Muslim's Contribution to Medical & neurobiology

Index
Introduction NEUROSCIENCE and PSYCHOLOGY Psychotherapy Neurosurgery Arabs and anesthesia Conclusion

Introduction

Medicine did not develop overnight. The civilizations of Egypt, Greece, Rome, Persia, India, China, and the European Renaissance took up the responsibility of the flame of medical development. During the dark ages when Europe thought mental illness was some demonic possession Muslims were establishing psychiatric clinics and during those dark ages the medical flame was taken up by the Islamic world.

Translations of Medical Texts: As Islam expanded out of the Arabian Peninsula in seventh century AD, towards Syria, Palestine, Lebanon, North Africa and Iraq, Arab scholars came across scientific works from many older, established civilizations. These scholars translated works from Greek, Syriac, Pahlavi, and Sanskrit into Arabic; thus, preserving scientific knowledge while additionally supplementing it with their own discoveries. While amalgamating and spreading this knowledge, they made important changes to the system of scientific recording such as adding illustrations and diagrams, replacing Roman numerals with the more efficient Arabic numeral system, and organizing text to make it more methodical and easier to understand and search. This work of Muslims was so efficient that even the Islamophobic historians praised it.

NEUROSCIENCE and PSYCHOLOGY

Islamic medicine stresses the need for the understanding of human mental health. The first psychiatric hospitals and insane asylums were built in the Islamic world in Baghdad in 705. The most characteristic features of medieval Muslim psychotherapy were the use of clinical observations of mentally ill patients, which resulted in the provision of ground-breaking applications of moral treatment, baths, drug medication, and occupational therapy. The concepts of mental health and mental hygiene were introduced by the Muslim physician Ahmed ibn Sahl al-Balkhi (850-934). His book, Sustenance for Body and Soul (in Arabic: Masalih al-Abdan wa al-anfus), was the first book that discussed psychosomatic diseases with an emphasis on mind and body: "if the nafs (psyche) gets sick the body may also find no joy in life with the development of a physical illness". Ahmed ibn Sahl al-Balkhi was a pioneer of psychotherapy, psychophysiology, and psychosomatic medicine. He was the first one who recognized that the body (fever, headache) and the soul (anger, anxiety, and sadness) can be healthy or sick or balanced or imbalanced. He recognized two types of depression: one caused by known causes physiological reasonsthat can be treated through physical medicine; and the other caused by unknown reasons that can be treated psychologically. Najab ud-din Muhamed (10th century) made careful observations of mentally ill patients with detailed descriptions of a number of mental diseases including agitated depression, neurosis, priapism and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania.

Al-Balkhi and Muhamed ibn Zakariya Razi (Rhazes) were the first known physicians to describe psychotherapy. Razi's books (El-Mansuri and Al-Hawi) formed landmarks for the description of mental illness in the 10th century and provided definitions, symptoms, and treatments for problems related to mental health and mental illness. Razi was also the director of a unique psychiatric ward in a Baghdad hospital. Such psychiatric clinics did not exist in Europe during that time for fear of demonic possession.

Ibn al-Haytham is considered to be the founder of experimental psychology and psychophysics with his distinguished book on the psychology of visual perception, Book of Optics (Steffens, 2006). Ibn al-Haytham was the first scientist to argue that vision occurs in the brain rather than the eyes in his Book of Optics (Edition III). Moreover, he pointed out that personal experience has an effect on what people see and how they see and that vision and perception are subjective feelings.

Figure 2: Ibn al-Haytham.

Al-Biruni was a pioneer in experimental psychology as he was the first person to describe empirically the concept of reaction time."Not only is every sensation attended by a corresponding change localized in the sense-organ, which demands a certain time, but also, between the stimulation of the organ and consciousness of the perception an interval of time must elapse, corresponding to the transmission of stimulus for some distance along the nerves."

Figure 3: Abu Baihan Alberuni. Afghanistan postage stamp, 1973.

Ali ibn Abbas al-Majusi (AD 982) discussed how the physiological and psychological aspects of a patient can have an effect on one another in his famous book, Complete Book of the Medical Art. He found a correlation between patients who were physically and mentally healthy and those who were physically and mentally unhealthy, and concluded that "joy and contentment can bring better living status to many who would otherwise be sick and miserable due to unnecessary sadness, fear, worry, and anxiety”. He is also the first person to discuss in detail mental disorders such as sleeping sickness, memory loss, coma, meningitis, vertigo, epilepsy, and hemiplegia. Moreover, he emphasized the preservation of health through diet and natural healing as much as on medication or drugs.

