Bull. Ind. Inst. HiH. lV'ed. Vol. XXIV p p , 15 to 26

AVICENNA'S CONTRIBUTION TO THE 'OEVELOPMENTAND PROGRESS OF MEOICAL SCIENCES

SAMIR YAHIA EL-GAMMAL *

ABSTRACT

Avicenna was born in the village of Belkh near Bukhara in P~rsia He

was u very famous philosopher, wiseman and an efficient physician He

wrote more than one hundred books on all aspects and sciences known If1

his time i.e. philosophy. wisdom. religion. ruathemat ic s. sophrsm. literature.poetry and medicine. In medicine, th:; most c elebr e t ed 01 t nem is "AI-Ganun

Iii Tibb", which surpassed other similar books on medicine. and considered

the biU9t1st medical encyclopaedia of his time. Those o r ien t a l rst s who

be l iev e in Greek medicrne consider this book as the only text book on the art01 cur,,,\] and recovery.

Avicenn a (980-1037 AD.) asknown to the European is Abu AliAl-Hussein ibn Abdullah ibn Sina,also called throughout the Arab--Islmicworld by the name AI SheikhAI Raees (the uld man and master),and was referred to as the third teacherof philosophv (after the first' Aristotle'and the second' AI Faraabv ) .

He was born in a family bel:>ngingto Ismaelite sect in the village ofBelkh near Bukkhara in Per s ia. Bythe age of ten. Avice nn a was wellacquainted with the Arabic languagetogether with his mother tonque the

Persian, also knew by heart all theverses of the Holy Our an. Duringthe next ten years, he was busyin studying tsrnlarnic legislations,philosophy natured sc.ences. mathe-maries and logic.

Later on, Avieenna became thepupil of the I.imous wiseman andphilo sophe r Abi Abdulla!1 Al-Narali.then rnemor ised the f arnous book'Esaqoqhi' written by the Greekphilosopher 'Phorpborius '. thenstudied the works 011 mathematicsand arithmatic by the Greek Euclide(300 Be) specially his famous hoc.k

• Pharmacist, R"s~archer .n the History of Me d.ctne & Fnar rnecv POBox 136, Mandl, Cur ioE~Jr'P!.

16

'Stoicheia.' also the book 'MegaleSyntaxis' that famous astronomicalvolume written by the great astron-omer Ptolemaeus the Alexandrian(2nd century A D.), (this book wasvery popular to the Arabs under thename AI-Magesti).

Avicenna became interestedafterwards in medical sciences andstudied it under the Persian physicianAI-Mansour AI-Hasan ibn NouhAI-Qamari (a celebrated physicianwho wrote a book on the Art ofMedicine in three parts. on internaldiseases, external diseases i e.dermatology and fevers).

He then studied under Abi Sahllssa AI-Gergani (that famousphysician who wrote a celebratedmedical encyclopaedia 'The HundredBook on the Art of Medicine' anddied in 1000 A.D ). Avicenna at theage of 17 memorised the famous bookon philosophy written by AI-Faraabi"The Philosophy of Plato andAristotle", in which he found allsolutions to his problems on thephilosophy of metaphysics.

At the age of 18, Avicennabecame very famous as a physicianand was called by the Prince Nouhibn Mansour of Khourasan (ruledfrom 976-997 A.D.) to cure him fromhis ailments and when succeeded,was appointed his private physicianand was granted the right and libertyto read whatever books he wished in

s palace.

Bull Ind. Inst. H,st. Med. Voi. XXIV

When Avicenna reached the ageof 20, he started writing medical andphilosophical books as well aspractising medicine in a place nearthe shores of the Caspian sea andduring that time his father died. Oneyear later, Avicenna completed thewriting of his first book, and at theage of 22 he became very famous inhis locality that the prince of HamazanState (one of the Persian states)appointed him as his prime minister.But after a while, Avicenna's rivalsconspired over him resulting in hisarrest and put in prison, but couldescape after sometime. He laterbecame the court physician for Aliibn Maamoun the governor ofKhouarizm, and again escaped fromthere due to a plot organised by hisrivals. After a long travel he reachedthe state of Gerqan where he heardabout the assasination of its charitableprince. Then left for Asfahan andgot refuge to its prince Alaa EI-Dineand became his personal physician.

