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The book contains the description and illustration of about 200 surgical instruments many of which were devised by Zahrawi himself. In it Zahrawi stresses the importance of the study of Anatomy as a fundamental prerequisite to surgery. He advocates the re implantation of a fallen tooth and the use of dental prosthesis carved from cow's bone, an improvement over the wooden dentures worn by the first President of America George Washington seven centuries later. Zahrawi appears to be the first surgeon in history to use cotton (Arabic word) in surgical dressings in the control of hemorrhage, as padding in the splinting of fractures, as a vaginal padding in fractures of the pubis and in dentistry. He introduced the method for the removal of kidney stones by cutting into the urinary bladder. He was the first to teach the lithotomy position for vaginal operations.
He described tracheotomy, distinguished between goiter and cancer of the thyroid, and explained his invention of a cauterizing iron which he also used to control bleeding. His description of varicose veins stripping, even after ten centuries, is almost like modern surgery. In orthopedic surgery he introduced what is called today Kocher's method of reduction of shoulder dislocation and patelectomy, 1,000 years before Brooke reintroduced it in 1937.Ibn Sina's description of the surgical treatment of cancer holds true even today after 1,000 years. He says the excision must be wide and bold; all veins running to the tumor must be included in the amputation. Even if this is not sufficient, then the area affected should be cauterized. The surgeons of Islam practiced three types of surgery: vascular, general, and orthopedic, Ophthalmic surgery was a speciality which was quite distinct both from medicine and surgery. They freely opened the abdomen and drained the peritoneal cavity in the approved modern style. To an unnamed surgeon of Shiraz is attributed the first colostomy operation.
Liver abscesses were treated by puncture and exploration. Surgeons all over the world practice today unknowingly several surgical procedures that Zahrawi introduced 1,000 years ago . MEDICINE The most brilliant contribution was made by Al-Razi who differentiated between smallpox and measles, two diseases that were hitherto thought to be one single disease. He is credited with many contributions, which include being the first to describe true distillation, glass retorts and luting, corrosive sublimate, arsenic, copper sulfate, iron sulphate, saltpeter, and borax in the treatment of disease . He introduced mercury compounds as purgatives (after testing them on monkeys); mercurial ointments and lead ointment. His interest in urology focused on problems involving urination, venereal disease, renal abscess, and renal and vesical calculi.
He described hay-fever or allergic rhinitis. Some of the Arab contributions include the discovery of itch mite of scabies (Ibn Zuhr), anthrax, ankylostoma and the guinea worm by Ibn Sina and sleeping sickness by Qalqashandy. They described abscess of the mediastinum. They understood tuberculosis and pericarditis. Al Ash'ath demonstrated gastric physiology by pouring water into the mouth of an anesthetized lion and showed the distensibility and movements of the stomach, preceding Beaumont by about 1,000 years Abu Shal al- Masihi explained that the absorption of food takes place more through the intestines than the stomach. Ibn Zuhr introduced artificial feeding either by gastric tube or by nutrient enema. Using the stomach tube the Arab physicians performed gastric lavage in case of poisoning. Ibn Al-Nafis was the first to discover pulmonary circulation. Ibn Sina in his masterpiece Al-Quanun (Canon), containing over a million words, described complete studies of physiology, patlhology and hygiene. He specifically discoursed upon breast cancer, poisons, diseases of the skin, rabies, insomnia, childbirth and the use of obstetrical forceps, meningitis, amnesia, stomach ulcers, tuberculosis as a contagious disease, facial tics, phlebotomy, tumors, kidney diseases and geriatric care. He defined love as a mental disease.
OPHTHALMOLOGY The doctors of Islam exhibited a high degree of proficiency and certainly were foremost in the treatment of eye diseases. Words such as retina and cataract are of Arabic origin. In ophthalmology and optics lbn al Haytham (965-1039 A.D.) known to the West as Alhazen wrote the Optical Thesaurus from which such worthies as Roger Bacon, Leonardo da Vinci and Johannes Kepler drew theories for their own writings. In his Thesaurus he showed that light falls on the retina in the same manner as it falls on a surface in a darkened room through a small aperture, thus conclusively proving that vision happens when light rays pass from objects towards the eye and not from the eye towards the objects as thought by the Greeks. He presents experiments for testing the angles of incidence and reflection, and a theoretical proposal for magnifying lens (made in Italy three centuries later). He also taught that the image made on the retina is conveyed along the optic nerve to the brain. Razi was the first to recognize the reaction of the pupil to light and Ibn Sina was the first to describe the exact number of extrinsic muscles of the eyeball, namely six.
The greatest contribution of Islamic medicine in practical ophthalmology was in the matter of cataract. The most significant development in the extraction of cataract was developed by Ammar bin Ali of Mosul, who introduced a hollow metallic needle through the sclerotic and extracted the lens by suction. Europe rediscovered this in the nineteenth century. PHARMACOLOGY Pharmacology took roots in Islam during the 9th century. Yuhanna bin Masawayh (777-857 A.D.) started scientific and systematic applications of therapeutics at the Abbasids capital. His students Hunayn bin Ishaq al-lbadi (809-874 A.D.) and his associates established solid foundations of Arabic medicine and therapeutics in the ninth century. In his book al-Masail Hunayn outlined methods for confirming the pharmacological effectiveness of drugs by experimenting with them on humans. He also explained the importance of prognosis and diagnosis of diseases for better and more effective treatment. Pharmacy became an independent and separate profession from medicine and alchemy.
