Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (936–1013), also known in the West as Albucasis, was an Arab Muslim physician who lived in Al-Andalus. He is considered the greatest medieval surgeon to have appeared from the Islamic World, and has been described by many as the father of modern surgery.[1] His greatest contribution to medicine is the Kitab al-Tasrif, a thirty-volume encyclopedia of medical practices.[2] His pioneering contributions to the field of surgical procedures and instruments had an enormous impact in the East and West well into the modern period, where some of his discoveries are still applied in medicine to this day.[3]Biography
Abū Al-Qāsim was born in the city El-Zahra, six miles northwest of Córdoba, Andalusia. The nisba (attributive title), Al-Ansari, suggests origin from the Medinian tribe of Al-Ansar.[4]He lived most of his life in Córdoba. It is also where he studied, taught and practiced medicine and surgery until shortly before his death in about 1013, two years after the sacking of El-Zahra. Few details remain regarding his life, aside from his published work, due to the destruction of El-Zahra during later Castillian-Andalusian conflicts. His name first appears in the writings of Abu Muhammad bin Hazm (993 – 1064), who listed him among the greatest physicians of Moorish Spain. But we have the first detailed biography of al-Zahrawī from al-Ḥumaydī‘s Jadhwat al-Muqtabis (On Andalusian Savants), completed six decades after al-Zahrawī’s death. He was a contemporary of Andalusian chemists such as Ibn al-Wafid, Maslamah Ibn Ahmad al-Majriti and Artephius. Albucasis was 77 years old when he died
Works
Abū al-Qāsim was a court physician to the Andalusian caliph Al-Hakam II. He devoted his entire life and genius to the advancement of medicine as a whole and surgery in particular. His best work was the Kitab al-Tasrif, discussed below. Abū al-Qāsim specialized in curing disease by cauterization. He invented several devices used during surgery, for purposes such as inspection of the interior of the urethra, applying and removing foreign bodies from the throat, inspection of the ear, etc. He is also credited to be the first to describe ectopic pregnancy in 963, in those days a fatal affliction.[3]Al-Zahrawi was the first to illustrate the various cannulae and the first to treat a wart with an iron tube and caustic metal as a boring instrument. He was also the first to draw hooks with a double tip for use in surgery.[5]
Kitab al-Tasrif
Main article: Al-Tasrif
Abū al-Qāsim’s thirty-chapter medical treatise, Kitab al-Tasrif, completed in the year 1000, covered a broad range of medical topics, including dentistry and childbirth, which contained data that had accumulated during a career that spanned almost 50 years of training, teaching and practice. In it he also wrote of the importance of a positive doctor-patient relationship and wrote affectionately of his students, whom he referred to as “my children”. He also emphasized the importance of treating patients irrespective of their social status. He encouraged the close observation of individual cases in order to make the most accurate diagnosis and the best possible treatment. Al-Tasrif was later translated into Latin by Gerard of Cremona in the 12th century, and illustrated. For perhaps five centuries during the European Middle Ages, it was the primary source for European medical knowledge, and served as a reference for doctors and surgeons.
Not always properly credited, Abū Al-Qāsim’s al-Tasrif described both what would later became known as “Kocher’s method” for treating a dislocated shoulder and “Walcher position” in obstetrics. Al-Tasrif described how to ligature blood vessels almost 600 years before Ambroise Paré, and was the first recorded book to document several dental devices and explain the hereditary nature of haemophilia.[3] He was also the first to describe a surgical procedure for ligating the temporal artery for migraine, also almost 600 years before Pare recorded that he had ligated his own temporal artery for headache that conforms to current descriptions of migraine.[6] Abū al-Qāsim was therefore the first to describe the migraine surgery procedure that is enjoying a revival in the 21st century, spearheaded by Elliot Shevel a South African surgeon. Abū al-Qāsim also described the use of forceps in vaginal deliveries.[7] He introduced over 200 surgical instruments.[8] Many of these instruments were never used before by any previous surgeons.[citation needed]His use of catgut for internal stitching is still practised in modern surgery. The catgut appears to be the only natural substance capable of dissolving and is acceptable by the body. Abū al-Qāsim also invented the forceps for extracting a dead fetus, as illustrated in the Al-Tasrif.[9]
Liber Servitoris
In pharmacy and pharmacology, Abū al-Qāsim al-Zahrawī pioneered the preparation of medicines by sublimation and distillation. His Liber Servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the “simples” from which were compounded the complex drugs then generally used.[10][11][12]
Legacy
Al-Zahrawi was the “most frequently cited surgical authority of the Middle Ages”.[13]
Donald Campbell, a historian of Arabic medicine, described Al-Zahrawi’s influence on Europe as follows:[14]
The chief influence of Albucasis on the medical system of Europe was that his lucidity and method of presentation awakened a prepossession in favour of Arabic literature among the scholars of the West: the methods of Albucasis eclipsed those of Galen and maintained a dominant position in medical Europe for five hundred years, i.e long after it had passed its usefulness. He, however, helped to raise the status of surgery in Christian Europe; in his book on fractures and luxations, he states that ‘this part of surgery has passed into the hands of vulgar and uncultivated minds, for which reason it has fallen into contempt.’ The surgery of Albucasis became firmly grafted on Europe after the time of Guy de Chauliac (d.1368).
