Ophthalmology in medieval Islam

Ophthalmology was one of the foremost branches in medieval Islamic medicine. The oculist or kahhal (کحال), a somewhat despised professional in Galen’s time, was an honored member of the medical profession by the Abbasid period, occupying a unique place in royal households. Medieval Islamic scientists (unlike their classical predecessors) considered it normal to combine theory and practice, including the crafting of precise instruments, and therefore found it natural to combine the study of the eye with the practical application of that knowledge.[1] The specialized instruments used in their operations ran into scores. Innovations such as the “injection syringe”, a hollow needle, invented by Ammar ibn Ali of Mosul, which was used for the extraction by suction of soft cataracts, were quite common.

An Arabic manuscript, dated 1200CE, titled Anatomy of the Eye, authored by al-Mutadibih.

Muslim physicians described such conditions as pannus, glaucoma (described as ‘headache of the pupil’), phlyctenulae, and operations on the conjunctiva. They were the first to use the words 'retina' and 'cataract'.

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, 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. One of Hunain ibn Ishaq's innovations was to describe the crystalline lens as being located in the exact center of the eye.[2]

Cataract extraction

The next major landmark text on ophthalmology was the Choice of Eye Diseases written in Egypt by the Iraqi Ammar ibn Ali al-Mawsili who attempted the earliest extraction of cataracts using suction. He invented a hollow metallic syringe, which he applied through the sclerotic and successfully extracted the cataracts through suction. He wrote the following on his invention:

"Then I constructed the hollow needle, but I did not operate with it on anybody at all, before I came to Tiberias. There came a man for an operation who told me: Do as you like with me, only I cannot lie on my back. Then I operated on him with the hollow needle and extracted the cataract; and he saw immediately and did not need to lie, but slept as he liked. Only I bandaged his eye for seven days. With this needle nobody preceded me. I have done many operations with it in Egypt."[3]

Other contributions

Avicenna, in The Canon of Medicine (c. 1025), described sight as one of the five external senses.[4] The Latin word "retina" is derived from Avicenna's Arabic term for the organ.[5]

In his Colliget, Averroes (1126–1198) was the first to attribute photoreceptor properties to the retina,[6] and he was also the first to suggest that the principal organ of sight might be the arachnoid membrane (aranea). His work led to much discussion in 16th century Europe over whether the principal organ of sight is the traditional Galenic crystalline humour or the Averroist aranea, which in turn led to the discovery that the retina is the principal organ of sight.[7]

Ibn al-Nafis wrote a large textbook on ophthalmology called The Polished Book on Experimental Ophthalmology. The book is divided into two sections: "On the Theory of Ophthalmology" and "Simple and Compunded Ophthalmic Drugs".[8] Other significant works in medieval Islamic ophthalmology include Rhazes’ Continens, Ali ibn Isa al-Kahhal’s Notebook of the Oculists, and the ethnic Assyrian Christian Jibrail Bukhtishu’s Medicine of the Eye, among numerous others.

Ottoman Empire

In the Ottoman Empire, 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.[9]

See also

• Islamic medicine
• Islamic science
• Islamic Golden Age
• List of Arab scientists and scholars
• List of Iranian scientists and scholars

References

1. David C. Lindberg (1980), Science in the Middle Ages, University of Chicago Press, p. 21, ISBN 0-226-48233-2
2. Leffler CT, Hadi TM, Udupa A, Schwartz SG, Schwartz D (2016). "A medieval fallacy: the crystalline lens in the center of the eye". Clinical Ophthalmology. 2016 (10): 649–662. doi:10.2147/OPTH.S100708. PMC 4833360. PMID 27114699.
3. Finger, Stanley (1994), Origins of Neuroscience: A History of Explorations Into Brain Function, Oxford University Press, p. 70, ISBN 0-19-514694-8
4. Finger, Stanley (1994), Origins of Neuroscience: A History of Explorations Into Brain Function, Oxford University Press, p. 71, ISBN 0-19-514694-8
5. Finger, Stanley (1994), Origins of Neuroscience: A History of Explorations Into Brain Function, Oxford University Press, p. 69, ISBN 0-19-514694-8
6. Martin-Araguz, A.; Bustamante-Martinez, C.; Fernandez-Armayor, Ajo V.; Moreno-Martinez, J. M. (2002). "Neuroscience in al-Andalus and its influence on medieval scholastic medicine", Revista de neurología 34 (9), p. 877-892.
7. Lindberg, David C. (1981), Theories of Vision from Al-Kindi to Kepler, University of Chicago Press, p. 238, ISBN 0-226-48235-9
8. Albert Z. Iskandar, "Ibn al-Nafis", in Helaine Selin (1997), Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures, Kluwer Academic Publishers, ISBN 0-7923-4066-3.
9. Laban Kaptein (ed.), Ahmed Bican, Dürr-i meknûn, p. 31f. Asch 2007. ISBN 978-90-902140-8-5

Further reading

• Ibn Abi Usaybi’ah, Uyun ul-Inba’ fi Tabaqat ul-Atibba, Cairo 1882.
• Nizami Arudhi, Chahar Maqalah. Gibb Series. London, 1921.
• Zeylessouf-ed-douleh, Matrah ul-anzār. Tabriz, 1916.
• Bar Hebraeus, Historia Dynastiarum, Edward Pococke's edition, Oxford 1663.
• M. Brett, W. Foreman. The Moors: Islam in the west. 1980.
• Cyril Elgood. A Madcap history of Persia and the eastern caliphate : the development of Persian and Arabic medical sciences, from the earliest times until the year A.D. 1932. 1979.
• Casey Wood. Memorandum book of a tenth-century oculist for the use of modern ophthalmologists : a translation of the Tadhkirat of Ali ibn Isa of Baghdad (cir. 940-1010 CE).