Category Archives: Muslim Inventions

The Islamic Roots of the Modern Hospital

by David W. Tschanz ]

Did you Know? The earliest documented general hospital was built in 805 in Baghdad.

Below is the translation of a young Frenchman’s letter from a Cordóba hospital in the 10th century:

You have mentioned in your previous letter that you would send me some money to make use of it in my medicines costs. I say, I don’t need it at all as treatment in this Islamic hospital is for free. Also there is something else concerning this hospital. This hospital gives a new suit and five dinars to every patient who has already got well lest he should find himself obliged to work in the period of rest and recuperation.

Dear father, if you’d like to visit me, you will find me in the surgery department and joints treatment. When you enter the main gate, go to the south hall where you will find the department of first aid and the department of disease diagnosis then you will find the department of arthritis (joint diseases). Next to my room, you will find a library and a hall where doctors meet together to listen to the lectures given by professors; also this hall is used for reading. The gynecology department lies on the other side of the hospital court. Men are not allowed to enter it. On the right of the hospital court lies a large hall for those who recovered. In this place they spend the period of rest and convalescence for some days. This hall contains a special library and some musical instruments.

Dear father, any place in this hospital is extremely clean; beds and pillows are covered with fine Damascus white cloth. As to bedcovers, they are made of gentle soft plush. All the rooms in this hospital are supplied with clean water. This water is carried to the rooms through pipes that are connected to a wide water fountain; not only that, but also every room is equipped with a heating stove. As to food, chicken and vegetables are always served to the extent that some patients do not want to leave the hospital because of their love and desire of this tasty food.

“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.” (policy statement of the bimaristan of al-Mansur Qalawun in Cairo, c. 1284 ce)

* * *

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.

Figure 1. 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. (Source)

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

Figure 2. 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. (Source)

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.

Figure 3. Fountains were central to the architecture of the Bimaristan Arghun: Three courtyards each held a fountain, around which patient rooms were arranged, while the central courtryard featured a large rectangular pool and well. (Since these photos were taken, unesco has listed the bimaristan as damaged by warfare.) (Source)


In a fashion that would still be recognizable today, the typical Islamic hospital was subdivided into departments such as systemic diseases, surgery, ophthalmology, orthopedics and mental diseases. The department of systemic diseases was roughly equivalent to today’s department of internal medicine, and it was usually further subdivided into sections dealing with fevers, digestive troubles, infections and more. Larger hospitals had more departments and diverse subspecialties, and every department had an officer-in-charge and a presiding officer in addition to a supervising specialist.

Hospitals were staffed also with a sanitary inspector who was responsible for assuring cleanliness and hygienic practices. In addition, there were accountants and other administrative staff to assure that hospital conditions—financial and otherwise—met standards. There was a superintendent, called a sa’ur, who was responsible for overseeing the management of the entire institution.

Physicians worked fixed hours, during which they saw the patients who came to their departments. Every hospital had its own staff of licensed pharmacists (saydalani) and nurses. Medical staff salaries were fixed by law, and compensation was distributed at a rate generous enough to attract the talented.

Funding for the Islamic hospitals came from the revenues of pious bequests called waqfs. Wealthy men and rulers donated property to existing or newly built bimaristans as endowments, and the revenues from the bequests paid for building and maintenance. To help make it pay, such revenues could come from any mix on the property of shops, mills, caravanserais or even entire villages. The income from an endowment would sometimes also cover a small stipend to the patient upon dismissal. Part of the state budget also went toward the maintenance of hospitals. To patients, the services of the hospital were free, though individual physicians occasionally charged fees.

Patient Care

Bimaristans were open to everyone on a 24-hour basis. Some only saw men while others, staffed by women physicians, saw only women; still others cared for both in separate wings with duplicate facilities and resources. To treat less serious cases, physicians staffed outpatient clinics and prescribed medicines to be taken at home.

Special measures were taken to prevent infection. Inpatients were issued hospital wear from a central supply area while their own clothes were kept in the hospital store. When taken to the hospital ward, patients would find beds with clean sheets and special stuffed mattresses ready. The hospital rooms and wards were neat and tidy with abundant running water and sunlight.

Inspectors evaluated the cleanliness of the hospital and the rooms on a daily basis. It was not unusual for local rulers to make personal visits to make sure patients were getting the best care.

The course of treatment prescribed by doctors began immediately upon arrival. Patients were placed on a fixed diet, depending on condition and disease. The food was of high quality and included chicken and other poultry, beef and lamb, and fresh fruits and vegetables.

The major criterion of recovery was that patients be able to ingest, at one time, an amount of bread normal to a healthy person, along with the roasted meat of a whole bird. If patients could easily digest it, they were considered recovered and subsequently released. Patients who were cured but too weak to discharge were transferred to the convalescent ward until they were strong enough to leave. Needy patients were given new clothes, along with a small sum to aid them in re-establishing their livelihood.

Figure 4. In Egypt, the al-Mansur Qalawun Complex in Cairo includes a hospital, school and mausoleum. It dates from 1284-85. (Source)

The 13th-century doctor and traveler ‘Abd al-Latif al-Baghdadi, who also taught at Damascus, narrated an amusing story of a clever Persian youth who was so tempted by the excellent food and service of the Nuri hospital that he feigned illness. The doctor who examined him figured out what the young man was up to and admitted him nevertheless, providing the youth with fine food for three days. On the fourth day, the doctor went to his patient and said with a rueful smile, “Traditional Arab hospitality lasts for three days: Please go home now!”

