Hospital

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Hospital
From Wikipedia, the free encyclopedia

For other uses, see Hospital (disambiguation) and General hospital (disambiguation).

F.D. Roosevelt Hospital in Banská Bystrica,Slovakia

All India Institute of Medical Sciences in Delhi, India

The red cross is a worldwide symbol of medical personnel and hospital infrastructure (except in Muslim
countries, where a red crescent is used instead, and Israel, in which the star of David used instead).

The Uniklinikum Aachen inGermany is one of the biggest hospitals in Europe.

A hospital is a health care institution providing patient treatment with specialized staff and
equipment. The best-known type of hospital is the general hospital, which has an emergency
department. A district hospital typically is the major health care facility in its region, with large
numbers of beds for intensive care and long-term care. Specialised hospitals include trauma
centres, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for
dealing with specific medical needs such as psychiatric problems (see psychiatric hospital) and
certain disease categories. Specialised hospitals can help reduce health care costs compared to
general hospitals.
A teaching hospital combines assistance to people with teaching to medical students and nurses.
The medical facility smaller than a hospital is generally called a clinic. Hospitals have a range of
departments (e.g.: surgery and urgent care) and specialist units such as cardiology. Some hospitals
have outpatient departments and some have chronic treatment units. Common support units include
a pharmacy, pathology, and radiology.
Hospitals are usually funded by the public sector, by health organisations (for profit or nonprofit),
by health insurance companies, or by charities, including direct charitable donations. Historically,
hospitals were often founded and funded by religious orders or charitable individuals and leaders.[1]
Today, hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in the
past, this work was usually performed by the founding religious orders or by volunteers. However,
there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters that
still focus on hospital ministry today, as well as several other Christian denominations, including the
Methodists and Lutherans, which run hospitals.[2] In accordance with the original meaning of the
word, hospitals were originally "places of hospitality", and this meaning is still preserved in the
names of some institutions such as the Royal Hospital Chelsea, established in 1681 as a retirement
and nursing home for veteran soldiers.
Contents
[hide]



1Etymology



2Types
o

2.1General

o

2.2District

o

2.3Specialized

o

2.4Teaching

o

2.5Clinics



3Departments or wards



4History
o

4.1Early examples

o

4.2Late Roman Empire

o

4.3Medieval Europe

o

4.4Medieval Islamic world


4.4.1St Giles, Norwich



4.4.2St. Anthony's, London



4.4.3St Leonards, York

o

4.5Early modern and Enlightenment Europe

o

4.619th century



5Criticism



6Funding



7Buildings
o

7.1Architecture



8See also



9References



10Bibliography
o



10.1History of hospitals
11External links

Etymology[edit]
During the Middle Ages hospitals served different functions from modern institutions,
as almshouses for the poor, hostels for pilgrims, or hospital schools. The word hospital comes from
the Latinhospes, signifying a stranger or foreigner, hence a guest. Another noun derived from
this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality,
friendliness, and hospitable reception. By metonymy the Latin word then came to mean a guestchamber, guest's lodging, an inn.[3]
Hospes is thus the root for the English words host (where the p was dropped for convenience of
pronunciation) hospitality, hospice, hostel and hotel. The latter modern word derives from Latin via
the ancient French romance word hostel, which developed a silent s, which letter was eventually
removed from the word, the loss of which is signified by a circumflex in the modern French
word hôtel. The German word 'Spital' shares similar roots.
Grammar of the word differs slightly depending on the dialect. In the United States, hospital usually
requires an article; in the United Kingdom and elsewhere, the word normally is used without an
article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs.
"in/to hospital"); in Canada, both uses are found. [citation needed]

Types[edit]

Lehigh Valley Hospital inAllentown, Pennsylvania

Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients')
without staying overnight; while others are 'admitted' and stay overnight or for several days or weeks
or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by
their ability to admit and care for inpatients whilst the others often are described as clinics.

General[edit]
The best-known type of hospital is the general hospital, which is set up to deal with many kinds
of disease and injury, and normally has an emergency department to deal with immediate and
urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities.
Some hospitals, especially in the United States and Canada, have their own ambulance service.

