HISTORICAL AND BIBLIOGRAPHICAL NOTES. 
A SERIES OF SKETCHES OF THE LIVES, TIMES AND 
WORKS OF SOME OF THE 
OLD MASTERS OF ANATOMY, SURGERY AND 
MEDICINE. 
XXI. ALBUCASIS. 
GEORGE JACKSON FISHER, M.D., 
OF SING SING, N. Y, 
REPRINTED FROM THE ANNALS OF Anatomy and SORGttRYt VOL. VIII., JULY, ATUGSS3*. 
AND SEPTEMBER, 1883. 
BROOKLYN, N. Y. 
ANNALS OF ANATOMY AND SURGERY. 
iBB3. HISTORICAL AND BIBLIOGRAPHICAL NOTES. 
A SERIES OF SKETCHES OF THE LIVES, TIMES AND 
WORKS OF SOME OF THE 
OLD MASTERS OF ANATOMY, SURGERY AND 
MEDICINE. 
XXI. ALBUCASIS. 
GEORGE JACKSON FISHER, M.D., 
OF SING SING, N. Y. 
REPRINTED FROM THE A.NNALS OF ANATOMY AND SURGKRY, VOL. VIII., JULY, AUGUST 
AND SEPTEMBER, 1883. 
BROOKLYN, N. Y. 
ANNALS OF ANATOMY AND SURGERY. 
1883. XXL ABUL-CASEM CHALAF EBN-ABBAS AL- 
ZAHARAVI, COMMONLY CALLED ALBUCASIS. 
1060—1122 
GEORGE JACKSON FISHER, M.D 
p. 128) says he finds “no 
certainty of this author’s 
age, but he is generally 
(though for what reason I do not apprehend) supposed 
to have lived about the year 1085.” Moir (Outlines of 
the Ancient Hist, of Med., p. 258) declares that “ Casiri 
has proved, from incontestable evidence, that, at all events, 
he died in 1122.” Haller places him in 1080, and Eloy 
in 1085. Choulant quotes two widely different dates for 
the year of Albucasis’ death, one being 1013, the other 
Copyright, 1880, by George Jackson Fisher, M.D.,Sing Sing, N. Y. 4 
GEORGE JACKSON FISHER. 
iio6. The period is probably very uncertain, and it is al- 
together needless to attempt to reconcile the discrepancies 
of learned writers on this point. 
A very curious bit of confusion also exists among medical 
historiographers as to the identity of two names not un- 
frequently met with, viz. : Albucasis and Alzaharavius. 
Freind maintains that they represent one and the same 
individual. Perhaps the most satisfactory thing to do is 
to transcribe P'reind’s own account of his mode of arriving 
at the conclusion, that the two names belong to the same 
author. In speaking of Alsaharavius, he says, “In perusing 
this author, I observed that he refers to a book, which 
contained the Precepts and Practice of Surgery: this ho 
does very often, particularly p. So to 127 (13 times), I com- 
pared these passages with Albucasis, as he is commonly 
called, the only Arabian who has left us any separate treatise 
of chirurgical operations; and I had the satisfaction to see, 
that every case in surgery, as mentioned by Alsaharavius, 
was treated of by him. I desired the favour of Mr. Gagnier, 
who has very great skill in the Oriental languages, to enquire 
whether the Arabic original of Albucasis could be found 
in the Bodleian Library. Upon searching, he met with one 
Manuscript in Archbishop Marsh’s collection, No. 54, with 
this title (translated into Latin thus): Tractatus x libri 
Zaharavi dictus operatio manus (i. <?.), Chirurgia and ars 
medica, etc.—but not finding the name of Albucasim (which 
is the name given him in a Latin M.S. there by Gerardus 
Carmonensis, who translated him), he went further, and 
found another M.S. amongst Dr. Huntington’s, No. 156, 
with this title at large—Pars xi libri Al-Tasrif, Authore 
AbM-cdsem Chalaf Ebn-Abbas Al-Zaharavi - and at the end 
of the M.S. were these words translated out of Arabic thus, 
Explicit Me Tractatus de Chirurgia estque conclusio totius libri 
Practices medicines cujus Author est Ab’ul-casem, etc. Die 
primo mensis Safar, A. H. 807, and in the Latin M.S. ALBUCASIS. 
5 
already mentioned of Gerardus, it is called particula 30 lihri 
Albucaism. The joint authority of these two MSS. con- 
curring with what I have observed before, about the refer- 
ences to a treatise of Surgery, puts it, I think, beyond 
all dispute, that what we have now under the name of 
Alsaharavius and Albucasis were writ by the same person. 
Add to this, that Albucasis often refers to a book, which he 
had writ concerning the Practice of Physic ” (Op. cit., p, 
126-128). Moir dissents from the above opinion of Friend, 
and believes that they are two distinct writers, Albucasis 
being a celebrated and quite an original author on Surgery, 
while Alzaharavius was a merely servile copyist from the 
writings of Rhazes, and Albucasis. The learned Dr. Ludwig 
Choulant (Handbuch der Biicherkunde fur die Altere 
Medicin, Leipzig, 1841, p. 372). Renouard {Hist, of Med., 
p. 264), and others, accept the two names as designating 
the same author. This seems to be the most sensible view 
to take of the matter, and quite evident when we observe 
the name of the place of nativity which all writers assign 
to Albucasis, viz :—AI-Zahera—which when Latinized was 
rendered Alzaharavius. 
