by Ibrahim Shaikh
This article was first published at The Proceedings of the 38th International Congress on the History of Medicine, ed. Nil Sari et. al. Ankara, 2005. We are grateful to the author and editor for allowing us to publish this article.
In search of the surgical contribution of Abul-Qasim Khalaf Ibn Abbas al-Zahrawi, who is commonly known as Albucasis in Latin form, this study begins in his native city Medinat al-Zahra in Spain, and from there takes us to France, England and Turkey. In what way did he inspire Guy Chauliac, John Ardern and Serafeddin Sabuncuoglu?
My study began in 1984 when I visited the city of his birth in Islamic Spain, called Andalusia in the tenth century Christian era. It was here during the reign of Caliph Abdu’r-Rahman III An-Nasir that a city was built called Medinat al-Zahra, where Albucasis was born in 936 C.E. to an Arabian family of the Arabian al-Ansar tribe which had migrated at an early date. After completing his medical studies he became Royal Physician and Surgeon to the western Ummayad caliphs.
The ruins of his birthplace, once famous, have little to show of its former glory. I had seen in the Wellcome Institute how the great surgeon would have looked in the painting dated 1922 by Ernest Boardman commissioned by Henry Wellcome. This remarkable painting illustrates the glory of the city palace where Albucasis is operating in the background. The archaeological reconstruction of the city, which was destroyed following an internal revolt in 1010 C.E., when the city was razed to the ground, is continuing. In 1013 C.E. Albucasis died. The historian Abu Hayyan, Ibn Hazm and Ibn al-Bashkwal (1101-1183) have all told us of its glory and its outstanding scholars.
A thousand years later George Sarton wrote:
“Such abundant activities had never occurred before, not even in the best day of Alexandria”. 1
In 1887 Stanley Lane Poole, in his book The Moors in Spain, paid tribute with these words:
“The Moors were banished; for a while Christian Spain shone, like the moon, with a borrowed light; then came the eclipse and in that darkness Spain has grovelled ever since.”
Our biographical knowledge about Albucasis comes from the author of Jadwat al-Muqtabis, Abu Abdallah ibn Muhammad al-Futuh al-Hutnaidi (1029-1095 C.E.), who was also a friend of Ibn Hazam. His account of Andalusian men of knowledge included Zahrawi (Albucasis) and we are indebted to him for the historical bio data which later was transmitted quoting this source by another biographer Ibn Bashkwal (1101-1183C.E.) in his work titled al-Silah. Haji Khalifa in his book of biographies titled Kashf al-Zanun also gave an account of al-Zahrawi and his work.
Albucasis learned anatomy from a Syrian, Yunus al-Harrani who emigrated from Damascus in Syria to Cordoba, where he for the first time began teaching anatomy as a subject. At the same time another Andalusian called al-Majriti (from Madrid which Arabs called al-Majrit hence al-Majriti) came to Cordoba. Here he established for the first time a school for teaching chemistry and mathematics. From such early schools Islamic Spain produced two outstanding world famous students: one, the great historian and philosopher Ibn Khaldun, and the other, our father of surgery Abul Qasim al-Zahrawi (Albucasis of Latin speaking Europe). Cordoba became a jewel city much envied by Europe, its libraries housing 400,000 books whose patron was none other than the king himself. Al-Hikam was himself a scholar, who not only catalogued authors in 44 volumes but wrote biographical notes on each contributor in his own handwriting. There Albucasis could read the Greek medical works of Paulus Aeginata, Galen, Susrata and Carca, which were available to him from earlier translations in Arabic by the Bagdad school of translators.
Today the city of Cordoba commemorates his name in Calle Albucasis, and in Calle al-Hurra Museum replicas of his surgical instruments remind us of his fame as the first to illustrate surgical instruments in his 30 part encyclopedia at-Tasrif, the last part on surgery being translated into Latin by Gerard Cremona in 12th century.
