The Canon of Medicine remained a medical authority for centuries. It set the standards for medicine in Medieval Europe and the Islamic world and was used as a standard medical textbook through the 18th century in Europe. The medical traditions of Galen and thereby Hippocrates , had dominated Islamic medicine from its beginnings. Avicenna sought to fit these traditions into Aristotle 's natural philosophy. The Canon of Medicine is divided into five books: [7]. Book 1 is made up of six theses which give a general description of medicine in general, the cosmic elements that make up the cosmos and the human body, the mutual interaction of elements temperaments , fluids of the body humours , human anatomy, and physiology.

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We'd like to understand how you use our websites in order to improve them. Register your interest. A historical approach could help in the detection of some viewpoints that cannot be paid attention to or signified by a purely medical one.

Ibn Sina provided extremely systematic knowledge on head traumas along with both his observations and experiences and citations from the writings of the ancient physicians, Galen and Paul of Aegina.

Regarding the treatment of skull fractures, Ibn Sina is a real successor of Galen and Paul of Aegina. In neurosurgery practice, head injuries have been frequently encountered and are one of the most important health issues, which might require surgical intervention, since humans came into being. This treatise, which is from seventeenth bc , consists of 48 cases, 27 of which concern head traumas related with deep scalp wounds exposing the skull and skull fractures.

Galen of Pergamon — ad was the most important medical writer of antiquity [ 19 ]. He was the first neurosurgeon in the arena of sports as well [ 6 , 19 ]. Galen wrote a commentary on De Capitis Vulneribus , which is not extant but cited in other treatises and in Arabic sources [ 9 ]. Galen mentioned Hippocratic treatise De Capitis Vulneribus in his three works: De methodo medendi libri , In Hippocratis librum de officina medici commentarii , and In Hippocratis librum primum epidemiarum [ 20 ].

Ibn Sina Bukhara —Hamadan ; Fig. Some authors emphasized that, at 16, there were physicians working alongside him. Ibn Sina, who has been respected because, when he was 18, he cured Noah II, the ruler of Samanids, is considered among the most famous and accountable scholars of his era in the fields of Quran, philosophy, mathematics, astronomy, geology, medicine, physics, chemistry, literature, et cetera.

After he had left Khwarizm, he traveled to Gorgan, Qazvin, and Hamadan. During this period, he not only worked as a physician but also served as vizier for Shams Al-Dawlah in Hamadan.

Sometimes, he was put in a dungeon, and sometimes he escaped from a city to another one in order to be free from malicious gossipers and generally persecutions [ 18 , 21 ]. The Canon may be considered the best one, which attempted to coordinate systematically all medical doctrines of Hippocrates and Galen with the biological concepts of Aristotle [ 8 ].

The Canon is both epitome and the summation of Greco—Arabian medicine. The Canon of Ibn Sina is divided into five large books. Each book is divided into treatises fen , each of which in its turn is subdivided into chapters and sections systematically [ 8 ].

The Canon of Ibn Sina consists of approximately a million words and is the most influential textbook ever written; for six centuries, it dominated the medical schools of Asia and Europe. The Canon was translated into Latin by Gerard of Cremona — for the first time in the twelfth century. A Latin version of Canon was published in Milan in Figs. A Hebrew version appeared in Naples in Fig. It is regarded as a law in its field, and the enquiry into Canon is regarded as sacrilege [ 21 ]. Editoriale Programme, Padova, p 14 [22].

Editoriale Programme, Padova, p 21 [22]. Editoriale Programme, Padova, p 61 [22]. Editoriale Programme, Padova, p 48 [22]. In this chapter, he emphasized that inflammation would spread from the fracture and wound in the head to the water membrane of brain [meningitis? When the cut reaches the edge of this membrane but not to the ventricles of the brain, this condition is healthier [than ever] and there is hope for recovery.

When the cut reaches the brain tissue, fever and vomiting of bile occur and very few people recover from this condition. The cut in the ventricles in frontal brain is the best of all. If you immediately help and stick both sides to each other, there is hope [for recovery]. When the cut is in the ventricles of the posterior, the treatment [of this condition] is more difficult, and if the cut is in the middle ventricles of the brain, it is the worst of all and it is difficult for the patient to regain his natural self, except if the fracture—the cut—is very small and treatment is begun immediately [ 12 , 15 ].

