MARISTAN (HOSPITALS) IN MEDIEVAL SPAIN

S. M. Imamuddin
Introduction of rice, sugar, orange, paper, alambique (an instrument
for distillation) and the art of ship building in Spain along with other
oriental products and their knowledge was complete by the 10th century
of Christian era. It is curious that Medieval Spain made laudable progress
in medical science from the 10th century and reached its zenith in the 12th
but the hospital service received little attention from historians
and geographers although works on medical science were written widely.
Edifices did not survive the political outrages and Arabic literature, which
could escape the horrible destruction by the Inquisition,1 is silent, although
in Cordova alone, according to local tradition, there were forty to fifty
hospitals in the Khilafat period. This curiosity makes the present writer
place certain data for consideration with the hope that some more informa
tion would be forthcoming in support of the expectations and local tradi
tions.
Medical science began to be studied in Spain from the time of
*Abd al-Rahman II (822-852 A.C.). Doctors receiving training in Iraq
opened a school at Cordova to study the works of Galen whose seven
original works although lost were available in Arabic versions. Yunus
al-IJarranl, a great physician of the East, settled in Spain under Muham
mad I (852-86) and established a family of physicians. They accompanied
the army to the battle-field for the treatment of the ailing and wounded
soldiers, and litters carried by camels and other animals were used as stre
tchers. According to Ibn IJayyan and Ibn *IdharI, the dead body of
Mundhir was transported on the back of a camel from the siege of Bobas
tro to Munyatal-Na'urah Palace in the western quarter of Cordova in

1
275/888.2
In 840 A.C. Theophilus the Byzantine Emperor of Constantinople
sent an embassy with valuable presents to Cordova. In return 4Abd
46 S.M. IMAMUDDiN
al-Rafcman II the Umayyad Amir's embassy under Yahya b. Hakam al
Ghazzal (773-864 A.C.) visited Constantinople and established cultural
and commercial relations with the Byzantines.3 Another embassy from
the Byzantine Emperor Constantine VII was received at Cordova by the
Umayyad Caliph 'Abd al-Rahman III (912-961 A.C). Among the
Byzantine presents brought by the Greek ambassador was an illustrated
manuscript of 'Dioscorides on Materia Medica' in the original Greek
which was translated into Arabic by the monk Nicholas sent by the Byzan
tine Emperor on the request of the Umayyad Caliph. In this noble task
the Greek scholar was assisted by 'Hasdai ebn Shaprut', a great Jewish
diplomat and court physician of Cordova. The earlier Arabic version
made by Stephenson of Basil and corrected by Hunayn ibn Ishaq was
improved and the Arabic names of the plants and shrubs which had been
left untranslated in the earlier Arabic version were added to it.4 Greek
knowing persons except a few like Abu 'Abd Allah al-Asqalabi, a renowned
Physician of Cordova, were rarely available in Spain under the Umayyad
Caliphs. Jewish doctors of the 10th century Cordova served as court
physicians in various kingdoms of Europe. Yahya ibn Ishaq was one of
them.5 In 951 Sancho the Fat of Pamplona (Navarre) sought Cor
dovan help against his rival Ordino IV: negotiations continued and Caliph
'Abd al-Rahman III sent a Jewish physician, 'Hasdai ebn Shaprut' to cure
him of his axcessiver corpulence.6 The Materia Medica became a source
book for the study of Greek medical science in addition to those of Galen

