,drawings and ,pharmacy in al-,zahrw's #ajth-,century ,surgical ,treatise by ,sami ,hamarneh ,paper #bb1 pages #ha-id1 from ,,contributions ,,from ,,the ,,museum ,,of ,,history ,,and ,,technology ,,united ,,states ,,national ,,museum ,,bulletin #bbh ,,smithsonian ,,institution ,,washington1 ,d4,c41 #aifa ,illustration3 ,figure #a4--,reproduction of a page from original ,arabic manuscript indexed as ,cod4 ,n4,f4 #dgf;,a at ,oesterreichische ,nationalbibliothek in ,vienna4 ,courtesy ,oesterreichische ,nationalbibliothek4 ,drawings and ,pharmacy in al-,zahrw's #ajth-,century ,surgical ,treatise by ,sami ,hamarneh ,probably the earliest independent work in ,arabic ,spain to embrace the whole of medical knowledge of the time is the encyclopedic al-,tasrf1 written in the late #ajth century by ,ab al-,qsim al-,zahrw1 also known as ,abulcasis4 ,consisting of #cj treatises1 it is the only known work of al-,zahrw and it brought him high prestige in the western world4 ,here we are concerned only with his last treatise1 on surgery4 ,with its many drawings of surgical instruments1 intended for the instruction of apprentices1 its descriptions of formulas and medicinal preparations1 and its lucid observations on surgical procedures1 this treatise is perhaps the oldest of its kind4 ,scholars today have available a translation of the text and reproductions of the drawings1 but many of the latter are greatly modified from the originals4 ,this study reproduces examples of al-,zahrw's original illustrations1 compares some with early drawings based on them1 and comments on passages in the treatise of interest to students of pharmacy and medical therapy4 ,,the ,,author3 ,sami ,hamarneh undertook this research into the history of medicine in connection with his duties as associate curator of medical sciences in the ,united ,states ,national ,museum1 ,smithsonian ,institution4 ,,the ,,introduction ,,of ,,the ,,writings of ,ab al-,qsim ,khalaf ibn ,abbs al-,zahrw--better known as ,abulcasis 7d4 ca4 #ajac7--to ,western ,europe was through the ,latin translation of his surgical treatise 7maqlah7 by ,gerard of ,cremona 7d4 #aahg74a ,the response to this treatise1 thereafter1 was much greater than the attention paid to the surgery of any of the three renowned physicians of the ,eastern ,caliphate3 al-,rz 7,latin1 ,rhazes1 d4 ca4 #ibe71 the greatest clinician in ,arabic medicine2 al-,majs 7,haly ,abbs1 d4 #iid71 the author of the encyclopedic medical work1 al-,malak2#b and ,ibn ,sn 7,avicenna1 #ihj-ajcg71 the author of the famous al-,qnn f al-ibb1 a codification of the whole of medical knowledge4 ,because of the widespread dissemination of this ,latin version in medieval ,europe beginning with the latter part of the #abth century1 al-,zahrw attained more prestige in the ,west than he did in ,arabic ,spain1 his native country1 or in any other part of the ,islamic world4#c ,illustration3 ,figure #b4--,the myrtle-leaf shape recommended for paper on which medicine is to be placed for cauterizing eyelid4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from ,channing1 ,albucasis4 ,the fame attached to this surgical treatise1 the #cjth and last in al-,zahrw's encyclopedic work al-,tarf ,liman #8,ajiza #8an al-,ta'lf1 is founded on certain merits4 ,the text is characterized by lucidity1 careful description1 and a touch of original observation of the surgical operations to which the treatise as a whole is devoted4#d ,al-,zahrw furnishes his own drawings of the surgical and dental instruments he used1 devised1 or recommended for a more efficient performance4 ,the illustrations were intended to provide instructional material for apprentices--whom al-,zahrw calls his children--as well as for the benefit of those who would read the work later on4#e ,the treatise is probably the oldest one known today that contains such instructive surgical illustrations and text4#f ,illustration3 ,figure #c4--,small funnel for pouring heated lead into fistula of the eye for cauterization4 ,top1 from original ,arabic manuscript 7,vel4 #bdia71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,sudhoff1 ,chirurgie1 courtesy ,national ,library of ,medicine4 ,illustration3 ,figure #d4--;,circular cauterization in stomach ailments4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from the #aeca ,latin edition of ,pietro d',argellata1 ,chirurgia ,argellata