The quality of care was subject to review and even arbitration, as related by Ibn al-Okhowa in his book ‘Ma’alem al-Qurba fi Talab al-Hisba’ (The Features of Relations in al-Hisba):

“If the patient is cured, the physician is paid. If the patient dies, his parents go to the chief doctor; they present the prescriptions written by the physician. If the chief doctor judges that the physician has performed his job perfectly without negligence, he tells the parents that death was natural; if he judges otherwise, he tells them: Take the blood money of your relative from the physician; he killed him by his bad performance and negligence. In this honorable way, they were sure that medicine is practiced by experienced, well-trained persons.”

In addition to the permanent hospitals, cities and major towns also had first aid and acute care centers. These were typically located at busy public places such as large mosques. Maqrizi described one in Cairo:

“Ibn Tulun, when he built his world-famous mosque in Egypt, at one end of it there was a place for ablutions and a dispensary also as annexes. The dispensary was well equipped with medicines and attendants. On Fridays there used to be a doctor on duty there so that he might attend immediately to any casualties on the occasion of this mammoth gathering.”

Medical Schools & Libraries

Because one of the major roles of the hospitals was the training of physicians, each hospital had a large lecture theater where students, along with senior physicians and medical officers, would meet and discuss medical problems in seminar style. As training progressed, medical students would accompany senior physicians to the wards and participate in patient care—much like a modern residency program.

Surviving texts, such as those in Ibn Abi Usaybi’ah’s ‘Uyun al-anba’ fi tabaqat al-atibb’ (Sources of Information on Classes of Physicians), as well as student notes, reveal details of these early clinical rounds. There are instructions on diets and recipes for common treatments, including skin diseases, tumors and fevers. During rounds, students were told to examine the patients’ actions, excreta, and the nature and location of swelling and pain. Students were also instructed to note the color and feel of the skin, whether hot, cool, moist, dry or loose.

Training culminated in an examination for a license to practice medicine. Candidates had to appear before the region’s government-appointed chief medical officer. The first step required was to write a treatise on the subject in which the candidate wanted to obtain a certificate. The treatise could be an original piece of research or a commentary on existing texts, such as those of Hippocrates, Galen and, after the 11th century, Ibn Sina, and more.

Candidates were encouraged not only to study these earlier works, but also to scrutinize them for possible errors. This emphasis on empiricism and observation rather than slavish adherence to authorities was one of the key engines of the medieval Islamic intellectual ferment. Upon completion of the treatise, candidates were interviewed at length by the chief medical officer, who asked them questions relevant to problems of the prospective specialties. Satisfactory answers led to licensed practices.

Another key aspect to the hospital, and of critical importance to both students and teachers, was the presence of extensive medical libraries. By the 14th century, Egypt’s Ibn Tulun Hospital had a library comprising 100,000 books on various branches of medical science. This was at a time when Europe’s largest library, at the University of Paris, held 400 volumes.

Cradle of Islamic medicine and prototype for today’s hospitals, bimaristans count among numerous scientific and intellectual achievements of the medieval Islamic world. But of them all, when ill health or injury strikes, there is no legacy more meaningful.

The Islamic Scientific Supremacy. Ameer Gafar Al-Arshdy. 1990, Beirut, Al-Resala Establishment.

Source -Courtesy –





Islamic Medical Science: 1,000 Years Ahead of its Times

From: Ink of Scholars

Within a century after the death of Prophet Muhammad (peace be upon him) the Muslims not only conquered new lands, but also became scientific innovators with originality and productivity. They hit the source ball of knowledge over the fence to Europe. By the ninth century, Islamic medical practice had advanced from talisman and theology to hospitals with wards, doctors who had to pass tests, and the use of technical terminology. The then Baghdad General Hospital incorporated innovations which sound amazingly modern. The fountains cooled the air near the wards of those afflicted with fever; the insane were treated with gentleness; and at night the pain of the restless was soothed by soft music and storytelling. The prince and pauper received identical attention; the destitute upon discharge received five gold pieces to sustain them during convalescence. While Paris and London were places of mud streets and hovels, Baghdad, Cairo and Cardboard had hospitals open to both male and female patients; staffed by attendants of both sexes. These medical centers contained libraries pharmacies, the system of interns, externs, and nurses. There were mobile clinics to reach the totally disabled, the disadvantaged and those in remote areas. There were regulations to maintain quality control on drugs. Pharmacists became licensed professionals and were pledged to follow the physician’s prescriptions. Legal measures were taken to prevent doctors from owning or holding stock. in a pharmacy. The extent to which Islamic medicine advanced in the fields of medical education, hospitals, bacteriology, medicine, anesthesia, surgery, pharmacy, ophthalmology, psychotherapy and psychosomatic diseases are presented briefly.

Prophet Muhammad (peace be upon him) who is ranked number one by Michael Hart, a Jewish scholar, in his book The 100: The Most Influential Persons in History, was able to unite the Arab tribes who had been torn by revenge, rivalry, and internal fights, and produced a strong nation acquired and ruled simultaneously, the two known empires at that time, namely the Persian and Byzantine Empires. The Islamic Empire extended from the Atlantic Ocean on the West to the borders of China on the East. Only 80 years after the death of their Prophet, the Muslims crossed to Europe to rule Spain for more than 700 years. The Muslims preserved the cultures of the conquered lands. However when the Islamic Empire became weak, most of the Islamic contributions in science were destroyed. The Mongols burnt Baghdad (1258 A.D.) out of barbarism, and the Spaniards demolished most of the Islamic heritage in Spain out of hatred.

