EXPERIMENTAL AND CLINICAL TRANSPLANTATION

Objectives: In this study, we translate from Arabic into English the chapters on surgical treatments related to nephrological issues in the ninth article of the second part of Haly Abbas’ Kāmil al-Şināʿa al-Ṭibbiyya. Our aim was to contribute to the medical history literature, to compare these chapters with the relevant chapters in Paul of Aegina’s Epitome, and to discuss findings in light of the related literature.
Materials and Methods: We examined the Cairo, Būlāq, copy of Kāmil al-Şināʿa al-Ṭibbiyya (printed in Arabic) and the manuscripts that are in the Istanbul University Rare Works Library, Yale University Library, and Süleymaniye Manuscript Library. We translated the chapters from Arabic to English. Translated chapters were then compared with the relevant chapters of Paul of Aegina’s Epitome and discussed in light of the related literature.
Results: Surgical treatments in nephrological issues are provided in Chapter 45 (On urination with a catheter) and Chapter 46 (On removing a stone from the bladder) of the ninth article of the second volume of Kāmil al-Şināʿa al-Ṭibbiyya. The same topics are covered in Section 59 (On catheterism and injection of the bladder) and Section 60 (On calculus) of Paul of Aegina’s sixth book in the second volume. The information provided by Haly Abbas on these subjects was remarkably similar to the information provided by Paul of Aegina.
Conclusions: It is considered that Haly Abbas benefited from Paul of Aegina’s knowledge of the causes of the bladder obstruction, the catheter to remove the accumulated urine, the catheter application technique, and all applications and treatments for stone removal.

Key words : Epitome, History of nephrology, Paul of Aegina

Between the 8th and 13th centuries, Islamic medicine claimed and protected previous civilizations’ medical heritage, developed and transferred it to the Western world, and contributed to the birth of modern medicine. During this time, many notable physicians were trained, including ?unayn b. Ishaq, Rhazes, Albucasis, Haly Abbas, and Avicenna. These physicians also practiced surgery and studied the works of Greco-Roman physicians such as Hippocrates, Galen, Oribasius, Aetius, Antyllus, and Paul of Aegina, gaining knowledge from their experiences.

Paul of Aegina (625-690) was born on the Greek island of Aegina and attended Alexandria Medical School.^1-3 He was the last great Byzantine physician and the last eclectic Greek compiler of the Byzantine period.⁴ He benefited from the knowledge of Greco-Roman physicians and primarily practiced surgery.^1,5-8 Throughout his life, he interacted with Islamic culture, civilization, and medical knowledge, influencing Islamic civilization’s physicians and writers, and was known as a “Fulūs” in Islamic medicine.^1,2,9-11

The Epitome (Medicoe Libri Septem), Paul of Aegina’s most significant work, contains a variety of treatments for medical and surgical subjects and is based primarily on Hippocratic and Galenic medical traditions. It was translated from Greek to English by Francis Adams and published in 3 volumes by the Sydenham Society in London between 1844 and 1847 as The Seven Books of Paulus Aegineta.^{1,3,5-8,12,13}

In the West, ʿAlī b. alʿAbbās al-Majūsī, known as “Haly Abbas,” was born in Arjan, near Ahvaz, in southwestern Iran (930?-994) and was known as al-Majūsī. He was a student of Abū Māhir Mūsā b. Sayyar (died 983). He went to Baghdad and worked in Bīmāristan A?ūdī as the palace physician of A?ūd al-Dawlah al-Buwayhid (949-983).^14-18 While working in Baghdad, he wrote an encyclopedic work of medicine, Kāmil al-?ināʿa al-Ṭibbiyya (The Perfect Book of the Art of Medicine), also known as Kitābu’l-Malikī (The Royal Book) in Arabic and died there in 994.^16,19-23 ʿAlī ʿAbbās stated in the first chapters of Kāmil al-?ināʿa al-Ṭibbiyya that he studied the works of previous physicians, namely, Hippocrates, Galen, Oribasius, Paul, Heron, Yuhannā b. Serābiyūn, Yuhannā b. Māsawayh, and Rhazes, and their shortcomings, evaluated them with a critical perspective, and produced a more perfect and more practical work.^20,23-25

