With the dawn of Islam on the Bedouin, nomadic tribes of the Arabian Peninsula came an enlightenment, not only strictly spiritual in nature, but also with cultural, educational and scientific connotations. 

Among the fruits of this enlightenment was the eventual establishment of huge health facilities that, among other things, played an important educational role amongst physicians of the age. 

The first bimaristan, as these establishments were called, was built in Damascus in 86 Hijri (707 A.D.) by Caliph Al-Waleed ibn `Abdul-Malik[1].  The aim of its construction was the treatment of acute diseases and the care of patients affected with chronic diseases (such as lepers and the blind). Leprosy patients were not only treated free of charge but were given money to help in supporting their families.

The word bimaristan is of Persian origin and means hospital, with bimar meaning disease and stan meaning location or place; thus the location or place of disease[2].

The Bimaristan System: 

The physicians of the Islamic world set up a concise system for bimaristans with two important aims: the welfare of their patients who were treated according to the latest in medical know-how, and teaching medicine to newly graduated physicians[3].

Bimaristans were constructed on sites that would provide optimum health conditions for patients. They were preferably built on hills or by rivers. Al-`Adadi's Bimaristan[4]  is a good example of this; it was built in Baghdad by the River Tigris, where the water of the river flowed through its courtyard and halls to return and pour back into the Tigris .

When Haroon Ar-Rashid asked Ar-Razi to build the first general hospital, Ar-Razi selected a site after putting pieces of meat in different areas of Baghdad to look for a location with the best fresh air.

Concerning organization, bimaristans were divided when possible into two sections, one for men and the other for women. Each section was independent, with large halls for the patients.

Each section of a bimaristan contained a hall for every type of disease, while each hall had one physician or more and each group of doctors in a section had a chief doctor. The halls were specialized: a hall for internal diseases, another for splinted patients (trauma and fractures), another for deliveries and a special hall for each type of disease including communicable diseases.

Ibn Abi Usaybah described in his book `Uyun Al-Anbaa’ the halls of internal medicine that frequently included a section for feverish patients and another for manic patients. All sections of the bimaristan were equipped with all the medical instruments and apparatuses necessary for the physician.

Ibn Abi Usaybah[5] tells us that `Adad Ad-Dawlah, upon his decision to build the `Adadi Bimaristan on the western side of Baghdad , prepared an evaluation exam for a hundred physicians, out of which only twenty four were actually chosen to work in the hospital.

The chief of all physicians in the hospital was called As-Sa`oor, and many of the administrative duties in the hospital were performed by boys, acting as employees or health workers, assistants or dressers. Others were responsible for cleaning the bimaristan and caring for the patients when necessary.

Muslim physicians also understood the importance of adjoining a pharmacy, known as Al Sharabkhana, to the Bimaristan to pass out the necessary medications prescribed by the physicians.

As is the case today, bimaristans underwent constant inspections. This was the responsibility of an employee assigned by the minister or the Caliph and given the authority to enter the hospital to be acquainted with the patients' status and the care offered to them, the food given to them, whether the boys were serving them or not and whether the physician was properly performing his duty or neglecting it. This system ensured that bimaristans continued to function with a high level of technical, scientific and administrative competence.

Al-Mansouri Hospital was built in Cairo in 1248 AD

It is worth mentioning that each patient had his own card on which the physician recorded his observations. The physician also had his own special register to record his observations on the diseases he was treating. The physician performed his experiments and tests according to his observations. If the physician faced any problem in any matter of diagnosis, he went to the head of his division or the chief physician. Frequently, the physicians held meetings to discuss cases. We do the same today!  

Al-Mansouri Hospital was built in Cairo , Egypt, in 1248 AD with 8000 beds and many specialized wards. The hospital contained a praying room for Muslim patients and another for Christians. Admission was regardless of race, color or religion. There was no limited time for in-patient treatment, and patients remained in the hospital until they fully recovered, which was assessed by their ability to eat a whole chicken! Discharged patients were provided not only with a new set of clothes but also with pocket money!

Doctors in bimaristans worked in shifts with some working in the morning and others at night, and some working for a certain period of time in the morning and another period at night. This system allowed physicians enough time to rest to be able to continue working in the bimaristan and supervise the treatment and medical care of their patients.

Al-Maqrizi mentioned in his book[6] that when patients were admitted to hospital, their clothes and money were taken and placed in trust of the bimaristan guardian. The patients received clean clothes, and were given drugs and food under the supervision of the physicians free of charge until they were cured.

Ibn Al-Ukhwah described in his book Al-Hisbah the process that occurred when a patient visited a physician in the outpatient clinic. He said in a very important text:

“The physician asks the patient about the cause of his illness and the pain he feels. He prepares syrups and other drugs, then writes a copy of the prescription to the parents attending with the patient. The following day he re-examines the patient and looks at the drugs and asks him how he feels, and accordingly advises the patient. This procedure is repeated every day until the patient is either cured or dies. If the patient is cured, the physician is paid.  If the patient dies, his parents go to the chief doctor and present the prescriptions written by the physician. If the chief doctor judges that the physician has performed his job without negligence, he tells the parents that death was natural; if he judges otherwise, he informs them to take the blood money of their relative from the physician as his death was the result of his bad performance and negligence. In this honorable way they were sure that medicine was practiced by experienced, well trained personnel[7]."

