Development Of Hospitals As Institution Of Medicine And Health Care

Hrishikesh Vinayak Mokashi

Development
of Hospitals has a very long History that is attached to it. Hospitals have
been the epitome of the medical and the surgical knowledge of humans through
the entire history of our development. The knowledge of Medicine and Surgery
date back the beginning of Human civilization. The presence of Hospitals in
some form of the other has been recorded by our ancestors.

Medicine and Surgery
date back to the beginnings of our History because the diseases were very much
prevalent on Earth before the advent of Humans. Earlier medical treatment was
always identified with complex religious services and ceremonies. The priests
were also the physicians or people of medicine that were said to minister our
spirit, mind and body. These priests/doctors were a part of a highly respected
ruling class who definitely had a strong influence on the political machinery
of that state. The Temple/Hospitals became the meeting places as was found out
in the religious scriptures of Katyl huyuk in ancient Sumerian civilization.
Later the roles of Priest/Doctor and that of the temples as the house of the
sick and infirm and also as training schools for Doctors became closely
associated with the level of the political development of the civilization. The
sophistication in the Health care system also became an tool for the political
propaganda used to describe the superiority of the civilization as was seen in
ancient Greek empire. The pagan Greek temples of

Sparta
and Ragus served a political role by
clearly describing the superiority of the city states in Medicinal facilities
that it provided. This clearly lead to the destruction of these temples when
the Christian Emperor Constantine closed down the Aesculapia. The same trend of
political motivation was also seen in the rising and expansion of Islamic rule
in Middle-eastern Asia and also in
Europe
. The
use of Medicine and Hospitals as a tool for expanding political agenda was also
witnessed 20th century when
Cuba
manipulated its Health statistics which lead to an overwhelming political
success and to the formation of first Communist nation in
North
America.

The developmental history
of Hospitals in human civilizations was a very slow and circumstantial process
that took about 3000-5000 years to develop to the present times. The
developmental process is discussed on the basis of the various civilization
that were seen in our history……

Mesopotamian Civlization

Medicine as an organized
and separately identifiable entity came to be known for the firstt time about
4000 years ago in the ancient region on Southwest Asia which is known as
Mesopotamia, between the majestic Tigris and Euphrates river banks which is
geographically present between modern day

Iraq

and

Iran

.

The Civilization of
Mesopotamia can be traced back to a group of people living in southern

Mesopotamia

called the Sumerians. By 3500 BC the
Sumerians developed their own successful pictographic language which no other
civilization had yet developed. The process of building temples began at an
monumental scale. But it is believed that the true form of the civilization
developed somewhere around 3100 BC with the development of Cuniform system of
writing. The clay tablets that were written in Cuniform system of writing are
the actual sources of information available to the scholars regarding the
development of Medicine and Hospital in ancient

Mesopotamia

.
Most of the clay tablets that mention Medical practice came from the Library of
Asshurbanipal, the Great king of Assriya. The Library was housed at the King’s
palace at

Nineveh

.
The Diagnostic treatise in the form of clay tablets organized  the Medical knowledge
they possessed from
head to toe with several sub-sections that were related to Convulsive
disorders, Gynaecology and Paediatrics.

It has also been
discovered that there were two types of Medical practicioners in Ancient
Mesopotamia viz. The “Ashipu” &  The
“Asu”. The “Ashipu” were often called as “Sorcerers” in older Mesopotamian
records. Their main function was to find the cause of the disease a person was
suffering from. The “Asu” were the “Healers” who were specialist in Herbal
medicine and in older treatment methods of Mesopotamian medicine. They were
frequently called “Physicians” because they dealt in empirical application of
Medicine.

The first recorded
prescription from a doctor came from

Sumer

,
in ancient

Babylonia
under the rule of
Hammurabi {1728-1686 BC}.  Hammurabi’s
code of laws provides the first record of the regulation of doctors’ practices,
as well as the regulation of their fees. The hospitals that were excavated in

Sumer

had a distinct presence of proper drainage system which clearly describes the
hygienic conditions in which the cities were maintained by the Mesopotamian
people.