District[edit]
A district hospital typically is the major health care facility in its region, with large numbers of beds
for intensive care and long-term care.
In California, "district hospital" refers specifically to a class of healthcare facility created shortly
after World War II to address a shortage of hospital beds in many local communities.[4][5] Even today,
District hospitals are the sole public hospitals in 19 of California's counties, [4] and are the sole locallyaccessible hospital within 9 additional counties in which one or more other hospitals are present at
substantial distance from a local community.[4] Twenty-eight of California's rural hospitals and 20 of its
critical-access hospitals are District hospitals.[5]
California's District hospitals are formed by local municipalities, have Boards that are individually
elected by their local communities, and exist to serve local needs. [4][5] They are a particularly
important provider of healthcare to uninsured patients and patients with Medi-Cal (which is
California's Medicaid program, serving low-income persons, some senior citizens, persons
with disabilities, children in foster care, and pregnant women).[4][5] In 2012, District hospitals provided
$54 million in uncompensated care in California.[5]

Specialized[edit]

McMaster University Medical Centre, a teaching hospital in Canada

Types of specialised hospitals include trauma centres, rehabilitation hospitals, children's hospitals,
seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such
as psychiatricproblems (see psychiatric hospital), certain disease categories such as cardiac,

oncology, or orthopedic problems, and so forth. In Germany specialised hospitals are
called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery).
A hospital may be a single building or a number of buildings on a campus. Many hospitals with pretwentieth-century origins began as one building and evolved into campuses. Some hospitals are
affiliated with universities for medical research and the training of medical personnel such as
physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on
a nonprofitbasis by governments or charities. There are however a few exceptions, e.g. China,
where government funding only constitutes 10% of income of hospitals. (need citation here. Chinese
sources seem conflicted about the for-profit/non-profit ratio of hospitals in China)
Specialised hospitals can help reduce health care costs compared to general hospitals. For
example, Narayana Hrudayalaya's Bangalore cardiac unit, which is specialised in cardiac surgery,
allows for significantly greater number of patients. It has 3000 beds (more than 20 times the average
American hospital) and in pediatric heart surgery alone, it performs 3000 heart operations annually,
making it by far the largest such facility in the world. [6][7] Surgeons are paid on a fixed salary instead of
per operation, thus the costs to the hospital drops when the number of procedures increases, taking
advantage of economies of scale.[6] Additionally, it is argued that costs go down as all its specialists
become efficient by working on one "production line" procedure. [7]

Teaching[edit]
A teaching hospital combines assistance to people with teaching to medical students and nurses
and often is linked to a medical school, nursing school or university. In some countries like UK exists
the clinical attachment system that is defined as a period of time when a doctor is attached to a
named supervisor in a clinical unit, with the broad aims of observing clinical practice in the UK and
the role of doctors and other healthcare professionals in the National Health Service (NHS).

Clinics[edit]
Main article: Clinic
The medical facility smaller than a hospital is generally called a clinic, and often is run by
a government agency for health services or a private partnership of physicians (in nations where
private practise is allowed). Clinics generally provide only outpatient services.

Departments or wards[edit]

Resuscitation room bed after atrauma intervention, showing the highly technical equipment of modern hospitals

Hospitals consist of departments, traditionally called wards, especially when they have beds
for inpatients, when they are sometimes also called inpatient wards. Hospitals may have acute
services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent
care. These may then be backed up by more specialist units such as the following:


Emergency department



Cardiology



Intensive care unit


Paediatric intensive care unit



Neonatal intensive care unit



Cardiovascular intensive care unit



Neurology



Oncology



Obstetrics and gynaecology, colloquially, maternity ward

In addition, there is the department of nursing, often headed by a chief nursing officer or director of
nursing. This department is responsible for the administration of professional nursing
practice,research, and policy for the hospital. Nursing permeates every part of a hospital. Many units
or wards have both a nursing and a medical director that serve as administrators for their respective
disciplines within that specialty. For example, in an intensive care nursery, the director of
neonatology is responsible for the medical staff and medical care while the nursing manager/director
for the intensive care nursery is responsible for all of the nurses and nursing care in that unit/ward.
Some hospitals have outpatient departments and some have chronic treatment units such
as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services,
and physical therapy.
Common support units include a dispensary or pharmacy, pathology, and radiology. On the nonmedical side, there often are medical records departments, release of information departments,
information management (aka IM, IT or IS),clinical engineering (aka biomed), facilities management,
plant ops (operations, also known as maintenance), dining services, and security departments.

History[edit]
Main article: History of hospitals

Early examples[edit]

View of the Askleipion of Kos, the best preserved instance of an Asklepieion.

