Al-Zahrawi: The Father of Surgery

Who He Was

Abu al-Qasim Khalaf ibn al-Abbas al-Zahrawi (936–1013 CE), known in the West as Abulcasis or Albucasis, was an Andalusian Arab physician and surgeon who served as court physician to the Caliph al-Hakam II in Córdoba. He is considered one of the greatest surgeons in history and the founder of modern surgical science.

What He Did

Al-Tasrif: His Kitab al-Tasrif, a 30-volume medical encyclopaedia compiled over five decades of practice, was the first illustrated surgical guide in history. The historian of medicine Arturo Castiglioni wrote that al-Zahrawi's treatise "in surgery held the same authority as did the Canon of Avicenna in medicine." It was translated into Latin by Gerard of Cremona in the 12th century and became the standard surgical textbook in European universities at Salerno and Montpellier for the next five centuries.

Surgical instruments: Al-Zahrawi introduced over 200 surgical instruments, most of which he invented himself: scalpels, retractors, curettes, pincers, specula, forceps, and cauterisation devices. Many of these instruments had never been used before. His use of catgut for internal stitching (discovered, according to tradition, when his monkey ate the strings of his oud) is still practised in modern surgery. Catgut is the only natural substance capable of dissolving in the body without harm.

Specific firsts:

• First to describe the hereditary nature of haemophilia
• First illustrated dental instruments and dental procedures, including replantation of teeth
• First to describe migraine surgery by ligating the temporal artery, a procedure enjoying revival in the 21st century
• First to use a lithotrite to crush bladder stones internally, avoiding dangerous open surgery
• First to describe the forceps for extracting a dead foetus
• First detailed description of surgical techniques for cauterisation across approximately 50 different operations

His principle: Al-Zahrawi insisted that surgery must not be attempted without thorough knowledge of anatomy. He wrote: "Before practising surgery one should gain knowledge of anatomy and the function of organs so that he will understand their shape, connections and borders. He should become thoroughly familiar with nerves, muscles, bones, arteries and veins." This principle (that anatomy is the foundation of surgery) is now self-evident. In his time, it was revolutionary.

What Was Attributed to Others

Several procedures first documented by al-Zahrawi were attributed to European surgeons who came centuries later:

• What became known as "Kocher's method" for treating a dislocated shoulder was described by al-Zahrawi 900 years before Kocher
• The "Walcher position" used in difficult childbirth deliveries was described by al-Zahrawi centuries earlier
• The ligation of blood vessels (attributed to the French surgeon Ambroise Paré in the 16th century) was described by al-Zahrawi nearly 600 years before Paré
• Migraine surgery by temporal artery ligation: Paré recorded this as well, nearly 600 years after al-Zahrawi's description

The Frontiers for Young Minds summary states plainly: al-Zahrawi "pioneered ground-breaking medical procedures that were ascribed to later physicians, without any credit to al-Zahrawi."