Ibn al-Nafis

Arab polymath and physician (1213–1288)

ʿAlāʾ al Dīn Abū al Ḥasan ʿAlī ibn Abī Ḥazm al Qarashī (Arabic: علاء الدين أبو الحسن عليّ بن أبي حزم القرشي ), known as Ibn al Nafīs (Arabic: ابن النفيس), was an Arab polymath whose areas of work included medicine, surgery, physiology, anatomy, biology, Islamic studies, jurisprudence, and philosophy. He is known for being the first to describe the pulmonary circulation of the blood. The work of Ibn al Nafis regarding the right sided (pulmonary) circulation pre dates the later work (1628) of William Harvey's De motu cordis. Both theories attempt to explain circulation. 2nd century Greek physician Galen's theory about the physiology of the circulatory system remained unchallenged until the works of Ibn al Nafis, for which he has been described as "the father of circulatory physiology". As an early anatomist, Ibn al Nafis also performed several human dissections during the course of his work, making several important discoveries in the fields of physiology and anatomy. Besides his famous discovery of the pulmonary circulation, he also gave an early insight of the coronary and capillary circulations. He was also appointed as the chief physician at al Naseri Hospital founded by Sultan Saladin. Apart from medicine, Ibn al Nafis studied jurisprudence, literature and theology. He was an expert on the Shafi'i school of jurisprudence and an expert physician.

Ibn al Nafis was born in 1213 to an Arab family probably at a village near Damascus named Karashia, after which his Nisba might be derived. Early in his life, he studied theology, philosophy and literature. Then, at the age of 16, he started studying medicine for more than ten years at the Nuri Hospital in Damascus, which was founded by the Turkoman emir of Aleppo and Damascus, Nur al Din Muhmud ibn Zanki, in the 12th century. He was contemporary with the famous Damascene physician Ibn Abi Usaibia and they both were taught by the founder of a medical school in Damascus, Al Dakhwar. Ibn Abi Usaibia does not mention Ibn al Nafis at all in his biographical dictionary "Lives of the Physicians". The seemingly intentional omission could be due to personal animosity or maybe rivalry between the two physicians. In 1236, Ibn al Nafis, along with some of his colleagues, moved to Egypt under the request of the Ayyubid sultan al Kamil. Ibn al Nafis was appointed as the chief physician at al Naseri hospital which was founded by Saladin, where he taught and practiced medicine for several years. One of his most notable students was the famous Christian physician Ibn al Quff. Ibn al Nafis also taught jurisprudence at al Masruriyya Madrassa (Arabic: المدرسة المسرورية). His name is found among those of other scholars, which gives insight into how well he was regarded in the study and practice of religious law. Ibn al Nafis lived most of his life in Egypt, and witnessed several pivotal events like the fall of Baghdad and the rise of Mamluks. He even became the personal physician of the sultan Baibars and other prominent political leaders, thus showcasing himself as an authority among practitioners of medicine. Later in his life, when he was 74 years old, Ibn al Nafis was appointed as the chief physician of the newly founded al Mansori hospital where he worked for the rest of his life. Ibn al Nafis died in Cairo after some days of sickness. His student Safi Abu al Fat'h composed a poem about him. Prior to his death, he donated his house and library to Qalawun Hospital or, as it was also known, the House of Recovery.

The most voluminous of his books is Al Shamil fi al Tibb (The Comprehensive Book on Medicine), which was planned to be an encyclopedia comprising 300 volumes. However, Ibn al Nafis managed to publish only 80 before his death, and the work was left incomplete. Despite this fact, the work is considered one of the largest medical encyclopedias ever written by one person, and it gave a complete summary of the medical knowledge in the Islamic world at the time. Ibn al Nafis bequeathed his encyclopedia along with all of his library to the Mansoory hospital where he had worked before his death. Along the time, much of the encyclopedia volumes got lost or dispersed all over the world with only 2 volumes still being extant in Egypt. The Egyptian scholar Youssef Ziedan started a project of collecting and examining the extant manuscripts of this work that are cataloged in many libraries around the world, including the Cambridge University Library, the Bodleian Library, and the Lane Medical Library at Stanford University.

