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      Ibn Rushd (Averroës): Prince of Science

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          Abu Al- Walid Muhammad Ibn Ahmad Ibn Muhammad Ibn Rushd, known in the West as Averroës or Avén Ruiz or Averrhoes, was born in 1126 A.D. in Cordova (once the capital of Moorish Spain), and died in Marrakech, Morocco (Capital of the Almohad or al-Muwahhidun dynasty) on December, 10, 1198 A.D. Akin to many Arab and Muslim physicians and scholars we discussed in this series,1–6 Ibn Rushd was a true polymath, with knowledge, expertise and genuine contributions to philosophy, islamic law (jurisprudence), medicine, astronomy, mathematics, physics and geography. Not surprisingly, he became known as the “Prince of Science”. Ibn Rushd was a descendent of distinguished family of scholars, excelling in Quranic studies and theology, and with a long and well-respected tradition of legal and public service. Ibn Rushd is sometimes referred to the grandson (Al-Hafid), since his grandfather who carried the same name, used to be the grand judge (Qadi) of Cordoba. Ibn Rushd (the grandfather) was the author of a famous treatise in Maliki jurisprudence, the kitab al-Mugad Dimat al Mumahhidat. Ibn Rushd’s father, Abu Al-Qasim Ahmad was also a Qadi.7 It was Ibn Tufail (Abubacer), the philosophic vizier of Almohad Caliph Abu Yaqub Yusuf, who introduced Ibn Rushd to the court. In 1169 A.D., Ibn Rushd was appointed a judge in Seville and in 1171 A.D., he was transferred to Cordova, where he held the position of a judge (Qadi) for ten years. During that time, he wrote commentaries and interpretations on the works of Aristotle, among others on Metaphysics, and on Plato’s Politeia. In 1182 A.D., he was called to Marrakesh to work as a personal physician for the Caliph there, but he was soon transferred back to Cordova with the title of Great Qadi (Chief Judge). Ibn Rushd fell out of favor with the Caliph due to the opposition that theologians had raised against his writings. He was accused of heresy, interrogated and banned to Lucena, close to Cordova. At the same time (1195 A.D.), the Caliph ordered the books of Ibn Rushd to be burnt, with the exception of his works on medicine, arithmetic and elementary astronomy. Sometime later, the Caliph revoked the banishment and called Ibn Rushd back to Marrakesh. Ibn Rushd’s Work Ibn Rushd loved books. It is said that he never missed reading or writing except the day he got married and the day his father died. Therefore, it is not surprising that he was prolific and encyclopedic author. Ibn Rushd’s writings spread more than 20,000 pages, the most famous of which deal with philosophy, medicine, logic and jurisprudence. He wrote 20 books on medicine. His work includes: Tahfut at Tahafut (The Incoherence of the Incoherence): It was written in the style of a dialogue against al-Ghazali’s claims in Tahafut alfalasifa (The Incoherence of the Philosophers). Ibn Rushd in a detail of Triunfo de Santo Tomas, 14th century florentine artist Andrea Bonaiuto. Talkis Kitab al-Jadal (Middle Commentary on Aristotle’s Topics) Fasl al-Maqal Fi Ma bayn al-Sharia wa Al-Hukma Min Al-Ittisal (Faith & Reason) Al-Kashf ‘an manahij al-’adla fi ‘aqaid al-mila (Clarifying the systems of proof in the beliefs of the nation {Muslims}). Al-Da’ruri fi Isul al-Fiqh: a summary of al-Ghazali’s Mustasfa. Bidāyat al-Mujtahid wa Nihāyat al-Muqta_id: a textbook of Maliki doctrine in a comparative framework Al-Bayān wa’l-Ta__īl, wa’l-Shar_ wa’l-Tawjīh wa’l-Ta’līl fi Masā’il al-Mustakhraja: a long and detailed commentary based on the Mustakhraja of Mu_ammad al-’Utbī al-Qurtubī. Kulliyat Fi A-Tibb (“Generalities”, i.e. general medicine): known in its Latin translation as Colliget. A commentary on The Canon of Medicine (Qanun fi ‘t-tibb) of Ibn Sina (Avicenna) (980–1037). Maqala fi ‘1-Tiryaq (“Treatise on Theriac”). Averroes on Plato’s Republic.7 Front page of a Latin translation of the Ibn Rushd book on medicine, “Kitab al Kulliyat” known in Europe as “Colliget”. Ibn Rushd the Philosopher