Tongue Diseases In Al-Qanun Book of Ibn-Sina

Abdul Nasser KAADAN* Abdul Fattah HANOON* translated into english by: Salma ALMAHDI, d. d. s

*History of Medicine Department, Institute for the History of Arabic Sciences, Aleppo University, Aleppo, Syria

Summary The is concedred a fundemental organ that share in chewing, swallowing & speech, & it can be exposed to different dis- eases that differs in its cause & symptoms. & Ibn-sina has explained in his book (Alqanonn) about the tongue anatomy, musculature, nerve innervations, & its disease with its two division the sensory & the motor, he also explained about the local diseases of the tongue & about the tongue disease when it’s a sine for a systemic disease. & he specified more than fourteen chapter about the tongue. As he has talked in these chapters about taste disturbance, tumors, & tongue tie, what we term ankylogossia. He also detailed for us about disturbance of speech, & also about the painful tongue disorders & he explained that its due to neurological causes, as he also indicated clearly for the bad effect of mouth breathing. Ibn-sina studies about the tongue diseases shows to us the extreme awareness & accuracy, & also the logical sequence for the eti- ological factors, & its clear management. As the modern medicine until now agrees completely in most of what Ibn-sina have wrote.

Key Words: Tongue Diseases, Ibn Sina, History of Medicine

Introduction: teen chapters specialized in the tongue diseases, in The old arabic medical books are not devoided addition to some other phrases related to the anatomy from chapters specified for studying the tongue dis- researches in the first chapter of the book. eases; for example, in the third chapter of (Alhawi) & here we are going to talk about Ibn-Sina have book for ar-Razi, we find a section about the taste wrote about the tongue in his book (Al-Qanunn) in sensation & another section about the , medicine, as we are going to study the chapters con- tongue, & soft diseases; as he explains very cerned about the tongue as Ibn-Sina organized:- briefly in the 49th chapter in his book (The Divition & Subdivision of The Tongue Diseases) about nine dis- Anatomy of the Tongue Muscles: orders which are; tumors, fissures, roughness, ulcers, spasm, heaviness, of the tongue, , As he mentions comprises four pairs of muscles & ); but Abullhassan Altabari the forming eight muscles & one single muscle which is author of (The Hipocratic Treatments), as he speci- the upper tongue muscle that is described very pre- fied ten sections concerned about the tongue diseases cisely by him. So as he mentions the tongue has nine such as (gagging reflexes of the tongue, ranula of the muscles, although what is known that the tongue con- tongue, tongue convulsion, speech disturbances, & sist in addition to the upper tongue muscle, eight disturbances of tongue taste, & so on our inherited another pairs from muscles instead of four, so the medical books never devoided from chapters talking total number of muscles are seventeen muscles. about the tongue diseases & its treatments. Alqanunn book of Ibn-Sina has been considered Neuroanatomy of the Tongue: one of the most famous medical edditions, as it seems As he talked about the trigeminal nerve which is clear, complete, & good presentation, also its gives a the fifth cranial nerve, & he term it the third pair from clear view about the medical sciences during his cen- the seven pairs, & he also describes this nerve tury. & we also find in the second section about four- branches very precisely similar to the modern anato-

