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."

modern europe

In Europe, the medieval concept of Christian care evolved over the centuries into a secular concept.[93]​ Theology was the problem. Protestant reformers rejected the Catholic belief that wealthy men could earn God's grace through good works – and escape purgatory – by donating to charitable institutions, and that patients themselves could earn grace through their suffering.[94]

Following the dissolution of the monasteries in 1540 by King Henry VIII, the Church abruptly ceased to support the hospitals, and only at the direct request of the citizens of London, the hospitals of St Bartholomew, St Thomas and St Mary of Bethlehem (Bedlam) were endowed directly by the crown. John Abernethy") developed important principles of modern surgery in the century and Mrs. Bedford Fenwich worked to advance the nursing profession at the end of the century.[96]

At the beginning of the Reformation there were 28 asylums in Sweden. Gustav I removed them from ecclesiastical control and expelled the monks and nuns, but allowed the asylums to retain their properties and continue their activities under the auspices of the local government.[97]

In much of Europe, municipal governments operated small Holy Spirit hospitals, founded in the 19th and 19th centuries. They distributed free food and clothing to the poor, cared for homeless women and children, and provided some medical and nursing care. Many were raided and closed during the Thirty Years' War (1618-1648), which devastated the cities and towns of Germany and neighboring areas for three decades.

In Denmark, the beginnings of modern hospital care date back to the Scanian War (1675-1679), in which Denmark suffered disastrous losses. Five public hospitals were founded around the strait: one in Elsinore, two in Copenhagen, one in Landskrona and one in Helsingborg. The one in Landskrona was based on the ancient institution of the Holy Spirit, but had now been modernized and expanded. One of the two institutions in Copenhagen was set up in a former plague hospital. The government spent large sums on equipment, from bone saws to beds and staff. Women cared for wounded and sick soldiers daily, but men were always in charge of these hospitals. They had several surgeons and doctors, but never enough. Meals were based on porridge, herring, beer and peas. When Denmark lost the war, Helsingborg and Landskrona were handed over to the Swedes, but the hospitals in Elsinore and Copenhagen continued their work.[98]

Meanwhile, in Catholic lands such as France and Italy, wealthy families continued to fund convents and monasteries that provided free health services to the poor. French practices were influenced by a charitable imperative that considered care for the poor and sick a necessary part of Catholic practice. The nursing nuns had little faith in the power of doctors and their medicines to cure the sick; The most important thing was to provide psychological and physical well-being, food, rest, cleanliness and, above all, prayer.[99]​.

In Protestant areas, more emphasis was placed on the scientific rather than the religious aspects of patient care, which contributed to the development of a view of nursing as a profession rather than a vocation. After 1530, the main Protestant churches developed very few hospitals. Some smaller groups, such as the Moravians and the Pietists of Halle, gave a role to hospitals, especially in missionary work.

colonial america

The first hospital founded in America was the San Nicolás de Bari Hospital in Santo Domingo, National District of the Dominican Republic. Fray Nicolás de Ovando, Spanish governor and colonial administrator from 1502 to 1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[103] Abandoned in the middle of the century, the hospital now lies in ruins near the Cathedral Basilica of Santa María la Menor in Santo Domingo.

The first hospital on American continental soil was the Santiago hospital "Hospital de Santiago (Santa María de la Antigua de Darién)") in Santa María de la Antigua de Darién (Colombia), founded in 1515. The conquistador Hernán Cortés founded the first two hospitals in North America: that of the Immaculate Conception and that of San Lázaro. The oldest was that of the Immaculate Conception, current Hospital de Jesús Nazareno "Hospital de Jesús Nazareno (México)") in Mexico City, founded in 1524 to care for the poor.[103]​.

In Quebec, Catholics ran hospitals continuously since the 1640s; They attracted nuns from the provincial elite. Jeanne Mance (1606-1673) founded the first hospital in the city of Montreal, the Hôtel-Dieu de Montréal"), in 1645. In 1657 she recruited three sisters from the Religious Hospitallers of Saint Joseph"), and continued to direct the hospital's operations. The project, initiated by the niece of Cardinal de Richelieu, received a royal charter from King Louis XIII and was attended by a colonial doctor, Robert Giffard de Moncel.

