Surgical medicine in Islamic civilization

 

The science of surgery was lagging behind the rest of the branches of medicine for long periods, and the knowledge of healers about the science of surgery in the early Arab Islamic state was simple, and despite the limited practice of Arab and Muslim scholars in general, except for a few of them, most of their books contained some topics related to surgery.

In its beginning, surgical operations were limited to cauterization, cupping, bloodletting, and amputation, with the development of medical science, the science of surgery began to grow and flourish, especially after Muslim scholars devoted themselves to studying Greek literature on this science.

It did not take long for this science to make great strides towards creativity and innovation, contrary to what some orientalists said, Muslim doctors were only carriers and did not innovate or contribute to the advancement of the science of surgery. 

Muslim doctors also had a leading hand in developing and designing many surgical machines, and this was the result of their genius in the art of surgery, which led them to innovate and design machines that help in performing surgical operations successfully.

The emergence of surgery in Islamic civilization

 

The Arabs, in their countryside and in their urban areas, knew of surgery, cauterization, bloodletting, cupping, splinting fractures, and restoring dislocations, this was mentioned in their poems and works, cauterization was the utmost effort of theirs, until they said, “The last cure is cauterization".

 

As in all other fields, in the beginning, the woman, whether a mother, wife, or sister, was the first, closest, and best resort for caring for the sick and wounded. Many women became famous throughout pre-Islamic times and at the beginning of Islam, who provided great services in first aid for the wounded and nursing care for the sick, especially stab wounds. Swords, arrows and spears, and the first procedure they performed was to stop the bleeding. 

Hardly any city in the country was devoid of doctors!

In the Umayyad era and the early Abbasid era, Muslims were open to the knowledge of those who preceded them, and accepted it by translating and transmitting it while attributing it to its owners with clear integrity, so that when they imitated it, they built on it and added to it, physicians from all religions and sects contributed to the translation, and the books of biographies were full of dozens of them, especially the book (Eyes of News in Doctors' History) by Ibn Abi Usaibah, and the book (Classes of Physicians and Sages) by Ibn Jaljal Al-Qurtubi.

Cultural and historical influences on the development of surgical medicine in Islamic civilization

Literary and scientific books included terms indicating that specialization among doctors was common, as people used to call doctors and those who treated diseases with surgery “surgeons,” those who treated bones “orthopedists,” those who treated the eyes “eyeliner”, those who practiced cupping “cuppers”, and they who practice bloodletting “phlebotomists''.

There were also “veterinarians” who collected experiences about animals and their diseases that required treatment.

“Castration” in its various forms was known to veterinarians who castrated animals “to flavor their meat,” as Al-Jahiz explained in his valuable book (The Animal), and castration was also known to slave traders. 

Every profession, including medicine, had its own controls and standards, the “chief physician” would organize their affairs under the direct supervision of the “muhtasib”, he would test whoever applied for medicine with exams to prove his eligibility, so he would be entitled to be granted a "permit to practice the profession". 

During the surgical practice of his work, the “Muhtasib” makes sure that he knows the anatomy of the organs and parts of the human body, and that his tools are safe, clean, and appropriate to the site of surgery and the organ he will operate on, and that they are complete, and that hemostatic treatments that accelerate bleeding are available. 

Doctors always relied on honest observation and correct experience that they examined, if it contradicted the well-known opinion of those who preceded them, they abandoned it and adopted what was proven to them through examination. 

Thus, they had a status in the hearts of their patients that preceded the status of their friends and family, and they trusted them even if their positions were among the ranks of their enemies.

- Important rules for Muslim scholars in developing surgical methods

The spread of surgery as a medical science and the genius of those working in it was not an easy matter, or a simple situation, rather, it was based on sophisticated and disciplined rules, foundations, and organizations, including: 

• Exchange of experiences between surgeons, with the expansion of the Arab Islamic State and the expansion of its area, the distances and the hardship of travel did not prevent surgeons from moving from the farthest countries of the Maghreb and Andalusia to the farthest countries of the East beyond Persia and entering between them to the center of the Islamic world in Egypt and the Levant and vice versa, and staying for a long time in order to ensure,  exchange experiences between them.

