Abu al-Qasim al-Zahrawi
Al-Zahwari blistering a patient in the hospital at Cordova by Ernest Board.
|Died||1013 (aged 76–77)|
|Era||Islamic Golden Age|
|Region||Al-Andalus, Caliphate of Córdoba|
|Notable idea(s)||Founder of modern surgical and medical instruments; Father of Surgery|
|Notable work(s)||Kitab al-Tasrif|
Abū al-Qāsim Khalaf ibn al-‘Abbās al-Zahrāwī al-Ansari (Arabic: أبو القاسم خلف بن العباس الزهراوي; 936–1013), popularly known as Al-Zahrawi (الزهراوي), Latinised as Abulcasis (from Arabic Abū al-Qāsim), was an Arab Muslim physician, surgeon and chemist who lived in Al-Andalus. He is considered as the greatest surgeon of the Middle Ages, and has been described as the father of surgery.
Al-Zahrawi’s principal work is the Kitab al-Tasrif, a thirty-volume encyclopedia of medical practices. The surgery chapter of this work was later translated into Latin where it received popularity and became the standard text book in Europe for the next 500 years. Al-Zahrawi’s pioneering contributions to the field of surgical procedures and instruments had an enormous impact in the East and West well into the modern period, where some of his discoveries are still applied in medicine to this day.
He was the first physician to identify the hereditary nature of haemophilia, as well as the first physician to describe an abdominal pregnancy; a sub type of ectopic pregnancy which in those days was a fatal affliction.
Al-Zahrawi was born in the city of Azahara, 8 kilometers northwest of Cordova, Andalusia. His birth date is not known for sure, however, scholars agree that it was after 936, the year his birthplace city of Azahara was founded. The nisba (attributive title), Al-Ansari, in his name, suggests origin from the Medinian tribe of Al-Ansar, thus, tracing his ancestry back to Medina in the Arabian peninsula.
He lived most of his life in Cordova. It is also where he studied, taught and practiced medicine and surgery until shortly before his death in about 1013, two years after the sacking of Azahara.
Few details remain regarding his life, aside from his published work, due to the destruction of El-Zahra during later Castillian-Andalusian conflicts. His name first appears in the writings of Abu Muhammad bin Hazm (993 – 1064), who listed him among the greatest physicians of Moorish Spain. But we have the first detailed biography of al-Zahrawī from al-Ḥumaydī‘s Jadhwat al-Muqtabis (On Andalusian Savants), completed six decades after al-Zahrawi’s death.
Al-Zahrawi was a court physician to the Andalusian caliph Al-Hakam II. He was a contemporary of Andalusian chemists such as Ibn al-Wafid, al-Majriti and Artephius. He devoted his entire life and genius to the advancement of medicine as a whole and surgery in particular.
Al-Zahrawi specialized in curing disease by cauterization. He invented several devices used during surgery, for purposes such as inspection of the interior of the urethra and also inspection, applying and removing foreign bodies from the throat, the ear and other body organs. He was also the first to illustrate the various cannulae and the first to treat a wart with an iron tube and caustic metal as a boring instrument.
While al-Zahrawi never performed the surgical procedure of tracheotomy, he did treat a slave girl who had cut her own throat in a suicide attempt. Al-Zahrawi sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. In describing this important case-history he wrote:
A slave-girl seized a knife and buried it in her throat and cut part of the trachea; and I was called to attend her. I found her bellowing like a sacrifice that has had its throat cut. So I laid the wound bare and found that only a little haemorrhage had come from it; and I assured myself that neither an artery nor jugular vein had been cut, but air passed out through the wound. So I hurriedly sutured the wound and treated it until healed. No harm was done to the slave-girl except for a hoarseness in the voice, which was not extreme, and after some days she was restored to the best of health. Hence we may say that laryngotomy is not dangerous.
Al-Zahrawi also pionered neurosurgery and neurological diagnosis. He is known to have performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache. The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children.