The Islamic Empire for more than 1000 years remained the most advanced and civilized nation in the world. This is because Islam stressed the importance and respect of learning, forbade destruction, developed in Muslims the respect for authority and discipline, and tolerance for other religions. The Muslims recognized excellence and hungering intellectually, were avid for the wisdom of the world of Galen, Hippocrates, Rufus of Ephesus, Oribasius, Discorides and Paul of Aegina. By the tenth century their zeal and enthusiasm for learning resulted in all essential Greek medical writings being translated into Arabic in Damascus, Cairo, and Baghdad. Arabic became the International Language of learning and diplomacy. The center of scientific knowledge and activity shifted eastward, and Baghdad emerged as the capital of the scientific world. The Muslims became scientific innovators with originality and productivity. Islamic medicine is one of the most famous and best known facets of Islamic civilization, and in which the Muslims most excelled. The Muslims were the great torchbearers of international scientific research. They hit the source ball of knowledge over the fence to Europe. In the words of Campbell’ “The European medical system is Arabian not only in origin but also in its structure. The Arabs are the intellectual forebearers of the Europeans.”

The aim of this paper is to prove that the Islamic Medicine was 1,000 years ahead of its times. The paper covers areas such as medical education, hospitals, bacteriology, medicine, anesthesia, surgery, ophthalmology, pharmacy, and psychotherapy.

In 636 A.D., the Persian City of Jundi-Shapur, which originally meant beautiful garden, was conquered by the Muslims with its great university and hospital intact. Later the Islamic medical schools developed on the Jundi-Shapur pattern. Medical education was serious and systematic. Lectures and clinical sessions included in teaching were based on the apprentice system. The advice given by Ali ibnul-Abbas (Haly Abbas: -994 -A.D.) to medical students is as timely today as it was then’. “And of those things which were incumbent on the student of this art (medicine) are that he should constantly attend the hospitals and sick houses; pay unremitting attention to the conditions and circumstances of their intimates, in company with the most astute professors of medicine, and inquire frequently as to the state of the patients and symptoms apparent in them, bearing in mind what he has read about these variations, and what they indicate of good or evil.”

Razi (Rhazes: 841-926 A.D.) advised the medical students while they were seeing a patient to bear in mind the classic symptoms of a disease as given in text books and compare them with what they found.

The ablest physicians such as Razi (Al-Rhazes), Ibn-Sina (Avicenna: 980-1037 A.D.) and Ibn Zuhr (Avenzoar: 116 A.D.) performed the duties of both hospital directors and deans of medical schools at the same time. They studied patients and prepared them for student presentation. Clinical reports of cases were written and preserved for teaching’. Registers were maintained.

Training in Basic Sciences 
Only Jundi-Shapur or Baghdad had separate schools for studying basic sciences. Candidates for medical study received basic preparation from private tutors through private lectures and self study. In Baghdad anatomy was taught by dissecting the apes, skeletal studies, and didactics. Other medical schools taught anatomy through lectures and illustrations. Alchemy was once of the pre-requisites for admission to medical school. The study of medicinal herbs and pharmacognosy rounded out the basic training. A number of hospitals maintained barbel gardens as a source of drugs for the patients and a means of instruction for the students.

Once the basic training was completed the candidate was admitted as an apprentice to a hospital where, at the beginning, he was assigned in a large group to a young physician for indoctrination, preliminary lectures, and familiarization with library procedures and uses. During this pre-clinical period, most of the lectures were on pharmacology and toxicology and the use of antidotes.

Clinical training: The next step was to give the student full clinical training. During this period students were assigned in small groups to famous physicians and experienced instructors, forward rounds, discussions, lectures, and reviews. Early in this period therapeutics and pathology were taught. There was a strong emphasis on clinical instruction and some Muslim physicians contributed brilliant observations that have stood the test of time. As the students progressed in their studies they were exposed more and more to the subjects of diagnosis and judgment. Clinical observation and physical examination were stressed. Students (clinical clerks) were asked to examine a patient and make a diagnosis of the ailment. Only after an had failed would the professor make the diagnosis himself. While performing physical examination, the students were asked to examine and report six major factors: the patients’ actions, excreta, the nature and location of pain, and swelling and effuvia of the body. Also noted was color and feel of the skin – whether hot, cool, moist, dry, flabby. Yellowness in the whites of the eye (jaundice) and whether or not the patient could bend his back (lung disease) was also considered important.

After a period of ward instructions, students, were assigned to outpatient areas. After examining the patients they reported their findings to the instructors. After discussion, treatment was decided on and prescribed. Patients who were too ill were admitted as inpatients. The keeping of records for every patient was the responsibility of the students.

