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Arab Hospitals in History

1982; King Faisal Specialist Hospital and Research Centre; Volume: 2; Issue: 2 Linguagem: Inglês

10.5144/0256-4947.1982.121

0975-4466

Maurice Atiyeh,

History of Medicine Studies

Arab MedicineArab Hospitals in History Maurice AtiyehMD Maurice Atiyeh * Visiting Consultant, Gastroenterology, King Faisal Specialist Hospital and Research Centre, Staff Gastroenterologist, American University of Beirut, Beirut, Lebanon Published Online:1 Apr 1982https://doi.org/10.5144/0256-4947.1982.121SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionThis hospital shall be opened to the old and to the young, to the poor patients, male or female, in order that they may be treated and cared for until cured. The medications prepared in the hospitals shall be dispensed to patients coming from far as well as those living in the neighborhood, to the citizens as well as to foreigners, to the strong and the weak, to the evil and the honest, to the famous and the unknown, to the proprietor and to the slave, to all without any condition, reservation, objection or rejection whatsoever, for the bounty of God.1This quote, taken from Sultan al-Mansur Qalawun when in 1285 A.D. he established the Cairo hospital that carries his name, expresses the Arab philosophy of health care which flourished from the seventh to the fifteenth centuries A.D. During this time the contributions of the Arabs were notable in almost all fields of science, particularly medicine. Doctors and pharmacists responsible for the advancements in medicine attained high and respected positions with the health sciences patronized first by the caliphs and later by the rulers of this vast Arab empire.There are many reasons why the medical sciences achieved such prominence. First there was the need to cope with the health problems of an extended empire. Second was the high status given to science in The Hadith, the teachings of Mohammed, the Prophet of Islam (570–622 A.D.), which states, “Science is really two sciences: The science of human bodies and the science of religion.” To this must be added the natural, human aspiration to remain healthy through the help of medicine.The focus of this article is on one aspect of medicine, Arab hospitals in early history. However, to understand the significance of these hospitals, which in fact established the health-care system used today in hospitals around the world, it is important to first review the achievements in Arab medicine in general.EARLY ARAB MEDICINEThe great doctors of Arab medicine, the doctors who contributed to its growth and development, were ethnically not all Arabs. Early Arab medicine attracted diverse races and creeds, the most important being the Greek, Indian, and Syriac, to advance the knowledge of the healing arts. However, the Arabic language with its flexibility and lexical wealth, provided an excellent vehicle to pool the contributions of the many civilizations which came under the rule of the Muslim empire. In fact, by the ninth century the vast Muslim domain had established itself in Baghdad and a great need arose to translate the scientific works of the Greeks into Arabic, the language of Islam. With these extensive translations, Greek science and medicine were spread throughout the Muslim empire and preserved in a language which is still used today.Figure 1. The Argon Kamili Hospital in Aleppo, Syria. (Reprinted from History of Arab Medicine by Sami I. Haddad.)Download FigureThe most important medical writings of the Greeks, those of Hippocrates, Dioscorides, and Galen, were translated into Arabic by Hunayn Ibn Ishaq al-Ibadi (809–873 A.D.) and his team of translators. Hunayn wrote more than 100 medical books, including an introduction to medicine which, for a long time, was the basic medical textbook.2 Hunayn is also responsible for coining a large number of terms in the Arabic medical lexicon.Shortly after Hunayn's death, the Persian physician and scientist Abu Bakr Muhammad Ibn Zakariyah Ar-Razi (860–932 A.D.) rose to prominence in the ninth century largely for his original treatise in which he vividly describes and differentiates between the symptoms of smallpox and measles. In addition, Ar-Razi is said to have written over 200 books, the most important of which is Kitab al-Hawi (Continens), which, for its time, was the largest encyclopedia of Greco-Arabic medicine. He provided considerable insight into psychiatric medicine. His interest extended beyond medicine and he became the first to describe the use of the sextant.3,4Ibn Sina (980–1037 A.D.), known in the West as Avicenna, is perhaps the best known physician from medieval times. More than a dozen medical texts are attributed to him, the best known of which is The Canon of Medicine which from the twelfth to the seventeenth centuries served as the chief guide to medical sciences in the Western world. In The Canon he emphasizes the importance of diet in therapy, which became the prominent feature of Arab medicine. Avicenna was the first to describe anthrax, calling it the “Persian Fire,” the first to describe in detail the extrinsic muscles of the eyeball, and the first to prescribe the use of urethral medications and vaginal tampons.5In Spain, renowned surgeon Abul Qasim Az-Zahrawi (1013–1106 A.D.), known in Latin as Albucasis, stressed the importance of a good doctor/patient relationship, encouraging understanding and cooperation between physicians and their clients. In his most important work, Al-Tasrif (Collection), Albucasis became the first to describe hemophilia and its sex-linked inheritance.6 The importance of Al-Tasrif, however, does not