The Forgotten Luminaries of the Middle Ages: The Islamic World’s Contributions to Medicine
By Ayah Abdirizak
“During this total darkness in Medieval Europe, they [the Muslims] lighted and fed the lamps of our science - from the Guadalquivir [in Spain] to the Nile [in Egypt] to the river Oxus [in Russia].”
- Professor Julius Hirschberg, July 1905
When you think about the history of medicine, what comes to mind? Maybe it’s Galen and Hippocrates, the discovery of penicillin, Edward Jenner and his vaccines, or the foundation of the National Health Service.
Now what about the Medieval period? Indeed, in most history books, it’ll usually be covered in a few short sentences: Galen and Hippocrates’ theories continued to dominate, the Church pushed a “care over cure” attitude, and human dissections were banned. Overall, very little medical advancement.
In the West, that is.
However, on the other side of the world, Islamic civilization was experiencing rapid rates of development in all its sectors, from architecture to medicine. This period was known as Islam’s Golden Age, and with it came an abundance of new medical advancements.
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Many features of the modern hospital can be traced back to the Islamic world, a collection of interconnected societies under Muslim rule from the 8th to 15th centuries, spanning Spain, North Africa, the Middle East and Central Asia.
In the early Middle Ages in the West, illness was often seen as a punishment from God for sin, and attempting to treat it was viewed as acting against God’s will. Therefore, places of care - mostly run by churches - that resembled rudimentary hospitals had limited medical knowledge among the monks and nuns, and mainly focused on keeping patients comfortable and praying. Certain groups, like those with leprosy, infectious diseases, mental health issues and disabilities, were often excluded for fear that they would “infect” others.
By contrast, in the Islamic world, a saying from Prophet Muhammad shaped Muslims’ attitudes towards medicine: “Allah (God) has not sent down a disease, except that He has sent down a cure for it”. This encouraged them to seek out treatment for every disease and expand their knowledge. In addition, the Islamic Golden Age was a time of political stability and urban wealth under the Abbasids, allowing for increased investment in education. The introduction and widespread access to paper during this period, as well as the building of libraries and translation centres (where Greek and Persian texts were translated into Arabic) improved literacy rates and the spread of medical knowledge. Together, these factors drove medical advancements.
This approach led to the establishment of bimaristans (hospitals). With separate wards for different illnesses, clean bedding and clothing for patients, trained specialists, fully stocked pharmacies, and administration offices containing medical records, these hospitals were far beyond their time. The larger bimaristans also had medical schools and libraries attached.
The first major Islamic hospital, or bimaristan, was established in 707 CE, in Damascus, and many more were established all over the Islamic world in the following centuries. By the 12th century, Baghdad alone had sixty hospitals - far more than any city in the Christian world at the time.
Bimaristans opened their doors to all people, regardless of their race, religion, class, gender or type of illness. The rule was that no patient would leave until fully recovered. Treatments were free of charge, and discharged patients were even given money to encourage them to rest and recover before continuing their work. Practices that modern hospitals are still struggling to implement, like free healthcare and medication for all, were standard in the medieval Islamic world.
A key feature of bimaristans that distinguished them from earlier hospitals was the inclusion of dedicated psychiatric wards. These focused on providing holistic care to psychiatric patients rather than ostracising them. Innovative methods were used, including music therapy. Soothing melodies were played for patients suffering from melancholia, insomnia and even lovesickness; in the major bimaristan Al-Mansuri in Cairo, an ensemble of musicians were hired to play daily. Even the architecture of bimaristans supported healing: fountains, gardens and large, open spaces exposed patients to nature and the sound of running water, stimulating the senses and promoting tranquility. Talking therapies, structured daily routines and recreational activities were also used. If we consider that mental illnesses were only formally recognised and taken seriously in Western medicine well into the 18th and 19th centuries, this advanced approach of Islamic bimaristans was truly remarkable.
Muslim Pioneers
Of course, hospitals are nothing without doctors to work in them. Throughout the Middle Ages, there were many doctors and scientists who pioneered medical innovations which are still relevant today.
One such figure was Al-Zahrawi (also known as Abulcasis), a 10th century Andalusian doctor. Considered the “father of modern surgery”, he wrote a 30-volume medical encyclopedia, Al-Tasrif, covering a range of medical topics, from surgery and orthopedics, to obstetrics and pharmacology. In it, he illustrated over 200 surgical tools, many of which lay the foundation for the instruments we use today. His work was translated into Latin and used as a key reference in European medical schools for five centuries.
His achievements were not just literary. Al-Zahrawi was among the first to use and clearly document catgut for internal stitches - a material made from sheep or goat intestines that naturally dissolves in the body, reducing the need for removal and lowering the risk of infection. Catgut suturing continues to be used in some regions to this day. He also performed tracheotomies to relieve airway obstruction, nine centuries before it became standard practice in Europe, and was among the first to use cotton to control bleeding. A man ahead of his time, Al-Zahrawi’s innovations set the standard for surgical practice for generations to come.
Another noteworthy pioneer was 10th century Iraqi-Egyptian surgeon, Al-Mawasili. A talented ophthalmologist, he designed a hollow needle to remove cataracts by suction, and became the first to perform a cataract operation which removed the lens entirely, rather than just dislodging it - the preferred method at the time. This marked a significant step forward in the field of ophthalmology, and his methods influenced the development of modern cataract surgery today.
But perhaps the most influential figure in the medieval Islamic world was Al-Razi (Rhazes). The 9th century Persian polymath was the first physician in history to clinically distinguish between smallpox and measles, which significantly helped advance epidemiology and infectious disease diagnosis. As a physician, he emphasised clinical observation, rejecting blind adherence to tradition and respected figures such as Galen. He used experimentation and carefully trialled treatments before using them on the wider patient population, an innovative approach for its time that can be viewed as an early form of evidence-based medical practice.
