Sabaah
al-khair. My name is Abu Ali al-Husayn ibn Abd Allah ibn Sina
(980-1037). It's
a mouthful isn't it? You can call me Ibn Sina or Avicenna as I am known
in the
Western World. Welcome to my library. Here I have spent my life
studying
physics, metaphysics, and my personal favorite, medicine. Since I was a
child I
have been intrigued by medicine. At age 18 I had become a full-fledged
physician a la Doogie Howser. I wrote the Canon
of Medicine a book compiling the medical knowledge of Greeks,
Romans, Muslims, and my own personal experience (St. Andrews). Not to
brag, but it was used as a medical textbook for centuries after it was
written. I didn't really feel like gouging students by making them buy
a new edition every other year. Well enough
about my
life, if you wanted to read my biography you'd be on Wikipedia instead
of here.
Let's get to the interesting part: surgery.
When the treatment of a
patient necessitates making incisions, the knowledge of the surgeon in
performing surgery is paramount. A good surgeon must know the path of
the
nerves, arteries, and veins so as not to sever them. The
locations,
contours, and natures of the organs must be known in order to best
treat the
patient. I have made careful descriptions of all of the organs in my
Canon of
Medicine.
In order to
control the pain of the patient during the incisions a drug must be
used.
Hemlock, mandrake, and hyoscyamus may be used to subdue the pain of the
patient, but a large amount of the drug is needed to keep the patient
from
moving. Opium is the most powerful of these stupefacients, the surgeon
must use
great care in the administration of this drug, lest the patient never
wake from
their drug-induced sleep (Avicenna). Drugs are also needed to control
the
bleeding of the patient.
Today you
will be able to follow me along as I perform a routine cauterization to
prevent
the spread of gangrene on the patient's leg. This lesion followed a
previous injury.
Previous attempts to resolve the lesion by cupping (hijama) which is
the use of
acupressure generated by creating a vacuum on the patient's skin. This
procedure was set forth by the prophet Mohammad (Avicenna). However,
this
procedure did not work.
The best
possible treatment of a patient requires the best tools to perform the
surgery.
The tools that I use are essential to my ability to perform surgery on
my
patient. Tools like Galen's remedy, rabbit-hair, spider's web, white of
egg,
and the cautery are all found in my surgeon's bag. The best material to
use as
a cautery is gold as it heats quickly and is malleable to a variety of
shapes
(Avicenna).
Photo of Ancient Roman
Tile Cautery
Website: Surgical Instruments of Ancient Rome
Weblink: http://www.healthsystem.virginia.edu/internet/library/historical/artifacts/roman_surgical/
Cauterization
can be an extremely painful procedure. Since too much pain is known to
cause
death, an anesthetic must be used. For today's procedure I will use
mandrake.
The patient must be awake because the cauterization will remove the
dead
tissue, but pain will show me when I have reached the healthy tissue
(Avicenna).
Right now I will place the iron over an open flame to heat it. Before
proceeding we will wash the patient's afflicted leg with an astringent
wine.
This could help prevent further spread of the gangrene. I am placing
cloths wet
with extremely cold rose-water on the healthy skin around the lesion
(Avicenna).
This makes a little pit for the cautery to go and also protect the
surrounding
tissue from damage. This is all of the preparations that we need for
the
surgery. Oh yes one more thing. Could you do me a favor and hold down
the
patient's leg? They do seem to squirm a bit once the cautery is
introduced.
Painting of physician
using a cautery (Early 18th Century)
Website: History of Spine Surgery in the Ancient and Medieval Worlds
Weblink: http://www.medscape.com/viewarticle/468452_print
I will make
the incision here in between the cloths to drain the bile from the leg.
There,
since that is done we are ready to burn off the gangrene. Hold
your
breath as I introduce the iron. The smell is putrid enough to make you
regret
becoming a physician. As the flesh is burned, it forms a natural seal
so that
no blood is lost. Since the partially sedated patient is showing some
signs of
feeling in the afflicted area, this means that we have reached healthy
flesh.
May Allah grant that the wound be healed. Now we will apply the
astringent wine
one last time and wrap it with another cloth that has been soaked in
rose-water.
As the
patient recovers from this cauterization, he should rest and take a
diet of
milk, lamb, and herbs to speed his recovery. If all goes well he should
be up
and running within a few weeks, but if the lesion reappears, amputation
of the
leg may be a necessity. Thank you for your help with the surgery, you
have made
an excellent assistant. I hope that you have learned a little bit about
medicine from my era. I encourage you to read my book the Canon
of Medicine in order to perfect your skills as a physician.
Avicenna
was a very knowledgeable man on all medical subjects of the day. He
advocated
the health of his patients as a mixture of medicine and surgery, much
like the
physicians of today. The cautery was one of the primary tools of the
medieval
Islamic surgeon used to stop bleeding, excise lesions, and destroy
growths on
the human body. The use of astringent wine is particularly interesting
in its
use as an antimicrobial agent even before the germ-theory of disease.
When one
reads the Canon of Medicine, it seems to be quite dry. There is also a
tone of
paternalism for the patient. The physician is the person in charge of
the
patient's health regardless of what the patient thinks. This is quite
different
from the health care of the present. Avicenna was a brilliant man of
his
era. He
drew upon the knowledge of the past great minds and the experiences in
his
practice to great a medical text that was used to teach medicine for
centuries
later.
Avicenna, Canon of
Medicine (Chicago, Abjad Book
Designers &
Builders, 1999)
Primary Source
Note:
I basically paraphrased what
Avicenna wrote in the Canon. I took bits and pieces from different
parts of the book and put it all together to make the story for the
episode.
Secondary Source
Note:
My secondary source was written
by two history professors from St. Andrews University in Scotland (the
birthplace of golf). On their web page they published a list of the 53
books and articles that they used to compile this comprehensive
biography of Avicenna.
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