Historic essay: An Arabic surgeon, Ibn al Quff’s (1232–128… : Anesthesia Essays and Researches
WHO WAS IBN AL QUFF?
Ibn al Quff was born in 630 AH/1232 CE and died in Damascus in 685 AH/1286 CE. He indicated that anesthetics might be given by inhalation and he described the medication utilized in anesthetic sponge [Figures 1 and 2].
Inventive impression of Arabia anesthetic sponge, by which the surgeon operates and the tabbaee retains the sedoanalgesic soaked anesthetic sponge over the nostril and squeezes the liquid which is absorbed by the mucous membrane of nostril and mouth (printed with the permission of Pan Arab anesthesia group)
Karak Citadel, the place Ibn al Quff was born. Throughout his time, it was in Syria, and now it’s in Jordan
His full identify was Amin al Dawlah Abu al Faraj Muwafak Al Deen ibn Ya’qub Ibn Ishaq Ibn al Quff Al Malaki Al Karki. He has authored many books, a very powerful being a surgical handbook “Al Omdah fi sina’at al jiraht”. The e-book consists of 20 maqalas of which maqala-17 is dedicated to traumatology, whereas maqala-19 discusses surgical issues and their remedy from head to foot. This e-book was printed on two events, as soon as in India and the opposite time in Jordan within the Nineteen Thirties and Nineteen Nineties, respectively. His different books have been manuscripts particularly Al Shafi Fi El Tobb (The healer in medication) which might be present in Vatican library and within the British museum, Jame’e Al Gharad iFi Hifz Al Sihah wa Rafi’e Al Maradh (Compodium in preserving well being and eliminating illness) discovered within the British Museum, Al Oussoul Fi Sharh Al Fousoul (Basis in clarification of Hippocratic Assortment) present in Cairo, Istanbul and Paris, and printed in Alexandria in 1902 and lastly, Al Kouliat Fi Kitab Al Quanoun Fi Al Tibb (Synopsis of Avecina’s Qanoun) obtainable in Al Assad Library in Damascus, Syria, the place he settled until his loss of life [Figures 2 and 3].
The primary web page of Ibn al Quff’s manuscript of his surgical e-book al umdah together with his full identify and a brief biography
HISTORICAL PROSPECTIVE
Within the seek for well being and remedy, human race developed all attainable means to attain this objective.[12]
To hint the event of medical and surgical apply within the previous world, it might be logical to comply with the event of human societies. World civilization first began alongside the foremost rivers of the Center East, particularly the Nile valley, and in between the rivers Euphrates and Tigris within the land of Mesopotamia 4000 years in the past. Indian and Chinese language civilizations sprouted out virtually in the identical time within the Far East of Asia. The oldest medical writings are present in cuneiform tablets [the oldest medical handbook] and in Eber pyperus. Each include medical textual content describing the medical and natural therapies. The Assyrians natural contained belladonna, Hashish and mandrake. The traditional Egyptians used opium poppy for colics and diarrhea. They influenced the Greek medication. The Assyrian and Egyptian physicians might get synthetic sleep for his or her sufferers by rapidly compressing carotid vessels of the neck; this apply was adopted as nicely by the Greek physicians.[2–6]
Dioscorides (circa 54–58 CE), a Greek doctor and surgeon, advisable sufferers ought to take mandrake combined with wine earlier than limb amputation: “For similar to can not sleep, or are grievously pained, and upon whom being reduce, or cauterized they want to make a not-feeling ache”.[7] Celsus (CE 14–37) in De Medicina suggests using opium earlier than surgical procedure.[8]
Surgical information in India was very superior. The next operations have been carried out by Indian surgeons: tonsillectomy, amputation, tumor excision, hernia restore, restore of harelips, removing of bladder stones, couching cataracts, nostril restore, and cesarean part. Additionally they developed surgical devices. They knew the washing and bandaging of wounds. Hyoscamus (Henbane) and Hashish indica have been used as anesthetics. In some instances, hypnosis was used throughout surgical remedy. Within the historic Indian work Sushruta Samhita, written maybe as early as 400 BC, alcohol was suggested for use earlier than surgical procedure to provide insensibility to ache.[9]
The Chinese language developed acupuncture and so they used opium powders for inhalations.
Greek and Roman medication was in a means a continuum. The daddy of drugs, Hippocrates, c.460–c.370 BC, and the nice doctor Galen of the second century influenced medical ideas over centuries. In line with his suggestions, nice care needs to be practiced with using highly effective narcotics similar to opium, contemplating it a harmful drug. It’s for use in colics and in different extremely violent pains.[10]
The Romans used decoction of mandrake in alcohol. Pliny (23–79 CE) has stated the next in regards to the juice of mandrake: “Administered in doses proportional to the energy of the affected person, this juice has a narcotic impact it’s given for accidents inflected by serpents, and earlier than incisions of punctures are made within the physique, so as to insure insensibility to the ache”. By the point of Paulus, (seventh century) opium and mandrake had fallen into neglect.
