1 Introduction
The 11th century was a period in which China experienced a great increase in its population along with an increase in trade volume and urbanization. Concurrently, the Song dynasty also experienced a rise in the frequency of epidemics as well as two major wars with the Western Xia and Liao dynasties during the 1000s and 1040s.1,2 The consequences of these changes were exacerbated by the increased geographical mobility of certain social groups in Song China, such as traders, students, and examinees attending the civil service examinations. Thus, casualties of wars, epidemics, or disease, especially people whose families were far away and could not care for them were left without care and “their corpses often lay bare along the roads (死者暴露于道).”3 This new social environment created a need for general relief in the form of shelters and hospitals. This article discusses how the Song government, especially during the reign of emperor Huizong (宋徽宗), established an innovative public health system to replace the Buddhist monasteries system that was in place from the Tang dynasty till the mid-11th century.
The studies on the history of public health as an organized governmental activity in the West often begin with the Renaissance. Despite this, isolation as a means of protection from epidemics actually began in Italy in the 14th century, when a number of city-states introduced quarantine to protect themselves against the major epidemic of bubonic plague that began in 1346, commonly known as the Black Death.4 This initiative, however, did not involve public sanitation or therapy. It seems that in China the systematization of public health may have occurred during an even earlier era.
This article traces the establishment of the first public health system in China, which began during the second half of the 11th century but could not have fully materialized without the patronage of the Northern Song dynasty emperor Huizong (r. 1101–1026). Moreover, this public health system was only part of a large-scale reform Huizong implemented in the field of medicine (Note 1).5 The article depicts the background, the organization, and the functions of the system. It also discusses the conditions and reasons that gave rise to such a unique undertaking by a 12th century government in China.
The public health system included poorhouses, public hospitals, and pauper’s cemeteries. The first of the three was more of a charity organization, whereas the latter two promoted public health by providing medical services for the poor and burial for the indigent as well as for travelers from far places with no family to care for them. The rationale behind these institutions was likely twofold. On the one hand, they constituted an attempt to provide relief for the poor and to get them off the streets. On the other hand, it seems that Huizong’s deep concern with and understanding of medicine propelled him to use his imperial authority to design and implement a public health system oriented to prevent contagion and outbreak of epidemics.6,7
2 Public health prior to Huizong’s reign
The earliest mention of hospices with dispensaries dates back to the Southern Qi dynasty (late 5th century CE). The first reference to a government hospital dates slightly later to the Northern Wei dynasty (early 6th century).8 During the Tang dynasty (618–907), both religious institutions and the government were involved in poor relief and public health operations, but neither was systematically organized. The earliest relief institutions of the Song dynasty (960–1276) operated on a small scale and were essentially a continuation of Tang dynasty practices but under a new name, the Blessed Field Houses (福田院).9,10
Poor relief underwent a major change during the late Northern Song dynasty (960–1127). It was transformed from a mostly private and often religious endeavor, into one in which the government played an ever-increasing role. The Song government continued to provide disaster relief, but in addition established relief institutions that functioned on a regular basis and not solely during catastrophes.9
3 The changing epidemiological environment during the Northern Song
Why did concern over what we term today as public health become a political issue during the Song dynasty? A number of factors consolidated to change the making of Chinese society during the Northern Song dynasty. One of the most striking changes is the stark increase in population. During this era the population doubled from a peak of around 50 to 60 million during the Tang dynasty to around 100 to 120 million during the turn of the 12th century.11,12 This was not only a change in magnitude, but also of location. During the Northern Song, China’s population balance shifted dramatically from the north—the traditional heartland of Chinese civilization—to the south.13–15 By the end of the dynasty over 60% of the population lived in the south, a significant increase from approximately 40 percent during the Tang. The concentration of population and economic strength, away from the political center of gravity, stimulated the first significant large-scale long-distance trade in Chinese history.
The expanding trade and the sheer increase of population created a major social change. The Northern Song dynasty experienced an unprecedented growth of cities, in essence creating the first large-scale cities of nonpolitical character, as well as a multiplication of smaller market-centers in the countryside. It has been argued that the level of urbanization reached in the Song dynasty was, probably, never exceeded in later Chinese history.16 Moreover, scholars claim that the development of the cities and the market-centers was an orderly process resulting in hierarchical and differential urban centers graded by size and specific marketing functions.17,18 These changes created great wealth for some but also abundant poverty that concentrated mainly in the urban centers. Furthermore, the increase in population especially in the south, the increase in urbanization, and the increase in long-distance trade volume facilitated the spread of epidemics.19 Nevertheless, all these changes did not prompt the government to take large-scale actions designed to enhance public health until the end of the 11th century.
