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Thirty-Three Clinical Observations by Rhazes (Circa 900 A.D.)

Max Meyerhof

Isis, Vol. 23, No. 2. (Sep., 1935), pp. 321-372.

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TueMay29 12:41:44 2007

Thirty^three clinical observations
by Rhazes (circa 900 A.D.) '"

A. — The Biographers of Rhazes

It is a singular fact that so little is known about the life of Abu
Bakr Muhammad ibn Zakariyya' ar-RazI (Rhazes), the greatest
physician of the Islamic Period. Those of his works which were
translated into Latin, particularly his treatise '' On Smallpox and
Measles," established his reputation as an excellent observer and
at the same time a critical compiler of Greek, Syriac and early
Arabic medical knowledge. Neuburger, in his excellent History
of Medicine (2), was very sound in his judgment when he said
that Rhazes was without doubt the greatest of the very few

(i) Bibliographical references :
Ahmed Issa Bey, Histoire des Birnaristans (Hopitaux) a Vepoqiie islamique. Le

Caire, 1928.
Brockelmann, Geschichte der arabischeri Litteratur. Weimar, 1898-1902. 2 vols.
Browne, E. G., Arabian Medicine. London, 1920.
Hippocrates, Q^uvres completes d'Hippocrate. Ed. E. Littre. Paris, 1839-61.

10 vols.
Ibn Ab! Usaibi'a (LA.U.), 'Uyiln al-Anba f'l Tabaqat al-Atibba\ ("Sources

of Information on the Classes of Physicians "). Cairo, 1882, 2 vols.
Ibn al-Qifti, TaWikh al-Hukama (" History of Learned Men "). Ed. J. Lippert,

1903.
Ibn an-Nadim, Kitdb al Fihrist (" The Catalogue "). Ed. G. Fluegel. Leipzig,

1871. 2 vols.
Ibn Khallikan, Wafaydt al-A'ydn (" the Deaths of Prominent Men "). Cairo-

Bulaq, 1929. 2 vols.
RusKA, J., Al-BTruni als Quelle filr das Leben und die Schriften <3/-Razi's. his,

vol. V (1923), PP- 27-50.
Sarton, George, Introduction to the History of Science. Vol. I, 1927.
H. E. Stapleton and M. Hidayat Husain, Cheiyiistry in 'Iraq and Persia in the

Tenth Century A.D. Memoirs of the Asiatic Society of Bengal, VIII (Calcutta,

1927), pp. 316-417-
(2) Neuburger, Max, Geschichte der Medizin, vol. II (Stuttgart, 191 1), p. 167
et seq.

322 MAX MEYERHOF

physicians of the Islamic Period who found their way to Hippo-
crates and the inestimable value of unbiassed clinical observation.
The present publication will, I hope, confirm Neuburger's views.
I now venture to offer the testimony of a direct translation from
one of Rhazes' original texts.

The first author to write about Rhazes was Ibn an-Nadim (3),
in his Literary History al-Fihrist, compiled in 987 A.D. He
gives no dates, is very brief and merely mentions the great numbers
of the Master's pupils and also his alleged blindness towards
the end of his life. He then gives a very extensive bibliography
but without any order of sequence. In this list, early as it is, there
are already blunders and several works are mentioned which
undoubtedly are only ascribed to Rhazes.

Not long ago J. Ruska published the German version of a
bio-bibliographical sketch on Rhazes (4), written about a century
after his death by Abu'r-Raihan Muhammad al-Bairuni, the
greatest physicist and astronomer and one of the most original
thinkers of the Muhammadan world (he lived about 975-
1050 A.D.). This very exact chronologist asserts that Rhazes
was born on the first day of the Arabic month of Sha^ban, 251 A.H.
(August 27, 865 A.D.) at Rayy (Rhages in Tabaristan, North
Persia), and died there on the fifth day of Sha'ban, 313 A.H.
(October 26, 925 A.D.). If al-Bairuni is right, Rhazes furnished
an enormous output of work during a sixty years' span of life.
The biographer proceeds to speak contemptuously of Rhazes'
philosophical and theological opinions, and adds a few notes
on his activity as physician and clinical teacher. But he fails
to give any detailed account of Rhazes' life. Instead, he gives
a very important catalogue of Rhazes' scientific output, arranged
according to subject.

Ibn AL-QiFTi (d. 1248 A.D.) also gives a very short note on
Rhazes' life (5). According to him, Rhazes was for the first
half of his life a musician. He later took to Medicine, and was
appointed director of the Hospital (mdristdn) in his native town,
Rayy, and afterwards in Baghdad. If this author is to be credited.

(3) Ibn an-NadTm, I, p. 299.

(4) Ruska, pp. 27-50. An English translation of a part of it is found in
Stapleton, p. 319-20.

(5) Ibn al-Qifti, pp. 271-277.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 323

Rhazes died about 320 A.H. (932 A.D.) : we think, however^
that the date given by al-BairunI is more Hkely to be exact.

Ibn Abi Usaibi *a (d. 1270 A.D.) wrote the most comprehensive
biography and by far the most extensive bibHography of Rhazes,
partly based on the above-mentioned sources (6). He corrected
some of the grave chronological errors committed by former
historians. Nevertheless, he thought, with Ibn al-Qifti, that
the North-Persian physician, *Ali ibn Rabban at-Tabari was
Rhazes' teacher. We proved, on the contrary (7), that this well-
known practitioner and scholar must have died before Rhazes
was born. Another error, which is not accepted by I.A.U., is
the story that Rhazes was requested to choose a site for the ' Adudi-
Hospital in Baghdad and was appointed its director, whereas
in fact the hospital was founded by Prince *ApuD ad-Dawla
in 980 A.D. — more than half a century after Rhazes' death ! (8).
I.A.U. thinks that Rhazes was given charge of the hospital which
existed before the time of *ApUD ad-Dawla, and this hospital
may perhaps have served as a model for the latter 's creation.
Rhazes wrote a record of observations at that hospital, which
must have been, in my opinion, the Muqtadiri-Hospital, founded
in Baghdad in 306 A.H. (918 A.D.) by order of the Caliph al-
Muqtadir bi'llah (9). I.A.U. tells, moreover, several stories of
a more anecdotic character about the medical skill and insight
of Rhazes. They have been reproduced in French by Leclerc (10).
Then follows a very long bibliography of about 230 works due
to Rhazes' pen. I.A.U., like previous biographers, fails to give
any details concerning Rhazes' life.

So also does the last of Rhazes' prominent biographers, Ibn
Khallikan (11), who died in 1282 A.D. His account of Rhazes'

(6) Ibn Abi Usaibi'a, I, pp. 309-321.

(7) Max Meyerhof, 'AlI ibn Rabban at-Tabari, ein persischer Arzt des 9. Jahrh.
n. Chr. Zeitschr. d. Deutschen Morgenland. Gesellsch. X (1931), pp. 38-68.

The same. 'AlI at-TabarI's " Paradise of Wisdom,'' etc. Isis, XVI (1931),
pp. 6-54.

(8) Ahmed Issa, p. 181 et seq. Compare, moreover, G. Le Strange, Baghdad
during the Abbasid Caliphate. Second edition (London, 1924), p. 62.

(9) It is probable that Rhazes lived in Baghdad during the long reign (908-
932 A.D.) of this Caliph.

(10) Histoire, vol. I, p. 337 et seq.

(11) Wafayat al-A'ydn, ed. Bulaq, 1275 A.H. Vol. I, p. 103 et seq.

324 ^^^^ MEYERHOF

life is Still shorter, with some digressions on the subject of other
doctors and the princes with whom Rhazes is said to have been
in relationship.

There is no doubt that much biographical material can be
extracted from Rhazes' most important work, of which we shall
treat in the following chapter.

B. — Remarks on Rhazes' Continens

Rhazes' best-known work is his '* On Smallpox and Measles,"
which has had the honour of about a dozen translations into
Latin and modern languages. Of it Neuburger says : "It ranks
high in importance in the history of epidemiology as the earliest
monograph upon smal!-pox, and shows us Rhazes as a conscientious
practitioner, almost free from dogmatic prejudices, following in
the footsteps of Hippocrates." Next in importance comes the
Kitdb at-Tibb al-Mansuri ('* The Book of Medicine dedicated
to Mansur ") (12), known to the Latin Middle Ages as Liber
Almansoris and edited in many Latin printed texts. It is a short,
practical textbook of Medicine, and its ninth part (Liber Nonus )
enjoyed great repute and formed the basis of medical learning
until late in the sixteenth century (13).

We omit mention of Rhazes' minor medical treatises, as well
as of his many writings on medical ethics. We recommend
particularly the study of his short treatise ** On the Reason for
which the Hearts of most People turn away from honest Physicians",
translated by Steinschneider (14).

