Medicine's Encyclopedic Memory: Kitab al-Hawi and Oncological Diagnosis
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Day 28 (The History of Cancer in 365 Days Series)
How was cancer, or sartan, defined in al-Razi's vast 23-volume legacy? The fine line between benign swellings and deadly tumors, and the critical criterion of adhesion that determined surgical decisions.
One of the most extensive and most candid works in medical literature, Kitab al-Hawi fi al-Tibb (The Comprehensive Book on Medicine / Continens Liber), al-Razi'scollection of cases and notes, was compiled by his students after his death. Rather than a polished textbook, it lays bare a physician's thought processes, doubts, and clinical experience. In the history of oncology, al-Hawi is one of the earliest texts to systematically distinguish cancer (sartan) from other hard swellings (waram/scirrhus).
Al-Hawi's Methodology: Experience versus Authority
Al-Hawi is not merely a compilation of information; it is a critical filter. Under each disease heading, al-Razi first records what ancient authorities such as Galen, Hippocrates, and Oribasius said, then adds his own clinical observations with the note Li, meaning in my view or in my experience. This symbolizes the transition from dogmatic to empirical, experience-based medicine.
FI AL-TIBB
Sartan (Crab): Naming and Pathology
Al-Razi used the Arabic word sartan for cancer. It is a direct translation of the Greek karkinos, meaning crab. This analogy is based on the tumor's physical appearance:
Humoral Pathology: Burnt Black Bile
According to al-Razi, cancer resulted from the burning and sedimentation of the humor called black bile (atrabile/sawda). Dysfunction of the liver or spleen poisoned the blood, making it dark, cloudy and acidic. This substance accumulated in tissues and hardened.
The Great Distinction: Scirrhus or Cancer?
Al-Razi's greatest contribution to oncology was the detailed clinical criteria he developed to distinguish benign indurations (scirrhus/waram) from true cancer (sartan). This distinction was the most critical step in determining whether a patient would survive.
(Benign Induration / Waram)
(Malignant / Cancer)
The Golden Rule for Surgical Decisions: Adhesion
For al-Razi, the most important examination finding was mobility. This criterion determined operability, or whether surgery was possible.
- A Mobile Mass: If the mass moved freely beneath the skin and was separate from the surrounding tissues, it was either a benign scirrhusor a very early stage of cancer. Surgery could be considered.
- An Adherent (Fixed) Mass: If the tumor had put down roots in the chest wall, muscles, or deep tissues and become fixed, al-Razi issued an unequivocal warning: “Do not touch!” (Noli me tangere). Surgery at this stage would provoke the cancer and hasten the patient's death.
DROZDOGAN Academy Commentary
“When we read al-Razi's notes in Kitab al-Hawi, we see the foundations of the modern oncological examination. Even today, one of the first things we assess in a breast examination is whether a lump is mobile or fixed. In an age without radiology, al-Razi perfectly distinguished operable from inoperable patients using only his fingertips and clinical intuition. His additions to the literature, marked Li (my experience), are among the earliest and purest examples of evidence-based medicine.”
- Doctors in Islamic History: Al-Razi Cancer Research Report, Part 2.
- Kitab al-Hawi fi al-Tibb (Continens Liber), Volumes 1-23.
- Rhazes' (864-925) views on cancer and the introduction of chemotherapy - JBUON.
- Diagnosis and treatment of cancer in medical textbooks of ancient Iran - PMC NIH.
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