RE: MANAGEMENT OF URINARY TRACT INFECTIONS: HISTORICAL PERSPECTIVE AND CURRENT STRATEGIES: PART 1-BEFORE ANTIBIOTICS

RE: MANAGEMENT OF URINARY TRACT INFECTIONS: HISTORICAL PERSPECTIVE AND CURRENT STRATEGIES: PART 1-BEFORE ANTIBIOTICS

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

Respectfully,

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