HOSPITALS AND CLINICAL MEDICINE

12 May

Certain  elements in Islamic theology,  especially the call for total  resig- nation  to  the will of God,  might  have inhibited  the faithful  from  ac- tively pursuing public-health  initiatives. On the other hand, Muhammad made  it a point  to visit the sick in order  to bring  comfort,  hope,  and advice.  This  exemplary  behavior  was cited  as the  inspiration  for  the establishment  of charitable  institutions, such as hospitals, hospices, religious  centers,  and  educational institutions. Financial  support  was encouraged,  or demanded,  by religious law. Little is known  about  the earliest Islamic hospitals,  but there is general agreement that such insti- tutions  were founded  in the early eighth century. Some were apparently modeled on the hospital  and school of Jundi Shapur,  but others served more specific roles, such as isolating  lepers or caring for the blind and disabled.   Other   charitable   enterprises   included  the  organization  of teams  of physicians  and  female medical  personnel  to  visit the sick in prisons and mobile dispensaries that  served rural areas.

Detailed records were compiled by clinicians at many Muslim hos-

pitals in a format  that became known as ‘‘treatments based on repeated experience.’’ Such records were important in allowing the larger hospi- tals  to  assume  much  of  the  task  of  medical  education   and  clinical research. It was the reputation of individual sages and masters of medi- cine  rather  than  that  of  the  hospital  per  se that  attracted  students. Moreover,  the teacher, rather than the institution, granted the student a certificate indicating achievements in medical theory and clinical experi- ence. A truly dedicated student  might travel to several different cities to study special areas  of medicine with famous  masters.  Women,  trained separately by private tutors, could serve as nurses, midwives, and gynecologists.

A scandal concerning the death of a patient  in a Baghdad  hospital in 931 is said to have been the stimulus for the establishment  of a more

formal  system  of  testing  doctors.   Reports   on  the  impact  of  testing say that  160 out  of  860 medical  practitioners in  Baghdad  failed  the examination. Formal  testing of pharmacists  began in the ninth century. Rules and regulations  varied considerably  with time and place through- out the Muslim world. In response to the perceived lack of ‘‘quality con- trol’’ for practitioners, handbooks for laymen offered advice on ‘‘How to Test a Doctor’’ in order to distinguish a true physician from a quack. Stories about  how patients  tested their doctors  seem to have universal appeal.  One famous  example involved a man who presented  his physi- cian  with  the  urine  of  a  mule  and  claimed  it was that  of  a  favorite slave girl. The wise physician  responded  that  the girl must  have been bewitched, because only a mule would pass such urine. When the doctor recommended  a good feed of barley as the appropriate remedy, he was appointed chief personal  physician to the caliph.

As institutions of religious learning known as madrasas developed,

the medical sciences became an optional  part  of the curriculum.  By the thirteenth century, students at some of these institutions could specialize in either religion or natural science. Many  physicians complained  that standards of medical  education  and  practice  deteriorated as teaching hospitals  were displaced  by religious  institutions where  theology  and religious law overshadowed  medicine and science.

Some doctors were known for the huge fortunes they had acquired, whereas a few were remembered for establishing hospitals and charitable clinics. Most experts in medical ethics argued that it was appropriate to charge fees for treating the sick. The physician needed to earn enough to marry and educate his children, without  having to engage in work that would  interfere  with the study  of science. Thus,  it was important for the rich to pay large fees so that the doctor could care for the poor with- out  charge.  Dressed  in his white  shirt  and  cloak,  distinctive  doctor’s turban, carrying  a silver-headed  stick, perfumed  with rose-water,  cam- phor, and sandalwood, the physician was an impressive figure. However, despite the honors accorded to scholar-physicians, skepticism about medical  practitioners remained  strong.  In  many  popular   stories,  the Devil appears  disguised as a physician, or the physician kills his patient through  ignorance or treachery. In one such story, a physician murdered his patient  by poisoning  the lancet used for venesection. Months  later, the physician himself needed bleeding; by accident, he used the poisoned lancet.  Another  eminent  physician  proved  he had  a fool for a patient when he treated  himself for elephantiasis  by allowing starving vipers to bite him. The venom drove out the elephantiasis,  but it induced leprosy, deafness,  and  loss of vision.  The  persistence  of this  attitude  towards physicians  is apparent in  the  autobiography of  Jehangir,  son  of  the great  Mogul  emperor  Akbar   (1542–1605). After  describing  how  the treatment that the aged Akbar  had endured turned  diarrhea  into dysen- tery,  dysentery  into  constipation, and  constipation into  diarrhea  and

death,  Jehangir  concluded  that,  except for God’s  decree and  doctors’

mistakes, no one would ever die.

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