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The paper presents aspects of the history and archives of Grace Memorial Hospital, founded in 1926 in the former town of Ponte Nova, now Wagner, in the Chapada Diamantina region of Bahia state, Brazil, by the American Presbyterian missionary and doctor Walter Welcome Wood. The documents in question have been kept at the Universidade do Estado da Bahia, campus II, Alagoinhas, since the hospital closed down definitively. They constitute a source of research for different areas of scholarship, especially the history of healthcare in Brazil. The documents are used in analyses of the incidence of diseases, medical treatments, and other care given to a population that had no access to other institutions working in this area.

The Order of St. Augustine (Ordo Eremitarum Sancti Augustini) was the first religious community in Rijeka. The monastery of St. Jerome, founded by the noble families of Devin and Walsee, existed from the 14th century till 1788, when it was dissolved by Joseph II. Unfortunately, the past of the Augustine Monastery of St. Jerome is mostly unknown. On the basis of largely unexplored sources in Croatia and overseas, the author reveals several facts about the relation between Rijeka's Augustinian community and medicine. The paper includes an important piece of information concerning the existence of a hospital on the lo-cation of Andrejšćica in Rijeka, founded in the 15th century, which has so far been unknown. Augustinian's sources (16th and 18th century) show the presence of several shaver-surgeon (barbitonsorius) and other various relevant topics for the history of medicine in Rijeka - pharmacopola, aromatarius etc.

The study is a presentation of the sole written testimony of the great plague epidemic that struck the island of Rhodes in 1498, at the time when the Order of the Knights of St. John was settled there. The Greek poem "The Thanatikon (i.e., plague) of Rhodes", which was written by Emmanuel Georgillas Limenitis in the late 15th century and recounts the terrible events of the epidemic, was used as a source of information. Among the 644 verses of the poem, elements like the place, time, duration and how the epidemic spread can be identified. Within the historical context of the era, evaluation and analysis of the data reveal the correlation between human activities and the physical history of the disease in the Mediterranean during the 15th century. The Plague of Rhodes confirms the value of non-medical sources in the medico-historical and historico-epidemiological study of the evolution of the disease caused by Yersinia pestis while highlighting an enduring intrinsic weakness of surveillance systems. Despite modern means of epidemiological surveillance, the risk of relaxation of a health system after a long period of absence of an infectious disease constitutes a major factor for future resurgence of the specific disease.

The Deaconess Hospital, Edinburgh, opened in 1894 and was the first establishment of its kind in the UK, maintained and wholly funded as it was by the Reformed Church. Through its 96-year lifetime it changed and evolved to time and circumstance. It was a school: for the training of nurses and deaconesses who took their practical skills all over the world. It was a sanctum: for the sick-poor before the NHS. It was a subsidiary: for the bigger hospitals of Edinburgh after amalgamation into the NHS. It was a specialised centre: as the Urology Department in Edinburgh and the Scottish Lithotripter centre. And now it is currently student accommodation. There is no single source to account for its history. Through the use of original material made available by the Lothian Health Services Archives - including Church of Scotland publications, patient records, a doctor's casebook and annual reports - we review its conception, purpose, development and running; its fate on joining the NHS, its identity in the latter years and finally its closure.

The origin story of professional nursing associated with antebellum American faith communities is all but lost. This paper provides historical evidence for professional nursing for that period using a case study approach that examines three faith communities: the Sisters and Daughters of Charity, the Shakers, and the Church of Jesus Christ of Latter Day Saints. The purpose is to present an historical analysis of the three communities' health beliefs, recipes and remedies that were foundational to the spiritual formation and education of professional nurses within their communities. The focus of the analysis is to place the evidence for professional nursing in these faith communities within the broader context of the contemporary American narrative of the "secularization" of professional nursing associated with the adoption of the Nightingale Training Model after 1873. Nursing became a profession in America because of the courage and passion of many for spiritual formation in community around a need to relieve suffering and demonstrate kindness. The history of American nursing is comprised of stories of powerful nurse ancestors that have the potential to inspire and unite us in that same purpose today despite the ambiguities that may still exist around spirituality, religiosity, and secularization., (Copyright © 2017 Elsevier Inc. All rights reserved.)