cum ,albucasis1 hereinafter cited as ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,this surgical treatise has been investigated1 translated1 and commented upon by eminent historians of medicine and surgery to whose works ,i shall refer in this article4 ,however1 the pharmaceutic and therapeutic details of the treatise have been somewhat overlooked4 ,as to the various illustrations of the surgical instruments 7over #bjj figures in all71 an almost complete representation of samples has been introduced by ,channing1#g ,leclerc1#h ,gurlt1#i ,sudhoff1#aj and others4 ,nevertheless1 a good number of the reproduced drawings are greatly modified1 most likely having been influenced by earlier illustrations in several ,latin and vernacular versions of the treatise4#aa ,this becomes clearer on comparison with seven ,arabic manuscripts that have not been fully examined by ,western scholars before and that--in several instances--show more authentic drawings of al-,zahrw's surgical instruments than any heretofore published4#ab ,illustration3 ,figure #e4--;,ink markings for identifying place of cauterization4 ,top1 from original ,arabic manuscript 7,vel4 #bdia71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,illustration3 ,figure #f4--;,cautery in hernia4 ,top1 from original ,arabic manuscript 7,vel4 #bdia71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,leclerc1 ,albulcasis4 ,this article therefore1 is an attempt to present a sample of these illustrations with brief comments regarding certain figures and passages of interest to pharmacy and medical therapy4 ,with much gratitude ,i express my indebtedness to ,prof4 ,g4 ,folch ,jou of ,madrid1 to ,dr4 ,a4 ,sheyl nver and ,mr4 ,h4 ,dener of ,istanbul1 and to the librarians of the depository institutions for their cooperation in the reproduction of the manuscripts on microfilm4 ,illustration3 ,figure #g4--;,fine tweezer for removing foreign bodies from the ear4 ,top1 from original ,arabic manuscript 7,ali #bhed71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,leclerc1 ,abulcasis4 ,illustration3 ,figure #h4--,syringe with metal plunger-pump4 ,top1 from original ,arabic manuscript 7,ali #bhed71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,channing1 ,albucasis4 ,al-,zahrw frequently introduces his treatises with brief instructive and sometimes informative preludes4 ,however1 in launching the last treatise of al-,tarf he expounded in a most interesting and illuminating manner the status of surgery during his time4 ,he also explains the reasons that forced him to write on this topic and why he wished to include1 as he did1 precautions1 advice1 instructional notes1 and beautifully illustrated surgical drawings4 ,for example1 the prelude to the treatise mentions four incidents that he witnessed1 all ending with tragic results because of the ignorance of physicians who attempted to operate on patients without the proper training in anatomy and surgical manipulation4 ,for if one does not have the knowledge of anatomy1 al-,zahrw protests1 then 444 he is apt to fall in errors that lead to death as ,i have seen it happen to many4#ac ,al-,zahrw divides his surgical treatise into three sections 7abwb74 ,in the first section 7#ef chapters7#ad he elaborates upon the uses and disadvantages of cautery in general4 ,and on the ground that fire touches only the ailing part 444 without causing much damage to surrounding area1 as caustic medicine does1 he prefers cautery by fire 7al-kay bi al-nr7 to cautery by medicine 7bi al-daw74#ae ,this1 he adds1 became clear to us through lifelong experience1 diligent practice1 and thorough investigations of facts4#af ,illustration3 ,figure #i4--,metal nose dropper4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,middle1 from ,channing1 ,albucasis 7,smithsonian photo #dfhia-;,c74 ,bottom1 from ,sudhoff1 ,chirurgie1 courtesy ,national ,library of ,medicine4 ,he also proposes that instruments made of iron are more practical in many ways than those made of gold1 because often1 when gold instruments are put in fire1 they either are not heated enough or are overheated1 causing the gold to melt4 ,illustration3 ,figure #aj4--;,dental scrapers4 ,top1 from original ,arabic manuscript 7,vel4 #bdia71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,left1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,right1 from ,channing1 ,albucasis4 ,al-,zahrw gently refutes the superstition that cautery is good only in springtime1 and states that under the right conditions of the body's humors it could be used in all seasons4#ag ,although he recommends cautery rather highly1 he never minimizes the importance of treatment by drugs4 ,actually1 he encourages the use of drugs1 before1 with1 and after cauterization4#ah ,for example1 in chapter #af on the cauterization of eyelid when its hair grows reversedly into the eye1 he recommends treatment by cautery and by medicine4 ,in cautery1 the area where fire is to be placed is marked with ink in the shape of a myrtle leaf4 ,in drug treatment1 the caustic medicine is applied to the eyelid over a paper in the shape of a myrtle leaf 7fig4 #b74 ,illustration3 ,figure #aa4--;,dental forceps4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from ,leclerc1 ,abulcasis4 ,in chapter #ag the author refers to an ancient method regarding cautery of the fistula in the inner corner of the eye4 ,after incising the fistula1 one dirham 7derived from the ,greek drachma1 which is equal to about #b4ig grams7#ai of melted lead is poured into it through a fine funnel used for cauterization 7fig4 #c74 ,illustration3 ,figure #ab4--;,golden bridge to stabilize shaky teeth4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,left1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,right1 from ,channing1 ,albucasis4 ,in like manner1 al-,zahrw discusses cautery of the stomach and the cold liver in chapters #bf and #bg1 respectively4 ,the drawings therein represent shapes of the burns on the skin 7fig4 #d7 and marks of ink to be drawn beneath the cartilage of the ribs 7fig4 #e7 for the purpose of spotting the area of operation4 ,here also he describes carefully and clearly the methods of applying cautery and the types1 position1 and number of tools employed in each case4 ,he likewise depicts 7in chapter #de7 instruments used in the treatment of hernia 7fig4 #f74 ,the second section 7bb71 with about #ii chapters1#bj deals with incision1 puncturing1 venesection1 cupping1 surgery on abscesses1 and the withdrawal of arrows from the body4 ,al-,zahrw warns that ignorance in such operations may lead to damage of an artery or vein1 causing loss of blood by which life is sustained4#ba ,moreover1 needle and thread 7more than one kind is mentioned7 for the stitching of wounds are repeatedly recommended4 ,according to al-,zahrw1 foreign bodies that lodge in the ear 7chapter #f7 are of four origins3 7#a7 mineral stones or substances resembling mineral stones such as iron and glass2 7#b7 plant seeds 7chick-peas and beans72 7#c7 liquids1 such as water and vinegar2 and 7#d7 animals1 such as fleas4 ,several instruments are recommended for the removal of such foreign bodies--fine tweezers shaped like a dropper 7fig4 #g71 a syringe with plunger-pump1 and a tube made of silver or copper 7fig4 #h74 ,also of interest to pharmacy and therapy is the advice in regard to the use of lubricants to be applied before administering these fine instruments into the body's cavities4 ,chapter #bd is concerned with the treatment of the polypus that grows in the nose4 ,the various kinds 7including cancer growth71 shapes1 and colors of this type tumor and its treatment by surgery or medicine are described4 ,a hollowed nose-dropper made of metal in the shape of a small kerosene lamp#bb is suggested 7fig4 #i74 ,the dropper is held by its handle while its contents are heated before use4 ,applying heat to nose drops was probably proposed because it serves two purposes3 it allows easier flow of the duhn1 or the fatty substance used1 and it raises the temperature of the drops to that of the body4 ,in his discussion on dental hygiene1#bc al-,zahrw describes scrapers and dental forceps for teeth cleaning and extraction 7figs4 #aj1 #aa7 and brings in a few points of historical interest4#bd ,he warns of the common error of extracting the adjacent healthy tooth instead of the ailing one due to the patient's sense deception4 ,for a gargle he prescribes salt water1 vinegar1 and wine 7sharb74 ,to stop hemorrhage he used blue vitriol 7al-zj7--copper sulfate in our modern terminology4 ,in chapter #cc al-,zahrw discusses bridge-making for the consolidation of shaky teeth 7fig4 #ab74 ,he prefers the use of stable gold over silver which1 he says1 putrifies and