Stomach

The medical scholars during the medieval Islamic era placed great emphasis on the value of dissection and the knowledge of anatomy for the diagnosis of affected organs, the relationships of the organs to one another and the application of adequate medical and surgical treatment...

Anatomy of the Ureterovesical Junction

An imaginary picture of Ibn Nafis when autopsied. Published in International journal of cardiology 2016 (Source)

Al-Rāzī, al-Zahrāwī, Ibn Sīnā, al-Baghdādī, Ibn al-Nafīs and Ibn al-Quff agreed with Galen that the ureters run obliquely for some distance in the bladder wall before opening into its cavity. Only al-Zahrāwī denoted that their course within the bladder wall is sinuous rather than straight. However, all of them, unlike Galen, identified the differentiation of the bladder wall into two layers with the ureters acquiring their course in between them, first by penetrating the outer layer then, near the bladder neck, penetrating the second layer to open into the lumen of the bladder. Meanwhile, Ibn al-Quff stated that the two penetration sites are not opposite each other and, as denoted by Ibn al-Nafīs, the first penetration is situated at a level superior to the second one.[1-7]

Location of the Stomach

ʿAlī ibn al-ʿAbbās and Ibn Sīnā followed the statement of Galen, that:

“the canal of the stomach (the oesophagus) is carried upon the first four vertebrae of the thorax and lies on the right side of the remaining eight”. [8-10]

Thus, according to Ibn al-Nafis, it became popular among physicians to think that the oesophagus, after piercing the diaphragm at the twelfth thoracic vertebra, gradually widens to make the so-called “mouth of the stomach” as a receiving channel. However, Ibn al-Nafīs believed that this was a common erroneous conception and that the mouth of the stomach must be at a higher level, which is about the lower end of the sternum. Consequently, when it is subjected to disease, excessive amounts of thin yellow bile, thick black bile or even over-feeding with a heavy meal, heartburn, which is a sharp pain at the mouth of the stomach, is felt behind the xiphoid process (al-Ghudrūf al-Khinjarī) at the lower end of the sternum. Also, the twelfth thoracic vertebra is the last thoracic one that joins the lumbar vertebra and gives rise to the last shortest rib. Hence, it is impossible for the mouth of the stomach to be located there, as it is very much lower than the lower end of the sternum, and the stomach will be opposite the lumbar vertebrae where the kidneys and the uterus are located. Hence, most of the small intestine will be above the umbilicus and higher up than the stomach, while we all know that the intestine is below or lower down than the stomach. Furthermore, it is known that the liver and spleen are on the right and left sides of the stomach, respectively, with the spleen being at a lower level than the liver. So, in the case of swelling in their convex regions, the liver will be felt along the right costal margin (alsharāsif al-yumnā), and the spleen along the left costal margin (al-sharāsif al-yusrā), which confirms that the location of the stomach is in between them and above the umbilicus. [11] Accordingly, Ibn al-Nafīs stated that:

“The expected location of the stomach in the lower abdomen, according to their concept with most of the small intestine at a higher position to it, seems ridiculous and wrong”.

Therefore, by using analogical reasoning from some anatomical and pathological data, Ibn al-Nafīs was able to confirm his correct conclusion as regards the location of the stomach, which is close to our up-to-date knowledge.

References

1. De Koning P., Trois Traites des Anatomie Arabes. op. cit. (17), pp. 26,72, 80, 82.
2. Al-Rāzī, Kitāb al-Ḥāwī Fī Al Ṭibb (Rhazes Liber Continens), First edition. Hyderabad: Dairatul Maarif Al-Osmania, 1961, Vol. 10, pp. 154,156.
3. Al-Zahrāwī, Al-Tasrīf: Mawsūʿah Ṭibbiyyah Mina al-Qarn Al-ʿAshir al-Mīlādī. op. cit. (19), pp. 125–126.
4. Ibn Sīnā, Kitāb al-Qānūn Fī al-Ṭibb (The Canon of Medicine), Books One and Two. Cairo: Boulaq edition 1877: Reprinted, Beirut: Dar Sadir, undated, Vol. I, p. 50; Vol. II, pp. 507–508.
5. Al-Baghdādī Muhadhdhabul-Dīn, Al Mukhtārāt Fī al-Ṭibb. Hyderabad: Osmania Oriental Publication Bureau, 1941, Vol. 1, p. 60.
6. Ibn al Nafīs, Kitāb Sharḥ Tashreeh Al-Qānūn. op. cit. (6), pp. 431–432.
7. Ibn Al-Quff, Al-ʿUmdah Fi Al-Jirāhah, Vol. 1. op. cit. (20), p. 121.
8. De Koning P., Trois Traites D’Anatomie Arabes. op. cit. (17), p. 354.
9. Ibn Sīnā, Al Qānūn Fi Al-Tibb ( the Canon of Medicine), Book Three. op. cit. (1), p. 284.
10. May M.T. (trans), Galen on the usefulness of the parts of the body, Vol. I. Ithaca (NY): Cornell University Press, 1968, p. 290.
11. Ibn al Nafīs, Kitāb Sharḥ Tashrīh al-Qānūn. op. cit. (6), pp. 396–397.