and Theologian Ibn Rushd greatly admired Aristotle and considered him a giant who had attained the truth. He regarded Aristotle as embodying the highest development of the human intellect. It is said that Ibn Rushd understood, and interpreted and analytically discussed Aristotle’s philosophy more than any of his predecessors or contemporaries. Ibn Rushd maintained that the deepest truths must be approached by means of rational analysis and that philosophy could lead to the final truth. He accepted revelation, and attempted to harmonize religion with philosophy without amalgamating them or eradicating their differences. He believed the Qur’an contained the highest truth while maintaining that its words should not be taken literally. He argued that philosophy confirms and does not contradict the revelation. He contended that philosophy is nothing more than the systematic probing into the phenomenon of creation, revealing God’s wisdom and might. Hence, revelation dictates the study of philosophy. In the Muslim world, Ibn Rushd is known above all for his Tahfut at Tahafut (The Incoherence of the Incoherence) and Mabâdi ‘l-Falâsifah (The Principles of Philosophy). In Tahfut at Tahafut, Ibn Rushd bitterly attacked Al-Ghazili’s Tahafut al-falasifa (The Incoherence of the Philosophers), a work in which the 12th century theologian Al-Ghazali sought a strengthening of piety by attacking the philosophers. Ibn Rushd, point by point, discussed the “alleged” errors in al-Ghazali’s views and methodology. He affirmed that the evidence brought out by al-Ghazali’s attack on philosophers arises when isolated components of philosophy are taken out of context, appearing to contradict the remainder. Ibn Rushd the Physician The philosophical, religious and legal works of Ibn Rusd have been studied more thoroughly than his medical books. Among his mentors in medicine were Ali Abu Ja’far Ibn harun al-Tarrajani and Abu marwan Ibn Jurrayul (or Hazbul, according to al-Safadi).8 His important contribution to medicine was “Al- Kulliyat fi Al-Tibb” (Colliget or “ Generalities on Medicine”), which was written between 1153 and 1169. The Colliget was translated to Hebrew and Latin 90 years later and taught in Europe until the 18th century. This treaty is a summary of the medical science at that time and is subdivided into seven books:8 Tashrih al-a’lda’ (“Anatomy of Qrgans”), al-Sihha (“Health”), al-Marad (“Sickness”), al-’Alamat (“Symptoms”), al-Adwiya wa ‘l-aghdhiya (“Drugs and Foods”), Hifz al-sihha (“Hygiene”), and Shifa al-amrad (“Therapy”) Ibn Rushd was very much interested in anatomy. He stated that the “practice of dissection strengthens the faith” due to his view of the human body as “the remarkable handiwork of God in his creation.”9 In neurology and neuroscience, Ibn Rushd suggested the existence of Parkinson’s disease and attributed photoreceptor properties to the retina.10 Ibn Rushd’s views on retinal sensitivity and ocular functions are addressed in several publications.11–13 Ibn Rushd’s work on stroke complemented the work of Al-Razi and Ibn Sina in replacing the fairly simple model handed down by Galenists of the Byzantine period by more detailed classifications, which proposed “cerebral” as well as “vascular” origins of the disease without suggesting a “cerebrovascular” etiology.14 In urology, he identified the issues of sexual and erectile dysfunction, and was among the first to prescribe medication for the treatment of these problems. He used several methods of therapy for this issue, including the single drug method where a tested drug is prescribed, and a “combination method of either a drug or food.” Most of these drugs were oral medication, though a few patients were also treated through topical or transurethral means.15 Averroes examined the nature, quality and utilization of theriac as an antidote of poisons or venoms and as a treatment of diseases. He stated that if the electuary, as antidote, was beneficial to the patient and to the physician, it might be dangerous as a regular and repeated medication of disease since it