Pennsylvania+Hospital

=Pennsylvania Hospital=

At the time of its founding society required a place to house and treat the infirm and the innovations that came from such an establishment. For this reason, the Pennsylvania hospital was founded as the first hospital in America. At a critical point in American history, Pennsylvania Hospital helped shape a set of ideals for the nation, as well as create a solid foundation for medical technology and research. Such innovations range from the first treatment of mentally ill patients, to the first medical library, the first medical students, and even the first recorded annual weather logbooks. The impact that this hospital had on society, and more astounding, the impact society had on the hospital is made evident by reading through the history and accomplishments of the establishment. The Pennsylvania Hospital located on 8th and Pine streets in Philadelphia PA was founded in 1751. At this time period in America, there was no established way to take care of the infirm, and no means of dealing with mentally ill patients other than putting them in prison. Because of this, jails were becoming overcrowded, and the sick that weren't wealthy typically had a very high mortality rate. According to J. Forsyth Meigs, people who were only wounded and had many years ahead of them of ‘useful work’ were dying because they did not have care

Contents

 * 1) Introduction
 * 2) History
 * 3) Psychiatric Care
 * 4) Medical Professions
 * 5) Apothecary
 * 6) Medical Business
 * 7) References

History
It was in 1751 that Dr. Thomas Bond taking note of the conditions around him, urged Benjamin Franklin to propose the idea of a governmentally funded institution that would care for the ill to the Assembly. Franklin understood the needs for such an establishment and urged the government to consider. Interestingly enough, it was looked upon as a poor idea, and was nearly rejected, until Franklin proposed an audacious scheme. He bargained that if he could raise £2000, then the house would have to match his sum and continue to support the effort. “Franklin and his cohorts exceeded their goal, gathering £2,751, the assembly approved the measure, and on May 11, 1751, Pennsylvania Hospital was established with the signature of Lieutenant Governor James Hamilton.” (Kristen A. Grahm). Since then the hospital has prevailed, and still receives patients to this day. The scope of the influence that it has had on America is astounding. From it founding it was given that the hospital would accept any patient that needed care, regardless of cost, ethnicity, or political standings. Amazingly, among the first patients were a Black slave, and a Native American “found lying ill near the house of Isaac Norris”, one of the founders. (Pennsylvania Hospital Records) During its early years, the hospital also treated as many patients for free as possible, only taking money from wealthy inpatients when needed. Rules were established such that "the Pay Patients in the House [and those to come] be accommodated with no other provisions for their diet than the Other Patients..." making the hospital a uniform society where all patients were equal(Thomas G. Morton).

Psychiatric Care
Due to the rise in the amount of 'insane' patients at the time of its inception, the Pennsylvania Hospital created a special care ward specifically for the mentally ill patients. At that time in society, insane patients were looked upon as inhuman creatures that needed to be locked away, and there was no means or way to cure them. The first psychiatric ward consisted of little more than small rooms in the basement of the building to house mentally ill patients, where they could be regularly attended. Over time, the building became overcrowded with the insane and had to be expanded. Though not officially recorded, when funds were tight for the hospital, more mentally ill patients were admitted because typically they came from wealthy families and were able to pay for care. This is particularly notable in wartimes because governmental funding was deferred for war expenses, and the number of incoming patients skyrocketed. Accordingly, so did the number of patients classified as insane. As the numbers of insane patients became unmanageable in one site, it was seen that society needed another way to take care of the mentally ill. Due to the ever increasing numbers, in 1841 the Pennsylvania Hospital broke off into two parts, the main campus, and then a special dedicated insane asylum that was off site (J. Forsyth Meigs). While not the first insane asylum, it was the first that was associated with a hospital, and therefore acted as the link that established the mentally ill as patients instead of criminals. Dr. Benjamin Rush was the pioneer of this idea, and he singlehandedly changed the way society viewed the insane. Rush saw mentally ill patients as patients, not criminals or victims, but as persons that had a 'disease of the brain'. For this reason, he demanded good living conditions for his patients, disallowed public viewings of the insane, and provided activities and regular events for all. Dr. Thomas Kirkbride adopted this idea and continued following these basic guidelines when he ran the new asylum. As mentioned by Kristen A. Grahm, instead of locking up and confining the mentally ill, he decided that they should have much room to roam, under supervision. He also eliminated restraints where possible, encouraged recreation, and hired nurses instead of keepers for the patients. By changing the way that society viewed the mentally ill, the treatment methods and procedures followed accordingly. What is now known as the American Psychiatric Association was formed under these pretenses by Kirkbride, by joining together the heads of 13 asylums nationwide. This solidified psychiatric care as a medical field.

