Dissection

Assalaamu'alaikum,

Dissecting Human Dead Bodies for Medical Purposes

In the first place, we would like to note that Islam cares much for a person whether dead or alive. Jabir Ibn `Abdullah (may Allah be pleased with him) said: “One day we accompanied the Prophet (peace and blessings be upon him) in a funeral of a person. When we reached the graves, we sat down. The gravedigger brought out a bone- of a leg or another organ- and began to break it. The Prophet (peace and blessings be upon him) said: ‘Do not break it, for breaking this bone, even after the death of its owner, is like breaking it while he/she is alive.’” (Reported by Malik, Ibn Majah and Abu Dawud)

Handling the issue of dissecting human dead body for medical purposes or the like, Sheikh `Attiya Saqr, former Head of Al-Azhar Fatwa Committee, issues the following fatwa:
In fact, there is no religious text tackling directly the issue of using the organs of the dead for medical or scientific research. The issue is controversial among Muslim scholars; each making his own Ijtihad (Personal Reasoning).

In the fatwa issued by the Egyptian House of Fatwa on 31st Oct. 1937 on the issue of dissecting the belly of a dead person who swallowed an amount of money, it is stated:
The Hanafi scholars permit dissecting the belly of such a person if the money belongs to another person and the deceased left no money that can be given to the owner. The simple reason for this is that the right of a human being takes priority over the right of Allah and the right of the wrongdoer. It goes without saying that it was a wrong thing done by the deceased by unjustifiably taking a person’s money.

The view of the Shafi`i scholars is that they permit dissecting the belly of a dead person for the purpose of taking out money without giving further details on the issue. The same view adopted by Maliki jurist, Sahnun, while Ahmad holds the opposite view.

As for opening the belly of a dead mother for the very purpose of taking out the baby, the Hanafi scholars permit it if the baby is known to be alive, for this will help in saving the life of a human being. The same view is upheld by Shafi`i scholars while the Malikis and the Hanbalis disallow it.

The correct opinion is that the rules and the objectives of Shari`ah indicate that if there is a benefit behind opening the belly of a dead person, leading to establishing the cause of death or restoring back a right, then dissection is permissible in this case.

The Fatwa of late Sheikh Jadul-Haq `Ali Haq, former Grand Imam of Al-Azhar (may Allah bless his soul) also reads:
According to both Imam Abu Hanifah and Ash-Shafi`i, it is permissible to open the belly of a dead person, if there is a valid reason for doing so, such as taking out a living baby or valuable or precious thing (money or jewelry or the like) that the person has swallowed. The view of Malik and Ahmad is that it is allowable to do so in case of money and not in case of a baby. I myself support this view. To me, there is nothing wrong in opening the belly of a dead person so as to take out something valuable such as a living baby or money of considerable value.

As for using human organs after death, late Sheikh Jadul-Haq adds:

It is permissible, if the deceased is of unknown personality or family, to take his/her bodily organs and use it in treating another person or for medical research. All these are in fact very important and of general benefit for all Muslims.

Now, to the question of using the bodily organs of a dead person for research purposes. The Fatwa of Sheikh `Ikrimah Sabri, the Mufti of Al-Quds & the Khatib of Al-Aqsa Mosque, states:
Islam shows unprecedented care for the needs of man and the necessities of life. It makes it permissible to reveal the private parts of a male or a female in case of necessity. All this stems from the juristic rules: “Necessity dictates exceptions.” This rule is also governed by another rule that reads: “Necessities are duly estimated."

It is thus permissible to dissect the dead body of a person with the very aim of discovering diseases or finding out a treatment or knowing the functions of bodily organs and the component of human body. It is also permissible to resort to carry out this process for the purpose of knowing the reason that caused the death of a person, and this will be useful for homicidal investigation. Using the bodily parts of a dead person is also permissible for the students of medicine who do so as a way of training. However, this is to be carried out in a place specialized for that purpose and not open for everybody.
By and large, dissecting human dead bodies for medical research is permissible so long as the Islamic morals of preserving the body and confining the process to such medical purposes are maintained.

Elaborating on the issue of conducting postmortem, we would like to cite for you the following:
A postmortem is permissible if it is conducted for the right purpose. We can say that determining the cause of death, either when a crime is suspected or to enable medical students and their teachers to learn about the effects of certain diseases, is a legitimate purpose to carry out a postmortem. Many people are under the impression that postmortems are forbidden in Islam. It is certainly forbidden to show disrespect to or assault the dead body of any person. Islam forbids the disfigurement of enemy soldiers in battle. It would certainly not allow the cutting up of dead bodies for idle play. A legitimate purpose, however, is different. If a medical purpose is not legitimate, what is?

Source: www.islamicity. com

Dr. Muzzamil Siddiq, former President of Islamic Society of North America (ISNA), adds:
Dissection of the human bodies for the purpose of medical education is allowed in Islam. There is a basic rule in the Shari`ah that says: “What is necessary for the fulfillment of an obligation, becomes an obligation itself.” It is obligatory to treat people and perform surgeries on them when they need. To perform this obligation it is necessary to study human anatomy and for this purpose dissection has to be done as and when necessary.

