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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0101-CONDITIONS OF ORGAN SYSTEMS

Lecture to 3rd year medical students on 27th January 2001 by Professor Omar Hasan Kasule Sr.

A. URO-GENITAL SYSTEM

DISORDERS OF THE URINARY TRACT

Urinary incontinence: is due to structural and functional anomalies. Wudhu is made followed immediately by salat.

 

Hematuria: Wudhu is valid in cases of continuous hematuria, microscopic and macroscopic. Salat must be performed immediately after making wudhu. Suitable urinary bags should be worn to prevent soling clothes and the place of prayer. Hematuria of enough severity to cause anemia is an exemption from obligatory fasting.

 

Renal failure: Salat is possible if the patients are not bed-ridden or in uremic coma. Fasting is postponed because of the need to control fluid and electrolyte balance.

 

Urolithiasis: Movements of salat are restricted if pain is triggered by the physical movements in salat. Some salat positions may be found more comfortable than others. Salat is delayed while patients are under sedation to control pain. Stress of hajj movements and change in meals in a hot and dry climate may trigger pain so care should be taken. Patients prone to stone formation have to be careful while fasting to make sure they take plenty of fluid and avoid hot environments that lead to excessive fluid loss

 

Neoplasms: The common types of neoplasm in the urinary system are renal carcinoma, transitional cell carcinoma of the bladder, and cancer of the prostate. They may be associated with hematuria or urinary incontinence. Wudhu is made followed immediately by prayer. Prostate cancer as well as its treatment may interfere with sexual function.

 

DISORDERS OF THE MALE GENITAL TRACT

Sexual dysfunction: Loss of libido due to various causes leads to stress in marital life. It is offensive for a male with no libido to marry. Lack of libido may be grounds for divorce or khulu’u. In cases of impotence, the qadhi can issue an order of nullification of marriage after a grace period of 1 year during which medical treatment is sought to treat the condition. Pre-mature, delayed, or no ejaculations are usually not sufficient grounds for divorce. Priapism causes physical harm to the wife and should be treated before sexual relations are attempted. Excessive unsatisfied sexual desire in one the male could be resolved by recourse to polygamy. The situation is more complex for the female.

 

Prostate disease: Benign prostatic hyperplasia can be associated with incomplete urinary voiding, urinary incompetence, and pain. Carcinoma of the prostate can cause hematuria. The legal rulings on wudhu in cases of urinary incompetence and hematuria have been discussed before.

 

Penis: Genital hygiene is necessary for preventing infection and carcinoma. Circumcision, partial or complete excision of the prepuce, is a hygienic measure highly recommended. Those who for some reason cannot be circumcised should be careful to clean properly under the prepuce during istinjah.

 

Testis and vas: Testicular torsion is a urologic emergency. Its pain is so severe that it can lead to delay of salat. Epidydimitis is an emergency that may delay salat. Treatment of testicular cancer could destroy reproductive function. Cases of cryptorchidism should seek counseling before marriage so that relations do not end in divorce as the wife becomes frustrated.

 

DISORDERS of THE FEMALE GENITAL TRACT

Sexual dysfunction: Wives may experience loss of libido, lack of sexual enjoyment, dyspareunia, and vaginismus. The prophet taught kindness to wives and in such situations husbands should not think of only their interests but should try to resolve the underlying causes in order to prevent marital tension and divorce. Lack of libido and sexual interest in a woman is not considered a barrier to marriage.

 

Bleeding disorders: Vaginal bleeding may be menstrual, spotting (pre-menopausal, or post-menopausal) and dysfunctional uterine bleeding due to hormonal causes or organic causes. In cases of prolonged menstruation or other causes of bleeding, it suffices to pad the perineum, make wudhu, and pray immediately without waiting. Exemption from fasting is only for cases of ordinary menstruation. Use of hormones to regulate menstruation is allowed for hajj but not for Ramadhan. DUB if prolonged may not be a barrier to sexual relations but care must be taken to maintain hygiene and prevent ascending infection. Bleeding disorders are ignored in the computation of the period of iddat in both pre-menopausal and post-menopausal women.