In the 20th century, under the influence of the Age of Enlightenment, the modern hospital began to appear, which only attended to medical needs and had trained doctors and surgeons. The nurses were untrained workers. The goal was to use modern methods to cure patients. They provided more limited medical services and were founded by secular authorities. A clearer distinction emerged between medicine and poor relief. Within hospitals, acute cases were increasingly treated alone and separate departments were created for different categories of patients.

1820 Engraving of Guy's Hospital in London, one of the first voluntary hospitals created in 1724.

The voluntary hospital movement began at the turn of the century, with the founding of hospitals in London in the 1710s and 1720s, including Westminster Hospital (1719) promoted by the private bank C. Hoare & Co) and Guy's Hospital (1724) financed from the bequest of the wealthy merchant Thomas Guy. Throughout the century other hospitals sprang up in London and other British cities, many paid for by private subscriptions. St. Bartholomew's in London was rebuilt in 1730, and the London Hospital opened in 1752.

These hospitals represented a turning point in the function of the institution; They began to evolve from being basic places of care for the sick to becoming centers of medical innovation and discovery and the main place for education and training of future physicians. Some of the best surgeons and doctors of the time worked and transmitted their knowledge in hospitals.[106] They also went from being mere foster homes to being complex institutions for the supply of medicines and care for the sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia in response to an outbreak of plague.

The concept of voluntary hospitals also spread to colonial America; Bellevue Hospital opened its doors in 1736, Pennsylvania Hospital in 1752, New York Hospital in 1771, and Massachusetts General Hospital in 1811. When the Vienna General Hospital opened in 1784 (which instantly became the largest hospital in the world), doctors acquired new facilities that gradually became one of the most important research centers.[107]

Another charitable innovation of the Enlightenment era was the dispensary, which provided medicines free of charge to the poor. The London Dispensary opened its doors in 1696 as the first clinic of its kind in the British Empire. The idea took time to catch on until the 1770s, when many such organizations began to appear, such as the Edinburgh Public Dispensary (1776), the Metropolitan Dispensary and Benevolent Fund (1779), and the Finsbury Dispensary (1780). Dispensaries were also opened in New York (1771), Philadelphia (1786), and Boston (1796).[108]

Throughout Europe, medical schools continued to rely primarily on lectures and lectures. In the final year, students had limited clinical experience following the professor around the rooms. Laboratory work was infrequent and dissections were rarely performed due to legal restrictions on cadavers. Most colleges were small and only Edinburgh, Scotland, with 11,000 students, had a large number of graduates.[109]​[110]​.

El médico inglés Thomas Percival") (1740-1804) escribió un exhaustivo sistema de conducta médica, Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons") (1803) que marcó la pauta para muchos libros de texto.[111]​.

A mediados del siglo , los hospitales y la profesión médica se profesionalizaron aún más, con una reorganización de la gestión hospitalaria en líneas más burocráticas y administrativas. La Ley de Boticarios de 1815") obligó a los estudiantes de medicina a realizar al menos medio año de prácticas en un hospital como parte de su formación.[112]​ Un ejemplo de esta profesionalización fue el hospital de Charing Cross"), creado en 1818 como "West London Infirmary and Dispensary" con fondos aportados por el doctor Benjamin Golding"). En 1821 atendía a cerca de 10 000 pacientes al año y se trasladó a unas instalaciones más amplias cerca de Charing Cross, en el corazón de Londres. En 1822 se inauguró la Escuela de Medicina del Hospital de Charing Cross"). Se amplió varias veces y en 1866 incorporó un equipo profesional de enfermería.[113]​.

Florence Nightingale fue pionera de la profesión moderna de enfermería durante la guerra de Crimea, cuando dio ejemplo de compasión, compromiso con la atención al paciente y administración hospitalaria diligente y reflexiva. El primer programa oficial de formación de enfermeras, la Nightingale School for Nurses, se inauguró en 1860 con la misión de formar enfermeras para trabajar en hospitales, atender a los pobres y enseñar.[114]​.

Nightingale desempeñó un papel decisivo en la reforma de la naturaleza del hospital, mejorando las normas sanitarias y cambiando la imagen del hospital, que pasó de ser un lugar donde los enfermos iban a morir a una institución dedicada a la recuperación y la curación. También hizo hincapié en la importancia de la medición estadística para determinar la tasa de éxito de una intervención determinada e impulsó la reforma administrativa de los hospitales.[115]​.

