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Efficient Hospitals: Islamic Medicine’s Contribution to Modern Medicine

By: Ibrahim B. Syed, PhD
Clinical Professor of Medicine
University of Louisville School of Medicine
Louisville, KY 40292,USA

" Hospital" is derived from the Latin "hospitium"- a guest, because the institutions were first designed for the reception of pilgrims, wayfarers, and the infirm.1 In the West almost all were established by the Church. In the Muslim world they are known as "bimaristans." Many great hospitals were built by rulers or by private individuals throughout the Islamic World. Hospitals were either constructed for a particular physician, or later put under the direction of a particularly eminent doctor. 
The development of efficient hospitals was an outstanding contribution of Islamic medicine. The hospitals served all citizens free and without any regard to their color, religion, sex, age or social status. Hospitals had separate wards for male and female patients and were staffed with nursing and other ancillary staff of the same sex. Patients with different diseases were allocated different wards. Hospitals provided patients with unlimited water supply and bathing facilities. Only qualified and licensed physicians were allowed to practice medicine. The hospitals were teaching hospitals to educate and train medical students. They had housing for students and house-staff, and contained pharmacies dispensing free drugs to patients. All hospitals had their own conference rooms and extensive and expensive libraries containing the most up-to-date books. Universities, cities and hospitals acquired large libraries, physicians had their own extensive personal book collections, at a time when printing was unknown and book editing was done by skilled and specialized scribes putting in long hours of labor. These hospitals kept records of all their patients and their medical care, something done for the first time in medical history. The hospital was divided into two main departments, outpatient and in-patient departments. The in-patient department differed only slightly from any modern in-patient department. On admission the patients were given special apparel while their clothes, money, and valuables were stored away, and returned to them at the time of their discharge. On discharge, they also received five gold pieces each to tide them over until they could support themselves. The hospital also provided facilities for performing prayers. Medical officers regularly visited the prisons. At a time when Paris and London were mud streets and hovels, Baghdad, Cairo, and Cordova had hospitals, which incorporated innovations, which sound amazingly modern. It was chiefly in the humaneness of patient caring that the Muslim hospitals excelled. Near the wards of those afflicted with fever, fountains cooled the air; the insane were treated with gentleness; and at night music and storytelling soothed the patients.
Key Words: Bimaristan, Music therapy, and famous hospitals, Efficient Hospitals, Islamic medical therapy techniques, Prophetic traditions.

Efficient Hospitals:
 During the Islamic civilization, hospitals had developed and attained specific characteristics:2
1. Secular: Hospitals served all peoples irrespective of color, religion, or background. They were run by the government rather than by the church, and their directors were commonly physicians assisted by persons who had no special religious color. In hospital, physicians of all faiths worked together with one aim in common: the well-being of patients.
2. Separate wards: Patients of different sexes occupied separate wards. Also different diseases especially infectious ones, were allocated diffe-rent wards. There were different wards for fever, wounds, mania, eye conditions, cold diseases, and diarrhea. Convalescents had separate sections within them.
3. Separate nurses: Male nurses were to take care of male patients, and vice-versa.
4. Baths and water supplies: Five times a day praying is an important pillar of Islam. Before praying one has to perform wudu or ablution. For certain conditions full bath is obligatory. Therefore the Muslim hospitals had to provide the patients and employees with unlimited supply of water and adequate bathing facilities.
5. Physicians: Only qualified physicians were allowed to practice medicine by law. In 931 CE, the chief court-physician Sinan Ibn-Thabit was ordered by Caliph A; -Muqtadir to grant licenses to practice medicine to only quali-fied physicians out of the 860 physicians in Baghdad. His counterpart Abu-Osman Sai'id Ibn-Yaqub was ordered to do the same thing in Damascus, Mecca and Medina. The latter two cities were very important because of hundreds of thousands of pilgrims visiting them every year for Umra and Hajj.
6. Medical Schools:3 The hospital served as a medical school to educate and train medical students, imparting medical knowledge and advancing medical knowledge. Extensive libraries were attached to the hospitals, containing most up-to-date books. Tulum Hospital in Cairo in 872 CE had 100,000 books. (Mustansiriyya University in Baghdad had 80,000 volumes. Cordova library had 600,000 volumes; Cairo had 2,000,000 and Tripoli 3,000,000). Physicians had their own extensive personal book collections, at a time when printing was unknown and book editing was done by skilled and specialized scribes putting in long hours of manual labor. There were conference halls for lectures and meetings. There were housing facilities for both students and staff of the hospital.
7. Medical records: The Muslim hospitals were the first in history to keep regular records of patients and their medical treatment.
8. Pharmacy: The hospital pharmacy of the Muslim hospitals was highly developed and performed an outstanding service to the patients. Chemistry became an advanced science and pharmacy developed into a specialized subject.
 The caliphs of the Islamic Empire built magnificent hospitals, because of Islam's emphasis on charity, to attain everlasting name, and to show to the public that they really cared for their welfare. 
 In the twelfth and thirteenth centuries, hospitals in Syria and Egypt had achieved such high levels of performance that travelers and historians regarded them as one of the treasures of Muslim civilization. They attracted gifted students and best medical educators and enjoyed rich endowments and generous patronage. They were elegant, spacious buildings, equipped with comfortable lecture halls, extensive libraries, well-stocked pharmacy shops, and efficient laboratories, where medications could be freshly prepared and dispensed.