 

Congenital anomalies: A septate or imperforate vagina can prevent sexual intercourse and marriage consummation. Before thinking of marriage dissolution, proper treatment should be sought from specialist surgeons. The Law treats infertility as a disease for which treatment must be sought. Cervical anomalies may cause infertility or frequent abortions. Uterine disorders preventing implantation lead to infertility. Tubal infection is a common cause of infertility. Ovarian and hormonal disorders are also implicated in some cases of infertility.

 

Infections: Cervical and uterine infections lead to infertility. Tubal obstruction due to infection, inflammation and post surgery leads to ectopic pregnancy. A spouse is legally liable for transmitting infection to her partner.

 

Neoplasms: Treatment of ovarian and uterine neoplams destroys reproductive function. A proper balancing of harm, dharar, and benefit, maslahat, must be made in each case especially if the malignancies are benign. Uterine fibroids lead to infertility, abortion, and bleeding. Hysterectomy for uterine fibroids destroys the reproductive function and leads to psychological problems in a woman who then can no longer menstruate. Adenomyositis and endometriosis lead to pain and infertility and have to be treated.

 

 

DISORDERS OF GENDER DIFFERENTIATION and GENDER IDENTITY:

The disorders are anatomical and physiological with serious behavioral and legal implications. The anatomical disorder is that it is difficult to assign gender based on the external genitalia. Physiological virilization is due to hormonal disorders. Behavioral disorders follow due to the stress of gender identity. Marriage is difficult and procreation may be difficult. Inheritance is complicated in cases of indeterminate gender because the portion due depends on the gender.

 

PREGNANCY, DELIVERY AND THEIR DISORDERS

Complications of early pregnancy: Chromosomal anomalies, maternal rubella infection, and other intra-uterine injuries lead to congenital anomalies in the fetus. Most abnormal fetii are aborted spontaneously. Pregnancy loss, primary or secondary, may be spontaneous, incomplete, and missed (fetus retained after its death). In some cases it is recurrent indicating persistence of the cause. The factors leading to pregnancy loss are: genetic, endocrinogenic, anatomic, immunologic, and microbiological. The period of post-abortion bleeding is recognized as nifaas.

 

Complications of late pregnancy: Diseases of hemostasis and ecclampsia may complicate late pregnancy and give rise to a complicated ethical situation. Termination of the pregnancy may be the best way to save the mother’s life but it will adversely affect the fetus who may not yet be viable extra-uterine.

 

Complications of labor: Pregnancy may be post-term necessitating induction of labor. Delivery complication may lead to difficult choices between saving one of the lives: mother or infant.

 

Post-partum complications: Infection and bleeding disorders. Post-partum depression

 

OTHER DISEASES

Breast: Three common types of breast disorder, galactorrhoea, mastitis, and carcinoma, have an effect on breast-feeding. Radical mastectomy for breast cancer has cosmetic implications that can affect marital relation through psychological effects.

 

Anovulation: The principal causes of anovulation are: hypothalamic disease (tumors, trauma, vascular), pituitary disease (tumors), thyroid diseases (hypothyroidism, hyperthyroidism), ovarian disorders, and psychological or behavioral disorders (stress, anorexia nervosa, pseudocyesis, bulimia).

 

Hirsutism is due to androgen excess and is associated with behavioral disorders. Hormonal treatment should be sought. Cosmetic procedures should be carried out to restore the normal female appearance.

 

B. CARDIO-RESPIRATORY SYSTEM

RESPIRATORY DISORDERS

Upper respiratory disorders: URTI are infections and allergies such as rhinitis, throat clearings, and sinusitis. A person with URTI can be excused from leading salat because of difficulty in recitation of the Qur’an. Patients who are actively secreting virus or bacteria should preferably pray at home. Isolation and other forms of restriction may have to be applied in hajj for fear of spreading infection. Social etiquette is affected. Patients with URTI should restrict their social interaction for example visiting others so that infection does not spread. Clearing of the throat and spitting is a bad unhygienic habit that should be discouraged.

