Established a war hospital5/10/2023 The distance of a hospital from its community affected its patient composition and consequently its medical service. 11 Travel time to their doors was measured in minutes. A handful of hospitals, including St Vincent’s and Beth Israel, did occupy sites embedded within the population center of the community they served. 10,11 This travel distance could prove excruciating or even deadly to patients with severe injuries or in need of urgent care. In Manhattan of the 1870s, the centers of population remained below 23rd Street, but 8 general hospitals, including the Presbyterian Hospital, were all located above 54th Street, at least an hour horse-car ride away. Pavilion-ward guidelines required that sites be located beyond the built-up areas of a city, distant from their supporting community. The greatest variation in hospital service was the result of site choice. St Elizabeth Hospital in Utica, New York, offered essentially the same facilities as St Luke’s Hospital in Chicago, Illinois the Miners’ Hospital in Hazleton, Pennsylvania the Grady Memorial Hospital in Atlanta, Georgia or the Good Samaritan Hospital in Portland, Oregon. 7-9 Pavilion-ward designs were widely adopted in the late 19th century across the United States, whether in large cities, small towns, or rural areas. Pavilion-ward hospital buildings included hygienic materials and details, large open wards, support spaces, and little else. These hospitals’ facilities were arranged in pavilion-wards-a standardized design popularized worldwide by Florence Nightingale-which promised to make hospital buildings into places of cure rather than incubators of disease. German physicians practiced in the German Hospital and Jewish physicians in Mount Sinai and Beth Israel. Presbyterian services were held in the Presbyterian Hospital, Jewish services in Mount Sinai, and Catholic services in St Vincent’s. Although each hospital officially admitted patients of any creed, race, or ethnicity, each also tailored its offerings to its own community. 5,6 At a time when home care-whether by family members or by physicians making house calls-was the norm, these hospitals were charities, providing free or low-cost care to the sick poor. In 1869, a call to support a new Presbyterian hospital in New York City noted that Jewish, German, Catholic, and Episcopalian communities had founded hospitals “for the exclusive benefit of their own people” 5 but that Presbyterian community members did not yet have a hospital of their own. The transformations in such interactions occurred first in urban areas, then spread across the nation this article initially draws on examples from New York City and then expands the discussion to include smaller towns and rural areas. This article uses the history of architecture-particularly, hospital site choice and building layout-and the history of the changing community context and individual institutions to illuminate hospital-community interactions since the 1860s. Over time, what changed was not just the interaction of hospital and community and the nature of care provided but which community was serving and being served. 4 Although this hope-that better community integration would improve care-implied that hospitals were not sufficiently connected to a specific community, the history of hospitals reveals that each hospital was a specific, locally determined attempt to provide service to a perceived underserved community. In reaction, postwar hospital practitioners hoped that the hospital of the future “would be inherently connected to a specific community” and thereby provide better, more personal care. During the 19th century, hospitals underwent a transformation 1,2-from traditional charitable institutions that provided “a place to be sick and die” to modern medical institutions that offered “a place to live and get well.” 3 An undesirable side effect of that shift, however, was an increasingly impersonal interaction between caregiver and patient and between the hospital and the community it inhabited. World War II marked a turning point in community hospital history. ![]() ![]() Shifts in Hospital-Community Interactions This article examines relationships between design-induced practice transformations in US hospitals between the 1850s and 1980s and transformations in hospitals’ roles in American communities, with a specific focus on underserved communities. When hospitals became places of treatment and recovery rather than places of sickness and death, hospital-based patient care also changed.
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