What a Hospital Looked Like 100 Years Ago

The coronavirus pandemic exposed several weaknesses of the U.S. health care system, including expensive hospital stays and shortages of doctors and nurses. Still, hospitals today are significantly different from hospitals 100 years ago. Despite their weaknesses, hospitals remain places of hope and innovation, far different from the unsanitary conditions and poor patients a century ago ago.

Just because hospitals have much improved, however, they have much more to improve still, especially in the context of the entire health care system. For example, during the pandemic, chronic conditions worsened and treatments were delayed, according to research by the Urban Institute, a think tank. Many people avoided going to hospitals despite needing treatment because of concerns about costs and getting infected.*

24/7 Tempo reviewed information from a dozen sources, including drug information resource Monthly Prescribing Reference and the National Library of Medicine National Institutes of Health, to compile a list of 29 differences between hospitals today and 100 years ago.

The American hospital system grew out of the creation of the almshouse, a charity home that tended to the needs of the mentally ill, the blind, the deaf, those with ailments such as tuberculous, as well as petty thieves, prostitutes, and abandoned children. These places did not provide medical services. The nation’s first institution founded to treat medical conditions was the Pennsylvania Hospital in 1751.

For much of the 19th century, hospitals tended mostly to the poor; the more well to do were treated in their homes by physicians. As the nation became more industrialized and mobile — making it more difficult for families to care for each other — and as health care became more sophisticated and professional, Americans in all economic strata began to use hospitals.

Most of the hospitals of the 19th century were created by Protestant stewards, who took it upon themselves to look after the poor. Those hospitals advanced the concept of the American hospital. Newly arrived immigrants, however, found them lacking, and they founded their own medical institutions to respond to cultural considerations.

In addition to the impact of immigration, hospitals were changing rapidly 100 years ago because of technological innovation and policy changes driven by progressive reformers that made health care an important public policy issue.

One hundred years ago, America was reeling from the impact of the influenza epidemic, which is often compared to the current coronavirus pandemic — these are the 21 deadliest outbreaks in history.

But out of that bleak episode would emerge a surge in the construction and funding of public hospitals, more widespread use of technology such as X-rays, as well as the discovery of vaccines for tuberculosis, tetanus, and yellow fever.

Despite their importance, many rural communities lack speedy access to a hospital with the nearest one miles away, while other communities may have too few hospitals. Amid the pandemic, these are the counties with the fewest hospitals.