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Nightingale Ward
Nightingale Ward, interior view, Royal Victoria Hospital (courtesy Notman Collection, McCord Museum).
Halifax Infirmary
Halifax Infirmary, exterior (courtesy WHW Architects, Inc).

From the 17th century until about 1900, hospitals  were unspecialized, multi-purpose institutions for the sick poor. Until around 1900 those able to pay doctors preferred to be treated at home. The first hospitals emerged in places where people were unable to get medical treatment by physicians in their own homes.

The financial sources and social mandates of hospitals have varied widely over the past 400 years. The earliest hospitals included military and marine hospitals, as well as Roman Catholic and then Protestant benevolent institutions. By the turn of the 20th century, the administration of scientific medicine was the major purpose of the hospital. Since about 1970, hospitals have become increasingly specialized; structurally they have become flexible and expandable.

In NEW FRANCE, urban institutions intended for healing were first housed in temporary wooden buildings. The Hôtel-Dieu in Montréal, for example, was a small building (24 x 60 feet) established in the fort at VILLE-MARIE in 1644. According to the first annalist, Soeur Morin, it contained two sick wards, a kitchen, rooms for servants and for founder Jeanne MANCE.
The first hospitals were sites where the proselytization of indigenous peoples by religious nursing sisters was carried on. Later, colonists were accepted as patients and offered more permanent quarters in generic (ie, unspecialized) masonry buildings. The HÔTEL-DIEU in Québec City, established in 1639 by Augustine nursing sisters, was given its first permanent stone building in 1658. This single-storey, gable-roofed structure contained one ward of 10 beds connected to a chapel, allowing the patients to hear mass. In 1672, a second, 24-bed ward was added and patients were segregated by gender. Hospitals such as this were connected to convents; windows in the 1672 Hôtel-Dieu looked directly onto the convent courtyard. Technologically advanced for its time, the Hôtel-Dieu had running water in the wards and latrines through a system of lead and stone ducts. Following a series of fires in 1725 and 1755, the Hôtel-Dieu was rebuilt in 1816-25. Other early hospitals established at Trois-Rivières (1697), Hôpital Général de Québec (1692) and Hôpital Général de Montréal (1694) took care of the aged poor and orphans, in addition to the sick.

The pattern of replacing rudimentary quarters with more solid buildings was followed throughout New France. LOUISBOURG, Cape Breton, originally included a crude hospital on the north shore of the harbour. In 1730, the Hôpital du Roi was completed, featuring its own chapel, morgue, apothecary, bakery, laundry, kitchen, latrines, and wards for members of the Brothers of Charity, the medical order which ran the institution. An anonymous soldier described the Louisbourg hospital in 1745 as a two-storey masonry structure and yard, surrounded by a massive wall, 12 feet high and 4 feet thick.

Atlantic Coast

The Atlantic coast was also the site of special hospitals for sick mariners, who did not have the option of home care. Marine hospitals were mostly constructed in the early 19th century and closed in the late 19th and early 20th centuries, as other institutions began to accept non-residents as patients. Six such institutions were built before Confederation, five in New Brunswick and one in Québec City. The Marine Hospital in Douglastown, New Brunswick, a single-storey, rectangular sandstone building, is a good example of this type of hospital. It had a low-pitched, hipped, slate roof, crowned by a domed cupola. The scale of the hospital's operations was relatively small. During its early years, the Marine Hospital in Douglastown accommodated 10-12 seamen who were treated by three physicians.

Thanks to

The National Health Service Norfolk and Norwich University Hospital in the UK.

All India Institute of Medical Sciences in Delhi, India

A hospital is an institution for health care, often but not always providing for longer-term patient stays. Today, hospitals are usually funded by the state, health organizations (for profit or non-profit), health insurances or charities, including direct charitable donations. In history, however, they were often founded and funded by religious orders or charitable individuals and leaders. Hospitals are nowadays staffed by professional physicians, surgeons and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers.

During the Middle Ages the hospital could serve other functions, such as almshouse for the poor, hostel for pilgrims, or hospital school. The name comes from Latin hospes (host), which is also the root for the English words hotel, hostel, and hospitality. The modern word hotel derives from the French word hostel, which featured a silent s, which was eventually removed from the word. (The circumflex on modern French hôtel hints at the vanished s.)

Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word is normally 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 usages are found.