From 1896 to 1942, a Japanese hospital operated in the village of Steveston, British Columbia, Canada. For the first 4 years, Japanese Methodist missionaries utilized a small mission building as a makeshift hospital, until a larger institution was constructed by the local Japanese Fishermen's Association in 1900. The hospital operated until the Japanese internment, after the attack on Pearl Harbor during World War II. This study offers important commentary about the relationships between health, hospitals, and race in British Columbia during a period of increased immigration and economic upheaval. From the unique perspective of Japanese leaders, this study provides new insight about how Japanese populations negotiated hospital care, despite a context of severe racial discrimination. Japanese populations utilized Christianization, fishing expertise, and hospital work to garner more equitable access to opportunities and resources. This study demonstrates that in addition to providing medical treatment, training grounds for health-care workers, and safe refuge for the sick, hospitals played a significant role in confronting broader racialized inequities in Canada's past.

In this research we focus on the medical evangelist Levi B. Salmans, and The Good Samaritan sanitarium. Doctor Salmans lived in Mexico for about 50 years (1885-1935). During the first part of his stay, he was devoted to found churches and Methodist schools. However, from 1891 he took a turn in his career by founding dispensaries in different towns of Guanajuato to create, in 1899, the private charity association for the sick and infirm The Good Samaritan. His intense, intellectual, and practical work led him to create health journals, to train nurses, and to promote physiotherapies in accordance with the science advances of that time. By itself, this research shows that the history of medicine in Mexico still has long way to go and that Protestant communities, in favor of modernity and scientific knowledge, took a big part in shaping the history of this discipline in Mexico.

This qualitative study explores how Catholicism influenced nursing in Catholic hospitals and how nurses met the religious needs of Catholic patients in the 1950s and early 1960s. Six nurses were interviewed who graduated from Catholic schools of nursing between 1952 and 1965 and worked in Catholic hospitals. Results indicate that nursing care was inexorably entwined with meeting the religious needs of Catholic patients. Religious practices were predictable and largely linked to the Holy Sacraments.

In April 1944 a ghetto was organized in the center of the town Nyíregyháza (East-Hungary). The ghetto proved to be 17 580 people’s temporary residence for a whole month. The major problem was to ensure hygienic circumstances and prevent epidemics in the overcrowded area. A temporary hospital worked in the orthodox synagogue with a personnel consisting of 6 Jewish pharmacist and 39 doctors. The hospital functioned 35 days visited by daily ca. 100 people. During the period 254 patients were recorded, their average age was 58 years and they mostly suffered in chronic illnesses. The hospital was regarded as a shelter by a good number of patients. During the evacuation of the ghetto the increased stress and brutality caused a lot of deaths and abortions. Within this single month 32 people died and 10 was bom in the ghetto. At the same time during the war and also still in the afterwar period the lack of deported or killed Jewis physicians caused severe problems in the public health of the town and the whole county.

This study gives a special overview of the history of homeopathy in Flungary focusing exclusively on the attitude of the Elungarian churches regarding this new healing method. Authors attempt to prove, that homeopathy actually was a system rooting in Christianity, and according to this fact several priests and eccelesiastical persons took part in the propagation of the method, especially during the 19. century. The essay lists the most important Flunga- rian homeopathic doctors with special regard on their close connections to Catholic priests or bishops and on homeopathic hospitals supported by Christian churches.

The Tinea hospital in Granada, Spain, was a charitable health facility founded in the 17th century and still treating patients well into the 20th century. The hospital accepted patients from anywhere, not only those residing in the surrounding area. We describe the hospital's founding and the characteristics of the patients and caregivers. We also discuss how tinea was considered at the time, including the typology and treatment protocols applied as well as diet and hygiene measures used. It is striking that a hospital so focused on treating a single disease did not produce studies on the condition or on the application of contemporary knowledge to guide treatment., (Copyright © 2013 Elsevier España, S.L.U. and AEDV. All rights reserved.)

