Until the 16th century C.E. the operation of Caesarean section was a mystery and highly controversial in Europe but in the Middle Ages, Muslims wrote about the operation and even illustrated it with pictures. Towards the end of the 12th Century C.E. the European nations were beginning to surpass their rivals in the Islamic East. The increasing strength of the West took full advantage of scientific and literary discoveries of the Muslims. Far from giving any credit to the Muslims or acknowledging their contributions to science, the Western scholars painted a very distorted picture and left highly biased opinions of their predecessors from the Islamic world. This fact can be very easily illustrated by many examples from the history of medicine.
It is unfortunate that the Western medical historians have not appreciated the value of the writings of early Muslim scholars. On the contrary, for many centuries they have made positive efforts to discredit the Muslims. As an example, it is a generally held view in the West that surgical advancement was discouraged by great Muslim physicians like Ibn Sina because, in his Al-Qanon he did not emphasise surgical procedures. In these futile efforts it is forgotten that Al-Qanon was primarily a treatise on internal medicine and not on surgery. Many European authors of later ages produced medical texts on similar patterns. Moreover these shortsighted historians completely ignored surgical geniuses and the contributions of people like Abu Qasim (known in the West as Al Bucasis). In this context, the history of Caesarean section presents a good example. In 1863 a French medical historian by the name of C. Rique recorded that the operation of Caesarean section was strictly prohibited in Islam . He went on to say that according to Islamic jurists any child born by such an operation should be killed immediately as a child of the Devil. This author also quoted the name of an unknown Arab to justify his conclusion. But even after exhaustive searches this reference can not be found in the authentic Arabic literature. From the middle of the last century until modem times, Rique's statement has been quoted and referred to by many historians without establishing the truth or its validity. The literature on this subject is littered with references to the above quotation without even referring to the original source. On the contrary, no medical historian has ever mentioned that during the middle ages it was a well known belief in Europe that the devil or the Antichrist would be born by Caesarean section before the end of the world. This legend is mentioned and supported by a picture in a book published in 1898 by R. Procter and can be seen in the British Museum.
Unfortunately worthwhile literature of the early Islamic period is scanty and scattered or else is in the wrong hands. Many valuable manuscripts are either in private hands used only as profitable investments or in museums all over Europe and America. The Islamic states and the statesmen who can easily afford to collect and compile copies of these manuscripts for free circulation have never shown any interest in this wealth of inheritance. Lack of interest and research in these early manuscripts has created an atmosphere of doubt and misinformation.
If someone cared to devote time and effort searching through the available literature, a great a deal of truth could easily be found buried under the sands of time. As regards Caesarean section we know that in the pre-Islamic days the Romans used to perform this operation after the death of a pregnant woman. This practice was strictly governed by law. Jewish religious books have also mentioned various rules in relation to a child born by an operation. If we go further back into history, in India we find that the Buddha was possibly born by an operation. A famous Indian medical man by the name of Susruta wrote about such an operation in 6th or 7th century B.C. All these rich sources relating to Caesarean section were available to Muslim scholars of the Middle Ages, when a vast amount of scientific literature was translated into Arabic. In fact many of the Syriac, Creek and Sanskrit texts were only saved and are available to us because of their Arabic translations whilst the originals are lost forever. Many of the famous translators in the Islamic period were Christians or Jews. We known that an Indian by the name of Manka was appointed to translate Susruta's works into Arabic.
A unique and extremely rare manuscript exists in Edinburgh University Library. It is manuscript number 161 called "Al-Asrar-al-Baqiyah-an-al-Qurun-al-Khaliydh" or the Chronological History of Nations. It was written by the famous Muslim, Al-Beruni, who died at the age of 78 in 1048 C.E. Al-Beruni has also left us a large volume on the history of India and many other texts. He travelled extensively in pre-Muslim India and his writings were greatly influenced by these experiences. In particular he was impressed by medicinal plants form India. In the above manuscript Al-Beruni has mentioned that Caesar Augustus (63 B.C. - 14 C.E.) was born by post-mortem Caesarean section. He also wrote that a folk hero Ahmed-Ibn-Sahl was born by Caesarean section after the death of his mother. Apart from these two very relevant references he actually included a picture of the Caesarean section in his book. Without any question this picture is the first ever illustration of such an operation in a textbook and places its author at least 500 years ahead of others.
Another famous name and contemporary of Al-Beruni was Firdousi (935-1025 C.E.), author of the well known "Shahnama". In this 60 000 verses long poems he described the birth of Rustum by Caesarean section. This lively and fascinating description and use of anaesthesia during the operation is there for everyone to read and provides convincing proof that the concept of Caesarean section was mature and its use was an accepted fact.
When we seek help from the religious authorities we discover no less than the towering figure of Imam Abu Hanifah (699 -767 C.E.) who decreed that an operation on a living or dead woman to save the life of an unborn child is allowed in Islam. This is mentioned in a book called Radd-ul-Mukhtar published in 1844 in Egypt.
Further strong evidence is available in the Fatawa Alamgeeria-a collection of Islamic decrees compiled by Sheikh Nitzam -ud -Din of Burhanpur under the auspices of the Mughal emperor, Aurangzeb, who himself was well versed in Islamic Sharia. In this document there is a decree that if a pregnant woman dies and a child is expected to be alive, then the child must be removed by operation. It goes on to say that the operation should also be performed in order to save the life of a mother when the child is known to be dead.
In conclusion it can be proved that Caesarean section has never been prohibited by any Muslim authority. On the contrary, the Muslims in the Middle ages were the first to write about it in text and poetry and to illustrate the operation in pictures. They also formulated rules governing religious matters to allow such a procedure when the need arose.
Article by Dr. N.H. Naqvi FFARCS
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This article originally appeared in Muslim Technologist, December 1989 and is reproduced with permission