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A hospital is a health facility where patients receive care, by trained doctors, nurses and other professionals. Hospitals are more unionized than other healthcare facilities, and some workers in hospitals, such as nurses, are mostly unionized in large states including California and Washington,[1] and are increasing their percentage of unionization in other states including Florida.[2] Most physicians at hospitals are now their employees, in contrast with a decade ago, and it is increasingly difficult to obtain a second opinion by an independent physician in private practice.


In ancient history, hospitals were institutions where the sick of the community could be brought for treatment; typically they were connected with religion. One Greek sanctuary was dedicated to Aesculapius (Asclepius), the Greek god of medicine, as early as 1134 BC. Aesculapia, as such institutions came to be called, spread throughout Greece.

In India, around 600 BC, the Buddha established a medical network of physicians on the village level, and hospitals for the crippled, the ill, and pregnant women.


Emperor Constantine in 335 AD closed the Greek and Roman aesculapia and encouraged the building of Christian hospitals. They were operated by monasteries (of men) and convents (of women) but were located outside the church buildings themselves. They focused on providing care for the poor, the old, and orphans. The main therapy was rest.

The Hôtel-Dieu in Paris, founded in 660 AD, is the oldest hospital still in use. The advent of the Crusades after 1100 led to the growth of hospitia, rest places for Crusaders and other travelers. Built next to monasteries, they provided food, lodgings, and medical care to pilgrims and other travelers.

In medieval Europe, many hospitals were founded by Christian religious orders such as the Knights of St. John.

In Florence, Italy, the most active period for hospital foundation beginning in the mid-thirteenth century was linked to population growth. Specialized hospitals served a variety of different groups, such as women, religious pilgrims, the old, the destitute, etc. As civic authorities worried more and more about contageous diseases and epidemics, the priority shifted to the medical treatment of the sick poor. Most new hospitals were created by philanthropic local bankers and businessmen, but the city oversaw hospitals, perceiving them as socially useful institutions both for assisting and for controlling the poor. The number, size, and facilities of Florence's hospitals, and the beauty of their buildings, became a source of frequently expressed civic pride.

Modern times

After 1600 European hospitals were generally either an expansion of the local almshouse, or a place to isolate the ill during epidemics of smallpox, typhus, and plague.

Latin America

The Royal Indian Hospital of Mexico City was established in 1553 by King Charles V. Hospital records provide important details concerning the problems of diseases, epidemics, and public health issues in Mexico City. Serving as many as 2,500 patients per month, doctors at the hospital treated the majority of patients for smallpox, venereal disease, tuberculosis, and rabies. Physicians prescribed Aztec herbs and remedies along with standard medical treatments that included quarantine and bloodletting.[3]


No concept of hygiene existed before the 19th century. The Hôtel-Dieu, for example, housed up to six patients in the same bed, with no attempt made to isolate those with contagious diseases.

Until the discovery of the anesthetic agents ether, (1842) and chloroform (1847), only the simplest, most urgent operations could be attempted. Mortality from infection was very high in the procedures that were performed, until Joseph Lister introduced antiseptic techniques in the operating rooms of England in 1865. English pioneer nurse Florence Nightingale during the Crimean War (1854 to 1856), and the nursing school in London that she founded, transformed nursing into a skilled profession requiring formal training. Her graduates went on to found their own schools throughout the English-speaking world.


Christian missionaries throughout Asia and Africa in the 19th and 20th centuries made modern medical care a high priority, opening many local clinics that sometimes grew into hospitals.

Early American hospitals

In 1639, three Augustinian nuns from Dieppe, France, established North America's first hospital, the Hôtel-Dieu in Quebec City. It was originally set up to care for (and isolate) the victims of a smallpox epidemic.

In the Thirteen Colonies that became the United States, almshouse infirmaries sometimes developed into public general hospitals (for example, Philadelphia General Hospital opened as the infirmary of an almshouse in 1732; Bellevue in New York began as the hospital ward of the public workhouse in 1736).

