Arab Physicians Research Articles

David E Shuttleton, Smallpox and the literary imagination 1660–1820, Cambridge and New York, Cambridge University Press, 2007, pp. xiii, 265, illus., £48.00, $85.00 (hardback 978-0-521-87209-6).

Uniting their forces, it seems, by sheer dint of scholarly writing, literary historians of the last generation have rewritten the cultural profile of numerous diseases: cancer, consumption, gout, heart disease, obesity and others. David Shuttleton, a literary historian interested in the interface of literature and medicine, has rounded out this record with his fine study of smallpox's profile in the eighteenth century, its most transformative epoch before inoculation and vaccination turned around its fortunes after 1800. Shuttleton revises smallpox's harsh realities, social effects, and especially its verbalizations and mentalizations by onlookers, close and distant. Smallpox's narrower medical history is, of course, far from certain. Identified in the ancient world, first described by the Arab physician Rhazes, and distinguished from measles by Fracastoro, its progress from the Middle Ages to 1600 still conceals mysteries. What can safely be affirmed is that by 1700 it was killing many thousands each year: the scourge from which the eighteenth century could never be free. Jenner's vaccinations at the end of the century, building on Lady Mary Wortley Montagu's earlier inoculations, were the Enlightenment's best hope for prevention. But the resistance to inoculation was immense. It was only when empire and imperialism in the Indian subcontinent made plain that smallpox would become a menace as dire as cholera, that the benefits of vaccination were securely applied. “Medical history” is a smaller field than “medical profile”, which extends to a malady's public understanding: here think of mental illness and AIDS. Shuttleton appropriately begins with this larger, bewildering profile in mind and augments our sense of smallpox's cultural casualties. A scourge that disfigures its victims through visible sores, scars, and red spots erupting hot pus will be moralized despite attempts to neutralize the condition. Yet if disease clusters possess inherent symbolic resonances, as cultural historians have been demonstrating for three decades that they do, smallpox's salient sign was disfigurement: disfigurement more than death. This perception did not sit easily with a Georgian civilization steeped in the lure of widely disseminated cults of beauty—aesthetic, physical, moral and sublime—and beauty's opposites in the realms of the ugly and grotesque. Historians have interpreted much Enlightenment culture through this specific opposition. Yet read the pathetic accounts of those dying of smallpox and the horror of disfigurement terrorizes them far more than death does. If obesity in our time has become the site of fiercely contested debates trading on our obsession with symmetrically trim bodies—so slim that they are often anorexic—smallpox before 1800 took a similar toll on the faces and figures of women and men, rich and poor. Shuttleton's accounts are often riveting, demonstrating the part played by imagination in the framing of this condition, especially the literary imagination that conceptualizes malady by first verbalizing it. This is not another pedestrian representation of a disease cluster: Shuttleton also embeds perplexing philosophical dimensions of “representing malady”—its degree of stigma—and takes sides in the ongoing debate about the need for demystification. Students of medical history know how assiduously Susan Sontag campaigned in the 1980s to demystify disease, which (in her view) should be a scientific category rather than moral sign or cultural stigma. Her aim was noble and eloquently argued, but history from time immemorial—continuing into the present—weighs against her position. People have always given meaning to disease; infected individuals cannot refrain from attaching morally loaded significance to their maladies that exceed the limits of the pathological signs and literal physical symptoms. For centuries smallpox was living proof of the moral tendency rather than its exception, just as psychological depression is today.

Ibn al-Nafis (1210–1288): The First Description of the Pulmonary Circulation

Ibn al-Nafis (1210-1288) was an Arab physician who contributed much to the advancement of medical knowledge and science in the 13th century. He was involved in jurisprudence, politics, and anatomical studies as well. Although a prominent ophthalmologist by training, today he is most recognized for his discovery of the lesser or pulmonary circulation. His was the first work to contradict the accepted teachings of Galen, which had existed since the 2nd century AD. His description included the observation that the wall of the septum is not porous either grossly or macroscopically as was believed by earlier scholars. Therefore, blood from the venous circulation had to be directed through the pulmonary artery ("venous artery") through the lungs to be "mixed with air" and drained back to the left side of the heart through the pulmonary vein ("arterial vein"). This discovery would lead to a change in the historical observations that the pulmonary circulation was discovered by European scientists in the 16th century and lead many to wonder if these scientists had access to Ibn al-Nafis' translated works. Ibn al-Nafis was devout to his work and to his religion, contributing much to the body of knowledge in anatomy and medicine as well as being a prominent and exceptional physician.

