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PAS : KE ARAH PEMERINTAHAN ISLAM YANG ADIL
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Islamic Culture and the Medical Arts
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Hospitals
The hospital was one of the great achievements of medieval Islamic society.
The relation of the design and development of Islamic hospitals to the
earlier and contemporaneous poor and sick relief facilities offered by some
Christian monasteries has not been fully delineated. Clearly, however, the
medieval Islamic hospital was a more elaborate institution with a wider
range of functions.
In Islam there was generally a moral imperative to treat all the ill
regardless of their financial status. The hospitals were largely secular
institutions, many of them open to all, male and female, civilian and
military, adult and child, rich and poor, Muslims and non-Muslims. They
tended to be large, urban structures.
The Islamic hospital served several purposes: a center of medical treatment,
a convalescent home for those recovering from illness or accidents, an
insane asylum, and a retirement home giving basic maintenance needs for the
aged and infirm who lacked a family to care for them. It is unlikely that
any truly wealthy person would have gone to a hospital for any purpose,
unless they were taken ill while traveling far from home. Except under
unusual circumstances, all the medical needs of the wealthy and powerful
would have been administered in the home or through outpatient clinics
dispensing drugs. Though Jewish and Christian doctors working in hospitals
were not uncommon, we do not know what proportion of the patients would have
been non-Muslim.
An Islamic hospital was called a bimaristan, often contracted to maristan,
from the Persian word bimar, `ill person', and stan, `place.' Some accounts
associate the name of the early Umayyad caliph al-Walid I, who ruled from
705 to 715 (86-96 H), with the founding of a hospice, possibly a
leprosarium, in Damascus. Other versions, however, suggest that he only
arranged for guides to be supplied to the blind, servants to the crippled,
and monetary assistance to lepers.
The earliest documented hospital established by an Islamic ruler was built
in the 9th century in Baghdad probably by the vizier to the caliph Harun
al-Rashid. Few details are known of this foundation. There is no evidence to
associate the construction of the earliest hospital with any of the
Christian physicians from Gondeshapur in southwest Iran, but the prominence
of the Bakhtishu` family as court physicians would suggest that they also
played an important role in the function of the first hospital in Baghdad.
In little more than a hundred years, 5 additional bimaristans had been built
in Baghdad. According to some accounts, directions were given by a vizier in
the early 10th century to provide medical care to prisons on a daily basis
and visits by doctors with a traveling dispensary to villages in lower Iraq.
The most important of the Baghdad hospitals was that established in 982 (372
H) by the ruler `Adud al-Dawlah. When it was founded it had 25 doctors,
including oculists, surgeons, and bonesetters. In 1184 (580 H) a traveller
described it as being like an enormous palace in size.
In Egypt, the first hospital was built in the southwestern quarter of
present-day Cairo in 872 (259 H) by Ahmad ibn Tulun, the `Abbasid governor
of Egypt. It is the earliest for which there is clear evidence that care for
the insane was provided. By the end of the century, two hospitals were also
said to have been built in Old Cairo (Fustat), though the evidence on this
point is questionable. In the 12th century, Saladin founded the Nasiri
hospital in Cairo, but it was surpassed in size and importance by the
Mansuri, completed in 1284 (638 H) after eleven months of construction. The
Mansuri hospital remained the primary medical center in Cairo through the
15th century. The Nuri hospital in Damascus was a major one from the time of
its foundation in the middle of the 12th century well into the 15th century,
by which time the city contained 5 additional hospitals.
Besides those in Baghdad, Damascus, and Cairo, hospitals were built
throughout Islamic lands. In al-Qayrawan, the Arab capital of Tunisia, a
hospital was built in the 9th century, and early ones were established at
Mecca and Medina. Iran had several, and the one at Rayy was headed by
al-Razi prior to his moving to Baghdad. Ottoman hospitals flourished in
Turkey in the 13th century, and there were hospitals in the Indian
provinces. Hospitals were comparatively late in being established in Islamic
Spain, the earliest possibly being built in 1397 (800 H) in Granada.
Of the great Syro-Egyptian hospitals of the 12th and 13th centuries, we
possess a considerable amount of information. They were built on a cruciform
plan with four central iwans or vaulted halls, with many adjacent rooms
including kitchens, storage areas, a pharmacy, some living quarters for the
staff, and sometimes a library. Each iwan was usually provided with
fountains to provide a supply of clean water and baths. There was a separate
hall for women patients and areas reserved for the treatment of conditions
prevalent in the area -- eye ailments, gastrointestinal complaints
(especially dysentery and diarrhoea), and fevers. There was also an area for
surgical cases and a special ward for the mentally ill. Some had an area for
rheumatics and cold sufferers (mabrudun). There frequently were out-patient
clinics with a free dispensary of medicaments. The staff included
pharmacists and a roster of physicians who were required at appointed times
to be in attendance and make the rounds of patients, prescribing
medications. These were assisted by stewards and orderlies, as well as a
considerable number of male and female attendants who tended the basic needs
of the patients. There were also instructors (mu`allimun), possibly aspiring
medical students, who trained the non-professional staff. The budget of such
institutions must have been considerable, and in fact the budget of the
Mansuri hospital in Cairo was the largest of any public institution there.
Over the entire staff and responsible for the management of the hospital was
an administrator who was not usually trained in medicine. In most instances
he was a political appointment, subject to the unpredictable fluctuations of
political favor, for the position of controller of a hospital was a very
lucrative one. The chief of staff, on the other hand, was a medical man.
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[639x532 8-bit color GIF, 268274 bytes]
Individual organs drawn in inks and opaque watercolors. Two of six leaves of
anatomical drawings appended to a Persian translation of an Arabic medical
compendium. On the righthand page are the liver with gallbladder, the
stomach with intestines, the testicles, and detail of the stomach. On the
left are a composite rendering of the tongue, larynx, heart, trachea,
stomach and liver; a composite drawing of the ureters, urethra, kidneys,
testicles, and penis; and a composite rendering of the bladder with female
genitalia, womb and foetus. Undated, probably 18th century India. NLM MS
P20, fols. 556-557a
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All the hospitals in Islamic lands were financed from the revenues of pious
bequests called waqfs. Wealthy men, and especially rulers, donated property
as endowments, whose revenue wen
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