History of hospitals

The history of hospitals has stretched over 2500 years.

Early examples

View of the Askleipion of Kos, the best preserved instance of a Greek Asklepieion.

Hôtel-Dieu de Paris circa 1500. The comparatively well patients (on the right) were separated from the very ill (on the left).

A physician visiting the sick in a hospital, German engraving from 1682

In ancient cultures, religion and medicine were linked. The earliest documented institutions aiming to provide cures were ancient Egyptian temples. In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Ancient Greek: Ἀσκληπιεῖα, sing. Asclepieion, Ἀσκληπιεῖον), functioned as centres of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as enkoimesis (ἐγκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium. The worship of Asclepius was adopted by the Romans. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.

Institutions created specifically to care for the ill also appeared early in India. Fa Xian, a Chinese Buddhist monk who travelled across India ca. 400 CE, recorded in his travelogue that

"The heads of the Vaisya [merchant] families in them [all the kingdoms of north India] establish in the cities houses for dispensing charity and medicine. All the poor and destitute in the country, orphans, widowers, and childless men, maimed people and cripples, and all who are diseased, go to those houses, and are provided with every kind of help, and doctors examine their diseases. They get the food and medicines which their cases require, and are made to feel at ease; and when they are better, they go away of themselves."

The earliest surviving encyclopaedia of medicine in Sanskrit is the Carakasamhita (Compendium of Caraka). This text, which describes the building of a hospital is dated by Dominik Wujastyk of the University College London from the period between 100 BCE and CE150. The description by Fa Xian is one of the earliest accounts of a civic hospital system anywhere in the world and, coupled with Caraka’s description of how a clinic should be equipped, suggests that India may have been the first part of the world to have evolved an organized cosmopolitan system of institutionally-based medical provision.

King Ashoka is wrongly said by many secondary sources to have founded at hospitals in ca. 230 B.C.

According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya of Sri Lanka (reigned 437 BC to 367 BC) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world. Mihintale Hospital is the oldest in the world.

Roman Empire

Further information: Byzantine medicine

The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.

The declaration of Christianity as accepted religion in the Roman Empire drove an expansion of the provision of care. Following First Council of Nicaea in 325 A.D. construction of a hospital in every cathedral town was begun. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey. Called the "Basilias", the latter resembled a city and included housing for doctors and nurses and separate buildings for various classes of patients. There was a separate section for lepers. Some hospitals maintained libraries and training programs, and doctors compiled their medical and pharmacological studies in manuscripts. Thus in-patient medical care in the sense of what we today consider a hospital, was an invention driven by Christian mercy and Byzantine innovation. Byzantine hospital staff included the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai). By the twelfth century, Constantinople had two well-organized hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialized wards for various diseases.

A hospital and medical training centre also existed at Jundishapur. The city of Jundishapur was founded in 271 CE by the Sassanid king Shapur I. It was one of the major cities in Khuzestan province of the Persian empire in what is today Iran. A large percentage of the population were Syriacs, most of whom were Christians. Under the rule of Khusraw I, refuge was granted to Greek Nestorian Christian philosophers including the scholars of the Persian School of Edessa (Urfa)(also called the Academy of Athens), a Christian theological and medical university. These scholars made their way to Jundishapur in 529 following the closing of the academy by Emperor Justinian. They were engaged in medical sciences and initiated the first translation projects of medical texts. The arrival of these medical practitioners from Edessa marks the beginning of the hospital and medical centre at Jundishapur. It included a medical school and hospital (bimaristan), a pharmacology laboratory, a translation house, a library and an observatory. Indian doctors also contributed to the school at Jundishapur, most notably the medical researcher Mankah. Later after Islamic invasion, the writings of Mankah and of the Indian doctor Sustura were translated into Arabic at Baghdad.

Medieval Islamic world

Further information: Medicine in medieval Islam

The first physicians under Muslim rule were Christians or Jews in conquered areas in the 7th century. The first prominent Islamic hospital was founded in Damascus, Syria in around 707 with assistance from Christians. However most agree that the establishment at Baghdad was the most influential. The public hospital in Baghdad was opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century. The bimaristan (medical school) and bayt al-hikmah (house of wisdom) were established by professors and graduates from Jundishapur. It was headed by the Christian physician Jibrael ibn Bukhtishu from Jundishapur and later by Islamic physicians. "Bimaristan" is a compound of “bimar” (sick or ill) and “stan” (place). In the medieval Islamic world, the word "bimaristan" referred to a hospital establishment where the ill were welcomed, cared for and treated by qualified staff.

