Islam House

Wednesday, October 6, 2010

Ophthalmology and Surgery

For ophthalmology there developed an extensive specialist literature. Islamic physicians displayed particular concern and skill in the diagnosis and treatment of eye diseases, perhaps because blindness was the major cause of disability throughout the Islamic lands. Nearly every medical compendium had chapters on eye diseases, but the most comprehensive coverage was to be found in the large number of monographs devoted solely to the subject.

In the 9th century the physician-translator Hunayn ibn Ishaq wrote monographs on ophthalmology, including the influential Ten Treatises on the Eye that showed considerable advancement in knowledge over that in the Greco-Roman treatises preserved today. One of the most highly regarded of ophthalmological manuals was that covering 130 eye ailments written by `Ali ibn `Isa al-Kahhal (d. 1010/400 H) who practiced in Baghdad. A contemporary of his was `Ammar ibn `Ali al-Mawsili, who was originally from Iraq but moved to Egypt where he dedicated his only writing, a treatise on eye diseases, to the Fatimid ruler al-Hakim, who ruled from 966 to 1020 (386-411 H). The latter work only discussed 48 diseases but contains some clinical cases and adaptations of surgical instruments, including a hollow cataract needle which he asserted could be used to remove a cataract from the eye by suction. This hollow tube is mentioned by later ophthalmologists, and the removal of a cataract by suction using a hollow needle was said to have been observed by the oculist and historian Ibn Abi Usaybi`ah about 1230 (628 H) in the Nuri hospital in Damascus. The 14th-century Egyptian oculist Sadaqah ibn Ibrahim al-Shadhili, however, said he had not seen it used and questioned its validity.

In treating cataracts, the technique commonly employed was couching. This method consisted of pushing the lens of the eye out of the way by inserting into the eye a needle or probe through the edge of the cornea. Infection and glaucoma were the major causes for failure. Considering that an untreated cataract results in blindness and the success rate for couching is about 4 in 10, it is not unreasonable that couching found widespread acceptance.

Impressive surgical and diagnostic skill was displayed in the treatment of trachoma, the major cause of blindness, and its sequelae trichiasis, entropion, and pannus. Trachoma itself was treated by everting the eyelid and scraping the interior with a selection of scrapers. Intricate surgical procedures were used for dealing with trichiasis and entropion (superfluous and ingrown eyelashes and rolled in eyelids). Trachomatous pannus, a vascularization which invades the cornea, was not apparently known to Greek physicians, but it was clearly described and treated by peritomy by the earliest of the Islamic doctors and was recognized to be a sequela of trachoma. The excision of pannus employed an instrument for keeping the eye open during surgery, a number of small hooks for lifting, and a very thin scalpel or couching needle. Similar instruments were used in excising pterygium, a triangular-shaped encroachment of the bulbar conjunctiva onto the cornea. Such surgical procedures are intricate and painstaking and cause considerable pain to the patient. Yet they appear to have been occasionally, if not routinely, performed.

For reasons as yet unknown, there was during the 12th and 13th centuries unprecedented interest in composing Arabic treatises on ophthalmology. In Spain Muhammad ibn Qassum ibn Aslam al-Ghafiqi, of whom essentially nothing is known, wrote a Guide to Ophthalmology that was illustrated with instruments. In Cairo the oculist Fath al-Din al-Qaysi, who died in 1259 (657 H) wrote The Result of Thinking about the Cure of Eye Diseases (Natijat al-fikar fi `ilaj amrad al-basar). Al-Qaysi was one of a three-generation family of court physicians in Cairo and was himself `Chief of Physicians' in Egypt and physician to two Ayyubid rulers, including Saladin. The treatise consists of 17 chapters dealing with the anatomy and physiology of the eye and the causes, symptoms and treatment of 124 eye conditions, some apparently described here for the first time. About a decade later, another comprehensive ocular manual was composed in Syria by Khalifah ibn Abi al-Mahasin al-Halabi, who included elaborate charts of instruments. Other ophthalmological manuals were written in Egypt and Syria in the 13th and 14th centuries, including a comprehensive survey of ophthalmology by the Syrian epitomizer of Ibn Sina's Canon, Ibn al-Nafis who practiced in both Damascus and Cairo.
Surgery in general tended to be viewed as distinct from the rest of general medical care, and at least one specialized treatise was written on it. Of major importance in the history of general surgery was the lengthy surgical chapter from the 10th-century medical encyclopedia composed in Spain by al-Zahrawi. This illustrated surgical section circulated by itself and later was influential in Europe through the Latin translation made two centuries later in Toledo by Gerard of Cremona.

Al-Zahrawi divided his discourse on surgery into three parts: on cautery, on incisions and bloodletting, and on bonesetting. He included in it copious illustrations and descriptions of instruments, which made the treatise particularly valuable even though scribes often misunderstood the illustrations when copying the treatise. He combined the surgical ideas derived from Greco-Roman sources with his own observations and experiences, and modified many of the earlier instruments as well as designing some new ones. For example, he described a bevel-ended cannula, instead of the earlier straight one, for use in drawing off liquid when treating abdominal dropsy. He introduced a technique using a fine drill inserted through the urinary passage for treating a calculus impacted in the urethra, and he designed a concealed knife for opening abcesses in a manner that would not alarm the nervous patient. Variations in the design of a vaginal speculum or dilator were introduced, and forceps described, though not for use in live births.

In the 13th century, a Syrian physician, Ibn al-Quff, composed a specialized surgical manual, in which he omitted all ophthalmological procedures because he considered these the province of a specialist. Nearly all the other general discussions of surgery did include some ophthalmological practices, though not with the detail and thoroughness evident in the monographs devoted solely to ophthalmology. The 16th and 17th-century surgical practices in the Ottoman empire and in Safavid Iran and Mughal India are largely derivative from these earlier Arabic ones, but some new techniques emerged including the treating of gunshot wounds.

The lack of antisepsis and anaesthesia were significant limitations on the surgery of the day. The precise extent to which sepsis was a factor in the success, or failure, of an operation is difficult to determine. With the exception of ophthalmological surgery, the vast majority of operations were following accidents or battle wounds, in which case infection may have already set in. Throughout the surgical writings, the Islamic physicians display a sensible and humane reluctance to undertake the riskiest and most painful operations.

sursa..islamic culture.

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