The Pennsylvania Hospital in Philadelphia, which opened in 1751 under the sponsorship of Benjamin Franklin and the physician Thomas Bond, was the first permanent British-American institution created solely for the care of the sick.

After the Revolution, general hospitals appeared in urban centers (New York Hospital, 1791; Massachusetts General in Boston, 1811). Following the pattern of the British voluntary hospitals, they were privately supported charitable institutions designed to provide short-term care for those who could not be nursed at home. Patients with incurable or terminal illnesses were sent to the public almshouse.

Specialized care

Special needs spawned various kinds of hospitals. In the early colonial days, communities often set up temporary pesthouses to isolate and care for the sick during epidemics; and after the middle of the 18th century when smallpox inoculation, the forerunner of vaccination, became accepted, private inoculation hospitals sprang up on the outskirts of towns. To care for the insane, custodial institutions developed, such as Eastern State Hospital at Williamsburg, Va., which opened in 1773. American Quakers played a prominent role in founding asylums for the mentally ill. To fill military needs, the federal government created temporary hospitals; the oldest permanent federally supported hospital system was the Marine Hospital Service legislated by an act of Congress in 1798.

19th century

Throughout the 19th century the American hospital scene included a mixture of city, state, and federally supported institutions and private philanthropic hospitals, the latter often established by ethnic, religious, or benevolent societies or Masonic groups. Hospitals devoted to the treatment of a single disease, organ, or age group evolved (for example, New York Eye Infirmary, established in 1820, and numerous tuberculosis sanatoriums).

Until the 1850s the private patient scarcely existed. The sick were cared for in their homes where the chances of recovery were greater than in crowded, unsanitary wards with little or no nursing care.

Civil War

During the Ciivl War the U.S. Army created a very large network of hospitals. Mower General Hospital, constructed by the US Army in the Chestnut Hill district of Philadelphia, Pennsylvania, was the largest general hospital created to serve Northern wounded during the Civil War. Built in 1862, the hospital was demolished in 1865. Three military hospitals built in the small Vermont cities of Brattleboro, Burlington, and Montpelier during the Civil War. They represent the expansion of general hospitals, as opposed to post hospitals that cared for soldiers near the battlefield, and the growing number of these hospitals in "remote" locations, away from Washington, D.C. Illustrations show their vast size and capacity. These hospitals provided rehabilitation and long-term care for physically and emotionally wounded soldiers and helped return them to active duty as soon as possible - which was particularly important when military strength dwindled in the latter years of the war.[4]

The largest and best-known hospital in the Confederacy was the Chimborazo in Richmond, Virginia. Beginning in October 1861, wounded and sick soldiers were housed in pavilion-style buildings—America's first. Tents for the convalescent and slightly wounded raised capacity to eight thousand. The hospital was headed by James B. McCaw, a talented and resourceful Richmond physician and professor at the Medical College of Virginia. He directed a dedicated staff of physicians, stewards, and matrons. Designated an independent army post by the Confederate surgeon general, Chimborazo remained in continuous operation until the fall of Richmond in April 1865. About 78,000 patients were treated here with a death rate of slightly over 11% (the comparable Union figure was 10%). Several drug and treatment trials for the Confederate Medical Department were also conducted here.


About 21,000 women served in Union hospitals. One in ten was black; they worked as laundresses and cooks (rather than as nurses or matrons). Most Union hospitals were built in cities. Confederates used mostly makeshift facilities in private residences, and were operated by upper class women "matrons." For example, Juliet Opie Hopkins, the wife of a wealthy Alabama businessman, organized and ran three hospitals in Richmond, Virginia, despite chronic shortages of medicine and other necessary supplies. Despite the local nature of their service, Southern women generally met with more resistance than Northern ones from men who thought hospital work to be inappropriate for "ladies." It took the heroic reputations of Florence Nightingale and American Clara Barton make the role of the woman nurse generally acceptable.

