HospitalNorfolk and Norwich University Hospital in the East of England. The UK has a publiclyfunded health care system called the National Health ServiceAll India Institute of Medical Sciences in Delhi, IndiaA hospital is a health care institution providing patient treatment by specialized staff andequipment. Hospitals often, but not always, provide for inpatient care or longer-term patientstays.Hospitals are usually funded by the public sector, by health organizations (for profit ornonprofit), health insurance companies, or charities, including direct charitable donations.Historically, hospitals were often founded and funded by religious orders or charitableindividuals and leaders. Today, hospitals are largely staffed by professional physicians,surgeons, and nurses, whereas in the past, this work was usually performed by the foundingreligious orders or by volunteers. However, there are various Catholic religious orders, suchas the Alexians and the Bon Secours Sisters, which still focus on hospital ministry today.There are over 17,000 hospitals in the world.In accord with the original meaning of the word, hospitals were originally "places ofhospitality", and this meaning is still preserved in the names of some institutions such as theRoyal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteransoldiers.EtymologyDuring the Middle Ages hospitals served different functions to modern institutions, beingalmshouses for the poor, hostels for pilgrims, or hospital schools. The word hospital comesfrom 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 andshelterer, hospitality, friendliness, hospitable reception. By metonymy the Latin word thencame to mean a guest-chamber, guests lodging, an inn. Hospes is thus the root for theEnglish 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 Frenchromance word hostel, which developed a silent s, which letter was eventually removed fromthe word, the loss of which is signified by a circumflex in the modern French word hôtel. TheGerman word Spital shares similar roots.Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usuallyrequires an article; in Britain and elsewhere, the word normally is used without an articlewhen 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 found.TypesLehigh Valley Hospital in Allentown, PennsylvaniaSome 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 forseveral days or weeks or months (inpatients). Hospitals usually are distinguished from othertypes of medical facilities by their ability to admit and care for inpatients whilst the othersoften are described as clinics.GeneralThe best-known type of hospital is the general hospital, which is set up to deal with manykinds of disease and injury, and normally has an emergency department to deal withimmediate and urgent threats to health. Larger cities may have several hospitals of varyingsizes and facilities. Some hospitals, especially in the United States, have their own ambulanceservice.DistrictA district hospital typically is the major health care facility in its region, with large numbersof beds for intensive care and long-term care; and specialized facilities for surgery, plasticsurgery, childbirth, bioassay laboratories, and so forth.Specialized
McMaster University Medical Centre, a teaching hospital in CanadaTypes of specialized hospitals include trauma centers, rehabilitation hospitals, childrenshospitals, seniors (geriatric) hospitals, and hospitals for dealing with specific medical needssuch as psychiatric problems (see psychiatric hospital), certain disease categories such ascardiac, oncology, or orthopedic problems, and so forth.A hospital may be a single building or a number of buildings on a campus. Many hospitalswith pre-twentieth-century origins began as one building and evolved into campuses. Somehospitals are affiliated with universities for medical research and the training of medicalpersonnel such as physicians and nurses, often called teaching hospitals. Worldwide, mosthospitals are run on a nonprofit basis by governments or charities.TeachingA teaching hospital combines assistance to patients with teaching to medical students andnurses and often is linked to a medical school, nursing school or university.ClinicsMain article: ClinicA medical facility smaller than a hospital is generally called a clinic, and often is run by agovernment agency for health services or a private partnership of physicians (in nations whereprivate practice is allowed). Clinics generally provide only outpatient services.Departments
Resuscitation room bed after a trauma intervention, showing the highly technical equipmentof modern hospitalsSee also: Category:Hospital departmentsHospitals vary widely in the services they offer and therefore, in the departments they have.They 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 suchas cardiology or coronary care unit, intensive care unit, neurology, cancer center, andobstetrics and gynecology.Some hospitals will have outpatient departments and some will have chronic treatment unitssuch as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitationservices, and physical therapy.Common support units include a dispensary or pharmacy, pathology, and radiology, and onthe non-medical side, there often are medical records departments, release of informationdepartments, Information Management (IM)(aka IT or IS), Clinical Engineering (akaBiomed), Facilities Management, Plant Ops (aka Maintenance), Dining Services, and Securitydepartments.HistoryEarly examplesView of the Askleipion of Kos, the best preserved instance of an Asklepieion.Hôtel-Dieu de Paris circa 1500. The comparatively well patients (on the right) were separatedfrom the very ill (on the left).
