Ibn Sina (Avicenna) And His Medical Science Legacy
Edited by Tachsin Fernandi

Avicenna, pronounced av ih SEHN uh (980-1037), also known as Ibn-Sina, pronounced IHB uhn SEE nah, was an Arab physician, philosopher, astronomer, and poet. He wrote Canon of Medicine, which was used as a medical text for over 600 years. It is still occasionally used in Asia. Avicenna's major philosophical work, The Cure, presented his interpretation of the philosophy of Aristotle. Of any of his books, it had the greatest effect on Western thought. Avicenna was born near Bokhara in what was then part of the Persian Empire (now Bukhara in Uzbekistan). He began to practice medicine at 16. When only 20, he was known as the most learned person of his time.

Avicenna, an Arab physician of the late 900's and early 1000's, produced a vast medical encyclopedia called Canon of Medicine. It summed up the medical knowledge of the time and accurately described meningitis, tetanus, and many other diseases. The work became popular in Europe, where it influenced medical education for more than 600 years.

A series of epidemics swept across Europe during the Middle Ages. Outbreaks of leprosy began in the 500's and reached their peak in the 1200's. In the mid-1300's, a terrible outbreak of plague, now known as the Black Death, killed about a fourth of Europe's people. Throughout the medieval period, smallpox and other diseases attacked hundreds of thousands of people.

The chief medical advances in Europe during the Middle Ages were the founding of many hospitals and the first university medical schools. Christian religious groups established hundreds of charitable hospitals for victims of leprosy. In the 900's, a medical school was started in Salerno, Italy. It became the chief center of medical learning in Europe during the 1000's and 1100's. Other important medical schools developed in Europe after 1000. During the 1100's and 1200's, many of these schools became part of newly developing universities, such as the University of Bologna in Italy and the University of Paris in France.

The Renaissance

A new scientific spirit developed during the Renaissance, the great cultural movement that swept across Western Europe from about 1300 to the 1600's. Before this time, most societies had strictly limited the practice of dissecting (cutting up) human corpses for scientific study. But laws against dissection were relaxed during the Renaissance. As a result, the first truly scientific studies of the human body began.

During the late 1400's and early 1500's, the Italian artist Leonardo da Vinci performed many dissections to learn more about human anatomy. He recorded his findings in a series of more than 750 drawings. Andreas Vesalius, a physician and professor of medicine at the University of Padua in Italy, also performed numerous dissections. Vesalius used his findings to write the first scientific textbook on human anatomy, a work called On the Structure of the Human Body (1543). This book gradually replaced the texts of Galen and Avicenna.

Other physicians also made outstanding contributions to medical science in the 1500's. A French army doctor named Ambroise Pare improved surgical techniques to such an extent that he is considered the father of modern surgery. For example, he opposed the common practice of cauterizing (burning) wounds with boiling oil to prevent infection. Instead, he developed the much more effective method of applying a mild ointment and then allowing the wound to heal naturally. Philippus Paracelsus, a Swiss physician, stressed the importance of chemistry in the preparation of drugs. He pointed out that in many drugs consisting of several ingredients, one ingredient made another useless.

Modern times

The beginnings of modern research. The English physician William Harvey performed many experiments in the early 1600's to learn how blood circulates through the body. Before Harvey, scientists had studied only parts of the process and invented theories to fill in the gaps. Harvey studied the entire problem. He performed dissections on both human beings and animals and made careful studies of the human pulsebeat and heartbeat. Harvey concluded that the heart pumps blood through the arteries to all parts of the body and that the blood returns to the heart through the veins.

Harvey described his findings in An Anatomical Study of the Motion of the Heart and of the Blood in Animals (1628). His discovery of how blood circulates marked a turning point in medical history. After Harvey, scientists realized that knowledge of how the body works depends on knowledge of the body's structure.