After the war veteran's care became a major activity.


In 1873 nursing became professionalized when Bellevue introduced the first American nurses' training school, modeled on the Nightingale School in Britain. The first U.S. hospital survey, made by the U.S. Bureau of Education in 1873, showed that there were only 149 hospitals, one-third of which were for mental patients. The Progressive Movement promoted and funded hospitals, including those run by cities and those operated by religious groups. By 1920 the U.S. had 6,762 hospitals, a growth caused chiefly by changes in the hospital's function. The accelerating progress in medical science and specialization had introduced procedures that could not be performed at home.

Hospital architecture

Before the germ theory was accepted in the late 19th century, infection and infectious diseases were attributed to bad air and lack of sunlight, so hospital wards were built on a pavilion plan, (exemplified by the Johns Hopkins Hospital, which opened in 1889), with high ceilings and tall windows for good ventilation and light. The Nightingale ward, a long narrow room with twenty beds against each wall between tall windows, was in vogue until World War I. By the 1920s rising land values, advancing medical technology, and additional hospital functions caused the pavilion plan to be abandoned in favor of the vertical monoblock.

Expanded role

Gradually the public image of the hospital changed, so that instead of being the hospice for the sick poor, it became the diagnostic and treatment center for all classes. The number of private or semiprivate rooms steadily increased. St. Vincent's Hospital in New York, founded in 1849, was among the first to provide private rooms, but there was at first little demand (the original Hopkins plans provided for only twenty-six pay beds). Since the mid-20th century, private and semiprivate rooms have predominated and influenced hospital architecture. Other additions since the 1873 hospital survey were scientific laboratories and special therapy areas, which began to appear in 1889 when Lankenau Hospital in Philadelphia and the Johns Hopkins introduced bacteriological and chemical laboratories.

Ethnic and religious hospitals

Although they assisted in founding wartime hospitals during 1863-65, Alabama Baptist involvement in the medical field began in earnest in 1905. Their efforts came to fruition in 1922, when the Alabama Baptist Hospital in Selma and the Birmingham Baptist Hospital opened. Other hospitals followed throughout the rest of the 20th century.[5]

Catholic bishops and orders of nuns asserted that hospitals should provide spiritual as well as surgical services. To tap the rising population of Catholic immigrants and counteract Protestant proselytizing, the Church created separate institutions, such as hospitals, and defined them along religious lines. Leaders sought women religious to staff these hospitals, in which they could preserve Catholic identity. Three major nursing orders emerged during 1865-1920: the Sisters of St. Joseph of Carondelet from St. Paul, Minnesota; the Sisters of Charity of the Incarnate Word from San Antonio, Texas; and the Sisters of the Holy Cross from South Bend, Indiana.[6]

For example, Lewiston, Maine's first public hospital became a reality in 1889 when the Sisters of Charity of Montreal, the "Grey Nuns," opened the doors of the Asylum of Our Lady of Lourdes. This hospital was central to the Grey Nuns' mission of providing social services for Lewiston's predominately French Canadian mill workers. The Grey Nuns struggled to establish their institution despite meager financial resources, language barriers, and opposition from the largely Protestant established medical community.[7]

Chicago's rival Jewish communities built two major hospitals. The German Jews, many of them successful businessmen who arrived in the 1850s, built Michael Reese Hospital in the 1880s. Later the poorer Orthodox Jews from Russia established Maimonides Hospital (later renamed Mount Sinai) in 1912.[8]

For three decades, the Taborian Hospital and the Friendship Clinic in Mound Bayou, Mississippi, provided quality medical care to thousands of poor blacks, without help from either the federal or state governments. Fraternal orders established both clinics in the 1940s as an alternative to Jim Crow humiliations. Ironically, segregation helped these establishments prosper by providing a ready market. By the 1960s, however, a combination of circumstances made this kind of "self-help" care unviable. Medicare and Medicaid, along with the demise of segregation, made it possible for poor Delta residents to choose health care facilities with more modern equipment. State regulations also became too burdensome for small, underfinanced facilities. Migration took its toll as well, as black families left the Delta for better opportunity in Memphis and Chicago.[9]

Today, many hospitals, including religious ones, are part of a chain; they are owned by corporations, non-profit organizations, and government authorities. For example, the Bon Secours Health System is a non-profit organization operating Roman Catholic hospitals in seven states in the eastern U.S.

