Brief History of American Hospitals

AMERICAN NURSEING HISTORY

Davida Michaels MSN, M.Ed. RN 10/1/2019

Grady Hospital Atlanta Ga. 1892

Genesee Hospital, Rochester NY -Just before being torn down

Table of Contents

Introduction ...... 2

Eighteenth Century - Colonial Times ...... 2

Colonial Health Care Institutions...... 3

Bellevue Hospital ...... 3

General Hospitals ...... 9

Pennsylvania Hospital ...... 9

Hospital Growth 1860 to 2000 ...... 10

Factors Leading to the Growth of Hospitals ...... 11

Physician Owned Hospitals ...... 13

Nursing and the Growth of Hospitals ...... 14

The Hospital and Clinical Education ...... 15

Hospital Finances ...... 17

Federal Government and Growth of Hospitals ...... 18

Hill-Burton Act - 1946 ...... 18

Social Security Amendments of 1965 ...... 18

Hospital Management ...... 19

Trustees ...... 19

Patient Care ...... 20

Appendix ...... 22

History of Medical Care in One Community in Upstate New York...... 22

Park Avenue Hospital – Example Private Hospital ...... 22

Bibliography ...... 24

References ...... 25

Cooley Dickinson Hospital Northampton, Ma.

Introduction

American hospitals in the18th and early 19th century were mainly funded and managed by wealthy citizens who considered this as part of their civic duties. These hospitals primarily treated the poor and offered very little actual medical therapy. Surgery was not safe as wound infections were common. The affluent were treated in their homes by physicians and stayed away from hospitals.. As a result, hospitals became known as places where the poor and “insane” went to die.i

Eighteenth Century - Colonial Times

Colonial households treated most illnesses by long standing household remedies; if there was a doctor available he was called only if the illness was considered severe enough to warrant having a doctor visit; otherwise home remedies were used. The status of medical knowledge at that time was such that what treatment or remedies were ordered by the physician could be administered by the family member providing nursing care. When someone became ill the last place they wanted to be was in what, in that time, passed for a hospital. If you had a family to care for you, you remained at home. ii Caring for ill family members was – and in some cases remains – the responsibility of women. Reverby points out caring for ill and aged family members were considered “a woman’s self-sacrificing service to others”.iii

Colonial Health Care Institutions

The three major forms of colonial health institutions were Seaman’s Hospitals, Public funded hospitals such as Almshouses (workhouse), Contagious disease (“Pest Houses”), Mental Health (“Insane Asylums”) and General Hospitals.

Seaman’s Hospitals were established by trading companies to care for their seamen who became ill and unable to work and passengers who were ill that could not be treated or cared for on the ship.

Public funded –almshouse (workhouse) were institutions established to care for those poor who were homeless and indigent . While almshouses were not established for the care of the sick they did, by default, care for those persons who were sick and were considered not eligible for admittance to a general hospital – such as those had cancer or another suffered from cancer, or other illness considered to be incurable and those with a contagious disease or mental illness or a long term chronic illness.

Several public funded hospitals initially established as almshouses or to care for victims of contagious illness have endured into the present day and now are general hospitals. One of these hospitals was Bellevue- its history also reflects the history of nurses and their role in the evolution of the modern hospital and the nursing profession.

Bellevue Hospital

Bellevue traces its beginnings from several sources.iv The first was a small hospital formed by the West India Company in the village of New Amsterdam (now part of New York) in December, 1658. At that time, merchants provided for some type of facility to care for seamen who were ill and far from home. The West India company hospital is considered the first to be built on what is now known as United States soil.v In March 1736 the Health Board of New York founded a "Publick

Workhouse and House of Correction of the City of New York.1"Here, in an area of twenty-five by twenty-three feet, on the upper floor of the building, were six beds and one doctor, John Van Buren, who had a salary of £100 a year, out of which he supplied his own medicines. Nutting vi cited Dr. Robert Carlisle’s Account of Bellevue Hospital New York that asserts that Bellevue Hospital may be the oldest hospital in the United States.

