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History: Health Services
Hospitals have existed since antiquity, but have historically aborbed a religious spirit since the early medieval ages. Early hospitals in the medieval ages were intrinsically connected to the Christian faith as they were operated by monastic orders. They were funded by charity and lay sponsors like priests and lay patrons. Hospitals were established for the care of plague victims, indigents, and pilgrims. With scientific developments and discoveries over time, hospitals became institutions where everyone came for recovery and diagnosis.
The 19th century was a significant period in the history of hospitals because many were established in a short period of time. According to McConnell in Hospitals: Origins and Growth from Early Times to 1900, by the end of the 19th century, there were 149 hospitals with more than 35,000 beds total. There was a variety of hospitals: municipal, county, elite voluntary, religious, and ethnic. Hospitals that made the most profit were those that served as surgical centers, were small, and were not related to medical schools. The elite voluntary hospitals were closely tied to universities and concentrated on acute care. Ethnic and religious hospitals rarely received any endowements, hence they relied on patient fees or charity. County and municipal hospitals had the most beds available and typically treated a range of acute and chronic illnesses.
- The Pennsylvania Hospital in Philadephia was the first incorporated hospital in the United States in 1751. It was founded by Benjamin Franklin and Dr. Thomas Bond, for the purpose of treating private patients. The first teaching hospital was not established until 1874 in Pennsylvania as well.
- The first psychiatric hospital was established in Williamsburg, Virginia in 1773.
The profession of physicans/doctors has existed since prehistory. Record of "healers" has been found in drawings inside caves dating back to 27,000 years ago. Medical knowledge at the time would be passed down generations. Ancient Egyptians were among the healthiest people on Earth and performed the some of the surgeries (i.e., root canals). Back then a physician was to have mastery of supernatural texts training in anatomy. Babylonians 3,000 years ago are believed to have been the first to offer prescriptions. In Ancient Greece medical ethics was born. The Ancient Greek Hippocrates, Father of modern medicine, wrote more than seventy books about diseases and their treatment. He also created the Hippocratic Oath, an oath new physicians take that states the obligations and conducts they are to abide by. By the 9th century, physicians knew how to use forceps, scalpels, surgical needles, saws, amongst other tools. Universities and the first medical schools were in opened in 12th century Italy. In ealry 17th century England, medical practice was divided into three categories: apothecaries, physicians, and surgeons. According to Ryan Winter in Soliant, by this time physicians used the existent medical knowledge and applied those texts rather than depend on them. That being said, physicians and treatments did not have a high success rate at this time. During the 19th century, physicians benefited from developments in other scientific disciplines, in particular chemistry. Knowledge of evolution, genetics, psychiatry, and and immunology became available to physicians in the 19th century.
The practice of medicine in the United States dates back to the 1600s. Physicians were seen as elite. Women began to be accepted as physicians in the later 19th century. The distinctions made in 17th century England did not exist in Colonial America, as educated doctors were to fulfill more than one role if necessary. According to Medline Plus, the first organization of medical professsionals was charted in 1766 in the English colonies and was known as the New Jersey Medical Society. Early medical societies regulated medical practice and examined licensing practitioners. Later on the medical societies developed proprietary medical colleges, society-related training programs for doctors. The American Medical Association was founded in 1847 and set standards and requirements for the education of physicians. Between 1802 and 1876, approximately 62 medical schools were established. The first medical school that was university-like, well-equipped and well endowed was the John Hopkins University School of Medicine opened in 1893. By the year 1900, there were 25,000 medicine students and 5,200 graduates. Many substandard schools were closed in 1910 as many medical schoools had become "diploma mills".
- Daniel Hale Williams (1856-1931) was the one of the first black MDs.
- Elizabeth Blackwell (1821-1920) was the first woman to have been granted a medical degree in the United States.
