Unknown 15th Century Medical Illustrator Helps Advance Neurosurgery

Newfound historical evidence highlights advancements in surgical techniques in Turkish-Islamic medicine in Anatolia during the 15th century. Although largely unrecognized in the Western world, these early advancements have had significant implications for contemporary surgical practice. 

While Renaissance-era anatomical depictions of surgical techniques have been widely acknowledged as early contributors to surgical illustration, little credit has been awarded to the author of what has now been recognized as one of the world’s first illustrated surgical textbooks.

Şerefeddin Sabuncuoğlu (1385–1468 CE), a Turkish surgeon and illustrator during the Ottoman era in the 15th century, penned the Cerrahiyetü’l-Haniyye (Imperial Surgery) in 1465 at the age of 83.¹ With three chapters and 193 sections, the textbook combined earlier known teachings from Greek, Arabic, and Persian textbooks with the author’s own findings from his medical practice with an emphasis on pictorial descriptions of incisions, surgical planning, and surgical instruments. Despite fluency in Arabic and Persian, Sabuncuoğlu intentionally penned his work in Turkish, allegedly with the intent of improving the Turkish medical vocabulary.

Even though the book contained revolutionary illustrations portraying both established and innovative techniques in orthopaedic surgery, obstetrics and gynecology, pediatric surgery, plastic surgery, urology, neurology, neurosurgery, ophthalmology, and vascular surgery, Sabuncuoğlu and his literary works were relatively unknown during his time.² In addition, and for reasons not well documented, his overall impact remained effectively veiled from the collective annals of medicine in the Western world until 1937. Currently, only three copies of Imperial Surgery are known to exist, two of which are located in Istanbul, Turkey, and one in Paris, France.

Sabuncuoğlu’s efforts to record his work were creative and highly advanced for their time. Written in rhyme and meter, his texts and illustrations violated traditional Islamic rule, which prohibited artistic representation of humans or animals.

Furthermore, he is credited with illustrating the first known depictions of female surgeons performing neurosurgery on infants with hydrocephalus and obstetric and gynecologic surgeries (see Figure 1) at a time when Western women were predominantly barred from participating in surgical practice.³ These images portray patient positioning for gynecologic surgeries that resemble those in practice today.

Sabuncuoğlu depicted early plastic and craniomaxillofacial surgical procedures, producing some of the earliest known illustrations of these interventions, including blepharoplasty and surgical management for gynecomastia in what may be described as an early attempt at reduction mammoplasty.⁴ His section on cancer offers an early description of surgical management for resectable malignancies such as breast cancer.

In addition to their artistic representation of surgical techniques, images found in Imperial Surgery yield intuitive approaches to gastroenterology, critical care, and trauma. The text includes an early depiction of a hollow tube used for upper endoscopy, axial traction techniques for vertebral dislocations (see Figure 2), and a comprehensive characterization of various etiologies of pain. It also features an early description of shock and possible pneumothorax in response to archery-related injuries: “If the arrow hits the thorax, the blood coming from the entrance wound becomes foamy, his neck veins become distended, he breathes long and requests cold air…the patient’s color changes.”⁵

Sabuncuoğlu also has been credited by numerous Iranian historians for having founded the surgery school of the Ottoman empire.¹ Now referenced in countless journals across various surgical subspecialties, Sabuncuoğlu’s contributions were so remarkable for their time that both the university in Amasya, where he practiced, and the neighborhood in which he was born, bear his name today. 

Unfortunately, despite his revolutionary advancements, recognition of Sabuncuoğlu’s work is largely limited to Turkey and its surrounding countries, while everyday Western medicine often fails to acknowledge his significant contributions to the profession.

Dr. Olivia Hoy recently graduated with her medical degree from the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. She began her residency training in general surgery at Thomas Jefferson University Hospital in Philadelphia this month. 

References

1. Ayduz S, Sabuncuoglu O. The 15th century Turkish physician Serefeddin Sabuncuoglu Author of Cerrahiyetu ‘l-Haniyye. Foundation for Science, Technology, and Civilization. Muslim Heritage. Available at: https://muslimheritage.com/serefeddin-sabuncuoglu-cerrahiyetu-l-haniyye. Accessed May 28, 2025.
2. Önkol Ertunç Ç, Deperler Mazi L. Sabuncuoğlu Şerefeddin’in Paris Bibliotheque Nationale’de Bulunan Cerrahiyyetü’l Haniyye İsimli Eserinin Minyatür Özellikleri. İSTEM 36. 2020;(36):305-323.
3. Bademci G. First illustrations of female “Neurosurgeons” in the fifteenth century by Serefeddin SabuncuogluPrimeras ilustraciones de una mujer “Neurocirujano” en el siglo XV, por Serefeddin Sabuncuoglu. Neurocirugía. 2006;17(2):162-165. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1130147306703621. Accessed May 28, 2025.  
4. Doğan T, Bayramiçli M, Numanoğlu A. Plastic surgical techniques in the fifteenth century by Serafeddin Sabuncuoğlu. Plast Reconstr Surg. 1997;99(6):1775-1779.
5. Kaynaroğlu V, Kiliç YA. Archery-Related Sports Injuries. In: Doral MN, ed. Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. Springer-Verlag Heidelberg, Germany; 2012:1081-1086.