Contributions of Islam To Medicine (3/4)

The Reasons for the High Standard of Islamic Hospitals

In the Islamic Empire, the hospitals attained a golden era unsurpassed in previous history. The reasons behind such a high standard include:

1. Being part of a civilization as a whole: The people were prosperous; thus, they were capable of taking care of their health and of seeking the best available treatment. Also, Islam stresses the necessity of seeking treatment of every disease; the Prophet says "For every disease, God created a cure." The required sciences for good medical care were at a high standard e.g. the Arabs were advanced in chemistry, mathematics, administration, pharmacy, medicine, etc. They gave the world the system of numbering which have replaced the cumbersome Roman numerals. The world owes to them the knowledge of the following chemical reactions, namely sublimation, precipitation, filtration, distillation, etc. The great Arab chemist Jabir Ibn-Hayan discovered sulphuric and nitric acids. According to Webster Dictionary, the words sugar, alcohol, alkali, syrup, coffee, cotton, all are Arabic words. Fielding H. Garrison, the author of the well-known work on the "History of Medicine" said:

"...The Saracens themselves were the originators not only of algebra, chemistry, and geology, but of many of the so- called improvements or refinements of civilization, such as street lamps, window-panes, firework, stringed instruments, cultivated fruits, perfumes, spices, etc...”

2. High prestige of physicians: The physicians in this era earned a high prestige. Although anyone, irrespective of his social status, can study medicine, yet the route was long and tedious. He had to finish Islamic studies, philosophy, astronomy, art, chemistry, etc. before being accepted as a medical student. Therefore, the physician was a cultured person who had wisdom and knowledge. In fact, the Arabic translation of a physician is "Hakim" which means sage. In the 9th and 10th century, the Court- Physician was in the protocol ahead of the Chief-Justice. Many eminent physicians, as we will discuss later, showed enough talent, social knowledge, political capabilities, and wisdom to be appointed by the Caliphs as Prime Ministers (Visiers). Owing to the high prestige and connections of physicians, generous funds for hospitals were easily obtained.

3. Rulers' involvement in public services: The Caliphs of the Islamic empire built magnificent hospitals for one or more of the following reasons:

a. Religion: Their religion stated that money spent on charity is a good investment for Judgment Day.

b. Eternity: The Pharoahs of Ancient Egypt sought eternity by building pyramids, the rulers of Islam sought the same thing by building mosques, hospitals, and schools carrying their names.

c. Politics: To show their people that they cared, and were interested in them, the rulers built hospitals.

Whatever the motive of the ruler, the population benefited and good hospitals were erected.

4. Adequate financing to run the hospitals: The rulers set aside generous funds to run these hospitals. Also the philanthropists gave generously, thus following their religious beliefs and imitating their rulers. In Islam, there is a special system called Al-Waqf. A person can donate part or all of this wealth to charity. The government takes care of such a donation, and its revenues help to maintain and build mosques, hospitals, and schools. Another source of funds and an important pillar of Islam is alms-giving (2 1/2% of property value). Collected alms goes to the state treasury which takes care of charitable organizations. Very few hospitals in the Islamic era were private. Thus, patient’s fees constituted an unimportant source of funding.

Specific Hospitals

The capital of the Islamic empire kept changing from one dynasty to the other. In each capital, an important medical center developed. Thus, by the end of the 13th century, there were many medical centers spread throughout the Arab world. Space does not allow the description of all the hospitals built throughout these centuries. We, therefore, chose some of the important ones which will be described according to the region where they were developed.

1. In El-Sham

El-Sham at that time included what is known now as Syria, Lebanon, Jordan, and Palestine, Damascus and Jerusalem were the important cities.

a. In Damascus: The first known hospital in Islam was built in Damascus in 706 A.D. by the Umayyad Caliph, Al-Walid (Hamarneh 1962). The most important hospital built in Damascus in the middle ages was named Al-Nuri Hospital, after King Nur Al-Din Zinki, in 1 156. This hospital was built during the Crusade Wars to fulfill a need for a well-equipped and well-staffed hospital. It turned out to be not only a first class hospital, but also a first class medical school. The king donated to the hospital a whole library rich in medical books. It is important to understand why books were expensive and limited in number in the middle ages. This was because they were hand-written as printing was not used until the middle of the fifteenth century. The hospital adopted medical records, probably the first in history. From its medical school, many eminent physicians graduated, an example is Ibn Al-Nafis, the scholar who discovered the pulmonary circulation as will be discussed. The hospital served the people for seven centuries and parts of it still exist.

b. In Jerusalem: In 1055 A.D., the Crusaders built Saint John Hospital. By the end of the eleventh century, it grew to such an extent to include a hospital, a palace for knights, and a convent for the nursing sisters. The medical activities of the hospital were tremendous because of the large number of daily admissions of patients, pilgrims, and wounded soldiers. After the liberation of Jerusalem by Salah Al-Din in 1187 A.D., the hospital name was changed into Al-Salahani Hopital. He expanded the hospital which continued to serve the people until its destruction by an earthquake in 1458 A.D.