The earliest documented institutions aiming to provide cures were ancient Egyptian temples.
In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieiafunctioned as

centres of medical advice, prognosis, and healing. [8] Asclepeia provided carefully controlled spaces
conducive to healing and fulfilled several of the requirements of institutions created for healing.
[9]
Under his Roman name Æsculapius, he was provided with a temple (291 B.C.) on an island in
the Tiber in Rome, where similar rites were performed.[10]
Institutions created specifically to care for the ill also appeared early in India. Fa Xian, a Chinese
Buddhist monk who travelled across India ca. A.D. 400, recorded in his travelogue that: The heads
of the Vaisya [merchant] families in them [all the kingdoms of north India] establish in the cities
houses for dispensing charity and medicine. All the poor and destitute in the country, orphans,
widowers, and childless men, maimed people and cripples, and all who are diseased, go to those
houses, and are provided with every kind of help, and doctors examine their diseases. They get the
food and medicines which their cases require, and are made to feel at ease; and when they are
better, they go away of themselves.[11]
The earliest surviving encyclopaedia of medicine in Sanskrit is the Charakasamhita (Compendium
of Charaka). This text, which describes the building of a hospital is dated by Dominik Wujastyk of
the University College London from the period between 100 B.C. and A.D. 150.[12] According to Dr.
Wujastyk, the description by Fa Xian is one of the earliest accounts of a civic hospital system
anywhere in the world and, coupled with Caraka's description of how a clinic should be equipped,
suggests that India may have been the first part of the world to have evolved an organised
cosmopolitan system of institutionally-based medical provision.[12]
According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century
A.D., King Pandukabhaya of Sri Lanka (reigned 437 B.C. to 367 B.C.) had lying-in-homes and
hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary
evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world.
[13][14]
Mihintale Hospital is the oldest in the world.[15] Ruins of ancient hospitals in Sri Lanka are still in
existence in Mihintale, Anuradhapura, and Medirigiriya.[16]
The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and
soldiers around 100 B.C., and many were identified by later archaeology. While their existence is
considered proven, there is some doubt as to whether they were as widespread as was once
thought, as many were identified only according to the layout of building remains, and not by means
of surviving records or finds of medical tools.[17]

Late Roman Empire[edit]
Further information: Byzantine medicine

Saint Sampson the Hospitablebuilt some of the earliest hospitals in the Roman Empire.

The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of
the provision of care. Following the First Council of Nicaea in A.D. 325 construction of a hospital in
every cathedral town was begun. Among the earliest were those built by the physician Saint
Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey. Called the
"Basilias", the latter resembled a city and included housing for doctors and nurses and separate
buildings for various classes of patients.[18] There was a separate section for lepers.[19] Some hospitals
maintained libraries and training programmes, and doctors compiled their medical and
pharmacological studies in manuscripts. Thus in-patient medical care in the sense of what we today
consider a hospital, was an invention driven by Christian mercy and Byzantine innovation.
[20]
Byzantine hospital staff included the Chief Physician (archiatroi), professional nurses (hypourgoi)
and the orderlies (hyperetai). By the twelfth century, Constantinople had two well-organised
hospitals, staffed by doctors who were both male and female. Facilities included systematic
treatment procedures and specialised wards for various diseases. [21]
A hospital and medical training centre also existed at Gundeshapur. The city of Gundeshapur was
founded in A.D. 271 by the Sasanian king Shapur I. It was one of the major cities
in Khuzestanprovince of the Persian empire in what is today Iran. A large percentage of the
population were Syriacs, most of whom were Christians. Under the rule of Khusraw I, refuge was
granted to GreekNestorian Christian philosophers including the scholars of the Persian School
of Edessa (Urfa)(also called the Academy of Athens), a Christian theological and medical university.
These scholars made their way to Gundeshapur in A.D. 529 following the closing of the academy by
Emperor Justinian. They were engaged in medical sciences and initiated the first translation projects
of medical texts.[22]The arrival of these medical practitioners from Edessa marks the beginning of the
hospital and medical centre at Gundeshapur.[23] It included a medical school and hospital
(bimaristan), a pharmacology laboratory, a translation house, a library and an observatory.[24] Indian
doctors also contributed to the school at Gundeshapur, most notably the medical researcher
Mankah. Later after Islamic invasion, the writings of Mankah and of the Indian doctor Sustura were
translated into Arabic at Baghdad.[25]
In the ninth and tenth centuries the hospital in Baghdad employed twenty-five staff physicians and
had separate wards for different conditions.[26] The Al-Qairawan hospital and mosque, in Tunisia,
were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls
organised into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened
in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and
the Maghrib to Persia. The first Islamic psychiatric hospital opened in Baghdad in 705. Many other
Islamic hospitals also often had their own wards dedicated to mental health.[27]
In contrast to medieval Europe, medical school under Islam did not have faculties and did not
develop a system of academic evaluation and certification[28]

