Hospitals – as we know today – the very structure where medicine is practiced all over the world, were the brainchild of the Islamic world! In other words, hospitals of Islamic era were the first so-called R&D centers of medical research
The Islamic Contributions to Medicine - Part II: Evolution of Hospitals, Dispensaries and Pharmacies
By Abdul-Majeed Azad
Technologist (formerly at NASA-Jet Propulsion Laboratory)
Pasadena, CA
To appreciate the noteworthy and long-lasting contributions of early Muslim physicians, surgeons, caregivers and dieticians, it is essential to examine what drove them to pursue their quest for knowledge in these fields. The single prime driver perhaps was the deep and thorough understanding of Qur’anic text and its interpretation. The gradual introduction of experimentation, clinical trials, quantification as well as the anatomical dissection, came later, which revolutionized the understanding of the intimate correlation among hygiene, environment, diet and various ailments and their treatment.
For the first time, analysis and examination of various ideas and theories were not based on mere speculation, rather through the affirmation of legitimate results obtained via thorough experimentation, testing and analyses. Different types of experiments were performed by teams of physicians. Those led to the formation of sound basis for the later generations in the medical field. Hospitals – as we know today – the very structure where medicine is practiced all over the world, were the brainchild of the Islamic world! In other words, hospitals of Islamic era were the first so-called R&D centers of medical research.
Medical field has seen remarkable advances in the ethics of medicine. It is, therefore, natural to question how and why these ethics evolved: were they sudden and overnight or steady and gradual? The answer is not that simple; of course, it was the Qur’an, but it was not just one verse or two of the Scripture that prompted so many individuals during the early Islamic era to pursue medicine. Islam strongly promotes seeking the truth by observing one’s surroundings. Islam stresses the importance of learning. The very first revelation to Prophet Muhammad (peace be upon him) was Iqra’ (read; Surah Al-‘Alaq, verse 1)). The pursuit of knowledge is highly encouraged and is obligatory on all Muslims – male and female. In the very early days of Islam, a captured enemy was freed upon paying ransom or by teaching ten Muslims how to read and write. A prominent companion Abū al-Dardā' stated: Teaching sacred knowledge even for a brief time is better than spending a night in prayer.
One constant theme in the Qur’an is the oft-repeated exhortation and reminder to the believers to understand (? افلاتعقلون ; Al-Baqarah verse 44 and 76, Al-A’raaf verse 169, Yusuf verse 109, Al-Anbiya’ verse 10 and 67), think/reflect (?أَفَلَا تَتَفَكَّرُونَ Al-An’aam verse 50 ), remember (? أَفَلَا تَتَذَكَّرُونَ Al-An’aam verse 80) remember/apply reasoning ( ? افلاتذکرون ; An-Nahl verse 17, As-Sajdah verse 4 ), believe (? افلا یومنون ; Al-Anbiya’ verse 30 ), hear (? افلا یسمعون ; As-Sajdah verse 26 ), reflect (? افلا یتدبرون ; Muhammad verse 24), see/observe (? افلا تبصرون ; Adh-Dhariyat verse 21), look/observe (? افلا ینظرون ; Al-Ghashiyah verse 17) and, know (? افلا یعلمُ ; Al’Adiyat verse 9) . Through its unparalleled narrative style, Qur’an always draws human attention towards the everyday natural and physical phenomena occurring around us on the land, in the seas, lakes, in the sky and in the most harmonious pattern of movements of stars and planets in the vastness of the universe. If we think about it, these instructions are subtle scientific clues, which act as truth-seeking media. The observation of day-to-day phenomena in the universe around them was a great manifestation of power that prompted early Muslims to get interested in the function of the human body with time and its near and distant environment. For example, the phenomena of cloud formation (via evaporation of water from lakes, rivers and oceans) and condensation (coming down as rain) were described in the Qur’an more than 1,400 years ago. This is beautifully captured in Surah Ali-“Imran (verse 190): Surely, in the creation of the heavens and the earth, and in the alternation of night and day, there are signs for people of wisdom.
