Tuesday, June 18, 2013

865-925: Rhazes describes allergies

Rhazes didn't choose to become a physician until he was
into his 40s, and this may have helped the man become among
the most well respected physicians of his era.  He wrote about
asthma, and is thought to be among the first physicians to
describe allergies. 
The first known writer to describe allergies was the Arabic physician Rhazes, yet it would be over a thousand years after his death before "allergy" was defined by the medical community.  So it's easy to see that he was a physician ahead of his time. 

He was born Abu Bekr Mohammed ben Zechariah in the year 865, and is known best by the name of Rhazes. He was born in a town in Persia, in the province of Baghdad, in d town called Rai, "and it is from this that his last name was derived -- Ar-Razi,"  said historian Thomas Bradford in his 1898 book "Quiz questions on the history of medicine."  (9, page 62).

He was originally a musician, playing the flute in his youth. And even while he was a "passionate lover of music," he put this love aside in favor of philosophy and medicine, claiming "that music proceeding from between mustachios and a beard had no charm to recommend it," said V.J. Fourageaud in an 1868 article in the Pacific Medical and Surgical Journal. (1, page 164)(9, page 62)

Yet this turned out to be a great thing for the medical community, as "he is said to have been the ablest physician of his age; a master of all kinds of learning; skilled both in the theory and practice of medicine, said Bradford." (9, page 62)

He started studying medicine in his forties, explained Bradford, and traveled abroad to "Jerusalem, Syria, Egypt, Persia, and Spain, the better to perfect his knowledge by conversing with botanists, oculists and surgeons. Having thus become master of his profession, he settled in Bagdad, and so great was his learning that he was selected from over a hundred eminent competitors as the director-in-chief of the grand hospital in that place.  He is said to have been the ablest physician of his age; master of all kinds of learning, skilled both in the theory and practice of medicine." (9, page 62-63)

By this position he was "director of the hospitals of Ray (the same town he was born in), Jondisabour, and Baghdad, said Fourageaud..  (1, page 164)

Bradford and Fourageaud both said that his reputation was so great as an Arabian professor that students traveled from far away to hear him speak. (1, page 164)(9, page 62)

Edward Withington, in his 1894 book, "Medical history from the earliest times, said he became the "first and most original of the Arab physicians."   (2, page 145)

He is considered by many historians as the most independent thinker among the Arabic physicians.  (5, page 156)  He encouraged physicians to practice by empirical means (experience and observation) and in this way became the first physicians to encourage scientific based medicine. (3, page 31)

He wrote over 150 books, although some say he wrote as many as 220.  He wrote on philosophy, medicine, history, and chemistry, although his passion was medicine.  Unfortunately most of these works are lost to history, said Fred Ramon in his 2006 book "Albacasis."  (8, page 62) (9, page 63)

While he copied many of the idea of ancient physicians, such as Hippocrates and Galen, it's his scientific descriptions of diseases that make him among the most well known of the Arabic writers.

He became famous while being among the few Arabic physicians who did not earn a medical license.  And, despite his fame, he did not become rich, mainly because he chose to practice among peasants who could not afford much.  This type of 'boldness and originality' earned him the title "The experimenter," said Withington.  (2, page 145)

Among the medical community he is best known for writing the "oldest existing treaties on smallpox and measles," said Withington.  (2, page 146)(9, page63) and he is the first to have described fever as a defense mechanism of fighting off diseases.

He's also the first to describe asthma as a specific disease, and the first to mention allergies.  He was a chemist and pharmacist, and by this he gathered a collection of remedies (some of his own too) and recorded them in one of his publications.  Some of the remedies were for asthma, said Ramon. (8, page 70)

As noted by these writings, coupled by his writings about asthma and coryza (inflammation of the nasal passages/ hay fever), he was the first to write a treaties on the diseases of children.  (6, page 175)

During his life he would create voluminous volumes for the medical community.  In his Hawi or Continens, which exceeded the length of the works of his contemporaries (including the Canon of Avicenna) he gives an account of asthma and it's remedies: (2, page 146)
Ben Musue (an Arabian physician of the 8th century) said, 'Let persons troubled with asthma or shortness of breath take two drachms of dried and powdered fox lung with decoction of figs in their drink.'  Galen (De med. simple.) said that many cure asthma with owls blood given in the drink, or by giving owl's flesh with the blood in spidebeg(?), and taking it's blood afterword in wine. I say that owl's blood is not to be given in any case of asthma, for I have seen it administered, and it was useless."
Maimonides wrote of the remedies for asthma, and in doing so mentions Rhazes:
Maimonides endorses a remedy of Rhazes' to clear the lungs of moisture, ease respiration, and eliminate the cough: soak wheat bran over night in hot water, filter, and add sugar and almond oil; place on the first until it resembles a julep and drink when lukewarm.  (7, page 27)
Also of significance is he was the first to write a book about hay fever:  A dissertation on the cause of the coryza which occurs in the spring when the roses give forth their scent.  (3, page 31)(4, page 338)

In his work Essay on the cause of why Abu Zayd al-Bahli is subject to rhinorrhea in springtime when smelling roses, he described the inflammation and runny nose that occurred in the springtime when the roses were blooming.

