The History of Hospitals
Last week our hospital on the coast underwent its Joint Commission site visit for the clinical portion of our accreditation survey. We passed with flying colors. This accreditation survey is done every three years and covers literally thousands of regulatory, safety and quality requirements. Pondering how we got here made me think that it might be interesting to explore the history of hospitals in general.
The word “hospital” derives from the Latin root hospes, which means “guest” and “hospitium” meaning “to welcome someone as a guest”. This is the same root that gives rise to other English words like hospitality, hospice, hostel and hotel.
While healers have been part of human civilization from the very beginning, it wasn’t until around 500 BCE that civilizations developed to the point of having dedicated schools of medical learning and facilities dedicated to taking care of the sick and injured. On the Western side of things, the Greek physician Hippocrates (460 – 370 BCE) founded a school of medicine that taught the concept of observing a patient’s response to treatment as an essential part of caring for the sick. He wrote about a location, that presumably he helped establish, where the sick were kept for such treatments and observations. By 100 BCE, the Roman Empire had military dispensaries, built as part of their barracks in larger fortifications, to treat sick and injured soldiers.
On the Eastern side of civilization, India and China drew upon thousands of years of Chinese medicine. King Pandukabhaya of Sri Lanka (437-367 BCE) established “laying-in homes” for sick people to go and stay for treatments. The first formal hospital in the world is considered to have been established in the ancient city of Gundeshapur, Persia, in 271 CE by King Shapur I. This medical center included a hospital, medical school and library.
When the Roman Emperor, Constantine, converted to Christianity, he held the First Council of Bishops in 325 CE. It declared that a hospital should be built in every city that possessed a cathedral. The first was built in Constantinople and by the 12th century it had developed into a well-organized hospital that had wards dedicated to treatment of different ailments and was staffed by both male and female doctors.
By the 10th century, the concept of hospitals was well developed, especially in Islamic countries. Under the Islamic tradition of healthcare at the time, several new ideas were added including nursing homes for the care of the aged and infirm and separate hospitals to treat mental illness. In fact, simply recognizing mental illness as an illness, and not an infliction of being possessed by daemons, has its roots in this Islamic tradition. They also added the concept that physicians who had formal training in medicine should receive diplomas indicating this and that a physician’s salary would be tied to whether or not they had such a diploma. Under Islamic law, hospitals were supported by government funds and were forbidden to turn away patients who were unable to pay.
While the Eastern world was moving forward, the Western world was suffering through the Dark Ages and one plague after another. With the Age of Enlightenment came improvements in public health, sanitation and healthcare in Europe. This rekindled an interest in building hospitals and every major city soon had several competing hospitals. Rural communities, however, were left with care being provided in the home by visiting nurses and doctors.
In 1889, Dr. William Osler (1849-1919), a Canadian physician who is considered to be the father of modern medicine, helped found the Johns Hopkins University School of Medicine and Hospital. Osler advocated for many changes to the way medicine was taught and practiced, most of which are the foundations of our present practice of medicine. One of his major beliefs was that treatments should be based on scientific evidence. With this shift, large hospitals became more than just places to treat the sick. They became centers of research.
Another important reformer of modern healthcare was Florence Nightingale (1820-1910). She revolutionized nursing into a formal profession, established standards for nursing education and is considered to by the founder of modern nursing. She founded the St. Thomas’ Hospital School of Nursing in London in 1860, which is now part of King’s College of London. With advancements in nursing training, quality of care in hospitals improved. She had a strong belief in the need for proper sanitation and handwashing in hospitals to prevent the spread of disease, especially at the time of childbirth and during surgery. This led to many of the standards which we still follow today. Another contribution of Nightingale was her idea that hospitals should have structured administrations whose leaders should possess standardized education and training.
Between World War I and World War II, there were major advancements in medical science that significantly changed the nature of hospitals with three areas standing out. First, surgery became less risky with development of better sterile techniques and more effective anesthetics. Second, was the development of antibiotics which, for the first time, gave a truly effective way of combating infectious diseases. Third, was the ability to start imaging internal structures of the body with the use of x-rays.
On August 13, 1946, President Harry S. Truman signed the Hill-Burton Act, also known as the Hospital Survey and Construction Act, which provided federal dollars so that all communities, but especially rural ones, could each have their own hospital. This led to a dramatic increase in construction of new hospitals. In 1946, there were about 2,300 hospitals in the US. This number peaked in 1975 at 7,156.
With the advancement of medical science towards increasingly more expensive and specialized treatments, many of the small hospitals built during that time have closed. The focus has become more and more towards regional hospitals. This has also been aided by advancements in medical transport. According to the American Hospital Association, currently there are 6,093 hospitals in the US, with only 1,796 being in rural communities.
We are indeed fortunate to have such a wonderful hospital as we do on the Coast.