CONTRIBUTION OF ISLAM TO MEDICINE

Ezzat Abouleish, M.B., CH.B., D.A., D.M., M.D.

Medicine, as it stands today, did not develop overnight. It is the culmination of efforts of millions of people, some we know and other we do not. The flame of civilization,including medicine, started thousands of years ago, was passed on from one generation to another, and from one country to the other. Depending on who took the sacred responsibility of hosting it,sometime it glowed brighter and sometimes dimmer: it never died away, because if it did, it wouldhave been impossible to re-kindle it.

AL-RAZI (RAZES) 841-926 A.D

His full name is Abu-Bakr Mohammed Ibn-Zakaria AI-Razi, known to the Western World as Razes. He was born in Ray, a suburb of Tehran, the capital of modern Persia (Profile oflran 1977, Sarton 1950). He first stud led music which was his main interest in his early life, and was a skillful flutist. He then studied phil(lsophy. and later medicine. But he was a better physician than a philosopher (Figure 2).

He first became the Court Physician of Prince Abu-Saleh Al-Mansur, the ruler of Khorosan. Then he moved to Baghdad where he became the Chief Physician of the Baghdad Hospital and the Court Physician ofthe caliph. He had a good basis of physics and chemistry as well as medicine.

He published several books which were translated into Latin, French, Italian, Hebrew, and Creek. One of his main books is "AI-Mansuri" (Liber Al-Mansoris) which he dedicated to his patron Prince Al-Mansur. It was Composed of ten treatises and included all aspects ofhealth and disease. He defined medicine as "the art concerned in preserving healthy bodies, in combating disease, and in restoring health to the sick." He thus outlined the three aspects of medicine, namely public health, preventive medicine, and treatment of specific diseases. He listed seven principles for the preservation ofhealth:

1. Moderation and balance in motion and rest.

2. Moderation in eating and drinking.

3. Elimination of superfluous matter.

4. Improvement and regulation of dwelling places.

5. Avoidance ofexcesses before they become uncontrollable.

6. Maintenance of harmony in ambitions and resolutions.

7. Acqu isition of reticence through possession of good habits including exercise.

He also published another book called A-Murshid. In it, he emphasized the important lines of therapy that we mentioned earlier. He described the different types of fever including continuous, relapsing, and hectic. He stated that fever can be a symptom of a disease or a disease in itself. He introduced mercury as a therapeutic drug for the first time in history, which was later adopted in Europe. He realized that normally no man wants to get sick, and if he is, he wants to recover as soon as possible. However, if a patient lacks the will or the desire to get well, there is very little a physician can do to help him. He stressed the continued medical education of the physician. He advised him to record his own observations. He encouraged him to meet with other physicians to discuss medical problems. He recommended that physicians try solving these problems rather than depend on others for finding solutions.

Another book written by Al-Razi was named "Al-Hawi", which means the complete text. It was composed of 22 volumes, and it, especially its 9th volume on pharmacology, was used as one of the main text books in the medical school of Paris. He also wrote a treatise on measles and smallpox and called it "de Peste or de Pestilentia." It was translated into Latin in 1565 A.D. It is a masterpiece in clinical medicine (Browne 1962). It describes the clinical difference between the two diseases so vividly that nothing since has been added (Keys 1971).

AL-ZAHRAWI (ABULCASIS, BUCASIS, ALZAHRAVIUS) 931-1013 A.D.

His full name is Abu-Al-Qasim Khalaf Ibn 'Abbas Al-Zahrawi. He is known in the Western World as Abulcasis, Bucasis or Alzahravius. He is the famous surgeon of the Arabs. In 930 A.D., he was born in Al-Zahra, a suburb of Cordova. He attended the University of Cordova which had been established for one and a half centuries. At that time Cordova had a population of one million (Hitti 1977). It was the magnificent capital of AlAndalus where culture and science were at their peak in Europe. In military power the Muslims also reached their zenith, not only in Spain but also throughout Europe after King Abdel-Rahman III defeated the Spanish kings ofNavarre, Castile, and Leon in the north in 997 A.D.