Curriculum: There was a difference in the clinical curriculum of different medical schools in their courses; however the mainstay was usually internal medicine. Emphasis was placed on clarity and brevity in describing a disease and the separation of each entity. Until the time of Ibn Sina the description of meningitis was confused with acute infection accompanied by delirium. Ibn Sina described the symptoms of meningitis with such clarity and brevity that there is very little that can be added after 1,000 years. Surgery was also included in the curriculum. After completing courses, some students specialized under famous specialists. Some others specialized while in clinical training. According to Elgood many surgical procedures such as amputation, excision of varicose veins and hemorrhoids were required knowledge. Orthopedics was widely taught, and the use of plaster of Paris for casts after reduction of fractures was routinely shown to students. This method of treating fractures was re-discovered in the West in 1852. Although ophthalmology was practiced widely, it was not taught regularly in medical schools. Apprenticeship to an eye doctor was the preferred way of specializing in ophthalmology. Surgical treatment of cataract was very common. Obstetrics was left to midwives. Medical practitioners consulted among themselves and with specialists. Ibn Sina and Hazi both widely practiced and taught psychotherapy. After completing the training, the medical graduate was not ready to enter practice, until he passed the licensure examination. It is important to note that there existed a Scientific Association which had been formed in the hospital of Mayyafariqin to discuss the conditions and diseases of the patients.

Licensing of Physicians: In Baghdad in 931 A.D. Caliph Al-Muqtadir learned that a patient had died as the result of a physician’s error. There upon he ordered his chief physician, Sinan ibn Thabit bin Qurrah to examine all those who practiced the art of healing. In the first year of the decree more than 860 were examined in Baghdad alone. From that time on, licensing examinations were required and administered in various places. Licensing Boards were set up under a government official called Muhtasib or inspector general. The Muhtasib also inspected weights and measures of traders and pharmacists. Pharmacists were employed as inspectors to inspect drugs and maintain quality control of drugs sold in a pharmacy or apothecary. What the present Food and Drug Administration (FDA) is doing in America today was done in Islamic medicine 1,000 years ago. The chief physician gave oral and practical examinations, and if the young physician was successful, the Muhtasib administered the Hippocratic oath and issued a license. After 1,000 years licensing of physicians has been implemented in the West, particularly in America by the State Licensing Board in Medicine. For specialists we have American Board of Medical Specialties such as in Medicine, Surgery, Radiology, etc. European medical schools followed the pattern set by the Islamic medical schools and even in the early nineteenth century, students at the Sorbonne could not graduate without reading Ibn Sina’s Qanun (Cannon). According to Razi a physician had to satisfy two condition for selection: firstly, he was to be fully conversant with the new and the old medical literature and secondly, he must have worked in a hospital as house physician.

The development of efficient hospitals was an outstanding contribution of Islamic medicine. Hospitals served all citizens free without any regard to their color, religion, sex, age or social status. The hospitals were run by government and the directors of hospitals were physicians.

Hospitals had separate wards for male patients and female patients. Each ward was furnished with a nursing staff and porters of the sex of the patients to be treated therein. Different diseases such as fever, wounds, infections, mania, eye conditions, cold diseases, diarrhea, and female disorders were allocated different wards. Convalescents had separate sections within them. Hospitals provided patients with unlimited water supply and with bathing facilities. Only qualified and licensed physicians were allowed by law to practice medicine. The hospitals were teaching hospitals educating medical students. They had housing for students and house-staff. They contained pharmacies dispensing free drugs to patients. Hospitals had their own conference room and expensive libraries containing the most up-to-date books. According to Haddad, the library of the Tulum Hospital which was founded in Cairo in 872 A.D. (1,100 years ago) had 100,000 books. Universities, cities and hospitals acquired large libraries (Mustansiriyya University in Baghdad contained 80,000 volumes; the library of Cordova 600,000 volumes; that of Cairo 2,000,000 and that of Tripoli 3,000,000 books), physicians had their own extensive personal book collections, at a time when printing was unknown and book editing was done by skilled and specialized scribes putting in long hours of manual labour.

For the first time in history, these hospitals kept records of patients and their medical care.

From the point of view of treatment the hospital was divided into an out- patient department and an inpatient department. The system of the in-patient department differed only slightly from that of today. At Tulun hospital, on admission the patients were given special apparel while their clothes, money, and valuables were stored until the time of their discharge. On discharge, each patient – received five gold pieces to support himself until he could return to work.

The hospital and medical school at Damascus had elegant rooms and an extensive library. Healthy people are said to have feigned illness in order to enjoy its cuisine. There was a separate hospital in Damascus for lepers, while, in Europe, even six centuries later, condemned lepers were burned to death by royal decree.

The Qayrawan Hospital (built in 830 A.D. in Tunisia) was characterized by spacious separate wards, waiting rooms for visitors and patients, and female nurses from Sudan, an event representing the first use of nursing in Arabic history. The hospital also provided facilities for performing prayers.

The Al-Adudi hospital (built in 981 A.D. in Baghdad) was furnished with die best equipment and supplies known at the time. It had interns, residents, and 24 consultants attending its professional activities, An Abbasid minister, Ali ibn Isa, requested the court physician, Sinan ibn Thabit, to organize regular visiting of prisons by medical officers. At a time when paris and London were places of mud streets and hovels, Baghdad, Cairo, and Cordova had hospitals which incorporated innovations which sound amazingly modern. It was chiefly in the humaneness of patient care, however, that the hospitals of Islam excelled. Near the wards of those afflicted with fever, fountains cooled the air; the insane were treated with gentleness; and at night music and storytelling soothed the patients.

The Bimaristans (hospitals) were of two types – the fixed and the mobile. The mobile hospitals were transported upon beasts of burden and were erected from time to time as required. The physicians in the mobile clinics were of the same standing as those who served the fixed hospitals. Similar moving hospitals accompanied the armies in the field. The field hospitals were well equipped with medicaments, instruments, tents and a staff of doctors, nurses, and orderlies. The traveling clinics served the totally disabled, the disadvantaged and those in remote areas. These hospitals were also used by prisoners, and by the general public, particularly in times of epidemics.