The name of this author will be found variously modified, 
and in some instances almost unrecognizable, as we meet 
it in medical literature. The original names of Arabic 
medical writers have undergone remarkable metamorphoses 
by translation into mongrel Spanish, barbarous Latin, and 
ever-varying English. In this instance we find Albucasis, 
Albucasa, Albucasim, Albuchasis, Abulcasis, Abou’l Kasem 
Khalaf ben Abbas Zaharavi, Albucazi, Abul-Kasem, Bulcha- 
sin, Bulcasis galaf, Bucasis, Casa, Alsaharavius, Alzaharavi- 
us, Alsahravius, Alsharavius, Alscharavius, Al-Zaharavius, 
Alsaharanus, Alcararius, Alzahrawi, and Benaberazerim. 
Of his personality and private history, unfortunately, 
no particulars have been handed down to us, with the 
exception, that he was a high-minded practitioner, to whom 6 
GEORGE JACKSON FISHER. 
the love of pecuniary gain was a minor consideration, who 
possessed a dignified, liberal, and disinterested spirit, and 
gained the respect, gratitude, and love of his countrymen. 
And now that nine centuries have rolled away, he is regarded 
as the most celebrated and eminent Arabian surgical writer, 
of any whose works have survived. 
The “Al-Tasrif,” or the Art of Healing, of Alzaravius, was 
little more than an abridgment of the theory and practice 
of Medicine as understood in that day, and though not 
devoid of merit, being in advance of all similar works in 
systematic and methodical arrangement, it must, however, be 
admitted that it was largely made up of extensive transcripts 
from Rhazes and others of his predecessors, as well as from 
the Greeks, Hippocrates, and Galen, zEtius, and Paulus 
Afgineta, although he fails to mention the names of any 
except the two former. What appears quite strange is the 
fact that Alzaravius is entirely unmentioned by any of the 
Arabian medical writers. 
It is with the Chirurgia of Albucasis that we are most 
interested, and with the perusal of which we are most amply 
repaid. This is a work of great value. Fabricius ab Aqua- 
pendente esteemed this work very highly, saying, “Celsus 
among the Latins, Paulus Afgineta among the Greeks, and 
Albucasis among the Arabians, form a triumvirate to which 
I confess I am under great obligations.” 
Avenzoar and Albucasis bear concurrent testimony to the 
almost extinction of surgery at the time they entered upon 
their career. Albucasis gives the following reasons for 
having written his work on surgery : 
“After having terminated, happily enough, the work on 
Medicine which I undertook for your instruction, my sons, 
I have thought it proper to add to it a small treatise on 
manual operations, seeing that this part of our science is so ALBUCASIS. 
7 
much neglected in our country at the present time, that 
there remains scarcely any vestiges of it. We can only find 
a few short descriptions of operations in the books of the 
ancients; they are, however, disfigured by the ignorance of 
the bookmakers; the manuscripts are so faulty, that at 
every step we are in such doubt as to the sense of the 
authors, that no one dare enter into the study of surgery. I 
have, therefore undertaken this little treatise for the purpose 
of reviving this most important and useful branch of our 
Art. I have detailed briefly the methods of operation, I 
have described all the necessary instruments, and I present 
their forms, by means of drawings ; in a word, I have omitted 
nothing of what can shed light on the practice. But one of 
the principal reasons why it is so rare to meet a skillful sur- 
geon is, that the apprenticeship to this branch is very long, 
and he that devotes himself to it must be versed in the 
science of anatomy, of which Galen has transmitted us the 
knowledge. He should know the functions of organs, their 
shape, and their relations; the number of the bones, and 
their modes of union ; the origin and termination of the 
muscles, the nerves', the arteries, and the veins. In fine, no 
one should permit himself to attempt this difficult art with- 
out having a perfect knowledge of anatomy, and the action 
of remedies ” (lib. I.). 
It will be observed that Albucasis, who places so high an 
estimate on the value and necessity of an exact knowlege of 
anatomy to the surgeon, is everywhere silent on the subject 
of dissection, and only points to the works of Galen as the 
repository of this science. 
His treatise on Surgery is divided into three books. The 
first comprehends everything relating to the multiple uses 
of the cautery, a favorite remedial agent among the Ara- 
bians, in all its forms—actual and potential—the modes of 
application, the various instruments and escharotics to be 8 
GEORGE JACKSON FISHER. 
employed, the requisite cautions, and much detail. He 
enumerates fifty diseases in which he had observed their 
utility. The second book comprises all that relates to oper- 
ations to be performed by the use of cutting instruments. 
He describes numerous instruments which may be seen fig- 
ured in both of the Bodleian MSS., as well as in most of the 
Latin editions of his works. He also gives directions for 
many surgical operations, ranging from the simplest to the 
most formidable. He describes ninety-seven operations per- 
formed with the knife, several of which will be mentioned 
farther on. The third book is devoted to the treatment of 
fractures and dislocations of the bones. He tells us that 
this branch of surgery had unhappily fallen into the hands 
of the most ignorant, vulgar and impudent pretenders, and 
was looked upon with contempt and suspicion. 
Albucasis assures us that his work is founded upon exten- 
sive reading and large personal experience, and that he had 
written nothing that he had not witnessed in his own prac- 
tice ; and yet the work is little more than a fair exposition 
and epitome of the principles and practice of Arabian sur- 
gery as taught by his predecessors. Thfcre is no other work 
of this period, however, that is at all comparable with this 
in general completeness, richness of detail, and lucidity in 
description. It is of especial interest and value in that it 
is the first surgical work that has furnished the moderns 
with figures of the ancient surgical instruments, already 
alluded to, as well as careful descriptions of the same. In- 
deed, it may truly be esteemed as one of the most precious 
relicques of the healing art which has been transmitted to 
us from mediaeval times. 
