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+<title>Drawings and Pharmacy in al-Zahr&#257;w&#299;&#8217;s 10th-Century Surgical Treatise by Sami Hamarneh</title>
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+<pre>
+
+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
+
+
+
+
+
+
+</pre>
+
+<h1>&nbsp;</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-Zahr&#257;w&#299;&#8217;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.&mdash;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-Zahr&#257;w&#299;&#8217;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-Tasr&#299;f,
+<i>written in the late 10th century by Ab&#363; al-Q&#257;sim al-Zahr&#257;w&#299;,
+also known as Abulcasis. Consisting of 30 treatises, it is
+the only known work of al-Zahr&#257;w&#299; 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-Zahr&#257;w&#299;&#8217;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 Ab&#363; al-Q&#257;sim Khalaf ibn &#699;Abb&#257;s
+al-Zahr&#257;w&#299;&mdash;better known as Abulcasis (d.
+ca. 1013)&mdash;to Western Europe was through the
+Latin translation of his surgical treatise (maq&#257;lah)
+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-R&#257;z&#299;
+(Latin, Rhazes, d. ca. 925), the greatest clinician
+in Arabic medicine; al-Maj&#363;s&#299; (Haly Abb&#257;s, d. 994),
+the author of the encyclopedic medical work, <i>al</i>-<i>Malak&#299;</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 S&#299;n&#257; (Avicenna, 980-1037), the
+author of the famous <i>al-Q&#257;n&#363;n f&#299; al-&#7788;ibb</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-Zahr&#257;w&#299; 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.&mdash;The myrtle-leaf shape recommended for paper on which medicine is to be
+placed for cauterizing eyelid. <i>Top</i>, from original Arabic manuscript (T&uuml;b. MS. 91),
+courtesy Universit&auml;tsbibliothek T&uuml;bingen. <i>Bottom</i>, from Channing, <i>Albucasis</i></p></div>
+
+<p>The fame attached to this surgical treatise, the 30th
+and last in al-Zahr&#257;w&#299;&#8217;s encyclopedic work <i>al-Ta&#7779;r&#299;f
+Liman &#699;Ajiza &#699;an al-Ta&#700; l&#299;f</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-Zahr&#257;w&#299; 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&mdash;whom al-Zahr&#257;w&#299; calls his
+children&mdash;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.&mdash;Small funnel for pouring heated
+lead into fistula of the eye for cauterization.
+<i>Top</i>, from original Arabic manuscript (Vel.
+2491), courtesy S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi
+M&uuml;d&uuml;rl&uuml;&#287;&uuml;. <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
+(T&uuml;b. MS. 91), courtesy Universit&auml;tsbibliothek
+T&uuml;bingen. <i>Bottom</i>, from the
+1531 Latin edition of Pietro d&#8217;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&mdash;in several instances&mdash;show
+more authentic drawings of al-Zahr&#257;w&#299;&#8217;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 S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi.
+<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.&mdash;Cautery in hernia. <i>Top</i>, from
+original Arabic manuscript (Vel. 2491),
+courtesy S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi
+M&uuml;d&uuml;rl&uuml;&#287;&uuml;. <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. S&uuml;heyl &Uuml;nver
+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.&mdash;Fine tweezer for removing foreign
+bodies from the ear. <i>Top</i>, from original
+Arabic manuscript (Ali 2854), courtesy
+S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi M&uuml;d&uuml;rl&uuml;&#287;&uuml;.
+<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 S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi M&uuml;d&uuml;rl&uuml;&#287;&uuml;. <i>Bottom</i>, from
+Channing, <i>Albucasis</i>.</p></div>
+
+<p><span class='pagenum'>87</span>Al-Zahr&#257;w&#299; frequently introduces his treatises with
+brief instructive and sometimes informative preludes.
+However, in launching the last treatise of <i>al-Ta&#7779;r&#299;f</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-Zahr&#257;w&#299; 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-Zahr&#257;w&#299; divides his surgical treatise into three
+sections (abw&#257;b). 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-n&#257;r)
+to cautery by medicine (bi al-daw&#257;).<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.&mdash;Metal nose dropper. <i>Top</i>, from
+original Arabic manuscript (T&uuml;b. MS. 91),
+courtesy Universit&auml;tsbibliothek T&uuml;bingen.
