Almost a thousand years ago at a time when Spain (Andulesia) 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 El Zahrawi, though in European languages his name is written in over a dozen different ways:
Abulcases, Albucasis, Bulcasis, Bulcasim, Bulcari, Alzahawi, Ezzahrawi, Zahravius, Alcarani, Alsarani, Aicaravi, Alcaravius, Alsahrawi etc.
El 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 practised medicine and surgery until shortly before his death in about 1013, two years after the sacking of El-Zahra.Because El-Zahra was pillaged and destroyed, little is known about its illustrious son El Zahrawi.
He was first mentioned by the Andalusian scholar Abu Muhammad bin Hazm (993-1064), who listed him among the great physician- surgeons of Moorish Spain. The first known biography of El Zahrawi, however, appeared in al-Humaydi’s Jadhwat al-Muqtabis (On Andalusian Savants), completed six decades after El Zahrawi’s death.It is clear from El 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.
El Zahrawi wrote a medical encyclopaedia spanning 30 volumes which included sections on surgery, medicine, orthopaedics, ophthalmology, pharmacology, nutrition etc. This book was known as At-Tasrif and contained data that El Zahrawi had accumulated during a career that spanned almost 50 years of training, teaching and practice. He apparently travelled very little but had wide experience in treating accident victims and war casualties.In At-Tasrif, El Zahrawi expressed his concern about the welfare of his students whom he called “my children”.
He emphasised 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.
At-Tasrif contains many original observations of historical interest. In it, El Zahrawi elaborates on the causes and symptoms of disease and theorises 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, materia medica, 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 Liber servitoris de preeparatione medicinarum simplicium, 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.
El 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 El Zahrawi discussed cauterisation, 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! El Zahrawi outlined the use of caustics in surgery, fully described tonsillectomy, tracheotomy and craniotomy- operations he had performed on a dead foetus. 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.
El Zahrawi was the first to describethe 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.
Once At-Tasrif was translated into Latin in the 12th century, El 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.
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. (Dr. Monzur Ahmed)
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