Contributions of Ibn al-Nafis to the Progress of Medicine and Urology

This primary-source study of four medical works of the 13th century Muslim scholar Ibn al-Nafis confirmed that his Kitab al-Mûjaz fi al-Tibb was authored as an independent book. It was meant as a handbook for medical students and practitioners not as an epitome of Kitab al-Qanun of Ibn Sina as thought by recent historians. Ibn al-Nafis' huge medical encyclopedia Al-Shamil represents a wave of intense scientific activity that spread among the scholars of Cairo and Damascus in the 13th century. Like his predecessors in the Islamic Era, Ibn al-Nafis critically appraised the views of scholars before him in the light of his own experimentation and direct observations. Accordingly, we find in his books the first description of the coronary vessels and the true concept of the blood supply of the heart as well as the correct description of the pulmonary circulation and the beginnings of the proper understanding of the systemic circulation. Those discoveries, spreading from East to West, were translated into Latin by Andreas Alpagus and appeared in the works of European scholars from Servetus to Harvey. Furthermore, this study documented several other contributions of Ibn al-Nafis to the progress of human functional anatomy and to advances in medical and surgical practice.

+ Click to read the full article
- Click to close

Professor Rabie E. Abdel-Halim*

Table of contents

1. Summary

2. Who was Ibn al-Nafis?

3. The Study Method

4. The art of writing a medical textbook

5. Critical appraisal of literature and reliance on observation and experimentation

6. Emphasis on the study of anatomy for physicians and further progress in anatomical drawings in medical textbooks

7. Contributions to the progress of urology

8. Supplement: Commentary and Response

8.1. [Ibn] Al-Nafis and Servetus by Giles N. Cattermole
8.2. Reply from the Author Rabie E. Abdel-Halim

***

Note of the editor

This article was published in Saudi Medical Journal 2008; Vol. 29 (1): 13-22 (electronic version here), followed by a "Commentary and Response" (2008 : Vol. 29 (9) : 1359-1360). It is online on the website of Professor Abdel-Halim here. The article is published on www.MuslimHeritage.com in a revised and re-edited format approved by the author. We thank Professor Abdel-Halim for allowing its republication.

***

1. Summary

This primary-source study of four medical works of the 13th-century Muslim scholar Ibn al-Nafis confirmed that his Kitab al-Mûjaz fi al-Tibb was authored as an independent book. It was meant to be a handbook for medical students and practitioners and not as an epitome of Kitab al-Qanun of Ibn Sina as thought by recent historians. His huge medical encyclopedia Al-Shamil represents a wave of intense scientific activity that spread among the scholars of Cairo and Damascus following the massive destruction of books by Hulago's army during the devastation of Baghdad in 1258. Like his predecessors in the Islamic era, Ibn al-Nafis critically appraised the views of scholars before him in the light of his own experimentation and direct observations. Accordingly, in his books Sharh Tashrih al-Qanun, Risalat al-A'dhâ' and Al-Risalah al-Kamiliyah, we find the first description of the coronary vessels and the true concept of the blood supply of the heart as well as the correct description of the pulmonary circulation and the beginnings of the proper understanding of the systemic circulation.

Those discoveries of Ibn al-Nafis, translated into Latin by Andreas Alpagus in a book that was printed in Venice in 1547, appeared six years later, in the Christianismi Restituto of Servetus and, in 1555, in the De Fabrica Humani Corporis of Vesalius (2nd edition) then in the works of Valvarde (1554), Columbus (1559), Cesalpino (1571), and finally Harvey in 1628. Furthermore, this study documented several other contributions of Ibn al-Nafis to the progress of human functional anatomy and to advances in medical and surgical practice.

Many historians recorded that in the 12th and 13th centuries Damascus and Cairo took the place of Baghdad as leading centers for science and culture [1]. Despite the turmoil caused by the invading Crusader and Mogul armies, great medical schools continued to advance medical knowledge and nurture medical education in those two cities and other cities of the Muslim World. Ibn al-Nafis was one of the distinguished medical scholars who lived during that turbulent era. This study is to evaluate his contributions to the progress of medicine.

