magnificent

2007-06-09T05:43:00.001-07:00

Islam, Culture and Women
by Ruqaiyyah Waris Maqsood

How can anyone justify Islam's treatment of women, when it imprisons Afghans under blue shuttlecock burqas and makes Pakistani girls marry strangers against their will?

How can you respect a religion that forces women into polygamous marriages, mutilates their genitals, forbids them to drive cars and subjects them to the humiliation of "instant" divorce? In fact, none of these practices are Islamic at all.

Anyone wishing to understand Islam must first separate the religion from the cultural norms and style of a society. Female genital mutilation is still practised in certain pockets of Africa and Egypt, but viewed as an inconceivable horror by the vast majority of Muslims. Forced marriages may still take place in certain Indian, Pakistani and Bangladeshi communities, but would be anathema to Muslim women from other backgrounds.

Indeed, Islam insists on the free consent of both bride and groom, so such marriages could even be deemed illegal under religious law.

A woman forbidden from driving a car in Riyadh will cheerfully take the wheel when abroad, confident that her country's bizarre law has nothing to do with Islam. Afghan women educated before the Taliban rule know that banning girls from school is forbidden in Islam, which encourages all Muslims to seek knowledge from cradle to grave, from every source possible.

The Koran is addressed to all Muslims, and for the most part it does not differentiate between male and female. Man and woman, it says, "were created of a single soul," and are moral equals in the sight of God. Women have the right to divorce, to inherit property, to conduct business and to have access to knowledge.

Since women are under all the same obligations and rules of conduct as the men, differences emerge most strongly when it comes to pregnancy, child-bearing and rearing, menstruation and, to a certain extent, clothing.

Some of the commands are alien to Western tradition. Requirements of ritual purity may seem to restrict a woman's access to religious life, but are viewed as concessions. During menstruation or postpartum bleeding, she may not pray the ritual salah or touch the Koran and she does not have to fast; nor does she need to fast while pregnant or nursing.

The veiling of Muslim women is a more complex issue. Certainly, the Koran requires them to behave and dress modestly - but these strictures apply equally to men. Only one verse refers to the veiling of women, stating that the Prophet's wives should be behind a hijab when his male guests converse with them.

Some modernists, however, claim that this does not apply to women in general, and that the language used does not carry the textual stipulation that makes a verse obligatory. In practice, most modern Muslim women appreciate attractive and graceful clothes, but avoid dressing provocatively.

What about polygamy, which the Koran endorses up to the limit of four wives per man? The Prophet, of course, lived at a time when continual warfare produced large numbers of widows, who were left with little or no provision for themselves and their children.

In these circumstances, polygamy was encouraged as an act of charity. Needless to say, the widows were not necessarily sexy young women, but usually mothers of up to six children, who came as part of the deal.

Polygamy is no longer common, for various good reasons. The Koran states that wives need to be treated fairly and equally - a difficult requirement even for a rich man. Moreover, if a husband wishes to take a second wife, he should not do so if the marriage will be to the detriment of the first.

Sexual intimacy outside marriage is forbidden in Islam, including sex before marriage, adultery or homosexual relationships. However, within marriage, sexual intimacy should be raised from the animal level to sadaqah (a form of worship) so that each considers the happiness and satisfaction of the other, rather than mere self-gratification.

Contrary to Christianity, Islam does not regard marriages as "made in heaven" or "till death do us part". They are contracts, with conditions. If either side breaks the conditions, divorce is not only allowed, but usually expected. Nevertheless, a hadith makes it clear that: "Of all the things God has allowed, divorce is the most disliked."

A Muslim has a genuine reason for divorce only if a spouse's behaviour goes against the sunnah of Islam - in other words, if he or she has become cruel, vindictive, abusive, unfaithful, neglectful, selfish, sexually abusive, tyrannical, perverted - and so on.

In good Islamic practice, before divorce can be contemplated, all possible efforts should be made to solve a couple's problems. After an intention to divorce is announced, there is a three-month period during which more attempts are made at reconciliation.

If, by the end of each month, the couple have resumed sexual intimacy, the divorce should not proceed. The three-month rule ensures that a woman cannot remarry until three menstrual cycles have passed - so, if she happens to be pregnant, the child will be supported and paternity will not be in dispute.

When Muslims die, strict laws govern the shares of property and money they may leave to others; daughters usually inherit less than sons, but this is because the men in a family are supposed to provide for the entire household.

Any money or property owned by women is theirs to keep, and they are not obliged to share it. Similarly, in marriage, a woman's salary is hers and cannot be appropriated by her husband unless she consents.

A good Muslim woman, for her part, should always be trustworthy and kind. She should strive to be cheerful and encouraging towards her husband and family, and keep their home free from anything harmful (haram covers all aspects of harm, including bad behaviour, abuse and forbidden foods).

Regardless of her skills or intelligence, she is expected to accept her man as the head of her household - she must, therefore, take care to marry a man she can respect, and whose wishes she can carry out with a clear conscience. However, when a man expects his wife to do anything contrary to the will of God - in other words, any nasty, selfish, dishonest or cruel action - she has the right to refuse him.

Her husband is not her master; a Muslim woman has only one Master, and that is God. If her husband does not represent God's will in the home, the marriage contract is broken.

What should one make of the verse in the Koran that allows a man to punish his wife physically? There are important provisos: he may do so only if her ill-will is wrecking the marriage - but then only after he has exhausted all attempts at verbal communication and tried sleeping in a separate bed.

However, the Prophet never hit a woman, child or old person, and was emphatic that those who did could hardly regard themselves as the best of Muslims. Moreover, he also stated that a man should never hit "one of God's handmaidens". Nor, it must be said, should wives beat their husbands or become inveterate nags.

Finally, there is the issue of giving witness. Although the Koran says nothing explicit, other Islamic sources suggest that a woman's testimony in court is worth only half of that of a man. This ruling, however, should be applied only in circumstances where a woman is uneducated and has led a very restricted life: a woman equally qualified to a man will carry the same weight as a witness.

So, does Islam oppress women?

While the spirit of Islam is clearly patriarchal, it regards men and women as moral equals. Moreover, although a man is technically the head of the household, Islam encourages matriarchy in the home.

Women may not be equal in the manner defined by Western feminists, but their core differences from men are acknowledged, and they have rights of their own that do not apply to men

2007-06-09T05:28:00.000-07:00

Women And Islam

By Tyseer Aboulnasr, Ph.D.

IMAGE OF MUSLIM WOMEN

As a Muslim woman, I found myself thrown right into the controversy of women's role in today's society. Over and over I had to explain that what you see in a Hollywood movie about Islam has nothing to do with Islam. For years and years, the average western person has been subjected to one image of a Muslim woman: mysteriously veiled, heavily guarded, living in a harem with a brutal sex maniac for a husband. One can't really blame this person if he or she accepts this image as true especially if he or she never saw Muslim women in any other light.

So how can one start this preconceived image and get this person to see where a woman fits in a truly Muslim society? I can only try to highlight the status of women in the actual teachings of Islam as opposed to the practices of many so-called Muslim countries and the misrepresentation of Hollywood movies. Then, it would be up to the individual to pass a fair judgement on where women stand in a truly Muslim society.

MEN AND WOMEN ARE EQUAL

Let us start right from the beginning, the creation of Adam and Eve as revealed by God in the Qur'an. Adam and Eve were forbidden to eat fruit from the tree but both were tempted by Satan to taste it. They both sinned and later regretted it. God repeatedly reprimanded them both. Thus, in no way was Eve and subsequently all women held responsible for the original sin nor was she considered as Satan's way to get to Adam and all his male descendants. That, to start with, breaks to pieces the general belief that women are the cause of men's sufferings on earth, that they are Satan's temptation, an evil to be avoided if at all possible. In Islam, men and women are created equal as human beings though obviously not identical. Throughout the Qur'an, it is repeated over and over that men and women are created as companions on earth to complement and comfort one another. They are both held accountable for their deeds, individually. Both are rewarded or punished equally for their deeds. Muslims have been spared the debate about whether a woman had a soul or whether she was a person or not. That was never questioned while it was a hot issue in western societies up to the 1930's when the Supreme Court of Canada passed a judgement that women really are persons! This was simply a fact asserted by a religion that was born in a society where burying newborn girls alive, out of shame, as common practice. Sons were a source of pride while girls brought along disgrace. Islam immediately prohibited such a brutal discrimination. It was spelled out clearly that one person, be it male or female, can be better than another by virtue of his or her piety alone, not sex, not origin.

ACTIVE PARTICIPATION

However, Islam's regard for women is not simply giving her a chance to survive. Muslims, men and women, are told to seek knowledge and education wherever they find it and to use this knowledge to help fellow human beings. This is a duty about which they will be asked on Judgement Day. When the Prophet himself could not read or write, his wife Hafsa, taught others to read and write. History tells us about the immense contribution of women to the Islamic community. The first believer in the message of the Prophet Muhammad was a woman. She was his wife, Khadija, and his source of protection from the pagans of Mecca in the early years. The Prophet himself was later actually physically saved by a woman during one of the battles after having been isolated by the pagans. Later, after he died, many of his sayings and teachings were narrated by another woman, his second wife Aisha. These sayings are an essential part of Islamic teachings. So what does that say about how Islam views woman, to entrust her with these roles? The Muslim woman's active participation in community affairs was established from the earliest days. This includes the right to vote. She has always been a separate individual with a separate vote. She had to swear allegiance independently of her husband and father.
MARRIAGE AND DIVORCENow what happened if this Muslim woman got married. For starters, she couldn't be married against her will, her consent was essential. If she did accept, she did not give up her family name for her husband's name. She did not have to be a staunch feminist or proclaim I am not a property to be passed on from father to husband. She simply was never expected to change her name. Important as that may be symbolically, it is even more important, on a practical level, that she was always considered a separate financial entity. When she married, her property remained her own and her husband had no access to it without her consent. She wasn't even required to share in the family's expenses even if she were a lot richer than the man. She was entitled to an explicit share of inheritance from family members. That share might be less than her male counterpart but that was only fair considering that her money was hers to keep while his money belongs to his whole family including his wife and any other women in his family who need financial support. All this was established more than 1400 years ago even before people in Europe realized it was unfair to shut daughters out of their father's inheritance or for the man to automatically acquire his wife's wealth upon her marriage.
If the marriage relationship fails and a divorce becomes the only option, a woman's rights are protected. A Muslim woman is entitled to maintain the right to divorce her husband if she specifies that right in the marriage contract. Otherwise, he retains that right. In any case, whoever has this right does not change the fact that divorce is considered a last resort, highly discouraged and to be used only if attempts for reconciliation by family members and even the judge have failed.

A MOTHER

As a mother, she is held in the highest regard. We are told that our mothers are the most worthy of our care, love and companionship. Fathers come in a distant second. Because God knows his own creation, he knows that men would be tempted to abuse their physical strength when dealing with women. Repeatedly, throughout the Qur'an and in the Prophet's sayings, men are reminded of their responsibility to be kind and compassionate to women. That was again stressed by the Prophet in his last public address where he highlighted the essentials of Islam. Men are told that the best among you are the kindest to the women in their families. They are often reminded not to take advantage of the woman's relative physical weakness since they will eventually have to answer to an even stronger Being, God himself.

WOMEN'S DRESS

All this seems to paint such a beautiful picture of women in Islam but what about the veil or, less romantic but more real, the Muslim dress code? Islam, as a whole, is described in the Qur'an as a religion of the centre balancing the needs and freedom of the individual with the good of the society. This is the general rule which also governs the relationship between men and women in society. They have the right to work and mix together as long as that right is not abused, hurting the society as a whole. This implies that the environment in which they see and talk to one another should be a clean respectable environment where sexual temptation is practically eliminated. Some westerners, and regrettably, some Muslims, take this to imply locking up the women or hiding them in veils. However, that contradicts the practices in the Prophet's life when women fought in battles, nursed the wounded, argued with the Caliph and even taught religion. The whole idea of modesty in dress is to ensure that both sides are not distracted by physical appearances. The dress code applies equally to men and women. Both should not look sexually inviting. That might not seem like too much fun, it certainly will not allow for Dallas-like episodes, but it would improve the chances for a better family-oriented society where men and women treat each other with mutual respect as human beings, rather than as sex objects. These are the general requirements for the Muslim dress code for men and women. How women actually dress in specific Muslim countries has a lot to do with the local culture and not just with Islam.

FACT OR FICTION: YOUR CHOICE

One can't help but wonder, if Islam is so good for women, how come what we see in countries with Muslim majorities is utterly different? If it makes things any easier to understand, without, justifying them, the same applies to all other religions. I am sure Jesus would be appalled to see how his teachings have been twisted around for ages to the extent of promoting slavery or tolerating exploitation through turning the other cheek.

Muslims, like people of other beliefs have done a super job of twisting their religion to suit the needs of the more powerful in their society by generalizing specific rules on the one hand and limiting general rules on the other as they find convenient. Add this to innovations added onto the religion to suit the local cultures and you get something that may or may not represent the original. If on top of that you have a media that is either too ignorant or too hostile then the end product that reaches the average unbiased non-Muslim definitely has nothing to do with the real teachings of Islam. The only hope lies in people realizing that before one judges anything, one has to separate fact from fiction, opinions from actual happenings, etc. . . The true image of a true Muslim woman in a true Muslim society may not be as fascinating as what we see in the movies. However, if given a choice between this image and any other alternative available to date, I doubt it will be a hard choice.

Source: http://www.cs.queensu.ca/home/fevens/CCMW/CCMW_S96_0.html

Women's rights in Islam

2007-06-09T03:21:00.000-07:00

A Collection of References from the Quran and Hadeeth about the Rights of Women guaranteed by Islam

Spiritual Equality of Women and Men

Allah has got ready forgiveness and tremendous rewards for the Muslim men and women; the believing men and women; the devout men and women; the truthful men and women; the patiently suffering men and women; the humble men and women; the almsgiving men and women; the fasting men and women, the men and women who guard their chastity; and the men and women who are exceedingly mindful of Allah. (Al-Ahzab 33:35)

Attitudes towards women ye who believe!

Ye are forbidden to inherit women against their will. Nor should ye treat them with harshness, that ye may take away part of the dower ye have given them,-except where they have been guilty of open lewdness; on the contrary live with them on a footing of kindness and equity. If ye take a dislike to them it may be that ye dislike a thing, and Allah brings about through it a great deal of good. (An-Nisa 4:19)

Collaboration and consultation

The believing men and women, are associates and helpers of each other. They (collaborate) to promote all that is beneficial and discourage all that is evil; to establish prayers and give alms, and to obey Allah and his Messenger. Those are the people whom Allah would grant mercy. Indeed Allah is Mighty and Wise. (Al-Taubah 9:71)

Examples of Consensual Decision Making

If both spouses decide, by mutual consent and consultation, on weaning [their baby], there is no blame on either. If you want to have your babies breastfed by a foster mother you are not doing anything blame-worthy provided you pay to the fostermother what you had agreed to offer, in accordance with the established manner. Fear Allah and know that Allah is aware it what you are doing". (Al-Baqarah, 2:233)

Women's Right to Attend Mosques

Narrated Ibn Umar: The Prophet (p.b.u.h) said, "Allow women to go to the Mosques at night." (Bukhari Volume 2, Book 13, Number 22)

Narrated Ibn Umar: One of the wives of Umar (bin Al-Khattab) used to offer the Fajr and the 'Isha' prayer in congregation in the Mosque. She was asked why she had come out for the prayer as she knew that Umar disliked it, and he has great ghaira (self-respect). She replied, "What prevents him from stopping me from this act?" The other replied, "The statement of Allah's Apostle (p.b.u.h) : 'Do not stop Allah's women-slave from going to Allah s Mosques' prevents him." (Bukhari Volume 2, Book 13, Number 23)

Ibn 'Umar reported: Grant permission to women for going to the mosque in the night. His son who was called Waqid said: Then they would make mischief. He (the narrator) said: He thumped his (son's) chest and said: I am narrating to you the hadith of the Messenger of Allah (may peace be upon him), and you say: No! (Sahih Muslim Book 004, Number 0890)
Ibn Umar reported: The Messenger of Allah (may peace be upon him) said: Do not deprive women of their share of the mosques, when they seek permission from you. Bilal said: By Allah, we would certainly prevent them. 'Abdullah said: I say that the Messenger of Allah (may peace be upon him) said it and you say: We would certainly prevent them! (Sahih Muslim Book 004, Number 0891)

Yahya related to me from Malik from Yahya ibn Said that Atika bint Zayd ibn Amr ibn Nufayl, the wife of Umar ibn al-Khattab, used to ask Umar ibn al-Khattab for permission to go to the mosque. He would keep silent, so she would say, "By Allah, I will go out, unless you forbid me," and he would not forbid her. (Sunan Abu Dawud Book 14, Number 14.5.14)

The Common Performance of Ablutions

Narrated Ibn Umar: "It used to be that men and women would perform ablutions together in the time of the Messenger of Allah's assembly." (Bukhari: 1: Ch. 45, Book of Ablution)

Women's Right of Proposal

Narrated Sahl: A woman came to the Prophet, and presented herself to him (for marriage). He said, "I am not in need of women these days." Then a man said, "O Allah's Apostle! Marry her to me." The Prophet asked him, "What have you got?" He said, "I have got nothing." The Prophet said, "Give her something, even an iron ring." He said, "I have got nothing." The Prophet asked (him), "How much of the Quran do you know (by heart)?" He said, "So much and so much." The Prophet said, "I have married her to you for what you know of the Quran." (Bukhari Volume 7, Book 62, Number 72)

Women's Right of Permission

Narrated Abu Huraira: The Prophet said, "A matron should not be given in marriage except after consulting her; and a virgin should not be given in marriage except after her permission." The people asked, "O Allah's Apostle! How can we know her permission?" He said, "Her silence (indicates her permission)." (Bukhari Volume 7, Book 62, Number 67)

Narrated Khansa bint Khidam Al-Ansariya that her father gave her in marriage when she was a matron and she disliked that marriage. So she went to Allah's Apostle and he declared that marriage invalid. (Bukhari Volume 7, Book 62, Number 69)

The Right of Women not to be Forced

Narrated Ibn 'Abbas: Barira's husband was a slave called Mughith, as if I am seeing him now, going behind Barira and weeping with his tears flowing down his beard. The Prophet said to 'Abbas, "O 'Abbas ! are you not astonished at the love of Mughith for Barira and the hatred of Barira for Mughith?" The Prophet then said to Barira, "Why don't you return to him?" She said, "O Allah's Apostle! Do you order me to do so?" He said, "No, I only intercede for him." She said, "I am not in need of him." (Bukhari: Volume 7, Book 63, Number 206)

Asserting Women's Rights

Ibn Al-Jauzi narrated the virtues and merits of Umar bin Al-Khattab (Allah bless him) in the following words: Umar forbade the people from paying excessive dowries and addressed them saying: "Don't fix the dowries for women over forty ounces. If ever that is exceeded I shall deposit the excess amount in the public treasury". As he descended from the pulpit, a flat-nosed lady stood up from among the women audience, and said: "It is not within your right". Umar asked: "Why should this not be of my right?" she replied: "Because Allah has proclaimed: 'even if you had given one of them (wives) a whole treasure for dowry take not the least bit back. Would you take it by false claim and a manifest sin'". (Al Nisa, 20). When he heard this, Umar said: "The woman is right and the man (Umar) is wrong. It seems that all people have deeper insight and wisdom than Umar". Then he returned to the pulpit and declared: "O people, I had restricted the giving of more than four hundred dirhams in dowry. Whosoever of you wishes to give in dowry as much as he likes and finds satisfaction in so doing may do so". quoted in: "On the Position and Role of Women in Islam and Islamic Society"

Seeking advice and comfort

Narrated 'Aisha (the mother of the faithful believers): ... Then Allah's Apostle returned with the Inspiration and with his heart beating severely. Then he went to Khadija bint Khuwailid and said, "Cover me! Cover me!" They covered him till his fear was over and after that he told her everything that had happened and said, "I fear that something may happen to me." Khadija replied, "Never! By Allah, Allah will never disgrace you. You keep good relations with your kith and kin, help the poor and the destitute, serve your guests generously and assist the deserving calamity-afflicted ones." Khadija then accompanied him to her cousin Waraqa bin Naufal bin Asad bin 'Abdul 'Uzza ... (Bukhari Volume 1, Book 1, Number 3)

The Characteristics of a Believing Man

Narrated AbuHurayrah: Allah's Messenger (pbuh) said: a believing man should not hate a believing woman; if he dislikes one of her characteristics, he will be pleased with another. (Muslim Book 8, Number 3469)

The Education of Women

Narrated Abu Said: A woman came to Allah's Apostle and said, "O Allah's Apostle! Men (only) benefit by your teachings, so please devote to us from (some of) your time, a day on which we may come to you so that you may teach us of what Allah has taught you." Allah's Apostle said, "Gather on such-and-such a day at such-and-such a place." They gathered and Allah's Apostle came to them and taught them of what Allah had taught him. (Bukhari Volume 9, Book 92, Number 413)

On the Treatment of Women

Narrated Mu'awiyah al-Qushayri: I went to the Apostle of Allah (pbuh) and asked him: "What do you say (command) about our wives?" He replied: "Give them food what you have for yourself, and clothe them by which you clothe yourself, and do not beat them, and do not revile them." (Sunan Abu Dawud: Book 11, Number 2139) "The best of you is one who is best towards his family and I am best towards the family". (At-Tirmithy). "None but a noble man treats women in an honourable manner. And none but an ignoble treats women disgracefully". (At-Tirmithy).

A Husband must keep the Privacy of his Wife

Narrated AbuSa'id al-Khudri: Allah's Messenger (peace_be_upon_him) said: The most wicked among the people in the eye of Allah on the Day of Judgement is the man who goes to his wife and she comes to him, and then he divulges her secret. (Muslim Book 8, Number 3369)
A Husband's Attitude'Umar ibn al-Khattab (RA) said that a man came to his house to complain about his wife. On reaching the door of his house, he hears 'Umar's wife shouting at him and reviling him. Seeing this, he was about to go back, thinking that 'Umar himself was in the same position and, therefore, could hardly suggest any solution for his problem. 'Umar (RA) saw the man turn back, so he called him and enquired about the purpose of his visit. He said that he had come with a complaint against his wife, but turned back on seeing the Caliph in the same position. 'Umar (RA) told him that he tolerated the excesses of his wife for she had certain rights against him. He said, "Is it not true that she prepares food for me, washes clothes for me and suckles my children, thus saving me the expense of employing a cook, a washerman and a nurse, though she is not legally obliged in any way to do any of these things? Besides, I enjoy peace of mind because of her and am kept away from indecent acts on account of her. I therefore tolerate all her excesses on account of these benefits. It is right that you should also adopt the same attitude." quoted in Rahman, Role of Muslim Women page 149

The Prophet's Disapproval of Women Beaters

Patient behavior was the practice of the Prophet, even when his wife dared to address him harshly. Once his mother-in-law- saw her daughter strike him with her fist on his noble chest. When the enraged mother -in-law began to reproach her daughter, the Prophet smilingly said, "Leave her alone; they do worse than that." And once Abu Bakr, his father-in-law, was invited to settle some misunderstanding between him and Aishah. The Prophet said to her, "Will you speak, or shall I speak?" Aisha said, "You speak, but do not say except the truth." Abu Bakr was so outraged that he immediately struck her severely, forcing her to run and seek protection behind the back of the Prophet. Abu Bakr said, "O you the enemy of herself! Does the Messenger of Allah say but the truth?" The Prophet said, "O Abu Bakr, we did not invite you for this [harsh dealing with Aishah], nor did we anticipate it." quoted in: Mutual Rights and Obligations

And Allah (swt) knows best.

The Status of Women In Islam

2007-06-09T03:17:00.000-07:00

I. INTRODUCTION

The status of women in society is neither a new issue nor is it a fully settled one.

The position of Islam on this issue has been among the subjects presented to the Western reader with the least objectivity.

This paper is intended to provide a brief and authentic exposition of what Islam stands for in this regard. The teachings of Islam are based essentially on the Qur'an (God's revelation) and Hadeeth (elaboration by Prophet Muhammad).

The Qur'an and the Hadeeth, properly and unbiasedly understood, provide the basic source of authentication for any position or view which is attributed to Islam.

The paper starts with a brief survey of the status of women in the pre-Islamic era. It then focuses on these major questions: What is the position of Islam regarding the status of woman in society? How similar or different is that position from "the spirit of the time," which was dominant when Islam was revealed? How would this compare with the "rights" which were finally gained by woman in recent decades?

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II. HISTORICAL PERSPECTIVES

One major objective of this paper is to provide a fair evaluation of what Islam contributed (or failed to contribute) toward the restoration of woman's dignity and rights. In order to achieve this objective, it may be useful to review briefly how women were treated in general in previous civilizations and religions, especially those which preceded Islam (Pre-610 C.E.). Part of the information provided here, however, describes the status of woman as late as the nineteenth century, more than twelve centuries after Islam.

Women in Ancient Civilization

Describing the status of the Indian woman, Encyclopedia Britannica states:

In India, subjection was a cardinal principle. Day and night must women be held by their protectors in a state of dependence says Manu. The rule of inheritance was agnatic, that is descent traced through males to the exclusion of females.

In Hindu scriptures, the description of a good wife is as follows: "a woman whose mind, speech and body are kept in subjection, acquires high renown in this world, and, in the next, the same abode with her husband."

In Athens, women were not better off than either the Indian or the Roman women.

"Athenian women were always minors, subject to some male - to their father, to their brother, or to some of their male kin.

Her consent in marriage was not generally thought to be necessary and "she was obliged to submit to the wishes of her parents, and receive from them her husband and her lord, even though he were stranger to her."

A Roman wife was described by an historian as: "a babe, a minor, a ward, a person incapable of doing or acting anything according to her own individual taste, a person continually under the tutelage and guardianship of her husband."

In the Encyclopedia Britannica, we find a summary of the legal status of women in the Roman civilization:

In Roman Law a woman was even in historic times completely dependent. If married she and her property passed into the power of her husband . . . the wife was the purchased property of her husband, and like a slave acquired only for his benefit. A woman could not exercise any civil or public office . could not be a witness, surety, tutor, or curator; she could not adopt or be adopted, or make will or contract. Among the Scandinavian races women were:

under perpetual tutelage, whether married or unmarried. As late as the Code of Christian V, at the end of the 17th Century, it was enacted that if a woman married without the consent of her tutor he might have, if he wished, administration and usufruct of her goods during her life.

According to the English Common Law:

...all real property which a wife held at the time of a marriage became a possession of her husband. He was entitled to the rent from the land and to any profit which might be made from operating the estate during the joint life of the spouses. As time passed, the English courts devised means to forbid a husband's transferring real property without the consent of his wife, but he still retained the right to manage it and to receive the money which it produced. As to a wife's personal property, the husband's power was complete. He had the right to spend it as he saw fit.

Only by the late nineteenth Century did the situation start to improve. "By a series of acts starting with the Married women's Property Act in 1870, amended in 1882 and 1887, married women achieved the right to own property and to enter contracts on a par with spinsters, widows, and divorcees." As late as the Nineteenth Century an authority in ancient law, Sir Henry Maine, wrote: "No society which preserves any tincture of Christian institutions is likely to restore to married women the personal liberty conferred on them by the Middle Roman Law."

In his essay The Subjection of Women, John Stuart Mill wrote:

We are continually told that civilization and Christianity have restored to the woman her just rights. Meanwhile the wife is the actual bondservant of her husband; no less so, as far as the legal obligation goes, than slaves commonly so called.

Before moving on to the Qur'anic decrees concerning the status of woman, a few Biblical decrees may shed more light on the subject, thus providing a better basis for an impartial evaluation. In the Mosaic Law, the wife was betrothed. Explaining this concept, the Encyclopedia Biblica states: "To betroth a wife to oneself meant simply to acquire possession of her by payment of the purchase money; the betrothed is a girl for whom the purchase money has been paid." From the legal point of view, the consent of the girl was not necessary for the validation of her marriage. "The girl's consent is unnecessary and the need for it is nowhere suggested in the Law."

As to the right of divorce, we read in the Encyclopedia Biblica: "The woman being man's property, his right to divorce her follows as a matter of course." The right to divorce was held only by man. "In the Mosaic Law divorce was a privilege of the husband only .... "

The position of the Christian Church until recent centuries seems to have been influenced by both the Mosaic Law and by the streams of thought that were dominant in its contemporary cultures. In their book, Marriage East and West, David and Vera Mace wrote:

Let no one suppose, either, that our Christian heritage is free of such slighting judgments. It would be hard to find anywhere a collection of more degrading references to the female sex than the early Church Fathers provide. Lecky, the famous historian, speaks of (these fierce incentives which form so conspicuous and so grotesque a portion of the writing of the Fathers . . . woman was represented as the door of hell, as the mother of all human ills. She should be ashamed at the very thought that she is a woman. She should live in continual penance on account of the curses she has brought upon the world. She should be ashamed of her dress, for it is the memorial of her fall. She should be especially ashamed of her beauty, for it is the most potent instrument of the devil). One of the most scathing of these attacks on woman is that of Tertullian: Do you know that you are each an Eve? The sentence of God on this sex of yours lives in this age: the guilt must of necessity live too. You are the devil's gateway: you are the unsealer of that forbidden tree; you are the first deserters of the divine law; you are she who persuades him whom the devil was not valiant enough to attack. You destroyed so easily God's image, man. On account of your desert - that is death - even the Sop of God had to die). Not only did the church affirm the inferior status of woman, it deprived her of legal rights she had previously enjoyed.

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III. WOMAN IN ISLAM

In the midst of the darkness that engulfed the world, the divine revelation echoed in the wide desert of Arabia with a fresh, noble, and universal message to humanity: "O Mankind, keep your duty to your Lord who created you from a single soul and from it created its mate (of same kind) and from them twain has spread a multitude of men and women" (Qur'an 4: 1).

A scholar who pondered about this verse states: "It is believed that there is no text, old or new, that deals with the humanity of the woman from all aspects with such amazing brevity, eloquence, depth, and originality as this divine decree."

Stressing this noble and natural conception, them Qur'an states:

He (God) it is who did create you from a single soul and therefrom did create his mate, that he might dwell with her (in love)...(Qur'an 7:189)

The Creator of heavens and earth: He has made for you pairs from among yourselves ...Qur'an 42:1 1

And Allah has given you mates of your own nature, and has given you from your mates, children and grandchildren, and has made provision of good things for you. Is it then in vanity that they believe and in the grace of God that they disbelieve? Qur'an 16:72

The rest of this paper outlines the position of Islam regarding the status of woman in society from its various aspects - spiritually, socially, economically and politically.

1. The Spiritual Aspect

The Qur'an provides clear-cut evidence that woman iscompletely equated with man in the sight of God interms of her rights and responsibilities. The Qur'an states:

"Every soul will be (held) in pledge for its deeds" (Qur'an 74:38). It also states:

...So their Lord accepted their prayers, (saying): I will not suffer to be lost the work of any of you whether male or female. You proceed one from another ...(Qur'an 3: 195).

Whoever works righteousness, man or woman, and has faith, verily to him will We give a new life that is good and pure, and We will bestow on such their reward according to the their actions. (Qur'an 16:97, see also 4:124).

Woman according to the Qur'an is not blamed for Adam's first mistake. Both were jointly wrong in their disobedience to God, both repented, and both were forgiven. (Qur'an 2:36, 7:20 - 24). In one verse in fact (20:121), Adam specifically, was blamed.

In terms of religious obligations, such as the Daily Prayers, Fasting, Poor-due, and Pilgrimage, woman is no different from man. In some cases indeed, woman has certain advantages over man. For example, the woman is exempted from the daily prayers and from fasting during her menstrual periods and forty days after childbirth. She is also exempted from fasting during her pregnancy and when she is nursing her baby if there is any threat to her health or her baby's. If the missed fasting is obligatory (during the month of Ramadan), she can make up for the missed days whenever she can. She does not have to make up for the prayers missed for any of the above reasons. Although women can and did go into the mosque during the days of the prophet and thereafter attendance et the Friday congregational prayers is optional for them while it is mandatory for men (on Friday).

This is clearly a tender touch of the Islamic teachings for they are considerate of the fact that a woman may be nursing her baby or caring for him, and thus may be unable to go out to the mosque at the time of the prayers. They also take into account the physiological and psychological changes associated with her natural female functions.

2. The Social Aspect

a) As a child and an adolescent

Despite the social acceptance of female infanticide among some Arabian tribes, the Qur'an forbade this custom, and considered it a crime like any other murder.

"And when the female (infant) buried alive - is questioned, for what crime she was killed." (Qur'an 81:8-9).

Criticizing the attitudes of such parents who reject their female children, the Qur'an states:

When news is brought to one of them, of (the Birth of) a female (child), his face darkens and he is filled with inward grief! With shame does he hide himself from his people because of the bad news he has had! Shall he retain her on (sufferance) and contempt, or bury her in the dust? Ah! What an evil (choice) they decide on? (Qur'an 16: 58-59).

Far from saving the girl's life so that she may later suffer injustice and inequality, Islam requires kind and just treatment for her. Among the sayings of Prophet Muhammad (P.) in this regard are the following:

Whosoever has a daughter and he does not bury her alive, does not insult her, and does not favor his son over her, God will enter him into Paradise. (Ibn Hanbal, No. 1957).

Whosoever supports two daughters till they mature, he and I will come in the day of judgment as this (and he pointed with his two fingers held together).

A similar Hadeeth deals in like manner with one who supports two sisters. (Ibn-Hanbal, No. 2104).

The right of females to seek knowledge is not different from that of males. Prophet Muhammad (P.) said:

"Seeking knowledge is mandatory for every Muslim". (AlBayhaqi). Muslim as used here including both males and females.

b) As a wife:

The Qur'an clearly indicates that marriage is sharing between the two halves of the society, and that its objectives, beside perpetuating human life, are emotional well-being and spiritual harmony. Its bases are love and mercy.

Among the most impressive verses in the Qur'an about marriage is the following.

"And among His signs is this: That He created mates for you from yourselves that you may find rest, peace of mind in them, and He ordained between you love and mercy. Lo, herein indeed are signs for people who reflect." (Qur'an 30:2 1).

According to Islamic Law, women cannot be forced to marry anyone without their consent.

Ibn Abbas reported that a girl came to the Messenger of God, Muhammad (P.), and she reported that her father had forced her to marry without her consent. The Messenger of God gave her the choice . . . (between accepting the marriage or invalidating it). (Ibn Hanbal No. 2469). In another version, the girl said: "Actually I accept this marriage but I wanted to let women know that parents have no right (to force a husband on them)" (Ibn Maja, No. 1873).

Besides all other provisions for her protection at the time of marriage, it was specifically decreed that woman has the full right to her Mahr, a marriage gift, which is presented to her by her husband and is included in the nuptial contract, and that such ownership does not transfer to her father or husband. The concept of Mahr in Islam is neither an actual or symbolic price for the woman, as was the case in certain cultures, but rather it is a gift symbolizing love and affection.

The rules for married life in Islam are clear and in harmony with upright human nature. In consideration of the physiological and psychological make-up of man and woman, both have equal rights and claims on one another, except for one responsibility, that of leadership. This is a matter which is natural in any collective life and which is consistent with the nature of man.

The Qur'an thus states:

"And they (women) have rights similar to those (of men) over them, and men are a degree above them." (Qur'an 2:228).

Such degree is Quiwama (maintenance and protection). This refers to that natural difference between the sexes which entitles the weaker sex to protection. It implies no superiority or advantage before the law. Yet, man's role of leadership in relation to his family does not mean the husband's dictatorship over his wife. Islam emphasizes the importance of taking counsel and mutual agreement in family decisions. The Qur'an gives us an example:

"...If they (husband wife) desire to wean the child by mutual consent and (after) consultation, there is no blame on them..." (Qur'an 2: 233).

Over and above her basic rights as a wife comes the right which is emphasized by the Qur'an and is strongly recommended by the Prophet (P); kind treatment and companionship.

The Qur'an states:

"...But consort with them in kindness, for if you hate them it may happen that you hate a thing wherein God has placed much good." (Qur'an 4: l9).

Prophet Muhammad. (P) said:

The best of you is the best to his family and I am the best among you to my family.

The most perfect believers are the best in conduct and best of you are those who are best to their wives. (Ibn-Hanbal, No. 7396)

Behold, many women came to Muhammad's wives complaining against their husbands (because they beat them) - - those (husbands) are not the best of you.

As the woman's right to decide about her marriage is recognized, so also her right to seek an end for an unsuccessful marriage is recognized. To provide for the stability of the family, however, and in order to protect it from hasty decisions under temporary emotional stress, certain steps and waiting periods should be observed by men and women seeking divorce. Considering the relatively more emotional nature of women, a good reason for asking for divorce should be brought before the judge. Like the man, however, the woman can divorce her husband with out resorting to the court, if the nuptial contract allows that.

More specifically, some aspects of Islamic Law concerning marriage and divorce are interesting and are worthy of separate treatment.

When the continuation of the marriage relationship is impossible for any reason, men are still taught to seek a gracious end for it.

The Qur'an states about such cases:

When you divorce women, and they reach their prescribed term, then retain them in kindness and retain them not for injury so that you transgress (the limits). (Qur'an 2:231). (See also Qur'an 2:229 and 33:49).

c) As a mother:

Islam considered kindness to parents next to the worship of God.

"And we have enjoined upon man (to be good) to his parents: His mother bears him in weakness upon weakness..." (Qur'an 31:14) (See also Qur'an 46:15, 29:8).

Moreover, the Qur'an has a special recommendation for the good treatment of mothers:

"Your Lord has decreed that you worship none save Him, and that you be kind to your parents. . ." (Qur'an 17:23).

