ORIGINAL ARTICLE

ANZJSurg.com

Surgical wisdom and Genghis Khan’s Pax Mongolica

Jakob Köstenbauer
Department of Surgery, Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia

Key words Abstract

Genghis Khan, history of surgery, Mongolian
Empire, Persia, Rashid al-Din.
Correspondence
Dr Jakob Köstenbauer, Department of Surgery,
Wagga Wagga Rural Referral Hospital, Sturt
Highway, Wagga Wagga, NSW 2650, Australia.
Email: jakobkuba@gmail.com
J. Köstenbauer BMed, MD.
This study was presented at the RACS Annual
Scientific Congress, 2014, Singapore and was
awarded the Trainees Prize for Surgical History.
Accepted for publication 12 September 2016.
doi: 10.1111/ans.13813
Background: The unrivalled conquests of Genghis Khan (CE c.1162–1227) led to the
establishment of the Greater Mongolian Empire. By 1279, the Mongol dynasty controlled a
vast Empire which, for the first time in history, unified Europe and China via the famous
Silk Road. The ensuing century of peace and stability is referred to by historians as the Pax
Mongolica, which facilitated Europe’s renaissance and remarkably contributed to the rise of
modern medicine and surgery.
Methods: Secondary sources from published literature, primary sources from manuscripts
and illustrations courtesy of universities, museum libraries and archives.
Results: There is ample evidence detailing the Mongol Empire’s power during the thir-
teenth century and the Silk Road’s role as a vehicle of commercial, cultural and scientific
exchange. Advances in medical knowledge and surgical skills were made in all parts of the
Empire and exchanged from China to Constantinople and back. Prominent medical figures
traversed these centres, and no doubt contributed to the spread of surgical science, including
Rashid al-Din and Mansur Ibn Ilyas. Their works, it is argued, enriched the practice of sur-
gery and may have indirectly ushered-in the rise of modern surgery in the early medical
schools at Salerno, Bologna, Pavia, Oxford, Montpellier and Constantinople to name
but a few.
Conclusion: The blossoming and diversification of medical and surgical knowledge was an
integral part of the great cultural exchange facilitated by the Pax Mongolica. This enhanced
surgical practice in China, Persia and Arabia, while coinciding with the renaissance of surgi-
cal teaching in Europe.

under Genghis Khan’s exceptionally tolerant legal code (the

Introduction: Genghis Khan’s century of
peace
Even before his death in 1227, Genghis Khan (Fig. 1) was consid-
ered a ruthless, blood-thirsty tyrant the world over.1 His reputation
was not without cause as his forces had crushed the ruling houses
of four civilizations. It was Genghis Khan’s grandson, Kublai
Khan, who inherited the second largest empire in human history
(Fig. 2), inhabited by over 25% of the world’s population.2 Despite
its violent beginnings, Mongol hegemony over Asia and the
Middle-East ushered in a century of stability referred to as the Pax
Mongolica. The influence of this period on the course of medical
and surgical history in Asia, the Levant and Western Europe, which
this article seeks to explore, remains understated in our prevailing
Eurocentric academic paradigms.2–4
For over a century, the Pax Mongolica enabled an unprece-
dented level of commercial, cultural, religious and scientific
exchange across Eurasia. Through the unification of the Silk Road
jasaq), Europe and China came into meaningful contact for the
first time in history.4 Nearly, every region under the new empire’s
control enjoyed a cultural rejuvenation, most of which lasted for
several centuries.5 Genghis Khan’s ‘new world order’ described
so eloquently by Weatherford, enabled the likes of Marco Polo
(1254–1324) to champion trade from East to West.2 Not only
goods but people traversed the vast empire. An intriguing study
has even estimated the carriers of Genghis Khan’s Y-chromosomal
finger-print at 16 million men, approximately 8% of Eurasian
males.6 Several ruling houses directly descend from his line,
including the Moghuls in India, China’s Yuan dynasty and Persia’s
Ilkhans. This early globalisation of goods and people brought
innovations to both the Mongols and their neighbours, most
notably Europe and the Middle East, who gained gunpowder
(first known as ‘Chinese salt’),7 paper making, bills of exchange
and banking, as well as knowledge in anatomy and pharmacy to
name but a few.2,4

© 2017 Royal Australasian College of Surgeons ANZ J Surg (2017)

