Transcript A SHORT HISTORY OF NEUROLOGY The Arab Contribution 500

A SHORT HISTORY OF
NEUROLOGY
The Arab & Muslim Contribution
500-1516 A.D
Regional and 21st International
Conference of Alzheimer's Disease 28th
Sep -1st Oct 2005
Ashraf Kurdi FRCP (G) FRCP (London)
Amman, JORDAN
Introduction
• The language of science at the time was Arabic.
• Many scientists and physicians throughout the Muslim Empire
taught and wrote in Arabic.
• Many scientists were born all over the Muslim Empire from
Central Asia to Andalusia with various ethnic and religious
backgrounds, but what united all of them was the Arabic
language which they all used in their work. The political and
cultural stability coupled with religious tolerance was
paramount in allowing their work to flourish.
• One should not restrict the term of Arab Medicine to those
born in what is now an "Arab" country, but think more
globally without ethnic, religious or social restraints.
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Introduction ...
• In the history of Arab medicine, we can easily identify
several consecutive periods:
– Pre-Islamic and early Islamic medicine from 500 - 750 A.D, the
end of the Umayyad caliphate in Damascus.
– The expansion of Arab medicine started when the Arabs
conquered Syria, Mesopotamia, Persia and Egypt and came in
contact with an established medical science and tradition. This
period coincided with the rise of the Abassid caliphate from 750
- 900 A.D, and the expansion of translation from the GrecoRoman medicine into Arabic with addition of personal
commentaries and experiences to the original text.
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Introduction ...
– The flourishing period of pure Arab medicine, which started
during the Abassid Caliphate around 900 A.D and spanned
through to the Andalusian era up to 1300 AD.
– The fourth period from 1300 - 1516 AD. This was exemplified by
the reverse wave of translations from Arabic into Latin starting in
the western countries of the Arab domain, and the propagation
of Arab medicine from the schools of Southern Italy and Spain
into the north, especially Northern Italy, France and Germany.
Although at the same time another direct translation from Greek
into Latin was provided to the physicians of Europe, the Arabic
translations, due to their rich and encyclopedic material
remained to be the basic textbooks to those physicians and thus
became the main stimuli for the renaissance in the West
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Pre-Islamic and early Islamic period (500 750 A.D)
• This period can be further broken down into two
distinct periods:
– Pre-Islamic period (500 – 621 AD), including the Late
Greek and Roman periods.
– The early Islamic period which included the rise of
Islam (621 - 661 A.D), which was during the
prophet's time and the Orthodox Caliphate and the
Umayyad period (661 - 750 A.D).
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The Abassid period (750 - 900 A.D)
• Center of power moved from Damascus to Baghdad
• Translators
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Bakhtyashoo Family (730 – 1058 AD)
Yohanna bin Masawaiyah (778 – 856 AD)
Hunain bin Ishaq (809 – 873 AD)
Costa bin Luqa (Died 912 AD)
Thabet Bin Qurra (836 – 901 AD)
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Ali Bin Rabban Al-Tabari
(838-870 AD)
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Ali Bin Rabban Al-Tabari
(838-870 AD)
• Author of the first Arabic Medical Encyclopedia (The
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Paradise of Wisdom)
Born and educated in Tabaristan before moving to
Baghdad
• The most important characteristic of Al-Tabari was his
reliance on his personal experience and the clinical
cases he treated or heard of from reliable sources. One
of the last chapters of his book is devoted to
psychotherapy where he cites several examples of the
effectiveness of this treatment in psychosis
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Ali Bin Rabban Al-Tabari
(838-870 AD)
• In neurology
– He wrote about anatomy and physiology of the Central Nervous
System
– first to mention the internal sensations, which are called
"common sensations”
– first among the Arab authors to write on Epilepsy, headache,
Effect of psychological states in disease occurrence
– Described tetanus as a disease and predicted the death of the
patient within four days
– Described hemiplegia, facial palsy and speech difficulties
associated with hemiplegia.
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The Flourishing Period (900 - 1300 AD)
• During this period the Islamic Empire extended from
China in the East to its Western Domain in the Iberian
Peninsula (Andalusia and Portugal).
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The Flourishing Period (900 - 1300 AD)
...
• The Arabic Language was by far the language of science
in that era
• Since the empire was so wide spread, the contribution
was not necessarily made just by Muslims. Many
Christians and Jews had major contributions and only
through the tolerance of Islam did these scientists and
physicians find the freedom to study, practice, write and
teach. Their contributions were accepted and highly
respected
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The Flourishing Period (900 - 1300 AD)
...
