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Paper presented by Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) professor of Epidemiology and Islamic Medicine at Universiti Brunei Darussalam and Visiting Professor of Epidemiology at Universiti Malaya at the 2nd Health Seminar of the Faculty of Medicine Universiti Sains Islam Malaysia held on 17th March 2007 at the Crown Princess Hotel Ampang Kuala Lumpur
ABSTRACT
The paper discusses food poisoning as a gastrointestinal disorder due to ingestion of food containing poisonous substances. The poisons could be chemicals, natural products of animal or plant origin, or microorganisms and their secretions. It focuses on microbial causes of gastrointestinal illness which is due food contamination during storage, preparation, serving, or consumption. Most food poisoning can be prevented by rigorous personal hygiene. The paper discusses Islamic guidelines on personal hygiene including toilet hygiene, the etiquette of defecation and urination, and the etiquette of drinking and eating. Because of shortage of time for presentation the paper has not discussed food as a poison that harms the body if taken in excessive quantities. This is linked to the life-style diseases in which diet play a role such as coronary heart disease, stroke, some forms of cancer, and diabetes mellitus.
1.0 POISONS IN FOOD
1.1 TYPES OF FOOD POISONING
Food poisoning is a term used to refer to gastro-intestinal illness resulting from consumption of food or drink that contains chemicals, animal products, plant products, or microorganisms that cause pathology. Most cases of food poisoning are caused by bacteria. The commonest bacterial species involves are Salmonella spp, Shigella spp, Escherichia coli spp, and Stapylococcus spp. We shall focus on microbial food poisoning.
Bacteria or viruses in the diet cause poisoning in two ways. They may grown and divide in the intestinal lumen causing various forms of pathological change or unfavorable alterations in the fluid and electrolyte balance. They also cause illness by producing toxins that cause pathological changes in the intestinal wall. The toxins may be ingested with the food or may be formed in the intestine as the micro-organisms grow and divide. The toxins may act locally in the intestine or in remote areas such as neural tissue.
In our local situation most food poisoning is due to fecal-oral contamination by micro-organisms. The contamination occurs during the storage, preparation, or the consumption of the food. I would like to focus on Islamic teachings on personal hygiene that if implemented would eliminated most of the food poisoning that occurs during preparation and consumption of food. Islam has teachings on hygienic toilet etiquette, etiquette of defecation, and etiquette of urination.
1.2 TOILETTE ETIQUETTE, adab qadhau al haajat:
Islam has emphasized toilet hygiene and treats it as a religious duty. The Prophet took great care to teach his followers the main principles of hygiene. All books of fiqh start with the chapter on cleansing, taharat. Islam has taught toilet etiquette to protect both human dignity and also prevent infection.
A dua must be recited on entering on entering[1] and expression of gratitude to Allah must be recited on exiting. The toilet is an undesirable place[2]. Toilet stay must be as short as possible and the stay should never be prolonged beyond need. Shoes or sandals must be worn to prevent the feet from being soiled by filth. In order to prevent air borne infection, it is forbidden to open the mouth in the toilet either in conversation[3], giving or returning greetings, or even mentioning Allah’s name. Utensils or pipes whose hygienic standards cannot be ascertained should not be used.
Defecation must be in special places to avoid environmental contamination. Excretion is forbidden on the road, shades where people sit, and on the banks of rivers[4].It is forbidden to defecate or urinate in water.
Hands play a big role in the spread of feco-oral infection. Islam therefore emphasizes their regular cleansing. After istinjah and before start of wudu the hands must be washed. Hands are also washed on waking up from sleep because they might have touched the anal or urethral openings[5]. On waking up from sleep, the hands cannot put into any utensil until they are washed three times.
1.3 PURIFICATION AFTER DEFECATION, istinja min al ghait
Istinjah refers to cleansing oneself of all traces of the excreta. Cleansing is needed for stool and urine but not for flatus. In case of flatus, no physical cleaning is necessary in the anal area; only the wudhu is repeated. The details of istinjah have been given by Islam to make sure that there is personal hygiene to prevent infection. Ritual ablution for prayer cannot be valid before istinjah[6]. Water and solid cleansers are used. The solids may be paper; stones; istijmar[7], or plant material. Human bones and material known to be najs are not allowed[8]. It is preferred to use a solid followed by water[9]. Other liquids like milk or vinegar cannot be used for cleansing. Rubbing the sole of a shoe on soil cleanses it of najs. It is recommended to use the left hand[10] so that the right hand is used only for feeding thus preventing spread of infective and toxic material to human food
Water is the universal and best cleanser or purifier. Water being a universal cleanser is preferred after defecation and urination[11]. In relation to purification, water is divided into three categories: pure water, tahuur; purifying water, mutahhir, and impure water, ghayr tahuur. Water may appear pure, tahuur, but is not considered purifying, mutahhir, because of pollutants like filth, microorganisms, and other hazardous solids and liquids. Water is purifying, mutahhir, unless contamination is beyond a reasonable limit such as when the color, smell, or taste of the water change[12]. Water that is obviously impure, ghayr tahuur, cannot be used for purifying at all.
