The Arab contribution to Neurology ( AD)

Transcription

1 The Arab contribution to Neurology ( AD) Ashraf Kurdi, Sami Khouri, Khaled A. Kurdi Jordan T he Arab contribution in medicine spanned over 10 centuries. Starting from the pre-islamic era in the 6th century AD and extending to the 16th Century AD when the Ottoman Sultan Salim I in 1516 AD invaded and destroyed the Mamluk Dynasty in Syria and Egypt extending the Ottoman Empire into North Africa. The language of science at the time was Arabic. Many scientists and physicians throughout the Muslim Empire taught and wrote in Arabic. This was later translated to Latin through Andalusia and back to Europe during the Renaissance. 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. In the history of Arab medicine, we can easily identify several consecutive periods: 1. Pre-Islamic and early Islamic medicine from A.D, the end of the Umayyad caliphate in Damascus. 2. The expansion of Arab medicine when the Arabs conquered Syria, Mesopotamia, Persia and Egypt and came in contact with an established medical science and tradition. This period started with the Abassid caliphate from A.D, and included the translation wave from the Greco-Roman medicine into Arabic with personal commentaries and additions to these translations. 3. The flourishing period of pure Arab medicine, which started during the Abassid Caliphate around 900 A.D and spanned through to the Andalusian era until 1300 A.D. 4. The fourth period from 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. And 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 the main stimuli for the inception of the new era of modern medicine in the world. Pre-Islamic and early Islamic period ( AD). This period can be further broken down into two distinct periods: 1. Pre-Islamic period ( AD), included the Late Greek and Roman periods. 2. The early Islamic period which included the rise of Islam ( AD), which was during the prophet's time and the Orthodox Caliphate and the Umayyad period ( AD). During the early Islamic period and before the conquest of Persia and Egypt, there were in these 2 countries very well-known schools of medicine, one in Jundishapur dominated by the Syriac doctors and the other one in Alexandria which was very well-known for its famous library of medicine which contained almost the totality of the Greco-Roman medicine. Jundishapur was founded by Shapur the First who reigned from AD, when he occupied Antioch on the seashore of Syria. Antioch had a very famous school of medicine competing with the school of Alexandria. Shapur closed down the school and deported, to Iran, the teachers and students who took with them all the books and the experience of the Greco-Roman medicine. When these prisoners were settled in Jundishapur they started practicing medicine and established a hospital where the practice of medicine was entirely based on scientific analysis in the true Hippocratic tradition. From the beginning, this school of medicine in Jundishapur was dominated by the Syriacs and assimilated the Persian and Indian tradition of medicine. With its name shining as a center of excellence, Jundishapur was a magnet to Arab doctors. One well-known physician who studied there was Al Hareth Bin Kilda who was the doctor of the Prophet Mohammed. Jundishapur was further given a boost when the second Orthodox Caliph Omar bin Al-Khattab conquered the Sassanide empire in Iraq in 638 AD. He supported Jundishapur by allowing the Nestorians full religious freedom and the right to teach and practice their medicine. Further Islamic conquests at the time ( AD) introduced the Muslim caliphs to an already established civilization in Syria Mesopotamia, Persia and Egypt. This added to Muslim wealth by the inclusion of the Alexandria school of Medicine and the extensively well kept Cyprus Library, both of which had a vast collection of Greek medical books. Consequently, the Caliphs felt the need to assimilate the ideas and practices of the Greco - Roman and Byzantine civilizations and the Persian and Indian Neurosciences 2003; Vol. 8 (1) Supplement 1 S7

2 practices mainly in medicine, thus a movement of translations started. Other famous physicians were also well known in that era. These include Ibin Abi Rumtha who practiced surgery and Zeinab who was known for her surgical operations and treatment of eye diseases. During the early years of the Ummayad rule in Damascus, a trained physician like Ibin Athal, who was from Damascus, was reported to be the personal physician to Muawya. He transmitted his knowledge to his son Al-Hakam the Damascene (died in 805 AD), and who in turn transmitted his art to his son Issa bin al Hakam. This latter one wrote a book in medicine "kinash". Another very well known physician in the early Umayyad era was Theadock who taught medicine to Furat bin Shahnata who became the physician of al-hajjaj bin Mansur. The first translation into Arabic occurred during the Umayyad period. One of the grandsons of Mua'wya, Khalid bin Yazeed, who did not accede to the throne (died 704 AD), was the first prince to order the translation of Greek books into Arabic. He studied medicine and collected several books in that field. Abd Al-Malek bin-marwan sponsored Masergis the Syriac (late 8th century AD) to translate from the Syriac