17 December 1288 (aged 74–75)|
|Era||Islamic Golden Age|
|Region||Syria and Egypt|
|Main interest(s)||Medicine, Anatomy|
|Notable work(s)||Commentary on Anatomy in Avicenna's Canon|
Ala-al-din abu Al-Hassan Ali ibn Abi-Hazm al-Qarshi al-Dimashqi (Arabic: علاء الدين أبو الحسن عليّ بن أبي حزم القرشي الدمشقي ), known as Ibn al-Nafis (Arabic: ابن النفيس ), was an Arab physician mostly famous for being the first to describe the pulmonary circulation of the blood. The work of Al-Nafis regarding the right sided (pulmonary) circulation pre-date the much later work (1628) of William Harvey's De motu cordis. Both theories attempt to explain circulation.
Apart from medicine, Ibn al-Nafis learned jurisprudence, literature and theology. He was an expert on the Shafi'i school of jurisprudence and an expert physician. He also performed several human dissections during the course of his work. The number of medical textbooks written by al-Nafis in his lifetime is estimated at more than 110 volumes.
He was born in a village called al-Qurashiyya Damascus and studied medicine at Nuri Hospital in Damascus, which was founded by the Turkish Prince Nur-al Din Muhmud ibn Zanki, in the 12th century. Ibn al-Nafis was taught by the founder of a medical school in Damascus, Muhadhdab al-Din ‘Abd al-Rabin ib ‘Ali al-Dakhwar. Al-Nafis taught and practiced at his own, then lesser known hospital in Egypt. He became the chief physician there and personal physician for prominent political leaders, thus becoming also an authority among practitioners of medicine. Prior to his death, he donated his house and personal library to Qalawun Hospital or, as it was also known, the House of Recovery. He died on December 17, 1288, in Cairo.
Al-Nafis also taught jurisprudence in Cairo at al-Masruriyya. His name is found among those of other scholars, which gives insight into how well he was regarded in the study and practice of religious law. He wrote Kitab al-Shamil fi ‘l-Sina’a al-Tibbiyya (Comprehensive Book in the Art of Medicine) around his 30s. It comprised 300 volumes of notes, but only 80 of these were published. His writings are cataloged in many libraries around the world, including the Cambridge University Library, the Bodleian Library, and the Lane Medical Library at Stanford University.
Kitab al-Shamil is a book that went unpublished, but it gives insight into his view of medicine and human relations. His surgical technique had three stages. Step one was to give the patient information on how it was to be performed and the knowledge it was based on. The second step was to perform the surgery itself. The final step was to have a post-surgery appointment and a routine of checkups. There is also a description of a surgeon's responsibility when working with nurses, patients, or other surgeons.
In 1236, Al-Nafis moved to Egypt.
The most voluminous of his books is Al-Shamil fi al-Tibb, which was planned to be an encyclopedia comprising 300 volumes, was left incomplete upon his death. The manuscript is available in Damascus.
His book on ophthalmology is largely an original contribution. His most famous work is The Summary of Law (Mujaz al-Qanun). Another famous work, also an original contribution, was on the effects of diet on health, entitled Kitab al-Mukhtar fi al-Aghdhiya.
He also wrote a number of commentaries on the topics of law and medicine. Commentaries include one on Hippocrates' book, several volumes on Avicenna's The Canon of Medicine, and a commentary on Hunayn Ibn Ishaq.
Other works include: Sharh Tabi’at al-Insan li-Buqrat (“Commentary on Hippocrates’ ‘Nature of Man’”); Sharh Tashrih al-Qanum (“Commentary on Anatomy in Books I and II of Ibn Sina’s Kitab al-Qanu”), in four parts: “A Commentary on Generalities,” “A Commentary on Materia Medicine and Compound Drugs,” “A Commentary on Head-to-Toe Diseases, ” and “A Commentary on Diseases Which Are Not Specific to Certain Organs." Sharh Abidhimya li-Buqrat (“Commentary on Hippocrates’ Endemics); Sharh Masa’il Hunayn (“Commentary on Hunayn [Ibn Ishaq’s] Questions”); al-Muhadhdhab fi ‘l-Kuhl (“Polished Book for Physicians”); Bughyat al-Talibin wa Hujjat al-Mutatabbibn (“Reference Book for Physicians”).
Discovery of pulmonary circulation
In 1924, an Egyptian physician, Muhyo Al-Deen Altawi, discovered a manuscript entitled, Sharh tashrih al-qanum li’ Ibn Sina, or "Commentary on Anatomy in Avicenna's Canon" in the Prussian State Library in Berlin while studying the history of Arabic Medicine at the medical faculty of Albert Ludwig’s University in Germany. This manuscript covers in detail the topics of anatomy, pathology, and physiology. This is the earliest description of pulmonary circulation.
The most commonly accepted theory of cardiac function prior to Al-Nafis was that of Galen. Galen taught that the blood reaching the right side of the heart went through invisible pores in the cardiac septum, to the left side of the heart, where it mixed with air to create spirit, and was then distributed to the body. According to Galen, the venous system was quite separate from the arterial system except when they came in contact through the unseen pores.
