The term hospital derives from the Latin word hospitalis, which relates to guests and their treatment. (72) The word reflects the early use of these institutions not merely as places of healing but as safe rooms for the poor or for weary travelers. Hospitals first appeared in Greece as aesculapia, named after the Greek god of medicine, Aesculapius. For many centuries they developed in association with religious institutions, such as the Hindu hospitals opened in Sri Lanka in the 5th century BC and the monastery-based European hospitals of the Middle Ages (5th century to 15th century) (73)The first hospital established in the United States was Pennsylvania Hospital in Philadelphia, which was open in 1751 with the support of Benjamin Franklin. (74)Although other U.S. hospitals were created in the 1700s, most people were treated for their illnesses by neighbors and friends in their homes well into the 1800s. Hospitals changed greatly after the Civil War--in the early years of the war no hospitals were available to treat the thousands of soldiers who were wounded or became ill, but by the war's end in 1865, 200 hospitals with more than 137,000 beds had opened in the northern states. (75)In addition to the military hospitals that emerged during the Civil War, many voluntary and public hospitals appeared in the 1850s.