Of all the many works of Rhazes by far the most voluminous
is ** The Comprehensive Book of Medicine " (Kitdb aUHdwi
fi't-Tibb). This book has never been published in the original
Arabic text which should comprise about twenty-four volumes.
There is, however, no complete copy in existence, while the
volumes extant, about twelve in number, are widely dispersed

(12) This was the Samanid Prince Abu SAlih Mansur ibn Ishaq, Governor
of the Eastern and Southern provinces of Persia, killed in 302 A.H. (925 A.D.)-

(13) See Sarton, Introduction, Vol. I, p. 609 et seq.

(14) ViRCHOw's Archiv, vol. XXXVI, pp. 570-586.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 325

in European libraries. The Escorial Library near Madrid has
live volumes, and in the uncatalogued Libraries of Istanbul and
its vicinity there may be still more of them. I, myself, was
recently able to buy fragments of about five other volumes. It
is certain that the book, on account of its size and price, was always
very rare, and it seems that at certain periods there were not more
than two copies of it available in the entire Muhammadan world.
All Rhazes' biographers agree that he left this work unfinished,
and that it was partly arranged by his pupils after the master's
death (see below). A Latin translation was made, in Sicily or
at Naples, by the Jewish physician and translator, Faraj ibn
SAlem (called Farraguth) for King Charles of Anjou. This
work, which must have taken nearly the whole lifetime of the
translator, was completed in 1279. ^^ ^^^ printed at Brescia
in Northern Italy in i486 A.D., and forms the most bulky of all
the incunabula, its two volumes weighing more than twenty
pounds. It was reprinted several times during the XVIth century,
but all the editions are rare. In the printed edition, Rhazes'
work is divided into 25 books. It is not known from what Arabic
MS. the translation was made.

The contents of the Continens is an encyclopaedia of therapeutics,
comprising much special Pathology but excluding Anatomy.
There is no doubt that the author throughout his life made extracts
from all the medical works of Greek, Syriac and Arabo-Persian
writers, probably in the form of a loose-leaf index, and later
collected the material in the various parts of his book, in which
he treats of the diseases of the body '* from top to toe." After
having quoted many former authorities, he usually adds a special
chapter under the heading Mine or my own (It), in which he
states his own experience and opinions. For this reason the
book is, on the one hand, a huge and indigestible mass of literature,
often lacking unity of plan and finish; but, on the other hand,
it is an invaluable record of quotations from several hundreds
of only partly known or completely forgotten writers whose works
are lost, not to mention the value of so many early Arabic
translations from known Greek medical writers whose texts are
available in Greek alone through late Byzantine MSS. More
than all this, we are bound to admire the learning, acuity, observa-
tion and the often surprisingly sound judgment of Rhazes himself

326 MAX MEYERHOF

in his personal notes and comments. From these notes, there
could be extracted an important record of his medical activity,
as well as of his clinical considerations on all the diseases known
to the physicians of that remote period. But this task would
mean a labour of many years and a thorough knowledge of Rhazes'
Arabic style and of Greek and Persian Medicine. In medical
theory, Rhazes was a pupil of Galen, but in practical observation
and therapy a pure Hippocratist. An alchemist of renown, he
often tried treatment with new chemical preparations which were
unknown to his forerunners.

Before we proceed to an examination of some clinical notes
in the Continens, I shall give translations of the very interesting
information given by Muhammadan physicians regarding the
plan and the circumstances of the publication of this immense
compilation.

The earliest of these physicians is the Persian, 'AlI ibn al-
'Abbas, surnamed " the Magus " (d. 994 A.D.). He must have
been born about the time of Rhazes' death. He practised for
some time at Baghdad and dedicated his main work, '' The Perfect
Treatise of the (Medical) Art " (Kdmil as-Sinaa), or " The
Royal Book " (Al-Kitdh al-Malikt) to the mighty Sultan 'ApuD
ad-Dawla, the real ruler of the East in the place of the weak
Caliphs. This " King of Kings " is known to have been a friend
of poets, writers and scientists, and to have founded, in 880 A.D.,
a famous hospital at Baghdad, to which we have referred in the
foregoing pages. The Introduction of 'Ali's book — which is the
first and perhaps the best complete treatise on Medicine as a
whole- — begins with a review of the medical treatises of former
times written in Greek and Syriac, and then continues with
the Arabic works. Most of this introduction is available in
Leclerc's translation (15) from the Arabic original. I shall give
here a new translation of that part which speaks of Rhazes' two
most important general treatises on Medicine. 'Ali (16) writes
as follows :

'' Concerning Muhammad ibn ZakariyyA' ar-RazI, he composed
his book known as al-Mansun, in which he treated, in the form

(15) Histoire de la medecine arabe. Vol. I, pp. 383-388.

(16) BulAq edition of the work (Cairo, 1293 A.H.) Vol, I, p. 5.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 327

of summaries, of the medical art. He did not omit anything
of indispensable matters, save that he did not provide explanations
of his sayings but proceeded in the way of abbreviation as this
was his aim."

** As to his book which is known as ** The Comprehensive ''
(Al-hdwi), I found that he mentions in it everything the
knowledge of which is necessary to the medical man, concerning
Hygiene and medical, as well as dietetical, treatment of diseases
and their symptoms. He did not neglect the smallest thing
required by the student of this art concerning treatment of diseases
and illnesses; but he made no mention at all of natural (physio-
logical) matters, such as elements, temperaments and mixtures
[of the humours]; nor did he speak of anatomy and surgical
treatment. He wrote, moreover, without order and method,
neglecting the side of (scholastic) learning; he omitted to sub-divide
his book into discourses, sections and chapters, as might have
been expected from his vast knowledge of the medical art and
from his talent as a writer. Far be it from me to contest his
excellence or to deny his knowledge of the medical art and his
eminence as an author ! Considering this condition or imagining
the causes of it by comparison with the vast knowledge shown
in this book, I think there are two possibilities : either he com-
posed it and collected in it the entire field of Medicine as a special
memorandum of reference for himself, comprising Hygiene and
Therapeutics, for his old age and the time of forgetfulness : or
being afraid of damage which might occur to his library, which
was to be made good (in this case) by the book in question. Like-
wise in order to relieve his writing from bulkiness and in order
to be useful to the people and to create for himself a good memorial
for coming generations he provided reference notes for his entire
text, put them in order and compared each one with its like and
fitted it in its chapter according to his knowledge of appropriateness
in this art. In this way the book should be complete and perfect."

'' He was, however, prevented from continuing it by hindran-
ces(i7), and death befell him before its completion. If such w^as his
aim, he treated his subject at too great length and made his book
too voluminous without any urgent necessity to claim in his

(17) Probably blindness by cataract which overtook Rhazes in his advanced age.

328 MAX MEYERHOF

favour. This was the reason why most scholars were not able
to order and purchase copies of the book, except a few wealthy
literary men, and so copies are scarce. He proceeded in such
a manner that for each disease, its causes, symptoms and treatment,
he mentioned the sayings of every ancient and modern physician
on the disease in question from Hippocrates and Galen down
to Ishaq ibn Hunain (18), and all the physicians, ancient and
modern, who lived in between them, without omitting the sayings
of any one of them and reference to them in this book, so that
the entirety of medical literature was comprised in this book.
You must know, however, that skilful and experienced physicians
agree about the nature of diseases, their causes, symptoms and
medical treatment, and that there exists no marked difference
between their opinions, except that they treat more or less of
the matter and that they speak in different terms, because the
rules and the schools they follow in the knowledge of diseases,
their causes and treatment, are obviously the same. If this is
so, it was not necessary to record the sayings of [all] the ancient
and modern physicians and the reiteration of their utterances
since they all repeat the same things..."

** It was necessar), and I would not blame him if he had done
so, to confine himself to some of their sayings and to limit the
quotations to the strictly necessary and to those writers who
were the most excellent, occupying the first rank in the [medical]
art and the best and most experienced among them. In this
way it would have been easier for scholars to acquire and to
copj the book which would have been relieved of its excessive
length and bulk, so that it would have been spread among the
people and would be more easily available; whereas, as far as
I know, copies of it are now in the possession of a few literary
and scientific men only."

This last statement perhaps supplies an explanation of why
there is in our days no complete copy of the book in existence.

The second record is a story of how the book came to be
published, told by Ibn AbI Usaibi*a, the famous author of the
History of the Arabic Physicians, He lived in the Xlllth century,

(18) The son of the famous translator, Hunain ibn Ishaq : he was Rhazes'
contemporary.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 329

but he quoted an account given by a Christian physician who
lived two centuries earher. This is *Ubaidallah ibn Jibra'il
IBN 'Ubaidallah (one of the last descendants of the celebrated
Syriac medical family of Bokhtyeshu*) (19), who wrote a bio-
graphical work w^hich is lost and only known from Ibn Abi
Usaibi'a's quotations. Ibn Abi Usaibi'a says (20) :

" 'Ubaidallah ibn JibrA'il said the following : Abu Bakr
Muhammad ibn Zakariyya' ar-RAzi possessed great dwellings
in Rayy and the other towns of al-Jabal (21). He said moreover :
He lived until he was met by Ibn al-'Amid (22), the teacher
of as-Sahib ibn 'Abbad (23). He was the cause of the publication
of Rhazes' book which is known as " the Comprehensive " (al-
Hdwi) for he happened to be at Rayy after Rhazes' death and
asked for the book from Abu Bakr's sister and offered her large
sums of money until [at last] she showed him the materials for
the book, l^hereupon he assembled the doctors, his (Rhazes')
pupils, who W'cre still in Rayy, and caused them to put the book
in order : in this way it was edited in its present disorderly
condition."

