04 II.qxd - International Society for the History of Islamic Medicine

Ibn al-NafîsA Biographical Sketch of the Discovererof Pulmonary and Coronary CirculationHusain F. NAGAMIA MD, FRCS (Eng & Edin)** Chairman, International Institute of Islamic Medicine, Past President, Islamic Medical Association of North America Past Editor inChief, Journal of Islamic Medical Association Consultant Cardiac Surgeon, Cardiac Institute of Florida and Tampa General Hospital,Clinical Assistant Professor of Surgery, University of South Florida Medical School - Tampa, Florida, USASummaryIbn Nafîs whose full name is recorded as: ‘Alâ’ al-dîn Abû’l-Hasan ‘Alî ibn Abi’l-Hazm ibn al- Nafîs al-Qurashî al-Misrî al-Shâfi`î al-Dimashqî’ (1) was a private physician to the ruler of Egypt, Al-Zahir Baybars al-Banduqdari (1260-1277) (2). Baybarsappointed him as the Chief of Physicians and gave him authority over all the physicians of Egypt (3).Ibn Nafîs was not only a practicing physician but like most physicians of his time he was learned in theology, philosophy, linguistics,grammar and jurisprudence of the Shâfi`î school. He was given the well-earned title of ‘the second Ibn Sînâ’. He is reportedto have initially worked as a physician in Damascus, where he graduated from the Medical School and but later on moved to Cairo(4), where he spent the major part of his life.Because of his numerous contributions to the field of medicine, he was well known throughout the Islamic world, during his lifetimeand after his death (in 1288). However his pioneering contribution to the understanding of circulatory anatomy and physiologyof the pulmonary circulation was not discovered by historians of medicine until an Egyptian physician Muhyi al-Din al-Tatawitranslated one of his manuscripts: ‘Sharh Tashrih al-Qanun: A Commentary on the Anatomy of Ibn Sînâ’ into German. This MSwas accidentally found by Dr Tatawi in the Prussian library in Berlin, (MS 912), while working on his dissertation for a doctorate atthe Faculty of Medicine of Freiburg in 1924 (5).Later research has unraveled that this pioneering discovery of Ibn Nafîs had been sited by several Islamic authors including Sadidal Din Muhammad ibn Mas’ud al-Kazaruni in 1344 and ‘Ali ibn Abdullah Zain al-Arab al-Misri in 1350 (6) but remained undiscoveredby the West until Dr Tatawi’s thesis in 1924. It has since been confirmed in several manuscripts of Ibn Nafîs’s around theworld (7) and lately by Dr Albert Zaki Iskandar in: (MS Ar.80) at the University of California, Los Angeles (8).Ibn Nafîs discovery of pulmonary circulation has been universallyacclaimed and there has been a great deal written about it already. Much less hasbeen written about his postulation of the coronary circulation. That Ibn Nafîshad a firm idea of the function and distribution of the coronary circulation aswell, is evident from his writings and I quote: “…again the notion (of Ibn Sînâ)that the blood in the right side of the heart is to nourish the heart is not true atall, for the nourishment of the heart is from the blood that goes through the vesselsthat permeate the body of the heart”. Judging by this quotation Ibn Nafîswas the first to put forward the concept of the coronary circulation and itsfunctional importance in ‘feeding or nourishing’the heart.Key Words Ibn Nafîs, Pulmonary Circulation, Lesser Circulation, CoronaryCirculationIbn NafîsHis Life and Times:Not much is known about his birth, but fromaccounts of al-Umari and al-Safadi (10) it is presumedthat he was born near Damascus in the villageof al-Qurash (Qasrs: beyond the river) in 1208 (607AH) (11). He is described by Safadi as a tall, thin,smooth cheeked and a chivalrous man; a piousShafi‘ite and a bachelor. He studied medicine at the22 JISHIM 2003, 1

Ibn al-Nafîs - A Biographical Sketch of the Discoverer of Pulmonary and Coronary CirculationHusain F. NAGAMIAfamous Nuri hospital in Damascus. This famous hospitalwas built by the Turkish Sultan Nur al-Din Zangiin Damascus, after its conquest in 1154 (apparently byfunds received from ransom of a Frankish prince)(12). He studied under the able tutorship ofMuhadhdhib al-Din ‘Abd al-Rahim ibn ‘Ali alDimashqi popularly called al-Dakhwar (1169-1230); an equally famous physician and teacher of histime, who taught many a prominent physicians. Al-Dakhwar was appointed as the Chief of Physicians ofEgypt and Syria, by the Ayyubid ruler al-Adil and waslater also appointed as head of the Nuri hospital inDamascus by ‘Adil’s successor al-Mu‘azzam. It isinteresting to note that besides Ibn Nafîs one of hisother famous pupils was none other than the greatmedical historian: Ibn abi Usaibi‘a (13) whosefamous book ‘Uyun al anba’ fi tabaqat al-atibba’contains history of about 400 Muslim and non-Muslim physicians. This historical source remains themain source of information of many