History of Medicine

The Canon: Essential Artillery of the Medieval Medical Student

Khurram J. Khan, BSc, MD, MSc Candidate, Department of Medicine, McMaster University Shiraz Noor, BA Candidate, Victoria College, University of Toronto

Abstract A historical review of The Canon of Medicine by Persian physician and philosopher Avicenna: This paper follows the trajectory of the Canons use in medical education in Europe, from its translation into Latin in the twelfth century to its long-standing status as an introductory textbook from the fteenth century onward. The changing role of the Canon in university curricula, which is perhaps its greatest historical legacy, attests to its durability as a medical encyclopaedia just one of the many consequences of its unprecedented comprehensiveness and organization.

in medicine. Concurrently, degree-granting universities were beginning to materialize, the rst ones being at Bologna, Italy and Paris, France. In the early thirteenth century, universities at Montpellier, France and Padua, Italy were also forming. The rst universities to make extensive use of The Canon were at Bologna and Padua in Italy during the early thirteenth century, initially as a surgical text.4 The curriculum in European universities was split over the next two centuries into theoria (theory), practica (practice), and, depending on the university, surgery. Of these three categories, The Canon was used the most for practica particularly Book Four, which was valued for its discussion of fevers.4 Considered a special disease, fevers and other systemic illnesses were approached using the following methodology as outlined in The Canons introduction:6 (i) the general diagnosis of their characters, causes and signs, (ii) the special diagnostic features, (iii) the general rules of treatment, (iv) the special methods of treatment by (a) simple, (b) compounded medicines. The curriculum in Bologna by the turn of the fteenth century included a course that also happened to be called Practica, which centred on a systematic study of Book Three of The Canon.9 This book discussed in great detail the causes and symptoms of diseases; its increasing use in universities during this time might have been a reaction to the devastation of the black plague in Europe. Even so, the most prominent use of any single part of The Canon was Book One, which comprised of a general overview of medical principles.4 For example, at the University in Montpellier in 1340 Book One of The Canon was the introductory theoria textbook for rst year students,while also being used for its fourth section on general therapy as a practica text.7 By the beginning of the fteenth century, the university at Bologna was using Book One as an introductory text as well.8 Thus, when including its earlier study as a surgical text, The Canon was used in all three areas of medical education two centuries after it was translated and three after its original publication.

ormal medical education never witnessed a text as robust as The Canon of Medicine by the Arab physician and philosopher Avicenna. A reputable physician by the age of 21, Avicenna excelled in his many endeavours, which also included mathematics, poetry, and religious sciences.1 Among his many texts, The Canon is by far the most famous and its legacy cannot be given justice in this short paper alone. Its name, The Canon, came from the Arabic title al-Qanun meaning the law. A unique encyclopaedia of medicine, it codied classical medicine of the Greeks, and built the foundation of the modern system-based approach to studying medicine. It was organized into ve books: Book One was an overview of contemporary medical theory, Book Two focused on pharmacology, Book Three on diseases described by organ systems like hepatology, Book Four on systemic conditions such as fever, and Book Five on treatments.2 Used in the rst medical universities in history, it was years ahead of its time, proving to be relevant in education half a millennium after it was originally written. The original collection, written in Arabic, was later translated a number of times in its entirety into Latin. The earliest and most enduring translation of Avicennas Canon dates back to the twelfth century, traditionally attributed to Gerard of Cremona.3 Soon after translation, the book permeated the writings of thirteenth century physicians as well as Vincent of Beauvais in his colossal thirteenth century encyclopaedia Speculum Maius.4 As the fourteenth century approached The Canon gradually disseminated from academic arena into wider scientic theory and became a reference for ordinary medical practitioners.5 Referencing of The Canon in European literature during this period established Avicenna as an authority

Corresponding Author Dr. Khurram J. Khan Assistant Professor of Medicine, McMaster University 50 Charlton Ave E Room H424, Hamilton, ON, L8N 4A6 Tel: 905-522-1155 x33673, Fax: 905-308-7201 Email: khankj@mcmaster.ca

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History of Medicine
The Canon: Essential Artillery of the Medieval Medical Student

As a book of early eleventh century medicine, The Canon remained prominent for half a millennium due to the changing role of the text in the curriculum. Its lasting use suggests that it had a degree of permanence, described in one history as an aura of authority that was to prove stultifying rather than invigorating3 probably due to its sheer size but also its comprehensive nature. It was extraordinarily organized, to the point where some individual sections contained only a few sentences. One can nd modern textbooks like Harrisons Principles of Internal Medicine9 mirror the organizational style of The Canon by opening with an overview of current medical theory (viz. Book One), followed by cardinal manifestations of disease (viz. Book Four), while the remaining parts focus on diseases described by organ systems (viz. Book Three). The Canon of Medicine is one of the most comprehensive collections of medical theory and practice. This is because Avicenna interpreted the classic Greek teachings of Hippocrates and Galen as the foundation of his text and also added newer ideas and theory, seamlessly combining what was ancient and contemporary into a unique medical lexicon. Together, these features provided a pretext for its changing role over time from an invaluable body of up-to-date knowledge in the eleventh century, to an authoritative practitioners handbook, an introductory university text and, nally, the historical monument that it is today.

References

1. Nasr, Seyyed Hossein. Britannica Online Encyclopaedia, Avicenna (Persian philosopher and scientist). Available from: http://www.britannica.com/ EBchecked/topic/45755/Avicenna. 2. Saab Medical Library, American University of Beirut. Ibn Sina / Avicenna. 2007. A detailed table of contents, outlining the meticulous organization of The Canon. Available from: http://ddc.aub.edu.lb/projects/saab/avicenna/contents-eng.html. 3. Savage-Smith E. Europe and Islam. In: Western Medicine: An Illustrated History, Loudon I (ed). Oxford University Press: New York. 1997. pp.45. 4. Siraisi NG. The Canon in the Medieval Universities. In: Avicenna in Renaissance Italy: The Canon and Medical Teaching in Italian Universities after 1500. Princeton University Press: Princeton. 1987; 44-46. 5. McVaugh MR. Europe and Islam. In: Medicine in the Latin Middle Ages. In: Western Medicine: An Illustrated History. Loudon I. (ed). Oxford University Press: New York. 1997; 58-59. 6. Gruner OC, and Avicenna 1930. Introductory Words. In: A Treatise on The Canon of Medicine of Avicenna. AMS Press: New York. pp.22. 7. Bullough VL. The Development of the Medical University at Montpellier to the End of the Fourteenth Century. In: Universities, Medicine and Science in the Medieval West. Variorum Collected Studies Series.CS781, Ashgate Publishing Limited: Aldershot, Hampshire. 2004; 26. 8. Grendler PF. The Medical Curriculum. In: The Universities of the Italian Renaissance. The Johns Hopkins University Press: Baltimore, USA. 2002; pp.320. 9. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrisons principles of internal medicine (17th ed.). New York: McGraw-Hill Medical Publishing Division. 2008.

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