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Bimaristan is a Persian word (بیمارستان bīmārestān) meaning hospital, with Bimar- from Middle Persian (Pahlavi) of vīmār or vemār, meaning "sick" plus -stan as location and place suffix. In the medieval Islamic world, the word "Bimaristan" was used to indicate a hospital in the modern sense, an establishment where the ill were welcomed and cared for by qualified staff. In this way, Muslim physicians were the first to make a distinction between a hospital and other different forms of healing temples, sleep temples, hospices, asylums, and leper-houses, all of which in ancient times were more concerned with isolating the sick and the mad from society "rather than to offer them any way to a true cure." The medieval Bimaristan hospitals are thus considered "the first hospitals" in the modern sense of the word. The first public hospitals, psychiatric hospitals and Medical schools/universities were also introduced by medieval Muslim physicians. Islamic hospitals are also considered the first academic medical centres.
- See also: Islamic medicine
Many hospitals were developed during the early Islamic era. They were called Bimaristan, which is a Persian word meaning "house [or place] of the sick." The idea of a hospital being a place for the care of sick people was taken from the early Caliphs. The bimaristan is seen as early as the time of the Prophet Muhammad, and the Prophet's mosque in the city of Madinah held the first Muslim hospital service in its courtyard. During the Ghazwah Khandaq (the Battle of the Trench), Muhammad came across wounded soldiers and he ordered a tent be assembled to provide medical care. Over time, Caliphs and rulers expanded traveling bimaristans to include doctors and pharmacists.
Umayyad Caliph Al-Walid ibn Abd al-Malik is often credited with building the first permanent Bimaristan in Damascus in 707 AD. The bimaristan had a staff of salaried physicians and a well equipped dispensary. It treated the blind, lepers and other disabled people, and also separated those patients with leprosy from the rest of the ill. Some consider this bimaristan no more than a lepersoria because it only segregated patients with leprosy. The first true Islamic hospital was built during the reign of Caliph Harun al-Rashid. The Caliph invited the son of chief physician, Jabril ibn Bukhtishu to head the new Baghdad bimaristan. It quickly achieved fame and led to the development of other hospitals in Baghdad.
After Sassanian Iran was conquered by Muslim Arab armies in 638, the Bimaristan survived the change of rulers and evolved into a public hospital with medical university and psychiatric facilities over the centuries under Muslim physicians.
The first permanent Bimaristan after Gundishapur was founded in 707 by the Islamic Caliph Al-Waleed bin Abdel Malek in Damascus. At the time, most Islamic hospitals had doctors that diagnosed and treated all patients, but the Bimaristan was unique in that it had doctors that specialized in certain diseases. Originally, these health centers were specifically for patients with specific afflictions such as pestilence and blindness, and all services were free of charge.
According to Sir John Bagot Glubb:
"By Mamun's time medical schools were extremely active in Baghdad. The first free public hospital was opened in Baghdad during the Caliphate of Haroon-ar-Rashid. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice. The first hospital in Egypt was opened in 872 AD and thereafter public hospitals sprang up all over the empire from Spain and the Maghrib to Persia."
Due to improved medical care, the average life expectancy in medieval Islamic society increased significantly. Other traditional agrarian societies are estimated to have had an average life expectancy of 20 to 25 years, while ancient Rome and medieval Europe are estimated at 20 to 30 years. The life expectancy of Islamic society diverged from that of other traditional agrarian societies, with several studies on the lifespans of Islamic scholars concluding that members of this occupational group enjoyed a life expectancy between 69 and 75 years. Such studies have given the following estimates for the average lifespans of religious scholars at various times and places: 72.8 years in the Middle East, 69–75 years in 11th century Islamic Spain, 75 years in 12th century Persia, and 59–72 years in 13th century Persia. However, Maya Shatzmiller considers these religious scholars to not be a representative sample of the general population. Conrad I. Lawrence estimates the average life expectancy (including infant mortality) in the early Islamic Caliphate to be above 35 years for the general population.
Mobile field hospitalsEdit
During the Muslim conquests, the Muslim armies during the time of Muhammad were reported to have had a mobile dispensary (i.e. field hospital) following them for the treatment of soldiers on the battlefield. In particular, a Muslim woman called Amina bint Qais at the age of seventeen was the youngest woman to lead a medical team in one of these early battles.
