Before anasthesia, even routine surgeries were painful and dangerous. Its advent has allowed for amazing advances in public health and patient safety.

Humanity has faced various kinds of health problems throughout history, and will be facing them until the end of time. Even someone who has not yet suffered from an illness, will almost certainly suffer from one in the future. Let’s take a moment to reflect on all the people who are currently undergoing treatment at hospitals in the hopes of curing an illness.

From time to time we visit close friends and relatives who have undergone such operations. We wish them health and talk with them a little. We ask them how the operation felt, how many stitches they have. They usually say, “They injected me with something and I don’t remember the rest.” Then they may show us their gall bladder, wrapped in gauze, or their kidney stone, which was removed. Have you ever pondered how it is possible not to feel any pain during these kinds of operations, or how it is possible not to remember anything?

Surgical practices have advanced so much in present times. Heart, liver, and kidney transplants are now commonplace, as are finger and arm reattachments. Anesthesia, which makes all of these operations possible and painless, is a great blessing. Even the small and simple surgeries performed just 150 years ago were very difficult for surgeons – not to mention very painful for patients.

In his famous book on physiology and treatment, The Canon of Medicine the renowned 10th and 11th century scholar, Avicenna (Ibn-i Sina) (980-1037), defines anesthesia as, “a numbing and a cooling remedy.” He gives pathophysiological commentary on the influences of anesthetics and analgesics, and summarized painkilling methods as following:

1. A mixture prepared from linseed and dill should be applied to the area of pain.
2. Decreasing the sensitivity of the area of pain by increasing the moisture of the area, or providing narcotics for sleep.
3. Providing cooling and analgesic and anesthetic medicine.

Biruni, another Islamic scholar from the 11th century, documented his work with analgesic and anesthetic medicine. One of his writings recommends boiling the root tubers of henbane, Mandragora, horned poppy (Glaucium flavum), and Iris, together with the attar of roses and vinegar.

In his pharmacological works of the 12th and 13th centuries, Samarqandi recorded the analgesic, sedative (calming), anesthetic, and hypnotic effects of opium, mandragora, henbane, lettuce, beaver testicles, aloe vera, and coriander.

During the end of the 17th century, in Italy, anasthesia was performed by preventing the patients from breathing until they lost consciousness, and then immediately performing surgery on the patient who had fainted. This was called the asphyxia technique. The surgeries performed were relatively easy, such as the cutting of an arm or leg. The surgeon who was fast was considered the best, because patients could wake up during the surgery – that is, if they survived the procedure.

Another interesting anesthetic technique was making the patient lose consciousness by hitting them on the head. The hitting had to be done, “Hard enough to break the shell of an almond but gentle enough not to destroy its seed.” However, a bitter truth is that many patients were killed during this process.

Many have suffered the consequences of the absence of anesthesia in the past. Dr. Warren, a professor at Boston’s Massachusetts General Hospital in 1846, had placed his operating room on the very top floor of the hospital in order to avoid disturbing others with the screams of the suffering patients. One day, while examining one of patient’s tongues with pliers and a scalpel, he pulled the tongue of the patient without warning, and cut off his tongue with the scalpel. Afterwards, without hesitation, he cauterized his patient’s tongue with a hot iron. Dr. Warren observed the screaming, moaning, and suffering of the patients with no sign of emotion. He did not seem disturbed, and this was the exact attitude he needed in order to perform his duty. However, years later when enough advancement was done in the area of anesthesia, he couldn’t hold back his tears during the first operation that was performed with anesthesia.

Surgeries performed without anesthesia were hard on surgeon and patient alike. During his studies, the English gynecologist, Doctor James Young Simpson, fainted while cutting off a breast and considered quitting being a surgeon. Prof. Dr. Robert Liston was a famous surgeon at London University College. Dr. Liston had a reputation for being rude, arrogant, and strong. But he had no choice: he was forced to cut off a leg in 28 seconds, as anesthesia was not yet developed.

As can be seen from these examples, the absence of anesthesia, and the incredible suffering of the patients, pushed surgeons to be incredibly fast and emotionally insensitive. This period of time defined surgeons as strict, insensitive, and despotic. This went on until 1846, when William Thomas Morton performed the first surgery with anesthesia.

Since then, anesthesia has made surgeries much easier for all involved. Today, the definition of general anesthesia is total or partial loss of sensation in a human or animal body before surgical intervention.

Usually, anesthesia is performed by injecting medicine into the blood, or by making a patient breath an anesthetic gas. First, the patient loses consciousness, and then, with the help of muscle relaxants, the patient is put in a state of paralysis. Artificial respiration is performed until the end of the operation with the help of breathing machines called ventilators. For this purpose, an endotracheal tube is inserted in the windpipe of the patient and they are hooked to an anesthesia machine. This feeds oxygen, air, and the anesthetic gas to the patient. The anesthesia doctor controls the patient’s breathing, blood pressure, and heart rhythm, as well as other various, vital parameters, and the fluids that will be fed to the patient throughout the surgery. By doing this, the continuity of the anesthesia is made possible. When the surgery is over, the anesthetic drugs are no longer fed to the patient. When the muscle relaxants lose their effect and breathing returns to normal, the endotracheal tube is taken out and the patient is taken to another room to wake up. This is where the patient opens their eyes; it’s almost like a re-birth.

The chemicals in cannabis, opium, and coca were the essence of the first drugs used for general anesthesia; they are still being used, partially, in modern times. These chemicals, and some synthetic chemicals like them, are used for anesthesia and can be used after surgery in order to soothe pain. Most of our contemporary drugs are mostly synthetic, and they require many years of difficult education to be properly handled. It takes four years of additional education, after medical school, for a surgeon to become proficient with anesthetics.

Medical research done in the last two centuries about the dosage and quantity of these chemicals has advanced the practice of anesthesia incredibly. All this research provides a very good answer to why drugs have been created. While surgeons use the chemicals extracted from cannabis, opium, and coca, and from the synthetic chemicals like them, as a service to humanity, it is really hard to understand why some ill intentioned people use them for the detriment of human health.

Open heart surgery is performed after putting the patient to sleep under a general anesthetic. The chest is then opened by the surgeon, and the heart is temporarily bypassed or deactivated for the duration of surgery (although in some new techniques like beating heart surgery or minimal invasion heart surgery, the operation is possible without deactivation of the heart) During this period the functions of the heart are performed by an artificial lung mechanism called the heart-lung machine (cardiopulmonary bypass machine). Performing surgery on a working heart cases where there is no facility for beating heart surgery would be like trying to repair the engine of a car while it is in motion. This is why it is necessary to temporarily prevent the functions of the heart during the operation, which requires great care and accuracy.

Stopping the heart

During this procedure the patient is connected to the machine, thin pipes called cannulae are inserted into the main veins which lead to the heart, and thus the blood which goes to the heart is directed into the heart-lung pump, fed with oxygen, and then redirected into the body. Preventing the function of the heart is not a very difficult process. When the heart-lung machine is activated and the blood is cooled and redirected into the blood vessels, the body temperature is reduced to below 30°C, and this lowers the heart rate and assists the heart to stop functioning. The actual stopping of the heart is performed by feeding a serum containing a concentrated solution of potassium ions into the coronary artery, which feeds the heart muscle. Potassium ions are normally found in the human body but in a fixed proportion; potassium is an electrolyte which, if increased, causes a defect in the heart’s rhythm and can lead to ceasing of the heart function. Feeding the coronary artery rapidly with a rich potassium solution causes the heart to stop within a few seconds and allows the surgeon to perform the operation on a non-functioning, motionless heart.

The heart should not be stopped from functioning for a long period, even if the heart-lung pump is performing the function of the heart successfully. Under normal conditions the pump cannot perform the whole duty of the actual heart and lungs. When the body temperature is reduced, there is a reduction of functioning in many organs of the body to such an extent that they almost stop working, especially the brain. This means that every organ freezes and if the patient’s pulse were taken within this period, they would be assessed as dead.

Restarting the heart

To restart the heart following the operation a reversal of the procedure performed at the beginning of surgery is necessary; the temperature of the body is increased to 36.5–37°C again with the help of the heart-lung pump, and at the same time the amount of potassium in the blood is reduced to a normal level. This is usually executed by ensuring the normal function of the kidneys which discard the potassium from the body. This is when the function of the heart is monitored closely because there is a reversal in the process of inducing low body temperature and the excess of potassium which caused the heart to stop. In other words, the barrier which stopped the flowing river is removed; therefore, according to the laws of physics, the trapped fluid should flow again at great speed, and although following surgery the majority of hearts do begin to function again when these procedures are performed, there is unfortunately no actual guarantee. There may be certain complications or even causes which we have not yet discovered, in which case an electric shock of 10–20 joules is delivered directly to the heart muscle to encourage it to function normally. If this is unsuccessful, medication such as adrenalin, which induces the functioning of the heart, is given to the patient. If, following these repeated procedures, there is no effect, and, regardless of all the effort, the heart does not function, then everything is performed again from the beginning, including the operation. But there is always the possibility that the desired result may not be achieved. Human beings always face the prospect of death in daily life, and although there is a very slim chance of death, with such a big operation there is always the possibility.