This narrative, although written by a scholar at Baghdad two
centuries after Rhazes' death, states what was very probably
the case. When studying parts of the Hdwi, one has the distinct
impression that the book is unfinished and merely a collection,
arranged without order, of loose sheets. Sometimes parts of the
text are not in the right place, and we shall remark this even in
the short text of which a translation follows below.

(19) See Leclerc, vol. I, pp. 99-103 and 370-4.

(20) I.A.U., I, p. 314, line 13 et seq.

(21) This name, meaning " the TVlountain," is here applied to the mountainous
districts of North Persia (Tabaristan, etc.) south of the Caspian Sea.

(22) This is Abu'l-Fadl Muhammad ibn AbI 'Abdallah al-Katib C' the
Secretary "), who was appointed vizier of the Persian ruler, RuKN ad-Dawla,
in 939 A.D., and died after an adventurous life about 960. He was not only
a statesman and warrior but also a renowned scholar. See Encyclopaedia of
Islam, II, 360.

(23) Abu'l-QAsim Isma'il ibn 'Abbad at-Talaqaxi was pupil, secretary and
successor as vizier to the above statesman, and received the title Sahib (" com-
panion ") on account of his close relations to Ibn al-'Amid. He held office
as vizier a long time and died in Rayy in 995 A.D. He was famous as a man
of learning, as a lover of philosophy and as a protector of the arts and sciences.

330 MAX MEYERHOF

C. — A Text containing Clinical Observations

The great orientalist, the late Edward Granville Browne,
in his wonderful Arabian Medicine (24), drew the attention of me-
dical historians to a hitherto unknown text (folios 239 Z? — 245 b
of MS. Marsh 156 in the Bodleian Library at Oxford) containing
some clinical observations by Rhazes. The MS. volume should
comprise the seventh book of Rhazes' al-Hdwi (Continens ), but
the identification is uncertain according to Browne's own state-
ment. I regret that I have not been able to compare its contents
with my own MS., which has long fragments from the seventh
book. The twelve pages of MS.Af<a:r^/z give aver}' interesting account
of thirty-three clinical cases, apparently from Rhazes' own note-
book. They are missing from the Latin translation as I am
informed by Dr. Paul Kraus (of Paris), to whom I am indebted
for the search he made for me in one of the editions of the Continens.

Browne himself said *' that it is as a clinical observer that
RAzT excels all his compeers; and since the clinical notes of these
old ' Arabian ' (25) physicians are of much greater interest and
importance than their obsolete physiology and pathology or their
second-hand anatomy, a careful study of the works of RAzT,
especially of his great Hdwi or " Continens," is probably the
most repaying field to which the Arabic scholar interested in
Medicine can devote himself." This encouraged me to undertake
the edition and translation of the following observations, the first
of which was given in Arabic, with an English translation, by
Professor Browne himself. As to the others, he stated that
'' they are not easy to understand, the Arabic text being represented
by one manuscript only, and the style, apart from apparent scribe's
errors, being crabbed and technical." I have to add that the
copyist was a rather ignorant Persian, perhaps not even a medical
man, who misunderstood the meaning of the text in many places.
To restore and rectify the text, I needed the help of an orientalist,
and this was offered me in the most generous way, as often before,

(24) Arabian Medicine, pp. 48-53.

(25) Inverted commas, because they were frequently Arabic- writing Persians,
Turks or Berbers, but not Arabs.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 33 1

by my friend, Professor Joseph Schacht, the well-known Arabic
scholar of Koenigsberg (now Cairo) : I take great pleasure in
thanking him here for his invaluable collaboration.

As I have had no opportunity of examining the complete Oxford
volume of the Hdwi, I have not been able to form an idea of
where the following cases have been interpolated by the editors
of the deceased master's main work. This is of minor importance
as they seem to have been independent of the other parts of the
book and are merely " illustrative accounts " to be compared
with observations by Hippocrates, the venerated master of all
the physicians of the Greek and Islamic period. It is probable
that they served Rhazes for the purpose of lectures in Rayy,
where he had many pupils right up to the end of his life. We
read, indeed, in al-BairunT's biographical sketch of Rhazes (26)
the following passage : ** He (Rhazes) was continuously studying,
and he had a great number of followers (pupils). He used to
put his lamp into a niche in the wall, to stand opposite it and
to rest his book against the wall so that it should fall from his
hand and wake him up if he were overpowered by sleep and
cause him to resume his duty (i.e. lecture)." Al-Bairuni then
concludes that Rhazes' abuse of his sight by eager study may
have been a contributory cause of the cataract from which he
suffered at the end of his life (27).

Rhazes says, moreover, that he has chosen his cases without
any special rule, and so we see, in fact, that they are varied, of
different nature, and concerning internal and ocular diseases and
women's maladies. They w^ere intended to be read in parallel
with cases from Hippocrates' Epidemic Diseases, but Rhazes,
himself, gave only one such parallel observation, and this is
not in its right place. It follows Case 27 with which it has no
connexion, whereas it should have been placed, perhaps, after
Case 28 or 33. It seems also that the critical quotation from
the Epidemics made by Rhazes is not complete, because a marginal
note remarks : ** Remainder of the Section on the Epidemics
by this great scholar."

(26) RusKA, p. 32.

(27) Here Stapleton (p. 320 line 7 from the bottom) made a mistake by trans-
lating " his eyes were always watering." '* Water" (ma ) in Arabic is the term
for cataract.

332 MAX MEYERHOF

We now give the translation of the 33 complete and one incom-
plete cases, hoping that in the future another MS. of this interesting
passage will enable us to verify the uncertain parts of this first
publication of Rhazes' clinical observations. The numbering of
the cases and their en-tetes are mine.

[fol. 239 v.]

In the name of Allah, the Merciful, the Compassionate !

Illustrative Accounts of patients and our own clinical histories,
only a mixed record of unusual cases which find their place here
on account of their relation to questions and narratives contained
in [Hippocrates'] Epidemics. We do not want to delay or postpone
this any longer because it is a very useful discussion, particularly
on account of the questions raised in it. We had [hitherto]
neglected these examples because we intended to collect them
all together here. According to this, our intention, we must
place the Epidemics beside these questions, read them side by
side, and write them down here as completely as possible — if
Allah will !

[Case I : Renal Abscess, Perforating into the Renal Pelvis.]
'Abdallah ibn Saw^ada used to suffer from attacks of mixed
fever which overtook him sometimes every six days, sometimes
like a tertian, quartan or quotidian. They were preceded by
a slight rigor, and micturition was very frequent. I gave it
as my opinion that either these accesses of fever would turn
into quartan, or that there was an abscess (khiirdj ) (28) of the
kidneys. Only a short while elapsed before the patient passed
pus in his urine; I informed him that these feverish attacks would
Eot recur, and so it was.

The only thing that prevented me at first from giving it as
my definite opinion that the patient was suffering from an abscess
of the kidneys was that he had previously suffered from tertian
and other types of fevers, and in this the (my) opinion that this
mixed fever might be due to inflammatory processes, which would
tend to become quartan, was strongly supported. Moreover, the
patient did not complain to me that he felt in his loins, when

(28) Browne translates by " ulcer," but the Arabic name of this is qarha.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 333

Standing, as it were a weight hanging from him; and I had neglected
to ask him about this. The frequency of micturition should
have strengthened my suspicion of an abscess in the kidneys,
except that I was unaware of the fact that his father suffered
from weakness of the bladder and was subject to this complaint,
and that he, himself, had suffered from it when he was healthy.
It is, therefore, our duty to avoid lack of solicitude with the
utmost possible care — if Allah will !

When he passed the pus in his urine, I administered to him
diuretics until the urine became free from pus. After that, I
prescribed to him terra [fol. 240 r.] sigillata, incense and dragon's
blood (28^); his malady departed from him, and he was completely
and quickly cured in about two months. That the abscess was
small, was indicated to me by the fact that he did not complain
to me at the first of a weight in the loins. After he had passed
pus, however, I inquired of him w^hether he had experienced
this symptom, and he replied in the affirmative. Had the abscess
been extensive, he would of his own accord have complained
of this symptom; and the rapid evacuation of the pus showed
the small volume of the abscess. Other physicians, however,
(whom he consulted beside myself) did not understand his case
at all, even after the patient had passed pus in his urine.

[Case II:] The Story of 'Ilk, the Accountant. [A bilious
Dysentery] .

