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HOSPITALS IN MEDIAEVAL ISLAM


The Muslims, even in the days of early Islam; had, developed a high culture and had organised their administration on a sound footing. The Islamic Caliphates as well as other Muslim principalities had created separate departments for different subjects which were headed by Ministers and supervised by Secretaries. Organised on highly efficient lines was the public works department whose function was the construction and maintenance of roads and bridges as well as the provision of sanitation and medical facilities to all classes of people. Never before had medical facilities been provided for the common people on such a large scale and in such an organised form. The Muslims were the first to establish hospitals, dispensaries and medical schools in the world. "In the curative use of drugs," writes Philip K. Hitti, “some remarkable advances were made at this time by the Arabs. It was they who established the first apothecary shop, founded the earliest school of pharmacy and produced the first pharmacopoeia." Several pharmacological books were written by Arabs. The author of the first of these books was the celebrated Jabir bin Hayyan. The greatest medical theorists during mediaeval times were Zakariya Razi (Rhzes), Ibn Sina (Avicenna), Tabari and Majusi. Among these Razi and Ibn Sina were also two of the outstanding practising physicians of their time.


Early period
Even before the anvent of Islam, Haris Ibn Kalda, ·a resident of Taif who had mastered medical science was welcomed in the court of the Persian emperor, Nausherwan, the Just. His son, Nasir Ibn Haris, earned an even greater reputation than his father as a physician and was instrumental in popularising medical science in early Islamic Arabia. Hazrat Omar, the second Caliph of Islam despatched a company of physicians along with the Arab army bound for Persia.

The Omayyad Caliphate represents a period of consolidation and proper organisation of Muslim resources. The third Omayyad Caliph, Walid Ibn Abdul Malik, who took much interest in public works, founded an institute for blind and disabled persons. He established the first medical dispensary in Islam in 88 A. H. and staffed it with a number of able physicians and surgeons. Soon afterwards dozens of small dispensaries sprang up all over the vast Omayyad empire.


Abbasids
The Abbasid Caliphate provided the most congenial atmosphere for the development of culture and the advancement of public welfare activities. The early hospitals in the Islamic domains were founded on the models of the old academy-hospitals of Jundeshapur and were named Bimaristan, The first hospital was founded at the beginning of the 9th century in Baghdad during the reign of the celebrated Abbasid Caliph Harun-ar-Rashid. Five more hospitals were established during the IOth century A.D. Greek and Persian methods of medical treatment were prevalent during the early period of the Abbasid Caliphate, but the talented Barmekides also introduced Indian methods. They invited a number of Indian raids, had their medical works translated into Arabic and founded a big dispensary in Baghdad in which patients were treated by Indian methods. Harun-ar-Rashid also created a separate department of health, which used to run several Government dispensaries staffed by talented physicians. The department was supervised by an Inspector-General of Health and Bukht Yishu was the first to be appointed to this high post in 171 A.H. The same post was occupied by his son Jabriel in 175 A.H. The medical practitioners were highly paid and Jabriel received ten thousand dirhams as his monthly salary and five thousand as allowances from the imperial exchequer. In addition he earned lacs through his private practice, mostly from high dignitaries of the State. His house and his person rivalled in luxury to that of the Caliph. According to the author of the Chahar Minar the biggest income of all the physicians was that of Bukht Yishu bin Jurjis. His salary from Harun-ar-Rashid was 10,000 dirhams a month. The value of presents received by him was estimated to be over 3,00,000 dirhams a year. From the house of the Caliph he received a retaining fee of 4,00,000 dirhams. He was also physician to the Barmekides who paid him 25,00,000 dirhams a year for his services. In addition to all this be received from his private practice about 5,00,000 dirhams a year. This amounts to a total income of not less than 40,00,000 dirhams a year which represents about- £1,75,000 per annum.

The maintenance of efficiency and high standards in the medical profession was also looked after. As early as the days of Mamun and Mutasim, pharmacists- had to pass a sort of proficiency test, before starting their practice.

