Professor of Anesthesia

Department of Anesthesia

King Khalid University Hospital Riyadh

Riyadh 11461 P.O. Box 2925

takrouri@ksu.edu.sa

King Khalid University Hospital Riyadh

Riyadh 11461 P.O. Box 2925

In the year 1924 a heated debate started regarding the discovery of the pulmonary circulation. This discovery was attributed only to European scholars. It stemmed back to the sixteenth century. When Michael Servetus (1511-1553), Anderea Vesalius (?1514-1654), Nicolai Massa (1485-1569), Realdo Colombo (1520-1654), Valverde De Hamusco (1508-1565), Andera Cesalpino (1519-1603), Fabrici d’Aquapendent (1533-1619) and William Harvey (1578-1657) developed the concept. However, Muhyi-d-din At-Tatawi (1896-1945) presented his thesis [1] "Der Lungenkreislauf nach El-Korachi. Dissert, z.eil. d. Doktorwrde, Freiburg im Brisgau 1924" of the blood circulation according to al Qurashi relaying on his discovery of his description of pulmonary circulation in one of ancient manuscripts, He proposed that the real credit for the discovery of the pulmonary circulation belongs this eminent physician of the thirteenth century: Ibn al-Nafis. Later another doctor Abdul Kareem Chihade (1922- ) presented another dissertation in Paris 1951 entitled " decouverte de la circulatio pulmonaire chez Ibn an-Nafis" [2]. Published by Institut Francais De Damas 1955. Other prominent professors like: Paul Galiounji [3] and Salman Qatayyah [4] researched extensively in his manuscripts and produced very important monographs. Even recently Ayman Soubany and Farouq Khan advocated the credit to Ibn Al Nafis for the discovery of pulmonary circulation [5]. This kept in the background other prospective regarding ibn Al Nafis. Many Scientific meetings [6,7] were studying the collection of contributions of this physician; the latest was the 2^nd seminar on Ibn al Nafis the physician, the scholar and the philosopher. This was under supervision of Dr Abdul Rahman al Awadi and editors Abdul Hamid Dousouki, Ahmad al-Jindi and Mukhtar Bishr in Kuwait [7]. The general consensus is that Ibn al-Nafis' work exerted great influence on the development of medical science, both in the Islamic world and Europe. A closer look on Ibn al-Nafis contribution would indicate that he also described the coronary circulation, the cranial nerves the gall bladder anatomy and many new aspect of ophthalmology. He advocated as well therapy through nutrition. His work integrated the medical knowledge with great clarity and emphasized precision. The purpose of this article is to update the notes on Ibn al-Nafis.

Ala al-Din Abu’l-Hasan Ali Ibn Abi’l-Haram al-Qurashi, known as Ibn al-Nafis.

1. The name of ibn Al Nafis in this manuscript we can see his name depicted as Ala al-Din Ibn Abi’l-Haram al-Qurashi

He was born about 607 AH 1210 AD in a village near Damascus called "Quersh’. Which is now a quarter south of Damascus Known as Al Qureshi quarter.

2. Al Qureshi quarter in AlMidan district in Damascus (a) The gate (b) inside the Alley

 (a) (b)

He joint the circles of medicine at the age of 22 (629 AH 1232 AD) in Aldakhoiriah School. Given the name of its founder; Al-Dakhwar (Died 628 AH 1231 AD). He studied the books of famous pioneers Muslims physicians such as Rhazes, and Avicenna also he read Galen and Hippocrates. He practiced Medicine in al Nuri’s bimaristan. (Currently is the museum for Arabic medical sciences in Damascus Syria).

3. Al Nuri ‘s bimaristan gate in Damascus where Ibn Al Nafis spent his formation years

In the year (636 AH 1236 AD), Ibn al-Nafis departed to Egypt, as he was invited by the Sultan to work in Al-Naseri Hospital as oculist. Then he became Egypt physicians’ chief and the Sultan Zaher Bebars’s personal physician. Not only he was a practicing physician, he was also a religious scholar read and taught theology in al Masrouriah school for Shafei’s doctrine in Islam. Just three years before his death he was appointed the dean of Qalaoon bimaristan Al Mansouri.