Al-Zahrawi became an eminent surgeon. He was appointed as the Court Physician of King Abdel-Rahman III. He spent a productive life in practicing medicine, especially in surgery and medical writings. He died at the age of 83.

He authored four main works. One of these is "Al-Tasrif Liman Ajiz 'an AI-Ta'lif' which was the best medieval surgical encyclopedia and was used in Europe until the 17th century. Stressing the importance of basic sciences he says: ".....Before practicing, one should be familiar with the science of anatomy and the functions of organs so that he will under stand them, recognize their shape, understand their connections, and know their limitations. Also one should know the bones, nerves, and mus cles, their numbers, their origin and Insertions, the arteries and the veins, their start and end. These anatomicaI and physiological bases are impor tant, and as said by Hippocrates 'There are many physicians by title and a few by practice...'. A physician who does not understand the anatomy and physiology may commit a mistake I-esulting in the death of a patient. 1 have seen someone, who pretended to be a surgeon, incised an aneurysm in the neck of a woman, mistaking it for an abscess. The woman bled to death."

Heller stated that Al-Zahrawi described the ligature of arteries long before Ambrose Pare (Khairallah 1942). Al-Zahrawi also used cautery to control bleeding. He used wax and alcohol to stop bleeding from the skull during cranial surgery. Sprengel said that Al-Zahrawi was the first to the lithotomy position for vaginal operations (Khairallah 1942). AI~ Zahrawi also described the tracheotomy operation and performed it in an emergency on one of his servants. He was the first to write on orthodontia. He showed evidence of great experience from details of clinical picture and surgical procedures e.g. his description of varicose veins stripping, even after ten centuries, is almost like modern surgery (Al-Okbi 1971): "..... Have the leg shaved if it is very hairy. The patient gets a bath and his leg is kept in hot water Until it becomes red and the veins dilate; or he exercises vigorously. Incise the skin opposite the varicose vein longitudinally either at the ankle or at the knee. Keep the skin opened by hooks. Expose, dissect, and separate the.,in. introduce a spatula underneath it. When the vein is elevated above the skin level, hang it with a blunt rounded hook. Repeat the procedure about three fingers from the previous site and hang the vein with another hook as Previously done. Repeat the procedure at as many sites along the varicose vein as necessary. At the ankle, ligate and strip it by pulling it from the Inclsionjust above. When it reaches there, repeat at the higher incision until all of it is stripped. Ligate the vein and then excise it. If difficulty is encountered in pulling it, ligate its terminal part with a string and pass It under the spatula and dissect it further. Pull gently andavoid its tearing, because ifit does, it becomes difficult to strip all of it and can cause harm to the patient. When you have stripped it all, put alcohol sponges at the sites of the skin incisions and take care of the incisions until they heal. If the varicose vein is tortuous, you have to incise the skin more frequently, at each change of direction. Dissect it and hang it with the hooks and strip it as previously described. Do not tear the vein or injure it~ If this happens, it becomes difficult to strip it. The hooks used should be blunt, eyeless, and rounded. otherwise it can injure the vein."

