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

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

. 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

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

. 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

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 Muḥammad 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

and Muḥammad V

or that of Avenzoar and the Almohad leader ´Abd

al-Mū´min

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

It is also important to note the existence of healers,

who acted at all levels, but especially in rural areas.

al-Rāzī refers to healers in his Kitāb al-Mansurī, tr-

ying to open the eyes of those who went to consult

them, by pointing out that all they did was sheer

trickery.

Surgery was not carried out by doctors and was so-

mething that fell to more or less specialised arti-

sans, artifex in Latin, who had very limited training

and basically empirical knowledge. What they did

8. GARCÍA GRANADOS, J.A.; GIRÓN IRUESTE, F.; SALVATIERRA

CUENCA, V. El Maristán de Granada. Un hospital Islámico. Grana-

da: Imprenta Alhambra, 1989. p. 100.

9. GUY DE CHAULIAC. Thecyrurgie of Guy de Chauliac. Edited by

Margaret S. Ogden. London: Oxford University Press, 1971.

10. See, for example, IBN HABIB (m. 238/853) Mujtasarfī l-tibb

(Compendium of Medicine) Introduction, critical edition and

translation by C. Álvarez de Morales, F. Girón Irueste. Madrid:

Consejo Superior de Investigaciones Científicas. Instituto de

Cooperación con el Mundo Árabe, 1992.

IL. 2. Representation of the doctor and the patient in the Middle

Ages in the 1250 Gerardo de Cremona Medical Treatise Collection.

have, however, was great courage to face situations

that in most cases overwhelmed them. Results did

not therefore meet expectations, with the exception

of specific operations such as for cataracts, in which

many of them acquired a certain skill.

The doctor Abulcasis, in the early 10th century,

rebelled against this situation of scientific shor-

tage. He recommended that doctors be trained in

surgery and to be able to guide the yārrah, the

surgeon, to avoid making serious mistakes (Il. 3).

Occasionally unique characters would appear in

the Nazarene Kingdom of Granada, as was the case

with Muhammad al-Šafra in the 14th century. A

simple surgeon, but who wrote a great treatise on

surgery. We understand that in the Islamic world

there were no classes for surgeons. However, in the

Latin world, the figure of the surgeon was to gra-

dually gain prominence, and the emergence of the

University would not have been coincidence, where

many came to learn at least Anatomy. An example

of this was Guy de Chauliac, master of Renaissance

surgeons, who interestingly based his work on the

work of Abulcasis

In this medieval world and even later, another op-

tion for healthcare existed; all Muslims could, in

fact, turn to religious people, the so–called hadith,

for help. These were not only knowledgeable about

prophetic traditions but also about aspects related

to medical practice of a spirit–belief nature. This

is what is known as the medicine of the prophet

Approaching a zāwiya in search of the holy man

who ran it to consult him about a problem was

always a possible resource. On the Christian side,

IL. 3. Representation of a doctor attending to a patient. Maquamat

al-Hariri Codex. (14th century). Vienna Library.

popular medicine in the field of belief rested on the

relics of the saints –to whom healing virtues were

attributed for this or that illness– and the use of

ejaculatory prayers specific to each illness

Finally, there is something that we believe is ex-

tremely important for the issue at hand: the place

where the patients were attended. It seems clear

that the powerful were attended to at home, in their

mansions. The middle class were attended to both

in their homes and by the doctors themselves, whe-

re patients would wait their turn. But what about

poor people who were sick? It is believed that they

did not have an appropriate place to be properly ca-

red for. This fact, as we shall see, would be decisive

for the development of hospital centres.

The urban space of medical assistance:

hospitals and maristanes

It is perhaps striking that, in the Middle Ages,

hospital institutions had much more to do with

religion than with the care of the sick. In fact, both

hospitals and Maristans, the name given to simi-

lar Arab centres, were locus religiosus, designed to

allow the political or economic power to show its

friendly side to the poor. In a word, they were pla-

ces expressly conceived to provide charity, in the

broadest sense of the word: they were all at once

hostels for pilgrims, places for the sick, hospices

for the elderly and shelters for the poor and des-

titute.

