FINAL PAPER HOSPITALS AS PART OF THE PUBLIC HEALTH SYSTEM IN MEDIEVAL ISLAM

BY NOR JANNAH HASSAN G0825830 HISTORY OF ISLAMIC SCIENCE

Course Code: IITC 6013/8013

Instructor: Emeritus Prof. Dr. Osman Bakar International Institute of Islamic Thought and Civilization April 5th 2010

TABLE OF CONTENTS

INTRODUCTION..........................................................................................................2

PHILOSOPHICAL BASIS OF THE DEVELOPMENT OF MEDIEVAL ISLAMIC MEDICINE............................................4

STATE POLICY ON SCIENTIFIC & MEDICAL ADVANCEMENTS PUBLIC HEALTH SYSTEM DURING MEDIEVAL ISLAM..................................................6

CHARACTERISTIC FEATURES OF HOSPITALS IN THE MEDIEVAL ISLAMIC CIVILIZATION ............................................................................................................9

HOSPITALS AND PUBLIC HEALTH INSTITUTIONS IN MEDIEVAL ISLAM ........................................................................................................................11

PHARMACY AND PUBLIC HEALTH INSPECTORS (MUHTASIB)26

CONCLUSION............................................................................................................29

HOSPITALS AND THE PUBLIC HEATH SYSTEM IN MEDIEVAL ISLAM

INTRODUCTION The origins of Islamic medicine can be traced back to the time of the Prophet Muhammad (pbuh), as a significant number of hadiths concerning medicine are attributed to him. Several Sahaba are said to have been successfully treated of certain diseases by following the medical advice of the Prophet (pbuh). There are several hadiths in the Sahih al-Bukhari, Sunan Abi Dawood and Al-Muwatta attributed to the Prophet (pbuh) with regard to seeking cure to deseases, such as: "There is no disease that Allah has created, except that He also has created its treatment." 1 "Make use of medical treatment, for Allah has not made a disease without appointing a remedy for it, with the exception of one disease, name was old age."2 "Allah has sent down both the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically."3 "The one who sent down the disease sent down the remedy."4 The belief that there is a cure for every disease encouraged the early Muslims to engage in research and seek out a cure for every disease known to them. Medicine was a central part of medieval Islamic culture. Responding to circumstances of time and place, Islamic physicians and scholars developed a large and complex medical literature exploring and synthesizing the theory and practice of medicine. Islamic medicine was initially built on tradition, chiefly the theoretical and practical knowledge developed in Arabia, Persia, Greece, Rome, and India. Galen and
1 2

Sahih al-Bukhari, 7:71:582 Sunan Abi Dawood, 28:3846 3 Sunan Abi Dawood, 28:3865 4 Al-Muwatta, 50 5.12

Hippocrates were pre-eminent authorities, as well as the Indian physicians Sushruta and Charaka, and the Hellenistic scholars in Alexandria.5 Islamic scholars translated their voluminous writings from Greek and Sanskrit into Arabic and then produced new medical knowledge based on those texts. In order to make the Greek and Indian traditions more accessible, understandable, and teachable, Islamic scholars ordered and made more systematic the vast and sometimes inconsistent Greco-Roman and Indian medical knowledge by writing encyclopedias and summaries. It was through Arabic translations that the West learned of Hellenic medicine, including the works of Galen and Hippocrates. From the 9th century, Hunayn ibn Ishaq translated a number of Galen's works into the Arabic language, followed by translations of the Sushruta Samhita, Charaka Samhita, and Middle Persian works from Gundishapur6. Muslim physicians soon began making many of their own significant advances and contributions to medicine, including the fields of allergology, anatomy, bacteriology, botany, dentistry, embryology, environmentalism, etiology, immunology, microbiology, obstetrics, ophthalmology, pathology,

pediatrics, perinatology, physiology, psychiatry, psychology, pulsology and sphygmology, surgery, therapy, urology, zoology, and the pharmaceutical sciences such as pharmacy and pharmacology, among others.7 Of great influence in Western Europe were systematic and comprehensive works such as Ibn Sinas Qanun fi al-ibb, which were translated into Latin and then

Hakeem Abdul Hameed, Exchanges Between India and Central Asia in the field of Medicine, Emel The Muslim Lifestyle Magazine, http://www.salaam.co.uk/knowledge/hakeems.php (accesed March 30, 2010) 6 Borchardt, John K. (2002), Arabic Pharmacy during the Age of the Caliphs, Drug News & Perspectives 15 (6): 383 7 Medicine in Medieval Islam, 1/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010).

disseminated in manuscript and printed form throughout Europe. During the fifteenth and sixteenth centuries alone, as described by George Sarton8 : "One of the most famous exponents of Muslim universalism and an eminent figure in Islamic learning was Ibn Sina, known in the West as Avicenna (981-1037). For a thousand years he has retained his original renown as one of the greatest thinkers and medical scholars in history. His most important medical works are the Qanun (Canon) and a treatise on cardiac drugs. The 'Qanun fi-l-Tibb' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments." The Canon of Medicine was published more than thirty-five times.9 The development and writing of such comprehensive and systematic corpus of medical treatises did not exist out of a vacuum. Systematic public health care systems which included sophisticated hospitals and other related health care institutions were established along with these magnum corpuses.

PHILOSOPHICAL BASIS OF THE DEVELOPMENT OF MEDIEVAL ISLAMIC MEDICINE Medieval Islamic medicine flourished during a period where the conduct of the masses was as a matter of course guided by the Tauheedic spirit and fervent observations to the Islamic tenets, with the underlying spirit of harmony between humans intellectual faculty, the traditions of the Prophet (pbuh) and the Quranic Revelations. As such, the early Muslims embarked on a myriad of scientific activities to study the inter-relations between human and the world of creation on one hand and
8

