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 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.