Ibn Sina: Transforming Medicine in the Arabic World

Introduction to Ibn Sina and His Canon of Medicine

Medical practice and study within the medieval Persian and Arabic world, particularly the written works and treatises of the great Persian thinker and practitioner Ibn Sina, still hold value in the world of modern medicine. While his most influential work Canon of Medicine is often praised as a historical text, it is important to also recognise the lasting impact of his methodologies and approaches toward medicine. I plan to discuss how Ibn Sina’s medical contributions provide modern medicine with invaluable insights and early recognition of ophthalmology and the workings of the heart. Ophthalmology is the study of disease, anatomy and physiology of the eye. Ibn Sina’s approach to ophthalmology and cardiology is important because he connects medical practice with surgery, as well as outlining early medical conditions and maladies. I will explore his physiological understanding of wine, focussing on its remedial qualities and relationship to medicine. Through this discussion, we can hopefully have some appreciation of the medieval Arabic world and their subsequent contributions toward early medicine.

Ibn Sina’s Early Life and Education

Ibn Sina (known as Avicenna in the Western world) was born in 980 AD in Afshaneh, which is old Persia. He was a promising young man, reading the Quran and important Persian works by the age of ten, and becoming a physician by the age of eighteen. After he medically treated the prince, he was rewarded with access to the royal library. Through this and other established networks and government connections, he became Prime Minister. Later in his career, he was imprisoned as well. While in prison, he engaged in writings on medicine and philosophy. Ibn Sina described neural functions with anatomy, joining physiology with early psychology. Ibn Sina also contributed towards palaeontology and the natural sciences, proposing the theory of petrifying fluids to explain fossils, which was influenced by Aristotle. It is important to note at this stage that Greek medicine reached the Arabic world before philosophy. Ibn Sina translated a wealth of Greek material, particularly the writings of Galen. He was familiar with the theories and works of Aristotle and Hippocrates, who had written about medicine. Islamic philosophers were exposed to a wide range of Indian and Persian medical works, as well as Greek sources. Ibn Sina wrote a treatise On Smallpox and Measles, which was not covered in the Greek texts, but these were two diseases that wrought havoc upon the Arabic world. He also wrote a treatise about why some people prefer quacks to skilled doctors, which would become a major medical issue in the late medieval and early Modern period.

The Canon of Medicine: A Revolutionary Text

The Canon emerges from this period as his most influential medical work. He describes medicine as the art whereby health is conserved and the art whereby it is restored, after being lost. In this book, he discusses sexually transmitted diseases, prevention, and treatment, and he also mentions quarantine and the value of its use. Gerard of Cremona translated The Canon in the twelfth century, introducing it to the Western world. The Canon has a lasting legacy in the later historical period, serving as the standard medical textbook, and it was used in Europe up until the sixteenth century. Furthermore, Ibn Sina’s medical teachings became the basis for the curriculum in the classrooms of Vienna and Frankfurt.

Contributions to Ophthalmology

While many researchers have focussed on sections of The Canon, his ophthalmological contributions have often been overlooked. In this text, he explains the causes of diseases, their symptoms, and treatment. His ophthalmological influences are largely influenced by Galen’s findings. He identifies nozul al maa as an obstruction where moisture accumulates and prevents images from entering the eye. This is suggestive of orbitopathy, a modern diagnosis where the obstruction causes swelling and redness around the orbital area. Ibn Sina also discusses cataracts, categorising them according to their density, size, and colour, and identifying two different types, complete and partial cataracts. His observations, which determine the necessary fluidity of the lens, are important for contact lens replacement. Contact lenses must be changed at regular intervals because the eye requires moisture and lubrication. These classifications helped him to advise methods of treatment. The symptoms of cataracts that he describes include seeing floating objects, blurred vision, monocular vision, and double vision. Many of these symptoms remain the same within modern cataract diagnoses. Ibn Sina recommends many herbal ointments for remedial care. To reduce cataract opacity, he advises varying levels of food intake, as well as consumption of fennel juice mixed with honey and wild marjoram. He attributes cataract formation to an imbalance of the four humours. While humourism is discredited in modern medicine, cataracts can be attributed to other health problems, such as smoking and air pollution. His recognition of build-up in the lens contributes to modern laser eye surgery, where the protein accumulation is assessed before proceeding with the operation. The methodology here is important because he considers the relationship between anatomy and function. He also demands practical study and observation of the body and its parts rather than assumption. Ibn Sina also considered the patient’s mental and psychological state during surgery and treatment. Ibn Sina ensured that the patient was comfortable and sound for surgery and medical procedures.

