History of hospitals:
The earliest documented institutions aiming to provide cures were ancient Egyptian temples. In ancient Greece, temples dedicated to the healer‐god Asclepius, known as Asclepieia functioned as centers of medical advice, prognosis, and healing. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.
As early as 4000 bce , religions identified certain of their deities with healing. The temples of Saturn, and later of Asclepius in Asia Minor, were recognized as healing centers. Brahmanic hospitals were established in Sri Lanka as early as 431 bce, and King Ashoka established a chain of hospitals in Hindustan about 230 bce. Around 100 bce the Romans established hospitals (valetudinarian) for the treatment of their sick and injured soldiers; their care was important because it was upon the integrity of the legions that the power of ancient Rome was based.
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 archaeology. 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. Saint Sampson the Hospitable built some of the earliest hospitals in the Roman Empire. It can be said, however, that the modern concept of a hospital having been converted to Christianity, abolished all pagan hospitals and thus created the opportunity for a new start. Until that time disease had isolated the sufferer from the community. The Christian tradition emphasized the close relationship of the sufferer to the members of the community, upon whom rested the obligation for care. Illness thus became a matter for the Christian church.
About 370 ce St. Basil the Great established a religious foundation in Cappadocia that included a hospital, an isolation unit for those suffering from leprosy, and buildings to house the poor, the elderly, and the sick. Following this example, similar hospitals were later built in the eastern part of the Roman Empire. Another notable foundation was that of St. Benedict of Nursia at Montecassino, founded early in the 6th century, where the care of the sick was placed above and before every other Christian duty. It was from this beginning that one of the first medical schools in Europe ultimately grew at Salerno and was of high repute by the 11th century. This example led to the establishment of similar monastic infirmaries in the western part of the empire.
The Hôtel‐Dieu of Lyon was opened in 542 and the Hôtel‐Dieu of Paris in 660. In these hospitals more attention was given to the well‐being of the patient’s soul than to curing bodily ailments. The manner in which monks cared for their own sick became a model for the laity. The monasteries had an infirmitorium, a place to which their sick were taken for treatment. The monasteries had a pharmacy and frequently a garden with medicinal plants. In addition to caring for sick monks, the monasteries opened their doors to pilgrims and to other travelers.
Institutions created specifically to care for the ill also appeared early in India. Fa Xian, a Chinese Buddhist monk who travelled across India ca. 400 CE, recorded in his travelogue that: The heads of the Vaisya [merchant] families in them [all the kingdoms of north India] establish in the cities houses for dispensing charity and medicine. All the poor and destitute in the country, orphans, widowers, and childless men, maimed people and cripples, and all who are diseased, go to those houses, and are provided with every kind of help, and doctors examine their diseases. They get the food and medicines which their cases require, and are made to feel at ease; and when they are better, they go away of themselves. The earliest surviving encyclopedia of medicine in Sanskrit is the Carakasamhita (Compendium of Caraka). According to Dr.Wujastyk, the description by Fa Xian is one of the earliest accounts of a civic hospital system anywhere in the world and, coupled with Caraka’s description of how a clinic should be equipped, suggests that India may have been the first part of the world to have evolved an organized cosmopolitan system of institutionally‐based medical provision.
According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya of Sri Lanka (reigned 437 BC to 367 BC) had lying‐in‐homes and hospitals (Sivikasotthi‐Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world. Mihintale Hospital is the oldest in the world. Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, and Medirigiriya.
The declaration of Christianity as accepted religion in the Roman Empire drove an expansion of the provision of care. Following the 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. There was a separate section for lepers. Some hospitals maintained libraries and training programmes, 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. Byzantine hospital staff included the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai). By the twelfth century, Constantinople had two well‐organised hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialised wards for various diseases.
A hospital and medical training centre also existed at Gundeshapur. The city of Gundeshapur was founded in 271 CE by the Sasanian 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 populations 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 Gundeshapur 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. The arrival of these medical practitioners from Edessa marks the beginning of the hospital and medical centre at Gundeshapur. It included a medical school and hospital (bimaristan), a pharmacology laboratory, a translation house, a library and an observatory. Indian doctors also contributed to the school at Gundeshapur, 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.
