Ancient Iranian medicine

Some of the earliest records of history of Ancient Iranian medicine can be found in Avesta, the primary collection of sacred texts of Zoroastrianism

The practice and study of medicine in Persia has a long and prolific history. The Iranian academic centers like Gundeshapur University (3rd century AD) were a breeding ground for the union among great scientists from different civilizations. These centers successfully followed their predecessors’ theories and greatly extended their scientific research through history. Persians were the first establishers of modern hospital system.

In recent years, some experimental studies have indeed evaluated medieval Iranian medical remedies using modern scientific methods. These studies raised the possibility of revival of traditional treatments on the basis of evidence-based medicine.

History and background

Pre-Islamic

Safavid lacquer work illustrating a physician taking the pulse of a patient. From a 17th-century copy of Avicenna's Canon of Medicine. Wellcome Library, London.

The medical history of ancient Persia can be divided into three distinct periods. The sixth book of Zend-Avesta contains some of the earliest records of the history of ancient Iranian medicine. The Vendidad in fact devotes most of the last chapters to medicine.

The Vendidad, one of the surviving texts of the Zend-Avesta, distinguishes three kinds of medicine: medicine by the knife (surgery), medicine by herbs, and medicine by divine words; and the best medicine was, according to the Vendidad, healing by divine words:

Of all the healers O Spitama Zarathustra, namely those who heal with the knife, with herbs, and with sacred incantations, the last one is the most potent as he heals from the very source of diseases.

— Ardibesht Yasht

Although the Avesta mentions several notable physicians, the most notable—Mani, Roozbeh, and Bozorgmehr—were to emerge later.

The second epoch covers the era of what is known as Pahlavi literature, where the entire subject of medicine was systematically treated in an interesting tractate incorporated in the encyclopedic work of Dinkart, which listed in altered form some 4333 diseases.

The third era begins with the Achaemenid dynasty, and covers the period of Darius I of Persia, whose interest in medicine was said to be so great that he re-established the school of medicine in Sais, Egypt, which previously had been destroyed, restoring its books and equipment.

The first teaching hospital was the Academy of Gundishapur in the Persian Empire. Some experts go so far as to claim that, "to a very large extent, the credit for the whole hospital system must be given to Persia".

Some of most influential medical texts in medieval Persian medicine

According to the Vendidad, physicians, to prove proficiency, had to cure three patients of the followers of Divyasnan; if they failed, they could not practice medicine. At first glance, this recommendation may appear discriminant and based on human experimentation. But some authors have construed this to mean that, from the beginning, physicians were taught to remove the mental barrier and to treat adversaries as well as friends. The physician’s fee for service was based on the patient’s income.

The practice of ancient Iranian medicine was interrupted by the Arab invasion (630 A.D.). However, the advances of the Sassanid period were continued and expanded upon during the flourishing of Islamicate sciences at Baghdad, with the Arabic text Tārīkh al-ḥukamā crediting the Academy of Gondishapur for establishing licensure of physicians and proper medical treatment and training. Many Pahlavi scripts were translated into Arabic, and the region of Greater Iran produced physicians and scientists such as Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā and Muhammad ibn Zakariya al-Razi as well as mathematicians such as Kharazmi and Omar Khayyám. They collected and systematically expanded the Greek, Indian, and Persian ancient medical heritage and made further discoveries.

Ancient Greek Views of Pre Islamic Persian Medicine by Herodotus

The Ancient Greeks often viewed Persian medicine with a contradictory combination of admiration and suspicion. This dynamic and attitude towards Persian medicine reflects the intellectual curiosity of the Greeks, anti-Persian biases and tensions between the two countries. Some Greek writers admired and respected Persian medicine, in particular, its surgery and lifestyle treatments, while some dismissed it for being overly religious, superstitious and dependent on magic, many more fall between these two extremes. This essay will identify the key traits of Persian medicine while discussing how the Ancient Greeks viewed and characterized them by analyzing primary source of Histories by Herodotus and secondary sources.

