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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/26038-0.txt b/26038-0.txt new file mode 100644 index 0000000..b906ed7 --- /dev/null +++ b/26038-0.txt @@ -0,0 +1,1110 @@ +The Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Drawings and Pharmacy in Al-Zahrawi's 10th-Century Surgical Treatise + +Author: Sami Hamarneh + +Release Date: July 24, 2008 [EBook #26038] + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + + + + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + + + + + Drawings and Pharmacy in al-Zahrāwī’s + 10th-Century Surgical Treatise + + _by Sami Hamarneh_ + + Paper 22, pages 81-94, from + + CONTRIBUTIONS FROM THE MUSEUM + OF HISTORY AND TECHNOLOGY + + UNITED STATES NATIONAL MUSEUM + BULLETIN 228 + + SMITHSONIAN INSTITUTION · WASHINGTON, D.C., 1961 + + [Illustration: Figure 1.--Reproduction of a page from + original Arabic manuscript indexed as "Cod. N.F. 476A" at + Oesterreichische Nationalbibliothek in Vienna. Courtesy + Oesterreichische Nationalbibliothek.] + + + + +Drawings and Pharmacy in al-Zahrāwī’s +10th-Century Surgical Treatise + +_by Sami Hamarneh_ + + +_Probably the earliest independent work in Arabic Spain to embrace the +whole of medical knowledge of the time is the encyclopedic al-Tasrīf, +written in the late 10th century by Abū al-Qāsim al-Zahrāwī, also known +as Abulcasis. Consisting of 30 treatises, it is the only known work of +al-Zahrāwī and it brought him high prestige in the western world._ + +_Here we are concerned only with his last treatise, on surgery. With its +many drawings of surgical instruments, intended for the instruction of +apprentices, its descriptions of formulas and medicinal preparations, +and its lucid observations on surgical procedures, this treatise is +perhaps the oldest of its kind._ + +_Scholars today have available a translation of the text and +reproductions of the drawings, but many of the latter are greatly +modified from the originals._ + +_This study reproduces examples of al-Zahrāwī’s original illustrations, +compares some with early drawings based on them, and comments on +passages in the treatise of interest to students of pharmacy and medical +therapy._ + +THE AUTHOR: _Sami Hamarneh undertook this research into the history of +medicine in connection with his duties as associate curator of medical +sciences in the United States National Museum, Smithsonian Institution._ + + +THE INTRODUCTION OF THE WRITINGS of Abū al-Qāsim Khalaf ibn ʻAbbās +al-Zahrāwī--better known as Abulcasis (d. ca. 1013)--to Western Europe +was through the Latin translation of his surgical treatise (maqālah) by +Gerard of Cremona (d. 1187).[1] The response to this treatise, +thereafter, was much greater than the attention paid to the surgery of +any of the three renowned physicians of the Eastern Caliphate: al-Rāzī +(Latin, Rhazes, d. ca. 925), the greatest clinician in Arabic medicine; +al-Majūsī (Haly Abbās, d. 994), the author of the encyclopedic medical +work, _al_-_Malakī_;[2] and Ibn Sīnā (Avicenna, 980-1037), the author +of the famous _al-Qānūn fī al-Ṭibb_, a codification of the whole of +medical knowledge. Because of the widespread dissemination of this Latin +version in medieval Europe beginning with the latter part of the 12th +century, al-Zahrāwī attained more prestige in the West than he did in +Arabic Spain, his native country, or in any other part of the Islamic +world.[3] + + [Illustration: Figure 2.--The myrtle-leaf shape recommended + for paper on which medicine is to be placed for cauterizing + eyelid. _Top_, from original Arabic manuscript (Tüb. MS. + 91), courtesy Universitätsbibliothek Tübingen. _Bottom_, + from Channing, _Albucasis_.] + +The fame attached to this surgical treatise, the 30th and last in +al-Zahrāwī’s encyclopedic work _al-Taṣrīf Liman ‘Ajiza ‘an +al-Ta’līf_, is founded on certain merits. The text is characterized +by lucidity, careful description, and a touch of original +observation of the surgical operations to which the treatise as a +whole is devoted.[4] Al-Zahrāwī furnishes his own drawings of the +surgical and dental instruments he used, devised, or recommended for +a more efficient performance. The illustrations were intended to +provide instructional material for apprentices--whom al-Zahrāwī +calls his children--as well as for the benefit of those who would +read the work later on.[5] The treatise is probably the oldest one +known today that contains such instructive surgical illustrations +and text.[6] + + [Illustration: Figure 3.--Small funnel for pouring heated + lead into fistula of the eye for cauterization. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlüğü. _Bottom_, from Sudhoff, + _Chirurgie_, courtesy National Library of Medicine.] + + [Illustration: Figure 4.--Circular cauterization in stomach + ailments. _Top_, from original Arabic manuscript (Tüb. MS. + 91), courtesy Universitätsbibliothek Tübingen. _Bottom_, + from the 1531 Latin edition of Pietro d’Argellata, + _Chirurgia Argellata cum Albucasis_, hereinafter cited as + Argellata 1531, courtesy National Library of Medicine.] + +This surgical treatise has been investigated, translated, and commented +upon by eminent historians of medicine and surgery to whose works I +shall refer in this article. However, the pharmaceutic and therapeutic +details of the treatise have been somewhat overlooked. + +As to the various illustrations of the surgical instruments (over 200 +figures in all), an almost complete representation of samples has been +introduced by Channing,[7] Leclerc,[8] Gurlt,[9] Sudhoff,[10] and +others. Nevertheless, a good number of the reproduced drawings are +greatly modified, most likely having been influenced by earlier +illustrations in several Latin and vernacular versions of the +treatise.[11] This becomes clearer on comparison with seven Arabic +manuscripts that have not been fully examined by Western scholars before +and that--in several instances--show more authentic drawings of +al-Zahrāwī’s surgical instruments than any heretofore published.[12] + + [Illustration: Figure 5.--Ink markings for identifying place + of cauterization. _Top_, from original Arabic manuscript + (Vel. 2491), courtesy Süleymaniye Umumi Kütüphanesi + Müdürlüğü. _Bottom_, from Argellata 1531, courtesy National + Library of Medicine.] + + [Illustration: Figure 6.--Cautery in hernia. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlüğü. _Bottom_, from Leclerc, + _Albulcasis_.] + +This article therefore, is an attempt to present a sample of these +illustrations with brief comments regarding certain figures and passages +of interest to pharmacy and medical therapy. + +With much gratitude I express my indebtedness to Prof. G. Folch Jou of +Madrid, to Dr. A. Süheyl Ünver and Mr. H. Dener of Istanbul, and to the +librarians of the depository institutions for their cooperation in the +reproduction of the manuscripts on microfilm. + + [Illustration: Figure 7.--Fine tweezer for removing foreign + bodies from the ear. _Top_, from original Arabic manuscript + (Ali 2854), courtesy Süleymaniye Umumi Kütüphanesi + Müdürlüğü. _Bottom_, from Leclerc, _Abulcasis_.] + + [Illustration: Figure 8.--Syringe with metal plunger-pump. + _Top_, from original Arabic manuscript (Ali 2854), courtesy + Süleymaniye Umumi Kütüphanesi Müdürlüğü. _Bottom_, from + Channing, _Albucasis_.] + +Al-Zahrāwī frequently introduces his treatises with brief instructive +and sometimes informative preludes. However, in launching the last +treatise of _al-Taṣrīf_ he expounded in a most interesting and +illuminating manner the status of surgery during his time. He also +explains the reasons that forced him to write on this topic and why he +wished to include, as he did, precautions, advice, instructional notes, +and beautifully illustrated surgical drawings. For example, the prelude +to the treatise mentions four incidents that he witnessed, all ending +with tragic results because of the ignorance of physicians who attempted +to operate on patients without the proper training in anatomy and +surgical manipulation. "For if one does not have the knowledge of +anatomy," al-Zahrāwī protests, then "... he is apt to fall in errors +that lead to death as I have seen it happen to many."[13] + +Al-Zahrāwī divides his surgical treatise into three sections (abwāb). In +the first section (56 chapters)[14] he elaborates upon the uses and +disadvantages of cautery in general. And on the ground that "fire +touches only the ailing part ... without causing much damage to +surrounding area," as caustic medicine does, he prefers cautery by fire +(al-kay bi al-nār) to cautery by medicine (bi al-dawā).[15] This, he +adds, "became clear to us through lifelong experience, diligent +practice, and thorough investigations of facts."[16] + + [Illustration: Figure 9.--Metal nose dropper. _Top_, from + original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Middle_, from Channing, + _Albucasis_ (_Smithsonian photo 46891-C_). _Bottom_, from + Sudhoff, _Chirurgie_, courtesy National Library of + Medicine.] + +He also proposes that instruments made of iron are more practical in +many ways than those made of gold, because often, when gold instruments +are put in fire, they either are not heated enough or are overheated, +causing the gold to melt. + + [Illustration: Figure 10.--Dental scrapers. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlüğü. _Left_, from Argellata 1531, + courtesy National Library of Medicine. _Right_, from + Channing, _Albucasis_.] + +Al-Zahrāwī gently refutes the superstition that cautery is "good only in +springtime," and states that "under the right conditions of the body’s +humors it could be used in all seasons."[17] Although he recommends +cautery rather highly, he never minimizes the importance of treatment +by drugs. Actually, he encourages the use of drugs, before, with, and +after cauterization.[18] For example, in chapter 16 on "the +cauterization of eyelid when its hair grows reversedly into the eye," he +recommends treatment by cautery and by medicine. In cautery, the area +where fire is to be placed is marked with ink in the shape of a myrtle +leaf. In drug treatment, the caustic medicine is applied to the eyelid +over a paper in the shape of a myrtle leaf (fig. 2). + + [Illustration: Figure 11.--Dental forceps. _Top_, from + original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Leclerc, + _Abulcasis_.] + +In chapter 17 the author refers to an ancient method regarding cautery +of the fistula in the inner corner of the eye. After incising the +fistula, one "dirham" (derived from the Greek "drachma," which is equal +to about 2.97 grams)[19] of melted lead is poured into it through a fine +funnel used for cauterization (fig. 3). + + [Illustration: Figure 12.--Golden bridge to stabilize shaky + teeth. _Top_, from original Arabic manuscript (Tüb. MS. 91), + courtesy Universitätsbibliothek Tübingen. _Left_, from + Argellata 1531, courtesy National Library of Medicine. + _Right_, from Channing, _Albucasis_.] + +In like manner, al-Zahrāwī discusses cautery of the stomach and the +"cold liver" in chapters 26 and 27, respectively. The drawings therein +represent shapes of the burns on the skin (fig. 4) and marks of ink to +be drawn beneath the cartilage of the ribs (fig. 5) for the purpose of +spotting the area of operation. Here also he describes carefully and +clearly the methods of applying cautery and the types, position, and +number of tools employed in each case. He likewise depicts (in chapter +45) instruments used in the treatment of hernia (fig. 6). + +The second section (bāb), with about 99 chapters,[20] deals with +incision, puncturing, venesection, cupping, surgery on abscesses, and +the withdrawal of arrows from the body. Al-Zahrāwī warns that ignorance +in such operations may lead to damage of an artery or vein, causing loss +of blood "by which life is sustained."[21] Moreover, needle and thread +(more than one kind is mentioned) for the stitching of wounds are +repeatedly recommended. + +According to al-Zahrāwī, foreign bodies that lodge in the ear (chapter +6) are of four origins: (1) "mineral stones" or substances resembling +mineral stones such as iron and glass; (2) plant seeds (chick-peas and +beans); (3) liquids, such as water and vinegar; and (4) animals, such +as fleas. Several instruments are recommended for the removal of such +foreign bodies--fine tweezers shaped like a dropper (fig. 7), a syringe +with plunger-pump, and a tube made of silver or copper (fig. 8). Also of +interest to pharmacy and therapy is the advice in regard to the use of +lubricants to be applied before administering these fine instruments +into the body’s cavities. + +Chapter 24 is concerned with the treatment of the polypus that grows in +the nose. The various kinds (including cancer growth), shapes, and +colors of this type tumor and its treatment by surgery or medicine are +described. A hollowed nose-dropper made of metal in the shape of a small +kerosene lamp[22] is suggested (fig. 9). The dropper is held by its +handle while its contents are heated before use. Applying heat to nose +drops was probably proposed because it serves two purposes: it allows +easier flow of the "duhn," or the fatty substance used, and it raises +the temperature of the drops to that of the body. + +In his discussion on dental hygiene,[23] al-Zahrāwī describes scrapers +and dental forceps for teeth cleaning and extraction (figs. 10, 11) and +brings in a few points of historical interest.[24] He warns of the +common error of extracting the adjacent healthy tooth instead of the +ailing one due to the patient’s sense deception. For a gargle he +prescribes salt water, vinegar, and wine (sharāb). To stop hemorrhage he +used blue vitriol (al-zāj)--copper sulfate in our modern terminology. + +In chapter 33 al-Zahrāwī discusses bridge-making for the consolidation +of shaky teeth (fig. 12). He prefers the use of stable gold over silver +which, he says, putrifies and rots in a short time. In a rational +approach, he also suggests that the fallen tooth itself, or a similar +one shaped out of a cow’s bone, be installed and connected with +adjacent, stable teeth by a bridge. + +Now, turning to chapter 36, we find al-Zahrāwī describing a knife-thin +tongue depressor (fig. 13) that he used to facilitate the examination of +inflamed tonsils and other swellings of the throat; it was made of +silver or copper. And in chapter 37 (chapter 34 in Bes. 503), he +describes the excision of an inflamed uvula by surgery. In the same +chapter, he also mentions the use of instruments made of steel. Of +pharmaceutical interest is the following free translation of the formula +he prescribes "as a milder treatment by fumigation ... to be resorted to +only when the swelling is subsiding":[25] + + Take pennyroyal [_Mentha pulegium_ Linn.], absinthe + [_Artemisia maritima_ Linn.], thyme, rue, hyssop, camomile, + abrotanum [_Artemisia abrotanum_ Linn.], and other similar + herbs. Put all in a casserole and cover them with vinegar. + Then close tightly with clay [_lutum-sapientiae_]--except + for a small hole in the middle of the cover--and boil. + Connect one end of a hollowed instrument, a crude form of an + inhaler [fig. 14], with the hole in the cover and insert the + other end, which contains the nozzle, into the patient’s + mouth, allowing the vapor to rise up to the uvula. And if + you are not able to secure this instrument, take a straw and + attach its end to an egg-shell. The egg-shell will prevent + burns in the patient’s mouth that might be caused by the + heated vapor. + + [Illustration: Figure 13.--Metal tongue depressor. _Top_, + from original Arabic manuscript (Ali 2854), courtesy + Süleymaniye Umumi Kütüphanesi Müdürlüğü._ Bottom_, from + Channing, _Albucasis_.] + + [Illustration: Figure 14.--Crude form of an inhaler. _Top_, + from original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +Al-Zahrāwī repeats in chapter 53, on cancer, what Greek physicians had +said earlier, that cancer could be removed by surgery only at its first +stage and when found in a removable part of the body, such as the +breast. Therefore, he confesses that neither he nor any one else he +knew of ever applied surgery with success on advanced cancer.[26] + + [Illustration: Figure 15.--Metallic syringe for injecting + solutions into the bladder. _Top_, from original Arabic + manuscript (Bes. 503), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlüğü. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + + [Illustration: Figure 16.--Metallic or porcelain syringes + for injection of enemas. _Top_, from original Arabic + manuscript (Ali 2854), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlüğü. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + +Of special interest in chapter 59 is the metallic "syringe" (fig. 15) +used to inject medicinal solutions into the bladder: "The hollow passage +[of the syringe] should be exactly equal to the plunger it contains and +no more, so that when such fluids from an excess of humors are aspirated +they will be drawn out, and likewise when the solutions are injected +they will be pushed in easily." Such description of the use of a +"bladder syringe" in the late 10th century clearly points to the +practical and interesting approach to surgery in _al-Taṣrīf_. Moreover, +his description of the removal of a stone from the bladder--an operation +we now call lithotomy--is considered a contribution to bladder surgery. + +One of the earliest recorded operations for the extractions of two dead +fetuses from the womb is clearly described in chapter 76. The account of +this case shows not only al-Zahrāwī’s intelligent approach as a shrewd +observer but also his clinical and surgical ability. + +Drawings of bulb-syringe instruments used for administering enemas in +ailments of the rectum and for the treatment of diarrhea and colic are +depicted in chapter 83. The text describes several kinds of syringes +made of silver, porcelain, and copper in various sizes (fig. 16). Of +particular interest is an illustration of a syringe, especially +recommended for children, to which a piece of leather (jildah) is +attached (fig. 17). This instrument is a precursor of our modern bulb +syringe. + +In chapter 84 al-Zahrāwī turns to the treatment of various wounds. He +prescribes the following powder formula for use: "Take olibanum +[frankincense] and dragon’s blood,[27] two parts of each, and three +parts of slaked or unslaked lime. Pound them well, pass through a sieve +and apply the powder to the wound." In cases of damaged blood vessels, +he tied the arteries by ligature, a practice of which he was a pioneer. +In another chapter he describes four methods for suturing the +intestines. + +Al-Zahrāwī, being associated with war casualties and writing his +treatise about the end of the 10th century, no doubt had the experience +of dealing with cases involving injuries caused by arrows. The text in +chapter 94 discloses his observations in elaborate investigations +regarding the extraction of various kinds of arrows from the body.[28] +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,[29] +notwithstanding the fact that Turkish bows and arrows were in common use +in the latter part of the 10th century. + + [Illustration: Figure 17.--A crude form of bulb syringe + recommended for use with children. _Top_, from original + Arabic manuscript (Ali 2854), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlüğü. _Bottom_, from Leclerc, _Abulcasis_.] + +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.[30] Evidently this is +an indication that he did not, as generally supposed, encourage the +widespread use of leeches. + + [Illustration: Figure 18.--Hooks and forceps used for the + extraction of arrows. _Top_, from original Arabic manuscript + (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. + _Bottom_, from Channing, _Albucasis_.] + + [Illustration: Figure 19.--Cupping. _Top_, from original + Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +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. + + [Illustration: Figure 20.--Splint "in the shape of a spoon + without a bowl." _Top_, from original Arabic manuscript + (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. + _Bottom_, from Channing, _Albucasis_.] + +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). + + [Illustration: Figure 21.--A splint to support the arm. + _Top_, from original Arabic manuscript (Cod. N.F. 476A), + courtesy Oesterreichische Nationalbibliothek. _Bottom_, from + Argellata 1531, courtesy National Library of Medicine.] + +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. + + + [1] George Sarton, _Introduction to the History of + Science_, Baltimore, 1927, vol. 1, p. 681. + + [2] 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. + + [3] Max Neuburger, _Geschichte der Medizin_, Stuttgart, + 1911, vol. 2, pt. 1, pp. 178-179. + + [4] 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. + + [5] See the prelude to the treatise. + + [6] 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. + + [7] 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. + + [8] 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. + + [9] 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. + + [10] 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. + + [11] See Leclerc, _Abulcasis_, in introduction. + + [12] 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. [5]-7. + + [13] 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. + + [14] 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. + + [15] 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.). + + [16] Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v. + + [17] 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. + + [18] 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). + + [19] 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. + + [20] The contents of several manuscripts (such as Ali 2854, + Wien 476 A, Bes. 503, and Tüb. MS. 91) give different + numbers. + + [21] See, for example, Tüb. MS. 91, fol. 45v; and Bes. 502, + fol. 530v. + + [22] Sudhoff, _op. cit._ (footnote 10), p. 29, fig. 6. + + [23] 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. [169]-180 and 222-229. + + [24] 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. + + [25] 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. + + [26] Tüb. MS. 91, fol. 99v. + + [27] 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. + + [28] 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. + + [29] Johannis Freind, _The History of Physick_, London, + 1726, vol. 2, p. 129. + + [30] In several manuscripts, the chapter on the use of + leeches is the last one in the second section of the + treatise. + + +U.S. GOVERNMENT PRINTING OFFICE: 1961 + +For sale by the Superintendent of Documents, U.S. Government Printing +Office Washington 25, D.C.-Price 20 cents + + + + + +End of the Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +*** END OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + +***** This file should be named 26038-0.txt or 26038-0.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/6/0/3/26038/ + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Drawings and Pharmacy in Al-Zahrawi's 10th-Century Surgical Treatise + +Author: Sami Hamarneh + +Release Date: July 24, 2008 [EBook #26038] + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + + + + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + +</pre> + +<h1> </h1> +<div class="figcenter" style="width: 500px;"> +<img src="images/icover.png" width="500" height="669" +alt= "cover." title="" /><br /><br /></div> + +<p><span class='pagenum'>Pg 81</span></p> +<p class="right"><span class="smcap">Contributions From</span></p> +<p class="right"><span class="smcap">The Museum of History and Technology</span></p> +<p class="right"><span class="smcap">Paper 22</span><br /><br /></p> + +<p class="right"><span class="smcap">Drawings and Pharmacy in al-Zahrāwī’s</span></p> +<p class="right"><span class="smcap">10th-Century Surgical Treatise</span></p> +<p class="right"><i>Sami Hamarneh</i><br /><br /></p> + +<p><span class='pagenum'>82</span></p> + +<div class="figcenter" style="width: 500px;"><img src="images/i004.png" width="500" height="773" alt= "Figure 1." +title="" /><br /><br /><p class="indent">Figure 1.—Reproduction of a page from original Arabic +manuscript indexed as "Cod. N.F. 476A" at Oesterreichische +Nationalbibliothek in Vienna. Courtesy Oesterreichische +Nationalbibliothek.</p><br /><br /></div> + +<hr /> + +<p><span class='pagenum'>83</span></p> +<h2>Drawings and Pharmacy in al-Zahrāwī’s</h2> +<h2>10th-Century Surgical Treatise<br /><br /></h2> +<h4><i>by Sami Hamarneh</i><br /><br /></h4> + + +<div class="blockquot"><p><i>Probably the earliest independent work in Arabic Spain to embrace +the whole of medical knowledge of the time is the encyclopedic</i> al-Tasrīf, +<i>written in the late 10th century by Abū al-Qāsim al-Zahrāwī, +also known as Abulcasis. Consisting of 30 treatises, it is +the only known work of al-Zahrāwī and it brought him high prestige +in the western world.</i></p> + +<p><i>Here we are concerned only with his last treatise, on surgery. +With its many drawings of surgical instruments, intended for the +instruction of apprentices, its descriptions of formulas and medicinal +preparations, and its lucid observations on surgical procedures, this +treatise is perhaps the oldest of its kind.</i></p> + +<p><i>Scholars today have available a translation of the text and reproductions +of the drawings, but many of the latter are greatly modified +from the originals.</i></p> + +<p><i>This study reproduces examples of al-Zahrāwī’s original illustrations, +compares some with early drawings based on them, and comments +on passages in the treatise of interest to students of pharmacy +and medical therapy.</i></p> + +<p><span class="smcap">The Author</span>: <i>Sami Hamarneh undertook this research into the +history of medicine in connection with his duties as associate curator +of medical sciences in the United States National Museum, Smithsonian +Institution.</i></p></div> +<hr /> +<p><img src="images/capital_t.png" class= +"floatLeft" alt="T" />HE INTRODUCTION OF THE WRITINGS +of Abū al-Qāsim Khalaf ibn ʻAbbās +al-Zahrāwī—better known as Abulcasis (d. +ca. 1013)—to Western Europe was through the +Latin translation of his surgical treatise (maqālah) +by Gerard of Cremona (d. 1187).<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">1</a> The response to +this treatise, thereafter, was much greater than the +attention paid to the surgery of any of the three +renowned physicians of the Eastern Caliphate: al-Rāzī +(Latin, Rhazes, d. ca. 925), the greatest clinician +in Arabic medicine; al-Majūsī (Haly Abbās, d. 994), +the author of the encyclopedic medical work, <i>al</i>-<i>Malakī</i>;<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">2</a> +<span class='pagenum'>84</span>and Ibn Sīnā (Avicenna, 980-1037), the +author of the famous <i>al-Qānūn fī al-Ṭibb</i>, a codification +of the whole of medical knowledge. Because of the +widespread dissemination of this Latin version in +medieval Europe beginning with the latter part of +the 12th century, al-Zahrāwī attained more prestige +in the West than he did in Arabic Spain, his native +country, or in any other part of the Islamic world.<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">3</a></p> + +<div class="figcenter" style="width: 500px;"><a name="f_2" id="f_2" /><img src="images/i008.png" width="500" height="306" alt= "Figure 2." +title="" /><br /><br /><p class="indent">Figure 2.—The myrtle-leaf shape recommended for paper on which medicine is to be +placed for cauterizing eyelid. <i>Top</i>, from original Arabic manuscript (Tüb. MS. 91), +courtesy Universitätsbibliothek Tübingen. <i>Bottom</i>, from Channing, <i>Albucasis</i></p></div> + +<p>The fame attached to this surgical treatise, the 30th +and last in al-Zahrāwī’s encyclopedic work <i>al-Taṣrīf +Liman ʻAjiza ʻan al-Taʼ līf</i>, is founded on certain merits. +The text is characterized by lucidity, careful description, +and a touch of original observation of the +surgical operations to which the treatise as a whole is +devoted.<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">4</a> Al-Zahrāwī furnishes his own drawings of +the surgical and dental instruments he used, devised, +or recommended for a more efficient performance. +The illustrations were intended to provide instructional +material for apprentices—whom al-Zahrāwī calls his +children—as well as for the benefit of those who +would read the work later on.<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">5</a> The treatise is +<span class='pagenum'>85</span>probably the oldest one known today that contains +such instructive surgical illustrations and text.<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">6</a></p> + +<div class="figcenter" style="width: 500px;"><a name="f_3" id="f_3" /><img src="images/i010.png" width="500" height="335" alt= "Figure 3." +title="" /><br /><br /><p class="indent">Figure 3.—Small funnel for pouring heated +lead into fistula of the eye for cauterization. +<i>Top</i>, from original Arabic manuscript (Vel. +2491), courtesy Süleymaniye Umumi Kütüphanesi +Müdürlüğü. <i>Bottom</i>, from Sudhoff, +<i>Chirurgie</i>, courtesy National Library of +Medicine.<br /><br /></p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_4" id="f_4" /><img src="images/i011.png" width="500" height="757" alt= "Figure 4." +title="" /><br /><br /><p class="indent">Figure 4.--Circular cauterization in stomach +ailments. <i>Top</i>, from original Arabic manuscript +(Tüb. MS. 91), courtesy Universitätsbibliothek +Tübingen. <i>Bottom</i>, from the +1531 Latin edition of Pietro d’Argellata, +<i>Chirurgia Argellata cum Albucasis</i>, hereinafter +cited as Argellata 1531, courtesy National +Library of Medicine.</p></div> + +<p>This surgical treatise has been investigated, translated, +and commented upon by eminent historians +of medicine and surgery to whose works I shall refer +in this article. However, the pharmaceutic and +therapeutic details of the treatise have been somewhat +overlooked.</p> + +<p>As to the various illustrations of the surgical instruments +(over 200 figures in all), an almost complete +representation of samples has been introduced by +Channing,<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">7</a> Leclerc,<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">8</a> Gurlt,<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">9</a> Sudhoff,<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">10</a> and others. +Nevertheless, a good number of the reproduced +drawings are greatly modified, most likely having been +influenced by earlier illustrations in several Latin and +vernacular versions of the treatise.<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">11</a> This becomes +clearer on comparison with seven Arabic manuscripts +that have not been fully examined by Western +scholars before and that—in several instances—show +more authentic drawings of al-Zahrāwī’s surgical +instruments than any heretofore published.<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">12</a></p> + +<div class="figcenter" style="width: 500px;"><a name="f_5" id="f_5" /><img src="images/i013.jpg" width="500" height="757" alt= "Figure 5." +title="" /><br /><br /><p class="indent">Figure 5.--Ink markings for identifying place +of cauterization. <i>Top</i>, from original Arabic +manuscript (Vel. 2491), courtesy Süleymaniye Umumi Kütüphanesi. +<i>Bottom</i>, from Argellata 1531, courtesy National +Library of Medicine.<br /><br /></p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_6" id="f_6" /><img src="images/i014a.png" width="500" height="415" alt= "Figure 6." +title="" /><br /><br /><p class="indent">Figure 6.—Cautery in hernia. <i>Top</i>, from +original Arabic manuscript (Vel. 2491), +courtesy Süleymaniye Umumi Kütüphanesi +Müdürlüğü. <i>Bottom</i>, from Leclerc, <i>Albulcasis</i>.</p></div> + +<p><span class='pagenum'>86</span>This article therefore, is an attempt to present a +sample of these illustrations with brief comments +regarding certain figures and passages of interest to +pharmacy and medical therapy.</p> + +<p>With much gratitude I express my indebtedness to +Prof. G. Folch Jou of Madrid, to Dr. A. Süheyl Ünver +and Mr. H. Dener of Istanbul, and to the librarians of +the depository institutions for their cooperation in the +reproduction of the manuscripts on microfilm.</p> + +<div class="figcenter" style="width: 500px;"><a name="f_7" id="f_7" /><img src="images/i014b.png" width="500" height="389" alt= "Figure 7." +title="" /><br /><br /><p class="indent">Figure 7.—Fine tweezer for removing foreign +bodies from the ear. <i>Top</i>, from original +Arabic manuscript (Ali 2854), courtesy +Süleymaniye Umumi Kütüphanesi Müdürlüğü. +<i>Bottom</i>, from Leclerc, <i>Abulcasis</i>.<br /><br /></p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_8" id="f_8" /><img src="images/i015.png" width="500" height="389" alt= "Figure 8." +title="" /><br /><br /><p class="indent">Figure 8.--Syringe with metal plunger-pump. +<i>Top</i>, from original Arabic manuscript +(Ali 2854), courtesy Süleymaniye Umumi Kütüphanesi Müdürlüğü. <i>Bottom</i>, from +Channing, <i>Albucasis</i>.</p></div> + +<p><span class='pagenum'>87</span>Al-Zahrāwī frequently introduces his treatises with +brief instructive and sometimes informative preludes. +However, in launching the last treatise of <i>al-Taṣrīf</i> he +expounded in a most interesting and illuminating +manner the status of surgery during his time. He also +explains the reasons that forced him to write on this +topic and why he wished to include, as he did, precautions, +advice, instructional notes, and beautifully +illustrated surgical drawings. For example, the prelude +to the treatise mentions four incidents that he +witnessed, all ending with tragic results because of the +ignorance of physicians who attempted to operate on +patients without the proper training in anatomy and +surgical manipulation. "For if one does not have the +knowledge of anatomy," al-Zahrāwī protests, then +" ... he is apt to fall in errors that lead to death as +I have seen it happen to many."<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">13</a></p> + +<p>Al-Zahrāwī divides his surgical treatise into three +sections (abwāb). In the first section (56 chapters)<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">14</a> +he elaborates upon the uses and disadvantages of +cautery in general. And on the ground that "fire +touches only the ailing part ... without causing +much damage to surrounding area," as caustic medicine +does, he prefers cautery by fire (al-kay bi al-nār) +to cautery by medicine (bi al-dawā).<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">15</a> This, he adds, +"became clear to us through lifelong experience, diligent +practice, and thorough investigations of facts."<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">16</a></p> + +<div class="figcenter" style="width: 500px;"><a name="f_9" id="f_9" /><img src="images/i016.png" width="500" height="793" alt= "Figure 9." +title="" /><br /><br /><p class="indent">Figure 9.