Furthermore, Al-Razi spread his ideas by writing books. Over his lifetime, he reportedly wrote over 224 books. His most prolific works include: Kitab-Al-Hawi, a 23-volume encyclopedia detailing all of his clinical experiences, observations and treatments; Akhlaq-Al-Tabib, a treatise on medical ethics and the responsibilities of a physician; and Kitab-Al-Mansuri, a shorter 10-chapter book intended as a practical manual for physicians. Kitab-Al-Hawi is considered one of the most significant medical books in the Middle Ages, as it was later used in universities and hospitals around the world as a reference book. Similarly, Kitab-Al-Mansuri became extremely popular in Europe after it was translated into Latin, becoming a core teaching textbook in European medical schools until the Renaissance period, highlighting the enduring nature and cross-cultural influence of Al-Razi’s contributions.
Together, these pioneers - along with many others - pushed medicine to new heights, and made contributions that helped shape the field into the one we know today.
Discoveries….Rediscovered?
I’m sure you must be thinking: if medieval Muslim physicians were so advanced, then why do we not hear more about them? Surely the origins of such influential medical advancements would be common knowledge among medics, if not the general population, in the same way that Galen, Hippocrates, Aristotle are.
However, most of this can be attributed to the language barrier and translation difficulties. As almost all of the Muslim scholars’ works were written in Arabic, to be understood in Europe, they had to be translated into Latin. Translation centres, like those in Toledo and Sicily, which focused on translating works from Arabic into Latin, were only properly established from the 12th century onwards - several centuries after many works from the Islamic Golden Age had been written. This delay largely contributed to Europe’s limited acknowledgement of discoveries from medieval Islamic civilization initially. Even after major translations began, some works weren’t translated at all, or only had partial translations, due to a perceived lack of practical importance. This severely limited their impact on the medical field. Additionally, local dialects and differing folk names for treatments and medications made translating them even harder and often resulted in important information being missed by Western physicians.
Cultural and political factors added to these challenges. Since European medicine was heavily shaped by the Church, there was hesitance to accept ‘foreign’ knowledge from the Islamic world - especially as Islamic scholars critiqued some of Galen’s ideas, which the staunchly-supportive Church forbade. Political tensions, particularly during the Crusades, further discouraged trust or curiosity in the East during the medieval period. Together, these barriers could explain why the advancements of medieval Islamic medicine were largely under-recognised in the West.
One major example of this is Al-Bakhli, a Persian scholar who wrote extensively on mental health. He was a pioneer of identifying and describing phobias, depression and Obsessive-Compulsive Disorder (OCD), as well as developing treatment methods for them which resemble modern Cognitive-Behavioural Therapy (CBT). But since his works circulated primarily in Arabic and were focused on a specialty which had hardly been developed in Europe at the time, Al-Bakhli’s findings did not gain global attention. It was only in the 20th century, eleven centuries after his lifetime, that modern scholars ‘rediscovered’ his ideas and built on them.
On the other end of the spectrum, Ibn Sina (also referred to as Avicenna), an 11th-century philosopher-physician from present-day Uzbekistan, was extremely well known in the West. Ascribed various titles, from “the Galen of Islam” and “the Prince of Physicians” to even “the father of modern medicine”, his Canon of Medicine (completed in 1025) organised medical knowledge across every speciality. It remained a standard text in both the Islamic world and Europe for centuries. Despite this, some of his discoveries did not receive acknowledgement in the West. Ibn Sina - as well as Al-Razi - discussed the theory of delayed splintage (delaying the application of a splint to allow for proper bone healing) and poor fracture healing in his books, but the ‘pioneer’ who often receives credit for its discovery is the British Professor George Perkins in the 1940s. He also talked about the bone injury Bennett’s fracture almost an entire millenium before the scholar it was named after. A similar pattern of delayed and selective translation meant that Ibn Sina’s more specialised observations - like those on fractures and delayed splintage - were largely overlooked in Europe.
A similar case occurred with a 13th-century Syrian physician, Ibn Al-Nafis. Although William Harvey is generally credited with describing systemic circulation in the 17th century, Ibn Al-Nafis had already accurately described pulmonary circulation four centuries earlier, challenging Galen’s ideas about blood flow. He even theorised the existence of capillaries connecting arteries to veins. Nevertheless, Harvey is still widely considered the only pioneer of circulation. It was only recently, in 1924, that Al-Nafis’ works were discovered in Egypt and his overlooked pioneering feats were brought to light.
It is astounding to see that such important discoveries made so long ago were largely forgotten or ignored, despite their enormous potential impact. Linguistic barriers, cultural divides, and conflicts between the East and West limited the reach of Islamic medical achievements. If these discoveries had been disseminated further and given the attention they deserved, could the medical field have advanced further even sooner? “Those who do not learn from history are doomed to repeat it” suddenly takes on a new meaning, as we see how Western physicians ended up researching work already extensively investigated by their medieval Islamic predecessors.
What is the message that we can take from all of this? That physicians of the Islamic world contributed greatly to the medical field? That decentering the West allows for a greater understanding of medical history? That medieval medicine was not as primitive as we tend to believe? Perhaps it is all of these.
The evidence is clear: the Islamic world’s innovations transformed medicine. Yet its impact could have been even greater had there been more acknowledgment and communication with the West. So, the next time someone asks about the so-called ‘dark’ Middle Ages, remember that somewhere in the world, there was a light, brighter than anyone could have believed: Islamic civilization.
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