Efforts were set on foot as early as 1709 to establish a hospital in Philadelphia. In 1730-31 the city almshouse was founded, and did medical work; but it was not until 1750-51 that the Pennsylvania Hospital first had its actual birth. Joshua Crosby was the first president of the board of managers, and Benjamin Franklin the first clerk. The New York Hospital was the second hospital of importance. Its charter was granted in 1771. From these early beginnings there has now grown up in the United States a veritable forest of hospitals. Every city, town, and village has its duly appointed hospitals, and the hospitals of the United States are now ac knowledged the most handsomely and thoroughly equipped in the world; they serve as models for European architects.
In most of the larger cities of the United States there are two or more hospitals that are under the control of the city government, and used exclusively for the city poor. Such are the Johns Hopkins Hospital, in Baltimore; the Phil adelphia Hospital, in Philadelphia; Bellevue, City. Fo•dham, Harlem, and Gouverneur hospi tals in New York; Massachusetts General, and Boston City, in Boston; Cook County lIospital, in Chicago; etc. In addition to these municipal hospitals there are numerous institutions founded by private gift and by sectarian societies, such as the New York Hospital. Roosevelt, Presby terian, Saint Luke's, German, French, 'Mount Sinai, Saint Vincent's, Saint Mark's hospitals, etc., etc., in New York, and hundreds of others in other cities. Further, there are numberless special hospitals for the treatment of separate diseases: hospitals for diseases of the eye, the ear, the nose, the throat; cancer hospitals; hos pitals for diseases of women; for diseases of the skin, and for all the various specialties.
The details of hospital management cannot be entered into here. The medical side of the work is usually fashioned on well-established lines. In the larger hospitals the patients are imme diately cared for by the nurses (nurses are paid a small salary unless they are sisters of some religious denomination) ; these are under the orders, so far as the treatment is concerned, of the internes, or young graduates in medicine oho have gained this privilege by competitive examinations, and who serve in graded positions for periods of time of from one to three years.
These generally reside in the hospital. receive no salary, save their living, and are constantly in attendance. The ea-ternes. on the other hand, are under the supervision of the attending or visiting physicians, who are practitioners in the city, chosen by the governing boards of the hospitals for their ability or for other reasons. These visit the hospitals at specified times, and outline the plans of treatment for the patients. Their time and services are usually given gratis, always so in the municipal hospitals. Many hospitals have consulting physicians who may be called in to diagnose rare conditions, but such appointments are usually rewards for work done in the other grades, and carry with them honor and position in the estimation of the laity.
In the smaller hospitals this system may be much modified to meet the circumstances, but the main features are preserved.
Chiefly within the past century a system of hospitals specially designed for the care and treatment of the insane has been established all over the world. In this country these institutions are supported by the several States. The State of New York has sixteen such hospitals, each accommodating from a few hundred to a few thousand patients. The physicians who serve in these hospitals are specialists in mental dis eases, and receive salaries which vary with the length of service. Very recently acute psycho pathic hospitals have been established in some of the large cities in connection with the principal general hospitals. In these institutions patients afflicted with mild and curable forms of mental trouble receive treatment without being regularly committed to an insane asylum. Such are the insane pavilions in Bellevue and Kings County hospitals, in New York. See NURSES, TRAINING o•. Consult Burdett, The hospitals and Asy lums of the World (London, 1891).