In the mid-1600's, a Dutch amateur scientist named Anton van Leeuwenhoek began using a microscope to study organisms invisible to the naked eye. Today, such organisms are called microorganisms, microbes, or germs. In the mid-1670's, Leeuwenhoek discovered certain microbes that later became known as bacteria. Leeuwenhoek did not understand the role of microbes in nature. But his research paved the way for the eventual discovery that certain microbes cause disease.

The development of immunology. Smallpox was one of the most feared and highly contagious diseases of the 1700's. It killed many people every year and scarred others for life. Doctors had known for hundreds of years that a person who recovered from smallpox developed lifelong immunity (resistance) to it. To provide this immunity, doctors sometimes inoculated people with matter from a smallpox sore, hoping they would develop only a mild case of the disease. But such inoculations were dangerous. Some people developed a severe case of smallpox instead of a mild one. Other inoculated persons spread the disease.

In 1796, an English physician named Edward Jenner discovered a safe method of making people immune to smallpox. He inoculated a young boy with matter from a cowpox sore. The boy developed cowpox, a relatively harmless disease related to smallpox. But when Jenner later injected the boy with matter from a smallpox sore, the boy did not come down with the disease. His bout with cowpox had helped his body build up an immunity to smallpox. Jenner's classic experiment was the first officially recorded vaccination. The success of the experiment initiated the science of immunology--the prevention of disease by building up resistance to it.

Discovery of the first anesthetic. For thousands of years, physicians tried to dull pain during surgery by administering alcoholic drinks, opium, and various other drugs. But no drug had proved really effective in reducing the pain and shock of operations. Then in the 1840's, two Americans--Crawford Long and William T. G. Morton--discovered that ether gas could safely be used to put patients to sleep during surgery. Long, a physician, and Morton, a dentist, made the discovery independently. With an effective anesthetic, doctors could perform operations never possible before.

The scientific study of disease, called pathology, developed during the 1800's. Rudolf Virchow, a German physician and scientist, led the development. Virchow believed that the only way to understand the nature of disease was by close examination of the affected body cells. He did important research in such diseases as leukemia and tuberculosis. The development of much improved microscopes in the early 1800's made his studies possible.

Scientists of the 1800's made dramatic progress in learning the causes of infectious disease. As early as the 1500's, scholars had suggested that tiny, invisible "seeds" caused some diseases. The bacteria discovered by Leeuwenhoek in the 1600's fitted this description. In the late 1800's, the research of Louis Pasteur and Robert Koch firmly established the microbial, or germ, theory of disease.

Pasteur, a brilliant French chemist, proved that microbes are living organisms and that certain kinds of microbes cause disease. He also proved that killing specific microbes stops the spread of specific diseases. Koch, a German physician, invented a method for determining which bacteria cause particular diseases. This method enabled him to identify the germ that causes anthrax, a severe disease of people and animals. The anthrax germ thus became the first germ definitely linked to a particular disease. Other research scientists followed the lead of these two pioneers. By the end of the 1800's, researchers had discovered the kinds of bacteria and other microbes responsible for such infectious diseases as plague, cholera, diphtheria, dysentery, gonorrhea, leprosy, malaria, pneumonia, tetanus, and tuberculosis.

Introduction of antiseptic surgery. Hospitals paid little attention to cleanliness before the mid-1800's. Operating rooms were often dirty, and surgeons operated in street clothes. Up to half of all surgical patients died of infections. In 1847, a Hungarian doctor, Ignaz Semmelweis, stressed the need for cleanliness in childbirth. But Semmelweis knew little about the germ theory of disease.

Pasteur's early work on bacteria convinced an English surgeon named Joseph Lister that germs caused many of the deaths of surgical patients. In 1865, Lister began using carbolic acid, a powerful disinfectant, to sterilize surgical wounds. But this method was later replaced by a more efficient technique known as aseptic surgery. This technique involved keeping germs away from surgical wounds in the first place instead of trying to kill germs already there. Surgeons began to wash thoroughly before an operation and to wear surgical gowns, gloves, and masks.