+<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.&mdash;Dental scrapers. <i>Top</i>, from original
+Arabic manuscript (Vel. 2491), courtesy
+S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi M&uuml;d&uuml;rl&uuml;&#287;&uuml;.
+<i>Left</i>, from Argellata 1531, courtesy
+National Library of Medicine. <i>Right</i>, from
+Channing, <i>Albucasis</i>.</p></div>
+
+<p>Al-Zahr&#257;w&#299; gently refutes the superstition that
+cautery is "good only in springtime," and states that
+under the right conditions of the body&#8217;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.&mdash;Dental forceps. <i>Top</i>, from original
+Arabic manuscript (T&uuml;b. MS. 91), courtesy
+Universit&auml;tsbibliothek T&uuml;bingen. <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.&mdash;Golden bridge to stabilize shaky teeth. <i>Top</i>, from original Arabic manuscript
+(T&uuml;b. MS. 91), courtesy Universit&auml;tsbibliothek T&uuml;bingen. <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-Zahr&#257;w&#299; 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 (b&#257;b), 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-Zahr&#257;w&#299; 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-Zahr&#257;w&#299;, 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&mdash;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&#8217;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-Zahr&#257;w&#299;
+<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&#8217;s sense deception. For a
+gargle he prescribes salt water, vinegar, and wine
+(shar&#257;b). To stop hemorrhage he used blue vitriol
+(al-z&#257;j)&mdash;copper sulfate in our modern terminology.</p>
+
+<p>In chapter 33 al-Zahr&#257;w&#299; 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&#8217;s bone, be installed
+and connected with adjacent, stable teeth by a bridge.</p>
+
+<p>Now, turning to chapter 36, we find al-Zahr&#257;w&#299;
+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>]&mdash;except for a
+small hole in the middle of the cover&mdash;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&#8217;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&#8217;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.&mdash;Metal tongue depressor. <i>Top</i>,
+from original Arabic manuscript (Ali 2854),
+courtesy S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi
+M&uuml;d&uuml;rl&uuml;&#287;&uuml;.<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.&mdash;Crude form of an inhaler. <i>Top</i>,
+from original Arabic manuscript (T&uuml;b. MS.
+91), courtesy Universit&auml;tsbibliothek T&uuml;bingen.
+<i>Bottom</i>, from Argellata 1531, courtesy
+National Library of Medicine.</p></div>
+
+<p>Al-Zahr&#257;w&#299; 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
+S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi M&uuml;d&uuml;rl&uuml;&#287;&uuml;.
+<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.&mdash;Metallic or porcelain syringes for
+injection of enemas. <i>Top</i>, from original
+Arabic manuscript (Ali 2854), courtesy
+S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi M&uuml;d&uuml;rl&uuml;&#287;&uuml;.
+<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-Ta&#7779;r&#299;f</i>. Moreover, his description of the
+removal of a stone from the bladder&mdash;an operation
+we now call lithotomy&mdash;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-Zahr&#257;w&#299;&#8217;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-Zahr&#257;w&#299; turns to the treatment
+of various wounds. He prescribes the following
+powder formula for use: "Take olibanum [frankincense]
+and dragon&#8217;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-Zahr&#257;w&#299;, 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-Zahr&#257;w&#299;&#8217;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.&mdash;A crude form of bulb syringe
+recommended for use with children. <i>Top</i>,
+from original Arabic manuscript (Ali 2854),
+courtesy S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi
+M&uuml;d&uuml;rl&uuml;&#287;&uuml;. <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.&mdash;Hooks and forceps used for the
+extraction of arrows. <i>Top</i>, from original
+Arabic manuscript (T&uuml;b. MS. 91), courtesy
+Universit&auml;tsbibliothek T&uuml;bingen. <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.&mdash;Cupping. <i>Top</i>, from original
+Arabic manuscript (T&uuml;b. MS. 91), courtesy
+Universit&auml;tsbibliothek T&uuml;bingen. <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-Zahr&#257;w&#299;&#8217;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-Zahr&#257;w&#299;&#8217;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&#257;w&#299;
+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.&mdash;Splint "in the shape of a spoon
+without a bowl." <i>Top</i>, from original Arabic
+manuscript (T&uuml;b. MS. 91), courtesy Universit&auml;tsbibliothek
+T&uuml;bingen. <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-Zahr&#257;w&#299;
+recommends for use over fractured bones. For example,
+he gives the following recipe for one such
+poultice: "Take the so-called 'mill&#8217;s dust' [ghub&#257;r
+al-rah&#257;], which is the part of the wheat flour that
+clings to the walls of the mill during grinding [lub&#257;b
+al-daq&#299;q], 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.&mdash;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-Zahr&#257;w&#299; 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-Ta&#7779;r&#299;f</i>&mdash;his only known
+writings&mdash;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&#257;w&#299;&#8217;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-Ta&#7779;r&#299;f</i>.</p>
+
+<p>In presenting his personal observations and original
+ideas on surgery late in life, al-Zahr&#257;w&#299;, 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-Zahr&#257;w&#299; 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&mdash;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-Ta&#7779;r&#299;f</i> al-Zahr&#257;w&#299; 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-Maj&#363;s&#299;&#8217;s surgery is clearer than that in al-Zahr&#257;w&#299;&#8217;s&mdash;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-Zahr&#257;w&#299; have been discovered in medieval manuscripts.