Figure 1 The first Bellevue, a 6-bed infirmary on the present site of City Hall. Department of Public Charities Collection, NYC Municipal Archives.vii

Figure 2 Ledger - almshouse Ledger columns included: date admitted, name, age, occupation, where from or born, complaints, by whom sent/by whose order, location/ward number., date of discharge, date of death, remarks. This collection was processed by the Municipal Archives in 2016 under a grant funded by the National Historical Publications and Records Commission and a digitized selection of ledgers are now online. Almshouse Ledger Collection, NYC Municipal Archives.viii

In 1794 the city realized the necessity of providing some place of isolation for persons afflicted with yellow fever. The most eligible place that presented itself was a plot, about five acres in extent, which had once been a part of Kips Bay Farm, and called by the owner Belle -Vue; the mansion became the public health hospital. Bellevue is considered the oldest public health hospital in the United States. For a number of years it was only used when there was yellow fever in the cityix but in 1811 more land was purchased and a new almshouse was built.

Bellevue Hospital Archives: Bellevue Hospital pictured from the East River, 1848.

Bellevue: Life within the walls “…the old grey stone structure fronting the broad arm of the sea called the East River looked dignified and interesting with its extensive green sweep of lawn, adorned with fine old trees, but it has had a terrible history. (Nutting)”x There were between 1600 and 2000 residents; they were the poor (paupers) including around 200 sick at any one time. Conditions were overcrowded and unsanitary resulting in Typhus fever. Physicians were few – only three to care for the entire population both sick and well.-and were ‘cruelly overworked ‘. Nursing was provided by inmates from the prison – one for 10 to 20 patients. These conditions best described as horrible existed for many years– In 1827 a committee of investigation was appointed. Their report described:”

“filth, no ventilation, no clothing and patients with high fevers lying naked in bed with only coarse blankets to cover them, wards overcrowded, jail fever rife no supplies, purification and vermin.” The resident physician and students – all but two –the matron and the nurses had left the building. The only part of the building that was clean was the female department.”xi

Before the growth of nurse training schools in the 1870’s, hospital nursing was considered a “menial occupation, taken up by women of the lower classes, some of whom were conscripted from the penitentiary or the

6 almshouse.”xii The reform movement originated among upper class women in their role as guardians of the new hygienic order.xiii

xiv

These reports lead to the formation of Bellevue’s Nurse training school.

xvIn March, 1873 Sister Helen from All Saints Sisterhood in London, England became the Superintendent of the newly formed school. At first, the physicians did not believe that Bellevue was a suitable place for a training school staffed by women as they believed that patients were a ‘difficult class’ to deal with and the service would be too difficult for the intelligent young woman who were sought as pupils would ‘lose heart and hope’ before their two years were over. (Bellevue Short History, p. 30)xvi

Recommended: For further information regarding the history and impact of Bellevue Hospital see: Oshinsky, David, BELLEVUE: Three Centuries of Medicine and Mayhem At America's Most Storied Hospital. Doubleday 2016.

General Hospitals

Rosenbergxvii defines a hospital as an institution “dedicated exclusively to inpatient care of the sick”. The term ‘general hospital’ referrers to a hospital that cares for patients with medical or surgical needs or conditions in contrast to other, specialized hospitals - such as hospitals that cared for women (gynecology and maternity), persons with mental illness (Insane Asylums) and persons suffering from long term chronic conditions or an incurable disease such as cancer who were commonly excluded from admission to a general hospital. Those rejected from admission to a general hospital were referred to a public funded institution such as an almshouse.

Pennsylvania Hospital

The Pennsylvania Hospital is considered by many to be the first general hospital in the United States. In the 1750’s Philadelphia was the fastest growing city in the 13 colonies without any facility to provide care for persons who were ill and homeless. In 1751 Dr. Thomas Bond, a Quaker, and Benjamin Franklin founded Pennsylvania Hospital considered the first general hospital in the United States founded “to care for the sick-poor and insane who were wandering the streets of Philadelphia."

.While the general hospital cared for patients with medical or surgical needs or conditions, there were other, specialized For a detailed history of hospitals that cared for women (gynecology and maternity), and Pennsylvania Hospital and persons with mental illness (Insane Asylums), those suffering Timeline see the following from long term chronic conditions or an incurable disease such link as cancer were commonly excluded from admission to a general http://www.uphs.upenn.edu/ paharc/timeline

9 hospital. Those rejected from admission were admitted to a public funded institution such as an almshouse.

A Note Regarding the First Hospital in America : Due to the mission cited by Bond and Franklin, there is some confusion as to whether Pennsylvania Hospital was the first ‘general’ hospital in America. Nutting (1907) citing Dr. Robert Carlisle’s Account of Bellevue Hospital New York (1893, p.i) states that Bellevue Hospital may be the oldest hospital in the United States as it traced its origins to the hospital built by the West India Company in December 1658 which was one of the roots of the city hospital of Bellevue. As it appears that historians referred to hospitals on the East Coast and tended to omit the role of the Mission Hospitals on the West Coast the ‘argument’ that a specific hospital, on what later became the United States of America, was FIRST may never be resolved to everybody’s satisfaction.

