Tuesday, June 26, 2012

980-1037: Avicenna: The Prince of Physicians

Avecinna (980-1037)
While the Western world slid into the dark ages between the 6th and 12th centuries, with most scientific and medical wisdom being lost, the opposite occurred in the Arabic world where Avecenna was born in Persia in  980 A.D.  He was a famous medieval philosopher and physician, and his book "The Canon" was one of the most well used medical texts for over five centuries.  
His official Arabic name was Abn Ali Al hosain Ibn Abdullah Ibn Sina, yet to the western world he's simply referred to as Avicenna. He was born in Afshena, one of the hamlets of the district of Bokhara in 980 A.D. His father was Abdullah, a local governor, and his mother was Sitareh.  (6)(8, page64)

His parents must have been pretty impressed by their young child, as explained by Fourgeaud said: (7, page 193-194)
His extraordinary memory, his extreme faculty for learning, soon attracted the attention of his father, who spared neither expense nor trouble for his education.  His power of memory were such, we are told by himself, that before he was ten years of age, he could repeat the whole of the Koran, and could converse familiarly on arithmetic, geometry and astronomy.  He repaired to Baghdad to study philosophy and medicine, and so entirely did he devote himself to these sciences, that he is said to have labored day and night, and to have warded off the approach of sleep and excited his exhausted faculties by the use of exhilarating beverages -- and when nature prevailed over all of his contrivances, problems that baffled his waking hours were solved in his dreams. (7, pages 193-194) (8, page 54)
According to his biography, he was so gifted as a student that his father assigned him a special instructor -- al Natali -- to teach him arithmetic, logic, science and astronomy.  In his early teens his interests shifted toward medicine, and when he was only 16 he became a physician. (6)

In fact, Fourgeaud said:
Before he was sixteen he not merely knew medical theory, but by gratuitous attendance on the sick had, according to his own account, discovered new methods of treatment.  By the end of his seventeenth year he had gone the round of learning of his time; his apprenticeship of study was concluded, and he went forth to find a market for his accomplishments." (8, page 64-65)
His quest did not take long, for he was only 16 when he became a "renowned physician."  Then, at the ripe age of 18, he earned fame and respect when the sultan of Bukhara, Nuh ibn Mansur al-Samai, became seriously ill and the person credited for healing him was Avecenna. As a reward for his services, Avecenna was granted access to the Sultan's library, which was loaded with all the wisdom of the ancient world. Avecenna loved to learn, so this was a great gift for him.   (6)(7, page 194)

He spent many hours studying by candlelight many volumes of books, most of which were those of Hippocrates and Galen, cramming his head with as much information as he could.  By the time he was 21 he had already started publishing volumes, sharing with others all he had learned.  In total he would write hundreds of volumes on a variety of topics, including ethics, logic, philosophy, science and medicine.  (6)

Bear with me now as I allow Fourgeaud and Bradford to tell the story of Avicenna, as I believe this is necessary in order to make a valid point.  When Avicenna was 22 his father died, and soon thereafter 'the reigning dynasty came to an end in the year 1004," said Thomas Bradford. He added:
Mahommed of Ghazni sought to attach the brilliant scholar to his retinue of learned followers, but he declined the honor, and made his way westward to the city of Urdjensh, in the modern district of Khiva, where the Vizier, who was a friend of scholars, gave him a small monthly stipend. But the pay was small, and Avicenna wandered from place to place through the districts of Nishapur and Mero to the borders of Khorasan, seeking an opportunity for his talents. Finally at Jorjan, near the Caspian, he met a friend who bought near his own house a dwelling in which Avicenna lectured on logic and astronomy. For this patron several treatises were written; and the commencement of his great Canon of Medicine dates from his stay in Hyrcania.(8, page 65)
He moved from place to place, writing all along, and "ultimately he," said Bradford:
Went southward to Hamadan, where the prince was established.  He first entered the services of a high born lady, but the Emir (sultan) learned of his arrival called him in as a medical attendant, and sent him back with presents in his dwelling.  He was now raised to the office of Vizier, but the turbulent soldiery mutined against their young sovereign, and demanded that his new vizier should be put to death.  Shems Addula consented that he should be banished from the country.  Avicenna remained hidden for forty days in a sheikh's house till a fresh attack of illness caused the Emir to again call for his physician.  Even during this troubled time he continued to study and teach. Every evening extracts from his great works, the Canon and the Senatio, were dictated and explained to his pupils; among whom, when the lesson was over, he spent the rest of the night in festive enjoyment with a band of singers and players.  (8, pages 65-66) 
He was likewise known as a good politician, yet despite the long-term popularity of his book "The Canon," he did not have much "'pull' with the authorities of his time." (2) 