Avicenna continued writing booksmostly in Arabic with few in Persianlanguage. He became the mostprominent Islamic philosopher andhis views considered as philosophyand art composed of two sciences ...one dealing with matters of the actualexistence of man while the other onwhat man has to do, so as to honourhimself and become a reasonablescientist equivalent to the presentworld and to become extremelycontented with the after life.

Avicenne:s contribution-Samir Yehle EI-Gammal 17

Avicenna's views about logicwere very conservative as he followedthose of Aristotle concerning causesof matter, thus, got in severe conflictwith his contemporary philologistsowing to clashes between his logicalthoughts and their religious ones. Inpsychology, Avicenna mixed betweenthe philosophies of both Aristotle andPlato, thus came out with a newconcept which was widely acceptedand concentrated on the immortalityof the human soul which heconsidered as an element and not animage.

He also contributed to the fieldof metaphysics following the steps ofall the philosophers of antiquityand his contemporaries, where hecommented on the books of Platonius,the Eqvptian philosopher (livedbetween 205-270 A.D.). He wasvery famous and established theNeo-Platonic ohiloscphv. he alsocommented on the books or his pupilPhcrphor ius (the latter tried toreconcile between the thoughts andideas of Plato and Aristotle bysimplifying and explaining Plato'spoints of view on religious unity),and so Avicenna helped Moslems toreconcile between the traditionalreligious beliefs and of the GreekPhilosophical ideas.

Avicenna's ideas on the belief inone God and that all existing lifeunites with him, found great approvalin the Western Islamic World (North

Africa and Spain) specially throughthe efforts of Maimonides inAndalucia). Avicenna established aUnitarian sect of his own in which hereconciled between the elements ofIslam and that of Plato and Aristotle.in other words between philosophyand religion through his interpreta-tions of the verses of the Holy Quranwith logical proofs he developed toascertain the existence of prophecy,and its social necessity to the peopleto manage their affairs and ascertainfor the facts of life.

Avicenna's personality was thenconsidered unique and genious andas the wonder or his time owing tohis brilliant ideas and abilities, andalso because of his writings thatshowed his characters and scientificabilities since early age, and reachedits peak in a short time that excelledin teaching, classification andinventions which survived in hisscientific and philosophical heritage,

He used his deep /-ihilo;,ophicalstudies and wide knowledge of logiclil analysing all matters, thenclassifying them in arranged mannerrevealing his great scientific andphilosophical mentality. He putdown rules even on himself by whichall physicians should not go beyondits limits and indulge themselves inphilosophical matters. He also putphilosophy before science ... sincescience at his time was not sopowerful to the extent it could do

IS

without philosophy, while philosophvon the other hand could do withoutscience, In his book 'The seasons'he could discuss his philosophypowerfully and trustworthy dependingon philosophy, but goil'g in its details,Avicenna went on explaining themon a pure scientific basis

In medicine, Avicenna wrotemany beaks, the most celebrated ofthem is 'At-Oanun Iii Tibb, in whichhe got benefit from his indulgence inphilosophy that was shown clearlyin the vo lurne.rIs the method ofclassitvinq the contents In an accuratesvstern contrary to the past phvsicianswho were busy In trifle matters awayfrom the right cour -e of medicine,which is diagnosis of the diseasesand th erapv which is based onexperience and acu tual findings(ancient medicine was under th.!

Influence of philosophical ideas baseuon logic solely),

The book 'Al-Oanun' is consi-dered a very valuable scientificheritage that shows the skill andextensive knowledge of its author,stating all the medical teaching ofHippocrates and Galen, mixed withAristotles ' philosophv in biology, ellput down in a neat classified system.divided into sections. He built hismedical basis on the theory ofhumours and temoeraments f otlo winuHip.iocrates. It also reveals hisprecise and docile description ofmorbid arid clinical symptoms of tl.e

Bull, t nd . Inst . Hist . MAti, VtJ/, XX, V

diseases, his precise ways oftreatrnert based on logic withoutmuch exageration and in an eloquentmethod,

Avicenna did not submit to theintermixing at medieval medicinewith priesthood, magic and spells,nor deny the influence of higher orlower spirits on the living bodies, butstated that the physician has torecoqnise the disease as being aphysical incident only and also as acondition of change of temperaments,

