Reflections of the Past,” Is Adapted from the Book Hospital Organization and Management by Malcolm T

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC History is relevant to understanding the to the sick, provided patients with fresh fruits and vegetables, NOT FOR SALE OR past,DISTRIBUTION defining the present, and influencing NOT FORprepared SALE their medicines, OR DISTRIBUTION gave massages, and maintained their the future. personal cleanliness. Hindu physicians, adept at surgery, were required to take daily baths, keep their hair and nails short, wear Author Unknown white clothes, and promise that they would respect the confi- © Jones & Bartlett Learning, LLCdence of their patients. Although© Jones bedside care& Bartlett was outstanding Learning, LLC NOT FOR SALE OR DISTRIBUTIONfor those times, medicine wasNOT only beginning FOR SALE to find ORits way. DISTRIBUTION Egyptian physicians were probably the first to use drugs This chapter provides the reader with a brief overview such as alum, peppermint, castor oil, and opium. In surgery, of the advance of civilization as disclosed in the history of anesthesia consisted of hitting the patient on the head with hospitals. A study of the past often reveals errors that then a wooden mallet to render the patient unconscious. Surgery can ©be Jonesavoided, &customs Bartlett that persistLearning, only because LLC of tradi- was largely© limitedJones to &fractures, Bartlett and Learning, medical treatment LLC was tion, and practices that have been superseded by others that NOT FOR SALE OR DISTRIBUTION usually givenNOT in FOR the home. SALE Therapy OR awayDISTRIBUTION from home was are more effectual. The past may also bring to light some often available in temples, which functioned as hospitals. long-abandoned practices, which may be revived to some advantage. The story of the birth and evolution of the hospital portrays the triumph of civilization over barbarism and GREEK AND ROMAN HOSPITALS the progress of civilization toward an ideal characterized by © Jones &an Bartlett interest in Learning, the welfare of LLC the community. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORThe SALE term hospital OR DISTRIBUTION derives from the Latin word hospitalis, which relates to guests and their treatment. The word reflects EARLY HINDU AND EGYPTIAN HOSPITALS the early use of these institutions not merely as places of healing, but also as havens for the poor and weary travelers. Hospitals first appeared in Greece as aesculapia, named Two ancient civilizations,© Jones the & Hindu Bartlett (in what Learning, is now LLCafter the Greek god of medicine,© Jones Aesculapius. & Bartlett For many Learning, cen- LLC India) and the Egyptian,NOT had FOR crude SALEhospitals. OR Hindu DISTRIBUTION litera- turies, hospitals developed inNOT association FOR SALEwith religious OR DISTRIBUTION in- ture reveals that in the 6th century BC, Buddha appointed stitutions, such as the Hindu hospitals opened in Sri Lanka in a physician for every 10 villages and built hospitals for the the 5th century BC and the monastery-based European hos- crippled and the poor. His son, Upatiso, built shelters for the pitals of the Middle Ages (5th century to 15th century). The diseased and for pregnant women. These examples probably Hotel-Dieu in Paris, a monastic hospital founded in 660 AD, moved© Jones Buddha’s & devotees Bartlett to erect Learning, similar hospitals. LLC Despite is still in operation© Jones today. & Bartlett Learning, LLC a lackNOT of records,FOR SALE historians OR agree DISTRIBUTION that hospitals existed in NOT FOR SALE OR DISTRIBUTION Ceylon as early as 437 BC. During his reign from 273 to 232 BC, King Asoka built Note: This chapter, “Reflections of the Past,” is adapted from the book Hospital Organization and Management by Malcolm T. MacEachern, MD, 18 hospitals that hold historical significance because of their CM, DSc (Hon), LLD (Hon), FACS, FACP, FACHA, FAIHA (Australia), similarities to the modern hospital. Attendants gave gentle care with permission from the Physician’s Record Company. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR InSALE early GreekOR DISTRIBUTION and Roman civilization, when medical NOTor FOR by wealthy SALE Romans OR DISTRIBUTION who had converted to Christianity. practices were rife with mysticism and superstitions, temples By the year 500, most large towns in the Roman Empire had were also used as hospitals. Every sanctuary had a sacred erected hospitals. Nursing, inspired by religion, was gentle altar before which the patient, dressed in white, was required and considerate, but soon began to discard the medical pre- to present gifts and offer prayers. If a patient was healed, the cepts of Hippocrates, Antyllus, and other early Greek phy- cure was credited to miracles© Jones and divine & Bartlett visitations. Learning, If the LLCsicians because of their pagan© origins. Jones Instead, & Bartlett health care Learning, LLC patient remained ill or died,NOT he orFOR she wasSALE considered OR DISTRIBUTION to be turned toward mysticism and theurgyNOT FOR (the working SALE of OR a di- DISTRIBUTION lacking in purity and unworthy to live. vine agency in human affairs) as sources of healing. Greek temples provided refuge for the sick. One of these Hospitals rarely succeeded during the centuries leading sanctuaries, dedicated to Asclepius, is said to have existed to the Middle Ages; only a few existed outside Italian cities. as early as 1134 BC at Titanus. Ruins attest to the existence Occasional almshouses in Europe sheltered some of the sick, of another,© Jones more famous & Bartlett Greek temple Learning, built several LLC centu- whereas inns© along Jones the Roman & Bartlett roads housed Learning, others. No LLC pro- ries laterNOT in the FOR Hieron, SALE or sacred OR grove, DISTRIBUTION at Epidaurus. Here, vision appearsNOT to have FOR been SALEmade for OR care DISTRIBUTIONof the thousands of physicians ministered to the sick holistically in body and helpless paupers who had been slaves and were later set free soul. They prescribed medications such as salt, honey, and when Christianity was introduced into the Roman Empire. water from a sacred spring. They gave patients hot and cold baths to promote speedy cures and encouraged long hours © Jonesof & sunshine Bartlett and Learning, sea air, combined LLC with pleasant vistas, as © Jones & Bartlett Learning, LLC islamic HOSPITALS NOT FORan importantSALE OR part DISTRIBUTION of treatment. The temple hospitals housed NOT FOR SALE OR DISTRIBUTION libraries and rooms for visitors, attendants, priests, and physicians. The temple at Epidaurus even boasted what might be The followers of Mohammed were almost as zealous described as the site of the first clinical records. The columns as the Christians in caring for the sick. In Baghdad, Cairo, of the temple were inscribed with the names of patients, brief Damascus, Cordova, and many other cities under their con- histories of their cases, and© Jonescomments & asBartlett to whether Learning, or not trol,LLC luxurious hospital accommodations© Jones & were Bartlett frequently Learning, LLC they were cured. NOT FOR SALE OR DISTRIBUTIONprovided. Harun al-Rashid, theNOT glamorous FOR caliph SALE (a title OR for DISTRIBUTION The asclepia spread rapidly throughout the Roman a religious or civil ruler claiming succession from Muham- Empire as well as through the Greek world. Although some mad) of Baghdad (786–809 AD), built a system of hospitals, hospitals were simply spas, others followed the therapy out- paying the physicians himself. Medical care in these hos- lined by the leading physicians of the day. Hippocrates, for pitals was free. Approximately 4 centuries later, in 1160, a example,© aJones physician & born Bartlett about 460 Learning, BC, advocated LLC medical Jewish traveler© Jones reported & that Bartlett he had found Learning, as many LLC as 60 theoriesNOT that haveFOR startling SALE similarity OR DISTRIBUTION to those of the present dispensaries NOTand infirmaries FOR SALE in Baghdad OR DISTRIBUTION alone. The Persian day. He employed the principles of percussion and ausculta- physician Rhazes, who lived from approximately 850 to tion, wrote intelligently on fractures, performed numerous 923 AD, was skilled in surgery. He was probably the first to surgical operations, and described such conditions as epi- use the intestines of sheep for suturing and cleansed patient lepsy, tuberculosis, malaria, and ulcers. He also kept detailed wounds with alcohol. He also gave the first rational accounts © Jonesclinical & Bartlett records Learning,of many of his LLC patients. Physicians like Hip- © Jonesof smallpox & Bartlett and measles. Learning, LLC NOT FORpocrates SALE not OR only DISTRIBUTION cared for patients in the temples, but also NOT FORIslamic SALE physicians OR likeDISTRIBUTION Rhazes received much of their gave instruction to young medical students. medical knowledge from the persecuted Christian sect known as the Nestorians. Nestorius, driven into the desert with his followers after having been appointed patriarch of Constantinople, took up the study of medicine. The school at HOSPITALS OF THE EARLY CHRISTIAN ERA © Jones & Bartlett Learning, EdessaLLC in Mesopotamia, with its© Jonestwo large &hospitals, Bartlett even Learning,- LLC NOT FOR SALE OR DISTRIBUTIONtually came under the control NOTof the FORNestorians, SALE in whichOR DISTRIBUTION Christianity and the doctrines preached by Jesus stressing they established a remarkable teaching institution. Even- the emotions of love and pity gave impetus to the establish- tually driven out of Mesopotamia by the orthodox bishop ment of hospitals, which, with the advance of Christianity, Cyrus, they fled to Persia, establishing the famous school at became integral parts of the church institution. These Chris- Gundishapur, which is conceded to be the true starting point tian hospitals© Jones replaced & Bartlett those of Greece Learning, and Rome, LLC were de- of Islamic medicine.