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The most important of the Arabian surgeons of the Middle Ages is
Albucasis or Abulcasis, also Abulkasim, who was born near Cordova, in
Spain. The exact year of his birth is not known, but he flourished in
the second half of the tenth century. He is said to have lived to the
age of 101. The name of his principal work, which embraces the whole of
medicine, is Altasrif, or Tesrif, which has been translated The
Miscellany. Most of what he has to say about medical matters is taken
from Rhazes. His work on surgery, however, in three books, represents
his special contribution to the medical sciences. It contains a number
of illustrations of instruments, and is the first illustrated medical
book that has come to us. It was translated into Latin, and was studied
very faithfully by all the surgeons of the Middle Ages. Guy de Chauliac
has quoted Albucasis about two hundred times in his Chirurgia Magna.
Even as late as the beginning of the sixteenth century Fabricius de
Acquapendente, the teacher of Harvey, confessed that he owed most to
three great medical writers, Celsus (first century), Paul of AEgina
(seventh century), and Abulcasis (tenth century).

Abulcasis insisted that for successful surgery a detailed knowledge of
anatomy was, above all, necessary. He said that the reason why surgery
had declined in his day was that physicians did not know their anatomy.
The art of medicine, he added further, required much time.
Unfortunately, to quote Hippocrates, there are many who are physicians
in name only, and not in fact, especially in what regards surgery. He
gives some examples of surgical mistakes made by his professional
brethren that were particularly called to his attention. They are the
perennially familiar instances of ignorance causing death because
surgeons were tempted to operate too extensively.

His description of the procedure necessary to stop an artery from
bleeding is an interesting example of his method of teaching the
practical technique of surgery. Apply the finger promptly upon the
opening of the vessel and press until the blood is arrested. Having
heated a cautery of the appropriate size, take the finger away rapidly
and touch the cautery at once to the end of the artery until the blood
stops. If the spurting blood should cool the cautery, take another.
There should be several ready for the purpose. Take care, he says, not
to cauterize the nerves in the neighborhood, for this will add a new
ailment to the patient's affection. There are only four ways of
arresting arterial hemorrhage. First, by cautery; second, by division
of the artery, when that is not complete--for then the extremities
contract and the blood clots--or by a ligature, or by the application of
substances which arrest blood flow, aided by a compressive bandage.
Other means are inefficient, and seldom and, at most, accidentally
successful. His instruction for first aid to the injured in case of
hemorrhage in the absence of the physician, is to apply pressure
directly upon the wound itself.

The development of the surgical specialties among the Arabs is
particularly interesting. Abulcasis has much to say about nasal polyps.
He divided them into three classes: (1) cancerous, (2) those with a
number of feet, and (3) those that are soft and not living,--these
latter, he says, are neither malignant nor difficult to treat. He
recommends the use of a hook for their removal, or a snare for those
that cannot be removed with that instrument. His instructions for the
removal of objects from the external ear are interestingly practical. He
advises the use of bird lime on the end of a sound to which objects will
cling, or, where they are smaller, suction through a silver or copper
canula. Hooks and pincettes are also suggested. Insects should be
removed with a hook, or with a canula, or, having been killed by warm
oil, removed by means of a syringe. Some of his observations with regard
to genito-urinary surgery are quite as interesting. He even treated
congenital anomalies. He suggests cutting of the meatus when narrowed,
dilatation of strictures with lead sounds, and even suggests plans of
operations to improve the condition in hypospadias. He gives the signs
for differentiation between epitheliomata and condylomata, and
distinguishes various forms of ulceration of the penis.

Abulcasis discusses varicose veins in very much the same spirit as a
modern surgeon does. They occur particularly in people who work much on
their feet, and especially who have to carry heavy burdens. They should
not be operated on unless they produce great discomfort, and make it
impossible for the sufferer to make his living. They may be operated on
by means of incision or extirpation. Incision consists of cutting the
veins at two or three places when they have been made prominent by means
of tight bandages around the limb. The blood should be allowed to flow
freely out of the cut ends, and then a bandage applied. For extirpation,
the skin having been shaved beforehand, the vein should be made
prominent, and then carefully laid bare. When freed from all adhesions,
it should be lifted out on a hook, and either completely extirpated or
several rather long pieces removed. He lays a good deal of stress on the
necessity for freeing the vein thoroughly and lifting it well out of
tissues before incising it. In old cases special care must be taken not
to tear the vein.

Minute details of technique are often found in these old authors.
Abulcasis, for instance, treats of adherent fingers with up-to-date
completeness. They can occur either congenitally or from injury, as, for
instance, burning. They should be separated, and then separation
maintained by means of bandages or by the insertion between them of a
thin lead plate, which prevents their readhesion. Adhesions of the
fingers with the palm of the hand, which Abulcasis has also seen,
should be treated the same way.

At times there is surprise at finding some rare lesion treated with
modern technique, and a hint at least of our modern apparatus. Fracture
of the pubic arch, for instance, is described in Abulcasis quite as if
he had had definite experience with it. When this occurs in a woman, the
reposition of the bone is often greatly facilitated by a cotton tampon
in the vagina. This tampon must be removed at every urination. There is
another way, however, of better securing the same purpose of
counterpressure. One may take a sheep's bladder into the orifice of
which a tube is fastened. One should introduce the bladder into the
vagina, and then blow strongly through the tube, until the bladder
becomes swollen and fills up the vaginal cavity. The fracture will, as a
rule, then be readily reduced. Here is, of course, not alone the first
hint of the colpeurynter, but a very practical form of the apparatus
complete. Old-time physicians used the bladders of animals very
generally for nearly all the medical purposes for which we now use
rubber bags.

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