He practised healing the sick withremedies according to his long[Aactice and was considered not justquo tin q from the Greek medIcine butd mall of innovation, invention aridexperimentation, He did not rely onold Greek sciences only but opposedwhat others agreed upon, thusrenovated medicine by putting downnew bases, He modified ancientmedicine, trimmed it through the useof his vast knowledge and power ofobservation then wrote his supremeencvc lopae diu which gained fameover all past medical compendiumsand remained for many centuries asthe only medical text-book in medicalschools of east and west, up to themid 16th century specially in Europeafter boino translated into Latin byGirard De Crernona in 1170,

Europe considered "Al-Oanuri'as a sacred insoiration and admiredits logical and undisputed clessifica-

Av icenne:s c ntributron-: Samir Yahia El-Gammel

tion, and took its prefaces for granted.It was looked upon as the best textbook on medicine with all merits ofinve stiq ati ons and coordination.contained the heritage of pastcivilisations on medical sciences,explaininq the symptoms of diseasesand prescribing the appropriatemedication together with a list ofdrugs and pharmaceuticals, descrip-tion of surgical operations and theirtools, and above all a considerableability to encvclopaedic arrangementnever before demonstrated.

He pointed out clearly hisscientific pattern in "Al-Oanun",mentioned to the beginning thegeneral outlines of medicine, bothti1eoreticaly and experimentally, thenmoved on to simple drugs and theirdivisions. then those diseasesoccurring in each organ of the body,cornmencinq with its anatomy thenits functions, followed by theanatomy of the simpler organs andtheir functions and describinq theway to keep it healthy. He thenproceeded with absolute evidence ofits diseases, etiology and symptomsthen their methods of treatment.

He then described minor diseaseswith their etiology and symptomstogether with their governing rules,then the general law of treatment,followed by particular therapy usingsimple drugs or compound ones,mentioning previous medication bysimple then compound drugs. (Thus

79

his pattern begin with the auatornvof each organ, its function, nature ofits diseases, then treatment showinghow accurate his system was, whichenabled his students to proceed in atrue scientific and academic way.

Avicenna was also a cleverphysician as weil as a thoughtfulphilosopher, with his theory ondiseases date back to the Greeks whostated that nature was composed offour elements; fire, water, earth andair ... also there are four temperaments:hot dry, cold humid, cold cry and hothumid. The human body also hasfour humours controlling it; blood,phlegm, black bile and yellow bile(these humours are liquid bodiesoriginated from food). Thus theblood is airy hot and humid; blackbile is earthly cold and dry; yellowbile is firey .. hot and dry; phlegm iswatery .. cold ana humid. The completebalance between these humours givesman good health, while the distur-bance in the equilibrium of thepercentage of each humour causesill health and sickness.

He then mentioned the causes ofthe diseases and their symptoms,showing that diseases are anabnormal phase in the body, arisingfrom abnormal humour function orstructure, eventually their symptomsare abnormal, whether direct such aspain in the abdomen or indirect suchas redness in the cheeks in case oftuberculosis. As an example; tile:

20

cause of putrefaction. the disease isfever, the symptoms are thirst andheadache. Another example; thecause is fullness in the vesselsconnected to the eyes, the disease isobstruction in the interior of theeye-ball, symptoms are loss of sight.

In case there are resemblance inthe symptoms, he gave accuratedifferentiation between them, depen-ding on comparative diagnosisbetween the different diseases, e g.concerning the difference betweenepilepsy and vertigo; he stated thatvertigo may last for sometime whileepilepsy occurs suddenly, the patientcollapses, falls at once then regainsconsciousness after a certain period.Meantime, dizziness is a conditionthrough which the patient becomesdrowsy if stands up after long sitting.have blackness in vision and aboutto fall down. It might look likeepilepsy if it is severe but with noco !lVU Is ions.

He was also capable of diagnosingthe illness from the examination ofthe urine, faeces and pulse of thepatient, he stated... the urine iscollected first thing in the morning,without drinkir.g water or eClting foodor having coloured food or drinkswith saffron. pomegranate or Indianlaburnum which colours the urine.Concerning the faeces examination.Avicenna mentioned in chapter 13,second volume of the Oanun itsch iracteristics such as colour. form

Bull. Ind. tnst . Hist. Med. Vol. XX/V

etc .• while pulse was examined todiagnose illness as mentioned inchapter 19, first volume of the Qanunwether even, different or normalpulse with its variations, and thatfemale pulse is different from males.Other types of pulse were teeth,humours, seasons, places, bodies,pulse related to consumption ofcertain materials or stimulants orsedatives. Also pulse of awakeness,sports, bathers, pregnancy, pain andspasms, tumours or psychiatricaffections.

