The Medieval Islamic Hospital: Medicine, Religion, and Charity.
The appearance of Ahmed Ragab's The Medieval Islamic Hospital sparked historical, historiographical, and methodological debates. The title of the book suggests a broad scope: the history of an important institution, namely, the hospital (bimdristan), during the medieval period (no exact definition provided) throughout the Islamic world (no exact definition here either), from three different angles: medical, religious, and charitable. With the understanding that titles also reflect marketing considerations, it should be noted, however, that Ragab has indeed set for himself several broad and ambitious tasks: (1) to explain the pre-Islamic origins of hospitals; (2) to differentiate between models that framed the foundation of Islamic hospitals under the Umayyads and early Abbasids; (3) to describe the royal patronage of hospitals in Egypt and the Levant and how the patron's involvement affected the hospital's location and architectural structure in the Ayyubid and Mamluk periods; (4) to situate the hospitals in the urban charitable context of the Mamluk period; (5) to evaluate the medical careers of Mamluk physicians in and out of hospitals; and (6) to explain the medical regimen or clinical realities prevailing in Mamluk hospitals.
Ragab examines the intellectual and social networks of physicians associated with the big hospitals in the Levant (al-Nuri in Damascus) and Cairo (al-Mansuri) based on a number of literary genres: chronicles, biographical dictionaries, and medical treatises. He explains how the Nuri circles shaped the medical theories and clinical reality that later prevailed in al-Mansuri, and notes the unique features of these medical circles, such as their inclination to be guided by specific medical authorities, mainly Ibn Sina and al-Razi, and their preference for practical medicine. Having identified these unique characteristics of medical thinking and practice, Ragab is able to illustrate the spatial movement of people (in our case, physicians), and the flow of texts and knowledge.
Based on his analysis, Ragab argues for "the reign of the bimaristan physicians" as the medical elite of the time (chap. 4). This claim raises several questions that require an explanation. First, having an "elite" suggests the existence of a well-defined professional group. The literature on medical practice of the time suggests that the medical scene was quite pluralistic: medical practitioners were found alongside those who engaged with medicine solely on a theoretical level, while many types of healers offered their services. Some inclined toward humoral medicine and others added folklore and religious Islamic medicine (al-tibb al-nabawi) to their toolkit. Given this diversity and variety, when historical evidence from the Ayyubid and Mamluk periods does not corroborate the existence of a distinct and well-defined professional medical group, what does an "elite" mean?
A second question raised by Rageb's phraseology relates to the evidence bolstering this claim. Ragab consulted a long list of written sources, as mentioned above, whose authors were members of the same urban elite that gave rise to the medical elite that was "the bimaristan physicians." People tend to evaluate and document their peers positively. The educated authors of the Ayyubid and Mamluk periods, many of whom were associated with urban learning institutions, wrote about physicians who were similar to them. Therefore, these sources likely reflect not a professional reality, but a specific social reading of a much more complex and competitive professional reality.
Ragab attributes much importance to the concept of charity associated with hospitals--from the decision to establish a hospital, to choices of locations, to its funding. A good number of studies have confirmed this with regard to major urban institutions in the Islamic Middle East, including medical institutions, and Ragab adds to this literature. Nonetheless, here too several questions arise.
One concerns the historical transformation of charity. The philanthropy that triggered the early Abbasid hospitals was not the institutionalized and bureaucratized form of waqf that came to be crucial for the existence of Mamluk hospitals. These are very different expressions of medical charity. Tying them together, and arguing that the later stage was a direct outcome or evolution of the earlier one, is an interesting idea, but it requires some further thinking and clarification. A second question touches upon the historical evidence drawn from endowment deeds (the legal documents that detail the correct conduct of the institution according to the wishes of its benefactor). For historians of charitable institutions, the endowment deeds constitute a gold mine. Ragab makes ample use of the endowment deed of al-Mansuri Hospital and analyzes it in detail (chap. 3). He introduces the discussion of the waqf document by saying that it was a testimony to the perception of the hospital and its role in society (p. 109). Here, it should be noted that the written document is evidence of perceptions regarding the hospital at a very specific point in time--the moment of putting it in writing. From cases where several versions of the foundation deed survived, we know that the envisioned role of the hospital could change in the eyes of the benefactor. Furthermore, it is worthwhile accentuating that endowment deeds spell out intentions, which, in turn, are in a constant dialogue with reality; endowment deeds are not evidence of the reality on the ground.
Ragab positions his book as a revision of past historiographies of early Islamic medicine. It is indeed the first to discuss the interface between structure, social life, and medical knowledge and practice in and around hospitals in the context of the late medieval Middle East. However, similar questions have already been posed and discussed by historians of another period in Islamic history, namely, the Ottoman world.
Scholarship on Ottoman medical institutions has examined the dialogue between physicians, medical texts, and medical institutions, and the society in which they functioned. Ottomanists have already addressed career paths of physicians, the relationship between structure and clinical medical practice, and the charitable context of hospitals. Several scholars have been writing on these issues in recent years (full disclosure: the author of this review is among them). The Turkish Historical Review (Brill), for instance, includes several relevant studies. Ragab does not build on this scholarship, acknowledge it, or argue with it.
The lack of reference to the Ottoman period and to relevant literature appears in several other places in the book. For instance, at the end Ragab describes his forthcoming project, which is presented as a chronological continuation of the current work: he intends to follow the historical realities of al-Mansuri Hospital into the Ottoman period and to study how the hospital and its medical scene interacted and compared with European medicine. This is indeed an interesting and important topic by all accounts, but missing is the regional context of Ottoman imperial hospitals--some newly established, others older pre-Ottoman hospitals incorporated into the Ottoman system. The existing literature has just started to scrape the surface of the Ottoman Egyptian medical scene, but it has been shown that medicine in Egypt during the Ottoman period was at least somewhat Ottomanized.
Ragab's monograph contributes to our understanding of the renowned al-Mansuri Hospital, and through it we grasp the multilayered meaning of hospitals in medieval Islamic society. The definitive history of medieval Islamic hospitals is still wanting, however--it is a task that should probably be undertaken as a group endeavor.
MIRI SHEFER-MOSSENSOHN UNIVERSITY OF TEL AVIV
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|Publication:||The Journal of the American Oriental Society|
|Article Type:||Book review|
|Date:||Oct 1, 2018|
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