In order to understand how medicine developed in the middle ages, we have to look back at the history and find out the important things that happened during the Seventh Century

In 570 A.D., a man was born in a small city in the Arabian peninsula, called Mecca (Haykal 1976), his name was Mohammed. In 610 A.D. he declared a new religion, Islam. In 632 A.D., he died after uniting the Arab tribes who had been torn by revenge, rivalry, and internal fights. Out of these mostly illiterate nomadic people, he produced a strong nation that encountered and conquered, simultaneously, the two known empires at that time, namely, the Persian and Byzantine Empires. In a man's life-time, the Islamic Empire extended from the Atlantic Ocean on the West, to the borders of China on the East. In 711 A.D., only 80 years after the death of their prophet, the Arabs crossed to Europe to rule Spain for more than 700 years. In 732 A.D., they threatened Paris and their thrust was stopped at Tours and Poiter (Eigeland 1976). In 831 A.D., the Moslems of North Africa invaded Sicily and ruled it for 200 years. By 846 A.D., they controlled the southern part of Italy and encountered Rome (Hitti 1977). The hold of the Moslems over Italy remained so firm that Pope John VIII (872-882 A.D.) deemed it prudent to pay tribute for two years (Hitti 1977) In 869 A.D., the Arabs captured Malta (Ibn-Khaldun). In the tenth century, from Italy and Spain, the Arabs extended their raids through the Alpine passages into mid-Europe. In the Alps, there are a number of castles and walls which tourists guides attribute to the invasion of the Moslems of Sicily. In the southern part of Italy and in Sicily, a great civilization was established and through which the torch of knowledge spread to Europe, mainly through the University of Salerno in the southern part of Italy (Hitti 1977, Parente 1967).

The expansion of the Moslems in Europe was not limited to those from North Africa and Spain. The Moslems, under the Ottoman Empire, invaded Europe from the East. They occupied a good part of Middle Europe and besieged Vienna twice, once during the reign of Sulayman 1 (1520-1566 A.D.) and the other during the reign of Mohammed IV (1648-1687 A.D.) (Hitti 1977).

As the Moslems challenged the civilized world at that time, they preserved the cultures of the conquered countries. On the other hand, when the Islamic Empire became weak, most of the Islamic contributions in art and science were destroyed. This was done by the Mongols who, out of barbarism, burnt Baghdad (1258 A.D.), and by the Spaniards, who out of hatred, demolished most of the Arabic heritage in Spain. The difference between the Arabs and these was the teachings of Islam which:

1. Stressed the importance and respect of learning.
For example, the first word revealed to the Moslems' prophet Mohammed was "Read". In Mohammed's era, a captured enemy was freed if he paid a ransom or taught ten Moslems writing and reading. In their holy book, the Qur'an, the importance of knowledge has been repeatedly stressed as it says "Those who know and those who do not are not equal." The prophet Mohammed stressed learning by saying. "One hour of teaching is better than a night of praying." One of the early princes, Khalid fbn Yazid (end of the 7th century), gave up his treasure for the study of medicine and chemistry. He studied medicine under John the Grammarian of Alexandria, and chemistry under Merrinos the Greek (Haddad 1942). He also encouraged several Greek and Coptic medical books to be translated into Arabic.

2. Forbade destruction.
On conquering Mecca, the prophet Mohammed strongly stated that no homes, animals, or trees should be destroyed. His followers abided with these principles when conquering other countries.

3. Encouraged cleanliness and personal hygiene.
Islam instructed them to approach God in their prayers five times a day with bodies and clothes spotlessly clean.

4. Developed in them the respect of authority and discipline.
For example, realizing the scourges and terror of plague, their prophet Mohammed (p.b.u.h.) decreed that "no man may enter or leave a town in which plague broke out." And to make this law all the more binding and effective, he promised the blessing of heaven to those who die of plague by stating that if a man died of plague he would be considered a martyr (Haddad 1942). Thus Mohammed (p.b.u.h.) laid for the Moslems the laws governing corden and quarantine for the first time in history and made it work.