Breast cancer in emerging countries: The status of breast care in South Africa

The impression among Arab Physicians dealing with breast cancer is that it presents at an earlier age and at a more advanced stage as compared to western countries. However, the statistical data to support this impression is remarkably scarce.We performed a comprehensive literature review of reports of breast cancer in Arab countries. Articles were identified from Saudi Arabia, Bahrain, Qatar, Kuwait, Emirate, Oman, Yemen, Iraq, Syria, Jordan, Lebanon, Egypt, Libya, Algeria, Tunis, Morocco, and Sudan.Twenty eight articles were identified and reviewed. The average age at diagnosis of breast cancer was available in 18 articles; the average age was 48 (SD = 2.8), range 43–52, median 48.5 and mode 45 years among the 7455 patients included. The median age of diagnosis of breast cancer was available in 8 articles; here, the average age was 45.4 (SD = 4.8), range 40–54.5, median 44.5 years among the 5379 patients included. The percentage of patients that were younger than 50 years old was reported in 11 articles from 8 countries and included 5144 patients; 65.5% (SD = 11) were less than 50 years old (range 49–78%, median = 66%).In this literature review, the average age at presentation of breast cancer in Arab countries appears to be a decade earlier than in western countries. If this is true, this has important implications for screening and cancer management strategies in these countries, including the ideal age at which to begin screening. Adoption of Western guidelines “without critical amendment” in planning breast cancer programs will waste resources without achieving desired outcomes. Determination of the true frequency and age of onset of breast cancer in Arab women should be an important research priority.

Concept and Treatment of Hydrocephalus in the Greco-Roman and Early Arabic Medicine

In the ancient medical literature hydrocephalus was not often described although its existence and symptomatology were well known. Most detailed descriptions of hydrocephalus including the surgical treatment are extant in the encyclopaedic works on medicine of the physicians Oreibasios and Aetios from Amida from the 4th and 6th centuries AD, respectively. Because of their broad scientific interests, this type of physicians, typical for the late Roman empire, were known as philosophy-physicians (iota alpha tau rho o sigma o phi iota sigma tau alpha iota). They defined hydrocephalus in contrast to our present understanding as a fluid collection excluding abscesses visible as a bulging tumour localised either outside or inside the skull of an infant. They classified the hydrocephalus similar as stated first by Galen in the 2nd century AD in four types corresponding to the assumed anatomic localisation of the fluid collection: 1st Type between the skin and the pericranium corresponding to the subgaleal haematoma or caput succedaneum of the newborn in our terminology, 2nd Type between the pericranium and the skull corresponding to the cephal haematoma after delivery, 3rd Type between skull and the meninges with increased head circumference, bone sutures being increasingly driven apart corresponding most likely to the hydrocephalus in our understanding, and 4th Type between the menings and the brain characterised by severe neurological deficit with lethal prognosis corresponding probably to all pathologies which were accompanied by an excessive increase of the intracranial pressure with a bulging fontanel. Due to the lack of autopsies in ancient times, the hydrocephalus was never linked to the pathology of the ventricles. All forms of hydrocephalus were believed to be caused by improper handling of the head by the midwife during delivery. Only the extracranial fluid collections, but not hydrocephalus in our sense, were considered to be suitable for surgical treatment. The surgery consisted in one or more incisions and evacuation of the fluid. The wound was not closed but let open for three days. Thereafter plasters or sutures closed the incisions. The surgical technique goes back probably to Antyllos a surgeon from the 3rd century AD whose considerations were cited in the work of Oreibasios. The early Arabic physicians took over the surgical indications, the operative technique and modified the Greek concept of hydrocephalus. Avicenna separated the traumatic haematomas outside the skull from the term hydrocephalus. However Avicenna, as all previous authors, had not linked hydrocephalus with the ventricular system. The autopsy of a child with an exorbitant hydrocephalus performed by the anatomist Vesalius in the 16th century revealed as a single pathology an extremely dilative ventricular system filled with water-like fluid which made it necessary to change completely the ancient concept of hydrocephalus.