• The relationship between the eastern and western part
of the Empire was never interrupted. Physicians and
scientists made several trips from one part to another
carrying with them books, knowledge and experience.
• In the East, Centers of Medical excellence were already
established and flourishing. Hospitals, as both, centers of
education, training and treatment were widely spread.
Libraries attached to these institutions contained
treasures of medical books.
• Among the most famous physicians of the time were ArRazi (Rhazes), Al-Majusi (Haly Abbas) and Ibn Sina
(Avicenna).
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The Flourishing Period (900 - 1300 AD)
...
• In
Andalusia, the Arabs established a highly
sophisticated civilization and many physicians and
philosophers appeared throughout this period.
• The most famous were: Ibn Rushd (Averroes), Musa bin
Maimun (Maimunedes) and several physicians from the
family of Ibn Zuhr (Avenzoar).
• The most famous surgeon of the era was Abu al-Qasim
al Zahrawi (Abulcasis). His book on surgery “Al-Tasrif”, in
which he described the surgical tools used at that time,
remained to be a reference for several centuries.
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Abu Bakr Mohammed Bin Zakariya Ar-Razi
(Rhazes) (841–925 AD)
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Rhazes
• Rhazes is considered to be one of the greatest doctors
known to humanity
• Princeton University in the U.S. set aside the best suite
in its most beautiful building to the achievements of
Rhazes and established a center to teach the Arabic
language and translate his manuscripts into English.
• Six hundred years ago, the school of medicine in Paris
had the smallest library in the world. It contained only
one book, Al-Hawi (the Container) in medicine by
Rhazes. He also excelled in many fields including
philosophy, Botany, zoology, mathematics, physics and
music.
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Rhazes ...
• Rhazes was born in Ray, near modern-day Tehran in Persia.
• He learned his anatomy from Galen’s books and from his
teacher Bin Masawaiyah.
• In Baghdad he dissected animals, particularly monkeys, and
also made many anatomical quotes, such as “knowing the
anatomy of that organ you will understand its functions, then
the illnesses that might attack that organ”.
• He established a new tradition assimilating Greek and other
medical cultures. He wrote more than two hundred books and
articles, half of which relate to medicine.
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Rhazes ...
• His work was translated from Latin and soon became the
standard textbooks in most of the medical schools of Europe.
• He emphasized in his writings and lectures, that doctors
should take note of the medical history as told by patients,
emphasized doctor patient relationship and advised patients
not to change doctors, except when necessary.
• Rhazes was the first to treat patients who were considered
incurable. He went against what Hippocrates advocated in
keeping one’s distance from incurable patients. He strongly
committed himself to treat these patients and continuously
encouraged them and helped them in facing their ailments.
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Rhazes ...
• He also was sympathetic and firm in trying to treat
patients with neurologically incurable diseases unlike
Medieval Europe and the church where such patients
used to be imprisoned and degraded. To that effect he
was a true humanitarian
• He was most noted in dealing with the question of
epilepsy. He was the first to distinguish between
Hereditary and Acquired Epilepsy.
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Rhazes ...
• He says: “epilepsy is a convulsion that affects the whole
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body. Yet it is not permanent, since its illness disappears
quickly. The ill effects that are caused to the head and
body organs indicate that the illness emanates from the
brain”.
Rhazes was also the first to describe the recurrent
laryngeal nerve and thought it originated near the
trachea. He studied the function of nerves. He said “ if
the nerve was cut longitudinally nothing will happen to
that nerve, but if cut transversely, both sensations and
motor power will be lost and it will be out of hand, no
use for treatment”.
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Rhazes ...
• He went against Galen as related to Hemiplegia when he
identified that the source of the paralysis is in the brain
whereas Galen related it to the ventricles.
• Al- Hawi (the Container) his most famous medical
encyclopedia was written in 25 volumes. The first
volume was dedicated to Head illnesses and contained
11 chapters dealing with most of the neurological
diseases such as stroke, paralysis, numbness,
convulsions, cognition, facial weakness, epilepsy,
nightmares, spasticity, tetanus, meningitis and
encephalitis, headache, migraine and confusion
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Ali Bin Abbas Al-Majusi
(Haly Abbas) (?-995 AD)
• Haly Abbas was born in the town of Ahwaz near
Jundishapur.
• The name “Al-Majusi” is said to indicate that he was a
Persian of Zoroastrian ancestry.
• He reached his greatest eminence about 50 years after
the death of Rhazes.
• He wrote “Kamil Al-Sina’ah al-Tibbiya”, also known as AlKitab Al-Malaki, the Royal Book (Liber Regius).
