Chapter 94 Discloses His Observations in Elaborate Investigations

regarding the extraction of various kinds of arrows from the body. Accordingly, several kinds of hooks and forceps for removing arrows are described and depicted in the treatise (see fig. 18). Al-Zahrāwī’s mention of Turkish bows and arrows led Freind to believe, erroneously, that the author of the treatise must have lived in the 12th century, notwithstanding the fact that Turkish bows and arrows were in common use in the latter part of the 10th century.

The next chapter, on cupping, mentions the use of cups made of horns, wood, copper, or glass, according to circumstances and the availability of material. The methods of treatment are divided into two kinds: dry cupping, with or without fire, and wet cupping (see fig. 19). He prescribes ointments and aromatic and medicated waters to be applied before and after cupping to facilitate healing. Only when cupping is not possible, as on the nose, fingers, and similar parts of the human body, does he propose the use of leeches for treatment. Evidently this is an indication that he did not, as generally supposed, encourage the widespread use of leeches.

The third and final section, of 35 chapters, deals with the reduction, luxation, and treatment of injured bones, including fracture of the pelvis. The advices and warnings in the prelude of this section appear to repeat some of al-Zahrāwī’s sayings that had been covered in his previous introductions. The text, however, presents many facets of interest to the health professions. It elaborates upon the application of various forms of bandages and plasters in a variety of operations. Al-Zahrāwī’s detailed description relating to fractures of bones is a fine anatomical document of historical interest. He illustrates and describes special methods for tying injured or broken bones, and he suggests that bandages made of soft linen be less and less tight as distance increases from the injured place (chapter 1). For the protection of areas adjacent to the injured part against contact with edges of splints he advocates padding with soft gauze and carded wool. In some cases, to guard against swelling, he preferred a delay of one or more days in applying bandages over splints. Al-Zahrāwī also devised and depicted many kinds and shapes of splints for use in simple and compound fractures of the head, shoulders, arms, fingers, etc. (see fig. 20). For example, in discussing the reduction of the humerus, he recommends a splint consisting of a smooth, thin stick bent in the shape of a bow with two strings, each attached to one end of the stick (fig. 21). The injured bone is then placed in the middle of the bent splint for reduction while the patient is seated on a chair. Tying is applied only when there is no "hot" swelling (chapter 11). One of the remarkable observations made in this section is the description of the paralysis caused by fracture of the spine.

Of interest to historians of medical therapy and pharmacy are the recipes for poultices that al-Zahrāwī recommends for use over fractured bones. For example, he gives the following recipe for one such poultice: "Take the so-called 'mill’s dust' [ghubār al-rahā], which is the part of the wheat flour that clings to the walls of the mill during grinding [lubāb al-daqīq], and, without sifting away the bran, knead with white-of-egg to a medium consistency, and apply." Another, more elaborate, recipe calls for 10 dirhams each of the roots of wild pomegranate [Glossostemon bruguieri D.C.], chickling vetch [the grass pea, Lathymus sativus], and white marshmallow; 5 dirhams each of myrrh and aloes; 6 dirhams of white gum Arabic [Acacia]; and 20 dirhams of bole [friable earthy clay consisting largely of hydrous silicates of aluminum and magnesium, usually colored red because of impurities of iron oxide]. Procedure was to pound all ingredients gently, pass them through a sieve, and knead with water or white-of-egg (chapter 1).

The question arises as to whether al-Zahrāwī did any human dissection. The answer is uncertain because our knowledge of his life is fragmentary. However, he gives no clue to the dissection of humans in any of the 30 treatises of al-Taṣrīf--his only known writings--and there is no evidence that he practiced it in secret. His upright attitude as a Muslim who repeatedly emphasized his adherence to his faith suggests that he relied completely on animal dissection and the writings of his Greek-Roman and Islamic predecessors. Physicians in both the Islamic domain and in Christendom for many centuries were hostile to the idea of human dissection for any purpose because of their traditional socio-religious convictions, considering it an unethical and undignified practice. Perhaps it has been al-Zahrāwī’s original contributions to surgery, his enthusiasm in emphasizing the value of anatomical knowledge, and his recognition of the necessity that only well-educated, well-trained doctors should perform surgery that have led some medical historians to wonder whether he did human dissection at some time in his long years of experience.

In Summary

The few examples of illustrations of surgical instruments given here indicate that the Arabic manuscripts, in general, have preserved the original, oriental, artistic features of the drawings in a way that has been overlooked in Latin and vernacular versions of al-Taṣrīf.

In presenting his personal observations and original ideas on surgery late in life, al-Zahrāwī, for the most part, was inspired by a thorough acquaintance with Greek and Arabic medical literature supplemented by lifelong intelligent observation and experience.

