One of the rarest and most valuable pieces in the Arcadian Library’s History of Science and Medicine collection is an early fourteenth-century manuscript of the Liber de Cirurgia—the Latin translation of the original title, Kitāb al-Tasrif, a pioneering work of surgery which exerted an enduring influence on European physicians. The library also owns the first printed edition of the work, dating from 1500, and the 1531 Venice edition which was edited by the medical lecturer Pietro d’Argellata, one of Albucasis’s most devoted adherents. The library also possesses Argellata’s own text on surgery, which was published in 1499. The Andalusian surgeon and physician Abū al-Qāsim Khalaf ibn al-‘Abbās az-Zahrāwī, commonly known in the West as either Albucasis or Abulcasis, exerted a profound and enduring influence upon Medieval European surgical practices.
Albucasis was born in 936 in Medina Azahara. He is widely regarded as the greatest of all Muslim surgeons, and worked initially for Al-Hakam II, the second Umayyad Caliph of Córdoba, himself a noted scientist who collected books in Arabic from all across the Middle East and Central Asia, and to whom some books produced in Abbasid Baghdad were dedicated in honour of his cooperation in facilitating the translation of Greek and Latin works into Arabic during the translation movement of the Islamic Golden Age. The Arcadian Library owns several copies of Albucasis’s pioneering work, most notably an exceptionally rare, fully illustrated manuscript from 1300, translated into Latin by Gerard of Cremona.
The Arcadian Library owns the first printed edition of Cyrurgia, a folio volume printed in Venice in 1500 by Bonetus Locatellus, and the second Giunta edition of the surgical work, printed in Venice in 1531 by Lucantonio Giunta, which combines Albucasis’s work with Pietro d’Argellata’s surgery, who, as mentioned above, was one of the most prominent scholars of Arabic medicine. Albucasis’s Liber servitoris de praeperatione medicinarum simplicium, a pharmacological treatise on the preparation of simple remedies, also appears in the Arcadian Library, bound with Mesue the Younger’s Opera medicinalia. The library owns the first edition of Mesue’s work to be bound with Albucasis’s pharmacopoeia, translated by Abraham of Tortosa and printed in folio format in Venice in 1479 by Reynaldus de Novimagio, as well as a folio edition printed by the heirs of Lucantonio Giunta in Venice in 1558.
The most important edition of Albucasis owned by the Arcadian Library, however, is a Venetian manuscript of the Liber de cirurgia from 1300, translated into Latin by the famed scholar Gerard of Cremona, who lived in Toledo, the epicentre of the European effort to translate Arabic works into Latin. Only twenty-seven manuscripts of Albucasis’s work survive in public institutions, and only three copies exist in private hands, one of which is currently unaccounted for. The only other private copy contains far fewer illustrations than the Arcadian manuscript and has a much later binding (Sotheby's, 1997). The binding of the Arcadian copy, by way of contrast, is contemporary: pink calf over oak boards, blind ruled with double lines in a lattice pattern, featuring remains of brass clasps and catches. It also features numerous annotations throughout.
Albucasis manuscripts are remarkable for their illustrations of surgical tools, and in this respect, the Arcadian codex ranks amongst the very best, featuring many highly detailed colour illustrations scattered throughout the text, complete with captions and descriptions. As the late collector of Medieval manuscripts, Loren C. MacKinney, records, these illustrations include tools for cautery, bloodletting, obstetrics, probing, incising, boring, scraping, suturing, sawing, trephining and dentistry. Less common than the scalpels, lancets, forceps, scissors, saw-edged knives and perforators, are the clysters, specula, cannulae and machines for traction and implements for fistula operations. Furthermore, he asserts that “manuscripts of the famous surgical writings of the later Middle Ages produced no more impressive array of instrument illustrations than those of Albucasis” (MacKinney, 1965).
The Arcadian codex is therefore an extremely important manuscript because of its contemporary binding, because it is early, and because it is a complete, fully illustrated copy. It also has an interesting provenance, having been owned in 1457 by the heirs of Andrea da Recanati, and in the late eighteenth century by Michele Vincenzo Giacinto Malacarne (1744–1816) from Turin, the founder of typographic anatomy and a notable historian of medicine who ended his career as professor of surgery at the University of Padua, and to whom the manuscript was presented in 1803 by Giorgio da Lazara. By the late nineteenth century it was owned by the Austrian dietician Dr Wilhelm Rock.
Comparatively little is known about the life of Albucasis. The palace of Medina Azahara, where he worked, was destroyed in 1010, together with its library (roughly ten years after it is generally agreed the Kitāb al-Tasrif was probably written), in a popular revolution whose participants destroyed the royal residence while the ruler was absent in battle, first plundering it and then setting it ablaze. Accounts of Albucasis’s life—and perhaps copies of other works of which we no longer have any record—were thus destroyed. The most significant of Albucasis’s works that remained was the Kitāb al-Tasrif. Of this large tome, volume 30 is the part that has elicited the most interest over the centuries, namely his treatise on surgical instruments and practices, which is widely regarded as one of the greatest of all Arabic texts on surgery.
