Al-Zahrawi – The Pioneer of Modern Surgery

It has often been stated on this website that the Muslim period of Spain’s history (also known as al-Andalus) was a Golden Age of Islamic civilization and society. Harmony between Islam, Christianity, and Judaism prevailed, great advancements were made in the sciences, and wealth and stability were the rule rather than the exception.

One of the great figures of Muslim Spain was Abu al-Qasim al-Zahrawi, Islam’s greatest medieval surgeon. He revolutionized how surgery was performed by inventing new methods and tools to help heal patients. His thirty-volume encyclopedia of medicine was used as a standard text for medicine throughout Europe for centuries. The impact he had on how medicine was practiced was truly revolutionary.

Background

Al-Zahrawi lived during most powerful period of the Umayyad Caliphate of Cordoba. He was born in 936 and died in 1013, and served the Umayyad Caliph al-Hakam II and the military ruler, al-Mansur. Throughout his life, al-Zahrawi was a court physician, having been patronized by the rulers of al-Andalus and recognized for his medical genius. He served in such a capacity as a doctor for over 50 years.

Unlike many doctors and hospitals in the “modern” world today, al-Zahrawi insisted on seeing patients regardless of their financial status. By seeing a wide variety of patients every day and recording his treatment of them, he left behind a very valuable text of medical knowledge that he called al-Tasrif.

Al-Tasrif

A page from the original al-Tasrif written by al-Zahrawi in the 900s

His encyclopedia of medicine is divided into 30 volumes. Each one of which dealt with a different aspect of medicine. He discussed how to diagnose diseases in one of the early volumes. He noted that a good doctor should always rely on his own observation of the patient and his/her symptoms instead of simply accepting what the patient says – a practice still employed by doctors today.

Al-Zahrawi takes a holistic approach to medicine. Not only does he discuss how to treat diseases, he describes how to prevent them. He dedicates parts of his books to discussing what foods should be avoided, how to maintain a healthy diet, and how to use food as part of a treatment plan. He particularly notes the effects of alcohol on the body. He states:

“[Alcohol causes] general weakness of most of the nerves of the body, difficulties in articulation, weakness of voluntary movements, arthralgias, gout, etc.. disturbances of the liver which causes tumors and obstructions which is a definite cause of ascites and general ill health”

Surgery

His most influential volume of al-Tasrif is the 30th, the one dedicated to surgery. In it, he explains in detail how to perform certain surgeries to cure certain ailments. He insists in it that all surgeons must first be very well versed in general medicine, anatomy, and even the writings of philosophers who studied medicine.

Al-Zahrawi pioneered many of the procedures and materials still used in operating rooms today. He was the first to use catgut as the thread for internal stitches. Catgut is a thread made from the lining of the intestines of animals. It is the only material that can be used for stitches and still be absorbed by the body, preventing the need for a second surgery to remove internal stitches. He invented many tools necessary for modern surgery. He was the first to use foreceps in childbirth, greatly decreasing the mortality rate of babies and mothers. He performed tonsillectomies with the same tongue depressors, hooks, and scissors used today. He used concealed knifes to cut into patients without making them apprehensive He used both local and oral anesthesia in order to reduce the pain patients experienced during surgery. He performed mastectomies removing a woman’s breast if she had breast cancer, a procedure still done today. He described how to set bone fractures, amputate limbs, and even how to crush bladder stones. To describe all his “firsts” in medicine would take a book of its own.
Despite his immense knowledge and ability, he always refused to do risky or unknown surgeries that would be stressful physically and emotionally for the patient. He believed in the importance of human life and sought to extend it as long as possible. His precedent was a prime example for effective bedside manner that all doctors should exhibit.
Legacy

Al-Tasrif made its way from al-Andalus throughout the Muslim and Christian worlds. Over the course of centuries, it was translated into Latin and other European languages. Thus, many of the procedures he pioneered were given names that do not indicate that he originated them. For example, the “Walcher position” of childbirth and the “Kocher method” for fixing dislocated shoulders were invented by al-Zahrawi but credited to later European physicians.

Regardless of credit, al-Zahrawi’s contributions to medicine and particularly surgery were revolutionary for his time. Without the procedures and tools that he pioneered, surgery today may still be a barbaric guessing game. His abilities and his consistent recording of procedures helped advance medicine for centuries, and we are still in debt to his genius.