Sarton, George (1927-31), Introduction to the History of Science, <http://www.cyberistan.org/islamic/Introl1.html#sarton2> (accessed March 31, 2010) 9 Medicine in Medieval Islam, 1/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010)

the Creator on the other. As the superpowers of the era, these Muslims encountered many civilisational and cultural dialogues with peoples of different parts of the world, especially Persia, Eastern Europe and India. Their strong and faithful adherence to the teachings of Islam availed the world immense advantages. The importance and respect for learning were religiously adhered to, as the Quran states, Say (unto them, O Muhammad): Are those who know equal with those who do not know? (39:9) and the Prophet (pbuh) stressed, "One hour of teaching is better than a night of praying." The prevalent culture was so propelled by knowledge acquisition that a captured enemy was freed if he paid a ransom of teaching ten Muslims writing and reading. The general philosophy in Islamic medicine is that the healer is Allah (SWT) and the doctor is the instrument that Allah uses to heal the people10. The physicianpatient relationship is viewed as a religious obligation in that the physician has responsibilities which are accountable by Allah in the Judgment Day. The medieval Islamic rulers guaranteed freedom of scientific research whether academic to reveal the signs of God in His creation, or applied aiming at the solution of a particular problem11. Due to the Tauheedic spirit prevalent during the period, these studies were only designed to be of benefit to humankind and to the surroundings. Islam provided the masses with laws and a basis for the protection and safeguarding of the human body as well as the spirit that seek to prevent any encumbrance to either the body or soul12. The Quran says: "And whoever saves a life it would be as if he saved the life of all the people" (5:32). Also, the Prophet (pbuh) was reported to have

10

Dr. Sharif Kaf Al-Ghazal, The Influence of Islamic Philosophy and Ethics on The Development of Medicine During the Islamic Renaissance. Journal of the International Society for the History of Islamic Medicine, June 2005; pg 3 9. 11 Ibid 12 Ibid

said that whoever helped a brother in difficulty, God would help him through his difficulties on the Judgment Day. Moreover, the Muslims rulers acknowledged the Christians and Jews as People of the Books, treated them respectably, provided them safety and protection, and valued their input and contributions towards knowledge advancement though they suffered from severe prosecutions in their own lands 13. So, there were many Christian and Jewish physicians who contributed significantly towards Islamic medicine during medieval Islamic periods (e.g. Jibra'il Ibn Bakhtashoo'e, Youhanna Ibn Masawaih, Ishaq Ibn Honain and Ishaq Ibn Moosa). In his Introduction to the History of Science George Sarton observed, "A philosophy of self-centredness, under whatever disguise, would be both incomprehensible and reprehensible to the Muslim mind. That mind was incapable of viewing man, whether in health or sickness as isolated from God, from fellow men, and from the world around him. It was probably inevitable that the Muslims should have discovered that disease need not be born within the patient himself but may reach from outside, in other words, that they should have been the first to establish clearly the existence of contagion." "We have reason to believe that when, during the crusades, Europe at last began to establish hospitals, they were inspired by the Arabs of near East.... The first hospital in Paris, Les Quinze-vingt, was founded by Louis IX after his return from the crusade 1254-1260."14

STATE POLICY ADVANCEMENTS

ON

SCIENTIFIC

&

MEDICAL

As a result of the inhospitable attitudes prevalent in many Christian lands, the Islamic empire in the early 8th century was the inevitable inheritors of the scientific tradition of late antiquity. At the time of the European Dark Ages, under the Umayyads, the Muslims built centuries of philosophical and scientific discoveries and developments.
13 14

Jacob Minkin, as cited in Ibid, pg 5 Sarton, George (1927-31), Introduction to the History of Science, <http://www.cyberistan.org/islamic/Introl1.html#sarton2> (accessed March 31, 2010)

The Muslims at the time not only assimilated the ancient wisdom of Persia, and the classical heritage of Greece, but adapted their own distinctive needs and ways of thinking. One of the very important factors that lead the Medieval Muslims into an era of unprecedented Scientific and Medical breakthroughs was the fact that the rulers took active and generous part in patronizing and sponsoring such wide-scale activities. One of the early Umayyad princes, Khalid Ibn Yazid (end of the 7th century), gave up his treasure for the study of medicine and chemistry. He studied medicine under John the Grammarian of Alexandria, and chemistry under Merrinos the Greek. He also encouraged several Greek and Coptic medical books to be translated into Arabic. 15 The Abbaside Caliphs during the 8th century encouraged the Persian physicians to translate into Arabic the medical knowledge therein, to build medical centres in Baghdad, the capital of their empire, and to run newly built hospitals. With further expansion east, the Muslims through contacts with India and China, brought new ideas and methods, in many fields and applications, inclusive those pertaining to medicine. What drove these Medieval Muslim rulers towards spending lavishly for such comprehensive scientific and medical advancements? As said and quoted by Ishtiaq Ahmad in a conference on Islamic Science and The Contemporary World16, it was their: deep adherence to a faith in which the pursuit of knowledge was equated with an act of worship. Such intricate link between the duty of faith and learning had impacted on the creation of institutions of learning; hospitals, universities, or public libraries, all taking firm root in Islam, where piety and learning were in many respects
15

Dr. Sharif Kaf Al-Ghazal, The Influence of Islamic Philosophy and Ethics on The Development of Medicine During the Islamic Renaissance. Journal of the International Society for the History of Islamic Medicine, June 2005; pg 3 9. 16 Ishtiaq Ahmad (2008), Caliphs as Sponsors of Islamic Sciences, Islamic Science and The Contemporary World Islamic Science in Contemporary Education Conference Proceedings, ISTAC, pg 108.

inseparable. The rooting of intellectual life in religion, the basis of Muslim society, created a respect for it such that rulers and rich men opened their doors to the representatives of the intellectual life and frequently lavished large sums of money on them. These rulers took personal interests and encouraged researches and translations with handsome grants and scholarships (apart from generous waqf from rich nobles and funding from zakah); and so propelled were the societies into the advancement of knowledge that knowledge culture became the prevalent norm of the period. As these rulers understanding and adherence to the tauheedic spirit demanded action from knowledge, public health infrastructures and institutions apart from public schools, universities, research centers (like Bayt al-Hikmah) and libraries were the natural outcomes. It must also be noted that because the society were so animated around knowledge, the possibility that these rulers might also be politically motivated cannot be overlooked. What is certain is that as a result of the Caliphs personal commitment to fund researches and developments, Islamic cities such as Baghdad (e.g. during al Mamuns Abbaside period) and Cordoba (e.g. during al Rahman III and al Hakim II from Umayyads period) became the centers of the medieval civilization. Ishtiaq Ahmad quoted, for example, Al Mamun (9th century) also built hospitals, which were crowded with their physicians, surgeons and dentists. Like other Abbaside rulers, the Caliph employed Nestorian physicians from the city of Gundishapur. . With his students, Hunayn translated almost all of the then known Greek medical works. At the same time these translations were made, original works were compiled in Arabic.17

17

Ishtiaq Ahmad (2008), Caliphs as Sponsors of Islamic Sciences, Islamic Science and The Contemporary World Islamic Science in Contemporary Education Conference Proceedings, ISTAC, pg 113.

