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Please use APA citation Evaluate the degree and quality of care established within the 18th Century U.S. hospitals, as compared to the level of care seen in today’s hospitals [Chapter 1, Pages 2-18]. Analyze the basic sources of law: common law, statutory law, and administrative law and identify which one is most prevalent in health care. Provide support for your rationale. [Chapter 2, Pages 20-25].Chapter 1 and 2 document will be attached please let me know if they are not or cannot be opened
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CHAPTER 1
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Hospitals Through the Ages
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I was created at the end of the Renaissance, watched pirates rule the oceans as Ivan the Terrible ruled Russia, and witnessed the
arrest of Galileo for believing the Earth revolved around the Sun.
—I Am History
▸▸
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LEARNING OBJECTIVES
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The reader, upon completion of this chapter, will be able to:
Explain &
how
societal Learning,
conflicts due LLC
to politics, religion, and warfare
have both
impeded the
growth of LLC
hospitals
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Bartlett
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& Bartlett
Learning,
and
contributed
to
their
progress.
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■■
■■
■■
Describe how advances in medicine led to the rise of the modern-day hospital and improved the quality of
patient care.
Describe how the knowledge gained from best practices (e.g., infection control) can lead to progress while at
the same time result in patient harm if not consistently followed over time.
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1
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2
Chapter 1 Hospitals Through the Ages
We can learn from history how past generations thought
repeat them. This chapter takes the reader on a jour-
& Bartlett Learning, LLC
© Jones & Bartlett
Learning,
LLCto the demands of their © Jones
and acted, how
they responded
ney from the past to the present, from which to spring
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OR
time and
howDISTRIBUTION
they solved their problems. We can learn NOT
forward
a betterOR
road
that returns the people’s trust
by analogy, not by example, for our circumstances will always
in the safety net of the nation’s hospital systems. Here,
be different than theirs were. The main thing history can teach
we go “back into the future” to bring forth the fruits of
us is that human actions have consequences and that certain
healthier hospitals and healthier lives. Let the reader
choices, once made, cannot be undone. They foreclose the posnow
travel that road.
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sibility of making other choices and thus they determine future
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events.
—Gerda Lerner 1
▸▸
EARLY HINDU AND EGYPTIAN
HOSPITALS
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This chapter provides the reader with notable histor© Jones
& Bartlett
Learning,
ical events,
from ancient
civilizations
to theLLC
present
Two ancient civilizations,
the Hindu
what is now
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OR
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OR(inDISTRIBUTION
time, which continue to revolutionize the delivery
India) and the Egyptian, had crude hospitals. Hindu
of patient care. It provides a review of the advance of
literature reveals that in the 6th century BC, Buddha
civilization as disclosed in the history of hospitals and
appointed a physician for every 10 villages and built
medical achievements through the ages. A study of
hospitals for the crippled and the poor. His son, Upaoften reveals
errors LLC
that then can be avoided, © Jones & Bartlett Learning, LLC
© Jonesthe&past
Bartlett
Learning,
tiso, built shelters for the diseased and for pregnant
customs
that
persist
only because of tradition, and NOT FOR SALE OR DISTRIBUTION
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OR
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women. These examples probably moved Buddha’s
practices that have been superseded by others that
devotees to erect similar hospitals. Despite a lack of
are more effective. The past may also bring to light
records, historians agree that hospitals existed in
long-abandoned practices, which may be revived to
­Ceylon as early as 437 BC.
some advantage. The story of the birth and evolution
During his reign from ©
273
to 232& BC,
King Learning, LLC
© the
Jones
& Bartlett
Learning, LLC
Jones
Bartlett
of the hospital portrays
triumph
of civilization
Asoka built 18 hospitals thatNOT
hold FOR
historical
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over barbarism and the NOT
progress
of civilization
toward
icance because of their similarities to the modern
an ideal characterized by an interest in the welfare of
hospital. Attendants gave gentle care to the sick,
the community.
provided patients with fresh fruits and vegetables,
This chapter reviews some of the most amazing
prepared their medicines, gave massages, and mainmedical
achievements
in the
history
©discoveries
Jones & and
Bartlett
Learning,
LLC
© Jonescleanliness.
