1700 - 1869

Philadelphia opens an almshouse, which later becomes Philadelphia General Hospital

In the early American colonial period, local governments established institutions to care for sick individuals without families or other means of care. In more populous areas, such as Philadelphia, these institutions were part of the municipal almshouse, an establishment providing housing and living services for those unable to provide their own. As many almshouse inmates were elderly, sick, very young, or otherwise infirm, the need emerged for a section of the almshouse devoted to caring for the ill. Later, many of these institutions shed their almshouse identities and assumed the status of general hospitals.

During the eighteenth and nineteenth centuries, providing institutions to care for the sick was in many ways more self-serving than altruistic. The frequent occurrence of epidemic illnesses drove local governments to establish such institutions in order to separate sick and potentially contagious individuals from the healthy population, even if it required public monies to do so. The Philadelphia Almshouse, one of the oldest and most famous, was reorganized and renamed several times. In 1902, the institution received its final name: Philadelphia General Hospital.

Jean Louis, a French seaman and boat builder, leaves his entire estate to fund the building of a hospital for the poor people of New Orleans

The hospital, originally called the Hospital of St John or the L’Hospital des Pauvres de la Charité, was later known by the name Charity Hospital.

Pennsylvania Hospital, an early private institution for care of the sick in the British colonies, opens in Philadelphia

One of the founders of the Pennsylvania Hospital was Benjamin Franklin, who was a strong advocate of high-quality nursing care. “Without good and careful nursing many must suffer greatly and probably perish that might have been restored to health and comfort, and become useful to themselves, their families, and the public for many years after.”¹Private donations as well as an allocation from the Pennsylvania Assembly provided the funding for the Pennsylvania Hospital, reinforcing the idea that the public had a stake in providing health care services.

    ¹ Benjamin Franklin.”Some Account of the Pennsylvania Hospital, from its first rise, to the beginning of the fifth month, called May, 1754…” (Philadelphia: B. Franklin and D. Hall, 1754), 3.

George Washington, commander in chief of the Revolutionary army, granted authorization to establish hospitals for sick troops to be staffed at the ratio of one nurse for every ten patients

Many women as well as men served as nurses during the Revolutionary War. The Second Continental Congress, heeding George Washington’s advice to establish a means of caring for wounded and sick soldiers, authorized the formation of hospitals. Nurses were not always easy to hire. Washington blamed the low compensation rate—originally $2 a month—for the shortage of nurses. Congress increased nurses’ pay to $4 a month in 1776 and, a year later, to $8 a month. Even this rate was still low, however, especially when compared to the $40 a month earned by surgeons and apothecaries.

A yellow fever epidemic hits Philadelphia, the capital city, killing close to 10 percent of the population

Epidemics such as yellow fever, smallpox, malaria, and typhus were common in the late eighteenth and early nineteenth centuries, often overwhelming the communities in which they occurred and straining the traditional sick care system that relied on family and friends as nurses. The presence of an epidemic illness created demand for organized caregiving arrangements.

The Free African Society provides organized nursing care to yellow fever victims

The Free African Society, a nondenominational organization founded for the benefit of free African Americans, recruited African American volunteers to provide nursing care for white citizens in the face of an acute shortage of nurses. Instead of offering accolades for their service, publisher Matthew Carey accused “the vilest” of the African American nurses of drunkenness, theft, and profiteering in his bestselling 1794 pamphlet, A Short Account of the Malignant Fever Lately Prevalent in Philadelphia with a Statement of the Proceedings that Took Place on the Subject in the Different Parts of the United States. Carey not only tapped into a long-standing racialized discourse that denigrated people of African descent, he also exploited stereotypes that portrayed hired nurses as drunkards, thieves, and prostitutes. The Free African Society nurses requested that their leaders Absalom Jones and Richard Allen defend their actions in the court of public opinion. In their pamphlet, A Narrative of the Proceedings of the Black People during the Late Awful Calamity in the Year 1793 and a Refutation of Some Censures Thrown Upon Them in Same Late Publication, published in 1794, Jones and Allen described nursing as “a considerable art, derived from experience, as well as the exercise of the finer feelings of humanity.” Over half a century before Florence Nightingale’s work in the Crimea, Free African Society nurses promoted a positive image of Protestant nurses working outside of the domestic sphere in a civic crisis. The nurses’ humanitarian actions advanced a powerful argument for African American civil equality and citizenship.

