The Islamic Hospital
The Islamic Hospital
by Ahmed Ragab
Hospitals were not medical institutions in the modern sense of the word. They were primarily – and before all else – institutions that formed an integral part of a charitable network composed of mosques, sufi lodges (khanaqah), charitable water fountains (sabils), public charitable kitchens, etc.
Although most hospitals in the medieval Islamic world were staffed by learned physicians and ostensibly cared for the sick, it is important to situate these institutions within their own particular contexts. Hospitals were not medical institutions in the modern sense of the word. They were primarily – and before all else – institutions that formed an integral part of a charitable network composed of mosques, sufi lodges (khanaqah), charitable water fountains (sabils), public charitable kitchens, etc. These networks served the poor urban population in most Islamic cities, and continued to grow apace with the waqf system over time (eds Bonner/Ener/Singer 2003). The bīmāristāns’ focus on the sick is unlikely to have served an exclusionary purpose, wherein the hungry, the cold or the fatigued were rejected at the door; rather, this focus on the sick was inclusionary; hosptials were the institution most able to serve the sick and were, therefore, sought out by that part of the population. While the medical nature of these institutions changed over time and varied from one locale to another, the main goal of the bīmāristān was to continue to care for the poor – a goal that united it with other charitable institutions in the region...
Left: Ibn Tulun mosque in Cairo. In the 9th century, the mosque had a bīmāristān attached to it. in the 9th century.
Most medieval Muslim historians wrote that the Abbasid bīmāristāns were built in Baghdad using Gundeshapur as a model. Gundeshapur was an old Sassanid city, the capital of Khuzestan province, and the oldest metropolitan seat of the Syriac Church of the East. Like a number of other metropolitan seats, Gundeshapur enjoyed a theological academy, to which an infirmary (or xenodocheion) was attached. Evidence suggests that some Syriac patriarchs and metropolitans established infirmaries in their regional seats to serve students and clergymen; this was certainly the case in places like Nisbis and Seleucia-Ctesiphon (the Sassanid capital and seat of the Syriac patriarch). However, such institutions for collective care were not part of Sassanid Zoroastrian charitable traditions; rather, Sassanid emperors helped establish these Syriac infirmaries as a means of patronising their favourite Syriac physicians or the Church. These institutions were not necessarily charities serving their people, though; they were quite small and were dedicated to clergymen and students. In all cases, no evidence supports later Muslim accounts of a huge and prosperous hospital and academy in Gundeshapur that would serve as inspiration for Abbasid institutions (Dols 1987). To all intents and purposes, Gundeshapur may have prospered under the Abbasids without necessarily inspiring them...
Right: Layout of Qalawun's hospital in Cairo, as it functioned in the early nineteenth century.
One of the major questions surrounding bīmāristāns is that of who used their services (and how they did so). Surviving endowment (waqf) documents from thirteenth-century bīmāristāns describe their openness to all: rich or poor, emir or slave, man or woman. However, these same documents follow such proclamations with strong instructions to favour the poor and the needy. Evidence suggests that bīmāristāns not only favoured the poor, but also that the rich or those who could afford other types of medical care were very unlikely to take up space in the bīmāristān (Al-Tabba 1982). Bīmāristāns were not, after all, the best places to seek medical care, and wealthier patients would have preferred to receive their physicians at their homes, or would even have sought them in the market place for a fee. Most of those served by bīmāristāns were not simply poor or needy; more importantly, they also tended to lack family support. Waqf documents show that poor patients could be seen by physicians in the bīmāristān, and could then take medications from there, free of charge, to be used at home. This was presumably the preferred way in which those members of the poorer classes who did have families to care for them would use the services of the bīmāristān. There is some evidence to suggest that even members of the scholarly elite might use the bīmāristān in this manner...
Left: Entrance of the Divrigi hospital in Turkey.
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"The Islamic Hospital" by Ahmed Ragab
~ Chapter Fourteen, Pages 136-145 ~
~ Chapter Fourteen, Pages 136-145 ~
1001 Cures Book tells the fascinating story of how generations of physicians from different countries and creeds created a medical tradition admired by friend and foe. It influences the fates and fortunes of countless human beings, both East and West.