By the 10th century, doctors were often assigned to mobile medical teams to treat patients outside of the hospital. For example, Ali Ibn Isa assigned Sinan ibn Thabit the task of sending doctors to treat the inmates of prisons, who were likely to have diseases "in view of their numbers and the harshness of their whereabouts." He also asked Sinan to send a mobile medical team to tour the countryside of southern Iraq and treat the residents there, whether Muslim or non-Muslim, as well as the cattle.
According to historian Andrew C. Miller:
The bimaristans were of two types; mobile and fixed. The mobile bimaristan dates back to the time of the Prophet Muhammad. During the Ghazwah Khandaq (the Battle of the Ditch), a separate tent was erected for the wounded. Over time, Caliphs and rulers developed and extended these‘ MASH’ units into true travelling dispensaries with doctors and pharmacists. These bimaristans were transported upon beasts of burden. The physicians in the mobile clinics were of the same standing as those in fixed hospitals, and the field hospitals were well equipped with medicaments, instruments, tents, and a staff of doctors, nurses and orderlies. These mobile bimaristans allowed state services to reach the disabled, the disadvantaged, and those in remote areas. By the reign of the Seljuq Turkish Sultan Muhammad Saljuqi, the mobile bimaristan had become so extensive that its equipment needed forty camels to transport it.
Medical schools and universitiesEdit
The hospital was not just a place to treat patients, it also served as a medical school to educate and train students. Basic science preparation was learned through private tutors, self-study and lectures. Islamic hospitals were the first to keep written records of patients and their medical treatment. Students were responsible in keeping these patient records, which were later edited by doctors and referenced in future treatments.
The first medical schools and universities were founded in the medieval Islamic world, where academic degrees and diplomas (ijazah) were issued to students who were qualified to be a practising Doctor of Medicine. The hospitals, medical schools and universities had systems for the nomination and elections of a head doctor or deans who would have "led the jihad" of teaching the sciences of Islamic medicine, Fiqh, Hadith and Qur'an to medical students. Islamic hospitals were also the earliest to establish a system of internship and externship.
During this era, another lasting advancement was that of physician licensure, which became mandatory in the Abbasid Caliphate. In 931 AD, 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. According to medical historian Andrew C. Miller:
Consequently, he ordered Sinan ibn Thabit to examine all those who practiced the art of healing. Of the 860 medical practitioners he examined, 160 failed. 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 chief physician gave oral and practical examinations, and if the young physician was successful, the Muhtasib administered the Hippocratic Oath and issued a license to practice medicine.
Many bimaristans also contained medical schools for resident and student education. The ablest physicians—such as Al-Razi (Rhazes), Ibn Sina (Avicenna) and Ibn Zuhr (Avenzoar)—were both hospital directors and deans of medical schools. Only Jundi-Shapur and Baghdad had separate schools for teaching the basic sciences. Otherwise, these were taught at the same facility as the clinical instruction. Basic science preparation consisted of lessons from private tutors, self-study and lectures. Anatomy was taught through lectures, illustrations and ape dissections. Students also studied medicinal herbs and pharmacognosia. The clinical training was accomplished by assigning small student groups to experienced instructors for ward rounds, discussions, lectures and reviews. Therapeutics and pathology were taught early on. After a period of ward instruction, students were assigned to outpatient areas. The keeping of detailed medical records for every patient was the responsibility of the students, as detailed above.
In the 12th century, the Andalusian physician Ibn Zuhr ("Avenzoar" to the West) established surgery as an independent discipline of medicine, by introducing a training course designed specifically for future surgeons, in order that they be qualified before being allowed to perform operations independently, and for defining the roles of a general practitioner and a surgeon in the treatment of a surgical condition.
Also in the 12th century, Al-Nuri hospital, a famous teaching hospital in Egypt where many renowned physicians were taught, was built by Nur ad-Din Zangi. The hospital's medical school is said had elegant rooms, and a library which many of its books were donated by Zangi's physician, Abu al-Majid al-Bahili. A number of Muslim physicians and physicists graduated from there. Among the well-known students are Ibn Abi Usaybi'ah (1203–1270) the famous medical historian, and 'Ala ad-Din Ibn al-Nafis (d. 1289) whose discovery of pulmonary circulation and the lesser circulatory system marked a new step in the better understanding of human physiology and was the earliest explanation until William Harvey (1628).