The result

We are normally totally unaware of the rhythmic incidents, a combination of great harmony, occurring within our bodies. Even breathing, a necessity for every living creature to stay alive, is not an action which we activate and continue of our own will. Sight, hearing, hunger and senses are acts of nature over which we have little direct will or power. Nevertheless, they are all events which we can only describe as divine miracles and what a great blessing it is that none of these complex functions of our bodies have been left to us humans.

The disintegration of communism led to the dawn of a new era in which Western values would predominate and the world re-organized on the basis of ‘global’ co-operation and international solidarity rather than confrontation and conflict, now looked upon as the remnants of the Old World Order.

After the collapse of the communist block with its ideology proven to be a failed experiment, the world’s attention turned to the establishment of a new and ‘just’ world order which would promote global peace and security and foster international solidarity. Today, few would dare claim that this has been achieved. The slogans have changed, as have some governments and a few flags, but for many, the new order has brought them nothing tangible.

The richest 20 per cent of the world’s population still earns 60 times more than the poorest 20 per cent. The disproportionate distribution of the world’s resources threatens the world with environmental and economic crises. In part, it was these crises that formed the motivation for a new order. Global problems can only be resolved through global co-operation and solidarity. The obvious answer was a new world order.

If the current level of population growth continues, over one billion people in Africa will be without the basic necessities of life, such as food and water by the year 2025. Poverty and political unrest due to disputes over resources have generated huge refugee flows. There are 75 million people displaced every year. Of the 75 million, 2 million migrate from the poor nations to the richer countries in search of a better life. Some may say they are the lucky ones, but often they face greater hardship in their adopted lands than at home.. They face a variety of new social problems and are forced to overcome different challenges. The terminology may have changed, but the reality has not.

The New World Order is said to be marked by three notions: democracy, market economy and peace and co-operation. As to the present world order, it was based on three citadels of positivism, namely, sovereignty, nation-statehood and the liberal notion of property, none of which can offer adequate solutions to the current crises of humankind. The new order is, in fact, not new, as its economic, military and philosophical underpinnings have much in common with those of the world order established alter the first and second World Wars. The present world order leads the way to a zero sum game of some sort; everyone wins everything or everyone loses everything.

Fortunately, not everyone subscribes to Fukayamis thesis concerning ‘the end of history’. They do not believe that history ends with liberalism’s victory over communism. The West may think that the end of communism is the total exhaustion of all viable systematic alternatives to Western ideology, and corollary, the universalization of Western liberal democracy, crafted with the norms set in the old world order, will be the ultimate point of humankind’s ideological evolution.

In a rapidly changing world order, those who do not accept this as the end of the story have a duty towards themselves and others not to remain marginalized. There is an alternative. We must strive to understand the contemporary world and apply the principle of trusteeship that is natural to all communities. The concept of the world being a trust in the hands of humankind is nothing new and it is not limited to any one community. Understanding that God gave us the world as a trust leads us to adopt a special world-view. It is this world-view that offers us alternatives for the future direction of humankind and the answer to our various problems. Surely the earth belongs to God and He bequeaths it to such of his servant as He pleases… (al-A’raf 7.129); and certainly, to Him belongs all that the heavens and the earth contain” (al- Hajj, 22.64).

A new world order should be built upon co-operation, solidarity and brotherhood among all the nations of the world. To this end, true understanding of trusteeship is a significant milestone one the way to universal brotherhood.

In a society be it domestic or global, where the world is seen as trust and concept of trusteeship is embedded in the hearts and minds of individuals and rulers, justice emerges in a natural divinely- ordained manner. Where the concept of amana, trusteeship, is forgotten, wealth is concentrated in the hands of a few. Lack of effective motivation to reduce inequalities is bound to destroy, rather than foster the feelings of brotherhood that submission to God’s natural way ultimately creates. Submission is not restricted to worship. God has ordained a role for humankind.