The nursing tradition had Christian beginnings during the Early Middle Ages. For centuries nursing care was provided by the religious, especially the Catholic Church. Nursing was significantly changed because of the contributions of Florence Nightingale during the 19th century. Thanks to her, hygiene and an organized approach were introduced. For this reason she is considered to have been the first true health administrator and credited with introducing the early use of the scientific method to the practice. She established an innovative nursing school in the mid-19th century in London which exerted great influence on the education and training of nurses in the United States. Nursing quickly became a female dominated profession as Nightingale (the founder of modern nursing) favored women for the profession, the training of nurses was overseen by women of the upper class, and war times necessitated the life-saving help women were able to supply for the wounded soldiers.
Nursing training schools were established in the New York, New Haven, and Boston in 1873. After a decade, there were 35 training schools in the United States. Even after nursing and medicine became more secularized with the development of science, the Church was still very involved in the care of the sick during the beginning of the 20th century. It was common for many hospitals to be run by churches and operated by nuns.
Records of dental and oral illnesses and treatments have ancient origins and go as far back as 5000 BCE in Ancient Mesopotamia. Acording to the American Dental Association (ADA) the earliest reference to a person identified as a dental practioner was an Egyptian man named Hesy-Re whose tomb includes an inscription that says "the greatest of those who deal with teeth, and of physicians", this dates back to 2600 BCE. The Ancient Greeks and Romans practiced and wrote plenty about dental illnesses, treatments, and oral hygiene. Dental prostetics have been used since the 2nd-century CE. Dentistry had beginnings as a profession though in the Middle Ages during which dental work was divided between barbers who performed routinary hygienic services like shaving, bleeding, and tooth extraction. There were also surgeons who possessed an education in dentistry and performed more complex dental operations. The Middle Ages were a great time for the publishing of academic works on dentistry. Over time, more complex dentistry evolved and modern dentistry was born for which French surgeon Pierre Fauchaurd is credited. Dentistry developed particularly in France and Germany during the Middle Ages up to the Early Modern Period.
In 1840 the world's first dental school, the Baltimore College of Dental Surgery, was established. The world's first national dental organization, the American Society of Dental Surgeons, was founded in 1840 as well. In 1867, for the first time a dental school became associated with a university which in this case was Harvard University. During the 19th century, dentistry lacked standarization as dentists were still being trained under preceptorships instead of schools. Licensing in dentistry began around 1868 in the United States. Interest in oral hygiene grew significantly at the end of the 19th century when a theory that stated dental caries were a result of bacterial acticity was published. The first clinic for the education of dental hygienists at a college level was established in 1913 by Alfred C. Hones in Bridgeport Connecticut.
- The earliest medically-trained dentist to practice in America was Englishman John Baker who settled in Boston around 1760.
- The first native-born American dentist was Isaac Greenwood. Greenwood's son was one of George Wasington's dentists.
The study of optics (the properties and behavior of light) was fundamental for the development of optometry. Since discoveries regarding how light works during the 17th-19th centuries, its porperties have been used to compensate for poor eye vision. According to the Georgia Eye Physicans and Surgeons P.C., the first pair of wearable spectables was created in Italy in the 13th century. The first to use spectacles were scholars and monks because their professions required upclose reading and attention. The demand for spectacles grew with the invention of the printing press in 1452. Later in the beginning of the 17th century, Johannes Kepler explained how light enters the eye, forms in the retina, and then is inverted. He was able able to explain how convex lenses corrected far-sightedness and concave ones near-sightedness. The first book on optometric principles was written in 1623 in Spain and for the following century other significant discoveries and inventions will be made. The first optometric shop was established in 1783 by John McAllister in the United States.
Charles Prentice is considered the Father of Modern Optometry by many as he helped standarize the practice of optometry. He was controversial at the time for charging $3 for an eye exam. In 1898 he helped organized the Optical Science Societies which we know today as the American Optometric Association. In 1910, Columbia University was the first school to teach optometry courses at the college level. Before then, American students of optometry would have to travel to Europe to receive an education. For the reasons aforementioned, Charles Prentice is contributed to be the one that lead the movement for the recognition of Optometry as a profession. Optometry was legally recognized for the first time in 1901 by the state of Minnesota. Twenty years later, all states lawfully recognized Optometry as a profession.
