By Zakaria Virk, Toronto
Science progressed at an impressive pace in the Muslim world during the Islamic golden age i.e. from 8th to 12th century. Not only voluminous & insightful books were composed on various scientific disciplines but new inventions and ground breaking discoveries were made. Of the various medical disciplines, most of the contributions were made by medical practitioners in the field of ophthalmology.
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye including the eye, brain, and areas surrounding the eye, such as the lacrimal system and eyelids. An eye specialist is known in Arabic as Al-Kahhal from the word Kuhl (kollyre).
Renowned Muslim scholars like Zakariya al-Razi, Ibn Sena, al-Haytham, al-Zahrawi, Ibn Zuhr, Ibn Rushd, Ibn Nafis made significant contributions in this field. Books authored by Al-Razi, Ibn Sena, & al-Zahrawai were used as medical text books in European universities for centuries. In the main hall of the Paris University’s Faculty of Medicine, there hang portraits of al-Razi and Ibn Sena as a tribute to these two giants of medicine. On the stained glass window pane of a church in Princeton University, al-Razi portrait is painted as acknowledgment to his skill and immense benefits of his skill & knowledge to humanity.
The way science is divided these days into various branches, this was not the case during the middle ages. I have yet to see curriculum of medical schools. To become a practitioner there was no fixed path. All one had to do was study medical books and get training under a seasoned physician. To become an ophthalmologist a license was required granted by Hakim-bashi, royal physician to the Caliph. Before 931 there was no medical certification, when Caliph al-Muqtadir asked Sinan ibn Sabit to examine and approve physicians. Ophthalmologists hence had to satisfy the examiner that they knew the principal diseases of the eye as well as their intricate complications, and were able to properly prepare collyria and ophthalmic ointments. Moreover they had to assert under oath not to allow unauthorized persons access to any surgical instruments, such as the lancet that was used for cases of pannus and pterygium, or the curette used for cases of trachoma. Compared to a physician, eye doctor fee was small.
Muslim physicians-oculists made astonishing contributions and discoveries in eye diseases and cures. It was a Muslim scholar who produced anatomy of the eye for the first time. The Latin word “retina” is derived from Avicenna’s Arabic term for the organ. The “injection syringe”, a hollow needle, was invented by Ammar ibn Ali of Mosul, Iraq. Al Mosuli attempted the earliest extraction of cataracts using suction. Eye conditions such as pannus, glaucoma (described as ‘headache of the pupil’), phlyctenulae, and operations on the conjunctiva were described by Muslim physicians/oculists. Ibn Rushd (1198) was the first to attribute photoreceptor properties to the retina. Arabic terms such as Eyeball, Conjunctiva, Cornea, Uvea and Retina were introduced by Muslims. Muslims also did operations on diseases of the lids such as trachoma, a hardening of the inside of the lid. Glaucoma (an increase in the intra-ocular pressure of the eye) under the name of “Headache of the pupil” was first described by a Muslim.
Muslim physicians/ oculists made significant contributions in ophthalmology: Yuhanna ibn Masawayh, al-Tabari, Ali ibn Abbas al-Majusi (994), a-Zahrawi (1013) Ammar bin Ali al-Mosuli, Hunayn ibn Ishaq (a Christian), Ali ibn Isa, al-Razi, Ibn Sena, Ibn al-Haytham (1039) Abu Abdulla al-Tamini, Adnan al-aynzarbi (12th century), al-Ghafiqi, Ibn Rushd, Khalifa abi al-Mahasin, Fatah al-Din al-Qaysi, Ibn al-Quff al-Karki, ibn Nafis, Daud al-Antaki (1599), Ibrahim al-Hanafi, Abd al-Qadir al-Khulasi al-Dimishqi, Ahmad Hassan al-Rashidi (1840).
Translations of more than 400 Arab authors, writing on such varied topics as ophthalmology, surgery, pharmaceuticals, child care and public health, deeply influenced the rebirth of European science. Works of the Muslim ophthalmologists were translated into Latin and became the foundation of the ophthalmology in Europe, with many Arabic texts used well into the nineteenth century.
