Hospital

A hospital is a health facility where patients receive care, by trained doctors, nurses and other professionals.

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

Hospital care has improved greatly over earlier times due to the work of Louis Pasteur on germ theory and Joseph Lister who implemented antiseptic cleaning.

Early American hospitals

In the Thirteen Colonies, 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. � 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. Duuring the Ciivl War the U.S. Army created a very large network of hospitals, and after the war veteran's care became a major activity.

Nures

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.

Catholic hospitals

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.

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.

Children's hospitals

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.

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.

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.

Further reading

• Connor, J. T. H. Doing Good: The Life of Toronto's General Hospital. (2000). 342 pp.
• Nelson, Sioban. Say Little, Do Much: Nursing, Nuns, and Hospitals in the Nineteenth Century. (2001). 240 pp.