NOTAS DE LITERATURA / LITERATURE NOTES

MANAGEMENT OF SPINAL DISORDERS ANDTRAUMA IN AVICENNA'S CANNON OF MEDICINE

TRATAMENTO DE DOENÇAS E TRAUMA DACOLUNA NO CÂNONE DE MEDICINA DE AVICENA

David Gonçalves Nordon, José Carlos Kesine *

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Rev.Fac.Ciênc.Méd.Sorocaba,v.13,n.4,p.38-40, 2011*Acadêmico do curso de Medicina - FCMS/PUC-SPRecebido em 9/2/2011. Aceito para publicação em 16/2/2011.Contato: d-nordon@uol.com.br

Knowing the history of medicine is understanding whatled us here. Scientific progress is each time more and moreimpressiveandhasbeengreater in the last century than it everwasinthewholehistoryofhumankind.Itsgrowthisexponential.

Nevertheless, a recent article published in the periodicalNeurosurgery shows us that the foundations of treatment forspinaldisorders havenot changed much- rather, it has evolved.

The first discovered document concerning the spine wasthe Edwin Smith Surgical Papyrus from Egypt, which is a seriesof six cases description written probably 31 centuries ago.

Celsus, who wrote De Re Medicina suggested immobilizationand stabilization rather than intervention for spinal fractures;surgeries were first suggested by Paul of Aegina, in the 7thcentury, andAl-Zahrawi described and drew the necessary toolsin the10thcentury.

Hippocrates, known as the father of medicine, also tooka part on spine diseases history and wrote his own observationsand conclusions, which guided medical thought for severalcenturies and inspired many doctors. One of them was Galen.Theother onewasAvicenna (Figure1).

Figure 1. Source: http://www.greekmedicine.net/history/Unani_Medicine.html

Ibn-Sena (980 - 1037) (Avicenna, for the Eastern World),the most famous doctor in the western world wrote the famousCanon of Medicine, a magnificent four-volume book thatcontained all the knowledge of medicine by his time. His workmay have dictated medicine in the west, but was only brought tothe east by the 15th century.Avicenna was so famous that he wassoughtbyeagermedical studentswhowanted topractice the“realmedicine”, insteadof the“barber-surgery”practiced inEuropebythat time, as is so well represented by Noah Gordon in his famous“ThePhysicist”.

In the first volume of his Canon,Avicenna considered theanatomy of the spine; pathology was studied in both the third andfourth volumes. Following the Hippocratic line of thought, heconsidered that humors controlled the body and that diseasesdepended on their adequate flux. Therefore, kyphosis could beconsidered as either an external (traumatic) or internal disease. Ifinternal, it could be presented either as rigid, when muscles andtendons become rigid due to the flux, or degenerative, when fluxdegenerates supportive structures. He also considered an isolatedinflammationora tuberculumaspossiblecauses.Onecaninferbythat that Avicenna knew of osteoarthritis, ankylosing spondylitisandevenPott'sdisease.

He also comments on the impact of kyphosis on thedevelopment of a child and on breathing. “Bad Efese” (JuvenileHunch Back) is considered as a childhood malnutrition syndrome

caused by the lack of milk; even though no explanation is given inthis article, one can also infer thatAvicenna had already observedrickets by then. Avicenna thought that an “infection” couldproduce local masses and spread to surrounding or distant organsand induce a plegia; he also knew cancer, in spite of considering itacommoninfection.

The canon provides signs and diagnostic techniques,such as the use of ointments. Specific herbs and no surgeryshould be prescribed for the treatment of this disease; the herbsshould be firming, warming, anderadicating.

The canon also offers protocols and surgicalinterventions for slippage and dislocation of vertebrae. Thespinal cord could be ruptured or compressed, what leads toswelling.Avicenna relates the first cervical vertebra dislocationto breathing incapacity and death; anterior dislocation of thedorsal vertebrae are considered as incurable and the patient diessoon; however, posterior dislocation without severecompression cause lower extremity paralysis and placid typebowel-bladder dysfunction and can be reduced, what is not onlyhard, but canalsobreak someribs.

For that, special techniques were applied (Figures 2 and3), a wooden plank was fixed in the back for immobilization andbath vapor was used as a myorelaxant. For posterior cervicaldislocation, strengthening and loosening agents should also beused after the reduction.

Revista da Faculdade de Ciências Médicas de Sorocaba

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Rev. Fac. Ciênc. Méd. Sorocaba, v. 13, n. 4, p. 38 - 40, 2011

Aciduman A, Belen D, Simsek S. Management of spinaldisorders and trauma in Avicenna's Canon of Medicine.Neurosurgery. 2006; 59:397-403.

As for coccyx dislocation (contrary to Hippocrates,Avicenna considered the sacrum and the coccyx as a part of thespine), thevertebracouldbereducedbyintroducingafinger in thepatients rectum,pushing theboneandcontrolling thesacrumwiththe other hand.After that, the patient should receive laxatives andspecificdrugsshouldbeputoverhissacrum.

For vertebral fractures, a surgical extraction of allfragments should be performed; when this was not possible, anti-

edema therapy should be applied. His medicine was so advanced,that such a complex procedure took centuries to be performed inEurope.

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