A hospital is a health care institution providing patient treatment
with specialized medical and nursing staff and medical equipment.
The best-known type of hospital is the general hospital, which
typically has an emergency department to treat urgent health problems
ranging from fire and accident victims to a heart attack. A district
hospital typically is the major health care facility in its region,
with large numbers of beds for intensive care and additional beds for
patients who need long-term care. Specialised hospitals include trauma
centres, rehabilitation hospitals, children's hospitals, seniors'
(geriatric) hospitals, and hospitals for dealing with specific medical
needs such as psychiatric treatment (see psychiatric hospital) and
certain disease categories. Specialised hospitals can help reduce
health care costs compared to general hospitals.
A teaching hospital combines assistance to people with teaching to
medical students and nurses. The medical facility smaller than a
hospital is generally called a clinic. Hospitals have a range of
departments (e.g. surgery and urgent care) and specialist units such
as cardiology. Some hospitals have outpatient departments and some
have chronic treatment units. Common support units include a pharmacy,
pathology, and radiology.
Hospitals are usually funded by the public sector, health
organisations (for profit or nonprofit), health insurance companies,
or charities, including direct charitable donations. Historically,
hospitals were often founded and funded by religious orders, or by
charitable individuals and leaders.
Currently, hospitals are largely staffed by professional physicians,
surgeons, nurses, and allied health practitioners, whereas in the
past, this work was usually performed by the members of founding
religious orders or by volunteers. However, there are various Catholic
religious orders, such as the
Alexians and the Bon Secours Sisters
that still focus on hospital ministry in the late 1990s, as well as
Christian denominations, including the Methodists and
Lutherans, which run hospitals. In accordance with the original
meaning of the word, hospitals were originally "places of
hospitality", and this meaning is still preserved in the names of some
institutions such as the Royal
Hospital Chelsea, established in 1681
as a retirement and nursing home for veteran soldiers.
3 Departments or wards
4.1 Early examples
Roman Empire and Sassanid Persia
4.3 Early medieval Europe
4.4 Medieval Islamic world
4.5 Late medieval Europe
4.5.1 St Giles, Norwich
4.5.2 St. Anthony's, London
4.5.3 St Leonards, York
4.6 Early modern and Enlightenment Europe
4.7 19th century
4.8 20th century and beyond
7 See also
9.1 History of hospitals
10 External links
During peacetime, hospitals can be indicated by a variety of symbols.
For example, a white 'H' on a blue background is often used in the
United States. During times of armed conflict, a hospital may be
marked with the emblem of the red cross, red crescent or red crystal
in accordance with the Geneva Conventions.
Look up hospital in Wiktionary, the free dictionary.
During the Middle Ages, hospitals served different functions from
modern institutions. Middle Ages hospitals were almshouses for the
poor, hostels for pilgrims, or hospital schools. The word "hospital"
comes from the Latin hospes, signifying a stranger or foreigner, hence
a guest. Another noun derived from this, hospitium came to signify
hospitality, that is the relation between guest and shelterer,
hospitality, friendliness, and hospitable reception. By metonymy the
Latin word then came to mean a guest-chamber, guest's lodging, an
inn. Hospes is thus the root for the English words host (where the
p was dropped for convenience of pronunciation) hospitality, hospice,
hostel and hotel. The latter modern word derives from Latin via the
ancient French romance word hostel, which developed a silent s, which
letter was eventually removed from the word, the loss of which is
signified by a circumflex in the modern French word hôtel. The German
word 'Spital' shares similar roots.
The grammar of the word differs slightly depending on the dialect. In
the United States, hospital usually requires an article; in the United
Kingdom and elsewhere, the word normally is used without an article
when it is the object of a preposition and when referring to a patient
("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are
Lehigh Valley Hospital
Lehigh Valley Hospital in Allentown, Pennsylvania
Some patients go to a hospital just for diagnosis, treatment, or
therapy and then leave ("outpatients") without staying overnight;
while others are "admitted" and stay overnight or for several days or
weeks or months ("inpatients"). Hospitals usually are distinguished
from other types of medical facilities by their ability to admit and
care for inpatients whilst the others, which are smaller, are often
described as clinics.
The best-known type of hospital is the general hospital, which is set
up to deal with many kinds of disease and injury, and normally has an
emergency department (sometimes known as "accident & emergency")
to deal with immediate and urgent threats to health. Larger cities may
have several hospitals of varying sizes and facilities. Some
hospitals, especially in the United States and Canada, have their own
A district hospital typically is the major health care facility in its
region, with large numbers of beds for intensive care and critical
care and long-term care.
In California, "district hospital" refers specifically to a class of
healthcare facility created shortly after
World War II
World War II to address a
shortage of hospital beds in many local communities. Even today,
district hospitals are the sole public hospitals in 19 of California's
counties, and are the sole locally-accessible hospital within 9
additional counties in which one or more other hospitals are present
at substantial distance from a local community. Twenty-eight of
California's rural hospitals and 20 of its critical-access hospitals
are district hospitals. They are formed by local municipalities,
have boards that are individually elected by their local communities,
and exist to serve local needs. They are a particularly
important provider of healthcare to uninsured patients and patients
Medi-Cal (which is California's
Medicaid program, serving
low-income persons, some senior citizens, persons with disabilities,
children in foster care, and pregnant women). In 2012, District
hospitals provided $54 million in uncompensated care in California.
