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Atlas of Laparoscopic
Gastrectomy for Gastric
Cancer

High Resolution Image for New

Surgical Technique
Chang-Ming Huang
Chao-Hui Zheng
Ping Li
Jian-Wei Xie

123
Atlas of Laparoscopic Gastrectomy
for Gastric Cancer
Chang-Ming Huang
Chao-Hui Zheng • Ping Li
Jian-Wei Xie

Atlas of Laparoscopic
Gastrectomy for Gastric
Cancer
High Resolution Image for New
Surgical Technique
Chang-Ming Huang Chao-Hui Zheng
Department of Gastric Surgery Department of Gastric Surgery
Fujian Medical University Fujian Medical University
Union Hospital Union Hospital
Fuzhou Fuzhou
China China

Ping Li Jian-Wei Xie

Department of Gastric Surgery Department of Gastric Surgery
Fujian Medical University Fujian Medical University
Union Hospital Union Hospital
Fuzhou Fuzhou
China China

ISBN 978-981-13-2861-9    ISBN 978-981-13-2862-6 (eBook)

https://doi.org/10.1007/978-981-13-2862-6

Library of Congress Control Number: 2018962493

© Springer Nature Singapore Pte Ltd. and Peoples Medical Publishing House, PR of China 2019
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
This book commemorates the 10th anniversary of performing
laparoscopic radical gastrectomies for gastric cancer and a
total of over 5000 such cases treated at the Department of
Gastric Surgery, Fujian Medical University Union Hospital
(Fujian, China).
Our team: Department of Gastric Surgery, Fujian Medical
University Union Hospital, China
Left→Right (row one): Jian-Wei Xie, Chao-Hui Zheng,
Chang-Ming Huang, Ping Li, Jia-Bin Wang
Left→Right (row two): Jian-Xian Lin, Mi Lin, Ru-Hong Tu,
Jun Lu, Ze-Ning Huang, Qi-Yue Chen, Hua-Long Zheng,
Ju-Li Lin, Long-Long Cao
Preface

Laparoscopic technology has achieved satisfactory clinical effects in the

treatment of early gastric cancer and has also been applied to the treatment of
locally advanced gastric cancer. The success of laparoscopic radical gastrec-
tomy for gastric cancer not only requires proficient surgical techniques but
also high-level, standardized, and programmed surgical procedures.
Accordingly, we decided to publish this atlas, which is based on Laparoscopic
Gastrectomy for Gastric Cancer: Surgical Technique and Lymphadenectomy,
published in 2015. All ultra-high-definition surgical images in the book were
collected by the Highlights Storz IMAGE1 S™ Platform and are of an excel-
lent quality that enhances the descriptions.
In this book, we introduce procedures and precautions associated with
lymph node dissection of laparoscopic radical gastrectomy for gastric cancer,
ranging from preoperative preparation to regional lymph node dissection, and
digestive tract reconstruction. The content is pragmatic and comprehensive
and relevant to clinical practical applications.
As the first specialized department in a large-scale Chinese general hospi-
tal devoted to the treatment of gastric cancer, the Department of Gastric
Surgery, Fujian Medical University Union Hospital, performs more than
1000 gastric cancer surgeries each year. Since the first case of laparoscopic
radical gastrectomy in May 6, 2007, ten years of unremitting efforts have
enabled our department to become one of the most respected centers for lapa-
roscopic gastric cancer surgery in the world.
During the past ten years, we have continuously evaluated the anatomic
characteristics and variation of gastric vessels, which has laid solid founda-
tions for the development of laparoscopic radical gastrectomy. We also opti-
mized lymph node dissection, especially “Huang’s three-step maneuver” in
laparoscopic spleen-preserving splenic hilar lymphadenectomy, which sim-
plifies the procedure, reduces its difficulty, and promotes popularization of
the technique. We have regularly modified laparoscopic reconstruction of the
digestive tract after radical gastrectomy and improved the safety of distal
gastrectomy and total gastrectomy by first proposing the modified delta-­
shaped gastroduodenostomy technique, then later isoperistaltic later-cut
Roux-en-Y anastomosis. At the same time, we have furthered high-level
evidence-­based medicine by conducting a number of multicenter prospective
clinical trials associated with laparoscopic gastric cancer surgery. These
included acting as principal investigator in the CLASS-04 test, and as the unit
with the most effective cases in the CLASS-01 test and the CLASS-02 test.

ix
x Preface

Additionally, more than ten single-center prospective clinical trials are

­currently in progress.
Based on the spirit of an ancient Chinese poem from the Tang Dynasty
which states that “ten years’ hard working molds a sword,” we have taken our
valuable experience of laparoscopic gastric cancer surgery and compiled it
into a book. We hope that it will inspire our colleagues who are committed to
gastric cancer surgery and aspire to work together to promote the develop-
ment of minimally invasive laparoscopic surgery for gastric cancer. This book
is dedicated to the 10th anniversary of laparoscopic radical gastrectomies for
gastric cancer and a total of over 5000 such cases at the Department of Gastric
Surgery, Fujian Medical University Union Hospital.
The editors of this book are doctors at the clinical front line of this depart-
ment. Besides their heavy clinical workload, they have sacrificed much of
their precious spare time to help publish this book, for which we are
immensely grateful. We would also like to express our appreciation to the
related departments of People’s Medical Publishing House and Springer for
their encouragement and support. Meanwhile, we hope that all experts, fel-
lows, and readers will feel free to enlighten us with suggestions to further
improve this book and its later editions; together, we can make it
extraordinary.

Fuzhou, China Chang-Ming Huang

December 2017
Contents

1 Points for Attention Before Performing Laparoscopic

Lymph Node Dissection for Gastric Cancer����������������������������������   1
1.1 Instrument Preparation��������������������������������������������������������������   1
1.2 Patient’s Position����������������������������������������������������������������������   7
1.3 Surgeons’ Positions������������������������������������������������������������������   8
1.4 Location of Trocars �������������������������������������������������������������������� 9
1.5 Establishment of Pneumoperitoneum �������������������������������������� 10
1.6 Preoperative Exploration���������������������������������������������������������� 11
1.7 Sequence of a Lymphadenectomy�������������������������������������������� 18
Reference ������������������������������������������������������������������������������������������ 19
2 Laparoscopic Subpyloric LN Dissection for
Gastric Cancer �������������������������������������������������������������������������������� 21
2.1 Operative Steps for LN Dissection in the Subpyloric
Region �������������������������������������������������������������������������������������� 22
2.1.1 Resection of the Omentum Majus and Exfoliation
of the Anterior Lobe of the Transverse
Mesocolon (ATM)�������������������������������������������������������� 22
2.1.2 No. 14v LNs Dissection������������������������������������������������ 28
2.1.3 No. 6 LNs Dissection���������������������������������������������������� 31
2.2 Operative Announcements of Laparoscopic Subpyloric
LN Dissection for Gastric Cancer�������������������������������������������� 37
2.2.1 Intraoperative Anatomy of the Subpyloric
LN Dissection �������������������������������������������������������������� 37
2.2.2 Operative Announcements of Laparoscopic
Gastric Cancer Lymph Node Dissection
in Infrapyloric Area������������������������������������������������������ 50
References������������������������������������������������������������������������������������������ 64
3 Laparoscopic Suprapancreatic Area LN Dissection
for Gastric Cancer �������������������������������������������������������������������������� 65
3.1 Operative Steps for LN Dissection in the
Suprapancreatic Area���������������������������������������������������������������� 65
3.1.1 Dissection of No. 7, 8a, 9, and 11p LNs ���������������������� 65
3.1.2 Dissection of No. 5 and No. 12a LNs �������������������������� 76
3.2 Operative Announcements of Laparoscopic
Suprapancreatic Area LN Dissection for Gastric Cancer �������� 81

