Al-Adudi Hospital | Hacker News Reader

Al-Adudi Hospital

en.wikipedia.org

121 pointsMPSimmons39 comments

> Within Baghdad, the Al-Adudi Hospital's location was decided upon by its administrator, Abu-Bakr al-Razi. He determined where it should be located by "hanging a piece of meat in several places for a few days and deciding in favor of the place where meat was found to be least infected."

That is actually quite a clever idea. I wonder what factors would lead to one location having higher microbe density than others? Probably things like nearby sewers, meat / fish markets, etc.

I assumed it was about flies, because maggots would be all over it in a couple of days.

Edit: since the chosen location was besides the Tigris river, maybe the river fauna acted as a natural pest control. Less flies and mosquitoes absolutely would help hygiene.

Interesting, it's sort of an inverse desire path[1] - instead of locating where foot traffic is the highest, you locate where microbe traffic is the lowest.

[1] https://en.wikipedia.org/wiki/Desire_path

Fascinating stuff. I wonder what kind of theory of disease they were working under

Probably the miasma theory. Bad vapours and stuff.

I would guess miasma theory. https://en.wikipedia.org/wiki/Miasma_theory:

“The miasma theory (also called the miasmatic theory) is an obsolete medical theory that held that diseases—such as cholera, chlamydia, or the Black Death—were caused by a miasma (μίασμα, Ancient Greek for "pollution"), a noxious form of "bad air", also known as night air. The theory held that epidemics were caused by miasma, emanating from rotting organic matter. Though miasma theory is typically associated with the spread of contagious diseases, some academics in the early nineteenth century suggested that the theory extended to other conditions as well, e.g. one could become obese by inhaling the odor of food.”

I think that’s an educated guess in the basis that this was a wide-spread theory, and fits the experiment performed.

> a noxious form of "bad air", also known as night air. The theory held that epidemics were caused by miasma, emanating from rotting organic matter.

Not far from the truth either, quite impressive for 1000 years ago.

It's very far from the truth imo. There are diseases that are airborne, but most aren't spread by rotting organic matter. It also ignores the other routes of infection (eg. food/water). The only thing it got right was "disease can spread through air". The magnitude of the effect is probably off too. AFAIK the miasma was thought to extend at least a few hundred feet (ie. encompassing entire neighborhoods), but I don't know of any disease that can spread that far through the air.

How far the disease can spread would depend on sources and sinks, no? If you have a huge pile of infected dead bodies in a "bowl shaped terrain" with little wind, maybe that would do it? Add a temperature inversion* for good measure.

https://i2.wp.com/www.naturphilosophie.co.uk/wp-content/uplo...

>How far the disease can spread would depend on sources and sinks, no?

By air alone? How far can it possibly spread? Can you get measles if you walked within 100ft of a mass grave? miasma theory would say yes, but I doubt that's actually the case.

If you include other forms of transmission (eg. insects, animals, food/water), then it can definitely spread miles away, but this goes back to my original point of only being correct about disease being (loosely) correlated by distance. But even then it gets a bunch of stuff wrong. A rat with the bubonic plague stowed away on a ship can infect people hundreds of miles away, for instance. You could also live next to a mass grave and be fine as long as you have mesh windows and boiled your drinking water.

It's a good point about other forms of transmission, but I think the air alone is an interesting question.

What would be the limiting factor on how far it can spread? Do the particles deactivate after a while in the air? Or is it that the concentration is not high enough? Latter case, wind patterns would matter a lot.

Surely, when authorities talk about diseases being able to spread x many feet, it ignores many factors and is meant to be an actionable simplification that works in a statistical sense.

Marcus Aurelius wrote about "disturbed air" around 160 AD, about the Antonine Plague that killed a significant portion of military and civilians.

> For corruption of understanding is much more a plague than such a distemper and change of this environing atmosphere; for this is a plague to animals, as animate beings, that is a plague to men, as human beings.

I don't think it's too far fetched to assume that the Al-Adudi Hospital was founded based on an nascent sense of Germ Theory. Allow me to explain:

To quote the wikipedia source: "hanging a piece of meat in several places for a few days and deciding in favor of the place where meat was found to be least infected." Infected definition = "contaminated with an infective agent (such as a bacterium or virus)."

I think they could likely see some infective agents such as flies, maggots, and spoilage in meat, and translate this to their own flesh as analogous to meat. In terms of theory, my best guess is simply one of "meat goes bad when it is infected by parasites (i.e. maggots as well as perhaps stuff we do not/cannot see)"

Note that per [1] "Basic forms of germ theory were proposed in the late Middle Ages by physicians including Ibn Sina in 1025"

Whereas, from OP's source: "The Al-Adudi Hospital was founded in 981 by the then ruler of Baghdad, Adud al-Dawlah, and was also named after him"

Given the proximity of those dates (981 vs 1025)-- the proposal of Germ Theory by Middle Eastern (specifically, Persian in the case of Ibn Sina) doctors, and the hospital's founding in the near Middle Eastern region of Turkey a few years decades earlier, and the prolific nature of science in the Medieval Islamic-sphere of influence/Middle Eastern world, I think it's a decently strong argument that the basis is very early germ theory.

[1] https://en.wikipedia.org/wiki/Germ_theory_of_disease

> Note that per [1] "Basic forms of germ theory were proposed in the late Middle Ages by physicians including Ibn Sina in 1025"

Note that also per [1] germ theory was stated pretty well in the first century BC:

> The Roman statesman Marcus Terentius Varro (116–27 BC) wrote, in his Rerum rusticarum libri III (Three Books on Agriculture, 36 BC): "Precautions must also be taken in the neighborhood of swamps […] because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases."

