Bashar Al-Assad was doing his specialist training in ophthalmology at the Western Eye Hospital in London when his brother Basil wrapped himself and his sports car round a tree. Bashar’s father summoned him back home to prepare to succeed him. When his father died in 2000, Bashar became president of Syria.
In Syria, Bashar’s mild features gaze out from every shop window, every hoarding, even the rear windows of cars. It is said that he is temperamentally unsuited to dictatorship, but he has not managed to democratise his country, and protests about the lack of freedom in Syria are being suppressed brutally, whether by his orders or those of his relatives who exercise the real control. Bashar may be reflecting that, but for an RTA, he could be running a lucrative private practice, or, who knows, head a national trachoma programme.
He came to London to learn from the medical expertise of the west and take it back to Syria. But 1,000 years ago the traffic of medical knowledge was all the other way.
At school I had to memorise a list of ‘Things we learned from the Arabs’. It included algebra and the silver-coated pill. I rather wished that we had not learned algebra, and I had never seen a silver-coated pill and did not see why merely adding silver to a pill should make it more effective. It took many years – till last month – for me to find out what the Arabs did know about medicine.
The Maristan (hospital) Nur Ad-Din in Damascus was built as a medical school in 1154 by Sultan Nur Ad-Din, and remained active as a hospital until the 19th century. The elegant building is now a medical museum, and it is possible to sit and relax in one of the iwans ¬– the vaulted recesses off the courtyard where consultations and lessons were held – admiring the fountain and the display of medicinal plants, and reflecting on the sophistication of medical knowledge developed in this part of the world. It gradually filtered to the west, much of it probably translated into Latin or directly into Castilian at the school of translators in Toledo, Castile.
On display in the old wards there are remarkably modern-looking diagrams of the structure of the eye and the heart. Types of facial paralysis, and symptoms and complications of diabetes are described. They knew about the infective nature of TB centuries before it was accepted in the west. Damascene doctors had charts to check which herbs and preparations were useful for what conditions. Dried lizard as an aphrodisiac might not pass the evidence-based medicine test (though I guess some wouldn’t mind being enrolled in a trial), but many preparations are still in use today, in allopathic as well as complementary practice. And like modern doctors, they sometimes called on a bit of magic as well, if the basket of talismans is anything to go by.
I thought John Snow developed inhalational anaesthesia. At the Maristan Nur Ad-Din you can see the sponge that doctors there used centuries earlier to administer a mixture of hashish, opium and belladonna dissolved in alcohol to surgical patients. Like Snow, they challenged the belief that pain is the price we pay for mankind’s sins.
Al-Zawhrawi’s dentist’s chair has a neck support and a ratchet for tipping back the head. He filled teeth with gold and silver, and saw extractions as a failure. Not surprising, except that this dentist died in 1013.
It is clear that the relationship between physical and mental health was understood. The Bimaristan Arghoun al-Kamili in Aleppo cared for patients with mental health problems from its founding (with a grant for research) in 1354 until the twentieth century. Like Nur Ad-Din’s hospital in Damascus, it offered patients an environment designed to rehabilitate them. Patients had rooms around a series of courtyards and the sound and sight of the fountain at the centre of each courtyard was an important part of their therapy. The courtyard for the most seriously disturbed patients has small rooms, barred for safety and rather dark because it was believed that low light levels were soothing, but patients could hear and see the fountain, and they were given a healthy diet and calming herbal teas.
As patients improved they moved to open rooms around a larger courtyard and were allowed out to sit in the iwan and listen to musicians playing round the fountain. There was a separate courtyard for female patients. On discharge all patients were given money for clothes and food to tide them over till they could work for themselves.
It is salutary to reflect that in Britain at that time, people with psychiatric conditions were locked up and chained, or drowned or burned as witches, and in Russia last century political dissidents were confined under brutal conditions in mental hospitals. It is to be hoped that President Assad will treat his people with the wisdom and understanding that his forebears 1,000 years ago showed to their patients.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…