Stesura Seveso


Archivio Italiano di Urologia e Andrologia 2014; 86, 4300

SHORT COMMUNICATION

Primitive robotic procedures: Automotions 
for medical liquids in 12th century Asia minor

Necmettin Penbegul 1, Murat Atar 1, Muammer Kendirci 2, Yasar Bozkurt 1, Namık Kemal Hatipoglu 1,
Ayhan Verit 3, Ateş Kadıoglu 4

1 Dicle University, Medical Faculty, Dept. of Urology, Diyarbakir, Turkey;
2 Liv Hospital Hospital, Dept. of Urology, Istanbul, Turkey;
3 Fatih Sultan Mehmet Research and Training Hospital, Dept. of Urology, Istanbul, Turkey;
4 Istanbul University, Istanbul Medical Faculty, Dept. of Urology, Istanbul, Turkey.

This study was presented at 30th World Congress of Endourology & SWL Congress, Poster no: UP-473, 4-8 Sept. 2012, Istanbul, Turkey.

In recent years, day by day, robotic sur-
gery applications have increase their role

in our medical life. In this article, we reported the discov-
ery of the first primitive robotic applications as automatic
machines for the sensitive calculation of liquids such as
blood in the literature. Al-Jazari who wrote the book “El-
câmi ‘Beyne’l - ‘ilm ve’l - ‘amel en-nâfi ‘fi es-sınaâ ‘ti’l -
hiyel”, lived in Anatolian territory between 1136 and
1206. In this book that was written in the twelfth century,
Al-Jazari described nearly fifty graphics of robotic
machines and six of them that were designed for medical
purposes. We found that some of the robots mentioned in
this book are related to medical applications. This book
reviews approximately 50 devices, including water clocks,
candle clocks, ewers, various automata used for amuse-
ment in drink assemblies, automata used for ablution,
blood collection tanks, fountains, music devices, devices for
water lifting, locks, a protractor, a boat-shaped water
clock, and the gate of Diyarbakir City in south-east of
Turkey, actually in northern Mesopotamia. We found that
automata used for ablution and blood collection tanks
were related with medical applications; therefore, we will
describe these robots.

KEY WORDS: Robots; History of Urology; Robotic surgery.

Submitted 21 October 2014; Accepted 31 October 2014

Summary

No conflict of interest declared.

The “Da Vinci Robotic Surgical Platform”, is the most com-
monly mentioned such device nowadays. The platform
was named after Leonardo da Vinci (1452-1519), who is
generally recognized in the literature as the first to design
a robot. However, based on in-depth research into the
history of robots, it is highly possible to see that the first
mechanism of a robot and the relationship between
robots and medical sciences occurred in Anatolian terri-
tory in the twelfth century.
Al-Jazari (1136-1206), who is known to have had a dis-
tinctive knowledge of mechanics, engineering, and
automation, was a Turkish scholar known to have been
“the ancestor of automation and robots” and lived in the
twelfth century (4). Al-Jazari was born in Cizre, Mardin
Province, and lived in the city of Amid, now known as
Diyarbakir, in the period of the Artuqids. As a scientist,
he served for 32 years as chief engineer in Artuqid
Palace. He wrote his book, ‘El-câmi ‘Beyne’l-‘ilm ve’l-‘amel
en-nâfi ‘fi es-sınaâ ‘ti’l-hiyel (The Book of Knowledge of
Ingenious Mechanical Devices)’ in the name of the throne
of the Artuqids. In this article, we discuss Al-Jazari and
explain that he has recently been credited with the
design of nearly fifty robots in the twelfth century; six of
these were designed for medical purposes.

MATERIALS METHODS
This book by Al-Jazari was described as a work forming
a keystone of world technological history and a work
ahead of its time (5). However, the first explanatory
English translation of this book was by Donald R. Hill in
1974 (6). Then, in 2002, Sevim Tekeli and her colleagues
translated and edited it into Turkish (5). 
The mechanisms that gave this reputation to Al-Jazari
could be described as follows: robot serving drink to sul-
tan, robot drinking on feet, robot drinking leftovers of
sultan’s chalice, clocks that ring alarms for the hours
with a series of events occurring automatically and com-
bination lock mechanisms (with 3.55 x 1015 probabili-
ty of unlock) that are similar/better to today’s combina-

DOI: 10.4081/aiua.2014.4.300

INTRODUCTION
The word robot was first used by Czech playwriter Čapek,
in his play ‘Rossum’s Universal Robots’ (1920), wherein he
described a population dependent on mechanical work-
ers, which he called robots (1). These robots were capa-
ble of performing every kind of intellectual and physical
function (2). By the 1980s, surgical robots were in use
for neurosurgery and orthopedic surgery (3). 
Recently, robot-assisted surgeries have been involved in
surgical applications and are becoming more widespread
as well as they improve with each passing day. 