xi
xii Contents

3.2.1 Anatomy Associated with LN Dissection

in the Suprapancreatic Area������������������������������������������ 81
3.2.2 Intraoperative Announcements of Laparoscopic
Suprapancreatic Area LN Dissection
for Gastric Cancer �������������������������������������������������������� 102
References������������������������������������������������������������������������������������������ 119
4 Laparoscopic Splenic Hilar Area LN Dissection
for Gastric Cancer �������������������������������������������������������������������������� 121
4.1 Operative Steps for LN Dissection in the
Splenic Hilar Area�������������������������������������������������������������������� 121
4.1.1 Operative Approach������������������������������������������������������ 121
4.1.2 Exposure Methods�������������������������������������������������������� 121
4.1.3 Operative Procedures���������������������������������������������������� 123
4.2 Operative Announcements of Laparoscopic
Splenic Hilar Area LN Dissection for Gastric Cancer�������������� 134
4.2.1 Anatomy Associated with LN Dissection
in the Splenic Hilar Area���������������������������������������������� 134
4.2.2 Intraoperative Announcements of Laparoscopic
Splenic Hilar Area LN Dissection
for Gastric Cancer �������������������������������������������������������� 154
References������������������������������������������������������������������������������������������ 166
5 Laparoscopic Cardial Area LN Dissection
for Gastric Cancer �������������������������������������������������������������������������� 167
5.1 Operative Steps for LN Dissection in the Cardial Area������������ 167
5.1.1 Baring the Gastric Lesser Curvature
and Dissection of No.1 and No. 3 LNs ������������������������ 167
5.1.2 Baring the Left Side of the Esophagus
and Dissection of No. 2 LNs���������������������������������������� 171
5.2 Operative Announcements of Laparoscopic
Cardial Area LN Dissection for Gastric Cancer ���������������������� 175
5.2.1 Anatomy Associated with LN Dissection
in the Cardial Area�������������������������������������������������������� 175
5.2.2 Intraoperative Considerations of LN
Dissection in the Cardial Area�������������������������������������� 183
Reference ������������������������������������������������������������������������������������������ 187
6 Total Laparoscopic Reconstruction of the Digestive
Tract After Radical Gastrectomy for Gastric Cancer������������������ 189
6.1 Modified Delta-Shaped Billroth I Anastomosis
After TLDG������������������������������������������������������������������������������ 189
6.1.1 Anastomosis Method���������������������������������������������������� 189
6.1.2 Technical Tips �������������������������������������������������������������� 189
6.2 Billroth II Anastomosis After TLDG���������������������������������������� 193
6.2.1 Anastomosis Method���������������������������������������������������� 193
6.2.2 Technical Tips �������������������������������������������������������������� 193
6.3 Isoperistaltic Jejunum-Later-­Cut Overlap for
Esophagojejunostomy Anastomosis After Total
Laparoscopic Total Gastrectomy���������������������������������������������� 195
6.3.1 Anastomosis Method���������������������������������������������������� 195
6.3.2 Technical Tips �������������������������������������������������������������� 195
Contributors and Editors

About the Authors

Chang-Ming Huang is a secondary level

professor, chief physician, doctoral supervi-
sor, recipient of a Government Special
Allowance, a science and technology inno-
vation talent from Fujian Province, and
Director of the Department of Gastric
Surgery of Fujian Medical University Union
Hospital, China. He is a member of the
Gastric Cancer Profession standing commit-
tee of the Chinese Anti-Cancer Association,
the vice chairman of the Surgical Oncology
Committee of the surgical branch of the
Chinese Medical Doctor Association, a
member of the gastrointestinal surgical
branch of the Chinese Medical Association,
and a member of the Minimally Invasive
Surgery Committee of the surgical branch of
the Chinese Medical Doctor Association. He
is also an editorial board member of the
Chinese Journal of Gastrointestinal Surgery,
Chinese Journal of Digestive Surgery, and
Journal of Laparoscopic Surgery, and a cor-
responding editor of the Chinese Journal of
Surgery; he has also acted as a reviewer for
more than ten core journals including Annals
of Surgical Oncology, Surgical Endoscopy,
World Journal of Gastroenterology, and the
Chinese Medical Journal. He has published
more than 200 articles, including more than
100 in SCI journals, as well as in Chinese
medicine magazines, and other professional
journals. As an editor-in-chief, he published

xiii
xiv Contributors and Editors

Laparoscopic Gastrectomy for Gastric

Cancer: Surgical Technique and
Lymphadenectomy in English (Springer,
2015) and two books in Chinese (People’s
Medical Publishing House, 2011 and 2015).
Moreover, he has been awarded the Fujian
Provincial Science and Technology
Achievement Award many times and is cur-
rently undertaking a number of national and
provincial scientific research projects.

Chao-Hui Zheng is an associate professor,

chief physician, and master’s supervisor who
currently works in the Department of Gastric
Surgery of Fujian Medical University Union
Hospital, China. He is a member of the Laparo-
Endoscopic Surgery of the surgical branch of
the Chinese Medical Association, a member of
the Gastric Cancer Association of the Chinese
Anti-Cancer Association, a member of the
Surgical Oncology Physicians Committee of
the surgical branch of the Chinese Medical
Doctor Association, a member of the Obesity
and Diabetes Surgeons Committee of the surgi-
cal branch of the Chinese Medical Doctor
Association, a member of the Obesity and
Diabetes Surgical Committee of the Chinese
Research Hospital Association, and a member
of the First Laparoscopic Subcommittee of the
Endoscopic Physicians Committee of the
Chinese Medical Doctor Association. He is
also corresponding editor of the Chinese
Journal of Digestive Surgery and on the edito-
rial board of the Chinese Journal of Obesity
and Metabolic Diseases. He has published
more than 50 articles, including more than
40 in SCI journals, as well as in Chinese medi-
cine magazines, and other professional jour-
nals. As an editor-in-chief, he published
Laparoscopic Gastrectomy for Gastric Cancer:
Surgical Technique and Lymphadenectomy in
English (Springer, 2015) and two books in
Chinese (People’s Medical Publishing House,
2011 and 2015). Moreover, he has been
awarded the Fujian Provincial Science and
Technology Achievement Award many times
and is currently undertaking a number of
national and provincial scientific research
projects.
Contributors and Editors xv

Ping Li is an associate professor, associate

chief physician, master’s supervisor, and medi-
cal postdoctoral fellow of the Memorial Sloan
Kettering Cancer Center, New York (NY,
USA). He is a member of the Bariatric and
Metabolic Committee of the surgical branch of
the Chinese Medical Association, a member of
the Upper Gastrointestinal Surgical Committee
and the Young Oncologists Committee of the
Surgical Oncology Committee of the surgical
branch of the Chinese Medical Doctor
Association, a member of the Academic
Instruction Rehabilitation Committee of the
Chinese Anti-Cancer Association, and a health
science member of the China International
Exchange and Promotive Association for
Medical and Healthcare. He has published 12
original articles in SCI journals, Chinese medi-
cine magazines, and other professional jour-
nals as first author or co-­corresponding author.
He is also the deputy editor of Laparoscopic
Gastrectomy for Gastric Cancer: Surgical
Technique and Lymphadenectomy in English
(Springer, 2015) and Laparoscopic Radical
Gastrectomy for Gastric Cancer: Technique of
Lymphadenectomy in Chinese (People’s
Medical Publishing House, 2015), as well as an
editor of a previous version of this latter publi-
cation, published in 2011. Moreover, he won
the César Roux Award in the Laparoscopic
Gastric Cancer Surgery Group in the 2014
Gastric Cancer Surgery Video Contest for
Young Chinese Physicians and was awarded
the 2014 Award of National Scholarship for
Doctoral Candidates, and the Fujian Provincial
Science and Technology Progress Award many
times. He is currently undertaking a number of
national and provincial scientific research
projects.
xvi Contributors and Editors

Jian-Wei Xie is a doctor of medicine and

associate chief physician. He is a member of
the Gastrointestinal Oncology Committee of
the oncological branch of the Chinese Medical
Association, a member of the neuroendocrine
tumor branch of the China Science and
Technology Industry Association, a young
member of the surgical branch of the China
Science and Technology Industry Association,
a member of the Professional Committee of
Gastrointestinal Stromal Tumor Diagnosis and
Treatment of the Chinese Medical Doctor
Association, and a member of the Robotic
Surgery Committee of the surgical branch of
the Chinese Medical Doctor Association. He
has completed further study in renowned hos-
pitals including the Mayo Clinic in the USA
and the National Cancer Center, Japan. He has
published more than 10 articles in SCI jour-
nals, Chinese medicine magazines, and other
professional journals. He is also deputy editor
of Laparoscopic Gastrectomy for Gastric
Cancer: Surgical Technique and
Lymphadenectomy in English (Springer, 2015)
and Laparoscopic Radical Gastrectomy for
Gastric Cancer: Technique of
Lymphadenectomy in Chinese (People’s
Medical Publishing House, 2015), as well as
an editor of a previous version of this latter
publication, published in 2011. Moreover, he
has been awarded the Fujian Provincial
Science and Technology Achievement Award
many times and is currently undertaking a
number of national and provincial ­scientific
research projects.
Contributors and Editors xvii