JISHIM 2003, 1 41 Abdul Nasser KAADAN TONGUE DISEASES IN AL-QANUUN BOOK OF IBN-SINA Abdul Fattah HANOON my description, telling the branch that innervates the Here as we can see his subdivision of the tongue tongue sensation to transmit the taste sensation & this diseases in motor & sensory, & one of the senses can is what we term today the lingual nerve which is one be affected more than the others, & the tongue can of the branches of the mandibular nerve the third pain due to systemic condition or local injury, as the branch of the trigeminal nerve. disease could be in relation to the stomach, or any other organ such as the lungs & the chest. & as its Anatomy of the Oral Cavity & the tongue: known many systemic diseases has clinical features on the tongue. The tongue pain due to local injury, & Here Ibn-Sina talks about the functions of the he said: the tongue diseases can be detected by tongue as he says: {the tongue is an organ from the inspecting any changes in the texture, color, & taste oral cavity which plays major part in the mechanism sensation or the dominance of one sense either sweat of chewing the food bolus, phonation, pronouncing or sour compared to the other. letters, & differentiation of tastes. & its ventral sur- face is with continues attachment with the esophagus He also differentiated between the neurological & the stomach. While the dorsum if the tongue is injury of the tongue that is specific to the tongue due divided into two parts by the V-shaped (sulcus termi- to the affection of the lingual nerve, & between the nalis), & there is a considerable sharing between injury to the tongue but not related to the tongue them by the communicating tendons. The tongue has nerve branches innervations, that at which the all a large network of subdividing nerve branches from senses can be affected with the injury. four protruding nerves. It also consist of large net- work of blood supply & nerve innervations. & Under Treatment of the Tongue: the tongue there are two orifices of the submandibu- Here he indicates that the treatment of the tongue lar salivary glands ducts, that opens & releases its should be general if the tongue diseases was in associ- secretions into the oral cavity to keep the tongue & ation with the head or stomach, i. e, if the cause was a the moist & wet. systemic diseases. Or the treatment can be local by & so on as he mentions the continuity of the mucus using gargles of the mouth, mouth rinses & rubbing membrane of the ventral surface of the tongue & the materials, & the tablet that is held in the mouth, which floor of the mouth with the mucus membrane of the should be flat in shape to increase the surface contact . He also observed the presence area between the medication & the oral tissues. of profused blood supply & heavy innervations of the & so on the treatment follow the cause of the dis- tongue. He also mentioned about the presence of the ease of the tongue, so if the tongue diseases was a orifices of the salivary gland ducts that secretes saliva syptom of a systemic disease, so we have to treat the from the salivary gland, beside this he enumerated the cause, & if it was a local disease of the tongue we functions of the tongue & saliva. treat it by local medications of the tongue. Disorders of the Tongue: He also insures in this chapter, to be carefull in using the tongue medications so he says: {we should As Ibn-Sina here describes the tongue diseases & be aware when using the tongue & mouth medica- he classifies it & he says: (the tongue can be affected tions if is was able to damage the soft palate & the by diseases that can restrict its mobility, or its sensi- lings, so it wont be ingested or reach to them, bility & taste, & perhaps inactivates one of its senses more than the other. The tongue diseases can be a & this sentence remind us with the warnnings combined diseases, local, or due to the communica- writen on the oral drugs pamphletes, which should tion of the brain, & there then the cheeks & the not be ingested or swallowed, as it is indicated clear- can in connection in most of the times, or perhaps the ly for external use only. all senses can take part in he tongue diseases if they where from the same nerve division that innervates Disturbance of the Taste: the tongue. & It might pain if the stomach & some- Ibn-Sina say: {the diseases can affect the taste in times the lungs & chest where involved. three aspects, & this could either be due to systemic

42 JISHIM 2003, 1 TONGUE DISEASES IN AL-QANUUN BOOK OF IBN-SINA Abdul Nasser KAADAN Abdul Fattah HANOON or local cause, & concerning the treatment it depends book, & what is specified about its treatment is the on the cause, so if it was due to systemic diseases that use packing for the neck, & warm water gargles, & causeÓ swelling of the tongue so the treatment will also the use of rubbing mixes or mingles wither it be with the emetic drugs was hot or melted sweat. & so on each case it treated according to the cause. Tongue Enlargment (Macroglossia) As he mentions its causes & features by saying: Tongue Relaxation, Heaviness, & {it could be due to heavy soft, simulative, mucous Disturbance of Speech: secretion, & the tongue might enlarge enough to Ibn-Sina mentioned about this disease: {it could extrude out of the mouth, in which the mouth can not be due to a cause in the brain or due to a cause in the hold it, & this condition have been describes in the motor innervation or its ascending branches to the chapter of tumors. tongue, as we know what have been in association & what he had mentioned about the heavy mucous with the brain & what is not, as we find that in the secretion, this happens due to swelling in the floor of other organs deriving its sensory or motor supply the mouth when it gets inflamed, so the tongue will from the brain. & The tongue relaxation can reach its protrude out because of this. & what he had men- maximum until its not able to coordinate to speak or tioned about the tumors its all known, as what occurs it might change. to the other parts of the body. He also mentioned that if the tongue disease was Concerning the treatments, he talked about the neurological it could be either central or peripheral, local medications that can be scrubbed through the he also described the differential diagnosis between tongue such as ammonia, salt, serum, & vinegar. the two situation, & how the sense & motion is going to be in the rest of the organs. Tongue Tie/Shortness/(Ankyloglossia): Until today the physicians are depending on In this chapter he talkes about the tongue tie that examining the specific function for each cranial occurs due to anatomical causes related to the lingual nerves to determine the site of injury precisely frenum, or due to convulsion of the tongue that depending for that on the differential diagnosis would prevent its normal movement, as he says: {the between the similar injuries that has similarities in its tip & sides of the tongue can get attached to the lin- clinical features. gual frenum, so this will not allow the tongue exten- But for the treatments he referred it to the chapters sion, or it could be due to tongue convulsion concerned about the head diseases, on what is result- & concerning the treatment, Ibn-Sina talked about ing from it. He mentioned also about using the mouth gargles & rinses, & He describes a combined prepa- the short frenum only, because what is related the ration that to be kept under the tongue & its called tongue convulsion had been discussed previously. Gwarshen preparation. But the treatment for the short frenum, he said it can be treated by incising the frenum from its both Tongue Spasm/Convulsion: sides slightly, & the incision extension of the frenum Ibn-Sina indicates about this, in which it happens can be determined as he says: {the extension of our sometimes during sever fever as he says: {the tongue incision depend on how much we need to relieve the convulsion can be due to viscous mucous secretion tongue to move freely to touch the palate & protrude that can expand the tongue muscle horizontally, or out of the mouth}. could be within sever diseases} & we still depend on the ability of the tongue to & concerning the treatment: {treating the tongue touch roof of the palate during opening the mouth as convulsion dose not differ from treating the general- a sign to indicates the need for the surgical treatment ized convulsion in the first chapter of Alqanunn or not

