Physician (tabib)

The physician is the person who diagnoses illness and treats it by the science of medicine. The Arabic word ṭibb points to preserving the health that exists and repairing what has been lost. ¹ In the Islamic states the craft was learned by study, practice and attachment to experienced practitioners. In the Abbasid period a practitioner was admitted after an examination before the head of physicians, who then issued a licence. ² In the Ottoman state the craft rested on the dârüşşifâ hospital, the medical madrasa and an official permit, with the chief physician (hekimbaşı) at its head. ³

Medicine among the Arabs before Islam was simple. The entry says that pre-Islamic and early Islamic poetry mentions coughs, eye inflammation and wounds from tribal war, that instruments such as the probe (mîl), taken from Greek medicine, were in use, and that most treatment relied on camel urine and honey. ¹

Before Islam the Arabs had contact with the Persians, the Byzantines and Syriac Christians, all of whom had advanced medical experience, and Greek medicine was the most developed among them. ¹ Alexandria was a centre for medical teaching. Its masters, called the physician-teachers (iatrosophists), taught the texts of Hippocrates and Galen, and some of them trained their pupils at the patient's bedside. ¹

In the ninth century the Greek medical books were rendered into Arabic largely through Syriac translators, and the entry names Hunayn ibn Ishaq and his circle as those who developed the medical vocabulary and raised translation to a precise standard. ¹

Medical practice rested on the theory of the four humours (blood, phlegm, yellow bile and black bile): health was their balance and illness their imbalance. Treatment began with diet and regimen, then moved to bloodletting, cupping and the expulsion of excess by medicines. ¹ Anatomy was a matter of interest to physicians, and the entry records that Ibn al-Nafis, in his commentary on Ibn Sina's Canon, described for the first time the passage of the blood through the lungs. ¹

Works on the Prophetic medicine (tibb al-nabawi) also arose. Jurists gathered medical sayings from the hadith collections into books, and this kind of writing gained weight from the thirteenth century. ¹

The entry says that in the earliest period physicians practised once they had reached a level of learning and experience, with no condition or record. Later some were appointed head, and examined the others before him or before the most experienced practitioners. ² The entry cites a hadith in Abu Dawud's book of blood-money, which makes a person who treats without knowledge liable for the harm he does, and holds that this hadith influenced the creation of an official medical office in the Islamic states. ²

The entry reports from Ibn Abi Usaybia that Harun al-Rashid examined Bukhtishu ibn Jurjis, who came from Jundishapur, before the physicians of Baghdad, and then made him head of all physicians. This is a report in a classical biographical work. The entry also notes that Ibn Fadl Allah al-Umari named Abu Quraysh Isa as head of physicians in Harun's time, which would make the office older than the story. ²

In the reign of al-Muqtadir (908 to 932) the caliph asked the market inspector (muhtasib) to forbid practice by anyone without a licence, after a man died under a treatment that had been badly given. The head of physicians, Sinan ibn Thabit ibn Qurra, then examined the physicians, excluding those of established reputation and the caliph's own physicians, and gave a document of medicine to those who passed. Ibn Abi Usaybia estimated their number in Baghdad at about 860. ² From then on a person who had completed his training was examined before the head of physicians to receive a licence to practise medicine (icazetü't-tıb). ²

The entry states that this examination was still in use in Damascus in the early tenth century. ² The market inspector supervised the system. The head of physicians issued the documents after examination, supervised the hospitals and the physicians, helped the inspector remove the unqualified, and was called to arbitrate when needed. ²

The physician wrote on a paper called the düstur the patient's condition, diagnosis, treatment and the medicines given. If the patient recovered, the physician took his fee. If the patient died, the paper went to the head of physicians for investigation. If no fault was found the physician was paid; if a fault was proved, he forfeited the fee and owed the patient's family blood-money. ²

Under the Fatimids and the Ayyubids the head of physicians was appointed by the deputy ruler, and ranked first among the professions, according to the entry's citation of Qalqashandi. ² In Umayyad al-Andalus the physicians formed an office attached to the market-supervision office (diwan al-ihtisab), whose head was called shaykh al-ṭibb. ²

In the Seljuk period Abu Sa'id al-Harawi, who introduced the method of writing a thesis into medical training, was head of physicians at the Adudi hospital (bimaristan) in Baghdad. ²

The entry notes that some Anatolian principalities had physicians at court, such as those of Germiyan, Aydın and Saruhan. It holds that the physicians who served the first Ottoman sultans, such as al-Shaykhi known as Hakim Sinan and his son, Qutb al-Din Ahmad Efendi, Ahi Çelebi and Ya'qub Pasha, were more likely court physicians who treated the ruling family than heads of an organised medical service. ^{4 3} Mehmed Muhyiddin of İzmit, appointed under Bayezid II (1481 to 1512), is the first chief physician to whom the general running of health services is attributed. ⁴

The chief physician was usually from the class of the ulema, and from 1836 some were drawn from outside it. He was first appointed by the grand vizier and later by the chief of the Dârüssaâde eunuchs. In the late eighteenth century he was invested with a fur robe in a public ceremony before the sultan. ⁴ Within the palace and beyond it he supervised the palace hospitals and pharmacies, appointed physicians, surgeons, oculists and pharmacists across the state, and appointed the army's physicians. He issued a permit under his seal for anyone who wished to open a practice in Istanbul, examined physicians together with the chief surgeon and the chief oculist, and closed the shops of those without a licence. ⁴