A man came to Prophet Muhammad (P) asking:

O Messenger of God, who among the people is the most worthy of my good company? The Prophet (P) said, Your mother. The man said then who else: The Prophet (P) said, Your mother. The man asked, Then who else? Only then did the Prophet (P) say, Your father. (Al-Bukhari and Muslim).

A famous saying of The Prophet is "Paradise is at the feet of mothers." (In Al'Nisa'I, Ibn Majah, Ahmad).

"It is the generous (in character) who is good to women, and it is the wicked who insults them."

3. The Economic Aspect

Islam decreed a right of which woman was deprived both before Islam and after it (even as late as this century), the right of independent ownership. According to Islamic Law, woman's right to her money, real estate, or other properties is fully acknowledged. This right undergoes no change whether she is single or married. She retains her full rights to buy, sell, mortgage or lease any or all her properties. It is nowhere suggested in the Law that a woman is a minor simply because she is a female. It is also noteworthy that such right applies to her properties before marriage as well as to whatever she acquires thereafter.

With regard to the woman's right to seek employment it should be stated first that Islam regards her role in society as a mother and a wife as the most sacred and essential one. Neither maids nor baby-sitters can possibly take the mother's place as the educator of an upright, complex free, and carefully-reared children. Such a noble and vital role, which largely shapes the future of nations, cannot be regarded as "idleness".

However, there is no decree in Islam which forbids woman from seeking employment whenever there is a necessity for it, especially in positions which fit her nature and in which society needs her most. Examples of these professions are nursing, teaching (especially for children), and medicine. Moreover, there is no restriction on benefiting from woman's exceptional talent in any field. Even for the position of a judge, where there may be a tendency to doubt the woman's fitness for the post due to her more emotional nature, we find early Muslim scholars such as Abu-Hanifa and Al-Tabary holding there is nothing wrong with it. In addition, Islam restored to woman the right of inheritance, after she herself was an object of inheritance in some cultures. Her share is completely hers and no one can make any claim on it, including her father and her husband.

"Unto men (of the family) belongs a share of that which Parents and near kindred leave, and unto women a share of that which parents and near kindred leave, whether it be a little or much - a determinate share." ((Qur'an 4:7).

Her share in most cases is one-half the man's share, with no implication that she is worth half a man! It would seem grossly inconsistent after the overwhelming evidence of woman's equitable treatment in Islam, which was discussed in the preceding pages, to make such an inference. This variation in inheritance rights is only consistent with the variations in financial responsibilities of man and woman according to the Islamic Law. Man in Islam is fully responsible for the maintenance of his wife, his children, and in some cases of his needy relatives, especially the females. This responsibility is neither waived nor reduced because of his wife's wealth or because of her access to any personal income gained from work, rent, profit, or any other legal means.

Woman, on the other hand, is far more secure financially and is far less burdened with any claims on her possessions. Her possessions before marriage do not transfer to her husband and she even keeps her maiden name. She has no obligation to spend on her family out of such properties or out of her income after marriage. She is entitled to the "Mahr" which she takes from her husband at the time of marriage. If she is divorced, she may get an alimony from her ex-husband.

An examination of the inheritance law within the overall framework of the Islamic Law reveals not only justice but also an abundance of compassion for woman.

4. The Political Aspect

Any fair investigation of the teachings of Islam o~ into the history of the Islamic civilization will surely find a clear evidence of woman's equality with man in what we call today "political rights".
This includes the right of election as well as the nomination to political offices. It also includes woman's right to participate in public affairs. Both in the Qur'an and in Islamic history we find examples of women who participated in serious discussions and argued even with the Prophet (P) himself, (see Qur'an 58: 14 and 60: 10-12).

During the Caliphate of Omar Ibn al-Khattab, a woman argued with him in the mosque, proved her point, and caused him to declare in the presence of people: "A woman is right and Omar is wrong."

Although not mentioned in the Qur'an, one Hadeeth of the Prophet is interpreted to make woman ineligible for the position of head of state. The Hadeeth referred to is roughly translated: "A people will not prosper if they let a woman be their leader." This limitation, however, has nothing to do with the dignity of woman or with her rights. It is rather, related to the natural differences in the biological and psychological make-up of men and women.

According to Islam, the head of the state is no mere figurehead. He leads people in the prayers, especially on Fridays and festivities; he is continuously engaged in the process of decision-making pertaining to the security and well-being of his people. This demanding position, or any similar one, such as the Commander of the Army, is generally inconsistent with the physiological and psychological make-up of woman in general. It is a medical fact that during their monthly periods and during their pregnancies, women undergo various physiological and psychological changes. Such changes may occur during an emergency situation, thus affecting her decision, without considering the excessive strain which is produced. Moreover, some decisions require a maximum of rationality and a minimum of emotionality - a requirement which does not coincide with the instinctive nature of women.

Even in modern times, and in the most developed countries, it is rare to find a woman in the position of a head of state acting as more than a figurehead, a woman commander of the armed services, or even a proportionate number of women representatives in parliaments, or similar bodies. One can not possibly ascribe this to backwardness of various nations or to any constitutional limitation on woman's right to be in such a position as a head of state or as a member of the parliament. It is more logical to explain the present situation in terms of the natural and indisputable differences between man and woman, a difference which does not imply any "supremacy" of one over the other. The difference implies rather the "complementary" roles of both the sexes in life.

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IV. CONCLUSION

The first part of this paper deals briefly with the position of various religions and cultures on the issue under investigation. Part of this exposition extends to cover the general trend as late as the nineteenth century, nearly 1300 years after the Qur'an set forth the Islamic teachings.

In the second part of the paper, the status of women in Islam is briefly discussed. Emphasis in this part is placed on the original and authentic sources of Islam. This represents the standard according to which degree of adherence of Muslims can be judged. It is also a fact that during the downward cycle of Islamic Civilization, such teachings were not strictly adhered to by many people who profess to be Muslims.

Such deviations were unfairly exaggerated by some writers, and the worst of this, were superficially taken to represent the teachings of "Islam" to the Western reader without taking the trouble to make any original and unbiased study of the authentic sources of these teachings.

Even with such deviations three facts are worth mentioning:

1. The history of Muslims is rich with women of great achievements in all walks of life from as early as the seventh century (B.C.)

2. It is impossible for anyone to justify any mistreatment of woman by any decree of rule embodied in the Islamic Law, nor could anyone dare to cancel, reduce, or distort the clear-cut legal rights of women given in Islamic Law.

3. Throughout history, the reputation, chastity and maternal role of Muslim women were objects of admiration by impartial observers.

It is also worthwhile to state that the status which women reached during the present era was not achieved due to the kindness of men or due to natural progress. It was rather achieved through a long struggle and sacrifice on woman's part and only when society needed her contribution and work, more especial!; during the two world wars, and due to the escalation of technological change.

In the case of Islam such compassionate and dignified status was decreed, not because it reflects the environment of the seventh century, nor under the threat or pressure of women and their organizations, but rather because of its intrinsic truthfulness.

If this indicates anything, it would demonstrate the divine origin of the Qur'an and the truthfulness of the message of Islam, which, unlike human philosophies and ideologies, was far from proceeding from its human environment, a message which established such humane principles as neither grew obsolete during the course of time and after these many centuries, nor can become obsolete in the future. After all, this is the message of the All-Wise and all-knowing God whose wisdom and knowledge are far beyond the ultimate in human thought and progress.

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BIBLIOGRAPHY

The Holy, Qur'an: Translation of verses is heavily based on A. Yusuf Ali's translation, The Glorious Qur'an, text translation, and Commentary, The American Trust Publication, Plainfield, IN 46168, 1979.

Abd Al-Ati, Hammudah, Islam in Focus, The American Trust Publications, Plainfield, IN 46168, 1977.

Allen, E. A., History of Civilization, General Publishing House, Cincinnati, Ohio, 1889, Vol. 3.

Al Siba'i, Mustafa, Al-Alar'ah Baynal Fiqh Walqanoon (in Arabic), 2nd. ea., Al-Maktabah Al-Arabiah, Halab, Syria, 1966.

El-Khouli, Al-Bahiy, "Min Usus Kadiat Al-Mara'ah" (in Arabic), A 1- Waay A l-lslami, Ministry of Walcf, Kuwait, Vol.3 (No. 27), June 9, 1967, p.17.

Encyclopedia Americana (International Edition), American Corp., N.Y., 1969, Vol.29.

Encyclopedia Biblica (Rev.T.K.Cheynene and J.S.Black, editors), The Macmillan Co., London, England, 1902, Vol.3.

The Encyclopedia Britannica, (11 th ed.), University Press Cambridge, England, 191 1, Vol.28.

Encyclopedia Britannica, The Encyclopedia Britannica, Inc., Chicago, III., 1968, Vol.23.

Hadeeth. Most of the quoted Hadeeth were translated by the writer. They are quoted in various Arabic sources. Some of them, however, were translated directly from the original sources. Among the sources checked are Musnad Ahmad Ibn Hanbal Dar AlMa'aref, Cairo, U.A.R., 1950, and 1955, Vol.4 and 3,SunanIbnMajah, Dar Ihya'a Al-Kutub al-Arabiah, Cairo, U.A.R., 1952, Vol.l, Sunan al-Tirimidhi, Vol.3.

Mace, David and Vera, Marriage: East and West, Dolphin Books, Doubleday and Co., Inc., N.Y., 1960.

Uronology

2007-06-09T02:25:00.000-07:00

Urinary Stone Disease in Arabian Medicine

by: A M Dajani, F.R.C.S(Glas.)Consultant Urologist, Amman, Jordan

This is a brief abstract of the full article which can be read by clicking the resource link at the bottom of this page.

Abstract

Urinary stone disease (urolithiasis) was discussed in great detail in Arabian Medicine. Explanations given by Ibn Qurrah, Al Razi, Ibn Sina and Al Zahrawi about the formation and growth of urinary stones do not basically differ from our modern concepts. Pain and findings on uroscopy were carefully discussed and explained. Differential diagnosis between colitis and kidney stone, and between kidney and bladder stones was very clearly made. Some operations on bladder stones were described and the first lithotriptor to break an obstructing urethral stone was invented by the great Muslim surgeon Al-Zahrawi.

To prevent recurrence of stones they advised diuretics and plenty of fluids, avoiding heavy foods and in particular dairy products.

Finally, Arabian Medicine pharmacology and pharmacopeia are rich in drugs and compounds prescribed for the treatment and breaking of urinary stones.

Read the full article which includes 2 figures, 3 tables and 12 references, please click on resources below.

by: A M Dajani, F.R.C.S(Glas.), Sat 31 August, 2002

Surgery

2007-06-08T03:41:00.000-07:00

The Earliest Paediatric Surgical Atlas: Cerrahiye-i Ilhaniye

By S. N. Cenk Buyukunal and Nil Sari*

The author of one of the earliest surgical books was Serafeddin Sabuncuoglu, who was born in one of the ancient cities of Central Anatolia. In 1465, he wrote a surgical book in Turkish. The aim of this study was to investigate the details of this book and compare it with the old classics. It was observed that the book of Sabuncuoglu did not contain only pictures or miniatures of paediatric surgical procedures, but there were many important and major new contributions to the surgical literature originally described by Sabuncuoglu himself. He based his contributions and techniques on formerly designed and described procedures, moreover, developing and nourishing paediatric surgical culture of that era. Thus a combination of Greek, Roman, Arabic, and Turkish paediatric surgery combined extraordinarily and influenced the development of European paediatric surgery.

Despite the rapid growth and dissemination of paediatric surgical knowledge, the historical aspect of paediatric surgery still has not been systematically explored. The author of one of the earliest surgical textbook was Serafeddin Sabuncuoglu, who was born in Amasya in the Northern part of Central Anatolia and practiced in an Amasya hospital for 14 years. In 1465, he wrote his original textbook. Cerrahiye-i Ilhaniye, in Turkish, describing surgical techniques, incisions and instruments. This book also contained many miniature drawings concerning the operative procedures. Some parts of this textbook include theoretical and practical points about paediatric surgery.[1]

In 1983, during the meeting of the Greek Association of Paediatric Surgeons in Chios, Montagnani of Rome it was declared that Sabuncuoglu made only a faithful translation of Abû Kâsim Al-Zahravî's[2] (Albucasis) Textbook of Surgery, the only additions being the miniatures designed by the surgical techniques.[3] In earlier times, there had been only two or three sources as reference books on surgery. Abû Kâsim Al-Zahravî's book was one of these source books.[4] Even minor additions to such a book were an important step for surgical literature. To investigate the differences and original aspects of Sabuncuoglu's textbook, we explored it and compared it with Zahravî's original text and translation of ancient surgical textbooks.

MATERIALS AND METHODS

There are three original, handwritten copies of Sabuncuoglu's book. Two of these copies are in Istanbul, in the Istanbul National Library of Fatih and Capa Medical History Department of Istanbul University. The third is in the Paris National Library.[5] Cerrahiye-i Ilhaniye includes four major parts: Cauterisation Techniques: General Surgery including Paediatric and Plastic Surgery; Orthopaedics; and Medical Preparations innovated by Sabuncuoglu." The three different manuscripts of the book were translated into the modern Turkish language and compared with Zahravî's textbook and other ancient surgical textbooks. Sabuncuoglu's special contributions and original remarks were investigated.

RESULTS

The surgical modifications, special contributions, and original remarks of Sabuncuoglu were as follows.

On the Cure of Hydrocephalus (Chapter 2)

Sabuncuoglu's instruments for incision and operation are modified forms of Zahravî's and ancient physicians' instruments. The scalpel he illustrates (Fig 1) for the incision is wider and has a sharp, pointed end. Instead of a cross-type incision, he used a special type (reversed T) incision as Zahravî did.

Sabuncuoglu was one of the earliest surgeons to use different drainage techniques and materials for neurosurgical procedures in paediatric cases. He stressed the danger of hemorrhage during neurosurgical operations and believed that contact of cerebrospinal fluid and blood was associated with a fatal outcome.

On the Incising of Ligament "Ribat" Below the Tongue. Which is an Impediment to Speech (Short Fremdum) (Chapter 34)

Sabuncuoglu uses the term "Ribat' as Zahravî to describe short fraenulum. He used a special lenticular cautery called "adesi daglagu" (Fig 2). He advocated a long postoperative drainage period for prevention of haematoma and infection.

On the Treatment of Boys Born With Imperforate Urinary Meatus or With the Meatus Small or Not in the Proper Place (Chapter 55)

In treatment of imperforate urinary meatus, a fine scalpel called a "mibza" was used (Fig 3). It differed from Zahravî's scalpel in that it was straighter. Sabuncuoglu used a tin sound with an intact lumen in paediatric urologic procedures in the postoperative period. Galen and Zahravî used leaden sounds with obliterated lumen.[6] However, Sabuncuoglu recommended a different method, which was to use a sound with a canal in it (like a tube) so that the patient can urinate through. In the treatment of urethral stenosis. Sabuncuoglu used a solid tin dilating tube and removed the tube after the dilating procedure.

In Sabuncuoglu's manuscript, the description and classification of hypospadias was more informative. In particular, the localization of urethral meatus was described in detail.

On Circumcision of Boys and Correction of Their Erroneous Treatment (Chapter 57)

Sabuncuoglu describes the use of bent scissors rather than the straight ones of Zahravî. He advises circumcision of the preputium by a single cut. For the correction of erroneous circumcisions performed by unqualified people practicing surgery, different repair methods are described by Sabuncuoglu.

On the Treatment of Hermaphroditism (Chapter 70)

Centuries ago. Paulus of Aeginae and Zahravî had already described genital ambiguities. But Sabuncuoglu made a detailed description and classification of the subject. He commented on the appearance of perineal region and clitoris.

On the Treatment of Unperformed Female Pudenda (Chapter 72)

Sabuncuoglu was the first to describe the classical position for gynaecologic examination. During manual division of the synechia between the two labiae, he covered the thumbs with special gauze to make the manipulation easy and not hurt the child. He recommended an oiled vaginal tampon for prevention of adhesions and recurrence. Paulus of Aegine provided the source for this anomaly. Celsus and Soraneus recommended using forceps and specula for this examination. For these types of procedures. Sabuncuoglu mentioned the importance of female physicians rather than the midwives favoured by Zahravî. Sabuncuoglu illustrated a "tabîbe" female physician operating on a patient.

On the Treatment of Superfluous Finger and the Separation of Webbed Fingers (Chapter 89)

Sabuncuoglu studied this subject under the title "yarligan" and "yincilmek" and used the special terms "artuk parmak" and "bitevi parmak." In the treatment of a superfluous finger arising at the root of a finger. Sabuncuoglu advised a twisting manoeuvre for amputation (a special technique). After the division of webbed fingers, special gauze soaked in rose oil was put between the fingers to prevent adhesions and recurrence. Sabuncuoglu was the first to advise placing a wooden splint under the palmer side after hand surgery for immobilization to enhance wound healing.

On the Treatment of Intestinal Hernia (Chapter 65)

Sabuncuoglu commented that hernias could be bilateral. He also gave a detailed description of the etiology, classification, and clinical types of inguinal hernias. He described a special drainage procedure for the scrotal pouch and a cauterisation technique for the drainage incision.

Imperforate Anus (Chapter 79)

In high anorectal atresia. Sabuncuoglu stressed intervention by a master surgeon rather than an inexperienced midwife to decrease the risks related with the levator muscle complex! Zahravî and Paul of Aeginea described this anomaly and gave some details of the procedure.

DISCUSSION

It was observed that the book of Serafeddin Sabuncuoglu, as claimed by others,[7] [8]contains not only pictures or miniatures of surgical and paediatric surgical procedures but also many important and major new contributions to the surgical literature originally described by Sabuncuoglu himself.[9] This historic book could also be accepted as the first paediatric surgical atlas. Its colourful, descriptive pictures of various operations and surgical instruments make it a significant piece of work. This important textbook combines knowledge of Greek. Roman. Arabic, and Turkish surgery and nourishes the basic concepts with Sabuncuoglu's original contributions on surgical procedures, postoperative care, and surgical instruments. Thus Greek Roman Arabic, and Turkish surgery combined extraordinarily and influenced the development of European surgery.

FIGURES

Fig 1. Incision and evacuation of hydrocephalus. Note the reversed T-type incision and wide and sharp pointed scalpel (no. 79, f. 48b; reprinted with permission from the Fatih National Library, Istanbul, Turkey).

Fig 2. Special lenticular cautery for the treatment of short frenulum (f. 72a; reprinted with permission from the Fatih National Library, Istanbul, Turkey).

Fig 3. Fine scalpels for the treatment of meatal stenosis. (A) From the manuscript in Fatih National Library, Istanbul, Turkey (f. 90a; reprinted with permission). (B) From the manuscript in Bibliotheque Nationale, Paris, France.

Fig 4. Two types of scissors for circumcision (Fatih National Library, Istanbul, Turkey).
* From the Departments of Paediatric Surgery and History of Medicine. Cerrahpasa Medical Faculty. University of Istanbul. Istanbul. Turkey.

[1] Koker A H. Erdogan Y: Serafeddin Sabuncuoglu. Proceedings of the First Congress of Sabuncuoglu. Kayseri. Turkey. Erciyes University Publications. 1985. pp. 9-123; Numanoglu I: Cerrahiye-i Ilhaniye: The earliest known book containing paediatric surgical procedures. J Pediatr Surg 8:547-548, 1973; Numanoglu I: Cerrahiye-i Ilhaniye and paediatric surgery. Med Bull Ankara University, 26:841-850. 1974.

[2] Rosenfeld, B. A.-E. Ihsanoglu, Mathematicians, Astronomers and other Scholars of Islamic Civilisation and their works (7th -19th c.). Istanbul: Research Center for Islamic History, Art and Culture, 2003. p. 117.

[3] Montagnani CA: Paediatric surgery in Islamic medicine from the middle ages to the Renaissance. Prog Pediatr Surg 20:39-51. 1986.

[4] Spink MS. Lewis GL (eds): Albucasis: On surgery and Instruments. London. England. The Wellcome Institute of the Histroy of Medicine. 1973. pp 170-827.

[5] Sabuncuoalu S: Cerrahiye-i Ilhaniye. Paris. France. Bibliotheque National, Suppl Turc. 693 (2nd manuscript); Sabuncuoalu S: Cerrahiye-Ilhaniye. Istanbul. Turkey. Fatih National Library, no. 79 (1st manuscript); Sabuncuoglu Ilhaniye. Istanbul. Turkey. Capa Medical History Department. Istanbul University. (3rd manuscript).

[6] Montagnani CA: Paediatric surgery in Islamic medicine from the middle ages to the Renaissance. Prog Pediatr Surg 20:39-51. 1986; Spink MS. Lewis GL (eds): Albucasis: On surgery and Instruments. London. England. The Wellcome Institute of the Histroy of Medicine. 1973. pp 170-827.

[7] Montagnani CA: Paediatric surgery in Islamic medicine from the middle ages to the Renaissance. Prog Pediatr Surg 20:39-51. 1986.

[8] Huard P. Grmek MD: Le Premier Manuscript Chirurgical Turc. Paris. France. Les Editions Roger Dacosta. L960.

[9] Unver A.S.: Serafeddin Sabuncuoglu: Kitabul Cerrahiye-i Ilhanive (Cerrahname). Istanbul. T.C. I.U. Tip Tarihi Enstitusu. Adet 12: 870-1465, 1939.

by: S. N. Cenk Buyukunal and Nil Sari, Wed 07 September, 2005

Pharmacy

2007-06-08T03:29:00.000-07:00

Scientific Transfer and Scholarship in Medieval Arabic Pharmacology
Dr. Oliver Kahl*

Figure 1. Dr. O. Kahl during his speech at 1001 Inventions Conference.

The article is originally a talk presented at the international conference 1001 Inventions: Discover the Muslim Heritage in our World held at the Museum of Science and Industry in Manchester on the 8th of March 2006, on the occasion of the launch of the exhibition 1001 inventions. The conference proceedings are edited by Dr. Salim Ayduz and Dr. Saleema Kauser.

Pharmacology, perhaps more than any other science in the so-called Middle Ages of Islam, lies at the crossroads of various other scientific genres – medicine with its philosophical basis of humoralism; botany, zoology, and mineralogy; alchemy insofar as its chemical principles may be concerned; and even astrology as it was occasionally used for the purpose of medical prognostication. Arabic pharmacology, that is to say the branch of scientific literature which deals with the preparation and application of compound drugs as formulated in the Arabic language, is therefore by its very nature an interdisciplinary subject. And it is no surprise that this quality left a mark on the intellectual attitude of those who studied that subject.

But there is also a vertical dimension which meets the horizontal plane of intersecting disciplines, and which manifests itself in the realm of general history rather than science proper. The rise of Arabic pharmacology from truly humble origins as Bedouin herbal lore and its rapid development into a superior scientific structure is a most remarkable historical event which depended on the coincidence of different factors. First, there is the Arabic reception of foreign scientific traditions in the course of a translation movement which took place between the middle of the 8th and the end of the 10th centuries CE in Baghdad, and which acquainted the Arabs with the medical and pharmacological theories and practices notably of the Greeks and Indians – either by way of direct translations from the Greek and Sanskrit or via Syriac and Pahlavi intermediate translations; the translation movement also played a major role in the evolvement of Arabic into a language of science and philosophy. Then there are the commercial and to some extent cultural relations between the Muslim world and China, which brought the Arabs in contact with certain aspects of Chinese herbal medicine. And lastly there is the enormous geographical extension of the Arab empire with its network of transcontinental trade routes which made possible the acquisition and relatively safe transport of medicinal drugs, and many other things, from literally all corners of the known planet. The fact that the early pharmacologists were almost all deeply involved in the translation movement and therefore often bilingual if not multilingual individuals some of whom were neither Muslims nor indeed Arabs, certainly contributed to the formation of a rather cosmopolitan view of the world. As the Arabic share in the adaptation of foreign scientific traditions grew, the relevant literature became more and more refined.

In the following, we will take a look at the Greek, the Indian, and then the Chinese contributions to the development of scientific pharmacology among the Arabs, and where appropriate illustrate the multicultural character of Arabic pharmacology by examples taken from life.

Figure 2. Al-Razi (Rhazes) on the cover of a modern Persian book. Source: reproduced from the article "Al-Razi" in Wikipedia: http://en.wikipedia.org/wiki/Image:Rhazes.jpg.

The transmission of Greek thought to the Arabs in the course of the translation movement had a huge impact on the development of Arabic science in its formative period. Insofar as Arabic pharmacology is concerned we must mention by name three important Greek texts which were available in Arabic translations by the middle of the 9th century CE: first, the book entitled On Medical Matters by Dioscorides, an army doctor who lived in the 1st century CE; second, the book entitled On the Mixing and the Properties of Simple Drugs by Galen, a physician who lived in the 2nd century CE; and third, the book entitled On the Composition of Medicinal Drugs by the same Galen. These texts not only broadened the horizon of the Arabs for their actual contents, they also provided patterns of formal arrangement and scientific organization. During this time the Arabs also became acquainted with the so-called Summaria Alexandrinorum, a summary of sixteen books of Galen compiled around the year 600 CE in the medical school of Alexandria – this summary of Galenic writings introduced to the Arabs the concept of humoralism, which was to dominate all later medical and pharmacological theories.

Turning to the transmission of Indian scientific texts to the Arabs, we must emphasize that we still know relatively little about this aspect of the translation movement. But we do know that the Arabs, as early as the beginning of the 9th century CE, possessed translations of important Sanskrit works on botany, pharmacology, and therapy, including the classical writings of the pre-Islamic Hindu physicians Sushruta, Charaka, and Vagbhata. Apart from providing the Arabs with a vast amount of practical knowledge, the Greek and Sanskrit texts thus translated also gave them, almost over night, a massive lexicon of technical terms. Incidentally, even the word for ‘pharmacy', as it is still used today in the Arab East, is of Sanskrit origin. There is a nice little anecdote in Arabic biographical literature involving the Abbasid caliph Harun al-Rashid, who is well-known also from the tales in the Arabian Nights. According to this story, Harun al-Rashid fell ill one day and none of his physicians was able to cure him; when somebody mentioned to him a famous Indian physician by the name of Mankah, the caliph dispatched an envoy to India to track him down, shower him with presents, and bring him to Baghdad; Mankah came, cured the caliph, and stayed on to translate Sanskrit medical and pharmacological writings into Persian and Arabic by commission [1].

As far as the Chinese influence on Arabic pharmacology is concerned, we have no records of any texts that would have been translated from Chinese into Arabic in the course of the translation movement. But there is ample evidence that the Arabs were in contact with the Chinese from at least the middle of the 8th century CE. The detailed geographical knowledge alone, which the Arabs had about China at the end of the 9th century CE, presupposes long-standing and well-established relations in more than one direction. Trade flourished, and both the land- and sea-routes between China and West Asia served the import and export of all kinds of goods, including medicinal drugs, and the exchange of medical knowledge. The early use of Chinese herbal medicine by Arab pharmacologists is well-attested already in manuals dating from the first half of the 9th century CE. There existed, around the year 800 CE, a sizeable Chinese community in Baghdad, made up of former prisoners of war who had decided to settle down in Iraq. But also in China itself things were not static. In his book entitled Miscellany of the Yu-Yang Mountain Cave, written in the year 860 CE, the Chinese scholar Tuan Ch'eng-shih recalls a discussion about medicinal drugs involving a Chinese, an Indian, and a Byzantine monk. In the year 923 CE, the Chinese botanist Li Hsün wrote a book entitled Medical Matters from the Countries beyond the Sea, in which he studied 121 medicinal drugs from the ‘West', that is Indo-Arabia, and made at least fifteen completely new entries to the Chinese lexicon.

Figure 3. Leaf from an Arabic translation of the Materia Medica of Dioscorides, dated 1224 CE in Iraq, preserved in the Metropolitan Museum of Art, New York. Source: http://www.metmuseum.org/toah/ho/07/wam/hob_57.51.21.htm.

And then there is this highly instructive and curiously overlooked account in Ibn al-Nadim's bibliographical work al-Fihrist [2], featuring the famous physician and alchemist Rhazes who lived in Baghdad for some time around the year 900 CE. In this account, Rhazes says: "A man from China came to seek me and lived with me for about one year. In five months of this time he learned to speak and write Arabic and developed a good understanding of the language. When he desired to return to his country, he said to me a month in advance, ‘I am about to leave and wish that someone would dictate to me the Arabic translation of the sixteen books of Galen, so that I can write them down'. I said, ‘Your time is short and you will not be able to copy more than a small part of it'. But the Chinese insisted, ‘Please devote yourself to me for the length of my stay and dictate to me as fast as you can – I will keep up with you in writing'. So I got some of my students to join in this project, and we dictated to him as fast as we could; but we did not have faith in the man until there was a chance for comparison and he showed us everything he had written. I questioned him about the matter and he said, ‘We have a form of shorthand known as grass-writing, which is what you see; if we need to write a great deal in a short time, we write it with this script; later, if we wish, we convert it into a script which is familiar and not abbreviated'. He thought that it takes 20 years to learn this". It is worth noting that the point of this story is not that a Chinese physician came to Baghdad around the year 900 CE, learned Arabic, and then wanted to take the books of Galen with him back to China – none of this was considered exceptional; what prompted the story is the possibility that anyone should be able to write that fast.

Figure 4. Sample from the Hyderabad edition of the Continens of Rhazes, showing a double column of a pharmacological table; the 'ideographs' are placed in the right-hand sides under the heading 'unknown', their common equivalents in the left-hand sides under the heading 'known'.

If we go a step further now and link this story to certain views which Rhazes held on the linguistic aspects of Arabic pharmacology, we will realize the full scale of intellectual exchange. In order to follow the plot one must remember that the Arabic script does not normally express vowels, that many consonants are only distinguished by little dots, and that an unusual word can therefore easily be misread and corrupted. When those Greek and Sanskrit pharmacological texts were translated into Arabic, it was found that a significant number of especially botanical terms had no equivalent in the Arabic language. So the translators decided to simply transliterate these terms, that is they replaced the letters of a foreign word by Arabic letters which roughly represented the same sounds. In the course of time, some of these new entries took on a specific and generally accepted form, but many escaped by constantly changing their forms under the hands of ignorant copyists, and began to lead an independent and for the specialist rather annoying existence – it was clear what they meant, but it was not at all clear how exactly they should be written and transmitted, let alone be pronounced. This is where Rhazes comes in again. In the 22nd volume of his medical encyclopedia known in the West by the title of Continens, Rhazes deals with precisely those awkward and elusive pharmacological terms [3]. He places them with all their variant forms in one column of a table, asserts their respective meanings in another column, and introduces this huge list by a brilliant suggestion, namely that these terms should neither be read nor pronounced at all but rather be treated as "pictorial images". A ghost-word thus becomes an ideograph, a symbol that represents the idea of a thing rather than its name – which is exactly the principle whereon the Chinese system of writing is based. Whether or not Rhazes got this flash of inspiration from his Chinese lodger is of course impossible to say, though I believe it is quite likely. In any case the true significance of Rhazes's move lies in the fact that with it he also anticipated by centuries the pharmaceutical system of generic naming.

End Notes
[1] See Manfred Ullmann, Die Medizin im Islam (Leiden-Köln 1970), p. 106 note 2.
[2] Ed. Gustav Flügel (Leipzig 1871), pp. 16ff.
[3] Ed. Hyderabad 1390H/1971, especially pp. 61-68.
* Dr. Oliver Kahl, Department of Middle Eastern Studies, School of Languages, Linguistics and Cultures, University of Manchester.

by: Dr. Oliver Kahl, Sun 06 May, 2007

Ophthalmology

2007-06-08T03:14:00.000-07:00

Eye Specialists in Islam

Dr Ibrahim Shaikhemail: info@fstc.co.uk

Professor J Hirschberg, a renowned German eye ophthalmologist, addressed the American Medical Association, California, on 11-14th July 1905. The subject of his work "Arab Ophthalmologists" or occulist. He began:

"I invite you... to go back with me 1000 years to consider the fascinating history of the Arabian Ophthalmology which I have studied in the past five years.

Two questions at first must be addressed:

What were the sources of information at the disposal of these Arab Ophthalmologists?

What is the contribution of the Arabian work in ophthalmology?

One of the outstanding classical works "Memorial of Ophthalmology" written by Ali Ibn Isa (1000 CE) was compiled from Greek material "The Ten Treatises of the Eye" of Galen and he added new knowledge." An eye specialist is known in Arabic as Al-Kahhal from the word Kuhl (Kollyre). Hirschberg considered this work to be as important as the contribution of the Muslims to the Mosque of Cordoba (Spain). The textbook of Kalifah (written around 1260 C.E) lists eighteen works on Ophthalmology. Muslims in just 250 years produced eighteen written works on ophthalmology. Whilst the Greek work from Hippocrates to Paulus, spanning one thousand years, produced only five books on this subject. In all there are some thirty ophthalmology textbooks produced by the Muslims. The most important of these were written by specialists and infact fourteen still exist today. Hirschberg then went on to mention some of the more notable names and gave an account of their work.

ALI IBN ISA

The most famous of all the occulists of Islam was born in Baghdad (Iraq). His work, "Tazkiratul-Kahhaleen" (Notebook of the Occulist), the best and most complete text book on diseases of the eye, was translated with commentary into German by Hirschberg and Lippert (1904) and into English by Casey Wood (1936). Isa's book was the most widely referred to textbook by later ophthalmologists. It was first translated into Persian and then into Latin and printed in Venice in 1497 C.E. Famous contemporaries of Isa Ibn Ali were Ammar Ibn Ali Al-Mosuli (see below) and Abul Hasan Ahmed Ibn Muhammad Al-Tabari who in his work "Kitab-ul Mu'Alaja-ul Buqratiyya" (Book of Hippocratic Treatment) says that he wrote a long treatise on diseases of the eye. Unfortunately this treatise is no longer available.

AMMAR IBN ALI AL-MOSULI

Ammar, from Mosul in Iraq, fluorished around 1010 C.E. He wrote a book entitled "Kitab-ul Muntakhab fi Ilaj-ul ‘Ayn" (Book of Choices in the Treatment of Eye Diseases) and practiced mainly in Egypt. His book deals with anatomy, pathology and describes six case histories for cataract operation and a case of optic neuritis! Hirschberg writes that Ammar was "The most clever eye surgeon of the whole Arabian Literature". Ammar discussed some 48-eye diseases in a short work of about 1500 words (the shortest work of its kind). This manuscript (No. 894) can be found in the Escorial Library in Madrid (Spain). Although shorter than the book of Isa Ibn Ali it contains many more original remarks and observations. Until the 20th century Ammar's work was only available in Arabic and a Hebrew translation made by Nathan the Jew in the 13th century. This work was translated into German by professor J Hirschberg in 1905. Ammar was the inventor of the cataract operation by suction, using a fine hollow needle inserted through the limbus (where the cornea joins the conjunctiva). This was the best-performed operation of its time. This type of cataract operation among others is still carried out today. The operation of "couching" i.e. violent displacement of the lens dates back to Babylonian times, but this had its obvious complications and risks. Ammar throughout his work, as a surgeon and researcher, never forgot that he was a Muslim first and scientist second. This is seen by his compassionate attitude towards his patients. On his travels he fulfilled his religious duties, visiting Medina and performing Hajj at Makkah.

ZARRINDAST (Gold Hand)

Abu Ruh Muhammad Ibn Mansur Bin Abdullah , otherwise known as Al-Jurjani, an excellent surgeon from Persia who fluorished around 1088 C.E., wrote a book, entitled "Nur-ul-'Ayun" (The Light of the Eyes). The book, much of which is original, was written during the reign of Sultan Malikshah and consists of ten chapters. In the seventh chapter he describes some 30-eye operations including 3 types of cataract operation. He also deals with anatomy and physiology of the eye and eye diseases. One chapter is devoted to eye diseases which can be seen such as cataract, trachoma, scleral and corneal diseases and problems of the eyelids. Another chapter deals with diseases that lie hidden (the signs are exhibited in the eye and vision but the cause may be elsewhere) i.e. 3rd nerve paralysis, blood disorders, toxicity etc. The book mentions curable and incurable diseases and gives methods of treatment. A large section is about surgery of the eye. There is section on drugs employed by the occulists.

Another name mentioned by Hirschberg in his address to the American Medical Association (1905) was Abu Muttarif from Seville (Spain) who flourished around the 11th century. Besides being an eye specialist he was also a Wazir. Unfortunately, his work is entirely lost.

AL-GHAFIQI

Muhammad Ibn Qassoum Ibn Aslam Al-Ghafiqi or simply known as Al-Ghafiqi (died 1165 C.E), also from Spain, wrote a book in the 12th century called "Al-Murshid fil Kuhl" (The Right Guide in Ophthalmology). The book is not just confined to the eye but gives details of the head and diseases of the brain. Al-Ghafiqi used Ammar's treatise as a reference for his work. Today a tourist visiting Cordoba can see the commemorated bust of Muhammad Al-Ghafiqi, a tribute paid from the people of Cordoba to an outstanding Muslim eye specialist. The bust with full Arab Ammama can be seen in the quadrangle of a municipal hospital in Cordoba, Spain. It was erected in 1965 to commemorate the eight hundredth anniversary of his death.

KALIFAH of Haleb

Kalifah Ibn Al-Mahasin of Allepo or Haleb (Syria) who flourished around 1260 CE wrote a book of 564 pages in which he describes and gives drawings of various surgical instruments including 36 instruments for eye surgery. He also discusses the visual pathways between the eye and the brain. He also writes about twelve kinds of cataract operations. The term for cataract in Arabic is Al-Ma' Nazul Ayn. Ma' means water or water descending onto the eye i.e. water accumulates in the lens and it becomes "soggy" thus making it cloudy. This cloudiness is sucked out by the use of hollow needle, thus the cataract is removed and the patient is once again able to see.