Greek Civilization

The Greek civilization
for a very long time enjoyed the benefits of cross fertilization of ideas along
with the ideas of the numerous other people like the Egyptians, Persians and
also the Indians. For ancient Greeks, health was a state of balance among four
bodily humours viz: Blood, Phelgem, Yellow bile and Black bile. According to
them illnesses occurred when humoral balance was upset either by lack of proper
nourishment or by imperfect production, circulation and elimination of bodily
humors. The greek physicians goal was to restore and maintain the balance in
the humors.

Even though the diesases were cured either by magic
or by some religious ceremonies, the Greeks knew the Anatomy and Physiology of
Human body more tentatively than any other civilization. The goal of curing of
the diseases were done in Temples of Greek gods such as Hades, Athena etc. The
temples of Saturn, Hygeia and Aesculapius, the Greek god of Medicine served
both as the center of treatment and resting place for patients under
observation and treatment and also as the medical schools for practitioners.

Indian Civilization

Historical records
clearly indicate the presence of very efficient hospitals constructed in

India
by the
beginning of 600 BC. During the golden reign of  the Maurya and Gupta Kings.
Under the rule of King Ashoka {273-232 BC},
Indian hospitals started to look more like the modern hospitals. The principles
of Sanitation and Drainage system were clearly followed in these hospitals.
Surgical cesarean sections were performed with close attention with an
intention to save both the mother and the infant. Physicians were appointed one
every ten villages to serve the health care needs of the residing population.
Along with the basic health needs, regional hospitals for the infirm and the
destitute were also built along this period.

A few religious and
charitable endowments in

South India

developed
Medical schools with attached Hospitals. Such Hospitals were called as “Veera
Solan”. An edict dated 1097 AD of Veera Chola Maharaj of the Chola Dynasty
refers to the presence of an sixteen hundred bedded hospital for the students
of the Medical schools attached to the Temple at Tirumakundal at the present
Chingleput district in Karnataka. Ruins of Hospital at Mahintale near
Anuradhpura in Sri-Lanka are also found. It is believed that it was constructed
by Mahendra, Son of Ashoka. Emperor Akbar of the medieval Mughal Dynasty in the
16

^th

century built a large Hospital at Fatehpur Sikri.

The concept of Modern
Medicine was introduced in

India

by the Portuguese in the 16

^th

century. In 1510,

Albuquerque

built a

Royal

Hospital

in

Goa

. While the English established a

Millitary

Hospital

in

Madras

in
1664 which later in 1740 was declared to be an civilian hospital.

The first Hospital in the

Bombay

presidency was opened in 1676. Later the J.J.Hospital founded in 1843 began
functioning in May 1845. The Hospital was named after Sir. Jamshetjee Jejeebhoy
who provided the requsite donation to build the hospital along with it’s Grant
Medical College, responsible for introducing Modern Allopathy in Western India.
The idea of starting such an institution was promoted by Robert Grant, The then
Governor of Bombay presidency.

By the turn of the
century seeing that the English preferred less qualified British doctors
against the competent Indian physicians, Indian nationalists decided to build
Hospitals where Indian Doctors could treat the patients, leading to the
formation of

King

Edward

VII

Memorial

Hospital

(

KEM

Hospital

) in 1926. Famous Physicians
such as Jivraj.N.Mehta and R.N.Vakil, Surgeons such as R.N.Cooper, A.V.Baliga
and P.K.Sen and Pathologists such as V.R.Khanolkar were associated with the
majestic

KEM

Hospital

. The Tata group of Industries
built, The Tata Memorial Hospital in 1941 and Cancer Research Institute in 1952
with an intention of providing Cancer treatment to patients in

India

.
Another Institution of high repute is the AIIMS (All India Institute of Medical
Sciences) in

New Delhi

which was started in 1956 with the intention of development of excellence in
all aspects of Health-Care which includes under-graduate and post-graduate
teaching, training, research and experimentation. The first Heart transplant in

India

was performed in AIIMS by P.K.Venugopal in 1994.