The first prominent Islamic hospital was founded in Damascus, Syria in around 707 with assistance from Christians. However most agree that the establishment at Baghdad was the most influential; it opened during the Abbasid Caliphate of Harun al‐Rashid in the 8th century. The bimaristan (medical school) and bayt al‐hikmah (house of wisdom) were established by professors and graduates from Gundeshapur and was first headed by the Christian physician JibraelibnBukhtishu from Gundeshapur and later by Islamic physicians.
In the ninth and tenth centuries the hospital in Baghdad employed twenty‐five staff physicians and had separate wards for different conditions. The Al‐Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organised into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter Fsprang up all over the empire from Islamic Spain and the Maghrib to Persia. The first Islamic psychiatric hospital opened in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health.
During this era, physician licensure became mandatory in the Abbasid Caliphate. In 931 AD, Caliph Al‐Muqtadir learned of the death of one of his subjects as a result of a physician's error. He immediately ordered his muhtasibSinanibnThabit to examine and prevent doctors from practicing until they passed an examination. From this time on, licensing exams were required and only qualified physicians were allowed to practice medicine.
The church at Les Invalides in France showing the often close connection between historical hospitals and churches.
Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel‐Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi‐ functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mérida, was a xenodochium designed as an inn for travelers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.
The Ospedale Maggiore, traditionally named Ca' Granda (i.e. Big House), in Milan, northern Italy, was constructed to house one of the first community hospitals, the largest such undertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance architecture in Lombardy.
The Normans brought their hospital system along when they conquered England in 1066. By merging with traditional land‐tenure and customs, the new charitable houses became popular and were distinct from both English monasteries and French hospitals. They dispensed alms and some medicine, and were generously endowed by the nobility and gentry who counted on them for spiritual rewards after death.
Religion continued to be the dominant influence in the establishment of hospitals during the middle Ages. The growth of hospitals accelerated during the Crusades, which began at the end of the 11th century. Pestilence and disease were more potent enemies than the Saracens in defeating the crusaders. Military hospitals came into being along the traveled routes; the Knights Hospitallers of the Order of St. John in 1099 established in the Holy Land a hospital that could care for some 2,000 patients. It is said to have been especially concerned with eye disease, and it may have been the first of the specialized hospitals. This order has survived through the centuries as the St. John Ambulance. Throughout the Middle Ages, but notably in the 12th century, the number of hospitals grew rapidly in Europe. Arab hospitals—such as those established at Baghdad and Damascus and in Córdoba in Spain— were notable for the fact that they admitted patients regardless of religious belief, race, or social order. The Hospital of the Holy Ghost, founded in 1145 at Montpellier in France, established a high reputation and later became one of the most important centers in Europe for the training of doctors. By far the greater number of hospitals established during the middle Ages, however, were monastic institutions under the Benedictines, who are credited with having founded more than 2,000.
The middle Ages also saw the beginnings of support for hospital‐like institutions by secular authorities. Toward the end of the 15th century, many cities and towns supported some kind of institutional health care: it has been said that in England there were no fewer than 200 such establishments that met a growing social need. This gradual transfer of responsibility for institutional health care from the church to civil authorities continued in Europe after the dissolution of the monasteries in 1540 by Henry VIII, which put an end to hospital building in England for some 200 years. The loss of monastic hospitals in England caused the secular authorities to provide for the sick, the injured, and the handicapped, thus laying the foundation for the voluntary hospital movement. The first voluntary hospital in England was probably established in 1718 by Huguenots from France and was closely followed by the foundation of such London hospitals as the Westminster Hospital in 1719, Guy’s Hospital in 1724, and the London Hospital in 1740. Between 1736 and 1787, hospitals were established outside London in at least 18 cities. The initiative spread to Scotland, where the first voluntary hospital, the Little Hospital, was opened in Edinburgh in 1729. The first hospital in North America (Hospital de JesúsNazareno) was built in Mexico City in 1524 by Spanish conquistador Hernán Cortés; the structure still stands. The French established a hospital in Canada in 1639 at Quebec city, the Hôtel‐Dieu du Précieux Sang, which is still in operation (as the Hôtel‐Dieu de Québec), although not at its original location. In 1644 Jeanne Mance, a French noblewoman, built a hospital of ax‐hewn logs on the island of Montreal; this was the beginning of the Hôtel‐Dieu de St. Joseph, out of which grew the order of the Sisters of St. Joseph, now considered to be the oldest nursing group organized in North America. The first hospital in the territory of the present‐day United States is said to have been a hospital for soldiers on Manhattan Island, established in 1663. The early hospitals were primarily almshouses, one of the first of which was established by English Quaker leader and colonist William Penn in Philadelphia in 1713. The first incorporated hospital in America was the Pennsylvania Hospital, in Philadelphia, which obtained a charter from the crown in 1751.