Arabic translation of the Greek medication helped to make Islamic physicians supreme within the Center Ages.
Baghdad turned the world’s main medical and drug heart. With the ability of the Arab alchemists, the artwork of drug making started to evolve into the science of pharmacology. Western physicians rising from the Center Ages discovered the Arab pharmacopoeia, by which a listing of medicinal crops composed the anesthetic armamentarium of Arabian surgeon.[3]
Avicenna (980–1037 CE) indicated {that a} affected person who needs to have an amputation of one among his limbs will need to have a drink ready from a combination of mandragora and different sleeping medication.[12] This comment reminds us the instructing of Dioscorides, the Greek doctor and surgeon.
Anesthetic sponge was an Arab contribution, seemingly so, the chemical radical (-O-).[12] Ali ibn Isa (940–1010 AD) is taken into account probably the most well-known physicians of the tenth century. His well-known Pocket book of the Oculists mixed info obtained from each Greco-Roman and Arab sources. He was thought-about one of many early Arab ophthalmologists to make use of anesthetic sponge, though an article printed in 1960 tried to solid doubts on his use of the phrase “tanweem” which is the Arabic phrase for “to place someone to sleep”. Additionally, within the article, there was a speculation that “tanweem” meant to put the affected person on his again which was solely a hypothesis.[13] So, it’s clear that Ibn Sina[1214–16] gave a suggestion to have oral anesthetics.[121415] The Arabs invented the soporific sponge, which was the precursor of contemporary anesthesia. It was a sponge soaked with aromatics and narcotics and held to the affected person’s nostrils.[1314] Using anesthesia was one of many causes for the rise of surgical procedure within the Islamic world to the extent of an honorable specialty.[101114–16]
Theodoric, a thirteenth century monk and doctor, described the spongia somnifera, a combination of a number of narcotic substances together with opium, mandrake, henbane, mulberry, lettuce and hemlock, all boiled inside a sponge, which was then sniffed to offer anesthesia for surgical procedure.[11]
A lacking hyperlink does exist. How come this discrepancy? How do fashionable historians take a look at it?
Some gentle has been shed on the style by which surgeons and physicians have mentioned their experiences of their books, within the following sections.
Restraining the Affected person Throughout Surgical procedure
Ibn al Nafis’ (1210–1288 CE) description of restraining the affected person throughout surgical procedure given in his e-book “Al Shamel” is as follows: “First, he ought to adjust to all of the directions of the doctor, and mustn’t abstain from following them. Secondly, he ought to hold his physique in the identical posture that he assumed originally, and all through the time of operative remedy, not altering the place of any half in any respect. If, nevertheless, the affected person couldn’t hold nonetheless due to the depth of ache or as a result of he’s an toddler or a baby, and so forth, he needs to be held in a set place by someone else. Whether it is troublesome to maintain him nonetheless, and it’s feared that the affected person’s disturbance might disrupt the operation – or he might inflict hurt upon himself in some other means – then he needs to be tied down in essentially the most favorable place. For instance, throughout the couching operation of the attention, whether it is feared that the tip of the needle might penetrate and disrupt the humors of the attention, and in like instances, it might be essential to tie the affected person down in essentially the most favorable place”.
Ibn al Quff’s Account of Surgical Ache Reduction
Ibn al Nafis’s pupil Ibn al Quff wrote an entire chapter on ache aid in his e-book “al Umdah Fi Sinaat Al Jirahah” [Figures 3 and 4]. He differentiated between true and unfaithful ache aid, contemplating unfaithful ache aid the “anesthetic” which the surgeon might use for remedy of ache or to institute the surgical remedy.[1314]
Chapter 13 by which Ibn al Quff explains the causes of surgical ache and about ache aid. He signifies the presence of al tabbaee to manage analgesia and session in ninth phrase, second line of the fourth paragraph
The medication used, described as “sleep and insensibility inducing substances,” in that e-book have been: opium, mandrake, Hyocymus albus, belladonna, Hashish sativus, C. indica and wild lettuce.
Translation of his statements is as follows: “Thus you must know that ache aid is of two varieties: True ache releif and unfaithful ache aid. The primary (i.e. true) is the opposition of the reason for ache both because of separation of continuation (e.g. wound) in line with Galen or maldisposition in line with Avicenna
As for the unfaithful, it’s (Al moukkhader) the anesthetic, which is what the surgeon wants on this state of affairs. It relieves the ache in 4 methods: Firstly, by its coolness it blocks the conduits of the spirit and prevents painful sensation from penetration, so it reduces the sensation and the ache is relieved or prevented. Secondly, by its coolness it hardens the essence of the spirit and prevents it from penetration and circulation. Thirdly, painful feeling occurs by the presence of warmth and moisture, and the anesthetic is cool and dry, thereby antagonizes it. This reduces its power and makes it weak. Fourthly, for the reason that anesthetic has some toxic impact, the sensory power is diminished, leading to ache discount.
