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Ever the twain shall meet: The interaction of medical science, East and West AN EXHIBITION AT THE WELLCOME INSTITUTE FOR THE HISTORY OF MEDICINE May1993 NIGEL ALLAN CONTENTS Introduction page3 From West to East THEPRESERVATIONOFCLASSICAL GREEKMEDICINEINTHEISLAMICWORLD page 7 From East to West THETRANSMISSIONOFISLAMICMEDICINETO MEDIEVALANDRENAISSANCEEUROPE page 15 IU4JM.III1 Medicine in India ANEXAMPLEOFCOEXISTENCEANDCOOPERATION page23 'Bringing the Smallpox' SMALLPOXINOCULATION,ORIENTALANDOCCIDENTAL page 40 1U4JM.U 'Chinese medicine was at least as good as that of Europe' EARLYWESTERNACQUAINTANCEWITHTHETRADITIONAL MEDICALSYSTEMSOFCHINAANDTHEFAREAST page 48 THEOPENINGOFTHE FAREASTTOWESTERNMEDICINE page 56 INTRODUCTION It is recorded in the first chapter ofthe Book ofGenesis that God made man in his own image afterhis likeness as the crowninggloryofhis cre- ation. Sincemanwasformedinthedivinelikeness,Godbeingconsideredas thesourceofall truthandgoodness, so mankindmustpossess thisinherent goodness not, perhaps, always apparent in a world torn bywar and blood- shed,famineandgreed. Itis,however,thisinherentgoodnessreflectedinthehealingactivitiesof mankindwhicheverycultureandrace hasgivenwitness to in all periodsof time.Thispositiveelementinhumannatureisseenamongthemostprimi- tive peoples, developing in different cultures in different ways throughout the world as a thread ofcontinuity linking the brilliant discoveries ofthe medicalsciencesofourowntimewithwhathasgonebefore. Itistothefur- thercontinuanceofhumanity'swellbeingthattheWellcomeTrusthasdedi- catedits resourcesso thatthispositivesideofhumannaturemaybefurther stimulatedtoevernewmedicaldiscovery. This exhibition seeks to demonstrate the interchange ofideas between EastandWestthathavebeenamutualstimulanttomedicalthoughtinboth hemispheres. Itwas astimulus based both on thecontinuityofthe medical heritageofthepastinitspreservationanddevelopmentwithindifferentcul- tures and thecontactbetween these cultures that gave rise to asynthesis of ideaswhichhasbeenofmutualbenefittoallpeoples. FollowingthedeclineoftheRomanEmpire,whenwesternEuropesank into semi-barbarism, the great corpus ofclassical Greek medical literature waspreservedin theemergentIslamicEmpireoftheeasternMediterranean. HeremanymedicalworksofancientGreecewerepreservedinArabic trans- lationwhichwouldotherwisehavebeenlost. Medicalknowledgewasfurther advanced especially in the fields ofmateria medicaand alchemy. Under the Abbasid Caliphs, Baghdadbecame thecentreofIslamicscience largelydue to the high esteem in which Christian physicians were held who acted as translators from Greek into Syriac and Arabic. The preservation and advancement ofscientific knowledge in the medieval Islamic world tran- scendedculturalandreligiousdifferences,sogreatwastheadmirationofthe Arabsfortheheritagethathadbeenpassedtothem. When Europe began to emerge from centuries ofpolitical and social 3 upheaval, the West was again in a position to turn its attention to more positive pursuits for the benefitof its peoples. During the twelfth and thir- teenth centuries, European contact with the Islamic world increased, espe- ciallyfollowingtheCrusades, andinterestgrewin Islamicscienceingeneral and the Hellenistic corpus of medical literature it preserved. Manyworks weretranslatedfromArabicintoLatin,resultinginanintellectualsummerof Islamic influence in late medieval Europe. SpanishJews, fluent in Arabic, were the natural intermediaries from East to West ofmedical andscientific knowledgepreservedinArabic. Furtherimpetus to this intellectual awaken- ing in Europe was given by the invention ofprintingwith moveable type, while the Renaissance followed closely by the Reformation aroused fresh interest in the Semitic languages ofthe East, particularly Hebrew, the lan- guageoftheOldTestament. Trade, missionary activity and finally political exigency brought the greattradingnationsoftheWestintocontactwiththeIndiansubcontinent. The Portuguese, Dutch and British all came and marvelled at the magnifi- cenceofIndiawhichwastobecomethejewelintheBritishCrownwhen,in 