Al-Tasrif

The Kitab al-Tasrif (The Method of Medicine) was an influential Arabic medical treatise on medicine and surgery, written near the year 1000 CE by Abu al-Qasim al-Zahrawi (Abulcasis), the "father of modern surgery". The 30-volume work includes anatomical descriptions, classifications of diseases, information on nutrition and surgery, and sections on medicine, orthopaedics, ophthalmology, pharmacology, nutrition, and especially surgery.

In the Western world, the book was known by the Latin title Concessio ei data qui componere haud valet. For at least six centuries, it remained an important medical practice guide for doctors and surgeons in both the Islamic world and medieval Europe.

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Overview

Content

The Kitab al-Tasrif covered a broad range of medical topics, including dentistry and childbirth, which contained data that had accumulated during a career that spanned almost 50 years of training, teaching and practice. In it he also wrote of the importance of a positive doctor-patient relationship and wrote affectionately of his students, whom he referred to as "my children". He also emphasised the importance of treating patients irrespective of their social status. He encouraged the close observation of individual cases in order to make the most accurate diagnosis and the best possible treatment.

Not always properly credited, Abu Al-Qasim's al-Tasrif described both what would later became known as "Kocher's method" for treating a dislocated shoulder and "Walcher position" in obstetrics. Al-Tasrif described how to ligature blood vessels before Ambroise Paré, and was the first recorded book to document several dental devices and explain the hereditary nature of haemophilia.

Influence

Al-Tasrif was later translated into Latin by Gerard of Cremona in the 12th century, and illustrated. For perhaps five centuries during the European Middle Ages, it was the primary source for European medical knowledge, and served as a reference for doctors and surgeons.

In the 14th century, French surgeon Guy de Chauliac quoted al-Tasrif over 200 times. Pietro Argallata (d. 1453) described Abu al-Qasim as "without doubt the chief of all surgeons". In an earlier work, he is credited to be the first to describe ectopic pregnancy in 963, in those days a fatal affliction. Abu Al-Qasim's influence continued for at least five centuries, extending into the Renaissance, evidenced by al-Tasrif's frequent reference by French surgeon Jaques Delechamps (1513-1588).

Advances in Surgery

Al-Qasim was a surgeon and specialized in curing disease by cauterization. He also invented several devices used during surgery, for the purpose of:

• inspection of the interior of the urethra
• applying and removing foreign bodies from the throat
• inspection of the ear

Al-Qasim also described the use of forceps in vaginal deliveries. ^[1]

Dental surgery

In dentistry and dental restoration, the earliest medical text to deal with dental surgery in detail was the Al-Tasrif by Abulcasis. He gave detailed methods for the successful replantation of dislodged teeth.^[2]

Lithotomy and Urology

In urology and lithotomy, Abulcasis performed the first successful extraction of bladder and kidney stones from the urinary bladder using a new instrument he invented—a lithotomy scalpel with two sharp cutting edges—and a new technique he invented—perineal cystolithotomy—which allowed him to crush a large stone inside the bladder, "enabling its piecemeal removal." This innovation was important to the development of bladder stone surgery as it significantly decreased the death rates previously caused by earlier attempts at this operation by the ancients.^[3]

Neurosurgery

Abulcasis developed material and technical designs which are still used in neurosurgery.^[4]

Surgical instruments

In his Al-Tasrif, al-Zahrawi introduced his famous collection of over 200 surgical instruments. Many of these instruments were never used before by any previous surgeons. Hamidan, for example, listed at least twenty six innovative surgical instruments that Abulcasis introduced.

Adhesive bandage and Plaster

Abu al-Qasim invented the modern plaster and adhesive bandage, which are still used in hospitals throughout the world.^[5] The use of plasters for fractures became a standard practice for Arab physicians, though this practice was not widely adopted in Europe until the 19th century.^[6]

Catgut and Forceps

Abu al-Qasim's use of catgut for internal stitching is still practised in modern surgery. The catgut appears to be the only natural substance capable of dissolving and is acceptable by the body

Abu al-Qasim invented the forceps for extracting a dead fetus, as illustrated in the Al-Tasrif.^[7]

Cautery and Ligature

A special medical instrument called a cauter, used for the cauterization of arteries, was first described by Abu al-Qasim in his Kitab al-Tasrif.^[8]

In the Al-Tasrif, Abu al-Qasim also introduced the use of ligature for the blood control of arteries in lieu of cauterization.^[9]

Cotton dressing

Al Zahrawi was the first surgeon to make use of cotton (which itself is derived from the Arabic word qutn) as a medical dressing for controlling hemorrhage.^[6]

Lithotomy scalpel and Surgical needle

Abulcasis invented a lithotomy scalpel with two sharp cutting edges in order to perform the first successful extraction of bladder and kidney stones from the urinary bladder.^[3]

The surgical needle was invented and described by Abu al-Qasim in his Al-Tasrif.^[10]

Other instruments

Other surgical instruments invented by Abu al-Qasim and first described in his Al-Tasrif include the scalpel, curette, retractor, surgical spoon, sound, surgical hook, surgical rod, and specula.^[11]

Other advances

Chemistry and Cosmetology

Al-Zahrawi was also a chemist and dedicated a section of his Kitab al-Tasrif to cosmetology, in which he made several advances in perfumery and invented perfumed stocks, rolled and pressed in special moulds, similar to modern roll-on deodorants.^[12]

Hematology

In hematology, al-Zahrawi wrote the first description on haemophilia in his al-Tasrif, in which he wrote of an Andalusian family whose males died of bleeding after minor injuries.^[6]

References