CHARACTERISTIC FEATURES OF HOSPITALS IN THE MEDIEVAL ISLAMIC CIVILIZATION The Muslims developed what would become the world's first modern hospitals. The Muslims eventually constructed 34 of these hospitals throughout their empire18. These hospitals had different wards for the treatment of different diseases, special quarters for the insane, outpatient departments for the treatment of minor injuries and dispensaries, which provided virtually every kind of remedy then known. These hospitals had specific characteristics19: i. Non-discriminatory

The hospitals served all peoples regardless of race, creed, or socio-economic background. They were funded and run by the state, with physicians chairing as Directors with qualified assistants. The physicians and personnel consisted of persons of all faiths that worked together with the well-being of patients as their common aim. ii. Separate wards and nurses

Patients were segregated into different sections (wards) according to gender and type of diseases, with infectious ones quarantined. Male nurses were to take care of male patients, and female ones were take of the female patients. iii. Proper records of patients

These hospitals kept records of patients and their medical care. Record keeping of patients was the first in history. iv. Baths and water supplies

In keeping with Islamic requirements and obligations of cleanliness, purity and the observance of the five daily prayers, these hospitals had plentiful supply of clean running water for the patients and employees.
18

Dr. Sharif Kaf Al-Ghazal, The Influence of Islamic Philosophy and Ethics on The Development of Medicine During the Islamic Renaissance. Journal of the International Society for the History of Islamic Medicine, June 2005; pg 3 9. 19 Ibid

10

v.

Practicing physicians

The hospital practiced stringent screening and regulations for the physicians. For example, in 931 A.D., the Caliph Al-Mugtadir from the Abbasid dynasty, ordered the Chief Court-Physician Sinan Ibn-Thabit to screen the 860 physicians-of Baghdad, and only those qualified were granted license to practice. Physicians in the medieval Islamic era earned esteemed reputation. Al-Ghazal observed20, although anyone, irrespective of his social status, can study medicine, yet the route was long and tedious. He had to finish Islamic studies, philosophy, astronomy, art, chemistry, etc. before being accepted as a medical student. Therefore, the physician was an educated person who had wisdom and knowledge. Many of the physicians earned such lofty recognitions by the Caliphs that they were appointed to several important positions in the Caliphs court, with some went as high as prime ministers. The above fact facilitated further generous funding for the hospitals vi. Medical schools

The hospitals were not only for treating patients, they were also teaching institutions for educating medical students, where medical knowledge and expertise were shared and developed further. The hospitals often had expensive well stocked libraries, theaters for meetings and lectures, and housing for students and house-staff. vii. Rulers' involvement in building hospitals

The Caliphs of the Medieval Islam built magnificent integrated and comprehensive hospital complexes. These hospitals later became the models for hospitals in Renaissance Europe

viii.
20

Adequate financing to run the hospitals

Ibid, pg 6

11

The state also had generous funds to finance the operations of these hospitals through the Caliphs personal commitments as well as through the Zakah and Waqf institutions; where alms and generous donations were pooled respectively and managed by the state to help finance the building and maintenance of masjids, hospitals, schools and other public institutions.

HOSPITALS AND PUBLIC HEALTH INSTITUTIONS IN MEDIEVAL ISLAM From the days of early Islam, the Muslims developed a fine culture and had organized their administration on a firm. The Islamic Caliphates had created separate departments headed by Ministers and supervised by Secretaries. In line with the Islamic spirit of khilafah, the Caliphates took pride in establishing infrastructures for public health and welfare. The public works department was put in charge of the construction and maintenance of roads and bridges as well as the provision of sanitation and medical facilities to all classes of people. The Muslims were the first to establish fully integrated, comprehensive and systematic hospitals, dispensaries and medical schools in the world. They also established the first apothecary shop, founded the earliest school of pharmacy and produced the first pharmacopoeia. Among the well known authors were Jabir bin Hayyan, Tabari, Majusi, Zakariya Razi and Ibn Sina; the last two of whom were also two of the outstanding practicing physicians of their time. Even before the advent of Islam, Haris Ibn Kalda, a resident of Taif who had mastered medical science was welcomed in the court of the Persian emperor, Nausherwan, the Just. His son, Nasir Ibn Haris, earned an even greater reputation than his father as a physician and was instrumental in popularising medical science in early

12

Islamic Arabia. Hazrat Omar, the second Caliph of Islam despatched a company of physicians along with the Arab army bound for Persia. The Omayyad Caliphate represents a period of consolidation and proper organisation of Muslim resources. The third Omayyad Caliph, Walid Ibn Abdul Malik, who took much interest in public works, founded an institute for blind and disabled persons. He established the first medical dispensary in Islam in 88 A. H. and staffed it with a number of able physicians and surgeons. Soon afterwards dozens of small dispensaries sprang up all over the vast Omayyad Empire. The Abbasid Caliphate provided the most congenial atmosphere for the development of culture and the advancement of public welfare activities. The early hospitals in the Islamic domains were founded on the models of the old academyhospitals of Gundeshapur and were named bimaristan (asylum of the sick), where the ailing saw, as a place where they could be treated and perhaps cured by physicians; while medical practitioners saw the bimaristan as an institution devoted to the promotion of health, the curing of diseases and the expansion and dissemination of medical knowledge21. These bimaristan were very much hospitals in the modern sense, where the ill were welcomed and cared for by qualified staff, and which were clearly distinguished from the ancient healing temples, sleep temples, hospices, lazarets and leper-houses which were more concerned with isolating the sick and the insane from society "rather than to offer them any way to a true cure." 22 The bimaristan later functioned as the first public hospitals23, psychiatric hospitals24 and
21

David W. Tschanz, Medieval Islamic Hospitals and Medical Schools , IslamOnline.net, < http://www.islamonline.net/servlet/Satellite?c=Article_C&pagename=Zone-English-HealthScience %2FHSELayout&cid=1157365861738> (accessed April 1st 2010) 22 Micheau, Francoise, The Scientific Institutions in the Medieval Near East, pp. 991-2, in (Morelon & Rashed 1996, pp. 985-1007) 23 Peter Barrett (2004), Science and Theology Since Copernicus: The Search for Understanding, p. 18. 24 Ibrahim B. Syed PhD, Islamic Medicine: 1000 Years Ahead of its Times, Journal of the International Society for the History of Islamic Medicine, 2002 (2): 2-9.