language into Arabic, a book in medicine called "Kinash Aharon" written by the Bishop Aaron about a century earlier in Alexandria. That was probably the first book of medicine to be translated into Arabic. The Abassid period ( AD). During the Abassid period, the movement of translations took a strong impetus. One of the earliest books in medicine to be translated from Syriac into Arabic was called "The Great Kinash of John" written by John bin Serapheun. He also wrote an essay called "The small Kinash", also translated into Arabic (late 8th and early 9th century). The Abassids moved the center of power from Damascus to the new capital Baghdad. The Abassid caliph, Al-Mansur who was suffering from severe pains in his stomach called the chief physician in Jundishapur, Gergis bin Bakhtyashoo' to treat him. He treated him and was cured. His son, Bakhtyashoo bin Gergis, remained in Jundishapur attending the hospital in the absence of his father till the caliphate of Al-Mahdi ( AD). Then Al-Mahdi's son, Al-Hadi became sick, and Bakhtyashoo bin Gergis was called to Baghdad to treat him. After successfully treating Al-Hadi, he returned to Jundishapur to continue attending the hospital and later was summoned to Baghdad when Harun ar-rashid suffered from a severe headache. He was handsomely rewarded by the caliph who made him the chief physician in Baghdad. He wrote a short textbook in medicine for his son Jubrail bin Bakhtyashoo, to be used as a quick reference. This family provided twelve consecutive famous physicians to the court of the Abassid caliphs over eight generations. The caliphs accepted the Bakhtyashoo family as they were and honored their science and knowledge regardless of their religious beliefs, which they respected. Early in the 9th century a center of knowledge called "Dar al-hikma", the House of Wisdom was established in Baghdad in 830 AD by the caliph Al-Ma moun, the son of Harun ar-rashid. Its mission was to acquire and translate all the medical, scientific and philosophical books from the Greek and Syriac known at that time. A special mission was sent to Constantinople, the capital of the Byzantine Empire to acquire all what they had of medical, philosophical and scientific books to be deposited in the great library of the House of Wisdom. At the head of this institute, the caliph appointed a Nestorian called Yohanna bin Masawaiyah (died in 857 AD), whose father was a well-known physician in Jundishapur before moving to Baghdad. Bin Masawaiyah started the movement of translation from the Greek and the Syriac into Arabic and he translated and authored more than 30 books including a manual in medicine and his noted book in the science of headache. He was the first to describe, in a scientific way, fever, leprosy, toxicology, epilepsy, ophthalmology and clinical examination. He practiced surgery and was the private physician for the caliphs Al-Ma moun, Al-Mu tasim, Al-Wathiq and Al-Mutawakil, who were the caliphs of the golden period of the Abassid era. His circle was the most frequented circle in Baghdad where medicine, philosophy, literature and all other contemporary sciences were discussed. Among his students was Hunain bin Ishaq who would become the most important translator of medicine into Arabic. Hunain bin Ishaq (Johanitius AD) was a Nestorian from Al-Hera in Iraq before he moved to Baghdad to attend the circle of bin Masawaiyah. He visited many countries and learned 2 languages, Greek and Farsee, beside his total command of Arabic and Syriac. After his travels, he returned to Baghdad carrying with him many important scientific treasures. He became the head of the House of wisdom and started translating all the important textbooks he brought back with him or which he found in the House and its library. He translated 93 books most of which were the books of Hippocrates and Galen and also had original contribution to medicine. As for those related to Neurosciences, there was a book dealing with the nerves and muscles, melancholic temperament; shivering and trembling; convulsions, epilepsy and another book on head injuries. Among the other translators was Costa bin Luqa from Ba'albeck (died 820 AD). He excelled in medicine, philosophy, geometry and music. Some of the Arab historians of medicine classified him as equal to Hunain bin Ishaq if not superior to him. He translated the books entitled "Recognition and Treatment of Numbness (stupor)", "Sudden Death", "Reason for, and Treatment of Insomnia". He also translated the index of Galen s Works. All these translators did not restrict themselves to translation only, but being accomplished physicians, they started writing commentaries on the books they translated which added, some times many topics to the original texts. They wrote their own experience in medicine and some of them became classical textbooks in that field. In the same period a most notable physician rose to prominence. He was heralded as the S8 Neurosciences 2003; Vol. 8 (1) Supplement 1