Al-Razi was asked to choose a site for a new hospital when he came to Baghdad. First he deduced which was the most hygienic area by observing where the fresh pieces of meat he had hung in various parts of the city decomposed least quickly.

Ibn Sina stated explicitly that the bodily secretion is contaminated by foul foreign earthly body before getting the infection. Ibn Khatima stated that man is surrounded by minute bodies which enter the human system and cause disease.

In the middle of the fourteenth century “black death” was ravaging Europe and before which Christians stood helpless, considering it an act of God.

At that time Ibn al Khatib of Granada composed a treatise in the defense of the theory of infection in the following way: To those who say, “How can we admit the possibility of infection while the religious law denies it?” We reply that the existence of contagion is established by experience, investigation, the evidence of the senses and trustworthy reports. These facts constitute a sound argument. The fact of infection becomes clear to the investigator who notices how he who establishes contact with the afflicted gets the disease, whereas he who is not in contact remains safe, and how transmission is effected through garments, vessels and earrings.

Al-Razi wrote the first medical description of smallpox and measles – two important infectious diseases. He described the clinical difference between the two diseases so vividly that nothing since has been added. Ibn Sina suggested the communicable nature of tuberculosis. He is said to have been the first to describe the preparation and properties of sulphuric acid and alcohol. His recommendation of wine as the best dressing for wounds was very popular in medieval practice. However Razi was the first to use silk sutures and alcohol for hemostatis. He was the first to use alcohol as an antiseptic.

Ibn Sina originated the idea of the use of oral anesthetics. He recognized opium as the most powerful mukhadir (an intoxicant or drug). Less powerful anesthetics known were mandragora, poppy, hemlock, hyoscyamus, deadly nightshade (belladonna), lettuce seed, and snow or ice cold water. The Arabs invented the soporific sponge which was the precursor of modem anesthesia. It was a sponge soaked with aromatics and narcotics and held to the patient’s nostrils.

The use of anesthesia was one of the reasons for the rise of surgery in the Islamic world to the level of an honourable speciality, while in Europe, surgery was belittled and practiced by barbers and quacks. The Council of Tours in 1163 A.D. declared Surgery is to be abandoned by the schools of medicine and by all decent physicians.” Burton stated that “anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in civilized West.”

Al-Razi is attributed to be the first to use the seton in surgery and animal gut for sutures.

Abu al-Qasim Khalaf Ibn Abbas Al-Zahrawi (930-1013 A.D.) known to the West as Abulcasis, Bucasis or Alzahravius is considered to be the most famous surgeon in Islamic medicine. In his book Al-Tasrif, he described hemophilia for the first time in medical history. The book contains the description and illustration of about 200 surgical instruments many of which were devised by Zahrawi himself. In it Zahrawi stresses the importance of the study of Anatomy as a fundamental prerequisite to surgery. He advocates the re implantation of a fallen tooth and the use of dental prosthesis carved from cow’s bone, an improvement over the wooden dentures worn by the first President of America George Washington seven centuries later. Zahrawi appears to be the first surgeon in history to use cotton (Arabic word) in surgical dressings in the control of hemorrhage, as padding in the splinting of fractures, as a vaginal padding in fractures of the pubis and in dentistry. He introduced the method for the removal of kidney stones by cutting into the urinary bladder. He was the first to teach the lithotomy position for vaginal operations. He described tracheotomy, distinguished between goiter and cancer of the thyroid, and explained his invention of a cauterizing iron which he also used to control bleeding. His description of varicose veins stripping, even after ten centuries, is almost like modern surgery. In orthopedic surgery he introduced what is called today Kocher’s method of reduction of shoulder dislocation and patelectomy, 1,000 years before Brooke reintroduced it in 1937.

Ibn Sina’s description of the surgical treatment of cancer holds true even today after 1,000 years. He says the excision must be wide and bold; all veins running to the tumor must be included in the amputation. Even if this is not sufficient, then the area affected should be cauterized.

The surgeons of Islam practiced three types of surgery: vascular, general, and orthopedic, Ophthalmic surgery was a speciality which was quite distinct both from medicine and surgery. They freely opened the abdomen and drained the peritoneal cavity in the approved modern style. To an unnamed surgeon of Shiraz is attributed the first colostomy operation. Liver abscesses were treated by puncture and exploration.

Surgeons all over the world practice today unknowingly several surgical procedures that Zahrawi introduced 1,000 years ago .

The most brilliant contribution was made by Al-Razi who differentiated between smallpox and measles, two diseases that were hitherto thought to be one single disease. He is credited with many contributions, which include being the first to describe true distillation, glass retorts and luting, corrosive sublimate, arsenic, copper sulfate, iron sulphate, saltpeter, and borax in the treatment of disease . He introduced mercury compounds as purgatives (after testing them on monkeys); mercurial ointments and lead ointment.” His interest in urology focused on problems involving urination, venereal disease, renal abscess, and renal and vesical calculi. He described hay-fever or allergic rhinitis.

Some of the Arab contributions include the discovery of itch mite of scabies (Ibn Zuhr), anthrax, ankylostoma and the guinea worm by Ibn Sina and sleeping sickness by Qalqashandy. They described abscess of the mediastinum. They understood tuberculosis and pericarditis.