So from those three guides ...urine, faeces and pulse the physiciancould identify and diagnose theillness, depending on his experience,skill and medical knowledge bothclinically and experimentally.

One of Avicenna's major medicalresults and achievements thatattracted universal attrntion wasAnkylostoma parasite present in thehuman body and mentioned in aspecial chapter of the Qanum onintestinal worms which he calledRour.d Worms He mentioned tuber-culosis, st atnd that diseases aretransmitted by water and dust; wasalso the first to describe Filariaparasite causing elephantiasis andshowed its distribution in the humanbody.

He was the first to describemalignant Anthrax (which he calledPersian Fire) and the fever it produces

Avicennos contribution Snmir Yuh:» it-Gsrnme! 2;

(Persian Fever). He could describeaccurately through his clinicalobservations the suppuration of thepleura, and differentiated betweenbronchitis and acute meningitis. Hecould also differentiate betweenintestin al and ren al colics, betweenfacial paralysis caused by centralaffection of the brain and that fromlocal affection to the nerve supplyingthe facial muscles, which is the majorcause.

Avicenna described brain arrestarisinq from excessive blood supply(haernorrhaqe) , and differentiatedbetween pain in the body sides andthat pain in the nerves it: bt:tween theribs. He also identified differenttypes of insect larvae ano gavereasons for that; was also the first totreat tear duct occlusion tluo uqh theinsertion of a sterilized probe. Alsoadvised the use of coated pills so asto cover their bitter taste; revealed ina very accurate way the symptomsof having stones in the bladder, andtheir difference from kidney stones.

He was the first to diagnoseaccurately inflammation of the ribs,lung infection and also liver abscess,he described well skin and ve nercu ldiseases and nervous disorders. Hedescribed in a precise way urinaryfistulae, post partum fever, sterilityand sex differentiation of the foetusand male responsibility in it (and notthe female). He described somegynaecological dise ar es sc.e.u.Ilcaltv

such as vaginal obstruction. Ivrnphaticturnouts etc. He skillfully pointed outthat external senses such as sight,hearing or taste are governed by aspecial centre in the brain.

Concerning psychology. Avicennastated that psychological influencesaffect the body organs and theirfunctions greatly. and proved that iti!:, a natural science away fromillusions and superstitions. He usedhis keen vision and vast intelligenceduring its therapy so as to identifythe symptoms of organic diseases,and did not forget to emphasize onthe use of psychological entrance as acure to human bodies.

Avicenna's writings on medicineare clear and simp!ifled for studentsand prof essto nats to understandeasily (coritr arv to Galen whoseworks are vague, obscure and lackorganisation and order). The book'Al-Oanun b , Avicenna is consideredthe biggest medical encyclopaedia cfhis time, where he mentioned thebases of medicine such as thetemperaments, humours, differentbody organs and their functions;different dis eases and their etiology,materia medica, simple drugs and theeffect of each on the body systems.He also mentioned compound drugs,effect of each on the diseases withtracing its fate in the body and putdown his remarks ... thus his remediesand opinions resulted from hisexperience.

AI-Oan[Jn contains one mil'~ioflwords, divided into five big books,each in turn is divided into sever a]sections and each section iscomposed of several treatises an~t'each is divided into chapters (<:IIdivisions are loqicallv related to Cil ;I}other). Thus the f ive books are;

Book I: comprise several sections;

Section 1 : deals with major facultiesof medicine such a s definitions,purposes, t~1e fOUT elernents.the temperaments, anatomy,researches in physiol,ony andpsvcholoqv.

Section 2: <,!eals vvith, diseases ...definitions. etioloqy, varieties.pulse: urine and faeces examina-tions.

Sect.on 3: dears II'Jitll newly bor ninfants. breast feeding, childr e ndiseases and their treatrne n i

sports. baths, food manaqernonr.geriatric diseases, temperamentsand their correction, travel andtheir care.