3 first Arab physician to write a medical Encyclopedia that was a culmination of his own experiences and a translation of earlier Works. This Physician was Al-Tabari and his Book "The Paradise of Wisdom" was bound in seven volumes. The fourth volume, which amounted to nearly half the size of the Encyclopedia, contained 12 chapters in which the second was dedicated to the diseases of the head and the brain. Ali Ibn Rabban Al-Tabari ( AD). He was born in Tabaristan to an influential family highly versed in science, philosophy and medicine. After finishing his education in Tabaristan, Al-Tabari moved to Iraq, where he settled and started practicing medicine. He became famous in his profession and during this period he reviewed the most important books of the Syrians, the Greeks and the Hindus. The review of these books gave him the idea of authoring a comprehensive book to be used as reference by students of medicine and a guide in their practice. That is how he started to write the first original book of medicine in Arabic, which he called "The Paradise of Wisdom". During this period, he visited the city of Rai and returned to the profession of medicine. One of his famous students in that city and era was Rhazes, who learned medicine under his supervision. Besides being the first original author in Arabic medicine that wrote in the Arabic language, he was well-versed in all branches of knowledge prevailing in his time: medicine, philosophy, Jewish, Christian and Islamic religions. He mastered all languages used at that time. His style was distinguished by his critique of all ideas he exposed and the honesty in his quotations without any alteration in the meaning or the text itself sometimes. His references were diverse. Beside the Arabic translation of the Greco-Roman medical literature, he was the first to use the Hindu literature and books by Charaka, Susruta, Nidana and Ashtangahrandaya. He also used his personal experience and observations to support his ideas. Most of the Arabic authors followed in his footsteps, but he was the pioneer in that field. Al-Tabari and Neurology in "The Paradise of Wisdom". The author starts with an anatomical review of what was known at that time about the anatomy and functions of the brain. He says that the anterior lobe of the brain is the center for imagination, the middle is for thinking and the posterior lobe is for memory. That brain is covered by two layers: one thin and composed of arteries and veins and provides the brain with nourishment through these vessels, the second is thick and is close to the skull bones and provides protection to the brain. This is the original thinking about the meninges. As physiology, the brain is the center of sensation, voluntary movement and language. The brain controls sensation and movement through the nerves, which are distributed throughout the organs of the body. The spinal cord starts from the brain and is the center of the peripheral nerves. The author starting with vision, hearing, smell, taste and tactile sensation enumerates the five senses. He was the first to mention the internal sensations, which are called "common sensations". He differentiates between sensations coming to the brain through the eye and the perception coming through the brain. He was the first among the Arab authors to dwell at length in his book on neurological diseases starting from the diseases of the brain. The most important is epilepsy which he called in Arabic "A philepsia", using the letter "f" instead of "p" in Greek. He described many symptoms of the disease especially the aura, which he did not distinguish from the disease itself. He mentioned loneliness "Al-Wahsha", fantasies, hallucinations, disturbance in imaginations and in judgement, seeing the person in two parts, amnesia, wandering in rural areas with animals, fugue, insomnia or long periods of sleep, hearing tinnitus, vertigo. He described very thoroughly the grand mal seizures with the sudden fall of the patient and foaming at the mouth which may be reddish in color sometimes, and loss of consciousness and sensations. Al-Tabari also described headache and its different types, and he differentiated migraine and cluster headache, which is felt mainly in the eye. He emphasized the effect of psychological states on disease and he may be the first one among the Arab authors to give his experience in treating the hysterical patient in a psychiatric manner. He also describes tetanus as a disease and predicted the death of the patient within four days. He described the progress of the convulsions from head to toe as well as episthotonus when the tetanus reaches the muscles of the neck and back. He also described hemiplegia and facial palsy and explained that the face is retracted towards the side, which was not affected by the paralysis. He described also the speech difficulties associated with hemiplegia. 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 and he cites several examples of the effectiveness of this treatment in psychosis. The Flourishing Period ( AD). During this period the Islamic Empire extended from as Far East as China to its Western Domain in Andalusia. The Arabic language was by far the language of science in that era and anybody wanting to study medicine had to learn the language. However, 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 and practice and their contributions accepted and highly respected. The relationship between the eastern Neurosciences 2003; Vol. 8 (1) Supplement 1 S9

