Bimaristan: the hospital that began as a house for the sick

Visit a large public hospital and you find a familiar system. A doctor first examines the patient in the OPD and writes a prescription. The medicine comes from the hospital’s own dispensary. If needed, the patient is admitted to the relevant ward. Medical students can be seen going round the wards with their teachers. This structure is not new. Many of its foundations lie in institutions more than a thousand years old, which were called “bimaristans”.

A Persian word

According to Encyclopaedia Iranica, “bimaristan” comes from the Persian word “bimar” and the suffix “stan”, which denotes a place. It means a place for the sick. The word and its shorter form, “marestan”, both passed into Arabic. The Persian names of several hospital posts also entered Arabic.

According to Iranica, the oldest hospital in Iran about which some information is available was at Jundishapur. It had a medical school attached to it. It is not known when it was founded.

From Jundishapur to Baghdad

According to Iranica, the Abbasid caliph al-Mansur (died 775 CE) summoned Jirjis ibn Jibril, head of the Jundishapur hospital, to Baghdad for his own treatment. After that, physicians from Jundishapur, especially members of the Bukhtishu family, gradually moved to Baghdad. They played an important part in the advance of medicine there.

In an article published in 2006 in the Journal of the Royal Society of Medicine in Britain, Dr Andrew Miller writes that the first permanent bimaristan of Baghdad, on which historians generally agree, was set up in the reign of Caliph Harun al-Rashid (786 to 809 CE). Jibrail ibn Bukhtishu was called to head it. The hospital soon became famous. Many more bimaristans were then built in Baghdad and other cities.

How it worked inside

According to Iranica, a large bimaristan was usually divided into two parts: a department for outpatients and an infirmary for inpatients. After examination, an outpatient was given a prescription, which was filled at the hospital’s dispensary. If admission was needed, the patient was sent to the relevant ward. The wards were separate by disease, for example wards for internal diseases, bone-setting, surgery and eye diseases. Each ward had physicians and attendants in proportion to the number of patients.

According to Iranica, physicians stood at the top of this hierarchy. Below them, male and female attendants did work similar to that of nurses today. The actual administrator of a hospital was always a physician. The buildings were usually put up in clean parts of the city, close to the best water. They also had quarters for physicians and students.

According to Miller, the wards for men and women were separate but equally equipped. Large hospitals had their own dispensary, library and lecture halls. Miller also writes that bimaristans came to keep written records of patients. Students wrote them and experienced physicians corrected them.

Where the money came from

According to Iranica, hospitals were generally run on the income of properties permanently endowed for the purpose, or on donations from the wealthy, ministers and other well-off people. Salaries of physicians and staff, treatment, medicines, upkeep and patients’ food were all paid from this income. The hospital thus had a steady source of funds.

A school of medicine

Bimaristans were not only places of treatment. According to Iranica, they were the principal centres of medical education and granted diplomas to their graduates. Physicians were paid for teaching as well as for treating patients. According to Miller, students toured the wards in small groups with experienced teachers and attended lectures. This is the same method used in teaching hospitals today.

Miller also recounts an incident. In 931 CE, a patient died in Baghdad because of a physician’s error. Caliph al-Muqtadir ordered that the city’s physicians be examined. According to Miller, the physician Sinan ibn Thabit examined 860 physicians.

Damascus and Cairo

Two bimaristans became especially famous in the 12th and 13th centuries. According to a research article published in 2007 in the Annals of Saudi Medicine, the “Nuri Bimaristan” of Damascus was founded by Nur al-Din Mahmud ibn Zanki after 1154 CE. Ibn al-Nafis, the noted physician of the 13th century, began his medical studies there.

According to the same article, the “Mansuri Bimaristan” of Cairo was built in 1284 CE by the Mamluk sultan al-Mansur Qalawun. In the last days of his life, Ibn al-Nafis gave his house and library to this new hospital. According to Miller, the hospital treated every citizen free of charge, whatever his colour, sex, age or social standing. An inpatient could stay as long as necessary. There was a separate ward for patients who had recovered but were still weak.

The hospital today

Look at the OPD, dispensary, separate wards, patient files and medical students going round the wards in a large hospital in Quetta or any other city, and a glimpse of the bimaristan is plain to see. The idea of the hospital was not invented by one person. But the bimaristans brought treatment, medicine, teaching and permanent financial arrangements together under one roof. This is the structure on which the modern hospital stands today.