In the early nineteenth century the palace had more than a hundred physicians. Most came from the dârüşşifâs and the Süleymaniye medical madrasa, some from physicians' families, and some held a licence from a famous physician. ³ A Jewish community of physicians formed in the state, most of whom came from Spain, and some worked at court from the late fourteenth to the seventeenth century. ³ The entry notes that the palace had women physicians and midwives, and that the state's medicine did not distinguish between Muslim and non-Muslim patients in treatment. ³

In 1837 the chief physician's powers were limited by the creation of a health department in the Ministry of War. In 1840 a Medical Affairs Commission was set up at the medical school, chaired by the chief physician until 1850. On 17 April 1850 his wide powers were ended, and the post remained that of the palace's first physician. The entry says forty physicians held the office, the last being Abdülhak Molla under Abdülmecid. ⁴

The Ottoman dârüşşifâ (hospital) was a waqf institution where the sick were treated free. Its endowment deed set out its management, its wages and the conditions for those appointed to it. ³ The first Ottoman dârüşşifâ was founded by Yıldırım Bayezid in Bursa, and the entry dates the Bursa Yıldırım Dârüşşifâ to 1399. ³ The first in Istanbul was founded by Mehmed the Conqueror. Outside the capitals the first Ottoman dârüşşifâ was in Manisa (the Hafsa Sultan dârüşşifâ), and the Bayezid dârüşşifâ in Edirne followed. ³

Physicians in the dârüşşifâ were paid by the day. In the sixteenth century the chief physician earned between twenty and thirty akçe a day, the second physician between ten and fifteen, rising to twenty-five, and the first surgeon between five and eight. ³

Training began as an apprenticeship in the dârüşşifâ. Trainees, called şâkird, worked with the physicians and earned five akçe a day. Those who completed training were appointed third or second physician in a dârüşşifâ. ³ The Süleymaniye Medical Madrasa (dârüttıb) was the first Ottoman madrasa to teach medicine, and at the start it had one professor, eight dânişmend students, an assistant (muid) and a checker (noktacı). ³ A graduate dânişmend might be appointed to a post among the ulema, and the assistant repeated the professor's lessons to the students. ³ After the Süleymaniye madrasa, the employment of foreign physicians at the palace declined. ³

Besides the dârüşşifâ and the madrasa, theory and practice were also taught in physicians' private offices. Opening an office needed a permit called the gedik, given only when a place fell vacant by death, retirement or transfer. A salaried physician could, with leave, open an office and see private patients. ³

Before this, the Islamic world knew hospitals as places of medical teaching from the tenth century. The entry says what set them apart from earlier institutions was the legal and financial security that the waqf gave, secular treatment, the presence of outstanding practitioners, and research and teaching. ¹ The entry gives as an example Hashim ibn Muhammad ibn Nasir al-Din al-Surujī, head of physicians at the Nur al-Din hospital in Aleppo in the mid-sixteenth century. ²

Lepers were isolated outside the town in places called leprosaria, and were not admitted to the ordinary dârüşşifâs. The physician who diagnosed the disease was the one who decided on the isolation. ³

Medicines were prepared in the dârüşşifâs until the nineteenth century. Physicians and surgeons made their own medicines, and between 150 and 200 raw materials were sold. In the mid-seventeenth century Istanbul had about two thousand perfumers' and druggists' shops. ³ Medicines were kept and sealed with the chief physician's seal. ⁴

Surgery was limited, because anaesthesia and antisepsis were not known. The most common operations were the removal of bladder stones, hernia repair, and the treatment of glands called sıraca. ³ Before an operation or treatment, the patient's consent, or that of his guardian, was taken before the judge and witnesses. The consent did not prevent a suit if fault was shown. ³

The dârüşşifâs used music in treatment. Instrumentalists and singers performed in the hospitals of Amasya, Fatih, Bayezid II and Süleymaniye, and some physicians linked melody with temperament and illness. ³

The outward examination was the basis of diagnosis: the colour of the skin, the urine and the pulse, and the account the patient gave of himself. ¹

The construction of Ottoman dârüşşifâs stopped in the seventeenth century, and their endowments were damaged by earthquakes, fires and loss of revenue, so they no longer met modern medicine. ³ In the nineteenth century the gurebâ (strangers') hospitals began on a new model, the first in 1836 at Edirnekapı. The Bezmiâlem Vâlide Sultan hospital was completed in 1845 and admitted patients from 1847. ³

In the reign of Mahmud II the official medical school (Tıbhâne-i Âmire) was founded in 1827. Teaching was opened to all communities in 1839, Turkish-language instruction began in 1867 and in the army in 1870, the school became a faculty of the university in 1908, and the two schools were united as the Ottoman university's medical faculty in 1909. ³

The entry does not cover the modern licensing of the profession in today's states. ³ It says that Islamic medicine survives in the Indian subcontinent under the name Yunani medicine, and in Muslim communities across the world. ¹

• TDV İslâm Ansiklopedisi, "TIP", Peter E. Pormann, vol. 41, pp. 95–101. ¹
• TDV İslâm Ansiklopedisi, "TIP" (second part, "Osmanlı Dönemi"), Nil Sarı, vol. 41, pp. 101–111. ³
• TDV İslâm Ansiklopedisi, "HEKİMBAŞI", Cemil Akpınar and Nil Sarı, vol. 17, pp. 160–164. ⁵
• Works the entries name but that were not read for this record: Ibn Abi Usaybia, Uyun al-anba; al-Ruhawi, Adab al-tabib; al-Shayzari, Nihayat al-rutba; Ibn al-Ukhuwwa, Ma'alim al-qurba; Hunayn ibn Ishaq, Mihnat al-tabib; al-Qalqashandi, Subh al-a'sha; Ahmed Isa Bey, Tarikh al-bimaristanat; Arslan Terzioğlu, on Turkish Islamic hospitals.