Oumeish Youssef Oumeish, MD, FAAD, FRCP (Glasgow) President: Jordan Private Physicians Association Visiting Professor –

1. Dermatology in the Ancient Arab Heritage(إنَّما يَخشى الله مِن عبادِهِ العُلماء)“Of All Bondsmen, Only Those Who Possess Knowledge Fear Allah”Surah (35)FATIR, Verses 28 Oumeish Youssef Oumeish, MD, FAAD, FRCP (Glasgow) President: Jordan Private Physicians Association Visiting Professor – Tulane University Medical School Louisiana-USA

2. Dermatology in the Ancient Arab Heritage • Introduction: • The Arab – Islamic Empire had spread since (622 AD) over the countries of the Middle- East, North Africa and Spain. • It also reached the borders of France, and The China Great Wall. • It carried to nations, culture, knowledge and sciences. • It also contributed to the development of medical sciences . • The Arabs message to all nations surpassed all ethnic, religious and national boundaries.

3. Dermatology in the Ancient Arab Heritage • Introduction: • Ancient Arab medicine owes a great deal to the influence of antecedent civilizations. • (1) Pharoahُs (2) Greeks. (3) Romans. (4) Babylonians (5) Chinese (6) Indians (7) Persians. • Medicine considered one of the best facets of Arab – civilization in which Arabs most excelled. • Pre-Arab medicine was: legendary, magic, clerical, and Witchcraft (الكهانه). • Arab medicine was a result of merging : old Roman and Greek sciences. Mainly due to famous scientists :(1) Hippocrates (460 – 317 BC). (2) Galen (129 – 199 AD). • Both composed many medical books which were, translated into Arabic by Arab scientists.

4. Dermatology in the Ancient Arab HeritageAncient Unconventional – Alternative Arab Medicine • physiognomy (علم الفراسه): The ability of discovering temperament and inner characters of a person from outward appearance. Was believed that a disease would attack a person or a tribe due to an evil, which can be driven away by magic. • Fortune – teller (Divination) (العرافة وقراءة البخت): To fortell the future and predicts knowledge about health, wealth, destiny and fate of persons by looking at and talking to them.

5. Dermatology in the Ancient Arab HeritageAncient Unconventional – Alternative Arab Medicine • Geomancy (الودع) (الضرب بالرمل) : The art of using sand or small stones of different shapes to tell the person's future. • Palmistry (قراءة الكف): Looking at the different lines on palms of a person and foretell his future, health, length of life, and destiny.

6. Dermatology in the Ancient Arab HeritageAncient Unconventional – Alternative Arab Medicine • Drove out (Exorcism) (الرُقىَ): To drive away bad spirits and evil from the soul and body in states of illness and catastrophies. Many believed in "jinn" and evil eye"al ayn". • Inspiration (الايحاء والالهام): An action put on a person to make him by suggestion, believe an Idea. "Burying" a green wedge or eggplant in a dark cave in the dark, then touching warts with it, believed that will cure them. • Amulets (التعويذة - التميمة): Prescribed by magicians and make people who carry them believe that will bring them good luck and health. Or beat their enemies, or make a sterile woman conceive.

7. Dermatology in the Ancient Arab HeritageAncient Unconventional – Alternative Arab Medicine • Precious stones (العلاج بالحجار الكريمة): Arabs believed in healing power of gemstones, metals, and crystals, that they protect body and soul if you wear them. They also drive away sickness. For each illness there was a special gemstone. • Astrology (التنجيم): Astrologists claimed to understand the meaning of stars movement and their relation to the development of epidemics, disasters, misery or happiness of persons or a tribe. • Horoscopy (خريطة البروج): A map or diagram of relative positions of planets, believed to indicate persons life events. Can denote revenge, hostility, optism, pessimism, travel and wealth.

