The American Hospital
Few institutions have undergone as radical a transformation as the hospital has in its modern history. It is perhaps distinctive among social institutions in having first been built for and primarily used by poor people and only later used in significant numbers by wealthier people. In the United States the change began in the second half of the nineteenth century with the scientific redefinition of the hospital and its incorporation into medicine. We now think of hospitals as the most visible embodiment of medical care in its technically most sophisticated form, but in the past hospitals and medical practice had had relatively little to do with each other. From their earliest origins in preindustrial societies, hospitals had been primarily religious and charitable institutions for tending to sick people, rather than medical institutions for curing them. In Europe from the eighteenth century, hospitals played an important part in medical education and research, whereas systematic clinical instruction and investigation were neglected in the United States until the founding of Johns Hopkins University in 1876. Before the Civil War (1861-1865)， an American doctor might have contentedly spent an entire career in practice without setting foot in a hospital ward. The hospital did not intrude on the worries of the typical practitioner, nor did the practitioner intrude on the routine of the hospital.
But in a matter of decades, roughly between 1870 and 1910， hospitals moved from the periphery to the center of medical education and medical practice. From refuges mainly for the homeless poor and insane, they evolved into doctors’ workshops for all types and classes of patients. From charities, dependent on voluntary gifts, they developed into market institutions, financed increasingly out of payments from patients. What drove this transformation was not simply the advance of science, important though that was, but the demands and example of an industrializing capitalist society, which brought larger numbers of people into urban centers, detached them from traditions of self-sufficiency, and projected ideals of specialization and technical competence. The same forces that promoted the rise of hospitals also brought about changes in their internal organization. Authority over the conduct of the institution passed from the trustees (group of people given high- level control) to the physicians and administrators. Nursing became a trained profession, and the division of medical labor was refined and intensified as conceptions of efficient and rational organization prevailing elsewhere in the economy were applied to care of the sick. The sick began to enter hospitals, not for the duration of an illness, but only during its acute phase to have some work performed on them. The hospital took on a more activist posture: it was no longer a place of sorrow and charity but a workplace for the production of health.
The effects of this change rippled outward, altering the relationship of doctors to hospitals and to one another and shaping the development of the hospital system as a whole. Once the hospital became an integral part of medical practice, control over access to its facilities became a strategic basis of power within the medical community. The tight grip that a narrow elite long held over hospitals no longer seemed tolerable to other physicians, who responded by forming their own institutions or pressing for access to established ones. Under financial pressures and the threat of increased competition, the older hospitals gradually opened their doors to larger numbers of practitioners, creating a wider network of associations stratifying and linking together the profession in new and unexpected ways.
The access that private practitioners gained to hospitals without becoming their employees became one of the distinctive features of medical care in the United States, with consequences not fully appreciated even today. In Europe and most other areas of the world, when patients enter a hospital today, their doctors typically relinquish responsibility to the hospital staff, who form a separate and distinct group within the profession. But in the United States, private doctors follow their patients into the hospital, where they continue to attend them. This arrangement complicates hospital administration, since many of the people making vital decisions are not the institution’s employees. Yet it also may encourage more private relationships between doctors and patients than exist where patients are attended solely by salaried hospital physicians.
1
Few institutions have undergone as radical a transformation as the hospital has in its modern history. It is perhaps distinctive among social institutions in having first been built for and primarily used by poor people and only later used in significant numbers by wealthier people. In the United States the change began in the second half of the nineteenth century with the scientific redefinition of the hospital and its incorporation into medicine. We now think of hospitals as the most visible embodiment of medical care in its technically most sophisticated form, but in the past hospitals and medical practice had had relatively little to do with each other. From their earliest origins in preindustrial societies, hospitals had been primarily religious and charitable institutions for tending to sick people, rather than medical institutions for curing them. In Europe from the eighteenth century, hospitals played an important part in medical education and research, whereas systematic clinical instruction and investigation were neglected in the United States until the founding of Johns Hopkins University in 1876. Before the Civil War (1861-1865)， an American doctor might have contentedly spent an entire career in practice without setting foot in a hospital ward. The hospital did not intrude on the worries of the typical practitioner, nor did the practitioner intrude on the routine of the hospital.
According to paragraph 1， which of the following was true of early nineteenth-century American hospitals?
Factual Information Questions事实信息题
AThey allowed doctors to practice medicine in them.
BThey focused mainly on looking after people who were ill.
CThey included regular clinical training.
DThey provided a place for practitioners to conduct research.
2
But in a matter of decades, roughly between 1870 and 1910， hospitals moved from the periphery to the center of medical education and medical practice. From refuges mainly for the homeless poor and insane, they evolved into doctors’ workshops for all types and classes of patients. From charities, dependent on voluntary gifts, they developed into market institutions, financed increasingly out of payments from patients. What drove this transformation was not simply the advance of science, important though that was, but the demands and example of an industrializing capitalist society, which brought larger numbers of people into urban centers, detached them from traditions of self-sufficiency, and projected ideals of specialization and technical competence. The same forces that promoted the rise of hospitals also brought about changes in their internal organization. Authority over the conduct of the institution passed from the trustees (group of people given high- level control) to the physicians and administrators. Nursing became a trained profession, and the division of medical labor was refined and intensified as conceptions of efficient and rational organization prevailing elsewhere in the economy were applied to care of the sick. The sick began to enter hospitals, not for the duration of an illness, but only during its acute phase to have some work performed on them. The hospital took on a more activist posture: it was no longer a place of sorrow and charity but a workplace for the production of health.