He also wrote about fracture of the skull (AI-Okbi 1971): "...... The types of skull fractures are numerous, their shapes are different, and their causes are many. For example, some skull fractures are due to a blow by a sword that splits the whole skull and reaches the dura, the same as the axe does to the wood, therefore it is called axial~fl~actur+e. Sometimes th, sword does not split the skull completely, and it is called incomplete axial fracture. Such a fracture can be small or big. Another type is comminuted fracture which can be due to a hitby a stone or a fall on a stone; and this fracture can reach the dura or only bC limited to the outer part of the bone. This fracture can also be small or big. A third type is the hairytype skull fracture which is Very tiny and linear like a hair. A fourth type is the depressed fracture which occurs due to a fall or a blow depressing thr bone like a brass iar hit by, blunt instrument. This usually happens when the bone is soft as in children. The types of these fractures are diagnosed by examining the wound, 'emoving the debris and contused part of the scalp, exposing the skull, and feeling it by the spatulas. The hairy fracture is difficult to discover and can be diagnosed by exposing the skull. and smearing it with ink; the linear fracture threatment of fractures of the Skull, Al-Zahrawi w'ote: ".....If the patient shows serious signs such as high fever, repeated vomiting: exophlhalmos convulsions, and coma, do not touch himbecause he is probably going to die. Othenvise, treat him as follows first shave the patient's head. In comminuted depressed fractures, Lhese pieces of bone should be removed as will be explained. If in the process of the patient's examination or during Surgery bleeding occurs, it can be controlled by pressure using towels Soaked in alcohol and with Wax. Then after control of the bleeding, the small pieces of bone are removed using special forceps (see illustrations). To remove the depressed fracture, first, make trephines in the healthy bone around it. These trephine instruments should not Penetrate beyond the skull into the soft tissues underneath, thus they are called non-penetrating trephines. They have a rounded ring in their proximal end to prevent them from penetrating beyond certain depths. You should have a number of these trephines that can stop at different depths depending on the thickness of the skull (see illuslration). Connect the holes in the skull using special raws (see illustration). First, use a fine small saw, then larger ones. These should be sharp and made of steel. Avoid cutting the dura by the trephine saw. Once the depressed bone is freed, remove it gently, then smoothen the edges of the skull by special instruments (see illustration). Wash with and treat the wound with packs soaked with ointment."

Al-Zahrawi described many dental operations such as dental extractions, fixation, reimplantation, and artificial teeth. He described tooth pain and cautioned the physician against removal of the healthy tooth to which pain is referred. He used gold threads to fix teeth because other metals would tarnish and cause a reaction. Chapter 6 of his book was all devoted to foreign bodies of the ear and their treatment. He also devoted one whole chapter to midwifery, giving tips to midwives, and describing the problems of difficult labor and obstetrical maneuvers. He recommended decompression of the fetal head for obstructed labor and described the instruments used. He described the management of liver abscess by treatment in two stages (Khairallah 1942). In the first stage adhesions around it were formed, and then closed from the peritoneal cavity. The second stage was to incise it. .. "if the procedure is done in one stage, the pus may spread to the whole abdomen and the patient may die." He described a total of 200 surgical and dental instruments most of which were original (Fig. 3). He said "...Choose your instruments carefully beforehand according to the operation. However, you should design other devices if needed." Thus he encouraged the physician to be innovative. During the time of Al-Zahrawi, surgery in the Islamic world became a respected specialty practiced by reputable physicians. On the contrary in Europe, surgery was belittled and practiced by barbers and butchers. In 1163 A.D., the Council of Tours declared the following resolution "Surgery is to be abandoned by the schools of medicine and by all decent physicians."

IBN-SINA (AVICENNA) 980-1037 A.D

Ibn-Sina's full name is Abu-Ali Husayn ibn-Abdullah Ibn-Sina, and his titles were Al- Shaykh Al-Rais (The Chief Master) or Al-Muallim Al-Thani (The Second Teacher), second to Aristotle (Browne 1962). He Is known in the Western World as Avicenna (Figure 4).

In 980 A.D., Avicenna was born in Bukhara which is now part of Russia and known as Uzben. By 10, he was already proficient in the Qur'an and Arabic classics. By 16, he finished Islamic law studies, geometry, anatomy, logic and philosophy. His metaphysics were influenced by an earlier Muslim philosopher, Al-Farabi. By 18, he completed the study of medicine. Soon after, he became the Prime Minister (the Vizier) and Court Physician of Prince Nuh-Ibn-Mansur, the Sasanid ruler of Bukhara.