—Metal nose dropper. <i>Top</i>, from +original Arabic manuscript (Tüb. MS. 91), +courtesy Universitätsbibliothek Tübingen. +<i>Middle</i>, from Channing, <i>Albucasis</i> (<i>Smithsonian +photo 46891-C</i>). <i>Bottom</i>, from Sudhoff, +<i>Chirurgie</i>, courtesy National Library of +Medicine.</p></div> + +<p><span class='pagenum'>88</span>He also proposes that instruments made of iron are +more practical in many ways than those made of gold, +because often, when gold instruments are put in fire, +they either are not heated enough or are overheated, +causing the gold to melt.</p> + +<div class="figcenter" style="width: 500px;"><a name="f_10" id="f_10" /><img src="images/i017.png" width="500" height="825" alt= "Figure 10." +title="" /><br /><br /><p class="indent">Figure 10.—Dental scrapers. <i>Top</i>, from original +Arabic manuscript (Vel. 2491), courtesy +Süleymaniye Umumi Kütüphanesi Müdürlüğü. +<i>Left</i>, from Argellata 1531, courtesy +National Library of Medicine. <i>Right</i>, from +Channing, <i>Albucasis</i>.</p></div> + +<p>Al-Zahrāwī gently refutes the superstition that +cautery is "good only in springtime," and states that +under the right conditions of the body’s humors it +could be used in all seasons."<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">17</a> Although he recommends +cautery rather highly, he never minimizes the +importance of treatment by drugs. Actually, he +encourages the use of drugs, before, with, and after +cauterization.<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">18</a> For example, in chapter 16 on "the +cauterization of eyelid when its hair grows reversedly +into the eye," he recommends treatment by cautery +and by medicine. In cautery, the area where fire is +to be placed is marked with ink in the shape of a +myrtle leaf. In drug treatment, the caustic medicine +is applied to the eyelid over a paper in the shape of a +myrtle leaf (<a href="#f_2">fig. 2</a>).</p> + +<div class="figcenter" style="width: 500px;"><a name="f_11" id="f_11" /><img src="images/i018.png" width="500" height="341" alt= "Figure 11." +title="" /><br /><br /><p class="indent">Figure 11.—Dental forceps. <i>Top</i>, from original +Arabic manuscript (Tüb. MS. 91), courtesy +Universitätsbibliothek Tübingen. <i>Bottom</i>, +from Leclerc, <i>Abulcasis</i>.</p></div> + +<p>In chapter 17 the author refers to an ancient method +regarding cautery of the fistula in the inner corner of +the eye. After incising the fistula, one "dirham" +(derived from the Greek "drachma," which is equal +to about 2.97 grams)<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">19</a> of melted lead is poured into it +through a fine funnel used for cauterization (<a href="#f_3">fig. 3</a>).</p> + +<div class="figcenter" style="width: 500px;"><a name="f_12" id="f_12" /><img src="images/i019.png" width="500" height="307" alt= "Figure 12." +title="" /><br /><br /><p class="indent">Figure 12.—Golden bridge to stabilize shaky teeth. <i>Top</i>, from original Arabic manuscript +(Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. <i>Left</i>, from Argellata 1531, +courtesy National Library of Medicine. <i>Right</i>, from Channing, <i>Albucasis</i>.</p></div> + +<p><span class='pagenum'>89</span>In like manner, al-Zahrāwī discusses cautery of the +stomach and the "cold liver" in chapters 26 and 27, +respectively. The drawings therein represent shapes +of the burns on the skin (<a href="#f_4">fig. 4</a>) and marks of ink to be +drawn beneath the cartilage of the ribs (<a href="#f_5">fig. 5</a>) for the +purpose of spotting the area of operation. Here also +he describes carefully and clearly the methods of +applying cautery and the types, position, and number +of tools employed in each case. He likewise depicts +(in chapter 45) instruments used in the treatment +of hernia (<a href="#f_6">fig. 6</a>).</p> + +<p>The second section (bāb), with about 99 chapters,<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">20</a> +deals with incision, puncturing, venesection, cupping, +surgery on abscesses, and the withdrawal of arrows +from the body. Al-Zahrāwī warns that ignorance in +such operations may lead to damage of an artery or +vein, causing loss of blood "by which life is sustained."<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">21</a> +Moreover, needle and thread (more than +one kind is mentioned) for the stitching of wounds are +repeatedly recommended.</p> + +<p>According to al-Zahrāwī, foreign bodies that lodge +in the ear (chapter 6) are of four origins: (1) "mineral +stones" or substances resembling mineral stones +such as iron and glass; (2) plant seeds (chick-peas and +beans); (3) liquids, such as water and vinegar; and (4) +animals, such as fleas. Several instruments are recommended +for the removal of such foreign bodies—fine +tweezers shaped like a dropper (<a href="#f_7">fig. 7</a>), a syringe +with plunger-pump, and a tube made of silver or +copper (<a href="#f_8">fig. 8</a>). Also of interest to pharmacy and +therapy is the advice in regard to the use of lubricants +to be applied before administering these fine instruments +into the body’s cavities.</p> + +<p>Chapter 24 is concerned with the treatment of the +polypus that grows in the nose. The various kinds +(including cancer growth), shapes, and colors of this +type tumor and its treatment by surgery or medicine +are described. A hollowed nose-dropper made of +metal in the shape of a small kerosene lamp<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">22</a> is suggested +(<a href="#f_9">fig. 9</a>). The dropper is held by its handle +while its contents are heated before use. Applying +heat to nose drops was probably proposed because it +serves two purposes: it allows easier flow of the +"duhn," or the fatty substance used, and it raises the +temperature of the drops to that of the body.</p> + +<p>In his discussion on dental hygiene,<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">23</a> al-Zahrāwī +<span class='pagenum'>90</span>describes scrapers and dental forceps for teeth cleaning +and extraction (figs. <a href="#f_10">10,</a> <a href="#f_11">11</a>) and brings in a few points +of historical interest.<a name="FNanchor_24_24" id="FNanchor_24_24"></a><a href="#Footnote_24_24" class="fnanchor">24</a> He warns of the common error +of extracting the adjacent healthy tooth instead of the +ailing one due to the patient’s sense deception. For a +gargle he prescribes salt water, vinegar, and wine +(sharāb). To stop hemorrhage he used blue vitriol +(al-zāj)—copper sulfate in our modern terminology.</p> + +<p>In chapter 33 al-Zahrāwī discusses bridge-making +for the consolidation of shaky teeth (<a href="#f_12">fig. 12</a>). He +prefers the use of stable gold over silver which, he says, +putrifies and rots in a short time. In a rational approach, +he also suggests that the fallen tooth itself, or +a similar one shaped out of a cow’s bone, be installed +and connected with adjacent, stable teeth by a bridge.</p> + +<p>Now, turning to chapter 36, we find al-Zahrāwī +describing a knife-thin tongue depressor (<a href="#f_13">fig. 13</a>) that +he used to facilitate the examination of inflamed +tonsils and other swellings of the throat; it was made +of silver or copper. And in chapter 37 (chapter 34 +in Bes. 503), he describes the excision of an inflamed +uvula by surgery. In the same chapter, he also mentions +the use of instruments made of steel. Of +pharmaceutical interest is the following free translation +of the formula he prescribes "as a milder treatment +by fumigation ... to be resorted to only when the +swelling is subsiding":<a name="FNanchor_25_25" id="FNanchor_25_25"></a><a href="#Footnote_25_25" class="fnanchor">25</a></p> + +<div class="blockquot"><p>Take pennyroyal [<i>Mentha pulegium</i> Linn.], absinthe +[<i>Artemisia maritima</i> Linn.], thyme, rue, hyssop, camomile, +abrotanum [<i>Artemisia abrotanum</i> Linn.], and other similar +herbs. Put all in a casserole and cover them with vinegar. +Then close tightly with clay [<i>lutum-sapientiae</i>]—except for a +small hole in the middle of the cover—and boil. Connect +one end of a hollowed instrument, a crude form of an +inhaler [<a href="#f_14">fig. 14</a>], with the hole in the cover and insert the +other end, which contains the nozzle, into the patient’s +mouth, allowing the vapor to rise up to the uvula. And +if you are not able to secure this instrument, take a straw +and attach its end to an egg-shell. The egg-shell will +prevent burns in the patient’s mouth that might be caused +by the heated vapor.</p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_13" id="f_13" /><img src="images/i023a.png" width="500" height="499" alt= "Figure 13." +title="" /><br /><br /><p class="indent">Figure 13.—Metal tongue depressor. <i>Top</i>, +from original Arabic manuscript (Ali 2854), +courtesy Süleymaniye Umumi Kütüphanesi +Müdürlüğü.<i> Bottom</i>, from Channing, <i>Albucasis</i>.<br /><br /></p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_14" id="f_14" /><img src="images/i023b.png" width="500" height="419" alt= "Figure 14." +title="" /><br /><br /><p class="indent">Figure 14.—Crude form of an inhaler. <i>Top</i>, +from original Arabic manuscript (Tüb. MS. +91), courtesy Universitätsbibliothek Tübingen. +<i>Bottom</i>, from Argellata 1531, courtesy +National Library of Medicine.</p></div> + +<p>Al-Zahrāwī repeats in chapter 53, on cancer, what +Greek physicians had said earlier, that cancer could +be removed by surgery only at its first stage and when +found in a removable part of the body, such as the +<span class='pagenum'>91</span>breast. Therefore, he confesses that neither he nor +any one else he knew of ever applied surgery with +success on advanced cancer.<a name="FNanchor_26_26" id="FNanchor_26_26"></a><a href="#Footnote_26_26" class="fnanchor">26</a></p> + +<div class="figcenter" style="width: 500px;"><a name="f_15" id="f_15" /><img src="images/i024a.png" width="500" height="529" alt= "Figure 15." +title="" /><br /><br /><p class="indent">Figure 15.--Metallic syringe for injecting solutions +into the bladder. <i>Top</i>, from original +Arabic manuscript (Bes. 503), courtesy +Süleymaniye Umumi Kütüphanesi Müdürlüğü. +<i>Bottom</i>, from Argellata 1531, courtesy +National Library of Medicine.<br /><br /></p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_16" id="f_16" /><img src="images/i024b.png" width="500" height="417" alt= "Figure 16." +title="" /><br /><br /><p class="indent">Figure 16.—Metallic or porcelain syringes for +injection of enemas. <i>Top</i>, from original +Arabic manuscript (Ali 2854), courtesy +Süleymaniye Umumi Kütüphanesi Müdürlüğü. +<i>Bottom</i>, from Argellata 1531, courtesy +National Library of Medicine.</p></div> + +<p>Of special interest in chapter 59 is the metallic +"syringe" (<a href="#f_15">fig. 15</a>) used to inject medicinal solutions +into the bladder: "The hollow passage [of the syringe] +should be exactly equal to the plunger it contains and +no more, so that when such fluids from an excess of +humors are aspirated they will be drawn out, and +likewise when the solutions are injected they will be +pushed in easily." Such description of the use of a +"bladder syringe" in the late 10th century clearly +points to the practical and interesting approach to +surgery in <i>al-Taṣrīf</i>. Moreover, his description of the +removal of a stone from the bladder—an operation +we now call lithotomy—is considered a contribution +to bladder surgery.</p> + +<p>One of the earliest recorded operations for the +extractions of two dead fetuses from the womb is +clearly described in chapter 76. The account of this +case shows not only al-Zahrāwī’s intelligent approach +as a shrewd observer but also his clinical and surgical +ability.</p> + +<p>Drawings of bulb-syringe instruments used for administering +enemas in ailments of the rectum and for +the treatment of diarrhea and colic are depicted in +chapter 83. The text describes several kinds of +syringes made of silver, porcelain, and copper in +various sizes (<a href="#f_16">fig. 16</a>). Of particular interest is an +illustration of a syringe, especially recommended for +children, to which a piece of leather (jildah) is +attached (<a href="#f_17">fig. 17</a>). This instrument is a precursor of +our modern bulb syringe.</p> + +<p>In chapter 84 al-Zahrāwī turns to the treatment +of various wounds. He prescribes the following +powder formula for use: "Take olibanum [frankincense] +and dragon’s blood,<a name="FNanchor_27_27" id="FNanchor_27_27"></a><a href="#Footnote_27_27" class="fnanchor">27</a> two parts of each, and +three parts of slaked or unslaked lime. Pound them +well, pass through a sieve and apply the powder to +the wound." In cases of damaged blood vessels, he +tied the arteries by ligature, a practice of which he +was a pioneer. In another chapter he describes four +methods for suturing the intestines.</p> + +<p>Al-Zahrāwī, being associated with war casualties +and writing his treatise about the end of the 10th +<span class='pagenum'>92</span>century, no doubt had the experience of dealing with +cases involving injuries caused by arrows. The text +in chapter 94 discloses his observations in elaborate +investigations regarding the extraction of various kinds +of arrows from the body.<a name="FNanchor_28_28" id="FNanchor_28_28"></a><a href="#Footnote_28_28" class="fnanchor">28</a> Accordingly, several kinds +of hooks and forceps for removing arrows are described +and depicted in the treatise (see <a href="#f_18">fig. 18</a>). 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,<a name="FNanchor_29_29" id="FNanchor_29_29"></a><a href="#Footnote_29_29" class="fnanchor">29</a> notwithstanding +the fact that Turkish bows and arrows were in common +use in the latter part of the 10th century.</p> + +<div class="figcenter" style="width: 500px;"><a name="f_17" id="f_17" /><img src="images/i026.png" width="500" height="527" alt= "Figure 17." +title="" /><br /><br /><p class="indent">Figure 17.—A crude form of bulb syringe +recommended for use with children. <i>Top</i>, +from original Arabic manuscript (Ali 2854), +courtesy Süleymaniye Umumi Kütüphanesi +Müdürlüğü. <i>Bottom</i>, from Leclerc, <i>Abulcasis</i>.</p></div> + +<p>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 <a href="#f_19">fig. 19</a>). 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.<a name="FNanchor_30_30" id="FNanchor_30_30"></a><a href="#Footnote_30_30" class="fnanchor">30</a> Evidently this is an indication +that he did not, as generally supposed, encourage +the widespread use of leeches.</p> + +<div class="figcenter" style="width: 500px;"><a name="f_18" id="f_18" /><img src="images/i027.png" width="500" height="734" alt= "Figure 18." +title="" /><br /><br /><p class="indent">Figure 18.—Hooks and forceps used for the +extraction of arrows. <i>Top</i>, from original +Arabic manuscript (Tüb. MS. 91), courtesy +Universitätsbibliothek Tübingen. <i>Bottom</i>, +from Channing, <i>Albucasis</i>.<br /><br /></p></div> + +<div class="figcenter" style="width: 500px;"><a name="f_19" id="f_19" /><img src="images/i028.png" width="500" height="827" alt= "Figure 19." +title="" /><br /><br /><p class="indent">Figure 19.—Cupping. <i>Top</i>, from original +Arabic manuscript (Tüb. MS. 91), courtesy +Universitätsbibliothek Tübingen. <i>Bottom</i>, +from Argellata 1531, courtesy National +Library of Medicine.</p></div> + +<p>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 +<span class='pagenum'>93</span>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 <a href="#f_20">fig. 20</a>). +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 (<a href="#f_21">fig. 21</a>). 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.</p> + +<div class="figcenter" style="width: 500px;"><a name="f_20" id="f_20" /><img src="images/i029.png" width="500" height="563" alt= "Figure 20." +title="" /><br /><br /><p class="indent">Figure 20.—Splint "in the shape of a spoon +without a bowl." <i>Top</i>, from original Arabic +manuscript (Tüb. MS. 91), courtesy Universitätsbibliothek +Tübingen. <i>Bottom</i>, from +Channing, <i>Albucasis</i>.</p></div> + +<p>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 +<span class='pagenum'>94</span>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 +[<i>Glossostemon bruguieri</i> D.C.], chickling vetch [the grass +pea, <i>Lathymus sativus</i>], and white marshmallow; 5 +dirhams each of myrrh and aloes; 6 dirhams of white +gum Arabic [<i>Acacia</i>]; 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).</p> + +<div class="figcenter" style="width: 500px;"><a name="f_21" id="f_21" /><img src="images/i030.png" width="500" height="550" alt= "Figure 21." +title="" /><br /><br /><p class="indent">Figure 21.—A splint to support the arm. +<i>Top</i>, from original Arabic manuscript (Cod. +N.F. 476A), courtesy Oesterreichische Nationalbibliothek. +<i>Bottom</i>, from Argellata +1531, courtesy National Library of Medicine.</p></div> + +<p>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 <i>al-Taṣrīf</i>—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.</p> + + +<div class="center"><big>In Summary</big></div> + +<p>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 +<i>al-Taṣrīf</i>.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Throughout the text of <i>al-Taṣrīf</i> al-Zahrāwī gave +careful attention to the importance of pharmaceutical +preparations in the healing art, including cases +requiring surgery.</p> + +<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">1</span></a> George Sarton, <i>Introduction to the History of Science</i>, Baltimore, +1927, vol. 1, p. 681.</p></div> + +<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">2</span></a> Mohammad S. Abu Ganima, in <i>Abul-Kasim ein Forscher der +Arabischen Medizin</i>, 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.