Early Encyclopedist Wrote the Book on Amputation

Imagine writing a medical encyclopedia so influential it was the standard surgical reference work across a whole continent for more than half a millennium.

Completed about 1000 C.E., Spaniard Abu al-Qasim al-Zahrawi’s tome was Europe’s surgical bible until the Renaissance.

“It is no wonder then that al-Zahrawi’s outstanding achievement awakened in Europe a hunger for Arabic medical literature, and that his book reached such prominence that a modern historian considered it as the foremost text book in Western Christendom,” Ibrahim Shaikh, MD, retired medical practitioner in the United Kingdom, wrote for the website Muslim Heritage.

al-Zahrawi, along with Persians Al Razi and Ibn Sina — the former a doctor and scientist, and the latter a philosopher — “presented to the world scientific treasures which are today considered important references for medicine and medical sciences as a whole,” according to Shaikh.

Out of the Dark Ages

al-Zahrawi was born in Spain, near Cordoba, in 936. The Roman Empire had fallen five centuries before, plunging Europe into what historians formerly called the Dark Ages, a period when much learning was lost in Christian Europe, but was largely preserved and advanced in the Muslim world.

Muslim armies conquered most of the Iberian Peninsula, including Portugal and Spain in the 8th century. Under Islamic rule, Muslims, Jews and Christians mostly coexisted peacefully — and sometimes cooperated. Culture, science and education flourished in Iberia and elsewhere in the Muslim world. Muslim scholars reintroduced Europe to the all-but-forgotten great works of Greek and Roman scientists and philosophers.

Abu al-Qasim al-Zahrawi wrote one of the world’s first medical encyclopedias.
Abu al-Qasim al-Zahrawi wrote one of the world’s first medical encyclopedias.

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Gradually, Catholic forces conquered Portugal and Spain. In the late 15th century, King Ferdinand and Queen Isabella united Spain, ruthlessly drove out or suppressed Muslims and Jews and imposed rigid Catholicism on the country.

al-Zahrawi is also known by his Latin name, Albucasis. His 1,500-page encyclopedia is titled Al-Tasrif li-man ‘ajaza ‘an al-ta’lif, which translates to The Recourse of Him Who Cannot Compose [A Medical Work of His Own], according to the 2013 Companion Encyclopedia of the History of Medicine. al-Zahrawi’s encyclopedia contains 30 treatises. The work was based on nearly a half century of al-Zahrawi’s medical practice and experience, according to Shaikh.

“What ever [sic] I know, I owe solely to my assiduous reading of books of the ancients, to my desire to understand them and to appropriate this science; then I have added the observation and experience of my whole life,” he quoted al-Zahrawi as saying.

The encyclopedia, like many Muslim scientific works, was translated into Latin, the language of the Catholic church and of Western scholars. “The book contains the earliest pictures of surgical instruments in history,” Shaikh wrote. “About 200 of them are described and illustrated. In places, the use of the instrument in the actual surgical procedure is shown.”

Ahead of its time

In the book, al-Zahrawi wrote the first piece on a hemorrhagic condition unaffected mothers pass on to their male children: hemophilia. Even so, the best-known and most influential part of the encyclopedia is Book 30, his treatise on surgery.

Most Muslim surgeons were quite conservative about amputations, but al-Zahrawi was an exception, according to John Kirkup, MD, MA, FRCS.


In his book, A History of Limb Amputation, Kirkup explained that the surgeon recommended amputation not only for congenitally superfluous fingers and gangrene, but also, as al-Zahrawi wrote, to stave off death from the poisonous “… bite of some dangerous reptile such as the marine scorpion, viper, or venomous spider, and so on.”

al-Zahrawi advised, “If the disease or bite be at the tip of the finger, cut off the finger, giving the disease no opportunity to spread to the rest of the hand. Similarly, if it attacks the hand, cut it off at the wrist. … If it attacks the forearm, cut it off at the elbow through the joint itself. If the disease passes onward … by no means cut the shoulder, for that will be the death of the patient.”

al-Zahrawi provided similar advice for bites on the lower limbs and emphasized “that patients diseased above the knee should resign themselves to death for amputation was perilous above knee joint level,” Kirkup wrote.

Before an amputation, al-Zahrawi wrapped bandages around the limb above and below where it was to be removed. The idea was “to tense the soft tissues during section which were then protected by linen dressings to avoid saw injury,” Kirkup wrote. “Haemorrhage [sic] was controlled with cautery and styptic powders.”

al-Zahrawi did not mention tying off vessels, according to Kirkup. Even so, “almost all European authors of surgical texts from the 12th to the 15th centuries referred to al-Zahrawi’s surgery and copied from him,” Shaikh wrote.

al-Zahrawi died in 1013.

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