SPECIAL ARTICLE. Surgical wisdom and Genghis Khan s Pax Mongolica. Introduction: Genghis Khan s century of peace. Jakob Köstenbauer. ANZJSurg.

Transcription

1 SPECIAL ARTICLE ANZJSurg.com Surgical wisdom and Genghis Khan s Pax Mongolica Jakob Köstenbauer Department of Surgery, Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia Key words Genghis Khan, history of surgery, Mongolian Empire, Persia, Rashid al-din. Correspondence Dr Jakob Köstenbauer, Department of Surgery, Wagga Wagga Rural Referral Hospital, Sturt Highway, Wagga Wagga, NSW 2650, Australia. jakobkuba@gmail.com J. Köstenbauer BMed, MD. This study was presented at the RACS Annual Scientific Congress, 2014, Singapore and was awarded the Trainees Prize for Surgical History. Accepted for publication 12 September doi: /ans Abstract Background: The unrivalled conquests of Genghis Khan (CE c ) led to the establishment of the Greater Mongolian Empire. By 1279, the Mongol dynasty controlled a vast Empire which, for the first time in history, unified Europe and China via the famous Silk Road. The ensuing century of peace and stability is referred to by historians as the Pax Mongolica, which facilitated Europe s renaissance and remarkably contributed to the rise of modern medicine and surgery. Methods: Secondary sources from published literature, primary sources from manuscripts and illustrations courtesy of universities, museum libraries and archives. Results: There is ample evidence detailing the Mongol Empire s power during the thirteenth century and the Silk Road s role as a vehicle of commercial, cultural and scientific exchange. Advances in medical knowledge and surgical skills were made in all parts of the Empire and exchanged from China to Constantinople and back. Prominent medical figures traversed these centres, and no doubt contributed to the spread of surgical science, including Rashid al-din and Mansur Ibn Ilyas. Their works, it is argued, enriched the practice of surgery and may have indirectly ushered-in the rise of modern surgery in the early medical schools at Salerno, Bologna, Pavia, Oxford, Montpellier and Constantinople to name but a few. Conclusion: The blossoming and diversification of medical and surgical knowledge was an integral part of the great cultural exchange facilitated by the Pax Mongolica. This enhanced surgical practice in China, Persia and Arabia, while coinciding with the renaissance of surgical teaching in Europe. Introduction: Genghis Khan s century of peace Even before his death in 1227, Genghis Khan (Fig. 1) was considered a ruthless, blood-thirsty tyrant the world over. 1 His reputation was not without cause as his forces had crushed the ruling houses of four civilizations. It was Genghis Khan s grandson, Kublai Khan, who inherited the second largest empire in human history (Fig. 2), inhabited by over 25% of the world s population. 2 Despite its violent beginnings, Mongol hegemony over Asia and the Middle-East ushered in a century of stability referred to as the Pax Mongolica. The influence of this period on the course of medical and surgical history in Asia, the Levant and Western Europe, which this article seeks to explore, remains understated in our prevailing Eurocentric academic paradigms. 2 4 For over a century, the Pax Mongolica enabled an unprecedented level of commercial, cultural, religious and scientific exchange across Eurasia. Through the unification of the Silk Road under Genghis Khan s exceptionally tolerant legal code (the jasaq), Europe and China came into meaningful contact for the first time in history. 4 Nearly, every region under the new empire s control enjoyed a cultural rejuvenation, most of which lasted for several centuries. 5 Genghis Khan s new world order described so eloquently by Weatherford, enabled the likes of Marco Polo ( ) to champion trade from East to West. 2 Not only goods but people traversed the vast empire. An intriguing study has even estimated the carriers of Genghis Khan s Y-chromosomal finger-print at 16 million men, approximately 8% of Eurasian males. 6 Several ruling houses directly descend from his line, including the Moghuls in India, China s Yuan dynasty and Persia s Ilkhans. This early globalisation of goods and people brought innovations to both the Mongols and their neighbours, most notably Europe and the Middle East, who gained gunpowder (first known as Chinese salt ), 7 paper making, bills of exchange and banking, as well as knowledge in anatomy and pharmacy to name but a few. 2,4 ANZ J Surg 87 (2017)