& Bartlett
Learning,
LLC
tained their personal
Hindu
physicians,
of medicine.
It alsoSALE
describes
of the failures
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adept at surgery, were required to take daily baths,
that continue to plague the healthcare industry. The
keep their hair and nails short, wear white clothes,
importance of the study of history is undeniable. The
and promise that they would respect the confidence
Spanish philosopher George Santayana (1863–1952)
of their patients. Although bedside care was outrecognized this all too well when he said, “Those who
standing for those times, medicine was only begin© Jonesdo¬
Bartlett
Learning,
LLC
remember
the past are
condemned to repeat © Jones & Bartlett Learning, LLC
ning to find its way.
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it.” SALE
GeorgeOR
Bernard
Shaw (1856–1950), an Irish NOT FOR SALE OR DISTRIBUTION
Egyptian physicians were probably the first to
dramatist and socialist, recognized the tragedies of
use drugs such as alum, peppermint, castor oil, and
the history of civilization when he said, “If history
opium. In surgery, anesthesia consisted of hitting the
repeats itself, and the unexpected always happens,
patient on the head with a wooden mallet to render
how incapable must man
of learning
from experi© be
Jones
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Learning,theLLC
© Jones
Bartlett
patient unconscious. Surgery
was &
largely
lim- Learning, LLC
ence.” Yes, Santayana and Shaw are right: If we do not
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ited to fractures, and medical
treatment
was usulearn from the mistakes of the past, we are doomed
ally given in the home. Therapy away from home
to repeat them. Progress in health care will only prewas often available in temples, which functioned as
vail so long as advances in medicine are practiced
hospitals.
by each new generation. Although the struggle to
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Learning,
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progress
a road&
filled
with many
pitfalls, LLC
hope still
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looms.


Martin Makary wrote in the Wall Street Journal
that “Medical errors kill enough people to fill four
jumbo jets a week . . . To do no harm going forward,
The term&hospital
derives
from theLLC
Latin word hospibe able
to learn LLC
from the harm we have © Jones
© Joneswe&must
Bartlett
Learning,
Bartlett
Learning,
talis, which relates to guests and their treatment. The
already done.”2 If we do not learn from historical
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word reflects the early use of these institutions not
events to those of the present days, we are bound to
GREEK AND ROMAN
HOSPITALS
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ISLAMIC HOSPITALS
merely as places of healing, but also as havens for the
HOSPITALS OF THE EARLY
CHRISTIAN ERA
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LLCHospitals first appeared©inJones▸▸& Bartlett Learning, LLC
poor andLearning,
weary travelers.
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GreeceOR
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aesculapia, named after the Greek godNOT
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3
medicine, Aesculapius. For many centuries, hospitals
Christianity and the doctrines preached by Jesus
developed in association with religious institutions,
stressing the emotions of love and pity gave impetus
such as the Hindu hospitals opened in Sri Lanka in the
with
the
­European LLCto the establishment of
5th century BC and
the monastery-based
© Jones
& Bartlett Learning,
© hospitals,
Jones &which,
Bartlett
Learning,
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advance
of
Christianity,
became
integral
parts
of
the
hospitals of the NOT
MiddleFOR
AgesSALE
(5th century
to 15th
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OR DISTRIBUTION
church institution. These Christian hospitals, which
­century AD). The Hotel-Dieu in Paris, a monastic
replaced those of Greece and Rome, were devoted
hospital founded in 660 AD, is still in operation today.
entirely to care of the sick, and accommodated
In early Greek and Roman civilization, when
patients in buildings outside the church proper.
medical practices were rife with mysticism and super©
Jones
&
Bartlett
Learning,
LLC
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& BartlettinLearning,
LLC the
A decree
of Constantine
335 AD closed
stitions, temples also were used as hospitals. Every
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­aesculapia and stimulated the building of Christian
sanctuary had a sacred altar before which the patient,
hospitals, which, during the 4th and 5th centuries,
dressed in white, was required to present gifts and offer
reached the peak of their development. Many were
prayers. If a patient was healed, the cure was crederected by the rulers of the period or by wealthy
ited to miracles and divine visitations. If the patient
Romans
who had
convertedLLC
to Christianity. By the
remainedLearning,
ill or died, he
or she was considered to©beJones
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LLC
& Bartlett
Learning,
year
500,
most
large
towns
in
the Roman Empire
lacking
in DISTRIBUTION
purity and unworthy to live.