Though medicine was most often taught at the Bimaristan teaching hospitals, there were also several madrasah medical schools dedicated to the teaching of medicine. For example, from the 155 madrasah colleges in 15th century Damascus, three of them were medical schools. In the Ottoman Empire, "Suleyman I added new curriculums to the Ottoman medreses of which one was medicine, which alongside studying of the Hadith was given highest rank."
Europe's first medical school, the Schola Medica Salernitana (later the University of Salerno), began as a monastery in the 9th century, and then during Arabic-Latin translation movement, beginning in the 11th century, it evolved into Europe's first medical school, modelled after the Islamic medical schools and teaching Islamic medicine.
The first psychiatric hospitals and insane asylums were built in the Islamic world as early as the 8th century. The first psychiatric hospitals were built by the Muslim Arabs in Baghdad in 705, Fes in the early 8th century, and Cairo in 800. Other famous psychiatric hospitals were built in Damascus and Aleppo in 1270. Many other Bimaristian hospitals also often had their own wards dedicated to mental health.
- See also: Islamic medicine
As hospitals developed during the Islamic civilization, specific characteristics were attained. Bimaristans were secular. They served all people regardless of their race, religion, citizenship, or gender. The Waqf documents stated nobody was ever to be turned away. The ultimate goal of all physicians and hospital staff was to work together to help the well-being of their patients. There was no time limit a patient could spend as an inpatient; the Waqf documents stated the hospital was required to keep all patients until they were fully recovered. Men and women were admitted to separate but equally equipped wards. The separate wards were further divided into mental disease, contagious disease, non-contagious disease, surgery, medicine, and eye disease. Patients were attended to by same sex nurses and staff. 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.
The largest hospital of the Middle Ages and pre-modern era was the Al-Mansuri Hospital, built in Cairo, Egypt, by Sultan Qalaun al-Mansur, in 1284. According to Will Durant, the hospital had a spacious quadrangular enclosure with four buildings around a courtyard "adorned with arcades and cooled with fountains and brooks." The hospital had "separate wards for diverse diseases and for convalescents", and had laboratories, a dispensary, out-patient clinics, kitchens, baths, a library, a religious place of worship, lecture halls, and "pleasant accommodations for the insane." Treatment was given for free to patients of all backgrounds, regardless of gender, ethnicity or income, while convalescents were offered disbursements on their departure so that they wouldn't need to return to work immediately. "The sleepless were provided with soft music, professional story-tellers, and perhaps books of history." The 14th century writer Al-Maqrizi described the hospital as follows:
I have founded this institution for my equals and for those beneath me, it is intended for rulers and subjects, for soldiers and for the emir, for great and small, freemen and slaves, men and women.
He ordered medicaments, physicians and everything else that could be required by anyone in any form of sickness; placed male and female attendants at the disposal of the patients, determined their pay, provided beds for patients and supplied them with every kind of covering that could be required in any complaint. Every class of patient was accorded separate accommodation: the four halls of the hospital were set apart for those with fever and similar complaints; one part of the building was reserved for eye-patients, one for the wounded, one for those suffering from diarrhoea, one for women; a room for convalescents was divided into two parts, one for men and one for women. Water was laid on to all these departments. One room was set apart for cooking food, preparing medicine and cooking syrups, another for the compounding of confections, balsams, eye-salves, etc. The head-physician had an apartment to himself wherein he delivered medical lectures. The number of patients was unlimited, every sick or poor person who came found admittance, nor was the duration of his stay restricted, and even those who were sick at home were supplied with every necessity.
The hospital was later "extended and improved. The nursing was admirable and no stint was made of drugs and appliances; each patient was provided with means upon leaving so that he should not require immediately to undertake heavy work." The influential Canadian physician William Osler noted that it "reads like that of a twentieth century institution with hospital units." According to Howard R. Turner, the medieval Islamic hospitals in Cairo, Baghdad and Damascus were no less advanced than the later hospitals of England's Victorian era.
According to medical historian Andrew C. Miller:
The Al-Mansuri bimaristan was one of the largest and most elaborate hospitals ever built. It had a total capacity of 8000 beds, and the annual income from endowments alone was one million dirhams. It freely served all citizens without regard for their colour, religion, sex, age or social status.
