The Hospital of the Future

Flashback

The Power of Words

What’s a hospital? This is a seemingly simple question for anyone who spends half of his or her life working in such a place. But the answer actually isn’t so easy. In this issue of The Hospitalist we introduce this section “Flashback.” To savor our medical world and to concoct a recipe for the future, knowledge of the past is a key ingredient. After all, a chef can make a stew, but without the bay leaf it’s just meat and vegetables. We hope that this historic section adds that spice.—Eds

Much of our medical terminology comes from Latin and Greek roots. Terms like iatrogenic and nosocomial are all familiar. This month, we explore these words.

In ancient Greece, the Temples of Aesculapius were places of healing. There are many versions of the origin of Aesculapius. Apollo, son of Zeus, could cause plagues by shooting arrows. When not driving his chariot of fire across the sky, he impregnated a nymph named Coronis. Her unfaithfulness led to her murder by Apollo or his sister, Artemis, who then placed Coronis on a burning pyre. At the last moment Apollo—regretting the deed—cut the baby, Aesculapius, from the body of Coronis. Aesculapius was raised by a centaur named Chiron (namesake of the company which recently produced unusable influenza vaccine) and instructed in the art of medicine. His two daughters, Hygeia and Panacea (familiar sounding names in their own right), assisted him.

The iatros was the classic Greek physician, epitomized by Hippocrates. The term iatros is the root of many modern words, such as psychiatry and pediatrics. The iatroi began as lay practitioners in the temples of Aesculapius, but eventually shifted from a religious role to a professional one.

In the age of Pericles (mid-fifth-century BC) the physician might receive a fixed annual fee—in essence, Hellenic managed care. The bed-bound sick patient was generally cared for at home.

Now shift half a millennium forward to Constantinople (present-day Istanbul, Turkey), established in 330 AD. This city’s shrines were dedicated to Christian martyrs, such as Saint Cosmos and Saint Damian, who were known for their healing powers and for helping the infirm. In 420 a shelter—called a nosokomion—was erected; it was dedicated to the care of the sick and poor. Thirty years later another nosokomion was built in Constantinople to care for lepers. After 499 when the bubonic plague decimated the city, its Great Church of Hagia Sophia was pressed into duty as an infirmary. Caring for the sick became institutionalized when the Egyptian and Jewish models of social welfare for marginalized groups were adopted into the Christian model. “I was a stranger and you took me in; naked and you covered me; sick and you visited me,” wrote St. Matthew. The age of the hospital had begun.

Language has power, and the words we use have meaning. The next time you see an iatrogenic illness or a nosocomial infection, think about Panacea and her sister Hygeia.

—Jamie Newman, MD