The very early hospices began in Europe during the eleventh and twelfth centuries. They were primarily monasteries but they opened their doors to welcome travellers who were in need of rest, shelter and food. Those who were ill were looked after until they were well enough to continue their journey. Many of the travellers were men who were fighting in the wars of the Crusades, or pilgrims on their way to the Holy Land.
The meaning of the word "hospice" comes from the Latin "hospis", which meant "a host and guest". The Latin "hospitalis" meant "friendly, welcome to a stranger". From this derived the word "hospitality".
After the Reformation, in which many convents, monasteries and priories were closed those that remained became almshouses for the elderly and continued their work in helping travellers.
By the Nineteenth Century the few remaining hospices offered an alternative to the "charitable hospitals for incurables" and workhouses, which were supposed to care for the sick and destitute, but which, in actual fact, were dreaded by the very people they were supposed to help.
From these early beginnings it can be seen how today's hospices became involved in looking after those who were very ill.
The word "hospice" as a description of a place which cared solely for people who were dying was first used in 1842 by Mme. Jeanne Garnier in Lyons, France. The Sisters of Charity began their work in Ireland in 1879, and used the same word, quite independently, to describe their institution.
The establishment of hospices in the United Kingdom as a place for the care of people with incurable illnesses began in 1885 in Edinburgh at what is now called Saint Columba's Hospice.
In 1891, the Hostel of God, now known as Trinity Hospice, Clapham, London, was opened by the Sisters of Margaret. It was funded by an appeal by the Hoare family (famous bankers) to fund a home for people in "the advanced stage of mortal illness". This started the heavy reliance on charitable giving which still continues in the hospice movement and without which many hospices would not survive.
In 1892, a Doctor Barrett and the West London Mission opened Saint Luke's Home for the dying poor, which later became Saint Luke's Hospital. This was significant because it was the first time a medical person had founded such a place.
At about the same time, Cardinal Vaughan was very concerned for the sick of London's slums. He brought the Sisters of Charity from Ireland to work in the East End and they set up Saint Joseph's Hospice in Hackney. The first patient, on the 14th January 1905, was a tram driver suffering from pulmonary tuberculosis (a disease of the lungs), which could not at that time be cured.
Although there was originally no intention that hospice care should be only for people with cancer, there was growing concern at the turn of the century for victims of the disease. In 1911, Douglas Macmillan was so moved by watching his father die of cancer that he founded the National Society for Cancer Relief, now known as Macmillan Cancer Relief. It recognised the need for special homes and home care services to help those with advanced cancer.
Building on this work, Squadron Leader Bernard Robinson founded the Marie Curie Memorial Foundation in 1948. He was inspired by Winston Churchill who had commented that the casualties from cancer were far worse than those caused by the Second World War. Squadron Leader Robinson and his colleagues named the foundation after the pioneering scientist who, until her death in 1934, had devoted her life to research into radiation and its use as a treatment for cancer.
In 1952 the Marie Curie Foundation issued a report urging the setting up of special residential homes for the care of cancer patients who were seriously ill and convalescing. The report stated that they should receive skilled nursing care in a non-stressful and cheerful environment.
The hospice movement as we know it today was founded in Britain by Dame Cicely Saunders.
In the 1950s Cicely Saunders (who later became Dame Commander of the British Empire because of her pioneering work) began to develop the techniques of pain control which she had first observed when a volunteer at Saint Luke's Hospital. It is little known that Dame Cicely is qualified in three different professions; she first became a registered nurse; then a certified social worker, and finally, she became a qualified doctor when she recognised it was the only way she would be able to realise her ambition to help those in pain in the way she wished.
At Saint Luke's Hospital the practice had been to give tablets regularly to stop pain, rather than wait until the person complained of discomfort. This system operated very well and provided the basis on which Dame Cicely continued her work.
She originally conceived her idea of opening a home, especially for those with incurable diseases, in 1947. Her aim was to establish a place dedicated to research and patients. These extra components make the modern hospice movement different from its forerunners and this is why Dame Cicely is acknowledged as the founder of the modern hospice movement.
Saint Christopher's in Sydenham in South East London, which is Dame Cicely's 'own' hospice, opened in 1967 and had largely been inspired by David Tasma, one of her early patients. Through their special relationship, as he lay ill, she gained a valuable insight into how the dying could be helped and cared for, not only physically but also emotionally and spiritually.
David left the first £500 she needed to launch Saint Christopher's. "I'll be a window in your home", he had said. Today a vast window at the front of the hospice is called "The David Window".
Since the opening of Saint Christopher's more than 220 similar units have been set up throughout the United Kingdom. Many of these have specialist palliative care teams which go into patients' homes working with other community healthcare professionals. Many also have day care facilities.
Although hospices have cared primarily for people who have advanced cancer, many are now including people with other life-limiting illnesses, such as Motor Neurone Disease and AIDS.
The Hospice Movement World-wide
Many people from all around the world visited hospices in Britain and saw what was being done to help those in need. Following Dame Cicely's example, they returned to their own countries, determined to give similar help to their own people.
The philosophy of hospice care, with its special approach to helping with the problems faced by the patients and their families, was not always easily understood by people who had not experienced it. It was not easy to explain, and even harder to gain the co-operation of doctors and nurses in countries where the concept was unknown. It was also very difficult, sometimes, to gain the agreement of governments to allow the establishment of hospices and to grant funds for development.
In many of the world's cultures, death is viewed differently from the United Kingdom. People have a more tolerant attitude to pain and dying; they do not expect help when they or their loved ones are suffering in the terminal stages of a disease. They accept extremes of pain without expecting relief. In many parts of Russia, for instance, cancer (the disease at which hospice care is most often directed there), is thought to be always hideously painful, infectious and incurable.
Historically, the people have never expected help without paying for it. They are suspicious of anyone offering good quality care for nothing. As a result, many suffer intolerably because they see no purpose in going to the doctor early enough for the disease to be treated in its early stages.
They fear the consequences of possible surgery and they fear being isolated by their families. When patients are eventually seen by a doctor, the disease has invariably spread out of control and is beyond curative treatment.
Nevertheless, pioneers in different countries continued to fight for what they believed to be right for the care of terminally ill people. Now, there are many other countries which have hospices.
They include the United States, Canada, Australia, New Zealand, France, Germany, Italy, Spain, Greece, Latin America, India, Kenya, Nigeria and many countries of Eastern Europe including Poland, Russia, the Czech Republic, Romania, Albania, Belarus, Croatia, Estonia and Lithuania.
Saint Christopher's Hospice in London keeps a Directory of Foreign Hospices, as a service to all those who need information about them.
Hospices in many of the poorer countries are quite unlike those which we know in the United Kingdom. They are often funded differently, either because the people do not have enough money to give to charitable causes, as they do here, or because there is no tradition of charitable giving, or because their governments simply do not have enough money to finance them.
Hospices in the third world are also different in appearance from those in the United Kingdom. They are often cramped, lacking comfortable furniture, and housed in dilapidated former orphanages, or hospitals.
Enthusiasts for the movement have worked in their spare time to rebuild and redecorate them. Richer nations have donated equipment and other resources.
It is this which is the distinguishing feature of hospice care everywhere and which is so successfully practised by our less fortunate colleagues in many countries abroad.
Farleigh Hospice opened in 1982 and was based upon the principles set our by Dame Cicely Saunders. Since then, like the much of the hospice movement, Farleigh Hospice has grown to care for patients and relatives from much earlier on in their conditions with the focus being on life rather than death. Our huge range of services support peope from diagnosis and care for patients and their families as a whole; physically, socially, emotionally and spiritually.