According to paragraph 2， patients in American hospitals before 1870 differed from patients in modern hospitals in which of the following ways?
Factual Information Questions事实信息题
ATheir decision to receive care in hospitals was voluntary.
BThey were treated by their doctors mainly to advance medical science.
CThey came from the physical periphery of urban populations.
DThey came from a smaller number of social groups.
3
But in a matter of decades, roughly between 1870 and 1910， hospitals moved from the periphery to the center of medical education and medical practice. From refuges mainly for the homeless poor and insane, they evolved into doctors’ workshops for all types and classes of patients. From charities, dependent on voluntary gifts, they developed into market institutions, financed increasingly out of payments from patients. What drove this transformation was not simply the advance of science, important though that was, but the demands and example of an industrializing capitalist society, which brought larger numbers of people into urban centers, detached them from traditions of self-sufficiency, and projected ideals of specialization and technical competence. The same forces that promoted the rise of hospitals also brought about changes in their internal organization. Authority over the conduct of the institution passed from the trustees (group of people given high- level control) to the physicians and administrators. Nursing became a trained profession, and the division of medical labor was refined and intensified as conceptions of efficient and rational organization prevailing elsewhere in the economy were applied to care of the sick. The sick began to enter hospitals, not for the duration of an illness, but only during its acute phase to have some work performed on them. The hospital took on a more activist posture: it was no longer a place of sorrow and charity but a workplace for the production of health.
Which of the sentences below best expresses the essential information in the highlighted sentence in the passage? Incorrect choices change the meaning in important ways or leave out essential information.
Sentence Simplification Questions句子简化题
AThis transformation occurred as large numbers of people who wanted access to better medical care moved to urban areas, where an expectation of specialization and competence was developing.
BThis transformation came about as medical science advanced and industrializing capitalism drew doctors to urban centers, encouraging self-sufficiency through specialization.
CThis change came about because of scientific advances and capitalist industrialization, which brought many people into cities, cut them off from traditions of independence, and promoted certain ideals in medical practice.
DWhat caused these changes were not scientific advances but rather the demands of people in urban centers, where technical competence was replacing specialization as an ideal.
4
But in a matter of decades, roughly between 1870 and 1910， hospitals moved from the periphery to the center of medical education and medical practice. From refuges mainly for the homeless poor and insane, they evolved into doctors’ workshops for all types and classes of patients. From charities, dependent on voluntary gifts, they developed into market institutions, financed increasingly out of payments from patients. What drove this transformation was not simply the advance of science, important though that was, but the demands and example of an industrializing capitalist society, which brought larger numbers of people into urban centers, detached them from traditions of self-sufficiency, and projected ideals of specialization and technical competence. The same forces that promoted the rise of hospitals also brought about changes in their internal organization. Authority over the conduct of the institution passed from the trustees (group of people given high- level control) to the physicians and administrators. Nursing became a trained profession, and the division of medical labor was refined and intensified as conceptions of efficient and rational organization prevailing elsewhere in the economy were applied to care of the sick. The sick began to enter hospitals, not for the duration of an illness, but only during its acute phase to have some work performed on them. The hospital took on a more activist posture: it was no longer a place of sorrow and charity but a workplace for the production of health.
The word “prevailing”in the passage is closest in meaning to
Vocabulary Questions词汇题
Adominant
Battempted
Ccreated
Ddeveloping
5
But in a matter of decades, roughly between 1870 and 1910， hospitals moved from the periphery to the center of medical education and medical practice. From refuges mainly for the homeless poor and insane, they evolved into doctors’ workshops for all types and classes of patients. From charities, dependent on voluntary gifts, they developed into market institutions, financed increasingly out of payments from patients. What drove this transformation was not simply the advance of science, important though that was, but the demands and example of an industrializing capitalist society, which brought larger numbers of people into urban centers, detached them from traditions of self-sufficiency, and projected ideals of specialization and technical competence. The same forces that promoted the rise of hospitals also brought about changes in their internal organization. Authority over the conduct of the institution passed from the trustees (group of people given high- level control) to the physicians and administrators. Nursing became a trained profession, and the division of medical labor was refined and intensified as conceptions of efficient and rational organization prevailing elsewhere in the economy were applied to care of the sick. The sick began to enter hospitals, not for the duration of an illness, but only during its acute phase to have some work performed on them. The hospital took on a more activist posture: it was no longer a place of sorrow and charity but a workplace for the production of health.
Why does the author mention that the sick no longer remained in hospitals “for the duration of an illness”?
