Thursday, May 12, 2005

hospitals and medical institutions (continued)

What follows is a description of the conditions of four major hospitals in four big cities of the Islamic world.

1. Azdi Hospital of Baghdad
Built by Azd al-Dawlah ibn Buwayh in 371 AH, the site for this hospital was selected by the then renowned physician, al-Razi [known as Rhazes of Europe]. He ordered that piece of fresh meat be placed at night at each proposed site. Upon examination in the morning, the place where the meat was found least affected by degenerative changes was considered most suitable for the hospital and construction was thus undertaken. A magnificent building was constructed at a tremendous cost and twenty-four of the most capable physicians were selected for the staff. A library, pharmacy, store and kitchen were provided for the hospital, of which were well equipped. In 449 AH, the Caliph Qa’im bin Amrillah renovated the hospital and equipped it with liquid medicines [infusions, decoctions, distilled extracts and syrups], herbs, roots and other medicines, which were of a rare nature. The patients were provided with sheets and blankets. Moreover, arrangements were made for perfumes, ice attendants, postmen, sentinels, watchmen and physicians to be available all the time. A big complex of washing facilities with a supply of hot and cold water was constructed and a garden and orchard were provided with flowers and fruits of all kinds. The patients who were too weak to move and did not have access to any other conveyance were regularly transferred from various places to this hospital, and the physicians attended to them morning and evening during their hours of duty.

2. Nuri Hospital of Damascus
Sultan Malik Nuruddin, the martyr (549 AH), constructed this hospital with the ransom paid to him by one of the Christian monarchs. At the time of its construction this was the most beautiful hospital in the Islamic world. It was constructed specifically for the poor and helpless, and only in extenuating circumstances were the rich allowed to seek its aid. Ibn Jubayr visited the hospital in 580 AH. He praised the kind treatment delivered by the physicians and their devotional care in the preparation and administration of medicine and food for their patients. There was a special department set aside for the management of psychological cases. Individuals who were found to be dangerous had to be restrained for the safety of others. However, they were properly fed and looked after in the matter of treatment. The historians narrate that in 831 AH, a non-Arab visitor went to Damascus. He was not only a great learned person but had fine tastes too. He happened to visit the hospital and was amazed to see the wholehearted commitment and devotion of the physicians, as well as the service of food, hygiene and other facilities provided for patients. What was still more surprising was that over and above the normal amenities, the patients had decoration and luxury articles supplied to them. In order to test the skills of the physicians of that hospital he pretended to be ill and managed to get hospitalized for diagnosis and treatment. For three days the Chief Medical Officer noted his pulse and appeared to be diagnosing his trouble. However, he discovered the very first day that the “patient” was fit and healthy and had come only to test their skills. Therefore, he prescribed for him a rich diet of good poultry meat, sweet dishes, refreshing and stimulating drinks and various kinds of fruits. For three days he was given this diet at the hospital. After that, the Chief Medical Officer left a note for him which read, “Hospitality here is for a limited period of three days.” That suggested to the non-Arab visitor that they had seen through his ruse and had entertained him only as a guest.

This hospital was functioning up until 1317 AH when it was converted to a hospital for foreigners. It is the same hospital which the Faculty of Medicine at the University of Syria now supervises. The Nuri Hospital was thus shut down and a local school was established.

3. The Major Mansuri Hospital
This hospital used to be the palace of some members of the nobility. Malik Mansur Sayfuddin Qala`un converted it into a hospital in 683 AH and endowed a particular estate for it with an annual income of one-thousand dirhams. A mosque, a Madrasah and a maktab for the orphans were also established along with it. According to historians, the hospital was established when, in 1675 AD during the time of Zahir Babyrus, the General set to oppose the advancing Roman armies, Amir Qala`un, was suddenly taken ill at Damascus. The physicians treated him there and the medicines were supplied from the Nuri Hospital. When he was completely cured he personally visited and inspected the Nuri Hospital. He was very much impressed by it and vowed that if Allah brought him to rule, he would build a hospital like it. When he became the Sultan, he selected and purchased the palace and he converted it into a hospital. This hospital from the point of view of organization and disposition was the only hospital of its kind. Admittance and treatment was open to all. The patients discharged and cured from this hospital were given new clothes to wear and those who died were buried at the hospital’s cost. There were separate physicians in charge of each branch of the medical sciences. There were attendants and nurses who washed the clothes of the patients, helped them to bathe, and cleaned and tidied the rooms and bedding. There were two attendees for every patient who did everything for their convenience and comfort. Every patient had a separate bed and bedding, and there were separate wards for patients of a certain type. There were fixed locations for discussions on medical themes and for lectures, where the principal used to teach the students. One of the unique aspects of this hospital was that treatment was not restricted to only inpatients, but was also provided for those who came as outpatients. They were supplied with medicines and nourishing food even under these conditions. Such was the extent of continuous medical treatment that one of the ophthalmologists at this hospital was reported to have said that more than four-thousand cases were treated daily. Those cured and discharged were offered clothes and cash to help them start some small business for their subsistence so that they would not be forced into difficult work immediately after coming out of hospital.

