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Could Al-Zahrawi Be Considered a Biomedical Engineer? [Retrospectroscope]

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Abstract

In one?s career, it is good to look back at the predecessors in the field. Biomedical engineering history is full of hidden treasures, one of whom is Al-Zahrawi, a Muslim surgeon who had a wide reputation in Europe during the Middle Ages. Herein, besides recalling that he was a surgeon, the intent is to spotlight his talent in biomedical engineering. Important contributions in surgical instruments come up readily in a review of his work, contradicting the view some have maintained of him as a mere compiler. He was a true inventor, creating many surgical instruments that were not known in the Greco-Roman era. Quite early, he produced contributions influencing surgical procedures in Europe from the 14th to the 18th centuries. As a problem solver, he was aware of anatomical and physiological problems, and he moved through design, methods of manufacturing, and practical applications. The illustrations of such instruments in his encyclopedic work, Al-Tasrif, reflect his willingness to teach.

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... Albucasis in children's back pain, also for the treatment of the superficial area around the sciatic nerve around the spine, used ring cautery. The difference between this and the ring cautery in hunchback was that it had more rings and a smaller diameter ( Figure 2C and D) [30]. ...
... He is faced with that issue several times; for example, in a clinical report, he talks about the non-union of the broken bones of a person suffering from tuberculosis, and he considers it to be the lack of blood in building cartilaginous vegetative tissue and does not mention treatment for it. Slow But his contemporary sage, Hally Abbas, solves this problem by stitching the bones together [17,24,26,30]. ...
... Because the melting point of iron is 1535, while the temperature of gold is 1063 °C, he was also very aware of the details of the cauterization process. He states that according to the cauterization process, iron first turns red and then white; it should be used in cauterization when the iron is red because the red-hot iron coagulates tissues, while a white-hot iron cuts tissues like a blade [30,36]. ...
... He was also the first to use cotton to stop bleeding and linen for dressing. Al-Zahrawi was the first to describe and use a vaginal speculum (Fig. 1) for gynecologic examinations and procedures [16,27]. He illustrated the speculum in his book (Al-Tasrif). ...
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... Nowadays, as a consequence of the works of Pasteur's germ theory in the 19 th century, surgeons are now aware of preventing bacteria culturing on surgical equipment and hence instigating septic shock and surgical site infections 35 . Furthermore, the use of alcohol was seen when combined with rose oil to become a haemostatic agent; this composition would be added to basil icon ointment to prevent ulceration of the wound 36 . Such was the importance of preventing haemorrhage, another tool used for this purpose was the cautery. ...
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Plaster has been used for centuries as a stiffening agent to treat fractures and other musculoskeletal conditions that require rest, immobilization, or correction of a deformity. Despite modern metallurgy and internal stabilization, plaster casts and splints remain an important means of external stabilization. Casting is a dying art as modern internal and external fixation replace external immobilization. Proper casting technique is paramount. This manuscript outlines the history and chemistry of immobilization materials and techniques as well as the differences among them and the advantages and disadvantages of each. Historical references, peer-reviewed journals, textbooks, and primary sources were reviewed to provide data for this review. The history of immobilization reveals a progressive development and refinement of materials that culminated in Mathijsen's plaster bandage in 1851. In 1798, calcium sulfate (plaster of Paris) was introduced. By 1927, crinoline rolls dipped in plaster treated with binding agents facilitated application. Synthetic casting "tapes" (45% polyurethane resin and 55% fiberglass) were introduced in the 1970s. Splinting techniques are ancient, with development spurred by treatment of war wounds. Plaster relies on soft-tissue contact to maintain rigidity. There are well-known advantages, disadvantages, and complications of plaster management. Casting materials all create an exothermic reaction. Burns are associated with water temperatures of >24°C, more than eight layers (ply), and inadequate ventilation. The maximum water temperature must be lower with fiberglass casts. Plaster was the definitive management for most fractures for over 100 years until it was replaced by modern surgical techniques involving internal fixation in the latter part of the twentieth century. Plaster casts and splints remain an important treatment method for acute and chronic orthopaedic conditions.
Article
