5th to 15th centuries
En la Edad Media, el término hospital englobaba albergues para viajeros, dispensarios para el alivio de los pobres"), clínicas y consultorios para heridos y asilos para ciegos, cojos, ancianos y enfermos mentales. Los hospitales monásticos desarrollaron numerosos tratamientos, tanto terapéuticos como espirituales.[34].
Durante el siglo se construyó un inmenso número de hospitales. Las ciudades italianas lideraron el movimiento. Milán contaba con no menos de una docena de hospitales y Florencia, antes de finales del siglo , con una treintena. Algunos de ellos eran edificios de gran belleza. En Milán, una parte del hospital general fue diseñada por Bramante y otra por Miguel Ángel. El Hospital de Siena, construido en honor de Santa Catalina, es famoso desde entonces. Por toda Europa se extendió este movimiento hospitalario. Virchow, el gran patólogo alemán, en un artículo sobre hospitales, demostró que cada ciudad de Alemania de cinco mil habitantes tenía su hospital. Remontó todo este movimiento hospitalario al papa Inocencio III, y aunque era el menos inclinado al papismo, Virchow no dudó en elogiar enormemente a este pontífice por todo lo que había realizado en beneficio de los niños y de la humanidad que sufría.[57].
Los hospitales comenzaron a aparecer en gran número en Francia e Inglaterra. Tras la invasión normanda francesa en Inglaterra, la explosión de ideales franceses llevó a la mayoría de los monasterios medievales a crear un hospitium u hospicio para peregrinos. Este hospitium acabó convirtiéndose en lo que hoy entendemos por hospital, en el que diversos monjes y ayudantes laicos se encargaban de la atención médica a los peregrinos enfermos y a las víctimas de las numerosas plagas y enfermedades crónicas que afligían a la Europa occidental medieval. Benjamin Gordon apoya la teoría de que el hospital – tal y como lo conocemos – es un invento francés, pero que en un principio se desarrolló para aislar a los leprosos y a las víctimas de la peste, y sólo más tarde sufrió modificaciones para servir al peregrino.[58].
Gracias a un relato bien conservado del siglo del monje Eadmer, de la catedral de Canterbury, existe una excelente relación del objetivo del obispo Lanfranc") de establecer y mantener ejemplos de estos primeros hospitales:.
Persia
Gondishapur Academy was a hospital and medical training center in Gundeshapur, Persia. The city of Gundeshapur was founded in by the Sassanid king Shapur I. It was one of the main cities of the Khuzestan province of the Persian Empire, in Iran. A large percentage of the population were Syriacs, mostly Christians. Under the reign of Khusraw I, Greek Nestorian Christian philosophers were granted refuge, among them scholars of the Persian School of Edessa (Urfa) (also called the Academy of Athens), a Christian theological and medical university. These scholars arrived at Gundeshapur in 529 after the closure of the academy by Emperor Justinian. They dedicated themselves to medical sciences and initiated the first projects of translation of medical texts.[60] The arrival of these doctors from Edessa marks the beginning of the Gundeshapur hospital and medical center.[33] It included a medical school and a hospital (bimaristan), a pharmacology laboratory, a translation house, a library and an observatory.[61] Indian doctors also contributed to the Gundeshapur school, most notably the medical researcher Mankah. Later, after the Islamic invasion, the writings of Mankah and the Indian doctor Susruta were translated into Arabic at the House of Wisdom in Baghdad.[62].
Medieval Islamic hospitals
The first Muslim hospital was a leprosy asylum, built at the beginning of the century, where patients were confined but, like the blind, were given a stipend to support their families.[63] The first general hospital was built in Baghdad by Harun Al-Rashid.[64][65] In the century, Baghdad had five more hospitals, while Damascus had six hospitals in the century and only Córdoba "Córdoba (Spain)") had 50 large hospitals, many of them exclusively for military personnel.[63] Many of the first important Islamic hospitals were founded with the help of Christians such as Jibrael ibn Bukhtishu) of Gundeshapur.[66][67] "Bimaristan" is a compound of "bimar" (sick) and "stan" (place). In the medieval Islamic world, the word "bimaristan" designated a hospital establishment where the sick were welcomed, cared for and treated by qualified personnel.