Section 4: deals ",:ith neatment ,pmgatFves etc.

Book 1/ : on sirnp!c druqs ar.d dealswith pharrn aceu tic al art andco nt ain many drugs that w er eunknown to the Greeks Itcomprise sover al sections such as:

Bli/I. Ind. Inst. t-its). IVIed. (10'1. XXIV'

1- discusses the nature of the drugs,their characters, action of eachdrug on the body organs.

2 discusses simplealphabetical order

druqs

Book 11/: discusses diseases in thehuman body organs from head10 foot, both externally andil',tefnall,! with mention of theirpathotoqv, symptoms of each.disease. a n d with fully accuratedescription, etiology and treat-ment, with mention of the pastwritten items on this subject andanatomv of the diseased organ

Rook I V: Sections 1 to 4; deal with,those diseases that affect more·than ana organ such as thedifferent types of fevers and theirtreatment. Also with descriptionof infective dise a se s such assmall-pox. measles and others.such as tumours, pimples, leprosy,fractures, bone-settino and( osmetics.

Sect.on 5: deals with surgery.dislocations and fractures.

Section 6 : deals with- poisons.

Sf ction 7 . r.1~ar,;with drugs used'it) co sme t.c s.

B o : k V. deals with prepar:l1ions ofco mpou :1(1 druqs (Aqr abazi n),different me tho ds used in the artof pr epari nq drl!~Js and aboutIn a te f ia rnn~; i.::"

Avicenne:s contribut i 017- .Semir Yahia EI- Gamma!

Avicenna was also skillful insurgery, evident in Book III of his"Al-Oanun". where he mentioned thetreatment of nerves, methods of stop-ping h aerno rrh aqe by using tourniquetor insertion of wicks or cauterizationor application of caustic materials orpressing the flesh around the veintightly.

He also mentioned anal infections,treatment of haemorrhoids (either byGutting them off or by drying orcauterization). Also described analfistula and showed that there is arelation between the fistula and thesphincter muscle through the insertionof a probe inside the fistula andpushing one finger inside the anus,then pressing on the muscle after thepatient had constricted it, thus couldidentify its position from the probe,

then the muscle is cut off partially or

completely. (This procedure is still

applied up till now in treating analfistula) _

Avicenna also mentioned kidneystones and warned of their extractionthrough an incision in the back. samewarning with bladder stones lestcomplications may arise danqerinqthe life of the patient (such asshock, haemorrhage and urineincontinence) _ He also mentionedthe use of catheters and bowls ifdrugs were useless, and warned oftheir use in case of bladder tumourthence the pain will aggravate.

23

He described in Book IV ofAl-Oanun surqic al shock and warnedof serious complications arising fromsho:k or falli;)g such as rupture to apart of the ho ar t muscle or even tothe stomach which is fatal. Alsourine or faecal retention may occuror drain involuntarilv. Blood vomitingor extreme haemorrhage may occurdue to cut in the veins of thecranium, spleen or liver. togetherwith abdomen flatulence, difficultrespiration, inabiiity to speak or talk.

Avicenna described also jointdislocation as an unusual depressionin the joint in comp ar ison to thehealthy one, and if the joint does notmove then the dislocation iscomplete. He favoured the use ofHippocraric method for setting thejoint back to normal with care infixing the shoulder tightly till thetissues heal.

He mentioned th a t vertebraldislocation causes paralysis, gave anaccount on the symptoms of bonefractures and their complications,emphasized on the importance offixing the fracture with splints and\ veil surgical interference to cure malhealing of the bones. He was thefirst to discover and describe theinternal occular muscles, the first todifferentiate between the types ofjaundice. the first to recognise somediseases that are transmitted bydrinking water and attributed themto the presence of minute animals

24

unseen by the naked eye andswallowed unnoticed.

Avicenna approved upon theanatomical theories attributed toAristotle and Galen, and mentionedthem in his medical books, but wasthe first to oppose them and evencorrected them specially in Opticswhere he showed that the centre ofvision is not the lens but in the opticnerve. He also described the liverand mentioned that by pressing overit, one can feel if it is hard, enlargedor having a tumour thus diagnosingits illness.