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Haly Abbas ...
• Haly Abbas considered that nerves originate in the brain,
which is the center of sensory and motor action.
• This action is mediated in the brain through the cranial
nerves and to the rest of the body through the spinal
cord.
• He identified that nerves originating from the brain are
bundled in 7 pairs and that each nerve prior to emerging
from the skull is covered with two layers referring to the
Pia matter and the Dura matter.
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Haly Abbas ...
• Haly Abbas described the pathophysiology of certain
disorders that affect the brain and the spinal cord.
• Examples of Brain disorders include headache, trauma,
parasthesia, confusional states, meningitis, apoplexy,
epilepsy, hemiplegia, melancholy, obsession, memory
loss, mania and coma. He also described different types
of skull fractures
• Examples of Spinal cord disorders include paralysis of
flaccid and spastic type, clonus and parasthesia.
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Abu Ali Al-Hussein Bin Abdallah ibn
Sina (Avicenna) (980-1037 AD)
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Avicenna
• Avicenna was born near Bukhara (Central Asia) and was
called the Sheik, the Chief and the second teacher, after
Aristotle.
• He is highly respected for his contribution to the field of
medicine, both as a transmitter of the knowledge of men
like Hippocrates, Aristotle and Galen, and as an original
thinker on the subject.
• His energy and intelligence were all embracing, and he
also studied and wrote widely on philosophy, astronomy,
mathematics, the Arabic Language, music and several
other domains of knowledge, thus producing over 276
books in all branches of knowledge. He was an
encyclopedic thinker
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Avicenna ...
• He was the first to identify Meningitis thus refuting the
sayings of the ancients that the soft and hard tissues
such as the brain and bones are not affected by
inflammation, he was the first to differentiate paralysis
based on primary and secondary etiological factors
related to the brain.
• He described stroke resulting from bleeding, contrary to
common belief of the era based on Greek medicine. He
differentiated central and peripheral facial weakness.
• Avicenna was the first to use oral anesthesia and
deduced that Opium was the strongest anesthetic.
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Avicenna ...
• Avicenna also described a fundamental scientific fact in
the fractures of the skull. The skull bones contrary to
other bones in the body do not heal after fracture in the
same way as other bones in the body. The skull is
connected by fibrous tissues and only through these
does the skull heals and broken segments reconnect.
• He further broke down skull fractures into two types,
closed and open fractures and ascertained that deep
broken fragments of skull fractures should be removed
to avoid further complications.
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Avicenna ...
• Avicenna also divided headache into three types;
Ordinary Headache, Headache caused by brain damage
and Migraine (Al-Shaqiqa).
• He was the first to formulate a mature idea about the
underlying pathophysiology of Migraine: “migraine is due
to hyper excitability of brain tissue which causes the
brain to react unusually to noises and to light stimuli”.
• He also described several effective medications for
headaches.
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Avicenna ...
• Avicenna differentiated between two types of epilepsy,
Grand Mal and Petit Mal. In his description of Grand Mal
epilepsy he identified three stages of the attack as
follows:
– Aura
– Clonic phase
– Relaxation
• He also differentiated between apoplexy and Coma.
Moreover, Avicenna introduced novel methods of
treatment such as the use of ice packs in the treatment
of various neurological illnesses and more dramatically
the use of swimming in tanks with Electric eels for the
treatment of Epilepsy (Electrotherapy)
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Avicenna ...
• His book (Al-Kanoon) was the most famous and
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contained the essence of Greek and Arab medicine.
It comprises five volumes among which are neurological
diseases.
It was printed twenty times in Latin in the sixteenth
century alone and was the principal medical text in the
Arab World and Europe for about eight centuries.
Avicenna summarized all medical knowledge in a poem
of 1326 verses.
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Avicenna ...
• The first topic in the third volume in Al-Kanoon deals
with the diseases of the head and the brain. It contains
five articles:
– The First covers the overall provisions of the diseases of the
head and thebrain.
– The Second deals with the aches and pain of the head
– The Third deals with head tumors
– The Fourth deals with the illnesses of the head that mostly affect
the sensory and management actions
– The Fifth deals with brain diseases that strongly affect voluntary
movement
• The second topic in the third Volume of Al-Kanoon deals
with nerve diseases.
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Abu Al-Qassim Bin Abbas Bin Khalaf AlZahrawi (Abulcasis) (936-1010 AD)
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Abulcasis
• Abulcasis was born in the city of Al-Zahraa, to the west
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of Qurtubah (Cordoba).
He placed his knowledge and expertise in a single book
called “Al-Tasreef” (practical guide for those who cannot
be authors).
