Paediatric Urology 1000 Years Ago
By Rabie E. Abdel-Halim*
Note of the editor
This article was originally published as: Professor Rabie E. Abdel-Halim, "Paediatric Urology 1000 Years Ago", Progress in Pediatric Surgery, edited by P.P. Rickham, Berlin Heidelberg: Springer-Verlag 1986, Vol. 20, pp 256-264. © Springer-Verlag. To visit the original article (HTML version), click on any one of the following links: link 1, link 2, link 3. We are grateful to Professor Rabie E. Abdel-Halim for allowing republishing.
* * * Summary
In this paper we present a commentary on four books from the paediatric urology point of view: al-Hawi fi al-tibb (The Continens), fi siyasat as-sibian wa-tadbirihim, at-Tasrif li-man 'ajiza 'an at-ta'lif and al-Qanun fi al-tibb by the Muslim scholars al-Razi, Ibn al-Jazzar, al-Zahrawi and Ibn Sina who lived within the period of the ninth to the eleventh centuries.
In these books the supreme abilities of the authors as clinicians and their role in the creation of clinical medicine are shown by: the presentation of the various pathological conditions usually starting with the complaint then describing the origin of the disease and enumerating the accurate signs necessary for diagnosis. Differential diagnosis between various conditions which produce similar complaints is precisely described. For example, retention of urine and different types of anuria, types of renal haematuria, dormant and moving renal stones and their precise localisation, renal or vesical pain and pain due to colitis. Finally the methodical classification of the diseases according to the organs affected is discussed.
The description of the pathology and the knowledge of new diseases was an important advance made by these scholars. From the urological point of view, spina bifida and its relation to incontinence was first described by al-Razi and most of the diseases of the kidney and bladder can be recognized in the systemic classification of the diseases of these organs given by Ibn Sina who pointed out the psychological role in some cases of nocturnal enuresis. Though al-Razi was the first to think of and practice meatotomy, introduce enema in the pre-operative preparation for lithotomy and break large vesical stones piecemeal in the bladder, the merit of having integrated surgery into scientific medicine must go to al-Zahrawi. The many operative procedures and instruments described in the thirteenth volume of his encyclopaedia of medicine and surgery (at-Tasrif), such as the Kalalib (a primitive lithotrite), the Michaab to drill a hole in an impacted urethral stone forming the foundation of true lithotripsy, the scissors used in the dissection technique of circumcision, straight catheters and the numerous instruments and techniques for bladder irrigation, do not appear in any other classical writing.
These books were translated into Latin as early as 1150 CE, and greatly influenced the European mediaeval schools of medicine up to the eighteenth century.
It is noticeable that, in any contemporary article on medicine, the more than 1000 years between Graeco-Roman times and the modern era are commonly over-looked, giving the appearance that during this period nothing worthy of mention happened in medicine. In Europe, this period is usually referred to as the 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   .
However, in the East, the firm establishment of the Moslem supremacy, coincided with the development of botany, pharmacy and chemistry, branches of science that the Moslem world is given credit for having established   . Between the ninth and the sixteenth centuries, the study of medicine and other branches of science revived and acquired a scientific basis  .
In this study, we present a brief commentary on four books having to do with urology, with a special view toward aspects of paediatric urology. The books were written by the Moslem scholars al-Razi, Ibn al-Jazzar, al Zahrawi and Ibn Sina, who lived between the ninth and the eleventh centuries.
AI-Hawi fi al-tibb
Al-Razi lived in Baghdad between 841 and 926 CE  . In addition to his treatise Liber de Variolis et Morbillis on eruptive fevers      , which was considered a masterpiece of clinical medicine , the 23-volume work al-Hawi (Continens), an encyclopaedia of medicine and surgery, is another major contribution by al-Razi to medicine    .
Al-Razi critically evaluated the views of the ancients in light of his own experience and practice, a mode of analysis that constitutes basic scientific research. Cumston  has stated that the Islamic physician has the merit of having carefully analysed the scattered insights of Greek medicine, extracting from them the most important material and leaving aside everything that was superfluous. According to Husain and al-Okbey, unlike his predecessors, al-Razi followed the original scheme of methodically classifying diseases according to the organs affected . In this, he showed his supreme abilities as a clinician by presenting various pathological conditions, usually starting with the complaint, then analysing its origin and finally describing the signs necessary for diagnosis  .
Al-Razi was a keen observer, differentiating with great precision among various conditions that produce similar complaints and accurately describing signs necessary for diagnosis. Given the symptom of heaviness in the loin, for example here is his precise differentiation of renal stones and renal obstruction or swelling:
"The differentiation between them is that; with inflammation, [there are] mixed fevers, rigors and polyuria with frequency; with obstruction, [there is] oliguria and the urine is clear and with stones, the urine is either clear or not and with sandy sedimentation" (, part 10, p.120).
Though Rufus of Ephesus had differentiated between vesical and renal haematuria , al-Razi also gave the underlying physio-anatomical reasons for this difference:
"Sudden haematuria is due to a ruptured renal vessel as this cannot be the case in the bladder because it cannot be for a vesical vessel to rupture due to plenty of blood coming to it as it happens in the kidney. And this is because blood is not filtered in the vessels of the bladder as i
by: Professor Rabie E. Abdel-Halim by: S. N. Cenk Buyukunal and Nil Sari
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