By: Rabie El-Said Abdel-Halim
[This study of the original Arabic edition of the book Al-Taysir fi ‘l-Mudawat wa’l-Tadbir (Book of Simplification Concerning Therapeutics and Diet) written by the Muslim physician Ibn Zuhr (Avenzoar, 1093-1162 CE) aims at evaluating his contributions to the progress of surgery and providing English translations of relevant excerpts. Ibn Zuhr’s unique experiment of performing a tracheotomy on a goat, proved the safety of this operation in humans and represented a further step in the development of the experimental school started by Al-Razi (Rhazes) of Baghdad in the 9th century who is known to have given monkeys doses of mercury to test it as a drug for human use. Ibn Zuhr also performed post mortems on sheep in the course of his clinical research on treatment of ulcerating diseases of the lungs. Same as all his predecessors in the Islamic Era, he stressed the importance of a practical and sound knowledge of anatomy for surgical trainees. Furthermore, Ibn Zuhr insisted on a well supervised and structured training program for the surgeon-to-be, before allowing him to operate independently. He also drew the red lines at which a physician should stop, during his general management of a surgical condition; a step forward in the evolution of general surgery as a specialty of its own. He believed in prophylaxis against urinary stone disease and reported the importance of dietary management for that purpose. Furthermore, Ibn Zuhr enriched surgical and medical knowledge by describing many diseases and treatment innovations not ever described before him.]
- Introduction
Many Western authorities on the history of medicine stated that with the spread of Islam in the 7th century, a great revival of the sciences took place in the new Islamic society. The school of Baghdad was characterized by a new scientific spirit. Proceeding from the known to the unknown, taking precise account of phenomena, accepting nothing as true, which was not confirmed by experience, or established by experiment; such were fundamental principles taught and acclaimed by the masters of the sciences. The Western Caliphate produced physicians and philosophers almost as brilliant as those of the East. Remarkable schools of medicine were founded at Seville, Toledo and Cordova. The most famous of the professors were Averroës, Albucasis and Avenzoar.
Avenzoar is the Latin name for Ibn Zuhr who is not, yet, as widely known in the current surgical literature as his predecessors Al-Razi (Rhazes, 854–925 CE), Ibn Sina (Avicenna, 980–1037 CE), and Al-Zahrawi (Albucasis, 930–1013 CE). This study, therefore, aims at evaluating the contributions of Ibn Zuhr to the progress of surgery. - Ibn Zuhr and his book Al-Taysir
Ibn Zuhr, known in the West as Avenzoar, Abumeron or Abynzoar, is the Muslim physician Abu Marwan: Abdel-Malik ibn Abi al-Ala’ Zuhr ibn abi Marwan: Abdel-Malik ibn Abi Bakr: Muhmad ibn Marwan ibn Zuhr, Al-Eyadi Al-Ishbily, who lived and practiced in Ishbiliya (modern-day Seville, Andalucia, Spain) between 1091-1162 CE. The name Al-Eyadi refers to his original Arabian tribe Eyad, descendants from Nizar son of Maad son of Adnan. Zuhr Al-Eyadi moved from Arabia to Andalucia in the 9th century (3d Hijri century) and of him issued: Abu Bakr Mohammad ibn Marwan Ibn Zuhr the famous Muslim Scholar in Fiqh (Islamic Jurisprudence) and Hadith (Prophetic Tradition) and the great grandfather of six successive generations of physicians in direct descent in the Ibn Zuhr family, in the period from the beginning of 11th to the end of the 13th century as documented by each of Ibn abi Usaybi’a, Ibn Khallikan, Al-Dhahaby, Al-Khoury, and Sarton. Historians also agreed that when the patronymic Ibn Zuhr is used alone, it represents without ambiguity the most illustrious member of that greatest medical family of Muslim Spain: Abu Marwan: Abdel Malik ibn Zuhr, the subject of this study.
In addition to this succession of male physicians, Ibn Zuhr’s daughter and her daughter were famous lady physicians; “‘âlimatin fi sina’at al tibb wa al-mudawah” (two lady scholars in medicine and therapeutics), with good experience in the treatment of ladies, as stated by Ibn abi Usaybi’a, the famous 13th century medical historian.
The most famous book of Ibn Zuhr is Kitab al-Taysir fi ‘l-Mudawat wa-‘l-Tadbir (Book of Simplification Concerning Therapeutics and Diet). In agreement with Sarton, Guthrie and Ullman, the reputation which Avenzoar has enjoyed in Europe is founded on his Al-Taysir book which was promptly translated into Hebrew and Latin. The work was printed eight times in Latin between 1490 and 1554. According to Sarton. all of these editions contain, both the Taysir of Ibn Zuhr and the Kulliyyat of his contemporary Ibn Rushd (Figures 1 and 2). These Generalia of Ibn Rushd were generally regarded as the counterpart of the Particularia of Ibn Zuhr. - Ibn Rushd and his book Al-Kulliyyat
Ibn Rushd, known in the West as Averroes, is Abu al-Walid Muhammad ibn Ahmad ibn Muhammad ibn Rushd Al-Qurtubi. He was a famous physician who lived and practiced in Cortoba (modern-day Cordova, Andalucia, Spain) between the years 1125 and 1198. His reputation, however, as a distinguished doctor was overshadowed by his great achievements in Islamic jurisprudence and philosophy.