13

diploma-granting medical universities25. Medical schools and libraries, where senior physicians taught the students medical techniques and how to fully apply their knowledge when dealing with their patients, were attached to the larger hospitals. Hospitals set examinations for their students, and issued diplomas. The bimaristan was, in short, the cradle of the medieval Islamic medicine and the archetype upon which the modern hospital is based. These institutions were not only critical to the dissemination of medical learning, but formed the basis for hospitals and medical schools as we know them today. Such advances resulted in the medieval Islamic Caliphate having a higher life expectancy than other pre-modern agricultural societies. 26, 27 By the 11th century there were even traveling clinics which were staffed by the hospitals. These clinics brought medical care to those too distant or too sick to come to the hospitals themselves. Early Islamic medical facilities could be subdivided into mobile dispensaries, first aid centers and permanent hospitals28. The idea of a mobile dispensary dates back to the time of the Prophet Muhammad (saws). During the Ghazwah Khandaq (the Battle of the Ditch) a separate tent was erected for the wounded. When Sa'id bin Mu'az was wounded and one of the blood vessels in his arm was injured, the Prophet ordered that he should be kept in the tent so that he could personally look after him. Later caliphs and rulers developed and extended these units into true traveling dispensaries complete with doctors and pharmacists. Their mission was to meet the needs of outlying communities that were far from the major cities and
25

Sir Glubb, John Bagot (1969), A Short History of the Arab Peoples, http://www.cyberistan.org/islamic/quote2.html#glubb, (accessed April 2nd 2010) 26 Shatzmiller, Maya (1994). Labour in the Medieval Islamic World. Brill Publishers. p. 66. ISBN 9004098968. 27 Sarton, George (1927-31), Introduction to the History of Science, http://www.cyberistan.org/islamic/Introl1.html#sarton2, (accessed April 2nd 2010) 28 David W. Tschanz, Medieval Islamic Hospitals and Medical Schools , IslamOnline.net, < http://www.islamonline.net/servlet/Satellite?c=Article_C&pagename=Zone-English-HealthScience %2FHSELayout&cid=1157365861738>, (accessed April 1st 2010)

14

permanent medical facilities. By the reign of the Seljuq Turkish Sultan Mohammed Saljuqi, the mobile hospital had become so extensive that its equipment needed forty camels to transport it. The first permanent Muslim hospital, a leprosarium, was constructed during the time of Waleed bin Abd-al Malik. Physicians appointed to this hospital were provided with large properties and salaries. Patients were essentially confined to the facility because of the contagious nature of their disease, but were granted stipends (just as the blind received) in order to care for their families. The first general hospital was founded at the beginning of the 9th century in Baghdad during the reign of the celebrated Abbasid Caliph Harun-ar-Rashid. Five more hospitals were established during the 10th century A.D. Greek and Persian methods of medical treatment were prevalent during the early period of the Abbasid Caliphate, but the talented Barmekides also introduced Indian methods. They invited a number of Indian raids, had their medical works translated into Arabic and founded a big dispensary in Baghdad in which patients were treated by Indian methods. Harun-ar-Rashid also created a separate department of health, which used to run several Government dispensaries staffed by talented physicians. The department was supervised by an Inspector-General of Health and Bukht Yishu was the first to be appointed to this high post in 171 A.H. The same post was occupied by his son Jabriel in 175 A.H. The maintenance of efficiency and high standards in the medical profession was also looked after. As early as the days of al Mamun and Mutasim, pharmacists had to pass a stringent proficiency test, before starting their practice. There were also separate hospitals for convicted prisoners. A doctor examined the prisoners every day and they were provided with the necessary facilities for

15

treatment. The Wazir 'Ali bin Isa bin Jarah bin Thabit wrote to the chief medical officer of Baghdad saying that29, "I am very much worried about the prisoners. Their large numbers and the condition of prisons make it certain that there must be many ailing persons among them. Therefore, I am of the opinion that they must have their own doctors who should examine them every day and give them, where necessary, medicines and decoctions. Such doctors should visit all prisons and treat the sick prisoners there." Other hospitals were open to all who needed them on a 24-hour basis. Some only saw men or women, while others cared for both in separate wings, but with duplicate facilities and resources. Hospitals were subdivided into various departments including: systemic diseases, ophthalmology, surgery, orthopedics and mental diseases. The department of systemic diseases, equivalent to the modern department of internal medicine, was usually further subdivided into sections dealing with fevers and digestive troubles. Larger hospitals had more departments and different subspecialties. Every department had an officer-in-charge and a presiding officer, in addition to a supervising specialist. There was a superintendent, called a sa'ur, who was responsible for overseeing the management of the entire institution. Hospitals were staffed with a sanitary inspector who was responsible for assuring that cleanliness and hygienic practices were maintained. In addition, there were accountants and other administrative staff to assure that hospital conditions financial and otherwise met established standards. Physicians worked fixed hours during which they were expected to see the patients that came to their departments. Every hospital had its own staff of licensed pharmacists (saydalani) and nurses. Medical staff salaries were fixed

29

David W. Tschanz, Medieval Islamic Hospitals and Medical Schools , IslamOnline.net, < http://www.islamonline.net/servlet/Satellite?c=Article_C&pagename=Zone-English-HealthScience %2FHSELayout&cid=1157365861738> (accessed April 1st 2010)