The purpose of this article was to trace the historical origin of the inserted cannula during tracheotomy. Tracheotomy is mentioned in most ancient medical texts, but the origin of cannula insertion into the windpipe is unclear. We reviewed the incunabula and Renaissance texts reporting the utilization of surgical cannulas and tracheotomy. The incunabula disclosed extended use of surgical cannulas during the middle ages and Renaissance. Although tracheotomy was advocated in acutely suffocating patients for a disease of the throat termed squinantia or angina, the first report of the procedure was found only at the end of the middle ages and a second during the middle Renaissance. The introduction of cannula use in tracheotomy was supported by a semantic misinterpretation by Antonio Musa Brasavola. The historical origin for tracheotomy in the middle ages and Renaissance is conflicting. Antonio Brasavola wrongly interpreted Avicenna's oral cannula introduced into the windpipe for angina. This misinterpretation allowed Giulio Casserio to draw the first curved cannula introduced for used during tracheotomy.
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It has been previously argued that science and engineering undergraduate students can benefit greatly from learning the history of their discipline. In order to successfully enhance learning by introducing history into undergraduate curriculum, it would be desirable to assess what the current educational uses of history are and to understand the needs and perceptions of teachers. Nevertheless, to our knowledge no quantitative study of the role of the history of science, engineering, and technology in the classroom has been so far conducted. In this paper we present the design of a survey aimed at assessing the current perception of teachers towards using the history of biomedical engineering (HBME) to enhance learning. This survey was part of a broader project originally led by the EMBS History Committee aimed at evaluating the educational value of the HBME, both for future biomedical engineers and for the broader public. The main goals of the survey are (1) to find out the current uses of the HBME in the classroom, and (2) to identify possible obstacles to expanding the HBME in the classroom.
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Albucasis lived throughout the tenth century, practicing medicine for more than 40 years in Zahra at the outskirts of Cordoba. This was the period of the greatest splendour of Arab domination of Spain. Albucasis taught medicine at the university of Cordoba and published an encyclopedia of medicine comprising 30 volumes, the last one dealing with surgery. This work was translated into all civilized languages and was the standard medical textbook right till the eighteenth century. This paper deals with many pediatric surgical conditions as described in Albucasis' 30th volume. The pathology and treatment of harelip, hydrocephalus, the adenoids, ranula, gynecomastia, imperforated external urinary meatus, circumcision, hermaphrodites, imperforate anus, and supernumerary and webbed finger were all described by Albucasis, and his remarks are discussed here in some detail.
Article
The authors highlight the neurosurgical contributions of an Arabic surgeon by the name of Abul-Qasim Al-Zahrawi, known in Western literature as Abulcasis. This man lived during the Middle Ages from 936 to 1013 AD and wrote a 30-volume treatise on medicine. A significant part of his work on surgery consists of early descriptions of neurosurgical diagnosis and treatment, including the surgical treatment of head injuries and skull fractures, spinal injuries and dislocations, hydrocephalus and subdural effusions, headache, and many other medical afflictions. He described neurosurgical instruments such as cranial drills that avoided puncture of the dura mater. Abulcasis is known for his concepts of pain as a symptom and his emphasis on anatomy of the skull and brain in relation to the neurosurgical operations of that period. Because his works were translated from Arabic to Latin, Hebrew, and Turkish with only recent or limited translation into the modern occidental languages, the historic role played by this man has been largely unknown by neurosurgeons who are not fluent in these languages.
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Conventional criteria for the evaluation of thyroid nodules are inaccurate in identifying the small proportion of malignant neoplasms. The diagnostic accuracy of fine-needle aspiration biopsy (FNAB) for cytology was therefore assessed in 562 patients with nodular thyroid disease, 373 of whom (66.4 per cent) had histological confirmation of the cytological diagnosis. Sixty-one aspiration biopsies were positive for malignancy, and the diagnosis was confirmed histologically in 59 of these (96.7 per cent). Thus, there were two false positive cytology results among 310 patients with proven benign disease (0.6 per cent). Four of sixty-three patients with proven carcinoma had a benign cytological diagnosis, a false negative rate of 6.3 per cent. In 57 of the 59 malignancies (96.6 per cent) correctly diagnosed by FNAB the histological type of tumour was successfully identified. Overall 367 of 373 patients received correct cytological discrimination between benign and malignant nodules, an overall accuracy of 98.4 per cent for FNAB. The sensitivity of the test was 93.7 per cent and the specificity 99.4 per cent. Besides being safe, cost-effective and reliable, FNAB directs the appropriate selection of patients for surgery and enables the correct operation to be performed for each type of tumour.