In the 14th century, the French surgeon Guy de Chauliac quoted al-Tasrif over 200 times. Pietro Argallata (d. 1453) described Abū al-Qāsim as “without doubt the chief of all surgeons”. Abū al-Qāsim’s influence continued for at least five centuries, extending into the Renaissance, evidenced by al-Tasrif‘s frequent reference by French surgeon Jacques Delechamps (1513–1588).[15]The street in Córdoba where he lived is named in his honor as “Calle Albucasis”. On this street he lived in house no. 6, which is preserved today by the Spanish Tourist Board with a bronze plaque (awarded in January 1977) which reads: “This was the house where Abul-Qasim lived.”[citation needed]
On Surgery and Instruments
On Surgery and Instruments is an illustrated surgical guide written by Albucasis, known in Arabic as ‘al-Zahrāwī’. Albucasis contributed many technological innovations, notably which tools to use in specific surgeries. In On Surgery and Instruments, he draws diagrams of each tool used in different procedures to clarify how to carry out the steps of each treatment. The full text consists of three books, intended for medical students looking to gain more knowledge within the field of surgery regarding procedures and the necessary tools.
Interestingly, Albucasis considers his educated opinion to be superior than that of the Ancients: “…whatever skill I have, I have derived for myself by my long reading of the books of the Ancients and my thirst to understand them until I extracted the knowledge of it from them. Then through the whole of my life I have adhered to experience and practice…I have made it accessible for you and rescued it from the abyss of prolixity”.[16] Because he has extensively studied and practiced these topics, he believes that has earned the authority to challenge the revered statements of the Ancients. He has reached the limit of book learning, and is now adding-on to this knowledge with his own experiences.
Tone
Throughout the text, Albucasis uses an authoritative tone to declare his expertise on the topic. For example, when introducing topics or describing procedures, Albucasis often warns the reader of the skills necessary to complete the task. In chapter forty-eight, On cauterization for numbness, he defines the required knowledge for the procedure in a commanding tone: “This should not be attempted except by one who has a good knowledge of the anatomy of the limbs and of the exits of the nerves that move the body”.[17] He invents a criterion to generate a standard of skill level, indicating that he himself has surpassed it due to training and experience. As such, he reiterates his preeminence by implying that he is part of an exclusive group of learned surgeons capable of correctly completing this cautery. In another instance, he states that the procedure should be avoided completely by incompetent surgeons: “However, no one should attempt this operation unless he has had long training and practice in the use of cautery”.[18] In this example, Albucasis prohibits lesser-trained surgeons from practicing cautery. He firmly makes a decision for the field rather than suggesting a plan of action, asserting his authority. By outlining the exact qualifications necessary to properly execute this procedure, Albucasis places himself in the role of the current expert of this field of medicine.
The ‘Ancients’
This objective is also demonstrated in willingness to openly disagree with the ‘Ancients’. By declaring himself a dedicated student of the Ancients, he appoints himself a worthy critic of their practices. For example, Albucasis openly disparages the Ancients’ opinion that cauterization should only be used in the spring season: “…the Ancients…[affirmed] that spring was the best. Myself, I say that cautery is suitable at all times”.[19] Four pages later, he again opposes the Ancients’ opinion that gold is the best material for cauterization, stating that iron is actually his preferred metal: “therefore in our own opinion cauterization is swifter and more successful with iron”.[20]
In these two quotes, Albucasis uses his personal experience as a reliable source worthy of challenging the Ancients’ teachings. In chapter twenty-nine, On cauterization for pleurisy, he even ventures to state that one practice of the Ancients’ is dangerously incorrect: “Now one of the Ancients mentioned that there were some people who used an iron cautery shaped like a probe, and introduced it red hot into the intercostal space until it reached the abscess itself and evacuated the pus…but in this perforation with the cautery there is a danger either that the patient may die on the spot or that an incurable fistula may raise at the place”.[21] By opposing the revered opinions of the Ancients throughout his guide, Albucasis pronounces himself as a new reliable source of medical knowledge worthy of followers . He believes that he has surpassed the limits of learning through studies, and is now in the realm of practice and experience, meriting his ability to critique the Ancients. Interestingly, while he does not hesitate to assert his expertise, he does not state his background training or any foundation that would prove his proficiency. He does state that he has extensively studied the Ancients, but not in what context.n ectopic pregnancy, and the first physician to identify the hereditary nature of haemophilia
Science Journal 