This paper focuses on structural development of institution-based medical specialism in the USA in the first third of the twentieth century. It examines organizational ideas of key reformers and specialty leaders and it examines corresponding characteristics of the institutions they built. The structural characteristics which they incorporated into medical care embodied forms of economic organization of the time. Leaders (variously) explained their reform activities in terms of scientific, professional, and/or economic development of medicine. The first section describes a form of specialization within academic medical centres as a vertical functional division of labour which divided medical work into procedures performed by a range of personnel. This division of labour and its required management changed the work of doctors and nurses and required a multiplication of 'auxiliary' hospital staff, as shown in the second section. The final section demonstrates how the departmental structure within academic medical centres provided a necessary institutional framework for vertical specialism. The literature has emphasized the fact that an industrial model was only partly implemented in medical care at the time. Nevertheless, the (industrial) characteristics identified had a significant impact on fundamental structures of twentieth-century medicine.
{"title":"Shaping institution-based specialism: early twentieth-century economic organization of medicine.","authors":"B. B. Perkins","doi":"10.1093/SHM/10.3.419","DOIUrl":"https://doi.org/10.1093/SHM/10.3.419","url":null,"abstract":"This paper focuses on structural development of institution-based medical specialism in the USA in the first third of the twentieth century. It examines organizational ideas of key reformers and specialty leaders and it examines corresponding characteristics of the institutions they built. The structural characteristics which they incorporated into medical care embodied forms of economic organization of the time. Leaders (variously) explained their reform activities in terms of scientific, professional, and/or economic development of medicine. The first section describes a form of specialization within academic medical centres as a vertical functional division of labour which divided medical work into procedures performed by a range of personnel. This division of labour and its required management changed the work of doctors and nurses and required a multiplication of 'auxiliary' hospital staff, as shown in the second section. The final section demonstrates how the departmental structure within academic medical centres provided a necessary institutional framework for vertical specialism. The literature has emphasized the fact that an industrial model was only partly implemented in medical care at the time. Nevertheless, the (industrial) characteristics identified had a significant impact on fundamental structures of twentieth-century medicine.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91282519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article examines shifts in attitudes and changes in provision with regard to never-married mothers within three broad chronological periods. The first section considers attitudes towards these mothers in the period 1918-45, when the issue was conceptualized as one of public health and moral welfare. Second, the article examines the period between 1945 and 1970, when the dominant professional view of never-married mothers focused on identifying individual pathology, but when significant continuities in treatment can nevertheless be found. Third, the article looks briefly at the substantial change in policy and provision for what were then called 'one-parent families' during the 1970s. In conclusion it argues that while there were substantial changes in terms of the way in which unmarried motherhood was defined, from the point of view of the unmarried mothers themselves the continuities have been more striking. Unmarried mothers have been persistently singled out and labelled a social problem and, in all but a brief period during the late 1960s and 1970s, also as a moral problem.
{"title":"The issue of never-married motherhood in Britain, 1920-70.","authors":"J. Lewis, J. Welshman","doi":"10.1093/SHM/10.3.401","DOIUrl":"https://doi.org/10.1093/SHM/10.3.401","url":null,"abstract":"This article examines shifts in attitudes and changes in provision with regard to never-married mothers within three broad chronological periods. The first section considers attitudes towards these mothers in the period 1918-45, when the issue was conceptualized as one of public health and moral welfare. Second, the article examines the period between 1945 and 1970, when the dominant professional view of never-married mothers focused on identifying individual pathology, but when significant continuities in treatment can nevertheless be found. Third, the article looks briefly at the substantial change in policy and provision for what were then called 'one-parent families' during the 1970s. In conclusion it argues that while there were substantial changes in terms of the way in which unmarried motherhood was defined, from the point of view of the unmarried mothers themselves the continuities have been more striking. Unmarried mothers have been persistently singled out and labelled a social problem and, in all but a brief period during the late 1960s and 1970s, also as a moral problem.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89632459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper explores the social and medical history and context of pink disease (acrodynia), a serious disease of infants and young children that baffled the medical world during the first half of the twentieth century until it was shown to be caused by mercury poisoning. In the English-speaking world the commonest source of the mercury was teething powders, which were widely available and advertised with increasing sophistication. Efforts to control them (such as the BMJ's campaign against 'Secret Remedies') were as yet unsuccessful. The article discusses the social conditions that influenced the existence and recognition of pink disease, the delay in finding its cause, the way in which it was explained as a virus infection or nutritional deficiency and why it seldom occurred outside the teething period. It discusses both professional and lay attitudes to health and diseases during the early twentieth century and provides a model of how the disease developed in a specific social setting and how the medical profession attempted to deal with it within the limitations of contemporary professional thought. The resistance to the evidence of mercury poisoning is typical of resistance to new medical knowledge and declined only when the opponents and sceptics grew old and disappeared from the scene. Meanwhile, the cause having been identified and accepted, pink disease disappeared, but its consequences emerged much later, in an unexpected quarter, as a cause of male infertility.
