THE MARISTAN OF GRANADA. SYMBOL
AND INSTITUTION OF
ANDALUSIAN MEDICINE
EL MARISTÁN DE GRANADA. ESCENARIO Y
SÍMBOLO DE LA MEDICINA ANDALUSÍ
ANTONIO CAMPOS MUÑOZ
FERNANDO GIRÓN IRUESTE
PROFESSOR AT THE FACULTY OF MEDICINE OF THE UNIVERSITY OF GRANADA
PROFESSOR OF HISTORY OF SCIENCE AT THE UNIVERSITY OF GRANADA
acampos@ugr.es
fmguiron@ugr.es
Resumen: con motivo de las obras de restauración del Maristán de Granada, se estudia y analiza en el pre-
sente trabajo su significado en el contexto de la cultura médica de su tiempo y el legado que puede seguir
teniendo en la Granada de nuestros días. A tal efecto se describen en distintos apartados las bases teóricas
de la medicina medieval, las relaciones médico paciente en la baja Edad Media, las características de los
hospitales y maristanes en el espacio urbano del mundo latino e islámico y, finalmente, la creación del Ma-
ristán en siglo XIV, así como sus distintas características. Se analiza por último la revitalización del legado
del Maristán que implica su restauración; primero, como símbolo representativo de una ciudad vinculada
al progreso y la innovación médica y, segundo, como recurso imprescindible para una educación sanitaria
de la población que potencie y valore con perspectiva histórica el progreso y los avances en salud.
PalabRas claves: maristán, Granada, legado
abstRact: on the occasion of the restoration of the Maristán of Granada, its meaning is studied and
analyzed in the context of the medical culture of its time and the legacy it can continue to have in Granada
at the present moment. To this end, the theoretical bases of medieval medicine, the doctor-patient relations-
hips in the late Middle Age, the characteristics of hospitals and maristanes in the urban space of the Latin
and Muslim world, and finally the creation of the Maristan in Granada during the XIV century as well as
its different characteristics. Finally, the revitalization of the Maristan’s legacy that involves its restoration
is analyzed; first, as a representative symbol of a Granada linked to medical progress and innovation and,
second, as an useful resource for a better health education for the population in order to give value to health
advances from a historical perspective.
KeywoRds: maristán, Granada, legacy
cómo citaR / how to cite: CAMPOS MUÑOZ, A; GIRÓN IRUESTE, F. El maristán de Granada. Escenario
y símbolo de la medicina andalusí, Cuaderno de la Alhambra. 2020, 49, págs. 273-285, ISN 0590-1987
CUADERNOS DE LA ALHAMBRA I núm. 49 I 2020 I págs. 273-285
Recibido: 25 julio 2020 | Revisado: 8 septiembre 2020 | Aceptado: 6 octubre 2020 | Publicado: 24 diciembre 2020
ISSN: 0590 - 1987 I eISSN: 2695-379X I Depósito legal: GR 70-1965
IL. 1. Representation of Hippocrates, Galen and Avicena, authors
on whose doctrines medieval medicine is based. Cover of the Latin
Canon edition (1512) . Pavia.
Introduction
The commencement of the restoration and rein-
forcement works on the Maristan, driven by the
Patronage of the Alhambra and the Generalife, re-
presents not only the satisfaction of protecting and
demonstrating the value of the historical heritage
of Hispanic-Muslim medical culture, but also the
opportunity to reflect on its meaning for Granada
and the medicine of its time, and on the legacy that
its presence, preserved and restored, can continue
having for Granada and for the medicine of today.
To address the challenge of such a reflection, this
paper will be divided into several sections. In the
first section we will establish the different theoretical
bases of medieval medicine, without the knowledge
of which it would be very difficult to understand the
context that surrounds the process of creation of the
Maristan of Granada. In the second section we will
deal with the figure of the doctor and the patient in
the late Middle Ages and the relationship between
the two, which is influenced by the social context in
which this relationship develops. In the third section
we will analyse the characteristics of the hospitals
and maristans
1
as urban healthcare spaces and their
links to the social, religious and political structure
of their time. In the fourth section we will describe
the different characteristics of the Maristan of Gra-
nada especially during its time as a hospital and its
evolution up to today. Lastly, in the final section we
will evaluate the current legacy of a health institution
created in the 14th century and the future impact of
its forthcoming restoration.
1. From now on, we will use the word maristanes, Anglicising the
Arabic māristānāt, plural of māristān.
2. GARCÍA BALLESTER,L. Galeno en la sociedad y en la ciencia de
su tiempo: (c. 130-c. 200 d. de C.). Madrid: Guadarrama, 1972.