© Jones Gundishapur & Bartlett was Learning, home to the world’sLLC voted entirelyNOT FORto care SALEof the sick, OR and DISTRIBUTION accommodated patients oldest knownNOT teaching FOR hospital SALE and ORalso comprisedDISTRIBUTION a library in buildings outside the church proper. and a university. It was located in the present-day province The decree of Constantine in 335 AD closed the aescula- of Khuzestan, in the southwest of Iran, not far from the pia and stimulated the building of Christian hospitals, which, Karun River. during the 4th and 5th centuries, reached the peak of their Islamic medicine flourished up to about the 15th century. © Jonesdevelopment. & Bartlett Many Learning, were erected LLC by the rulers of the period © JonesIslamic & physicians Bartlett were Learning, acquainted LLCwith the possibilities of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR inhalationSALE OR anesthesia. DISTRIBUTION They instituted precautions againstNOT FORFinally, SALE an activeOR DISTRIBUTIONperiod of hospital growth came during adulteration of drugs and developed a vast number of new the late 12th and early 13th centuries. In 1198, Pope Innocent drugs. Islamic countries also built asylums for the mentally III urged hospitals of the Holy Spirit to be subscribed for by ill 1000 years before such institutions appeared in Europe. the citizenry of many towns. He set an example by founding The people of Islam made a brilliant start in medicine but a model hospital in Rome, known as Santo Spirito in Sassia. never fulfilled the great© Jones promise &that Bartlett glowed in Learning, their early LLCBuilt in 1204, it survived until© Jones 1922, when & Bartlettit was destroyed Learning, LLC work in medical arts, andNOT hospitalization FOR SALE was ORnever DISTRIBUTION fulfilled. by fire. In Rome, nine otherNOT hospitals FOR were SALE founded OR shortly DISTRIBUTION Wars, politics, superstitions, and a nonprogressive philoso- after completion of the one in Sassia; it is estimated that in phy stunted the growth of a system that had influenced the Germany alone, 155 towns had hospitals of the Holy Spirit development of hospitals. during early medieval times. Although most hospitals constructed during the Middle © Jones & Bartlett Learning, LLC Ages were© associatedJones & with Bartlett monasteries Learning, or founded LLC by re- NOT FOR SALE OR DISTRIBUTION ligious groups,NOT aFOR few cities,SALE particularly OR DISTRIBUTION in England, built EARLY MILITARY HOSPITALS municipal institutions. Like all hospitals of the period, the buildings were costly and often decorated with colorful tap- Engraved on a limestone pillar dating back to the Sum- estries and stained glass windows, but the interiors often erians (2920 BC) are pictures that show, among other mili- consisted of large, drafty halls with beds lining each side. © Jones &tary Bartlett procedures, Learning, the assemblage LLC of the wounded. The book© JonesA few & ofBartlett the better Learning, institutions wereLLC arranged on the ward NOT FOR ofSALE Deuteronomy OR DISTRIBUTION records that Moses established outstandingNOT FORplan, usuallySALE built OR in DISTRIBUTION the shape of a cross. Floors were made rules for military hygiene. Out of the urgency of care for the of red brick or stone, and the only ventilation came from the wounded in battle came much of the impetus for medical cupola in the ceiling. progress. Hippocrates is quoted as saying that “war is the With the spread of leprosy during the 12th and 13th cen- only proper school for a surgeon.” Under the Romans, sur- turies, lazar houses sprang up, supplying additional hospital gery advanced largely© because Jones of experience& Bartlett gained Learning, through LLCfacilities. Made up of crude© structures,Jones & lazar Bartlett houses Learning, were LLC gladiatorial and militaryNOT surgery. FOR SALE OR DISTRIBUTIONusually built on the outskirtsNOT of towns FOR and SALE maintained OR DISTRIBUTIONfor the segregation of lepers rather than for their treatment. Spe- cial groups of attendants, including members of the Order of St. Lazar, nursed the patients. The group represented an im- Medieval Hospitals: The Dark Ages portant social and hygienic movement because their actions © Jones & Bartlett Learning, LLC served to ©check Jones the spread & Bartlett of epidemics Learning, through LLCisolation. ReligionNOT FOR continued SALE to dominate OR DISTRIBUTION the establishment of hos- The groupNOT is credited FOR for SALE virtually OR stamping DISTRIBUTION out leprosy. pitals during the Middle Ages. Although physicians cared During the same period of hospital growth, three famous for physical ailments to afford relief, they rarely attempted London institutions were established: St. Bartholomew’s in to cure the sick. Dissection of a human body would have 1137; St. Thomas’s before 1207; and St. Mary of Bethlehem been sacrilege because the body was created in the image in 1247. St. Bartholomew’s, founded by Rahere (the reported © Jones &of Bartlett God. Learning, LLC © Jonescourt & jester Bartlett of Henry Learning, I), cared for LLC the sick poor but, unlike NOT FOR SALEReligion OR continued DISTRIBUTION to be the most important factor in theNOT FORmany SALEhospitals OR of that DISTRIBUTION day, was well organized. St. Thomas’s establishment of hospitals during the Middle Ages. A num- Hospital was founded by a woman who was later canonized ber of religious orders created hospitia or travelers’ rests and St. Mary Overie. It burned in 1207, was rebuilt 6 years later, infirmaries adjacent to monasteries that provided food and and was constructed again on a new site in 1228. St. Mary temporary shelter for weary travelers and pilgrims. One of of Bethlehem was the first English hospital to be used exclu- these, the famous alpine© Joneshospice of& St. Bartlett Bernard Learning,founded in LLCsively for the mentally ill. © Jones & Bartlett Learning, LLC 962, gave comfort to theNOT weary FOR and SALEsent its renownedOR DISTRIBUTION dogs The Hotel-Dieu of Paris NOTwas probably FOR typicalSALE of OR the bet-DISTRIBUTION to the rescue of lost mountain climbers. ter hospitals of the Middle Ages. Built at the beginning of The hospital movement grew rapidly during the Crusades, the 13th century, the hospital provided four principal rooms which began in 1096. Military hospital orders sprang up, and for patients in various stages of disease, as well as a room accommodations for sick and exhausted crusaders were pro- for convalescents and another for maternity patients. Illus- vided© alongJones well-traveled & Bartlett roads. Learning, One body of LLCcrusaders orga- trations by© artists Jones of the& Bartletttime show Learning,that two persons LLC gener- nizedNOT the Hospitallers FOR SALE of the OR Order DISTRIBUTION of St. John, which in 1099 ally sharedNOT one bed.FOR Heavy SALE curtains OR sometimesDISTRIBUTION hung from established in the Holy Land a hospital capable of caring for canopies over the bed to afford privacy, but this advantage 2000 patients. Knights of this order took personal charge of was more than offset by the fact that the draperies, which service to patients and often denied themselves so that the were never washed, spread infection and prevented free ven- sick might have food and medical care. For years, these insti- tilation. The institution was self-contained, maintaining a © Jones &tutions Bartlett were theLearning, best examples LLC of hospitals of that period. © Jonesbakery, & Bartlettherb garden, Learning, and farm. Often, LLC patients who had fully NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORrecovered SALE remained OR DISTRIBUTION at the hospital to work on the farm or in NOTanesthetics, FOR SALE and surgeryOR DISTRIBUTION was practiced by the long-robe the garden for several days in appreciation for the care they surgeons, a small group who were educated in the universi- had received. ties and permitted to perform all types of operations, and by the short-robe surgeons, the barbers who, in most com- munities, were allowed only to leech and shave the patient, The “Dark Age” of H©ospitals Jones & Bartlett Learning, LLCunless permission was granted© to Jones extend the & scopeBartlett of treat Learning,- LLC NOT FOR SALE OR