Medieval Europe[edit]

The church at Les Invalides in France showing the often close connection between historical hospitals and
churches

The Romans first introduced hospitals to Britain during the early Anglo-Saxon period. During this
period, hospitals were mainly confined to the domestic household or existed as small, military
hospitals with the function of caring to the sick, travellers, and of the long-term infirm. More formal
hospital institutions came from the advent of Christianity in A.D. 597 [29]:17 During the late Saxon
period, monasteries, nunneries, and hospitals functioned mainly as a site of charity to the poor. After
the Norman Conquest of 1066, hospitals are found to be autonomous, freestanding institutions. They
dispensed alms and some medicine, and were generously endowed by the nobility and gentry who
counted on them for spiritual rewards after death. [30] In time, hospitals became popular charitable
houses that were distinct from both English monasteries and French hospitals.
The primary function of medieval hospitals was to worship to God. Most hospitals contained one
chapel, at least one clergyman, and inmates that were expected to help with prayer. Worship was
often a higher priority than care and was a large part of hospital life until and long after
the Reformation. Worship in medieval hospitals served as a way of alleviating ailments of the sick
and insuring their salvation when relief from sickness could not be achieved. [29][31]
The secondary function of medieval hospitals was charity to the poor, sick, and travellers. Charity
provided by hospitals surfaced in different ways, including long-term maintenance of the infirm,
medium-term care of the sick, short-term hospitality to travellers, and regular distribution of alms to
the poor.[29]:58 Though these were general acts of charity among medieval hospitals, the degree of
charity was variable. For example, some institutions that perceived themselves mainly as a religious
house or place of hospitality turned away the sick or dying in fear that difficult healthcare will distract
from worship. Others, however, such as St. James of Northallerton, St. Giles of Norwich, and St.
Leonard of York, contained specific ordinances stating they must cater to the sick and that "all who
entered with ill health should be allowed to stay until they recovered or died". [29]:58
The tertiary function of medieval hospitals was to support education and learning. Originally,
hospitals educated chaplains and priestly brothers in literacy and history; however, by the 13th
century, some hospitals became involved in the education of impoverished boys and young adults.
Soon after, hospitals began to provide food and shelter for scholars within the hospital in return for
helping with chapel worship.[29]:65

Three well-documented medieval European hospitals are St. Giles in Norwich, St. Anthony's in
London, and St. Leonards in York.[32] St. Giles, along with St. Anthony's and St. Leonards, were open
ward hospitals that cared for the poor and sick in three of medieval England's largest cities. [32]:23 The
study of these three hospitals can provide insight into the diet, medical care, cleanliness and daily
life in a medieval hospital of Europe.

Medieval Islamic world[edit]
Main article: Medicine in medieval Islam
The first prominent Islamic hospital was founded in Damascus, Syria in around 707 with assistance
from Christians.[33] However most agree that the establishment at Baghdad was the most influential; it
opened during the Abbasid Caliphateof Harun al-Rashid in the 8th century.
[34]
The bimaristan (medical school) and bayt al-hikmah (house of wisdom) were established by
professors and graduates from Gundeshapur and was first headed by the Christian physician Jibrael
ibn Bukhtishu from Gundeshapur and later by Islamic physicians.[35]
St Giles, Norwich[edit]
Discrepancies exist among sources regarding the founding of St. Giles of Norwich, or the "Great
Hospital" as it is known today. Some sources maintain that it was founded in 1246. [29]:65[31]:140 [36] Other
sources state that it was founded in 1249.[32]:23 Though the date may be debatable, it seems agreed
upon that The Great Hospital was founded by Walter Suffield, a Bishop known to be very liberal to
the poor especially in the city of Norwich.[37] St Giles provided thirty beds and maintained within its
ten-acre precinct, many meadows courtyards, ponds, and fruit trees until the late fifteenth century.
[32]:23, 34
The hospital cultivated many productive gardens abundant
in apples, leeks, garlic, onions and honey. The gardens were so productive that surplus goods were
sold on the open market. St Giles of Norwich owned six manors and advowson of eleven churches.
[32]:34