The documents relating to the endowments of these hospitals tells that a patient in the hospital was given his food in a vessel reserved for his exclusive use and no other patient could use it, and the food was always served covered. Another unique aspect of this hospital was that patients suffering form insomnia had a place set apart for them where they were entertained with charming music and interesting stories. Very weak patients were treated to amusing plays, jokes and rural dances. The muezzins of the neighborhood were ordered to make calls for the early morning Prayer two hours ahead of the scheduled time, and recite verses with proper intonation so that the patients may be cheered and their distress may be reduced, since lack of sleep and long nights were painful for them. When the French entered Egypt in 1798, their learned men saw these things with their own eyes, and stated them in their books in detail.

It is said that in Tripoli, there was a strange trust whose income was reserved exclusively for two people who would visit the hospitals daily. Sitting beside the patients, they would speak with each other in a whisper and in such a way that the patients would overhear them, getting the impression that their health was improving; the glow of health on their faces and the brightness of their eyes appearing to be evidence of that.

It is necessary to mention here the trust deed of this magnificent hospital in its entirety, as reported by the author of History of the Hospitals of the Islamic World (please refer to the comments section).

4. The Moroccan Hospital
Sultan Mansur Abu Yusuf, a well-known ruler of the Muwahiddin Dynasty of Morocco, built this facility. Spacious land was selected in one of the most temperate places of the country and the architects and builders were ordered to make it the most beautifully designed building possible. All sorts of fruit trees and plants were grown on the premises. Canals of running water passed by every room of the hospital. Four special reservoirs were built, one of them of pure white marble. Fine beddings were provided for the hospital beds, made out of wool, linen, silk and leather. A pharmacy was built in the hospital in which different kids of syrups, oils, collyria and other medicines were prepared. Patients were provided with different clothes for the day and night and summer and winter. Once completely cured, the poor patient would be given sufficient funds to help him start a business and earn a livelihood. A patient who was rich also received his share. This hospital was not dedicated to the poor and the indidgent only, for the affluent also benefited from its existence. In whichever section of Morocco a stranger was found ill, he was brought to the hospital and admitted as an inpatient. He was either cured and discharged or died there. The Sultan would go to the hospital every Friday and learn firsthand about the health of the patients, the work of the physicians and their dealings with the patients.

These are four examples out of hundreds of the hospitals that were functioning at that time in the Islamic world from the East to the West. They existed at a time when Europe was wandering under layers of darkness and was unaware of these hospitals and of their level of cleanliness and human concern. A well-known German Orientalist Dr. Marx Mayerhoff says about the European hospitals of the time, in light of the conditions in those of the Islamic Civilization, “The Arab hospitals and the health systems existing in the Islamic countries of the past is giving us a harsh and bitter lesson. We cannot fully appreciate it unless we compare this system with that of the European hospitals of that period.”

…In conclusion, we can say that the Islamic Civilization established the highest standard in the field of the management of hospitals about nine hundred years prior to Western Civilization. The hospitals of the Islamic Civilization were established under such exalted human sentiments and principles of mercy and justice to humanity, which have no parallel in history. Furthermore, these sentiments and principles have not yet been fully witnessed to this day in the Western countries…


THE ISLAMIC CIVILIZATION
Dr Mustafa Siba`i
(from Chapter 10: Hospitals and Medical Institutions)

1 Comments:

At 5:44 PM , Blogger abli said...