Starship Children's Health
Starship Children's Health is a children's hospital in Auckland, New
Types of specialised hospitals include trauma centres, rehabilitation
hospitals, children's hospitals, seniors' (geriatric) hospitals, and
hospitals for dealing with specific medical needs such as psychiatric
problems (see psychiatric hospital), certain disease categories such
as cardiac, oncology, or orthopedic problems, and so forth. In Germany
specialised hospitals are called Fachkrankenhaus; an example is
Fachkrankenhaus Coswig (thoracic surgery).
A hospital may be a single building or a number of buildings on a
campus. Many hospitals with pre-twentieth-century origins began as one
building and evolved into campuses. Some hospitals are affiliated with
universities for medical research and the training of medical
personnel such as physicians and nurses, often called teaching
hospitals. Worldwide, most hospitals are run on a nonprofit basis by
governments or charities. There are however a few exceptions, e.g.
China, where government funding only constitutes 10% of income of
hospitals. (need citation here. Chinese sources seem conflicted about
the for-profit/non-profit ratio of hospitals in China)
Specialised hospitals can help reduce health care costs compared to
general hospitals. For example, Narayana Health's Bangalore cardiac
unit, which is specialised in cardiac surgery, allows for
significantly greater number of patients. It has 3000 beds (more than
20 times the average American hospital) and in pediatric heart surgery
alone, it performs 3000 heart operations annually, making it by far
the largest such facility in the world. Surgeons are paid on a
fixed salary instead of per operation; thus, the costs to the hospital
drops when the number of procedures increases, taking advantage of
economies of scale. Additionally, it is argued that costs go down
as all its specialists become efficient by working on one "production
McMaster University Medical Centre
McMaster University Medical Centre is a teaching hospital in Hamilton,
A teaching hospital combines assistance to people with teaching to
medical students and nurses and often is linked to a medical school,
nursing school or university. In some countries like UK exists the
clinical attachment system that is defined as a period of time when a
doctor is attached to a named supervisor in a clinical unit, with the
broad aims of observing clinical practice in the UK and the role of
doctors and other healthcare professionals in the National Health
Main article: Clinic
The medical facility smaller than a hospital is generally called a
clinic, and often is run by a government agency for health services or
a private partnership of physicians (in nations where private practise
is allowed). Clinics generally provide only outpatient services.
Departments or wards
Resuscitation room bed after a trauma intervention, showing the highly
technical equipment of modern hospitals
Hospitals consist of departments, traditionally called wards,
especially when they have beds for inpatients, when they are sometimes
also called inpatient wards. Hospitals may have acute services such as
an emergency department or specialist trauma centre, burn unit,
surgery, or urgent care. These may then be backed up by more
specialist units such as the following:
Intensive care unit
Paediatric intensive care unit
Neonatal intensive care unit
Cardiovascular intensive care unit
Obstetrics and gynaecology, colloquially, maternity ward
In addition, there is the department of nursing, often headed by a
chief nursing officer or director of nursing. This department is
responsible for the administration of professional nursing practice,
research, and policy for the hospital.
Nursing permeates every part of
a hospital. Many units or wards have both a nursing and a medical
director that serve as administrators for their respective disciplines
within that specialty. For example, in an intensive care nursery, the
director of neonatology is responsible for the medical staff and
medical care while the nursing manager/director for the intensive care
nursery is responsible for all of the nurses and nursing care in that
Some hospitals have outpatient departments and some have chronic
treatment units such as behavioral health services, dentistry,
dermatology, psychiatric ward, rehabilitation services, and physical
Common support units include a dispensary or pharmacy, pathology, and
radiology. On the non-medical side, there often are medical records
departments, release of information departments, information
management (a.k.a. IM, IT or IS), clinical engineering (a.k.a.
biomed), facilities management, plant ops (operations, also known as
maintenance), dining services, and security departments.
Main article: History of hospitals
See also: Timeline of hospitals
View of the Askleipion of Kos, the best preserved instance of an
The earliest documented institutions aiming to provide cures were
ancient Egyptian temples. In ancient Greece, temples dedicated to the
healer-god Asclepius, known as Asclepieia 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 B.C.) on an
island in the
Tiber in Rome, where similar rites were performed.
Institutions created specifically to care for the ill also appeared
early in India. Fa Xian, a Chinese Buddhist monk who travelled across
India ca. A.D. 400, recorded in his travelogue that: The heads of the
Vaisya [merchant] families in them [all the kingdoms of north India]
establish in the cities houses for dispensing charity and medicine.
All the poor and destitute in the country, orphans, widowers, and
childless men, maimed people and cripples, and all who are diseased,
go to those houses, and are provided with every kind of help, and
doctors examine their diseases. They get the food and medicines which
their cases require, and are made to feel at ease; and when they are
better, they go away of themselves.
The earliest surviving encyclopaedia of medicine in Sanskrit is the
Charakasamhita (Compendium of Charaka). This text, which describes the
building of a hospital is dated by Dominik Wujastyk of the University
London from the period between 100 B.C. and A.D. 150.
According to Dr. Wujastyk, the description by
Fa Xian is one of the
earliest accounts of a civic hospital system anywhere in the world
and, coupled with Caraka's description of how a clinic should be
equipped, suggests that
India may have been the first part of the
world to have evolved an organised cosmopolitan system of
institutionally-based medical provision.
According to the Mahavamsa, the ancient chronicle of Sinhalese
royalty, written in the sixth century A.D., King Pandukabhaya of Sri
Lanka (reigned 437 B.C. to 367 B.C.) had lying-in-homes and hospitals
(Sivikasotthi-Sala) built in various parts of the country. This is the
earliest documentary evidence we have of institutions specifically
dedicated to the care of the sick anywhere in the world.
Hospital is the oldest in the world. Ruins of ancient
Sri Lanka are still in existence in Mihintale,
Anuradhapura, and Medirigiriya.
