Muslim Sicily and the Beginnings ofMedical Licensing in Europe

Leonard C Chiarelli, PhDSalt Lake City, Vtah

Key words: Medieval medicine, medieval Sicily, Muslim Sicily, medical licens­ing.

AbstractOne of the legacies of Arab 1'1Jlc in Sicily is in tbe arca of medicine, its study.

and practice. Those who study the history of medicine seem to agree the firstregulations on the licensing of Ilhysicians and pharmacists in Europe can betraced to 1140, when the Norman king of Sicily, Roger II (1095-1154), estab­lished (he requirement of physicians taking an examination before tbey couldpractice medicine. Later, the Hohenstauffen king of Sicily, Frederick n (1194~

1250), went further in his Constitutions of Melfi by legislating that for a physi­cilln to practice medicine or to heal, he first must be apl)rovcd iD a convenedpublic examination by the master of the School of Salerno. Thus, with the adol)­tion of this le~is'ation, the procedures for the practice of medicine in Europebegan and soon spread to Silain and France. The origins of these regulations,however, seem to have thei r roots in the medical I)ractices of the Arahs, who viaNorth Africa, tran!Cfcrrcd them 10 Sicily. The period of Muslim rule on theisland had also introduced schools teacbing the art of medicine an d establishedhospitals. The Nonnan conquest, together with the licensing of ph)'sicians, Iheschoolin!!, examining, and (l racticing of the medical arts, brought these tradi­tions to med icval Europe, where they became the fnundat ion of Westem medicaJcustomary practice.

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ined before lhey could praclice medicine.' The relevant lextreads: "Whoever in !.he future desires to become a physi­cian shouJd present himself to our officials and judges foran examination according 10 !.heir jlldgmenL"1 Later. !.heHohenstaulfen King of Sicily, Frederick n (1194-1250), wentfurther in his Constitutions ofMelfi (Uber Augusta/is) bylegislating that "in the future no one may dare otherwise topraclicc or to heal. prelending thc lille of physician, unlesshe has first been approved in a cOllvencd public examina­lion by the Masters of Salerno," lind that "testimonial [el­ters conceming his trustworthiness and sufficienl knowl­edge" should be presented before the examining body be­fore he may "obtt1.i n lhc license for healing from us." Thosemaking medicines were obliged to Lc'lke an oath to "makelhem failhfully. "1 The adoption of this legislation in 1231appears (0 have sel Ule procedures for the praclice of medi­cine in Europe, and soon they are found in the other parts of

One of the legacies of the period of Arab rule in Sic­ily is in the area of medicine, ilS study, and prac­tice. Scholars in tl1c hislory of medicine appear 10

agree Ihllt the firsl regulations governing Ihe praclice ofphysicians in Europe dales 101140, when the Nomlan kingof Sicily, Roger II (1095-1154), estilblished in his ]tlWS, \lIe

"Assizes," lhe requirement Ihal physicians mUSI be exam-

From the Marriot LibraryUniversity of UtahSalt Lake City. Utah

Reprint Requests: Leonard C Chiarelli, PhDMarriol LibraryUniversity of UtahSa/I Lake City, UT 84//2

lUlly, then in Spain and France in the following century.)The origins of these reguJations, or at least their inspi ra­tion, seem to have tJleir roots in the medical practicc!> of theArabs~ who. via North Africa., tran!iferrcd them to Sici ly.

The possible influence ofIslamic mcdiOlI praclices uponmedieval Europe has hardly been studied, aJthough it isknown lhal Arabic medical texts had a profound impact onscientific teaming of Europe. [n aJl article addressing theantecedents of the Norman legislation on medic.'1l eX31l1.ina­lions and licensing. the American medievalist hmes MPowell stales lhat the Latin Norman texts, and the practicesthemselves, evidencc Byzantine influence. He goes on tomentioll, however, that the Greek text upon which his con­clusion is based is not clear and thJ'll there is no definitivepiclure of lhe medic.1.l profession practiced in Byzantiwn.He even declares that Ihe "precedents" for the Normalllawson medical practice are largely unknown.-' Nowhere in thearticle does hc mention thai t.hese laws. or their inspiralion,may hnve had a connection with the Arabs who ruled theisland for 200 years prior to the arrival of the Nonnflns. ill\dwhose institulions were still in prflclicc when King Roger IIpromulgated these laws."