The earliest primary source from Ancient Greece that documents Persian Medicine is of the 5^th Century BC, from Herodotus’ work Histories. Herodotus records many Persian medicinal practices, most significant of which is Persian hygiene and preventative healthcare measures, concepts that are unprecedented so early on in human history. Histories contain occasional truthful depiction of Persian medical practices, however Herodotus’ Greek bias does appear often in some passages that mentioning foreign practices. Regardless, the source still provides valuable insight into what the ancient Greeks know and thought of Persian medicine. Herodotus notes in that Persian citizens with diseases like leprosy or white fever may not enter town and may, in some cases, even be cast out from town to avoid infection of others. Despite their flawed superstitious reasoning of believing disease was due to the infected person “sinning against the sun”, this shows that Persians have some concept of the infectiousness of diseases and preventative measures to combat diseases. This knowledge of the Persians have on hygiene is further reinforced upon in the same book and chapter where Herodotus notes that the rivers are especially revered by the Persians and they do not let anyone “urinate nor spit nor wash their hands” in their rivers to prevent pollution of the stream as part of ritual purity laws. The Persians caution when handling their water source shows their extensive knowledge of hygiene and the importance of a clean water supply, further establishing the Persian’s advanced medical knowledge. Persian hygienic practices, although stemmed from false religious and superstitious beliefs, bring major health benefits to those who practice it as Herodotus observed, however these positive benefits were often overlooked and its false religious reasonings were often magnified due to the anti-Persian biases of Herodotus. This bias is well known and is echoed by François Hartog's book The Mirror of Herodotus, where it states that anti Persian bias was often used by Herodotus as the “other” to form Greek cultural identity as a people.

Another major Persian medical practice noted by Herodotus was their surprisingly modern and pragmatic approach to healthcare and medical infrastructure. Herodotus highlights that the Persians’ willingness to accept and adopt foreign medical practices, collaboration with foreign physicians regardless of their social rank and a robust compensation system for physicians. These traits are all very advanced for their time and are exemplified nowhere better than in the story of Democedes of Croton. Chapter 129-133 of Histories’ Book 3 starts the story with the Persian king Darius I violently dislocating his ankle while hunting horseback, Egyptian physicians were summoned at first due to Egyptian physician’s being seen as more medically specialized than Persian ones but to no avail despite a week of treatment. This shows the willingness and trust that Persians have for foreign physicians as seen when they allowed physicians from a rival country to treat their head of state. On the eighth day, Darius I  summoned Democedes, and he was found in chains and rags “among the slaves of Oroetes”, this also shows the Persians’ value of medical competence over social rank since they ignore Democedes being a slave and poor, a source of discrimination and common disqualifier for many pursuits in the ancient world. Herodotus claimed Democedes using Greek remedies instead of Egyptian ones healed Darius quickly and allowed him to sleep after a week of pain induced insomnia. However viewers must note that Herodotus and Histories have been known to have inconsistencies and exaggerations, with Herodotus’ personal biases often muddling the truth, as seen here where Herodotus characterized Greek remedies as “gentleness” and Egyptian ones as “violence”. This bias further extends to when Herodotus falsely faults the Persians’ incorporation of foreign physicians and uses it to highlight Persia’s dependence on Greek and Egyptian doctors despite collaboration between doctors across nationalities often spurs medical progress. Herodotus also goes further with this to imply that Persia’s dependence on foreign physicians despite their empire’s great wealth was because of Persian medicine was not advance as its Greek and Egyptian counterparts, which was very untrue. For Democedes’ service, he was rewarded handsomely with golden fetters, a great sum of gold and a grand house, establishing that Persians had a concept of compensation for healthcare. This is further reinforced scholar Pierre Briant who asserts that the Persepolis Tablets prove that Persians had a well established state-sponsored healthcare system for workers and elites alike that pays healthcare workers for their services.

The Persians’ preventative medical practices such as hygiene and clean water along with its forward thinking pragmatism in their willingness to collaborate with foreign physicians and to adopt foreign medical practices show how advanced their knowledge and approach to medicine was for its time. However, Herodotus contrasts this with his critique of some Persian medicinal practices with religious and superstitious roots as ineffective. Herodotus notably mentions the Persian incorporation of the Magi or religious ritual healers in the medical process, whose methods were ineffective. Herodotus notes the Magi “made offerings and cast spells” and sacrificed animals to ward of storms, diseases and other calamities. Herodotus implies the Persian use of Magi in medicine is theatrical, superstitious, and ineffective, paling in comparison to the rational Greek medicine. This notion was further reinforced when he highlighted how Democedes, a Greek slave, could heal Darius I’s ankle quickly and effectively, when Egyptian and Persian physicians could not. However, Herodotus has made no mention Persian medicinal discoveries in medicinal herb use of sagapenon and surgery detailed in other primary sources at the time like Ctesias of Cnidus’ Persica and also reinforced in archaeological findings of the Persepolis Tablets and Persian surgical tools. These criticisms and lack of acknowledgement of Persian medical innovations along with many instances of Herodotus portraying the Persian people and customs as irrational, barbaric, decadent and inferior to Greek counterparts show Herodotus’ strong anti-Persian biases. This is most likely due to the book being written after the Graeco-Persian Wars along with mutual xenophobia and hatred between the two countries due to their cultural divide. Hence, his criticisms of Persian medicine should be critically read with caution and cross examined with other primary sources whenever possible.