16

by law and compensation was distributed at a high rate. Hospitals, like all medical care, were free and available to all -- rich or poor; foreigner or resident; commoner or nobleperson. Physicians staffed outpatient clinics where less serious cases were given prescribed medicines to be taken at home. Serious cases requiring regular attention and supervision were admitted to the hospital. Inpatients were issued hospital wear from a central supply area while their own clothes were kept in the hospital store. If a patient was taken to the hospital ward, he would find a bed with clean sheets was ready for him. The course of treatment prescribed by the doctor began immediately upon arrival and the hospital rooms and wards were neat and tidy with an abundant supply of water. Patients were placed on a fixed diet, depending on their condition and disease. The criterion of sound health (following recovery from illness) was that the patient was able to ingest an amount of bread, normally taken by a perfectly healthy person, with the roasted meat of a whole bird at one time. If he could easily digest it, he was considered perfectly recovered and healthy and was released. Patients who were cured of their maladies but considered too weak to discharge were transferred to the convalescent ward until they were healthy enough to leave. Where applicable (e.g. the poor), patients were given new clothes along with a grant of money to aid them in establishing a livelihood30. In the reign of another Abbasid Caliph, al-Muqtadir Billah, the Medical Department registered phenomenal progress. His talented minister Ali Ibn Isa took a lively interest in public welfare activities. Sinan Ibn Thabit Ibn Qurra an eminent physician was the Inspector-General of Health. The outbreak of large scale epidemics in the Abbasid domains necessitated the expansion of the Health Department. A number of new hospitals were opened and a separate hospital was attached to each
30

Medicine in Medieval Islam, 1/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010)

17

jail. A section of temporary dispensaries was also opened. Hundreds of physicians were appointed who toured the rural areas with mobile dispensaries and attended to ailing persons. In addition to these arrangements, Muqtadir Billah also founded several large hospitals, one of which was built on the bank of the river Tigris and spent copiously for their annual expenditures. Due to the discovery of a case of malpractice, Sinan, who was the Inspector-General of Health, was ordered by the Caliph in 931 A.D. to test all practicing physicians and grant certificates to those who could satisfy him, Diplomas were awarded to successful candidates. Arrangements were made for practical instruction. Orthopedists were examined as to whether they were acquainted with anatomy and surgery. Like surgeons, the ophthalmologists had to undergo a further test and were-forbidden to practice unless they knew the gross anatomy of the eye-ball. They had to satisfy the examiner that they knew the three principal diseases of the eye as well as their complications. Hence a system of medical proficiency tests was introduced and over 860 men passed the test in Baghdad alone and started their practice. Medical facilities were provided in the distant part of the far flung Abbasid domains. At least 34 hospitals were scattered all over the Islamic world during the Abbasid Caliphate and mobile clinics existed in the 11th century. The hospitals trained physicians as well as treating patients. They were divided into male and female sections and also contained medical libraries which offered courses in medicine. A post of Inspector-General of Hospitals was created during the Abbasid Caliphate, which was usually occupied by the most outstanding physician of the Islamic world. Another post, which was that of Chief Chemist, was also created, to head the Department which supervised the preparation of drugs. Zia Ibn Baytar, who was a great botanist and herbalist, occupied this post in 646 A.H.

18

Egypt was somewhat later in establishing centers of medical facilities. According to Allama Maqrizi, a dispensary was opened in Cairo under the orders of Fath Ibn Khaqan, the Minister of Caliph Al-Mutawakkil Billah. The first hospital in Cairo was built by Ibn Tulun, the Governor of Cairo in 872 A.D., and it survived until the 15th century. The celebrated Governor had set aside property yielding a generous amount each year to meet the necessary expenditures of the hospital. He had made elaborate arrangements for the free boarding, lodging and dress of the patients. The hospital was equipped with all available medical facilities and had obtained the services of the best physicians who regularly examined the patients twice a day. Hospitals were built not only for the physically sick, but for the mentally sick also. One of the first ever psychiatric hospitals that cared for the mentally ill was built in Cairo. The Governor himself visited the hospital on every Friday. Each of the two main sections of the hospital was divided into several halls. The biggest hall, meant for general medical cases, was partitioned into small rooms each serving a different disease. There were separate wards for surgical cases, eye diseases and orthopedic cases. From the point of view of treatment the hospital was divided into two main sections--the out-patient department and the in-patient department. The Qalawun Hospital in Cairo could care for 8,000 patients with a staff that included physicians, pharmacists, and nurses. One could also access a dispensary, and research facility that led to advances, which included the discovery of the contagious nature of diseases, and research into optics and the mechanisms of the eye. Muslim doctors were removing cataracts with hollow needles over 1000 years before Western physicians dared attempt such a task. Hospitals later spread to Europe during the Crusades, inspired by the hospitals in the Middle East. The first hospital in Paris, Les Quinze-

19

vingts, was founded by Louis IX after his return from the Crusade between1254126031. At a time when the dwindling Abbasid Caliphate was helpless to meet the greatest threat to Islam, Sultan Nuruddin Zangi and Sultan Salahuddin Ayyubi successfully met the challenge and rolled back the surging waves of crusaders who had swarmed into the Holy land. These incessant military campaigns could not lessen their interest in the patronage of art and learning and they spent the major part of their income on public welfare activities. Allama Ibn Jubayr, who, on his way to Mecca in the 6th century A.H. passed through Baghdad, Mosul, Aleppo and Damascus found a network of charitable public welfare institutions there. Nuruddin had opened a big dispensary in Damascus which was called Nooviya which met the expenses of indoor and outdoor patients. Another institution of the same type existed in Damascus. In 577 A.H., Sultan Salahuddin Ayyubi converted a large Fatimid Palace into a hospital. Allama Ibn Jubayr visited this grand hospital in Cairo and gives a detailed description in his Travelogue. It contained hundreds of beds for indoor patients and had a separate ward for female patients who were attended to by female staff only. A separate portion of the hospital, with spacious grounds bounded by high walls was reserved for the lunatics. This hospital was frequently inspected by the Sultan himself who kept a strict watch over it. The Sultan had also built another magnificent hospital in Alexandria. The lead given by Sultans Nuruddin Zangi and Salahuddin Ayyubi was enthusiastically followed by others and well-to-do people vied with each other in founding public welfare institutions. In 678 A.H., when Mansur Qalaun ascended the throne of Cairo, he built a magnificent hospital in Cairo, which was second only to the Azdiya Hospital in Baghdad. The hospital was housed in four big buildings,
31

Michael Woods, Islam, Once at Forefront of Science, Fell by Wayside, Post-Gazette National Bureau, Sunday, April 11, 2004 as cited in ibid.