Hunyan ibn Ishaq (873 Baghdad) was the first one to provide anatomy of the eye in his ground breaking work Kitab al-ashr maqalat fil Ayn – i.e. Ten Treatises on the Eye. His detailed explanations of the physiology of the eye, reached Europe during the Renaissance and carried many terms still used today, based upon the Arabic words. European scholars gave diagrams of the eye made by Hunayn. He described cysts, tumors and ulcers, their causes and also laying out recommended treatments and suggestions for repairing cataracts.
Abu Bakr Muhammad Ibn Zakariya al-Razi (923 Iran/Baghdad) was known in Medieval Europe by the title of The Arab Galen. He was the first one to state retina reacts to light. Also he was the first doctor to describe the reflex action of the pupil. In his treatise On the Nature of Vision he stated eyes do not emit rays of light, as the Greek scholars had thought. In his landmark book Kitab al-Mansuri, Razi documented the removal of cataracts with a glass tube and described the cauterization of lachrymal fistulas, truly innovative work in the field. His treatise on ophthalmology was translated into German in 1900. In his magnum opus Kitab al-Havi there is a chapter on ophthalmology. He explained causes for glaucoma i.e. salt consumption. His other books in this field are fee kaifiyat al-absar, kitab fee hait-al ayn, kitab fee elaj al-ayn bil-hadid.
There are some sections in Kitab al-Mansuri that deal with anatomy of the eye and eye ailments. He observed how airborne germs can cause infectious diseases, including inflammation of the eye: “Among the things that are infectious are: leprosy, scabies, consumption and epidemic fever, when one sits with those who are afflicted in small houses and downwind (from them). Often ophthalmia infects by being looked at and often (the condition of) multiple evil ulcers is (also) transferable. Generally speaking in every illness which has decomposition and (bad) air, one should distance oneself from the afflicted or sit upwind from them. His essay on infectious diseases was the first scientific treatise on the subject. His originality is evident in his veritable clinical observations.
The earliest known medical description of the eye, from a ninth-century work by Hunayn ibn Ishaq, is shown in this copy of a 12th-century manuscript at the Institute for the History Arab-Islamic Science in Frankfurt.
Abu Mansur al-Hassan al-Qumri (990) lived in Khorasan, Iran. He was teacher of Ibn Sina. His only treatise Kitab al-Ghina wa-al Muna is preserved in NLH, USA. He explained reasons for weak eyesight namely: such a person had constipation, looked at a bright object, read books with small letters, consumed too much salt in food, or had too much sugar for a prolonged period. Now a day it is called diabetic retinopathy.
Abul Hassan Muhammad bin Tabari (10th century) his book Mu’alijat al-Buqratiyya contains 10 dissertations, 4th one is on diseases of the eye, giving its layers and their uses. Hirshberg has praised his depth of experience in this field.
Ali ibn Abbas al-Majusi (994) composed a book on ophthalmology Kamil al-San’aa al-Tibbiya. It’s translation in Latin by Constantine the African in the 11th century was known as Liber Regius (Kitab al-Malaki). In the 13th chapter there is description of eyes and its uses, eye ailments and their treatments like ophthalmia, swelling, hardness in conjunctiva, itch, pannus, blood spot, ulcers, pustules, protuberance in the eyes, treatment of corneal cancer, chemosis, thrush, tinea and scrofula.
It was translated into Urdu by Hakim Ghulam Hussain Kantori and published from Lucknow in 1889. In this book he presented the idea of capillary system and Pterygium. He knew three eye ailments i.e. optic nerve, retina, and choroidal disease. He prescribed special foods for people with eye ailments. He stated that people who have diabetes and kidney complications their eyes can be affected. He described 130 eye diseases, 143 simple drugs, and names of herbs beneficial for the afflicted eyes. It was translated into Latin 1499, French 1903, & in German 1904.
Abul Qasim al-Zahrawi (1009) was pioneer of modern surgery. He performed cataract operations and expounded it in detail. In his comprehensive book on surgery Kitab al-Tasrif, he divides eye diseases into 12 divisions, including those of the eyelids such as scabies, adhesion, and cohesion. He says chemosis is of two kinds. He described diseases of conjectiva such as ophthalmia, blood clot in the white of the eye, diseases of cornea such as ulcers, causing severe pain, headache and flowing of tears. In Maqala 30 he described surgical operations on the eye. He was the first one to give diagrams of surgical instruments.