T HE first general hospital in the United States was chartered in I76I by the Assembly of Pennsylvania under the auspices of Benjamin Franklin.' Over one hundred years later, in I873, the first census of hospitals in the United States was conducted by the Bureau of Education. This census revealed that there were I78 hospitals and 34,453 beds in existence at that time.2 With the growth of population and income in the United States, the number of hospitals grew rapidly after I873. Between I873 and I909, the number of hospitals increased over 24 times. The American Medical Directory of I909 listed 4,357 hospitals. Of these, 7I were federal, 230 state and 4,056 either private, church or church affiliated, or owned by local government. By I909, the number of hospital beds in existence was 42I,065.3 From I909 to