5. Tolerated other religions.
The Islamic religion recognizes Christianity and Judaism and considers their followers to be people with holy books like Moslems. Moreover, they candidly treated the Jews at an era when the latter were persecuted in Europe. Dr. Jacob Minkin, a reputable Rabbi and scholar says "It was Mohammadan Spain, the only land of freedom the Jews knew in nearly a thousand years of their dispersion... While during the Crusades, the armored Knights of the Cross spread death and devastation in the Jewish communities of the countries through which they passed, Jews were safe under the sign of the Crescent. They were not only safe in life and possessions, but were given the opportunity to live their own lives and develop a culture so unique and striking that it went down in history as the 'Golden Ages'. The Moors, the Muslim conquerors of Spain in 711, were not religious fanatics. They were strong in their faith but generous with regard to the religious convictions of others.... "The Ranaissance of Art in Italy, says George A. Dorsey, has blinded us to the Renaissance of Science in Spain, which fostered science, promoted culture, encouraged learning, and set a premium on intellectual pursuits, no matter whether the intellect was Moslem, Christian or Jew. Not since the days of Greece had the world known such thirst for knowledge, such passion for learning, such spirit shared by the prince and the courtien alike" (Minkin 1968).

The Arabs were assimilated by the vast new countries they reached. From this marriage of genuine characters and righteousness with the ancient and well established civilizations, a great new nation was born. It is difficult to identify this new breed as Arabs, because although the language was Arabic, all the scientists were not necessarily from the Arabian Peninsula. It is also equally difficult to describe it as Islamic, because although the majority of the scientists were Moslems, sponsored by Moslem rulers, and governed by the Islamic law, yet some scientists were Christians or Jews, especially at the early phase of the lslamic civilization: the translation period to Arabic, and the decline part: the translation period to Latin and Hebrew. Therefore, in this article, the adjectives Arabic or Islamic will be used as synonyms.

In order to comprehend the contributions of Arabs to medicine,we must have in our minds a picture of the condition of medicine before they arrived to the scene. Generally speaking, two elements are required for medical practice:

A. Manpower before Islam:
There were medical centers in different parts of the world which were later either under control of the Arabs or in touch with them. For example, in Syria, medicine was advanced and was greatly influenced by the Byzantine civilization which affected also the economic and administrative systems (Hammameh 1962). From the fifth century on, the Greek was the language of learning in Syria. The knowledge of the Arabs of the Greek civilization was mainly through the Syrian scholars who translated it into Arabic.

In Egypt, Alexandria was another center for culture. The Arabs got in touch with both the ancient Egyptian and Greek civilizations through the Egyptian scholars. In Persia, there was a medical school in a city called Jundi-Shapur in which medicine was highly developed. The Abbasi Caliphs during the 8th century encouraged the Persian physicians to translate into Arabic the medical knowledge therein, to build medical centers in Baghdad, the capital of their empire, and to run newly built hospitals. With further expansion east, the Arabs through contacts with India and China, brought ideas and methods, not only in medicine, but also in mathematics, chemistry, philosophy, etc.

B. Hospitals Before Islam:
Hospitals as we know them now probably were not present. True, there were places for the sick to stay, but these were mainly temples or annexes to temples that were run by priests. Gods were supposed to play a major role in the art of healing. For example, the Goddess Toueris was the Egyptian symbol of fecundity and protectress of the pregnant and parturient. She was shown as a standing pregnant hippopotamus carrying the hicroglyph meaning protection in one paw, and the sign of life in the other. Small figures of Toucris were popular as amulets (Speert 1973). In those days, sanctuary, prayers, inactation, and hypnosis were integral parts of the therapy.

During the Islamic civilization, hospitals had much developed and attained specific characteristics:

1. Secular:
Hospitals served all peoples irrespective of color, religion, or background. They were run by the government rather than by the church, and their Directors were commonly physicians assisted by persons who had no religious color. In hospitals, physicians of all faiths worked together with one aim in common: the well-being of patients.

2. Separate wards:
Patients of different sexes occupied separate wards. Also different diseases especially infectious ones, were allocated different wards.

3. Separate nurses:
Male nurses were to take care of male patients, and vice versa.

4. Baths and water supplies:
Praying five times a day is an important pillar of Islam. Sick or healthy, it is an Islamic obligation; of course physical performance depends on one's health, even he can pray while laying in bed. Before praying, washing of face, head, hands, and feet must be done, if possible. For certain conditions, a bath is obligatory. Therefore, these hospitals had to provide the patients and employees with plentiful water supply and with bathing facilities.