 

Lower respiratory disorders: The most serious conditions are bronchiectasis, lung abscess, TB, and lung cancer. Dyspnoea arises in acute or chronic respiratory infections as well as pneumothorax or hemothorax. Dynoeic patients should limit their physical movements in salat and hajj. Repetitive cough may make recitation in salat difficult.  Hemoptysis does not void wudhu and fasting. Patients with pneumonia or pneumonitis will experience pain on recitation and prostration. Respiratory support: patients on respiratory support cannot recite Qur’an during salat.

 

DISEASES OF BLOOD VESSELS

Hypertension: Orthostatic hypotension occurs due to lowering of blood pressure on prolonged standing. It is avoided by shortening the recitation to avoid standing for a long time, prolonged sitting between prostrations, frequent periods of rest and sitting down during rites of hajj like tawaaf.

 

Cerebro-vascular disease: Syncope can occur as part of stroke and may necessitate delay of salat and hajj rites. Judicial proceedings have to be suspended until functional recovery.

 

Coronary artery disease: Patients with a history of coronary artery disease have to be careful because physical exertion in salat, hajj and coitus may trigger a coronary attack. Coronary artery disease manifests as Ischemic heart disease. The pain of ischemic heart disease is so severe that it may necessitate delaying salat. Anginal pain may be triggered by exertion especially in hajj. Those with a history of myocardial infarction should take care in physical exertion in salat and hajj. Sexual exertion may trigger an anginal attack.

 

Aneurysm: Physical exertion in salat or hajj may lead to rupture of an aneurysm

 

Occlusive arterial disease: Patients with intermittent claudification may have to be careful in wudhu with very cold water that may trigger symptoms of Raynaud’s disease. It is preferable that they perform tayammum. They also have to be careful in their movements during salat.

 

Venous disease: For patients with varicose veins, tayammum may have to be considered in place of wudhu if water will cause pain or there are blisters and wounds or when the limb is bandaged. In phlebitis and thrombophlebitis, tayammum may have to be considered instead of wudhu. Sitting down in tashahhud may be difficult for those with phlebitis or blisters on their legs. In cases of elephantiasis, wudhu may be difficult especially if there are blisters and tayammum may have to be considered. It may not be possible to sit down in salat because of the size of the enlarged lower limb.

Emboli: For patients with DVT, movements of the lower limb in salat and hajj may have to be limited when it is feared that an embolus may be released. Prolonged sitting mat predispose to embolus formation. The embolus is dislodged as soon as the patient starts moving.

 

DISEASES OF THE HEART

Congenital heart disease: Congenital heart disease may take 3 main forms: left to right shunts, right to left shunts, and congenital valve stenos is. The decision for surgical treatment must weigh the benefits against the risk in such young patients. Since these diseases have a large genetic component, decisions have to be made about having more children.

 

Acquired valvular disease: The aortic valve may have stenosis or incompetence. The mitral valve may have stenosis or regurgitation. In either case care must be taken that physical exertion in salat and hajj does not lead to more severe decompensation.

 

Pericarditis: Restrictive pericarditis limits cardiac function. Care has to be taken in physical exertion in salat and hajj not to exacerbate the condition.

 

Congestive cardiac failure: Patients in CCF may be too weak to pray. Standing up for prolonged periods in salat may worsen the lower leg edema and compromise venous return even further. The muscle movements of salat may however have a beneficial effect in venous return. Hajj is better postponed in CCF because the patient may not be able to withstand the extra physical exertion involved.

 

Circulatory failure (shock): There are 4 main types of shock: hypovolemic, cardiogenic, septic, and neurogenic. The causes of shock are: endocrine, metabolic respiratory, cardiac, vascular, GIT, gynecological, obstetric, and neurological disorders. Dehydration and hemorrhage can also cause shock. Resuscitation in shock has 5 main elements: patency of the airway, restoration of breathing and blood circulation, removing the disability, and exposure. The following are monitored during treatment: pulse rate, respiratory rate, blood pressure, pulse pressure, capillary refill time, temperature, urinary output, CVP, blood gases, and blood sugar. Specific treatment of shock is by blood transfusion and IV fluids. In states of shock the physical movements of salat and hajj are not possible. Fasting is not allowed because of the need to replace body fluids. A patient in shock may not be able to feed in the conventional way; IG feeding and IV fluids may be necessary.

