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Title: Drawings and Pharmacy in Al-Zahrawi's 10th-Century Surgical Treatise
Author: Sami Hamarneh
Release Date: July 24, 2008 [EBook #26038]
Language: English
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| Transcriber’s note: |
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| Following table describes the meaning and the origin of |
| the characters enclosed in square brackets which do not |
| have their correspondents in the English Alphabet: |
| |
| [=a] letter a with a macron (straight line) above (Arabic) |
| [=i] letter i with a macron (straight line) above (Arabic) |
| [=u] letter u with a macron (straight line) above (Arabic) |
| [h.] letter h with a dot below (Arabic) |
| [s.] letter s with a dot below (Arabic) |
| [t.] letter t with a dot below (Arabic) |
| [T.] letter T with a dot below (Arabic) |
| [s,] letter s with a cedilla (comma-like symbol) below (Turkish) |
| [S,] letter S with a cedilla (comma-like symbol) below (Turkish) |
| [)g] letter g with a breve (u-shaped symbol) above (Turkish) |
| |
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Drawings and Pharmacy in al-Zahr[=a]w[=i]’s
10th-Century Surgical Treatise
_by Sami Hamarneh_
Paper 22, pages 81-94, from
CONTRIBUTIONS FROM THE MUSEUM
OF HISTORY AND TECHNOLOGY
UNITED STATES NATIONAL MUSEUM
BULLETIN 228
SMITHSONIAN INSTITUTION · WASHINGTON, D.C., 1961
[Illustration: Figure 1.--Reproduction of a page from
original Arabic manuscript indexed as "Cod. N.F. 476A" at
Oesterreichische Nationalbibliothek in Vienna. Courtesy
Oesterreichische Nationalbibliothek.]
Drawings and Pharmacy in al-Zahr[=a]w[=i]’s
10th-Century Surgical Treatise
_by Sami Hamarneh_
_Probably the earliest independent work in Arabic Spain to embrace the
whole of medical knowledge of the time is the encyclopedic al-Tasr[=i]f,
written in the late 10th century by Ab[=u] al-Q[=a]sim al-Zahr[=a]w[=i],
also known as Abulcasis. Consisting of 30 treatises, it is the only
known work of al-Zahr[=a]w[=i] and it brought him high prestige in the
western world._
_Here we are concerned only with his last treatise, on surgery. With its
many drawings of surgical instruments, intended for the instruction of
apprentices, its descriptions of formulas and medicinal preparations,
and its lucid observations on surgical procedures, this treatise is
perhaps the oldest of its kind._
_Scholars today have available a translation of the text and
reproductions of the drawings, but many of the latter are greatly
modified from the originals._
_This study reproduces examples of al-Zahr[=a]w[=i]’s original
illustrations, compares some with early drawings based on them, and
comments on passages in the treatise of interest to students of pharmacy
and medical therapy._
THE AUTHOR: _Sami Hamarneh undertook this research into the history of
medicine in connection with his duties as associate curator of medical
sciences in the United States National Museum, Smithsonian Institution._
THE INTRODUCTION OF THE WRITINGS of Ab[=u] al-Q[=a]sim Khalaf ibn
‘Abb[=a]s al-Zahr[=a]w[=i]--better known as Abulcasis (d. ca. 1013)--to
Western Europe was through the Latin translation of his surgical
treatise (maq[=a]lah) by Gerard of Cremona (d. 1187).[1] The response to
this treatise, thereafter, was much greater than the attention paid to
the surgery of any of the three renowned physicians of the Eastern
Caliphate: al-R[=a]z[=i] (Latin, Rhazes, d. ca. 925), the greatest
clinician in Arabic medicine; al-Maj[=u]s[=i] (Haly Abb[=a]s, d. 994),
the author of the encyclopedic medical work, _al_-_Malak[=i]_;[2] and
Ibn S[=i]n[=a] (Avicenna, 980-1037), the author of the famous
_al-Q[=a]n[=u]n f[=i] al-[T.]ibb_, a codification of the whole of
medical knowledge. Because of the widespread dissemination of this Latin
version in medieval Europe beginning with the latter part of the 12th
century, al-Zahr[=a]w[=i] attained more prestige in the West than he did
in Arabic Spain, his native country, or in any other part of the Islamic
world.[3]
[Illustration: Figure 2.--The myrtle-leaf shape recommended
for paper on which medicine is to be placed for cauterizing
eyelid. _Top_, from original Arabic manuscript (Tüb. MS.
91), courtesy Universitätsbibliothek Tübingen. _Bottom_,
from Channing, _Albucasis_.]