An exhibition held at Madrid Archaeological Museum in April-June 1991 devoted a section to the reconstructed surgical instruments of Albucasis. These gold replicas of surgical instruments were loaned by Prof. Fuat Sezgin. 2 Replicas of gold surgical instruments were made by Prof. Fuat Sezgin. Director of the Institute for the History of Arabic-Islamic Studies at the Johann Wolfgang Goethe University, Frankfurt am Main, Germany. 3
A recent television channel showed a program of four series under the title Barbarians: “Dark Ages”. The concluding part of the series shown on July 22, 2002, covered the illustrious Cordoba and the ruins of Medinat al-Zahra, and several flashing sequences of the Arabic Bodleian Huntington manuscript 186, folio 85 v. Then from Calle al-Hurra Museum replicas of surgical instruments were shown to the paediatric surgeon of Cordoba, Dr. Perez Sobrino, who was asked about the validity and modern implication of Albucasis. I was fascinated and curious to hear what Dr. Peres said. Let us read an account in the book accompanying the series, where presenter anthropologist Richard Rudgley in Cordoba writes:
“I was able to borrow some accurate replicas of some of the instruments Albucasis describes, and I took them to a surgeon (Dr. Perez Sobrino) at a local hospital to get his professional opinion on their practical value. He was greatly surprised at the similarity between these replicas and their modern-day counterparts. Even my untrained eye could see clear correspondences in the size and shape of numerous different instruments: scalpels and other more specialist tools of the trade to remove blood clots, to operate on the nasal bone, for dentistry and for eye operations.” 4
There are also silver replicas of the instruments of Albucasis in Hamdard University, Karachi, Pakistan. A booklet dedicated to the 1985 Sixth Asia-Pacific Congress of the International College of Surgeons held in Karachi, Pakistan written by Hakim Mohammed Said; titled “Abu Al-Qasim al-Zahrawi (c. 936-1013) Life and Works”, with 9 colour plates showing different types of Albucasis instruments made of silver, Hamdard University Press (1985) Karachi, Pakistan.
The Royal Library in Madrid El-Escorial has preserved a copy of Al-Tasrif. Reading historical manuscripts, we begin to realize the extent of his influence. I had the opportunity to visit the Bibliotheca National in Paris and see the French manuscript of Guy Chauliac, who translated the work of Albucasis into French. The Mt Pellier 1984 edition in French of the treatise on fracture dislocation still in use in southern France is a great tribute to Albucasis. In 1997 a French translation with commentaries by Prof. Said Mestiri was published by Arcs Editions, Tunis. The Arabic text and French translation of Albucasis’ orthopaedic and fracture treatment was included in Jean-Charles Sournia’s book, Medecines Arabes Xe et siecles, 1986 Paris edition.
In England I visited the Bodleian Library in Oxford (1980). Two Arabic manuscripts were shown to me personally by curator Mr. Colin Wakefield.
The oldest manuscript originally in the collection of Archbishop Marsh, is dated A.H. 670 (A.D. 1271) and profusely illustrated. The drawings are in an intense black ink, strongly outlined, reliable drawings having been done from instruments actually before the eyes of the copyist. Channing has suggested that the writer of the Marsh copy had transcribed it for his own use in the exercise of medical practice.
The second manuscript, brought from Aleppo by the Orientalist Robert Huntington (1637-1701) when chaplain to the English merchants there, is dated A.H. 870 (A.D. 1465) and is now No. 156 in the Huntington collection in the Bodleian. It is carefully and neatly written on excellent paper. The drawings are well executed. 5
In 1998 I organized a trip for visiting US delegates of the International Institute of Islamic Medicine (HIM) to the conference held in Birmingham to visit the Oxford Bodleian library with Dr. Emily Savage-Smith and Colin Wakefield to see Arabic medical manuscripts. Incidentally an 1778 Arabic edition and Latin translation was published from Marsh 54 and Huntington 186, the two Arabic manuscripts in the Bodleian library.