• Codification and documentation by recording everything new in the science of surgery, whether it was the product of their work, or a translation from other nations, the spread of surgical books and their extension like other knowledge was rapid despite the absence of printing and reliance on copyists.

  • Paying attention to the detailed, practical anatomy in which Muslim surgeons have excelled, and through it, learning about the functions of organs. 

  • Paying attention to the various and different surgical tools and working to develop them continuously, one of the manifestations of interest in them is their depiction in surgical books by Muslim scholars and the creation of a catalog of how to use them.

  • Introducing new types of other branches of surgery that were not known at the time, and working to develop and pay attention to them

• Paying attention to the surgical environment, including cleaning the place, sterilizing it with alcohol, and expanding the use of various anesthesia methods such as opium infusion, poppy seeds, syrup, paste, and inhalation. 

• Great interest in the bimaristans (hospitals), starting with choosing a place in which a clean environment is achieved, and a distinctive, spacious building surrounded by green trees, some of which are fruitful and others exuding aromatic scents, and medicinal plants for the manufacture of drugs that supply the bimaristans, in addition to the interest related to serving patients in terms of cleanliness, order, and availability. Beds, changing sheets, and even replacing the patient's personal clothing.

• The practice of the medical profession spread so widely that the number of doctors in Baghdad alone during the time of the Abbasid Caliph Al-Muqtadir Billah reached more than 860 doctors. In fact, works appeared that classified doctors according to the time period in which they lived or according to the regions in which they settled. Perhaps the most important of them is 2 books “The Classes of Physicians and Sages.” "Ibn Jaljal and "The eyes of news in Tthe Classes of Physicians " by Ibn Abi Usaibah.

•  Women even practiced medicine, to the point that there were two female doctors from the Ibn Zuhr family who served in the court of the Almohad caliph Abu Yusuf Ya'qub al-Mansur in the twelfth century AD, female doctors, midwives, and wet nurses were mentioned in the writings of literature of that period.

 Translation and critical assimilation of foreign  medical sources

The translation movement, which began in the Umayyad era and flourished in the Abbasid one, played a major role in the distinction of Islamic civilization in knowledge in general and medicine and surgery in particular. 

The Arabs were interested in the works of ancient Greek and Roman doctors, such as Hippocrates, Galen, and Dioscorides, which the Syriacs had transferred into their language in the Jundisapur School, to which they fled to escape the persecution of the Nestorian doctrine they had embraced by the Byzantine emperors.

With the beginning of the Abbasid era, the matter developed after the Arabs began to transfer medical sciences directly from their Greek sources, after they became aware of the weaknesses in the Syriac translations, at the hands of some doctors who had mastered Greek, such as the Bakhtishu family and Hunayn ibn Ishaq.

The critical sense that Arab doctors enjoyed forms another bright picture in the history of Arab medicine. In fact, Arab doctors - at the beginning of their renaissance - benefited from what was translated from Greek medicine and others, but they quickly criticized, corrected and transcended it, in an era when no one dared to criticize the opinions and theories of Greek doctors, such as Hippocrates and Galen. 

This physician, Al-Razi (d. 926 AD) wrote a book entitled “Doubts on Galen”, he also responded to those who blamed him for his criticism of Galen by saying: He who does not dare to criticize is not considered a philosopher, but rather one of the rabble who imitate leaders and do not dare to object to them. Al-Razi supports this critical position by referring to a famous saying by the Greek philosopher Aristotle, when he said: “Truth and Plato disagreed? We both have friends - except that the truth is truer than Plato''.

Avicenna (d. 1037 AD) also revealed many contradictions in Galen’s medical opinions in his book “The Law on Medicine''.   

 

As for Ibn al-Nafis (d. 1288 AD), in his book “Explanation of the Anatomy of the Law,” he did not hesitate to criticize Galen’s works in the field of anatomy. 

It is important for us to emphasize that if this critical sense indicates anything, it indicates the independence of Arab doctors with their theories and experiences from Greek medicine. 

