ISLAMIC MEDICINE

Islamic Medicine in its true context, can be defined as a body of knowledge of Medicine that was inherited by the Muslims in the early phase of Islamic History (40-247 AH/661 -861 AD) from mostly Greek sources, but to which became added medical knowledge from, Persia, Syria, India and Byzantine.

HALAL AND HARAM THERAPEUTICS

Some medicine is good and others are bad. Bad medicine is forbidden. Bad medicine causes more harm than benefit.

While seeking treatment, the moral teachings of Islam must be respected. The end never justifies the means. Haram material is not allowed as medicine except in special circumstances where the legal principle of necessity applies. Alcohol is for example not an accepted cure for any disease; it is actually itself a disease.

THE MAIN ISLAMIC PHYSICIANS

AL-RAZI (RAZES) 841-926 A.D

> He defined medicine as "the art concerned in preserving healthy bodies, in combating disease, and in restoring health to the sick." He thus outlined the three aspects of medicine, namely public health, preventive medicine, and treatment of specific diseases.

> He published several books which were translated into Latin, French, Italian, Hebrew, and Creek. One of his main books is "AI-Mansuri" (Liber Al-Mansoris) which he dedicated to his patron Prince Al-Mansur. It was composed of ten treatises and included all aspects of health and disease.

> He listed seven principles for the preservation of health:

1. Moderation and balance in motion and rest.

2. Moderation in eating and drinking.

3. Elimination of superfluous matter.

4. Improvement and regulation of dwelling places.

5. Avoidance of excesses before they become uncontrollable.

6. Maintenance of harmony in ambitions and resolutions.

7. Acquisition of reticence through possession of good habits including exercise.

> He also published another book called A-Murshid. In it, he emphasized the important lines of therapy that we mentioned earlier.

> Another book written by Al-Razi was named "Al-Hawi", which means the complete text. It was composed of 22 volumes, and it, especially its 9th volume on pharmacology, was used as one of the main text books in the medical school of Paris.

> He also wrote a treatise on measles and smallpox and called it "de Peste or de Pestilentia." It was translated into Latin in 1565 A.D. It is a masterpiece in clinical medicine (Browne 1962). It describes the clinical difference between the two diseases so vividly that nothing since has been added (Keys 1971).

AL-ZAHRAWI (ABULCASIS, BUCASIS, ALZAHRAVIUS) 931-1013 A.D.

> Al-Zahrawi became an eminent surgeon. He spent a productive life in practicing medicine, especially in surgery and medical writings. He died at the age of 83.

> He authored four main works. One of these is "Al-Tasrif Liman Ajiz 'an AI-Ta'lif' which was the best medieval surgical encyclopedia and was used in Europe until the 17th century. Stressing the importance of basic sciences he says:

“Before practicing, one should be familiar with the science of anatomy and the functions of organs so that he will understand them, recognize their shape, understand their connections, and know their limitations. Also one should know the bones, nerves, and muscles, their numbers, their origin and Insertions, the arteries and the veins, their start and end”.

> Al-Zahrawi also used cautery to control bleeding. He used wax and alcohol to stop bleeding from the skull during cranial surgery. Sprengel said that Al-Zahrawi was the first to the lithotomy position for vaginal operations. AI~ Zahrawi also described the tracheotomy operation and performed it in an emergency on one of his servants.

> He was the first to write on orthodontia. He showed evidence of great experience from details of clinical picture and surgical procedures e.g. his description of varicose veins stripping, even after ten centuries, is almost like modern surgery (Al-Okbi 1971).

> He also wrote about fracture of the skull (AI-Okbi 1971).

> Al-Zahrawi described many dental operations such as dental extractions, fixation, reimplantation, and artificial teeth. He described tooth pain and cautioned the physician against removal of the healthy tooth to which pain is referred.

> He also devoted one whole chapter to midwifery, giving tips to midwives, and describing the problems of difficult labor and obstetrical maneuvers.

> During the time of Al-Zahrawi, surgery in the Islamic world became a respected specialty practiced by reputable physicians. On the contrary in Europe, surgery was belittled and practiced by barbers and butchers. In 1163 A.D., the Council of Tours declared the following resolution "Surgery is to be abandoned by the schools of medicine and by all decent physicians."