In the ninth and tenth centuries the hospital in Baghdad employed twenty-five staff physicians and had separate wards for different conditions. The Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. The first Islamic psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health.

In contrast to medieval Europe, medical schools under Islam did not have faculties and did not develop a system of academic evaluation and certification

Medieval Europe

The church at Les Invalides in Paris, showing the typically close connection between hospitals and the Catholic church

Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580AD at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.

The Ospedale Maggiore, traditionally named Ca' Granda (i.e. Big House), in Milan, northern Italy, was constructed to house one of the first community hospitals, the largest such undertaking of the fifteenth century. Commissioned by Francesco Sforza in 1456 and designed by Antonio Filarete it is among the first examples of Renaissance architecture in Lombardy.

The Normans brought their hospital system along when they conquered England in 1066. By merging with traditional land-tenure and customs, the new charitable houses became popular and were distinct from both English monasteries and French hospitals. They dispensed alms and some medicine, and were generously endowed by the nobility and gentry who counted on them for spiritual rewards after death.

Latin America

Hospicio Cabañas was the largest hospital in colonial America, in Guadalajara, Mexico

The first hospital founded in the Americas was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic, authorized in 1503 and completed in 1519. It was abandoned in the mid-eighteenth century. Hernán Cortés founded the Hospital de Jesús Nazareno in Mexico City in 1524 to care for the poor.

Catholic bishops, regional governors, local charities, religious members of the order of St. Vincent de Paul, physicians and the Christian principles of distributing charity by the rich and helping the poor through a social and professional network combined to encourage the building of hospitals in all the major cities of Latin America.

Argentina's government put numerous obstacles in the way of hospital development. For example in Buenos Aires, 1880s to 1980s, mental hospitals suffered serious overcrowding and appalling living conditions; lack of suitable staff and resources; and low rates of confinement compared to similar periods in modern nations.

Early modern Europe

In Europe the medieval concept of medical care by monasteries and religious orders was rejected by the Reformation, and most hospitals in Protestant areas were closed down. Theology was the problem. The Protestant reformers rejected the Catholic belief that rich men could gain God's grace through good works—and escape purgatory—by providing cash endowments to charitable institutions, and that the patients themselves could gain grace through their suffering. On the other hand, local officials recognized the public value especially of urban hospitals. There were 28 asylums in Sweden at the start of the Reformation. Gustav Vasa removed them from church control and expelled the monks and nuns, but allowed the asylums to keep their properties and to continue their activities under the auspices of local government. In London, St Bartholomew's Hospital and St Thomas' Hospital survived because local elites petitioned the crown. The king allowed the two hospitals to resume their charitable work, under nonreligious control of city officials. It was at St Bartholomew William Harvey conducted his research on the circulatory system in the 17th century, Percivall Pott and John Abernethy developed important principles of modern surgery in the 18th century, and Mrs. Bedford Fenwich worked to advance the nursing profession in the late 19th century.

In much of Europe town governments operated small Holy Spirit hospitals, which had been founded in the 13th and 14th centuries. They distributed free food and clothing to the poor, provided for homeless women and children, and gave some medical and nursing care. Many were raided and closed during the Thirty Years War (1618–48), which ravaged the towns and villages of Germany and neighboring areas for three decades.

Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries that provided free health services to the poor. French practices were influenced by a charitable imperative which considered care of the poor and the sick to be a necessary part of Catholic practice. The nursing nuns had little faith in the power of physicians and their medicines alone to cure the sick; more important was providing psychological and physical comfort, nourishment, rest, cleanliness and especially prayer.

In Protestant areas the emphasis was on scientific rather than religious aspects of patient care, and this helped develop a view of nursing as a profession rather than a vocation. There was little hospital development by the main Protestant churches after 1530. Some smaller groups such as the Moravians and the Pietists at Halle gave a role for hospitals, especially in missionary work.