But the best known

Indian

Hospital

all over the world is the

Christian

Medical

College

in

Vellore

. It
is a 1500 bed Hospital located at a distance of 130 km from

Madras

in

South India

. It was basically started as a
Medical school for women in 1918, but started admitting men right from 1947.

Roman Civilization

The Roman talent for
organization did not readily extend to the care of the sick and the injured,
although infirminaries for the sick slaves were established. The system of
Hospitalization was developed among the millitary legions. The injured
Legionaries were cared for in the field tents that were built during war times.
The soliders were then moved into "valetudinaries", which were a form
of hospitals that were errected in all the major garrisions along the frontiers
of
Roman empire                     

These structures of wood
and stone were apparently carefully planned and were stocked with instruments,
supplies and medications. The decree of Emperor Constantine in 335 AD closed
the Greek Aesculapia and stimulated the building of modern Roman hospitals for
the civilians living inside the frontiers of the empire. But it was not until
369AD that the wealthy Romans started to build hospitals from the Justinians to
the benefactress, Fabiola who built a hospital in 394 AD at

Constantine

.

Islamic Civilization

The 7th century witnessed
the new evangelical religion, Islam which began to preserve the classical
learning to a large extent and which it later yeilded to the European world.
The Islamic civilization greatly influenced the development of Hospitals by
creating secular institutions which were completely devoted to the care of
sick. These institutions were called “Bimaristans” (House for the sick).                                                                      

The roman millitary
hospitals and the few Christian hospitals built before were absolutely no match
against the number, organization and the excellence the “Bimaristans” provided.
The first of such institution was established in

Baghdad

in 803 AD by Ibn Barmak, the wazir of
Caliph Harun-al-rashid. The inspiration behind the Arab medicine largely came
from the persian hospital in Djoundisabour present in 6th century Ottoman

persia

{Modern day

Turkey

}.

Many of the pioneers of
Arab medicine studied medicine there, returned to there homes and founded
similar institutions that were remarkably well organised for their times. But
unlike the Christian “infirmariums” or “nosokomeias”, Bimaristans were private
hospitals which symbolised the royal prestige, wealth and charity.                                            

The selected patients
came from all the sectors of population which also included mentally sick
people. These hospitals were operated by well-educated medicinal staff,
pharmacists, alchemists and servants. They provided comprehensive medical care
which was not seen in any other part of the world yet. Some of the best Arabic
hospitals were present in

Damascus

and

Cairo

along with the one present in

Baghdad

. The hospital and the medical school
at

Damascus

was
reputed in the Arab world for it’s elegant rooms, extensive medical libraries
and also for it’s fine cusine meant of it’s patients. The Arabic Hospitals had
separate wards which were set aside for different diseases such as for the Eye,
Diarrhoea, Wounds and Gynaecological condotions. Covalescing patients were
seperated from the sicker patients and provisions were also made for the
abulatory patients. In the medical school clinical reports of the cases were
collected and were used for teaching purposes.

The Middle Ages

The hospitals that were
seen in middle ages were opened in response to the repeated attacks of deadly
plague that struck

Europe
between 1348-1350.
It caused a pandemonium in the northern Italian city states. In this period
hospitals were completely managed by various religious communities.The rational
non-religious approach that characterized the Greek medicine was lost as the
hospitals became ecclesiastical in nature and not mere medical
institutions.                                                                                                               

The growing burden of diseases
that were spreading in Europe in the Middle ages lead to the emergence of
various communities which principally laid the foundation of Institutionalized
hospitals in

Europe

. The Knights of St.John,
The Teutonic Knights and the Augustinian Brotherhood were some of these
communities. Only the hopeless and homeless found their way to these hospitals
in which the system of seperation of patients was eliminated by accomodating
three to five patients on each bed while the principles of sanitation were completely
ignored. Surgical procedures were avoided with only the exception of
amputation, in order not to “disturb the body”. The religious orders emphasized
on nursing care. Yet during these period the process of construction of
hospitals gained mommentum in

Europe

.           