Al-Zahrawi’s thirty-volume medical encyclopedia, Kitab al-Tasrif, completed in the year 1000, covered a broad range of medical topics, including on surgery, medicine, orthopaedics, ophthalmology, pharmacology, nutrition, dentistry, childbirth, and pathology.
The first volume in the encyclopedia is concerned with general principles of medicine, the second with pathology, while much of the rest discuss topics regarding pharmacology and drugs. The last tretise and the most celebrated one is about surgery. Al-Zahrawi stated that he chose to discuss surgery in the last volume because surgery is the highest form of medicine, and one must not practice it until he becomes well-acquainted with all other branches of medicine.
The work contained data that had accumulated during a career that spanned almost 50 years of training, teaching and practice. In it he also wrote of the importance of a positive doctor-patient relationship and wrote affectionately of his students, whom he referred to as “my children”. He also emphasized the importance of treating patients irrespective of their social status. He encouraged the close observation of individual cases in order to make the most accurate diagnosis and the best possible treatment.
Not always properly credited, modern evaluation of al-Tasrif manuscript has revealed on early descriptions of some medical procedures that were ascribed to later physicians. For example, Al-Zahrawi’s al-Tasrif described both what would later become known as “Kocher’s method” for treating a dislocated shoulder and “Walcher position” in obstetrics. Morover, Al-Tasrif described how to ligature blood vessels almost 600 years before Ambroise Paré, and was the first recorded book to explain the hereditary nature of haemophilia. It was also the first to describe a surgical procedure for ligating the temporal artery for migraine, also almost 600 years before Pare recorded that he had ligated his own temporal artery for headache that conforms to current descriptions of migraine. Al-Zahrawi was therefore the first to describe the migraine surgery procedure that is enjoying a revival in the 21st century, spearheaded by Elliot Shevel a South African surgeon.
On Surgery and Instruments
On Surgery and Instruments is the 30th and last volume of Kitab al-Tasrif. It is without a doubt his most important work and the one which established his authority in Europe for centuries to come.
On Surgery and Instruments is the first illustrated surgical guide ever written. Its contents and descriptions has contributed in many technological innovations in medicine, notably which tools to use in specific surgeries. In his book, al-Zahrawi draws diagrams of each tool used in different procedures to clarify how to carry out the steps of each treatment. The full text consists of three books, intended for medical students looking forward to gaining more knowledge within the field of surgery regarding procedures and the necessary tools.
The book was translated into Latin in the 12th century by Gerard of Cremona. It soon found popularity in Europe and became a standard text in all major Medical universities like those of Salerno and Montpellier. It remained the primary source on surgery in Europe for the next 500 years, and as the historian of medicine, Arturo Castiglioni, has put it: al-Zahrawi’s treatise “in surgery held the same authority as did the Canon of Avicenna in medicine”.
Al-Zahrawi claims that his knowledge comes from careful reading of previous medical texts as well as his own experience: “…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…I have made it accessible for you and rescued it from the abyss of prolixity”.
In the beginning of his book, al-Zahrawi states that the reason for writing this treatise was the degree of underdevelopment surgery had reached in the Islamic world, and the low status it was held by the physicians at the time. Al-Zahrawi ascribed such decline to a lack of anatomical knowledge and a misunderstanding of the human physiology.
must be versed in the science of
al-Zahrawi, Kitab al-Tasrif.
“Before practicing surgery one should gain knowledge of anatomy and the function of organs so that he will understand their shape, connections and borders. He should become thoroughly familiar with nerves muscles bones arteries and veins. If one does not comprehend the anatomy and physiology one can commit a mistake which will result in the death of the patient. I have seen someone incise into a swelling in the neck thinking it was an abscess, when it was an aneurysm and the patient dying on the spot.”
