Abu Qasim Al ZahrawiAl-Zahrawi's pioneering and monumental work, l-Tasrif provides a clear exposition of his surgical thinking and philosophy. Undoubtedly, Al-Zahrawi drew on the medical observations and researches of the ancients, whom he mentions with great respect and advises his pupils to benefit from their wisdom. At the same time, as a practising surgeon he differed from the Greeks in respect of certain surgical theories and questioned their beneficial application. Moreover, he introduced new operations and devised innovative surgical techniques and instruments. For instance, while discussing the treatment for the abnormal curvature of the spine, he says: "the ancients indulged in lengthy dissertation there on giving many kinds of treatment, the greatest part of which is of no use" 1
While discussing difficult operative steps, Al-Zahrawi places great emphasis on a thorough grounding in anatomy, without which a surgeon will be greatly handicapped even today. In the opening part of Al-Tasrif, al-Zahrawi says: "He who is not skilled in anatomy ......is bound to fall into error that is destructive of life". Al-Zahrawi emphasises that a surgeon must ensure the safety of the patient in the course of any surgical procedure. He disapproves of surgical procedures that are rash and devoid of practicality. He says: "My sons! show caution and care for yourself and gentleness and perseverance for your patients". He asks his pupils to take the "best road that leads to health and a happy outcome". He advised them that it is preferable to cure a disease by medicine, and if that is not possible, through a surgical procedure that involves the least amount of pain and discomfort to the patient. At the same time, he cautions his pupils to be ready for any eventuality that might arise in the course of surgical interventions. He says: "The more instruments the practitioner has ready by him the more rapidly he operates and the greater his reputation amongst them. So do not neglect to have ready by you a single one of these instruments". 2 While discussing the treatment for malignancy, Al-Zahrawi points out that cancer should not be touched with a knife unless it is in a part of the body from where it can be removed thoroughly and in its entirety (as in the case of breast cancer). He emphasises that the excision should be done with the utmost thoroughness so that "not the least root of it remains" and that surgery should be done in the early stage of the malignancy as late cases with extensive involvement can never be cured. Self-introspection and self-correction are of the utmost importance in scientific advancement. Al-Zahrawi openly acknowledged his occasional mistakes and failures in the course of surgical interventions, such as the amputation of a gangrenous limb or the failure of wound healing due to a left out sequestrum. Al-Zahrawi had great concern for medical ethics. He ensured that when a female patient was being examined or operated, a trained midwife was also around. He emphasised that surgery should be patient-oriented. Cautioning his pupils, he says: "Do not embark upon anything unless you have positive knowledge of giving the patient a good outcome......Let caution be stronger than your greed and desire for gain". 3 |
Ambroise PareAmbroise Paré was an innovative French surgeon who served as royal surgeon for a number of French kings, including Henri II. Having been apprenticed to a barber,
Paré joined the army in 1536, and spent much of the next 30 years as a military surgeon. He improved or invented many techniques, especially in the treatment of war wounds. Many surgeons gained experience as a result of war, and Paré was no exception. It was common practice at the time for surgeons to seal wounds by the use of cauterisation but, in his first job as a war surgeon in 1536, Paré ran out of the boiling oil which was used to seal the soldier's wounds in this way. Instead, he made a tincture of egg yolk, turpentine and oil of roses. The following morning, and to his amazement, the soldiers who had been treated with the tincture were in a much better condition than those who had been treated with boiling oil. Paré also rejected cautery to seal wounds after amputation. Instead, he used ligatures to tie off the blood vessels. While this was less painful for the patient, the ligatures could cause infection, complications and death, so were not adopted as readily by other surgeons. He was also interested in the application of new anatomical ideas - such as those of Andreas Vesalius - developed a number of instruments and artificial limbs, and introduced new ideas in obstetrics. His famed work as a war surgeon, and afterward as a surgeon in Paris, together with the publication of his book Les Oeuvres in 1575, ensured that Ambroise Paré’s techniques and ideas spread across Europe. His success was also influential in beginning to raise the status of barber-surgeons. |