Bimaristan Varieties

Special bimaristans were set up for various diseases and purposes.  These included:

a) Psychiatric Bimaristans

Muslims realized the importance of special care for the mentally ill. As a result, special wards for psychiatric patients, isolated from the rest of the hospital by iron bars in order to avoid the aggression of these patients on the others, were frequently added to the larger bimaristans[8]. 

b) Leprosy Bimaristans:

These were built especially for patients with leprosy. Al-Waleed ibn `Abdul-Malik was the first to establish this type of bimaristan.

According to Ibn Al-Qifi[9], the first to write a book about leprosy was Yohana ibn Masuwiy. The reason for interest in such a disease arose from the Muslims' idea of isolating patients who had communicable diseases from the rest of society.

c) Road Bimaristans:

Arabs realized the importance of this type of bimaristan early on as a result of the annual pilgrimage to Makkah and the frequent departure of commercial caravans that traveled for long distances. These caravans required the availability of medical care for the travelers or for people they might meet on the way in need of medical assistance.

Ibn Kathir pointed out in his book The Beginning and the End[10] that road bimaristans were conducted by a wise director who knew how to provide medical treatment. The rich, who had the ability to equip such caravans with medical missions, supported these bimaristans financially.

d) Prison Bimaristans:

Muslims provided medical care to prisoners in the same way they did for society at-large. This is clear from a letter written by `Isa ibn `Ali Al-Jarrah[11], the minister of Al-Muqtadir, to Sinan ibn Thabit, who was distinguished in Arab medicine and embraced Islam at the hands of Al-Qahir.

After visiting the prisons, 'Isa sent his famous letter to Sinan in which he said,

''I thought of the imprisoned people and that they are exposed, due to their large number and difficult situation, to diseases. They are incapable of dealing with their excretions or of meeting doctors to seek their advice about diseases. You must - May God grant you honor - assign physicians to visit them daily, and they should carry with them drugs and syrups and all they need to treat the patients and cure illnesses with God's will ''.

Sinan bin Thabit followed this advice. Also according to Ibn Al-Qifi, Al-Muqtadir asked Sinan ibn Thabit to build a bimaristan to be named after him. It was built in 306 Hijri at Bab Al-Sham[12], called the Muqtadir Bimaristan and financed with 200 dinars a month. Sinan bin Thabit was assigned as the chief doctor. When al- Muqtadir was told that one of his physicians killed a man by mistake, he ordered Sinan to test all his physicians. They were tested in Baghdad and their number eventually reached eight hundred physicians.

e) The Mobile Bimaristan:

This type of Bimaristan visited villages, the peripheries and cities, and cared for the health of people who lived away from the state capital, thus allowing state services to have a longer reach.

Ali bin Issa al-Garrah, al Muqtadir's minister, ordered the first state physician, Sinan bin Thabit, to allow doctors to travel to the peripheries of the state. He said in his letter,

 ''I thought of the ill who live in the peripheries who do not receive any medical care due to a lack in doctors. So, assign - May God prolong your life - some physicians to visit the peripheries; also send a pharmacy containing drugs and syrups. They should travel all through the peripheries and stay in each region long enough to treat patients, after which they should travel to another region."

It was the state's responsibility to care for the bimaristans. Senior physicians were aware of the importance of establishing work rules and a strong basis for teaching students who came to learn medicine. Schools of medicine were thus established in the Islamic world, in which teaching was performed using two methods:

1- The theoretical method taught in medical schools

2- A practical method for training and practice where students gathered around the doctor-in-chief to see and examine the patients and the treatment he prescribed. When the students finished the studying period they applied for an exam, took an oath and received their certificates. When they started to practice medicine, they always worked under the state's supervision. This meant that bimaristans were institutes for teaching medicine and for junior doctors to complete their studies[13]. From a practical point of view, the professors prescribed the treatment for the patients and examined them in the presence of the students. Junior doctors implemented these instructions and performed a follow-up on the patients, thus acquiring the necessary practical experience for a successful career in the medical field. 

* Dr. Sharif Kaf Al-Ghazal is a plastic surgeon and one of the founders and executive members of the International Society for History of Islamic Medicine. You can contact him at: skalghazal@hotmail.com or visit his web site at: www.islamicmedicine.org

Health & Science Please feel free to contact the Health & Science editor at: ScienceTech@islam-online.net Science News | Health and Alternative Medicine   Faith and Science/Medicine | Institutions and Scientists Environment | Computers and Communications | Genetics| Technology Natural Sciences | Muslim Heritage back