could transform the human nature and render it poison-like.16 Ibn Rushd requested his close friend Ibn Zuhr (Avensoar, 1091–1161 A.D.) to write a book on al-Umur al-juz’iyya (particularities, i.e., the treatment of head-to-toe diseases), which he did, and called his book al-Taisir fi ‘l-muddawat wa ‘l-tadbir (“An Aid to Therapy and Regimen”). Ibn Rushd’s al-Kulliyyat and Ibn Zuhr’s al-Taisir were meant to constitute a comprehensive medical textbook. (hence certain printed Latin editions present these two books together and attributes both to Ibn Rushd).8 Ibn Rushd showed interest in Ibn Sina’s Urjuza fi ‘I-tibb (“Poem on Medicine,” Canticum de medicina), on which he wrote a commentary, Sharh Urjuzat Ibn Sina. Because Ibn Rushd’s frame as a physician was eclipsed by his frame as a philosopher, his book Kitab al-Kulyat fi al-Tibb stands no comparison to ‘Continents’ of Al-Raxi (Rhazes) and ‘Canon’ of Ibn Sina (Avicenna). Another reason, alluded to earlier, is that Ibn Rushd was known more as a philosopher and theologist than a physician. The German physician Max Meyerhof remarked that: “In Spain, the philosophical bias predominated among medical men”. The prototypes of this combination are the two Muslims, Ibn Zuhr (Avenzoar) and Ibn Rushd (Averroes). Ibn Rushd’s ideas influenced the transformation of thought in medieval Europe. The last of the great Muslim thinkers, his beliefs were to have an affect on the minds of many middle ages intellectuals of the Middle Ages well beyond the borders of Moorish Spain. A great Christian thinker like Thomas Aquinas was influenced by him.17 In the Western world; he was recognized, as early as the thirteenth century, as the Commentator on Aristotle, contributing thereby to the rediscovery of the Master, after centuries of near-total oblivion in Western Europe. That discovery was instrumental in launching Latin Scholasticism and, in due course, the European Renaissance of the fifteenth century, and Ibn Rushd was depicted in the fresco” The School of Athens,” by the future Renaissance painter Raphael, as one of the greatest philiosophers of all time.17

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          Abu Al Qasim Al Zahrawi (Albucasis): Pioneer of Modern Surgery

          Abu Qasim Khalaf Ibn Abbas Al Zahrawi, known in the West as Albucasis or Zahravius, was born in 936 AD in Al-Zahra’, a suburb, six miles northwest of Cordoba, the capital of Muslim Spain (Al-Andalus). His ancestors were from the Al Ansar tribes of Al Madina Al Munawwarah who came from the Arabian peninsula with the Muslim armies which conquered and lived in Spain. Al-Zahrawi traveled rarely, and spent most of his life in his hometown as a practicing physician-pharmacist-surgeon.1 He served as the court physician to Caliph Al-Hakam-II, at a period considered as the “Golden Age” of Arab Spain when natural and mathematical sciences reached their peak. After a long and distinguished medical career, he died in 1013 AD at the age of 77. Around the year 1000 AD, he wrote his famous book “Al Tasreef Liman ‘Ajaz ‘Aan Al-Taleef”, (The Clearance of Medical Science For Those Who Can Not Compile It). It was a summation of about fifty years of medical education, training, practice and experience. The thirty volumes of the medical encyclopedia covered various aspects of medical knowledge. In addition to sections on medicine and surgery, there were sections on midwifery, pharmacology, therapeutics, dietitics, psychotherapy, weighs and measures, and medical chemistry.1 In Al-Tasreef, three chapters were devoted to surgery. Some of the procedures and techniques detailed in these chapters include the following: Surgery of the eye, ear, and throat. He fully de scribed tonsillectomy and tracheostomy. He devised instruments for internal examination of the ear. He devised an instrument used to remove or insert objects into the throat. He described how to use a hook to remove a polyp from the nose. He described the exposure and division of the temporal artery to relieve certain types of headaches. He utilized cauterization, usually