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Presented at a MINI MEDICAL SCHOOL for High School students held on Sunday 25th June 2006 at Dewan Cancelor Universiti Brunei Darussalam by Dr Omar Hasan Kasule, Sr. MB ChB (MUK), MPH, DrPH (Harvard) Professor of Epidemiology and Islamic Medicine, Institute of Medicine, Brunei Darussalam. WEB http://omarkasule.tripod.com
1.0 HISTORICAL BACKGROUND
1.1 Pre-Islamic period
Medicine was practiced from the start of human history. Ancient Egyptians learned a lot about the internal structure of the body and developed medical and surgical techniques because they preserved bodies of their dead. Babylonians who lived in what is modern Iraq knew how treatment of eye cataracts[1] and epistaxis[2]. Ancient Chinese developed acupuncture[3] and were experts in various branches of medicine[4]. Ancient Indian surgeons were experts in several surgical operations[5], anesthetics, and poisons. Indian physicians who lived in Baghdad played a role in transferring Indian medical knowledge to Muslims[6]. Greeks and Romans also made many contributions to medicine[7]
1.2 Islamic period
The prophet’s teachings gave a big impetus to medicine. He taught disease prevention, personal and environmental hygiene. He practiced medicine and urged his companions to seek cures for their diseases. Prophetic medicine, tibb nabawi, refers to words and actions of the Prophet with a bearing on disease, treatment of disease, and care of patients. In the Omayyad and Abassid periods many medical books were translated into Arabic. Muslim physicians carried out research on new treatments and added to medical knowledge. Medical schools[8] and hospitals[9] were established. Many of the textbooks used in ancient Muslim medical schools were translated into Latin and were used in European universities until recently. Muslims developed nursing[10]. Muslims made many discoveries in anatomy[11], physiology[12], infectious diseases[13], public health[14], blood circulation[15], allergy, dietetics, pharmaceuticals[16], ophthalmology[17], and general surgery, wound treatment, urology[18], gastro-enterology[19], otorhinolaryngology[20], plastic surgery[21], dentistry[22], and neurosurgery[23]. Out of concern for proper medical education, Khalifah al Muqtadiri ordered in 319 H that nobody would be allowed to practice medicine unless examined by Sinan bin Thaabit bin Qurra.
1.3 Transfer of medical knowledge to Europe
While Muslim medicine was flourishing in West Asia, Europe was in the ignorance and decline of its middle ages. Modern European medicine owes its origins to the knowledge transferred from the Muslim world to Europe. Constatine Africanus (d. 1087 M) translated the most important medical books from Arabic into Latin. This gave new life to the Salerno (Italy) school of medicine. After him more books were translated and were used in European medical schools. Europeans came to study at Muslim institutions in Andalusia and took back the knowledge to Europe.
2.0 MOTIVATION FROM ANCIENT PHYSICIANS
2.1 All-rounded medical professionals
Ancient Muslim physicians were encyclopedic in knowledge, all-rounded, motivated, hardworking, and productive. They excelled in medicine as committed Muslims because Islam is compatible with science. Their achievements are a motivator for today’s medical students and physicians.
2.2 West Asia
Abubakr Al Razi (251-313H), wrote more than 100 books (the most famous being al Hawi al Kabir), investigated diseases (gynecological, obstetrical, hereditary, eye, small pox, and measles), discovered surgical sutures, used anesthetics, used ammonia to control diarrhea, considered psychological factors in disease treatment, and was director of hospitals in Baghdad and Rayy. Ibn Sina (370-428H) wrote many books (the most famous being al Qanuun fi al Tibb), recognized that TB was contagious, accurately described the symptoms of diabetes mellitus, discovered ancylostomiasis, and contributed to science, mathematics, chemistry, and philosophy. Ibn Al Nafees (d. 686H) described blood circulation before William Harvey and authored Sharh tashriih al qanuun in which he explained pulmonary circulation.
2.3 Andalusia
Al Zahrawi (d. 404H) had interest in surgery, pharmacology, and anatomy. He designed over 200 surgical instruments. His book Kitaab al tasriif, became a standard textbook of surgery. He was an expert in cancer surgery and tooth extraction. Ibn Zuhr (d. 487H), lived in Andalusia and Morocco and authored the book al Taysir translated into Latin and used in Europe. Ibn Rushd (d. 595H) was a philosopher and a medical practitioner. His book al Kulliyat translated in Europe. He made the observation that smallpox infected only once.
3.0 WHAT DO DOCTORS DO
3.1 Clinical Medicine
People who study medicine carry out a wide variety of activities in the following main areas: hospital care, public health, and medical research. Physicians who work in hospitals provide clinical care which includes diagnosis (finding out the type and cause of disease) and treatment (using drugs, surgery, radiotherapy, immunotherapy, and others). Investigation can be by taking a sample of blood, urine, or stool and examining in the laboratory. It may also be by using x-rays, CT scan or MRI to visualize internal body structures. Sometimes instruments have to be inserted inside the body for better visualization. For example an esophagoscope can be used to look inside the esophagus and a gastroscope can be used to look inside the stomach.
