ARABIC CONTRIBUTIONS TO ANATOMY AND SURGERY* By AMIN A. KHAIRALLAH, B.A., M.D., F.A.C.S. BEIRUT, LEBANON, SYRIA T HAS always been taught that where he was dean of the Mansuri Hos- the Arabs did not contribute pital of Cairo. He was a keen observer anything to our knowledge of and a careful recorder and did not ac- anatomy and surgery, as the Mos- cept established authority blindly. Sev- lem law prohibited dissection of theeral books were written by him, the Ihuman body. The “Arabic” knowledge most important being “Al-Mujaz,” of anatomy was derived from the teach- which is the best compendium on the ings of Galen and from animal dissec- Canon of Avicenna. Another book was tion, especially of the special organs “Sharh Tashrih al-Qanun” from which such as the eye, the heart and the liver. the following quotations are taken: A more careful study of Arabic manu- We have relied chiefly on his (Galen) scripts and medical literature, however, teachings, except in a few details which shows that they did contribute to our we thought might be due to mistakes of knowledge of anatomy in several ways. copyists or due to the fact that his descrip- They classified and arranged the writ- tion had not been given after a thorough ings of Galen in a logical and tangible investigation. In describing the use of the wTay, making its acquisition much eas- organs we have depended on careful in- ier. Avicenna codified all the anatom- vestigation, observation and honest study, ical writings of Galen in his “Canon.” regardless of whether or not these fit the Ibn Nafis, in his book “Sharh Tashrih teachings and theories of those who have al-Qanun” (A Commentary on the An- preceded us.2 atomy of the Canon), commented on the In describing the anatomy of the anatomy of Avicenna. Again, the an- pulmonary vessels, Ibn Nafis also de- atomy of Galen was saved for future scribes, for the first time, the pulmo- generations by the Arabic translations nary circulation and declares, three cen- of his books.1 The Greek originals have turies before Servetus, that the blood is been lost and are only known through aerated in the lung. the Arabic translations. Further, the Arabs were not blind followers as is seen But between these two cavities (of the heart) there is no passage as that part of from a study of the writings of Ibn the heart is closed and has no apparent Nafis and Al-Baghdadi. openings as some believed and no non- Abi al-Hasan ’Ala’ al-DIn ’Ali ibn apparent openings fit for the passage of Abi al-Hazm, better known as Ibn this blood as Galen believed. The pores Nafis, flourished during the first half of the heart there are obliterated and its of the thirteenth century. He was born body is thick and there is no doubt that and brought up in Damascus, but spent the blood, when thinned, passes through most of his life practicing in Egypt the vena arteriosa (pulmonary artery') to * This article is taken from a book entitled “Arabic Contributions to Medicine,” written by the same author. the lung to permeate its substance and is to nourish the heart is not true at all, mingle with the air, its thinned part puri- for the nourishment of the. heart is from fied. It then passes through the arteria the blood that goes into the vessels that venosa (pulmonary vein) to reach the left permeate the body of the heart.6 cavity of the two cavities of the heart; having mixed with the air and become fit Muwaffaq al-DIn ’Abd al-Latif al- for the creation of the spirit.3 Baghdadi, the noted Arabian physician and traveler, was born in Baghdad but Ibn Nafis reiterates the same thing traveled extensively all over Iraq, Syria, in his description of the lung4 In de- and Egypt. In his book on his travels scribing the anatomy and function of in Egypt, he describes his visit to a the heart he states: little hill where there was a big mound Therefore, for the nourishment of the of skeletons. After having studied hun- spirit that is in the heart, it is necessary dreds of these he wrote: for the blood to become attenuated in the Some physicians find difficulty in un- heart and its consistency very much derstanding anatomy as they have not thinned, then pass to the lung and mix seen except the description in their books. with what there is of air there and be . We were told that on a certain hill cooked in it until it is tempered and be- there were many skeletons. We went come fit for the nourishment of the spirit, out there and saw thousands of bones and and afterwards pass to the spirit that is in the heart and mix with it and nourish it. articulations. We studied their relations . And his (Avicenna’s) statement that carefully and gained a great deal of knowl- edge from studying them, a knowledge the heart has three ventricles ... is not that we could not get from studying books correct, as the heart has only two ven- only. For while we have the greatest tricles, one on the right side filled with respect for Galen, what we see with our blood and one on the left side filled with spirit, and between these two there is ab- own eyes is more trustworthy. Thus solutely no opening, for if there were, the while Galen taught that the lower man- blood would pass to the place of the spirit dible consists of two bones united by a and spoil its essence. Also DISSECTION suture, we examined over two thousand gives the lie to what they said, as the bones and did not see one that consisted septum between these two cavities is much of two bones. It is one with no suture.7 thicker than elsewhere, lest some blood ’Ali ibn al-’Abbas al-Majusi (Haly or spirit pass through and get lost. Abbas) ought to be given the credit for The benefit of this blood (that is in the the closest description, prior to Harvey, right cavity of the heart), when it is of the capillary circulation. In speak- thinned and attenuated, is to pass up to the lung, mix with what is in the lung of ing of the animal functions of the body, air, then pass through the arteria venosa he discusses the functions of expansion to the left cavity of the two cavities of the and contraction and then states: heart. Of that mixture is created the ani- You must know that during relaxation mal spirit.5 (diastole) the pulsating vessels (arteries) In his description of the anatomy of that are near the heart draw the air and the heart, Ibn Nafis, further, gives the the thinned blood from the heart by the nearest description, of those times, of vacuum action, because during their con- traction (systole), they empty themselves the coronary circulation. He states: of the blood and air, and when they relax, And his (Avicenna’s) statement that the air and blood return to them and fill blood that is in the right side of the heart them. Those that are near the skin, draw air from the outside, while those that are contraction of the iris. Ibn Sina (Avi- in the middle between the heart and the cenna) give a perfect description of the skin, have the property of drawing the six motor muscles of the globe of the thinnest blood from the non-pulsating eye. Four of these, he states, arc on vessels (veins). That is because the veins the four sides—above, below, inside have pores communicating with the ar- and outside—and each moves the globe teries. The proof of this is that if the ar- in its special direction. The other two tery is cut all the blood that is in the vein are oblique and rotate the eyeball. He is emptied through the cut* was the first to teach that the first four While it is true that the Arabs did muscles are inserted by a common band. little or no dissection of the human According to Portal, the Greeks did not body, they did a great deal of dissection write anything about that. Ibn Sina was of animals and of special organs such also the first to teach that hard tissue as the eye, heart and liver, and thus such as bone could be inflamed and gained a great deal of practical anatom- could swell and that it could be the seat ical knowledge, Yuhanna ibn Masa- of tumefaction and tumor formation, wayh (Mesiie Sr.) dissected a large contrary to the teachings of the Greeks. monkey that had been sent as a present Further careful study of the literature to the Caliph from his representative would probably reveal other contribu- in Nubia and wrote a book describing tions in anatomy and physiology. They carefully what he found, a book that often mention dissection as a proof for “was liked by his friends as well as by what they wrote but did not dare to his enemies.”9 Mesiie even threatened to dissect a weak-minded son of his.10 mention directly that they did dissec- Al-Razi was the first to describe the tion. laryngeal branch of the recurrent laryn- The first of the Arabic physicians to geal nerve. This nerve, he notes, is write comprehensively about surgery sometimes double on the right side, and was ’Ali ibn al-’Abbas al-Majusi (Haly all due honor should be given him for Abbas) in his book al-Maliki (Kamil this discovery which has long been con- al-Sina’ah al-Tibbiyah, Liber Regius).