Volume 30 of the Kitāb al-Tasrif is the very first complete and illustrated treatment of surgery, and constitutes a record of cutting-edge surgical practices as developed in Al-Andalus by Albucasis and his contemporaries, building upon the legacy of their forbears in Abbasid Baghdad and ancient Greece. The work of Albucasis himself, however, as recorded in this treatise, sets him apart from his contemporaries and predecessors. The numerous personal observations interspersed throughout the text indicate that he was a working surgeon, as do the descriptions and illustrations of numerous surgical instruments, of which one hundred are his own inventions, and many of which are still used today in one form or another.
As Spink and Lewis have noted, many of the surgical procedures and tools that Albucasis records do not appear in other writings from the period or in any surviving Hellenic or Indian treatises on the subject, which were translated en masse in Baghdad during the Islamic Golden Age, and are therefore likely either to have been invented by Albucasis, or at least to have been unique to Arab surgical procedures. In particular, Spink and Lewis note the tonsil guillotine, the concealed knife and its use in opening abscesses, the trocar for paracentesis, the syringe, the lithotrite, the forceps, and his unique design for a vaginal speculum. They even suggest that there is a case for Albucasis or his contemporaries having invented scissors, or at least having first used the instruments as surgical tools (Spink & Lewis, 1973).
Before Paracelsus reputedly invented laudanum in the sixteenth century, Albucasis pioneered the use of inhaled anaesthetic to relieve patients’ distress during surgery. He was deeply concerned with ethical standards amongst physicians and surgeons, but unlike Paracelsus, endeavoured to separate practical medicine from philosophy and pseudo-science (Gillispie, 1970–1978). With the patient’s well-being firmly in mind, he also pioneered the use of catgut for internal stitches. This was revolutionary, as Albucasis found that catgut did not provoke adverse reactions in the body, and would last for a few weeks before dissolving, by which point the wound would have healed. This eliminated the need for an additional round of invasive surgery.
In the third and final part in volume 30, he also describes a method for healing a dislocated shoulder, which many historians of science suggest resembles Kocher’s method, a technique that involves rotating the arm into the correct position. Similarly, in the second part of the volume, in aiding a particularly difficult birth, Albucasis recommends a position similar to the Walcher position, developed by the German gynaecologist Gustav Adolf Walcher (1856–1935), in which the patient is supine on a raised flat surface, with her legs, still supported, hanging off the edge of the table. Though both of these procedures are rarely used today, they are not unheard of, and were well ahead of their time.
The Kitāb al-Tasrif is widely considered to be the most important and influential medieval work on surgical practices and instruments, and its European legacy is of immense significance. Translations appeared as early as the late twelfth century, and it was published continuously in Europe from the late fifteenth century onwards. It was consulted by physicians until well past the Renaissance. The text preserves much of what we know about early medieval medicine, and its illustrations proved invaluable to European surgeons. Donald Campbell notes that Albucasis’s chief influence on European medicine was that his clarity of explanation and presentation opened Western scholars’ eyes to the treasures to be found in Arabic literature. Moreover, he argues, Albucasis’s dim view of the ethics of contemporary surgeons—particularly those concerned with fractures and dislocations—awakened passion for new surgical procedures in Europe (Campbell, 2001). His work only began to be eclipsed when the germ theory of disease began to gain some degree of credence in the late Renaissance, since Albucasis, like other Arabic scientists, based his theories on humorism (the idea that the body was governed by the four humours, or elements), derived from their translations of the work of Hippocrates and Galen.
Albucasis’s work is reputed to have exerted influence on William Hunter, a preeminent eighteenth-century Scottish physician, who had an interest in Arabic medicine and owned a copy of the Kitāb al-Tasrif (Farmer, 1945), and in 1939 the British Medical Journal went as far as to suggest that a Latin manuscript of Albucasis’s surgery (bound with six other treatises), completed c. 1250, may at the time have been the oldest medical textbook written in England (Anon., 1939). One of Albucasis’s greatest European proponents, however, was Pietro d’Argellata (d. 1423). As well as a copy of the Kitāb al-Tasrif bound with Argellata’s own work, the Arcadian Library also owns an incunable folio copy of Argellata’s Cirurgia, printed in Venice in 1499. Argellata was an influential lecturer of medicine at the University of Bologna at the end of the fourteenth and beginning of the fifteenth centuries. This is the only work of his to have survived, and comprises his lectures on Avicenna’s Canon. His work, however, abounds with references to Albucasis, whom he pronounces ‘the chief of all surgeons’, no doubt influenced by his tutor Guy de Chauliac, an influential surgeon who served as court physician to three popes in Avignon, and who quoted the over two hundred times. Many of Argellata’s influential observations and procedures build upon Albucasis’s own—in particular he was an innovator in the fields of obstetrics and dentistry, which Albucasis had been four centuries beforehand.