In the second half of the thirteenth century, Ibn al Nafïs composed the first Arabic commentary on Hippocrates' Endemics. The commentary is lengthy and contains two extant manuscripts, made up of 200 and 192 folios. Ibn al Nafïs’ commentary on Hippocrates’ Endemics in Sharh Abidhimya li Burqrat is an analysis of Hippocrates three constitutions. Al Nafïs revisited the cases of illnesses described by Hippocrates in his text, while comparing and contrasting those cases to his own cases and conclusions. In his commentary, al Nafïs emphasized disease outbreaks. In one example, he compared a particular outbreak of malnutrition in Damascus, Syria, to an outbreak described by Hippocrates. Like Hippocrates, al Nafïs constructed an outbreak map and both men concluded that Damascus was the origin of the outbreak. This method of locating an outbreak origin was used by John Snow 600 years later, when he constructed his own outbreak map.

Ibn al Nafis also wrote a number of books and commentaries on different topics including on medicine, law, logic, philosophy, theology, grammar and environment. His commentaries include one on Hippocrates' book, several volumes on Avicenna's The Canon of Medicine, and a commentary on Hunayn Ibn Ishaq. al Mūjaz fī al Tibb (“A Summary of Medicine”); a short outline of medicine which was very popular among Arab physicians and got translated into Turkish and Hebrew. Kitāb al Mukhtār fī al Aghḏiyah (“The Choice of Foodstuffs”); a largely original contribution which was on the effects of diet on health. Bughyat al Tālibīn wa Hujjat al Mutaṭabbibīn (“Reference Book for Physicians”); a reference book for physicians containing his general knowledge to aid physicians in the diagnosis of disease, treatment of illness, and execution of surgical procedures. Sharḥ Masā’il Hunayn (“Commentary on Hunayn Ibn Ishaq's Questions”). al Risālah al Kāmiliyyah fī al Ssīrah al Nabawiyyah; (“Theologus Autodidactus”); a Philosophical treatise that is claimed by some to be the first theological novel.

Ibn al Nafis had an insight into what would become a larger theory of the capillary circulation. He stated that "there must be small communications or pores (manafidh in Arabic) between the pulmonary artery and vein," a prediction that preceded the discovery of the capillary system by more than 400 years. Ibn al Nafis' theory, however, was confined to blood transit in the lungs and did not extend to the entire body:

For this reason the arterious vein has solid substance with two layers, in order to make more refined that (the blood) which transsudes from it. The venous artery, on the other hand, has thin substance in order to facilitate the reception of the transsuded [blood] from the vein in question. And for the same reason there exists perceptible passages (or pores) between the two [blood vessels].

Ibn al Nafis also disagreed with Galen's theory that the heart's pulse is created by the arteries’ tunics. He believed that "the pulse was a direct result of the heartbeat, even observing that the arteries contracted and expanded at different times depending upon their distance from the heart. He also correctly observed that the arteries contract when the heart expands and expand when the heart contracts.

There is some debate about whether or not Ibn al Nafis participated in dissection to come to his conclusions about pulmonary circulation. Although he states in his writings that he was prevented from practicing dissection because of his beliefs, other scholars have noted that Ibn al Nafis must have either practiced dissection or seen a human heart in order to come to his conclusions. According to one view, his knowledge about the human heart could have been derived from surgical operations rather than dissection. Ibn al Nafis' comments to the contrary and the alternate explanations, however, keep his possible practice of dissection in question. During Ibn al Nafis’ studies of the human body, there remains controversy whether he performed dissection, as dissection was mentioned in any texts on jurisprudence or Islamic tradition, and there was no concrete prohibition. Though many scholars would argue that Ibn al Nafis would have needed to perform dissection to be able to see pulmonary circulation. Greek physician, Aelius Galenus' book, “On the Usefulness of the Parts”, explicitly tells his readers to rely on dissection for anatomical knowledge and not rely on books. Thus would give an indication that dissection was not some otherworldly idea but had been looked as an opportunity to better one's knowledge of the human body. In the “Commentary of the anatomy of the Canon of Avicenna”, human anatomy experts such as Patrice Le Floch Prigent and Dominique Delaval, concluded that Ibn al Nafis used clinical, physiological, and dissection results in discovering and describing the pulmonary heart circulation in humans. Through their study on the “Commentary of the anatomy of the Canon of Avicenna”, they both concluded that Nafis did indeed use dissection to acquire his results, even though the practice of dissection was banned in Muslim tradition.

