The Medieval Islamic Hospital
Ahmed Ragab Cambridge University Press 282pp £64.99
Medieval hospitals used to be represented as hell holes: overcrowded reservoirs of infection lacking medical facilities; places in which to die, not recover. Scholarship of recent decades has done much to modify this depressing picture. We now know that there were many hospital doctors and nurses doing their best by the standards of the time. In Florence and some other Italian city-states, indeed, the highest-paid physicians shuttled between elite clients and hospital practice. Even the smallest hospitals aimed to provide the clean sheets and the nourishing diet that were as important as elaborate medication.
Still, much of this revisionist scholarship applies to the later Middle Ages and the European hospital remained what it always had been since its invention in the fourth century: a religious and charitable institution in which healing the soul took precedence over healing the body. If we want hospitals that seem more secular, that accepted patients of different faiths, that took a relatively enlightened view of patients that most European hospitals excluded, such as the insane – that is, that look quite modern – then we turn to Baghdad and other centres in the Islamic world from as early as the ninth century. This is where Ahmed Ragab’s valuable book comes in. Like those revising our idea of European hospitals, he stands on the shoulders of several giants who have been studying the Islamic bimaristan (house of the sick) and relating it to the history of patronage, medicine, law and the economy, so that despite its apparent medical modernity it is set in the context of its time.
This book is not a general history of Islamic hospitals, but a richly contextualised study of one hospital, established by the Mamluk sultan al-Mansur Qalawun around 1285 in his empire’s capital, Cairo, as part of a philanthropic and religious complex that included a mausoleum and madrasa.
This foundation is examined against the background of its predecessors, in Islamic Egypt and the Levant, and in Crusader Jerusalem, where the main hospital, though indebted to Islamic exemplars, may also have exercised an influence of its own.
Ragab places the Mansuri establishment within a wider setting of rulers’ patronage and piety and urban topography and architecture, as well that of medicine. Sometimes the contextual detail is so wide-ranging that it overwhelms the main argument and the general reader may be put off by the overly discursive footnotes. Specialists may feel that the author is not always ruthless enough in his source criticism (no anecdote too implausible not to be told one more time before being set aside). Yet specialist and non-specialist alike will be enthralled by much of what the author has to tell them, as he unveils a medieval hospital world far too little known even to Islamicists, let alone historians of medieval Europe.
Peregrine Horden is Professor of Medieval History at Royal Holloway, University of London.