Given the rigors of hospital life, the stigma of charity that accompanied hospi- tal care, and the popular association of hospitals with death, early 19th-century Americans entered hospitals only as a last resort. During the Civil War, however, the need to care for sick and wounded soldiers led to significant improvements in hospital organization and care, at least for the bet- ter-financed Union Army. These changes demonstrated that hospitals need not be either deadly or dehumanizing.
After the war, widespread adoption of new ideas about the dangers of germs and the importance of cleanliness helped make hospitals safer and more pleasant. So, too, did technological changes such as the development of disposable gauze and cheaper linens, which made cleanliness feasible. Concurrently, population increases (through births and immigration), the movement from farms to overcrowded cities, and the rise of dangerous factories led to a rise in both contagious diseases and serious accidents. These changes increased patient demand for hospitals. Meanwhile, doctors also began pushing for hospital construction to gain access to new medical technologies and sterile surgical theaters.