2. Who was Ibn al-Nafis?

Ibn al-Nafis was the 13th-century Muslim physician ‘Alâ' al-Dîn abu al-Hasan ‘Ali ibn abi al-Hazm al-Qarshi, born in the year 1210 at Al-Qarsh near Damascus. He studied medicine in Damascus under the supervision of the distinguished professor Muhadhab al-Din al-Dakhwar in the Al-Nuri hospital's medical school. Ibn al-Nafis moved to Cairo where he practiced and taught medicine in the Al-Naseri hospital built by Salah al-Din al-Ayyubi. Then in 1285, he became the chief physician of the Mansuri hospital, a position he held until he died in 1288 at the age of 80. Figure 1 shows the timeline of Ibn al-Nafis in relation to some of his predecessors and contemporaries who, like him, pioneered the original contributions of the Islamic school of medicine. According to Al-Dhahaby [2], Al-Sobky [3], Ibn Tagra Bardi Al-Atabki [4], al-Maqrizi [5], Al-Yafi' [6], Sarton [7], Ziedan and Abdel-Qader [8], Ziedan [9], and many other historians [10], Ibn al-Nafis was a great physician and a prolific author, the best among his contemporaries and the most distinguished scholar of his time in the medical profession. Ibn al-Nafis was also a distinguished authority on Quranic studies, Prophetic Tradition, Islamic jurisprudence, Islamic philosophy and Arabic language studies [11]. He wrote famous authoritative works in almost each of those sciences.


Figure 1: Timeline (in CE) of Ibn al-Nafis in relation to some of his contemporaries and predecessors. The filled-in event box is for Ibn al-Nafis, the dotted-boundary box for his professor Muhadhdhab al-Din al-Dakhwar and the dashed-boundary box for Ibn al-Quff, one of his most famous students.

3. The Study Method

In order to evaluate the contributions of Ibn al-Nafis to the progress of medicine and urology, authentic primary sources were utilized to review his biography and the original Arabic editions of his book Al-Mûjaz fi al-Tibb [12] (An epitome of Medicine) together with chapters from his other medical books: Sharh Tashrih al-Qanun [13] (A commentary on the Anatomy of the Canon of Medicine [of Ibn Sina]), Risalat al-A'dhâ' [14] (A Monograph on Physiology) and Sharh Fusul Abuqrat [15] (Commentary on the Aphorisms of Hippocrates), were studied. Furthermore, pertinent references including books, periodicals and online history-of-medicine resources have been reviewed.

4. The art of writing a medical textbook

Al-Mûjaz [16] book shows the skill of Ibn al-Nafis in classifying his medical knowledge and writing it down using a planned, rigorous and orderly method and a lucid, concise but precise and to-the-point style (Figure 2 and Table 1):

Table 1 - The general arrangement of topics in Kitab al-Mûjaz fi al-Tibb of Ibn al-Nafis.

Section I: General Principles

Subsection 1: Of the theory of medicine

Part 1: The normal

Part 2: The abnormal

Part 3: Etiology

Part 4: Symptoms and signs

Subsection 2: Of the practice of medicine

1. The science of maintaining health

2. The science of treating illness

Section II: Medicaments & Diet

Subsection 1: Simple drugs

1. Generalities

2. Mentioning of the simple drugs alphabetically listed

Subsection 2: Compound drugs

1. On the rules for compounding drugs

2. Some examples of compound drugs

Section III: Diseases of organs (and systems)
Diseases of organs, one by one starting from the brain downwards describing the causes, diagnosis and treatment

Section IV: Diseases not specific for a particular organ
Chapter 1: Fevers
Chapter 2: Crisis and lysis
Chapter 3: Swellings, ulcers, leprosy, and the plague and how to avoid it
Chapter 4: Fractures, Contusions, Dislocations, Falls and Abrasions
Chapter 5: Care of skin, hair and figure (body weight)
Chapter 6: On poisons and their avoidance


Figure 2: Chart showing the subject classification of Kitab al-Mûjaz fi al-Tibb of Ibn al-Nafis.

This represents a salient feature of medical textbooks authored during the Islamic period and is in agreement with Cumston [17] and Leclerc [18] who admired the clarity of medical textbooks written by Islamic physicians when compared with those of ancient authors. In the early biographies of Ibn al-Nafis [19], the title of this book is given as Kitab al-Mujaz fi al-Tibb (The Epitome in Medicine) or is shortened as Kitab al-Mujaz (The Epitome). None of those early biographers mentioned that the book was a summary of Kitab al-Qanun fi al-Tibb written by Ibn Sina 250 years previously.