Enlightenment

Finally in the eighteenth century, under the influence of scientific emphasis of the Age of Enlightenment, the modern hospital began to appear, serving only medical needs and staffed with trained physicians and surgeons. The nurses were untrained workers. The goal was to use modern methods to cure patients. They provided more narrow medical services, and were founded by the secular authorities. A clearer distinction emerged between medicine and poor relief. Within the hospitals, acute cases were increasingly treated alone, and separate departments were set up for different categories of patient. The Charité (founded in Berlin in 1710) is an early example. When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research centre.

Across Europe medical schools in the 18th-century relied primarily on lectures and readings. In the final year students would have limited clinical experience by trailing the professor through the wards. Laboratory work was uncommon, and dissections were rarely done because of legal restrictions on cadavers. Most schools were small, and only Edinburgh, Scotland, with 11,000 alumni, produced large numbers of graduates.

19th century Europe

By the mid-nineteenth century nearly all of Europe had established a variety of public and private hospital systems. In continental Europe the new hospitals generally were built and run from public funds.

During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.

Church sponsored hospitals and nurses

Main article: deaconess

The Protestant churches reentered the health field, especially by setting up orders of women, called deaconesses who dedicated themselves to nursing services.

The modern deaconess movement began in Germany in 1836 when Theodor Fliedner and his wife opened the first deaconess motherhouse in Kaiserswerth on the Rhine. It became a model and within a half century were over 5,000 deaconesses in Europe. The Chursh of England named its first deaconess in 1862. The North London Deaconess Institution trained deaconesses for other dioceses and some served overseas.

William Passavant in 1849 brought the first four deaconesses to Pittsburgh, in the United States, after visiting Kaiserswerth. They worked at the Pittsburgh Infirmary (now Passavant Hospital).

The American Methodists – the largest Protestant denomination—engaged in large scale missionary activity in Asia and elsewhere in the world, making medical services a priority as early as the 1850s. Methodists in America took note, and began opening their own charitable institutions such as orphanages and old people's homes after 1860. In the 1880s, Methodists began opening hospitals in the United States , which served people of all religious backgrounds beliefs. By 1895 13 hospitals were in operation in major cities. well

Lutherans in the U.S. in 1884 brought seven sisters from Germany to run the German hospital in Philadelphia. By 1963 the Lutheran Church in America had centers for deaconess work in Philadelphia, Baltimore, and Omaha.

The Catholic population grew rapidly after 1840 with the arrival of millions of Germans, Irish, French-Canadians, Italians, Poles, Hungarians, Dutch, Lithuanians and other ethnic groups. They concentrated in industrial areas and created a demand for hospitals. Young Catholic women join the sisterhood and provided the nursing force. Mercy Hospital, operated after 1851 by the Sisters of Mercy was the city's oldest By 1930 22 Catholic hospitals were operating in metropolitan Chicago.

Britain

The London Dispensary opened in 1696, the first clinic in the British Empire to dispense medicines to poor sick people. Innovation was slow to catch on, but new dispensaries were open in the 1770s. In the colonies, dispensaries were opened in New York 1771, Philadelphia 1786, and Boston 1796.

Guy's Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. St Bartholomew's opened in London in 1730, and the London Hospital in 1752.

English physician Thomas Percival (1740-1804) wrote a comprehensive system of medical conduct, 'Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks.

Charing Cross Hospital began in 1818 as the 'West London Infirmary and Dispensary' from funds provided by Dr. Benjamin Golding. Royalty became interested; the Duke of York became a patron and the name was changed to the Royal West London Infirmary. By 1821 it treating nearly 10,000 patients a year, and it was relocated to larger quarters near Charing Cross in the heart of London; it had twelve beds. Its Charing Cross Hospital Medical School opened in 1822. It expanded several times and 1866 added a professional nursing staff.

At St Bartholomew's Hospital, London, surgical trauma and postoperative infection were the greatest causes of death in the mid-19th century. Tuberculosis, however, remained the most fatal nontraumatic cause of death.

The National Health Service, the principal provider of health care in Britain, was founded in 1948, and took control of nearly all the hospitals.

United States

Important hospitals opened in Philadelphia in 1752, New York in 1771, and Boston (Massachusetts General Hospital) in 1811.