In the reign of another Abbasid Caliph, al-Muqtadir Billah, the Medical Department registered phenomenal progress. His talented minister Ali Ibn Isa took a lively interest in public welfare activities. Sinan Ibn Thabit Ibn Qurra an eminent physician was the Inspector-General of Health. The outbreak of large scale epidemics in the Abbasid domains necessitated the expansion of the Health Department. A number of new hospitals were opened and a separate hospital was attached to each jail. A section of temporary dispensaries was also opened. Hundreds of physicians were appointed who toured the rural areas with mobile dispensaries and attended to ailing persons. In addition to these arrangements, Muqtadir Billah also founded several large hospitals, one of which was built on the bank of the river Tigris and spent about Rs. 35,000 a year. Another hospital built in his own name, had an annual expenditure of about Rs. 12,000. Due to the discovery of a case of malpractice, Sinan, who was the Inspector-General of Health, was ordered by the Caliph in 931 A.D. to test all practising' physicians and grant certificates to those who could satisfy him, Diplomas were awarded to successful candidates. Arrangements were made for practical instruction. Orthopaedists were examined as to whether they were acquainted with anatomy and surgery. Like surgeons, the ophthaImologists had to undergo a further test and were-forbidden to practise unless they knew the gross anatomy of the eye-ball. They had to satisfy the examiner that they knew the three principal diseases of the eye as well as their complications. Hence a system of medical proficiency tests was introduced and over 860 men passed the test in Baghdad alone and started their practice. In this way the Metropolis of Abbasids rid itself of its quaks.

Medical facilities were provided in the distant part of the far flung Abbasid domains. At least 34 hospitals were scattered all over the Islamic world during the Abbasid Caliphate and mobile clinics existed in the 11th century. The hospitals trained physicians as well as treating patients. They were divided into male and female sections and also contained medical libraries which offered courses in medicine.


Egypt
Egypt was somewhat backward in establishing centres.of medical facilities. According to Allama Maqrizi, a dispensary was opened in Cairo under the orders of Fath Ibn Khaqan, the Minister of Caliph Al-Mutawakkil Billah. The first hospital in Cairo was built by Ibn Tulun, the Governor of Cairo in 872 A.D., and it survived until the 15th century. The celebrated Governor had set aside property yielding Rs. 3 lakhs a year to meet the necessary expenditures of the hospital. He had made elaborate arrangements for the free boarding, lodging and dress of the patients. The hospital was equipped with all available medical facilities and had obtained the services of the best physicians who regularly examined the patients twice a day. A separate section of the building was reserved for the treatment of lunatics. The Governor himself visited the hospital on every Friday. Each of the two main sections of the hospital was divided into several halls. The biggest hall, meant for general medical cases, was partitioned into small rooms each serving a different disease. There were separate wards for surgical cases, eye diseases and orthopaedic cases. From the point of view of treatment the hospital was divided into two main sections--the out-patient department and the in-patient department.


Ayyubids and other dynasties
At a time when the dwindling Abbasid Caliphate was helpless to meet the greatest threat to Islam, Sultan Nuruddin Zangi and Sultan Salahuddin Ayyubi successfully met the challenge and rolled back the surging waves of crusaders who had swarmed into the Holy land. These incessant military campaigns could not lessen their interest in the patronage of art and learning and they spent the major part of their income on public welfare activities. Allama Ibn Jubayr, who,on his way to Mecca in the 6th century A.H. passed through Baghdad, Mosul, Aleppo and Damascus found a network of charitable public welfare institutions there. Nuruddin had opened a big dispensary in Damascus which was called Nooviya which met.the expenses of indoor and outdoor patients. Another institution of the same type existed in Damascus.

In 577 A.H., Sultan Salahuddin Ayyubi, better known in the west as Saladin, converted a large Fatimid Palace into a hospital. Allama Ibn Jubayr visited this grand hospital in Cairo and gives a detailed description in his Travelogue. It contained hundreds of beds for indoor patients and had a separate ward for female patients who were attended to by female staff only. A separate portion of the hospital, with spacious grounds bounded by high walls was reserved for the lunatics. This hospital was frequently inspected by the Sultan himself who kept a strict watch over it. The Sultan had also built another magnificent hospital in Alexandria.

The lead given by Sultans Nuruddin Zangi and Salahuddin Ayyubi was enthusiastically followed by others and well-to-do people vied with each other in founding public welfare institutions. In 678 A.H., when Mansur Qalaun ascended the throne of Cairo, he built a magnificent hospital in Cairo, which was second only to the Azdiya Hospital in Baghdad. The hospital was housed in four big buildings, occupying an area of 10,600 square yards. A canal which ·flowed throwgh the-hospital supplied it with water. The ruler had set aside property yielding a million dirhams per annum for its expenses. This hospital which was open to all had separate apartments for the treatment of patients suffering from different diseases. A teaching institution was also attached to this hospital.

The biggest hospital-of the world of Islam which was equipped with all available medical facilities was built by Azud-al-Daulah in 368 A.H. in Baghdad. This hospital which, with its spacious buildings, up-todate medical instruments, excellent arrangements and efficient administration could rank with the best hospitals built until the middle of the 19th century was in reality a Medical University. Drawn from all parts of the Islamic world were the more than eighty medical specialists including Ibn Baksh, Abu Yaqoob and Abu Isa who treated patients and also delivered lectures on various medical subjects.