</p></div> + +<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">3</span></a> Max Neuburger, <i>Geschichte der Medizin</i>, Stuttgart, 1911, vol. +2, pt. 1, pp. 178-179.</p></div> + +<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">4</span></a> Heinrich Haeser, <i>Lehrbuch der Geschichte der Medizin und der +epidemischen Krankheiten</i>, Jena, 1875, vol. 1, pp. 578-584; and +Donald Campbell, <i>Arabian Medicine and Its Influence on the +Middle Ages</i>, London, 1926, vol. 1, p. 88.</p></div> + +<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">5</span></a> See the prelude to the treatise.</p></div> + +<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">6</span></a> Fielding H. Garrison (<i>An Introduction of the History of Medicine</i>, +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," <i>Proceedings +of the Royal Society of Medicine</i>, 1937, vol. 30, p. 654.</p></div> + +<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">7</span></a> Johannis Channing, <i>Albucasis de Chirurgia. Arabice et Latine</i>, +Oxford, 1778, 2 vols. (hereinafter referred to as Channing, +<i>Albucasis</i>). 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.</p></div> + +<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">8</span></a> Lucien Leclerc, <i>La Chirurgie d’Abulcasis</i>, Paris, 1861 (hereinafter +referred to as Leclerc, <i>Abulcasis</i>). This excellent French +version was first published in a series of articles in <i>Gazette +Médicale de l’Algérie</i>, 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, <i>Histoire de la Médecine Arabe</i>, +Paris, 1876, vol. 1, pp. 453-457.</p></div> + +<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">9</span></a> Ernst Gurlt, <i>Geschichte der Chirurgie und ihrer Ausübung +Volkschirurgie-Alterthum-Mittelalter-Renaissance</i>, 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.</p></div> + +<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">10</span></a> Karl Sudhoff, <i>Beiträge zur Geschichte der Chirurgie im Mittelalter</i>, +Leipzig, 1918 (hereinafter referred to as Sudhoff, +<i>Chirurgie</i>), 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.</p></div> + +<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">11</span></a> See Leclerc, <i>Abulcasis</i>, in introduction.</p></div> + +<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">12</span></a> 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," "Beșir +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 <i>al-Taṣrīf</i>, 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 "Meșhur Arab Cerrahi Elbülkasimi Zehravi ve onun Kitabül +Cerrahiyesi," Istanbul, 1935. See also Ünver, <i>Serefeddin +Sabuncuoğlu: Kitabül Cerrahiyei Illhaniye</i>, Istanbul, 1939, pp. [5]-7.</p></div> + + +<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">13</span></a> See introduction to the treatise; for example, Bes. 502, fol. +522v-523v and Vel. 2491, fol. 104r-105v. See also K. P. J. +Sprengel, <i>Versuch einer pragmatischen Geschichte der Arzneikunde</i>, +Halle, 1823, vol. 2, pp. 449-451. George J. Fisher, in "Abul-Casem +Chalaf Ibn Abbas al-Zahrāwī, Commonly Called +Albucasis," <i>Annals of Anatomy and Surgery</i>, July-December, 1883, +vol. 8, pp. 24-25, gives a translation of only the first part of +the introduction.</p></div> + +<div class="footnote"><p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">14</span></a> 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.</p></div> + +<div class="footnote"><p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">15</span></a> 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 +(<i>Ruta graveolens</i> Linn.), and juice of the Oriental cashew nut +(<i>Senecarpus anacardium</i> Linn.).</p></div> + +<div class="footnote"><p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">16</span></a> Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v.</p></div> + +<div class="footnote"><p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">17</span></a> 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.</p></div> + +<div class="footnote"><p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">18</span></a> 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).</p></div> + +<div class="footnote"><p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">19</span></a> 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, <i>Islamische Masse und Gewichte +umgerechnet ins metrische System</i>, Leiden, 1955, pt. 1, pp. 2-8; +and George C. Miles, <i>Early Arabic Glass Weights and Stamps</i>, +New York, 1948, p. 6.</p></div> + +<div class="footnote"><p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">20</span></a> The contents of several manuscripts (such as Ali 2854, +Wien 476 A, Bes. 503, and Tüb. MS. 91) give different numbers.</p></div> + +<div class="footnote"><p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">21</span></a> See, for example, Tüb. MS. 91, fol. 45v; and Bes. 502, +fol. 530v.</p></div> + +<div class="footnote"><p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">22</span></a> Sudhoff, <i>op. cit.</i> (footnote 10), p. 29, fig. 6.</p></div> + +<div class="footnote"><p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">23</span></a> 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," <i>Revue de Stematologie</i>, April 1911, +vol. 18, pp. [169]-180 and 222-229.</p></div> + +<div class="footnote"><p><a name="Footnote_24_24" id="Footnote_24_24"></a><a href="#FNanchor_24_24"><span class="label">24</span></a> It is regrettable that Franz Rosenthal in his fine article +"Bibliographical Notes on Medieval Muslim Dentistry" +(<i>Bulletin of the History of Medicine</i>, 1960, vol. 34, pp. 52-60) +failed to refer to this or any other section of al-Zahrāwī’s work.</p></div> + +<div class="footnote"><p><a name="Footnote_25_25" id="Footnote_25_25"></a><a href="#FNanchor_25_25"><span class="label">25</span></a> Bes. 502, fol. 538. See also Channing, <i>Albucasis</i>, 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, <i>Tuḥfat al-Aḥbāb, Glossaire de la Matière +Médicale Marocaine</i>, Paris, 1934, pp. 133, 143, 193-194, and +Max Meyerhof, <i>Un Glossaire de Matière Médicale Composé par +Maimonide</i>, Cairo, 1940, pp. 168-169.</p></div> + +<div class="footnote"><p><a name="Footnote_26_26" id="Footnote_26_26"></a><a href="#FNanchor_26_26"><span class="label">26</span></a> Tüb. MS. 91, fol. 99v.</p></div> + +<div class="footnote"><p><a name="Footnote_27_27" id="Footnote_27_27"></a><a href="#FNanchor_27_27"><span class="label">27</span></a> Dragon’s blood is a resin obtained from the scales covering +the surface of the ripe fruits of "<i>Daemonorops draco Blume</i>" +(Heber W. Youngken, <i>Textbook of Pharmacognosy</i>, ed. 6, Philadelphia, +1948, p. 175). See also Renaud and Colin, <i>op. cit.</i> +(footnote 25), pp. 54-55.</p></div> + +<div class="footnote"><p><a name="Footnote_28_28" id="Footnote_28_28"></a><a href="#FNanchor_28_28"><span class="label">28</span></a> Heinrich Frölich, "Abul-Kasem als Kriegschirurg," <i>Archiv +für klinische Chirurgie</i>, 1884, vol. 30, pp. 365-376. This well-presented +study was reviewed by Paul Schede in <i>Centralblatt +für Chirurgie</i>, 1884, no. 38, pp. 626-627.</p></div> + +<div class="footnote"><p><a name="Footnote_29_29" id="Footnote_29_29"></a><a href="#FNanchor_29_29"><span class="label">29</span></a> Johannis Freind, <i>The History of Physick</i>, London, 1726, vol. +2, p. 129.</p></div> + +<div class="footnote"><p><a name="Footnote_30_30" id="Footnote_30_30"></a><a href="#FNanchor_30_30"><span class="label">30</span></a> In several manuscripts, the chapter on the use of leeches is +the last one in the second section of the treatise.</p></div> + + +<p>U.S. GOVERNMENT PRINTING OFFICE: 1961</p> + +<p>For sale by the Superintendent of Documents, U.S. Government Printing Office +Washington 25, D. 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at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..879a574 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #26038 (https://www.gutenberg.org/ebooks/26038) diff --git a/old/26038-0.txt b/old/26038-0.txt new file mode 100644 index 0000000..b906ed7 --- /dev/null +++ b/old/26038-0.txt @@ -0,0 +1,1110 @@ +The Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Drawings and Pharmacy in Al-Zahrawi's 10th-Century Surgical Treatise + +Author: Sami Hamarneh + +Release Date: July 24, 2008 [EBook #26038] + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + + + + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + + + + + Drawings and Pharmacy in al-Zahrāwī’s + 10th-Century Surgical Treatise + + _by Sami Hamarneh_ + + Paper 22, pages 81-94, from + + CONTRIBUTIONS FROM THE MUSEUM + OF HISTORY AND TECHNOLOGY + + UNITED STATES NATIONAL MUSEUM + BULLETIN 228 + + SMITHSONIAN INSTITUTION · WASHINGTON, D.C., 1961 + + [Illustration: Figure 1.--Reproduction of a page from + original Arabic manuscript indexed as "Cod. N.F. 476A" at + Oesterreichische Nationalbibliothek in Vienna. Courtesy + Oesterreichische Nationalbibliothek.] + + + + +Drawings and Pharmacy in al-Zahrāwī’s +10th-Century Surgical Treatise + +_by Sami Hamarneh_ + + +_Probably the earliest independent work in Arabic Spain to embrace the +whole of medical knowledge of the time is the encyclopedic al-Tasrīf, +written in the late 10th century by Abū al-Qāsim al-Zahrāwī, also known +as Abulcasis. Consisting of 30 treatises, it is the only known work of +al-Zahrāwī and it brought him high prestige in the western world._ + +_Here we are concerned only with his last treatise, on surgery. With its +many drawings of surgical instruments, intended for the instruction of +apprentices, its descriptions of formulas and medicinal preparations, +and its lucid observations on surgical procedures, this treatise is +perhaps the oldest of its kind._ + +_Scholars today have available a translation of the text and +reproductions of the drawings, but many of the latter are greatly +modified from the originals._ + +_This study reproduces examples of al-Zahrāwī’s original illustrations, +compares some with early drawings based on them, and comments on +passages in the treatise of interest to students of pharmacy and medical +therapy._ + +THE AUTHOR: _Sami Hamarneh undertook this research into the history of +medicine in connection with his duties as associate curator of medical +sciences in the United States National Museum, Smithsonian Institution._ + + +THE INTRODUCTION OF THE WRITINGS of Abū al-Qāsim Khalaf ibn ʻAbbās +al-Zahrāwī--better known as Abulcasis (d. ca. 1013)--to Western Europe +was through the Latin translation of his surgical treatise (maqālah) by +Gerard of Cremona (d. 1187).[1] The response to this treatise, +thereafter, was much greater than the attention paid to the surgery of +any of the three renowned physicians of the Eastern Caliphate: al-Rāzī +(Latin, Rhazes, d. ca. 925), the greatest clinician in Arabic medicine; +al-Majūsī (Haly Abbās, d. 994), the author of the encyclopedic medical +work, _al_-_Malakī_;[2] and Ibn Sīnā (Avicenna, 980-1037), the author +of the famous _al-Qānūn fī al-Ṭibb_, a codification of the whole of +medical knowledge. Because of the widespread dissemination of this Latin +version in medieval Europe beginning with the latter part of the 12th +century, al-Zahrāwī attained more prestige in the West than he did in +Arabic Spain, his native country, or in any other part of the Islamic +world.[3] + + [Illustration: Figure 2.--The myrtle-leaf shape recommended + for paper on which medicine is to be placed for cauterizing + eyelid. _Top_, from original Arabic manuscript (Tüb. MS. + 91), courtesy Universitätsbibliothek Tübingen. _Bottom_, + from Channing, _Albucasis_.] + +The fame attached to this surgical treatise, the 30th and last in +al-Zahrāwī’s encyclopedic work _al-Taṣrīf Liman ‘Ajiza ‘an +al-Ta’līf_, is founded on certain merits. The text is characterized +by lucidity, careful description, and a touch of original +observation of the surgical operations to which the treatise as a +whole is devoted.[4] Al-Zahrāwī furnishes his own drawings of the +surgical and dental instruments he used, devised, or recommended for +a more efficient performance. The illustrations were intended to +provide instructional material for apprentices--whom al-Zahrāwī +calls his children--as well as for the benefit of those who would +read the work later on.[5] The treatise is probably the oldest one +known today that contains such instructive surgical illustrations +and text.[6] + + [Illustration: Figure 3.--Small funnel for pouring heated + lead into fistula of the eye for cauterization. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlüğü. _Bottom_, from Sudhoff, + _Chirurgie_, courtesy National Library of Medicine.] + + [Illustration: Figure 4.--Circular cauterization in stomach + ailments. _Top_, from original Arabic manuscript (Tüb. MS. + 91), courtesy Universitätsbibliothek Tübingen. _Bottom_, + from the 1531 Latin edition of Pietro d’Argellata, + _Chirurgia Argellata cum Albucasis_, hereinafter cited as + Argellata 1531, courtesy National Library of Medicine.] + +This surgical treatise has been investigated, translated, and commented +upon by eminent historians of medicine and surgery to whose works I +shall refer in this article. However, the pharmaceutic and therapeutic +details of the treatise have been somewhat overlooked. + +As to the various illustrations of the surgical instruments (over 200 +figures in all), an almost complete representation of samples has been +introduced by Channing,[7] Leclerc,[8] Gurlt,[9] Sudhoff,[10] and +others. Nevertheless, a good number of the reproduced drawings are +greatly modified, most likely having been influenced by earlier +illustrations in several Latin and vernacular versions of the +treatise.[11] This becomes clearer on comparison with seven Arabic +manuscripts that have not been fully examined by Western scholars before +and that--in several instances--show more authentic drawings of +al-Zahrāwī’s surgical instruments than any heretofore published.[12] + + [Illustration: Figure 5.--Ink markings for identifying place + of cauterization. _Top_, from original Arabic manuscript + (Vel. 2491), courtesy Süleymaniye Umumi Kütüphanesi + Müdürlüğü. _Bottom_, from Argellata 1531, courtesy National + Library of Medicine.] + + [Illustration: Figure 6.--Cautery in hernia. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlüğü. _Bottom_, from Leclerc, + _Albulcasis_.] + +This article therefore, is an attempt to present a sample of these +illustrations with brief comments regarding certain figures and passages +of interest to pharmacy and medical therapy. + +With much gratitude I express my indebtedness to Prof. G. Folch Jou of +Madrid, to Dr. A. Süheyl Ünver and Mr. H. Dener of Istanbul, and to the +librarians of the depository institutions for their cooperation in the +reproduction of the manuscripts on microfilm. + + [Illustration: Figure 7.--Fine tweezer for removing foreign + bodies from the ear. _Top_, from original Arabic manuscript + (Ali 2854), courtesy Süleymaniye Umumi Kütüphanesi + Müdürlüğü. _Bottom_, from Leclerc, _Abulcasis_.] + + [Illustration: Figure 8.--Syringe with metal plunger-pump. + _Top_, from original Arabic manuscript (Ali 2854), courtesy + Süleymaniye Umumi Kütüphanesi Müdürlüğü. _Bottom_, from + Channing, _Albucasis_.] + +Al-Zahrāwī frequently introduces his treatises with brief instructive +and sometimes informative preludes. However, in launching the last +treatise of _al-Taṣrīf_ he expounded in a most interesting and +illuminating manner the status of surgery during his time. He also +explains the reasons that forced him to write on this topic and why he +wished to include, as he did, precautions, advice, instructional notes, +and beautifully illustrated surgical drawings. For example, the prelude +to the treatise mentions four incidents that he witnessed, all ending +with tragic results because of the ignorance of physicians who attempted +to operate on patients without the proper training in anatomy and +surgical manipulation. "For if one does not have the knowledge of +anatomy," al-Zahrāwī protests, then "... he is apt to fall in errors +that lead to death as I have seen it happen to many."[13] + +Al-Zahrāwī divides his surgical treatise into three sections (abwāb). In +the first section (56 chapters)[14] he elaborates upon the uses and +disadvantages of cautery in general. And on the ground that "fire +touches only the ailing part ... without causing much damage to +surrounding area," as caustic medicine does, he prefers cautery by fire +(al-kay bi al-nār) to cautery by medicine (bi al-dawā).[15] This, he +adds, "became clear to us through lifelong experience, diligent +practice, and thorough investigations of facts."[16] + + [Illustration: Figure 9.--Metal nose dropper. _Top_, from + original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Middle_, from Channing, + _Albucasis_ (_Smithsonian photo 46891-C_). _Bottom_, from + Sudhoff, _Chirurgie_, courtesy National Library of + Medicine.] + +He also proposes that instruments made of iron are more practical in +many ways than those made of gold, because often, when gold instruments +are put in fire, they either are not heated enough or are overheated, +causing the gold to melt. + + [Illustration: Figure 10.--Dental scrapers. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlüğü. _Left_, from Argellata 1531, + courtesy National Library of Medicine. _Right_, from + Channing, _Albucasis_.] + +Al-Zahrāwī gently refutes the superstition that cautery is "good only in +springtime," and states that "under the right conditions of the body’s +humors it could be used in all seasons."