4. Qalaoon Mosque (a) and Bimaristan Al Mansouri (b)(under restoration) in Cairo Egypt where Ibn al Nafis practiced medicine and he was the dean. (a)

 (b)

In his lifetime He wrote medical books mainly,-some are printed recently- and he tackled various topics concerning religion and Prophet Mohamad’s Hadith – printed recently also-. But most third of his manuscripts are lost. He mingled with the high society of Egypt. He had many scientific followers; and the most famous of Egypt Hakeems (Physician scholars).

There are many debates among the historians concerning the following items:

1. His name; weather Abu Al Hazm or Abu Al Haram?.

2. His principle teacher was he Al Dakhwar as mentioned in many reference books?

3. His social status: was he married or not?.

4. Date of his birth and Death

The latest confirmation search notes the name as Abu Al Haram, As far as the statement that his principle teacher was Al Dakhwar. We find among others some conflict. He started learning Medicine at the age 22, i.e. in the year (629 AH 1232 AD). While Al Dakhwar who suppose to be his teacher died in the year (628 AH. 1231). So it is wise to say that he learned medicine at al Dakhwariah school.

He was married, but died alone. He endued his money and books to the hospital no route to parents, spouse or offspring

On Friday 21th Dhulqadah 687 AH, December 17^th, 1288 AD. -Most of the historian agreed with this date-. He died at the age of 80 after an unknown illness.[4] so he was born in the year (607 AH 1208 AD)

5. Picture of painting of artist impression of Ibn Al Nafis (®Source Islam set) http://www.islamset.com

 

Ibn al-Nafis wrote valuable texts such as:

1. "Shareh Fusul Boukrat" Commentary on Hippocrates Aphorisms, ( Published book). [8]

2. "Shareh epidemia Boukrat" Commentary on Hippocrates; Epidemics, (in press by Zeedan).

3. "Al Muhadhab Fi Al Kouhl Al Mujarrab"; Polished Book on Ophthalmology, (Published book). [9]

4. "Al Moujaz Fi al Tobb" Synopsis of medicine ( published book). [10]

5. "Al MuKhtar min aL-Aghziya" The choice of Foodstuffs (Printed book) [11]

6. "Risalet al A’ada’a" An Essay on organs (published book) [12]

7. "Al Shamel Fi al Tobb; Reference Book for Physicians, (Still in the form of Manuscript).

8. "Epidemia’ Epidemics by Hippocrates,

6. "Sharih Al Adwiah al Moufradah Wal Murakabah" Commentary on Materia Medica and Compound Drugs.

7. " al Risalah al Kamiliah" The story of Fadel bin Nateek ( published book)

8. "Muktasar Ousoul al Hadeath". Synopsis of foundation of science of Prophet’s Hadeath. (Published book) Omar A.M.M. Heridy A. A.M.

9. " Sharh Tashrih al Qanoun " Commentary on the Anatomy of the Canon of Avicenna, (Published book) in which he described the pulmonary circulation accurately to the best of his knowledge.

 

In general there are in all 24 titles some of it are still not printed, some are already lost.

Physicians in the Middle Ages in Islamic culture, followed Galen’s teaching in anatomy blindly. Till some physicians like Al Bougdadi and Ibn al-Nafis criticized and challenge it. Galen and Avicenna after him considered the right heart in communication with left side of the heart with invisible pores. So the blood from the right side of the heart goes through these invisible pores in the septum of the heart to the left side where it mixes with air to create spirit and then is distributed to the body. Accordingly the venous blood side is quite separate from the arterial system, except when they come in contact by the unseen pores.[5-8] Ibn al-Nafis said "…the blood from the right chamber of the heart must arrive at the left chamber. But there is no direct pathway between both chambers. 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…"

In another site he said:

"The heart has only two ventricles …and between these two there is absolutely no opening. Also dissection disagrees 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 al-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... 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". [5-8]

11. The blood circulation according to Ibn al-Nafis (®Modified form Ibn al-Nafis and modern physiology Al-Hajaj in proceedings of symposium on al Soufi and ibn al-Nafis, p.132 Amman, Jordan 1987 [6])

Ibn al-Nafis described 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..."; [5-8] by this, Ibn al-Nafis was the first to put forward the concept of coronary circulation.

