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History of Anesthesia in the Arab World

Surgical, medical and anesthesia in the Middle East: Notes on Ancient and medieval practice with reference to Islamic-Arabic medicine.

M.S. Takrouri, The Internet Journal of Health, 2006, Volume 5, Number 1

Historians agree that World civilization first started along the major rivers of the Middle East, namely the Nile valley and in between the rivers Euphrates and Tigris in the land of Mesopotamia 4000 years ago. The oldest medical writings were to be found in cuneiform tablets which is known as the oldest medical handbook and in Eber's pyperus. Both contain medical text describing the medical and herbal treatments [1, 2, 3, 4] The Assyrians herbal contained: Belladonna, Cannabis and Mandragora. The Ancient Egyptians used opium poppy and influenced the Greek medicine. Both the Assyrian and Egyptian physicians obtained artificial sleep for their patients by quickly compressing the Carotid vessels of the neck, this practice was followed as well by the Greek physicians.[1, 3, 4, 5].

Greek and Roman Medicine was in a way a continuum. The father of medicine Hippocrates, and the great physician Galen of the second century influenced medical thoughts over centuries. According to Galen's recommendations “great care” should be exercised, with the use of powerful narcotics such as opium, considering it a dangerous drug. It is to be used in colics and in other very violent pains

The Romans used decoction of mandrake in alcohol. Pliny (A.D. 23-79) says of the juice of mandrake: “Administered in doses proportional to the strength of the patient, this juice has a narcotic effect...it is given... for injuries inflected by serpents , and before incisions or punctures are made in the body, in order to insure insensibility to the pain.”. By the time of Paulus (7th century) opium and mandrake have fallen into neglect.

Arabic translation of the Greek medicine helped to make Islamic physicians supreme in the Middle Ages.

Baghdad became the world's leading medical and drug center. With the skill of the Arab Alchemists, the art of drug making began to evolve into the science of Pharmacology. Western physicians emerging from the Middle Ages found the Arab pharmacopoeia, in which a list of medicinal plants composed the anesthetic armamentarium of our forefathers [1].

Ibn al Nafis (1208-1288) the Arabic scholar who described the pulmonary circulation, mentioned in his book Al Shamel a paragraph on how patient could be restrained during surgery and his remarks do not mention anesthesia. The reason may be that he worked as ophthalmologist.

The Arabs were familiar with surgery and practiced several procedures. Surgeons administered sedative-analgesic mixtures before surgical operation. Anaesthetic sponge was an Arabic contribution, seemingly so, the radical (-O-) [1, 2, 3, 4, 5, 6, 7, 8].

Avicenna indicated that a patient who wants to have an amputation of one of his limbs must have a drink prepared from a mixture of mandragora and other sleeping drugs [1, 3, 6, 7, 8].

Ibn Al Quff (1232-1286 AD) wrote a complete chapter on pain relief in his book “ Al Omdah Fi Sinaat Al Jirahah”.[9, 10, 11, 12] He differentiated between true and non-true pain relief considering non-true pain relief the “Anesthetic” which the surgeon may use for treatment of pain or to be able to institute the surgical treatment [3, 9].

Although Ibn Al Quff included in his book mention that “Anesthetics may be given by inhalation: “shaman”, the issue of Anesthetic sponge still basically depending on account of Orientalists writings [13].

This state of medical practice and doctrines continue to dominate over many centuries [11]. The major books which were followed were : Avicinna's Al Canon, and Ali Ibn Al Abbas's Al Kamel. The Arabic political power terminated in the East by the fall of Baghdad. But the medical heritage stood the events and so was during Salajic and early Ottmanic periods. “Between 1481-1520” traditional medical education in Ottmanic schools was comparable to those of other famous European medical centers. Physicians and scientists from Arabic, Persian and Mid-West Asia regions were taught in the ottmanic medical schools. By the year 1520 the medical schools deteriorated, as the state was going in rough times. This situation changed when the Sultan Mohammed II (1808-1839) opened modern medical schools in Istanbul One for medicine Toubanah, and one for surgery Jirahanah which in 1911 became the Faculty of Medicine.[11].

References

1. Muhammad Taha al Jasir [Editor] Anesthesia Essays On Its History In Arab World And Islamic Medicine And The Current Arab World. ISBN:1-59239-730-1 Dar Al Fikr Damascus Syria 2008.http://www.fikr.com
2. Jasser M.T. Anaesthesia in the history of Islamic Medicine in "The History of anaesthesia. International congress and symposium series 134 (eds.) Atkinson R.S., and Boulton T.B. Royal Society of Medicine Services and The Parthenon Publishing Group, London - New York 1989
3. Mohamad S. Takrouri : Surgical, medical and anesthesia I n the Middle East: Notes on Ancient and medieval practice with reference to Islamic-Arabic medicine. The Internet Journal of Health. 2006. Volume 5 Number 1.
4. Haddad F.S. History is our pride (Editorial). M.E.J. Anaesth. 1971; 3,1, 3-4
5. Baraka A. Historical aspect of opium M.E.J.Anaesth. 1982;6,5,289-302
6. Baraka A (Arabic) . Opium. Anaesthesia: Essays and researches 1985;1,1, 7-20
7. Jasser M.T.. Anaesthesia in Arab medicine. M.E.J. Anaesth. 1978; 5 (2), 125-128
8. Jasser M T. Anaesthesia in the history of Islamic Medicine. The History of anaesthesia. International congress and symposium series 134 (eds.) Atkinson R.S., and Boulton T.B. Royal Society of Medicine Services and The Parthenon Publishing Group, London - New York 198
9. Ibn Al-Koff . Al-Oumdah Fi Sinaat Al-Jiraha, Othmania University press. Haidar Abad Addiken. India 1932.
10. Hammarneh S.K The Physician, Therapist and Surgeon IbnAl-Quff (1233-1286). An Introductory Survey of His Time, Life and Works. Cairo, Egypt, Atlas Press, I974
11. Takrouri M.S.M.. History of anaesthesia in Jordan. M.E.J.Anaesth., 1987; 9: 141
12. Al Mazrooa A.A. Abdel-Halim R.E. Anaesthesia 1000 years ago. The History of Anaesthesia (Eds.) Atkinson R.S., Boulton T.B.. Royal society of Medicine Congress and Symposium Series No 134 1989 ; 46-48 London - New York
13. Hunke S. Allah Sonne Uber Dem Abendkand Unser arabisches Erbe" Dar Al-Afaq Al-Jadidah p 280 Beirut, Lebanon 7th printing 1982 (Arabic Translation).