1213-1288 Ibn Al-Nafis (Ala-al-din abu Al-Hassan Ali ibn Abi-Hazm al-Qarshi al-Dimashqi)

Islamic World.

Ibn Al-Nafis(1213-1288 C.E.)

IBN AL-NAFĪS AND PULMONARY TRANSIt

His complete name is 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 who is mostly famous for being the first to describe the Pulmonary Circulation of the Blood.

He was born in 1213 in Damascus. He attended the Medical College Hospital (Bimaristan Al-Noori) in Damascus. Apart from medicine, Ibn al-Nafis learned Jurisprudence, Literature and  He became an expert on the Shafi’i school of Jurisprudence and an expert Physician

, Al-Nafis moved to Egypt. He worked at the Al-Nassri Hospital, and subsequently at the Al-Mansouri Hospital, where he became chief of physicians and the Sultan’s personal physician. When he died in 1288, he donated his house, library and clinic to the Mansuriya Hospital.

The most voluminous of his books is Al-Shamil fi al-Tibb, which was planned to be an encyclopedia comprising 300 volumes, but was not completed as a result of his death. The manuscript is available in Damascus.His book on Ophthalmology is largely an original contribution. His most famous book is The Summary of Law (Mujaz al-Qanun). Another famous book, embodying his original contribution, was on the effects of diet on health, entitled Kitab al-Mukhtar fi al-Aghdhiya.His Al-Risalah al-Kamiliyyah fil Siera al-Nabawiyyah, translated in the West under the title Theologus Autodidactus has been argued to be both the first theological novel and the first science fiction novel.He also wrote a number of commentaries on the topics of law and medicine. His commentaries include one on Hipocrates‘ book, and several volumes on Ibn Sina’s The Cannon of Medicine Additionally, he wrote a commentary on Ibn Hunayn Ishaq’s book.

This great muslim scholar was died on17 December 1288 (aged 74–75) Cairo.

THEMES

Arabic Manuscripts

Sciences and Medicine

In the thirteenth century, Ibn al-Nafīs wrote a substantial commentary on Avicenna’s entire Canon of Medicine thereby revising existing understandings of human physiology and anatomy. His theory of the pulmonary transit of blood formed a cornerstone of the modern theory of blood circulation.

Galenic physiology and anatomy dominated the Arabic medical tradition from the time of Ḥunayn ibn Isḥāq (AD 809–873). Medical authorities such as al-Rāzī (AD 865–c. 925) and al-Majūsī (died AD c. 982–994) innovated and critiqued medical practice, but seldom challenged the underlying principles of the Galenic system. In his Canon of Medicine, Avicenna (AD 980–1037) 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 to Ibn al-Nafīs’ devastating critique and reform of the entire basis of Galenic medicine that laid the foundations for William Harvey’s (AD 1578-1657) theory of blood circulation.

Ibn al-Nafīs’s reforms 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.

THE INVISIBLE PORES OF THE HEART

Galen had claimed that the septum (a muscle wall separating the two sides of the heart) is porous, but since he could not see these pores during dissection, he suggested they were so small they were invisible. Ibn al-Nafīs harmonised theory and empirical observation in his proposal that blood travelled from the right side to the left side of the heart via the lungs. This is known as the pulmonary transit.

IBN AL-NAFĪS AND PULMONARY TRANSIT

THEMES

Arabic Manuscripts

Sciences and Medicine

In the thirteenth century, Ibn al-Nafīs wrote a substantial commentary on Avicenna’s entire Canon of Medicine thereby revising existing understandings of human physiology and anatomy. His theory of the pulmonary transit of blood formed a cornerstone of the modern theory of blood circulation.