to treat skin tumors or open abscesses. He applied cauterization procedure to as many as 50 different operations. Application of ligature for bleeding vessels and internal stitching utilizing catgut. He preceded the famous French military surgeon Ambroise Pare (1510–1590), claimed to be the first European to utilize sutures, by five centuries. Treatment for anal fistulas. Setting dislocated bones and fractures. His method for setting and reducing a dislocated shoulder was centuries before Kocher introduced his similar technique to European medicine. Removal of urinary bladder calculi. He advised that the treating physician has to insert a finger into the rectum of the patient, move the stone down to the neck of the bladder, then make an incision in the rectal wall or the perineum and remove the stone. He devised instruments for inspection of the urethra. He is credited to be the first to describe ectopic pregnancy. He devised several dental devices and artificial teeth made of animal bones. Page from a 1531 Latin translation by Peter Argellata of Al Zahrawi’s treatise on surgical and medical instruments. Al Zahrawi is considered the father of operative surgery.2,3 He is credited with performance of the first thyroidectomy.4 The last chapter of his comprehensive book, named “On Surgery”, was dedicated to surgical instruments. He introduced over 200 surgical tools, a staggering number by all standards. He gave detailed descriptions of for using probes, surgical knives, scalples, and hooks. He also devised and invented surgical scissors, grasping forceps and obstetrical forceps. His illustrations of surgical instruments were the earliest intended for use in teaching and in methods of manufacturing them.1 Abdel-Halim et al gave a detailed study of Al Zahrawi’s technique of cystolithotomy after inventing operative instruments not known in the Greco-Roman era.5 They reviewed his operative technique in women, his recommendations of two-stage operation in complicated cases and his contributions to lithotripsy by introducing a crushing forceps (Al-Kalaleeb forceps) and a driller fragmenting forceps (Al-Mishaab) to remove impacted stones.5 Al Zahrawi contributed early descriptions of neurosurgical diagnoses and treatment including management of head injuries, skull fractures, spinal injuries and dislocations, hydrocephalus, subdural effusions, headache and many other conditions.6 He described vividly a case of hydrocephalus due to congenital defect of drainage of cerebrospinal fluid: “I have seen a baby boy whose head was abnormally enlarged with prominence of the forehead and sides to the point that the body became unable to hold it up”.1 In addition, he made significant contributions to pediatric surgery. In addition to his description of hydrocephalus, he described harelip, adenoids, ranula, imperforated external urinary meatus, perforated anus, hermaphrodites, gynecomastia, supernumerary and webbed fingers.7 He was the first to describe in detail the medical aspects of hemophilia. His medical writings were highly regarded in the West particularly after being translated by Gerard of Cremona, Rogerius Frugardi, Ronaldus Parmensis and others. His surgical teachings were the most advanced in the Middle Ages until the thirteenth century.1 Al-Tasreef was an essential component of the medical curriculum in European countries for many centuries. 8 The famous French surgeon Guy de Chauliac (1300–1368) quoted him over 200 times in his book appended its Latin edition to his own book on surgery. Several editions of this book (surgical chapters) were published including one at Venice (1497), at Basel (1541) and at Oxford (1778). Finally, he emphasized child education and behavior, school curriculum and academic specialization. He advised that gifted and intelligent students be encouraged to study medicine after completing their primary education in language, grammar, mathematics, astronomy and philosophy.1 This article is just a glimpse of the medical and surgical contributions of this great Arab physician from Andalus to the world.
