Islamic Physicians (4/4)

Ibn-El-Nafis 1208 - 1288 A.D.

In 1208 A.D., Ala'El-Deen Ibn-El-Nafis was born in a small town near Damascus called Kersh (Ibrahim 1971). He learned medicine and philosophy in Damascus and spent most of his life in Cairo. He was a physician, a linguist, a philosopher, and a historian. He was the first chief of Al-Mansuri Hospital in Cairo and the dean of the School of Medicine in 1284 A.D.

During this era, the medical profession together with other branches of science were passing a crisis. The Mongol Tartar invasion and destruction of Baghdad in 1258 A.D. caused an injury to the Islamic civilization from which it never recovered. It destroyed forever the Caliphate, symbolic unity of the Arabian Empire, and the preeminence of Baghdad as a center for learning. Also during that period Islamic culture was declining in Spain. It was then Cairo and Damascus the centers for education and medical prestige. There, the medical profession was characterized by the freedom of discussion and expression of opinion, something that was very new in medicine and not known to Europe until the 17th century when introduced to England by Sedenbam (Ibrahim 1971).

Ibn-El-Nafis was a dedicated person. He used to start his day after dawn prayers by making rounds at the hospital, followed by case discussions with students and colleagues, then hospital administration. His evenings were spent reading, writing and discussing medicine and philosophy with frequent scholar guests at his home in El-Hussein District in Old Cairo. His house was an example of beautiful Arabic architecture, made of marble with a fountain in the central hall.

In the history of mankind, there are persons whose importance is revealed with the flight of time and their truth glows with the passage of centuries; Ibn-El-Nafis is one of those. He wrote many books, ten of them in medicine and a special one in philosophy. In the latter book "Fadel Ibn- Natik", he tried to present the counter point of the philosophical view of Avicenna expressed in his book "Hai Ibn-Yakzan". He was an authority in theology on which he wrote several books, e.g. "The complete Message of the Prophet" and "Al-Ragol Al-Kamel" (The Perfect Man) supporting Unitarianism. Ibn-El-Nafis had an important character, not being a follower but a scholar. This was evident in his writings whether in philosophy or medicine. In medicine he wrote many books, two of them are "Mujaz Al-Qanun" which means the "Summary of the Canon". In these two books which were based on Avicenna’s writings, he criticized the short comings of Avicenna's book and of Galen's views and added to them. That is why he was named by some as Avicenna the Second. For example he wrote "... We have relied chiefly on his (Galen) teachings, except in a few details which we think are wrong and were not given after a thorough investigation. In describing the function of the organs, we have depended on careful investigation, observation, and honest study, regardless of whether or not these fit with the teachings and theories of those who have preceded us."

Ibn-El-Nafis added lights to the physiology of the circulation. In the ancient history, Erasistratus of the Alexandria Scbool (310 B.C. - 250 B.C.) believed that blood was contained only in the eight side of the circulation, namely the veins and the fight side of the heart. The left side of the circulation, namely the left side of the heart and the arteries were supposed to contain air because arteries were found empty when an animal was sacrificed, hence the name "arteria".

When Galen came (131 - 210 A.D.), he described blood to pass from the right side of the heart to the left side through minute openings in the septum of the heart, then it mixed with air from the lungs, and sequently distributed to the whole body. For centuries this was the prevalent belief and no one, including the Arab physicians and their eminent writer Avicenna, could dare to challenge this sacred view. Ibn-El-Nafis did. Five times he stated in unmistakable terms 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 substance, he mingled with air, pass through the arteria venosa (Pulmonary vein) to reach the left chamber of the heart..." (Salem 1968). In describing the anatomy of the lung Ibn-El-Nafis stated: "The lung is composed of. first, the bronchi: second, the branches of the arteria a venosa; and third, the branches of the vena arteriosa; all of these are connected by loose porous flesh ... The need of the lung 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 lung may mix with what is of air therein and combine with it ... and the mixture is carried to the left cavity of the heart by the arteria venosa" (Haddad 1936).

Ibn-El-Nafis also made other contributions in the circulation. Avicenna, following Galen's description of the anatomy, stated that the human heart has three ventricles. Ibn-El-Nafis rejected that as he said "...And his statement ((Avicenna's) that the heart has three ventricles is not correct, as the heart has only two ventricles..." He was also the first to describe the coronary circulation as he wrote "...Again, his statement (Avicenna's) that the blood in the right side is to nourish the heart is not true at all, for the nourishment of the heart is from the blood that goes through the vessels that permeate the body of the heart...

Three centuries after the discovery of the pulmonary circulation by Ibn- El-Nafis, others, such as Michael Servetus, Realdus Colombus, Carlo Ruini, Andrea Cesalpino, and Francois Rabelais, claimed the same thing (Mayerhof 1935). There is a strong suspicion that these authors obtained their knowledge from the Arabic literature which was available at that time to the European investigators without giving credit to Ibn-El-Nafis (Keys 1971, Haddad 1942). It is considered to be more than a coincidence that Servetus would discover the pulmonary circulation, and also to write a book, similar to that of Ibn-El-Nafis, on Unitarianism. Servetus was burnt with his book, "Restitutio Christianismi" in Geneva in October 1553 at the order of Calvin because he was considered heretic.