In presenting a brief analysis of the surgical views and 
practice of the Arabians as we find them set forth in the 
writings of Albucasis, I will begin with his first book relating 
to the use of the cautery. ALB UCA SIS. 
9 
Albucasis, in common with all the Arabian surgeons, was 
particularly partial to the actual cautery. Freind says, “he 
seems to be in a rapture in speaking of the divine and secret 
virtues of fire.” Even ages before, Dioscorides, the con- 
temporary of Celsus, spoke of the use of the actual cautery 
as the “Arabian burnings.” We find Albucasis using it 
extensively and with great success as he claims in obstinate 
cases of Sciatica. 
Albucasis mentions four modes of curing trichiasis, 
i. By the actual cautery. 2. By the potential cautery. 
3. By incision and suture, which operation he describes with 
minute detail, much after the mode of Paulus FEgineta. 
4. By making an incision the whole length of the lid, within 
the ciliary hairs, and twisting the redundant skin firmly 
about reeds or small pieces of wood until it mortifies, then 
curing the wound as any other. Fie describes many other 
operations belonging to ophthalmic surgery; such as eversion 
of the eyelids, lipoma of the lids, adhesion of the eyelids, 
encanthis, pterygia, staphyloma, hypopyon, fistula lachry- 
malis, and cataract. 
In cases of abscess resulting from obstruction of the 
lachrymal duct, he directs us to open the abscess freely, so 
as to make an outlet for the pus, and expose the bone, if 
it is found to be diseased, he recommends us to scrape it 
with an iron instrument, and then to apply styptic and 
desiccative medicines to it. When this treatment fails, he 
directs us to perforate the bone with a triangular instru- 
ment of iron. When air issues from the nose by the open- 
ing we know, he says, that the operation is completed. 
In operations for cataract by depression, Albucasis des- 
cribes the process of Paulus FEgineta with great minute- 
ness of detail, and gives drawings of the couching-needles, 
called by him almagda. The instrument is to be passed 
down into the eye to as great a space as the pupil of the 10 
GEORGE JACKSON FISHER. 
eye is distant from the end of the black part called the 
cornea. He says nothing of tearing the cataract into pieces 
when it proves difficult to depress. He mentions that he 
had heard of a certain oculist who, it was said, sucked out 
the cataract (lens) through a small tube. Fie adds, however, 
that he had never seen any person who had performed this 
mode of operation, nor had he read about it in the works of 
the ancients (Chirurg. ii., 23). Rhazes accurately describes 
the operations of couching, extracting, and sucking out the 
cataract (ad Mansor, ix., 27, and Cont. ii.). Our author 
gives judicious directions for treating imperforate meatus 
auditorius; and also for the removal of foreign bodies from 
the same passage. For the extraction of a piece of stone 
he recommends us, among other means, to use a slender 
forceps, of which he gives a drawing. It resembles the 
ordinary dissecting forceps now in use. He also gives a 
drawing of a hook slightly bent, which he commends; and 
also of a brazen tube to be used for sucking out foreign 
bodies from the ear. When other means do not succeed, 
he directs us to make an incision at the upper part of the 
ear, having previously let blood in order to avert inflamma- 
tion and convulsions. Insects are to be sucked out with a 
tube narrow below and wider externally, or they are to be 
extracted with a forceps or hook. When these means do 
not succeed, an oil, to which some substance destructive to 
these animals has been added, is to be injected with an in- 
strument, of which he also furnishes a drawing. 
Albucasis minutely describes the operation of excision 
and also of sawing out fibrous polypi from the nasal cavi- 
ties. In the former case he directs us to seize the tumor 
with a hook, to pull it down, and cut it out. If any part 
remain he recommends us to scrape it out with a slender 
instrument, and then to apply styptics, such as vinegar, 
water, or snow. The operation of sawing it out with a A LB UCA S IS. 
11 
thread moderately thick, like a cord, tied in knots at short 
distances, is fully described by him. He also speaks of 
cauterizing the part from which the tumor was removed. 
Epulis, a soft, fleshy excrescence which forms upon the 
gums, was treated by Albucasis by excision with forceps 
and scalpel, after which styptics are to be applied to the 
part, and if the tumor should grow again, the actual cautery, 
knob-shaped, must be resorted to. (Chirurg. L, 22, and ii., 
28). The same treatment is advised by modern surgeons. 
Of all the ancient surgical writers Albucasis has treated 
the subject of operations upon the teeth with the greatest 
fullness and care. He directs that free scarification of the 
gums be made before performing extraction, and then pull- 
ing the tooth direct with forceps, the patient’s head being 
meantime held between the knees of the operator. (The 
writer of this sketch has vivid and painful recollections of 
submitting to this mode of vice-like retention of the head, 
while a rural Arab-of-a-doctor wrenched a molar from his 
inferior maxillary with a cant-hook, known to many still 
living, as a turn-key. This heroic method is not yet entirely 
obsolete). Albucasis directs that hollow teeth be stuffed 
with a tent of cloth before applying the forceps. If a piece 
of the alveolar process be broken, he advises its removal. 
He also gives directions for filing projecting points or dis- 
eased portions of teeth. When teeth have been loosened 
by accident, he directs that they shall be secured by threads 
or wires of gold. In his second book, thirtieth chapter, he 
gives drawings of instruments for the extraction of roots of 
teeth. 
Albucasis operated upon tongue-tie in the same manner as 
it is now done by modern surgeons. He gives particular 
cautions against opening the artery below the tongue, on 
account of haemorrhage. Should the accident occur, he ad- 
vises the prompt use of the actual cautery (Ch. ii., 34), 12 
GEORGE JACKSON FISHER. 
