The Canon of Medicine

The Canon of Medicine (original title in Arabic: القانون في الطب "Al-Qanun fi al-Tibb") is a 14-volume medical encyclopedia by the Persian Muslim scientist and physician Ibn Sīnā (Avicenna) in the 1020s. Written in Arabic, the book was based on a combination of his own personal experience, medieval Islamic medicine, the writings of the Greek physician Galen,^[1] the Indian physicians Sushruta and Charaka, and ancient Arabian and Persian medicine.^[2] The Canon is considered one of the most famous books in the history of medicine.

Also known as the Qanun, which means "law" in Arabic and Persian, the Canon of Medicine remained a medical authority up until the 18th century^[3] and early 19th century.^[4] It set the standards for medicine in Europe and the Islamic world, and is Avicenna's most well-renowned written work. Qanun was used at many medical schools—at University of Montpellier, France, as late as 1650.^[5] The principles of medicine described by him ten centuries ago in this book, are still taught at UCLA and Yale University, among others, as part of the history of medicine. Among other things, the book is known for the introduction of systematic experimentation and quantification into the study of physiology,^[6] the discovery of the contagious nature of infectious diseases,^[7] the introduction of quarantine to limit the spread of contagious diseases, the introduction of experimental medicine, evidence-based medicine, clinical trials,^[8] randomized controlled trials,^[9][10] efficacy tests,^[11][12] clinical pharmacology,^[13] risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases.^[14]

George Sarton, the father of the history of science, wrote in the Introduction to the History of Science:

"One of the most famous exponents of Muslim universalism and an eminent figure in Islamic learning was Ibn Sina, known in the West as Avicenna (981-1037). For a thousand years he has retained his original renown as one of the greatest thinkers and medical scholars in history. His most important medical works are the Qanun (Canon) and a treatise on Cardiac drugs. The 'Qanun fi-l-Tibb' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments."^[7]

Additional recommended knowledge

Weighing the right way

How to quickly check pipettes?

Safe Weighing Range Ensures Accurate Results

Overview

The book explains the causes of health and disease. Ibn Sina believed that the human body cannot be restored to health unless the causes of both health and disease are determined. Ibn Sina stated that medicine (tibb) is the science by which we learn the various states of the human body when in health and when not in health, and the means by which health is likely to be lost, and when lost, is likely to be restored. In other words, medicine is the science whereby health is conserved and the art whereby it is restored after being lost.

Avicenna regarded the causes of good health and diseases to be:

1. The Material Causes
2. The Elements
3. The Humors
4. The Variability of the Humors
5. The Temperaments
6. The Psychic Faculties
7. The Vital Force
8. The Organs
9. The Efficient Causes
10. The Formal Causes
11. The Vital Faculties
12. The Final Causes

(There are many other sources that explain his concepts in depth and are accessible through the world-wide web in medical and Islamic sites.)

The Qanun distinguishes mediastinitis from pleurisy and recognises the contagious nature of phthisis (tuberculosis of the lung) and the spread of disease by water and soil. It gives a scientific diagnosis of ankylostomiasis and attributes the condition to an intestinal worm. The Qanun points out the importance of dietetics, the influence of climate and environment on health, and the surgical use of oral anaesthetics.^[15] Ibn Sina advised surgeons to treat cancer in its earliest stages, ensuring the removal of all the diseased tissue.^[16] The Qanun 's materia medica considers some 760 drugs, with comments on their application and effectiveness. He recommended the testing of a new drug on animals and humans prior to general use.

The earliest known copy of the Canon of Medicine dated 1052 is held in the collection of the Aga Khan and is to be housed in the Aga Khan Museum planned for Toronto, Ontario, Canada.

Influence in Europe

The Arabic text of the Qanun was translated into Latin as Canon medicinae by Gerard of Cremona in the 12th century and into Hebrew in 1279. Henceforth the Canon served as the chief guide to medical science in the West and is said to have influenced Leonardo da Vinci. Its encyclopaedic content, its systematic arrangement and philosophical plan soon worked its way into a position of pre-eminence in the medical literature of Europe, displacing the works of Galen and becoming the text book for medical education in the schools of Europe. The text was read in the medical schools at Montpellier and Leuven as late as 1650, and Arnold C. Klebs described it as "one of the most significant intellectual phenomena of all times." In the words of Dr. William Osler, the Qanun has remained "a medical bible for a longer time than any other work". The first three books of the Latin Canon were printed in 1472, and a complete edition appeared in 1473. The 1491 Hebrew edition is the first appearance of a medical treatise in Hebrew and the only one produced during the 15th century. In the last 30 years of the 15th century it passed through 15 Latin editions.

In recent years, a partial translation into English was made.

Experimental medicine

The Canon of Medicine was the first book dealing with experimental medicine, evidence-based medicine, randomized controlled trials,^[9][10] efficacy tests,^[11][12] risk factor analysis, and the idea of a syndrome in the diagnosis of specific diseases.^[14]

Clinical pharmacology

The Canon laid out the following rules and principles for testing the effectiveness of new drugs and medications, which still form the basis of clinical pharmacology^[13] and modern clinical trials:^[8]

1. "The drug must be free from any extraneous accidental quality."
2. "It must be used on a simple, not a composite, disease."
3. "The drug must be tested with two contrary types of diseases, because sometimes a drug cures one disease by Its essential qualities and another by its accidental ones."
4. "The quality of the drug must correspond to the strength of the disease. For example, there are some drugs whose heat is less than the coldness of certain diseases, so that they would have no effect on them."
5. "The time of action must be observed, so that essence and accident are not confused."
6. "The effect of the drug must be seen to occur constantly or in many cases, for if this did not happen, it was an accidental effect."
7. "The experimentation must be done with the human body, for testing a drug on a lion or a horse might not prove anything about its effect on man."