rots in a short time4 ,in a rational approach1 he also suggests that the fallen tooth itself1 or a similar one shaped out of a cow's bone1 be installed and connected with adjacent1 stable teeth by a bridge4 ,now1 turning to chapter #cf1 we find al-,zahrw describing a knife-thin tongue depressor 7fig4 #ac7 that he used to facilitate the examination of inflamed tonsils and other swellings of the throat2 it was made of silver or copper4 ,and in chapter #cg 7chapter #cd in ,bes4 #ejc71 he describes the excision of an inflamed uvula by surgery4 ,in the same chapter1 he also mentions the use of instruments made of steel4 ,of pharmaceutical interest is the following free translation of the formula he prescribes as a milder treatment by fumigation 444 to be resorted to only when the swelling is subsiding3#be ,take pennyroyal ,mentha pulegium ,linn41 absinthe ,artemisia maritima ,linn41 thyme1 rue1 hyssop1 camomile1 abrotanum ,artemisia abrotanum ,linn41 and other similar herbs4 ,put all in a casserole and cover them with vinegar4 ,then close tightly with clay lutum-sapientiae--except for a small hole in the middle of the cover--and boil4 ,connect one end of a hollowed instrument1 a crude form of an inhaler fig4 #ad1 with the hole in the cover and insert the other end1 which contains the nozzle1 into the patient's mouth1 allowing the vapor to rise up to the uvula4 ,and if you are not able to secure this instrument1 take a straw and attach its end to an egg-shell4 ,the egg-shell will prevent burns in the patient's mouth that might be caused by the heated vapor4 ,illustration3 ,figure #ac4--,metal tongue depressor4 ,top1 from original ,arabic manuscript 7,ali #bhed71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,channing1 ,albucasis4 ,illustration3 ,figure #ad4--;,crude form of an inhaler4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,al-,zahrw repeats in chapter #ec1 on cancer1 what ,greek physicians had said earlier1 that cancer could be removed by surgery only at its first stage and when found in a removable part of the body1 such as the breast4 ,therefore1 he confesses that neither he nor any one else he knew of ever applied surgery with success on advanced cancer4#bf ,illustration3 ,figure #ae4--,metallic syringe for injecting solutions into the bladder4 ,top1 from original ,arabic manuscript 7,bes4 #ejc71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,illustration3 ,figure #af4--,metallic or porcelain syringes for injection of enemas4 ,top1 from original ,arabic manuscript 7,ali #bhed71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,of special interest in chapter #ei is the metallic syringe 7fig4 #ae7 used to inject medicinal solutions into the bladder3 ,the hollow passage of the syringe should be exactly equal to the plunger it contains and no more1 so that when such fluids from an excess of humors are aspirated they will be drawn out1 and likewise when the solutions are injected they will be pushed in easily4 ,such description of the use of a bladder syringe in the late #ajth century clearly points to the practical and interesting approach to surgery in al-,tarf4 ,moreover1 his description of the removal of a stone from the bladder--an operation we now call lithotomy--is considered a contribution to bladder surgery4 ,one of the earliest recorded operations for the extractions of two dead fetuses from the womb is clearly described in chapter #gf4 ,the account of this case shows not only al-,zahrw's intelligent approach as a shrewd observer but also his clinical and surgical ability4 ,drawings of bulb-syringe instruments used for administering enemas in ailments of the rectum and for the treatment of diarrhea and colic are depicted in chapter #hc4 ,the text describes several kinds of syringes made of silver1 porcelain1 and copper in various sizes 7fig4 #af74 ,of particular interest is an illustration of a syringe1 especially recommended for children1 to which a piece of leather 7jildah7 is attached 7fig4 #ag74 ,this instrument is a precursor of our modern bulb syringe4 ,in chapter #hd al-,zahrw turns to the treatment of various wounds4 ,he prescribes the following powder formula for use3 ,take olibanum frankincense and dragon's blood1#bg two parts of each1 and three parts of slaked or unslaked lime4 ,pound them well1 pass through a sieve and apply the powder to the wound4 ,in cases