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            Ibn Sina (Avicenna): The Prince Of Physicians

            Abu Ali Al-Hussein Ibn Abdullah Ibn Sina, known in the West as Avicenna, was one of the most eminent Muslim physicians and philosophers of his days whose influence on Islamic and European medicine persisted for centuries. He was named by his students and followers as “Al Shaikh Al Ra’ees” or the master wise man. The Europeans called him the “Prince of Physicians”. As a thinker, he represented the culmination of Islamic renaissance, and was described as having the mind of Goethe and the genius of Leonardo da Vinci.1 Ibn Sina was born in 980 AD in the village of Afshanah near the city of Bukhara in Central Asia, the capital of the Samani kingdom at that time, in the present country of Uzbekistan. His father, Abdullah, was from the city of Balkh and worked as a local governor for a village near Bukhara. His mother was a Tadjik woman named Sitara. Abdullah realized that his son was a prodigy child and was keen on getting the best tutors for his genius son. At the age of ten, he finished studying and memorizing the Koran by heart and was proficient in Arabic language and its literature classics. In the following 6 years, he devoted his time for studying Islamic law and jurisprudence, philosophy, logic and natural sciences. At the age of thirteen, he started studying the medical sciences. By the age of eighteen, he was a well established physician and his reputation became well known in his country and beyond. He was quoted as stating that: “Medicine is no hard and thorny science like mathematics and metaphysics, so I soon made great progress; I became an excellent physician and began to treat patients using approved remedies”.2 A portrait of Al Hussain Ibn Abdullah Ibn Sina When the Sultan of Bukhara, Nuh Ibn Mansour of the Samanid dynasty, became seriously ill, Ibn Sina was summoned to treat him. After the recovery of the Sultan, Ibn Sina was rewarded and was given access to the royal library, a treasure trove for Ibn Sina who read its rare manuscripts and unique books thus adding more to his knowledge. After the Sultan’s death, and the defeat of the Samanid dynasty at the hands of the Turkish leader Mahmoud Ghaznawi, Ibn Sina moved to Jerjan near the Capsian Sea. He lectured there on astronomy and logic and wrote the first part of his book “Al Qanun fi al Tibb”, better known in the West as “Canon”, his most significant medical work. Later, he moved to Al-Rayy (near modern Tehran) and had a medical practice there. He authored about 30 books during his stay there. He then moved to Hamadan. He cured its ruler Prince Emir Shams al-Dawlah of the Buyid dynasty from a severe colic. He became the Emir’s private physician and confidant and was appointed as a Grand Viser (Prime Minister). When Shams al-Dawlah died, Ibn Sina wrote to the ruler of Isfahan for a position at his court. When the Emir of Hamadan became aware of this, he imprisoned Ibn Sina. While in prison, he wrote several books. After his release, he went to Isfahan. He spent his final years serving its ruler Emir Ala al-Dawlah. He died in 1037 AD at the age of 57. He was burried in the city of Hamadan. A monument was erected in that city near the site of his grave. It is claimed that Ibn Sina had written about 450 works, of which 240 had survived.3 Some bibliographers list only 21 major and 24 minor works dealing with philosophy, medicine, astronomy, geometry, theology, philology and art. He wrote several books on philosophy, the most significant was “Kitab al Shifa” (The Book of Healing). It was a philosophical encyclopedia that brought Aristotelian and Platonian philosophical traditions together with Islamic theology in dividing the field of knowledge into theoretical knowledge (physics, metaphysics and mathematics) and practical knowledge (ethics, economics and politics). Another book on philosophy was “Kitab al-Isharat wa al tanbihat” (Book of Directives and Remarks). However, his book Al Qanun fi al Tibb or simply the Canon is the most influential medical book ever written by a Muslim physician. It is a one million word medical encyclopedia representing