Hospital Growth 1860 to 2000

After the civil war ended, when many of the sick and wounded men returned to their homes, they were accompanied by dedicated and capable women. This was the first time that relatives of those wounded experienced nursing care being performed by women outside their family or community. Just as the Crimean war brought the appreciation of female nurses, the civil war in America brought about the appreciation and acceptance of non-religious females as nurses.

Starr, considering the growth of hospital systems in the America, states that the hospital system emerged in three ‘more or less’ coherent phases:xviii

 First phase –running for roughly a century after 1751 – consisted of formation of two main types of institutions – the voluntary hospital operated by charitable lay boards and the public hospitals descended from almshouses operated by municipalities, counties and the federal government for merchant marine hospitals.

 Second phase – 1850s – ‘particularistic’ – religious or ethnic institutions; specialized hospitals for certain The Development of Rubber diseases (ex. Orthopedic) or categories of patients (ex. Gloves children and women) and medical philosophies (ex. Caroline Hampton RN was the first medical professional to use rubber gloves in the homeopathy). operating room. Caroline Hampton graduated  Third phase – 1890-1910 – private profit making from New York Hospital School of Nursing in 1888. When the Johns Hopkins Hospital opened hospitals – operated by physicians singly or in in 1889, she moved to Baltimore and was partnership (ex. surgical care centers – such as eye appointed chief nurse of the operating room by Dr. William Halsted . Caroline became Dr. surgery) and hospitals owned by corporations. Usually Halsted's scrub nurse, but she developed a these were not tied to medical schools. severe contact dermatitis in 1889, as her sensitive hands could not tolerate the disinfectants mercuric chloride and carbolic Factors Leading to the Growth of Hospitals acid (phenol). As Dr. Halsted explained (as quoted by Sherwin Nuland in Doctors: The On September 30, 1846, William Morton, DDS first used Biography of Medicine): ether in extraction of a tooth. On October 16 he successfully “In the winter of 1889 and 1890—I cannot demonstrated its use, administering ether to a patient recall the month—the nurse in charge of my operating-room complained that the undergoing a tumor operation at Massachusetts general solutions of mercuric chloride produced a dermatitis of her arms and hands. As she Hospital. With the use of anesthesia, surgeons were able to was an unusually efficient woman, I gave the matter my consideration and one day perform slower and more complex operations. Post-operative in New York requested the Goodyear Rubber Company to make as an infection limited the range of surgery; surgery requiring entry experiment two pair of thin rubber gloves with gauntlets. On trial these proved to be into the major body cavities was avoided and used only when so satisfactory that additional gloves were ordered. In the autumn, on my return to “all other hope had been exhausted.”xixApplying Pasteur's town, an assistant who passed the instruments and threaded the needles was advances in microbiology, a Glasgow-based surgeon, Joseph also provided with rubber gloves to wear at the operations. At first the operator Lister, put forward his system of antiseptic surgeryxx. Lister wore them only when exploratory incisions into joints were made. After a was correct in his view that surgical wound infection was the time the assistants became so accustomed to working in gloves that they also wore result of bacteria.. His method of prevention of infection in them as operators and would remark that they seemed to be less expert with the bare surgery was the use of carbolic acid as an antiseptic. Lister’s hands than with the gloved hands.” https://www.ncbi.nlm.nih.gov/pmc/articles work was contested by his contemporaries, because it proved /PMC2943454/ difficult to reproduce and wasn’t adopted until the 1880s.

11 xxi

Lister’s work was superseded by aseptic techniques – referred to as “an antiseptic conscience.” these additional regimens such as doctors’ and nurses’ use of rubber gloves and masks during surgical procedures, intended to reduce infection which became normative practice in hospitals.

Application of antiseptic and aseptic techniques required a corps of workers expert in carrying out such regimen. This led to calls for an educated, organized nurse workforce.xxiiThe advent and success of trained nurses in providing for the proper care of sick in the hospital, led to physician’s and to some extent the public’s acceptance of receiving care in the hospital.xxiii

The first list of all hospitals in the United States was published in 1873 by the American Medical Association. Dr. Toner, working under the United States Office of Education reported receiving 178 responses to letters of inquiry. Dr. Toner stated that he was ‘quite certain’ that not all existing institutions were on his list.xxiv

By 1910, there were over 4000 acute bed hospitals in America. In the east, wealthy citizens funded hospitals such as Massachusetts General Hospital and Johns Hopkins. In the Midwest, religious groups such as Catholics, Jesuits, Methodists,

12 and Baptists opened up hospitals to treat immigrants. In the south, because of a lack of wealthy donors and immigrants, many hospitals were opened for-profit and were physician-owned.