'Ilk, the accountant, consulted me and complained of colics,
without giving an exact description. I advised him to take
tamarinds; he did it and the pain subsided. Some time after,
the pain in his bowels returned during several days, with
constipation. This was followed by a dysentery (sahj), caused
by a black-biled mixture [of humours], and he died from it while
he was far from me (or, during my absence).

Therefore it is important to know that sometimes people are
attacked by a violent pain in the bowels, arising from an ill-
natured bile which flows into their intestines and so generates
a kind of colic and leaves traces. After this, they are easily

(zSa) A kind of blood-red resinous secretion exuded from the fruits of certain
tropical palm-trees (Daemonorops, etc.)

334 MAX MEYERHOF

subject to malignant dysentery, particularly people of black-biled
constitution. Such was the case of this 'Ilk.

[Case III :^^ The Story of Ibn *Amrawaih. [Otitis followed
by Meningitis^

He was a man who was inclined to have meningitis (sirs dm)
and he had suffered from this disease before my arrival. He
was, however, cured of it by the escape of the superfluity
(discharge) into the ear with subsequent formation of fistulae
in it after phlebotomy. Thereafter this suppuration in his ear
became chronic owing to inadequate medical treatment. There-
fore when the suppuration became deep-rooted later in his aural
cavity, it gave rise to a... (caret) ... as we are used to do it in
the phlebotomy in order to cause the breaking out of the abscess
in the interior of the ear in the event of the ulceration becoming
chronic in the ear. The abscess burst, in fact, in the interior
of the ear, and was cured by treatment. There remained, however,
some residue of ill-natured humours in the patient because he
had not been cured of his first disease by energetic evacuation
[fol. 240 ^.] and because the matter had turned into the ear.
Thereupon he ate sheep's-head and grapes in excessive quantity,
after which he got a continuous fever; he became disturbed,
meteoric and of dry temperament. He took fruit-juice and gentle
purgatives, but he vomited them.

I went to see him on the third day ; I found him suffering from
a violent headache, photophobia, strong lacrymation and red eyes.
I gave him a phlebotomy without letting a large quantity of blood
because I hesitated on account of the persons present (29). I
intended to purge his nature on the following day; but on this
day most of the symptoms subsided. Then came from the
cavity of his ear symptoms of meningitis, and I feared that he
would in reality be attacked by meningitis. I omitted to administer
to him a strong laxative, which should have relieved him, through
hesitation and for no other reason. I prescribed for him purging
cassia and the like; but all that did not help him. Then I ordered
enemas to be given him during three days. When this time had

(29) In the sick-rooms of Oriental patients of rank there is always a large number
of persons present.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 335

elapsed, I came back and found him in a most critical condition;
he was unsettled in mind, his urine was deep red and his face
puffy. I intended to make him bleed at the nose, but hesitated
on account of the large crowd which was present and because
there had not been a reliable physician before myself. On this
occasion I had with me only barley-water, which I administered
to him, hoping to procure him some relief. I prescribed for
him to drink the juice of vegetable marrow and the mucilage
of flea- wort; but he neglected all. The fourth day after this
day his condition became extremely critical, and the fatal symptoms
made their apparition : one of his eyes became small, his tongue
turned blackish and swollen, and be died on the same day at
the time at which I had predicted his extinction.

The ignorant physicians (whom he had consulted beside myself)
supposed that he was suffering from a (left) facial paralysis,
caused by moisture (of his temperament), w^hereas (on the con-
trary) the strong contraction of the right eye was due to a spasm
in this region.

[Case IV : Aortic Regurgitation.]

I was consulted by a man w^ho complained of palpitation of
his heart within his chest. When I laid my hand on his left
mamma, I felt a pulsation of his aorta so violent as I had never
observed before. When he stretched out his left arm to show
me his basilic vein, the pulsation of his brachial artery was equally
violent, so that it was visible, the flesh being raised and sinking
(in a regular fluctuation). He informed me [fol. 241 r.] that
he had been bled from his basilic vein without any useful result,
but that eating of hot dishes procured him some relief. I confess
that this case baflled me for some time. After having obtained
more insight into his disease, I administered to him the musk-
remedy, and I obtained an improvement in this patient of such
a kind that his condition as regards pulse changed to be the same
as in asthmatic patients who have an (emphysematous) distention
of the chest, which is not able to inhale the breath sufficiently.

[Case V: Genital Herpes.]

Muhammad ibn al-Husain suffered from the appearance of
itch and pustules; later on, pustules broke out on his penis, outside

336 MAX MEYERHOF

on the gland. I feared that the same would happen from inside,
and this had happened, indeed, as I suspected, some time before.

[Case VI : Hypertrophy of Prostate (or Calculus? ), Causing
Paradox Stillicidium, Cystitis and Inflammation in the Pelvis.^

The long-bearded cotton-merchant (30) suffered from chronic
pain in his stomach. They administered to him undiluted strong
wine; after he had drunk it, the whole pain descended into his
navel, and his urine was obstructed while his bladder was full.
One of the diuretic waters caused him to urinate, without my
knowing of it, and he made use of this, viz. the diuretic, repeatedly
and excessively. Finally it caused his bladder to reach such
a condition that the urine exuded involuntarily, containing a
white, crude mixture which I supposed to have come down from
the upper parts while there was something else obstructing the
urine.

After that, he was attacked by paralysis of his two legs simul-
taneously. He sent for me, and when I came, I found the doctors
anointing both his legs with warm oil. I supposed that there
was a disease of his bladder and that, by its influence, the two
nerves were affected which run to the legs since they are quite
near to one another; and that there was a swelling (inflammation)
in the region of the origin of these nerves. I made a venesection
in the sacral region (qatan) and it was only a few days before he
was able to move both his legs, continuing until the time w^hen
I write down this narrative.

[Case VII : Incomplete.']

Abu'l-Husain, the tailor, had suffered from an inflammatory
disease and was cured under my care. After that, he complained
to me of a weakness in his stomach. I administered to him
pastilles composed of rose and spikenard, and he was seized
on the spot with an acute fever which continued with him
afterwards...

[Case VIII : An Ophthalmia or acute, purulent Conjunctivitis ]^
A man who accompanied us on our way (journey) — he was

(30) Al-Oattan ; this may be a proper name as well.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 337

Abu Dawud who led the donkey (31) — was overtaken with an
ophthalmia. When it began, I advised him to have a venesection
made, but he did not do it and only applied some cupping. He
took a remedy which he had with him, dropped it in his ear — about
one ounce — -and repeated this in excess, although I warned him
seriously [fol. 241 v.] so that I at last became weary of it; but
he did not follow my advice. On the next day his condition
grew worse and he developed a violent ophthalmia such as I had
never seen before. I greatly feared perforation of the tunics
of his eye and escape (of the vitreous) because of the whole cornea
there was no more visible than the area of a lentil owing to the
intensity of the swelling of the conjunctiva (32). At the first
possible moment I applied to him a venesection and took from
him in two operations three pounds of blood and even more;
this cleaned his eyes of discharge. I then applied the white
eye-powder, and he slept from that very hour, his pain was soothed
and he was completely cured on the following day so that the people
were astonished at it.

[Case IX : An Appendicitis ?]

KhAlid, of Tabaristan (33), suffered from a hot (feverish)
disease through a fatigue which befell him. I gave him barley
water and the like until (the heat) was extinguished. But this
caused him a pain in the region of the flanks and of the abdomen
(hdlib, abdominal veins ?) ; the doctors thought it to be a colic
and intended to administer to him hot electuaries (jawdrishdt ),
as they supposed that the barley-water had been harmful to him
because he had a residue of the feverish disease in his stomach.

I touched the diseased spot and felt it hot and hard. Thereupon
I asked him whether he felt a throbbing in it, and he answered :
*' A rather violent throbbing.'' So I supposed that he had a
hot swelling (an inflammatory tumour) in that region, made him
a venesection in both his armpits and extracted from him about

(31) The camel caravans in the Near East are mostly headed by a donkey
wearing a bell and led by his driver who is, consequently, the guide of the whole
caravan.

(32) This is called chemosis : an oedema of the conjunctiva surrounding
the cornea.

(33) A Persian province south of the Caspian Sea (today called Mazenderan).

338 MAX MEYERHOF

200 dirhams (drachmae) at one sitting. After this, I administered
to him the juice (or an infusion) of leaves of night-shade i^'inah
ath-tha'labjy endive and cucumber-seeds during several days. He
was cured and even to such an extent that his affection was much
improved on the day on which I made the venesection.

I supposed that the hot (and vicious) water causing the disease
was partly allayed and partly carried to the spot in question (34),
as there had been no perceptible evacuation (35).

[Case X : Abnormally concentrated Urine after a Fever.]
Al-'Ibadi suffered from a hot fever. This passed, but the
urine remained discoloured during many days. His condition
improved at times and grew worse again, but his urine showed
no difference in its colouration (36), although the fever went
and came again. Thereupon, I made him a venesection, bled
him from the basilic vein and extracted the blood with the lancet.
On the same day his urine became light-coloured, and he was
completely cured.