Al Ash’ath demonstrated gastric physiology by pouring water into the mouth of an anesthetized lion and showed the distensibility and movements of the stomach, preceding Beaumont by about 1,000 years” Abu Shal al- Masihi explained that the absorption of food takes place more through the intestines than the stomach. Ibn Zuhr introduced artificial feeding either by gastric tube or by nutrient enema. Using the stomach tube the Arab physicians performed gastric lavage in case of poisoning. Ibn Al-Nafis was the first to discover pulmonary circulation.

Ibn Sina in his masterpiece Al-Quanun (Canon), containing over a million words, described complete studies of physiology, patlhology and hygiene. He specifically discoursed upon breast cancer, poisons, diseases of the skin, rabies, insomnia, childbirth and the use of obstetrical forceps, meningitis, amnesia, stomach ulcers, tuberculosis as a contagious disease, facial tics, phlebotomy, tumors, kidney diseases and geriatric care. He defined love as a mental disease.

The doctors of Islam exhibited a high degree of proficiency and certainly were foremost in the treatment of eye diseases. Words such as retina and cataract are of Arabic origin. In ophthalmology and optics lbn al Haytham (965-1039 A.D.) known to the West as Alhazen wrote the Optical Thesaurus from which such worthies as Roger Bacon, Leonardo da Vinci and Johannes Kepler drew theories for their own writings. In his Thesaurus he showed that light falls on the retina in the same manner as it falls on a surface in a darkened room through a small aperture, thus conclusively proving that vision happens when light rays pass from objects towards the eye and not from the eye towards the objects as thought by the Greeks. He presents experiments for testing the angles of incidence and reflection, and a theoretical proposal for magnifying lens (made in Italy three centuries later). He also taught that the image made on the retina is conveyed along the optic nerve to the brain. Razi was the first to recognize the reaction of the pupil to light and Ibn Sina was the first to describe the exact number of extrinsic muscles of the eyeball, namely six. The greatest contribution of Islamic medicine in practical ophthalmology was in the matter of cataract. The most significant development in the extraction of cataract was developed by Ammar bin Ali of Mosul, who introduced a hollow metallic needle through the sclerotic and extracted the lens by suction. Europe rediscovered this in the nineteenth century.

Pharmacology took roots in Islam during the 9th century. Yuhanna bin Masawayh (777-857 A.D.) started scientific and systematic applications of therapeutics at the Abbasids capital. His students Hunayn bin Ishaq al-lbadi (809-874 A.D.) and his associates established solid foundations of Arabic medicine and therapeutics in the ninth century. In his book al-Masail Hunayn outlined methods for confirming the pharmacological effectiveness of drugs by experimenting with them on humans. He also explained the importance of prognosis and diagnosis of diseases for better and more effective treatment.

Pharmacy became an independent and separate profession from medicine and alchemy. With the wild sprouting of apothecary shops, regulations became necessary and imposed to maintain quality control.” The Arabian apothecary shops were regularly inspected by a syndic (Muhtasib) who threatened the merchants with humiliating corporal punishments if they adulterated drugs.” As early as the days of al-Mamun and al-Mutasim pharmacists had to pass examinations to become licensed professionals and were pledged to follow the physician’s prescriptions. Also by this decree, restrictive measures were legally placed upon doctors, preventing them from owning or holding stock in a pharmacy.

Methods of extracting and preparing medicines were brought to a high art, and their techniques of distillation, crystallization, solution, sublimation, reduction and calcination became the essential processes of pharmacy and chemistry. With the help of these techniques, the Saydalanis (pharmacists) introduced new drugs such as camphor, senna, sandalwood, rhubarb, musk, myrrh, cassia, tamarind, nutmeg, alum, aloes, cloves, coconut, nuxvomica, cubebs, aconite, ambergris and mercury. The important role of the Muslims in developing modern pharmacy and chemistry is memorialized in the significant number of current pharmaceutical and chemical terms derived from Arabic: drug, alkali, alcohol, aldehydes, alembic, and elixir among others, not to mention syrups and juleps. They invented flavorings extracts made of rose water, orange blossom water, orange and lemon peel, tragacanth and other attractive ingredients. Space does not permit me to list the contributions to pharmacology and therapeutics, made by Razi, Zahrawi, Biruni, Ibn Butlan, and Tamimi.

From freckle lotion to psychotherapy- such was the range of treatment practiced by the physicians of Islam. Though freckles continue to sprinkle the skin of 20th century man, in the realm of psychosomatic disorders both al-Razi and Ibn Sina achieved dramatic results, antedating Freud and Jung by a thousand years. When Razi was appointed physician-in-chief to the Baghdad Hospital, he made it the, first hospital to have a ward exclusively devoted to the mentally ill.”

Razi combined psychological methods and physiological explanations, and he used psychotherapy in a dynamic fashion, Razi was once called in to treat a famous caliph who had severe arthritis. He advised a hot bath, and while the caliph was bathing, Razi threatened him with a knife, proclaiming he was going to kill him. This deliberate provocation increased the natural caloric which thus gained sufficient strength to dissolve the already softened humours, as a result the caliph got up from is knees in the bath and ran after Razi. One woman who suffered from such severe cramps in her joints that she was unable to rise was cured by a physician who lifted her skirt, thus putting her to shame. “A flush of heat was produced within her which dissolved the rheumatic humour.”

The Arabs brought a refreshing spirit of dispassionate clarity into psychiatry. They were free from the demonological theories which swept over the Christian world and were therefore able to make clear cut clinical observations on the mentally ill.