Galenic physiology and anatomy dominated the Arabic medical tradition from the time of Ḥunayn ibn Isḥāq (AD 809–873). Medical authorities such as al-Rāzī (AD 865–c. 925) and al-Majūsī (died AD c. 982–994) innovated and critiqued medical practice, but seldom challenged the underlying principles of the Galenic system. In his Canon of Medicine, Avicenna (AD 980–1037) 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 to Ibn al-Nafīs’ devastating critique and reform of the entire basis of Galenic medicine that laid the foundations for William Harvey’s (AD 1578-1657) theory of blood circulation.

Ibn al-Nafīs’s reforms 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.

THE INVISIBLE PORES OF THE HEART

Galen had claimed that the septum (a muscle wall separating the two sides of the heart) is porous, but since he could not see these pores during dissection, he suggested they were so small they were invisible. Ibn al-Nafīs harmonised theory and empirical observation in his proposal that blood travelled from the right side to the left side of the heart via the lungs. This is known as the pulmonary transit.

Beginning of Galen’s description of the anatomy of the veins from the Arabic version of his De anatomicis administrationibus. Or. 9202, f. 122r

According to Galen, the veins were responsible for distributing blood and the humours (i.e. nourishment) to the entire body, and the arteries for distributing the vital spirit. This spirit was generated in the left side of the heart from concocted air received from the lungs. The two sets of vessels comprised two distinct systems, each governed by a separate organ, and each possessing its own soul (or part of soul) that gave the necessary powers to its respective organ.

The veins were part of the system of nutrition that was governed by the liver, which received the powers of nourishment from the nutritive soul. The arteries were concerned with distributing the spirit and heat from the heart, which received its powers from the passionate soul. Galen also believed that some less dense parts of the body could not be nourished by the thick blood of the veins. He therefore suggested the existence of invisible pores in the heart’s septum to allow for some blood to mix with the air and spirit found in the left side of the heart, refining the blood enough to nourish these parts of the body.

THE SOUL HAS NO PARTS: THE SEPTUM HAS NO PORES

On philosophical grounds, Ibn al-Nafīs rejected the claim that the soul (nafs) had parts. Physiologically, he considered the heart responsible for generating the spirit (rūḥ) and introducing movement into the body. He then claimed that the septum could not possess invisible pores, since the thick blood of the veins would then corrupt the fine texture of the spirit, and suggested that the blood from the right side was taken up by the lungs.

The beginning of Ibn al-Nafīs’s Commentary on the Anatomy of the Canon. Or. 5596, f. 1v

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. The filtered blood passed into the open spaces of the lungs, where it mixed with air and was then absorbed by the ‘vein-like artery’ (pulmonary vein). This light, air-blood mixture generated the spirit in the left side of the heart, while the thicker blood remaining in the pulmonary artery nourished the lungs.

This new physiology and anatomy also led Ibn al-Nafīs to reject Galen’s belief that the pulse was caused by a power that resided in the arteries’ tunics, which caused all arteries to contract and expand simultaneously. Instead, he claimed 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 identified that the arteries contract when the heart expands, and expand when the heart contracts.

TRANSIT AND CIRCULATION

According to Ibn al-Nafīs, the blood was entirely used up during its journey through the body, and only a small part of the blood participated in the pulmonary transit. Yet, the new physiology that supported this anatomical theory was often discussed in later Arabic commentaries on Avicenna’s Canon and Ibn al-Nafīs’s Concise Book on Medicine.

Some of these texts, such as Quṭb al-Dīn al-Shīrāzī’s (AD 1236-1311) Commentary on the Canon, were read in Latin translation by Renaissance anatomists. Realdo Colombo (AD 1519–1559), for example, used anatomical observations to defend theories of the pulmonary transit and of the heart as the cause of the arterial pulse. These two theories then provided the basis for Harvey’s modern theory of blood circulation.