It is composed of 30 articles divided into two parts,
medical and surgical, with the surgical part divided into
three sections. The last one is devoted to brain and
Neurosurgery, particularly ailments resulting from head
and brain injuries, skull fractures and the use of skull
trepanation.
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Abulcasis ...
• John Shaning did the first modern Latin translation in
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Oxford in 1778.
Lucien de Clerq did the first French translation in 1861.
In 1908, Loco published an Arabic illustrated edition. In
1974, Loco printed an English edition together with the
Arabic original and the illustrating instruments.
Al-Tasreef gained world fame and was the basic book for
surgery in Europe for five centuries.
The Europeans adopted and developed a lot of its
Contents.
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Contributions to Neurosurgery
• General Scientific contributions
– Abulcasis compiled all that pertained to Neurosurgery
and added a more developed type of surgery based
on anatomy.
– He used anesthesia during surgical operations to
alleviate the pain of patients
– He was the first to
• describe skull fractures and their complications and also the
first to describe depressed skull fractures in children.
• to call on surgeons to familiarize themselves with the
anatomy of the body parts they were about to operate on
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Contributions to Neurosurgery ...
– He understood and realized that pain should not
be considered as an illness, but as a symptom.
Accordingly the root cause of the pain, not pain
itself should be treated
– He considered hygiene as basic in the treatment
of wounds.
– He called for the sterilization of wounds and used
Alcohol for this purpose contrary to the ideas of
his contemporaries
– He described head injuries including bleeding
inside/outside the skull
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Contributions to Neurosurgery ...
• Technical Contributions
– Abulcasis invented an instrument that prevents
involuntary penetration of the skull of the patient
during the process of trepanation, and this
modification is still in existence today.
– Described and performed a cranium fissure in the
same manner performed nowadays. He made several
holes in the skull and then connected them.
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Contributions to Neurosurgery ...
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Contributions to Neurosurgery ...
– Stressed the need for utmost care before brain surgery to
remove bones and coarseness resulting from injuries. He
stressed the need to have these areas clean and sterile.
– Called for the readiness of surgical instruments for emergencies.
(i.e. to be kept sterile and clean)
– Advised the use of female assistants and nurses when operating
on women to ensure calmness and peace of mind of woman
patients
– Used instruments for the stretching of the neck and prolapsed
Disc.
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… And other Contributions
• Abulcasis had also numerous contributions not only in
Neurosurgery but also in the field of neurology in the
areas of Apoplexy, hemiplegia, Facial Paralysis,
Convulsions and Tonic Spasms, Flaccidity and Anosmia.
• Professor Garcia Palestero of Granada University in Spain
stated: “Abu Al-Qasim Al-Zahrawi was the greatest
Muslim surgeon in the whole of the middle ages. He was
the point of departure for all types of brain and skull
surgeries in Spain and Western Europe”.
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Concluding Remarks on the Arab
Contributions to Medical Sciences
• The Arabic language was the world language (Lingua Franca) of
science. Until the sixteenth and seventeenth centuries, every
medical student had to master the Arabic language. Between 8501350 AD, there were 4000 medical books written in the Arabic
language.
• During that time, students headed towards Baghdad, Alexandria,
Damascus and Andalusia to study medicine.
• Translating from various pre-Arab civilizations like the Babylonian ,
Egyptian, Greek, Indian and Persian cultures
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Concluding Remarks on the Contribution in
Medical Sciences …
• Polishing, developing, expanding and adding to the
neurological sciences
• Writing encyclopedic books on medicine and pharmacology
• The first to introduce illustrations and tables in the study of
medicine and the first to write medical sciences in poetical
form to make it easy for students to memorize
• Established various types of hospitals (called Bimaristan)
including a new residency system for doctors and specialized
wards for psychiatric patients.
• Attached hospitals to the schools of medicine with large
libraries of medical books.
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Concluding Remarks on the Contribution in
Medical Sciences …
• Introduced examinations and prohibited unlicensed or
unqualified persons from practicing medicine.
• Emphasized ethical standards that were based on
– Hippocrates
– Christian values and principles
– Islamic values and principles
• Played an important and prominent role in the study of
anatomy, physiology, diagnosis and treatment of various
neurological disorders.
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Concluding Remarks on the Contribution in
Medical Sciences …
• Described Neurosurgical operations, instruments and
sutures.
• Played a large role in discovering anesthesia and
sterilization by alcohol.
• The West built on this foundation and embarked on its
modern renaissance that came in the wake of the
stillness of the middle ages, and took off at the
beginning of the seventeenth century.
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