Ibn al Nafis contributed to ophthalmologic literature by writing critically. He recognized that the muscle behind the eyeball does not support the ophthalmic nerve and do not get in contact with it. The optic nerves transect and do not just get in touch with each other. He added many new views regarding treatment of glaucoma and weakness of the vision in one eye when the other is affected by disease. He contributed to healthy being by depending on nutrition and controlling the food of the patient rather on giving drugs and prescriptions.

In conclusion we can enumerate his medical aspects of his contribution to humanity as:

1- Describing of the lesser pulmonary circulation.

2- Describing the bronchi and lungs

3- Stating that the heart has two ventricles

4- Those coronary arteries are the rout to nourish the heart

5- Depending on dissection to verify these findings.

6- Contribution to the ophthalmology by many new views for his time

7- Stressing the sound principle of controlling the diet in illness and in health

The contributions in other field of knowledge are a different another story.

1. At-Tatawi MD: Der Lungenkreislauf nach el-Kerachi. These medicines.(in German) Freiburg i. Br. 1924 Dactilographice, non consultec

2. Chehade AK Ibn an-nafis et la decouverte de la circulation pulmonaire. (French) Institut francais de Damas Imprimerie Catholique, Beyrouth 1955

3. Galiounji P Ibn al-Nafis; Egypt press Cairo 1966.

4. Qatayyah S. The Arabic Physician Ibn al-Nafis (in Arabic). 1st Ed. Beirut: Arabic Corporation for Studies and Publication, 1984:37-43.

5. Soubani A.O Khan F. The Discovery of the pulmonary circulation revisited. Annals of Saudi Medince March 1995

6. Preceedings of the conference on Al Soufi and ibn al-Nafis. Jordan University 5-8/10 1978 Amman Jordan. Dar al Fikr; Damascus and Beirut 1991.

7. Al Awadi AR Basiuni AH, Jindi AR, Bishr M: Ibn Al Nafis Physician theologist and philosopher proceedings of the second seminar on Ibn al Nafis in Kuwait 8-10 /8/1418 8-10 November 1997 Publisher Islamic organization for medical sciences Kuwait 1999

8. Ibn al-Nafis, Sharh fusul Bocrat (A Commentary on Hippocrates Aphorisms by Abdel Kader M. Zeedan Y, The Library of Ibn An-nafis: Critical Edition and introduction Al Dar Al-Masriah Al-Lubnaniah 1990 Cairo Egypt.}

9. Ibn al-Nafis. Al Muhadhab Fi Al Kouhl Al Mujarrab; Critical edition by Waafai M.Z Rawas Kalaaji M. Unceco 1987 Rabat

10. Ibn al-Nafis. Al Moujaz Fi al Tobb; Critical study and introduction; by Al- Azbawi AA, Ammar A Revision Abdel alTawab R : Minstery of Al Aowkaf Cairo-Egypt 1997 2^nd edition.

11. Ibn al-Nafis The choice of Foodstuffs study and critical edition by Zeedan Y., The Library of Ibn An-Nafis;, Al Dar Al-Masriah Al-Lubnaniah 1992 Cairo Egypt

12. Ibn al-Nafis , Risalet al Adhaa ;Critical study and introduction. By Zeedan Y . The Library of Ibn An-Nafis; Al Dar Al-Masriah Al-Lubnaniah 1991 Cairo Egypt

13. Ibn al-Nafis Ibn al-Nafis

14. Keys TE, Wakim KG. Contributions of the Arabs to medicine. Proceedings of the staff meet. Mayo Clinic 1953;28:423-37.

15. Gordon EJ. William Harvey and the circulation of the blood. South Med J 1991;84:1439-44.

16. Haddad TE, Khairallah AA. A forgotten chapter in the circulation of the blood. Ann Surg 1936;104:1-8.

17. Coppola ED. The discovery of the pulmonary circulation: A new approach. Bull Hist Med 1957;31:44-77.

18. Mettler CC. History of Medicine. Philadelphia, PA, USA. The Blakiston Co, 1947:40-59 and 113-128.

19. Al-Dabbagh SA. Ibn al-Nafis and the pulmonary circulation. Lancet 1978;1:1148.

20. Meyerhof M. Ibn al-Nafis and his theory of the lesser circulation. Isis 1935;23:100-20.