The number of hospitals reached 4400 in 1910, when they provided 420,000 beds. They were operated by city, state and federal agencies, by churches, by stand-alone non-profits, and by for-profit enterprises run by a local doctoer All the major denominations built hospitals; the 541 Catholic ones (in 1915) were staffed primarily by unpaid nuns. The others sometimes had a small cadre of deaconesses as staff. Most larger hospitals operated a school of nursing, which provided training to young women, who in turn did much of the staffing on an unpaid basis. The number of active graduate nurses rose rapidly from 51,000 in 1910 to 375,000 in 1940 and 700,000 in 1970.

In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School.

The rapid decline in the membership of religious orders after 1960 meant the virtuaql end of unpaid nursing nuns.

Canada

The first hospital in New France (now Canada) was the Hôtel-Dieu de Québec. It was established in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project, begun by the niece of Cardinal de Richelieu was granted a royal charter and was led by a trained physician, Robert Giffard de Moncel.

France

Professionalization of nursing in France came in the late 19th and early 20th century. In 1870 France's 1,500 hospitals were operated by 11,000 Catholic sisters; by 1911 there were 15,000 nuns representing over 200 religious orders. Government policy after 1900 was to secularize public institutions, and diminish the role the Catholic Church. The lay staff was enlarged from 14,000 1890 to 95,000 in 1911. This political goal came in conflict with the need to maintain better quality of medical care in antiquated facilities. Many doctors, while personally anti-clerical, realized their dependence on the Catholic sisters. Most lay nurses came from peasant or working class families and were poorly trained. Faced with the long hours and low pay, many soon married and left the field, while the Catholic sisters had renounced marriage and saw nursing as their God-given vocation. New government-operated nursing schools turned out nonreligous nurses who were slated for supervisory roles. During the World War, an outpouring of patriotic volunteers brought large numbers of untrained middle-class women into the military hospitals. They left when the war ended but the long-term effect was to heighten the prestige of nursing. In 1922 the government issued a national diploma for nursing.

See also

• Hospitals
• History of Medicine
• Nursing
• Timeline of nursing history

Further reading

General

• Bowers, Barbara S. Medieval Hospital And Medical Practice (2007) excerpt and text search
• Brockliss, Lawrence, and Colin Jones. "The Hospital in the Enlightenment," in The Medical World of Early Modern France (Oxford UP, 1997), pp. 671–729; covers France 1650-1800
• Chaney, Edward (2000),"'Philanthropy in Italy': English Observations on Italian Hospitals 1545-1789", in: The Evolution of the Grand Tour: Anglo-Italian Cultural Relations since the Renaissance, 2nd ed. London, Routledge, 2000. http://books.google.co.uk/books/about/The_evolution_of_the_grand_tour.html?id=rYB_HYPsa8gC
• Goldin, Grace. Hospital: A Social and Architectural History (Yale U. P., 1975), scholarly
• Goldin, Grace. Work of Mercy: A Picture History of Hospitals (1994), popular
• Harrison, Mark, et al. eds. From Western Medicine to Global Medicine: The Hospital Beyond the West (2008)
• Henderson, John, et al., eds. The Impact of Hospitals 300-2000 (2007); 426 pages; 16 essays by scholars table of contents
• Henderson, John. The Renaissance Hospital: Healing the Body and Healing the Soul (2006).
• Horden, Peregrine. Hospitals and Healing From Antiquity to the Later Middle Ages (2008)
• Jones, Colin. The Charitable Imperative: Hospitals and Nursing in Ancient Regime and Revolutionary France (1990)
• McGrew, Roderick E. Encyclopedia of Medical History (1985)
• Morelon, Régis and Roshdi Rashed, eds. Encyclopedia of the History of Arabic Science (1996)
• Porter, Roy. The Hospital in History, with Lindsay Patricia Granshaw (1989) ISBN 978-0-415-00375-9
• Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals (1999), 716pp; world coverage excerpt and text search
• Scheutz, Martin et al. eds. Hospitals and Institutional Care in Medieval and Early Modern Europe (2009)

