The American hospital experience both mirrors and distorts the history of hospitals in Europe. In our own time, the differences have become the more salient facts. Contemporary analysts point particularly to variations in strategies for allocating scarce resources and for ensuring access across social classes. These differences are certainly significant, but it may be more useful in this setting to begin with fundamental similarities that appear across national boundaries in the history of hospitals in the West. The essential commonalty is that hospitals developed in the West long before any purely medical factors made them necessary.

For a millennium the hospital was a response to social forces; nearly the whole of its history predated any scientific imperative making the institution the preferred site of medical treatment. Premodern versions of the hospital provided care for individuals willing - or desperate enough - to abandon their own people at times in their lives when they were especially vulnerable and go among strangers for care. Home care until recently remained the norm; families looked after their sick as they socialized their young. In a seminal article, Henry E. Sigerist traced the appearance of the hospital to medieval Europe, where institutional care of the sick originated in the incidental medical care provided inmates of guesthouses, poorhouses, and jails. The population movements and social turmoil that accompanied the Crusades increased the numbers of these institutions, and with them the numbers of travelers, the impoverished, or the incarcerated who might be in need of medical treatment. Social forces also provided the key to the second stage in Sigerist s topology; the nineteenth century witnessed the appearance of specifically medical institutions. These were devoted to the care of the poor, and the otherwise marginal, groups by their social position.