Through its descriptions and illustrations, the surgical treatise of al-Zahrāwī very likely played a significant role in the designing of improved surgical instruments in the Middle Ages. Also, the treatise no doubt promoted the development of improved surgical techniques in Islam and, through its translations, promoted these techniques to an even greater extent in the West, a fact that justifies the fame of this treatise as the highest expression of the development of surgery in Arabic Spain--a treatise whose influence continued to the Renaissance. It contributed in no small measure to the idea of equipping learned and well-trained surgeons with the best surgical tools and techniques of the time; moreover, it encouraged the invention of new instruments to meet differing circumstances and special conditions. These tools no doubt greatly facilitated the work of the surgeon.

Throughout the text of al-Taṣrīf al-Zahrāwī gave careful attention to the importance of pharmaceutical preparations in the healing art, including cases requiring surgery.

George Sarton, Introduction to the History of Science, Baltimore, 1927, vol. 1, p. 681.

Mohammad S. Abu Ganima, in Abul-Kasim ein Forscher der Arabischen Medizin, Berlin, 1929, suggested that description of operations in al-Majūsī’s surgery is clearer than that in al-Zahrāwī’s--a statement which does not seem acceptable.

Max Neuburger, Geschichte der Medizin, Stuttgart, 1911, vol. 2, pt. 1, pp. 178-179.

Heinrich Haeser, Lehrbuch der Geschichte der Medizin und der epidemischen Krankheiten, Jena, 1875, vol. 1, pp. 578-584; and Donald Campbell, Arabian Medicine and Its Influence on the Middle Ages, London, 1926, vol. 1, p. 88.

See the prelude to the treatise.

Fielding H. Garrison (An Introduction of the History of Medicine, ed. 4, rev., Philadelphia, 1929, p. 132), states, in reference to "Sudhoff and others," that many drawings earlier than those of al-Zahrāwī have been discovered in medieval manuscripts. However, Garrison overlooked the fact that al-Zahrāwī’s surgical illustrations were mainly depicted for instructional purposes--a unique approach. It should be noted also that al-Zahrāwī died almost a century earlier than Garrison thought. See also Martin S. Spink, "Arabian Gynaecological, Obstetrical and Genito-Urinary Practice Illustrated from Albucasis," Proceedings of the Royal Society of Medicine, 1937, vol. 30, p. 654.

Johannis Channing, Albucasis de Chirurgia. Arabice et Latine, Oxford, 1778, 2 vols. (hereinafter referred to as Channing, Albucasis). The text has many errors in spelling and grammar, but Leclerc went too far in criticizing this edition, which has many merits. Moreover, the surgical illustrations (reproduced from the Huntington and Marsh manuscripts of the Bodleian Library) in Channing’s edition are of special interest.

Lucien Leclerc, La Chirurgie d’Abulcasis, Paris, 1861 (hereinafter referred to as Leclerc, Abulcasis). This excellent French version was first published in a series of articles in Gazette Médicale de l’Algérie, and seems influenced by Channing’s edition more than Leclerc admits. Leclerc consulted several Arabic copies of the treatise as well as Latin and vernacular translations, but only a few of these Arabic manuscripts are considered complete. The Arabic manuscripts studied for the present article are not the same as those used by Leclerc. See also Leclerc’s monumental work, Histoire de la Médecine Arabe, Paris, 1876, vol. 1, pp. 453-457.

Ernst Gurlt, Geschichte der Chirurgie und ihrer Ausübung Volkschirurgie-Alterthum-Mittelalter-Renaissance, Berlin, 1898, vol. 1, pp. 620-649, with more than 100 figures. In the text and illustrations, Gurlt relied upon Leclerc’s translation and modified drawings of the surgical instruments; nevertheless, he presents a brief, systematic study--probably the best so far--of the entire treatise.

Karl Sudhoff, Beiträge zur Geschichte der Chirurgie im Mittelalter, Leipzig, 1918 (hereinafter referred to as Sudhoff, Chirurgie), vol. 2, pp. 16-84, with a few plates. Although Sudhoff consulted the fragmentary Arabic manuscript indexed as "Cod. Arab. 1989" in Gotha, Germany, he relied mainly upon Latin versions of the treatise and the illustrations contained in them.

See Leclerc, Abulcasis, in introduction.

The seven Arabic manuscripts are indexed as "Berlin MS. Or. fol. 91," temporarily at Universitätsbibliothek Tübingen, in Germany; "Escorial MS. Arabe No. 876," at Biblioteca del Monasterio de San Lorenzo el Real de El Escorial, in Spain; "Wien MS. Cod. N.F. 476 A.," at Oesterreichische Nationalbibliothek, in Vienna; and "Ali Emiri Arabi No. 2854," "Beşir Ağa Nos. 502 and 503," and "Veliyyudin No. 2491," all at Süleymaniye Umumi Kütüphanesi Müdürlüğü, in Istanbul. Hereinafter these manuscripts are referred to, respectively, as Tüb. MS. 91; Esc. 876; Wien 476 A; Ali 2854; Bes. 502; Bes. 503; and Vel. 2491. The Smithsonian Institution recently obtained a microfilm copy of Bankipore Manuscript No. 17 from the Khuda Bakhsh O. P. Library, Patna (Bihar), India. This manuscript, containing only the 30th treatise of al-Taṣrīf, was copied in 1189; therefore, it is the earliest dated Arabic manuscript of the surgical treatise known to exist. The surgical illustrations therein add weight to the belief that the Arabic manuscripts show more originality in the drawings than do the later copied versions, which often were inaccurate and possibly distorted. About ten other illustrations from the Arabic manuscript in Istanbul indexed as "Topkapi MS. No. 1990" (which contains 215 beautifully illustrated figures) were presented by A. S. Ünver and Hüseyin Usman in an extract titled "Meşhur Arab Cerrahi Elbülkasimi Zehravi ve onum Kitabül Cerrahiyesi," Istanbul, 1935. See also Ünver, Şerefeddin Sabuncuoğlu: Kitabül Cerrahiyei Illhaniye, Istanbul, 1939, pp. -7.