a summation of Arabian medicine with its Greek roots, modified by the personal observations of Ibn Sina. This book was translated to Latin in the 12th century by Gerard of Cremona. It became the textbook for medical education in Europe from the 12th to the 17th century. It is stated that in the last 30 years of the 15th century, the Canon passed through 15 Latin editions and one Hebrew edition. The Canon is divided into five books, including medical therapeutics, with 760 drugs listed. The books are: Book I: Part 1: The Institutes of Medicine: Definition of medicine, its task, its relation to philosophy. The elements, juices, and temperaments. The organs and their functions. Part 2: Causes and symptoms of diseases. Part 3: General dietetics and prophylaxis. Part 4: General Therapeutics. Book II: On the simple medications and their actions. Book III: The diseases of the brain, the eye, the ear, the throat and oral cavity, the respiratory organs, the heart, the breast, the stomach, the liver, the spleen, the intestine, the kidneys and the genital organs. Book VI: Part 1: On fevers. Part 2: Symptoms and prognosis. Part 3: On sediments. Part 4: On wounds. Part 5: On dislocations. Part 6: On poisons and cosmetics. Book V: On compounding of medications. In his book, Ibn Sina correctly documented the anatomy of the eye along with description of ophthalmic conditions such as cataracts. He stated that tuberculosis was contagious. He described the symptoms of diabetes, and gave descriptions of the types of facial paralysis. He described several psychiatric disorders including the so-called disorder of love, which he considered as an obsessive disorder resembling severe depression. He described a cachectic debilitated male patient with fever. By reaching to his loved one, he quickly regained his health and strength.4 Eight chapters in the Canon dealt with the functional neuroanatomy of the spine including the structure of the vertebrae and the various parts of the vertebral column and its biomechanics.5 Other authors wrote about Ibn Sina contributions to perinatal medicine, including binding of infants, their sleeping quarters, bathing and feeding as well as on causes of deformity.6 At the millenium of his birth in 1980, numerous articles were published in his honor in numerous languages, a tribute for this great Muslim physician.
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              Ibn Al-Nafis: Discoverer of the Pulmonary Circulation

              The Arab physician Ala’ al-Din ibn Abi al-Hazm, well known as Ibn al-Nafis, was born in the year 1210 in al-Qurashiyya, a village near Damascus, hence he was known as Al-Dimashqi. His family originally came from Qarash, a village beyond the River Oxus, and that, according to some authors, gave him the “nisbah” of al-Qurashi.1 His initial medical studies were in Damascus at the Great Nuri Hospital, Al-Bimaristan Al-Nuri Al-Kabir, built by the Turkish Prince Nur al-Din Mahmoud ibn Zanki after his conquest of Damascus in 1154. Ibn al-Nafis teacher at that hospital was Muhadhdhab al-Din Abd al-Rhim ibn Ali Al-Dakhwar, who established al-Dakhwariyya Medical School in Damascus, and was the Chief of Physicians for Syria and Egypt during the rule of the Ayyubid ruler al-Adil. Al-Dakhwar was appointed by al-Adil’s successor, al-Muazzam, as the head of the Nuri Hospital.2 Other contemporaries of Ibn al-Nafis were Ibn Abi Usaybi’a and Ibn al-Quff. In 1236, Ibn al-Nafis moved to Egypt. He became Chief of Physicians (Ra’is Al-Atibba’) in Egypt and the private physician for the Mamluk ruler Sultan Al-Zahir Baybars al-Bunduqdari, who ruled Egypt during the period 1260–1277. He had a thriving practice and became wealthy. He built a house in Cairo, and entertained rulers, leading physicians and colleagues. Towards the end of his life, Ibn al-Nafis donated his house and library to the newly established Al Mansouri Hospital, which was built in 1284 by the Mamluk Sultan al-Mansur Sayf al-Din Qalawun al-Alfi.1–3 He died in Cairo on December 17, 1288, at the age of 78, after an unknown illness. In addition to his medical studies, Ibn al-Nafis learnt Islamic religious law, and became a renowned