A mediados del siglo surgió la Segunda Escuela Médica de Viena con las aportaciones de médicos como Carl Freiherr von Rokitansky"), Josef Škoda, Ferdinand Ritter von Hebra e Ignaz Philipp Semmelweis. La ciencia médica básica se expandió y la especialización avanzó. Además, en Viena se fundaron las primeras clínicas dermatológicas, oftalmológicas y otorrinolaringológicas del mundo.[116]​.

En Roma, donde la hospitalidad era muy patrimonial gracias a una larga tradición de legados y cuantiosas donaciones (Spedalità romane")), con un real decreto de 1896 se centralizó el vasto patrimonio hospitalario en un solo organismo: el Istituto Pio di Santo Spirito") e Ospedali Riuniti"), que se convirtió así en el mayor de Europa.[117]​.

A finales del siglo , el hospital moderno empezaba a tomar forma con la proliferación de diversos sistemas hospitalarios públicos y privados. En la década de 1870, los hospitales habían triplicado ampliamente su media original de 3000 pacientes. En la Europa continental, los nuevos hospitales solían construirse y gestionarse con fondos públicos"). La enfermería se profesionalizó en Francia a principios del siglo . En aquella época, los 1500 hospitales del país estaban gestionados por 15 000 monjas que representaban a más de 200 órdenes religiosas. A partir de 1900, la política del gobierno fue secularizar las instituciones públicas y reducir el papel de la Iglesia Católica. Este objetivo político entró en conflicto con la necesidad de mantener una mejor calidad de la atención médica en instalaciones anticuadas. Las nuevas escuelas de enfermería gestionadas por el gobierno formaron enfermeras no religiosas a las que se destinó a funciones de supervisión. Durante la Primera Guerra Mundial, una avalancha de voluntarios patrióticos llevó a un gran número de mujeres de clase media sin formación a los hospitales militares. Se marcharon cuando terminó la guerra, pero el efecto a largo plazo fue aumentar el prestigio de la enfermería. En 1922 el gobierno expidió un diploma nacional de enfermería.[118]​.

En Estados Unidos, el número de hospitales alcanzó los 4400 en 1910, cuando proporcionaban 420 000 camas.[119]​ Estaban gestionados por organismos municipales, estatales y federales, por iglesias, por organizaciones independientes sin ánimo de lucro y por empresas con ánimo de lucro. Todas las principales religiones construyeron hospitales; los 541 católicos (en 1915) estaban atendidos principalmente por monjas no remuneradas. Los demás contaban a veces con un pequeño grupo de diaconisas.[120]​ Los hospitales sin ánimo de lucro") se complementaban con grandes hospitales públicos") en las principales ciudades y hospitales de investigación a menudo afiliados a una facultad de medicina. El mayor sistema hospitalario público de Estados Unidos es la New York City Health and Hospitals Corporation"), que incluye el Bellevue Hospital"), el hospital más antiguo de Estados Unidos, afiliado a la Facultad de Medicina de la Universidad de Nueva York.[121]​.

El Servicio Nacional de Salud "Servicio Nacional de Salud (Reino Unido)"), principal proveedor de asistencia sanitaria en Gran Bretaña, se fundó en 1948 y asumió el control de casi todos los hospitales.[122]​.

Paris Medicine

At the beginning of the century, Paris medicine played an important role in shaping clinical medicine. The new emphasis on physical examination of the body gave rise to methods such as percussion, inspection, palpation, auscultation, and autopsy. The situation in Paris was especially unique because there was a large concentration of medical professionals in a very small environment, allowing for a great flow of ideas and the spread of innovation. One of the innovations that emerged in Paris hospitals was the stethoscope. Laennec. Weiner states that widespread acceptance of the stethoscope would likely not have occurred in any other environment, and that this allowed Laennec to convey this technology to the eager medical community that had gathered there. This invention also brought even more attention to the Parisian scene.[123]​.

Before the turn of the century, the French medical system had many problems. These problems were exposed by many who were trying to reform hospitals, including a contemporary surgeon, Jacques Tenon, in his book Memoirs on Paris Hospitals (in French: Memoirs on Paris Hospitals). Some of the problems that Tenon drew attention to were lack of space, the impossibility of separating patients based on the type of disease (including contagious), and general sanitation problems.[124] In addition, the secular revolution led to the nationalization of hospitals that formerly belonged to the Catholic Church and gave rise to a call for hospital reform that, in effect, promoted the deinstitutionalization of medicine.[125] This contributed to the disorganization of Parisian hospitals, which ended up requiring the creation of a new hospital system, outlined in the law of 1794. The law of 1794 played an important role in the revolution of Parisian medicine, as it sought to solve some of the problems faced by Paris hospitals at the time.

