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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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