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A. B. Khan It is generally spoken that Muslims did not contribute to our knowledge of anatomy and surgery as the Muslims law prohibited dissection of the human body. Their knowledge was mainly derived from Greeks and animal dissections. However, on a more careful study of Arabic medical literature, we find that Muslims contributed a lot towards surgery. The present paper deals with the independent contribution by al-Razi, Ibn Sina and al-Zahrawi etc. towards surgery. The paper also includes the Islamic surgery in France during the first two decades of the present century A.D. AI-Razi (841-926 A.D.) was the first to describe the use of the Seton, (a sort of thread which keeps the wound open), suturing of wounds by the use fo silk thread, catgut and the use of alcohol in surgery was also for the first time described by al-Razi. He carried out skilfully the operation of eye specially of cataract for which he became very much famous in his time. He knew well that cataract was due to the ,; opacity of lense. Al-Razi and many other Arab Ophthalmologists used various kinds of lenses for defective visions. The commentator of al-Asbab has mentioned these lenses in the chapter on cataract 1. Al-Razi performed the operation of Tracheotomy on Wazir Ahmad Ibn Ismail in the case of tracheal obstruction due to diphtheria. This was his excellent operation for which he became more famous in Khurasan 2 . Ibn Sina deserves the credit for introducing the treatment of lacrymal fistula by probing when he suggested the introduction of a medical probe into the channel. Dry dressing was also stressed by him in his Canon. He pointed out that healing was hastened by this method. He also deserves the credit for prescribing the complete and thorough removal of the tissues and all blood vessels of the affected part and its adjoining areas as the treatment of cancer (Sa/tan). According to him even then the cure was not certain 3 . The greatest of Muslim surgeons was undoubtedly Abul- Qasim- Khalaf- ibn-al-Abbas (1936- -1013), known as al-Zahrawi. His book al- Tasrif li-man Ajazanal- Talif established his name not only as the best surgeon produced by the Arabs but also as one of the best and most frequently quoted surgeons during the middle ages. This book was the guide to the early European surgeons in the Renaissance and was used as a text book until the beginning of seventeenth century 4 .The most important part of the book is the last section dealing with surgery .It contained all the surgical knowledge upto that time and laid great stress on cautery and vene-section. He used the cautery extensively for opening of abscesses and for the removal of cancer in preference to incision as advised by Hippocrate. In describing the technique for opening of the liver abscess with cautery, al-Zahrawi speaks of the necessity of having adhesion between liver and the peritoneum, otherwise there will be danger of pus going to the general peritoneal cavity causing the death of the patient. AI-Zahrawi was the first to treat surgery as a distinct science founded on the knowledge of Anatomy and separate from the other medical branches. He advised the ligature of vessels and should also be considered first to use hooks in the extraction of polyps. He was first to teach the methods of vaginal lithotomys. Spencer holds that Zahrawi was the first to write on the treatment of the deformities of mouth and dental arches and the first to describe the " Walcher Position of Child 11.6 He was the first to describe the haemorrhagic diathesis, having noted several cases in one family and treated them by cautery. He also invented many delicate surgical instruments and has reported 280 in his book. Zahrawi has given full description in his book about the operation of hydrocephalus, cataract, removal of vesicle calculi from bladder, complete removal of breast carcinoma, thyroidectomy, transversal tracheotomy, operation on the cervical Iymphnodes, elephantiasis, scrotal and anal surgery and orthopaedic surgery etc... besides above mentioned surgery. He added greatly from his wealth of experience. His personal observations he gives, are very important and clearly show that he was a skilful and experienced operator. His precise description about the symptoms and private technique show that he had repeatedly done the work and done it well 7. Some of these Arab Muslims developed a method for the reduction of shoulder dislocation known even now as the Arabian method. In the use of anaesthesia in surgery they were the pioneers. They probably invented the anaesthesia sponge which was extensively used during the Middle Ages. They also deserve the credit of causing unconsciousness in certain cases for seven days before the major operation 8 . ISLAMIC SURGERY IN FRANCE In 1912, Mr. Hilton Simpson , an English man visited the northern part of Africa which comes under France and known as Aures. This place is surrounded by hills and forests, so the people living there got no awareness about the progress and development of the rest of the world. His basic aim was to study the condition of the people living there. Mr. Hilton has given a detailed description about his visits in his book, Arab Medicine and Surgery This book was published in 1 922 by the Oxford University Press, London. In Aures he came to know about a group of Arab Muslims who were excellently and smoothly doing surgery specially the operation of craniotomy which is even now a major and difficult operation. Their surgical activities were legally prohibited by the Government of France. Anyhow, Mr. Hilton Simpson succeeded in contacting those surgeons and making them friends after assuring that he will not disclose their surgical activities to the government officials. He visited Aures four times, first in 1912, second in 1913, third in 1914 and the fourth in 1920. In the third visit he brought about fifty instruments and drugs used by those surgeons and in 1919 he presented these materials to the Royal Society of Medicine. To complete his notes, Mr.Hilton visited Aures the fourth time in 1920. This time he was able to know about hundred more surgical instruments and the drugs used in surgery 9. He has reported in detail about Craniotomy, removal of bone from limbs with their substitution, fractures and management of collar bone ribs and jaw, hernia, dentistry, eye surgery, skin grafting, obstetric surgery and bullet wounds and its management etc.. but I am taking here only Craniotomy as example because it is not possible here to describe each and everyone. OPERATION ON SKULL (CRANIOTOMY) Majority of the Aures surgeons completely removed a portion of the scalp usually with the help of cylindrical or slightly oblong cutting instrument resembling a gun maker "wad punch". It was used red hot in which cutting edge was placed at right angles to the hand, variants of this being small circular or diamond shaped specimen with the cutting