The hospital, which took three years to be built, employed skilful ophthalmologists like Abu Nasr Ibn-ul-Duhali, surgeons like Abul Khair and orthopaedic surgeons like Abul Salh. According to Al-Qifti, ibn Manduyah of Isfahan was summoned from Central Asia. "All these (hospitals) were overshadowed" says a European writer, "by the hospital that he founded in Baghdad, complete with equipment, numerous trust funds and a pharmacy stocked in drugs brought from the ends of the earth". A list of diets and drugs used in this hospital is preserved in the British Museum in London. The main dispensary of the hospital was housed in a palatiai building. Benjamm of Tudela, a Jew-who visited Baghdad in 1160 A.D. found no less than sixty medical institutions there. He writes:-"All are well provided from the king's stores with spices and other necessaries. Every patient who claims assistance is fed at the king's expense' until his cure is complete There is another large building called the Darul Maraphtan in which are locked up all those insane persons who are met with during the hot season, everyone of whom is secured by iron chain until his reason returns, when he is allowed to return home. For this purpose they are regularly examined once a month by the king's officers appointed for the purpose, and, when they are found to be possessed of reason, they are immediately liberated. All this is done by the king in pure charity towards all those who come to Baghdad, either ill or insane, for the king is a pious man and his intention is excellent in this respect".'

A number of medical institutions and hospitals were opened in Baghdad and in the provinces during the 11th and 12th centuries A.D. In 1113 A.D., a hospital was opened in Baghdad by Khumastigin and was known as Tutushi hospital. A few years later a school for orphans was built by Mustufi Aziz-ud-Din who bore all the expenses of its residents. A hospital attached to a medical university was founded by Azud-al Daulah in Shiraz. Abu Said Kukuburi, built four asylums in Arbela for the blind and for persons suffering from chronic diseases.

The big hospitals like that of Azud-al Daulah employed a large staff both technical and administrative. The Chief Officer of the dispensary was called Shaikh Saydalani. The administration of the hospital was headed by a governor who used to be a non-technical man usually a general or prince. The post of mutwalli or dean was usually filled by a medical man. It was occupied by AI-Razi(Rhazes) at Rayy and later he was appointed mutawalli of the old hospital in Baghdad. Al-Jurjani held this post at Khwarizm.

One of the finest Islamic hospitals was built by Abdul Wahid al-Marakeshi in Morocco in about 1200 A.D. According to the writer of the Medical History of Persia, "The hospital was unequalled in the world. First there was selected a large open space in the most level part of the town. The workmen embellished with a beauty of sculpture and ornamentation even beyond what was demanded of them. All sorts of suitable trees and fruit trees were planted there. Water there was in abundance, flowing through all the rooms. In addition there were four large pools in the centre of the building, one of them was lined with white marble. The hospital was furnished with valuable carpets of wool, cotton, silk and leather, so wonderful that I cannot even describe them. For the use of patients there were provided day-dresses and night dresses, thick for winter, thin for summer. After he was cured, a poor patient received on leaving the hospital a sum of money sufficient to keep him for a time. Rich patients received back their money and clothes......Every Friday the Prince after the midday prayer mounted his horse to go and visit the patients and learn about each of them".

A number of hospitals and dispensaries were established in Mecca and Medina. In 628 A.H., the Abbasid Caliph, Al-Mustansir Billah built a large dispensary in Mecca. Muslim India did not lag behind other countries in this humanitarian work and according to Allama Maqrizi, in the reign of Muhammad Tughlaq, Delhi alone possessed more than 70 dispensaries. The Moghal Emperor Jehangir had issued a proclamation for the establishment of a greater number of hospitals and dispensaries in his dominions. A Muslim physician in Cadiz (Spain) had planted in the park of the governor a botanical garden in which he cultivated rare medical herbs which he had brought from his travels.


Special Features
A military medical unit existed from the days of early Islam, and during the reign of the second Caliph such a unit was attached to each army. Sultan Mahmud, the Saljuq was first to organise military hospitals and mobile dispensaries on a regular basis. The military medical equipment of the Saljuq kings moved on hundred camels.

A post of Inspector-General of Hospitals was created during the Abbasid regime, which was usually occupied by the most outstanding physician of the Islamic world. Another post, that of Chief Chemist was also created, to head the Department which supervised the preparation of drugs. Zia Ibn Baytar, who was a great botanist and herbalist occupied this post in 646 A.H.

Copied from 'THE ISLAMIC SCHOLAR'