A physician visiting the sick in a hospital, German engraving from 1682In ancient cultures, religion and medicine were linked. The earliest documented institutionsaiming to provide cures were ancient Egyptian temples. In ancient Greece, temples dedicatedto the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing. AsclepieionΑσκληπιείον), functioned as centers of medical advice, prognosis, and healing. At theseshrines, patients would enter a dream-like state of induced sleep known as "enkoimesis"(Greek: ενκοίμησις) not unlike anesthesia, in which they either received guidance from thedeity in a dream or were cured by surgery. Asclepeia provided carefully controlled spacesconducive to healing and fulfilled several of the requirements of institutions created forhealing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BCpreserve the names, case histories, complaints, and cures of about 70 patients who came to thetemple with a problem and shed it there. Some of the surgical cures listed, such as the openingof an abdominal abscess or the removal of traumatic foreign material, are realistic enough tohave taken place, but with the patient in a state of enkoimesis induced with the help ofsoporific substances such as opium. The worship of Asclepius was adopted by the Romans.Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island inthe Tiber in Rome, where similar rites were performed.Institutions created specifically to care for the ill also appeared early in India. Fa Xian, aChinese Buddhist monk who travelled across India ca. 400 CE, 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 inthe country, orphans, widowers, and childless men, maimed people and cripples, and all whoare diseased, go to those houses, and are provided with every kind of help, and doctorsexamine their diseases. They get the food and medicines which their cases require, and aremade to feel at ease; and when they are better, they go away of themselves."The earliest surviving encyclopedia of medicine in Sanskrit is the Carakasamhita(Compendium of Caraka). This text, which describes the building of a hospital is dated by
Dominik Wujastyk of the University College London from the period between 100 BCE andCE150. According to Dr.Wujastyk, the description by Fa Xian is one of the earliestaccounts of a civic hospital system anywhere in the world and, coupled with Caraka’sdescription of how a clinic should be equipped, suggests that India may have been the firstpart of the world to have evolved an organized cosmopolitan system of institutionally-basedmedical provision.King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physiciansand nursing staff, the expense being borne by the royal treasury. Stanley Finger (2001) inhis book, Origins of Neuroscience: A History of Explorations Into Brain Function, cites anAshokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds ofhospitals, hospitals for people and hospitals for animals. Where there were no healing herbsfor people and animals, he ordered that they be bought and planted." However DominikWujastyk disputes this, arguing that the edict indicates that Ashoka built rest houses (fortravellers) instead of hospitals, and that this was misinterpreted due to the reference tomedical herbs.According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixthcentury A.D., King Pandukabhaya of Sri Lanka (reigned 437 BC to 367 BC) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is theearliest documentary evidence we have of institutions specifically dedicated to the care of thesick anywhere in the world. Mihintale Hospital is the oldest in the world. Ruins ofancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, andMedirigiriya.The first teaching hospital where students were authorized to practice methodically onpatients under the supervision of physicians as part of their education, was the Academy ofGundishapur in the Persian Empire. One expert has argued that "to a very large extent, thecredit for the whole hospital system must be given to Persia".Roman EmpireFurther information: Byzantine medicineThe Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators,and soldiers around 100 B.C., and many were identified by later archeology. While theirexistence is considered proven, there is some doubt as to whether they were as widespread aswas 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.The declaration of Christianity as accepted religion in the Roman Empire drove an expansionof the provision of care. Following First Council of Nicaea in 325 A.D. construction of ahospital in every cathedral town was begun. Among the earliest were those built by thephysician Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-dayTurkey. Called the "Basilias", the latter resembled a city and included housing for doctors andnurses and separate buildings for various classes of patients. There was a separate sectionfor lepers. Some hospitals maintained libraries and training programs, and doctorscompiled their medical and pharmacological studies in manuscripts. Thus in-patient medicalcare in the sense of what we today consider a hospital, was an invention driven by Christianmercy and Byzantine innovation. Byzantine hospital staff included the Chief Physician
(archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai). By the twelfthcentury, Constantinople had two well-organized hospitals, staffed by doctors who were bothmale and female. Facilities included systematic treatment procedures and specialized wardsfor various diseases.A hospital and medical training center also existed at Jundishapur. The city of Jundishapurwas founded in 271 CE by the Sassanid king Shapur I. It was one of the major cities inKhuzestan province of the Persian empire in what is today Iran. A large percentage of thepopulation were Syriacs, most of whom were Christians. Under the rule of Khusraw I, refugewas granted to Greek Nestorian Christian philosophers including the scholars of the PersianSchool of Edessa (Urfa)(also called the Academy of Athens), a Christian theological andmedical university. These scholars made their way to Jundishapur in 529 following theclosing of the academy by Emperor Justinian. They were engaged in medical sciences andinitiated the first translation projects of medical texts. The arrival of these medicalpractitioners from Edessa marks the beginning of the hospital and medical center atJundishapur. It included a medical school and hospital (bimaristan), a pharmacologylaboratory, a translation house, a library and an observatory. Indian doctors alsocontributed to the school at Jundishapur, most notably the medical researcher Mankah. Laterafter Islamic invasion, the writings of Mankah and of the Indian doctor Sustura weretranslated into Arabic at Baghdad.Medieval Islamic worldMain article: Medicine in medieval IslamFurther information: BimaristanJundishapur surrendered to Islam in 636 AD. The first physicians under Muslim rule wereChristians or Jews. One source indicates the first prominent Islamic hospital was foundedin Damascus, Syria in around 707 with assistance from Christians. However most agreethat the establishment at Baghdad was the most influential. The public hospital in Baghdadwas opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century. Thebimaristan (medical school) and bayt al-hikmah (house of wisdom) were established byprofessors and graduates from Jundishapur. It was headed by the Christian physicianJibrael ibn Bukhtishu from Jundishapur and later by Islamic physicians. "Bimaristan" is acompound of “bimar” (sick or ill) and “stan” (place). In the medieval Islamic world, the word"bimaristan" referred to a hospital establishment where the ill were welcomed, cared for andtreated by qualified staff.In the ninth and tenth centuries the hospital in Baghdad employed twenty-five staff physiciansand had separate wards for different conditions. The Al-Qairawan hospital and mosque, inTunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equippedwith halls organized into waiting rooms, a mosque, and a special bath. The first hospital inEgypt was opened in 872 and thereafter public hospitals sprang up all over the empire fromIslamic Spain and the Maghrib to Persia. The first Islamic psychiatric hospital was built inBaghdad in 705. Many other Islamic hospitals also often had their own wards dedicated tomental health. Thus between the eighth and twelfth centuries CE Muslim hospitalsdeveloped a high standard of care.Some suggest that physicians and surgeons were appointed who gave lectures to medicalstudents and issued diplomas (ijazah) to those who were considered qualified to
practice. However others assert that, in contrast to medieval Europe, medical schoolsunder Islam did not develop a system of academic evaluation and certification.Medieval EuropeHospicio Cabañas was the largest hospital in colonial America, in Guadalajara, MexicoThe church at Les Invalides in France showing the often close connection between historicalhospitals and churchesCancer Hospital at the University of FloridaMedieval hospitals in Europe followed a similar pattern to the Byzantine. They were religiouscommunities, with care provided by monks and nuns. (An old French term for hospital ishôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independentand had their own endowments, usually of property, which provided income for their support.
Some hospitals were multi-functional while others were founded for specific purposes such asleper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The firstSpanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mérida, wasa xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia ofMérida) as well as a hospital for citizens and local farmers. The hospitals endowmentconsisted of farms to feed its patients and guests.The Ospedale Maggiore, traditionally named Ca Granda (i.e. Big House), in Milan, northernItaly, was constructed to house one of the first community hospitals, the largest suchundertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 anddesigned by Antonio Filarete it is among the first examples of Renaissance architecture inLombardy.Colonial AmericaThe first hospital founded in the Americas was the Hospital San Nicolás de Bari [CalleHostos] in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicolás de Ovando,Spanish governor and colonial administrator from 1502–1509, authorized its construction onDecember 29, 1503. This hospital apparently incorporated a church. The first phase of itsconstruction was completed in 1519, and it was rebuilt in 1552. Abandoned in the mid-eighteenth century, the hospital now lies in ruins near the Cathedral in Santo Domingo.Conquistador Hernán Cortés founded the two earliest hospitals in North America: theImmaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was theImmaculate Conception, now the Hospital de Jesús Nazareno in Mexico City, founded in1524 to care for the poor.The first hospital north of Mexico was the Hôtel-Dieu de Québec. It was established in NewFrance in 1639 by three Augustinians from lHôtel-Dieu de Dieppe in France. The project,begun by the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIIIand staffed by a colonial physician, Robert Giffard de Moncel.Modern eraIn Europe the medieval concept of Christian care evolved during the sixteenth andseventeenth centuries into a secular one, but it was in the eighteenth century that the modernhospital began to appear, serving only medical needs and staffed with physicians andsurgeons. The Charité (founded in Berlin in 1710) is an early example.Guys Hospital was founded in London in 1724 from a bequest by the 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 PennsylvaniaGeneral Hospital was chartered in Philadelphia in 1751, after £2,000 from privatesubscription was matched by funds from the Assembly.When