The prince was impressed by the intelligence and endurance of his vizier and opened for him the royal library, which was unique in its literary richness. Ibn-Sina wrote his first book at the age of 21. Then he became Vizier of Ali ibn Maimun, the ruler of Khawarazm or Khiva. But he ultimately fled to avoid being kidnapped by Sultan Mohammed El-Ghazin. Ironically, fate played an important role in the life of Avicenna. The ruler of Hamadan, the southern part of Persia, who was called Amir Shamsu'dDawla, had renal colic. Ibn-Sina treated the amir's colic. The latter was very pleased and appointed Ibn-Sina, not only his Court Physician, but also his vizier. Avicenna was a proud and arrogant man. This created enemies; military leaders mutinied against him, resulting in his dismissal and imprisonment. Fortunately, the amir got renal colic once more and no one could relieve his pain. He thus summoned Avicenna who cured him. The amir apologized to Avicenna and reinstated him.

Avicenna's life during this time was extraordinarily strenuous. He was busy all day in the service of the amir. The great part of the night was passed in lecturing and writing his books, with intervals of wine drinking, music, and minstrelsy. After many vicissitudes, worn out by hard work and hard living, Avicenna died and was buried in Hamadan, Persia, in 1037 A. D. at a comparatively early age of 57. In his last illness, he treated himself unsuccessfully, so that it was said by his detractors that neither could his physics save his body nor his metaphysics save his soul (Browne 1962).

Avicenna wrote 100 treatises, 21 of them were major, of which 16 were on medicine. He wrote on philosophy, medicine, and named the book Al-Qanun fi Al-Tibb (Canon of Medicine). It was an encyclopedia containing more than one million words, composed of 5 volumes:

Volume 1 described the principles and theories of medicine.

Volume II contained the names of simple drugs arranged alphabetically.

Volume III described localized diseases of the body from the head to the toes.

Volume IV was addressed to general diseases ofthe body e.g., fevers.

Volume V explained compound drugs.

The Canon contained all medical knowledge up to the IOth century. It was translated into many languages and was a maJor source book for medical schools in Europe up to the 17th century. Although the Canon was a great book, it overshadowed the important earlier or later works written prior to it by Al-Razi and Al-Zahrawi, and subsequent to it by Ibn-Al-Nafis Ali Ibn- Abbas, and Halle Abbas (Haddad 1942).

Avicenna wrote Arabic and Persian poems. The last of his Arabic poem, which is considered a classical beauty, describes the descent of the Soul into the Body from the Higher Sphere which is its home (Browne 1962).

Avicenna is considered a great philosopher, and his writings affected the thinkers and influenced many of those who appeared after him. He was a unique man, not only because of his encyclopedic accomplishments in medicine, but also because of the versatility of his genius. He has been compared in this respect with Aristotle, Leonardo da Vinci, and Goethe (Keys 1971).

IBN-RUSHD (AVERROES) 1126-1198 A.D.

Ibn-Rushd, or Averroes as known in Europe, was born in Granada in 1126 A.D. He studied philosophy, medicine and law, and was appointed a judge in Seville in 1 169 A.D., where he stayed in office for a quarter of a century. He was greatly influenced by Aristotle on whom he wrote important commentaries (Black 1970, Al-A'sar 1972). In some of these interpretations he asserted that the human soul is not independent, but shares a universal mind. This belief caused a great controversy and was later declared heretical by both the Muslims and Christians alike because it contradicted the doctrine of personal immortality.

He was admired by the Jews of Spain who spread his philosophy into Europe especially into Italy and France after they were forced out of Spain. His followers interpreted some of his writings to mean that there are two kinds of truth, a philosophical and a religious truth. This implied a separation of reason and faith and influenced philosophical and theological speculation for many centuries. Because of his bold ideas, he was dismissed from his work and sent to Morocco where he was kept in prison till he died on December 12, 1198. His important contribution to medicine was "Al-Kulliyat fi Al-Tibb" (Colliyet). It was a summary of the medical science of that time and was composed of seven parts. He wrote another book, "AlTaisir" on practical medicine. It consisted of useful excerpts and a clinical description of diseases including serous pericarditis and mediastinal abscess. He personally suffered from the latter disease and left very careful records of his own symptoms. The book is not known in Arabic, but there are several Latin editions (Haddad 1942). Ibn-Rushd was another example of the cultured Muslim physician.