4 and western part of the Empire was never interrupted. Books, physicians and scientists made several trips from one part to another carrying with them knowledge and books. In the East, centers of medical excellence were already established and flourishing. Hospitals, as both, centers of education and treatment were widely distributed and libraries contained a treasure of medical books. Among the most famous of physicians of the time where Ar-Razi (Rhazes), Al-Majusi (Haly Abbas) and Ibn Sina (Avicenna). 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 (Albucasis), whose book on surgery, in which he described the surgical tools used at that time, remained famous for several centuries. A description of the contribution of these physicians in Neurology is presented below taking into consideration that these doctors came from the East and the West of the Islamic Empire. Abu Bakr Muhammad Bin Zakariya Ar-Razi (Rhazes) ( AD). The American Princeton University set aside the best suite in its most beautiful building to the achievements of the doctor philosopher Rhazes. It established, alongside, a center to teach the Arabic language and translate its manuscripts into the English language. Rhazes is considered one of the greatest doctors known to humanity. 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 alchemy, philosophy, botany, zoology, mathematics, physics and music. 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. When he first came to Baghdad for study; they 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 medical tradition assimilating Greek and other cultures medical science and experiments. He wrote more than two hundred books and articles, half of which relate to medicine. His works, which excited western scholars, were translated into foreign languages from Latin. They were the standard medical books in the schools of Europe for a long period of time. His books indicated maturity and distinguished Arab Medicine with its technical aspects and methodology. He emphasized in his writings and lectures, that doctors should take note of the medical history as told by patients. He also emphasized doctor patient relationship. He advised patients not to change doctors, except when necessary. He considered this to be a waste of health, money and time. He encouraged inter-doctor consultations. He was most noted in dealing with the question of epilepsy. He was the first to distinguish between hereditary and acquired epilepsy. He dedicated a long chapter on this subject in his medical encyclopedia, Al-Hawi. He included former and contemporary contributions of doctors on the subject. He also added his own contribution, which could be considered an unprecedented leap in the history of medical sciences. The evidence is to be found in the preface to the seventh chapter of the first volume of Al-Hawi under the title (regarding epilepsy; nightmares; mother of lads and sleeping fright). He says: "epilepsy is a convulsion that affects the whole 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 also described the symptoms that precede the epileptic attack (Aura). 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. To the contrary he strongly committed himself to treating these patients and continuously encouraged them and helped them in facing their ailments. 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. Rhazes was also the first to describe the recurrent laryngeal nerve and thought it originated near the trachea. Rhazes studied the function of nerves. In his discussion he is quoted "if the nerve was cut longitudinally nothing will happen to that nerve, but if cut transversely, both sensation and motor power will be lost and it will be out of hand, no use for treatment". Additionally 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. Rhazes most famous medical encyclopedia was Al-Hawi (The Container, the All Encompassing) was written in 25 books. The first book was dedicated to head illnesses and was written in 11 chapters as follows: 1. A chapter on stroke, paralysis, numbness, convulsions, disturbance of sensation and movement, melancholy. 2. A chapter on focal convulsions, neurological pain. 3. A chapter on melancholy and the effect of food. 4. A chapter on cognition. 5. A chapter on purification of the head by inhalation. 6. A chapter on facial weakness and jaw dislocation. 7. A chapter on epilepsy; nightmares; mother of lads and sleeping fright. 8. A chapter on convulsions, spasticity and tetanus. 9. A chapter on Qranitis, litherghis and their differences (Meningitis and S10 Neurosciences 2003; Vol.8 (1) Supplement 1

5 Encephalitis). 10. A chapter on Qranitis, Qatrab, madness and confusion. 11. A chapter on headache and migraine. Ali Ibn Abbas Al-Majusi (Haly Abbas). (?