Journal of Pediatric Surgery 51 (2016) 192193

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Journal of Pediatric Surgery

journal homepage: www.elsevier.com/locate/jpedsurg

Correspondence

Surgical Repair of Imperforate Anus: A Report from Haly Abbas

(949982 AD)
To the Editor,
Surgeons have, for many centuries treated infants born with imperforate anus. Most reports have focused on post-renaissance work, however ancient Islamic manuscripts described the surgical repair of
imperforate anus [14].
Ali ibn al-Abbas al-Majusi [949982, AD], known in the west as Haly
Abbas was born in southwest Persia and studied under Shaikh Abu
Maher Musa ibn Syyar, one of the greatest physicians of his time.
Abbas is best known for his medical encyclopedia, Kamil al-Sinaat alTibbiyya [Complete Book of the Medical Arts]. It is also known as Kitab
al-Maliki or the royal book [5] [Fig. 1]. The Kitab dealt with the theory
and practice of medicine that included a rudimentary description of
capillaries, ethics and clinical observations on sleeping sickness, memory loss, hypochondriasis, coma, meningitis and hemiplegia. His advice to
physicians is worthy of Hippocrates or William Osler.
Abbas, like his contemporaries knew of the Greek physicians, and was
critical of Hippocrates and Galen. In 1127, Steven of Antioch translated the
Kitab into Latin and it was later published in Venice in 1492 and in Lyon in
1523. He was interested in congenital anomalies, since he discussed hydrocephalus, vaginal atresia, hermaphroditism, anomalies of the extremities and urethral meatus as well as imperforate anus [6,7].
Paulus Aegineta, [625690 AD] may have been the rst to describe a
surgical treatment for imperforate anus [8]. Abbas, however was the
rst to emphasize preserving the sphincter muscles and the prevention
of strictures with a stent. His use of wine suggests he knew the importance of antisepsis. His original discussion of imperforate anus appears
in the 63rd chapter of the 9th division of the 3rd part of the Kitab.
Some children are born with a closed anal lumen, [Mghaadat
Ghaira Masghobat]. In these cases, the midwife should perforate and dilate it with her nger or a sharp knife and care the muscles not to be dissected. Then she should insert a piece of lint or a lead tube for some days
to avoid stricture and then help healing the ulcer with wine.
Later Islamic surgeons, especially Albucasis, [1013 AD] used this
method with minor modications and reported surviving children [9].
Surgeons in the 17th century, Scultetus, Fatio and Cooke modied and
improved on the techniques pioneered by Haly Abbas [10].
Abolfazl Iranikhah
Department of pediatrics, pediatric gastroentrology ward
Qom University of Medical Science, Qom, Iran

http://dx.doi.org/10.1016/j.jpedsurg.2015.11.001
0022-3468/ 2016 Elsevier Inc. All rights reserved.

Mojtaba Heydari
Research Center for Traditional Medicine and History of Medicine
Shiraz University of Medical Sciences, Shiraz, Iran
Javad Hakimelahi
Department of pediatrics
Qom University of Medical Science, Qom, Iran
Corresponding author
E-mail address: meshkat_114@yahoo.com
Mohammad Gharehbeglou
Gastroentrohepatology Research Center
Qom University of Medical Science, Qom, Iran
Mohammad Reza Ghadir
Gastroenterology and Hepatology, Qom University of Medical Sciences
Qom, Iran

References
[1] Yesildag E, Muiz RM, Buyukunal SN. How did the surgeons treat neonates with imperforate anus in the eighteenth century? Pediatr Surg Int 2010;26:114958.
[2] Cule JH. John Pughe, 18141874. A scholar surgeon's operation on the imperforate
anus in 1854. Ann R Coll Surg Engl 1965;37:24757.
[3] Greenwood RD. "A case of malformation": an early description of imperforate anus,
1853. Ala Med 1985;54(32):53.
[4] Davis CF, McCabe AJ, Raine PA. The ins and outs of intussusception: history and management over the past fty years. J Pediatr Surg 2003;38:604.
[5] Heydari M, Shams M, Hashempur MH, et al. The origin of the concept of neuropathic
pain in early medieval Persia (9th 12th century). Acta Med Hist Adriat 2015;13:
922 [in press].
[6] Aciduman A, Arda B, Akit C, et al. Account of Haly Abbas regarding the management
of hydrocephalus in children: a text from medieval times. World Neurosurg 2014;
82:e7916.
[7] Aciduman A, Arda B, Kahya E, et al. The Royal Book by Haly Abbas from the 10th century: one of the earliest illustrations of the surgical approach to skull fractures. Neurosurgery 2010;67:146674.
[8] Dunn PM. Paulus Aegineta (625690 AD) and Bysantine medicine. Arch Dis Child
Fetal Neonatal Ed 1997;77:F1556.
[9] Raffensperger John G. Children's surgery: a worldwide history. Jefferson N.C:
McFarland; 2012 50.
[10] Upadhyaya VD, Gangopadhyay A, Srivastava P, et al. Evolution of management of
anorectal malformation through the ages. Int J Surg 2008;17:16.

Correspondence / Journal of Pediatric Surgery 51 (2016) 192193

Fig. 1. The chapter of "Imperforate anus", from Kitab al-Maliki of Haly Abbas (949982 AD), kept in Iran Parliament Library, record number: 531818. Link: http://dlib.ical.ir.

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