Hospitals and Treatment Facilities in the Ancient World
Hospitals and Treatment Facilities in the Ancient World
Today's hospitals and facilities for medical treatment have a history that dates back to the Roman Empire, when military hospitals were organized to treat and repair the critically important Roman Army. Perhaps the most rudimentary form of the hospital prior to this were the healing temples of ancient Greece. Healing temples were sacred sites created for the sick to receive divine aid. They were often associated with public baths and spa-type facilities whose priest-physicians administered rituals of healing, massage, and herbal medicines. Overall, Greek medicine combined a philosophy of proper living, with regular exercise, proper diet, and massage, augmented by herbal drugs and regular visits to a healing temple for ritual devotions and tribute. Physicians, surgeons, and other specialists would typically provide specific treatments including surgeries and amputations at the home of the patient. Both Greek and Roman cultures were engaged in bloody wars and found it necessary to make advances in the medical treatment of wounds and illnesses. The Roman Empire was built by and dependent upon its powerful military, and although it was not a physician-friendly society, it did advance the concept of the military hospital, as well as the public water supply and sanitation systems. Later, as Christianity spread throughout the Roman world, charitable institutions for the poor and societal outcasts such as lepers and plague sufferers were established, and they gradually developed into charitable hospitals that offered various medical treatments for patients and medical training for physicians in several Roman cities. When Roman civilization declined and fell, education, medicine, and medical facilities also declined, and they did not recover to even the levels reached in late Rome until well after the Renaissance.
The historical time period from 2000 b.c. to the first few centuries a.d. is known to us from various forms of early written accounts, works of art and architecture, as well as many religious and mythical beliefs. The earliest civilizations of Mesopotamia, Egypt, Greece, and Rome grew from their military successes, and they were plagued by periodic wars, dependent upon slavery, and dominated by ritual pagan religions. Texts from the earlier Sumerian and Egyptian civilizations contain instructions for the treatment of physical wounds, and include herbal-based medicines for various internal illnesses. Their medicine and religion were closely interrelated and virtually inseparable. They sought divine aid from their gods of war and healing, and their drugs were herbal-based concoctions and likely of a limited effectiveness. They practiced haruspicy—divination by examination of animal entrails—chanted incantations, and displayed amulets, often in temples or at ritual altars. More elaborate medical treatments were performed by priest-physicians at the estate of the affluent patient, or at a temple visited by the lower-class patients. These temples were the closest approximation to any known medical facility in the Mediterranean and Middle Eastern civilizations prior to the first century b.c.
The Code of Hammurabi indicates that Sumerian medicine included prescribed medical treatments, use of medical instruments, and regulations such as the charging of fees and penalties for therapeutic failures. Egyptian medicine and religion were both state-controlled hierarchies, and their concept of health included the belief that diseases are caused by spirits, intestinal putrefaction, or worms. Medicine and religion were closely connected: priest healers treated the sick and injured, administered herbal medicaments with specific incantations and amulets, and mummified the bodies of the dead. Some of the Sumerian and Egyptian surgical instruments that have been found were used to lance abscesses, cauterize infections and wounds, and were combined with many drugs and antiseptics of vegetable and mineral origins. These civilizations did not establish any facilities for medical care or treatment.
By the fifth century b.c. Greek medicine was practiced by a range of folk healers and priest-physicians who also used a combination of ritual divination procedures and applications of herbal-based drugs. While clearly influenced by Egyptian medicine initially, the Greeks began to develop a more open and secular approach to health and disease. Greek culture emphasized the benefits of rigorous exercise and proper diet to develop a healthy body and mind, and the sacredness of healing is evidenced by their reliance on their gods of healing and disease, such as Apollo, and his son Asclepius. The cult of Asclepius gradually gained widespread following throughout the Greek world, and hundreds of Asclepian healing temples were built and visited by the sick and injured. The temples were located in salubrious locations near springs, and their priests were trained in the use of mineral baths, massage, diet, and herbal drugs. The patient paid tribute and made a request of the god, then slept within the confines of the temple, probably aided by an opiate, and the god would visit in a dream. The patient would wake in the morning and have his dreams interpreted by a priest-physician, who would then perform the proper animal sacrifice and administer an herbal medicine as a cure. The healing temples became associated with the bath or spa, where exercise, massage, mineral baths, and various herbal medicines were employed vigorously and combined with the Greek doctrine of proper diet and moral philosophy (perhaps even psychotherapy). The preventive and therapeutic benefits of this approach to health were likely to do no harm at the least and probably offered substantial health improvements in many cases. While healers of various types had their shops and physicians and surgeons apparently associated with apothecaries on contract basis, there were no facilities that could be construed as public hospitals.
The Hippocratic school of medicine, which advocated the careful study of the patient and the illness, can be considered the first major advance in medical care and treatment, and it began the separation of medicine from religion. Hippocrates (460-377 b.c.) and his adherents developed a theory of disease based on natural causes, and created a medical system that sought to comfort and aid the patient. Hippocratic medicine was based on the bedside visit and careful physical examination, with cautious drug therapies and strict dietary regulations. Heroic intervention and risky procedures were rejected, although specialists trained in wound treatments, fractures, and amputations were allowed to perform their necessary functions in extreme cases. Hippocrates advocated a proper moral philosophy, bathing, sex, and sleep. However, for all the intellectual interest they had in medicine, the ancient Greeks had little interest in hospitals.
Roman culture gradually adopted the Greek system of medicine, but Rome's greatest contribution to medicine was the organization of medical schools, medical instruction, and public physicians, as well as the development of military and public hospitals. Roman cities and towns also constructed sanitary drainage systems and large aqueducts to provide clean water supplies. When Rome fell, it was plagued by a failure of its drainage systems and the subsequent increase in associated diseases, notably malaria. After Rome, it was not until the seventeenth century that Europe saw the existence of any public hospitals and medical facilities, and the standards of urban sanitation climbed back to the levels that Rome enjoyed at its pinnacle.