However, almost all the recent biographers, following Hajji Khalifah [20] (1017-1067 H/1609-1657) identified the book as Kitab Mujaz al-Qanun (An epitome of the Canon book) [21]. Most of them repeated a statement that in Al-Mujaz Ibn al-Nafis meant to give a summary of Ibn Sina's book The Canon of Medicine [22]. This is not proven by our study, which confirmed that Kitab al-Mujaz was authored by Ibn al-Nafis as an independent book intended to be a handbook of general medicine for medical students and practitioners. In his introduction to the book [23], Ibn al-Nafis did not mention The Canon of Ibn Sina at all or any plan to summarize it. Furthermore, both the arrangement and content of the chapters are different in both books.

Moreover, contrary to Iskander [24], and for the same reasons, the Mujaz of Ibn al-Nafis is not a summary of his other book Kitab Sharh al-Qanun. The most voluminous book of Ibn al-Nafis is his encyclopedic work entitled Kitab al-Sahmil fi al-Sina'a al-Tibbiya (The comprehensive book on the art of medicine) [25]. According to the 13th to 14th century historian Al-Dhahaby (1274-1348) [26], judging from its pre-planned table of contents, the book was intended to be in 300 volumes. However, Ibn al-Nafis lived only to write 80 volumes out of which, until now, only 28 volumes could be found and which are being edited and published in a series by Ziedan [27]. Al-Shamil is the sixth encyclopedic scientific work ever written by a single author. The five famous encyclopedic medical works that preceded Al-Shamil are shown in Table 2. They were all written in the period from the 9th to the 13th centuries. According to Ziedan [28], the encyclopedic work Kitab al-Shamil of Ibn al-Nafis represents a wave of intense scientific activity that spread among the scholars of Cairo and Damascus, following the massive loss and destruction of books during the devastation of Baghdad by Hulago's army in 1258. Ibn al-Nafis was then fifty years old and at the peak of his medical experience. He wrote Al-Shamil and other scholars wrote similar huge encyclopedic works in different branches of science in an attempt to cope with the disaster and to preserve the scientific and cultural heritage pioneered by Baghdad, the leading centre of Islamic civilization in that era.

This intensive encyclopedia writing activity also extended to the Islamic scholars of the 14th and 15th centuries enriching and preserving the world's heritage of knowledge [29].

Table 2 - Encyclopedic medical works that preceeded Al-Shamil book of Ibn al-Nafis

Scholar Century (CE) Encyclopedic Book
Al-Razi (Rhazes) 9-10th Al-Hawi*
Ali ibn al-Abbas 9-10th Kamil al-Sina'a*
Al-Zahrawi (Albucasis) 10-11th Al-Tasrif*
Ibn Sina (Avicenna) 10-11th Al-Qanun*
Ibn Zuhr (Avenzoar)
Ibn Rushd (Averroes)
11-12th Al-Taysir together with Al-Kulliyat**
Al-Baghdadi,
Muhadhdhab Al-Din
12-13th Al-Mukhtar fi al-Tibb*
Ibn al-Nafis 13th Al-Shamil fi al-Sina'a al-Tibbiyya*

 

*Written by a single author
** The first multi-authored medical textbook [30]

Table 3 - Titles and description of some of the medical works of Ibn al-Nafis

The Book Description
Al-Shamel fi al-Sina'a al-Tibbiya
(The Comprehensive Book on the Art of Medicine)
Massive encyclopedia
Al-Mujaz fi al-Tibb
(The Epitome in Medicine)
Comprehensive summary
Sharh al-Qanun
(Commentary on the Canon of Medicine)
General Principles
Pharmacy
Sharh Tashrih al-Qanun
(Commentary on the Anatomy of the Canon of Medicine)
Anatomy
Risalat Al A'dha'
(A Treatise on Physiology)
Physiology
Al-Muhadhab fi al-Kuhl al-Mujarrab
(The Refined Book on Ophtalmology)
Textbook on ophthalmology

Examining Table 3, which lists of some of the medical works authored by Ibn al-Nafis, will further reveal his skill in preplanning his works. All the books integrate and complement each other. Al-Shamil [31] is an encyclopedic data base for the researcher; Al-Mujaz [32] is a handbook for medical students and the general practitioner. Anatomic, physiological or surgical details are not included in that book. Surgical details are available in volume 42 of Al-Shamil [33]; physiological in Kitab Risalat al-A'dha' [34] and anatomical in Kitab Sharh Tashreeh al-Qanun [35]. Kitab al-Mujaz [36] contains general practice knowledge on diseases of the eye but Al-Muhadhab fi al-Kuhl al-Mujarab [37] is a book for the specialist ophthalmologist.

