History of American Hospitals

A Brief History of American Hospitals

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.

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 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. [i] Caring for ill family members was – and in some cases remains – the responsibility of women. Revenby points out caring for ill and aged family members were considered “a woman’s self-sacrificing service to others”.[ii]

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.

General Hospitals
Rosenberg 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.

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."

Pennsylvania Hospitil.jpg

Pennsylvania Hospital

n 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."

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.

Stay tuned - more to come

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[i] Rosenberg, Charles, 1987. The Care of Strangers, Basic Books, p.4

[ii] Revenby, Susan, 1987. Ordered to Care The Dilemma of American Nursing 1850 – 1945, Cambridge History of Medicine Cambridge University Press, p.11


References

[i] 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.