Table 1: Principle Islamic Physicians (quoted from Ezzat Abouleish)

Name (Arabic)	Life span (AD)	Specialty & contribution	Special books	City/Country
Jurjis ibn Bakhtishu Jibril Yuhanna ibn Masawayh	700- 800	Translation from Greek and Syriac into Arabic	Translation of works of Hippocrates, Galen and Aristotle	Baghdad
Hunain Ibn Ishak	826- 882
Abu Zaid Ahmed ibn Sahl al- Balkhi	850- 934	Muslim psychology, medicine, neuroscience	Masalih al-Abdan wa al- anfus	Shamistiyan, Persian province of Balkh (Afghanistan)
Al-Razi	841- 926	Internal medic ine, epidemiology, ophthalmology, chemistry, physics, philosophy	Kitab Al-Mansuri (The Liber Al-Mansuris), Al-Murshid, Al-Hawi (Continents), Al-Gudari wa, Al-Gudari (de Peste or de Pestilentia)	Kharasan, Baghdad
Abū Nasr Muhammad ibn al-Farakh al-Fārābi	872- 950	Political philosophy, Epistemology, medicine	Purposes of metaphysic Translations of works of Aristotle, Focus Al- Hekam, Kitab Mabda' ara'ahl Al-Madina Al- Fadhila	Central Asia, Iran, Iraq, Syria and Egypt
Al-Zahrawi (Abu-Al- Qasim Khalaf Ibn'Abbas Al- Zahrawi)		Neurosurgery	al-Tasrif Liman Ajiz 'an al' Ta'lif	Al-Andalus (Cordova)
Abū Rayhān Muhammad ibn Ahmad Bīrunī		Anthropology, pharmac ology, psychology father of anthropology, geodesy and experimental mec hanics, pioneer of experimental psychology	Ta'rikh al-Hind, The Mas'udi Canon, Understanding Astrology	Persia
Ibn-Sina	980- 1037	Medical encyclopedia, philosophy, astronomy, poetry	100 books Al-Qanun (Canon Law) (over 1 million words)	Hamazan, Jurjan
Ibn-Rushd	1126- 1198	Philosophy, medic ine, law	Kitab Al-Kulliat	Al-Andalus, Granada
Ibn-Maimon	1135- 1208	Philosophy, translations Hebrew & Latin, poisons, hygiene and public health	Al-Tadbir El-Sihhi, Moushid El-Hairan	Cairo (Saladdin's physician)
Ibn-Al-Nafis	1208- 1288	Pulmonary circulation, blood supply to the heart	Sharah Tashrih al Qanun, Al-Mujaz	Damascus, Cairo

Avicenna – Persian physician Ibn-Sina.

Avicenna (Ibn-Sina; 980-1037) is considered as the father of modern medicine. It was he who first recognized 'physiological psychology' for the treatment of illness involving emotions. He was a pioneer in psychophysiology and psychosomatic medicine, developing a system for associating changes in the pulse rate with inner feelings. This idea was in anticipation of the word-association test attributed to Carl Jung. Moreover, Avicenna was also a pioneer of neuropsychiatry as he first described numerous neuropsychiatric conditions, including insomnia, mania, hallucinations, nightmares, dementia, epilepsy, stroke, paralysis, vertigo, melancholia, and tremors. George Sarton, father of the history of science, wrote in his famous book, The Introduction to the History of Science:

"One of the most famous exponents of Muslim universalism and an eminent figure in Islamic Learning was Ibn Sina, known in the West as Avicenna (981-1037). For thousands of years, he has retained his original renown as one of the greatest thinkers and medical scholars in history. His most important medical works are the Qanun (Canon) and a treatise on Cardiac drugs. The 'Qanun fi-l-Tibb' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to the distinction of mediastinitis from pleurisy; contagious nature of phthisis, distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions, of nervous ailments".

The Canon of Medicine (Qanun: Law of Medicine) by Ibn-Sina is one of the most famous books in the history of medicine. This book is a 14-volume medical encyclopedia that was completed in 1025. This book was used in many medical schools, for example, the University of Montpellier, France (1650). The book explains the causes of health and disease. Ibn-Sina believed that the human body can be healthy if the causes of health and disease are determined. He defined medicine (tibb) as the science by which we learn the different aspects of the human body in both health and disease.