Clinical characteristics, diagnosis and surgical management of hydatid cysts

Echinococcosis was described by Hippocrates more than two thousand years as a "fluid-filled liver", followed by the famous Arabian physician "Al-Rahzes." It is endemic in the Middle East, India, Africa, South America, New Zealand, Australia, Turkey and Southern Europe. The disease has got different clinical presentations, depending on the organ(s) involved, and may present a clinical dilemma regarding diagnosis and treatment. Surgery for hydatid cysts has been always considered as the treatment of choice; however, other options like chemotherapy, interventional and minimally invasive procedures or combination of all, are to be put into considerations as well In addition, selection of patients for any of these options is an important part of management. The disease might undertake a "malignant" course in the sense of high rate of recurrence, which further enforces the importance of meticulous evaluation and proper planning of treatment. In this communication, we critically reviewed the literature and present a brief summary of common clinical presentations, current methods of diagnosis, medical and surgical management, and follow-up strategy of Echinococcosis granulosus or Cystic Echinococcosis (CE).

Vascular Knowledge in Medieval Times was the Turning Point for the Humanistic Trend

Objective Knowledge of the history of our surgical specialty may broaden our viewpoint for everyday practice. We illustrate the scientific progress made in medieval times relevant to the vascular system and blood circulation, progress made despite prevailing religious and philosophical dogma. Methods We located all articles concerning vascular knowledge and historical reviews in databases such as MEDLINE, EMBASE and the database of abstracts of reviews (DARE). We also explored the database of the register from the French National Library, the French Medical Inter-University (BIUM), the Italian National Library and the French and Italian Libraries in the Vatican. All data were collected and analysed in chronological order. Results Medieval vascular knowledge was inherited from Greek via Byzantine and Arabic writings, the first controversies against the recognized vascular schema emanating from an Arabian physician in the 13th century. Dissection was forbidden and clerical rules instilled a fear of blood. Major contributions to scientific progress in the vascular field in medieval times came from Ibn-al-Nafis and Harvey. Conclusion Vascular specialists today may feel proud to recall that once religious dogma declined in early medieval times, vascular anatomic and physiological discoveries led the way to scientific progress.

Who Invented 'Avicenna's Gilded Pills'?

This article questions the belief expressed in various histories of pharmacy that the tenth-century Arab physician Avicenna introduced the tradition of coating pills with gold and silver. Although an examination of his Canon documents Avicenna's interest in the medicinal application of gold and silver, no mention is made of coating pills. Nor do other Islamic physicians seem to have been familiar with this practice, any more than such medieval European authors as Arnaldus of Villanova, Raymund Lull or Johannes de Rupescissa. The same is true of medicinal compendia representative of later periods, such as the Ortus sanitatis, Valerius Cordus' Dispensatorium or the Secrets of Alessio Piemontese. The earliest known mention of coating pills with precious metals occurs in a non-medical book, The Golden Fleece (London, 1626), and the earliest mention in the professional literature seems to appear only in the second half of the seventeenth century. The practice of coating pills with gold and silver was to be practiced in Europe into the first half of the twentieth century.

Mummies as medicinal tools

The term “mummy” is thought to be derived from the Persian or Arab word “moumiya”, meaning pitch or bitumen. It likely referred to the black, hard, and resinous substance probably used by the Egyptians in their embalming procedures during the late period and Ptolemaic Roman period. During medieval times and later, Arab and European physicians thought that mummies had medicinal properties. Egyptian mummies dug out of their tombs were sometimes grinded into powder and shipped across the Mediterranean to be sold as medicine for the cure of different diseases; for example epilepsy, abscesses, rashes, migraine, nausea etc. From the 12th to the 17th centuries, mummy remains could be found in apothecaries’ shops, and as late as 1908 they could be ordered from the catalogue of the Merck pharmaceutical company.