-995 AD). Haly Abbas was born in the town of Ahwaz in Persia, which then lay near to 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. His literary contribution was through the production of the second most important medical book of the era. The book was entitled "Kamil Al-Sina ah al-tibbiya", also known as Al-Kitab Al-Malaki (The complete medical profession; or Liber regius). He wrote about the brain and the spinal cord. Haly Abbas concluded 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. The first, referring to the pia matter, is a thin layer containing blood vessels and the second, referring to the dura matter, is a thick layer for protection. Haly Abbas described the spinal cord as having 31 pairs of nerves and an additional single nerve emerging from it. These nerves are distributed as follows: 8 pairs in the cervical region, 12 pairs in the thoracic region, 5 pairs in the lumbar region, 3 pairs in the sacral region, 3 nerves in the coccyx and in the lower part of the coccyx the single nerve. He further described the exits of these nerves from the vertebral column in a manner consistent to the description of his predecessors. Haly Abbas described the pathophysiology of certain disorders that affect the brain and the spinal cord. Examples of brain disorders include headache, trauma, paresthesia, confusional states, meningitis, apoplexy, epilepsy, hemiplegia, melancholy, obsession, memory loss, mania and coma. Examples of spinal cord disorders include paralysis of flaccid and spastic type, clonus and paresthesia. He also described different types of skull fractures Abu Ali Al-Hussain Ibn Abdallah Ibn Sina (Avicenna) ( AD). Avicenna was born near Bukhara 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 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, and was the first to differentiate paralysis based on primary and secondary etiological factors related to the brain. Avicenna differentiated peripheral nerves into cranial and spinal nerves and identified the function of each one. He also described stroke resulting from bleeding, contrary to common belief of the era based on Greek medicine. He differentiated central and peripheral facial weakness for which he prescribed medicines that produce congestion to the facial skin and other chewable medicines. In addition, he prescribed face and neck massaging and looking in the mirror to manually adjust the face and described the surgical treatment of the facial nerve when the nerve is completely paralyzed. Avicenna was the first to use oral anesthesia and deduced that Opium was the strongest anesthetic. 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 via fibrous tissues and only through these does the skull heal 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. 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" (Isler 1987). He also described several medications for headaches. 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: 1. Aura. 2. Clonic phase. 3. 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. His book (Al-Kanoon) was the most famous and contained the essence of Greek and Arab medicine. 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 around eight centuries. It comprises five volumes among which are neurological diseases. The first volume dealt in general subjects. The second dealt with individual medicines, the third with partial diseases, the fourth with general diseases and the fifth with compounded medicines. Avicenna summarized it in a poem of 1326 verses. The book was divided into 22 topics. Each topic contained several Neurosciences 2003; Vol. 8 (1) Supplement 1 S11

6 articles. Each article contained a number of chapters that deal with partial disease that affect hidden and visible human organs. The first topic in the third book in Al-Kanoon deals with the diseases of the head and the brain. It contains five articles. The First Article covers the overall provisions of the diseases of the head and brain: A chapter relating to the knowledge of the head and brain; A chapter on the Brain s anatomy; A chapter of the diseases of the head that cause symptoms affecting it; A chapter on the clues leading to the identification of the state of the brain; A chapter on how to use these clues to ascertain the conditions of the brain; A chapter on total deduction (inference) of the brains actions; A chapter on deduced inferences from psychological actions; A chapter on deduced inferences from motor action; A chapter on deduced inferences from normal actions; A chapter on deduced inferences from conformity and contrast; A chapter on deduced inferences from the head size; A chapter on deduced inferences from the head shape; A chapter on deduced inferences from brain s feelings; A chapter on deduced inferences from symptoms of organs; A chapter of deduced inferences from organs associated with the brain or lie in proximity to it; A chapter on identifying the organ that suffers from its association with the brain; A chapter on the clues to the temperate brain s mode; A chapter on the clues to natural dispositions; A chapter on the symptoms of every disease of the head; A chapter on the rules of treatment. The Second Article deals with the aches and pain of the head. It is of various types. The first chapter is a general one on headache: A chapter on headache types resulting from indisposition; A chapter on the headache types resulting from dissociation; A chapter on headaches resulting from tumors; A chapter on the symptoms of headaches resulting from substances; A chapter on the types of headache resulting from association; A general chapter on the symptoms that indicate the type of headache; A chapter on the symptoms that indicate headaches resulting from the existence of diseases; A chapter on the total management of headaches; A chapter on treating hot headache without using any substance; A chapter on treating cold headache without using any substance: Prescription for lotions