Hospitals and Public Health

      DURING the Middle Ages, the Muslims became the primary reservoir of medical knowledge. Inspired by the Holy Qur’aan and the sayings of the Holy Prophet Muhammad (u.w.b.p.), the two basic fountains of Islam, the Muslims were not only tolerant and favourable towards learn­ing hut also produced the most meteoric rise in the intellectual efforts of man. Their system of medicine was constructed in a logical and regular manner. Much of their original contribution has become incor­porated into the medical science of today. Muslims excelled in the science of Medicine, and had a profound effect on European medicine, a statement supported by the fact that Islamic medicine has been the basis of the curriculum of medical schools throughout the Western world as late as only one hundred years ago. Today in the East, many aspects of Islamic medicine are still studied and practised, and this is not done merely for historical interest.

      Islam, as a guide for all aspects of human life, also concerned it­self with the general principles of medicine and hygiene. Several verses of the Holy Qur’aan make general reference to medical questions, and several sayings of the Prophet deal with medicine. The sayings of the Prophet on medical questions have been systematised by later Muslim writers, and became known as Medicine of the Prophet (Tiibb a/-Nabi). The beginning of the fourth volume of the prophetic tradi­tions of Bukhari consists of two books in which are compiled, in 80 chapters, such sayings dealing with disease, its treatment and the ill patient. These sayings not only determined the Muslim’s dietary and hygienic habits, but also played a major role in infusing the Muslim mind with the spirit of enthusiasm to religiously pursue the science of medicine. Had not the Holy Prophet himself said, “0 servant of God, use medicine, because God hath not created a disease without a remedy for it?“ There was thus a brotherhood of scholars in the Muslim world and wise men received the greatest respect.

      Throughout the Muslim world medical care and services were provided to all and sundry. Daily medical visits were made to the prisons. Ill prisoners were examined and treated. Mobile medical units, consisting of doctors and a travelling dispensary, went to the various villages, carrying medicines and administering relief to the sick. All those who were ill, Muslims as well as non-Muslims, benefited from these clinical mobile services. These efforts reflect an admirable interest in medicine and public hygiene unknown to the rest of the world at that time. Lunatics received special examination from time to time by the orders of a commissioner. These commissioners were medical men. Acute cases of lunacy were hospitalised, while chronic cases that were harmless were allowed some freedom to walk the streets. Hospitals were established in various parts of the Muslim world, from Persia to Morocco, and’ from Syria to Egypt. These hospitals were known as “bimaristan”, a term which in modern usage has been altered to specifically refer to a lunatic asylum, the general modern term for hospital, being Mutashfa. Hospitals in Islam were not only basi­cally motivated by charity for pious purposes, but also provided the atmosphere for the development of medical science on an impressive scale. They cared for the sick and also had courses in theoretical and practical training. Many of these hospitals were supported by consid­erable endowments (waqf) and managed b_Y trustees. Four of the most famous of these hospitals are Al-Adudi in Baghdad, al-Kabir al Nuri in Damascus, and the two in Cairo, al-Atiq founded by Salah-ud­Din (Saladin), and al-Mansuri, founded by Sultan Kala’un.

      In every hospital there was a director who received advice from the heads of various sections, each a specialist in his own branch. There was also a pharmacy in every hospital where prescriptions of the doctors were filled. The head pharmacist ensured the efficiency of this depart­ment. Fixed salaries were paid out of endowments. The physician was given every opportunity for his experiments, and could prescribe new treatments. The results of his experiments were written up in special reports to which members of the public had access. An insight into the hospital system of the glorious Muslim era can be gained by further considering some of the more famous hospitals of the time.

      In Baghdad one of the most famous of these institutions was the great Adudi bimaristan (Adudi Hospital) founded by the Buwayhid ruler, Adud-ai-Dawla, on the west side of the city, at the bend of the Tigris River. It was opened in 982 C.E. (372 A.H.). At its opening it had twenty-four doctors. There were several specialists such as sur­geons (jara’ibiyyun), physiologists (taba’ii’iyyun) and oculists (kahha­lun). This hospital had an endowment of 100,000 dinars. It was stocked with various types of equipment. There were numerous trust funds, and a pharmacy having drugs brought from different countries. An in-and-out patient system corresponding to its modern counterpart was also in operation there. Definite specialisation among members of the medical staff was encouraged. The system of interns and externs was in practice, and there were lay-governors and an almoner’s office, as well as a nursing system. At the hospital, lectures were also given. The institution received its water supply from the Tigris. 

      The Nuri hospital at Damascus was founded by Nur al-Din b. Zangi ( 1146-1175 C.E.). At this institution, names of patients were carefully recorded together with the amount of medicine and food which each needed. A routine day in the life of a senior doctor at this hospital included going on rounds, thereby examining patients, and writing down not only prescriptions for medicine, but also instructions for general management. After the rounds, private patients were visit­ed. Later in the evening, the doctor returned to the hospital and lectured on medical topics to students for three hours.