4 The public health system during Huizong’s reign
During Huizong’s reign, more precisely during the first 4 years of his rule (A.D. 1101–1104), the government instituted a new system for poor relief, entitled the Poorhouse System (居养法, literally the Reside and Support System) (Note 2). This Poorhouse System was much more than a simple charity organization. It was likely designed to function as an elaborate public health system, to care for the homeless, sick, and family-less dead. The first question that comes to mind is whether this was indeed a comprehensive system or just a set of disjointed projects. In two edicts, dating to 1106 and 1112, Huizong provides us with his perception of how these institutions function as parts of a complete system:
“At the present widows and widowers, the orphaned, and sole survivors, all have the Poorhouse System. [The state] uses it to aid the poor. But, what if they are sick and have no medicine or doctor? To solve this we established the Peace and Relief Hospitals. To deal with poor men who die and have no [means of] burial, we established the Pauper’s Cemetery. My mind is deeply with the people.” 20
“今鳏寡孤独。既有居养之法。以厚穷民。若疾而无医。则为之置安济坊。贫而不葬。则为之置漏泽园。朕之志于民深矣。”
“The widows and widowers, the orphaned and sole survivors have the Poorhouses to be used for residence and support. The sick have the Hospitals for rest and relief (Huizong is using here the characters of the institutions in reverse order to show their meaning and functions.). Those who have died have the Pauper’s Cemeteries for burial. This is the foundation of the kingly way [Dao]. I have ordered the implementation of this system, but officials have not followed my orders.” 21
“鳏寡孤独。有院以居养。疾病者有坊以安济。死者有园以葬。王道之本也。诏令具在。而吏不奉法。”
The language Huizong uses here suggests that the emperor perceived the three institutions as complementary parts of a single integrated system.9 It also hints to Huizong’s conviction that implementing public health system was part of the sagely way of ruling the state or the “kingly Dao” in his own words, as recorded in the above edict.
The Poorhouse System included three separate institutions. The first was the Poorhouse (居养院), literally translated as the Reside and Support House, a hospice designed to provide shelter and food to the indigent (Note 3).22 The second was the Peace and Relief Hospital (安济坊), literally translated as the Rest and Relief Office, a charity clinic designed to provide free medical care for those who could not afford medical treatment. The third was the Pauper’s Cemetery (漏泽园), literally translated as the Left Out of Favor Funerary Park, an institution that provided free burial plots and services for both the poor, who could not afford burial and soldiers or travelers who died away from home without anyone to take care of their funeral arrangements (Note 4).
The government financed the Poorhouse System primarily by confiscating property of the heirless dead.23 This new financial foundation enabled the government to establish a greater number of facilities and aid a greater share of the population than its Tang dynasty and early Song dynasty privately funded forerunners had. In addition, the new system functioned on a year round basis, unlike its precursors that operated only during emergencies. However, the system did not always function ideally. For example, in one surviving record the author complained that the system had outrun its resources.24
4.1 Poorhouses
The origins of the poorhouses can be traced to the last years of the reign of the Song emperor Zhezong (宋哲宗, 1086–1100). An imperial edict, dating to 1098, describes a governmental charity system, designed to provide shelter and health care for the poor and the indigent.
