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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0004-CONDITIONS OF ORGAN SYSTEMS (PART II)

Background reading material for medicine and fiqh panel held on 15th April 2000 at the Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA by Professor Omar Hasan Kasule Sr.

14.3.4 ALIMENTARY SYSTEM

A. GIT DISEASES

ACUTE ABDOMEN:

The following are common causes of the clinical syndrome called acute abdomen: acute appendicitis, acute cholecystitis, perforated peptic ulcer, pancreatitis, diverticulitis, and PID. These are serious conditions that require emergency treatment.

 

PEPTIC ULCERS

Fasting may not be possible in advanced stages of peptic ulcers. Gastric ulcer and duodenal ulcer may be complicated by: perforation, hemorrhage, obstruction due to chronic fibrosis.

 

NEOPLASMS

The following are common gastro-intestinal malignancies: adenocarcinoma of the stomach, primary hepatocellular carcinoma, metastatic liver cancer, carcinoma of the pancreas,and adenocarcinoma of the colon. Carcinoma of the small intestine is rare.

 

ORO-PHARYNGEAL CAVITY:

Common conditions of the oropharyngeal cavity are: tonsilllits, sialedinitis, and neoplasms. The neoplasms are: Squamous cell carcinoma, carcinoma of the larynx, and salivary gland tumors.

 

DISEASE OF THE ESOPHAGUS

The common disorders of the esophagus are motility disorders (achalasia, spasm, reflux), strictures

Barret's esophagus, esophageal cancer, perforation of the esophagus. The esophagus is intimately involved in nutrition that any esophageal lesions interfere with proper nutrition. This may have implications for fasting patients.

 

DISEASES OF THE SMALL INTESTINE

The small intestine may be afflicted by the following conditions: obstruction, Chrohn's disease, and infections. Fasting by resting the intestine may be beneficial.

 

DISEASE OF THE LARGE INTESTINE

The common diseases of the large intestine are: diverticula, volvulus, ulcerative colitis, and chron's disease.

 

DISEASES OF THE ANUS

The common conditions of the anus are hemorrhoids and anal fissure. They may cause bleeding. Wudhu will have to be made immediately before the salat and for that salat only. It has to be repeated for every salat.

 

GENERAL CONDITIONS

Obesity: extreme obesity makes salat difficult because of the body weight. Saum is good for the obese.

Food poison:

 

B. IBADAT

NAUSEA & VOMITING:

Salat is delayed while anticipating vomiting because vomiting is najasat and will nullify the salat anyway. Vomiting nullifies fasting; it is recommended to continue fasting even after an episode of vomiting but make up the day after.

 

HICCUP

Hiccup in salat may make recitation of the Qur’an impossible.

 

PEPTIC ULCER, GASTRITIS:

In extreme cases of peptic ulcer disease the patient is exempted from fasting

 

FLATULENCE

Any incidence of audible smelt flatus nullifies wudhu. A general feeling of flatulence does not nullify wudhu

 

DIARRHOEA

A situation of continuous diarrhoea makes it difficult to maintain a state of wudhu

 

ANAL INCONTINENCE

In cases of anal incontinence, wudhu is made immediately before each prayer

 

UPPER GIT BLEEDING

Upper GIT bleeding that does not cause visible blood at the anal opening does not nullify wudhu

 

LOWER GIT BLEEDING (HEMORRHOIDS)

Bleeding from hemorrhoids and anal lesions and wudhu

 

ABDOMINAL DISCONFORT

Any cause of abdominal discomfort such as pain, cramps, spasms, and digestive disorders make it difficult to concentrate in salat.

 

CHOLELITHIASIS:

Pain of gall stones and salat

 

COLOSTOMY:

The colostomy is kept as clean as possible. Wudhu is made before each salat

 

ORAL CAVITY:

Halitosis: Bad oral smell due to caries, gingivitis, and oral ulcer is a reason for keeping away from public assemblies

 

AADAAT

 

MUAMALAAT

Disease transmission by feco-oral route and work in food service

 

E. OTHERS

 

14.3.5 THE SENSORY SYSTEM

A.THE VISUAL SYSTEM

IBADAT

The obligation of salat al jamaat and salat al jumaat is lessened for a blind person who has not guide to the mosque. A blind person can be muaddhin only if he has someone to tell him the correct time. He can also be imaam. The obligation to travel to Makka and perform hajj is considered id there are others to help him see the way.

 

B. HOLDING PUBLIC OFFICE

A blind person can be imaam/political leader if the visual impairment is not judged to impair performance of leadership functions. He can not be a judge because a judge in court must see the witnesses and must be able to assess their demeanor. He however can be a scholar or a mufti.

 

C. EVIDENCE IN COURT

Evidence requiring sight can not be accepted from a blind person. Other types of evidence are acceptable.