The Physician and the Other: Images of the Charlatan in Medieval Islam

Physicians have always tried to demarcate themselves from the Other, whom they labeled as a "charlatan." During the medieval period, Arabic physicians such as al-Rāzī attacked charlatans in their theoretical and deontological writings, and, like their Greek predecessors, called on the authorities to stamp out malpractice. Their advice was partly heeded, as can be seen from manuals on market inspection (hisba). Physicians accused their colleagues of quackery based on charges of incompetence or deceit, which must be seen partly as an attempt to protect themselves from potential competitors. Certain groups of society, including women and Jews, were an especially convenient target. Moreover, charlatans also appear in nonmedical texts such as al-Gaubarī's manual on tricksters and al-Harīrī's Assemblies or Maqāmāt. These accounts suggest that, despite the calls of the medical elite to exclude quacks from the marketplace, the latter were able to attract customers and continue to practice.

Antonio Maria Valsalva (1666 - 1723)

Antonio Maria Valsalva (1666 - 1723)

Tradition and Perspectives of Arab Herbal Medicine: A Review

Complementary and Alternative Medicine (CAM), including herbal medicine, are popular in the general population worldwide. Parallel to the increasing interest in ‘modern’ CAM therapies and the historical importance of Arab medicine, there is also a similar trend in research activities dealing with the efficacy and safety of medicinal plants in our region. Historical and current studies and surveys indicate that the Eastern region of the Mediterranean has been distinguished throughout the generations with a rich inventory of natural medicinal herbs. It is well documented that indigenous Arab medicine has contributed greatly to the development of modern medicine in Europe and remains one of the closest forms of original European medicine. The rapid increase in consumption of herbal remedies worldwide has been stimulated by several factors, including the notion that all herbal products are safe and effective. This article presents a systematic review on traditional Arab medicine including historical background, medical innovations introduced by Arab physicians in the field of safety and efficacy of herbal medicine and a state-of-the-art description of traditional Arab herbal medicine in the Mediterranean region.

Termination of pregnancy: attitudes and behavior of women in a traditional society

The Bedouin Arabs, a Muslim traditional ethnic minority in Israel, are faced with difficult choices when offered prenatal diagnosis as part of the universally provided prenatal care in Israel. This paper is to examine attitudes towards and practice of pregnancy termination, following an unfavorable prenatal diagnosis. Semistructured interviews with 83 women were conducted to study attitudes. Data from the Soroka Medical Center, where all births in the area take place, were used to assess the rate of terminations of pregnancies following a diagnosis of a chromosomal anomaly. While divided on the question of termination, many women believed that a second medical opinion is needed, preferably from an Arab physician. The reasons for termination are both child- and mother-related. Opposing termination is based on both the suspicion that the diagnosis might be wrong and on religious reasons. Between 1995 and 1999, 686 Bedouin women had undergone amniocentesis (2.4% of all pregnancies). Six of 11 pregnancies with the diagnosis of a trisomy were terminated (54.5%). All cases in which a trisomy was terminated were trisomy 21. Culturally acceptable prenatal diagnostic services for Muslim populations should be based on early testing, and should involve Muslim physicians and religious authorities.

