Appendix A

Notes and Sources for Figure 1 : Comparative Chronology

1. Greek Asclepieia, or ‘healing temples’.[1]

2. Temkin describes the role of “public physician” as dating from the fifth century BCE but there is much debate as to if, or when, they provided a place for patients to recuperate. Miller, for example, acknowledges that physicians performed surgery in their offices, or iatreia, but disputes any claim that accommodation was provided in them before the Christian era.[2]

3. Based on the Zhouli”.[3] See page 27 ff.

4. Based on the Guanzi[4]. See page 28 ff.

5. Valetudinaria, or military hospitals, provided for Roman soldiers, gladiators, and by plantation owners, for slaves date from early in the first century CE.[5] Thompson and Goldin, who focus on the physical manifestation revealed by excavations, are impressed by the planning and sanitary techniques, as is Scarborough.[6]

6. From the biography of Han Emperor Hanping 汉平.[7]  See fn. 50 at page 30.

7. A Royal proclamation of Yongping 永平, in 60 CE.[8] See page 81.

8. These small, sometimes short-lived, institutions provided refuge for people who were sick, travelling or elderly.[9]

9. Xenodocheia or xenones, associated with Christian churches from early in the fourth century CE.[10] Miller cites the xenon at Antioch, which was described in 381 CE as being a place where “every root of evil, the strange forms of disease, and the many causes of depression” could be observed, as being “perhaps a true hospital”.[11] See page 32 ff.

10. According to Wong, the Liubing guan 六病馆, or Six Diseases Home, a “charity hospital” was organised by Crown Prince Hui Wen and Prince Jing Ling who were admirers of Buddhism. Prince Jing Ling also established a “hai” where he took in the poor and provided them with medicine and clothing.[12]

11. The first permanent hospital with a dispensary was established in 491 by Xiao Ziling, “a Buddhist prince of the Southern Qi dynasty”.[13] Ren Yingqiu describes the event which motivated its establishment: “there was a big flood and millions were affected by the epidemic. Ling Wangxiao 陵王萧… set up a dispensary and took in the sick poor. This was probably China’s earliest private benevolent hospital” (my translation).[14]

12. In 510 CE “Toba Yu, a prince of Northern Wei” established a “government hospital” under the auspices of the Ministry of Imperial Sacrifices (taichangbu). It was intended for poor or destitute suffering from disabling diseases.[15] Ren Yingqiu describes this establishment as “maybe the earliest type of public hospital”.[16]

13. The refuge set up by Xin Gongyi 辛公义.[17] See page 34.

14. Nosokomeia , specifically for the care of the sick developed into late sixth or early seventh-century hospitals like the “Sampson – an institution with a specialized staff of physicians and trained assistants”.[18] See page 32.

15. Christian charitable institutions for orphans, the aged and foundlings.[19] See page 32.

16. There were “400-odd” Hôtels Dieu by the early seventeenth century.[20]

17. Buddhist temples served as hostels for monks, pilgrims, lay travellers, officials and students.[21]

18. State-sponsored welfare.[22] See page 35 ff.

19. Beitian yuan or Beitian fang (Fields of Compassion).[23] See page 34 ff.

20. State-sponsored infirmaries established following the proscription of Buddhism in 845 AD.[24] See page 35 ff.

21.  First Islamic Bimaristan (hospital)at Baghdad at the turn of the ninth century.[25]

22. The first Muslim hospital was not widely emulated in the ninth century and only emerged widely throughout the empire in the 10th century. They were well established in major cities by the 12th century.[26] See page 25 ff.

23. Carlin describes the leper hospitals as “the first and perhaps easiest to distinguish” of the medieval hospitals in England. According to Porter, by early in the thirteenth century there existed some 19,000 leprosaria in Europe. As leprosy declined some of these became hospitals for people with other infectious diseases, the insane or merely indigent. Some were brought into use as quarantine hospitals during the plague of the fourteenth century. Almshouses were by far the most common English medieval welfare institution (67 percent) followed by leper hospitals (31 percent) and refuges for poor pilgrims or travellers (12 percent). Generally, in none of these was medical or nursing care provided. Only 10 percent of the medieval institutions provided any form of medical care, those for the “non-leprous sick poor” and of these less one fifth were devoted exclusively to the sick.[27]

24. In the official history of the Song, futian yuan 幅田院 Blessed Fields  (or Good Fortune Home) are already referred to as the “old system” when discussing the reforms undertaken during the reign of Yingzong 英宗(1064-1068).[28]

25. Huimin yaoju (惠民药局), or charity pharmacieswhich distributed free medicines, particularly during epidemics but at other times for common illnesses, were established at least by the Yuanfeng 元丰reign (1078-1085) when the publication of state-sponsored books of prescriptions was initiated.[29]

26. Anle fang 安乐坊, or peace and happiness ward: set up by “the famous scholar-official” Su Shi (1036-1101) in Hangzhou in 1089”.[30] See page 38 ff.