JISHIM 2003, 1 43 Abdul Nasser KAADAN TONGUE DISEASES IN AL-QANUUN BOOK OF IBN-SINA Abdul Fattah HANOON &he specifies a special way to perform it, & he dysphsis, as he says: {it could be within the mus- says: {f you could not excise it with the stainless steal cle either due to convulsion, expansion, stiffness, blade, to avoid any profused bleeding, so you can &relaxation, or tongue tie, or surgical complica- introduce your needle with a sharp thread under the tion that ended up with scaring or solid tumor. frenum, that will penetrate the frenum with out cut- — Accidental causes on the surface of the tongue ting it, so the organ will not stick ant more}. and so that impair speech due to its resulting pain :he on, he defines precisely what we know the tongue tie, says: {the tongue disorder can be due to tumors or & he mentioned its surgical treatment, & its done ulcers that can affect the tongue & its different according to what is needed, & he detemined exactly aspects} the amount of that. — General systemic causes: he says: {it can appear Tumors of the Tongue: after cerebral accident, when the embolus ascends from the brain to block the tongue supply, or in Ibn-Sina says: {he tongue can get affected by dif- sever fever cases due to dehydration so the tongue ferent tumors such as, infammatory tumores, mucous tumores, solid & malignant tumores, & the sign for will get shrunk & convulsed which occurs seldom. all theses indicatesnfor tumores. — Causes related to the larynx without the tongue: He diffrentiated between the flabby, inflammatory he ends enumerating the causes of dysphasis by & the solid tumores & this is an important indication to mentioning that the causes could not be related to diffrentiate between these tumores, as the solid tumores the tongue, but due an injury to the larynx, so he could not be infected or it could be intact tumores or says: {the speech disturbance can be because of malignant or other, & we still use palpitation to inspect the muscles of the larynx in which they can be & differentiate primarly between the cases. either extended or relaxed, so the person will not be able to phonate easily unless he struggles to & what he says about the treatment: (if it supu- move his chest & larynx muscles so hardly that rates use acostics drugs in the oral cavity such as wont be tolerated by theses, muscles, so if he get simak cook, thunja bitter drink stocked in the first world then he continues, so & If the tumore is flabby & viscouse or infamma- theses people should not inhale deeply & move tory tumore that is reaching to its last stage, we can the chest, but he should fasten as possible, stick to it the burned the root of aniseed because if he got used to that, the speech will be so easy for him, & concerning the treatment it has Disturbance of Speech (dyphasis): been mentioned in other chapters} Here Ibn-Sina details in clear discription, & we We see in this paragraph his clear explanation will mention the causes that Ibn-Sina gave & the about the misuse of voice, by mentioning the main sequence he dependent on him self, because it shows causes of sever laryngitis & especially with geriatrics the clear presentation from the medical & the logical aspects, & theses causes are classified into:- Ranula of the Tongue: — Central nervous system causes: he says; [the apha- Ibn-Sina says about the ranula: {the ranula is a sia & other speech disorders can be due to, disor- semi solid gland situated uber the tongue similar in der in he brain, & from the exit if the ascending color with surface of the tongue & its vein in which nerve to motor innervate the tongue} the ranula is located, & the ranula is caused by heavy — Peripheral nervous system causes: he says: {the viscous mucous secretion} cause of the disorder could be in the same nerve & we still use the term (Ranula: Dim of Frog) to branch} describe this condition, & Ibn-Sina mentioned its — Anatomical & phathological causes related to the cause is due to (heavy viscous mucous secretion), & tongue: he continue enumerating the causes of also this word will express as Ibn-Sina said, mucous