Nursing

• Bullough, Vern L. and Bullough, Bonnie. The Care of the Sick: The Emergence of Modern Nursing (1978).
• D'Antonio, Patricia. American Nursing: A History of Knowledge, Authority, and the Meaning of Work (2010), 272pp excerpt and text search
• Davies, Celia, ed. Rewriting Nursing History (1980),
• Dingwall, Robert, Anne Marie Rafferty, Charles Webster. An Introduction to the Social History of Nursing (Routledge, 1988)
• Dock, Lavinia Lloyd. A Short history of nursing from the earliest times to the present day (1920)full text online; abbreviated version of M. Adelaide Nutting and Dock, A History of Nursing (4 vol 1907); vol 1 online; vol 3 online
• Donahue, M. Patricia. Nursing, The Finest Art: An Illustrated History (3rd ed. 2010), includes over 400 illustrations; 416pp; excerpt and text search
• Fairman, Julie and Joan E. Lynaugh. Critical Care Nursing: A History (2000) excerpt and text search
• Hutchinson, John F. Champions of Charity: War and the Rise of the Red Cross (1996) 448 pp.
• Judd, Deborah. A History of American Nursing: Trends and Eras (2009) 272pp excerpt and text search
• Lewenson, Sandra B., and Eleanor Krohn Herrmann. Capturing Nursing History: A Guide to Historical Methods in Research (2007)
• Schultheiss, Katrin. Bodies and souls: politics and the professionalization of nursing in France, 1880-1922 (Harvard U.P., 2001) full text online at ACLS e-books
• Snodgrass, Mary Ellen. Historical Encyclopedia of Nursing (2004), 354pp; from ancient times to the present
• Takahashi, Aya. The Development of the Japanese Nursing Profession: Adopting and Adapting Western Influences (Routledgecurzon, 2011) excerpt and text search

Hospitals and nursing in Britain

• Bostridge. Mark. Florence Nightingale: The Making of an Icon (2008)
• Carruthers, G. Barry. History of Britain's Hospitals (2005) excerpt and text search
• Cherry, Stephen. Medical Services and the Hospital in Britain, 1860-1939 (1996) excerpt and text search
• Gorsky, Martin. "The British National Health Service 1948-2008: A Review of the Historiography," Social History of Medicine, Dec 2008, Vol. 21 Issue 3, pp 437–460
• Helmstadter, Carol, and Judith Godden, eds. Nursing before Nightingale, 1815–1899 (Surrey, UK: Ashgate, 2011) 219 pp. on England
• Nelson, Sioban, and Ann Marie Rafferty, eds. Notes on Nightingale: The Influence and Legacy of a Nursing Icon (2010) 172 pp.
• Sweet, Helen. "Establishing Connections, Restoring Relationships: Exploring the Historiography of Nursing in Britain," Gender and History, Nov 2007, Vol. 19 Issue 3, pp565–580

Hospitals and nursing in U.S. and Canada

• Agnew, G. Harvey. Canadian Hospitals, 1920 to 1970, A Dramatic Half Century (University of Toronto Press, 1974)
• Bonner, Thomas Neville. Medicine in Chicago: 1850-1950 (1957). pp 147-174
• Connor, J. T. H. "Hospital History in Canada and the United States," Canadian Bulletin of Medical History, 1990, Vol. 7 Issue 1, pp 93–104
• Crawford, D.S. "Bibliography of Histories of Canadian hospitals and schools of nursing".
• D'Antonio, Patricia. American Nursing: A History of Knowledge, Authority, and the Meaning of Work (2010), 272pp excerpt and text search
• Fairman, Julie and Joan E. Lynaugh. Critical Care Nursing: A History (2000) excerpt and text search
• Judd, Deborah. A History of American Nursing: Trends and Eras (2009) 272pp excerpt and text search
• Kalisch, Philip Arthur, and Beatrice J. Kalisch. The Advance of American Nursing (2nd ed. 1986); retitled as American Nursing: A History (4th ed. 2003), the standard history
• Reverby, Susan M. Ordered to Care: The Dilemma of American Nursing, 1850-1945 (1987) excerpt and text search
• Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System (1995) history to 1920 table of contents and text search
• Rosner, David. A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York 1885-1915 (1982)
• Starr, Paul. The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry (1984) excerpt and text search
• Stevens, Rosemary. In Sickness and in Wealth: American Hospitals in the Twentieth Century (1999) excerpt and text search; full text in ACLS e-books
• Vogel, Morris J. The Invention of the Modern Hospital: Boston 1870-1930 (1980)
• Wall, Barbra Mann. Unlikely Entrepreneurs: Catholic Sisters and the Hospital Marketplace, 1865-1925 (2005)
• Wall, Barbra Mann. American Catholic Hospitals: A Century of Changing Markets and Missions (2010) excerpt and text search