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

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.

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.

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.

This article examines the place of emotion in modern hospital administration and the relationship between professional identities and emotional landscapes in the healthcare field. The focus is a broad emotional and philosophical investment that many administrators made in their work. In the United States and then in Britain, amidst rapid change in the practice and provision of health services, a new sense of professional identity emerged. This was often underpinned by a kind of emotional investment, one which had to be constructed and cultivated. Here formal training and education, collective identities, and a shared understanding of the kind of personal qualities required were important. The extent to which developments in Britain were influenced by best practice in the US is also striking. This process might best be understood as the further drawing out of established beliefs and ways of working rather than an abstract transfer of ideas and practices across the Atlantic, but there was a distinct Anglo-American dimension to the development of hospital administration.

For some post-Roe abortion providers, the emotional cost of their abortion practice was untenable. By the 1980s, former abortion providers had become prominent anti-abortion advocates. Although physicians such as Beverly McMillan grounded their pro-life conversions in medical technologies and "fetological" research, affective connections to the fetus animated their activism. McMillan explained that through abortion practice, the medical profession - her vocation - had gone astray, and her pro-life activism was the cure to the resulting emotional damage. For these physicians, emotional well-being could only be recovered through principled attempts to right the perceived wrongs of the medical profession. Another group of emotionally-engaged pro-life health workers emerged from their pasts as abortion patients. Myriad post-abortion narratives followed the same trajectory: the woman reluctantly underwent an abortion, and was subsequently plagued by apathy, depression, grief, guilt, and substance-use disorders. Pro-life research came to understand this cluster of symptoms as Post-abortion Syndrome (PAS). Some women, such as Susan Stanford-Rue, opted to heal from their pain by becoming PAS counselors. Just as the "reformed" physicians combined their affective experiences with their medical expertise to argue against abortion, the counselors merged emotion and psychiatric language to redefine what it meant to be an "aborted woman" and therefore a PAS counselor. Examining pro-life publications, Christian counseling manuals, and activist speeches, this article argues that, for these activists, science and technology provided the rationale to make abortion unthinkable, but it was the activists' emotional framework that made this rationale pro-life in the first place.

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.