And to confirm this we rely on the fact that in its

origin, the Christian hospital, whose model would

be copied by Islam, was apparently born in the city

of Caesarea, in Cappadocia, where in 370 the bi-

shop and theologian Saint Basil expressly created

a place to receive orphans, the elderly, strangers

and the sick, calling it Basiliades

. It was Chris-

tianity, with its idea of charity for the benefit of

the poor, that was responsible for building centres

to house the most needy. And the various counci-

ls urged the prelates to allocate whatever income

was necessary to establish them. In the Christian

world, hospitium, origin of the word hospital, was

born from charity. And that is why the monastic

orders were the first institutions to welcome in

some rooms of their monasteries the first hospi-

tium, that is, the first hospitals.

The creation of hospitals was, therefore, the respon-

se to the evangelical precept that guaranteed eternal

salvation to those who help their neighbours: «be-

cause I was hungry and you gave me food... I was

a stranger and you welcomed me... sick and you

visited me...»

. As a result, there was always a cha-

pel inside a hospital or attached to the hospital buil-

ding; something that would continue for centuries.

Likewise, patients who were admitted to the centre

were obliged to confess their sins in order to heal

their soul in anticipation of healing their body.

With the passing of time, similar centres would

develop, taking into account the initiatives and

interests of their various founders: kings, nobles,

bishops, confraternities, and orders of knights.

Likewise the members of what is currently ca-

lled the middle class, clergymen and elements of

what we understand today as the bourgeoisie were

also founding different models of care centres. In

doing so there were reasons of simple human va-

nity, of trying to demonstrate religious solvency on

the part of some minorities, generally questioned,

such as converts, or simply in the interests of ob-

taining a good burial place for their founder and

his descendants.

In the Muslim world the reasons that we can qua-

lify as human did not change excessively, although

also the care for the sick or simply poor and hungry,

was within the religious practice as was the obliga-

tion of legal alms. On the other hand, although the

Christian principle of charity does not exist in Is-

lam, there is the religious principle of iḥsān which

requires that every human being be treated with

kindness and justice, respecting the divine imprint

on them. Some authors also relate it to charity. It

is for this reason that Maristans were usually su-

11. GIRON, F. Médicos y sanadores en el Medievo Islámico. El Médi-

co, Profesión y Humanidades. 1988: No. 267, LXXIV–LXXXI.

12. C. ÁLVAREZ DE MORALES, C.; GIRÓN IRUESTE, F. Marista-

nes y Hospitales. IbnJaldun. El Mediterráneo en el siglo XIV. Auge y

declive de los Imperios. Seville: El Legado Andalusí, 2006, p. 276.

13. Biblia de Jerusalén ilustrada por Gustavo Doré, 2 vols., Madrid:

Club Internacional del libro, 1975.Mateo, 25, 35.

14. FRANCO SÁNCHEZ, F. La asistencia al enfermo en al–Andalus.

La Medicina en al–Andalus. Granada: Junta de Andalucía, Conse-

jería de Cultura, D.L. 1999, pp. 137–38.

15. An example of this: IBN ABÌ L–BAYÀN. El formulario de los

hospitales de... introduction, Spanish translation and comments,

with glossaries by José Luis Valverde López and Carmen Peña

Muñoz. Granada: Secretariado de Publicaciones de la Universi-

dad de Granada, 1981.

pported economically by goods called «habices»,

pious legacies of rich people, or of the sovereign

himself

However, while in the hospitals direction and su-

pervision was carried out by religious personnel, in

Maristans the directors were prestigious doctors,

who were assisted by other doctors of lower rank.

We know that, in general, they had a mosque –we

again see the obvious connection with religion– a

library, the teaching function seems clear, because

a certain number of students were trained there.

Here again they differed from Christian hospitals,

where there was no such function, at least in the

Middle Ages. It seems that there was a botanical

garden and an apothecary, where they prepared the

medicines extracted from the same. We also know

of the existence of specific medical literature, the

so-called dustūr al-bīmāristānī or «hospital forms»,

in which the different prescriptions and the way

they were written were listed

It seems that in Maristans the sick were grouped

in specific rooms, according to the diseases. And

we know that in some Maristans, as happened in

that of Marrākuš, today’s Morocco, when the pa-

tient was discharged he was given aid, so that he

could spend the time of his convalescence without

worry. As in the Christian world, when it came

to welcoming them, it seems that there was not

much difference between the poor and the sick.

We know that Maristans not only admitted poor

patients, since it has been established that those

who could pay for their stay had to do so. It does

not seem that in Christian hospitals such a thing

happened, given they were institutions designed

only for the needy.

