Sara Ali, MD
University of Florida, Gainsville, United States (Summer 2013)
Al-Adudi Hospital, Baghdad, 9th century
The period between the 5th to the 15th century, known in Europe as the Dark Ages, was characterized in the Middle East and the Arab world by the rise of great civilizations. It was built by people of differing religions and ethnicities, Muslims and non-Muslims, working under the umbrella of the Islamic civilization in educational and translational institutions, developing science, inventing instruments, and translating books from other languages, such as Indian and Greek books. There were great advances in medicine and medical education. Hospitals evolved from simple buildings used for the care of the elderly, the leprous, and individuals with chronic diseases to well-established hospitals according to our modern definitions. A need for well-trained physicians motivated rulers and wealthy families to establish medical schools.
The training of physicians took various forms. Some trained in famous hospitals that served as medical schools; others studied under the supervision and mentorship of family members; and others still learned by reading books. Training in famous medical hospitals was the most prestigious. One of the earliest hospitals known was the one build in Baghdad in the 9th century by the vizier to Caliph Harun Al-Rashid. An Islamic hospital was called a bimarestan. The word is derived from the Persian word “bimar,” which means sick, and “stan,” which means place. Bimarestans were secular hospitals serving the poor and rich, Muslim and Non-Muslim, women, men, children, elderly, and lunatics. Another five hospitals were built in Baghdad between the 9th and 10th century.
In Cairo the governor Ahmad Ibn Tulun built the first hospital in 872. In the 12th century, two more hospitals were founded in Egypt, the Nasiri Hospital and the Mansuri Hospital. In Damascus, the Nuri Hospital was built in the 12th century and remained functioning as a major hospital till the 15th century. In Tunisia, the Al-Qayrawan Hospital was built in the 9th century. Later on, many hospitals were built in several countries, in Mecca, Medina, Cairo, Turkey and Spain. Some of these hospitals, such as the Adudi hospital in Baghdad, the Nuri in Damascus, and the Mansuri in Cairo were affiliated with medical schools. They had lecture rooms and rich medical libraries. Students attending these schools had the privilege of gaining clinical and theoretical experiences at the same time.
Some families were famous for working as physicians. The Bakhtishu family in Baghdad provided mentorship and training to their family members to become skilled physicians. In Spain, the Ibn Zuhr family had five generations of physicians. Some physicians were self-taught through studying medical books. Ibn Radawan and Ibn Sina were examples of self-taught physicians.
Some medical books were so important and reliable that they were used as teaching books. Ibn Radwan authored several important books, one of which was called Kitab al-Kifayah fi al-Tibb. Ibn Sina (Avicenna) authored one of the most famous books in cardiology, Al-Qanoon Fil-Tibb. Ten Treatises on the Eye written by Hunayn ibn Ishaq was an important for those who practiced ophthalmology. In 1669 Tufat al-Muminin authored by Muhammad Mumin was one of the most reliable books in medieval Islam.
Ibn-Al Nafis’ signed certification that his Christian student, Shams al-Dawlah Abu al-Fadl, studied his commentary on a Hippocratic treatise
Hospitals were funded by the charity money called waqf, which was donated property used for charity; its revenues were used to build hospitals, mosques, schools and other institutions to serve the needs of the community. Most probably, physicians and others staff members who were serving patients in these hospitals were paid in waqf. The most prestigious jobs were for those who worked as court physicians serving the Caliph “governor” and his family. Court physicians were given generous salaries. Some physicians had private clinics, and their fees were not as high as court physicians or hospital-affiliated physicians.
We have little information regarding the licensing and certification of physicians. Some manuscripts were found where a teacher physician confirms that his student mastered a certain medical book, such as the Ibn al-Nafis treatise. An excerpt of the Ibn al-Naffis text reads:
[In the name of] God the Provider of Good Fortune. The wise, the learned, the excellent shaykh Shams al-Dawlah Abu al-Fadl ibn al-shaykh Abi al-Hasan al-Masihi, may God make long lasting his good fortune, studied with me this entire book of mine—that is, the commentary on the book by the imam Hippocrates, which is to say his book known as ‘On the Nature of Man’—by which he demonstrated the clarity of his intellect and the correctness of his thought, may God grant him benefit and may he make use of it. Certified by the poor in need of God, Ali ibn Abi al-Hazm al-Qurashi [known as Ibn al-Nafis] the physician. Praise be to God for his perfection and prayers for the best of His prophets, Muhammad, and his family. And that is on the twenty-ninth of Jumada I [in the] year six hundred and sixty eight [AD 25 January 1270].
During the Abbasid period, the rulers wanted to ensure that physicians are skilled enough to practice medicine. Passing oral and written examinations were required to get licensed. In 931, 860 physicians in Baghdad were screened, and only those qualified were allowed to practice medicine. Although there may not have been a uniform standardized system for physicians, Medieval Islamic medicine was the first to introduce the idea of regulations and licensing that were later on developed during the Renaissance.
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SARA ALI, MD, has graduated from the school of Medicine at Cairo University, Egypt in 2007. She is currently a research assistant at the Psychiatry and Behavioral Science department of Stanford University, and is also pursuing an online graduate degree in Public Health at the University of Florida.