IBN-SINA (AVICENNA) 980-1037 A.D

> Avicenna, considered the father of modern medicine, introduced experimental medicine and systematic experimentation and quantification in physiology, discovered the contagious nature of diseases, and described many medical treatments, including anesthetics and medical and therapeutic drugs, in The Canon of Medicine.

IBN-EL-NAFIS 1208 - 1288 A.D.

> On medicine he wrote many books, two of them are "Mujaz Al-Qanun" which means the "Summary of the Canon". In these two books which were based on Avicenna's writings, he criticized the shortcomings of Avicenna's work and of Galen's views and showed their weaknesses. That is why he was called by some as Avicenna the Second.

> Ibn-El-Nafis added to our knowledge of the physiology of the circulation.

IBN-AL-QUFF (1233-1305)

> Another physician who contributed to perinatology.

MEDICAL THEORY AND THE HUMAN BODY

Islamic theoretical formulations about the human body were founded on those of classical Greek philosophy and Graeco-Roman medicine, elaborated and developed by individual authors in the Arab Islamic tradition, not always in agreement with one another.

The functions and activities attributed to the systems of the body, however, and the connections drawn between them, often betrayed the limited extent to which empirical data could be collected and verified in the pre-modern age.

Arab-Islamic medicine, like Greek medicine before it, attributed key roles to certain major organs, each of which performed a specific vital function. The heart was the source of the ‘innate heat’ that sustains life.

The brain was the seat of the psychical faculties — reason, imagination, thought, memory, and sense perception all had their origin here.

All of the above are part of what Islamic medicine called the ‘naturals’: the humours; the basic qualities of hot, cold, wet, and dry; personal temperament, and the faculties and pneumata — in sum, all that human beings really are. In addition, there were two other sets of factors that were deemed to affect the body, but that were not regarded as part of it. These were the ‘extra-naturals’ by which was meant illness and its symptoms, and the ‘non-naturals’ — six things external to the body, but vital to the preservation or restoration of health.

The first of the non-naturals was the consideration of air: good air encouraged and maintained good health, while corrupt air could throw the humours out of balance and cause illness. Epidemics, for example, were routinely attributed to bad or corrupt air.

The second was movement. Islamic medicine placed great stress on the role of exercise in maintaining health, and prescribed it in moderation as part of a recuperative routine.

The third was eating and drinking: these were divided into categories of regular foodstuffs, foodstuffs with a remedial function, drugs, and poisons. Diet was a paramount consideration in both maintenance of health and recovery from illness. This category also covered matters of attire.

Another of the non-naturals was sleep, along with wakefulness. Sleep was deemed to help digest food and mature humours, since it allowed innate heat to spread through the body. Wakefulness was also important, since too much sleep dulled the mind and could also cool the body.

The fifth non-natural was excretion and retention: this not only had to do with digestive function, including constipation and diarrhoea, but also covered intercourse and bathing.

The last of the non-naturals was psychical states, illustrating how mental function was integrated into the physical and how it was recognized that this could have a decisive impact on one's physical well-being.

The doctrine of the non-naturals highlights the themes of moderation and balance that dominated medieval Islamic thinking on the healthy body.

Method of Therapy in Islamic Medicine

The patients were treated according to a well-defined treatment plan. It began with physiotherapy and diet; if this failed, drugs were used. Only as a last resort was surgery used.

EPIDEMIOLOGY, ETIOLOGY, PATHOLOGY

In etiology and epidemiology, Muslim physicians were responsible for the discovery of infectious disease and the immune system and the introduction of bacteriology, microbiology and pathology. Their discovery of contagious disease in particular is considered revolutionary and is one of the most important discoveries in medicine.

By then, the pathology of contagion had been fully understood, and as a result, hospitals were created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients who do not have any contagious diseases.

In epidemiology, Avicenna introduced the method of quarantine as a means of limiting the spread of contagious diseases, and introduced the method of risk factor analysis and the idea of a syndrome in the diagnosis of specific diseases He also described the first known surgical treatment for cancer. In

PULSOLOGY AND SPHYGMOLOGY

Muslim physicians were pioneers in pulsology and sphygmology.

The first correct explanations of pulsation were given by Muslim physicians.

Avicenna was a pioneer of sphygmology after he refined Galen's theory of the pulse and discovered the following in The Canon of Medicine:

"Every beat of the pulse comprises two movements and two pauses. Thus, expansion : pause : contraction : pause. [...] The pulse is a movement in the heart and arteries ... which takes the form of alternate expansion and contraction."