The Romans constructed buildings called valetudinaria for the care of
sick slaves, gladiators, and soldiers around 100 B.C., 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
Roman Empire and Sassanid Persia
Byzantine medicine and Ancient Iranian medicine
A physician taking the pulse of a patient. From a 17th-century copy of
Avicenna's Canon of Medicine. Wellcome Library, London.
The declaration of
Christianity as an accepted religion in the Roman
Empire drove an expansion of the provision of care. Following the
First Council of Nicaea
First Council of Nicaea in A.D. 325 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, bishop of
Caesarea in modern-day Turkey. 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. Some hospitals maintained libraries
and training programmes, 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
Christian mercy and
Byzantine innovation. Byzantine
hospital staff included the Chief
Physician (archiatroi), professional
nurses (hypourgoi) and the orderlies (hyperetai). By the twelfth
Constantinople had two well-organised hospitals, staffed by
doctors who were both male and female. Facilities included systematic
treatment procedures and specialised wards for various diseases.
A hospital and medical training centre also existed at Gundeshapur, a
major city in southwest of the
Sassanid Persian Empire
Sassanid Persian Empire founded in A.D.
271 by Shapur I. A large percentage of the population were Syriacs,
most of whom were Christians. Under the rule of Khusraw I, refuge was
granted to Greek Nestorian
Christian philosophers including the
scholars of the Persian School of Edessa (Urfa) (also called the
Academy of Athens), a
Christian theological and medical university.
These scholars made their way to
Gundeshapur in A.D. 529 following the
closing of the academy by Emperor Justinian. They were engaged in
medical sciences and initiated the first translation projects of
medical texts. The arrival of these medical practitioners from
Edessa marks the beginning of the hospital and medical centre at
Gundeshapur. It included a medical school and hospital
(wēmārestān), a pharmacology laboratory, a translation house, a
library and an observatory. Indian doctors also contributed to the
school at Gundeshapur, most notably the medical researcher Mankah.
Later after Islamic invasion, the writings of Mankah and of the Indian
doctor Sustura were translated into Arabic at Baghdad's House of
Early medieval Europe
The Romans first introduced hospitals to Britain during the early
Anglo-Saxon period. During this period, hospitals were mainly confined
to the domestic household or existed as small, military hospitals with
the function of caring to the sick, travellers, and of the long-term
infirm. During the Early Middle Ages (476529–800) and the middle
time period (ca. 800–1100), the rise of
Christianity had a great
effect on the practice of medicine. Church-sponsored hospitals began
to appear already after A.D. 350, but they primarily furnished bed and
board and seldom ventured into actual treatment. Over the next seven
centuries, the hospitals gradually passed from Church to monastic
control. Soon many
Christian monasteries became centers of
accumulation of the medical knowledge and practical experience in
Around 529 A.D. St.
Benedict of Nursia
Benedict of Nursia (480-543 A.D.), later a
Christian saint, the founder of western monasticism and the Order of
St. Benedict, today the patron saint of Europe, established the first
monastery in Europe (Monte Cassino) on a hilltop between
Naples, that became a model for the Western monasticism and one of the
major cultural centers of Europe throughout the Middle Ages, where he
wrote the "Rule", containing directions for monks and Christians. The
Rule of Saint Benedict
Rule of Saint Benedict is one of the most important written works in
the shaping of Western civilian society because it included a written
constitution, authority limited by law, and a degree of democracy.
Besides, it mandated the moral obligations to care for the sick. In
Monte Cassino St. Benedict founded a hospital that is considered today
to have been the first hospital in Europe of the new era. There
Benedictine monks took care of the sick and wounded according to the
Benedict's Rule. The monastic routine called for hard work. The care
of the sick was such an important duty that those caring for them were
enjoined to act as if they served Christ directly. Benedict founded
twelve communities for monks at nearby Subiaco (about 64 km to
the east of Rome), where hospitals were settled too as adjuncts to the
monasteries in order to provide charity and care for soldiers and
patients. Since that time the Benedictines were very involved in
healing and caring for the sick and dying, so in many cases early
Medieval medicine was closely connected with
Christianity and the
Benedictines in particular. This is why very often the early Middle
Ages are called "the Benedictine centuries".
Medieval Islamic world
Medicine in medieval Islam, Bimaristan, and Dar
Entrance to the Qawaloon complex which housed the notable Qawaloon
The earliest general hospital was built in 805 in
Baghdad by Harun
Al-Rashid. By the tenth century,
Baghdad had five more
Damascus had six hospitals by the 15th century and
Córdoba alone had 50 major hospitals, many exclusively for the
military. Some of the prominent early Islamic hospitals are
believed to have been founded with the assistance of Christians such
as Jibrael ibn Bukhtishu from Gundeshapur; there is no
evidence to associate the construction of the earliest hospital with
Christian physicians from Gondeshapur, but they may have played a role
in the function of the first hospital in Baghdad.
Compared to contemporaneous
Christian institutions, which were poor
and sick relief facilities offered by some monasteries, the Islamic
hospital was a more elaborate institution with a wider range of
functions. In Islam, there was a moral imperative to treat the ill
regardless of financial status. Islamic hospitals tended to be large,
urban structures, and were largely secular institutions, many open to
all, whether male or female, civilian or military, child or adult,
rich or poor, Muslim or non-Muslim. The Islamic hospital served
several purposes, as a center of medical treatment, a home for
patients recovering from illness or accidents, an insane asylum, and a
retirement home with basic maintenance needs for the aged and
The typical hospital was divided into departments such as systemic
diseases, surgery and orthopedics with larger hospitals having more
diverse specialties. "Systemic diseases" was the rough equivalent of
today's internal medicine and was further divided into sections such
as fever, infections and digestive issues. Every department had an
officer-in-charge, a presiding officer and a supervising specialist.
