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.