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occupying an area of 10,600 square yards. A canal which flowed through the-hospital supplied it with water. The ruler had set aside property yielding a million dirhams per annum for its expenses. This hospital which was open to all had separate apartments for the treatment of patients suffering from different diseases32 so that people with contagious diseases could be kept away from other patients. A teaching institution was also attached to this hospital. The biggest hospital-of the world of Islam which was equipped with all available medical facilities was built by Azud-al-Daulah in 368 A.H. in Baghdad. This hospital which, with its spacious buildings, up-to-date medical instruments, excellent arrangements and efficient administration could rank with the best hospitals built until the middle of the 19th century was in reality a Medical University. Drawn from all parts of the Islamic world were the more than eighty medical specialists including Ibn Baksh, Abu Yaqoob and Abu Isa who treated patients and also delivered lectures on various medical subjects. The hospital, which took three years to be built, employed skilful ophthalmologists like Abu Nasr Ibn-ul-Duhali, surgeons like Abul Khair and orthopedic surgeons like Abul Salh. According to Al-Qifti, ibn Manduyah of Isfahan was summoned from Central Asia. "All these (hospitals) were overshadowed" says a European writer33, "by the hospital that he founded in Baghdad, complete with equipment, numerous trust funds and a pharmacy stocked in drugs brought from the ends of the earth". A list of diets and drugs used in this hospital is preserved in the British Museum in London. The main dispensary of the hospital was

32

Islamic Science, the Scholar and Ethics, Foundation for Science Technology and Civilisation as cited in Medicine in Medieval Islam, 1/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010). 33 Hospitals in Medieval Islam, http://www.netmuslims.com/index.php? option=com_content&view=article&id=101:hospitals-in-medieval-islam&catid=22&Itemid=100055 (accessed March 31st 2010)

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housed in a palatial building. Benjamin of Tudela, a Jew-who visited Baghdad in 1160 A.D. found no less than sixty medical institutions there. He writes34:"All are well provided from the king's stores with spices and other necessaries. Every patient who claims assistance is fed at the king's expense' until his cure is complete There is another large building called the Darul Maraphtan in which are locked up all those insane persons who are met with during the hot season, everyone of whom is secured by iron chain until his reason returns, when he is allowed to return home. For this purpose they are regularly examined once a month by the king's officers appointed for the purpose, and, when they are found to be possessed of reason, they are immediately liberated. All this is done by the king in pure charity towards all those who come to Baghdad, either ill or insane, for the king is a pious man and his intention is excellent in this respect". A number of medical institutions and hospitals were opened in Baghdad and in the provinces during the 11th and 12th centuries A.D. In 1113 A.D., a hospital was opened in Baghdad by Khumastigin and was known as Tutushi hospital. A few years later a school for orphans was built by Mustufi Aziz-ud-Din who bore all the expenses of its residents. A hospital attached to a medical university was founded by Azud-al Daulah in Shiraz. Abu Said Kukuburi, built four asylums in Arbela for the blind and for persons suffering from chronic diseases. The big hospitals like that of Azud-al Daulah employed a large staff both technical and administrative. The Chief Officer of the dispensary was called Shaikh Saydalani. The administration of the hospital was headed by a governor who used to be a non-technical man usually a general or prince. The post of mutwalli or dean was usually filled by a medical man. It was occupied by AI-Razi at Rayy and later he was appointed mutawalli of the old hospital in Baghdad. Al-Jurjani held this post at Khwarizm. One of the finest Islamic hospitals was built by

34

Hospitals in Medieval Islam, http://www.netmuslims.com/index.php? option=com_content&view=article&id=101:hospitals-in-medieval-islam&catid=22&Itemid=100055 (accessed March 31st 2010)

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Abdul Wahid al-Marakeshi in Morocco in about 1200 A.D. According to the writer of the Medical History of Persia35, "The hospital was unequalled in the world. First there was selected a large open space in the most level part of the town. The workmen embellished with a beauty of sculpture and ornamentation even beyond what was demanded of them. All sorts of suitable trees and fruit trees were planted there. Water there was in abundance, flowing through all the rooms. In addition there were four large pools in the centre of the building, one of them was lined with white marble. The hospital was furnished with valuable carpets of wool, cotton, silk and leather, so wonderful that I cannot even describe them. For the use of patients there were provided day-dresses and night dresses, thick for winter, thin for summer. After he was cured, a poor patient received on leaving the hospital a sum of money sufficient to keep him for a time. Rich patients received back their money and clothes......Every Friday the Prince after the midday prayer mounted his horse to go and visit the patients and learn about each of them". A number of hospitals and dispensaries were established in Mecca and Medina. In 628 A.H., the Abbasid Caliph, Al-Mustansir Billah built a large dispensary in Mecca. Muslim India did not lag behind other countries in this humanitarian work and according to Allama Maqrizi, in the reign of Muhammad Tughlaq, Delhi alone possessed more than 70 dispensaries. The Mughal Emperor Jehangir had issued a proclamation for the establishment of a greater number of hospitals and dispensaries in his dominions. A Muslim physician in Cadiz (Spain) had planted in the park of the governor a botanical garden in which he cultivated rare medical herbs which he had brought from his travels. One of the major roles of the hospitals was the training of physicians. Each hospital had a large lecture theater where students, along with senior physicians and the senior medical officers, would meet and discuss medical problems, seminar style. As training progressed, medical students would accompany senior physicians to the
35

Hospitals in Medieval Islam, http://www.netmuslims.com/index.php? option=com_content&view=article&id=101:hospitals-in-medieval-islam&catid=22&Itemid=100055 (accessed March 31st 2010)

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wards and participate in patient care, much like a modern day residency. Training culminated in the application for a license to practice medicine. Candidates had to appear before the region's government appointed chief medical officer. The first step required writing a treatise on the subject in which the candidate wanted to obtain a certificate of proficiency. The treatise could be an original piece of research or a commentary on existing texts, such as those of Hippocrates, Galen and, after the 11th century, those of Ibn Sina. Candidates were encouraged to carefully examine these earlier works for errors. This emphasis on empiricism and observation, rather than a slavish adherence to authorities, was one of the keystones of the medieval Islamic intellectual ferment. Upon completion of the treatise, the candidate was interviewed at length by the chief medical officer and questioned on all the relevant problems of his prospective specialty. If he succeeded in giving satisfactory answers he was licensed to practice medicine. Hospitals in the medieval Islamic world featured not only competency tests for doctors, but also drug purity regulations, nurses and interns, and advanced surgical procedures.36 Another key aspect to the hospital, and of critical importance to both students and teachers, was the presence of extensive medical libraries. Egypt's Ibn Tulun Hospital had a library comprising of one hundred thousand books on various branches of medical science in the 14th century, at a time when Europe's largest library, at the University of Paris, consisted of a mere 400 volumes. In addition to the permanent hospitals discussed above, cities and major towns also had first aid centers. These acute care centers were typically located at busy public places, such as large mosques. Maqrizi described one such facility in Cairo saying37,
36

