Ancient History of Hospitals: Dr. (Prof.) Roopam Kumar Gupta, Ratan Lal Gupta
Ancient History of Hospitals: Dr. (Prof.) Roopam Kumar Gupta, Ratan Lal Gupta
awareness’ is endowed to the Homo                    have been found in Nyero rock paintings of
Sapiens, to take care of themselves and their        Eastern Uganda. [5]
loved ones if they were not well.                            The clear evidences of surgeries
        Hospitals would invariably exist in          being successfully performed and the
any crude form, if ‘Surgical Procedures’ and         coincidence of proximity to mysterious
‘Treatment’ of the diseased took place. The          caves in Peru and cave paintings of witch-
oldest surgical procedure known is                   doctors inside the caves, lends support to the
‘trephination’ and we have archaeological            hypothesis that the first hospitals in the
evidence in the form of trephined skulls             prehistoric times of ‘cave men’ were indeed
discovered from ‘Neolithic period’. At a             the ‘cave hospitals’.
burial site dating to 6500 BCE, in France,
there were forty trephined skulls found              Ancient Indian ‘Ayurvedic Medical
together. [1] Many of the skulls showed              Schools’
healing signs, indicating that the patients                  Ayurveda is sacredly considered to
spent their post-operative time somewhere            be as old as ‘Brahma’ the Hindu God of
recovering, while the wounds healed and              Creation. The practice may have started in
then lived for years after the surgery. [2]          pre historic times when people started to
There is evidence of prehistoric trephination        become conscious of their health and
being commonly performed in the Cusco                became aware that they had to take
region, of Andean highlands. This is the             measures to improve and preserve their
same region where mysterious caves called            lives. By the time of Indus Valley
‘Naupaiglesia’ have been discovered with             Civilization, Ayurveda was the established
interesting geometry, especially flat smooth         system of healthcare. Archaeologists have
surfaces, made by high technology                    found stag-horn and cuttlefish bone
machines.[3] This coincidence leads to the           suggesting that vegetables, animals and
question, if these caves were used as                minerals were used as sources for drugs. [6]
hospitals for surgeries? Along with                  Indus Valley people placed great emphasis
neurosurgery, dentistry was also practiced           on personal hygiene and used cosmetics like
during this period as archaeologists have            collyrium for preventing and curing eye
found Neolithic teeth in Mehgarh,                    diseases. [7] There are no documented
Baluchistan province, showing clear signs            evidences, but the excavations of the
of drilling, using flint-tipped drills and           archaeological sites at Harappa and
bowstrings. [4]                                      Mohenjo Daro, show a high degree of town
        In prehistoric communities there             planning, awareness and practice regarding
were medicine men, witch doctors or                  public health and sanitation, therefore the
‘shamans’ who were in charge of the tribe’s          strong possibility of one of the buildings
health, practiced plant based medicines,             being used as a ‘Hospital’, exists.
carried out rudimentary surgeries like                       The knowledge of Ayurveda is
trephinations and of course, used spells and         believed to have been passed on through
charms to ward off evil spirits. In the cave         ‘Shruti and Smriti’ from ‘Brahma’ through a
of Lascaux, France, where Neanderthals and           chain of great Sages like ‘Atreya’ and
early Homo Sapiens lived 30,000 years ago,           ‘Dhanvantri’, eventually to ‘Maharshi
there is a cave painting depicting a ‘Dis-           Charak’. There is no consensus on the dates
emboweled bison’ and bird-headed human               when Maharshi Charak lived but few
figure,     which     is    interpreted    by        researchers claim this as 200-100 BC. [8] He
archaeologists as a ‘shaman’, a kind of              wrote “Charak Samhita”, which is
priest or healer with powers including the           considered as an encyclopaedia of Ayurveda
ability to communicate with spirits of other         and he is hailed as the Father of Indian
worlds. Similar paintings of witch doctors           medicine. The place where the Sages Atreya
                                                     and Maharshi Charak taught and practiced
the art of Ayurveda, was ‘Taxila’ or                  until 1197. It was devoted to Buddhist
‘TakshShila’ the ancient world’s first                studies, but it also trained students in
international university that existed approx.         medicine. [12]
400-500 BCE to 550 CE. [9] The University
was undoubtedly the first ‘Teaching                   Buddhist Sinhalese ‘Monastic Hospitals’
Hospital’ for Ayurvedic medicine and                          The art of healing was promoted in
surgery that was studied for up to seven              Buddhism,       with      Buddha      himself
years. This famous university not only                emphasizing that health was among the
attracted medical students from far off               most precious goods a person can possess.