In cases of enlarged and indurated tonsils he removes 
them by incision. The patient is to sit with his head on 
the operator’s bosom, and while an assistant depresses his 
tongue, the operator seizes the tonsil with a tenaculum, 
draws it out, and cuts it off with a sharp instrument resem- 
bling a forceps, or in other words a pair of scissors. He 
likewise gives a drawing of another instrument, which con- 
sists of a lunated piece of iron fixed in a handle ; the primi- 
tive form from which the moderns have evolved the tonsil- 
lotome. He relates an interesting case in which he per- 
formed this operation (Ch. ii., 36). Giudo de Cauliaco copies 
the description of Albucasis. 
Albucasis gives directions for truncating the uvula by in- 
cision, and also gives a drawing of an instrument for operat- 
ing with caustic medicines (Ch. ii., 37). 
He directs the removal of fish-bones, and other substances 
which may be lodged in the pharynx, by the forceps, and in 
case of failure to introduce an instrument made of lead, of 
which he gives a drawing, and either to extract the sub- 
stance or push it downwards. When a morsel of food 
sticks in the oesophagus, he directs that the person be 
struck on the back to facilitate its descent. This time- 
honored proceeding, courteous reader, you observe, has the 
sanction of eight centuries, and when again you hammer a 
strangling friend, or are yourself hammered on the back, 
under like conditions to produce reflex-excito-motor-pha- 
ryngo-oesophageal-peristaltic-back-action, please do not for- 
get the old Arab Alsaharavius, vel Albucasis, alias Bulcasim, 
etc., etc. 
Our author copies from Paulus Aigineta his description of 
the operation of Laryngotomy. He probably never performed 
it or ever saw it done. He declares that wounds of the 
windpipe are not extremely dangerous or fatal, and demon- 
strates it by the narration of the case of a female, who, in ALB UCA SIS. 
13 
attempting suicide, cut her trachea, in which case, by sew- 
ing up the wound, he effected a cure without difficulty 
(Ch. ii.f 13). 
Albucasis directs the excision of large adenoid tumors, and 
when there is a large blood vessel at the bottom of the tumor 
to apply a ligature round its root, and allow it to drop out 
by putrefaction. In some cases he used the red-hot iron. 
If the tumor contained fluid, he opened it and dressed the 
interior with irritating ointments. In other tumors he di- 
rects an explorative puncture, in order to ascertain the na- 
ture of the contents of its structure. Fatty and other solid 
tumors are to be cut out by a crucial incision, always 
being careful to remove the entire capsule. He gives 
drawings of various instruments, namely, scalpels, tenacula, 
and perforators, for dissecting out tumors (Ch. ii., 45, 46). 
His description of aneurism, and its treatment by ligature 
above and below, and laying open and evacuating the sac, 
is much the same as that of Paulus Aigineta. It is remark- 
ably lucid and indicates much skill and good sense. 
The cure by compresses and tight bandages is also spoken 
of (vide Alsaharavius, Pract xxix., 11). 
Mr. Adams, to whom I am so much indebted in prepar- 
ing this analysis of the surgical procedures of Albucasis 
(Commentary on the Seven Books of Paulus Aigineta), says, 
“no author, ancient or modern, has described the modes of 
performing venesection in all parts of the body more accu- 
rately than Albucasis. Bleeding from the jugular vein he 
describes in much the same way that it is now practiced by 
veterinary surgeons, namely, by placing a sort of Scalpel, 
bent at the point, which he calls a fossorium, upon the 
vein, and striking the instrument with a hammer or some 
such body. He gives drawings of variously-shaped lancets 
for opening the veins of the arm (Chir. ii., 97). 
He gives a minute description of the operation of arteri- 14 
GEORGE JACKSON FISHER. 
otomy, and the mode of ligating the vessels, which he advises 
in cases of inveterate hemicrania, catarrh, etc. (Chirurg. ii., 3). 
Albucasis gives a most circumstantial and interesting 
account of the methods of cupping every part of the body. 
He particularly recommends cupping the nape of the neck 
in affections of the brain and eyes. He gives a full account 
of dry cupping. He advises it to be applied when the 
disease is seated in places which do not bear cupping with 
scarifications, such as the regions of the liver, or spleen, the 
kidneys, the bowels, and the joints affected with gout. In 
applying the instrument he directs us either to create a flame 
in it, or to fill it with hot water. He gives drawings of 
various instruments for cupping (Chir. ii., 98). He also 
treats fully of leeching, which, however, he advises only in 
cases in which the cupping instrument cannot be applied. 
When the bleeding continues longer than is desired, he 
directs a piece of cloth soaked in cold water to be applied 
to the place, or if this fails, styptics, such as galls, beans 
without their skins, and the like. When the leeches will 
not take, the place is to be smeared with fresh blood. When 
it is desired to make them drop off, powdered aloes, salts, 
or ashes are to be sprinkled on them (ii., 99). 
He gives directions for the removal of preternatural and 
supernumerary digits. When fingers are adherent to one 
another, he tells us to divide them with a scalpel, and keep 
them separated by a pledget moistened with oil of roses, or 
a thin plate of lead between them, until the healing is com- 
pleted (Chir. ii., 91). 
In cases of empyema, cauteries were much used by the 
ancients. In some cases the hot iron was made to penetrate 
between the fifth and sixth ribs, into the chest, and thus 
evacuate the pus at once. Others used the knife for the 
same purpose. Albucasis gives a drawing of an instrument 
for perforating the chest expeditiously (Chir. i., 26). ALBUCASIS. 
