draft ~ TOPIC-#10_p-20-21_The last gasps of 19th century hospitals as they were dragged into the 20th century

by faithgibson on February 10, 2023

in Draft


TOPIC-#10_p-20-21_The last gasps of 19th century hospitals as they were dragged into the 20th century

Prior to the scientific era, the basic function of hospitals was providing “hospitality”, that is, a medicalized version of a well-staffed hotel that provided clean dry linens, three meals a day, and help to the bathroom or a bedside commode. Basic nursing function were done by non-professionals (often members of a religious order) who provided nursing care to bed-ridden patients, bathing them, changing bandages, emptying bedpans, and feeding patients too ill to feed themselves. This category of “palliative care” was typically provided to patients with chronic or terminal diseases or recovering from a debilitating injury. No matter how sick these patients were, scientific medical treatments such as IVs, blood transfusions or chemotherapy drugs were not a possibility.


But as the healing “arts” morphed into a very modern medical science during the first three decades of the 20th century, the nature of hospitals in America changed dramatically. Among the many “gifts” produced by medical science was a tsunami of must-have medical equipment, specialized supplies and eventually various medical technologies. Hospitals of any size that wanted to be “modern” had to figure out how to afford the purchase of capital-intensive equipment like x-ray machines and other new and usually expensive medical equipment.


Over the course of a few decades, many these small 2-to-10 bed hospitals that provided palliative and “end of life” care morphed into vibrant institutions in which the idea of “medical science” had become an active verb. This gave rise to many different forms of effective medical and surgical treatments, which meant the majority of its seriously ill or injured patients not only lived, but they walk out of the hospital on their own two feet!


But who pays the bill that medical science runs up?

Note-2-self ~Economics from the hospital’s perspective (i.e. NOT pts as paying customers)


Further more, I think the following rendition is redundant and should be melded together into a single topic

For all of their lifesaving and world-changing properties, these scientific discoveries and new technologies had a substantial economics downside for hospitals. As already noted, modern medical miracles don’t come cheap. This was particularly a problem for the 8,000 small, private, doctor-owned hospitals that suddenly found themselves in a time warp that relegated them to the Dark Ages! It was like they’d been were doing a brisk business in horse-and buggy transportation, only to wake up one day and see the streets filled with cars! What to do?


This brings us back to Dr. JWW and his vision.  As mention to earlier, he saw two different but intertwined problems. The first had to do with those 8,000 small privately-owned hospitals that were so out-of-step with the times. In order to catch up, they needed to purchase the latest medical equipment and upgrade or remodel their physical facilities. Keep in mind that these hospitals were all “for-profit” businesses that depended on relatively well-to-do patients as paying customers.  Unless they found a way to increase their revenue – more patients, longer hospitalizations, maybe a generous endowment from grateful philanthropist — these small hospitals would remain stuck in 19th century “healing arts” as providers of palliative treatments to the chronically and terminally ill.


From Dr. JWW’s perspective as Dean of a famous medical school, the second and more difficult problem was the desperate lack of “general” hospitals in the United States. These are large regional hospitals, like Johns Hopkins in Baltimore, that are equipped to provide comprehensive medical and surgical care to patients of all ages, all stages of life, and across the spectrum of serious illnesses and injuries.


He wanted to solve both of these problems and do so without depending, in any way, on government funding, which the medical profession was afraid would lead to unwanted government interference. So he began by trying to find or invent a way to privately fund the modernization of small private hospitals. He saw this as a gradual process in which each hospital would be able to slowly upgraded or remodeled their facility, purchase new or better equipment and generally improve their technological capabilities. He believed that a significant number of these smaller hospitals would gradually, over a few decades, grow into a well-equipped “general” hospital that was able to provide “comprehensive” medical and surgical services to patients of all ages and all kinds of medical problems in a particular geographically area of the country.


{{redundant{{ This brings our story back to Dr. JWW and his dream of modernizing these the 8,000 or so small privately-owned hospitals and eventually developing a nationwide system of acute-care “general” hospitals }}}}}


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