of translations from
Arabic into Latin starting in the western countries of the
Arab domain, and the propagation of Arab medicine
from the schools of Southern Italy and Spain into the
north, especially Northern Italy, France and Germany.
Although at the same time another direct translation
from Greek into Latin was provided to the physicians of
Europe, the Arabic translations, due to their rich and
encyclopedic material remained to be the basic
textbooks to those physicians and thus became the
main stimuli for the renaissance in the West
4
Pre-Islamic and early Islamic period (500 -
750 A.D)
• This period can be further broken down
into two distinct periods:
– Pre-Islamic period (500 – 621 AD), including
the Late Greek and Roman periods.

– The early Islamic period which included the rise

of Islam (621 - 661 A.D), which was during the
prophet's time and the Orthodox Caliphate and
the Umayyad period (661 - 750 A.D).

5
The Abassid period (750 - 900 A.D)

• Center of power moved from Damascus to

Baghdad

• Translators
– Bakhtyashoo Family (730 – 1058 AD)
– Yohanna bin Masawaiyah (778 – 856 AD)
– Hunain bin Ishaq (809 – 873 AD)
– Costa bin Luqa (Died 912 AD)
– Thabet Bin Qurra (836 – 901 AD)

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Ali Bin Rabban Al-Tabari
(838-870 AD)

7
Ali Bin Rabban Al-Tabari
(838-870 AD)
• Author of the first Arabic Medical Encyclopedia
(The Paradise of Wisdom)
• Born and educated in Tabaristan before moving
to Baghdad

• The most important characteristic of Al-Tabari

was his reliance on his personal experience and
the clinical cases he treated or heard of from
reliable sources. One of the last chapters of his
book is devoted to psychotherapy where he cites
several examples of the effectiveness of this
treatment in psychosis
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Ali Bin Rabban Al-Tabari
(838-870 AD)
• In neurology
– He wrote about anatomy and physiology of the Central
Nervous System

– first to mention the internal sensations, which are called

"common sensations”

– first among the Arab authors to write on Epilepsy,

headache, Effect of psychological states in disease
occurrence

– Described tetanus as a disease and predicted the death

of the patient within four days

– Described hemiplegia, facial palsy and speech

difficulties associated with hemiplegia.
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The Flourishing Period (900 - 1300 AD)

• During this period the Islamic Empire extended

from China in the East to its Western Domain in
the Iberian Peninsula (Andalusia and Portugal).

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The Flourishing Period (900 - 1300 AD)
...

• The Arabic Language was by far the language of

science in that era

• Since the empire was so wide spread, the

contribution was not necessarily made just by
Muslims. Many Christians and Jews had major
contributions and only through the tolerance of
Islam did these scientists and physicians find the
freedom to study, practice, write and teach. Their
contributions were accepted and highly respected

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The Flourishing Period (900 - 1300 AD)
...
• The relationship between the eastern and
western part of the Empire was never interrupted.
Physicians and scientists made several trips from
one part to another carrying with them books,
knowledge and experience.

• In the East, Centers of Medical excellence were

already established and flourishing. Hospitals, as
both, centers of education, training and
treatment were widely spread. Libraries attached
to these institutions contained treasures of
medical books.

• Among the most famous physicians of the time

were Ar-Razi (Rhazes), Al-Majusi (Haly Abbas) and
12
The Flourishing Period (900 - 1300 AD)
...

• In Andalusia, the Arabs established a highly

sophisticated civilization and many physicians
and philosophers appeared throughout this
period.

• The most famous were: Ibn Rushd (Averroes),

Musa bin Maimun (Maimunedes) and several
physicians from the family of Ibn Zuhr (Avenzoar).

• The most famous surgeon of the era was Abu al-

Qasim al Zahrawi (Abulcasis). His book on surgery
“Al-Tasrif”, in which he described the surgical
tools used at that time, remained to be a
reference for several centuries.
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Abu Bakr Mohammed Bin Zakariya Ar-Razi
(Rhazes) (841–925 AD)

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Rhazes

• Rhazes is considered to be one of the greatest

doctors known to humanity

• Princeton University in the U.S. set aside the best

suite in its most beautiful building to the
achievements of Rhazes and established a center
to teach the Arabic language and translate his
manuscripts into English.

