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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.
Etymology
During the Middle Ages the hospital could serve other functions, such as
almshouse for the poor, or hostel for pilgrims. The name comes from German
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; Russian for
hospital is больницы.
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.
Types
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 do not care for inpatients.
Specialized
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. 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.
Clinics
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.
History
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 records of hospitals in Islam refer to the hopital of al-Walid ibn
'Abdulmalik (ruled 705-715 CE) which he built in 86 A.H (706-707 CE).It
resembled more 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 Aghlabids rule in 830 CE was simple but adequately equipped
with halls organized into waiting rooms, a mosque, and a special bath. The
hospital employed female 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 the
Otoman rule 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
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
This short section requires expansion.
Architecture
Modern hospital buildings have to designed specially to minimize the effort of
medical personel and possibility of contamination while maximizing the
efficiency of whole system. The steps for each kind of personel has to be
counted and minimzed and the patient transport between units be faciliated. The
building should be build with heavy departments such as X-ray department and
special wiring, waste disposal, operation rooms in mind.
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.
Electrical
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.
Information
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.
Costs
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.
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Contact Information
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