2 Surgery and the Pax Mongolica 117 Fig. 1. Genghis Khan creator of the Mongol Empire ( ). (Public domain: YuanEmperorAlbumGenghisPortrait.jpg). Surgical wisdom spreads West In accordance with Genghis Khan s policy of strength through diversity, the Mongol Khans directly encouraged the growth and exchange of medical knowledge throughout their Empire. Hospitals based on the Persian model, much like those of today, were established and teams of physicians sent from all corners of the empire to serve there. 2,8 High ranking Mongol officials relied on Mongolian, Chinese, Tibetan, Indian, Uighur, Arabic and Nestorian physicians and there is ample evidence of medical exchange between these schools. 3,8 Perhaps of greatest relevance to current academic debate is the exchange of innovative anatomical knowledge based on human cadaveric dissections from Yuan China to Europe. A key figure in this era was Rashid al-din ( ) a Persian Jew who converted to Islam in his mid-thirties he became a famous physician, statesman and key historian of the Mongol era. 2,9 In Tabriz, he established a famous academic institution, the Rabi Rashidi (Rashidi Quarters), which featured a research hospital and medical school with adjacent caravanserai, paper factory and a library containing upwards of books. 10,11 History s earliest manuscript on Chinese surgery or medicine ever published outside China was printed in the Rabi Rashidi in 1313 entitled Tans uqn ama-i Ilkh an dar fun un-i ul um-i Khat a i (Treasure Book of the Ilkhans on the Branches of the Chinese Sciences). 9,12 It contains, amongst other detailed discussion, dozens of anatomical drawings based on cadaveric dissections performed in China s Guangxi Province on 50-odd rebels executed in 1045 (Fig. 3). 13 The Persian manuscript is an amalgamation of several Chinese texts ranging from the Song to Yuan dynasties, including a manuscript written in 1095, based on the anatomical dissections of executed prisoners (Fig. 4). 9,14 At the Rabi Rashidi, the texts were compiled and translated by a team of Chinese and Persian doctors into Persian and Arabic. Wood-block printed copies were made publicly available for a small fee. Figures 3 and 4 compare the original Chinese illustrations with Rashid al-din s 1313 translations. As yet, use of these remarkable illustrations has been traced to an original discovered in 1931 in the Süleymaniye Library, Istanbul, Fig. 2. Map of the Mongol Empire s greatest extent c.1280 under Kublai Khan, grandson of Genghis Khan. (Modified from Creative Commons domain: wfryer/ ).

3 118 Köstenbauer Fig. 3. (a e) Persian illustrations with translations. The heart, abdominal viscera from lateral, anterior and posterior views, and the diaphragm. (Rashid al- Din, Tans uqn ama-i Ilkh an dar fun un-i ul um-i Khat a i, Tabriz, Istanbul, Süleymaniye Library, Ms. Aya Sofya 3596, fols. 65b; 63b-64a; 71a; 66b. Photos: courtesy of the Süleymaniye Library). Fig. 4. (a e) Chinese illustrations of abdominal viscera based on Sung dynasty dissections of Ou Hsi-fan s rebel gang. (Author s personal collection). dated As claimed by Miyasita, the Tans uqn ama possibly reawakened European interest in anatomy and cadaveric dissection. 9,12 The Rabi Rashidi was also host to the famous Persian physician and anatomist Mansur ibn Ilyas. 15 Mansur studied and travelled widely, writing several treatises on medicine and surgical anatomy. 16,17 Not only did Mansur hail from a long line of physicians but also his great-grandfather Najm al-din Mahmud had been appointed Chief-Doctor of a Tabriz hospital by Rashid al-din. Like Rashid al-din, Mansur s elders travelled to Eastern oriental countries and wrote manuscripts incorporating eastern medicine. 15 Of greatest importance though, is Mansur s Tashrih-i Mansuri (Mansur s Anatomy) the world s first colour atlas of human anatomy, published in ,18 From China to Europe, illustrations had been previously used for the communication of anatomical science and so the Tashrih-i Mansuri is not ground breaking in its use of illustrations. 