IBN-MAIMON (MAIMONIDES) 1135-1204 A.D.

In 1135, Musa Ibn-Maimon (Moses Maimonides) was born in Cordova, Spain. (Minkin 1968). His father was a rabbi and had a great influence on Moses in his interests and future achievements. During that period, the Jews had a golden era in Spain. Minkin (1968), a renown scholar and an eminent rabbi wrote "it was Mohammedan Spain, the only land the Jews knew in nearly a thousand years of their dispersion, which made the genius of Moses Maimonides possible."

In 1160 A.D., Moses emigrated to North Africa to the city of Fas where he studied medicine. In 1165 A.D., he left for Palestine. However, he was dissatisfied with the cultural atmosphere there, so he went to Egypt where he stayed until he died in 1200 A.D. He was buried in Teberias, Palestine.

Maimonides started his career as the Rabbi of the Jewish Community of El-Fostat City, the capital of Egypt at that time and a part of old Cairo now. Later on in life, he practiced medicine, and became an eminent and respected physician. He served both King Salah El-Din (Saladin) and his elder son Sultan Al-Malik Al-Afdel during his short reign (1198-1200 A.D.). He had the confidence of both. During the crusades King Richard the Lion-Hearted, fell sick, Salah El-Din sent Ibn-Maimon to treat him. When Richard recovered, he asked Ibn-Maimon to join his court, but he politely declined and stayed with Saladin (Minkin 1968).

Ibn-Maimon' s impact on the Jewish religion is very very significant. He wrote a classical work in the Jewish religion besides codifying the Jewish laws (Black and Roth 1970). He also wrote on philosophy. His book, "Dalalat Al-Hai'ran" (The Guide of the Perplexed) is an important work which was welcomed not only by those of the Jewish faith, but also by Muslims and Christians alike. The book was in Arabic, and it was only after his death that a Hebrew translation of it was done. He was influenced by his contemporary Ibn-Rushd, and by Aristotle, but he tried to reconcile logic with faith.

In medicine Ibn-Maimon did two important things: First, he translated many Arabic books into Hebrew which were then translated into Latin and other European languages. An example of these books is the Canon or Avicenna. Second, he wrote a few books of his own. One of them is "Magala fi Tadbir Al-Sihha" (Regimen Sanitatis) which stressed proper diet, personal hygiene, and moderation in the pleasures oflife. It was written in the form of letters to Sultan Al-Afdel. The other was "Kitab" Al +Fusul fi Al-Tibb" (Fisul Musa). This was a collection of 1,500 aphorisms extracted from calen writings together with forty-two critical remarks. Moses also wrote a book on poisons and their antidotes (AI-A'sar 1971).

When he died, the Jewish Community in Egypt built a synagogue and named it after him. Some Jews, until now stay overnight in this synagogue in the hope of receiving healing through the spirit of this great physician (Minkin 1968).

IBN-EL-NAFIS 1208 - 1288 A.D.

In 1208 A.D., Ala EI-Deen Ibn-El-Nafis was born in a small town near Damascus called Kersh (Ibrahim 1971). He studied medicine and philosophy in Damascus and spent most of his life in Cairo. He was a physician, a linguist, a phi losopher, and a historian. He was the first chief of AI-Mansuri Hospital in Cairo and the Dean of the School of Medicine in 1284 A.D.