With the wild sprouting of apothecary shops, regulations became necessary and imposed to maintain quality control. The Arabian apothecary shops were regularly inspected by a syndic (Muhtasib) who threatened the merchants with humiliating corporal punishments if they adulterated drugs. As early as the days of al-Mamun and al-Mutasim pharmacists had to pass examinations to become licensed professionals and were pledged to follow the physician's prescriptions. Also by this decree, restrictive measures were legally placed upon doctors, preventing them from owning or holding stock in a pharmacy. Methods of extracting and preparing medicines were brought to a high art, and their techniques of distillation, crystallization, solution, sublimation, reduction and calcination became the essential processes of pharmacy and chemistry. With the help of these techniques, the Saydalanis (pharmacists) introduced new drugs such as camphor, senna, sandalwood, rhubarb, musk, myrrh, cassia, tamarind, nutmeg, alum, aloes, cloves, coconut, nuxvomica, cubebs, aconite, ambergris and mercury.
The important role of the Muslims in developing modern pharmacy and chemistry is memorialized in the significant number of current pharmaceutical and chemical terms derived from Arabic: drug, alkali, alcohol, aldehydes, alembic, and elixir among others, not to mention syrups and juleps. They invented flavorings extracts made of rose water, orange blossom water, orange and lemon peel, tragacanth and other attractive ingredients. Space does not permit me to list the contributions to pharmacology and therapeutics, made by Razi, Zahrawi, Biruni, Ibn Butlan, and Tamimi. PSYCHOTHERAPY From freckle lotion to psychotherapy- such was the range of treatment practiced by the physicians of Islam. Though freckles continue to sprinkle the skin of 20th century man, in the realm of psychosomatic disorders both al-Razi and Ibn Sina achieved dramatic results, antedating Freud and Jung by a thousand years. When Razi was appointed physician-in-chief to the Baghdad Hospital, he made it the, first hospital to have a ward exclusively devoted to the mentally ill. Razi combined psychological methods and physiological explanations, and he used psychotherapy in a dynamic fashion, Razi was once called in to treat a famous caliph who had severe arthritis. He advised a hot bath, and while the caliph was bathing, Razi threatened him with a knife, proclaiming he was going to kill him.
This deliberate provocation increased the natural caloric which thus gained sufficient strength to dissolve the already softened humours, as a result the caliph got up from is knees in the bath and ran after Razi. One woman who suffered from such severe cramps in her joints that she was unable to rise was cured by a physician who lifted her skirt, thus putting her to shame. A flush of heat was produced within her which dissolved the rheumatic humour. The Arabs brought a refreshing spirit of dispassionate clarity into psychiatry. They were free from the demonological theories which swept over the Christian world and were therefore able to make clear cut clinical observations on the mentally ill.Najab ud din Muhammad', a contemporary of Razi, left many excellent descriptions of various mental diseases. His carefully compiled observation on actual patients made up the most complete classification of mental diseases theretofore known. Najab described agitated depression, obsessional types of neurosis, Nafkhae Malikholia (combined priapism and sexual impotence).
Kutrib (a form of persecutory psychosis), Dual-Kulb (a form of mania) .Ibn Sina recognized 'physiological psychology' in treating illnesses involving emotions. From the clinical perspective Ibn Sina developed a system for associating changes in the pulse rate with inner feelings which has been viewed as anticipating the word association test of Jung. He is said to have treated a terribly ill patient by feeling the patient's pulse and reciting aloud to him the names of provinces, districts, towns, streets, and people. By noticing how the patient's pulse quickened when names were mentioned Ibn Sina deduced that the patient was in love with a girl whose home Ibn Sina was able to locate by the digital examination. The man took Ibn Sina's advice , married the girl , and recovered from his illness. It is not surprising to know that at Fez, Morocco, an asylum for the mentally ill had been built early in the 8th century, and insane, asylums were built by the Arabs also in Baghdad in 705 A.D., in Cairo in 800 A.D., and in Damascus and Aleppo in 1270 A.D. In addition to baths, drugs, kind and benevolent treatment given to the mentally ill, musico-therapy and occupational therapy were also employed.
These therapies were highly developed. Special choirs and live music bands were brought daily to entertain the patients by providing singing and musical performances and comic performers as well.CONCLUSION1,000 years ago Islamic medicine was the most advanced in the world at that time. Even after ten centuries, the achievements of Islamic medicine look amazingly modern. 1,000 years ago the Muslims were the great torchbearers of international scientific research. Every student and professional from each country outside the Islamic Empire, aspired, yearned, a dreamed to go to the Islamic universities to learn, to work, to live and to lead a comfortable life in an affluent and most advanced and civilized society. Today, in this twentieth century, the United States of America has achieved such a position. The pendulum can swing back. Fortunately Allah has given a bounty to many Islamic countries - an income over 100 billion dollars per year. Hence Islamic countries have the opportunity and resources to make Islamic science and medicine number one in the world, once again.
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Dr. Ibrahim B. Syed, Ph.D is Clinical Professor of Medicine, University of Louisville School of Medicine, Louisville, KY 40292 and President, Islamic Research Foundation International, Inc, 7102 W. Shefford Lane, Louisville, KY 40242-6462Read other articles by Dr. Ibrahim B. Syed, Ph.D here. Shahid Athar M.D. is Clinical Associate Professor of Internal Medicine and Endocrinology, Indiana University School of Medicine Indianapolis, Indiana, and a writer on Islam.
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