According to medical historian Andrew C. Miller:
Bimaristans also pioneered the development of written medical records. It was the students' responsibility to keep records of the patients and their medical treatment. These admirably detailed records were compiled, edited by clinicians, and formatted in a way that became known as ‘treatments based on repeated experience.
The Bimaristans were organized into two sections, one for men and one for women. Within those sections were halls, each for a specific disease and monitored by one or more doctors. Some examples of the specialized halls are the ones for internal diseases, patients that were splinted, delivery, and communicable diseases. The administration of the hospital was based on the employment of health workers that cleaned the hospital and took care of the patients, physicians; and the head doctor, called Al Saoor. The employees took shifts both day and night to ensure they were all well-rested. An extra wing, called Al Sharabkhana, also known as a pharmacy, was added to enable doctors to easily distribute medication. Bimaristans mainly had two goals: the welfare of their patients and to educate new physicians. An excerpt from Ibn Al-Ukhwah's book, Al-Hisbah reveals how the Bimaristan system made sure their patients were taken care of:
"The physician asks the patient about the cause of his illness and the pain he feels. He prepares syrups and other drugs, then writes a copy of the prescription to the parents attending with the patient. The following day he re-examines the patient and looks at the drugs and asks him how he feels, and accordingly advises the patient. This procedure is repeated every day until the patient is either cured or dies. If the patient is cured, the physician is paid. If the patient dies, his parents go to the chief doctor and present the prescriptions written by the physician. If the chief doctor judges that the physician has performed his job without negligence, he tells the parents that death was natural; if he judges otherwise, he informs them to take the blood money of their relative from the physician as his death was the result of his bad performance and negligence. In this honorable way they were sure that medicine was practiced by experienced, well trained personnel."
Once admitted into a Bimaristan, the patient can stay for as long as she/or he needed; there was no time limit. Once the patient has fully recovered, they were provided, not only with clean clothes, but with pocket money.
According to medical historian Andrew C. Miller:
Each hospital was equipped with its own pharmacy, library, lecture halls, mosque and occasionally a chapel for Christian patients. Musicians were employed to comfort and cheer patients via music therapy.
Upon admission, the patient's clothes and money were placed into trust. The patients received clean clothes and were freely given medication and food under physician supervision until they were cured. Upon discharge, the patient's possessions were returned to them and they were sent with clean clothes and a grant of money to compensate them for lost wages and aid them in establishing a new livelihood.
There was no limit to the time a patient could be treated as an inpatient, thus the patient could stay until he was fully recovered. Patients who were cured of their maladies but still too weak for discharge were transferred to the convalescent ward until they were healthy enough to leave.
Men and women occupied separate but equally equipped wards and were attended by nurses and orderlies of the same sex. There were separate wards for medicine, surgery, fever, wounds, mania and eye diseases.
The earliest recorded hospitals in the medieval Islamic world were more general than previous Bimaristans as they extended their services to the lepers and the invalid and destitute people. All treatment and care was free of charge and there was more than one physician employed in this hospital. Between the 8th and 12th centuries, Muslim hospitals developed a high standard of care. Hospitals built in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. Like modern hospitals which require physicians to wear white coats, medieval Islamic hospitals also had a dress code that required physicians to "wear clean, white clothes," as stated by Ibn Hazm in the 11th century.
Another unique feature of medieval Muslim hospitals was the role of female staff, who were rarely employed in ancient and medieval healing temples elsewhere in the world. Medieval Muslim hospitals commonly employed female nurses. Muslim hospitals were also the first to employ female physicians, the most famous being two female physicians from the Banu Zuhr family who served the Almohad ruler Abu Yusuf Ya'qub al-Mansur in the 12th century. This was necessary due to the segregation between male and female patients in Islamic hospitals. Later in the 15th century, female surgeons were illustrated for the first time in Şerafeddin Sabuncuoğlu's Cerrahiyyetu'l-Haniyye (Imperial Surgery).
In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists. These group of religious scholars offered medical services which included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a mental hospital and medical madrasa in Edirne, and a number of other early hospitals were also built in Turkey. Unlike in Greek temples to healing gods, the clerics working in these facilities employed scientific methodology far beyond that of their contemporaries in their treatment of patients.