SECONDARY SOURCES

Nahyan Fancy, Science and Religion in Mamluk Egypt: Ibn al-Nafīs, Pulmonary Transit and Bodily Resurrection (London: Routledge, 2013)

Nahyan Fancy, 'Medical Commentaries: A Preliminary Examination of Ibn al-Nafīs’s Shurūḥ, the Mūjaz and Commentaries on the Mūjaz' Oriens 41 (2013): 525-545

Beginning of Galen’s description of the anatomy of the veins from the Arabic version of his De anatomicis administrationibus. Or. 9202, f. 122r

According to Galen, the veins were responsible for distributing blood and the humours (i.e. nourishment) to the entire body, and the arteries for distributing the vital spirit. This spirit was generated in the left side of the heart from concocted air received from the lungs. The two sets of vessels comprised two distinct systems, each governed by a separate organ, and each possessing its own soul (or part of soul) that gave the necessary powers to its respective organ.

The veins were part of the system of nutrition that was governed by the liver, which received the powers of nourishment from the nutritive soul. The arteries were concerned with distributing the spirit and heat from the heart, which received its powers from the passionate soul. Galen also believed that some less dense parts of the body could not be nourished by the thick blood of the veins. He therefore suggested the existence of invisible pores in the heart’s septum to allow for some blood to mix with the air and spirit found in the left side of the heart, refining the blood enough to nourish these parts of the body.

THE SOUL HAS NO PARTS: THE SEPTUM HAS NO PORES

On philosophical grounds, Ibn al-Nafīs rejected the claim that the soul (nafs) had parts. Physiologically, he considered the heart responsible for generating the spirit (rūḥ) and introducing movement into the body. He then claimed that the septum could not possess invisible pores, since the thick blood of the veins would then corrupt the fine texture of the spirit, and suggested that the blood from the right side was taken up by the lungs.

The beginning of Ibn al-Nafīs’s Commentary on the Anatomy of the Canon. Or. 5596, f. 1v

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. The filtered blood passed into the open spaces of the lungs, where it mixed with air and was then absorbed by the ‘vein-like artery’ (pulmonary vein). This light, air-blood mixture generated the spirit in the left side of the heart, while the thicker blood remaining in the pulmonary artery nourished the lungs.

This new physiology and anatomy also led Ibn al-Nafīs to reject Galen’s belief that the pulse was caused by a power that resided in the arteries’ tunics, which caused all arteries to contract and expand simultaneously. Instead, he claimed 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 identified that the arteries contract when the heart expands, and expand when the heart contracts.

TRANSIT AND CIRCULATION

According to Ibn al-Nafīs, the blood was entirely used up during its journey through the body, and only a small part of the blood participated in the pulmonary transit. Yet, the new physiology that supported this anatomical theory was often discussed in later Arabic commentaries on Avicenna’s Canon and Ibn al-Nafīs’s Concise Book on Medicine.

Some of these texts, such as Quṭb al-Dīn al-Shīrāzī’s (AD 1236-1311) Commentary on the Canon, were read in Latin translation by Renaissance anatomists. Realdo Colombo (AD 1519–1559), for example, used anatomical observations to defend theories of the pulmonary transit and of the heart as the cause of the arterial pulse. These two theories then provided the basis for Harvey’s modern theory of blood circulation.

Discovering Pulmonary Circulation

The pulmonary circulation according to Ibn Al-Nafis.

The discovery of the pulmonary circulation is an interesting and much debated topic. It is commonly believed that this discovery had its inception in Europe in the sixteenth century by Servetus, Vesalius, Colombo, and finally Harvey.

However, in view of the discovery of ancient manuscripts, it is proposed that the real credit for the discovery of the pulmonary circulation belongs to an eminent physician of the thirteenth century: Ibn Al-Nafis.

In 1924 an Egyptian physician, Dr. Muhyo Al-Deen Altawi, discovered a script titled, "Commentary on the Anatomy of Canon of Avicenna" in the Prussian state library in Berlin while studying the history of Islamic Medicine at the medical faculty of Albert Ludwig’s University in Germany.

This script is considered one of the best scientific books in which Ibn Al-Nafis covers in detail the topics of anatomy, pathology and physiology. This discovery revealed an important scientific fact, which up to then had been ignored: the first description of the pulmonary circulation.