SALAHUDDIN

Salahuddin Ibn Yusuf from Hammah (Syria) in 1290 C.E. wrote a book called "The Light of the Eyes" in which he discussed new work on the optical theory of vision. He also quoted many extracts from Ammar's treatise. He did work on the eye from a more general medical point of view, as did other notables such as Az-Zahrawi, Ibn Zuhr and Ibn Rushd.

IBN HAITHAM

Ibn Haitham born in 965 C.E. was the first to explain that all vision was made possible because of refraction of light rays (see Islamic Banner issue no. 12 "Newton or Ibn Haitham"). The work of Ibn Haitham was repeated and expanded upon by a Persian by the name of KAMAL-UDDIN (died 1320 C.E) who observed the path of rays of light in the interior of a glass sphere in order to examine the refraction of sunlight in rain drops. This led him to an explanation of the genesis of primary and secondary rainbows.

"From 800-1300 C.E. the World of Islam produced not less than 60 renowned Eye Specialists or Occulists, authors of textbooks and producers of monographs in Ophthalmology. Meanwhile in Europe prior to the 12th century an Occulist was unheard of." Hirschberg

Professor J. Hirschberg told this to an enthralled audience at the American Medical Association. It was not until the 18th century that the method of removal of cataract by a hollow needle was employed in Europe.

The Muslims produced many original works on the anatomy of the eye. Their studies were, however, limited because they carried out their observations only on animal eyes. The dissection of any part of the human body was considered disrespectful in principle. These works give us the oldest pictures of the anatomy of the eye.

The original work of the Arabs includes the introduction of terms such as Eyeball, Conjunctiva, Cornea, Uvea and Retina. Muslims also did operations on diseases of the lids such as Trachoma, a hardening of the inside of the lid. Glaucoma (an increase in the intra-ocular pressure of the eye) under the name of "Headache of the pupil" was first described by an Arab. However, the greatest single contribution, in ophthalmology, by the Arabs was in the matter of cataracts.
According to the Journal of the American Medical Association (1935) there is, in the Vatican Library, a unique manuscript ascribed to Ibn Nafis, died in 1288 C.E (see Islamic Banner issue no.24 "Pulmonary Circulation") entitled "Kitab-ul Muhazzab fi Tibb-il ‘Ayn" (A Book of Corrections in the Medicine of the Eye). It contains a description of the eyes of animals and a discussion on the varieties and colours of the human eye. Ibn Nafis died in 1288 C.E.

Gerard of Cremona in Toledo (Spain) spent 40 years of his life (1147-1187 C.E.) translating the work of Muslims including the works of Ar-Razi and Ibn Sina. This fact has been attributed on a Spanish postal stamp. Arab physicians have been in the forefront of the effort to prevent blindness since 1000 C.E, when Ar-Razi became the first doctor to describe the reflex action of the pupil. At about the same time, Ammar Bin Ali Al-Mosuli invented the technique of suction removal of cataracts by the use of a hollow needle." (Optometry Today, publication of the Association of Optometrists, England, March 28, 1987)

Professor J Hirschberg concluded his address to the American Medical Association with the words:
"During this total darkness in medieval Europe they (the Arab Muslims) lighted and fed the lamps of our science (ophthalmology) - from the Guadalquivir (in Spain) to the Nile (in Egypt) and to the river Oxus (in Russia). They were the only masters of ophthalmology in medieval Europe." Professor J. Hirschberg.

So we can see from Hirschberg's work that the Muslim Ophthalmologists of the 10th-13th century were many hundreds of years ahead of their time.

by: Dr. Ibrahim Shaikh, Thu 20 December, 2001

Medical School

2007-06-08T02:43:00.000-07:00

Suleymaniye Medical Madrasa

Figure 1. General view of the medical school from the minaret of the Süleymaniye mosque. Source:

https://archnet.org/library/images/one-image.tcl?location_id=4395&image_id=62300&start=1&limit=9.

This short article is taken from the full article (by Dr. Salim Ayduz) which is available here as 16 page PDF file

The Süleymaniye Complex (kulliye), sponsored by Süleyman the Magnificent and built in Istanbul by the great architect Sinān (1489-1588) between 1550 and 1557, is the largest of the Ottoman building enterprises. It is functionally designed as a socio-religious centre with geometrically organised dependencies in the Ottoman Empire. It follows the example of the Fatih Complex, but architect Sinān made its architectural qualities vastly superior. The courtyard is surrounded by streets where there are schools (madrasas) for different levels of education, a medical school, a large hospital and other social buildings were set up on the slopes of the terrain. As for the architectural characteristics of the Medical Madrasa, we can begin by saying that it was planned as a component of the Süleymaniye Complex. Ottoman medicine reached a formal teaching institution with the Süleymaniye Medical School. Thus, this should be examined within the system of a multi-functional building complex. The Medical Madrasa, with a perpendicular plan, is composed of twelve domed-cells lined up on the shops in the Tiryakiler Street which is located in the south-western part of the Süleymaniye Mosque.

A physical relation existed between the Medical Madrasa and other components (public kitchen). A kind of division of labour shows itself with respect to these components. The medical students depending on the Madrasa used the cells as a dormitory, had meals cooked in the kitchen of imaret without paying, used the hospital Dār al-shifā for practicing the theoretical lessons they learned in the Medical Madrasa, received their medicine from the drugs house: Dār al-akakir, and after being cured in the hospital, they would stay in Tabhane for the period of convalescence.

The construction of this madrasa is considered to be a new stage in the history of Ottoman medical institutions. Unlike the previous traditional hospitals, which had medical education in their bodies, Süleymaniye was the first medical school in the Islamic civilisation to have a deed of trust (waqfiyya) mentioning its character as an institution for medical learning. The Medical school, which consisted of a section of the Süleymaniye complex and is described in the charter as "the good madrasa which will house the science of medicine", was the first medical school built by the Ottomans. The Medical Madrasa was established to train specialised physicians and occupied a very important place in the field of Ottoman medical education in terms of medical specialisation. Medical education, which had previously taken place in hospitals, acquired an independent institutional structure with the founding of this school. The entrance to the medical school, which is located across from the hospital of which only the south-western wing has survived to this day, opens out onto Tiryâkiler Market. The north-eastern wing of the structure is located above the arches and shops of the market.

Süleymaniye Medical Madrasa was the first institution which was built next to Dār al-Shifā in Istanbul. Süleyman the Magnificent ordered the establishment of a medical madrasa in his complex to educate highly skilled physicians for both the public and army needs.

The Medical Madrasa and the Dār al-shifā buildings as a component of the complex were built side-by-side to provide both a medical education and a public health service. This is very similar to contemporary university hospitals. In the complex, which was based on a very large area, Sinān had planned at one corner for medical education and a health site and put them on a parallel axis by two rectangular courtyards with a separate block.

The idea of two buildings together, a Medical Madrasa and the Dār al-shifā, is considered superior in application and was ahead of its time. The medical student after having a theory lesson would go to the Dār al-shifā straight away to put into practice what he had learned. Hence, the Süleymaniye Medical School and Dār al-shifā had a very important place in the history of medical education and its application to a hospital.

Staff of the Medical Madrasa

According to the deed of the complex the Medical Madrasa had a very basic and small staff. One Muderris (lecturer), eight danismends (student) and three auxiliary staff who are noktaci (assistant), bevvab (door keeper) and ferrash (cleaner) were assigned. There was a muderris as head of the madrasa, just as the other madrasas. However, there were some special conditions for a muderris of a medical madrasa, they had to be well educated on the medical sciences and be able to direct the students through the medical sciences.

The first teacher at the Süleymaniye Medical School was Tabib Ahmed Çelebi b. İsa Çelebi who received sixty akças per day. Although the deed mentioned the daily wage of the muderris was twenty akças per day, he was receiving a higher salary due to his level of skills in medicine.

Some of the Medical Madrasa muderrisses were appointed to other medical institutions as a shagird. As we see from the documents, some famous physicians were appointed at the medical madrasas as muderris, such as chief physician Büyük Hayatizâde Mustafa Feyzi, Ayasli Saban Sifai, chief physician Ömer Efendi and chief physician Gevrekzâde Hasan Efendi.

Figure 2. The Süleymaniye medical school and its garden.

The Education at the Medical Madrasa

Although we have no sources available that fully explain the teaching and the educational methods followed in the Süleymaniye Medical Madrasa, it is understood from its deed that the constitutions for courts and madrasas (ilmiye kanunnameleri) and primary sources belonging to the classical period (1300-1600) was formerly taught and carried out in terms of the master-apprentice method. This practical method used also to be popular among other medical and social institutions such as the trade market system and ahl-i hiraf (artisans) organizations. This system was also common before the Ottomans in the Seljuk period. The textbooks used in the Süleymaniye Medical Madrasa are only generally mentioned in the deeds and other sources.

They were teaching the famous medical text books at the Medical Madrasa. Although the deed does not mention the names of the textbooks, we do have a list of books which were given to the head physician to teach. In the list we find sixty-six famous medical books of which eighteen were written by Ibn Sīnā. Although there is no indication that these books were given for Medical Madrasa teaching purpose, we can say that at that time these books were circulating between physicians for educational purposes. On the other hand, according to the deeds, courses on logic (ilm-i mizan), medicine (ilm-i abdan) and rational sciences (fenn-i hikmet, ulum-i akliye) were also somehow taught at the School.

In the deeds, there is no clear statement about the days and hours of the courses. In general, we know that Süleyman the Magnificent stipulated the teaching of five courses a day on four weekdays. It is thought that pre-Ottoman practices were followed by taking Tuesday, Thursday, and Friday as holidays. Festival days were also holidays and the rest was for teaching. But these holidays could be decreased accordingly.

There is no exact information how many years medical education lasted at this madrasa. Ahmed b. İbrahim, who is the author of Tashil al-tadâbir, mentioned that he himself graduated at the Süleymaniye Medical School after fifteen years and then became a physician at the palace. From his case, we understand that the educational process was very long. Most of the physicians appointed to the palace as a palace physician were selected from amongst physicians who graduated at the Süleymaniye Medical School, and of course suitability was a very important point for appointments.

Abbé Toderini, who lived between 1781 and 1786 in Istanbul, provides information on the teaching method in the Medical Madrasa of Süleymaniye in a chapter of his famous book De La Littérature Des Turcs. According to Toderini, Turkish medical lecturers taught courses in general pathology and surgery in Süleymaniye for four days of the week. In addition to medical students, the courses were open to those who wished to attend. There was no barrier to francs (Europeans) attending these courses. Ubezio, a European physician, said that he followed the courses many times as a listener. The teaching method consisted of reading medical books, studying diseases and medicines through clinical observations and benefiting from physicians' knowledge and advice.

The Süleymaniye Medical School offered medical education for about three centuries and was the institution which provided doctors for almost all the Ottoman medical institutions, and mostly for the Fatih Hospital in Istanbul. The Süleymaniye Medical Madrasa's graduates or students such as Osman Saib Efendi, Abdülhak Molla and Mustafa Behçet Efendi were among the founders and teachers of the modern medical school in 1827. Thus, they pioneered the modernising of medical education in Turkey.

The School most likely continued to train students until the middle of the nineteenth century, until, that is, sometime after the new medical school (tibbiye) opened. The founders of the Tibbiye in Istanbul (1827) composed the staff of the Medical Madrasa. After the Second Constitutional Period (II. Mesrutiyet), the Süleymaniye Madrasa was included in the body of "Dâru'l-hilafeti'l-aliyye Medresesi" which was planned to assemble all the madrasas of Istanbul under one roof. It is understood that the Medical Madrasa was out of use and needed restoration during the year 1914. It also seems that on 21 December 1918, this madrasa was used by people who had lost their homes during a fire. Since 1946, after a full restoration, the building was used as a Maternity Clinic (Süleymaniye Dogum ve Çocuk Bakimevi).

by: FSTC Limited, Sat 03 February, 2007

Medical History

2007-06-07T05:54:00.000-07:00

The Book of Water (Kitab Al-Ma'a)
Kitab Al-Ma'a (The Book of Water) appears to be a strange title for the first known Encyclopedia of Medicine arranged according to the alphabet.

It was recently discovered in Algeria and published in Oman.
The author's apparent reason for naming the book as Kitab Al-Ma'a was because the word Al-Ma'a (the water) appears first in the book.

The author was Abu Mohammed Abdellah Ibn Mohammed Al-Azdi, known as Ibno Al-Thahabi, (died 1033 AD, 466 AH) in Valencia, Muslim Spain.

He was actually born in the city of Suhar, Oman. He moved into Basra then to Persia where he studied under Al-Biruni and Ibn Sina. Later he migrated to Bait Al-Maqdis (Jerusalem) and finally settled in Valencia.

The manuscript contains about nine hundred pages. Under each letter of the alphabet, there are names of an illness, a medicine, a physiological process or a treatment This is the first known alphabetical classification of medical terms. In this encyclopedia, Ibn Al-Thahabi not only lists the names but adds numerous original ideas about the function of the human organs. Indeed, he explains an original idea of how the vision takes place. He described how seeing is a process of an image which goes through the pupil of the eye and strikes the vision nerves. The brain, then, unifies the two images into one and stores it in its memory bank. Such explanation resembles the vision theory of Ibn Al-Haitham who died in 1040, just 33 years before the death of Ibn Al-Thahabi. However, it is not certain whether they met or were aware of each other's work.

The book contains treatment, usually herbal, of a vast number of ailments and diseases. It also contains a course for the treatment psychological symptoms. The main thesis of his medication is that cure must start from controlled food and exercise and if it persists then use specific individual medicines if it still persists then use medical compounds.

The manuscript has recently been edited by Dr. Hadi Hamoudi and published by the Ministry of National Heritage and Culture, Oman, 1996.

by: FSTC Limited, Fri 17 January, 2003

Medical History

2007-06-07T05:36:00.000-07:00

Muslim Contribution to Cosmetics

In Muslim Spain, Andalusia, in the city of Cordoba lived the famous physician and surgeon, Al-Zahrawi (936-1013 CE), Latinized Albucassis.

He wrote a monumental work, a medical encyclopaedia entitled Al-Tasreef, in 30 volumes, which was translated into Latin and used as the main medical textbook in most Universities of Europe from the 12th-17th century. This book influenced many authors in the East and in Europe.

In the 19th volume of Al-Tasreef a chapter was devoted completely to cosmetics and is the first original Muslim work in cosmetology.

Zahrawi's contribution in medicated cosmetics include under-arm deodorants, hair removing sticks and hand lotions. Hair dyes are mentioned turning blond hair to black and hair care is included, even for correcting kinky or curly hair. He even mentioned the benefits of suntan lotions, describing their ingredients in detail.

For bad breath resulting from eating onions and garlic he suggested cinnamon, nutmeg, cardamom and chewing on coriander leaves. Another remedy for bad breath was fried cheese in olive oil seasoned with powdered cloves.

In the book he also included methods for strengthening the gums and bleaching the teeth.
Zahrawi considered cosmetics a definite branch of medication (Adwiyat Al-Zinah). He deals with perfumes, scented aromatics and incense. There were perfumed stocks rolled and pressed in special moulds, perhaps the earliest antecedents of present day lipsticks and solid deodorants. He used oily substances called Adhan for medication and beautification. There are many a Hadith of the Prophet (pbuh) which refer to cleanliness, management of dress, and care of hair and body. On this basis Zahrawi described the care and beautification of hair, skin, teeth and other parts of the body, all within the boundaries of Islam.

Towards the medicaments, he recommend "Ghawali and Lafayfe" for epileptic fits and "Muthallaathat", prepared from camphor, musk and honey, in fact very much like Vicks Vapour Rub, for the treatment of cold relief. Other utilities which we tend to consider as part of the twentieth century but which were present in Muslim Spain and which are described by Zahrawi include nasal sprays, mouth washes and hand creams.

Zahrawi even suggested keeping cloths in an incense filled rook so that they would have a pleasant fragrance for the wearer. These days the same is achieved by detergents and washing powders and conditioners such as "Lenor".

The tradition of taking flowers for the sick in hospital is not a recent social trend because Zahrawi advocated this custom a thousand years ago.

Such was the civilization of Muslim Spain (Andalusia) when Cordoba boasted 600 mosques, 300 public baths, 50 hospitals, 70 public libraries and well lit streets. In contrast the rest of Europe was dark, dirty (bathing was seldom enjoyed by the majority) and without education. Islamic rule in Spain lasted 800 years (711-1492 CE) producing the most glorious period of prosperity, law and order, progress in science and technology and a civilisation which was the envy of all Europe.

In 1887 Stanley Lane Poole in his book "The Moors in Spain" paid tribute to the Muslims with the following words:
"The Moors were banished; for a while Christian Spain shone, like the moon, with a borrowed light; then came the eclipse and in that darkness Spain has grovelled ever since." Stanley Lane Poole

There is a street in Cordoba in tribute to Al-Zahrawi named "Calle Albucasis" - the street of Abul Qasim or Al-Zahrawi. House number 6 is preserved today by the Spanish Tourist Board. A bronze plaque, awarded in January 1977 reads: "This was the house where lived Abul-Qasim."
Further reading:1- Bulletin of the History of Medicine, Baltimore (1965).2- Spanish Islam - R Dozy3- Moorish Culture in Spain - Titus Burckhardt (1972) George Allen & Unwin, London.

by: FSTC Limited, Tue 20 May, 2003

Medical History

2007-06-07T05:30:00.000-07:00

Arabic Medicine in the Mediteranean

The physician Razi (circa 865-925 C.E.) at the bedside of a young patient afflicted with measles.
by Charles Burnett Professor of the History of Islamic Influences in EuropeWarburg InstituteUniversity of London

In spite of differences of religion and language, a single scientific culture can be found throughout the Mediterranean region from at least the period of the Roman Empire until the early modern period. This culture was developed by the Greeks (who themselves owed much to the Egyptians, the Mesopotamian civilisations and the Indians), partly committed to Latin in Antiquity, but more comprehensively translated into Syriac and Arabic from the seventh century onwards; from the late tenth century onwards the slender threads of ancient science in Latin began to be woven into the rich fabric of Arabic science, so that, by the mid-thirteenth century, Latin culture in Europe enjoyed the same level of sophistication as Arabic culture in the Islamic world and relied on the same authorities: the Greek classics of arithmetic (Nicomachus), geometry (Euclid), astronomy (Ptolemy), astrology (again Ptolemy, but also Dorotheus and Vettius Valens), and medicine (Hippocrates and Galen), as well as the Arabic masters in arithmetic, algebra and trigonometry (al-Khwarizmi and Abu Kamil), in astronomy (again al-Khwarizmi, al-Battani, and az-Zarqali), astrology (Abu Ma‘shar and numerous others) and medicine (Hunayn ibn Ishaq, Ishaq al-Isra'ili, Ibn al-Jazzar, az-Zahrawi, and, again, numerous others). Moreover, through the spreading of Islam to Persia, Central Asia, the Indian subcontinent and beyond, the same scientific culture embraced an area far wider than the Mediterranean basin. Thus, a work written by an astronomer in Morocco in the thirteenth century can be found copied in a manuscript in Hyderabad. A `philosopher' at the court of Frederick II in Sicily, originating from Antioch, was trained in medicine and philosophy in Mosul and Baghdad, and served the Turkish Seljuks of Rum and the Armenian regent before coming to Western Europe. A scholar writing a philosophical work in Greek, also in Sicily in the thirteenth century, could use a Latin translation of a commentary on Aristotle by the Arabic Ibn Rushd, etc.

The history of this culture in respect to medicine can be summarised briefly. Ancient Greek medicine culminated in the work of Galen (who wrote in Greek in Rome in the second century CE). His works, several of which are commentaries on those of Hipppocrates of Kos, fill 39 volumes in their modern edition, but a selection of 16 of them was made for teaching medicine in Alexandria in late Antiquity. Greek medical centres flourished in Rome, Constantinople, Antioch, Edessa and Amida, and even spread into the Sassanid kingdom of Persia. After the rise of Islam, it was from one of these Persian centres, Gundishapur in southwest Iran, that, according to a well-known story of the time, a Nestorian Christian doctor called Jurjis ibn Jibra'il ibn Bakhtishu‘, came to Baghdad in the third quarter of the eighth century, and introduced Greek medicine to the caliph there. But other Syriac Christian communities within the Islamic caliphate were also sources for this medical knowledge. In the early ninth century, a ‘house of wisdom' was founded in Baghdad, as a library and a centre for the translation of scientific texts. It is here that Hunayn ibn Ishaq, another Nestorian Christian, translated into Syriac or Arabic a vast number of Greek texts, including (of Galen's works) some 95 into Syriac, and 34 into Arabic. (His son Ishaq ibn Hunayn, and his nephew Hubaysh, rendered the remaining Syriac texts into Arabic.) But Galen was not the only source of Arabic medicine: another Christian, Ali ibn Sahl Rabban al-Tabari, included a chapter on Indian medicine in his book The Paradise of Wisdom, written in 850.

Some who were concerned at the danger of the faith shown in Greek science generally as threatening Islam, established a ‘medicine of the Prophet', based on the sayings of Muhammad, and indigenous Arabic medical lore. However, the Galenic tradition became the main source of medical learning, and the great Arabic and Muslim medical writers belonged to it: Abu Bakr Muhammad ibn Zakariya al-Razi (865-925), Ali ibn al-‘Abbas al-Majusi (tenth century), and above all, Abu ‘Ali al-Husayn ibn ‘Abdallah Ibn Sina (Avicenna, d. 1037). These scholars and practitioners wrote their main works in Arabic, but by origin were Persian, and we can deduce from the name of al-Majusi that he came from a Zoroastrian family. During the eleventh century an important medical centre developed in Qayrouan in present-day Tunisia, and it is from here that a certain `Constantine the African' travelled to nearby Sicily and Salerno in Southern Italy in the third quarter of the eleventh century and introduced Arabic medicine to the West for the first time. In Salerno there was already a school of medicine, where a few Greek medical texts, mainly of a practical nature, were known in Latin translations. Constantine complemented, and a to a large extant, replaced these texts with his translation of the comprehensive medical textbook of al-Majusi, and several texts by the Qayrouanese doctors, Ishaq Isra'ili, Ishaq ibn ‘Imran, and Ibn al-Jazzar. In this context a short curriculum of five texts on medicine was established, called the Articella, which was based on translations from both Arabic and Greek, and included texts on determining medical conditions by examining urine and by feeling the pulse, respectively. Constantine's work was, in turn, complemented by the activity of Gerard of Cremona in Toledo (d. 1187) in the mid-twelfth century, who translated from Arabic several of the texts of Galen from the Alexandrian curriculum, as well as substantial works by al-Razi and the Spanish-Arabic authors, al-Zahrawi and Ibn al-Wafid. His most important contribution, however, was the translation of Avicenna's Canon of Medicine, which became the main textbook for medical education in Western universities until well into the seventeenth century.

What was the nature of this medicine? Avicenna gives the classical definition at the beginning of his Canon: ‘I say that medicine is a science in which one learns of the states of the human body with respect to what is healthy and what deviates from it, for the purpose of preserving health when it already exists, and restoring it when it has been lost.' The basis of this medicine was ‘humoral pathology', i.e. an understanding that the human body consisted of four humours: blood, yellow bile (choler), phlegm, and black bile (melancholy), which were related to other `quaterneries': the elements air, fire, earth and water; the seasons spring, summer, autumn and winter; the ages of man, childhood, youth, middle age and old age; and the triplicities of the signs of the zodiac. Good health depended on the four humours being well-balanced in respect to each other (the Greek term is ‘eukrasia' – a ‘good mixing', ‘temperament' or ‘complexion'). According to an account (reported, for example, by Petrus Alfonsi, the Arabic-educated Christian convert from Judaism in the early twelfth century), Adam was created with a perfect balance of the four humours. Galen, however, believed that each man had an individual complexion, determined by his nature and age, and by external factors such as the climate. Hence each person had a `temperament' which affected both his character and his health, and could be described as sanguine, choleric, phlegmatic or melancholic. The aim of medicine was to preserve the best temperament for each man, and to restore the balance of the humours when one or other became excessively strong or weak. For the first, comprehensive works on `diets' and `regimina sanitatis' (i.e. healthy living practices) were compiled, the best known being that of Ishaq Isra'ili, in which different `diets' are prescribed according to the temperament of the man, his age, the climate, the time of year, etc. For the second, it was necessary either to drain off or burn off the excessive humour (by `blood-letting' or `cautery' respectively), or to counteract the deficiency of one humour by prescribing medicines rich in the opposite one. Since each humour was conceived in terms of an element with two qualities (e.g. melancholy was earth, consisting of the cold and the dry), one used medicines which had the requisite complementary qualities. Thus plants, minerals, seeds, `waters' and the other `simple medicines' were described in terms of how hot, cold, dry and moist they were. For each quality there were four degrees, and these are listed in textbooks called `books of simples' or ‘of degrees'. For example, Ibn al-Jazzar (in a work translated by Constantine the African as ‘Liber de gradibus') writes that: `Aloes wood is hot and dry. both in the second degree: it strengthens the brain and all the interior parts of the body. It drives out superfluous moisture from the body, and especially dissolves ‘windiness' in the stomach (i.e. flatulence). It stops diarrhoea and attacks incontinence which results from coldness and weakness of the bladder'[1] .

The origin of this classification by ‘degrees', which is fully developed in Galen, is not clear. In Arabic medicine, however, the system is extended much further, probably under Indian influence. First, foods become classified under one of eight `tastes', each of which is associated with two qualities (e.g. sweet is hot-moist, and therefore associated with air and blood). Thus, the qualities of different foodstuffs can be gauged by tasting them. This leads some writers to say that taste is, in fact, the most dependable of the five senses, because it alone discerns the true nature of a substance. (Arabic doctors may owe their systematization of the tastes to Indian medicine, although the number of tastes for the Indians is six;[2] ) This classification is extended to the planets and to the signs of the zodiac, so that Jupiter is described as sweet and Mars, bitter; the triplicity of Aries is bitter, while, of the individual signs in the triplicity, Aries is hot in the second degree and dry in the first, Leo is hot and dry in the fourth degree and Sagittarius is hot in the first degree, and dry in the second.[3] The right amount of the relevant qualities can also be obtained by combining several different ingredients, in `compound medicines' or `theriacs' (the origin of our word ‘treacle'), which also formed a genre of medical literature.

Constantine the African, in the preface to his translation of al-Majusi, regards medicine as belonging as much to ethics as to natural science and logic/metaphysics (the two other divisions of secular science current in his day). In the same work, he translates al-Majusi's version of the ancient Hippocratic oath, of which some phrases may be given here: ‘Whoever a master undertakes to educate (in medicine), should be of good character and should in turn teach others, without payment.… aim should be to restore the health of the patient, and he should not do this in the hope of earning money, nor should he pay more attention to wealthy patients than to poor ones, or to the noble rather than the ignoble. He should not include harmful potions in his teaching, nor allow his pupils to do so, lest any lay person might overhear the lesson and mix a deadly potion on his own accord. Nor should he teach how to cause an abortion. When he visits the patient he should not pay amorous attentions to the wife (of the patient) or his maid or daughter… He should avoid overindulgence; he should beware of the delights of this world, including alcohol. Such things disturb the mind and strengthen the vices of the body… He should be god-fearing, humble, kind, and loving, and should seek to be helped by divine aid'.

A more basic ethical dimension, however, is intrinsic to Arabic medicine in itself. As I have already indicated, the complexions also determined the character of the individual--whether he is sanguine, melancholy etc.--and the whole idea of balancing the humours by avoiding excesses has a moral tone. But above all, this kind of medicine can be seen as encompassing both the body and the soul. Galen wrote a separate text on `how the nature of the soul follows the complexion of the body', and many symptoms that we might today characterise as emotional states, such as ‘love sickness' and `melancholy', were classified along with physical diseases. Correspondingly, therapies included pleasant recreations, and, especially, music.

Music

In certain texts `spiritual diseases' were separated from `bodily diseases'.[4] Thus al-Razi added to the book of medicine that he composed for his patron, Abu Salih al-Mansur, governor of Rayy, another book `on spiritual medicine' (al-tibb al-ruhani), which he begins as follows:
"Now that I have finished describing physical remedies, I am going to mention spiritual ones. Know that mental diseases are also amenable to treatment. But their treatment is carried out by means of musical instruments which convey to the soul through the sense of hearing the harmonious sounds which are created by the motions and contacts of the heavenly spheres in their natural motion, which affect the right perceptions…"

The Greek doctor, Rufus of Ephesus, dedicated a whole text to cures for melancholy, of which fragments have survived mainly in Arabic medical works. As a sample one may quote the following passage from Ibn al-Jazzar's Guide to the Traveller (Viaticum):

In the case of sickness caused by excessive love, to prevent men from being submerged in excessive brooding, tempered and fragrant wine should be offered, and hearing various kinds of music and speaking with dear friends (should be encouraged)… Rufus says: "Sadness is taken away not only by wine drunk in moderation, but also by other things like it, such as a temperate bath. Hence it is that, when certain people enter a bath, they are inspired to sing. Therefore, certain philosophers say that the sound is like the spirit, the wine is like the body, of which the one is aided by the other." Others say that Orpheus said: "Emperors invited me to feasts so that they might take their pleasure from me, but I am, rather, delighted by them, since I can turn their spirits in whatever direction I want to, for example from anger to gentleness, from sadness to happiness, from greed to generosity, from fear to boldness". This is the application of musical instruments and wine in respect to the health of the soul'.

In the Arabic world, the effects of music were made into a science of music therapy. The various `modes' (called maqamat) out of which melodies were composed, which differed by both rhythmic and melodic patterns, were brought into line with the humoral quaterneries that I have already described. At the simplest level `cold' maqamat could be used for refreshing patients during the day, while ‘hot' maqamat were appropriate to the evening and at night-time.

But more detailed combinations were devised: e.g. al-Kindi, the ninth-century ‘philosopher of the Arabs', assigned 12 maqamat to the twelve signs of the zodiac, with which they shared the corresponding elemental qualities. He extended the analogy further: the ratios which create musical harmony would have the same effects as the aspects of the planets, one to another, in the sky. A tenth-century writer, Ibn Hindu, describes how these theories should be put into practice:

`There is a maqam which arouses sadness, another which brings joy, one relaxing and tranquilizing, another disquieting and exciting, one which keeps one awake, another which induces sleep. Whenever we order those who suffer from melancholy to be treated with the respective modes, it helps them. The physician need not himself be a performer of the drum, the flute or the dance, just as he does not need to be a pharmacist or a phlebotomist, but rather he employs these people to aid him in his therapy.'

In the mid seventeenth century the Turkish sultan Bayezit is described as employing ten musicians for the cure of the sick, to strengthen the spirit of the mentally ill, and to reduce black bile. Three of them were singers, the rest were instrumentalists who played the flute, violin, flageolet, cymbals, harp and lute. They came three times a week and played a piece for the ill, whereupon many of them felt relieved. They understood most of the maqamat. When the maqamat Rast, Busalik and Zankula were played, they instilled life in the patients. He ends by saying that `all instruments and all maqamat provide nourishment for the soul.'

As in the classification of tastes, so in that of maqamat the Indians provide a close parallel in their doctrine of raga. Both could have influenced Arabic mentalities at the time when Indian astronomers arrived in Baghdad with texts on astronomical tables and astrology in the late eighth century.

Balance of Mind, Body and Spirit

I emphasize the role of music and astrology to underline the holistic nature of Arabic medicine. The balance within a human being depended on the balance within the natural world surrounding him, and the harmony within his body and soul (as the microcosm) reflected the harmonies of the universe as whole (the macrocosm) whether viewed in terms of the regular movements of the heavenly bodies, or in terms of the laws of musical harmony. It is quite apt, in this case, that one of the principal translators of Arabic texts in the mid-twelfth century, Hermann of Carinthia, should end his own cosmology (the De essentiis) with a description of man in the following terms:

"(God) fitted man into a certain miniature pattern through the agency of the consonant choruses of the Muses, following the example of the heavenly harmony, whose leading movements, by their perpetual guidance, would temper the modes of this related music in man's body and soul."
I would like to end my talk by describing al-Majusi's account of the spirit in man—i.e. the entity that is affected by music.[5] The Arabic doctor provides, in a succinct form, the common view expressed in Arabic medicine and its Latin derivatives as a whole. ‘Spirit' is a corporeal substance that is divided into three parts. The first is the `natural spirit': it arises in the liver, and facilitates the natural processes of growth, digestion etc. The second is the `vital spirit': it arises in the heart and facilitates the natural movements of breathing and sensation. This `vital spirit' rises from the heart through the carotid veins in the neck into the head, becoming progressively purer as it rises and as it is `sieved' by the `rete mirabile' (a latticework of nerves) at the base of the brain. (Its impurities are expelled through the mucus of the nostrils). By the time it has reached the brain it has become an extremely subtle body, but remains corporeal. Here it has different functions in different parts of the brain. In the forepart it gathers together all the sensations and forms images of them. These it passes to the middle part of the brain, where it brings reason to bear on these images. Then it either produces action as a result of this application of reason, or it saves the considered images in the back part of the brain, as memories. (Al-Majusi goes on to say that there is a small opening in the partition between the middle and back part of the brain, which is covered by a worm-like object. When one wishes to remember something one bows one's head so that this cover opens and lets the memory through). At this point al-Majusi asks whether the spirit in the brain is the soul, as many say. If this is so (as al-Majusi is inclined to believe), then, since the spirit is corporeal, the soul also is corporeal. Soul and body form one continuum, of which the spirit/soul is at the most refined end. Now, this way of looking at the soul caused great problems when Arabic medicine was introduced into the Christian West. For Christians believed that the soul was a distinct entity from the body: it survived as an individual after the body, and was capable of experiencing punishment or reward. Several texts were written from the early twelfth century onwards to try to reconcile these two positions, and in the end, at least in popular opinion, the idea of the separate entity of an immortal soul prevailed. But it is worth remembering that, in Arabic medicine, and consequently for many centuries in Western medicine too, through the idea of `spirit', the body and the soul were linked as closely as they are several forms of Eastern medicine.

[1] Mary Wack, in Constantine the African and ‘Ali ibn al-‘Abbas al-Magusi : The Pantegniand Related Texts, eds C. Burnett and D. Jacquart, Leiden, 1994, p. 177.
[2] See D. Wujastyk, `The Combinatorics of Tastes and Humours in Classical Indian Medicine and Mathematics', Journal of Indian Philosophy, 28, 2000, pp. 479-95.
[3] Pseudo-Galen, De spermate, and glosses in Oxford, Bodleian Library, Bodley 463.
[4] For further details concerning the following account of music therapy see C. Burnett, ‘‘"Spiritual Medicine": Music and Healing in Islam and its Influence in Western Medicine', in Musical Healing in Cultural Contexts, ed. P. Gouk, Aldershot, 2000, pp. 85–91, and C. Bürgel, The Feather of the Simurgh, pp. nos.
[5] The following paragraph takes information from C. Burnett, ‘The Chapter on the Spirits in the Pantegni of Constantine the African', in Constantine the African and ‘Ali ibn al-‘Abbas al-Magusi : The Pantegniand Related Texts, eds C. Burnett and D. Jacquart, Leiden, 1994, pp. 99–120.

by: Prof. Charles Burnett, Mon 29 November, 2004

Medical History

2007-06-07T05:11:00.000-07:00

Ibn al-Nafis and Vinegar

I was in the Library of the great Mosque in al-Medina al-Munawara (the Illuminated city) during my visit to Saudi Arabia for hajj (pilgrimage) when I came across a book called Al-Mujaz fi Al-Tibb [1] (A Summary of Medicine). I must admit that although I had been in the profession of medicine for more than 14 years and with my Arabic and Islamic background, that this was the first time I had examined an old Arabic Islamic manuscript which dealt with the subject of medicine.

The book, which is about 500 pages, was written in Arabic yet I could not comprehend what I was reading for I had studied medicine at the medical school of Benghazi, Libya, where the subject was taught in English. Arabic for me was for poetry. Undeterred I moved to the index at the back of the book, looking for anything related to my speciality field of Ear, Nose, and Throat Surgery (Otolaryngology). There was a chapter dealing with discharging the ear or what is called Otorrhea in medical terminology. Ibn Al-Nafis was describing different preparations and remedies which I could not fully grasp but vinegar was one I immediately recognised. Memory took me immediately back to Dublin where I did my Ear Surgery training. I remembered a day when one of my fellow Irish colleagues came out with the idea of using vinegar to irrigate the external ear for a condition called Otitis externa where there was discharge and irritation within the external ear canal. He did not claim the discovery for himself. He knew at that stage that using vinegar was an old remedy but he was not clear about the historical background.

Ibn Al-Nafis

Born in Damascus [2] as Ala-al-Din Abu al-Hasan Ali Ibn Abi al-Hazm al-Qarshi al-Damashqi al-Misri in 1213, Ibn Al-Nafis became famous for his important discovery of the lesser blood circulation, known as the pulmonary circulation. He also described the heart muscle's own circulation known as the Coronary arteries. He said, "The nourishment of the heart is from the blood that goes through the vessels that permeate the body of the heart." Ibn Al-Nafis left for Cairo where he started work in the Nisaria Hospital and became the dean of the Muntaseria Medical School. His work on the anatomy of the heart and circulation was only acknowledged and credited to him in the 20th Century.