The beginnings of organized medicine. During the 1800's and early 1900's, groups were founded in the United States and Canada to organize and reform the medical profession in the two countries. In 1847, U.S. doctors founded the AMA to help raise the nation's medical standards. Partly as a result of the AMA's efforts, the first state licensing boards were set up in the late 1800's. The Canadian Medical Association was founded in 1867 for much the same purpose. The National Medical Association was started in 1895 by black doctors who felt discriminated against by the AMA. Osteopathic physicians founded the AOA in 1897.

In 1910, the Carnegie Foundation for the Advancement of Teaching issued a report called Medical Education in the United States and Canada. The U.S. educator Abraham Flexner prepared the report for the foundation. Flexner's report stated that only 1 of the 155 medical schools in the United States and Canada at that time provided an acceptable medical education. That school was the Johns Hopkins Medical School, founded in Baltimore in 1893. Flexner's report and the example of the Johns Hopkins school helped bring far-reaching reforms in U.S. and Canadian medical education.

The medical revolution. Advances in many fields of science and engineering have created a medical revolution in the 1900's. For example, the discovery of X rays by the German physicist Wilhelm Roentgen in 1895 enabled doctors to "see" inside the human body to diagnose illnesses and injuries. The discovery of radium by the French physicists Pierre and Marie Curie in 1898 provided a powerful weapon against cancer.

In the early 1900's, Christiaan Eijkman of the Netherlands, Frederick G. Hopkins of England, and a number of other physician-scientists showed the importance of vitamins. Their achievements helped conquer such nutritional diseases as beriberi, rickets, and scurvy. About 1910, the German physician and chemist Paul Ehrlich introduced a new method of attacking infectious disease. Ehrlich's method, called chemotherapy, involved searching for chemicals to destroy the microbes responsible for particular diseases.

Ehrlich's work greatly advanced drug research. In 1935, a German doctor, Gerhard Domagk, discovered the ability of sulfa drugs to cure infections in animals. His discovery led to the development of sulfa drugs to treat diseases in human beings. In 1928, the English bacteriologist Sir Alexander Fleming discovered the germ-killing power of a mold called Penicillium. In the early 1940's, a group of English scientists headed by Howard Florey isolated penicillin, a product of this mold. Penicillin thus became the first antibiotic.

Since the discoveries made by Domagk and Fleming, scientists have developed hundreds of antibiotics. These drugs have helped control the bacteria that cause most of the serious infectious diseases. Other drugs have been developed to fight such disorders as diabetes, high blood pressure, arthritis, heart attacks, and cancer.

The development of new vaccines has helped control the spread of such infectious diseases as polio, hepatitis, and measles. During the 1960's and 1970's, the World Health Organization conducted a vaccination program that eliminated smallpox from the world.

Since 1901, many people have received Nobel Prizes in physiology or medicine. For a list of the winners and their achievements, see the article NOBEL PRIZES.

Much progress in modern medicine has resulted from engineering advances. Engineers have developed a variety of instruments and machines to aid doctors in the diagnosis, treatment, and prevention of diseases and disorders (see BIOMEDICAL ENGINEERING). Microsurgery done through small instruments eliminates the need for large incisions and enables many patients to avoid hospitalization ( SURGERY [Technique]). Some devices have helped surgeons develop new lifesaving techniques, especially in the fields of heart surgery and organ transplants (see HEART [History of heart research]; TRANSPLANT). Other advances have opened up whole new fields of medicine, such as aviation medicine and occupational medicine.

MEDICINE/Current problems in U.S. medicine

Financial problems. Since the early 1960's, medical costs in the United States have risen rapidly. As a result, most people need some kind of health insurance. However, some Americans do not have any health insurance at all, and many other people are only partially covered.