places in India and from foreign countries            In one iconic story in the ‘Vinaya Pitaka’,
like Babylonia, Egypt, Phoenicia, Syria,              the Buddha comes across a monk with
Arabia, China and Greece. ‘Jivaka’, the               dysentery who has been abandoned by his
great physician to Gautama Buddha and an              fellow monastics. After caring for the monk
expert in pulse reading is also said to have          with Ananda’s help, the Buddha admonishes
studied Ayurveda in TakshaShila University            the sangha. “Whoever would tend to me,”
for seven years.                                      he says, “should tend to the sick.” Buddha
         Maharshi ‘Sushruta’, often referred          first taught medicine to his ‘sangha’ and
to as the “Father of Plastic Surgery,” was an         then he allowed monks to visit patients and
influential physician in ancient India (circa         to carry medicines with them as described in
600 BCE) who is still revered today for the           the ‘Dulwa-smangzhi’, in Vinaya Pitaka. He
critical development of Ayurvedic surgical            later taught the ‘Gyud-shi’, which are the
procedures and his work ‘Sushruta                     four medical ‘tantras’ that laid the
Samhita’. [10] It describes ‘shalya tantra’,          foundation of the Tibetan medical system.
the practice of surgery and it is the oldest          This system focuses on the direct healing of
known document on surgery in the world.               the patient’s body and mind with the help of
The book describes more than 300 surgical             the appropriate medicines, diet, behaviour
procedures, including plastic reconstruction          and therapies in order to pacify the result of
surgery (like Rhinoplasty) and the removal            mentally negative passions. The second
of cataracts. It also describes over 120              rock edict of King Asoka states that
surgical instruments including ‘tubular’              monasteries functioned as hospitals in early
instruments (endoscopy) and more than                 Indian society. King Asoka established
1,120 diseases, injuries, and conditions. [11]        hospitals for men and animals (3rd century
         However there is no mention of the           BC) and the old Buddhist medicine of
‘Hospital’ with the ‘Operation Theaters’              Mahavagga (4th century BC), was
where he performed his great surgeries. We            practiced. [14]
may certainly conclude that the ‘Surgical                     The earliest Monastic hospitals can
Hospital’ was also very developed                     be traced back as far as the 5th Century BC,
technically to match the brilliance of the            to the ancient ‘Sinhalese’ (Sri Lankans).
‘Father of Indian Surgery’. He is known to            Excavations have revealed three hospitals
have practiced medicine in northern India             situated in Buddhist monasteries in
along the banks of the Ganges River, near             Anuradhapura, Madirigivi and Polonnaruva.
Varanasi. It may be inferred that Maharshi            According to the ‘Mahavamsa’, written in
Sushruta taught and practiced in the                  the 4th century B.C., King ‘Pandukabhaya’
university at ‘Benares’ or ‘Kasi’ which was           had ‘Sivikasotthi Sala’ or ‘lying in homes’
a famous school of medicine, moulded on               as hospitals built in various parts of the
the lines of Taxila by students from Taxila.          country. ‘Mihintale’ is a mountain peak near
It flourished from 7th B. C. to 12 AD.                Anuradhapura in Sri Lanka. Several
Another ancient medical school was the                significant artifacts were discovered in
Nalanda University, founded in 427 AD in              ancient hospital site like medicine grinders
northeastern India (Bihar), and it survived           of granite, vessels, medical instruments of
bronze and a medicinal trough of stone                this early period included bandaging and
‘Behethoruwa’ (Medicine bath bed). This is            making plasters for wounds. The Asus made
carved in the shape of the human body; the            house calls and many patients were treated
length is 7 feet and the width is 2 ½ feet. A         in their home.