Treatment is determined by the diagnosis. Physicians can treat using medicine that are either swallowed through the mouth, are injected in the muscles or blood vessels, or are given through the anus. Treatment also can be by surgery in which the body is opened using special instruments in order to remove diseased parts or correct structures. Sometimes powerful energy sources like irradiation or laser are used in surgery to cut away or destroy structures that are diseased.
3.2 Public Health Medicine
Public health physicians also investigate and prevent diseases at the community level. They undertake immunization, control the environment, and other activities of disease prevention and health promotion.
3.3 Medical Research
Some physicians choose to work in research to advance medical knowledge. They may work in laboratories or may work in hospitals. Thos in a hospital setting usually test new drugs to see whether they are effective against disease.
3.4 Other forms of medical practice
There are other specialized functions that physicians undertake such as forensic physicians who examine patients or carry out post-mortem examinations to look for evidence required in a court of law. Sports physicians treat injuries of sportsmen and ensure that players are in good health.
4.0 HOW DO YOU BECOME A DOCTOR
4.1 Basic education
Medicine is both a science (academic study) and an art (apprenticeship learning on the job). Language skills (literacy) and mathematical skills (numeracy) learned in primary schools are the foundation on which future learning is laid. Sciences are very important in secondary school. In some countries students leaving high school enter directly into a medical school and graduate as doctors 5 years later. In other countries they need to obtain a bachelor of science degree before they enter a medical school as postgraduate students.
4.2 University education
The medical curriculum is divided into a pre-clinical phase (study of basic medical sciences) and a clinical phase (study by examining actual patients). On graduation young doctors work for 1 year under supervision before being registered as independent general practitioners.
4.3 Postgraduate training
Some may choose to become specialists in which case they enter a hospital based training program that lasts 3-4 years. When they acquire the necessary experience and pass the examinations they can then become specialists who are experts in a given branch of medicine.
5.0 MEDICINE AS COMMUNITY SERVICE and LEADERSHIP
Medicine is a service, khidmat, for the community. It is a form of mutual social support, takaful. It is social responsibility, amanat. The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health. The physician as a respected opinion leader with close contact with the patients must be a model for others in moral values, attitudes, akhlaq, and thoughts. He must give leadership in preventing or solving ethical issues arising out of modern biotechnology. He must understand the medical, legal, and ethical issue involved and explain them to the patients and their families so that they can form an informed decision. He should also provide leadership in advocating for the less privileged and advocacy for human rights.
6.0 COMPENSATION
The physician working in a materialistic society is torn between contradictory forces of greed and service. Service should have the higher priority but the material rights and privileges of the physician should not be forgotten because he also wants to live a happy life. The prophet talked a lot about payment of the physician. The physician fee should be fixed and known in advance. The prophet paid the cupper who operated on him[24].
[1] Scar on the surface of the eye preventing proper sight
[2] Bleeding from the nose
[3] A form of medical treatment using needles applied to various parts of the body
[4] Hua Chu was a famous Chinese surgeon who lived in the 3rd century M. He wrote about physiology (how the body functions), anatomy (structure of the body), pathology (science of diseases), and anesthetics (putting patients to sleep so that surgery can be carried out without pain). Chinese medicine reached Muslims through contacts in Central Asia. Yuan Chwang (630-645 N) and I Tsung (675-685 N) were Chinese physicians with contacts with Muslims in Central Asia.
[5] such as tonsillectomy (removing the tonsils that are swellings at the entrance to the throat), amputation (cutting off diseased hands and legs), tumor excision (removing swellings), hernia repair, repair of harelips, removal of bladder stones, couching cataracts, nose repair, and ceserian section (surgical delivery of women who fail to deliver naturally).
[6] Indian physicians such as such as Kankah, Urnda, Siddhayogar, and Zantah worked in Baghdad and were welcomed and respected by the Khalifah.
[7] Hippocrates (460- 377 BC) was a Greek physician who is called the father of European medicine and was the first to introduce scientific medicine. Romans leaned medicine from the Greeks and their most famous physician called Claudius Galen (130-201 BC) was a skilled Roman military surgeon whose medical writings were compiled and were translated into Arabic.
[8] The most famous medical college was Bayt al hikmat in Baghdad but others were attached to hospitals throughout the Muslim world.
[9] The most famous hospitals (called bimaristan) were built in Baghdad, Cairo, Andalusia, and Damascus.
[10] and Rufaidah bint Sa'ad al Aslami who lived at the time of the prophet is generally recognized as the first Muslim nurse.
[11] Science of the structure of the body
[12] Science of the functioning of the body
[13] Diseases that can be transmitted from person to person
[14] Science of prevention and control of disease in a community
[15] Movement of blood in the heart and blood vessels
[16] This term refers to drugs or chemical substances used in disease treatment
[17] Branch of surgery dealing with eye diseases
[18] Branch of surgery dealing with diseases of the urinary tract which consists of the kidney, ureters, bladder, and urethra including the prostate in males
[19] Branch of surgery concerned with diseases of the stomach and the intestines
[20] Branch of surgery concerned with disease of the ears, nose, and throat
[21] Branch of surgery concerned with reconstruction of parts of the body destroyed or distorted by disease or injury
[22] Treatment of teeth
[23] Branch of surgery dealing with diseases of the brain and nerves
[24] (Bukhari K34 B39)