Revisiting Ibn Sina's (Avicenna) Heritage

Medicine and the “Twelfth-century Renaissance”

The study and practice of medicine was influenced by the rapid development in Western Europe that took place between 1050 and 1225, often referred to as “twelfth-century Renaissance”. The population growth, urbanization and the development of more sophisticated forms of secular and ecclesiastical government led to the broadening of philosophical, scientific and all around deepened interest in medicine that demanded sophisticated medical literature.³

The need for a more comprehensive and sophisticated medical literature caused the establishment of a medical practice center in the mid-900s in Salerno, Italy. At the end of the 10^th century, Salerno became well known in northern France. Among the Salernitan practitioners in the tenth and eleventh centuries were many clergymen as well as famous “Salerno women”.⁴ Modern resources about the Salernitan male and female practitioners contain anecdotes highlighting not only their learning but their healing skills. However, throughout the 12^th century, Salerno’s medicine became more theoretical, more official and academic in terms of the medicine training.⁵

The growth of centers of medical study was in turn intimately connected with the multiplication of medical books and their accumulation, in an age in which the circulation of books was still limited, in particular places. The available Latin medical literature began to expand at the beginning of the late eleventh century through the translations of Arabic texts and subsequently Greek ←16 | 17→texts, to include substantial parts of the corpus of Greek medical writing, especially of works attributed to Hippocrates and Galen as well as the major recent Arabic contributions. There were many very important translators and centers of translation. Near Salerno, a Monte Cassino monk named Constantinus Africanus (d. 1087) translated Pantegni and many other texts from Arabic. In the 12^th century, Gerard of Cremona and his students in Spain translated the works of Galen, Rāzī (Rhazes), Abu al-Qasim al-Zahrawi (Albucasis) and Ibn Sīnā (Avicenna) from Arabic. Burgundio of Pisa, who traveled between Italy and Istanbul, translated Galen’s work from Greek. At around the same time, an enlarged and alphabetized version of the Latin Dioscorides became available. In these developments, of course, medicine paralleled other fields, notably logic, natural philosophy, astronomy, and geometry.⁶

Medicine was integrated into the efforts to ensure access to the entire Greco-Arab philosophy and science, which characterized western education between the end of the 11^th century and the beginning of the 13^th century. As in the other fields mentioned, in medicine as well, it could be assumed that the interest of scientists in acquiring new materials was both a reason and a result of new translations. Medical books did not just offer practical benefits but also contributed to the clergy intellectualism and general scientific culture in the 12^th century.⁷

The strong tradition of literate, learned Jewish medicine drew on both Jewish and non-Jewish sources. Under Muslim rule in Spain and elsewhere, Jewish physicians had come into close contact with learned Arabic medical culture and had access to the written heritage of Arabic medicine in the original language. Through this means, they too came to incorporate much of the heritage of Greek medicine into their own teaching and practice. Thus, for example, the medical writings of Maimonides (1135–1204), who spent his youth in Cordoba and other parts of Spain, then under Muslim rule, and most of his adult life in Egypt, were written in Arabic and show extensive knowledge of Arabic versions of works of Hippocrates and Galen.⁸

In the Iberian Peninsula, following the Reconquista, Jewish physicians lost direct access to the Arabic medical texts. Therefore, important Arabic texts were ←17 | 18→translated into Hebrew. Many translations from Hebrew into Spanish or Italian are contained in over 100 handwritings of Ibn Sīnā’s encyclopedic Canon. At the end of the 13^th century, the Canon had two different Hebrew translations, one of which was revised around the year 1400. At the end of the 13^th century, Jewish and Christian medical circles exchanged information and texts. For example, in, Montpellier around 1300, Jewish practitioners who were excluded from the university medical schools were in contact with faculty members, as a result of which some Latin medicine and astronomy books were translated into Hebrew. Despite great diversity among Jewish practitioners in terms of learnedness, it is clear that their medical ideas and techniques penetrated the Greco-Arab medical culture as did Christians’.⁹