After the Islamic waqf law (a form of trust law) and madrassah foundations were firmly established by the 10th century, the number of hospitals multiplied throughout throughout Islamic lands. In the 11th century, every Islamic city had at least several hospitals. Córdoba, Spain alone was reported to have had as many as 50 hospitals at the time of Abu al-Qasim al-Zahrawi (Abulcasis).
The waqf trust institutions funded the hospitals for various expenses, including the wages of doctors, ophthalmologists, surgeons, chemists, pharmacists, domestics and all other staff, the purchase of foods and remedies; hospital equipment such as beds, mattresses, bowls and perfumes; and repairs to buildings. The waqf trusts also funded medical schools, and their revenues covered various expenses such as their maintenance and the payment of teachers and students.
Muslim physicians set up some of the earliest dedicated hospitals. In the medieval Islamic world, hospitals were built in all major cities; in Cairo for example, the Qalawun Hospital could care for 8,000 patients, and a staff that included physicians, pharmacists, and nurses. One could also access a dispensary, and research facility that led to advances, which included the discovery of the contagious nature of diseases, and research into optics and the mechanisms of the eye. Muslim doctors were removing cataracts with hollow needles over 1000 years before Western physicians dared attempt such a task. Hospitals were built not only for the physically sick, but for the mentally sick also. One of the first ever psychiatric hospitals that cared for the mentally ill was built in Cairo. Hospitals later spread to Europe during the Crusades, inspired by the hospitals in the Middle East. The first hospital in Paris, Les Quinze-vingt, was founded by Louis IX after his return from the Crusade between 1254-1260.
Hospitals in the Islamic world were institutions which treated patients of all ethnic backgrounds and financial statuses, including patients who were male and female, civilian and military, child and adult, rich and poor, and Muslims and non-Muslims. Like modern hospitals, medieval Muslim hospitals were often large urban structures which served a variety of different purposes, including its roles as a centre of medical treatment, a home for patients recovering from illness or accidents, an insane asylum for patients suffering from mental illness, a retirement home for the elderly, a medical school for students, and an outpatient clinic dispensing medical drugs. The dispensaries of urban hospitals "prescribed accurate amounts of drugs of controlled composition."
Muslim hospitals were the first to feature competency tests for doctors, drug purity regulations, nurses and interns, and advanced surgical procedures. As the pathology of contagion was better understood by Muslim physicians, hospitals were created with separate wards for specific illnesses for the first time, so that people with contagious diseases could be kept away from other patients.
Most hospitals also had attached libraries. For example, Tulum Hospital in Cairo had 100,000 books in 872. In comparison, 14th century Europe's largest library, at the University of Paris, had only 400 volumes.
- See also: Islamic ethics
One of the features in medieval Muslim hospitals that distinguished them from their contemporaries was their higher standards of medical ethics. Hospitals in the Islamic world treated patients of all religions, ethnicities, and backgrounds, while the hospitals themselves often employed staff from Christian, Jewish and other minority backgrounds. Muslim doctors and physicians were expected to have obligations towards their patients, regardless of their wealth or backgrounds. The ethical standards of Muslim physicians was first laid down in the 9th century by Ishaq bin Ali Rahawi, who wrote the Adab al-Tabib (Conduct of a Physician), the first treatise dedicated to medical ethics. He regarded physicians as "guardians of souls and bodies", and wrote twenty chapters on various topics related to medical ethics, including:
- What the physician must avoid and beware of
- The manners of visitors
- The care of Remedy|remedies by the physician
- The dignity of the medical profession
- The examination of physicians
- The removal of corruption among physicians
On a professional level, al-Razi (Rhazes) introduced many practical, progressive, medical and psychological ideas in the 10th century. He attacked charlatans and fake doctors who roamed the cities and countryside selling their nostrums and 'cures'. At the same time, he warned that even highly educated doctors did not have the answers to all medical problems and could not cure all sicknesses or heal every disease, which was humanly speaking impossible. To become more useful in their services and truer to their calling, Razi advised practitioners to keep up with advanced knowledge by continually studying medical books and exposing themselves to new information. He made a distinction between curable and incurable diseases. Pertaining to the latter, he commented that in the case of advanced cases of cancer and leprosy the physician should not be blamed when he could not cure them. Razi felt great pity for physicians who took care for the well-being of princes, nobility, and women, because they did not obey the doctor's orders to restrict their diet or get medical treatment, thus making it most difficult being their physician. He also wrote the following on medical ethics:
"The doctor's aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose mortiferous remedies."
