Health care is an activity which exists since the origin of humankind. It is influenced by sociocultural circumstances which characterize every time and place in history. Within this sociocultural context, beliefs and among them religion along with the prevalent concept of sickness in every time are going to be crucial to analyze the evolution of health care.
Since its beginning, health care has been directly linked with satisfying the most basic needs for survival such as feeding, security assurance, shelter, coziness…and tied to two different periods during life where dependency from other people is blatant: childhood and old age. Therefore, the first background of health care are related to the beginning of the vital cycle, childbirth care and of each new incorporation to the community…focused on the basic needs' satisfaction. If in addition it is considered that first civilizations developed their activities within a ile environment, where the number of natural foes of humankind were considerable, physical differences men and women propitiated a work sexual division. Men devoted to external work which requires a higher physical strength. Women devoted to the close environment, especially to everything related with cares. This circumstance marked the becoming of history.
This women's entailment to care and the beginning of the vital cycle propitiate the appearance of women devoted to health care beyond their home. During Roman Empire there were women giving health care in childbirth and the newborn. Same happened during Middle Age, where women were recognized as caregivers, due to their distinguished characteristics related to fertility, be the bearer of every new family member, responsible for giving birth and in charge of protecting and feeding the new offspring.
Since its origins, the concept of disease of physical handicap had a magical component which stemmed from myths and superstition beliefs invented by the ancient man to control ideologically as a mean to reduce fear, explain the nature phenomena that were not explicable. In this context, disease is read into as an ill produced by spirits of god's punishment. Each disease was linked to superstition, the patient was attended by the members of her family which appealed to the warlock, quack or shaman.
These figures, witches, quacks…combined some rituals with their capacity to observe natural phenomena, gathering information of attended cases to apply it to new ones. Magical thinking is prevalent in the disease attendance in this way.
In this context, Catholic Church, takes the advantage of Cristian thinking promotes altruism, charity and sick and helpless attendance people as a path to follow in order to save one's soul. Hence it starts to monopolize health care by adapting and transforming the rituals and superstitions tied through the magical thinking to the disease into religious matters. That is to say, magical thinking is kept, but the focus is transformed. The shape changes but not the ground.
Thereby during Middle Age Hospital or closed institutions loomed up close to or at the sides of churches and cathedrals. These ones are built by nobles' and riches' exercise of charity preached by the Church as a path to salvation. These institutions devoted to the attendance of the least favored people in the society at that time had an important role during the big epidemics that razed Europe. In addition to the numberless shortages that these places piled up, an inadequate diet merged which caused the emergence of deficiency diseases, unknown by that time, to which. Skin diseases caused by vermin joined.
Health care in those places were given by religious man and women from different orders. It doesn't have to be forgotten that women kept on being the main provider of cares in the domestic environment. In this way, during the third century of our age, the Cesárea Bishop, Saint Basile creates an order devoted to Hospitals building for caring sick and helpless people. The Saint Benito Rule, in VI century will be the one which definitely mark the development of religious orders in Europe.
Medieval Hospitals encompassed four type of institutions: leprosarium, asylum and poorhouse; refuge and institutions dedicated to homeless sick people. All of them were located close to Cathedrals and rivers. Later, guilds built and maintained hospitals. The weight of care always relapsed on the different orders' sisters belonging to the hospital service and on the service personal employed in the institution.
During the Late Middle Age, an epoch where misery and famine were in the agenda, the population was at the mercy of big epidemics that devastated Europe. Pilgrimage paths to Jerusalen, Holy Land, and Santiago de Compostela come up. During those, thousands of pilgrims died. More hospitals and nurses were required to attend the wayfarers. The Church promoted Hospital building held up by collections opportunely carried out. Military orders tied to nursing, attention and protection of sick pilgrims loomed. These orders were a consequence of the crusades to Holy Land. There is not much information about cares given by this warrior nurses. On the contrary there is evidence that they built and equipped big hospitals and care the sick people themselves.
