1 / 24

Hospitals and Surgeons

Hospitals and Surgeons. The American Hospital. 1750-1920 1870 < 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

andie
Download Presentation

Hospitals and Surgeons

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hospitals and Surgeons

  2. The American Hospital 1750-1920 1870 < 200 hospitals in U.S. 1927 ~ 7000 hospitals in U.S.

  3. 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.”

  4. Why not a medical hospital? • Concepts of disease and therapy • Nature of nursing • Nature of technology

  5. The voluntary hospital • Purpose • The worthy poor – the Civilizing Mission of the Children’s hospital – the alternative to the almshouse and the problem of pauperization • No chronic disease (tb), no infectious disease (typhus, small pox), no terminal disease (cancer) • Temporary, curable conditions (heart, respiratory, digestive) • Ornament of charity, lure for physicians • Mainly free (+ sailors, the paying mad) • The Carceratorial Hospital – Walled anarchy

  6. Managed care in the voluntary hospital– the hospital as home • The board of governors (churchwardens) • The privilege to recommend • Oversight of finances • The master & matron (mom and dad) • The medical staff (friendly uncles) • Consultants • Senior attending staff (admitting privileges) • House staff (interns, externs and later [c 1900] residents) • Students • Nurse, admitting officer, and apothecary

  7. 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 (Hertzler’shospital) 4 Catholic (from 1849, St. Vincent’s), Jewish, ethnic (St. Francis’s, 1865), race-based hospitals – Sisters of Charity 5 resort hospitals -- our home on the hill 6 regional – municipal gospel hospitals (1890-1920) 7 almshouse 8 public sanatoria 9 RR and industrial (mining hospitals)

  8. Hospitals vs dispensaries • Hospital: inpatient, long term, high prestige, mainly male, after 1850, site of surgery – rise after 1870 • Dispensary: outpatient or in-home; oriented toward pharmacy, mainly women, children, site of social activism -- decline after 1920 • The current fate of the dispensary

  9. The triumph of the hospital, 1870-1920 • Surgery • Anesthesia, antisepsis, asepsis • Nursing • Civilizing Nightingale • The conquest of nurse autonomy • Admitting privileges • Not just another form of primary care (1870 <2%; 1905 c. 10 %; 1927 52%) • You too can collect fees in the hospital • RESULT: PEOPLE PAY

  10. The fall of the dispensary, c 1920 • Imputations of socialism • settlement house – social worker professionalization issues • Competition with general practice • Irv Watters’ views • Lack of specialized services, technology • Development of other training means • Dissociation with science and control • Short life of Sheppard- Towner 1921-9 • Opposition of AMA

  11. The issue of the Catholic Hospital • Conversion concerns; evangelical concerns • Entrepreneurial sisters – supply side, finding clients • Sacramental power • Ethnic identity • Middle class dignity – the paying hospital • The bargain with the surgeons

  12. Changes in surgery • The classic problems of surgery • Pain • Infection • Hemorrhage • C. 1850 25% surgical mortality good • Inevitable infection – laudable pus • The problem of surgical cleanliness as a problem of materials- steel and chemistry

  13. From kitchen tables to Operating rooms Both images courtesy of the National Library of Medicine, National Institutes of Health.

  14. The Emergence of American Surgery • Europe: surgeons, physicians, overlapping, independent (Dr. or Mr.) • The Irish case • America: Who Gets to Cut? • The problem of fee-splitting • From medical to surgical appendectomy

  15. Pain • Pre 1842, pain as good; earlier use of narcotics (opium, marijuana, henbane, wine) • 1810s -- NO, ether -- • recreational drugs • 1842 – Crawford Long, ether • 1844 – Wells/Morton NO/ ether • 1846 – John Collins Warren • 1846 – use of chloroform: problem of ethics : suffering vs. life; pain in birth Image courtesy of National Library of Medicine, National Institutes of Health

  16. infection • Healing by 1st intention – the problem of closing the wound • Healing by 2nd intention – dressing the wound • Laudible pus • Ichorous pus • Lister, late 1860s – antiseptic surgery • Early 1880s – germ free surgery

  17. Crossing the membranes • Arachnid, peritoneum, pleural • From inflammation of the bowels to appendectomy, c. 1886 (Hall, Fitz): 1st 24 hrs. • 1900 25% of all surgeries in Atlanta • St. Mary’s Rochester • 1900 186 appendectomies • 1905 > 1000 “ • 1890: exploratory abdominal surgery – if unsure, go in. If maybe cancer go in

  18. Surgery and Society • J. Marion Sims and vesicovaginal fistula, 1852; the 30th operation – silver suture • 1845: Anarcha, Betsy, and Lucy • No anesthesia, filthy rags: African-American women bear pain better….

  19. W. W. Mayo (1819-1911) • Chemist, Manchester England, to US • Pharmacist, Bellvue, Buffalo, late 1840s • Tailor, Lafayette, In, 1848-9 • Indiana College of Medicine, 1850 • To Minnesota, via Missouri, 1854, • iron range mine claim inspector • Practice LeSueur, 1856 • Farmer, boatman, judge, editor-publisher • Draft board doctor, Rochester, MN, 1863 • Practice evolves toward surgery • Hospital founder following 1883 tornado • St. Mary’s, 1889; leads ultimately to group practice of Mayo Clinic (run by sons Will and Charlie) Image: http://commons.wikimedia.org/wiki/File:William_Worrall_Mayo.jpg

  20. Surgery as the cash cow • 1880: WW Mayo: a life in debt • No bookeeping, no fees • Sliding scale • 1900 Halsted, Kelly, $10000/operation • C. 1916 Mayos millionaires

  21. Gynecological surgery • 1905 laprectomy/hysterectomy common • “they went a little wild and were inclined to find in hysterectormy a panacea for all the ills of women” Clapesattle, 188 • “it was only a step from removing the ovaries for tumor to removing them for pain in menstruation, and then for various nervous symptoms that baffled physicians” (189)

  22. Other Mayo surgery • Even quiet ulcers aren’t cured • 75% require surgery • Gastroenterostomy: bowel bypass • Abdominal surgery: ST. Mary’s hospital • 1890-3=54, 1900=612, 1905=2157 • Adenoid-tonsil removal • 1890 = 5, 1900=100

  23. The anti-MayoArthur Hertzler 1870-1946 • MD Northwestern, 1894; practice Halsted KS • Interest in surgery, surgical pathology: • 1899-1901 postgraduate study in pathology – Berlin • 1901 prof. Pathology, UMissouri, KC, 1907 prof. Surgery U of KS med school • C. 1905 founder of Halsted hospital and Hertzler clinic • Max operation fee $150 • 1938 The Horse and Buggy Doctor • 1942 The Doctor and his Patients

  24. Credits Slide 13 • Surgery on a kitchen table. In the public domain. Accessed from http://www.nlm.nih.gov/exhibition/cesarean/images/abdsurgery.jpg on August 4, 2010. • Hospital operating room. In the public domain. Accessed from http://www.nlm.nih.gov/exhibition/aframsurgeons/images/douglass2.jpg on August 5, 2010. Slide 15 • Chloroform inhaler. In the public domain. Accessed from http://www.nlm.nih.gov/ on August 5, 2010. Slide 19 • Photo of W.W. Mayo. In the public domain. Accessed from http://commons.wikimedia.org/wiki/File:William_Worrall_Mayo.jpg on August 5, 2010.

More Related