The Lions of Granada Maristan

Leo Africanus (Hasan al-Wazzān, c.1485–1554) was famous for his geography of North Africa. Following reconquest of his native Granada, Spain, by the Catholic Monarchs, his family moved to Fez, Morocco, where he worked 1 year in a maristan, which means “place for the sick” in Persian (1). Another travel writer, the Austrian physician Hieronymus Münzer (c.1437–1508), described the maristan of Granada as a “house for lunatics, built by the Moors” (2). Maristans had spread widely in the 9th and 10th centuries into North Africa and reached Moorish southern Spain (Al-Andalus) in the 14th century. Most were founded by sultans and supported by donations and patient fees, and they were typically supervised by physicians. Many were teaching hospitals. Their clinical units usually were organized by type of disease, and some evolved to care for specific disorders, including mental illnesses. The maristan of Cairo, Egypt (872), was the earliest identified as primarily psychiatric (3, 4).

In 1365, Granada’s Sultan Muhammed V (1338–1391) initiated construction of a maristan at the foot of his palace, the Alhambra. This two-story rectangular brick structure covered in plaster had a central courtyard surrounded by clinical living spaces accommodating 200 patients in individual rooms measuring 6 by 6 meters and connected by galleries (3). Statues of lions (figure) that served as fountains for a central pool can still be found in the Alhambra Museum.

The Granada Maristan was one of the earliest European hospitals that included care for the mentally ill, and the maristan tradition probably influenced other early European hospitals (3, 4). Many Moorish and Christian mental asylums in Europe, including Bethlem Hospital in London, began as hospices for foreigners and homeless persons, later becoming hospitals for general medical conditions and eventually more specialized for care of the mentally ill (4). The Fez Maristan (1286), where Leo Africanus worked, probably was a model for psychiatrically oriented institutions in Spain (5). The Christian Hospital for Lunatics, the Insane, and Innocents in Valencia, Spain (1409), founded by Friar Juan Gilabert Jofré (1350–1417), who had visited maristans in North Africa, is considered the first purely psychiatric asylum in Europe (6).