| The knowledge of differentiation between hepatic
and post-hepatic jaundice was unknown to the
ancient physicians. Modern literature often points
to Albrecht von Haller as being the first to describe
obstructive jaundice in 1764 (1). Our recent
investigations elucidated that Haly Abbas (? 930-
994 CE), a medieval Persian physician, introduced
this disease and its characteristic clinical findings
prior to him. He was an influential physician and
surgeon of the Islamic Medicine Golden Age (9th-12th
centuries CE). He authored a concise and practical
textbook on surgery and medicine, entitled Kāmil
al-Sinā„ah al-Tibbīyah (The Perfect Book of the Art
of Medicine) or al-Kitāb al-Malikī (The Royal
Book) (Fig. 1) (2). The Royal Book was originally
written in Arabic language. It can be divided into
two main sections (Juz') by content, each comprised
of ten chapters (Maqala), and several
subsections (3). Gastrointestinal issues are one of
the main topics discussed in The Royal Book (4).
Haly Abbas has specifically discussed Jaundice in
the subsection entitled Al-Bab-o al-Salis wa al-Salasoun;
fi Elal al-Marareh, wa Asbabaha wa Alamataha
(The Thirty-Third Subsection; On the Conditions Affecting
Gallbladder, Their Causes and Manifestations). Haly
Abbas pointed to the post-hepatic jaundice, as follows:
“… and sometimes the obstruction occurs within the
ducts connecting the gallbladder to the bowel; therefore, the
bile amount increases and flows back toward the liver, and
distributes through the blood in the body…” (4). Haly
Abbas enumerated the clinical manifestations
resulting from post-hepatic obstruction, including
icteric skin and sclera, dark urine, and pale stool.
He explained that the pale stool is only present in
the post-hepatic form of the disease (all recent
terms in modern nomenclature) (4).
Based on this fact, and according to the aforementioned
excerpts from The Royal Book, for what
may be the first time in history of medicine, Haly
Abbas distinguished between hepatic and posthepatic
jaundice. Avicenna also has described the
mentioned differentiation in the chapter of liver
diseases after Haly Abbas. It is noteworthy that
Avicenna was immensely influenced by his
predecessors, including Haly Abbas (5-6). |