Hospital

I

Introduction

Hospital, institution with an organized medical and nursing staff, and with permanent facilities, that provides a range of medical services, including surgery, for people requiring intensive treatment or observation. It may also include facilities for childbirth and infant management, as well as various outpatient clinics.

II

History

Some authorities state that as long ago as 4000 bc temples of the ancient gods were used as houses of refuge for the sick and infirm, and as training schools for doctors. Later the temples of Asclepius, the Greek god of medicine, served the same purpose. Historical records also show that hospitals existed in India under Buddhist auspices as early as the 3rd century bc.

The number of hospitals grew in the first centuries of the Christian era. In the 4th century ad hospitals were founded in Caesarea and in Rome. The subsequent rise of the monastic orders also resulted in the creation of hospitals, which, together with hospices and schools, functioned as an integral part of the monasteries that built them. Elsewhere other hospitals were founded under the direction of the Roman Catholic Church, such as the Hôtel Dieu in Paris, begun under the direction of St Landry, the Bishop of Paris in c. 660.

During the Crusades, religious orders were created that had as their chief duty the care of the sick, and these orders built a number of hospitals, particularly in the Mediterranean area. The most famous was the Knights of St John of Jerusalem. Throughout the Middle Ages, the Renaissance, and even later, hospitals were almost entirely run by religious groups.

During the 18th century, municipal hospitals operated by the civil authorities began to appear, particularly in England. In the United States, various small private hospitals were operated by churches and by individual doctors, but not until 1751 was the first public hospital, the Pennsylvania Hospital in Philadelphia, opened through the efforts of Benjamin Franklin and the Philadelphia doctor Thomas Bond.

From the middle of the 19th century on, the number of hospitals greatly increased, principally because of the discovery of anaesthesia and aseptic surgical techniques. During the 20th century the demand for hospital services expanded further with the spread of economic prosperity.

In the United Kingdom, legislation implemented in 1948 enabled the setting up of the National Health Service (NHS), which is paid for by taxpayers and provides a wide range of medical services for all residents regardless of income. Its programme includes provision of hospital care.

III

General Hospitals

General hospitals treat patients with all kinds of medical and surgical needs and are concerned primarily with conditions likely to require treatment lasting for days or, at most, a few weeks. There is a considerable trend towards day-care surgery in which patients are not detained overnight after their operations. This not only saves the NHS money, but may also enable the patient to recover quickly from anaesthesia and restore normal bodily functions, including exercise.

Nearly all medium-size and large hospitals also have out-patient departments covering a wide range of specialities, to which patients are referred by general practitioners (GPs). Most of the patients admitted to the hospital wards for surgical treatment are brought in after being seen at an out-patient clinic. Clinical staff work in out-patient departments as well as in wards, operating theatres, intensive care units, and other departments. Most medium-size general hospitals also have an accident and emergency (A&E) or casualty department and often a maternity department.

A

Staffing and Facilities

General hospitals are staffed by consultants in the various medical, surgical, gynaecological, paediatric, and psychiatric disciplines and by their junior medical and nursing staff. In addition, there is a parallel hierarchy on the administrative side concerned with general staff administration, catering, housekeeping, laundry, engineering, accounting, medical records, cleaning, finance, purchasing, stocktaking, and salaries. Clinical departments include a range of special diagnostic facilities such as X-ray, computerized axial tomography, and ultrasound scanning, electrodiagnostic facilities and pathology laboratories; pharmaceutical services; physiotherapy; social services; and suites of operating rooms (theatres) with their ancillary services for instrument sterilization, changing rooms, and stock rooms.

The largest general hospitals cover a wider range of specialities and usually have, in addition to those mentioned, a premature-baby unit; a psychiatric wing; full facilities for dental and facial surgery, plastic surgery, and reconstructive surgery; a radiotherapy unit; MRI (magnetic resonance imaging) scanning; a renal dialysis unit; organ transplant facilities; an occupational therapy department; a physical medicine unit with physiotherapy gymnasium and therapeutic pool; a burns unit; a department of medical physics; and a lithotriptor unit for the non-invasive treatment of kidney stones and gallstones. Some very large general hospitals have a cyclotron for the production of artificial isotopes for PET scanning (positron emission tomography).