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Zahrawi: The Father of Operative Surgery

posted on: Jul 29, 2021

“Surgeons can cut out everything except cause.” Herbert M Shelton

By: Ahmed Abu Sultan/Arab America Contributing Writer        Abū al-Qāsim Khalaf ibn al-‘Abbās al-Zahrāwī al-Ansari, popularly known as Al-Zahrawi, was an Arab Andalusian physician, surgeon, and chemist. Considered to be the greatest surgeon of the Middle Ages, he has been described as the father of surgery. Al-Zahrawi’s principal work is the Kitab al-Tasrif, a thirty-volume encyclopedia of medical practices. The surgery chapter of this work was later translated into Latin, attaining popularity and becoming the standard textbook in Europe for the next five hundred years. Al-Zahrawi’s pioneering contributions to the field of surgical procedures and instruments had an enormous impact in the East and West well into the modern period, where some of his discoveries are still applied in medicine to this day. He pioneered the use of catgut for internal stitches, and his surgical instruments are still used today to treat people.

Youth and Career

Al-Zahrawi was born in the city of Azahara, 8 kilometers northwest of Cordoba, Andalusia. Al-Ansari, in his name, suggests origin from the Medinian tribe of Al-Ansar, thus, tracing his ancestry back to Medina in the Arabian peninsula. He lived most of his life in Cordoba. It is also where he studied, taught, and practiced medicine and surgery until shortly before his death in about 1013, two years after the sacking of Azahara. Few details remain regarding his life, aside from his published work, due to the destruction of El-Zahra during later Castillian-Andalusian conflicts. His name first appears in the writings of Abu Muhammad bin Hazm, who listed him among the greatest physicians of Moorish Spain. But the first detailed biography of al-Zahrawī from al-Ḥumaydī’s Jadhwat al-Muqtabis was completed six decades after al-Zahrawi’s death. Al-Zahrawi was a court physician to the Andalusian caliph Al-Hakam II. He was a contemporary of Andalusian chemists such as Ibn al-Wafid, al-Majriti, and Artephius. He devoted his entire life and genius to the advancement of medicine as a whole and surgery in particular.

Al-Zahrawi specialized in curing disease by cauterization. He invented several devices used during surgery, for purposes such as inspection of the interior of the urethra and also inspection, applying, and removing foreign bodies from the throat, the ear, and other body organs. He was also the first to illustrate the various cannulae and the first to treat a wart with an iron tube and caustic metal as a boring instrument. Al-Zahrawi also pioneered neurosurgery and neurological diagnosis. He is known to have performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions, and headache. The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children.

“A good surgeon operates with his hand, not with his heart.” Alexandre Dumas

Kitab al-Tasrif

Al-Zahrawi’s thirty-volume medical encyclopedia, Kitab al-Tasrif, completed in the year 1000, covered a broad range of medical topics, including surgery, medicine, orthopedics, ophthalmology, pharmacology, nutrition, dentistry, childbirth, and pathology. The first volume in the encyclopedia is concerned with general principles of medicine, the second with pathology, while much of the rest discuss topics regarding pharmacology and drugs. The last treatise and the most celebrated one is about surgery. Al-Zahrawi stated that he chose to discuss surgery in the last volume because surgery is the highest form of medicine, and one must not practice it until he becomes well-acquainted with all other branches of medicine. The work 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 emphasized 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, modern evaluation of al-Tasrif manuscript has revealed early descriptions of some medical procedures that were ascribed to later physicians. For example, Al-Zahrawi’s al-Tasrif described both what would later become known as Kocher’s method, for treating a dislocated shoulder and Walcher position, in obstetrics. Moreover, Al-Tasrif described how to ligature blood vessels almost 600 years before Ambroise Paré, and was the first recorded book to explain the hereditary nature of hemophilia. It was also the first to describe a surgical procedure for ligating the temporal artery for migraine, also almost 600 years before Pare recorded that he had ligated his temporal artery for a headache that conforms to current descriptions of migraine. Al-Zahrawi was, therefore, the first to describe the migraine surgery procedure that is enjoying a revival in the 21st century, spearheaded by Elliot Shevel a South African surgeon.

“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray.” Rene Leriche


In pharmacy and pharmacology, Al-Zahrawi pioneered the preparation of medicines by sublimation and distillation. He dedicated the 28th chapter of his book to pharmacy and pharmaceutical techniques. The chapter was later translated into Latin under the title of Liber Servitoris, where it served as an important source for European herbalists. The book is of particular interest, as it provides the reader with recipes and explains how to prepare the “simples” from which were compounded the complex drugs then generally used. Al-Zahrawi also touched upon the subject of cosmetics and dedicated a chapter for it in his medical encyclopedia. As the treatise was translated into Latin, the cosmetic chapter was used in the West. Al-Zahrawi considered cosmetics a branch of medicine, which he called “Medicine of Beauty” (Adwiyat al-Zinah). He deals with perfumes, scented aromatics, and incense. He also invented perfumed sticks rolled and pressed in special molds, perhaps the earliest antecedents of present-day lipsticks and solid deodorants.

Al-Zahrawi was the most frequently cited surgical authority of the Middle Ages. In the 14th century, the French surgeon Guy de Chauliac quoted al-Tasrif over 200 times. Pietro Argallata described Al-Zahrawi as “without doubt the chief of all surgeons”. Al-Zahrawi’s influence continued for at least five centuries, extending into the Renaissance, evidenced by al-Tasrif’s frequent reference by French surgeon Jacques Daléchamps. The street in Cordova where he lived is named in his honor as “Calle Albucasis”. On this street, he lived in house no. 6, which is preserved today by the Spanish Tourist Board with a bronze plaque that indicates Al-Zahrawi living space. It is unfortunate that nowadays there a few that can continue to revive his legacy in the Arab World.

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Arab America Contributor, Ahmed Abu Sultan, discusses the legacy of Al-Zahrawi, otherwise known as the father of Operative Surgery. Ever since the fall of the Islamic Dynasties, much of the scientific work done by Arabs all over the world was lost to the Latin translation of the same work. Because of that, many of the founding fathers of the science that we use even today were lost to time. However, Al-Zahrawi managed carefully to engrave his name as the foundation for many medical sciences. As a result, he immortalized his name and is still remembered nowadays. Even his original home address is kept and preserved to modern times.