It is, however, important that the bodies should be taken with the consent of the deceased or his/her relatives. If the deceased had no relative and his/her body was unclaimed, then such bodies can be used for the dissection purpose only with the permission of a local other legal authorities.

The Prophet (peace and blessings be upon him) said: “The ruler (or the legal authority) is the guardian of him who has no guardian.” If a Muslim’s body is used for the dissection, then it should be washed. Funeral prayer should be performed before the dissection. After the dissection all the parts of the body should be collected in a bag and then they should be properly buried. I am told that some Muslim medical schools did follow this procedure.

However, stealing the bodies from the graveyards is prohibited. This is exactly a grave sin. A Muslim should neither steal a dead person’s body, nor should Muslim medical students buy or use such bodies. Those who have done that out of ignorance should make repentance to Allah and ask His forgiveness.

Excerpted, with slight modifications, from: www.pakistanilink. com

In conclusion, it is to be noted that scholars have a lot to say on the issue at hand, but as we have noticed the preponderant view is that dissecting human dead bodies is permissible on the condition that it is done while adhering to the Islamic regulations stated above which aim at maintaining the highest degree of security and safety of the body.

Kejadian Manusia

Friday, May 15, 2009

VAGUS NERVE- CN 10

Assalaamu'alaikum,

Sudah bersedia dengan topik baru? Ya, hari ni akan agak panjang sikit sesi pembelajaran kita sebab saraf VAGUS mempunyai ruang lingkup pensarafan yang besar berbanding saraf kranial yang lain kerana ia mempunyai cabangan-cabangan di leher, cabangan-cabangan di bahagian thorax dan juga di abdomen. Jadi, saya berharap anda memberi tumpuan dengan baik dan S.A.B.A.R. ;)

1. Serat-serat saraf vagus datang dari nucleus ambiguus dalam medula oblongata.
2. Daripada nucleus itu, ia keluar daripada sebelah sisi medula (lateral) dan meninggalkan skull melalui jugular foramen.
3. Perhatikan: bahagian saraf vagus yang berada di dalam jugular foramen mengalami bengkakkan atau swelling atau enlargement yang disebut sebagai SUPERIOR GANGLION.
4. Just bawah daripada foramen ini saraf vagus mempunyai satu lagi bengkakkan yang agak lebih besar yang disebut sebagai INFERIOR GANGLION. Lihat atlas.
5. Kemudian saraf vagus turun secara menegak ke bawah di dalam leher. Semasa di leher, saraf vagus berada di dalam carotid sheath. Di sini (di dalam carotid sheath) ia berada pada kedudukan di antara artery dan vein. Di bahagian atas sedikit ia berada di antara belakang internal carotid artery dengan internal jugular vein, apabila turun ke bawah ia berada di antara belakang common carotid artery dengan internal jugular vein.
6. Di bahagian bawah leher, saraf vagus akan memintas depan atau anterior daripada first part of subclavian artery (lihat atlas) dan memasuki thorax dan terus ke abdomen.

Kita sekarang melihat secara detail cabangan-cabangan daripada saraf vagus. Ia bolehlah dibahagikan kepada berikut:

A. CABANGAN SARAF VAGUS- KETIKA DI BAHAGIAN LEHER
B. CABANGAN SARAF VAGUS- KETIKA DI BAHAGIAN THORAX
C. CABANGAN SARAF VAGUS- KETIKA DI BAHAGIAN ABDOMEN

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A. CABANGAN SARAF VAGUS- KETIKA DI BAHAGIAN LEHER:

Seperti yang kita tahu, saraf vagus akan memberi cabangan-cabangan yg banyak di bahagian leher, thorax dan abdomen.

Ketika saraf vagus melalui bahagian leher ia memberi cabangan-cabangan berikut:

Sila lihat atlas ya.

1. Satu cabangan meningeal yang muncul berdekatan dengan hujung atas daripada saraf vagus.
2. Satu cabangan auricular yang muncul daripada superior ganglion. Ia disebarkan ke kulit cuping telinga (auricle), external acoutic meatus dan tympanic membrane.
3. Cabangan pharyngeal yang muncul daripada inferior ganglion. Ia membahagi lagi kepada lebih banyak cabangan bagi membentuk pharyngeal plexus. Serat-serat saraf plexus ini akan mensarafi otot-otot pharynx dan juga soft palate (KECUALI otot TENSOR PALATINI yang disarafi oleh saraf kranial 5/trigeminal melaui cabangan mandibularnya).
4. Satu atau lebih cabangan daripada saraf vagus akan mensarafi carotid body.
5. Saraf SUPERIOR LARYNGEAL juga muncul daripada inferior ganglion. Ia kemudian turun ke sisi dinding pharynx dan tamat dengan membahagi kepada beberapa cabangan lagi:

1. Internal Laryngeal nerve:
Ia adalah cabangan SENSORY. Ia memasuki larynx dan memberi cabangan pensarafan kepada:
a) mucous membrane of separuh atas daripada larynx (up to vocal folds) dan
b) mucous membrane daripada bahagian pharynx, dan bahagian paling belakang daripada lidah (most posterior part).