2
and others. It was fully utilised in writing a book on medicine by the
great botanist of Hisham IFs time, namely, Abu Da'ud Sulayman ibn
Juljul.
In the early period the Muslims made admirable progress in some
aspects of medical science other than in anatomy and surgery because
dissection of human body was considered against Islamic teachings.
Opposition to dissection and vivisection no doubt discouraged anatomy
and physiology, but still the Arabs made ample progress in this field by
studying the skeletons of monkeys imported from Africa. Here also they
corrected and made laudable progress in aetiology, pathology and ther
apeutics. The Tratado de Cirugia e.g. al-Tasrif, a work on surgery by
Khalaf ibn 'Abbas accounts about the religious toleration shown and pa
tronage received by the doctors in the 10th century from the Spanish
rulers, Hakam II and Hajib al-Mansur. Despite the ritual rigidity and
conservativeness of the Muslims surgical operations were practised as early
MARISTAN 47
as the 10th century in Spain so much that the Ta?rlf of the celebrated
physician 'Abulcasis' became the master-piece of surgery in the medieval
age throughout the world.
Abu'l Qasim (Abul Casis, sp. Albucasis) Khalaf ibn 'Abbas al
Zahrawi (ca. 936-1013), the court physician of tlakam II (961-76), was
a great surgeon of the Arabs. In the last section of his aUTasrlfli Man
'Ajaz 'an al-Ta'dlif (an aid to him who is not equal to the large treatises),
which is divided into thirty parts, Abu'l Qasim deals with the new ideas of
surgery, like crushing a stone inside the bladder. Its Latin translation
became the manual of surgery at Salerno and Montpellier medical schools.
It contained illustrations of sophisticated instruments which led to the

3
development of surgery in Europe. These instruments included
knives and scissors made of iron. The use of such surgical instruments
and patronage of surgeons by Caliphs and Hajibs could be possible only
in private or government hospitals in the 10th century as confirmed by
local traditions, but details of the workings of such hospitals are lacking.
After al-Razi (856-925 A.C.) of Rayy, the chief physician of the great
hospital of Baghdad,7 the greatest clinician in Islam was Ibn Zuhr Abu
Marwan 'Abd al-Malik ibn abl al-'Ala (Avenzoar) of Seville (1019-1162).
He was the court Physician and wazlr of 'Abd al-Mu'min, the founder of
the Muwahhid dynasty in Morocco. Of his three extant medical works
the most valuable al-Taysir al-Muddwah wa'l-Tadbir was written by him
at the request of his great disciple and admirer Ibn Rushd as a counter
part of his al-Kulliyat ft al-Tibb {Colliget, Sp. Colig). Ibn Zuhr was the
first Muslim physician to describe cancer of the stomach and became
known for treating sciatica. Seville produced distinguished physicians in
the Muwahhid period, e.g. during the rule of Abu Ya'qub, Yusuf and al
Mansur like Avenzoar and his disciple Averroes and vied with Cordova
for the advancement in medical science. The famous work of Averroes
on general medicine namely Colliget surpassed all others in the medieval
period.His statue has been placed in the vestibule of the University of
Barcelona as a memorial.
A work on hygiene which received great admiration and was translated
into various European languages and a MS. of which was found in the
University library of Lioja8 was of Abulcasis who laid great stress on
48 S.M. IMAMUDDIN
preventive measures and cleanliness practised so much in Spain that at
Cordova alone there were more than 900 public baths (Ffammams)' in the

4
Caliphate period.
Francisco in his learned study has tried to emphasize religious
restrictions and Muslim conservativeness as the drawback for the surgical
study.10 The medical values of five times ablutions in twenty four hours,
keeping one self neat and clean always, fasting for one month in a year
during the month of Ramadan and abhorrence of sex during the period
of women's monthly course and also during the fasting period all based on
Islamic teachings cannot be ignored; which has also been noticed by the
learned author too. These naturally made the religious biased Muslims
conscious of their health, hygiene and medical science and find out ways
and means for the preservation and restoration of health.
During the golden era, the Caliphate period in Spain, there had been
some forty to fifty hospitals in Cordova as the local tradition goes, and
Seville vied with the Umayyad capital where these surgeons and clinicians
had worked although it is known that effective treatment of ulcer was not
possible in Spain in the early Caliphate period and Ibn al-Ahmar, a scribe
of 'Abd al-Rahman III, was advised to travel to India across the Indus11
and no reference to any hospital in the Umayyad Spain is found in the
extant work of Arabic literature nor has any edifice with an inscription
escaped the political outrages. A foundation-stone of Mdristdn of a very
late period e.g. the Nasrid period has, however, come to light. This gives
us clue to the foundation of such hospitals in the Caliphate Spain even
though lacking in the details of its working. The royal hospital of Burgos
in the Christian part of Spain of an earlier period was extant up to the 19th
century.
Muslims are known for making important progress in medical sci
ence at Baghdad and elsewhere as early as eighth century of the Christian

