Ophthalmology in medieval Islam

Ophthalmology in medieval Islam

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Encyclopedia
Ophthalmology
Ophthalmology
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...

was one of the foremost branches in medieval Islamic medicine
Islamic medicine
In the history of medicine, Islamic medicine, Arabic medicine or Arabian medicine refers to medicine developed in the Islamic Golden Age, and written in Arabic, the lingua franca of Islamic civilization....

. The oculist or kahhal (کحال), a somewhat despised professional in Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...

’s time, was an honored member of the medical profession by the Abbasid
Abbasid
The Abbasid Caliphate or, more simply, the Abbasids , was the third of the Islamic caliphates. It was ruled by the Abbasid dynasty of caliphs, who built their capital in Baghdad after overthrowing the Umayyad caliphate from all but the al-Andalus region....

 period, occupying a unique place in royal households. As such, medieval Islamic physicians are considered founders of ophthalmology as an independent discipline in its own right. The specialized instruments used in their operations ran into scores. Innovations such as the “injection
Injection (medicine)
An injection is an infusion method of putting fluid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body...

 syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...

”, a hollow needle
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...

, invented by Ammar ibn Ali of Mosul
Mosul
Mosul , is a city in northern Iraq and the capital of the Ninawa Governorate, some northwest of Baghdad. The original city stands on the west bank of the Tigris River, opposite the ancient Assyrian city of Nineveh on the east bank, but the metropolitan area has now grown to encompass substantial...

, which was used for the extraction by suction of soft cataracts, were quite common.

Muslim physicians described such conditions as pannus
Pannus
Pannus is a medical term for an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface , or on a prosthetic heart valve...

, glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

 (described as ‘headache of the pupil’), phlyctenulae, and operations on the conjunctiva
Conjunctiva
The conjunctiva covers the sclera and lines the inside of the eyelids. It is composed of rare stratified columnar epithelium.-Function:...

. They were the first to use the words 'retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...

' and 'cataract
Cataract
A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light...

'.

Fertile grounds for emergence


The scientific achievements of the late Abbasid period may perhaps be attributed to the worldview that had developed as a result of the establishment of the House of Wisdom
House of Wisdom
The House of Wisdom was a library and translation institute established in Abbassid-era Baghdad, Iraq. It was a key institution in the Translation Movement and considered to have been a major intellectual centre during the Islamic Golden Age...

, and intermingling of scholars from India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

, Persia, North Africa and the west, in Baghdad
Baghdad
Baghdad is the capital of Iraq, as well as the coterminous Baghdad Governorate. The population of Baghdad in 2011 is approximately 7,216,040...

.

Education and history


To become a practitioner, there was no one fixed method or path of training. There was even no formal specialization in the different branches of medicine, as might be expected. But some students did eventually approximate to a specialist by acquiring proficiency in the treatment of certain diseases or in the use of certain drugs.

Nevertheless it was standard and necessary to learn and understand the works and legacy of predecessors. Among those one can mention, The alteration of the eye by Yuhanna ibn Masawayh
Masawaiyh
Yuhanna ibn Masawaih, also written Ibn Masawaih, Masawaiyh, and in Latin Mesue, Masuya, Mesue Major, Msuya, and Mesue the Elder was an Assyrian physician from the Academy of Gundishapur...

, whose work can be considered the earliest work on Ophthalmology, followed by Hunain ibn Ishaq, known in the west as Johannitius, for his work The ten treatises of the eye.

Cataract extraction


The next major landmark text on ophthalmology was the Choice of Eye Diseases written in Egypt
Egypt
Egypt , officially the Arab Republic of Egypt, Arabic: , is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Southwest Asia. Egypt is thus a transcontinental country, and a major power in Africa, the Mediterranean Basin, the Middle East and the Muslim world...

 by the Iraq
Iraq
Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....

i Ammar bin Ali Al Mawsili http://www.nlm.nih.gov/exhibition/islamic_medical/islamic_09.html who attempted the earliest extraction of cataract
Cataract
A cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light...

s using suction
Suction
Suction is the flow of a fluid into a partial vacuum, or region of low pressure. The pressure gradient between this region and the ambient pressure will propel matter toward the low pressure area. Suction is popularly thought of as an attractive effect, which is incorrect since vacuums do not...

. He invented a hollow metallic syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...

 hypodermic needle
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...