Kāmil al-?ināʿa al-Ṭibbiyya, also known as Liber Regius in the West, is divided into 20 chapters (called maqāla) and 2 sections (juz?): theoretical and practical medical information.^15,16,20-26

The African Constantine (1015-1087) translated Kāmil al-?ināʿa al-Ṭibbiyya into Latin without mentioning ʿAlī ʿAbbās and introduced it to the West as Pantechne (Liber Pantegni).^17,22,25 Stephanus of Antioch/Pisa translated the entire work into Latin for the second time in 1127, mentioning the name of ʿAlī ʿAbbās; this work was published in Venice in 1492 and Lyon in 1523.^15,20,25,27 This work, which includes many Arabic manuscripts, was printed as lithographs in Lahore, Pakistan (1283 AH/1866 AD) and Būlāq, Egypt (1294 AH/1877 AD). Some parts have been translated into French, German, Urdu, Hebrew, and Turkish.^{16,19,20,23,27-29}

In this study, we translated from Arabic into English the chapters on surgical treatments related to nephrological issues in the ninth article of the second part of Haly Abbas’ Kāmil al-Şināʿa al-Ṭibbiyya, with the aim to contribute to the medical history literature, to compare these chapters with the relevant chapters in Paul of Aegina’s Epitome,and to discuss findings in light of the related literature.

Materials and Methods

We used the Cairo, Būlāq, copy of Kāmil al-Şināʿa al-Ṭibbiyya, printed in Arabic (1294 AH/1877 AD),³⁰ and, to compensate for the deficiencies caused by printing or typographical errors, we also examined the manuscripts that are in the Istanbul University Rare Works Library (AY 4713a),³¹ the Yale University (no. 1085640),³² and the Istanbul Süleymaniye Manuscript Library (Murad Molla Collection, no 1482).³³ We translated the chapters on surgical treatments for nephrological issues from Arabic to English. After the translation, we compared these chapters with the relevant chapters of Paul of Aegina’s Epitome⁸ and discussed in light of the related literature. Regarding nephrological surgical treatments, we attempted to identify the source of the similarities and differences by examining different articles or subject titles in different volumes or books of both works. Based on the literature, the relevant sections of Albucasis’ work, Kitāb al-Ta?rīf li-man ʿajaza ʿan al-ta?lif, were examined.

Results and Discussion

The information on surgical treatments in nephrological issues is provided in Chapter 45 (On urination with a catheter) and Chapter 46 (On removing a stone from the bladder) of the ninth article of the second volume of Kāmil al-Şināʿa al-Ṭibbiyya.³⁰ The same topics are covered in Section 59 (On catheterism and injection of the bladder) and Section 60 (On calculus) of Paul of Aegina’s sixth book (Epitome) in the second volume.⁸ The information provided by Haly Abbas on these subjects is remarkably similar to that provided by Paul of Aegina.²⁹

The explanations for the causes of bladder obstruc-tion and catheter application are nearly identical when both sections about “catheter application” are compared. Similarities and differences are shown in Figure 1.^8,30 For differences between the 2 sections, Haly Abbas stated, “A catheter with a length is taken according to the amount of need. The catheter selection in adult males is long, in children are short…”.^29,30 However, Paul of Aegina stated, “taking a catheter proportionate to the age and sex we prepare the instrument for use…”.^8,29

At the start of the catheter application, which Paul of Aegina removed at the end of the procedure, he suggested that “a small and round piece of wool, which he attached to the thread, was passed through the tube inside the catheter and inserted into the opening at the tip, cut the protrusions of the wool with scissors and put the catheter in the oil…”.^8,29 However, Haly Abbas did not include this information.^29,30 Haly Abbas appears to have skipped or forgotten to write this section. He claims that “after pouring hot water and oil directly on the groin area, he lubricated the tip of the catheter with violet oil and started the application…”.^29,30