List of Contributors

Long-Long Cao Department of Gastric Surgery, Fujian Medical University

Union Hospital, Fuzhou, China
Hai-Feng Chen Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Qi-Yue Chen Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Zhi-Jiang Chen Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Yun Dai Department of Gastric Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
Zhi-Liang Hong Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Chang-Ming Huang Department of Gastric Surgery, Fujian Medical
University Union Hospital, Fuzhou, China
Ying-Qi Huang Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Ze-Ning Huang Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Ping Li Department of Gastric Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
Yang Liao Department of Gastric Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
Guang-Tan Lin Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Jian-Xian Lin Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Ju-Li Lin Department of Gastric Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
Jun-Peng Lin Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Mi Lin Department of Gastric Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
Zhi-Yu Liu Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Jun Lu Department of Gastric Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
xviii Contributors and Editors

Xin-Chang Shang-Guan Department of Gastric Surgery, Fujian Medical

University Union Hospital, Fuzhou, China
Ru-Hong Tu Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Jia-Bin Wang Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Liang-Bin Wang Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Zu-Kai Wang Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Jian-Wei Xie Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Bin-Bin Xu Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Chao-Hui Zheng Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Hua-Long Zheng Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Zhi-Fang Zheng Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Qing Zhong Department of Gastric Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
 Points for Attention Before
Performing Laparoscopic Lymph 1
Node Dissection for Gastric Cancer

1.1 Instrument Preparation needle holders, hemolock release clamps, vascu-

lar clamps, absorbable clip appliers, titanium clip
Routine laparoscopy equipment includes soft-­ appliers, small gauzes, 5 and 12 mm trocars, and
acting gastric forceps, soft-acting intestinal for- ultrasonic scalpels (Figs. 1.1, 1.2, 1.3, 1.4, 1.5,
ceps, aspirators, dissection forceps, scissors, 1.6, 1.7, 1.8, 1.9, 1.10, 1.11, and 1.12).

Fig. 1.1 Soft-acting

gastric forceps

© Springer Nature Singapore Pte Ltd. and Peoples Medical Publishing House, PR of China 2019 1
C.-M. Huang et al., Atlas of Laparoscopic Gastrectomy for Gastric Cancer,
https://doi.org/10.1007/978-981-13-2862-6_1
2 1 Points for Attention Before Performing Laparoscopic Lymph Node Dissection for Gastric Cancer

Fig. 1.2 Soft-acting

intestinal forceps

Fig. 1.3 Aspirator

1.1 Instrument Preparation 3

Fig. 1.4 Dissecting

forceps

Fig. 1.5 Scissors

4 1 Points for Attention Before Performing Laparoscopic Lymph Node Dissection for Gastric Cancer

Fig. 1.6 Needle holder

Fig. 1.7 Hemolock

release clamp
1.1 Instrument Preparation 5

Fig. 1.8 Absorbable

clip applier

Fig. 1.9 Titanium clip

applier
6 1 Points for Attention Before Performing Laparoscopic Lymph Node Dissection for Gastric Cancer

Fig. 1.10 Small gauze b

Fig. 1.11 (a) 5 mm trocar. (b) 12 mm trocar

Fig. 1.12 Ultrasonic

scalpel
1.2 Patient’s Position 7

1.2 Patient’s Position

Fig. 1.13 Patient positioning: place in the supine and the reverse Trendelenburg position

Fig. 1.14 Patient

positioning for splenic
hilar lymph node (LN)
dissection: elevate the
head of the bed by
10–20° and tilt it to the
right by 20–30°
8 1 Points for Attention Before Performing Laparoscopic Lymph Node Dissection for Gastric Cancer

1.3 Surgeons’ Positions

Fig. 1.15 General

position of surgeons

Fig. 1.16 Position of

surgeons during splenic
hilar LN dissection
1.4 Location of Trocars 9

1.4 Location of Trocars

Fig. 1.17 Diagram of

trocar locations

Fig. 1.18 Locations of

the trocars (Reproduced
with permission from
[1])
10 1 Points for Attention Before Performing Laparoscopic Lymph Node Dissection for Gastric Cancer

1.5 Establishment To reduce the mist generated by the ultrasonic

of Pneumoperitoneum scalpel during the operation and help maintain a
clear vision, a low vacuum suction set can be con-
SFVS (small flow vacuum suction). nected to the trocar in the major hand port (Fig. 1.19).

Fig. 1.19 (a) Major hand port connected a

with a small flow vacuum suction set. (b)
Low vacuum suction

b
1.6 Preoperative Exploration 11

1.6 Preoperative Exploration infiltration depth of the primary tumor, as well

as the presence of lymph node metastasis
Preoperative diagnostic laparoscopic examina- (LNM), peritoneal implantation, ascites, and
tion with a high-definition imaging system can invasion of adjacent tissues (Figs. 1.20, 1.21,
effectively investigate the location, extent, and 1.22, and 1.23).

Fig. 1.20 (a) The tumor

is located on the anterior a
gastric wall invading the
serosa (model:
CLARA), (b) The tumor
is located on the anterior
gastric wall invading the
serosa (model:
CHROMA), (c) The
tumor is located on the
anterior gastric wall
invading the serosa
(model:
CLARA+CHROMA),
(d) The tumor is located
on the anterior gastric
wall invading the serosa
(model: SPECTRA A),
(e) The tumor is located b
on the anterior gastric
wall invading the serosa
(model: SPECTRA B)

c
12 1 Points for Attention Before Performing Laparoscopic Lymph Node Dissection for Gastric Cancer

Fig. 1.20 (continued)

d

e
1.6 Preoperative Exploration 13

Fig. 1.21 (a) Gastric

cancer with a
intraperitoneal
metastasis and ascites
(model: CLARA), (b)
Gastric cancer with
intraabdominal extensive
metastasis and ascites
(model: CHROMA), (c)
Gastric cancer with
intraperitoneal
metastasis and ascites
(model:
CLARA+CHROMA),
(d) Gastric cancer with
intraperitoneal
metastasis and ascites
(model: SPECTA), (e)
Gastric cancer with b
intraperitoneal
metastasis and ascites
(model: SPECTB)