Theoretical bases of 14th century medicine
Medieval medicine, regardless of the field under
consideration, whether Latin or Arabic, is made up
of a set of concepts of belief and rationality. Leaving
aside the first –astrological medicine, popular belie-
fs, ejaculatory and talismans– we can establish that
the world of medieval medical knowledge is within
the framework of what is known as galenism
2
. Ga-
len (129-210/216) was a Greek doctor born in Per-
gamon (Asia Minor) who worked for a long time in
the Rome of the Caesars, where he achieved enor-
mous prestige. He was also responsible for the ori-
gin of a medical doctrine, with Hippocratic roots,
which remained without much criticism from the
3rd to the 16th century. Medieval writers of diffe-
rent origins, Arabic, Latin or Hebrew, confirmed,
retouched or questioned, in each case, the primiti-
ve Galenic doctrines, but contributed to the secular
survival of the same with their writings (Il. 1).
As far as diseases are concerned, for the majority
of them, with the exception of trauma, the galenic
doctrine stated that these were caused by one of the
four humours, blood, yellow bile, phlegm or black
bile, being altered in the human anatomy, which
would have serious effects. It could also be due to
a pernicious mixture of humours or the excessive
accumulation of one or more of them, even if these
were not altered. In addition, according to medical
doctrines in use, we should also take into account
the presence of the so-called temperaments, also
known as complexions, of which there were five.
Certain men and women would have a balanced
temperament, especially those of noble birth. This
could be hot and wet, since it was dominated by the
blood humour and also blood temperament. Or it
could be hot and dry, as was the case with yellow
bile, giving rise to a bilious temperament. Cold and
wet like phlegm: a phlegmatic temperament. And
finally, cold and dry like black bile, which would
correspond to an atrabiliary or melancholic tempe-
rament. This was important because the effect of a
disease in which coldness prevailed over a body that
was also cold, melancholic or phlegmatic in nature,
would be harmful.
Finally, there were the so-called six «unnatural»,
or «necessary», things that were not part of the
patient, but related to him, and that could be a
cause of illness. These were: the air and the en-
vironment; food and drink; work and rest; sleep
and wakefulness; secretions and excretions and,
oddly, movements of the soul. The curious thing
is that these causes, converted into «things», and
skilfully handled by the doctor, allowed him to pre-
serve the health of his patients. And as soon as the
disease appeared, they could be used as curative
remedies
3
.
Let us now look at the procedure for treating the
sick. The doctor began his work by making changes
to the patient's daily life, which may have been so-
mewhat disorganised. To do so, he may have chan-
ged the place of residence, or at least the ventilation
of the same. The patient would be ordered to rest
or advised to keep certain company to stimulate his
soul. The treatment continued, almost invariably,
with the use of bleeding, being in urgent cases the
most immediate treatment, which was intended to
eliminate the altered humours. All this was com-
plemented with nil-by-mouth or with the use of
certain foods-medicines. Baths would also be used.
If all this was not enough –and usually it was not
enough– medicines were either used –either sim-
ple or compound– or surgery, if required, although
this was less frequent.
Bleeding was a universal procedure that was used
as a preventive measure, to avoid the seasonal ac-
cumulation of a humour, usually blood, and was to
be carried out in the spring. However, more usually
it had a curative purpose once a disease had appea-
red, to eliminate an affected humour, or one that
was about to be in excess. In the use of therapeutic
medicine, in general, it was a matter of opposing
qualities: a cold illness was combated with a medi-
cine of a hot nature, just as excessive wetness was
combated with a medicine that caused extreme dry-
ness. However this, apparently easy, was complica-
3. LAÍN ENTRALGO, P. La medicina hipocrática. Madrid: Alianza,
D.L, 1987.
4. ULLMANN, M. Die MedizinimIslam. Leide: E.A.J. Brill, 1970,
p. 301.
ted by the appearance of the so–called «doctrine of
degrees», of galenic origin, which was confirmed
and structured in the Islamic world by Abū Yūsuf
Ya´qūb ibn Isḥāq al-Kindī, in the 9th century
4
. It
goes without saying that all the degrees, of diseases
and of medicines, were only the product of utmost
speculation.
In relation to the above, the doctor would also con-
sider the age and sex of the patient when prescri-
bing medicines. Generally speaking, children had a
hot and wet nature; young people dry and hot; ma-
ture men cold and wet and old men cold and dry.
To treat an old man with a dry and cold medicine
was to condemn him ahead of time, for this would
increase two harmful conditions in his body: a lack
of moisture and a lack of heat. As far as women are
concerned, we must say that there is a major gap in
medical texts about them, as their existence is hard-
ly taken into account, except in cases of pregnancy,
childbirth, breastfeeding and little else. In any case,
one should consider that their nature was always
colder and wetter than that of men, at any age. As a
final resource, once the dietary and pharmacologi-
cal possibilities had been exhausted, surgery could
be used, but only if it was absolutely necessary.