St Giles was unique in that food was provided for children who were getting free education
elsewhere.[37]:27 It is also noted that St Giles arranged for seven poor scholars to receive board at the
hospital during their term at Norwich School.[29]:65 Accommodations of early medieval hospitals were
frequently communal. For example, in St Giles, the master and brothers ate in the common hall
while sisters ate by themselves.[29]:90 St Giles hospital was a complex building that housed a
community of clergy with cloister and residential accommodation, a hospital and a parish church. St
Giles was also wealthy enough to maintain its own kitchen and staff. This allowed poor men to
receive a dish of meat, fish, eggs or cheese in addition to the customary daily ration of bread and
drink.[29]:122
St. Anthony's, London[edit]
St. Anthony's was erected in the thirteenth century (some time before 1254), in the heart of London
on Threadneedle Street, atop the less than ideal site of a Jewish synagogue. [29]:43,88 [32]:23 The chapel of
St. Anthony's was built in 1310 without permission of the bishop of London. To prevents its
degradation, the hospital petitioned for a chapel on the bishops terms. [29]:88 Unlike St. Giles, there was
insufficient land at St. Anthony's, London, for recreation or food production. As a result, herbs or
'erbys' and vegetables had to be bought on a daily basis for consumption by the entire community.
[36]:178
Accounts of foreign expenses at St. Anthony's also show the purchase of various spices, often
with intrinsic medicinal qualities that could alter the level of heat and moisture within the body. Some
of the spices bought include, saffron, cloves, ginger, cinnamon, lavender, pepper and mustard.
[32]:35
Interestingly, the amount spent on herbs, produce, and spices were far surpassed by the amount
spent on fish and meat. According to quarterly expenditure reports, fifty-eight percent of the quarterly
budget was spent on meat, thirty-four percent on fish, three percent on pottage, two percent on
dairy, one percent herbs and one percent on eggs. [32]:33 The unusually detailed records of diet and
expenditures at St. Anthony's have revealed that the diet of the clerical establishment ('the hall') and
the diets of the almsmen, patients and children ('the hospital') were quite different and class-based.

During a typical week, "the entire community shared dishes of pottage, veal, mutton and eggs;
the hall alone consumed pork, ribs of roast beef, duck, fresh salmon and eels; and the hospital was
supplied with mutton, plaice and haddock."[32]:41 It is clear that the hall, or more wealthy, enjoyed
extravagant meals of meat and fish, while the hospital, the patients and the poor, were fed simpler
and cheaper food.
[36]:179

In addition to its reputation of spending lavishly on food, St. Anthony's was famous for its grammar
school, choir and pigs, which roamed freely among the streets identified by bells. [32]:23 Pigs on sale in
London, which were considered by officials to be unfit for food were handed over to St. Anthony's.
The pigs were fed through charity or by scavenging and later, when their condition improved, they
were then taken by the hospital for use as food for the poor or sick.[29]:122
As mentioned, medieval hospitals became concerned in education and in the feeding and housing of
students as early as the thirteenth century. In 1441, John Carpenter, the master of St. Anthony
London, was able to finance a grammar school whose teachings were without fees to any student.
This was the first source of free education in London and remained one of London's leading schools
for one hundred years following its founding.[29]:144
In 1449, St. Anthony's received a handsome legacy for the support of a clerk to train scholars in
both polyphony and plainsong. St. Anthony's became so famous for its choir that in 1469, the
royal minstrels set up a fraternity at the hospital so they may also study music.[36]:125
St Leonards, York[edit]
St Leonard's was one on England's largest and richest hospitals with a primary purpose of caring for
the poor, the sick, the old and infirm.[32]:24 It maintained 200 beds and in its prosperous days,
"maintained up to eighteen clergy, 16 sister and female servants, 30 choristers, 10 private boarders
(corrodarians) and between 144 and 240 poor sick people."[29]:36 Additionally, during Easter of 1370,
records show accommodation of 224 sick and poor in the infirmary and 23 children in the
orphanage.[37]:156
The records of St Leonard provide the best details of daily hospital worship and patient life. In 1249,
for example, matins and lauds were said in the morning hours of darkness, followed by mass of
the Virgin Mary held by members of the clergy. The "lesser hours and mass of the day were said at
mid-morning, vespers in the afternoon and compline in the early evening after supper." [29]:50, 52 Sisters
at St. Leonard's were instructed to feed the poor and the sick, wash them, and lead them around the
grounds.[32]:43 Although the food given to the sick were the simple, and often quite cheap, daily
provisions, sisters were allowed to distribute special food if they were very ill. [29]:62
At St Leonard's, charity and care for the sick was not only given to inmates of the hospitals, but also
to the poor in other neighboring institutions as well as inmates of local leper houses. [29]:63 Additionally,
one or two of the chaplains at St Leonard's were instructed to "minister spiritually to the poor by
speaking consoling words, hearing confessions, and administering the sacraments". [29]:80