[Case XI : A Case of Smallpox.]

The daughter of al-Husain Ibn 'Abdawaih had drunk camel's
milk as usual, without asking my advice. When she became
meteoric after the milk, she took the musk-remedy without having
previously submitted herself to a venesection or to purgation.
She developed a continuous fever, and there appeared on her
body the symptoms [fol. 242 r.] of smallpox; she had, in fact,
four attacks of smallpox one after another (37). When the small-
pox began and she consulted me, I took care of her eye[s], and
strengthened it [them] with antimony -powder rubbed in rose-
water, and nothing appeared in her eye (38), although its sur-
roundings were very severely affected. All the people who were
near her, wondered at this astonishing fact that her eye was saved.

I applied to her for some time barley-w^ater and the like, and

(34) I.e. the ho,t and hard spot in the abdomen (appendicitis?).

(35) That is to say, the breaking out of an abscess or the like.

(36) Probably dark, reddish brown, as usual in fevers.

(37) I.e. four attacks of recrudescent fever.

(38) Dangerous purulent pustules of the cornea, often a cause of blindness,
are a frequent complication of smallpox.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 339

her nature did not show any change as is so frequent a consequence
of this disorder. There remained some residue of hot fever,
and 1 supposed that this might be because the remainder of the
(ill-natured) humours had not been expelled by the usual purgation;
I could not venture to obtain an evacuation at once because of
the weakening of her forces. So I confined myself to administering
to her dried apricots (naqW ) at day-break and barley-water at
noon during a fortnight. This procured her two evacuations
a day, and she was completely cleared of the disease. The matura-
tion of the urine (39) appeared after forty days, and her recovery
was complete at the end of fifty days.

[Case XII : Obesity and Gout.]

Concerning the son of al-Husain ibn 'Abdawaih, the doctors
supposed that he was of humid temperament on account of his
obesity, because they were unable to distinguish between a fleshy
man and a fat man. He had an attack of pain in his articulations,
which subsided later on. I applied to him several venesections
and administered to him once a week a purgative containing
a remedy which evacuates the yellow bile, because this (nocive)
mixture (of humours) was an acrid purulent matter. I prescribed
to him as diet sour, bitter and astringent aliments and forbade
him sweets, strong and fatty foods. This disease subsided and
caused him only unimportant attacks. When he had followed
this prescription for a long time, he was completely [restored]
and his body began simultaneously to lose flesh.

[Case XIII : Semitertian Fever.]

Ibn IdrIs was suspected of being attacked by the worst for n
of semitertian fever (40), the acuteness of which was great; it
became chronic while the doctor administered to him pastilles
of bamboo-sugar (tabdshir ). I prescribed to him to drink barley-
water after a dose of oxymel ( sikanjubin ) and to delay his meal
every day until the time of the decrease of the fever and to avoid
as much as possible the time of the (feverish) attack. I insisted

(39) I.e. its clear, normal, yellow colour.

(40) It is mixed fever, described by Galfn {De Differentiis Febrium, II, 7.
Ed. KuHN, vol. VII, pp. 358-65) under the name of -qfurpLralos Trvpero?; the
Arabic term is hummd shatr al-ghihb.

340 MAX MEYERHOF

upon this prescription, but he found it difficuh. I told him,
however : '' You cannot have any other prescription than this '!'
Thereupon he followed my advice during several days in my
absence, and he came to see me after ten [fol. z\z v?\ days and
was completely restored.

[Case XIV : A lacrymal Fistula.']

The son of 'Abd al-Mu'min, the goldsmith, had a lacrymal
fistula (gharab). I prescribed to him to rub in an eye-wash
which I had prepared for him [scil. with w^ater) and to insert
it by drops into the inner corner (milq) (41); he did this and was
healed.

I know, however, that this is not a real healing, only a shrinking
and drying up of the fistula, but not a clogging (cicatrisation);
I have experienced that repeatedly. Galen speaks of the same
matter among his rare cases ; it was this that caused me to compound
the eye-wash in question (42).

[Case XV : A Mastitis]

The wife of Ja'dawaih, the sister of Haidara, suffered from
a feverish disease; I gave him every day a prescription (for her)
when he brought me her urine (43). One day he came to tell
me that she had got pain and swelling in her mamma. I prescribed
to him to avoid the application of cold and to employ massage,
and in this way the disease was cured. I informed him that the
affection would recur if the pain was soothed suddenly without
administering a purgative. But this woman was inclined to rest,
as I believe, and allowed her extremities to become cold. This
pain and swelling subsided, indeed; but the disease and the
(nocive) mixture (of humours) returned in the severest possible
manner. Thereupon I advised him to repeat the covering
and cooling, and I purged her; she was cured.

(41) Better ma'q] muq is the popular name of the inner corner (canthus) and
caruncula of the eye.

(42) Perhaps a plaster of white-lead and oxelaeum, mentioned by Galen in
his De Compositione Medica7ne7itorimi per Genera, I, 7 (ed. Kuhn, vol. XIII, p. 401
et seq.).

(43) We must not forget that in olden times many pious Muslims did not permit
the doctor to examine or even to see their wives; so the diagnosis was confined
to the inspection of the urine.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 341

[Case XVI : Septic Arthritis after an Abscess in the Liver?]
The door-keeper, al- Hasan, was attacked by a very acute
disease; he had suffered from a hot (sweUing of the) Hver and
the residue (matter) had been repelled to the articulations so that
they became swollen while the fever subsided; this condition
continued with him. A doctor made him a venesection, whereupon
some acute feverish affection returned, his strength decreased
rapidly and he died after three days.

[Case XVII : Eclampsia ?]

The woman who was brought to me by Abu 'Isa al-HashimI,
the coppersmith, was of very fat and humid constitution. She
had suffered during her confinement from a plegia (fdlij ) and
after that from epileptic fits (sar ) ; there was no doubt about
her case as it showed real and unmistakeable indications. I
purged her with strong potions which expelled the phlegm, and
I prescribed to her after that to take the Theriac of the Four (44) ;
but the druggist (saidaldni) gave her, instead of this, Anacar-
dium (45); she was marvellously well restored.

[ Case X VIII : Epilepsy .]

Our neighbour, the cloth merchant in the Street of Lucerne
(Darb an-Nafal) (46) suffered from epileptic fits from his child-
hood; he was slim. So I supposed that his disease was not caused
by an excess of phlegm and prescribed to him emetics to be
taken repeatedly. After that, I administered to him a potion
which energetically expelled the black bile. Thereupon he was
free from epileptic fits [fol. 243 r.] for three months, and the
neighbours in the quarter came to thank us. Hereafter he ate
fish and drank much wine; he had an epileptic fit the same night.
He again began to take the emetic, followed by the potion as
before, and his condition improved. Then he resigned himself
to take regularly and without reluctance the emetic and that
potion up to the time when we left Baghdad. Previously he had

(44) The composition of this remedy is given by Guigues, Le livre de Vart
du traitement de Najni ad-Dyn Mahmoud, Beyrouth, 1903. p. 146. See below
under A.

(45) The cashew nut (fruit of Semecarpus Anacardium).

(46) This must have been one of the wards of Baghdad. See below under E.

342 MAX MEYERHOF

been treated at the Hospital (47) with purgations without any
success.

[Case XIX : Epilepsy ? (48)]

I recognised a bookseller, named Nazif, as epileptic by his
face as I saw that his Jugular veins (widdjdn) were full, his face
red and puffy. He was stout, with red eyes and of plethoric
constitution. I ordered the physician-lecturer (49) to bleed
him at the Vena saphena; he bled him at the Basilic vein. I
followed the case, who during a year remained free from
epileptic fits.

[Case XX : Haematemesis. Varices of the Oesophagus in
Hepatic Cirrhosis .^]

A man consulted me, who had vomited two pounds (rati)
of blood following on excessive drunkenness. I found his eyes
red and his body plethoric. Thereupon, I made him a venesection
and administered to him astringent remedies, and he was restored
to health.

[Case XXI : Haemoptysis.']

A man expectorated blood when coughing. One day he ate
sparrows fried in oil, and expectorated after that three pounds
of blood, like the blood extracted by cupping, big clots ; it was
feared for his life. Later on I saw him again in healthy condition
except that he had a slight but incessant cough. Thereupon
I prescribed to him as diet fresh fish, and the expectoration was
stopped.

(47) This was perhaps the hospital founded in 306 A.H. (c. 918 A.D.) by
the caliph al-Muqtadir, under the name of al-Bimdristdn al Muqtadirf, and
in which Rhazes was for some time one of the physicians. See Ahmed Issa
Bey, Histoire des Bimaristans (hopitaux) a Vepoque islamique, Le Caire, 1928,
p. 177 et seq. and our remarks under A.

