Journal of the History of Medicine and Allied Sciences最新文献

While most are aware of the Tuskegee syphilis experiments in which African American syphilis patients went untreated, less is known about experiments with malaria fever therapy conducted upon syphilis patients during the same period by the Unites States Public Health Service at the Williams Laboratory on the grounds of the South Carolina State Hospital (SCSH) in Columbia, SC. Over a twenty-year period, physicians maintained patients as malaria reservoirs for patient-to-patient inoculation and subjected patients to extreme fevers and thousands upon thousands of insect bites as part of a program in which one disease was tested as therapy for another. Using extant administrative files, medical journals from the period, and a database created from SCSH annual reports, this paper considers the ethics of malaria fever therapy experiments while exposing the conditions under which patients suffered the intersecting oppressions of race, class, and mental illness. It illuminates the prevalent scientific racism of the period that enabled pseudo-medical assumptions about African Americans' perceived penchant for poverty, deviant sex, and pain tolerance, which combined to enable a culture of experimentation that influenced events at Stateville Penitentiary and continued long after penicillin became widely available.

In the second half of the twentieth century, concerns about problems in the doctor-patient relationship gave way to a new medical discourse on suffering, owed largely to the work of American physician Eric Cassell. This article tracks the development of his theory of suffering and its global success in transforming tragic medical experiences into diagnosable clinical entities. Beginning with his intellectual development in the 1960s, this article traces Cassell's initial interest in suffering first to his early research on truth-telling and autonomy, followed by his pioneering work in bioethics. Although closely aligned with philosophy, much of the institutional success of bioethics came from American law, which affected Cassell's theorizing. At the same time, doctors experienced a growth in medical malpractice lawsuits, driven in large part by costly "pain and suffering" awards, which the medical community sought to curb by encouraging legislatures to codify informed consent. The success of these efforts mandated that doctors disclose previously withheld bad news capable of causing suffering. The cultural changes that followed these disclosures became Cassell's impetus, while legal pain and suffering supplied much of his theory's language and concepts.

This essay uses the unpublished casebook kept by the Tuscan surgeon Giovanbattista Nardi to examine the provision of urgent medical care in sixteenth-century Italian hospitals. Most major hospitals on the peninsula maintained separate therapeutic spaces known as medicherie for this purpose. Written in the 1580s while Nardi worked as a staff surgeon at a Florentine civic hospital, this rare surgical casebook provides insight into the types of institutional resources devoted to acute medical problems; the clientele seeking immediate assistance and the situations that brought them there; the treatments used to achieve short-term "cures"; and the clinical experiences of hospital surgeons who served as frontline healers. A close analysis of the seventy-nine cases recorded sheds new light on everyday surgical treatments for conditions ranging from serious head injuries requiring trephination to syphilitic lesions and genital trauma. Casebook entries also reveal Nardi's deep engagement with the composition and use of topical remedies as both practitioner and experimenter. Intended as a memory aid for future reference, the casebook shows material traces of the author's shifting occupational identity as he matured from hospital surgeon to university-trained physician. Viewed through multiple lenses, this richly layered source expands our understanding of both the practice and profession of early modern surgery.

Peptic ulcers were a common, and seemingly intractable, problem for surgeons in the US through the early twentieth century. Initial surgical efforts reduced operative mortality and achieved short term successes but failed to establish a definitive solution. The flawed successes of early ulcer surgery drove sustained effort to improve, producing a stream of novel operations over the decades. An examination of the history of ulcer surgery confirms the recent observation that surgical operations of this period were malleable entities subject to constant tinkering and repurposing. Yet, this dynamism in surgical practice remained in tension with conservative pressures, as surgeons hung on to familiar practices and sought to codify agreement on which operation served best for which purpose. Ulcer surgery became a workshop for attempts to resolve this tension. In this context, a canon of recognized operations emerged that accommodated novelties while preserving in surgical discourse an awareness of older operations. Established operations that fell from use literally remained on the books for decades. This compromise between innovation and operative conservatism favored the creative reuse of older ulcer operations, some repurposed, and some combined with other operations in new modular configurations. Ulcer surgery demonstrated recurring patterns of operative repurposing, reconfiguration, and modular recombination. This feature of twentieth-century ulcer surgery also highlights the attachment in modern surgical culture to the historicity of their endeavor, manifested for example in the wide use of eponyms and a fondness for deep genealogies of mentoring and training.

From the stress of burnout to the gratification of camaraderie, medicine is suffused with emotions that educators, administrators, and reformers have sought to shape. Yet historians of medicine have only begun to analyze how emotions have structured health care work. This introductory essay frames a special issue on health care practitioners' emotions in the twentieth-century United Kingdom and United States. We argue that the massive bureaucratic and scientific changes in medicine after the Second World War helped to reshape affective aspects of care. The articles in this issue emphasize the intersubjectivity of feelings in healthcare settings and the mutually constitutive relationship between patients' and providers' emotions. Bridging the history of medicine with the history of emotion demonstrates how emotions are instilled rather than innate, social as well as personal, and, above all else, change over time. The articles reckon with the power dynamics of healthcare. They address the policies and practices that institutions, organizations, and governments have implemented to shape, govern, or manage the affective experiences and well-being of healthcare workers. And they point to important new directions in the history of medicine.

Readers of Samuel Shem's medical satire The House of God (1978) have long worried about the bad attitude of his main characters: young male internal medicine trainees. This article examines the interns' atrocious affections, using the feminist classic Our Bodies, Ourselves (1973) as a counterweight to the masculinist perspective of House of God. These radically different critiques of United States medicine derive from a shared sociopolitical context and represent a historically specific response to the personal politics of sexual liberation and self-actualization in the 1970s. I show that Shem and the Boston Women's Health Book Collective share a rhetorical strategy of "loose expertise" grounded in embodied knowledge, which connects both texts to the radical social movements of the late 1960s. Loose expertise enables institutional critique by shifting the domain of knowledge away from traditional structures of authority, but inhibits intersectional critique by essentializing the individual subject position of the author. The article concludes by examining the relationship of both texts to the medical humanities.

A survivor of child sexual abuse felt that doctors missed opportunities to notice her distress when, at fourteen, she had an unexplained illness that lasted for a year. The cause, she wrote, was "explained by Doctors as psychological, but nobody questioned further. WHY??? … If adults don't listen[,] then we have no one to turn to." For decades, community health practitioners have been identified as an important group in protecting children from maltreatment, but survivor testimony and agency statistics demonstrate that they rarely receive verbal disclosures or recognize the physical or behavioural warning signs of sexual abuse. The accounts we have of the 1980s tell of swiftly heightening professional awareness, followed by a visceral backlash in the latter part of the decade that discouraged practitioners from acting on their concerns. This article uses trade and professional journals, training materials, textbooks, and new oral histories to consider why community-based doctors and nurses have struggled to notice and respond to the sexually abused child. It will argue that the conceptual model of child sexual abuse that community health practitioners encountered in the workplace encouraged a mechanical and procedural response to suspicions of abuse. In a highly gendered and contested workplace, practitioners' feelings about how survivors, non-abusing family members, and perpetrators should be understood were rarely debated in training or in practice. The emotional cost to the practitioners of engagement with sexual abuse, and their need for spaces of reflexivity and structures of support, were ignored.