15 Mansur s Anatomy relied heavily on the works of the Arabic masters Avicenna and Rhazes, who in-turn followed Galenic and Hippocratic theories. 16,17 Mansur s colour atlas does however, detail with astounding accuracy the anatomy and physiology of the optic nerves, their relations and the cruciform optic chiasm. 16 Moreover, it presented a brave and novel approach to the teaching of anatomy, especially so for the first ever anatomical depiction of a gravid uterus, it s consideration as a unit within the circulatory system, the use of multiple colour images in an atlas format and its publication despite religious mores of the time. 15,17 For centuries later, illustrations from the Tashrihi Mansuri were copied, enhanced and used to various extents in medical texts from Persia to Europe. 15 Figures 5 and 6 show Mansur s illustration of the arterial and skeletal systems, found in a fourteenth-century edition of Avicenna s Canon of Medicine. In this form, Mansour s works readily found their way into the libraries and lecture halls of the newly established European medical schools of the fourteenth century. Mansur s significance to the teaching of anatomy for all subsequent generations of anatomy students is thus evident. A non-surgical technique disseminated from China to Persia was pulse diagnosis an ancient Chinese practice still practiced in India and China. In Persia, acupuncture was rejected but pulse diagnosis favoured as it required less physical exposure of females in particular. To therefore serve Persian physicians, Chinese texts on pulse diagnosis were among the sizeable body of literature translated first into Mongolian and then Farsi under the direct order of Kublai Khan and made a compulsory part of the curriculum of the Chinese Imperial Academy of Medicine in

4 Surgery and the Pax Mongolica 119 Fig. 5. Illustration of the skeletal system based on Mansur s Anatomy (1386) in the Canon of Avicenna. (Qanun fi l-tibb, by Ibn Sina (Avicenna), Published: Isfahan Folio 126 recto. With permission: Wellcome Library/ Wellcome Images, London. Copyright.). Western historians have previously maintained that Europe s rediscovery of Greco-Roman medical authors was entirely through contact with Byzantium and the Arabic kingdoms, which at the time stretched from southern Spain to Palestine with no mention of the Mongol empire s role. 19 More recent sources have, however, highlighted several landmark events occurring during the Pax Mongolica which render this paradigm too simplistic. During this prosperous time, the status of modern Islamic medicine in Europe began to rise, no doubt influenced by the works of the aforementioned authors Mansour and Rashid al-din. By 1467, more than half the material in Ferrari s library at Pavia University were Arabic or Persian texts and his textbook of 1471 quotes Avicenna 3000 times but Galen 1000 and Hippocrates only 140 times, while the university held weekly lectures on Rhazes. 19 For the first time, fourteenth-century European medical schools awarded higher degrees in medicine, much like those of eastern academies. 3 This signified a shift from clerical medical teaching, operating under the oppressive censorship of the Church, to a more tolerant if not Fig. 6. Illustration of arteries and viscera based on Mansur s Anatomy (1386). (Qanun fi l-tibb, by Ibn Sina (Avicenna), Published: Isfahan, Folio 123 verso. With permission: Wellcome Library/Wellcome Images, London. Copyright.). secular university system. The emergence of modern human cadaveric (as opposed to animal) anatomy, as practiced by Mundinus in fourteenth-century, Bologna was preceded by Chinese anatomists of the Sung dynasty ( ) by over 300 years. 13 It is therefore conceivably no coincidence that the majority of Europe s early medical schools blossomed in Genghis Khan s wake. Medical and surgical practices disseminated from West to East Trade of ideas and knowledge was by no means unidirectional from East to West and so it would be remiss to ignore the reciprocal integration of Persian and European medical practice in Yuan China. Given their bellicose way of life, Mongols were well practiced in the management of traumatic injuries. Fractures and dislocations were treated by a Bariachi specialist bonesetters, considered separate to any physician. Driven by Mongol demand, subjugated