DISTRIBUTIONment. Both groups were regardedNOT as inferiorFOR SALEto physicians. OR DISTRIBUTION Most hospitals during the Middle Ages, however, were not In 1506, a band of long-robe surgeons organized the Royal as efficiently managed as the Hotel-Dieu of Paris. Pictures and College of Surgeons of Edinburgh. By 1540, both the long- and records prove that many hospitals commonly crowded several short-robe surgeons in England joined to form the Company of patients into one bed regardless of the type or seriousness of Barber-Surgeons of London. In 1528, Thomas Linacre, physi- illness. ©A mildlyJones ill patient& Bartlett might be Learning, placed in the LLCsame bed as cian to Henry© VIII, Jones founded & andBartlett became Learning, the first president LLC of an occupantNOT suffering FOR SALE from a contagious OR DISTRIBUTION disease. the Royal CollegeNOT of FORPhysicians SALE of England. OR DISTRIBUTION Medical care was deplorable during this dark age of Although English physicians were organized during the hospitals. A notable exception to the general deterioration 16th century, Henry VIII of England ordered that hospitals in medicine during this era was the conscientious effort of associated with the Catholic Church be given over to secu- those monks who copied by hand and preserved the writings lar uses or destroyed. The sick were turned into the streets. © Jonesof & Hippocrates Bartlett andLearning, other ancient LLC physicians. © JonesConditions & Bartlett in hospitals Learning, became so intolerableLLC that the king NOT FOR TheSALE great OR Al-Mansur DISTRIBUTION Hospital, built in Cairo in 1276, NOTwas FOR petitioned SALE to returnOR DISTRIBUTION one or two buildings for the care of struck a contrast to the European institutions of the Middle patients. Henry consented and restored St. Bartholomew’s Ages. It was equipped with separate wards for the more seri- in 1544. Practically the only hope for the sick poor among ous diseases and outpatient clinics. The handful of hospitals outlying towns was to journey many miles to London. like Al-Mansur would lay the groundwork for hospital prog- The dearth of hospitals in England continued throughout ress to come in later centuries.© Jones & Bartlett Learning, theLLC 17th century, when the medical© Jones school & was Bartlett developed. Learning, LLC NOT FOR SALE OR DISTRIBUTIONThe French and the English quicklyNOT accepted FOR whatSALE had OR origi- DISTRIBUTION nated in Italy—the first attempt to make medical instruction practical. St. Bartholomew’s took the lead in education by HOSPITALS OF THE RENAISSANCE establishing a medical library in 1667 and permitted appren- tices to walk the wards for clinical teaching under experi- During© Jones the revival & of Bartlett learning around Learning, the close LLC of the 14th enced surgeons.© Jones & Bartlett Learning, LLC century,NOT hundreds FOR of medicalSALE hospitalsOR DISTRIBUTION in western Europe re- In 1634, anNOT outstanding FOR SALEcontribution OR was DISTRIBUTION made to nursing ceived the new, more inquiring surgeons that the Renaissance by the founding of the order of the Daughters of Charity of produced. New drugs were developed, and anatomy became St. Vincent de Paul. Originating at the Hotel-Dieu of Paris a recognized study. Ancient Greek writings were printed, and as a small group of village girls who were taught nursing by dissection was performed by such masters such as Leonardo the nuns, the order grew rapidly and was transplanted to the © Jonesda & Vinci, Bartlett known Learning, as the originator LLC of cross-sectional anatomy, © JonesUnited &States Bartlett by Mother Learning, Seton in 1809. LLC NOT FORand SALE Vesalius. OR Hospitals DISTRIBUTION also became more organized. Memo- NOT FOR SALE OR DISTRIBUTION randa from 1569 describe the duties of the medical staff in the civil hospital of Padua, a city that was home to the most HOSPITALS OF THE 18TH CENTURY famous medical school during the 16th century. These read, as noted by MacEachern (p. 10): © Jones & Bartlett Learning, LLCDuring the 18th century, the© building Jones of hospitals& Bartlett revived Learning, LLC There shall be a NOTdoctor FORof physic SALE upon ORwhom DISTRIBUTION partially. Because of poverty, NOT at first FOR the SALE movement OR madeDISTRIBUTION rests the duty of visiting all the poor patients in slow progress in England, but a few hospitals were built the building, females as well as males; a doctor of and supported jointly by parishes. By 1732, there were 115 surgery whose duty it is to apply ointments to all such institutions in England, some of them a combination of the poor people in the hospital who have wounds almshouse and hospital. As hospitals grew in number, new of© any Jones kind; and & Bartletta barber who Learning, is competent LLC to do, advances in health© Jones care began. & Bartlett Learning, LLC forNOT the womenFOR SALEas well asOR the DISTRIBUTION men, all the other The RoyalNOT College FOR of Physicians SALE ORestablished DISTRIBUTION a dispensary things that a good surgeon usually does.1 where medical advice was given free and medicines were sold to the needy at cost. Controversies and lawsuits, however, The practice of surgery during the Renaissance be- brought an untimely end to this early clinic. Not discouraged came more scientific and progressive. Operations for litho- by this experience, the Westminster Charitable Society cre- © Jonestomy & Bartlett and hernioplasty Learning, were undertakenLLC without the use of © Jonesated a similar& Bartlett dispensary Learning, in 1715. The LLC same organization in NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR 1719SALE founded OR DISTRIBUTIONWestminster Hospital, an infirmary built NOTby FORstructure, SALE and in OR 1755, DISTRIBUTION the hospital, quite modern in plan with voluntary subscription, in which the staff gave its services a central administration unit and two wings, was opened to the gratuitously. Ten years later, the Royal College of Physicians public. The first staff consisted of Dr. Phineas Bond, Dr. Lloyd in Edinburgh opened the Royal Infirmary. London Hospital, Zachary, and the founder, Dr. Thomas Bond, all of whom gave another notable institution, was founded in 1740. Admission their services without remuneration for 3 years. of charity patients to © the Jones London & Hospital Bartlett was Learning, apparently LLCRich in the history of hospitals,© Jones Philadelphia & Bartlett must Learning, also LLC by ticket because amongNOT its historicalFOR SALE relics isOR an admissionDISTRIBUTION be credited with the first quarantineNOT FOR station SALE for immigrants OR DISTRIBUTION card. On the back of that card is a representation of a biblical (created in 1743) and the first lying-in hospital (established scene drawn by the artist Hogarth. in 1762), a private institution owned by the noted obstetri- As hospitals worked to provide services to more people, cian William Shippen. The quality of American health care scientists worked to provide better services. Filling a need seemed to be improving. in hospitals© Jones at the & time Bartlett was Desaguliers’s Learning, invention LLC in 1727 Dr. John© Jones,Jones an &American, Bartlett published Learning, a book LLC in 1775 of aNOT machine FOR for pumpingSALE ORfresh DISTRIBUTIONair into and foul air out of calling attentionNOT toFOR frightful SALE conditions OR DISTRIBUTION existing in hospitals. rooms. Used at first for prisons and public buildings, it later He charged that hospitals abroad were crowded far beyond was installed in hospitals. capacity and that Hotel-Dieu of Paris frequently placed three In the Elizabethan period, however, the deterioration of to five patients in one bed—placing the convalescent with the hospital service that had set in under Henry VIII continued. dying and fracture cases with infectious cases. He estimated © Jones &Despite Bartlett advances Learning, made during LLC the 18th century and the© Jonesthat &one Bartlett fifth of the Learning, 22,000 patients LLC cared for at Hotel-Dieu NOT FOR steadySALE growth OR DISTRIBUTION in population and wealth, hospital progressNOT FORdied eachSALE year. OR Wounds DISTRIBUTION were washed daily with a sponge was uneventful. that was carried from patient to patient. The infection rate Antony van Leeuwenhoek (1632–1723) succeeded in was said to be 100%. Mortality after amputation was as high making some of the most important discoveries in the his- as 60%. Jones’s call to action had a positive effect on Ameri- tory of biology. Although Leeuwenhoek did not invent the can health care. first microscope, he ©was Jones able to perfect& Bartlett it. Many Learning, of his dis- LLCAs late as 1769, New York© JonesCity, with & nearly Bartlett 300,000 Learning, in- LLC coveries included bacteria,NOT free-living FOR SALE and parasitic OR DISTRIBUTION micro- habitants, was without hospitals.NOT In FOR 1771, SALE a small ORgroup DISTRIBUTION of scopic protists, sperm cells, blood cells, and microscopic citizens, Dr. Jones among them, formed the Society of the nematodes. His research opened up an entire world of mi- New York Hospital and obtained a grant to build. The society croscopic life. Leeuwenhoek had a pronounced influence on purchased a 5-acre site and made plans for a model structure the creation of the sciences of cytology, bacteriology, and that would allow a maximum of eight beds per ward and pro- pathology.