In this way the first Military Orders such as The Hospitable Knights of San Juan de Jerusalen, The Teutonic Knights; the Malt Order, The San Juan de Lázaro Knights and the Holy Tomb Knights, the famous Templars. The heyday of religious military orders also arrived to Spain and The Calatrava, Montesa Orders and Santiago Knights appeared.
The first acknowledged hospitals are: the Hotel Dieu in Lyon (France, year 542), Hotel Dieu in Paris (France, year 650) and the Santo Espirito Hotel in Rome (Italy, year 717). In Spain, the first one is the Merida Hospital, founded by the Bishop of the city.
In Hispania with Goth Monarchy, during Visigoths reign V and VIII centuries The “Fuero Juzgo” or “Judges' Book” came up. The name of our forefathers, the “bleeders” already appears in this book. In XIII century in Castille Reign according to the Code "The Seven Items" from King Alfonso X the Wise they ranked as alfajemes, also known vulgary as barbers. They were to shave and bleed in separated places, not in squares and streets.
Our forefathers already started to marshal guilds and brotherhoods with an important growing of liberal professionals such as ours.
It is written that during XIV century the first Barbers' and Surgeons' Brotherhoods are founded under the invocation of Holy Patrons Saint Cosme and Saint Damian. These brotherhoods were religious–beneficial institutions. Although in their statutes norms about professional practise were dictated in as much as to practice as barber–surgeons they had to be examined by two brotherhood's surgeons.
It has to be noted that every Group, Guild, Association, etc. was realizing that it is not only "to give care" but also to "know how to give care" what is all about. Therefore they grouped up and as it has already been said before belonging to a Brotherhood one had to pass an exam and be examined. Not only did they realize that know was important, but also study.
As an example, during year 1310 in Valencia the Barbers' and Surgeons' Brotherhood had one theoretical part and one practical part in the exam for its candidates. It is also collected in Barcelona in 1408 that its exams were the same as the Valencia's in the Barbers' and Surgeons' Professional Brotherhood of Saint Cosme and Saint Damian.
In Madrid, during year 1385, 11 hospitals were unified to one. "The General Hospital" divided into two houses: one for the infectious and another for the noninfectious sick people. In 1524, Carlos V established "Royal Hospitals" where tasks and personal funcions, amongs them the main nurse and the assistant nurses. The healthcare was also covered in brotherhoods, guilds and fraternities.
The capability to practise the profession was gathered in by King Fernando and Queen Isabel, on the April 9th 1500 in a Royal Pragmatic dictated in Segovia which stated that:
“We command that from now on, Senior Barbers and Examiners, neither accept nor bring on that either any barber or other alien person, may set up shops to lance or bleed, take leeches or suckers, extract teeth or molars, without previously having been examined by such Senior Barbers. In case any person should incur in aforementioned activities without the prescriptive examination as said, shall be d perpetually incompetent to practice such job, and shall pay two thousand maravedies as penalty to our Chamber, etc…”
We know what our forefathers study. Hence in 1541 they had as study book, the “Book of Midwives and Pregnant, Parturient and Children Regiment”, in 1583 the “Treatise on venae festosin usefulness”; in the same year the “Treatise on bleeding usefulness”; in 1604 “Prematica by which the examination order is given to Novelist Surgeons”; in 1617 “Nurse Instruction and Comfort to Afflicted Sick People. And True Practise as to how the remedies prescribed by doctors must be applied. Very Indispensable for sick people to be well healed and helpful for medicine practitioners”; etc.
By Royal Document from Felipe V, on the 29th January 1711, the Bleeders Class was created. This supposed a first step for the coordination of the different jobs and professions that formed an all in the different branches of the science advocated to healing sick people.
In 1843 the “Medicine and Practical Surgery Auxiliary in the art of healing” was approved and in 1846 the “Ministering” were.
Such laws were substituted by the Royal Order on 9th September 1857, the so called “Moyano Law” (due to the Promotion Minister Mr. Claudio Moyano) who under the shelter of the Organic Sanitary Law of 1855 regulated the auxiliary sanitarians professions, thus recognising practisioners and midwives as practisioners of one job.
In 1896 Dr Federico Rubio y Gali opens up the first Santa Isabel of Hungary Secular School of Nursing.