c
Other documents randomly have
different content
[6] Mishkát el-Maṣábeeḥ, i. 26-34, 373. [Cp. S. Lane-Poole, "The
Speeches and Tabletalk of the Prophet Moḥammad" (1882), 180-
182.]
[7] Nuzhet el-Mutaämmil wa-Murshid el-Mutaähhil, section 7.
[8] Mishkát el-Maṣábeeḥ, ii. 381.
[9] For a translation of the whole of this prayer, see my "Account
of the Manners and Customs of the Modern Egyptians," ch. xxv.
[10] Ḳur. v. 35.
[11] For a fuller account of the prayers, see "Modern Egyptians,"
ch. iii.
[12] The Iḳámeh: see below, ch. viii.
[13] [For the collected legislation of the Ḳur-án, see my
"Speeches and Tabletalk of the Prophet Moḥammad," 133 ff. S. L-
P.]
[14] Among a people by whom falsehood, in certain cases, is not
only allowed but commended, oaths of different kinds are more
or less binding. In considering this subject we should also
remember that oaths may sometimes be expiated. There are
some oaths which, I believe, few Muslims would falsely take; such
as saying, three times, "By God the Great!" (Wa-lláhi-l-´aẓeem),
and the oath upon the muṣḥaf (or copy of the Ḳur-án), saying,
"By what this contains of the word of God!" This latter is rendered
more binding by placing a sword with the sacred volume, and still
more so by the addition of a cake, or piece of bread, and a
handful of salt. But a form of oath which is generally yet more to
be depended upon is that of saying, "I impose upon myself
divorcement!" (that is, "the divorce of my wife, if what I say be
false!"); or, "I impose upon myself interdiction!" which has a
similar meaning ("My wife be unlawful to me!"); or, "I impose
upon myself a triple divorcement!" which binds a man by the
irrevocable divorce of his wife. If a man use any of these three
forms of oath falsely, his wife, if he have but one, is divorced by
the oath itself, if proved to be false, without the absolute
necessity of any further ceremony; and if he have two or more
wives, he must under such circumstances choose one of them to
put away.
[15] [But see my "Speeches and Tabletalk of the Prophet
Moḥammad," 139, S. L-P.]
[16] Ḳur. v. 49.
[17] Hence it has been called, by many travellers, and even by
some learned Orientalists, the Great Feast; but it is never so
called by the Arabs.
 CHAPTER II.
DEMONOLOGY.
The Muslims, in general, believe in three different species of created
intelligent beings: Angels, who are created of light; Genii, who are
created of fire; and Men, created of earth. The first species are
called Meláïkeh (sing. Melek); the second, Jinn (sing. Jinnee); the
third, Ins (sing. Insee). Some hold that the Devils (Sheyṭáns) are of
a species distinct from Angels and Jinn; but the more prevailing
opinion, and that which rests on the highest authority, is, that they
are rebellious Jinn.
"It is believed," says El-Ḳazweenee, "that the Angels are of a simple
substance, endowed with life and speech and reason, and that the
difference between them and the Jinn and Sheyṭáns is a difference
of species. Know," he adds, "that the Angels are sanctified from
carnal desire and the disturbance of anger: they disobey not God in
what He hath commanded them, but do what they are commanded.
Their food is the celebrating of his glory; their drink, the proclaiming
of his holiness; their conversation, the commemoration of God,
whose name be exalted; their pleasure, his worship; they are
created in different forms, and with different powers." Some are
described as having the forms of brutes. Four of them are
Archangels; Jebraeel or Jibreel (Gabriel), the angel of revelations;
Meekaeel or Meekál (Michael), the patron of the Israelites; ´Azraeel,
the angel of death; and Isráfeel, the angel of the trumpet, which he
is to sound twice, or as some say thrice, at the end of the world—
one blast will kill all living creatures (himself included), another, forty
years after, (he being raised again for this purpose, with Jebraeel
and Meekaeel), will raise the dead. These Archangels are also called
Apostolic Angels. They are inferior in dignity to human prophets and
apostles, though superior to the rest of the human race: the angelic
nature is held to be inferior to the human nature, because all the
Angels were commanded to prostrate themselves before Adam.
Every believer is attended by two guardian and recording angels,
one of whom writes his good actions, the other, his evil actions: or,
according to some, the number of these angels is five, or sixty, or a
hundred and sixty. There are also two Angels, called Munkir (vulg.
Nákir) and Nekeer, who examine all the dead and torture the wicked
in their graves.
The species of Jinn is said to have been created some thousands of
years before Adam. According to a tradition from the Prophet, this
species consists of five orders or classes; namely, Jánn (who are the
least powerful of all), Jinn, Sheyṭáns (or Devils), ´Efreets, and
Márids. The last, it is added, are the most powerful; and the Jánn
are transformed Jinn, like as certain apes and swine were
transformed men.[18]—It must, however, be remarked here that the
terms Jinn and Jánn are generally used indiscriminately as names of
the whole species (including the other orders above mentioned),
whether good or bad; and that the former term is the more
common; also, that Sheyṭán is commonly used to signify any evil
Jinnee. An ´Efreet is a powerful evil Jinnee: a Márid, an evil Jinnee
of the most powerful class. The Jinn (but, generally speaking, evil
ones) are called by the Persians Deevs; the most powerful evil Jinn,
Nárahs (which signifies "males," though they are said to be males
and females); the good Jinn, Perees, though this term is commonly
applied to females.
In a tradition from the Prophet, it is said, "The Jánn were created of
a smokeless fire."[19] El-Jánn is sometimes used as a name of
Iblees, as in the following verse of the Ḳur-án:—"And the Jánn [the
father of the Jinn; i.e. Iblees] we had created before [i.e. before the
creation of Adam] of the fire of the samoom [i.e. of fire without
smoke]."[20] Jánn also signifies "a serpent," as in other passages of
the Ḳur-án;[21] and is used in the same book as synonymous with
Jinn.[22] In the last sense it is generally believed to be used in the
tradition quoted in the commencement of this paragraph. There are
several apparently contradictory traditions from the Prophet which
are reconciled by what has been above stated: in one, it is said that
Iblees was the father of all the Jánn and Sheyṭáns,[23] Jánn being
here synonymous with Jinn; in another, that Jánn was the father of
all the Jinn,[24] Jánn being here used as a name of Iblees.
"It is held," says El-Ḳazweenee, a writer of the thirteenth century,
"that the Jinn are aërial animals, with transparent bodies, which can
assume various forms. People differ in opinion respecting these
beings: some consider the Jinn and Sheyṭáns as unruly men, but
these persons are of the Moạtezileh [a sect of Muslim freethinkers];
and some hold that God, whose name be exalted, created the
Angels of the light of fire, and the Jinn of its flame [but this is at
variance with the general opinion], and the Sheyṭáns of its smoke
[which is also at variance with the common opinion], and that [all]
these kinds of beings are [usually] invisible[25] to men, but that they
assume what forms they please, and when their form becomes
condensed they are visible."—This last remark illustrates several
descriptions of Jinnees in the "Thousand and One Nights," where the
form of the monster is at first undefined, or like an enormous pillar,
and then gradually assumes a human shape and less gigantic size. It
is said that God created the Jánn (or Jinn) two thousand years
before Adam (or, according to some writers, much earlier), and that
there are believers and infidels, and every sect, among them, as
among men.[26] Some say that a prophet, named Yoosuf, was sent
to the Jinn; others, that they had only preachers or admonishers;
others, again, that seventy apostles were sent, before Moḥammad,
to Jinn and men conjointly.[27] It is commonly believed that the
preadamite Jinn were governed by forty (or, according to some,
seventy-two) kings, to each of whom the Arab writers give the name
of Suleymán (Solomon); and that they derive their appellation from
the last of these, who was called Jánn Ibn Jánn, and who, some say,
built the Pyramids of Egypt. The following account of the preadamite
Jinn is given by El-Ḳazweenee.—"It is related in histories that a race
of Jinn in ancient times, before the creation of Adam, inhabited the
earth and covered it, the land and the sea, and the plains and the
mountains; and the favours of God were multiplied upon them, and
they had government and prophecy and religion and law. But they
transgressed and offended, and opposed their prophets, and made
wickedness to abound in the earth; whereupon God, whose name be
exalted, sent against them an army of Angels, who took possession
of the earth, and drove away the Jinn to the regions of the islands,
and made many of them prisoners; and of those who were made
prisoners was ´Azázeel [afterwards called Iblees, from his despair];
and a slaughter was made among them. At that time, ´Azázeel was
young: he grew up among the Angels [and probably for that reason
was called one of them], and became learned in their knowledge,
and assumed the government of them; and his days were prolonged
until he became their chief; and thus it continued for a long time,
until the affair between him and Adam happened, as God, whose
name be exalted, hath said, 'When we said unto the Angels,
Worship[28] ye Adam, and [all] worshipped except Iblees, [who] was
[one] of the Jinn.'"[29]
"Iblees," we are told by another author, "was sent as a governor
upon the earth, and judged among the Jinn a thousand years, after
which he ascended into heaven, and remained employed in worship
until the creation of Adam."[30] The name of Iblees was originally,
according to some, ´Azázeel (as before mentioned); and according
to others, El-Ḥárith: his patronymic is Aboo-Murrah, or Abu-l-Ghimr.
[31] It is disputed whether he was of the Angels or of the Jinn. There
are three opinions on this point.—1. That he was of the Angels, from
a tradition from Ibn-´Abbás.—2. That he was of the Sheyṭáns (or
evil Jinn); as it is said in the Ḳur-án, "except Iblees, [who] was [one]
of the Jinn:" this was the opinion of El-Ḥasan El-Baṣree, and is that
commonly held.—3. That he was neither of the Angels nor of the
Jinn; but created alone, of fire. Ibn-´Abbás founds his opinion on
the same text from which El-Ḥasan El-Baṣree derives his: "When we
said unto the Angels, Worship ye Adam, and [all] worshipped except
Iblees, [who] was [one] of the Jinn" (before quoted): which he
explains by saying, that the most noble and honourable among the
Angels are called "the Jinn," because they are veiled from the eyes
of the other Angels on account of their superiority; and that Iblees
was one of these Jinn. He adds that he had the government of the
lowest heaven and of the earth, and was called the Ṭáoos (literally,
Peacock) of the Angels; and that there was not a spot in the lowest
heaven but he had prostrated himself upon it: but when the Jinn
rebelled upon the earth, God sent a troop of Angels who drove them
to the islands and mountains; and Iblees being elated with pride,
and refusing to prostrate himself before Adam, God transformed him
into a Sheyṭán. But this reasoning is opposed by other verses, in
which Iblees is represented as saying, "Thou hast created me of fire,
and hast created him [Adam] of earth."[32] It is therefore argued, "If
he were created originally of fire, how was he created of light? for
the Angels were [all] created of light."[33] The former verse may be
explained by the tradition that Iblees, having been taken captive,
was exalted among the Angels; or perhaps there is an ellipsis after
the word "Angels;" for it might be inferred that the command given
to the Angels was also (and à fortiori) to be obeyed by the Jinn.
According to a tradition, Iblees and all the Sheyṭáns are
distinguished from the other Jinn by a longer existence. "The
Sheyṭáns," it is added, "are the children of Iblees, and die not but
with him, whereas the [other] Jinn die before him;"[34] though they
may live many centuries. But this is not altogether accordant with
the popular belief: Iblees and many other evil Jinn are to survive
mankind, but they are to die before the general resurrection, as also
even the Angels, the last of whom will be the Angel of Death,
´Azraeel. Yet not all the evil Jinn are to live thus long: many of them
are killed by shooting stars, hurled at them from heaven; wherefore,
the Arabs, when they see a shooting star (shiháb), often exclaim,
"May God transfix the enemy of the faith!" Many also are killed by
other Jinn, and some even by men. The fire of which the Jinnee is
created circulates in his veins, in place of blood: therefore, when he
receives a mortal wound, this fire, issuing from his veins, generally
consumes him to ashes.
The Jinn, it has been already shown, are peccable. They eat and
drink, and propagate their species, sometimes in conjunction with
human beings; in which latter case, the offspring partakes of the
nature of both parents. In all these respects they differ from the
Angels. Among the evil Jinn are distinguished the five sons of their
chief, Iblees; namely, Teer, who brings about calamities, losses and
injuries; El-Aạwar, who encourages debauchery; Sóṭ, who suggests
lies; Dásim, who causes hatred between man and wife; and
Zelemboor, who presides over places of traffic.[35]
The most common forms and habitations or places of resort of the
