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Zahrāwī Al-

By:
Salah E. Zaimeche
Source:
The Oxford Encyclopedia of Philosophy, Science, and Technology in Islam What is This? Includes complete coverage of Islamic philosophy, sciences, and technologies from the classical through contemporary periods.

Zahrāwī Al-

Abū al-Qāsim al-Zahrāwī (known as al-Zahrāwī [Latin Albucasis], 936–1013 CE) of Córdoba, a key figure in the historical development of surgery, was born and flourished during the rules of the great Andalusian kings, ʿAbd al-Rahman III (912–961), his son al-Ḥakam II (961–976), and Ibn Abī Amīr (al-Manṣūr, d. 1002). During that period, Muslim Spain and Córdoba were at the apogee of glory and power. Tenth-century Córdoba was the most civilized city in Europe. There, the medical profession had attained a high standard of excellence. The surgeons of Córdoba were universally recognized as unrivaled in the extent and variety of their knowledge. Al-Zahrāwī was among the greatest of these medical figures.

Al-Zahrāwī’s Scientific Work.

Al-Zahrāwī is famed for his surgery; however, he also contributed to pharmaceutical sciences. In his Tasrif, known in Latin as Liber servitoris de praeparatione medicinarum simplicium, al-Zahrāwī explains how to prepare “simples” from which complex drugs were then generally compounded. He devotes one third of the treatise to the preparation of chemical compounds; tablet making; and the purification, calcination, and washing of raw material of mineral origin for medicinal purposes. Al-Zahrāwī explains how to prepare litharge, white lead, lead sulfide (burnt lead), burnt copper, cadmia, marcasite, yellow arsenic, and lime, vitriols, salts, natron, and so forth. His distillation as a means of preparing drugs was also significant.

Al-Zahrāwī influenced subsequent Muslim scholars in the field of pharmaceutics as well as botany. Ibn al-Baytar would rely very heavily on him two or so centuries later.

In the nineteenth volume of his Al-Tasrif, al-Zahrāwī addresses matters relating to cosmetics, including the care and beautification of hair, skin, teeth, and other parts of the body. He includes methods for strengthening gums and bleaching teeth, suntan lotions, nasal sprays, and hand creams.

Al-Zahrāwī also gives attention to problems and diseases of the teeth and their cures. He draws attention to the corruption of the teeth by substances that attack the gums, and recommends scraping teeth with a metallic instrument. He also notes that the tool used for the inner surface of the tooth is different from that used for the outer surface, and that another one should be used for scraping between the teeth. All these instruments are illustrated. Al-Zahrāwī also recommends the interlacing of loose teeth with silver and gold wire.

Muslim Contributions to Surgery.

One of the earliest and most popular books in the West was Kitab al-Maliki (The Complete or “Perfect” Book on Medical Art) of ʿAlī ibn al-ʿAbbas al-Majusi (written before 977/78 CE), called in Latin the Pantegni. This book was first translated by Constantine the African at Salerno and subsequently in 1127 by Stephen of Antioch during the Crusades. It was the only book known to have been translated in the East during the medieval period. Al-Majusi considers treatment with surgery of equal importance as treatment with drugs. In the surgical section of his work, he describes many surgical conditions and gives advice on treatment after operations.

Other Muslim physicians who gave importance to surgery include Ibn Sīnā, of course, and members of the Ibn Ẓuhr family.

Muslim innovations in surgery were multiple. ʿAlī ibn Isa (Jesu Haly) (d. 1010 CE) from Baghdad completed Tadkirat al-Kahhaleen (Notebook of the Oculist) on diseases of the eye. A point of great importance in ʿAlī ibn Isa’s treatise relates to the use of the expression tanwim (sedating) the patient. According to Hirschberg, Ibn Isa speaks of general anesthesia in four places; in operations for hydatids of the eyelids, he remarks: “In case the patient is one of those who can’t hold still and causes trouble, put him to sleep and let one assistant hold his head and the other his arm” (Major, 1954, p. 247).

While the East witnessed a great advance in surgery, it was in the western half of the Muslim world, thanks to al-Zahrāwī, that Muslim surgery blossomed.

Al-Zahrāwī’s Surgery.

