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INTRODUCTION

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Since early human history and throughout many cultures, accessing a healer or someone with “expert health knowledge” was considered beneficial in alleviating maladies. Healers such as shamans, priests, and medicine men or women are known to have been part of prehistoric cultures. These healers normally required communication with and ideally visualization of the patient in order to diagnose and treat. 1 In many cultures, over time, healers became known as physicians; the first acknowledged physician, an Egyptian named Imhotep, lived during the 27th century BCE. 1 By 420 BCE medicine began to develop standards, with Hippocrates credited for initiating the age of “rational medicine.” That era was characterized by the development of the idea that diseases have natural causes and the origination of the concept of ethics in medicine, perpetuated as the Hippocratic Oath. The Asclepion Temples that the Greeks erected became some of the world's first health centers. 2 People (pilgrims) traveled great distances to these temples to seek medical advice, prognosis, and healing. 2,3 In approximately 300 BCE in India, specific structures were constructed for health care, with basic sanitization standards. 4 Around 100 BCE, the Romans erected buildings called valetudinarians for the care of sick slaves, gladiators, and soldiers. 3 With the fall of the Roman, Greek, and Egyptian civilizations came a decline in the formal study and practice of medicine in these cultures. 5

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Medical care improved in the early Middle Ages (6th to 10th century CE), when an infirmary became an established part of nearly every monastery, under the influence of the Benedictine Order. Also during that time the first medical schools were opened. Quite possibly the earliest, reported to have developed out of a monastery dispensary, was the Schola Medica Salernitana at Salerno in southern Italy. 6 During the late Middle Ages (beyond the 10th century) monastic infirmaries continued to expand, and public hospitals were opened, financed by city authorities, the church, and private sources. Specialized institutions, including leper houses, also originated at this time. 7

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Health care evolved over time, from a largely nonscientific discipline involving home remedies and traveling doctors, to one encompassing vast amounts of scientific knowledge, increasingly reliant on technology, technical expertise, and complex systems of care. The work of Benjamin Franklin and Dr. Thomas Bond led to the establishment of Pennsylvania Hospital, which upon its opening in 1751 became the first hospital in the continental United States. 8 This was followed by New York Hospital, which was chartered in 1771. During the 1800s, significant advancements began to occur, including the development of the stethoscope, antiseptic surgery, anesthesia, germ theory, and vaccines. During this time, Johns Hopkins and other academic centers were built. However, despite the development of formal hospitals, physicians generally performed medical care in the homes of their patients, a practice that continued throughout that century. 9 As the equipment and treatments became more sophisticated and cumbersome, physicians opened ...

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