Childbirth and children

Before 1920, many women of all social classes delivered their babies at home. This continued into the 1940s in the rural South, where midwives handled the deliveries. However, as doctors became aware of the problematic spread of bacteria and germs, they realized they could not create a sterile environment in a house and began urging families to go to modern hospitals where they promised the women good treatment, excellent food, pain-free births, and excellent, professional attention from nurses.[10]

The changing ideas about the treatment of children can be explored through the architecture of pediatric hospitals in Montreal and Toronto from 1875 to 2000. Hospital architecture reveals three distinct phases in the structuring of medical care spaces for children as patients. Late-19th- and early-20th century children's hospitals remained bastions of older spatial attitudes toward health, while the post-World War I hospital was self-consciously modern, with an arrangement more scientific and institutional than its predecessor. Through references to other typologies, the postmodern hospital marks a return to the earlier attitude that children's health is a family affair.[11]


X rays, discovered in 1895, were quickly adopted, making the hospital the workshop of medicine. With the introduction of aseptic techniques in the late 19th century, surgery advanced rapidly, with the uperior facilities of the hospital replacing the doctor's office. In 1918 the College of Surgeons sponsored a program of hospital standardization that set forth minimum requirements for properly equipped hospitals. In 1918 only 13% of hospitals won approval. Great gains were made in the 1920s so that by 1936, 72% met the standards.


Typical hospital chapel

Religion plays a significant role in most hospitals, even those without a particular religious theme. Hospitals of all types usually employ a hospital chaplain.[12][13][14] The Gideons International places copies of the Holy Bible in most hospital rooms.[15] Some hospitals without a religious theme were originally built by religious organizations. Atheists generally do not establish hospitals in free societies, and even if a hospital were established by an atheist, there are no "religious free" hospitals as it wouldn't be a profitable business practice to abolish religion in such facilities, and atheists are much too uncharitable to establish a non-profit facility. There are/were substandard atheist hospitals in communist dictatorships such as Cuba and the former Soviet Union.

Costs and insurance

The costs of hospital care were rising, and in 1933 the American Hospital Association recommended prepaid nonprofit hospital insurance (Blue Cross), initiating a new pattern of prepayment for health-related expenses. There was a massive growth of a private health industry in the United States during the 1940s-1950s, in contrast to the public health insurance programs implemented in Western Europe and Canada. Rising family income and tax policies encouraged a close link between employment and health insurance, thus promoting insurance. On the supply side, hospitals sought to stabilize fluctuating income through prepayment plans that later became Blue Cross. Doctors, although adamantly opposed to government insurance, formed Blue Shield plans. These two created a new supply of health insurance and demonstrated the viability of the private health insurance model, stimulating competitor companies and increasing consumer purchase of health insurance.[16]

Political battles over the federal role in health financed continued, with the major change coming in 1965, when Lydon Johnson's "Great Society" created Medicare, that is low-cost hospital care for Social Security recipients. Actual costs of Medicare proved much higher than predicted, making it a major element of the federal budget.

The ongoing controversy about how much more hospitals charge self-paying or uninsured patients compared to patients having insurance or being in government programs like Medicare or Medicaid is referred to as hospital pricing.