President John Adams signs into law a bill providing for the care and relief of sick and injured merchant seaman

This law, providing for medical services for merchant seamen in American ports, marked the entry of the federal government into matters of health and the delivery of health services. Initially, the government negotiated contracts with existing hospitals to provide medical care to the seamen. Later, hospitals built along the coasts and inland seaways, funded through deductions from seamen’s wages, accommodated ill merchant seamen. In 1870, the service was named the Marine Hospital Service. The functions of the Marine Hospital Service grew when it took over medical inspection of immigrants. Reflecting this expanded function, the service was renamed The Public Health and Marine Hospital Service in 1902. In 1912, it became the United States Public Health Service.

Valentine Seaman, a physician at New York Hospital, organizes a course of lectures for nurses on the care of maternity patients

Seaman’s course of lectures was an early of example of instruction in nursing. A synopsis of the several of the lectures was published in 1800 by Isaac Collins.

Ladies Benevolent Society of Charleston, South Carolina, initiates a program to nurse the sick poor at home

The Ladies Benevolent Society’s effort is the first known example of organized home care nursing in the United States. The primary recipients of the society’s care were free blacks and poor whites. What began as individual uplift and good works associated with the Ladies Benevolent Society’s faith became a mission complicated by the unpredictable variables of caring for the sick poor at home: family circumstances, chronic illness, and poverty.

The Friends Asylum for the Relief of Those Deprived of the Use of Their Reason and for the Relief of Their Families and Friends, the first private psychiatric hospital in the United States, opens for patients in Philadelphia

The Friends Asylum established by Philadelphia’s Quaker community, was a new kind of institution dedicated to the implementation of “moral treatment,” then a radically new way of caring for the insane. Moral treatment, as practiced at the Friends Asylum, focused on the reproduction of a calm family-farm environment in which patients could experience themselves as responsible men and women. The asylum’s philosophy stood in sharp contrast to that of other American hospitals and almshouses also caring for the insane in which custodial care predominated; and it encouraged families who provided most of the care of the mentally ill in their own homes to consider the benefits of institutional treatment.

The Friends Asylum’s success with moral treatment provided a model for other asylums throughout the United States. It also supplied the rationale for the construction of state-funded asylums for those unable to pay for private care. Dorothea Dix, who would later superintend female nurses for the Union Army during the Civil War, championed the right of the mentally ill to receive treatment in these kinds of therapeutic institutions. She traveled widely, testifying in state after state about their benefits. By 1860, many states had at least one state-funded asylum for the mentally ill.

Physician Joseph Warrington organizes the Nurse Society of Philadelphia to educate women to care for mothers during childbirth and the postpartum period

The Nurse Society trained working women in the care of the new mother and infant, management of the sick room, and preparation of the convalescent diet. These nurses, like midwives, would care for parturient mothers and newborns, but, unlike midwives, they would be responsible to the physician who supervised their work rather than to the mother who paid for it. Between 1839 and 1850 about fifty nurses were employed with the Society, establishing an early practice of engaging nurses for care of the sick in the home. The demand for these nurses exceeded supply, suggesting either that this model of nurse training and practice may not have been attractive to working women or that the need for trained nurses outpaced the ability of the Nurse Society to deliver nurse services.

Warrington also published The Nurse’s Guide, a book that instructed women wishing “…to engage in the important business of nursing mother and child in the lying-in chamber.”¹ In 1851, the Nurse Society and the Philadelphia Lying-In Charity Hospital united as one institution.

¹ Joseph Warrington, The Nurse’s Guide (Philadelphia: Thomas Cowperthwait, 1839).