The fame attached to this surgical treatise, the 30th and last in
al-Zahr[=a]w[=i]’s encyclopedic work _al-Ta[s.]r[=i]f Liman ‘Ajiza
‘an al-Ta’l[=i]f_, is founded on certain merits. The text is
characterized by lucidity, careful description, and a touch of
original observation of the surgical operations to which the treatise
as a whole is devoted.[4] Al-Zahr[=a]w[=i] furnishes his own drawings
of the surgical and dental instruments he used, devised, or
recommended for a more efficient performance. The illustrations were
intended to provide instructional material for apprentices--whom
al-Zahr[=a]w[=i] calls his children--as well as for the benefit of
those who would read the work later on.[5] The treatise is probably
the oldest one known today that contains such instructive surgical
illustrations and text.[6]
[Illustration: Figure 3.--Small funnel for pouring heated
lead into fistula of the eye for cauterization. _Top_, from
original Arabic manuscript (Vel. 2491), courtesy Süleymaniye
Umumi Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Sudhoff,
_Chirurgie_, courtesy National Library of Medicine.]
[Illustration: Figure 4.--Circular cauterization in stomach
ailments. _Top_, from original Arabic manuscript (Tüb. MS.
91), courtesy Universitätsbibliothek Tübingen. _Bottom_,
from the 1531 Latin edition of Pietro d’Argellata,
_Chirurgia Argellata cum Albucasis_, hereinafter cited as
Argellata 1531, courtesy National Library of Medicine.]
This surgical treatise has been investigated, translated, and commented
upon by eminent historians of medicine and surgery to whose works I
shall refer in this article. However, the pharmaceutic and therapeutic
details of the treatise have been somewhat overlooked.
As to the various illustrations of the surgical instruments (over 200
figures in all), an almost complete representation of samples has been
introduced by Channing,[7] Leclerc,[8] Gurlt,[9] Sudhoff,[10] and
others. Nevertheless, a good number of the reproduced drawings are
greatly modified, most likely having been influenced by earlier
illustrations in several Latin and vernacular versions of the
treatise.[11] This becomes clearer on comparison with seven Arabic
manuscripts that have not been fully examined by Western scholars before
and that--in several instances--show more authentic drawings of
al-Zahr[=a]w[=i]’s surgical instruments than any heretofore
published.[12]
[Illustration: Figure 5.--Ink markings for identifying place
of cauterization. _Top_, from original Arabic manuscript
(Vel. 2491), courtesy Süleymaniye Umumi Kütüphanesi
Müdürlü[)g]ü. _Bottom_, from Argellata 1531, courtesy
National Library of Medicine.]
[Illustration: Figure 6.--Cautery in hernia. _Top_, from
original Arabic manuscript (Vel. 2491), courtesy Süleymaniye
Umumi Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Leclerc,
_Albulcasis_.]
This article therefore, is an attempt to present a sample of these
illustrations with brief comments regarding certain figures and passages
of interest to pharmacy and medical therapy.
With much gratitude I express my indebtedness to Prof. G. Folch Jou of
Madrid, to Dr. A. Süheyl Ünver and Mr. H. Dener of Istanbul, and to the
librarians of the depository institutions for their cooperation in the
reproduction of the manuscripts on microfilm.
[Illustration: Figure 7.--Fine tweezer for removing foreign
bodies from the ear. _Top_, from original Arabic manuscript
(Ali 2854), courtesy Süleymaniye Umumi Kütüphanesi
Müdürlü[)g]ü. _Bottom_, from Leclerc, _Abulcasis_.]
[Illustration: Figure 8.--Syringe with metal plunger-pump.
_Top_, from original Arabic manuscript (Ali 2854), courtesy
Süleymaniye Umumi Kütüphanesi Müdürlü[)g]ü. _Bottom_, from
Channing, _Albucasis_.]
Al-Zahr[=a]w[=i] frequently introduces his treatises with brief
instructive and sometimes informative preludes. However, in launching
the last treatise of _al-Ta[s.]r[=i]f_ he expounded in a most
interesting and illuminating manner the status of surgery during his
time. He also explains the reasons that forced him to write on this
topic and why he wished to include, as he did, precautions, advice,
instructional notes, and beautifully illustrated surgical drawings. For
example, the prelude to the treatise mentions four incidents that he
witnessed, all ending with tragic results because of the ignorance of
physicians who attempted to operate on patients without the proper
training in anatomy and surgical manipulation. "For if one does not have
the knowledge of anatomy," al-Zahr[=a]w[=i] protests, then "... he is
apt to fall in errors that lead to death as I have seen it happen to
many."[13]
Al-Zahr[=a]w[=i] divides his surgical treatise into three sections
(abw[=a]b). In the first section (56 chapters)[14] he elaborates upon
the uses and disadvantages of cautery in general. And on the ground that
"fire touches only the ailing part ... without causing much damage to
surrounding area," as caustic medicine does, he prefers cautery by fire
(al-kay bi al-n[=a]r) to cautery by medicine (bi al-daw[=a]).[15] This,
he adds, "became clear to us through lifelong experience, diligent
practice, and thorough investigations of facts."[16]
[Illustration: Figure 9.--Metal nose dropper. _Top_, from
original Arabic manuscript (Tüb. MS. 91), courtesy
Universitätsbibliothek Tübingen. _Middle_, from Channing,
_Albucasis_ (_Smithsonian photo 46891-C_). _Bottom_, from
Sudhoff, _Chirurgie_, courtesy National Library of
Medicine.]