In urology, al-Zahrawi wrote about taking stones out of the bladder. By inventing a new instrument, an early form of the lithotrite which he called “Michaab”, he was able to crush the stone inside the bladder without the need for a surgical incision. His technique was important for the development of lithotomy, and an improvement over the existing techniques in Europe which caused severe pain for the patient, and came with high death rates.
In dentistry and periodontics, al-Zahrawi had the most significant contribution out of all Muslim physicians, and his book contained the earliest illustrations of dental instruments. He was known to use gold and silver wires to ligate loosened teeth, and has been credited as the first to use replantation in the history of dentistry. al-Zahrawi also invented instruments to scale the calculus from the teeth, a procedure he recommended as a prevention from periodontal disease.
Al-Zahrawi introduced over 200 surgical instruments, which include, among others, different kinds of scalpels, retractors, curettes, pincers, specula, and also instruments designed for his favoured techniques of cauterization and ligature. He also invented hooks with a double tip for use in surgery. Many of these instruments were never used before by any previous surgeons.
His use of catgut for internal stitching is still practised in modern surgery. The catgut appears to be the only natural substance capable of dissolving and is acceptable by the body. An observation Al-Zahrawi discovered after his monkey ate the strings of his oud. Al-Zahrawi also invented the forceps for extracting a dead fetus, as illustrated in the Al-Tasrif.
Throughout the text, Al-Zahrawi uses an authoritative tone to declare his expertise on the topic. For example, when introducing topics or describing procedures, Al-Zahrawi often warns the reader of the skills necessary to complete the task. In chapter forty-eight, “On cauterization for numbness“, he defines the required knowledge for the procedure in a commanding tone: “This should not be attempted except by one who has a good knowledge of the anatomy of the limbs and of the exits of the nerves that move the body”. He invents a criterion to generate a standard of skill level, indicating that he himself has surpassed it due to training and experience. As such, he reiterates his preeminence by implying that he is part of an exclusive group of learned surgeons capable of correctly completing this cautery. In another instance, he states that the procedure should be avoided completely by incompetent surgeons: “However, no one should attempt this operation unless he has had long training and practice in the use of cautery”.
Al-Zahrawi was not afraid to depart from old practice, for example, he openly disparages the opinion that cauterization should only be used in the spring season: “…the Ancients…[affirmed] that spring was the best. Myself, I say that cautery is suitable at all times”. Four pages later, he again opposes the opinion that gold is the best material for cauterization, stating that iron is actually his preferred metal: “therefore in our own opinion cauterization is swifter and more successful with iron”. In chapter twenty-nine, “On cauterization for pleurisy”, he states: “Now one of the Ancients mentioned that there were some people who used an iron cautery shaped like a probe, and introduced it red hot into the intercostal space until it reached the abscess itself and evacuated the pus…but in this perforation with the cautery there is a danger either that the patient may die on the spot or that an incurable fistula may rise in its place”.
Pharmacology and Cosmetics
In pharmacy and pharmacology, Al-Zahrawi pioneered the preparation of medicines by sublimation and distillation. He dedicated the 28th chapter of his book to pharmacy and pharmaceutical techniques. The chapter was later translated into Latin under the title of Liber Servitoris, where it served as an important source for European herbalists. The book is of particular interest, as it provides the reader with recipes and explains how to prepare the “simples” from which were compounded the complex drugs then generally used.
Al-Zahrawi also touched upon the subject of cosmetics and dedicated a chapter for it in his medical encyclopedia. As the treatise was translated into Latin, the cosmetic chapter was used in the West. Al-Zahrawi considered cosmetics a branch of medicine, which he called “Medicine of Beauty” (Adwiyat al-Zinah). He deals with perfumes, scented aromatics and incense. He also invented a perfumed sticks rolled and pressed in special molds, perhaps the earliest antecedents of present-day lipsticks and solid deodorants.