To emphasize the point, let us digress a little. NASA was founded in 1958 – a year after the Jet Propulsion Laboratory was established in Pasadena, California. Interestingly, two things drive NASA: (i) a persistentcuriosity about life on other planets besides earth, and (ii) a hypothesis that if water is found on other celestial bodies, there will be life on them in one form or the other. The first is borne out of human beings’ innate natural quest to discover, the second is a rational deduction of our observation of the presence of life around us, due possibly to the omnipresence and abundance of water on our planet; around 70% of the earth is occupied by water. The main goal of all the ‘rover’ and ‘lander’ space missions by NASA and other global space agencies so far has been to detect and/or establish the presence of water on distant alien bodies in our solar system. This endeavor falls within the purview of NASA’s second line of reasoning: find water and you will find life!
Miraculously, more than 1,400 years ago Qur’an had confirmed that all biological life in the universe begins from water (the Arabic word for water is maa’a), as we read in the following verses:
1. Al-Anbiya, verse 30: وَجَعَلْنَا مِنَ ٱلْمَآءِ كُلَّ شَىْءٍ حَىٍّ (And We made from water every living thing).
2. An-Noor, verse 44: وَٱللَّهُ خَلَقَ كُلَّ دَابَّةٍۢ مِّن مَّآءٍۢ (And Allah has created every living creature from water).
3. Al-Furqan, verse 54: وَهُوَ ٱلَّذِى خَلَقَ مِنَ ٱلِْمَآء بَشَرًۭا (And it is He Who has created man from water).
The essence of the nobility of the medical profession among Muslims arose from the core belief that the real healer is the Creator of the Universe; doctor is mere Allah’s instrument to heal. The patient-physician relationship is therefore important. From this perspective, ethical standards were created - not for nefarious legal purposes, but more because the physician would be answerable to the Creator on the day of judgement regarding his actions. Hence, besides caring for a patient, a doctor must behave in a manner that will be looked upon favorably by Allah!
Islam guarantees care, protection and survival of the human body by preventing harm from coming to it. This is stated very explicitly in Qur’an: and whoever saves a life it is as if he saved all humanity (An-Nisa, verse 32). An authentic narration recorded in Sahih Muslim and Bukhari states that Prophet Muhammad (peace be upon him) said: whoever helps a brother in difficulty, Allah will help him through his difficulties on the Day of Judgment. Visiting the sick in the community also constitutes ‘help’. For this act, great reward for a person visiting the sick at home or in hospital, has been mentioned in authentic narrations.
These Qur’anic and prophetic instructions undoubtedly shaped the career path for people pursuing medical studies during the height of the Islamic era. However, in addition to the Qur’anic verses and/or prophetic narrations alone that Not only was Islam, but other factors also played a large role in advancing scientific studies and discoveries. Caliphs, Kings, Sultans and other government agencies strongly encouraged and financially patronized the pursuit of scientific knowledge, including medicine. There was a strong coherence between those seeking knowledge and those eager to facilitate it by their patronage during this time. So, everyone worked together harmoniously for a greater good for the Islamic society at large. Success was achieved through discipline and authority. The strong unity of societies during the golden Islamic era helped create the atmosphere for a greater academic environment. It was because of this steadfast discipline and togetherness that there was so much of success. There was also a sense of tolerance among all people, regardless of their origin and religious beliefs. Jews and Christians living under Islamic state were treated with much respect, dignity and tolerance. They were encouraged and welcome to study and pursue medicine just as much as any Muslim.
Chronologically, the establishment of hospitals began in the Arab world first. Even in the very early days of Islam, Muslims had developed a culture of tending to the sick in a very organized way. Rufaida bint Sa’ad Al-Aslameya (Allah be pleased with her) is known to be the first official nurse in Islamic history for her pioneering medical work during the time of Prophet Muhammad (peace be upon him). She was a trained medical worker and healer who learned clinical skills from her father, who was a physician. She is credited with setting up the first mobile field hospital/tent to care for the injured soldiers during the battles of Uhud, Khandaq (trench) and Khaybar. She would treat the wounded soldiers, stop bleeding and remove arrows from their bodies. She also trained other women as corps of volunteers for this task. Aisha bint Abu Bakr and some other wives (Allah be pleased with them all) would also accompany the Prophet (peace be upon him) on similar expeditions. Their primary role, however, involved carrying water in leather skins to the fighters on the battlefield to quench the thirst and assist with basic relief rather than serving as dedicated nurses. Another notable female is Zainab bint Ali (Allah be pleased with her). She is said to have cared for women, children, and her sick nephew Zayn al-Abidin, following the tragedy of Karbala in 681/682 AD. Her birth anniversary is commemorated in Iran as Nurse's Day.
