See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/289991697

Alzahravi: Jewel of "the jewel of the world"

Article · April 2011

CITATIONS READS
0 1,106

1 author:

Muhammad Abid Bashir

King Abdulaziz University
19 PUBLICATIONS   31 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Muhammad Abid Bashir on 11 January 2016.

The user has requested enhancement of the downloaded file.

 M. Abid Bashir
Faisalabad, Pakistan
Heritage
Al Zahrawi: Jewel of the
“Jewel of the World”
T he story of Al-Aundulas or
Moorish Spain is both a tale of
inspiration and depression. Under
the Muslim rule, Iberian Peninsula
experienced a remarkable cultural
advancement, far ahead of rest of
the Europe. The capital city of
Qartaba became a leading center
of cultural and scientific activity
attracting scholars and artists from
all over the world. In the days of
Abdul Rehman the third, a nun gave
Qartaba the title of “the jewel of the
world”. A new capital was construc-
ted by the name of Alzahra six
kilometer from Qartaba. This for-
gotten treasure and masterpiece of
Muslim architecture, destroyed by
Berbers only 80 years after its
construction, is more readily
remembered by its famous scientist,
“without doubt chief of all surg-
eons” as Pietro Argallata calls him,
Abu al-Qasim Khalaf ibn al-Abbas
Al-Zahrawi.
Al Zahrawi is also known as Zahra-
vius or Albucasis in the west. He was
born around 930 AD and was
descendant of Ansaar of Madinah.
He did not travel much but his work
in different fields of medicine is of
tremendous value. His book “Al
Tasreef Leman Aijaz al Ta'lif” is
recognized as encyclo-pedia of
clinical sciences. It was completed
around 1000 AD and remained a
standard text book for next 800
years all over the world.
104 April to June, 2010
IR-048
Al Tasreef is a large encyclopedia
comprising of 30 volumes. Its last
volume is dedicated to surgery. Al-
Zahrawi is considered as the
pioneer of modern surgery. He was
frustrated by the pathetic condition
of surgery at that time and attrib-
uted it to lack of knowledge of
anatomy.1-3
He stressed the importance of basic
sciences:
“... Before practicing, one should be
familiar with the science of anatomy
and the functions of organs so that
he will understand them, recognize
their shape, understand their
connections, and know their
borders. Also he should know the
bones, nerves, and muscles, their
numbers, their origin and insertions,
the arteries and the veins, their start
and end. These anatomical and
physiological bases are important. If
one does not comprehend the
anatomy and physiology, he may
commit a mistake that can kill the
patient.”
He not only explained various
surgical procedures in his book, but
also pioneered many operations.
He described about 200 instru-
ments in detail regarding their
shape, structure and uses. Most of
these instruments were invented by
him and many are being used even
INDEPENDENT REVIEWS
today but under various western
names (intellectual copyrights is
only valid if it suits Americans). It is
because of him that surgery
became a scientific art instead of a
practice left to butchers.
He contributed to almost every
branch of surgery; from ENT and
ophthalmology to Orthopedics,
Gynecology, Urology, Spinal and
Plastic surgery. He was one of the
first surgeons to describe hydro-
cephalus, surgical treatment of
head injuries & skull fractures,
spinal injuries and subdural
effusions4,5. The use of catgut as
absorbable sutures is probably one
of the most significant advance-
5 2
ments in the history of surgery.
Surgical needles, syringe, lithotrite,
otoscope, vaginal speculum, stone
holding forceps, tonsillectomy
guillotine, trocar, concealed knife
and plaster cast are few other
important surgical inventions by
AlZahrawi.
He pioneered so many procedures
that one wonders how a single
person can contribute so much in
brief life span of 77 years. He
described hemophilia, stripping of
varicose veins, ligation of blood
vessels and Walchar's position for
obstetrics for the first time.
He operated for goiter nine centu-
ries before any further progress in
the field of thyroid surgery at the
hands of Halstead who acknowl-
edged his debt to al-Zahrawi and
Kocher6. Even Kocher's method for
April to June, 2010 INDEPENDENT
reduction of dislocated shoulder
was described in AlTasreef centuries
before even forefathers of Kocher
2
were born .
He made numerous contributions
to dental surgery. He described
referred pain and warned the
surgeons against extracting normal
tooth with referred pain. He was first
to use dental prosthesis made of
cow bone as improvement over
what even after 700 years the first
American president George Some of the instruments
invented by Al-zahrawi
Washington used (wooden den-
2
tures) . He was also first to use
cotton (from the Arabic word
“katan”) for dressing, control of
hemorrhage, padding under splints
and vaginal and dental swabs .
In plastic surgery, he was the first to
use ink to mark the incisions before
surgery which is still practiced by
modern plastic surgeons. He
advocated removal of glandular
tissue as well as skin by making “two
incisions” (elliptical incision) for
reduction mammoplasty 7 . He
described C-shaped incision for
gynecomastia still practised today8.
He explained the difference bet-
ween primary and secondary
wound closure and also the impor-
tance of wound debridement befo-
