National Heart Institute, Cairo, Egypt (Winter 2015)
Around 1248 AD, when Islam was at its prime and the Nile was wide, and its seven delta branches coursed through the land with a heavy network of connecting channels in place of the two branches left today, there was the Bimaristan al-Mansouri, with water channels from the Nile running through the hospital to fresh water fountains. There patients were given fresh clean hospital clothing, and their valuables were safely stored away on admission. Their accommodations included a fresh clean bed with new pillowcases, sheets, and blankets in a ward with patients being treated for the same illness they were suffering from.
The breeze was fragrant with chlorophyll from the fields, papyrus, and the grass of the Nile; and the smell of fertile muddy waters mingled with the smell of the Nile flowers. Lilies danced with the breeze in the morning sunlight and bobbed in the moonlight reflection of the Nile at night; and those in the psychiatric ward, like all the other inpatients, would savor the rejuvenating vibes of the music therapy amidst the story-telling nightly gaiety. The invention of the hospital was one of the greatest achievements of Islamic medicine, its mission being to treat of all people who came to it regardless of their status.1
It was a prosperous time, when papyrus was used to make the invaluable medicinal volumes, as well as reed boats, mats, ropes, sandals, and baskets. Patients were admitted for free, treated and fed for free, and given food and money in compensation for being out of work during their hospital stay. For the less fortunate, a funeral with all of its proceedings was arranged also for free.
Al-Mansouri, one of the first hospitals ever, would accommodate some 4000-8000 patients at any one time. It had a colossal domed lecture hall, a library, a school, an orphanage, and a mosque for Muslim patients, along with a chapel for Christian patients (as the teachings of Islam mandate freedom of worship). Although the money came from the endowment of the Muslim money house, the hospital was run by the state. Treatment covered not only in-hospital treatment but also house calls. A guiding text called the “Waqf document,” which was written in compliance with Islamic principles, stated:
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, rich or poor, employed or unemployed, blind or sighted, 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 Allah, the generous one.1
Life in Islam stresses the upholding of harmony and equality in society.
Bimaristan (hospital) is a word of Persian origin, “bimar” meaning disease and “stan” location – thus ” a location of disease.” The bimaristan was truly the mother of modern-day hospitals, with housing facilities for the students and staff. It had doctors, doctors’ assistants, students, nurses, nurses’ assistants, janitors, laundry facilities and workers, a kitchen with a chef and his assistants, a medicinal manufacturing plant, and dispensary.
Administration included the chief of physicians along with a non-medical manager and accountants to manage the endowment money and give salaries, buy hospital equipment and supplies, and provide maintenance of the premises.
The bimaristan system provided separate wards for men and women as well as for different diseases, especially contagious ones. Each ward had additional sections for convalescents. Male nurses attended the men and female nurses the women. There was unlimited bathing and fresh water supplies for all—for special patients whose conditions entailed obligatory bathing, as well as for Muslim patients and staff to wash for prayers (wudu/ablusion) at least five times a day.
Only qualified physicians could practice there. To qualify they had to study the theoretical sciences and were mentored under the chief physician in patient examination, disease diagnosis, and management. They then had to pass an examination in order to graduate and work under the state’s supervision. Each physician had his own extensive personal book collection, arduously written by hand and edited by professional scribes; and the Cairo library alone held two million volumes. Muslim hospitals were the first ever to archive patient records and their treatments. It was a time when chemistry became an advanced science and pharmacy became a subject of its own.2
It is not surprising that Bimaristan Al-Mansouri followed the system set up for bimaristans by the physicians of the Islamic world. At the time bimaristans were built on top of hills or near rivers to provide an optimum healthy atmosphere. They had to undergo regular inspections by an authoritative figure assigned by the caliph to follow up on the patients, their food, their medications, and the service they were receiving, including that of their attending physicians in pursuance of a high level of quality, medically and administratively.3
The physicians worked in shifts to allow for rest and continue top-quality performance. The attending physician would make his daily rounds, following up and recording his observations on each patient’s card, which was kept on the patient as well as recorded in the registry. He based his therapy on his observations and should he need guidance, he would consult the head of his division or the chief physician. Cases were regularly discussed at scheduled staff meetings.3
Proceedings in the outpatient clinic as quoted from al-Hisbah, written by Ibn al-Ukhwa:
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.3
The scholar Ibn al-Nafis started working at al-Mansouri bimaristan at age twenty-nine. His last work: Alkitab alshamel fi altib, or the 43-volume Comprehensive Book on the Art of Medicine, corrected common beliefs and replaced the Avicenna book of medicine in all the hospitals at the time. On his death in 1288 he donated his house, library, and clinic to Bimaristan al-Mansouri (a copy of The Comprehensive Book on the Art of Medicine is located in the Prussian State Library in Berlin at Albert-Ludwig’s University in Germany). The main emphasis of his life’s work, which was not fully comprehended until modern times, was on:
- The anatomy of two ventricles.
- Absence of pores in the interventricular septum.
- The concept that blood flows from the right ventricle to the lungs to mix with air.
- The presence of a porous system of blood vessels that form a capillary network to make the passage of air into pulmonary circulation – at a time when no microscopes were available. He called this system the Nafisian system.
- In the lungs blood mixes with air and then passes to left heart chambers.
- The ventricles take their nourishment from the blood flowing in the vessels in its substance, in other words, from the coronary arteries.
Civilizations rise and fall. The Nile no longer floods the lands with its fertile waters and Al-Mansouri bimaristan no longer has a “Nile-view.” The only specialty practiced in it today is ophthalmology, currently under supervision of the ministry of health of a “third world country.”
- Ilene Springer, “Egypt: The Invention of the Hospital A Credit to Islamic Medieval Medicine”, last accessed 12/12/2014, http://www.touregypt.net/featurestories/hospital.htm
- Ibrahim B. Syed, Ph. D. ,President Islamic Research Foundation International, Inc, “Efficient Hospitals: Islamic Medicine’s Contribution to Modern Medicine”, last accessed 12/12/2014, http://www.irfi.org/articles/articles_1_50/islamic_hospital.htm
- SharifKaf Al-Ghazal, The Origin of Bimaristans in Islamic Medical History, last accessed 12/9/2014, http://www.onislam.net/english/health-and-science/science/441856-the-origin-of-bimaristans-in-islamic-medical-history.html
MONA YOUSSEF, MD, PGDIM, ECB is a consultant cardiologist at the Egyptian National Heart Institute and coordinator of the Egyptian Cardiology Board Fellowship at the Institute. Founder of CardiologyLinks Educational Plaza website, Youssef is also a AHA Basic and Advanced CPR instructor and NHI Training Center Assistant Coordinator. She completed her pre-University schooling was at Ames, Iowa and is a medical graduate of al-Kasr al-Aini Medical School, with a residency was in the ICU. She has a post-graduate diploma in internal medicine and is a member of the Egyptian Cardiology Board.