of damaged blood vessels1 he tied the arteries by ligature1 a practice of which he was a pioneer4 ,in another chapter he describes four methods for suturing the intestines4 ,al-,zahrw1 being associated with war casualties and writing his treatise about the end of the #ajth century1 no doubt had the experience of dealing with cases involving injuries caused by arrows4 ,the text in chapter #id discloses his observations in elaborate investigations regarding the extraction of various kinds of arrows from the body4#bh ,accordingly1 several kinds of hooks and forceps for removing arrows are described and depicted in the treatise 7see fig4 #ah74 ,al-,zahrw's mention of ,turkish bows and arrows led ,freind to believe1 erroneously1 that the author of the treatise must have lived in the #abth century1#bi notwithstanding the fact that ,turkish bows and arrows were in common use in the latter part of the #ajth century4 ,illustration3 ,figure #ag4--;,a crude form of bulb syringe recommended for use with children4 ,top1 from original ,arabic manuscript 7,ali #bhed71 courtesy ,sleymaniye ,umumi ,ktphanesi ,mdrl4 ,bottom1 from ,leclerc1 ,abulcasis4 ,the next chapter1 on cupping1 mentions the use of cups made of horns1 wood1 copper1 or glass1 according to circumstances and the availability of material4 ,the methods of treatment are divided into two kinds3 dry cupping1 with or without fire1 and wet cupping 7see fig4 #ai74 ,he prescribes ointments and aromatic and medicated waters to be applied before and after cupping to facilitate healing4 ,only when cupping is not possible1 as on the nose1 fingers1 and similar parts of the human body1 does he propose the use of leeches for treatment4#cj ,evidently this is an indication that he did not1 as generally supposed1 encourage the widespread use of leeches4 ,illustration3 ,figure #ah4--;,hooks and forceps used for the extraction of arrows4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from ,channing1 ,albucasis4 ,illustration3 ,figure #ai4--;,cupping4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,the third and final section1 of #ce chapters1 deals with the reduction1 luxation1 and treatment of injured bones1 including fracture of the pelvis4 ,the advices and warnings in the prelude of this section appear to repeat some of al-,zahrw's sayings that had been covered in his previous introductions4 ,the text1 however1 presents many facets of interest to the health professions4 ,it elaborates upon the application of various forms of bandages and plasters in a variety of operations4 ,al-,zahrw's detailed description relating to fractures of bones is a fine anatomical document of historical interest4 ,he illustrates and describes special methods for tying injured or broken bones1 and he suggests that bandages made of soft linen be less and less tight as distance increases from the injured place 7chapter #a74 ,for the protection of areas adjacent to the injured part against contact with edges of splints he advocates padding with soft gauze and carded wool4 ,in some cases1 to guard against swelling1 he preferred a delay of one or more days in applying bandages over splints4 ,al-,zahrw also devised and depicted many kinds and shapes of splints for use in simple and compound fractures of the head1 shoulders1 arms1 fingers1 etc4 7see fig4 #bj74 ,for example1 in discussing the reduction of the humerus1 he recommends a splint consisting of a smooth1 thin stick bent in the shape of a bow with two strings1 each attached to one end of the stick 7fig4 #ba74 ,the injured bone is then placed in the middle of the bent splint for reduction while the patient is seated on a chair4 ,tying is applied only when there is no hot swelling 7chapter #aa74 ,one of the remarkable observations made in this section is the description of the paralysis caused by fracture of the spine4 ,illustration3 ,figure #bj4--,splint in the shape of a spoon without a bowl4 ,top1 from original ,arabic manuscript 7,tb4 ,,ms4 #ia71 courtesy ,universittsbibliothek ,tbingen4 ,bottom1 from ,channing1 ,albucasis4 ,of interest to historians of medical therapy and pharmacy are the recipes for poultices that al-,zahrw recommends for use over fractured bones4 ,for example1 he gives the following recipe for one such poultice3 ,take the so-called 'mill's dust' ghubr al-rah1 which is the part of the wheat flour that clings