First, the law of 1794 created three new schools in Paris, Montpellier, and Strasbourg due to the lack of medical professionals available to treat the growing French army. It also gave doctors and surgeons equal status in the hospital environment, whereas previously doctors were considered intellectually superior.[125] This led to the integration of surgery into traditional medical education, contributing to a new generation of doctors focused on pathology, anatomy and diagnosis. The new orientation toward anatomy was facilitated by this law because it ensured that medical students had enough cadavers to dissect.[125]​ In addition, pathological education was aided by the increased use of autopsies to determine the cause of a patient's death.[123]​ Finally, the 1794 law allocated funds for full-time salaried professors in hospitals, as well as creating scholarships for medical students.[125]​ In Overall, the law of 1794 contributed to medical education moving away from theory and towards practice and experience, all in a hospital environment. Hospitals became a center of learning and development of medical techniques, which was a departure from the previous notion of a hospital as a space that welcomed people who needed help of any kind, sick or not.[126] This change was consistent with much of the philosophy of the time, particularly with the ideas of John Locke, who preached that observation through the senses was the best way to analyze and understand a phenomenon.[125] Foucalt, however, criticized this change in his book The Birth of the Clinic), stating that this change diverted attention from the patient and reified him, which ultimately translated into a loss of the patient's narrative. He argued that from that moment on, in the eyes of doctors, patients lost their humanity and became rather objects of inspection and examination.[127]

Protestant hospitals

Protestant churches re-entered the health field in the 19th century, especially with the establishment of orders of women, called deaconesses, who were dedicated to nursing services. This movement began in Germany in 1836, when Theodor Fliedner and his wife opened the first motherhouse of deaconesses in Kaiserswerth, on the banks of the Rhine. It became a model, and within half a century there were more than 5,000 deaconesses in Europe. The Church of England appointed its first deaconess in 1862. The North London Deaconess Institution trained deaconesses for other dioceses and some served abroad.[128]

In 1849, William Passavant took the first four deaconesses to Pittsburgh, United States, after visiting Kaiserswerth. They worked in the Pittsburgh Infirmary (now Passavant Hospital).[129]

American Methodists made medical services a priority starting in the 1850s. They began opening charitable institutions, such as orphanages and nursing homes. In the 1880s, Methodists began opening hospitals in the United States, serving people of all religious beliefs. In 1895, 13 hospitals were already operating in the main cities.[130]​.

Catholic hospitals

In the 1840s-1880s, Philadelphia Catholics founded two hospitals, for Irish and German Catholics. They depended on the income of paying sick people, and became important health and welfare institutions of the Catholic community.[131] By 1900, Catholics had created hospitals in most large cities. In New York, the Dominicans, Franciscans, Sisters of Charity, and other orders created hospitals to serve primarily their own ethnic group. In the 1920s, they already served everyone in the neighborhood.[132] Also in smaller cities, Catholics created hospitals, such as St. Patrick Hospital in Missoula "Missoula (Montana)") (Montana). The Sisters of Providence opened it in 1873. It was funded in part by the county's contract to care for the poor, and also operated a day school and boarding school. The nuns provided nursing care especially for infectious diseases and traumatic injuries among the young, mostly male clientele. They also proselytized among patients to attract followers and return Catholics who had stopped practicing it to the Church. In 1890 they built a larger hospital.[133]​ The staff of Catholic hospitals was largely made up of Catholic nuns and nursing students, until the number of nuns decreased dramatically beginning in the 1960s. In 1915 the Catholic Hospital Association was created.[134][135]​.

Chinese hospitals

Traditionally, Chinese medicine was based on small private clinics and individual healers until the middle of the century, when missionary hospitals run by Western churches were first established in China. In 1870, Tung Wah Hospital was the first to offer traditional Chinese medicine. After the cultural revolution of 1949, most Chinese hospitals became public.[136][137]​.

Improvements in medicine, medical technology, the great global pandemics of 1918 and 2020, and the management and consolidation of hospitals were the major influences on hospitals during the centuries and .