The chief influence of Albucasis on the medical system of Europe was that his lucidity and method of presentation awakened a prepossession in favour of Arabic literature among the scholars of the West: the methods of Albucasis eclipsed those of Galen and maintained a dominant position in medical Europe for five hundred years, i.e long after it had passed its usefulness. He, however, helped to raise the status of surgery in Christian Europe; in his book on fractures and luxations, he states that ‘this part of surgery has passed into the hands of vulgar and uncultivated minds, for which reason it has fallen into contempt.’ The surgery of Albucasis became firmly grafted on Europe after the time of Guy de Chauliac (d.1368).
In the 14th century, the French surgeon Guy de Chauliac quoted al-Tasrif over 200 times. Pietro Argallata (d. 1453) described Al-Zahrawi as “without doubt the chief of all surgeons”. Al-Zahrawi’s influence continued for at least five centuries, extending into the Renaissance, evidenced by al-Tasrif‘s frequent reference by French surgeon Jacques Daléchamps (1513–1588).
The street in Cordova where he lived is named in his honor as “Calle Albucasis”. On this street he lived in house no. 6, which is preserved today by the Spanish Tourist Board with a bronze plaque (awarded in January 1977) which reads: “This was the house where Al-Zahrawi lived.”
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- Hamarneh, Sami Khalaf; Sonnedecker, Glenn Allen (1963). A Pharmaceutical View of Abulcasis Al-Zahrāwī in Moorish Spain: With Special Reference to the “Adhān,”. Brill Archive. p. 15.
- Meri, Josef W. (2005). Medieval Islamic Civilization: An Encyclopedia. Routledge. p. 783.”The greatest surgeon of the medieval ages was Abu’l-Qasim az Zahrawi (d. 1010), a most important representative of the Andalusian school.”
- Weinberg, Steven (2015). To Explain the World: The Discovery of Modern Science. Penguin Books Limited.”al-Zahrawi (Abulcasis) was born in 936 near Cَrdoba, the metropolis of Andalusia, and worked there until his death in 1013. He was the greatest surgeon of the Middle Ages, and highly influential in Christian Europe.”
- Gerli, E. Michael (2017). Routledge Revivals: Medieval Iberia (2003): An Encyclopedia. Routledge. p. 12.”Book 30, on surgery, was translated in the twelfth century by Gerard of Cremona (Liber Alsahravi de cirurgia) and it established the reputation of Abulcasis as the greatest surgeon of the Middle Ages.”
- Krebs, Robert E. (2004). Groundbreaking Scientific Experiments, Inventions, and Discoveries of the Middle Ages and the Renaissance. Greenwood Publishing Group. p. 95.” Al-Zahrawi (930 or 963-1013 C.e.), also known as Abu-Al Quasim Khalaf ibn’Abbas al-Zahrawi, was a court physician. He was known for his practice of surgery as well as medicine. Sometimes referred to as the “father of surgery,””
- Estreicher, Stefan K. (2006). Wine: From Neolithic Times to the 21st Century. Algora Publishing. p. 46.”Al-Zahrawi (936-1013), better known as Albucasis, writes a 30-volume medical encyclopedia and designs modern-looking surgical instruments. Many consider him the father of surgery.”
- Ahmad, Z. (St Thomas’ Hospital) (2007), “Al-Zahrawi – The Father of Surgery”, ANZ Journal of Surgery, 77 (Suppl. 1): A83, doi:10.1111/j.1445-2197.2007.04130_8.x
- al-Zahrāwī, Abū al-Qāsim Khalaf ibn ʻAbbās; Studies, Gustave E. von Grunebaum Center for Near Eastern (1973). Albucasis on surgery and instruments. University of California Press. ISBN 978-0-520-01532-6. Retrieved 16 May 2011.
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- Cosman, Madeleine Pelner; Jones, Linda Gale (2008). Handbook to Life in the Medieval World. Handbook to Life Series. 2. Infobase Publishing. pp. 528–530. ISBN 978-0-8160-4887-8.