Buddha image was in the middle of the                          For the Asipu, institutions, referred
hospital complex. The structures include a            to as ‘House of Life’ (per ankh) are known
dispensary room, a large patient waiting              to have been established in ancient Egypt as
hall, two separate rooms presumably used              early as 2200 BC. These institutions could
for examining patients, an inner court with a         perform amazing feats with magic and could
Buddha Shrine, with a corridor leading to 32          call upon the power of the gods. Magic was
residential rooms for in-house patients. Each         so relevant that healing amulets played an
of these rooms measures 3.96m x 3.96                  important role in treatments, especially one
meters. There was also a ‘Jantaghara’ or a            called the ‘Eye of Horus’. The symbolic
room where steam and hot water therapy                shape ‘Rx’ continues to be used at the
was administered in the hospital building.            beginning of all medical prescriptions by
The remains of a separate building, which             physicians even today. The hieroglyphic
could be the kitchen of the hospital, are             script found under the statue of chief
visible in the northern side beyond the               physician ‘Wedjahorresnet’, now in the
hospital. [15,16]                                     Gregorian Egyptian Museum at Vatican,
                                                      states that the King Darius commanded him
Mesopotamia and Egypt’s ‘House of Life’               to return to Egypt to establish the bureau of
        The ancient Mesopotamians used a              the ‘House of Life’ for the exercise of
balance of rational science and magic for             healing. [18] Thus we may conclude that the
healing. At around 3500 B.C., there were              ‘House of Life’, were the earliest hospitals
two kinds of medicine men in                          in Mesopotamia and Egypt.
Mesopotamia–the asipu who practiced the                        The first architect of the great
more ritual or magical side of medicine and           pyramids ‘Imhotep’ who lived in Egypt
the asu who practiced therapeutic medicine,           during the reign of pharaoh ‘Djoser’ (2667-
composed of surgical and herbal treatments.           2648 BC) was also his ‘vizier’ or chief
Although modern-day scholars refer to the             minister. Imhotep is also hailed as founder
asipu as a 'witch doctor' or expert in ‘white         of Egyptian medicine and as the author of
magic’ and the asu as a 'medical                      the scroll ‘Smith papyrus’ which is
practitioner,' the Mesopotamians regarded             considered the oldest treatise on trauma.
the two with equal respect. The asu kept              Imhotep was considered as the ‘inventor of
cots in their places of business for the              healing’ and after his death, he was elevated
treatment and recovery of patients; had               to the position of a god of medicine and
surgical and pharmacological equipment;               healing. [19] At the temple of Heliopolis, a
and though there were no large facilities that        major city of ancient Egypt, they discovered
could be termed as hospitals, these facilities        gravestones of the doctors. Engraved on
resembled small clinics. The asu were                 them are inscriptions as “superintendent of
trained in schools associated with temples of         the secrets of health of the house of Thoth”,
the goddess of medicine and healing called            “the greatest of doctors”, “eye specialist to
Gula and would remain always associated               the palace.” From the hieroglyphics found
with some temple complex. The practices of            on the tomb of doctor Iry, we learn that he
asu were later regulated by the famous Code           was called “keeper of the king’s rectum.”
of Hammurabi. [17] Asu used medical                   There was also a “keeper of the king’s right
manoeuvres such as inspection, palpation              eye,” and “keeper of the kings left eye.”
and auscultation in order to obtain                   Ancient Egyptian medicine was later
information from the patient’s body and               adopted by the Greeks who purified it from
used the concept of syndromes. Practices in           its magic concepts. [20]
Chinese Healer Monks on ‘House Calls’                 and Bila Gaje attained immortality and still
        In China there were Buddhist                  exist in a forest of sandalwood. It is
‘healer-monks’         who     worked       as        therefore inferred that the palace of the King
missionaries, translators, and advisers across        ‘Yumbu Lakhar’ must have housed the first
medieval Asia and there was a huge inter-             ‘Buddhist Hospital’ of Tibet. [22]
regional trade in medicinal substances such
as herbs, animal products, gemstones, relics,         Greek Temple Hospitals ‘Asclepeions’.
