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COMPREHENSIVE BOOK ON THE ART OF MEDICINE BY IBNAL-NAFIS

 

Dr. Albert Zaki Iskandar,
U.K.

Historians of medicine do not know the exact date of birth of Ala al-Din Abu'l-Hasan Ali Ibn Abi'l-Hazm al-Qurashi, known as Ibn al-Nafis.1  His name 'Ibn Abi'l-Hazm' is recorded in many sources.  Some historians, however, claim that they have read 'Ibn Abi'l-Haram'.2  One may find some justification for their claim: Ibn al-Nafis, like many other authors, did not place the diacritical points carefully on the letter, as is shown in his autograph of the Comprehensive Book on the Art of Medicine.

"... The thirty-third volume of the Comprehensive Book on the Art of Medicine, written by Ali Ibn Abi'l haram (sic) al-Qurashi, who is in need of Allah the exalted; may Allah forgive him..."3.

"... Treatise on plants: the forty-second volume of the Comprehensive Book on the Art of Medicine, written by Ali Ibn Abi'I-Haram (sic) al-Qurashi, who is need of Allah the exalted; may Allah forgive him..." 4.

In the above two extracts, Ibn al-Nafis had neglected to place the diacritical points in each of the following words: kitab, al-sinaa, al-tibbiyya, al-Hazm, maqala, al-nabat, kitab, al-tibbiyya, taala, and Ibn Abi'l-Hazm."

Conclusive evidence that his name is Ibn Abi'l-Hazm (with a fatha on the letter ha and a sukun on the letter zay) is derived from his own handwriting:  He wrote his name with the diacritical points and vowels clearly placed, in an ijaza which he had recorded t the end of his well-known book Commentary on Hippocrates 'Book 'Nature of Man'.  This ijaza (testimony) runs as follows

"The eminent Shaykh, physician-philosopher, Shams al-Dawla Abu'l-Fadl Ibn al-Shaykh Abi'l-Hasan al-Masihi, may Allah grant him eternal happiness, discussed with me all the contents of this book of mine, which contains my commentary on the book of the leader Hippocrates, that is his book known as Nature of Man. This discussion has revealed the clarity of his mind and the straightforwardness of his thought; may Allah the exalted [help] him to make use [of my book] and render him useful [to mankind]; and so writes cAli Ibn Abi'l-Hazm al-Qurashi, a practitioner, who is in need of Allah the exalted. Praise be to Allah for His graces; may He bless His best Prophet Muhammad ( pbuh ) and his people; twenty-ninth Jumada of the year six hundred and sixty-eight."5

In the colophon of Ibn al-Nafis' Commentary on Hippocrates' 'Nature of Man', in this particular manuscript, the' following note by the copyist reveals that he had copied directly from Ibn al-Nafis' own autograph

"... [Transcription of] this book has been completed -from a copy in the author's own handwriting -may his life be prolonged ala manzilat al-lubuna [sic], on fourth Rabi of the year six hundred and sixty-eight.

This was written as an exhortation to myself: Abu'l-Fadl Ibn Abi'l-Hasan al-Katib, a practitioner..."6

Ibn al-Nafis was a great physician and a prolific author. He was also a famous jurist. This paper merely presents extracts from his Comprehensive Book on the Art of Medicine.

Ibn al-Nafis studied medicine in Damascus, at the Great Nuri hospital, which was founded by Prince Nur al-Din Mahmud Ibn Zanki in the sixth century A.H. / twelfth century A.D. 7  Muhadhdhab al-Din Abd al-Rahim Ibn Ali al-Dakhwar (d. A.H. 628 / A.D. 1230) was one of Ibn al-Nafis' teachers in Damascus.8 Another pupil of al-Dakhwar, also in Damascus, was Muwaffaq al-Din Abu'l-Abbas Ahmad Ibn Qasim Ibn Khalifa al-Khazraji, better known as Ibn Abi Usaybia (d. A.H. 668 / A.O. 1270).9 It has been established that Abu'l -Faraj Ibn Yacqub Ibn Ishaq Ibn al-Quff Amin al-Oawla al-Karaki (d. A.H. 685 / A.O. 1286) studied medicine under both of Ibn al-Nafis 10 and Ibn Abi Usaybia 11.  It is therefore surprising that Ibn Abi Usaybia should fail to include a biography of Ibn al-Nafis in his well-known book: Uyun al-anba fi tabaqat al-atibba . The short account which is to be found at the end of uyun al-anba , only in one manuscript (at the Zahiriyya Library, Damascus),12 seems to have been written at a later date, and in the past tense. This also shows that the writer of Ibn al-Nafis' biography was not a contemporary of Ibn al-Nafis. It is very likely that a former owner of this Zahiriyya manuscript had recorded the biography of Ibn al-Nafis in order to make his own copy more useful. He made a mistake in mentioning the nisba of Ibn al-Nafis as follows:'... al-Qarashi, with a fatha on the letter qaf and a fatha on the letter from a village near Damascus...'13

