Historical perspective in arabic and islamic obestetric practice

By Dr/ Asmaa Mostafa Amer

Obstetrician and gynecologist

AGH-k

introduction

We all are familiar with the contribution of Arabs and Muslims in science in general and medicine in particular In this presentation I am going to concentrate on the contribution in ObstetricsWhile it is possible that ancient Egyptians had specialized medicine, It is the Muslims who seem to have made midwifery and diseases of the women special branch of medical art

This is to be contrasted with the European medicine where gynecology separated from comprehensive field of surgery as a special discipline only in the early 19th century

The golden age of the Arab civilization and Arab Medicine began with the Abbasid Caliphate at Baghdad. The history of Arab Medicine offer us one of the most interesting studies in the drift of culture of which it is possible to give a systematic and authentic narrative.

There was a large list of names of Arab authors who wrote about gynecologic and obstetric diseases. The most eminent authors among them were El-Razi (865-925 A.O.) who wrote "Al-Hawi" or the "Continent of Medicine"; Ali Ibn Abbas who died in 944 A.O .. wrote "Al-Maliki''; Ibn Sina (980-1037 A.O.) wrote "El-Cannon'' or "Canon of Medicine" and El- Zahrawi (1030-1106 A.O.) wrote "El-Tasrif'.

(a) Zakariah Razi (865-925 A.O.)

'Abu Baker Muhammad Zakariyya al-Razi, the great Muslim physician, was born in 865 in alray(iran). He studied and worked several years in Baghdad. His greatest medical work is "al-Kitab al-hawi” (The Comprehensive book), consisting of 23 volumes. A Latin translation appeared in Sicily in 1279 as Liber Continens. One of the volumes addressed the diseases of uterus, gynecology, and midwifery. In this book, al-Razi made interesting observations:

Fetuses born before the eighth month commonly present as breeches and they usually die. The fetus changes its position from breech to vertex in the eighth month because the head is the heaviest part of the body and will gravitate downwards. AI-Razi recognized that breech delivery is dangerous. He states, "If the foot or the hand is present, it can cause death of the fetus and mother." The latter is probably a reference to transverse presentations, which lead to obstructed labor.

He states, "Twins are delivered within few days of each other at the most“Al-Razi also noted that "sexual intercourse brings on labor and facilitates delivey!)'." This observation is now explained by the effect of oxytocin release and deposition of seminal prostaglandins in the vagina; both are oxytocic agents. AI-Razi also noted that acute fever can cause fetal death.

Al-Razi noted that if labor pains are in the pelvic area labor will usually be easy, but if the pain is mostly in the lower back, labor will usually be difficult (referring to the occipito-posterior position of the fetal head).

AI-Razi described the complication of the (umbilical) cord around the neck and stated that it can be a cause of difficult labor and fetal death.

AIrazi. in his book, gives different prescriptions of medicinal herbs with their respective dosages and prescribes special kinds of food' to facilitate" labor and delivery. He describes different maternal positions to facilitate the delivery of the fetus in certain malpresentations. In difficult vertex delivery, he would have the parturient in the lithotomy position and then insert a catheter in the uterus and infuse certain fluids. If the fetus were still alive, he used fluids with lubricant effects, whereas if the fetus· were dead, he used "spicy" fluids. AI-Razi gave different contraceptive as well as abortifacient

B) Ali Ibn Abbas (died 944 A.O)

Ali Ibn Abbas. was known in the Latin west as Holy Abbas. His principal work was "Al-Kitabu Al Maliki" which was acomprehensive compilation on theoretical and practical medicine in 20 books.

He described the anatomy of the uterus and gonads,, physiology of menstruation, amenorrhea. leucorrhea. displacement of the uterus, cervical erosion, signs of menopause, tumour of the uterus

He described formation of the fetus from fertilization until its expulsion at the 7th, or 9th month, antenatal care, etiology of abortion, normal and abnormal delivery and its management, difficult labour, care of the newborn and lactation. Al-Maliki is generally regarded as the best work of the Arab period. This royal book was the standard text book of Arab Medicine until it was replaced by the Canon of Avicenna about a century later.

(c)Abu-Ali Husayn lbn Abdullah Ibn Sina (980-1037 A.D.)

He was born in bokarah ( ospakistan ) and died in hamdan(iran)He was the first one to establish school for teaching medicine it was called AlmadrassaHe was pioneer in observational treatment and value history taking to diagnose diseasesHis famous quoting” we treat patient not disease”

He was known in the Latin West as Avicenna or Ibn Sina of the Arabs. He was the most famous of Arab physicians and philosophers. His influence extended throughout the world of Islam and in the West of Europe. The best known of his work is the ·'Canon of Medicine'" called in Arabic .. Al-Quanoon-fil-Tib .. , the most famous textbook of medicine ever written. This work was the final codification of all Greek and Arab Medicine. For more than 6 centuries it was the standard textbook in the medical schools of Asia and Europe. Even as late as the 15th century in Europe. It has been repeatedly mentioned in 14 editions.