+However, Garrison overlooked the fact that al-Zahr&#257;w&#299;&#8217;s
+surgical illustrations were mainly depicted for instructional
+purposes&mdash;a unique approach. It should be noted also that
+al-Zahr&#257;w&#299; 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&#8217;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&#8217;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
+M&eacute;dicale de l&#8217;Alg&eacute;rie</i>, and seems influenced by Channing&#8217;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&#8217;s monumental work, <i>Histoire de la M&eacute;decine 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 Aus&uuml;bung
+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&#8217;s translation and modified
+drawings of the surgical instruments; nevertheless, he
+presents a brief, systematic study&mdash;probably the best so far&mdash;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>Beitr&auml;ge 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 Universit&auml;tsbibliothek T&uuml;bingen,
+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&#537;ir
+A&#287;a Nos. 502 and 503," and "Veliyyudin No. 2491," all at
+S&uuml;leymaniye Umumi K&uuml;t&uuml;phanesi M&uuml;d&uuml;rl&uuml;&#287;&uuml;, in Istanbul.
+Hereinafter these manuscripts are referred to, respectively, as
+T&uuml;b. 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-Ta&#7779;r&#299;f</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. &Uuml;nver and H&uuml;seyin Usman in an extract
+titled "Me&#537;hur Arab Cerrahi Elb&uuml;lkasimi Zehravi ve onun Kitab&uuml;l
+Cerrahiyesi," Istanbul, 1935. See also &Uuml;nver, <i>Serefeddin
+Sabuncuo&#287;lu: Kitab&uuml;l 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-Zahr&#257;w&#299;, 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 T&uuml;b. 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-Zahr&#257;w&#299; 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-Zahr&#257;w&#299; 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&#8217;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&mdash;"al-kay
+&#257;khir al-&#7788;ibb." 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-Zahw&#257;r&#299;
+suggested medications, such as egg white, salt water (normal
+saline), sap of psyllium, several ointments, "duhn" of rose, and
+other "adh&#257;n" (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 T&uuml;b. 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, T&uuml;b. 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&#8217;Abulcasis Compar&eacute;e 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-Zahr&#257;w&#299;&#8217;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>Tu&#7717;fat al-A&#7717;b&#257;b, Glossaire de la Mati&egrave;re
+M&eacute;dicale Marocaine</i>, Paris, 1934, pp. 133, 143, 193-194, and
+Max Meyerhof, <i>Un Glossaire de Mati&egrave;re M&eacute;dicale Compos&eacute; 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> T&uuml;b. 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&#8217;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 Fr&ouml;lich, "Abul-Kasem als Kriegschirurg," <i>Archiv
+f&uuml;r klinische Chirurgie</i>, 1884, vol. 30, pp. 365-376. This well-presented
+study was reviewed by Paul Schede in <i>Centralblatt
+f&uuml;r 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. C.&mdash;Price 20 cents</p>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of Drawings and Pharmacy in Al-Zahrawi's
+10th-Century Surgical Treatise, by Sami Hamarneh
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