2. In Iraq and Persia:

In 750 A.D., Baghdad was built to be the capital of the Abbasid dynasty by the Calip Abu-Gaifar Al- Mansur. In 766 A.D., he assigned the dean of the medical school of Jindi Shapur, Judis Ibn-Babtishu', to be the Court- Physician and to establish hospitals proportionate to the glory and prosperity of Baghdad.

When Harun Al-Rashid followed (786-809 A.D.), he ordered the grandson of Ibn-Bahtishu and his Court-Physician, Jibril, to build a special hospital named Baghdad Hospital. This hospital developed into an important medic center. One of its chiefs was Al-Razi, the eminent Internist.

In 918 A.D., the Caliph Al-Mugtadir built two hospitals in Baghdad. One was on the east side of the city which he named Al-Sayyidah Hospital, after his mother. The other was on the west side which he named, Al- Mugtadiri Hospital, after himself. Another important hospital was named Al-Adudi Hospital. It was built in 981 A.D. after King Adud Al-Dawlah. It was the most magnificent hospital built in Baghdad before modern time. The Caliph wanted to outdo his predecessors. It was furnished with the best equipment and supplies known at the time. It had interns, residents, and 24 consultants attending its professional activities. Haly Abbas, who wrote the famous book "Liber Regius (Al-Malaki)", was one of the staff. It was destroyed in 1258 when the Mongols, led by Holagu the grandson of Ghingiz Khan, invaded Baghdad.

3. In Egypt:

In 872 A.D., Ahmed Ibn-Tulun built a hospital called Al-Fusta Hospital in the City Al-Fustat which is now in old Cairo. It served the growing Cairo population for six centuries. It was divided into separate wards. On admission, the patients were given special apparel while their clothes, money, and valuables were stored until the time of their discharge.

In 1284 A.D., King Al-Mansur Qalawun built an important hospital named Al-Mansuri Hospital. The story behind its construction is interesting. King Al-Mansur Qalawun was an officer in the Arabian army fighting the Crusaders. While in the Holy Land, he fell sick and was admitted to Al- Nuri Hospital. On recovery, he vowed that if he ever became the ruler of Egypt, he would build a great hospital in Cairo even more magnificent than Al-Nuri Hospital for, the sick, poor, and rich alike. At the dedication ceremony, he asked for a cup of wine from the pharmacy. After drinking it he declared that by taking that portion as a medication, he was signifying that the hospital was serving all people from the king to the least of his subjects (Hamarneh 1962).

It was the best hospital built then as reported by the contemporary historians such as Ibn-Battota and El-Kalkashandi. It had different sections for different diseases. Music therapy was used as a line of treatment for psychiatric patients. It served 4,000 patients daily. The patient's stay in the hospital was free moreover on his discharge; the patient was given food and money for compensation for being out of work during his hospital stay. Al-Mansuri Hospital has served Cairo for seven centuries since it has been built. It is now used for ophthalmology and called Mustashfa Qalawun. Its ancient door is preserved in the Islamic Museum of Cairo.

4. In North Africa (Al-Maghrib Al-Arabi):

a. Tunisia: In 830 A.D., Prince Ziyadat Allah I, built Al-Qayrawan Hospital in a district of the Qayrawan city called Al-Dimnah. Subsequently all hospitals in Tunisia were called Dimnah instead of Bimaristan as they were called in the East, which is a Persian word meaning a hospital. The Qayrawan Hospital was characterized by spacious separate wards waiting rooms for visitors and patients, and female nurses from Sudan, an event representing the first use of nursing in Arabic history. The hospital also included a chapel for prayers.

b. Morocco: In 1190 A.D., the king Al-Mansur Ya'qub Ibn-Yusuf, built a hospital in the capital city, Marakesh, named it the Marakesh Hospital. It was a huge hospital beautifully landscaped with fruit trees and flowers. Water was brought by aqueducts to all sections. Patients were provided with special apparel: one for winter and another for summer. The pharmacy was taken care of by specialists called the Sayadlah. There was an expensive private section where a patient was charged what is equivalent to $ 1501 day. One thousand years ago, this fee was quite expensive.

5. Al-Andalus (Spain):

In 1366 A.D., Prince Muhammed Ibn-Yusuf Ibn Nasr, built the Granada Hospital in the city of Granada which had expanded to half a million population. The hospital represented the beauty of the Arabic architecture in Spain and served the people until the fall of Granada in 1492 A.D.

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