15 
In treating of surgical operations for the removal of 
cancerous growths, Albucasis says that he never saw a case 
of cancer cured unless the tumor was small and recently 
formed. He directs us, when the operation of excision is 
attempted, to cut out the tumor by the roots, and if the 
haemorrhage from any vessels be profuse, to arrest it by the 
cautery (Chir. ii., 53). 
In cases of abscess of the liver, Albucasis directs the pus 
to be evacuated with the red-hot iron, and gives a drawing 
of a spear-shaped cautery for this purpose (ii., 30). 
Albucasis speaks of paracentesis in cases of hydroceph- 
alus internus in infancy, but adds that in every case it had 
proved fatal. He cautions against wounding the artery 
lest instant death should occur. 
Paracentesis was resorted to by most of the ancients in 
cases of abdominal dropsy. The description of the opera- 
tion, the instruments, and the place of incision as given by 
Albucasis is very minute. After the incision he tells us to 
introduce a canula made of silver, copper, or brass, having a 
small hole at the bottom and three at the sides. He ad- 
vises the evacuation of not more than one-half of the fluid 
at first, the remainder subsequently, according to the 
strength of the patient. He says the opening readily con 
tracts when the canula is removed (ii., 540- 
In cases of abdominal wounds, and wounds of the intes- 
tine, Albucasis gives several modes of performing gastro- 
raphy, and relates the history of a case in which he treated 
the wound by this operation (ii., 87). 
Albucasis quotes quite literally from Paulus ALgineta, all 
that relates to hypospadias, to imperforate glans penis, 
phimosis, and adhesion of prepuce to the glans. He des- 
cribes the operation of circumcision on boys as a rite of the 
Jewish religion. He directs the prepuce to be cut with a 
pair of scissors, and the part to be allowed to bleed freely. 16 
GEORGE JACKSON FISHER. 
From the manner in which he expresses himself respecting 
the operation, there can be no doubt that Albucasis was a 
Jew, and Paulus Aigineta a Pagan (ii., 57). 
Catheterism, and injection of the bladder, were well- 
recognized operations in Arabian surgery in mediseval times. 
Albucasis borrows his account chiefly from Paulus. The 
catheter recommended by Albucasis was made of silver. 
He gives a description and drawing of an instrument for 
throwing injections of oil and water into the bladder when 
inflamed or ulcerated. It is a tube of silver or copper 
having the bladder of a ram attached to it (Chir. ii., 59). 
The operation of lithotomy, and all that relates to vesical 
calculi is carefully and well described by Albucasis. It can- 
not fail to be interesting to the modern surgeon to read the 
following account given by this ancient chirurgeon of this 
very important operation. 
Having cleared out the bowels with a clyster, the patient 
is to be shaken so as to make the stone descend, and he 
is then to be secured in the arms of an assistant, with 
his hands under his nates. The surgeon is then to press 
upon the perineum, and, if the stone be felt, the operation 
is to be proceeded with ; but otherwise, the index finger 
of the left hand, if the patient be a child, and the middle 
if an adult, is to be introduced into the anus, and the stone 
is thereby to be gradually brought down to the neck of the 
bladder. Having pushed it outwards to the place where 
you mean to make your incision, an assistant is to be 
directed to press down the bladder from above the pubes, 
while another draws up the testicles with the one hand, and 
with the other stretches the skin under them. Then with a 
proper scalpel the operator is to make an incision between 
the anus and the testicles, not in the middle, but towards 
the left nates, straight upon the stone which is to be pressed 
out by the finger. Let the incision be transverse (oblique ?), ALBUCASIS. 
17 
large externally, but internally the size of the stone. If 
the stone does not then start out, the operator must seize 
upon it with a forceps, or a hook having a lunated extremity. 
If there be more than one stone, the largest must be 
extracted first, and then the others may be easily removed. 
When the stone is large he directs us to break it down with 
a forceps. His directions respecting the after treatment 
are similar to those of Paulus. When a calculus sticks 
in the urethra, he tells us to cut down upon it. His 
description of lithotomy in the female is more minute and 
particular than that of any previous writer. Having pro- 
cured a dextrous midwife, or some proper person to intro- 
duce her finger into the rectum or vagina, and press the 
stone down to the left hip, the operator is to make first 
a small incision over it, and afterwards, by the help of a 
sound or specillum, it is to be enlarged so as to allow 
a passage for the stone (Chirurg. ii., 60, 61). 
All that is said above is little more than a repetition 
of what Celsus wrote on this subject in the first century. 
The ancient operation with scarcely any alterations will 
be found described in the works of nearly all of the earlier 
modern writers on surgery. See, Brunus (Chirurg. Magna, 
ii., 17), and Guido de Cauliaco (Chir, vi., 2). Brunus, how- 
ever, preferred the strictly median incision. 
In hydrocele, the treatment adopted by Albucasis con- 
sisted in making an incision in the swelling and dissecting 
out the tunica vaginalis of the testicles. The chief dressing 
was to fill the interior with wool soaked in oil; and applying 
externally wool dipped in warm oil and wine. In some 
cases the actual cautery was used instead of cutting out the 
tunica vaginalis. He adds, that if the patient be timid and 
do not choose to submit to these operations, the surgeon 
may let out the water either with a scalpel or the instrument 
used for tapping in dropsy. He states, however, that after 18 
GEORGE JACKSON FISHER. 
this operation the water will collect again (Chirurg. 
ii., 62). 