In his book "Al Mugiza", Ibn al Nafis distinguishes the difference between kidney stone and bladder stones. He does this by their pathogenesis and clinical picture. He also discussed the difference between kidney and bladder infections, different types of inflammatory and noninflammatory renal swellings, the conservative management of renal stones and commonly used and well known lithontriptic medicaments. Both the body and its parts are in a continuous state of dissolution and nourishment, so they are inevitably undergoing permanent change.

Ibn al Nafis' philosophical views are mostly known from his philosophical novel, Theologus Autodidactus. The novel touches upon a variety of philosophical subjects like cosmology, empiricism, epistemology, experimentation, futurology, eschatology, and natural philosophy. It deals with these themes and others through the story of a feral child on a desert island, and the development of his mind after contact with the outside world. The plot of Theologus Autodidactus was intended to be a response to Ibn Tufail (Abubacer), who wrote the first Arabic novel Hayy ibn Yaqdhan (Philosophus Autodidactus) which was itself a response to al Ghazali's The Incoherence of the Philosophers. Ibn al Nafis thus wrote the narrative of Theologus Autodidactus as a rebuttal of Abubacer's arguments in Philosophus Autodidactus. Ibn al Nafis described his book Theologus Autodidactus as a defense of "the system of Islam and the Muslims' doctrines on the missions of Prophets, the religious laws, the resurrection of the body, and the transitoriness of the world." He presents rational arguments for bodily resurrection and the immortality of the human soul, using both demonstrative reasoning and material from the hadith corpus to prove his case. Later Islamic scholars viewed this work as a response to the metaphysical claim of Avicenna and Ibn Tufail that bodily resurrection cannot be proven through reason, a view that was earlier criticized by al Ghazali. Unlike Avicenna who supported Aristotle's idea of the soul originating from the heart, Ibn al Nafis on the other hand rejected this idea and instead argued that the soul "is related to the entirety and not to one or a few organs." He further criticized Aristotle's idea that every unique soul requires the existence of a unique source, in this case the heart. Ibn al Nafis concluded that "the soul is related primarily neither to the spirit nor to any organ, but rather to the entire matter whose temperament is prepared to receive that soul" and he defined the soul as nothing other than "what a human indicates by saying ‘I’." Ibn al Nafis dealt with Islamic eschatology in some depth in his Theologus Autodidactus, where he rationalized the Islamic view of eschatology using reason and science to explain the events that would occur according to Islamic tradition. He presented his rational and scientific arguments in the form of Arabic fiction, hence his Theologus Autodidactus may be considered the earliest science fiction work.

There is currently debate over whether Ibn al Nafis influenced later Western anatomists such as Realdo Columbo and William Harvey. In AD 1344, Kazrouny wrote a verbatim copy of Ibn al Nafis' commentary on Canon in his Sharh al Kulliyat. In AD 1500, Andrea Alpago returned to Italy after studying in Damascus. In Alpago's 1547 A. D. publication of Libellus de removendis nocumentis, quae accident in regimime sanitatis, there is a Latin translation containing part of Ibn al Nafis' commentary on pharmacopeia. The debate currently turns on whether these events are causally connected or are historical coincidences. Years before Ibn al Nafis was born, Galenic physiology and anatomy dominated the Arabic medical tradition from the time of Hunayn ibn Ishaq (AD 809–873). George Sarton, in his "Introduction to the History of Science", written about the time Ibn al Nafis's theory had just been discovered, said:
If the authenticity of Ibn al Nafis' theory is confirmed his importance will increase enormously; for he must then be considered one of the main forerunners of William Harvey and the greatest physiologist of the Middle Ages.