Mercy Hospital, Pittsburgh
Public funded –almshouse (workhouse) were institutions established to care for those poor who were homeless and indigent while they were not established for the care of the sick they did, by default, care for those persons who were sick and were considered not eligible for admittance to a general hospital – such as those had cancer or another suffered from cancer, or other illness considered to be incurable and those with a contagious disease or mental illness or a long term chronic illness.
Several public funded hospitals initially established as almshouses or to care for victims of contagious illness have endured into the present day . One of these hospitals was Bellevue.
Civil War - Impact on Future
Religious Women – Role in Nursing and Nursing Education
Role in Establishment of Hospitals
For a detailed history of Pennsylvania Hospital see the following link http://www.uphs.upenn.edu/paharc/timeline to their website and time line.
Picture and excerpts above copied from Bellevue: A Short History of the Bellevue Hospital and Training Schools. 1915
from Bellevue: A Short History of the Bellevue Hospital and Training Schools. 1915
Bellevue: Life Within the Walls
Nutting (1907, p.156 – 157 ) described conditions within Bellevue:
Colonial Health Care Institutions
Colonial institutions comprised three major forms:
• Seaman’s Hospitals
• Public funded –almshouse (workhouse
• General Hospitals
Seaman’s Hospitals were established by trading companies to care for their seamen who became ill and unable to work, needed care. It was necessary in seaport towns to find refuge for sailors and passengers who were ill with a contagious disease who were left ashore. (History American Hospitals. P.70)
In America during the 17th , 18th and to some extent the 19th centuries education there were few physicians who had formal medical education. Those that did have formal education were educated in England, Scotland, France and Germany and emigrated to America bringing their knowledge with them. America , lacking the formal educational resources early physician training began their education as an apprentice indentured to an established physician . The established physician , accompanied by his apprentice – if he had one, treated patients in the office which was usually part of his home or made house calls traveling to the homes of those too ill or infirm to be seen in the office.
Nurse’s training, on the other hand began as a ‘trainee’ in an apprentice role within the hospital. Formal education with the exception of a few programs started by physicians such as Dr. Valentine Seaman and D, Joseph Warrington  , was not introduced until much later.
By the late18th century and the 19th century there were medical schools in America. however the majority of these left much to be desired. Ludmerer (1985) points out that being a medical student in 1the 1800’s was easy..
“No one worried about admission, for entrance requirements were lower than they were for a good high school. Instructions were superficial and brief. The terms lasted only sixteen weeks, and after the second term, the M.D. degree was automatically given, regardless of a student’s academic performance. Teaching was by lecture alone.”…”students would often graduate without ever having touched a patient.” 
On the other hand, the nursing education model was as apprentice s in the hospital setting. Future nurses were immediately immersed in the clinical area with minimal if any formal lectures .For years this discrepancy endured where future physicians had little clinical exposure to patients before they graduated and started to practice medicine while the nurse had more practice but little, if any formal education. This situation was highlighted when the civil war found physicians and surgeons who had never seen, nor treated, the mass casualties result of battles while the nurse had more clinical experience with traumatic injuries of battle. .
 Flexner, Abraham, 1910. Medical Education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of teaching. Bulletin Number Four. Reproduced 1972 by D.B. Updyke, Merrymount Press, Boston p.3.
 See http://www.nursingeducationhistory.org/early-days.html ,- Early History of Nursing Education: Hospital "Training " Schools.
 Ludmerer, Kenneth, 1985. Learning to Heal: The Development of American Medical Education. John Hopkins University Press. p.3
 This situation was highlighted in the TV production of Mercy Street where one of the prime characters served in the Crimea with Florence Nightingale and espoused her methods.
Bellevue Archives: Bellevue Hospital pictured from the East River, 1848.
The term ‘ general hospital’ referred to a hospital that cared for patients with medical or surgical needs or conditions in contrast to other, specialized hospitals - such as hospitals that cared for women (gynecology and maternity), persons with mental illness (Insane Asylums) and persons suffering from long term chronic conditions or an incurable disease such as cancer who were commonly excluded from admission to a general hospital. Those rejected from admission to a general hospital were referred to a public funded institution such as an almshouse.
Rosenberg’s (1987, p.4 ) defines a hospital as an institution “dedicated exclusively to inpatient care of the sick”. Pennsylvania Hospital is considered by many to be the first general hospital in the United States . In the 1750’s Philadelphia was the fastest growing city in the 13 colonies without any facility to provide care for persons who were ill and homeless. .In 1751 Dr. Thomas Bond , a Quaker, and Benjamin Franklin founded Pennsylvania Hospital "to care for the sick-poor and insane who were wandering the streets of Philadelphia.".
Nursing and Effect on Modern Hospital Development
Rosenberg (1987), in discussing the rise of the modern hospital states that “perhaps the most important single element in reshaping the day-to-day texture of hospital life was the professionalization of nursing. In 1800, as today, nurses were the most important single factor determining ward and room environment.” (p 8)
There are many parallels in the history of the education of nurses and physicians. The education of each profession requires access to patients and through the years, hospitals have provided a primary source of clinical resources.. Thus, the education of both professions is closely tied in with the history of hospitals .
