Saturday, January 28, 2023

Islamic History: The Development of Hospitals (Bīmāristān) and Some of Its Characteristics

SINCE In the early Abbasid era, hospitals (bīmāristān) emerged and developed in the Islamic world. On previous post it has been mentioned how bīmāristān initially appeared in the era of Hārūn al-Rashīd, including through the role of his vizier Yaḥyā ibn Khālid al-Barmaki.

In the years that followed, many other hospitals sprang up in Muslim cities. At the end of the 9th century, a bīmāristān was built in the city of Rayy (Teheran) where Muḥammad ibn Zakariyya al-Rāzī (d. 932) was appointed head, before moving to Baghdad. Another bīmāristān was built on the east bank of the Tigris River in the city of Baghdad by Caliph al-Muᶜtadid (d. 902) (Dunlop, 1986, I/1223).

It is said that it was al-Rāzī who had been asked to build this latter hospital. To choose the most ideal place to build the hospital, al-Rāzī hung some fresh meat in several potential places. He then chose the place where the flesh rotted the slowest as the site for the bīmāristān (Tschanz, March-April 2017, 23).

Several years later, the vizier Alī bin sā (d. 946) funded the construction of a bīmāristān in the Harbiyah District of Baghdad in 302/914. Saᶜīd bin Yaᶜqūb al-Dimashqī, a scientist who is also known as a translator, was appointed head of health in charge of the hospital along with several other hospitals in Baghdad, Mecca and Medina.

al-Dimashqī’s position as head of health was apparently replaced a few years later by Sinān bin Thābit (d. 942), who founded Bīmāristān al-Sayyidah in Baghdad in 306/918. In this era, Alī bin sā requested that doctors be sent daily to existing prisons to ensure the health of the prisoners (Dunlop, 1986, I/1223).

The vizier addressed the chief medical officer in a letter:

“I am very worried about the prisoners. With their large numbers and the state of the prisons, there must be many sick among them. Therefore, I think that they need doctors who can examine them daily and give them, if needed, medicines and herbs. The doctors have to visit all the prisons and treat the sick inmates there.” (Tschanz, March-April 2017, 24).

In the first quarter of the 10th century several other hospitals were also built in Baghdad: Bīmāristān al-Muqtadirī and Bīmāristān Ibn al-Furāt.

These hospitals generally operate with waqf funds prepared by emirs or wealthy people. Bīmāristān al-Muktadiri’s expenses were 200 dinars per month, while Bīmāristān al-Sayyidah’s was 600 dinars per month (Dunlop, 1986, I/1223; Hamarneh, 1962, 369).

Aḍud al-Dawlah (d. 983), emir of the Buwayhid family who became vizier of the Abbasids, founded a bīmāristān in Baghdad in 372/982. At the beginning of its establishment the hospital had 24 doctors. Jibrāᶜīl bin Ubayd Allāh who served in the hospital two days and two nights a week was given a monthly salary of 300 dirhams.

There are several experts working at the hospital, including surgeons, ophthalmologists, and physiologists. Those who receive services at bīmāristān are not only Muslim patients, but also non-Muslims.

In the era of vizier Alī bin sā there was already a mobile clinic or pharmacy (mobile dispensary/khizānah li-l-adwiyah wa-l-ashribah) sent to villages in Iraq, so that those who can receive health services are not only those who live in urban areas (Dunlop, 1986, I/1223-1224).

In the early 12th century, during the reign of Sultan Muhammad of the Seljuqs, mobile clinics sent to remote areas were so large that they required 40 camels to transport their equipment (Tschanz, March-April 2017, 23).

Sultan Nūr al-Dīn Maḥmūd Zankī who ruled in Syria between 1146 and 1174 built bīmāristān in Aleppo as well as in Damascus (Dunlop, 1986, I/1224). Bīmāristān al-Nūrī in Damascus was completed and started operation in 1156. Ibn Jubayr praised the hospital when he visited it in 1184 and considered it “one of the great manifestations of Islam”.

Among the doctors who had led this hospital were Abū al-Majd al-Bāhilī and Muhadib al-Dīn ibn al-Naqqāsh (d. 1178). Al-Dakhwār, who was the teacher of Ibn Abī Uṣaybiᶜah (d. 1270), author of the medical encyclopedia, and Alā’ al-Dīn Ibn Nafīs (d. 1288), discoverer of blood capillaries, starting his career from the bottom at al-Nūrī Hospital. , before he became famous and had a large income as a private doctor (Hamarneh, 1962, 371-372).

The Bīmāristān al-Nūrī building in Damascus still exists, but has now been converted into the Museum of Medicine and Science (Tschanz, March-April 2017, 23).

In Egypt, bīmāristān was first built in 872-874 by Aḥmad ibn lūn (d. 884), who gave him generous support. alāḥuDīn al-Ayyūbī (d. 1193) who ruled Egypt since 1174 built the Nāṣirī Hospital in Cairo.

However, an even larger hospital was built by Sultan al-Manṣūr Qalāwūn (d. 1290) of the Mamluk Dynasty in 1284. The hospital building used was a former Fatimid palace which could accommodate 8,000 people and, like many other bīmāristāns, was equipped with pharmacy, library, and several other facilities.

The hospital employs a large number of administrative staff – in addition to doctors of course – and the benefits provided to the hospital are close to one million dirhams per year (Dunlop, 1986, I/1224).

In 830, emir Ziyādat Allāh I (d. 838) built a hospital in Qayrawan known as Dimnah. In addition to doctors, a group of Muslim theologians who study medicine and are referred to as fuqaha’ al-badan take care of patients through practice ibb al-Nabawī.

In North Africa, Sultan Yaᶜqūb al-Manṣūr (d. 1199) of the al-Muwahidun dynasty built a large hospital in Marrakesh in 1190. The hospital, which is run on an allowance of 30 dinars per day, was built on a large plot of land and surrounded by by fruit trees, flower gardens, vegetables, and herbal plants (Hamarneh, 1962, 375-376).

Sultan Yaᶜqūb al-Manṣūr also built leprosaries, mental hospitals, and homes for the blind in various areas of his kingdom. These institutions continued to survive and increase in number in the early Marinid era (1244-1465), but suffered a serious decline in the 16th century.

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