Did Ibn Zuhr (Avenzoar) Postulate Before Vesalius That Liquid Collects in Ventricles in the Hydrocephalus?

OBJECTIVE: This study aimed to present and evaluate the part of Avenzoar's Liber Teisir that pertains to hydrocephalus. Avenzoar was an Andalusian physician prominent in the history of medicine because of the broadness of his observations and original methods. His most important work is recognized to be the Al-Taysir fi al-Mudawat wa al-Tadbir (On Preventive Regimen and Treatment), and its Latin version, Alteisir scilicet regiminis et medelae, which was in use for centuries in Europe. METHODS: The Arabic (Rabat, Morocco, in 1991) and Latin (Venice, Italy, in 1530) versions of Avenzoar's work were perused, relevant sections were separately translated into English, and both translations were then compared. An English version was prepared and is given in our results. RESULTS: The location of liquid collection was described as the anterior ventricles of the brain and around the brain. CONCLUSIONS: Avenzoar might have noted one of the earliest records on the clinical state called idiopathic adult hydrocephalus and postulated liquid collection in the ventricles of the brain in hydrocephalus before Vesalius.

Concept and treatment of hydrocephalus in the Greco-Roman and early Arabic medicine.

In the ancient medical literature hydrocephalus was not often described although its existence and symptomatology were well known. Most detailed descriptions of hydrocephalus including the surgical treatment are extant in the encyclopaedic works on medicine of the physicians Oreibasios and Aetios from Amida from the 4th and 6th centuries AD, respectively. Because of their broad scientific interests, this type of physicians, typical for the late Roman empire, were known as philosophy-physicians (iota alpha tau rho o sigma o phi iota sigma tau alpha iota). They defined hydrocephalus in contrast to our present understanding as a fluid collection excluding abscesses visible as a bulging tumour localised either outside or inside the skull of an infant. They classified the hydrocephalus similar as stated first by Galen in the 2nd century AD in four types corresponding to the assumed anatomic localisation of the fluid collection: 1st Type between the skin and the pericranium corresponding to the subgaleal haematoma or caput succedaneum of the newborn in our terminology, 2nd Type between the pericranium and the skull corresponding to the cephal haematoma after delivery, 3rd Type between skull and the meninges with increased head circumference, bone sutures being increasingly driven apart corresponding most likely to the hydrocephalus in our understanding, and 4th Type between the menings and the brain characterised by severe neurological deficit with lethal prognosis corresponding probably to all pathologies which were accompanied by an excessive increase of the intracranial pressure with a bulging fontanel. Due to the lack of autopsies in ancient times, the hydrocephalus was never linked to the pathology of the ventricles. All forms of hydrocephalus were believed to be caused by improper handling of the head by the midwife during delivery. Only the extracranial fluid collections, but not hydrocephalus in our sense, were considered to be suitable for surgical treatment. The surgery consisted in one or more incisions and evacuation of the fluid. The wound was not closed but let open for three days. Thereafter plasters or sutures closed the incisions. The surgical technique goes back probably to Antyllos a surgeon from the 3rd century AD whose considerations were cited in the work of Oreibasios. The early Arabic physicians took over the surgical indications, the operative technique and modified the Greek concept of hydrocephalus. Avicenna separated the traumatic haematomas outside the skull from the term hydrocephalus. However Avicenna, as all previous authors, had not linked hydrocephalus with the ventricular system. The autopsy of a child with an exorbitant hydrocephalus performed by the anatomist Vesalius in the 16th century revealed as a single pathology an extremely dilative ventricular system filled with water-like fluid which made it necessary to change completely the ancient concept of hydrocephalus.

Hydrocephalus and its management in Avicenna's Canon of Medicine.

Hydrocephalus and macrocrania in children have been regarded as amazing disorders throughout the history of medicine. Although the main underlying causes and pathophysiology of hydrocephalus were not understood until the middle of the 18th century, early physicians had made important contributions to this field with their careful observations, management protocols, and anatomical studies. Among these pioneering physicians was Avicenna, widely accepted as an influential and leading scientific figure of the medieval ages. Avicenna was interested in the study of hydrocephalus, and in his principal medical book, the Canon of Medicine, he devoted a large section to this topic. In this paper, a short excerpt concerning hydrocephalus is presented from Avicenna's Canon.