and other magical materials. Buddhist                         In Homer's Iliad, Asclepius was the
healing became popular in the early                   physician healing the soldiers wounded on
medieval period (3rd to 8th century C.E.)             the battlefield at Troy. He was considered
among both the common people and the                  the son of Apollo, the patron God of
elite. A network of monastic dispensaries,            Medicine. Asclepius was so an expert in the
hospices, and asylums were established                art of surgery, that he was known to have
across the empire. The concept of ‘Medicine           the ability to return the living from the dead.
Buddha (Bhaishajyaguru)’ became an                    He was later elevated to the status of the
important part of the medieval Chinese                Gods. In ancient Greece, around 350 BCE,
healing practice. The Medicine Buddha                 temples known as ‘Asclepieia’ were
mantra is held to be extremely powerful for           dedicated to him as the healer-god
healing of physical illnesses and purification        ‘Asclepius’, and they functioned as centres
of negative karma. Chinese medicine                   of medical advice, prognosis, and healing,
includes Acupuncture, Tai Chi and Herbal              where patients and pilgrims would flock to
medicines. Physicians during this time did            seek spiritual and physical healing. Over
not have offices or one exact area where              300 asclepieia have been discovered
they treated patients. So, these individuals          throughout ancient Greece, the famous ones
travelled to the patient’s houses, and treated        at Trikka, Epidaurus, island of Kos, Athens,
them at home on ‘house calls’. This is very           Corinth and Pergamon. It was peculiar to
different from today’s society where doctors          have presence of dogs and non-venomous
have their own offices in hospitals or                snakes, known as ‘Aesculapian snake’ at
medical facilities. [21]                              these temples. The treatment practised was
                                                      of two stages- Katharsis & Incubation. The
Tibetan ‘Palaces’ as Buddhist Hospital                initial step of ‘Katharsis’, or purification,
        It has been mentioned in a Bon text           consisted of a series of cleansing baths and
titled “Jam-ma tsa-drel” (200 B.C.), that             purgation, accompanied by a cleansing diet,
there lived twelve scholars of Bon tradition          which lasted several days. The next step of
including a medical scholar, who treated              ‘Incubation’ or ‘Dream Therapy’ was
diseases through medication and therapy.              performed        at     an     “Abaton”      or
This indicates that there were Tibetan                “Enkoimeterion,” which was a dormitory
physicians even prior to the advent of                located in the asclepeion. Patients would be
Buddhism in Tibet. The introduction of                induced into a dream-like state of sleep
Buddhist medicine happened when in 245-               known as ‘enkoimesis’, and this practice
364 A.D., two monks Biji Gaje and Bila                was known as ‘incubatio’, or ‘Temple
Gaje, went to Taxilla and studied medicine            Sleep’. Asclepius or his daughters, Hygea
under the great Physician Atreya and then             and Panacea, would come in their dreams
visited Magadha to study under Kumara                 and tell them how to cure their ailment. The
Jivaka. The Tibetian King Lha Thotho-Ri-              patients would interpret the dream with the
Nyantsen, invited both to his Palace in               help of the priests and perform the ritual that
Tibet. He requested them to remain there to           was mostly to visit the baths or a
teach and practice medicine, and he gave his          gymnasium.
