Sabaah al-khair. My name is Abu Ali al-Husayn ibn Abd Allah ibn Sina (980-1037). It's a mouthful isn't it? You can call me Ibn Sina or Avicenna as I am known in the Western World. Welcome to my library. Here I have spent my life studying physics, metaphysics, and my personal favorite, medicine. Since I was a child I have been intrigued by medicine. At age 18 I had become a full-fledged physician a la Doogie Howser. I wrote the Canon of Medicine a book compiling the medical knowledge of Greeks, Romans, Muslims, and my own personal experience (St. Andrews). Not to brag, but it was used as a medical textbook for centuries after it was written. I didn't really feel like gouging students by making them buy a new edition every other year. Well enough about my life, if you wanted to read my biography you'd be on Wikipedia instead of here. Let's get to the interesting part: surgery.
When the treatment of a patient necessitates making incisions, the knowledge of the surgeon in performing surgery is paramount. A good surgeon must know the path of the nerves, arteries, and veins so as not to sever them. The locations, contours, and natures of the organs must be known in order to best treat the patient. I have made careful descriptions of all of the organs in my Canon of Medicine.
In order to control the pain of the patient during the incisions a drug must be used. Hemlock, mandrake, and hyoscyamus may be used to subdue the pain of the patient, but a large amount of the drug is needed to keep the patient from moving. Opium is the most powerful of these stupefacients, the surgeon must use great care in the administration of this drug, lest the patient never wake from their drug-induced sleep (Avicenna). Drugs are also needed to control the bleeding of the patient.
Today you will be able to follow me along as I perform a routine cauterization to prevent the spread of gangrene on the patient's leg. This lesion followed a previous injury. Previous attempts to resolve the lesion by cupping (hijama) which is the use of acupressure generated by creating a vacuum on the patient's skin. This procedure was set forth by the prophet Mohammad (Avicenna). However, this procedure did not work.
The best possible treatment of a patient requires the best tools to perform the surgery. The tools that I use are essential to my ability to perform surgery on my patient. Tools like Galen's remedy, rabbit-hair, spider's web, white of egg, and the cautery are all found in my surgeon's bag. The best material to use as a cautery is gold as it heats quickly and is malleable to a variety of shapes (Avicenna).
Cauterization can be an extremely painful procedure. Since too much pain is known to cause death, an anesthetic must be used. For today's procedure I will use mandrake. The patient must be awake because the cauterization will remove the dead tissue, but pain will show me when I have reached the healthy tissue (Avicenna). Right now I will place the iron over an open flame to heat it. Before proceeding we will wash the patient's afflicted leg with an astringent wine. This could help prevent further spread of the gangrene. I am placing cloths wet with extremely cold rose-water on the healthy skin around the lesion (Avicenna). This makes a little pit for the cautery to go and also protect the surrounding tissue from damage. This is all of the preparations that we need for the surgery. Oh yes one more thing. Could you do me a favor and hold down the patient's leg? They do seem to squirm a bit once the cautery is introduced.
I will make the incision here in between the cloths to drain the bile from the leg. There, since that is done we are ready to burn off the gangrene. Hold your breath as I introduce the iron. The smell is putrid enough to make you regret becoming a physician. As the flesh is burned, it forms a natural seal so that no blood is lost. Since the partially sedated patient is showing some signs of feeling in the afflicted area, this means that we have reached healthy flesh. May Allah grant that the wound be healed. Now we will apply the astringent wine one last time and wrap it with another cloth that has been soaked in rose-water.
As the patient recovers from this cauterization, he should rest and take a diet of milk, lamb, and herbs to speed his recovery. If all goes well he should be up and running within a few weeks, but if the lesion reappears, amputation of the leg may be a necessity. Thank you for your help with the surgery, you have made an excellent assistant. I hope that you have learned a little bit about medicine from my era. I encourage you to read my book the Canon of Medicine in order to perfect your skills as a physician.
Avicenna was a very knowledgeable man on all medical subjects of the day. He advocated the health of his patients as a mixture of medicine and surgery, much like the physicians of today. The cautery was one of the primary tools of the medieval Islamic surgeon used to stop bleeding, excise lesions, and destroy growths on the human body. The use of astringent wine is particularly interesting in its use as an antimicrobial agent even before the germ-theory of disease. When one reads the Canon of Medicine, it seems to be quite dry. There is also a tone of paternalism for the patient. The physician is the person in charge of the patient's health regardless of what the patient thinks. This is quite different from the health care of the present. Avicenna was a brilliant man of his era. He drew upon the knowledge of the past great minds and the experiences in his practice to great a medical text that was used to teach medicine for centuries later.
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