Elsevier

World Neurosurgery

Volume 107, November 2017, Pages 834-838
World Neurosurgery

Historical Vignette
One of the Earliest Accounts of Head Wounds in Firdaws al-Ḥikma by al-Ṭabarī from the 9th Century

https://doi.org/10.1016/j.wneu.2017.08.037Get rights and content

Objective

To present the first Arabic text on suturing scalp wounds.

Methods

A related section entitled “On the wounds in the head” from the book Firdaws al-Ḥikma (Paradise of the Wisdom) written by al-Ṭabarī in the 9th century was identified and analyzed. This work was one of the earliest medical compendiums in the Islamic world during the medieval period. A printed copy of Firdaws al-Ḥikma edited by Muḥammad Zubayr al-Ṣiddīqī was examined, and findings were compared with relevant knowledge in the literature.

Results

A notable part of this text is based on appropriate closure of scalp wounds using sutures. Before this work, only the well-known Indian medical book Suśruta-Saṃhitā had mentioned closure of scalp wounds using sutures. In his work, al-Ṭabarī recommended using materials made of silk or linen for suturing. He additionally proposed some recipes that have a coating feature that prevents bleeding from the wound after it was closed properly. He also dealt with persistent swelling and provided formulas for solving the problem with special compositions.

Conclusions

Firdaws al-Ḥikma is a noteworthy work in the history of medicine, and it includes a unique chapter on head wounds. To the best of our knowledge, this is the first mention of suturing scalp cuts in Arabic literature and the second reference in medical literature after the Indian work Suśruta-Saṃhitā.

Introduction

Abū al-Ḥasan ʿAlī b. Sahl Rabban al-Ṭabarī, who was the author of Firdaws al-Ḥikma (Paradise of the Wisdom), which is one of the earliest medical compendiums in the Islamic world during the medieval period,1 was born to a Nestorian family in Merv (c. 778–779). He immigrated with his family to Ṭabaristān, in the Mazandaran province in modern Iran.2, 3 He was educated in medicine, philosophy, mathematics, geometry, and astronomy as well as in Syriac, Greek, and Hebrew by his father Sahl Rabban Ṭabarī,1, 2, 3, 4, 5 who was a calligrapher, prominent physician, and learned man on the Bible, philosophy, astronomy, mathematics, and geometry and who also knew Greek, Hebrew, Persian, and Arabic languages.2

After completing his education, Al-Ṭabarī went to Iraq in 813.2, 3 There he practiced medicine and acquired ancient medical knowledge, including Greek, Syrian, and Indian medical knowledge.2 Subsequently, he began to compile a book on medicine, Firdaws al-Ḥikma, which would become a reference book for medical students containing almost all knowledge including old and new works until his time.2 Al-Ṭabarī was invited to the administrative palace by Caliph Muʿtaṣim and was appointed to dīwān inshāʾ (Council of Letter Writing).2, 4 After the death of Caliph Muʿtaṣim in 842, al-Ṭabarī went to Surra-man-Ra'ā (Sāmarrāʾ) and resided there until the death of Caliph Wāthiq in 847.2, 3

Later, al-Ṭabarī became the private physician and courtier of Caliph Mutawakkil.2, 3, 4 He was given the title “Mawlā Amīr al-Muminīn” (Master of Commander of the Believers) by the Caliph.3, 4 In 850, he completed Firdaws al-Ḥikma and dedicated it to Caliph Mutawakkil, who was commemorating the third anniversary of his caliphate.1, 2, 3, 6 Al-Ṭabarī converted to Islam in his 70s under the influence of Caliph Mutawakkil.2, 3, 4 His date of death is uncertain; he probably died after 861, which was the date of Caliph Mutawakkil's murder.2

Firdaws al-Ḥikma is arranged in 7 parts (nawʿ) and contains 30 discourses (maqāla), in which 3601, 6 or 3653, 7 chapters (bāb) are included. When al-Ṭabarī was compiling his book, he benefited from the works of previous physicians and philosophers, such as Hippocrates, Galen, Aristotle, Dioscorides, Archigenes, Magnes of Emessa, Theophrastus, Democritus, Stephanus, Alexander, Anaximenes, Pythagoras, Charaka, Suśruta, Vāgbhata, and Mādhavakara, as well as from the works of his contemporaries, such as Māsarjawayh, Yūḥannā b. Māsawayh (Messues), and Ḥunayn b. Isḥāq (Johannitus).1, 6, 7 The aim of this article is to present and review the second chapter of the second discourse of the fourth part of Firdaws al-Ḥikma, subtitled “On the Wounds in the Head.”