He also proposes that instruments made of iron are more practical in
many ways than those made of gold, because often, when gold instruments
are put in fire, they either are not heated enough or are overheated,
causing the gold to melt.
[Illustration: Figure 10.--Dental scrapers. _Top_, from
original Arabic manuscript (Vel. 2491), courtesy Süleymaniye
Umumi Kütüphanesi Müdürlü[)g]ü. _Left_, from Argellata 1531,
courtesy National Library of Medicine. _Right_, from
Channing, _Albucasis_.]
Al-Zahr[=a]w[=i] gently refutes the superstition that cautery is "good
only in springtime," and states that "under the right conditions of the
body’s humors it could be used in all seasons."[17] Although he
recommends cautery rather highly, he never minimizes the importance of
treatment by drugs. Actually, he encourages the use of drugs, before,
with, and after cauterization.[18] For example, in chapter 16 on "the
cauterization of eyelid when its hair grows reversedly into the eye," he
recommends treatment by cautery and by medicine. In cautery, the area
where fire is to be placed is marked with ink in the shape of a myrtle
leaf. In drug treatment, the caustic medicine is applied to the eyelid
over a paper in the shape of a myrtle leaf (fig. 2).
[Illustration: Figure 11.--Dental forceps. _Top_, from
original Arabic manuscript (Tüb. MS. 91), courtesy
Universitätsbibliothek Tübingen. _Bottom_, from Leclerc,
_Abulcasis_.]
In chapter 17 the author refers to an ancient method regarding cautery
of the fistula in the inner corner of the eye. After incising the
fistula, one "dirham" (derived from the Greek "drachma," which is equal
to about 2.97 grams)[19] of melted lead is poured into it through a fine
funnel used for cauterization (fig. 3).
[Illustration: Figure 12.--Golden bridge to stabilize shaky
teeth. _Top_, from original Arabic manuscript (Tüb. MS. 91),
courtesy Universitätsbibliothek Tübingen. _Left_, from
Argellata 1531, courtesy National Library of Medicine.
_Right_, from Channing, _Albucasis_.]
In like manner, al-Zahr[=a]w[=i] discusses cautery of the stomach and
the "cold liver" in chapters 26 and 27, respectively. The drawings
therein represent shapes of the burns on the skin (fig. 4) and marks of
ink to be drawn beneath the cartilage of the ribs (fig. 5) for the
purpose of spotting the area of operation. Here also he describes
carefully and clearly the methods of applying cautery and the types,
position, and number of tools employed in each case. He likewise depicts
(in chapter 45) instruments used in the treatment of hernia (fig. 6).
The second section (b[=a]b), with about 99 chapters,[20] deals with
incision, puncturing, venesection, cupping, surgery on abscesses, and
the withdrawal of arrows from the body. Al-Zahr[=a]w[=i] warns that
ignorance in such operations may lead to damage of an artery or vein,
causing loss of blood "by which life is sustained."[21] Moreover, needle
and thread (more than one kind is mentioned) for the stitching of wounds
are repeatedly recommended.
According to al-Zahr[=a]w[=i], foreign bodies that lodge in the ear
(chapter 6) are of four origins: (1) "mineral stones" or substances
resembling mineral stones such as iron and glass; (2) plant seeds
(chick-peas and beans); (3) liquids, such as water and vinegar; and (4)
animals, such as fleas. Several instruments are recommended for the
removal of such foreign bodies--fine tweezers shaped like a dropper
(fig. 7), a syringe with plunger-pump, and a tube made of silver or
copper (fig. 8). Also of interest to pharmacy and therapy is the advice
in regard to the use of lubricants to be applied before administering
these fine instruments into the body’s cavities.
Chapter 24 is concerned with the treatment of the polypus that grows in
the nose. The various kinds (including cancer growth), shapes, and
colors of this type tumor and its treatment by surgery or medicine are
described. A hollowed nose-dropper made of metal in the shape of a small
kerosene lamp[22] is suggested (fig. 9). The dropper is held by its
handle while its contents are heated before use. Applying heat to nose
drops was probably proposed because it serves two purposes: it allows
easier flow of the "duhn," or the fatty substance used, and it raises
the temperature of the drops to that of the body.
