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October 2005, 174:4, Part 1 of 2 > RE: MANAGEMENT OF URINARY TRACT...
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The Journal of Urology: Volume 174(4, Part 1 of 2) October 2005 p 1502


Abdel-Halim, Rabie E.

Department of Surgery, Division of Urology, King Khaled University Hospital, P. O. Box 7805, Riyadh 11472, Saudi Arabia, e-mail: rabie@doctors.org.uk

To the Editor.


J. C. Nickel

J Urol, 173: 21-26, 2005

I read with interest this historical article about urinary tract infection. Nickel deserves to be congratulated on this comprehensive review. However, additional clarification is needed in relation to the Ancient, Greco-Roman and Islamic civilization eras.

Catheterization. The use of urethral catheters can be traced back to antiquity.1 A bronze S-shaped catheter with 1 terminal eye and size proportionate to age and sex was in common use since the Hippocratic period in Greece2 and the days of Charaka and Susruta in India,3 and up to the seventh century AD.4

From the ninth to the 14th centuries in Europe the development of Greco-Roman medicine came to an end and no progress was made in medical science.5-9 Meanwhile, in the East, with the spread of Islam, medicine and other branches of knowledge were revived and acquired a scientific nature.5,8,9 Under this influence in the ninth century new catheters made of gold, silver and copper with only 1 curve to follow the normal curvature of the male urethra and a smooth rounded terminal end with many lateral holes were in use.10 This design had the advantages of resisting incrustation by urine and far fewer incidences of blockage.10,11

A stylet in the lumen of the catheter was first thought of and used by al-Razi (Rhazes, 841 to 926 AD) to save patients the agony of repeat catheterization due to blockage.10 Then more malleable and subsequently safer catheters were made, first from lead by al-Razi,10 and afterward from the salve of white lead treated with ram blood to make it firmer so that it could be shaped, as described by ibn Sina (Avicenna, 980 to 1037 AD).12 Also, the tanned skin of some marine or wild animals was tried and the edges were joined by cheese or fish glue.12 Meanwhile, the notion of a straight metal catheter was introduced and designed by Alzahrawi (Albucasis, 930 to 1013 AD).13 According to al-Baghdadi (1219 AD),14 straight or curved metal catheters made of gold, silver, copper or salve of white lead were more popular than the leather ones, as they were far smoother. Also, ibn Sina and al-Razi warned against catheterization in the presence of inflammation, as it increases swelling and pain.15

Cystolithotomy. During the Islamic Era important progress was made in lithotomy.15-17 The innovations introduced, at first by al-Razi and then by Alzahrawi,15-17 made the operation easier and safer. Alzahrawi was the first to describe in detail the operative technique in women, and to recommend the 2-stage operation in complicated cases.17 His influence is vividly seen in the practice of the Italian lithotomist Marianus Sanctus (16th century), the French lithotomist Jack De Beaulieu (17th century) and the English lithotomist Shelsden (18th century).17 Alzahrawi is also the founder of lithotripsy. He introduced al-Kalaleeb forceps to crush large bladder stones and al-Mishaab drill to fragment an impacted urethral stone.15-17

Finally, Aetius of Amida was a Byzantine, not an Arabian, physician.18


Rabie E. Abdel-Halim

Department of Surgery

Division of Urology

King Khaled University Hospital

P. O. Box 7805

Riyadh 11472, Saudi Arabia

e-mail: rabie@doctors.org.uk

1. Abdel-Halim, R. E.: Urethral catheters: a historical review. Saudi Med J, 11: 87, 1990
2. Spencer, W. G.: Celsus De Medicina. Cambridge: Harvard University Press, p. 425, 1938
3. Desnos, E. C.: The history of urology up to the latter half of the nineteenth century. In: The History of Urology. Edited by L. J. T. Murphy. Springfield, Illinois: Charles C. Thomas, 1972
4. Adams, F.: The Seven Books of Paulus Aegineta. London: Syndenham Society, p. 351, 1846
5. Cumston, C. G.: An introduction to the history of medicine from the time of Pharaohs to the end of the XVII century. In: Islamic Medicine. London: Dawsons of Pall Mall, pp. 187-200, 1968
6. Bickers, W.: Adventures in Arabian medicine. J R Coll Surg Ireland, 5: 5, 1969
7. Margotta, R.: The dark ages, the decline of Rome. In: An Illustrated History of Medicine. Edited by P. Lewis. Feltham, Middlesex: Paul Hamlyn, pp. 100-105, 1968
8. Dickinson, E. H.: The Medicine of the Ancients. Liverpool: Adam Holden, pp. 37-39, 1875
9. Kirkup, J. R.: The history and evolution of surgical instruments. I. Introduction. Ann R Coll Surg Engl, 63: 279, 1981
10. al-Razi, Abu Bakr Muhammad ibn Zakariya: Kitab al-Hawi fi al-tibb (Rhazes' Liber Continens). Hyderabad: Osmania Medical Publications, pp. 164-166, 1961
11. Wangesteen, O. H. and Wangesteen, S. D.: The Rise of Surgery From Empiric Craft to Scientific Discipline. Minneapolis: University of Minnesota Press, p. 91, 1978
12. ibn Sina, Abu Ali al-Husayn ibn Abd Allah: Kitab al-Qanun fi al-tibb (Avicenna Canon on Medicine). Cairo: Dar Sadir, pp. 522-523, 1877
13. Alzahrawi, Abu al-Qasim Khalaf ibn Abbas: Albucasis on Surgery and Instruments. Berkeley: University of California Press, pp. 403-405, 1973
14. al-Baghdadi, Abu al-Hassan Ali ibn Ahmad ibn Ali ibn Hubal: Kitab al-Mukhtarat fi al-tibb. Hyderabad: Osmania University, pp. 435-436, 1943
15. Abdel-Halim, R. E.: Paediatric urology 1000 years ago. Prog Pediatr Surg, 20: 256, 1986
16. Abdel-Halim, R. E.: Lithotripsy-a historical review. Presented at Third Congress of International Society of Urologic Endoscopy. Karlsruhe, Federal Republic of Germany, August 26-30, 1984
17. Abdel-Halim, R. E., Altwaijiri, A.S., Elfaqih, S. R. and Mitwalli, A. H.: Extraction of urinary bladder stone as described by Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis) (325-404 H, 930-1013 AD). A translation of original text and a commentary. Saudi Med J, 24: 1283, 2003
18. Sarton, G.: Introduction to the History of Science. Baltimore: Williams & Wilkins Co., vol. 1, pp. 419-435, 1931
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