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Modern Medical Views of Persian Physician, Ahavazi [1]

By M.H. Nadjmabadi. M.D. Specialist in Intensive Care [2]
Translated by Roya Monajem

Ten centuries ago, in his famous book "Maleki" (Al-sanatol-teb) that attracted the attention of European medical circles in the nineteenth century, Ahvazi (930-990), the Persian physician, writes on the treatment of lung inflammation: "Cough should be stopped in any possible way." On the same line, he then continues, "Moreover, lung is constantly in motion and cough agitates this organ to the extent that healing can not take place easily, thereby leading to degeneration of the infected lungs." So for the treatment of what is now called lung inflammation, Ahvazi who worked in the most famous hospital of Baghdad, Azodi, prescribed 10g of White Poppy Seeds together with 3g of Greek Reed. Combined together, these herbs usually produce a powerful tranquillizing and antipyretic effect. In other words, by prescribing codeine, one of the most important alkaloids of poppy seeds, known today as one of the best tranquilizers of cough center in the brain and Greek Reed and a few other expectorant medicines, Ahvazi had reached a very important therapeutic point a thousand years ago that today and with our relatively far advanced knowledge of pathophysiology of lung inflammation, we have discovered only lately by virtue of our researches in the field of intensive care and that is: to calm down the agitated walls of the air sacs (alveolar membrane) of the lungs in any possible way.

In the international congress of intensive care of last year (2002), while introducing his respiratory technique for the first time, Dr. Gattioni the well-known Italian physician and intensive care specialist, presented the same idea of decreasing the mobility of alveolar membranes as one of the most important factors in treatment of lung inflammation. I had also reached more or less the same conclusion when I devised a respiratory technique for the treatment of lungs in the state of shock, mentioned in my book "Lung in Shock" (first published in German in 1988) with the goal of producing a state of relaxation in the walls of air sacs. ".in use of artificial respiration, it is necessary to choose the most suitable respiratory dynamism, that is one whose goal is to maintain maximum stasis and relaxation and the least possible amount of mobility in the walls of alveolar sac."[3] This is in fact one of the first therapeutic measures that should be taken into consideration in treatment of inflammation regardless of the affected organ. For example, in dislocation of the knee joint, what is prescribed is to immediately immobilize the joint, use icing and keep the knee stationary. Similarly, in cardiac insufficiency, rest and relaxation of body and mind are among the preliminary goals of therapy.

In fact such a therapeutic approach has long been adopted in relation to all organs, except lungs. Cough and use of incorrect ventilation which unfortunately is still quite prevalent prevent lungs from regenerating and healing easily. Cough is a natural biological reflex that automatically occurs when mucus or some other foreign object enters the lungs. What happens in this reflex is that following a deep inhalation and closure of trachea in the pharynx, the chest muscles contract as strongly as possible, compressing the air in the lung where the pressure rises to 100cm of water. Then suddenly with opening of trachea the air leaves the lung with a speed of 80km/hour expelling the mucus or the foreign object from the lung.

In inflammation of the lungs, in addition to the lung tissue, the mucus membrane of the trachea, bronchi, smaller air passages and the walls of the air sacs are also inflamed and during coughing, the high pressure and speed of air while passing forcefully across the mucus membrane of the lung tissue can tear this membrane. Then the existing bacteria present as the result of inflammation may find their way to these wounded areas of the mucus membrane where they are thus trapped and form abscesses. The suppuration produced by the trapped bacteria and as a reaction to their presence will then find its way into the trachea through the fistulae thereby formed that in turn leads to activation of the cough reflex. In this way a vicious circle is created.

In addition to the injury of the mucus membrane and production of fistulae, the high pressure present in the air sacs produces turbulence which in turn prevents rest and relaxation of the infected tissues that as mentioned before should be the primary therapeutic factor taken into consideration. The only way to prevent the formation of such a vicious circle -- which also occurs in chronic bronchitis that usually arise from a simple pulmonary infection and unfortunately is mistakenly diagnosed as asthma in the majority of cases and is treated as such-- is to prevent coughing.