In the Christian world, the first hospital in the Ibe-

rian Peninsula that we know of was founded by Bi-

shop Masona, in the Visigothic period at the end

of the 6th century in Mérida, and was located next

to a convent. Servers of the same walked the city

streets collecting the poor and the sick to be cared

for there. We should also take into account the hos-

pitals built on the Camino de Santiago in the 11th

century, such that in Jaca (Camino Aragonés). And

also those in Pamplona, Burgos, Sahagún, León,

Foncebadon, El Cebrero, Portomarín and Santiago

de Compostela (Camino Francés).

A well-known pilgrim hospital is the Hospital

del Rey, next to the monastery of Las Huelgas, in

Burgos. It was built by Alfonso VIII and his wife,

Leonor Plantagenet, at the end of the 12th century.

Another is Hospital de Orbigo, in Leon, located on

the right bank of the river with the same name, on

the Camino Leonés. It was founded by the order of

Knights of St. John of Jerusalem, later the Order

of Malta. Also in Leon, and in the 12th century, the

first steps were taken to build the Convent of San

Marcos, which was used as a hospital for pilgrims

and as a religious temple. In Andalusia, and almost

at the same time as Granada's Maristan, which we

will look at later, there was the hospital of San Cos-

me and San Damián in Seville, in the parish of El

Salvador, which was better known as the hospital of

«bubas», which was the Spanish name for syphilis

at the time. It was built in 1387, intended to care

for people suffering from the plague, given that a

few years earlier there had been a major outbreak

of this disease

With few exceptions, Christian hospitals used to be

small, with one room for men and one for women.

There were a few other rooms, such as the cells for

religious personnel, or for nurses, again generally

one for men and one for women, where they had

to always stay. As indicated earlier, it was also com-

mon for them to have a chapel within the building.

As for maristans in Spain, we believe that none

existed, strictly speaking, before the one built in

Granada. Lucien Leclerc mentions the existence of

one in Algeciras, but it would seem that this was

a mistake

. We are convinced, however, that the-

re were many lazaret to house leprosy patients. It

would seem that this was the case in Madrid with

those of San Lazaro and San Ginés, apparently esta-

blished during the period of Islamic rule.

However, there were many Islamic hospital cen-

tres, both in the East and in North Africa, built in

imitation of the hospitals they found in the conque-

red territories. One well known example was the

Bīmāristān built in al-Fusṭaṭ, the old Cairo, in the

year 827, by the governor Ahmad Ibn Tulūn, foun-

der of the Tulunis dynasty in Egypt. It is close to the

main mosque and we know that it had some limi-

tations on the admission of patients: no soldiers or

slaves could be admitted, but it did accommodate

madmen. It is one of the first-known references of

the presence of mentally-ill patients in hospitals.

On the banks of the Tigris in the western part of

Baghdad, Iraq, the hospital known as Bīmāristān

Adudī

, founded by Adud al-Dawla, a Buwayhida so-

vereign, was established in the 10th century. There

is a legend about its establishment. It is said that its

first director, al-Rāzī –Rhaces in Latin– while trying

to find the most suitable place to build it, placed

four pieces of meat at four points in the city and

chose the place where it took longer to for the meat

to spoil. Two centuries later, the Andalusian geo-

grapher, traveller, man of letters and poet Muḥam-

madIbn Ahmad Ibn Ŷubayr, describes the centre as

a large and luxurious building «with some rooms

fit for a royal palace»

In Damascus, Syria, Nūr al-Dīn Ibn Zankī, sove-

reign of the Syrian territory and other adjacent

territories, founded in 1154 a hospital that was

named Bīmāristān Nūrī in his honour, which still

16. BARRIGA GUILLÉN, C., et al. Hospitales y centros benéficos se-

villanos: inventarios de sus fondos. Seville: Diputación Provincial,

1997.

17. LECLERC, L. Histoire de la médecine arabe, 2 vols. New York:

Burt Franklin, 1971, [ed. facsimil] Actually, the centre that Leclerc

indicates was in Marrākuš, not in Algeciras. GIRON, F. Note on

a supposed Arab hospital in Algeciras: Llull. Revista de la Socie-

dad Española de Historia de las Ciencias y de las Técnicas. 1978: 2,

113-115.