Al-Zahrāwī’s al-Tasrif is a rich treatise that describes many operations in great detail. The surgical portion, produced separately, was the first illustrated work on surgery. Al-Zahrāwī’s book includes illustrations of instruments, their use for particular operations, as well as his personal experience. Toward the end of this book, he says:

"Whatever skill I have, I have derived for myself by my long reading of the books of the ancients and my thirst to understand them until I extracted the knowledge of it from them. Then through the whole of my life, I have adhered to experience and practice. So now I have described for you in this book all that my knowledge has encompassed on the subject, and that my experience has encountered; I have reduced it to a brief outline; and have explained it most clearly. I have made for you many drawings of the instruments that are used in it, which is an adjunct to explanation, as I did in the previous two books. (Spink and Lewis, 1973, p. 676)"

Al-Zahrāwī constructed and devised a great number of instruments and surgical procedures. He explains with the aid of drawings the use of these instruments in surgical operations. Most of the instruments were new, their introduction and use thus constituting breakthroughs in the history of science in general, and surgery in particular. In the use of the scalpel and cutting instruments, al-Zahrāwī shows how incisions are to be made (for the eyes, for example, the direction of the cut, depth, the care needed to avoid muscles). He also shows how to use knives during surgery. He deals with fractures of the head caused by swords or stones, hemorrhages, and what instruments to use in each situation and what sort of bone is involved. He insists on the extreme care to be taken in using instruments in sensitive areas. Al-Zahrāwī’s descriptions of operations and surgical instruments had a great impact on medieval surgical practice and science.

Al-Zahrāwī’s surgical techniques were also revolutionary. For calculus in the urethra, for instance, he introduced the use of a fine drill inserted through the urinary passage. He also practiced the bronchotomy, or incision of the windpipe, which modern science still uses. In gynecology, he included instructions on training midwives to perform unusual deliveries, ways of extracting dead fetuses, and removing the afterbirth; the design and introduction of vaginal dilators; the description of forceps; and the use of caesarean methods. Al-Zahrāwī was at the forefront of many innovative breakthroughs such as cauterization and also pioneered the use of instruments made of iron. In opposition to the prejudices of the age, which held that every metal had some special occult property, he argued, instead, that only iron ought to be employed.

Al-Zahrāwī was both an anatomist and physiologist and did not implicitly accept the often contradictory authority of Ibn Sīnā and Galen, most particularly. He believed in the principle that medicine and surgery were complementary to each other. He refuted the Ancients in relation to many issues such as in the treatment of dislocations of the spinal vertebrae:

"If the curvature dates from childhood, there is no treatment or cure at all. As for the sort that occurs from a fall or a blow or the like, the Ancients indulged in lengthy disquisitions, giving many kinds of treatment, most of which are of no use. I have abbreviated, making a little which will serve in place of their much, consisting in my clarification and exposition of the sense. I have also depicted the instrument differently from theirs. (Spink and Lewis, 1973, p 34)"

Al-Zahrāwī uses numerous examples throughout his work, describing what he saw, what happened, what he did, and the precautions taken, before, during, and after an operation; how to cover wounds and cuts; how to loosen bandages, rinse wounds, apply balms; and other treatments. He devotes, for instance, an extensive amount of writing to the single operation of extracting arrows. He describes their wounds; the reactions according to each wound in any part of the body; when the wounded person should not be operated upon; and accounts of arrows he extracted from patients.

In respect to the particular surgery to remove arrow heads, Sournia (1986) remarks how when an arrowhead was so deep inside the flesh that only the point of entry of the arrow was visible, al-Zahrāwī advises that the victim be put in the same position as when he received the wound so that the foreign body could be more easily located through a probe technique. This technique was later attributed to the Frenchman Ambroise Paré for use in the location of bullets; however, Sournia insists, Paré followed al-Zahrāwī’s technique.

Al-Zahrāwī was possibly the first surgeon to understand how malignant diseases spread and the need for radical surgery in multiple instances. On the subject of cauterization of cancer, he advises burning around the circumference of the cancer rather than extensive cauterization in the middle. On gangrenous amputations, he insists on radical, prompt surgery. On the couching of the cataract, he says that although the patient's sight can be tried, it must not be at the time of the treatment or immediately after the perforation by the needle. Here again, he mentions the existence in Iraq of the hollow needle to extract cataracts.

Like other surgeons, al- Zahrāwī showed great reluctance in undertaking the riskiest and most painful operations. He was aware of the patients’ discomfort, which could be regarded as a decisive breakthrough in the relationship between the surgeon and the patient.