Figure 5: Latin copy of the Canon of Medicine dated 1484, PI Nixon Medical Historical Library, University of Texas Health Science Center.

The Arabic text of the Qanun was translated into Latin as the Canon of Medicine by Gerard of Cremona in the 12th century and into Hebrew in 1279. Avicenna dedicated three chapters of his book to neuropsychiatric disorders. He defined madness (Junun) as a mental disorder of reason in which reality is replaced by fantasy and he located its origin in the middle part of the brain. In the Canon of Medicine, Avicenna was considered to be the father of the science of psychoanalysis through his extension of the theory of temperaments to include mentality, emotions, morality, self-awareness, movements, and dreams.

Avicenna was the first person to diagnose love sickness (Ishq) when he was treating a very ill patient by "feeling the patient's pulse and reciting aloud to him the name of provinces, districts, towns, streets and people". He noticed the changes in the patient's pulse and decided that the patient was in love with a girl whose home Avicenna was able to locate by the digital examination of the patient's pulse. Avicenna also linked physical and psychological illnesses as he described melancholia (depression) as a type of mood disorder with characteristic associated phobias. Also, he pointed to anger as a factor in the progression of melancholia to mania. He hypothesized that happiness increases the breath, leading to uncontrolled increase in brain moisture and resulting in mental disorders. Avicenna also discovered a condition resembling schizophrenia and described it as Junun Mufrit (severe madness) with characteristic symptoms such as agitation, behavioral and sleep disturbance, giving inappropriate answers to questions, and occasional inability to speak. He wrote that these patients must be restrained in order to avoid any harm they might cause to themselves or to others. Avicenna discovered the cerebellar vermis which he named vermis and the caudate nucleus, which he named tailed nucleus or nucleus caudatus. These terms are still used in modern neuroanatomy and neurophysiology. Moreover, he was the first person to relate intellectual dysfunctions to deficits in the brain's middle ventricle and frontal lobe, which mediates common sense and reasoning. Avicenna also diagnosed facial nerve paralysis, distinguishing between paralysis and hyperemia. He also diagnosed meningitis as a disease induced by the brain itself, differentiating it from infectious brain disease. Moreover, he was able to diagnose and describe other types of meningitis induced by an infection in other parts of the body.

One may think that they all could be liberal Muslims and have nothing to do with Islam. So let me tell you they all were classical orthodox Muslims. Just look at the work of Ibn-Sina on (wajib Al-Wujud) how he places the formal argument on proof of god existence.

The earliest works on social psychology and animal psychology were written by al-Jahiz (766– 868), an Afro-Arab scholar who studied the social organization of ants and animal communication and psychology. Another great scholar who was a pioneer of social psychology is Al-Farabi (Alpharabius).

Figure 6: Al-Farabi on Republic of Kazakhstan currency.

Al-Farabi was the first to state that "an isolated individual could not achieve all the perfections by himself, without the aid of other individuals … [it is the] innate disposition of every man to join another human being or other men in the labor he ought to perform." He concluded that in order to "achieve what he can of that perfection, every man needs to stay in the neighborhood of others and associate with them". Al-Farabi's Social Psychology and Model City were the first treaties dealing with social psychology. His book, Opinions of the People of the Ideal City, was the first book to distinguish between dream interpretation and the nature and causes of dreams. Ibn Zuhr (Avenzoar) was the first to provide accurate descriptions of neurological disorders including intracranial thrombophlebitis and mediastinal germ cell tumors. Averroes suggested the existence of Parkinson's disease and referred to the photoreceptor properties of the retina. Maimonides wrote about neuropsychiatric disorders and described rabies and belladonna intoxication.

Psychotherapy

When Al-Razi was appointed as a physician-in-chief at Baghdad Hospital, he made it the first hospital in history to have a ward devoted to mentally ill patients. Razi was considered the first person to combine psychological methods and psychological explanations and to use psychotherapy in an applicable fashion. Razi was once called to treat a famous caliph who had severe arthritis. Razi advised a hot bath and, while the caliph was bathing, Razi threatened him with a knife, proclaiming he was going to kill him. This deliberate provocation increased the natural caloric, thus creating sufficient strength to dissolve the already softened humors. As a result, the caliph got up from his knees in the bath and ran after Razi. Najab ud din Muhammad, a contemporary of Razi, left many excellent descriptions of mental diseases. His carefully compiled observations of patients comprised the most complete classification of mental diseases known before then. Najab described agitated depression, obsessional types of neurosis, Nafkhae Malikholia (combined priapism, sexual impotence), Kutrib (a form of persecutory psychosis), and Dual-Kulb (a form of mania).