Medicine And Health, "Rise and Spread of Islam 622-1500: Science, Technology, Health", World Eras, Thomson Gale. As sited in Medicine in Medieval Islam, 1/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010)
37

David W. Tschanz, Medieval Islamic Hospitals and Medical Schools , IslamOnline.net, < http://www.islamonline.net/servlet/Satellite?c=Article_C&pagename=Zone-English-HealthScience

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"Ibn-e-Tulun, when he built his world famous mosque in Egypt, at one end of it there was a place for ablutions and a dispensary also as annexes. The dispensary was well equipped with medicines and attendants. On Fridays there used to be a doctor on duty there so that he might attend immediately to any casualties on the occasion of this mammoth gathering." One of the features in medieval Muslim hospitals that distinguished them from their contemporaries and predecessors was their significantly higher standards of medical ethics. Hospitals in the Islamic world treated patients of all religions, ethnicities, and backgrounds, while the hospitals themselves often employed staff from Christian, Jewish and other minority backgrounds. Muslim doctors and physicians were expected to have obligations towards their patients, regardless of their wealth or backgrounds. The ethical standards of Muslim physicians was first laid down in the 9th century by Ishaq bin Ali Rahawi, who wrote the Adab al-Tabib (Conduct of a Physician), the first treatise dedicated to medical ethics. He regarded physicians as "guardians of souls and bodies", and wrote twenty chapters on various topics related to medical ethics.38 It is astounding to observe how Al-Tabari, the chief physician in 970 A.D., described the Islamic code of ethics in his book Fardous Al Hikma (The paradise of wisdom) stressing on good Personal characters of the physician, the physicians obligations towards his patients, community and colleagues . He stated: The physician should be modest, virtuous and merciful He should wear clean clothes, be dignified, and have well-groomed hair and beard. He should select his company to be persons of good reputation. He should be careful of what he says and should not hesitate to ask forgiveness if he has made an error. He should be forgiving and never seek revenge. He should be friendly and peacemaker. He should avoid predicting whether a patient will live or die, only Allah knows He ought not loose his temper when his patient keeps asking questions, but should answer gently and
%2FHSELayout&cid=1157365861738> (accessed April 1st 2010) 38 The Art as a Profession, United States National Library of Medicine as cited in As sited in Medicine in Medieval Islam, 1/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010)

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compassionately He should treat alike the rich and the poor, the master and the servant . God will reward him if he helps the needy He should be punctual and reliable He should not wrangle about his fees. If the patient is very ill or in an emergency, he should be thankful, no matter how much he is paid He should not give drugs to a pregnant woman for an abortion unless necessary for the mother's health. . He should be decent towards women and should not divulge the secrets of his patientsHe should speak no evil of reputable men of the community or be critical of any one's religious belief He should speak well of his colleagues. He should not honor himself by shaming others. 39

Another unique feature of medieval Muslim hospitals was the roles of female staff, who were rarely employed in ancient and medieval healing temples elsewhere in the world. Medieval Muslim hospitals commonly employed female nurses, including nurses from as far as Sudan, a sign of great breakthrough. Muslim hospitals were also the first to employ female physicians, the most famous being two female physicians from the Banu Zuhr family who served the Almohad ruler Abu Yusuf Ya'qub alMansur in the 12th century40. Later in the 15th century, female surgeons were illustrated for the first time in erafeddin Sabuncuolu's Cerrahiyyetu'l-Haniyye (Imperial Surgery).41

PHARMACY AND PUBLIC HEALTH INSPECTORS (MUHTASIB) The first drugstores were opened by Muslim pharmacists in Baghdad in 754, during the Abbasid Caliphate. Due to the extraordinary advances that were made in the fields of chemistry and botany by Muslim chemists in the Middle East, it was a motive for
39

Dr. Sharif Kaf Al-Ghazal, The Influence of Islamic Philosophy and Ethics on The Development of Medicine During the Islamic Renaissance. Journal of the International Society for the History of Islamic Medicine, June 2005, pg 3. 40 G. Bademci (2006), First illustrations of female "Neurosurgeons" in the fifteenth century by Serefeddin Sabuncuoglu, Neurociruga 17: 162-165. 41 Amber Haque (2004), Psychology from Islamic Perspective: Contributions of Early Muslim Scholars and Challenges to Contemporary Muslim Psychologists, Journal of Religion and Health 43 (4): 357377 [361]

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the Muslim physicians to develop the study of pharmacology. In the beginning, medicine and chemistry was kept separate from pharmacy; the 9th century was when pharmacies were first recognized. They were not only simply stores where one could buy medicine and drugspharmacists had also been skilled and knowledgeable in compounding, preserving, and storing the different types of drugs. As Baghdad had been the central learning region of the Middle East at the time, not only was it where around 60 pharmaceuticals were dispensing drugs by prescription (in Baghdad alone)42, but it was also the region where the first school of pharmacy was established by the Caliph al Mamun. The new increasing interest in pharmacology not only benefitted the process of healing those in need, but it also seemed to correlate with the increase in literary productivity- books where being written and published describing new remedies, treaties, and natural medicinal substances. Schooling, examination, and licensing were required as of 931 A.D. by the Caliph Al-Muqtadir in Baghdad after he had learned that a patient had died as a result of a physicians error. Afterwards, he had ordered Sinan-ibn Thabit bin Qurrah (his chief physician) to evaluate all those who claimed to be practicing the art of healing. In Baghdad alone, over 860 practitioners were examined over the first year. From then on, the Muhtasib (Inspector of Public Services) inspected pharmacies on regular bases, ensuring that things such as the quality of drugs, measures of traders, and weights maintained high quality as they were sold at the pharmacies and apothecaries.43 The advances made in medieval Islam by Muslim chemists in botany and chemistry led Muslim physicians to substantially develop pharmacology. Muhammad ibn Zakarya Rzi (865-915), for instance, acted to promote the medical uses of chemical compounds, while Abu al42