The resources with which God has endowed this world are finite but sufficient to cater for the well-being of all, if used efficiently and equitably. The responsibility of khilafa, guardianship, should lead us to find ways of utilizing the God-given resources in so efficient and equitable a manner that the well-being of all is ensured. This can only come about if the resources are used with a sense of responsibility and a constraint determined by Divine Guidance.

Although the khilafa was the ultimate symbol of Muslim political aspiration, responsibility according to Divine Guidance has been lost in their lands and the imbalance of resources is even greater among its people than elsewhere. They present the best examples of unequal and unjust distribution.

There are great disparities among the fifty or so Muslim states. Natural resources are unequally distributed. Where water is abundant, oil is scarce; where oil flows like the sea, there is scarcity of water and arable land; in a country where the land is arable, there are no mineral resources; where there are tropical forests, there is insufficient supply of energy etc. The Muslim states clearly need each other. However, forgetting trusteeship has led them to disunity.

As well as unequal distribution of natural resources, wealth has also been distributed unevenly. For example, following the sharp rise in petroleum revenues in 1974, Saudi Arabia became one of the fastest growing nations in the world. Saudi foreign assets grew from about $4.3 billion in 1973 to nearly $150 billion in 1982. However, due to the steady decrease in the price of oil, that amount has fallen down by more than $60 billion since 1982. The same can be said for other petrol-rich Arab countries.

Accordingly, six Arab states-namely Saudi Arabia, Kuwait, Bahrain, UAE, Qatar and Oman-with a total population of approximately 16 million people have a combined GNP of about 150 billion dollars. The other Arab states, with a total population of about 205 million, have a combined GNP of 200 million dollars. As a result, GNP per capita in the ‘rich six’ is about 9,400 dollars as compared to only 975 dollars in the poor states, a ratio of almost 10 to 1. (Rabie, 1992. p.103). Consider the immense divide between Brunei and Bangladesh. Brunei’s GNP rate per capita is slightly more than 15,000 US dollars; in Bangladesh, it is only 179 dollars. The ratio is a staggering 84 to 1.

We recently witnessed how the uneven distribution of strategic energy resources was used to destroy Muslim brotherhood. Muslim countries spent billions of dollars on weapons to protect God’s resources and wealth from satisfying the needs of God’s servants. The military industry of the West is being fed at the expense of Muslim solidarity. Imagine what could happen if, instead, these billions of dollars were to used for the welfare of the Muslim peoples.

In the future, we may see regional wars fought for control of the most important resource in the Middle East, namely, fresh water. Scientists estimate that the total population of the region will be 423 million by the year 2000 and will have doubled in twenty-five years time and therefore many countries will have only about half as much water as they had in the 1970s (Bulloch & Dhrimsh, 1993). If water is exploited as a political weapon rather than shared among the people of the region, in accordance with the terms of amana. we may witness the coming to pass of one of the prophecies of God’s Messenger, upon him he peace, who said: There will emerge a mountain on the waters of the Euphrates. A treasure will be unearthed from beneath it. War will break out to possess this wealth. Ninety nine out of every hundred will be killed. Each will hope that he will be the only one to survive’ (Bukhari and Muslim). Elsewhere, he advised us not to participate in this war. There are interpretations among some scholars that the ‘mountain’ refers to a gigantic dam, and ‘treasure’ to the most precious of commodities, water.

As a result, to prevent such regional conflicts and wars. Muslims must rediscover the spirit of the concept of amana. That is to say, the problems of the Muslim states such as foreign debt, hunger, malnutrition, environmental degradation and resource scarcity can only be alleviated if we truly understand that we are obliged to share and care. When we start sharing our natural resources and technology with the poor and the needy; an important barrier in the way of solidarity will be brought down. This will replace enmity with gratitude and war with peace and security.

If we desire radical changes in the foreseeable future, it is our duty to change our own conceptions and to seek to influence the way our countries are ruled. A just world order can be realized only if we understand fully that we are only trustees of God. Denying our responsibilities will burden our shoulders with a great sin.

It is our duty to be ready to discharge fully our God- given trust on this earth. When this happens, God will grant us the keys of the universe. God has said: ‘My servants, the righteous shall inherit the earth’ (Al-Anbiya, 21.105). No one should doubt that one day this truth, guaranteed by God’s oaths, will come true. At that time, those who become the trustees and masters of the earth will also rule over the remotest parts of outer space.