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 Ã†sculapius, he was
provided with a temple (291 BC) on an island in the Tiber in
Rome, where similar rites were performed.
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
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 Carakaâ€™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".
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.
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 â€œbimarâ€ (sick or ill) and â€œstanâ€ (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.
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 hÃ´tel-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 MÃ©rida, 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.
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.
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.