44 JISHIM 2003, 1 TONGUE DISEASES IN AL-QANUUN BOOK OF IBN-SINA Abdul Nasser KAADAN Abdul Fattah HANOON extravasation due to obstruction of one of the salivary could be due to its large tumore or in cases of diph- glands ducts, that will cause this pathological condi- teroids so the tongue will extrude outside to open the tion under the tongue repiratory airway. He also indicated that it could be due to tumores Painfull Tongue (glossodynia): of the tongue or due to diphteriods , which Ibn-Sina says: {it could be due to tongue ulcers, are infectios in the floor of the mouth & the larynx brain fever but not reaching the meninges or the that causes obsructive odema in the soft palate & the intake of spicy, salted, sour, & sweets, or polydypsia, pharynx that would prevent respiration, due to con- or due to other greater causes such as sever fever & triction in the airway tract. internal tumors} It seems to us in this chapter that Ibn-Sina had Aphthous : focused on the adverse effect of mouth breathing that Here he takes about the ulcers of the tongue & can cause dryness of the mouth that can affect the mouth, & the causes can be general from inflamtion mucous membrane & the oral tissue cells, as well as of the stomach & the head or due to fevers. the taste sensation. As he mentions many medication used in the treat- So due to his notice to this adverse effect in this ment of the ulcers such as as the first line of treatment chapter that made him to mention first of all about the cooling & drying with (myrobalan emblic, thunja bit- treatment of painful tongue, in which he patient is not ter drinks, rose seeds, astragalus, & armenian mud, & allowed to continue opening his mouth during sleep- from the hot medications that are needed at the end ing & lying down because when sleeping in this posi- (nutmeg), cyperus, saffron, anchusa officinalis, clove, tion can increase the possibility for opening the peppermint, & green dates, & he ends this chapter by mouth & mouth breathing, so on that Ibn-Sina says: saying: {the majority of the physician said that noth- {the treatment for this condition, is by asking the ing is more effective in treating the oral ulcers like patient to sleep on his back & close his mouth. painting the tongue with warm indian spikenard}. So as we see here the clear sign to know the con- sequence of mouth breathing that can cause the Oral Thrush & painful tongue, because the mouth breathing can lead Malignant Ulcerative Stomatitis: to dryness of the mucous membrane of the mouth, & They are ulcers located on the furface of the h also talked about the related changes to the tongue, mouth & the tongue as it can affect the taste sensation. & he mentioned that it could be due to indiges- The preventive dentistry recent researches indi- tion, he also mentioned for its treatment many med- cates about the nose breathing always, because the ications such as thunja bitter drink & unripe sour nose is the correct passage for breathing, otherwise grapes juice, as well as a combined ointment. the mouth can get affected with many diseases & infections, & especially if it was exposed cold or dry Pharmaceutics Preparations That Were air, or even contaminated with dust. Used by Ibn-Sina to Treat the Tongue: Treatment of : He mentioned many pharmaceutics preparationes for treating the tongue so he prescribed to use oint- He mentioned the treatment could be with catton ments, mixes, mouth rinses, garggles, drinks, cover- seeds, micromelus, partialy boild eggs, & scrubing ing the tongue with packs, tongue rubbers, the tablest with pices from cucumber & cordiamyxa that are kept under the tongue, creams, & gwarshins, beside other different types preparations that has Gagging Reflex of the Tongue: been mentioned during his talk about treating every Ibn-Sina says about the gagging reflexes: {it diseases after describing its causes & its diagnosis.

JISHIM 2003, 1 45 Abdul Nasser KAADAN TONGUE DISEASES IN AL-QANUUN BOOK OF IBN-SINA Abdul Fattah HANOON Conclusion & Results: gicaly treating & reliefing the tongue tie, & the exten- As we have seen from Ibn-Sina previuse study tion of the incesion for the lingual frenum. about the tongue diseases that how he was encyclo- He also indicated the different causetive factors pedic & well aware of this topic with out any prolo- for speech distuurbance in logical sequence seems to giation or wordiness, & this is fom the factors that be a very specific scientific classification similar to made Alqanunn Book the first academic book in what we use nowadays, he also talked about change medicine during many centuries. in taste sensation & its different causes, he also indi- He described the diagnosis & the treatment fo many cated for the side effect of mouth breathing. of the pathological conditions related to the tongue, He also warned about the cross reaction of drugs such as the ranula, & tongue tie, with its diffrential used for treatment, as he warned from reaching of diagnosis for the cases with similar clinical features. As local oral medications to the digestive system, which he talked about the goal that we should reach when sur- can lead to damaging to these organs if it reaches to it.

46 JISHIM 2003, 1