physicians of theearly and medieval time, as well as one of the greatestsources of the history of Islamic Medicine. However,in the manuscript of Ibn abi Usaibi‘a translated byMüller into German there is no description of IbnNafîs. This was initially attributed to a professionaljealousy between Ibn Nafîs and Ibn abi Usaibi‘a, asthese two were contemporaries and may have been incompetitive positions. But in a later manuscript of Ibnabi Usaibi‘a found in Zahiriyya Library (14) inDamascus there is a description of Ibn Nafîs. In thisMS Ibn Usaibi‘a gives him great credit as a notableand famous physician of his time.The period of history (the thirteenth century) duringwhich Ibn Nafîs lived and practiced was a turbulentperiod for Islamic history. It was made especiallyturbulent by the Mongols’ sack of Baghdad in1258, a devastating event in Islamic history. It wasmade worse by the continuous strife with theCrusaders. However, these events seemed to have littleinfluence on the scholastic and learned environment,‘the creative Weltanschauung’ that prevailed inDamascus and Cairo at the time. Great hospitals (15)were being built under the patronage of the rulers andthese attracted a great number of learned and scholarlyphysicians. Nur al-Din who entered Damascus victoriouslybuilt the famous Nuri Hospital andMedical School already described where Ibn Nafîsreceived his medical education. Amongst the otherJISHIM 2003, 1famous hospitals and institutions built at the time wasthe one built by Salahuddin Ayyubi the greatMuslim general who liberated Jerusalem. Despitebeing occupied by the Crusades, he built the NasiriHospital in Cairo which was to become famous as ateaching institution. The magnificent MansûrîHospital in Cairo was built by the ruler Qala’un. Forthe description of its opulence and appurtenances thereader is referred to other sources (16). Ibn Nafîs hadassociation which each of these institutions.Ibn Nafîs was to become as, or more famous thanhis teacher al-Dakhwar. He moved from Damascus toCairo, where he got appointed as the Chief Physicianof Egypt and a personal physician to the SultanBaybars. He also became attached to the famousMansoury medical school and hospital. Here hebecame actively involved in medical practice, inteaching and in writing. He made himself availableday or night for the service of his patients.Because of his thriving practice and royal patronage,he became rich and lived in a beautiful house inCairo. The house was inlaid with expensive marblestones and had all needed amenities. Here he entertainedprinces, ministers of state, leading physiciansand colleagues.He is reputed to have had a tremendous memoryand to have written most of his books from memorywithout reference to any books or compendia. Shaikhal-Husain Rashidi spokesman of the Prince HusseinMosque described Ibn Nafîs’s writing session in thismanner: “He used to turn his face to the wall and towrite as fluently as a waterfall. And when the quill inhis hand got blunt, he discarded it and took a freshone from the collection made ready and placed beforehim. In this way he lost no time.” An interesting storyis told about how he wrote a treatise on ‘Pulse’. Oneday he had gone to a public bath and whilst in themiddle of washing himself he decided to go to thedressing room and asked for pen and paper. There andthen he started writing his treatise on pulse and did notreturn to his ablution until he had completed it. Thistreatise was to be later translated and quoted in Latin,by Andreas Alpago in his book ‘De Pulsibus’.Ibn Nafîs was acclaimed by his contemporaryphysicians as the second Ibn Sînâ (Avicenna).Some, however, criticized his regimen as being toosimple. He prescribed a diet before he would pre-23

Husain F. NAGAMIAIbn al-Nafîs - A Biographical Sketch of the Discoverer of Pulmonary and Coronary Circulationscribe a drug or medication. He prescribed a simpledrug before he would prescribe a compound medication.This led his druggist to remark to him (perhapsin jest!): “If you continue to write such prescriptionsfor your patients, you would be better to send them toa butcher’s, but if you would like me to be your druggist,pray prescribe all the fine drugs that I have” asquoted by al-‘Umari’s biographical account (17).His WorksIbn Nafîs’s works can be divided broadly into fivecategories:1. His scholarly commentaries on ancient Greektexts.2. His commentaries on early Islamic texts.3. His original contributions to medical texts of histime.4. His writings on non-medical subjects includingtheology, philosophy.5. His pioneering discoveries like that of the lesseror pulmonary circulation and perhaps the coronarycirculation.We shall try to summarize the first four andexpound on the last one.1. His commentaries on existing medical works.Ibn Nafîs achieved fame amongst his contemporariesHe had