The theory that was accepted prior to Ibn Al-Nafis was placed by Galen in the second century, who had theorized 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 consequently distributed to the body.

According to Galen's views, the venous system was quite separate from the arterial system, except when they came in contact through the unseen pores (3). However, Ibn Al-Nafis, based on his knowledge in anatomy and scientific thinking stated that, "...The 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...”

Elsewhere in his book 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 is in the lungs of air, then pass through the arteria venosa to the left cavity of the two cavities of the heart...”

In describing the anatomy of the lungs, Ibn Nafis stated, "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." (4)

Another important contribution of Ibn Nafis that is rarely mentioned is his postulation that the nutrition of the heart is extracted from the small vessels passing through its wall, when he said "... 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..." (4) Ibn Al-Nafis was thus the first to put forward the concept of the coronary circulation.

Europe’s Late Awakening

These important observations were not known in Europe until 300 years later when Andrea Alpago of Belluno translated some of Ibn Al-Nafis’ writings into Latin in 1547 (5). Later, Michael Servetus described the pulmonary circulation in his theological book, "Christianismi Restitutio", in 1553 and wrote, "...air mixed with blood is sent from the lungs to the heart through the arterial vein; therefore, the mixture is made in the lungs.

The bright color is given to the sanguine spirit by the lungs, not by the heart." (6). It is worth mentioning that the Church accused Servetus of heresy for opposing the teachings of Galen, and was consequently -with his book -burnt at the stake. Andreas Vesalius described the pulmonary circulation in his book "De Fabrica", in a manner similar to Ibn Nafis' description.

An interesting observation is that in the first edition of the book (1543), Vesalius agreed with Galen that the blood "... soaks plentifully through the septum from the right ventricle into the left...” Then in the second edition (1555) he omitted the above statement and wrote instead..."I still do not see how even the smallest quantity of blood can be transfused through the substance of the septum from the right ventricle to the left..." (5). Another similar description was given by Realdus Colombo in 1559 in his book "De re Anatomica" (6).

Then it was William Harvey who, in 1628, demonstrated by direct anatomic observation in laboratory animals the movement of blood from the right ventricle to the lung and then observed the blood returning to the left side of the heart via the pulmonary vein and again he stated that he could not find any pores in the interventricular septum. He wrote in his monograph, "Exercitatio anatomica de motu cordis et sanguinis in animalibus": "I began to think there was a sort of motion as in a circle.

I afterwards found true, that the blood is pushed by the beat of the left ventricle and distributed through the arteries to the whole body and back through the veins to the vena cava and then returned to the right auricle, just as it is sent to the lungs through the pulmonary artery from the right ventricle and returned from the lungs through the pulmonary vein to the left ventricle, as previously described." (6) However, he did not understand the physiology of the pulmonary circulation (dissipation of carbon dioxide and replacement with oxygen), which was fully elucidated by Lavoisier in the 18th century (3).

Views of Some Modern Historians

It may be useful to mention the views of a few modern historians who reviewed the works of Ibn Nafis; Mieli said, "We believe that henceforth it is fair to attribute the discovery of the pulmonary circulation to Ibn Nafis who was a distant precursor of the physicians of the sixteenth century Italian School and of William Harvey who, four centuries later, described the whole of the pulmonary circulation in an accurate, clear and definitive manner."

Max Meyrholf, a distinguished scholar of Arabic historical medicine, stated: “... We have seen that Ibn Nafis, three centuries before Colombo, had already noticed visible passages between the two types of pulmonary vessels."

In the William Osler Medal Essay on the discovery of the pulmonary circulation, Edward Coppola said, "...The theory of pulmonary circulation propounded by Ibn Nafis in the 13th century was not forgotten and that centuries after his death it may have influenced the direction of the anatomical investigations of Colombo and Valverde, who finally announced it to the Western world as a physiological fact susceptible to experimental proof." (5)

Sami Haddad (4) from Lebanon published an article in the Annals of Surgery in 1936 about Ibn Nafis and other articles were published also by Ayman et al and Dr. Abdul Kareem Shahadah from Syria showing clearly that Ibn Al-Nafis should be given the credit for the discovery of the pulmonary circulation 300 years before William Harvey was even born!