The diversity, scope and increased depth of medical writing in local languages can be demonstrated through sources in English. Although old English from the Anglo-Saxon period contains some important medieval medical texts, Middle English contains some recipes from the 12^th and 13^th centuries. The Anglo-Norman (French) medical writings of the time comprise, for the most part, recipes and other short texts.¹⁰ However, by the end of the 15^th century, the medical course books translated or adapted from Latin into English contained a series of long, complicated and sophisticated works. Until then, English seems to have been as important a language as Latin in the medical book production in England. Furthermore, these works owed a lot to ancient medicine and medieval Islam and included many theoretical and explanatory materials. Translating medical and surgical books was challenging because the Latin terminology did not often have local equivalents. Just as Greek and Arabic translations into Latin had helped expand the Latin technical vocabulary before, translators came up with creative solutions and broadened the medical lexicon. By the 15^th century, practitioners who owned English medicine and surgery books ranged from master physicians who could read Latin to the barber-surgeons in London.¹¹

A similar story could be told of the expansion of technical writing on medicine in other vernacular languages over the same period. In the German lands, where the late foundation and small size of university faculties of medicine ←18 | 19→meant that university-trained physicians were a rarity before the fifteenth century, the dissemination of medical books in the vernacular took on a special importance. For example, perhaps as early as 1280, Ortolf von Baierland (Bavaria), a practitioner in Würzburg, put together in German a comprehensive handbook of medicine in 167 chapters. It transmitted some account of physiological theory as well as information about diseases and remedies and drew on standard Latin or translated Greek and Arabic authors, Hippocrates (the Aphorisms), and Ibn Sīnā (the Canon). In the course of the fourteenth and fifteenth centuries, Ortolf’s work became one of the most widely disseminated medical textbooks in Germany and central Europe; it was translated, wholly or in part, into a variety of languages, Latin among them, and in one form or another it survives in numerous manuscripts and early editions.¹²

The Medical Curriculum and Teaching Methods

Abundant Latin medical texts of Greek and Arabic origin ranging over various genres (Commentaries, Compendia and Glossaries) could be selected as study and teaching materials. It should be noted that teachers and students could only apprehend the medical and physiological concepts through the study of longer treaties of ancient authors; however, until the fifteenth century, only a limited number of ideas from ancient medicine and Greco-Islamic materials were translated into Latin and incorporated into university curricula. Lists of books officially assigned for medical lectures at Montpellier in 1309 and 1340 and at Bologna in 1405 show a curriculum of courses on works in the articella collection, which continued to supply the pedagogical need for brief statements of fundamental concepts; on up to a dozen or more longer works of Galen; and on selections from Arabic writers, notably Ibn Sīnā.¹³

Lectures did not appear to be organized in order of ascending difficulty, but certain books such as the brief Galenic compendium known as Ars parva, Hippocratic Aphorisms and parts of Avicenna’s encyclopedic Canon were deemed to be basic texts. Sections of Avicenna’s Canon were integrated into textbooks for university lectures that contained a synopsis of physiology (Book ←19 | 20→1, Part 1), a treatise on fevers (Book 4, Part 1), principles of disease and treatment (Book 1, Part 4) and diseases from head to toe (Book 3). The writings of Rhazes on diseases also frequently served as the basis of lectures. The exposition of the Ars, the Aphorisms, and the Canon was hence a major task of late medieval medical masters, as surviving commentaries on these works suggest the significant and valuable role they had in education. Professors’ commentaries on assigned texts (based on their lectures) show that there was considerable room for variation and personal opinion in the way the standard works were interpreted.¹⁴

Without doubt, the position of university-trained professors of medicine was confined to consultative posts, assigning physical interventions and examination to their delegated assistants. Tommaso del Garbo’s demeanor toward his medical duty illustrates the varied attitudes among practicing professors. According to Tommaso del Garbo’s biographer, he deemed the demands of the medical practice as a distraction from study. It is recorded of Gentile da Foligno, an exceptionally prolific medical author who commented on almost the whole of Ibn Sīnā’s Canon (which is about one million words long), that he died in 1348 during the great plague epidemic “from too constant attendance on the sick”.¹⁵

The views on and uses of the sections from the Canon as medical course books in at the beginning of the 13^th and 14^th centuries in both Paris and Montpellier meant that the training in Montpellier was practically similar to that in Paris. This was probably true for most of the centers of medical education.¹⁶

The differences were real enough, being those between the physiological doctrines of Aristotle, the master of the philosophers, and those of Galen and his followers. Both Avicenna and Averroes had discussed these differences and thus helped to focus the attention of Latin authors upon them.¹⁷