27. Juyang fa 居养法 , or  ‘Poorhouse System’.[31] See page 38 ff.

28. Anji fang 安济坊, or  ‘Peace and Relief Wards or Hospitals’.[32] See page 39 ff.

29. St Bartholomew’s, London.[33]

30. Pantocrator XenonComplex Byzantine hospital at Constsntinople, Miller’s “first modern hospital”, founded in 1136.[34]

31. Yüan dynasty military hospitals modelled on anle fang.[35]

32. St Maria Nuova established in Florence in 1288.[36] See page 24.

33. Quarantine hospitals: The idea of quarantine, isolation wards and boards of health were developed in the Italian city states in the fourteenth and fifteenth centuries as a response to the bubonic plague.[37]

34. Yüan emperor Chengzong (r.1295-1308) re-established state hospitals.[38]

35. The monastic hospitals, for example, St Thomas, and St. Bartholomew’s were re-established under the auspices of the City of London after a short break following the Reformation and the dissolution of the monasteries. This time they had physicians on the staff so that they could provide specifically for the sick poor. London was an exception to the rest of the country where there were no comparable institutions.[39]

36. Hospitaux Generaux:  Jones describes the duel role of compassion and control in the establishment of these “catch all institutions”, or “hospital-cum-workhouse”, by the French state.[40]

37. The Tongshan hui 同善会, or Society for Sharing Goodness, was the first documented benevolent society. Started in 1590 in Yucheng 虞城, Henan at the instigation of Ming scholar, Yang Dongming (1548-1624) 杨东明 its charter was to build roads and bridges and distribute alms to the poor and needy. The following year Yang led an elite group to establish a second society, the Guangren hui 广仁会, or Society for Spreading Humaneness, in the same city. This time they included medical care for the poor in the charter: effected by the distribution of prescriptions and medicine.[41] Rogaski discusses a similar institution, the Yuli tang, established in Tianjin in 1687.[42]

38. Charitable dispensary set up in a temple by “the late Ming patriot”, Qi Biaojia (1602-1645) in Shaoxing in 1636. Ten physicians worked in six-hour rotating shifts.[43]

39. Shiyao ju 施药局: the first new charitable dispensary of the Qing.[44]

39. Two medical general hospitals in London:  St Bartholomew’s and St Thomas’s.[45]

40. First hospitals in America: Pennsylvania Hospital in 1792 and New York Hospital in 1771.[46]

41. Free Dispensaries, England and Scotland. 1770, Aldersgate Street Dispensary, London.[47]

42. 1802, London Fever Hospital.[48]

43. Puji tang 普济堂. This general clinic and infirmary was formed from the merging of a dispensary and a charitable institution which provided a medical service. The majority of people were treated as outpatients by “Confucian doctors” but those without families who were seriously ill could be accommodated in “a ward at the rear of the building’. In the mid 18th century the Yongzheng 雍正emperor ordered that these be set up all over the country.[49]

44.Specialised hospitals were ‘medicalised’ earlier than general hospitals.[50]

45. Map showing Qing Charitable Institutions with a medical service in the Jiangnan region before 1840.[51]

46. Peter Parker, the “first medical missionary” arrives and sets up a hospital in Canton, 1834.[52]

47. Hospitals played a central role in health care by the 1920s.[53]



[1] See Risse, Mending Bodies, pp.15-38

[2] Miller, Birth of the Hospital, pp. 41-47 ; Temkin, Double Face of Janus, pp. 205-6

[3] Lu Gwei-Djen and Needham, “Origin of Examinations”: pp. 63-4. See also Croizier, Traditional Medicine, pp. 28-9.

[4] See, Croizier, Traditional Medicine, pp.29-30 ; Demieville, Buddhism and Healing, p. 58 ; Wong and Wu Lien-teh, History of Chinese Medicine, pp. 43-4

[5] Risse, Mending Bodies, pp. 38-59.

[6] Scarborough, Roman Medicine, pp. 76-9 ; Thompson and Goldin, The Hospital, pp. 4-6.

[7] Han Shu Ban Gu (32-92). Beijing: Zhonghua shuju, 1975.. See Wong and Wu Lien-teh, History of Chinese Medicine, p. 77 and Needham, Sc. and Civ., vol. 6, p. 54.

[8] Wong and Wu Lien-teh, History of Chinese Medicine, p. 138.

[9] See Granshaw, “The Hospital”, p.1181 ; Miller, Birth of the Hospital, p. 21-2 ; Rosen, “The Hospital: Historical Sociology”, pp. 3-4 ; Temkin, Double Face of Janus, p. 218.