Jinn must now be described.
The following traditions from the Prophet are the most to the
purpose that I have seen.—The Jinn are of various shapes; having
the forms of serpents, scorpions, lions, wolves, jackals, etc.[36] The
Jinn are of three kinds: one on the land, one in the sea, and one in
the air.[37] The Jinn consist of forty troops; each troop consisting of
six hundred thousand.[38]—The Jinn are of three kinds: one have
wings and fly; another are snakes and dogs; and the third move
about from place to place like men.[39] Domestic snakes are
asserted to be Jinn on the same authority.[39a]
The Prophet ordered his followers to kill serpents and scorpions if
they intruded at prayers; but on other occasions he seems to have
required first to admonish them to depart, and then, if they
remained, to kill them. The Doctors, however, differ in opinion
whether all kinds of snakes or serpents should be admonished first,
or whether any should; for the Prophet, say they, took a covenant of
the Jinn [probably after the above-mentioned command], that they
should not enter the houses of the faithful: therefore, it is argued, if
they enter, they break their covenant, and it becomes lawful to kill
them without previous warning. Yet it is related that ´Aïsheh, the
Prophet's wife, having killed a serpent in her chamber, was alarmed
by a dream, and fearing that it might have been a Muslim Jinnee, as
it did not enter her chamber when she was undressed, gave in alms,
as an expiation, twelve thousand dirhems (about £300), the price of
the blood of a Muslim.[40]
The Jinn were said to appear to mankind most commonly in the
shapes of serpents, dogs, cats, or human beings. In the last case,
they are sometimes of the stature of men, and sometimes of a size
enormously gigantic. If good, they are generally resplendently
handsome: if evil, horribly hideous. They become invisible at
pleasure, by a rapid extension or rarefaction of the particles which
compose them, or suddenly disappear in the earth or air or through
a solid wall. Many Muslims in the present day profess to have seen
and held intercourse with them:—witness the following anecdote,
which was related to me by a Persian with whom I was acquainted
in Cairo, named Abu-l-Ḳásim, a native of Jeelán, then superintendent
of Moḥammad ´Alee's Printing-office at Booláḳ.
One of this person's countrymen, whom he asserted to be a man of
indubitable veracity, was sitting on the roof of a house which he had
hired, overlooking the Ganges, and was passing the closing hour of
the day, according to his usual custom, in smoking his Persian pipe
and feasting his eyes by gazing at the beautiful forms of Indian
maidens bathing in the river, when he beheld among them one so
lovely that his heart was overpowered with desire to have her for his
wife. At nightfall she came to him, and told him that she had
observed his emotion and would consent to become his wife; but on
the condition that he should never admit another female to take or
share her place, and that she should only be with him in the night
time. They took the marriage-vow to each other, with none for their
witness but God; and great was his happiness, till, one evening, he
saw again, among a group of girls in the river, another who excited
in him still more powerful emotions. To his surprise, this very form
stood before him at the approach of night. He withstood the
temptation, mindful of his marriage-vow; she used every allurement,
but he was resolute. His fair visitor then told him that she was his
wife; that she was a jinneeyeh; and that she would always
thenceforward visit him in the form of any females whom he might
chance to desire.
The Zóba´ah, which is a whirlwind that raises the sand or dust in
the form of a pillar of prodigious height, often seen sweeping across
the deserts and fields, is believed to be caused by the flight of an
evil Jinnee. To defend themselves from a Jinnee thus "riding in the
whirlwind," the Arabs often exclaim, "Iron! Iron!" (Ḥadeed!
Ḥadeed!), or, "Iron! thou unlucky!" (Ḥadeed! yá mashoom!) as the
Jinn are supposed to have a great dread of that metal: or they
exclaim, "God is most great!" (Alláhu akbar!).[41] A similar
superstition prevails with respect to the water-spout at sea, as may
be seen in the adventures of King Shahriyár in the introduction to
the "Thousand and One Nights."
It is believed that the chief abode of the Jinn is in the Mountains of
Ḳáf, which are supposed to encompass the whole of our earth. But
they are also believed to pervade the solid body of our earth, and
the firmament; and to choose as their principal places of resort or of
occasional abode, baths, wells, ovens, ruined houses, market-places,
the junctures of roads, the sea, and rivers. The Arabs, therefore,
when they pour water on the ground, or enter a bath, or let down a
bucket into a well, and on various other occasions, say "Permission!"
or "Permission, ye blessed!" (Destoor! or Destoor yá mubárakeen!
[42])The evil spirits (or evil Jinn), it is said, had liberty to enter any
of the seven heavens till the birth of Jesus, when they were
excluded from three of them: on the birth of Moḥammad they were
forbidden the other four.[43] They continue, however, to ascend to
the confines of the lowest heaven, and there listening to the
conversation of the Angels respecting things decreed by God, obtain
knowledge of futurity, which they sometimes impart to men, who, by
means of talismans, or certain invocations, make them to serve the
purposes of magical performances. What the Prophet said of Iblees,
in the following tradition, applies also to the evil Jinn over whom he
presides:—His chief abode [among men] is the bath; his chief places
of resort are the markets, and the junctures of roads; his food is
whatever is killed without the name of God being pronounced over
it; his drink, whatever is intoxicating; his muëddin, the mizmár (a
musical pipe, i.e. any musical instrument); his Ḳur-án, poetry; his
written character, the marks made in geomancy;[44] his speech,
falsehood; his snares, women.[45]
That particular Jinn presided over particular places was an opinion of
the early Arabs. It is said in the Ḳur-án, "And there were certain men
who sought refuge with certain of the Jinn."[46] In the Commentary
of the Jeláleyn, I find the following remark on these words:—"When
they halted on their journey in a place of fear, each man said, 'I seek
refuge with the lord of this place, from the mischief of his foolish
ones!'" In illustration of this, I may insert the following tradition,
translated from El-Ḳazweenee:—"It is related by a certain narrator of
traditions, that he descended into a valley with his sheep, and a wolf
carried off a ewe from among them; and he arose, and raised his
voice, and cried, 'O inhabitant of the valley!' whereupon he heard a
voice saying, 'O wolf, restore to him his sheep!' and the wolf came
with the ewe, and left her and departed." The same opinion is held
by the modern Arabs, though probably they do not use such an
invocation. A similar superstition, a relic of ancient Egyptian
credulity, still prevails among the people of Cairo. It is believed that
each quarter of this city has its peculiar guardian-genius, or
Agathodaemon, which has the form of a serpent.[47]
It has already been mentioned that some of the Jinn are Muslims,
and others infidels. The good Jinn acquit themselves of the
imperative duties of religion, namely, prayers, alms-giving, fasting
during the month of Ramaḍán, and pilgrimage to Mekkeh and Mount
´Arafát; but in the performance of these duties they are generally
invisible to human beings.[48]
It has been stated, that, by means of talismans, or certain
invocations, men are said to obtain the services of Jinn; and the
manner in which the latter are enabled to assist magicians, by
imparting to them the knowledge of future events, has been
explained above. No man ever obtained such absolute power over
the Jinn as Suleymán Ibn Dáood (Solomon, the son of David). This
he did by virtue of a most wonderful talisman, which is said to have
come down to him from heaven. It was a seal-ring, upon which was
engraved "the most great name" of God, and was partly composed
of brass and partly of iron. With the brass he stamped his written
commands to the good Jinn; with the iron (for the reason before
mentioned, p. 36), those to the evil Jinn or Devils. Over both orders
he had unlimited power; as well as over the birds and the winds,[49]
and, as is generally said, over the wild beasts. His Wezeer, Áṣaf the
son of Barkhiyà, is also said to have been acquainted with "the most
great name," by uttering which, the greatest miracles may be
performed,—even that of raising the dead. By virtue of this name
engraved on his ring, Suleymán compelled the Jinn to assist in
building the Temple of Jerusalem, and in various other works. Many
of the evil Jinn he converted to the true faith, and many others of
this class, who remained obstinate in infidelity, he confined in
prisons. He is said to have been monarch of the whole earth. Hence,
perhaps, the name of Suleymán is given to the universal monarchs
of the preadamite Jinn; unless the story of his own universal
dominion originated from confounding him with those kings.
The injuries related to have been inflicted upon human beings by
evil Jinn are of various kinds. Jinn are said to have often carried off
beautiful women, whom they have forcibly kept as their wives or
concubines. Malicious or disturbed Jinn are asserted often to station
themselves on the roofs or at the windows of houses, and to throw
down bricks and stones on persons passing by. When they take
possession of an uninhabited house, they seldom fail to persecute
terribly any person who goes to reside in it. They are also very apt
to pilfer provisions, etc. Many learned and devout persons, to secure
their property from such depredations, repeat the words "In the
name of God, the Compassionate, the Merciful!" on locking the doors
of their houses, rooms, or closets, and on covering the bread-basket,
or anything containing food.[50] During the month of Ramaḍán, the
evil Jinn are believed to be confined in prison; and therefore, on the
last night of that month, with the same view, women sometimes
repeat the words above mentioned, and sprinkle salt upon the floors
of the apartments of their houses.[51]
To complete this sketch of Arabian demonology, an account must be
added of several creatures generally believed to be of inferior orders
of the Jinn.
One of these is the Ghool, which is commonly regarded as a kind of
Sheyṭán or evil Jinnee, that eats men; and is also described by some
as a Jinnee or an enchanter who assumes various forms. The Ghools
are said to appear in the forms of human beings, and of various
animals, and in many monstrous shapes; to haunt burial-grounds
and other sequestered spots; to feed upon dead human bodies; and
to kill and devour any human creature who has the misfortune to fall
in their way: whence the term "Ghool" is applied to any cannibal. An
opinion quoted by a celebrated author respecting the Ghool is that it
is a demoniacal animal, which passes a solitary existence in the
deserts, resembling both man and brute; that it appears to a person
travelling alone in the night and in solitary places, and being
supposed by him to be itself a traveller, lures him out of his way.[52]
Another opinion stated by him is this: that when the Sheyṭáns
attempt to hear words by stealth [from the confines of the lowest
heaven] they are struck by shooting-stars; and some are burnt;
some, falling into a sea, or rather a large river (baḥr), are converted
into crocodiles; and some, falling upon the land, become Ghools.
The same author adds the following tradition:—"The Ghool is any
Jinnee that is opposed to travels, assuming various forms and
appearances;"[53] and affirms that several of the Companions of the
Prophet saw Ghools in their travels, and that ´Omar, among them,
saw a Ghool while on a journey to Syria, before El-Islám, and struck
it with his sword. It appears that "Ghool" is, properly speaking, a
name only given to a female demon of the kind above described: the
male is called "Ḳuṭrub." It is said that these beings, and the Ghaddár
or Gharrár, and other similar creatures which will presently be
mentioned, are the offspring of Iblees and of a wife whom God
created for him of the fire of the samoom (which here signifies, as in
an instance before mentioned, "a smokeless fire"); and that they
sprang from an egg.[54] The female Ghool, it is added, appears to
men in the deserts, in various forms, converses with them, and
sometimes yields herself to them.
The Seạláh, or Saạláh, is another demoniacal creature, described by
most authors as of the Jinn. It is said that it is mostly found in
forests; and that when it captures a man, it makes him dance, and
plays with him as the cat plays with the mouse. A man of Iṣfahán
asserted that many beings of this kind abounded in his country; that
sometimes the wolf would hunt one of them by night, and devour it,
and that, when it had seized it, the Seạláh would cry out, "Come to
my help, for the wolf devoureth me!" or it would cry, "Who will
liberate me? I have a hundred deenárs, and he shall receive them!"
but the people knowing that it was the cry of the Seạláh, no one
would liberate it; and so the wolf would eat it.[55]—An island in the
sea of Eṣ-Ṣeen (China) is called "the Island of the Seạláh," by Arab
geographers, from its being said to be inhabited by the demons so
named: they are described as creatures of hideous forms, supposed
to be Sheyṭans, the offspring of human beings and Jinn, who eat
men.[56]

