The hospital shall keep all patients, men and women, until they are completely recovered. All costs are to be borne by the hospital whether the people come from afar or near, whether they are residents or foreigners, strong or weak, low or high, rich or poor, employed or unemployed, blind or signed, physically or mentally ill, learned or illiterate. There are no conditions of consideration and payment; none is objected to or even indirectly hinted at for non-payment. The entire service is through the magnificence of God, the generous one.

The modern West’s approach to health and medicine owes countless debts to the ancient past: Babylon, Egypt, Greece, Rome and India, to name a few. The hospital is an invention that was both medical and social, and today it is an institution we take for granted, hoping rarely to need it but grateful for it when we do. Almost anywhere in the world now, we expect a hospital to be a place where we can receive ease from pain and help for healing in times of illness or accidents.

We can do that because of the systematic approach—both scientifically and socially—to health care that developed in medieval Islamic societies. A long line of caliphs, sultans, scholars and medical practitioners took ancient knowledge and time-honored practices from diverse traditions and melded them with their original research to feed centuries of intellectual achievement and drive a continual quest for improvement. Their bimaristan, or asylum of the sick, was not only the true forerunner of the modern hospital, but also virtually indistinguishable from the modern multi-service healthcare and medical education center.

The bimaristan served variously as a center of treatment, a convalescent home for those recovering from illness or accident, a psychological asylum and a retirement home that gave basic maintenance to the aged and infirm who lacked a family to care for them.

Asylum of the Sick

The bimaristan was but one important result of the great deal of energy and thought medieval Islamic civilizations put into developing the medical arts. Attached to the larger hospitals—then as now—were medical schools and libraries where senior physicians taught students how to apply their growing knowledge directly with patients. Hospitals set examinations for the students and issued diplomas. The institutional bimaristans were devoted to the promotion of health, the curing of diseases and the expansion and dissemination of medical knowledge.

tarker / bridgeman images The Nur al-Din Bimaristan, a hospital and medical school in Damascus, was founded in the 12th century. Today it is the Museum of Medicine and Science in the Arab World.

The First Hospitals

Although places for ill persons have existed since antiquity, most were simple, without more than a rudimentary organization and care structure. Incremental improvements continued through the Hellenistic period, but these facilities would barely be recognizable as little more than holding locations for the sick. In early medieval Europe, the dominant philosophical belief held that the origin of illness was supernatural and thus uncontrollable by human intervention: As a result, hospitals were little more than hospices where patients were tended by monks who strove to assure the salvation of the soul without much effort to cure the body.

Muslim physicians took a completely different approach. Guided by sayings of the Prophet Muhammad (hadith) like “God never inflicts a disease unless He makes a cure for it,” collected by Bukhari, and “God has sent down the disease and the cure, and He has appointed a cure for every disease, so treat yourselves medically,” collected by Abu al-Darda, they took as their goal the restoration of health by rational, empirical means.

Hospital design reflected this difference in approach. In the West, beds and spaces for the sick were laid out so that the patients could view the daily sacrament of the Mass. Plainly (if at all) decorated, they were often dim and, owing to both climate and architecture, often damp as well. In the Islamic cities, which largely benefited from drier, warmer climates, hospitals were set up to encourage the movement of light and air. This supported treatment according to humoralism, a system of medicine concerned with corporal rather than spiritual balance.

Mobile Dispensaries

The first known Islamic care center was set up in a tent by Rufaydah al-Aslamiyah during the lifetime of the Prophet Muhammad. Famously, during the Ghazwah Khandaq (Battle of the Ditch), she treated the wounded in a separate tent erected for them.

Later rulers developed these forerunners of “mash” units into true traveling dispensaries, complete with medicines, food, drink, clothes, doctor and pharmacists. Their mission was to meet the needs of outlying communities that were far from the major cities and permanent medical facilities.

They also provided the rulers themselves with mobile care. By the early 12th-century reign of Seljuq Sultan Muhammad Saljuqi, the mobile hospital had become so extensive that it needed 40 camels to transport it.

Permanent Hospitals

The first Muslim hospital was only a leprosarium—an asylum for lepers—constructed in the early eighth century in Damascus under Umayyad Caliph Walid ibn ‘Abd al-Malik. Physicians appointed to it were compensated with large properties and munificent salaries. Patients were confined (leprosy was well known to be contagious), but like the blind, they were granted stipends that helped care for their families.

The earliest documented general hospital was built in 805 in Baghdad.

The earliest documented general hospital was built about a century later, in 805, in Baghdad, by the vizier to the caliph Harun al-Rashid. Few details are known, but the prominence as court physicians of members of the Bakhtishu’ family, former heads of the Persian medical academy at Jundishapur, suggests they played important roles in its development.

Over the following decades, 34 more hospitals sprang up throughout the Islamic world, and the number continued to grow each year. In Kairouan, in present-day Tunisia, a hospital was built in the ninth century, and others were established at Makkah and Madinah. Persia had several: One in the city of Rayy was headed for a time by its Baghdad-educated native son, Muhammad ibn Zakariya al-Razi.

In the 10th century five more hospitals were built in Baghdad. The earliest was established in the late ninth century by ‘Al-Mu’tadid, who asked Al-Razi to oversee its construction and operations. To start, Al-Razi wanted to determine the most salubrious place in the city: He had pieces of fresh meat placed in various neighborhoods, and some time later, he checked to determine which had rotted the least and sited the hospital there. When it opened, it had 25 doctors, including oculists, surgeons and bonesetters. The numbers and specialties grew until 1258, when the Mongols destroyed Baghdad.

The vizier ‘Ali ibn Isa ibn Jarah ibn Thabit wrote in the early 10th century to the chief medical officer of Baghdad about another group:

I am very much worried about the prisoners. Their large numbers and the condition of prisons make it certain that there must be many ailing persons among them. Therefore, I am of the opinion that they must have their own doctors who should examine them every day and give them, where necessary, medicines and decoctions. Such doctors should visit all prisons and treat the sick prisoners there.

Shortly afterward a separate hospital was built for convicts, fully staffed and supplied.

bernard gagnon This plaque on the wall of the Bimaristan Arghun in Aleppo, Syria, commemorates its founding by Emir Arghun al-Kamili in the mid-14th century. Care for mental illnesses here included abundant light, fresh air, running water and music.

In Egypt, the first hospital was built in 872 in the southwestern quarter of Fustat, now part of Old Cairo, by the ‘Abbasid governor of Egypt, Ahmad ibn Tulun. It is the first documented facility that provided care also for mental as well as general illnesses. In the 12th century, Saladin founded in Cairo the Nasiri hospital, which later was surpassed in size and importance by the Mansuri, completed in 1284. It remained the primary medical center in Cairo through the 15th century, and today, renamed Qalawun Hospital, it is used for ophthalmology.

In Damascus the Nuri hospital was the leading one from the time of its foundation in the mid-12th century well into the 15th century, by which time the city contained five additional hospitals.

In the Iberian Peninsula, Cordóba alone had 50 major hospitals. Some were exclusively for the military, and the doctors there supplemented the specialists who attended to the caliphs, military commanders and nobles.