While the number of hospitals in the U.S. increased, there was no oversight or mass coordination. Each hospital would hire its own staff, regulate itself including its expenditure, set its own fees, and determine how patients would pay and how they would collect the bills.xxv

Physician Owned Hospitals. Early in the history of the country, as the country was settled, there were few physicians and it was common it was common practice of physicians to care for patients in their own homes. This practice continued during as people moved west. This led to the practice of physicians establishing and managing their own, private hospital.

Dr. Lee’s Private Hospital.

Excerpt from “The Legacy of 179 Lake Avenue”xxvi

“The city of Rochester, New York is widely recognized as a leader in the photo imaging industry, but little is known of Rochester’s contribution to the advancement of the medical field. The Rochester community became an important area in the practice and advancement of homeopathic medicine. One of Rochester’s leading homeopathic physicians was John Mallory Lee, a renowned surgeon and a leading figure in Rochester medicine. Dr. Lee established the Lee Private Hospital on the corner of Lake and Jones Avenues on January 8, 1898. For the next seventy-three years, this hospital would embody the virtues of commitment to medicine and service to the community from Dr. Lee and his family and under his successor, Charles C. Teresi M.D. While the hospital was a small facility it included a training school for homeopathic nurses. The two-year training program was later extended to three years to provide the students hands on training in the community. The hospital’s staff of

physicians provided weekly lectures and weekly quizzes and quarterly exams rounded out the academic course work.”

Private hospitals soon moved toward larger institutions, and some of the most influential institutions today, such as Mayo Clinic and Cleveland Clinic, were originally founded and managed by physicians.xxvii

Nursing and the Growth of Hospitals

Paul Starr,xxviii discussing the history of hospitals in America states that they have developed from “places of dreaded impurity and exiled human wreckage into awesome citadels of science and bureaucratic order.”xxix Furthermore, they acquired a new moral identity, as well as new purposes and patients of higher status.”xxx Rosenberg (1987), considering the rise of the modern hospital states that “perhaps the most important single element in reshaping the day-to-day texture of hospital life was the professionalization of nursing. In 1800, as today, nurses were the most important single factor determining ward and room environment.” (p 8 - 9)xxxi

The following question was asked: “If the professionalization of nursing has had the important effect on the quality of the hospital experience that Charles Rosenberg has suggested, the changes in the nature of hospitals have had a profound effect on the profession of nursing, since the vast majority of nurses’ practice in a hospital or setting. xxxiiThe future of both the hospital as an institution and nursing as a profession will depend on the decisions we make in the coming years about how health care is provided and to whom.” “xxxiii

With the advent of antibiotics, new medicines and oxygen, physicians were able to treat diseases that heretofore they were unable to treat. It became no longer realistic to stay at home and be treated with a family member and a home remedy. A person with an acute problem required hospitalization

As the surgeons adopted the principles of asepsis and developed an understanding of wound infection, surgery could now include more complex operations such as

14 abdominal surgery. With increased complexity of surgical operations, post operative care required knowledgeable, educated nurses. Patients requiring these complex operations could not be operated on at home; they needed to be hospitalized. Care prior to surgery, during surgery e and postoperatively required knowledgeable, educated nurses.

The Hospital and Clinical Education

Rosenberg points out that education has played a prominent role in American hospitals. However, it was not until the twentieth century that a stable relationship between care and learning evolved.xxxiv There are many parallels in the history of the education of nurses and physicians. The education of each profession requires access to patients and through the years, hospitals have provided a primary source of clinical education resources.. Thus, the education of both professions is closely tied in with the history of hospitals.

. In America during the 17th, 18th and to some extent the 19th centuries, there were few physicians who had formal medical education. Those that did have formal education were educated in England, Scotland, France and Germany and immigrated to America bringing their knowledge with them. America, lacking the formal educational resources, a person with financial resources traveled to Europe for their education or, lacking financial resources, began their education as an apprentice indentured to an established physician. xxxvThe established physician , accompanied by his apprentice treated patients in the office which was usually part of his home or made house calls traveling to the homes of those too ill or infirm to be seen in the office.