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301Archivio Italiano di Urologia e Andrologia 2014; 86, 4

Medical robots in 12th century

tion locks (5). In another work, Al-Jazari drew peacocks
from whose mouths water flowed and robot men of
machinery that poured abluting water into the hands of
his beloved sultan who wished to avoid employing slaves
in the palace. 

RESULTS
We especially evaluated robot designed as ewers, blood
collection tanks, and washbowls for ablution which we
think were pioneering automatic mechanisms for the
health sector.

Ewers, washbowls for ablution, and automata
designed for hand washing sink with peacock used 
for ablution (Figure 1a)
The device consists of a sink placed on the ground, four
columns rising above the sink, and, on these columns, a
castle with two gates carrying the peacock.
The neck of the bird is laid like a spring and its beak is
toward the sink. Its tail is vertical. Water flows through
the beak of the bird. At that moment, one of the gates
opens and a robot child appears holding a soap pot in his
hand. When the water flow is stopped, another gate
opens, and from there another robot child holding a
towel emerges.

Automat designed for hand washing (Figure 1b-c)
This mechanism consists of a platform with a child hold-
ing an ewer in the right hand and a comb and towel in the
left hand. In addition to the platform are a tank with a pea-
cock adjacent to a platform, its beak pointing toward the
floor, and a dome, which is placed on four columns on top
of the platform and is capped with a bird. 
Water flows through the ewer and the bird sings as long
as it flows. Flowing water is collected in the tank and the
bird drinks it. When the water runs out, the child pass-
es the towel and the comb using his left hand.

Blood collection tanks
Among Al-Jazari’s works are blood collection tanks that
measure the blood collected from a patient. No record
has been found related to the blood collection tanks
designed on the base of principles of equilibrium before
Al-Jazari (7). In this automaton, floats rise with the help
of a liquid that is collected in a pot and causes a coun-
terweight to be lowered. 
The device described here and illustrated with a picture
serves for the measurement of blood collected by cup-
ping (8). 

Tank with a monk indicating the amount of blood flow
(Figure 2a-b) 
The machinery is shaped like a sink and is placed on the
ground. A monk stands on the platform in the middle of

the tank. There is a “C” hole through
which blood flows to the collector in the
bottom of the tank. The blood drained
into the tank flows to the collector from
the hole. The collector has a “D” float
and there is a rope “E” bound to the top
of it. The rope coils up the “F,” “G,” and
“H” reels inside the platform that carries
the monk and the “J” weight is bound to
its end. The shaft of the “G” reel, “K,”
comes out of the platform and is fixed
to the feet of the monk. 
The monk has a rod and it reaches the
edge of the tank, which is numbered
from 1 to 120. The device is located in
front of the individual from whom the
blood will be collected. When the blood

Figure 1. 
(A) Sink with peacock used for ablution. 
(B-C) Automat designed for hand washing.

Figure 2. 
(A-B) Tank with a Monk indicating the amount of blood flow. (C) Blood collection tank with two clerks. 
(D) Calculator tank by which collected blood amount can be measured. (E) Blood collection tank with a castle. 

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302

has been drained into the tank, the float rises and the “G”
reel spins. In accordance with the spinning of the reel,
the monk and its rod spin in a way that shows the
amount of blood taken. The rod in the hand of the monk
reaches the first sign once 1 dirham (dirham = 3.207 gr)
of blood has been collected in the tank (5). 

Blood collection tank with two clerks (Figure 2c)
This mechanism consists of a sink placed on the ground.
Four columns rise from the tank’s floor, and a platform
on the column supports two seated clerks. In the hand of
one of the clerks, there is a pen, and the tip of the pen is
on the arc of a circle numbered to 120. 
The other clerk holds a segmented plate in one hand,
and in the other a pen is positioned close to the surface
of this plate. 
The clerk holding the pen spins accordingly as the blood
drains off to the tank and the plate in the hand of the
other clerk rises. The blood amount collected is indicat-
ed by the segments indicated by the pens of both of the
clerks (5). 

Calculator tank in which the amount 
of collected blood can be measured (Figure 2d)
The mechanism consists of a tank placed on the ground
and having four columns located on a floor. There is a
platform on the columns on which two clerks are seated.
One of them holds a pen, while the other has a plate. 
There is a castle between the two clerks in which the
chest, head, and two hands of a third man can be seen.
As long as the blood is flowing into the tank, the pen of
the clerk continuously shows the amount, while the
plate of the other clerk shows the same amount. 
When the blood amount is 10 dirhams, the man in the
castle shows this with his hands and shows 20 when the
amount reaches 20 dirhams (5). 