- Benjamin Franklin invented bifocals eyeglasses in 1784.
- The cause of astigmatism was discovered in 1801.
- The acuity chart was invented in 1862.
- The first pair of usable contact lenses was invented in 1888 and was 18mm thick.
Druggists are synonymous to pharmacists, other names that have been used in the past are apothecarist, herbalist, and chemist. The role of a pharmacist is to prepare medicine for customers, dispense medicines, and provide any counsel in that regard to patients. Like other forms of health services, pharmacy has ancient origins as people used what was found in nature a source for remedies to different ills or maladies. Since the role of a druggist, pharmacist, or herbalist has been one of preparing remedies for healing, the history of pharmacy is closely related to that of medicine which has a very similar purpose.
According to Krantz and Hartley from Britannica, the division between the duties of a physician and a herbalist happened in several instances in Ancient Greece, Rome, and during the Middle Ages. The distinction between a physician and pharmacist was brought along by the Arabian presence in Europe during the 8th century CE. The distinction between the duties of these two roles happened again in different places of Europe during the 13th century and later again at the end of the 17th century. In the United States, Benjamin Franklin reinforced the distinction between the two when he appointed an apothecary to the Pennsylvania Hospital.
- The first college of pharmacy was established in the United States in 1821, this college is known today as the Philadeplphia College of Pharmacy and Science.
- Coca-Cola and Dr. Pepper were created by pharmacists.
If one looks at a newspaper from 1910, one would see it filled of advertisements of remedies and self-treatments that claim to cure ailments or improve health status. This is characteristic of the time period as well as of the decades surrounding 1910, particularly in the later 19th century. In the decades ranging from 1880-1920, American medicine was taking its modern form. At the same time there were several factors that influenced the health industry. Firstly, there was a strong consumer culture on the rise in which according to Nancy Tomes (2001) the 19th century obsession of the reformers with good health and bodily discipline became more popular. Consumerism and commercialization created a persistence of self-help traditions in popular culture. In the increasingly robust consumer culture of the early 20th century, "...everyone was exposed to commercial messages designed to leave consumers feeling dissatisfied with their current health status and desiring a new and improved self." (Tomes 2001, 531).
As health seeking behaviors were influenced by consumerism, consumerism was in turn was exacerbated by the efficiency and productivity of American Industries in the form of national advertising and marketing schemes. All sorts of goods and services were advertised and marketed for consumers regardless of their effects on human health. Americans were allured and dazzled by all the options available in the market for achieving health according to the standards of the time. Naturally, health advertising and marketing became a source of revenue from which print media and radio became dependent on. In the late 19th and early 20th centuries, people sought "health a bottle" through over the counter remedies or medicines, and "health in a book" in the form of commercialized health advice (Tomes 2001, 531). Consequently there was a substantial amount of money being spent outside of organized medicine.
Prior to the period under study there was no health insurance. Even during the 1910s, health insurance as we know it did not exist. That being said, the spirit of the Progressive Era brought along the predecessors of health insurance: workers' compensation and sickness funds. In 1912, President Theodore Roosevelt and his party endorsed as part of their platform social insurance that included health insurance. That same year the National Convention of Insurance Commissioners developed the first model of laws regulating health insurance. In 1915, the American Association for Labor Legislation (AALL) published a bill draft for compulsory health insurance and campaigned for it in several states. Approximately 15 states showed interest in compulsory health insurance but the bill was not enacted as the United States entered into World War I. In the 1930s, hospitals began to implement private forms of health insurance to deal with revenue consequences of the Great Depression. It was under the Presidency of Franklin D. Roosevelt and his New Deal during which there was significant health reform.