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OR
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had
hospitals.
Nursing,
inspired
by
religion, was genGreek temples provided refuge for the sick. One
tle and considerate, but soon began to discard the
of these sanctuaries, dedicated to Aesculapius, is said
medical precepts of Hippocrates, Antyllus, and other
to have existed as early as 1134 BC at Titanus. Ruins
early Greek physicians because of their pagan origins.
attest to the existence of another, more famous Greek
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Instead, health care turned
toward
mysticismLearning,
and
temple built several centuries later in the Hieron, or
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theurgy (the working of a divine agency in human
sacred grove, at Epidaurus. Here, physicians minisaffairs) as sources of healing.
tered to the sick holistically in body and soul. They
Hospitals rarely succeeded during the centuries
prescribed medications such as salt, honey, and water
leading
to the Middle Ages; only a few existed outfrom a sacred spring. They gave patients hot and cold
side Italian
cities. &
Occasional
Europe
baths
to promote
speedyLearning,
cures and encouraged
long
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LLC
© Jones
Bartlett almshouses
Learning,inLLC
sheltered
some
of
the
sick,
whereas
inns
along
the
hours
sunshine
andOR
sea air,
combined with pleasant
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Roman
roads
housed
others.
No
provision
appears
to
vistas, as an important part of treatment. The temple
have
been
made
for
care
of
the
thousands
of
helpless
hospitals housed libraries and rooms for visitors, attenpaupers who had been slaves and were later set free
dants, priests, and physicians. The temple at Epidaurus
when Christianity was introduced into the Roman
even boasted what might be described as the site of the
Empire.
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first clinical records. The columns of the temple were
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inscribed
the names of patients, brief historiesNOT
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their cases, and comments as to whether or not they
were cured.
▸▸
The aesculapia spread rapidly throughout the
were almost
as dedicated
Roman Empire, as
as through
the Greek
world. LLCThe followers of Mohammed
© well
Jones
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Learning,
© Jones
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Learning, LLC
as the Christians in caring for the sick. In Baghdad,
Although some hospitals were simply spas, others
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Cairo, Damascus, Cordova, and many other cities under
followed the therapy outlined by the leading physitheir control, luxurious hospital accommodations were
cians of the day. Hippocrates, for example, a physifrequently provided. Harun al-Rashid, the glamorous
cian born about 460 BC, advocated medical theories
caliph (a title for a religious or civil ruler claiming sucthat have startling similarity to those of the pres©
Jones
&
Bartlett
Learning,
LLC
Jones
& Bartlett
Learning,
LLCAD),
cession©from
Mohammad)
of Baghdad
(786–809
ent day. He employed the principles of percussion
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built a system of hospitals and paid the physicians himand auscultation, wrote intelligently on fractures,
self. Medical care in these hospitals was free. Approxperformed numerous surgical operations, and
imately four centuries later, in 1160, a Jewish traveler
described such conditions as epilepsy, tuberculosis,
reported that he had found as many as 60 dispensaries
malaria, and ulcers. He also kept detailed clinical
and
in Baghdad LLC
alone. The Persian physirecords of
many of hisLLC
patients. Physicians like Hip© Jones & Bartlett
Learning,
© Jones
& infirmaries
Bartlett Learning,
cian Rhazes, who lived from approximately 850 to 923
pocrates not only cared for patients in the temples,
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AD, was skilled in surgery. He is believed to be the
but also gave instruction to young medical students.
ISLAMIC HOSPITALS
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4
Chapter 1 Hospitals Through the Ages
first to use the intestines of sheep for suturing and to
and medical advancements might have been lost due
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& Bartlett
cleanse
patient Learning,
wounds with LLC
alcohol. He also gave the
to the failure of mankind to sit at the table of peace and
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first rational accounts of smallpox and measles.
compromise
on differences
based on logic and reason?