Multiple roles

After World War II the hospital began to assume a new role as community health center, for the outpatient department and the emergency room became a substitute for the rapidly vanishing general practitioner to whom families had formerly turned for help. At the same time, the increasing expensiveness of medical care stimulated attempts to economize by creating new forms of health delivery systems, such as health maintenance organizations, which build and operate their own hospitals to serve their prepaid members. By 1973 the 7,000, existing hospitals had grown much larger, with 1.65 million beds.

Best rated

The annual U.S. news rating of hospitals gives the top dozen in 2009:[17]

  • 1 Johns Hopkins Hospital, Baltimore
  • 2 Mayo Clinic, Rochester, Minnesota
  • 3 Ronald Reagan UCLA Medical Center, Los Angeles
  • 4 Cleveland Clinic, Cleveland
  • 5 Massachusetts General Hospital, Boston
  • 6 New York-Presbyterian University Hospital, New York
  • 7 UCSF Medical Center (University of California at San Francisco)
  • 8 Brigham and Women's Hospital, Boston
  • 8 Duke University Medical Center, Durham NC
  • 10 Hospital of the U. of Pennsylvania, Philadelphia
  • 10 U. of Washington Medical Center, Seattle
  • 12 Barnes-Jewish Hospital/ Washington U., St Louis

Religion/atheism and hospitals

See also: Atheist hospitals and Atheism in medicine

Christianity and hospitals

See: Christianity and hospitals

Atheist hospitals

Atheist hospitals, meaning hospitals created by people who believe there is no creator God, do indeed exist although their quality tends to be lower than those created by agnostics and the religious. Particularly substandard are those in Cuba, which are perennially underfunded, poorly stocked and often are unsanitary. Mental hospitals in the Soviet Union were used to persecute believers.[18]

Even though many hospitals do not actively push a religious viewpoint on their patients and staff, almost all of them were funded and founded by those whose faith and religious beliefs pushed them to help those in need.

Further reading

  • Goldin, Grace and John Thompson. Hospital: A Social and Architectural History (1975)
  • Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals. (1999). 716 pp. standard scholarly history
  • Rosenberg, Charles. The Care of Strangers: The Rise of America's Hospital System (1987) 456 pp excerpt and text search
  • Starr, Paul. The Social Transformation of American Medicine (1982) online edition
  • Stevens, Rosemary. In Sickness and in Wealth: American Hospitals in the Twentieth Century. (1989). 432 pp. excerpt and text search
  • Vogel, Morris. The Invention of the Modern Hospital: Boston, 1870-1930 (1980).

Specialized studies

  • Abel-Smith, Brian. The Hospitals, 1800-1948: A Study in Social Administration in England and Wales (1967)
  • Beardsley, E. H. "Good-Bye to Jim Crow: The Desegregation of Southern Hospitals, 1945-70." Bulletin of the History of Medicine 1986 60(3): 367-386.
  • Commission on Hospital Care. Hospital Care in the United States (1947), for 1940s
  • Corwin, E.H.L. The American Hospital (1946), for the 1940s
  • Finzsch, Norbert and Jütte, Robert, eds. Institutions of Confinement: Hospitals, Asylums, and Prisons in Western Europe and North America, 1500-1950. (1996). 369 pp.
  • Henderson, John. The Renaissance Hospital: Healing the Body and Healing the Soul. (2006) 492 pp.
  • Howell, Joel D. Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century. (1995). 341 pp.
  • Jones, Colin. The Charitable Imperative: Hospitals and Nursing in Ancien Régime and Revolutionary France. (1989). 317 pp.
  • Loudon, Irvine. Western Medicine: An Illustrated History (1997) online edition
  • Nelson, Sioban. Say Little, Do Much: Nursing, Nuns, and Hospitals in the Nineteenth Century. (2001). 240 pp.
  • Opdycke, Sandra. No One Was Turned Away: The Role of Public Hospitals in New York City since 1900. (1999). 244 pp.
  • Orme, Nicholas and Webster, Margaret. The English Hospital, 1070-1570. (1995). 320 pp.
  • Pickstone, John V. Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946. (1985). 369 pp.
  • Rice, Mitchell F. and Woodrow Jones Jr.Public Policy and the Black Hospital: From Slavery to Segregation to Integration (1994) online edition
  • Rosner, David. A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York, 1885-1915 (1982).
  • Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. (2004) 360pp.

