Hospital Life: Theory and Practice from the Medieval to the Modern ed. by Laurinda Abreu and Sally Sheard (review)

Twelve historical case studies illustrate the gradual transformations of an institution currently experiencing challenges to its dominant position in health care: the hospital. Like its 2007 predecessor, the collection contains papers from the 2011 conference organized by the International Network for the History of Hospitals created in 1995. The topic, hospital life, primarily features a detailed analysis of the external circumstances that shaped it: social, cultural, and economic. Such framing allows authors to present their contingent and richly documented accounts in a chronologically arranged manner from medieval times to the present.

Life in a hospital is still shaped by the needs of sponsors and those sufferers permitted to enter. For the latter, cast among strangers, the sudden transition into an alien world with stricter rules and routines can still be shocking and disorienting. To achieve institutional order and communicate meaningful support, hospitals historically engaged in a variety of routines and rituals, beginning with regular, communal meals. As one essay concerned with a medieval English institution (Bonfield) attests, this “regimen” included spiritual support, nourishment, and clean clothing, all attempts to provide a measure of comfort and perhaps facilitate rehabilitation. But could these measures be considered “therapeutic”? The picture becomes clearer in subsequent centuries as medicine and nursing came to recast hospital functions in the face of new contagious diseases. Two chapters, one about patient care for syphilis in Lisbon’s Real Hospital (Arrizabalaga) and one about Florence’s Hospital of the Incurable (Strocchia), illustrate a willingness to exploit larger institutional populations for the acquisition of new medical knowledge—mercurial or guaiac therapy—and eventually training and education (Abreu).

Another contribution is devoted to the financial management of an early modern hospital in Düsseldorf (Dross), exposing in great detail the primary goal of its private founders: ensure institutional continuity for their eternal salvation. For this purpose, keen business practices from real estate rents and crop and wine sales to annuities and mortgages all generated the income required for the upkeep of buildings, lodging, feeding inmates, and paying physicians’ visits. Later, as states assumed the responsibility of sponsoring and running hospitals, foundations such as the Infirmary of the Hotel des Invalides in Paris (Belmas) and Royal Lying-in Hospital in Copenhagen (Løkke) imposed their own social and therapeutic agendas to shape hospital life.

By the eighteenth century, larger institutions, especially in metropolitan centers such as Paris and London, demanded a more rigid structuring of nursing and medical routines. Controlling working-class patients, forcing them into total subordination and subjecting them to experimental treatments became the norm (Belmas, Tanner, and Hawkins). Lunatic asylums in Corfu and Malta, however, allowed for an “open gate” policy with family and friends visiting daily (Chircop). The New World is represented by an essay on slave hospitals in Augusta, Georgia, focused on a private pre–Civil War institution designed for the rehabilitation of individuals who were then viewed as valuable commodities (Kenny). Following accidents and obstetrical complications, the goal was to restore their “soundness,” particularly the capacity for labor and reproduction. Here again business and professional medical agendas were the primary drivers.

Two important chapters address recent issues of cost containment and efficiency affecting the character and length of hospital stay. As twentieth-century establishments became expensive houses of technology, planning and architectural design sought to assist in streamlining their diagnostic and therapeutic functions in compact, assembly-line fashion (Theodore). “Traffic efficiency” (coded through colored lines and arrows) for a more economic movement of nurses, doctors, and patients—later supplemented by computers and robots, reshaped institutions into a “cybernetic healing machine.” Evermore shorter hospital stays compress hospital life; often domicile recovery follows overnight sojourns, even after invasive surgery. A close look at the background and shifting boundaries between active care and convalescence offers a fascinating glimpse into medical economics (Sheard). In sum, as the editors contend, this collection...