This is similar to our current story about the treatment of outer ear infection using vinegar. The use of such old remedies in the modern day treatment of diseases should always be ascribed to its first describer. Ibn Al-Nafis was describing a condition similar in its symptoms and signs to outer ear canal infection (otitis externa)[3], the ear was painful and tender, slightly swollen and producing a smelly coloured discharge. His patient had a degree of hearing impairment. The vinegar was mixed with some milk and almond paste, and slightly heated before it was introduced drop by drop into the ear canal. In another manuscript he described treating a discharging divided ear with a mix of vinegar and opiates from a poppy for the pain. In that section he divided the condition into an early stage, what we call nowadays acute and later stage known as chronic [4]. This is exactly similar to modern day classification of ear diseases.
Ibn Al-Nafis wrote several books. His best-known work is Mujaz Al-Qanun which was an explanatory and complementary book to Avicenna's Al-Qanun book. Ibn Al-Nafis died in Egypt in 1288 CE.

Modern Medicine

I do not think that Ibn Al-Nafis would know that vinegar works by restoring and maintaining a low pH and hence an acidic environment which is not suitable for bacteria and fungus growth [5]. In his days, microorganisms like bacteria had not been discovered yet. Treatment was based on careful observation and trials.

Today vinegar is administered either as a diluted solution alone or as a salt in combination with antibiotics and mild local steroids. There are more preventive roles for vinegar in ear disease [6]. People with the risk of developing this condition, like swimmers, are advised to prophylactically use a home remedy of white vinegar, 70% isopropyl alcohol and water [7]. One to two drops in the ear canal are used after exposure.

Vinegar

Vinegar can be prepared from any material containing sugar. There are two stages in this process. The first is to utilise yeast, this is called alcoholic fermentation. The second is acidic fermentation which utilises bacteria called acetobacter hence the name acetic acid. Ibn Al-Nafis explained the contents of vinegar in very simple words [8] describing its chemical components with the limited chemistry knowledge of those days. He prescribed vinegar to a long list of diseases ranging from digestion difficulty to skin abnormality Hence there are many beneficial uses for vinegar.

Notes
[1] Al-Mujaz fi Al-Tibb, Ibn Al-Nafis, Edited by Dr Ahmed Amaer, 1st edation Al Ahram Press, Cairo 1986.
[2] Al- Saidalia Al- Mujerba, Ibn Al-Nafis, Edited by Muhsen Agail, Dar Al Mahagea Al Bida, Beirut- Lebanon. 2002.
[3] Ibid.
[4] Ibid.
[5] The evolving role of ototopical therapy, E Mark, Current opinion in otolaryngology,8(6), 454-457, 2000.
[6] Letter, Isaacson, The pediatric infectious disease journal, 22(8). 759-760. Aug 2003.
[7] T Davidson, Managing Inflammatory Ear Conditions, , the physician and sport medicine, 22(8). 56-60. Aug 1994.
[8] Al- Saidalia Al- Mujerba, Ibn Al-Nafis, op.cit.

References

Davidson, T., 'Managing Inflammatory Ear Conditions', The Physician and Sport Medicine, 22(8). 56-60. Aug 1994.
Letter, Isaacson, The pediatric infectious disease journal, 22(8). 759-760. Aug 2003.
Mark, E, 'The evolving role of ototopical therapy', Current Opinion in Otolaryngology, 8(6), 454-457, 2000.
Ahmed Amaer (ed.), 'Al-Mujaz fi Al-Tibb', Ibn Al-Nafis, 1st edation Al Ahram Press, Cairo 1986.
Muhsen Agail(ed.), 'Al- Saidalia Al- Mujerba', Ibn Al-Nafis, Dar Al Mahagea Al Bida, Beirut- Lebanon. 2002.

by: Mohamed Hussein Benamer, Fri 17 June, 2005

Medical History

2007-06-07T02:30:00.000-07:00

The Classification of Mental Diseases in the Ottoman Medical Manuscripts

Figure 1. A miniature picture that illustrate Ibn Sînâ examining a patient suffering from the "love sickness".

This article was first published in the Turkish review History of Medicine Studies (ed. Hasan Âli Göksoy, Hüsrev Hatemi, Nil Sari), Istanbul 1986, No. 1, pp. 105-112. We are grateful to Nil Sari, author of the article, that she is allowing its publication.

Here we are going to present the classification of mental and neurological diseases found in Turkish medical manuscripts between the fifteenth and eighteenth centuries. Although there are some variations in detail among different manuscripts, I do not intend to go into the description of these details, nor am I going to compare them, for the general overview is the same. Therefore I am going to give the classification of Mukbilzâde (Zahîre-i Muradiye, 1437), whose writing on head diseases is one of the best. Also, I am going to give briefly the descriptions and symptoms of the diseases, so that it will be easier to understand the classic classification of mental diseases found in Ottoman medical manuscripts.

Before giving the classic list I must state that, although mental diseases are studied under the title of the illnesses of the head, a few illnesses such as "ihtinak-i rahm" (hysteria), "hafakan" or "yurek oynamasi" (anxiety), 'sehvetu'l kelbiyye" or "kopekgibi istahli olmak" (obesity), "noksanu'l-sehvet" (lack of appetite) and some other psychosomatic illnesses and sexual diseases due to mental disorders are mentioned amongst the group of related physical diseases.

Still other mental illnesses are given under independent titles, one of which is an alcoholic (sûcîye muptela olanlar) and opium eaters (afyonkesler ve berse muptelâ olanlar) and tobacco addicts. Another illness studied separately is "teza'zu-i dimag" which means traumatic head injuries, such as falling over a high place, a hard blow on the head and fighting. Gevrekzâde describes the organic changes resulting in the brain following the shock and the consequent motor and sensorial disturbances. Still, another disturbance studied separately is "infiâlât-i nefsâniye" which means shortly emotional and personality disorders.

I am sure that if the Turkish medical manuscripts are studied more thoroughly other mental illnesses will be discovered and in this way a complete and correct classification will be accomplished.

Here we are going to deal with those mental diseases studied under the illnesses of the head of which "ser-sâm" is usually mentioned first. "Ser-sâm", supposed to be originally Persian, is composed of two words, "ser" meaning "head" and "sâm" meaning "swell". The main symptoms of "sersâm" are confusion of the mind, talking nonsense, fever and trembling.

There are different types of "sersâm". One is "feranitis" (sersâm-i safravî), also called "tîz sersâm", which is swelling of the brain membranes. We believe it to be meningitis.
Another type of sersâm is "flegmoni" (demevi verem), which is the inflammation of the brain itself. We suppose it to be encephalitis. It has five kinds of different symptoms. These are, face and eyes of the patient turned quite red, eyes protruded from their .socket, intense headache, patient is continuously disturbed, spasm (küzâz), drowsiness and vomiting.

Still another type of "sersâm" is "subârî" (sersâm-i sevdâvî), which is the worst type of "sersâm", said to be in Turkish "ifratla olan sersâm-i tîz". Its main symptoms are madness (divânelik) and agitation (asuftelik).

The other symptoms are briefly the following: he can't sleep well, sees complicated dreams, wakes up in fear, his eyes are bloody red, sometimes the white of the eyes turn yellow, eye movements are slow and involuntary, tears come out as if something had gone into the eye; speaks non-sense in bewilderment; at the beginning he is very restless, but later slows down so much that he hardly can open his eyes; he has high fever, his tongue is swollen, his mouth is dry; his pulse beats fast and strongly at the beginning, but later on it changes and becomes weak and slow. His breath is also strong in the beginning but later it weakens; he feels such a pain on his neck that it seems as though his veins are being strung.

In Mukbilzâde's writings "humre" and "demregu" are said to be diseases of the brain itself. But I am not sure whether it is a type of "sersâm" or not. In the Redhouse dictionary and Tarama Sozlugu "humre" is erysipelas and in Turkish "yilancik, alazlama". "Demregu" (temriye) is a skin disease, lichen or eczema (Tarama Sozlugu). It has three different symptoms. These are, in short, headache, a strong feeling of heat; coolness of the skin of the face, the colour of the eyes is yellowish; later, from time to time his face heats up and his eyes grow red. The fever and trembling (sitma) it causes are much higher than that of the flegmoni. But most of those who suffer this illness die in three days. If they survive three days they may expect to live on. I wonder if these diseases are mentioned under the title of head diseases, because they might have caused complications when left without effective treatment.

Figure 2. A room in a mental hospital. Lunatics and physicians trying to pacify them.

The last type of "sersâm" is the cold sersâm (soguk sersâm or sersâm-i balgâmî), "sersâm" without fever, "lijergis" in Greek. The Arabic-Turkish terms for it are "nisyan" and "unutsaguluk" forgetfulness, respectively, for its main symptom is forgetfulness. It has twelve special symptoms. These are: a light headache, a very slight or no fever, a strong feeling of sleepiness, extreme forgetfulness, extreme slowness in movement, pulse beats slowly and lightly, labored breathing, frequent gaping, a white toung, profusion of saliva, he is confused and unable to distinguish good from bad etc. Lijergis is said to be lethargy but it may also be dementia.

"Seher subati" and "(subât-i seherî" are two different illnesses, "Subat" (nevm-i mufrit) seems to have various meanings, such as hypersomnia, absent-mindedness lethargy. The Turkish term for it is "ogunmak", meaning, to be overcome by sleep, to lose consciousness, feeling sleepy, doze. "Seher" is sleeplessness or insomnia. One who suffers "seher subati" wants to go to sleep, but no sooner than he goes to sleep, he wakes up again. They talk nonsense just as an insane and some symptoms of frenitis can be observed. Here the humour "safra" (bile) is dominant. Those who suffer "subat-i seheri" sleep much more than "seher subati"; although they can be woken up, they go to sleep again soon. They show symptoms like those of lisergos. If the illness is heavy, then there is difficulty in swallowing, urinating and inability to defecate and asthma. In "subat-i seheri", the humour balgam is dominant.

"Ahze" (catalepsy or catatonia) is a sudden paralysis of all the senses and motor activities. One, who suffers from "ahze", suddenly becomes rigid in the posture as he is, sitting or standing. If the attack comes while sleeping eyes remain closed, if one is awake eyes remain wide open. The terms such as "suhus", "cumud" and "dutmak" are said to be synonymous.

"Mal-i hulyâ" is attached to a great importance and it is not a single illness but a group of illnesses appearing with various symptoms. "Merâkî" and "Kutrub" and sometimes even

"Ashk" (Emir Celebi: Enmuzec) are said to be different kinds of "mâl-i hulyâ". Although the main symptoms of "mâl-i hulyâ" are fear, obsession and sadness, they seem to have a great variety. For example, delirium, talking nonsense is an important symptom. In "merâkî" (hypochondriac attitudes) disorders of the digestive system; in "kutrub", continuous fugitiveness are the main characteristic symptoms.

Under the title of "envâ-i dîvânelikler" (different kinds of madness) we find "mania", "dau'l-kelb", "subara" and "kutrub". I suppose they were mentioned under the same title because they have similar symptoms, mainly aggressiveness.

Those who suffer from "mania" are in a state of excitation and attack anyone they come across, like beasts of prey. Both their anger and love are always excessive. They usually talk franticly and they have the looks of beasts of prey. They are skinny.

"Dau'l-kelb" is a kind of "mania". Now they are in a bad temper and then they are cheerful and compassionate. And he is fawny, running about as horses.

An old dictionary defines "subara" as a disease between "frenitis" and "cilnun" (madness) (Hayrullah Efendi: Lugat-i Tibbiye) We have already described "subara".

"Ashk" (love) is an illness. Here the victim causes himself to be ill. When the feeling of love is too deep an illness such as "mal-i hulya" and anxiety will develop. One gets afflicted with this illness when he comes across someone beautiful; he falls in love and becomes fond of his beloved.

One who falls in love begins to be thinking of the beloved day and night. This is a widespread story. The main symptoms are: dry and sunken eyes, when he cries he sheds tears profusely, when he hears a poem or a couplet of separation of the beloved, he feels sad and cries. When his beloved is spoken about his pulse beats up and becomes irregular.

Figure 3. Sultan Bayezid II's mental illnesses patients' hospital and medical madrasa in Edirne, Turkey.

"Unutsaguluk" or "unutsaligi" (fasâdu's-zikr) means forgetfulness (amnesia). The senses of the patients suffering from this illness are all sound. Whatever they see, they see correctly, whatever they hear, they hear correctly, but as soon as they hear or see, they forget. If the illness has begun with forgetfulness and dysfunction of the mind has resulted from it, it is easier to cure it. But if the illness begins with the inability of thought and discrimination, then treatment is difficult.

"Eblehlik" ("humk", "ru'unet", "ahmaklik") or "gaflet" is a hereditary disease. It is a kind of feeblemindedness, and imbecility. They act as little children or old-aged people.

"Ihtilât-i zihn", meaning the confusion of the mind, is an extremely troublesome disease. The functions of thought and discrimination are harmed. They will not speak, do, hear or care as they are expected to. In this illness there may be "tahayyul fesadi" (illusion), so that the person suffering from this illness perceives images of man, animal and objects distortedly; or he has hallucinations, perceiving images that, in fact, do not exist.

"Uykusuzluk (insomnia) and uyaniklik (vigilance): "Uyaniklik" is a state of perceiving and acting deliberately and as he wills. Insomnia is the opposite of vigilance. Among the different causes of insomnia are various anxieties, sorrows, hurting pains, indigestion, tumours like cancer and old age. Among the symptoms of insomnia are: sleeplessness, dryness of eye, nose, gums, toung etc.

Suban: "Kafatasinin (bas, canaginin) icinde toplanan su" (liquid collecting in the skull: Hydrocephalus): It is often observed that liquid is collected in the skull around the hard membrane (gisâ-sulb). Symptoms: Heaviness in the head, difficulty in closing the eyes and it is incurable. Mostly children suffer from this illness. The parts where the water is collected seem to be pulled down. When touched by hand, it moves softly.

"Dawwar" (bas cigzinmek, dolab marazi) and "sedere" (gozu kararmak): This is such an illness that the world seems to be circling around the patient. As a result, he is unable to stand up and if he tries to stand up feels dizzy and almost fainting he falls down again. Objects before his eyes move about.

"Kabus" (Agir basmag; nightmare, sleep apnea): While asleep the patient feels as if something or someone, a weighty man has fallen over him; that heaviness weights upon him. As a result, he breathes with difficulty, tries to shout and move, but he can't. He nearly goes mad. As soon as the "kabus" has gone, he wakes up. This disease is the beginning of three serious illnesses: "sar'a" (epilepsy), "sekte" (apoplexy) and the insanity called mania.

"Sar'a" (Tutanik: epilepsy): Sensorial and motor functions are both irregular and inefficient. While the epileptic attack is on, the organs of the patient fail to function properly. There are contractions all over the body (tesennuc-i kullî). The cause of the foam in the patient's mouth is spasm (tesennuc). Several types of "sar'a" are mentioned, such as the "sar'a" of the brain (sar'a-i dimag); "sar'a" is starting in the stomach (sar'a-i midevî); "sar'a" which is caused by the sting of scorpions, bees etc.; and "sar'a" seen in women undergoing menopause (ihtinaki'r-rahm: Histeria).

"Sekte" (Can kasilmasi; apoplexy): "Sekte" comes suddenly and as a single attack. "Sekte" begins with vertigo (dewar) and ringing in the ears (tanîn). Sensorial and motor transmission from the brain to the body fails. When sekte comes all the organs and senses cease functioning. The main cause of "sekte" is the excess of blood in the blood vessels; too much blood collects in the cavities of the brain and prevents connection with organs. All the organs grow cold. Some doctors call this illness "ihtinâk-i dîl" or "kalbin nefes alamamasi", meaning failure of the heart to breath, suffocation. It is hard to decide whether the patient with an attack of "sekte" is dead or alive, but the patient may revive in spite of this condition. Therefore the patient supposed to be dead should not be buried after a certain time. In "subat" there may also be a failure of the sensorial and motor functions, but this condition develops slowly in contrast with "sekte".

Figure 4. A miniature picture of the insane, illustrating musical therapy at the Bayezid II's Hospital, composed by Nil Sari.

"ihtilac": (convulsion) is the involuntary convulsion of the muscles. This convulsion is temporary, passes away rapidly. Besides cold, anger, happiness and anxiety also may cause "ihtilac". It may sometimes be the beginning of "sekte" or "guzaz" (tetanus); or, if it develops in the abdominal muscles it may be the beginning of "mal-i hulya" or "sar'a". If it occurs in the facial muscles, it may be the beginning of "lâkve" (facial paralysis) etc.

"Lâkve" (Yuz-goz egilmek: facial paralysis): It is a disease occurring in the eye muscles. The eye, eyebrow, skin of the forehead, lips, chin are distorted from their natural condition and undergo change. Lâkve may be the beginning of "sekte". A patient suffering from this illness is unable to spit properly or chew easily. He emits saliva from one side of his mouth. Two different kinds of facial paralysis are dealt with. One is "lâkve tesennucu" (spasmodic facial paralysis) and the other is "lâkve-i istirha" (loosening facial paralysis) and in this type senses are weakened, the upper eyelid drops down, the gum loosens and fails to hold saliva.

"Hadr" (to get numb) is an Arabian term, which means in Turkish (archaic) "tutulmaklik, tutmakhk, a'za uyusmasi "that is, the failure of the senses. This illness occurs in sensorial and motor organs. First the sensorial organs function poorly or fail to function altogether; consequently, motor ability also loses its natural capacity. "Hadr" has seven causes, some of which are opium eating, too much cold affecting organs, bite or sting of poisonous animals or insects such as snake, scorpion, wrenching of the nerves etc. If the factor causing the illness in the brain, all the motor and sensorial functions cease. If it is in the spinal marrow, weakening of the sensorial and motor functions spread either all over the body or only in one half, proportionately with the effectiveness of the cause. The senses in the face are sound. Sometimes a vertebra is dislocated, and "hadr" develops. When a nerve of the neck or the vertebra is damaged, the organ which it serves is affected and the symptom can be observed there. Sometimes "hadr" may result in "felg" (paralysis), "sar'a" (epilepsy), "sekte" (apoplexy) or "tesennuc" (spasm).

"Ra'se" (tremor, trembling): Ra'se is a disease affecting the organs that are means of movement. When one tries to move his hand to do something, involuntary movement intervenes and hinders voluntary movement and from the combination of them ra'se results. It mostly appears in hands or head (bas titremek) and sometimes in all organs. "Ra'se" is incurable in the old age.

"Falic" (paralysis, hemiplegia) is the complete failure and paralysis of muscles and tendons ("mutlak istirha"). Although it is sometimes described as hemiplegia affecting half the 'body, it should be noted that in Turkish manuscripts "falic" has a wider meaning, including paraplegia, in which the head is not affected and sometimes in "falic" all the body is affected, while sometimes a single finger is paralyzed.

"Tesennuc" (Sinir cekilmek: spasmodic contraction of a muscle; spasm, cramp, convulsion). There are three types of "tesennuc", in one of which there is congestion of the nerves and muscles (tesennuc-i imtilayî), where the muscles spasm. In Arabic it is called "tekallus" (shrink). The cause is generally humidity. In the sanguine type muscles swell and enlarge. When the cause is cold, the patient recovers fast. In "kuru tesennuc" muscles get contracted both in length and width. In "tesennuc" of extreme dryness (yubûset galebesi), muscles contract. Other causes of "tesennuc" are, sting of scorpions, extreme cold, anxiety and fear, sleeplessness, too much crying, extreme fever, fever and tremor (issi isitma) in children.

"Kuzaz" (spasm, tetanus, shivering: spastic paralysis): There are several meanings of "kuzâz". One is related with "tesennuc". The other meanings are: The "tesennuc" of the neck ("ense gekilmesi"). In this illness the neck must be put straight so that it will not move forward or backward; "kuzaz" caused by cold and freezing in which muscles shrink. Nerves and muscles become rigid, can not move, organs are shrinked in every way. But in "tesennuc" the organ shrinks in one way, nerves and muscles expand and contract. Both usually cause ache. "Kuzaz-i dimagî" or "kuzaz" of the brain is the worst. In children's "kuzaz" all the muscles in the back of the head stiffen, they can eat and drink with difficulty, there are convulsions in all extremities, they speak with difficulty etc. In some types of "kuzaz" the muscles of the face are spastic; in others suffering from "kuzaz", the head and neck are turned to one side. There are different kinds of "kuzaz", such as "ku'zaz-i imtilai" and "ku'zaz-i veremi".

Figure 5. An Ottoman vehicle to carry patients.

"Levi", supposed to be Persian or a'ya in Arabic is a state in which one eats, drinks too much for a couple of days, gets tired and is unwilling to move. He, also, feels weak. His veins and muscles contract, he tends to stretch himself. This state is called "levi" meaning to have a bad stomach from overeating.

"Suda" (headache) and "sakîka" (migraine) are important titles in medical manuscripts. For instance in "Zahîre-i Murâdiye" 21 and in "Nuzhetu'l-ebdân" 14 types of headaches are mentioned and these main types of headache are classified into other minor groups. Headaches are classified according to their ethiology which depends generally on the four humours and temperaments. "Sakîka" (migraine) or "yarim basagrisi" is described as an illness which comes for a couple of days and then passes away. Pain is felt when the attack (nobet tutmak) is on.

Several factors are mentioned as the cause of headaches. Some of them are: Walking too long in the sun, sitting before the fire, taking a long bath, taking hot food cold, sitting too long without movement, anger, shouting too much, sleeplessness, thinking too much, sleeping too long, fear, crying too much, sorrow, exhaustive reading, anxiety etc.

Discussion and conclusion:
— The majority of the mental and neurological illnesses are mentioned under the title of "the diseases of the head". Most of the illnesses due to the disorders of the central and peripheral nervous systems are dealt less than one comprehensive title.
— The relations among these diseases are all ways discussed.
— Some of the diseases are more like syndromes, while others are only symptoms. For instance while "mal-i hulya", "ask" are a group of illnesses, "ra'se", "unutsaguluk", "devvar" are symptoms. Some others such as "eblehlik", "kafatasi icinde toplanan su" and "Iâkve" obviously seem to be single illnesses.
— Although the names of these illnesses are specific and are classified in a similar way in different medical manuscripts, variations can be noted.
— Under the title of one major illness there is usually sub-classifications of which I gave a few examples here. Thus we have seen four sub-types of "sersâm". For instance there are several types of "sar'a", "sekte", "tesennuc" etc.
— Although this classification is very different from todays, it is also based on symptoms and organic factors.
— Classification depends usually on organic symptoms. I did not come across a tendency of subjective speculation.
— The Ottoman physicians know that such illnesses were disorders of the central and peripheral nervous systems.
— The sub-types of some diseases are classified according to their etiology which depends generally on the four humours and temperaments.
— We find some of the Turkish terminology quite interesting and absolutely to the point. For example, "unutsaguluk", "bas cigzinmek", "agirbasma", "dutarik", "can kasilmasi", "yuz-goz egilmek" etc. We expect others to be discovered in the course of study and research.
— I conclude from my studies that Ottoman doctors had an advantage of having a medical heritage of the previous Islamic medicine, to which they made their own contributions and so could build up a good knowledge of psychiatry and neurology.

BIBLIOGRAPHY
Emir Celebi: Enmuzecu't-tib. Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 96.
Emir Celebi: Neticetu't-tib. Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 59.
Esref bin Muhammed: Hazâ'inu's-Saâ'dat. By. Bedi N. Sehsuvaroglu. TTK,. XI. No: 9, Ank. 1961.
Hayrullah Ef.: Kamus-i- tib, Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 581.
Ibn-i Serif: Yadigar. Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 311.
Koptagel -Ilal, G. ve Kazancigil: A.: Ortadogu ve Islam Dunyasinda Bilimsel Dusunce ve Psikosomatik Hekimlik Kavraminin Tarihsel Temeli. I. Uluslararasi Turk-Islam Bilim ve Teknoloji Tarihi Kongresi. Bildiriler II., s. 71-86, Istanbul 1981.
Mukbilzâde Mu'min: Zahîre-i Muradiye. Suleymaniye Ktp. H. Mahmud No. 5507.
Nidâî: Menâfiu'n-nâs: Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 133.
Sâlih b. Nasrullah: Gâyetu'l-beyan fi tedbir beden-il insan. Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 117.
Sâlih b. Nasrullah: Nuzhetu'l-ebdân fî tercumet gayetu'l-itkan. Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 551.
Sari (Akdeniz), Nil: Gevrekzâde Hafiz Hasan Efendi ve Kafa Travmalan Hakkindaki Bilgisi. I. Uluslararasi Turk-Islam Bilim ve Teknoloji Kongresi, 14-18 Eylul 1981.
Sari (Akdeniz), Nil: "Osmanli Tibbinda Beden ve Nefis Terbiyesi" "IV. Milli Turkoloji Kongresi Bildirisi, 19-23 Ekim 1981 Ist.
Sari (Akdeniz), Nil: "Nidaîye Gore 'Keyif ve 'Afyonkes' Tedavisi". Yeni Symposium, Yil: 19, Sayi: 1, Ocak 1981, Ist. S. 19-25.
Sari (Akdeniz), Nil: "Halk Hekimliginde ve Osmanlica Tip Yazmalarinda Akil ve Sinir Hastaliklarinin Tedavisi" II. Milletlerarasi Turk Folklor Kongresi Bildirileri, C. IV, 1982, Ank.
Sari (Akdeniz), Nil: Osmanlica Tip Yazmalarinda Mâl-i hulya ve Tedavisi (XV.-XVIII. yy.) Ist. Uni. Cerrahpasa Tip Fak. Deontoloji Anabilim Dah, 1982, Ist.
Suleyman b. Abdulmennân: Cem-ul mucerrebât (1176) Cerrahpasa Tip Fak. Tip Tarihi Ktp. No. 166.
Sehsuvaroglu, Bedi N.: Sair ve Hekim Ahmedî, Ist. Tip Fak. Mec. C. 16, Sayi: 4, 1953.

by: Prof. Nil Sari Akdeniz , Tue 12 July, 2005

Medical History

2007-06-07T02:19:00.000-07:00

Educating Ottoman Doctors

The Kayseri Hospital (Gevher Nesibe Sultan Shifahâna). Drawn by Suheyl Unver
This short article is taken from the full article which is available here as a PDF file

This article was first published in the Turkish review History of Medicine Studies (Editors, Nil Sari-Husrev Hatemi), Istanbul 1988, pp. 40-64. We are grateful to Nil Sari, author of the article for allowing publication.

The Ottomans had a special concept of medicine and methods of medical training. Besides the "tabîb" whom we can call a specialist of internal diseases, there were several other specialists such as the surgeon, ophthalmologist, orthopaedist, syrup preparer, herbalist etc… all dealing with public health and trained in different ways.

The physician held the highest position in the class focusing on health and he was usually educated at a madrasa and dâr al-shifa (hospital). But, since the documents studied so far do not give full and satisfactory information, there is a great gap of knowledge about the education at the "madrasa" and "dâr al-shifa". It is certain that in the Ottoman Hospitals, as well as in Seljuk Hospitals of Kayseri (1205-6) which has a double "madrasa plan" and Sivas, the physician was trained both theoretically and practically.

The young man who entered a trade in order to learn an art or a craft, serving under the supervision of a master or foreman was called "cirak" or "Shaqird". One who wanted to be a physician was called "tâlib" and the name of the student physician was "Shaqirdi tabîb." The "Sakird" attended clinical cases at the hospital and acquired theoretical learning in medical science at the madrasa and by reading medical manuscripts in the library of the "madrasa."
Ottomans carried on the good tradition, building new hospitals, in addition to the old ones of the Seljuks. One of these was the Bursa Hospital (1399), a part of the Sultan Yildirim complex where physicians were trained at the "dâr al-tib" (school of medicine). There was a schoolroom in the hospital and a teacher who was a physician. It was the first hospital built by the Ottomans. It is also noted that in the Fatih Hospital (1470) in Istanbul, there was a teacher; called "darsiâm" and medical students called "tabîb shaqirdi". In Edirne (Adrianople) at the Bâyezid II Hospital (1484) it is noted that there was a medical school called "madrasa-i atibba". As a continuation of the Islamic tradition, just as in the Seljuk period and the Ottoman period, theoretical and practical medical sciences were taught in the hospitals. Until the mid nineteenth century, physicians were trained at hospitals that also served as medical schools.

Gevher Nesibe Sultan (d. circa 1204)

A separate medical school was founded at the "Suleymaniye Complex" (1556-7) where medicine was taught as an independent field of study. The medical students had their courses in applied medicine at the hospital near the "madrasa". Suleymaniye medical school is described in the "Waqfiya," as "a supreme and honourable school built for the science of medicine..."

Graduation from classical madrasa was required in order to be qualified for enrolment to the medical school to specialize. The physician who had already studied Islamic jurisprudence, divinity, philosophy, and literature had by then learned Arabic and Persian as well. Physicians educated at hospital were always required to have "madrasa" education as well as medical learning. In addition to learning Islamic divinity, they were expected to acquire knowledge of all sciences. Having received a certificate according to the textbooks he had studied in the class, he continued in the class of another professor (mudarris). And when he had received the last certificate he became a "mudarris", or a "qâdî" (qâdî-judge of the Islamic canon; governor of a district) As a result many physicians could chose to work in various fields, as a "mudarris", a "qâdî", an "imam" and "kazasker"-(Chief military judge)-.

The Ottoman scholars used to attend the madrasas in Syria, Egypt and Iran. For instance the Hajji Pasa (1424), obeying the fashion of the day, studied at a madrasa in Egypt and after a while he developed an interest in medicine. He became a physician and in time he was promoted to the post of head-physician of Kalavun Hospital.

There was a close relation between the medical service in the palace and in the hospitals. Just as the physicians of Suleymaniye were appointed as palace physicians, there were also palace physicians who were transferred to a hospital. And there were even physicians working as palace physicians who at the same time served at Fatih and Suleymaniye Hospitals.
Yildirim Dâr al-shifa in Bursa, built in 1399 by Yildirim Bayezid (1389-1402). A view of the lecture hall

The chief physician (Hekimbasi) was not only in charge of the health affairs of the state but was also closely interested in medical education. From a document in Topkapi Palace Archive, we find a list of the books to be used by the head-physician. In a record at the back of this document, it is noted that these books were given to the head physician Molla Kasim in 1575 who, on his retirement, delivered them over to Isa Celebi who replaced him in 1580. We can conclude from these documents that head physicians were closely interested in medical education.

The organization of artisans in the palace was an important institute of education. Surgeons and ophthalmologists were educated at hospitals or learned medicine at a shop, working as an apprentice with a master. There were also families that carried on the medical profession as a family tradition, the younger learning it from their elders in from within the family. There was, however, an organization in the palace which also trained surgeons and ophthalmologists who were regarded as craftsmen. This organisation of artisans in the palace was an important institute of education. It was named "hâssa ehl-i hiref" and selected and educated those sufficiently talented to fulfil these roles.

There was another form of education besides the madrasa, the hospital, and the palace. It was also possible to be trained by a qualified physician in his office or in a special class by the master-apprentice method and get a certificate for practicing medicine. In this case, little research has been made regarding the relation between the craftsmen's guild (ahî teskilati) and the physicians, surgeons and ophthalmologists who practiced independently.
Many experienced physicians trained students in private courses, even in their private classrooms. Especially at the end of the seventeenth century and in the eighteenth century, with the deterioration of the "madrasas" and the appearance of ignorant ones amongst real scholars, there was an increase of the practice of private education outside hospitals.

Another important item for the history of medical education is that decrees were issued from time to time as a result of the appearance of quacks requiring physicians, surgeons, ophthalmologists and herbalists to be examined and those found efficient were to be given a certificate but those who failed were forbidden to practice. It was decreed that those who practiced therapy were to be examined in their field by the head-physician of the day and those who were successful were given a certificate sealed by the head-physician which enabled them to practice. Those who had not studied medical science with a great master and the ignorant who practiced medicine without learning the medical art from skilful physicians were forbidden from practice and punished.

More extensive research needs to be made in Ottoman history of medicine and the conclusions to be arrived at are sure to shed light on our problems today and enable us to understand them better. This will be possible, however, by the classification, study, and publication of all the documents and manuscripts relating to the field that exist in archives and libraries.

by: Prof. Nil Sari, Fri 02 September, 2005

Medical History

2007-06-07T02:03:00.000-07:00

Ethical Aspects of Ottoman Surgical Practice

This article was first published in the T. Klin J Med Ethics 2000, 8:9-14. We are grateful to Prof. Nil Sari** for allowing publication.

Information and hints about the requirements and expectations of medical ethics regarding surgery during the Ottoman period is found in medical manuscripts and the deed of trusts of hospitals; while the moral principles based on Islamic Canon Law (Shari'ah) and the oral tradition (the Hadith) observed in surgical operations, that is reflection of Muslim morality to practice, are found in judges' registers.

This study is an overview of the subject, based on main sources, though not a critical approach.

Virtues Required For Surgeons

In the Ottoman period every hospital was expected to be ruled according to its deed of trust, which described the ethical issues expected to be observed by the surgeons to be appointed. As we learn from these sources, ethical rules to be observed by the surgeon were basically the same for the adult and paediatric patients [1].

Figure 1. Application of the cauterization method to treat a sick man. Serefeddin Sabuncuoglu. Jarrahiyatu'l-Hâniya. Millet Library, Ali Emiri, Tib 79.

For example, the most important three rules expected to be observed by the surgeons of the hospital founded by Sultan Bayezid II in Edirne (Adrianople) in 1488 were, nonmaleficience, avoiding negligence and punctuality. Skilfulness had primary importance for surgical practice.

Virtues regarded as essential for the surgeon were earnestness, patience and assiduity [2].
Ethical rules for the surgeons to be appointed to the Suleymaniye Hospital in Istanbul founded by Sultan Suleyman the Magnificent in 1556, are basically about the technical knowledge and skill to be comprised. Besides basic medical education, efficiency and skilfulness; the surgeon was responsible for the treatment of at least twenty different kinds of cases, such as treating head injuries and fractures, tumours, hernias, wounds, ulcers, pustules; and bandaging, drainage of abscesses, etc. Though pharmacists were responsible for the preparation of medical compounds, every surgeon was expected to know the methods of preparing drugs necessary for pre and post-operative medical treatment [3].

Figure 2. The office of chief physician (Hekimbasi) of the Ottoman State in the Topkapi Palace Museum, Istanbul, Turkey.

According to the ethical rules for the surgeons to be appointed to the hospital at Uskudar (Scutari), a suburb of Istanbul, founded by Nurbânû Sultan, wife of Sultan Selim II in 1582, the surgeon should treat his patient tenderly, mercifully; must keep up the standard of his practice; never behave rudely to the patient; should be conscious of his responsibility; and act with due care to every patient [4].

Ethical Advices in Medical Manuscripts for Surgeons

In regularly kept surgical manuscripts we find the special ethical rules given as advices for the initiates and practitioners of surgery. For example, Serefeddin Sabuncuoglu, an eminent Turkish surgeon of Amasya, at Central Anatolia, gives important ethical advices to the practitioner in his famous surgical work Jarrahiyat al-Hâniye, written in Turkish in 1465. This textbook includes theoretical and practical points about general surgery. Sabuncuoglu warns every surgeon to be conscious of the potential risks of extensive bleeding and major infections; and that removal of bladder stones may be dangerous for some patients. Sabuncuglu also warns surgeons not to operate if there is risk for the patient; and writes that, a surgeon should not operate any patient only for self interest; priority should always be given to the patient's interests. Before the operation, the patient or his family should be informed of the details and its potential risks [5].

Another Turkish surgical book, Alaim-i Jarrahîn (1500), draws attention to the virtues and skills expected from a surgeon. According to this text, a surgeon should be good humoured; honest and modest; behave respectfully to his masters; be quick and skilful; have enough basic medical knowledge; and should be informed of the methods of preparing ointments, dressings, coatings and cataplasms; must prepare drugs suited for children; and his surgical instruments must be plated gold, silver or at least tin [6].

Hulasa-i Divan, a 17th century manuscript, warns surgeons to be careful of right diagnosis before deciding for operation [7].

Figure 3. A human body miniature shows internal organs. By Mansur bin Muhammad bin Ahmad, Kitâb-i Tashrih-i Badan-i Insân. Cerrahpasha Medical Faculty Library, 31.

Registers of the Canonical Courts' Judges

Islam's juridical and ethical rules to be observed in surgical operations carried out in the Ottoman State can be traced in the registers of the canonical courts' judges. Legal problems in the Ottoman cities and towns were handled by judges (kadi) of the canonical courts, appointed by the Palace, that is the central government or their substitutes appointed by judges. Judges registered all kinds of processes and decisions, such as judgements, sentences and contracts, etc. in their special registry known with various names, such as "Shar'iya sicili, kadi defteri" etc. From the early years of the Ottoman State, until 1924 when the canonical law courts were closed, the judicial organization continued and hundred thousands of law scripts were recorded. Most of these records have not been preserved and those available, about 20.000 in number have not been systematically studied until recently, however important these documents are.

These scripts are of great importance, because they are documents that reflect the daily social life of the people in Ottoman cities and towns. Local medical problems can also be studied from these documents; such as epidemics, hospitals (buildings and names of the personnel), the names of the known physicians and surgeons, local names of diseases, cases of forensic medicine, such as abortion, post-mortem examination, examination for virginity etc., and certificates of consent arranged between the patient and his/her physician or surgeon or oculist or midwife etc [8].

Ethical Principles Based on Islamic Canon Law Observed in Surgical Operations

Muslim Canonical jurisprudence involves law, ethics, good manners and tradition. Reasoning is fundamental in Islamic Law. We must bear in mind that classical Muslim jurisprudence is not the Muslim law itself, but the commentary of the period.

The surgical operation is a risk taken against the worst; that is, a balancing of beneficence against harm and choice of the act expected to be more beneficial. The right to live and the protection of human life and health in Islam is a matter of individual right covering everybody [9]. The patient gives his / her consent for an operation in accordance with his right on the integrity of his body, which is an individual right, but not an absolute one. There is a concept of a divine trust (amanah) to the individual for safekeeping himself. That is, as there's no light of yielding to death in Islam; the obligation to live is prior to the will for death of the individual. The beneficence for the patient is prior to his/her autonomy [10].