This study is about the Sisters of Charity of St. Joseph in New Orleans' Charity Hospital during the years between 1834 and 1860. The Sisters of Charity of St. Joseph was founded in 1809 by Saint Elizabeth Ann Bailey Seton (first native-born North American canonized in 1975) in Emmitsburg, Maryland. Seton's Sisters of Charity was the first community for religious women to be established in the United States and was later incorporated with the French Daughters of Charity of St. Vincent de Paul in 1850. A call to work in New Orleans' Charity Hospital in the 1830s meant a significant achievement for the Sisters of Charity, since it was the second oldest continuously operating public hospitals in the United States until 2005, bearing the same name over the decades. In 1834, Sister Regina Smith and other sisters were officially called to Charity Hospital, in order to supersede the existing "nurses, attendants, and servants," and take a complete charge of the internal management of Charity Hospital. The existing scholarship on the history of hospitals and Catholic nursing has not integrated the concrete stories of the Sisters of Charity into the broader histories of institutionalized medicine, gender, and religion. Along with a variety of primary sources, this study primarily relies on the Charity Hospital History Folder stored at the Daughters of Charity West Center Province Archives. Located in the "Queen city of the South," Charity Hospital was the center of the southern medical profession and the world's fair of people and diseases. Charity Hospital provided the sisters with a unique situation that religion and medicine became intertwined. The Sisters, as nurses, constructed a new atmosphere of caring for patients and even their families inside and outside the hospital, and built their own separate space within the hospital walls. As hospital managers, the Sisters of Charity were put in complete charge of the hospital, which was never seen in other hospitals. By wearing a distinctive religious garment, they eschewed female dependence and sexuality. As medical and religious attendants at the sick wards, the sisters played a vital role in preparing the patients for a "good death" as well as spiritual wellness. By waging their own war on the Protestant influences, the sisters did their best to build their own sacred place in caring for sick bodies and saving souls. Through the research on the Sisters of Charity at Charity Hospital, this study ultimately sheds light on the ways in which a nineteenth-century southern hospital functioned as a unique environment for the recovery of wellness of the body and soul, shaped and envisioned by the Catholic sister-nurses' gender and religious identities.

This study aims to examine the beginning and the development of Christian Charities during the 4(th)-6(th) centuries which would eventually result in the birth of the hospital in modern sense in the first half of the 7(th) century. For this purpose, I looked carefully into various primary sources concerning the early Christian institutions for the poor and the sick. Above all, it's proper to note that the first xenodocheion where hospitality was combined with a systematic caring, is concerned with the Trinitarian debate of the 4(th) century. In 356, Eustathios, one of the leaders of homoiousios group, established xenodocheion to care for the sick and the lepers in Sebaste of Armenia, whereas his opponent Aetios, doctor and leader of the heteroousios party, was reckoned to have combined the medical treatment with his clerical activities. Then, Basil of Caesarea, disciple of Eustathios of Sebaste, also founded in 372 a magnificent benevolent complex named 'Basileias' after its founder. I scrupulously analysed several contemporary materials mentioning the charitable institution of Caesarea which was called alternatively katagogia, ptochotropheion, xenodocheion. John Chrysostome also founded several nosokomeia in Constantinople at the end of the 4(th) century and the beginning of the 5(th) century. Apparently, the contemporary sources mention that doctors existed for these Charities, but there is no sufficient proof that these 'Christian Hospitals,' Basileias or nosokomeia of Constantinople were hospitals in modern sense. Imperial constitutions began to mention ptochotropheion, xenodocheion and orphanotropheion since the second half of the 5(th) century and then some Justinian laws evoked nosokomium, brephotrophia, gerontocomia. These laws reveal that 'Christian Hospitals' were well clarified and deeply rooted in Byzantine society already in these periods. And then, new benevolent institutions emerged in the 6(th) century: nosokomeia for a specific class and lochokomeia for maternity. In addition, one of the important functions of Sampson Xenon was, according to Novel 59, to hold a funeral service for the people of Constantinople. Nevertheless, there is no sufficient literary material that could demonstrate the existence of a hospital in modern sense. The first hospital where outpatient service, hospitalization and surgery were confirmed was Sampson Xenon in the first half of the 7th century, figured in the tale of Stephanos of the The Miracles of St. Artemios. Why was the early Byzantine literary so reticent as to write the medical activities in the Christian Charities? It's because Christian innovation didn't rest on the medical treatment but caring for the poor and the sick, depending on the word of Mt. 25.35-36. In this meaning, I'd like to say that the Early Byzantine history of Christian Charities or 'Christian Hospitals' consists of only a footnote of the verse.