TIle licensing of medical practitioners appears to havebegun in Baghdad in 931, when a man died due to aphysician's error. TIle Abb~sid caJiph. al-Muqtadir (908­932), alarmed by this death. decreed that the Inspector ofMarkets. "Mu!llasib" or "~a!lib al-Sllq" should not allowanyone to practice medicine IInless he was licensed by lheC<1liph's chieCphysici(ln.7 He first had to examine the quali­fications of the prospective prilctitioner before issuing n'''Ij;17.ah.'' a certificflte or license. 8 The 'ijnzah w;,\s usunllya letter issued by a student's teacher attesting lhflt he Il<ldsuccessfully completed a set course of study under his su­pervision, Clnd that he was cenifying lhat he was competcntto teach the si\id subject'

Soon this procedure spread lhroughour the Muslim Eastand West, but with some variations. For example, it is kIlO\.\'ntJlat studenlS who received Iheir education and traini ng inahospitClI wouJd receive lheir license from the head pmct ic­ing physician. 1o Then, ill order to practice, the medical prac­titioner was obliged to be examined by Ihe nlll!lt<lsib, whotJlercaftcr administered to him the Hippocralic Oath ilndissued a permit or liccnse. 1I 1n many cascs, the prospcctivcphysicinl\ would first be exami ned by the chief physic innwho was appointed by the government 10 bc "hcad of hiscrafl"'~ and subjcct to Ule conlrol oCthe mul,llasib,1J an ap­poinled governmenl offici;)l who was under Ihe authorily ofthe "Qa<:!l." a municipal judge. and whose major f\luctionwas to be guardian of public morals and the regulating ofall trades in the market. His duties embmced lhe variouslIspeets of public life, from keeping the walkways and bathsclcan, to protecting Ihe public from fmud, As such, he wascharged wilh licensing physicians. pltClnn.'lcisls. oculislS, lindblood-leiters, etc. ,., as well as making certain lhal tJle weighlsand measures of the merch"lrllS in the !nllrket ",'ere accurntc_Hflndbooks were compiled !Il;lt detailed his responsibilities

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and the procedures he was to follow in order to aJlow mer­chants and health practitioners to carry on their business.

The office of the muhtasib seems LO date back to the 9thccntury'~ but soon became widesprcad. extcnding within acentury 10 North Africa, Spain, and Sicily.'o Al times, inaddition to the 'ijazah. the aspiring physician had to presenta certi fiCtlte ofgood conduct iSSlJed by tJle "S.M.ib al-shuf!.ah,"the chief of police."

Thc sllldy of medicine among the Arabs began SOOIl

after the 9th century, when Ule learning center. the House ofWisdom (Bflyl uJ·Hikmah), started translating into Arabicthe ancient Coptic: Greek, Sanskrit, Nabatacn, and Syriacmedical works.'s In a shol1 period of time. the study ofIhese ancient texIS spread 10 tJle Muslim Wesl, where underthe Aghlabid dynasty in Ifrlqyah (Tunisia) a House ofWis­dom, modeled after the one in Baghdad. was established. '9

The AghJabids launched lheir conCJuest ofSicily in 827,and, \\Iilh the occupation of the whole island by 902, re­mained Ilnder Muslim rule until the Noml(1n conquest in1086, However, the Arab e]cment in the government andilS bureaucracy. as well as ils culture, continued in much ofSicily for another 150 years. The Tunisian scholar J:lasanHusnl abdul Wnhh:ID staled thnt (lller lhe invflsion of Sicily,the Aghlflbid "AmCrs" (princes) urilized the Sicilian monksby bri ngi ng them 10 Qayrawan in order to h;we them tr:l IIS­

laIc lhe classics inlo Ambic. He also speculated that thesemonks were charged wilh doing lhe same on the isl:lnd. 1o