How did Ahvazi manage to discover this vital therapeutic point ten centuries ago without having any exact knowledge of pathophysiology of the lungs - a point that unfortunately is still overlooked by many physicians of today?

No doubt that the practice of medicine in ancient Iran, with a past history of 7000 years recorded in more than 120 - now lost- medical books must have been considerably advanced in its own way.[4] So perhaps it is not very surprising that Ahvazi speaks with such certainty on the importance of relaxation of lung tissue in treatment of lung inflammation. However, considering the pathophysiology of inflammation of this organ and the mechanism of cough reflex, it is not that difficult to reach such a conclusion. In fact the real question is why did we not discover it much earlier despite our relatively far advanced scientific knowledge?

The answer perhaps lies in the following lines by Goethe, the great naturalist German poet and writer of the seventeenth century:

What is hardest
Is that which is in front of our eyes
And appears most simple.

1. Unfortunately we do not know much about the life of Abolhassan Ali-ibn Abaas Ahvazi, born in Ahvaz or Behbahaan in 930, except that until two generations before him, his family were Zoroastrian and thus he was also famous as Majousi (The Great Islamic Encyclopedia) which might be the reason for his vast medical knowledge. For as is well-known Avesta, the Holy Book of Zoroastrians had a great chapter on Medicine which is now lost, but could have still been accessible at that time. He studied medicine in Shiraz under the guidance of Abumaher Mussa first and soon he turned to such a great physician that was invited to the court of Fana Khosro Azadololeh Deilami (Ghafti, Ibn Abi Assibe-eh). His book, Maleki is a systematic medical book very popular from the first day of its appearance (See, Nezami, Four Essays, p.110), but was forgotten after the appearance of Avecina's Law (Ghanoon). However, Ghafti believes that Ahvazi's book is far more superior than Avecina's Law (Ibid, p.232). What he has written on Surgery and Clinical medicine is an evidence of his great experience in treatment of different types of illnesses. He has many interesting and innovative views on contraction and extension of blood vessels, the blood flow and the way air and blood mix which are in fact the first description of capillary flow and the first clear scientific description of capillary network. He has expressed several interesting views on embryology and development of fetus and the movements of uterus during parturition and diagnosis of uterine cancer.

2. Dr. Nadjmabadi graduated from Medical School of the University of Dusseldorf is one of the first pioneers in using dopamine in (Nadjmabadi M. H., Purschke R., Tarbiat S., Lennartz H., Bircks W. Comparing studies on the influence of dopamine and orciprenalin of heart and renal function of patients after cardiac surgery. Thoraxichirurgie 23:552 1975). And Nadjmabadi: Influence of Dopamine on the Pulmonary Pressure and Shunt Volumes after Cardiac Surgery, Anaesthesist, 26:274.1976) and catecholamine in combination of vasodilators in cardiac surgery (Nadjmabadi M. H et al, Simultaneous Dopamine and Sodium Nitroprusside Therapy following open heart surgery, Japanese Heart Journal, Vol. 21. 1981). He is also the first person using Svan-Ganz catheter via subclavian vein (Nadjmabadi M.H., Rastan H: Subclavian approach for cardiac catheterization with balloon tipped pulmonary arterial catheter. American Journal of Cardiology, 39: 471. 1977), and peritoneal catheter in pediatric cardiac surgery (published in Iranian Heart Surgery, 2000). He has organized intensive care unit of the heart surgery department of Tehran Heart Hospital in 1974, Khatamolanbia Hospital (1989), Shariati Hospital (1990), and finally Sorkheh Hesaar Hospital (1992) where 8000 heart surgeries (including 4000 children) were carried out in 8 years. In addition to "Lung in Shock," he has written a book on Pediatric Heart Surgery, together with his colleagues in Sorkheh Hesaar Hospital published two years ago in Tehran.

3. Lung in Shock, Persian translation, p.130.

4. See footnote 1.

... Payvand News - 1/28/03 ... --

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