5
era. Jurjis son of Bakhtyishu the chief physician of Jundishapur (Persia)
and his family members served in the 'Abbasid court for about 250 years
from 765 A. C. onwards. Sinan ibn Thabit ibn Qurrah, the principal
of the Medical College of Baghdad during the Khildfat of al-Muqtadir
(908-932 A.C.), examined the medical students and granted them diplomas.
About 860 physicians passed such tests from the Baghdad Medical college
in 931. Under the supervision of Sinan physicians visited patients in their
MARISTAN 49
houses and even in prisons and distributed drugs, as described by a dis
tinguished historian of medicine Muwaffaq al-DIn Abu al-'Abbas Ahmad
ibn 4 All U$aybi4ah (1203-70) of Damascus.**
The details of science known to the orient Muslims in the 10th century
can be had from the two contemporary works Maf&tty al-'Ulum (the keys
of the Sciences) and the Fihrist (Index) composed by Muhammad ibn Ah
mad ibn Yusuf the scribe of Khwarizmi in 976 and by Ibn Nadfm al-War
raq of Baghdad, twelve years after, in 988, respectively.13
The Firdausul ffikma of 'All ibn Rabban al-Jabarl; al-Hawi
of Abu Bakr Muhammad al-RazI (Rhazes, d. 925) of Rayy; al-Qanun ft
aUJibb (Canon of Medicine) of Abu 'All IJusain ibn Sina (Avicenna) (d.
1037); al-Judari wa'l ffafbah of RazI, and the Kitab al-Mana&r of 'AH
al-flasan ibn al-Haytham (Alhazen, d. 538/1090) all on medical science
are worth mentioning.14 Among them al-Judari is the first and the best
of its kind. It deals with the clinical science and accounts for small-pox
and measles. Al-ffawi is an encyclopaedic work on medical science
dealing with the knowledge acquired by the Muslims through Greek,
Persian and Indian medical science and their own contributions to it. This
scholarly work created a remarkable impact on the Latin West for cen

6
turies. AUQanun represented the final condition of Greco-Arabic medical
thought displacing previous medical works of Rhazes and others. It re
cognizes the spread of disease by water and soil and prescribes 760 drugs
for various types of disease.15
In 1248 A.C. Qala'un, the Bahri Mamluk Sultan of Egypt, built
a grand edifice of the well-known Maristan in the outskirts of Cairo similar
to that of Nun (Nur al-DIn Zangl, 1146-May 1174) Hospital of Damascus
with separate wards for each disease and a separate one for women too,
lecture rooms, laboratories with medical applicances and a dispensary
for free medical treatment and distribution of medicine among the poor as
well as the rich. Three centuries before the Portuguese Seryetus, who is cre
dited with the discovery of the pulmonary circulation of blood, it was
known to the Dean of Qala'un's Hospital Abu'l IJasan 'All ibn al-Nafls
(d. at Damascus in 1288-9) who wrote with clear conception on it in his
SharhTashrlbal-QanunA*
The physicians used to have delivery of the child by cutting through
walls of abdomen during the time of the Romans and this Caesarian type
50 S.M. IMAMUDDIN
of operation was practised by the Muslim physicians, as depicted in the
illustrated MS. of al-BIrunl's al-Athar al-Baqiyah, dated 707/1307-8
preserved in the library of the University of Edinburgh.17
Europe is very much indebted to the Muslims for the knowledge
of medical science and technology. Out of the channels through which
oriental knowledge passed to other parts of Europe, Spain was the most
important and resourceful. Of the translators of the Toledan School
founded by Raimundo, the Archbishop of Toledo (1125-52), Gerard of
Cremona (d. 1187 and Michael Scot stood first. Gerard, who was