The United States National Library of Medicine attributes the hospital to medieval Islamic civilization. Compared to contemporary Christian institutions, which were relief centers for the poor and sick offered by some monasteries, the Islamic hospital was a more elaborate institution with a wider range of functions. In Islam there was a moral imperative to treat the sick regardless of their economic situation. Islamic hospitals tended to be large urban structures and were largely secular institutions, many of them open to all, whether men or women, civilians or military, children or adults, rich or poor, Muslim or non-Muslim. The Islamic hospital fulfilled several functions: a medical treatment center, a home for patients recovering from illnesses or accidents, an asylum, and a residence for the elderly and sick with basic maintenance needs.[68].
The typical hospital was divided into departments such as systemic diseases, surgery, and orthopedics; larger hospitals had more diverse specialties. "Systemic diseases" was the rough equivalent of today's internal medicine and was divided into sections such as fever, infections, and digestive problems. Each department had a head, a president, and a supervising specialist. Hospitals also had classrooms and libraries. The hospital staff included sanitary inspectors, who regulated cleanliness, and accountants and other administrative staff. Twenty-five doctors worked in the Baghdad hospital. Hospitals were usually run by a council of three members: a non-medical administrator, the chief pharmacist, called shaykh saydalani, who was of the same rank as the chief physician, who served as mutwalli (dean). Medical centers closed at night, but in the century laws were passed to keep hospitals open 24 hours a day.[71].
For less serious cases, doctors attended outpatient consultations. Cities also had first aid centers staffed by doctors for emergencies that were often located in crowded public places, such as large Friday prayer gatherings, to care for the injured. The region also had mobile units staffed with doctors and pharmacists who had to attend to the needs of remote communities. Baghdad is also known to have had a separate hospital for convicts since the turn of the century, after vizier 'Ali ibn Isa ibn Jarah ibn Thabit wrote to Baghdad's chief medical officer that "prisons must have their own doctors, who must examine them every day." The first hospital built in Egypt, in the southwestern neighborhood of Cairo, was the first documented facility to treat mental illness, while the first Islamic psychiatric hospital was opened in Baghdad in 705.[63][72].
European medieval hospitals
Medieval European hospitals followed a model similar to the Byzantine one. They were religious communities attended by monks and nuns. An old French term for hospital is hôtel-Dieu, "lodge of God".[79] Some were linked to monasteries; others were independent and had their own endowments, usually property, which provided income for their maintenance. Some hospitals were multifunctional, while others were founded for specific purposes, such as leprosariums, shelters for the poor or pilgrims: not all of them cared for the sick.
Around , Saint Benedict of Nursia (480-), later a Christian saint, founder of Western monasticism and the Order of Saint Benedict, today patron saint of Europe, established Europe's first monastery (Monte Casino) on a hill between Rome and Naples, which became a model of Western monasticism and one of the main cultural centers of Europe throughout the Middle Ages. Saint Benedict wrote the Rule of Saint Benedict, which mandated the moral obligation to care for the sick.
The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in the year in Mérida "Mérida (Spain)"), was a xenodochium conceived as an inn for travelers (mostly pilgrims to the sanctuary of Eulalia de Mérida) and as a hospital for local citizens and farmers. The hospital's facilities consisted of farms to feed its patients and guests. From the account of Paul the Deacon we know that this hospital was staffed with doctors and nurses, whose mission included the care of the sick wherever they were, "slave or free, Christian or Jew".[80] In the year 650 the "Hôtel-Dieu" was found in Paris,[81] but its first documented mention only dates back to the year 829,[82] it is considered by many to be the oldest hospital in the world still operating in the present day.[83] It was a multipurpose institution that cared for the sick and poor, offering them accommodation, food and medical care.