 

C. CONNECTIVE TISSUE SYSTEM

HEMATOPOIETIC SYSTEM (DAM)

Anemia is common in childhood and pregnancy. It is obligatory for the mother to take hematinics as directed in the interests of the fetus. It is obligatory on parents to provide sufficient nutrition to the infant to prevent anemia. Although breast-feeding is recommended for 2 years, it is not sufficient by itself after the 6th month. The father is obliged by Law to provide sufficient nutrition to the nursing mother and the infant to prevent anemia.

BONY SKELETON

Congenital and acquired disorders. Disorders of the bony skeleton are deformations leading to restricted movements that limit the range of possible physical movements in salat and hajj. The following are common congenital anomalies: dysplasia (achondroplasia & osteogenesis imperfecta); cerebral palsy due to neuronal injury; congenital club foot (talipes equinovarus); bow leg (genu varum; knock knee (genu valgum); developmental dysplasia of the hip joint; and scoliosis. They may limit the range of movements in salat. Acquired disorders include fractures and various types of arthritis.

 

Neck problems: The sideways movement of the neck in tasliim may be limited. Putting the head on the floor during prostration may cause pain.

 

Upper limb: Raising the hands in takbir may be restricted in cases of fractures and arthritis. Pointing with the finger is difficult after traumatic injury and arthritis. Pointing with the index finger is required in tashahhud (KS 320). It is forbidden to point with more than one finger (KS 320) or to intertwine fingers (KS 320).

 

Lower limb: The prophet described the method of bowing, kaifa yakuun al ruku’u (KS 319). In lower limb pathology bowing can be restricted. Prostration is also difficult since it requires flexion at both the hip and the knee joints. Tawaaf in hajj may be difficult with lower limb pathology. Patients can support themselves on a stick or a pillar during salat (KS 321).

 

Back problems: Pain and restricted movements of the vertebral column make bowing more difficult. Standing for prolonged periods may also be difficult. It is required that the back be straightened after bowing, istiwa al dhahar fi al ruku’u (KS 320); this is not possible in cases of back pathology. Back pain may also interfere with sexual function.

 

Knee problems: The prophet described the manner of sitting in salat, kaifa yakuun al juluus (KS 319). Sitting is required between every two prostrations, al juluus bayna kulli sajdatayn (KS 320) as well as in the last raka’a (KS 319). Restricted bending of the knees interferes with sitting properly. Knee problems may make tawaaf and sa’ay in hajj difficult.

 

Ankle problems: The prophet taught the proper way of placing the feet in sitting down, la yasaffu bayna qadamayhi (KS 320). These may not be possible with ankle problems.

 

Fractures & sprains: Wudhu may not be possible with open wounds and compound fractures and resort is made to tayammum. Pain due to sprains and fractures may limit movements in salat. Movements will not be possible at all when the limbs are immobilized. When a pilgrim has a fracture or becomes lame for any other reason, he is discharged from the rites of hajj and has to repeat the hajj later (KS 182).

 

Orthopedic fixation: Orthopedic fixation of some joints like the hip or knee joints may limit the range of movements possible in salat. In hajj tawaaf may have to be done in a wheelchair.

 

Osteomyelitis: Pain may limit movements in salat. If there is a discharging wound, tayammum will be needed instead of wudhu.

 

Malignant neoplasm: Care is exercised in salat and hajj to avoid pathological fractures that are common in bones with neoplastic disease.

 

Osteoporosis: care has to be taken in movements in salat and hajj to avoid fractures. Treatment of osteoporosis with hormone and mineral replacement is obligatory for postmenopausal women so that they can lead a normal life.