The hospitals also had lecture theaters and libraries. Hospitals staff
included sanitary inspectors, who regulated cleanliness, and
accountants and other administrative staff. The hospitals were
typically run by a three-man board comprising a non-medical
administrator, the chief pharmacist, called the shaykh saydalani, who
was equal in rank to the chief physician, who served as mutwalli
(dean). Medical facilities traditionally closed each night, but by
the 10th century laws were passed to keep hospitals open 24 hours a
For less serious cases, physicians staffed outpatient clinics. Cities
also had first aid centers staffed by physicians for emergencies that
were often located in busy public places, such as big gatherings for
Friday prayers to take care of casualties. The region also had mobile
units staffed by doctors and pharmacists who were supposed to meet the
need of remote communities.
Baghdad was also known to have a separate
hospital for convicts since the early 10th century after the vizier
‘Ali ibn Isa ibn Jarah ibn Thabit wrote to Baghdad's chief medical
officer that "prisons must have their own doctors who should examine
them every day". The first hospital built in Egypt, in Cairo's
Southwestern quarter, was the first documented facility to care for
mental illnesses while the first Islamic psychiatric hospital opened
Baghdad in 705.
Hospitals in this era were the first to require medical diplomas to
license doctors. The licensing test was administered by the
region's government appointed chief medical officer. The test had two
steps; the first was to write a treatise, on the subject the candidate
wished to obtain a certificate, of original research or commentary of
existing texts, which they were encouraged to scrutinize for errors.
The second step was to answer questions in an interview with the chief
medical officer. Physicians worked fixed hours and medical staff
salaries were fixed by law. For regulating the quality of care and
arbitrating cases, it is related that if a patient dies, their family
presents the doctor's prescriptions to the chief physician who would
judge if the death was natural or if it was by negligence, in which
case the family would be entitled to compensation from the doctor. The
hospitals had male and female quarters while some hospitals only saw
men and other hospitals, staffed by women physicians, only saw
women. While women physicians practiced medicine, many largely
focused on obstetrics.
Hospitals were forbidden by law to turn away patients who were unable
to pay. Eventually, charitable foundations called waqfs were
formed to support hospitals, as well as schools. Part of the state
budget also went towards maintaining hospitals. While the services
of the hospital were free for all citizens and patients were
sometimes given a small stipend to support recovery upon discharge,
individual physicians occasionally charged fees. In a notable
endowment, a 13th-century governor of Egypt
Al Mansur Qalawun
Al Mansur Qalawun ordained
a foundation for the Qalawun hospital that would be free for patients
and contain a mosque, a library for doctors and a pharmacy and the
hospital is used today for ophthalmology. The hospital had
accommodation for 8,000 people -  "it served 4,000 patients
Late medieval Europe
The church at
Les Invalides in France showing the often close
connection between historical hospitals and churches
The Hospitaller Order of St. John of Jerusalem, founded in 1099 (The
Knights of Malta) itself has - as its raison d’être - the founding
of a hospital for pilgrims to the Holy Land. In Europe, Spanish
hospitals are particularly noteworthy examples of
Christian virtue as
expressed through care for the sick, and were usually attached to a
monastery in a ward-chapel configuration, most often erected in the
shape of a cross. This style reached a high point during the hospital
building campaign of Portuguese St. John of God in the
sixteenth-century, the founder of the Hospitaller Order of the
Brothers of John of God.
Soon many monasteries were founded throughout Europe, and everywhere
there were hospitals like in Monte Cassino. By the 11th century, some
monasteries were training their own physicians. Ideally, such
physicians would uphold the Christianized ideal of the healer who
offered mercy and charity towards all patients and soldiers, whatever
their status and prognosis might be. In the 6th–12th centuries the
Benedictines established lots of monk communities of this type. And
later, in the 12th–13th centuries the Benedictines order built a
network of independent hospitals, initially to provide general care to
the sick and wounded and then for treatment of syphilis and isolation
of patients with communicable disease. The hospital movement spread
through Europe in the subsequent centuries, with a 225-bed hospital
being built at York in 1287 and even larger facilities established at
Florence, Paris, Milan, Siena, and other medieval big European cities.
In the North during the late Saxon period, monasteries, nunneries, and
hospitals functioned mainly as a site of charity to the poor. After
the Norman Conquest of 1066, hospitals are found to be autonomous,
freestanding institutions. They dispensed alms and some medicine, and
were generously endowed by the nobility and gentry who counted on them
for spiritual rewards after death. In time, hospitals became
popular charitable houses that were distinct from both English
monasteries and French hospitals.
The primary function of medieval hospitals was to worship to God. Most
hospitals contained one chapel, at least one clergyman, and inmates
that were expected to help with prayer. Worship was often a higher
priority than care and was a large part of hospital life until and
long after the Reformation. Worship in medieval hospitals served as a
way of alleviating ailments of the sick and insuring their salvation
when relief from sickness could not be achieved.
The secondary function of medieval hospitals was charity to the poor,
sick, and travellers. Charity provided by hospitals surfaced in
different ways, including long-term maintenance of the infirm,
medium-term care of the sick, short-term hospitality to travellers,
and regular distribution of alms to the poor.:58 Though these were
general acts of charity among medieval hospitals, the degree of
charity was variable. For example, some institutions that perceived
themselves mainly as a religious house or place of hospitality turned
away the sick or dying in fear that difficult healthcare will distract
from worship. Others, however, such as St. James of Northallerton, St.