“The edict from the Office for the Editing of Imperial Pronouncements said: ‘Regarding widows, widowers, the orphaned, sole survivors, the poor, and those who cannot support themselves, it is the duty of the Prefects, General-controllers, Magistrates, and Assistants to inspect and verify that officials are responsible for supporting and residing them [the indigent]. Regarding those who are sick they [should] provide them with medications. Circuit Supervisors when they arrive they [should] investigate and inspect [that officials] in charge of the Poorhouse provide the [allotted housing spaces titled] ‘residence of childless families’ to those in need. If there are not enough housing spaces [they should] use officials’ residence [to house those in need]. If these housing spaces produces income [via renting them out], hand out the earned sum [to those in need] without limitation on the number of months. They should rely on the Stabilization System to provide them with rice and beans. If the emperor is not satisfied, then use the Stabilization interest funds to compliment. If officials will provide residence to those who can maintain themselves they will be dismissed from office.’ Follow this!”25,26
“详定一司敕令所言：「鳏寡孤独贫乏不得自存者，知州、通判、县令、佐验实，官为居养之；疾病者仍给医药。监司所至检察阅视，应居养者，以户绝屋居，无户绝以官屋居之；及以户绝财产给其费，不限月分，依乞丐法给米豆，阙若不足者以常平息钱充。已居养而能由存者罢。」从之。”
This order was never implemented until the reign of Huizong who established these charity institutions as part of a larger public health system. The Poorhouses were designed to provide food, clothing, and shelter to the needy, which were defined as the aged poor, widows, orphans, and all those otherwise unable to care for themselves. The forms of aid varied according to local conditions and the age of the person.27 Generally, each adult was to be allotted one sheng (升) of rice, which is approximately 0.7 L, and 10 cash per day, with children receiving half as much.28,29 During the winter months, additional five cash per day was allotted for fuel. Over the years, poorhouses also provided residents with clothing, bedding, utensils, and at times even mosquito nets. The scope of relief was extended during the winter when the need for shelter became more acute, especially in cold northern China.9
In summary, the Poorhouses mainly served as a way to provide shelter for people living on the streets. The Poorhouses had only indirect effects since providing support and sustenance may have prevented sickness, in comparison to the other two institutions, on public health.
4.2 Peace and Relief Hospitals
The Peace and Relief Hospitals (Note 5), established in 1102, were modeled on an earlier infirmary founded by Su Shi (苏轼, 1036–1101) in Hangzhou. In 1089, Su Shi was appointed the prefect of Hangzhou. Confronted with poverty and a high rate of disease he established what might have been China’s first specialized charity clinic, titled the Peace and Happiness Hospital (安乐坊). Su Shi funded the clinic mostly from private funds.30,31 According to surviving records, during a 3-year span of operation, the clinic treated over a thousand poor patients free or charge. During Huizong’s reign, Su Shi’s privately operated Peace and Happiness Hospital was incorporated into the national system of hospitals.32
Huizong’s government established the Peace and Relief Hospitals in response to a memorial submitted to the court in 1102 by Wu Juhou (吴居厚, 1037–1113), the governor of the capital prefecture.33 Wu urged that an institution, for which he suggested the title Rest and Recuperation Houses (将理院), be established in all prefectures to aid the poor, though this name was proposed but never adopted in practice.34 Wu’s memorial specified:
“The Rest and Recuperation Houses ought to take the sick and separate them according to the severity of their illness and then place them in different wards. This is done to prevent contagion. There should also be a kitchen to decoct drugs and prepare food and drink for the patients. The living quarters of the attendants and the wards of the patients should be separated. Each of the wards, which are differentiated based on the severity of the patients’ disease, should include up to ten rooms.”35
“将理院宜以病人轻重而异室处之。以防渐染。又作厨舍以为汤药饮食。人宿舍及病人分。轻重异室，逐处可修居屋一十间。”
Wu’s proposal constitutes one of the earliest mentions of quarantining patients to prevent contagion. However, it is important to note that these quarantining measures were proposed only to the indigent, and are not found in other records discussing epidemics in general. To make these hospitals self sufficient, they were to have a pharmacy to prepare medicinal formulas as well as a kitchen to prepare food for the patients and to boil medicinal formulas before patients consumed.
Contrary to the more common procedure of starting such facilities in the capital, the network of hospitals was established first in the provinces. For example, there is a record stating that a hospital was established in Hebei in 1102.36 Another source records that such a hospital was established in Hangzhou in 1104.37 Huizong himself questioned leaving the capital out of this new network. In 1105, he personally wrote an edict to rectify the situation.