 

D. MARRIAGE

A blind person getting married without seeing and knowing the bride

Marriage to a woman with congenital blindness, man tazawaaja imra at wa biha baras (KS 550)

A blind person being waly

 

E. MUALAMALAT

Selling and buying by a blind person

Professional services by the blind

 

B. THE AUDITORY SYSTEM

CLINICAL CONDITIONS

Ear infections are otitis media and otitis externa interfere with hearing. Nose and para-nasal sinuses suffer from acute and chronic sinusitis. Assessment of hearing can be made using the Weber test and Rinne test

 

IBADAT

Hearing the adhan: Inability to hear adhan is not an excuse for not going to congregational prayers because one can rely on others.

 

Being muaddhin: A deaf person can be a muaddhin if there is a way for him to know the right time for salat

 

Being imaam: a deaf person can be imaam

 

Following the imaam: the deaf person can follow by imaam by watching what the imaam does even of he ca not hear

 

Teaching Qur'an: A deaf person can teach Qur’an but it is preferred he does not do so because he can not hear and correct mispronunciations.

 

Returning greetings: the deaf is not obliged to return greetings because he can not hear. He however is obliged to respond to sign language of greeting if he is sighted.

 

Sense of balance in salat and hajj (tawaaf): In vestibular disturbances standing up in salat or tawaaf may require support

 

HOLDING PUBLIC OFFICE

As imaam/political leader: deafness reduces competence as a leader but is not an absolute contra-indication

 

As judge: a deaf judge will not be able to discharge duties fully

 

As scholar/mufti: a deaf person can be a scholar and can give religious rulings because he can read the questions and can give either written answers or respond using sign language.

 

EVIDENCE IN COURT

Evidence requiring hearing: Evidence that assumes that the witness heard is not accepted from a deaf person unless the deafness occurred after the event. Such evidence could also be rejected if hearing is impaired and not completely lost.

 

Other types of evidence:

 

MARRIAGE

The marriage declaration: a deaf person can contract a marriage by use of reading or sign language

Declaration of divorce: A deaf person can declare divorce. The situation is complicated if the spouse being divorced in deaf because she can claim that she can not hear and understand the divorce pronouncement.

 

MUALAMALAT

Selling and buying: a deaf person can buy and sell as long as he understands the transaction and can communicate in writing or by sign language

 

Professional activities: It is forbidden for a deaf person to engage in any professional work such as driving a truck for which hearing is necessary.

 

C. CHEMICAL SENSATION

THE OLFACTORY SYSTEM (SHAMM):

Ibadat: In hyposmia the victim may not be able to smell flatus and thus may continue praying with an invalid wudhu. Hyperosmia and parosmia may results in unnecessary concern about presence of najasat where it is insignificant. The halitosis associated with fasting is due to reduced oral cleansing action of saliva. It can be reduced by increased oral hygiene.

 

Aadaat: Impairment of the taste sensation may reduce enjoyment of food. It may also impair ability to discriminate dangerous things and avoiding swallowing them. Halitosis due to disease or poor oral hygiene may make social intercourse difficult. It is especially offensive in the mosque.

 

Family: body or oral odor may cause so much distress in a marriage that it may lead to divorce.

 

Muamalat: Impaired smell may make transactions involving perfumes invalid because the buyer can not identify what is being bought. Similarly impaired smell may lead to buying of rotten products without knowing their true state

 

Court: Court evidence based on smell may not acceptable in situations of olfactory disorders.

Others: use of perfume to control body odor in public places like the mosque is mandatory to avoid annoying others.

 

THE TASTE SYSTEM (dhawq):

Ibadat: If taste is defective, it will not be possible to tell that water is polluted and is not suitable for wudhu

 

Aadaat: Enjoyment of food decreases when the sense of smell is defective. Dangerous food may also be consumed if it can not be tasted

Family:

 

Muamalat: in selling food and drinks, the buyer may use taste to make sure the product is wholesome. This is not possible when the sense of taste is defective.

 

Court: Evidence in court based on taste of products may not be accepted in cases of a defective taste sense

Others:

 

SURFACE SENSATION

Ibadat: loss of tactile sensation does not affect the processes of wudhu and salat in any major way however there is danger of being hurt without realizing

 

Aadaat: With loss of tactile sensation there is a danger of ingesting rough and dangerous materials

 

Family: Sexual sensation is a complex phenomenon that may be impaired when tactile sensation is lost and this may lead to stresses in marital life

 

Muamalat: Loss of tactile sensation may be a cause of accidents at work

 

Court: The integrity of the tactile sensation is considered when assessing certain types of court evidence

 

OTHER SENSATIONS

The Temperature Sensory System (Harara, Buruda): An impaired sensation of temperature may result in unnecessary exposure and heat stroke during hajj. Hot and therefore harmful food may be eaten when temperature sensation is impaired. Inability to adjust to extreme climatic conditions may be grounds for divorce. Workers must not be exposed to extremes of temperature.