Status of Nursing Education Formal education with the exception of a few programs started by physicians such as Dr. Valentine Seaman and Dr. Joseph Warrington was not introduced until the 1870’s.xxxvi Prior to the introduction of

15 hospital schools of nursing, nurses learned by ‘doing ‘in an apprentice role within the hospital.

Status of Medical Education. By the late18th century and the 19th century there were medical schools in America. However the majority of these left much to be desired. Ludmerer (1985) points out that being a medical student in 1the 1800’s was easy.xxxvii

“No one worried about admission, for entrance requirements were lower than they were for a good high school. Instructions were superficial and brief. The terms lasted only sixteen weeks, and after the second term, the M.D. degree was automatically given, regardless of a student’s academic performance. Teaching was by lecture alone.”…”students would often graduate without ever having touched a patient.” ]xxxviii

On the other hand, the nursing education model was an apprentice system in the hospital setting. Future nurses were immediately immersed in the clinical area with minimal if any formal lectures .For years this discrepancy endured where student physicians had little clinical exposure to patients before they graduated and started to practice medicine while the nurse had more practice but little, if any formal education. This situation was highlighted when the civil war found physicians and surgeons who had never seen, nor treated, the mass casualty’s result of battles while the nurse had more clinical experience with traumatic injuries of battle.xxxix

In the nineteenth and early twentieth century nursing care was provided by students, who were sometimes paid a small stipend, lived within the hospital and required room and board. These costs were usually relatively small and the savings of having nursing students who provided 24/7 patient care kept total costs of operating the hospital manageable. As the need for educated, knowledgeable nurses to care for patients with complex needs grew, the education of nurses also changed. Graduate nurses were hired to care for patients; the curriculum for student nurses was revised to include more theory and clinical patient care by students was supervised by a

16 nursing instructor. No longer were hospitals able to utilize their ‘free’ labor; nursing care became an expense.

One of the barriers to ‘hands on’ clinical education for medical students was, according to Ludmerer, “the extraordinary difficulties medical schools were encountering in acquiring control of large, well-equipped hospitals. Without true teaching hospitals at their disposal, medical schools could not introduce the clinical clerkship, nor could they effectively pursue clinical research.”xl

Hospital Finances

Hospitals had a financial problem from the very beginning of scientific medicine. By their nature they are extremely labor intensive and expensive to operate. Moreover, their costs are relatively fixed and not dependent on the number of patients being served.

Whether patients required medical or surgical care, the man or woman who formerly could receive care at home now entered the hospital for their surgery and treatment for an acute illness. These patients expected a higher standard of care and privacy. Than provided for those less well off. They did not want to be on the older, large open wards. Hospitals began to remodel and expand to include floors with private or semi-private rooms.

According to John Steele Gordon,

“Hospitals had a financial problem from the very beginning of scientific medicine. Their services are labor intensive and, considering that a large number of employees are professional ; the technology required to support them is expensive and the operating costs to perform their services and care for patients is expensive, relatively fixed and not dependent on the number of patients being served. To help solve this problem, someone in the late 1920s had a bright idea: hospital insurance. The first hospital plan was introduced in Dallas, Texas, in 1929. The subscribers, some 1,500 schoolteachers, paid six dollars a year in premiums, and Baylor University

Hospital agreed to provide up to 21 days of hospital care to any subscriber who needed it”.xli See article A Short History of American Medical Insurance by John Steel Gordon, Click here for link

Federal Government and Growth of Hospitals

Hill-Burton Act - 1946

In 1946, the federal government aided for the first time in hospital proliferation by passing The Hill-Burton Act of 1946. After World War II, President Truman urged Congress to pass a bill providing funds for constructing hospitals and clinics to serve a growing population. As a result of adopting this bill, many poorer states were able to build new hospitals for their communities. xlii

“Construction of Moses H. Cone Memorial Hospital in Greensboro, N.C., was partially funded by the Hill-Burton Act. The hospital, seen circa 1973, was at the center of a court case, Simkins v. Moses H. Cone Memorial Hospital, that brought an end to racially segregated health care.” xliii

Social Security Amendments of 1965

The passage of the Social Security Amendments of 1965 created Medicare and Medicaid. This provided hospitals with capital which they could use to upgrade their hospital and their technology since they no longer were required to provide free care or subsidized care for the poor and elderly poor. xliv

At that time, Medicare payments were generous, and virtually all hospitals profited from it. Medicare paid hospitals for their costs plus a percentage to compensate for capital expenditures related to expansion. This incentivized both increasing costs to increase profits, and hospital expansion that would be paid for. This inflationary payment system lasted until DRGs and prospective payment was introduced in the 1980s. xlv

