How a 10th-century Muslim surgeon revolutionised surgical procedures

Abu al Qasim al Zahrawi was a man ahead of his time. Known as the father of operative surgery, he invented over 200 surgical tools in the 11th Century, which saved millions of lives. He was not given enough credit for his discoveries, however.  

One of Al Zahrawi's highly acclaimed books is ‘Al Tasrif’, the first illustrated encyclopedia of surgical tools, which was used as a manual in European universities for over 500 years, influencing modern scientific perspectives on operative surgery and contributing to Europe's Renaissance. The book has 30 chapters, a result of Zahrawi's 50 years of medical practice and experience. 

Commonly known by his Latin(ised) name Albucasis, al Zahrawi's skills and knowledge of surgery earned him the title of the greatest medieval surgeon of the Islamic world and the Middle Ages. He pioneered the use of catgut for internal stitches and his surgical instruments are still used today. Al Zarhawi was influenced by the treatments of diseases as told by the Prophet Muhammed and used them to treat people. 

He developed surgical tools for C-sections and cataract surgeries and was also the first to discover the root cause of paralysis. Before him, it was not known what exactly caused paralysis. Al Zahrawi explained how it comes from fracturing the spine. He's also known for using a unique combination of chemicals for sterilisation of surgical tools, which had a similar impact to anti‐bacterial properties in our age. 

Over a hundred years after Zahrawi's death, the famous Italian translator of scientific manuscripts Gerard of Cremona arrived in Spain to translate his work from Arabic to Latin. By 1250, England had its first, now oldest, medical manuscript and according to the British Medical Journal, it has a "startling similarity" with Al Zahrawi’s encyclopedia. 

The period between the 8th Century and the 13th Century commonly known as the Islamic Golden Age has produced countless scholars. Muslim intellectuals made groundbreaking inventions, contributing to various branches of human knowledge such as philosophy, astronomy, mathematics and medicine.

Al Zahrawi also played a pivotal role in neurosurgical diagnosis, which includes management of head injuries, spinal injuries, skull fractures, hydrocephalus and subdural effusions.

Once in his lifetime, he came across a baby boy whose head was abnormally large. His diagnosis was spot on as he vividly described how the abnormality, now known as hydrocephalus, occurs due to the defective drainage of cerebrospinal fluid, a colourless body fluid found in the brain and spinal cord. 

The Origins

Born in 936 in El Zahra near Cordoba in southern Spain, Zahrawi came of age during the time of the Umayyad Caliphate, one of the most prosperous periods of Islamic history.

As a medical genius he spent more than 50 years serving as the court physician to the second caliph of Cordoba, al Hakam II, and al Mansur, the de facto ruler of Muslim Spain after the death of al Hakam. 

It is narrated that his family tree was originally from al Ansar of al Madina al Monawara (now in the Kingdom of Saudi Arabia). 

Other works

Al Zahrawi has made significant contributions to pediatric surgery as well. He was the first to explain medical aspects of haemophilia in detail. 

He was said to have been the first surgeon to use cat intestines for sutures. The practice of stitching up internal cuts and wounds using a thread like material made of animal intestines was followed for several centuries. 

Al Zahrawi also described the tracheotomy operation and performed it as an emergency on one of his servants. He was the first to detail the classic operation for breast cancer, lithotripsy for bladder stones, techniques for removing thyroid cysts, treatment of sebaceous cysts using an exploratory needle, and treatment of lacrimal fistula by converting it to a fistula into the nasal cavity using cautery. 

In the field of obstetrics and gynaecology, Al Zahrawi described several instruments used for delivery and was the first to describe the “Walcher position” in obstetrics and also first to teach the lithotomy position for vaginal operations.

One of Zahrawi’s greatest contributions

Zahrawi's 30-volume medical encyclopedia consists of three books on cauterisation, incision, perforation, venesection, wounds and bone-setting. In the pharmacology and therapeutics section, he discussed several drugs from cardiac drugs and laxatives to cosmetology and dietetics. In his book, ‘Liber Servitoris’, Zahrawi also gave some tips about how to prepare the simple and compound-complex drugs used in those days.

In the surgery section, he handled eyes; ear, nose and throat; head and neck; general surgery; obstetrics and gynaecology in all its aspects while including military medicine, urology, orthopaedics – even what later became known as “Kocher’s method” for reducing a dislocated shoulder.

Furthermore, he described how to ligate blood vessels 600 years before Ambroise Pare. Besides, he wrote extensively about bones and joints while mentioning fractures of the nasal bones and vertebrae.

His book contains pictures of gynaecological instruments used in the 10th Century, in his book Al Zahrawi also described the surgical options of treating gynecomastia and his techniques are still considered for such conditions nowadays.

Al Zahrawi’s medical writings were highly regarded in the West following their translation by Gerard of Cremona, Rogerius Frugardi, Ronaldus Parmensis and others. General acceptance believes that his surgical teachings were the most advanced in the Middle Ages until the thirteenth century. 

The famous 14th-century French surgeon Guy de Chauliac quoted him over 200 times in his book, which was published in cities such as Venice, Basel and Oxford up until the 18th Century. 

After a long and distinguished medical career, he died in 1013 AD at the age of 77.