He described the structure of the uterus, physiology of menstruation, amenorrhoea, bleeding, leucarrhoea, displacement of the uterus, uterine and urinary fistula !.sterility and infertility, contraception, tumour of the uterus, sexology. fetal circulation. physiological changes associated with pregnancy, etiology of abortion as incompetent cervix and its treatment. etiology of multiple pregnancy. normal and abnormal delivery. signs of onset of labour, signs of difficult labour and duration of puerperium and its complications as hemorrhage and sepsis

He stated that baby’s sex related to the man not to the woman

He was the first one to use anasthesia from oil he extracted from certain plant called Alzawan or shilum

(d) Abu-l.-Qasim El-Zahrawi (1030~1106 A.0.)

'Abualqasim Khalaf ibn alAbbs al-Zahrawi (Albueasis) (936·JOI3 A.D.), the great Muslim surgeon, was born in 936 at al-Zahra near Qurrtobah (Cordoba), Spain. His greatest contributions are contained in the famous book “al-Tas'rif Ii-man ‘ajaza an al-Ta 'Iif"

There is a section in the book about "operative obstetrics," which gives a detailed account of all possible malpresentations and how to affect delivery under such circumstances. He starts with using medicines, mucilages, perfumes, changing the position of the parturient, sitting in a special seat, etc. He then describes maneuvers to facilitate delivery to include artificial rupture of membrane (AROM), internal podalic version in breech, or other malpresentations in fine detail. He recognized multifetal pregnancy. He correctly noted that twins are commonly born alive, and that triplets or quadreplets can sometimes be born alive while higher order multifetal pregnancies are usually aborted early in the pregnancy.

AI-Zahrawi adevised several surgical instruments to be used in gynecological examinations and treatment; others to facilitate delivery, to extract a live fetus; and special instruments to deliver and extract dead fetuses. In his book, there are actual illustrations of these various instruments that probably formed the basis of the design for modem obstetric instruments .

AI-Zahrawi stressed that the placenta should be removed completely after delivery and described methods to affect its removal: he described a case of abdominal pregnancy that was mistaken for a case of IUFD. The extrauterine sac turned into an abscess, which started drainage with extrusion of the bones of the dead fetus. With proper treatment (evacuation and dressing) the woman survived in good health

Alzahrawi is the first one who ligate arteries to stop the bleeding and he is ahead of Ambroise Pare by 600 yearsHe invented a special mirror to examine the vagina and an instrument to dilate the cervixHe also advised to use female assistants and nurses in Ob\Gyne operations for the sake of comfortHe also invented the sutures from the cats gutHe described the walcher position to engage the baby’s head

Cesarean section

The operation of Cesarean section is of particular interest both medically and historically.In Islam, there is no direct mention of this type of delivery either in the Qur'an or the hadith However, Islamic principles in general will support the performance of cesarean section on a mother who just died if there is a reasonable chance to deliver a live fetus

This is quite evident and does not need proving. Quoting from Brandenburg, "Islam up held the principle that is still mandatory for every obstetrician today. First, save the mother, even if the child has to be sacrificed, only once hope has been abandoned for the mother should an attempt be made to save the child (by post mortem cesarean section).“

In the light of this fact, it is so strange and bizarre that a physician scientist states that "Mohammedanism absolutely forbids it (i.e. cesarean section), and directs that any child so born must be slain forthwith as it is the offspring of the devil.“A statement like that without any reference or basis only belies ignorance and bigotry. Unfortunately, the same erroneous information has been restated in a more recent article,') again without reference, but probably it was based on the statement in Young's book.

The illusllation of the cesarean birth of Rustum by al-Furdusi in his "Shah Nameh" (Book of Kings) 1560- 1580, in the possession of the Metropolitan Museum of Art in New York,18 indicates that he must have seen a cesarean section performed before illustrating it in his book.

AI·Biruiini's book, 'al-'Athar al-Baqiyah 'an al- qurun al-Khaliyah" (The chronology of ancient nations) dated 1307-8, available in Edinburgh University Library (161 folio 6)1~ reveals

that in the Islamic world, the cesarean operation has not only

continued to be performed under special circumstances on recently dead mothers, but has also probably been performed on living wives of Muslim kings, Sultans, and Princes to rescue both the mother and the fetus.

There have been historians who had endeavored to search for the facts and !then report them without adulteration or bias. Examples would include some of the books like: Brandenburg, Ullman/ and Watt. Watt is quoted to have said, "for our cultural indebtedness to Islam; however, we Europeans have a blind spot. For the sake of good relations with Arabs and Muslims we must acknowledge our indebtedness to the full" It behooves Muslim physicians to take the responsibility for searching our heritage and bringing the facts to life.

In conclusion, it can be said that the Arabs were truly pioneers in the Art of Medicine especially in the field of Obstetrics and Gynecology