Medieval hospitals in Islamic cities: scientific and evidence-based medicine!

Medieval hospitals in Christian Europe were typically represented as places of misery and squalor, over-crowded reservoirs of infection that had no medical role. Rather they were places in which sick people waited for death. My own notion of medieval health care, at least as offered to Christian pilgrims, was a place where the sick and dying lay on the floor in a cathedral crypt, and the slanted floor was sluiced down once a week. Care of the soul was more important than care of the body.

The David Collection of Applied Arts in Copenhagen includes a section on objects/images of Islamic Medical Science and on Islamic hospitals. They noted that the advent of Islam did not cause any disruption in the evolution of medical science. In fact the Classical Greek and Roman tradition for treatment and medication was positively enhanced in the Islamic world, where it was gradually enriched with new scientific thinking from the East.

By the early C9th, the famous medical works of Hippocrates and Galen were translated at schools and libraries in Damascus, Baghdad and other major Islamic cities. Dioscorides’s De Materia Medica was translated into Arabic and revised for a wider, reading public. And inspired by Dioscorides, new Arabic texts showed scientific research and progress in the medieval world (see photo below). Herbs and other medicines were categorised according to their effectiveness.

A very important contribution to medicine in the Islamic world was the pioneering manuscript by al-Razi/Rhazes: The Book on Smallpox and Measles. This volume, which was translated many times into Latin from the late C15th on, was the first to carefully analyse the two diseases.

1. Bimaristan Nur al-Din, 
Damascus, Syria (1154)

 2. Central courtyard Bīmaristan Arghun AI-Kāmilī, 
Aleppo, Syria (1354).
When the pool was filled with water, patients could enjoy the fountains.

3. Sultan Bayezid II mosque and hospital complex, 

Edirne, Turkey (1484)

The bimaristan/hospital was perhaps the most important medical innovation contributed by Islam. The first true hospitals were found in C9th Baghdad, with special departments for eye problems, internal medicine, orthopaedic complaints, mental illnesses and infectious diseases. Nasim Hasan Naqvi  reported that at least 63 major hospitals were built during the Middle Ages in all major cities in Iraq, Persia, Syria and Egypt.

In Syria only 4 medieval hospitals that were built during C12th-C14th have survived. 2 out of 4 of these hospitals are still standing in perfect condition, one used as a medical museum and the other was used as mental asylum. The other two exist in rundown condit­ion and can only been inspected from the outside. Historians of Syrian architecture have naturally taken great interest in all four.

Now a book by Prof Ahmed Ragab called The Medieval Islamic Hospital: Medicine, Religion and Charity (2015 Cambridge UP). He agreed that the first bimaristans were built in the C9th in Baghdad, and spread to other Islamic urban centres within 100 years. Perhaps those early Muslim pilgrims understood that bimaristans were hospitals AND that they also functioned as a site of charitable care and support, essential for the sick and for long distance travellers.

Ragab's new book, The Medieval Islamic Hospital

published 2015.

From Baghdad to Cairo to Edirne, hospitals were major and integral components of medieval and early modern Islamic populations. But what role did they play in these societies? Were they sites noted largely for the development of medical knowledge?

Ragab examined the history and significance of hospitals in Mamluk Egypt and Syria. He argued that we must view these medieval hospitals as charitable institutions that provided needed services and drugs to the urban poor, rather than as the early progenitors of our modern medical institutions. He explored how these hospitals functioned as charitable institutions, what type of medical theories and treatments they employed, why medieval rulers regarded them as so important, and why their importance decreased after the end of the medieval era.

In mid-C12th Damascus, each hospital was beautifully designed and built. So much money was spent on the art and architecture that the hospital was seen as the crown jewel of any new ruler’s attempt to refashion his city. And not just hospitals. In Aleppo Nur Al din’s patronage extended to important madrasas and Sufi monstaries (see photo above). Bimaristans had become part of the politico-architectural landscape, part of a complex system of institutions that defined urban Islam!

Ragab’s book focused on the Egyptian and Levantine institutions of the C12th-14th. By the C12th, hospitals serving the sick and the poor could be found in nearly every Islamic city. Ahmed Ragab traced the varying origins and development of these institutions, locating them in their urban environments and linked them to charity networks and patrons' political projects.

The book Medieval Islamic Hospital explored the medical networks surrounding early hospitals and examined the particular brand of scientific, practice-oriented medicine they helped to develop. And since he focused on Muslim institutions in particular, Ragab analysed the effect of the Muslim religion on medieval medicine.

Ragab reiterated that European hospitals were religious and charitable institution in which healing the soul took precedence over healing the body. How different this was from Baghdad and other centres in the Islamic world! Ahmed Ragab explained the Islamic bimaristan by relating it to the medieval history of patronage, medicine, law and the economy. And he achieved this via the specific history of one hospital, the Mamluk sultan al-Mansur Qalawun c1285 in his empire’s capital, Cairo.

As part of a philanthropic and religious complex that included a mausoleum and madrasa, the al-Mansur foundation was examined against the background of its predecessors, in Islamic Egypt and the Levant, and in Crusader Jerusalem. Ragab placed the Mansuri establishment within medical history, of course, but also within a wider setting of rulers’ patronage and piety, and urban topography and architecture.

Medieval Islamic rulers regarded the hospitals as important because they were part of an overall architectural and urban buil­ding project in the centre of town. All the major and unifying estab­lishments were built near the main mosque and near the governor’s palace. The architecture of these buildings symbolised the governor’s power and control, as well as his religious piety and perhaps even his military might. The hospital definitely showed the governor’s care for his people!

I loved the Classics and Ancient History essay topic set by Warwick University, based on the writings of Ragab etc: "How were the changes in medieval and Renaissance medicine reflected in architecture?"