Sometimes an illness does away with the individual's capability of consent; or a patient may be under aged or incompetent. Therefore, for children and those who are not competent, the qadi chose whomever he found appropriate as the guardian. The concept of guardianship originated according to the patriarchal type of family that is father, grandfather, uncle or sons were to be guardian; though we have rare examples in the Ottoman period where the mother was the guardian [11].

Inflicting physical or moral harm (muessir fil, that is, assault and battery) intentionally or in deliberately, such as injury and murder are crimes committed against individuals. Islamic law prescribes immunity for life and property [12]. Cause of death or injury or invalidating of the patient necessitates compensation / blood money, which is required by the victim himself/ herself or if under-aged, by his / her parent or guardian; and if dead, by inheritors. Blood money punishment for the whole body (diyet) or for a wound or partial loss of an organ or limb (ersh), is to ensure the balance of harm against punishment. Blood money is an alternative of retaliation (kisas). That is, in case of harm, while preventing retaliation, it also prevents the sufferer from impoverishment, hence begging because of loss of health or invalidation; or compensates for the loss of inheritors [13].

Consent against Compensation before Medical Intervention

In Islam, all legal and commercial mutual relations have to be based on consent; but, guaranteed cure and recovery in advance is not regarded as acceptable in Islam. Also, the physician can not be obliged to guarantee the result of the treatment, for the result can not be known before hand. Healing is a matter of destiny and it can not be regarded as the power of anybody. As nothing is absolutely certain, there is a probability of misfortune. Here, destiny is connected with the end, just as the concept of death, which provides for the resistance to bear the results of a misfortune [14].

Figure 4. A human body miniature shows the blood vessels and nerve system. By Mansur bin Muhammad bin Ahmad, Kitâb-i Tashrih-i Badan-i Insân. Cerrahpasha Medical Faculty Library, 31.

The requirement of a written consent was inevitable then, because surgical technology was not developed and the death or invalidation risk was high, [15] there were a few kinds of operations often practiced, that is hernia and lithotomic, which were less risky.

A special consent was used to be taken from the patient; or the parent or guardian of the child; or from the judge before treatment or a surgical operation; and a contract was signed to certify this, in order to withhold the patient, his/her relatives or the child's parent or guardian from starting a suit for compensation against the surgeon in case of death or injury. Consent of a person for a surgical operation in advance means the renunciation of the future right of suing, in case of a harm or dissatisfaction. This certificate (huccet) of consent was arranged at the presence of the judge and witnesses, between the surgeon and patient or his/her parent or guardian. Written and oral consent was not regarded as satisfactory and to guarantee against conflicts about the probable unwelcome results, the agreement was arranged and signed by witnesses at the presence of the judge. To be a legally valid consent though, its content should be clearly known by the patient; but, no sufficient written information about the intervention is given, except in a few examples, and sometimes it is only implicitly expressed in these documents [16].

In this contract, usually the surgeon's skill was also noted and it was marked that the surgeon was going to operate the patient skilful and was to do his best. In some of these contracts the surgeon's fee and the amounts to be paid before and after the operation, was also noted. In the Ottoman period, there was a wage relation between the physician and the patient who was a client. That is, medical treatment was considered as a paid service [17].

Then, when was a surgeon regarded responsible? Surgeons were not considered responsible for the un welcomed results of their treatment, provided that they observed certain requirements: if a written consent was taken; when there was not any unacceptable surgical or medical failure; when the surgical technique practiced was found to be in accordance with the standards of its time; when no ill will was found to be in the practice; and when found to be qualified, skilled and efficient enough, a surgeon was not regarded responsible [18]. When the treatment caused any harm, in order to understand whether the practice was in accordance with the day's knowledge and technique, an expert (ehl-i hibre), that was another surgeon / physician was called; and if found responsible, all unjustly given harm was to be compensated. This meant that the consent of the patient removed the physician's responsibility only for normal situations. If the surgeon treated his patient honestly with assiduity and used his surgical skill properly, no compensation was to be claimed in case of death or injury, as a result of this consent; but, if the surgeon was found to be negligent, incautious faulty or unskilful, he had to compensate the harm given to the patient; that is, if the harm or death was the result of malpractice, the consent was not regarded to be valid any more. Non-professionals were regarded as responsible for the harm that they may give to the patient. In Islam, ignoring the harm is not legally right; it exists only from the point of view of destiny [19].

Examples of Ottoman Consent Certificates Related With Paediatric Surgery

There are several examples of the above said contracts, dating back to the 15th century Ottoman reign [20]. I would like to give two cases of negotiation between two parties in 1765; one between a surgeon and a child's parents; the other between a midwife and a new born baby's parents:

Case I

"Omer and his wife from Sehrekustu, a district in Gaziantep, southeast of Turkiye, accused the son of Mustafa, Molla Mehmet, the surgeon, who lived in the same neighbourhood and claimed: 'A swelling had developed on our son Mehmed's back and we took him to the accused surgeon for treatment. The accused incised the swelling and as a result our son died in four days.'So the plaintiff asked the court to start the necessary process.The surgeon defended himself saying:'The illness known as Duzuncu in our city was on the back of the child. This illness is treated by incising (delving) and then draining the liquid in it, called ma-i cedid. Later, the wound is treated (medically). The method of treatment has been practiced successfully for a long time. I had the plaintiffs consent for incising and treating the swelling.' and he also submitted an opinion on legal matter (fatwa) proving the truth of what he had said in his defence.The plaintiff said that he did not have their consent. So, the accused was asked to submit his defence.The witnesses who were heard said that the operation was performed on the plaintiffs consent. They also added that, Molla Mehmed was an efficient surgeon.The plaintiff's claims were refused [21].

Case 2

"Mehmed Emin, the son of Mustafa and Hanife, the daughter of Ahmet, who lived at Kucukpazar in Istanbul, who were known to be the father and mother of the infant called Mustafa, mentioned below, came to the Islamic juridical court. Saliha, the daughter of Ali, the acquised, a known midwife of Kasimpasa, also being present, the plaintiff stated:'Our son Mustafa was born last year after seven months pregnancy, on the 9th of December. Saliha also being present, the infant's navel cord was cut off as usual and he was named Mustafa. Six days later, Saliha came and cut the navel cord off the infant again with a scissors. After having cut and injured, it started to bleed and he died in 24 hours. As we wanted Saliha, the mentioned midwife to be punished, we applied to court and sued her.She (the midwife) objected and an argument started between us. Our Moslem neighbours tried to negotiate us; and an agreement was made for the accused to pay us 33 piasters (gurush); consequently we were reconciled. Having agreed to be paid the said 33 piasters in certain periods, we admitted to end all suits and claims related with the compensation for the death of Mustafa.'

As she also accepted this negotiation and the agreement being confirmed by the court, it was literally recorded as required. (29 January 1765)Witnesses: Molla Mustafa, Huseyin Odabasi bin Hasan, Turmus bin Ibrahim, Ali bin Hasan, Debbag el-Hajj Halil [22].

In short, considering the fact that the idea of the need for the consent of the patient in the West began in the 19th century and the notion of patient rights is a newly developing concept [23], the common practice of requiring a written consent of the patient in the Ottoman State is quite significant, as this need had been felt earlier than the Western World, where medicine was started to progress earlier than the Ottoman World.

REFERENCES
[1] Sari N. "Osmanli Darussifalarina Tayin Edilecek Gorevlilerde Arananacak Nitelikler". Yeni Tip Tarihi Arastirmalari, No. 1, Istanbul, 1995, pp. 11-54. See. pp. 19, 25.
[2] Ibid, pp. 32-33; Gokbilgin M. T. XV-XVI. Asirlarda Edirne ve Pasa Livasi; Vakiflar-Mulkler-Mukataalar. Istanbul, 1952, I. U. Edebiyat Fakultesi Yayini, No. 508, pp. 150-72.
[3]Sari, N. op. cit., note 1 above, p. 33; Kurkcuoglu K. E. Suleymaniye Vakfiyesi. Ankara 1962, Vakiflar Umum Mudurlugu Nesriyati, pp. 40-1.
[4]Sari, N.: op. cit. note 1 above, p. 33; Vakiflar Genel Mudurlugu, Y.Y.D: 1766 / 136-27ss, sira no. 27, Kasa no. 121.
[5]Akdeniz (Sari) N. Osmanhlarda Hekim ve Deontolojisi. Istanbul, 1977, p. 40. S. Sabuncuoglu: Cerrahiyetu'l Haniyye. Millet Ali Emiri National Library, No. 79, f. 47b-48a.
[6]Akdeniz (Sari) N. ibid, pp. 40-1. Ibrahim b. Abdullah'ul Cerrah: Alaim-i Cerrahin. Cerrahpasa Medical School Medical History Department Library, No. 125, f. 2b-3a.
[7]Akdeniz (Sari) N. Osmanhlarda Hekim ve Deontolojisi. op. cit. note 5 above; Hulasa-i Divan tercumesi. Cerrahpasa Medical School Medical History Department Library, No. 164, p. 2-3
[8]Uzuncarsi I. H." Ser'i Mahkeme Sicilleri ". Ulku, vol. 5, No. 29, 1935, pp. 365-8. Ulucay M. C. "Manisa Ser'iye Sicillerine Dair Bir Arastirma ". Turkiyat Mecmuasi, vol. 10, 1951-53, pp. 285-98. Bayat A.H. "Seriye Sicilleri ve Tip Tarihimiz." Turk Dunyasi Arastirmalari, Agustos 1992, No. 79, pp. 9-21.
[9]Akgunduz A. Belgeler Gercekleri Konusuyor (I). Izmir, 1989, Nil Yayinlari, pp. 1-5, 10-3. Udeh A. (trans. Ozcan R. - Safak A.). " Et-Tesrui'l-Cinaiyyu'l- Islamî Mukarinen Bi'l Kanuni'l- Vaz'i. "Mukayeseli Islam Hukuku ve Beseri Hukuk. (Notlar ilaveli ve Turk Ceza Kanunu ile karsilastirmali). Ankara, 1990, Rehber Yayim 11, Temel Eserler series 1, vol. 2, p. 135.
[10]Udeh A. (trans. Ozcan R. - Safak A.), op. cit. note 9 above, vol. 2, pp. 62, 65-6, 83; vol. 3, pp. 139-40, 224-5. Bilmen O.N. Hukuki islamiyye ve Istilahati Fikhiyye Kamusu. Istanbul, Bilmen Yaymevi, vol. 3, p. 100. Quran: Ali imran 3 / 185; El-Mulk 67 /1-2; El-Ahzab 33 / 36.
[11]Udeh A. (Ozcan R. - Safak A.): op. cit. note 9 above, vol. 2, p. 24. Bilmen N. op. cit. note 10 above, vol. 3, p. 114; vol. 7, pp. 271, 274, 277, 284, 286, 288. Tan M (Editor Onur B.). Toplumsal Tarihte Cocuk Sempozyumu (23-24 Nisan 1993). Istanbul 1994, Tarih Vakfi Yayini, p. 14. Ankara register: No. 40, p. 100 (date. 17 Sewal 1065/22. 06. 1655). Here, the mother, Zeyneb binti Cafer is the guardian.
[12]Udeh A. (Ozcan R. - Safak A.): op. cit. note 9 above, vol. 1, pp. 76-7.
[13]A. Udeh (trans. R. Ozcan - A. Safak): op. cit., note 9 above, vol. 1, pp. 121-122; vol. 2, pp. 242-5. Bilmen O. N. op. cit. note 10 above, vol. 1, pp. 286-7. Safak A. Mezheblerarasi Mukayeseli islam Ceza Hukuku. Ataturk Universitesi Yayinlari, No. 503, Erzurum 1977, p. 130. Quran: En'am 6/164; Fatir 35/18; Necm 53 / 39; Fussilet 41 / 46; Nisa 4 / 123. Bakara 2 /178-179; Maide 5/32. 14.
[14]Quran: Bakara 2 /188; Nisa 4 / 29.
[15]Udeh A. (trans. Ozcan R. - Safak A.), op. cit. note 9 above, vol. 2, p. 124.
[16]Udeh A. (trans. Ozcan R. - Safak A.): op. cit. note 9 above, vol. 2, pp. 19, 23-4, 61-8, 71-79, 83-4, 125, 135, 242-5; vol 3, pp. 101-2, 193-8; vol. 3, pp. 269, 273. For huccet (promissory note) see: Kutukoglu M. S. Osmanli Belgelerinin Dili. Istanbul, 1994, pp. 350-9. Bilmen ON. op. cit. note 10 above, vol. 1, p. 281; for jurisdiction about witnesses see: vol. 8, pp. 123-36; 167-74.[17]Akgunduz A. Ser'iyye Sicilleri. vol. 1, Turk Dunyasi Arastirmalari, Istanbul, 1988, p. 282.[18]Udeh A. (trans. Ozcan' R. - Safak A.): op. cit. note 9 above, vol. 2, pp. 84-5; vol. 3, pp. 101-2, 107, 109, 111; vol. 2, pp. 62, 84, 122-4. Gunenc H. Gunumuz Meselelerinde Fetvalar. Istanbul 1983, ilim Yayinlari, vol. l, p. 138. Bilmen ON. op. cit. note 10 above, vol. 3, pp. 113-4. Bardakoglu A. "Islam Hukukunda Doktor ve Diger Saglik Personelinin Hukuki Mesuliyeti." Kayseri Universitesi Gevher Nesibe Bilim Haftasi ve Tip Gunleri. 11-13 Mart 1982, Kayseri, pp. 527-30.
[19]H. Gunenc: op. cit., note 18 above, p. 138. Bilmen O. N. op. cit. note 10 above, vol. 3, p. 113; vol. 7, p. 272. Udeh A. (trans. Ozcan R. - Safak A.): op. cit. note 9 above, vol. 2, p. 123.
[20]References for agreements signed before paediatric surgery (examples of consent for the extraction of the bladder stone and the operation of inguinal haernia): Aksu F. "Ispartali Hekim ve Cerrahlar." Un, vol. 4, No. 37, 1937, p. 527. Baki E. A. " Afyonda Eski Zamanlarda Yasayis 18: Afyon'un Buyuk Hekimleri ". Taspinar, No. 86, 1941, pp. 26-7. Baki E. A. "Afyonkarahisar'da XVII-XVIII. Asirlarda Mechul Halk Tarihinden" Yeni Mat, Afyon, 1951, pp. 42-3. Gokpinar E. A. " Seriye Sicillerine Gore: Eski Zamanlarda Afyon'da Yasayis.. " Taspinar, vol. 4, No. 42, 1936, p. 214. Ozdemir R. XIX. Yuzyilin ilk Yarisinda Ankara. Kultur ve Turizm Bakanligi Yayini, No. 694, Ankara, 1986, p. 294. Examples of unpublished references: Konya register: No. 42, p. 198 (date: 8. Muharrem. 1119/11. 04. 1707); Konya register: No. 26, p. 266 (date: 17. Ramazan 1087/23. 11. 1676); Ankara register: No. 40, p. 100 (date: 17. Sewal. 1065 / 22. 06. 1655).
[21]Guzel C.C.,-Yetkin H. Gaziantep Ser'i Mahkeme Sicillerinden Ornekler (Cilt: 81-141/ Miladî 1729 -1825 ). Gaziantep, 1970, Gaziantep Kultur Dernegi Yayini, No. 55, p. 80; (Gaziantep register, vol. 122, p. 72, 15 Saban 1178 / 8. 02. 1765).
[22]Osmanli Toplum Yasayisiyla ilgili Belgeler -; Bilgiler / Suclar ve Cezalar- III ". Tarih ve Toplum. 1984, No. 9, p. 9 (153); Istanbul Kadi Sicili, vol 25, p. 237, (Istanbul register vol. 25, p. 237; date: 17 Saban 1179 / 29 January 1765).
[23]Faden RR, Beauchamp T. L. A History and Theory of Informed Consent. Oxford, 1986, Oxford University Press, Inc.

FIGURE SOURCES :Figure (front). Treatment of a stomach illness by a medic from Serefeddin Sabuncuoglu's book Jarrahiyat al-Hâniye. (Millet Library, Ali Emiri Tip 79).

by: Prof. Nil Sari , Wed 27 December, 2006

Medical History

2007-06-07T01:47:00.000-07:00

Ear, Nose and Throat Medical Practice in Muslim Heritage

Figure 1. A miniature illustrating the treatment of a patient. Serefeddin Sabuncuoglu. Jarrahiyatu'l-Hâniya. Millet Library, Ali Emiri, Tib 79.

It is a good practice to unroll the pages of the past to discover the successive steps by which the existing state of things has been brought about. This statement is confirmed by Charles Cumston (1926) who said that "we can never be in full possession of a science until we know the history of its development" [1].

The Muslim civilization started at the seventh century and progressed rapidly in a relatively short time.

The Quran mentioned the ears and the sense of hearing several times and stressed its importance for learning, understanding and the development of mental capabilities [2]. It also mentioned the larynx and the respiratory distress that may be fatal in cases of severe exhaustion [2].

The nose, mouth, face and ears receive good hygienic care, as they should be washed several times daily in the process of ablution before the regular prayers.
There are several sayings by Prophet Mohammed about care for the ears, nose and throat and the use medications for their problems. In this respect he encouraged the use of local antiseptics, the hot and cold fomentations and the occasional use of venisection, cupping and thermo-cautery [3].

During later centuries at the time of the Umayads and Abbasid dynasties, more than one thousand eminent physicians led the progress of medicine in the main capitals of the Islamic world, Baghdad, Damascus, Cairo, Alexandria, Qairouan, Cordoba, Seville and Valencia.

Ear, nose and throat diseases and their treatment were under the care of general physicians, surgeons and paediatricians.

By their original thought and highly skilful medical practice, they added new discoveries, inventions and information to the existing knowledge of the anatomy and physiology of the ear, nose and throat. They discovered new diseases and new lines of medical and surgical treatment.

All this has been documented in several large medical books describing their work, that remained the essential reference works for many centuries all over the ancient world [4].

Anatomy and Physiology of the Ear, Nose and Throat:

Previous knowledge of the anatomy and physiology of the ear, nose and throat was limited and the method of hearing and phonation was unknown.

Credit goes to Rhazes (850-923), Avicenna (980-1036), Ali Ibn Abbas (……-994), Abdol Latif al-Baghdady (1161-1242), Ibn al-Baladi (……-971), Avinzoar (1092-1162), Abulcasis 936-1013) and Ibn al-Nafis (1210-1288) for the detailed description of the anatomy and physiology of the ear, nose and throat. They devoted complete chapters in their medical books to that purpose.

The books are al-Hawy by Rhazes, The Canon by Avicenna, Al Kitab El-Malaky by Ali Ibn Abbas, The Compendium in Medicine by al-Baghdady, The Care of Pregnant Women, Infants and Children by Ibn al-Baladi, Al-Tayseer by Avinzoar, Al-Tassrif by Abulcasis and Al-Shamel Fi Sinaat Al-Tibb by Ibn al-Nafis [6,7,8,9,11,12].

Figure 2. Application of the cauterization method to treat a sick man. Serefeddin Sabuncuoglu. Jarrahiyatu'l-Hâniya. Millet Library, Ali Emiri, Tib 79.

The anatomy of the ear was well described by Avicenna. The auricle has a funnel shape to collect sound waves, the external auditory canal has a narrow curved passage to protect the ear drum and to keep the external ear warm. This shows the importance of using warm ear drops in therapy. The drum is a thin membrane that responds to sound vibrations [6,7]. Ali Ibn Abbas [11] al-Baghdady [13] and Ibn al-Nafis were the pioneers who corrected the mistaken belief of a single common nerve to the ear and face and proved that there are two separate cranial nerves for them. Avicenna was also the first to explain hearing as the reception of sound waves on the ear drum [7].

The anatomy of the pharynx and larynx received detailed description by Avicenna. He described cartilages, ligaments, joints and the small muscles of the larynx, and identified their role in performing the different laryngeal functions [7].

Ibn Sidah, the eminent scientist and linguist of the tenth century, wrote a large text book, "Al-Mokhassus", on speech and singing. He described the characters, degrees and types of human voice. He added new scientific terms to describe the voice intonation, rhythm, humming, repetition, and resonance. He differentiated between pleasant toned voice, husky and melancholic voice [17].

Further phonetic studies were described by al-Faraby (878-950), the great Arab philosopher of the tenth century in his large valuable book "The Great Musician" [18]. More significant additions were found in the writings of Safa Brothers, a group of Arab philosophers who wrote a large collection of treatises on speech and other subjects. They explained sound, speech and language [21]. Their studies are considered the summit of pure science and forms the bases of present-day phonetic science [18,28].

The Ear, Nose and Throat diseases:

In the middle ages there were no equipment or tools available for the diagnosis of diseases. By their good observation and clinical skill, the Arab physicians were able to diagnose most of the known diseases of the ear, nose and throat.

As early as the ninth century, a complete documentation of the diagnosis and management of the diseases was available and large numbers of text books were written and became the main reference works for many centuries.

Rhazes (850-923) devoted a medical book to dealing with diseases of the teeth, ear, nose and throat, beside complete chapters in his large voluminous book "Al-Hawi". He used to examine patients under direct sunlight or by the use of reflecting mirrors, using special specula for the ear and nose and tongue depressors for the mouth and throat [4].

He described the inflammatory diseases of the external and middle ear and enumerated their complications, beside the description of the other diseases of the nose, mouth, pharynx and larynx [23].

He was the first to describe seasonal rhinorrhea and gave its causes, beside the study of different forms of the common cold. He was also the first to differentiate measles from smallpox and corrected the mistaken belief that they were one disease [22,25].

He identified alcohol and was the first physician who used it as a good antiseptic.

In surgery he added new discoveries. He has the credit of being the first physician who used general inhalation anaesthesia in the form of the anaesthetic sponge. A sponge immersed in a solution of opium, hyocyamus, mandragora and loisleuria was for inhalation before any surgery [10]. He used catgut in surgical practice for the first time and used to sterilise his instruments in a fresh liquid of bile. He also devised new surgical instruments used in his surgical practice.
The most admirable device was his invention of the knotted rope for the removal of nasal and nasophayngeal swellings. It is a thin rope with multiple knots, passed through the nose to the mouth and moved in out, having the same action as the present Gigli saw [25].

Avicenna (980-1036) was one of the leading Muslim physicians. He collected and synthesised much of the earlier work whilst also making additions. His major medical textbook "The Canon" became one of the main reference works in medieval times.

This work is a monumental contribution not only to medieval medicine but also to the universal history of professional medicine of all times. It was preferred over the previous medical works of Hippocrates, Galen and Rhazes in teaching in Eastern and Western universities.

His study of diseases and their management was partly borrowed from antiquity and partly developed from his own empirical observation and practices that are still alive today in traditional medicine in Far Eastern countries.

In his large encyclopaedia of medicine, Al-Canon, he devoted complete chapters to the anatomy, physiology and diseases of the ear, nose and throat [7].

Figure 3. A human body miniature shows internal organs. By Mansur bin Muhammad bin Ahmad, Kitâb-i Tashrih-i Badan-i Insân. Cerrahpasha Medical Faculty Library, 31.

For the diagnosis of E.N.T diseases he used reflecting mirrors, special specula and the use of finger palpation to differentiate between different swellings. His highly developed skill in palpation enabled him to diagnose oral, pharyngeal and laryngeal diseases with great accuracy.

He could differentiate between benign and malignant lesions and was able to diagnose vocal cord paralysis without any light visualisation [7].

He gave detailed information about the ear, nose and throat symptoms of deafness, tinnitus, vertigo, rhinorrhea, hoarseness, dysphagia and stridor. He enumerated the known causes of deafness and tinnitus and enumerated at least five types of tinnitus and referred for the first time to the oto-toxic deafness and tinnitus [5].

He devised new tools and instruments for the examination and diagnosis of diseases. He described a new way for evaluating the level of hearing by a free field voice test. He advised also for the first time a new curved metal tube made of silver or gold passed orally to the larynx to save suffocating patients. However, some historians have wrongly attributed the performance of the first endotracheal intubation to Mac Ewan and Einsenmenger in 1847 [16].

He used to perform his surgical operations under general inhalation anaesthesia administered by the anaesthetic sponge, and to sterilise the instruments in fresh liquid of bile and devised new instruments for surgery of the ear, nose and throat [19].

Ibn al-Baladi (……-971) was an eminent paediatrician during the tenth century, who wrote complete chapters on diseases of the ear, nose and throat in his large medical book "Care of Pregnant Women, Infants and Children" [8]. He discussed in detail the congenital, traumatic, inflammatory and neoplastic diseases of these organs [8].

Avinzoar (1092-1162), a great physician of Andalucia, who lived in Seville during the 12th century wrote a large medical book "Al-Tayseer", in which he fully discussed diseases of the ear, nose and throat.

He was the first Arab physician who disputed the humour theory of Hippocrates; he denied the four humours of the body and confirmed the presence of one body liquid which is the blood [12,24].

He was the first to give a real scientific aetiology of the inflammatory diseases of the ear, clearly discussed causes of stridor and gave a correct description of the tracheostomy operation for suffocating patients [12].

Abulcasis (936-1013) whose full name is Abol-Kasem al-Zahrawy, was a great 12th century surgeon, who is honourably considered the Father of Arab and European surgery. His large medical text book, "Al-Tassreef", is the first classic reference of his time. The thirtieth volume of this book is devoted to general surgery in which surgery of the ear, nose and throat is described in detail [6,9].

His eminence as a surgeon made historians consider him of equal reputation and standing and even surpassing Hippocrates. His surgical techniques flourished all over the world until the 18th century and have persisted in a modified form in our present day surgery [10,19].

He devised about 200 new surgical instruments such as knifes, curettes, retractors, spoons, sounds, hooks, rods and specula [26].

In his surgical practice he adopted such Arab innovations and additions as the use of the anaesthetic sponge for inhalation anaesthesia, the use of ice locally for surface anaesthesia, the sterilization of instruments in a fresh solution of bile. As did Avicenna and Ali Ibn Abbas, he used to ligate bleeding vessels at operations which was a new Arab addition [10,19,26].

Abulcasis revolutionized thermo-cautery by devising many new cauterizing tools for different purposes and he used them in the treatment of many diseases. This rational and careful use of thermo-cautery convinced historians to consider him the real inventor of thermo-cautery [9].

Figure 4. A human body miniature shows the blood vessels and nerve system. By Mansur bin Muhammad bin Ahmad, Kitâb-i Tashrih-i Badan-i Insân. Cerrahpasha Medical Faculty Library, 31.

The Muslim medical history comprises many other examples of great physicians, who added important innovations and discoveries to the field of the ear, nose and throat. Those who can be mentioned with great respect are Ali Ibn Abbas al-Magoussy (……-994) and his large text book, Al-Kitab Al-Malaky, Ibn al-Gazzar (899-979) and his medical book Zad al-Mosafer, Abdel-Lateef al-Baghdady (1161-……) and his Compendium of Medicine, and Ibn El-Nafis (1210-1288) and his large medical book, Al-Shamel Fi Sinn-aat Al-Tibb.

Summary and Conclusions

Muslim medicine is characterised by a high level of personal experience and critical clinical observation setting aside mythologies and legends.

The ear, nose and throat exemplify the participation of Muslim medicine and the contribution of the great Arab physicians to the study of the anatomy, physiology and diseases of these organs.
The Arab additions, discoveries and innovations were vital in the progress of medicine. They were all quoted by European physicians and helped in the rapid appearance of the European Renaissance.

A final word that deserves to be mentioned is that declared by the European physician De Boer who said "Medicine was absent till Hippocrates created, dead till Galen revived, dispersed till Rhazes collected, and deficient till Avicenna completed [19].

References

1. Cumston C.G., "An Introduction to the History of Medicine", Kegan Paul, Trench, Trubner and Co. Ltd, London, 1926, p. 78.
2. Al-Quran, The holy sacred book of Muslims.
3. Ibn El-Goziah, "Prophetic Medicine" (In Arabic), Arab Books Revival Press, Cairo, 1957, pp. 38, 66 and 74.
4. Guerrier Y. and Kuhn P.M., "Histoire des Maladies De l'Oreille, du Nez et de la Gorge", le Editions Roger Dacoste, Paris, 1980, pp. 18, 157.
5. Stephens S.D.G., "The treatment of Tinnitus, A Historical Perspective", the Journal of Laryngology, and Otology, October 1984, Vol. 98, p. 963.
6. Kataya S. (1982), "Ear Inflammation in Children in Arab Medicine", Proceedings of the Child in Arab Medicine Intern. Conference, Tripoli, Libya, March 15, 1982.
7. Avicenna A.H.A., "Al-Canon in Medicine", Vol. 1, 2 & 3, Dar Sader Press, Beirut, Lebanon, 1980, pp. 55, 148, 161, 1988.
8. Ibn al-Baladi, "Care of Pregnant Women, Infants and Children" (In Arabic), translated by Dr. Mahmoud Kassem, Ministry of Culture, Iraq, 1980, p. 262.
9. Abulcasis A.K.Z., "El-Tassrif", El-Nami Press, El-Kinoue, Vol. 30, Egyptian Public Library, No. 1035 Medicine. 1908.
10. Sigrid Hunke, "Allahs Sonne Uber Dem Abendland Uber Arabisches Erbe", Translated by Farouk Beydoune under the title of "Sun of Arabs Rises on the West", First Edition, The New Dar al-Aafak Press, Beirut, Lebanon, 1964, pp. 238, 279.
11. Ali Ibn Abbas al-Magussy, "Al-Kitab El-Malaky", Boulaq Press, Vol. 1 & 2, 12877, p. 462.
12. Avinzoar, "Abd al-Malek Ibn Zohr", "Al-Tayseer Fil Modawat Wal-Tadbeer", The 3rd Week of Science, The High Council of Sciences, Damascus, Syria, 1972, p. 148.
13. Abdol-Latif al-Baghdady, "Two Treatises on Sensations", Realised by Dr. Paul Ghalliounghi and Saieed Abdo, Kuwait, 1972, p. 85.
14. Ibn al-Nafis, "Al-Shamel Fi Sinaat Al-Tibb", Bodleian Manuscript Group, Youkuk, No. 248, 290, 291, 356, and 539.
15. Ibn al-Gazzar, "Siyasat Al-Sobian Wa Tadbeerohom", Realised by Mohammed Heilah, Tunisie, 1968, p. 102.
16. Sercer A., "Tracheostomy Through Two Thousand Years of History", Ciba Symposium Journal, Vol. 10, No. 2, 1965, p. 78.
17. Ibn Siedah A.A.I., "Al-Mokhassus", First Edition, Amiriah Public Press, Bulaq, Cairo, 1898, p. 142.
18. Al-Faraby A.M.T., "The Great Musician", Arab Writers Publishing and Printing House, Cairo, p. 1069, 1085.
19. Hussein M.K., al-Tennir A., al-Roby M. and Arab M., "The Concise History of Arabic Medicine and Pharmacy", The Arab League, 1978, pp. 85, 104, 207, 408.
20. Saleem Ammar, "Ibn al-Jassar and the Medical School of Qairouan", Proceedings of the 36th Intern. Congress of History of Medicine, Tunisie, Carthage September 1998.
21. Posty A.M.N., Zingati A.A.H., Nahregory and Rifaha O.Z. "Safa Brothers' Letters", Eygptian Printing House, 1857, pp. 117, 437.
22. Salman Kataya, "Comments on Rhazes' Treatise on Rhinorrhea", Journal of History of Arab Sciences, Vol. 1, No. 1, 1977.
23. Rhazes M.Z., "Al-Hawy in Medicine", The Ottoman Council of Knowledge, Heider Abad al-Dekin, India, Copy in The General Egyptian Library under the Serial No. 11193, year 1925.
24. Salman Kataya, "Abo Marwan Ibn Zohr", The Arab Medicine Journal of World Thought, Vol. 10, No. 8, Ministry of Kuwait Media, Sept. 1979, pp. 278, 286.
25. Faisal Dipsy, "The Ear, Nose and Throat in Rhazes's Medicine", Proceedings of the 16th Intern. Conference on History of Sciences, Emirates, Dec. 1996.
26. Khaled al-Hadidi, "The Role of Muslem Scholars in Oto-rhino-Laryngology", The Egyptian Journal of O.R.L., Vol. 4, No. 1, 1978, pp. 1-15.
27. Sabra A.I., "Avicenna", The Encyclopaedia Americana, Grolier Incorporated, U.S.A., 1982, Vol. 2, p. 87.
28. Letters of Safa Brothers and Waffa Friends, Dar Sader Printing House, Beirut, Lebanon, 1957.
* Mostafa Shehata is a Professor at Faculty of Medicine, Alexandria, Egypt

by: Prof. Mostafa Shehata, Fri 23 March, 2007

Medical History

2007-06-07T01:39:00.000-07:00

Selected Gleanings from the History of Islamic Medicine

A Series of Five Articles by Dr. Sharif Kaf al-Ghazal
1. The Influence of Islamic Philosophy and Ethics on the Development of Medicine in the Islamic Civilisation
2. The Valuable Contributions of al-Razi (Rhazes) in the History of Pharmacy
3. Al-Zahrawi (Albucasis) the Great Andalusian Surgeon
4. Ibn al-Nafis and the Discovery of Pulmonary Circulation
5. The Origin of Bimaristans (Hospitals) in Islamic Medical History

Islamic medicine is part of a long medical and scientific tradition that goes back to classical Greek times, ancient Persia and Sanskrit India. From the beginning, the Islamic civilisation showed a lasting curiosity and an open attitude to the intellectual products of previous civilisations, mainly in science, medicine and technology.

The earlier Greek medical teachings were welcomed and valued by the founders of the emerging Islamic science and medicine which needed to find ways of dealing with medical problems common to all peoples: disease, pain, injuries, and successful childbearing. This heritage of medical theory and practice, mingled with some Persian, Indian, and Arab elements, was assimilated and elaborated by a community of both Muslim and non-Muslim physicians speaking many languages – Arabic, Persian, Syriac, Hebrew, though Arabic became progressively the lingua franca and the dominant faith was Islam.

In the following, we introduce a series of five articles by Dr. Sharif Kaf Al-Ghazal on numerous aspects of the history of Islamic medicine. The author is a consultant plastic surgeon in England, honorary senior lecturer in Leeds university and founder and executive member of the International Society for the History of Islamic Medicine.

The articles deal with various subjects of medical history in Islam. Firstly, a general analysis of the influence of Islamic philosophy and ethics on the development of medicine is provided. This is followed by a focus on the appreciable contributions made by the well known scholar Muhammad al-Razi in pharmacy. Then the achievements of the great Andalusian physician Al-Zahrawi in surgery are detailed. The discovery of the pulmonary circulation by Ibn al-Nafis is the subject of the fourth article, while the fifth is dedicated to the description of an important medical Islamic institution, the hospital, known as Bimaristan. The article describes the

Bimaristan system and the varieties of hospitals in Islamic times (like the hospital for mental disease or for leprosy), and hospitals for different locations and social functions (road, prison and mobile hospitals).

Physicians of Islam

Among the names that influenced profoundly the history of Islamic medicine we can mention the following names:

Abu Bakr Muhammad Ibn Zakariya al-Razi (865-925), a prolific author of dozens of medical treatises. Al-Razi is a well known Muslim physician and writer, whose medical writings greatly influenced the Islamic world and Europe in the Middle Ages where he was known under the Latinized form of his name, Rhazes.

Hunayn Ibn Ishaq (lived in Iraq between 808 and 873) was a Christian of Syriac origin. He was a great translator of the works of Aristotle, Galen, and Hippocrates and the author of numerous original texts in different fields of medicine, from ophthalmology to odontology. His works on the eye remained influential until the 15th century.

Figure 1. Opening of Al-Qanun fi 'l-tibb (Canon of Medicine) by Ibn Sina.

Ibn Sina, the famous Avicenna (d. in 1037 CE), left a huge amount of works, of which the most famous in medicine is without contest al-Qanun fi 'l-Tibb (The Canon of Medicine), an encyclopedic text that constituted the basis for medical teaching in the Muslim West as well as in Europe until the last centuries.

Abu 'l-Walid Muhammad ibn Ahmad Ibn Rushd, known in the West as Averroes, was born in Cordoba in 1126 and died in Marrakech in 1198. Jurist, philosopher and physician, his commentaries on the treatises of Aristotle influenced European thought until the 16th century. His knowledge of medicine is appreciable and is illustrated by his famous book Kitab al-Kulliyyat fi 'l Tibb (Book of the Generalities in Medicine), translated into Latin under the title Colliget.

Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (936-1013), also known in the West as Abulcasis, was an Andalusian physician. He is considered as the greatest surgeon in the Islamic medical tradition. His comprehensive medical texts, combining Middle Eastern and Greco-Roman classical teachings, shaped European surgical procedures up until the Renaissance. His greatest contribution to history is Al-Tasrif, a thirty-volume collection of medical practice.

Ibn al-Nafis, whose full name is 'Ala' al-Din Abu Al-Hassan al-Qarshi (1213-1288), was a physician from Damascus, Syria and he worked also in Egypt. He is mostly famous for being the first to describe the pulmonary circulation of the blood and the coronary blood supply to the heart. The most voluminous of his books is Al-Shamil fi 'l-Tibb (The Comprehensive Book in Medicine), an encyclopaedia which was planned to comprise 300 volumes. Ibn al-Nafis challenged the theory accepted by Galen about the circulation of the blood and proposed a new one based on his anatomical knowledge. He was the first to describe the circulation of the blood from the right chamber of the heart through the pulmonary artery to the lungs where it is mingled there with air, and then how it passes through the pulmonary vein to reach the left chamber of the heart. He conceived of the heart as clearly composed of two ventricles between which there is "absolutely no opening". His description of the anatomy of the heart and of the lungs attest that he was at least familiar with the results of dissection, even if he did not perform it himself as far as we know.

