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Background material for Year 1 Semester 2 on April 15, 2009
1.0 PATIENT HYGIENE, nadhafat al mariidh
1.1 Intra-vascular fluids
There are 2 types of intra-vascular fluids: blood (haemorrhage, epistaxis, menstruation) and lymph. Blood is the most often encountered intravascular fluid. Blood of epistaxis is not najasat but must be washed away immediately. Fresh blood (venous or arterial) is not and cleaned away with water and does not require repeating wudhu.
Modern medical procedures, diagnostic and therapeutic, involve dealing with blood. Phlebotomy is one of the commonest procedures in medicine. Venepuncture for diagnostic or therapeutic purposes is more common than operations on arteries. Lymphatic channels are rarely operated on. Surgery and catheterisation also involve dealing with blood. Fresh blood is not najs when in the body. At the time of the prophet the therapeutic procedure of cupping, hijaamah, was common and the blood was not treated as najs.
1.2 Interstitial space fluids
Membranous cavities have various secretions: pleural, peritoneal, pericardial, and synovial fluids are not najs and must be washed away if they are outside their respective cavities. Diagnostic and therapeutic procedures are carried out involving pleural, peritoneal, pericardial, cerebro-spinal, synovial, and amniotic cavities or spaces. The fluids and effusions are generally not considered najs.
1.3 Pathological secretions
Respiratory infections are associated with discharges. These are not najs but must be washed away to prevent infections.
The commonest discharges in GIT infection are diarrhea and vomiting. Upper GIT vomitus is not najs and does not nullify wudhu. This is because contents of the upper GIT are mostly recently ingested food. The lower GIT vomitus especially the lower intestine has fecal excretory material that is najs. Vomitus that is severe may contain intestinal contents and should always be considered najs. The vomitus of a baby is treated like its urine.
Esophageal, gastric, and naso-gastric tubes are inserted for diagnostic or therapeutic purposes. The fluids involved are not najs but must be washed away to prevent their becoming nidi of infection. A tracheostomy tube may be inserted in cases of respiratory distress and respiratory secretions may accumulate in it. These secretions are not najs.
2.0 TAHARAT FOR THE SICK, taharat al mariidh
2.1 Wudhu
The patient should be advised to make wudhu as much as possible. Where not possible they can make tayammum.
The patient washes the parts that can safely be washed and makes tayammum for the remaining parts that cannot be washed safely. If no part of the body can be washed safely then tayammum is carried out for all parts. The patient or the attendant can wipe over the bandage. If a person has no hands, he can make tayammum on any remaining rudiments of the limbs or where they were supposed to be attached.
One tayammum can be used for more than one salat as long as one of the nullifiers of wudhu does not occur. Tayammum is carried out only for a specific salat interval. If both wudhu and tayammum are not possible due to disease, salat is carried out without taharat and there is no need to repeat it. In that case the patient should not pray salat al sunnat or prolong the recitation.
In urinary incontinence ablution is followed immediately by prayer with no delay. Suitable urinary bags should be worn to prevent soling clothes and the place of prayer.
Patients with urinary catheters wash and pray as usual even if the catheter is discharging urine. They should pray immediately after wudhu.
In hematuria, wudhu is followed immediately by salat with no delay. Suitable urinary bags should be worn to prevent soling clothes and the place of prayer. Hematuria causing anemia exempts from puasa.
Discharges from colostomies are najs. Fistulae that contain stool or urine are treated as najasat and they can nullify wudhu.
Bladder fistulae may join the vagina (vesico-vaginal fistula) or the colon (vesico-intestinal fistula). They usually follow trauma, infection, or irradiation. Rarely intestinal fistulae may discharge to the outside. Urethral fistulae may open into the vagina (urethro-vaginal), the rectum (urethro-rectal) or the skin (urethro-cutaneous). For purposes of prayer fistulae are treated like incontinence either of urine or of feces.