, which he applied through the sclerotic
Sclerosis (medicine)
In medicine, sclerosis refers to the stiffening of a structure, usually caused by a replacement of the normal organ-specific tissue with connective tissue.Types include:...

 and successfully extracted the cataracts through suction. He wrote the following on his invention of the hypodermic needle and how he discovered the technique of cataract extraction while experiment
Experiment
An experiment is a methodical procedure carried out with the goal of verifying, falsifying, or establishing the validity of a hypothesis. Experiments vary greatly in their goal and scale, but always rely on repeatable procedure and logical analysis of the results...

ing with it on a patient:

Other contributions


Avicenna
Avicenna
Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...

, in The Canon of Medicine
The Canon of Medicine
The Canon of Medicine is an encyclopedia of Galenic medicine in five books compiled by Ibn Sīnā and completed in 1025. It presents a clear and organized summary of all the medical knowledge of the time...

(c. 1025), described sight as one of the five external sense
Sense
Senses are physiological capacities of organisms that provide inputs for perception. The senses and their operation, classification, and theory are overlapping topics studied by a variety of fields, most notably neuroscience, cognitive psychology , and philosophy of perception...

s. The Latin word "retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...

" is derived from Avicenna's Arabic
Arabic language
Arabic is a name applied to the descendants of the Classical Arabic language of the 6th century AD, used most prominently in the Quran, the Islamic Holy Book...

 term for the organ.

In his Coliget, Averroes
Averroes
' , better known just as Ibn Rushd , and in European literature as Averroes , was a Muslim polymath; a master of Aristotelian philosophy, Islamic philosophy, Islamic theology, Maliki law and jurisprudence, logic, psychology, politics, Arabic music theory, and the sciences of medicine, astronomy,...

 (1126–1198) was the first to attribute photoreceptor properties to the retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...

, and he was also the first to suggest that the principle organ of sight
Visual perception
Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...

 might be the arachnoid membrane
Arachnoid mater
The arachnoid mater, literally from Latin "spider -like mother", is one of the three meninges, the membranes that cover the brain and spinal cord...

 (aranea). His work led to much discussion in 16th century Europe over whether the principle organ of sight is the traditional Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...

ic crystalline humour
Humorism
Humorism, or humoralism, is a now discredited theory of the makeup and workings of the human body, adopted by Greek and Roman physicians and philosophers, positing that an excess or deficiency of any of four distinct bodily fluids in a person directly influences their temperament and health...

 or the Averroist aranea, which in turn led to the discovery that the retina is the principle organ of sight.

Ibn al-Nafis wrote a large textbook on ophthalmology called The Polished Book on Experimental Ophthalmology in which he made a number of original contributions to the field. The book is divided into two sections: "On the Theory of Ophthalmology" and "Simple and Compunded Ophthalmic Drugs". Ibn al-Nafis discovered that the muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...

 behind the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...

ball does not support the ophthalmic nerve
Ophthalmic nerve
The ophthalmic nerve is one of the three branches of the trigeminal nerve, the fifth cranial nerve. The ophthalmic nerve carries only sensory fibers.-Branches:*Nasociliary nerve**sensory root of ciliary ganglion**posterior ethmoidal nerve...

, that they do not get in contact with it, and that the optic nerve
Optic nerve
The optic nerve, also called cranial nerve 2, transmits visual information from the retina to the brain. Derived from the embryonic retinal ganglion cell, a diverticulum located in the diencephalon, the optic nerve doesn't regenerate after transection.-Anatomy:The optic nerve is the second of...

s transect
Transect
A transect is a path along which one records and counts occurrences of the phenomena of study .It requires an observer to move along a fixed path and to count occurrences along the path and, at the same time, obtain the distance of the object from the path...

 but do not get in touch with each other. He also discovered many new treatments for glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

 and the weakness of vision
Visual system
The visual system is the part of the central nervous system which enables organisms to process visual detail, as well as enabling several non-image forming photoresponse functions. It interprets information from visible light to build a representation of the surrounding world...

 in one eye when the other eye is affected by disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

.

Other famous landmarks in ophthalmology include Rhazes’ Continens, Ali Ibn Isa’s Notebook of the Oculists, and the ethnic Assyrian Christian Jibrail Bukhtishu
Jabril ibn Bukhtishu
Jabril ibn Bukhtishu, also written as Bakhtyshu, was an 8-9th century physician from the Bukhtishu family of Persian Nestorian physicians from the Academy of Gundishapur...

’s Medicine of the Eye, among numerous others.

Ottoman Empire


In the Ottoman Empire
Ottoman Empire
The Ottoman EmpireIt was usually referred to as the "Ottoman Empire", the "Turkish Empire", the "Ottoman Caliphate" or more commonly "Turkey" by its contemporaries...