• Six hundred years ago, the school of medicine in

Paris had the smallest library in the world. It
contained only one book, Al-Hawi (the Container)
in medicine by Rhazes. He also excelled in many
fields including philosophy, Botany, zoology, 15
mathematics, physics and music.
Rhazes ...
• Rhazes was born in Ray, near modern-day Tehran in
Persia.

• He learned his anatomy from Galen’s books and from

his teacher Bin Masawaiyah.

• In Baghdad he dissected animals, particularly

monkeys, and also made many anatomical quotes,
such as “knowing the anatomy of that organ you will
understand its functions, then the illnesses that might
attack that organ”.

• He established a new tradition assimilating Greek and

other medical cultures. He wrote more than two
hundred books and articles, half of which relate to
medicine. 16
Rhazes ...
• His work was translated from Latin and soon became
the standard textbooks in most of the medical schools
of Europe.

• He emphasized in his writings and lectures, that

doctors should take note of the medical history as told
by patients, emphasized doctor patient relationship
and advised patients not to change doctors, except
when necessary.

• Rhazes was the first to treat patients who were

considered incurable. He went against what
Hippocrates advocated in keeping one’s distance from
incurable patients. He strongly committed himself to
treat these patients and continuously encouraged
them and helped them in facing their ailments. 17
Rhazes ...

• He also was sympathetic and firm in trying to

treat patients with neurologically incurable
diseases unlike Medieval Europe and the church
where such patients used to be imprisoned and
degraded. To that effect he was a true
humanitarian

• He was most noted in dealing with the question of

epilepsy. He was the first to distinguish between
Hereditary and Acquired Epilepsy.

18
Rhazes ...

• He says: “epilepsy is a convulsion that affects the

whole body. Yet it is not permanent, since its
illness disappears quickly. The ill effects that are
caused to the head and body organs indicate that
the illness emanates from the brain”.
• Rhazes was also the first to describe the
recurrent laryngeal nerve and thought it
originated near the trachea. He studied the
function of nerves. He said “ if the nerve was cut
longitudinally nothing will happen to that nerve,
but if cut transversely, both sensations and motor
power will be lost and it will be out of hand, no
use for treatment”.
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Rhazes ...

• He went against Galen as related to Hemiplegia

when he identified that the source of the
paralysis is in the brain whereas Galen related it
to the ventricles.

• Al- Hawi (the Container) his most famous medical

encyclopedia was written in 25 volumes. The first
volume was dedicated to Head illnesses and
contained 11 chapters dealing with most of the
neurological diseases such as stroke, paralysis,
numbness, convulsions, cognition, facial
weakness, epilepsy, nightmares, spasticity,
tetanus, meningitis and encephalitis, headache,
migraine and confusion
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Ali Bin Abbas Al-Majusi
(Haly Abbas) (?-995 AD)

• Haly Abbas was born in the town of Ahwaz near

Jundishapur.

• The name “Al-Majusi” is said to indicate that he

was a Persian of Zoroastrian ancestry.

• He reached his greatest eminence about 50 years

after the death of Rhazes.

• He wrote “Kamil Al-Sina’ah al-Tibbiya”, also

known as Al-Kitab Al-Malaki, the Royal Book (Liber
Regius).
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Haly Abbas ...

• Haly Abbas considered that nerves originate in

the brain, which is the center of sensory and
motor action.

• This action is mediated in the brain through the

cranial nerves and to the rest of the body through
the spinal cord.

• He identified that nerves originating from the

brain are bundled in 7 pairs and that each nerve
prior to emerging from the skull is covered with
two layers referring to the Pia matter and the 22
Haly Abbas ...

• Haly Abbas described the pathophysiology of

certain disorders that affect the brain and the
spinal cord.

• Examples of Brain disorders include headache,

trauma, parasthesia, confusional states,
meningitis, apoplexy, epilepsy, hemiplegia,
melancholy, obsession, memory loss, mania and
coma. He also described different types of skull
fractures

• Examples of Spinal cord disorders include

paralysis of flaccid and spastic type, clonus and
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parasthesia.
Abu Ali Al-Hussein Bin Abdallah ibn
Sina (Avicenna) (980-1037 AD)

24
Avicenna
• Avicenna was born near Bukhara (Central Asia)
and was called the Sheik, the Chief and the
second teacher, after Aristotle.