In his discussion on dental hygiene,[23] al-Zahr[=a]w[=i] describes
scrapers and dental forceps for teeth cleaning and extraction (figs. 10,
11) and brings in a few points of historical interest.[24] He warns of
the common error of extracting the adjacent healthy tooth instead of the
ailing one due to the patient’s sense deception. For a gargle he
prescribes salt water, vinegar, and wine (shar[=a]b). To stop hemorrhage
he used blue vitriol (al-z[=a]j)--copper sulfate in our modern
terminology.
In chapter 33 al-Zahr[=a]w[=i] discusses bridge-making for the
consolidation of shaky teeth (fig. 12). He prefers the use of stable
gold over silver which, he says, putrifies and rots in a short time. In
a rational approach, he also suggests that the fallen tooth itself, or a
similar one shaped out of a cow’s bone, be installed and connected with
adjacent, stable teeth by a bridge.
Now, turning to chapter 36, we find al-Zahr[=a]w[=i] describing a
knife-thin tongue depressor (fig. 13) that he used to facilitate the
examination of inflamed tonsils and other swellings of the throat; it
was made of silver or copper. And in chapter 37 (chapter 34 in Bes.
503), he describes the excision of an inflamed uvula by surgery. In the
same chapter, he also mentions the use of instruments made of steel. Of
pharmaceutical interest is the following free translation of the formula
he prescribes "as a milder treatment by fumigation ... to be resorted to
only when the swelling is subsiding":[25]
Take pennyroyal [_Mentha pulegium_ Linn.], absinthe
[_Artemisia maritima_ Linn.], thyme, rue, hyssop, camomile,
abrotanum [_Artemisia abrotanum_ Linn.], and other similar
herbs. Put all in a casserole and cover them with vinegar.
Then close tightly with clay [_lutum-sapientiae_]--except
for a small hole in the middle of the cover--and boil.
Connect one end of a hollowed instrument, a crude form of an
inhaler [fig. 14], with the hole in the cover and insert the
other end, which contains the nozzle, into the patient’s
mouth, allowing the vapor to rise up to the uvula. And if
you are not able to secure this instrument, take a straw and
attach its end to an egg-shell. The egg-shell will prevent
burns in the patient’s mouth that might be caused by the
heated vapor.
[Illustration: Figure 13.--Metal tongue depressor. _Top_,
from original Arabic manuscript (Ali 2854), courtesy
Süleymaniye Umumi Kütüphanesi Müdürlü[)g]ü._ Bottom_, from
Channing, _Albucasis_.]
[Illustration: Figure 14.--Crude form of an inhaler. _Top_,
from original Arabic manuscript (Tüb. MS. 91), courtesy
Universitätsbibliothek Tübingen. _Bottom_, from Argellata
1531, courtesy National Library of Medicine.]
Al-Zahr[=a]w[=i] repeats in chapter 53, on cancer, what Greek physicians
had said earlier, that cancer could be removed by surgery only at its
first stage and when found in a removable part of the body, such as the
breast. Therefore, he confesses that neither he nor any one else he knew
of ever applied surgery with success on advanced cancer.[26]
[Illustration: Figure 15.--Metallic syringe for injecting
solutions into the bladder. _Top_, from original Arabic
manuscript (Bes. 503), courtesy Süleymaniye Umumi
Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Argellata 1531,
courtesy National Library of Medicine.]
[Illustration: Figure 16.--Metallic or porcelain syringes
for injection of enemas. _Top_, from original Arabic
manuscript (Ali 2854), courtesy Süleymaniye Umumi
Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Argellata 1531,
courtesy National Library of Medicine.]
Of special interest in chapter 59 is the metallic "syringe" (fig. 15)
used to inject medicinal solutions into the bladder: "The hollow passage
[of the syringe] should be exactly equal to the plunger it contains and
no more, so that when such fluids from an excess of humors are aspirated
they will be drawn out, and likewise when the solutions are injected
they will be pushed in easily." Such description of the use of a
"bladder syringe" in the late 10th century clearly points to the
practical and interesting approach to surgery in _al-Ta[s.]r[=i]f_.
Moreover, his description of the removal of a stone from the bladder--an
operation we now call lithotomy--is considered a contribution to bladder
surgery.
One of the earliest recorded operations for the extractions of two dead
fetuses from the womb is clearly described in chapter 76. The account of
this case shows not only al-Zahr[=a]w[=i]’s intelligent approach as a
shrewd observer but also his clinical and surgical ability.