The T4 euthanasia programme within Nazi Germany has been well researched, but much less is known about the extermination of psychiatric patients in Nazi-occupied territories during the same period. In Poland 20,000 mentally ill patients were deliberately killed during the German occupation. This paper traces the history of one psychiatric hospital, Zofiówka, in Otwock, south-east of Warsaw. The hospital once served the Jewish population of Poland and was the largest, most prestigious neuropsychiatric centre in the country. It is now in ruins and said to be haunted by ghosts., (© The Author(s) 2014.)

This essay tries to show that, in the Berlin of the Weimar Republic, Protestant hospitals were built not only to relieve the suffering of the population, but also out of a sense of inferiority to a reinvigorated Catholicism. Hospitals were consequently not only places of care and healing but also of denominational self-assertion. Based on Olaf Blaschke's thesis of a "second denominational age," this contribution tries to demonstrate that the responsible Protestant agents did not make anti-Catholic proclamations at every occasion and in all the media. The founders of the "Protestant Hospital Building Association," which this essay investigates, made deliberate use of anti-Catholic resentment, expressing it boldly when approaching the Protestant elites, while playing it down deliberately when addressing the people of Berlin. With a view to the severe economic crisis and mass unemployment prevailing from 1930, they justified the building of new hospitals with the need to create work places, without making recourse to the denomination argument. The political situation, the addressees and the hope for economic success seem to have informed the representation of denominational resentments decisively. Confessionalism therefore seemed to have been not as much a question of ideology as one of strategy.

The article analyzes the relationship between hygienist policies in effect in Belém in the late nineteenth century and the expansion of activities of the Santa Casa de Misericórdia do Pará. Considered one of the first hospital institutions in the former Grão-Pará Province, in addition to its own hospital, the Brotherhood administered several other health facilities in the capital, and the study of its physical displacement made it possible to "map" three health centers in Belém: Pioneer, Expansion and the Santa Casa, which reinforce the growth vectors of the city. The expansion of its activities is configured as the expansion of the Santa Casa de Misericórdia to serve the underprivileged and sick, preceding the establishment of a public health system in Pará.

In the year 1966, the first government hospital, Oshakati hospital, was inaugurated in northern South-West Africa. It was constructed by the apartheid regime of South Africa which was occupying the territory. Prior to this inauguration, Finnish missionaries had, for 65 years, provided healthcare to the indigenous people in a number of healthcare facilities of which Onandjokwe hospital was the most important. This article discusses these two agents' ideological standpoints. The same year, the war between the South-West African guerrillas and the South African state started, and continued up to 1988. The two hospitals became involved in the war; Oshakati hospital as a part of the South African war machinery, and Onandjokwe hospital as a 'terrorist hospital' in the eyes of the South Africans. The missionary Onandjokwe hospital was linked to the Lutheran church in South-West Africa, which became one of the main critics of the apartheid system early in the liberation war. Warfare and healthcare became intertwined with apartheid policies and aggression, materialised by healthcare provision based on strategic rationales rather than the people's healthcare needs. When the Namibian state took over a ruined healthcare system in 1990, the two hospitals were hubs in a healthcare landscape shaped by missionary ambitions, war and apartheid logic.

The juxtaposition of official regulations and letters of complaint from Vienna's Rothschild Hospital shows, beyond the rhetoric and euphemisms of hospital reports, how lively and diverse day-to-day life was in a Jewish hospital around the year 1900. The letters of complaint query the official hospital rules and show that ideal and reality did not always coincide. Often, religious questions were at the root of the critique--such as doubts as to whether kosher dietary laws were adhered to--or conflicts between the agents involved, be they individuals or groups, patients, nurses, physicians or administrative staff. As part of this process, power structures, social hierarchies, patient rights and gender issues were called into question and renegotiated.

Background: The Catholic Church oversees the nation's largest group of not-for-profit health care facilities, and in certain areas a Catholic hospital is the only hospital available. Recently, Catholic hospitals' provision of health care services to women in the areas of reproductive procedures has come under scrutiny., Purpose: This article examines the role of Catholic sister nurses in health policy for women., Methods: Using historical analysis, this article focuses on the tensions between Catholic religious priests and sister nurses over access to health care., Discussion: A historical examination of Catholic hospitals' influence on health policy offers a vehicle to contemplate the role that religion plays in the area of women's health., Conclusion: Catholic sister nurses used the Catholic Church's organizational power to influence health policy that affected their hospitals. However, they exercised due restraint in their advocacy efforts, always having to be mindful of ecclesiastical barriers they could not abridge, particularly those that pertained to reproduction. This has significantly affected health policy for women., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This paper deal with a manuscript from the years 1714-1720, originating most probably from the hospital of the Brothers of Mercy in Nové Mesto nad Metují. it contains the records of the hospital pharmacy about the drugs prepared for both patients and monks who operated this hospital. The included drugs were mainly intended for elderly males. The manuscript lists about fifteen hundred drugs and more than three hundred active ingredients, of which about two thirds were of plant origin. The paper presents the compositions of more important drugs and partly deals also with their preparation.

