Al-Zahrawi (Albucasis) - A light in the dark middle ages in Europe
"without
doubt
Albucasis
was the chief of all surgeons"
Pietro Argallata
Dr. Sharif Kaf Al-Ghazal , MD,
MS, RCS (Plast.Cert.), DM (Plast.)
Plastic , Reconstructive & Hand Surgeon
England
Abu al-Qasim Khalaf bin Abbas Al-Zahrawi (A.D. 936-1013), known to the West by his Latin name Albucasis, was born in Al Zahra’a , six miles northwest of Cordoba in Andalusia. He was simply the greatest Muslim surgeon, with European surgeons of his time coming to regard him as a greater authority than even Galen, the ancient world's acknowledged master. It is clear from Al-Zahrawi's life history and from his writings that he devoted his entire life and genius to the advancement of medicine as a whole and surgery in particular.
What is known about Al-Zahrawi is
contained in his only written work: At-Tasrif
liman 'Ajiza 'an at-Ta'lif
(The Method of Medicine). At-Tasrif is a
medical encyclopaedia compendium of 30 volumes compiled from medical data that
Al-Zahrawi accumulated in a medical career that spanned five decades of teaching
and medical practice. He apparently travelled very little but had wide
experience in treating accident victims and war casualties.
The last and largest volume of At-Tasrif,
"On Surgery," was nothing less than the greatest achievement of medieval
surgery. It was the first independent surgical treatise ever written in
detail . It included many pictures of surgical
instruments, most invented by Al-Zahrawi himself, and explanations of their use.
Al-Zahrawi was the first medical author to provide illustrations of instruments
used in surgery. There are approximately 200 such drawings ranging from a tongue
depressor and a tooth extractor to a catheter and an elaborate obstetric device.
The variety of operations covered is amazing. In this treatise Al Zahrawi
discussed bloodletting, midwifery and obstetrics ,
the treatment of wounds , the extraction of arrows and the setting of bones in
simple and compound fractures. He also promoted the use of antiseptics in wounds
and skin injuries; devised sutures from animal intestines, silk, wool and other
substances . He described the exposure and division
of the temporal artery to relieve certain types of headaches, diversion of urine
into the rectum, reduction mammoplasty for
excessively large breasts and the extraction of cataracts. He wrote extensively
about injuries to bones and joints, even mentioning fractures of the nasal bones
and of the vertebrae , in fact 'Kocher's method' for
reducing a dislocated shoulder was described in At-Tasrif
long before Kocher was born !
Al-Zahrawi outlined the use of caustics in surgery, fully described
tonsillectomy, tracheotomy and craniotomy operations which
he had performed on a dead foetus.
He explained how to use a hook to extract a polyp from the nose, how to use a
bulb syringe he had invented for giving enemas to children and how to use a
metallic bladder syringe and speculum to extract bladder stones.
Al Zahrawi was the first to describe the so-called "Walcher
position" in obstetrics; the first to depict dental arches, tongue depressors
and lead catheters and the first to describe clearly the hereditary
circumstances surrounding haemophilia. He also described ligaturing of blood
vessels long before Ambroise Pare.
Al-Zahrawi is the first to detail the classic operation for
cancer of the breast, lithotrities for bladder stones, and techniques for
removing thyroid cysts.
He was considered one of the early leading “plastic surgeon” as he performed
many plastic surgery procedures. In the 11th chapter of volume 30 of
his book he put many principles in that surgical field .
He used ink to mark the incisions in his patients preoperatively which became
now as a routine standard procedure . In (chapter
26 ) he explained the differences between primary and
secondary wound closure and also the importance of wound
Debridement before closure.
In (chapter 47 )
he described the surgical options to treat Gynecomastia
as he recommended removal of the glandular tissue by a
C-shaped incision. For large breasts with excess skin that cannot be corrected
with glandular excision alone, “...make two incisions so that the edges join
each other, then remove the skin and glandular tissue in between and suture the
edges of the defect...” . This technique is still
considered for such condition nowadays.
Al-Zahrawi had a special interest in eyelid
surgery. He gave sensible suggestions on the use of fine instruments, of which
he had a wide variety. He described surgical management of different pathologies
such as entropion, ectropion, trichiasis and
symblepharon
.
In the treatment of entropion, Al Zahrawi advised eversion of the eyelid with
fingers or with a traction suture. An incision under the eyelashes from medial
to lateral is then carried out so that the skin is separated from the lid
margin. A leaf-shaped piece of eyelid skin is excised, and lash eversion is
achieved as the defect is sutured primarily.
He also classified ectropion as congenital and
acquired and he advised eversion and resection of a base-down triangular segment
from the inner layers for lower lid laxity to treat to cases of eye ectropion.
His book At-Tasrif
is also the first work in diagramming surgical instruments, detailing over two
hundred of them, many of which Al-Zahrawi devised himself. Many of these
instruments, with modifications, are still in use today.
Once At-Tasrif was translated into Latin in the 12th
century, Al Zahrawi had a tremendous influence on surgery in the West. The
French surgeon Guy de Chauliac in his 'Great
Surgery', completed in about 1363, quoted At-Tasrif
over 200 times.
With the reawakening of European interest in medical
science, At-Tasrif quickly became a standard
reference and was translated into Latin five times. The arrangement of the work,
its clear diction, and its lucid explanations all contributed to its popularity
and great success.
Al Zahrawi was described by Pietro
Argallata (died 1423) as "without doubt the
chief of all surgeons". Jaques
Delechamps (1513-1588), another French surgeon, made
extensive use of At-Tasrif in his elaborate
commentary, confirming the great prestige of Al Zahrawi throughout the
Middle Ages and up to the Renaissance.
Selected References:
1. Hamareh S K in The Genius of Arab Civilisation edited by J R Hayes; 2nd edition, 1983; Eurabia (Publishing) Ltd; pp 198-200
2. Albucasis;
On Surgery and Instruments; English translation and commentary
by Spink M S and Lewis G L; 1973
4.Az-Zahrawi: The Great Surgeon . by David Tschanz
5.
Al-Zahrawi and Plastic Surgery. By Dr.Sharif Kaf
Al-Ghazal. ArabMed Journal,
Issue 2(12); 2002. Page
16-18 .
6- Al Zahrawi and his influence on eye
surgery . Dr. M.Zafer
Wafawi.
Page from a 1531 Latin translation by Peter Argellata of El Zahrawi's treatise which shows many surgical and medical instruments.