expert on Shafi’i school of jurisprudence (Fiqh). He lectured at al-Masruriyya School in Cairo. His name was included in a book on “Great Classes of Shafi’i Scholars (Tabaqat al-Shafi’iyyin al-Kubra) by Taj al-Din al-Subki indicating his fame in religious law.1 Ibn al-Nafis was a prolific author. He had an outstanding memory and had written his books from memory without reference to other textbooks or compendia. According to Nagmia, his works can be divided into several categories2: I. Original contributions Kitab Al-Shamil fi al-Sina’a al-Tibbiyya (Comprehensive Book on the Art of Medicine). He wrote this book when he was in his thirties. It consisted of 300 volumes of notes, 80 of which were published. This book contained a section on surgical techniques, thus shedding lights on Ibn al-Nafis as a surgeon. According to Iskandar, there are three stages for each Operation: al-I’ta’ (The presentation for diagnosis); al-’amal (the operative procedure); and al-hifz (preservation-post operative care).1 Kitab Al-Mukhtar Min al-Aghdiyah (Book of Selection of Nutrients). Al Muhadhab fi al-Kohl (The Polished Book on Ophthalmology). Bughyat al-Talibin wa Hujjat al-Mutatabbibin (Reference Book for Physicians). Kitab Jame’ Al-Daqai’q fi al tibb (The Composite of Details in Medicine). II. Commentaries on Greek works Sharh Fusul Al Buqrat (Commentary on Hippocratic Aphorism). Ibidimiya li Buqrat wa tafsiruhu li al Amrad al Wafideh (Commentary on the Epidemiology of Disease by Hippocrates) Sharh Taqdimat Al-Ma’rifah (Commentary on Hippocratic Prognostics). Sharh Tabi’at al-Insan li Buqrat (Commentary on Hippocrates book “De Natura Hominis’ or Nature of Man). III. Commentaries on Islamic medical works; Kitab Mujaz al-Qanun (Commentary on Al Qanun fi al Tibb by Ibn Sina). This commentary made Ibn Al Nafis most famous, and was published several times. A review of this book was written by Kahya from a copy in Turkey.4 Sharh Tashrih Al Qanun (Commentary on the Anatomy in Al-Qanun). In this book, he gives the earliest description of the pulmonary circulation. Sharh Mufrada Al Qanun (Commentary on Simple Medicines in Al Qanun). Sharh Masai’l Hunain (Commentary on Questions of Hunain Ibn Ishaq). VI. Contributions to Islamic theology and philosophy Al Risalah Al Kamaliyyah fi al Sira al Nabawiyyah known also as Fadil bin Natiq on the life story of the prophet of Islam. Al Mukhtasar fi Ilm Usoul al Hadith (A Short Account of the Methodology of Hadith). Several articles by Arab and Western authors discuss the role of Ibn al-Nafis in the discovery of the pulmonary circulation.5–10 He challenged the Galenic concept of circulation which stated that blood reaching the right side of the heart went through invisible pores in the septum of the left side of the heart, where it mixes with air to create spirit and then was distributed to the body.6 Western writers gave credit of the discovery of the pulmonary circulation to Michael Servetus (1511–1553), a Spanish physician and theologist,11 and to William Harvey.12 Soubani and Khan elaborated on the European descriptions of circulation and the resemblance between the writings of Ibn al-Nafis on this issue and those of later European writers such as Servetus, and Colombo.6 Some authors believe that Western writers used Ibn al-Nafis concept of circulation in their “re-discovery” three hundred years later.13 One writer raised questions regarding whether Ibn al-Nafis was known to the European scholars during the age of Renaissance and that they opted to ignore his writing or not give proper credit to him.14 The credit for recognizing Ibn al-Nafis as the discoverer of the pulmonary circulation goes to Dr. Muhyi al-Din al-Tatawi of Egypt. In 1924, Dr. al-Tatawi found a manuscript of “Sharh Tashrih al-Qanun” in the Prussian State Library in Berlin (Manuscript 912), while working on his dissertation for a doctorate at the Faculty of Medicine of the Albert Ludwigs University in Freiburg, Germany.2,5–7 Ibn al-Nafis stated the following regarding the pulmonary circulation: “...This is the right cavity of the two cavities of the heart. When the blood in this cavity has become thin, it must be transferred into the left cavity