      However, one of the most elaborate and splendid hospitals of the glorious Muslim era was the Mansur Hospital at Cairo, founded by al-Mansur al-Kala’un. This magnificent hospital was completed in eleven months in 1284 CE. (683 A.H.). To assist in the construction of this building, masons, carpenters and skilled workers were brought from all parts of Egypt. Loiterers in the streets, and passers-by re­gardless of their rank, were all obliged to help in this holy work. This institution received an annual endowment (waqf) of approximately one million dirhams. No individual was turned away from its doors, nor was the period of treatments limited or curtailed for anyone. There were separate wards for men and women, wards for general cases, and also special wards for treating fevers, wounds, eye diseases, bone in­juries, dysentery and surgical cases. The ward for fever was cooled by specially constructed fountains. There were galleries for convales­cents, accommodation for interns, and also rooms for other medical officers. There were also courtyards for lectures, a botanical garden (where herbs were cultivated for medicinal purposes), a pharmacy, a dispensary, kitchens, store-rooms, baths, wards for melancholics and for mentally deranged patients, a library with six librarians, a prayer-room, a staff-room, lecture-rooms, attendants of both sexes and a large administrative staff. The chief of the medical staff instructed his stu­dents in a properly equipped lecture-room. Fifty speakers recited the Qur’aan day and night without ceasing, while at night soft music was played to lull the sleepless, and there were story-tellers to amuse all”[1]. Every patient, on leaving hospital, was given an adequate sum of money to help him during his period of recovery until he became fit to work again. Hospitals were also founded for special treatment of the insane, lepers and the blind.

      Concerning the administration of these institutions, precise information is available from Islamic records and registers. Not only the budgets of the hospitals are known, but also the salary scales of the various employees, physicians and specialists. The monthly expendi­ture of the Sayyida Hospital (Bimarisan al-Say’yidat) on the East bank of the Tigris in Baghdad, for example, was known to be 600 dinars (see Footnote). (This hospital was founded in al-Muharram 306 A.H. (June 918 C.E.), while the Muktadiri Hospital (Bimaristan al-Muktadiri) had a monthly expenditure of 200 dinars. However, these expenditures are very conservative and not all inclusive. They do not, for example, include extra financial efforts made for providing patients with such comforts as blankets and charcoal in cold weather. And without doubt efforts in such direction very often went very far indeed! To a large extent, these monthly expenditures reflect the size of the hospitals. At the ‘Adudi Hospital, Jibra’il ibn Ubayd Allah re­ceived a monthly salary of 300 dirhams. He worked at the hospital two days and two nights per week.

      These hospitals carried out all the duties corresponding to those of modern hospitals and also served as schools of medicine. At these institutions the chief physicians and surgeons lectured to students and arranged for their practical instruction. After a course in theoretical and practical medicine, students were examined, and if successful were granted diplomas called ijaza.

      The distinguished physician Ali ibn-al-Abbas, whose work (to­gether with those of Razi and Avicenna) is considered as one of the three most highly esteemed medical works current in mediaeval Europe [2], emphasised the significance of regular visits to hospitals. In his medical work, “ Kitab’ul-Maliki”, he says:

“And of those things which are incumbent on the student of this Art are that he should constantly attend the hospitals and sick-houses; pay unremitting attention to the conditions and circumstances of their inmates, in company with the most acute professors of Medicine; and enquire frequently as to the state of the patients and the symptoms apparent in them, bearing in mind what he has read about these variations, and what they indicate of good or evil. If he does this, he will reach a high degree in this Art. Therefore it behoves him who desires to be an accomplished physician to follow closely these injunctions, to form his character in accordance with what we have mentioned therein; and not to neglect them. If he does this, his treatment of the sick will be successful; people will have confidence in him and be favourably disposed towards him, and he will win their affection and respect and good reputation; nor withal will he lack profit and advantage from them. And God Most High knoweth best” [3].

      The idea of systematic hospitalisation which flowed in a practical manner through the Muslim world was soon transported to Europe, especially due to the cultural contacts made between the East and the West during the crusades. The modern hospital is a direct growth from the Islamic foundations.

 

PUBLIC HEALTH

      The religion of lslam has aided public health by extolling sobriety, general cleanliness, personal hygiene, the maintenance of family life, isolation of infectious persons, and the abstention from certain foods likely to carry germs and parasites. Ablution before each of the five daily prayers, teeth-cleansing and regular baths have been recommend­ed. The Prophet himself gave instructions that utensils should be covered, and that all foodstuffs should be protected from flies, mice, worms and insects. Clean clothes must be worn; circumcision of males as an act of cleanliness has been prescribed; and in passing urine or stools, special instructions have been given to facilitate the cleanliness of the individual and prevent the pollution of the general environment.

      The Muslim civilisation had health departments with sanitary inspectors, and its standard of food hygiene has been ranked as perhaps the best achieved; anytime before the twentieth century. Sanitary measures were introduced, for example, in all parts of the capital city of Baghdad and included the diversion of dirty water of the public baths from the Tigris River into specially constructed cesspools. Special places were allotted for the cleaning and curing of fish. Animals were slaughtered under the most humane and sanitary conditions. Public drinking fountains were _Placed in various parts of Baghdad. Drainage systems were constructed for the proper flow of water. Indeed, it must also be remarked. that it was the Muslim world that was responsible for re-introducing into Europe the system of public baths which had been formerly discouraged in the European continent. Drug Stores were inspected by Public Health officials to ensure that sanitary condi­tions were maintained and also to prevent the adulteration of drugs.

      The contribution of Muslims to medical sciences has been vast and impressive, and further research will definitely show that their contribution is greater than can at present be claimed.

 

REFERENCES

[1] A History of Medicine” by Douglas Guthrie (p. 96)

(Published Thomas Nelson and Sons Ltd., 1960).

[2] “Arabian Medicine” by E. G. Browne (p. 32)

(Published Cambridge University Press, 1962).

[3] “Kitab ‘ul-Maliki” by Auli ibnu’l Abbas, re-quoted from Arabian Medicine” (pp. 56-57) by E. G. Browne.

 

Footnote: During the Middle Ages, the Muslims had an independent hi-metallic monetary system whose two basic units were the gold dinar and the silver dirham The rate of ex­change between the dinar and the dirham fluctuated considerably at different times and at different parts of the Muslim commonwealth. At times the rate of exchange varied from 10 dirhams to the dinar and at other times it varied from 15, 20, 30 and even 50 dirhams to the dinar.