hospital is an institution that, as a care environment, shapes practices and connects the people who reside there. While this environment transforms its mission, expands or benefits from new equipment, then new knowledge emerges and will be acquired by those who work or live in the hospital. In fact, the hospital environment in a way describes the nature of the background in which care is given. This environment becomes central when the foundations of the discipline and the space and time in which knowledge is created must be rediscovered. “The institution thus shapes the interpretative procedures of situations. Institutions are shaped by models of rationality that they develop reflexively” [DEM 99].
The foundations of the nursing discipline are rooted in hospital space and time. The lay era of the discipline, by linking language to “the only truly scientific concepts that were those related to the geometry of space and time” for Thom, gave meaning to the knowledge in use. The nursing discipline did not grow “above ground”. Hospital spaces allowed the knowledge of care and assistance to life to exist. This knowledge could then be transformed into deeds and words. “Only concepts that can be geometrized and related to space and time are susceptible to universalization and therefore scientificity (…). We know and act only locally” [THO 83]. Hospital space and time as an environment thus determined the first scientific element of the discipline still to be born. With the birth of the hospital, these traditions of language became important for the quality of knowledge and the background of discursive events dear to Foucault in which the nursing discipline could appear. The framework was set. These are the reasons why we place the care environment (the hospital) as the first and central concept that conditions the unique perspective of the so-called “nursing” sciences. For many theorists today, the care environment is also a central concept that characterizes the substance of the nursing discipline [DAL 08a]. Space refers to place, time is what escapes and reminds us of our condition as mortals. These two elements allow us to perceive movement.
Without these two particular dimensions, space and time, language first, discipline second, as signs of human activity, cannot exist. For he or she who could hold this language would have had no place to speak or to make speak, to write or to make write, and consequently, no discursive activity to carry out either. For Auffray “space and time are the familiar benchmarks within which we interpret what we perceive of the world around us, especially movement. This has been the case since the beginning of humanity” [AUF 96]. Therefore, identifying the space in which knowledge of action begins is fundamental to account for the transformation of tacit knowledge into scientific knowledge and to recover the knowledge of care that inhabits the discipline. The first words pertaining to lay care thus constituted “a set of anonymous, historical rules, always determined in time and space, which have defined at a given time and for a given social, economic, geographical or linguistic area, the conditions for exercising the enunciative function” [FOU 69].
From the Middle Ages to the end of the 18th Century in Europe, particularly in French-speaking Switzerland, cities had their lay hospital institutions to “take care” of people who were often marginalized or lonely and bear the miseries of life. These institutions, financed by the bourgeoisies of the time, began to organize themselves in many ways, but were very often inspired by the ordinary family dynamic associated with models from old-style communities, inns, farms or various collective households. For example, the Geneva hospital in 1744 (a Protestant canton), which could accommodate about 136 people for a population of 14,400 inhabitants around 1590, already represented a veritable spatial mosaic through its multiple work and speech spaces, among which was the “general hospital”, more often referred to as “the house”, the cellar, the bakery, the butcher’s shop, the stables, the factories, the house of correction, the shoemaker’s shop, the school for the children housed in the hospital, the tailor’s room, the mills, the granary of the seed collector, the hospital funds (the countryside with farms, vineyards, meadows and gardens, the forests of Jussy, des frères, de Bay, of La Petite Grave and Céligny)4, the hospital shop, the houses belonging to the hospital (staff accommodation), the temple of the house, the refectory, the shops and pyres, the large kitchen, the room “of the bourgeois women and girls”, the room “of the poor of the house”, the room “of the working class”, the room “of the able-bodied women and girls”, the room of the sick “both men and boys and women and girls received in the house”, the room of passers-by and beggars, the room of “those bleeding, epileptic and others” who had unfortunate illnesses, the room of “those who suffered from venereal diseases, shameful illnesses or of a particular character” [NAD 93].
These talking spaces of course had their occupants with their lifestyles and languages. As early as 1759, the Freiburg Hospital (Catholic canton) could accommodate between 80 and 110 people for a town with a population of about 6,100. The distribution of the premises in Freiburg in 1759 demonstrated some differences with those of the Geneva hospital in 1744. It is rather classes (from the first to the eighth) and statuses that we are talking about. Thus, we can distinguish the apartments of the hospital staff, their family and servants, the men’s dormitory, the women’s dormitory (the dormiaudes), the servants’ room, which were often, as the texts say, “fed, housed, heated, lit, whitewashed and medicated”, the room or stove for the sick or krankenstube, the children’s room (kinderstube), a space (often in the basement) for the inpatients, foolish, chained, dumb5 and a space for the “poor passers-by” who were often “foreign beggars, French deserters, prowlers” [NAD 93, NAD 12b].
There was also an investment in stone6. “In the 15th century, the hospital became a large landowner with a high income” [ROD 05] and made the institution a source of liquidity for the municipal authorities. This situation was not unusual in many medieval hospitals. Sometimes it worked, sometimes it did not, because of wars, bad management, spoliations or difficulties in maintaining the constructed heritage. The Freiburg Hospital was managed to function as usual between the 14th and early 19th Centuries (over five centuries), despite the invasion, economic and disciplinary problems caused by Napoleonic troops as early as March 2, 1798. The hospitals of the Franche-Comté region near the Franco-Swiss border were also destroyed, particularly in the 15th Century. This remark shows the difference that could sometimes exist between hospitals with regard to the integrity of the places and structures. Out of 33 establishments listed by Nicole Brocart, “three were reported destroyed between 1363 and 1376, twelve were destroyed in 1435 and 1459, and eleven again between 1479 and 1484”. The 15th Century proved to be particularly disastrous for the Franc-Comté hospitals, “whose temporality was turning into a time of ruin and lesser value”. The difficult economic situation also contributed to compromising their management and reducing their revenues [BRO 98].
The urban or rural space where there were hospitals, some of which have now disappeared, was “a highly compartmentalized world, a mosaic of territories with extremely diverse statuses. We can speak of an atomized urban fabric” [WAL 94]. The size of the regions was often a function of the accessibility threshold. In the 18th Century, this threshold was defined as 2 hours of walking, or 8 km or 10 to 20 km by stagecoach. Cities were then used as staging posts in the era of slow transport. “Nomadism was also a fundamental feature of the population structure in the 18th century” [WAL 94]. Under these conditions, small, medium or large towns at the same time welcomed travelers who could not afford an inn and made their properties and the products of hospital work bear fruit. This may also explain the presence of small hospitals as well as hospitality houses along the communication routes.
Around the hospital, in buildings sometimes adjoining it, it was not uncommon to find, depending on the size of the town, functional buildings such as barns, stables, attics, sheds, stores, an oven, a butcher’s shop or slaughterhouses, as well as buildings that could be used as functional housing for employees. In comparison with the urban Geneva hospital, the rural lay Bulle hospital in 1738, had only one floor, a kitchen, the “poile des pauvres” (6–12 places in “two poorly constructed bedframes”7),
