The life and work of Abu ul-Ala Shirazi (d. 1001): a Persian pioneer in the treatment of malaria,in the style of Rhazes (865–925)

Abu ul-Ala Shirazi lived around the 10th-century in the Court of Amir Azud ul-Duleh. The dynasty of the Caliph of Abassid ruled the Middle East and the remainder of the Old Persioan Empire after the collapse of the Old Persian Empire. Gradually the Iranians rebelled their rule and local governments took over. One of these is the Dailamis dynasty that ruled the Fars province of Iran.

Abu ul-Ala Shirazi discovered ¹ that arsenic, known as sam-al-far, could cure malaria; it is still used as an effective remedy for malaria by some old-school physicians in the Indian subcontinent. This discovery predated the microscope ² and the concept of chemotherapy introduced by Paul Ehrlich (1854–1915). ³

Abu ul-Ala Shirazi was a Military Physician in the court of Amir Azud ul-Duleh and was obliged to accompany all military campaigns. He had to deal with endemic diseases in all climates and many of his patients were incurable. He wrote:

In a campaign to Baghdad, a military general was under my care and treatment. He had multiple episodes of fever and I tried several methods that were ineffective, and he was getting weaker and weaker. He became disappointed by his treatment and expected death, so he took some ‘sam-al-far’, a mouse toxin, for suicide. I was informed by some of his attendants and, to prevent his death as I was responsible, I gave him an emetic. A great deal of poison was discharged. However, considering his poor health and the strength of toxin he had taken, I did not expect a cure and found some excuse. I left him, thinking he would not survive the night. Next morning, I saw one of his slaves who was very happy and thankful for my treatment and for the health of his master. I was surprised and went to see the patient. After my examination, I found the fever had gone and he complained only of hunger. So I prescribed chicken meat and tonic drinks. After a few days, since no sign of his disease remained, I suspected sam-al-far and thereafter in the army, when somebody came with malaria, under my supervision I gave him some of this drug mixed with several narcotics and I found it effective in most of the patients. There was no need to repeat the treatment. This treatment of several patients resulted in my fame. Several of Amir bueieh talked about me. Amir (the king) gave me a prize and took me at his court. ⁴

This is the first Persian case report, dating back to the 10th century, and shows Abu ul-Ala Shirazi's careful clinical observation, intelligence and thinking – new thinking in Persian medicine. Another example is the description of smallpox and its distinction from measles by Rhazes. ⁵

After Amir Azud ul-Duleh's death, Abu ul-Ala joined the court of his son, King Amir Sharfaddine (971–999). However, the new amir (King Amir Sharfaddine) lived in spite of the health advice of his physicians: he avoided Abu-ul-Ala Shirazi. Some years later, the king developed a sore throat, thought to be due to drinking too much wine. Physicians told him to avoid drinking wine and prescribed phlebotomy. He did not comply and continued his way of life until he could no longer swallow any food, had lost weight and became weak.

Abu Ahmad (954–990), a minister in the court, sent a gift to Abu ul-Ala Shirazi and asked for his medical advice. When he visited the king, he found the time for effective treatment had passed and required the famous physicians to gather and undertake phlebotomy but, before this could happen, King Amir Sharfaddine died. Some of the court members accused Abu ul-Ala of a deliberate delay in treatment and held him responsible for the King's death and so he left for Basreh where he became infected with Dracunculus medinensis and died around 1101. ⁶ It is thought that Amir Sharfaddin (971–999) may have had cancer: bleeding could not help him and therefore Abu ul-Ala Shirazi was not responsible for his death. Few books are attributed to him.

One book on the medicine in the name of Bain Tabein, in the library of Navab Madresse (Mashhad–Iran), was written by Abu ul-Ala son of Zahar at the time of Azud ul-Duleh's Buivee, which may have been written by this Shirazian scientist and in which he rejects daubs of Rhazes on the 10th thesis of Galen (200–129 BC). ⁴

Abu ul-Ala Shirazi was a good clinical observer and an intelligent thinker and scientist who practised in the tradition of Rhazes medicine, based on experimentation. ⁵

Rhazes

Rhazes, the Latinized version whose name is ABU-BAKR MUHAMMAD IBN ZAKARIYYA ARR-RAZI in Persian, was a Persian physician and alchemist, born in Rhages (now Rai near Tehran in Iran) at the time of the Abbasid Caliphate (750–1258) who was the great Caliph of Baghdad at the time. He used to work as a chemist but in 880 (or thereabouts) Rhazes visited Baghdad and there, so we are told, came across an old apothecary who fascinated him with stories of medicine and diseases. Rhazes decided to study medicine and ended up as chief physician of Baghdad's largest hospital. He is said to have been the first to differentiate clearly between smallpox and measles. He also studied and described metallic antimony. He used this for transmutation of lesser metals to silver and gold. Apparently Razi's contemporaries believed that he had obtained the secret of turning iron and copper into gold.

He shared with Aristotle (384–322 BC) a delight in classifying and is thought to be the first to divide all substances into the grand classification of animal, vegetable and mineral. He also subclassified minerals into metals, volatile liquids (spirits), stones, salts and so on, a division that was much the most useful up to his time. He went along with Geber's (721–815) notions concerning mercury and sulphur as the basic ingredients of solid substances and he added to it salt as a third. ⁷