pozgar chapter01 law
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Chapter 1Historical Perspective
History is relevant to understanding the Past, defining the Present, and influencing the Future.
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India’s Early Hospitals
Provided Fresh Fruits & Vegetables
Administered Medications
Provided Massages
Maintained Rules of Personal Cleanliness
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Hindu Physicians
Took Daily Baths
Keep Hair & Nails Short
Wore White Clothes
Respected Confidence of Patients
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Egyptian Medicine
Physicians
Used Castor Oil & OpiumUsed Wooden Mallet for AnesthesiaSurgery mostly limited to FracturesMedical Care in the HomeTemples functioned as Hospitals
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Early Greek & Roman Hospitals
Medical Practice Rife with Mysticism
Snakes considered Sacred
Patients Presented Gifts before Altar
Greek Temples - Refuge for Sick
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Greek Temple Medicine
Holistic Medicine - Body & Soul
Medications - Salt, Honey, Sacred Springs
Hot & Cold Baths
Sunshine, Sea Air, Pleasant Vistas
Libraries for Visitors
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Temple at Epidaurus
1st Clinical records
Inscribed on columns of the temple
Recorded
• Patients Names
• Brief Histories
• Treatment Outcomes
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Hippocrates – The Physician
Principles of Percussion & Auscultation
Wrote about Fractures
Performed Surgical Operations
Wrote on Fractures
Described Epilepsy, TB, Malaria, & Ulcers
Maintained Detailed Records
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Early Christian Era
Hospitals Outgrowth of Religion
Care included - Magical & Religious Rites
Doctrines of Jesus - Love & Pity
Sick treated outside temples & churches
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Mohammedan Hospitals
School at Gundishapur
Beginning of Mohammedan Medicine
Medical care free
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Persian Physician Rhazes
Skilled in Surgery
Used Sheep Intestines for Suturing
Cleansed Wounds with Alcohol
1st descriptions of smallpox & measles
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Mohammedan Medicine
Inhalation Anesthesia
Precautions against Adulterated Drugs
Origination of New Drugs
Asylums for Mentally Ill
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Islam
Brilliant beginnings in Medicine
Promise that glowed in early medicine not fulfilled
Wars, Politics, Superstitions, stunted growth
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Early Military Hospitals
Limestone pillar – 2920 B.C.
Pictures illustrating wounded
Moses laid down rules of Military Hygiene
Hippocrates – “war is the only proper school for a surgeon”
Under Romans, Surgery Advanced
Experience through military surgery
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Medieval Hospitals - 1
Religion – dominant influence in hospitals
England built Municipal Hospitals
Military Hospitals during Crusades
Lazar Houses Established
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Medieval Hospitals - 2
Hotel Dieu of Paris
Provided rooms for various stages of disease
Provided room for Convalescents
Provided room for Maternity Patients
Two persons often shared 1 bed
Draperies not washed, infection spread
Patients often worked on hospital’s farm
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Hospitals of the Renaissance -1
Building of hospitals continued
New Drugs
Anatomy - Recognized Study
New writings Printed
Dissections Performed
Surgery was more scientific
Van Leeuwenhook- Microscope
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Hospitals of the Renaissance -2
16th Century: Hospitals associated with Catholic Church ordered by Henry VIII to be given over to secular uses or destroyed
Sick Turned into Streets
Hospitals conditions intolerable
St. Bartholomew’s restored
Few hospitals throughout 17th century
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Hospitals of the Renaissance -3 Practice of Surgery
Long robed surgeons
Trained in universities
Permitted to perform all surgeries
Royal College of Surgeons founded-1540
Short robed surgeons (barber-surgeons)
Generally allowed only to leech & shave
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Hospitals of the 18th Century
Royal College of Physicians Establishes Dispensary
Medications Distributed at cost to Poor
Free Medical Care for Poor
Controversies & lawsuits • Untimely End to Early Clinic
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Westminister Charitable Society
Established Similar Dispensary in 1715
Established Westminister hospital in 1719
• Infirmary built - voluntary subscription
• Staff provide services gratuitously
Deterioration of hospitals continues
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Early Hospitals in the U.S.