8. Dermatology in the Ancient Arab HeritageAncient Clinical Arab Medicine (Since 22 AD) • Theriaca, or Teriac = Antidote (الترياق): • A remedy that used by Arab physicians to counteract the effect of allergic reaction to snake and scorpion bites or any poison. • It was composed of 66 herbs and spices. • Cauterization (الكي): • Used in the form of burnstick to treat warts. Used to treat pain such as sciatica, lumbago and arthritis. Or cauterize a bleeding wound or amputated limb stump to stop bleeding and prevent gangrene. • Stimulation (التحفيز): • Garlic and vinegar used to rub areas of alopecia to stimulate hair growth or reduce pain from bites stings.

9. Dermatology in the Ancient Arab HeritageAncient Clinical Arab Medicine (Since 22 AD) • Scarification (تشطيب الجلد) : • Skin incision or scratching for blood letting to get rid of poisoned blood as in case of snake or scorpion bites, then the limb is fastened tight by a rope. • Cupping (الحجامه): • Used for chest infection, pneumonia and myositis. • Arab physicians used it to treat 72 diseases including (leprosy, toothache, boils, gout, piles and elephantiasis). • Leech Therapy (العلاج بالعلق): • Leeches applied on skin (15-30 minutes) to suck blood from face, ears, neck, thighs and legs. • Useful to treat hypertension, headache, and varicose veins. • Still used by barbers till now.

10. Dermatology in the Ancient Arab HeritageAncient Clinical Arab Medicine (Since 22 AD) • Venesection (phlebotomy) (العلاج بالفصد): • Arab physicians believed that letting blood will get rid of the excess contaminated blood. Used heated knife, razor blade, or a warmed needle. • Useful to treat hypertension, headache, and both chickenpox and measles. • Henna (الحناء): • Tropical shrub small tree – Lowsonia intermis. • Used as hands and feet paint in marriage ceremonies. • Used as dye of hair, and paint to treat brittled nails. • Used as camouflage to cover vitiligo and skin scars. • Used as paint to cure eczema, burns, and scabies, • Used as poultic to treat sciatica. • Chewed for treating oral ulcers.

11. Dermatology in the Ancient Arab HeritageAncient Clinical Arab Medicine (Since 22 AD) • Paracentesis (البزل): A puncture in the abdomen was created using a knife sterilized by fire, to treat ascites which Arab believed due to bad water in the abdomen. • Kohel (الكحل): Used as eyeliner to lengthen eyelashes, improve vision and treatment of blepharitis. • Circumcision (الختان): Performed by barbers for boys and girls as a Muslim rite and for hygienic purpose. • Contraceptives (وسائل منع الحمل): • Drinking water of sweet basil or weeping willow leaves. • Eating lot of beans on empty stomach. • Using tar suppositories. • Using myrrh and cinnamon after menstruation.

12. Dermatology in the Ancient Arab HeritageAncient Clinical Arab Medicine (Since 22 AD) • Miswack (المسواك): The first tooth brush in history. Made of a splitted branch of a tree. • Abortifacients (وسائل الاجهاض): • Smear penis with onion juice or tar and white lead, before coitus. • Jumping backward to expel semen. • Introduce Jew’s melon green sticks into the cervix and manipulated to help induce abortion. • Honey Therapy (العلاج بالعسل): • Improve blood circulation, and laxative • Protects children against scurvy and rickets and treat lice in children. • Improve hearing and vision. • Antimicrobial and antifungal as (5% cream or liquid). • Warm ear drops with salt to treat wax. • Mouth gargle for tonsillitis. Soothes skin ulcers and folliculitis.

13. Dermatology in the Ancient Arab HeritageAncient Clinical Arab Medicine (Since 22 AD) • Tattooing Therapy: (العلاج بالوشم) • Originally associated with marriage ceremonies. • Used as decorative and beauty sign. • Believed to protect people from evil and sickness and has the power of talisman. • Believed to protect the body from a sword or dagger. • It has many complications. • The prophet prohibited tattooing because it is painful.