[17] Although he recommends +cautery rather highly, he never minimizes the importance of treatment +by drugs. Actually, he encourages the use of drugs, before, with, and +after cauterization.[18] For example, in chapter 16 on "the +cauterization of eyelid when its hair grows reversedly into the eye," he +recommends treatment by cautery and by medicine. In cautery, the area +where fire is to be placed is marked with ink in the shape of a myrtle +leaf. In drug treatment, the caustic medicine is applied to the eyelid +over a paper in the shape of a myrtle leaf (fig. 2). + + [Illustration: Figure 11.--Dental forceps. _Top_, from + original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Leclerc, + _Abulcasis_.] + +In chapter 17 the author refers to an ancient method regarding cautery +of the fistula in the inner corner of the eye. After incising the +fistula, one "dirham" (derived from the Greek "drachma," which is equal +to about 2.97 grams)[19] of melted lead is poured into it through a fine +funnel used for cauterization (fig. 3). + + [Illustration: Figure 12.--Golden bridge to stabilize shaky + teeth. _Top_, from original Arabic manuscript (Tüb. MS. 91), + courtesy Universitätsbibliothek Tübingen. _Left_, from + Argellata 1531, courtesy National Library of Medicine. + _Right_, from Channing, _Albucasis_.] + +In like manner, al-Zahrāwī discusses cautery of the stomach and the +"cold liver" in chapters 26 and 27, respectively. The drawings therein +represent shapes of the burns on the skin (fig. 4) and marks of ink to +be drawn beneath the cartilage of the ribs (fig. 5) for the purpose of +spotting the area of operation. Here also he describes carefully and +clearly the methods of applying cautery and the types, position, and +number of tools employed in each case. He likewise depicts (in chapter +45) instruments used in the treatment of hernia (fig. 6). + +The second section (bāb), with about 99 chapters,[20] deals with +incision, puncturing, venesection, cupping, surgery on abscesses, and +the withdrawal of arrows from the body. Al-Zahrāwī warns that ignorance +in such operations may lead to damage of an artery or vein, causing loss +of blood "by which life is sustained."[21] Moreover, needle and thread +(more than one kind is mentioned) for the stitching of wounds are +repeatedly recommended. + +According to al-Zahrāwī, foreign bodies that lodge in the ear (chapter +6) are of four origins: (1) "mineral stones" or substances resembling +mineral stones such as iron and glass; (2) plant seeds (chick-peas and +beans); (3) liquids, such as water and vinegar; and (4) animals, such +as fleas. Several instruments are recommended for the removal of such +foreign bodies--fine tweezers shaped like a dropper (fig. 7), a syringe +with plunger-pump, and a tube made of silver or copper (fig. 8). Also of +interest to pharmacy and therapy is the advice in regard to the use of +lubricants to be applied before administering these fine instruments +into the body’s cavities. + +Chapter 24 is concerned with the treatment of the polypus that grows in +the nose. The various kinds (including cancer growth), shapes, and +colors of this type tumor and its treatment by surgery or medicine are +described. A hollowed nose-dropper made of metal in the shape of a small +kerosene lamp[22] is suggested (fig. 9). The dropper is held by its +handle while its contents are heated before use. Applying heat to nose +drops was probably proposed because it serves two purposes: it allows +easier flow of the "duhn," or the fatty substance used, and it raises +the temperature of the drops to that of the body. + +In his discussion on dental hygiene,[23] al-Zahrāwī describes scrapers +and dental forceps for teeth cleaning and extraction (figs. 10, 11) and +brings in a few points of historical interest.[24] He warns of the +common error of extracting the adjacent healthy tooth instead of the +ailing one due to the patient’s sense deception. For a gargle he +prescribes salt water, vinegar, and wine (sharāb). To stop hemorrhage he +used blue vitriol (al-zāj)--copper sulfate in our modern terminology. + +In chapter 33 al-Zahrāwī discusses bridge-making for the consolidation +of shaky teeth (fig. 12). He prefers the use of stable gold over silver +which, he says, putrifies and rots in a short time. In a rational +approach, he also suggests that the fallen tooth itself, or a similar +one shaped out of a cow’s bone, be installed and connected with +adjacent, stable teeth by a bridge. + +Now, turning to chapter 36, we find al-Zahrāwī describing a knife-thin +tongue depressor (fig. 13) that he used to facilitate the examination of +inflamed tonsils and other swellings of the throat; it was made of +silver or copper. And in chapter 37 (chapter 34 in Bes. 503), he +describes the excision of an inflamed uvula by surgery. In the same +chapter, he also mentions the use of instruments made of steel. Of +pharmaceutical interest is the following free translation of the formula +he prescribes "as a milder treatment by fumigation ... to be resorted to +only when the swelling is subsiding":[25] + + Take pennyroyal [_Mentha pulegium_ Linn.], absinthe + [_Artemisia maritima_ Linn.], thyme, rue, hyssop, camomile, + abrotanum [_Artemisia abrotanum_ Linn.], and other similar + herbs. Put all in a casserole and cover them with vinegar. + Then close tightly with clay [_lutum-sapientiae_]--except + for a small hole in the middle of the cover--and boil. + Connect one end of a hollowed instrument, a crude form of an + inhaler [fig. 14], with the hole in the cover and insert the + other end, which contains the nozzle, into the patient’s + mouth, allowing the vapor to rise up to the uvula. And if + you are not able to secure this instrument, take a straw and + attach its end to an egg-shell. The egg-shell will prevent + burns in the patient’s mouth that might be caused by the + heated vapor. + + [Illustration: Figure 13.--Metal tongue depressor. _Top_, + from original Arabic manuscript (Ali 2854), courtesy + Süleymaniye Umumi Kütüphanesi Müdürlüğü._ Bottom_, from + Channing, _Albucasis_.] + + [Illustration: Figure 14.--Crude form of an inhaler. _Top_, + from original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +Al-Zahrāwī repeats in chapter 53, on cancer, what Greek physicians had +said earlier, that cancer could be removed by surgery only at its first +stage and when found in a removable part of the body, such as the +breast. Therefore, he confesses that neither he nor any one else he +knew of ever applied surgery with success on advanced cancer.[26] + + [Illustration: Figure 15.--Metallic syringe for injecting + solutions into the bladder. _Top_, from original Arabic + manuscript (Bes. 503), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlüğü. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + + [Illustration: Figure 16.--Metallic or porcelain syringes + for injection of enemas. _Top_, from original Arabic + manuscript (Ali 2854), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlüğü. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + +Of special interest in chapter 59 is the metallic "syringe" (fig. 15) +used to inject medicinal solutions into the bladder: "The hollow passage +[of the syringe] should be exactly equal to the plunger it contains and +no more, so that when such fluids from an excess of humors are aspirated +they will be drawn out, and likewise when the solutions are injected +they will be pushed in easily." Such description of the use of a +"bladder syringe" in the late 10th century clearly points to the +practical and interesting approach to surgery in _al-Taṣrīf_. Moreover, +his description of the removal of a stone from the bladder--an operation +we now call lithotomy--is considered a contribution to bladder surgery. + +One of the earliest recorded operations for the extractions of two dead +fetuses from the womb is clearly described in chapter 76. The account of +this case shows not only al-Zahrāwī’s intelligent approach as a shrewd +observer but also his clinical and surgical ability. + +Drawings of bulb-syringe instruments used for administering enemas in +ailments of the rectum and for the treatment of diarrhea and colic are +depicted in chapter 83. The text describes several kinds of syringes +made of silver, porcelain, and copper in various sizes (fig. 16). Of +particular interest is an illustration of a syringe, especially +recommended for children, to which a piece of leather (jildah) is +attached (fig. 17). This instrument is a precursor of our modern bulb +syringe. + +In chapter 84 al-Zahrāwī turns to the treatment of various wounds. He +prescribes the following powder formula for use: "Take olibanum +[frankincense] and dragon’s blood,[27] two parts of each, and three +parts of slaked or unslaked lime. Pound them well, pass through a sieve +and apply the powder to the wound." In cases of damaged blood vessels, +he tied the arteries by ligature, a practice of which he was a pioneer. +In another chapter he describes four methods for suturing the +intestines. + +Al-Zahrāwī, being associated with war casualties and writing his +treatise about the end of the 10th century, no doubt had the experience +of dealing with cases involving injuries caused by arrows. The text in +chapter 94 discloses his observations in elaborate investigations +regarding the extraction of various kinds of arrows from the body.[28] +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,[29] +notwithstanding the fact that Turkish bows and arrows were in common use +in the latter part of the 10th century. + + [Illustration: Figure 17.--A crude form of bulb syringe + recommended for use with children. _Top_, from original + Arabic manuscript (Ali 2854), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlüğü. _Bottom_, from Leclerc, _Abulcasis_.] + +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.[30] Evidently this is +an indication that he did not, as generally supposed, encourage the +widespread use of leeches. + + [Illustration: Figure 18.--Hooks and forceps used for the + extraction of arrows. _Top_, from original Arabic manuscript + (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. + _Bottom_, from Channing, _Albucasis_.] + + [Illustration: Figure 19.--Cupping. _Top_, from original + Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +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. + + [Illustration: Figure 20.--Splint "in the shape of a spoon + without a bowl." _Top_, from original Arabic manuscript + (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. + _Bottom_, from Channing, _Albucasis_.] + +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). + + [Illustration: Figure 21.--A splint to support the arm. + _Top_, from original Arabic manuscript (Cod. N.F. 476A), + courtesy Oesterreichische Nationalbibliothek. _Bottom_, from + Argellata 1531, courtesy National Library of Medicine.] + +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. + + + [1] George Sarton, _Introduction to the History of + Science_, Baltimore, 1927, vol. 1, p. 681. + + [2] 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. + + [3] Max Neuburger, _Geschichte der Medizin_, Stuttgart, + 1911, vol. 2, pt. 1, pp. 178-179. + + [4] 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. + + [5] See the prelude to the treatise. + + [6] 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. + + [7] 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. + + [8] 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. + + [9] 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. + + [10] 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. + + [11] See Leclerc, _Abulcasis_, in introduction. + + [12] 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. [5]-7. + + [13] 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. + + [14] 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. + + [15] 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.). + + [16] Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v. + + [17] 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. + + [18] 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). + + [19] 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. + + [20] The contents of several manuscripts (such as Ali 2854, + Wien 476 A, Bes. 503, and Tüb. MS. 91) give different + numbers. + + [21] See, for example, Tüb. MS. 91, fol. 45v; and Bes. 502, + fol. 530v. + + [22] Sudhoff, _op. cit._ (footnote 10), p. 29, fig. 6. + + [23] 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. [169]-180 and 222-229. + + [24] 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. + + [25] 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. + + [26] Tüb. MS. 91, fol. 99v. + + [27] 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. + + [28] 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. + + [29] Johannis Freind, _The History of Physick_, London, + 1726, vol. 2, p. 129. + + [30] In several manuscripts, the chapter on the use of + leeches is the last one in the second section of the + treatise. + + +U.S. GOVERNMENT PRINTING OFFICE: 1961 + +For sale by the Superintendent of Documents, U.S. Government Printing +Office Washington 25, D.C.-Price 20 cents + + + + + +End of the Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +*** END OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + +***** This file should be named 26038-0.txt or 26038-0.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/6/0/3/26038/ + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + http://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. diff --git a/old/26038-0.zip b/old/26038-0.zip Binary files differnew file mode 100644 index 0000000..05aaddf --- /dev/null +++ b/old/26038-0.zip diff --git a/old/26038-8.txt b/old/26038-8.txt new file mode 100644 index 0000000..fe055d5 --- /dev/null +++ b/old/26038-8.txt @@ -0,0 +1,1141 @@ +The Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Drawings and Pharmacy in Al-Zahrawi's 10th-Century Surgical Treatise + +Author: Sami Hamarneh + +Release Date: July 24, 2008 [EBook #26038] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + + + + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + + +---------------------------------------------------------------------+ + | | + | Transcriber’s note: | + | | + | Following table describes the meaning and the origin of | + | the characters enclosed in square brackets which do not | + | have their correspondents in the English Alphabet: | + | | + | [=a] letter a with a macron (straight line) above (Arabic) | + | [=i] letter i with a macron (straight line) above (Arabic) | + | [=u] letter u with a macron (straight line) above (Arabic) | + | [h.] letter h with a dot below (Arabic) | + | [s.] letter s with a dot below (Arabic) | + | [t.] letter t with a dot below (Arabic) | + | [T.] letter T with a dot below (Arabic) | + | [s,] letter s with a cedilla (comma-like symbol) below (Turkish) | + | [S,] letter S with a cedilla (comma-like symbol) below (Turkish) | + | [)g] letter g with a breve (u-shaped symbol) above (Turkish) | + | | + +---------------------------------------------------------------------+ + + + + + Drawings and Pharmacy in al-Zahr[=a]w[=i]’s + 10th-Century Surgical Treatise + + _by Sami Hamarneh_ + + Paper 22, pages 81-94, from + + CONTRIBUTIONS FROM THE MUSEUM + OF HISTORY AND TECHNOLOGY + + UNITED STATES NATIONAL MUSEUM + BULLETIN 228 + + SMITHSONIAN INSTITUTION · WASHINGTON, D.C., 1961 + + [Illustration: Figure 1.--Reproduction of a page from + original Arabic manuscript indexed as "Cod. N.F. 476A" at + Oesterreichische Nationalbibliothek in Vienna. Courtesy + Oesterreichische Nationalbibliothek.] + + + + +Drawings and Pharmacy in al-Zahr[=a]w[=i]’s +10th-Century Surgical Treatise + +_by Sami Hamarneh_ + + +_Probably the earliest independent work in Arabic Spain to embrace the +whole of medical knowledge of the time is the encyclopedic al-Tasr[=i]f, +written in the late 10th century by Ab[=u] al-Q[=a]sim al-Zahr[=a]w[=i], +also known as Abulcasis. Consisting of 30 treatises, it is the only +known work of al-Zahr[=a]w[=i] and it brought him high prestige in the +western world._ + +_Here we are concerned only with his last treatise, on surgery. With its +many drawings of surgical instruments, intended for the instruction of +apprentices, its descriptions of formulas and medicinal preparations, +and its lucid observations on surgical procedures, this treatise is +perhaps the oldest of its kind._ + +_Scholars today have available a translation of the text and +reproductions of the drawings, but many of the latter are greatly +modified from the originals._ + +_This study reproduces examples of al-Zahr[=a]w[=i]’s original +illustrations, compares some with early drawings based on them, and +comments on passages in the treatise of interest to students of pharmacy +and medical therapy._ + +THE AUTHOR: _Sami Hamarneh undertook this research into the history of +medicine in connection with his duties as associate curator of medical +sciences in the United States National Museum, Smithsonian Institution._ + + +THE INTRODUCTION OF THE WRITINGS of Ab[=u] al-Q[=a]sim Khalaf ibn +‘Abb[=a]s al-Zahr[=a]w[=i]--better known as Abulcasis (d. ca. 1013)--to +Western Europe was through the Latin translation of his surgical +treatise (maq[=a]lah) by Gerard of Cremona (d. 1187).