Drawings of bulb-syringe instruments used for administering enemas in
ailments of the rectum and for the treatment of diarrhea and colic are
depicted in chapter 83. The text describes several kinds of syringes
made of silver, porcelain, and copper in various sizes (fig. 16). Of
particular interest is an illustration of a syringe, especially
recommended for children, to which a piece of leather (jildah) is
attached (fig. 17). This instrument is a precursor of our modern bulb
syringe.
In chapter 84 al-Zahr[=a]w[=i] turns to the treatment of various wounds.
He prescribes the following powder formula for use: "Take olibanum
[frankincense] and dragon’s blood,[27] two parts of each, and three
parts of slaked or unslaked lime. Pound them well, pass through a sieve
and apply the powder to the wound." In cases of damaged blood vessels,
he tied the arteries by ligature, a practice of which he was a pioneer.
In another chapter he describes four methods for suturing the
intestines.
Al-Zahr[=a]w[=i], being associated with war casualties and writing his
treatise about the end of the 10th century, no doubt had the experience
of dealing with cases involving injuries caused by arrows. The text in
chapter 94 discloses his observations in elaborate investigations
regarding the extraction of various kinds of arrows from the body.[28]
Accordingly, several kinds of hooks and forceps for removing arrows are
described and depicted in the treatise (see fig. 18). Al-Zahr[=a]w[=i]’s
mention of Turkish bows and arrows led Freind to believe, erroneously,
that the author of the treatise must have lived in the 12th century,[29]
notwithstanding the fact that Turkish bows and arrows were in common use
in the latter part of the 10th century.
[Illustration: Figure 17.--A crude form of bulb syringe
recommended for use with children. _Top_, from original
Arabic manuscript (Ali 2854), courtesy Süleymaniye Umumi
Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Leclerc,
_Abulcasis_.]
The next chapter, on cupping, mentions the use of cups made of horns,
wood, copper, or glass, according to circumstances and the availability
of material. The methods of treatment are divided into two kinds: dry
cupping, with or without fire, and wet cupping (see fig. 19). He
prescribes ointments and aromatic and medicated waters to be applied
before and after cupping to facilitate healing. Only when cupping is not
possible, as on the nose, fingers, and similar parts of the human body,
does he propose the use of leeches for treatment.[30] Evidently this is
an indication that he did not, as generally supposed, encourage the
widespread use of leeches.
[Illustration: Figure 18.--Hooks and forceps used for the
extraction of arrows. _Top_, from original Arabic manuscript
(Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen.
_Bottom_, from Channing, _Albucasis_.]
[Illustration: Figure 19.--Cupping. _Top_, from original
Arabic manuscript (Tüb. MS. 91), courtesy
Universitätsbibliothek Tübingen. _Bottom_, from Argellata
1531, courtesy National Library of Medicine.]
The third and final section, of 35 chapters, deals with the reduction,
luxation, and treatment of injured bones, including fracture of the
pelvis. The advices and warnings in the prelude of this section appear
to repeat some of al-Zahr[=a]w[=i]’s sayings that had been covered in
his previous introductions. The text, however, presents many facets of
interest to the health professions. It elaborates upon the application
of various forms of bandages and plasters in a variety of operations.
Al-Zahr[=a]w[=i]’s detailed description relating to fractures of bones
is a fine anatomical document of historical interest. He illustrates and
describes special methods for tying injured or broken bones, and he
suggests that bandages made of soft linen be less and less tight as
distance increases from the injured place (chapter 1). For the
protection of areas adjacent to the injured part against contact with
edges of splints he advocates padding with soft gauze and carded wool.
In some cases, to guard against swelling, he preferred a delay of one or
more days in applying bandages over splints. Al-Zahr[=a]w[=i] also
devised and depicted many kinds and shapes of splints for use in simple
and compound fractures of the head, shoulders, arms, fingers, etc. (see
fig. 20). For example, in discussing the reduction of the humerus, he
recommends a splint consisting of a smooth, thin stick bent in the shape
of a bow with two strings, each attached to one end of the stick (fig.
21). The injured bone is then placed in the middle of the bent splint
for reduction while the patient is seated on a chair. Tying is applied
only when there is no "hot" swelling (chapter 11). One of the remarkable
observations made in this section is the description of the paralysis
caused by fracture of the spine.
[Illustration: Figure 20.--Splint "in the shape of a spoon
without a bowl." _Top_, from original Arabic manuscript
(Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen.
_Bottom_, from Channing, _Albucasis_.]