The Ancient Greek perspective on Persian medicine as recorded by Herodotus often heavily included anti-Persian biases, suspicion, mischaracterizations of Persian medicine being backwards, superstitious and reliant on foreign physicians and theatrical Magi rituals. Even when there were positive aspects of Persian medicine, theirs faults were often magnified as seen with the river hygiene taboos coming from religious reasons or outright omitted as seen with Persian medical breakthroughs in surgery and herbal medicine not being mentioned at all. Overall, Herodotus’ Histories provide great insight into Graeco-Persian relations during his time and reveal more about Greek attitudes towards Persians rather than the realities of Persian medicine. Despite the Greek anti-Persian mischaracterizations by Herodotus, Ancient Persia did have some valuable and valid contributions to medical knowledge that was very forward thinking, which would be adopted and refined by the Greeks themselves, the Romans and future civilizations.

Medieval Islamic Period

Main article: Medicine in medieval Islam

A 500-year-old Latin translation of the Canon of Medicine by Avicenna

One of the main roles played by medieval Iranian scholars in the scientific field was the conservation, consolidation, coordination, and development of ideas and knowledge in ancient civilizations. Some Iranian Hakim (practitioners) such as Muhammad ibn Zakariya ar-Razi, known to the West as Rhazes, and Ibn Sina, better known as Avicenna, were not only responsible for accumulating all the existing information on medicine of the time, but adding to this knowledge by their own astute observations, experimentation and skills. "Qanoon fel teb of Avicenna" ("The Canon") and "Kitab al-Hawi of Razi" ("Continens") were among the central texts in Western medical education from the 13th to the 18th centuries.

In the 14th century, the Persian language medical work Tashrih al-badan (Anatomy of the body), by Mansur ibn Ilyas (c. 1390), contained comprehensive diagrams of the body's structural, nervous and circulatory systems.

Cranial surgery and mental health

Evidence of surgery dates to the 3rd century BC when the first cranial surgery was performed in the Shahr-e-Sukhteh (Burnt City) in south-eastern Iran. The archaeological studies on the skull of a 13-year-old girl suffering from hydrocephaly indicated that she had undergone cranial surgery to take a part of her skull bone and the girl lived for at least 6 months after the surgery.

Several documents still exist from which the definitions and treatments of a headache in medieval Persia can be ascertained. These documents give detailed and precise clinical information on the different types of headaches. The medieval physicians listed various signs and symptoms, apparent causes, and hygienic and dietary rules for prevention of headaches. The medieval writings are both accurate and vivid, and they provide long lists of substances used in the treatment of headaches. Many of the approaches of physicians in medieval Persia are accepted today; however, still more of them could be of use to modern medicine. An antiepileptic drug-therapy plan in medieval Iranian medicine is individualized, given different single and combined drug-therapy with a dosing schedule for each of those. Physicians stress the importance of dose, and route of administration and define a schedule for drug administration. Recent animal experiments confirm the anticonvulsant potency of some of the compounds which are recommended by Medieval Iranian practitioners in epilepsy treatment.

In The Canon of Medicine (c. 1025), Avicenna described numerous mental conditions, including hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.

Obstetrics and gynecology

In the 10th century work of Shahnama, Ferdowsi describes a Caesarean section performed on Rudaba, during which a special wine agent was prepared by a Zoroastrian priest and used as an anesthetic to produce unconsciousness for the operation. Although largely mythical in content, the passage illustrates working knowledge of anesthesia in ancient Persia.

See also

• Iranian traditional medicine
• Science and technology in Iran
• Medicine in the medieval Islamic world
• Unani medicine

External links

• Iranchamber.com: Medical Sciences in Avesta