The oldest hospital from
this period and still in existence is the”Hotel-Dieu” in Lyons and

Paris

,

France
.
The term “Hotel-Dieu” indicates that the hospital was a public hospital. The
earliest mentions of this hospital is found in a manuscript dated 580 AD in
which it’s establishment by Childbert is clearly mentioned. The “Hotel-Dieu” of

Paris
was
founded by Bishop Landry in 660 AD. At the beginning of 12th century the
hospital had an attending staff of physicians and surgeons capable of handling
about 800-900 patients, the capacity which was doubled in the 15th century. By
17th century the hospital had been enlarged to two buildings linked to each
other by an Pount au Double. In about 1880 the buildings were replaced by the
present “Hotel-Dieu”.                                                                                                                        

The St.Bartholomew’s
hospital established in

london

in 1123 was attached to the Augustinian priory of (Great) St.Bartholomew. Both
the church and the Hospital still exist but the hospital was rebuilt between
1730-1759. The

of

Santo

spirito was built in

Rome

in 1204 by Pope Innocent III. By 1447
the capacity of the hospital was increased to 360 beds and also utilised a system
of streacher-ambulances. The hospital survived upto 1922 when it was destroyed
by a fire, but was later rebuilt. The development of hospitals in

Germany

occurred between 13th and 14th century
through the activities of Order of the Holy Ghost, while in

Belgium

the still-active

hospital

of

St.John

was established in the 12th century.                                                              

During these period in
order to enforce the requirements of public health, “Quarrentanaria”-designed
to protect the healthy elite from the ravages of the diseases by isolating the
diseased individuals were constructed.

Venice

and

Ragusa

were first city-states in

Italy

to build
these structures for isolating the diseased population. Leprosy was widely
prevalent in the 12th century

Europe

and
nearly half million of the European population was severly inflicted by it.
Hence in order to isolate these diseased individuals nearly 20,000
“Quarrentinaria” shelters were built. The onslaught of plague in 1348 forced
the local authorities to  set up
quarrentine stations and pest houses in order to isolate suspected plague
harbourers.                                                                

Spurred by the Islamic
rule and the Crusades construction of efficient hospitals in Asia and

Africa

gained mommentum. These hospital system enforced
strict sanitary measures, performed surgical procedure and seperated the
patients according to the disease. During the period of Crusades (1096-1270),
the religious orders whoose principal duty was taking care of the sick built
several hospitals in the Mediterranean area. The most famous of these was the
one built by Knights of St.John in

Jerusalem

.
Because of the need of the treatment of casualties of combat, large hospitals
with capacity of 2000 beds were built.

Renaissance Period Hospitals

This period witnessed the
re-birth of the healing arts which were characterised by scientific and
rational approach. The academic world of

Northern Italy

became tolerant to new cosmopolitian ideas. The period of Renaissance did not
witness the consturction of majestic hospitals but witnessed the increase in
the knowledge related to the Human Anatomy. The Royal College of Surgeons was
established in 1506 in

England

followed by the organization of Royal College of Physicians in 1528. The major
contribution to the development of Hospitals in this period was the improved
management of hospitals by segregating the patients according to their disease
and also the higher quality of medicine provided within the hospital. It was in
this period only that great strides were taken in developing Clinical surgery
not only in

Italy

but also
in

France
.
Epidemic diseases such as Cholera, 
sweating sickness and Leprosy almost ceased to exist.