1858,itsadministrationwastransferredfromtheEastIndiaCompany.From theearlyyearsofWesterncontactastreamofmedicalknowledgerelatingto plants and spices, descriptions ofdiseases and surgical practices hitherto unknown was brought back to Europe. India in turn benefited from the greatdevelopmentsinthemedicalworldofeighteenth-andnineteenth-century Europe. Hospitals were established and medical colleges set up to pro- videinstructioninthelatestmedicaltechniques. Concurrentwiththisinter- change ofideas between theWestern system ofmedicine and those indige- nous to India or long extant in the subcontinent, these systems themselves were interacting, particularly theAyurvedic system ofHindu India and the Undn?ov Greek system which had come to India with Islam. Today, the Westernandindigenoussystemscoexist, complementingeachotherwithout anyconceptofrivalryorcompetition. Similarmedicalpracticesareknowntohavebeencarriedoutindifferent partsoftheworldquiteindependently. Circumcisionwasperformedforrea- sonsofhygienebyquitedisparatepeoples livingin hotclimates in different partsoftheworld. Similarly,variolationwaspractisedbythepeoplesofAsia andAfricawhere itwas realisedfrom timeimmemorial thatthosewhocon- tractedsmallpoxand survived neverexperienceda recurrenceofthedisease. 4 Thepracticeofvariolationwas introducedto Britain in theeighteenthcen- turybythewifeofaBritishambassadortotheOttomanPorte,whohadwit- nesseditperformedatConstantinople.Althoughitbecamefashionablefora while,riskofinfectionlostitpopularity.Almostacenturywastopassbefore theWest could give the EastJenner'svaccination- the use ofcowpox as a thoroughly safe means ofimmunization against smallpox. Countless num- bersinbothEastandWesthavebenefitedsinceandnowsmallpoxhasbeen eradicated. Since theseventeenth century the West has been awareofmanyofthe traditionalmedicalpracticesoftheFarEast,especiallyChina.Jesuitmission- aries,whowereheldinhighesteembytherulersofimperialChina,recorded muchofwhattheywitnessed. Itis not, however, untilcomparativelyrecent timesthattheancientmedicalskillsofChina,particularlyacupuncture,have achieved acceptance in the West. Now medical practices employed from antiquityin Chinaarealso usedin theWestto treatnumerousdisorders. It was not, however, until the nineteenth century that a serious attempt was made to bring the benefits ofWestern medicine to the peoples ofthe Far EastwhenJennerianvaccination againstsmallpoxwas introduced to Macao in 1815.Medicalmissionariesplayedamajorroleinsettinguphospitals,dis- pensaries and colleges for the dissemination ofWestern medicine and instruction.ItwastheywhosawtheneedfortranslationsofWesternmedical textbooksintoChineseandwerepioneersindevelopingavocabularytocon- veymedicalconceptshithertounknowntotheChinese. Itwastothistaskof translating medical textbooks that Sir Henry Wellcome gave his financial support.Japan receivedalargepartofhermedical heritagefromChinaand it was here thatWesterners first sawacupuncture practised. Western medi- cineinJapanowedmuchtoPhilippvonSiebold, thedistinguishedGerman physician and scientist whose fascination withJapan is an epic in itself beyondthepurviewofthisexhibition. I recordmyappreciationoftheexpertiseofDrKenArnold, Exhibitions Officer ofthe Wellcome Institute, withoutwhose assistance this exhibition wouldnothavebeenpossible. Mythanksarealsodue to mycolleagues, Dr Richard Aspin, Dr Peter Friedlander and Dr Dominik Wujastyk for infor- mation regarding exhibits ofwhich they have a special knowledge. Unless otherwise stated, all items are from the Wellcome Institute Library. I am grateful totheauthoritiesattheOrientalandIndiaOfficeCollectionsatthe 5 British LibraryandattheScience Museum fortheloanofitems from their respective collections. It is hoped this exhibition will illustrate through the richness and diversity ofthe Wellcome Collections that the pursuit ofthe advancement ofmedical knowledge knows no barriers ofculture, creed or racebutonlyacooperationthattranscendsallhumandivisionintheendeav- our to improve thewellbeingofhumanity. In tribute to the eminent Scots physician and scientist SirJames Cantlie, who spent many years work- ing among the Chinese