Biomedical Engineering Reference
In-Depth Information
“unfortunates” of society and helped to ease their suffering by advocating the power of
reason and spearheading prison reform, child care, and the hospital movement. Ironically,
as the hospital began to take up an active, curative role in medical care in the eighteenth
century, the death rate among its patients did not decline but continued to be excessive.
In 1788, for example, the death rate among the patients at the Hotel Dru in Paris, thought
to be founded in the seventh century and the oldest hospital in existence today, was nearly
25 percent. These hospitals were lethal not only to patients but also to the attendants work-
ing in them, whose own death rate hovered between 6 and 12 percent per year.
Essentially the hospital remained a place to avoid. Under these circumstances, it is not
surprising that the first American colonists postponed or delayed building hospitals. For
example, the first hospital in America, the Pennsylvania Hospital, was not built until
1751, and the city of Boston took over two hundred years to erect its first hospital, the
Massachusetts General, which opened its doors to the public in 1821.
A major advancement in the history of modern medicine came in the mid-nineteenth
century with the development of the now well-known Germ Theory. Germ Theory simply
states that infectious disease is caused by microorganisms living within the body. A popu-
lar example of early Germ Theory demonstration is that of John Snow and the Broad Street
pump handle. When Cholera reached epidemic levels in the overcrowded Industrial Era
streets of London, local physician John Snow was able to stop the spread of the disease with
a street map. Snow plotted the cases of Cholera in the city, and he discovered an epicenter
at a local water pump. By removing the handle, and thus access to the infected water
supply, Snow illustrated Germ Theory and saved thousands of lives at the same time.
French chemist Louis Pasteur is credited with developing the foundations of Germ Theory
throughout the mid-nineteenth century.
Not until the nineteenth century could hospitals claim to benefit any significant number of
patients. This era of progress was due primarily to the improved nursing practices fostered
by Florence Nightingale (Figure 1.2) on her return to England from the Crimean War. She
demonstrated that hospital deaths were caused more frequently by hospital conditions than
by disease. During the latter part of the nineteenth century, she was at the height of her
influence, and few new hospitals were built anywhere in the world without her advice.
During the first half of the nineteenth century, Nightingale forced medical attention to
focus once more on the care of the patient. Enthusiastically and philosophically, she
expressed her views on nursing: “Nursing is putting us in the best possible condition
for nature to restore and preserve health.
The art is that of nursing the sick. Please
...
mark, not nursing sickness.”
Although these efforts were significant, hospitals remained, until the twentieth century,
institutions for the sick poor. In the 1870s, for example, when the plans for the projected Johns
Hopkins Hospital were reviewed, it was considered quite appropriate to allocate 324 charity
and 24 pay beds. Not only did the hospital population before the turn of the century
represent a narrow portion of the socioeconomic spectrum, but it also represented only a
limited number of the types of diseases prevalent in the overall population. In 1873, for exam-
ple, roughly half of America's hospitals did not admit contagious diseases, and many others
would not admit incurables. Furthermore, in this period, surgery admissions in general
hospitals constituted only 5 percent, with trauma (injuries incurred by traumatic experience)
making up a good portion of these cases.