During the English
reformation period from 1536-1539 all the hospitals affiliated with the
Catholic church were plundered following the orders of King Henry VIII and were
ordered to be converted to secular use or be destroyed, due to this many
hospitals in the countryside of England were forced to closed down and remain
closed for almost 200 years. Only the reputed large hospital institutions in

London

survived when the
citizens petitioned the King to endow St.Bartholomew, St.Thomas and St.Mary of
Bethlehem which was the first instance of secular support to the hospitals.

Hospitals On The American Continent

The first hospitals in
the new world were built in the colonies establised by

Spain

,
France

and

England.
The hospitals that were built under the flag of Catholic Spain and France
retained their Jesuits ideas, the Sisters of Charity and the Augustinian
Sisters along with their massive knowledge in Medicine and Hospitals. However
the hospitals that were built in the English colonies, reacted against the
English traditions.                                                                

The first hospital in the
new world was constructed by Bartolome de las Casas, one of the priest who
accompanied Columbus on his first voyage to the America, after founding the
village of La Isabela in Hispaniola (Present Santa Domingo) in January 1494.
Documentary evidence also indicates the building of a hospital in St.Nicolas of
Bari by mid-1494. In

Mexico

,
Hermann Cortez errected the Immaculate Conception Hospital in

Mexico city

in 1524 which is still active.
While the French constructed their first hospital, “The Hotel Dieu du Precieux
sanz” founded by “Duchess d'Aquilon” in

Quebec

,

Canada

in 1639, while “The Hotel Dieu de St.Joseph”
was founded in

Montreal

in 1644.

The oldest hospital in
the English colonies was a small almshouse for the poor that was supported by
the church in the city of

New
Amsterdam

. This house and a tiny hospital established
by West Indian Company in 1658 eventually combined and grew into the

majectic

City

Hospital

of

Bellevue

in

New-York

City

. The 18th century Hospitals exept
for the New Amsterdam Hospital and the one constructed in New Orleans by the
Catholic Church in 1720 departed from the charitable and the religious spirit
of the Old world hospitals by following the model of the Pennsylvania Hospital
founded in 1751 and started charging fees for their services. The

New-York

Hospital

, breaking the tradition founded
the Society of New-York Hospital in 1771 and obtained a grant to build it. The
New-York Infirmary for Women and Children was opened in 1853 and was entirely
managed by women. It was founded by the first women who earned a Medical degree
in

United States
,
Elizabeth Blackwell and her sister.                                                                                           

In accordance to the
United States Marines Hospital Service Act passed in 1798 the first Marine
hospital was built in

Norfolk

,

Virginia

in 1802 while another one was built in the same year in

Boston
, Masachusetts. In the following year
another Marine hospital was built in
Newport

,

Rhode Island

and by 1861 there
were about 30 Marine hospitals. The first Psychiatric hospital in United States
was built in Williamsburg, Virginia in 1773 which led to the large-scale
construction of state physhiatric hospitals which by 1950's had reached to the
total of 557 Hospitals with 6,28,300 beds.

Hospitals In Seventeenth, Eighteenth And Nineteenth Century

The Seventeenth century
was the age of Scientific revolution, a major turning point in the history of
Hospitals and Medicine. In 1661, a book published in

England
's Natural and Political
Observations and which was based upon the Bill of Mortality by John Gaunt,
presented for the first time that a large population was an asset to a country
and that public health mesures were a necessity. The book advocated certain
measures emphasizing on public health measures such as seperate hospitals for
plague victims and specialized maternity hospitals. However these measure were
far too advanced fat the seventeenth century thinking and were obviously
ignored.                                       

In Seventeenth century,
hospitals were constructed in the new occupied lands and colonies in the

Americas

. The
old hospitals in Europe were either slumbering under the maternal care of the
church as in

Italy

or were
passing into the control of national or municipal governments as in

France

and

Germany

. New hospitals were being
founded by an enlightened crown as in

Denmark

,

Germany

and

Austria

. The
Eighteenth century witnessed partial revival in the construction of hospitals
in

