# Blackwood's Magazine/Volume 1/Issue 2/On the Origin of Hospitals for the Sick

ON THE ORIGIN OF HOSPITALS FOR THE SICK.
The Greeks had no name to express what we understand by the word hospital. Νοσοχωμιον has a different meaning in the classical Greek writers, and is first used, as we now translate it, by St Jerome and St Isidore. At Athens, provision was made in the prytaneum for the maintenance of those who had been severely wounded in war, as well as for that of their wives and children; but there was no asylum for even these persons in case of sickness. Far less was any such accommodation within the reach of the poor citizens, or the mercenaries who always formed a large proportion of the Athenian force. At Lacedemon, where, according to the rule of Lycurgus, all the citizens eat in common, there was nevertheless no establishment which bore any resemblance to our hospitals. The Helots were abandoned in case of sickness; and a similar fate attended even the Ephori themselves, if they happened to have no private fortune. This neglect of the Athenian and Spartan legislatures was imitated by the other Grecian states. In the oath of Hippocrates, that illustrious physician swears, "that he will all his life visit the sick and give them his advice gratis." At that time the medical practitioners were both surgeons and apothecaries, so it would appear that Hippocrates furnished the sick in his neighbourhood with medicines without expecting any reward.
Among the Romans, in like manner, we should seek in vain for any establishments intended to alleviate the sufferings of the indigent sick. Nothing of the sort is mentioned among the pious institutions of Numa; and Servius, who distributed the people into classes, never thought of the numerous classes of poor, sick, and infirm. During the time of the republic there were frequent distributions of land, and divisions of the spoils taken from the enemies of the state, which ameliorated in some degree the lot of those who were called the capite censi, because they could offer nothing to the service of their country but their valour and their life. Yet all these largesses and gratifications were distributed among those who enjoyed good health, and no establishments for the sick were erected either under ​the republic or under the emperors. These last indeed erected baths and thermæ for the use of the poor, and also made public distributions of food; and in these respects their example was followed by the wealthy patricians, who affected to give every day to their poor clients what went by the name of the sportula. We see by the descriptions of Juvenal, that the poor and infirm dependants of these nobles had no other resource to look to; for, according to him, the most acute distempers could not prevent them dragging their steps to the portico, and soliciting their share in the sportula.
"Quid macies ægri veteris quem tempore longo
Torret quarta dies olimque domestica febris, &c."
It is easy to see that no public asylum was open for their reception. Both Greeks and Romans, then the two most polished nations of antiquity, consecrated no retreats for the unfortunate. This was most probably the consequence of their constitutions and forms of government. Divided at all times into freemen and slaves, the legislatures of these two nations never bestowed much attention on the second of these great bodies of men—but always regarded them as of a different race, and, as it were, the dregs of humanity. A slave dangerously ill was left entirely to the care of his fellows in servitude; in many instances his master would not even be at the expense of burying his corpse, and allowed it to be thrown out to the vultures. The Esquiline Mount, whitened, according to Horace, by the great number of bones left there in heaps by these birds of prey, is a sufficient proof how little care was taken of the funerals of the poor. These unhappy men, of whom there was always a great number even in the best days of Athens and Rome, had then no other resource in their calamities but private charity, the strength of their constitutions, or the crisis of nature.
The temple of Esculapius, in the island of the Tiber, was indeed a sort of hospital, although far from corresponding exactly to what we call by that name; at least, the law of the Emperor Claudius, which declares that slaves abandoned by their masters in the island of Esculapius, should be held tree in case of their recovery, seems to intimate that there was in that place a seigneurial hospital destined for their reception. But it is not till the establishment of Christianity that we can find any traces of those institutions, which are now so common in Christendom, for the accommodation of the infirm and the unfortunate. In spite of all the persecutions to which the first Christians were exposed, we find, that about the year 258, Laurentius, chief of the deacons, assembled a great number of poor and sick, who were supported by the alms of the church. But it was in the year 380 that the first regular hospital was built. St Jerome informs us, that Fabiola, a Roman matron of distinguished piety, founded, for the first time, a nosocomium, that is, as he himself explains it, "a house in the country for the reception of those unhappy sick and infirm persons who were before scattered among the places of public resort,—and for the purpose of furnishing them in a regular manner with nourishment, and those medicines of which they might stand in need." This establishment was situated at some distance from the city, and in a healthy part of the country.
