21 May 2016

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?"


Anonymous said...

While it doesn't sound like a book I would read for pleasure, what you have written raises many questions in my mind that no doubt the book would answer in detail.

Deb said...

You will remember discussing the 15th century charitable almshouse/hospital for the poor in Beaune. Our visit was memorable. I best remember the chapel and the Room of the Poor.

Hels said...


I would not have bought that book in a bookshop either, but I started with The David Collection of Applied Arts in Copenhagen which is fascinating. Then you know how it is; one reference links to a second, then a third pops up at work, then someone comes back from Cairo and mentions a fourth reference. Thus I unexpectedly arrived at Prof Ahmed Ragab's book.

Hels said...


I loved the Hospices de Beaune too. The multi-coloured, multi gabled roof stands out in the landscape, so clearly some Duke was throwing loads of money at the institution. But I agree it is the curtained four-poster beds are down both sides of the Great Hall that most attract our attention. And the Roger van der Weyden chapel that the residents could see from bed, even if they couldn't stand up.

So what were Beaune's priorities - clean and comfortable beds, quality meals and spiritual nourishment from the nuns and in the chapel. If I was sick in 1450s France, those are the medical priorities I would have valued most.

Train Man said...

The case of surgical instruments in Copenhagen looks quite modern and effective for operations and amputations. Scary however

Hels said...

Train Man

Not as scary as operations and amputations attempted in medieval Christian Europe where pain served God's purpose and was not to be alleviated!

In medieval Islamic countries, the doctors developed a large number of anaesthetics. They included a wide range of medical plants as well as ice as an efficient and safe mode of local anaesthesia even though there might be an increase in the pain at the beginning. According to Ibn Sina (Avicenna), opium was the most powerful, then mandrake, papaveris, henbane or hyocyamus, hemlock etc. These drugs, especially opium, were used as local anaesthetics in dental cases, earache, eye pain and joint pain in gout.


Lord Cowell said...

Yes, after the progress made in the classical world, the east being a part of that, the dark ages certainly did much to plunge mankind back into ignorance for a prolonged period. However, I think sometimes we can be a little harsh judging those who had to practice / live through that period. They were not personally responsible for being born in that time and were trying to do their best despite being unconsciously incompetent. I still know of some practicing midwives who actively counsel against women having pain relief during labour as childbirth is a natural thing and the pain is all a beautiful part of it. That sounds a little medieval to me!

Hels said...

Lord Cowell

agreed. That is always the issue for historians, using their 21st century brains to put themselves into a geographically distant country, with an unfamiliar set of values, in a very different century.

But the point Prof Ragab was making was that the medieval hospitals in Islamic cities and their staff were not unconsciously incompetent. They were very careful with cleanliness, medicines, surgery, drugs etc, reading the famous ancient medical works and writing new medical texts in Arabic.

If any medical system looked unscientific in the medieval era, it was not in Islamic cities.

Jarek said...

Very interesting post and beautiful pictures

Parnassus said...

Hello Hels, Regarding the comment above, this is just the kind of book I would like to read for fun. So much of ancient western culture and science was preserved through Islamic venues, that I am not surprised to read about their advances in medicine.

The fact that here are still some of those medieval hospitals left makes it a shame that so many more recent (i.e., Victorian) hospitals are being lost, often without much of a struggle or even documentation.

Hels said...


thank you. Have you seen any of the surviving facilities? What was the most impressive part?

Hels said...


it breaks my heart when historically significant buildings are pulled down and for what - a cark park? a fast food shop? I was heart broken when they tried to destroy the Cleveland Street Workhouse in London next to where Charles Dickens for most of his young life. Presumably Oliver Twist was located in that workhouse.

The destruction in that case failed. But how many other important historical or architectural sites were knowingly and wilfully vandalised by local government.

mem said...

A very interesting topic . I hope those marvellous buildings will survive the current war ! My ancestors were doctors in Ireland . Their positions were hereditary and they fulfilled the role of poet musician and doctor to the ancient kings of Ulster , the Maguire . Apparently their are medical texts probably written in Gaelic from the 1300 or thereabouts , written by these " doctors" in the library at Trinity College Dublin . I would love to go and read them ! I wonder if the patient was sung to or had poetry recited to them if the "cur " dint work 😳

Hels said...


that is very impressive ... how far back were your relatives doctors in Ireland? If it was back to the pre-census days ( i.e before The Census Act of 1800), how did you trace the story? My grandmother and mother always promised that my maternal line was brilliant, educated and cultivated, but I suspect they were just plodders who could write well :)

I love programmes like Who Do You Think You Are because they always throw up such surprises, both good and bad.

Mandy said...

I hope those buildings survive the war! In our (my) Eurocentric world, it is so easy to forget that the Middle East was the pinnacle of advancement and innovation in the Middle Ages when us Europeans were primarily living on farms and in slums.

Hels said...


agreed. That should prove to us all that
a] history is not linear i.e starting in miserable caves and moving relentlessly onwards to more and more progress. Instead, I would say that Greek-Roman medicine was clever, followed by Dark Ages superstition, then Renaissance learning, then Industrial Revolution with horrific coal mine diseases/deaths and poor houses etc etc
b] learning was not, as you say, the prerogative of the West. There were centuries when the Islamic and Chinese empires made Western civilisation look primitive.

Víctor Pallejà de Bustinza said...

Right. And not just Iraq, Persia, Syria and Egypt.

Islamic medicine spread far beyond the bounds of the Muslim world, making Arabic the international language of science in the late Middle Ages. In the city of Montpellier in southern France, the 13th century scholar Arnau de Villanova studied, taught and translated Arabic. In 1593 Avicenna's Canon of Medicine was published in Rome by the Medici's prestigious press. Despite there having been a Latin version since the 12th century, it was published in Arabic as a mark of the prestige and scholarship of the edition.

Víctor Pallejà de Bustinza

Hels said...


That makes perfect sense. It was not that France and Italy had a lot of Islamic doctors... it was that some Christian scholars could study, read and translate from the Arabic language. Thank you.

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Hels said...

Madinah Media

many thanks. Not only were the medieval hospitals important for health care; hospitals had more roles for medieval Islamic societies than we normally think about - specialist architecture, charitable care, scientific museums, drug collections, scientific libraries etc etc.