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.

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