Zehravi's Contributions to Medicine and Surgery

There is no harm in saying that surgical treatments, as well as disease treatments, are as old as human history. Early humans generally thought that diseases were sent by evil gods. However, some observant individuals noticed which foods were good for certain illnesses and developed some practices. It's possible to trace these practices back thousands of years. In fact, at a symposium organized by UNESCO in 2017, it was announced that the world's first surgery was discovered on a skull fragment found in Göbeklitepe 14,000 years ago. This article will discuss operating rooms, surgery, and surgical instruments from ancient times to the present. It will address which scientists made what discoveries and how they have shed light on surgical treatments until today.

People probably first tried to stop bleeding, but the first known surgical intervention with evidence is trepanation. Trepanation is a form of treatment that involves removing a part of the skull with drill-like tools and is frequently used for the treatment of diseases such as head trauma and epilepsy. The oldest bone finds showing this practice date back 14,000 years. Evidence of trepanation has been found in many different civilizations from the Neolithic Age, in the early periods of the Incas in South America in 2000 BC, in France in 5100 BC, and in findings from Egypt dating back to 8000 BC.

Rome: The Birth of the Surgery Tent

Modern operating rooms were developed inspired by Roman military tents. In addition, the hospital system of the Romans maintained its excellence until the Napoleonic era. The first Roman medical class was established during the reign of Emperor Augustus. In Rome, military surgeons were called "medicus vulnerarius" (wound doctors). Wound doctors would be on the battlefield with the soldiers during war. In addition, immediate intervention was provided to the wounded thanks to an ambulance team and two emergency war hospital tents where operations were performed. The tent system would move with the army.

Islamic-Arab Period

The Arabs tried to learn the culture and knowledge of the lands they conquered during this period. For this reason, almost all ancient Greek knowledge books were translated into Arabic, and thus Arab states were saved from destruction. Moreover, they not only protected science but also produced new knowledge. The first name that stands out in this period is Razi, who was also a good observer. Another name is Ibn Sina, who was born in Khorasan. Ibn Sina was first a student of Hunayn ibn Ishaq, then continued his education with Ali ibn Rabban. Ibn Sina wrote a total of more than 200 books. In addition to a 10-volume work on Greek medicine, he has another 20-volume work on medicine known as "Canon".

In general, no new information was added to anatomy and physiology during this period. Only a few new drugs were found and new diseases were defined. Great progress was made in ophthalmology. The hospitals built were comparable to 20th-century hospitals.

As a result of the decision taken by the papacy at the Council held in 1163, all medical schools were closed. While medicine was banned in medieval Europe, important steps were being taken in the field of health in the Islamic world, and great physicians were being trained. One of these physicians is Zehravi, who is known as the father of surgery.

Zehravi was an Arab-Muslim physician and surgeon who lived in Andalusia. He was one of the leading physicians of the medieval Islamic world. Zehravi's greatest contribution to medicine was his 30-volume work called Kitab al-Tasrif. The surgical instruments he used have guided modern medicine.

Instruments Developed by Zehravi

The detailed explanation of surgical instruments in the "On Surgery" section of al-Tasrif was far ahead of its time. Using special instruments for surgery was an innovative move at that time. This approach helped science transition from theoretical to experimental studies. Zehravi's work is the first in medical history to explain surgical instruments with illustrations.

In fact, these instruments were so well designed that only minor changes were made over a thousand years. Surgery in Europe was founded on these drawings. In his hand-drawn illustrations, Zehravi showed the instruments he developed in detail and specified when and how to use them.

The number of instruments introduced to medicine by Zehravi is quite high. He contributed many instruments for use in neurology, ophthalmology, cauterization, ear-nose-throat, dental treatment, orthopedics and general surgery, urology, and gynecology. Each of these is a metal product with different forms, specific to regional use, and created with fine craftsmanship.

Use of Blunt Hooks to Clear Clots

Among the instruments Zehravi introduced to surgery were cautery tools of various shapes and sizes, scalpels, extremely sharp instruments designed to make incisions, and hooks with sharp or blunt ends that are still used under the same name today. Blunt hooks easily opened clogged vessels, while sharp hooks were used to hold, lift, and direct tissue. Zehravi also researched urinary tract stones. He produced an instrument called mis'ab (drill) to crush these stones, and Ibn Zuhr, who lived in Seville in the 12th century, transformed the device by adding a diamond to the tip of the steel rod.

Gynecology

Forceps are two-handled metal instruments used in surgeries to hold and pull tissues and provide more room for movement. Crushing forceps are used to crush stones in the bladder or to hold and remove foreign tissues. Delivery forceps, which are included in these, are used to pull out the fetus from the womb.

801: Vaginal speculum. A two-plate canal widening instrument used to open the uterus.

802: Canal widening instrument.

803: Canal widening instrument.

804: A forceps used to crush the head of a dead fetus after miscarriage (805-806).

807: Spiked hook used to remove a dead fetus

Conclusion

From the 14,000-year-old skull fragments found in Göbeklitepe, we can see how far back surgery dates. In this context, it's a fact that surgical interventions and instruments frequently used in modern medicine from those ages to the present actually carry the quality of a historical artifact. Today's surgeons are the "medicus vulnerarius" or wound doctors of the age. Surgeons who trained with difficulties in every period also faced these difficulties in ancient times. The council held in 1163 is one of the biggest examples of this. All medical schools were closed by the papacy. Meanwhile, during the Islamic-Arab period, states translated the cultural and scientific contents found in the lands they conquered into their own languages, preventing a possible loss of knowledge. The Islamic world, which took good steps compared to medieval Europe, was raising great physicians. Zehravi, known as the father of surgery, is one of them.

Zehravi has a 30-volume book called Kitab al-Tasrif, which guides modern medicine and is his only book that has survived to the present day. In addition to producing multiple surgical instruments, Zehravi produced instruments and treatments used in diseases currently in the literature. Approaching every case ingeniously, Zehravi made a name for himself in the surgical field. Surgical instruments used today are still developing and have evolved into robotic technologies that keep up with the times. Hospitals that used to prefer hand tools in the old days have now become hospitals that prefer robotic technology more than human power, and they have become able to treat patients with great ease and conduct research for new studies. Aside from the instruments keeping up with modern medicine, the medical world has now become able to research modern age diseases and produce solutions. The process is this productive and open to development.