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Some
one thousand years ago, the Iberian Peninsula, which
makes the corner of South-Western Europe, was
experiencing a remarkable cultural advancement. Under
the prosperous Muslim Andalusian Umayyad reign, the
capital city of Cordoba flourished. It became a leading
center of cultural and scientific activity, attracting
scholars, artists, and poets from all directions
throughout the Mediterranean and Europe. At about the
turn of the 9th Century AD, Cordoba had
become a metropolis of half a million people – a notable
number for those days.
The ruler of Andalusia at the time, Caliph Abd Al Rahman
Al Nasir, took to building a new capital for his empire
in 936 AD. He saw the slopes of the mountain Al Arus,
which was six miles northwest of Cordoba, as the perfect
location for his new capital. He named the new city Al
Zahra (El Zahra). Once competed, the Al Zahra stunned
with its beauty and splendid grandeur, becoming the
prime example of Muslim architectural achievement.
In around the year of 940 AD, Abul Qasim Khalaf Ibn Al
Abbas Al Zahrawi was born in the just completed capital
Al Zahra. Al Zahrawi’s early life has remained somewhat
of a mystery, perhaps partly because Al Zahra and all
its records were destroyed in 1011. What is known,
however, is that Al Zahrawi developed to become perhaps
the single greatest contributor to surgery as it is
practiced until the present day.
Al
Zahrawi – the Extraordinary Physician, Surgeon, and
Inventor
Al Zahrawi, found
in different sources also as El Zahrawi, Alzahawi,
Ezzahrawi, Zahravius, Alcarani, Alsarani, Aicaravi,
Alcaravius, Alsahrawi, or from his first name Abul Qasim
as Abulcases, Albucasis, Bulcasis, Bulcasim, Bulcari,
was a person who would change the practice of medicine.
In his native Al Zahra, he became the personal physician
of Al Hakam the Second, also known as Al Montassir.
During his career, his obsession with the advancement of
medicine made him the most celebrated surgeon of the
time. European practitioners of this and later periods
looked up to him as a greater authority than Galen - the
legendary ancient expert in surgery. Proof to this is
the fact that most Medieval European surgical books
referred to Al Zahrawi more often than to Galen.
The earliest
known reference to Al Zahrawi was made by the Andalusian
Muslim intellectual Abu Muhammad bin Hazm (993-1064).
Bin Hazm presented Al Zahrawi as the most able physician
and surgeon of Umayyad Spain. The earliest known attempt
for a complete biographical account of Al Zahrawi’s life
and work is in Al Humaydi's “Jadhwat Al Muqtabis.” The
title translates as “On Andalusian Servants” and was
produced some sixty years after El Zahrawi's death.
However, this text manages to identify Al Zahrawi’s
ancestry and early place of residence only with dubious
accuracy.
“Al Tasrif” – Al
Zahrawi’s Magnum Opus in Medical Research
Only one book is
known to have been written by Al Zahrawi. In itself, the
text not only served as the greatest medical
encyclopedia of the time, but it gives us a solid basis
to infer about his methods and to some extent about his
life. Al Zahrawi called this masterpiece “Al Tasrif.”
“Al Tasrif liman
'Ajiza 'an Al Ta'lif,” translating as “The Method of
Medicine” or called in short “Al Tasrif,” was Al
Zahrawi’s account of his lifelong research and practice
in field of medicine, and in surgery in particular. This
encyclopedia is a collection of thirty volumes
accumulated over some fifty years of his medical
experience. In it, he managed to give detailed accounts
of the full dental, pharmaceutical, and surgical
disciplines of his time.
Among the
recurring topics in Al Tasrif are those of obstetrics,
maternal and child health, the anatomy and physiology of
the human body, surgery, orthopedics, ophthalmology,
pharmacology, and even nutrition. Al Zarhrawi goes into
detail to examine the first warning signs of an ailment,
then the possible reasons for its occurrence, and
finally he points out the cure technique for the
problem. In the process, he looks into and illustrates
the preparation and use of the needed medicines and
tools for the treatment. These included emetic and
cardiac medicines, laxatives, geriatrics, cosmetology,
dietetics, materia medica, weight and measures, and drug
substitution.
As a result of its complete expertise and innovation, Al
Zahrawi’s Al Tasrif became very influential in many
fields of medical-related activities. For example, Al
Zahrawi’s advice proved very helpful in the field of
nursing with his texts on mother and child well-being
and the occupation of midwifery.
The nature of Al
Zahrawi’s comments and methods of teaching and treatment
allow us to infer a little bit about his character. He
seems to have been a very humane person, not only
because of the nature of his profession. He cared not
only for his patients, but also for his followers. He
enjoyed sharing his knowledge and discussing medical
matters with his students, who in his book he called his
children. Al Zahrawi taught them to value his patients
irrespective of their social status, and to build a good
doctor-patient relationship with every one of them. He
also taught them the importance of examining each
medical problem as a unique case, taking into
consideration all aspects that may have come into play.
