A Brief Overview of History of Medicine in Iran

1. A Brief Overview of History of Medicine in Iran Mehran Moghaddam, Ph.D. Signal Pharmaceuticals, LLC A wholly owned subsidiary of Celgene Corporation March 7, 2007

2. If you don’t know where you’ve been… Main sources of Information: Medicine in Persia by Cyril Elgood, M.D. (1892), and The Internet Considering all the negative propaganda about Iran and Iranians these days, it is critical to know about our heritage and who we really are. Of interest to this presentation is the role Iranians have played in the development of medical sciences.

3. IranAchamenid Dynasty (circa 500 B.C.) Let’s go back to the beginnings of Iran as a unified multicultural country. The above map shows that Iranian borders extended into three continents of Africa, Europe and Central Asia, 25 centuries ago. Clearly, in an Empire that large and as prosperous as Achaemenid (Hakhamaneshi) Iran, there was a need for a healthcare system during times of peace and war. This role was originally entrusted to the Magi, the Zoroastrian (Zarthushti) priests.

4. “Wise Men of the East” in Romanesque mosaic from the Basilica of St Apollinarius in Ravenna, Italy. Gothic depiction of the adoration of the Magi from Strasbourg Cathedral The Magi – Zorastrian Priests(Etymology of the word “Magic”)(Birth of Zoroasterianism to 622 A.D.) • The Magi were the priests practicing Zoroastrian. The best known • Magi to the Western world are the three “Wise men from the East” • Zoroastrian priests were in charge of religious, funerary, • and even medical needs of people of Media (Maad) and Persian empire • They became highly influential in Median society until the • unification of the Median and Persian Empires in 550 BC by Cyrus the Great • The political power of the Magi was curtailed by Cyrus the Great and other emperors in Achamenid dynasty • The Magi served as royal physicians until they revolted against • the royal family • The Magi army, led by Smerdis, was defeated by Darius I • They were never trusted with the healthcare of the royalty, again. As a result, that responsibility was entrusted to the Greek physicians • Medical expertise of the Magi became largely ignored after that and • accurate and expanded accounts of their knowledge and expertise • disappeared with time and was replaced by those of the Greeks • Perhaps the only way to take a glimpse at the state of medicine as practiced by the Magi would be to study medical references in Avesta, the holy book of Zoroaster

5. Avesta The sacred book of Persia (Zoroastrianism) • Two main forces at work, the good and the evil (dualism) • …”Aryama (the good spirit) conquers all sickness and death, just as the evil spirit produces them. Rain from Heaven produces plants and trees, whose properties are to cure disease and prevent death.” (Fargard xx.) Diseases were thought to be caused by the evil and the solution to that was provided by the good spirit. The Magi had a knowledge of medicinal properties of plants.

6. Practice of Medicine during Zoroastrian Iran(….- ~642 AD) • …”If he shall ever treat with the knife any worshipper of Mazda and wound him with a knife, he shall pay for it the same penalty as is paid for willful murder. But if he can cure three infidels in succession, he is free to practice for ever” (Fargard vii, 7.) • Fees varied according to the sex, age, and wealth of the patient • The abortifacient properties of certain drugs were well recognized and severe penalties were enacted for those procuring abortions • In case of abortion, father, daughter, and the operator were punished • The fatherless were to be supported in the society • “It lies with the faithful to look in the same way after every pregnant female, either two footed or four-footed. Young dogs ought to be supported for six months, children for seven years.” (Fargard xv.) • Medicine and religion were related It appears that surgeries took place in ancient Iran. Furthermore, there were rules and regulations for practice of medicine. By moving forward about 1000 years we can develop a better understanding of pre-Islamic practice of medicine in Iran.

7. IranSassanid Dynasty (circa 610 A.D.) Jundi Shapur Ctesiphon Iranian capital for ~800 years. Measuring about 30 square kilometers, it was known as the largest city in the world from 570-637 A.D. (Wikipedia) During the Sassanid (Sasanian) era, Iran had been restored to its previous grandeur. By 610 A.D., Ctesiphon (Tisfun), around 20 miles south of today’s Baghdad had been the capital of Iran for 800 years and Jundi Shapur had develped into a medical and industrial center.

8. Jundi Shapur Medical UniversitySassanid Era (226 A.D. – 642 A.D.) • The city of Jundi (Gundi) Shapur, in Khuzistan (Southwest Iran), was rebuilt by Shapur I (depicted in the pictures) in 3rd century A.D. using mostly captured Roman soldiers • Jundi Shapur was a multicultural city • The oldest self-contained medical university and hospital in the world was established there in the 4th century A.D. • Staffed mainly with Zoroastrian, Christian, Jewish, Greek, Indian, and Persian professors and researchers • Jundi Shapur university was also a theological school (ie. Nestorian Christian theology was also thought in Jundi Shapur!)