England

.
A movement was started to build a hospital in every parish by 1732, whcih
resulted in the construction of 115 hospitals by the parishioners the best
known of them being the

St.Peters

Hospital

in
Bristol

.                                                    
                            

At about the same time
philanthropists such as Thomas Guy founded hospitals for both charity and
paying patients including the Guy's Hospital in 1724, St.George's Hospital in
1733 and The Great London Hospital in 1740. William Tuke (1732-1822), another
philanthropist founded the York Retreat for Humane Care of Mentally ill.                                                                          

The discovery of
vaccination was a key medical acheivement of the eighthteenth century. Lady
Mary Wortley Montagu(1689-1762) brought to

England

the Asian technique of variolation which she observed in

Turkey

. Not only was eighteenth
century the period of mass construction of new hospitals but also a period of
consolidation and systematization of Medicine.

The Nineteenth Century is
the keystone in the history of Hospitals and is considered as the period of the
beginning of Modern Medicine. The building of factories and expansion of cities
during the Industrial Revolution(1790-1825) period demanded effecient Hospital
functioning because the spread of epidemic diseases was a danger to all the
segents of the population, which in turn acclerated the rate of construction of
Hospitals. The legacy of Florence of Nightingale may be the greatest
contribution of the nineteenth century to the evolution of hospitals.                                               
                                               

The introduction of
professional nursing services provided kindly treatment and emphasized the need
for clean enviornment, a giant step forward in the institutional treatment
protocol. Due to many inventions and discoveries such as the discovery of
Bacteria as an disease causing agent as discovered by Louis Pasteur(1822-1895),
discovey of anasthetic agents such as Ether, Nitrous oxide and Cholorform and
development of steam steralization technique in 1886 enabled the development of
modern hospitals. It is belived that Dr.Clariford.W.Long (1815-1878) of

Georgia

was the
first surgeon to perform minor operations using sulphuric ether as an
anasthetic agent in 1842. The discovery of X-rays by Wilhelm Konrad Rontgen(1845-1923)
lead to further development in the the Medicinal techniques.                                            

Hospitals were now
nolonger a place for the sick and homeless but rather a special place where
treatment and  exact diagnosis aided by
modern technology was possible. At the same time the cost of hospital care
increased dramatically and hospitals came to be placed in direct competition
with private practitioners who usually could afford the costly equipment. The
American Medical Association was founded in 1847 under the leadership of
Dr.Nathan.Smith.Davis(1817-1907). In 1864, 16 nations signed a treaty
establishing the International Red Cross Society, specifying regulations for
the treatment of wounded soilders and civilians and included the provision that
all hospitals-millitary and civillian were to be neutral territories. Another
landmark of the nineteenth century was the final acceptance of women as
full-fledged medical practitioners.                                                       
                       

The next logical step in
the development of medicine was specialization which was also acheived by the
end of nineteenth century and beginning of twentieth century. Due to
specialization in medicine many hospitals were constructed in

United States

in a relatively short period of time.

Mercy

Hospital-

Chicago

in 1852,

Cook

County

Hospital

in 1863,

St.Luke

Hospital

in 1864,

Chicago

Hospital

for Women in 1856, The Jewish
Hospital in 1868. In

New-York

City-Roosevelt

Hospital

in 1871, The

Presbysterian

Hospital

in 1872 and The

Cancer

Hospital

in 1886. In

Baltimore

,

John

Hopkins

Hospital

in 1889. By the
end of the century there were 149 specialized hospitals in

United States

with bed-capacity of
35,000.

Modern Hospitals And Health Services

The ideal modern hospital
is a place where ailing people seek and receive care and where clinical
education is provided to the medical students, nurses and virtually the whole
spectrum of health professionals.                                          

It provides continuing
education for the practising physicians and increasingly serves the function of
an institution of higher learning for the entire neighbourhoods, comunities and
regions. In addition to it's educational role the modern hospitals conduct
investigations studies and research in medical sciences both from clinical
records form it's patients as well as basic research in various branches of
Medicine and allied feilds.                                  