© Jones His discoveries & Bartlett have Learning, forever affected LLC not only the vide good© ventilation. Jones &The Bartlett hospital fell Learning, into the hands LLC of the deliveryNOT of FOR health SALEcare in hospitals,OR DISTRIBUTION but also the way health British troopsNOT during FOR the SALE American OR Revolution DISTRIBUTION and was used care is delivered in all settings. as a barracks and military hospital. During postwar reconstruction, the New York Hospital broadened its services. Under the supervision of Dr. Valentine Seaman, the hospital began providing instruction in nursing, Early Hospitals in the United States © Jones & Bartlett Learning, LLC © Jonesand in& 1779,Bartlett it introduced Learning, vaccination LLC in the United States and NOT FOR SALE OR DISTRIBUTION NOT FORestablished SALE an ambulance OR DISTRIBUTION service. Manhattan Island claims the first account of a hospital Other early American hospitals of historic interest include in the New World, a hospital that was used in 1663 for sick the first psychiatric hospital in the New World, founded at soldiers. Fifty years later, in Philadelphia, William Penn Williamsburg, Virginia, in 1773, and a branch of federal hospi- founded the first almshouse established in the American tals created by the passage of the US Marine Hospital Service colonies. The Quakers© supported Jones the& almshouse,Bartlett Learning,which was LLCAct in 1798. Under this act, ©two Jones marine hospitals& Bartlett were estabLearning,- LLC open only to membersNOT of that FOR faith. SALE However, OR Philadelphia DISTRIBUTION lished in 1802; one in BostonNOT and another FOR in SALE Norfolk, OR Virginia. DISTRIBUTION was rapidly growing and also in need of a public almshouse. The Massachusetts General Hospital (MGH), which pio- Such an institution for the aged, the infirm, and persons with neered many improvements in medicine, originated in Boston. mental illness was established in 1732. The institution later Its first patient, admitted in 1821, was a 30-year-old sailor. became the historic Old Blockley, which in turn evolved into the ©Philadelphia Jones & General Bartlett Hospital. Learning, LLC More© Jones than a decade & Bartlett earlier, twoLearning, Boston doctors LLC PhiladelphiaNOT FOR was SALE the site OR of theDISTRIBUTION first incorporated hospi- had NOTappealed FOR to the SALE city’s “wealthiest OR DISTRIBUTION and most in- tal in America, the Pennsylvania Hospital. Dr. Thomas Bond fluential citizens” to establish a general hospital. wished to provide a place where Philadelphia physicians may The War of 1812 delayed the dream, but on July 4, treat their private patients. With the aid of Benjamin Franklin, 1818, the cornerstone was finally laid. The original Bond sought a charter for the Pennsylvania Hospital, which building, designed by Boston’s leading architect © Jones &was Bartlett granted byLearning, the Crown in LLC 1751. Franklin helped design the© Jones &Charles Bartlett Bulfinch, Learning, is still in LLCuse. One of the world’s NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEleading OR centers DISTRIBUTION of medical research and treatment NOTwhom FOR she SALE had assembled, OR DISTRIBUTION she found that the sick were lying has grown up around it. The original domed op- on canvas sheets in the midst of dirt and vermin. There was erating amphitheater, where anesthesia was first neither laundry nor hospital clothing, and beds were made publicly demonstrated in 1846, is now a Registered of straw. She proceeded to establish order and cleanliness. National Historic Landmark. MGH has achieved She organized diet kitchens, a laundry service, and depart- countless medical milestones,© Jones including& Bartlett the firstLearning, LLCments of supplies, often using ©her Jones own funds & Bartlettto finance Learning,her LLC successful reattachmentNOT of FORa human SALE limb.2 OR DISTRIBUTIONprojects. Ten days after her arrival,NOT FOR the newly SALE established OR DISTRIBUTION kitchens were feeding 1000 soldiers. Within 3 months, In 1832, the Boston Lying-In Hospital opened its doors 10,000 soldiers were receiving clothing, food, and medicine. to women unable to afford in-home medical care. It was one As a result of her work, the death rate substantially declined. of the nation’s first maternity hospitals, made possible be- She has been credited with observing the following: cause of© fundraisingJones & appealsBartlett to individualsLearning, and LLC charitable © Jones & Bartlett Learning, LLC organizations.NOT FOR SALE OR DISTRIBUTION A goodNOT nursing FOR staff SALE will perform OR DISTRIBUTION their duties Despite the increased volume of institutions providing more or less satisfactorily under every disadvan- care for the sick, the first half of the 19th century stands as tage. But while doing so, their head will always a dark period in hospital history. Surgeons of the day had try to improve their surroundings, in such a way sufficient knowledge of anatomy to lead them to perform as to liberate them from subsidiary work, and © Jonesmany & Bartlett ordinary operations,Learning, and LLC as a result, more surgery was © Jonesenable & Bartlett them to devote Learning, their time LLC more exclusively NOT FORprobably SALE undertaken OR DISTRIBUTION than during any previous era. However, NOT FORto the SALE care of OR the sick.DISTRIBUTION3 there was one important aspect: Although the medieval and ancient surgeons had sought to keep wounds clean, even Because of her organizational skills, many consider using wine in an attempt to accomplish this purpose, 19th Florence Nightingale to be the first true healthcare admin- century surgeons believed suppuration (the production and istrator. Later she extended her administrative duties to in- discharge of pus) to be desirable© Jones and encouraged& Bartlett it. HospitalLearning, cludeLLC planning the details of sanitary© Jones engineering & Bartlett in a new Learning, LLC wards were filled with dischargingNOT FOR wounds, SALE which OR madeDISTRIBUTION the military hospital. NOT FOR SALE OR DISTRIBUTION atmosphere offensive enough to warrant the use of perfume. As the field of nursing continued to progress, so did medi- Nurses of that period are said to have used snuff to make cine. Crawford Long, for example, first used ether as an an- conditions tolerable. Surgeons wore their operating coats for esthetic in 1842 to remove a small tumor from the neck of months without washing. The same bed linens served several a patient. He did not publish any accounts of his work until patients.© Pain,Jones hemorrhage, & Bartlett infection, Learning, and gangrene LLC infested later, however,© soJones the discovery & Bartlett is often Learning,attributed to W. LLC T. G. the wards.NOT Mortality FOR SALEfrom surgical OR DISTRIBUTIONoperations rated as high Morgan, a dentistNOT who FOR developed SALE sulfuric OR DISTRIBUTIONether and arranged as 90% to 100%. Nathan Smith, in the second decade of that for the first hospital operation under anesthesia at MGH in century, advocated a bichloride of mercury solution for re- 1846. Although not put to practical use immediately, ether ducing infection, but his ideas were ignored. soon took away some of the horror that hospitals had en- gendered in the public mind. Sir James Simpson first used © Jones & Bartlett Learning, LLC © Joneschloroform & Bartlett as an anesthetic Learning, in 1847 LLC for an obstetrical case in England. NOT FOR SALE LateOR DISTRIBUTION 19th Century Renaissance NOT FOR SALE OR DISTRIBUTION The year 1847 also brought about the founding of the American Medical Association (AMA) under the leadership To the modern healthcare worker who takes for granted of Dr. Nathan Smith Davis. The association, among its main hospital cleanliness and the kindly treatment of the sick, the objectives, strived to improve medical education, but most magnitude of Florence Nightingale’s© Jones service& Bartlett may be Learning, incom- ofLLC the organization’s tangible efforts© Jones in education & Bartlett began Learning,at LLC prehensible. The famous NOTEnglish FOR nurse SALEbegan her OR career DISTRIBUTION by the close of the century. The AMANOT was FOR a strong SALE advocate OR for DISTRIBUTION training at Kaiserswerth on the Rhine in a hospital and dea- establishing a code of ethics, promoting public health mea- coness home established in 1836 by Theodor Fliedner and sures, and improving the status of medicine. his wife. Florence Nightingale wrote disparagingly of her The culmination of Florence Nightingale’s work came training there, particularly of the hygiene practiced. Return- in 1860, after her return to England. There she founded the ing to ©England, Jones she & put Bartlett her own ideasLearning, of nursing LLC into effect Nightingale ©School Jones of Nursing & Bartlett at the St. Learning, Thomas’ Hospital. LLC and rapidlyNOT acquired FOR SALEa reputation OR for DISTRIBUTION efficient work. From this school,NOT a FOR group SALEof 15 nurses OR graduatedDISTRIBUTION in 1863. By 1854, during the Crimean War, the English govern- They later became the pioneer heads of training schools ment, disturbed by reports of conditions among the sick and throughout the world. wounded soldiers, selected Florence Nightingale as the one In 1886, the Royal British Nurses’ Association (RBNA) person capable of improving patient care. Upon her arrival at was formed. The RBNA worked toward establishing a stan- © Jonesthe & militaryBartlett hospital Learning, in Crimea LLC with a small band of nurses © Jonesdard of &technical Bartlett excellence Learning, in nursing. LLC A charter granted to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR theSALE RBNA OR in 1893DISTRIBUTION denied nurses a register, although it didNOT FORAlso SALE of great OR importance DISTRIBUTION to hospitals and infection con- agree to maintain a list of persons who could apply to have trol was Ernst von Bergmann’s introduction of steam steril- their name entered thereon as nurses.4 ization in 1886 and William Stewart Halsted’s introduction The first formally organized American nursing schools of rubber gloves in 1890. were established in 1872 at the New England Hospital for By the end of the century, Joseph Lister carried Pas- Women and Children© inJones Boston & (Brigham Bartlett and Learning, Women’s LLCteur’s work a step further and© Jones showed that& Bartlett wound healing Learning, LLC Hospital), and then inNOT 1873 FOR at Bellevue, SALE New OR Haven, DISTRIBUTION and could be hastened by usingNOT antiseptics FOR to SALE destroy OR disease- DISTRIBUTION Massachusetts General Hospitals. In 1884, Alice Fisher was bearing organisms and by preventing contaminated air appointed as the first head of nurse training at Philadelphia from coming into contact with these wounds. Lister was Hospital’s (renamed as the Philadelphia General Hospital in not content with obtaining better results in his own surgi- 1902) nurse’s training school. She had the distinction of be- cal cases; he devoted his life to proving that suppuration ing the© Jonesfirst Nightingale-trained & Bartlett Learning, nurse recruited LLC to Philadel- is dangerous© Jones and that & it Bartlett should be Learning, prevented or LLCreduced phiaNOT upon recommendationFOR SALE OR by Florence DISTRIBUTION Nightingale. by use ofNOT antiseptics. FOR SALE Despite OR his successfulDISTRIBUTION work and Mrs. Bedford Fenwick, a nurse leader in the English eloquent pleas, his colleagues persisted in following their nurse registration movement, traveled to Chicago in 1893 old methods. Years after his discovery, they continued to to arrange the English nursing exhibits to be displayed in deride him and his technique, which consisted of spraying the women’s building at the World’s Fair. As part of the carbolic solution so profusely about the operating room © Jones &Congress Bartlett on Learning,Hospitals and LLC Dispensaries, a nursing section© Jonesthat &both Bartlett surgeons Learning, and patients LLC were drenched. As time NOT FOR includedSALE ORpapers DISTRIBUTION on establishing standards in hospital trainNOT- FORwent onSALE and antiseptics OR DISTRIBUTION and the techniques of using them ing schools, the establishment of a nurses association, and were improved, even the skeptical were impressed by the nurse registration. The group formulated plans to improve clinical results. Surgeons, at last, realized that they could nursing curriculum and hospital administration in the first undertake major operations without the fear of morbidity concerted attempt to improve hospitals through a national and mortality. organization. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Progress in Infection Control The Continuing Problem

Ignaz Philipp Semmelweis of Vienna, Austria, unknow- Unfortunately, infections continue to be a major con- ingly© laidJones the foundation & Bartlett for Pasteur’sLearning, later work.LLC In 1847, cern in the© Joneshome and & healthcareBartlett Learning,setting. In light LLC of an at theNOT Vienna FOR Lying-In SALE Hospital, OR DISTRIBUTION Europe’s largest teaching excerpt fromNOT the FOR article, SALE “99,000 OR Die DISTRIBUTION Yearly From Pre- obstetrical department, he boldly declared that the alarming ventable Hospital Infections, CDC Finally Gets Data as number of deaths from puerperal fever was a result of infec- State Laws Force Hospitals to Count Infections” organi- tion transmitted by students who came directly from the dis- zations must ask themselves, have we learned anything secting room to take care of maternity patients. Semmelweis from the history of hospitals and how much progress have © Jones ¬ed Bartlett that Division Learning, 1 of the LLC hospital was a medical student–© Joneswe really& Bartlett made? Learning, LLC NOT FOR teachingSALE serviceOR DISTRIBUTION and Division 2 was used for midwife trainees.NOT FOR SALE OR DISTRIBUTION Maternal deaths for Division 1 averaged 10%, whereas the May 27, 2010— As some 99,000 Americans die rate for Division 2 averaged 3%. Medical students performed yearly from hospital-acquired infections, state laws autopsies; midwives did not. As a result of these findings, an are finally forcing hospitals to report the infections. order was posted on May 15, 1847, requiring all students to Early data released by CDC today suggest this scrub their hands in chlorinated lime until the cadaver smell © Jones & Bartlett Learning, LLC is cutting infection rates.© ButJones the data & paintBartlett a big- Learning, LLC was gone. The order was later revised to include hand washing NOT FOR SALE OR DISTRIBUTIONger picture. Despite theNOT huge sizeFOR of theSALE problem, OR DISTRIBUTION between patients. most hospitals in most states still haven’t come to Despite having made bitter enemies, Semmelweis had grips with it. the satisfaction of seeing the mortality rate in his obstetrical cases drop from 9.92% to 1.27% in little more than That’s going to change, says Health and Hu- a year© Jonesas a result & ofBartlett an aseptic Learning, technique that LLC he devised. man© Services Jones Secretary & Bartlett Kathleen Learning, Sebelius. . .LLC . A few years later, Louis Pasteur demonstrated the scien- NOT FOR SALE OR DISTRIBUTION McGiffertNOT FOR has a SALE more balanced OR DISTRIBUTION view of the im- tific reason for Semmelweis’s success when he proved that portance of the CDC report. bacteria were produced by reproduction and not by spon taneous generation, as was then generally believed. From “The main thing this means is that the CDC his work came the origin of modern bacteriology and clini- has finally embraced public reporting as a compo- © Jones &cal Bartlett laboratories. Learning, LLC © Jones &nent Bartlett of prevention Learning, strategies,” LLC she says.5 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR InSALE a special OR DISTRIBUTION issue of Emerging Infectious Diseases, NOTprocedures FOR SALE and the OR modern DISTRIBUTION hospital. Anesthesia improved Dr. William R. Jarvis, Associate Director for Program pain control, and improved hygiene practices helped reduce Development, Division of Healthcare Quality Promotion the incidence of surgical site infections. (currently Hospital Infections Program), Centers for Disease Control and Prevention (CDC), writes: © Jones & Bartlett Learning, LLCModern Hospital Laboratory© Jones & Bartlett Learning, LLC Over the past twoNOT decades, FOR acute-care SALE ORfacili DISTRIBUTION- NOT FOR SALE OR DISTRIBUTION ties have become smaller and fewer, but the hos- The study of cytology originated about the middle of the pitalized patient population has become more 19th century and influenced the development of the mod- severely ill and more immunocompromised and ern hospital clinical laboratory. The cell theory was first ad- thus at greater risk for hospital-acquired infec- vanced in 1839 by the German anatomist Theodor Schwann tions.© Jones At the & same Bartlett time, the Learning, proportion LLC of the and was further© Jones developed & Bartlett by Jacob Learning, Henle, whose LLC writ- U.S.NOT population FOR SALE.65 years OR of DISTRIBUTION age has increased, ings on microscopicNOT FOR anatomy SALE appeared OR about DISTRIBUTION 1850. Rudolf as have the number of long-term care facili- Virchow was the most eminent proponent of the cell theory. ties and the number of beds in these facilities. His studies in cellular pathology speeded research in the eti- This trend is expected to continue for the next ology of disease. 