U.S. Experts May Help Build New MH System in Iraq

Back to table of contents Previous article Next article International NewsFull AccessU.S. Experts May Help Build New MH System in IraqChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:2 Apr 2004https://doi.org/10.1176/pn.39.7.0024Charles Curie, M.A.: “There are only two psychiatric hospitals in [Iraq] serving the entire population of 24 million.”Charles Curie, M.A., director of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), wants to invest U.S. resources in building a new Iraqi mental health system that is community based and integrated with primary care.“Iraq still uses an outdated system of institutions to treat the seriously mentally ill. There are only two psychiatric hospitals in the entire country, located in the capital city of Baghdad, serving the entire population of 24 million,” Curie told Psychiatric News.Rather than support or build more psychiatric institutions, Curie wants to use U.S. expertise and assistance to build a community-based system of care that is integrated into the nearly 1,000 health care clinics now operating in Iraq.Curie accompanied Health and Human Services (HHS) Secretary Tommy Thompson on a two-day visit to Iraq in February. They toured three hospitals and met with health officials, medical personnel, and patients to assess the health and mental health needs of the Iraqi health system, according to Curie.He also spoke with his Iraqi counterpart, Sadik Sabah, M.D., who is the mental health advisor to Iraqi Minister of Health Khodair Abbas, M.D.To help rebuild the decimated health care system, Abbas recently returned to Iraq after having lived in exile in England during Saddam Hussein’s dictatorship, according to an HHS press release.Curie described his visit to Iraq to the APA Board of Trustees at its March meeting in Washington, D.C. APA President Marcia Goin, M.D., commented afterward to Psychiatric News, “Mr. Curie was clearly enthusiastic about mental health playing a prominent role in the reconstruction of Iraq and its health care system.”Goin said she and her colleagues had a similar enthusiastic response to recommendations for rebuilding Iraq’s mental health system made at a conference sponsored by the World Health Organization and the World Psychiatric Association in Cairo last July (Psychiatric News, September 5, 2003).“I suspect,” Curie said, “that rates of posttraumatic stress disorder are endemic in Iraq because large numbers of Iraqis were tortured and traumatized under Hussein’s brutal dictatorship.”Many physicians were traumatized by having to watch patients die in emergency rooms for lack of sutures and other medical supplies, Curie said. “We heard that Hussein held back lifesaving medications so that he could blame the resulting deaths on the U.S. trade embargo.”Curie is aware of the country’s shortage of psychiatrists and mental health professionals (see Original article: page 1). “There is already an effort under way by Iraqi psychiatrists and mental health professionals to train primary care professionals to conduct mental health assessments and counseling and to know when to refer to local psychiatrists,” said Numan Ali, M.D., secretary-general of the Iraqi Society of Psychiatrists, in an online interview with Psychiatric News.Curie said that an Iraqi behavioral health care task force had asked for U.S. medical assistance and expertise.The SAMHSA administrator envisions international teams of psychiatrists and mental health professionals visiting Iraq in the next six months to help expand the mental health training of local health care professionals. He said that mental health officials in New Zealand and England have expressed interest in joining the United States in sending teams of mental health experts to Iraq.In addition, Curie would like to establish partnerships between U.S. and Arab medical schools and specialty-training programs to facilitate professional exchanges with Arab physicians and mental health professionals.He cautioned, “We must also ensure that any Western assistance is culturally sensitive to Iraqi and Arab cultures, as well as to the numerous ethnic and religious minorities and tribes living in Iraq.”Funding in the short term for international medical teams will come from SAMHSA’s 2004 budget. “We don’t know yet how the long-term partnerships will be funded. We hope that our international partners will invest some resources also,” Curie said.He was optimistic that the U.S. military in Iraq could continue to provide adequate security for medical teams visiting Iraq. “If you follow the military’s safety guidelines and avoid venturing into unknown areas, you should be all right,” Curie said. ▪ ISSUES NewArchived

Libro de la Melancholía by Andrés Velázquez (1585). Part 1. The Intellectual Origins of the Book

Part 1 of this paper examines views on melancholy from the Hellenic era (especially Hippocrates), the Roman era (especially Galen), Arab physicians (Ishaq Ibn Imran, Rhazes and Avicenna) and the views of physicians from the Renaissance period. The medical orthodoxy followed Galenic theory as late as the sixteenth century, regarding melancholy as a disease of the body.

Oribasius (Fourth Century) and Early Byzantine Perinatal Nutrition

ABSTRACTBackgroundThe purpose of the study is the investigation of perinatal nutrition in the early Byzantine period.MethodsThe original Greek language works of the celebrated physician of the fourth century, Oribasius, were studied.ResultsThe first Byzantine author who studied perinatal nutrition, Oribasius, provided his own concepts about the topic, focusing on the suitable choice of wet nurse and evaluation of the quality of the milk. His research proves that physicians from early Byzantine times were greatly interested in perinatal nutrition. He was aware of the knowledge of eminent ancient Greek and Roman physicians, whose extracts he quoted and opinions he generally followed.ConclusionsThe study concludes that concepts of perinatal nutrition in the early Byzantine period followed those of the Hippocratic, Hellenistic, and Roman periods. The early Byzantine physicians then influenced later Byzantine and Arab physicians, and afterward, their research was introduced to European medicine.

Oribasius (fourth century) and early Byzantine perinatal nutrition.

