Today, hospitals are an integral institution, with nearly 6,000 registered hospitals in the US alone, including federal clinics, long term care facilities, and rehabilitation services. Healthcare represents a core community pillar in many areas, and where those services are absent or difficult to access, the local population suffers. But it might surprise you that facilities focused on treating sick patients haven’t always existed, especially not in the West.
While they may not have been structures like the multi-storied, multi-winged buildings we are accustomed to today, hospitals existed in just a few select places around the world in early antiquity. There is evidence of organized healthcare facilities as early as 2000 BC in Mesopotamia, and because of the strong Buddhist tradition in Southeast Asia, monastic communities were in charge of providing public healthcare as early as 500 BC. In fact, nursing as a practice originated in these same Indian monastic traditions.
The Greeks--and subsequently the Romans and all of the European cultures to come after them--placed little value in public outreach for the sick and disabled, so they had no such healthcare infrastructure throughout much of history. Physicians existed, but they tended to make house calls and were only available to those with wealth and status. There was one other Greecian infrastructure that, on its surface, purported to be a place of healing. At the temple of Asclepius, sick people would gather to be induced into incubation sleep by priests. The priests would then interpret the sleeper’s dreams and send them off with medicinal herbs to treat what ailed them. Because this practice was more closely associated with magico-mysticism than medical care, it is difficult to define the Asclepius priests as anything like physicians at all. The Romans did have hospital facilities, but because they were not intended for public use and instead were available only for the treating of military injuries and chronic conditions among slaves, they don’t really classify as a true public healthcare system.
Perhaps the most impressive hospital systems--called bimaristans in Persian--belonged to the Islamic empire. The Mansuri hospital established in Cairo in 1284 had amenities and attentive personal care that rivals even today’s best hospital systems. The building was separated into multiple wards for privacy between male and female patients, and then further separated into rooms by illness. Fever wards had fountains installed to cool down burning foreheads, and musicians and storytellers were brought in to entertain the bed bound and chronically ill. The Mansuri hospital also featured lecture halls for medical students, a pharmacy, an area of worship, an extensive library, and an out-patient ward for those who did not require overnight care. Most surprising of all, the Mansuri hospital--and several other public bimaristans of its kind--provided a lump sum of money to a patient on release in order to tide them over until they could feasibly start working again.
By the 10th century AD, leper houses and colonies became widespread around much of the world. People with leprosy were corralled into isolated communities as a kind of early quarantine, even though leprosy has an incredibly low rate of infectious spread. In a sense, these leper colonies were akin to long term care facilities, even if they were created out of coercion and social stigma.
When Christianity spread to Europe and gained traction in many places as a majority religion, local Christians began building hospices. Originally designed to shelter pilgrims, travelers, and the destitute, these hospices eventually expanded around the 10th century AD into infirmaries overseen by the monastic order. Without Christianity’s entrenchment and its teaching’s focus on the public good, there likely would have been no impetus in the West to create healthcare infrastructure at all. And even then, it wasn’t until the early 19th century that true physician practices became more widespread.
The turn of the 20th century is really where hospitals became a major public project in the Western world. After World War I had shown the importance of aseptic surgery on the battlefield, surgeons became highly sought after specialists. New hospital floor plans in the 1920s began to accommodate entire wings dedicated to surgical procedures.With an emphasis on the hospital as a quiet, healing space, foundations and walls were designed with noise cancellation in mind. Driveways were built to wrap around building entry points so that patients could be transported in and out of the hospital facilities with ease, whether in an emergency vehicle or a car. The standardized hospital was modeled to function like a self-sufficient city, with hospital staff including not only physicians, but also cooks, cleaning staff, and laundry staff, among others. The insular nature of this hospital design allowed staff to cut down rates of hospital-acquired infections and speed up care to patients in need.
The refining and reorganizing of healthcare services continued to expand in the 1940s and 50s, leaving us with the modern hospital system we have today. With all the healthcare reformation in the last two centuries, it's exciting to imagine where public policy and healthcare initiatives might take us in the next 200 years.
The evolution of hospitals from antiquity to the Renaissance: https://www.ajol.info/index.php/actat/article/download/52575/41180%E2
The Earliest Hospitals in Byzantium, Western Europe, and Islam: https://www.jstor.org/stable/3657030?seq=1
The Origin of Bimaristans: https://muslimheritage.com/uploads/The_Origin_of_Bimaristans_in_Islamic_Medical_History.pdf
Mental Hospitals in India: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957702/pdf/IJPsy-42-125.pdf
Modernism and Medicine: https://jsah.ucpress.edu/content/58/1/42
The historical development of mental health services in Europe: https://apps.who.int/iris/bitstream/handle/10665/107811/E89814.pdf?#page=43