lie in the description of hemophilia as much as in the treatment of the anatomy and the physiology of the human body and in raising surgery to its rightful place in the medical sciences. The surgical parts of the book, translated into Latin, contained full descriptions of various surgical procedures including amputations for gangrene, plus illustrations of surgical instruments which influenced Arab doctors and helped establish the foundations for surgery in Europe.There were, of course, other distinguished Arab doctors, important for their contributions to medicine both for the Arab and Western world. By the eighth and ninth centuries some of these doctors, assisted by the rulers of the time, had established hospitals, paving the way for what today is the format for modern hospitals.ARAB HOSPITALSThe Arabs were not the first to construct hospitals, but they were the first to improve early hospitalization systems and to make hospitals familiar features of the medical profession. Although the majority of the Arab hospitals could be classified as general, there were hospitals which specialized in one kind of illness such as leprosy, eye diseases, and mental disturbances. Military and prison hospitals were also common, and in Baghdad a mobile military hospital was carried to the battle front by 40 camels. Writing to his chief physician concerning medical care for prisoners, the vizier Ali Ibn Isa said, “I thought, may God prolong your life, that those in prison, on account of their large numbers and the climate in their quarters, were prone to contact various diseases. They are confined and therefore unable to attend to their personal needs… There should be assigned to them physicians who should see them everyday and carry them medications and drugs…”7Almost all hospitals were similar in design, each having two separate sections, one for males, the other for females, with each section provided with the necessary furniture, medical equipment, and instruments. The patients were assigned to wards according to the types of illnesses with wards for internal medicine, ophthalmics, orthopedics, and surgery. The internal medicine ward was, in turn, subdivided into related illness such as dysentery, feverish diseases, psychiatry, and others. Minimal care facilities were also available in special areas of the main hospital.Three hospitals stand out as the most important: Al-Adudi in Baghdad, Al-Nuri in Damascus, and Al-Mansuri (Mansur) in Cairo.Al-Adudi, built at the bend of the Tigris River in West Baghdad in the late 900s, was furnished with the best equipment and supplies available at the time. It was staffed by 24 doctors, some specializing in internal medicine, others in surgery, ophthalmology, or orthopedics. Ibn Jubayr, the famous traveler who visited Al-Adudi in 1184 A.D., almost 200 years after its foundation, compares it to a palace, explaining that it had several wings, each with running water and a great number of rooms.8 The Al-Adudi Hospital operated until 1258 A.D. when it was destroyed during the fall of Baghdad to the armies of Hulagu the Mongolian.By some reports Ar-Razi selected the site of the Al-Adudi Hospital by ordering that a piece of meat be suspended in every part of the city. He is then said to have ordered that the hospital be built where there was the least putrefaction. This story is apparently an anachronism, however, as Ar-Razi died 50 years before the foundation of the hospital.7In Damascus the Al-Nuri Hospital, built in 1160 A.D., was named for its founder Nur al-Din Ibn Zangui. For three centuries patients at Al-Nuri received free treatment and drugs. By some accounts, the hospital was built with the ransom of an unnamed king of the Franks.9 Ibn Jubayr, who also visited Al-Nuri, observed that records were kept of the amount of medicine and food required by each patient. Parts of the building that housed this hospital are still standing in Damascus.Al-Mansuri Hospital in Cairo, founded in 1285 A.D. by King Al-Mansur Qalawun, was the most splendid of its kind in Egypt and perhaps in the entire Middle East. It had separate wards for the treatment of fevers, surgical cases, dysentery, and ophthalmology. It also had a dispensary, storage rooms, extensive library, mosque, lecture rooms, out-patient clinics, and kitchens. Further, the hospital had a large administrative staff, attendants of both sexes, and employees to clean the wards, care for the sick, and work in the well-equipped kitchen. Ambulatory patients were allowed to respond to prayer calls and to chant religious songs. Al-Mansuri Hospital, which continued to operate until modern times, still stands in Cairo as a beautiful reminder of Islamic architecture.Administration of the HospitalsHospitals, which were often founded by the highest authority of the land or by rich philanthropists, were always non-profit institutions. All hospitals were supported by religious endowments called waqfs, some of which were large enough to pay all expenses including food, clothing, fuel, and drugs as well as staff salaries. Evidently, hospitals were well financed because many offered their services free of charge while some even donated money to poor patients when they left the hospital.10The actual administration of the hospital was similar to that of other public establishments of the time such as mosques, courts, and schools.11 The ruler himself appointed the director from among the princes, nobility, or military officers. The appointment was often celebrated publicly with an official parade and a colorful procession in which the director was accompanied to the hospital by high government officials, mounted on horses and all wearing