2 Köstenbauer
Fig. 1. Genghis Khan – creator of the Mongol Empire (1162–1227).
(Public domain: https://en.wikipedia.org/wiki/Genghis_Khan#/media/File:
YuanEmperorAlbumGenghisPortrait.jpg).
Surgical wisdom spreads West
In accordance with Genghis Khan’s policy of strength through
diversity, the Mongol Khans directly encouraged the growth and
exchange of medical knowledge throughout their Empire. Hospitals
based on the Persian model, much like those of today, were estab-
lished and teams of physicians sent from all corners of the empire
to serve there.2,8 High ranking Mongol officials relied on Mongo-
lian, Chinese, Tibetan, Indian, Uighur, Arabic and Nestorian physi-
cians and there is ample evidence of medical exchange between
these schools.3,8
Perhaps of greatest relevance to current academic debate is the
exchange of innovative anatomical knowledge based on human
cadaveric dissections from Yuan China to Europe. A key figure in
this era was Rashid al-Din (1247–1313) – a Persian Jew who con-
verted to Islam in his mid-thirties – he became a famous physician,
statesman and key historian of the Mongol era.2,9 In Tabriz, he
established a famous academic institution, the Rabi Rashidi
(Rashidi Quarters), which featured a research hospital and medical
school with adjacent caravanserai, paper factory and a library con-
taining upwards of 60 000 books.10,11
History’s earliest manuscript on Chinese surgery or medicine
ever published outside China was printed in the Rabi Rashidi in

