Ophthalmology in medieval Islam: Encyclopedia II - Ophthalmology in medieval Islam - Certification and malpractice

Ophthalmology in medieval Islam - Certification and malpractice

Being an ophthalmologist was not an easy profession then, for a license was required to be able to practice. The granting or withholding of this rested with the hakim-bashi, the chief physician to the Caliph. However, in addition to this test of certification, there was an additional means of checking for malpractice: Aside from the chief physician whom to which the Caliph delegated his powers to, there was another official known as the Muhtasib, or Inspector–General, who was appointed to oversee the practice of medicine by all physicians.

Before the year 931CE, there was hardly any means of professional certification, for in that year the Abbasid Caliph al-Muqtadir, was informed that the mistake of a private medical practitioner had resulted in the death of a patient. The Caliph therefore issued orders to the Inspector-General Ibrahim Muhammad ibn Abi Batiha to see to it that the practice of medicine by anyone who had not been examined and approved by Sinan bin Sabit bin Qurra be prohibited. Sinan thus only authorized physicians to practice whom he personally endorsed. He furthermore would suggest to each applicant what branch of medicine he ought to practice in. It is said that he examined a total number of physicians exceeding the number 860 in Baghdad alone during the first year.

The chairing of the board was later passed to Sinan’s son Ibrahim, who became chief physician of Baghdad, and Abu Sa’id Yamāni of Basra who certified the practice of 700 physicians through examinations. The board continued to function, being chaired by the likes of Ibn al-Tilmiz, court physician to caliph Al-Mustazhir.

Both the offices of the chief physician and the inspector general formed part of the royal caliphate. Among the Muhtasib’s duties were the administering of the Hippocratic Oath, which required physicians to swear that they would prepare, administer, or entrust no poisonous drafts to any unauthorized persons: that they would avoid gazing upon unrelated women folk within the sick household they visit: and that they would never reveal to any third person anything revealed to them in confidence by the patient. So important was this oath that Hunain ibn Ishaq was said to have reminded the Caliph of his oath when asked to prepare a lethal poison for an enemy of the Amir.

It was also the Muhtasib’s duty to see that physicians possessed proper instruments of his calling that were necessary and befitting for practice, as was with all the other branches of medicine. He would further, if he wished, require them to undergo a further examination. For example, physicians would be required to be thoroughly familiar with the ‘Ten treatises on the eye’, and were forbidden to practice unless they demonstrated knowledge of the gross anatomy of the eyeball. Rhazes, for instance, when about to undergo an operation for his deteriorating vision, orally examined his surgeon on the anatomy of the eye, and finding him lacking in knowledge refused to submit to his blade for the operation.

Ophthalmologists hence had to satisfy the examiner that they knew the principal diseases of the eye as well as their intricate complications, and were able to properly prepare collyria and ophthalmic ointments. Moreover they had to assert under oath not to allow unauthorized persons access to any surgical instruments, such as the lancet that was used for cases of pannus and pterygium, or the curette used for cases of trachoma.

The penalties for disregarding proper professional conduct varied from the warning of divine punishment on the Day of Resurrection, to more drastic measures such as the beating of the soles of the feet. The Muhtasib had such authority as to even inspect shops during after hours, as frequently and unexpectedly as he wished. He could enter shops and observe operations being performed. The inspector-general would oversee the preparation of certain ointments and destroy jars that he determined to be old or smelly. The rules for maintaining sanitary conditions were quite severe for such places including those of the druggists, public eating houses, and butchers. In earlier days, the Muhtasib had the right to punish, even by death, gross neglect of the health of the public. It was not uncommon to hear of a baker be thrown into his own furnace for selling poisonous corn, or for a cook to be boiled in his own cauldron for selling carrion or putrid meat.

Still, the sheer number of ignorant and fraudulent eye-charlatans caused many problems. So shocking was the conduct of these ignorant doctors that it was the declared duty of the Muhtasib to see that such men perform no operation upon the eyes, and never give a patient any preparation intended to be applied within the lids. Rhazes poured out his wrath when encountering quacksters and charlatans.

Adapted from the Wikipedia article "Certification and malpractice", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki