Abulcasis

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.