Ibn al-Nafis was a private physician to the Mamluk ruler al-Zahir Baybars al-Bunduqdari (fegnabat A.H. 658 / A.O. 1260-1277), 14 who appointed Ibn al-Nafis as 'Chief of physicians', and eventually gave him 'authority on all physicians in Egypt'. This post was not merely honorific but vested him with full authority to punish practitioners for any slips due to carelessness. l5

So far students of Arabic medicine have not found evidence from manuscripts that would connect Ibn al-Nafis' name with the Nasiri hospital of Egypt, which is also called the Old hospital, that was founded in A.H. 577 / A.D. 1181 by the King al-Nasir Salah al-Din al-Ayyubi (Saladin, fegnabat A.H. 564- -589/ A.D. 1169-1193).16 It is worth mentioning that Ibn Abi Usaybia was an oculist at that hospital during the one year (A.H.634 / A.D. 1236-1237) he had spent in Egypt. 17 When Ibn al-Nafis retired, due to old age, he bequeathed his house and private library -which was full of his own written works -to Dar al-shifa (House of recovery)18, also called Qalawun hospital or al-Mansuri hospital 19, after the name of its founder in A.H. 683 / A.O. 1284, the Mamluk al-Mansur Sayf al-Oin Qalawun al-Alfi (fegnabat A.H. 678-689 / A.O. 1279-1290), 20 I have already published a list of Ibn al-Nafis' medical writings, and referred to the manuscript-numbers of some of his books that are extant in different libraries all over the world.21.

In addition to practising medicine, Ibn al-Nafis lectured on fiqh Jurisprudence) at al-Masruriyya school, 22 founded by the eunuch Masrur Shams al-khawasi of the Court of Salah al-Din al-Ayyubi .23 Ibn al-Nafis also wrote a book on the principles of jurisprudence, entitled Shafh al-tanbih, being a commentary on al-Tanbih fi'l-fiqh of al-Firuzabadi (d. A.H. 476/ A.D. 1083).25 The inclusion of Ibn al-Nafis' name in the Tabaqat al-Shafiiyyin al-Kubra 26 of al-Subki (d. A.H. 771 / A.D 1370) indicates his eminence in religious law.

Furthermore, Ibn al-Nafis wrote al-Risala al-Kamiliyya fi'l-Sira al-Nabawiyya, known by the title Fadil Ibn Natiq, a counterpart to Ibn Tufayl's (d. A.G. 581 / A.D. 1185) 28 Hayy Ibn Yaqzan. In al-Risala al-Kamiliyya; Ibn al-Nafis contemplated the creation of a human being within a cave in an uninhabited island, in a way similar to that of the emergence of a chich from an egg. The four elements: air, water, earth and fire are acted upon by the four quaiities: the hot, the cold, the dry and the wet, and result in the spontaneous generation of man. Ibn al-Nafis' purpose in writing this book is to show the ability of such an isolated man to discover the sciences and wisdom, then to know about the prophecies, the noble conduct of the Prophet Muhammad (pbuh) and the legal customs.

In this paper I give a short reference to Ibn al-Nafis' great discovery of the pulmonary circulation.29  It is not at all important whether his great discovery was the result of practising anatomy or using the method of speculation and the correct method of scientific thinking. What concerns us, as historians of Arabic Islamic medicine, is that Ibn al-Nafis had discovered the pulmonary circulation, thus defying the doctrines of Galen himself. Moreover, this discovery of Ibn al-Nafis took place at least forty-seven lunar years (forty-six calendar years) before his death. I have found the pulmonary circulation in a copy of Ibn al-Nafis' Sharh tashrih al-qanun Ibn Sina (Commentary on anatomy in Ibn Sina's 'Canon'), in MS Ar. 80 (at the University of California, Los Angeles) 30, dated 25th Jumada 640 / 20th November 1242. I have also provided evidence that some Arab physicians had accepted Ibn al-Nafis' blood circulation, since I found it recorded in Sharh al-qanun (Commentary on [Ibn Sina's] 'Canon') by Sadid al-Din Muhammad Ibn Mascud al-Kazaruni, who completed his commentary in A.H. 745/ A.D. 1344.31 A few years later, the same pulmonary circulation was also recorded in Ali Ibn Abdallah Zayn al-Arab al-Misri's Sharh al-qanun (completed in A.H. 751/ A.D. 1350). 32 As to the accounts of Servetus (d. A.D. 1553) 33 and Colombo (d. A.D. 1559),:14 these were recorded more than three centuries later than Ibn al-Nafis' discovery. Historians of medicine should, in fact, look for a satisfactory answer to the following question: Did the Latin West have access to Ibn al-Nafis' pulmonary circulation? It is a well-known fact that Andrea Alpago of Belluno (d. A.D. 1520) had lived in Syria for about thirty years, during which he had actively collected and translated Arabic medical heritage. He translated into Latin Ibn al-Nafis' Sharh al-adwiya al-murakkaba (Commentary on compound drugs), printed in Venice (1547), which is a part of Ibn al-Nafis' Sharh al-qanun lbn Sina (Commentary on Ibn Sina's 'Canon'). On folios 24 verso to 30 recto of Alpago's book, which I mention in the following marginal note, the author gives some information concerning Galen's doctrines on the heart and the blood vessels, and adds Ibn al-Nafis' criticism of these doctrines. 35

