THE HOSPITAL

The hospital as we know it is a modern invention. Before the 20th century, almost all Americans, whether rich or poor, received their health care at home from friends, relatives, and assorted health care providers. Because these providers used only a few small and portable tools, hospitals were unnecessary.

Some form of institution, however, was needed for those Americans who lacked friends or relatives to provide care at home or the means to purchase such care. For these individuals, the only option was the almshouse. Here they—along with orphans, criminals, people with disabilities, people with mental illnesses, and other public wards—received essentially custodial care. Conditions in almshouses generally were appalling. Inmates often had to share beds or sleep on the floor, and rats often outnumbered humans. Hunger was common, and blankets and clothing scarce. These conditions, coupled with the lack of basic sanitation, made alms- houses ideal breeding grounds for disease.

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