{"id":324,"date":"2018-03-05T17:29:14","date_gmt":"2018-03-05T17:29:14","guid":{"rendered":"http:\/\/commons.trincoll.edu\/amst-mpp\/?p=324"},"modified":"2018-03-05T17:31:27","modified_gmt":"2018-03-05T17:31:27","slug":"healing-america-hospitals-in-u-s-history-space-and-culture","status":"publish","type":"post","link":"https:\/\/commons.trincoll.edu\/amst-mpp\/2018\/03\/05\/healing-america-hospitals-in-u-s-history-space-and-culture\/","title":{"rendered":"Healing America: Hospitals in U.S. History, Space, and Culture"},"content":{"rendered":"

The evolution of the hospital in America<\/strong> traces medicine’s shifting role in American society, and its interventions\u2014for better and worse\u2014into the lives of its citizens. More than a place to heal, hospitals have a complex political, social, and cultural history that both responded to and shaped every era in American history. By studying hospitals, we can perceive the material, human consequences of design, and trace the ways medical institutions have governed bodies and space in the U.S. Here are 10 facts about hospitals you should know.<\/strong><\/p>\n

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  1. The first hospitals<\/strong> established in America were modeled after European ones, which were closer to workhouses or penitentiaries than to the therapeutic and scientific centers of today. Only the destitute and indigent were forced into hospitals. Anyone with means preferred to be cared for at home. The hospital usually cited as America\u2019s first is the Pennsylvania Hospital, chartered in 1751. (Read Ben Franklin\u2019s 1754 account of it here.<\/a>) However, Marks and Beatty suggest an even earlier hospital existed at Jamestown, as far back as 1612. It contained 80 beds and was staffed by \u201ckeepers\u201d\u2014likely male nurses.[1]<\/a>.\n

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    Pennsylvania Hospital (William Strickland, 1755)<\/figcaption><\/figure><\/li>\n
  2. Marine Hospitals were instrumental in the consolidation of the early American State.<\/strong> The 1798 \u201cAct for Relief of Sick and Disabled Seamen\u201d established a tax on the wages of merchant seamen with which the federal government established and operated a series of Marine Hospitals. While these operated much like other early hospitals by accepting local poor patients, they served primarily for the rehabilitation of sailors. Gautham Ra\n
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    U.S. Public Health service considers the 1798 Marine Hospital Act their founding.<\/figcaption><\/figure>\n

    o explains that Marine Hospitals, which were modeled after similar British institutions, served to maintain an adequate maritime labor force, necessary for the development and expansion of the young state’s imperial and economic interests.[2]<\/a> Rao argues that the program \u201cfit squarely within the main themes of early American statecraft\u2014associative structure, tax and revenue power, local influence, and contested centralization.\u201d[3]<\/a> Marine Hospitals provided a basis on which essential functions of the U.S. federal government were later elaborated, and constituted the first federal welfare program.<\/li>\n

  3. Hospitals began to adopt their modern form in the mid-18th<\/sup> century, as young adults left family homes and moved to cities. As women got jobs outside the home, and living space became increasingly\n
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    Operating room of the Massachusetts General Hospital, Boston, ca. 1850 (Southworth, Albert Sands, 1811-1894)<\/figcaption><\/figure>\n

    compact, hospitals began to provide for a growing middle-class the healing functions previously handled by the family.<\/strong> As suburbanization increased travel times between work and home,<\/u>\u00a0working\u00a0family members became less and less<\/span>\u00a0available to care for the sick at home. In this way, the emergence of modern hospitals reflected the segmentation and professionalization of services previously provided in the domestic sphere.[4]<\/a><\/li>\n

  4. Hospitals’ designs reflect\u00a0the social as well as the scientific conditions of their construction.<\/strong> In the second half of the 19th<\/sup> century, the \u201cpavilion plan\u201d dominated hospital design in North America, wherein patients would live in large, shared dormitories designed to let in light and circulate fresh air. This was in order to dispel \u201cmiasma\u201d\u2014an atmosphere thought to be the cause of infection.[5]<\/a> Even as the germ theory of disease gained acceptance, “pavilion plan” hospitals remained the norm into the 1930s. Starting in the early 20th<\/sup> century, newer hospitals were designed with the goal of segregating patients from each other, both as an antiseptic medical\u00a0principle and as an effort to appeal to new, paying middle-class customers. Some hospitals began to advertise themselves as akin to hotels, evoking luxury and domesticity. In Medicine by Design<\/em>, Annmarie Adams discusses Royal Victoria Hospital in Montreal, a large public hospital which had two separate entrances. One\u2014high on a hill overlooking manicured gardens\u2014was for the paying middle- and upper- class patients, while the other\u2014for its working class and poor patients\u2014ran into the hospital through a tunnel nearly 60 feet below it, out of view and almost underground. As hospitals expanded their reach and services, they transformed from a last-resort site of destitution to an institution of civic pride and high regard that served the varying needs and expectations of different classes of patients.[6]<\/a>\n