During this era, the medical profession together with other branches of science were facing a crisis. The Mongol Tartar invasion and destruction of Baghdad in 1258 A.D., caused an injury to the Islamic civilization from which it never recovered. It destroyed forever the Caliphate, symbolic unity of the Islamic Empire, and the pre-eminence of Baghdad as a center of teaming. The Islamic culture was also declining in Spain at the time. Now Cairo and Damascus were the two centers of education and medical science. The medical profession there enjoyed the freedom of discussion and expression of opinion, something new in medicine and not known in Europe until the 17th century when Sedenham introduced it to England (Ibrahim 1971).

Ibn-El-Nafis was a dedicated person. He used to start his day with dawn prayers after which he would make rounds at the hospital, followed by case discussions with students and colleagues, and then hospital administration. His evenings were spent reading, writing and discussing medicine and philosophy with frequent scholar guests at his home in the EI-Hussein District of Old Cairo. His house, made ofmarble with a fountain in the central hall. was a beautiful example of Arabic architecture.

In the history of mankind, there are persons whose importance is revealed with the flight of time and their truth glows with the passage of centuries. Ibn-El-Nafis is one of those. He wrote many books, ten of them on medicine and another one on philosophy. In the latter book "Fadel Ibn -Natik", he tried to counter the philosophical view of Aviccnna expressed in his book "Hai Ibn- Yakzan'. He was an authority in theology on which he wrote several books, e.g. "The complete Message of the Prophet" and "Al-Ragol Al-Kamel" (The Perfect Man), supporting unitarianism. The significance oflbn-El-Nafis's life and work lies in that he was a genuine scholar and not a mere follower. This is evident from his writings whether they are on philosophy or medicine.

On medicine he wrote many books, two of them are "Mujaz Al-Qanun" which means the "Summary of the Canon". In these two books which were based on Avicenna's writings, he criticized the shortcomings of Avicenna's work and of Galen's views and showed their weaknesses. That is why he was called by some as Avicenna the Second. For example he wrote "... We have relied chiefly on his (Galen) teachings, except for a few details which we think are wrong and were not given after a thorough investigation. In describing the function of the organs, we have depended on careful investigation, observation, and honest study, regardless of whether or not these fit with the teachings and theories of those who have preceded us."

Ibn-El-Nafis added to our knowledge of the physiology of the circulation. In ancient history, Erasistratus of the Alexandria School (310 B.C - 250 B.C.) believed that blood was contained only in the right side of the circulation, namely the veins and the right side of the heart. The left side of the circulation, namely the left side of the heart and the artenes were supposed to contain air because arteries were found empty when an animal was sacrificed, hence the name "arteria"

When Galen came (131 - 210 A.D.), he described blood to pass from the right side of the heart to the left heart to the left side through minute openings in the septum of the heart, then it mixed with air from the lungs, and subsequently distributed to the whole body. For centuries this was the prevalent belief and no one, including the Muslim physicians, even the most emi nent one, like Avicenna, could dare challenge this sancrosanct view. Ibn El-Nafis challenged this view. times he stated in unmistakable terms that "... the blood from the right chamber of the heart must arrive at the left chamber, but there is no direct pathway between them. The thick sep trrm of the heart is not perforated and does not have visible pores as some 8sople thought or invisible pores as Galen thought. The blood from the chamber must flow through the vena arteriosa (pulmonary artery) to lungs, spread through its substance, be mingled with air, pass through larteria venosa (pulmonary vein) to reach the left chamber of the " (Salem 1968). In describing the anatomy of the lung Ibn-El-Nafis "The lung is composed of: first, the bronchi; second, the branches arteria venosa; and third, the branches of the vena arteriosa; all of are connected by loose porous flesh.... The need of the lung for the vena arteriosa is to transport to it the blood that has been thinned and warmed in the heart, so that what seeps through the pores of the branches of this vessel into the alveoli of the lung may mix with what is of air there in and combine with it... and the mixture is carried to the left cavity of the heart by the arteria venosa" (Haddad 1936).