The trust deed of the Major Mansuri Hospital, as reported by the author of History of the Hospitals of the Islamic World:


The opportunities of the reward of the highest acts of righteousness afforded to lofty aims, such as those which are regarded as beneficial – like the curing of such people – are acts of goodness. These acts, which have everlasting reward and bring people happiness, are based on the firm foundation of piety with aspirations of a far-reaching nature. Such acts of goodness are trusts whose beneficence is general, whose reward is abiding, whose benefits are unlimited and the reward of the Hereafter is very valuable. So these acts of goodness are the real heaven, and this is the one sacrifice that takes one to the good will and pleasure of Allah. This is the sadaqa which is the dower of the houris in Heaven. Consider the elation of a helpless patient feels, how much support is afforded to a broken heart and how through treatment of his malady and offering him refuge he comes to feel independent. Its reward is so great that it cannot be expressed in words. Fortunate, indeed, is that person who has had such a compact with His Lord, Allah the All-Forgiving and most Merciful. In his income and expenditure he had such a compact with Allah, who knows both one’s open and hidden acts. He offered a goodly loan to Allah according to his capacity, and he valued the opportunity of surpassing others in the field of virtue. He helped a sick Muslim brother in his treatment, took away his grief; and as a reward, tomorrow, in the Court of Divine Justice, he will have deliverance from the chastisement of Hell. More than this, there is also hope of being the recipient of further exaltation in his rank and position with Allah. He will be endowed with the good fortune of closeness to Allah, where he will have no fear of any oppression or tyranny. This is such a virtuous act that will become a means of forgiveness to all his sins, and he will be free from all forms of grief. So under the urge of the attainment of these high ranks, Malik `Adil Mansur ordered the endowment of Mansuri Hospital [here the deed of this trust mentions the endowment, their situation and particulars]. This hospital is dedicated to the treatment of the rich, the poor, men and women alike, irrespective of their place of residence, color or race. We treat whatever malady or trouble they are tormented with, whether they are physical, spiritual or nervous ailments. Those maladies may be mild or sufficiently aggravated, similar or dissimilar, apparent or concealed. They may be victims of mental aberration whose remedy is one of the most important objectives, and whose treatment is most imperative and of great importance, and can neither be overlooked nor slighted and discarded. They may also be suffering from other disorders whose early diagnosis is necessary for man. Here treatment will be undertaken with roots and herbs that are well known to physicians. Common people, individual and collective, old and young, boys and girls will all be eligible for treatment. Indigent patients, male or female, shall stay at the hospital as inpatients for the duration of their treatment. There, they shall receive all the facilities of treatment available at the hospital and the necessities shall be distributed among all those in need of it, irrespective of them being strangers or relatives, locals or strangers on a journey here. This they shall receive, irrespective of whether they are strong or weak, from the masses or the classes, high or low, rich or poor, officer or subordinate, blind or seeing, superior or inferior, renowned or unknown, glorious or insignificant and unimportant, entrepreneur or poverty-stricken, master or slave. This treatment shall be free of charge, and nobody shall have any objection to it. This treatment shall be undertaken for the pleasure of Allah alone, attainment of the reward of the Hereafter and His Beneficence, since Allah has ordained spending for the welfare of the patient and for those who take care of the patients, such as physicians, ophthalmologists, surgeons, pharmacists, those cooking tasty and appetizing foods, those preparing electuaries, collyria men, those preparing simple and compound purgatives, postmen, treasurers, guardians or trustees, superintendents, and all workers who are employed in hospitals for various jobs; also spending on those things that are necessary for the treatment of the patient; spending on things needed for the food and dress of the patients, lenses needed for the eyes, cauldrons and the like. Allah has also ordained spending on electuaries, various kinds of ointments, oils, drinks, simple and compound drugs, carpets and beddings, vessels and any new implementation required in this work. The manager shall have the authority to spend on the daily needs of the patients, for example, the daily expenses of incense burnt by them, the plates for food, glass tumblers to drink water and other drinks from, earthenware tumblers and goblets, earthen lamps and oil to burn in them. He shall also have the authority to spend on new implementations to procure water for drinking and cooking food from the River Nile and to purchase covers for the food offered to the patients; during summer season the date-palm leaf fans must be purchased. The superintendent or manager of the trusts shall spend on all these things from the income of the trust, but this expenditure shall not be extravagant, nor out it waste anything willfully, as there ought to be no excess over what is sufficient. All the expenses must be within the limits of genuine needs, so that as much as possible reward may be gained. The controller of the trusts shall appoint two persons paid from the income of this trust who must be trustworthy and honest Muslims. One of them shall hold charge of the distribution