Hospital Management

Trustees

The Pennsylvania Hospital “founded in 1751, largely through the efforts of the celebrated Benjamin Franklin. It was designed to be the hospital of the province of Pennsylvania,—" for the relief of the sick poor and the care of ‘lunaticks’." "The increase of poor diseased foreigners and others, settled in the distant parts of this province, where regular advice and assistance cannot be procured, but at an expense that neither they nor their township can afford," is among the reasons given for establishing it. The opening words of the preamble to the act authorizing the hospital, " Whereas the saving and restoring useful and laborious members to a community is a work of public service, and the relief of the sick poor is not only an act of humanity, but a religious duty, "have a curious likeness to the kindly and shrewd nature of the author of Poor Richard's Almanac. It is as if it were said, the state ought to aid to restore the sick to health because it is humane to do so, and because, when in health, they can pay taxes or work for others who so pay. In these thoughts lie the germs of state aid to hospitals.xlvi (Italics added ) As hospitals grew, trustees needed to hire superintendents to manage the day-to-day hospital affairs. For example, in 1825 Massachusetts General Hospital hired a former sea captain, Nathan Gurney and his wife as superintendent and matron.xlvii The hospital staff was “requested to “conform to their orders.”Physicians were not considered as the trustees “expected the superintendent to place the physical and moral needs of his patients above every other consideration (except balanced accounts), no medical man could be expected to do the same.”xlviii

Trustees continued to have inspection tours of the hospital looking at cleanliness, infrastructure as well as ‘issues’ in patient care. They maintained a ‘sharp sense’ of

19 their responsibilities and the ‘nature of a benevolent institution’ patients were to some extent considered as ‘inmates’ subject to rules and regulations.xlix As hospitals grew, it became more difficult for lay trustees to keep up personal oversight.

Physicians not being ‘involved’ - i.e. not having a seat at the table and a role in decisions regarding hospital administration - felt constrained in their ability to utilize their growing technical skills while being ‘subordinate’ to lay administrators. The result was a conflict and power struggle between administration and physicians. Physicians considered that because they were ‘skilled and knowledgeable’ and autonomous in the care of patients.

Patient Care

Rosenberg in discussing care of those hospitalized uses the expression “Life on the Wards to describe care environment and changes which occurred as medical science, technology and growth of products used for patient care evolved over time.l

For example, in 1874, Pennsylvania Hospital in Philadelphia appointed physician as Officer of Hygiene to inspect the hospital building and report to the Board of Managers.li What he found was that the building – and care – had not changed significantly from the beginning f the century despite the work of the trustees and superintendant. Foremost were cultural differences as hospitalized patients were largely from people that could not afford private care. They lived in crowded, often unsanitary conditions many families sharing out houses. Most – if not all – came to the hospital covered with lice. Crowded conditions and lack of privacy meant they were accustomed to sleeping in their clothes – many had no beds at home, if they did have a bed it was not unusual for all members of one family to share a bed or to put two chairs together for a bed. These habits, born of necessity were carried into the hospital settings. There was a huge gap between these patients and those that were referred to as the ‘genteel’ class. Care was provided by untrained nurses. It was not unusual that patients were expected to clean and assist with the care of other patients.

By the 1900’s the average patient’s experience improved mainly due to (1) scientific and technological advances; (2) progress in medical and surgical knowledge and (3) improvements in nursing education with licensing of nurses.

Appendix

History of Medical Care in One Community in Upstate New York

Rochester, located in upstate New York, is famous for George Eastman, Eastman Kodak® and the University of Rochester and its medical school “The origin of medical care in Rochester can be traced back to the early days of the nineteenth- century when Rochester was America’s newest “Boom” town. Dr. Jonah Brown was the first physician to settle in Rochester around 1813. Over the following two decades, Rochester grew rapidly as the center of commerce in Western New York.lii

Rochester was also known as a major center for homeopathic medicine. In the nineteenth- century, the practice of medicine became divided into various schools of thought. The two major schools were the traditional practice of Allopathic medicine and the other being Homeopathic medicine. Whereas Allopathy treats the symptoms of an illness, such as an antibiotic for an infection or pain medication to relieve pain, and is based in science, Homeopathy is the practice of treating the cause of the illness, (rather than the symptoms), with natural remedies that would produce similar symptoms in healthy patients. The underlying premise is that the body’s natural systems fight disease rather than the use of drugs. liii