When Constantine transferred the seat of the empire to Byzantium, he caused an hospitium to be erected for the use of those strangers and pilgrims who had by his time begun to visit the East from motives of religion. This edifice was constructed after the model of the house which Hircanus had built at Jerusalem, about 150 years before the commencement of our era. That prince sought, by the establishment to which I allude, to purify himself, in the eyes of the Jews, from the stain which he had contracted by the sacrilegious rifling of the tomb of David. The riches which he had procured in that impious manner, would, he flattered himself, be less unfavourably regarded, if he should share them with the poor pilgrims, whom zeal or curiosity drew in multitudes to the capital of Judæa. This, according to Isidore, is the origin of the name Ξεν δοχιον, i.e. hospital for strangers, which was given to this building. In the year of our Lord 550, the Emperor Justinian constructed, at Jerusalem, the celebrated hospital of St John, which was the cradle of the military order of the knights of Rhodes and Malta. His successors imitated his example with so much ​zeal, that Ducange thinks Constantinople contained at one time thirty-five different charitable institutions of this nature. Those who travelled to the holy land were there received gratis into commodious hotels, and from these the caravansaries of the East have taken their origin—buildings which a few centuries ago attracted so much admiration from Europeans, accustomed to the hostelleries of their own countries, at that time at once dear and filthy. The Emperor Julian attributed in a great measure to these charitable institutions the rapid progress of Christianity, and had it in view to attempt the re-establishment of Paganism by similar means. "We pay not sufficient attention (says he in a letter to Arsaces, sovereign pontiff of Galatia) to those means which have most contributed to the extension of the Christian superstition—I mean kindness to strangers, and attention to the burial of the poor. Erect forthwith, in all your cities, hospitals for the reception of strangers, not only those of your own faith, but all indifferently; and if they stand in need of money, let them be supplied by the imperial officers."
In the Byzantine historians, and in the ancient charters, these hospitals receive different names, as, Nosocomium, retreat for the sick—Xenodochium, Xenon, retreat for strangers—Ptochium, Ptochodochium, Ptochotrophium, hospital for the poor and mendicants—Brephotrophium, asylum for indigent children—Orphanotrophium, orphan hospital—Gerocomium, hospital for old men—Pandochæum, gratuitous hotel or caravansary—Morotrophium, hospital for idiots.
In the very interesting work of Durand, entitled, "Parallele des Edifices de tout genre," we find a comparative view of the plans of a great many different hospitals of various kinds, such as those of Milan, Geneva, Plymouth, St Louis at Paris, Langres, the Incurables at Paris, the Lazaretto for persons afflicted with the plague at Milan, &c.—The great hospital at Milan, on account of its vast dimensions, and the form of a cross in which it is built, and also on account of the numerous galleries which every where surround the building, was long looked upon as the best model of hospital architecture. The architects of the different hospitals in Paris, as well as those of this country, have all taken useful hints from it. A report was play formed, by order of the French government, about the year 1788, in which a committee of medical persons and architects, gave their united opinions as to the general rules which ought to be observed in all buildings of this nature. Their principal remarks are these—that all the wards should be separate—that a free communication, by means of covered galleries, should be kept up between all parts of the house—so large as to admit of the utmost purity of air, and to be serviceable, as promenades, for the convalescents.
The hospitals of this city, and of Glasgow, have been long regarded with much admiration by all visitors; and the Lunatic asylum, lately erected in the latter city, is perhaps the most noble monument of the professional talents of the late Mr Stark. Q.
Edinburgh, March 1817.