Blood collection tank with a castle (Figure 2e)
The mechanism consists of a tank with six columns on the
floor, at the top of which is positioned a castle with twelve
gates and two wings at each gate. Two clerks are seated
atop the castle. One of them holds a pen and the other has
a plate. The appearance of the mechanism is similar to that
of the other blood collection tanks. The movements of the
clerk’s plate, of the clerk holding the pen, and the hand
seen at the “P” window are the same as those of the figures
in the previous tanks. However, ten figures of children
emerge from the gates to show each amount of 10 dirhams
of blood and show 10, 20, 30 . . . and 120 dirhams with
their hands that are positioned on this device (5). 

DISCUSSION
Al-Jazari described many machine parts that are includ-
ed in the European engineering terminology of the
 current time, plus he mentioned these long before Leo -
nardo Da Vinci, who first referred to the cone valve in the
1500s (4). In the machines he designed, Al-Jazari was
the first to use the systems that are reminiscent of “the
crankshaft” and “camshaft” that are now used in all motor
vehicles (9-11). 
These automatic ablution machines and automata de -

signed for hand washing can be accepted as the first
design draft of the hand-washing sinks and automatic
towel-holding apparatuses used especially in surgery
rooms today and it is astonishing that this level could be
reached in the circumstances of the twelfth century. 
Al-Jazari invented a blood-letting measuring device that
contained a maximal amount of 120 dirhams (120
dirhams = 120 x 3.207 = 380 g), which, interestingly,
corresponds to one unit of blood. 
Probably the maximal amount of blood to be transfused
at one time had been kept at that level, which is nowa-
days used as a cut-off value. 
Al-Jazari started to fabricate a blood-letting measuring
device with a simple design and then invented more
sophisticated models. In the first of his blood collection
devices, the amount of blood drawn was indicated with
only one robot (Figures 2A-B), while he mounted four
indicators in his latest robots (Figure 2E). To us, this
contrivance suggests transmission from a one-armed
robotic telescoping grasper system to four-armed robot-
ic surgical systems. 
Based on literature reviews, robotic surgery was firstly
employed in 1983 during an orthopedic procedure;
however, Al-Jazari is the scientist who designed the first
robot, which he used in medical procedures in the
twelfth century. 
In fact, his peculiar automation of a blood-letting meas-
uring device displayed the amount of the blood drawn at
a given moment during a phlebotomy procedure (2).
Even though some devices were fabricated that resem-
bled the automata made by Al-Jazari in the twelfth cen-
tury, the crank gears designed and used by Al-Jazari that
were depicted in his works were quite distinct from any
others. It is known that the crank system was firstly used
by Leonardo da Vinci in the twelfth century (10). 
Thus, the name of the robotic system used in urologic
surgery is dedicated to him (da Vinci robots). But in fact,
Al-Jazari used this system 300 years before da Vinci and
depicted its three-dimensional design, which we still
admire today. 
Even in the article in which the historical background of
the “da Vinci” robot was told, Al-Jazari was credited as
the first scientist to have invented the first programma-
ble humanoid robot (2).
Inventions of Al-Jazari are still in vogue in modern engi-
neering (12), and with his everlasting designs of automa-
ta, he is regarded as the “father of robots” (13-14). Not
only did he invent automata that were not surpassed for
centuries, he also described their construction process
step by step. Robots fabricated based on his instructions
in his works, are still functioning perfectly well.
In conclusion, we think that robots were firstly
described, and even used in medical procedures, by the
famous scientist Al-Jazari even three hundered years
before Leonardo da Vinci, thus recently, popularized as
“da Vinci” robotic surgical systems. Even though he depict-
ed his robotic systems in his books, Al-Jazari’s robotic
contrivances could not pass his name on to future gen-
erations. 
This heritage should be transferred to future generations,
and his life and his inventions should be better recog-
nized. 

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Correspondence
Necmettin Penbegul, MD
Murat Atar, MD
Yasar Bozkurt, MD 
Namık Kemal Hatipoglu, MD 
Dicle University, Medical Faculty, Dept. of Urology, Diyarbakir, Turkey

Muammer Kendirci, MD
Liv Hospital Hospital, Dept. of Urology, Istanbul, Turkey 

Ayhan Verit, MD      
veritayhan@yahoo.com 
Fatih Sultan Mehmet Research and Training Hospital, Dept. of Urology,                           
Içerenköy/Atasehir - Tr- 34752 Istanbul, Turkey

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