9. Jundi ShapurAchievements and Downfall • Indian, Greek, Persian knowledge and science were followed and built upon – Well known for eye surgery • Scientific methodology was used: “…cases should be written down and general laws deduced therefrom.” • The Persian emperors kept a close contact with Jundi shapur. Honored graduates met with the king. In 541 A.D. Khosru Anushirvan summoned a general medical council to discuss regulations for the advancement of medicine • Haris al-Saqafi, a Jundi Shapur honor student from Arabia, was tested by Khosru himself • Haris provided medical services to Prophet Mohammad after his return to Arabia • Jundi Shapur, in addition to being a medical center, became an industrial center famous for its perfumes and weaving • It fell into the hands of the conquering Muslim army in 638 A.D., but according to most historians was not disturbed. Then one might ask, what happened to the detailed records of scientific activities in Jundi Shapur??? • After some 300 years from its inception, Jundi Shapur university began to decline due to establishment of medical colleges in Baghdad and Rey (today’s Tehran). How many medical universities/hospitals do you know that are 300 years old?

10. Ruins of Ctesiphon and Jundi Shapur With demise of the Iranian Sassanid empire and inception of Islamic era, the 800 year old capital of Iran, once the largest city in the world, fell to ruins (left). With gradual destruction of Jundi Shapur (right), the center of learning shifted to Baghdad and Rey.

11. Post-Islamic EraRise of Arabian Medicine (Al Razi, Ibn Sina, Al Jurjani,…) A large percentage of the most prominent figures responsible for the development of “Arabian Medicine” were Persians. The fact that they assumed Arabic names (probably a wise decision considering Iranians were second class citizens in their own country) and wrote in Arabic (or else their writing would become obsolete and remain largely unread in the Islamic Empire) caused a confusion about the ethnicity of these prominent physicians.

12. State of Medicine Under Caliphs • The high medical standards of Jundi Shapur was transferred to Baghdad and Rey • In tradition of Jundi Shapur, a Board of Medical Examiners was set up in Baghdad in the 900’s A.D. • In 931 A.D., the Caliph demanded a more rigorous standard of examination and certification due to death of a patient • In that year, 860 physicians (excluding the royal physicians) applied for examination! • There are records indicating presence of female physicians • At one point, under the rule of Caliphs Baghdad had 15 functioning hospitals! • Eye surgeries were performed (…Rhazes refused cataract surgery after examining the physician on eye anatomy.) • Monkeys were used for medical research! (…in 836 A.D. the ruler of Nubia was ordered to supply a particular species of apes, resembling man, for dissection) • Who were some of the best known physicians of that era? I recommend that in order to remember these names, you simplify them as follows: Jabir Ibn Hayyan = Hayyan, Mohammad Ibn Zakarya Razi = Razi …..

13. Jabir Ibn Hayyan(known to the West as Geber)721-815 A.D. • Jabir was born in Tus, Khorasan, in Iran, but is believed by most to be of Yemeni descent • Extremely prolific as a chemist, pharmacist, astronomer, and philosopher • He is credited with the invention of many types of basic chemical laboratory equipment, and with the discovery and description of many commonplace chemical substances and processes – such as the hydrochloric, citric, tartaric, and nitric acids, distillation, and crystallization • The Geber crater, located on the Moon, is named after him • He wrote in codes, so the word gibberish is sometimes theorized to be derived from his name

14. Ali Ibn Abbas Al-Majusi (Know in the West as Holy Abbas, Ali Abbas, Masoudi)? – 994 A.D. • Born in a Zoroastrian family in Ahwaz, but became a Muslim • Wrote a medical encyclopedia called “The Complete book of Medical Arts” or Liber Rigalis • The first 10 chapters are theory and the second 10 chapters are practice of medicine • Some examples of topics covered are dietetics and materia medica, a rudimentary conception of the capillary system, interesting clinical observations, and proof of the motions of the womb during parturition (e.g. the child does not come out; it is pushed out).

