MEDICINE AND MEDICAL EDUCATION IN ISLAMIC HISTORY

Ibrahim B. Syed

MEDICAL EDUCATION

In 636 A.D., the Persian City of Jundi-Shapur, which originally meant beautiful garden, was conquered by the Muslims. Its great university and hospital were left intact. Later other Islamic medical schools were built according to the Jundi-Shapur pattern. Medical education was serious and systematic. Lectures and clinical sessions included in teaching were based on the apprentice system. The advice given by Ali ibnul-Abbas (Haly Abbas: - 994 A.D.) to medical students is as timely today as it was then2. "And of those things which were incumbent on the student of this art (medicine) are that he should constantly attend the hospitals and sick houses: pay unremitting attention to the conditions and circumstances of their inmates, stay in company with the most astute professors of medicine, and inquire frequently as to the state of the patients and symptoms apparent in them, bearing in mind what he has read about these variations, and what they indicate of good or evil."

Razi (Razes: 841-926 A.D.) advised the medical students that while they examine a patient, they should bear in mind the classic symptoms of a disease as given in textbooks and compare them with what they found".

The ablest physicians such as Razi (Al-Razes), Ibn-Sina (Avicenna: $80-1037 A.D.) and Ibn Zuhr (Avenzoar: 116 A.D.) worked both as the directors and the deans of medical schools. They studied patients and prepared them for student presentation. Clinical reports of cases were written and preserved for teaching," and regular registers were maintained.

Training in Basic Science

Only Jundi-Shapur or Baghdad had separate schools for studying basic sciences. Candidates for medical study received basic preparation from private tutors through private lectures and self study. in Baghdad anatomy was taught by dissecting the apes, observing skeletal studies, and studying didactics. Other medical schools taught anatomy through lectures and illustrations. Alchemy was one of the prerequisites for admission to a medical school. The study of medicinal herbs and pharmacognosy rounded off the basic training. A number of hospitals maintained herbal gardens as a source of drugs for the patients and a means of instruction for the students.

Upon completion of the basic training, a candidate was admitted as an apprentice to a hospital where, along with a large group, he was assigned to a young physician for indoctrination, preliminary lectures, and familiarization with library procedures and uses. During this preclinical period, most of the lectures were on pharmacology and toxicology and the use of antidotes.

Clinical training

The next step was to give the student full clinical training. During this period students were assigned in small groups to famous physicians and experienced instructors, for ward rounds, discussions, lectures, and reviews. Early in this period therapeutics and pathology were taught. There was a strong emphasis on clinical instruction and some Muslim physicians contributed brilliant observations that have stood the test of time. As the students progressed in their studies they were exposed more and more to the subjects of diagnosis and judgment. Clinical observation and physical examination were stressed. Students (or clinical clerks) were asked to examine a patient and make a diagnosis of the ailment. Only after all else had failed would the professor make the diagnosis himself. While performing physical examination, the students were asked to examine and report six major factors: the patients' actions, excreta, the nature.and location of pain, and swelling and effluvia of the body. Also noted was color and feel of the skin-whether hot, cool, moist, dry, flabby. Yellowness in the whites of the eye (jaundice) and whether or not the patient could bend his back (lung disease) was also considered important.'

After a period of ward instructions, students were assigned to outpatient areas. After examining the patients, they reported their findings to the Instructors. After discussion, treatment was decided and prescribed. Patients who were too ill were admitted as inpatients. The maintenance of records for every patient was the responsibility of the students.

Curriculum

Different medical schools pursued different clinical curriculum and offered separate courses of studies, but the mainstay was usually internal medicine. Emphasis was placed on clarity and brevity in describing a disease and the separation of each eAtity. Until the time of Ibn Sina the description of meningitis was confused with acute infection accompanied by delirium. Ibn Sina described the symptoms of meningitis with such clarity and brevity that there is very little that can be added to it even after a thousand years(6). Surgery was also a part of the curriculum. After completing the prescribed course of studies, some students specialized under famous specialists, while others specialized during their clinical training. According to Elgood,6 knowledge of many surgical procedures such as amputation, excision of varicose veins, and hemorrhoids was essential. Orthopedics was widely taught, and the use of plaster of paris for casts after reduction of fractures was routinely shown to students. This method of treating fractures was rediscovered in the West in 1852. Although ophthalmology was practiced widely, it was not taught regularly in medical schools. Apprenticeship to an eye doctor was the preferred way of specializing in ophthalmology. Surgical treatment of cataract was very common. Obstetrics was left to midwives. Medical practioners consulted among themselves and with specialists Ibn Sina and Hazi both widely practiced and taught psychotherapy. After completing his medical training, every medical graduate was required to pass a licensing examination before starting his medical practice. It is important to note that there existed a Scientific Association which was formed in the hospital of Mayyafariqin to discuss the conditions and diseases of the patients.'

Licensing of Physicians

In Baghdad in 931 A.D., Caliph Al-Muqtadir learned that a patient had died as the result of a physician's error. Thereupon he ordered his chief physician, Sinan ibn Thabit bin Qurrah to examine all those who practiced the art of healing. In the first year of the decree more than 860 were examined in Baghdad alone. From that time on, licensing examinations required and administered in various places. Licensing Boards were under a government Official called Muhtasib or inspector general. Muhtasib also inspected weights and measures of traders and pharmacists. Pharmacists were employed as inspectors to inspect drugs and maintain quality control for drugs sold in a pharmacy or apothecary. The chief physician gave oral and practical examination, and if the young physician was successful, the Muhtasib administered the Hippocratic oath and Issued a license. After a thousand years, licensing Of physicians has been implemented in the West, particularly in America by the State Licensing Board Specialties such as in Medicine, Surgery, Radiology, etc. European medical schools followed the pattern set by the Islamic medical schools and even in the early nineteenth century, students at the Sorbonne could not graduate without reading Ibn Sina's Qanun (Canon). According to Razi a physician had to satisfy two conditions for selection: firstly, he was to be fully conversant with the new and the old medical literature, and secondly, he must have worked in a hospital as house physician.

HOSPITALS

The development of efficient hospitals was an outstanding contribution of Islamic medicine (7). 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.Diffrent diseases such as fever, wounds, infections, mania, eye conditions, cold diseases, diarrhea, and female disorder were allocated diffeient 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 libranes containing the most up-to-date books. According to Had