Chapter 1 Historical Perspective

History is relevant to understanding the Past, defining the Present, and influencing the Future.

Indias Early Hospitals

Provided Fresh Fruits & Vegetables Administered Medications Provided Massages Maintained Rules of Personal Cleanliness

Hindu Physicians
Took Daily Baths Keep Hair & Nails Short Wore White Clothes Respected Confidence of Patients

Egyptian Medicine
Physicians
Used Castor Oil & Opium Used Wooden Mallet for Anesthesia Surgery mostly limited to Fractures Medical Care in the Home Temples functioned as Hospitals

Early Greek & Roman Hospitals

Medical Practice Rife with Mysticism Snakes considered Sacred Patients Presented Gifts before Altar Greek Temples - Refuge for Sick

Greek Temple Medicine

Holistic Medicine - Body & Soul Medications - Salt, Honey, Sacred Springs Hot & Cold Baths Sunshine, Sea Air, Pleasant Vistas Libraries for Visitors

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

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 hospitals 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. Bartholomews 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 Island
1st account of hospital for sick soldiers

Philadelphia
1st

Almshouse Established - Philadelphia The Pennsylvania Hospital 1st chartered

Williamsburg, VA
Site 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 bed Convalescent patients placed with dying Fracture cases placed with infectious cases 1/5th of 22,000 patients died each year Patient wounds washed with same sponge Infection rate said to be as high as 100% Mortality after amputation as high as 60%

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19th Century Hospitals Period 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 care Considered 1st hospital administrator Founded Nightingale School of Nursing - 1860 Crawford Long uses ether as anesthetic to remove small tumor American Medical Association founded - 1847 Chloroform 1st used as an anesthetic - 1847

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Mass General Hospital - 1846

W.T.G. Morgan Develops Sulfuric Ether Morgan 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 Astonished
Patient 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 structure
to be destroyed when it became infected.

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America's 1st Nursing Schools

Brigham and Womens 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 hospitals
Critical 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 technology
CT, 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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Research
National Library of Medicine
Library Collections Contains 6 million items One of worlds finest medical history collections Website: www.nlm.nih.gov/

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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 todays health care system.

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