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.

ABSTRACT

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. DATA SOURCES 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. SUBJECTS: None. DESIGN: The relevant sections of the Hebrew Canon on the origin of the body fluids were translated and compared with the existing English translation. OBSERVATIONS 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. DATA ANALYSIS: 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 AND IMPLICATIONS 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.