Hospitals and Surgeons,The American Hospital,1750-19201870 200 hospitals in U.S.1927 7000 hospitals in U.S.,The Voluntary Hospital to 1870,“ this is city desperately needs a hospital”New York, Philadelphia“ perish the thought that I or my family should ever be admitted to this place of death.”,Why not a medical hospital?,Concepts of disease and therapyNature of nursingNature of technology,The voluntary hospital,PurposeThe worthy poor the Civilizing Mission of the Childrens hospital the alternative to the almshouse and the problem of pauperizationNo chronic disease (tb), no infectious disease (typhus, small pox), no terminal disease (cancer)Temporary, curable conditions (heart, respiratory, digestive)Ornament of charity, lure for physiciansMainly free (+ sailors, the paying mad)The Carceratorial Hospital Walled anarchy,Managed care in the voluntary hospital the hospital as home,The board of governors (churchwardens)The privilege to recommendOversight of financesThe master & matron (mom and dad)The medical staff (friendly uncles)ConsultantsSenior attending staff (admitting privileges)House staff (interns, externs and later c 1900 residents)StudentsNurse, admitting officer, and apothecary,Varieties of Hospitals (after 1870),1 voluntary hospital (the Pennsylvania; Boston childrens)2 municipal hospital (Bellvue, epidemics, sailors, lying-in, VD)3 specialist and proprietary hospitals (c 1890-1920), including surgical (Hertzlershospital)4 Catholic (from 1849, St. Vincents), Jewish, ethnic (St. Franciss, 1865), race-based hospitals Sisters of Charity5 resort hospitals - our home on the hill6 regional municipal gospel hospitals (1890-1920)7 almshouse8 public sanatoria9 RR and industrial (mining hospitals),Hospitals vs dispensaries,Hospital: inpatient, long term, high prestige, mainly male, after 1850, site of surgery rise after 1870Dispensary: outpatient or in-home; oriented toward pharmacy, mainly women, children, site of social activism - decline after 1920The current fate of the dispensary,The triumph of the hospital, 1870-1920,SurgeryAnesthesia, antisepsis, asepsisNursingCivilizing NightingaleThe conquest of nurse autonomyAdmitting privilegesNot just another form of primary care (1870 1000 “1890: exploratory abdominal surgery if unsure, go in. If maybe cancer go in,Surgery and Society,J. Marion Sims and vesicovaginal fistula, 1852; the 30th operation silver suture1845: Anarcha, Betsy, and LucyNo anesthesia, filthy rags: African-American women bear pain better.,W. W. Mayo (1819-1911),Chemist, Manchester England, to USPharmacist, Bellvue, Buffalo, late 1840sTailor, Lafayette, In, 1848-9Indiana College of Medicine, 1850To Minnesota, via Missouri, 1854, iron range mine claim inspectorPractice LeSueur, 1856Farmer, boatman, judge, editor-publisherDraft board doctor, Rochester, MN, 1863Practice evolves toward surgeryHospital founder following 1883 tornadoSt. Marys, 1889; leads ultimately to group practice of Mayo Clinic (run by sons Will and Charlie),