8
re closure .
In spinal surgery, his methods were
rather dangerous dealing with
fractured vertebrae but he recog-
nized spinal injury with flaccid limbs
and involuntary actions (fecal and
A page from Al-Tasreef
urinary incontinence) as terminal
REVIEWS 105
 and incurable as compared to
partial injuries8. He advocated
removal of bone fragments from
the fractured vertebra4 to avoid
injury to cord by these fragments
and stenosis of canal is rather
genius at his time when aseptic
fixation was not possible, although
it is not practised nowadays.
He described aneurysm 1000 years
ago and warned against its incision
for a misdiagnosed abscess. His
Instruments by Al-Zahrawi description is so close to what is
known today. He writes;
A page from Al-Tasreef
106 April to June, 2010
He described inguinal hernia,
differentiated between direct and
indirect hernia and described
omentocele and enterocele. He
also mentioned obstructed and
incarcerated hernia. His operative
technique closely resembles
modern herniotomy except that
orchiectomy is not routinely done
now.
In his book tapping of ascites with a
pointed scalpel and canula through
a vulvular incision and the use of
warm water sponge to facilitate
bowel reduction into the peritoneal
cavity in abdominal wounds is also
mentioned. He also emphasized
extending the incision if bowel
reduction was still not possible.
His work in Urology is marvelous.
His clinical findings of “a bladder
calculus most frequently occurs in
boys, and of its signs is that urine
may contain gravel, the patient
keeps on rubbing his penis and
many of them get a prolapse of the
rectum" as well as “the treatment is
INDEPENDENT REVIEWS
easier in patients whose stone is
larger whiles with a small stone it is
the opposite of that” clearly shows
close observation. He described the
extraction of stone in great detail
from making the position to the role
of assistant10. He even distinguished
between stones formed inside
urinary bladder from those migrat-
ing from kidney. He made many
modifications to one of the oldest
operations in history; vesicolitho-
tomy. He introduced preoperative
preparation, avoided midline
incision, invented special perineal
scalpel and “Kalaleeb” (probably
the origin of the word 'clamp'),
modern stone holding forcep for
stone extraction. He challenged the
old wisdom of not breaking the
stone inside bladder as a very large
incision for extraction of large
stones would lead to permanent
incontinence, he warned. Rather he
introduced lithotripsy, breaking the
stone and extracting it piecemeal.
Similarly for stone impacted in
urethra, he introduced “Mishaab”
10
or drill to break the stone.
His contribution to ophthalmology
is no less than other specialties. He
invented many fine instruments
including eye speculum and fine
scissors, described blephroplasty,
surgical management of entropion,
trichiasis and symblepharon. His
operation for ectropion is still
performed as Kuhnt-Szymanowski
operation with minor modifications.
He pioneered tonsillectomy, nasal
polypectomy & tracheostomy and
April to June, 2010 INDEPENDENT
invented otoscope, tongue depres-
sor, tonsil guillotine and an instru-
ment for removal of foreign bodies
from ear and nose, the precursor of
modern toothed and non-toothed
forceps.
He was not only a surgeon but also
a harbinger of independent think-
ing and an excellent teacher. He
repeatedly advised his pupils not to
follow the ancestors blindly but to
think and innovate as he writes
“you should know that dental
instruments are very numerous, as
are the other instruments, almost
beyond reckoning, and the
experienced worker with knowledge
of his craft may devise fresh
instruments, as his work on actual
cases suggests them to him. For
there are certain diseases for which
the ancients did not mention any
instruments.”11
The earliest known reference to Al
Zahrawi was made by the Abu
Muhammad bin Hazm (993-1064)
who mentioned Al Zahrawi as the
most able physician and surgeon of
Umayyad Spain. The earliest known
attempt for a complete biogra-
phical account of Al Zahrawi's life
and work is in Al Humaydi's “Jad-
hwat Al Muqtabis.”8
The first translation of Al-Tasrif was
done at Toledo by Gerard of
Cremona in 1100 AD. It received a
warm welcome and more transla-
tions soon followed. The Renais-
sance revival of attention to medi-
REVIEWS 107
 cine helped make Al Tasrif the most
popular medical reference. Simple
layout, illustrations, transparent
delivery, and the logical reasoning
all contributed to the same effect.
“On Surgery” was first printed in
Venice in 1471 and republished in
1497 and 1499. In the following
16th century, the book's popularity
had gained momentum and was
being printed in various prominent
European printing houses. The
1531 Pietro Argallata (died 1423)
edition's introduction stated that
“without doubt, Albucasis (Al
Zahrawi) was the chief of all sur-
geons.” The famous French sur-
geon Guy de Chauliac in his book
“Great Surgery” quoted Al Tasrif
more than 200 times. Another
prominent French surgeon, Jaques
Delechamps (1513-1588), later
referred to Al Tasrif on numerous
occasions, reinforcing the authority
of Al Zahrawi on medicine, espe-
cially surgery, all the way through
the Middle Ages and up to the
Renaissance. Its publication contin-
ued in different translations until as
late as 1770.

