Tongue
Diseases in Al-Qanoon book of Ibn-Sina
DR.ABDULLNASER KAADAN
TRANSLATED BY: DR .SALMA
ALMAHDI,D.D.S
Summary:
The tongue is
considered
as a fundamental organ that share in chewing ,swallowing & speech,
& it can be exposed to different
diseases 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 etiological factors,& its
clear management. As the modern medicine until now agrees completely in most
of what IBN-SINA have wrote.
Introduction:
The
old Arabic medical books are not divided
in chapters specified for studying the tongue diseases ;for
example, in the third chapter of (ALHAWI) book for ARAZI ,we find a section
about the taste sensation
(i)& another section about the pharynx
,tongue,& soft palate diseases(ii);as he explains very briefly
in the 49th chapter in his
book (THE
DIVISION & SUBDIVISION OF THE TONGUE DISEASES) about nine
disorders which are; tumors ,fissures ,roughness ,ulcers ,spasm ,heaviness
,ranula of the tongue, ankyloglossia,& macroglossia)(iii); but
ABULLHASSAN ALTABARI the author of (THE
HIPPOCRATIC TREATMENTS) ,as he specified
ten sections concerned about the tongue diseases such as (gagging reflexes of
the tongue (iv), ranula of the
tongue
(v), tongue convulsion, speech
disturbances ,& disturbances of tongue taste (vi),& so on our
inherited medical books never divided
in chapters talking about the tongue
diseases & its treatments.
ALQANUNN
book of IBN-SINA has been considered one of the most famous medical edditions ,as it seems clear ,complete,
& good presentation ,also its gives a clear view about the medical sciences
during his century.& we also find in the second section about fourteen
chapters specialized in the tongue diseases(vii), in addition to
some other phrases related to the anatomy researches in the first chapter of
the book(viii)
&
here we are going to talk about IBN-SINA have wrote about the tongue in his
book (LAQANUNN)in medicine ,as we are going to study the chapters concerned
about the tongue as IBN-SINA organized:-
Anatomy of the tongue muscles:
As he
mentions comprises four pairs of muscles forming eight muscles & one single
muscle which is the upper tongue muscle that is described very precisely
by him. So as he mentions the tongue has nine muscles, although what is known
that the tongue consist in addition to the upper tongue muscle ,eight another
pairs from muscles instead of four ,so the total number of muscles are
seventeen muscles.(ix)
Anatomy of the oral cavity & the tongue:
Here
IBN-SINA talks about the functions of
the tongue as he says:{the tongue is an organ
from the oral cavity which plays major part in the mechanism of chewing
the food bolus ,phonation , pronouncing letters,& differentiation of tastes
.& its ventral surface is with continues attachment with the esophagus
& the stomach. While the dorsum if the tongue is divided into two parts by
the V-shaped (sulcus terminals),& there is a considerable sharing between
them by the communicating tendons. The tongue has a large network of
subdividing nerve branches from four protruding nerves. It also consist of
large network of blood supply & nerve innervations. & under the tongue
there are two orifices of the submandibular salivary glands ducts ,that opens
& releases its secretions into the oral cavity to keep the tongue &
the oral mucosa moist & wet. (xi)
&
so on as he mentions the continuity of the mucus membrane of the ventral
surface of the tongue & the floor of the mouth with the mucus membrane of
the gastrointestinal tract. He also observed the presence of profused blood
supply & heavy innervations of the tongue. He also mentioned about the presence of the orifices of the
salivary gland ducts that secretes saliva from the salivary gland, beside this
he enumerated the functions of the tongue & saliva.
As IBN-SINA here
describes the tongue diseases & he classify it & he says:( the tongue
can be affected by diseases that can restrict its mobility ,or its sensibility
& taste,& perhaps inactivates one of its senses more than the other.
The tongue diseases can be a combined
diseases, local ,or due to the communication of the brain,& there
then the cheeks & the lips can in connection in most of the times ,or
perhaps the all senses can take part in he tongue diseases if they where from
the same nerve division that innervates the tongue.& it might pain if the
stomach & sometimes the lungs & chest where involved. (xii)
Here he indicates that
the treatment of the tongue should be general if the tongue diseases was in
association with the head or stomach, i.e , if the cause was a systemic
diseases. Or the treatment can be local by using gargles of the mouth ,mouth rinses(xvi)
& rubbing materials,& the tablet that is held in the mouth ,which
should be flat in shape to increase the surface contact area between the
medication & the oral tissues.