This is evidenced through the words of Fourgeaud, who added that after he was appointed visier many vicissitudes beset his path. Fourgeaud wrote:
He was thrown into prison, where he remained two years, for being accessory to a conspiracy, or according to some historians, for refusing to administer poison to the nephew of a Sultan. For some time after his release he had to conceal himself, but being discovered he was once again incarcerated for four months, when he effected his escape under the disguise of a monk.  He then made his way to Ispahan, where he was treated with great distinction." ( 7, page 194)
Bradford continues telling the story:
On the death of the Emir, Avicenna ceased to be Vizier, and hid himself in the house of an apothecary, where, with intense assiduity, he continued the composition of his works. Meanwhile he had written to Abujaafar, the prefect of Ispahan, offering his services; but the new Emir of Hamadan, hearing of his correspondence, and discovering the place of his concealment, imprisoned him in a fortress. War continued between the rulers ofI spahan and Hamadan. In 1024 the former captured Hamadan and its towns, and expelled the Turks. Avicenna, after the war, returned with the Emir to Hamadan, and carried on his literary labors; but at length, accompanied by his brother, a favorite pupil, and two slaves, he made his escape fromt he city in the disguise of a Sufite ascetic. (8, page 66)
After a perilous journey they reached Ispahan, and received an honorable welcome from the prince. The remaining ten or twelve years of his life he spent in the service of his patron Abu Jaafar Ala Addaula, whom he had accompanied as physician and general literary and scientific adviser, even in his numerous campaigns. During these years he began to study literary matters and philosophy. But amidst all his study Avicenna never forgot his love of enjoyment. Unusual bodily vigor enabled him to combine severe devotion to work with indulgence in sensual pleasures. His passion for wine and women was almost as well known as his learning. (8, pages 66-67)
But his bouts of pleasure gradually weakened his constitution; a severe colic which seized him on the march of the army against Hamadan was checked by measures so violent that Avicenna could hardly stand. On a similar occasionthe 'disease returned; with difficulty he reached Hamadan, where, finding the disease gradually gaining ground, he refused to keep up the regimen imposed, and resigned himself to his fate. On his death-bed remorse seized him; he bestowed his goods on the poor, restored unjust gains, freed his slaves, and every third day till his death listened to the reading of the Koran. He died in June, 1037, in his 58th year, and was buried among the palm trees by the Kiblah of Hamadan. (8 page 67)
I transcribed for you here a synopsis of the life and times of Avicenna to show how difficult it was for a man of his stature during his time.  In order for him study medicine, practice medicine, and write about medicine he had to constantly gain the favor of the sultan. If he wasn't willing to make such a sacrifice, the wisdom of the ancient medical sages would probably be lost forever.

While he did come up with some ideas on his own, his writings mainly save for us the ideas of Hippocrates and Galen, but also the surgical wisdom of Paul of Aegineta, who was perhaps one of the greatest surgeons of the ancient world. Of course he also preserves for us many of the ideas of other ancient medical sages as well, such as Areteaus. (7, page 194) (8, page 68)

Instead, the Canon was translated into Latin in 1492 and would become the medical encyclopedia, or medical Bible, for Europe during the 15th, 16th and 17th centuries. (6, 1)  During these times, the Canon was used at the various universities throughout Europe to teach the wisdom of the medical sages, and it even eclipsed the writings of the other Arabic physicians of his era, including Rhazes, Haly Abbas, and Avenzoar.  (8, page 67) (7, page 194)

Mark Jackson, in his 1987 book "Asthma: The Biography," said the Canon was about
"According to Ibn Sina, asthma was a chronic disease in which patients often suffered 'acute paraxysms with similarity to the paroxysms of epilepsy and spasm.  The flow of thick humours from the head to the lungs produced a situation in which 'the patient finds no escape from rapid panting, like the labored panting of one who is being choked or rushed'.  (3, pages 30-31)
Jackson listed Avicenna's recommended treatment for asthma: (3, pages 30-31):
  1. Purging
  2. Vomiting
  3. Blood letting
  4. Voice exercises
  5. Fats of hares
  6. Deer
  7. Gazelles
  8. Penises of foxes
  9. Lungs of foxes (3)
  10. Arsenic in a pill with pine resin in a drink with honey water or inhalation (5, page 325)
  11. Sulphur in water with soft boiled eggs or inhalation
In 1933 E. Stolkind described Avicenna as not providing much new information as was provided by Galen.  However, Avicenna, along with other physicians of his day, mentioned the relationship between asthma and nerves of the brain.   (4, pages 1121-2) Along with the brain, he also linked asthma with the liver and the stomach.  It's for this reason that he recommended arsenic as a remedy.  (5, page 408)

Some credit his demise to his excessive desire for wine.  (2, page 349)  He died of dysentery at the age of 58 in 1037.

Regarding "The Canon," Fourgeaud said thatJ:
The physicians of the middle ages accepted its teachings with the same faith with which they were accustomed to submit to the laws of the church... medical men were taught that Avicenna was "the Prince of Physicians" -- that he was infallible, that his works contained all the knowledge of the ancients and of the Arabians -- and they believed it; and were satisfied in following his precepts. (7, page 195)
His words were revered in much the same way as those of Galen were.  John Brock said that the Canon, "once translated into Latin, even overshadowed the authority Galen himself for some four centuries." (9, page xx)
  
References:
  1. Drake, Miriam, "Encycopedia of Library and Information Science," 2nd ed., 2003, New york, page 1840
  2. Michael, J. Edwin, ed., Medical and Chirurgical Faculty of the State of Maryland, "Maryland Medical Journal," May 1891-Oct. 1891, Baltimore, vol. XXV, page 349
  3. Jackson, Mark, "On Asthma: The Biography," 2009, New York, pages 30-31
  4. Stolkind, E, "The History of Bronchial Asthma and Allergy," Proceedings of the Royal society of Medicine, "1933, Vol 26, part 2, Great Britain, pages 1121-2
  5. Aegineta, Paulus, translated by Adams, Francis, "The Medical Works of Paulus Aegineta, The Greek Physician, 1834, vo 1, page 408
  6. "Avecenna: Prince of Physicians and Giant in Pharmacology," http://www.afghan-network.net/Culture/avicenna.html
  7. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203
  8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
  9. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
Further reading:
  1. Check the above and this for aegeneta postssss

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