AMERICAN NURSEING HISTORY Brief History of American Hospitals 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 1 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 2 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 3 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 4 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. 5 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. 7 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