Wealthy Americans considered almshouse conditions quite acceptable for those they regarded as lazy, insolent, alcoholic, promiscuous, or incurable (categories they believed included all nonwhites). By the end of the 18th century, however, wealthy Americans began to view these conditions as unacceptable for those they considered the “deserving” poor—the respectable widow, the worker disabled by an accident, or the sailor struck by illness far from home. With such individuals in mind, philanthropists decided to develop a new form of institution, the hospital, devoted to inpatient care of the “deserving” sick—so long as they didn’t suffer from chronic, contagious, or mental illnesses. These hos- pitals were nonprofit and became known as voluntary hospitals because they relied heavily on unpaid (volunteer) charity work.
Although hospitals offered better conditions than did almshouses, they remained chaotic and dirty places. According to historian Charles Rosenberg:
Nurses were often absent from assigned wards and servants insolent or evasive. Chamber pots [used for urinating and defecating] remained unemptied for hours under wooden bedsteads, and mattresses were still made of coarse straw packed tightly inside rough ticking. Vermin continued to be almost a condition of life among the poor and working people who populated the hospital’s beds, and lice, bedbugs, flies, and even rats were tenacious realities of hospital life. These conditions, plus the severe limitations of contemporary medicine, kept mortality rates high and taught the public to associate hospitals with death rather than treatment. To make matters even worse, hospitals functioned as total in- stitutions (described in Chapter 7) in which patients traded individual rights for health care. Hospital rules regulated patients’ every hour, even mandating work schedules for those who were physically capable. Patients who didn’t follow the rules could find themselves thrown into punish- ment cells or frigid showers.