7
the Hunayn ibn Ishaq of the West, established a regular school of transla
tion at Toledo and brought out Latin versions of more than seventy Arabic
books on different subjects, chief being the surgical part of al-Tasrif of al
Zahrawi, the Kitdb al-Mansuri of al-Raz! and al-Qanunfi al-Tibb of Ibu
Sma, all on medical and surgical science. Medical Europe is also greatly
indebted to Constantine of Carthage (d. 1087), Gerard of Cremona (d.
1187) and Faraj ibn Salim (Ferarius or Feragut in the 13th century), the
Jewish physician of Sicily ? for its knowledge of Arabic medicine.
Constantine taught medical science at Salerno and translated al-Kitab al
Mdliki of 'All ibn al-'Abbas (Haby 'Abbas, d. 994), while Faraj translated
al-Razfs al-lldwi and Juzlah's Taqwim al-Abddn into Latin for Charles I
of Anjou in 1279.
All these developments and Spain's role in the transmission of
medical knowledge to other parts of Europe lead us to believe the local
traditions that there had been medical schools and hospitals at Cordova
and elsewhere under the Umayyad caliphs. Spain was rich for the produc
tion of medicinal herbs and shrubs. They grew in abundance in Elvira,
Selba, Shulayr (Sierra Nevada) and Guadix,18 and were collected from
June to September for the preparation of antiveneno and other medicines.19
The medicinal shrubs of Sierra Nevada were better in quality than those
produced in India or elsewhere.20 Medicine was commonly prepared
from dardar (ash tree) grown in Spain. They had invented an instrument
of distillation named alambique, of living plants and prepared liquids and
chemicals.
Among the agricultural treatises dealing with medicinal herbs and
arboriculture written in the 10th and following centuries were the Kitdb
Awqdt al-San'at by Abu'l Ilasan 'Arlb ibn Sa'Id (d. circa 370/980-81),

8
al-Qa?d-wa'l-Baydn by Abu 'Abd Allah Muhammad ibn Ibrahim ibn Bassal
(2nd half of the 11th century), the Kitdb al-Fdldbah by Abu al-M utarrif 'Abd
MARISTAN 51
al-Rahman ibn Muhammad al-Lakhml known as Ibn al-Wafid of Toledo
(d. 467/1075), the Zahar al-Bust&n wa Nuzhat al-Adhhdn by Abu *Ab
Allah Muhammad ibn Malik known as al-Tighnarf (d. after 480/1087),
the Kitdb al Fdlabah by Abu Zakariya Yahya ibn Muhammad ibn Afrmad
bin. al-'Awwam of Seville (12th century). The famous Malagonese
botanist Abenalbeitar (Ibn al-Baytar) who also lived in Seville in 1290,
flourished during the time of the Nasrid ruler Yusuf I (1333-54). He was
a great expert in producing medicine out of plants, shrubs and herbs. His
work on medical herbs and their proprieties namely 'Coleccion de los Sim
ples' translated by Leclerc is more complete than those of other Arabs.
He has acquired an expert knowledge of medicinal propriety of plants and
was very much estimated for his art of pharmacy (pharmacopoeia). He
fought against the disease of the sick with the local medicine till his hos
pitalization not known elsewhere in Europe then. To meet this necessity
of the sick and insane persons hopsitals were erected in Muslim Spain as
one in Algeziras which was founded in the 12th century21 and another in
Granada,22 in 767/1365-6. By the 11th century the Hispano-Muslims
had started the treatment of cancer of the stomach. They had made
remarkable progress in chemistry and pharmacy and had all arrange
ments that they needed for medical treatment as early as in the Caliphate
period, although Ibn al-Ahmar (d. 960) the author of a contemporary
biographical work of the Umayyad Caliph 'Abd al-Rahman III al-Na?ir
(d. 961) had to travel to India across the Indus for the treatment of an
ulcer from which he suflered in Spain.23

9
The notes and annotations which Casiri has added to his Catalogues
of the rich Arabic manuscripts of Escorial, the History of the Arab Medi
cine by Friend y de Leclerc and the works of Abu Muhammad 'Ali and of
Ibn abl U?aybi'ah do not lack in citing interesting and reliable references
to many 'Arab-Sevillan or Cordovan physicians and above all their know
ledge which they exercised in raising the standard of medical science in
Seville24 until 535 years after the Muslim conquest, according to Morgado,
the author of the History of Seville, the Castilian king's son Fernando cap
the author of the History of Seville, the Castilian king's son Fernando cap
tured it on the 23rd November 1248 with the military assistance of one
Ibn al Ahmar al-Na?ir who was in return helped by the Castilian monarch
in laying the foundation of a petty Nasrid dynasty inspite of the opposi
tions of his strong rivals, the Banu Mardanish of Valencia and the Banu
Hud of Murcia.25
In Christian parts of Spain the Castilian kings opened schools for
translations of Arabic works and hospitals for the treatment of ailing per
52 S.M. IMAMUDDIN
sons. The 'Hispital del Rey' in Burgos, the capital of old Castile was
founded by Alfonso VIII in 1210 and completed in the following year ad
jacent to the Monastery of (Sancte Marie) Huelgas as identified by Lam
perez26 although called 'Arcos de la Magdalena' by the people. It is also
known as 'Hospitale Sancte Marie'. The grand rectangular hall of its
infirmary divided, into three naves by stone pillars was completed by Fer
nando III in 1228. It received rich donations in 1212, 1213 and 1235.
In connection with the construction of this hospital it is written in the
Cantigas that Alfonso VIII
en Burgos moraba