In castration, on account of tumor, or other morbid growth 
of the testicle, Albucasis directs us to separate the cre- 
master muscle from the blood vessels, to tie the vessels, 
and then remove the testicle from the surrounding parts. 
When the disease consists of a fleshy tumor which adheres 
to the testicle he directs us to cut it out, and save the 
organ. After the operation, the wound is to be filled with 
rose-oil and wine (Chir. ii., 63). 
In ancient times the radical cure of hernia was not only 
a serious but a most cruel operation. In strangulated hernia 
no operation was undertaken. In the operation for the 
radical cure of hernia, the testicle was always sacrificed, 
the vessels were ligated, a portion of the peritoneum re- 
moved, and antiseptic or air-excluding dressings of wool 
and rose-oil applied. This operation which was described 
by Paulus Aigineta, in the seventh century, was done much 
in the same manner by Albucasis, and continued to be 
practiced until within about two centuries of the present 
time. The operation, hazardous as it may appear to us, 
could not have been attended with great danger, otherwise 
it would not have been so frequently performed as it seems 
to have been, for, according to Fabricius ab Aquapendente, 
a celebrated specialist, known as a rupture doctor, of his 
time informed him that he used to operate upon two 
hundred patients at an average every year. Fabricius, how- 
ever, disapproved of this operation, and would have it 
resorted to only in extreme cases, and to be content in 
general with supporting the parts with a truss. 
Albucasis gives the following account of the operation: 
He says the disease is occasioned by the descent of a por- 
tion of intestine to the testicle, owing to rupture or disten- 
tion of the peritoneum. Sometimes, he says, faeces get into ALB UCA BIS. 
19 
the prolapsed bowels, and being retained give rise to violent 
and sometimes fatal symptoms. When going to operate he 
directs us, in the first place, to make the patient reduce the 
intestine if reducible. Then an incision is to be made along 
the whole skin of the testicle, and hooks are to be fixed in 
the lips of the wound so as to enlarge it and allow a passage 
for the testicle. The membranes, then, below the skin, are 
to be dissected, so as to expose completely the tunica 
vaginalis (.sifac album). The index-finger is then to be intro- 
duced between the tunica vaginalis and the second coat 
(tunica albuginea?) so as to free the adhesions at the back 
part of the testicle. The operator is afterwards to separate 
the testicle from all its adhesions and raise it up to the ex- 
ternal wound. He must now examine whether any portion 
of intestine remains protruded, and if so it must be replaced. 
The operator is then to take a large needle armed with a 
cord of ten threads, and having introduced it behind the 
tunic under the skin of the testicle its extremities are to be 
cut, and the threads arranged into four pieces. With them 
the peritoneum is to be tightly bound in a crucial form, 
so that the nutrient vessels may not be able to reach it, 
which will obviate inflammation. Another ligature is to be 
applied afterwards at the distance of less than two fingers’ 
breadth from the former. After applying these two liga- 
tures, about a finger’s breadth of the peritoneum is to be 
left, and the rest is then to be cut all around, and the testicle 
removed along with it. An incision is then to be made at the 
lower part so as to allow an outlet for the blood and matter. 
Wool dipped in oil is to be applied afterwards, and bound 
as formerly described. Sometimes, he adds, the cautery is 
applied to the tunica vaginalis after the incision for fear 
of haemorrhage (Chir. ii., 65). He minutely describes the 
treatment by burning in another place (i., 47). 
The operation of extracting the dead foetus from the uter- 20 
GEORGE JACKSON FISHER. 
us, by embryotomy, is given by Albucasis in almost the same 
words as it is described by Paulus, which will be found in 
my sketch of this ancient Greek surgeon. Albucasis relates 
a case of extra-uterine pregnancy that came under his own 
observation, A woman being pregnant, the foetus died 
without delivery, and subsequently an abscess formed at 
the navel, and coming to maturity, discharged, to his great 
surprise, not only pus but the bones of a foetus. The 
mother lived many years after this event, a fistulous open 
ing always remaining from which a purulent discharge 
never ceased to flow. This is one of the earliest, if not the 
first case of the kind on record. 
The work of Albucasis contains drawings of the instru- 
ments used in his time for obstetrical operations. Among 
them are several forms of forceps, but as they all have teeth* 
it is to be presumed that they were used only for delivering 
the foetus when dead. It is to be regretted that he has 
entirely omitted the forceps mentioned by Avicenna (Chirurg, 
ii., 76 and 77). These rude and curious figures of obstetrical 
instruments are all copied in a rare book entitled Gynceciorum, 
hoc est, De Mulierum turn alsii, turn gravidarum, parientiuvt 
et puerperarum affectibus, etc., 40, Basilece, 1566. This is a 
collection of works on the subject of obstetrics, made by 
Caspar Wolph. One of the books is extracted chiefly from 
Albucasis, the figures of twelve instruments, including a 
speculum uteri, several forceps, hooks, and cutting instru- 
ments, are to be found in Chapter 72. 
Fistulae are treated of by Albucasis at great length. He 
advises making free incisions, and the removal of pieces of 
diseased bone which chance to be found at the bottom of 
the sore. He relates a case of fistulous ulcer in the thigh, 
to cure which he removed large pieces of bone, sawing it 
down as far as the marrow. Some of his saws are of very 
ingenious construction, one of them being very like that ALBUCASIS. 
21 
known to us as Key’s saw. He enumerates nine specific 
causes which prevent the healing of wounds. Space will 
not permit me to repeat them. 