It is also important to consider how he viewed eyesight. While he retained much of Galen’s notions about the eye, he favours Aristotelian thought of the intromission (light affects the eye) theory as opposed to Galen’s extramission (eye affects the light) theory. Ibn Sina agrees that the crystalline lens is the principal instrument of vision and that sight is one of the five senses. He also agreed with Galen on the distribution of light through hollow optic nerves. However, Ibn Sina was against Plato and Galen’s extramission theory, and as part of his adherence to Aristotelian thought, Ibn Sina reasoned that light affected the eye. His understanding benefits the contemporary use of contact lenses, which are put in place to improve vision by concentrating light and reducing refractive error. In The Canon, he describes the different parts of the eye, including the iris, cornea, lens, optic nerve, optic chiasma, choroid, retina, and other parts which are still recognised in medicine today. Ibn Sina further improves Galen’s view of the eye, detailing its specific features.

Ibn Sina had contemporaries who also contributed to the literature of the eye. Huyayn ibn Ishaq wrote Ten Treatises of the Eye, which is a ninth-century account of vision and largely derives from Galen’s understanding of the eye. His interpretation follows a hierarchal and orderly structure, specifically the lens as fundamental for sight. He proceeds to describe the other parts in relation to facilitating the eye’s function. Alhazen blended Euclidean, Aristotelian, and Galen’s theories of optics and sight to explain vision, culminating with his Book of Optics. He describes parts of the eye and light refraction, following Ptolemy and Euclid’s ideas about vision. Al-Nafis would later offer his contributions to ophthalmology in the thirteenth century.

Contributions to Cardiology

Ibn Sina also describes the heart and its properties. Although his physiology of the heart is predominantly Galenic in theory, he does integrate Aristotle into his explanation of the system. Ibn Sina identifies the heart, liver, and brain as the three principal organs in the human body, and he also mentions the reproductive glands. He tells us that the heart warms the diaphragm and the body. Al-Nafis would later write about pulmonary circulation in the body. He recognises the heart’s central function to the body, this nexus of life, providing function to the liver and brain. Ibn Sina recommends paying close attention to the heart, where its role and purpose were often overlooked. He anatomises the heart, linking the major arteries to the heart and their role in facilitating the heart. Ibn Sina’s focus on arterial direction benefits modern physicians, enabling them to place heart stents to relieve blocked arteries. He observes how the aorta has three valves which open during contraction and close during relaxation of the heart. This effect disallows blood from flowing back into the heart. Ibn Sina discusses how different drugs affect the heart and their effects. He outlines their advantages and disadvantages, writing that the heart has the responsibility and function of regulating and maintaining warmth and breath. The heart also enables the soul to convey its different faculties, providing a theory that establishes that the senses can properly function through the heart. Ibn Sina attributes the temperament and morality of the individual to the heart, and if one stays too long in a bath, it can affect the heart, claiming that the bilious humour will cause an imbalance within the system. The heart is also identified with pulse and respiration. With regards to remedial care, Ibn Sina suggests treatments for tachycardia (from the Greek word tachys meaning quick, fast, and kardia, which means heart), which is the medical term for when the heart beats too fast. He associates the occurrence of tachycardia with irregularities of pulse and other conditions. More importantly, he deduces that fatty degeneration and accumulation affect the heart. He recognises that tobacco intake is detrimental to the heart, relating it to maladies and health problems. He mentions tremors of the heart leading to sudden death. Analysing tremors of the heart is particularly difficult because they could indicate a wide range of issues, ranging from heart palpitations to tachycardia to heart disease. He links intensive pain to tremors of the heart, which indicates potentially more harmful symptoms. As with his ophthalmological care, Ibn Sina offers remedial advice for heart care. He recommends using cloths to remediate diseased conditions of the heart. Furthermore, he cites the use of stupefacients (drugs that induce stupor) such as opium and mandrake seed for pain relief and better heart condition. Similarly, in modern times drugs are used to relieve pain during surgery. Furthermore, Ibn Sina’s observance of regulated heartbeats anticipates the application of adenocine and cardioversion, which aim to stabilise the heart.