At the end of the century and the beginning of the century, Emperor Charlemagne decreed that hospitals that had functioned well before his time and had fallen into decay should be restored according to the needs of the time.[84] In addition, he ordered that a hospital be annexed to each cathedral and monastery.[84]
During the 19th century, monasteries became a dominant factor in hospital work. The famous Benedictine Abbey of Cluny, founded in 910, set the example that was widely imitated throughout France and Germany.[85] In addition to its infirmary for the religious, each monastery had a hospital in which outpatients were cared for. These were in charge of the eleemosynarius, whose duties, carefully prescribed by the rule, included all kinds of services that the visitor or patient might need.
As the eleemosynarius was obliged to seek out the sick and needy in the neighborhood, each monastery became a center for the relief of suffering. Among the notable monasteries in this regard were the Benedictines of Corbie in Picardy, Hirschau, Braunweiler, Deutz"), Ilsenburg, Liesborn"), Pram "Pram (Austria)") and Fulda; the Cistercians of Arnsberg, Baumgarten, Eberbach, Himmenrode"), Herrnalb"), Volkenrode and Walkenried.
Hospitals of late medieval Europe
The Hospitaller Order of Saint John of Jerusalem itself, founded in 1099 (the Knights of Malta), has as its purpose the founding of a hospital for pilgrims to the Holy Land. In Europe, Spanish hospitals are particularly notable examples of Christian virtue expressed through the care of the sick, and were often attached to a monastery in a hall-chapel configuration, almost always erected in the shape of a cross. This style reached its peak during the hospital-building campaign of the Portuguese Saint John of God in the 19th century, founder of the Hospitaller Order of the Brothers of John of God.[88].
Soon many monasteries were founded throughout Europe, and everywhere there were hospitals like at Monte Cassino. In the 19th century, some monasteries trained their own doctors. Ideally, these doctors defended the Christianized ideal of the healer who offered mercy and charity to all patients and soldiers, regardless of their condition and prognosis. In the centuries -, the Benedictines created many communities of monks of this type. And later, in the centuries, the Benedictine order built a network of independent hospitals, at first to provide general care for the sick and wounded and later for the treatment of syphilis and the isolation of patients with contagious diseases. The hospital movement spread across Europe in subsequent centuries, with the construction of a 225-bed hospital in York in 1287 and even larger facilities in Florence, Paris, Milan, Siena and other large medieval European cities. In 1120, a man named Rahere fell ill with malaria in Rome: he was treated by the monks of the small hospital near the church of San Bartolomeo, on the Tiber Island, and vowed to found a hospital in case he was cured. Effectively cured, in 1123 he founded a small hospital for the poor on the outskirts of London: it was the first nucleus of the famous St. Bartholomew's Hospital, still active today, commonly called "Bart."
In the north, in the late Saxon period, monasteries, convents and hospitals functioned primarily as places of charity for the poor. After the Norman conquest of 1066, hospitals became autonomous and independent institutions. They dispensed alms and some medicines, and were generously endowed by the nobility and gentry, who counted on them for spiritual rewards after death.[89] Over time, the hospitals became popular almshouses that differed from both English monasteries and French hospitals.
The main function of medieval hospitals was the worship of God. Most hospitals had a chapel, at least one clergyman, and inmates who had to help in prayer. Worship was often a priority over care and was an important part of hospital life until and long after the Reformation. The cult in medieval hospitals served to alleviate the ailments of the sick and ensure their salvation when the illness could not be alleviated.[90][91].
The secondary function of medieval hospitals was charity to the poor, sick and travelers. The charity provided by hospitals manifested itself in different ways, including long-term maintenance of the sick, medium-term care of the sick, short-term hospitality to travelers, and regular distribution of alms to the poor.[90] Although these were general acts of charity among medieval hospitals, the degree of charity was variable. For example, some institutions that perceived themselves primarily as a religious house or place of hospitality turned away the sick or dying for fear that difficult health care would distract from worship. Others, however, such as St. James, Northallerton, St. Giles Hospital, Norwich, and St. Leonard's Hospital, York, contained specific ordinances stating that they must care for the sick and that "anyone who entered in poor health should be allowed to stay until they recovered or died."