The Latin translation of his Canon also laid the foundations for the later invention of the sphygmograph.

ALLERGOLOGY AND IMMUNOLOGY

The study of allergology and immunology originate from the Islamic world.

Muhammad ibn Zakarīya Rāzi (Rhazes) was responsible for discovering "allergic asthma", and was the first physician known to have written articles on allergy and the immune system.

BACTERIOLOGY AND MICROBIOLOGY

In bacteriology, Avicenna stated that bodily secretion is contaminated by foul foreign earthly bodies before being infected, and gave the first descriptions on bacterial and viral organisms (though he did not view them as primary causes of disease).

DENTISTRY

Muslim dentists were pioneers in dentistry, particularly dental surgery and dental restoration. The earliest medical text to deal with dental surgery in detail was the Al-Tasrif by Abulcasis. He gave detailed methods for the successful replantation of dislodged teeth.

OPHTHALMOLOGY

1050 A.D. at Baghdad, Ali Ibn-Isa (Jesu Haly) wrote the classic book on ophthalmology, Tathkirat Al-Kahhalin (A Note for the Occulists). As stated by Cunistan(l921), it is the oldest book in its original language on diseases of the eye. Written in a clear and logical style, the author described trachoma, conjunctivitis, and cataract, and prescribed treatment (Keys 1971). Avicenna described the six extrinsic muscles of the eyeball.

In the thirteenth century, Ibn Abu-Al-Kawafer wrote a book on therapeutic ophthalmology entitled "Natigat-El-Fikr fi Ilag Amrad El-Bassar", (Conclusions from Experience on Treatment of Diseases of the Eye). According to Kahil (1920), it is one of several textbooks on ophthalmology considered to be superior to any written in Europe up to the eighteenth century

ANESTHESIA

First, in anaesthesia, they described in detail the pharmacology of important narcotics such as opium and other central nervous system depressants such as hyoscyamus and hashish (Khairallal 1942).

Modern anesthesia was developed by Muslim anesthesiologists. They were the first to utilize oral as well as inhalant anesthetics.

In Islamic Spain, Abu al-Qasim and Ibn Zuhr, among other Muslim surgeons, performed hundreds of surgeries under inhalant anesthesia with the use of narcotic-soaked sponges which were placed over the face.

Muslim physicians also introduced the anesthetic value of opium derivatives during the middle Ages.

OBSTETRICS

Muslim physicians made many advances in obstetrics, especially perinatology.

In the 10th century, Ali ibn Abbas al-Majusi proved this theory false as he discovered that uterine contractions are in fact the cause of delivery of the fetus.

EMBRYOLOGY

Embryology was discussed to some extent in early Islamic literature, including the Qur'an and the Hadith literature.

Ibn al-Nafis develop his own theories on embryology and generation.He believed that when a male and female semen mix, and when they create a mixed matter that has an appropriate temperament to receive an animal or human soul, God issues a soul to this matter, which then develops into an embryo that grows and generates organs.

The Arab physician Ibn al-Quff (1233-1305), a student of Ibn al-Nafis, described embryology and perinatology more accurately in his Al-Jami.

CLINICAL PHARMACOLOGY

Avicenna's contribution to pharmacology and the pharmaceutical sciences in The Canon of Medicine (1020s) include the introduction of systematic experimentation and quantification into pharmacology and the study of physiology.

. The Canon laid out the following rules and principles for testing the effectiveness of new drugs and medications, which still form the basis of clinical pharmacology and modern clinical trials:

"The drug must be free from any extraneous accidental quality."

"It must be used on a simple, not a composite, disease."

"The drug must be tested with two contrary types of diseases, because sometimes a drug cures one disease by Its essential qualities and another by its accidental ones."

"The quality of the drug must correspond to the strength of the disease. For example, there are some drugs whose heat is less than the coldness of certain diseases, so that they would have no effect on them."

"The time of action must be observed, so that essence and accident are not confused."

"The effect of the drug must be seen to occur constantly or in many cases, for if this did not happen, it was an accidental effect."

"The experimentation must be done with the human body, for testing a drug on a lion or a horse might not prove anything about its effect on man."