The earliest known prohibition of illegal drugs occurred under Islamic law, which prohibited the use of Hashish, a preparation of cannabis, as a recreational drug. Classical jurists in medieval Islamic jurisprudence, however, accepted the use of the Hashish drug for medicinal and therapeutic purposes, and agreed that its "medical use, even if it leads to mental derangement, remains exempt" from punishment. In the 14th century, the Islamic scholar Az-Zarkashi spoke of "the permissibility of its use for medical purposes if it is established that it is beneficial."
Most ancient and medieval societies believed that mental illness was caused by either demonic possession or as punishment from a god, which led to a negative attitude towards mental illness in Judeo-Christian and Greco-Roman societies. On the other hand, Islamic neuroethics and neurotheology held a more sympathetic attitude towards the mentally ill, as exemplified in Sura 4:5 of the Qur'an:
"Do not give your property which God assigned you to manage to the insane: but feed and cloth the insane with this property and tell splendid words to him."
This Qur'anic verse summarized Islam's attitudes towards the mentally ill, who were considered unfit to manage property but must be treated humanely and be kept under care by a guardian, according to Islamic law. This positive neuroethical understanding of mental health consequently led to the establishment of the first psychiatric hospitals in the medieval Islamic world from the 8th century, and an early scientific understanding of neuroscience and psychology by medieval Muslim physicians and psychologists, who discovered that mental disorders are caused by dysfunctions in the brain.
The first documented description of a peer review process is found in the Ethics of the Physician written by Ishaq bin Ali al-Rahwi (854–931) of al-Raha, Syria, who describes the first medical peer review process. His work, as well as later Arabic medical manuals, state that a visiting physician must always make duplicate notes of a patient's condition on every visit. When the patient was cured or had died, the notes of the physician were examined by a local medical council of other physicians, who would review the practising physician's notes to decide whether his/her performance have met the required standards of medical care. If their reviews were negative, the practicing physician could face a lawsuit from a maltreated patient.
Public health careEdit
Islamic cities also had an early public health care service. "The extraordinary provision of public bath-houses, complex sanitary systems of drainage (more extensive even than the famous Roman infrastructures), fresh water supplies, and the large and sophisticated urban hospitals, all contributed to the general health of the population." Competency tests were also carried out by medical authorities visiting hospitals and clinics "to regulate, in one way or another, the performance and competency of those providing medical care or active in the medical market-place."
Legacy and influenceEdit
According to medical historian Andrew C. Miller:
Building upon the inspiration afforded by the bimaristan at Jundi-Shapur, near- and middle-easterners transformed hospitals into institutionalized establishments for patient care, medical education and training. The complex structure and hierarchy of these hospitals, advent of medical records, physician licensure, government oversight and universal access to care set the example upon which later hospitals were modelled.
It is purely cultural nepotism to assert that western hospitals developed independently of their near-eastern predecessors, when Spain and Portugal (part of the Islamic empire for over 700 years) were riddled with bimaristans. Cordova alone had fifty major hospitals and the Granada bimaristan served as the model for the Hospital Real in Santiago di Compostela and later Granada hospital, commissioned by Ferdinand and Isabella. Physicians fleeing Spain moved on to establish academic medical centres in other European cities such as Salerno. Additionally, upon returning from a crusade, the Knights of St John were called ‘Hospitallers’ due to the hospitals they constructed based upon the Arabic model founded by Saladin. Between the Andalusian hospitals, those in the lands of the Crusades and the bimaristans, where westerners were treated along trade routs and during travel expeditions, westerners had extensive interactions with the bimaristans that were nearly 1000 years the predecessors of their western counterparts.
- ↑ Micheau, Françoise, "The Scientific Institutions in the Medieval Near East", pp. 991–2, in (Morelon & Rashed 1996, pp. 985-1007)
- ↑ Peter Barrett (2004), Science and Theology Since Copernicus: The Search for Understanding, p. 18, Continuum International Publishing Group, ISBN 056708969X.
- ↑ 3.0 3.1 Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", Journal of the Islamic Medical Association, 2002 (2), p. 2-9 [7-8].