The Ghaddár, or Gharrár,[57] is another creature of a similar nature,

described as being found in the borders of El-Yemen, and sometimes
in Tihámeh, and in the upper parts of Egypt. It is said that it entices
a man to it, and either tortures him in a manner not to be described,
or merely terrifies him, and leaves him.[58]
The Delhán is also a demoniacal being, inhabiting the islands of the
seas, having the form of a man, and riding on an ostrich. It eats the
flesh of men whom the sea casts on the shore from wrecks. Some
say that a Delhán once attacked a ship in the sea, and desired to
take the crew; but they contended with it; whereupon it uttered a
cry which caused them to fall upon their faces, and it took them.[59]
The Shiḳḳ is another demoniacal creature, having the form of half a
human being (like a man divided longitudinally); and it is believed
that the Nesnás is the offspring of a Shiḳḳ and of a human being.
The former appears to travellers; and it was a demon of this kind
who killed, and was killed by, ´Alḳamah, the son of Ṣafwán, the son
of Umeiyeh; of whom it is well known that he was killed by a Jinnee.
So says El-Ḳazweenee.
The Nesnás (above mentioned) is described as resembling half a
human being; having half a head, half a body, one arm, and one leg,
with which it hops with much agility; as being found in the woods of
El-Yemen, and being endowed with speech: "but God," it is added,
"is all-knowing."[60] It is said that it is found in Ḥaḍramót as well as
El-Yemen; and that one was brought alive to El-Mutawekkil: it
resembled a man in form, excepting that it had but half a face,
which was in its breast, and a tail like that of a sheep. The people of
Ḥaḍramót, it is added, eat it; and its flesh is sweet. It is only
generated in their country. A man who went there asserted that he
saw a captured Nesnás, which cried out for mercy, conjuring him by
God and by himself.[61] A race of people whose head is in the
breast, is described as inhabiting an island called Jábeh (supposed to
be Java), in the Sea of El-Hind (India).[62] A kind of Nesnás is also
described as inhabiting the Island of Ráïj, in the Sea of Eṣ-Ṣeen
(China), and having wings like those of the bat.[63]
The Hátif is a being that is heard, but not seen; and is often
mentioned by Arab writers. It is generally the communicator of some
intelligence in the way of advice, or direction, or warning.
Here terminating this chapter, I must beg the reader to remark that
the superstitious fancies which it describes are prevalent among all
classes of the Arabs, and the Muslims in general, learned as well as
vulgar.