Of interest to historians of medical therapy and pharmacy are the
recipes for poultices that al-Zahr[=a]w[=i] recommends for use over
fractured bones. For example, he gives the following recipe for one such
poultice: "Take the so-called 'mill’s dust' [ghub[=a]r al-rah[=a]],
which is the part of the wheat flour that clings to the walls of the
mill during grinding [lub[=a]b al-daq[=i]q], and, without sifting away
the bran, knead with white-of-egg to a medium consistency, and apply."
Another, more elaborate, recipe calls for 10 dirhams each of the roots
of wild pomegranate [_Glossostemon bruguieri_ D.C.], chickling vetch
[the grass pea, _Lathymus sativus_], and white marshmallow; 5 dirhams
each of myrrh and aloes; 6 dirhams of white gum Arabic [_Acacia_]; and
20 dirhams of bole [friable earthy clay consisting largely of hydrous
silicates of aluminum and magnesium, usually colored red because of
impurities of iron oxide]. Procedure was to pound all ingredients
gently, pass them through a sieve, and knead with water or white-of-egg
(chapter 1).
[Illustration: Figure 21.--A splint to support the arm.
_Top_, from original Arabic manuscript (Cod. N.F. 476A),
courtesy Oesterreichische Nationalbibliothek. _Bottom_, from
Argellata 1531, courtesy National Library of Medicine.]
The question arises as to whether al-Zahr[=a]w[=i] did any human
dissection. The answer is uncertain because our knowledge of his life is
fragmentary. However, he gives no clue to the dissection of humans in
any of the 30 treatises of _al-Ta[s.]r[=i]f_--his only known
writings--and there is no evidence that he practiced it in secret. His
upright attitude as a Muslim who repeatedly emphasized his adherence to
his faith suggests that he relied completely on animal dissection and
the writings of his Greek-Roman and Islamic predecessors. Physicians in
both the Islamic domain and in Christendom for many centuries were
hostile to the idea of human dissection for any purpose because of their
traditional socio-religious convictions, considering it an unethical and
undignified practice. Perhaps it has been al-Zahr[=a]w[=i]’s original
contributions to surgery, his enthusiasm in emphasizing the value of
anatomical knowledge, and his recognition of the necessity that only
well-educated, well-trained doctors should perform surgery that have led
some medical historians to wonder whether he did human dissection at
some time in his long years of experience.
In Summary
The few examples of illustrations of surgical instruments given here
indicate that the Arabic manuscripts, in general, have preserved the
original, oriental, artistic features of the drawings in a way that has
been overlooked in Latin and vernacular versions of _al-Ta[s.]r[=i]f_.
In presenting his personal observations and original ideas on surgery
late in life, al-Zahr[=a]w[=i], for the most part, was inspired by a
thorough acquaintance with Greek and Arabic medical literature
supplemented by lifelong intelligent observation and experience.
Through its descriptions and illustrations, the surgical treatise of
al-Zahr[=a]w[=i] very likely played a significant role in the designing
of improved surgical instruments in the Middle Ages. Also, the treatise
no doubt promoted the development of improved surgical techniques in
Islam and, through its translations, promoted these techniques to an
even greater extent in the West, a fact that justifies the fame of this
treatise as the highest expression of the development of surgery in
Arabic Spain--a treatise whose influence continued to the Renaissance.
It contributed in no small measure to the idea of equipping learned and
well-trained surgeons with the best surgical tools and techniques of the
time; moreover, it encouraged the invention of new instruments to meet
differing circumstances and special conditions. These tools no doubt
greatly facilitated the work of the surgeon.
Throughout the text of _al-Ta[s.]r[=i]f_ al-Zahr[=a]w[=i] gave careful
attention to the importance of pharmaceutical preparations in the
healing art, including cases requiring surgery.
[1] George Sarton, _Introduction to the History of Science_,
Baltimore, 1927, vol. 1, p. 681.
[2] Mohammad S. Abu Ganima, in _Abul-Kasim ein Forscher der
Arabischen Medizin_, Berlin, 1929, suggested that
description of operations in al-Maj[=u]s[=i]’s surgery is
clearer than that in al-Zahr[=a]w[=i]’s--a statement which
does not seem acceptable.
[3] Max Neuburger, _Geschichte der Medizin_, Stuttgart,
1911, vol. 2, pt. 1, pp. 178-179.
[4] Heinrich Haeser, _Lehrbuch der Geschichte der Medizin
und der epidemischen Krankheiten_, Jena, 1875, vol. 1, pp.
578-584; and Donald Campbell, _Arabian Medicine and Its
Influence on the Middle Ages_, London, 1926, vol. 1, p. 88.
[5] See the prelude to the treatise.