SOME FAMOUS HOSPITALS:4
Al-Nuri Hospital: the Umayyad Caliph, Al-Walid, built the first hospital in Islam in Damascus in 706 CE. Al-Nuri hospital named after King Nur Al-Din Zanji was built in 1156 CE during the crusades. It was a first class hospital and medical school. The hospital initiated medical record keeping-the first in the world. Eminent physicians, like Ibn Al-Nafis (discoverer of pulmonary circulation), graduated from the medical school. The hospital served the public for over seven centuries.
Al-Salahani Hospital: It was built in Jerusalem in 1055 CE by the Crusaders as Saint John Hospital. It was renamed Al-Salahani Hospital in 1187 CE. Salah Al-Din expanded the hospital and it served the people until 1458 CE when it was destroyed by an earthquake.
Al-Muqtadiri Hospital: Built in Baghdad in 918 CE by Caliph Al-Muqtadir.
Al-Adudi Hospital: It was built in 981 CE and named after King Adud Al-Dawlah. It was the most magnificent hospital built in Baghdad before modern times. It was outfitted with the best equipment and supplies available at that time. It had residents, interns, and twenty-four consult-ants to care and look after the patients. Haly Abbas was a staff physician. It was destroyed by Hulagu, the grandson of Chengiz Khan in 1258.
Al-Fustat Hospital: It was built in 872 CE by Ahmed Ibn-Tulum in the city of Al-Fustat(part of old Cairo). It had separate wards. On admission the patients were given special garments while their personal belongings were stored away and returned to them at the time of discharge. It served the population of Cairo for six centuries.
Al-Mansuri Hospital:Built in 1248 CE by King Al-Mansur Qalawun in Cairo. While fighting the Crusaders, general Qalawun became sick and was treated in Al-Nuri hospital. On recovery, he vowed that if he ever became the ruler of Egypt, he would build a larger and magnificent hospital in Cairo for the sick, poor and rich alike. Music therapy was used as a line of treatment for psychiatric patients. It served four thousands patients daily. Hospital stay was free and upon discharge the patient was given food and money as a compensation for the wages he lost during his stay in the hospital. It has served for the past seven centuries. Today it is used for ophthalmology and is called Mustashfa Qalawun.
Al-Qayrawan Hospital: In 830 CE Prince Ziyadat Allah I, built this hospital in the district of the Qayrawan city called Al-Dimnah. Subsequently all hospitals in Tunisia were called Dimnah instead of Bimaristan. It had spacious wards, waiting rooms for visitors and patients, and female nurses from Sudan-the first use of nursing in Arabic history. The hospital had a mosque for prayers.
Marakesh Hospital: In 1190 CE, King Al-Mansur Ya'qub Ibn-Yusuf, built this hospital in the capital city of Morocco-Marakesh. It was beautifully landscaped with fruit trees and flowers. Aqueducts carried water to all sections. Patients were provided with special attire: one for winter and another for summer. Specialists called Sayadlah ran the pharmacy. There was an expensive private room where patients were charged today's equivalent of $150.00 per day. This fee was quite expensive thousand years ago.
Granada Hospital: In Spain in 1366 CE, Prince Muhammed Ibn-Yusuf Ibn Nasr built this hospital in the city of Granada which had a population of half million. This hospital had the beauty of the Arabic architecture and served the people until the fall of Granada in 1492 CE.
Delhi Hospitals: In the fourteenth century in Delhi, India, there were one thousand schools and colleges (madrasas) and seven hundred hospitals, two thousand Sufi lodges and hospices in and around Delhi.

Technique of Therapy in Islamic Medicine5
 The patients were treated according to a well-defined treatment plan. Initially the treatment began with physiotherapy and diet. If this treat-ment failed, then the patients were treated with drugs. Only as a last resort surgery was employed. The physiotherapy included exercises and water baths. The Muslim physicians were aware of food deficiencies and hence developed a detailed system of diet therapy. Drugs were divided into two groups: simple and compound drugs. The Muslim physicians were aware of interaction between drugs. First they used the simple drugs. If these drugs did not work then they used two or more compounds. When all these traditional measures failed, surgery was performed.