One essential question underlies this. Were the
patients cured of their condition? We estimate that
only in very few cases. It is true that some authors,
for example, Avenzoar, include in their treatises
some clinical cases that show their patients were
healed, however it is quite possible that they would
also have been cured without any special medical
help. Generally speaking, these were middle–aged
patients, many of them healthy, who would have
survived anyway. The bleeding and the compound
medicines used, we believe, did not guarantee that
sick old people would survive.
The doctor and the sick in the late Middle Ages
As the doctor and philosopher Pedro Laín
5
pointed
out in his day, the age are looking at is clearly de-
termined by the difference between the medicine
for the rich and medicine for the poor, and even
within the former we find some differences. In fact,
the prestigious doctors, the hūkama, in the Islamic
world and the magisters in the Latin world, that is,
the wise men par excellence, firmly installed in the
field of science, only dealt with the care of kings –as
chamber doctors– and of the nobles and great mag-
nates. In short, those who could amply reward their
services. There is credible evidence that many of
these patients gave away huge amounts of property
to those who had saved their lives, or promoted the
doctors who served them to prominent positions in
the administration. Examples are Arnau de Villano-
va, ambassador of Jaime II of Aragon o Lisān al-Dīn
Ibn al-Jaṭīb, double vizier of Muammad V in the
kingdom of Granada.
These doctors were seen as wise because, in addi-
tion to medicine, they practised many other specia-
lities such as astronomy, philosophy, music, history
and poetry. They had another special characteristic,
and that was that they usually carried out works
of teaching, being responsible for the training of
disciples. To this end, they commented on medi-
cal books by their predecessors and even their own
works, written for teaching purposes. Students
would attend consultations with or interventions
on patients. In the Western Latin world these wise
men often became university professors, as was the
case with Arnau de Villanova or Bernardo de Gor-
don. From the 13th century onwards, students had
the opportunity to train as doctors in the faculties of
«General Studies», that is, in the new universities
that were emerging. There is no reliable evidence
that similar work was carried out in the Islamic ma-
dāris
o madrasas.
Often, these wise men dedicated their medical wri-
tings to the person they were treating. On many
occasions his activity consisted in establishing the
daily health regime for the person who required it.
This is the case of Ibn al-Jaṭīb
6
and Muammad V
or that of Avenzoar and the Almohad leader ´Abd
al-Mū´min
7
for whom he wrote Kitāb al-taysīrr.
5. LAÍN ENTRALGO, P. La relación médico-enfermo. Madrid: Re-
vista de Occidente, 1964.
6- IBN AL–JATIB. Libro del cuidado de la salud según las estaciones
del año or Libro de higiene. Ed. and trad. María Concepción Váz-
quez de Benito, Salamanca: Salamanca University, 1984.
7. ABŪ MARWĀN ´ABD AL-MALIK IBN ZUHR. Kitāb al-taysīrfī
l-mudāwātwa-l-tadbīrEd. M. al-Jurī. Damascus: Dār al-Fikr, 1983.
Another characteristic of the wise men is that some
were directors of a Maristan, a health institution
to which we will refer later. This was the case of
al-Rāzī, who chose the site for and ran one of Ba-
ghdad's best known hospitals. The same happened
with Ibn al-Nafīs, for important hospitals in Egypt.
In the Latin world this phenomenon does not seem
to exist and the reason is that, for many centuries,
the management of healthcare facilities was entrus-
ted to religious personnel. In addition, the few emi-
nent patients of these hūkama and wise men used
to be, with a few exceptions, the only ones who had
enough training to be able to understand what their
doctors intended to do with them, in search of a
prevention or a cure.
In the Islamic world, the ṭabbib, or also the practi-
cal doctor, with a lower medical category, took care
of the general public, as long as they could pay a
fee. Their counterpart in the Latin world were ca-
lled physicus (Il. 2). Artisans, officials, merchants
and farmers were their customers. Generally, nei-
ther aṭibba nor physicus would write books, so they
could not be classified as wise men in any way. They
constituted a much larger group than the previous
one, and in al-Andalus they were very often mem-
bers of the Mozarabic or Jewish minorities. They
were not usually producers of science, but rather
consumers.
The poor, those who only had their daily wage, or
the miserable, who used to beg, in search of help
and the charity of any doctor and also of the wise.
And they could always go to hospitals generally lo-
cated, as we will see later, in large towns and built
exclusively to house them, both in the Latin and Is-
lamic world
8
.