- Hamarneh, Sami Khalaf; Sonnedecker, Glenn (1963). A Pharmaceutical View of Abulcasis Al-Zahrāwī Moorish Spain: With a Special Reference to the “Adhān”. Brill Archive. p. 15″The incipit to the seventeenth treatise in these manuscripts gives al–Zahrawi the additional title of “al–Ansari,” the physician. From this, one could infer that al–Zahrawi is the scion of “al–Ansar, the people of “al–Madinah”. and hence the nickname “al–Ansari.”.
- Hamarneh, Sami Khalaf; Sonnedecker, Glenn (1963). A Pharmaceutical View of Abulcasis Al-Zahrāwī Moorish Spain: With a Special Reference to the “Adhān”. Brill Archive. p. 15.“Al-Zahrawi’s ancestry then, one might infer, goes back to the Arabian Peninsula, to the inhabitants of “al-Madinah,” the first city that accepted the message of Islam.”
- Missori, Paolo; Brunetto, Giacoma M.; Domenicucci, Maurizio (7 February 2012). “Origin of the Cannula for Tracheotomy During the Middle Ages and Renaissance”. World Journal of Surgery. 36 (4): 928–934. doi:10.1007/s00268-012-1435-1. PMID 22311135.
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- Karagِzoğlu, Bahattin (2017). Science and Technology from Global and Historical Perspectives. Springer. p. 155.”This last volume is a surgical manual describing surgical instruments, supplies, and procedures. Scholars studying this manual are discovering references to procedures previously believed to belong to more modern times.”
- Shevel, E; Spierings, EH (April 2004). “Role of the extracranial arteries in migraine headache: a review”. Cranio : The Journal of Craniomandibular Practice. 22 (2): 132–6. doi:10.1179/crn.2004.017. PMID 15134413.
- Fleischer, Aylmer von. Moorish Europe. Aylmer von Fleischer.”His work, Al-Tasrif, later translated into Latin by Gerard of Cremona, became the standard medical text for European Universities such as those at Salerno and Montpellier. This work was widely used by European medical practitioners for centuries.”
- Castiglioni, Arturo (1958). A history of medicine. A. A. Knopf. p. 274.”Abulcasis (Alsaharavius or Abu’l-Qasim) (d. c. 1013) was the author of a surgical treatise which in surgery held the same authority as did the Canon of Avicenna in medicine.”
- Abū Al-Qāsim Khalaf Ibn ʾabbās Al-Zahrāwī. Albucasis on Surgery and Instruments. Berkeley: University of California Press, 1973. (676)
- “Abulcasis, the pharmacist surgeon | Hektoen International”. hekint.org.
- Selin, Helaine (2008). Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures. Springer Science & Business Media. p. 1545.
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- Ingle, John Ide; Baumgartner, J. Craig (2008). Ingle’s Endodontics. PMPH-USA. p. 1281.”The individual first credited with the principle of extraction and replantation was an Arabian physician by the name of Abulcasis who practiced in the eleventh century.”
- Ingle, John Ide; Bakland, Leif K. (2002). Endodontics. PMPH-USA. p. 727.”Abulcasis, an Arabian physician practicing in the eleventh century, is the first credited with recording the principle of extraction/replantation.”
- Andrews, Esther K. (2007). Practice Management for Dental Hygienists. Lippincott Williams & Wilkins. p. 6.”Abu al-Qasim, also known as Abulcasis, wrote an encyclopedia of medicine and surgery (al-Tasrif) that is now kept at Oxford University. His unique contribution to dentistry reported the relationship between calculus and periodontal disease. He promoted prevention by recommending scaling calculus above and below the gums until all accretions were removed even if it takes multiple visits.”
- Holmes-Walker, Anthony (2004). Life-enhancing plastics : plastics and other materials in medical applications. London: Imperial College Press. p. 176. ISBN 978-1-86094-462-8.
- Ingrid Hehmeyer and Aliya Khan (2007). “Islam’s forgotten contributions to medical science”, Canadian Medical Association Journal 176 (10).