people, Dr Sun Yat-sen, founder ofthe Chinese Republic, quoted thewell-known words ofRudyard Kipling, words appro- priate to manyinvolved in theexchange ofmedical ideas between Eastand Westthroughthecenturies: 'Oh,EastisEast,andWestisWest,andneverthetwainshallmeet, TillEarthandSkystandpresentlyatGod'sgreatJudgementSeat. ButthereisneitherEastnorWest,Border, norBreed, norBirth, Whentwostrongmenstandfacetoface, thoughtheycome fromtheendsoftheearth!' NIGELALLAN CuratorofOrientalManuscriptsandPrintedBooks 6 FROM WEST TO EAST THE PRESERVATION OF CLASSICAL GREEK MEDICINE IN THE ISLAMIC WORLD Islamhasbeendefinedasa'crossroadofcultures'sinceitstandsatapoint ofcontact betweenJudaism, Christianityand Islam, between the ancient culturesoftheEastandWestwhichinturnproducedIslam'sowndistinctive scienceandculture.Thissynthesisofideaswasaprocesswhichbeganbefore theriseofIslamas theinevitableresultofcontactbetweendifferentpeoples through commerce and trade. With the decline ofthe Roman Empire and theriseofChristianity,theburdenofGreeklearningpassedfromtheformer to the latter. Under the Abbasid Caliphs, Baghdad became the centre of IslamicsciencelargelyduetoChristiansactingastranslatorsfromGreekinto SyriacandArabicatthefamousbaytal-hikma, 'HouseofWisdom'directed by Hunayn ibn Ishaq (d. AD 873), aNestorian Christian priestand physician. Thepassingofknowledge from onedispensation to anotherpreserved muchofthecorpusofclassicalGreekmedicinewhichwouldotherwisehave been lost. In the world ofIslam the practical application ofmedical skills, empirical observation and development, particularly in the field ofmateria medica,furtherenhancedituntiltheWestwassufficientlycivilizedtoreceive oncemorethiscorpusofmedicalliterature, applyandyetfurtherdevelopit intothemedicalknowledgeofRenaissanceEuropeandlater. Hippocrates AcceptedastheFatherofMedicine, Hippocrateswasborn c. 460 BC. Heis acknowledgedasoneofthegreatestclinicalphysiciansofalltime. Hedisso- ciated medicine from superstition, systematized the empirical knowledge whichhadaccumulatedinEgyptandintheschoolsofCnidosandCos,and established inductive and positive medicine. The importance of the Hippocratic corpus was fully appreciated by theArabs who both translated andtherebypreservedmuchofitandquotedfromitintheirownwritings. item1 Undated Greek manuscript transcribed in an early fifteenth-century hand containing, among other works, the Aphorismsand the Prognostics of 7 Hippocrates. The Aphorisms, 'A(popiopwi (known in Latin as Aphorismi), werecommentatedonbyGalenaswellasbyotherphysicians.SeveralArabic translationsweremadeincludingonebyHunaynibnIshaqentitledal-fusid. Theworkcomprisesshortsentencesdevotedto generalmedicalscience. The Prognostics{npoyvcoGTiKov), knowninLatin as Prognosticum,wasa popularworkto which Galenwroteacommentary. Several Muslimwriters also wrote commentaries to this work, known in its Arabic translation as taqdimatal-ma(rifa. Shown herearethefinalsectionsoftheAphorismsandthebeginningof thePrognostics. MSL.60ff.11\12r Galen KnowninArabicasJalinus,GalenwasborninPergamoninAD 129.Inthe annals ofmedicine in antiquity he occupies a place second only to Hippocrates and from his numerous dissections and observations advanced theknowledgeofanatomy, physiology, embryology, pathology, therapeutics and pharmacology. Galen's medical works were particularly admired by all laterIslamicphysicianswhotranslatedthemintheiroriginalformaswellas in summary, commentated on them and wrote works based on them, so ensuring that the authorityofGalenic medicine should remain unimpaired untilthesixteenthcentury. item2 UndatedGreekmanuscriptcopiedinasemi-currenthandtypicalofthelate sixteenth century containing MedicalDefinitionsattributed to Galen. This work, known in its original Greek as "Opoi iavpiKoi, was translated into ArabicunderthetitleKitdbal-Hadud.ItwascitedbyRhazesinal-Hdwiand known to Hunayn ibn-Ishaq. In its Latin form it is known as Definitiones medicae. Aselectionofthe479medicaltermstheworkdescribesisshown. WMS289ff.5V,6r item3 Syriac translation ofIJepi Kpdoecoq kcli Svvdpiecoq tWv anXUJv <papiiaKcov composedbyGalenandknown in Latinas DeSimpliciumMedicamentorum 8