Bull.lnd. Inst. Hist, Med. Vol. XXVI pp. 69 to 74

HUNAIN BIN ISHAQ ON OPTHALMIC SURGERY

KHURSHID AHMED SHAFQAT AZMI*

ABSTRACT

Hunain Ibn Ishaq was a doyen in the field of medicine during the Arab era of

Unani medicine, and made significant contributions in ophthalmic surgery by add-

ing new therapeutic uses and techniques. He established the opthalmic surgery

on sound systemic footing. His earliest work on the subject may not be ignored by

historians.

Introduction:The ancient Hakims are univocally

accepted as fountain sources of all sortsof knowledge. The acquisitiveness regard-ing the knowledge always accelerated theUnani system of medicine adding moreand more knowledge as per their own ef-forts. Consequently it became realm ofmedicine and message of healing on glo-bal level.

Besides, some of the physicianspreferred different special branches ofmedicine ego gynaecology, opthalmologyand obstetrics etc. Likewise their clearcutilluminated footsteps may be seen in thefield of surgery which was evolved by UnaniMedical Surgeons according to the needand deed. Unani medical surgeons mademany advancements in the field of Sur-gery, of which a few are stated to adducethe condition. However, Exclusive contri-bution of Unani Medical Surgeons Viz.Abul-Qasim Zahrawi (d. 1000 AD.) andIbnul-Quf(d.1286AD.)etc. became modelfor all the subsequent ages.

Opthalmic Surgery: In the field of Oph-thalmic Surgery, the work of Hunain binIshaq (809-877 AD.) and AIi-bin Isa maynot be ignored. Their contribution viz.Kitabul-Ashr Maqalat fil-Ain and TazkeratulKahaleen are of high altitude. They not onlyelaborated the research particularly onophthalmic surgery available upto theirtime, but also included personal experi-ments and observations. According toHassan Nagrami, "Kitabul-Ashr MaqalatfiI-Ain is a comprehensive book on oph-thalmology with the contents of anatomi-cal informations regarding the eye alongwith its diseases, aetiology, signs andsymptoms and treatment. This is a famousbook on ophthalmology.Hunain Bin Ishaq on Ophthalmicsurgery:Abu Zaid Hunain bin Ishaq AI-Ibadi wasborn at Hira (Mesopotamia) in 809 AD.asthe son of Nestorian Christian druggist.He was not only eminent physician of hisperiod but also he was a translator of high

"Assistant Director Incharge(U), Literary Research Institute of Unani Medicine (CCRUM), JamiaHamdard Campus, New Delhi -110 062.

70 Hunain Bin Ishaq on ophthalmic Surgery - Azmi

dignity. He had rendered the books intoArabic more than any of his contempo-rary translators. Hakim Wasim AhmedAzmi has given a detailed list of his com-pilations and translation, according to him,"the total number of Hunain's writingscomes to 116". He further says:

"Indeed, Hunain Ibn Ishaq is wellknown figure as a translator; however, hehas also high Status in compilation andwriting. According to Qifti, he has authored36 books and according to Ibn Nadim heis author of 21 books on medicine!"

His significant work "Ten TreatisesOn Ophthalmology, as per Max Meyerhof,is the earliest existing systematic textbook of ophthalmology, who has editedthe Arabic text from the only two knownMss and presented to the scholars alongwith English Translation and glossary. Thebook was published by Max Meyerhof,Govt. Press, Cairo, in 1928". After goingthrough the book it is clearly evident that,he not only elaborated the research workavailable upto that time, but also includedhis personal experiences and observa-tions. This learned ophthelmic surgeon en-lightened even the minute facts of ophthal-mology. Some salient features of his sur-gica~ work are as under:Cysts and Tumours:

Ibn Ishaq was fully aware regardingthe therapeutic variations concerning theswelling (tumours) produced by temper-ate blood. As per his statement:

" If there is no plethora, it istreated with dissolvent faculty acting on

the organ itself, attracts more (badhumours) to it than it dissolves"2,3

He further says:

"The remedy, which surpasses theflow of matter must not be applied imme-diately".2,3

The above claims and statementsgiven by Hunain bin Ishaq are self explana-tory. Need not to mention that the accu-mulation of pus is inevitable not only forreduction of pus, but also for surgical re-moval.

Purulent Keratitis and Corneal ulcer:The line of treatment given by Hunain

bin Ishaq is of significant value. He hasdescribed gradual steps for its treatmentas maturation, moderation and dissolutionwith the medicinal regimen. Need not tomention that there are number of drugsfor the eradication of cataract in primarystage, where as the modern system ofmedicine seems helpless in this way, quot-ing Miller:

"No medical treatment by drugs orotherwise has been shown to any signifi-cant effect inducing the disappearance ofcataract once opacities have developed"

He further states:"The only way for the treatment of

papillomata or simple granulomata is "Sur-gical Removal?". The surgical procedurehas been recommended only in chroniccases not curable with medicinaltheraphy, in Unani system of medicine.

Likewise, Hunain-Bin-Ishaq has rec-ommended the surgical removal only in

Bull. Ind. Inst. Hist, Med. Vol. XXVI

chronic cases, or in other words incurablewith remedies. He has prescribed even thestrong corrosives and other clearningdrugs prior to its removal particularly inthe case of pterygium. Modern surgeonsare of the opinion that pterygium is bestleft alone unless it is progressing towardsthe pupillary area or is dis-figuring, it cannot be removed without leaving a scar un-less it is replaced by a lameller cornealgraft5,?