Medical Professions
As medicine became linked to the idea of education, as well as a unified profession, it became apparent that the people needed well trained doctors. Pennsylvania Hospital is the first place in America to train students for a future in medicine, as well as to recognize that nurses needed training. With the wide berth of resources, such as a medical library, and policies to allow trainees to observe doctors working, the foundation was laid to create a formal field. Lectures were given weekly and a small fee was charged that initially went towards the hospital's general funds. It was in 1773 that the first student, Jacob Ehrenzeller was signed into a formal training regimen. He was to attend regular lectures, train in the apothecary for the creation of tinctures as well as gathering the ‘ways of Physic and Surgery”, and to observe the doctors as they worked (William H. Williams). After some harsh criticism about how out of date the research materials were to their overseas counterparts', the fees collected from the medical students, as well as the proceeds from lectures was now put towards acquiring books and journals for the medical archive. As demand grew, a surgical amphitheater was created, which allowed large groups of students or physicians to observe a live surgery, a first for the medical profession. This move is attributed to solidifying surgery as a single medical profession. Certain surgeries were pioneered here as well, such as the appendectomy, lithotomy, and the thoracoplasty. The medical library, which is said to be the first of its kind, allowed students to check out books for their studies. Eventually, the requests for training from both national and international students grew so large that a formal school was created. This offshoot is part of the foundation of the University of Pennsylvania.

As society shaped the ideas of what good medical care was, there became more of an emphasis on nursing. Nurses were sought to assist the doctor in his duties, as well as comfort and provide for the patients. For this reason, females were the likely candidates for nurses due to their inherent nurturing qualities. As early as the inception of the hospital, nurses were hired to take care of regular tasks such as serving food to the patients and enforcing the sets of rules. The high concentration of women had an influence on the creation of the first maternity ward in America which was opened in 1803. It was initially frowned upon that male doctors should attend to women giving birth, and the majority of the work was done by the female nurses. Again, it can be said that this maternity ward was the genesis of obstetrics in America, and the creation of yet another specialized medical field. To this day, Pennsylvania hospital is renowned for its specialization in birthing and success rate of high risk deliveries. Nursing schools were established for both men and women by the hospital, lending to another influence that the hospital had on the field of medicine, and the people's view of medicine.

The Apothecary
Seeing how medical technology was progressing overseas, it became a standard practice to use drugs and tinctures for healing.

"The practitioners charitably supplied Medicines grants till December 1752, when the Managers having procured an assortment of Drugs from London, opened an Apothecary's shop in the Hospital, and it being found necessary, appointed an Apothecary to attend and make up the Medicines daily, according to the Prescriptions, with an allowance of Fifteen Pounds per Annum." (Benjamin Franklin).

The apothecary's was dubbed the 'Elaboratory'. Kristen A. Grahm writes that this was "...[America's] first apothecary..." meaning that previously, there was no establishment that created or distributed standard medicines. Having an apothecary on site allowed for doctors to create custom drugs and doses per patient. It also allowed for medical students to study under the apothecary, whom at the time, was typically a very learned man. By doing this, the students got first had experience crafting drugs, as well as measuring doses, and understand how the different compounds reacted. Another small example of the hospital's effect on society was that one of the duties of the apothecary was to record the weather conditions daily. Within the first year, the weather conditions were being used in court cases as facts.

The Hospital As A Business
Throughout the life of the hospital, all of the major wars in America have been fought, the nation was being founded, the economy crashed, and many other factors which influenced the direction of the hospital occurred. The initial concept of the hospital was to provide free care to ill people, regardless of their socioeconomic standings by way of government funding. This was quickly shown to be infeasible due to the nature of the business. In order to get the House Assembly to sign the bill initially, on top of the matching funds drive, three doctors agreed to work for free at the hospital for a term of three years. During this time, the doctors even paid for their patients' medicines out of pocket. Eventually, the government had trouble funding the hospital during the revolutionary war. Philadelphia was occupied by the British, and the government was spending as much money as possible to fund the war; however, the hospital remained opened and free to as many patients as possible. Many of the patrons were British soldiers who had been wounded in the war. To counteract this, the hospital was expanded with the remaining surplus funds from before the beginning of the war to accommodate all of the soldiers, and more paying inpatients were accepted as well to counteract the deficit. The hospital had become necessity by this time. Had society not needed the hospital, it would have been dissolved due to its operating costs. Over time, the hospital actually faced bankruptcy numerous times, and it was saved by generous donations, or governmental grants (Sydney P. Clark). By mandating fees for care and due to the rising cost of technology over time, the Hospital system has become what it is now.