2-3 pages assignment

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Reflections of the Past

Chapter 1

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

Who Am I?

I was Created at the End of the Renaissance,

Watched Pirates Rule the Oceans,

As Ivan the Terrible Ruled Russia,

And witnessed the arrest of Galileo,

For Believing the Earth Revolved Around the Sun.

I AM HISTORY

History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again. −Maya Angelou

We can learn from history how past generations thought and acted, how they responded to the demands of their time and how they solved their problems. We can learn by analogy, not by example, for our circumstances will always be different than theirs were. The main thing history can teach us is that human actions have consequences and that certain choices, once made, cannot be undone. They foreclose the possibility of making other choices and thus they determine future events. —Gerda Lerner

Those who cannot remember the past are condemned to repeat it.” —George Bernard Shaw

LEARNING OBJECTIVES

Discuss how the conflicts of society due to politics, religion, and warfare have often impeded the growth of hospitals, as well as, contributed to their progress.

Explain how advances in medicine through the ages led to the rise of the modern day hospital and improving the quality of patient care.

LEARNING OBJECTIVES

Describe how knowledge gained from best practices (e.g., infection control) can lead to progress while at the same time result in patient harm if not consistently followed over time.

Early Hindu & Egyptian Hospitals

6th century BC: Buddha appointed a physician for every 10 villages

built hospitals for the crippled & the poor;

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 Physicians

Used Castor Oil & Opium

Used Wooden Mallet for Anesthesia

Surgery mostly limited to Fractures

Medical Care in the Home

Temples functioned as Hospitals

Greek & Roman Hospitals

Hospital derives from Latin word hospitalist, which relates to guests & their treatment

Early use of these institutions not merely as places of healing but as havens for the poor & weary travelers

Medical Practice Rife with Mysticism

Greek Temple Medicine - I

Hospitals ﬁrst appeared in Greece as Aesculapia

named after Greek god of medicine

Patients Presented Gifts before Altar

Greek Temples - Refuge for Sick

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 temple

Recorded

Patients Names

Brief Histories

Treatment Outcomes

Hippocrates – The Physician

Noted for:

Principles of Percussion & Auscultation

Performed surgery

Wrote about fractures

Described Epilepsy, TB, Malaria, & Ulcers

Maintained detailed records

Hospitals of the Early Christian Era

Hospitals Outgrowth of Religion

Care included - Magical & Religious Rites

Doctrines of Jesus - Love & Pity

Sick treated outside temples & churches

Islamic Hospitals

Luxurious hospital accommodations frequently provided School at Gundishapur

Medical care free

Gundishapur

home to world’s oldest known teaching hospital

Persian Physician Rhazes

Skilled in Surgery

Used Sheep Intestines for Suturing

Cleansed Wounds with Alcohol

1st descriptions of smallpox & measles

Islamic Medicine – I

Inhalation Anesthesia

Precautions against Adulterated Drugs

Origination of New Drugs

Asylums for Mentally Ill

Brilliant beginnings in Medicine

Promise that glowed in early medicine not fulfilled

Wars, Politics, Superstitions, stunted growth

Early Military Hospitals – I

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

Medieval Hospitals – I

Religion – dominant influence in hospitals

England built Municipal Hospitals

Military Hospitals during Crusades

Lazar Houses Established

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

Dark Age of Hospitals

Hospitals Commonly crowded patients into one bed

Monks preserved the writings of Hippocrates

Al-Mansur Hospital, built in Cairo in 1276

Equipped with separate wards for the more serious diseases

laid the groundwork for hospital progress to come in later centuries

Hospitals of the Renaissance – I

Building of hospitals continued

New Drugs

Anatomy - Recognized Study

New writings Printed

Dissections Performed

Surgery was more scientific

Van Leeuwenhoek- Microscope

Hospitals of the Renaissance – II

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

Hospitals of the Renaissance – III

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

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

Westminster Charitable Society

Established Similar Dispensary in 1715

Established Westminster hospital in 1719

Infirmary built - voluntary subscription

Staff provide services gratuitously

Deterioration of hospitals continues

Early Hospitals in the U.S. – I

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

Early Hospitals in the U.S. – II

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%

Early Hospitals in the U.S. – III

Increase in Surgical Procedures

Inappropriate Wound Care Administered

Wards Filled with Discharging Wounds

Nurses of that period are said to have used snuff to make conditions tolerable

Late 19th Century Renaissance – I

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%

Late 19th Century Renaissance – II

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

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

W.T.G. Morgan

Morgan performed surgery with on looking skeptical audience

Audience Astonished

Patient did not Scream

“Gentlemen,” Dr. Warren proclaimed, “this is no humbug!”

Discipline of anesthesiology was born.

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.

Civil War Days

As many as 25 to 50 beds in ward

Little provision for segregation of patients.

Roosevelt Hospital - 1871

Built on lines of pavilion

small wards

set the style for new type of architecture

became know as the American plan

Dr. W.G. Wylie - 1877

Favored Roosevelt Hospital pavilion

Wylie advocated temporary structure

to be destroyed when it became infected.

America's 1st Nursing Schools

Brigham and Women’s Hospital – 1872

Bellevue – 1873

Massachusetts General Hospital - 1873

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

Halstead & Rubber Gloves – 1890

Bergmann & steam sterilization - 1886

Roentgen discovers the X-ray - 1895

19th Century Inventions

Clinical Thermometer

Laryngoscope

Hermann Helmholtz Ophthalmoscope

Medicine 1880 - 1890

Hospitals crowded, patients suffering

Scarlet Fever

Diphtheria

Typhoid

Smallpox

Most Disorders Untreated for

Metabolism

Glandular Disturbances

Nutritional Diseases

20th Century Progress

Treatment of

Metabolic Diseases

Nutritional & Vitamin Deficiencies

Rickets with Ultra-Violet Light

Banting’s Introduction of Insulin

Treatment of Pernicious Anemia

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

Hospital Standardization - 1918

American College of Surgeons - development of “Minimum Standards” for Hospitals

Established Requirements for Care of Patients

First Survey Conducted - 1918

Today known as “The Joint Commission”

1929 Trying Period for Hospitals

Critical economic conditions

Lowered bed occupancy

Decreasing revenues from endowments

Latter Half of 20th Century

Increased hospital competition

Notable advances in medical technology

CT, MRI, & PET scanners

For-profit chains spring up

Competing delivery systems

Many new medications introduced

Healthcare in the 21st Century

Grading Hospital Safety

Translational Medicine

Minimally Invasive Surgery

Surgical Simulation Training

Social Media Impacts Caregivers

Healthcare in the 21st Century - II

National Health Insurance

Boutique Medicine

Medical Errors Plague Hospitals

History Challenges Us to Do Better

The maintenance of hospitals today is a result of the human emotions of fear, pity, and sympathy, together with civic consciousness and religious zeal. If society has changed, human nature has remained much the same, for it was with these fundamental emotions which led ancient peoples to build hospitals for their sick and injured. Malcolm T. MacEachern, MD., C.M., D.Sc., L.L.D.—

Review Questions - I

1. Who is often recognized as being the first hospital administrator?

2. Which invention attributed to Van Leeuwenhoek 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?

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.