Park Avenue Hospital – Example Private Hospital

Park Avenue Hospital began in 1894 when Dr. John F.W. Whitbeck, a respected Rochester Surgeon and physician at the Rochester City Hospital, commissioned the construction of a three-story brick building on the south-west corner of Park Avenue and Brunswick Street. The twenty- five bed hospital operated for about ten years before closing due to financial insolvency. The building that was referred to as Dr. Whitbeck’s Hospital was converted into a private school for boys in 1904. In 1907 the school was relocated and the building was purchased from Dr. Whitbeck by Dr. Charles R. Barber who, after remodeling, opened the renamed 40 bed hospital as the Park Avenue Hospital in 1908. That same year, the Park Avenue Training School for Nurses was chartered by the state and graduated its first class of Nurses three years later. The school remained in operation until 1949. Many of the graduates remained at Park Avenue Hospital and other local hospitals during their nursing careers. liv // lv

Bob Dickson has written a comprehensive history of medical care and hospitals in the city of Rochester, New York.lvi“To honor the past service of the individuals who served the people of Rochester, in these hospitals, as well as the present generation who continued to serve this community” Please visit Rochester Regional Health’s website at https://www.rochesterregional.org/about/history/rochester-medical-museum-and- archives/digital-exhibits/history-of-rochester-area-ho\pitals/rochesters-early-hospitals/

Bibliography

Rosenberg, Charles, 1987. The Care of Strangers : The Rise of America’s Hospital System, Basic Books

Higgins, Thomas L. and Linda S. Baillargeon. 2014. Images of America: Baystate Medical Center, Arcadia Publishing., Charleston, South Carolina

Corwin, E.H.L. 1946. The American Hospital. New York. The Commonwealth Fund.

Zand, Behrouz, Evolution of American Hospitals, 2018 . https://bzandmd.blog/2018/02/11/the-evolution-of-american-hospitals .accessed 9/13/2018

Ludmerer, Kenneth, 1985. Learning to Heal: The Development of American Medical Education. John Hopkins University Press, Baltimore and London and Time to Heal, 1999.Oxford University press.

References i Evolution of American Hospitals Written by Behrouz Zand,M.D., M.Saccessed 9/13/2018 ihttps://bzandmd.blog/2018/02/11/the-evolution-of-american-hospitals/ . ii Rosenberg, Charles, 1987. The Care of Strangers, Basic Books, p.4 iii Revenby, Susan, 1987. Ordered to Care The Dilemma of American Nursing 1850 – 1945, Cambridge History of Medicine Cambridge University Press, p.11 ivhttp://www.boweryboyshistory.com/2013/05/the-startling-history-of-bellevue.html Downloaded 5/27/2017 vAlumnae Association of Bellevue, Pension Fund Committee, A Short History of Bellevue Hospital and Training Schools,. December, 1915. Book downloaded from the Internet, 5/28/2017.Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons viNutting, Mary Adelaide, A History of Nursing V.2 1907, pg.156, General Books, LLC vii NYC Department of Records & Information Services http://www.archives.nyc/blog/2018/6/7/department-of-public-welfare-of-the-city-of-new-york . viii Ibid ix Nutting op.cit. x Ibid xi Ibid xii Starr, Paul, 1982. The Reconstitution of the Hospital in The Social Transformation of American Medicine. Basic Books. Ch. 4, p.155 xiii Ibid xivPicture and excerpts above copied from Bellevue: A Short History of the Bellevue Hospital and Training Schools. 1915 Op.Cit. xvIbid xviInformation copied from https://www.nursingeducationhistory.org/hospital-history.html xvii Rosenberg, op.cit .

xxJ. T. H. Connor The Victorian Revolution in Surgery 2 APRIL 2004 VOL 304 SCIENCE www.sciencemag.org. xxi Ibid.

xxiv Corwin, E.H.L. 1946. The American Hospital. New York. The Commonwealth Fund. p. 1 xxv Zand, Behrouz, Evolution of American Hospitals, 2018 . https://bzandmd.blog/2018/02/11/the- evolution-of-american-hospitals .accessed 9/13/2018. xxvi https://www.rochesterregional.org/about/history/rochester-medical-museum-and- archives/digital-exhibits/the-legacy-of-179-lake-avenue/ xxviiTomcanin , Renee. 2009, Attack on Physician-Owned Hospitals in America: History, Current Efforts and the Impact on the Future of Healthcare,November 30, 2009 downloaded 8/12/2018