Various plans have been suggested to guarantee more complete health coverage for all Americans. One such plan calls for employers to provide insurance that would protect all employees from large medical expenses. Under this plan, the government would provide increased health care benefits for the elderly, the poor, and the unemployed. Another plan calls for comprehensive national health insurance to cover all people. These health care plans would be financed largely through general tax revenues and increased premiums on the health insurance now provided by employers.

One factor driving up the price of medical care in the United States has been the sharp rise in the cost of hospital services. To deal with this problem, the United States Department of Health, Education, and Welfare started issuing health planning guidelines in 1978. These guidelines were designed to hold down hospital costs by preventing the expensive duplication of hospital facilities, equipment, and services, and by improving care. Many professional groups have developed similar but more extensive practice guidelines to deal with hundreds of medical problems. However, such measures cannot eliminate increases in hospital costs resulting from inflation, expensive new equipment, and the increased range and amount of services needed by the growing number of elderly people in the United States.

An increase in the number of malpractice suits during the 1970's also forced up the cost of medical care. As the price of malpractice insurance increased, doctors were forced to raise their fees. To protect themselves from malpractice charges, many physicians began to order more medical tests for their patients and to prescribe more cautious--and more expensive--treatment.

Poor distribution of doctors. Health experts believe the United States has enough physicians, but that the supply of physicians is badly distributed. Many rural areas and inner cities do not have enough doctors, while many suburban areas have more doctors than they need. To help remedy this situation, the federal government established the National Health Service Corps (NHSC) in 1970. Through NHSC, the government recruits physicians to work in areas that have a shortage of doctors. Another problem is an overabundance of specialists and a shortage of primary-care doctors.

Legal and ethical questions. Malpractice is the main legal dilemma confronting doctors today. Doctors may be accused of malpractice if a patient believes that he or she has been injured through the doctor's mistake or negligence. Some doctors believe that malpractice suits have become more common because many patients now have unrealistic expectations about medical care. Patients expect their treatment to be successful, even though some modern medical techniques are highly complicated and potentially dangerous.

Medical progress has raised a large number of new, complex, and difficult problems in the day-to-day practice of medicine. For example, modern medicine's ability to prolong life raises the question of when death actually occurs. In the past, people were considered legally dead when their heart and lung action stopped. But today, machines can keep a patient's heart and lungs working for days or even months after they can no longer function by themselves. As a result, many experts believe that a person should be considered legally dead when the brain stops functioning.

Other ethical questions raised by modern medicine concern organ transplants, abortion, euthanasia (helping or allowing patients to die), gene therapy, and the use of human subjects in experiments. Some hospitals have established ethics committees which doctors can consult when faced with an ethical question.

Problems for research. Medical research has yet to find the underlying causes of diseases of the heart and blood vessels and of cancer--the chief causes of death in the United States. Knowledge of the molecular and cellular causes of these disorders will help scientists develop better ways of treating and preventing them. Women's health issues, especially breast cancer, hip fracture, and mother-and-child care, are also receiving attention from researchers. In addition, many researchers are studying how preventive strategies, such as exercising, eating a balanced diet, and avoiding alcohol and cigarettes, can be made part of daily routines. Such strategies can lower death rates, especially among middle-aged and younger adults.

Contributor: James Webster, M.D., Prof. of Medicine and Director, Buehler Center on Aging, Northwestern Univ. Medical School.

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Additional resources

Bynum, William F., and Porter, Roy, eds. Companion Encyclopedia of the History of Medicine. 2 vols. Routledge, 1994.

Curtis, Robert H. Great Lives: Medicine. Scribner, 1993.

Damp, Dennis V. Health Care Job Explosion! Careers in the 90's. D-Amp, 1993.

Marshall, Eliot L., and Finn, Jeffery. Medical Ethics. Chelsea Hse., 1990.

O'Neil, Karen E. Health and Medicine Projects for Young Scientists. Watts, 1993.

Sacks, Terrence J. Careers in Medicine. VGM Career, 1993.

Skrabanek, Petr, and McCormick, J. S. Follies and Fallacies in Medicine. Prometheus, 1990.