In the treatment of haemorrhoids Albucasis prefers excis- 
ion and burning, but if the patient will not submit to these 
methods of cure, he then resorts to the ligature. Excision 
is done by seizing the pile with a hook and cutting it at its 
base, after which styptics are applied. He applied the liga- 
ture by transfixing the base of the haemorrhoid with a needle 
armed with a thread (Chir. ii., 81). He gives full directions 
for the use of the actual cautery (p. i., 37). 
In operating on an imperforate anus, our author advises, 
after incision, the introduction of a leaden canula to pre- 
vent closure of the artificial opening. 
Amputation of the extremities in cases of mortification 
was practiced in the days of Albucasis. When the disease 
is seated in the hand, he recommends us to amputate at the 
fore-arm ; when in the fore-arm, at the elbow ; and if the 
arm itself be affected, he considers the case to be hopeless. 
The same view is taken in regard to the lower extremities, 
all cases of mortification above the knee he pronounced in- 
curable. In performing the operation, he directs us to 
apply two bandages around the limb, one above and the 
other below the point selected for the amputation. These 
bandages are to be pulled by two assistants ; the former 
upwards and the latter downwards, in order to put the skin 
upon the stretch ; the fleshy parts are then to be divided 
with a large scalpel down to the bone, which is then to be 
cut out or sawed across; and, before this is done, a retractor 
of linen is to be applied around all the fleshy parts to pre- 
vent injury by the sawing. Should any haemorrhage occur 
during the operation, he directs us to apply the cautery, or 
a styptic powder, and, after the operation, he has the limb 
properly bandaged until the stump is healed. 22 
GEORGE JACKSON FISHER. 
The imperfect state of surgery in his time, and the timid 
practice of our author, are illustrated by a case related by 
Albucasis. A person who had a spreading mortification in 
the foot, cut it off himself at the ankle-joint, and was cured 
for the time. The disease next attacked the hand, upon 
which he applied to Albucasis, requesting that he would cut 
it off in the same manner, but this he refused to do, for fear 
that the man’s strength might not be able to endure the 
operation. He afterwards learned that the man had cut off 
his whole hand, and had recovered (Chirurg. ii., 89). 
Albucasis gives a very full account of the modes of ex- 
tracting various weapons. He also relates some interesting 
cases of recovery from very severe wounds. An arrow entered 
at the root of a man’s nose, and was extracted by Albucasis 
behind his ear ; the man recovered without injury to the 
eye. He extracted another large arrow which had lodged 
deep below the eye of a Jew ; and, in this case also, the 
sight was not impaired. He extracted a barbed arrow, 
which had lodged in the throat of a Christian, by enlarging 
the wound, and the man recovered. An arrow had lodged 
in a man’s belly, so that, at first sight, Albucasis considered 
the case as hopeless ; but, after thirty days, as no mortal 
symptoms had supervened, he enlarged the wound and ex- 
tracted the weapon. He says he saw a man who got an ar- 
row lodged in his back ; the wound healed, but, after an 
interval of seven years, the weapon came out below his 
buttocks. He knew a woman who had an arrow lodged in 
her abdomen ; the wound healed, the weapon never after- 
wards occasioned her any inconvenience. He also relates 
that he finally extracted an arrow, which had been buried in 
the nose of a prince, after making various fruitless attempts 
for the space of four months. 
He gives many sensible directions for removing arrows 
which are driven into bone, for the use of the probe, the ALBUCASrS. 
23 
trephine, etc. He concludes with giving drawings of various 
form of forceps, and instruments called impellents (Chir. 
ii., 96). 
There is nothing of special note in the works of Albucasis 
that is not to be found in Paulus Higineta, and still more 
ancient authors, concerning fractures and dislocations of the 
bones. He says that fracture of a bone is recognized by 
the derangement of the broken pieces, by their projection, 
and the crepitus produced upon pressure. He remarks, 
however, that there may be a splitting or fissure, without 
displacement or crepitus. In fractures of the skull with de- 
pression, Albucasis resorted to the trephine. The drawings 
which he gives of the surgical instruments used by the an- 
cients in operations on the head are very interesting, and 
serve to illustrate the descriptions of Paulus and other ear- 
lier surgical writers. 
In fractures of the clavicle, Albucasis enjoins the surgeon, 
when there are any projecting spiculse, to make an incision 
and cut them out ; after which, if the wound is large, unite 
it with sutures. A compress moistened with rose-oil, vine- 
gar, and wine, is to be applied to allay inflammation. He 
understood the value of postural treatment in this fracture, 
and hence directs the patient to sleep on his back with a 
pillow under his arm-pit. 
In cases of comminuted fracture of the ribs, our author 
advises making an incision and removing any pieces of 
bone which may irritate the pleura. He gives a drawing of 
the meningophylax, or instrument for protecting membranes 
during the sawing of bones. 
In the treatment of fractures of the arm, Albucasis directs 
us to make the bandages of soft thin linen cloth ; but of 
broader and firmer linen, if the thigh or leg is to be treated. 
Below them is to be applied a smooth cloth spread with 
a liniment. After the under bandages have been put on 24 
GEORGE JACKSON FISHER. 
in the manner already described (which is the same as 
that of Paulus), the splints are to be applied, provided 
no swelling nor inflammation be present, for in that case 
they are to be deferred for a few days. These splints 
are to be constructed from the middle part of the alcanna, 
or of pine, or of the palm-tree, or of a tree which he calls 
calingi. 
Avicenna directs us to form the splints of the wood of 
alcanna, or of oleander, or of pomegranate tree, or the like. 
In the treatment of fractures of the ulna, and radius 
Albucasis is veiy lucid and accurate. He calls the ulna the 
larger of the bones. He directs the arms to be suspended 
with the thumb uppermost. When fragments of bone are 
likely to occasion irritation, he advises making an incision 
and removing them. When the arm is affected by severe 
pruritus, he tells us to remove the dressings and bathe 
it with hot water. 