from https://www.beckershospitalreview.com/news-analysis/attack-on-physician-owned-hospitals- in-america-history-current-efforts-and-the-impact-on-the-future-of-healthcare.html xxviii Paul Starr is Professor of Sociology and Public Affairs, and Stuart Professor of Communications and Public Affairs, Princeton University xxix Starr, Paul 1982, Chapter 4 The reconstruction of the Hospital, in The Social Transformation of American Medicine, Basic Books inc, Harper Colophon Books,CN, p 144 xxx Ibid xxxi Rosenberg, Charles, 1987, The Care of Strangers: The Rise of America's Hospital System xxxii Personal comment - - Consider hospital Settings include hospital associated clinics and community public health services and home health agencies. xxxiii Wall, Barbara Mann https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of- hospitalsBarbara Mann Wallis the Thomas A. Saunders III Professor of Nursing and Director of The Eleanor Crowder Bjoring Center for Nursing Historical Inquiry, University of Virginia School of Nursing.

xxxiv Rosenberg, op.cit. p. 100. xxxv Flexner, Abraham, 1910. Medical Education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of teaching. Bulletin Number Four. Reproduced 1972 by D.B. Updyke, Merrymount Press, Boston p.3. xxxvi Refer to: website - https://www.americannursinghistory.org/education xxxvii Ludmerer, Kenneth, 1985. Learning to Heal: The Development of American Medical Education. John Hopkins University Press. p.3 xxxviii Ibid xxxix This situation was highlighted in the TV production of Mercy Street where one of the prime characters served in the Crimea with Florence Nightingale and espoused her methods xl Ludmerer, Kenneth, 1985. Learning to Heal: The Development of American Medical Education. John Hopkins University Press, Baltimore and London.p.152 xli John Steele Gordon,Imprimis A Short History of American Medical Insurance ,September 2018 • Volume 47, Number 9 •https://imprimis.hillsdale.edu/short-history-american-medical-insurance/ downloaded 9/23/2019. xlii Zand, Behrouz op cit. xliii https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when- bipartisanship-led-to-health-care-transformation xliv Ibid xlv Ibid xlviWood, Richard. 1893 The Trustee of the Hospital in Section III of the International Congress of Charities, Correction and Philanthropy, which was held in Chicago, from June 12 to 17, 1893, under the auspices of the World's Congress Auxiliary of the World's Columbian Exposition. Papers and Discussions in the International Congress of Charities, Correction and Philanthropy, collection Editors .John S, Billings, MD, Henry M. Hurd MD . Publisher The Johns Hopkins Press and London, The Scientific Press, Limited 428 Strand, W. C 1894 p.60 xlvii Rosenberg, op,cit p. 262. See also Notes to Pages, p.408, #1. xlviii Ibidp. 262. xlix Ibid p.264 l Ibid 286. li Ibid 286 liihttps://www.rochesterregional.org/about/history/rochester-medical-museum-and-archives/digital- exhibits/history-of-rochester-area-hospitals/rochesters-early-hospitals/ liii Rosenberg, op.cit, p.8 liv Dickson, Bob https://www.rochesterregional.org/about/history/rochester-medical-museum-and- archives/digital-exhibits/history-of-rochester-area-hospitals/rochesters-early-hospitals/ lv Website author’s note: My family lived near Park Avenue Hospital. I can recall visiting my Husband’s Grandmother there after she had had a stroke. I was not a nurse at that time. recall it was small and the staff were friendly and Grandma received great care. lviTomcanin , Renee. 2009, Attack on Physician-Owned Hospitals in America: History, Current Efforts and the Impact on the Future of Healthcare,November 30, 2009 downloaded 8/12/2018 from https://www.beckershospitalreview.com/news-analysis/attack-on-physician-owned-hospitals- in-america-history-current-efforts-and-the-impact-on-the-future-of-healthcare.htmlFor information on the Pros and Cons of Public v Private Hospitals see https://www.npinstitute.com/public-vs- private-hospitals-s/1852.htm . lvi Starr, Paul. Op. cit. p.156. lvihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943454/ lvihttps://www.nursing.upenn.edu/nhhc/nursing-through-time/1700-1869/ - 1867 lvi Starr, op.cit. 169-170 lvi Caroline Hampton Halstead was Dr. Halstead’s ‘favorite’ scrub nurse later married him lvi Robb, Isabel Hunter, 1897. Nursing in the Smaller Hospitals and in Those Devoted to the Care of

Special Forms of Disease in Birnbach, Nettie and Sandra Lewenson, ed. First Words, National League for Nursing, New York. 1991