“The capital is the heart of the land, the place where the king’s transformative influence begins. Concerning widows and widowers, the orphaned, and sole survivors, along with those who are poor and without anyone to turn to, in the rest of the country the Poor House System has been put in place, but it has not yet reached the capital. This misses the idea of beginning with what is close at hand and then extending it to distant places. Now, although we have Blessed Fields Houses, they cannot care for many. At the coldest and hottest times of the year, the poor without anyone to turn to as well as the ill may lack places to live, which pains me deeply. I order Kaifeng prefecture to follow the law used in the outer prefectures to establish Poorhouses for widows and widowers, orphans, and sole survivors, as well as Peace and Relief Hospitals, thus according with my intentions.”38,39
“京师根本之地。王化之所先。鳏寡孤独与贫而无告者。居养之法。施于四海而未及京师。殆失自近及远之意。今虽有福田院。所养之数未广。祁寒盛暑。穷而无告及疾病者或失其所。朕甚悯。可令开封府依外州法。居养鳏寡孤独及置安济坊。以称朕意。”
Each Peace and Relief Hospital was designed to have several wards with administrators assigned to manage them. Each physician in the hospitals was required to keep accurate records of the cases he treated, listing the number of patients who were cured and the number who died under their treatment. At the end of the year, these records should be examined and should serve for evaluating the status of each physician based on his success rate.40 Physicians would be compensated financially when they were successful in their treatment (Note 6).41,42 Each clinic was to be managed by a staff of four people who were replaced seasonally.9
In summary, the hospitals treated the poor and were designed to prevent the outbreak of contagious diseases and epidemics. Unfortunately, there is little evidence concerning how many hospitals operated, where, and how.
4.3 Pauper’s Cemetery
The need for public cemeteries was made more apparent by the social and geographical mobility of Northern Song China. Care for the sick and burial of the dead had long been viewed as family responsibilities in China, but the increasingly commercial and mobile nature of Song society brought merchants and opportunity-seekers, which included seekers to the cities without their kin. During the first century of the Song dynasty, Buddhist monasteries provided land and coffins for the poor to bury their dead. The Song government made a few attempts to take over this role, especially during the early 1020s, but with limited success.9
The year 1079 presents, probably, the point in time when the Song conceived the idea of Pauper’s Cemeteries, when Chen Xiang (陈向), native of Muzhou, Zhejiang, jin shi (进士) in 105943 submitted a memorandum asking for government land to bury scattered skeletons or corpses (Note 7). A book authored by Chen’s grandson, Xu Du (徐度, fl. 1138–1147), includes an interesting perspective of how this institution was conceived. It states that the system of Pauper’s Cemeteries (漏泽园之法) arose during the Yuanfeng era (1078–1085). He writes that his grandfather on his mother side, once came to Kaifeng and stayed overnight in a Buddhist temple in Chenliu (陈留) area. In the middle of the night he was awoken by a commotion outside the walls. “My grandfather raised the candle and looked around, he saw piles of skeletons [or corpses] covering the field. All of them were skeletons of poor people whose families could not afford to bury them, so they just left them there [outside the walls].” Following this, his grandfather could not bear this situation and requested some land to bury them. When emperor Shenzong (宋神宗) heard about this he appointed Chen Xiang to manage these affairs. Chen buried 30 skeletons or corpses in each pit and mapped all of the pits. He constructed a small Buddhist temple at the edge of the plot and appointed a monk to care for the cemetery.44 Shenzong also issued an edict instructing each district to allot land and funds for burial of unattended corpses once a year. This initiative was the first time the government attempted to establish a system to bury the dead that no one was responsible to bury.45
Chen Xiang’s initiative had only a short-term effect and was predominantly local in scope. The problems of bodies lying in the streets continued and posed an even more pressing hazard to public health than did the sick. The Secretary of the Court (中书) reported in 1104, “Prefectures and counties [in the empire] all have poor people who are without means to cover their own burial when they die. Also, there are visitors [from out of town] who die and their corpses lie exposed in the streets untouched. This is extremely sad and distressing.”46 The sanitation problems associated with the disposal of the bodies of the indigent as well as the traditional Confucian emphasis on filial piety made this matter one of great official concern.
The Pauper’s Cemeteries were formally established in 1104. Originally, they were conceived as an improvement on the precedent set in Shenzong’s reign (1067–1085).46 Each prefecture was ordered to establish a cemetery enclosed by a wall on a plot of unfertile public land. The prefecture appointed officials to keep records and maps (图籍) of the cemeteries and to parcel out the burial plots when needed. Each body buried in these cemeteries was to be allotted an eight-chi (尺) plot (approximately 2.46 m) and a coffin. Each grave was to be dug at least three chi deep (approximately 0.92 m) “to ensure that the corpse will not be exposed.”40 Each grave was provided with a marker recording the name, age, dates and any other known details about the deceased. A central shrine was set up in each cemetery to provide a place for ancestral sacrifices.47 During the 1960s, a Song dynasty Pauper’s Cemetery was discovered in Xiazhou (present day in the city Sanmenxia 三门峡, Henan province). Following excavations conducted in the springs of 1985, 1993, and 1994, altogether 849 tombs have been unearthed at the site with records of burial dating to the years 1105–1116. From the excavations, we learn that many bodies were buried in clay coffins.48 This archeological discovery of a pauper’s cemetery is the only “hard evidence” we have of a unique and innovative attempt by an emperor to employ his authority to install a government-sponsored and operated public health program.