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one. After the dissolution of the monasteries in 1540 by King Henry VIII the church abruptly ceased to be the supporter of hospitals, and only by direct petition from the citizens of London, were the hospitals St Bartholomew's, St Thomas's and St Mary of Bethlehem's (Bedlam) endowed directly by the crown; this was the first instance of secular support being provided for medical institutions. 1820 Engraving of Guy's Hospital in London one of the first voluntary hospitals to be established in 1724.
The voluntary hospital movement began in the early 18th century, with hospitals being founded in London by the 1710s and 20s, including Westminster Hospital (1719) promoted by the private bank C. Hoare & Co and Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. St. Bartholomew's opened in London in 1730 and the London Hospital in 1752.
These hospitals represented a turning point in the function of the institution; they began to evolve from being basic places of care for the sick to becoming centers of medical innovation and discovery and the principle place for the education and training of prospective practitioners. Some of the era's greatest surgeons and doctors worked and passed on their knowledge at the hospitals. They also changed from being mere homes of refuge to being complex institutions for the provision of medicine and care for sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia as a response to an outbreak of plague.
The concept of voluntary hospitals also spread to Colonial America; the Pennsylvania Hospital opened in 1752, New York Hospital in 1771, and Massachusetts General Hospital in 1811. When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into one of the most important research centers.
Another Enlightenment era charitable innovation was the dispensary; these would issue the poor with medicines free of charge. The London Dispensary opened its doors in 1696 as the first such clinic in the British Empire. The idea was slow to catch on until the 1770s, when many such organizations began to appear, including the Public Dispensary of Edinburgh (1776), the Metropolitan Dispensary and Charitable Fund (1779) and the Finsbury Dispensary (1780). Dispensaries were also opened in New York 1771, Philadelphia 1786, and Boston 1796.
English physician Thomas Percival (1740‐1804) wrote a comprehensive system of medical conduct, 'Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks. A ward of the hospital at Scutari where Florence Nightingale worked and helped to restructure the modern hospital.
In the mid 19th century, hospitals and the medical profession became more professionalized, with a reorganization of hospital management along more bureaucratic and administrative lines. The Apothecaries Act 1815 made it compulsory for medical students to practice for at least half a year at a hospital as part of their training.
Florence Nightingale pioneered the modern profession of nursing during the Crimean War when she set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration. The first official nurses’ training programme, the Nightingale School for Nurses, was opened in 1860, with the mission of training nurses to work in hospitals, to work with the poor and to teach. Nightingale was instrumental in reforming the nature of the hospital, by improving sanitation standards and changing the image of the hospital from a place the sick would go to die, to an institution devoted to recuperation and healing. She also emphasized the importance of statistical measurement for determining the success rate of a given intervention and pushed for administrative reform at hospitals.
By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a variety of public and private hospital systems. By the 1870s, hospitals had more than trebled their original average intake of 3,000 patients. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principle provider of health care in the United Kingdom, was founded in 1948.
During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.
To better serve the wide‐ranging needs of the community, the modern hospital has often developed outpatient facilities, as well as emergency, psychiatric, and rehabilitation services. In addition, “bed less hospitals” provide strictly ambulatory (outpatient) care and day surgery. Patients arrive at the facility for short appointments. They may also stay for treatment in surgical or medical units for part of a day or for a full day, after which they are discharged for follow‐up by a primary care health provider.
Hospitals have long existed in most countries. Developing countries, which contain a large proportion of the world’s population, generally do not have enough hospitals, equipment, and trained staff to handle the volume of persons who need care. Thus, people in these countries do not always receive the benefits of modern medicine, public health measures, or hospital care, and they generally have lower life expectancies.
In developed countries the hospital as an institution is complex, and it is made more so as modern technology increases the range of diagnostic capabilities and expands the possibilities for treatment. As a result of the greater range of services and the more‐involved treatments and surgeries available, a more highly trained staff is required. A combination of medical research, engineering, and biotechnology has produced a vast array of new treatments and instrumentation, much of which requires specialized training and facilities for its use. Hospitals thus have become more expensive to operate, and health service managers are increasingly concerned with questions of quality, cost, effectiveness, and efficiency.