 

The Sensation Of Pain (alam, wajau): extreme pain may prevent concentration in salat  Pain may cause insomnia. Chronic pain due to PID and other causes of dyspareunia may create marital stress. Chronic pain may lead to psychological stress. Severe pain may lead to criminal behavior.

 

The Sensation Of Hunger (juu): Salat is delayed in cases of extreme hunger sensation, al ta’aam qabla al salay (KS 315). Loss of the hunger sensation is dangerous to life. Inability to extinguish the feeling of hunger with food intake may lead to loss of appetite control. Children may be severely undernourished when they do not feel hungry and refuse to eat food. Extremes of pain may lead to crime.

 

The Sensation Of Thirst (‘atash): concentration is salat is impaired in extreme thirst

 

DISCUSSION

UROGENITAL SYSTEM

Wudhu and salat with hematuria

Fasting in chronic hematuria complicated by anemia

Saum in cases of renal failure

Kidney stone pain and salat or hajj

Fasting in persons with predisposition to stone formation

Rulings on priapism

Excessive sexual desire

Benign prostatic disease and incomplete urinary voiding

Genital hygiene and prevention of male cancer of the penis and the female cancer of the cervix

Circumcision and prevention of cancer and genital infection

Cleaning under the prepuce for the uncircumcised

Ruling on treatment of testicular or ovarian cancer destroying reproductive ability and leading to marital stress

Rulings on dyspareunia

Wudhu and hajj in presence of pre-menopausal and post-menopausal spotting

Sexual relations in dysfunctional uterine bleeding

Congenital vaginal anomalies (septate, imperforate) preventing consummation of marriage

Cervical disorders leading to infertility or frequent abortions and marital stress

Tubal disorders leading to infertility and marital stress

Ovarian disorders leading to infertility and marital stress

Infertility as a reason for taking a second wife

Ruling on obligation of both spouses to undergo examination and testing for causes of infertility

Does radical mastectomy require husband's approval?

Rulings on anatomical and physiological disorders of gender differentiation

Rulings on psychological disorders of gender differentiation

Marriage and inheritance in cases of indeterminate gender

Rulings on therapeutic abortion in cases of maternal or fetal disorders

Rulings on choice of action to take in a complicated delivery in which only one life can be saved

Rulings on post-partum depression

 

CARDIO-RESPIRATORY SYSTEM

Obligation of congregational salat for person with upper respiratory infection

Rulings on isolation of persons with respiratory  infections in hajj

Salat in states of dyspnea

Recitation in salat with a repetitive cough

Salat in status asthmaticus

Hemoptysis and repetition of wudhu

Salat of patients on respiratory support

Salat and hajj with orthostatic hypotension

Physical exertion in salat, hajj, or coitus triggering an anginal attack or rupture of aneurysm

Wudhu with cold water triggering Reynaud's sundrome

Wudhu in cases of varicose veins and phlebitis

Physical movements of  salat and hajj dislodging an embolus in DVT

Decisions about future pregnancy after delivering a baby with congenital heart disease

Physical exertion in salat and vulvular heart disease

Salat and hajj for patients with congestive cardiac failure

Fasting in states of circulatory shock

 

CONNECTIVE TISSUES

Obligation on the pregnant woman to take hematinics to prevent anemia

Ruling on exclusive breast feeding beyond 6 months

Wudhu and salat for patients with elephantiasis

Tasliim with neck skeletal problems

Raising the hands in takbir with shoulder joint disease

Bowing and prostration in salat with lower limb pathology

Back problems and bowing or prostration

Sitting in salat and tawaaf with knee problems

Sitting in salat with ankle problems

Wudhu with a compound fracture

Orthopedic fixation and salat and tawaaf

Joint diseases (OA and RA) and salat & tawaaf

Wudhu with skin lesions, bandaged or not bandaged

 

GIT CONDITIONS

Fasting with peptic ulcer disease

Wudhu with  bleeding hemorrhoids

Delaying salat when feeling nauseated

Wudhu and salat with continual diarrhoea

Wudhu and salat in anal incontinence

Wudhu and salat in upper GIT bleeding

Wudhu and salat with a colostomy

Halitosis and attending the mosque

 

SENSORY SYSTEMS

Obligation of salat and hajj on the blind

A blind person as a muaddhin or imaam

A blind person as a public leader or judge

Court testimony by a blind person

Blind person concluding a marriage contract

Blind person as waliy in a marriage

Transactions by a blind person

A deaf person as muaddhin or imaam

Obligation to return greetings for a deaf person

Deafness and public office

Deafness and teaching or issuing fatwa

Deafness and court testimony

Marriage and divorce by a deaf person

Transactions by a deaf person

Prevention halitosis in fasting

Bad smell in the mosque or other public places

Transactions with impaired sense of smell

Body odor as a cause of marital stress

Professor Omar Hasan Kasule 2000