[10] Miller, Birth of the Hospital, pp.20-21 ; Rosen, “The Hospital: Historical Sociology”, pp. 3-4.

[11] Miller, Birth of the Hospital, p. 21.

[12] Wong, “Chinese Hospitals in Ancient Times”: p. 78.

[13] P.Y. Ho and F.P. Lisowski, A Brief History of Chinese Medicine, 2nd Edition (Singapore: World Scientific Publishing Co., 1997), p. 21. See also Needham, Sc. and Civ., vol. 6, p.54.

[14] Ren Yingqiu, “Yiyuande”: p. 19.

[15] Zhen Zhiya, “Zhongguo gudaide yiyuan”: p. 55 ; Ho and Lisowski, Brief History, p. 19 and Needham, Sc. and Civ., vol. 6, p. 54.

[16] Ren Yingqiu, “Yiyuande”: p. 19.

[17] Wong and Wu Lien-teh, History of Chinese Medicine, p. 137. See also Needham, Sc. and Civ., vol. 6, p. 54

[18] Miller, Birth of the Hospital, p. 23, 25-7.

[19] Ibid, pp. 24-5.

[20] Jones, Charitable Imperative, p. 10.

[21] See Ch’en, Buddhism in China, pp. 263-4.

[22] Ch’en, Chinese Transformation, p. 297

[23] Demieville, Buddhism and Healing, pp. 58-60 ; Leung, “Organized Medicine”: p. 135 ; Scogin, “Poor Relief”: p. 3 ; Wong and Wu Lien-teh, History of Chinese Medicine, p. 139.

[24] Scogin, “Poor Relief”: p.31 ; Wong and Wu Lien-teh, History of Chinese Medicine, p. 139; and Demieville, Buddhism and Healing, pp. 59-60.

[25] Dols, “Origins of the Islamic Hospital”: pp. 382-4 and Risse, Mending Bodies, pp. 125-29.

[26] Dols, “Origins of the Islamic Hospital”: p. 388.

[27] Carlin, “Medieval English Hospitals”, pp. 23-5.

[28] Scogin, “Poor Relief”: p. 31.

[29]  Leung, “Organized Medicine”: pp. 136-37.

[30] Ibid: p.136; Scogin, “Poor Relief”; Wong and Wu Lien-teh, History of Chinese Medicine, p. 139.

[31] Scogin, “Poor Relief”: pp. 32-3.

[32] Ibid: pp. 34-5.

[33] Porter, Cambridge Illustrated History, p. 212.

[34] See Miller, Birth of the Hospital, pp. 11-29 ; Rosen, “The Hospital: Historical Sociology”, pp. 12-29; Risse, Mending Bodies, pp. 125-130.

[35] Zhen Zhiya, “Zhongguo gudaide yiyuan”: p. 56.

[36] See Henderson, “Hospitals of Florence”, pp. 70-1; Granshaw, “The Hospital”, pp.1183-4 ; Porter, Greatest Benefit, p. 211.

[37] See Benedict, “Policing the Sick”: p. 62 and Dorothy Porter, “Public Health” in Companion Encyclopedia of the History of Medicine, ed. W.F. Bynum and Roy Porter (London: Routledge, 1993), p. 1232.

[38] Yuan shi Song Lian (1310-1381). Beijing: Zhonghua shuju, 1976. speaks of appointing doctors and setting up the old huimimyaoju to distribute medicine to the widowed and poor who are sick.  The use of the word “hospital” is K.C. Wong’s (unsourced) interpretation. Wong, “Chinese Hospitals in Ancient Times”: p. 80.

[39] Granshaw, “The Hospital”, p. 1184.

[40] Jones, Charitable Imperative, pp. 39-41.

[41] Handlin-Smith, “Benevolent Societies”: p. 311 ; Leung, “Organized Medicine”: p. 145.

[42] Rogaski, “From Protecting Life”, pp. 82-3.

[43] For details of this and similar establishments, see Leung, “Organized Medicine”: pp.145-46.

[44] Ibid: p. 146.

[45] Granshaw, “The Hospital”, p. 1184.

[46] Rosenberg, The Care of Strangers, pp. 18-22 and Bordley and Harvey, Two Centuries of American Medicine, p. 57.

[47] See Cherry, Medical Services, p. 42 ; Granshaw, “The Hospital”, pp. 1188-89.

[48] Freidson, ed., The Hospital in Modern Society, p. 21.

[49] Leung, “Organized Medicine”: pp. 147-48..

[50] Granshaw, “The Hospital”, pp. 1189-91.

[51] Leung, “Organized Medicine”: p. 148.

[52] See “Peter Parker : Bodies or Souls” in Jonathon Spence, To Change China: Western Advisers in China 1620 – 1960 (London: Penguin Books, 1969), pp. 34-56.

[53] Granshaw, “The Hospital”, p. 1195-6.