Islamic physicians like Rhazes received much
of their medical knowledge from the persecuted
­Christian sect known as the Nestorians. Nestorius
▸▸
(Archbishop of Constantinople
April 428
to
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Learning,
LLC
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Religion continued to be the most important factor
August 431) was drivenNOT
into FOR
the desert
withOR
hisDISTRIBUTION
folNOT FOR SALE OR DISTRIBUTION
SALE
in the establishment of hospitals during the Middle
lowers after having been appointed patriarch of
Ages. A number of religious orders created hospitia,
Constantinople and took up the study of medicine.
or travelers’ rests, and infirmaries adjacent to monasThe school at Edessa, in Mesopotamia, with its two
teries provided food and temporary shelter for weary
large hospitals, eventually came under the control of
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&
Bartlett
Learning,
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& of
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travelers and pilgrims.
One
these, the
famous alpine
the Nestorians, where they established a remarkable
hospice
of
St.
Bernard,
founded
in
962,
gave
comfort
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teaching institution. Eventually driven out of Mesoto the weary and sent its renowned dogs to the rescue
potamia by the orthodox bishop Cyrus, they fled to
of lost mountain climbers.
Persia, where they established the famous school at
The hospital movement grew rapidly during
Gundishapur, which is considered to be the true startthe
Crusades, which began in 1096. Military hospiof Islamic
medicine.
Gundishapur was home © Jones
© Jonesing&point
Bartlett
Learning,
LLC
& Bartlett Learning, LLC
tal orders sprang up, and accommodations for sick
to the
world’s
oldest
known teaching hospital and also NOT
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and exhausted crusaders were provided along well-­
comprised a library and a university. It was located in
traveled roads. One body of crusaders organized the
the present-day province of Khuzestan, in southwestHospitallers of the Order of St. John, which in 1099
ern Iran, not far from the Karun River.
established in the Holy Land a hospital capable of carIslamic medicine flourished up to about the
©
Jones
&
Bartlett
Learning,
LLC
& Bartlett
ing
for 2,000 patients. Knights©ofJones
this order
took per- Learning, LLC
15th century. Physicians were acquainted with the possonal
charge
of
service
to
patients
and
often
denied
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sibilities of inhalation anesthesia. They instituted prethemselves
so
that
the
sick
might
have
food
and
medcautions against adulteration of drugs and developed a
ical care. For years, these institutions were the best
vast number of new drugs. Islamic countries also built
examples of hospitals of that period.
asylums for the mentally ill 1,000 years before such
Although physicians cared for physical ailments
institutions
appeared
in Europe.
The peopleLLC
of Islam
© Jones
& Bartlett
Learning,
© Jones & Bartlett Learning, LLC
to
afford
relief, they rarely attempted to cure the sick.
made aNOT
brilliant
start
in medicine,
but never fulfilled
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Dissection of NOT
a human
body
wouldOR
haveDISTRIBUTION
been sacrilege
the great promise that glowed in their early work in
because
the
body
was
created
in
the
image
of God.
medical arts and hospitalization was never fulfilled.
Finally,
an
active
period
of
hospital
growth
came
Wars, politics, superstitions, and a nonprogressive
during
the
late
12th
and
early
13th
centuries.
In
1198,
philosophy stunted the growth of a system that had
Pope Innocent
III urged
hospitalsLLC
of the Holy Spirit
© Jonesinfluenced
& Bartlett
Learning, LLC
© Jones
& Bartlett
Learning,
the development
of hospitals.
to
be
subscribed
for
by
the
citizenry
of many towns.
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He set an example by founding a model hospital in
Rome, known as Santo Spirito, in Sassia. Built in 1204,
▸▸
it survived until 1922, when it was destroyed by fire. In
Engraved on a limestone pillar dating back to the SumeRome, nine other hospitals were founded shortly after
© Jones
& Bartlett
LLC
© itJones
& Bartlett
rians (2920 BC) are pictures
that depict,
among Learning,
other
completion
of the one in Sassia;
is estimated
that in Learning, LLC
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military procedures, theNOT
assemblage
of the wounded.
Germany alone, 155 towns had
hospitals
the Holy
The Book of Deuteronomy records that Moses estabSpirit during early medieval times.
lished outstanding rules for military hygiene. Out of
Although most hospitals constructed during the
the urgency of care for the wounded in battle came
Middle Ages were associated with monasteries or
much of
impetus
medicalLearning,
progress. Hippoc …
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