50 years. Similarly, delivery of health care in the © Jones & Bartletthome has becomeLearning, the most LLC rapidly growing sec- © Jones & Bartlett Learning, LLC NOT FOR SALEtor of theOR health-care DISTRIBUTION system. Currently, nearly as NOTC hangingFOR SALE Hospital OR DISTRIBUTION Structure many patients are receiving care in the home as in the inpatient setting. Provision of health care in managed-care and outpatient and ambulatory- With nursing, anesthesia, infection control, and cytology care settings continues to expand. Thus, the spec- under way, a change in hospital structure began in the last trum of health-care© deliveryJones in& 2000Bartlett is larger Learning, quarterLLC of the 19th century. Buildings© Jones of the & Civil Bartlett War days Learning, LLC than ever before. BecauseNOT FORof the SALEseverely ORill and DISTRIBUTION continued, with as many as 25 toNOT 50 beds FOR in a SALE ward and OR little DISTRIBUTION immunocompromised populations in these set- provision for segregation of patients. In New York City in tings, prevention of infections and other adverse 1871, construction of Roosevelt Hospital, which was built events is a major component of providing quality on the lines of a one-story pavilion with small wards, set the care. . . . style for a new type of architecture that came to be known © Jones & Bartlett Learning, LLC as the American© Jones plan. A ¬eworthy Bartlett feature Learning, was ventilation LLC Infection control personnel will need to ex- NOT FOR SALE OR DISTRIBUTION by means of NOTopenings FOR in the SALE roof, a definiteOR DISTRIBUTION improvement on pand their efforts to match the expansion of the earlier hospitals that were characterized by a lack of provi- health-care delivery system. Enhanced admin- sion for ventilation. Dr. W. G. Wylie, writing in 1877, said istrative support for programs to prevent infec- he favored this type of building, but he advocated that it be tions and medical errors will be needed if we are a temporary structure only, to be destroyed when it became to reduce the risk of infection and other adverse infected. © Jones & Bartlettevents and Learning, improve the qualityLLC of care in the en- © Jones & Bartlett Learning, LLC NOT FOR SALEtire spectrum OR DISTRIBUTION of health-care delivery. Now, instead NOT FOR SALE OR DISTRIBUTION of the acute-care facility being the center of the Changing Hospital Function infection control universe, the infection control department has become the center of the diverse Promoted by the wealth of bacteriologic discoveries, health-care delivery system. Infection control de- hospitals began to care for patients with communicable partments will need© to Jones expand their& Bartlett surveillance Learning, LLC © Jones & Bartlett Learning, LLC diseases. During the decade from 1880 to 1890, the tu- of infections and adverseNOT events FOR and SALE their preven OR DISTRIBUTION- NOT FOR SALE OR DISTRIBUTION bercle bacillus was discovered; Pasteur vaccinated against tion efforts to all settings in which health care is anthrax; Koch isolated the cholera bacillus; diphtheria was delivered.6 first treated with antitoxin; the tetanus bacillus and the par- asite of malarial fever were isolated; and inoculation for © Jones & Bartlett Learning, LLC rabies was successful.© Jones Treatment & Bartlett of patients Learning, with some LLC of Discovery of Anesthesia NOT FOR SALE OR DISTRIBUTION the infectionsNOT necessitated FOR SALE isolation, OR and DISTRIBUTION hospitals were the logical place for observation of communicable diseases. As the 19th century neared its close, surgery was be- Consequently, at the end of the century, in addition to their coming more frequent. The discovery of anesthesia and many surgical cases, hospitals were crowded with large the principle of antiseptics are to be regarded as two of the numbers of patients suffering from scarlet fever, diphthe- © Jonesmost & Bartlett significant Learning, influences LLC in the development of surgical © Jonesria, typhoid, & Bartlett and smallpox. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR DiscoverySALE OR of DISTRIBUTION the X-Ray NOT FORThe SALE 20th century OR DISTRIBUTION is also characterized by rapid growth in nursing education. The earlier schools were maintained almost entirely to secure nursing service at a low cost. Wilhelm Conrad Röntgen’s discovery of the x-ray in The nurse’s duties were often menial, the hours long, and 1895 was a major scientific achievement. The first use classroom and laboratory study almost entirely lacking. of the x-ray symbolizes the beginning of the period that Nurses themselves had begun to organize for educational necessitated equipment© soJones costly that& Bartlett the average Learning, practitio- LLC © Jones & Bartlett Learning, LLC reforms. By 1910, training increasingly emphasized the- ner could not afford toNOT install FOR it. The SALE natural OR result DISTRIBUTION was the NOT FOR SALE OR DISTRIBUTION oretical studies. This movement was largely a result of founding of community hospitals in which physicians could the work of organizations such as the American Nurses jointly use such equipment. Nineteenth century inventions Association and the National League for Nursing, along also included the clinical thermometer, the laryngoscope, with the organization of the Committee on the Grading of the Hermann von Helmholtz ophthalmoscope, and innu- Nursing Schools. In 1943, the US Cadet Nurse Corps was merable© Jones other aids & toBartlett accurate Learning,diagnosis. LLC © Jones & Bartlett Learning, LLC organized to spur enrollment of student nurses in nursing AlthoughNOT FOR the medical SALE and OR nursing DISTRIBUTION professions of the later NOT FOR SALE OR DISTRIBUTION schools to help meet the shortages caused by enlistment half of the 19th century did not reap the full reward of their of graduate nurses for military service. As a result, efforts discoveries, they provided the 20th century with a firm foun- increased to train practical nurses and nurses’ aides in or- dation upon which to build. der to relieve the shortage of graduate nurses. © Jones & Bartlett Learning, LLC © JonesReform & Bartlett in medical Learning, education LLCbegan early in the century and was almost wholly a result of the efforts of the Council NOT FOR SALE OR DISTRIBUTION20th Century ProgressNOT FOR SALE OR DISTRIBUTION on Medical Education and Hospitals, which was established in 1905 by the AMA. Immediately after its organization, this The treatment of metabolic diseases and nutritional defi- council began inspection of medical schools. The council, by ciencies, the importance of vitamins, and the therapy of glan- establishing standards and by grading the schools, brought dular extracts played an© Jonesimportant & role Bartlett in the advancement Learning, LLCabout gradual elimination of© most Jones of the &unethical, Bartlett commer- Learning, LLC of medicine in the 20thNOT century. FOR As earlySALE as 1906,OR DISTRIBUTIONFrederick cial, and unqualified institutions.NOT FOR SALE OR DISTRIBUTION Gowland Hopkins began investigations of vitamins. Two A great stimulus to the profession of hospital adminis- years later, Carlos Finlay produced experimental rickets by tration has been the work of the American Hospital Asso- means of a vitamin-deficient diet. This, in turn, was followed ciation. Organized in 1899 as the Association of Hospital by Kurt Huldschinsky’s discovery that rickets could be treated Superintendents, it took its present name in 1907. Since its successfully© Jones with & ultraviolet Bartlett light. Learning, In quick succession LLC came inception,© the Jones organization & Bartlett has concerned Learning, itself particularly LLC CasimirNOT Funk’s FOR work SALE with vitamins,OR DISTRIBUTION Elmer McCollum’s dis- with the problemsNOT FOR of hospital SALE management. OR DISTRIBUTION As early as 1910, covery of vitamins A and B, Joseph Goldberger’s work in the the association held educational programs for hospital chief prevention of pellagra, and Harry Steenbock’s irradiation of executive officers and trustees. foods and oils. Other outstanding contributions to the sci- The American College of Surgeons was founded in 1913 ence of nutrition include Frederick Banting’s introduction of under the leadership of Dr. Franklin H. Martin, the first di- © Jones &insulin Bartlett in 1922, Learning, the studies LLCin anemia carried out by George© Jonesrector & generalBartlett of the Learning, organization. LLC One of the most dramatic NOT FOR HoytSALE Whipple OR DISTRIBUTIONand Frieda Robscheit-Robbins, and the MinotNOT FORachievements SALE ofOR the DISTRIBUTIONAmerican College of Surgeons was the and Murphy liver extract. hospital standardization movement that began in 1918. The Willem Einthoven’s invention of the electrocardiograph in founders drew up what was known as the “minimum stan- 1903 marked the beginning of an era of diagnostic and thera- dard,” a veritable constitution for hospitals, setting forth re- peutic aids. Shortly after that invention came the first basal quirements for the proper care of the sick. An annual survey metabolism apparatus,© then Jones the Wassermann & Bartlett (August Learning, Von) LLCof all hospitals having 25 or© more Jones beds & made Bartlett the standard Learning, LLC test in 1906, and testsNOT for pancreatic FOR SALE function. OR Invention DISTRIBUTION of effective. In 1918, when the NOTfirst survey FOR wasSALE conducted, OR DISTRIBUTIONonly the fluoroscopic screen followed in 1908. Subsequently, the 89 hospitals in the United States and Canada could meet the introduction of blood tests and examinations of numerous requirements. body secretions required well-equipped and varied labora- The hospital standardization movement focused all ef- tories. Concurrent with this progress in the field of internal forts on the patient, with the goal of providing the patient medicine© Jones was the & introduction Bartlett Learning,of radium for theLLC treatment of with the best© Jones professional, & Bartlett scientific, Learning, and humanitarian LLC care malignantNOT growths,FOR SALE increasing OR the DISTRIBUTION use of the clinical labora- possible. NOTThe growth FOR of SALE this movement OR DISTRIBUTION is remarkable, espe- tory for microscopic examination of pathologic tissue and cially given that participation in the hospital standardiza- developments in antibiotics. The result of these many new tion (now referred to as The Joint Commission) program is aids was the conquest of diseases formerly regarded as in- voluntary. curable, which in turn resulted in improved public confi- The years following 1929 will long be remembered as © Jones &dence Bartlett in hospitals. Learning, LLC © Jonesone &of Bartlettthe most trying Learning, periods inLLC the history of hospitals. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORAs SALEa result ofOR critical DISTRIBUTION economic conditions, many institu- NOT56 FOR million SALE Americans OR wouldDISTRIBUTION have been uninsured, with this tions found it difficult to keep their doors open. Lowered number increasing to 61 million by the year 2020. The cost bed occupancy and increased charity load, coupled with of employer-provided plans continues to increase from an steadily decreasing revenues from endowments and other estimated $5790 per year per family in 1999 to $13,375 in sources of income, worked hardships on private institu- 2009.8 Even those with insurance are often underinsured tions. Fortunately, however,© Jones every economic& Bartlett crisis Learning, brings LLCfor catastrophic occurrences. © In Jones addition, & with Bartlett employer- Learning, LLC forth new ideas and meansNOT and FORmethods SALE of organization OR DISTRIBUTION to based coverage declining, manyNOT working FOR families SALE are OR left DISTRIBUTION benefit humanity. with decreasing health benefits. The following newspaper In the later half of the 20th century, competition among article describes the frustrations and ongoing difficulties hospitals began to grow as for-profit hospital chains began of patients with limited resources facing the astronomical to spring up and compete with nonprofit organizations. Ad- costs of health care. vances ©in Jonesmedical technology,& Bartlett such Learning, as computed LLC tomogra- © Jones & Bartlett Learning, LLC phy (CT),NOT magnetic FOR resonance SALE OR imaging DISTRIBUTION (MRI), and positron NOT FOR SALE OR DISTRIBUTION emission tomography (PET) scanners and robotic surgery, As Medicaid Payments Shrink, Patients as well as an ever-growing list of new medications, have Are Abandoned revolutionized the practice of medicine. During this period, less invasive surgical procedures and a trend toward care Carol Y. Vliet’s cancer returned with a fury last sum- © Jonesin & outpatient Bartlett settings Learning, have reduced LLC the need for lengthy in- © Jones & Bartlett Learning, LLC mer, the tumors metastasizing to her brain, liver, hospital stays. NOT FOR SALE OR DISTRIBUTION NOT FORkidneys SALE and throat. OR DISTRIBUTION

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of com- HEALTH CARE AND HOSPITALS © JonesIN THE & 21SBartlettT CEN Learning,TURY LLCfort in her monthly appointments© Jones with &her Bartlett primary Learning, LLC care physician, Dr. Saed J. Sahouri, who had been NOT FOR SALE OR DISTRIBUTIONmonitoring her health for nearlyNOT twoFOR years. SALE OR DISTRIBUTION The modern hospital is a complex healthcare organization that continues to be the revolutionary product of She was devastated, therefore, when Dr. Sahouri a long and arduous struggle. The challenges of health informed her a few months later that he could no care are enormous and continue to test the health system. © Jones & Bartlett Learning, LLC longer see© Jones her because, & Bartlett like a growing Learning, number LLC Some of today’s healthcare challenges have carried over of doctors, he had stopped taking patients with from theNOT 20th FOR century, SALE including OR DISTRIBUTION exorbitant malpractice Medicaid.NOT FOR SALE OR DISTRIBUTION awards; skyrocketing insurance premiums; high expec- tations of society for miracle drugs and miracle cures; Dr. Sahouri said that his reimbursements from balancing fairly the mistakes of caregivers with the hun- Medicaid were so low—often no more than $25 per dreds of thousands of successful events that occur each office visit—that he was losing money every time a © Jonesyear & Bartlett across the Learning,nation; negative LLC press that increases public © Jonespatient & Bartlett walked in Learning, his exam room. LLC9 NOT FORfear; SALE the ethical OR dilemmasDISTRIBUTION of abortion and human cloning; NOT FOR SALE OR DISTRIBUTION the exponential growth of information and medical tech- Headlines, such as the one from the previous article, fi- nology; and the ever-increasing shortage of nurses, physi- nally received the attention of Congress as to the need for cians, pharmacists, physical therapists, and other health healthcare reform. Although the health reform legislation, professionals. © Jones & Bartlett Learning, theLLC Patient Protection and Affordable© Jones Care & Act Bartlett (PPACA), Learning, LLC NOT FOR SALE OR DISTRIBUTIONpassed by Congress and signedNOT by President FOR BarackSALE Obama, OR DISTRIBUTION will ensure that more Americans receive healthcare benefits, National Health Reform the costs associated with health care will continue to soar. Taxes will continue to increase, bureaucracy will become The ability to provide affordable access to healthcare ser- more complex, and discontent with the healthcare system vices to© evenJones the insured & Bartlett continues Learning, to be an ongoing LLC chal- will most likely© Jones continue. & Bartlett Learning, LLC lenge. TheNOT high FOR cost ofSALE health ORcare hasDISTRIBUTION risen from $28 billion The WhiteNOT House FOR announced SALE the followingOR DISTRIBUTION major reforms: in 1960 to $2.5 trillion in 2009, with an estimated cost of $4.4 trillion in 2018.7 Health reform will make health care more At the beginning of the 21st century, there were nearly affordable, make health insurers more account- 49 million uninsured Americans, and the number contin- able, expand health coverage to all Ameri- © Jonesues & Bartlett to increase. Learning, It was estimated LLC that by the year 2015, © Jonescans, & Bartlett and make Learning, the health system LLC sustainable, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEstabilizing OR DISTRIBUTION family budgets, the Federal budget, NOT FOR SALE OR DISTRIBUTION and the economy: Va. Begins Courtroom Assault on Health Law • It makes insurance more affordable by provid- RICHMOND—The legal challenge to the nation’s ing the largest middle class tax cut for health new health-care law was launched Thursday in a care in history,© Jones reducing & premium Bartlett costs Learning, for LLC court room in Richmond,© Joneswhere the & office Bartlett of Vir- Learning, LLC tens of millions of families and small business NOT FOR SALE OR DISTRIBUTIONginia Attorney GeneralNOT Ken CuccinelliFOR SALE II argued OR DISTRIBUTION owners who are priced out of coverage today. that the measure is an unprecedented overreach by This helps 32 million Americans afford health Washington that violates the founders’ intention of care who do not get it today–and makes cover- a limited federal government. age more affordable for many more. Under the © Jonesplan, 95% & Bartlettof Americans Learning, will be insured. LLC Arguing© Jonesthe case &for BartlettVirginia, Solicitor Learning, General LLC E. Duncan Getchell Jr. told a judge that it would be NOT• It FORsets up SALEa new competitive OR DISTRIBUTION health insurance “unprecedented,”NOT FOR “ahistorical” SALE OR and DISTRIBUTION “radical” for the market giving millions of Americans the same federal government to require an individual to buy a choices of insurance that members of Con- private product—in this case, health insurance. . . . gress will have. Regardless of the outcome at the District Court • It brings greater accountability to health care © Jones & Bartlett Learning, LLC © Jones &level, Bartlett the case Learning, will almost certainly LLC be appealed to by laying out commonsense rules of the road NOT FOR SALE OR DISTRIBUTION NOT FORthe SALE US. Court OR ofDISTRIBUTION Appeals for the 4th Circuit and to keep premiums down and prevent insurance then to the Supreme Court.12 industry abuses and denial of care. • It will end discrimination against Americans And so the battle rages on, as millions of Americans with pre-existing conditions. wait the outcome of the tug-of-war between the two ma- © Jones & Bartlett Learning, LLCjor political parties, the