Innovative surgical instruments in Islamic civilization

Surgical tools in Islamic civiliation

In this regard, four surgeons should be mentioned who are the most famous in the field of surgery in light of Islamic civilization. 

Abu al-Qasim al-Zahrawi

He was born in Al-Zahra in Andalusia. He performed surgical operations and used machines. His book was “Disposal for those who are unable to compose”,  and he was the first author to make surgery a science in itself, independent of medicine, and established it on foundations based on the science of anatomy. As Ángel Palencia says he is the greatest influence on the European Renaissance for five centuries.

 It contains sections and chapters in which there are descriptions of operations, including the operations of extracting bladder stones by incision and fragmentation. 

The book is distinguished by its abundance of drawings and the abundance of forms of the machines that he used, most of which he invented. 

Ibn al-Nafis

One of the famous Damascus doctors, he wrote the book “Al-Shamil”- means comprehensive -   in medicine, and his book “Explanation of the Anatomy of Law” is of utmost importance because in its description of the lung he preceded others. 

He discovered the pulmonary circulation and described it in a correct, scientific way. 

Thus, he came before Servetus, to whom the Europeans attribute this discovery. 

There is no doubt that this is the greatest discovery in anatomy that the Arabs have made. 

al-Razi

Al-Razi talked in his book “Al-Hawi” about muscle and nerve surgeries and suturing of abdominal and intestinal surgery. 

Avicenna

Avicenna wrote in “The Canon of Medicine” about the anatomy of the skull, jaws, nose, and thoracic vertebrae.

Some surgical techniques in Islamic civilization

Lithotomy

Islamic surgeons pioneered suprapubic lithotomy, a technique for removing bladder stones, and contributed significantly to urological surgery.

Cauterization

 They employed cauterization to stop bleeding and control infections, showcasing their understanding of wound healing.

Suturing

Islamic surgeons developed sophisticated suturing techniques using silk, catgut, and other materials, improving wound closure and minimizing scarring. 

Anesthesia

They employed various forms of anesthesia, including herbal concoctions, opium, and alcohol, to manage pain during surgery.

Bone Setting and Fracture Treatment

: Islamic surgeons developed effective techniques for setting fractures and treating bone injuries, laying the groundwork for modern orthopedic practices.

Medical education in Islamic civilization

The cities of Islamic countries were full of medical institutes and schools, which were mostly located inside hospitals or in what was called the House of Wisdom in Baghdad in the Abbasid era or Cairo in the Fatimid era. New doctors were given an exam to practice the profession, supervised by the chief physician himself, and the same was true for pharmacists.

The influence of Islamic civilization on modern societies in the field of surgical medicine

Europe benefited from translations of Islamic medical books at the hands of translators such as Gerardo of Cremona, who translated the surgical portion of comprehensive for those who are unable to compose by Al-Zahrawi into Latin. 

It was used from then on in European medical schools for centuries, and they continued to issue editions of it until about 1770. Constantine the African also translated The book Zad al-Musafir and Qut al-Hadir by Ibn al-Jazzar, the book al-Qanun fi al-Tibb by Avisenna, and the book al-Jami’ al-Kabir by al-Razi. 

Some medical works by Muslims, such as the book al-Qanun fi al-Tibb by Avicenna, al-Hawi fi al-Tibb by al-Razi, and comprehensive for those who are unable to compose by al-Zahrawi, were taught in European universities until the eighteenth century. 

Conclusion

After reviewing the contributions of Muslims to surgery, the broad features of those contributions must be presented.

Transmission of Knowledge

 Islamic medical topics, texts and practices were translated and incorporated into European medicine during the Renaissance, fostering cross-cultural knowledge exchange.

Foundation of Modern Surgery

Foundation of Modern Surgery: Islamic surgical developments  paved the way for modern surgical operations, influencing techniques, instruments, and ethical considerations.

Enduring Impact

 Islamic surgeons' contributions continue to inform and inspire modern surgical practice, highlighting the enduring legacy of their medical ingenuity.