In summary, the cemeteries provided respectable burial to the poor and to people without relatives while ensuring that rotting corpses, a sure means to transmit pathogens for diseases and epidemics, will not lie bare in the streets.
5 The demise of the system
The idea behind the Poorhouse System was altruistic and noble and was meant to exemplify emperor Huizong’s kingly Dao, but costs were high and corruption was a persistent problem. The first mention of corruption appears in 1105, when a report was made that prefectural officials were not keeping proper records of relief operations. Subsequently, inspectors were sent to check into the actual number of people being handled.49 Surviving records mention that local officials padded the lists of relief recipients with names of healthy people or dead people to obtain more support from the government for their own use. Punishments for corruption often were harsh and included public beating.50 Even Huizong lamented that officials did not carry out the system the way it was designed and thus brought grief instead of relief to the indigent.51 The following testimony, dating to 1114, described the situation of the Poorhouse System:
“I have ascertained that in the various prefectures the people who actually are elderly and who should be placed in a Poorhouse, those who actually are sick and should be hospitalized in a Peace and Relief Hospital, and those who actually should receive aid, suffer because those with family connections enter false claims and bend the regulations at will. The local officials protect one another making it impossible to investigate.”9
“臣僚言访闻诸路民之实老而正当居养，实病而真欲安济者，往往以亲戚识认为名，虚立案牍，随时遣逐使法，当收恤者复被其害。官吏相蒙，无以检察。”52
During Huizong’s later years, the government cut back allocations to the public health system. Accordingly, the number of the poor and the indigent aided by the system declined significantly.9,28 Although Huizong’s public health system had to be cut back, it remained in place for at least a few more decades during the Southern Song. Its long-term impact, however, seems to have been limited.
6 The objective of the system: benefiting or policing the sick?
There is a question to be asked, why did Huizong establish such an elaborate and expansive public health system, one never before considered essential? Did he intend to benefit the indigent or was he determined to police the sick and the homeless in order to preserve public health?
Huizong had profound medical knowledge. He compiled a unique medical treatise Sheng Ji Jing (《圣济经》 Canon of Sagely Benefaction) that elucidated ancient canonical medical doctrines. He oversaw, and some scholars even claim that he participated in, the compilation of an enormous clinical formulary Zheng He Sheng Ji Zong Lu (《政和圣济总录》 Medical Encyclopedia: A Sagely Benefaction of the Zhenghe Reign Period). In addition he was personally involved in imperial initiatives to transform the status of medicine, as his government established a new medical school and added official medical positions, in an attempt to lure the sons of the elite to study and practice medicine.5,53 Given Huizong’s interest in and involvement with medicine, it is not surprising that he attempted to promote the health of the people and as a byproduct prevent the outbreak of epidemics. This was, according to him, the way the emperor implements his “kingly Dao” or caring for the people by providing medical care.
Although some researchers claim that the Poorhouse System was inherently tied to the rocky career of Cai Jing (蔡京, 1046–1126), who served as grand councilor during the reign of Huizong, a closer analysis suggests that Huizong was personally involved and used his cultural authority to implement the public health system.31,53–55 He wrote several edicts discussing the importance and the goals of the public health and relief system initiated by his government. These edicts, which specify the target population of each institution and its function, show that Huizong was concerned by the state of health among the common people in the empire. In one of them, he even claims that officials do not implement his orders to the letter as he expects. But by far, the most important proof of Huizong’s personal involvement with the system comes from the preface he wrote to his medical book Sheng Ji Jing. There he states that he set up the different functions of the system. He also claims that constructing this system was part of his larger reforms in medicine, all actions that demonstrate his “kingly Dao.”56–58
Reading the imperial edicts and official government documents as those presented above, we may come to the conclusion that Huizong’s government established such a public health system for the sole purpose of benefiting the people, helping the indigent, and supporting the poor. This is indeed what we may expect from an emperor who wants to show his benevolence and care for the people. However, is this all there is to it? Was the Song government so enlightened or did it have other reasons or incentives? If this is the case, why did not it establish such institutions before Huizong era?