Bimaristans, the first hospitals

Historians of Islamic medicine, from Lucien Leclerc to Françoise Michau, stressed the importance of the foundation of the bimaristan system in medical history. They described also in full detail the modernity of the funding system of these institutions, based on charitable endowment (Waqf), a system similar to modern sponsorship but with a strong religious and moral dimension.

Figure 2. The classical work of Lucien Leclerc Histoire de la médecine arabe, 2 vols. (Paris:

Ernest Ledoux, 1876). On-line publication at the Bibliothéque interuniversitaire de Médecine, Paris: http://web2.bium.univ-paris5.fr/livanc/?cote=31500x02&do=chapitre

Figure 3. Cover of La médecine arabe et l'occident médiéval (Arabic Medicine and the Medieval West) by Danielle Jacquart and Françoise Micheau (Paris: Maisonneuve & Larose, 2005).

When he visited the Muslim Middle East in the years 1183–1184, the Andalusian historian and traveller Ibn Jubayr could not hide his admiration and exclaimed that the hospitals are among the best titles of glory of Islam. He found these institutions in most of the towns of Egypt, Syria and Iraq. The hospital was known in Arabic by the original name of Bimaristan, a word of Persian origin that was often contracted to maristan. The modern use in certain Arabic countries of maristan in a limited sense, such as that of mental hospital in Egypt, comes from this old origin.

The most famous hospitals of the classical times of Islamic civilisation were Al-Adhudi in Baghdad, Al-Nuri in Damascus and Al-Mansuri in Cairo. Al-Adhudi hospital was established in 372 H / 982 CE by the Sultan 'Adhud al-Dawlah. When it was founded it had twenty five doctors, including oculists, surgeons, and bonesetters. In 580 H / 1184 CE a traveller described it as being like an enormous palace in size. In the 12th century, Salah al-Din al-Ayyubi (known as Saladin) founded Al-Nasiri hospital in Cairo, but it was surpassed in size and importance by Al-Bimaristan al-Mansuri, which was completed in 638 H / 1284 CE, after eleven months of construction. The hospital Al-Nuri in Damascus was a major medical institution from the time of its foundation in the middle of the 12th century until the 15th century, by which time the city contained a further five additional hospitals.

Other towns of the Islamic world knew the foundation of hospitals. In the Arabian Peninsula, the cities of Mecca and Medina, and in al-Qayrawan, hospitals were built. In Iran, several relief and healing institutions existed. The hospital of Rayy was headed by al-Razi as early as the late 9th century, before his moving to Baghdad. Later on, Ottoman hospitals flourished in Turkey in the 13th century, and there were hospitals which spread through the Indian Muslim provinces. In al-Andalus, the Muslim Spain, even though hospitals were comparatively late to be founded, the earliest was possibly built in Granada, other similar institutions existed in Sevilla and Cordoba.

by: FSTC Limited, Tue 03 April, 2007

Hospital

2007-06-07T01:38:00.000-07:00

The Marrakech Hospital

The hospital was called Hospital of Amir al-Muminin al-Mansur ibn Yusuf.

AI-Mansur was an Almohad ruler who ruled Morocco and Spain from 1184 until his death in 1199.

Al-Mansur had a hospital built has no equal in the world. For his purpose he chose a very extensive area in the centre of the city. He ordered the masons and the builders to carry out his plans with the greatest perfection possible. He decorated the hospital with inscriptions and designs of surpassing beauty.He ordered that flowers should be planted and cultivated in the courtyard, as well as fruit trees, and to have flowing water conducted to all the wards and rooms.

He ordered the hospital to be equipped with furniture. He endowed it with ample waqfs and donations, providing the hospital with a daily sum of forty dinars for its expenses.
Pharmacists were employed to prepare food and drink and needed medicaments, as well as clothing for the summer and winter for the patients. When a poor patient left the hospital he was given a sum of money until he could find employment. When a rich patient was discharged he received his money and belongings beforehand. The hospital was accessible to rich and poor alike. If a stranger was taken ill in the city he was admitted and treated until he was well or until he died.

Every Friday the monarch rode to the hospital and visited the sick, asking about the state of their health and making inquiries about their needs. The caliph continued this custom until his death.

by: FSTC Limited, Fri 20 December, 2002

Hospital

2007-06-07T01:30:00.000-07:00

The Al-Nuri Hospital

Nur al-Din al-Zangi was the first great leader to first defeat the crusaders, over half a century after they set foot on Islamic land. It was said of him that he was a just, pious and charitable monarch.
ln 1154 Nur-al-Din Zangi built a hospital in Damascus. It was called al-Nuri, or al-Zangi.

The revenues of the hospital according to al-Maqrizi owe to the fact that Nur-al-Din had made prisoner a European king, and had planned to have him executed. But the king paid as his ransom, four forts and 500,000 dinars, and he was put at liberty. Nur-al-Din decided to use this ransom to build the hospital in Damascus that was named after him. Ibn abi Usaybi'ah wrote:

"When Nur-al-Din built the Grand Bimaristan he appointed as the director Abul Majd al-Bahilli. This physician went regularly to the hospital to care for the patients, to examine them and to give the necessary orders to the attendants and servants who worked under his direction. After that this physician went to the citadel to examine the dignitaries and the noblemen that were ill.

This task completed he returned to the hospital, sat in the liwan (vestibule hall) richly furnished, and commenced his lectures."

Nur-al-Din furnished and endowed this hospital with many books on medicine that were kept in two great cases in the center of the liwan. The physicians and practitioners assembled before him to discuss medical subjects and to listen to the lectures that Abul Majd gave his pupils.

These discussions and lectures lasted three hours.Khalil ibn-Shahine al-Zahiri told about his visit to Damascus :

"I was accompanied by a distinguished and affable Persian. When he visited the al-Nuri hospital and saw the diets, the utilities and the comforts to be found there, he decided to see for himself, what being a patient was like in that hospital. He pretended illness and was admitted to the hospital. There the medical chief visited him every day and took his pulse and prescribed his diet, consisting of a variety of meats, fat chickens, candies and drinks and fresh fruits. On the third day the doctor told him that such patients were not allowed to stay more than three days, and asked him to leave."

by: FSTC Limited, Fri 20 December, 2002

Hospital

2007-06-07T01:27:00.000-07:00

The Beginning of the Islamic Hospitals

Possibly the earliest hospital in Islam was a mobile dispensary following the Muslim armies, dating from the time of Prophet Mohammed (PBUH); a tradition which remained throughout the centuries of Islamic Civilisation.Decades elapsed, before the first hospital building was built in Damascus in 706 by Al-Walid, the Ummayad Caliph. It was to cater for all sorts of patients (including the blind, and even the lepers). Its equipment, staff and organisation, served as model for other hospitals to follow.Both Caliphs Harun al-Rashid and Al-Mansur had hospitals built in Baghdad.' In Cairo, the first hospital was established at al-Fustat by Ibn Tulun, governor of the city in 872.

By the 12th century, the hospital had become a very advanced institution, witness al-Nuri hospital, built in 1156 by Nur al-Din Zangi, a hospital where patients were well fed, and cared for, and where there was a large library for teaching. In Cairo, in 1285, Sultan Qalaun al-Mansur built the largest of all hospitals, described by Durant: (see reference below)

`Within a spacious quadrangular enclosure four buildings rose around a courtyard adorned with arcades and cooled with fountains and brooks. There were separate wards for diverse diseases and for convalescents; laboratories, a dispensary, out-patient clinics, diet kitchens, baths, a library, a chapel, a lecture hall, and particularly pleasant accommodations for the insane.

Treatment was given gratis to men and women, rich and poor, slave and free; and a sum of money was: disbursed to each convalescent on his departure, so that he need not at once return to work. The sleepless were provided with soft music, professional story-tellers, and perhaps books of history.'

by: FSTC Limited, Fri 10 January, 2003

Hospital

2007-06-07T01:19:00.000-07:00

Central Asian Contributions to the earlier phases of hospital building – Activity in Islam

The illustration of gate of Divrigi Dar al-shifa

This short article is taken from the full article which is available here as a PDF file
By Aydin Sayili

In ancient Egypt and Mesopotamia scientific medicine lived side by side with religious and magical medicine. With the passage of time, scientific medicine made remarkable strides and the Greeks, in developing their scientific medicine, benefited greatly from the knowledge and experiences of Egyptian and Mesopotamian physicians.
Asklepion was the Greek temple of cures which was devoted to Apollo and Asklepios, the gods of healing. Treatment was brought about by priests in these institutions and the psychological aspect occupied a prominent place within it. They were places of miraculous cures yet ordinary physicians did not participate in any major way. Thus, although Greek philosophers were eminently successful in excluding magic from medicine, they could not extend their hegemony to the field of religious medicine and they could not dominate the procedures of cure exercised in the asklepia, where miraculous cures were supposed to be an almost daily occurrence.
With the beginning of Christianity the temples of cure did not wholly evaporate but belief in pagan gods gradually disappeared. Asklepios was abandoned together with the other gods and Christ became the true healer. Likewise, the Dioscuri, Castor and Pollux gave their places to new patrons of the healing art. Apollo's temple on the Palatine was demolished and out of the same stones, on the same site, was erected the first church consecrated to Sebastian, the Christian martyr and protector against the plague.

Some scholars have looked upon the Byzantine hospitals as the direct predecessors of the Islamic ones. Geographical considerations make this position seem reasonable, especially since hospitals such as that of Jerusalem lay within the territories annexed by the Arabs during the reign of the first four caliphs. But the main point of resemblance between the Byzantine and the Muslim hospitals is found in their charitable nature. However in this respect influence from Byzantium may not be considered to be essential. Moreover there are contrasting features between the two. For, contrary to the Islamic hospitals, the priest also seems to have had some role in the Byzantine hospitals in their curing of the sick.

Some of the differences between the pre-Islamic hospitals of Byzantium and the Islamic hospitals seem indeed to be very sharp. In Islam there were hospitals in the modern sense of the word, specialized establishments where the sick were treated and discharged at the termination of their treatment. The Byzantine hospitals had not reached this stage of specialization.

The Romans had hospitals setup especially for military purposes in addition to the valetudinaria of the slaves and the gladiators and there were also pre-Islamic hospitals in India. But perhaps the most important pre-Islamic hospital, available as a model for the early Islamic ones, was that of Jundisapur.
The humanitarian features of the Islamic medieval hospital must not be allowed to eclipse its high medical standing per se. The hospital, by the middle of the tenth century at least, was one of the high water marks of the Muslim civilization. The best available medical knowledge was put to practice within them and they had specialized physicians with special wards and organised staff members.

The first hospital built in Islam was in Damascus in the year 88 after the Hijra (AH), i.e. 706-707 CE. The founder was Walûd ibn Abdulmalik (705-715) - the sixth Umayyad caliph. This first Islamic hospital had been created for the purpose of curing the sick and giving care to those afflicted with chronic diseases and for looking after lepers, the blind and the poor. There was more than one physician employed at this hospital.

The construction of one other hospital in Umayyad times is reported; this was in Cairo. Our only source concerning its existence is in Ibn Duqmaq (d. 1406) and it contains no specific information concerning the nature and characteristic traits of this hospital.

I have not come across other examples of this nature in medieval Islam. Thus, though the medical aid station of Ibn Tulun does not seem to have served to establish a tradition in Islam, it serves to corroborate the existence of influences from Indian medicine upon the early hospitals of Islam. It also shows that there were Central Asian and, more specifically, Turkish contributions to the early hospital building activities of the Islamic World.

by: FSTC Ltd , Tue 03 May, 2005

Hospital

2007-06-07T00:51:00.000-07:00

The Modern Hospital in Medieval Islam

This short article is taken from the full article (by Prof. Aydin Sayili) which is available here as 8 page PDF file

Piety and Philanthropy cannot very well be divorced in medieval Islam, but by observing the Muslim hospitals and other institutions of charity and social welfare it is seen quite clearly that the idea of public assistance had developed beyond what piety alone could have produced. A discriminating and comprehensive consideration of the necessity of public assistance and social welfare, beyond mere religiosity, may be said to have been responsible for the quality and quantity of the hospitals of Islam.

Moreover, the humanitarian features of the Islamic medieval hospital must not be allowed to eclipse its high medical standing per se. The hospital was one of the most developed institutions of medieval Islam and one of the high-water marks of the Muslim civilisation. The hospitals of medieval Islam were hospitals in the modern sense of the word. In them the best available medical knowledge was put to practice. They were specialised institutions. Unlike the Byzantine hospitals, they did not have a mixed function of which the treatment of the sick was only one part.

Of the pre-Islamic hospitals, the temples of healing, represented mainly by the Greek asklepion, were places to which the idea of miraculous cure was far from being alien. The psychological effect and the mystifying atmosphere of these temples must certainly have played a great part as far as the experience of t he patients was concerned. Although psychological factors were not ignored or excluded from the Islamic medieval hospitals, the essential and epoch-making characteristic of these institutions was their insistence on high standards and their strict adherence to scientific medicine.

The king of Egypt Mansur Qalawun (1279-1290), while still a prince, fell ill during an expedition which he was directing in Syria. He was so impressed by the Nuri Hospital of Damascus, founded in 1154 by Nuruddin Mahmud Zangi ibn Aksungur, in which he was treated, that he made a vow to found a similar institution as soon as he ascended the throne. The Famous Mansuri Hospital of Cairo thus resulted from that enthusiasm borne out of close acquaintance with Damascus's Nuri Hospital. This shows that the larger hospitals of medieval Islam were fit to cater to people of highest social standing.

As the hospital reached in Islam a high standard to which it had not attained before, it must have gone through a process of development within the World of Islam itself. The first and earliest six hospitals of Islam may be said to mark an initial process of speedy evolution spanning a period of less than two centuries during which, beginning apparently from a modest status, the Islamic hospital became a stronghold of scientific medicine and adapted itself to Muslim ideologies and economic requisites. It thus acquired a stabilised form, spread widely, and became an integral part of city life.

Image Sources

Image (front). Bayazid II Kulliye, Edirne, Turkey from Islamic Science, Seyyed Hossein Nasr, 1976

Image (top). Mansur Qalawun's mosque from http://weekly.ahram.org.eg

Image (bottom). The treatment of a patient by the surgeon miniature by Sharaf al-Din Sabuncuoglu's book Jarrahiyat al-Haniyya

by: FSTC Limited, Wed 13 December, 2006

Health Protection

2007-06-07T00:48:00.000-07:00

Health Protection in Islam

Quoted from N. Daniel in The Arabs and Mediaeval Europe; Edinburgh University Press; 1974: Chapter I 0; p.292:

Ibn Butlan's Taqwim As-Sihha (Protection of Health) was translated as Tacuinum Sanitatis, retaining the Arabic word with the translation "regimen". It begins, "On the six things that are necessary to any man for the daily conservation of his health, with its corrections and operations." These are immediately listed

"The first care of health is the preparation of the air, which affects the heart. The second is the regulation of food and drink. The third is the regulation of movement and rest. The fourth is the restraint of the body from sleep and from much watching. The fifth is the regulation of the relaxation and constriction of the humours. The sixth is regulation of the person to moderate joy, anger, fear and anxiety.

So the preservation of health will be in these methods of balance, and the removal of these six from that balance makes illness, God the Glorious, the Almighty, permitting. And under each of these kinds there are many types, and many things necessary of which, God willing, we will describe the natures ... Let us invoke the help of God that He may make straight our mind, for human nature can scarcely be prevented from error…"

The emphasis is more on health than on disease. Near the beginning of Ibn Sina's Canon of Medicine there comes this happy start: "I say that medicine is the science by which the dispositions of the human body are known, in order that customary health may be preserved or, being lost, may be recovered." Ibn al-Wafid's On the Powers of Medicines and Foods… makes similar points:

"I have put together this book on the virtues of medicines and foods, out of the books of the ancients; for long have I wearied my mind with it . . . I have poured forth prayers on it that it may come near to God, the Exalted, the Glorious . . . The object of medicine is health, and according to two modes. The first is the knowledge of the complexions of the bodies of men. The second is the knowledge of medicines and foods, by the knowledge of which health is maintained in the healthy man and restored in the sick man."

by: N. Daniel, Sun 21 July, 2002

Health Protection

2007-06-07T00:41:00.000-07:00

Lady Mary Wortley Montagu and the Introduction of Smallpox Vaccination to England

Smallpox - "the most dreadful scourge of the human species" according to Edward Jenner - was declared to be eradicated in 1980 after its existence for thousands of years as a contagious and potentially fatal disease. The English doctor Edward Jenner is credited with discovering the vaccine for smallpox. Yet as with all great breakthroughs, it could not have happened had he not been standing on the shoulders of others who did their bit to reduce the dangerous impact of this illness.

Before Jenner's discovery, the usual method of immunisation from smallpox was variolation which is "the earliest known inoculation technique" and had been practiced for millennia throughout the world. Variolation involved "exposing a healthy person to infected material from a person with smallpox in the hopes of producing a mild disease that provided immunity from further infection."

By the later part of the seventeenth century, inoculation for smallpox was an established practice in several European countries at which the disease had arrived by the coast of the Bosporus via Constantinople. In the early part of the Eighteenth century, Doctor Timoni noted the method as he had observed in Constantinople. Other European doctors in Constantinople and a Reverend in America also raised awareness of the variolation process during this same period.

However, the person acknowledged with promoting variolation in England is Mary Wortley Montagu (1689-1762), otherwise known as Lady Montagu. She was the daughter of the Duke of Kingston and the wife of Edward Wortley Montagu, British Ambassador to the Court of the Ottoman Empire in Constantinople and representative of the Levant Company. Edward and Mary Montagu along with their young son arrived in what is now Turkey in 1717.

Lady Montagu was renowned as a writer and her works are used by scholars in many disciplines for their comments on politics, diplomacy, music, health, art, medical history and social history. In her first year of living in the Ottoman Empire, Lady Montagu came across variolation (which she named ingrafting). She wrote to her friend Miss Sarah Chiswell and explained the process as she had seen it in Constantinople. She intended to introduce this knowledge to English physicians and campaigned enthusiastically for the launch of smallpox inoculation in England.

Lady Montagu was especially interested in smallpox prevention as two of her relatives died from the illness and she herself had survived a childhood bout of the disease although it had left her face pockmarked (although, she managed to hide her marks and was considered quite beautiful).

In her letters to various influential people, Lady Montagu pushed for inoculation in England. So convinced was she of the efficacy of variolation in preventing the disease, that she had Edward, her only son inoculated at the British embassy with the assistance of an old Greek woman who had practiced inoculation for some years, and with the assistance of Dr. Maitland, surgeon to the embassy.
After her return to England in 1721, she urged for trials of the variolation method. Consequently a group of criminals under sentence of death in Newgate Prison were offered a full pardon if they would undergo inoculation. Six men agreed to this and none suffered from the medical procedure. Subsequently they were released. The method was also successfully practised on a number of orphans, and soon afterwards, the two children of the Princess of Wales were also inoculated. This latter royal approval ensured that variolation became rapidly acceptable amongst elite society. There was, however, scepticism and resistance amongst the general public, while the church condemned the practice as immoral.
However, despite the successes detailed above there was still a risk of fatality since variolation could potentially spread the disease as inoculated people were temporarily carriers of smallpox. But for at least another seventy years variolation was used as a form of immunisation against smallpox until Edward Jenner introduced his vaccine which involved the inoculation of humans with cowpox in order to prevent smallpox infection. (Incidentally, the term vaccine comes from the Latin word vacca which translates as cow).
In more recent times, it is estimated that 300 million people died from smallpox during the 20th century. Following mass vaccination programmes after 1966, the World Health Assembly announced, fourteen years later, that the world is free of small pox.
Image Sources:
Image 1 (Lady Mary Montagu) source: www.sheffieldgalleries.org.uk
Image 2 (Turkish stamp) source: www.adc.bmjjournals.com
Image 3 (A Caricature of Dr. Jenna): www.micro.msb.le.ac.uk

by: Dr. Salim Ayduz, Fri 24 March, 2006

Health Protection

2007-06-07T00:23:00.000-07:00

Al-Razi on Smallpox and Measles

Muhammad Ibn Zakariyya al-Razi was the first physician in history who described in details the symptoms and signs of smallpox and measles based on clinical examination, and he was the first who distinguished between these two diseases by putting what is called now the differential diagnosis. This was very clear in his book: The Book on Smallpox and Measles. A manuscript of this book is kept now in Leiden University Library in the Netherlands under the number 761.

We have in our Institute for the History of Arabic Science in Aleppo a microfilm of this manuscript. This book was twice translated into Latin in the 18th century. This book consists of fourteen chapters. The third chapter is considered the most important of this book; it is entitled ?The chapter related to the symptoms suggesting the exacerbation of smallpox and measles'. The aim of this study is to describe this book revealing its importance in the field of history of Islamic medicine.

Short Biography

Abu Bakr Muhammad Ibn Zakariya al-Razi was born in al-Ray City near Tehran in 251 H / 865 CE and died there in 313 H / 925 CE. He was a well known Muslim physician and writer, whose medical writings greatly influenced the Islamic world as well as Western Europe in the Middle Ages. He wrote on almost every aspect of medicine. Al-Razi moved to Baghdad when he was forty years old, and headed many hospitals. Europe knew him under the Latinized form of his name, Rhazes.

The Sultan 'Adhud al-Dawla asked him to find a suitable place for establishing the Bimaristan al-Adhudi. He hanged pieces of meat in various places of the city and decided for the place where the putrefaction of the meat was the slowest.

Al-Razi composed more than two hundred books related to medicine, pharmacy, philosophy, music and many other sciences. And he is considered the first who founded experimental science especially in the field of medicine and chemistry, given his major interest in the experimental methodology in different natural sciences.

Al-Razi's Book on Smallpox and Measles (Kitab al-Jadari wa 'l-Hasba)

Al-Razi was the first physician in history who described in details the symptoms and signs of smallpox and measles based on clinical examination, and he was the first who distinguished between these two diseases by putting what is called now the differential diagnosis. This was very clear in his Book on Smallpox and Measles. A manuscript of this book is kept now in Leiden University Library in the Netherlands under the number 761. A microfilm of this manuscript exists in the Library of the Institute for the History of Arabic Science in Aleppo. This book was edited in Arabic and gained a great popularity in Europe after that it was translated several times into Latin and other European languages, including French, English and German.

According to Honka, the book was published in Europe forty times between 1498 and 1866. But the interest that surrounds this book was during the 18th century, at a time when there was much interest in the inoculation or varulation around 1720 following the description of the procedure in Turkey by Lady Mary Wortley Montagu, the wife of the Ambassador Extraordinary to the Turkish court in Istanbul.

Figure 1. On-line publication of al-Razi's Kitab fi 'l-jadari on the website of the American University of Beirut, Lebanon (p. 1). Source: ttp://almashriq.hiof.no/ddc/projects/saab/S16R27/index.html.

Al-Razi began his book with a short introduction, in which he explained the direct cause for composing his treatise, as he did not find a satisfying book written by the physicians before him dealing with this subject.

The book consists of fourteen chapters. The first defines the causes of the two diseases and why just few people could escape from the attack. In the second chapter al-Razi mentioned the bodies which are more susceptible to get smallpox, and the times in the year in which the disease is more common. In this regard he says that thin, hot and dry bodies are more susceptible for measles and not to smallpox, while thin, cold and dry bodies are not susceptible for both diseases, but if they are attacked by smallpox, the disease will be benign. The times in which smallpox is most probable to widespread are at the end of autumn and the beginning of spring. In severely hot and dry summers and also if the autumn was hot and dry without rain, measles would be more expected in susceptible individuals.

The third chapter is the most important of the whole book. It is entitled ?the chapter related to the symptoms suggesting the exacerbation of smallpox and measles'. In this chapter al-Razi declares that before a smallpox eruption, the patient complains of continuous fever, back pain, nose itching and sleeping disorders. Then he mentions many other general symptoms and signs such as generalized pain, breathing difficulties, cough, redness in the cheeks and eyes, sore throat, dry mouth, hoarseness, headache, anxiety and sometimes syncope may be developed.

Upon reviewing this text we can recognize that al-Razi clearly emphasized that smallpox is different from measles, and he declared that there are common signs for the two diseases, and other more specific signs for every disease, enabling the physician to make a differential diagnosis between them.

The most probable common signs between smallpox and measles are: Continuous fever, nose itching, allergy in the body, cheek and eyes redness, sore throat, chest pain, breathing difficulties, cough, hoarseness, headache and sometimes syncope. The author says that it is not necessary that all of these symptoms and signs should appear together, as some of them may be absent. On the other hand, regarding the symptoms, which are specific for every disease, he says that back pain is more sever in smallpox, while it may be slight or absent in measles.

Distress, syncope and anxiety are more prominent in measles.

The fourth chapter is on the management of smallpox in general, so he indicates ten procedures which should be carried out to achieve this purpose. The fifth chapter, which is the longest chapter of the book, deals with the prevention of smallpox before the appearance of its signs, and diminishing its diffusion after the signs appear.. In this chapter al-Razi advises to perform venesection to all patients above fourteen years old, and cupping for young patients. Then his advice is to use special diets according to the patient's condition and age.

The sixth chapter is on the factors which accelerate the appearance of skin lesions in smallpox. Al-Razi says that a massage and drinking cold water could accelerate the appearance of smallpox and measles especially when the fever is severe, thus the disease will pass easily. Also he mentioned the use of many herbal drugs which may play an important role to achieve this purpose.

The seventh chapter is on taking care of the eye, throat and other organs, which need to be cared for after the appearance of smallpox signs. In this chapter al-Razi explains how this care should be performed. He also draws attention for taking care of the feet and hands, as severe pain may develop resulting from sclerosis of the skin in these members.

The eighth chapter is on the factors which accelerate the maturation of smallpox. Here al-Razi advises in the case where the patient is in a good condition, the physician should do his best to mature smallpox. In this case, bandages of hot water with some flowers boiled inside it are applied to the sites of the lesion.

The ninth chapter is on the factors which dry or desiccate smallpox. In the case where smallpox is wet, some kinds of ointments taken from many kinds of plants like rice are applied to dry it and make it possible to be removed.

The tenth chapter is on the substances which remove the crust. Al-Razi says that if the lesion became dry and a residual of crust is still dominant, the physician should look if it was thin and dry the ointment of acetic acid should be applied first several times until it completely disappears. When the lesion is located in the face, a special kind of ointment derived from peanuts should be used. If the crust is wet, the physician may carefully scrape it off without using any ointment.

The eleventh chapter is on the substances, which remove the residual effect of smallpox on the eye and all the body. Here al-Razi differentiates between the residual effects of smallpox on the eye from that on the rest of the body. In the first case he indicates to use many kinds of ointments, some of them derived from animal products. If the lesions are located all over the body, many compound ointments may be used.

The twelfth chapter is on the diet recommended to a smallpox patient. The patient should drink malt (barley with water) exactly as done in acute diseases. Also, peeled lentils mixed with some other juices like acetic acid, may be of beneficial effect for smallpox patients.

The thirteenth chapter is on the management of bowel function. Al-Razi states that in the last stages of most cases of measles and smallpox the faeces is soft especially in measles, therefore laxatives should be avoided except in the early stages of some cases of smallpox especially when there is fever or headache.

The fourteenth chapter is on the prognosis of smallpox and measles. In this last chapter al-Razi describes the signs where the prognosis is bad, and where the prognosis is good. He considered severe pain, continuous fever, insomnia, nose itching and a shining color of the eruption as signs of bad prognosis.

Figure 2. On-line publication of al-Razi's Kitab fi 'l-jadari on the website of the American University of Beirut, Lebanon (p. 1). Source: On-line publication of al-Razi's Kitab fi 'l-jadari on the website of the American University of Beirut, Lebanon (pp. 2-3). Source: http://almashriq.hiof.no/ddc/projects/saab/S16R27/html-640/003-002.html.

The Scientific Value of the Book

1. Al-Razi's Book on Smallpox and Measles is considered the first one of its kind, as it gives an explanation for smallpox and measles in an isolated book.

2. In the first chapter he mentioned that the putrefying air is a contributive factor for spreading the disease.

3. In this respect, al-Razi is credited as the scholar who differentiated, for the first time in the history of medicine, between these two diseases, and described every disease separately in details, unlike all Greek and Arab physicians before him, who considered the two diseases as one disease. Many historians such as Justave Lebon, Sigrid Honka, Douglas and others recognized this priority.

In this book, al-Razi differentiated between the two diseases in three places: in the second chapter, when he talked about the bodies which are more susceptible to get smallpox, and the times in the year, in which the disease is more common. Also, in the third chapter he pointed out the symptoms that suggest the eruption of smallpox and measles. In the fourteenth chapter, which is on the prognosis of smallpox and measles, he also differentiated between these two diseases.

4. He recognized the relationship between the type of the eruption in measles and the severity of the disease.

5. The opinions of al-Razi are characterized by being free of false old concepts, so it was clear that al-Razi was very keen to prescribe the treatment in detail and the kinds of food which are more suitable, as he believed that food has an important role in the treatment.

6. Al-Razi disagrees with other physicians before him in using cold water to neutralize severe fever in smallpox and measles diseases.

7. The Kitab al-judari wa 'l-hasba provides a decisive proof that al-Razi, such as many other Muslim physicians, was not just a translator of Greek, Indian and Syriac medicine. Indeed, in addition to the very important achievement exposed in the treatise, he innovated a lot of theories and new opinions, which contributed in medicine development at that time.
Harrison's textbook of internal medicine mentioned that al-Razi was the first who described the measles disease and differentiated it from smallpox. Also, in the popular Encarta Encyclopedia (1998 edition), it is written: "Al-Razi's personal experiences and observations as a physician make al-Hawi a landmark in the history of medicine. In his most famous work, Treatise on Smallpox and Measles, al-Razi gives the earliest known description of smallpox".

The smallpox and measles diseases were dealt with by al-Razi in several of his other medical works, as shown in the following paragraphs.

Al-Hawi fi 'l-Tibb

Al-Hawi fi 'l-Tibb is an extremely important source for our knowledge of Greek, Indian and early Arabic writings, for al-Razi was meticulous about crediting his sources. Al-Razi died before arranging fully the book, but his followers rearranged it under the supervision of Ibn al-'Amid who was the minister of al-Hassan ibn Bouyeih. This comprehensive book on medicine, al-Hawi, was translated into Latin in 1279 under the title of Liber Continens by Faraj ben Salem, a physician of Sicilian Jewish origin, employed by Charles of Anjou to translate medical works. Later it was translated many times into Latin, and became one of the nine books relied on in teaching in the medical college library of Paris in 1395. A special part of this book, which is related to pharmacology, was still considered the first reference in Europe for a long time after the renaissance age. There is a rare manuscript of the translation of al-Hawi into Latin, written in 1282, in the French National Library in Paris. The first edition was published in Italy in 1486 under the title: Liber Dictus Elhavi, then many editions appeared, the last one was under the title: Continens Rasis in 1542. There exists a rare copy of this edition in the Cambridge Library, UK.

Figure 3. On-line publication of al-Razi's Kitab fi 'l-jadari on the website of the American University of Beirut, Lebanon (p. 1). Source: On-line publication of al-Razi's Kitab fi 'l-jadari on the website of the American University of Beirut, Lebanon (pp. 2-3). Source: http://www.nlm.nih.gov/exhibition/islamic_medical/image/image09.gif.

Al-Hawi' is still considered the largest medical textbook edited from the Arabic language up to date, as it consists of twenty three volumes, according to the edition which was accomplished by the Othmania Publishing House in Haydarabad, India between 1955 and 1971.

In the 17th volume of the book, al-Razi discussed smallpox and measles. He described the eruption of measles as a red skin maculae without protrusion into or out of the skin, while the eruption in smallpox is infiltrated into skin. Then, he mentions that the smallpox eruption appears as groups, while the measles eruption appears altogether. He considered the black and violet colors of the eruption in smallpox as bad prognosis.

Figure 4. The Latin translation of al-Hawi: Albubecar Muhamed Rhazes, Continens Rasis… (Venise: Ottaviano Scoto, 1529). Online publication on the website of the Bibliothèque Interuniversitaire de médecine in Paris. Source: http://194.254.96.21/livanc/?cote=extbibcomsiena25_2a019&do=chapitre.

A treatise on pediatric diseases (Risala fi amradh al-atfal wa 'l-'ianaya bhihim): Al-Razi wrote this treatise in 900 H. Most historians like Rabdill, Gustave Lebon, and Sigrid Honka consider it as the first separated book written in pediatric diseases, because al-Razi for the first time in the history of medicine separated between pediatrics and gynecology, while all other physicians before him used to gather the two subjects in one book.

Unfortunately, the original Arabic version of this book seems to be lost. In the past it was translated into Hebrew then into Latin between 1114 and 1187, and it was published many times. Lately, Pieper translated many chapters into German, and Ruhra accomplished another translation into English, then the entire treatise was translated into Italian. Recently, Dr. Samuel Rabdill put a new English translation of this treatise and published it in the American Pediatric Journal (n° 5, vol. 122, 1971). This translation is considered now the best version. Dr. Mahmood Haj Kasem from Iraq translated it into Arabic.

The treatise contains twenty-four chapters discussing many pediatric diseases and their treatment. Among these diseases smallpox and measles were discussed. Also, many other pediatric diseases were described such as tinea, scabies, hydrocephalous, abdominal enlargement, sneezing, insomnia, epilepsy, ear discharges, eye diseases, teeth diseases, mouth ulceration, vomiting, diarrhea, cough, worms, umbilical protrusion, hernia, urethral stone, and poliomyelitis.

In addition to the historical importance of this treatise it has a scientific importance, as it contains new opinions and theories related to pediatric diseases.

The effect of al-Razi concepts related to smallpox and measles on the physicians after him
It is well known that during the time of al-Razi, books were not written and widely published like in our time, but there were only some manuscripts available for some scholars for every book. Therefore, we can expect that many Muslim physicians after al-Razi's time did not mention the master's concepts regarding smallpox and measles. I would like here to trace the effect of al-Razi concepts in this issue on the Muslim physicians after him.

Ali 'ibn Abbas al-Majusi: He died in 994 (about 70 years after al-Razi). In the fourteenth chapter of the first volume of his book Kamel al-Sina'a al-Tibiya, he talked about smallpox. He considered smallpox and measles as one disease. This means that al-Majusi had no idea about al-Razi writings in this regard, or his pride prevented him to quote from al-Razi's book.

Ibn Sina: He lived about one hundred years after al-Razi. Upon comparison between what was written by Ibn Sina in his book al-Qanun fi 'l-ttib (The Canonof Medicine) with al-Razi's writings on smallpox and measles, it is clear that Ibn Sina quoted a lot of information from al-Razi. In the third book of al-Qanun, he devoted a special part to deal with smallpox and measles. Ibn Sina differentiated between the two diseases and said they have common signs, and other signs specific for every disease. Then he described the skin eruption of every disease, resembling that written by al-Razi. But Ibn Sina did not mention that he had quoted from al-Razi's writings.

Ibn Zuhr: He lived in al-Andalus and died there in 1162. His book is entitled Al-Taysir fi 'l-Mudawati wa-'l-Tadbir. It was translated into Hebrew then into Latin, and published many times under the name of Facilicito Adjumentum. In the second volume of the book, ibn-Zuhr devoted a chapter to smallpox and measles, and he considered them as one disease. It is clear that Ibn Zuhr did not quote from Ibn Sina's or al-Razi's writings regarding smallpox and measles, especially if we know that al-Qanun was well known in al-Andalus during that time.

Ibn al-Nafis: He was born in Damascus and died in Cairo in 1288. His book is entitled al-Mujaz fi al-tib (The Concise Book in Medicine). It is considered as a revision of Ibn Sina's Canon. Therefore, ibn al-Nafis repeated briefly what Ibn Sina had exposed about smallpox and measles, and he differentiated between the two diseases. But, it is worth mentioning that ibn al-Nafis did not mention the back pain as a differential sign of smallpox.

Dawud al-Antaki: He was born in Antakia and died in Mecca in 1599. His medical book, known as Tadhkirat Dawud (Memoir of Dawud), has a longer title: Tadhkirat Uli al-albab wa 'l-Jami' li-l-'ajab al-'ujab. In the first part of this book he describes the signs of measles and smallpox in a way very like that described by al-Razi. In addition, he differentiated between the two diseases. In the same chapter he talked about chicken pox, and considered it as a benign form of smallpox.

Madian al-Qawsuni: He was an Egyptian physician who lived in the 17th century. His medical book is entitled Qamus al-atiba wa namuus al-aliba (The Physician's Dictionary). In the first chapter of the book, where he dealt with measles, he described the signs of measles and smallpox, mentioning that he quoted it from Ibn Sina's Canon. He differentiated between the two diseases saying that the lesion in measles is small, thin and does not extend outside the skin, while smallpox lesion is protruded outside the skin and thick.

Conclusion

No doubt that al-Razi was the first physician in the history of medicine who differentiated between smallpox and measles, and considered them as two diseases. The influence of his concepts in the diagnosis of these diseases on the Muslim physicians was very clear, especially on Ibn Sina, ibn al-Nafis, al-Antaki and al-Qawsuni. But it is worth mentioning that the majority of these physicians have quoted their information in this regard from The Canon of Ibn Sina, as it was the book that knew the widest diffusion and exerted the largest influence in the east as well as in the west.

At the end, I would like to conclude this presentation by a word of truth, written by the European Doctor De Poure, who declared: "Medicine was absent till Hypocrites created it, dead till Galen revived it, dispersed till Rhazes collected it, deficient till Avicenna completed it".