several to his credit: His commentaries on theworks of Hippocrates (Al Buqrat) and other Greekauthors. Several of these are extant:I. Sharh Fusul Al Buqrat: Commentary onHippocratic Aphorisms.II. Sharh Taqdimat Al-Ma‘rifa: Commentary onHippocratic Prognostics.III.Ibidimiya li Buqrat Watafsiruhu l’Amrad Al-Wafideh: Commentary on the Epidemiology ofHippocrates.IV.Commentary on Hippocrates’ De NaturaHominisV. Commentary on Galen’s Anatomy (Book viii )2. His Commentaries Early Islamic Medical Texts:I. ‘Mujiz al-Qanun’: Commentary on Ibn Sînâ’sQanun-fil-Tibb. This commentary was the onethat made him most famous. It has survived ininnumerable manuscript copies. It has beenpublished several times in India and Persia (18).II. Sharh Al Qanun: Commentary on the Canon.III.Sharh Tashrih Al Qanun: Commentary on theAnatomy of the Canon.IV.Sharh Masai‘l Hunain: Commentary on thequestions of Hunain Ibn Ishaq.V. Sharh Al Hidaya fil Tibb: Commentary on IbnSînâ’s Guide to Medicine.VI.Sharh Mufradat Al-Qanun: Commentary on thesimple medicines of Qanun.3. His Original Contributions to Medical Texts:I. Kitab Al-Shamilli: The Comprehensive bookon the art of Medicine: According to Khalil IbnAybak al-Safadi’s biography of Ibn Nafis heundertook to write an encyclopedic medicalreference in 300 volumes. Only eighty volumeswere completed during his lifetime andthese were donated together with his house tothe Mansoury Hospital in Cairo. Dr. N. Heerhas made a study of this book and identified itscontents (19). More recently Dr Albert ZakiIskander has analyzed and presented the surgicalsections in this book from a manuscript inthe Lane Medical Library (MS Z 276) atStanford University (20).II. Kitab Al-Mukhtar Min al Aghdiya: The Bookof Selections of Nutrition.III.Kitab Al-Muhazzab f’il Kuhl: The wellarranged book on Ophthalmology. No copiesof this book are known extant.IV. Kitab Jame‘ Al-Daka‘ik fil tibb: The compositeof Exactitudes in Medicine.V. Kitab al-Shafii: Book of the healer.VI.Kitab Mawalid Al-Thalash: Book of the TripleBorn.VII.Risalah fi Awia’Al-Atfaal: Dissertation on diseasesof children.4. His Contributions to Non-medical TextsIncluded contributions to Shari‘a(theology), Logic,Philosophy, Linguistics, Grammar and Language.I. Al Risala Al-Kamiliyya fi’l Sira al Nabawiyyaalso known by the title ‘Fadil bin Natiq’ a24 JISHIM 2003, 1

Licensed to:4 Chapter One/The Essence of AnthropologyFor as long as they have been on earth, people havesought answers to questions about who they are,where they come from, and why they act as they do.Throughout most of human history, though, people reliedon myth and folklore for answers, rather than onthe systematic testing of data obtained through carefulobservation. Anthropology, over the last 150 years, hasemerged as a tradition of scientific inquiry with its ownapproaches to answering these questions. Simply stated,anthropology is the study of humankind in all times andplaces. While focusing primarily on Homo sapiens—thehuman species—anthropologists also study our ancestorsand close animal relatives for clues about what itmeans to be human.This is not to say that people have been unaware ofthe existence of others in the world who look and actdifferently from themselves. The Bible’s Old and NewTestaments, for example, are full of references to diverseancient peoples, among them Babylonians, Egyptians,Greeks, Jews, and Syrians. However, the differencesamong these people pale by comparison to those amongany of the more recent European nations and (for example)traditional indigenous peoples of the Pacific islands,the Amazon rainforest, or Siberia.THE DEVELOPMENTOF ANTHROPOLOGYAlthough works of anthropological significance havea considerable antiquity—two examples being crossculturalaccounts of people written by the Greek historianHerodotus about 2,500 years ago and the NorthTHOMSON AUDIOSTUDY PRODUCTSTake advantage ofthe MP3-ready Audio LectureOverviews and comprehensiveaudio glossary of key termsfor each chapter. See thepreface for information onhow to access this on-the-gostudy and review tool.African Arab scholar IbnKhaldun nearly 700 yearsago—anthropology as adistinct field of inquiry isa relatively recent productof Western civilization. Inthe United States, for example,the first course in generalanthropology to carrycredit in a college or university(at the Universityof Rochester in New York)was not offered until 1879. If people have always beenconcerned about themselves and their origins, and thoseof other people, then why did it take such a long time fora systematic discipline of anthropology to appear?The answer to this is as complex as human history.In part, it relates to the limits of human technology.Throughout most of history, people have been restrictedin their geographic horizons. Without the means of travelingto distant parts of the world, observation of culturesand peoples far from one’s own was a difficult—ifnot impossible—undertaking. Extensive travel was usuallythe exclusive privilege of a few; the study of foreignpeoples and cultures was not likely to flourish until improvedmodes of transportation and communicationcould be developed.anthropology The study of humankind in all times and places.