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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.