As a memorial, Ibn Rushd’s statues have been placed along the ancient walls in the modern-day city of Cordova and in the vestibule of the University of Barcelona. He was taught medicine by Abu Harun al-Tergali and Abu Marwan ibn Hazbool, not by Ibn Zuhr as stated by some modern historians. However, he was a colleague and a great friend of Ibn Zuhr and, also, a co-author with him.
The most famous medical book of Ibn Rushd is Kitab al-Kulliyyat fi al-
Tibb, the Book of Generalities in Medicine, the famous Colliget in the
Latin translation, that provides the generalia of medicine in seven parts:
A. Anatomy of organs
B. Health (physiology),
C. Sickness (pathology)
D. Signs (symtomatology)
E. Drugs and foods (pharmacology)
F. Hygiene
G. Therapy (therapeutics). - The scientific collaboration between Ibn Zuhr and Ibn Rushd
As stated by Ibn abi Usaybi’a, when Ibn Rushd wrote his book on the general topics of medicine, he requested from Ibn Zuhr to write a book on the special topics; so that the sum of their two works will be a complete work on Sina’at al-Tibb, the Practice of Medicine. This is further authenticated by the statements of the two authors, themselves; Ibn Rushd at the end of his book Al-Kulliyayat and Ibn Zuhr in the introduction of his book Al-Taysir.
Kitab Al-Taysir by Ibn Zuhr provides the particularia of medicine including clinico-pathological correlations, diagnosis and treatment of diseases starting from the head and neck, chest, upper abdomen, lower abdomen then bones then general affections, fevers and epidemics. It is followed by Al-Jami’, a health education book for patients and their relatives.
Combined together, both books constituted one complete comprehensive multi-author medical textbook. Figures 1 and 2 show two editions of this 2 volumes-in-one book printed in Venice in 1542 and 1553 consecutively. Accordingly, this is a clear documentation of the first-ever example of joint authorship of a medical textbook. - Methods of study
In order to evaluate the contribution of Ibn Zuhr to the progress of surgery, this original Arabic edition of his Book Al-Taysir (Figure 1) was carefully studied. The edition was published in 1983 by the Arab Educational Scientific and Cultural Organization. The editor of the book, Dr Micheel Al-Khori, the late member of the Arabic Language Academy (Majma’ al-Lugha al-‘Arabiya) in Damascus, did an excellent job in his edition, based on four manuscrpts of Al-Taysir, one of which was copied in Barcelona only four years after the death of Ibn Zuhr.
We translated, into English relevant excerpts from various sections of the book. Furthermore, references including books, periodicals and online history of medicine resources have been reviewed. - Ibn Zuhr’s Contributions to the Progress of Surgery
I. The most important contribution in this field is his application, for the first time, of experimental methodology in evaluating new, or controversial surgical procedures. The role of tracheotomy in the resuscitation of life threatening suffocation due to upper airway obstruction remained controversial for several centuries. According to Adams and Spink & Lewis, Aretaeus in the 2nd century and Caelius Aurelinus in the 4th century did not approve of tracheotomy. Therefore, although Paulus (7th century), quoting Antyllus (2nd century), described the technique of tracheotomy, the operation remained in disfavor.
This state of affairs lasted until the Islamic era when AI-Razi (9th century) and later Ibn Sina (early 11th century) spoke favorably of the operation and refined the technique. Although AI-Razi spoke of tracheotomy as a drastic measure, he reported seeing patients with wounds in the throat through which breath came out, yet the wounds eventually healed and patients survived. Al-Zahrawy, in his book Al-Tasrif Liman ‘Ajaz ‘an al-Ta’lif reported from his own experience the successful management of a suicidal cut wound of the trachea and concluded that tracheotomy is not a dangerous procedure. However, controversy continued in the time of Ibn Zuhr who noticed that tracheotomy, therefore, was not being carried out on patients who badly needed it. In order to sort out that controversy and prove that tracheotomy is a safe operation, Ibn Zuhr decided to do the following decisive experiment (as translated from page 149 of Al-Taysir):
“Earlier on in my training when I read those opinions (controversies), I cut on the lung pipe of a goat after incising the skin and the covering sheath underneath. Then I completely cut off the substance of the pipe, an area just less than the size of a tirmisah (lupine seed). Then, I kept washing the wound with water and honey till it healed and it (the animal) totally recovered and lived for a long time.”
(to be cont.)