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The Muhtasib also inspected weights and measures of traders and pharmacists. Pharmacists were employed as inspectors to inspect drugs and maintain quality control of drugs sold in a pharmacy or apothecary. What the present Food and Drug Administration (FDA) is doing in America today was done in Islamic medicine I 000 years ago. The chief physician gave oral and practical examinations, and if the young physician was successful, the Muhtasib administered the Hippocratic oath and issued a license. After 1000 years licensing of physicians has been implemented in the West, particularly in America by the State Licensing Board in Medicine. For specialists we have American Board of Medical Specialties such as in Medicine, Surgery, Radiology, etc. European medical schools followed the pattern set by the Islamic medical schools and even in the early nineteenth century, students at the Sorbonne could not graduate without reading Ibn Sina's Qanun (Cannon).
According to Razi a physician had to satisfy two condition for selection: firs0y, he was to be fully conversant with the new and the old medical literature and secondly, he must have worked in a hospital as house physician. HOSPITALS The development of efficient hospitals was an outstanding contribution of Islamic medicine (7). Hospitals served all citizens free without any regard to their color, religion, sex, age or social status. The hospitals were run by government and the directors of hospitals were physicians.
Hospitals had separate wards for male patients and female patients. Each ward was furnished with a nursing staff and porters of the sex of the patients to be treated therein. Different diseases such as fever, wounds, infections, mania, eye conditions, cold diseases, diarrhea, and female disorders were allocated different wards. Convalescents had separate sections within them. Hospitals provided patients with unlimited water supply and with bathing facilities.
Only qualified and licensed physicians were allowed by law to practice medicine. The hospitals were teaching hospitals educating medical students. They had housing for students and house-staff. They contained pharmacies dispensing free drugs to patients. Hospitals had their own conference room and expensive libraries containing the most up-to-date books. According to Haddad, the library of the Tulum Hospital which was founded in Cairo in 872 A.D. (I 100 years ago) had 100,000 books. Universities, cities and hospitals acquired large libraries (Mustansiriyya University in Baghdad contained 80,000 volumes; the library of Cordova 600,000 volumes; that of Cairo 2,000,000 and that of Tripoli 3,000,000 books), physicians had their own extensive personal book collections, at a time when printing was unknown and book editing was done by skilled and specialized scribes putting in long hours of manual labour. For the first time in history, these hospitals kept records of patients and their medical care.
From the point of view of treatment the hospital was divided into an out- patient department and an inpatient department. The system of the in-patient department differed only slightly from that of today. At Tulun hospital, on admission the patients were given special apparel while their clothes, money, and valuables were stored until the time of their discharge. On discharge, each patient - received five gold pieces to support himself until he could return to work. The hospital and medical school at Damascus had elegant rooms and an extensive library. Healthy people are said to have feigned illness in order to enjoy its cuisine. There was a separate hospital in Damascus for lepers, while, in Europe, even six centuries later, condemned lepers were burned to death by royal decree.
The Qayrawan Hospital (built in 830 A.D. in Tunisia) was characterized by spacious separate wards, waiting rooms for visitors and patients, and female nurses from Sudan, an event representing the first use of nursing in Arabic history.
The hospital also provided facilities for performing prayers. The Al-Adudi hospital (built in 981 A.D. in Baghdad) was furnished with die best equipment and supplies known at the time. It had interns, residents, and 24 consultants attending its professional activities, An Abbasid minister, Ali ibn Isa, requested the court physician, Sinan ibn Thabit, to organize regular visiting of prisons by medical officers (14). At a time when paris and London were places of mud streets and hovels, Baghdad, Cairo, and Cordova had hospitals which incorporated innovations which sound amazingly modern. It was chiefly in the humaneness of patient care, however, that the hospitals of Islam excelled.
Near the wards of those afflicted with fever, fountains cooled the air; the insane were treated with gentleness; and at night music and storytelling soothed the patients. The Bimaristans (hospitals) were of two types - the fixed and the mobile. The mobile hospitals were transported upon beasts of burden and were erected from time to time as required. The physicians in the mobile clinics were of the same standing as those who served the fixed hospitals. Similar moving hospitals accompanied the armies in the field. The field hospitals were well equipped with medicaments, instruments, tents and a staff of doctors, nurses, and orderlies. The traveling clinics served the totally disabled, the disadvantaged and those in remote areas. These hospitals were also used by prisoners, and by the general public, particularly in times of epidemics.
BACTERIOLOGY Al-Razi was asked to choose a site for a new hospital when he came to Baghdad. First he deduced which was the most hygienic area by observing where the fresh pieces of meat he had hung in various parts of the city decomposed least quickly. Ibn Sina stated explicitly that the bodily secretion is contaminated by foul foreign earthly body before getting the infection. Ibn Khatima stated that man is surrounded by minute bodies which enter the human system and cause disease. In the middle of the fourteenth century black death was ravaging Europe and before which Christians stood helpless, considering it an act of God. At that time Ibn al Khatib of Granada composed a treatise in the defense of the theory of infection in the following way: To those who say, How can we admit the possibility of infection while the religious law denies it? We reply that the existence of contagion is established by experience, investigation, the evidence of the senses and trustworthy reports. These facts constitute a sound argument.
The fact of infection becomes clear to the investigator who notices how he who establishes contact with the afflicted gets the disease, whereas he who is not in contact remains safe, and how transmission is effected through garments, vessels and earrings. Al-Razi wrote the first medical description of smallpox and measles - two important infectious diseases. He described the clinical difference between the two diseases so vividly that nothing since has been added. Ibn Sina suggested the communicable nature of tuberculosis. He is said to have been the first to describe the preparation and properties of sulphuric acid and alcohol. His recommendation of wine as the best dressing for wounds was very popular in medieval practice.
However Razi was the first to use silk sutures and alcohol for hemostatis. He was the first to use alcohol as an antiseptic. ANESTHESIA Ibn Sina originated the idea of the use of oral anesthetics. He recognized opium as the most powerful mukhadir (an intoxicant or drug). Less powerful anesthetics known were mandragora, poppy, hemlock, hyoscyamus, deadly nightshade (belladonna), lettuce seed, and snow or ice cold water. The Arabs invented the soporific sponge which was the precursor of modem anesthesia. It was a sponge soaked with aromatics and narcotics and held to the patient's nostrils.
The use of anesthesia was one of the reasons for the rise of surgery in the Islamic world to the level of an honourable speciality, while in Europe, surgery was belittled and practiced by barbers and quacks. The Council of Tours in 1163 A.D. declared Surgery is to be abandoned by the schools of medicine and by all decent physicians. Burton stated that anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in civilized West. SURGERY Al-Razi is attributed to be the first to use the seton in surgery and animal gut for sutures. Abu al-Qasim Khalaf Ibn Abbas Al-Zahrawi (930-1013 A.D.) known to the West as Abulcasis, Bucasis or Alzahravius is considered to be the most famous surgeon in Islamic medicine. In his book Al-Tasrif, he described hemophilia for the first time in medical history. |
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