The Aghlabids also established medicaJ learning circlesal RaC\<1iid<lh and Qayrawan, where by the Illh century.IfrIqyah became a celller for the leaching of medicinc.Eminent physicians from Egypt and Baghdad were asked toscllJe in Qayrawan in order to teach Clnd practice medicineamollg the mcmbers of the amir's COIlI1. Such \\'ell knownfigures as 'lshaq ibn ·Ulman (fl. 9th century). '{sllaq ibnSulaymiin al.'·lsra·iJI (d. 955), lind his sllldenl, ibn ill--Jazzar(d. 980), taughl tlnd wrOle renowned works on disease andthe prnclice of medicine. The writings produced there madeQayrnw:in a center for medicalleamillg. which came to in­fluence the whole of North Africa, including Spain and Sie­ily.2\ Along wilh schools tcaching medicine. Uley estab­lished hospilals, known there by the Berber word "dimnah,"which made lheir appearance arollnd 831 in Qayrawan buLsoon spread lhroughout the larger cities of IfriqyahY

Surviving Icllers of Jc\vish merchallts of tile period.known collectively a..~ the Geni7.<l documents. clearly dcm­onstrate lhat QaYr<lwnn was an aClive medical learning cen­tcr for Jews and Muslims alike.))

The study and pmclicc of medicine in North Africasurely had an irnpnct in Sicily. Allhough specific dow­menls rel(lted to medical 1eaming ilnd practice Oil the is­land have so fllr eluded liS, there is some evidence to showlhal Sicily h;ld been part of the medicaJ regime ofQayrawall,Even though medical learning w/lsconcentrflted in Ifrqiyllh,Sicily not only hnd il s medical practilioners but also per­SOllllgCS who leclurcd in medicinc_ The renowned religiousscholar, 'Abu Sa'i-d Luqmiin ibn Ylisuf<1I-Ghass:fni-(d. <))1)

ofQayrawan spent 14 years in Sicily teaching religious lawand medicineY A native Sicilian, 'Ail ibn aJ-Hasan ibnal-TUb1 (fl. 11th century) Iraveled abroad and the~ returnedhome as a learned physician who followed and laught lhemedical teachings of the famous 9th century Baghdad phy­sician and teacher YUhanna ibn Masawafh (d. 857),2.1

Another native of the island..Ali ibn Ibrahim ibn' All(d. 1137). called "Son of the Teacher". taught medicine andwas known as an eminent grammarian and calJigrapher,1.6Some of the government officials sent to the island fromQayrawan were skilled in medicine, For example.MuJ:Iammad ibn 'Ibrahim ibn' Abi Sabi~l (d. 944). who wasscnt as the chiefjudge or "Qriql" of the island, was in addi­tion to an expert in religiolls law, a well-known physician. 27

The teaching of basic medicine seems to have had aplace in lhe educationaJ system on Ihe island and there isno doubt that the ancient Greek works on medicine, me­chanics, and philosophy, which were 10 bc found in thelibraries of Palermo and Syracuse, were ut ilind, II seemslikely that the ancienl Greco-Roman library in Syrncusccontinued 10 be active throughollt the period of Arilb rulesince we read in a letter wriucn by the Norman official andarchdeacon ofCalilni<l. Hcnricus Aristippus (11. 1150). that"you have in Sicily the Syracusan and Greek librnry."21l Anindication of the knowledge a.nd availability of the Greekworks is indicated in the report t1u1t in 95 I. the Umily)'i1dcaliph of Spain, 'Abd al-RaJ:lman II( (912-961). sought tileassislance of the Sicilian physician 'Abu' Abd Alliih (/1.

10th century) to help lranslate Ihe "Materia Afedica" ofDioscorides. He was sought out because of his knowledgeof the Greek language and his Jll<lstery of medicinnl plams. lO

Another Sicilian. whose namc and work h;lVe been 10Sl,

wrote a book on materia medica and prescriptioJls clltilledKiliib al-,~iq;lfnTheBook of the Sicilian), which coversmany areas ofphannacologyJO

It is even possible thatt here were female medical prnc­titioners in Muslim Sicily. There is no direct informationconceming their practice. but it is well known that femalephysicians Ihrived in (he lslam..ic world,]' and it is reportedl]lat in the 14th century Sicily had, along .....ith Florence.the largest number of felllllie medical pract itioncrs ilt all oflIal)':"