 

CARTILAGE DISORDERS

Laryngeal, pharyngeal, or other oral diseases may impair the ability to recite the Qur’an. Patients with such conditions cannot be prayer leaders, imaam al salat. Public duties like leadership that require communication may be impaired. Pleas and evidence in court may also be affected.

 

JOINTS

Salat is intimately related to joints because of the physical movements involved, salaat al awaabiin wa al fisaal (KS 318). Osteoarthritis and rheumatoid arthritis cause pain and limitation of movement. These limit the physical actions needed for salat and hajj. Degenerative disorders of the vertebral column such as spondylosis (arthritis of the spine), intervertebral disc disease (herniation), spondylolisthesis (anterior displacement) impair ability to stand for long periods in salat as well as tawaaf and sa’ay.

 

MUSCLES

Injury to muscles will necessitate limitation of movements in salat while they heal. Some diseases of muscle weakness like myasthenia make it impossible to make the full range of movements required in salat.

 

OTHER CONNECTIVE TISSUES

Skin lesions: Skin lesions such as eczema, dermatitis, itch, discharges, rashes, and chronic ulcer are a reason for tayammum. If the skin is bandaged, the bandage is wiped with the wet hand

 

Hair: Shaving or cutting hair is forbidden in hajj. An exemption is made for those with lice in their hair but a fidyat has to be paid.

 

INJURY TO LIGAMENTS

Injury to ligaments may limit movements in salat

 

 

 

D. ALIMENTARY SYSTEM

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. The patients are immediately excused from the obligation of fasting until full recovery. Salat can be performed as much as their physical condition allows.

 

Peptic ulcers: Fasting may not be possible in advanced stages of peptic ulcer disease. Gastric ulcer and duodenal ulcer may be complicated by: perforation, hemorrhage, and obstruction due to chronic fibrosis. Perforation and hemorrhage are a surgical emergency. Chronic obstruction is a cause of pain, indigestion, and other gastro-intestinal problems that could interfere with fasting.

 

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. Their impact of saum and salat is variable depending on the complications.

 

Disease of the oro-pharyngeal cavity: Common conditions of the oropharyngeal cavity are tonsillitis, sialedinitis, and neoplasms. The neoplasms are squamous cell carcinoma, carcinoma of the larynx, and salivary gland tumors. They interfere with eating and drinking as well as recitation of the Qur’an in salat.

 

Disease of the esophagus: The common disorders of the esophagus are motility disorders (achalasia, spasm, reflux), strictures, Barret's esophagus, esophageal cancer, and 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. Esophageal varices may lead to hematemesis that voids fasting.

 

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. Patients with malabsorption may be exempted from fasting while they are on treatment with special diets that have to be taken during the day or if their nutritional status requires regular food intake.

 

Disease of the large intestine: The common diseases of the large intestine are: diverticula, volvulus, ulcerative colitis, and chron's disease. They interfere directly with fasting if they are associated with vomiting which voids fasting. Continuous diarrhoea may make the maintenance of wudhu difficult. Stoma created after operation for cancer of the colon do not normally interfere with saum, salat, or hajj.

 

Diseases of the anus: The common conditions of the anus are hemorrhoids and anal fissure that are associated with bleeding and pain. Wudhu will have to be made immediately before the salat and for that salat only. It has to be repeated for every salat. Care must be taken during instinjah not to cause undue pain in case of anal fissures.

 

General conditions: Extreme obesity makes salat difficult because of body weight, physical weakness, and restricted movements. Saum is good for the obese.

 

IMPACT OF GIT SYMPTOMS AND SIGNS ON 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. If the hiccup persists it is preferable to terminate the salat and wait until it subsides.

 

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. Salat should not be terminated on mere suspicion of passing flatus.

 

Diarrhoea: A situation of continuous diarrhoea makes it difficult to maintain a state of wudhu or to pray in congregation. When an episode of diarrhoea is impending, salat is terminated by tasliim at any stage and is resumed after defecation and a new wudhu.

 

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

 

GIT bleeding: Upper GIT bleeding that does not cause visible blood at the anal opening does not nullify wudhu. If it leads to hematemesis, saum is void and has to be made up later. Fresh bleeding from hemorrhoids and anal lesions does not nullify wudhu but must be washed away immediately and before salat commences.