Manhattan Island1st account of hospital for sick soldiers
Philadelphia1st Almshouse Established - PhiladelphiaThe Pennsylvania Hospital – 1st chartered
Williamsburg, VASite of 1st Psychiatric Hospital
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Dr. John Jones, an American Publishes - 1775
Called attention to frightful conditions in hospitals
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Hotel-Dieu Paris, Dr. Jones wrote
3-5 patients placed in 1 bedConvalescent patients placed with dyingFracture cases placed with infectious cases1/5th of 22,000 patients died each yearPatient wounds washed with same spongeInfection rate said to be as high as 100%Mortality after amputation as high as 60%
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19th Century HospitalsPeriod of Ignorance
Increase in Surgical Procedures
Inappropriate Wound Care Administered
Wards Filled with Discharging Wounds
Atmosphere so Offensive that Perfume Required
Nurses used Snuff to make Conditions Tolerable
OR Coats Worn for Months without Washing
Same Bed Linens Served Several Patients
Mortality from Operations 90 to 100%
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Late 19th Century Renaissance
Florence Nightingale improves careConsidered 1st hospital administratorFounded Nightingale School of Nursing - 1860
Crawford Long uses ether as anesthetic to remove small tumorAmerican Medical Association founded - 1847Chloroform 1st used as an anesthetic - 1847
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Mass General Hospital - 1846
W.T.G. Morgan Develops Sulfuric EtherMorgan arranges for 1st operation under Anesthesia, using ether vapors
Surgery at Operating Theater - Mass General
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W.T.G. Morgan
Morgan performed surgery with on looking skeptical audience
Audience AstonishedPatient did not Scream
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"Gentlemen,“ Dr. Warren proclaimed,
"this is no humbug!“
Discipline of anesthesiology was born.
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Semmelweis Of Vienna
Determined Deaths from Puerperal Fever of Maternity patients
• Due to Infections Transmitted by Students Leaving Dissecting Room to take care of Maternity Patients without Washing Hands.
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Civil War Days
As many as 25 to 50 beds in ward
Little provision for segregation of patients.
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Roosevelt Hospital - 1871
Roosevelt Hospital
• built on lines of pavilion
• small wards
• set the style for new type of architecture became know as the American plan
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Dr. W.G. Wylie - 1877
Favored Roosevelt Hospital pavilion
Wylie advocated temporary structureto be destroyed when it became infected.
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America's 1st Nursing Schools
Brigham and Women’s Hospital – 1872
Bellevue – 1873
Massachusetts General Hospital - 1873
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Medicine 1880 - 1890
Tubercle Bacillus Discovered
Pasteur vaccinated against anthrax
Koch Isolates Cholera Bacillus
Diphtheria 1st treated with antitoxin
Tetanus Bacillus & Parasite of Malarial Fever Isolated
Rabies Inoculation Successful
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Medicine 1880 - 1890
Halstead & Rubber Gloves – 1890
Bergmann & steam sterilization - 1886
Roentgen discovers the X-ray - 1895
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19th Century Inventions
Clinical Thermometer
Laryngoscope
Hermann Helmholtz Ophthalmoscope
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Medicine 1880 - 1890
Hospitals crowded, patients suffering
Scarlet Fever
Diphtheria
Typhoid
Smallpox
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Medicine 1880 - 1890
Most Disorders Untreated for
Metabolism
Glandular Disturbances
Nutritional Diseases
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20th Century Progress
Development of New Services
Progress of Non-profit Insurance Plans
Increased Public Confidence in Hospitals
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20th Century Inventions
Einthoven invents Electro-cardiograph
Wassermann Test for Pancreatic Function
Introduction of Radium for Treatment of Malignant Growths
Increased use of Examination of Tissue
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Hospital Standardization - 1918
American College of Surgeons - development of “Minimum Standards” for Hospitals
Established Requirements for Care of Patients
First Survey Conducted - 1918
Became “Joint Commission on Accreditation of Hospitals” in 1952
Today, known as “Joint Commission on Accreditation of Healthcare Organizations”
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1929
Trying period for hospitalsCritical economic conditions
Lowered bed occupancy
Decreasing revenues from endowments
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Latter Half of 20th Century
Increased hospital competition
Many advances in medical technologyCT, MRI, & PET scanners
For-profit chains spring up
Competing delivery systems
Many new medications introduced
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The 21st Century
Skyrocketing malpractice insurance premiums
High expectations of the public for miracles
Zero tolerance for mistakes
Ethical Dilemmas (e.g., human cloning)
Era of information explosion
Physicians exiting the marketplace
Shortages of nurses, physical therapists . . .
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Just a Beginning
Since history repeats itself – we must learn from its many lessons!
Because history often repeats itself, society must learn from its many lessons; otherwise, it will be doomed for a return to the dark ages of medicine.
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National Library of Medicine
• Library Collections Contains 6 million items
• One of world’s finest medical history collections
• Website: www.nlm.nih.gov/
Research
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What we have come to expect, and Our future directions, Have been influenced by
what has preceded us.
Author Unknown
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Questions - I
1. Who is often recognized as being the first hospital administrator?
2. Which invention attributed to Van Leeuwenhook had a pronounced influence on the creation of the sciences of cytology, bacteriology, and pathology?
3. What issue did Florence Nightingale identify in the 1800s as being a major source/vehicle for the spread of infection and continues to be so today?
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Questions - II
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 how you think history is repeating itself in today’s health care system.