(48) Possibly a hypertonic, cerebral, convulsive affection.

(49) Literally, " the reading-out physician." The lectures on Medicine,
Philosophy and other sciences were given in this way : one of the students
or assistants read out part of a medical, or other text-book, and the professor
then gave explanations, asked and answered questions. This scholastic method
of instruction had been in existence since the Hellenistic period and was in use
in Europe as late as the XVI Ith century.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 343

[Case XXII : Alopecia.]

A man, a native of Dara'i al-Aqwal (50), consulted me for
an alopecia (51) on his head, two fingers in diameter. I advised
him to rub the place with a piece of cloth until it almost began
to discharge blood, and to rub it after that with onion. He
did this in an excessive way many times, provoking blisters.
I prescribed to him to anoint the spot with fowl's fat; thereupon
the itch ceased, the malady subsided and the hair grew again within
a month and became more beautiful, blacker and thicker than before.

[Case XXIII : Hydrorrhoea tiibalis intermittens,]
The wife of the fuller (52), agent of the son of Sa'id ibn 'Abd
AR- Rahman, showed symptoms of dropsy; it was not possible
to ascertain that by direct inspection (53). I administered to
her sometimes water of the great cardamon ( ? faldfil) and some-
times a remedy of turmeric (kurkiim). One day, when she was
washing and bending over the washtub, there suddenly poured
from her about twenty pounds (rati) of a yellow liquid, and she
was relieved and at rest [fol. 243 v.] for a while; later on it recurred
(the dropsy). I then took exact information about her and
ascertained that she must suffer from a disease in the uterus,
and so I treated her accordingly. She believed that she was
pregnant, but she was not.

You must understand this and make your investigations accord-
ingly as there is one of the diseases of the uterus resembling
pregnancy !

[Case XXIV : Acute Glomerulonephritis following Measles.]
The little son of Ibn Sawada had a yellow bile fever from
his throat. On the fourth day in the morning he began to urinate
blood and to pass with the stool green and bloody bile, resembling
water in which fresh meat had been washed ; his strength decreased
suddenly. We were baffled because his malady had been slight
and benign and then had changed in one night to this acuteness

(50) This may be the name either of a ward or of a house in Baghdad.

(51) Literally, " fox-disease " (dd'ath-tha'lab), a translation of the Greek name
dXwncKLa (bald patches on the head).

(52) In Arabic al-qa^sdr, which may be a proper name.

(53) Probably not allowed for the reason given in the note 43.

344 MAX MEYERHOF

and severity; we supposed that he had drunk something (harmful).
When the afternoon came, he had a quite black micturition and
equally black stools. He died in the early morning of the sixth
day. He had had from the beginning a malign form of measles,
prone to attack the internal organs (54).

[Case XXV : A Cholecystitis?.]

A woman came to consult me with a urine as black as bile.
She declared she had pain in the spine of her back, and that
this pain had subsided since the time she had this (black) micturi-
tion; she had had this micturition for ten days before she came
to see me. She suffered from a nocturnal fever causing shivering
every night, and the bile was black-natured. I prescribed to
her a diuretic.

[Case XXVI : An Abortion, or a submucous Myoma.]
The wife of Abu 'Isa (55) was attacked by a colic of moderate
severity. She took sahar-bdrdn (56) and after that a remedy
containing a quantity of heating elements. The seat of the pain
was in the uterus; at the same time the patient suffered from
constipation owing to pain and swelling in the uterus, which
compressed the Coecum (a'zvar ). The pain became violent when
the " burden " came down, and the constipation was caused
by the coming forth (prominence) of the '' burden." When she
had taken these remedies, something protruded from her anterior
parts (pudenda) resembling the placenta. I ordered the midwife (57)
to touch and ascertain its consistency; she found it soft, flabb}/
and lacking sensation. I prescribed to the patient to bind her
legs together for two days and then ordered (the midwife) to cut
off the insensible part. Thereafter, something protruded three
times, was cut off, and the patient was healed.

[Case XXVII : Phthisis.]

Our neighbour, the phthisical old man expectorated much blood

(54) See end of Case XXVII.

(55) See Case XVII.

(56) An Arabo-Persian name for a drink, perhaps syrup of melissa (bdrdn).

(57) Midwives alone were allowed to examine female patients, and to operate
on their genital parts.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 345

during a long time. Afterwards his condition grew worse; he
took pills (pastilles) which stopped the cough and he felt better
each time he underwent this treatment for some days. But soon
afterwards he died while I had been unable to examine his condition
during these [fol. 244 r.] days.

Therefore it is important to avoid remedies which stop expect-
oration, except in the cases where the matter flows down from
the head.

It is, moreover, important to refrain from compresses on the
abdomen in cases of measles and smallpox as this may cause
distress to the respiration immediately, and malignant diarrhoea
and haematuria; an example of this is the son of SawAda (58).

[Case XXVIII : Vasomotoric Collapse in Pleurisy] [fol. 244 v.,
last line].

The money-changer (jihhidh), al- Hasan had a disease
regarding which it was at first doubtful whether it was
a pleurisy (dhdt al-janb) [fol. 245 r.]; afterwards this diagnosis
was confirmed, but they made him no venesection... (59) was
hot and his expectoration creamy and white. When I saw him
on the eleventh day, his extremities were like ice and could not
be warmed by any means. There had been no fever beforehand
— I had been informed about him since the seventh day — but
his body had been cold and his eyes had been fixed. He asked
on that day for a venesection, but when I touched his artery,
I found it collapsed and slack, and so I prevented him from being
bled. His saliva had a bad smell and his condition was as it
is described in the Book of Acute Diseases (60). I thought that
he would live one day more, but he died after only eight hours.

[Case XXIX : Hay- fever (?), followed by Rheumatic Polyar-
thritis.]

The son of al- Hasan ten 'Abdawaih (61) suffered from attacks

(58) See Case XXIV.

Now follows an interpolation by Razi regarding the first case of Hippocrates'
Epid. J. It is placed at the end of this translation.

(59) A gap in the Arabic text.

(60) V^hat is meant is probably Hippocrates* De Diaeta Acutorum.

(61) See Cases XI and XII.

346 MAX MEYERHOF

of coryza so heavy and severe that I have never witnessed a similar
case before. Even the sUghter form of it used to remain with
the sufferer a month and more and to descend to the chest, causing
coughing and expectoration. This patient showed an improve-
ment about the middle of the day so that he did not feel any
discomfort, but this caused him pain in the articulations.

You must know that this case is like Galen's description (62),
viz. that the discharge of residue (matter) is not effected by the
canals (pores) of the body, but by the joints of the limbs. For
this reason (his coryza) used to leave him suddenly, but caused
pain in the articulations, because the residue was attracted to
the articulations.

[Case XXX : Sciatica or Lumbago.]

A nobleman in Baghdad had a pain in the hip-bone (wark).
The doctor administered to him grains of gnidium (mathandn)
and fumitory (shaitaraj ) because his urine was light-coloured
and his body robust, his diet heavy. But his hip-pain increased,
and his malady grew worse so that he was not able to stand in
an erect position. Then he administered to him an enema, but
his condition grew worse. Thereupon he asked for my help,
and I prescribed to him an emetic on a full stomach several times.
After that I anointed his hip-bone with mustard until it {sciL
the skin) was covered with blisters. His pain subsided and
lessened until it nearly disappeared. After that I administered
to him an enema causing abrasion (of his intestinal mucous
membrane) (63), and he was cured.

[Case XXXI : Sciatica or Lumbago ?]

The sister of the bookseller suffered from a pain in the hipbone.
I administered to her an enema, but she asked for a purgative.
I then prescribed to her an enema with the water in which salted
fish had been washed; she took it and was cured after having
received an il)rasion (of the intestinal mucosa).

(62) It is impossible to find which case of Galen's many observations on
arthritis is meant. Rhazes, himself, wrote two short treatises on hay-fever
('* On the reason why the heads of people swell at the time of the roses and generate
coryza," etc.). See J. Ruska, p. 37.

(63) I.e. an enema with caustic remedies, such as mustard or salt water. See
the following case.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 347

I Case XXXII : Sciatica ?]

The same was the case of Ibn Dalil. He had refused an
enema and had become lame from his hip-bone. He then drank
the pulp [fol. 245 V.} of colocynths in great quantity (64) and
was healed.

[Case XXXIII : Cholangitis ( ? ) ; Infectious Icterus ^^
The son of 'Amr ibn Wahb became feverish and a very intense
jaundice made its appearance on him, so that his eye looked
on the fifth day like a piece of cartham (65). On the ninth day
he had a retention of urine, and he passed only very little, three
drops (coloured) like the contents of the gall-bladder. He passed
blackbiled stools, and his urine on the sixth day was black, then
red with yellow froth on it. Then... (66). On the eleventh night
he had a severe haemorrhage from the right nostril ; then he
died on the thirteenth night without having lost his sound mental
capacity and consciousness. He was attacked by gasp (death-
rattle) and coryza, and the swelling of his liver was manifest.