, and well into the Republic of Turkey of the 20th century, a class of ambulatory eye surgeons, popularly known as the ‘kırlangıç oğlanları’ (‘sons of the swallow’) operated on cataract using special knives. From contemporary sources can be glimpsed that the reputation of these “blinding frauds” was far from spotless.

Fees and income



There was a good deal of drama surrounding the men of medical professions in those days. A physician could on the one hand receive no less than an astronomical sum of 4,000,000 dirhams a year, as did Bukhtishu
Bukhtishu
Bakhtshooa Gondishapoori were Persian Nestorian Christian physicians from the 7th, 8th, and 9th centuries, spanning 6 generations and 250 years. Some of them served as the personal physicians of Caliphs. Jurjis son of Bukht-Yishu was awarded 10,000 dinars by al-Mansur after attending to his malady...

 ibn Jurjis, the Assyrian Christian chief physician to the great Caliph Harun al-Rashid
Harun al-Rashid
Hārūn al-Rashīd was the fifth Arab Abbasid Caliph in Iraq. He was born in Rey, Iran, close to modern Tehran. His birth date remains a point of discussion, though, as various sources give the dates from 763 to 766)....

; or pay for the unfortunate death of his patient or failure of his treatment with his own life, as was often the case with physicians treating many a royalty.

But in general, the fee varied according to the status of the physician and the patient. The life of Ibn Masawayh, can perhaps be quite instructive in this regard: When still unknown and still a so called “road-side” physician in Baghdad, in return for successfully treating a servant suffering from Ophthalmia
Ophthalmia
Ophthalmia is inflammation of the eye. It is a medical sign which may be indicative of various conditions, including sympathetic ophthalmia , gonococcal ophthalmia, trachoma or "Egyptian" ophthalmia, ophthalmia neonatorum ,...

, he was paid with a daily allowance of bread and meat and sweets and a promise of a monthly salary of a few silver and copper coins. When The Vizier fell ill and Ibn Masawayh achieved similar success with him, his salary rose to 600 silver dirhams a month, food for two mules, and the services of five servants. And when he finally obtained the rank of chief ophthalmologist to the Khalifah, his salary was fixed at 2000 dirhams a month plus gifts valued at 20,000 dirhams a year, including forage for his mules as well as the services of a number of servants.

However, fees paid to ophthalmologists were measly in comparison to the elephantine fees which others were apt to receive overall. At the time when Ibn Masawayh received 2000 dirhams a month as ophthalmologist-in-chief to the Caliph Harun al-Rashid, Jibrail the physician was receiving 10,000 dirhams per month.

As to the means of obtaining the fee, in cases deemed chronic requiring multiple visits, they would receive the fee only on the fair conclusion of the case. If the patient recovered, there was, in most cases, no question of refusal to pay. But if the case ended fatally, then the relatives could if they so choose, show the chief physician of the city a copy of all prescriptions and medicaments which he ordered for the sick person. If the Hakim-bashi determined they were proper and fitting for the case and that the physician was exempt of any negligence or fault, he could declare that the person’s life had reached its allotted span by the will of Allah, and that the fees had to be paid in full. If on the other hand, the chief physician found evidence of neglect, he would direct the relatives to collect dieh (or blood money) for their kinsman from the physician, ‘for it is he who slew him by his poor skill and negligence.’

Nevertheless, some ophthalmologists would be fortunate enough to work as personal ophthalmologist to an Amir of good heart and intellect, and some Caliphs were even known to have kept a personal ophthalmologist in addition to a personal physician.

So well ingrained did the science of ophthalmology become in medieval Islamic culture that the word used for "wisdom" in Arabic is "al-Basirah", meaning the ability to see. In fact, one refers to loved ones as "Nour al-Ayni" meaning the light of my eyes.

See also

  • Islamic medicine
    Islamic medicine
    In the history of medicine, Islamic medicine, Arabic medicine or Arabian medicine refers to medicine developed in the Islamic Golden Age, and written in Arabic, the lingua franca of Islamic civilization....

  • Islamic science
    Islamic science
    Science in the medieval Islamic world, also known as Islamic science or Arabic science, is the science developed and practised in the Islamic world during the Islamic Golden Age . During this time, Indian, Iranian and especially Greek knowledge was translated into Arabic...

  • Islamic Golden Age
    Islamic Golden Age
    During the Islamic Golden Age philosophers, scientists and engineers of the Islamic world contributed enormously to technology and culture, both by preserving earlier traditions and by adding their own inventions and innovations...

  • List of Arab scientists and scholars
  • List of Iranian scientists and scholars