Mayo Clinic is recognized as a worldwide leader in innovative, high-quality health care. However, the Catholic mission and ideals from which this organization was formed are not widely recognized or known. From partnership with the Sisters of St. Francis in 1883, through restructuring of the Sponsorship Agreement in 1986 and current advancements, this Catholic mission remains vital today at Saint Marys Hospital. This manuscript explores the evolution and growth of sponsorship at Mayo Clinic, defined as "a collaboration between the Sisters of St. Francis and Mayo Clinic to preserve and promote key values that the founding Franciscan sisters and Mayo physicians embrace as basic to their mission, and to assure the Catholic identity of Saint Marys Hospital." Historical context will be used to frame the evolution and preservation of Catholic identity at Saint Marys Hospital; and the shift from a "sponsorship-by-governance" to a "sponsorship-by-influence" model will be highlighted. Lastly, using the externally-developed Catholic Identity Matrix (developed by Ascension Health and the University of St. Thomas, Minnesota), specific examples of Catholic identity will be explored in this joint venture of Catholic health care institution and a secular, nonprofit corporation (Mayo Clinic).

Institutional families were widespread in the 20th century. As there is very little empirical material on the function of the housemother, a qualitative study was launched to explore members' memories of the function of the housemother between 1945 and 1995 and how communal life in the institutional families of the period was possible. The study was methodologically oriented towards oral history techniques and the principles of Grounded Theory as well as towards sequential line by line analysis. For the purposes of this article, the interviews with nine housemothers were selected from the interviews conducted for the wider study (n=42). The central question concerned how housemothers experienced professional developments in retrospect and the influence these had on the function of the housemother. The interviews resulted in the definition of three phases which the housemothers passed through during their role as housemother. This article describes the third phase: "Leaving the function of the housemother - lost and frustrated power and dominance". Housemothers were not only housekeepers but also carers. Together with the husbands, they represented the heads of their institutional families. Housemothers found living in one house with the other members of the "family" a burden, but at the same time they benefitted from the great freedom they had. This aspect is described using the core categories of power and dominance.

The Parochial Hospital of San Bernardo is an intermediate complexity hospital that functions in its original 115- year- old building. It is one of the oldest hospitals in the country. Driven by the local Catholic Church and despite multiple difficulties, the hospital has uninterruptedly served a progressively growing community, with medical care and spiritual support. In the last two decades, it also has incorporated teaching activities with Universidad de los Andes Medical School.

The author analyzes the development of the Holy Spirit hospital's economic power during the XIII century through some illustrative examples of original parchment documents, pontifical and private. After the hospital was founded by the pope Innocentius III and gifted of many properties, its charitable activity attracted the admiration and respect of many people, who, with donations and testamentary dispositions, not only around Rome, but also in several Italian regions and outside Italy, contributed to make it ever more powerful in an economic sense.

Doing God's work through vocation and caring for the less fortunate has been a long-time focus of the Catholic faith. In the early 20th century Catholic orders of nuns made major contributions to nursing education and clinical practice. This historical research article illustrates the sisters' vast influence on nursing as they introduced spirituality into quality patient care.

The article analyses the medical activities of Moscow communities of Sisters of Charity in curative and educational institutions organized by the communities themselves. The social ministration of communities on the territory of Moscow is considered.

American hospitals were started by religious, ethnic and community groups to serve local health care needs. Immigration into the eastern cities and the constant movement west of the frontier required the creation of educational and service facilities to serve these populations and localities. In the nineteenth century, Catholic sisters went all across the country establishing schools and hospitals. They were motivated to care for the sick, establish charitable institutions and spread their religious beliefs. Their impact on the development of the American health system was enormous. They also supported the importance of nursing for the provision of scientifically based medical care and created schools of nursing. Their historical record as founders, builders, financiers and managers of hospitals is unmatched by any other group between 1850 and 1950. And, this was accomplished at a time when women played no similar leadership and institutional ownership role elsewhere in society.

