Glisson's Capsule in The Avicenna’s Canon of Medicine

The rich history of anatomy in Persian Medicine is evident and significant (1). In the medieval era, there were a large number of experienced Persian physicians who studied and were experts in the field of human dissection such as Avicenna that we can see his innovations in anatomy, for example, his description of the Willis circle (2). Another Persian scholar, Jorjani (1041–1136 AD) in his book Zakhire kharazmshahi collected and explained important achievements such as the methods of stopping severe bleeding with plastering, treating airway obstruction by tracheotomy, solving urinary problems with a catheter, the exact method of removing the apophasis and suturing the scar after cutting and paring in polyp surgery in full details (3). Therefore, their role in the development of applied anatomy in patient care are important (1).

The liver is a vital organ in the body. In Persian Medicine, the role of the liver in human health is undeniable so that the Persian Medicine scholars have regarded liver as one of the main members of the body (along with the heart and brain) with fundamental functions which affects the whole body organs (4). The surface of the liver is covered by Gleason’s capsule, which is a collagenous layer (5). Gleason’s capsule plays a role in preventing the entry of bacteria, pathogens and other harmful substances (6). It seems that Johannis Walaeus first discovered this capsule in 1640 and Francis Gleason described it in 1654. Gleason’s capsule got its name because of Francis Gleason’s great findings in its anatomical description (5).

The book The Canon of Medicine (1020 AD) was written by Avicenna (980–1037 AD) and is known as one of the medical reference books in Europe from the 12th to the 17th century. This book itself consists of five volumes of medical textbook. A large part of the first volume of The Canon of Medicine is about anatomy (1). Avicenna well described the anatomy of the venous system of the liver. He believed that the liver has two main vessels called “Baab” (Port) and “Ajvaf” (Venacava) which are directly connected to it. The “Baab” vein, which enters from the bottom of the liver, brings the digested food from the intestine to the liver. Then the portal vein branches in the liver and the blood flows in small and narrow hair-like vessels. Finally, blood goes from the liver to the right ventricle through the “Ajvaf” (Venacava) (7). Avicenna in thesis five of the first book of Canon referred to the liver membrane in which he described the importance and role of membranes in the body (Figure 1). In this regard, he stated: “since by providing a sensitive covering they enable the member to be aware of anything befalling it. For instance: the lung, the liver, the spleen, the kidney; all of which are in themselves insensitive, and wound not feel being touched were there not a membrane over them. A flatulent distension or an inflammatory deposit in the organ is felt by us only because the enclosing membrane, being stretched, feels it; or, in the case of an inflammatory mass, is aware of the weight.” (9).

Figure 1 An old manuscript of The Canon of Medicine by Avicenna (8) (from Noor Digital Library, Qum, Iran). Here, Avicenna described the membrane of liver.

According to the above passage, it seems that many centuries before Gleason, this membrane was known for Persian Medicine’s scholars. Persian scholars in the ancient and medieval eras developed the previous Greco-Roman knowledge and had a significant impact on human anatomy and physiology (1,7). In the Renaissance, Western scientists took the lead in science by rejecting medieval and traditional knowledge and creating a new model of medical science. During this transition, it seems that many finds from the Eastern Middle Ages were forgotten. Thus, we can see that many erudite topics known in the Middle Ages were rediscovered after the 16th century AD (2).

Acknowledgments

Funding: None.

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