18. MUHAMMAD B. AHMAD IBN YUBAYR.A través del Oriente:

el siglo XII ante los ojos: [Rihla]; intr., trad. and notes Felipe Maillo

Salgado, Barcelona: Serbal, 1988.

IL. 4. F. Enríquez. Maristán, supposed elevation and section. Facade section of the destroyed Maristán in Granada. (According to F. Enriquez)

Photograph of a book illustration of the front section of the Maristán. One of the lions can be seen in the lower section of the central arch; it

was later moved to the El Partal pool and is now housed at the Alhambra Museum (19??). APAG. Colección de Fotografías. F-007301.

exists today. It had a large central courtyard with

a pond, around which four vaulted rooms opened

onto the courtyard, and another four windowless

rooms that occupied the corners. Ibn Ŷubayr,

again informs us of the existence of records of pa-

tients admitted, and the medicines they received.

The most famous Islamic Maristan, perhaps

because of size, is undoubtedly the Bīmāristān

Manṣūrī

in Cairo, which takes its name from its

founder Manṣūr Sayf al-Dīn Qalāwūn, a Mamluk

sultan. It began to operate in the 13th century. It

is said that it could hold eight thousand people

and that, like other Maristans, it had a mosque

inside.

As for the Muslim West, we will make reference to

the Maristan built in the city of Marrākuš by Abu

Yūsuf Ya´qūb al-Manṣūr, an Almohad leader, at

the end of the 12th century. It was a luxurious es-

tablishment, with four large swimming pools, and

in its courtyards fruit trees were planted for the

comfort of the sick. The poor were given sufficient

resources to survive on until they could return to

work, and the rich were returned their money and

clothes, so it would seem that they took in well–off

patients as well. We even know the name of one

of its directors, Ibrāhīm al-Dānī

an Andalusian

doctor.

Already in the 14th century, the century in which

Granada's Maristan was built, according to another

well–known traveller, Muḥammad b. ‘Abd Allāh

Ibn Baṭṭuṭa, the sovereign Abū´Inān Fāris, of the

Moroccan Banū Marīn, undertook the task of...buil-

ding hospitals in all the country's cities, to meet the

needs of the sick, and to appoint doctors to care for

and heal them. It is possible that Muḥammad V,

the Sultan of Granada, followed the same policy in

the city of Granada

The Maristan of Granada

One of the most striking facts about hospitals in

Andalusia is that the Maristan of Granada is the

only centre of this nature documented in literatu-

re and archaeological remains. We obviously we

have no answer to this fact. However, what follows

perhaps avoids further digression as to whether or

not it was the first: the foundation stone states that

«with its construction [the sultan] has carried out

an unprecedented work since the entrance of Islam

into this country

».

Location, authorship and reasons for the

construction of the Maristan

The Maristan was built in what is generally known

as the lower Albaycín, on the right bank of the Da-

rro River, a short distance from it, and close to the

Bridge of the Boards, also known as the Bridge

of Cadi, and the so–called Nogal Baths, popularly

known as Bañuelo (Il. 4). We believe that its loca-

tion was not at all a product of chance, since it is

found in the neighbourhood called by its inhabi-

tants al-rāha or tranquillity. On the other hand, in

Granada it was colloquially known as «the hospital

of Africa», because many sick people of that natio-

nality came their to stay, eager to regain their heal-

th. Today this part of the city is specifically called

the Barrio de la Coracha, due to its proximity to the

double wall that joined the Alhambra fortress with

the Alcazaba quarter.

If we take into account the guidelines contained

in the health regimes, in the section «air and en-

vironment», the site chosen is absolutely ideal. For

Hippocrates, author of the work Air, Water and Pla-

ces

, liberally used by all medieval doctors, the most

perfect building to live in had to be protected from

the warm south winds, which are those that bring

fevers, and also from the cold north winds, origin of

many other diseases. Well the Maristan sits at the

bottom of a slope that enjoys this protection from

19. IBN ABI USAYBI`A. 'Uyûn al–Anbâ' fîT'abaqât al–At'ibbâ'.

Sources d'informations sur les classes des médecins: XIII echapitre:

médecins de l'Occident musulman...publié, traduit et annoté par

Henri Jahier et Abdelkader Noureddine. Alger: Librairie Ferraris,

1958.

20. MUHAMMAD B. ‘ABD ALLĀH IBN BATTUTA. A través del Is-

lam…, introduction, translation and notes by Serafín Fanjul and

Federico Arbós. Madrid: Alianza, 2010.