edge in the same plane as the handle which had been designed by one successful operator . When scalping with the knife or by means of the scalping-knife and saw combined, some surgeons used to tie a handkerchief tightly around the patient's head in order to check haemorrhage. Then a rectangular piece of skin was removed in four straight cuts, others made two incisions intersecting at right angles and then turning back the points of scalp which were retained by means of hooks or by a V-shaped spring inserted between the flaps. Some surgeons employed the knife cold, others red hot while some used an instrument specially made for the making of incisions by means of red hot wade. When the scalp over the seat of the injury had been removed or turned back, many surgeons scraped away tissues adhering to the bone by applying a fan shaped scraper or of a combined saw and scraping instruments. Some surgeons used to treat the surface of the bones with powdered bark of Juniperus Phoenicea upon which a little warm butter was poured, before commencing the work upon it. The next step of the operation was the perforation of the skull by means of a drill. The purpose of this perforation was to let out any pus or blood which may be beneath the bone. The drill was merely used to produce a shallow hole in order to serve as a starting point for the saw. In some cases several holes were made with the drill e.g. where cracks in the bone radiated from a central punctured wound. It was a collective opinion of those surgeons that drill should be applied to the good bone just clear of the damaged surface beyond the extrimities of the cracks. After the work of drill was over the operation continued with the saw. Most of the surgeons completed sawing in one and a half hour. The damaged piece of the skull having been completely sawn round, was very carefully lifted out by means of elevators and retractors. Some left it in position for three days in order that nerves of the dead bone may withdraw on third day, others still left it from ten to fifteen days preventing the scalp from a tendency to close over it, meanwhile by applying a pad of cotton soaked in honey and butter. After the interval of ten or fifteen days, the fragment of the bone was found to have risen up so as to be easily removed. This whole process of the operation was generally completed in thirteen hours. These surgeons were of the opinion that this operation must be done within seven days of injury. Some surgeons immediately lift away the bone after sawing and recommended a dressing of the gum of Aleppopine melted with sheep butter upon which a few drops of honey was poured subsequently sprinkling a little of the finest wheat and barley flour upon the dressing. Then a pad of wool was applied which was retained in position by a rectangular leaden weight, slightly larger than the hole and fitted with a boss of its upper surface through which was passed a thread wherewith to raise it. The object of the weight was to check the tendency of the brain to rise up through the aperture formed in the skull by the operation. The dressing was renewed daily for a fortnight. After seven days the duramater was seen to have become steady save for the pulsation permanently noticeable even when the scalp had closed over the aperture. Duramater appeared red in colour instead of white with red tissues in it as appeared when first revealed by the operation. After a fortnight of daily dressing it was replaced alternatively for a month or six weeks, at the end of which time the patient restored normal health. Few surgeons used the powdered leaves of Ajugaiva and Tencrium polium mixed together for sprinkling upon a dressing of butter while another employed a butter dressing upon which was sprinkled some powdered saffron and white cone sugar before pitch of pine was poured over it. None of the surgeons applied stitches to the scalp and none attempted to replace the bone removed, by any form of artificial plate. However, grandfather of one of these surgeons had replaced the bone by means of a cap plaited Halfagrass .Another surgeon used a piece of Camel's skin as his material. Here, I am reporting in brief about Haemostatics, and anaesthetics used by Aureus surgeon along with their method of sterilization of surgical instruments. Haemostatics: These surgeons besides cautery and ligation of vessels to check the haemorrhage used to apply this drug combin ation. (1) Ashes of rag or paper, (2) A piece of wool dripped in olive oil, (3) powdered green leaves of solanum nigrum, (4) Fresh leaves or barks of the walnut tree, (5) dried goat's dung (6) Damp earth, (7) powdered gallnut, (8) sulphide of copper, (9) Juniperus Phoenicea. Anaesthetics: Most of the Aures surgeons performed their operations without anaesthesia but the fol- lowing drugs had been reported to be in the use of these surgeons. (1) Hyocyamus albus, (2) 3 grams of the powdered fresh seeds of wild opium swallowed in rose water was sufficient to produce unconsciousness in the patients for fifteen minutes, (3) white excrement of the lizard uromastrix acanthinurus was dried, powdered and applied to wounds, such as those caused by a bullet. This was also proved as an excellent local anaesthetic while some such operations as the removal of a foreign body was carried out. Method of Sterilization: These surgeons generally made incisions by means of red-hot cutting instruments. This appeared to be done to check haemorrhage and not to secure surgical cleanliness. Dressings for wounds: A number of dusting powders were prepared and used by the surgeons to cuts, e.g. dried and powdered leaves of Globularia alypum, dried and powdered leaves of Tamarix gallica, L.mixed in equal parts with alum, dried and powdered leaves of Ajugaiva L. mixed with a little alum, green leaves of Marrubium supinum, L, dried in the sun, powdered and mixed with a little alum, dried and powdered leaves of Erodium Guttatum and five parts of the dried and powdered leaves of Erodium Malocoides mixed with one part alum etc.. Besides these powders, some ointments were also used for suppurating wounds and sores, such as, (a) six parts of the drugs of red-vinegar boiled over a charcoal fire with six parts of honey and mixed with one part of copper acetate, (b) Honey heated till it simmers with equal parts of red vinegar, copper acetate, Myrrh and aloes. These Aures surgeons were so expert in operating on skull that some of them could cut through the shell of an egg without damaging its inner membrane and so gentle were their methods of operation that the patient rarely fainted during the operation. Mr. Hilton Simpson has given detailed description about the kinds, shape and size etc.. of the knives, drills, saws, retractors, elevators and weight etc.. in his book along with illustrations. REFERENCES 1.
SIDDIQUI, n.z., "Studies in Arabic and Persion Medical Uterature",
1959, pp. XIV-XXI,. |
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