Abū al-Qāsim al-Zahrāwī | |
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أبو القاسم الزهراوي | |
 Imaginary drawing of al-Zahrawi, from a 1964 Syrian postage stamp | |
| Born | c. 936 Medina Azahara, al-Andalus (near present-dayCórdoba, Spain) |
| Died | 1013 (aged 76–77) |
| Occupation |
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| Known for |
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| Academic work | |
| Era | Islamic Golden Age |
| Influenced | Abu Muhammad bin Hazm,Guy de Chauliac,Jacques Daléchamps |
Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari[1] (Arabic:أبو القاسم خلف بن العباس الزهراوي; c. 936–1013), popularly known asal-Zahrawi (الزهراوي),Latinised asAlbucasis orAbulcasis (from ArabicAbū al-Qāsim), was an Arabphysician,surgeon andchemist fromal-Andalus. He is considered one of the greatest surgeons of theMiddle Ages.[2][3]
Al-Zahrawi's principal work is theKitab al-Tasrif, a thirty-volume encyclopedia of medical practices.[4] The surgery chapter of this work was later translated intoLatin, attaining popularity and becoming the standard textbook in Europe for the next five hundred years.[5] 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.[6] He pioneered the use ofcatgut for internal stitches, and his surgical instruments are still used today to treat people.
He was the first physician to identify the hereditary nature ofhaemophilia and describe anabdominal pregnancy, a subtype ofectopic pregnancy that in those days was a fatal affliction, and was first to discover the root cause ofparalysis. He also developed surgical devices forCaesarean sections andcataract surgeries.[6]
Al-Zahrawi was born in the city ofAzahara, 8 kilometers northwest ofCordoba,Andalusia. His birth date is not known for sure, however, scholars agree that he was born around 936, the year his birthplace city ofAzahara was founded. Thenisba (attributive title),Al-Ansari, in his name, suggests origin from theMedinian tribe ofAl-Ansar,[7] thus, tracing his ancestry back toMedina in theArabian Peninsula.[8]
He lived most of his life in Cordoba. 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 ofAbu 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 fromal-Ḥumaydī'sJadhwat al-Muqtabis (On Andalusian Savants), completed six decades after al-Zahrawi's death.
Al-Zahrawi was a court physician to theAndalusian caliphAl-Hakam II. He was a contemporary ofAndalusianchemists such asIbn al-Wafid,al-Majriti andArtephius. He devoted his entire life and genius to the advancement of medicine as a whole and surgery in particular. As a court physician, Zahrawi had access to the most advanced medical knowledge and resources of the time, allowing him to develop new techniques and instruments for surgical procedures. Zahrawi's time as a court physician to Al-Hakam II allowed him to develop his skills and knowledge as a physician and surgeon, and to make significant contributions to the field of medicine. His work helped to lay the foundation for modern surgical techniques and has had a lasting impact on thepractice of medicine.[9][10]
Al-Zahrawi specialized in curing disease bycauterization. He invented severaldevices used during surgery, for purposes such as inspection of the interior of theurethra and also inspection, applying and removing foreign bodies from thethroat, theear and other body organs.[6] He was also the first to illustrate the variouscannulae and the first to treat awart with an iron tube and caustic metal as a boring instrument.[11]
While al-Zahrawi never performed the surgical procedure oftracheotomy, he did treat a slave girl who had cut her ownthroat in a suicide attempt. Al-Zahrawi sewed up the wound and the girl recovered, thereby proving that anincision in thelarynx could heal. In describing this important case-history he wrote:[12]
A slave-girl seized a knife and buried it in her throat and cut part of thetrachea; 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 littlehaemorrhage had come from it; and I assured myself that neither anartery norjugular 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 ahoarseness in the voice, which was not extreme, and after some days she was restored to the best of health. Hence we may say thatlaryngotomy is not dangerous.
Al-Zahrawi also pioneeredneurosurgery andneurological diagnosis. He is known to have performed surgical treatments ofhead injuries,skull fractures,spinal injuries,hydrocephalus,subdural effusions andheadache. The first clinical description of an operative procedure forhydrocephalus was given by Al-Zahrawi who clearly describes the evacuation of superficialintracranial fluid inhydrocephalic children.[13]
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Al-Zahrawi's thirty-volume medical encyclopedia,Kitāb al-Taṣrīf, completed in the year 1000, covered a broad range of medical topics, including onsurgery,medicine,orthopaedics,ophthalmology,pharmacology,nutrition,dentistry,childbirth, andpathology.[14]The first volume in the encyclopedia is concerned with general principles ofmedicine, the second withpathology, while much of the rest discuss topics regardingpharmacology anddrugs. The last treatise and the most celebrated one is aboutsurgery. Al-Zahrawi stated that he chose to discusssurgery in the last volume because surgery is the highest form ofmedicine, and one must not practice it until he becomes well-acquainted with all other branches ofmedicine.
