Surgery

Note of the editor
Abu al-Qasim Al-Zahrawi the Great Surgeon, Dr Ibrahim Shaikh, Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi, Al-Zahrawi, Abulcasis, Islamic medicine, history of surgery, Andalus, Islamic Spain.

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1. Al-Zahrawi

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Figure 1: Imaginary portrait of Al-Zahrawi. (Source)

Abu al-Qasim al-Zahrawi, known also by his Latin name Albucasis, was born near Cordoba in 936 CE. He was one of the greatest surgeons of his time. His encyclopaedia of surgery was used as standard reference work in the subject in all the universities of Europe for over five hundred years.

The Muslim scientists, Al-Razi, Ibn Sina and Al-Zahrawi are among the most famous of those who worked in the field of medicine in pre-modern times. They have presented to the world scientific treasures which are today still considered important references for medicine and medical sciences as a whole.

Abu al-Qasim Khalaf ibn Abbas Al-Zahrawi (known in the West as Albucasis) was born at Madinat al-Zahra near Cordoba in Islamic Spain on 936 CE and died in 1013 CE. He descended from the Ansar tribe of Arabia who had settled earlier in Spain. His outstanding contribution to medicine is his encyclopaedic work Al-Tasrif li-man 'ajaza 'an al-ta'lif, a long and detailed work in thirty treatises. The Al-Tasrif, completed about 1000 CE, was the result of almost fifty years of medical practice and experience. Here is how the author expressed his credo in this book:

"What ever I know, I owe solely to my assiduous reading of books of the ancients, to my desire to understand them and to appropriate this science; then I have added the observation and experience of my whole life."

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Figure 2: The beginning of the first article of Part I of a manuscript of Kitab al-tasrif li-man 'ajaza 'an al-ta'lif authored by Al-Zahrawi. The page shows his definition of medicine, quoted from Al-Razi, as the preservation of health in healthy individuals and its restoration to sick individuals as much as possible by human abilities (Source)

Al-Tasrif is an illustrated encyclopaedia of medicine and surgery in 1500 pages. The contents of the book show that Al-Zahrawi was not only a medical scholar, but a great practicing physician and surgeon. His book influenced the progress of medicine and surgery in Europe after it was translated into Latin in the late 12th century, by Gerard of Cremona, and then afterwards into different European languages, including French and English. Al-Tasrif comprises 30 treatises or books (maqâlat) and was intended for medical students and the practicing physician, for whom it was a ready and useful companion in a multitude of situations since it answered all kinds of clinical problems.

The book contains the earliest pictures of surgical instruments in history. About 200 of them are described and illustrated. In places, the use of the instrument in the actual surgical procedure is shown. The first two treatises were translated into Latin as Liber Theoricae, which was printed in Augusburg in 1519. In them, Al-Zahrawi classified 325 diseases and discussed their symptomatology and treatment. In folio 145 of this Latin translation, he described, for the first time in medical history, a haemorrhagic disease transmitted by unaffected women to their male children; today we call it haemophilia. Book 28 is on pharmacy and was translated into Latin as early as 1288 under the title Liber Servitoris.^[1]

Of all the contents of Al-Zahrawi's Al-Tasrif, book 30 on surgery became the most famous and had by far the widest and the greatest influence. Translated into Latin by Gerard of Cremona (1114-1187), it went into at least ten Latin editions between 1497 and 1544. The last edition was that of John Channing in Oxford (1778), which contained both the original Arabic text and its Latin translation on alternate pages. Almost all European authors of surgical texts from the 12th to the 16th centuries referred to Al-Zahrawi's surgery and copied from him. They included Roger of Salerno (d. 1180), Guglielmo Salicefte (1201-1277), Lanfranchi (d. 1315), Henri de Mondeville (1260-1320), Mondinus of Bologna (1275-1326), Bruno of Calabria (d. 1352), Guy de Chaulliac (1300-1368), Valescus of Taranta (1382-1417), Nicholas of Florence (d. 1411), and Leonardo da Bertapagatie of Padua (d. 1460).