ANALGESICS, ANTIEMETICS, ANTIPYRETICS, DIURETICS

In the medieval Islamic world, Arabic physicians discovered the diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic (pain killing) and antipyretic properties of medical cannabis, specifically cannabis sativa, and used it extensively as medication from the 8th to 18th centuries.

ANTISEPTICS

Razi used mercurial compounds as topical antiseptics. From the 10th century, Muslim physicians and surgeons were applying purified alcohol to wounds as an antiseptic agent. Surgeons in Islamic Spain utilized special methods for maintaining antisepsis prior to and during surgery. They also originated specific protocols for maintaining hygiene during the post-operative period.

MEDICAL AND THERAPEUTIC DRUGS

Chemotherapeutical drugs were first developed in the Muslim world. Muslim physicians used a variety of specific substances to destroy microbes. They applied sulfur topically specifically to kill the scabies mite.

MEDICINAL ALCOHOL

Numerous Muslim chemists produced medicinal-grade alcohol through distillation as early as the 10th century and manufactured on a large scale the first distillation devices for use in chemistry. They used alcohol as a solvent and antiseptic.

SURGERY

Abu al-Qasim (Abulcasis), the father of modern surgery, performed surgeries under inhalant anesthesia, and invented the plaster and many surgical instruments.

TRACHEOTOMY

The surgical procedure of tracheotomy was invented by Ibn Zuhr (Avenzoar) in the 12th century.

LITHOTOMY

In lithotomy, Abulcasis performed the first successful extraction of bladder and kidney stones from the urinary bladder using a new instrument he invented—a lithotomy scalpel with two sharp cutting edges—and a new technique he invented—perineal cystolithotomy—which allowed him to crush a large stone inside the bladder before its removal, significantly decreasing the death rates previously caused by earlier attempts at this operation by the ancients.

CIRCUMCISION

Most Fuqaha' (Islamic Jurists) say that circumcision is obligatory upon the men and this is the opinion of Jumhur (the majority of the scholars).

SURGICAL INSTRUMENTS

Adhesive bandage and Plaster

Catgut and Forceps

Cauter and Ligature

Cotton dressing and Surgical needle

Injection syringe

THERAPY

Aromatherapy

> Steam distillation was invented by Avicenna in the early 11th century for the purpose of producing essential oils, giving rise to aromatherapy. As a result, he is regarded as a pioneer of aromatherapy.

Chemotherapy

> Chemotherapy was pioneered by al-Razi (Rhazes) in the 10th century, when he introduced the use of chemical substances and drugs as forms of medication. These chemicals included vitriol, copper, mercuric and arsenic salts, sal ammoniac, gold scoria, chalk, clay, coral, pearl, tar, bitumen and alcohol.

Hirudotherapy

> Hirudotherapy, the use of medicinal leech for medical purposes, was introduced by Avicenna in The Canon of Medicine (1020s).

> He also introduced the use of leech as treatment for skin disease. Leech therapy became a popular method in medieval Europe due to the influence of his Canon. A more modern use for medicinal leech was introduced by Abd-el-latif in the 12th century, who wrote that leech could be used for cleaning the tissues after surgical operations.

Physiotherapy

> The physiotherapy prescribed by Muslim physicians usually included physical exercise and bathing. Muslim Arab physicians developed an elaborate system of dieting, in which there was an awareness of food deficiencies, and proper nutrition was an important item of treatment.

SEXUAL HEALTH

In sexual health, Muslim physicians and pharmacists identified the issues of sexual dysfunction and erectile dysfunction, and they were the first to prescribe medication for the treatment of these problems.

They developed several methods of therapy for this issue, including the single drug method where a drug is prescribed, and a "combination method of either a drug or food."

NEUROSCIENCE AND PSYCHOLOGY

The concepts of mental health and "mental hygiene" were introduced by the Muslim physician Ahmed ibn Sahl al-Balkhi (850-934). In his Masalih al-Abdan wa al-Anfus (Sustenance for Body and Soul), he was the first to successfully discuss diseases related to both the body and the mind, and argued that "if the nafs [psyche] gets sick, the body may also find no joy in life and may eventually develop a physical illness."

Avicenna was a pioneer of psychophysiology and psychosomatic medicine. He recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as an anticipation of the word association test attributed to Carl Jung.

Avicenna was also a pioneer of neuropsychiatry. He first described numerous neuropsychiatric conditions, including hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.

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