- ↑ 4.0 4.1 4.2 Sir Glubb, John Bagot (1969), A Short History of the Arab Peoples, http://www.cyberistan.org/islamic/quote2.html#glubb, retrieved 2008-01-25
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 Miller, Andrew C (December 2006). "Jundi-Shapur, bimaristans, and the rise of academic medical centres", Journal of the Royal Society of Medicine, pp. 615–617.
- ↑ Horden, Peregrine (Winter 2005). "The Earliest Hospitals in Byzantium, Western Europe, and Islam". Journal of Interdisciplinary History 35 (3): 361–389.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Nagamia, Hussain (October 2003). "Islamic Medicine History and Current Practice". Journal of the International Society for the History of Islamic Medicine 2 (4): 19–30. Retrieved on 1 December 2011.</cite>
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 <cite style="font-style:normal">Rahman, Haji Hasbullah Haji Abdul (2004). "The development of the Health Sciences and Related Institutions During the First Six Centuries of Islam". ISoIT: 973–984.</cite> </li>
- ↑ Shatzmiller, Maya (1994), Labour in the Medieval Islamic World, Brill Publishers, pp. 63-4 & 66, ISBN 90-04-09896-8, "At the same time, the “demographic behaviour” of the Islamic society as an agricultural society varied in some significant aspects from other agricultural societies, particularly in ways which could explain a decline in birth rate. It is agreed that all agricultural societies conform to a given demographic pattern of behaviour, which includes a high birth-rate and a slightly lower death-rate, significant enough to allow a slow population increase of 0.5 to 1.0 per cent per year. Other demographic characteristics of this society are high infant mortality, with 200-500 deaths per 1000 within the first year of birth, a lower average life expectancy, of twenty to twenty-five years, and a broadly based population pyramid, where the number of young people at the bottom of the pyramid is very high in relationship to the rest of the population, and that children are set to work at an early stage. Islamic society diverged from this demographic profile in some significant points, although not always consistently. Studies have shown that during certain periods, such factors as attitudes to marriage and sex, birth control, birth and death rates, age of marriage and patterns of marriage, family size and migration pattems, varied from the traditional agricultural model. [...] Life expectancy was another area where Islamic society diverged from the suggested model for agricultural society." </li>
- ↑ "Life expectancy (sociology)", Encyclopædia Britannica, http://www.britannica.com/eb/topic-340119/life-expectancy, retrieved 2010-04-17, "In ancient Rome and medieval Europe the average life span is estimated to have been between 20 and 30 years." </li>
- ↑ Shatzmiller, Maya (1994), Labour in the Medieval Islamic World, Brill Publishers, p. 66, ISBN 90-04-09896-8, "Life expectancy was another area where Islamic society diverged from the suggested model for agricultural society. No less than three separate studies about the life expectancy of religious scholars, two from 11th century Muslim Spain, and one from the Middle East, concluded that members of this occupational group enjoyed a life expectancy of 69, 75, and 72.8 years respectively!" </li>
- ↑ Shatzmiller, Maya (1994), Labour in the Medieval Islamic World, Brill Publishers, p. 66, ISBN 90-04-09896-8 </li>
- ↑ Bulliet, Richard W. (April 1970), "A Quantitative Approach to Medieval Muslim Biographical Dictionaries", Journal of the Economic and Social History of the Orient (Brill Publishers) 13 (2): 195–211  </li>
- ↑ Ahmad, Ahmad Atif (2007), "Authority, Conflict, and the Transmission of Diversity in Medieval Islamic Law by R. Kevin Jaques", Journal of Islamic Studies 18 (2): 246–248 , Error: Bad DOI specified </li>
- ↑ Shatzmiller, Maya (1994), Labour in the Medieval Islamic World, Brill Publishers, p. 66, ISBN 90-04-09896-8, "This rate is uncommonly high, not only under the conditions in medieval cities, where these ‘ulama’ lived, but also in terms of the average life expectancy for contemporary males. [...] In other words, the social group studied through the biographies is, a priori, a misleading sample, since it was composed exclusively of individuals who enjoyed exceptional longevity." </li>
- ↑ Conrad, Lawrence I. (2006), The Western Medical Tradition, Cambridge University Press, p. 137, ISBN 0521475643 </li>
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