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Figure 3: Frontispiece of the Latin translation of Al-Zahrawi's Kitab al-tasrif: Liber theoricae necnon practicae Alsaharavii... iam summa diligentia & cura depromptus in lucem (Impensis Sigismundi Grimm & Marci Vuirsung, Augustae Vindelicorum, 1519, 159 leaves). This is a translation of the first two books of Al-Tasrif, edited by Paul Ricius. For a long time, Al-Tasrif was an important primary source for European medical knowledge, and served as a reference for doctors and surgeons. There were no less than 10 editions of its Latin version between 1497 and 1544, before it was translated into French, Hebrew, and English. (Source).

The 300 pages of the book on surgery represent the first book of this size devoted solely to surgery, which at that time also included dentistry and what one may term surgical dermatology. Here, Al-Zahrawi developed all aspects of surgery and its various branches, from ophthalmology and diseases of the ear, nose, and throat, surgery of the head and neck, to general surgery, obstetrics, gynaecology. Military medicine, urology, and orthopaedic surgery were also included. He divided the surgery section of Al-Tasrif into three part:

1. on cauterization (56 sections);
2. on surgery (97 sections),
3. on orthopaedics (35 sections).

It is no wonder then that Al-Zahrawi's outstanding achievement awakened in Europe a hunger for Arabic medical literature, and that his book reached such proeminence that a modern historian considered it as the foremost text book in Western Christendom.

Serefeddin Sabuncuoglu (1385-1468) was a surgeon who lived in Amasia in central Anatolia. He wrote his book Cerrahiye-tu l-Hanniyye in 1460 at the age of 80 after serving for many years as a chief surgeon in Amasiya Hospital (Darussifa) for years. His text Cerrahiye-tu l-Hanniyye was presented to Sultan Mohammad the conqueror, but the manuscript disappeared afterwards until it emerged in the 1920s. The book is roughly a translation of Al-Tasrif of Al-Zahrawi, but Sabuncuoglu added his own experiences and brought interesting comments on previous application, besides that every surgical procedure is illustrated in his work.

William Hunter (1717-1783) used Arabic manuscripts for his study on Aneurysm. Among them was a copy of Al-Zahrawi's Kitab al-Tasrif.^[2] In his biography of William Hunter, Sir Charles lllingworth, the author described the circumstances and the context of the purchase by William Hunter of an Arabic manuscript of Al-Tasrif of Al-Zahrawi, which he obtained from Aleppo in Syria.^[3]

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Figure 4: Artistic scene of Al-Zahrawi treating a patient while students look on. Credits: Wellcome Library, London (Source)

The oldest medical manuscript written in England around 1250 according to The British Medical Journal has startling similarity with Al-Zahrawi's volume:

"This interesting relic consists of eighty-nine leaves of volume, written in beautiful gothic script in the Latin tongue. The work contains six separate treatises, of which the first and most important is the DE CHIRURGIA OF ALBU-HASIM [sic] (Albucasis, Albucasim ). This occupies forty four leaves, three of which are missing. It may be contended that this really is the oldest extant medical textbook written in England."^[4]

Thus, in conclusion, Al-Zahrawi was not only one of the greatest surgeons of medieval Islam, but a great educationist and psychiatrist as well. He devoted a substantial section in the Tasrif to child education and behaviour, table etiquette, school curriculum, and academic specialisation.^[5]

In his native city of Cordoba there is a street called 'Al-Bucasis' named after him. Across the river Wadi Al-Kabir on the other side of the city, in the Calla Hurra Museum, his instruments are displayed in his honour. As a tribute, his 200 surgical instruments were reproduced by Fuat Sezgin and exhibited in 1992 in Madrid's Archaeological Museum. A catalogue, El-legado Cientifico Andalusi, published by the museum, has good colour photos and manuscripts, some of which are on Al-Zahrawi's achievements, legacy and influence.

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Figure 5: A copper spoon used as a medical implement to press down the tongue (dated from the 3rd century H/ 9th century CE, Abbasid period) preserved at the Museum of Islamic Art in Cairo. This tool demonstrates that the physicians of the Islamic medical tradition attached much importance to medicine and medical tools in various areas of treatment and how they developed them. A detailed description of these tools can be found in the book Al-Tasrif of al-Zahrawi. (Source).