5. Practicing physicians:
Only qualified physicians were allowed by law to practice medicine. In 931 A.D., the Caliph Al-Mugtadir from the Abbasid dynasty, ordered the Chief Court-Physician Sinan Ibn-Thabit to screen the 860 physicians-of Baghdad, and only those qualified were granted license to practice (Hamarneh 1962). The counterpart of Ibn- Tbabit, Abu-Osman Sai'd Ibn-Yaqub was ordered to do the same in Damascus, Mecca, and Medina. The latter two cities were in need for such an act because of hundreds of thousands of pilgrims visiting them every year. This was to prevent taking advantage of these pilgrims and to curb the spread of diseases among them.

6. Rather medical schools:
The hospital was not only a place for treating patients, but also for educating medical students, interchanging medical knowledge, and developing medicine as a whole. To the main hospitals, there were attached expensive libraries containing the most up-to-date books, auditoria for meetings and lectures, and housing for students and house-staff.

7.Proper records of patients:
For the first time in history, these hospitals kept records of patients and their medical care.

8. Pharmacy:
During the Islamic era, the science and the profession of pharmacy had developed to an outstanding degree. The Arabic materia medica became so rich and new drugs and compounds were introduced because the Muslims had contact with almost all the known world at that time, either through control or trade. Their ships sailed to China and the Philippines, and their convoys made trades with black Africa, Europe and Asia. Chemistry became an advanced science, and there were means and need for a specialization called pharmacy.

Thus, the main Arabian hospitals were models for medieval hospitals built later in Europe. They were rather medical schools to which those seeking advanced medical knowledge, from the East or West, attended.

In the Islamic Empire, the hospitals attained a golden era unsurpassed in previous history. The reasons behind such a high standard include:

1. Being part of a civilization as a whole:
The people were prosperous; thus, they were capable of taking care of their health and of seeking the best available treatment. Also, lslam stresses the necessity of seeking treatment of every disease; the Prophet says "For every disease, God created a cure." The required sciences for good medical care were at a high standard e.g. the Arabs were advanced in chemistry, mathematics, administration, pharmacy, medicine, etc. They gave the world the system of numbering which have replaced the cumbersome Roman numerals. The world owes to them the knowledge of the following chemical reactions, namely sublimation, precipitation, filtration, distillation, etc. The great Arab chemist Jabir Ibn- Hayan discovered sulphuric and nitric acids. According to Webster Dictionary, the words sugar, alcohol, alkali, syrup, coffee, cotton, all are Arabic words. Fielding H. Garrison, the author of the well-known work on the "History of Medicine" said: "...The Saracens themselves were the originators not only of algebra, chemistry, and geology, but of many of the so- called improvements or refinements of civilization, such as street lamps, window-panes, firework, stringed instruments, cultivated fruits, perfumes, spices, etc... "

2. High prestige of physicians:
The physicians in this era earned a high prestige. Although anyone, irrespective of his social status, can study medicine, yet the route was long and tedious. He had to finish Islamic studies, philosophy, astronomy, art, chemistry, etc. before being accepted as a medical student. Therefore, the physician was a cultured person who had wisdom and knowledge. In fact, the Arabic translation of a physician is "Hakim" which means sage. In the 9th and 10th century, the Court- Physician was in the protocol ahead of the Chief-Justice. Many eminent physicians, as we will discuss later, showed enough talent, social knowledge, political capabilities, and wisdom to be appointed by the Caliphs as prime ministers (Visiers). Owing to the high prestige and connections of physicians, generous funds for hospitals were easily obtained.

3. Rulers' involvement in public services:
The Caliphs of the Islamic empire built magnificent hospitals for one or more of the following reasons:

a. Religion: Their religion stated that money spent on charity is a good investment for Judgment Day.

b. Eternity: The Pharoahs of Ancient Egypt sought eternity by building pyramids, the rulers of Islam sought the same thing by building mosques, hospitals, and schools carrying their names.

c. Politics: To show their people that they cared, and were interested in them, the rulers built hospitals.

Whatever the motive of the ruler, the population benefited and good hospitals were erected.

4. Adequate financing to run the hospitals:
The rulers set aside generous funds to run these hospitals. Also the philanthropists gave generously, thus following their religious beliefs and imitating their rulers. In Islam, there is a special system called Al-Waqf. A person can donate part or all of this wealth to charity. The government takes care of such a donation, and its revenues help to maintain and build mosques, hospitals, and schools. Another source of funds and an important pillar of Islam is alms-giving (2 1/2% of property value). Collected alms goes to the state treasury which takes care of charitable organizations. Very few hospitals in the Islamic era were private. Thus, patients fees constituted an unimportant source of funding.