History Early development
Linguistically, the word "hospice" derives from the Latin hospes, a word which served double-duty in referring both to guests and hosts.[1] The first hospices are believed[by whom?] to have originated in the 11th century, around 1065. The rise of the Crusading movement in the 1090s saw the incurably ill permitted into places dedicated to treatment by Crusaders.[1][2] In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying.[3] Hospices flourished in the Middle Ages, but languished as religious orders became dispersed.[1] They were revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul.[3] France continued to see development in the hospice field; the hospice of L'Association des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843.[4] Six other hospices followed before 1900.[4]
Meanwhile, hospices also developed in other areas. In the United Kingdom, attention was drawn to the needs of the terminally ill in the middle of the 19th century, with Lancet and the British Medical Journal publishing articles pointing to the need of the impoverished terminally ill for good care and sanitary conditions.[5] Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, which by 1892 offered 35 beds to patients dying of tuberculosis.[5] Four more hospices were established in London by 1905.[5] Australia, too, saw active hospice development, with notable hospices including the Home for Incurables in Adelaide (1879), the Home of Peace (1902) and the Anglican House of Peace for the Dying in Sydney (1907).[6] In 1899, New York City saw the opening of St. Rose's Hospice by the Servants for Relief of Incurable Cancer, who soon expanded with six locations in other cities.[4]
The more influential early developers of Hospice included the Irish Religious Sisters of Charity, who opened Our Lady's Hospice in Harold's Cross, Dublin, Ireland in 1879.[4] It became very busy, with as many as 20,000 people—primarily suffering tuberculosis and cancer—coming to the hospice to die between 1845 and 1945.[4] The Sisters of Charity expanded internationally, opening the Sacred Heart Hospice for the Dying in Sydney in 1890, with hospices in Melbourne and New South Wales following in the 1930s.[7] In 1905, they opened St Joseph's Hospice in London.[3][8] There in the 1950s Cicely Saunders developed many of the foundational principles of modern hospice care.[3]
Rise of the modern hospice movement
St Christopher's Hospice in 2005
(Dame) Cicely Saunders was a British registered nurse whose chronic health problems had forced her to pursue a career in medical social work. The relationship she developed with a dying Polish refugee helped solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns as well as palliative comfort for physical symptoms.[9] After the refugee's death, Saunders began volunteering at St Luke's Home for the Dying Poor, where a physician told her that she could best influence the treatment of the terminally ill as a physician.[9] Saunders entered medical school while continuing her volunteer work at St. Joseph's. When she achieved her degree in 1957, she took a position there.[9]
Saunders emphasized focusing on the patient rather than the disease and introduced the notion of 'total pain',[10] which included psychological and spiritual as well as the physical aspects. She experimented with a wide range of opioids for controlling physical pain but included also the needs of the patient's family.
She disseminated her philosophy internationally in a series of tours of the United States that began in 1963.[11][12] In 1967, Saunders opened St. Christopher's Hospice. Florence Wald, the dean of Yale School of Nursing who had heard Saunders speak in America, spent a month working with Saunders there in 1969 before bringing the principles of modern hospice care back to the United States, establishing Hospice, Inc. in 1971.[3][13]
At about the same time that Saunders was disseminating her theories and developing her hospice, in 1965, Swiss psychiatrist Elisabeth Kübler-Ross also began to consider the social responses to terminal illness, which she found inadequate at the Chicago hospital where her American physician husband was employed.[14] Her 1969 best-seller, On Death and Dying, was influential on how the medical profession responded to the terminally ill,[14] and along with Saunders and other thanatology pioneers helped to focus attention on the types of care available to them.[11]