The best interpretation of the language of Albucasis 
in describing the process of treating fracture of the thigh 
bone, is that he applied splints which extended the entire 
length of the limb. He says the surgeon must stuff up 
all the hollow places in the limb with soft pads before 
applying the splints. Also, that a bandage be applied from 
the heel to the nates. Rhazes is the only one among 
the ancients who directs the thigh to be placed in a bent 
position, with suitable supports beneath, in other words, 
the double-inclined plane. 
When a redundant callus is formed as a result of union 
in fractures, if recent, Albucasis directs us to use astringents, 
such as aloes, olibanum, and myrrh, with wine and vinegar. 
He also speaks of applying a plate of lead to promote 
absorption by its pressure. When the callus is hard, he 
would have it scraped or sawed off. 
In complete dislocation of the lower jaw Albucasis directs ALB UCA SIS. 
25 
its reduction by introducing the thumbs into the mouth, 
and grasping the jaw in the manner described by Hip- 
pocrates. 
Albucasis, as well as Rhazes, Avicenna, and Haly Abbas, 
believed that dislocations occur more frequently at the 
acromial than at the sternal end of the clavicle. Sir. Astley 
Cooper and Mr. Liston confirm this ancient opinion, in 
opposition to Desault and Boyer. 
Albucasis describes four varieties of dislocation of the 
hip, and the methods of reduction. The latter are ; First, 
by rotating the limb in all directions. (This would seem 
to imply reduction entirely by manipulation). Second, by 
making extension and counter-extension, with the aid of two 
assistants. Third, by suspending the patient, and getting 
a strong assistant to grasp the affected leg, and swing him- 
self by it. Fourth, by making extension with ropes fastened 
to two sticks or pieces of wood as in dislocation of the 
spine. When the dislocation is forwards, the surgeon is 
to press down the prominent part with his hands; but if 
backwards, a board is to be used as described by Paulus. 
According to Albucasis, dislocation at the ankle can only 
take place inwards or outwards. When the tarsal bones 
are displaced, he directs us to restore them by making 
the patient put his foot upon the ground ; and the surgeon 
by placing his foot upon it and standing erect is to 
push them into their place. After their reduction a splint 
is to be put under the sole, and secured with bandages. 
This author has also treated of all the other varieties of 
fractures and luxations of the bones, but as no additional 
observations are to be found in his works, which are at all 
original, but merely such as are contained in the writings of 
still earlier surgeons, I will not repeat further what he has 
said upon the subject. In all cases he exhorts the surgeon 
to act with caution but confidently, assuring him that such 2 6 
GEORGE JACKSON F/SNER. 
conduct will prove most pleasing in the sight of his Creator, 
and redound to his own glory. 
The works of Albucasis were held in very high estimation 
by the early modern writers on surgery, as we find him ex- 
tensively quoted by Guy de Cauliac, Theodoricus, Brunus, 
Gulielmus de Saliceto, and others, down even to the time 
of Fabricius of Aquapendente, 
The works of Albucasis and Alsaharavius, if we are to 
consider them as one and the same author, have been 
printed and published, either complete or in part, in five 
and twenty editions. The earliest was at Venice in 1471, 
the latest at Oxford, England, in 1778. They have not 
always been published separately. They have been pub- 
lished with Mesue, Horatianus, with Roland and Roger, 
and Constantine the African. 
I have a fine folio copy with the following title : Libri 
theorice necnonpractice A Isaharavii, qui vulgo Acararius dicitur, 
Lmpensis Sigismundi Grim Medici, & Marci Vuirsung Au- 
guste Vindelicorum. Anno virgineipartus. MD.XIX. Die 
vigesima quarta Martn. It contains one hundred and fifty- 
nine folios (equals 320 pages), and five index leaves, double 
columns, marginal references, no catch-words, two large and 
very curious initial letters. I also have an old copy of a 
folio edition printed in Arabic ; but being unable to deci- 
pher Arabic, I cannot say where or when it was published. 
It formerly belonged to Atkinson, the quaint old biogra- 
pher, and contains his book-plate. The Oxford edition, 
two volumes, quarto, 1778, in Arabic and Latin, with fig- 
ures of the surgical instruments, is considered the best. 
The figures are also to be found in some of the earlier edi- 
tions, viz.; Venice, 1500, and Basil, 1541. 
Liber Servitoris de Prceparatione Simplicium Bulchasi Ben- 
aherazerin translatus a Simone Januensi, interprete Abram 
Judoeo Tortuosiensi Lib. xxviii. Venet. 40, 1471 ; ibid fol. ALB UCA SIS. 
27 
1479 ; fol. 1483 ; fol. 1484 ; fol. 1490: fol. 1495 ; fol. 1497 ; 
fol. 1502; fol. 1527; fol. 1538; fol. 1558; fol. 1561 ; fol. 
1602. 
Albucasce chirurgi methodus medendi Lib. 111. Venet. fol. 
1500 ; ibid fol. 1506; fol. 1520 ; fol. 1530 ; fol. 1531 ; Argent, 
fol. 1532; Basil, fol. 1541; Oxonii, 4°, 1778. The titles 
vary somewhat in the different editions. 
Alzaharavii compendium artis medicce. Aug. Vind. fol 
1490 ; fol. 1530. 
Libri theoricce necnon practices Alzaharavii, qui vulgb Al- 
zararius dicitur. Aug. Vind. fol. 1519. Roma fol. 1519.