Avicenna often used psychological methods to treat his patients. One of his patients was a prince of Persia who had melancholia and suffered from the delusion that he was a cow, and who would low like a cow crying "Kill me so that a good stew may be made of my flesh" and would never eat anything. Avicenna was persuaded to take on the case and sent a message to the patient, asking him to be happy as the butcher was coming to slaughter him, and the sick man rejoiced. When Avicenna approached the prince with a knife in his hand, he asked "Where is the cow so I may kill it?" The patient then lowed like a cow to indicate where he was. "By order of the butcher, the patient was also laid on the ground for slaughter." When Avicenna approached the patient pretending to slaughter him, he said, "The cow is too lean and not ready to be killed. He must be fed properly and I will kill it when it becomes healthy and fat." The patient was then offered food which he ate eagerly and gradually "gained strength, got rid of his delusion, and was completely cured".

Neurosurgery

Al-Zahrawi (Abulcasis) was considered the father of modern surgery as he developed material and technical designs that are still used in neurosurgery today. He was born in Al-Zahra, a suburb of Cordova. During his era, neurosurgery in the Islamic world became a respected specialty practiced by reputable physicians.

On the other hand, European surgery was belittled and practiced by barbers and butchers. This is why in AD 1163 the Council of Tours declared the following resolution: "Surgery is to be abandoned by the schools of medicine and by all decent physicians." Al-Zahrawi wrote about the fracture of the skull.

"The types of skull fractures are numerous, their shapes are different, and their causes are many. For example, some skull fractures are due to a blow by a sword that splits the whole skull and reaches the dura, the same as the ax does to the wood, therefore it is called an axial fracture. Sometimes the sword does not split the skull completely, it is thus called an incomplete axial fracture. Such a fracture can be small or big. Another type is comminuted fracture, which can be due to a hit by a stone or a fall on a stone; this fracture can reach the dura or only be limited to the outer part of the bone. This fracture can also be small or big. A third type is the hairy type of skull fracture which is so tiny and linear like a hair. A fourth type is the depressed fracture, which occurs due to a fall or a blow so the bone is depressed like a brass jar when hit by a blunt instrument. This usually happens when the bone is soft as children. The types of these fractures are diagnosed by examining the wound, removing the debris and contused pan of the scalp, exposing the skull, and feeling it with the spatulas. The hairy fracture is difficult to discover and can be diagnosed by exposing the skull, and smearing it with ink; the linear fracture thus appears stained."

Figure 7: Al-Zahrawi - Albucasis.

Al-Zahrawi also wrote about the treatment of skull fractures using special instruments.

The Egyptian physician Ibn al-Nafis performed the earliest-known dissections on the human brain. Moreover, he corrected some of the incorrect theories of Galen and Avicenna on brain anatomy

Arabs and anesthesia

The Arabic physicians gave a detailed description of the pharmacology of important narcotics such as opium, hyoscyamus and hashish.This is why Burton stated that "anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in the civilized West." In a Treatise on the Canon of Medicine by Avicenna (Ibn-Sina) under the article 8l4 Anesthetics The soporific sponge was first introduced by the Arabs. It was commonly used for anesthesia in the Middle Ages. It was soaked with aromatics and narcotics to be sucked and then held under the nostril leading to anesthesia prior to surgery (Keys and Wakim, 1971), more than 1,000 years ago.

Conclusion

1,000 years ago Islamic medicine was the most advanced in the world. Even after ten centuries, the achievements of Islamic medicine appear amazingly modern. 1,000 years ago Muslims were the great torch-bearers of international scientific research. Every student and professional from each country outside the Islamic Empire aspired, yearned, and dreamed to go to the Islamic universities to learn, work, and live in an affluent, advanced and civilized society.

Irfan Khan

Pursuing 2nd year BAMS (bachelor of ayurvedic medicine & surgery) Student of islamic philosophy & islamic theology, social activist

“Wise people have knowledge and they use it, Foolish people have knowledge and they do not.”