SECONDARY SOURCES

Nahyan Fancy, Science and Religion in Mamluk Egypt: Ibn al-Nafīs, Pulmonary Transit and Bodily Resurrection (London: Routledge, 2013)

Nahyan Fancy, 'Medical Commentaries: A Preliminary Examination of Ibn al-Nafīs’s Shurūḥ, the Mūjaz and Commentaries on the Mūjaz' Oriens 41 (2013): 525-545

Ar Razi (865-925) dokter muslim yang pertama medeskripsi dengan jelas cacar dan campak serta menduga akan merangsang timbulnya kekebalan.

Cendekiawan Muslim di Abad Pertengahan Di antara abad ke 9 dan 14, para ilmuwan dari umat Muslim yang menguasai ilmu kimia, kedokteran, astronomi, matematika, ilmu bumi dan banyak lagi lainnya, tidak saja telah menghidupkan kembali disiplin ilmu bangsa Yunani, tetapi juga telah memperluas cakrawalanya dengan meletakkan dan memperkuat fondasi di atas mana pengetahuan modern bertumpu. (Stewart, 1967).

Ala-al-Din Abu al-Hasan Ali Ibn Abi al-Hazm al-Qarshi al- Damashqi alMisri was born in 607 A.H. of Damascus. He was educated at the Medical College-cum-Hospital founded by Nur al- Din Zangi. In medicine his

teacher was Muhaththab al-Din Abd al- Rahim. Apart from medicine, Ibn al-Nafis learnt jurisprudence, literature and theology. He thus became a renowned expert on Shafi'i School of Jurisprudence as well as a reputed physician.

After acquiring his expertise in medicine and jurisprudence, he moved to Cairo where he was appointed as the Principal at the famous Nasri Hospital. Here he imparted training to a large number of medical specialists, including Ibn al-Quff al-Masihi, thefamous surgeon. He also served at the Mansuriya School at Cairo.

When he died in 678 A.H. he donated his house, library and clinic to the Mansuriya Hospital.

His major contribution lies in medicine. His approach comprised writing detailed commentaries on early works, critically evaluating them and adding his own original contribution. Hlis major original contribution of great significance was his discovery of the blood's circulatory system, which was re-discovered by

modern science after a lapse of three centuries. He was the first to correctly describe the constitution of the lungs and gave a description of the bronchi and the interaction between the

human body's vessels for air and blood. Also, he elaborated the function of the coronary arteries as feeding the cardiac muscle.

The most voluminous of his books is Al-Shamil fi al-Tibb, which was designed to be an encyclopaedia comprising 300 volumes, but it could not be completed due to his death. The manuscript is available at Damascus. His book on ophthalmology is largely an original contribution and is also extant. However, his book that became most famous was Mujaz al-Qanunand a number of commentaries were written on this. His own commentaries include one on Hippocrates' book. He wrote several volumes on Ibn Sina's Qanun, that are still extant. Likewise he wrote

a commentary on Hunayn Ibn Ishaq's book. Another famous book embodying his original contribution was on the effects of diet on health entitled Kitab al-Mukhtar fi al-Aghdhiya. Ibn Al-Nafis' works integrated the then existing medical knowledge and enriched it, thus exerting great influence on the development of medical science, both in the East and the West.

However, only one of his books was translated into Latin at early stages and, therefore, a part of his work remained unknown to Europe for a long time.

He treatise The Concise Book (Kitab Mujiz) which epitomized the Canon of Ibn Sina. The undated copy, written in a fine professional hand with an illuminated heading and opening text in cloud bands, was probably produced in Iran or India in the 17th to 18th century. NLM MS A44.1, fol. 1b