References
- Al-Baba M.Z., History and legislation of pharmacy, Damascus: Damascus University, 1986, p. 344.
- Ibn Sina, Al-Qanun fit-Tibb. Beirut: Dar Sader, 1980, vol. 3, p. 197.
- Honka, Zigrid, Shamsu 'l-'Arab Tasta'u 'ala al-Gharb, 2nd edition, Beirut, 1969.
- Al-Majusi, Kamel al-Sina'a al-Tibiyya, Cairo, 1918.
- Al-Razi, Kitab al-Jadari wa 'l-Hasbah, Italy, 1766.
- Al-Razi, Al-Hawi, Haydarabad, India, 1955-1976.
- Al-Razi, Kitab fi al-Jadari wa 'l-Hasbah. Printed at the expense of the Syrian Evangelical College of the city of Beirut. Beirut, 1872.
- Savage-Smith, Emilie, Islamic Culture and Medical Arts, Bethesda (Maryland): National Library of Medicine, 1994.
* Dr. Abdul Nasser Kaadan is the Chairman of History of Medicine Department, Aleppo University, Aleppo – Syria. He is also the President of the International Society for the History of Islamic Medicine ISHIM (http://www.ishim.net/).
Dr. Kaadan has been awarded by the Syrian Government the Bassel al-Assad Prize in the field of History of Medical Research Dr. Kaadan, who is an orthopedic surgeon since 1986, received his PhD in History of Medicine in 1993 from the Institute for the History of Arabic Science in Aleppo.
Address: P.O. Box 7581, Aleppo, Syria. E-mail: a.kaadan@scs-net.org.

by: Abdul Nasser Kaadan, MD, PhD, Sun 08 April, 2007

Haematology

2007-06-07T00:17:00.000-07:00

Who discovered Pulmonary Circulation, Ibn Al-Naphis or Harvey?

Ibn Al-Naphis (Ala al-Din Abu al-A'la Ali ibn Abi Hazm al-Quraishi) of Damascus, an Arab physician of the thirteenth century (1210-1288 CE), explained the basic principles of the modern theory of the lesser or PULMONARY circulation nearly three hundred and fifty years before Sir William Harvey of Kent, England, who is wrongly credited with this discovery.

This fact was acknowledged in 1957 by Professor Dr J B Latham of the University of Manchester at the tercentenary of the death of William Harvey (Sunday Times 9 June 1957).
He also stated that Ibn Al-Naphis had "recognised the fallacy of Galen's theory of invisible channels between the ventricles.
He similarly explained that blood was purified in the lungs where it was refined on contact with the air inhaled from the outer atmosphere. "It should not be assumed too readily that great discoveries were made only in Europe." (The Statesman, Calcutta, 11 June 1957).

Ibn Al-Naphis was the chief physician at the Al-Mansuri Hospital, Cairo, Egypt, where he practised and taught medicine and Muslim theology until his death at the age of 77. He wrote a book "Sharh al Qanun" in which he expounded the pulmonary circulation for the first time. This commentary was consulted by Ibn Al-Quff, a great scientist and contemporary of Ibn Al-Naphis.

All scholarly standards and historical fairness should accredit Ibn Al-Naphis as being the first to discover and illustrate the Pulmonary Circulation.

by: Dr Ibrahim Shaikh, Sun 14 October, 2001

Dermatology

2007-06-07T00:13:00.000-07:00

Ibn Sina's writing on Beauty

This short article is taken from the full article which is available here as a PDF file

Ibn Sina (980-1037 CE), known in Latin as Avicenna, whose compatriots gave him the honorary title "Shaikhal-Rai's" (Leader among Wise Men), was the one of the most influential philosopher-scientist of Islam. One of his best known works is the "Canon of Medicine" which is the epitome of Islamic medicine, taught to this day in the East. It was translated into Latin and taught for centuries in Western Universities, being in fact one of the most frequently printed scientific texts during the Renaissance.

The seventh and the last art in the fourth book of the Canon is assigned to the topic "ziynet" meaning "beauty" or "physical appearance." Although the term "ziynet" calls to mind ornament and ornamentation, when we get a look at the text in the Canon, we see that it deals with appearance, that is to say, the care of hair and body; as well as skin diseases and their treatment; and also subjects such as obesity and thinness that affect the appearance, and preventive methods and measures for all of these are discussed.

The main subjects and findings within the topic of "zinyet" can be summarised as follows:
1. Subjects are essentially classified according to the "symptoms". For example: Shedding of hair, skin-growing pale, getting thin... Thus, some of the skin diseases are discussed in the article on "hair" while also being studied in the article on "the colour of the skin" and the discourses on this subject are excluded from the third article where only skin diseases are studied
Another classification was used for the organs. The topic ziynet starts with the head, studying the "hair" and ends with the foot by focusing on the "nail". Only in this way can we explain why nail diseases are discussed just the after the subjects obesity and emaciation.

2. The topic ziynet deals only partly with cosmetics. Especially in the first and second articles, there are formulas for hair and skin care. Besides chapters on other subjects, primarily skin diseases, metabolism and nourishment, haematology, physical therapy is also discussed thoroughly.

I would also like to make it clear that the main goal of Ibn Sînâ in the chapter on "ziynet" is not beautifying people. He discussed all subjects from the point of view of medicine and aimed to "cure" these diseases which "spoil the appearance."

3. Many "observations" given under the title "ziynet" are surprisingly interesting. The subject "Ziynet" dealing with the externally observable symptoms, observation ought to have been easier for physicians. While acquisition of clinical knowledge was good, the etymology of diseases depended on the old theories of medicine, since technical aids were not developed. Physiopathology and the etymology of diseases were explained according to the medical theory based on the humoral theory. Many terms used in the explanations are form the medical terminology of the time. Although we know the meanings of these words commonly used in language, their medical meanings are not yet satisfactorily explained. For instance in this text there are several words such as "dem-i rakîk, dem-i latîf, dem-i ceyyîd, dem-i zekî" etc… describing different types of blood, the meanings of which are obscure, especially as medical terms. Although these are considered to be theories or philosophy, I believe that they are based on medical observations not aided by technology. This is why we associate "buhâr-i duhâni" with male hormone (testosterone) and "ebhire-i ratbe" with female hormone (estrogen).
Drugs are classified in categories according to their effects. While we know what some of these are, the composition of the others has not been discovered yet. In the topic, "ziynet" drugs are considered in categories with certain names according to their effects. For example, in this text, it is interesting to see that while astringent drugs were called "quvva-i kabîza" (astringent agents), they were also used externally to cure hair and skin diseases.

A complete criticism and evaluation of Ibn Sînâ's medicine will be possible only when the ancient medical terminologies have been interpreted correctly and when their meaning is brought into light.

4. Some definitions we come across in the topic "Ziynet" are worth noting in respect of their similarity with today's medical knowledge; for an example, we can quote the fact that Ibn Sînâ distinguished vitiligo from lepra.

The chapter "Ziynet" comprises some extremely interesting knowledge; such as geophagia, is an illness discovered and described in the twentieth century which we find clearly described by Ibn Sînâ.

When we have studied Ibn Sînâ's Canon as well as the works of the other great names of the old medicine, attentively and patiently, we shall have to bring about some changes in our learning and knowledge of the history of the old medicine.

by: Prof. Nil Sari Akdeniz , Fri 17 June, 2005

Medicine - Anatomy

2007-06-06T23:56:00.000-07:00

Bone Fractures in Ibn Sina's Medicine

First page of Al-Qanun by Ibn Sina
Ibn-Sina, or Avicenna as he is known in the west, was born in the year 980 CE in Afshana near Bukhara in Turkistan, which is now called Uzbekistan. He left Bukhara when he was 21 years of age, and spent the rest of his life in various towns in Persia. When he died in the year 1037 he was known as one of the greatest philosophers in Islam, and in Medicine he was highly regarded and was compared to Galen, so he was known as the Galen of Islam. Because of his great celebrity, many nations disputed and competed to celebrate his anniversary. The Turkish were the first who revived his anniversary in 1937, when they held a great meeting for the occasion of nine hundred years since his death. Then Arabs and Iranians followed them by holding two festivals in Baghdad in 1952, then in Tehran in 1954. To appreciate his contribution in developing the philosophical and medical sciences, in 1978 UNESCO invited all its members to celebrate the anniversary of one thousand years since his birth. All the members participated in the celebration, which was held in 1980.

Ibn-Sina composed 276 works; all of them written in Arabic except very few small books written in his mother tongue Persian. Unfortunately, most of these works were lost, but there are still 68 books or treatises available in eastern and western libraries. He composed in all branches of science, but he was more interested in philosophy and medicine. Some recent historians consider him as a philosopher more than a physician, but others consider him as a prince of the physicians during the Middle Ages.

The classification of Ibn-Sina's works according to their contents is as follows:
43 works in medicine, 24 in philosophy, 26 in physics, 31 in theology, 23 in psychology, 15 in mathematics, 22 in logic, 5 in the Holy Koran interpretation. In addition he wrote many treatises in asceticism, love, music as well as some stories.

Al-Qanun fit-Tibb: (or Code of Laws in Medicine) represents the most important work of Ibn-Sina, which is written in Arabic, and as William Osler described it, is the most famous medical textbook ever written (1). This book is considered a unique reference or document containing all medical knowledge, as it accumulated through many civilizations until the time of Ibn-Sina himself.

In his way of explanation ibn-Sina was very close to the way which modern medical textbooks follow regarding classification, causes of diseases, epidemiology, symptoms and signs, treatment and prognosis. In this respect we can say that the excellence in its arrangement and comprehensiveness made this book the most widespread in Islamic and European countries.

The Qanun was known to the Europeans through the Latin translations of Gerard of Cremona, in the 15th century, and remained in use in medical schools at Louvain and Montpellier until the 17th century. According to the Journal of UNESCO, October issue, 1980, Al-Qanun remained in use in Brussels University until 1909.

By the 12th century awareness in the Muslim world set in that these compendia were too large to be really useful for ready reference. Consequently, epitomes of al-Qanun were produced to make the ideas more quickly accessible, and commentaries were written to clarify the contents. The most popular of all the epitome of al-Qanun was that called Kitab al-Mujaz fil Tibb or the Concise Book in Medicine. It was written in Syria by ibn-al-Nafis, who died in 1288.

Ibn-Sina begins his book al-Qanun by defining medicine by saying: Medicine is a science, from which one learns the states of the human body, with respect to what is healthy and what is not, in order to preserve good health when it exists, and restore it when it is lacking.

Al-Qanun consists of five books, the first is concerned with general medical principles, the second with materia medica, the third with diseases occurring in a particular part of the body, the fourth on diseases not specific to one bodily part (such as fevers), in addition, to traumatic injuries such as fractures and dislocations of bones and joints And the final book contains formulas giving recipes for compound remedies.

Ibn-Sina devoted two treatises in the fourth book of al-Qanun, to fractures. The first treatise is entitled: "Fractures as a Whole", and the second is "Fractures of Every Bone Separately".
In the first treatise, he described the causes, types, forms, methods of treatment, and complications of fractures. While in the second treatise, he determined the special characteristics of fractures of each bone.

The first treatise: Fractures as a Whole

Ibn Sina defined a fracture as a loss of continuation in the bone (2). Then, he determined the types of fractures such as transverse, longitudinal, or comminuted. When he talked about symptoms and signs of a fracture, he considered the pain, swelling, and deformity of the limb to be of great importance to the diagnosis.

In this chapter, Ibn-Sina distinguishes the fractures that reach the joint line. He says:
"If the fracture was at the joint line and healed, the movement of the joint could be difficult as the rigidity of the callus needs more time to become soft,"(3).

It is well known now that fractures which occupy the joint line, cause stiffness of that joint after they heal, unless appropriate physiotherapy is applied to the limb.

Factors that stimulate and inhibit bone healing

Ibn Sina mentions that fractures of children heal more rapidly than those of adults. He determined the time span necessary for bone to heal.

He said, for example, a nose bone fracture needs 10 days to heal, a rib needs 20 days, a forearm needs 30 to 40 days, and a femur needs 50 to 120 days. It is clear that these figures are similar to those written in modern medical textbooks.

At the end of the chapter, he pointed out the factors that affect negatively bone healing, such as the lack of a splint at the site of the fracture, quickness in moving the affected limb, loss of blood (anemia), and the existence of a disease in the body (4). These factors, and others, are now considered to have a considerable role in delaying bone healing.

Principles of splinting the bone

In this chapter, Ibn Sina talked about treating a bone fracture by splinting it. He warned the physician against over-tightening the affected limb, which could cause gangrene.

In respect to what is called now open fracture, he pointed out the importance of taking care of the wound more than the fracture. If the fracture was complicated by hematoma formation, Ibn Sina advises the bone setter to make an incision at the site of swelling to allow the blood to get out.

In this chapter, Ibn Sina also focuses on a very important issue in the treatment of comminuted fractures. He said if the fracture is associated with a sequestrum, and is painful, it has to be mended and reduced into its position. If this is impossible, the sequestrum has to be excised using a thin saw or by drilling many holes at the base. Whatever the method, the physician has to be very careful not to injure an important structure. Sometimes the sequestrum is not visible; remarking the discharge from the wound can identify its position. In such cases, the wound must be enlarged to allow the removal of sequestrum (5).

Recommendation to the bone setter

Before treating any fracture, Ibn Sina advised that the physician should inspect and examine the fracture accurately and splint it quickly, because fracture reduction will be more difficult and complications may develop if there is a delay.

At the same time, Ibn Sina drew attention to the necessity of not splinting the fracture immediately. He advised postponing it beyond the fifth day or more, until the swelling disappearing. This is called now the Theory of Delayed Splintage, and Professor George Perkins is considered the pioneer of this theory today (6).

Fractures associated with a wound (open fractures)

In this chapter, Ibn Sina talked about treating fractures associated with a wound. He stressed the necessity of not applying a splint to the wound; ointment should be put on first, then the wound may be covered by a special dressing that would let out the wound discharges, and allow the physician to apply medicine.

This method of treating open fractures as described by ibn-Sina is similar, in many aspects, to that used today, except the use of antiseptic procedures during the course of treatment.
Mal-union fractures

What ibn-Sina meant by mal-union fracture was a fracture that is joined in a nonsuitable position, allowing the limb to become deformed. To treat this case, he suggested breaking the bone again at the site of old fracture and splinting it properly. If the callus is hard, this method should be avoided, otherwise a fracture may occur elsewhere. In such cases, ibn-Sina advised the bone setter to apply a material that softens the callus until the limb can be splinted in the correct position.

Today, all types of mal-union are treated surgically.

The second treatise-- Fractures of every bone separately

Skull fracture

Ibn Sina clarified that a skull fracture may happen even if the skin above it is still intact. In such cases, a hematoma may develop under the skin. The physician should not omit fracture treatment because this may lead to bone decay. The patient may complain of tremors and mind loss. In such cases, ibn Sina advised the operator to make an incision at the site of fracture to treat it. Next, he described the signs of skull fracture such as unconsciousness, dizziness, and speech loss.

At the end of this chapter, ibn Sina said: "If the fracture is severely comminuted it should be completely excised, but if is linear and distended you should not widen the incision, as no damage could result from the fracture."(7)

Mandible fracture

The method Ibn Sina described for treating these fractures resembles what is used today, except in some modern special surgical techniques. In this respect, he said that if the fracture is in the right side and displaced internally, the physician must insert his left index and middle fingers into the patient's mouth to elevate the fracture edge outward. The complete reduction could be identified by a good occlusion of teeth.

If the fracture is comminuted or associated with a wound, ibn Sina said to make an incision at the fracture site, and remove any sequestrum that may be present. He advises the physician to suture the teeth using a gold wire in order to stabilize the correct position of the mandible. The patient is asked to remain at rest and avoid speaking. His diet should be liquids. The mandibular bone needs three weeks to heal; it is filled with bone marrow.

Nose-bone fractures

Ibn Sina stated that a delay in treating a nose-bone fracture may lead to tilting of this bone, and anosmia may develop. So, he insisted on treating this fracture during the first 10 days. If the fracture is comminuted, and the reduction is impossible, the bone setter should incise the skin and remove all the comminuted bone.

Clavicle fracture

Ibn Sin's treatment of clavicle fracture is extremely different from those known today. He considered clavicle fractures difficult to splint. He described a long method to achieve a complete reduction. Today, this fracture is considered easy to treat, and complete reduction is not required to achieve healing.

Shoulder fractures (fracture of scapula)

Ibn Sina said: "The shoulder is rarely fractured in its broadest part, but its borders and sides are commonly affected . . . The most common signs are pain and crepitation on palpation, and the patient may complain of anesthesia in the hand . . . This fracture is treated by pushing the shoulder from the anterior aspect as a trial to reduce it; otherwise, the physician has to use cupping glasses in order to tract the fractured part posteriorly . . . In cases of existence of some painful bone fragments, they should be excised. . . . After the treatment the patient is asked to sleep on the intact side."(8)

Now all types of scapular fractures needs no more treatment than rest until the pain subsides.

Fractures of the sternum

Ibn Sina classified this fracture into types:
1. An isolated splitting fracture, which is diagnosed by the existence of crepitation on palpation.
2. A fracture that is displaced anteriorly and may cause bad symptoms such as difficulty in breathing, dry cough, and, sometimes, hemoptysis.
The treatment of this fracture is similar to that of the shoulder.
Rib fractures

In this chapter, Ibn Sina stated that the seven true ribs are fractured at their lateral sides, while the false ribs are fractured at their medial sides. The diagnosis of a rib fracture is very easy to determine by palpation, which allows the physician to feel abnormal movement at the fracture site. The patient may complain of pleurisy and hemoptysis. The treatment is accomplished by using cupping glassing to tract fractured rib. If the bone is compressing the diaphragm, the skin must be incised to excise carefully that bone.

Vertebral fractures

Ibn Sina talked about vertebral fractures very briefly, perhaps because of the rarity of information about these fractures at that time. He attributed all this information to Paulus Egine (who is famous surgeon from the Alexandria school who lived in the 7th century and wrote a medical book containing seven treatises on surgery and obstetrics, translated into Arabic by Hunin ibn Ishaq).(9)

Ibn Sina drew the physician's attention to the danger of this type of fracture that could cause death if the cervical vertebrae were involved.

Finally, he described the method for reducing coccygeal fractures by inserting the left index finger into the patient's rectum.

Humeral fractures

Ibn Sina elucidated that this fracture often tilts outside, so the physician must reduce it according to this tilting. It should be stabilized by using three bandages; the first one is ascending while the second is descending and the third is ascending. The upper limb must be stabilized in an angular shape with a sling. It is better to stabilize it to the chest to prevent movement.

After seven to 10 days, the bandages should be released and replaced by applying suitable splints for another 40 days.

Forearm fractures

Ibn Sina said: "Both of ulnas or one of them may be fractured. The fracture of the inferior one is worse, while the fracture of the superior one is easier to treat."(10) At that time, the bones of the forearm were called the superior ulna (radius) and the inferior ulna (ulna).

Ibn Sina explained the methods for stabilizing the fractured forearm. He said not to tighten the bandage too much, otherwise severe swelling of the fingers may develop, and not to loosen it, so no swelling at all may appear. After that, he explained a very important item that still occupies a considerable role in the field of treatment of forearm fractures: the necessity of not applying the splints so they extend beyond the base of the fingers, which may cause these fingers to become stiff.

After accurate reduction and complete stabilization are achieved, ibn Sina advised the physician to sling the affected forearm to the neck in an angular shape by using a wide rag so that it cover the whole length of the forearm. Forearm fractures heal quickly (within 28 days).

Wrist fractures

Ibn Sina said: "These bones rarely fracture, as they are very hard. And if they severely injured, dislocation may result, which could be treated as we had said in the dislocation section."(11)
It is well known today that wrist fractures are extremely rare, except for scaphoid fractures, which can not be diagnosed without performing an X-ray on the wrist joint.

Finger bone fractures

In this chapter, ibn Sina said that finger bones are affected more by dislocation than by fractures. To treat finger fractures, the patient is seated on a high chair and is told to put his hand on a flat chair, an assistant should extend the fracture bones, and the physician reduce them with his thumb and index fingers.

Ibn Sina pointed to what is called "Bennet's fracture 1982" when he said, "If the fracture was in the thumb and was displaced inferiorly, then you have to use the broad bandage from above to prevent the occurrence of the hot tumor."(13)

Ibn Sina said if the fracture is in the thumb, it should be bound to the hand; If it is in the index or small finger, it should be bound to the nearest finger.

Broad bones and hip fractures

This chapter represents the cases of central hip fracture-dislocation and fracture of the sacrum, which was called the broad bone at that time.

Ibn Sina said a central hip fracture-dislocation rarely occurs. The injured patient may complain of severe pain and anesthesia in his leg and thigh, resembling that of an arm or shoulder fracture.

In order to achieve a good reduction in broad bone fractures, he said the physician should put the patient in a prone position, and two strong people should tract the patient's two thighs while two other people use splints to try to reduce the fracture and put on the bandages.

Femur fractures

Ibn Sina said: "If the femur fracture needs severe traction to reduce it to the normal position, which is convex in its lateral side and concave in its medial side, the traction should be upward to be more effective."(14)

He said that when this fracture occurs, the distal fragments displace anteriorly and outside because the femur is broader at that side.

After the reduction is achieved by applying severe traction, a bandage should be applied above the fracture and another one below it if the fracture is in the middle of the femur.

Femur fractures heal within 50 days. The most common complication is deviation at the fracture site.

Patella fractures

Ibn Sina said: "The patella is rarely fractured, but it is sprained frequently. The fracture is diagnosed by the presence of crepitation, which can be palpated or heard. In respect to treatment, the leg should be extended, then the patella be reduced. But if the fracture was comminuted, the fragments should be gathered first then reduced."(15)

Al-Razi (who lived before ibn Sina) is considered the first who pointed to excision of patella before Brook (1903).(16)

Leg fractures

Ibn Sina stated that fractures of the small bone of a leg (which is now called the fibula) are better than fractures of the big bone (tibia). If the fracture is in the upper part of the tibia, the deformity is outside and anterior, and walking is possible. If the fracture is in the lower part of the tibia, the deformity is posterior and outside. If the fracture is in both bones, the situation is bad and the deformity may be at any direction.

He said the physician should apply traction to reduce the fracture in the same method used for forearm fractures.

Talus fractures

In this chapter, Ibn Sina said the talus is protected against fracture because it is solid and surrounded by structures that guard it. This bone may be dislocated.

Today, this fracture may happen rarely; its diagnosis is difficult unless an X-ray is performed.

Calcaneus fractures

Ibn Sina said: "Calcaneus fracture is a bad case as its treatment is difficult. It occurs when a person falls down on his feet from a high place . . . It may cause severe signs like fever, confusion, tremor, and spasm . . . . After Calcaneus fracture unites walking becomes difficult."(17)

This fracture now is called now parachutist's fracture. The most important complication of this fracture is difficulty it causes in walking, due to the development of osteoarthritis in the talo-calcaneal joint after the union of this fracture.

Toe fractures

This is the last chapter on fractures. In this chapter, ibn Sina pointed out that the treatment of toe fractures is like that of the fingers.

Conclusion

A survey was conducted to find out the most important points related to fractures as described by ibn Sina in his medical book, al-Qanun-fit-Tibb.

From this survey we can conclude:
1. Ibn Sina played an important role in keeping the medical heritage that developed over thousands of years. His medical book, al-Qanun-fit-Tibb. represents a unique reference document containing medical knowledge in general and traumatology in particular as it accumulated through many civilizations until the age of ibn Sina.
2. In his way of explanation, ibn Sina was very close to the way modern medical textbooks follow. At the beginning, he talked about fractures in general. He described their cause, types, forms, methods of treatment, and complications. Then he described the fractures that occur in every bone.
In this respect, one can say that the excellence in its arrangement and comprehensiveness made al-Qanun the most widely used medical textbook in Islamic and European countries until the 17th century.
3. Ibn Sina drew attention to the necessity of not splinting the fracture immediately, advising postponing it beyond the fifth day. Today, this is called the Theory of Delayed Splintage; now Professor George Perkins is considered the pioneer of this theory.
4. Ibn Sina talked about what is called now "Bennet's fracture 1882." We know that neither al-Razi before him, nor ibn al-Quf after him, had described this type of fracture, this means that ibn-Sina is considered the first who described this fracture nearly one thousand year before Bennet.

In the west, it had been said: "Anyone who wants to be a good doctor must be an Avicennist." A word of truth was written by the European physician De Poure who declared: Medicine was absent until Hippocrates created it, dead until Galen revived it, dispersed until Rhazes (al-Razi) collected it, and deficient until Avicenna (ibn-Sina) completed it.

References
1. Al-Baba MZ: some of medical books edited by Ibn Sina. Institute for History of Arabic Science-Aleppo University, Aleppo-Syria, 1984.
2. Ibn-Sina: Al-Qanun fit-Tibb. Vol. 3, P. 197, Dar Sader, Lebanon, 1980.
3. Ibn Sina, vol. 3, p. 197.
4. Ibn Sina, vol. 3, p. 198.
5. Ibn Sina, vol. 3, p. 199-200.
6. Apley AG, Solomon L: Apley's system of orthopedic and fractures, p. 344, 6th ed., Butterworth & Co.,Ltd., London, 1982.
7. Ibn Sina, vol. 3, p. 210.
8. Ibn Sina, vol. 3, p. 213.
9. Al-Baba MZ: History and legislation of pharmacy, p. 344, Damascus university, Damascus-Syria, 1986.
10. Ibn Sina, vol. 3, p. 215.
11. Ibn Sina, vol. 3, p. 215.
12. Rockwood CA, Green DP: Fractures. P.305, vol. 1, H. K. Lewis and Co. Ltd., London, 1975.
13. Ibn Sina, vol. 3, p. 215-216.
14. Ibn Sina, vol. 3, p. 216.
15. Ibn Sina, vol. 3, p. 217.
16. Rockwood CA, Green DP: Fractures. P.1153, vol. 1, H. K. Lewis and Co. Ltd., London, 1975.
17. Ibn Sina, vol. 3, p. 217.

by: Abdul Nasser Kaadan MD, PhD, Thu 29 September, 2005

Windmills

2007-06-06T23:52:00.000-07:00

Introduction of Wind Power

During the reign of Caliph Ummar (634-44) began the use of wind as a source of power in Islam. A Persian came to the Caliph and said he could build a mill operated by wind, so the Caliph ordered him to have one built. Wind-power became widely used in Islam to run mill stones for grinding corn, and also to draw up water for irrigation. Descriptions and drawings of Islamic windmills exist in a large abundance.

`A millstone is attached to the end of a wooden cylinder, half a metre wide, and 3.5 to 4 metres high, standing vertically in a tower open on the north east side to catch the wind blowing from this direction. The cylinder has sails made of bundles of ush or palm leaves (which reminds of the modern European windmill), attached to the shaft of the axle. The wind, blowing into the tower, exerts strong pressure on the sails, so turning the shaft and millstone.'

The windmills were erected on substructures built for the purpose, or on the tower of castles or on hilltops. Early windmills for grinding corn were, indeed, two storey buildings; in the upper storey were placed the millstones, and in the lower one, a wheel driven by the sails-six or twelve in number and covered with fabric-which turned the upper millstone. The walls of the lower chamber were pierced by four vents with the narrower end towards the interior, like the loopholes of a fortress so as to direct the wind on to the sails, and increase its speed.

In Europe, the oldest text in relation to windmills is a French act of 1105 granting a religious community the right to establish one of these apparatuses, called molendinam ad ventum (moulin a vent in French: windmill in English).

by: FSTC Limited, Fri 10 January, 2003

Muslim Engineer

2007-06-06T23:37:00.000-07:00

Al-Jazari - the Mechanical Genius
by: Foundation for Science Technology and Civilisation. Info@fstc.co.uk

By Prof. STS Al-Hassani, UMIST, Manchester, UK.
Al-Jazari was the most outstanding Mechanical Engineer of his time. His full name was Badi Al-Zaman AbulI-Ezz Ibn Ismail Ibn Al-Razzaz Al-Jazari and he lived in Diyar-Bakir (in Turkey) during the 6th century AH (12th century CE).

He was called Al-Jazari after the place of his birth, Al-Jazira, the area lying between the Tigris and the Euphrates in Iraq. Like his father before him he served Urtuq kings of Diyar-Bakir, from 570-597 AH (1174-1200 CE) as a Mechanical Engineer. In 1206 he completed an outstanding book on engineering entitled "Al-Jami Bain Al-Ilm Wal-Amal Al-Nafi Fi Sinat'at Al-Hiyal" in Arabic. It was a compendium of theoretical and practical mechanics. Writes Sarton (1884-1956):"This treatise is the most elaborate of its kind and may be considered the climax of this line of Muslim achievement." Sarton vol.2; page 510.

Al-Jazari's book is distinctive in its practical aspect because the author was a competent engineer and skilled craftsman. The book describes various devices in minute detail hence an invaluable contribution in the history of engineering. British charter engineer Donald Hill (1974) who has a special interest in Arab technology writes:

"It is impossible to over emphasize the importance of Al-Jazari's work in the history of engineering, it provides a wealth of instructions for design, manufacture and assembly of machines."

Al-Jazari describes fifty mechanical devices in six different categories, including water clocks, hand washing device (wadu machine) and machines for raising water etc. Following the "World of Islam Festival" held in the United Kingdom in 1976 a tribute was paid to Al-Jazri when the london Science Museum showed a successfully reconstructed working model of his famous "Water Clock."

Hill translated Al-Jazari's work in 1974, seven centuries and 68 years after it was completed by its author. Al-Jazari's book includes six main categories of machines and devices. Several of the machines, mechanisms and techniques that first appear in this treatise, later entering the vocabulary of European mechanical engineering, including double acting pumps with suction pipes and the use of a crank shaft in a machine, accurate calibration of orifices, lamination of timber to reduce warping, static balancing of wheels, use of paper models to establish a design, casting of metals in closed mould boxes with green sand etc. Al-Jazari also describes methods of construction and assembly in scrupulous detail of the fifty or so machines in it to enable future craftsmen to reconstruct them.

And he was successful in that, for many of his devices were constructed following his instructions. The work by al-Jazari is also unique in the way that other writers often fail to give sufficient details, because amongst others, they are not craftsmen themselves, or kept their secrets, or if they were craftsmen, they could have been illiterate. Al-Jazari in this respect was unique, and this gives his work immense value. His book, Hill states, is an absolute wealth of Islamic mechanical engineering.

In their paper in the charter Engineer of the I.Mech.E., Ludlow and Bahrani have raised the important point that it is more than likely that there is more on the subject in some of the thousands of Arabic manuscripts in the European and North American libraries which have been inspected closely, and obviously require looking into.
Hill, too, and constantly raises the two major issues with respect to the history of engineering in general, and that of fine technology in particular. He first states the fact that the field, which is absolutely immense, is yet totally unexplored.

The other issue is related to fine technology. One of his concluding points states that `it is hoped that, as research proceeds, firmer evidence for the transmission of Islamic fine technology into Europe can be provided.' Hill also offers some hints for such transmission. The most likely route being Spain. Such fine technology could have followed the same route as the astrolabe (itself part of this fine technology.) Apart from Spain, there was Sicily, another land of transfer, Byzantium, and Syria during the Crusades. And Hill is also right on a further account, that what will be seen in this work is just a fraction of the whole process, which, as with much else has hardly been explored.

The animation shows a virtual model of one of al-Jazari's water raising pumps. The details of this unique pump were obtained from his manuscript and Hill's diagrams. We see two suction pumps in synchronous motion driven by a paddle wheel, which is driven by a water stream.
The other animation is for a 3D model recreated from the description of the elephant clock as described by Al-Jazari. Full details of this animation are given in the book by Prof. S T S Al-Hassani on "The History of Muslim Engineering", to be published.

by: Professor Salim Al-Hassani, Fri 09 February, 2001

Dam and Water Management

2007-06-06T23:15:00.000-07:00

Dam Construction
Summarised extracts from a full article, see resources below, where end notes, references and bibliography are given.
by: Foundation for Science Technology and Civilisation. Info@fstc.co.uk

In his `History of Dams,' Norman Smith, began his chapter devoted to Muslim dams,(endnote 1) by stating that:
`Historians of civil engineering have almost totally ignored the Muslim period, and in particular historians of dam building, such as there have been, either make no reference to Moslem work at all or, even worse, claim that during Umayyad and Abbasid times dam building, irrigation and other engineering activities suffered sharp decline and eventual extinction. Such view is both unjust and untrue.'(endnote 2)

Similar point is raised by Pacey, who notes that it is often said that hydraulic engineering `made little progress under the Muslim,' and that the latter's achievements hardly evolved beyond the Greek or Roman's. Pacey corrects this view, pointing out that the Islamic civilisation adapted ancient techniques `to serve the needs of a new age,' and that the Muslims extended the application of mechanical and hydraulic technology enormously.(endnote 3) To explain the reasons behind the belittling Muslim achievements as observed by Smith, Pacey and others(endnote 4) is a mammoth a task which requires people versed in political, religious, and historical matters.

Dams and Construction Techniques

The Muslims built many dams in a rich variety of structures and forms. The majority of the earliest Muslim dams were completed in Arabia itself; and full information on their height, length, and ratios between height and length is given by Schnitter. He also specifies that with the exception of the Qusaybah dam near Medina, a 30 m high-205 m long structure, which was slightly curved in plan, the alignment of all others were straight.(endnote 5) About half such dams were provided with a flood overflow at one end, and often with a downstream training wall to guide the spilled water to a safe distance from the dam's foot. Schnitter also observes that about a third of such very early dams (7th-8th century) are still intact.(endnote 6) In Iraq, in the vicinity of Baghdad, a considerable number of dams were built during the Abbasid Khalifate.(endnote 7) Most such dams are on the Tigris, but a few are on water diversions, further illustration of high engineering skills. In Iran can be found the Kebar dam, dating from the 13th century, the oldest arched dam known to have survived.(endnote 8) The dam has a core of rubble masonry set in mortar, the mortar made from lime crushed with the ash of a local desert plant, the addition of ash making the lime hydraulic. This resulted in a strong, hard and impervious mortar, ideal for dams, the very reason for such dam's long life, and the absence of cracks in it. Much earlier than this dam, in today's Afghanistan, were three dams completed by King Mahmoud of Ghaznah (998-1030) near his capital city. One named after him, was located 100 km SW of Kabul, and was 32m high, and 220m long.(endnote 9)

Dam construction in Muslim Spain was prolific. In the city of Cordoba, on the river Guadalquivir, can be found what is probably the oldest surviving Islamic dam in the country.(endnote 10) According to the twelfth- century geographer al-Idrisi it was built of Qibtiyya stone and incorporated marble pillars.(endnote 11) The dam follows a zig-zag course across the river, a shape which indicates that the builders were aiming at a long crest in order to increase its overflow capacity. Remains of the dam can still be seen today, a few feet above the river bed, although in its prime, it was probably about seven or eight feet above high- water level and eight feet thick.(endnote 12)

Techniques used by Muslim masons and engineers reached great heights of ingenuity. On the river Turia, still in Spain, as an instance, modern measurements have shown that the eight canals have between them a total capacity slightly less than that of the river, thus raising the possibility that the Muslims were able to gauge a river and then design their dams and canals to match.(endnote 13) Smith elaborates on such skills.(endnote 14) Muslim engineers used sophisticated land surveying methods to locate their dams in the most suitable sites, and also to lay out very complex canal systems. For such, they used astrolabes and also trigonometric calculations.(endnote 15)

Around Baghdad water was diverted into the Nahwran Canal which supplied water for irrigation, whilst improvements were made to existing, old systems.(endnote 16) Dams were built of carefully cut stone blocks, joined together by iron dowels, whilst the holes in which the dowels fitted were filled by pouring in molten lead.(endnote 17) An impressive structure of masonry is Hill's impression of the dam at Marib in Yemen, with its carefully cut and fitted blocks using lead dowels in their joints.(endnote 18) It was also fourteen metres high and 600 metres long, with elaborate waterworks including sluices, spillways, a settling tank and distribution tank. So strong a structure, it survived for about ten centuries until lack of financial and technical means made it impossible to maintain.(endnote 19)

Back in Spain, according to Scott, the masonry of the reservoirs was of the finest description, and the cement used was harder than stone itself.(endnote 20) Contingencies were provided for in such manner that no overflow occurred, and no damage resulted even during the worst flooding. Evidence of Muslim engineering `genius' is the fact that these dams needed hardly any repair in a thousand years.(endnote 21) The eight dams on the Turia River at first sight seem to have an exaggerated amount of weight placed on their foundations, the masonry of each dam going some fifteen feet into the river bed, and further support provided by the addition of rows of wooden piles. Such solid foundations were justified by the river's erratic behaviour, which in times of flooding reaches a flow that is a hundred time greater than normal, the structure having to resist the battering of water, stones, rocks and trees.(endnote 22) These dams, now over ten century old, still continue to meet the irrigation needs of Valencia, requiring no addition to the system.(endnote 23)

On the River Segura, the Muslims built a dam in order to irrigate vast lands in the Murcia region.(endnote 24) Because of the nature of the terrain, not just the location, but the design and construction had to be absolutely perfect, too. The height of the dam was only 25 feet, yet its base thickness was 150 and l25 feet, which may seem excessive. Such thickness was necessary to meet the softness and weakness of the river's bed to prevent it from sliding along. The water flowing over the crest initially fell vertically through a height of 13-17 feet on to a level platform, running the length of the dam. This served to dissipate the energy of the water spilling over the crest. The over-flow then ran to the foot of the dam over flat or gently sloping sections of the face. In this way the whole dam acted as a spillway and the energy gained by the water in falling 25 feet was dissipated en route. Thus the risk of undermining the downstream foundations was greatly reduced. Like with other dams, rubble masonry and mortar were used for the interior, and the whole was finished with large masonry blocks.(endnote 25)

The Destruction of Muslim Dams

Like with much else regarding Islamic civilization, once the transfer was accomplished, destruction followed. Muslim dams did not escape in their vast majority the onslaught against Islam. In 1220, the armies of Jenghis Khan devastated the whole eastern parts of the Muslim land. The destruction of al-Jurjaniyah dam south of the Aral Sea diverted the River Oxus from its course and deprived the Aral Sea of water, causing it to nearly dry out centuries later.(endnote 51) A hundred and sixty three years later, in 1383, it was Timur's hordes, which this time completed the work of their predecessors. The Tartars laid the land waste, Zaranj the capital of the province of Seistan, suffering terrible fate; its dams and all its irrigation works completely laid waste. A similar fate befell the Band-I-Rustam, and the region of Bust.(endnote 52) Today, hardly anything survives in those lands once the seats of great civil engineering accomplishments.

by: FSTC Limited, Sun 30 December, 2001

Dam and Water Management

2007-06-06T23:04:00.000-07:00

Water Management and Hydraulic Technology

Summarised extracts from a full article, see resources below, where end notes, references and bibliography are given.
by: Foundation for Science Technology and Civilisation. Info@fstc.co.uk
Reservoirs

By far, the most original Muslim reservoirs are to be found in tmhe region of Qayrawan in Tunisia. A lengthy (about 270 pages) account of such structures is offered by the French Solignac.(endnote 26) These reservoirs, possibly for their high aesthetics, and like many other Islamic achievements,(endnote 27) were attributed, despite all evidence,(endnote 28) to both Phoenicians(endnote 29) and Romans.(endnote 30) Such erroneous views were adopted by a number of scholars until modern archaeological excavations and advanced studies proved the Islamic origin of such structures. These reservoirs have two basins, one used for decantation, one as a reserve, and at times a third one for drawing water out of it. Other than their impressive numbers, over two hundred and fifty in the region, such reservoirs also offer a great attraction in their form and structure.