In


United States


the construction of
modern hospitals is regulated or influenced by Federal laws, State health
department regulations, city ordinances, the standards of Joint Commision on
Accreditation of Healthcare Organizations, and national and local
codes(Building maintainence, Fire protection, Sanitation etc). These
requirements safeguard patient's privacy and the safety and well-being of
patients and staff and controls cross-infections. The concept of Wards, once
popular in the nineteenth century is now no longer permissible and today's hospitals
mainly have semiprivate and private rooms. Although permisible in most of the
American states four bedrooms are seldom planned. The changing emphasis from
inpatient to outpatient service and rapid advances in medical technology have
recently focussed on facility planning activities on medical and ancilliary
expansion and freestanding outpatient centres. Developing seperate or
freestanding outpatient centres has allowed the modern hospitals to minimize
the financial impact of restrictive hospital building codes and regulations.
However rapid expansion of non-hospital based and independent ambulatory care
facilities slowed substantially in the beginning of late 1980's as a result of
changes in reimbursement deteriorating rates of reimbursement, and an overall
decline in the American economy. Hospital failures increased as did the bed
closing rate. In addition there was an increase in Federal and State
anti-kickback and safe harbour regulations that dampened the enthusiasm for the
joint ventures for non-hospital based facilities. The early period of  1990's
and beyond place today's modern
hospitals in the position of being only one of 
the component in the evolution of an virtually integrated hospital and
other allied networks. The concept of Inpatient care has progressively
diminished with continued advances in Medicine; and the hospitals are likely to
downsize. Simultaneously ambulatory services and doctors' office care
facilities will increase. The hospitals, when particularly compared with it's
earliest days of existence will definately play a very different role in the
future as a part of an integrated collection of medical service providers and
sites of care.

Summary

The Institution of
Hospitals as centres of Medicine has certainly evolved to a great extent
through the ages. These Institutins witnessed many aspects of Human History
including the majestic achievements and also the drastic failures which in
totality framed the modern Human civilization. In all the ages Hospitals stood
by as a majestic colossus and developed in centres par excellence providing
Medical care. It if for this reason only that their value in shaping the
destiny of Human civilization cannot be replaced.

1.)Cambridge
History of Ancient Medicine and Tropical Diseases; Dr. Richard Mason; Cambridge
University Press; 2002; Page No- B2566- B2785

2.)History
of Women’s Medical College, Philadelphia, Pennsylvania; Alsop G.F Oxford
Publications; 1950; Page No- L1841-1898

3.)Men
& Memorabilla of
Grant

Medical

College

and

J.J

Hospital

;
Talwalkar N.G; University Press;

Bombay
;
1995; Page no- 25-78

4.)Hospitals-Design
and Development; Delon.G.L, Prokosch.H.U, et al; Penguin Publications; 1986;
Page no-21-57

5.)Hospitals
and Health care Facilities Development; Robert. Reid, Konrad.G.C, et al;
University Press;

Montreal
;
1990; Page no-149-256

6.)A
History Of
India

;
Romila Thapar; Penguin Books; 2000; Page No-187-198

7.)Pictoral
History of Medicine; Brettman.O.L,
Thomas.Charles.C
,

Illinois

,

USA

;
1956; Page no-23-41

8.)A
History of Medicine; Mettler.Cecila.C, et al; The Blackstone Company;
Philadelphia, Toronto; 1947; Page no-105-126

9.)History
of Medicine with special reference to the Orient; Maj.Gen Bhatia.S.L;
Management Committee, Office of Medical Council of India; New Delhi; Page
no-A10-A167.

About Authors:

Hrishikesh Vinayak Mokashi

Mrs. R N Joshi

Dr. S R Parakh