flowing robes.The director had access to the ruler on the same status as prominent ministers. In addition to being in charge of all administrative matters, the director was responsible for the orderlies and supporting labor, plus all supplies, medications, the grounds, and the buildings. In some instances he administered the religious endowment. The director's responsibilities, however, did not include any of the medical functions which were the responsibility of the chief physician or dean who was assisted by a chief ophthalmologist and chief surgeon.Hospital StaffIn addition to the director and chief physician, the hospital staff generally included a resident physician, a pharmacist, both male and female nurses, and a bursar.Physicians, selected on the basis of their qualifications and through a process of elimination, worked fulltime at the hospitals, taking morning and afternoon duty. Night shifts were on a rotational basis. Salaries for physicians and reimbursement for their services varied. Hospital doctors were paid a fixed salary while those who occupied two positions, one in the hospital, the other in a palace, usually received double salaries with the caliphs, kings, and princes giving highest consideration to their own doctors, rewarding them with money and special gifts. Inevitably some of the doctors amassed great wealth.Table 1. Examples of salaries of medical and auxiliary staff at the Qalawun Hospital in Damascus12Table 1. Examples of salaries of medical and auxiliary staff at the Qalawun Hospital in Damascus12The nursing service was an integral part of every hospital, and the ratio of nurses to patients, judging by today's standards, was satisfactory. For example, at, one time a Cairo hospital had two nurses for every patient. The nurses' duties included changing the patients' clothing following the morning baths and taking the convalescing patients out for walks in the hospital gardens. Care for the patients was, on the whole, very good. On occasion, the ruler himself would inspect the hospital for quality control.TreatmentMedical treatment, following the procedure developed by Arabic medicine, consisted of therapy by exercises and baths. Diet played an important role in the healing process, and if diet alone was sufficient, no drugs were administered. When diet was not enough, simple remedies like herbs, their extracts and many of the organic salts were used. Drugs were combined only in extreme cases, and surgery was undertaken only when drugs provided no cure. The use of music in therapy as well as story telling, dancing, and other kinds of entertainment was highly developed. In fact, musical bands entertained patients by providing songs and music. This was especially prominent in the fifteenth century.13The Hospital PharmacyFor all practical purposes, the Arabs were the founders of pharmaceutics and were the first to write pharmacopoeias. Consequently, it is little wonder that all hospitals in the Arab world had pharmacies which were called Khizanat al-Sharab or Saydaliyah. Pharmacists, called saydalani, had to be competent, licensed, and were subject to inspection by the inspector general. Pharmacists collected and preserved materia medica and compound remedies, dispensing and selling medications to hospital patients and to those who came to the out-patient clinics. Laboratories for manufacturing electuaries, syrups, and other frequently needed medications were often connected with hospital pharmacies.14 In addition, the pharmacy was well stocked with all sorts of drugs, their ingredients, and drug preparation utensils plus fancy porcelain vases, plates, pots, and jars, all of great value and beauty. Such containers were found only in the palace of the caliph or sultan, and today are displayed in museums.Medical SchoolsAlthough separate medical schools existed, large hospitals generally had their own medical schools. Students studied in special hospital halls where they not only reviewed their lessons, but copied medical manuscripts or simply consulted them. Often they watched a doctor examine and treat his patients, and it was common practice for prospective physicians to go on rounds after which students would gather around the physician to discuss difficult cases or listen while several physicians discussed different cases and treatments.Abu al-Majd Ibn Abi al-Hakam was a famous physician of the twelfth century in charge of the Al-Nuri Hospital who conducted his daily rounds with another physician and the hospital's nursing staff. Following rounds, physicians and students would listen to his teachings and discussions of the cases. For about three hours daily he would question the students and do research in the hospital's library.7 Ali Ibn Abbas al-Majusi, in his famous book Kamil al-Sina ah al-Tibbiyah, translated into Latin as Liber Regius (Royal Book), gives perhaps the best description of what was expected of medical students.The students of medicine should frequent and constantly attend the hospital and pay special attention to the condition and circumstances of the patient when on rounds with the experienced, astute, and sharp teachers. They should inquire frequently and carefully as to the state of health of the patients and to their symptoms, keeping in mind all along what they have read about their conditions and prognoses. There it behooves him who desires to become an accomplished physician to follow closely these injunctions and obey them and to form his character and live in accordance with the principles herein stated. If he does this, treatment of the sick will be successful and people will be favourably disposed towards him and God knows best.15Before they