How Did Hospitals Emerge

We think of hospitals as being a foundation to modern healthcare systems; however, the emergence of hospitals is not only ancient but it also evolved through a complex history. Hospitals were seen as a way to address healthcare in increasingly urban spaces in the ancient world. In the Medieval and Modern periods, new practices emerged that allowed them to be integrated within educational, government, and private institutions.

The Rise of Early Hospitals

Early hospitals may have had their origins from temple institutions in ancient Egypt and Mesopotamia. In both these cultures, temples and priests, who also performed healing duties, may have used part of the temple compounds as areas for patients to be healed for a variety of diseases and sicknesses. Early surgical practice is also recorded, mostly likely by the 3rd millennium BCE. In both Egypt and Mesopotamia, doctors like performed surgery dealing with c-section and removal of boils. More complicated surgery may have been practiced; however, the limitation of not having anesthesia and infection would have made surgery at times very dangerous. What these early hospitals, or institutions, indicate is that as cities and urban areas emerged, it was clear that large populations also made it easy for sickness to spread. Hospitals and healing of common diseases, infections and every surgery became a major necessity at the dawn of urbanism. Similar to ancient Egypt and Mesopotamia, ancient Greece also had gods devoted to healing. The god Asclepius and his cult may have functioned similarly to healing gods and practices in Egypt and Mesopotamia, where the temples could have been used as areas for people to come and receive a form of healthcare, including medicine and surgery in cases.

Among early healthcare facilities, the Achaemenid Persians in the late 6th century and 5th centuries BCE may have established something comparable to a teaching hospital in Egypt and other places. In the Roman period, structures known as valetudinaria , which were likely secular facilities devoted to health care of soldiers, gladiators, slaves, and even potentially others. In the Christian period, by the late 4th century CE, there were edicts to now build dedicated hospitals. This was largely motivated by Christian interests in healing in relation to relgious practices and following New Testament teaching on healing. The hospital in Constantinople and Casesarea in Turkey are among the first known. Little is known about these structures but they likely indicate a type of healthcare facility for the masses.

Perhaps the first true teaching hospital known to us, at the Academy of Gondishapu, was established by the Sassanid Persians by the 5th century CE. Groups of medical scholars, who also came from the Byzantine Empire as Christian refugees because they were Nestorian Christians, banned by the emperor in Constantinople, came to Gundeshapur in Southwest Iran. They helped found an academy that had devoted medical facilities not only for healing and practice of surgery but the academy was now dedicated to education. It is here that concepts of anatomy were likely developed. By the 6th and 7th centuries CE, it likely became the most important medical center in the world. The academy attracted physicians from much of the ancient world, including from India and China. Medical students now were required to work closely with their educators and became apprenticed in the practice.

The Rise of Medieval Hospitals

With the Muslim conquest, the city and academy in Gondishapur fell into eventual disrepair; however, the knowledge and training were now transferred to Baghdad, as that city became the new center for medical education and development of hospitals. There, knowledge was not only integrated with Sassanid medicine and development of hospitals, but Indian medicine, such as Ayurveda, were incorporated. Lecture rooms, pharmacies and libraries were incorporated in instructions. Hospitals were soon founded in the 7-10th centuries throughout the Middle East, including in Cairo, Damascus, and Baghdad. While hospitals became affiliated with Islamic teaching and instruction, Christians and Jews were active in medical work and developing hospitals. Doctors and medical students began to make rounds and examine patients closely after treatment. At this time, the concept of medical records for patients was developed, where doctors would record patient information and results of treatments as they visited patients. Surgery was practiced in theaters where medical students would observe and medical books were also written about surgical practice and anatomy. The development of the pharmacy, first established by Middle East doctors, evolved in the 9th century CE as a separate department that was also affiliated with hospitals and medical departments. What this development recognized is the importance of pharmacology as a separate science requiring both herbal and chemical knowledge.

In Europe, hospitals were even less secular and affiliated with religious institutions, particularly the Catholic church. Monks and priests would often work these institutions. In fact, the relationship of hospitals and the Catholic church, in particular, has continued to this day. However, what created more secular hospitals was the Protestant Reformation. In this case, hospitals that were once supported by the Catholic Church lost their support. In England, the loss of support for hospitals led many citizens to often demand that the government begin to take control of these institutions. This began the process of government-supported and eventually private hospitals.