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Letter to the Editor
“Clinical methods and team work: 1,000 years ago”
Rabie E. Abdel-Halim, F.R.C.S.Ed.
Department of Surgery, Division of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia
Available online 25 January 2006.
Rabie E. Abdel-Halim, F.R.C.S.Ed.
In the article “On the uniqueness of surgery,” Fischer’s proposal that medicine and surgery should work together as much as they can is of great importance to the progress of both specialties worldwide . However, more clarification is needed regarding his statement that, in medieval times, physicians never examined or came in contact with their patients but made their diagnoses from looking only at their flasks of urine. This was the case in Europe during those Dark Ages, in which the great era of the Graeco-Roman medicine came to an end and no progress in medical science was made until the Renaissance ,  and . However, in the East, coinciding with the spread of Islam, the study of medicine and other branches of science revived and acquired a scientific basis during the same period ,  and . Under this influence, the famous physician Mohamed lbn Zakaria Al-Razi (Rhazes, 841–926 ad) opposed every form of charlatanism and combated the exaggerated importance that was given to the examination of urine . His book Al-Hawi (The Liber Continens) showed his supreme abilities as a clinician  by presenting various pathological conditions, usually starting with the complaint and then analyzing its origin and finally describing the signs necessary for diagnosis  and . Thus, he differentiated, for the first time , between retention and anuria:
The urine stops either because the kidney lacks it and the sign of this is the stoppage of urine and no heavy pains in the back and not in the loin, ureter and bladder, any discomfort and not at the bladder neck, any cause of obstruction as we will show and together with this, the abdomen is lax and in the body there is swelling and dropsy or profuse sweating…And if the urine is stopped because of the urinary passages from the kidney the bladder will be empty … .
This translation shows that, in addition to careful history taking, complete general and abdominal examination was performed in order to reach an accurate diagnosis. Furthermore, Al-Razi described, for the first time, a clinical physical sign on rectal examination to diagnose the presence of more than one bladder stone: “and you detect that [presence of more than one stone] by your finger, because it will crackle so you then know it” .
Scholars who came after Al-Razi continued to follow him in giving prime importance to clinical observations and differential diagnosis . Furthermore, in this Islamic era, physicians did work together with surgeons. Ibn El Quff’s (1236–1286 ad), in his book Al-Omda Fi Sinaat Al-Jarrah  (the mainstay in surgeon’s craft), clearly stated that pain relief should be the responsibility of a second medical man other than the surgeon performing the operation. Al-Tabaaei (the physician) was to look after pain relief by giving AI-Murquid to allow Al-Jaraaehi (the surgeon) to perform the operation. This represents the first report, in the literature, on the role of the anesthetist.
According to Sigrid Hunke , a third medical man used to be present, putting a finger on the pulse during the operation. Also, the memoirs of Prince Osama Ibn Al-Munquiz  and  reported that the Tabaaei and Jaraaehi also worked together as a resuscitation team.Both were called for the resuscitation of a warrior who collapsed immediately after an arrow hit him.
 W. Bickers, Adventures in Arabian medicine, J R Coll Surg Irel 5 (1969), pp. 5–14.
 C.G. Cumston, An Introduction to the History of Medicine From the Time of the Pharoahs to the End of the XVIII Century, Dawsons of Pall Mall, London (1968) 23–6, 185–212..
 E. Desnos, The History of Urology Up to the Latter Half of the Nineteenth Century. In: U.T. Murphy, Editor, The History of Urology, Thomas, Springfield (1972), p. 30.
 E.H. Dickinson, The Medicine of the Ancients, Liverpool, Holden (1875), pp. 37–39.
 J.R. Kirkup, The history and evolution of surgical instruments. I. Introduction, Ann Roy Coll Surg Engl 63 (1981), pp. 279–285.
 A. Castiglioni, A History of Medicine, Jason Aronson Inc, New York, NY (1975), pp. 267–270.
 G. Sarton, Introduction to the History of Science, Williams & Wilkins Company, Baltimore, MD (1931) Reprinted New York: Robert E. Krieger Publishing Co; 1975..
 R.E. Abdel-Halim, Pediatric urology 1000 years ago. In: P.P. Rickham, Editor, Progress in Pediatric Urology, Spriger-Verlag, Berlin, Heidlberg (1986), pp. 256–264.
 K.H.T. Al-Razi (1st ed.), The Book of the Collector of Medicine (Rhazes, Liber Continens) Vol. 10, Osmania Oriental Publications, Osmania University, Hyderabad (1961), pp. 167–168.
 K.H.T. Al-Razi (1st ed.), The Book of the Collector of Medicine) (Rhazes, Liber Continens) Vol. 10, Osmania Oriental Publications, Osmania University, Hyderabad (1961), pp. 110–153.
 R.E. Abdel-Halim, A.S. Altwaijri, S.R. Elfaqih and A.H. Mitwalli, Extraction of urinary bladder stone as described by Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis) (325-404 H, 930-1013 AD), Saudi Med J 24 (2003), pp. 1283–1291.
 M.Y.A. lbn El Quff (1st ed.), AI-Omda Fil AI-Jiraha Vol. 2, Osmania University, The Bureau, Osmania Oriental Publications, Hyderabad (1936), pp. 104–105.
 H. Sigrid, Allah’s Sonne Uber Dem Abendland Unser Arabische Erbe (6th ed.), Dar Al-afak AI-Jadida, Beirut (1981), p. 239.
 A.A. Al-Mazrooa and R.E. Abdel-Halim, Anesthesia 1000 years ago. 1991, Middle East J Anesthesiol 15 (2000), pp. 383–392.
 I.M. Osama, Kitab ul-Ieetibar (1st ed.), Dar Alassala For Culture, Publication and Information, Riyadh (1987), p. 75.
Volume 191, Issue 2 , February 2006, Pages 289-290
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