Ibn-El-Nafis also made other contributions in the circulation. Avicenna, following Galen's description of the anatomy, stated that the human heart has three ventricles. Ibn-El-Nafis rejected this and said " And his statement (Avicenna's) that the heart has three ventricles is not correct. as the heart has only two ventricles...." He was also the first to describe the coronary circulation: he wrote "... Again, his statement (Avicenna's) that the blood in the right side is to nourish the heart is not true at all, for the nourishment of the heart is from the blood that goes through the vessels that permeate the body ofthe heart...."

Three centuries after the discovery of the pulmonary circulation by Ibn-El-Nafis, others, such as Michael Servetus, Realdus Colombus, Carlo Ruini, Andrea Cesalpino, and Francois Rabelais, claimed the same thing (Mayerhof 1935). There is a strong suspicion that these authors obtained their knowledge from the Arabic literature which was available at that time to the European investigators but they failed to give due credit to Ibn ElNafis (Keys 1971, Haddad 1942). It is not a mere coincidence that Servetus discovered the pulmonary circulation, and also wrote a book, similar to the one by Ibn-EI-Nafis, on Unitarianism. Servetus was burnt with his book, "Restitu tio Christianismi" in Geneva in October 1553 on the orders of Calvin for his heretical views.

THE ARABS AND OPHTHALMOLOGY

The Arabs were very interested in ophthalmology. In the ninth century, Hunayn Ibn-lshak (Joannitius) translated into Arabic the Greek literature on the eye. As mentioned before. Al-Razi described the changes in the caliber of the eye produced by relaxation and contraction of the iris. He also described the cataract operation.

In 1050 A.D. at Baghdad, Ali Ibn-Isa (Jesu Haly) wrote the classic book on ophthalmology, Tathkirat Al-Kahhalin (A Note for the Occulists). As stated by Cunistan(l921), it is the oldest book in its original language on diseases of the eye. Written in a clear and logical style, the author described trachoma, conjunctivitis, and cataract, and prescribed treatment (Keys 1971). Avicenna described the six extrinsic muscles of the eyeball.

In the thirteenth century, Ibn Abu-Al-Kawafer wrote a book on thcrapeutlc ophthalmology entitled "Natigat-El-Fikr fi Ilag Amrad El-Bassar", (Conclusions from Experience on Treatment of Diseases of the Eye). According to Kahil (1920), it is one of several textbooks on ophthalmology considered to be superior to any written in Europe up to the eighteenth century.

ARABS AND ANESTHESIA

Being an obstetric anesthesiologist, I feel obligated to write a little more on the contributions of the Arabs to both anesthesia and obstetrics.

First, in anesthesia, the Arabs described in detail the pharmacology of important narcotics such as opium and other central nervous system depressants such as hyoscyamus and hashish (Khairallal 1942). Burton (1886 A.D.) stated that "anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in the civilized West. In a Treatise on the Canon ofMedicine by Gruner, it is stated by Avicenna under article 814 ANAESTHETICS: "If it is desirable to induce unconsciousness in a person quickly and without harming him, then add sweet smelling moss to the wine, or lignum aloes. If it is desirable to induce a deep unconscious state, so as to make the pain involved in painful surgery of an organ bearable place darnel-water into the wine, or administer fumitory, opium, hyoscyamus (half-dram doses of each); nutmeg, crude aloes-wood (4 grains of each). Add this to the wine, and take as much as is necessary for the purpose. Or, boil black hyoscyamus in water, with mandragore bark, until it becomes red. Add this to the wine."

The Arabs also introduced "the Soporific Sponge" which was commonly used for anesthesia in the middle ages. The sponge was soaked with aromatics and narcotics to be sucked and then held under the nostril to provide anesthesia prior to surgery (Keys 1971).

Avicenna wrote more than 1,000 years ago about the effect of pain on ventilation: "Pain dissipates the bodily strength and interferes with the normal functions of the organs. The respiratory organs are inhibited from drawing in air, and consequently the act of breathing is interfered with, and the respiration becomes intermittent, rapid, or altogether unnatural in rhythm" (Gruner 1930).