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- Levey M. (1973), Early Arabic Pharmacology, E. J. Brill, Leiden.[page needed]
- A Pharmaceutical View of Abulcasis Al-zahrawi in Moorish Spain. Brill Archive. 1963. pp. 19–.
- See:Luisa Arvide
- Epstein, Samuel; Fitzgerald, Randall (2011). Healthy Beauty: Your Guide to Ingredients to Avoid and Products You Can Trust. BenBella Books, Inc.
- Snodgrass, Mary Ellen (2015). World Clothing and Fashion: An Encyclopedia of History, Culture, and Social Influence. Routledge. p. 153.
- Mikaberidze, Alexander, ed. (2011). Conflict and Conquest in the Islamic World: A Historical Encyclopedia: A Historical Encyclopedia. ABC-CLIO. p. 586. ISBN 978-1598843378.
- Campbell, Donald (2001). Arabian Medicine and Its Influence on the Middle Ages: Trubner’s Oriental Series. London: Routledge. p. 88. ISBN 978-0415244626.
- Badeau, John Stothoff; Hayes, John Richard (1983). Hayes, John Richard, ed. The Genius of Arab civilization: source of Renaissance (2nd ed.). MIT Press. p. 200. ISBN 978-0262580632.
- Al-Benna, Sammy (29 September 2011). “Albucasis, a tenth-century scholar, physician and surgeon: His role in the history of plastic and reconstructive surgery”. European Journal of Plastic Surgery. 35 (5): 379–387. doi:10.1007/s00238-011-0637-3.
- al-Zahrāwī, Abū al-Qāsim Khalaf ibn ʻAbbās (1973). مقالة في العمل باليد: A Definitive Edition of the Arabic Text. University of California Press. ISBN 9780520015326. Retrieved 7 December 2012.
- Arvide Cambra, Luisa Maria (1994). Un tratado de polvos medicinales en Al-Zahrawi. University of Almeria. ISBN 978-8482400020.
- Arvide Cambra, Luisa Maria (1996). Tratado de pastillas medicinales segْn Abulcasis. Junta de Andalucia. ISBN 978-8460554851.
- Arvide Cambra, Luisa Maria (2000). Un tratado de oftalmologيa en Abulcasis. University of Almeria. ISBN 978-8482402413.
- Arvide Cambra, Luisa Maria (2003). Un tratado de odontoestomatologيa en Abulcasis. University of Almeria. ISBN 978-8482406367.
- Arvide Cambra, Luisa Maria (2010). Un tratado de estética y cosmética en Abulcasis. Grupo Editorial Universitario (GEU). ISBN 9788499153421.
- Pormann, Peter E. (2004). The Oriental Tradition of Paul of Aegina’s Pragmateia. BRILL. ISBN 9789004137578. Retrieved 7 December 2012.
- Hamarneh, Sami Khalaf; Sonnedecker, Glenn Allen (1963). A Pharmaceutical View of Abulcasis Al-Zahrāwī in Moorish Spain: With Special Reference to the “Adhān,”. Brill Archive. Retrieved 8 October 2014.
- Facsimile of codex: Abu´l Qasim Halaf ibn Abbas al-Zahraui – Chirurgia; Vienna, Austrian National Library, Cod. Vindob. S. N. 2641, Southern Italy, 2nd half of the 14th century, Akademische Druck- u. Verlagsanstalt (ADEVA) Graz 1979, Complete colour facsimile edition of the 166 pp. (78 fol. + 8 pp. + 2 pp.) in original size 405 x 280 mm. 227 smaller golden initial letters, 1 ornamental page, 1 pen drawing and 68 miniatures with illustrations from the medical sphere; text in Gothic Rotunda. Binding: Leather. All folios are cut according to the original. Commentary volume: E. Irblich, Vienna. 70 pp. text and 11 illustrations, cloth. Facsimile and commentary in a solid slip case. Limited edition: 960 numbered copies. CODICES SELECTI, Vol. LXVI