Historical Perspective

61301_CH01_5090.qxd 8/8/08 10:42 AM Page 1 1 HISTORICAL PERSPECTIVE This chapter provides the reader with a brief pregnant women. These examples probably overview of the advance of civilization as moved Buddha’s devotees to erect similar hos- disclosed in the history of hospitals. A study pitals. Historians agree that hospitals existed of the past often reveals errors that can be in Ceylon as early as 437 BC. avoided, customs that persist only because of During his reign from 273 to 232 BC, King tradition, and practices that have been su- Asoka built hospitals that hold historical sig- perseded by others that are more effectual. nificance because of their similarities to the The past can also bring to light some long- modern hospital. Attendants gave gentle care abandoned procedures, which can be revived to the sick, provided patients with fresh fruits to some advantage. The story of the birth and and vegetables, prepared their medicines, gave evolution of the hospital portrays the triumph massages, and maintained their personal of civilization over barbarism and the progress cleanliness. Hindu physicians, adept at surgery, of civilization toward an ideal characterized by were required to take daily baths, keep their an interest in the welfare of the community. hair and nails short, wear white clothes, and promise that they would respect the confi- EARLY HINDU AND EGYPTIAN dence of their patients. Although bedside care HOSPITALS was outstanding for those times, medicine was only beginning to find its way. Two ancient civilizations, India and Egypt, had Egyptian physicians were probably the first crude hospitals. Hindu literature reveals that to use drugs such as alum, peppermint, castor in the 6th century BC, Buddha appointed a oil, and opium. In surgery, anesthesia con- physician for every 10 villages and built hospi- sisted of hitting the patient on the head with tals for the crippled and the poor. His son, a wooden mallet to render the patient uncon- Upatiso, built shelters for the diseased and for scious. Surgery was largely limited to fractures, 1 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 61301_CH01_5090.qxd 8/8/08 10:42 AM Page 2 2 CHAPTER 1: HISTORICAL PERSPECTIVE and medical treatment was usually given in clinical records. The columns of the temple the home. Therapy away from home was were inscribed with the names of patients, often available in temples, which functioned brief histories of their cases, and comments as hospitals. as to whether or not they were cured. The aesculapia spread rapidly throughout GREEK AND ROMAN HOSPITALS the Roman Empire as well as through the Greek world. Although some hospitals were The term “hospital” derives from the Latin simply spas, others followed the therapy out- word hospitalis, which relates to guests and lined by the leading physicians of the day. their treatment. The word reflects the early Hippocrates, for example, a physician born use of these institutions not merely as places about 460 BC, advocated medical theories, of healing but as havens for the poor and which have startling similarity to those of the weary travelers. Hospitals first appeared in present day. He employed the principles of Greece as aesculapia, named after the Greek percussion and auscultation, wrote intelligently god of medicine, Aesculapius. For many cen- on fractures, performed numerous surgical turies, hospitals developed in association with operations, and described such conditions as religious institutions, such as the Hindu hospi- epilepsy, tuberculosis, malaria, and ulcers. He tals opened in Sri Lanka in the 5th century BC also kept detailed clinical records of many of and the monastery-based European hospitals his patients. Physicians like Hippocrates not of the Middle Ages (5th century to 15th cen- only cared for patients in the temples but also tury). The Hotel-Dieu in Paris, a monastic hos- gave instruction to young medical students. pital founded in 660, is still in operation today. In early Greek and Roman civilization, HOSPITALS OF THE EARLY when medical practices were rife with mysti- CHRISTIAN ERA cism and superstitions, temples were also used as hospitals. Every sanctuary had a sa- Christianity and the doctrines preached by cred altar before which the patient, dressed in Jesus stressing the emotions of love and pity white, was required to present gifts and offer gave impetus to the establishment of hospitals, prayers. If a patient was healed, the cure was which, with the advance of Christianity, be- credited to miracles and divine visitations. came integral parts of the church institution. Greek temples provided refuge for the sick. These Christian hospitals replaced those of One of these sanctuaries, dedicated to Aescu- Greece and Rome and were devoted entirely lapius, is said to have existed as early as 1134 to care of the sick, and they accommodated BC at Titanus. Ruins attest to the existence of patients in buildings outside the church proper. another, more famous Greek temple built