FOOTNOTES:
[18] Mir-át ez-Zemán (MS. in my possession)—a great history
whose author lived in the thirteenth century of our era. See also
Ḳur. v. 65.
[19] Mir-át ez-Zemán. Ḳur. lv. 14. The word which signifies "a
smokeless fire" has been misunderstood by some as meaning
"the flame of fire:" El-Jóheree (in the Ṣiḥáḥ) renders it rightly;
and says that of this fire was the Sheyṭán (Iblees) created.
[20] Ḳur. xv. 27; and Commentary of the Jeláleyn.
[21] Ḳur. xxvii. 10; and xxviii. 31; and the Jeláleyn.
[22] Ḳur. lv. 39, 74; and the Jeláleyn.
[23] ´Ikrimeh, from Ibn-´Abbás, in the Mir-át ez-Zemán.
[24] Mujáhid, from the same, ibid.
[25] Hence the appellations of "Jinn" and "Jánn."
[26] Tradition from the Prophet, in the Mir-át ez-Zemán.
[27] Ibid.
[28] The worship here spoken of is prostration, as an act of
obeisance to a superior being.
[29] Ḳur. xviii. 48.
[30] Eṭ-Ṭabaree, quoted in the Mir-át ez-Zemán.
[31] Mir-át ez-Zemán.
[32] Ḳur. vii. 11; and xxxviii. 77.
[33] Mir-át ez-Zemán.
[34] El-Ḥasan El-Baṣree, in the Mir-át ez-Zemán. My interpolation
of the word "other" is required by his opinion before stated.
[35] Mujáhid, quoted by El-Ḳazweenee.
[36] Mujáhid, from Ibn-´Abbás, in the Mir-át ez-Zemán.
[37] El-Ḥasan El-Baṣree, ibid.
[38] ´Ikrimeh, from Ibn-´Abbás, ibid.
[39] Mishkát el-Maṣábeeḥ, ii. 314.
[39a] Ibid. ii. 311, 312.
[40] Mir-át ez-Zemán. See above, p. 18.
[41] Modern Egyptians, ch. x.
[42] Ibid.
[43] Sale, in a note on chap. xv. of the Ḳur-án.
[44] So I translate the word "khaṭṭ;" but in Es-Suyooṭee's Nuzhet
el-Mutaämmil wa-Murshid el-Mutaähhil, section 7, I find, in its
place, the word "weshm," or "tattooing;" and there are some
other slight variations and omissions in this tradition as there
quoted.
[45] El-Ḳazweenee.
[46] Ḳur. lxxii. 6.
[47] Modern Egyptians, ch. x.
[48] Ibid. ch. xxiv.
[49] Ḳur. xxvii. 17; xxxviii. 35.
[50] Modern Egyptians, ch. x.
[51] Ibid.
[52] El-Ḳazweenee.
[53] El-Jáḥiz (´Amr Ibn-Baḥr).
[54] Tradition from Wahb Ibn-Munebbih, quoted in the account of
the early Arabs in the Mir-át ez-Zemán.
[55] El-Ḳazweenee.
[56] Ibn-El-Wardee [fourteenth century].
[57] Its name is written differently in two different MSS. in my
possession.
[58] El-Ḳazweenee, and Mir-át ez-Zemán.
[59] El-Ḳazweenee. In my MS. of Ibn-El-Wardee, I find the name
written "Dahlán." He mentions an island called by this name, in
the Sea of ´Omán; and describes its inhabitants as cannibal
Sheyṭáns, like men in form, and riding on birds resembling
ostriches. There is also an inferior class of the Jinn, termed El-
Ghowwáṣah, that is, the Divers or Plungers in the seas.
[60] El-Ḳazweenee, in the khátimeh [or epilogue] of his work.
[61] Mir-át ez-Zemán.
[62] Ibn-El-Wardee.
[63] Idem.
 CHAPTER III.
SAINTS.
The Arabs entertain remarkable opinions with respect to the offices
and supernatural powers of their saints, which form an important
part of the mysteries of the Darweeshes (Dervishes), and are but
imperfectly known to the generality of Muslims.
Muslim Saints and devotees are known by the common appellation
of Welees, or particular favourites of God. The more eminent among
them compose a mysterious hierarchical body, whose government
respects the whole human race, infidels as well as believers, but
whose power is often exercised in such a manner that the subjects
influenced by it know not from what person or persons its effects
proceed. The general governor or coryphaeus of these holy beings is
commonly called the Ḳuṭb, which literally signifies a "pole," or an
"axis," and is metaphorically used to signify a "chief," either in a civil
or political, or in a spiritual sense. The Ḳuṭb of the saints is
distinguished by other appellations: he is called Ḳuṭb el-Ghós, or
Ḳuṭb el-Ghóth (the Ḳuṭb of Invocation for Help), etc.; and simply, El-
Ghós.[64] The orders under the rule of this chief are called ´Omud
(or Owtád), Akhyár, Abdál, Nujaba, and Nuḳaba: I name them
according to their precedence.[65] Perhaps to these should be added
an inferior order called Aṣḥáb ed-Darak, i.e. "Watchmen," or
"Overseers." The members are not known as such to their inferior
unenlightened fellow-creatures, and are often invisible to them. This
is more frequently the case with the Ḳuṭb, who, though generally
stationed at Mekkeh, on the roof of the Kaạbeh, is never visible
there, nor at any of his other favourite stations or places of resort;
yet his voice is often heard at these places. Whenever he and the
saints under his authority mingle among ordinary men, they are not
distinguished by a dignified appearance, but are always humbly clad.
These, and even inferior saints, are said to perform astonishing
miracles, such as flying in the air, passing unhurt through fire,
swallowing fire, glass, etc., walking upon water, transporting
themselves in a moment of time to immense distances, and
supplying themselves and others with food in desert places. Their
supernatural power they are supposed to obtain by a life of the most
exalted piety, and especially by constant self-denial, accompanied
with the most implicit reliance upon God, by the services of good
genii, and, as many believe, by the knowledge and utterance of "the
most great name" of God. A miracle performed by a saint is
distinguished by the term "karámeh" from one performed by a
prophet, which is called "moạjizeh."
El-Khiḍr and Ilyás (Elias), are both believed to have been Ḳuṭbs, and
the latter is called in the Ḳur-án an apostle; but it is disputed
whether the former was a prophet or merely a welee. Both are said
to have drunk of the Fountain of Life, and to be in consequence still
living; and Ilyás is commonly believed to invest the successive
Ḳuṭbs. The similarity of the miracles ascribed to the Ḳuṭbs to those
performed by Elias or Elijah, I have remarked in a former work.[66]
Another miracle, reminding us of the mantle of Elijah in the hands of
his successor, may here be mentioned.—A saint who was the Ḳuṭb of
his time, dying at Tunis, left his clothes in trust to his attendant,
Moḥammad El-Ashwam, a native of the neighbouring regency of
Tripoli, who desired to sell these relics, but was counselled to retain
them, and accordingly, though high prices were bidden for them,
made them his own by purchase. As soon as they became his
property, he was affected, we are told, with a divine ecstasy, and
endowed with miraculous powers.[67]
Innumerable miracles are related to have been performed by Muslim
saints, and large volumes are filled with the histories of their
wonderful lives. The author of the work from which the above story
is taken, mentions, as a fact to be relied on, in an account of one of
his ancestors, that, his lamp happening to go out one night while he
was reading alone in the riwáḳ of the Jabart (of which he was the
sheykh), in the great mosque El-Azhar, the forefinger of his right
hand emitted a light which enabled him to continue his reading until
his naḳeeb had trimmed and lighted another lamp.[68]
From many stories of a similar kind that I have read, I select the
following as a fair specimen: it is related by a very celebrated saint,
Ibráheem El-Khowwáṣ.—"I entered the desert [on pilgrimage to
Mekkeh from El-´Iráḳ], and there joined me a man having a belt
round his waist, and I said, 'Who art thou?'—He answered, 'A
Christian; and I desire thy company.' We walked together for seven
days, eating nothing; after which he said to me, 'O monk of the
Muslims, produce what thou hast in the way of refreshment, for we
are hungry:' so I said, 'O my God, disgrace me not before this
infidel:' and lo, a tray, upon which were bread and broiled meat and
fresh dates and a mug of water. We ate, and continued our journey
seven days more; and I then said to him, 'O monk of the Christians,
produce what thou hast in the way of refreshment; for the turn is
come to thee:' whereupon he leaned upon his staff, and prayed; and
lo, two trays, containing double that which was on my tray. I was
confounded, and refused to eat: he urged me, saying, 'Eat;' but I did
it not. Then said he, 'Be glad; for I give thee two pieces of good
news: one of them is that I testify that there is no deity but God and
that Moḥammad is God's Apostle: the other, that I said, O God, if
there be worth in this servant, supply me with two trays:—so this is
through thy blessing.' We ate, and the man put on the dress of
pilgrimage, and so entered Mekkeh, where he remained with me a
year as a student; after which he died, and I buried him in [the
cemetery] El-Maạlà." "And God," says the author from whom I take
this story, "is all-knowing:" i.e. He alone knoweth whether it be
strictly true: but this is often added to the narration of traditions
resting upon high authority.[69]
The saint above mentioned was called "El-Khowwáṣ" (or the maker
of palm-leaf baskets, etc.) from the following circumstance, related