See introduction to the treatise; for example, Bes. 502, fol. 522v-523v and Vel. 2491, fol. 104r-105v. See also K. P. J. Sprengel, Versuch einer pragmatischen Geschichte der Arzneikunde, Halle, 1823, vol. 2, pp. 449-451. George J. Fisher, in "Abul-Casem Chalaf Ibn Abbas al-Zahrāwī, Commonly Called Albucasis," Annals of Anatomy and Surgery, July-December, 1883, vol. 8, pp. 24-25, gives a translation of only the first part of the introduction.

There are 56 chapters listed in almost all manuscripts and commentary works I checked except Tüb. MS. 91 and Esc. 876, where only 55 chapters are listed.

Al-Zahrāwī mentions several caustic medicines used in cautery, among which are garlic, mustard, melted lead, slaked or unslaked lime with or without "common" soap, Thapsia (Ruta graveolens Linn.), and juice of the Oriental cashew nut (Senecarpus anacardium Linn.).

Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v.

Al-Zahrāwī criticizes those who interpret the saying "cautery is the end of treatment" to mean that cauterization is the best and only conclusive treatment at the physician’s disposal. He points out that other treatments, such as drugs, should be resorted to first, and used until they prove of no avail; and he states that only after cautery proves to be the cure should it be considered the completion of medical treatment--"al-kay ākhir al-ṭibb." See Vel. 2491, fol. 106; and Bes. 502, fol. 524r-525v.

For healing, soothing, or emollient purposes, al-Zahwārī suggested medications, such as egg white, salt water (normal saline), sap of psyllium, several ointments, "duhn" of rose, and other "adhān" (plural of "duhn," the fatty or oily essences extracted from various substances through pharmaceutical processes).

For a more accurate estimate of the equivalence of "dirham" according to the area in which the measurement was taken, the reader may consult Walter Hinz, Islamische Masse und Gewichte umgerechnet ins metrische System, Leiden, 1955, pt. 1, pp. 2-8; and George C. Miles, Early Arabic Glass Weights and Stamps, New York, 1948, p. 6.

The contents of several manuscripts (such as Ali 2854, Wien 476 A, Bes. 503, and Tüb. MS. 91) give different numbers.

See, for example, Tüb. MS. 91, fol. 45v; and Bes. 502, fol. 530v.

Sudhoff, op. cit. (footnote 10), p. 29, fig. 6.

For a more detailed and interesting discussion with beautiful illustrations included, the reader may consult Ch. Niel, "La Chirurgie Dentaire D’Abulcasis Comparée a celle des Maures du Trarza," Revue de Stematologie, April 1911, vol. 18, pp. -180 and 222-229.

It is regrettable that Franz Rosenthal in his fine article "Bibliographical Notes on Medieval Muslim Dentistry" (Bulletin of the History of Medicine, 1960, vol. 34, pp. 52-60) failed to refer to this or any other section of al-Zahrāwī’s work.

Bes. 502, fol. 538. See also Channing, Albucasis, pp. 206-208. For the identification of the drugs and their botanical origins the author of the present paper consulted H. P. J. Renaud and Georges S. Colin, Tuḥfat al-Aḥbāb, Glossaire de la Matière Médicale Marocaine, Paris, 1934, pp. 133, 143, 193-194, and Max Meyerhof, Un Glossaire de Matière Médicale Composé par Maimonide, Cairo, 1940, pp. 168-169.

Tüb. MS. 91, fol. 99v.

Dragon’s blood is a resin obtained from the scales covering the surface of the ripe fruits of "Daemonorops draco Blume" (Heber W. Youngken, Textbook of Pharmacognosy, ed. 6, Philadelphia, 1948, p. 175). See also Renaud and Colin, op. cit. (footnote 25), pp. 54-55.

Heinrich Frölich, "Abul-Kasem als Kriegschirurg," Archiv für klinische Chirurgie, 1884, vol. 30, pp. 365-376. This well-presented study was reviewed by Paul Schede in Centralblatt für Chirurgie, 1884, no. 38, pp. 626-627.

Johannis Freind, The History of Physick, London, 1726, vol. 2, p. 129.

In several manuscripts, the chapter on the use of leeches is the last one in the second section of the treatise.

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