Perspectives of Medieval Persian Medicine on Multiple Sclerosis.

INTRODUCTION: Traditional Persian Medicine (TPM) was the prevailing practice of medicine in the Eurasia region up through the 18th century, a practice of medicine stemming back to Hippocrates and to the 5000 year old civilization of the region. It is a school of medicine which touches on many a delicate points which may seem unimaginable within the realm of modern allopathic medicine. This practice of ancient medicine besides shedding light on various possible theoretical modern day disorders serves as a vast resource for therapeutics. In this paper, we present study of the manuscripts of this ancient medical practice in search of symptom presentations coinciding with presentation of multiple sclerosis (MS). MATERIAL & METHOD: This paper represents a comprehensive search through TPM texts and manuscripts with the intention to seek possible clues on MS from potentially valuable age-old resources. We predominantly focused our search on the works of five eminent physicians of Medieval Persia: Avicenna (980-1037 AD), Haly Abbas (949-982 AD), Rhazes (865-925 AD), Averroes (1126-1198 AD) and Jorjani (1042-1137 AD). RESULTS: In this paper, the authors attempt a theory and conclude with high probability that a conjunction of a series of signs, symptoms found in TPM texts under the terms khadar, isterkha and falej form the symptoms and the disease pattern of modern day MS. This theory draws upon existent similarities in terms of disease pathology, disease patterns and predisposing factors seen between MS and the related morbidities within Persian Medicine. CONCLUSION: We recommend further examinations of such potentially valuable long-standing resources, examining the diagnoses and treatments as set forth by Persian Medicine through international collaboration within the global scientific community.

Acroparesthesia and carpal tunnel syndrome: a historical perspective.

This article presents the history of acroparesthesia and its contribution to the discovery of idiopathic carpal tunnel syndrome (CTS). We used primary sources from the middle of the nineteenth century onward to show that the first short descriptions of patients with nocturnal and early morning paresthesias, numbness, pain, and weakness in the hands, without accompanying physical signs, were published around 1850. The condition was named acroparesthesia in 1890 and, in the following years, was accepted as a disease in medical textbooks. Almost all of the patients with acroparesthesia, described at the end of the nineteenth and the first half of the twentieth century, would today be diagnosed with idiopathic CTS. Although physicians proposed many hypotheses for the etiology of acroparesthesia throughout its 100-year history, they did not understand that the condition arose from compression of the median nerve in the carpal tunnel, and the concept of acroparesthesia did not lead to the discovery of CTS. Even Russell Brain-who, in 1946 and 1947, showed that the "syndrome of partial thenar atrophy" was due to compression of the median nerve in the carpal tunnel-did not realize that acroparesthesia shared the same origin. This understanding developed in the late 1940s and through the 1950s, and the disease came to be accepted under the name carpal tunnel syndrome.

Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: a historical perspective.

This article presents the history of the discovery of compression of the median nerve in the carpal tunnel without an identifiable cause as a distinct clinical entity. By analyzing primary sources, we show that, at the beginning of the twentieth century, physicians described patients with paresthesias and numbness in the hands, most prominent at night, accompanied by bilateral symmetrical atrophy along the radial side of thenar eminence. At the time, the 2 most influential hypotheses regarding etiology were, first, compression of the lower trunk of the brachial plexus by a cervical or first rib, and second, compression of the thenar branch of the median nerve as it passes beneath the anterior annular ligament of the wrist. The condition was named syndrome of partial thenar atrophy and was considered a distinct clinical entity. In 1946, after extensive analysis, neurologist Walter Russell Brain concluded that both sensory and motor symptoms of the syndrome were caused by "compression neuritis" of the median nerve in the carpal tunnel. At his suggestion, surgeon Arthur Dickson Wright performed decompression of the nerve by "an incision of the carpal ligament," with excellent results. Brain presented this work at the Royal Society of Medicine in London in 1946 and published his landmark paper in Lancet the following year. In so doing, he established the basis for the disease we know today as idiopathic carpal tunnel syndrome. Unfortunately, in 1947, Brain did not realize that another "condition" with the same clinical picture but without atrophy of the thenar muscles, known as acroparesthesia at the time, was actually the same disease as syndrome of partial thenar atrophy, but of lesser severity. As a result of Brain's influence, 7 other papers were published by 1950. Between 1946 and 1950, there were at least 10 papers that presented, in total, 31 patients (26 women) who exhibited symptoms of compression of the median nerve without an identifiable cause and underwent section of the transverse carpal ligament.

Deficiency neuropathy in wartime: the "paraesthetic-causalgic syndrome" described by Manuel Peraita during the Spanish Civil War.

This paper discusses the contribution of Spanish neurologist Manuel Peraita (1908-1950) to the study of deficiency neuropathy in the setting of the Spanish Civil War (1936-1939). The clinical characteristics of "paraesthetic-causalgic syndrome" or "Madrid syndrome" as described by Peraita are discussed, and the syndrome is presented in relation to other similar conditions, including Strachan's syndrome and burning feet syndrome.

The Tinel sign: a historical perspective.

The Tinel sign is one of the most well-known and widely used clinical diagnostic tools in medicine. Aside from Jules Tinel, after whom the sign is named, several authors have described the famous "tingling" sign seen in regenerating injured nerves. In fact, Tinel was not the first to present the sign to the scientific community. The clinical value and utility of the Tinel sign have remained in question since its introduction; many may misinterpret the sign as a prelude to complete functional recovery of injured nerves, when in fact it only signals the progress of nerve regeneration. Today the Tinel sign is widely associated with the diagnosis of carpal tunnel syndrome and in the evaluation of regenerating peripherally injured nerves. Knowledge of the history and misconceptions surrounding the sign provides clinicians today with a greater appreciation of current debates on the use of the Tinel sign.