[6] Fielding H. Garrison (_An Introduction of the History of
Medicine_, ed. 4, rev., Philadelphia, 1929, p. 132), states,
in reference to "Sudhoff and others," that many drawings
earlier than those of al-Zahr[=a]w[=i] have been discovered
in medieval manuscripts. However, Garrison overlooked the
fact that al-Zahr[=a]w[=i]’s surgical illustrations were
mainly depicted for instructional purposes--a unique
approach. It should be noted also that al-Zahr[=a]w[=i] died
almost a century earlier than Garrison thought. See also
Martin S. Spink, "Arabian Gynaecological, Obstetrical and
Genito-Urinary Practice Illustrated from Albucasis,"
_Proceedings of the Royal Society of Medicine_, 1937, vol.
30, p. 654.
[7] Johannis Channing, _Albucasis de Chirurgia. Arabice et
Latine_, Oxford, 1778, 2 vols. (hereinafter referred to as
Channing, _Albucasis_). The text has many errors in spelling
and grammar, but Leclerc went too far in criticizing this
edition, which has many merits. Moreover, the surgical
illustrations (reproduced from the Huntington and Marsh
manuscripts of the Bodleian Library) in Channing’s edition
are of special interest.
[8] Lucien Leclerc, _La Chirurgie d’Abulcasis_, Paris, 1861
(hereinafter referred to as Leclerc, _Abulcasis_). This
excellent French version was first published in a series of
articles in _Gazette Médicale de l’Algérie_, and seems
influenced by Channing’s edition more than Leclerc admits.
Leclerc consulted several Arabic copies of the treatise as
well as Latin and vernacular translations, but only a few of
these Arabic manuscripts are considered complete. The Arabic
manuscripts studied for the present article are not the same
as those used by Leclerc. See also Leclerc’s monumental
work, _Histoire de la Médecine Arabe_, Paris, 1876, vol. 1,
pp. 453-457.
[9] Ernst Gurlt, _Geschichte der Chirurgie und ihrer
Ausübung Volkschirurgie-Alterthum-Mittelalter-Renaissance_,
Berlin, 1898, vol. 1, pp. 620-649, with more than 100
figures. In the text and illustrations, Gurlt relied upon
Leclerc’s translation and modified drawings of the surgical
instruments; nevertheless, he presents a brief, systematic
study--probably the best so far--of the entire treatise.
[10] Karl Sudhoff, _Beiträge zur Geschichte der Chirurgie im
Mittelalter_, Leipzig, 1918 (hereinafter referred to as
Sudhoff, _Chirurgie_), vol. 2, pp. 16-84, with a few plates.
Although Sudhoff consulted the fragmentary Arabic manuscript
indexed as "Cod. Arab. 1989" in Gotha, Germany, he relied
mainly upon Latin versions of the treatise and the
illustrations contained in them.
[11] See Leclerc, _Abulcasis_, in introduction.
[12] The seven Arabic manuscripts are indexed as "Berlin MS.
Or. fol. 91," temporarily at Universitätsbibliothek
Tübingen, in Germany; "Escorial MS. Arabe No. 876," at
Biblioteca del Monasterio de San Lorenzo el Real de El
Escorial, in Spain; "Wien MS. Cod. N.F. 476 A.," at
Oesterreichische Nationalbibliothek, in Vienna; and "Ali
Emiri Arabi No. 2854," "Be[s,]ir A[)g]a Nos. 502 and 503,"
and "Veliyyudin No. 2491," all at Süleymaniye Umumi
Kütüphanesi Müdürlü[)g]ü, in Istanbul. Hereinafter these
manuscripts are referred to, respectively, as Tüb. MS. 91;
Esc. 876; Wien 476 A; Ali 2854; Bes. 502; Bes. 503; and Vel.
2491. The Smithsonian Institution recently obtained a
microfilm copy of Bankipore Manuscript No. 17 from the Khuda
Bakhsh O. P. Library, Patna (Bihar), India. This manuscript,
containing only the 30th treatise of _al-Ta[s.]r[=i]f_, was
copied in 1189; therefore, it is the earliest dated Arabic
manuscript of the surgical treatise known to exist. The
surgical illustrations therein add weight to the belief that
the Arabic manuscripts show more originality in the drawings
than do the later copied versions, which often were
inaccurate and possibly distorted. About ten other
illustrations from the Arabic manuscript in Istanbul indexed
as "Topkapi MS. No. 1990" (which contains 215 beautifully
illustrated figures) were presented by A. S. Ãœnver and
Hüseyin Usman in an extract titled "Me[s,]hur Arab Cerrahi
Elbülkasimi Zehravi ve onum Kitabül Cerrahiyesi," Istanbul,
1935. See also Ünver, _[S,]erefeddin Sabuncuo[)g]lu: Kitabül
Cerrahiyei Illhaniye_, Istanbul, 1939, pp. [5]-7.