Najab ud din Muhammad, a contemporary of Razi, left many excellent descriptions of various mental diseases. His carefully compiled observation on actual patients made up the most complete classification of mental diseases theretofore known.” Najab described agitated depression, obsessional types of neurosis, Nafkhae Malikholia (combined priapism and sexual impotence). Kutrib (a form of persecutory psychosis), Dual-Kulb (a form of mania) .

Ibn Sina recognized ‘physiological psychology’ in treating illnesses involving emotions. From the clinical perspective Ibn Sina developed a system for associating changes in the pulse rate with inner feelings which has been viewed as anticipating the word association test of Jung. He is said to have treated a terribly ill patient by feeling the patient’s pulse and reciting aloud to him the names of provinces, districts, towns, streets, and people. By noticing how the patient’s pulse quickened when names were mentioned Ibn Sina deduced that the patient was in love with a girl whose home Ibn Sina was able to locate by the digital examination. The man took Ibn Sina’s advice , married the girl , and recovered from his illness.

It is not surprising to know that at Fez, Morocco, an asylum for the mentally ill had been built early in the 8th century, and insane, asylums were built by the Arabs also in Baghdad in 705 A.D., in Cairo in 800 A.D., and in Damascus and Aleppo in 1270 A.D. In addition to baths, drugs, kind and benevolent treatment given to the mentally ill, musico-therapy and occupational therapy were also employed. These therapies were highly developed.

1,000 years ago Islamic medicine was the most advanced in the world at that time. Even after ten centuries, the achievements of Islamic medicine look amazingly modern. 1,000 years ago the Muslims were the great torchbearers of international scientific research. Every student and professional from each country outside the Islamic Empire, aspired, yearned, a dreamed to go to the Islamic universities to learn, to work, to live and to lead a comfortable life in an affluent and most advanced and civilized society. Today, in this twentieth century, the United States of America has achieved such a position. The pendulum can swing back. Fortunately Allah has given a bounty to many Islamic countries – an income over 100 billion dollars per year. Hence Islamic countries have the opportunity and resources to make Islamic science and medicine number one in the world, once again. 

Dr. Ibrahim B. Syed, Ph.D is Clinical Professor of Medicine, University of Louisville School of Medicine, Louisville, KY 40292 and President, Islamic Research Foundation International, Inc, 7102 W. Shefford Lane, Louisville, KY 40242-6462

by Ibrahim B. Syed. Edited by Shahid Athar, M. D. 

Shahid Athar M.D. is Clinical Associate Professor of Internal Medicine and Endocrinology, Indiana University School of Medicine Indianapolis, Indiana, and a writer on Islam.

Al-Zarqali: Astronomer and Inventor of Clocks

By Professor Irfan Shahid

Al-Zarqali, also called Arzachel in the West, was an early Muslim polymath from Spain – an astronomer and engineer – whose discoveries and inventions influenced a number of Islamic and European scientists, like Johannes Kepler and Regiomontanus.

Al-Zarqali was one of the several great scientists produced by Islamic Spain. He advanced the study of astronomy through his extensive observations.

He stated that Planetary Orbits are elliptical and not circular. He was also a mechanical engineer and maker of precision instruments. His public water-clocks and advanced astrolabe have been highly admired.

Abu Ishaq Ibrahim Ibn Yahya al Naqash Al-Zarqali was born in Qurtuba (Cordova) in 420 AH / 1029 CE. In the west, he was known as Arzachel. Al-Zarqali means ‘the blue-eyed.’

He belonged to a family of craftsmen who made several mechanical devices and inherited his family skill. Staying at Qurtuba (Cordoba) until he completed his education, he then moved to Talita (Toledo) where he entered the service of its Sultan al-Ma’mun. His job was to make instruments for the astronomers of al-Ma’mun who were engaged in a major research project on astronomy.

With hard work and by virtue of being highly talented, he soon became the director of the project. He spent a long fruitful year at Toledo, where he conducted extensive observations, made mechanical devices and astronomical instruments, and wrote a number of books.

His water clock of Toledo attracted huge attention. Jewish scholar Moses ben Ezra wrote a poem about it.

Leaving Toledo in 470 AH/ 1078 CE when it was repeatedly attacked by Alfonso VI, Al-Zarqali went to Cordoba where he continued his research.

He died in Cordova in 493 AH/ 1100 CE


Al- Zarqali wrote several books on astronomy and astronomical instruments and the most famous of his books is the Toledan Tables.

It deals with various aspects of astronomy, like the determination of the right ascensions, the equation of sun, moon and planets, ascendant, parallax, eclipses, the setting of planets, theory of trepidation, tables of stellar positions, trigonometrical tables etc.

The Toledan Tables was translated into Latin by Gerard of Cremona (d. 1187) and was highly popular in Europe and in the Islamic world.

His other works were also translated into Latin and Hebrew from the twelfth century onwards. In fact, some of his works are preserved in their Latin versions only, the Arabic originals having been lost.

He influenced a number of Islamic and European scientists, like Johannes Kepler and Regiomontanus.

Al-Zarqali stated that the orbits of planets are elliptical (and not circular) five centuries before Kepler (d. 1630). He established that, with reference to stars, the solar apogee is variable.

He determined the longitude of the Regulus; presented improved trigonometrical tables of sines, cosines, versed sines, secants and tangents; calculated the obliquity of the ecliptic at between 13.13” and 13.5”; presented the stereographic projection of the sphere on a plane etc.


