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A hospital is an institution for health care providing treatment by specialised staff and equipment, and often but not always providing for longer-term patient stays.

Today, hospitals are usually funded by the state, health organizations (for profit or non-profit), health insurances or charities, including direct charitable donations. In history, however, they were often founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers.

EtymologyEdit

The name comes from Latin hospes (host), which is also the root for the English words hotel, hostel, and hospitality. The modern word hotel derives from the French word hostel, which featured a silent s, which was eventually removed from the word. (The circumflex on modern French hôtel hints at the vanished s)

Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word is normally used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both usages are found.

History Edit

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In ancient cultures, religion and medicine were linked. The earliest known institutions aiming to provide cure were Egyptian temples. Greek temples dedicated to the healer-god Asclepius might admit the sick, who would wait for guidance from the god in a dream. The Romans adopted his worship. 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.[1]

The Sinhalese (Sri Lankans) are perhaps responsible for introducing the concept of dedicated hospital-like institutions. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty written in the 6th century A.D., King Pandukabhaya (4th century BC) had lying-in-homes/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.[2][3] Mihintale Hospital is perhaps the oldest in the world.[4]

Institutions created specifically to care for the ill also appeared early in India. King Ashoka is said to have founded at least 18 hospitals, ca. 230 BC, with physicians and nursing staff, the expense being borne by the royal treasury.[5] However, there are historians who strictly dispute the claim that Ashoka built any hospitals at all, and argue that it is based on a mistranslation, with references to 'rest houses' being mistaken for hospitals. The error is thought to have occurred because similar edicts and records talk of Ashoka importing medicinal supplies.[6]

The first teaching hospital where students were authorized to methodically practice on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".[7]

State-supported hospitals later may have appeared in China some time during the first millennium A.D.

The Romans created valetudinaria for the care of sick slaves, gladiators and soldiers around 100 BC, 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.[8]

The adoption of Christianity as the state religion of the empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the Church to provide for the poor, sick, widows and strangers. It ordered the construction of a hospital-like institution in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.[9]

Medieval IslamEdit

See also: Islamic medicine

The earliest recorded hospitals, in the modern sense of the world, appeared in the medieval Islamic world, dating back to the hopital of al-Walid ibn 'Abdul Malik (ruled 705-715 CE), which he built in 86 AH (706-707 CE). It was much more general than the Byzantine nosocomia, with Islamic hospitals extending their services to the lepers and the invalid and destitute people. All treatment and care was free of charge and there was more than one physician employed in this hospital.[10] Islamic hospitals are considered the first academic medical centres.[11]

In the medieval Islamic world, the word "Bimaristan" was used to indicate a hospital in the modern sense, an establishment where the ill were welcomed and cared for by qualified staff. In this way, Muslim physicians were the first to make a distinction between a hospital and other different forms of healing temples, sleep temples, hospices, assylums, lazarets and leper-houses, all of which in ancient times were more concerned with isolating the sick and the mad from society "rather than to offer them any way to a true cure." Some thus consider the medieval Bimaristan hospitals as "the first hospitals" in the modern sense of the word.[12] The first public hospitals,[13] psychiatric hospitals[14] and medical universities[15] were also introduced by medieval Muslim physicians.

Between the eighth and twelfth centuries CE, Muslim hospitals developed a high standard of care. Hospitals built in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan, a sign of great breakthrough. In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists, group of religious scholars whose medical services included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a mental hospital and medical madrasa in Edirne, and a number of other early hospitals were also built in Turkey. Unlike in Greek temples to healing gods, the clerics working in these facilities employed scientific methodology far beyond that of their contemporaries in their treatment of patients.[16]

According to Sir John Bagot Glubb:

By Mamun's time medical schools were extremely active in Baghdad. The first free public hospital was opened in Baghdad during the Caliphate of Haroon-ar-Rashid. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice. The first hospital in Egypt was opened in 872 AD and thereafter public hospitals sprang up all over the empire from Spain and the Maghrib to Persia.[15]

Umayyad Caliph Al-Walid ibn Abd al-Malik is often credited with building the first permanent Bimaristan in Damascus in 707 AD.[11] The bimaristan had a staff of salaried physicians and a well equipped dispensary.[17] It treated the blind, lepers and other disabled people, and also separated those patients with leprosy from the rest of the ill.[17] Some consider this bimaristan no more than a lepersoria because it only segregated patients with leprosy.[11] The first true Islamic hospital was built during the reign of Caliph Harun al-Rashid.[18] The Caliph invited the son of chief physician, Jabril ibn Bukhtishu to head the new Baghdad bimaristan. It quickly achieved fame and led to the development of other hospitals in Baghdad.[18]

During this era, another lasting advancement was that of physician licensure, which became mandatory in the Abbasid Caliphate.[11] In 931 AD, Caliph Al-Muqtadir learned of the death of one of his subjects as a result of a physician's error.[19] He immediately ordered his muhtasib Sinan ibn Thabit to examine and prevent doctors from practicing until they passed an examination.[19][11] From this time on, licensing exams were required and only qualified physicians were allowed to practice medicine.[19][11]

Influence in EuropeEdit

According to medical historian Andrew C. Miller:[11]