14. Dermatology in the Ancient Arab HeritageAncient Observational Arabian medicine Introduction • Arab physicians used their abilities of observation to recognize diseases and in particular of the skin. • They used physiognomy, vision and keeness to recognize signs and symptoms of illnesses. • Perspicacity of mind enabled them to give diseases their names, based on their observance of the characteristics. • Smallpox: • Used to break in epidemics. • Arabs recognized the pimples and vesicles "protuberances" appearing on the skin of the camels neck. • The pimples also resembled small, raised scattered spots on the ground that are pushed by the growing roots of plants.

15. Dermatology in the Ancient Arab HeritageAncient Observational Arabian medicine • Measles: • Pebbles or small rounded stones or quartz were also used to describe the rash of measles, because the rash which was recognized by Arabs look like pebbles on the ground. • Jaundice (اليرقان – داء الصفار): • It was called "Yellow" because the color of the leaves of plants look yellow in autumn, like the color of patients eyes and skin. • Plague (Black Death) (الطاعون): Was called "Taoon", in Arabic means a "Stab" (to kill). • Alopecia (الثعلبة): • Means in Arabic "The Female Fox" because, the Arabs observed a yearly loss of hair of the female fox or. • Because the female fox destroys the plants in farms in search for food, leaving empty areas behind, look like empty scalp hair areas of alopecia.

16. Dermatology in the Ancient Arab HeritageAncient Observational Arabian medicine • Leprosy (الجذام): • Was named by Arabs as "Jootham" or "Juthm" in Arabic means “to cut" or "to amputate" because they observed that the disease ends up with spontaneous loss of parts of body like fingers and nose. • Vitiligo (البهق او البرق) : • Arabs noticed the loss of skin colour in different sites and called it (بهق، برق) “white Bahak” or “Barag” and related it to the loss of pigment cells function. • But they differentiated it from leprosy (Baras) (برص) “ Black Bahak”, which they knew as infections disease.

17. Dermatology in the Ancient Arab HeritageAncient Observational Arabian medicine • Psoriasis (داء الصدف) • Psoriasis means – Covered with a crust like a Shell Oyster. • Treated with “Burdock Herbs” (الارقطيون) and “Aloe Vera” (الصبر) and Willow plants (الصفصاف). • Treated also with olive oil, coal tar, willo. • Dead Sea mud (Contain Bitumen – a tar). • Ichthyosis (داء السماك) • It is covered with a layer looks like fish scals. • Treated with mixture of willow ( الصفصاف ) and Osier (صفصاف السلال). • Acne (حب الشباب) • Garlic, Aloe Vera and lemon , patches of vinegar , rose water.

18. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Jaber ibn Hayyan al- Sufi (721 AD – 815 AD) • He Came from Khurasan and settled in Baghdad. • He was the founder of Arabic Alchemy. • He was Known as “Alchemist “at Harun – al – Rashid court. • He wrote 3000 short treatises in a corpus that also include under his Latin name "Geber" • His important works include : • "The Hundred and Twelve Books ". "The Seventy Books". and • "The Books of the Balance". Most of them translated into Latin. • He was the first discoverer of the constitution of Acids and in particular sulphuric and the first to extract sodium, potassium, arsenic, mercury, lead and silver nitrate.

19. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Jaber ibn Hayyan al- Sufi (721 AD – 815 AD) • He divided the materials in alchemy into three classes. 1. The spirits. 2. The metalic bodies. 3.The mineral bodies. • He classified spirits into: sulfur, arsenic, mercury, ammonias and camphor. • He also showed that metals include: lead, tin, gold, silver, copper, iron and kharsine (Chinese iron) • Was the first scientist to outline the modern acid – base theory: (the sulphur - mercury principles). • He converted mercury into a mercuric sulfide = cinnabar. • His discovery of metals and minerals enabled physicians later on to use them for treating skin diseases.

20. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Yohanna ibn Masawaih (778 AD – 856 AD) • He lived during the reign of al – Mansour - The Second Abbasid Caliph, the founder of Baghdad. • Then became private physician to Caliph Harun al – Rashid. • Was a famous Christian physician and pharmacologist. • He wrote " The Book of Leprosy " and believed that the disease develops in 2 stages: 1. The white non - infective shining spots 2. The active infectious late stage.

21. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Ali ibn Rabbah al – Tabari (770 AD – 850 AD) • A student of Yuhanna ibn Masawaih. • Composed the famous book (Firdaus – al –hikmat) or (Paradise of wisdom). • He described leprosy and believed that it is due to an increase in the black of the “Four Humors” of the body. • He described the major clinical picture of leprosy as: Loss of eyebrows, and nails, nose atrophy and fingers deformity, which gives the face a lion shape, so he called the disease (Lion disease). • He believed that leprosy is an inherited disease, and contagious, and that isolation of patients was important.

22. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Ali ibn Rabbah al – Tabari (770 AD – 850 AD) • He also described eczema in detail. • He described scabies and that itching is due to an insect that he could remove by a needle. But never relate it as the cause of scabies. • He made comprehensive description of hair, nails, and the skin. • He mentioned that skin is the origin of sweating . • He also mentioned that castration prevents hair growth. • He tried to find causes of hair greying and baldness. • He described leprosy and vitiligo on “Four Humors” bases. • He treated leprosy and scalp fungus by using yellow sulphur and arsenic. • He treated scabies and pediculosis by using tar, sulphur, mercuri and red arsenic.

23. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Ali ibn Rabbah al – Tabari (770 AD – 850 AD) • He described various types of tumors and prescribed treatment for them mostly of herbal nature. • He also described boils, abscesses, wounds, and other skin infections and prescribed many ointments for treating them, which were combination of tar, wax, vinegar and mercury. • He described aphthous stomatitis and that it affects mucosa of mouth, tongue and lips and related it to ingestion of spoiled milk and to indigestion.

24. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Abu Yusuf Ya’qub ibn Ishaq al- kindi (801 AD – 873 AD) • His name in Latin was "Mesue Senior" or "Janus Damascus " • Lived in Kufa. • He studied Graeco – Hellenistic (Gracian) sciences and philosophy. • Was the first famous of the Muslim philosopher and scientists. • He wrote a book on leprosy: with details of its etiology and treatment. • He was the author of the first Arabic Ophthalmological Treatise.

25. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Mohammed ibn Zakariya al – Razi (865 AD – 925 AD) • Was called “The Arabic Galen” and was the greatest Arab clinical physician, and well known in the west. • He wrote 184 works in medicine. The most important one was "Continens al Hawi ". • His masterpiece " The Treatise on Smallpox and Measles " known in Latin as " Pestilentia " or " De peste ". • He described "measles" as: harsh voice, red eyes and cheecks, pain in the throat and chest, dry tongue, red skin, tearing of eyes, vomiting, and backache. • He also described " Hay Fever " in detail and made a correlation with blossoming of flowers. • He described Elephantiasis and Guinea worms. • He advised venesection for both measles and chickenpox.

26. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Mohammed ibn Zakariya al – Razi (865 AD – 925 AD) • Described "Chickenpox" as: red eyes and face, headache, body- aches, itching, and sneezing. • Advised the treatment as: vaporization with the use of myrtle. • Plant (الآس), and to paint the blisters with juice of cane plant and the use of kohl as eyeliner and the use of drops of pomegranate grease, or rose water. • He also advised the use of peanut grease, lily (الزنبق) leaves and a mixture of wheat with peeled almond and seeds of watermelon and barley saffron (الزعفران). All are grinde to powder and applied to the skin and kept overnight and washed next morning with water mixed with chamomile (البابونج) and pansy (البنفسج).

27. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Mohammed ibn Zakariya al – Razi (865 AD – 925 AD) • He treated "Paronychia" by applying honey and gall oak leaves (اوراق البلوط المر), then if it expands, it is punctured with a probe, then bind by the use of lentil (العدس). • Treatment of "Abscesses" by applying ginger mixed with asphintage and anzaroot, then it is covered with a wet bandage. • He described symptoms of "Intestinal Worms" in adults as: abdominal cramps, nausea, vomiting, loss of appetite, paleness. • In children: insomnia, grounding of teeth, abdominal pain, fever, sweating, anal pruritus, and blood in stools (in case of small worms).

28. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Mohammed ibn Zakariya al – Razi (865 AD – 925 AD) • He described treatment for "Intestinal Worms" as: Razin syrup to be taken for 3 days, and seeds of cavern (grotto) plant (الغار), and mulberry (التوت) juice, dates and wormwood plant (المرارة). All given for 3 days preceeded by drinking milk on empty stomach in the morning. • Treatment of "Piles": using leek (الكُراث) and gee compressors. • Peeled cucumber also used as compressors when piles bleed. • Pilonidal Sinuses: Duck fat and teribenth gum (صمغ البطم) and sweet clover (البرسيم) (Kog's cloves) mixed together and used as compressors. • "Anal Fissures": application of rose water and opium.

29. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Mohammed ibn Zakariya al – Razi (865 AD – 925 AD) • He described "Impetigo" and classified it into two types: (1) The "Wet" red itchy that become blackish and easy to cure. (2) The "whitish" late chronic type. • He treated impetigo with: Arab gum, bitter almond paint, white petrolium, and venesection then to be covered with tar.

30. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Abul–Walid Muhammad ibn Rushd (Averroes) (1126AD- 1198AD) • Was one of the greatests Andalusian physicians and philosophers. • Most of his work survived until today in Latin and Hebrew versions – Translation was done in the 13 and the 16 countries. • He composed " The Book of Generalities on medicine " • He wrote commentaries on the medical work of Avicena. • Studied chickenpox and confirmed that it only affects humans. • He described scabies mite as a parasite and gave it its name. • Believed to be due to lack of bathing, exercise, malnutrition and wearing dirty clothes. • Described pediculosis to be associated to bad hygiene, and lack of baths. • Treated with frequent bathing with salt water, and cleaning clothes daily, eating a lot of garlic, and topical application of sumac, sulfur, red arsenic, mercury and application of vinegar in summer, and tar in winter.

31. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Abdulla ibn Muhammad ibn – al – Baitar (1182AD – 1248AD) • Born in Malaga and died in Damascus. • Was the greatest of Arabs Botanists and pharmacologists. • He composed "The complete Book of Simple Drugs", and "The sufficient Book of simple Drugs ". • In those books, he introduced three hundred drugs mainly for treating skin disease never previously described, and were discussed in details. • Described vitiligo to affect only the pigment cells of skin, and he differentiated it from leprosy which affect deeper organs. • He was the first to use khellin plant for vitiligo and was called (Istersal) a Barber word which means (Bird leg). The flower or leaves are ground and applied directly to the affected area or the seeds of plant mixed with honey is eaten, then exposure of skin to sunlight, that can cause blistering or burns.

32. Dermatology in the Ancient Arab HeritageArab Scientists – The Founders of Dermatology • Abu Ali al – Husain ibn sina (Avicenna) (980AD – 1037AD) • Known as "Shaikh al – rais " (leader among wisemen) • Wrote 250 works. Best known was "The canon of medicine" "Al- Qanun fi-at- Tibb". In four volumes (2500 pages). • It was translated into Latin, French, German, and Hebrew. • The book was taught for centuries in western universities. • The second Book was "Kitab a-shifa" or "The Book of Healing" • Ibn Sina mentioned in the fourth part of "The canon of medicine" every illness related to skin and hair and also wrote detailed chapter on cosmetics, that were mainly extracted and distilled from plants.

33. Thank you