daughter YidkyiRolcha as a bride to Biji                      In the Asclepieion of Epidaurus,
Gaje. It is believed in Tibet that Biji Gaje          there are three large marble boards dating
back to 350 BC having the names, case                  kitchen, staff quarters, and washing and
histories, complaints, and cures of about 70           latrine facilities. [24]
patients who had been successfully treated                      Marcus Terentius Varro (116BC–
there. It includes realistic details of surgical       27BC) a Roman scholar who was patronized
cures, such as the draining an abdominal               by Augustus, knew the importance of
abscess or the removal of traumatic foreign            micro-organisms in the pathogenesis of
body, perhaps under the influence of                   disease long before Louis Pasteur
‘enkoimesis’ which could have been opium.              formalised the germ theory of disease and
These asclepeion was also the first Greek              his guidance was used for the designing of
Medical School. The ‘Father of Medicine’               the valetudinarian. “When building a
Hippocrates (470-360 BCE) is said to have              hospital special care should be taken to
received his medical training at an                    place it at the foot of a wooded hill where it
asclepeion on the isle of Kos. Claudius                is exposed to health-giving winds. Care
Galenus or Galen (129-210 AD), one of the              should be taken where there are swamps in
most accomplished of all medical                       the neighbourhood, because certain tiny
researchers of ancient times, treated and              creatures which cannot be seen by the eyes
studied at the famed asclepeion at                     breed there. These float through the air and
Pergamon. [23]                                         enter the body by the mouth and nose and
                                                       cause serious disease.” [25] The Roman
Roman Military Hospitals                               valetudinarian, set pioneering standards in
‘Valetudinaria’                                        Hospital Infection Control Practices.
         The Romans established hospitals
‘valetudinaria’ for the treatment of their sick        Roman Medi-cities ‘Basilias’
slaves and injured soldiers; their care was                    Around A.D. 325, with Christianity
important because it was upon the integrity            becoming an accepted religion in the Roman
of the legions that the power of ancient               Empire, the construction of a hospital in
Rome was based. Latin term valetudinarian              every cathedral town was begun. The first
is derived from ‘valetudo’, or "good health".          Christian hospital in the eastern Byzantine
They were built in the time of Emperor                 Empire (Asia Minor- modern day Turkey)
Augustus, as military hospitals within each            was built by Basil of Caesarea, or Saint
legion. The concept was to isolate the                 Basil the Great, the bishop of Caesarea in
diseased from the community till he was                Cappadocia. Therefore these hospitals were
normal again. Initially the valetudinaria              called as Basiliad, Basileias or Basileiados.
were ‘field hospitals’ or ‘flying military             They resembled a town that included
camps’ and began as a small cluster of tents           housing for doctors and nurses, separate
and fortresses dedicated to wounded                    buildings for various types of patients and
soldiers. Over time, the temporary forts               separate section for lepers. There were few
developed into permanent facilities. The               basilias with libraries and training activities
original hospitals were built along major              where doctors compiled their medical and
roads, and soon became part of Roman fort              pharmacological studies into manuscripts.
architecture. They were usually placed near            The hospital staff included the Chief
the outer wall in a quiet part of the                  Physician (archiatroi), professional nurses
fortification. A standard valetudinarium was           (hypourgoi) and the orderlies (hyperetai).
a rectangular building consisting of four              John     Chrysostom,      the     bishop     of
wings, connected by an entrance hall that              Constantinople, in 398-404 AD developed a
could be used as a triage centre. Each                 Basilia in Constantinople, and many basilias
legion's hospital was constructed to                   arose in other cities, some run by monks,
accommodate 6% to 10% of the legion's                  some supported by wealthy citizens and
5,000 men. The building also included a                they also received privileged tax treatment
large hall, reception ward, dispensary,                from the government. Between 420 and 650
AD, the hospitals became more numerous               of Medicine into the literary language of the
and larger, like the ones found in Ephesus,          Sasanian Empire - ‘Pahlavi’. He also sent
Edessa, and Jerusalem (of 200 beds). The             the famous physician ‘Borzouye’ to invite
famous basilia of Sampson Xenon, was built           Indian     and     Chinese      scholars   to
by physician Saint Sampson, in the late              Gundeshapur. These visitors helped
fourth century in Constantinople. It was a           translate Indian texts on medicine and
complex of elaborate buildings where                 Chinese texts on herbal medicine to be
patients were treated in wards by specialized        taught at Gundeshapur. Interestingly the
physicians. It may be noted that the Greek           teaching     hospital    was     known     as
word ‘Hospital’ signifies the etymological           ‘bimaristan’, which is a compound of
link between ‘Hotel, Hospitality and                 “bimar” (sick or ill) and “stan” (place). The
Hospital’ as these structures catered to the         most notable Indian doctor who contributed
‘travellers’, strangers, orphans, sick and           to the development of the medical school at
poor. In fact the ‘basiliad’ was a social            Gundeshapur,       was     Mankah.       Thus
welfare endeavour. The Roman ‘basilias’              Gundeshapur developed into a uniquely
were indeed the earliest professionally              tolerant and peaceful meeting point for the
administrated hospitals.                             study of the philosophical and medical
                                                     traditions of Persians, Greeks, Indians,
The ‘Bimaristan’ of Gondeshapur                      Zoroastrians, Jews and Nestorians. In fact
        The Persian mythology ascribes the           Harith bin Kalada, the Prophet Mohammed's
introduction of medicine to Persia to                physician, was also trained at Gundeshapur.