As the roots of Western medicine were being established in ancient Greece, a gradual demystification of illnesses and a separation of medicine and disease from religious doctrine and divine causes began. Greek culture was dominated by wars with its neighboring city-states, which necessitated improved medical treatment of arrow and sword wounds. Greek war heroes were also described as skilled healers, and a strong mythical and religious connection was attached to all healing and medical treatments.
Medicine practiced in the third century b.c. was Greek medicine with an Egyptian influence: human dissections performed in Alexandria by Herophilus (c. 335-c. 280 b.c.) and Erasistratus (fl. c. 250 b.c.) expanded the knowledge of human anatomy and advanced the understanding of physiology greatly. Medical treatment at this time was as advanced as any in seventeenth-century Europe, but in both cases the societies lacked any type of hospital facilities.
The medicine practiced in Rome was largely of Greek origin, with both male and female physicians. Initially, Roman leaders accused the newly arriving Greek physicians of being little more than paid killers. Romans believed disease, famine, and pestilence to be the wrath of vengeful and angry gods. As the need for improved health care continued to grow in Rome, Greek medicine became more prevalent as Greek medical sects and healing cults became more widespread. Celsus (25 b.c.-a.d. 40) advocated medical self help with his written volume On Medicine, a guide for the nonprofessional.
The Romans of course also valued the same preventive approaches endorsed by Greek culture and medicine: proper exercise, diet, and spa-type public baths, with some aspects of divine respect and tribute included. As towns enlarged into cities with large populations and trading centers, Roman public officials recognized the correlation between disease and hygiene. Public granaries were strictly regulated for cleanliness; public latrines and plumbed sanitation to control sewage were established in many Roman areas; and a good, clean, reliable water source was a prime directive of public works in Roman cities. Vitruvius (fl. first century b.c.) wrote of the importance of such a water supply, and the aqueducts built for this reason still function today in some areas. Though none of these constructs were hospitals or medical treatment facilities, they are the precursors of institutions built for the health benefits of the general public.
The Roman ethic of military organization and improvement extended from the battlefield to the development of the standard military hospital. The sick and wounded were treated in buildings set aside for this purpose, with large, well lit halls that had individual cells and larger rooms set off of the corridors, as well as baths, latrines, and food-preparation areas. Roman soldiers and officers were treated with respect and honor, and this was certainly extended to their proper medical treatment. Roman military hospitals have been found as far north as the Rhine river in Germany. Surgeries, splints, drainage tubes, and healing salves were applied to wounds. This was also true for Roman gladiators, who received care from the best Roman physicians, including Galen (129-c. 199), and were treated in designated clinics.
When Christianity began to replace the Roman pagan faith, one of its most powerful tools of persuasion was its appeal to the poor, sick, and lame, who were promised the miraculous healing powers of Christ. Though the Church doctrine subordinated medicine to theology and the physician to the priest, the obligation of charity became very strong. Alms for the needy led to houses for the poor and for lepers, such as the ones established by the Church of Rome in a.d. 250. Christianity employed the use of holy relics, oils, and baptisms, as well as the retelling of the Bible stories of healing miracles, but many Christian converts sought to do more. In Roman towns, churches and monasteries began to carry the burden of charity and medical care for the poor and needy. It is believed that at the Monastery of the Pantokrator in the Greek town of Caesarea (a.d. 369) in Roman-controlled Cappadocia, Saint Basil established the first true hospital (nosocomia). This facility could be considered a forerunner of today's charity hospital.
In Rome, a student of Saint Jerome became well known for her incredible acts of charity. Fabiola (d. a.d. 399) was an affluent Christian convert who dedicated her time, energy, and resources to caring for the sick and indigent of Rome. She is said to have bodily carried even the most filthy and wretched off the streets, washing and caring for them herself, and she is credited with having established a public clinic for the poor and sick in Rome (a.d. 390). Important hospitals were also founded by the churches and monasteries of Edessa (375), Monte Cassino (529), Iona (563), Ephesus (610), and St. Albans (794). These hospitals became large complexes that included a hierarchy of physicians and specialists, with hundreds of beds, as well as teaching facilities, and homes for the poor, elderly, and lepers. The hospital in Jerusalem had over 200 beds by the mid-sixth century, and St. Sampson's Hospital in Constantinople was even larger, with surgical theaters and facilities for various medical specialists.
When the city of Rome was sacked by Alaric the Goth in a.d. 410, all of the Roman towns in the western part of the Empire suffered severe economic collapse. As the populations of its towns and cities dwindled, education and medicine suffered similar fates, and Europe slipped into many centuries of decline. The empire of the East, centered in Byzantium, remained strong and continued the traditions of medicine, as did the growing Islamic and Jewish communities. Medicine in these areas was reinvigorated by the addition of new ideas to the Greek and Roman traditions. But without the wealth of the Roman Empire, the hospitals of the Mediterranean area declined and disappeared, and did not return until the twelfth through the fourteenth centuries, when urban hospitals were created as charitable establishments by the ruling princes and patricians of Europe.
KENNETH E. BARBER
Clendening, Logan. Source Book of Medical History. New York: Dover Publications, Inc., 1942.
Porter, Roy. The Greatest Benefit to Mankind: A MedicalHistory of Humanity. New York: W.W. Norton and Company, 1997.
Singer, Charles. A Short History of Anatomy and Physiology from the Greeks to Harvey. New York: Dover Publications, Inc., 1957.