Roman Empire

Further information: Byzantine medicine

The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.^[16]

The declaration of Christianity as accepted religion in the Roman Empire drove an expansion of the provision of care. Following First Council of Nicaea in 325 A.D. construction of a hospital in every cathedral town was begun. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey. Called the "Basilias", the latter resembled a city and included housing for doctors and nurses and separate buildings for various classes of patients.^[17] There was a separate section for lepers.^[18] Some hospitals maintained libraries and training programs, and doctors compiled their medical and pharmacological studies in manuscripts. Thus in-patient medical care in the sense of what we today consider a hospital, was an invention driven by Christian mercy and Byzantine innovation.^[19] Byzantine hospital staff included the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai). By the twelfth century, Constantinople had two well-organized hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialized wards for various diseases.^[20]

A hospital and medical training center also existed at Jundishapur. The city of Jundishapur was founded in 271 CE by the Sassanid king Shapur I. It was one of the major cities in Khuzestan province of the Persian empire in what is today Iran. A large percentage of the population were Syriacs, most of whom were Christians. Under the rule of Khusraw I, refuge was granted to Greek Nestorian Christian philosophers including the scholars of the Persian School of Edessa (Urfa)(also called the Academy of Athens), a Christian theological and medical university. These scholars made their way to Jundishapur in 529 following the closing of the academy by Emperor Justinian. They were engaged in medical sciences and initiated the first translation projects of medical texts.^[21] The arrival of these medical practitioners from Edessa marks the beginning of the hospital and medical center at Jundishapur.^[22] It included a medical school and hospital (bimaristan), a pharmacology laboratory, a translation house, a library and an observatory.^[23] Indian doctors also contributed to the school at Jundishapur, most notably the medical researcher Mankah. Later after Islamic invasion, the writings of Mankah and of the Indian doctor Sustura were translated into Arabic at Baghdad.^[24]

Medieval Islamic world

Main article: Medicine in medieval Islam

Further information: Bimaristan

Jundishapur surrendered to Islam in 636 AD. The first physicians under Muslim rule were Christians or Jews.^[25] One source indicates the first prominent Islamic hospital was founded in Damascus, Syria in around 707 with assistance from Christians.^[26] However most agree that the establishment at Baghdad was the most influential. The public hospital in Baghdad was opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century.^[27] The bimaristan (medical school) and bayt al-hikmah (house of wisdom) were established by professors and graduates from Jundishapur.^[28] It was headed by the Christian physician Jibrael ibn Bukhtishu from Jundishapur and later by Islamic physicians.^[29] "Bimaristan" is a compound of “bimar” (sick or ill) and “stan” (place). In the medieval Islamic world, the word "bimaristan" referred to a hospital establishment where the ill were welcomed, cared for and treated by qualified staff.

In the ninth and tenth centuries the hospital in Baghdad employed twenty-five staff physicians and had separate wards for different conditions.^[30] The Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. The first Islamic psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health.^[31] Thus between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care.

Some suggest that physicians and surgeons were appointed who gave lectures to medical students and issued diplomas (ijazah) to those who were considered qualified to practice.^[27][32] However others assert that, in contrast to medieval Europe, medical schools under Islam did not develop a system of academic evaluation and certification.^[33]