• He is highly respected for his contribution to the

field of medicine, both as a transmitter of the
knowledge of men like Hippocrates, Aristotle and
Galen, and as an original thinker on the subject.

• His energy and intelligence were all embracing,

and he also studied and wrote widely on
philosophy, astronomy, mathematics, the Arabic
Language, music and several other domains of
knowledge, thus producing over 276 books in all
branches of knowledge. He was an encyclopedic25
Avicenna ...

• He was the first to identify Meningitis thus

refuting the sayings of the ancients that the soft
and hard tissues such as the brain and bones are
not affected by inflammation, he was the first to
differentiate paralysis based on primary and
secondary etiological factors related to the brain.

• He described stroke resulting from bleeding,

contrary to common belief of the era based on
Greek medicine. He differentiated central and
peripheral facial weakness.

• Avicenna was the first to use oral anesthesia and26

Avicenna ...

• Avicenna also described a fundamental scientific

fact in the fractures of the skull. The skull bones
contrary to other bones in the body do not heal
after fracture in the same way as other bones in
the body. The skull is connected by fibrous
tissues and only through these does the skull
heals and broken segments reconnect.

• He further broke down skull fractures into two

types, closed and open fractures and ascertained
that deep broken fragments of skull fractures
should be removed to avoid further
complications.
27
Avicenna ...

• Avicenna also divided headache into three types;

Ordinary Headache, Headache caused by brain
damage and Migraine (Al-Shaqiqa).

• He was the first to formulate a mature idea about

the underlying pathophysiology of Migraine:
“migraine is due to hyper excitability of brain
tissue which causes the brain to react unusually
to noises and to light stimuli”.

• He also described several effective medications

for headaches. 28
Avicenna ...

• Avicenna differentiated between two types of

epilepsy, Grand Mal and Petit Mal. In his
description of Grand Mal epilepsy he identified
three stages of the attack as follows:
– Aura
– Clonic phase
– Relaxation
• He also differentiated between apoplexy and
Coma. Moreover, Avicenna introduced novel
methods of treatment such as the use of ice
packs in the treatment of various neurological
illnesses and more dramatically the use of
swimming in tanks with Electric eels for the
treatment of Epilepsy (Electrotherapy) 29
Avicenna ...

• His book (Al-Kanoon) was the most famous and

contained the essence of Greek and Arab
medicine.
• It comprises five volumes among which are
neurological diseases.
• It was printed twenty times in Latin in the
sixteenth century alone and was the principal
medical text in the Arab World and Europe for
about eight centuries.
• Avicenna summarized all medical knowledge in a
poem of 1326 verses.
30
Avicenna ...

• The first topic in the third volume in Al-Kanoon

deals with the diseases of the head and the brain.
It contains five articles:
– The First covers the overall provisions of the diseases of
the head and thebrain.
– The Second deals with the aches and pain of the head
– The Third deals with head tumors
– The Fourth deals with the illnesses of the head that
mostly affect the sensory and management actions
– The Fifth deals with brain diseases that strongly affect
voluntary movement
• The second topic in the third Volume of Al-Kanoon
deals with nerve diseases.
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Abu Al-Qassim Bin Abbas Bin Khalaf Al-
Zahrawi (Abulcasis) (936-1010 AD)

32
Abulcasis

• Abulcasis was born in the city of Al-Zahraa, to the

west of Qurtubah (Cordoba).
• He placed his knowledge and expertise in a single
book called “Al-Tasreef” (practical guide for those
who cannot be authors).
• It is composed of 30 articles divided into two
parts, medical and surgical, with the surgical part
divided into three sections. The last one is
devoted to brain and Neurosurgery, particularly
ailments resulting from head and brain injuries,
skull fractures and the use of skull trepanation.

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Abulcasis ...