& so on the
treatment follow the cause of the disease of the tongue, so if the tongue
diseases was a symptom of a systemic disease ,so we have to treat the
cause,& if it was a local disease of the tongue we treat it by local
medications of the tongue.
He also insures in this
chapter, to be
careful in using the tongue medications so he says:{ we should
be aware when using the tongue & mouth medications if is was able to
damage the soft palate & the
lings, so it wont be ingested or reach to them,(xvii)
&
this sentence remind us with the warnings written on the oral drugs
pamphletes, which should not be ingested or swallowed ,as it is indicated clearly
for external use only.
IBN-SINA say:{ the diseases can affect the taste in three
aspects,& this could either be due to systemic or local cause(xviii),&
concerning the treatment it depends on the cause ,so if it was due to systemic
diseases that causeس swelling of the tongue so the treatment will be with the emetic
drugs(xix)
&
so on each case it treated according to the cause.
Tongue relaxation ,heaviness,& disturbance of speech:
IBN-SINA indicates about
this, in which it happens sometimes during sever fever as he says:{ the tongue
convulsion can be due to viscous mucous secretion that can expand the
tongue muscle horizontally ,or could be within sever diseases} (xxiii)
Tongue enlargment(macroglossia)
Tongue tie/shortness/(ankyloglossia):
&he specifies a
special way to perform it, & he says:{f you could not excise it with the stainless steal blade ,to avoid
any profused bleeding ,so you can introduce your needle with a sharp thread
under the frenum ,that will penetrate the frenum with out cutting it
,so the organ will not stick ant more.}
and so on, he defines
precisely what we know the tongue tie ,& he mentioned its surgical
treatment,& its done according to what is needed,& he detemined
exactly the amount of that.
IBN-SINA
says:{he tongue can get affected by different tumors such as, infammatory
tumors, mucous
tumors, solid & malignant tumors,& the sign for all
theses indicates for tumores.
He
diffrentiated between the flabby,inflammatory & the solid tumors &
this is an important indication to differentiate between these tumors ,as the
solid tumors could not be infected or it could be intact tumors or malignant or other, & we still use
palpitation to inspect & differentiate primarily between the cases.(xxxvi)
& what he says about the treatment:( if it
supurates use acostics drugs in the oral cavity such as simak cook, thunja
bitter drink(xxxvii)
& if the tumor is flabby & viscouse
or inflammatory tumor that is reaching
to its last stage, we can stick to it the burned the root of aniseed(xxxviii)
Disturbance
of speech( dyphasis):
Here
IBN-SINA details in clear discription,& we will mention the causes that
IBN-SINA gave & the sequence he
dependent on him self ,because it shows the clear presentation from the medical
& the logical aspects,& theses causes are classified into:-
§
Central nervous system
causes: he says;[the aphasia & other speech disorders can be
due to ,disorder in he brain,& from the exit if the ascending nerve to
motor innervate the tongue} (xi)
§
Anatomical & phathological causes related
to the tongue:
he continue enumerating the causes of
dysphsis ,as he says:{ it could be within the muscle either due to
convulsion ,expansion ,stiffness, &relaxation ,or tongue tie, or surgical
complication that ended up with scaring or solid tumor.(xlii)
§
Accidental causes on the surface of the
tongue that impair speech due to its resulting pain :he says:{the tongue
disorder can be due to tumors or ulcers that can affect the tongue & its
different aspects}(xxxiii)
§
General systemic causes: he says:{ it can appear after cerebral accident, when the embolus ascends from the brain to block the tongue supply ,
or in sever fever cases due to dehydration so the tongue will get shrunk &
convulsed which occurs seldom.(xliv)
§
Causes related to the larynx without the
tongue: he ends enumerating the causes of dysphasis by mentioning that the causes could
not be related to the tongue ,but due an injury to the larynx, so he says: {the
speech disturbance can be because of the muscles of the larynx in which they
can be either extended or relaxed ,so the person will not be able to phonate
easily unless he struggles to move his chest & larynx muscles so hardly
that wont be tolerated by theses, muscles ,so if he get stocked in the first
world then he continues ,so theses people should not inhale deeply & move