sev- The decree of Constantine in 335 closed the eral centuries later in the Hieron, or sacred aesculapia and stimulated the building of grove, at Epidaurius. Here physicians minis- Christian hospitals. By the year 500, most large tered to the sick holistically in body and soul. towns in the Roman empire had erected hos- They prescribed medications such as salt, pitals. Nursing, inspired by religion, was gen- honey, and water from a sacred spring. They tle and considerate. The medical precepts of gave patients hot and cold baths to promote Hippocrates, Antyllus, and other early Greek speedy cures and encouraged long hours of physicians soon began to be discarded be- sunshine and sea air, combined with pleasant cause of their pagan origins. Instead, health vistas, as an important part of treatment. The care turned toward mysticism and theurgy (the temple hospitals housed libraries and rooms working of a divine agency in human affairs) for visitors, attendants, priests, and physi- as sources of healing. cians. The temple at Epidaurius even boasted Hospitals rarely succeeded during the cen- what might be described as the site of the first turies leading to the Middle Ages; only a few © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 61301_CH01_5090.qxd 8/8/08 10:42 AM Page 3 Medieval Hospitals 3 existed outside Italian cities. Occasional cians were acquainted with the possibilities of almshouses in Europe sheltered some of the inhalation anesthesia. They instituted pre- sick, while inns along the Roman roads housed cautions against adulteration of drugs and others. developed a vast number of new drugs. Mo- hammedan countries also built asylums for the MOHAMMEDAN HOSPITALS mentally ill a thousand years before such institutions appeared in Europe. The people of The followers of Mohammed were almost as Islam made a brilliant start in medicine but zealous as the Christians in caring for the sick. never fulfilled the great promise that glowed In Baghdad, Cairo, Damascus, Cordova, and in their early work in medical arts and hospi- many other cities under their control, luxuri- talization. Wars, politics, superstitions, and a ous hospital accommodations were frequently nonprogressive philosophy stunted the growth provided. Harun al-Rashid, the glamorous of a system that had influenced the develop- caliph (a title for a religious or civil ruler claim- ment of hospitals. ing succession from Muhammad) of Baghdad (786 to 809), built a system of hospitals. Med- ical care in these hospitals was free. About four EARLY MILITARY HOSPITALS centuries later, in 1160, a Jewish traveler re- Engraved on a limestone pillar dating back to ported that he had found as many as 60 dis- the Sumerians (2920 BC) are pictures, which, pensaries and infirmaries in Baghdad alone. among other military procedures, show the The Persian physician Rhazes, who lived from assemblage of the wounded. The book of about 850 to 923, was skilled in surgery. He Deuteronomy records that Moses laid down was probably the first to use the intestines of outstanding rules of military hygiene. Out of sheep for suturing and cleansing patient the urgency of care for the wounded in battle wounds with alcohol. came much of the impetus for medical Mohammedan physicians like Rhazes re- progress. Hippocrates is quoted as saying that ceived much of their medical knowledge “war is the only proper school for a surgeon.” from the persecuted Christian sect known as Under the Romans, surgery advanced largely the Nestorians. Nestorius, driven into the because of experience gained through gladia- desert with his followers after having been torial and military surgery. appointed patriarch of Constantinople, took up the study of medicine. The school at Edessa in Mesopotamia, with its two large MEDIEVAL HOSPITALS hospitals, eventually came under the control of the Nestorians in which they established a Religion continued to dominate the establish- remarkable teaching institution. Eventually ment of hospitals during the Middle Ages. Al- driven out of Mesopotamia by the orthodox though physicians cared for physical ailments bishop Cyrus, they fled to Persia, establishing to afford relief, they rarely attempted to cure the famous school at Gundishapur, which is the sick. Dissection of a human body would conceded to be the true starting point of Mo- have been sacrilege because the body was cre- hammedan medicine. Gundishapur was home ated in the image of God. to the world’s oldest known teaching hospital Religion continued to be the most important and also contained a library and a university. factor in the establishment of hospitals during It was located in the present-day province of the Middle Ages. A number of religious orders Khuzistan, in the southwest of Iran, not far created travelers’ rests and infirmaries adja- from the Karun river. cent to monasteries that provided food and Mohammedan medicine flourished up to temporary shelter for weary travelers and about the 15th century.

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