Health care law and legislation assignment week 1

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Chapter 3

Reflections of the Past

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

the Future.

LEARNING OBJECTIVES

• Explain purpose of the Patient Protection and Affordable Care Act.

• Describe how advances in medicine over the centuries have not consistently been followed & continue to serve as reminders of the need to understand & build upon best practices.

LEARNING OBJECTIVES

• Explain how the conflicts of society due to politics, religion, & warfare have often impeded the growth of hospitals & at times contributed to their progression and many successes.

• Describe how the advances in medicine led to the rise of the modern day hospital & improved upon the quality of patient care.

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

Hindu & Early 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

Early 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

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 • New writings Printed • Dissections Performed • Surgery was more scientific • Van Leeuwenhoek- Microscope

Hospitals of the Renaissance – III

• 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

• Development of New Services

• Progress of Non-profit Insurance Plans

• Increased Public Confidence in Hospitals

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

• Became “Joint Commission on Accreditation of Hospitals” in 1952

• 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

• Many advances in medical technology

– CT, MRI, & PET scanners

• For-profit chains spring up

• Competing delivery systems

• Many new medications introduced

The 21st Century

• 47 Million Uninsured Americans

• Skyrocketing malpractice insurance premiums

• High expectations of the public for miracles

• Zero tolerance for mistakes

The 21st Century- 2

• Ethical Dilemmas (e.g., human cloning)

• Era of information explosion

• Physicians exiting the marketplace

• Shortages of nurses, physical therapists

• National Health Reform

– Insurance

• Boutique Medicine

Just a Beginning

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.

Research: National Library of Medicine

• Library collection contains 6 million items

• One of worlds finest medical history collections

• Website: www.nlm.nih.gov

What we have come to expect,

and Our future directions,

Have been influenced by what has preceded us.

−Author Unknown

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 today’s health care system.