the chest ,but he should fasten as possible ,because if he got used to that
,the speech will be so easy for him,& concerning the treatment it has been
mentioned in other chapters} (xlv)
IBN-SINA
says about the ranula: { the ranula is a semi solid gland situated uber the
tongue similar in color with surface of the tongue & its vein in which the ranula is located, & the
ranula is caused by heavy viscous mucous secretion} (xlvii)
& we
still use the term (RANULA:DIM OF FROG) to describe this condition,&
IBN-SINA mentioned its cause is due to (heavy viscous mucous secretion),&
also this word will express as IBN-SINA said ,mucous extravagation due to
obstruction of one of the salivary glands ducts ,that will cause this
pathological condition under the tongue (xlix)
Painfull tongue(glossodynia):
IBN-SINA says:{ it could be due to tongue ulcers,brain
fever but not reaching the meninges or
the intake of spicy ,salted ,sour,& sweets, or polydypsia , or due to other
greater causes such as sever fever & internal tumors} (l)
So due to his notice to this adverse effect
in this chapter that made him to mention first of all about the treatment of
painful tongue ,in which he patient is not allowed to continue opening his
mouth during sleeping & lying down
because when sleeping in this position
can increase the possibility for opening the mouth & mouth breathing
,so on that IBN-SINA says:{ the treatment for this condition ,is by asking the patient to sleep on his back & close
his mouth.(li)
So as we see here the clear sign to know the
consequence of mouth breathing that can
cause the painful tongue ,because the mouth breathing can lead to dryness of
the mucous membrane of the mouth,& h also talked about the related changes
to the tongue ,as it can affect the taste sensation.
The preventive dentistry recent researches indicates about the nose breathing
always, because the nose is the correct passage for breathing ,otherwise the
mouth can get affected with many diseases & infections,& especially if
it was exposed cold or dry air, or even contaminated with dust.(lii)
He mentioned the treatment could be with
cotton
seeds (liii),micromelus(liv),
partially boiled eggs (lv),& scrubbing with pices from cucumber &
cordiamyxa(lvii)
Gagging reflex of the tongue:
IBN-SINA says about the
gagging reflexes:{it could be due to its large tumore or in cases of
diphteroids so the tongue will extrude outside to open the repiratory airway.(lvii)
oral thrush & malignant ulcerative stomatitis:
they are ulcers located on the furface of the mouth &
the tongue(lxxvi)
& he mentioned that it could be due to indigestion, he
also mentioned for its treatment many medications such as thunja bitter drink
& unripe sour grapes juice, as well as a combined ointment.
Pharmaceutics preparations that where used by IBN-SINA to
treat the tongue:
He mentioned many pharmaceutics preparationes for treating
the tongue so he prescribed to use ointments(lxxvii),mixes(lxxviii),mouth
rinses(lxxix),garggles(lxxx),drinks(lxxxi),covering
the tongue with packs(lxxxii),tongue rubbers(lxxxiii),the
tablest that are kept under the tongue(lxxxiv),creams(lxxxv),&
gwarshins(lxxxvi) ,beside other different types preparations that
has been mentioned during his talk about treating every diseases after
describing its causes & its diagnosis.
conclusion & results:
as we have seen from IBN-SINA previuse study about the tongue diseases
that how he was encyclopedic & well
aware of this topic with out any prolongation or wordiness, & this is from
the factors that made ALQANUNN BOOK the first academic book in medicine during
many centuries.
He described the diagnosis & the treatment for many of
the pathological conditions related to the tongue, such as the ranula, &
tongue tie, with its differential diagnosis for the cases with similar clinical
features. As he talked about the goal that we should reach when surgically
treating & relieving the tongue tie,& the extension of the incision for
the lingual frenum.
He also indicated the different causative factors for
speech disturbance in logical sequence seems to be a very specific scientific
classification similar to what we use nowadays ,he also talked about change in
taste sensation & its different causes, he also indicated for the side
effect of mouth breathing.
He also warned about the cross reaction of drugs used for
treatment, as he warned from reaching of local oral medications to the
digestive system, which can lead to damaging to theses organs if it reaches to
it.