AHADITH ON MEDICAL CARE6
1. The Muslims are exhorted to visit the sick and give them hope and comfort.
2. Hadith Qudsi # 18: " O son of Adam, I fell ill and you visited Me not. He will say: O Lord, and how should I visit You when You are the Lord of the worlds? He will say: Did you not know that My servant So-and-so had fallen ill and you visited him not? Did you not know that had you visited him you would have found Me with him?...."
3. When the Prophet visited a sick person (after 3 days of illness) he would say "Do not fear, it (illness) is a Catharsis (purification), God willing."
4. People visiting the sick are asked to say such things to them as would make them happy.
5. God also visits the sick and says, "O my servant! Health unites you
With yourself, but sickness unites you to Me."
 The Umayyad caliph al-Waleed (ruled 705-715 CE) is said to have been the first to set up institutions for lepers and the blind where servants and guides were employed to help the inmates. The hospitals proper did not begin until the Abbasid caliphate (750-1257). Caliph Harun al-Rashid ordered the establishment of the first hospital at Baghdad. This hospital was set up by the Christian Jibra'IL ibn Makhtishu, a doctor at Gundaishapur. A Persian Christian, Yuhanna ibn Masawaih, eventually became the head of this hospital. The Persian term bimaristan, "the place for the sick" was used for hospital by both the Arabs and later the Turks. After Harun's hospital, at the end of the ninth century a number of new hospital foundations were followed in quick succession. The first of these was established by the page of the caliph al-Mutadid (d.902) and named for the caliph. Ali ibn Isa, the "good vizier", founded a bimaristan in 914 and appointed Abu Uthman al-Dimashqi, a Christian who also made translations from the Greek, as the director of this hospital as well as those in Mecca and Medina. Sinan ibn Thabit, a Christian succeeded him as the superintendent of these hospitals. He himself set up a new hospital in 914.
 Many larger hospitals had quarters for mental patients. Still several hospitals were specifically established for them. The same vizier, Ali ibn Isa ordered Sinan ibn Thabit to organize a team to visit the sick in jails. Again the same vizier ordered mobile dispensaries to be established to look after the health needs of the countryside, particularly surrounding the towns where no doctors were available.
 Many doctors are mentioned in the history of Islamic medicine that, from their income from medicine, set up their own hospitals and charitable clinics. The governments (called musadara) confiscated the wealth of politicians, viziers, governors and military generals, the wealth of professionals like doctors were immune from this danger.
 Besides the hospitals and asylums, there were other types of health establishments. Special health centers were located near Jamia Masajids.
There were Army hospitals, with their own doctors and services. They were mobile hospitals and they followed the movements of the army. It is reported that the army of the Ghaznavid sultan Mahmud (d.1030) was accompanied by a special medical caravan consisting of forty camels.
 The Adudi hospital set up in Baghdad in 982 by the Buyid Adud al-Daula (d.983) became the most famous of the early hospitals. Abu-Bakr al-Razi was the administrator who was chosen out of one hundred applicants. He selected the hospital site at the banks of the river Tigris after hang-ing a piece of meat in several places for a few days and deciding in favor of the place where meat was found to be least infected. This hospital had 24 doctors with different specializations. A doctor who did his duty two days and two nights a week is said to have been paid 300 dirhams per month.

THIRTEENTH CENTURY HOSPITAL IN PARIS7
The hospital in Paris was called Hotel-Dieu (House of God) and it was a house of refuge for the poor, sick, and infirm, as well as a shelter for travellers and pilgrims.
 There were four main wards and several annexes. The ceilings were High, the average being 18 to 25 feet high. A system of pulleys and cords provided excellent ventilation, and assisted in the regulation of temperature. Heat was provided in each ward by means of charcoal stoves with chimneys.
 Administration and work of the hospital was conducted by thirty lay brothers, four clerical brothers, four priests, and twenty-five sisters.
The hospital was controlled by an administrative board. The prior was in charge of six departments: household, kitchen, chapel, cellar, baths, and charity-box.
Diet: Meat was served on Sundays, Tuesdays, Thursdays, and on certain religious holidays, including Christmas. Food was served twice a day. The patients were served before the staff. Each patient had his own dishes, including a wooden plate and a spoon. Beef was the most common meat. Fowl, soup, eggs, fish, and fruits such as figs, raisins, apples, and pears appeared regularly. They had wine with each meal, and each ward received three pints of milk weekly.
Classification of patients: (1) the aged, (2) the sick (3) the poor
and (4) the pensioners. The pensioners were not patients but lived
on the estates of the hospital by paying money for boarding and lodging.
Admission criteria: The patient presents himself at the door, where he was received by a sister. He confessed his sins, took communion, and was then placed in a ward according to the apparent seriousness of his condition. Men and women were admitted to all wards, but there was one
ward exclusively for women with eighty beds. They placed several persons in one bed. At Hotel-Dieu there were not more than two in one bed.
Visitors were admitted at any time, but came most frequently to spend the afternoon.