Democrats© Jones and & theBartlett Republicans. Learning, LLC • It puts our budgetNOT and FOR economy SALE on a ORmore DISTRIBUTION sta- Meanwhile, the greatest challengeNOT FOR of the SALE 21st century OR DISTRIBUTION re- ble path by reducing the deficit by more than quires that each member of society take a more responsible $100 billion over the next ten years–and more and proactive role in his or her health and well-being (e.g., than $1 trillion over the second decade–by healthy living, healthy eating, exercising, reducing stress, cutting government overspending and reining quitting smoking). © Jonesin waste, & fraud Bartlett and abuse. Learning,10 LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION According to Kathleen Sebelius, Secretary, Just a Beginning Department of Health and Human Resources, new healthcare rules will: The pinnacle of the hospital evolution has not been © Jones & Bartlett• Stop Learning, insurance companies LLC from imposing pre- © Jonesreached & Bartlett nor has the Learning, final page LLCof its colorful history been existing condition exclusions on your children; written. As long as there remains a humanitarian impulse NOT FOR SALE OR DISTRIBUTION NOT FORand as SALE long as ORa society DISTRIBUTION feels compassion, love, and sym- • Prohibit insurers from rescinding or taking pathy for its neighbors, there will be hospitals. In the past, away your coverage based on an unintentional hospitals changed as conditions changed. In the future, mistake on an application; they will continue to change to meet the needs of their • Ban insurers ©from Jones setting & lifetime Bartlett limits Learning, on LLCcommunities. Healthcare leaders© Jones of the & 21st Bartlett century Learning,must LLC understand their roots and the historical value of knowing your coverageNOT and restrict FOR theirSALE use ORof annual DISTRIBUTION NOT FOR SALE OR DISTRIBUTION limits on coverage; the past, have the vision to preserve the good, and have the passion to create an even better healthcare system to • Ensure that you can choose the primary care provide superior care for all of the needs of the people all doctor or pediatrician you want from your of the time. © Jonesplan’s provider& Bartlett network; Learning, LLC © Jones & Bartlett Learning, LLC Where we were, NOT• Eliminate FOR SALE the need OR for DISTRIBUTION a referral to see an NOTWhat FOR we haveSALE come OR to expect, DISTRIBUTION and ob-gyn; Our future directions, • Prohibit insurance companies from requiring Have been influenced by what has preceded us. “prior approval” before you seek emergency © Jones & Bartlettcare Learning, at a hospital outside LLC your plan’s network.11 © Jones & Bartlett Learning, LLCAuthor Unknown NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1. In its evolution, the hospital climbed a long, tortuous road and struggled along a hazardous path from India and Egypt to Greece and© Jones Rome, to & the Bartlett Islamic countries, Learning, to England, LLC France, Germany, Spain,© Italy, Jones and on & to Bartlett America. Learning, LLC The existence of NOThospitals FOR is evidence SALE of OR a high DISTRIBUTION degree of civilization in which people areNOT interested FOR not SALE only in theOR DISTRIBUTION well-being of themselves and their families, but also in the community. 2. Religion played an important role in the development of hospitals. Faith healing was practiced in India and Egypt many centuries before Christ. Aesculapia (hospital temples) were numerous in ancient Greece and Rome and were dedicated to the god of medicine. Hospitals in the early Christian era and in the Middle Ages were an integral part ©of Jonesthe church. & BartlettNot until abuses Learning, crept into LLC their administration under ecclesiastical© Jones &authority Bartlett in the Learning, 15th and 16th LLC NOTcenturies FOR were SALE some of OR them DISTRIBUTION taken over and managed by civil bodies. NOT FOR SALE OR DISTRIBUTION 3. The development of the hospital has not been a smooth and easy advance. Centuries of experiments, scientific discoveries, and public enlightenment were necessary to break down the barriers of ignorance and prejudice. The evolution was accomplished in cycles, with alternating dark and golden ages. However, never has the hospital pos- sessed the quality and quantity of scientific care for the sick that it has today, never before has its influence been so © Jones & Bartlettextensive Learning, and so widespread, LLC and never before has it ©played Jones such &an Bartlettimportant roleLearning, in the life ofLLC the community. In NOT FOR SALEall of OR this DISTRIBUTION growth and development, hospitals benefitedNOT by FORthe technical SALE and OR scientific DISTRIBUTION developments that occurred during the various periods. 4. Although patients often approach hospitals with some reluctance, apprehension, and fear of death, there continues to be confidence and hope of improved health with a longer, healthier, happier, and productive life. 5. The primary function of the hospital—the one that has been constant throughout its evolution—is to care for the sick and injured. ©The Jones scope of & services Bartlett offered Learning, by hospitals LLC continues to change as they take© Jones on the role & ofBartlett not only Learning, LLC treating the sick andNOT injured, FOR but SALE also preventing OR DISTRIBUTION illness and prolonging purposeful, productiveNOT lives. FOR SALE OR DISTRIBUTION 6. Although this chapter is but a short synopsis of the history of hospitals, students wishing to expand their knowledge in this area should access the National Library of Medicine’s website at www.nlm.nih.gov. The National Library of Medicine has the world’s largest medical library. The library’s collections contain more than 6 million items, including books, journals, photographs, and images. Housed within the library is one of the world’s finest medical history ©collections Jones of& oldBartlett and rare Learning, medical books. LLC © Jones & Bartlett Learning, LLC 7. NOTNational FOR health SALE insurance OR will DISTRIBUTION ensure that more Americans receive healthcareNOT benefits. FOR SALE However, OR the DISTRIBUTIONcosts associated with health care will continue to soar.

1. Who is often recognized as being the first hospital administrator? 2. Which invention attributed to Van Leeuwenhoek had a pronounced influence on the creation of the sciences of cytology, bacteriology,© Jones and pathology? & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3. What issue did Florence Nightingale identify in the 1800s as being a major source/vehicle for the spread of infection and continues to beNOT so today? FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4. What data did Semmelweis collect? What was the significance of that data as related to performance improvement in the present-day hospital? 5. What were two of the greatest influences in the development of present-day hospitals? 6.© Describe Jones how & Bartlettyou think history Learning, is repeating LLC itself in today’s healthcare ©system. Jones & Bartlett Learning, LLC 7. Discuss why you believe that the healthcare system is in turmoil today. Describe the benefits and risks of national NOThealth FOR insurance. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR 6. William SALE R. Jarvis, OR “Infection DISTRIBUTION Control and Changing Health-Care Deliv- NOTES ery Systems,” Emerging Infectious Diseases, Centers for Disease Con- trol and Prevention, http://www.cdc.gov/ncidod/eid/vol7no2/jarvis.htm 1. Malcolm T. MacEachern, Hospital Organization and Management (accessed August 31, 2010). (Berwyn, IL: Physician’s Record Company, 1957), 10. 7. Barry A. Rand, “Health Care Reform Marches On,” AARP Bulletin 50 2. Mass Moments, “Massachusetts General Hospital Admits First (2009): 17. Patient, September 3, © 1821,” Jones http://www.massmoments.org/moment & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC .cfm?mid=256 (accessed June 21, 2006). 8. James S. Toedtman, “7 Critical Maneuvers,” AARP Bulletin 50 (2009): NOT FOR SALE OR DISTRIBUTION12–14. NOT FOR SALE OR DISTRIBUTION 3. Mary Ann Byrnes, “Non-Nursing Functions: The Nurses State Their Case,” American Journal of Nursing 82 (1982): 1089. 9. Kevin Sack, “As Medicaid Payments Shrink, Patients Are Abandoned,” The New York Times, March 15, 2010. 4. Carrie Howse, “Registration—A Minor Victory,” Nursing Times 85 (1989): 32. 10. The White House, “Health Care: Health Reform,” http://www.whitehouse .gov/issues/health-care (accessed August 31, 2010). 5. Daniel J. DeNoon, “99,000 Die Yearly from Preventable Hospital Infections, CDC© Jones Finally Gets & Data Bartlett as State Laws Learning, Force Hospitals toLLC Count Infections” 11. Kathleen© Sebelius, Jones e-mail & messageBartlett to author, Learning, June 23, 1010. LLC WebMD, http://www.webmd.com/news/20100527/99-thousand-die-yearly- 12. Rosalind S. Helderman, “Va. Begins Courtroom Assault on Federal from-preventable-hospital-infectionsNOT FOR SALE OR (accessed DISTRIBUTION August 31, 2010). Health-CareNOT Overhaul,” FOR The SALE Washington OR Post DISTRIBUTION, July 2, 2010.