were licensed to practice medicine on their own, doctors had to submit to rigorous examinations. In Baghdad in 931 A.D. the licensing system was toughened by the caliph Al-Muqtadi when he learned that a physician's mistake had caused the death of a patient. The caliph responded by giving orders prohibiting all physicians, who had not been examined by the chief physician, Sinan ibn Thabit of Harran from practicing medicine. Close to 900 practicing physicians were examined before being allowed to resume their work. Thus the method of licensing a doctor only after he had successfully passed an examination given by competent physicians was introduced into the medical licensing procedure. By 1140 A.D. the system had found its way to the school of Salerno where it was instituted for the first time in Europe as required by the Norman king, Roger.Interestingly, physicians were allowed to practice only that part of medicine for which they were trained. In order to specialize, they had to present theses in the branch they preferred with most theses based on the writings of prominent ancient or contemporary doctors. The following paragraph from a special certificate for surgery provides an idea of how a doctor was approved for specialization.I have taken cognizance of the interesting thesis offered… and after asking God's guidance will authorize him (the physician) to exercise what he has perfected from the art of surgery in order to be successful and fortunate in work… He can therefore treat wounds until they heal, venesect veins, cut arteries, extract teeth, suture wounds and circumcise babies… However, he should consult his superiors in the profession as well as his capable and experienced teachers.1LibrariesLibraries, some of which may be compared to the national libraries of present day industrial nations, constituted an essential part of Arab learning. The Tripoli Library in Lebanon, which was burned during the Crusades, contained three million volumes; the Fatimide Library in Egypt had two million volumes; in the ninth century the Cordova Library in Spain contained 600,000 volumes with its catalogues alone comprising 40 volumes; and the Mustansiriyah Madrasah Library in Baghdad contained at least 80,000 volumes.16 However, it is not clear whether or not these numbers represented volumes or works, many of which were bound together in one volume as it was common practice to bind together a number of treatises whose subjects were unrelated.There is a story that the Baghdad libraries held so many books at the time of the Mogul invasion in 1258 A.D. that the invaders simply used them to build a bridge across the Tigris River. While unsupported by hard evidence, this story, if nothing else, gives us an idea of the vast number of books believed to be held in the libraries.Hospital libraries usually contained medical works from many cultures including Arabic, Greek, Persian, Syriac, and Hindu. Some prominent Arab physicians became more famous simply by their impressive private collection of medical works. So important were libraries that it is reported that one physician employed a number of scribes on a permanent basis to copy books for his library.SUMMARYThe Arabs had a well-organized, comprehensive system of medicine based on knowledge, justice, benevolence, and compassion. Specialization was advanced and organized on the principle of division of functions. Medical education stressed the clinical and practical experience in the hospital and was aimed at enabling the physician to master the theory as well as the practice.Furthermore, the Arab system of supervised medical care was controlled by medical examinations and licensing. All of these approaches to good medical care are markedly similar to those used in advanced countries today.The medical system as a whole was enriched by the large number of translations from the works of other peoples, most notably those of the Greeks and Hindus. By becoming centers for learning the art of healing, Arab hospitals rendered a great service, keeping alive, enlarging and passing on their medical knowledge and experience to Europe during the Middle Ages and the Renaissance. The medical contributions of the Arabs constituted a significant part of the foundation from which evolved Western medicine during the Renaissance.ARTICLE REFERENCES:1. 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Google Scholar10. Elgood C: A Medical History of Persia and the Eastern Caliphate. Cambridge, The University Press; 1951 p 177. Google Scholar11. Hamarneh S: "Development of hospitals in Islam" . J Hist Med Allied Sci 17 (3): 3811962. Google Scholar12. Haddad SI: History of Arab Medicine. Beirut, Bouheiry Brothers; 1975 p 64. Google Scholar13. Haddad FS: "Arab contributions to medicine" . JMed Liban 26 (4): 3331973. Google Scholar14. Hamarneh S: Origins of Pharmacy and Therapy in the Near East. Tokyo, The Naito Foundation; 1973 p 49. Google Scholar15. al-Majusi IA: Kamil al-Sinaah al-Tibbiyah. Collection of Dr F. S. Haddad, Beirut. Google Scholar16. Eche Y: Les bibliothèques Arabes publiques et semi-publiques en Mésopotamie en Syrie et en Egypte au Moyen age. Damascus, Institut Francais de Damas; 1967. Google Scholar Previous article FiguresReferencesRelatedDetails Volume 2, Issue 2April 1982 Metrics History Published online1 April 1982 KeywordsHistory of MedicineACKNOWLEDGEMENTSThe author would like to thank Dr Farid Haddad, Veterans Administration Hospital, Phoenix, Arizona for providing selected references and Dr George Atiyeh, Library of Congress, Washington, DC for his valuable comments and editorial assistance.InformationCopyright © 1982, Annals of Saudi MedicinePDF download