Seawater is generally taken to be purifying[13]. A big amount of water is generally considered purifying because the concentration of pollutants is low. Ancient jurists had opined that 2 qullatain of water (216 liters) cannot be polluted[14]. With present-day sewage and industrial discharges into water, even amounts beyond 2 qullatain can be made impure. Water that has any filth dumped into it cannot be used for cleansing if it is less than 216 liters. This is on the basis that a lot of water does not become najasat, al mau al kathiir la yanjis. It is not usable if there are easily visible signs of pollution such as change of color, taste or smell even if it is more than 216 liters. We can extrapolate and say that water that appears normal and is more than 216 liters should not be used if bacterial assays indicate that it has more than the allowable coliform content.
Polluted stagnant water is not purifying while running water may be. There are limits of microbiological and hazardous material contamination beyond which water should not be used for purification. Water that has been used already in wudhu or cleaning, mau musta'mal, is not usable in istinjah because it could transfer infection. Recycled water can be used for cleansing.
1.4 PURIFICATION AFTER URINATION, istinjau min al bawl
It is a great sin not to protect the body and clothes from urine, istibrau min al bawl[15]. Care must be taken not to be contaminated by urine, al tawaqqi min al bawl[16]. Care must be taken to avoid splashing urine. In cases of urinary incompetence, the person is exempted and can pray even if the clothes are contaminated. Touching the penis requires repeat of wudhu[17].
The regulations about urine are logical measures to prevent urinary contamination and infection. Attempts must be made to empty the bladder fully to prevent spotting after urination[18]. Urethral massage for both the male and the female is recommended for this purpose. Urethral massage should be repeated three times to ensure complete emptying of the penis[19].
The following are prohibited because they lead to urinary contamination: urination on hard ground, urinating in a bath, urinating in a hole, urinating in stagnant water[20], and urination on any edible material. It is prohibited to urinate while standing[21] if it is feared that it will cause splashing of urine. In some cases it is better to stand when urine splashing is less likely that away. Urination is a vessel is forbidden[22].
Urine of adults, male and female, is washed away[23]. Floors contaminated by urine are washed with water[24]. The urine of babies still breast-feeding is treated differently because it has less content of impurities; for boys splashing of water is enough but for girls washing is necessary[25]. There is a difference in the composition of the urine of male and female infants[26]. Human urine is more infectious to humans than animal urine. Animal urine may contain organisms generally not pathogenic to humans. The Prophet ordered people to drink camel urine for medicinal reasons[27]. Dog's urine in the mosque was not washed away[28] whereas human urine was. Human urine cannot be used as medicine[29].
1.5 ETIQUETTE OF EATING AND DRINKING
The prophet taught eating is with the right hand[30] even if the person is left-handed. He also forbade drinking with the left hand, la yashrabu bi al shamaal[31]. This helps separate in an effective way the possible contamination of food since the left hand is used in the toilet and the right hand is used for food.
It is sunnah to eat from the top of the dish. It is sunnat to eat only the food next to you, yakul kullu rajuli mimma yaliihi[32]. These practices ensure that the food is not all exposed to environmental contamination so that the leftover can be stored to be eaten later.
The Prophet forbade blowing over food, la yanfakhu ala al ta'aam[33]. He also forbade breathing into a vessel It is forbidden to breathe into the vessel, al tanaffus fi al inaa[34] or into a drink nahy .an al tanaffus wa al nafakh fi al sharaab[35]. Blowing over food will spread bacteria and viruses over the food that others will eat and may lead to infections. Food should be covered as much as possible to prevent environmental contamination.
Drinking from the mouth of the vessel is forbidden[36]. This is because it contaminates the rest of the vessel’s contents. The Prophet recommended rinsing the mouth, madhmadhat, after drinking[37]
[1] (Buloogh al Maraam No 78 reported by Ahmad, Bukhari, Muslim, Abudaud, Nisai, Tirmidhi, Ibn Majah)
[2] Bukhari 1:144)
[3] Buloogh al Maram No 82 reported by Ahmad
[4] (BG81 Abudaud)
[5] Bukhari 1:163
[6] Bukhari 1:176
[7] Bukhari 1:157
[8] Bukhari 1:158
[9] Buloogh al maram No 93 reported by al Bazzaar
[10] Bukhari 1:155
[11] Bukhari 1:145
[12] Buloogh al Maram No 3 reported by Ibn Majah
[13] Buloogh al Maram No 1 reported by Abudaud, Nisai, Tirmidhi, and Ibn Majah
[14] Buloogh al Maram No 4 reported by Abudaud, Nisai, Tirmidhi, Ibn Majah)
[15] Bukhari 1:215
[16] Bukhari K4 B55
[17] Buloogh al Maram No 68 reported by Ahmad, Abudaud, Nisai, Tirmidhi, Ibn Majah)
[18] Buloogh al Maram No 92 reported by Ibn Majah
[19] Buloogh al Maram No 92 reported by Ibn Majah
[20] Bukhari 1:239
[21] Tirmidhi K1 B8
[22] Abudaud K1 B13
[23] Bukhari 1:216
[24] Bukhari 1:219
[25] Bukhari K4 B59
[26] Ibn Majah K1 B77
[27] Bukhari 1:234
[28] Bukhari 1:174
[29] Bukhari K74 B15
[30] Bukhari K70 B2
[31] Muslim K36 H105
[32] Bukhari K70 B2
[33] Ibn Majah K29 B18
[34] (Tayalisi H2118)
[35] Bukhari K74 B25
[36] Bukhari K74 B23
[37] Tirmidhi K1 B66