Ibn Sina suggests preventing the swelling with drugs as the treatment. He underlines that there are two different treatment approaches of physicians to this subject. Those in the first group prefer relieving pain and tranquilizing the patient, while the physicians in the second group prefer using drugs that would dry the cut. Sometimes skull may be fractured, but the scalp may not be lacerated, just swollen.

In such a case, if you attempt to treat the swollen area and neglect the treatment of fracture, fractured bone may decay underneath.

Before the swelling resulting from the fracture recovers and even after it recovers, dangerous implications may arise, e. Then, when the skull is fractured, you should not only treat the swelling, but also tear open the scalp so that you can observe and cure the fracture. You can often detect the fractured area by the help of the patient. The patient puts his hand on the fractured area and points out the aching area.

If you observe any implications of a fracture on the skull, leave the wound and swelling as they are, and start treating the fracture. Lift the scalp so that purulent matter and fester do not accumulate in one place. This precautionary measure is necessary not only for the fractures of the head but also for all fractures of the body.

Under no circumstances, should you spare an area where purulence and fester can accumulate and remain, except when you are sure that swelling does not increase but gradually reduces [ 7 , 14 , 17 ]. The beginning page of skull fracture in Liber Canonis printed in Venice in , f o.

The beginning page of the Canon for skull fracture in Hamidiye manuscript, f o b [in Ottoman Turkish] [ 17 ]. Ibn Sina, in the beginning of the text, brings into attention that the physician should examine a patient very carefully while evaluating skull fractures; if not, he would make a mistake.

Therefore, he details what the physicians should do. He also emphasizes the importance of taking the story of the patient as well as the importance of examination. Sometimes there may be a fracture in the skull but we cannot consider it a fracture.

A split of hair-thin may be seen in that part of the skull, but it may not have reached the lower layer of the bone and have remained superficial. This may not even be visible in some cases. This kind of injury is not essentially a fracture, and it is the easiest one of the fractures to treat and you should be less worried than in any other condition. In this case, you will scrape the bone. If this split of hair-thin, which is on the upper layer of the bone, is not well visible, pour the black colored fluid onto it to make it appear.

Then, scrape and clear it up until no trace is left [ 7 , 14 , 17 ]. Ibn Sina emphasizes the importance of cleaning the fracture area for not only skull fractures but also all fractures of the body. He recommends removing the dirt from the bone when skull is cracked and the split reaches down to the lowest layer of the cranium.

Ibn Sina says that, after examining the cover of the brain [dura mater], if it is in its normal state, there will be less damage and, if it has lost its normal state, there will be great danger. In conditions involving cracks in the skull, Ibn Sina claims that it usually recovers by binding and bandaging; thus, he recommends bringing together two sides of the wound gap and suturing when required, dressing the wound with medications, and making the patient rest and keep still [ 7 , 14 , 17 ].

Ibn Sina provides the treatment principles of comminuted skull fractures and describes the healing process of the bones of the skull bones, which, he believes, affects the treatment process. Do not have the idea of removing the fractured bone in each kind of fissure or fracture of the skull, which is impossible anywhere, anyway, but, do not forget our advice on general fracture and its treatment and execute it. When a part of the skull is fractured in bits and pieces, you should know that the bones of the skull are different from the other bones [of the body] and so, the treatment [principles] of the fractures of the skull differs from that of other fractures [in body] as well.

If the skull is fractured, nature cannot place a strong and rigid patch on the fracture as it does on other bones. The patch of the skull is weak and a less enduring one. Both for this reason and to prevent pus and dirt of the wound from penetrating the fracture and when you have diagnosed that the fracture is a complete one, remove the fractured bone and if the fracture is not complete and holds on a side, cut the fracture and do not occupy yourself with its fusion [ 7 , 14 , 17 ].

Ibn Sina explains why skull fractures should be treated by cutting and removing the fractured bone of the skull in his own words:. Why do I insist on the treatment of a skull fracture and say that seeing the bone bare and cutting and removing the fractured bone are necessary? If the fractured bone is not of the skull, but of another organ other than the skull, bandage it to stop harmful matters from penetrating the fracture—which I explained. This folded bandaging is not possible on the head.

In treatment of bone fractures of the organs other than the skull, a certain amount of bone needs to be cut and elevated to have pus and watery filth drain out of the fracture easily and if there is pus in the bone, we still need to cut the bone so that this pus and filth—as I pointed out before—do not combine with bone marrow and make trouble. If fractures in other bones are like this, why should not we take the same measures in fractures of the skull? In fractures of the bones other than those of the skull, tying, bandaging, wrapping a splint et cetera protect them from adaptation of bad matters, but this is impossible in the skull, so we should be more protective in skull fractures.