Inductive logic

While Ibn Sina often relied on deductive reasoning in The Book of Healing and other writings on logic in Islamic philosophy, he used a different approach in The Canon of Medicine. Ibn Sina contributed inventively to the development of inductive logic, which he used to pioneer the idea of a syndrome in the diagnosis of specific diseases. In The Canon of Medicine, Avicenna was the first to describe the methods of agreement, difference and concomitant variation which are critical to inductive logic and the scientific method.^[14][17]

Pharmaceutical sciences

Avicenna's contribution to the pharmaceutical sciences include the introduction of systematic experimentation and quantification into pharmacology and the study of physiology,^[18] the introduction of experimental medicine, evidence-based medicine, clinical trials,^[8] randomized controlled trials,^[9][10] efficacy tests,^[11][12] and clinical pharmacology,^[13] and the first careful descriptions of skin troubles, sexually transmitted diseases, perversions, and nervous ailments,^[19] as well the use of ice to treat fevers, and the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences.^[20]

Pharmacy

Ibn Sina described no less than 700 preparations of medications, their properties, mode of action and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine.

Etiology and Pathology

In etiology and pathology, Avicenna discovered the contagious nature of infectious diseases such as phthisis and tuberculosis, the distribution of disease by water and soil, and the existence of sexually transmitted disease.^[19] He fully understood the pathology of contagious disease.^[21]

Avicenna also distinguished between mediastinitis and pleurisy, provided careful descriptions of skin troubles, perversions, and nervous ailments."^[7] Meningitis was also first described in The Canon of Medicine. He also described the first known surgical treatment for cancer.^[16]

Since the Canon, Bimaristan hospitals were created with separate wards for specific illnesses, so that people with contagious diseases could be kept away from other patients who do not have any contagious diseases.^[22]

Bacteriology and Microbiology

The Canon stated that bodily secretions are contaminated by "foul foreign earthly bodies" before a person becomes infected, but he did not view these bodies as primary causes of disease.^[23]

Quarantine

The Canon introduced quarantine as a means of limiting the spread of contagious diseases.^[8]

Neuroscience and Psychology

Ibn Sina noted the close relationship between emotions and the physical condition and felt that music had a definite physical and psychological effect on patients. Of the many psychological disorders that he described in the Qanun, one is of unusual interest: love sickness. Ibn Sina is reputed to have diagnosed this condition in a Prince in Jurjan who lay sick and whose malady had baffled local doctors. Ibn Sina noted a fluttering in the Prince's pulse when the address and name of his beloved were mentioned. The great doctor had a simple remedy: unite the sufferer with the beloved.

Neuropsychiatry

Ibn Sina was a pioneer of neuropsychiatry. He first described numerous neuropsychiatric conditions, including hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.^[24]

Psychophysiology and psychosomatic medicine

Ibn Sina was also a pioneer in psychophysiology and psychosomatic medicine. He recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as an anticipation of the word association test attributed to Carl Jung. Avicenna identified love sickness when he was treating a very ill patient by "feeling the patient's pulse and reciting aloud to him the names of provinces, districts, towns, streets, and people." He noticed how the patient's pulse increased when certain names were mentioned, from which Avicenna deduced that the patient was in love with a girl whose home Avicenna was "able to locate by the digital examination." Avicenna advised the patient to marry the girl he is in love with, and the patient soon recovered from his illness after his marriage.^[25]

Physiology

The contributions of Avicenna's Canon to physiology include the introduction of systematic experimentation and quantification into the study of physiology.^[18]

Anatomy

Writings on anatomy in the Canon are scattered throughout the text in sections regarding to illnesses related to certain body parts. The Canon included numerous discussions on anatomy and diagrams on certain body parts, including the first diagrams of the cranial sutures.^[26]

Surgery

In surgery, Avicenna was the first to describe the surgical procedure of intubation in order to to facilitate breathing.^[16]

Anesthesia

The Canon described the "soporific sponge", an anasthetic imbued with aromatics and narcotics, which was to be placed under a patient's nose during surgical operations.^[16]

Cancer

Avicenna described the first known surgical treatment for cancer. He stated that the excision should be radical and that all diseased tissue should be removed, which included the use of amputation or the removal of veins running in the direction of the tumor. He also recommended the use of cauterization for the area being treated if necessary.^[16]

Hirudotherapy

Hirudotherapy, the use of medicinal leech for medical purposes, was introduced by Avicenna in The Canon of Medicine. He considered the application of leech to be more useful than cupping in "letting off the blood from deeper parts of the body." He also introduced the use of leech as treatment for skin disease. Leech therapy became a popular method in medieval Europe due to the influence of his Canon.^[27]

See also

• Avicenna
  • The Book of Healing
• Ibn al-Nafis
  • Commentary on Anatomy in Avicenna's Canon
• Abu al-Qasim al-Zahrawi
  • Al-Tasrif
• Medical literature

References