[1] The response to +this treatise, thereafter, was much greater than the attention paid to +the surgery of any of the three renowned physicians of the Eastern +Caliphate: al-R[=a]z[=i] (Latin, Rhazes, d. ca. 925), the greatest +clinician in Arabic medicine; al-Maj[=u]s[=i] (Haly Abb[=a]s, d. 994), +the author of the encyclopedic medical work, _al_-_Malak[=i]_;[2] and +Ibn S[=i]n[=a] (Avicenna, 980-1037), the author of the famous +_al-Q[=a]n[=u]n f[=i] al-[T.]ibb_, a codification of the whole of +medical knowledge. Because of the widespread dissemination of this Latin +version in medieval Europe beginning with the latter part of the 12th +century, al-Zahr[=a]w[=i] attained more prestige in the West than he did +in Arabic Spain, his native country, or in any other part of the Islamic +world.[3] + + [Illustration: Figure 2.--The myrtle-leaf shape recommended + for paper on which medicine is to be placed for cauterizing + eyelid. _Top_, from original Arabic manuscript (Tüb. MS. + 91), courtesy Universitätsbibliothek Tübingen. _Bottom_, + from Channing, _Albucasis_.] + +The fame attached to this surgical treatise, the 30th and last in +al-Zahr[=a]w[=i]’s encyclopedic work _al-Ta[s.]r[=i]f Liman ‘Ajiza +‘an al-Ta’l[=i]f_, is founded on certain merits. The text is +characterized by lucidity, careful description, and a touch of +original observation of the surgical operations to which the treatise +as a whole is devoted.[4] Al-Zahr[=a]w[=i] furnishes his own drawings +of the surgical and dental instruments he used, devised, or +recommended for a more efficient performance. The illustrations were +intended to provide instructional material for apprentices--whom +al-Zahr[=a]w[=i] calls his children--as well as for the benefit of +those who would read the work later on.[5] The treatise is probably +the oldest one known today that contains such instructive surgical +illustrations and text.[6] + + [Illustration: Figure 3.--Small funnel for pouring heated + lead into fistula of the eye for cauterization. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Sudhoff, + _Chirurgie_, courtesy National Library of Medicine.] + + [Illustration: Figure 4.--Circular cauterization in stomach + ailments. _Top_, from original Arabic manuscript (Tüb. MS. + 91), courtesy Universitätsbibliothek Tübingen. _Bottom_, + from the 1531 Latin edition of Pietro d’Argellata, + _Chirurgia Argellata cum Albucasis_, hereinafter cited as + Argellata 1531, courtesy National Library of Medicine.] + +This surgical treatise has been investigated, translated, and commented +upon by eminent historians of medicine and surgery to whose works I +shall refer in this article. However, the pharmaceutic and therapeutic +details of the treatise have been somewhat overlooked. + +As to the various illustrations of the surgical instruments (over 200 +figures in all), an almost complete representation of samples has been +introduced by Channing,[7] Leclerc,[8] Gurlt,[9] Sudhoff,[10] and +others. Nevertheless, a good number of the reproduced drawings are +greatly modified, most likely having been influenced by earlier +illustrations in several Latin and vernacular versions of the +treatise.[11] This becomes clearer on comparison with seven Arabic +manuscripts that have not been fully examined by Western scholars before +and that--in several instances--show more authentic drawings of +al-Zahr[=a]w[=i]’s surgical instruments than any heretofore +published.[12] + + [Illustration: Figure 5.--Ink markings for identifying place + of cauterization. _Top_, from original Arabic manuscript + (Vel. 2491), courtesy Süleymaniye Umumi Kütüphanesi + Müdürlü[)g]ü. _Bottom_, from Argellata 1531, courtesy + National Library of Medicine.] + + [Illustration: Figure 6.--Cautery in hernia. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Leclerc, + _Albulcasis_.] + +This article therefore, is an attempt to present a sample of these +illustrations with brief comments regarding certain figures and passages +of interest to pharmacy and medical therapy. + +With much gratitude I express my indebtedness to Prof. G. Folch Jou of +Madrid, to Dr. A. Süheyl Ünver and Mr. H. Dener of Istanbul, and to the +librarians of the depository institutions for their cooperation in the +reproduction of the manuscripts on microfilm. + + [Illustration: Figure 7.--Fine tweezer for removing foreign + bodies from the ear. _Top_, from original Arabic manuscript + (Ali 2854), courtesy Süleymaniye Umumi Kütüphanesi + Müdürlü[)g]ü. _Bottom_, from Leclerc, _Abulcasis_.] + + [Illustration: Figure 8.--Syringe with metal plunger-pump. + _Top_, from original Arabic manuscript (Ali 2854), courtesy + Süleymaniye Umumi Kütüphanesi Müdürlü[)g]ü. _Bottom_, from + Channing, _Albucasis_.] + +Al-Zahr[=a]w[=i] frequently introduces his treatises with brief +instructive and sometimes informative preludes. However, in launching +the last treatise of _al-Ta[s.]r[=i]f_ he expounded in a most +interesting and illuminating manner the status of surgery during his +time. He also explains the reasons that forced him to write on this +topic and why he wished to include, as he did, precautions, advice, +instructional notes, and beautifully illustrated surgical drawings. For +example, the prelude to the treatise mentions four incidents that he +witnessed, all ending with tragic results because of the ignorance of +physicians who attempted to operate on patients without the proper +training in anatomy and surgical manipulation. "For if one does not have +the knowledge of anatomy," al-Zahr[=a]w[=i] protests, then "... he is +apt to fall in errors that lead to death as I have seen it happen to +many."[13] + +Al-Zahr[=a]w[=i] divides his surgical treatise into three sections +(abw[=a]b). In the first section (56 chapters)[14] he elaborates upon +the uses and disadvantages of cautery in general. And on the ground that +"fire touches only the ailing part ... without causing much damage to +surrounding area," as caustic medicine does, he prefers cautery by fire +(al-kay bi al-n[=a]r) to cautery by medicine (bi al-daw[=a]).[15] This, +he adds, "became clear to us through lifelong experience, diligent +practice, and thorough investigations of facts."[16] + + [Illustration: Figure 9.--Metal nose dropper. _Top_, from + original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Middle_, from Channing, + _Albucasis_ (_Smithsonian photo 46891-C_). _Bottom_, from + Sudhoff, _Chirurgie_, courtesy National Library of + Medicine.] + +He also proposes that instruments made of iron are more practical in +many ways than those made of gold, because often, when gold instruments +are put in fire, they either are not heated enough or are overheated, +causing the gold to melt. + + [Illustration: Figure 10.--Dental scrapers. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy Süleymaniye + Umumi Kütüphanesi Müdürlü[)g]ü. _Left_, from Argellata 1531, + courtesy National Library of Medicine. _Right_, from + Channing, _Albucasis_.] + +Al-Zahr[=a]w[=i] gently refutes the superstition that cautery is "good +only in springtime," and states that "under the right conditions of the +body’s humors it could be used in all seasons."[17] Although he +recommends cautery rather highly, he never minimizes the importance of +treatment by drugs. Actually, he encourages the use of drugs, before, +with, and after cauterization.[18] For example, in chapter 16 on "the +cauterization of eyelid when its hair grows reversedly into the eye," he +recommends treatment by cautery and by medicine. In cautery, the area +where fire is to be placed is marked with ink in the shape of a myrtle +leaf. In drug treatment, the caustic medicine is applied to the eyelid +over a paper in the shape of a myrtle leaf (fig. 2). + + [Illustration: Figure 11.--Dental forceps. _Top_, from + original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Leclerc, + _Abulcasis_.] + +In chapter 17 the author refers to an ancient method regarding cautery +of the fistula in the inner corner of the eye. After incising the +fistula, one "dirham" (derived from the Greek "drachma," which is equal +to about 2.97 grams)[19] of melted lead is poured into it through a fine +funnel used for cauterization (fig. 3). + + [Illustration: Figure 12.--Golden bridge to stabilize shaky + teeth. _Top_, from original Arabic manuscript (Tüb. MS. 91), + courtesy Universitätsbibliothek Tübingen. _Left_, from + Argellata 1531, courtesy National Library of Medicine. + _Right_, from Channing, _Albucasis_.] + +In like manner, al-Zahr[=a]w[=i] discusses cautery of the stomach and +the "cold liver" in chapters 26 and 27, respectively. The drawings +therein represent shapes of the burns on the skin (fig. 4) and marks of +ink to be drawn beneath the cartilage of the ribs (fig. 5) for the +purpose of spotting the area of operation. Here also he describes +carefully and clearly the methods of applying cautery and the types, +position, and number of tools employed in each case. He likewise depicts +(in chapter 45) instruments used in the treatment of hernia (fig. 6). + +The second section (b[=a]b), with about 99 chapters,[20] deals with +incision, puncturing, venesection, cupping, surgery on abscesses, and +the withdrawal of arrows from the body. Al-Zahr[=a]w[=i] warns that +ignorance in such operations may lead to damage of an artery or vein, +causing loss of blood "by which life is sustained."[21] Moreover, needle +and thread (more than one kind is mentioned) for the stitching of wounds +are repeatedly recommended. + +According to al-Zahr[=a]w[=i], foreign bodies that lodge in the ear +(chapter 6) are of four origins: (1) "mineral stones" or substances +resembling mineral stones such as iron and glass; (2) plant seeds +(chick-peas and beans); (3) liquids, such as water and vinegar; and (4) +animals, such as fleas. Several instruments are recommended for the +removal of such foreign bodies--fine tweezers shaped like a dropper +(fig. 7), a syringe with plunger-pump, and a tube made of silver or +copper (fig. 8). Also of interest to pharmacy and therapy is the advice +in regard to the use of lubricants to be applied before administering +these fine instruments into the body’s cavities. + +Chapter 24 is concerned with the treatment of the polypus that grows in +the nose. The various kinds (including cancer growth), shapes, and +colors of this type tumor and its treatment by surgery or medicine are +described. A hollowed nose-dropper made of metal in the shape of a small +kerosene lamp[22] is suggested (fig. 9). The dropper is held by its +handle while its contents are heated before use. Applying heat to nose +drops was probably proposed because it serves two purposes: it allows +easier flow of the "duhn," or the fatty substance used, and it raises +the temperature of the drops to that of the body. + +In his discussion on dental hygiene,[23] al-Zahr[=a]w[=i] describes +scrapers and dental forceps for teeth cleaning and extraction (figs. 10, +11) and brings in a few points of historical interest.[24] He warns of +the common error of extracting the adjacent healthy tooth instead of the +ailing one due to the patient’s sense deception. For a gargle he +prescribes salt water, vinegar, and wine (shar[=a]b). To stop hemorrhage +he used blue vitriol (al-z[=a]j)--copper sulfate in our modern +terminology. + +In chapter 33 al-Zahr[=a]w[=i] discusses bridge-making for the +consolidation of shaky teeth (fig. 12). He prefers the use of stable +gold over silver which, he says, putrifies and rots in a short time. In +a rational approach, he also suggests that the fallen tooth itself, or a +similar one shaped out of a cow’s bone, be installed and connected with +adjacent, stable teeth by a bridge. + +Now, turning to chapter 36, we find al-Zahr[=a]w[=i] describing a +knife-thin tongue depressor (fig. 13) that he used to facilitate the +examination of inflamed tonsils and other swellings of the throat; it +was made of silver or copper. And in chapter 37 (chapter 34 in Bes. +503), he describes the excision of an inflamed uvula by surgery. In the +same chapter, he also mentions the use of instruments made of steel. Of +pharmaceutical interest is the following free translation of the formula +he prescribes "as a milder treatment by fumigation ... to be resorted to +only when the swelling is subsiding":[25] + + Take pennyroyal [_Mentha pulegium_ Linn.], absinthe + [_Artemisia maritima_ Linn.], thyme, rue, hyssop, camomile, + abrotanum [_Artemisia abrotanum_ Linn.], and other similar + herbs. Put all in a casserole and cover them with vinegar. + Then close tightly with clay [_lutum-sapientiae_]--except + for a small hole in the middle of the cover--and boil. + Connect one end of a hollowed instrument, a crude form of an + inhaler [fig. 14], with the hole in the cover and insert the + other end, which contains the nozzle, into the patient’s + mouth, allowing the vapor to rise up to the uvula. And if + you are not able to secure this instrument, take a straw and + attach its end to an egg-shell. The egg-shell will prevent + burns in the patient’s mouth that might be caused by the + heated vapor. + + [Illustration: Figure 13.--Metal tongue depressor. _Top_, + from original Arabic manuscript (Ali 2854), courtesy + Süleymaniye Umumi Kütüphanesi Müdürlü[)g]ü._ Bottom_, from + Channing, _Albucasis_.] + + [Illustration: Figure 14.--Crude form of an inhaler. _Top_, + from original Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +Al-Zahr[=a]w[=i] repeats in chapter 53, on cancer, what Greek physicians +had said earlier, that cancer could be removed by surgery only at its +first stage and when found in a removable part of the body, such as the +breast. Therefore, he confesses that neither he nor any one else he knew +of ever applied surgery with success on advanced cancer.[26] + + [Illustration: Figure 15.--Metallic syringe for injecting + solutions into the bladder. _Top_, from original Arabic + manuscript (Bes. 503), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + + [Illustration: Figure 16.--Metallic or porcelain syringes + for injection of enemas. _Top_, from original Arabic + manuscript (Ali 2854), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + +Of special interest in chapter 59 is the metallic "syringe" (fig. 15) +used to inject medicinal solutions into the bladder: "The hollow passage +[of the syringe] should be exactly equal to the plunger it contains and +no more, so that when such fluids from an excess of humors are aspirated +they will be drawn out, and likewise when the solutions are injected +they will be pushed in easily." Such description of the use of a +"bladder syringe" in the late 10th century clearly points to the +practical and interesting approach to surgery in _al-Ta[s.]r[=i]f_. +Moreover, his description of the removal of a stone from the bladder--an +operation we now call lithotomy--is considered a contribution to bladder +surgery. + +One of the earliest recorded operations for the extractions of two dead +fetuses from the womb is clearly described in chapter 76. The account of +this case shows not only al-Zahr[=a]w[=i]’s intelligent approach as a +shrewd observer but also his clinical and surgical ability. + +Drawings of bulb-syringe instruments used for administering enemas in +ailments of the rectum and for the treatment of diarrhea and colic are +depicted in chapter 83. The text describes several kinds of syringes +made of silver, porcelain, and copper in various sizes (fig. 16). Of +particular interest is an illustration of a syringe, especially +recommended for children, to which a piece of leather (jildah) is +attached (fig. 17). This instrument is a precursor of our modern bulb +syringe. + +In chapter 84 al-Zahr[=a]w[=i] turns to the treatment of various wounds. +He prescribes the following powder formula for use: "Take olibanum +[frankincense] and dragon’s blood,[27] two parts of each, and three +parts of slaked or unslaked lime. Pound them well, pass through a sieve +and apply the powder to the wound." In cases of damaged blood vessels, +he tied the arteries by ligature, a practice of which he was a pioneer. +In another chapter he describes four methods for suturing the +intestines. + +Al-Zahr[=a]w[=i], being associated with war casualties and writing his +treatise about the end of the 10th century, no doubt had the experience +of dealing with cases involving injuries caused by arrows. The text in +chapter 94 discloses his observations in elaborate investigations +regarding the extraction of various kinds of arrows from the body.[28] +Accordingly, several kinds of hooks and forceps for removing arrows are +described and depicted in the treatise (see fig. 18). Al-Zahr[=a]w[=i]’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,[29] +notwithstanding the fact that Turkish bows and arrows were in common use +in the latter part of the 10th century. + + [Illustration: Figure 17.--A crude form of bulb syringe + recommended for use with children. _Top_, from original + Arabic manuscript (Ali 2854), courtesy Süleymaniye Umumi + Kütüphanesi Müdürlü[)g]ü. _Bottom_, from Leclerc, + _Abulcasis_.] + +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.[30] Evidently this is +an indication that he did not, as generally supposed, encourage the +widespread use of leeches. + + [Illustration: Figure 18.--Hooks and forceps used for the + extraction of arrows. _Top_, from original Arabic manuscript + (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. + _Bottom_, from Channing, _Albucasis_.] + + [Illustration: Figure 19.--Cupping. _Top_, from original + Arabic manuscript (Tüb. MS. 91), courtesy + Universitätsbibliothek Tübingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +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-Zahr[=a]w[=i]’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-Zahr[=a]w[=i]’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-Zahr[=a]w[=i] 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. + + [Illustration: Figure 20.