10
e un hospital facia
el, e su moller labraba
o monasterio das Olgas.11
It is richly decorated by a combination of Gothic and Mudejar arts?
arches and stone capitals similar to those used in Cordova and Toledo,
mihrab shape entrance, decorated with Kufic inscription. Its wooden roof
is unique not found in the 13th century buildings except in the Generalife
and the 'portico del portal' of al-Hamra' Palace which are of later dates.
Its decoration begins with the Gothic style but ends partly with rich Mu
dejar covering. Architecturally the edifice of the Hospital is rich with
Gothic art but having profound origin in the East.28 In the 14th and 15th
centuries among the Cordova Muslim architects and masons the names of
Mahomed, Yunce, Hali and Abdalla were found working in Burgos and
elsewhere. Leopoldo Torres Balbas a great authority on Hispano-Arab
architecture concludes by saying that the building of the Hospital of Burgos
reflects the beginning of the great influence of Mudejar art on the medieval
Spanish life29. It is strange indeed that the first Hospital established in
Christian North Spain in 1210 could survive the ravages of time for seven
centuries although it had gon out of use long ago but no trace of hospital
called Maristan by the Arabs could be had in Muslim South Spain until
the public hospital of Muhammad V al-Ghanl Bi'llah the Nasrid ruler of
Granada in 767/1365-6. It is strange indeed that no hospital of the
Muslims' bright period (10th to 12th centuries) at Cordova and Seville at
least, except the local traditions, could survive the ravages of time.
In 1365-6 Muhammad al-Ghani Bi'llah Abu 'Abdullah, the Nasrid
Caliph of Granada, constructed al-Maristan for the insane and sick Muslims
as inscribed in the foundation stone of the building which was demolished

11
MARISTAN 53
in 1844, as recorded by Lamperez.30 In the Spanish version the inscription
reads thus "Alabanza a Dios, Mando construir este Hospital, amplia
misericordia para los debiles enfermos musulmanes, y sitio de pronto
remedio _el sultan Algani Billah Abu 'Abdullah, ano/1365-66".31
"Praise be to God! ordered for the construction of this Hospital opened
for the weak and sick Muslims, and seat of quick recovery_al-Sultan
al-Ghanl Bi'llah Abu 'Abdullah, the year/1365-6 A.C."
The Maristan was endowed with rents colleced in the second half
of Shawwal, the month of Charity observed in al-Andalus. Muhammad
VI al-Ghani Bi'llah (1354-59) who constructed the 'Patio de Liones of al
Hamra' Palace also donated to this hospital raising the prestige and value
of human life.
For the works and life of the Spanish Muslim physicians, the DiccU
onario de Sevillanos illustres by Menendez Bejarano, the Histoire de la
medecine arabe (paris, 1876) by Leclerc, and los primeros historiadores
bibliograficos and biograficos de la medicina espanola by Hernandez
Morejon are worth mentioning al-though they are confused and
incorrect sometimes. Padre Antuno has made a deep study of the two
Sevillan medical savants basing his informations gathered from the
Arabic works on medicine preserved in the Escorial Library.32.
Notes
1. From the Church library of Granada the chief of Inquisition Francisco Lopez
recei
ved thirty Arabic MSS. on the 28th March 1582. Out of these three on medicine
and one on astronomy only were allowed to be seen and read by him, cf. Manus
crites arabes en la Inquisicion, Granada 1582 by Ron de La Bastida in al-Andalus,
vol. 23, (1958), pp. 210-212.
12
2. Gayangos,P, The Muhammedan Dynasties of Spain, London, 1840-43, II, p.
437,
n. 47; Ibn *Idh&ri, al-Baydn, II, 22; Imamuddin, Some Aspects of the Socio
economic History, p. 94.
3. Cf. al-Pabbi, Bughyat al-Multamis fl Ta'rlkh Rijal al-Andalus, Madrid, 1884-
85,
pp. 485-6, no. 1467., Gayangos, Dynasties, II, pp. 114-5; Imamuddin, S.M., A
Poli
tical History of Muslim Spain, Karachi, 1974, p. 102.
4. Cf." A Letter of the Bazyntine Emperor to the court of the Spanish Umayyad
Caliph
al-Qakam 11'* by S.M. Stern in al-Andalus, (Cordova-Granada 1961), vol. 26,
pp.
40-41.
5. a. A Political History of Muslim Spain, p. 160.
6. Ibid., p. 147
54 S.M. IMAMUDDIN
7. Cf. Browne, E.G., Arabian Medicine, Cambridge, 1921, p. 44; Ibn al-
U?aybt4ah,
vol. I, pp. 309-10.
8. Francisco Blazquez Bores, Sevillay Tetuan en la Medicina de la Espana
Musulmana
Tetuan, 1954, p. 22.
9. Ibid., p. 22.
10. Ibid., p. 16.
11. Al-Dhahabi, Kitdb Ta'rlkh al-'Utamd' al-Andalus, pp. 116-18; Al-Andalus,
1956,
pp. 210-11.
12. Ibn abi U?aybi*ah, *Uyi*n-al-Anbd\ fl Tabaqdt al-Atibbd\ Konigsberg 1884,
vol.1,