Building upon the inspiration afforded by the bimaristan at Jundi-Shapur, near- and middle-easterners transformed hospitals into institutionalized establishments for patient care, medical education and training. The complex structure and hierarchy of these hospitals, advent of medical records, physician licensure, government oversight and universal access to care set the example upon which later hospitals were modelled.
It is purely cultural nepotism to assert that western hospitals developed independently of their near-eastern predecessors, when Spain and Portugal (part of the Islamic empire for over 700 years) were riddled with bimaristans. Cordova alone had fifty major hospitals and the Granada bimaristan served as the model for the Hospital Real in Santiago di Compostela and later Granada hospital, commissioned by Ferdinand and Isabella. Physicians fleeing Spain moved on to establish academic medical centres in other European cities such as Salerno. Additionally, upon returning from a crusade, the Knights of St John were called ‘Hospitallers’ due to the hospitals they constructed based upon the Arabic model founded by Saladin. Between the Andalusian hospitals, those in the lands of the Crusades and the bimaristans, where westerners were treated along trade routs and during travel expeditions, westerners had extensive interactions with the bimaristans that were nearly 1000 years the predecessors of their western counterparts.

Medieval EuropeEdit

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Medieval hospitals in Europe followed a similar pattern. 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-function 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. Not until later where most hospitals multi-functional, though the first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580 at Mérida, was a xenodochium designed as an inn for travellers (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.

Colonial AmericaEdit

It is believed that the first hospital founded in the Americas [Western Hemisphere] following Columbus arrival to the island now known as Hispaniola was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, [Distrito Nacional] Dominican Republic.

Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502-1509, authorized its construction in or after 1504. It is believed that this hospital also served as a church during its lifetime. The first phase of its construction was completed in 1519. Erwin Walter Palm, [former author and professor of Spanish American art, culture, and history] wrote that "the Brotherhood of Our Lady of the Conception continued the construction of the hospital in 1533, adding modern elements, including additional buildings." Abandoned in the mid-18th century the hospital now lies in ruins near the Cathedral in the colonial zone in Santo Domingo, DR, amid additional historical New World sights.

The Hospital de Jesús Nazareno in Mexico City is the oldest hospital in North America. It was founded in 1524 with the economic support of conquistador Hernán Cortés to care for poor Spanish soldiers and the native inhabitants.

The first hospital in North America north of Mexico is the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project of the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by colonial physician Robert Giffard de Moncel.

Modern era Edit

In Europe, the medieval concept of religious care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.

Guy's Hospital was founded in London in 1724 from a bequest by wealthy merchant Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.[20]

When the Viennese General Hospital (Allgemeines Krankenhaus) opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the 19th 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 was the birth of specialized medicine.[citation needed]

By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In Continental Europe the new hospitals were generally built and run from public funds. The National Health Service, the principle provider of healthcare in the United Kingdom, was founded in 1948.

In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax-exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. In the late twentieth century, chains of for-profit hospitals arose in the USA.

References & NotesEdit

  1. Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), pp.134-5.
  2. Prof. Arjuna Aluvihare, "Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" Vidhusara Science Magazine, Nov. 1993.
  3. Resource Mobilization in Sri Lanka's Health Sector - Rannan-Eliya, Ravi P. & De Mel, Nishan, Harvard School of Public Health & Health Policy Programme, Institute of Policy Studies, February 1997, Page 19. Accessed 2008-02-22.
  4. Heinz E Müller-Dietz, Historia Hospitalium (1975).
  5. Encyclopedia of Medical History - McGrew, Roderick E. (Macmillan 1985), p.135.
  6. The Nurses should be able to Sing and Play Instruments - Wujastyk, Dominik; University College London. Accessed 2008-02-22.)
  7. C. Elgood, A Medical History of Persia, (Cambridge Univ. Press), p. 173.
  8. The Roman military Valetudinaria: fact or fiction - Baker, Patricia Anne, University of Newcastle upon Tyne, Sunday 20 December 1998
  9. Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), p.135.
  10. al-Hassani, Woodcock and Saoud (2007), 'Muslim heritage in Our World', FSTC Publishing, pp.154-156
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Miller, Andrew C (December 2006). "Jundi-Shapur, bimaristans, and the rise of academic medical centres". Journal of the Royal Society of Medicine 99 (12): pp. 615–617. doi:10.1258/jrsm.99.12.615. http://jrsm.rsmjournals.com/content/99/12/615.short. 
  12. Micheau, Francoise, "The Scientific Institutions in the Medieval Near East", pp. 991-2 , in (Morelon & Rashed 1996, pp. 985-1007)
  13. Peter Barrett (2004), Science and Theology Since Copernicus: The Search for Understanding, p. 18, Continuum International Publishing Group, ISBN 056708969X.
  14. Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", Journal of the Islamic Medical Association, 2002 (2), p. 2-9 [7-8].
  15. 15.0 15.1 Sir Glubb, John Bagot (1969), A Short History of the Arab Peoples, http://www.cyberistan.org/islamic/quote2.html#glubb, retrieved on 25 January 2008 
  16. Turkish Contributions to Scientific Work in Islam - Aydin Sayili, Foundation For Science, Technology and Civilisation, Septermber 2004, Page 9
  17. Cite error: Invalid <ref> tag; no text was provided for refs named Rahman
  18. Cite error: Invalid <ref> tag; no text was provided for refs named Nagamia
  19. Cite error: Invalid <ref> tag; no text was provided for refs named Shanks
  20. Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), p.139.

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