The purpose of the study is the investigation of perinatal nutrition in the early Byzantine period. The original Greek language works of the celebrated physician of the fourth century, Oribasius, were studied. The first Byzantine author who studied perinatal nutrition, Oribasius, provided his own concepts about the topic, focusing on the suitable choice of wet nurse and evaluation of the quality of the milk. His research proves that physicians from early Byzantine times were greatly interested in perinatal nutrition. He was aware of the knowledge of eminent ancient Greek and Roman physicians, whose extracts he quoted and opinions he generally followed. The study concludes that concepts of perinatal nutrition in the early Byzantine period followed those of the Hippocratic, Hellenistic, and Roman periods. The early Byzantine physicians then influenced later Byzantine and Arab physicians, and afterward, their research was introduced to European medicine.

The saphenous vein: Derivation of its name and its relevant anatomy

Generally, when the origin of the word saphenous is discussed, most affirm that the term derives from the Greek word safaina, which means “evident.” The ancient Greeks knew only the caudal portion of the vein, and neither the Greeks nor the Romans used the term saphena. In fact, the term first appeared in the writings of Avicenna. In contrast, the term saphenous is derived from the Arabic el safin, which means “hidden” or “concealed.” Ancient Arabic physicians knew the anatomy of superficial veins of the human body and its extremities because they performed therapeutic bleeding. Arabic physicians phlebotomized the distal portion of the greater saphenous vein (GSV) at the ankle. Such phlebotomies were never performed on the proximal portions of the GSV because they were not superficial enough to be clearly evident. As a consequence, the proximal GSV was called el safin, or “the concealed.” The modern reader will recognize that based on duplex examination, the GSV is correctly identified on the basis of its deep position with the superficial fascia covering it. This information may be useful in modern saphenous vein surgery in identifying the proximal portion of the GSV. (J Vasc Surg 2002;35:172-5.)

The saphenous vein: Derivation of its name and its relevant anatomy

Generally, when the origin of the word saphenous is discussed, most affirm that the term derives from the Greek word safaina, which means “evident.” The ancient Greeks knew only the caudal portion of the vein, and neither the Greeks nor the Romans used the term saphena. In fact, the term first appeared in the writings of Avicenna. In contrast, the term saphenous is derived from the Arabic el safin, which means “hidden” or “concealed.” Ancient Arabic physicians knew the anatomy of superficial veins of the human body and its extremities because they performed therapeutic bleeding. Arabic physicians phlebotomized the distal portion of the greater saphenous vein (GSV) at the ankle. Such phlebotomies were never performed on the proximal portions of the GSV because they were not superficial enough to be clearly evident. As a consequence, the proximal GSV was called el safin, or “the concealed.” The modern reader will recognize that based on duplex examination, the GSV is correctly identified on the basis of its deep position with the superficial fascia covering it. This information may be useful in modern saphenous vein surgery in identifying the proximal portion of the GSV. (J Vasc Surg 2002;35:172-5.)

International Society for The History of Islamic Medicine

This is the website of an international society whose purpose is to promote public awareness of contributions in the field of Islamic medical sciences. A statement by the Executive Council of the society explains that “there is a consensus among history of medicine researchers that early Arab and Muslim physicians played a very important role in the development of medical science for about eight centuries, during the renaissance of Islamic civilisation”. Despite this, only a small part of Islamic medical heritage has been studied and brought to public attention. The International Society for the History of Islamic Medicine was founded by an international group of physicians and historians, with the aim of reviving and celebrating this heritage. The organisation is now trying to establish a library to house old medical manuscripts and indexes, to publish a journal, to convene international conferences (every 2 years), and to allocate a prize, to be awarded every 2 years, for the best contribution to our understanding of the history of Islamic medicine.

Le mal d’amour dans la médecine arabomusulmane

This article presents lovesickness as viewed by Arab physicians. One of the major features of medieval Islamic medicine was the idea that strong emotions could produce physical illness as interaction between body and mind was the basis of medical thought of the time. In this perspective, Arab physicians studied lovesickness, a condition related to melancholia and obsession. They described it, discussed its origin and proposed remedies to soothe loverˈs suffering. A few examples are given to illustrate the importance of this clinical entity in the medical practice of the time.