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    Typhoid ward, Royal Victoria Hospital, ca. 1894<\/figcaption><\/figure><\/li>\n
  5. Hospitals were starkly racially segregated<\/strong> after the Civil War. Black Americans\u2019 access to hospitals was either limited to \u201ccolo\n
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    One of the first \u201cblack hospitals\u201d in America.<\/figcaption><\/figure>\n

    red\u201d wards or to a handful \u201cblack hospitals,\u201d both offering vastly inferior care than that which was available to whites. In 1948, Mississippi had only five general hospital beds per 100,000 black citizens.[7]<\/a> Further, many hospitals subjected black patients to non-consensual scientific testing and forced sterilization as part of racist eugenic efforts at population control.[8]<\/a><\/p>\n

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    Second-floor plan, Royal Victoria Montreal Maternity Hospital<\/figcaption><\/figure><\/li>\n
  6. The designs of maternity wards reflected and transmitted cultural notions of motherhood.<\/strong> At the Royal Victoria Hospital, Adams notes, the maternity ward catered to two competing versions of birth popular in the early 20th<\/sup>\u00a0century. One held that birth was a natural event to be treated as routine and normal. The maternity ward for middle-class patients was accordingly decorated to suggest a \u201chomelike\u201d environment, with comfortably furnished social space for the patients designated \u201cmaternity lounges.\u201d[9]<\/a> At the same time, the architects responded to residual notions of birth as pathological, which manifested as \u201cextensive record keeping and observation,” as well as the institutional regimes of a rehabilitative hospital.\u00a0 In William Rosengren and Spencer DeVault\u2019s fascinating 1958 study, \u201cThe Sociology of Time and Space in an Obstetrical Hospital,\u201d they examine the ways American maternity clinics were spatially organized<\/strong>.[10]<\/a> They note\u2014similarly to Adams\u2014that expecting patients were coded somewhere between \u201cill\u201d and \u201cnot ill.\u201d They examine the ways nurses, doctors, and patients behaved differently in \u201cbackstage\u201d areas like offices or break rooms than\u00a0they did in \u201constage\u201d areas such as the labor room, in which delivery nurses were segregated from other personnel by non-functional barriers denoting their authority. Rosengren and DeVault also suggest what they call an \u201cecology of pain,\u201d remarking that, \u201cspatially there appeared to be a kind of gradient as to the legitimation of pain, with the greater sanctioning of pain found the closer the \u2018place\u2019 is to the delivery rooms.\u201d[11]<\/a> They note that it is the delivery room where nurses and doctors were most able to medically manage pain with anesthesia and were not required, as in other spaces of the clinic, to respond to patients\u2019 pain affectively and emotionally. The space of the clinic is thus organized in order to maintain a professional, \u201caffectively neutral\u201d attitude towards patients.<\/li>\n
  7. During the Cold War, American maternity wards began to deploy a clinical practice called \u201crooming-in\u201d<\/strong>. Shortages of hospital staff and a high birth rate meant that it became effective for hospi\n
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    Preventing neurosis. Source: M. Edward Davis and Catherine E. Sheckler, De Lee\u2019s Obstetrics for Nurses, 15th ed. (Philadelphia: Saunders, 1951), p. 499.<\/figcaption><\/figure>\n

    tals to have infants stay in mothers\u2019 rooms rather than in a central nursery. Elizabeth Temkin explains that this practice resonated with a post-Hiroshima fear of science and a cultural imperative to privilege individuality and family over uniformity and autocracy: \u201cIn other words, only Nazis would insist on feeding infants on a schedule in an impersonal central nursery. Rooming-in was not just a floor plan for the maternity ward, it was the basis of democracy.\u201d[12]<\/a> This development demonstrates the ways hospital designs are negotiations among medical technology, institutional circumstance, and the political moment. It also suggests the power the hospital holds as a national imaginary\u2014a place where the nation is alternatively healed and born.<\/li>\n

  8. 99% invisible: the blue yarn.