Last week, I wrote about Al-Razi, father of pediatrics. In this article, I will be discussing one of my favourite historical figures, Abū-ʿAlī al-Ḥusayn ibn-ʿAbdallāh Ibn-Sīnā, known in the west as Avicenna.
Ibn Sina (980–1037) is considered to be one of the most renowned scholars of all time, and rightly so. Said to have memorized the entire Qu’ran by the age of 10, Ibn Sina began his study of medicine when he was 13. He famously treated many royal figures, including the Sultan of Bukhara, Nuh Ibn Mansour and Prince Emir Shams al-Dawlah of the Buyid dynasty. He lived a chaotic life, moving from city to city seeking knowledge and fleeing persecution.
In his book ash Shifa, Ibn Sina discusses the connection between the body and the mind. He believed that there were ten senses, five internal and five external. He refers to the sensus communis, which psychologists now refer to as executive function, the ability to consolidate sensory and perceptual information at a central point in the mind.
He discussed imagination, intelligence, and instinct as psychological qualities. He understood that our knowledge of the world informs our intelligence and intuition, and impacts the way that we experience the world around us. Early Muslim psychologists referred to the study of psychology as Ilm-al Nafsiat, translated as “self-knowledge,” emphasizing the connection between psychology and philosophy that was intrinsic in a great deal of ancient thinking.
Ibn Sina is credited with writing over 200 works (along with an estimated 200 more which were lost to history), including possibly the most comprehensive book of medicine up to that point Al-Qānūn fī al-ṭibb, also known as The Canon of Medicine. It contains over a million words and is perhaps the most widely used medical text in world history. There are parts of the Canon of Medicine describing the importance of preventative medicine, such as proper nutrition, regular exercise, and hygiene in maintaining good health.
One of the most significant themes in The Canon of Medicine is the idea of conducting experiments in order to assess the efficacy of a treatment. Ibn Sina outlines seven conditions that an experiment must meet in order to be an accurate measure of a drug’s effect. He states that the drug being tested must be pure and untampered with. It was well-known at the time that the chemical properties of a drug could be altered by temperature change or poor storage, so Ibn Sina dedicated an entire chapter of his second volume to the importance of proper chemical storage.
He also stated that medicines should only be tested on participants with a single ailment, so that if improvement does occur, it can be attributed to the drug, and not another condition. This is the first known use of exclusion criteria in a scientific study. He built upon Al-Razi’s idea of a control group, suggesting that medicines should be tested in multiple patient groups to ascertain their effectiveness in treating different illnesses. Ibn Sina wrote about something that scientists today refer to as the dose-response effect. He writes that:
“The strength of the drug must be proportionate to the severity of the diseases…in these instances it is better to test the drug in low quantities, and test it in increasing quantities to determine its effect and to prevent untoward effects.”
He also stated that experiments should go on for a long period of time and in as many patients as possible, “for if its effect is real, then it will be seen continuously or in many instances.” His final point emphasized the importance of human trials over animal trials. The extent to which these values are reflected in modern clinical trials exemplifies the sheer influence of Islamic scholars on the field of medicine. An abridged Latin translation of The Canon of Medicine known as The Medical Poem made its way around Europe during the Middle Ages and is thought to be responsible for the transmission of Islamic knowledge to the rest of the world.
This article only begins to explore Ibn Sina’s influence. He was not only a physician, but a philosopher, astronomer, mathematician, and all-around polymath. While Ibn Sina certainly revolutionized the idea of a clinical trial, he was not the first to attempt them. In my next piece, I will write about Abū Bakr Muḥammad bin Zakariyyāʾ al-Rāzī, who is considered by many to be the father of clinical trials and experimental medicine.
The House of Wisdom: How Arabic Science Saved Ancient Knowledge and Gave Us the Renaissance by Jim Al-Khalili