Chicago, Il – Norwegian Lutheran Deaconess Home and Hospital Surgical Ward – 1909
In March, 1873 Sister Helen from All Saints Sisterhood in London, England became the Superintendent of the newly formed school. At first, the physicians did not believe that Bellevue was a suitable place for a training school staffed by women as they believed that patients were a ‘difficult class’ to deal with and the service would be too difficult for the intelligent young woman who were sought as pupils would ‘lose heart and hope’ before their two years were over. (Bellevue Short History, p. 30)
Before Florence Nightingale brought reforms to nursing , there were religious women ─ Catholic Nursing Sisters (Nuns) and Protestant Deaconesses ─ whose vows included the care of the sick . They were often called to nurse victims of typhoid, cholera and other epidemics. and through their religious communities were responsible for starting hospitals throughout the young country.
Hospitals and Their Role
Rosenberg, Charles, 1987, The Care of Strangers: The Rise of America's Hospital System
http://www.boweryboyshistory.com/2013/05/the-startling-history-of-bellevue.html Downloaded 5/27/2017
Alumnae Association of Bellevue, Pension Fund Committee, A Short History of Bellevue Hospital and Training Schools,. December, 1915. Book downloaded from the Internet, 5/28/2017. Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons
Nutting, Mary Adelaide, 1907, A History of Nursing V.2
A Note Regarding the First Hospital in America: Due to the mission cited by Bond and Franklin , there is some confusion as to whether Pennsylvania Hospital was the first ‘general’ hospital in America. Nutting (1907) citing Dr. Robert Carlisle’s Account of Bellevue Hospital New York (1893, p.i) states that Bellevue Hospital may be the oldest hospital in the United States as it traced its origins to the hospital built by the West India Company in December 1658 which was one of the roots of the city hospital of Bellevue.
As it appears that historians referred to hospitals on the East Coast and tended to omit the role of the Mission Hospitals on the West Coast the ‘argument’ that a specific hospital , on what later became the United States of America, was FIRST may never be resolved to everybody’s satisfaction. [Note: Future Plans To -discuss the growth hospitals in the West and across the continent – including the West - Mission Hospitals, and transcontinental - Railroad Hospitals.]
Colonial Period : 17th Century (1600’s) thru 18th Century (1700’s)
Healthcare in the Colonial Period.
Colonial households treated most illnesses by long standing household remedies; the doctor was called if the illness was considered severe enough to warrant having a doctor visit; otherwise home remedies were used.. The status of medical knowledge at that time was such that what treatment or remedies were ordered by the physician could be administered by the family member providing nursing care.
When illness occurred the last place you wanted to be was in what passed for a hospital If you had a family to care for you, you remained at home . (Rosenberg, 1987, p. 4). Caring for ill family members was – and in some cases remains – the responsibility of women. As Revenby (1987) points out caring for ill and aged family members was considered “ a woman’s self-sacrificing service to others”. (p,11).
Recommended: For further information regarding the history and impact of Bellevue Hospital see:
Oshinsky, David, BELLEVUE: Three Centuries of Medicine and Mayhem At America's Most Storied Hospital,, 2016 published by Doubleday
“…the old grey stone structure fronting the broad arm of the sea called the East River looked dignified and interesting with its extensive green sweep of lawn, adorned with fine old trees, but it has had a terrible history.”There were between 1600 to 2000 residents ; they were the poor (paupers)including around 200 sick at any one time. Conditions were overcrowded and unsanitary resulting in Typhus fever.
Physicians were few – only three to care for the entire population both sick and well.-and were ‘cruelly overworked ‘. Nursing was provided by inmates from the prison – one for 10 to 20 patients. For many years conditions best described as horrible existed – In 1837 a committee of investigation was appointed. - The conditions in general were such as to shock even the alderman themselves, and a committee of investigation was appointed. The only part of the building that was clean was the female departments of the almshouse division, which furnished "silent rebuke" in contrast with the rest.”
Among the specifications they gave were:
It was reported, furthermore, that the resident physician and students – all but two –the matron and the nurses had left the building" (Nutting, 1907, p.157)
Bellevue traces its beginnings from several sources. The first was a small hospital formed by the West India Company in the village of New Amsterdam (now part of New York) in December, 1658. At that time, merchants provided for some type of facility to care for seamen who were ill and far from home. The West India company hospital is considered the first to be built on what is now known as United States soil. In March 1736 the Health Board of New York founded a "Publick Workhouse and House of Correction of the City of New York. " Here, in an area of twenty-five by twenty-three feet, on the upper floor of the building, were six beds and one doctor, John Van Buren who had a salary of £100 a year, out of which he supplied his own medicines . Nutting (1907) cites Dr. Robert Carlisle’s Account of Bellevue Hospital New York that asserts that Bellevue Hospital may be the oldest hospital in the United States .
In 1794 the Government realized the necessity of a the necessity of providing some place of isolation for persons afflicted with yellow fever. The most eligible place that presented itself was a plot, about five acres in extent, which had once been a part of Kips Bay Farm, and called by the owner Belle Vue; the mansion became the public health hospital . Bellevue is considered the oldest public health hospital in the United States. For a number of years it was only used when there was yellow fever in the city but in 1811 more land was purchased and a new almshouse was built.