The primary (true ache aid) means is the helpful one and has a very good final result, however the second though may give ache aid or is utilized in (surgical) remedy, because it reduces ache it reduces the important power and fixes the painful substance to the organ. So the surgeon ought to use it solely in nice duties” (2024–32).
The Soporific Sponge (Anesthetic Sponge) “Inhalational Anesthesia” (Al Esphanjah al Mourakkidah)
The Arab surgeons’ utility of botanication analgesic sedatives in operative surgical procedure was debated and mentioned by many historians. Trendy anesthesiologists would discover it troublesome to grasp. It’s because medieval physicians lacked the at the moment present ideas of physiology and pharmacology, although they used smart method to clarify the ideas of inhalation and analgesic results, ruled by present Greek doctrines of 4 humors. Ibn al Quff isn’t any exception. Although he lived in a interval the place some criticism was directed to previous theories, it led to the manufacturing of recent concepts like the reason of pulmonary circulation by Ibn al Nafis and the capillary hyperlinks to venous facet of the circulation by Ibn al Quff. Trendy anesthesiologists tried to hyperlink the previous, and considered inhalational anesthesia even with unsuitable medication. Opium and different medication weren’t risky to the extent to provide anesthesia, like ether and nitrous oxide, in the course of the nineteenth century. This concept of medieval inhalational anesthesia was rejected by some and accepted by others as mucous membrane absorption of squeezed narcotic combination within the water of the sponge [Figure 1]. Some others indicated that inhalational method was only a signal of hopeful pondering and it was with out impact.[32] In Ibn al Quff’s account on ache aid throughout surgical procedure, he indicated the hazards and unwanted effects, and in discussing a person single drug, he had indicated if it was appropriate for ingestion, consuming, inhalational technique or rectally by inserting soaked suppositories with these medication.[25–32]
One creator commented as follows: “Using common sedatives in operative surgical procedure within the Arab anesthetization was distinctive, true in its motion and merciful to the receiver. It differed utterly from the alcoholic drinks which the Indians, Greeks and Romans compelled on their sufferers simply to scale back the ache however to not relieve them from it. This scientific discovery is attributed to an Italian or the physicians from Alexandria. The reality stays that the strategy of use of “soporific sponge” is solely in Arabic and was not identified earlier than. The “soporific sponge” was put in juice of cannabis, papver, and hyocymine, after which dried below the solar. Throughout use, it was humidified once more, and positioned on the affected person’s nostril in order that it will get absorbed by the mucus membranes, inflicting deep sleep and aid of surgical pains. The invention was launched into Europe and was practiced till the 18th century when fashionable inhalational anesthesia was launched within the 1840s”.[15]
One other creator has commented as follows: The precept of anesthetic inhalation was identified to Arab Islamic surgeons as described by an Arab medical historian: “Anesthetization was identified within the Arab East throughout Center Ages. The method consisted of both inhaling anesthetizing materials positioned on sponge referred to as “soporific sponge” or positioned in a swinging censor spreading odors of anesthetizing supplies which can be perfumed with Al-Oud. Some have been used orally. The method relied on suggestibility and using the next crops: Conium maculatum (Hemlock), Papver somniferum and Hyocymus albus, belladonna, C. sativus, C. indica.”[12–19]
CONCLUSION
In conclusion, Ibn al Quff’s account on ache aid throughout surgical procedure provides us a novel alternative to learn about how he handled ache in surgical procedure or in surgical circumstances. He talked about the hazard of the obtainable medication and he indicated that they need to be used solely in nice activity. He additionally indicated that al tabee needs to be there to manage the medication and to advise the indication for his or her use. He positively indicated that the anesthetic needs to be used by way of ingestion, consuming, inhalation and suppositories. All of the medication used by way of inhalation route have been quoted in western literature as a recipe for anesthetic sponge. Ibn al Quff didn’t give recipes in his e-book as within the western sources; he solely described the recopies of the medication as a sleep inducing and analgesic opium, mandruk, Hyocymus albus, and Nigra letteci, belladonna.
He was the primary on to present an outline on capillary and venule connection, which is understood at the moment as microcirculation.
ACKNOWLEDGMENT
The creator wish to thank the historians who allowed utilizing their work as reference and medical images and the Pan Arab group for giving permission to breed anesthetic sponge drawing. Additionally, the creator wish to thank Miss. Farah Maani Takrouri for her assist in the preparation of the manuscript.
REFERENCES
Supply of Help: Nil
Battle of Curiosity: None declared.