Giles of Norwich, and St. Leonard of York, contained specific
ordinances stating they must cater to the sick and that "all who
entered with ill health should be allowed to stay until they recovered
The tertiary function of medieval hospitals was to support education
and learning. Originally, hospitals educated chaplains and priestly
brothers in literacy and history; however, by the 13th century, some
hospitals became involved in the education of impoverished boys and
young adults. Soon after, hospitals began to provide food and shelter
for scholars within the hospital in return for helping with chapel
Three well-documented medieval European hospitals are St. Giles in
Norwich, St. Anthony's in London, and St. Leonards in York. St.
Giles, along with St. Anthony's and St. Leonards, were open ward
hospitals that cared for the poor and sick in three of medieval
England's largest cities.:23 The study of these three hospitals
can provide insight into the diet, medical care, cleanliness and daily
life in a medieval hospital of Europe.
St Giles, Norwich
The ruins of St. Giles Hospital.
Discrepancies exist among sources regarding the founding of St. Giles
of Norwich, or the "Great Hospital" as it is known today. Some sources
maintain that it was founded in 1246.:65:140  Other
sources state that it was founded in 1249.:23 Though the date may
be debatable, it seems agreed upon that The
Great Hospital was founded
by Walter Suffield, a Bishop known to be very liberal to the poor
especially in the city of Norwich. St Giles provided thirty beds
and maintained within its ten-acre precinct, many meadows courtyards,
ponds, and fruit trees until the late fifteenth century.:23, 34
The hospital cultivated many productive gardens abundant in apples,
leeks, garlic, onions and honey. The gardens were so productive that
surplus goods were sold on the open market. St Giles of Norwich owned
six manors and advowson of eleven churches.:34
St Giles was unique in that food was provided for children who were
getting free education elsewhere.:27 It is also noted that St
Giles arranged for seven poor scholars to receive board at the
hospital during their term at Norwich School.:65 Accommodations of
early medieval hospitals were frequently communal. For example, in St
Giles, the master and brothers ate in the common hall while sisters
ate by themselves.:90 St Giles hospital was a complex building
that housed a community of clergy with cloister and residential
accommodation, a hospital and a parish church. St Giles was also
wealthy enough to maintain its own kitchen and staff. This allowed
poor men to receive a dish of meat, fish, eggs or cheese in addition
to the customary daily ration of bread and drink.:122
St. Anthony's, London
St. Anthony's was erected in the thirteenth century (some time before
1254), in the heart of
London on Threadneedle Street, atop the less
than ideal site of a Jewish synagogue.:43,88 :23 The chapel of
St. Anthony's was built in 1310 without permission of the bishop of
London. To prevents its degradation, the hospital petitioned for a
chapel on the bishops terms.:88 Unlike St. Giles, there was
insufficient land at St. Anthony's, London, for recreation or food
production. As a result, herbs or 'erbys' and vegetables had to be
bought on a daily basis for consumption by the entire
community.:178 Accounts of foreign expenses at St. Anthony's also
show the purchase of various spices, often with intrinsic medicinal
qualities that could alter the level of heat and moisture within the
body. Some of the spices bought include, saffron, cloves, ginger,
cinnamon, lavender, pepper and mustard.:35 Interestingly, the
amount spent on herbs, produce, and spices were far surpassed by the
amount spent on fish and meat.
According to quarterly expenditure reports, fifty-eight percent of the
quarterly budget was spent on meat, thirty-four percent on fish, three
percent on pottage, two percent on dairy, one percent herbs and one
percent on eggs.:33 The unusually detailed records of diet and
expenditures at St. Anthony's have revealed that the diet of the
clerical establishment ('the hall') and the diets of the almsmen,
patients and children ('the hospital') were quite different and
class-based.:179 During a typical week, "the entire community
shared dishes of pottage, veal, mutton and eggs; the hall alone
consumed pork, ribs of roast beef, duck, fresh salmon and eels; and
the hospital was supplied with mutton, plaice and haddock.":41 It
is clear that the hall, or more wealthy, enjoyed extravagant meals of
meat and fish, while the hospital, the patients and the poor, were fed
simpler and cheaper food.
In addition to its reputation of spending lavishly on food, St.
Anthony's was famous for its grammar school, choir and pigs, which
roamed freely among the streets identified by bells.:23 Pigs on
sale in London, which were considered by officials to be unfit for
food were handed over to St. Anthony's. The pigs were fed through
charity or by scavenging and later, when their condition improved,
they were then taken by the hospital for use as food for the poor or
As mentioned, medieval hospitals became concerned in education and in
the feeding and housing of students as early as the thirteenth
century. In 1441, John Carpenter, the master of St. Anthony London,
was able to finance a grammar school whose teachings were without fees
to any student. This was the first source of free education in London
and remained one of London's leading schools for one hundred years
following its founding.:144
In 1449, St. Anthony's received a handsome legacy for the support of a
clerk to train scholars in both polyphony and plainsong. St. Anthony's
became so famous for its choir that in 1469, the royal minstrels set
up a fraternity at the hospital so they may also study music.:125
St Leonards, York
The remains of St Leonard's hospital.