ARABS AND OBSTETRICS

Hynayn Ibn-Ishak (Joannitius, 809-873 A.D.) translated the work of Greek pioneer in obstetrics, Paul of Aegina, into Arabic. Hunayn also into the Arab world most of the works of Hippocrates, Galen, and Ptolemy. He was a gifted physician and philosopher. Ali Ibn-Al-Abbas Al-Majusi (Halle Abbas) who died in 994 A.D. was the first to describe in his book "Al-Kitab Al- Malaki' (The Royal Book) that the uterine contractions are the cause of delivery of the fetus (Keys 1971). Before him, it was thoughtthatthe uterine contractions were only an indication of the onset of labor; subsequently the Fetus would swim its way out of the womb and birth canal.

Most of the deliveries were performed bq; midwives at home. For complicated obstetrics, Al-Zahrawi offered advice to midwives, as mentioned before, used fetal craniotomy for delivery of obstructed labor, and introduced the required instruments. The operation of cesarean section was described in 1010 in the Book of Kings by Abul Kasim Al-Firdaws as shown in figure 8 (Speert 1973). It described cesarean section practiced on R 'uda'ba. the mother of King Rustam at his birth. Another reference for cesarean section is written by Al-Biruni in his book, Al-Athar Al- Bahiyah dated 1307 A.D. (Hitti 1()77) as shown in figure 9 which is prcsen;ed in the library of the University of Edinburgh (Hitti 1977).

Ibn-Al-Quff(1233-1305) is another physician who contributed to perinatology. He was born in Jordan (Hamarneh 1971). In his book "Al-Jami", he presented original observations on embryology. He spoke of "... the formation of a foam stage in the first 6 to 7 days, which in 13 to 16 days, is gradually transformed into a clot and in 28 to 30 days into a small chunk of meat. In 38 to 40 days, the head appears separate from the shoulders and limbs. The brain and heart followed by the liver are formed before other organs. The fetus takes its food from the mother In order to grow and to replenish what it discards or loses ..... There are three membranes covering and protecting the fetus, of which the first connects arteries and veins with those in the mother's womb through the umbilical cord. The veins pass food for the nourishment of the fetus, while the arteries transmit air. By the end of seven months, all organs are complete .... After delivery, the baby's umbilical cord. four fingers from the body, is cut and tied with fine, soft wooden twine. The area of the cut is covered with a filament moistened in olive oil over which a styptic is sprinkled to prevent bleeding .... After delivery, the baby is nursed by his mother whose milk is the best. There after the midwife puts the baby to sleep in a darkened quiet room ....Nursing the baby is performed two to three times daily. Before nursing, the mother's breast should be squeeZed out two or three times to get rid of the milk near the nipple." These findings of Ibn-Al-Quff, appear basic and fun damental, but seven hundred years ago, they were new and different.

CONCLUSION

One cannot help but look with admiration upon the way the Muslims handled their responsibility towards mankind. They not only preserved, but also added to earlier achievements in medicine. They have kindled the flame of civilization, made it brighter, and handed it over to Europe in the best possible condition. Europe, in turn, passed it to the United States of America, and the cycle continues.

Between the ancient civilization, namely the Egyptians, Greek,Roman,Persian,Indian,and Chinese, and the Renaissance era in Europe, there was a gap, commonly called "the darkages", during which the flame was hosted, not by the West, but by another group of people called the Arabs or the Moslems. The term "the dark ages" reflects the civilization in Europe between the 7th and 13th centuries, but by no means does it express the state of affairs in the Arab world or the Islamic Empire at that time when the position of art and science were as bright as the middaysun. That era, unjustifiably, has been commonly neglected and passed over, as if it never existed. This paper is an effort to focus on some of the important events which took place during this period, including the accomplishments ofthe prominent physicians who lived at that time.