Hakim Saead, from Hamdard Foundation in Karachi, Pakistan, has a permanent display of silver surgical instruments of Al-Zahrawi in the library of the Foundation. He also published a colour booklet. Professor Ahmed Dhieb of Tunis has also studied the surgical instruments and reconstructed them; they were displayed in the 36th International Congress for the History of Medicine held in Tunis City in Tunisia. In this exhibition, all surgical instruments of Al-Zahrawi were described and illustrated in detail in three languages - Arabic, French and English under the title Tools of Civilisation.

2. Selected articles on Al-Zahrawi and Islamic medicine on MuslimHeritage.com

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Figure 6: Extract from the Arabic text published in De chirurgia. Arabice et Latine, cura Johannis Channing, natu etr civitate Londinensis (Oxford, 1778). This book contains the surgical section of Al-Tasrif, the first rational, complete and illustrated treatise on surgery and surgical instruments. The surgical portion of Al-Tasrif was published separately and became the first independent illustrated work on the subject. It contained illustrations of a remarkable array of surgical instruments and described operations of fractures, dislocations, bladder stones, gangrene and other conditions. It replaced Paul of Aegina's Epitome as a standard work and remained the most used textbook of surgery for nearly 500 years.(Source)

Abdel-Halim, Rabie E., The Missing Link in the History of Urology: A Call for More Efforts to Bridge the Gap (published 01 May 2009).

Abdel-Halim, Rabie E.,

Paediatric Urology 1000 Years Ago (published 13 May 2009).

Abdel-Halim, Rabie E., and Al-Mazrooa, Adnan A.,

Anaesthesia 1000 Years Ago: A Historical Investigation (published 05 June 2009).

Abdel-Halim, Rabie E., and Elfaqih, Salah R., Pericardial Pathology 900 Years Ago: A Study and Translations from an Arabic Medical Textbook (published 06 May 2009).

Burnett, Charles, Arabic Medicine in the Mediterranean (published 29 November 2004).

Buyukunal, S. N. Cenk, and Sari Nil

The Earliest Paediatric Surgical Atlas: Cerrahiye-i Ilhaniye (published 07 September, 2005).

FSTC Research Team, Medical Sciences in the Islamic Civilization: Scholars, Fields of Expertise and Institutions. Section 3: Al-Zahrawi the Genius Surgeon (published 2 February 2009).

Kaf al-Ghazal, Sharif, Selected Gleanings from the History of Islamic Medicine ( series of 5 articles published 03 April, 2007). Article 3: Al-Zahrawi (Albucasis) the Great Andalusian Surgeon.

Khan, Aliya, and Hehmeyer, Ingrid, Islam's Forgotten Contributions to Medical Science (09 January 2009).

Sayili, Aydin, Certain Aspects of Medical Instruction in Medieval Islam and its Influences on Europe (published 24 October, 2008).

Shaikh, Ibrahim, Eye Specialists in Islam (20 December, 2001)

3. General References on al-Zahrawi

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Figure 7: Front cover of Albucasis (Abu Al-Qasim Al-Zahrawi): Renowned Muslim Surgeon of the Tenth Century by Fred Ramen (Rosen Central, 2005)

Abdel-Halim, Rabie E., Altwaijiri, Ali S., Elfaqih, Salah R., Mitwali, Ahmad H., "Extraction of Urinary Bladder Described by Abul-Qasim Khalaf Alzahrawi (Albucasis) (325-404 H, 930-1013 AD)", Saudi Medical Journal 24 (12), 2003: 1283-1291.

Abdel-Halim, A. E., et al., Extraction of Urinary Bladder Stone as Described by Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis) (930-1013 AD, 325-404 H), Saudi Journal of Kidney Diseases and Transplantation, 9(2), 1998, pp. 157-168. See also the article in PDF here.

Abd al-Rahim, Abd al-Rahim Khalaf, Al-Adawat Jirahiya wa al-Awani al-Tibiya fi al-'asr al-Islami min al-Qarn al-Awal hatta al-Qarn al-Tasi' lil Hijra [Surgical Instruments and Medical Vessels in the Islamic Period from the First Century to the Ninth Century], MA thesis, University of Cairo, 1999.

Ahmad, Z., "Al-Zahrawi, The Father of Surgery", ANZ Journal of Surgery, vol. 77, (Suppl. 1), 2007, A83.

Al-Hadidi, Khaled, "The Role of Muslem Scholars in Oto-rhino-Laryngology", The Egyptian Journal of O.R.L., 4 (1), 1978, pp. 1-15.