In 1973 the Wellcome Institute for the History of Medicine published the Arabic text and English translation of al-Tasrif with translation and commentary by Prof. Lewis and Blackburn pathologist Dr. Spinks. In Oxford, I successfully persuaded Prof. Lewis to give a presentation on his 17 year period of study and translation of al-Tasrif, which he delivered at the Birmingham HIM Conference and this paper has subsequently been published in Islamic Culture from Hyderabad India, under the title The Surgeiy ofAlbucasis. 6
Prof. Lewis writes:
“One would like to know more about Albucasis, I did come across one scrap of information in the form of a note (folio 228) by the scribe Veliuddin in a manuscript, written 250 years after Albucasis’s death ‘/ I have been told that he was extremely ascetic; that half of his work every day he did without fee as chanty, and that he wrote this compendium over a period of forty years.'”
Prof. Lewis continues,
“One respect in which Albucasis improved on the methods of the Ancients was in the use of gut sutures, the Greeks seeming to have employed only wool or linen. Albucasis uses gut for mending wounds of the intestine, but first he tells us of another technique (550):
“Some men of experience have said that when a wound occurs in the intestine and it is small, it should be sutured in this manner. Ants with large heads are taken, then the edges of the wound are brought together and one of these ants is applied by its open jaws to the two edges of the wound. When it seizes it and closes its jaws, the head is cut off, then another ant is applied near the first, and so on. The heads will remain sticking to the intestine until it is healed, and no harm will come to patient.”
Then he says, “The intestine may also be sewn up with the fine suture which is extracted from an animal’s gut. The end is taken of this suture, well scraped, and to it is fixed a fine linen thread, twisted, which is passed through the needle. The intestine is sewn with the gut, then replaced in the abdominal cavity.”
It is often quoted that Albucasis copied Paulus Aeginata and followed the Indian Susrata. Here are one or two more examples of how Albucasis went beyond his ancient masters. My own investigation of catgut and ant stitch resulted in publication of my article “Ant Stitch” in popular educational and scientific magazine The Fountain 7.
It is interesting to note that in The Lancet, 8, Joseph Lister published “observations on ligature of arteries on the antiseptic system tells us about chromatization of cat gut. He wrote in 1869 that eight centuries later he was able to improve the method of catgut preparation described by Albucasis in his Tasrif.
“Catgut, manufactured from the small intestine of sheep the method which I have found best is to keep the gut steeping in a solution of carbolic acid in five parts of olive oil, with a very small quantity of water diffused through it.” 9
A remarkable account of catgut making by Albucasis was reported in Medical History, vol: xvii, 1973 under the title “The History of Sutures” by Mr. David Mackenzie, product manager of Ethicon Ltd. A video produced by Ethicon Company gives a vivid picture of washing sheep’s gut, scraping and cutting it into strips as described by Albucasis in at-Tasrif.
Guy Chauliac (1300-1368) was the first of a long series of French surgeons influenced by Albucasis. He studied in Bologna, France, taught in Montpellier and then joined the Pope’s court in Avignon. A most eminent surgeon of his time, of the Montpellier school, he adopted the methods of Arab physicians for rupture and cataract. In 1363, C.E his first edition in French appeared which remained an authority 200 years. The Bristol Guy Chauliac Ms. written about 1430 C.E. is in Bristol City Library in England. Charles Singer gave an account of its illustrations in the proceedings of the Royal Society of Medicine (1917, vol. X, pt.ii.). The figures of surgical instruments are in the style of Albucasis. (Fig 9 Page 83) is of importance as it is based on Albucasis. Singer states:
“It will be noted that Guy de Chauliac performs the operation of trephining by means of separate borers or trebrae. The holes thus made were ultimately joined by use of chisel and hammer or by other means. He does not use the trephine but in this respect follows the tradition of Albucasis.”
Henri de Mondeville was the teacher of Guy de Chauliac, and he belonged to the school of Montpellier.
According to Donald Campbell:
“The School of Montpellier was a famous Arabist centre, and at a time when the medical libraries of Paris was limited to under a score of books, Montpellier had all the Latin translations from Arabic manuscripts by Constantine and Gererd Cremona, including the three tracts of Albucasis. The medical writings of the thirteenth and fourteenth centuries consisted of compilations, commentaries, and concordances, most of which were based on the Latin translations of Arabic works available at Toledo”.