As required and as much as possible, cutting, elevating, and cutting the scalp and flesh over the fractured bone should be performed on the exposed fracture and the fractured skull should not be fused unless you are sure of bad signs will not develop [ 7 , 14 , 17 ].

For surgical intervention, he first recommends estimating and determining the most appropriate area where pus and filth will collect and which will be cut easily, away from the nerves. According to Ibn Sina, if the physician has determined an indication for elevation of the bone, he should do so immediately before inflammation develops.

In his own words:. If you realize that cutting and extracting a part of the bone is required, immediately start working and do not wait for pus and filth to appear. If you think of waiting for sufficient pus accumulation and then cutting the bone, this is possible in some cases and does no harm. But, if the thin sheet—the main sheet that covers the brain—has been under pressure because of the skull fracture or if something has penetrated it, immediately and without hesitation, you should begin to take it out.

Even when the smallest piece of bone penetrates this main sheet, not even piercing it, swelling and spasm appear very fast and brain stroke of patient is possible, and when stroke emerges, you should take the piercing bone out, under this condition: very swiftly and without hesitation. Normal sense of the brain may recover, but if this piece has pierced the main sheet, the deed is more difficult and needs to be done more swiftly.

If you have to delay the treatment, it should not be delayed more than two or three days and usually treatment is required in the second, you must have learned the treatment of such cases earlier [ 7 , 14 , 17 ]. On technical details of the operation, Ibn Sina suggests that the operation should be performed with very thin saws and declares that touching the cover of the brain with a drill and saws will be dangerous.

After he defines the shaving of the hair of the patient, the most convenient position of the patient for the surgeon, and the scalp incisions, he tells us how to cope with bleeding which may be confronted. If the bone, which will be cut, is soft or weak, he suggests cutting it with thin saws without inflicting any damage to the membrane and the intact tissues of the brain. If the bone is tough and strong, he describes the removal procedure as drilling holes side by side using a special drill with a projection on the thinner tip, which will prevent damage to the membrane of the brain.

After quotations from Galen regarding safe surgical techniques and amount of bone which will be cut, Ibn Sina explains the method of dressing the wound after the operation. He uses rose oil and vinegar. He suggests not bandaging tightly and recommends the use of drugs that will bond the flesh granulation tissue [ 7 , 14 , 17 ]. After the operation, using a quotation from Paul of Aegina, Ibn Sina mentions a complication , in which the membrane may swell and the swollen membrane may rise above the skull as far as the scalp [cerebral edema?

In order to reduce swelling, Ibn Sina suggests drawing blood, using anti-inflammatory drugs, and, if they prove useless, inducing diarrhea in the patient as treatment methods [ 7 , 14 , 17 ]. Ibn Sina finishes this chapter with quotations from Paul of Aegina and Galen, explaining good prognosis of patients who underwent surgery because of skull fractures:.

They had removed all the broken bones from his head; one year later, the man completely recovered.


What does Al-Qanun Fi Al-Tibb (The Canon of Medicine) say on head injuries?

A historical approach could help in the detection of some viewpoints that cannot be paid attention to or signified by a purely medical one. In this text, the important points of Ibn Sina's Avicenna treatise on head injuries have been introduced in light of neurosurgery. The most detailed chapter regarding head injuries in Canon, under the title of "Fracture of the Skull," presents rather detailed knowledge concerning skull fractures and their surgical treatments in the eleventh century and the medical paradigm of that era. Ibn Sina provided extremely systematic knowledge on head traumas along with both his observations and experiences and citations from the writings of the ancient physicians, Galen and Paul of Aegina. Regarding the treatment of skull fractures, Ibn Sina is a real successor of Galen and Paul of Aegina.


What Does Al-Qanun Fi Al-Tibb (The Canon of Medicine) Say on Head Injuries?

We'd like to understand how you use our websites in order to improve them. Register your interest. A historical approach could help in the detection of some viewpoints that cannot be paid attention to or signified by a purely medical one. Ibn Sina provided extremely systematic knowledge on head traumas along with both his observations and experiences and citations from the writings of the ancient physicians, Galen and Paul of Aegina. Regarding the treatment of skull fractures, Ibn Sina is a real successor of Galen and Paul of Aegina.


The Canon of Medicine



Al-Qanun Fi at-Tibb


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