Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi.

"Father of Surgery"

 

             Almost a thousand years ago at a time when Spain (Al Andalus) was part of the Islamic empire, there lived near the capital city of Cordoba one of the great, but now largely forgotten, pioneers of surgery. He was known as Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi. Al-Zahrawi (also known as Albucasis) 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.

 

He is considered as Islam's greatest medieval surgeon, whose comprehensive medical texts, combining Middle Eastern and Greco-Roman classical teachings, shaped European surgical procedures up until the Renaissance.

 When reading Al Zahrawi’s life history and his writings, it is clear that he devoted his entire life and genius to the development and enhancement of medicine as a whole and surgery in particular. Although he traveled very little, he had wide experience in treating accident victims and war casualties.


 Al Zahrawi is believed to have been born in the city of El-Zahra, six miles northwest of Cordoba, sometime between 936 and 940. It was here that he lived, studied, taught and practiced medicine and surgery.

He is best known for his early and original breakthroughs in surgery. 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 encyclopedia 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. It included sections on surgery, medicine, orthopedics, ophthalmology, pharmacology, nutrition etc.

At-Tasrif contains many original observations of historical interest. In it, El Zahrawi elaborates on the causes and symptoms of disease and theorizes on the upbringing of children and youth and on the care of the aged and convalescent. In the section on pharmacology and therapeutics, he covers areas such as cardiac drugs, emetics, laxatives, cosmetology, dietetics, material medical, weights and measures and drug substitution.


 At-Tasrif was translated into Latin by Gerard of Cremona in the 12th century and alongside Avicenna's Canon, played a major role as a medical text in the universities of Europe from the 12th to the 17th century AD. Two of El Zahrawi's treatises deserve special mention. Firstly his 28th treatise, known in Latin as Libber servitors de preparation Medici arum simplified, describes chemical preparations, tablet making, filtering of extracts and related pharmaceutical techniques. This treatise was printed in Venice in 1471 by Nicolaus Jensen.

Perhaps the most importance treatise is the one on surgery. This monumental work was the first in Arabic to treat surgery independently and in detail. It included many pictures of surgical instruments, most invented by El Zahrawi himself, and explanations of their use. 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 El Zahrawi discussed cauterization, bloodletting, midwifery and obstetrics and the treatment of wounds. 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!

Once At-Tasrif was translated into Latin in the 12th century, El Zahrawi had a tremendous influence on surgery in the West.

In At-Tasrif, El Zahrawi expressed his concern about the welfare of his students whom he called "my children". He emphasized the importance of a good doctor patient relationship and took great care to ensure the safety of his patients and win their trust irrespective of their social status.

 El Zahrawi's clinical methods showed extreme foresight - he promoted the close observation of individual cases in order to establish the most accurate diagnosis and the best possible treatment. He insisted on compliance with ethical norms and warned against dubious practices adopted by some physicians for purposes of material gain. He also cautioned against quacks who claimed surgical skills they did not possess.

Some of Al-Zahrawi's accomplishments:

1.      Al Zahrawi was an expert in dentistry, and his book contains sketches of various instruments used thereof, in addition to a description of various important dental operations.

2.     He discussed the problem of non-aligned or deformed teeth and how to rectify these defects.

3.    He developed the technique of preparing artificial teeth and of replacement of defective teeth by these.

4.     In medicine, he was the first to describe in detail the unusual disease, hemophilia.

5.    The first to describe clearly the hereditary circumstances surrounding hemophilia.

6.    He also described ligaturing of blood vessels long before Ambroise Pare.

7.    El Zahrawi was the first medical author to provide illustrations of instruments used in surgery.

8.     El Zahrawi outlined the use of caustics in surgery, fully described tonsillectomy, tracheotomy and craniotomy- operations he had performed on a dead fetus.

9.    He explained how to use a hook to extract a polyp tiom 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.

10.                        In connection with the preparation of medicines, he has also described in detail the application of such techniques as sublimation and decantation.

 

11. He was the first to detail the classic operation for cancer of the breast, lithotrities for bladder stones, and techniques for removing thyroid cysts.

12.                        Also he was considered one of the early leading “plastic surgeon” as he performed many plastic surgery procedures.

13.                        Al Zahrawi has specialized in curing disease by cauterization and applied the technique to as many as 50 different operations.

 

The French surgeon Guy de Chauliac in his 'Great Surgery', completed in about 1363, quoted At-Tasrif over 200 times. El 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 El Zahrawi throughout the Middle Ages and up to the Renaissance.

Al Zahrawi was the physician of King Al-Hakam-II of Spain. After a long medical career, full of rich and significant contributions, Al Zahrawi died in 1013 C.E.

     There can be no doubt that Al Zahrawi influenced the field of medicine and surgery very deeply and the principles he laid down were recognized as authentic in medical science, especially surgery, and these continued to influence the medical world for five centuries. According to Dr. Cambell (History of Arab Medicine), "Al Zahrawi’s principles of medical science surpassed those of Galen in the European medical curriculum".



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