Medicine in Medieval Islam, 3/7 http://wapedia.mobi/en/Medicine_in_medieval_Islam ; (accessed March 30, 2010)

43

Ibrahim B. Syed, 1000 Years Ahead Of Its Times. Islamic medicine (2002): 1-8, http://www.ishim.net/ishimj/2/01.pdf, (accessed April 3rd, 2010)

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Qasim al-Zahrawi (936-1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples from which compounded the complex drugs then generally used. 44 The Muhtasibs responsibilities might include seeing that correct weights and measures were used by merchants (so no one would be cheated), insisting upon proper street cleaning, seeing that a dangerous building was condemned, ensuring a supply of clean water, and other related matters. A number of books were written as guides to help an inspector perform his duties.45 The Health Inspector had the power to make regular inspections on all the shops in the city at any hour, night or day. He could arrest offenders. He also fought to keep the streets clear from the dumping of refuse and regulated (made it work according to laws). The medieval Muslim scientists recognized the importance of clean food and drink in the prevention of disease. Therefore, there were strict rules and the Muhtasib enforced them. All slaughtering of animals was to be carried out in public slaughterhouses. The sale of the meat from sick animals was forbidden. At the end of the day, butchers and fish sellers were supposed to clean up their area and dispose of bad or unpreserved meat scraps beyond the city limits. The Muhtasib also inspected public eating houses. All pots of food had to be kept covered against flies and insects. If a man was repeatedly charged with a serious offense against the community, such as selling diseased meat, the Muhtasib was empowered to have him executed. The importance of milk and water as sources of communicable diseases was also recognized during Medieval Islam. The best water was from wells, with less good water coming from the river. Water was sold around
44

David W Tshanz (2003), A Short History Of Islamic Pharmacy: 1-7. http://www.ishim.net/ishimj/3/03.pdf, (accessed April 3rd, 2010) 45 Caroline Stone(1977), The Muhtasib, ARAMCO World Magazine, Sept.-Oct. 1977.

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the city of Baghdad in large jars that had to be kept covered. Water was sold to travelers using little jars, and it was strictly forbidden to drink from the main jar or to dip one's hand into it. All the jars had to be scrubbed daily with boiling water and dried. Milk sales were regulated very strictly. All dairies had to be whitewashed (painted white) and paved. There were many tests of the milk's quality. The public baths were also inspected by the Muhtasib. The water had to be clean and fresh and the floors well scrubbed. People with skin diseases or leprosy were excluded. The Muhtasib also checked on doctors, surgeons, blood-letters, and pharmacists. In 931 the Caliph ordered that all doctors were licensed. Unlicensed persons were not allowed to practice medicine. The Muhtasib checked doctors' equipment and gave the Hippocratic Oath (an oath doctors took promising to do their best to cure their patients, first started by Hippocrates, the famous Greek doctor).46 The druggist, too, was inspected, and if he charged a patient a lot of money for cheap drugs he could be severely punished.

CONCLUSION The scientific spirit was not at all at odds to the early Muslims consciousness of their deen, since it was an integral part of their strong rooted belief in al-Taweed the Unity of God. These Muslims possessed a consciousness of Divine Unity in that God is One in His Essence, in His Attributes and Qualities, and in His (Creative) Works. One important consequence of affirming this central truth was that one had to accept
46

Medival Islamic Cultures, http://www.sfusd.k12.ca.us/schwww/sch618/Medicine/Pharmacies_and_Public_Heal.html (accessed April 3rd 2010)

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the objective reality of cosmic unity and in the early Muslims comprehension all things in the universe were interrelated in a web of cosmic unity through the cosmic laws governing them. They understood that the cosmos, made up of many levels of reality including that of the physical, constituted a unity because it must manifest the oneness of its metaphysical source and origin (i.e. God). The early Muslims strongly rooted in the entire Quranic text and teachings knew from the scripture that cosmic unity is a clear proof of Divine Unity. The Islamic scientific spirit of the early Muslims provided them the impetus to study the natural world around them in their quest to know more about the Creator. With this thirst of knowledge and the fervent zeal to acquire it, these Muslims took all opportunity in getting their hands to knowledge that was contained in books of the old from around the globe. These books were translated into Arabic and with these orchestrated translation movement came new knowledge and application which the Muslims developed out of their duty as Gods vicegerents to know the Creator as well as for the benefit of humankind. The passion for truth and objectivity, the general respect for fully corroborated empirical evidence, and a mind skilled in the classification of things were some of the most outstanding features of early Muslim religious scholarship as can clearly be seen in their studies of jurisprudence and the prophetic traditions. With this scientific frame of mind that came about from souls that were constructed totally by the teachings of the Quran and the prophetic traditions, they set about exploring everything around them in their quest to know more about the Creator, and in turn came out with medical discoveries and creativity that were meant to assist them in benefitting the public as part of executing their duties towards the Lord. This amazing creativity was apparent from the most mundane utilizing materials from their immediate surroundings to the most

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sophisticated medical formulae and apparatus and hospital systems to help them execute systematic patients care and complicated medical procedures that later gave birth to modern medical practices as we know them today. As far as hospitals are concerned, the medieval Islamic bimaristans where as modern as hospital system, practices and administrations are today. The early Muslims opened up the horizon for medicine and the public health care system to levels never imagined possible before. This was further made possible and sustained to unprecedented levels by protection and generous state policies towards the advancements of scientific and medical researches and practices. Furthermore, the Muslims strong adherence to al Tauheed guided them through all of their endeavors with an ethical spirit that brought about order, civility and prosperity to the Islamic cities such as Cordoba, Baghdad and Cairo as global centers of knowledge, civilization and development. Truly, the Medieval Islamic Civilisation bore the torches that illuminated the European Dark Ages and set models for modern civilization, where advancements, civility, harmony and respect are indivisible with obedience and servitude towards God. Regardless of the weaknesses of each caliphate in the medieval Islamic period, they demonstrated through their glorious history of the public health care systems and institutions vicegerency as ordained by the Almighty.

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