The origins of human experimentation may be traced from the Book of Daniel to ancient Rome. Nearly 1,000 years elapsed before further significant advances occurred. It is significant that subsequent improvements in medical experimentation arose following the decline of the Greek and Roman civilizations, when Islamic Arab culture reached its period of maturity. By the 11th century, the Islamic empire extended from Western Europe to the far borders of China.
Avicenna and Medicine
Medical experimentation likely would not have progressed without the contributions of a Persian physician and philosopher named 'Abu 'Ali al-Husin ibn 'Abdullah ibn Sina (c. 980 AD–1037 AD), who is more familiarly known by his European name of Aven Sina, or Avicenna. By all accounts, Avicenna was a prodigy who could master academic subjects such as medicine with incredible ease: “Medicine is not one of the difficult sciences, so naturally I became proficient in it in the shortest time, until the excellent scholars of medicine began to study under me.”
Avicenna began to treat patients and evaluated different treatment methods, including those that were successful as well as those that failed. According to Professor Kaf al-Ghazal (2007), Avicenna was the first physician to discover that some diseases could be spread through water or soil, which allowed later Renaissance physicians to research possible cures.
The Book of the Canon of Medicine
In 1012, Avicenna began work on a compendium of medical knowledge, Kitab al Qanoun fi Al Toubb, or The Book of the Canon of Medicine. Not completed until approximately 1030, the book contained five volumes:
- Book I focused on general medical principles, such as physiology and hygiene.
- Book II concentrated on simple drugs and their effects.
- Books III and IV examined the pathology of diseases, including the study of rashes, tumors, and fevers.
- Book V explored more complex drugs that could be combined from simple ingredients and used as remedies for various maladies.
The Canon was freely based on previous works by Hippocrates (c. 460 BC–370 BC), Aristotle (384 BC–322 BC), and Galen (129 AD–199 AD). Nevertheless, the Canon also was notable for including Avicenna’s own clinical observations as a physician.
Avicenna’s Contribution to Pharmacopoeia
Avicenna’s lasting mark on medicine was his contribution to pharmacopoeia, which is the study of how drugs are made from natural and synthetic sources. Islamic physicians were first to separate medicine from pharmacology — thereby allowing doctors to focus on diagnosing diseases, while leaving the extraction and preparation of remedies to other skilled practitioners.
Arab pharmacists were renowned for their skills in formulation, using syrups and flavored water to disguise the taste of bitter remedies. They also introduced drugs such as camphor, aconite, mercury, and sandalwood into medical practice, while aware of simple anesthetics such as hemp. Avicenna included approximately 760 medicinal plants in his Canon and explained how drugs could be made from them. For example, wood from the deciduous tree acacia catechu could be boiled in water, evaporated, and the residue used as a treatment for sore throats or gastric complaints. Even today, Saad et al (2005) estimate that 25% of all prescription medicines continue to be derived from plants.
Avicenna’s Contribution to Clinical Medicine
Avicenna is also remembered for his role in establishing guidelines for clinical medicine. In his systematic approach to pharmacology, Avicenna devised basic principles in drug administration that form the basis for clinical trials today. Among those principles are four fundamental axioms:
- As it is difficult to correlate the effects of drug use on animals with that in humans, drug testing requires human experimentation.
- Any drug used in treatment must be pure and free from contamination.
- A drug's time of action must be observed so as not to confuse effect with accident.
- In order for any drug to be considered useful, its effect must be consistent in many patients.
The Canon was translated into Latin in 1175 and went through 16 editions in the 15th century and 20 editions in the 16th century. It was used extensively by physicians and medical students throughout Europe, where it continued to be influential until the 18th century. Avicenna's contribution to clinical medicine laid the foundation for further advances in human experimentation in the Middle Ages and beyond.
References
al-Rahman al Naqib A. 1993. Avicenna (370?–428 AH — 980?–1037 AD). Prospects: The Quarterly Review of Comparative Education. XXIII(1/2):53–69.
Kaf al-Ghazal S. 2007. The influence of Islamic philosophy and ethics on the development of medicine in the Islamic civilisation. Foundation for Science Technology and Civilisation. Manchester: FSTC Limited.
Saad B, Azaizeh H, Said O. 2005. Tradition and perspectives of Arab herbal medicine: a review. Evidence-Based Complementary and Alternative Medicine. 2(4):475–479.
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