21. Franco Sánchez F. Op. Cit., pp.154–5.

22. HYPOCRATES. Oeuvres complètes d'…traduction nouvelle avec

le texte grec en regard ... par É. Littré. 10 vols. Amsterdam: Hakkert,

1989.

the north, and the hill of the Alhambra serves as a

protective screen from the south.

As shown on the foundation stone (Il. 5), cons-

truction of the building began in September-Octo-

ber 1365 and was completed in June 1367. It was

built under the patronage of the Granadan Sultan

Muḥammad Ibn Yūsuf Ibn Ismāyl Ibn Faraŷ Ibn

Ismāyl Ibn Yūsuf Ibn Naṣr (1338-1391) who would

come to be known as Muḥammad V.

It would seem it was a certain set of circumstan-

ces that converged in the construction of the Ma-

ristan. Firstly, the sultan's wish to thank God for

the benefits obtained from his mercy. It was evi-

dently no small favour received by Muḥammad

V, who regained the throne of Granada after re-

turning from several years' exile in North Africa.

Secondly, the sultan's desire to offer the building

as a special merit to attain eternal life. The above–

mentioned foundation stone is very clear in this

regard «Offering this merit before the face of God,

in order to obtain the divine reward, God is the

possessor of immense grace!». Thirdly, the impact

and consequences of the terrible plague epidemic

that struck Granada between 1348 and 1350, a few

years before he first came to power. The plague

had caused many deaths, and hundreds of hel-

pless Granadans had died without receiving any

care. As indicated previously, the construction of

hospitals in the cities of North Africa driven by

Abū ´Inān Fāris, of the Banū Marīn, with whom

Muḥammad V had much relation during his exi-

le, without a doubt influenced very favourably the

construction of the Maristan. The period of relati-

ve internal and external peace after the turbulent

times before and after the period of construction

of the Maristan facilitated in fourth and last place

the establishment of Granada's health centre. The

Kingdom’s economic prosperity also made it pos-

sible to carry out important works on the Alham-

bra and on the Kingdom’s defences.

A figure that was most likely decisive and of great

importance in the origin and construction of the

Maristan was that of the already mentioned double

vizier of Muḥammad V, Lisān al-Dīn Ibn al-Jaṭīb

(Il. 6), presently considered to be, with his lights

and his shadows, the great intellectual figure of the

Nazarí Kingdom

. Ibn al-Jaṭīb, as he is usually re-

ferred to, was, besides a politician, a poet, a histo-

rian, also a wise doctor. Among his great medical

works, in addition to the text that includes most of

the known diseases of his time and his well–known

book on the plague in 1348, his Book on Health Care

during the Seasons also stands out. In this book he

develops a whole set of recommendations aimed at

the hygiene of daily activities such as eating, drin-

king, travelling, resting, moving, socialising, etc.

and the impact that seasonal variations and perso-

nal characteristics have on these activities. It would

be truly paradoxical if a character like Ibn al–Jaṭīb,

the main political leader after the Sultan and hol-

der of the innovative medical knowledge reflected

IL. 5. Lucía Rivas. Maristan Foundation Stone. Alhambra and

Generalife Board of Trustees (2020). APAG.

23. BOSCH VILÁ, J. Ben Al–Jatib y Granada. Madrid: German–

Spanish University Cultural Association, 1982.

in his works, did not actively participate in the Ma-

ristan project; without a doubt, the most relevant

healthcare project of the Nazarí Kingdom

Architectural design

Regarding the Maristan, Ibn al–Jaṭīb wrote in his

History of Granada

that «it was a compendium

of beauty and a luxurious building. It has many

rooms, a large courtyard, running water and a

healthy atmosphere, many storage rooms and pla-

ces for ablutions»

. According to the study of its

ruins, the building was rectangular in shape (Il. 7),

and occupied an area of nearly 300 square metres.

The main facade, where the door was located, was

in one of the smallest sections, specifically that

furthest from the Darro River. The central court-

yard, also rectangular, according to Francisco Enri-

quez's plan, was mostly taken up by a pool, which

was filled with water via two pipes that each emer-

ged from the mouth of two large, marble, partia-

lly-seated lions. These were located at the centre

of the principal sides of the pool. They remained

in the Gardens of the Partel at the Alhambra for a

long time and are today preserved in the Alham-

bra Museum (Il. 8).

