Debunking The Golden Age Of Islam #4: Can Al Zahrawi Be Considered The Father Of Surgery?
Today’s article and video is the fourth in my series Debunking the Golden Age of Islam and the whole project is turning into something of a personal journey. I’m a great believer in becoming reasonably well-versed in a topic because the only way to get past a superficial cliches is by digging a bit deeper. Furthermore, if your understanding of an area is very solid, it allows you to extrapolate into other areas and fill in gaps in your knowledge almost as if it were a jigsaw puzzle.
The more I find out about the so-called Islamic Golden Age, the clearer it becomes that there was definitely a flowering of learning and investigation in the Muslim world between the middle of the 8th and tenth centuries, which continued to have an influence on Islamic thought well into the 13th century. So while not denying that advances in many scientific fields were made, three main questions occur to me. Firstly, Why did this flowering of knowledge take place and where did the knowledge it was based on come from? Secondly, Did the period give us any groundbreaking discoveries that are still in use today? And finally, Why did the creative period in the Islamic World come to an end and is it likely to return?
These three questions are going be part of the subtext of all the articles and videos in the series, and today we’re going to be look at them in the context of Islam’s contribution to medicine or more specifically, surgery, because the central character is Abu Qasim Al-Zahrawi, the third inventor to make an appearance in 1001 Inventions and the Library of Secrets.
Abu Qasim Al-Zahrawi was an Arab Muslim physician and surgeon, who lived in Al-Andalus between from 936 to 1013 and spent most of his life in Cordoba as court physician to Andalusian caliph, Al-Hakam II. In the 1001 Inventions video, Al-Zahrawi describes himself as the Father of Surgery claiming that many of the surgical tools that he invented are still used in modern hospitals. The use of catgut for stitches is also attributed to Al-Zahrawi.
Paul Vallely’s How Islamic inventors changed the world article has plenty to sayabout Al-Zahrawi but also makes even stronger claims about Islam’s contribution to surgery. This what he has to say:
“Many modern surgical instruments are of exactly the same design as those devised in the 10th century by a Muslim surgeon called al-Zahrawi. His scalpels, bone saws, forceps, fine scissors for eye surgery and many of the 200 instruments he devised are recognisable to a modern surgeon. It was he who discovered that catgut used for internal stitches dissolves away naturally (a discovery he made when his monkey ate his lute strings) and that it can be also used to make medicine capsules. In the 13th century, another Muslim medic named Ibn Nafis described the circulation of the blood, 300 years before William Harvey discovered it. Muslims doctors also invented anaesthetics of opium and alcohol mixes and developed hollow needles to suck cataracts from eyes in a technique still used today.”
Fortunately, WikiIslam’s How Islamic Inventors Did Not Change The World debunks these claims easily.
“More than a thousand years before al-Zahrawi, the Greek and Roman physicians in the Classical World had access to a variety of surgical instruments. This is known through several ancient texts which give brief descriptions and also from a 1887 find in the ruins of Pompeii. A house that belonged to a Greek surgeon in 79 AD was identified by its large stores of surgical equipment numbering over a hundred. These medical instruments, which are now on display in museums around the world, were all available to the ancient Greek physician Hippocrates (460–370 BC) who lived more than a thousand years before Islam, and many of them in a similar form are still being used today. These instruments include a variety of scalpels, hooks, uvula-crushing forceps, bone drills, bone forceps, catheters and bladder sounds, vaginal speculum, and even a portable medicine chest to carry them in. It was also the Greek physician and medical researcher Claudius Galenus (129–217 AD), someone who greatly influenced Western medical science, who first used catgut to close wounds and not al-Zahrawi. In fact “Muslim” physician Ibn Sina (Avicenna) 700 years later (920 AD) used a pig product. The actions of a pious Muslim, we’re sure.
As for the circulation of the blood, it may have been described by Muslim medic Ibn Nafis 300 years before William Harvey, but the Chinese Book of Medicine describes this 1,600 years before Ibn Nafis.
The article also alleges that Muslim doctors first developed hollow needles to suck cataracts from the eye, and anaesthetics of opium and alcohol mixes. This is not so. Cataract surgery has been performed for many centuries. The earliest reference to cataract surgery was written by the Hindu surgeon Susruta in manuscripts dating from the 5th century BC. In Rome, archaeologists found surgical instruments used to treat cataract dating back to the 1st and 2nd century AD. Hollow needles were used to break up the cataract and remove it with suction. Anaesthetics of opium and alcohol mixes were used both by the ancient Chinese and Romans. Greek physician, pharmacologist, and botanist Pedanius Dioscorides (40–90 AD) in his work Materia Medica (one of the most influential herbal books in history) referred to the taking of an alcoholic extract before an operation. This would suggest that it was typical for the surgeons of ancient Rome to decrease pain of an operation by giving their patients sedative drugs.”