St Leonard's was one on England's largest and richest hospitals with a
primary purpose of caring for the poor, the sick, the old and
infirm.:24 It maintained 200 beds and in its prosperous days,
"maintained up to eighteen clergy, 16 sister and female servants, 30
choristers, 10 private boarders (corrodarians) and between 144 and 240
poor sick people.":36 Additionally, during Easter of 1370, records
show accommodation of 224 sick and poor in the infirmary and 23
children in the orphanage.:156
The records of St Leonard provide the best details of daily hospital
worship and patient life. In 1249, for example, matins and lauds were
said in the morning hours of darkness, followed by mass of the Virgin
Mary held by members of the clergy. The "lesser hours and mass of the
day were said at mid-morning, vespers in the afternoon and compline in
the early evening after supper." :50, 52 Sisters at St. Leonard's
were instructed to feed the poor and the sick, wash them, and lead
them around the grounds.:43 Although the food given to the sick
were the simple, and often quite cheap, daily provisions, sisters were
allowed to distribute special food if they were very ill.:62
At St Leonard's, charity and care for the sick was not only given to
inmates of the hospitals, but also to the poor in other neighboring
institutions as well as inmates of local leper houses.:63
Additionally, one or two of the chaplains at St Leonard's were
instructed to "minister spiritually to the poor by speaking consoling
words, hearing confessions, and administering the sacraments".:80
Early modern and Enlightenment Europe
In Europe the medieval concept of
Christian care evolved during the
sixteenth and seventeenth centuries into a secular one. In England,
after the dissolution of the monasteries in 1540 by King Henry VIII,
the church abruptly ceased to be the supporter of hospitals, and only
by direct petition from the citizens of London, were the hospitals St
Bartholomew's, St Thomas's and St Mary of Bethlehem's (Bedlam) endowed
directly by the crown; this was the first instance of secular support
being provided for medical institutions.
A hospital ward in sixteenth century France.
1820 Engraving of
Guy's Hospital in
London one of the first voluntary
hospitals to be established in 1724.
The voluntary hospital movement began in the early 18th century, with
hospitals being founded in
London by the 1720s, including Westminster
Hospital (1719) promoted by the private bank C. Hoare & Co and
Guy's Hospital (1724) funded from the bequest of the wealthy merchant,
Other hospitals sprang up in
London and other British cities over the
century, many paid for by private subscriptions. St Bartholomew's
London in 1730, and the
Hospital in 1752.
These hospitals represented a turning point in the function of the
institution; they began to evolve from being basic places of care for
the sick to becoming centres of medical innovation and discovery and
the principal place for the education and training of prospective
practitioners. Some of the era's greatest surgeons and doctors worked
and passed on their knowledge at the hospitals. They also changed
from being mere homes of refuge to being complex institutions for the
provision of medicine and care for sick. The
Charité was founded in
Berlin in 1710 by King
Frederick I of Prussia
Frederick I of Prussia as a response to an
outbreak of plague.
The concept of voluntary hospitals also spread to Colonial America;
Bellevue Hospital Center
Bellevue Hospital Center opened in 1736; the Pennsylvania Hospital
opened in 1752,
New York Hospital
New York Hospital in 1771, and Massachusetts General
Hospital in 1811. When the
Vienna General Hospital
Vienna General Hospital opened in 1784
(instantly becoming the world's largest hospital), physicians acquired
a new facility that gradually developed into one of the most important
Another Enlightenment era charitable innovation was the dispensary;
these would issue the poor with medicines free of charge. The London
Dispensary opened its doors in 1696 as the first such clinic in the
British Empire. The idea was slow to catch on until the 1770s, when
many such organisations began to appear, including the Public
Dispensary of Edinburgh (1776), the Metropolitan
Charitable Fund (1779) and the Finsbury
Dispensaries were also opened in New York 1771,
Philadelphia 1786, and
The Royal Naval Hospital, Stonehouse, Plymouth, was a pioneer of
hospital design in having "pavilions" to minimize the spread of
John Wesley visited in 1785, and commented "I never saw
anything of the kind so complete; every part is so convenient, and so
admirably neat. But there is nothing superfluous, and nothing purely
ornamented, either within or without." This revolutionary design was
made more widely known by John Howard, the philanthropist. In 1787 the
French government sent two scholar administrators, Coulomb and Tenon,
who had visited most of the hospitals in Europe. They were
impressed and the "pavilion" design was copied in France and
A ward of the hospital at Scutari where
Florence Nightingale worked
and helped to restructure the modern hospital
Thomas Percival (1740–1804) wrote a comprehensive
system of medical conduct, 'Medical Ethics, or a Code of Institutes
and Precepts, Adapted to the Professional Conduct of Physicians and
Surgeons (1803) that set the standard for many textbooks. In the
mid-19th century, hospitals and the medical profession became more
professionalised, with a reorganisation of hospital management along
more bureaucratic and administrative lines. The Apothecaries Act 1815
made it compulsory for medical students to practise for at least half
a year at a hospital as part of their training.
Florence Nightingale pioneered the modern profession of nursing during
Crimean War when she set an example of compassion, commitment to
patient care and diligent and thoughtful hospital administration. The
first official nurses' training programme, the Nightingale School for
Nurses, was opened in 1860, with the mission of training nurses to
work in hospitals, to work with the poor and to teach. Nightingale
was instrumental in reforming the nature of the hospital, by improving
sanitation standards and changing the image of the hospital from a
place the sick would go to die, to an institution devoted to
recuperation and healing. She also emphasised the importance of
statistical measurement for determining the success rate of a given
intervention and pushed for administrative reform at hospitals.
