As early as 4000 bce, religions identified certain of their deities with healing. The temples of Saturn, and later of Asclepius in Asia Minor, were recognized as healing centres. Brahmanic hospitals were established inSri Lanka as early as 431 bce, and King Ashoka established a chain of hospitals in Hindustan about 230 bce. Around 100 bce the Romans established hospitals (valetudinaria) for the treatment of their sick and injured soldiers; their care was important because it was upon the integrity of the legions that the power of ancient Rome was based.
It can be said, however, that the modern concept of a hospital dates from 331 ce when Roman emperor Constantine I (Constantine the Great), having been converted to Christianity, abolished all pagan hospitals and thus created the opportunity for a new start. Until that time disease had isolated the sufferer from the community. The Christian tradition emphasized the close relationship of the sufferer to the members of the community, upon whom rested the obligation for care. Illness thus became a matter for the Christian church.
About 370ce St. Basil the Great established a religious foundation in Cappadocia that included a hospital, an isolation unit for those suffering from leprosy, and buildings to house the poor, the elderly, and the sick. Following this example, similar hospitals were later built in the eastern part of the Roman Empire. Another notable foundation was that of St. Benedict of Nursia at Montecassino, founded early in the 6th century, where the care of the sick was placed above and before every other Christian duty. It was from this beginning that one of the first medical schools in Europe ultimately grew at Salerno and was of high repute by the 11th century. This example led to the establishment of similar monastic infirmaries in the western part of the empire.
Religion continued to be the dominant influence in the establishment of hospitals during the Middle Ages. The growth of hospitals accelerated during the Crusades, which began at the end of the 11th century. Pestilence and disease were more potent enemies than the Saracens in defeating the crusaders. Military hospitals came into being along the traveled routes; the Knights Hospitallers of the Order of St. John in 1099 established in the Holy Land a hospital that could care for some 2,000 patients. It is said to have been especially concerned with eye disease, and it may have been the first of the specialized hospitals. This order has survived through the centuries as the St. John Ambulance.
Throughout the Middle Ages, but notably in the 12th century, the number of hospitals grew rapidly in Europe. Arab hospitals—such as those established at Baghdad and Damascus and in Córdoba in Spain—were notable for the fact that they admitted patients regardless of religious belief, race, or social order. The Hospital of the Holy Ghost, founded in 1145 at Montpellier in France, established a high reputation and later became one of the most important centres in Europe for the training of doctors. By far the greater number of hospitals established during the Middle Ages, however, were monastic institutions under the Benedictines, who are credited with having founded more than 2,000.
The Middle Ages also saw the beginnings of support for hospital-like institutions by secular authorities. Toward the end of the 15th century, many cities and towns supported some kind of institutional health care: it has been said that in England there were no fewer than 200 such establishments that met a growing social need. This gradual transfer of responsibility for institutional health care from the church to civil authorities continued in Europe after the dissolution of the monasteries in 1540 by Henry VIII, which put an end to hospital building in England for some 200 years.
The loss of monastic hospitals in England caused the secular authorities to provide for the sick, the injured, and the handicapped, thus laying the foundation for the voluntary hospital movement.
The first voluntary hospital in England was probably established in 1718 by Huguenots from France and was closely followed by the foundation of such London hospitals as the Westminster Hospital in 1719, Guy’s Hospital in 1724, and the London Hospital in 1740. Between 1736 and 1787, hospitals were established outside London in at least 18 cities. The initiative spread to Scotland, where the first voluntary hospital, the Little Hospital, was opened in Edinburgh in 1729.
The first hospital in North America (Hospital de Jesús Nazareno) was built in Mexico City in 1524 by Spanish conquistador Hernán Cortés; the structure still stands. The French established a hospital in Canada in 1639 at Quebec city, the Hôtel-Dieu du Précieux Sang, which is still in operation (as the Hôtel-Dieu de Québec), although not at its original location. In 1644 Jeanne Mance, a French noblewoman, built a hospital of ax-hewn logs on the island of Montreal; this was the beginning of the Hôtel-Dieu de St. Joseph, out of which grew the order of the Sisters of St. Joseph, now considered to be the oldest nursing group organized in North America. The first hospital in the territory of the present-day United States is said to have been a hospital for soldiers on Manhattan Island, established in 1663.
The early hospitals were primarily almshouses, one of the first of which was established by English Quaker leader and colonist William Penn in Philadelphia in 1713. The first incorporated hospital in America was the Pennsylvania Hospital, in Philadelphia, which obtained a charter from the crown in 1751.
