What’s in a Name? What is a Hospital? Part 2

LGI sign


Healthcare establishments have gone by many names with the meanings changing over time. Indeed hospital should be seen as a generic term rather than one that holds the specific meaning it has today. Certainly it was widely used, but its early meaning owed more to concepts of hospitality or hosting than cure. However, in the second half of the nineteenth century in Britain, North America and France it was increasingly associated with the treatment of acute patients with an intention to cure or ‘materially relieve’ by the use of medical knowledge, techniques and technologies.

Grange Blanche

The new Hopital Edouard-Herriot in Lyon (c.1934) constructed to replace the Hotel-Dieu

Yet in the mid-eighteenth century, when many new general institutions were opened by British philanthropists, the word infirmary was commonly used, as with the General Infirmary at Leeds, the Royal Infirmary of Edinburgh or Bristol Royal Infirmary. Moreover, this was a tradition that continued into the nineteenth century, for example with Middlesbrough’s North Riding Infirmary opened in 1864. Yet the name was increasingly associated with a place for the non-acute patient, a trend speeded up with the development of the workhouse Poor Law Infirmary.



Alexianer St. Hedwig Krankenhaus, opened in 1846

In a similar vein many of Europe’s sick were treated in places not called hospital. In France, for example, more patients were admitted to hospices than hôpitaux. Similar in heritage and function to the English poor law infirmary, the hospice cared for a wide range of patients unable to care for themselves. In the German speaking world the central health care institution was the krankenhaus or literally sick house with the word hospital rarely used. In the early twentieth century the word clinic was increasingly adopted. Originating in France, it was taken up enthusiastically by US institutions – most famously the Mayo Clinic – and returned to Europe where it was usually associated with a specific, but potentially self governing, specialist part of a hospital. In Lille the Regional Hospital Centre initially opened in 1953 grew by adding more and more clinics based on the original Calmette tuberculosis clinic.

Mayo Clinic - 1927-79

The First Mayo Clinic in Rochester, 1914. 

The nineteenth century also saw the rise of the sanatorium, an environment where care and cure were mixed. Predominantly associated with tuberculosis treatment and often located in remote spots with plenty of fresh air and sunlight, the sanatorium attempted to sit outside the conventions of institutional medicine. The word was also used for convalescent homes, especially for the worn out wealthy! In the British context the latter category of patients were also to be found in the obliquely named nursing homes. Here the suggestion is of care not cure, yet many of these places were run by leading physicians and surgeons who successfully treated a significant proportion of the middle and upper classes in often impressive surroundings.


However, the most interesting of the health care institutions to eschew the name hospital is the asylum. The word derives from place of refuge and was used widely in the nineteenth century for a range of caring institutions. However, it became most closely associated with the care and treatment of mental health conditions. It was in vogue from the early nineteenth century until the early-twentieth century when changes in treatment regimes brought these institutions more into line with the curative practices of the general hospital. Thus in the 1920s the Royal Edinburgh Asylum was renamed the Royal Edinburgh Hospital for Mental and Nervous Disorders, but in most cases the name asylum remained.

Wakefield PLA

Wakefield Pauper Lunatic Asylum, later renamed Stanley Royd Hospital

Thus, a sick person could end up in an institution for the delivery of medical care or cure that may or may not have been called a hospital. Out of the confusion of the eighteenth century different names came to represent different functions – hospital for the acute and the curative, infirmaries and hospices for the long term sick or frail, asylum for those with mental health conditions, sanatoria for long term recovery, especially from TB, nursing homes for the wealthy, and clinics for the latest therapies. Yet some of the old words have stuck, leaving us to wonder why Scotland’s newest hospital is an infirmary?


{It looks like this series may run and run – Like Purnell’s History of the Second World War!]



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