Anyone who wants to work as a doctor today needs a licence to practise. Anyone who wants to operate needs a specialist examination. The idea is not new. In the hospitals of the Islamic world, not everyone was allowed simply to take up the knife. The head of a discipline examined whether a candidate had mastered his craft and then issued him a permit: an ijāza.[1]
One such certificate has survived. It was issued in 1602 by ʿAlī ibn Muḥammad, the head of the surgeons at the Dār ash-Shifāʾ al-Manṣūrī in Cairo. Sultan Qalāwūn had had this hospital built in 1284.[2] More than three centuries later it was still a place where the sick were cared for and surgeons were examined.
The man examined was Shams ad-Dīn Muḥammad, called al-Qayyim. He had put a textbook on bloodletting and cupping into verse so that it would be easier to learn. What makes this certificate special is its language. Here a surgeon is writing, and he speaks of his faith in the words of his discipline. This is its wording:[3]
In the name of God, the Most Gracious, the Most Merciful.
From the Sustainer of the cosmos I seek assistance. Praise be to God, who granted this community healing in the medicine of Muhammad. He healed the diseases of its understanding through His truthful tradition, after they had stood at the edge of the abyss in the sickness of falsehood. I praise Him with a praise by which the weak grows strong. And I thank Him with full thanks, which may be for us the best remedy with the All-Wise, the Kind.
I bear witness that there is no god but God alone, without partner. He has made bloodletting and cupping among the most beneficial treatments for the bodies, for through both the harmful heat and the bad mixture of the humours are brought to a halt. And we bear witness that Muhammad is His servant and Messenger, who severed the vein of polytheism. Blessings be upon his family and his companions, the pious lords. Through knowledge and eloquence they united wisdom and decisive judgement. They treated the age of ignorance with their good guidance, so that it recovered, remained healthy and fared well.
To proceed: I have examined this significant treatise and noble writing. It bears the title “The Healing of Pains in the Art of Bloodletting and Cupping”. It is a didactic poem by the most perspicacious of his time and the shrewdest of his age: Shams ad-Din Muhammad, known as al-Qayyim, a surgeon by profession and by skill.
Its base text comes from the excellent Shaykh Shams ad-Din Muhammad ash-Sharbini, the surgeon, a man of all virtues. May the rain of mercy and good pleasure fall upon his grave morning and evening, and the fragrance of narcissus and basil stream from his resting place. His work bears the title “The Highest Aim concerning What Is Incumbent upon the Bloodletter and the One Bled”, for in this art it is the highest of aims.
The author read this work with him thoroughly and in depth and clarified the difficult words and meanings. He saw no other way than to put it into verse, so that these benefits would be more easily retained and these rules more easily learned. Thus arose a work more radiant than the light of the rivers and brighter than the light of nightly conversations, like poured gold or streaming rain.
The poet has achieved excellence in examining the material and has spent great effort on elaboration and precision. He has joined the words with care and dived into the depth of the meanings. He has raised the precious pearl from the base text and brought together the separate with the connected, so that the work shines in its meanings like a bride.
In this craft it has become the authoritative work, and the expert acknowledges that it is a guide and a direction. Beside it the “Tadhkira” fell into oblivion, and no other praiseworthy textbook remained to this discipline. Before it every learned scholar held back, and the history of the physicians bears witness that it reproduces what stands in the “Canon” of Ibn Sina.
When the result of this selection became visible in question and answer, the work was counted off on the fingers as the best. Its author drew from the purest core. Ibn al-Akfani, it is true, also wrote a treatise on it, but what a difference between his treatise and the treatise of Muhammad! This work strikes the core of what is sought and records what is incumbent upon the bloodletter and the one bled. Therefore the maker of its pattern and weaver of its garment deserves to be crowned with the crown of the ijāza.
So I asked God, the Exalted, for the right choice and granted him permission to practise of the art of the surgeon that which he has thoroughly mastered, so that success and good fortune may be granted to him. He may treat wounds that heal by incision, and remove arrowheads and spearheads that are visible without an incision. He may let blood and sever arteries, extract carious and corrupted teeth, close gaping wounds with thread and other means, and circumcise boys.