By the late 19th century, the modern hospital was beginning to take
shape with a proliferation of a variety of public and private hospital
systems. By the 1870s, hospitals had more than trebled their original
average intake of 3,000 patients. In continental Europe the new
hospitals generally were built and run from public funds. The National
Health Service, the principal provider of health care in the United
Kingdom, was founded in 1948. During the nineteenth century, the
Second Viennese Medical School emerged with the contributions of
physicians such as Carl Freiherr von Rokitansky, Josef Škoda,
Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic
medical science expanded and specialisation advanced. Furthermore, the
first dermatology, eye, as well as ear, nose, and throat clinics in
the world were founded in Vienna, being considered as the birth of
20th century and beyond
By the late 19th and the beginning 20th century, medical advancements
such as anesthesia and sterile techniques that could make surgery less
risky, and availability of more advanced diagnostic devices such as
X-rays continued to make hospitals a more attractive option for
treatment. The number of hospitalizations in the United States
continued to grow and reached its peak in 1981 with 171 admissions per
1000 Americans and 6933 hospitals. 
This trend, however, has been reversed since then, with the rate of
hospitalization falling by more than %10 and the number of
hospitals shrinking to 5534 in 2016 compared to 1981 in the United
States. Among the reasons for this are the increasing availability
of more complex care elsewhere such as at home or at the physicians'
offices and also the less therapeutic and more life-threatening image
of the hospitals in the eyes of the public .
Clinical Hospital Dubrava
Clinical Hospital Dubrava in Zagreb, Croatia
In the modern era, hospitals are, either funded by the government of
the country in which they are situated, or survive financially by
competing in the private sector (a number of hospitals also are still
supported by the historical type of charitable or religious
In the United Kingdom for example, a relatively comprehensive, "free
at the point of delivery" health care system exists, funded by the
Hospital care is thus relatively easily available to all legal
residents, although free emergency care is available to anyone,
regardless of nationality or status. As hospitals prioritise their
limited resources, there is a tendency for 'waiting lists' for
non-crucial treatment in countries with such systems, as opposed to
letting higher-payers get treated first, so sometimes those who can
afford it take out private health care to get treatment more
quickly. On the other hand, some countries, including the USA,
have in the twentieth century introduced a private-based,
for-profit-approach to providing hospital care, with few state-money
supported 'charity' hospitals remaining today. Where for-profit
hospitals in such countries admit uninsured patients in emergency
situations (such as during and after
Hurricane Katrina in the USA),
they incur direct financial losses, ensuring that there is a clear
disincentive to admit such patients. In the United States, laws exist
to ensure patients receive care in life-threatening emergency
situations regardless of the patient's ability to pay.
As the quality of health care has increasingly become an issue around
the world, hospitals have increasingly had to pay serious attention to
this matter. Independent external assessment of quality is one of the
most powerful ways to assess this aspect of health care, and hospital
accreditation is one means by which this is achieved. In many parts of
the world such accreditation is sourced from other countries, a
phenomenon known as international healthcare accreditation, by groups
Accreditation Canada from Canada, the
Joint Commission from
the USA, the
Trent Accreditation Scheme
Trent Accreditation Scheme from Great Britain, and Haute
Authorité de santé (HAS) from France.
The medical center at the
University of Virginia
University of Virginia shows the growing
trend for modern architecture in hospitals.
National Health Service
National Health Service
Norfolk and Norwich University Hospital
Norfolk and Norwich University Hospital in
the UK, showing the utilitarian architecture of many modern hospitals
Hospital chapel at
Fawcett Memorial Hospital
Fawcett Memorial Hospital (
Port Charlotte, Florida)
Modern hospital buildings are designed to minimise the effort of
medical personnel and the possibility of contamination while
maximising the efficiency of the whole system. Travel time for
personnel within the hospital and the transportation of patients
between units is facilitated and minimised. The building also should
be built to accommodate heavy departments such as radiology and
operating rooms while space for special wiring, plumbing, and waste
disposal must be allowed for in the design.
However, many hospitals, even those considered "modern", are the
product of continual and often badly managed growth over decades or
even centuries, with utilitarian new sections added on as needs and
finances dictate. As a result, Dutch architectural historian Cor
Wagenaar has called many hospitals:
"... built catastrophes, anonymous institutional complexes run by
vast bureaucracies, and totally unfit for the purpose they have been
designed for ... They are hardly ever functional, and instead of
making patients feel at home, they produce stress and anxiety."
Some newer hospitals now try to re-establish design that takes the
patient's psychological needs into account, such as providing more
fresh air, better views and more pleasant colour schemes. These ideas
harken back to the late eighteenth century, when the concept of
providing fresh air and access to the 'healing powers of nature' were
first employed by hospital architects in improving their
The research of
British Medical Association
British Medical Association is showing that good
hospital design can reduce patient's recovery time. Exposure to
daylight is effective in reducing depression. Single-sex accommodation
help ensure that patients are treated in privacy and with dignity.
Exposure to nature and hospital gardens is also important – looking
out windows improves patients' moods and reduces blood pressure and
stress level. Open windows in patient rooms have also demonstrated
some evidence of beneficial outcomes by improving airflow and
increased microbial diversity. Eliminating long corridors can
reduce nurses' fatigue and stress.
Another ongoing major development is the change from a ward-based
system (where patients are accommodated in communal rooms, separated
by movable partitions) to one in which they are accommodated in
individual rooms. The ward-based system has been described as very
efficient, especially for the medical staff, but is considered to be
more stressful for patients and detrimental to their privacy. A major
constraint on providing all patients with their own rooms is however
found in the higher cost of building and operating such a hospital;
this causes some hospitals to charge for private rooms.
History of medicine
Lists of hospitals
Hospital information system
The Waiting Room
^ "Hospitals". World Health Organization. Retrieved 2018-01-24.