Section snippets

Materials and Methods

A printed copy of al-Ṭabarī's Firdaws al-Ḥikma, which was edited by Dr. Muḥammad Zubayr al-Ṣiddīqī and printed in the Buch- u. Kunstdruckerei “Sonne” G.m.b.H. in Berlin, Germany, in 1928, was studied (Figure 1).8 Results were compared with related knowledge in the literature.

The Second Chapter on Wounds in the Head

Ancients washed a wound in the head with hot wine and olive oil [using] a clean woolen [pellet]. If the flesh is split, warm vinegar [mixed] with oil is poured inside it. Then, the skin is sutured with silken or linen [threads]. Because it is beneficial for [preventing] hemorrhage of the wound, frankincense medicine is sprinkled, that is, a dirham of weight of aloe, a dirham of weight of frankincense, and two dirhams of weight of Dragon's blood are crushed [together] and sprinkled over the

Discussion

Written history of medicine includes countless records of head wounds because of the nature of the skull that contains brain. Ancient physicians were always impressed by the symptoms that developed after head wounds. Masters of this era made substantial contributions to this field with their observations and interventions. Skull fracture and liquid collection from the scalp were successfully managed using knowledge available at that time. Nonetheless, the brain has remained a “no man zone” for

Conclusions

Firdaws al-Ḥikma is a noteworthy work in the history of medicine that contains a unique chapter on head wounds. To the best of our knowledge, this is the first mention of suturing of scalp cuts in Arabic literature and the second reference in medical literature after the Indian work Suśruta-Saṃhitā.

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  • Cited by (3)

    • A Study on Head Wounds in Kitāb al-ʿUmda fī Ṣināʿa al-Jirāḥa by Ibn al-Quff

      2021, World Neurosurgery
      Citation Excerpt :

      The treatment recommendations presented in this section are consistent with those of previous investigators. For example, a recipe sample is found in ʿAlī b. Sahl Rabban al-Ṭabarī’s Firdaws al-Ḥikma,39,40 Thābit b. Qurra's al-Dhakhīra fī al-Ṭibb,41,42 and Avicenna's al-Qānūn fī al-Ṭibb (Canon of Medicine).20 The section in which Ibn al-Quff says that surgical treatment is required in al-munaqqila, al-maʾmūma, and al-jāʾifa wound types seems to be consistent with the information written in Avicenna's Canon of Medicine,20,21 particularly regarding the information on the weakness of the callus formed in the head bones and not bandaging the skull as is done for other bones.

    • Wounds in the Head from Kitāb al-Dhakhīra fī ʿIlm al-Ṭibb by Thābit b. Qurra in the Ninth Century

      2019, World Neurosurgery
      Citation Excerpt :

      An interesting finding is that Thābit b. Qurra’s prescription of the elixir (al-iksīrīn) containing aloes, frankincense, dragon’s blood, myrrh, and sarcocolla for fresh wound and/or wound in the head is a rather interesting example of a compound medicine. A composition similar to that of “frankincense medicine” containing aloes, frankincense, and dragon’s blood, excluding sarcocolla, can be observed in Ṭabarī’s Firdaws al-Ḥikma.11,12 “A medicine which stops the bleeding from wounds” of Isḥāq comprises very similar ingredients of Thābit’s medication with the addition of egg white and hair of hare, excluding myrrh.13,14

    Conflict of interest statement: Preparation for publication of this article was partly supported by the Turkish Neurosurgical Society.

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