where the pneuma is generated. But there is no passage between these two cavities, the substance of the heart there being impermeable. It neither contains a visible passage, or as some people thought, nor does it contain an invisible passage which would permit the passage of blood, as Galen thought. The pores of the heart there are compact and the substance of the heart is thick. It must, therefore, be that when the blood has become thin, it is passed into the arterial vein (pulmonary artery) to the lung, in order to be dispersed inside the substance of the lung, and to mix with the air. The finest parts of the blood are then strained, passing into the venous artery (pulmonary vein) reaching the left of two cavities of the heart, after mixing with the air and becoming fit for the generation of pneuma...”1 Ibn Al-Nafis’ 13th century treatise The Concise Book (Kitab Mujiz) which epitomized the Canon of Ibn Sina. 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.9 Ibn al-Nafis also postulated that the nutrition of the heart is extracted from the small vessels passing through its wall. He stated “...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...”. This rarely mentioned contribution of Ibn al-Nafis on the nutrition of the heart and its blood supply made him the first to put forward the concept of coronary circulation.6 Ibn al-Nafis’ works were translated to Latin in Venice, Italy, by Andrea Alpago of Belluno in 1547. He was a physician working for the Consulate of the Venice in Damascus. Few years later, Michael Servetus from Aragon, Spain, 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 The Church accused Servetus of heresy for his insistence on denying the dogma of the Trinity, and for opposing the teachings of Galen. He was burnt at the stake by order of the protestant Geneva governing council as a heretic. About the same time, Andreas Vesalius, the famous Flemish anatomist, described the pulmonary circulation in his book “De Humani Corporis Fabrica”, in a manner similar to Ibn Nafis’ description. 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...” However, 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...” It is not clear whether Vesalius had access to Ibn al-Nafis translated work or not. William Harvey wrote in his book “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus”, published in 1628, about the movement of the blood and the importance of valves in the circulation of blood.12 In his book he described the movement of the blood from the heart to the lung. However, he did not elaborate on the physiology of the pulmonary circulation and its role in the exchange of gases.6 We conclude that Ibn al-Nafis should be recognized as the first discoverer of the pulmonary circulation, 300 years before it was described by European physicians.
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                Author and article information

                Journal
                Ann Saudi Med
                Ann Saudi Med
                Annals of Saudi Medicine
                King Faisal Specialist Hospital and Research Centre
                0256-4947
                0975-4466
                Mar-Apr 2008
                : 28
                : 2
                : 145-147
                Affiliations
                [a ]Department of Pathology and Laboratory Medicine, Hôtel-Dieu Grace Hospital, University of Western Ontario, Windsor, Canada
                [b ]Dhahran Health Center, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
                Author notes
                Correspondence and reprints: Abdelghani Tbakhi, MD, Department of Pathology and Laboratory Medicine Hôtel-Dieu Grace Hospital, 1030 Ouellette Ave., Windsor, ON-N9A 1E1, T: (519) 973-4411, ext 3579, Abdelghani.Tbakhi@ 123456hdgh.org
                Article
                asm-2-145
                10.5144/0256-4947.2008.145
                6074522
                18398288
                1824cb92-423e-45c3-bb48-31283b113c8f
                Copyright © 2008, Annals of Saudi Medicine

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Medicine
                Medicine

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