The Evolution of Hospitals and Major Historical Diseases
The Evolution of Hospitals Through History
Early Hospitals: Roman Empire
The first records of hospitals, known as infirmaries (or valetudinaria), developed at the end of the Roman Republic and early Roman Empire (1st and 2nd centuries AD). They were primarily institutions for slaves and military personnel, as nobles received care in their homes.
Byzantine Medieval Hospitals
Hospitals emerged in the Byzantine Empire in the second half of the 4th century AD, closely related to monastic orders. They were dedicated to the care of the sick and the poor, serving as instruments of Christian charity. These were very stable institutions that influenced the development of Bimaristans in the Muslim world and later Western Christian hospitals.
Western Christian Medieval Hospitals
In the 6th and 7th centuries, hospitals developed in episcopal cities. The Domus Dei (House of God) comprised the church, the episcopal palace, and the hospital. In the 9th century, monastic hospitals arose, providing nursing care for the poor and monks. In the 12th and 13th centuries, hospitals for pilgrims developed along pilgrimage routes, and hospital orders emerged in relation to the Crusades. Additionally, specialized buildings like leprosaria (leprosy hospitals) became more abundant during the Middle Ages.
The Modern Hospital Era
During the modern age, there were significant changes in hospital architecture, moving away from the Greek cross basilica layout. This period saw progressive secularization, increasing medicalization, and the rise of general hospitals.
Contemporary Hospitals
Contemporary hospitals began to be built with isolation wards connected by a central body to combat infections. The hospital’s purpose expanded to include teaching, research, and patient care.
Current Hospital Trends
Today, skyscraper hospitals are sometimes built to fight infections and due to land scarcity. However, their drawbacks include a lack of adaptability and flexibility, and high costs. Current trends favor smaller, more functional, and adaptable hospitals.
Major Historical Diseases and Public Health
The Black Death (Plague)
The Black Death emerged in 1347, impacting a booming population in many cities with burgeoning bourgeois life and fortified places. This created significant sanitary and hygienic problems. The transit of Europeans in Asia or Central Highlands led to plague-carrying rats entering food carts used by merchants. The plague spread from Sicily to the rest of Europe. Urban conditions greatly favored plague transmission. Today, there is significant concern about viruses like Ebola.
Jews were falsely blamed for the plague and subjected to extermination. (They were notably physicians and merchants).
The end of the plague was marked by:
- Population decline, leading to lower infection rates.
- Control of the population and health education.
Yellow Fever
Yellow Fever originated in West Central Africa and was identified in the 17th century.
Symptoms included:
- Severe fever
- Jaundice (yellow skin/eyes)
- Black vomit
It arrived in the West, specifically Barbados (West Indies), due to sugar cane cultivation. The labor of enslaved Africans, combined with mosquito populations, facilitated the disease’s spread. Consequently, the yellow fever outbreak expanded to the Spanish American colonies.
Smallpox
The British intentionally provided blankets infected with smallpox to indigenous Native Americans, who were severely affected. Europeans had some immunity.
Cholera
Cholera thrives in shallow, precarious water sources, such as those found in the Ganges Delta. In the 19th century, cholera spread globally following the English colonization of India, which became a source of wealth and saw railway development.
Actions by the English that influenced its spread included:
- Construction of railways
- Flooding of land
- Expansion into previously uninhabited territories
Milestones in Medical History
- William Harvey: Greater circulation
- Jean-Baptiste Denis: Transfusions
- Paul Ehrlich: Chemotherapy
- Joseph Murray: Kidney Transplants
- Ian Wilmut: Cloning
- Thomas Willis: Epilepsy
- Wilhelm Conrad Röntgen: X-ray
- Franz Joseph Gall: Phrenology
- David Ferrier: Vivisection
- Rune Elmqvist / Åke Senning: Pacemaker