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 positivedoctor-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 ofKitab al-Tasrif manuscript[15] has revealed on early descriptions of some medical procedures that were ascribed to later physicians.[16] For example, Al-Zahrawi'sKitab al-Tasrif described both what would later become known as "Kocher's method" for treating a dislocated shoulder and "Walcher position" inobstetrics. Moreover, theKitab al-Tasrif described how toligature blood vessels almost 600 years beforeAmbroise Paré, and was the first recorded book to explain the hereditary nature ofhaemophilia.[6] It was also the first to describe a surgical procedure for ligating the temporal artery formigraine, also almost 600 years beforePare recorded that he had ligated his own temporal artery for headache that conforms to current descriptions ofmigraine.[17] Al-Zahrawi was, therefore, the first to describe themigraine surgery procedure that is enjoying a revival in the 21st century, spearheaded byElliot Shevel, a South African surgeon.
On Surgery and Instruments is the 30th and last volume of theKitab al-Tasrif. It was 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 inmedicine, 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 intoLatin in the 12th century byGerard of Cremona. It soon found popularity in Europe and became a standard text in all major Medical universities like those ofSalerno andMontpellier.[18] 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 theCanon ofAvicenna in medicine".[19]
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".[20]
In the beginning of his book, al-Zahrawi states that the reason for writing this treatise was the degree of underdevelopmentsurgery had reached in the Islamic world, and the low status it held amongst physicians at the time. Al-Zahrawi ascribed such decline to a lack ofanatomical knowledge and a misunderstanding of the humanphysiology.
He who devoted himself to surgery
must be versed in the science of
anatomy.[21]
Noting the importance ofanatomy he wrote:[22]
"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."
Inurology, al-Zahrawi wrote about taking stones out of the bladder. By inventing a new instrument, an early form of thelithotrite which he called "Michaab", he was able to crush the stone inside the bladder without the need for a surgical incision.[23] His technique was important for the development oflithotomy, and an improvement over the existing techniques in Europe which caused severe pain for the patient, and came with high death rates.
Indentistry andperiodontics, 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,[24] and has been credited as the first to use replantation in thehistory ofdentistry.[25][26] He also invented instruments toscale thecalculus from the teeth, a procedure he recommended as a prevention fromperiodontal disease.[27]
Al-Zahrawi introduced over 200surgical instruments,[28] which include, among others, different kinds ofscalpels,retractors,curettes,pincers,specula, and also instruments designed for his favoured techniques ofcauterization andligature. He also invented hooks with a double tip for use in surgery. Many of these instruments were never used before by any previous surgeons.[28]
His use ofcatgut for internal stitching is still practised in modern surgery. 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 hisoud. Al-Zahrawi also invented the forceps for extracting a deadfetus, as illustrated in theKitab al-Tasrif.[29]
Throughout the text, Al-Zahrawi assumes an authoritative tone. In "Oncauterization fornumbness", he declares the procedure "should not be attempted except by one who has a good knowledge of the anatomy of the limbs and of the exits of thenerves that move the body".[30] He warns that another procedure should not be attempted by any surgeon lacking "long training and practice in the use of cautery".[31] He is not afraid to depart from old practice, disparaging the opinions thatcauterization should only be used in the spring[32] or thatgold is the best material for cauterization: "cauterization is swifter and more successful withiron".[33] In "On cauterization forpleurisy", he notes that the introduction of a red-hot probe into theintercostal space to evacuatepus from anabscess could result in the creation of "an incurablefistula" or even the immediate death of the patient.[34]
Inpharmacy andpharmacology, Al-Zahrawi pioneered the preparation of medicines bysublimation anddistillation. He dedicated the 28th chapter of his book to pharmacy and pharmaceutical techniques. The chapter was later translated into Latin under the title ofLiber 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.[35][36][37]
Al-Zahrawi also touched upon the subject ofcosmetics and dedicated a chapter for it in his medical encyclopedia. As thetreatise was translated intoLatin, the cosmetic chapter was used in the West. Al-Zahrawi consideredcosmetics a branch of medicine, which he called "Medicine of Beauty" (Adwiyat al-Zinah).[38] He deals withperfumes, scentedaromatics andincense. He also invented a perfumed sticks rolled and pressed in special molds, perhaps the earliest antecedents of present-daylipsticks and soliddeodorants.[39]
Al-Zahrawi was the "most frequently cited surgical authority of theMiddle Ages".[40]Donald Campbell, a historian ofArabic medicine, described Al-Zahrawi's influence on Europe as follows:[41]
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, theFrench surgeonGuy de Chauliac quotedal-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 theRenaissance, evidenced byal-Tasrif's frequent reference by French surgeonJacques Daléchamps (1513–1588).[42]
The street inCórdoba 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."