to be applied to the head suffering from cold headache; Prescription for useful ointments for cold headache; Prescription for useful air blowing to chronic headache; Treatment of dry headache; Treatment of tumor headache; Treatment of the headache resulting from blockage or obstruction. A chapter on the treatment of headache resulting from scents and fumes; A chapter on the treatment of headache resulting from scents that penetrated the head from external sources; A chapter on the treatment of headache resulting from vile fumes penetrating the head from outside; A chapter on the treatment of headache caused by good scents; A chapter on the treatment of headache caused by vile scents; A chapter on the treatment of headache resulting from Alcohol; A chapter on the treatment of headache resulting from the sexual intercourse; A chapter on the treatment of headache caused by a blow or fall; A chapter on the treatment of headache caused by the weakness of the head; A chapter on the treatment of headache caused by the head over sensitivity; A chapter on the treatment of headache resulting from fevers and acute disease; A chapter on the treatment of sea headache; A chapter on the treatment of headache that are claimed to be caused by worms; A chapter on the treatment of headache that result from sleeping and drowsiness; A chapter on the management of association headache; A chapter on the treatment of heavy headedness; A chapter on the headache named the egg-and-the helmet; A chapter on migraine. The Third Article deals with head tumors and the dislocation of its contacts: A chapter on Qranitis (hot sirsam - a cerebral disease); A chapter on its common symptoms; Symptoms of real sirsam; A chapter on treatment of its types; A chapter on incidental falgamuli to the essence of the brain; A chapter on redness (ST. Anthony s fire) in brain and teeter; A chapter on severe colds; A chapter on lethargis (cold sirsam - forgetfulness); A chapter on water inside the cranium (Skull); A chapter on tumors and water outside the skull, and the sneezing of children; A chapter on sleeping slumber; A chapter on copious flowing and the cuts of the skin of the head. The Fourth Article deals with the illnesses of the head that mostly harm the sensory and management actions: A chapter on drowsiness and sleep; Treatment of drowsiness and heavy sleep in fever; A chapter on alertness and sleep disturbances; A chapter on the ills of the mind; A chapter on mental confusion and delirium; A chapter on levity (thoughtlessness) and stupidity; A chapter on deficiency of remembrance; A chapter on misconception; A chapter on mania and rabies; A chapter on Qatrab; A chapter on passionate love. The Fifth Article deals with brain diseases that strongly affect voluntary movement: A chapter on vertigo (dizziness); A chapter on curvedness; A chapter on nightmares; A chapter on epilepsy; Those prone to epilepsy; Factors that activate epilepsy; Epileptic medicines; Stroke, Apoplexy; Proneness to stroke. The second topic contains a single article dealing with nerve diseases. Abu Al-Qassim Bin Abbas Bin Khalaf Al-Zahrawi (Abulcasis) ( AD). Abulcasis was born in the city of Al-Zahraa, to the west of Qurtubah (Cordoba). He placed his knowledge and expertise in a single book called "Al-Tasreef li man Ajiza an Al-Ta leef" (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 those resulting from head and brain injuries, skull fractures and the use of skull trepanation. This great book was translated into various languages. John Shaning did the first modern Latin translation in Oxford in Lucien de Clerq did the first French translation in In 1908, Loco published an Arabic illustrated edition. In 1974, Loco printed an S12 Neurosciences 2003; Vol. 8 (1) Supplement 1

7 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. The contribution of Abulcasis to Neurosurgery can be divided into two main parts. General Scientific contributions: Abulcasis compiled all that pertained to Neurosurgery and added a more developed type of surgery based on anatomy. He was the first to describe skull fractures and its complications and also the first to describe depressed skull fractures in children. He was the first to call on surgeons to familiarize themselves with the anatomy of the parts they were to operate on. He used anesthesia during surgical operations to alleviate the pain of patients. 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 to 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 and outside the skull. Technical Contribution: 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. He described and performed a cranium fissure in the same manner performed nowadays. He made several holes in the skull and then connected them. He 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. He called for the readiness of surgical instruments for emergencies. (i.e. to be sterile and clean). He advised the use of female assistants and nurses when operating on women to ensure calmness and peace of mind of woman patients. He used instruments for the stretching of the neck and prolapsed disc. 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). Selections from Al-Zahrawi's book "Al-Tasrif". Apoplexy: This usually presents itself in three forms: 1. Strong and chronic which is non-curable. 