Unani physicians and surgeons havegiven the priority of medical treatment in-stead of surgical one in these cases, how-ever, in the chronic or uncurable cases theyhave recommended the surgical treatmentfor these cases ego pterygium and tra-choma, if they are hard and chronic, theymust have treated by excision andscrabing. If they are thin (mild cases),they can be cured with cleaning remedieslike burnt copper, blue vitriol, gall of pigs,rock salt and goats' gall. If these be notefficient, they must be mixed with corro-sive and putrifactive remedies2,3.

Modern Surgeons also recom-mended such type of corrosives in addi-tion to systemic treatment, quoting Miller;"Cauterisation may be performed with purecarbolic acid or trichlor acetic acid (10-20%), it acts both as a caustic and anti-septic?".

Cataract:In this chapter, Hunain bin Ishaq has

given significant hints for the operation ofcataract, more of the techniques are stillin the practise quoting the text: "It is saf-est to operate on the cataract towards the

71

end of the month and end of the body; ifyou intend (couching operation) put yourneedle at the extremely of the eye in theouter corner of the eye, hold the eye ballwith your fingers, be at the origin of theneedle. Then pierce it, through taking carethat the eye ball does not slip from underyour fingers, and the needle reach the lay-ers of the comea or enter between the con-junctive and the cornea and so reach theblack of eye and tear it"2,3.

This scientific approach may be con-firmed by modern books, as I.S. Roy is ofthe opinion that:

"At 12 '0' Clock position a preplaced8-0 virgin silk corneoscleral stitch is givenand the loop is left loose. Two peripheraliridectomies are done at 10 '0' clock and2-0, clock position+".

Anterior capsule of lense is thenpinched near the lower pole with anintracapsular forceps and an upward pullis exerted with a slight side zig-zag move-ment4

Hunain Ibn Ishaq was also aware re-garding the dangerous consequences andsequelae, that is why he has subsequentlydescribed the prRcautionary measures, tobe adopted during the surgical removal ofCataract, Example:

"Beware of tuming your needle in thewrong disrection and of reaching the backof the cornea from inside and tearing it,for that would destroy its pupil and it is(an injury) not likely to be cured. Deal gen-tly with the cataract, until you have removeits place, and beware oftreating it wrongly,lest you should tear its layer, and the cata-

72 Hunain Bin Ishaq on ophthalmic Surgery - Azmi

ract be difficult for you to collect it andbring it back2,3"

Post operative medicinal theraphyand measures also play important role inthe cataract operation. Hunain Ibn Ishaqhas given significant line of treatment andmeasures for the same. The following quo-tation is quite enough to highlight thisclaim.

"After having couched it (the cata-ract), dress it (The eye) with the yolk ofeggs and crushed cumin which you puton a piece of cotton or wool and bind onboth of his (Patient's)2,3 eye.

Let him beware of lowering his headof coughing, sneezing and too muchspeaking. He may eat moistened histemples and there by disturb his eye .....

The operated patient must sleep onhis back and keep his head straight andnot more than day or night untill the nextday. Then dress it again with egg andcumin and repeat this for three days"2,3.

It seems that Hunain bin Ishaq wasfully aware about importance of post op-erative management. Need not be men-tion that the above measures if adoptedmay give tremendous result in the field ofophthalmic surgery, particularly operationof the cataract:

Hunain bin Ishaq has the courage toput on record his experiences having posi-tive as well as negative result,as below"

"... It is safe only in a few cases. Ingeneral its (the cataract), treatment is arisky one and its benefit cannot entirelyrelied on" 2.3

Hunain Ibn Ishaq has also mentionedthe treatment of prolapse of the eye aswell as for blood spot.

Discussions:

After going through the book titled "Kitabul-Ashr Maqalat fiI-Ain", it is clearly evidentthat, Hunain Ibn Ishaq was a capable eyesurgeon. Number of ophthalmic alimentsego swelling (tumours) pus and pustulesin the cornea, prolaps of the eye and cata-ract have been described in lenght fromthe surgical point of view. Need not to men-tion that pre operative, pan operative andpost operative measures and medicaltherapies which are of high appreciation.

Conclusion:

Hunain Ibn Ishaq was a doyen in thefield of Medicine during the Arab era ofUnani Medicine, and made significant con-tributions in ophthalmic surgery by add-ing new therapeutic uses and techniques.He established the ophthalmic surgery onsound systemic footing. His earliest workon the subject may not be ignored by his-torians.

Bull. Ind. Inst. Hist, Med. Vol. XXVI 73

REFERENCES

1. Azmi, HK. Wasim Ahmed

2. Max Meyerhof 1928

Baitul-Hikmat Ki Tibbi Khidmat, AbuZaid Hunain Bin Ishaq al-Ibadi, 116.Hunain bin Ishaq "AI-Maqalatul-Ashr fil-Ain" edited & translated by MaxMyerhof, Govt. Press, Cairo.The book of the ten treatises on the eyeascribed to Hunain Ibn Ishaq, Govt.Press."Disease of the eye"., 18th Edn.Principles of practice of Opthalmology,VoLlI.

3. -do- 1928

4. Miller, Stephen J.H., Parasons 19905. Peyman, Sanders and Globerg 1987

6. Nagrami, HK. SayedMohd. Hassan

7. Roy, I.S.1989 Tarikh-e-Tib, Hunain Ibn Ishaq 218 -219.1992 B.M. Chatterjee's Handbook of Ophthal

mology, 4th Edn.1990 Tibbul-Arab, Izhar Sons Printers,

Lahore, 50.8. Wasty, HK. Naiyer

74 Hunain Bin Ishaq on Opthalmic Surgery - Azmi

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