to the walls of the mill during grinding lubb al-daqq1 and1 without sifting away the bran1 knead with white-of-egg to a medium consistency1 and apply4 ,another1 more elaborate1 recipe calls for #aj dirhams each of the roots of wild pomegranate ,glossostemon bruguieri ,d4,c41 chickling vetch the grass pea1 ,lathymus sativus1 and white marshmallow2 #e dirhams each of myrrh and aloes2 #f dirhams of white gum ,arabic ,acacia2 and #bj dirhams of bole friable earthy clay consisting largely of hydrous silicates of aluminum and magnesium1 usually colored red because of impurities of iron oxide4 ,procedure was to pound all ingredients gently1 pass them through a sieve1 and knead with water or white-of-egg 7chapter #a74 ,illustration3 ,figure #ba4--;,a splint to support the arm4 ,top1 from original ,arabic manuscript 7,cod4 ,n4,f4 #dgf;,a71 courtesy ,oesterreichische ,nationalbibliothek4 ,bottom1 from ,argellata #aeca1 courtesy ,national ,library of ,medicine4 ,the question arises as to whether al-,zahrw did any human dissection4 ,the answer is uncertain because our knowledge of his life is fragmentary4 ,however1 he gives no clue to the dissection of humans in any of the #cj treatises of al-,tarf--his only known writings--and there is no evidence that he practiced it in secret4 ,his upright attitude as a ,muslim who repeatedly emphasized his adherence to his faith suggests that he relied completely on animal dissection and the writings of his ,greek-,roman and ,islamic predecessors4 ,physicians in both the ,islamic domain and in ,christendom for many centuries were hostile to the idea of human dissection for any purpose because of their traditional socio-religious convictions1 considering it an unethical and undignified practice4 ,perhaps it has been al-,zahrw's original contributions to surgery1 his enthusiasm in emphasizing the value of anatomical knowledge1 and his recognition of the necessity that only well-educated1 well-trained doctors should perform surgery that have led some medical historians to wonder whether he did human dissection at some time in his long years of experience4 ,in ,summary ,the few examples of illustrations of surgical instruments given here indicate that the ,arabic manuscripts1 in general1 have preserved the original1 oriental1 artistic features of the drawings in a way that has been overlooked in ,latin and vernacular versions of al-,tarf4 ,in presenting his personal observations and original ideas on surgery late in life1 al-,zahrw1 for the most part1 was inspired by a thorough acquaintance with ,greek and ,arabic medical literature supplemented by lifelong intelligent observation and experience4 ,through its descriptions and illustrations1 the surgical treatise of al-,zahrw very likely played a significant role in the designing of improved surgical instruments in the ,middle ,ages4 ,also1 the treatise no doubt promoted the development of improved surgical techniques in ,islam and1 through its translations1 promoted these techniques to an even greater extent in the ,west1 a fact that justifies the fame of this treatise as the highest expression of the development of surgery in ,arabic ,spain--a treatise whose influence continued to the ,renaissance4 ,it contributed in no small measure to the idea of equipping learned and well-trained surgeons with the best surgical tools and techniques of the time2 moreover1 it encouraged the invention of new instruments to meet differing circumstances and special conditions4 ,these tools no doubt greatly facilitated the work of the surgeon4 ,throughout the text of al-,tarf al-,zahrw gave careful attention to the importance of pharmaceutical preparations in the healing art1 including cases requiring surgery4 #a ,george ,sarton1 ,introduction to the ,history of ,science1 ,baltimore1 #aibg1 vol4 #a1 p4 #fha4 #b ,mohammad ,s4 ,abu ,ganima1 in ,abul-,kasim ein ,forscher der ,arabischen ,medizin1 ,berlin1 #aibi1 suggested that description of operations in al-,majs's surgery is clearer than that in al-,zahrw's--a statement which does not seem acceptable4 #c ,max ,neuburger1 ,geschichte der ,medizin1 ,stuttgart1 #aiaa1 vol4 #b1 pt4 #a1 pp4 #agh-agi4 #d ,heinrich ,haeser1 ,lehrbuch der ,geschichte der ,medizin und der epidemischen ,krankheiten1 ,jena1 #ahge1 vol4 #a1 pp4 #egh-ehd2 and ,donald ,campbell1 ,arabian ,medicine and ,its ,influence on the ,middle ,ages1 ,london1 #aibf1 vol4 #a1 p4 #hh4 #e ,see the prelude to the treatise4 #f ,fielding ,h4 ,garrison 7,an ,introduction of the ,history of ,medicine1 ed4 #d1 rev41 ,philadelphia1 #aibi1 p4 #acb71 states1 in reference to ,sudhoff and others1 that many drawings earlier than those of al-,zahrw have been discovered in medieval manuscripts4 ,however1 ,garrison overlooked the fact that al-,zahrw's surgical illustrations were mainly depicted for instructional purposes--a unique approach4 ,it should be noted also that al-,zahrw died almost a century earlier than ,garrison thought4 ,see also ,martin ,s4 ,spink1 ,arabian ,gynaecological1 ,obstetrical and ,genito-,urinary ,practice ,illustrated from ,albucasis1 ,proceedings of the ,royal ,society of ,medicine1 #aicg1 vol4 #cj1 p4 #fed4 #g ,johannis ,channing1 ,albucasis de ,chirurgia4 ,arabice et ,latine1 ,oxford1 #aggh1 #b vols4 7hereinafter referred to as ,channing1 ,albucasis74 ,the text has many errors in spelling and grammar1 but ,leclerc went too far in criticizing this edition1 which has many merits4 ,moreover1 the surgical illustrations 7reproduced from the ,huntington and ,marsh manuscripts of the ,bodleian ,library7 in ,channing's edition are of special interest4 #h ,lucien ,leclerc1 ,la ,chirurgie d',abulcasis1 ,paris1 #ahfa 7hereinafter referred to as ,leclerc1 ,abulcasis74 ,this excellent ,french version was first published in a series of articles in ,gazette ,mdicale de l',algrie1 and seems influenced by ,channing's edition more than ,leclerc admits4 ,leclerc consulted several ,arabic copies of the treatise as well as ,latin and vernacular translations1 but only a few of these ,arabic manuscripts are considered complete4 ,the ,arabic manuscripts studied for the present article are not the same as those used by ,leclerc4 ,see also ,leclerc's monumental work1 ,histoire de la ,mdecine ,arabe1 ,paris1 #ahgf1 vol4 #a1 pp4 #dec-deg4 #i ,ernst ,gurlt1 ,geschichte der ,chirurgie und ihrer ,ausbung ,volkschirurgie-,alterthum-,mittelalter- ,renaissance1 ,berlin1 #ahih1 vol4 #a1 pp4 #fbj-fdi1 with more than #ajj figures4 ,in the text and illustrations1 ,gurlt relied upon ,leclerc's translation and modified drawings of the surgical instruments2 nevertheless1 he presents a brief1 systematic study--probably the best so far--of the entire treatise4 #aj ,karl ,sudhoff1 ,beitrge zur ,geschichte der ,chirurgie im ,mittelalter1 ,leipzig1 #aiah 7hereinafter referred to as ,sudhoff1 ,chirurgie71 vol4 #b1 pp4 #af-hd1 with a few plates4 ,although ,sudhoff consulted the fragmentary ,arabic manuscript indexed as ,cod4 ,arab4 #aihi in ,gotha1 ,germany1 he relied mainly upon ,latin versions of the treatise and the illustrations contained in them4 #aa ,see ,leclerc1 ,abulcasis1 in introduction4 #ab ,the seven ,arabic manuscripts are indexed as ,berlin ,,ms4 ,or4 fol4 #ia1 temporarily at ,universittsbibliothek ,tbingen1 in ,germany2 ,escorial ,,ms4 ,arabe ,no4 #hgf1 at ,biblioteca del ,monasterio de ,san ,lorenzo el ,real de ,el ,escorial1 in ,spain2 ,wien ,,ms4 ,cod4 ,n4,f4 #dgf ,a41 at ,oesterreichische ,nationalbibliothek1 in ,vienna2 and ,ali ,emiri ,arabi ,no4 #bhed1 ,beir ,aa ,nos4 #ejb and #ejc1 and ,veliyyudin ,no4 #bdia1 all at ,sleymaniye ,umumi ,ktphanesi ,mdrl1 in ,istanbul4 ,hereinafter these manuscripts are referred to1 respectively1 as ,tb4 ,,ms4 #ia2 ,esc4 #hgf2 ,wien #dgf ,a2 ,ali #bhed2 ,bes4 #ejb2 ,bes4 #ejc2 and ,vel4 #bdia4 ,the ,smithsonian ,institution recently obtained a microfilm copy of ,bankipore ,manuscript ,no4 #ag from the ,khuda ,bakhsh ,o4 ,p4 ,library1 ,patna 7,bihar71 ,india4 ,this manuscript1 containing only the #cjth treatise of al-,tarf1 was copied in #aahi2 therefore1 it is the earliest dated ,arabic manuscript of the surgical treatise known to exist4 ,the surgical illustrations therein add weight to the belief that the ,arabic manuscripts show more originality in the drawings than do the later copied versions1 which often were inaccurate and possibly distorted4 ,about ten other illustrations from the ,arabic manuscript in ,istanbul indexed as ,topkapi ,,ms4 ,no4 #aiij 7which contains #bae beautifully illustrated figures7 were presented by ,a4 ,s4 nver and ,hseyin ,usman in an extract titled ,mehur ,arab ,cerrahi ,elblkasimi ,zehravi ve onum ,kitabl ,cerrahiyesi1 ,istanbul1 #aice4 ,see also nver1 erefeddin ,sabuncuolu3 ,kitabl ,cerrahiyei ,illhaniye1 ,istanbul1 #aici1 pp4 #e-g4 #ac ,see introduction to the treatise2 for example1 ,bes4 #ejb1 fol4 #ebbv-#ebcv and ,vel4 #bdia1 fol4 #ajdr-#ajev4 ,see also ,k4 ,p4 ,j4 ,sprengel1 ,versuch einer pragmatischen ,geschichte der ,arzneikunde1 ,halle1 #ahbc1 vol4 #b1 pp4 #ddi-dea4 ,george ,j4 ,fisher1 in ,abul-,casem ,chalaf ,ibn ,abbas al-,zahrw1 ,commonly ,called ,albucasis1 ,annals of ,anatomy and ,surgery1 ,july-,december1 #ahhc1 vol4 #h1 pp4 #bd-be1 gives a translation of only the first part of the introduction4 #ad ,there are #ef chapters listed in almost all manuscripts and commentary works ,i checked except ,tb4 ,,ms4 #ia and ,esc4 #hgf1 where only #ee chapters are listed4 #ae ,al-,zahrw mentions several caustic medicines used in cautery1 among which are garlic1 mustard1 melted lead1 slaked or unslaked lime with or without common soap1 ,thapsia 7,ruta graveolens ,linn471 and juice of the ,oriental cashew nut 7,senecarpus anacardium ,linn474 #af ,vel4 #bdia1 fol4 #ajf2 ,bes4 #ejb1 fol4 #ebcr-#ebdv4 #ag ,al-,zahrw criticizes those who interpret the saying cautery is the end of treatment to mean that cauterization is the best and only conclusive treatment at the physician's disposal4 ,he points out that other treatments1 such as drugs1 should be resorted to first1 and used until they prove of no avail2 and he states that only after cautery proves to be the cure should it be considered the completion of medical treatment--al-kay khir al-ibb4 ,see ,vel4 #bdia1 fol4 #ajf2 and ,bes4 #ejb1 fol4 #ebdr-#ebev4 #ah ,for healing1 soothing1 or emollient purposes1 al-,zahwr suggested medications1 such as egg white1 salt water 7normal saline71 sap of psyllium1 several ointments1 duhn of rose1 and other adhn 7plural of duhn1 the fatty or oily essences extracted from various substances through pharmaceutical processes74 #ai ,for a more accurate estimate of the equivalence of dirham according to the area in which the measurement was taken1 the reader may consult ,walter ,hinz1 ,islamische ,masse und ,gewichte umgerechnet ins metrische ,system1 ,leiden1 #aiee1 pt4 #a1 pp4 #b-h2 and ,george ,c4 ,miles1 ,early ,arabic ,glass ,weights and ,stamps1 ,new ,york1 #aidh1 p4 #f4 #bj ,the contents of several manuscripts 7such as ,ali #bhed1 ,wien #dgf ,a1 ,bes4 #ejc1 and ,tb4 ,,ms4 #ia7 give different numbers4 #ba ,see1 for example1 ,tb4 ,,ms4 #ia1 fol4 #dev2 and ,bes4 #ejb1 fol4 #ecjv4 #bb ,sudhoff1 op4 cit4 7footnote #aj71 p4 #bi1 fig4 #f4 #bc ,for a more detailed and interesting discussion with beautiful illustrations included1 the reader may consult ,ch4 ,niel1 ,la ,chirurgie ,dentaire ,d',abulcasis ,compare a celle des ,maures du ,trarza1 ,revue de ,stematologie1 ,april #aiaa1 vol4 #ah1 pp4 #afi-ahj and #bbb-bbi4 #bd ,it is regrettable that ,franz ,rosenthal in his fine article ,bibliographical ,notes on ,medieval ,muslim ,dentistry 7,bulletin of the ,history of ,medicine1 #aifj1 vol4 #cd1 pp4 #eb-fj7 failed to refer to this or any other section of al-,zahrw's work4 #be ,bes4 #ejb1 fol4 #ech4 ,see also ,channing1 ,albucasis1 pp4 #bjf-bjh4 ,for the identification of the drugs and their botanical origins the author of the present paper consulted ,h4 ,p4 ,j4 ,renaud and ,georges ,s4 ,colin1 ,tufat al-,abb1 ,glossaire de la ,matire ,mdicale ,marocaine1 ,paris1 #aicd1 pp4 #acc1 #adc1 #aic-aid1 and ,max ,meyerhof1 ,un ,glossaire de ,matire ,mdicale ,compos par ,maimonide1 ,cairo1 #aidj1 pp4 #afh-afi4 #bf ,tb4 ,,ms4 #ia1 fol4 #iiv4 #bg ,dragon's blood is a resin obtained from the scales covering the surface of the ripe fruits of ,daemonorops draco ,blume 7,heber ,w4 ,youngken1 ,textbook of ,pharmacognosy1 ed4 #f1 ,philadelphia1 #aidh1 p4 #age74 ,see also ,renaud and ,colin1 op4 cit4 7footnote #be71 pp4 #ed-ee4 #bh ,heinrich ,frlich1 ,abul-,kasem als ,kriegschirurg1 ,archiv fr klinische ,chirurgie1 #ahhd1 vol4 #cj1 pp4 #cfe-cgf4 ,this well-presented study was reviewed by ,paul ,schede in ,centralblatt fr ,chirurgie1 #ahhd1 no4 #ch1 pp4 #fbf-fbg4 #bi ,johannis ,freind1 ,the ,history of ,physick1 ,london1 #agbf1 vol4 #b1 p4 #abi4 #cj ,in several manuscripts1 the chapter on the use of leeches is the last one in the second section of the treatise4 ,u4,s4 ,,government ,,printing ,,office3 #aifa ,for sale by the ,superintendent of ,documents1 ,u4,s4 ,government ,printing ,office ,washington #be1 ,d4,c4-,price #bj cents