The Role of Wine in Ibn Sina’s Medicine

As well, he determines the values and remedial qualities of wine. His insights propose new herbal remedies and methodologies towards health care and treatment. At the time of his writing, the Islamic view towards alcohol was less orthodox. The Quran passages about alcohol were less defined. Centuries later, the Quran forbade alcohol consumption, and Ibn Sina’s wine embrace has given him some detractors, which is unfortunate. He also physiologically assesses its benefits, advantages, disadvantages, and treatment for overconsumption. Ibn Sina knows about the antiseptic qualities of alcohol, using wine to wash and clean wounds. He praises good wine, claiming that excellent wine causes strong emotions and good breath. He considers wine rich because its nutrients are distributed to the body. He believed that wine heats the body, and excess wine affects the pulse. He gives us his essential healthy meal, which includes fragrant wine, sweets, wheat, and goat or lamb meat. Ibn Sina informs us about inebriation and hangover remedies. He advises drinking in moderation, ideally three glassfuls in a meal, and it should be consumed during the meal, not after, so that the digestion process is not affected. Excess wine can be injurious, and he rationalises that it swims in the stomach. We see wine used during surgery and for remedial purposes, to nourish and comfort. He praises older wine as medicinal, whereas he sees newer wine as dysenteric. Ibn Sina believes that the best wine is clear, white, tending to a red tinge of good bouquet, and neither tart nor sweet. He relates wine to intellect, stating that wine does not readily inebriate a person of vigorous brain. If wine goes too quickly to the head, he suggests dilution, and the other alternative he gives involves taking lozenges and myrtle seeds. Ibn Sina looks at the disadvantages of wine excess as well, noting the breakdown of the liver and brain. His hangover remedy includes emesis (procured vomiting), followed by water, a bath, and rubbing the body with oil. This also indicates his interest in hygiene and its medicinal value. His remedy for inebriation includes white cabbage, pomegranate, and vinegar. Ibn Sina establishes this methodology in his medical explanations. He describes wine and its properties, outlines its uses, advantages, and disadvantages, and then proceeds to propose remedial action for excess and misuse. The order and formulaic structure of The Canon is important towards its use and understanding.

The Legacy of Ibn Sina’s Medical Work

The Canon of Medicine offers us an incredible lens into the past where we can interact not only with the fascinating medical history of the medieval Persian and Arabic world but also with his methodology and insight, which still holds meaning in our current age. Ibn Sinas’s structured and systematic approach to ophthalmology and cardiology exemplifies how we can find meaning and interact with these texts. It is important that we continue to understand these sources and consider how they are associated with our own lives. His medical work opens gateways for cooperation and further learning. Ibn Sina’s desire here is not to preach or convert, but rather to inform and educate, and as members of the academic world, I think we can all appreciate this idea. Revisiting The Canon of Medicine gives us the opportunity for discovery and a relationship with the past and our health care and well-being. Vision and hearts are so central to our lives and literally how we see the world, and perhaps reviewing these treasures of the past can promise a fruitful and healthy future.