• John Shaning did the first modern Latin

translation in Oxford in 1778.
• Lucien de Clerq did the first French translation in
1861.
• In 1908, Loco published an Arabic illustrated
edition. In 1974, Loco printed an English edition
together with the Arabic original and the
illustrating instruments.
• Al-Tasreef gained world fame and was the basic
book for surgery in Europe for five centuries.
• The Europeans adopted and developed a lot of its
Contents. 34
Contributions to Neurosurgery

• General Scientific contributions

– Abulcasis compiled all that pertained to
Neurosurgery and added a more developed
type of surgery based on anatomy.
– He used anesthesia during surgical operations
to alleviate the pain of patients
– He was the first to
• describe skull fractures and their complications and
also the first to describe depressed skull fractures in
children.
• to call on surgeons to familiarize themselves with the
anatomy of the body parts they were about to
operate on 35
Contributions to Neurosurgery ...
– He understood and realized that pain should
not be considered as an illness, but as a
symptom. Accordingly the root cause of the
pain, not pain itself should be treated

– He considered hygiene as basic in the

treatment of wounds.

– He called for the sterilization of wounds and

used Alcohol for this purpose contrary to the
ideas of his contemporaries

– He described head injuries including

bleeding inside/outside the skull

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Contributions to Neurosurgery ...

• Technical Contributions

– Abulcasis invented an instrument that prevents

involuntary penetration of the skull of the
patient during the process of trepanation, and
this modification is still in existence today.

– Described and performed a cranium fissure in

the same manner performed nowadays. He
made several holes in the skull and then
connected them.
37
Contributions to Neurosurgery ...

38
Contributions to Neurosurgery ...

– Stressed the need for utmost care before brain surgery

to remove bones and coarseness resulting from injuries.
He stressed the need to have these areas clean and
sterile.

– Called for the readiness of surgical instruments for

emergencies. (i.e. to be kept sterile and clean)

– Advised the use of female assistants and nurses when

operating on women to ensure calmness and peace of
mind of woman patients

– Used instruments for the stretching of the neck and

prolapsed Disc.

39
… And other Contributions

• Abulcasis had also numerous contributions not

only in Neurosurgery but also in the field of
neurology in the areas of Apoplexy, hemiplegia,
Facial Paralysis, Convulsions and Tonic Spasms,
Flaccidity and Anosmia.

• Professor Garcia Palestero of Granada University

in Spain stated: “Abu Al-Qasim Al-Zahrawi was
the greatest Muslim surgeon in the whole of the
middle ages. He was the point of departure for all
types of brain and skull surgeries in Spain and
Western Europe”.

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Concluding Remarks on the Arab
Contributions to Medical Sciences
• The Arabic language was the world language (Lingua
Franca) of science. Until the sixteenth and seventeenth
centuries, every medical student had to master the Arabic
language. Between 850-1350 AD, there were 4000 medical
books written in the Arabic language.

• During that time, students headed towards Baghdad,

Alexandria, Damascus and Andalusia to study medicine.

• Translating from various pre-Arab civilizations like the

Babylonian , Egyptian, Greek, Indian and Persian cultures

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Concluding Remarks on the Contribution in
Medical Sciences …
• Polishing, developing, expanding and adding to the
neurological sciences

• Writing encyclopedic books on medicine and

pharmacology

• The first to introduce illustrations and tables in the

study of medicine and the first to write medical
sciences in poetical form to make it easy for students
to memorize

• Established various types of hospitals (called

Bimaristan) including a new residency system for
doctors and specialized wards for psychiatric patients.
42
Concluding Remarks on the Contribution in
Medical Sciences …

• Introduced examinations and prohibited

unlicensed or unqualified persons from practicing
medicine.
• Emphasized ethical standards that were based on
– Hippocrates
– Christian values and principles
– Islamic values and principles

• Played an important and prominent role in the

study of anatomy, physiology, diagnosis and
treatment of various neurological disorders.
43
Concluding Remarks on the Contribution in
Medical Sciences …

• Described Neurosurgical operations, instruments

and sutures.

• Played a large role in discovering anesthesia and

sterilization by alcohol.

• The West built on this foundation and embarked

on its modern renaissance that came in the wake
of the stillness of the middle ages, and took off at
the beginning of the seventeenth century.

44