Avicenna (980-1037) on the Role of the Liver in Separating Fluid from the Blood, with Insight into the Process from E.H. Starling (1866-1907) a Millennium Later.
BACKGROUND
A statement was made by Avicenna (980-1037) in his Canon of Medicine that the liver separates fluid from the blood. An explanation for this view has not been considered.


METHODS
Since the statement emerged from an existing English translation of the Canon (which was made from a prior Latin edition), an alternative English translation of the first Hebrew edition was made in order to verify the statement and to seek additional insight, which could explain its basis, in fact.


METHODS
The English edition of Avicenna's Canon of Medicine published in 1932, translated from the Latin. First Hebrew edition of Avicenna's Canon of Medicine published in 1491, translated from the Arabic.


METHODS
None.


METHODS
The relevant sections of the Hebrew Canon on the origin of the body fluids were translated and compared with the existing English translation.


METHODS
The fluid generated by the liver is likely to be protein-containing, since it was described as frothy and suggests that it is lymph. The suggestion that the liver needs a watery fluid for its action cannot be explained. Ernest Henry Starling (1866-1907) measured lymph formation, showing it to be driven by physical forces. The liver stood out as being the organ with the largest capacity for lymph formation. The vascular walls within the liver were shown to have a higher permeability to serum proteins than any other source of lymph.


METHODS
Data are derived from Starling's publications based on individual experiments. These were not analyzed statistically.


RESULTS
The explanation for Avicenna's statement that the liver separates moisture from the blood is most likely to be the discovery by Starling, a millennium later, that the liver is the major source of lymph production.


CONCLUSIONS
The liver is a major source of lymph. Distortion of the architecture of the liver in cirrhosis and other chronic liver diseases lead to ascites, a condition of lymph overflow from the liver.
Department of Biomedical Sciences, Cedars-Sinai Medical Center, and University of California, Los Angeles, Los Angeles, Calif., USA.
Leon G
LG
Fine
D001769:Blood / Q000378:metabolism*; D001826:Body Fluids; D049672:History, 19th Century; D049673:History, 20th Century; D049690:History, Ancient; D006801:Humans; D008099:Liver / Q000502:physiology*