Early modern and Enlightenment Europe[edit]
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth
centuries into a secular one. After the dissolution of the monasteries in 1540 by King Henry VIII the
church abruptly ceased to be the supporter of hospitals, and only by direct petition from the citizens
of London, were the hospitals St Bartholomew's, St Thomas's and St Mary of Bethlehem's (Bedlam)
endowed directly by the crown; this was the first instance of secular support being provided for
medical institutions.

A hospital ward in sixteenth century France.

1820 Engraving of Guy's Hospitalin London one of the first voluntary hospitals to be established in 1724.

The voluntary hospital movement began in the early 18th century, with hospitals being founded in
London by the 1720s, including Westminster Hospital (1719) promoted by the private bank C. Hoare
& Co and Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy.
Other hospitals sprang up in London and other British cities over the century, many paid for by
private subscriptions. St Bartholomew's opened in London in 1730, and the London Hospital in 1752.
These hospitals represented a turning point in the function of the institution; they began to evolve
from being basic places of care for the sick to becoming centres of medical innovation and discovery
and the principal place for the education and training of prospective practitioners. Some of the era's
greatestsurgeons and doctors worked and passed on their knowledge at the hospitals. [38] They also
changed from being mere homes of refuge to being complex institutions for the provision of medicine
and care for sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia as a
response to an outbreak of plague.
The concept of voluntary hospitals also spread to Colonial America; the Bellevue Hospital
Center opened in 1736; the Pennsylvania Hospital opened in 1752,New York Hospital in 1771,
and Massachusetts General Hospital in 1811. When the Vienna General Hospital opened in 1784
(instantly becoming the world's largest hospital), physicians acquired a new facility that gradually
developed into one of the most important research centres.[39]
Another Enlightenment era charitable innovation was the dispensary; these would issue the poor
with medicines free of charge. The London Dispensary opened its doors in 1696 as the first such
clinic in the British Empire. The idea was slow to catch on until the 1770s, when many such
organisations began to appear, including the Public Dispensary of Edinburgh (1776), the
Metropolitan Dispensary and Charitable Fund (1779) and the Finsbury Dispensary (1780).
Dispensaries were also opened in New York 1771, Philadelphia 1786, and Boston 1796.[40]

19th century[edit]

English physician Thomas Percival (1740–1804) wrote a comprehensive system of medical
conduct, 'Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct
of Physicians and Surgeons (1803) that set the standard for many textbooks.[41]
A ward of the hospital at Scutariwhere Florence Nightingale worked and helped to restructure the modern
hospital.

In the mid 19th century, hospitals and the medical profession became more professionalised, with a
reorganisation of hospital management along more bureaucratic and administrative lines.
TheApothecaries Act 1815 made it compulsory for medical students to practise for at least half a
year at a hospital as part of their training.[42]
Florence Nightingale pioneered the modern profession of nursing during the Crimean War when she
set an example of compassion, commitment to patient care and diligent and thoughtful hospital
administration. The first official nurses' training programme, the Nightingale School for Nurses, was
opened in 1860, with the mission of training nurses to work in hospitals, to work with the poor and to
teach.[43]
Nightingale was instrumental in reforming the nature of the hospital, by
improving sanitation standards and changing the image of the hospital from a place the sick would
go to die, to an institution devoted to recuperation and healing. She also emphasised the importance
of statistical measurement for determining the success rate of a given intervention and pushed
for administrative reform at hospitals.[44]
By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a
variety of public and private hospital systems. By the 1870s, hospitals had more than trebled their
original average intake of 3,000 patients. In continental Europe the new hospitals generally were
built and run from public funds. The National Health Service, the principal provider of health care in
the United Kingdom, was founded in 1948.
During the nineteenth century, the Second Viennese Medical School emerged with the contributions
of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra,
and Ignaz Philipp Semmelweis. Basic medical science expanded and specialisation advanced.
Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were
founded in Vienna, being considered as the birth of specialised medicine.[45]