Al-Zarqali constructed an advanced version of the astrolabe used in Europe for a long time as Sphaea (from al-Sahifa).

His two public water clocks set up at Toledo evoked great admiration. They consisted of a precise lunar calendar and two vessels which gradually filled while the moon was waxing and emptied as the moon waned.

They were fore-runners of the clocks and planetary calendar machines of the seventeenth century Europe. The clocks were in the use until 1133 when they were dismantled by orders of Alfonso VII to find out their workings but could not be restored.

Tipu Sultan’s Rockets – The World’s First War Rockets

“In this world, I would rather live two days like a tiger, than two hundred years like a sheep.” – Tipu Sultan

(- From Alexander Beatson’s book, A View of the Origin and Conduct of the War with Tippoo Sultan)


Rockets had been used in warfare since the 13th century. The Chinese had used them to defend themselves against Mongol invaders, the Mughals frequently used them on the battlefield and the Europeans had started experimenting with them by the 15th century.


However, these rockets were built with flimsy materials like cardboard and were not very effective in inflicting damage on the enemy, similar to modern-day firecrackers. Thus, their use as a weapon had been discarded in favour of cannons and other forms of artillery.

It was the de facto ruler of 18th century Mysore, Hyder Ali, who developed the first prototypes of sturdier explosives-filled rockets. His innovation was further fine-tuned by his son Tipu who planned, designed and crafted cylindrical iron tubes that would allow for great compression of the filled gunpowder and consequently, greater range (nearly 2 km).

Tipu then fastened them to swords or bamboo poles to provide stability, that would, in turn, lead to better accuracy. Thus, the predecessor of the modern rocket was born. It had a greater range, better accuracy and a far-more destructive bang than any other rocket in use, making it the best in the world at that time.

During the Anglo-Mysore wars of the late 1700s, Mysorean rockets were used by Tipu to great effect.

Especially during the Battle of Pollilur (the Second Anglo-Mysore War in 1780), when a devastating barrage by Tipu’s rocket corps set fire to the East India Company’s ammunition dumps to hand the British army one of its worst ever defeats in India.

The shocked British infantry had never seen the likes of them before and quite literally didn’t know what hit them. Such was their fear and confusion that British soldiers would go on to describe the iron tubes of gunpowder mounted on swords of Tipu’s army as “flying plagues”

Major Dirom, who was the deputy adjutant general of British forces in India in 1793, later described the rockets used by the Mysorean army as “Some of the rockets had a chamber, and burst like shells; others, called ground rockets, had a serpentine motion, and on striking the ground, rose again, and bounded along till their force be spent.”

Utilizing the advantage provided by the superior quality of hammered iron available in Mysore, Tipu also established four taramandalpets (that translates to ‘star-cluster bazaars’) at Srirangapatna, Bangalore, Chitradurga and Bidanur (present-day Nagara in central Karnataka in India) to conduct research on rocket technology.

At this medieval tech parks, craftsmen-turned-rocketmen (called jourks) conducted experiments to improve the iron casting, accuracy and range of the rockets. Furthermore, they were taught basic calculations to help them fine-tune launch settings that would allow rockets of different sizes and weights to hit targets varying distances and elevations. For instance, wheeled carts were fitted with multiple rocket ramps so as to allow the rocket artillery brigades (called cushoons) to launch about a dozen missiles at a time.

The many encounters in the 1700s between the colonial army and Tipu’s rocket corps also formed the basis for many interesting anecdotes. Here’s how one of them about Arthur Wellesley, the famous British hero of Waterloo.

In 1799, Wellesley (the Duke of Wellington) was on reconnoitering mission in an areca nut grove (near Srirangapatana) when he found himself under attack. Having never encountered Tipu’s rocket fire before, he was scared silly by the ferocious barrages and ran away from the scene.

Later, he was so abashed by his behavior that he promised himself that he would never show fear on the battlefield again. With time, he famously came to be known as a man who could not be rattled by anything. So, the Iron Duke’s spine of steel was actually forged in Srirangapatna!

Interestingly, APJ Abdul Kalam was fascinated by Srirangapatna’s historic connection with modern missiles. During his tenure as President, he was keen on preserving the Rocket Court (the laboratory where Tipu tested his rockets) and developing it as a museum — an idea that found mention in his book ‘Wings of Fire‘. At his behest, DRDO scientist Sivathanu Pillai (who later headed Brahmos Aero Space) visited the ruins to study the site. However, work is yet to begin in this regard.

As for the Mysorean missiles, after the fall of Srirangapattana in 1799, the British army found 600 launchers, 700 serviceable rockets and 9,000 empty rockets at Tipu’s fort. Many of these were sent to the Royal Artillery Museum in Woolwich (where two specimens are still preserved), inspiring it to start a a military rocket research and development program in 1801.

It was here that William Congreve started studying them and did some fine reverse engineering to invent the Congreve rocket (it had collapsible frames for launching). In a quirk of fate, it was Iron Duke Wellesley who would go on to use these Congreve rockets systematically against Napoleon and defeat him at Waterloo in June 1815.

Today, there is not much left in Srirangapatna (India) to stand testimony to one of the most interesting technological episodes in Indian history. The mark of Mysorean rockets on world military history, however, remains indelible.

“It was Tipu who first realized the full potential of rockets as weapons — both in his mind and on the field — and used them to create havoc in the East Indian Company lines. Thus, all the rockets in the world today can be traced to those used during the wars in Mysore.”