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
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
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).
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
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
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"
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.
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.
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