--Splint "in the shape of a spoon + without a bowl." _Top_, from original Arabic manuscript + (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. + _Bottom_, from Channing, _Albucasis_.] + +Of interest to historians of medical therapy and pharmacy are the +recipes for poultices that al-Zahr[=a]w[=i] recommends for use over +fractured bones. For example, he gives the following recipe for one such +poultice: "Take the so-called 'mill’s dust' [ghub[=a]r al-rah[=a]], +which is the part of the wheat flour that clings to the walls of the +mill during grinding [lub[=a]b al-daq[=i]q], 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). + + [Illustration: Figure 21.--A splint to support the arm. + _Top_, from original Arabic manuscript (Cod. N.F. 476A), + courtesy Oesterreichische Nationalbibliothek. _Bottom_, from + Argellata 1531, courtesy National Library of Medicine.] + +The question arises as to whether al-Zahr[=a]w[=i] 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-Ta[s.]r[=i]f_--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-Zahr[=a]w[=i]’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-Ta[s.]r[=i]f_. + +In presenting his personal observations and original ideas on surgery +late in life, al-Zahr[=a]w[=i], 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-Zahr[=a]w[=i] 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-Ta[s.]r[=i]f_ al-Zahr[=a]w[=i] gave careful +attention to the importance of pharmaceutical preparations in the +healing art, including cases requiring surgery. + + + [1] George Sarton, _Introduction to the History of Science_, + Baltimore, 1927, vol. 1, p. 681. + + [2] Mohammad S. Abu Ganima, in _Abul-Kasim ein Forscher der + Arabischen Medizin_, Berlin, 1929, suggested that + description of operations in al-Maj[=u]s[=i]’s surgery is + clearer than that in al-Zahr[=a]w[=i]’s--a statement which + does not seem acceptable. + + [3] Max Neuburger, _Geschichte der Medizin_, Stuttgart, + 1911, vol. 2, pt. 1, pp. 178-179. + + [4] 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. + + [5] See the prelude to the treatise. + + [6] 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-Zahr[=a]w[=i] have been discovered + in medieval manuscripts. However, Garrison overlooked the + fact that al-Zahr[=a]w[=i]’s surgical illustrations were + mainly depicted for instructional purposes--a unique + approach. It should be noted also that al-Zahr[=a]w[=i] 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. + + [7] 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. + + [8] 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. + + [9] 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. + + [10] 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. + + [11] See Leclerc, _Abulcasis_, in introduction. + + [12] 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," "Be[s,]ir A[)g]a Nos. 502 and 503," + and "Veliyyudin No. 2491," all at Süleymaniye Umumi + Kütüphanesi Müdürlü[)g]ü, 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-Ta[s.]r[=i]f_, 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 "Me[s,]hur Arab Cerrahi + Elbülkasimi Zehravi ve onum Kitabül Cerrahiyesi," Istanbul, + 1935. See also Ünver, _[S,]erefeddin Sabuncuo[)g]lu: Kitabül + Cerrahiyei Illhaniye_, Istanbul, 1939, pp. [5]-7. + + + [13] 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-Zahr[=a]w[=i], + 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. + + [14] 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. + + [15] Al-Zahr[=a]w[=i] 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.). + + [16] Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v. + + [17] Al-Zahr[=a]w[=i] 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 [=a]khir + al-[t.]ibb." See Vel. 2491, fol. 106; and Bes. 502, fol. + 524r-525v. + + [18] For healing, soothing, or emollient purposes, + al-Zahw[=a]r[=i] suggested medications, such as egg white, + salt water (normal saline), sap of psyllium, several + ointments, "duhn" of rose, and other "adh[=a]n" (plural of + "duhn," the fatty or oily essences extracted from various + substances through pharmaceutical processes). + + [19] 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. + + [20] The contents of several manuscripts (such as Ali 2854, + Wien 476 A, Bes. 503, and Tüb. MS. 91) give different + numbers. + + [21] See, for example, Tüb. MS. 91, fol. 45v; and Bes. 502, + fol. 530v. + + [22] Sudhoff, _op. cit._ (footnote 10), p. 29, fig. 6. + + [23] 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. [169]-180 and 222-229. + + [24] 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-Zahr[=a]w[=i]’s work. + + [25] 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, _Tu[h.]fat + al-A[h.]b[=a]b, 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. + + [26] Tüb. MS. 91, fol. 99v. + + [27] 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. + + [28] 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. + + [29] Johannis Freind, _The History of Physick_, London, + 1726, vol. 2, p. 129. + + [30] In several manuscripts, the chapter on the use of + leeches is the last one in the second section of the + treatise. + + +U.S. GOVERNMENT PRINTING OFFICE: 1961 + +For sale by the Superintendent of Documents, U.S. Government Printing +Office Washington 25, D.C.-Price 20 cents + + + + + +End of the Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +*** END OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + +***** This file should be named 26038-8.txt or 26038-8.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/6/0/3/26038/ + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Drawings and Pharmacy in Al-Zahrawi's 10th-Century Surgical Treatise + +Author: Sami Hamarneh + +Release Date: July 24, 2008 [EBook #26038] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + + + + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + + +---------------------------------------------------------------------+ + | | + | TranscriberaEuro(TM)s note: | + | | + | Following table describes the meaning and the origin of | + | the characters enclosed in square brackets which do not | + | have their correspondents in the English Alphabet: | + | | + | [=a] letter a with a macron (straight line) above (Arabic) | + | [=i] letter i with a macron (straight line) above (Arabic) | + | [=u] letter u with a macron (straight line) above (Arabic) | + | [h.] letter h with a dot below (Arabic) | + | [s.] letter s with a dot below (Arabic) | + | [t.] letter t with a dot below (Arabic) | + | [T.] letter T with a dot below (Arabic) | + | [s,] letter s with a cedilla (comma-like symbol) below (Turkish) | + | [S,] letter S with a cedilla (comma-like symbol) below (Turkish) | + | [)g] letter g with a breve (u-shaped symbol) above (Turkish) | + | | + +---------------------------------------------------------------------+ + + + + + Drawings and Pharmacy in al-Zahr[=a]w[=i]aEuro(TM)s + 10th-Century Surgical Treatise + + _by Sami Hamarneh_ + + Paper 22, pages 81-94, from + + CONTRIBUTIONS FROM THE MUSEUM + OF HISTORY AND TECHNOLOGY + + UNITED STATES NATIONAL MUSEUM + BULLETIN 228 + + SMITHSONIAN INSTITUTION A. WASHINGTON, D.C., 1961 + + [Illustration: Figure 1.--Reproduction of a page from + original Arabic manuscript indexed as "Cod. N.F. 476A" at + Oesterreichische Nationalbibliothek in Vienna. Courtesy + Oesterreichische Nationalbibliothek.] + + + + +Drawings and Pharmacy in al-Zahr[=a]w[=i]aEuro(TM)s +10th-Century Surgical Treatise + +_by Sami Hamarneh_ + + +_Probably the earliest independent work in Arabic Spain to embrace the +whole of medical knowledge of the time is the encyclopedic al-Tasr[=i]f, +written in the late 10th century by Ab[=u] al-Q[=a]sim al-Zahr[=a]w[=i], +also known as Abulcasis. Consisting of 30 treatises, it is the only +known work of al-Zahr[=a]w[=i] and it brought him high prestige in the +western world._ + +_Here we are concerned only with his last treatise, on surgery. With its +many drawings of surgical instruments, intended for the instruction of +apprentices, its descriptions of formulas and medicinal preparations, +and its lucid observations on surgical procedures, this treatise is +perhaps the oldest of its kind._ + +_Scholars today have available a translation of the text and +reproductions of the drawings, but many of the latter are greatly +modified from the originals._ + +_This study reproduces examples of al-Zahr[=a]w[=i]aEuro(TM)s original +illustrations, compares some with early drawings based on them, and +comments on passages in the treatise of interest to students of pharmacy +and medical therapy._ + +THE AUTHOR: _Sami Hamarneh undertook this research into the history of +medicine in connection with his duties as associate curator of medical +sciences in the United States National Museum, Smithsonian Institution._ + + +THE INTRODUCTION OF THE WRITINGS of Ab[=u] al-Q[=a]sim Khalaf ibn +aEuro~Abb[=a]s al-Zahr[=a]w[=i]--better known as Abulcasis (d. ca. 1013)--to +Western Europe was through the Latin translation of his surgical +treatise (maq[=a]lah) by Gerard of Cremona (d. 1187).[1] The response to +this treatise, thereafter, was much greater than the attention paid to +the surgery of any of the three renowned physicians of the Eastern +Caliphate: al-R[=a]z[=i] (Latin, Rhazes, d. ca. 925), the greatest +clinician in Arabic medicine; al-Maj[=u]s[=i] (Haly Abb[=a]s, d. 994), +the author of the encyclopedic medical work, _al_-_Malak[=i]_;[2] and +Ibn S[=i]n[=a] (Avicenna, 980-1037), the author of the famous +_al-Q[=a]n[=u]n f[=i] al-[T.]ibb_, a codification of the whole of +medical knowledge. Because of the widespread dissemination of this Latin +version in medieval Europe beginning with the latter part of the 12th +century, al-Zahr[=a]w[=i] attained more prestige in the West than he did +in Arabic Spain, his native country, or in any other part of the Islamic +world.[3] + + [Illustration: Figure 2.--The myrtle-leaf shape recommended + for paper on which medicine is to be placed for cauterizing + eyelid. _Top_, from original Arabic manuscript (TA1/4b. MS. + 91), courtesy UniversitAtsbibliothek TA1/4bingen. _Bottom_, + from Channing, _Albucasis_.] + +The fame attached to this surgical treatise, the 30th and last in +al-Zahr[=a]w[=i]aEuro(TM)s encyclopedic work _al-Ta[s.]r[=i]f Liman aEuro~Ajiza +aEuro~an al-TaaEuro(TM)l[=i]f_, is founded on certain merits. The text is +characterized by lucidity, careful description, and a touch of +original observation of the surgical operations to which the treatise +as a whole is devoted.[4] Al-Zahr[=a]w[=i] furnishes his own drawings +of the surgical and dental instruments he used, devised, or +recommended for a more efficient performance. The illustrations were +intended to provide instructional material for apprentices--whom +al-Zahr[=a]w[=i] calls his children--as well as for the benefit of +those who would read the work later on.[5] The treatise is probably +the oldest one known today that contains such instructive surgical +illustrations and text.[6] + + [Illustration: Figure 3.--Small funnel for pouring heated + lead into fistula of the eye for cauterization. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy SA1/4leymaniye + Umumi KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Sudhoff, + _Chirurgie_, courtesy National Library of Medicine.] + + [Illustration: Figure 4.--Circular cauterization in stomach + ailments. _Top_, from original Arabic manuscript (TA1/4b. MS. + 91), courtesy UniversitAtsbibliothek TA1/4bingen. _Bottom_, + from the 1531 Latin edition of Pietro daEuro(TM)Argellata, + _Chirurgia Argellata cum Albucasis_, hereinafter cited as + Argellata 1531, courtesy National Library of Medicine.] + +This surgical treatise has been investigated, translated, and commented +upon by eminent historians of medicine and surgery to whose works I +shall refer in this article. However, the pharmaceutic and therapeutic +details of the treatise have been somewhat overlooked. + +As to the various illustrations of the surgical instruments (over 200 +figures in all), an almost complete representation of samples has been +introduced by Channing,[7] Leclerc,[8] Gurlt,[9] Sudhoff,[10] and +others. Nevertheless, a good number of the reproduced drawings are +greatly modified, most likely having been influenced by earlier +illustrations in several Latin and vernacular versions of the +treatise.[11] This becomes clearer on comparison with seven Arabic +manuscripts that have not been fully examined by Western scholars before +and that--in several instances--show more authentic drawings of +al-Zahr[=a]w[=i]aEuro(TM)s surgical instruments than any heretofore +published.[12] + + [Illustration: Figure 5.--Ink markings for identifying place + of cauterization. _Top_, from original Arabic manuscript + (Vel. 2491), courtesy SA1/4leymaniye Umumi KA1/4tA1/4phanesi + MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Argellata 1531, courtesy + National Library of Medicine.] + + [Illustration: Figure 6.--Cautery in hernia. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy SA1/4leymaniye + Umumi KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Leclerc, + _Albulcasis_.] + +This article therefore, is an attempt to present a sample of these +illustrations with brief comments regarding certain figures and passages +of interest to pharmacy and medical therapy. + +With much gratitude I express my indebtedness to Prof. G. Folch Jou of +Madrid, to Dr. A. SA1/4heyl Aoenver and Mr. H. Dener of Istanbul, and to the +librarians of the depository institutions for their cooperation in the +reproduction of the manuscripts on microfilm. + + [Illustration: Figure 7.--Fine tweezer for removing foreign + bodies from the ear. _Top_, from original Arabic manuscript + (Ali 2854), courtesy SA1/4leymaniye Umumi KA1/4tA1/4phanesi + MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Leclerc, _Abulcasis_.] + + [Illustration: Figure 8.--Syringe with metal plunger-pump. + _Top_, from original Arabic manuscript (Ali 2854), courtesy + SA1/4leymaniye Umumi KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from + Channing, _Albucasis_.] + +Al-Zahr[=a]w[=i] frequently introduces his treatises with brief +instructive and sometimes informative preludes. However, in launching +the last treatise of _al-Ta[s.]r[=i]f_ he expounded in a most +interesting and illuminating manner the status of surgery during his +time. He also explains the reasons that forced him to write on this +topic and why he wished to include, as he did, precautions, advice, +instructional notes, and beautifully illustrated surgical drawings. For +example, the prelude to the treatise mentions four incidents that he +witnessed, all ending with tragic results because of the ignorance of +physicians who attempted to operate on patients without the proper +training in anatomy and surgical manipulation. "For if one does not have +the knowledge of anatomy," al-Zahr[=a]w[=i] protests, then "... he is +apt to fall in errors that lead to death as I have seen it happen to +many."[13] + +Al-Zahr[=a]w[=i] divides his surgical treatise into three sections +(abw[=a]b). In the first section (56 chapters)[14] he elaborates upon +the uses and disadvantages of cautery in general. And on the ground that +"fire touches only the ailing part ... without causing much damage to +surrounding area," as caustic medicine does, he prefers cautery by fire +(al-kay bi al-n[=a]r) to cautery by medicine (bi al-daw[=a]).[15] This, +he adds, "became clear to us through lifelong experience, diligent +practice, and thorough investigations of facts."[16] + + [Illustration: Figure 9.--Metal nose dropper. _Top_, from + original Arabic manuscript (TA1/4b. MS. 91), courtesy + UniversitAtsbibliothek TA1/4bingen. _Middle_, from Channing, + _Albucasis_ (_Smithsonian photo 46891-C_). _Bottom_, from + Sudhoff, _Chirurgie_, courtesy National Library of + Medicine.] + +He also proposes that instruments made of iron are more practical in +many ways than those made of gold, because often, when gold instruments +are put in fire, they either are not heated enough or are overheated, +causing the gold to melt. + + [Illustration: Figure 10.--Dental scrapers. _Top_, from + original Arabic manuscript (Vel. 2491), courtesy SA1/4leymaniye + Umumi KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Left_, from Argellata 1531, + courtesy National Library of Medicine. _Right_, from + Channing, _Albucasis_.] + +Al-Zahr[=a]w[=i] gently refutes the superstition that cautery is "good +only in springtime," and states that "under the right conditions of the +bodyaEuro(TM)s humors it could be used in all seasons."[17] Although he +recommends cautery rather highly, he never minimizes the importance of +treatment by drugs. Actually, he encourages the use of drugs, before, +with, and after cauterization.[18] For example, in chapter 16 on "the +cauterization of eyelid when its hair grows reversedly into the eye," he +recommends treatment by cautery and by medicine. In cautery, the area +where fire is to be placed is marked with ink in the shape of a myrtle +leaf. In drug treatment, the caustic medicine is applied to the eyelid +over a paper in the shape of a myrtle leaf (fig. 2). + + [Illustration: Figure 11.--Dental forceps. _Top_, from + original Arabic manuscript (TA1/4b. MS. 91), courtesy + UniversitAtsbibliothek TA1/4bingen. _Bottom_, from Leclerc, + _Abulcasis_.] + +In chapter 17 the author refers to an ancient method regarding cautery +of the fistula in the inner corner of the eye. After incising the +fistula, one "dirham" (derived from the Greek "drachma," which is equal +to about 2.97 grams)[19] of melted lead is poured into it through a fine +funnel used for cauterization (fig. 3). + + [Illustration: Figure 12.