[Al-Zahrawi], Albucasis on Surgery and Instruments. A definitive edition of the Arabic text with English translation and commentary by M. S. Spink and G. L. Lewis. London, Wellcome Institute of the History of Medicine, 1973.

[Al-Zahrawi], Albucasis de chirurgia. Arabice et Latine… Cura Johannis Channing. Oxonii: e typographeo Clarendoniano, 1778.

'Awad, H. A., "Al- Jiraha fi al-'asr al-Islami [Surgery in the Islamic Period]", Majalat al-Dirasat al-Islamiya [Journal of Islamic Studies], Cairo, vol. 3, 1988.

Hamarneh, Sami Khalaf, and Sonnedecker, Glenn, A Pharmaceutical View of Abulcasis al-Zahrawi in Moorish Spain, with special reference to the "Adhean, Leiden, E.J. Brill, 1963.

Horden, P., 'The Earliest Hospitals in Byzantium, Western Europe, and Islam' Journal of Interdisciplinary History, vol. 35 (3), 2005, pp 361-389.

Hussain, F. A., The History and Impact of the Muslim Hospital. London, Council for Scientific and Medical History, 2009.

Kaadan, Abdul Nasser, "Albucasis and Extraction of Bladder Stone", Journal of the International Society for the History of Islamic Medicine, vol. 3, 2004, pp. 28-33.

Levey M., Early Arabic Pharmacology, E. J. Brill, Leiden, 1973.

Martin-Araguz, C. Bustamante-Martinez, Ajo V. Fernandez-Armayor, J. M. Moreno-Martinez, "Neuroscience in al-Andalus and its Influence on Medieval Scholastic Medicine", Revista de neurología, vol. 34 (9), 2002, p. 877-892.

[Medarus], "Portraits de Médecins", Albucasis, (Khalaf ibn Abbas Al-Zahrawi) 936-1013 Chirurgien arabe d'Espagne.

Noble, Henry W., Tooth transplantation: a controversial story, History of Dentistry Research Group, Scottish Society for the History of Medicine, 2002.

Ramen, Fred, Albucasis (Abu Al-Qasim Al-Zahrawi), The Rosen Publishing Group, 2006.

Savage-Smith, Emilie, "Attitudes Toward Dissection in Medieval Islam", Journal of the History of Medicine and Allied Sciences (Oxford University Press), vol. 50 (1), 1995, pp. 67–110.

Tabanelli, Mario, Albucasi, un chirurgo arabo dell'alto Medio Evo: la sua epoca, la sua vita, la sua opera. Firenze [Florence], L.S. Olschki, 1961.

[Wikipedia], Al-Zahrawi.

Wikipedia], [Kitab] Al-Tasrif

4. Notes

[1.] Liber servitoris de praeparatione medicinarum simplicium. Bulchasin Benaberazerin, translatus a Simone Januensi, interprete Abraam Tortuosiensi, et divisit in tres tractatus. Dixit agregator hujus operis (Venetiis: Per Nicolaum Ienson, 1471, 1 vol., in-quarto. There are several copies of this edition, for example in the library of the University of Glasgow, Special collections, MS Hunterian Bx.3.26.

[2.] See H. G. Farmer, "William Hunter and his Arabic Interest", in Presentation volume to William Barron Stevenson, edited by Cecil James Mullo Weir, University of Glasgow Oriental Society, 1945, "Studia semitica et orientalia, vol. 2". See a description of the Hunterian Collection on the website of the library of Glasgow University.

[3.] Sir Charles Illingworth, The Story of William Hunter, Edinburgh: E. S. Livingstone, 1967, p. 58.

[4.] [Note in "Nova Vetera" section], "The Oldest Medical Manuscript Written In England", The British Medical Journal (published by BMJ Publishing Group), vol. 2, no. 4096 (July 8, 1939), pp. 80-81; p. 81.

[5.] Sami K. Hamarneh, Health Sciences in Early Islam: Collected Papers, Zahra Publishing Co., 1984.

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* Dr Ibrahim Shaikh is a retired medical practitioner. He is a Fellow of the Manchester Medical Society, Manchester, UK.

by: Dr. Ibrahim Shaikh, Sat 22 December, 2001