The manuscript was translated by Max Meyerhof. It includes critiques of Galen’s theory, including a discussion on the pores of the heart. Based on animal dissection, Galen hypothesized porosity in the septum in order for blood to travel within the heart as well as additional help on the part of the lungs. However, he could not observe these pores and so thought they were too small to see. “Ibn al-Nafīs’s critiques were the result of two processes: an intensive theoretical study of medicine, physics, and theology in order to fully understand the nature of the living body and its soul; and an attempt to verify physiological claims through observation, including dissection of animals.” Al-Nafis rejected Galen’s theory in the following passage:
“The blood, after it has been refined in [the right] cavity, must be transmitted to the left cavity where the (vital) spirit is generated. But there is no passage between these cavities, for the substance of the heart is solid in this region and has neither a visible passage…”
He posited that the “pores” of the heart are closed, that there is no passage between the two chambers, and the substance of the heart is thick. Instead, al-Nafis hypothesized that blood rose into the lungs via the arterial vein and then circulated into the left cavity of the heart. Paul Ghalioungui also theorized concerning the structure of the heart. He believed that blood (spirit) and air passes from the lung to the left ventricle and not in the opposite direction. Some points that conflict with Al-Nafis' are that there are only two ventricles instead of three and that the ventricle gets its energy from the blood flowing in the vessels running in the coronary vessels, not from blood deposited in the right ventricle.
Based on his anatomical knowledge, Al-Nafis stated:
"Blood from the right chamber of the heart must arrive at the left chamber, but there is no direct pathway between them. The thick septum of the heart is not perforated and does not have visible pores as some people thought or invisible pores as Galen thought. The blood from the right chamber must flow through the vena arteriosa (pulmonary artery) to the lungs, spread through its substances, be mingled there with air, pass through the arteria venosa (pulmonary vein) to reach the left chamber of the heart, and there form the vital spirit..."
Al-Nafis also disagreed with Galen’s theory that the heart's pulse is created by the arteries’ tunics. He believed that "the pulse was a direct result of the heartbeat, even observing that the arteries contracted and expanded at different times depending upon their distance from the heart. He also correctly observed that the arteries contract when the heart expands and expand when the heart contracts.”
Elsewhere in this work, he said:
"The heart has only two ventricles ...and between these two there is absolutely no opening. Also dissection gives this lie to what they said, as the septum between these two cavities is much thicker than elsewhere. The benefit of this blood (that is in the right cavity) is to go up to the lungs, mix with what air is in the lungs, then pass through the arteria venosa to the left cavity of the two cavities of the heart; and of that mixture is created the animal spirit."
In describing the anatomy of the lungs, Al-Nafis said:
"The lungs are composed of parts, one of which is the bronchi; the second, the branches of the arteria venosa; and the third, the branches of the vena arteriosa, all of them connected by loose porous flesh."
He then added:
"The need of the lungs for the vena arteriosa is to transport to it the blood that has been thinned and warmed in the heart, so that what seeps through the pores of the branches of this vessel into the alveoli of the lungs may mix with what there is of air therein and combine with it, the resultant composite becoming fit to be spirit when this mixing takes place in the left cavity of the heart. The mixture is carried to the left cavity by the arteria venosa."
It is also found that "In the lungs, some blood was filtered through the two tunics (coverings) of the vessel that brought blood to the lungs from the heart. Ibn al-Nafīs called this vessel the ‘artery-like vein’, but we now call it the pulmonary artery."
Al-Nafis also postulated that nutrients for heart are extracted from the coronary arteries:
"Again his (Avicenna's) statement that the blood that is in the right side is to nourish the heart is not true at all, for the nourishment to the heart is from the blood that goes through the vessels that permeate the body of the heart."
Practice of dissection
There is some debate about whether or not Ibn al-Nafis participated in dissection to come to his conclusions about pulmonary circulation. Although he states in his writings that he was prevented from practicing dissection because of his beliefs, other scholars have noted that al-Nafis must have either practiced dissection or seen a human heart in order to come to his conclusions. According to one view, his knowledge about the human heart could have been derived from surgical operations rather than dissection. Other comments found in al-Nafis’s writings such as dismissing earlier observations with a reference to dissection as proof, however, support the view that he practiced dissection in order to come to his conclusions about the human heart and pulmonary circulation. Ibn al-Nafis’s comments to the contrary and the alternate explanations, however, keep his possible practice of dissection in question.
Influences on Ibn-al Nafis and his influence on others
Ibn al-Nafis was most well-known for this work on the pulmonary circulation of the blood. Years before Ibn al-Nafis was born, Galenic physiology and anatomy dominated the Arabic medical tradition from the time of Ḥunayn ibn Isḥāq (AD 809–873). Medical authorities at the time seldom challenged the underlying principles of this system. What set Al-Nafis apart as a physician was his boldness in challenging Galen’s work. In studying yet criticizing the Galenic system, he formed his own medical hypotheses. Thus Galen was a major influence on Al-Nafis’ medical work.
Avicenna (AD 980–1037) was another influence, as Avicenna “undertook the first rigorous attempt to align Galenic medicine with a philosophically sound understanding of the nature of the living body, and in so doing modified certain aspects of physiology”. This led Al-Nafis to seek his own understanding of the nature of the living body and its soul through theoretical study of medicine, physics, and theology.
Possible Western influence
In AD 1344, Kazrouny wrote a verbatim copy of Ibn al-Nafis’s commentary on Canon in his Sharh al-Kulliyat. In AD 1500, Andrea Alpago returned to Italy after studying in Damascus. In Alpago’s 1547 A.D. publication of Libellus de removendis nocumentis, quae accident in regimime sanitatis, there is a Latin translation containing part of Ibn al-Nafis’ commentary on pharmacopeia. This was published in Venice during its rule over Padua. Harvey arrived in Padua in AD 1597.
Ibn al-Nafis died in Cairo after some days sickness. His student Safi Aboo al-fat'h composed a poem about him. He was wealthy man, and because he was childless and unmarried, his estate devolved to Mansoory's hospital.
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