“Guy Chauliac (d. 1368) was surnamed ‘The Restorer’ because his works re-introduced Arabic terms; he made free use of anatomical nomenclature and his writings show frequent use of such medieval Arabic terms as meri: esophagus, siphac: peritoneum, sumen or sumac, myrrah, and zirbus. The vigour of Guy’s work led to his influence on surgery extending to the sixteenth century and later”.
According to Sir William Osier, ‘the hand of the Arab’ is decipherable in the work of Guy de Chauliac.
In the frieze at the Faculty of Medicine in Paris Chauliac holds a place with Razi, Avicenna, Albucasis and others. Guy’s Arabic Scholastic Surgery was printed in fifty two editions in Europe during the fifteenth and sixteenth centuries. 10
John Ardern, Surgeon of Early England
The earliest great English surgeon John Ardern’s (1307-1377) most important work is Practica de Fistula in Ano, written in 1376, one of the outstanding medical works of the middle ages. George Sarton writes: “It is full of original details derived from his own experience. His method of operating the fistula was an original modification of the method of Abu-l-Qasim al-Zahrawi; its principles still holds good today.” 11
The early English surgeon, John Ardern, was the first to teach surgery by illustration of the living pathology as he saw it. He was the first educated surgeon in England. His operation for fistula consisted in first passing a metal sound through the fistula until the internal orifice was found, this instrument was called sequere me (follow me). The structures between the tract and the bowel were divided either by passing a thread through the fistula and out of the anus and tightening it until it cut through or by incision with a knife. In either event the entire tract was to be laid open. This, in its ultimate aim, is practically the modern operation.
In addition to the sequere me probe John used the acus rostrata, a snouted needle; the wooden tendicula; a thread called the frenum cesaris; a syringe which he describes as “an hollow instrument by the midez”.
John Ardern recognized ischio-rectal abscess and its pathological relation to fistula in ano. His treatment of wounds consisted of ointments and various medications but it is interesting to note that a good deal of washing with hot and cold water was also done.
ŞERAFEDDiN SABUNCUOGLU (1385-1468)
Author of the earliest paediatric surgical atlas Cerrahiyet al-Haniye
The author of one of the earliest surgical textbooks was Şerafeddin Sabuncuoğlu, who was born in Amasya in northern Anatolia and practiced in Amasya hospital for fourteen years.
In 1465, he wrote his original textbook Cerrahiyet al-Haniye in Turkish, describing surgical techniques and instruments. This book also contained many miniature illustrations concerning operative procedures.
Excellent analysis of its comparison with Zahrawi and the original aspects of Sabuncuoglu’s surgery study has been carried out by Nil Sari and Cenk Buyukunal and published in the Journal of Pediatric Surgery 12. They won a medal for this original investigation.
The authors have consulted three original copies of Cerrahiyet al-Haniye. Two of these copies are in Istanbul. The first manuscript is in the Millet Library (No. 79) and the second in Capa Medical History Department, University of Istanbul. The third is in the Paris National Library (Ms. Supl. Turk 693).
The three different manuscripts have been translated into modern Turkish. Comparison with Zahrawi’s text and ancient surgical text books was carried out.
Sabuncuoğlu’s special contributions and original remarks were investigated under the following headings:
- Urinary meatus stenosis
- Circumcision of boys
- Treatment of hermaphrodites
- Treatment of intestinal hernia
- Imperforate anus.
Their study concludes with this summary: “This historic book could also be accepted as the first surgical atlas, its colourful, descriptive pictures of the various operations and surgical instruments make it a significant piece of work.”
Ihsan Numanoglu’s article: “The Earliest Known Book Containing Pediatric Surgical Procedure” 13 published the illustrations of anal malformation; perinial fistula; surgical treatment of inguinal hernia; hypospadias correction by forming new urethra; circumcision by utilizing a pair of scissors; and vaginal atresia or fused labia which was corrected by women.
