Light in the Dark Ages (2/2)

Anesthesia

Ali ibn Isa was the first in history to propose the use of anesthesia. The soporific sponge, which was a sponge soaked with aromatics and narcotics and then held to the patient’s nostrils, was also invented by Islamic physicians. This implementation of anesthesia was one of the causes of the “rise of Arab surgery to the level of an honorable specialty” while it remained a less cultivated profession in Europe until the formula for the soporific sponge was received from Muslim sources in the thirteenth century.

In 1886, Burton reiterated the precedence of Islamic physicians in the field of anesthesia by stating that “anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in the civilized West” thereby reminding that communication of medical research and discovery is integral to global health and well-being.

In addition, it was Avicenna who introduced the concept of oral anesthetics. He described numerous recipes for anesthetics and analgesics in his Canon of Medicine and was the first to propose the pharmacological effects of opium as well as various other drugs. Avicenna was also the first to describe the effect of pain on one’s ability to ventilate.

Pharmacology

The field of pharmacology saw tremendous growth during the Dark Ages within the Islamic world. Indeed it was during this era that pharmacology was first established as a separate discipline from alchemy and medicine. For the first time, licensing for pharmacists was introduced. These changes were also accompanied by refinement of the methods of drug production as drug preparation and extraction became a high art.

Furthermore, pharmacies were introduced adjacent to numerous hospitals for the first time in history – this is yet another example of the precociously progressive approach of early Islamic medicine towards multi-disciplinary care.

Islamic physicians of the time also introduced a variety of new drugs, including camphor, musk, and senna. The use of alcohol as a pharmaceutical, anesthetic, and anti-septical so originated during this era.

The various medical texts published during this time consistently included chapters devoted solely to pharmacology and it was Ibn al-Baytar whose compendium described more than five hundred drugs discovered by Islamic scientists in addition to over one thousand classical drugs derived from previous knowledge.

Neurology and Psychiatry

Several significant developments occurred in the field of neurology and psychiatry in the Islamic world as well. Contrary to the common practices in Europe, Islamic medicine attributed psychological problems to neurological deficits and not to demonic possession or supernatural forces. The importance of sharing knowledge globally is evident as this could have prevented much of the social stigmatization that accompanied psychiatric disorders throughout the world in subsequent centuries.

Some modern-day history-taking techniques were also evident during this time. For example, in his 11^th century practice, Ibn Ridwan would ask questions to determine a patient’s state of mind and note both their responses and behaviour. He also noted whether the affliction was of recent or long-term origin and treated accordingly. Ibn Ridwan’s exam tested the acuity of vision and hearing and articulation of speech. Furthermore, he evaluated muscle strength by asking patients to lift weights and grasp objects. He also recommended that physicians observe a patient’s gait both forwards and backwards during their clinical assessments.

Physicians such as Ibn Ridwan exemplify the truly advanced state of medical sciences in the Islamic world over one millennium ago. Physicians in the Islamic world at this time were also responsible for discovering hydrocephalus and various brain tumours, as well as differentiating between delirium, meningitis, and meningismus. They were also the first to describe post-traumatic epilepsy and the notion of epilepsy as a manifestation of brain disease.

Numerous other developments in neurology were made, including Rhazes description of the pupillary light reaction and his original description of the laryngeal branch of the recurrent laryngeal nerve. Avicenna elucidated the differences between vertigo and epilepsy and also gave the first account of a trigeminal neuralgia. This era also brought the first description of a brain abscess following otitis as well as the association between headaches and temporal arteritis.

Other Contributions

Islamic physicians made numerous other notable contributions to medicine during this era. One of the most significant was the first description of the pulmonary circulation by Ibn el Nifas in the thirteenth century.

Furthermore, it was Rhazes who distinguished measles from smallpox, Avicenna who introduced the use of catgut for surgery, Halle Abbas who first proposed that childbirth was caused by uterine contractions, and Ibn al-Quff who presented novel works on embryology.

The era between the seventh and thirteenth centuries was one of tremendous development and growth in the Islamic world, playing host to many physicians who made profound contributions to the world of medicine. Their compendiums and texts were commonly used throughout Europe during the subsequent centuries, illustrating that throughout time, the torch of knowledge was passed from one civilization to the next. It is important for physicians, students, researchers and historians today to realize that this torch continued to burn brightly even during the Dark Ages.

It is also important that we apply the lessons learnt from early Islamic physicians, such as the value of interdisciplinary and patient-centered care, as well as recognize that global sharing of information in medical care today is essential to ensure the success of medical care tomorrow.