An Architectural History of US Community Hospitals.

When hospitals became places of treatment and recovery rather than places of sickness and death, hospital-based patient care also changed. 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.

Description of in-hospital deaths in Vienna during 1850-2000.

The aim of this study was to compare in-hospital deaths in different hospital settings between 1850 and 2000 in Vienna. We reviewed 120 autopsy records for each of the selected years from the Clinical Institute of Pathology of the Medical University Vienna and two community hospitals. In 2000 the autopsy rate was 37.5 % at the community hospitals and 52.5 % at the university hospital. The mean age of those being dissected was significantly lower compared with those not being dissected in the community hospital. Infections were the leading cause of death during the nineteenth and early twentieth century, after 1950 the rate of cardiovascular diseases and cancer increased. In the year 2000 the majority of patients with an underlying malignant disease died because of cardiovascular disease. Causes of death vary between institutions. They should be reported as accurately as possible in order to create a cogent basis for central mortality statistics.

The rise of emergency medicine in the sixties: paving a new entrance to the house of medicine.

Emergency medicine evolved into a medical specialty in the 1960s under the leadership of physicians in small communities across the country. This paper uses three case studies to investigate the political, societal, and local factors that propelled emergency medicine along this path. The case studies-Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital-demonstrate that the changes in emergency medicine began at small community hospitals and later spread to urban teaching hospitals. These changes were primarily a response to public demand. The government, the American public, and the medical community brought emergency medical care to the forefront of national attention in the sixties. Simultaneously, patients' relationships with their general practitioners dissolved. As patients started to use the emergency room for non-urgent health problems, emergency visits increased astronomically. In response to rising patient loads and mounting criticism, hospital administrators devised strategies to improve emergency care. Drawing on hospital archives, oral histories, and statistical data, I will argue that small community hospitals' hiring of full-time emergency physicians sparked the development of a new specialty. Urban teaching hospitals, which established triage systems and ambulatory care facilities, resisted the idea of emergency medicine and ultimately delayed its development.

From cottage to community hospitals: Watlington Cottage Hospital and its regional context, 1874-2000.

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

Bold vision: Catholic sisters and the creation of American hospitals.

American hospitals were started by religious, ethnic and community groups to serve local health care needs. Immigration into the eastern cities and the constant movement west of the frontier required the creation of educational and service facilities to serve these populations and localities. In the nineteenth century, Catholic sisters went all across the country establishing schools and hospitals. They were motivated to care for the sick, establish charitable institutions and spread their religious beliefs. Their impact on the development of the American health system was enormous. They also supported the importance of nursing for the provision of scientifically based medical care and created schools of nursing. Their historical record as founders, builders, financiers and managers of hospitals is unmatched by any other group between 1850 and 1950. And, this was accomplished at a time when women played no similar leadership and institutional ownership role elsewhere in society.

Hospital Comunitario de Salud Familiar Dr. Eduardo Contreras Trabucco de Coelemu / Community Hospital of Family Health Dr. Eduardo Contreras Trabucco of Coelemu

El principal establecimiento de salud de Coelemu se ubica 76 kilómetros al noroeste de Chillán, en la Cordillera de la Costa y junto al Río Itata. El establecimiento fue inaugurado el año 1964, transformándose entonces en uno de los pilares fundamentales del progreso de la comuna. Su primer director fue el médico cirujano Dr. Eduardo Contreras Trabucco, quien en un extenso período de administración, logra darle una extensa difusión, permitiendo su trascendencia incluso en el ámbito nacional como establecimiento de salud. La contribución de cada uno de sus funcionarios, la tecnificación de los procedimientos, el aumento de cobertura, la elevación del grado de complejidad, el equilibrio diagnóstico y su alta capacidad resolutiva, hacen de este establecimiento un centro de capital importancia en la red. (AU)

Hospital Comunitario de Salud Familiar de Bulnes

Los antecedentes fundacionales del Hospital Comunitario de Salud Familiar de Bulnes, se remontan a principios del siglo XX, cuando se pone en funcionamiento un pequeño hospital bajo la administración de la congregación de las “Madres del Sagrado Corazón”, religiosas encargadas de cuidar a los pacientes, contando para ello con sólo dos camas de hospitalizados. El terremoto de 1939 redujo a escombros la pequeña edificación, por lo que se levantó un hospital de campaña para afrontar la situación. Eso dio paso a la edificación de un nuevo edificio de emergencia, que con el paso de los años, fue ampliando su infraestructura para albergar posteriormente el funcionamiento del Hospital de Bulnes hasta el año 1978.Cuando las autoridades de salud iniciaron las gestiones de construcción del edificio definitivo, el hospital debió habilitarse en dependencias del antiguo liceo, lugar que albergó por casi 5 años las acciones de salud de la comuna.El actual establecimiento se inauguró en 1983 y alberga a más de 100 camas de hospitalización entre los servicios clínicos, su servicio de Urgencia y el Consultorio Adosado de Atención Primaria. (AU)

Hospital Comunitario de Salud Familiar de Quirihue

Las Sociedades Benefactoras de fines del siglo XIX son artífices de los llamados Hospitales de Caridad, en donde encuentra su origen más remoto el establecimiento de la comuna quirihuana. Específicamente, es la Sociedad de Beneficencia del Itata, la entidad precursora del actual hospital.El año 1975 culmina la construcción del actual edificio, que permitió reemplazar la vetusta edificación de madera donde funcionara por tantos años. De todos modos, la antigua estructura sigue prestando utilidad como servicio geriátrico.

Union Memorial Hospital: an insight to the origin of community-based surgical training.

Community-based surgical training centers comprise almost half of the current ACGME-approved programs. Yet the histories of these community hospital programs have not been defined clearly. University programs were founded with the time-honored mission to deliver patient care, teaching, and research. We feel that early community programs developed with close ties to university programs before diverging in their evolution. As successful university faculty expanded their elective surgical practice, they often admitted patients to private hospitals, most in close proximity to their university hospitals. Many surgeons maintained joint appointments on the university and private hospital staffs, whereas others left the university staff to focus their efforts on their clinical practice. The more prominent clinicians continued to attract students interested in apprenticeships in surgery; and community based training programs developed that focused primarily on patient care and teaching. We review the history of our program that we feel illustrates this process.