Avicenna's compilations exceededone hundred in all aspects andsciences known in his time such asphilosophy, wisdom. religion, mathe-matics, sophism, literature, poetryand medicine (68 in religion andmetaphysics; 11 on astronomy andphysical philosophy; 16 on medicine;4 on poetry etc). Of his medical

<lurnes. 8 were written in the form..erns and in different subjects

such as "Symptoms and Signs ofDeath Approach". "Hygienic Com-mandments". 'Experimental Therapy',"Notes on Anatomy" etc., and aboveall "Poetical Metre on Medicine" onall arts of medicine, composed of1000 lines.

Apart from his very famous book"AI-Qanun", Avicenna wrote anotherimportant book "Treatise on CardiacDrugs" and a third one "Notes c)11

Bull. Ind. Inst. Hist. Med . Vol. XXIV

Body Constitution". Also wrote abook on ..Reasons of Occurrence ofGeometrical Letters" which dealtwith sound (from the perspectiveview of the Arabic and Persianlanguages), composed of sixchapters ...

chapter I.' on the reasons of soundoccurrence (he mentioned that itoccurs due to strong and swift wavemovements in the air. and that wavingarise from; 1) knocking. which is theapproach of a body to somethingresistinq it, followed by violentreaction to the velocity of approachmovement and its strength ...• 2)displacement, which is the migrationof one body away from another.,coherent to it and superimposed oneach other. to a distance with a vastspeed.

chapter 1/.' on the reasons of lettersoccurrence; a letter is an organisedvoice. related to it and characteristic,so differentiates from another voicewhich is similar in pitch and tone .

chapter III.' on the anatomy of theLarynx (showed that it is composedof three cartilages.

chapter IV: on some reasons to oneletter of the Arabic alphabets.

chepter V.' on letters resemblingthose letters which are absent int he Arabic language such a:, thePersian" J".

Avicenne:s c ontributi on : Samir Yahia EI-Gammal 25

chapter VI: on how to hear the lettersfrom non-vocal movements.

Avicenna wrote also a book on"Signals" (AI lsharaat) in which heexpressed his philosophy which wasvery close to mysticism. He alsowrote a book called "The Recovery"('AI Shite,') which contained varioussubjects such as logic, physics,mathematics and theology (he wrotelater on an abridged form of this bookwhich he called "The Salvation").The bock "AI Shif a" consists of threesections; the first deals with logic ...the second and third deal withphysics and metaphysics. This bookis a huge scientific encyclopaedia inwhich Avicenna mentioned accuratelyinferrnations on physics, plants,animals and minerals.

Concerning the part of this bookon physics, Avicenna wrote aboutthe mountains, earthquakes, velocityof sound and light, clouds, shadow.ice, cold weather. fog, rainbow. sun,meteors. winds. lightning andthunder He also mentioned exten-sively his opinions and theories onplants. their multiplication, male andfemale flowers, that the plant sharesthe animal in action and emotionstowards food. Also mentioned plantfruits. thorns and plants that growon the coasts. sand. rivers andmountains, also grafting, evergreenand deciduous plants

In the section on animals in thisbook. Avicenna described studies,remarks and different observationsabout the animal species, birds; alsodescribed aquatic animals such asclams. fish, frcgs and sponges Hethen moved on to land animals andmentioned their different or q ars.muscles, tendons, ligaments, arterie- ..veins. membranes. nerve fibres, lunc sheart, voluntary and involunt arvmovements. He then discussedminerals and how to transfer lowminerals to precious ones (Alchemy).classified minerals to stones, solublerocks. sulphurated rocks, salts, andshowed how mistaken these lieralchemists were in pretention oftransfering elements to each other.since their constitution remain intactand unchanqed, and that other similarelements might arise which causethat confusion.

To conclude, Avicenna becamevery famous throughout the Islamicworld as a wiseman and philosopherbesides being an efficient physician.His book" AI Oanun" surpassed othersimilar books on medicine whichwritten by Rhazes or AI-Magusi andeven replaced them. Those orienta-lists who believe in Greek medicineconsider this book as the only textbook on the art of curing andrecovery.

26 Bull. Ind. Inst. Hist Med. Vol. XXIV

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8 Mieli. Aldo

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10. Ullman, Manfred.

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Avicenna's contribution-Samir Yahia EI-Gammal 27

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V'i iii) f:qf~c6' ~m:w i6 ferq'~ it rwrwcr Iffaa1~ «Ill QT'l6 & I