Defining A Hospital

The first sentence of William A. Nolen’s article “Bellevue: No One Was Ever Turned Away” in your February/March issue says that Bellevue is the oldest hospital in the United States. This is not, strictly speaking, true.

The very first semblance of American hospitals appeared in the early eighteenth century—hastily built structures intended to confine contagious disease. They were built primarily in seaport towns and were operational only during the course of a full-scale epidemic.

Later in the eighteenth century, another institution attempted to provide the continuous service that the early centers lacked. This was the almshouse, established solely for the care of a city’s poor. Almshouses performed a multitude of functions—they housed the destitute sick, they served as orphanages, they confined criminals, and they harbored the insane. Bellevue Hospital was established as such an almshouse in 1736 to house New York’s “poor, aged, insane, and disreputable.”

The next type of medical care institution to emerge was the voluntary hospital. As an urbanized middle class began to grow in the colonies, it demanded better care than the largely inefficient almshouses provided. Patients were willing to pay for that care.

Voluntary hospitals generally were begun by philanthropic gifts, but their ongoing operations were financed both by voluntary contributions and by patients’ fees. Between 1751 and 1840 at least eleven of these hospitals were founded. The first was Pennsylvania Hospital.

What this all boils down to is that Pennsylvania Hospital was the first hospital founded as a hospital . It wasn’t established as a temporary means of dealing with a crisis. Nor was it an almshouse that later became a hospital.