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."

modern europe

In Europe, the medieval concept of Christian care evolved over the centuries into a secular concept.[93]​ Theology was the problem. Protestant reformers rejected the Catholic belief that wealthy men could earn God's grace through good works – and escape purgatory – by donating to charitable institutions, and that patients themselves could earn grace through their suffering.[94]

Following the dissolution of the monasteries in 1540 by King Henry VIII, the Church abruptly ceased to support the hospitals, and only at the direct request of the citizens of London, the hospitals of St Bartholomew, St Thomas and St Mary of Bethlehem (Bedlam) were endowed directly by the crown. John Abernethy") developed important principles of modern surgery in the century and Mrs. Bedford Fenwich worked to advance the nursing profession at the end of the century.[96]

At the beginning of the Reformation there were 28 asylums in Sweden. Gustav I removed them from ecclesiastical control and expelled the monks and nuns, but allowed the asylums to retain their properties and continue their activities under the auspices of the local government.[97]

In much of Europe, municipal governments operated small Holy Spirit hospitals, founded in the 19th and 19th centuries. They distributed free food and clothing to the poor, cared for homeless women and children, and provided some medical and nursing care. Many were raided and closed during the Thirty Years' War (1618-1648), which devastated the cities and towns of Germany and neighboring areas for three decades.

In Denmark, the beginnings of modern hospital care date back to the Scanian War (1675-1679), in which Denmark suffered disastrous losses. Five public hospitals were founded around the strait: one in Elsinore, two in Copenhagen, one in Landskrona and one in Helsingborg. The one in Landskrona was based on the ancient institution of the Holy Spirit, but had now been modernized and expanded. One of the two institutions in Copenhagen was set up in a former plague hospital. The government spent large sums on equipment, from bone saws to beds and staff. Women cared for wounded and sick soldiers daily, but men were always in charge of these hospitals. They had several surgeons and doctors, but never enough. Meals were based on porridge, herring, beer and peas. When Denmark lost the war, Helsingborg and Landskrona were handed over to the Swedes, but the hospitals in Elsinore and Copenhagen continued their work.[98]

Meanwhile, in Catholic lands such as France and Italy, wealthy families continued to fund convents and monasteries that provided free health services to the poor. French practices were influenced by a charitable imperative that considered care for the poor and sick a necessary part of Catholic practice. The nursing nuns had little faith in the power of doctors and their medicines to cure the sick; The most important thing was to provide psychological and physical well-being, food, rest, cleanliness and, above all, prayer.[99]​.

In Protestant areas, more emphasis was placed on the scientific rather than the religious aspects of patient care, which contributed to the development of a view of nursing as a profession rather than a vocation. After 1530, the main Protestant churches developed very few hospitals. Some smaller groups, such as the Moravians and the Pietists of Halle, gave a role to hospitals, especially in missionary work.

colonial america

The first hospital founded in America was the San Nicolás de Bari Hospital in Santo Domingo, National District of the Dominican Republic. Fray Nicolás de Ovando, Spanish governor and colonial administrator from 1502 to 1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[103] Abandoned in the middle of the century, the hospital now lies in ruins near the Cathedral Basilica of Santa María la Menor in Santo Domingo.

The first hospital on American continental soil was the Santiago hospital "Hospital de Santiago (Santa María de la Antigua de Darién)") in Santa María de la Antigua de Darién (Colombia), founded in 1515. The conquistador Hernán Cortés founded the first two hospitals in North America: that of the Immaculate Conception and that of San Lázaro. The oldest was that of the Immaculate Conception, current Hospital de Jesús Nazareno "Hospital de Jesús Nazareno (México)") in Mexico City, founded in 1524 to care for the poor.[103]​.

In Quebec, Catholics ran hospitals continuously since the 1640s; They attracted nuns from the provincial elite. Jeanne Mance (1606-1673) founded the first hospital in the city of Montreal, the Hôtel-Dieu de Montréal"), in 1645. In 1657 she recruited three sisters from the Religious Hospitallers of Saint Joseph"), and continued to direct the hospital's operations. The project, initiated by the niece of Cardinal de Richelieu, received a royal charter from King Louis XIII and was attended by a colonial doctor, Robert Giffard de Moncel.