[13] See introduction to the treatise; for example, Bes.
502, fol. 522v-523v and Vel. 2491, fol. 104r-105v. See also
K. P. J. Sprengel, _Versuch einer pragmatischen Geschichte
der Arzneikunde_, Halle, 1823, vol. 2, pp. 449-451. George
J. Fisher, in "Abul-Casem Chalaf Ibn Abbas al-Zahr[=a]w[=i],
Commonly Called Albucasis," _Annals of Anatomy and Surgery_,
July-December, 1883, vol. 8, pp. 24-25, gives a translation
of only the first part of the introduction.
[14] There are 56 chapters listed in almost all manuscripts
and commentary works I checked except Tüb. MS. 91 and Esc.
876, where only 55 chapters are listed.
[15] Al-Zahr[=a]w[=i] mentions several caustic medicines
used in cautery, among which are garlic, mustard, melted
lead, slaked or unslaked lime with or without "common" soap,
Thapsia (_Ruta graveolens_ Linn.), and juice of the Oriental
cashew nut (_Senecarpus anacardium_ Linn.).
[16] Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v.
[17] Al-Zahr[=a]w[=i] criticizes those who interpret the
saying "cautery is the end of treatment" to mean that
cauterization is the best and only conclusive treatment at
the physician’s disposal. He points out that other
treatments, such as drugs, should be resorted to first, and
used until they prove of no avail; and he states that only
after cautery proves to be the cure should it be considered
the completion of medical treatment--"al-kay [=a]khir
al-[t.]ibb." See Vel. 2491, fol. 106; and Bes. 502, fol.
524r-525v.
[18] For healing, soothing, or emollient purposes,
al-Zahw[=a]r[=i] suggested medications, such as egg white,
salt water (normal saline), sap of psyllium, several
ointments, "duhn" of rose, and other "adh[=a]n" (plural of
"duhn," the fatty or oily essences extracted from various
substances through pharmaceutical processes).
[19] For a more accurate estimate of the equivalence of
"dirham" according to the area in which the measurement was
taken, the reader may consult Walter Hinz, _Islamische Masse
und Gewichte umgerechnet ins metrische System_, Leiden,
1955, pt. 1, pp. 2-8; and George C. Miles, _Early Arabic
Glass Weights and Stamps_, New York, 1948, p. 6.
[20] The contents of several manuscripts (such as Ali 2854,
Wien 476 A, Bes. 503, and Tüb. MS. 91) give different
numbers.
[21] See, for example, Tüb. MS. 91, fol. 45v; and Bes. 502,
fol. 530v.
[22] Sudhoff, _op. cit._ (footnote 10), p. 29, fig. 6.
[23] For a more detailed and interesting discussion with
beautiful illustrations included, the reader may consult Ch.
Niel, "La Chirurgie Dentaire D’Abulcasis Comparée a celle
des Maures du Trarza," _Revue de Stematologie_, April 1911,
vol. 18, pp. [169]-180 and 222-229.
[24] It is regrettable that Franz Rosenthal in his fine
article "Bibliographical Notes on Medieval Muslim Dentistry"
(_Bulletin of the History of Medicine_, 1960, vol. 34, pp.
52-60) failed to refer to this or any other section of
al-Zahr[=a]w[=i]’s work.
[25] Bes. 502, fol. 538. See also Channing, _Albucasis_, pp.
206-208. For the identification of the drugs and their
botanical origins the author of the present paper consulted
H. P. J. Renaud and Georges S. Colin, _Tu[h.]fat
al-A[h.]b[=a]b, Glossaire de la Matière Médicale Marocaine_,
Paris, 1934, pp. 133, 143, 193-194, and Max Meyerhof, _Un
Glossaire de Matière Médicale Composé par Maimonide_, Cairo,
1940, pp. 168-169.
[26] Tüb. MS. 91, fol. 99v.
[27] Dragon’s blood is a resin obtained from the scales
covering the surface of the ripe fruits of "_Daemonorops
draco Blume_" (Heber W. Youngken, _Textbook of
Pharmacognosy_, ed. 6, Philadelphia, 1948, p. 175). See also
Renaud and Colin, _op. cit._ (footnote 25), pp. 54-55.
[28] Heinrich Frölich, "Abul-Kasem als Kriegschirurg,"
_Archiv für klinische Chirurgie_, 1884, vol. 30, pp.
365-376. This well-presented study was reviewed by Paul
Schede in _Centralblatt für Chirurgie_, 1884, no. 38, pp.
626-627.
[29] Johannis Freind, _The History of Physick_, London,
1726, vol. 2, p. 129.
[30] In several manuscripts, the chapter on the use of
leeches is the last one in the second section of the
treatise.
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