Physical hygiene is an integral part of Islamic faith; an unclean person, cannot even pray – an injunction laid out in Qur’an very clearly. Thus, facilities for sanitation (toilets, washrooms, ablution rooms, baths, and other facilities) were created by the Caliphates very early on for all people, regardless of their socioeconomic standing or race. This concept was never present anywhere in the world before. For the first time, access to medical facilities and treatment was provided for the common people on a large scale in a meticulous, orderly and organized fashion. It was during the Islamic era that hospitals, dispensaries and medical schools were established. The third Umayyad Caliph, Walid ibn Abdul Malik, had deep interest in public works. He founded an institute for the blind and the disabled. He was also the first to an Islamic medical dispensary – the first of its kind – in the year 88 AH that was staffed with physicians and surgeons. Soon, dozens of small dispensaries sprung up all over the Umayyad Empire. Specialty departments were created by Islamic caliphates and other principalities within hospitals for the study of different aspects of medical sciences. In his book, In the Curative Use of Drugs , Philip K. Hitti writes: some remarkable advances were made by the Arabs. It was they who established the first apothecary shop, founded the earliest school of pharmacy and produced the first pharmacopoeia.
The Abbasid Caliphate was the bastion of cultural and public welfare development. The first hospital was founded at the beginning of the 9 th century AD in Baghdad during the rule of Abbasid Caliph Harun-al-Rashid. Five more hospitals were established in the 10 th century. Harun-al-Rashid also created a separate department of health, which used to run several government dispensaries staffed by highly qualified physicians. The Caliphate made sure that the efficiency and high standards of medical profession were strictly enforced, maintained and properly looked after. Physicians, pharmacists and other medical professionals were mandated to take and pass some sort of proficiency tests, before entering the field of medical practice.
In one solitary stance after discovering a case of malpractice, the Caliphate ordered these tests mandatory for all medical professionals. Only those who passed were given diplomas and grant certificates. For the first time, arrangements were made for formal instruction/training of the new doctors, pharmacists, and other medical practitioners. Similarly, orthopedists were tested to assess whether they were well-versed in anatomy and surgery. Ophthalmologists also had to undergo thorough proficiency tests and were not allowed to practice unless they were fully familiar with the entire anatomy of the eye. They had to know the principal diseases of the eye, their sources as well as their complications. This newly introduced method of assessing physicians later developed into a formal system of medical proficiency tests. This was the approach the Abbasids established to rid the entire medical professions of con artists, thus laying down the foundation of very high standards of medical practice, as seen today globally. The standards put in place during the Islamic era directly influenced the procedures of maintaining high proficiency among doctors. It is well known that the price of medical malpractice is very high – both professionally and financially.
The outbreak of epidemics resulted in further expansion of their healthcare organization during the Abbasid era. This led to more hospitals being opened. Hospitals were also opened next to jails, realizing the relatively poor sanitary and health conditions there. Physicians were also required to visit distant rural areas, far away from main cosmopolitans of the kingdom to attend to the sick. By some historical records, as many as 34 hospitals were scattered all over the Islamic world during the reign of the Abbasids. They would also serve as training centers for new batches physicians, in addition to treating the sick. Dedicated medical libraries also were established in each hospital, pharmacy and dispensary for ready access to relevant literature on case studies.
The rapid expansion of Islamic Caliphate necessitated the establishment of military medical schools too. During the reign of Sultan Mahmud (the second Abbasid Caliph), special medical units were attached to army battalions. He was the first to organize military hospitals and mobile dispensaries on a regular basis. Medical equipment and supplies along with a full-fledged team of doctors, surgeons, nurses and other auxiliary medical staff were transported on horses and camels during wartime to the battlefields via safest routes. These units consisted of highly trained physicians, surgeons and other essential staff, trained to attend a range of situations from simple laceration of skin to complex injuries to bones, brain and other internal organs.