13
p. 22, (quoted by P.K. Hitti, History of the Arabs, p. 365).
13. Imamuddin, S. M.? A Political History of the Muslims, vol. II, p. 312.
14. Imamuddin, S. M., Arab-Muslim Administration, Karachi, 1976, p. 132.
15. Imamuddin, A Political History of the Muslims, II, p. 312.
16. Hitti, History of the Arabs, p. 685.
17. Ibid., p. 407 for reproduction.
18. Al-Andalus, XVIII, 65-66; Moro-Rasis (Memorias, VIII), p. 37
19. Banqueri, J.A., Kitdb al-Filaha (Libro de Agricultural of Ibn al-Aww&m, I,
Madrid,
1802, p. 398.
20. Dozy, Calendrier de Cordove de Panne 961 (Kitdb al-$an'at of 'Arib ibnSa'id,
pp.
65, 67, 75, 84, 92, Homenaje a Coder a, p. 466; Some, Aspects of the Socio-
Economic
and Cultural History of Muslim Spain, Leiden, 1965, p. 90.
21. Cf. Scot, S.P., History of the Moorish Empire in Europe, vol. Ill, p. 516.
22. Levi-Provencal, La civilization Arabe en Espana, p. 417; Imamuddin, Some
Aspects
of the Socio-Economic and Cultural History of Muslim Spain, p. 164.
23. Al-Andalus, 1956, pp. 210-11; Al-Dabbi, Kitdb Ta'rlkh 'ulama* al-Andalus,
116-18.
24. Francisco Blazquez Bores, Sevilla y Tetuan en la Medicina de la Espana
Musulmana,
p. 15.
25. Ibid., p. 16.
26. Vicente Lamperez Y Romea, Arquitectura civil espanda de los sighs I at
XVIII,
Madrid 1922, II, pp. 260-61 and figures 187 and 188; Francisco Blazquez, Sevilla
y Tetuan, p. 19.
27. Cf. Leopoldo Torres Balbas, "EL Hospital del Rey en Burgos" in Al-Andalus,
14
IX, Fasc, 1,1944, p. 195.
28. Ibid., p. 197.
MARISTAN 55
29. Cf. Lcopoldo Torres Balbas, pp. 197-8.
30. Lamperez, p. 19; Lcopoldo Torres Baibas, El-maristan de Granada** in Al*
Andalus, IX, Fasc II, 1944.
31. Ibid., p. 19; ibid., A I-Andalus, IX, Fasc II, 1944.
32. Francisco Blazquez Bores, pp. 22-23.

15