How Hospitals Reinvented the Doctor

October 1, 2013

Brit Trogen

Going to the hospital when you're seriously sick or injured is so ingrained into our current medical system that it is difficult to imagine what people could have done without them. But in fact, hospitals are incredibly recent developments in modern medicine. A few hundred years ago, a broken limb might result in disfigurement or death. Any illness stronger than a cold might mean, at best, a course of blood-letting or change in diet.


The invention of the hospital—believed to have occurred in Paris around 1800 CE—changed medicine dramatically. Amazingly, though, this transformation was not always an improvement.


Before delving into the birth of the hospital, it's important to first take a glimpse of what medicine consisted of beforehand. Perhaps the biggest surprise is that doctors in the eighteenth century were almost completely unrecognizable in comparison to the medical practitioners we know today. Doctors, on the whole, weren't highly paid. And neither were they of particularly high social standing; in this era, having to work at all placed you firmly in the lower classes relative to the aristocracy and nobility. And most surprisingly, perhaps, doctors didn't typically engage in any formal education. Medical schools were still novel developments at this time, and the vast majority of doctors were trained through an apprentice-like system with other established doctors.


The relationship between the doctor and the patient was, then, drastically different from what exists today. The only people who could afford to pay for medical care were the upper classes, which meant that doctors were much more akin to hired servants to their patients than respected professionals, and they almost exclusively conducted their business through house calls. The entire power dynamic of this system was held by the patient; if they didn't feel respected, listened to, or properly treated, they would simply take their business elsewhere.



With the growth of the hospital system in the nineteenth century, however, this entire system was turned upside-down. The first hospitals were not, surprisingly, intended solely as medical treatment facilities. The Paris Hospital of 1800 was, perhaps foremost, a method of keeping the troubled, insane, and sick away from the general population. There were thousands of patients crammed together in these buildings, often resulting in massive spreading of disease.


But doctors began to flourish under this system. First, having so many patients in close proximity made it possible to begin to observe symptoms of disease in a scientific manner, looking for commonalities and successful treatments across a wide number of cases. The creation of "rounds" occurred, and groups of students were able to observe more than ever before about illness and treatment. For doctors, working at established hospitals quickly began to be viewed as a respectable (and even preferable) option to the system of house-calls. And finally, doctors were now placed firmly above the vast majority of their patients in socio-economic status. 


The repercussions of this shift were enormous for modern medicine. Interestingly, it is only in this period that medicine begins to take on Latin as a reference language. What doctors previously described as a simple "cough" became a tussis, highlighting the aura of intelligence and respect to be attributed to medicine. And of course, therapeutic advances in this period began to increase the efficacy of medicine by leaps and bounds.


With all the debate about healthcare these days, it might seem as though the quality and efficiency of medical treatment is at an all-time low. But in fact, these are really only minor developments in the history of medicine. Historically speaking, doctors are faring extremely well under the current system. And while patients may not hold the upper hand they once did, it should be at least a small relief to know that the emergency room offers more of a safety net than the blood-letters of yore.



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