the Vienna General Hospital opened in 1784 (instantly becoming the worlds largesthospital), physicians acquired a new facility that gradually developed into the most importantresearch center. During the nineteenth century, the Second Viennese Medical School emergedwith 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, andthroat clinics in the world were founded in Vienna, being considered as the birth ofspecialized medicine.By the mid-nineteenth century most of Europe and the United States had established a varietyof public and private hospital systems. In continental Europe the new hospitals generally werebuilt 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 areligious denomination. One of the earliest of these "almshouses" in what would become theUnited 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 medicalcare. They are supplemented by large public hospitals in major cities and research hospitalsoften affiliated with a medical school. The largest public hospital system in America is theNew York City Health and Hospitals Corporation, which includes Bellevue Hospital, theoldest U.S. hospital, affiliated with New York University Medical School. In the latetwentieth century, chains of for-profit hospitals arose in the United States. The decline in themembership of religious orders has changed the status of Catholic hospitals.In the 2000s, modern private hospitals began to appear in developing countries such as India.CriticismWhile hospitals, by concentrating equipment, skilled staff and other resources in one place,clearly provide important help to patients with serious or rare health problems, hospitals alsoare criticised for a number of faults, some of which are endemic to the system, others whichdevelop from what some consider wrong approaches to health care.One criticism often voiced is the industrialised nature of care, with constantly shiftingtreatment staff, which dehumanises the patient and prevents more effective care as doctorsand nurses rarely are intimately familiar with the patient. The high working pressures oftenput on the staff can sometimes exacerbate such rushed and impersonal treatment. Thearchitecture and setup of modern hospitals often is voiced as a contributing factor to thefeelings of faceless treatment many people complain about.FundingClinical Hospital Dubrava Modern Medical Center in Zagreb, Croatia.In the modern era, hospitals are, broadly, either funded by the government of the country inwhich they are situated, or survive financially by competing in the private sector (a number ofhospitals also are still supported by the historical type of charitable or religious associations).
In the United Kingdom for example, a relatively comprehensive, "free at the point ofdelivery" health care system exists, funded by the state. Hospital care is thus relatively easilyavailable to all legal residents, although free emergency care is available to anyone, regardlessof nationality or status. As hospitals prioritize their limited resources, there is a tendency forwaiting lists for non-crucial treatment in countries with such systems, as opposed to lettinghigher-payers get treated first, so sometimes those who can afford it take out private healthcare to get treatment more quickly.As the quality of health care has increasingly become an issue around the On the other hand,many countries, including the USA, have in the twentieth century followed a largely private-based, for-profit-approach to providing hospital care, with few state-money supported charityhospitals remaining today. Where for-profit hospitals in such countries admit uninsuredpatients in emergency situations (such as during and after Hurricane Katrina in the USA), theyincur direct financial losses, ensuring that there is a clear disincentive to admit suchpatients.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 thisaspect of health care, and hospital accreditation is one means by which this is achieved. Inmany parts of the world such accreditation is sourced from other countries, a phenomenonknown as international healthcare accreditation, by groups such as Accreditation Canada fromCanada, the Joint Commission from the USA, the Trent Accreditation Scheme from GreatBritain, and Haute Authorité de santé (HAS) from France.BuildingsArchitectureThe National Health Service Norfolk and Norwich University Hospital in the UK, showingthe utilitarian architecture of many modern hospitals.Hospital chapel at Fawcett Memorial Hospital, a for-profit facility operated by HCA.
The Horton General Hospital in Banbury, during 2010. It was built in 1872 and slightlyexpanded in both 1964 and 1972 and was nearly closed early in 2005.Modern hospital buildings are designed to minimize the effort of medical personnel and thepossibility of contamination while maximizing the efficiency of the whole system. Traveltime for personnel within the hospital and the transportation of patients between units isfacilitated and minimized. The building also should be built to accommodate heavydepartments such as radiology and operating rooms while space for special wiring, plumbing,and waste disposal must be allowed for in the design.However, the reality is that many hospitals, even those considered modern, are the product ofcontinual and often badly managed growth over decades or even centuries, with utilitariannew sections added on as needs and finances dictate. As a result, Dutch architectural historianCor 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 patients psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas hearken 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 buildings. The research of British Medical Association is showing that good hospital design can reduce patients 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 improvies patients mood, reduces blood pressure and stress level. 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.