Al-Tasrif

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Abu'l Qasim al-Zahrawi's 11th century medical encyclopedia: Kitab al-Tasrif.

The Kitab al-Tasrif (Arabic,كتاب التصريف لمن عجز عن التأليف) (The Method of Medicine) was an influential Arabic medical encyclopedia on medicine and surgery, written near the year 1000 CE by Abu al-Qasim al-Zahrawi (Abulcasis), the "father of modern surgery". The 30-volume work includes anatomical descriptions, classifications of diseases, information on nutrition and surgery, and sections on medicine, orthopaedics, ophthalmology, pharmacology, nutrition, and especially surgery.

In the Western world, the book was known by the Latin title Concessio ei data qui componere haud valet. For at least six centuries, it remained an important medical practice guide for doctors and surgeons in both the Islamic world and medieval Europe.

Overview

Content

File:Al-zahrawi surgical tools.gif

Page from a 1531 Latin translation by Peter Argellata of al-Zahrawi's Kitab al-Tasrif on surgical and medical instruments.

The Kitab al-Tasrif التصريفcovered 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 emphasised 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.

Not always properly credited, Abu Al-Qasim'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 before Ambroise Paré, and was the first recorded book to document several dental devices and explain the hereditary nature of haemophilia.

Influence

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.

In the 14th century, French surgeon Guy de Chauliac quoted al-Tasrif over 200 times. Pietro Argallata (d. 1453) described Abu al-Qasim as "without doubt the chief of all surgeons". In an earlier work, he is credited to be the first to describe ectopic pregnancy in 963, in those days a fatal affliction. Abu Al-Qasim's influence continued for at least five centuries, extending into the Renaissance, evidenced by al-Tasrif's frequent reference by French surgeon Jaques Delechamps (1513-1588).

Advances in Surgery

Abu al-Qasim was a surgeon and specialized in curing disease by cauterization. He also invented several devices used during surgery, for the purpose of:

• inspection of the interior of the urethra
• applying and removing foreign bodies from the throat
• inspection of the ear

Abu al-Qasim also described surgical instruments unique to women, such as the use of forceps in vaginal deliveries. He also carried out the first breast reduction surgeries, using methods resembling modern techniques, as described in the Kitab al-Tasrif.

Dental surgery

In dentistry and dental restoration, the earliest medical text to deal with dental surgery in detail was the Al-Tasrif by Abulcasis. He gave detailed methods for the successful replantation of dislodged teeth.

Dissection

Abu al-Qasim was influential in the revival of dissection in the study of anatomy and surgery. He emphasizes the importance of dissection in the surgical chapter of the Al-Tasrif:

"Now this is the reason why there is no skillful practitioner in our day: the art of medicine is long and it is necessary for its exponent, before he exercises it, to be trained in the science of anatomy/dissection (Urn al-tashrih), as Galen has described it, so that he may be fully acquainted with the uses, forms and constitutions of the parts; also how they are related and in what way they are independent; that he should understand fully also die bones, nerves, and muscles, their numbers and origins; and also the blood vessels, body arteries and veins, with the locations of their sources.... For he who is not skilled in as much anatomy as we have mentioned is bound to fall into error that is destructive to life."

Lithotomy and Urology

In urology and lithotomy, Abulcasis performed the first successful extraction of bladder and kidney stones from the urinary bladder using a new instrument he invented—a lithotomy scalpel with two sharp cutting edges—and a new technique he invented—perineal cystolithotomy—which allowed him to crush a large stone inside the bladder, "enabling its piecemeal removal." This innovation was important to the development of bladder stone surgery as it significantly decreased the death rates previously caused by earlier attempts at this operation by the ancients.

Neurosurgery

Abulcasis developed material and technical designs which are still used in neurosurgery. The first clinical description of and operative procedure for hydrocephalus appears in the Al-Tasrif by al-Zahrawi, who clearly described the evacuation of superficial intracranial fluid in hydrocephalic children. He decribed it in his chapter on neurosurgical disease, which describes traumatic head injuries, fractures of the spine, skull tumors, and infantile hydrocephalus, which he supposed was caused by mechanical compression. He states:

“The skull of a newborn baby is often full of liquid, either because the matron has compressed it excessively or for other, unknown reasons. The volume of the skull then increases daily, so that the bones of the skull fail to close. In this case, we must open the middle of the skull in three places, make the liquid flow out, then close the wound and tighten the skull with a bandage.”

