Figure 12.—Golden bridge to stabilize shaky teeth. Top, from original Arabic manuscript (Tüb. MS. 91), courtesy Universitätsbibliothek Tübingen. Left, from Argellata 1531, courtesy National Library of Medicine. Right, from Channing, Albucasis.
In like manner, al-Zahrāwī discusses cautery of the stomach and the "cold liver" in chapters 26 and 27, respectively. The drawings therein represent shapes of the burns on the skin ([fig. 4]) and marks of ink to be drawn beneath the cartilage of the ribs ([fig. 5]) for the purpose of spotting the area of operation. Here also he describes carefully and clearly the methods of applying cautery and the types, position, and number of tools employed in each case. He likewise depicts (in chapter 45) instruments used in the treatment of hernia ([fig. 6]).
The second section (bāb), with about 99 chapters,[20] deals with incision, puncturing, venesection, cupping, surgery on abscesses, and the withdrawal of arrows from the body. Al-Zahrāwī warns that ignorance in such operations may lead to damage of an artery or vein, causing loss of blood "by which life is sustained."[21] Moreover, needle and thread (more than one kind is mentioned) for the stitching of wounds are repeatedly recommended.
According to al-Zahrāwī, foreign bodies that lodge in the ear (chapter 6) are of four origins: (1) "mineral stones" or substances resembling mineral stones such as iron and glass; (2) plant seeds (chick-peas and beans); (3) liquids, such as water and vinegar; and (4) animals, such as fleas. Several instruments are recommended for the removal of such foreign bodies—fine tweezers shaped like a dropper ([fig. 7]), a syringe with plunger-pump, and a tube made of silver or copper ([fig. 8]). Also of interest to pharmacy and therapy is the advice in regard to the use of lubricants to be applied before administering these fine instruments into the body’s cavities.
Chapter 24 is concerned with the treatment of the polypus that grows in the nose. The various kinds (including cancer growth), shapes, and colors of this type tumor and its treatment by surgery or medicine are described. A hollowed nose-dropper made of metal in the shape of a small kerosene lamp[22] is suggested ([fig. 9]). The dropper is held by its handle while its contents are heated before use. Applying heat to nose drops was probably proposed because it serves two purposes: it allows easier flow of the "duhn," or the fatty substance used, and it raises the temperature of the drops to that of the body.
In his discussion on dental hygiene,[23] al-Zahrāwī describes scrapers and dental forceps for teeth cleaning and extraction (figs. [10,] [11]) and brings in a few points of historical interest.[24] He warns of the common error of extracting the adjacent healthy tooth instead of the ailing one due to the patient’s sense deception. For a gargle he prescribes salt water, vinegar, and wine (sharāb). To stop hemorrhage he used blue vitriol (al-zāj)—copper sulfate in our modern terminology.
In chapter 33 al-Zahrāwī discusses bridge-making for the consolidation of shaky teeth ([fig. 12]). He prefers the use of stable gold over silver which, he says, putrifies and rots in a short time. In a rational approach, he also suggests that the fallen tooth itself, or a similar one shaped out of a cow’s bone, be installed and connected with adjacent, stable teeth by a bridge.
Now, turning to chapter 36, we find al-Zahrāwī describing a knife-thin tongue depressor ([fig. 13]) that he used to facilitate the examination of inflamed tonsils and other swellings of the throat; it was made of silver or copper. And in chapter 37 (chapter 34 in Bes. 503), he describes the excision of an inflamed uvula by surgery. In the same chapter, he also mentions the use of instruments made of steel. Of pharmaceutical interest is the following free translation of the formula he prescribes "as a milder treatment by fumigation ... to be resorted to only when the swelling is subsiding":[25]