Nil Sari in her article “Women dealing with health during the Ottoman Period” confirms this as she writes in New History of Medicine Studies:
“As is depicted in the miniature paintings of the 15th century Turkish manuscripts on surgery called Cerrahiyet al-Haniyye by Sabuncuoğlu, female physicians who were involved with the operation on women patients were called tabibe meaning female physician, while midwifes called kabile were noted as treating living and dead fetuses. Their roles were illustrated from original manuscripts. 14
In conclusion, I have not yet come to the end of the road. It is only the beginning of scanning the life and times of Albucasis through the work of Chauliac, Ardern and Şerafeddin Sabuncuoğlu, who were all influenced by Albucasis with respect to illustration and the addition of figures of surgeons engaged in surgery. Although Albucasis is long gone, and nearly a thousand years have elapsed, yet the Nova Vetera which exploded and showed its brilliance has kindled the flame in me. My quest for Albucasis will go on.
- Hamarneh, S. and Sonnedecker, A Pharmaceutical View of Albucasis in Moorish Spain, E.J. Brill 1963, page 14.
- Hamarneh, S. and Sonnedecker, A Pharmaceutical view of Albucasis in Moorish Spain. E.J. Brill 1963. page 15.
- Hamarneh, S and Sonnedecker, A. Pharmaceutical View of Albucasis in Moorish Spain E.J. Brill 1963. page 20-21.
- Singer, Charles, Bristol Manuscript of Guy de Chauliac, Proceedings of Royal Society of Medicine 1917, vol x, pt ii.
- Campbell, Donald.-Medical Curriculum of Universities in the Sixteen Centuries, Essays written in honour of Charles Singer, vol one pages 337-367, Oxford University press, 1953.
- British Medical Journal, 8 July 1939, ii, pp 80-81. The Oldest Medical Manuscript written in England.
- Sarton, George. Introduction to the History of Science, Baltimor 1948, vol Hi, page 1700.
- Sarton, George Introduction to the History of Science, Baltimore 1948, vol iii, page 1700.
- Numanoglu, ihsan, The Journal of Pediatric Surgery, The Earliest Known Book containing Pediatric Surgery, vol:8, 1973 pp 547-548.
- Sari, N, Cenk, S. N. and Buyuknal, Journal of Pediatric Surgery, The Author of the Earliest Pediatric Surgical Atlas: Cerrahiye-I-Ilhaniya vol 26: no 10, October 1991, pp 1148-1151.
- Sari, N. The New History of Medicine Studies, “Women dealing with health during The Ottoman Reign” no 2-3, 1996/97, pp. 1-54.
- Sarton, introduction vol, 1: 647-8 ↩
- The exhibition catalogue was published in 1992 under the title El legado cientifico andalusi, a publication of Ministerio de Cultura. Centro National de Exposiciones, Madrid; Comision Quinto Centenario Al-Andalus 92, 1992. (ISBN 8474838193) ↩
- See book review in Isis, 87:2 (1996) pp 347-348. ↩
- Barbarians: Secrets of the Dark Ages, Richard Rudgley page 271. T.V. series made by Granada Media for Channel 4 Directed by Chris Malone A Granada T.V. presentation for Channel 4 part relevant to Albucasis with the compliments of Chris Malone, series producer. ↩
- Martin S. Spinx “Arabian and Gynaecological, Obstetrical and Genito-Urinary Practice Illustrated from Albucasis.” Proceedings of the Royal Society of Medicine Vol: XXX No Jan 13, 1937 pp 653-670. ↩
- Islamic Culture An English Quarterly Hyderabad, Deccan, India. Vol: LXXII, No. 1, January 1999, pp 21-36. ↩
- The Fountain, July-Sept 1996 vol; 2, No 15 pp 36-37 ↩
- The Lancet, April 3, 1869 pp 451-455 ↩
- The Lancet, April 3, 1869 p. 455. ↩
- “Medical Curriculum of Universities in the Sixteenth Century”, Donald Campbell, Science Medicine and History, Essays written in honour of Charles Singer, Volume one, pp337-367, Oxford University Press, 1953. ↩
- Introduction to the History of Science vol: III, Baltimore 1948, pp. 1700. ↩
- Journal of Pediatric Surgery, Vol 26: no 10, October 1991, pp. 1148-1151 ↩
- The Journal of Pediatric Surgery, vol: 8, 1973, pp. 547-548 ↩
- The New History of Medicine Studies 2-3, 1996/97 pp 11-64. ↩