MEDICAL TREATMENT:
Hotel-Dieu had medical and surgical staff. The members were licensed. Obstetrics was left entirely in the hands of midwives. Victims of plague, leprosy and other widely feared contagious diseases were isolated. Emphasis was laid on natural treatments rather than on the extensive use of herbs and drugs. Purgatives were freely prescribed, both medicines and fruits being used for that purpose. Baths and exercise were usually prescribed to follow. Since Hotel-Dieu was run by the church, great attention was paid to the religious needs of the sick. Priests and clerical brothers performed regular services for them. They visited the sick, confessed them, adminis-tered sacraments to the dying, conducted funerals, made and executed the wills.

MUSIC THERAPY8
 The Qur'an does not say anything about music directly one
way or the other, however it looks upon melodious voice with favor.
 Says al-Dhahabi author of Prophetic Medicine, (famous traditionist and historian, d.1348 CE), "Singing is the soul's pleasure, the heart's delight and food for the spirit; it constitutes part of the most exalted spiritual medicine. It is pleasurable even to some animals. Its moderate enjoyment kindles natural warmth, strengthens the activity of the various faculties, slows down aging, and repels many diseases." Abu Nu'aim (d.1038), the theologian and man of piety who was among the first to write a work on the Prophetic Medicine, reports from the Prophet that "music beautifies and refreshes the body just as excessive worry ails it." The best part of singing is, of course, the melodious recital of the Qur'an because, apart from the beauty of its words, the soul benefits from its lofty idea. The Prophet said, "embellish the Qur'an with your beautiful voices."
 Ibn Qutaiba (d.889), a famous ninth-century man of letters, a profound defender of Hadith, and a secretary of state in the Abbasid caliphate was heavily in favor of music and its healthy effects, both spiritual and physical. Al-Dhahabi tells us that music can be unlawful, reprehensible, permissible, recommended, and even religiously obligatory (that is Qur'an-recital with tajweed, when accompanied by an understanding of its meaning). The only unlawful and reprehensible forms of music are found where the singers are low-class ruffians performing with beautiful young girls who excite the people's passions.
 It was chiefly in the humaneness of patient caring that the Muslim hospitals excelled. Near the wards of those afflicted with fever, fountains cooled the air; the insane were treated with gentleness; and at night music and storytelling soothed the patients.
Islamic medicine is one of the most amazing and best-known facets of Islamic civilization, and is an area in which the Muslims excelled most.
 R E F E R E N C E S 
1. Carstens HR: The History of Hospitals, with Special Reference to some of the World's Oldest Institutions. Ann Intern Med 1937; 10:670-682.
2-Hadees-E-Qudsi. Translated by Dehlvi, AS, Chapter 8"Paying a visit
To a Patient and Patient in Miseries, Taj Publishers, Bombay, 1995:55 
3. Al-Ashi A: Visiting the Sick. MWL Series on Islam No.25, Muslim World League Canada Office, Etobicoke, Ontario, Canada, 1998.
4. Hadees-E-Qudsi, ibid p.55.
5. Tibbe Nabawi. Edited by Alam K, In: Dehlvi AS, Prophetic Medical Sciences. Bombay: Taj Publishers, 1995:21
6. Rahman F: Health and Medicine in the Islamic Tradition. Cross Road Pub Co, New York-, Pub Co, New York, 1987:41-58. 
7. Hamarneh SK: Development of Hospitals in Islam. J History of Med and Allied Sciences 1962; 17:366-84. 
8. Syed IB: Medicine and Medical Education in Islamic History. In: Athar S, Ed, and Islamic Perspectives in Medicine. Indianapolis: American Trust Publishers, 1993:45-56. 
9. Rahman F: Health and Medicine in the Islamic Tradition. Cross Road Pub Co, New York-, Pub Co, New York, 1987: 59-90. 
10. Abouleish E: Contribution of Islam to Medicine. In: Athar S, Ed, and Islamic Perspectives in Medicine. Indianapolis: American Trust Publishers, 1993: 15-43.
11. Nasr SH: Science and Civilization in Islam. Barnes & Noble Books, New York, 1992:89,

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