15. Rhazes (Razi) - 860 - 932 AD • Razi was born in Ray, Iran (modern day Tehran) • Wrote over 180 books in medicine and chemistry • Described distillation, sublimation, and calcination processes; and established procedures for purification, separation, and the mixing of substances • For the first time generated pure alcohol from wine via distillation • Rhazes developed apparatus such as mortars and pestles, flasks, spatulas, beakers, phials, and glass vessels • He described a process for refining crude oil to obtain Naft • He was chief physician at the Baghdad and later at Ray hospital and trained many physicians • Known for his concentric teaching/diagnosing method in the hosptial • The first scientific description of Measles and its distinction from smallpox is attributed to Razi (Health-Disease.org) • The first in the medical field to use animal gut for sutures and plaster for casts • When he was not occupied with pupils or patients he was always writing and studying • Razi is also known for having discovered "allergic asthma," and was the first physician ever to write articles on allergy and immunology. In the Sense of Smelling he described the occurrence of “rhinitis” after smelling a rose during the Spring • Razi was the first to realize that fever is a natural defense mechanism, the body's way of fighting disease • Razi was a very generous man, with a humane behavior towards his patients, and acting charitable to the poor – treatment without a charge

16. Ibn Sina(known to the West as Avicenna and Often referred to as “Persian Galen”) - 980 – 1037 A.D. • Sina was born in a Persian family near Bukhara (today’s Uzbekistan) • His education started in theology and mathematics • At age 16 started medical training and soon after that he became a physician to the royalty • By age 21 he had completed 2 book: one was a synopsis of all the sciences of the day and another was a commentary on the Law • Due to his genius and reputation he was hired by the ruler of Khawrazm • Sultan Mahmud Ghaznavi (ancient Taliban) required Sina’s presence in his court • Sina fled from one city to another to preserve his freedom • He loved socializing, practicing medicine, writing books on diverse subjects • At the end, women, wine, and hard work wore him out and he died at 57 years of age. • After his death, he was given the title of “Chief of Chiefs” (Rais Al Hokama) • He is best known for his book called “Canon” (Ghanoon), which was translated into Latin in the 1500’s • Canon in its Latin translation became the textbook for all the universities in Europe until 19th century • Canon is believed to be a bridge between Galen and Hippocrates and Harvey and modern medicine

17. Sina’s Contributions • Anatomy of eye muscles • “…it is not a ray that leaves the eye and meets an object that gives rise to vision, but rather that the form of the perceived object passes into the eye and is transmuted by its transparent body, the Lens.” • Suggested that certain diseases were water-borne and caused by minute animals that lived in the water, too small to be viewed by human eye (microbial theory!?) • First to distinguish obstructive and hemolytic jaundice • Wrote extensively on nervous, cutaneous, and genitourinary diseases • He condemned astrology and made serious attempts to separate that from medicine

18. Arteries Veins Sina’s Contributions (continued) • He hypothesized that the veins and arteries were carriers of nourishment to organs, and they stayed as two separate compartments • Sina was not aware of circulation (through capillaries) and believed the blood in each compartment supplied nutrients by ebbing back and forth due to the heart • He suggested that veins and arteries were also principle organs of respiration. The purpose of respiration was to intake air into the blood and outpour of harmful vapors from body • Sina stated that inspiration of air took place into the skin and in the lungs through invisible pores, but that the latter played a major role • He claimed that the actual mechanics by which this took place was due to the heart expansion and contraction • William Harvey received credit for describing this in the 1600’s

19. Sina’s Contributions (Continued) • Disease might be caused by an obstruction to excretion of vapors, but it might also arise from the inspired air • At certain times the air becomes infected and anyone breathing the infected air falls sick (ie. plague) – getting very close to the microbial theory • Sina was also a philosopher: • Why should any one man suffer from any one disease rather than another? Why does disease exist at all? • Sina stated that in the make-up of most people there is somewhere a natural tendency to get out of order, some congenital weakness in one particular organ, tissue or system. He called this “personal disposition” • Sina put forward the view that each patient is to be looked upon as a distinct and separate case! (Personalized Medicine?! ~1000 years ahead of his time) • His emphasis was on the patient, not on the disease, on treatment, not on diagnosis

20. Ismail Al-Jurjani(Gorgoni) – Royal physician in 1100’s A.D. • Gorgoni was born in Gorgon – date unknown • The last of the Trinity of the great Persian physicians • The first one to write in Farsi (limited exposure?) • Gorgoni described all the Arabic medical terminology in Farsi and generated a medical dictionary for generations of Iranian physicians to come • Gorgoni is the first to connect goiter and swellings of the throat to exophthalmos, a sign rediscovered by Parry in 1825 (Graves-Basedow disease) He was referred to as Jurjani because in the Arabic alphabet there are no letter to sound like “گ”. Another example: Nargess was called Narjess.

21. From Mongol Invasion to Present No more prominent names due to sparse Activity in the medical field!

22. Thank you for your attention I hope that once again we witness presence of Iranians as the leaders in the fields of medicine and pharmaceutical sciences in the near future For more information on Iranian Scientist, please look up: http://en.wikipedia.org/wiki/List_of_Iranian_scientists_and_scholars