[Case XXXIV : Hemiplegia? Incomplete observation.^
The whole of one half of Ibn Nusair^s body felt continually
hot and the other half cold as ice; the cold half had no pulse,
the other half a quick pulse. The tendons of his neck were
taut, his urine was white like running water and the eye on his
cold side was small and very much wrinkled (contracted)... (67).

[Interpolation between Cases XXVII and XXVIII, beginning on
fol. 244 r., line 4 of the M-S\]

Epidemics : The first patient of the first Book (68) : This
man had a burning fever with great heat during the whole of one
day; thereafter he perspired greatly during the night, without
this perspiration checking his fever or bringing him any relief.

(64) A very drastic purgative.

(65) Safflower or bastard saffron.

(66) A gap in the Arabic text.

(67) Unfinished.

(68) This observation, concerning a man named Philiscus, is extracted from
Hippocrates' Epidemics, Book I (Littre's edition, vol. II, p. 682 et seq.) and
Gai.en's Commentary III on the same book, second part (Kuhn's edition, vol.
XVII A p. 253 et seq.).

34^ MAX MEYERHOF

On the contrary, during the whole of this night and on the second
day the symptoms of his disease grew worse. After this, he
received an enema on the day in question, had a motion and was
better during the whole of the following night and half of the
third day. Near the end of this day the fever recurred with
violent thirst, dryness of the mouth and sweating, which did
not relieve the fever at all, also with delirium and hallucinations,
and the patient during the course of this night passed dark-coloured
urine. Thereafter he had some relief in the night preceding
the fifth day and during the first half of this day. Then he
discharged from his nostrils a few^ drops of blackish blood, and
he passed urine in which were suspended particles like semen
virile of varied shape, roundish and other forms, which did not
form a deposit. The patient's condition was still serious during
the whole of the night preceding the sixth day; this night his
limbs became cold and were to be warmed only with difficulty,
he slept very little, passed blackish urine and had delirium. On
the morning of the sixth day he was speechless and had cold
perspiration. Later, about the middle of the day, his extremities
became greenish, and he died. Throughout the course of the
disease his perspiration was cold, his respiration deep and broken.

In this patient the symptoms of malignancy were evident from
the beginning of the first night as shewn by the fact that he perspi-
red constantly but had no relief from his fever. Hippocrates says
that in the event of symptoms of a crisis being present without
the coming of a crisis, these symptoms either announce death
■ — and this if they are accompanied by symptoms of fatal prognosis
■ — or predict a long course of the disease— this latter in the case
of their being accompanied by symptoms [foL 244 v^^ of healing.
When this patient's fever did not relax after the perspiration
but became more violent and malignant on the second day and
the sufferer passed dark-coloured urine on the third day, all this
confirmed the indications of malignancy. I mean to say, after the
symptoms of crisis there appeared still another symptom
announcing death and confirming and corroborating the first.
I mean by the first the fact that the fever was not relieved by
the perspiration; this was followed by sleeplessness, delirium
and thirst. When, on the fourth day, the symptoms became
more definite and he passed blackish urine, this indicated two

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 349

features, viz., firstly, that the disease had reached the (vital)
spirits (arwdh) because they were affected already on the second
and third day, and, secondly, that his death would occur by
way of the (vital) spirits. The fourth day is similar to the sixth
and seventh, except if the acuteness is very great and the symptoms
indicate death, when it is likely to occur on the sixth day. When he
reached the sixth day and the attack came on with severe symptoms
and he died on this day, it was confirmed that his crisis had presaged
the occurrence (of his death) on this day. He had passed blackish,
urine on the third and fourth days, and this indicates extreme
malignity and acuteness; for if the intensity and violence (of
the fever) appears in two subsequent attacks, this is a strong
indication of the acute character (of the fever). When this was
followed, on the fifth day, by trickling of blood from his nostrils,
this was a sure sign of dwindling of his strength. Had his strength
been greater and the violence of his malignant symptoms less,
his death would have been delayed until the eighth day. His
mental condition supplied an indication of the confusion of his
intelligence, as it has been described (by Hippocrates) in the
Epidemics^ and the cold perspiration throughout the course of
the disease lessened his strength but not the power of the disease.
The second acute attack which seized him on this occasion,
is an indication that one must not rely on an intermittent calming
down (of the symptoms) if there is not at the same time an
improvement in the causative crisis; for the acute attack is likely
to recur in such cases. Consequently, the symptoms occurring
in this observation have all been mentioned, except the urine
in which a spermatoid formation was suspended. All the other
observations are in accordance with the contents of the books
of the Prognostic, the Crisis and its Days,

D. — Supplementary remarks

As I mentioned earlier, Rhazes, himself, did not place heads
or a diagnosis above his observations. They follow on without
any separation. It is not always possible to recognise the diseases
which are described in the foregoing text. In attempting to do
this I have received precious help from several medical friends

350 MAX MEYERHOF

practising in Cairo : Dr. Schlesinger, specialist in internal
diseases, Drs. Rosenauer and LuCHS, surgeons, and Dr. Roy
Dobbin, professor of Gynaecology and Obstetrics of the Faculty
of Medicine, Egyptian University : I take great pleasure in
thanking them for their kindness.

Case I has been translated by E. G. Browne. He found
in it ** several difficulties, both verbal and material,'' but could
recognise the general nature of the case. In his translation, as
mentioned earlier, we have to replace the word ** ulceration ''
by ** abscess,'' and (p. 52) ** the ulceration was slight " by " the
abscess was small." We thus obtain a clear idea of the case,
which was one of renal abscess, characterised by a very irregular
fever, and then perforating into the renal pelvis. The judgment of
my Cairo colleagues on Rhazes' accomplishments in this case is
** that he made all the observations that he could make without
the help of modern chemical and microscopical methods."

Case II is a simple case of dysentery. Here Rhazes followed
the theories of the Greek physicians concerning the influence
of yellow and black bile.

Ca^e III : This is an undoubted case of otitic meningitis,
well diagnosed and expounded by Rhazes.

Case IV : It is certainly an incompetence of the aortic valve,
one of the rare cases described during the Middle Ages.

Ca^e V : In this case, the diagnosis of genital herpes is not
quite sure but very probable. The preceding internal affection
of the urethra may have been a gonorrhoea.

Ca^e VI is not quite clear. It offers remarkable resemblance
to certain tuberculous affections of the pelvis, causing at first
retention of the urine and calculi in the bladder and then paralysis
or paresis of the sciatic nerves. The rapid cure of this latter
affection is somewhat puzzling.

Case VIII is a very common one in the Near East, especially
in countries which have a very hot and dry summer. It is a
case of acute conjunctivitis, offering the appearance of a gonorrhoea!
ophthalmia. We know to-day that this form of contagious
conjunctivitis is generally caused by the bacillus discovered in
1883 i^ Egypt by Robert Koch and in 1887 in New York by

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 35 1

JOHN Weeks. It is able to cause an enormous swelling of the
lids and conjunctiva (chemosis) without causing any harm to the
cornea. As nitrate of silver, the best remedy for this affection,
was unknown in the time of Rhazes, his de-congestive treatment
was not bad.

Case IX is probably, but not for certain, an appendicitis.

Case X is only a symptomatical observation : high con-
centration of the urine lasting for a long time after a fever, possibly
a case of nephritis. The clearing up of the urine is called by
the old doctors its '' maturation."

Case XI is one of smallpox, described in such a masterly manner
by Rhazes in his famous book On Smallpox and Measles. In
the present case he lays stress on his successful measures to preserve
the cornea of the eyes from pustules. This is of the greatest
importance in Oriental countries where, even in our time,
destruction of the cornea, by formation of white spots and resulting
blindness is one of the most frequent consequences of smallpox.
Up to the time of the introduction of Jenner's vaccination, it
was one of the principal causes of blindness even in Europe
and much more so in the East.

Case XII is one of obesity with gout, combated by Rhazes
in a very reasonable manner. The only difference is that what
Rhazes terms " yellow bile," we call uric acid.

Case XIII follows the lines of ancient, especially Galenic,
medicine. We see the physician making his prescription on diet
with severity because Oriental patients very often refuse to follow
advice which does not accord with their daily habits.

Case XIV : In this case of lacrymal fistula Rhazes shows sound
judgment regarding the doubtful value of medical treatment. The
oculists who wrote not long after Rhazes' death ('Ali ibn 'Isa of
Baghdad, *Ammar of Mosul and others) insisted on the necessity
of surgical treatment f scraping and cauterisation) of such fistulae.

Case XV was not seen by Rhazes personally, as it concerned
a woman suffering from mastitis, and he was obliged to form
his opinion on the basis of descriptions given by her husband.
Half a century ago similar conditions still existed in Egypt, Turkey

352 MAX MEYERHOF

and Persia, and still do today in some remote parts of the Islamic
world (Afghanistan, India, etc.).