5. Critical appraisal of literature and reliance on observation and experimentation

Like his predecessors in the Islamic medical tradition, Ibn al-Nafis critically appraised the views of those who came before him in the light of his own experience, experimentation and direct observations. The following translation from his introduction to his book Sharh Fusul Abuqrat (Commentary on the Aphorisms of Hippocrates) clearly shows his aim of rejecting what is superfluous and accepting only what is proved to be true:

"In our previous commentaries on this book, copies (editions) varied according to the various purposes of those who requested them. However, in this copy (edition) we are going to follow what we believe is appropriate for commentary works and just right in composing and bringing together. Furthermore, with regard to throwing light on and standing by true opinions as well as denouncing those which are false and wiping out their traces; that was the constant policy we followed in all studied subjects. And may Allah guide and help us to do that [38]."

This critical appraisal is also quite obvious in his other book Sharh Tashrih al-Qanun, where he disagreed with several of the Galenic and Hippocratic doctrines. In this book, Ibn al-Nafis stated the following:

"However, as regards the function of organs, we rely only on what is dictated by investigative observations and accurate research; not caring whether it conformed with, or differed from, the opinions of those who came before us [39]."

Accordingly, in Sharh Tashrih Al-Qanun, we find one of the great discoveries in the history of physiology: the first correct description of the pulmonary circulation (translated as follows from page 293-294):

"In the human heart and in the hearts of similar beings possessing a lung, it is necessary to have another cavity where the blood becomes thin and ready to be admixed with air. Indeed, if air gets mixed with blood while it is still thick, the resulting mix will not be of homogeneous particles. That cavity is the right cavity of the two cavities of the heart. And when the blood in that cavity becomes thin, it must pass to the left cavity where the vital spirit (ruh or pneuma) is formed. But, there is no connecting passage in between them (the two cavities) because the heart substance there is compact without any obvious passage, as thought by some, or invisible passage that could transmit that blood as thought by Galen. Indeed the texture of the heart, there, is compact and its substance is thick. Therefore that blood when becomes thin, must pass through the arterial vein (pulmonary artery) to the lungs to spread in its substance and mix with air in order to purify (filter, clear) the thinnest part of it then pass to the venous artery (pulmonary vein) to be carried to the left cavity of the two cavities of the heart admixed with air and, thus, made ready to generate the vital spirit. And the blood that remains less thinner will be used by the lung for obtaining its nutrients. It is for that reason that the arterial vein was made of greater compactness and with two layers so that what passes through its pores would be very thin while the venous artery was made thin walled with only one layer in order to easily allow in what comes out of that vein. For that reason, perceptible connecting passages were made between these two vessels [40]."

In agreement with Poynter [41], Isakander [42], Castiglioni [43], and others [44], in this unambiguous description of the pulmonary circulation, Ibn al-Nafis firmly denied the Galenic concept of the existence of invisible pores in the septum between the right and left ventricles of the heart. Furthermore, the last sentence of the above-mentioned new extended translation furnishes evidence that Ibn al-Nafis discovered the capillary circulation that connects the pulmonary artery branches to the tributaries of the pulmonary vein in the lung substance. The following translated quotations from Sharh Tashrih al-Qanun show some more places where Ibn al-Nafis, using his own anatomical observations, disproved other Galenic doctrines, which were taken for granted for several hundred years:

"As regard his statement [the statement of Galen accepted by Ibn Sina] that the heart has three ventricles: this cannot be correct because the heart has only two ventricles. Indeed dissection disproves what they said [45]."

Furthermore, the first ever mention of coronary vessels is found on page 389 of Sharh Tashrih al-Qanun of Ibn al-Na