5 120 Köstenbauer Chinese surgeons began to specialize in orthopaedics. Most famous was Wei Yilin, who wrote a manual on setting fractures, basic anaesthetics using opium and pioneered the suspension method of joint reduction, a technique not seen in the West until its development in 1927 by Dr G Davis. 8 The Mongols also ensured that European and Islamic medicine was well represented in medieval Beijing. There they established the Medical Bureau of the Capital in 1263 an office dedicated entirely to propagating Western medicine in China placing Nestorian Christian physicians in charge. The imperial library contained Chinese translations of Western medical classics including Avicenna s Canon of Medicine, a well-known synthesis of Greek and Arabic medicine written in 1025, which was to become standard teaching in Europe from the fourteenth to eighteenth centuries. 19 Interestingly, the first Archbishop of Beijing John of Montecorvino recorded in his diaries in 1303 that the Great Khan Temür employed an unnamed Lombard surgeon in his court. 8 Conclusion The role of the Pax Mongolica in the wake of Genghis Khan s epic conquests is best illustrated by examples from fourteenth-century Persia, which represented the western frontier and interface of prerenaissance Europe and the Mongol empire. The previously held view of Europe s medical and surgical renaissance based on an isolated Greco-Roman and Arabic model has been called into question. Safavi-Abbasi et al. suggested: It is intriguing to postulate that the spread of Greek, Arab, Persian, and Indian scientific and medical knowledge and the rise of medical teaching in Europe may not have been in spite of Genghis Khan, but because of him. 3 Perhaps, it is now time to cease postulating and acknowledge our eastern inheritance. References 1. Hoang M. Genghis Khan. London: Saqi Books, Weatherford J. Genghis Khan and the Making of the Modern World. New York: Three Rivers Press, Safavi-Abbasi S, Brasiliense LB, Workman RK et al. The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire. Neurosurg. Focus 2007; 23: E Boulnois L, Loveday H, Wong HM et al. Silk Road: Monks, Warriors & Merchants on the Silk Road. Hong Kong: Odyssey, Abu-Lughod JL. Before European hegemony: the world system AD New York: Oxford University Press, Zerjal T, Xue Y, Bertorelle G et al. The genetic legacy of the Mongols. Am. J. Hum. Genet. 2003; 72: Chase KW. Firearms: A Global History to Cambridge: Cambridge University Press, Lane G. Daily Life in the Mongol Empire. Westport: Greenwood Publishing Group, Berlekamp P. The limits of artistic exchange in fourteenth-century Tabriz: the paradox of Rashid Al-Din s book on Chinese medicine, part I. Muqarnas 2010; 27: Shushtery AMA. Outlines of Islamic Culture: Historical & Cultural Aspects. Bangalore: Bangalore Print & Publishing Company, Abbasnejad F, Shoja MM, Agutter PS et al. Rabi Rashidi (Rashidi Quarters): a late thirteen to early fourteenth century Middle Eastern Medical School. Childs Nerv. Syst. 2012; 28: Miyasita S. A link in the westward transmission of Chinese anatomy in the later middle ages. Isis 1967; 58: Fu L. A forgotten reformer of anatomy in China: Wang Ch ing-jen. ANZ J. Surg. 2008; 78: Watanabe K. General remarks on dissection and anatomical figures in China. Nippon Ishigaku Zasshi 1956; 7: Khalili M, Shoja MM, Tubbs RS, Loukas M, Alakbarli F, Newman AJ. Illustration of the heart and blood vessels in medieval times. Int. J. Cardiol. 2010; 143: Zarshenas MZA, Mehdizadeh A, Mohagheghzadeh A. Mansur ibn Ilyas ( AD): a Persian anatomist and his book of anatomy, Tashrih-i Mansuri. J. Med. Biogr. 2014: 24: Newman AJ. Tashrih-e Mansuri : Human anatomy between the Galenic and Prophetic medical traditions. In: BHaTB VZ (ed.). La Science dans le Monde Iranien. Tehran: Institut Francais de Recherche en Iran, 1998; Islamic Medical Manuscripts at the National Library of Medicine. U.S. National Library of Medicine, [Accessed 4 Jan 2016.] Available from URL: Osler W. Evolution of Modern Medicine. London: New Haven, 1922.