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 of Medicine by Gruner it is stated by Avicenna under the article 8l4 ANESTHETICS:"If it is desirable to get a person unconscious quickly, without him being harmed, add sweet smelling moss to the wine, or lignum aloes. If it is desirable to procure a deeply unconscious state, so as to able the pain to be borne which is involved in painful applications to a member. place darnel-water into the wine, or administer fumitory, opiuium, 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).

Hynayn Ibn-Ishak (Joannitius, 809-873 A.D.) translated the work of the Greek pioneer in obstetrics, Paul of Aegina, into Arabic. Hunayn also translated to the Arabic world most of the work of Hippocrates, Galen, and Ptolemy. Moreover, he was a gifted physician and philosopher. Ali Ibn-Al- Abas 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 thought that the uterine contractions were only as 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 by 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 (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-Baliiyah dated 1307 A.D. (Hitti 1977) as shown in figure 9 which is preserved in the library of the University of Edingurgh (Hitti 1977).

Ibn-Al-Quff (1233-1305) is another physician who contributed to perinatology. He was born in Jordan (Hamameh 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 mothers 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 is cut at a distance of four fingers breadth from the body, and is tied with fine, soft woolen twine. The area of the cut is covered with a filament moistened in olive oil over which a styptic to prevent bleeding is sprinkled ... After delivery, the baby is nursed by his mother whose milk is the best. Then 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 fundamental, but seven hundred years ago, they were new and different.

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 fostered 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.

AL-A'SAR Y.H.: Lights on History of Science. Famous physicians of the Western part of the Arab World. Hospital Medical Practice. Cairo, Egypt, 2:1-3, 1972.

AL-A'SAR Y.H.: Lights on History, of Science. Famous physicians of the Eastern part of the Arab World. Hospital Medical Practice, Cairo, Egypt 1:14-29, 1971.

AL-OKBI, M.D.: Lights on History of Science: Abu Al- Khasim Al- Zahrawi, the pioneer in surgery Hospital Medical Practice, Cairo 1: 14-29, 1971.

AMARI,STORIA,ed.NaUino,vol. i, pp. 588-93 (from Hitti P.K. 1977, p. 604).

BLACK M. ROTH C: Maimonides, Merit Students Encyclopedia Vol. 11, 409, Crowell-Collier Educational Co. 1970.

BLAC, M: Averroes, Merit Students Encyclopedia Vol. 2, 476, Crowell-Collier Educational Co. 1970.

BROAWE, E.G.: Arabian Medicine: Cambridge at the University Press, 1962. BURTON, L. edition of 1001 Nights (Six volumes). 1886.

CAWBELL, DAVID: Arabian Medicine and its influence on the middle ages. Kegon Paul. French, Frubner & Co. London, 1926, Vol. 1, pp. 69-77.

CUSTON, C.G.: A Brief Historical Summary of the Treatment of Trachoma. With a Speical Reference to the Arabian School and the Writing of Ali Ibn-el-Aissa (Jesu Hali). Am. M. Hist. 3: 244-251, 1921.

EIGELAND, T: Islam in Al-Andalus, Aramco World Magazine 27/5, Sept. Oct., 1976.

GARRISON, FIELDING A: An Introduction to the History of Medicine with Medical Chronology, Suggestions for Study and Bibliographic Data. W.B. Saunders Co., Philadelphia, 1929.

GRUNER, O.C.: A treatise on the Canon of Medicine of Avicenna, Incorporating a Translation of the First Book, London, Luzac & Co. 1930.

HADDAD S.I. and KHAIRALLAH A.A.: A forgotten Chapter in the History of the Circulation of the Blood. Arinuals of Surgery 104: 1-8, 1936.

HADDAD, S.I.: Arabian Contribution to Medicine. Anna Med. Hist. 3:60-72, 1942.

HAMARNEH S: The Physician and the Health Professions in Medeival Islam. Bull. N.Y. Acad. Med. 47.1088-1110, 1971.

HAMARNEH, S.: Development of Hospitals in Islam. J. History of Med. and Allied Sciences 17: 366-84, 1962.

HAYKAL, M.H.: The life of Mohammed, 8th edition, North American Trust Publications-, 1976.

HITTI, P.K.: History of the Arabs, 10th Edition, St. Martin's Press, New York, 602-614, 1977.

IBN-KHALDUN, VOL. IV, P. 201.

IBRAHIM, S.: Lights on History of Science: Ibn-El-Nafis, Hospital Medical Practice, Cairo 1: 35-39, 1971.

KAHIL, N.: Une ophthalmologic Arabe par un practici en due Caire du XIII, me siecle - VII me de I'Hegire, Rend. Internat. Med. Trop. Cairo 2: 241-260, 1929.

KEYS, T.E., WAKIM, K.G.: Contributions of the Arabs to Medicine Staff Meetings of the Mayo Clinic 28: 42-437, 1971.

KHAIRALLAH, A. A.: Arabic Contributions to Anatomy and Surgery: Ann. Med. Hist. 3:4 409-15, 1942.

LEVY, M.: Medical Ethics of Medieval Islam with Special Reference to Al-Ruhawis, "Practical Ethics of the Physican". May 19067, Vol. 57 Part-3.

MEYERHOF, M.: Ibn-El-Nafis (Xlllth Cent) and His. Theory of the Lesser Circulation. Isis 23: 100-120, 1935.

MIN-KIN, J.S.: The World of Moses maimonides: Thomas Yoseloff Inc. New York, 1968.

PARENTE, P. The Medical School of Salemo in the Regimen of Health of the Medical School of Salcmo. N.Y. Vantage Press, 1967, pp. 15-20. Profile of Iran. Health Care in Iran. May 1977, 2536, Vol. 11, No. 5.

SALEM, R.A.: Discovery of the Pulmonary Circulatioii by an Arab in the 13th century.

Anesthesia & Analgesia... Current Researches, 47: 587- 588, 1968.

SARTON, G.: Introduction of the history of Science. Vol. I Baltimore, Camegic Inst. of Wash. 1950.

SPEERT, H.: Iconographia Gyneatrica and Obstetrics. Philadelphia: T.A. Davis Co. 1973.