The interior was distributed in eight naves, four

on each of the building’s two floors. At least at the

end of its existence as a hospital, these were com-

partmentalised into cells, approximately fifty, mea-

suring about 2.5 by 2.5 metres. These cells opened

onto a rear corridor, where healthcare personnel

would move around. It is quite possible that the

compartmentalisation was added later and at the

beginning the rooms were open–plan. The naves

were open to the central courtyard and it would

seem that there were no windows to the outside.

The top floor, according to Francisco Enriquez's

plan, was accessed by four stairs, located near the

corners of the building

Healthcare

The information we have on this subject is not

very extensive, not even that provided by Ibn al–

Jaṭīb, a thorough contemporary, allows us to exp-

lain very much about patient care. He just points

out that «any sick person» could be admitted. He

would undoubtedly be the best person to enligh-

24. CAMPOS, A. Ibn al–Jatib. Pandemia y confinamiento en la

Granada de 1348. Actualidad Médica, 2020:105 (809) pp. 62–65.

25. MUHAMMAD B. ABD ALLAH IBN AL–JATIB. Al–ihata fi aj-

bar Garnata … [muhaqqiqadabî] Muhammad AbdAllahInan. 4 vols.

Cairo: Maktabat al–Janyi, 1973–1977.

26.Franco Sánchez F. Op. Cit., p. 156.

27. GARCÍA GRANADOS; GIRÓN IRUESTE; SALVATIERRA

CUENCA. Op. Cit., p. 12.

IL. 6. Lucía Rivas. Hall of Kings. The Maristan was constructed in

1367 under the rule of Muhammad V with Ibn al-Khatib as vizier.

(2020). APAG.

IL. 7. Leopoldo Torres Balbás. Floor plan of the Maristán (1923).

“Granada, la ciudad que desaparece”, Arquitectura, V, September.

APAG. Colección de planos. P-003535.

ten us, since in addition to being a historian he

was a great medical figure in Granada, and even

in Europe, in the 14th century. In any case, the

fact that he does not indicate anything in parti-

cular about the healthcare almost leads us to say

that it was an sanctuary, like many other similar

centres and that therefore we can qualify it as a

general hospital. Nor do we know the names of

the doctors associated with it. The reality is that

we have little data on Granada's medicine from

the 14th century

. We believe that in the Maris-

tan only the poor were cared for, for this is clear-

ly stated on the founding stone: «he ordered the

construction of this Maristan as a sign of great

mercy towards the poor sick Muslims»

In the representation of the building's ground floor,

there are four stairs that go down to the pool, loca-

ted at each of the building's four corners. This su-

ggests the possibility that cold water bathing in the

pool was applied to certain patients. For those who

needed hot or warm water, the Bañuelo building

was located right next door. In fact, Avenzoar some-

times recommended bathing patients in the water

of swimming pools, considering their water to be

of better quality than that of public baths in cities.

Jerónimo Münzer, a German doctor who visited Gra-

nada two years after it was taken over by the Catholic

Monarchs in 1492, stated that the latter «had increa-

sed the income of the leper hospital (the future St.

Lazarus Hospital) and those of the house for the in-

sane (the Maristan), both Moor foundations»

. This

indicates that, at least at that time, the Maristan was a

place for the mentally ill. It is possible that as the 15th

century progressed without any major epidemic, a

decision was made to transform the Maristan into a

centre for poor, mentally–ill patients or people with

some form of mental deficit. The enormous respect

that such people enjoy in the Muslim world is well

known. To this end, in all probability, the structure

was modified by replacing the rooms with cells. The-

se facts confirm that it was one of the first centres

in Europe to house the mentally–ill and is therefore

on a par with the Bethlem Hospital in London, the

origin of which dates back to 1403, or the Casa del

Padre Jofré in Valencia, which began operating in

1409. Perhaps this important honour will compen-

sate the precariousness of its existence.

Evolution of the Maristan

The Maristan had a short history as a hospital, bare-

ly 128 years. In 1495, the Catholic Monarchs assig-

ned the building to the Mint, or Casa de la Mone-

da, and the madmen who were housed there were

evicted. This must have been influenced by its large

size, and the fact that it was somehow a public buil-

ding. This led to protests from Granada's Mudejar

dignitaries, as the capitulations for the handover

of the city specified that their customs and institu-

tions were to be respected. From the 17th century

onwards it was used as a wine store, a tenement

house, a barracks and a prison

. The water that su-

pplied the pool was fraudulently used by water ven-

dors, who claimed that it came from the Avellano

Fountain.