In the 20th century, under the influence of the Age of Enlightenment, the modern hospital began to appear, which only attended to medical needs and had trained doctors and surgeons. The nurses were untrained workers. The goal was to use modern methods to cure patients. They provided more limited medical services and were founded by secular authorities. A clearer distinction emerged between medicine and poor relief. Within hospitals, acute cases were increasingly treated alone and separate departments were created for different categories of patients.

1820 Engraving of Guy's Hospital in London, one of the first voluntary hospitals created in 1724.

The voluntary hospital movement began at the turn of the century, with the founding of hospitals in London in the 1710s and 1720s, including Westminster Hospital (1719) promoted by the private bank C. Hoare & Co) and Guy's Hospital (1724) financed from the bequest of the wealthy merchant Thomas Guy. Throughout the century other hospitals sprang up in London and other British cities, many paid for by private subscriptions. St. Bartholomew's in London was rebuilt in 1730, and the London Hospital opened in 1752.

These hospitals represented a turning point in the function of the institution; They began to evolve from being basic places of care for the sick to becoming centers of medical innovation and discovery and the main place for education and training of future physicians. Some of the best surgeons and doctors of the time worked and transmitted their knowledge in hospitals.[106] They also went from being mere foster homes to being complex institutions for the supply of medicines and care for the sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia in response to an outbreak of plague.

The concept of voluntary hospitals also spread to colonial America; Bellevue Hospital opened its doors in 1736, Pennsylvania Hospital in 1752, New York Hospital in 1771, and Massachusetts General Hospital in 1811. When the Vienna General Hospital opened in 1784 (which instantly became the largest hospital in the world), doctors acquired new facilities that gradually became one of the most important research centers.[107]

Another charitable innovation of the Enlightenment era was the dispensary, which provided medicines free of charge to the poor. The London Dispensary opened its doors in 1696 as the first clinic of its kind in the British Empire. The idea took time to catch on until the 1770s, when many such organizations began to appear, such as the Edinburgh Public Dispensary (1776), the Metropolitan Dispensary and Benevolent Fund (1779), and the Finsbury Dispensary (1780). Dispensaries were also opened in New York (1771), Philadelphia (1786), and Boston (1796).[108]

Throughout Europe, medical schools continued to rely primarily on lectures and lectures. In the final year, students had limited clinical experience following the professor around the rooms. Laboratory work was infrequent and dissections were rarely performed due to legal restrictions on cadavers. Most colleges were small and only Edinburgh, Scotland, with 11,000 students, had a large number of graduates.[109]​[110]​.

El médico inglés Thomas Percival") (1740-1804) escribió un exhaustivo sistema de conducta médica, Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons") (1803) que marcó la pauta para muchos libros de texto.[111]​.

A mediados del siglo , los hospitales y la profesión médica se profesionalizaron aún más, con una reorganización de la gestión hospitalaria en líneas más burocráticas y administrativas. La Ley de Boticarios de 1815") obligó a los estudiantes de medicina a realizar al menos medio año de prácticas en un hospital como parte de su formación.[112]​ Un ejemplo de esta profesionalización fue el hospital de Charing Cross"), creado en 1818 como "West London Infirmary and Dispensary" con fondos aportados por el doctor Benjamin Golding"). En 1821 atendía a cerca de 10 000 pacientes al año y se trasladó a unas instalaciones más amplias cerca de Charing Cross, en el corazón de Londres. En 1822 se inauguró la Escuela de Medicina del Hospital de Charing Cross"). Se amplió varias veces y en 1866 incorporó un equipo profesional de enfermería.[113]​.

Florence Nightingale fue pionera de la profesión moderna de enfermería durante la guerra de Crimea, cuando dio ejemplo de compasión, compromiso con la atención al paciente y administración hospitalaria diligente y reflexiva. El primer programa oficial de formación de enfermeras, la Nightingale School for Nurses, se inauguró en 1860 con la misión de formar enfermeras para trabajar en hospitales, atender a los pobres y enseñar.[114]​.

Nightingale desempeñó un papel decisivo en la reforma de la naturaleza del hospital, mejorando las normas sanitarias y cambiando la imagen del hospital, que pasó de ser un lugar donde los enfermos iban a morir a una institución dedicada a la recuperación y la curación. También hizo hincapié en la importancia de la medición estadística para determinar la tasa de éxito de una intervención determinada e impulsó la reforma administrativa de los hospitales.[115]​.

