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Hospitals and Clinics

 

In ancient cultures, religion and medicine were linked. 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 (Greek: Ασκληπιεία, sing. Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" (Greek: ενκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium. The worship of Asclepius was adopted by the Romans. 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.

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). This text, which describes the building of a hospital is dated by Dominik Wujastyk of the University College London from the period between 100 BCE and CE150. 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.

King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physicians and nursing staff, the expense being borne by the royal treasury. Stanley Finger (2001) in his book, Origins of Neuroscience: A History of Explorations Into Brain Function, cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted." However Dominik Wujastyk disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs.

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 first teaching hospital where students were authorized to practice methodically 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".

Roman Empire

The Romans created valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., 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.

The adoption of Christianity as the state religion of the Roman Empire drove an expansion of the provision of care. Following 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 programs, 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 organized hospitals staffed by medical specialists which included female doctors. Facilities included systematic treatment procedures and specialized wards for various diseases..

A hospital and medical training center also existed at Jundishapur. The city of Jundishapur was founded in 271 CE by the Sassanid 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 population 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 Jundishapur 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 center at Jundishapur. 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 Jundishapur, 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.

Medieval Islamic world

Jundishapur surrendered to Islam in 636 AD. The first physicians under Muslim rule were Christians or Jews. One source indicates 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. The public hospital in Baghdad was 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 Jundishapur. It was headed by the Christian physician Jibrael ibn Bukhtishu from Jundishapur and later by Islamic physicians. "Bimaristan" is a compound of “bimar†(sick or ill) and “stan†(place). In the medieval Islamic world, the word "bimaristan" referred to a hospital establishment where the ill were welcomed, cared for and treated by qualified staff.

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 organized into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. The first Islamic psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health. Thus between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care.

Some suggest that physicians and surgeons were appointed who gave lectures to medical students and issued diplomas (ijazah) to those who were considered qualified to practice. However others assert that, in contrast to medieval Europe, medical schools under Islam did not develop a system of academic evaluation and certification.

Medieval Europe

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 travellers (mostly pilgrims to the shrine of Eulalia) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.

Colonial America

The first hospital founded in the Americas was the Hospital San Nicol's de Bari (Calle Hostos) in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicol's de Ovando, Spanish governor and colonial administrator from 1502 to 1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552. Abandoned in the mid-eighteenth century, the hospital now lies in ruins near the Cathedral in Santo Domingo.

Conquistador Hernando Cortes founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was the Immaculate Conception, now the Hospital de Jesus Nazareno in Mexico City, founded in 1524 to care for the poor.

The first hospital north of Mexico was 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, begun by the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by a colonial physician, Robert Giffard de Moncel.

    

       

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