References 2005 [cited 2010 April, 05] available

1. Hehmeyer I, Khan A. Islam's forgotten
contribution to medical science.
Canad. Med A J. 2007; 176(10):
1467-8
2. Syed IB. Islamic Medicine. 1000
years ahead of its times. JISHIM
2002; 2:2-9
3. Goodrich JT. History of spine surgery
in the ancient and the medieval
worlds. Neurosurg focus. 2004;
16(1):1-13
4. AlRodhan NRF. Alzahrawi and
Arabian Neurosurgery, 936-1013
AD. Surgical Neurology. 1986;
26(1):92-5
5. How Islam changed medicine. Arab
Physicians and scholars laid the basis
of medical practice in Europe.
Editorial. BMJ. 2005; 331:1486-7
6. HALSTEAD WS. The Operative Story
of goiter. Johns Hopkins Hosp Rep.
1929; 19: 71
7. Nick M. AlZahrawi; extra-ordinary
physician, surgeon and inventor. Al-
shindagah [internet] Issue 62 Jan-Feb
at http://www.alshindagah.com/
janfeb2005/zahrawi.html
8. Ka f A l G h a z a l F. A l - Z a h r a w i
(Albucasis) - A light in the dark middle
ages in Europe. JISHIM 2003;
(2):37-8
9. Hajar R. Al-Zahrawi; father of surgery.
Heart Views. Dec 2006-Feb2007;
7(4):154-6
10. Abdel-Helim RE, Altwaijiri AS, ElFaqih
SR, Mitwalli AH. Extraction of urinary
stone as described by Abul Qasim
Khalaf Ibn Abbas AlZahrawi
(Albucasis) (325-404 H, 930-1013
AD ) A translation of original text and
a commentary. Saudi Med J. 2003;
24(12):1283-91
11. Mansour AM. Surgery of Abul Qasim
al Zahrawi. Islam science,
environment and technology website
[internet] no date [cited 2010 April
06] available at www.islamset.com
/muslimscientists/alzahrawi/surgery
ofalzahravi.html
The author :
Muhammad Abid Bashir,
FCPS
is associate professor in
department of Surgery at
Independent Medical
College Faisalabad and
®
instructor of ATLS .
abidbashir@hotmail.com

108 April to June, 2010 INDEPENDENT REVIEWS

View publication stats