For the initiation of the French journalist Raoul Follereau in 1954 the UNO inaugurated the Leprosy Day (Martyr's Day) that is celebrated on the last Sunday of January every year. Although the bacterium that causes leprosy was isolated by the Norwegian scientist Gerhard Henrik Armauer Hansen in 1873 and from 1982 this disease can be cured with a special pharmaceutical complex, still 219.826 new leprous are detected on Earth every year, according to the data published in August, 2010 by WHO-experts. Ancient Chinese and Hindu source-strings from 600 B. C. are referring to leprosy, however, the disease was imported by the army of Alexander the Great from India around 327-326 B. C. Even the Old and the New Testament from the Holy Bible are mentioning leprosy in several details. During the Middle Ages the Military and Hospitaller Order of St. Lazarus of Jerusalem, established in the Holy Land in 72 A. D., did pioneer work in nursing leprous. In the process of time the medical attendance concerning leprous was organized in special hospitals called "leprosoriums" built on river-banks. Special office and even services were organized for the treatment and isolation of the people infected. Although medical science has prevailed against leprosy, and almost simultaneously even jurisprudence defended the patients' rights via legislation, still mankind can regrettably not get rid of this disease that stigmatizes seriously.

In inland Croatia, Franciscan friars had been scattered across three multi-national provinces - the Croatian and Carniolan province in the west, the province of St Ladislaus in the north, and the province of St John Capistrano in the east. The three provinces united into a single Croatian Franciscan province of St Cyrill and Methodius in 1900. As the monastery in Zagreb, the Croatian capital, was the number one in the province of St Ladislaus, it is quite likely that the way of living and the laws of this province influenced the other two inland provinces. The legislation in these two provinces was not as advanced as St Ladislaus' that was based on the so called Constitutiones Sambucanae, drawn up by Franciscan General Michele Buongiorno of Sambuca in 1663, which are best reflected in the four editions of St Ladislaus Province statutes (1687, 1749, 1768, and 1806). They provide a wealth of information about the Franciscan life and activities of that province. This article focuses on the provisions regulating the health care of the ill brethren. It also includes ample information from the monastery of Virovitica and from the archives of the Province of St John of Capistrano to give the reader an idea about Franciscan health care in these monasteries.

The Second World War brought much grief to the world. Roermond was at the forefront of the war for a period of five months. Before the war, in this part of The Netherlands, physicians were more attuned to scientific development taking place in Germany than in the United Kingdom. It wasn't until after the war that anesthesiology developed as a separate specialty. The impression that the hospital records give is that anesthesia was practiced at a far higher level than we had always assumed, using a wide variety of drugs and techniques, in spite of the fact that there were no professional anesthesiologists at the time. That high level was maintained throughout the war in spite of all the hardships.

The Barrow Neurological Institute (BNI), founded in 1961, is in partnership with St. Joseph's Hospital and Medical Center and part of the Catholic Healthcare West system. The BNI is a relative newcomer to academic neuroscience. However, since its inception it has grown to become an international destination for neurologic disease. This article describes the history of the institute as it has grown over the years in its commitment to excellence in patient care, education, and research., (Copyright © 2010. Published by Elsevier Inc.)

In 1944, the Medical Mission Sisters opened the Catholic Maternity Institute in Santa Fe, New Mexico, primarily to serve patients of Spanish American descent. The Maternity Institute offered nurse-midwifery care and functioned as a school to train nurse-midwifery students. Originally planned as a home birth service, the Catholic Maternity Institute soon evolved into a service in which patients chose whether to deliver in their own homes or in a small freestanding building called La Casita. In fact, despite their idealism about home birth and strong feelings that home birth was best, the sisters experienced significant ambivalence concerning La Casita. Births there met many of the institute's pragmatic needs for a larger number of student experiences, quick and safe transfers to a nearby hospital, and more efficient use of the midwives' time. Importantly, as the sisters realized that many of their patients preferred to deliver at La Casita, they came to see that this option permitted these impoverished patients an opportunity to exercise some choice. However, the choice of many patients to deliver at La Casita--which was significantly more expensive for the Maternity Institute than home birth--eventually led to the demise of the Maternity Institute.