Bimaristan
A bimaristan, or simply maristan, known in Arabic as dar al-shifa, is a hospital in the historic Islamic world.
Etymology
Bimarestān is a New Persian word inherited from the Middle Persian wēmārestān, from wēmār "sick, ill person" plus the suffix -stan "place, location."In English literature, the term designates institutions of medicine in the medieval Islamic world. It is still used sometimes in languages of Persianate societies to refer to modern hospitals or specific types of medical institutions.
Origins
Many centers of health in antiquity helped shape the ways Muslim scholars would pursue the study and advancement of medical science.Mobile hospitals were the first version of the bimaristans. These mobile versions carried medications, food, and water, and traveled with physicians and pharmacists to aid those in need. According to tradition, the first mobile bimaristan was set up in a tent by Rufaidah al-Asalmia in 627 CE during the Battle of Khandaq. Later on, these mobile care centers would evolve from one or two tents to enormous units of medical care equipped with medicinal herbs, food, physicians, and pharmacists. Under the Seljuq Sultanate reign of Muhammad Saljuqi, a single mobile care center required 40 camels for transportation. The idea was to be able to better extend medical care to rural communities that lived on the outskirts of major cities. The services provided from the mobile hospitals transitioned into the other Islamic hospitals as time went on.
The Umayyad caliph al-Walid I is sometimes credited with establishing the first permanent bimaristan in the Islamic world in Damascus in 707, but this has been disputed by historians. The claim is largely based on the writings of later medieval historians such as al-Tabari and al-Maqrizi. Modern historians Michael W. Dols and Douglas Morton Dunlop concluded that some of the early historical sources suggest that al-Walid I created something like a leprosarium rather than a hospital, consistent with contemporary Byzantine practices. Historian Lawrence Conrad concluded that al-Walid did not establish a hospital, and this view was accepted by multiple other historians, including Peregine Horden and Peter E. Pormann. More recently, Ahmad Ragab argued that there is no evidence that al-Walid's foundation resembled the later bimaristans of the Islamic world, which were more sophisticated medical institutions, but that there is evidence he would have established charitable institutions offering shelter for lepers, the blind, and the handicapped. These likely continued or competed with existing Byzantine charitable institutions of the era and may have formed a precedent that was continued by later Muslim institutions.
The first bimaristan proper was more likely the one founded by the Abbasid caliph Harun al-Rashid in Baghdad. This foundation was inspired by the hospital and medical school of Gundeshapur in Khuzistan, which had been established since the Sasanian period and had brought together the medical traditions of ancient Greece, Iran, and India. According to the traditional narrative, Harun al-Rashid summoned from Geundeshapur a Christian doctor named Jibril ibn Bakhtishu, whom he charged with establishing a state hospital in 787. The details of this story have been questioned by Dols, who argues the hospital may have actually been founded by the Barmakid vizier Yahya ibn Khalid under al-Rashid. Nonetheless, he notes that historical records demonstrate that state hospitals were already a well-known feature of the Abbasid realm by the first decades of the 9th century. Ragab also questions the accuracy of the traditional account but notes that the bimaristan was evidently a well-known institution in Baghdad in the 9th and 10th centuries.
Though the Islamic realm was very large, Baghdad, Damascus, and Cairo housed the most well-known bimaristans for much of their history.
Features
Admission and treatment of all
As hospitals developed during the Islamic civilization, specific characteristics were maintained. For instance, Bimaristans served people regardless of their race, religion, citizenship, or gender. The waqf documents instructed that nobody should be turned away, this included those with mental illnesses or disorders. In Aleppo's Arghun Hospital, for example, care for mental illness included abundant light, fresh air, running water, and music. Physicians and hospital staff aimed to work together to help the well-being of their patients.Inpatients were not given a time limit. Instead, waqf documents stated that the hospital was required to care for patients until full recovery. Male and female wards were separate but equally equipped. These wards were further divided to attend to mental illnesses, contagious diseases, non-contagious diseases, surgery, medicine, and eye diseases. Patients were treated by nurses and staff of their same gender. Each hospital contained a lecture hall, kitchen, pharmacy, library, mosque, and occasionally a chapel for Christian patients. Recreational materials and musicians were often employed to comfort and cheer patients up.
Hygiene
The Qur'an provided the basis for the development of professional ethics. The rise of washing to attain ritual purity in Islam and in Judaism also influenced the importance of hygiene in medical practice. The importance of hygiene promotes healthy lifestyles and cuts down on disease by enticing communities to create hygienic infrastructures. Bimaristans promoted hygiene by regularly bathing patients and staff, providing clean bedding and medical materials, and through their architecture, which promoted air circulation and bright, open lighting. Pharmacies were periodically visited by government inspectors called muhtasib, who checked to see that the medicines were mixed properly, not diluted, and kept in clean jars. Additionally, Muhammad ibn Zakariya al-Razi, who was once asked to choose the site for a new hospital in Baghdad, suspended pieces of meat at various points around the city and recommended building the hospital at the location where the meat putrefied the slowest.Education
The various Quranic injunctions and Hadith, which place value on education and emphasize the importance of acquiring knowledge, played a vital role in influencing the Muslims of this age in their search for knowledge and the development of the body of science.Bimaristans were not only used to provide care for individuals. They were also educational institutions meant to advance medical students' knowledge in the medical field, especially in cities like Baghdad, Damascus, and Cairo. Some madrasas were also closely linked with bimaristans, so that students could learn in the institutions and put their theoretical knowledge directly into practice. Basic science preparation was learned through private tutors, self-study, and lectures. Many of these hospitals also contained a conjoined library typically filled with any possible writings that may be relevant to the medicine practiced in the hospitals.