Rhetorical Purpose Questions修辞目的题
ATo point out one effect of requiring patients to pay for their medical care
BTo indicate that hospitals became more effective at ending illnesses quickly after nursing became a trained profession
CTo suggest that hospitals encouraged patients to recover from illnesses outside the hospital
DTo help support the claim that the care of patients was reorganized to promote greater efficiency
6
The effects of this change rippled outward, altering the relationship of doctors to hospitals and to one another and shaping the development of the hospital system as a whole. Once the hospital became an integral part of medical practice, control over access to its facilities became a strategic basis of power within the medical community. The tight grip that a narrow elite long held over hospitals no longer seemed tolerable to other physicians, who responded by forming their own institutions or pressing for access to established ones. Under financial pressures and the threat of increased competition, the older hospitals gradually opened their doors to larger numbers of practitioners, creating a wider network of associations stratifying and linking together the profession in new and unexpected ways.
The word “integral”in the passage is closest in meaning to
Vocabulary Questions词汇题
Anecessary
Brespected
Cpopular
Ddominant
7
The effects of this change rippled outward, altering the relationship of doctors to hospitals and to one another and shaping the development of the hospital system as a whole. Once the hospital became an integral part of medical practice, control over access to its facilities became a strategic basis of power within the medical community. The tight grip that a narrow elite long held over hospitals no longer seemed tolerable to other physicians, who responded by forming their own institutions or pressing for access to established ones. Under financial pressures and the threat of increased competition, the older hospitals gradually opened their doors to larger numbers of practitioners, creating a wider network of associations stratifying and linking together the profession in new and unexpected ways.
In paragraph 3， it can be inferred that some physicians began to form their own institutions for which of the following reasons?
Inference Questions推理题
AThey were excluded from practicing medicine in existing hospitals.
BThey were dissatisfied with the quality of the facilities at older hospitals.
CThe financial pressures of working with established hospitals were too great.
DThey wanted to practice medicine on larger numbers of patients.
8
The access that private practitioners gained to hospitals without becoming their employees became one of the distinctive features of medical care in the United States, with consequences not fully appreciated even today. In Europe and most other areas of the world, when patients enter a hospital today, their doctors typically relinquish responsibility to the hospital staff, who form a separate and distinct group within the profession. But in the United States, private doctors follow their patients into the hospital, where they continue to attend them. This arrangement complicates hospital administration, since many of the people making vital decisions are not the institution’s employees. Yet it also may encourage more private relationships between doctors and patients than exist where patients are attended solely by salaried hospital physicians.
Why does the author discuss doctors who “relinquish responsibility to the hospital staff”when their patients enter the hospital?
Rhetorical Purpose Questions修辞目的题
ATo help clarify why the professional status of doctors in American hospitals is unusual
BTo suggest the limited medical value of private practitioners’ gaining access to hospitals
CTo indicate one reason that doctors in Europe and most other areas of the world formed professional groups
DTo demonstrate the particular flexibility of European doctors
9
Few institutions have undergone as radical a transformation as the hospital has in its modern history. It is perhaps distinctive among social institutions in having first been built for and primarily used by poor people and only later used in significant numbers by wealthier people. In the United States the change began in the second half of the nineteenth century with the scientific redefinition of the hospital and its incorporation into medicine. We now think of hospitals as the most visible embodiment of medical care in its technically most sophisticated form, but in the past hospitals and medical practice had had relatively little to do with each other. From their earliest origins in preindustrial societies, hospitals had been primarily religious and charitable institutions for tending to sick people, rather than medical institutions for curing them. ⬛ In Europe from the eighteenth century, hospitals played an important part in medical education and research, whereas systematic clinical instruction and investigation were neglected in the United States until the founding of Johns Hopkins University in 1876. ⬛ Before the Civil War (1861-1865)， an American doctor might have contentedly spent an entire career in practice without setting foot in a hospital ward. ⬛ The hospital did not intrude on the worries of the typical practitioner, nor did the practitioner intrude on the routine of the hospital.⬛
Look at the four squaresthat indicate where the following sentence could be added to the passage
This restricted view of hospitals was not universal.Insert Text Questions句子插入题
Where would the sentence best fit？Click on a square sentence to the passage.
10
In its modern history, the hospital has undergone significant changes in the United States and elsewhere.
Prose Summary Questions概要小结题
Select 3 answers
AIn Europe and the United States, hospitals were founded as charitable institutions, but by the early twentieth century American hospitals were funding themselves by charging patients fees.
BAmerican doctors were rarely involved with hospitals until the late nineteenth century, when hospitals in the United States began to focus on providing science-based medical care.
COlder hospitals closed down because of financial pressures and increased competition from newer hospitals staffed by complex networks of medical professionals.
DIn Europe, modern hospitals first emerged within universities, but in the United States, modern hospitals first emerged to meet the urgent medical needs created by the Civil War (1861-1865).
EWith hospitals becoming market institutions at the end of the nineteenth century, high-level control was given to trustees, whose business expertise helped ensure that hospitals remained profitable.
FAs American hospitals grew, medical care was conducted rationally, nursing became a trained profession, and American doctors worked to maintain private relationships with patients in hospital settings.