© Documentary Educational ResourcesAnthropologists come from many corners of the world and carry outresearch in a huge variety of cultures all around the globe. Dr. JayasinhjiJhala, pictured here, hails from the old city of Dhrangadhra inGujarat, northwest India. A member of the Jhala clan of Rajputs, anaristocratic caste of warriors, he grew up in the royal palace of hisfather, the maharaja. After earning a bachelor of arts degree in India,he came to the United States and earned a master’s in visual studiesfrom MIT, followed by a doctorate in anthropology from Harvard. Currentlya professor and director of the programs of Visual Anthropologyand the Visual Anthropology Media Laboratory at Temple University, hereturns regularly to India with students to film cultural traditions in hisown caste-stratified society.Copyright 2008 Thomson Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Ibn al-Nafîs - A Biographical Sketch of the Discoverer of Pulmonary and Coronary CirculationHusain F. NAGAMIAThe passing Away of Ibn Nafîs:Ibn Nafîs’s life was entirely devoted to practiceof Medicine. He never married and remained a bachelor.He continued working and writing almost untilhis death. Like his teacher Al-Dakhwar hebequeathed his house and his entire library to theMansourya hospital and medical school where hetaught. Close to the 80 th year of his life he suddenlytook ill and took to bed. His fellow physicians recommendedthat he take wine as a remedy. But like a trueMuslim he refused saying: “I would not face my creatorwith a single drop of wine in my body”. He knewof his impending death and on the sixth day of his illnesson Friday December 18 th , 1288 he quietlypassed away in Cairo (26).These interesting comments of Ibn Nafîs in theTashreeh clearly shows that Ibn Nafîs did not acceptthe Galenic views of the pulmonary circulation,which were perpetuated by Ibn Sînâ in his Canon.The descriptions of his findings are so emphatic andclear that he could have not conceivably arrived atthese conclusions by just deduction as suggested byMayeroff. We can almost assume that Ibn Nafîs hadhimself undertaken dissection of animals or cadavers(perhaps in secret) and out of religious and societalconcerns denied that he had ever done so. The latterargument is professed by Dr Sulaiman Oataya alsowho has done exhaustive study of the subject andpresented his findings (25).JISHIM 2003, 1Ibn Sina (Avicenna)Conclusions:Ibn Nafîs was one of the greatest physicians thatpracticed during the era of Islamic Epoch. His title asthe ‘Second Ibn Sînâ’ is well deserved. His contributionsto the medical literature and to medicine remainvoluminous. He will be long remembered for hisoriginal thought, pioneering discovery and succinctdescription of the of Pulmonary Circulation full 300years before any such description occurred in the literatureof the West. Until Dr Tatawi discovered hismanuscript in the German library in 1924 the creditof this discovery was given to Michael Servitus in1553 and to Realdo Colombo in 1559.Michael Servetus who published his findings in‘Christianismi restitutio’ was declared a heretic andburned at stake for his views in 1553 (27). Accordingto Haddad (28) ‘he who reads Servetus cannot helpnoticing that it is almost a literal translation of thewritings of Ibn Nafîs. Whether or not Servetus hadaccess to Ibn Nafîs MS in Arabic or as a Latin translation,is still subject of much debate and controversyand as more investigations continue, it is being suggestedthat perhaps he did have knowledge of IbnNafîs’ writing through the works of Andreas Alpagoa Latin scholar who traveled extensively in the Arablands and collected a large number of medical MSincluding those of Ibn Nafîs. In 1520 he returned toPadua and ultimately was given the Chair of theoreticalmedicine prior to his death in 1522.One of his publicationis ‘De Pulsibus’ which contains references ofboth Serapion and Ibn Nafîs. He was also influentialon his nephew Paulus Alpago who ultimately studiedmedicine and continued to publish Latin translationsof Arabic works including the Canon of Ibn Sînâ in1544. As for Realdo Colombo, he was an anatomist,who taught in Pisa. His description of the PulmonaryCirculation appeared in ‘De re Anatomica’ in 1559(29). It was very similar to that of Servetus. It was notuntil the dissections and experimentation of WilliamHarvey in the early seventeenth century, that the pathof pulmonary and systemic circulation was finally and27