A mediados del siglo surgió la Segunda Escuela Médica de Viena con las aportaciones de médicos como Carl Freiherr von Rokitansky"), Josef Škoda, Ferdinand Ritter von Hebra e Ignaz Philipp Semmelweis. La ciencia médica básica se expandió y la especialización avanzó. Además, en Viena se fundaron las primeras clínicas dermatológicas, oftalmológicas y otorrinolaringológicas del mundo.[116]​.

En Roma, donde la hospitalidad era muy patrimonial gracias a una larga tradición de legados y cuantiosas donaciones (Spedalità romane")), con un real decreto de 1896 se centralizó el vasto patrimonio hospitalario en un solo organismo: el Istituto Pio di Santo Spirito") e Ospedali Riuniti"), que se convirtió así en el mayor de Europa.[117]​.

A finales del siglo , el hospital moderno empezaba a tomar forma con la proliferación de diversos sistemas hospitalarios públicos y privados. En la década de 1870, los hospitales habían triplicado ampliamente su media original de 3000 pacientes. En la Europa continental, los nuevos hospitales solían construirse y gestionarse con fondos públicos"). La enfermería se profesionalizó en Francia a principios del siglo . En aquella época, los 1500 hospitales del país estaban gestionados por 15 000 monjas que representaban a más de 200 órdenes religiosas. A partir de 1900, la política del gobierno fue secularizar las instituciones públicas y reducir el papel de la Iglesia Católica. Este objetivo político entró en conflicto con la necesidad de mantener una mejor calidad de la atención médica en instalaciones anticuadas. Las nuevas escuelas de enfermería gestionadas por el gobierno formaron enfermeras no religiosas a las que se destinó a funciones de supervisión. Durante la Primera Guerra Mundial, una avalancha de voluntarios patrióticos llevó a un gran número de mujeres de clase media sin formación a los hospitales militares. Se marcharon cuando terminó la guerra, pero el efecto a largo plazo fue aumentar el prestigio de la enfermería. En 1922 el gobierno expidió un diploma nacional de enfermería.[118]​.

En Estados Unidos, el número de hospitales alcanzó los 4400 en 1910, cuando proporcionaban 420 000 camas.[119]​ Estaban gestionados por organismos municipales, estatales y federales, por iglesias, por organizaciones independientes sin ánimo de lucro y por empresas con ánimo de lucro. Todas las principales religiones construyeron hospitales; los 541 católicos (en 1915) estaban atendidos principalmente por monjas no remuneradas. Los demás contaban a veces con un pequeño grupo de diaconisas.[120]​ Los hospitales sin ánimo de lucro") se complementaban con grandes hospitales públicos") en las principales ciudades y hospitales de investigación a menudo afiliados a una facultad de medicina. El mayor sistema hospitalario público de Estados Unidos es la New York City Health and Hospitals Corporation"), que incluye el Bellevue Hospital"), el hospital más antiguo de Estados Unidos, afiliado a la Facultad de Medicina de la Universidad de Nueva York.[121]​.

El Servicio Nacional de Salud "Servicio Nacional de Salud (Reino Unido)"), principal proveedor de asistencia sanitaria en Gran Bretaña, se fundó en 1948 y asumió el control de casi todos los hospitales.[122]​.

Paris Medicine

At the beginning of the century, Paris medicine played an important role in shaping clinical medicine. The new emphasis on physical examination of the body gave rise to methods such as percussion, inspection, palpation, auscultation, and autopsy. The situation in Paris was especially unique because there was a large concentration of medical professionals in a very small environment, allowing for a great flow of ideas and the spread of innovation. One of the innovations that emerged in Paris hospitals was the stethoscope. Laennec. Weiner states that widespread acceptance of the stethoscope would likely not have occurred in any other environment, and that this allowed Laennec to convey this technology to the eager medical community that had gathered there. This invention also brought even more attention to the Parisian scene.[123]​.

Before the turn of the century, the French medical system had many problems. These problems were exposed by many who were trying to reform hospitals, including a contemporary surgeon, Jacques Tenon, in his book Memoirs on Paris Hospitals (in French: Memoirs on Paris Hospitals). Some of the problems that Tenon drew attention to were lack of space, the impossibility of separating patients based on the type of disease (including contagious), and general sanitation problems.[124] In addition, the secular revolution led to the nationalization of hospitals that formerly belonged to the Catholic Church and gave rise to a call for hospital reform that, in effect, promoted the deinstitutionalization of medicine.[125] This contributed to the disorganization of Parisian hospitals, which ended up requiring the creation of a new hospital system, outlined in the law of 1794. The law of 1794 played an important role in the revolution of Parisian medicine, as it sought to solve some of the problems faced by Paris hospitals at the time.