Specific hospitals

  • Carson, Carolyn Leonard. Healing Body, Mind, and Spirit: The History of the St. Francis Medical Center, Pittsburgh, Pennsylvania. (1995). 246 pp.
  • Castleman, Benjamin; Crockett, David C.; and Sutton, S. B. The Massachusetts General Hospital 1955-1980. (1983). 410 pp.
  • Clapesattle, Helen. The Doctors Mayo (1941),
  • Connor, J. T. H. Doing Good: The Life of Toronto's General Hospital. (2000). 342 pp.
  • Green, Carol C. Chimborazo: The Confederacy's Largest Hospital. (2004) 200pp.
  • Hendricks, Rickey and Foster, Mark S. For a Child's Sake: History of the Children's Hospital, Denver, Colorado, 1910-1990. (1994). 209 pp.
  • Kraut, Alan M. and Deborah A. Kraut. Covenant of Care: Newark Beth Israel and the Jewish Hospital in America (2007) online edition
  • Levey, Samuel et al. The Rise of a University Teaching Hospital, a Leadership Perspective: The University of Iowa Hospitals and Clinics, 1898-1995. (1996). 465 pp.
  • Salvaggio, John. New Orleans' Charity Hospital: A Story of Physicians, Politics, and Poverty. (1992). 406 pp.
  • Sibley, Marilyn McAdams. The Methodist Hospital of Houston: Serving the World. (1989). 241 pp.

See also


  3. John S. Leiby, "The Royal Indian Hospital of Mexico City, 1553-1680." Historian 1995 57(3): 573-580.
  4. Nancy E. Boone and Michael Sherman, "Designed to Cure: Civil War Hospitals in Vermont". Vermont History 2001 69(1-2): 173-200. 0042-4161
  5. Jennifer Blair, "Baptists Minister Through Hospitals." Alabama Baptist Historian 2001 37(2): 66-69. 0002-4147
  6. Barbra Mann Wall, "Science and Ritual: The Hospital as Medical and Sacred Space, 1865-1920." Nursing History Review 2003 11: 51-68. 1062-8061
  7. Susan Hudson, "Les Soeurs Grises of Lewiston, Maine 1878-1908: An Ethnic Religious Feminist Expression." Maine History 2001-02 40(4): 309-332. 1090-5413
  8. Steven M. Schwartz, Strong Medicine. Chicago History 1999 28(1): 4-25. 0272-8540
  9. David T. Beito, "Black Fraternal Hospitals in the Mississippi Delta, 1942-1967". Journal of Southern History 1999 65(1): 109-140. 0022-4642
  10. Judith Walzer Leavitt, "'Strange Young Women on Errands': Obstetric Nursing between Two Worlds". Nursing History Review 1998 6: 3-24. 1062-8061
  11. Annmarie Adams and David Theodore, "Designing For 'The Little Convalescents': Children's Hospitals in Toronto and Montreal, 1875-2000." Canadian Bulletin of Medical History 2002 19(1): 201-243. 0823-2105
  12. Health Management Associates facility Charlotte Regional Medical Center employs Rev. Larry Pope
  13. Hospital Corporation of America facility employs Rev. Bob Carlson
  14. Sarasota Memorial Hospital, a county-run facility, employs more than one chaplain
  16. Melissa A. Thomasson, "From Sickness To Health: The Twentieth-Century Development of U.S. Health Insurance." Explorations in Economic History 2002 39(3): 233-253. 0014-4983
  17. see rankings March 22, 2009
  18. The Cry of the New Martyrs - Psychiatric “Treatment” of Christians

See also