of various commodities and articles, liquid medicines, collyria, roots and herbs, electuaries, oils and wicks, and issue only those things sanctioned by the officer concerned. The other officer shall distribute their particular cups to the patients, male or female, every morning and evening and give them the medicine prescribed for them. It will also be his duty to supervise the working of the kitchen where nourishing food for the patients, poultry meat, chicken and other kinds of meat, shall be prepared. It will be his duty to give every patient the food prescribed for him on a platter exclusively set apart for his use only. No other patient shall partake of that food with him. It will also be his duty to distribute properly covered food among the patients, and he shall supervise this distribution until every patients has received his prescribed food. He will be responsible for such distribution in a proper manner every morning and evening the controller shall also have authority to appoint physicians, ophthalmologists and surgeons on reasonably lucrative remunerations. He shall determine these salaries in compliance with the existing conditions and the needs of the patients. He is fully authorized in the matter of the fixation of pay and the number of employees, but he should not allow either excess or deficiency. An attitude of moderation should be his policy. The staff shall be duty-bound to look after the conveniences and comforts of the patients all the time as regards duty hours, they are free to either be there all at a time or take turns at it. Working hours may be fixed through mutual consultation and with the approval of the controller of endowments. It is their duty to talk to every patient and find out whether a certain patient is improving or his malady is aggravated. It should be noted properly, and with the permission of the controller of the trusts the medicines and diet of every patient should be prescribed and noted on his sheet and he should be given both according to that plan. The staff should stay at the hospital during the night, all of them together or by turns. The ophthalmologists should sit in the outpatient clinic daily and treat the patients that come to them. Every patient that comes in the morning any day of the week for getting his eyes tested and treated should under no circumstances be compelled to return disappointed. They must treat him kindly and give him the necessary aid. Those with damaged eyes and poor vision should be dealt with more courteously. If the eyes have developed wounds, the ophthalmologist should consult the surgeon in his case, taking him personally to the surgeon and not leave him to fend for himself. Even after that, the physician should keep an eye on such cases until recovery. The controller of the trusts should appoint a scholar of medicine with the income of the trust, who will, all the time, remain engaged in research, particularly in relation to the pressing problems. This expert or research officer should sit in the large consultation room that has been set apart for him in the trust deed. It will be the duty of this expert to conduct research in various branches of the medical science and the problems cropping up from day to day. The working hours for him shall be fixed by the controller of the trust according to his discretion. However, it must be kept in mind carefully that the staff should be within the limits prescribed by the trust deed. The controller of the trusts should pay reasonably good emoluments to the appointed staff of this hospital and attendants, men and women. The salaries should be in keeping with the nature of their work. This remuneration is to be paid to the attendants for their services rendered to the men and women that have been admitted to the hospital for treatment. They should also keep their place neat and tidy, wash their clothes and never mistreat the facilities and comforts provided by the hospital. These facilities too must be in keeping with the circumstances at any particular period. It is the duty of the controller of the trust that he should arrange the burial of the patients, men and women, who pass away in the hospital. They should be bathed and embalmed with aroma at the cost of the hospital. The wages of digging a grave should be met by the trust and the deceased person buried with due honors in accordance with the Sunnah of the Prophet SAW. The controller of the trust should supply a person, sick at home but helpless, at his residence with whichever medicine, syrup or electuary he needs. However, this should be in such a manner that the inpatients at the hospital may not suffer from a shortage of drugs. If such an outpatient dies at his own place, the keeper of the hospital should pay for his shroud bath, digging of the grave and taking the dead body to the graveyard according to the status of the deceased. Those who are staying at the hospital and are cured by the grace of Allah, at the time of discharge they should be provided an average type of change of clothes in keeping with his status. Under this head the controller of the trust, in office, at any given time, should not go to such limits that the internal needs of the hospital may suffer for want of funds. It is, however, left to his discretion. The controller of this trust should fear Allah and consider himself responsible to men also in the discharge of his duties and never give priority to an influential person in comparison with the common people and treat him more lavishly on the basis of discrimination between the rich and poor. He should not give preference to a local patient over a foreign national, but must keep in view, in the matter of expenditure on them, the reward of the Hereafter and closeness to Allah who is the Lord of all cherishes

 

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