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MEDICINE AND MEDICAL EDUCATION IN ISLAMIC HISTORY (PART 2)

HOSPITALS

The development of efficient hospitals was an outstanding contribution of Islamic medicine. The hospitals served all citizens free and without any regard to their color, religion, sex, age or social status. The hospitals Were run by government and their directors were physicians.

Hospitals had separate wards for male and female patients and were staffed with nursing and other ancillary staff of the same sex. Different diseases such as fever, wounds, infections, mania, eye conditions, cold diseases, diarrhea, and female disorder were allocated different wards. Convalescence centers were divided into separate sections. Hospitals provided patients with unlimited water supply and bathing facilities. Only qualified and licensed physicians were allowed by law to practice medicine. The hospitals were teaching hospitals to educate and train medical students. They had housing for students and house-staff,g and contained pharmacies dispensing free drugs to patients. All hospitals had their conference rooms 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. (1100 years ago) had 100,000 books. Universities, cities and hospitals acquired large libraries, 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 labor. 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.

These hospitals kept records of all their patients and their medical care, something done for the first time in medical history.

For considerations of treatment, the hospital was divided into two main departments, out- patient and in-patient departments. The in-patient department differed only slightly from any modern in-patient department. At the Tulum hospital, on admission the patients were given special apparel while their clothes, money, and valuables were stored away, and returned to them at the time of their discharge. On discharge, they also received five gold pieces each to tide them over until they could support themselves.

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, lepers were condemned and burned to death by royal decree.

The Qayrawan Hospital (built in 830 A.D. in Tunisia) was characterized by its spacious wards, waiting rooms for visitors and patients, and female nurses from Sudan, the first account of nursing in Arab history. The hospital also provided facilities for performing prayers.

The Al-Adudi hospital (built in 981 A.D. in Baghdad) was furnished with the latest equipment and supplies available 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.”

At a time when Paris and London were 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 that the Muslim hospitals 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 were of the same standing as those who served the regular in the hospitals. Similar mobile hospitals accompanied the armies in the field. The field hospitals were well equipped with medicament’s, 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. In order to choose the most hygienic area, he hung pieces of meat in different parts of the city and observed where they decomposed the least.

Ibn Sina stated explicitly that the bodily secretion is contaminated by foul earthly body before getting infected. 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 when the “black plague” ravaged Europe and Christians stood helpless, considering it an act of God, 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 affected 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 sulfuric 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 homeostasis. He was also 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 (intoxicant or drug). Less powerful anesthetics known at the time 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 modern anesthesia. It was a sponge soaked with aromatics and narcotics and held to the patient’s nostrils.

The use of anesthesia in Islam was one of the reasons why surgery rose to the level of an honorable profession, 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 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. The book contains the description and illustration of about 200 surgical instruments many of which were devised by Zahrawi himself” In it Zahrawi stresses the importance of the study of Anatomy as a fundamental prerequisite to surgery. He advocates the re-implantation of a fallen tooth and the use of dental prosthesis carved from cow’s bone, a better alternative to the wooden dentures worn by the first President of America, George Washington seven centuries later. Zahrawi appears to be the first surgeon in history to use cotton (Arabic word) in surgical dressings in the control of hemorrhage, as padding in the splinting of fractures, as a vaginal padding in the tearing of the pubis and in dentistry. He introduced the method for the removal of kidney stones by cutting into the urinary bladder. He was the first to teach the lithotomy position for vaginal operations. He described tracheotomy, distinguished between goiter and cancer of the thyroid, and explained his invention of a cauterizing iron which he also used to control bleeding. His description of varicose veins stripping, even after ten centuries, sounds almost like modern surgery.” In orthopedic surgery he introduced what is called today Kocher’s method of reduction of shoulder dislocation and patellectomy, thousand years before Brooke reintroduced it in 1937.

Ibn Sina’s description of the surgical treatment of cancer holds true even today after 1,000 years. He says the excision must be wide and bold; all veins running to the tumor must be included in the amputation. Even if this is not sufficient, then the area affected should be cauterized.

The Muslim surgeons performed three types of surgery: vascular, general, and orthopedic. Ophthalmic surgery was a specialty which was quite distinct both from medicine and surgery. They freely opened the abdomen and drained the peritoneal cavity in the approved modern style. To an unnamed surgeon of Shiraz is attributed the first colostomy operation. Liver abscesses were treated by puncture and exploration. Today surgeons all over the world practice and use several surgical procedures first introduced by Zahrawi a thousand years ago.