Muslim Surgeons: 1,000 Years Ahead of Their Times
By: Dr. Ibrahim B. Syed
Clinical Professor of Medicine
University of Louisville School of Medicine
Louisville, KY 40292,USA
Within a century after the death of Prophet Muhammad (peace be upon him) the Muslims not only conquered new lands, but also became scientific innovators with originality and productivity. They hit the source ball of knowledge over the fence to Europe. By the ninth century, Islamic medical practice had advanced from talisman and theology to hospitals with wards, doctors who had to pass tests, and the use of technical terminology. Muslim doctors used Seton and animal gut for sutures in surgery and used alcohol as an antiseptic. Al-Zahrawi, the most eminent surgeon among Muslim physicians in his book Al-Tas'rif, described and illustrated about 200 surgical instruments many of which Zahrawi himself devised. Importance of the study of Anatomy as a fundamental prerequisite to surgery was stressed. Al-Zahrawi's description of varicose vein stripping, even after ten centuries is almost like modern surgery. His techniques in orthopedic surgery have been reintroduced in the 20 the century. Surgeons all over the world practice today unknowingly several procedures that Muslim surgeons introduced 1,000 years ago.
Prophet Muhammad (peace be upon him) who is ranked number one by Michael hart (1), a Scientist and Scholar, in his book "The 100: The Most Influential Persons in History", was able to unite the Arab tribes who had been torn by revenge, rivalry, and internal fights, and produced a strong nation that conquered, simultaneously, the known super powers (empires) at that time., namely the Persian and Byzantine Empires. The Islamic Empire extended from the Atlantic Ocean on the West to the borders of China on the East. Only 80 years after the death of their prophet, the Muslim crossed to Europe to rule Spain for more than 700 years. The Muslims preserved the cultures of the conquered lands. However when the Islamic Empire became weak, most of the Islamic contributions in art and science were destroyed. The Mongols burnt Baghdad (1258 CE) out of barbarism, and the Spaniards demolished most of the Islamic heritage in Spain out of hatred.
The Islamic Empire for more than 1,000 years remained the most advanced and civilized nation in the world. This is because Islam stressed the importance and respect of learning, forbade destruction, developed in Muslims the respect for authority and discipline, and tolerance for other religions. The Muslims recognized excellence and, hungering intellectually, were avid for the wisdom of the world of Galen, Hippocrates, and Rufus of Ephesus, Oribasius, Dioscorides and Paul of Aegina. By the tenth century their zeal and enthusiasm for learning resulted in all essential Greek medical writings being translated into Arabic in Damascus, Cairo, and Baghdad. Arabic became the international language of learning and diplomacy. The center of scientific knowledge and activity shifted eastward, and Baghdad emerged as the capital of the scientific world. The Muslims became scientific innovators with originality and productivity. Islamic medicine is one of the most famous and best known facets of Islamic civilization, and in which the Muslims most excelled (2). The Muslims were the great torchbearers of international scientific research (3). They hit the source ball of knowledge over the fence to Europe. In the words of Campbell (4) "The European medical system is Arabian not only in origin but also in its structure. The Arabs are the intellectual forebears of the Europeans."
The aim of this paper is to prove in a concise manner that the Muslim Surgeons were 1,000 years ahead of their times.
Al-Razi is attributed to be the first to use the Seton in surgery (5) and animal gut for sutures (6). He was the first to use silk sutures and alcohol for hemostasis (7). He was the first to use alcohol as an antiseptic (2).
Ibn Sina originated the idea of the use of oral anesthetics (8). The Arabs invented the soporific sponge, which was the precursor of modern anesthesia. It was a sponge soaked with aromatics and narcotics and held to the patient's nostrils (8). The use of anesthesia was one of the reasons for the rise of surgery in the Islamic world to the level of an honorable specialty, while in Europe, surgery was belittled and practiced by barbers and quacks. The Council of Tours in 1163 CE declared "Surgery is to be abandoned by the schools of medicine and by all decent physicians." (9). Burton (10) stated that "anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in civilized west.."
Abu al-Qasim Khalaf Ibn Abbas al-Zahrawi (930-1013 CE) known to the west as Abulcasis, Bucasis, or
Alzahravius is considered to be the most famous surgeon in Islamic medicine. In his book Al-Tasrif, he described hemophilia for the first time in medical history. The book contains the description and illustration of about 200 surgical instruments, many of which devised by Zahrawi himself (11). In it Zahrawi stresses the importance of the study of Anatomy as a fundamental prerequisite to surgery (9). He advocated the reimplantation of a fallen tooth and the use of dental prosthesis carved from cow's bone, and improvement over the wooden dentures worn by the first President of America, George Washington, seven centuries later (12). Zahrawi appears to be the first surgeon in history to sue cotton (Arabic word) in surgical dressings in the control of hemorrhage, as padding in the splinting of fractures, as a vaginal padding in fractures of the pubic, and in dentistry. He introduced the method for the removal of kidney stones by cutting into the urinary bladder. He was the first to teach the lithotomy position for vaginal operations (13). He described tracheotomy, distinguished between goiter and cancer of the thyroid, and the invention of a cauterizing iron, which he also used to control bleeding. His description of varicose veins stripping, even after ten centuries, is almost like modern surgery (14). In orthopedic surgery he introduced what is called today Kocher's method of reduction of shoulder dislocation and patelectomy (15). 1,000 years before Brook reintroduced it in 1937 (16.
Ibn Sina's description of the surgical treatment of cancer holds true even today after 1,000 years. He says the excision must be wide and bold; all veins running to the tumor must be included in the amputation. Even if this is not sufficient, then the area affected should be cauterized (17). His recommendation of wine as the best dressing for wounds was very popular in medireview practice (18).
The surgeons of Islam practiced three types of surgery; vascular, general, and orthopedic. Ophthalmic surgery was a specialty, which was quite distinct both from medicine and surgery. They freely opened the abdomen and drained the peritoneal cavity in the approved modern style. To an unnamed surgeon of Shiraz is attributed the first colostomy operation. Liver abscesses were treated by puncture and exploration.
Surgeons all over the world practice today unknowingly several surgical procedures that Zahrawi introduced 1,000 years ago (15)
1,000 years ago Islamic Medicine including Surgery was the most advanced in the world at that time. Even after ten centuries later the achievements of Islamic Medicine and Surgery look amazingly modern. 1,000 years ago the Muslims were the great torchbearers of international scientific research. Every student and professional from each country outside the Islamic Empire, aspired, yearned, and dreamed to go to the Islamic Universities to learn, to work, to live and to lead a comfortable life in an affluent and most modern and civilized society. Islamic countries have the opportunity and resources to make Islamic Medicine and Surgery number one in the world, once again.
M. H. Hart, "The 100: A Ranking of the Most Influential Persons in History." Hart Publishing Co., New York, 1978.
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3. D. Campbell, "Arabian Medicine," Cambridge University Press, 1921, pp. 56-57.
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6. A. Castiglioni , "A History of Medicine", E. Krumhbhaar (trans), Alfred A. Knopf, New York, 1958, p.268.
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17. C. Elgood, " A Medical History of Persia", Cambridge University Press, Cambridge, 1951, pp. 278-301.
18. F. H. Garrison, "History of Medicine", 4th Edition, W. B. Saunders Co., Philadelphia, 1929. P.134.