First, the law of 1794 created three new schools in Paris, Montpellier, and Strasbourg due to the lack of medical professionals available to treat the growing French army. It also gave doctors and surgeons equal status in the hospital environment, whereas previously doctors were considered intellectually superior.[125] This led to the integration of surgery into traditional medical education, contributing to a new generation of doctors focused on pathology, anatomy and diagnosis. The new orientation toward anatomy was facilitated by this law because it ensured that medical students had enough cadavers to dissect.[125]​ In addition, pathological education was aided by the increased use of autopsies to determine the cause of a patient's death.[123]​ Finally, the 1794 law allocated funds for full-time salaried professors in hospitals, as well as creating scholarships for medical students.[125]​ In Overall, the law of 1794 contributed to medical education moving away from theory and towards practice and experience, all in a hospital environment. Hospitals became a center of learning and development of medical techniques, which was a departure from the previous notion of a hospital as a space that welcomed people who needed help of any kind, sick or not.[126] This change was consistent with much of the philosophy of the time, particularly with the ideas of John Locke, who preached that observation through the senses was the best way to analyze and understand a phenomenon.[125] Foucalt, however, criticized this change in his book The Birth of the Clinic), stating that this change diverted attention from the patient and reified him, which ultimately translated into a loss of the patient's narrative. He argued that from that moment on, in the eyes of doctors, patients lost their humanity and became rather objects of inspection and examination.[127]

Protestant hospitals

Protestant churches re-entered the health field in the 19th century, especially with the establishment of orders of women, called deaconesses, who were dedicated to nursing services. This movement began in Germany in 1836, when Theodor Fliedner and his wife opened the first motherhouse of deaconesses in Kaiserswerth, on the banks of the Rhine. It became a model, and within half a century there were more than 5,000 deaconesses in Europe. The Church of England appointed its first deaconess in 1862. The North London Deaconess Institution trained deaconesses for other dioceses and some served abroad.[128]

In 1849, William Passavant took the first four deaconesses to Pittsburgh, United States, after visiting Kaiserswerth. They worked in the Pittsburgh Infirmary (now Passavant Hospital).[129]

American Methodists made medical services a priority starting in the 1850s. They began opening charitable institutions, such as orphanages and nursing homes. In the 1880s, Methodists began opening hospitals in the United States, serving people of all religious beliefs. In 1895, 13 hospitals were already operating in the main cities.[130]​.

Catholic hospitals

In the 1840s-1880s, Philadelphia Catholics founded two hospitals, for Irish and German Catholics. They depended on the income of paying sick people, and became important health and welfare institutions of the Catholic community.[131] By 1900, Catholics had created hospitals in most large cities. In New York, the Dominicans, Franciscans, Sisters of Charity, and other orders created hospitals to serve primarily their own ethnic group. In the 1920s, they already served everyone in the neighborhood.[132] Also in smaller cities, Catholics created hospitals, such as St. Patrick Hospital in Missoula "Missoula (Montana)") (Montana). The Sisters of Providence opened it in 1873. It was funded in part by the county's contract to care for the poor, and also operated a day school and boarding school. The nuns provided nursing care especially for infectious diseases and traumatic injuries among the young, mostly male clientele. They also proselytized among patients to attract followers and return Catholics who had stopped practicing it to the Church. In 1890 they built a larger hospital.[133]​ The staff of Catholic hospitals was largely made up of Catholic nuns and nursing students, until the number of nuns decreased dramatically beginning in the 1960s. In 1915 the Catholic Hospital Association was created.[134][135]​.

Chinese hospitals

Traditionally, Chinese medicine was based on small private clinics and individual healers until the middle of the century, when missionary hospitals run by Western churches were first established in China. In 1870, Tung Wah Hospital was the first to offer traditional Chinese medicine. After the cultural revolution of 1949, most Chinese hospitals became public.[136][137]​.

Improvements in medicine, medical technology, the great global pandemics of 1918 and 2020, and the management and consolidation of hospitals were the major influences on hospitals during the centuries and .