                                                     [26]
‘Jamshid’ who was the fourth king of Iran.                Elgood writes that ‘to a very large
‘Gundeshapur’ was one of the major cities            extent, the credit for the whole hospital
in Khuzestan province of the Persian                 system must be given to Persia’. [27]
empire. The Sasanian King Shāpur I,                          The     history    continues     with
founded the city as a garrison town after            tremendous intellectual activity, culminating
defeating a roman army and later made it his         in the ‘Golden era of Islamic Medicine’ but
capital. ‘Gund-dēz-i Shāpūr’, means                  as the period of Ancient History by
"military fortress of Shapur”. Shāpur I 's           consensus extends till the coming of Islam
wife, was the daughter of ‘Aurelian’ the             (650 AD), the scope of this article concludes
Roman Emperor, who lived in the capital              here.
with him. She had brought with her two
Greek physicians, who settled in the city            CONCLUSION
and     taught     Hippocratic    medicine.                  Thus the journey of rediscovering
Gundeshapur soon had a teaching hospital             the ‘Ancient History of hospitals’ comes to
with a library. It provided systemized               an end. It began with hypothesis that
medical treatment to patients and the                hospitals existed as ‘Cave Hospitals’ in
scholars of the academy imparted formal              prehistoric times as early as the Neolithic
medical education of the highest standards           era, where surgeries like trephination were
where medical students were required to              performed and witch doctors healed the
work in the hospital under the supervision           sick. The discussion followed to the Ancient
of the medical faculty. The Arabic text, the         Indian ‘Ayurvedic Medical Schools’ during
‘Tārīkh al-ḥukamā’ records that medical              7th century BC of Takshila and Kasi where
students had to pass exams in order to               Charaka and Sushruta taught medicine and
practice as accredited Gondeshapur                   surgery.    Then      Buddhist     ‘Monastic
physicians. The emperor Khusraw I, (A.D.             Hospitals’ in Srilanka of 3rd Century BC,
531-579) gave refuge to various Greek                especially the oldest ruins of Mihintale
philosophers fleeing religious persecution           Hospital was described. The ancient
by the Byzantine empire and ordered these            Mesopotamian ‘House of Life & Healing’
refugees to translate Greek and Syriac texts         that used magic charms in temple hospitals,
24. Byrne EH. Medicine in the Roman army.              27. Elgood C. A Medical History of Persia and
    The Classical Journal. 1910 Apr 1;5(6):267-            the Eastern Caliphate: from the earliest
    72.                                                    times until the year AD 1932. Cambridge
25. Scott Chimileski, Ancient Imaginations of              University Press; 2010 Oct 31.
    the Microbial World. 2017. Available from
    https://asm.org/Articles/2017/May/ancient-         How to cite this article: Gupta RK, Gupta RL.
    imaginations-of-the-microbial-world                Ancient history of hospitals. International
26. Brewer H. Historical perspectives on health:       Journal of Research and Review. 2020; 7(12): 1-
    early Arabic medicine. The journal of the          9.
    Royal Society for the Promotion of Health.
    2004 Jul;124(4):184-7.
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