History of Medicine
Islamic Culture and the Medical Arts
The hospital was one of the great achievements of medieval Islamic society. The relation of the design and development of Islamic hospitals to the earlier and contemporaneous poor and sick relief facilities offered by some Christian monasteries has not been fully delineated. Clearly, however, the medieval Islamic hospital was a more elaborate institution with a wider range of functions.
In Islam there was generally a moral imperative to treat all the ill regardless of their financial status. The hospitals were largely secular institutions, many of them open to all, male and female, civilian and military, adult and child, rich and poor, Muslims and non-Muslims. They tended to be large, urban structures.
The Islamic hospital served several purposes: a center of medical treatment, a convalescent home for those recovering from illness or accidents, an insane asylum, and a retirement home giving basic maintenance needs for the aged and infirm who lacked a family to care for them. It is unlikely that any truly wealthy person would have gone to a hospital for any purpose, unless they were taken ill while traveling far from home. Except under unusual circumstances, all the medical needs of the wealthy and powerful would have been administered in the home or through outpatient clinics dispensing drugs. Though Jewish and Christian doctors working in hospitals were not uncommon, we do not know what proportion of the patients would have been non-Muslim.
An Islamic hospital was called a bimaristan, often contracted to maristan, from the Persian word bimar, `ill person', and stan, `place.' Some accounts associate the name of the early Umayyad caliph al-Walid I, who ruled from 705 to 715 (86-96 H), with the founding of a hospice, possibly a leprosarium, in Damascus. Other versions, however, suggest that he only arranged for guides to be supplied to the blind, servants to the crippled, and monetary assistance to lepers.
The earliest documented hospital established by an Islamic ruler was built in the 9th century in Baghdad probably by the vizier to the caliph Harun al-Rashid. Few details are known of this foundation. There is no evidence to associate the construction of the earliest hospital with any of the Christian physicians from Gondeshapur in southwest Iran, but the prominence of the Bakhtishu` family as court physicians would suggest that they also played an important role in the function of the first hospital in Baghdad.
In little more than a hundred years, 5 additional bimaristans had been built in Baghdad. According to some accounts, directions were given by a vizier in the early 10th century to provide medical care to prisons on a daily basis and visits by doctors with a traveling dispensary to villages in lower Iraq. The most important of the Baghdad hospitals was that established in 982 (372 H) by the ruler `Adud al-Dawlah. When it was founded it had 25 doctors, including oculists, surgeons, and bonesetters. In 1184 (580 H) a traveller described it as being like an enormous palace in size.
In Egypt, the first hospital was built in the southwestern quarter of present-day Cairo in 872 (259 H) by Ahmad ibn Tulun, the `Abbasid governor of Egypt. It is the earliest for which there is clear evidence that care for the insane was provided. By the end of the century, two hospitals were also said to have been built in Old Cairo (Fustat), though the evidence on this point is questionable. In the 12th century, Saladin founded the Nasiri hospital in Cairo, but it was surpassed in size and importance by the Mansuri, completed in 1284 (638 H) after eleven months of construction. The Mansuri hospital remained the primary medical center in Cairo through the 15th century. The Nuri hospital in Damascus was a major one from the time of its foundation in the middle of the 12th century well into the 15th century, by which time the city contained 5 additional hospitals.
Besides those in Baghdad, Damascus, and Cairo, hospitals were built throughout Islamic lands. In al-Qayrawan, the Arab capital of Tunisia, a hospital was built in the 9th century, and early ones were established at Mecca and Medina. Iran had several, and the one at Rayy was headed by al-Razi prior to his moving to Baghdad. Ottoman hospitals flourished in Turkey in the 13th century, and there were hospitals in the Indian provinces. Hospitals were comparatively late in being established in Islamic Spain, the earliest possibly being built in 1397 (800 H) in Granada.
Of the great Syro-Egyptian hospitals of the 12th and 13th centuries, we possess a considerable amount of information. They were built on a cruciform plan with four central iwans or vaulted halls, with many adjacent rooms including kitchens, storage areas, a pharmacy, some living quarters for the staff, and sometimes a library. Each iwan was usually provided with fountains to provide a supply of clean water and baths. There was a separate hall for women patients and areas reserved for the treatment of conditions prevalent in the area -- eye ailments, gastrointestinal complaints (especially dysentery and diarrhoea), and fevers. There was also an area for surgical cases and a special ward for the mentally ill. Some had an area for rheumatics and cold sufferers (mabrudun). There frequently were out-patient clinics with a free dispensary of medicaments. The staff included pharmacists and a roster of physicians who were required at appointed times to be in attendance and make the rounds of patients, prescribing medications. These were assisted by stewards and orderlies, as well as a considerable number of male and female attendants who tended the basic needs of the patients. There were also instructors (mu`allimun), possibly aspiring medical students, who trained the non-professional staff. The budget of such institutions must have been considerable, and in fact the budget of the Mansuri hospital in Cairo was the largest of any public institution there. Over the entire staff and responsible for the management of the hospital was an administrator who was not usually trained in medicine. In most instances he was a political appointment, subject to the unpredictable fluctuations of political favor, for the position of controller of a hospital was a very lucrative one. The chief of staff, on the other hand, was a medical man.
Individual organs drawn in inks and opaque watercolors. Two of six leaves of anatomical drawings appended to a Persian translation of an Arabic medical compendium. On the righthand page are the liver with gallbladder, the stomach with intestines, the testicles, and detail of the stomach. On the left are a composite rendering of the tongue, larynx, heart, trachea, stomach and liver; a composite drawing of the ureters, urethra, kidneys, testicles, and penis; and a composite rendering of the bladder with female genitalia, womb and foetus.
Undated, probably 18th century India.
NLM MS P20, fols. 556-557a
All the hospitals in Islamic lands were financed from the revenues of pious bequests called waqfs. Wealthy men, and especially rulers, donated property as endowments, whose revenue went toward building and maintaining the institution. The property could consist of shops, mills, caravanserais, or even entire villages. The income from an endowment would pay for the maintenance and running costs of the hospital, and sometimes would supply a small stipend to the patient upon dismissal. Part of the state budget also went toward the maintenance of a hospital. The services of the hospital were to be free, though individual physicians might charge fees.
Little detailed information is available regarding the hospitals as teaching institutions. We have accounts of teaching at certain hospitals, such as the `Adudi hospital in Baghdad, but how many hospitals had such formal classes is not known. Clinical training at bedside in a hospital, whether as an apprentice or through formal instruction, was, however, a part of medical learning for a substantial number of formally trained physicians. In the medical writings, such as the encyclopedia by al-Majusi, there was frequent encouragement of students to acquire clinical training.