It seems that in addition to Huizong’s interest in medicine and its relation to ruling the state, the growing problem of the indigent and the homeless also played a role in the decision to implement the system. Reading testimonies by imperial officials reveals a gruesome picture of the streets in Chinese cities. “In the winter cold, people who collapse are not being cared for. Beggars are falling down and sleeping in the streets beneath the imperial carriage.”53,59 Another record states, “In the capital during cold winters there are often uncovered beggars without cloths collapsing in the streets and thoroughfares. Those are beggars that the Poorhouses stopped housing… Therefore the Poorhouse System must be supported!”60 In addition, there are records depicting a gruesome picture of unburied bodies in the public scene stating, “in prefectures and districts corpses of poor that no one buries as well as of visitors who have died lie bare in the streets.”61
This growing hazard to public health, even without understanding contagion, necessitated suitable means to get the sick and the dead off the streets. It seems that despite Huizong’s attempt to portray the system as an extension of a sage emperor, his officials conceptualized the system as a utilitarian tool, namely getting rid of a nuisance with minimal necessary cost. Accordingly, we find records that officials criticize prefectures and districts that are too “extravagant” in their operations, providing mosquito nets, wine and even delicacies to the residents of the Poorhouses and the hospitals. (Note 8)62,63
7 Conclusion
To sum up, it seems that emperor Huizong strived to implement what he terms as the “kingly Dao” and establish a system that would both promote health and benefit the poor. In contrast, his officials, it seems, attempted to satisfy the needs of the elite and run an economic system. Huizong saw the Poorhouse System as part of his larger reforms in medicine. Being knowledgeable in medicine he saw the establishment of such a health system as another facet of improving life in the empire by aiding the indigent while preventing epidemics at the same time. Thus, he used his cultural authority as an emperor and his professional authority as a physician, at least to his own perception, to implement an innovative public health system.
Notes
1. This reform included the establishment of a new medical school, reforms in the positions of physicians in the civil service, and expansion of medical institutions. One such institution was actually a related public health institution—the Imperial Pharmacy. Established in 1076, but largely expanded during Huizong’s reign, the pharmacy, which operated all year long, sold prepared drugs and ready-made prescriptions in many locations throughout the empire. During times of catastrophes, the pharmacy dispensed the drugs free of charge upon orders from the Imperial Physician.
2. The term “Poorhouse System” is adopted here because it seems that the Song government and Huizong in particular conceptualized a system made of three different and specialized institutions.
3. There is a distinction between two terms when referring to poorhouse, fa (法) and yuan (院). According to Scogin (“Poor Relief,” p. 33), the former refers to a system or approach, while the latter implies the existence of a specific facility. Prior to 1106, the term “Poorhouse System” (居养法) was used as a general term meaning either the system or the facility depending on whether the relief functions of the facility were listed or not. From 1106, the term Poorhouse (居养院) was used for the facility.
4. The imperial agency of the Left Out of Favor Funerary Park (漏泽园) does not appear in A Dictionary of Official Titles in Imperial China (Stanford: Stanford University Press, 1985) edited by Charles O. Hucker. For clarity I follow the title “Pauper’s Cemetery” proposed by Scogin in “Poor Relief.”
5. It is important to note that although I use the term “hospital,” I do not presume that these institutions resembled modern-day hospitals.
6. Physicians who lost no more than twenty percent of their patients were rewarded according to the numbers of patients they treated in a year: if over a thousand, they received a Monastic Certificate (度牒); if over 500, 50 strings of cash; if over two hundred, twenty strings of cash. A physician who treated a thousand patients and lost no more than ten percent would receive a special bonus.
7. The character in the text is Hai (骸). The most common translation is “skeleton” however it also refers to “body.”, The story probably refers to corpses, but I use “skeleton” as translation to remain close to the original meaning.
8. In another record, we find a reference that the hospitals were actually used to hold prisoners, which may further indicate that the system was more practical than sagely in reality.
Funding
None.
Ethical approval
This study does not contain any studies with human or animal subjects performed by the author.
Author contributions
Asaf Goldschmidt did the research and wrote the paper.
Conflicts of interest
The author declares no financial or other conflicts of interest.
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