--Golden bridge to stabilize shaky + teeth. _Top_, from original Arabic manuscript (TA1/4b. MS. 91), + courtesy UniversitAtsbibliothek TA1/4bingen. _Left_, from + Argellata 1531, courtesy National Library of Medicine. + _Right_, from Channing, _Albucasis_.] + +In like manner, al-Zahr[=a]w[=i] discusses cautery of the stomach and +the "cold liver" in chapters 26 and 27, respectively. The drawings +therein represent shapes of the burns on the skin (fig. 4) and marks of +ink to be drawn beneath the cartilage of the ribs (fig. 5) for the +purpose of spotting the area of operation. Here also he describes +carefully and clearly the methods of applying cautery and the types, +position, and number of tools employed in each case. He likewise depicts +(in chapter 45) instruments used in the treatment of hernia (fig. 6). + +The second section (b[=a]b), with about 99 chapters,[20] deals with +incision, puncturing, venesection, cupping, surgery on abscesses, and +the withdrawal of arrows from the body. Al-Zahr[=a]w[=i] warns that +ignorance in such operations may lead to damage of an artery or vein, +causing loss of blood "by which life is sustained."[21] Moreover, needle +and thread (more than one kind is mentioned) for the stitching of wounds +are repeatedly recommended. + +According to al-Zahr[=a]w[=i], foreign bodies that lodge in the ear +(chapter 6) are of four origins: (1) "mineral stones" or substances +resembling mineral stones such as iron and glass; (2) plant seeds +(chick-peas and beans); (3) liquids, such as water and vinegar; and (4) +animals, such as fleas. Several instruments are recommended for the +removal of such foreign bodies--fine tweezers shaped like a dropper +(fig. 7), a syringe with plunger-pump, and a tube made of silver or +copper (fig. 8). Also of interest to pharmacy and therapy is the advice +in regard to the use of lubricants to be applied before administering +these fine instruments into the bodyaEuro(TM)s cavities. + +Chapter 24 is concerned with the treatment of the polypus that grows in +the nose. The various kinds (including cancer growth), shapes, and +colors of this type tumor and its treatment by surgery or medicine are +described. A hollowed nose-dropper made of metal in the shape of a small +kerosene lamp[22] is suggested (fig. 9). The dropper is held by its +handle while its contents are heated before use. Applying heat to nose +drops was probably proposed because it serves two purposes: it allows +easier flow of the "duhn," or the fatty substance used, and it raises +the temperature of the drops to that of the body. + +In his discussion on dental hygiene,[23] al-Zahr[=a]w[=i] describes +scrapers and dental forceps for teeth cleaning and extraction (figs. 10, +11) and brings in a few points of historical interest.[24] He warns of +the common error of extracting the adjacent healthy tooth instead of the +ailing one due to the patientaEuro(TM)s sense deception. For a gargle he +prescribes salt water, vinegar, and wine (shar[=a]b). To stop hemorrhage +he used blue vitriol (al-z[=a]j)--copper sulfate in our modern +terminology. + +In chapter 33 al-Zahr[=a]w[=i] discusses bridge-making for the +consolidation of shaky teeth (fig. 12). He prefers the use of stable +gold over silver which, he says, putrifies and rots in a short time. In +a rational approach, he also suggests that the fallen tooth itself, or a +similar one shaped out of a cowaEuro(TM)s bone, be installed and connected with +adjacent, stable teeth by a bridge. + +Now, turning to chapter 36, we find al-Zahr[=a]w[=i] describing a +knife-thin tongue depressor (fig. 13) that he used to facilitate the +examination of inflamed tonsils and other swellings of the throat; it +was made of silver or copper. And in chapter 37 (chapter 34 in Bes. +503), he describes the excision of an inflamed uvula by surgery. In the +same chapter, he also mentions the use of instruments made of steel. Of +pharmaceutical interest is the following free translation of the formula +he prescribes "as a milder treatment by fumigation ... to be resorted to +only when the swelling is subsiding":[25] + + Take pennyroyal [_Mentha pulegium_ Linn.], absinthe + [_Artemisia maritima_ Linn.], thyme, rue, hyssop, camomile, + abrotanum [_Artemisia abrotanum_ Linn.], and other similar + herbs. Put all in a casserole and cover them with vinegar. + Then close tightly with clay [_lutum-sapientiae_]--except + for a small hole in the middle of the cover--and boil. + Connect one end of a hollowed instrument, a crude form of an + inhaler [fig. 14], with the hole in the cover and insert the + other end, which contains the nozzle, into the patientaEuro(TM)s + mouth, allowing the vapor to rise up to the uvula. And if + you are not able to secure this instrument, take a straw and + attach its end to an egg-shell. The egg-shell will prevent + burns in the patientaEuro(TM)s mouth that might be caused by the + heated vapor. + + [Illustration: Figure 13.--Metal tongue depressor. _Top_, + from original Arabic manuscript (Ali 2854), courtesy + SA1/4leymaniye Umumi KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4._ Bottom_, from + Channing, _Albucasis_.] + + [Illustration: Figure 14.--Crude form of an inhaler. _Top_, + from original Arabic manuscript (TA1/4b. MS. 91), courtesy + UniversitAtsbibliothek TA1/4bingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +Al-Zahr[=a]w[=i] repeats in chapter 53, on cancer, what Greek physicians +had said earlier, that cancer could be removed by surgery only at its +first stage and when found in a removable part of the body, such as the +breast. Therefore, he confesses that neither he nor any one else he knew +of ever applied surgery with success on advanced cancer.[26] + + [Illustration: Figure 15.--Metallic syringe for injecting + solutions into the bladder. _Top_, from original Arabic + manuscript (Bes. 503), courtesy SA1/4leymaniye Umumi + KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + + [Illustration: Figure 16.--Metallic or porcelain syringes + for injection of enemas. _Top_, from original Arabic + manuscript (Ali 2854), courtesy SA1/4leymaniye Umumi + KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Argellata 1531, + courtesy National Library of Medicine.] + +Of special interest in chapter 59 is the metallic "syringe" (fig. 15) +used to inject medicinal solutions into the bladder: "The hollow passage +[of the syringe] should be exactly equal to the plunger it contains and +no more, so that when such fluids from an excess of humors are aspirated +they will be drawn out, and likewise when the solutions are injected +they will be pushed in easily." Such description of the use of a +"bladder syringe" in the late 10th century clearly points to the +practical and interesting approach to surgery in _al-Ta[s.]r[=i]f_. +Moreover, his description of the removal of a stone from the bladder--an +operation we now call lithotomy--is considered a contribution to bladder +surgery. + +One of the earliest recorded operations for the extractions of two dead +fetuses from the womb is clearly described in chapter 76. The account of +this case shows not only al-Zahr[=a]w[=i]aEuro(TM)s intelligent approach as a +shrewd observer but also his clinical and surgical ability. + +Drawings of bulb-syringe instruments used for administering enemas in +ailments of the rectum and for the treatment of diarrhea and colic are +depicted in chapter 83. The text describes several kinds of syringes +made of silver, porcelain, and copper in various sizes (fig. 16). Of +particular interest is an illustration of a syringe, especially +recommended for children, to which a piece of leather (jildah) is +attached (fig. 17). This instrument is a precursor of our modern bulb +syringe. + +In chapter 84 al-Zahr[=a]w[=i] turns to the treatment of various wounds. +He prescribes the following powder formula for use: "Take olibanum +[frankincense] and dragonaEuro(TM)s blood,[27] two parts of each, and three +parts of slaked or unslaked lime. Pound them well, pass through a sieve +and apply the powder to the wound." In cases of damaged blood vessels, +he tied the arteries by ligature, a practice of which he was a pioneer. +In another chapter he describes four methods for suturing the +intestines. + +Al-Zahr[=a]w[=i], being associated with war casualties and writing his +treatise about the end of the 10th century, no doubt had the experience +of dealing with cases involving injuries caused by arrows. The text in +chapter 94 discloses his observations in elaborate investigations +regarding the extraction of various kinds of arrows from the body.[28] +Accordingly, several kinds of hooks and forceps for removing arrows are +described and depicted in the treatise (see fig. 18). Al-Zahr[=a]w[=i]aEuro(TM)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,[29] +notwithstanding the fact that Turkish bows and arrows were in common use +in the latter part of the 10th century. + + [Illustration: Figure 17.--A crude form of bulb syringe + recommended for use with children. _Top_, from original + Arabic manuscript (Ali 2854), courtesy SA1/4leymaniye Umumi + KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4. _Bottom_, from Leclerc, + _Abulcasis_.] + +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.[30] Evidently this is +an indication that he did not, as generally supposed, encourage the +widespread use of leeches. + + [Illustration: Figure 18.--Hooks and forceps used for the + extraction of arrows. _Top_, from original Arabic manuscript + (TA1/4b. MS. 91), courtesy UniversitAtsbibliothek TA1/4bingen. + _Bottom_, from Channing, _Albucasis_.] + + [Illustration: Figure 19.--Cupping. _Top_, from original + Arabic manuscript (TA1/4b. MS. 91), courtesy + UniversitAtsbibliothek TA1/4bingen. _Bottom_, from Argellata + 1531, courtesy National Library of Medicine.] + +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-Zahr[=a]w[=i]aEuro(TM)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-Zahr[=a]w[=i]aEuro(TM)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-Zahr[=a]w[=i] 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. + + [Illustration: Figure 20.--Splint "in the shape of a spoon + without a bowl." _Top_, from original Arabic manuscript + (TA1/4b. MS. 91), courtesy UniversitAtsbibliothek TA1/4bingen. + _Bottom_, from Channing, _Albucasis_.] + +Of interest to historians of medical therapy and pharmacy are the +recipes for poultices that al-Zahr[=a]w[=i] recommends for use over +fractured bones. For example, he gives the following recipe for one such +poultice: "Take the so-called 'millaEuro(TM)s dust' [ghub[=a]r al-rah[=a]], +which is the part of the wheat flour that clings to the walls of the +mill during grinding [lub[=a]b al-daq[=i]q], 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). + + [Illustration: Figure 21.--A splint to support the arm. + _Top_, from original Arabic manuscript (Cod. N.F. 476A), + courtesy Oesterreichische Nationalbibliothek. _Bottom_, from + Argellata 1531, courtesy National Library of Medicine.] + +The question arises as to whether al-Zahr[=a]w[=i] 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-Ta[s.]r[=i]f_--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-Zahr[=a]w[=i]aEuro(TM)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-Ta[s.]r[=i]f_. + +In presenting his personal observations and original ideas on surgery +late in life, al-Zahr[=a]w[=i], 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-Zahr[=a]w[=i] 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-Ta[s.]r[=i]f_ al-Zahr[=a]w[=i] gave careful +attention to the importance of pharmaceutical preparations in the +healing art, including cases requiring surgery. + + + [1] George Sarton, _Introduction to the History of Science_, + Baltimore, 1927, vol. 1, p. 681. + + [2] Mohammad S. Abu Ganima, in _Abul-Kasim ein Forscher der + Arabischen Medizin_, Berlin, 1929, suggested that + description of operations in al-Maj[=u]s[=i]aEuro(TM)s surgery is + clearer than that in al-Zahr[=a]w[=i]aEuro(TM)s--a statement which + does not seem acceptable. + + [3] Max Neuburger, _Geschichte der Medizin_, Stuttgart, + 1911, vol. 2, pt. 1, pp. 178-179. + + [4] 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. + + [5] See the prelude to the treatise. + + [6] 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-Zahr[=a]w[=i] have been discovered + in medieval manuscripts. However, Garrison overlooked the + fact that al-Zahr[=a]w[=i]aEuro(TM)s surgical illustrations were + mainly depicted for instructional purposes--a unique + approach. It should be noted also that al-Zahr[=a]w[=i] 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. + + [7] 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 ChanningaEuro(TM)s edition + are of special interest. + + [8] Lucien Leclerc, _La Chirurgie daEuro(TM)Abulcasis_, Paris, 1861 + (hereinafter referred to as Leclerc, _Abulcasis_). This + excellent French version was first published in a series of + articles in _Gazette MA(C)dicale de laEuro(TM)AlgA(C)rie_, and seems + influenced by ChanningaEuro(TM)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 LeclercaEuro(TM)s monumental + work, _Histoire de la MA(C)decine Arabe_, Paris, 1876, vol. 1, + pp. 453-457. + + [9] Ernst Gurlt, _Geschichte der Chirurgie und ihrer + AusA1/4bung Volkschirurgie-Alterthum-Mittelalter-Renaissance_, + Berlin, 1898, vol. 1, pp. 620-649, with more than 100 + figures. In the text and illustrations, Gurlt relied upon + LeclercaEuro(TM)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. + + [10] Karl Sudhoff, _BeitrAge 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. + + [11] See Leclerc, _Abulcasis_, in introduction. + + [12] The seven Arabic manuscripts are indexed as "Berlin MS. + Or. fol. 91," temporarily at UniversitAtsbibliothek + TA1/4bingen, 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," "Be[s,]ir A[)g]a Nos. 502 and 503," + and "Veliyyudin No. 2491," all at SA1/4leymaniye Umumi + KA1/4tA1/4phanesi MA1/4dA1/4rlA1/4[)g]A1/4, in Istanbul. Hereinafter these + manuscripts are referred to, respectively, as TA1/4b. 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-Ta[s.]r[=i]f_, 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. Aoenver and + HA1/4seyin Usman in an extract titled "Me[s,]hur Arab Cerrahi + ElbA1/4lkasimi Zehravi ve onum KitabA1/4l Cerrahiyesi," Istanbul, + 1935. See also Aoenver, _[S,]erefeddin Sabuncuo[)g]lu: KitabA1/4l + Cerrahiyei Illhaniye_, Istanbul, 1939, pp. [5]-7. + + + [13] 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-Zahr[=a]w[=i], + 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. + + [14] There are 56 chapters listed in almost all manuscripts + and commentary works I checked except TA1/4b. MS. 91 and Esc. + 876, where only 55 chapters are listed. + + [15] Al-Zahr[=a]w[=i] 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.). + + [16] Vel. 2491, fol. 106; Bes. 502, fol. 523r-524v. + + [17] Al-Zahr[=a]w[=i] 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 physicianaEuro(TM)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 [=a]khir + al-[t.]ibb." See Vel. 2491, fol. 106; and Bes. 502, fol. + 524r-525v. + + [18] For healing, soothing, or emollient purposes, + al-Zahw[=a]r[=i] suggested medications, such as egg white, + salt water (normal saline), sap of psyllium, several + ointments, "duhn" of rose, and other "adh[=a]n" (plural of + "duhn," the fatty or oily essences extracted from various + substances through pharmaceutical processes). + + [19] 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. + + [20] The contents of several manuscripts (such as Ali 2854, + Wien 476 A, Bes. 503, and TA1/4b. MS. 91) give different + numbers. + + [21] See, for example, TA1/4b. MS. 91, fol. 45v; and Bes. 502, + fol. 530v. + + [22] Sudhoff, _op. cit._ (footnote 10), p. 29, fig. 6. + + [23] For a more detailed and interesting discussion with + beautiful illustrations included, the reader may consult Ch. + Niel, "La Chirurgie Dentaire DaEuro(TM)Abulcasis ComparA(C)e a celle + des Maures du Trarza," _Revue de Stematologie_, April 1911, + vol. 18, pp. [169]-180 and 222-229. + + [24] 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-Zahr[=a]w[=i]aEuro(TM)s work. + + [25] 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, _Tu[h.]fat + al-A[h.]b[=a]b, Glossaire de la MatiA"re MA(C)dicale Marocaine_, + Paris, 1934, pp. 133, 143, 193-194, and Max Meyerhof, _Un + Glossaire de MatiA"re MA(C)dicale ComposA(C) par Maimonide_, Cairo, + 1940, pp. 168-169. + + [26] TA1/4b. MS. 91, fol. 99v. + + [27] DragonaEuro(TM)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. + + [28] Heinrich FrAlich, "Abul-Kasem als Kriegschirurg," + _Archiv fA1/4r klinische Chirurgie_, 1884, vol. 30, pp. + 365-376. This well-presented study was reviewed by Paul + Schede in _Centralblatt fA1/4r Chirurgie_, 1884, no. 38, pp. + 626-627. + + [29] Johannis Freind, _The History of Physick_, London, + 1726, vol. 2, p. 129. + + [30] In several manuscripts, the chapter on the use of + leeches is the last one in the second section of the + treatise. + + +U.S. GOVERNMENT PRINTING OFFICE: 1961 + +For sale by the Superintendent of Documents, U.S. Government Printing +Office Washington 25, D.C.-Price 20 cents + + + + + +End of the Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's +10th-Century Surgical Treatise, by Sami Hamarneh + +*** END OF THIS PROJECT GUTENBERG EBOOK DRAWINGS AND PHARMACY *** + +***** This file should be named 26038.txt or 26038.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/6/0/3/26038/ + +Produced by Chris Curnow, Turgut Dincer, Joseph Cooper and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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