The bimaristan al-Nuri (1154) in Damascus contains in its western iwan Qur'anic inscriptions that are quite telling about the place of medicine and hospitals within Islamic society:
"O mankind! There has come unto you an admonition from your Lord, and a cure for all the ill that may be in men's hearts (X, 58). And lo! there issues from these a fluid of many hues, wherein is healing for mankind (XVI, 68). Who has created me and is the One who guides me, and is the One who gives me to eat and to drink, and when I fall ill, is the One who restores me to health, and who will cause me to die and then will bring me back to life, and who, I hope, will forgive my faults on Judgement Day (XXVI, 78-82)."
These verses deal with illness, medicine and healing, not as scientific abstractions, but as symptoms of divine grace. Humans are under God's mercy: He cures them when ill and provides for them medicine even from the entrails of a bee. Doctors and their preparations are mere instruments in the hands of God, who alone causes life, brings death, and predetermines the ajal of all mortals.
How did hospitals exist within this rather restrictive cultural space; and why were they deemed necessary in the first place? What forces led to their rise and spread to the entire Islamic world; and what factors contributed to their ultimate decline? What new perspective can we, as archaeologists and art historians, bring to the study of this important Islamic institutions; and how does this material perspective interpenetrate with social and medical perspectives? These questions stand at the center of my ongoing work on the architecture and sociomedical history of the medieval Islamic hospital.
Y. Tabbaa. Aleppo, bimaristan Arghun al-Kamili, 1354: main courtyard
Curiously, we find that whereas the first hospitals in Baghdad coincided with the peak of Islamic medicine in the ninth and tenth centuries, most in fact postdated this alleged by peak by several centuries. Rather than continuity with Abbasid practice, we are therefore entitled to speak of a revival of medicine in the middle of the twelfth century, spearheaded by hospitals and instigated by the patronage of Nur al-Din. In other words, although the theoretical medical advances of the previous centuries were already on the decline, the practice of Galenic medicine continued to be developed and refined within the confines of hospitals. The bimaristan, therefore, contributed toward the institutionalization of Islamic medicine and to the professionalization of physicians, features that are also paralleled by madrasas for the juridical sciences.
The functioning and continued prosperity of these hospitals rested directly on their financial endowments (waqf, pl. awqaf) and less directly on a tolerant intellectual climate. My research in various libraries and archives in Syria, Egypt and Turkey has confirmed the importance of the awqaf dedicated to theses hospitals, endowments that quite specifically prescribe - and perhaps for some time describe - the functioning of the hospital and the nature of its personnel. Viewed in relations to other documents, such as court registers and financial records, or through the eyes of later travellers, we discover a continuous process of encroachment on these endowments and even on the physical structure of the institution itself. For example, one of the main waqf properties of the bimaristan al-Nuri was the town of Qtaife and its adjacent khan, itself built by Nur al-Din. In the early seventeenth century, these properties were usurped through istibdal, and rededicated as endowments for the Hajj, which was of far greater concern for the Ottomans. Another document, a royal decree dated 1130/1718, stipulates that one nazir should be appointed to the two hospitals in Aleppo (al-Nuri and al-Kamili); his sole responsibility being to provide soup once a day for the inmates and bury them when they died. Two important hospitals with great properties had thereby become little more than a hospice and mortuary1.
Y. Tabbaa. Damascus, bimaristan al-Nuri, 1154: west iwan
As long as the intellectual climate permitted and provided its endowments remained intact, the bimaristan continued to treat the sick and insane, provide drugs and teach medicine. For several centuries during the silver age of Islam, it perpetuated and refined earlier medical practices but rarely went beyond them. Despite its high degree of development, the medieval Islamic hospital remained closely intertwined with pre-Islamic cosmologies and with the absolute power of God, contributing to the continuity of medicine long after the rejection of other rational sciences.
1The situation was, of course, significantly different in the Ottoman capitals of Edirne and Istanbul, where several large and well-endowed hospitals continued to perform their prescribed functions until the end of the nineteenth century.