2. External Laryngeal nerve:
Ia adalah cabangan MOTOR yang mensarafi otot cricothyroid.

cont..
6. Saraf RECURRENT LARYNGEAL.
Perhatikan: Perjalanan saraf ini TIDAK SAMA di sebelah kiri dan di sebelah kanan. Mengapa?

i. Di sebelah kanan, saraf ini muncul daripada saraf vagus semasa saraf vagus sedang melepasi depan daripada subclavian artery (lihat atlas). Ia kemudian berlalu ke belakang, di bawah subclavian artery tersebut dan kemudiannya naik ke atas dengan membentuk loop. Ia terus naik ke atas dan ke medial deep to common carotid artery untuk sampai ke sisi daripada trachea.

ii. Di sebelah kiri pula, saraf ini muncul daripada saraf vagus ketika saraf vagus berada di dalam thorax iaitu ketika memintas lateral to arch of aorta. Ia memusing di bawah arch of aorta itu, immediately belakang ligamentum arteriosum dan terus berlalu ke atas dan ke medial untuk sampai kepada sebelah sisi daripada trachea.

Note: sampai sahaja ke trachea, kedua-dua saraf recurrent laryngeal sebelah kiri dan kanan akan menaik dalam satu groove atau celah diantara trachea dan esophagus betul-betul deep to the medial side of thyroid gland. Di hujung atas (upper end) daripada trachea dan esophagus, saraf ini berlalu deep to the lower border of otot inferior constrictor dan terus memasuki larynx. Ianya disebarkan seperti berikut:

a) Ia memberi pensarafan MOTOR kepada semua otot intrinsic larynx (KECUALI otot larynx cricotyroid yang disarafi oleh external laryngeal nerve tadi).
b) Ia memberi pensarafan SENSORY kepada mucous membrane of the lower half of the larynx iaitu; bahagian yang bawah daripada level vocal folds.
c) Ia memberi cabangan SENSORY ke trachea, esophagus dan juga inferior constictor. Juga memberi cabangan ke CARDIAC PLEXUS

Cont.
7. Cabangan CARDIAC daripada vagus nerve.
Setiap saraf vagus (kiri dan kanan) memberi satu atau lebih SUPERIOR CERVICAL CARDIAC BRANCH di bahagian atas daripada leher dan INFERIOR CERVICAL BRANCH di bahagian bawah daripada leher. Cabangan-cabangan ini berakhir dalam superficial and deep cardiac plexus seperti yang disebut sebelum ini.

Ok. Rehat sebentar. Sebelum kita pergi kepada cabangan saraf vagus di bahagian thorax eloklah kita mengetahui dahulu apakah komponen fungsian (functional components) saraf vagus ini.

(1). Saraf vagus terdiri daripada predominantly serat-serat PARASYMPATHETIC yang sangat tersebar luas yang bertanggungjwb untuk pensarafan parasympathetic organ viscera thorax termasuk jantung, bronchi dan sebahagian besar daripada gastrointestinal tract.
Jadi serat-serat saraf vagus ini adalah PREGANGLIONIC. Ia muncul daripada DORSAL NUCLEUS of vagus dan melepasi saraf vagus dan cabangan-cabangannya untuk sampai kepada organ viscera yg disarafinya. As a rule,saraf POSTGANGLIONIC akan berada dekat dengan organ viscera, atau terus dalam dinding organ viscera itu sendiri!
Serat-serat sarafnya mensarafi:

i. otot licin (smooth muscle) dan
ii. kelenjar (glands) yg ada dalam dinding organ viscera yg berkenaan.

(2). Serat-serat saraf yg muncul daripada nucleus ambiguus akan melepasi cabangan superior laryngeal, recurrent laryngeal dan cabangan pharyngeal daripada saraf vagus dan mensarafi otot-otot pharynx, larnynx dan soft palate.

(3). Serat-serat afferent (sensory) daripada pharynx, larynx, trachea dan esophagus; dan organ viscera thorax dan abdomen berjalan melaui saraf vagus to sampai kepada NUCLEUS OF SOLITARY TRACT (lihat atlas).

(4). Saraf vagus juga membawa sensation of taste daripada posterior most part of the tongue dan daripada epiglottis. Serat-serat saraf ini melalui superior laryngeal nerve dan berakhir di dalam NUCLEUS OF SOLITARY TRACT (lihat atlas).

(5). AKHIRNYA vagus juga ada mempunyai serat-serat saraf yg mensarafi kulit. Serat-serat itu melalui cabangan auricularnya untuk sampai kepada skin of auricle.

To be continued...

JustRehat ;)
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