Intensive care bed after a trauma intervention, showing the highly technical equipment of modern hospitals.

Some patients in a hospital come just for diagnosis and/or therapy and then leave ('outpatients'); while others are 'admitted' and stay overnight or for several weeks or months ('inpatients'). Hospitals are usually distinguished from other types of medical facilities by their ability to admit and care for inpatients.

General hospitals
The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and typically has an emergency ward to deal with immediate threats to health and the capacity to dispatch emergency medical services. A general hospital is typically the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have many different hospitals of varying sizes and facilities.

Specialized hospitals
Types of specialized hospitals include trauma centers, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.

A hospital may be a single building or a campus. (Many hospitals with pre-20th-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. Worldwide, most hospitals are run on a non-profit basis by governments or charities. Within the United States, most hospitals are not-for-profit.

A medical facility smaller than a hospital is called a clinic, and is often run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

Other facilities
Many hospitals have hospital volunteer programs where people (usually students and senior citizens) can volunteer and provide various ancillary services.

Hospitals may be required by law to have backup power generators, in case of a blackout. Additionally they may be placed on special high priority segments of the public works (utilities) infrastructure to ensure continuity of care during a state of emergency.


A physician visiting the sick in a hospital. German engraving from 1682.

Early history
In ancient cultures, religion and medicine were linked. The earliest known institutions aiming to provide cure were Egyptian temples. Greek temples dedicated to the healer-god Asclepius might admit the sick, who would wait for guidance from the god in a dream. The Romans adopted his worship. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.[1]

Ancient Asia
The Sinhalese (Sri Lankans) are perhaps responsible for introducing the concept of dedicated hospitals to the world. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty written in the 6th century A.D., King Pandukabhaya (4th century BC) 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.[2] Mihintale Hospital is perhaps the oldest in the world.[3]

Institutions created specifically to care for the ill also appeared early in India. King Ashoka founded 18 hospitals c. 230 BC. There were physicians and nursing staff, and the expense was borne by the royal treasury.[4] State-supported hospitals later appeared in China during the first millennium A.D.

The first teaching hospital where students were authorized to methodically practice on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia". [5]

Roman Empire
The Romans created valetudinaria for the care of sick slaves, gladiators and soldiers around 100 BC, and many were identified by later archeology. 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.[6]

The adoption of Christianity as the state religion of the empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the Church to provide for the poor, sick, widows and strangers. It ordered the construction of a hospital in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.[7]

Medieval Islam
The earliest recorded hospitals in the medieval Islamic world refer to the hopital of al-Walid ibn 'Abdul Malik (ruled 705-715 CE) which he built in 86 AH (706-707 CE). It somewhat resembled the Byzantine nosocomia, but was more general as it extended its services to the lepers and the invalid and destitute people. All treatment and care was free of charge and there was more than one physician employed in this hospital.[8] Between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Hospitals built in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan, a sign of great breakthrough. In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists, group of religious scholars whose medical services included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a mental hospital and medical madrasa in Edirne, and a number of other early hospitals were also built in Turkey. Unlike in Greek temples to healing gods, the clerics working in these facilities employed scientific methodology far beyond that of their contemporaries in their treatment of patients.[9]

According to Sir John Bagot Glubb:

"By Mamun's time medical schools were extremely active in Baghdad. The first free public hospital was opened in Baghdad during the Caliphate of Haroon-ar-Rashid. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice. The first hospital in Egypt was opened in 872 AD and thereafter public hospitals sprang up all over the empire from Spain and the Maghrib to Persia."

Medieval Europe

Hospicio Cabañas was the largest hospital in colonial America.

The church at Les Invalides in France showing the often close connection between historical hospitals and churches.

Medieval hospitals in Europe followed a similar pattern. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-function while others were founded for specific purposes such as leper hospitals, or as refuges for the poor or for pilgrims: not all cared for the sick. Not until later where most hospitals multi-functional, though the first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580 at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.

North America
It is believed that the first Spanish style hospital founded in the Americas [Western Hemisphere] following Columbus arrival to the island now known as Hispaniola was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, [Distrito Nacional] Dominican Republic.

Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502-1509, authorized its construction in or after 1504. It is believed that this hospital also served as a church during its lifetime. The first phase of its construction was completed in 1519. Erwin Walter Palm, [former author and professor of Spanish American art, culture, and history] wrote that "the Brotherhood of Our Lady of the Conception continued the construction of the hospital in 1533, adding modern elements, including additional buildings." Abandoned in the mid 18th century the hospital now lies in ruins near the Cathedral in the colonial zone in Santo Domingo, DR, amid additional historical New World sights.

The Hospital de Jesús Nazareno in Mexico City is the oldest hospital in North America. It was founded in 1524 with the economic support of conquistador Hernán Cortés to care for poor Spanish soldiers and the native inhabitants.

The first hospital in North America north of Mexico is the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project of the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by colonial physician Robert Giffard de Moncel.

Modern era
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.

Guy's Hospital was founded in London in 1724 from a bequest by wealthy merchant Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.[10]

When the Viennese General Hospital (Allgemeines Krankenhaus) opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the 19th 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 specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose and throat clinics in the world were founded in Vienna — it was the birth of specialized medicine.

By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In Continental Europe the new hospitals were generally built and run from public funds. The National Health Service, the principle provider of healthcare in the United Kingdom, was founded in 1948.

In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax-exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. In the late twentieth century, chains of for-profit hospitals arose in the USA.

In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situates, or survice financially by competing in the private sector. For example, In the United Kingdom, there remains in existence a comprehensive National Health Service free at the point of delivery and funded by the state, so hospital care is easily available to all (although there is a tendency for "waiting lists" to be generated). On the other hand, the USA has followed a largely private-based approach to providing hospital care, and while this has produced some of the best hospitals in the world a very large proportion of Americans have little or no access to healthcare services of adequate quality.

As quality of healthcare has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this. Independent external assessment of quality is one of the most powerful ways of assessing the quality of healthcare, 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 such as the Joint Commission from the USA and the Trent Accreditation Scheme from Great Britain.

Support infrastructure

Modern hospital buildings have to specially designed to minimize the effort of medical personel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personel within the hospital and the transportation of patients between units must be facilitated and minimized. The building should be built to accommodate heavy departments such as radiology and operating rooms; and special wiring, plumbing and waste disposal must be installed.

The surgical, special procedures, radiological, intensive care unit, and patient rooms typically have medical gases, emergency and normal electrical power; and heating, air conditioning and ventilation systems.

The reliability of the electrical power systems that serve a hospital is important. In order to provide higher electrical reliability, the National Institutes of Health, NIH, requires that all secondary substations > 500 kVA at their Bethesda, MD campus be the spot network type. The spot network substations cost more than other arrangements.

Pneumatic tube conveying systems are often used to move the actual paper prescriptions for medicines to the Pharmacies, and to move medicines, especially intra-venous, IV, bags to the patient care rooms. Tissue samples can be sent to the Laboratory. Medical notes can be transcribed, printed, and then transported via a Pneumatic Tube Conveying System.

As measured by the weight of the item be transferred, the 15 cm (6”) diameter tube systems have about 225% of the lifting and moving capacity of a 10 cm (4”) system. When the seals are new, the 10 cm tube carriers will move a 1 kg (2+ pound) IV bag. But when the seals on the tube carriers are worn, the tubes can stop moving in the piping, and require a trained technician to recover the tube carrier.

Modern hospitals have information infrastructure such as secured patient information system and PACS.

The cost of building and maintaining a hospital has increased dramatically in the last decades. Most of increase is due to high cost advanced technological devices such as MRI, PACS systems and expensive modern drugs.

^ Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), pp.134-5.
^ Prof. Arjuna Aluvihare, "Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" Vidhusara Science Magazine, Nov. 1993.
^ Heinz E Müller-Dietz, Historia Hospitalium (1975).
^ Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), p.135.
^ C. Elgood, A Medical History of Persia, (Cambridge Univ. Press), p. 173.
^ The Roman military Valetudinaria: fact or fiction - Baker, Patricia Anne, University of Newcastle upon Tyne, Sunday 20 December 1998
^ Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), p.135.
^ al-Hassani, Woodcock and Saoud (2007), 'Muslim heritage in Our World', FSTC Publishing, pp.154-156
^ Turkish Contributions to Scientific Work in Islam - Sayili, Aydin, Foundation For Science, Technology and Civilisation, Septermber 2004, Page 9
^ Roderick E. McGrew, Encyclopedia of Medical History (Macmillan 1985), p.139.