All this on the condition that he continues to consult the experienced heads of this discipline and the expert teachers and to serve them, with fear of God and sincerity in the craft. Then he need not fear that his craft will find no takers.
We ask God, glorified and exalted is He, to help us and him to good deeds, in every state and at every outcome. O God, I ask You out of Your immense grace for the forgiveness of our sins and for well-being for our bodies. There is no god but You, and nothing is hoped for but Your good, Lord of the worlds.
Written in his own hand by the least of the servants of the Opener, the one in need of the Truth: Ali ibn Muhammad ibn Muhammad ibn Ali, the surgeon, servant of the poor and weak in the House of Healing in Egypt the well-protected. He wrote it praying, asking for blessing and peace, with the words “There is no power and no strength except with God”, and asking for forgiveness, in the blessed month of Safar of the year 1011 after the Hijra of the Prophet, upon him the best blessing and peace. And all praise belongs to God alone.ʿAlī ibn Muḥammad, ijāza for al-Qayyim, Cairo 1602
Two sentences carry this certificate. The first: al-Qayyim may practise “that which he has thoroughly mastered”. In the Arabic it reads mā atqana maʿrifatahu, from the same root as itqān. The Prophet ﷺ said:
إِنَّ اللَّهَ يُحِبُّ إِذَا عَمِلَ أَحَدُكُمْ عَمَلًا أَنْ يُتْقِنَهُ
“Allah loves that, when one of you does a work, he carries it out with perfection.”
Abū Yaʿlā, Musnad · Ṣaḥīḥ al-Ǧāmiʿ 1880 4
The permission extends exactly as far as the skill, not one step further. The second sentence is the condition: he is to go on consulting the masters of his discipline, “with fear of God and sincerity in the craft”. The word for sincerity, an-nuṣḥ, is one we know from the hadith: “The Dīn is sincerity.”[5] Expertise alone was not enough, and neither was piety alone. Only the two together made a surgeon.
The licence to practise as an amāna
What do we learn from this as healthcare professionals? Our licence to practise is more than a document. It is an amāna. We work within the limits of what we can truly do. We keep learning from those who know more than we do. And we treat every patient in the awareness that Allah sees what we do. ʿAlī ibn Muḥammad could have signed as a great master. He signed as “servant of the poor and weak in the House of Healing”.
May Allah taʿālā have mercy on them both and make us among those who practise their craft with itqān and taqwā.
This series is part of HAKIM Forgotten Heroes. We welcome feedback and suggestions: https://www.surveymonkey.com/r/T7SK5N7
Footnotes
- On the examination and licensing of physicians and surgeons by the heads of their discipline, with several surviving ijāzas: Aḥmad ʿĪsā Bek, Tārīkh al-Bīmāristānāt fī l-Islām (History of the Bimaristans in Islam), Hindawi edition 2012, introduction, section on the ijāzas: https://archive.org/details/ktp2019-bk2582 ↩
- Foundation of the Bīmāristān al-Manṣūrī by Sultan Qalāwūn in 683 AH (1284 CE), according to al-Qalqashandī, as cited in Aḥmad ʿĪsā Bek, ibid., chapter on the Bīmāristān al-Manṣūrī. ↩
- Wording of the ijāza: Aḥmad ʿĪsā Bek, ibid., section “The Second Ijāza”, pp. 31 to 33. German translation: HAKIM, smoothed for readability; one word illegible in the original is omitted. Arabic key passages: وأجزت له أن يتعاطى من صناعة الجراح ما أتقن معرفته مع تقوى الله والنصح في الصناعة ↩
- “Allah loves that, when one of you does a work, he carries it out with perfection (itqān).” Abū Yaʿlā, Musnad; al-Bayhaqī, Shuʿab al-Īmān; graded ḥasan by al-Albānī, Ṣaḥīḥ al-Jāmiʿ 1880. ↩
- “The Dīn is sincerity (an-naṣīḥa).” Sahih Muslim 55a, from Tamīm ad-Dārī: https://sunnah.com/muslim:55a ↩