Case XVI : Rhazes' notes on this patient whom, evidently,
he had not seen until a few days before his death, are not sufficiently
complete to allow of a retrospectiye diagnosis.

Case XVII is a doubtful case of eclampsia. The Theriac of
the Four, which is mentioned in this observation, contains
(according to Guigues' publication quoted in the note 44)
Greek gentian, laurel grains, long aristolochia and pure myrrh.
None of these drugs has, according to our present conception,
any active, antispasmodic principle.

Case XVIII is described as an epilepsy, while Case XIX seems
to show more an apoplectic than an epileptic type.

Case XX is too brief a description to allow of an exact retrospec-
tive diagnosis. In a drunkard haematemesis by varices of the
oesophagus (hepatic cirrhosis) is possible and even probable.

Case XXI is probably a tubercular haematemesis.

Case XXIIy an alopecia, is interesting on account of the remedy.
The principle of causing the hair to grow on the diseased, round,
bald spots by application of irritating substances, is still in use
in our day.

Case XXIII is very well described. It is possibly one
of intermittent tubal hydrorrhoea, which Rhazes noted with the
intention of explaining the difference of diagnosis in this affection
and in a pregnancy.

Case XXIV : There is hardly any doubt here that it was
a case of Bright's disease after quinsy or measles.

Case XXVI may refer to an abortion of slow progress or a
submucous myoma. Personal observation was impossible for
Rhazes, who had to base his report on the sayings of the midwife.

Case XXVII is one of phthisis. Rhazes wishes to show the
dangers of cough-relieving remedies in similar cases.

Here follows in the original text the explanation of the first
case in Hippocrates' Epidemic Diseases. It is certainly not in
its right place since it should be compared with a similar case
out of Rhazes' own observations. This case is missing in our

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 353

text. I have therefore placed the expose on Epidemics at the end
of Rhazes' cases.

Case XXVIII, to be compared with one in Hippocrates' Diet
in Acute Diseases^ is one of vasomotoric collapse during a
pleurisy.

Case XXIX is not clear : possibly hay-fever or simply a severe
cold, followed by rheumatism. It should be compared with one
of Galen's cases, or, perhaps, with his assertion in De probis
pravisque Alimentortim Succis (chap. 19, ed. Kuhn, vol. VI, p. 814)
that " thick chymes " are a cause of arthritis.

Cases XXX to XXXII are sciatica or lumbago. The application
of counter-irritation by blistering the skin with powdered mustard
is very reasonable.

Case XXXIII is one of feverish jaundice (infectious Weil's
disease ?) and may in certain particulars compare with the case
from the Epidemics preceding Case XXVIII.

Case XXXIV y like Case VII, is incomplete : it is a vasomotoric
paralysis, caused perhaps by a cerebral affection.

The exposition of Case I of Hippocrates' Epidemics does not
follow the lines of Galen's commentary (ed. Kuhn, vol. XVII A,
p. 253 et seq.), who lays more stress on the respiration which
in this case resembled the Cheyne Stokes' symptom. Rhazes
insists more on the cold perspiration, bleeding at the nose > and
other external symptoms of malignant fever.

To sum up, the above observations are certainly good, interesting
and almost unique in the whole medical literature of the Middle
Ages.

E. — Some light on Rhazes as a practitioner

The above text, in addition to its medical interest, makes it
possible to learn for the first time a little about Rhazes' practical
work during his sojourn in Baghdad. In Case XVIII he says,
himself, that the observation in question w^as made in that capital
of the Caliphs some time before he left the city. He writes, also,
that he lived in " the Street of Lucerne " (Darb an-Nafal) (69),

(69) Corrupted in the text to Darb an-Naql, which has no reasonable meaning.

354 ^"f^X MEYERHOF

which is not mentioned in the geographical treatises of the Arabs,
but is in accord with the names of many streets, quarters and
bridges in the suburb of al-Karkh, the great commercial centre
in the south of the capital. Here we find " the Myrtle Wharf,"
*' the Melon House," " the Barley Street," " the Thorn Bridge,"
*' the Alkali Bridge," '* the Pomegranate Bridge," and other
names which show that the markets for the commodities in question
were situated in those districts. Here also were the markets
of the butchers, poulterers, soab-poilers, reed-weavers, oil-
merchants, cooks, cloth and cotton merchants and many others
Moreover, the " old " hospital, viz. the Muqtadiri Hospital,
mentioned before, where Rhazes must have given his lectures,
was situated in the western part of al-Karkh, near the bridge
over the Karkhaya Canal (70). I suppose that Rhazes had his
lodging in this quarter because most of his patients belonged
to the craftsman and merchant class.

First of all, we observe that the names of patients given by
Rhazes in his short account, are nearly all Muhammadan names
(Muhammad, al-Hasan, al-Husain, Khalid, 'Abdallah, 'Abd
al-Mu'min, ' Amr, Nusair, Idris, al~Hashimi, al-*IbAdi, etc.) (71).
There is only one name, NazIf, which could be Christian (Its
meaning is " pure," an equivalent of the Greek Katharos (72)).
The occurrence of several half-Persian names (*Abdawaih,
'Amrawaih, Ja'dawaih) is in no way surprising as the amalgama-
tion of the Arabian conquerors with the vanquished inhabitants
of Mesopotamia had begun in the Vlllth century. We see also
that Rhazes was family-doctor of several families. He treated
the son and daughter of al-Hasan (or al-Husain) ibn 'Abdawaih
(Cases XI and XXIX), 'Abdallah ibn Saw Ada and his son (Cases I
and XXIV), the coppersmith, Abu 'Isa al-Hashimi, and his wife
(Cases XVII and XXVI), the bookseller, Nazif, and his sister
(Cases XIX and XXXI). Several of the patients were his neigh-

(70) See Le Strange, Bagdad during the Abhasid Caliphate. Second edition
(London, 1924). Map IV, facing p. 57, No. 7.

(71) The repeated mention of wine and drunkenness show that the Muslim
inhabitants of Baghdad did not regularly observe the prohibitory rule of the
Islamic religious Law.

(72) I met with this name as that of a Greek Christian in Ibn AbT Usaibi'a's
work. The name KaOapos is testified to by Greek documents from Egypt, accor-
ding to Fr. Preisigke, Nafnenbuch, etc. Heidelberg, 1922, p. 156.

THIRTY-THREE CLINICAL OBSERVATIONS BY RHAZES 355

hours in the street or the quarter (Cases XVIII and XXVII).

As to the rank and profession of Rhazes' patients, we find
among them a modest doorkeeper and a caravan-guide, as well
as craftsmen (a coppersmith, a fuller, a goldsmith, a tailor, etc.),
merchants (a cloth and a cotton merchant, a bookseller, a money-
changer), officials (an accountant), and noblemen (Cases III and
XXX). It is pleasant to learn that Rhazes, who did not come
to Baghdad until he had alread}/ a great reputation, took under
his care patients of all kinds without regard to their social or
financial standing. The fact that the names of Christian and
Jewish patients are missing from Rhazes' observations (although
both these elements were largely represented in Baghdad and
particularly in the suburb of al-Karkh) may be due to the mistrust
with w^hich Muslim practisers of medicine were regarded even
by their own people (73). It w^as, indeed, Rhazes himself, who
by his prodigious skill and science — the like of which had up
to then only been seen among Christian scholars — broke the
ice and prepared the way for the Muslims. We read in his
account, looking between the lines, that he had to combat mistrust
and bad faith on the part of some patients who either did not
consult him a second time or consulted other doctors behind
his back, just as we still observe to-day with Oriental patients.
Regarding the impossibility of a thorough examination of Muham-
madan female patients, we have already referred to this difficulty
in our notes on the cases.

If other Arabic and medico-historical scholars will follow and
set to work to extract the many personal observations made
by Rhazes in his enormous Continens, the aim of this modest
sketch will be fulfilled.

Cairo. Max Meyerhof.

Additional Note : Concerning the observation no. VII, Dr. Paul
Kraus (of Paris) was kind enough to attract my attention to
the fact that a certain Abu'l-Husain al-Khayat (i.e. " the
Tailor ") was a contemporary and philosophical opponent of
Rhazes in Baghdad. He belonged to the eighth " generation "

(73) See Browne, Arabian Medicine, p. 7 et seq.

356 MAX MEYERHOF

of Mu^tazilites (rationalistic theologians) in this capitaL One of
his works, a refutation of the heretic Ibn ar-Rawandi was edited
by Nyberg (Cairo, 1925). Rhazes himself wrote several polemical
tracts against Abu'l-Husain al-KhayAt (see Ruska's edition
of AL-BiRUNf s list, Isis, 5, 26-50). It would be of great interest
to know wether, in spite of their scientific dissensions, he had
to take medical care of his adversary.

Concerning case X, Dr. Kraus thinks that the Mesopotamian
tribe of al-'Ibadi was Christian and remained so still during
the Xth century A. D,

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