Many consider this the first description of hay fever, or what would eventually be considered as springtime allergies, sinusitis, hay fever, seasonal allergies or rhinorrhea.  In a sense, he may also have been the first to describe allergic asthma.

Fourageaud said that near the end of his life he approached Al-Mansur, the Prince of Chorasan, in Baghdad to present to him a book on alchemy he dedicated to the prince.  The prince loved the work and rewarded Rhazes with a thousand dinars. (1, page 64)
The Prince said, "I wish for you to put into practice what you have laid down in this book."
Rhazes said, "That is a task for the execution for which ample funds are necessary, as also various implements and aromatics of genuine quality; and all this must be done according to the rules of art, so that the whole operation is one of great difficulty."
The Prince said, "All the implements that you require shall be furnished you, with everything necessary for the operation; so that you may be in the practice the rules contained in your book."
Rhazes said he was unable to perform the task, at which time the Prince said, "I should never have thought a philosopher capable of such faleshoods in a work represented by him as a scientific treaties, and one which will engage people's hearts in a labor from which they can derive no advantage.  I have given you a thousand dinars as a reward for this visit, and the trouble you have taken, but I shall assuredly punish you for being guilty of a falsehood." 
The Prince struck Rhazes in the head with a whip and sent him on his way with provisions to complete the task.  Rumor has it this is what made him blind, although some say it was because he was because he ate too many beans.

Believing his blindness was caused by cataracts, an "occultist" was about to operate on him when Rhazes said something like, "How many membranes does the eye have?" 
The occultist had no response.  Rhazes then said something like, "I will not entrust my eyes to someone who is ignorant of their structure."
Later, when further urged to have the operation, he said, "No, for I have seen so much of the world that I am weary of it."  (1, page 64)
So most historians describe his as a very wise man, and Bradford credits him with the following wise sayings: (9, page 63)

  • When you can cure by regimen, avoid having recourse to medicine
  • When you can affect a cure by a simple medicine, avoid a compound one.
  • When a wise physician and an obedient patient, sickness soon disappears.
  • Treat and incipient malady with remedies that will not prostrate the strength. (9, page 63)

Exactly when he died remains unknown, although much speculation of modern historians has the date at 925 A.D. Regardless, he was a renowned physician in his day, and was one of the Arabs who helped save medicine while a dark cloud hovered over western medicine.

References:
  1. Fourageaud, V.J., "Historical Sketches: XIII: The epidemics of the sixth century, the plague, small pox, and measles.  Ahrun, Bachtishwa, Mesue the Elder, Honain, Serapion, Alkhandi, and Rhazes," Pacific Medical and Surgical Journal,  Medical and Surgical Journal, edited by V.J. Fouregaud and J.F. Morse, Volume VII, 1864, San Francisco
  2. Withington, Edward, "Medical history from its earliest times: a popular history of the healing art," 1894, London, The Scientific Press 
  3. Colgan, Richard, "Advice to the Young Physician: on the art of medicine," 2009, New York
  4. Lehrer, Steven, "Explorers of the body: Dramatic Breakthroughs in Medicine from Ancient Times," 2006, United States
  5. Fantini, Bernardino, Grmek Mirko editors, Antony Shugaar, translator., "Western Medical Thought from Antiquity to the Middle Ages," 1998, U.S., 
  6. Gee, Samuel, "A Survey of the Literature of the Diseases of Childhood:  An address delivered at the offering of the section of diseases of children at the annual meeting of the British Medical Association in Liverpool, August, 1883, The Medical Times and Gazette, Vol. II, 1883, London, Pardon and Sons
  7. Rosner, Fred, translator, "The Medical Legacy of Moses Maimonides," 1998, KTAV Publishing House, U.S.
  8. Ramen, Fred, "Albucasis (Abu Al-Qasam Al-Zahrawi):  Renowned Muslim Surgeon of the 10th Century,"  2006,New York
  9. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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