Haly Abbas concluded, “as the catheter erodes these areas, blood comes out with the urine. In this case, it is necessary to inject a small syringe into the urethra with “anzarot [a resin of the sarcocolla tree once used on wounds] and white opiate containing opium dissolved in women’s milk.”^29,30 However, Paul of Aegina suggested using an ear syringe for abrasions and ulcerations in the bladder caused by catheter application and, if it is unsuccessful, discharge and open with an ox catheter.^8,29

When we compared the 2 sections on “Removing a stone from the bladder,” we observed a similarity in the expressions that both physicians used for causes, symptoms, and drug treatment of bladder stones in another part of their works. The similarities are quite striking (Figure 2),^8,30 and all applications and treatments for stone removal are nearly identical (Figure 3).^8,30

For differences between them, Paul of Aegina stated at the beginning of his study that the cause of the formation of the stones, “in children they are formed most readily in the bladder, and in adults in the kidneys…”.⁸ However, these descriptions are not available in the Haly Abbas’ chapter.^29,30

Before a lithotomy is described, Paul of Aegina explained the symptoms of bladder stones. He stated, “The patients then void urine of a watery consistence with a sandy sediment and from constant itching the member is now relaxed and again stretched in an uncommon degree; because owing to the irritation, they are perpetually handling it, more especially in case of children. When the stone falls into the neck of the bladder, sudden retention of urine take place.”^8,29 These descriptions, however, are not available in Haly Abbas’ work.^29,30

Moreover, we inquired whether Haly Abbas had included these explanations in another section of his work. When we examined his work, we found statements similar to Paul of Aegina in the first volume, ninth article, and 34th and 35th chapters of Kāmil al-Şināʿa al-Ṭibbiyya (Figure 4).³⁴

On the other hand, we also saw Paul of Aegina’s description of calculus in another book of his work, as shown in Figure 5.⁷

Furthermore, we examined a few examples from the literature. Papadakis and colleagues, in their work, stated, “Francis Adams in the preface of the sixth book, stating Paul’s impact on Arabic surgery, quoted that ‘Albucasis is indebted for whole chapters to Paulus’ and ‘Haly Abbas in the 9th book of “Practica’ copies almost everything from Paulus.”^8,35 Markatos and colleagues stated, “He [Paul] influenced subsequent authors of medical and surgical texts like Rhazes, Haly Abbas, Albucasis, Avicenna and Fabricius.”¹ Aciduman and colleagues, in their work, stated, “Haly Abbas might have borrowed this idea from Paul of Aegina.”³⁶ We also examined Albucasis’ explanations on these issues.

We looked at Spink and Lewis’ English translation of Kitāb al-Ta?rīf li-man ʿajaza ʿan al-ta?lif.³⁷ Albucasis mentioned the catheter application in Chapter 58 (On the treatment of retention of urine). His explanations for bladder obstruction and catheter application are nearly identical to those of Paul of Aegina and Haly Abbas. In contrast, he suggested using a silver catheter and explained the catheter’s shape. He also did not specify the age and sex of the person to be catheterized and stated that the catheter was one-and-a-half spans long.³⁷

Albucasis mentioned removing a stone in Chapter 60 (On the extraction of a stone) and Chapter 61 (On the extraction of a stone from the female). His explanations and surgical procedures for bladder stone removal are identical to those of Paul of Aegina and Haly Abbas. When the calculus impacted the urethra, he used a fine drill without incision and described it. On the other hand, he also mentioned how to remove a bladder stone in women.³⁷

It is considered that Haly Abbas benefited from Paul of Aegina’s knowledge of the causes of bladder obstruction, the catheter to remove the accumulated urine, the catheter application technique, and all applications and treatments for stone removal. Haly Abbas used a different method than Paul of Aegina, dividing the subjects based on theoretical and practical parts and using them in different articles or topics of his work. In general, his applications adhere to the principles of the “humoral pathology theory” and employ the methods of his predecessors in his surgical applications.

Volume: 21 Issue: 6 June 2023 - Supplement - 2

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