THE COMPREHENSIVE BOOK ON THE
ART OF MEDICINE

In his book al-Wafi bi'l-Wafayat, Khalili Ibn Aybak al-Safadi writes that Ibn al-Nafis "is the author of the Comprehensive Book on the Art of Medicine.   According to its index, it consists of three hundred volumes.. out of which eighty volumes were writeen neatly by him.  These are now (extant), by religious bequest, in the Mansuri hospital in Cairo." 36  This statement of al-Safadi is also supported by al-Subki, who writes in his book Tabaqat al-Shafiiyyin al-kubra that Ibn al-Nafis "wrote on medicine, besides what we have already mentioned, a book entitled the 'Comprehensive (Book)', said to have consisted of three hundred volumes had it been finished; out of these eighty volumes were completed." 37

Dr. N.Heer made an interesting study of this book: 38 , and published an article in which he listed its contents and gave references to some manuscripts of the Comprehensive Book on the Art of Medicine extant in Public libraries.39 In his paper, he mentions MS Z 276 (at the Lane Medical library, Stanford University, California). All this manuscript is in Ibn al-Nafis' handwriting. It contains the thirty-third, the forty-second, and the forty-third volumes of the Comprehensive Book on the Art of Medicine. Some folios of this manuscript are possibly misplaced. It also seems that there are gaps in the text. (I have transcribed a large section of this manuscript).

In practising medicine, Ibn al-Nafis preferred the Hippocratic method to the methods of other physicians. He wrote interesting commentaries on some Hippocratic books,40 but he did not write commentaries on any of Galen's works. Ibn al-Nafis' discovery of the pulmonary circulation was by way of criticism of Galen's doctrines.41 In a section devoted to surgery, in the Comprehensive Book on the Art of Medicine, Ibn al-Nafis selects some subject-matter from the Hippocratic book, In the Surgery, 42 then he clarifies the selected excerpts through his detailed commentary .

Ibn al-Nafis believes that for the success of any surgical operation, full attention should be paid during three stages: In the first stage, which he calls the 'time of presentation', the surgeon diagnoses the affected place. It is called the 'time of presentation' because the patient submits his body to the surgeon, to deal with it in the way he sees right. In the second stage, which he calls the 'time of operative treatment', the surgeon repairs the affected organs. The third stage, called the 'time of preservation', refers to the post-surgical care, a phase during which the patient should take good care of himself. It is also the duty of the nurses and servants to watch over the patient during this period, until he recovers, by the will of God the exalted. For each of these three stages, Ibn al-Nafis gives a detailed record of the role of each of the surgeon, the patient, and the nurses. He also gives a detailed description of the manipulation of surgical instruments, how these should be properly maintained, and the like. Ibn Sina had some influence on Ibn al-Nafis: this is apparent from the logical way of presentation of subject-matter in the Comprehensive Book on the Art of Medicine. Following are: the first five fusul, of the third ta'lim, of the third kitab, of the first namat, of the second juz , of the second fann, of the Comprehensive Book on the Art of Medicine. It is edited here, for the first time, from the autograph of Ibn al-Nafis:

Lane Medical Library, Stanford Univeristy, MS Z 276, fols. lb, line 1-fol. 7a, line 11 (see Photographic Plate, no.3)

"In the name of Allah the merciful, the compassionate; from Him I have succour, and on Him I rely: The third kitab of the first namat of the second juz of the second fann of the Comprehensive Book on the Art of Medicine.

In this book, our purpose is to discuss the kind of treatment that is called surgery. It consists of three ta'lim. The first ta'lim is concerned with the general and absolute principles of surgery; the second ta'lim is concerned with surgical instruments; and the third ta'lim examines the types of surgical operations, one by one.

The first talim, which is concerned with the general principles of surgery, comprises twenty chapters.

  1. Chapter I - On the different stages of surgical operations, and the role of the patient in each stage.
  2. Chapter II - On the role of the physician during the time of presentation', the 'time of operative treatment', and the 'time of preservation'.
  3. Chapter III - On a detailed discussion of the role of the physician during the 'time of presentation
  4. Chapter IV - On relating the things to which the physician should pay attention during the 'time of operative treatment'.
  5. Chapter V - On the patient's posture during surgical treatment.
  6. REFERENCES

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