Plastic surgery

Abulcasis made the first advances in plastic surgery since the time of Sushruta in ancient India. Abulcasis developed the methods of incision, the use of silk thread suture to achieve good cosmesis, and invented the surgical procedure of reduction mammoplasty for the management of gynecomastia.

Surgical instruments

In his Al-Tasrif, al-Zahrawi introduced his famous collection of over 200 surgical instruments. Many of these instruments were never used before by any previous surgeons. Hamidan, for example, listed at least 26 innovative surgical instruments that Abulcasis introduced.

Adhesive bandage and Plaster

Abu al-Qasim invented the modern plaster and adhesive bandage, which are still used in hospitals throughout the world. The use of plasters for fractures became a standard practice for Arab physicians, though this practice was not widely adopted in Europe until the 19th century.

Catgut and Forceps

Abu al-Qasim pioneered the use of catgut for internal stitching, which is still practised in modern surgery. The catgut appears to be the only natural substance capable of dissolving and is acceptable by the body. Salim Al-Hassani considers it to be one of the most important Muslim medical contributions.

Abu al-Qasim invented the forceps for extracting a dead fetus, as illustrated in the Al-Tasrif.

Cautery and Ligature

A special medical instrument called a cauter, used for the cauterization of arteries, was first described by Abu al-Qasim in his Kitab al-Tasrif.

In the Al-Tasrif, Abu al-Qasim also introduced the use of ligature for the blood control of arteries in lieu of cauterization.

Cotton dressing

Al Zahrawi was the first surgeon to make use of cotton (which itself is derived from the Arabic word qutn) as a medical dressing for controlling hemorrhage.

Lithotomy scalpel and Surgical needle

Abulcasis invented a lithotomy scalpel with two sharp cutting edges in order to perform the first successful extraction of bladder and kidney stones from the urinary bladder.

The surgical needle was invented and described by Abu al-Qasim in his Al-Tasrif.

Other instruments

Abū al-Qāsim devised about 200 new surgical instruments such as scalpels, curettes, retractors, spoons, sounds, hooks, rods and specula.

Chemistry and Cosmetology

Al-Zahrawi was also a chemist and dedicated a chapter of the 19th volume of his Kitab al-Tasrif to cosmetology, The medicated cosmetics he invented include under-arm deodorants, hair removal sticks, hand lotions, hair dyes for changing human hair color to blond or black hair, hair care for correcting kinky or curly hair, and early suntan lotions, describing their ingredients and benefits in depth. As a remedy for bad breath resulting from eating garlic or onions, he suggested cinnamon, nutmeg, cardamom and chewing on coriander leaves.

Other cosmetics he invented include solid lipsticks which were perfumed stocks rolled and pressed in special moulds, and mineral oils used for medication purposes as well as aesthetic and beautification purposes. He also described the care and beautification of hair, skin, teeth and other parts of the body, which were all recommended in Islamic hadiths.

Cosmetic dentistry

In cosmetic dentistry, he described methods for strengthening the gums as well as the method of tooth bleaching using tooth whiteners.

Flowers

The al-Tasrif introduced the modern cultural tradition of taking flowers whenever visiting the sick in hospital (Bimaristan).

Perfumery

He made several advances in perfumery and invented perfumed stocks, rolled and pressed in special moulds, similar to modern roll-on deodorants.

He also recommended that after laundry, clothing should be in a room full of incense or perfume, so that the clothes will give a pleasant fragrance.

Other advances

Medication

Al-Zahrawi developed a variety of medications, which he described in his chapter on cosmetics. For epilepsy and seizures, he invented medications called Ghawali and Lafayfe. For the relief and treatment of common colds, he invented Muthallaathat, which was prepared from camphor, musk and honey, similar to modern Vicks Vapour Rub. He also invented nasal sprays and hand cream, and developed effective mouth washes.

Hematology and heredity

In hematology, al-Zahrawi wrote the first description on haemophilia, a hereditary genetic disorder, in his Kitab al-Tasrif, in which he wrote of an Andalusian family whose males died of bleeding after minor injuries.

External links

• Al-Tasrif - islamset.com