Successful administration of anesthesia during a surgical operation carried out

The use of anesthesia enabled surgeons to carry out surgical operations of greater complexity and also created a need for more expert and educated patient caretakers for the intra- and post-operative periods.

Dorothea Lynde Dix appointed to superintend female nurses for the Union army during the Civil War

More than 20,000 northern and southern women engaged in relief work during the Civil War. A great amount of this was the delivery of nursing care. Several women, such as Sojourner Truth, Harriet Tubman, Susie Taylor, Mary Livermore, and Mary Ann Bickerdyke (Mother Bickerdyke), achieved recognition for their nursing activities during the war. Approximately 617 Catholic sisters from 21 different religious communities, many with hospital nursing experience, served both Union and Confederate soldiers in army hospitals, on battlefields, and on hospital ships. Catholic sisters did not volunteer individually for nursing service; rather authorities such as medical and army officers or priest superiors specifically requested them and in response their religious orders sent the sisters to nurse the sick and wounded.

Woman’s Hospital of Philadelphia offers a six month, course in nursing

This course, under the direction of physician Ann Preston, awarded its first diploma in 1869 and is considered the first state chartered school for nurses in the United States. In the 1860s, several women physicians in Boston and New York including Susan Dimock and Marie Zakrzewska established formal training schools for nurses in hospitals they began for treating poor women and training other women physicians.

These first formal training schools had similar structures. At the Woman’s Hospital training school, for example, women who nursed families and those who planned to nurse as an occupation received the same theoretical instruction: each term they sat side-by-side in the Woman’s Hospital classrooms. The ladies who were in the program to learn how to nurse sick family members paid two dollars for a course of ten lectures on nursing. Those nurses expecting to follow the occupation of nursing paid seventy-five cents a course or ten cents for a single lecture. Apart from sporadic supervision on the wards, there was little that differentiated the instruction of mothers from that of trained nurses. The most important difference, however, lay in the nurses’ expertise in the skilled work of nursing and their ability to look more carefully and closely at their patients bodies developed in the three months they would, much like physicians, apprentice on the hospital’s wards, bartering day-to-day care of patients for experience.

Joseph Lister publishes the successful results of his antiseptic and asepsis regimen for surgical patients in the British medical journal The Lancet

The use of antiseptic, the inhibition of the growth of microorganisms, and aseptic, the removal of all pathogenic microorganisms, techniques during surgical procedures demonstrated that the rate of overwhelming surgical infection could be reduced dramatically. Acceptance of Lister’s methods, which came to be called “Listerism,” was neither immediate nor universal. Yet, over a period of time, Lister’s techniques, as well as additional regimens intended to reduce infection such as doctors’ and nurses’ use of rubber gloves and masks during surgical procedures, became normative practice in hospitals. Application of antiseptic and aseptic techniques required a corps of workers expert in carrying out such regimens and led to calls for an educated, organized nurse workforce.

Samuel Gross, president of the American Medical Association, presents a report to the association, “Remarks on the Training of Nurses,” in favor of nurse training

The relatively new American Medical Association, founded in 1847, turned to Samuel Gross, an eminent Civil War surgeon and professor at Jefferson Medical College in Philadelphia, to examine and report on the best methods for organizing and running institutions that would formally train nurses. There was little new and even less that was controversial in his 1869 report: Gross called for women with some education, a gentle disposition, good powers of observation, and great powers of endurance. Gross saw nursing as a carefully honed medical intervention. While he did not think the nurse was more valuable than the physician, he did claim that she was “often incomparably more valuable than his most skillful medication.” Gross also believed that carefully trained nurses were a critical part of medicine’s own reform agenda. The nurse, Gross reminded his American Medical Association audience, “can do much to correct the errors of an ignorant, careless, or unscrupulous physician.”¹

¹ Samuel Gross, “Report of the Committee on the Training of Nurses.” Transactions of the American Medical Association, 1896: 161-74