Physicians in these proto-medical schools were not exclusively Muslim; Jewish and Christian physicians also practiced and taught. In the major hospitals at Cairo, Baghdad, and Damascus, students often visited patients while under the supervision of a practicing physician—a system comparable to a medical residency today. Like in today's medical training programs, working and learning in the bimaristans under the supervision of practicing physicians allowed medical students to gain hands-on experience treating various ailments and responding to a multitude of situations.
During this era, physician licensure became mandatory in the Abbasid Caliphate. In 931 CE, Caliph Al-Muqtadir learned of the death of one of his subjects as a result of a physician's error. He immediately ordered his muhtasib Sinan ibn Thabit to examine and prevent doctors from practicing until they passed an examination. From this time on, licensing exams were required and only qualified physicians were allowed to practice medicine.
The early Islamicate empires, while on their quest for knowledge, translated the work of early pre-Islamic times from empires such as Rome, Greece, Pahlavi, and Sanskrit into Arabic. Before this translation, the work had been lost, and perhaps it may have been lost forever. The discovery of this new information exposed the Islamicate empires to large amounts of scientific research and discoveries. Arabs translated a variety of different topics throughout science, including Greek and Roman research in medicine and pharmacology. Translated artifacts, such as medical dictionaries and books containing information on hygiene and sexual intercourse, are still preserved. Perhaps one of the most notable translated pieces is a human anatomy book translated from Greek to Arabic by Muslim physician Avicenna. The book was used in schools in the West until the mid-17th century.
Function and organization
One of the most remarkable contributions of the Islamic hospitals was the organizational structure itself and how it functioned in Islamic culture. These contributions still influence contemporary medical practice. For example, bimaristans kept written records of patients and their medical treatment—the first written medical histories for patients. Students were responsible in keeping these patient records, which were later edited by doctors and referenced in future treatments.The first documented general hospital arose in Baghdad in 805, built by the caliph Harun al-Rashid and his vizier, Yahya ibn Khalid. Although not much is known about this hospital due to poor documentation, the system of the general hospital itself set forth an example for the many other hospitals to come. By the year 1000, Baghdad had five more hospitals. As new hospitals were built throughout the Islamic world, they followed similar organizational structures to the hospital in Baghdad.
The typical hospital was divided into departments such as systemic diseases, surgery, and orthopedics, with larger hospitals having more diverse specialties. "Systemic diseases" was the rough equivalent of today's internal medicine and was further divided into sections such as fever, infections, and digestive issues. Every department had an officer-in-charge, a presiding officer and a supervising specialist. The hospitals also had lecture theaters and libraries. Hospitals staff included sanitary inspectors who regulated cleanliness, accountants, and other administrative staff. The hospitals were typically run by a three-person board comprising a non-medical administrator, the chief pharmacist, called the shaykh saydalani, who was equal in rank to the chief physician, who served as mutwalli. Medical facilities traditionally closed each night, but by the 10th century laws had been passed to keep hospitals open 24 hours a day.
Both men and women worked in these hospitals, including as physicians, but hospital staff had work in a range of professions. Much like today's hospitals, they also relied on pharmacists, nurses, sanitary inspectors, supervising specialists, secretaries, and superintendents. The superintendents, or in Arabic, sa'ur, ensured that hospitals met certain standards in addition to managing the entire hospital institution. Pharmacists produced drugs as means for treatment of the hospitals' patients; they relied on a knowledge of chemistry, or Alchemia.
Before the 10th century, hospitals operated throughout the day and closed at night. Later, hospitals operated on a 24-hour basis. Nonetheless, the practicing physicians worked a set number of hours with their salaries prescribed by law; the physicians were paid generously enough so as to retain their talent. Chief of staff physician, Jabril ibn Bukhtishu, was salaried 4.9 million Dirham; for comparison, a medical resident worked significantly longer hours salaried at 300 Dirham per month.
Islamic hospitals attained their endowment through charitable donations or bequests, called a waqf. The legal documents establishing a waqf also set forth rules for how the hospital should be organized and operate in relation to the patient, stating that anyone could be admitted regardless of race, gender, or citizenship. Patients of all socioeconomic statuses would have had access to full treatment, as all costs were borne by the hospital itself. An example was the Al-Mansuri Hospital in Cairo, built under the orders of the Mamluk ruler of Egypt, Al-Mansur Qalawun. Its maximum capacity was around 8000 people and the annual endowment alone was said to be one-million Dirhams. The design was intended to accommodate various pathologies for both men and women, as well as a pharmacy, a library, and lecture halls. The lecture halls were used for regular meetings on the status of the hospital, lecturing residents, and staff as well.