Impact on the West.

For centuries, al-Zahrāwī’s work remained the manual of surgery in all early medical universities such as Salerno and Montpellier, while the illustrations of his instruments laid the foundations for practical surgery in Europe.

The surgical part of al-Zahrāwī’s Tasrif was translated into Latin by Gerard of Cremona, and various editions were published in Venice in 1497, Basel in 1541, and Oxford in 1778. The Latin translation was printed in Venice in 1497 (and reprinted in 1500) and also in Strasbourg in 1532. Al-Zahrāwī was also translated into local languages. Jaime II (king of Aragon from 1291 to 1327) employed the Jewish scholar Judah ben Astruc Bonsenyor to translate from Arabic into Catalan The Surgery of Abulcasis (Al-Zahrāwī).

Guy de Chauliac (1300–1368 CE), surnamed “The Restorer” because “he introduced the use of Arabic terms and doctrines with increased vigour into the European medical system of thought,” (Campbell, 1926, p. 176) completed works that revealed al-Zahrāwī’s influence in content, form, and methodology. De Chauliac propagated Islamic surgery through the rest of Europe. Fifty-two editions of his work were printed in Europe during the fifteenth and sixteenth centuries.

Henry of Mondeville (d. c. 1335 CE) became one of the main links between Italian and French surgery; and thanks to him, and a little later to Chauliac, surgical leadership passed from Italy to France. His Chyrurgia is much more than a compilation, referring mainly to Hypocrates and Galen on the Greek side, but principally to Islamic authors: Ibn Masawaih, Ibn Sarabi, Al-Razi, ʿAlī ibn ʿAbbas, ʿAlī ibn Radwan, Ibn Sīnā, Ibn Rushd, Constantine the African, and of course, Al-Zahrāwī.

The greatest South Italian physician, Bruno da Longoburgo, a Calabrian, was educated in Salerno. However, his life was spent, and his fame was obtained, in the North, in Padua, where he completed, c. 1252, his Chirurgia Magna. Bruno’s main authority was al-Zahrāwī. His work marked a new stage in the transmission of Islamic medicine to the West. The Chirurgia was translated into Hebrew before the end of the century and had a great impact on both Jewish and Christian medicine.

Farbrice d’Aquapendente in the sixteenth century also used Al-Zahrāwī extensively, and the whole Renaissance literature in the field, Sournia (1986) remarks, is indebted to al-Zahrāwī and to Chauliac.

The Basel edition (dated 1541) of al-Zahrāwī’s work, referred to earlier, is illustrated with woodcuts, which are dissimilar to those in Channing’s translation. Still the Basel edition formed the basis of the work of John Channing, who published his Albucasis de Chirugia in 1778. The reference to gynecology in it was published by Gaspar Wolph in his Collectio Gynaeciorum. Intellectually for the West, Shalick (2005) concludes, the most innovative event for the development of surgical instruments was the translation of al-Zahrāwī’s Al-Tasrif.

[See also IBN AL-JAZZāR.]

Bibliography

  • Campbell, Donald. Arabian Medicine and Its Influence on the Middle Ages. Amsterdam: Philo Press, 1926.
  • Guthrie, D. A History of Medicine. London: Thomas Nelson and Sons, 1958.
  • Hamarneh, S. K., and G. Sonnedecker. A Pharmaceutical View of Abulcasis al-Zahrāwī in Moorish Spain. Leiden, Netherlands: Coll. Janus, Suppl. 5, 1963.
  • Major, R. H. A History of Medicine. Vol. 1. Oxford: Blackwell, 1954.
  • Savage-Smith, E. “Medicine.” In Encyclopaedia of Arabic Sciences, edited by R. Rashed, pp. 902–962. London: Routledge, 1996.
  • Shalick, W. O. III. “Medical Instruments.” In Medieval Science, Technology and Medicine: An Encyclopaedia, edited by T. Glick, S. J. Livesey, and F. Wallis, pp. 270–272. London: Routledge, 2005.
  • Sournia, Jean-Charles. Médecins arabes anciens, Xe et XIe Siècles. Paris: Conseil International de la Langue Française, 1986.
  • Spink, M. S., and G. L. Lewis. Abulcasis on Surgery and Instruments. London: Wellcome Institute of the History of Medicine, 1973.
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