2. Mild which is curable, and this is rare. 3. Very strong and rapidly fatal. Hemiplegias: Hemiplegia is of two types of origin: 1. From tenacious phlegm. 2. Due to trauma. Facial Paralysis: He differentiated between paralysis and spasm of the facial muscles. Convulsions and Tonic Spasms: Tonic Spasm comprises three types: 1. In the nerve and the flexor muscles. 2. In the nerve and the extensor muscles. 3. In both. Flaccidity: This occurs due to disease affecting the nerves that emerge from the brain or the spine. Diminished or absent power of smelling (Anosmia): This is either congenital, and is incurable or acquired. Comments on the selected papers of Al-Zahrawi's book. His clinical descriptions are very near to recent classifications and observations and many of his anatomical findings have been referred to accurately. In the chapter dealing with apoplexy (he called it the major stroke or major hemiplegia), he classified it into three main forms; the first is the chronic and incurable, the second is the curable one, and the third which is rapidly fatal. If we compare this classification with the recent thinking we would not find a great difference. Still we classify the cerebral strokes into three types: the chronic type of gradual onset, which is usually due to a thrombus in any of the cerebral vessels or atherosclerosis. The curable type, which may be due to spasm of any of the cerebral vessels due to either sudden rise of the blood pressure or small vessel thrombus that may be dislodged into a smaller vessel. The third type is the fatal one, which is usually due to cerebral hemorrhage. Also we notice the accurate clinical description of some important clinical signs as the regularity of the respiration and pulse rate as an indication of the severity of the stroke. His definition of coma as that in which there is absence of the mental faculties together with absence of sensation and power of voluntary movement. He also described the prodromata of stroke as sudden severe headache, vertigo, visual hallucinations and presence of froth around the mouth (he considered the latter sign as bad prognostic sign). He further discriminated between simple hemiplegia and that associated with loss of consciousness. Abulcasis accurately described the clinical signs of facial palsy and discriminated between facial paralysis and facial spasm. In his descriptions of various types of convulsions, Abulcasis differentiated between convulsions and other types of involuntary movements. He also differentiated between the various types of convulsions and tonic spasms. In this latter type, he described a case very similar to cases of tetanus and referred to the important sign (risus sardonicus), which is an essential diagnostic sign of that disease. Abulcasis could diagnose causes of flaccid paralysis and ascribed them to cutting of the motor nerves what we call nowadays as lower motor neuron lesion. He also described several causes of interruption of the nerve function including the abscesses of the spine, which is usually due to tuberculosis of the vertebral column and we call it Pott's disease of the spine. On anosmia, we notice a very accurate and reasonable classification of the various causes, which closely simulate the recent thinking. Abulcasis differentiated between the congenital type of Anosmia and acquired forms. He could also follow the olfactory pathway from the orbital surface of the frontal lobe down to its termination in the nasal mucosa. He additionally described the cribriform plate of the ethmoid bone in which the olfactory nerve fibers pass. This may show that he dissected this complicated part of the head. Concluding remarks on the Arab contribution in medical sciences. For several centuries, the Arabic Neurosciences 2003; Vol. 8 (1) Supplement 1 S13

8 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 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. The Arab influence on the West was clear in the following fields: Translation from various pre-arab civilization like the Babylonian, Egyptian, Greek, Indian and Persian cultures. Polishing, developing and revision of these sciences. Writing of various books on medicine and pharmacology. The Arabs were the first to introduce illustrations and tables in the study of medicine, they were the first to write medical sciences in poetical form to make it easy for students to memorize. They established hospitals (called Bimaristan) and doctor s residency system. They attached hospitals to the schools of medicine. They introduced examinations and prohibited unlicensed or unqualified persons from practicing medicine. They emphasized ethical standards that were based on Hippocrates; Christian values and principles; Islamic values and principles. The Arabs played an important and prominent role in the study of anatomy, physiology, diagnosis and treatment. Various medical specialties came into existence. They described various surgical operations. They had an important role in discovering surgical instruments and surgical sutures. They 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 beginnings of the seventeenth century. References The full manuscript in Arabic with references will appear in a future issue of the Neurosciences Journal. S14 Neurosciences 2003; Vol. 8 (1) Supplement 1