The Muslim apologist YouTube channel Ilm Film also has a video about him entitled Abu al-Qasim Al Zahrawi (Albucasis) – the Father of Surgery , which despite the title and a few factual mistakes doesn’t actually exaggerate Al Zahrawi’s importance too much. It describes him as “one of the greatest surgeons in history” as a result of his “outstanding encyclopaedic work Al Tasri” both of which are true. He then says that Al Tasri “has been used in European universities for over 500 years” when in fact the only part of Al Tasri to be translated into Latin was the chapter on surgery. I think the whole book was only translated much later and I’ve also read somewhere that medieval scribes had difficulty copying Al Zahrawi’s medical diagrams correctly. The clip goes on to make some incorrect claims about the translation of Al Tasri as a whole and closes with the statement “many of the 200 instruments he devised are recognisable to modern day surgeons”.
One of the problems with the whole Golden Age of Islam movement is that when you scratch the surface a lot of the information seems to vanish. Here, for example, is the entry for Al Zahrawi in the 1911 Encyclpaedia Britannica.
“ABŪ-L-QĀSIM [Khalaf ibn ‛Abbās uz-Zahrāwi], Arabian physician and surgeon, generally known in Europe as Abulcasis, flourished in the tenth century at Cordova as physician to the caliph ‛Abdur-Rahmān III. (912–961). No details of his life are known. A part of his compendium of medicine was published in Latin in the 16th century as Liber theoricae nec non practicae Alsaharavii (Augsburg, 1519). His manual of surgery was published at Venice in 1497, at Basel in 1541, and at Oxford Abulcasis de Chirurgia arabice et latine cura Johannis Channing (2 vols. 1778).
For his other works see Carl Brockelmann, Geschichte der arabischen Litteratur (Weimar, 1898), vol. i. pp. 239-240.”
If so little was known about him in 1911, it’s unlikely that he could have had such an enormous influence on surgery and medicine for 500 years.
This article on Ophthalmology and Surgery is from the Islamic Culture and the Medical Arts section on the U.S. National Library of Medicine website and gives more details about Al Zahrawi’s contribution to surgery.
“Surgery in general tended to be viewed as distinct from the rest of general medical care, and at least one specialized treatise was written on it. Of major importance in the history of general surgery was the lengthy surgical chapter from the 10th-century medical encyclopedia composed in Spain by al-Zahrawi. This illustrated surgical section circulated by itself and later was influential in Europe through the Latin translation made two centuries later in Toledo by Gerard of Cremona.
Al-Zahrawi divided his discourse on surgery into three parts: on cautery, on incisions and bloodletting, and on bonesetting. He included in it copious illustrations and descriptions of instruments, which made the treatise particularly valuable even though scribes often misunderstood the illustrations when copying the treatise. He combined the surgical ideas derived from Greco-Roman sources with his own observations and experiences, and modified many of the earlier instruments as well as designing some new ones. For example, he described a bevel-ended cannula, instead of the earlier straight one, for use in drawing off liquid when treating abdominal dropsy. He introduced a technique using a fine drill inserted through the urinary passage for treating a calculus impacted in the urethra, and he designed a concealed knife for opening abscesses in a manner that would not alarm the nervous patient. Variations in the design of a vaginal speculum or dilator were introduced, and forceps described, though not for use in live births.”
The sentence “He combined the surgical ideas derived from Greco-Roman sources with his own observations and experiences, and modified many of the earlier instruments as well as designing some new ones” makes it clear that Al Zahrawi based his work on earlier sources and addresses my first question. Islamic scholars were not working in a vaccuum and the fact that Islam had conquered so many different cultures meant they had access to knowledge that was available to their Western European counterparts. Greco-Roman knowledge was particularly important in the field of Medicine whereas Hindu or Chinese knowledge was often more relevant in fields such as Mathematics, Astronomy or Physics.
In fact, in the 1973 edition of Al-Zahrawi claims that his knowledge comes from careful reading of previous medical texts as well as his own experience: “… whatever skill I have, I have derived for myself by my long reading of the books of the Ancients and my thirst to understand them until I extracted the knowledge of it from them. Then through the whole of my life I have adhered to experience and practice … I have made it accessible for you and rescued it from the abyss of prolixity”.
Furthermore, it appears that it was in the field of cauterisation that Al Zahrawi made most progress with respect to physicians who had gone before him. He openly disparages the opinion that cauterisation should only be used in the spring season and counter to popular belief, preferred to use iron rather than gold. He also had his opinions on methodology as the following quotation shows. “Now one of the Ancients mentioned that there were some people who used an iron cautery shaped like a probe, and introduced it red hot into the intercostal space until it reached the abscess itself and evacuated the pus … but in this perforation with the cautery there is a danger either that the patient may die on the spot or that an incurable fistula may raise at the place”.
