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MEDICINE AND MEDICAL EDUCATION IN ISLAMIC HISTORY (PART 3 OF 3)

MEDICINE

One of the most brilliant contribution to medicine was made by AlRazi who differentiated between smallpox and measles, two diseases that were hitherto thought to be one single disease.'” He is credited with many contributions: he was the first to describe true distillation, glass retorts and luting, corrosive sublimate, arsenic, copper sulfate, iron sulfate, saltpeter, and borax in the treatment of diseases.” 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.

Among other Arab contributions to medicine are included the discovery of itch mite of scabies (Ibn Zuhr), anthrax, ankylostoma and the guineaworm by Ibn Sina, and sleeping sickness by Qalqashandy. They described abscess of the mediastinum. They also 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 a thousand years. Abu Sahl 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-Qanun (Canon), containing over a million words, described complete studies of physiology, pathology 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 dixax, facial ties, phlebotomy, tumors, kidney diseases and geriatric care. He defined love as a mental disease.

OPHTHALMOLOGY

The Arab physicians 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 Ibn 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 qroving that vision happens when light rays pass from objects towards the eye and not from the eye towards the object as thought by the Greeks. He 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 All 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 in the Abbasid capital. His student Hunayn bin Ishaq al-Ibadi (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 necessar~ and were imposed to maintain quality control. The Arabian apothecary shops were regularly inspected by a syndic (Muhtasib) who threatened the merehants with humiliating corporal punishments if they adulterated drugs.” As early as the days of al-Mamun and alMutasim 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, nux vomlca, 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 flavoring extracts made of rose water, orange blossom water, orange and lemon peel, tragacanth and otheraromatic 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 ofIslam. 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 at least a thousand years.(l5) When Razi was appointed physician- inchief to the Baghdad Hospital, he devoted a ward exclusively for the mentally ill making it the first hospital ever to have such a ward.”Al-Razi combined psychological methods and physiological explanations, and he used psychotherapy in a dynamic fashion. Al-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, saying he was going to kill him. This deliberate provocation increased the natural caloric, enhanced its strength, and consequently dissolved the already softened humors, so that the caliph stood up in the bath and ran after A1-Razi.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 clearcut clinical observations about the mental diseases.”

Najab ud din Muhammad,” a contemporary of Al-Razi, has left many excellent descriptions of various mental diseases. His carefully compiled observations about the patients made up the most complete classification of mental diseases theretofore known. Najab described agitated depression, obsessional types of neurosis, Nafkhae hrlalikholia (combined priapism and sexual impotence). Kutrib (a form of persecutory psychosis), Dual-Kulb (a form of mania).(40)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 predating the word association test of Jung. He is said to have treated a seriously 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 mental asylums were also built by the Arabs in Baghdad in 705 A.D., in Cairo in 800 A.D., and in Damascus and Aleppo in 1270 A.D.40 I, 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 played daily to entertain the patients by singing, music, and other light-hearted performances.

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