by himself.—"I used," said he, "to go out of the town [Er-Rei] and sit
by a river on the banks of which was abundance of palm-leaves; and
it occurred to my mind to make every day five baskets [ḳuffehs],
and to throw them into the river, for my amusement, as if I were
obliged to do so. My time was so passed for many days: at length,
one day, I thought I would walk after the baskets, and see whither
they had gone: so I proceeded awhile along the bank of the river,
and found an old woman sitting sorrowful. On that day I had made
nothing. I said to her, 'Wherefore do I see thee sorrowful?' She
answered, 'I am a widow: my husband died leaving five daughters,
and nothing to maintain them; and it is my custom to repair every
day to this river, and there come to me, upon the surface of the
water, five baskets, which I sell, and by means of them I procure
food; but to-day they have not come, and I know not what to do.'
Upon hearing this, I raised my head towards heaven, and said, 'O
my God, had I known that I had more than five children to maintain,
I had laboured more diligently.'" He then took the old woman to his
house, and gave her money and flour, and said to her, "Whenever
thou wantest anything, come hither and take what may suffice
thee."[70]
An irresistible influence has often been exercised over the minds of
princes and other great men by reputed saints. Many a Muslim
Monarch has thus been incited (as the Kings of Christendom were by
Peter the Hermit) to undertake religious wars, or urged to acts of
piety and charity, or restrained from tyranny, by threats of Divine
vengeance to be called down upon his head by the imprecations of a
welee. ´Alee, the favourite son of the Khaleefeh El-Ma-moon, was
induced for the sake of religion to flee from the splendour and
luxuries of his father's court, and after the example of a self-denying
devotee to follow the occupation of a porter in a state of the most
abject poverty at El-Baṣrah, fasting all the day, remaining without
sleep at night in a mosque, and walking barefooted, until, under an
accumulation of severe sufferings, he prematurely ended his days,
dying on a mat. The honours which he refused to receive in life were
paid to him after his death: his rank being discovered by a ring and
paper which he left, his corpse was anointed with camphor and
musk and aloes, wrapped in fine linen of Egypt, and so conveyed to
his distressed father at Baghdád.[71]
Self-denial I have before mentioned as one of the most important
means by which to attain the dignity of a welee. A very famous
saint, Esh-Shiblee, is said to have received from his father an
inheritance of sixty millions of deenárs (a sum incredible, and
probably a mistake for sixty thousand, or for sixty million dirhems)
besides landed property, and to have expended it all in charity: also,
to have thrown into the Tigris seventy hundred-weight of books,
written by his own hand during a period of twenty years.[72]
Sháh El-Karmánee, another celebrated saint, had a beautiful
daughter, whom the Sulṭán of his country sought in marriage. The
holy man required three days to consider his sovereign's proposal,
and in the mean time visited several mosques, in one of which he
saw a young man humbly occupied in prayer. Having waited till he
had finished, he accosted him, saying, "My son, hast thou a wife?"
Being answered "No," he said, "I have a maiden, a virtuous devotee,
who hath learned the whole of the Ḳur-án, and is amply endowed
with beauty. Dost thou desire her?"—"Who," said the young man,
"will marry me to such a one as thou hast described, when I possess
no more than three dirhems?"—"I will marry thee to her," answered
the saint: "she is my daughter, and I am Sháh the son of Shujáạ El-
Karmánee: give me the dirhems that thou hast, that I may buy a
dirhem's worth of bread, and a dirhem's worth of something
savoury, and a dirhem's worth of perfume." The marriage-contract
was performed; but when the bride came to the young man, she
saw a stale cake of bread placed upon the top of his mug; upon
which she put on her izár, and went out. Her husband said, "Now I
perceive that the daughter of Sháh El-Karmánee is displeased with
my poverty." She answered, "I did not withdraw from fear of
poverty, but on account of the weakness of thy faith, seeing how
thou layest by a cake of bread for the morrow."[73]
One of my friends in Cairo, Abu-l-Ḳásim of Jeelán, entertained me
with a long relation of the mortifications and other means which he
employed to attain the rank of a welee. These were chiefly self-
denial and a perfect reliance upon Providence. He left his home in a
state of voluntary destitution and complete nudity, to travel through
Persia and the surrounding countries and yet more distant regions if
necessary, in search of a spiritual guide. For many days he avoided
the habitations of men, fasting from daybreak till sunset, and then
eating nothing but a little grass or a few leaves or wild fruits, till by
degrees he habituated himself to almost total abstinence from every
kind of nourishment. His feet, at first blistered and cut by sharp
stones, soon became callous; and in proportion to his reduction of
food, his frame, contrary to the common course of nature, became
(according to his own account) more stout and lusty. Bronzed by the
sun, and with his black hair hanging over his shoulders (for he had
abjured the use of the razor), he presented in his nudity a wild and
frightful appearance, and on his first approaching a town, was
surrounded and pelted by a crowd of boys; he therefore retreated,
and, after the example of our first parents, made himself a partial
covering of leaves; and this he always afterwards did on similar
occasions, never remaining long enough in a town for his leafy apron
to wither. The abodes of mankind he always passed at a distance,
excepting when several days' fast, while traversing an arid desert,
compelled him to obtain a morsel of bread or a cup of water from
the hand of some charitable fellow-creature.
One thing that he particularly dreaded was to receive relief from a
sinful man, or from a demon in the human form. In passing over a
parched and desolate tract, where for three days he had found
nothing to eat, not even a blade of grass, nor a spring from which to
refresh his tongue, he became overpowered with thirst, and prayed
that God would send him a messenger with a pitcher of water. "But,"
said he, "let the water be in a green Baghdádee pitcher, that I may
know it to be from Thee, and not from the Devil; and when I ask the
bearer to give me to drink, let him pour it over my head, that I may
not too much gratify my carnal desire."—"I looked behind me," he
continued, "and saw a man bearing a green Baghdádee pitcher of
water, and said to him, 'Give me to drink;' and he came up to me,
and poured the contents over my head, and departed! By Allah it
was so!"
Rejoicing in this miracle, as a proof of his having attained to a
degree of wiláyeh (or saintship), and refreshed by the water, he
continued his way over the desert, more firm than ever in his course
of self-denial, which, though imperfectly followed, had been the
means of his being thus distinguished. But the burning thirst
returned shortly after, and he felt himself at the point of sinking
under it, when he beheld before him a high hill, with a rivulet
running by its base. To the summit of this hill he determined to
ascend, by way of mortification, before he would taste the water,
and this point, with much difficulty, he reached at the close of day.
Here standing, he saw approaching, below, a troop of horsemen,
who paused at the foot of the hill, when their chief, who was
foremost, called out to him by name, "O Abu-l-Ḳásim! O Jeelánee!
Come down and drink!"—but persuaded by this that he was Iblees
with a troop of his sons, the evil Genii, he withstood the temptation,
and remained stationary until the deceiver with his attendants had
passed on and were out of sight. The sun had then set; his thirst
had somewhat abated; and he only drank a few drops.
Continuing his wanderings in the desert, he found upon a pebbly
plain an old man with a long white beard, who accosted him, asking
of what he was in search. "I am seeking," he answered, "a spiritual
guide; and my heart tells me that thou art the guide I seek." "My
son," said the old man, "thou seest yonder a saint's tomb; it is a
place where prayer is answered; go thither, enter it, and seat
thyself: neither eat nor drink nor sleep; but occupy thyself solely,
day and night, in repeating silently, 'Lá iláha illa-lláh' (There is no
deity but God); and let not any living creature see thy lips move in
doing so; for among the peculiar virtues of these words is this, that
they may be uttered without any motion of the lips. Go, and peace
be on thee!"
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