The photograph of the `Basin des Aghlabides,' built in the ninth century by Abu Ibrahim Ahmed reveals, indeed, a sort of temple of water, it is hoped, still preserved in its majesty.

Water Management

Water management in all its intricacies, from Andalusia to Afghanistan, Bolens reminds, was the basis of agriculture, and source of all life. All the Kitab al-Filahat (books of agriculture), whatever their origin, Maghribian, Andalusian; Egyptian, Iraqi; Persian or Yemenite, insist, and meticulously, on the deployment of equipment and on the control of water.(endnote 31) The authorities of the time played a crucial role in that, too. In Iraq, as a rule, hydraulic tasks of a vast nature were left to the state, while the local population focussed its efforts on lesser ones.(endnote 32)

In Egypt, a more elaborate picture comes out.(endnote 33) There, indeed, the management of The Nile waters was most crucial to every single aspect of life, and dams responded to such necessity. Both al-Nuwayri(endnote 34) and al-Makrizi(endnote 35) stressed the role of maintenance of dams and waterways of the Nile for maximum benefits. It was the responsibility for both sultans and holders of large holdings, under both Ayyubids and Mamelouks, to dig and clean canals and maintain dams. As in Iraq the sultan took over the larger structures, and the people the lesser ones. Most distinguished Amirs and officials were also made chief supervisors of such works.(endnote 36) Under the Mamluks there was even an officer for the inspection of dams for each province of Egypt: the Kashif al-Djusur.(endnote 37)

Water Storage

Dams are used to store water, and this has major implications on economic and social life. Smith observes that `not only do dams represent some of the most impressive achievements of engineers over the centuries, but their vital role in supplying water to towns and cities, irrigating dry lands, providing a source of power and controlling floods is more than sufficient to rank dam building amongst the most essential aspects of man's attempt to harness, control and improve his environment.(endnote 38) Effective storage and use of water for irrigation, for instance, can have dramat ic repercussions, in cheapening the process and bringing into use lands that were hitherto impossible or uneconomic to irrigate.(endnote 39)

Both Spain and Sicily offer good illustrations of that. Water is also stored for the aim of providing power for milling. In Khuzistan, at the Pul-I-Bulaiti dam on the Ab-i-Gargar, the mills were installed in tunnels cut through the rock at each side of the channel, constituting one of the earliest examples of hydro-power dams, and not the only one in the Muslim world.(endnote 40) Another example is the bridge-dam at Dizful, which was used to provide power to operate a noria that was fifty cubits in diameter, which supplied all the houses of the town.(endnote 41) Many such hydraulic works can still be seen today.(endnote 42)

Transfer of Hydraulic Technology to Europe

The Islamic mastery of hydraulic technology is far more advanced than acknowledged by some of the sources many writers are too keen to follow. Some references are keen to distort the exact role of Muslim engineering skills. Indeed, to the likes of Gimpel(endnote 43) and White,(endnote 44) the Muslims hardly made any contributions in such a field. Reality, however, is far the opposite. First and foremost, the hydraulic works of the Ancients were found by the Muslims in a terrible state of decay and ruin,(endnote 45) and they did not just repair them, but also added considerable skills of their own. To Spain, for instance, the Muslims brought irrigation techniques which not only laid the foundations for the prosperity of the country, but also with nothing as elaborate and as efficient seen before in Europe.(endnote 46)

After the country was retaken by Christian forces, the Muslims, masters of great skills then, were allowed to retain their functions and serve the new crown. Alongside builders, paper and textile makers, manufacturers of iron and experts of all sorts, the Spaniards also retained and used Muslim irrigation works, their attendant rules and even regulations.(endnote 47) And as soon as the Muslims, who refusing to be baptized as Christians were expelled, or massacred, economic ruin, and famine always followed.(endnote 48) And Spain never recovered its former prosperity and levels of advancement once the Muslims had been eliminated from its land. Hill also notes that the introduction of desilting sluices, the arch dam, and hydropower made their first appearances in the Islamic world, observing that it is `difficult to see how these can be other than Muslim inventions.'(endnote 49)

Further illustration of Islamic impact in the field is not just obvious through the works of Hill, Pacey, Smith and others, it is also visible via the works of Muslim engineers themselves as can still be observed through the remains of old age storage structures all over the Islamic land. Furthermore, White's, Gimpel's and their followers' argument lacks historical backing, for the major changes that took place in Europe, and not just in terms of hydraulic technology, but all others,(endnote 50) did, and without one single exception, at the time the Europeans came into contact with the flourishing Islamic civilisation (twelfth-thirteenth centuries), and not the centuries before. Also, the fact that Western technology in nearly every respect is identical to the Islamic one offers further evidence of such impact.

by: FSTC Limited, Sun 30 December, 2001

Water Management

2007-06-06T22:49:00.000-07:00

Water management in Valencia

Quoted from T. Glick in Islamic and Christian Spain in the early Middle Ages, Princeton University Press, New Jersey, 1979. pp 71-3.

The distribution of water among the eight canals of the Valencian huerta is a particularly useful example of [water management] because the underlying principles of the distribution arrangements are well documented and quite easily associated with a specific Islamic model.

The river, now called by its Roman name the Turia, but in Islamic times known as the Wâd al-Abyad (Guadalaviar, "White River"), was considered to be divided into successive stages, each stage representing the point of derivation of one main canal which drew all the water at that stage, or of two canals, dividing the water among them. At each stage the river was considered to hold twenty-four units of water.

The twelve-base system… is standard in many areas of the Islamic world and is clearly related to the hours of the day. A paradigmatic system, so structured, would envision a river divided into 168 units (representing seven days and nights, or 144 if a day of rest was customary). The units were not, however, expressed in hours, but as simple proportions of a whole.

Thus, in times of abundance, each canal drew water from the river according to the capacity of the canal; in times of drought, the canals would take water in turn, for a commensurate number of hours or a proportional equivalent.

The same was true of individual irrigators (and herein lies the genius of the Valencia system): when the canal ran full, each irrigator could open his gate as he pleased, but when water was scarce, a turn was instituted; each irrigator, in turn, drew enough water to serve his needs (this style of irrigation was by submersion of the field, typically to a standard depth of an ankle). But he could not draw water again until every other irrigator in the system had his turn. Thus a relatively equal distribution was ensured, both in times of abundance and of scarcity, and no measurements of time or orifice of delivery were needed.

by: Quoted from T. Glick, Sun 21 July, 2002

Control Engineering

2007-06-06T22:42:00.000-07:00

A review of Early Muslim Control Engineering
Summarised extracts from a full article, see resources below, where end notes, references and bibliography are given.

Professor Dr Mohamed MansourEmeritus Professor of Control Eng.ETH Zürich, Switzerlandmailto:info@fstc.co.uk

During the period of Islamic-Arabic extraordinary activity in Science and Technology (9th-13th century) there are some recorded contributions to the area of Automatic Control mainly in the development of water clocks using float valve regulators, different level controls using float valves or combination of syphons and the development of On-Off control.

The Islamic Arabic Automatic Control Technology had as a basis the Greek Technology of two scientists namely Philon of Byzantium (Rhodes and Alexandria) of the second half of the third century BC (his book "pneumatica" was translated from Arabic into French and German in 1902 and 1899 respectively) and Heron of Alexandria of the first century AD (his book "pneumatica" was translated from Greek into English and German in 1851 and 1899 respectively).

It is noted in Greek technology the language is Greek but the scientists need not be Greek as in the case with Islamic-Arabic technology.

It is known that there are hundreds of thousands of manuscripts dealing with Islamic Science and Technology to be edited and it is assumed that some of them deal with technology. This report is based on references [1-6] (see resources below).
PART I - AUTOMATIC CONTROL IN WATER CLOCKS

1. "The work of Archimedes on the Building of Clocks"
This is an Arabic book whose arabic author is called pseudo-Archimedes with the earliest reference to it in "The Fihrist "of Al-Nadim (died 955 AD). From the literary style and the technique of its drawings this clock book seems to be an Islamic work based on Greek-Roman technology as mentioned ini. This clock used a float level regulator, which makes it a feedback device. A large float drove the whole apparatus. The description of the complicated clock is so thorough that it could be reconstructed almost completely. This book did have considerable influence on the two great horological books of Al-Jazari and Ibn Al-Saati and other Arabic authors like Ibn Al-Akfani.

2. "Al-Jami bain Al-Ilm..." by Al-Jazari [5]
This book was written in 1206.Al-Jazari is from Al-Jazira the area between Tigris and Euphrates. Sarton [6] mentions "This treatise is the most elaborate of its kind and may be considered the climax of this line of Muslim achievement "The distinctive feature of the book is its practical aspect. The book is rich in minute discription of various kinds of devices.
Hill [3] maintains "It is impossible to over-emphasize the importance of Al-Jazari`s work in the history of engineering. Until modern times there is no other document from any cultural area that provides a comparable wealth of instructions for the design, manufacture and assembly of machines" "Al-Jazari did not only assimilate the techniques of his non-Arab and Arab predecessors, he was also creative. He added several mechanical and hydraulic devices. The impact of these inventions can be seen in the later designing of steam engines and internal combustion engines, paving the way for automatic control and other modern machinery. The impact of Al-Jazari`s inventions is still felt in modern contemporary mechanical engineering." Hill [4] translated the book to English in 1974. A German translation was made in 1915.The chapter on water clocks describes 10 water clocks, the first two of them use float valve regulators. The various time-indicating mechanisms are propelled by a float. The other clocks are regulated differently. Al-Jazari mentions an old machine, which he inspected, in which a musical automaton was powered by a vertical water wheel. In his comments on this machine he clearly implies that he knew how to control the speed of such a wheel by means of an escapement.

3. "Book on the Construction of Clocks and their Use", Ridwan b.Muhammad Al-Saati Al-Khurasani (1203)
This book describes the monumental water clock built by Ridwan`s father at the Jayrun gate in Damascus. A German translation was made in 1915. A large float drives the clock, float valve regulator and the device for varying the length of the hours are incorporated.

4. "The Book of Secrets about the Resulte of Thoughts", Al-Muradi of Andalusia(11th century) This is the earliest description in Arabic of water clocks. This book deals with water clocks and other devices using automata. The treatise consists of 31 models of which 5 are essentially very large toys similar to clocks in that automata are caused to move at intervals, but without precise timing. The prime movers are water wheels that can be overshot or undershot depending on the intensity of flow. There are nineteen clocks, all of which record the passage of the temporal hours by the movements of automata. The power came from large outflow clepsydras provided with concentric siphons. This power was transmitted to automata by very sophisticated mechanisms, which included segmental and epicyclic gears and the use of mercury. These are highly significant features; they provide the first known examples of complex gearing used to transmit high torque while the adoption of mercury reappears in European clocks from the thirteenth century onwards. Unfortunately, the only known manuscript of this work is badly defaced and it is not possible to understand exactly how the clocks worked. A weight driven clock with a mercury escapement appears in "Libros del Saber" a work written in Spanish at the court of Alfonsos of Castille about 1277 and consisting of translations and paraphrases of Arabic works A novel feature in this treatise is the use of mercury in balances. Al-Zarquali built two large water clocks on the banks of the river Tagus at Toledo in 11th centuryii.

5. "Kitab Mizan Al-Hikma (The Book on the Balance of Wisdom)", Al-Khazini (1121-1122) [2]
The eighth treatise of this work described two steelyard clebsydras. The main one, called the Universal Balance, was designed for 24-hour operation, and consisted of an iron beam divided into unequal arms by a fulcrum. An outflow clepsydra equipped with a syphon was suspended on the end of the short arm, and two movable weights, one large and one small, were suspended from the long arm, which was graduated into scales. As water discharged from the clepsydra, the weights were moved along the scale to keep the beam in balance. At any moment the hour of the day could be told from the position of the large weight, its minutes from the position of the small one."

Part II - Automatic Control of Banu Musa

"Kitab Al-Hiyal" (The Book of Ingenious Devices) by Banu Musa bin Shakir (9th century). The three sons of Musa organized translation and did original work in "Bayt Al-Hikma"(House of Wisdom) which is the science academy in Baghdad the greatest scientific institution since the Museum and Library of Alexandria. Banu Musa were the main supporters of the translation movement which gathered momentum as that important epoch of the Islamic scientific awakening reached fruition in the 9th century. They extended their patronage to Thabit Ibn Qurra, to Hunain Ibn Ishaq and to many other translators and scholars. They have more than 20 works which are known including the seminal engineering book "Kitab Al-Hiyal" translated into English by Donald Hill in 1979 and parts of it into German by Wiedemann and Hauser in 1918 and Hauser in 1922.The book was edited in Arabic by Ahmad Al-Hassan in 1981.

The written Arabic heritage in mechanical technology begins with the Banu Musa book. It is possible they knew Hero`s mechanics written in Alexandria in the first century and translated by Qusta Ibn Luqa at the time of Banu Musa.Hero's other books may have been known to the brothers for he enjoyed great fame among Arabic scholars in the 10th century. Banu Musa describe hundred ingenious devices. Hill identified twenty five devices resembling the ones of Hero and Philo(3rd century BC)books. There exist also other parts of the Banu Musa machines which resemble certain elements in Hero and Philo work. There are Banu Musa machines which bear no resemblance to either Hero or Philo. These include the fountains and dredging machine designed to salvage submerged objects from the bottom of rivers and seas and so on. Banu Musa made use primarily of the principles of the science of hydrostatics and aerostatics. Banu Musa use of automatic valves, delayed-action systems and their application of the principles of automatic control testify of creative mentality. Hill notes the use of crankshafts for the first time in the history of technology.

In two models, they used a mechanism similar to the modern crankshaft, thus outstripping by 500 years the first description of the crankshaft in Europe. Mayr [1] mentions that they use syphons, float valves, Philon`s oil lamp, water wheels, etc. Some control systems work with nonmoving parts combining the principle of Philon`s oil lamp with some cleverly arranged syphons. They have contributions in technological refinements and new applications. They install throttling valves directly in the pipe requiring no constant force to keep them closed. These appear first in the book of Banu Musa. Also they introduce improvements on Philon`s oil lamp by ingenious combination of syphons added to the original system. Most important is the use of On-Off control with upper and lower limit for the controlled variable. Systems of this class are widely used in modern technology. The float valve used by Banu Musa, Al-Jazari and other Arabic engineers emerges again in the middle of the 18th century in Europe and in England.

by: Professor Dr Mohamed Mansour, Fri 22 March, 2002

Control Engineering

2007-06-06T22:04:00.000-07:00

Pioneers of Automatic Control Systems

The theory of automatic control systems is an idea closely related to feedback concept. A system is a combination of components that act together and perform certain objectives. In a feedback system the output signal is fed back in order to increase or reduce the input signal.
Although the feedback concept, which is lying in the foundation of dynamic systems, has been perceived relative recently (at the end of the 19th century), it is known that the idea has been understood and applied correctly since the ancient times. In the engineering, the aim of control is to guide the system to a desired direction or kept constant at a certain value. A feedback control system is one which tends to maintain a prescribed relationship between the output and the reference input by comparing these and using the difference as the means of control. Thus, in an automatic control system, the variable to be controlled is first measured, secondly compared against a reference value and at least the difference applied to the system input, in order to influence the system in a desired manner. In the block diagram of an automatic control system, the controlled system take place in the forward path and the measuring device of the controlled variable take place in the feedback loop. A disturbance is a signal that tends to affect adversely the value of the output of a system.
To differentiate an automatic control system, realized and used unconsciously during centuries from the open loop control system, one has to check the existing system for the feedback characteristic. The oldest automatic control systems technically mindfully designed and tested for their operational merit, date back to the Hellenistic era. The oldest applications are flow rate control in water clocks.
Scientific advancement, which reached its peak in the Hellenistic age, lost its luster in the palaces of Byzantium; the Abbasid Caliphs in Baghdad once more let lit the science torch. Muhammad, Hassan and Ahmad known as Benu Musa or Sons of Musa bin Shakir of Khurasan, are very famous in the history of technology. They played an important role in the advancement of mathematical sciences during the reign of Abbasid caliph al-Ma'mun (813-833 A.D) and the succeeding caliphs. Ahmad's interest in technology might have led them to write the book titled Kitab al Hiyal (Book of Mechanical Devices) (850 A.D). The manuscript in the Ahmed III Library at Topkapi Palace is almost a complete copy (A 3474) and includes magical vessels, water jets, o il lamps, a densimeter, a bellow, and a lifting device. This science of 'ingenious devices' and 'ingenious automata' created by the use of matter, water and air is known as 'ilm al-alat al ruhaniyet': science of pneumatic devices. According to Akfani, "the science of pneumatic devices deals with the construction of various devices based on the principle of the 'horror of vacuum'. The purpose is to educate the mind while designing these systems that deal with measured cups, siphons and other elements."
Kitab al Hiyal of Benu Musa brothers describes 100 systems of which 18 are automatic control systems. On close inspection, these control systems are technically perfect and applicable to modern use.

Ancient Egyptian water clocks continuously improved during the ancient Classical period reached monumental dimensions in the Hellenistic period. This tradition continued into the period of Islam and reached its height with al-Jazari, who introduces himself in his manuscript as Badi'al- Zaman abu al-'Izz Ismail al-Razzaz al-Jazarî. He served in the Artukid capital Amid (Diyarbakir) as court engineer. He is famous for his book Kitab al-Hiyal, 'Book of Ingenious Devices' where he explain the design, construction and working principles of fifty different systems of practical use and aesthetic value such as water clocks, automata, water jets, vessels for blood collecting, water raising devices and ciphered keys. In the foreword of his manuscript, he mentions that he served the Artukid rulers Sultan Nasir al-Din Mahmud (1200-1222). For twenty-five years he had been in the service of the royal family, served first for the father of the king Nur al-Din Muhammed (1174-1185) and then for the brother Kutb al-Din Sokman II (1186-1199). He completed his book in 1206. Today, Ahmed III Library at Topkapi Palace houses a second-hand copy of the original manuscript (A 3472). In six sections, the book describes fifty different systems.

Taqi al-Din (1521-1585) was a brilliant engineer and astronomer. He built the Istanbul observatory during the reign of Murad III (1564-1595), and wrote numerous books mainly on astronomy and mechanics. His work on the construction of mechanical clocks is a testimony to competition with the West. When in 1583 the Sultan has ordered the destruction of the observatory, the last research centre of the East closed for more then 200 years.

Figure Sources: Figure (front). An example of a level control from Benu Musa's book titled Kitab al-Hiyal. Donald R. Hill, the Book of Ingenious Devices (Kitab al-Hiyal) by the Band (sons of) Musa bin Shakir, D. Reidel, Dordrecht-Boston, 1979.Figure (top). Rear view of the water clock mechanism. Kitab al-Hiyal, al-Jazari, Topkapi Palace Library, A 3472, fol.18b. Figure (bottom). Front view of the regulator disc with zodiac signs, the marker and the outflow end of the pipe. Kitab al-Hiyal, al-Jazari, Topkapi Palace Library, A 3472, fol. 8a.
by: FSTC Limited, Fri 22 December, 2006

Engineering Inventors

2007-06-04T00:47:00.000-07:00

The Machines of Al-Jazari and Taqi Al-Din

This article is based on a paper presented by the Professor Salim Al Hassani at the 22nd Annual Conference on the History of Arabic Sciences, Aleppo, and 23-25 October 2001. It summarises the results of three recent investigations on the Machines of Al-Jazari and Taqi Al-Din, sponsored by the Foundation for Science, Technology and Civilisation (FSTC) and carried out at the University of Manchester Institute of Science and Technology (UMIST) as Final Year student projects for the award of B.Eng Hons. Degree in Mechanical Engineering.

These investigations explore the origin and genius of the inventors and their inventions, (Water Raising Machines and Water Clocks) with in-depth research and discussion from the evolution of the inventions to the rudimentary components used.

Geometrical and mechanical details were obtained from the Arabic original manuscripts and from English translations. Mathematical descriptions of the working (kinetic, motion and energy characteristics) were coded in MATHCAD to predict the various positions of the parts and the motion of the water. The mathematical analysis confirmed the viability and efficiency of the original design as described by Al-Jazari and Taqi Al-Din.

The original dimensions of the components were used to produce modern engineering drawings and these were used to produce images in 3D Studio Max software for each object. After assembling the objects a full three dimensional image is produced of the machine.

The images can be rotated to produce the effect of a fly over and around the machines. By incrementally adjusting the position, according to the machine kinematics of each component, a sequence of images was obtained to produce the effect of 3D animated motion. A CD with full interactive instructions to assist in understanding and investigating the mechanisms of the machines has been produced. This project, for the first time, succeeded in combining state-of-the-art Engineering and Information Technology to bring life to these machines.

Muslim Contributions to Engineering

Studies made during the past fifty years demonstrate that the Muslims made substantial contributions to developments in engineering and that some of their accomplishments were passed on to the Europeans through Spain, Italy and the Crusades.
Many of the achievements made in engineering and technology in the Islamic world in earlier centuries are not well known. Two main reasons for this were suggested by Ludlow and Bahrani [1]:
1. During that period, engineers and technologists were practical rather than literary people. They carried out their work competently but did not write down or publish their discoveries and achievements. Their skills and knowledge were passed on from master to pupil without being recorded. The extent of their ability and skill can now be judged from the few articles and instruments they made which still survive in some museums.
2. In the few cases where the engineers and technologists did write down an account of their work and observations, their manuscripts have been mislaid or destroyed.

During the past fifty years there has been a revival of interest in the history of technology during the early Islamic period. A few Arabic manuscripts dealing with mechanical engineering have been found and some of these were translated into European languages. Among the most important of these manuscripts are:
a. Book of Artifices by Banu Musa (The three sons of Musa Ibn Shakir). This manuscript, which was written in Baghdad about 830 CE, describes approximately one hundred pieces of technical equipment. The book has not yet been properly translated into English.
b. The Book of Knowledge of Ingenious Mechanical Devices by Ibn-al-Razzaz Al-Jazari written in Diyar Bakr (Turkey) about 1206 CE. This book, which has recently been translated into English by Donald R Hill [2] contains descriptions and illustrations of clocks, fountains and perpetual flutes, machines for raising water and a miscellany of other devices.
c. Sublime Methods of Spiritual Machines by Taqi Al-Din, written in Damascus about 1551 CE. This manuscript, which is not yet translated into English, contains descriptions and illustrations of clocks, weightlifting equipment, pumps and various other machines.

The contributions of Engineering in the Islamic world are evidently many yet the materials or treatises available to researchers are very limited, and much more effort is needed to study this field. Useful contributions have been made by Eilhard Widemann, Fritz Hauser, Ahmed Y Al-Hassan and Donald Hill. The latter is the most important contributor to this project and most of his works focus on Al-Jazari's "fi ma 'rifat al-hiyal al-handasiyyah" (The Book of Knowledge of Ingenious Mechanical Devices).
Quoting Dr Donald Hill:
"as far as I am aware, there has been no archaeological study of medieval Islamic technology, nor any detailed technical examination of those machines, which still exist, such as the Noria at Hamah, Syria."
Medieval Islamic technology can be divided into two categories; namely "fine technology" and "utilitarian technology".

The term "fine technology" refers to machines or instruments that were designed to cause wonder and aesthetic pleasure to courtly circles, or for timekeeping, or for the use of scientists (mainly astronomers). The source of information on fine technology can be found in a few previous technical treatises, such as Al-Jazari's "The Book of Knowledge of Ingenious Mechanical Devices".

The term "utilitarian technology" refers to machines that were essential to the economic prosperity of society but were very much simpler technically than the construction of fine technology. The source of information on utilitarian technology comes largely from archaeology finds, examination of existing machines and references in the works of geographers, travellers and other non-technical writers. Machines of this category include mills, water-raising devices and textile machinery [3] .

It is interesting to note that Al-Jazari's Third Water-Raising Device incorporates the two categories of technology together, as the machine is designed to be a beautiful ornamental artefact with splendid craftsmanship, and raises water at the same time.

Al-Jazari
Al-Jazari was in the service of Nasir Al-Din, the Artuqid King of Diyar Bakr, and he spent twenty-five years with the family, having served the father and brother of Nasir Al-Din. The Artuqids were a Turcoman Dynasty who maintained a precarious autonomy during the twelfth century in Mesopotamia [4]. He received patronage from the Artudqid Kings and financial means were provided through salary and pension. Therefore, he was able to devote all his time to study, research, writing and inventions [5]. Al-Jazari was quite evidently a master craftsman himself [6] and regarded himself as one person in a succession of craftsmen and engineers. He states this point, by describing in scrupulous detail how each device was constructed, and much of the language that he used, which involved terms common amongst the craftsmen of that time, are in use right up to the present day. Furthermore, he expressed awareness of the need to develop machines with a better design and greater output than the traditional ones. He did not like to copy his predecessors' work blindly. Rather he was concerned only with innovative and ingenious designs and inventions. Al-Jazari's main virtues were the ability to carefully manufacture and assemble components, and to devise real improvements on the work of his predecessors. He did however have a tendency to be inconsistent in his dimensions, some vagueness about the positioning of the equipment, and failed to give a coherent record of mathematical or geometrical processes.

Taqi Al-Din
Taqi Al-Din was born in Damascus in 1525/6 CE. He died in 1585 in Turkey. His full name was Taqi Al-Din Mohammad bin Ma'aroof bin Ahmad bin Mohammad bin Mohammad bin Ahmad bin Yousef bin Mohammad Al-Shami. He was the son of a judge and he became a judge himself. He was described by his contemporaries as the greatest Scientist / Engineer on earth. He is known to have written 19 books. For details see the book by Prof. A Y Al-Hassan [7]. The machines we modelled are described in his book "al-toruq al-saniyah fi al-alat al-rohanyah".
Much the same observations can be made about Taqi Al-Din as those made for Al- Jazari. Nevertheless, taking drawings and text together, it can be said that they fulfilled their declared intention of describing the devices so that they could be reconstructed by their successors. Indeed, the "castle" water clock was reconstructed in the Science Museum, London, for the 1976 World of Islam Festival. It works perfectly, exactly in accordance with Al-Jazari's intention. Recently the Frankfurt Institute of Arab and Islamic History, under the direction of Professor Fuat Sezgin, has constructed small models of a few of Al-Jazari's devices. Our present project also fulfils that aspiration in that all of Al-Jazari's machines as well as those of Taqi Al-Din will be re-constructed by engineering and computer graphics.

THE WORKING PRINCIPLES OF THE MACHINES

Fig. 1 The reciprocating pump from Al-Jazari's manuscript

(i) The Reciprocating Pump of Al-Jazari
This pump, see Fig. 1, was first made by Al-Jazari in 1206. Taqi Al-Din, 1551, also gave a full description of this pump (see Fig. 2) shows a 3D image of this pump as produced from engineering analysis of the details given by Al-Jazari.
The pump consists of two opposing copper cylinders each containing a piston. The two pistons are connected through a rod which is pin jointed to a swinging arm pivoted at the base of the pump. The arm is slotted so that a crank pin on a gear wheel causes it to swing with wheel rotation. The wheel is driven by a water wheel or an animal drive. The two cylinders are connected to manifolds with inlet and outlet flap. The flaps act as no return valves.

Fig. 2 3D Image of the reciprocating pump with a water wheel as the drive source

Fig. 3 The six cylinder water pump from Taqi Al-Din's manuscript

(ii) The Six Cylinder Pump of Taqi Al-Din
Taqi Al-Din explained how the pump works in his manuscript, see Fig. 3. The input power source is the river and the resultant output is the delivered water head. The river exerts a force on the scoops, which provides the drag force causing the wheel and camshaft to rotate. With rotation of the camshaft, each cam pushes its connecting rod downwards. The connecting rods are pivoted at the centre. The distal end of the connecting rod lifts the lead weight upwards. As the lead weight moves upwards, it pulls the piston with it, creating vacuum which sucks the water through a non return clack valve into the piston cylinder. After the camshaft rotates a certain angle the cam releases the connecting rod. This marks the point where the piston's stroke ends. Thence, the lead weight pushes the piston under gravity forcing against the clack valve. As mentioned earlier, the clack valve closes when the water moves in this direction, so the water is forced to go through the other hole and through the delivery pipes. The synchronisation and control sequence of all the pistons is provided by the angular arrangement of the cams around the shaft.

Fig. 4 3D image of the six cylinder water pump

Fig. 5 The third water raising machine from Al-Jazari's manuscript

(iii) The third water rising machine of Al-Jazari
This machine, See Fig. 5, was described in full by Al-Jazari. Fig. 6 shows a 3D image of this machine. Water flows through the inlet pipe into the basin and out on to the scoops turning the water turbine. The rotation is transferred through the cogwheel (gear A), the Lantern (pinion gear B). The rotation is then transmitted via a pillar connected to the upper Lantern and cogwheel which turn the sindi-wheel. The sindi-wheel carries a series of jars connected to ropes. As the jars dip in and out of the water basin they carry water up to the aqueduct.

Fig. 6 3D image of Al-Jazari's third water raising machine

Fig. 7 The elephant clock from Al-Jazari's manuscript

(iv) The Elephant Clock of Al-Jazari
Fig. 7 shows a sketch of the elephant clock by Al-Jazari. Fig. 8 shows a schematic of the clock as given in foootnote #1. Fig. 9 shows a 3D image of the various components of the clock. The elephant clock is a fine example of the many exquisite devices created during the Muslim Golden Age. It is classified as fine technology as the device is used either for amusement and aesthetic pleasure or for astronomical observation and computation. It is described as one of the most spectacular clocks invented by Al-Jazari and is estimated to be about 4 feet long and 6 feet high. It also demonstrates his considerable skill in both design and construction. The characteristics of the elephant clock consist of several mechanisms that are presently used in modern engineering such as automata, flow regulators and a closed-loop system.
Automata: The clock employed automata, such as striking of the cymbal and chirping of the bird, to mark the passage of the hours.
Flow Regulators: A small orifice in the submersible float is carefully calibrated to produce correct rates of flow under various head of water rates. This rate of flow determines the time at which the clock strikes at hourly interval. It is set by trial and error methods.

Fig. 8 Schematic of the elephant clock

Closed-loop system: The clock will continue to work as long as there are metal balls in the magazine.

Gravitational Force: The clock employs the use of gravitational force as motive power. A submersible float or tarjahar drives it. The steady sinking of the float acts as gravitational force, pulling the wire that activates the tripping mechanism. (a tarjahar is a device used for timing the allocation of irrigation water to farmers). In addition, as the ball drops onto the serpent's mouth (during operation), it activates a gravitational force pulling down the serpent's head. As the ball leaves the serpent's mouth, it activates a return mechanism.
Return Mechanism: The serpent has a return mechanism in the form of a pulley. When the return mechanism is activated, the lowered serpent's head returns to its original position and lifts a chain along with it. This chain is connected to the float and it lifts up the submersible float and empties its content, the submersible float is now on the surface again and the cycle repeats.

Fig. 9 The Mahout on the neck of the elephant, the vases on either side and the scribe on top of the circular platform

Control Mechanisms: The submersible float or tarjahar drives the clock. Initially, the submersible float lies on the surface of the water in the tank. A calibrated orifice on its underside allows water to enter and subsequently sinks the float. Attached to the submersible float are a wire and a chain. The wire runs from the float to the ball release mechanism inside the castle and activates it when the float sinks. The chain runs from the underside of the float to a staple on the tail of the serpent. Upon activation of the return mechanics for the serpent, the chain will tilt the sunken float out of the water thus emptying it of its contents. Then the emptied float will rest on the water surface and repeat the cycle. At the top of the lock, supported by four columns, is the castle (a square brass box with a detachable dome). Inside the castle is a ball release mechanism, which when activated, releases a ball that travels down a channel leading to the beak of the falcon. The ball will travel from the beak of the falcon onto the open mouth of the serpent. The serpent is in effect a pulley which rotates on an axle that rests on bearings fixed between each pair of the columns. Upon loading with the ball, the serpent head will be lowered down to the vase. Once the ball drops away from the serpent's mouth, the return mechanism of the serpent is activated and the serpent returns to its original position.

MATHEMATICAL ANALYSIS

Full mathematical analyses of each machine are contained in the respective project reports placed in the Department of Mechanical Engineering, UMIST, May 2001. It is beyond the scope of this paper to describe these analyses. MATHCAD was used to link up all the equations describing the motion of each component. The dimensions were obtained from Al-Jazari's and Taqi Al-Din's manuscripts. On a number of occasions we had to make a best guess of the actual dimensions of the component.

Essentially, each analysis starts with equating the forces acting on each component allowing for friction as well as compatibility of velocities and displacements and the output is predicted. For example, in the case of Taqi Al-Din's six cylinder pump, the analysis starts with equating the weight of the lead and pistons to the required water head through the collective output pipe. The lead weights are then balanced by the force on the connecting rods which determine the torque on the camshaft which then fixes the force required by the water flow from the river.
Allowance had to be made for friction forces at the pivot and for all sliding surfaces. Further allowances are made for the shape of the scoop at the end of each spoke of the water wheel.
When all the equations are encoded into MATHCAD the solution provides the relationship between the geometrical and mechanical parameters and graphs are plotted to assist in the assessment of the efficiency of the machine. Additional analysis was conducted on the strength requirement of the components. From the forces and torques, stresses were calculated which are compared to the failure strengths and buckling capacity of the components.

3D GRAPHICS AND ANIMATIONS

Modelling and animation were carried out using 3D Studio MAX R3.1 package based on the findings on the research and mathematical analysis of the machines. 3D studio MAX is a very powerful graphics software package used for modelling, animating, image processing and texture mapping for both 2D and 3D objects. Modelling the machines was done in four steps:
1. Creating objects and setting them into positions.
2. Modifying some objects to match those in the real machine.
3. Assigning materials to objects to make them look realistic.
4. Creating lights and cameras and setting them into proper positions to give a real look to the model.

The graphics show the components, devices and machines in different angles of views, close up views and "wire frame" views. The different angles of views include the front perspective view, rear perspective view, front view and left view. The close-up view zooms onto the chambers of the device in perspective view while the "wire frame" view shows the "skeleton" view of the devices. The 3D animations consist of two movie files: a 360o rotational view and one that shows the movements of individual components during their operations. These animations enable the reader to view the device in different angles and also to view the device in operational mode.

The 3D drawing file and animations are stored on CDs to enable a step-by-step construction of the machines or modification of the drawings.
[1] C G Ludlow and A S Bahrani, 1978, Mechanical Engineering during the Early Islamic Period, I. Mech. E, The Chartered Mechanical Engineer, pp 79-83.
[2] Ibn Al-Razzaz Al-Jazari, 1974, The Book of Knowledge of Ingenious Mechanical Devices, translated and annotated by Donald R Hill, Dordrecht, and D. Reidel.
[3] Dionisius A Agius and Richard Hitchcock (Editors), 1994, The Arab Influence in Medieval Europe, Ithaca Press. (p.25)
[4] Donald R Hill, 1998, Studies in Medieval Islamic Technology, Edited by David A King, Ashgate Variorum collected studies series. (p. 253)
[5] Ahmad Y Al-Hassan and Donald R Hill, 1986, Islamic Technology (An Illustrated History), Cambridge University Press. (p.12)
[6] Compilation of writers, 1976, The Genius of Arab Civilisation (Source of Renaissance), Edited by John R Hayes, Oxford, Phaidon. (p.177)
[7] Dr Ahmad Yosuf Al-Hassan, 1999, Taqi Al-Deen wa al-handasah al-meekaneekiyah al-arabiyah (Taqi Al-Deen and the Arabic mechanical engineering) with "Kitab al-toruq al-saniyah fi al-a'alat al-rohaniyah" from the sixteenth century.

by: FSTC Limited, Thu 30 December, 2004