The history of hospitals began in antiquity with hospitals in Greece, the Roman Empire, Sasanian Iran and on the Indian subcontinent as well, starting with precursors in the Asclepian temples in ancient Greece and then the military hospitals in ancient Rome. The Greek temples were dedicated to the sick and infirm but did not look anything like modern hospitals. The Romans did not have dedicated, public hospitals. Public hospitals, per se, did not exist until the Christian period. Towards the end of the 4th century, the "second medical revolution" took place with the founding of the first Christian hospital in the eastern Byzantine Empire by Basil of Caesarea, and within a few decades, such hospitals had become ubiquitous in Byzantine society. The hospital would undergo development and progress throughout Byzantine, medieval European and Islamic societies from the 5th to the 15th century. European exploration brought hospitals to colonies in North America, Africa, and Asia. St Bartholomew's hospital in West Smithfield in London, founded in 1123, is widely considered the oldest functioning hospital today. Originally a charitable institution, currently an NHS hospital it continues to provide free care to Londoners, as it has for 900 years. In contrast, the Mihintale Hospital in Sri Lanka, established in the 9th century is probably the site with the oldest archaeological evidence available for a hospital in the world. Serving monks and the local community, it represents early advancements in healthcare practices.
The first Western-style hospital in Japan was established in 1556 by Jesuit missionary Luis de Almeida. Early Chinese and Korean hospitals were founded by Western missionaries in the 1800s. In the early modern era care and healing would transition into a secular affair in the West for many hospitals. During World War I and World War II, many military hospitals and hospital innovations were created. Government run hospitals increased in Korea, Japan, China, and the Middle East after World War II. In the late 1900s and 21st century, hospital networks and government health organizations were formed to manage groups of hospitals to control costs and share resources. Many smaller, less efficient hospitals in the West were closed because they could not be sustained.
Antiquity In ancient history, hospitals have been documented in Greece, Rome, the Indian subcontinent, and Iran. In ancient cultures, religion and medicine were linked.
Greece
In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (, sing. Asclepieion, ), functioned as centres of medical advice, prognosis, and healing. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. Under his Roman name Æsculapius, he was provided with a temple (291 BCE) on an island in the Tiber in Rome (the Tiber Island), where similar rites were performed.
At these shrines, patients would enter a dream-like state of induced sleep known as enkoimesis () not unlike anesthesia, in which they either received guidance from the deity in a dream.Askitopoulou, H., Konsolaki, E., Ramoutsaki, I., Anastassaki, E. Surgical cures by sleep induction as the Asclepieion of Epidaurus. The history of anaesthesia: proceedings of the Fifth International Symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V., International Congress Series 1242 (2002), pp. 11–17. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BCE 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.
The Athenian Navy had a ship named Therapia, and the Roman Navy had a ship named Aesculapius, their names indicating that they may have been hospital ships.
Roman Empire
The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 BCE, and many were identified by later archaeology. 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 declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision of care. Following First Council of Nicaea in 325 CE 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 of Caesarea in modern-day Turkey towards the end of the 4th century. By the beginning of the 5th century, the hospital had already become ubiquitous throughout the Christian east in the Byzantine world, this being a dramatic shift from the pre-Christian era of the Roman Empire where no civilian hospitals existed. 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.Roderick E. McGrew, Encyclopedia of Medical History (1985), p. 135. 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.James Edward McClellan and Harold Dorn, Science and Technology in World History: An Introduction (The Johns Hopkins University Press, 2006), pp. 99, 101. 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 doctors who were both male and female. Facilities included systematic treatment procedures and specialized wards for various diseases.Byzantine medicine
South & East Asia
During the 4th century BCE in ancient Sri Lanka, according to the Mahāvaṃsa chronicle from the 6th century CE, King Pandukabhaya constructed hospitals and lying-in-homes after fortifying his capital in Anuradhapura. This provides the earliest literary evidence of hospitals, where patients could be housed and treated collectively. The oldest archaeological evidence of a hospital in Asia can be found in the ruins of Mihintale, dating back to the ninth century. Scholars suggest that this may be one of the oldest hospitals in the world.
King Ashoka is said by many secondary sources to have founded hospitals ca. 230 BCE.Encyclopaedia of Medical History – McGrew, Roderick E. (Macmillan 1985), p. 135. Early medical practices emerged early on in the Indian subcontinent with the practice of Ayurvedic medicine, one of the earliest texts for which survive being the Charaka Samhita and Sushruta Samhita. Some early Buddhist communities established monastic communities with monasteries, and many of these monasteries were centers of learning for medicine. While sick monks within the monastic communities were usually treated in their own cells, some monasteries reserved a room where sick monks could be taken care of.Mossensohn & Hershkovitz, "Early Muslim Medicine and the Indian Context: A Reinterpretation" Medieval Encounters 2013 p. 291 While some of these rooms in Buddhist monasteries may have been open to the public, the majority were closed off to the public and were reserved for treating other monks within the monastery.C. Pierce Salguero, "Toward a Global History of Buddhism and Medicine". Buddhist Studies Review 2015, p. 42.Amy Paris Langenberg, "Female Monastic Healing and Midwifery: A View from the Vinaya Tradition", Journal of Buddhist Ethics 2014. This ideal is reflected in the story of the monk with dysentery.Dhivan Thomas Jones, "Illness, Cure, and Care: Selections from the Pali Canon" in (ed. Salguero) Buddhism and Medicine, Columbia University Press 2017, pp. 7–9 The first clear reference to an actual hospital within the southeast Asian world occurs in the accounts of the traveller Fa Xian in the 5th century CE, who describes hospitals in the city of Pataliputra and a few other sites:
The first clear archaeological evidence of such hospitals first appears in the eighth and ninth centuries. Nevertheless, it would be inaccurate to portray the period as a time when a system of hospitals had existed. Rather, rulers from time to time may have sponsored and allocated resources for particular medical care for the population in particular places.Mossensohn & Hershkovitz, "Early Muslim Medicine and the Indian Context: A Reinterpretation" Medieval Encounters 2013 pp. 291–292 In one case, a countrywide system of hospitals was established in 12th century Cambodia under the Cambodian king Jayavarman VII, who associated it with the Buddha of healing Bhaisajyaguru.Dhivan Sharrock and Jacques, "'The Grief of the King is the Suffering of their Subjects': A Cambodian King's Twelfth Century Network of Hospitals" in (ed. Salguero) Buddhism and Medicine, Columbia University Press 2017, pp. 223–232
Significant and asymmetric transfers of knowledge to the southeast Asian world from the Greek one began during the reign of Alexander the Great in the late 4th century BCE as Hellenization swept the continent.Georgios Halkias. "When the Greeks Converted the Buddha: Asymmetrical Transfers of Knowledge in Indo-Greek Cultures" in Religion and Trade, Brill, 2014, pp. 65–115. While usually assumed that Tibetan medicine was largely Chinese in origin, it turns out that Tibetan medicine was actually largely Westernized, at least during the first century of the Tibetan Empire in the 7th–8th centuries. Persian and Arab doctors from the Islamic Caliphate could be found all across China in this time period.Beckwith. "The Introduction of Greek Medicine into Tibet in the Seventh and Eighth Centuries". Journal of the American Oriental Society 1979. It's also possible that Indian physicians played a role in a short-lived, but still one of the earliest Abbasid hospitals established by the Barkamid family.
5th to the 15th century + Notable hospital articles by century established (number of articles in Wikipedia)5th ()6th ()7th ()8th ()9th ()10th ()11th ()12th ()13th ()14th ()15th ()