The Bimaristan and the Doctor Who Doubted Galen
The Islamic Golden AgeA Death, and an Examination
In 931 a man in Baghdad died because a physician got something wrong. The caliph al-Muqtadir responded by ordering his market inspector to let nobody practise medicine in the city without a licence from the court physician, Sinan ibn Thabit. The figure usually given is more than 860 examined — but the tellings differ over whether 860 sat the test or 860 passed it, and the number reaches us through Arabic biographical dictionaries compiled roughly three centuries afterwards, not through any surviving register from 931. Read it as an order of magnitude rather than a count. What it does establish is a city with enough working physicians, and enough institutions employing them, that vetting them had become a job worth inventing.
Borrowed Before It Was Built
The bimaristan did not appear from nothing. Byzantine Christianity had the xenodocheion, a hostel for travellers, the poor and the sick; Syriac-speaking monasteries ran sick-relief; Sasanian Persia had its own medical culture, and Sanskrit medical works reached Baghdad in translation. The Abbasid court's own physicians were, for generations, Nestorian Christians — the Bukhtishu family, serving caliph after caliph from the 760s onward. The tidiest version of the story routes all of this through a great teaching hospital at Gondeshapur in south-west Iran. Michael Dols argued in 1987 that this origin story rests largely on late and legendary material, and historians still disagree about what actually stood there. The transmission is real; the neat founding scene is not.
Wards, Wages and Endowments
A hospital is recorded in Baghdad around 800, founded under Harun al-Rashid, but nothing survives that describes it. The earliest Islamic hospital we know much about is the one Ahmad ibn Tulun built at Fustat, now part of Old Cairo, between 872 and 874: treatment without charge, patients' clothes and valuables taken in at the door and returned on discharge, separate bathhouses for men and women. In 918 al-Muqtadir founded two in Baghdad — one at the Bab al-Sham funded at 200 dinars a month, one on the east bank named for his mother. Such places were increasingly tied to waqf, a charitable endowment that could let a hospital outlive the patron who paid for it. The vizier Ali ibn Isa wrote to Sinan telling him to send physicians into the prisons daily with medicines, and doctors out to the villages of the Sawad. Much of the vivid detail, though, comes from historians writing centuries afterwards, and the tenth-century picture is thinner than the retellings suggest.
The Man from Rayy
Muhammad ibn Zakariyya al-Razi was born at Rayy, near modern Tehran, in 864 or 865; he ran hospitals there and in Baghdad and died around 925, though some sources say 935. The book that carries his name, al-Hawi, is not the encyclopedia he sat down and wrote. It is a posthumous compilation from his working papers — largely excerpts from Greek, Indian and Arabic authorities, with his own bedside observations set beside them to see whether they held. A separate collection, the Casebook, gathers some nine hundred clinical accounts assembled by his students, the largest body of case records to survive from medieval Islamic medicine. His treatise separating smallpox from measles was still being printed in Arabic with a facing Latin translation in London in 1766.
Doubts About Galen
Then there is the book called Doubts About Galen. Al-Razi admired Galen and said so; his defence was that Galen had corrected his own predecessors. But the wards gave him numbers that would not obey. Of roughly two thousand patients, he reports, about three hundred developed contrary to what the rule predicted — and a careful mind, he warned, should not expect utmost certainty from such methods. He could only make that argument because the previous century had put Galen so completely into Arabic that a working doctor could hold him up against a ward. One much-loved story has al-Razi siting a hospital by hanging meat around Baghdad and building where it rotted slowest. No contemporary records it, the versions disagree over which hospital, and one common telling attaches it to a foundation of 981 — decades after he was dead. The counted patients are the better story.
Key Dates to Remember
- 864/865 — Muhammad ibn Zakariyya al-Razi born at Rayy, near modern Tehran; sources give both years
- 872-874 — Ahmad ibn Tulun's hospital built at Fustat — the earliest Islamic hospital about which substantial detail survives
- 918 — Caliph al-Muqtadir founds two hospitals in Baghdad; the Bab al-Sham foundation is funded at 200 dinars a month under Sinan ibn Thabit
- c. 925 — Al-Razi dies at Rayy; a minority of sources place his death in 935. Al-Hawi and the Casebook are assembled after him
- 931 — After a fatal medical error, al-Muqtadir orders Baghdad's physicians licensed by Sinan ibn Thabit; later sources report more than 860 examined