Criticism[edit]
Further information: Hospital acquired infections
While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly
provide important help to patients with serious or rare health problems, hospitals also are criticised
for a number of faults, some of which are endemic to the system, others which develop from what
some consider wrong approaches to health care.
One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff,
which dehumanises the patient and prevents more effective care as doctors and nurses rarely are
intimately familiar with the patient. The high working pressures often put on the staff can sometimes
exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals
often is voiced as a contributing factor to the feelings of faceless treatment many people complain
about.[46]

Funding[edit]

Clinical Hospital Dubrava Modern Medical centre in Zagreb, Croatia.

In the modern era, hospitals are, broadly, either funded by the government of the country in which
they are situated, or survive financially by competing in the private sector (a number of hospitals also
are still supported by the historical type of charitable or religious associations).
In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health
care system exists, funded by the state. Hospital care is thus relatively easily available to all legal
residents, although free emergency care is available to anyone, regardless of nationality or status.
As hospitals prioritise their limited resources, there is a tendency for 'waiting lists' for non-crucial
treatment in countries with such systems, as opposed to letting higher-payers get treated first, so
sometimes those who can afford it take out private health care to get treatment more quickly.[47] On
the other hand, some countries, including the USA, have in the twentieth century introduced a
private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity'
hospitals remaining today.[48] Where for-profit hospitals in such countries admit uninsured patients in
emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct
financial losses,[48] ensuring that there is a clear disincentive to admit such patients. In the United
States, laws exist to ensure patients receive care in life-threatening emergency situations regardless
of the patient's ability to pay.[49]
As the quality of health care has increasingly become an issue around the world, hospitals have
increasingly had to pay serious attention to this matter. Independent external assessment of quality
is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is
one means by which this is achieved. In many parts of the world such accreditation is sourced from
other countries, a phenomenon known as international healthcare accreditation, by groups such
as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation
Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.

Buildings[edit]

The medical center at theUniversity of Virginia shows the growing trend for modern architecture in hospitals.

Architecture[edit]

The National Health Service Norfolk and Norwich University Hospital in the UK, showing the utilitarian
architecture of many modern hospitals.

Hospital chapel at Fawcett Memorial Hospital (Port Charlotte, Florida)

Modern hospital buildings are designed to minimise the effort of medical personnel and the
possibility of contamination while maximising the efficiency of the whole system. Travel time for
personnel within the hospital and the transportation of patients between units is facilitated and
minimised. The building also should be built to accommodate heavy departments such as radiology
and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed
for in the design.[50]
However, the reality is that many hospitals, even those considered 'modern', are the product of
continual and often badly managed growth over decades or even centuries, with utilitarian new
sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor
Wagenaar has called many hospitals:
"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and
totally unfit for the purpose they have been designed for ... They are hardly ever functional,
and instead of making patients feel at home, they produce stress and anxiety." [51]
Some newer hospitals now try to re-establish design that takes the patient's psychological needs
into account, such as providing more fresh air, better views and more pleasant colour schemes.
These ideas harken back to the late eighteenth century, when the concept of providing fresh air
and access to the 'healing powers of nature' were first employed by hospital architects in
improving their buildings.[51]
The research of British Medical Association is showing that good hospital design can reduce
patient's recovery time. Exposure to daylight is effective in reducing depression. Single sex
accommodation help ensure that patients are treated in privacy and with dignity. Exposure to
nature and hospital gardens is also important – looking out windows improves patients' moods
and reduces blood pressure and stress level. Eliminating long corridors can reduce nurses'
fatigue and stress.[52]
Another ongoing major development is the change from a ward-based system (where patients
are accommodated in communal rooms, separated by movable partitions) to one in which they
are accommodated in individual rooms. The ward-based system has been described as very
efficient, especially for the medical staff, but is considered to be more stressful for patients and
detrimental to their privacy. A major constraint on providing all patients with their own rooms is

however found in the higher cost of building and operating such a hospital; this causes some
hospitals to charge for private rooms.[53]

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