Unfortunately, it was largely demolished in 1843,

an act not without protest from Granada's intellec-

tuals. The architect Francisco Enríquez y Ferrer re-

corded the floor plan, elevation and the facade in

plans drawn by him, and Juan de Dios de La Rada

y Delgado, an exemplar archaeologist, painted its

facade, all shortly before it was demolished.

The legacy of the Maristan of Granada

The Maristan, built between 1365 and 1367, is an

important historical landmark for the city, being

the first and only Maristan, properly speaking, that

was built between 711 and 1492 in all of al–Andalus,

that is, during the entire period of Muslim presence

in the Iberian Peninsula. In our opinion, the refur-

bishment and restoration work recently undertaken

will allow our contemporaries to discover not only

28. PEÑA, C.; DÍAZ, A.; ALVAREZ DE MORALES, C; GIRÓN, F.;

LABARTA,A.; VÁZQUEZ DE BENITO, C. Corpus medicorum ara-

bicorum, Awrāq. Revista del Instituto Hispano–Árabe de Cultura,

1981: 4, 79–110.

29. Franco Sánchez F. Op. Cit., pp.154.

30. HIERONYMUS MÜNZER. Reino de Granada; preliminary

study by Fermín Camacho Evangelista. Granada: TAT, 1987.

31. GARCÍA GRANADOS; GIRÓN IRUESTE; SALVATIERRA

CUENCA. Op. Cit., pp.51–7.

IL. 8. Lucía Rivas. Maristan pool lion. Alhambra Museum (2020).

APAG.

the structural characteristics of a unique 14th cen-

tury building, but also the specific place where the

comfort and hope of healing of the poor, sick peo-

ple of Granada resided for many years.

In our opinion, and that of the Royal Academy of

Medicine of Eastern Andalusia whom we repre-

sent, the legacy of a restored Maristan can and

must be projected for the future on two funda-

mental levels. Firstly, as a fundamental represen-

tative symbol of an avant-garde medical Granada,

pioneer in primordial contributions to the his-

tory of medicine. A tour of its facilities, and the

knowledge of the reasons that led to its construc-

tion, the medicine practised in its facilities and its

possible role as one of the first European centres

dedicated to mentally–ill patients, if not the firs-

,will undoubtedly contribute to our society's un-

derstanding and recognition of the important con-

tribution made in Granada in the second half of

the 14th century. And to this recognition we must

add the just tribute that corresponds to the two key

figures in its promotion and development: the Sul-

tan Muḥammad V and the doctor, poet, historian

and vizier Ibn al-Jaṭīb.

Secondly, the restored Maristan must be projected

into the future as a centre for the dissemination of

Andalusian medical culture through exhibitions and

cultural programmes of various types that contribu-

te not only to the specific knowledge of that culture

in its historical–medical context but also, and even

more importantly, to the promotion of health edu-

cation for the public. This last objective is especially

important because human beings often forget that

our society's achievements in art and the science of

healing are the fruit of many previous contributions

and are supported by the progressive and continuous

character with which human beings have advanced

through time in their fight against disease. Health

education based on what was yesterday's medicine,

in our case in Nasrid Granada, must inevitably invi-

te us to constructively reflect on the achievements

of medicine today and to assess, consequently, with

greater complicity and willingness to cooperate, the

health reality of our present time.

The restoration of the Maristan is a major challenge,

but one that is not only architectural. It is a cultural

challenge of great magnitude for Granada and for

medicine; a challenge to which the Royal Academy

of Medicine of Eastern Andalusia, based in Grana-

da, would like to contribute with its support. One

of its aims is, besides the recovery of the historical

and cultural heritage of medicine, the promotion of

our society’s understanding of what the progressive

fight against pain, illness and death has meant for

human beings

. If Granada is to advance towards

being the European capital in 2031, the recovery of

the Maristan and the projection of its legacy should

be essential factors of this objective.

32. VERNET, J. Lo que Europa debe al Islám de España. Barcelona:

Acantilado, 2006, pp. 392–94.

33. CAMPOS, A. La Real Academia de Medicina y Cirugía de An-

dalucía Oriental. Actualidad Médica. 2013: Supl. 790. pp. 29-30.