However, addressing my second question, Can any or of these discoveries be considered groundbreaking in a Newtonian, Darwinian or Einsteinian sense? I don’t think so. I think Al Zahrawi, like many other Islamic scholars of his day, made important contributions to the progress of knowledge in his chosen field. He made some discoveries and improvements but in many respects the importance of his Al Tasri is that it compiled what was known about medicine at the time. It is for this reason that his works and those of others, such as Ibn Sina (Avicenna), were used as medical student textbooks until the next wave of scientific discovery came about in the 17th and 18th centuries.
So that brings us on to the Why did the creative period now known as the Islamic Golden Age come to an end and is it likely to return? The reason why it came to an end was probably the increasing weakness and eventual fall of the Abbasid Caliphate in Baghdad in 1238 and the Caliphate of Cordoba even earlier in 1031 but the reason why there has been no resurgence is more down to the Asharite school of jurisprudence that came to dominate late medieval Islam. This is what Wikipedia has to say about Asharite Occasionalism and how it affected Islamic thought.
“The doctrine first reached prominence in the Islamic theological schools of Iraq, especially in Basra. The ninth century theologian Abu al-Hasan al-Ash’ari argued that there is no Secondary Causation in the created order. The world is sustained and governed through direct intervention of a divine primary causation. As such the world is in a constant state of recreation by God.
The most famous proponent of the Asharite occasionalist doctrine was Abu Hamid Muhammad ibn Muhammad al-Ghazali, an 11th-century theologian based in Baghdad. In The Incoherence of the Philosophers, Al-Ghazali launched a philosophical critique against Neoplatonic-influenced early Islamic philosophers such as Al-Farabi and Ibn Sina. In response to the philosophers’ claim that the created order is governed by secondary efficient causes (God being, as it were, the Primary and Final Cause in an ontological and logical sense), Ghazali argues that what we observe as regularity in nature based presumably upon some natural law is actually a kind of constant and continual regularity. There is no independent necessitation of change and becoming, other than what God has ordained. To posit an independent causality outside of God’s knowledge and action is to deprive Him of true agency, and diminish his attribute of power. In his famous example, when fire and cotton are placed in contact, the cotton is burned not because of the heat of the fire, but through God’s direct intervention, a claim which he defended using logic. In the 12th century, this theory was defended and further strengthened by the Islamic theologian Fakhr al-Din al-Razi, using his expertise in the natural sciences of astronomy, cosmology and physics.
Because God is usually seen as rational, rather than arbitrary, his behaviour in normally causing events in the same sequence (i.e., what appears to us to be efficient causation) can be understood as a natural outworking of that principle of reason, which we then describe as the laws of nature. Properly speaking, however, these are not laws of nature but laws by which God chooses to govern his own behaviour (his autonomy, in the strict sense) — in other words, his rational will. This is not, however, an essential element of an occasionalist account, and occasionalism can include positions where God’s behaviour (and thus that of the world) is viewed as ultimately inscrutable, thus maintaining God’s essential transcendence. On this understanding, apparent anomalies such as miracles are not really such: they are simply God behaving in a way that appears unusual to us. Given his transcendent freedom, he is not bound even by his own nature. Miracles, as breaks in the rational structure of the universe, can occur, since God’s relationship with the world is not mediated by rational principles.”
So is an Islamic Golden Age likely return or rather is the Muslim world likely to put itself on a par with West or even places in other parts of the world such as Japan or South Korea, which have embraced the Western spirit of enquiry? It’s clear from reports we see that there is high investment in technology in many Muslim states but the Muslim world until the religious strangehold that Islam has over it is relaxed.
As so far there have only been two, a few more Muslim Nobel prize winners would be a good sign as would a number higher than nine scientists, engineers, and technicians per thousand people in Muslim countries compared with an average of 41 worldwide. However, this won’t happen until attitudes to education and investigation change and the wider population is given access to this rather than dogmatic theocratic Quran-based madrassas. We have little hope of reforming Islam in the immediate future so our energies are best used in helping people escape from its cult-like grip.
Watch on YouTube
Watch on VidMe
1001 Inventions and The Library of Secrets – starring Sir Ben Kingsley as Al-Jazari
How Islamic inventors changed the world
How Islamic Inventors Did Not Change The World
Abu al-Qasim Al Zahrawi (Albucasis) – the Father of Surgery
1911 Encyclopædia Britannica/Abu-l-Qasim
Islamic Culture and the Medical Arts: Ophthalmology and Surgery
Science in a Golden Age – Al-Razi, Ibn Sina and the Canon of Medicine