1313 – entitled Tansuqnama-i Ilkhan  i
 dar funun-i ’ulum-i Khata’
(Treasure Book of the Ilkhans on the Branches of the Chinese
Sciences).9,12 It contains, amongst other detailed discussion, dozens
of anatomical drawings based on cadaveric dissections performed
in China’s Guangxi Province on 50-odd rebels executed in 1045
(Fig. 3).13 The Persian manuscript is an amalgamation of several
Chinese texts ranging from the Song to Yuan dynasties, including a
manuscript written in 1095, based on the anatomical dissections of
executed prisoners (Fig. 4).9,14 At the Rabi Rashidi, the texts were
compiled and translated by a team of Chinese and Persian doctors
into Persian and Arabic. Wood-block printed copies were made
publicly available for a small fee. Figures 3 and 4 compare the orig-
inal Chinese illustrations with Rashid al-Din’s 1313 translations.
As yet, use of these remarkable illustrations has been traced to an
original discovered in 1931 in the Süleymaniye Library, Istanbul,
Fig. 2. Map of the Mongol Empire’s greatest
extent c.1280 under Kublai Khan, grandson of
Genghis Khan. (Modified from Creative Com-
mons domain: https://www.flickr.com/photos/
wfryer/19183908542).
© 2017 Royal Australasian College of Surgeons
Surgery and the Pax Mongolica
Fig. 3. (a–e) Persian illustrations with translations. The heart, abdominal viscera from lateral, anterior and posterior views, and the diaphragm. (Rashid al-
Din, Tansuqnama-i Ilkhan dar funu a’i, Tabriz, 1313. Istanbul, Süleymaniye Library, Ms. Aya Sofya 3596, fols. 65b; 63b-64a; 71a; 66b. Photos:
m-i Khat
n-i ’ulu
courtesy of the Süleymaniye Library).
Fig. 4. (a–e) Chinese illustrations of abdominal viscera based on Sung dynasty dissections of Ou Hsi-fan’s rebel gang. (Author’s personal collection).
 possibly re-
dated 1313.9 As claimed by Miyasita, the Tansuqnama
awakened European interest in anatomy and cadaveric
dissection.9,12
The Rabi Rashidi was also host to the famous Persian physician
and anatomist Mansur ibn Ilyas.15 Mansur studied and travelled
widely, writing several treatises on medicine and surgical anat-
omy.16,17 Not only did Mansur hail from a long line of physicians
but also his great-grandfather Najm al-Din Mahmud had been
appointed Chief-Doctor of a Tabriz hospital by Rashid al-Din. Like
Rashid al-Din, Mansur’s elders travelled to Eastern oriental coun-
tries and wrote manuscripts incorporating eastern medicine.15 Of
greatest importance though, is Mansur’s Tashrih-i Mansuri
(Mansur’s Anatomy) – the world’s first colour atlas of human anat-
omy, published in 1386.16,18
From China to Europe, illustrations had been previously used
for the communication of anatomical science and so the Tashrih-i
Mansuri is not ground breaking in its use of illustrations.15 Man-
sur’s Anatomy relied heavily on the works of the Arabic masters
Avicenna and Rhazes, who in-turn followed Galenic and Hippo-
cratic theories.16,17 Mansur’s colour atlas does however, detail
with astounding accuracy the anatomy and physiology of the
optic nerves, their relations and the cruciform optic chiasm.16
Moreover, it presented a brave and novel approach to the
© 2017 Royal Australasian College of Surgeons
3
teaching of anatomy, especially so for the first ever anatomical
depiction of a gravid uterus, it’s consideration as a unit within
the circulatory system, the use of multiple colour images in an
atlas format and its publication despite religious mores of the
time.15,17 For centuries later, illustrations from the Tashrihi Man-
suri were copied, enhanced and used to various extents in medi-
cal texts from Persia to Europe.15 Figures 5 and 6 show
Mansur’s illustration of the arterial and skeletal systems, found in
a fourteenth-century edition of Avicenna’s Canon of Medicine. In
this form, Mansour’s works readily found their way into the
libraries and lecture halls of the newly established European med-
ical schools of the fourteenth century. Mansur’s significance to
the teaching of anatomy for all subsequent generations of anat-
omy students is thus evident.
A non-surgical technique disseminated from China to Persia was
pulse diagnosis – an ancient Chinese practice still practiced in India
and China. In Persia, acupuncture was rejected but pulse diagnosis
favoured as it required less physical exposure of females in particu-
lar. To therefore serve Persian physicians, Chinese texts on pulse
diagnosis were among the sizeable body of literature translated –
first into Mongolian and then Farsi – under the direct order of
Kublai Khan and made a compulsory part of the curriculum of the
Chinese Imperial Academy of Medicine in 1305.11
4 Köstenbauer
Fig. 5. Illustration of the skeletal system based on ‘Mansur’s Anatomy’
(1386) in the ‘Canon of Avicenna’. (Qanun fi’l-tibb, by Ibn Sina (Avicenna),
Published: Isfahan Folio 126 recto. With permission: Wellcome Library/
Wellcome Images, London. Copyright.).
Western historians have previously maintained that Europe’s re-
discovery of Greco-Roman medical authors was entirely through
contact with Byzantium and the Arabic kingdoms, which at the
time stretched from southern Spain to Palestine – with no mention
of the Mongol empire’s role.19 More recent sources have, however,
highlighted several landmark events occurring during the Pax Mon-
golica which render this paradigm too simplistic. During this pros-
perous time, the status of ‘modern’ Islamic medicine in Europe
began to rise, no doubt influenced by the works of the aforemen-
tioned authors Mansour and Rashid al-Din. By 1467, more than
half the material in Ferrari’s library at Pavia University were Arabic
or Persian texts and his textbook of 1471 quotes Avicenna 3000
times but Galen 1000 and Hippocrates only 140 times, while the
university held weekly lectures on Rhazes.19 For the first time,
fourteenth-century European medical schools awarded higher
degrees in medicine, much like those of eastern academies.3 This
signified a shift from clerical medical teaching, operating under the
oppressive censorship of the Church, to a more tolerant if not
Fig. 6. Illustration of arteries and viscera based on ‘Mansur’s Anatomy’
(1386). (Qanun fi’l-tibb, by Ibn Sina (Avicenna), Published: Isfahan, Folio
123 verso. With permission: Wellcome Library/Wellcome Images,
London. Copyright.).
secular university system. The emergence of modern human cadav-
eric (as opposed to animal) anatomy, as practiced by Mundinus in
fourteenth-century, Bologna was preceded by Chinese anatomists
of the Sung dynasty (960–1126) by over 300 years.13 It is therefore
conceivably no coincidence that the majority of Europe’s early
medical schools blossomed in Genghis Khan’s wake.
Medical and surgical practices
disseminated from West to East
Trade of ideas and knowledge was by no means unidirectional from
East to West and so it would be remiss to ignore the reciprocal inte-
gration of Persian and European medical practice in Yuan China.
Given their bellicose way of life, Mongols were well practiced in
the management of traumatic injuries. Fractures and dislocations
were treated by a ‘Bariachi’ – specialist bonesetters, considered
separate to any physician. Driven by Mongol demand, subjugated
© 2017 Royal Australasian College of Surgeons
Surgery and the Pax Mongolica
Chinese surgeons began to specialize in orthopaedics. Most famous
was Wei Yilin, who wrote a manual on setting fractures, basic
anaesthetics using opium and pioneered the suspension method of
joint reduction, a technique not seen in the West until its develop-
ment in 1927 by Dr G Davis.8
The Mongols also ensured that European and Islamic medicine
was well represented in medieval Beijing. There they established
the ‘Medical Bureau of the Capital’ in 1263 – an office dedicated
entirely to propagating Western medicine in China – placing Nesto-
rian Christian physicians in charge. The imperial library contained
Chinese translations of Western medical classics including Avicen-
na’s Canon of Medicine, a well-known synthesis of Greek and Ara-
bic medicine written in 1025, which was to become standard
teaching in Europe from the fourteenth to eighteenth centuries.19
Interestingly, the first Archbishop of Beijing – John of Montecor-
vino – recorded in his diaries in 1303 that the Great Khan Temür
employed an unnamed Lombard surgeon in his court.8
Conclusion
The role of the Pax Mongolica in the wake of Genghis Khan’s epic
conquests is best illustrated by examples from fourteenth-century
Persia, which represented the western frontier and interface of pre-
renaissance Europe and the Mongol empire. The previously held
view of Europe’s medical and surgical renaissance based on an
isolated Greco-Roman and Arabic model has been called into ques-
tion. Safavi-Abbasi et al. suggested: ‘It is intriguing to postulate
that the spread of Greek, Arab, Persian, and Indian scientific and
medical knowledge and the rise of medical teaching in Europe may
not have been in spite of Genghis Khan, but because of him’.3
Perhaps, it is now time to cease postulating and acknowledge our
eastern inheritance.
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