 

Abdominal discomfort: Any cause of abdominal discomfort such as pain, cramps, spasms, and digestive disorders make it difficult to concentrate in salat. It is recommended to delay salat until the discomfort is treated.

 

Cholelithiasis: Pain of gallstones in an acute attack makes concentration in salat difficult. Associated vomiting may void saum.

 

Colostomy: The colostomy site is kept as clean as possible all the time. Wudhu is made before each salat. Normally there is no interference with saum.

 

Oral cavity: Halitosis, bad oral smell due to caries, gingivitis, and oral ulcer; is a reason for keeping away from public assemblies until the condition is cured.

 

IMPACT OF GIT DISEASE ON ‘AADAAT

Eating and drinking are the most important of the ‘aadaat and are impacted directly by an GIT disease. They in turn cause many GIT diseases. Human activity is intimately related to the daily routines of meals. Thus GIT disease by interfering with meals causes considerable change to the daily routines and obligations.

 

IMPACT OF GIT DISEASE ON MUAMALAAT

Disease transmission by feco-oral route requires special measures to protect public health in the food service industry. Islamic teachings about personal hygiene play a role in preventing the spread of infection.

 

E. SENSORY SYSTEMS

THE VISION SYSTEM

Ibadat: The obligation of salat al jama'at and salat al jumu'at 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 if there are others to help him see the way.

 

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 cannot 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.

 

Evidence in court: Evidence requiring sight cannot be accepted from a blind person. Other types of evidence are acceptable.

 

Marriage: A blind person can get married without seeing and knowing the bride but measures must be taken to make sure there is enough mutual knowledge of the future spouse based on other senses that are intact like hearing and getting information from others. The sunnat mentioned marriage to a woman with congenital blindness, man tazawaaja imra at wa biha baras (KS 550). A blind person can be being wali in marriage if there is sufficient information that he knew the spouses before getting blind and can recognize both using other senses.

 

Mu'alamalat: Selling and buying by a blind person can take place in transactions where fraud is unlikely. Blind persons can offer professional services if there is no possibility of harm due to their lack of sight.

 

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: Inability to hear adhan is not an excuse for not going to congregational prayers because one can rely on others. A deaf person can be a muaddhin if there is a way for him to know the right time for salat. A deaf person can be imaam. A deaf person can follow by imaam by watching what the imaam does even of he cannot hear. In vestibular disturbances standing up in salat or tawaaf may require support. A deaf person can teach Qur’an but it is preferred he does not do so because he cannot hear and correct mispronunciations.

 

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

 

Holding public office: Deafness reduces competence as a leader but is not an absolute contra-indication. A deaf judge will not be able to discharge duties fully. 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 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.

 

Marriage and divorce: A deaf person can contract a marriage by use of reading or sign language. A deaf person can declare divorce. The situation is complicated if the spouse being divorced in deaf because she can claim that she cannot hear and understand the divorce pronouncement.

 

Mu’alamalat: A deaf person can buy and sell as long as he understands the transaction and can communicate in writing or by sign language. It is forbidden for a deaf person to engage in any professional work such as driving a truck for which hearing is necessary.

 

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

 

Munakahaat: Body or oral odor may cause so much distress in a marriage that it may

lead to divorce.

 

Mu’amalat: Impaired smell may make transactions involving perfumes invalid because

the buyer cannot identify what is being bought. Similarly impaired smell may lead to buying of rotten products without knowing their true state.

 

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

 

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 cannot be tasted. Family

 

Mu’amalat: 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.

 

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

 

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.

 

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

 

Mu’amalat: Loss of tactile sensation may be a cause of accidents at work.

 

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

 

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 if a promise was made in the marriage contract that the spouse will not be taken to another country. 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) & THE SENSATION OF THIRST (‘ATASH):

Salat is delayed in cases of extreme hunger sensation, al ta’aam qabla al salat (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. Concentration is salat is impaired in extreme thirst

Professor Omar Hasan Kasule Sr. January 2001