He didn’t encourage his followers to go by the book and
apply the standard method before considering how each
case differs from the common example. Perhaps, most
vividly describing his personal character and integrity
is his insistence on ethical correctness and in
opposition to unfair treatment for personal reasons such
as material gain.
AL Zahrawi Breakthroughs in Surgery
The biggest
section in Al Tasrif – the thirtieth and last one –
deals exclusively with surgery. Entitled simply “On
Surgery,” it is considered the earliest surgical
exposition known as well as the single best medieval
source on the matter. “On Surgery” deals with a broad
scope of surgical matters among which are many
treatments he invented which are still in use today. For
example, Al Zahrawi was the first to promote the now
classic surgery for breast cancer, for removing thyroid
cysts, and for lithotrities for bladder stones. In
addition to his thorough explanations, Al Zahrawi
included his own precise illustrations to “avoid any
risk of confusion.” These were some 150 diagrams and
sketches of surgical instruments, syringes, droppers,
and others. The visual examples, detailing various
surgical tools, either in use already or invented by Al
Zahrawi, figured prominently in medieval medical texts
and journals in Europe and the Muslim world for
centuries to come.
Some of the more
popular surgical tools devised by Al-Zahrawi are a
device for internal examination of the ear, a tool for
internal check up of the urethra, and an apparatus for
removing foreign objects from the throat. Elsewhere in
the 190 chapters of “On Surgery” are texts detailing the
advantages and disadvantages of cautery and the
instruments used, the setting of bones in simple and
compound fractures, cupping, withdrawal of arrows from
the injured body, and various kinds of needles and
threads for stitching wounds, and wound treatment as a
whole. Other prominent chapters examine dental surgery
and oral sanitation. Some of these describe in detail
the preparation of dental arches for fixing teeth,
tongue depressors, and related surgical procedures that
are the earliest such records in medical history.
Noteworthy innovations by Al Zahrwai include
interdiction of amputations above the knee and the elbow
due to a dangerous situation, lucid account of
hemophilia, explanation of spinal paralysis caused by
injury to the medulla or the spinal cord, and the
earliest precise diagram-supported explanation of the
popular “Walcher Position” in obstetrics using
parturition supported by instruments.
The
First Ever Plastic Surgeon
Interestingly,
in modern medical circles, Al Zahrawi is often regarded
as the inventor of plastic surgery. Indeed, he did
perform operations which can clearly be defined as a
form of plastic surgery some one thousand years ago. In
the Al Tasrif volume “On Surgery,” he proposed a
considerable collection of plastic surgery solutions and
methods. Some of these are still used by the best modern
plastic surgeons today. For example, Al Zahrawi used
ink to indicate the incision path on the skin before the
operation which nowadays is common practice. Elsewhere,
for the correction of large breasts with excess skin
which cannot be adjusted simply by glandular excision,
he instructs “Make two incisions so that the edges join
together, then take out the skin and glandular tissue in
between and suture the edges of the defect.” This method
is also taken into account for such treatments in
present practice.
Growing Fame
Al
Zahrawi’s labors of lifelong devotion to medicine
started to be recognized popularly with the translation
of his book Al Tasrif. His fame first came to Western
Europe with the translation of his texts by Gerard of
Cremona. More translations soon followed, increasing the
interest in Al Tasrif up to the Renaissance period. “On
Surgery” was first printed in Venice in 1471, then it
was republished in 1497 and 1499. In the following 16th
century, the book’s popularity had gained momentum and
was being printed in various prominent European printing
houses. The 1531 Pietro Argallata (died 1423) edition’s
introduction stated that “without doubt, Albucasis (Al
Zahrawi) was the chief of all surgeons.” The Renaissance
revival of attention to medicine helped make Al Tasrif
the most popular medical reference. The simple layout of
the composition, the transparent delivery, and the
logical reasoning all contributed to the same effect.
The famous French surgeon Guy de Chauliac in his book
“Great Surgery” completed in 1363 quoted Al Tasrif more
than 200 times. Another prominent French surgeon, Jaques
Delechamps (1513-1588), later referred to Al Tasrif on
numerous occasions, reinforcing the authority of Al
Zahrawi on medicine, especially surgery, all the way
through the Middle Ages and up to the Renaissance.
Al Zahrawi died of natural causes in his native Al Zahra two years after
the fall and destruction of the city under the Berbers
attack in 1013. It is clear from his 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. His deeds towards the development
of medicine had a profound effect on the field and can
be felt to our present day. |