This doesn't really differ from the germ theory of disease as we understand it today.

Thanks, that’s fascinating.

The difference is that the Romans had no way of telling if their theory was right, it was based on guesses. Plato considered whether matter was continuous or discontinuous 400 years earlier and he settled on discontinuous, and the properties of the "atoms" as he called them were what gave macroscopic matter its properties. But the Greeks had no way of detecting atoms.

But when the microscope was discovered in the 17th century people looked at microorganisms and found that the grosser the sample the more microorganisms you could find. That was material to work with, and the germ theory followed in due course.

> The difference is that the Romans had no way of telling if their theory was right, it was based on guesses.

That's true, but it doesn't stop people from doing things that are "correct" based on the theory.

> But the Greeks had no way of detecting atoms.

There's an experiment in which you pour oil over water with a movable constraint on one side. As you enlarge the area available to the oil, it will eventually become unable to cover the water, suggesting that it is not infinitely divisible. This is well within the means of the Ancient Greeks.

Oil molecules are gargantuan monstrosities, not atoms, but I think it's similar enough to count.

You can explain away the oil monolayer experiment with surface tension. Anyway, this experiment works best if the oil is dissolved in a large quantity of petrol and it's fairly certain that the Greeks did not know distillation.

More compelling would be Brownian motion. Glass was known in the Hellenistic era, and the Romans were expert stonecutters. The principles of optics were known to the Ancient Greeks, and some guy could have made lenses and assembled them into a microscope. Unfortunately that path was not taken until the 1600s, but the technology was all there.

>This doesn't really differ from the germ theory of disease as we understand it today.

I disagree. Germ theory also covers stuff like non-airborne transmission (food/water/bodily fluids). The only thing that it got right is "you can get infected by invisible things in the air", but even then it's not that accurate. Do people really get sick from the air near swamps, or is it the mosquitoes?

> Germ theory also covers stuff like non-airborne transmission (food/water/bodily fluids).

First, that's not correct; the germ theory of disease is simply the statement that diseases are caused by germs as opposed to being caused in some other way. Transmission is not a part of it.

Second, if you believe that small creatures too small to see can make you sick if you inhale them, it's not really a stretch to think that those creatures can make you sick if they get into your body by any other means.

(Note that not all apparent diseases are caused by germs; some are caused by genetic conditions, some are caused by dietary deficiencies, some are caused by inorganic poisons, and some are caused by creatures which are easily large enough to see with the naked eye. Does this make the "germ theory of disease" incorrect?)

The same theory of flight that birds use to fly, i.e., none. Some birds might notice they use less energy if they don't flap their wings and instead catch an updraft. I don't think they need a theory of pressure gradients to exploit this phenomenon. They just have to feel it in their bones.

I know my response is glib, but no "theory of" is needed to do useful work. Humans can build intuitive understanding through personal experience, observation, and thinking. And they can pass some forms of this understanding via apprenticeship, laws, rules, organizational structures and cultural norms among other things.

That's some pretty awesome engineering thinking: don't have a theory to explain phenomena? No problem, still can do useful things without it!

How do you come up with this in the first place without elements of a theory like:

+ the causes of disease are the same as the causes of meat rotting

+ that cause is localised in space, and stays there over time

That's just intuition, not a complete theory.

I know they say scientific progress is not linear but boy how cool would it have been if a Joseph Lister was around at that time there. We would have discovered germs much earlier. Maybe even avoided the plague?

Then he would not have had access to the body of knowledge accrued by others to build upon his theory of infection. He would probably have made some scientific progress - provided the circumstances did not make him a brick layer instead - but not the same as what he did 900 years in the future.

Well, there most likely was the closest thing you could find to Joseph Lister then. 981 is pretty much in the middle of the Islamic golden age and Baghdad was the capital of the Abbasid caliphate. This story is happening in what was at the time the most advanced place in the world.

The section about hospitals on Cairo is interesting, universal free healthcare with lost wages covered.

The healthcare may have been primitive but the policy goes further than what a lot of countries offer today.

Assuming you lived in Cairo

I wonder what kind of meat they used

I wonder if you could find hospitals today by hanging meat (or some sensors) around cities. Just as factories can issue clouds of soot or other pollution, could hospitals be emitting clouds of bacteria?

The article means "locating" in the sense of "where should it be placed", not "finding"—perhaps you knew that and were just riffing off the other meaning, since I had the same misunderstanding based off of the title.

Yes, I realized that (and I hoped by saying “hospitals today” it would be clear that I had read the article).

But I still wondered if my (and your) surmised interpretation would hold true. I think it is well understood (certainly is within the medical community) that hospitals are a dangerous place to be, though clearly if you’re seriously ill it’s worth the risk. But do hospitals pose a risk to their neighbours?

Apologies—I couldn't tell, and I had that exact misunderstanding. That is an interesting question, though.

This is a interesting because, while they may not have understood the science behind why the meat spoiled less, there may have been utility in this fact (if that location naturally had less bacteria). I wish the U.S. had performed this much thought with regard to COVID.

“ I wish the U.S. had performed this much thought with regard to COVID.”

I don’t understand this side comment. What are you referring to? The supposed source (bats) came from an infested market in China, not the US

I'm referring to the fact that there was no national policy, enforcement and only a waffled set of guidelines. And moreso that the experts were pushed to the side for political expediency. As an aside, I'm a U.S. citizen and will publicly state that I'm going to do more to isolate (and we've already been on the more extreme edge of isolation). We should ALL do more.

This makes more sense than how I was trying to connect the dots for your original message. I couldn't agree more

Huh. That feels like potentially coming very close to germ theory.

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