In regards to the eSlablishmetll of hospitals. il appears01al the hospilal known as San Giovanni dei Lcbbrosi lo­cated outside Palenno ilnd at1ributed to Normnn construc­tion, is of older origin and was originally the Arab castle ofYahya. III fact. Sicilian historian Michele Amari stntes thatthere is no document lhat proves thai it was buill by theNorm<los.'J The Spanish Muslim traveler ibn Jubayr s.;.lWthis hospital ill 1185 and noted lhat it was constructed onthe model oflhe Muslim hospitals he saw ill Acre and Tyre,llAs far as the eXClmining and Jiccllsing ofphysiciiU1S. it seemsIhal Sicily had the same procedures ilS those found in NorthAfrica. The office of muhtasib wcnt under v~lrious titles aldifferent times and places. Originally, the office wenl un­der the tiOc of ~;ihib al-sLiq and remilined under thai name

in some parts of the Muslim world. "Mu1llasib" was a titlepredominately found in the Arab East, while in Nonh Af­rica and Spain. we oOen find the tiUe "$<ih.ib aJ-stiq,"'" AmilaJ~siiq," or even ":;i<i!:Ub aJ~shurtah" (chief of police).Jl Itoften occurred thaI the posiLioll of mu~tasib and shurtahwere joi ned, which may have been III the discrelion of Iheappointing qJ~i.l6 The inspector of markets, then, could be

called "mu~tasib," "~I).ib al-sUq." or "~a~ib al-shurtah."Sieil ian documents indicate thJt the office of"sahib a1­

suq," master of the market, was so Ilin use inS iei Iy around1145, i.e .. during lhc period tJlilt Roger n's laws were made. I'

uter. documents from the period of Angevin rule (1264­1283) show ilial in 1282. the office and the title continuedunder the Latin fonn magislrum mercii,)R During the sameperiod, another document also used the title "magistris Surtemercii," i.e., "chief of police of Ule markets,")9

Historical documents indicate lhat during the period ofMuslim rule. Sicily followed the same adminiSlrative frame­work as other Muslim regions, witll the office ofchiefphy­sieian and muhtasib active in examining. certifying, licens­ing, aud overseeing medical practitioners. The procedureappears to be that Ole mfXlical student received a license ordiploma from his mentor on completion ofhis studies. Then.if he wished to practice medicine, he was examined firsl bya government-appointed chief physician whose position wassi milar to a master of a trade guild. Thereafter. ifapproved,he would receive a license to practice from a judicial offi­cial, the mul.llasib or ~a~ib al-siiq.

The laws of Roger II appear lo have adopted and cadi·fied the process. aud in doi ng so, incorporaled some of theI;}ws of the Muslim community:o There is ample evidenceto show that Islamic law continued to be used on Ole islandup through the 12th Celllury.'1 The Assizes promulgated byRoger [J were meant to fix the obligations and competenceof (he royal officials.~l of which the office of mul)tasib wasprobably included, At the time the laws were drawn, Arabofficials held many roynl positions of importance:) and theking sought via the new Il'lws 10 unify the administralivesystem so that il would embrace Ihe traditions of Latin andGreek Italy with those of Muslim Sicily.41 As part of theking's administrative reorganization, he codified the obli­gations of the royal officials, lhereby placing the office ofmul.ltasib, and probably "chief physician" as examiner. un­der a ccntrnlized royal administrarive system.

II appears that l:lter Frederick 11 elaborated on Roger!l's legislation in his Constitutions ofMelfi by placing lheresponsibility of exnmining and licensing of medical prac­titioners upon a board of medical examiners atlhc medicalschool at Salerlllo1 Ihus, nOI only codifying. bUI instilulion­<lliz.jug. the procedures for examining and licensing of phy­sicians.

A detailed silldy. however, of Ute Uber A uglls'ali~ andlhc Assize~' is needed 10 deduce if their contents concerningtllC provisions on heal(h ....'erc innucnced by the MuslimCOJllIllUluty, 011 the island 'Uld especially if the litcralurc ofLhc office of mul.Il:lsib had any impact. <l Thc fonnaJized

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regulations of Frederick II appear 10 have had an impact onthe European mainland where the sludy and practice ofmedicine was beginning to flourish in the great medicalschools of France. Italy, and Spain.

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