^ a b c "India's 'production line' heart hospital". bbcnews.com. 1
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^ Hall, Daniel (December 2008). "Altar and Table: A phenomenology of
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193–8. PMC 2605310 . PMID 19099050. Although physicians
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Rome and Athens, the
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Christian innovation rooted in the monastic virtue and
practise of hospitality. Arranged around the monastery were concentric
rings of buildings in which the life and work of the monastic
community was ordered. The outer ring of buildings served as a hostel
in which travellers were received and boarded. The inner ring served
as a place where the monastic community could care for the sick, the
poor and the infirm. Monks were frequently familiar with the medicine
available at that time, growing medicinal plants on the monastery
grounds and applying remedies as indicated. As such, many of the
practicing physicians of the Middle Ages were also clergy.
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^ Risse, G.B. Mending bodies, saving souls: a history of hospitals.
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^ Roderick E. McGrew, Encyclopaedia of Medical History (Macmillan
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Wujastyk, Dominik; University College London. Archived 27 February
2008 at the Wayback Machine.
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Lankikayo" Vidhusara Science Magazine, November 1993.
^ Resource Mobilisation in Sri Lanka's Health Sector – Rannan-Eliya,
Ravi P. & De Mel, Nishan,
Harvard School of Public Health
Harvard School of Public Health &
Health Policy Programme, Institute of Policy Studies, February 1997,
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^ Heinz E Müller-Dietz, Historia Hospitalium (1975).
^ Ayurveda Hospitals in ancient
Sri Lanka Archived 7 June 2008 at the
Wayback Machine. – Siriweera, W. I., Summary of guest lecture, Sixth
International Medical Congress, Peradeniya Medical School Alumni
Association and the Faculty of Medicine
^ The Roman military Valetudinaria: fact or fiction – Baker,
Patricia Anne, University of Newcastle upon Tyne, Sunday 20 December
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^ Roderick E. McGrew, Encyclopedia of Medical History (Macmillan
^ James Edward McClellan and Harold Dorn, Science and Technology in
World History: An Introduction (Baltimore: The Johns Hopkins
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^ The American Journal of Islamic Social Sciences 22:2 Mehmet Mahfuz
Gundeshapur School: Its History, Structure, and
^ Gail Marlow Taylor, The Physicians of Gundeshapur, (University of
California, Irvine), p.7.
^ Cyril Elgood, A Medical History of Persia and the Eastern Caliphate,
(Cambridge University Press, 1951), p.7.
^ Cyril Elgood, A Medical History of Persia and the Eastern Caliphate,
(Cambridge University Press, 1951), p.3.
^ Husain F. Nagamia, [Islamic
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Hospitals, (Oxford University Press, 1999), p.125 
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^ a b Islamic Culture and the Medical Arts: Hospitals, United States
National Library of
Medicine This article incorporates text from this
source, which is in the public domain.
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Medicine And Health, "Rise and Spread of
Islam 622–1500: Science,
Technology, Health", World Eras, Thomson Gale.
^ Alatas, Syed Farid (2006). "From Jami'ah to University:
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^ Gordon, Benjamin, Medieval and Renaissance Medicine, (New York:
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Medicine for the Soul: The Life,
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Norwich, c. 1249–1550. Sutton Publishing. p. xvi.
^ a b c Clay, Rotha Mary (1909). The Medieval Hospitals of England.
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^ Reinarz, Jonathan. "Corpus Curricula: Medical Education and the
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^ Erna Lesky, The
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^ a b
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Surgery worries create
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^ Annmarie Adams,
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History of hospitals
Brockliss, Lawrence, and Colin Jones. "The
Hospital in the
Enlightenment," in The Medical World of Early Modern France (Oxford
UP, 1997), pp. 671–729; covers France 1650–1800
Chaney, Edward (2000),"'Philanthropy in Italy': English Observations
on Italian Hospitals 1545–1789", in: The Evolution of the Grand
Tour: Anglo-Italian Cultural Relations since the Renaissance, 2nd ed.
London, Routledge, 2000.
Connor, J. T. H. "
Hospital History in
Canada and the United States,"
Canadian Bulletin of Medical History, 1990, Vol. 7 Issue 1, pp
Crawford, D.S. Bibliography of Histories of Canadian hospitals and
schools of nursing.
Gorsky, Martin. "The British
National Health Service
National Health Service 1948–2008: A
Review of the Historiography," Social History of Medicine, December
2008, Vol. 21 Issue 3, pp 437–460
Harrison, Mar, et al. eds. From Western
Medicine to Global Medicine:
Hospital Beyond the West (2008)
Horden, Peregrine. Hospitals and Healing From Antiquity to the Later
Middle Ages (2008)
McGrew, Roderick E. Encyclopedia of Medical History (1985)
Morelon, Régis; Rashed, Roshdi (1996), Encyclopedia of the History of
Arabic Science, 3, Routledge, ISBN 0-415-12410-7
Porter, Roy. The
Hospital in History, with Lindsay Patricia Granshaw
(1989) ISBN 978-0-415-00375-9
Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals
(1999); world coverage
Rosenberg, Charles E. The Care of Strangers: The Rise of America's
Hospital System (1995); history to 1920
Scheutz, Martin et al. eds. Hospitals and Institutional Care in
Medieval and Early Modern Europe (2009)
Wall, Barbra Mann. American Catholic Hospitals: A Century of Changing
Markets and Missions (Rutgers University Press, 2011).
Wikimedia Commons has media related to Hospital.
Medical History open access scholarly journal; quarterly since 1957
Jean Manco, The Heritage of Mercy (medieval hospitals in Britain)
Hospital Care in
Canada (an illustrated historical essay)
Medieval Hospitals of England, by Rotha Mary Clay, historyfish.net
(1909 book, now in the public domain)
Directory and Ranking of more than 17000 Hospitals worldwide,
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