{"title":"The rise and fall of pink disease.","authors":"A. Dally","doi":"10.1093/SHM/10.2.291","DOIUrl":"https://doi.org/10.1093/SHM/10.2.291","url":null,"abstract":"This paper explores the social and medical history and context of pink disease (acrodynia), a serious disease of infants and young children that baffled the medical world during the first half of the twentieth century until it was shown to be caused by mercury poisoning. In the English-speaking world the commonest source of the mercury was teething powders, which were widely available and advertised with increasing sophistication. Efforts to control them (such as the BMJ's campaign against 'Secret Remedies') were as yet unsuccessful. The article discusses the social conditions that influenced the existence and recognition of pink disease, the delay in finding its cause, the way in which it was explained as a virus infection or nutritional deficiency and why it seldom occurred outside the teething period. It discusses both professional and lay attitudes to health and diseases during the early twentieth century and provides a model of how the disease developed in a specific social setting and how the medical profession attempted to deal with it within the limitations of contemporary professional thought. The resistance to the evidence of mercury poisoning is typical of resistance to new medical knowledge and declined only when the opponents and sceptics grew old and disappeared from the scene. Meanwhile, the cause having been identified and accepted, pink disease disappeared, but its consequences emerged much later, in an unexpected quarter, as a cause of male infertility.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77775147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper describes the results of a search for the obstetric records of a cohort of over 5,000 children who participated in surveys of childhood diet and growth during the late 1930s and early 1940s conducted by the Rowett Research Institute in Aberdeen. The surveys were conducted at sixteen centres throughout England and Scotland. Birth-weight data were found in hospitals, health authority archives and local authority record offices for approximately 10 per cent of these children. The sources and methods used to find the records are described and their representativeness is evaluated. It is anticipated that this report will be of some interest to medical historians and epidemiologists conducting retrospective studies.
{"title":"Finding and using inter-war maternity records.","authors":"M. Kemp, D. Gunnell, G. Davey Smith, S. Frankel","doi":"10.1093/SHM/10.2.305","DOIUrl":"https://doi.org/10.1093/SHM/10.2.305","url":null,"abstract":"This paper describes the results of a search for the obstetric records of a cohort of over 5,000 children who participated in surveys of childhood diet and growth during the late 1930s and early 1940s conducted by the Rowett Research Institute in Aberdeen. The surveys were conducted at sixteen centres throughout England and Scotland. Birth-weight data were found in hospitals, health authority archives and local authority record offices for approximately 10 per cent of these children. The sources and methods used to find the records are described and their representativeness is evaluated. It is anticipated that this report will be of some interest to medical historians and epidemiologists conducting retrospective studies.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86984297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The inter-war years in the UK were notable for debates about the extent to which an extension of state intervention in hospital provision was desirable and necessary, and about the limits to and future of the voluntary hospital system which relied largely on various forms of private charity. These themes were intertwined in the UK's 'Special Areas', locations recognized as having suffered adversely from the inter-war depression, with consequent effects on their ability to finance desirable investments in social infrastructures. Grant aid was offered to hospitals in these locations under the terms of the Special Areas legislation of 1934, but there were extensive debates about the principle and practice of such subsidies to hospital development. This paper reviews these debates and considers whether the measures taken by the Commissioners can be seen as neglected antecedents of the regionalism detected in British hospital policy by several commentators.
{"title":"Neglected roots of regionalism? The Commissioners for the special areas and grants to hospital services in the 1930s.","authors":"J. Mohan","doi":"10.1093/SHM/10.2.243","DOIUrl":"https://doi.org/10.1093/SHM/10.2.243","url":null,"abstract":"The inter-war years in the UK were notable for debates about the extent to which an extension of state intervention in hospital provision was desirable and necessary, and about the limits to and future of the voluntary hospital system which relied largely on various forms of private charity. These themes were intertwined in the UK's 'Special Areas', locations recognized as having suffered adversely from the inter-war depression, with consequent effects on their ability to finance desirable investments in social infrastructures. Grant aid was offered to hospitals in these locations under the terms of the Special Areas legislation of 1934, but there were extensive debates about the principle and practice of such subsidies to hospital development. This paper reviews these debates and considers whether the measures taken by the Commissioners can be seen as neglected antecedents of the regionalism detected in British hospital policy by several commentators.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76086843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This essay documents how, in the 1940s and early 1950s, one scientifically discredited racialist assumption, namely the notion that 'hybridity', embodied by the 'American Negro', and linked to degeneration and disease, was re-authorized, again by science, through the discursive fusion of anthropology, medicine and genetics in the context of a particular disease--sickle cell anaemia. More specifically, I am concerned with the construction of what came to be called an 'anthropathology' of the 'American Negro', the discourse networks that situated it, its conditions of possibility and its consequences.
{"title":"An 'anthropathology' of the 'American Negro': anthropology, genetics, and the new racial science, 1940-1952.","authors":"M. Tapper","doi":"10.1093/SHM/10.2.263","DOIUrl":"https://doi.org/10.1093/SHM/10.2.263","url":null,"abstract":"This essay documents how, in the 1940s and early 1950s, one scientifically discredited racialist assumption, namely the notion that 'hybridity', embodied by the 'American Negro', and linked to degeneration and disease, was re-authorized, again by science, through the discursive fusion of anthropology, medicine and genetics in the context of a particular disease--sickle cell anaemia. More specifically, I am concerned with the construction of what came to be called an 'anthropathology' of the 'American Negro', the discourse networks that situated it, its conditions of possibility and its consequences.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79192332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What is colonial about colonial medicine? And what has happened to imperialism and health?","authors":"S. Marks","doi":"10.1093/SHM/10.2.205","DOIUrl":"https://doi.org/10.1093/SHM/10.2.205","url":null,"abstract":"","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84986667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The reminiscences and personal testimony of retired pharmaceutical chemists provide a rich and valuable source of historical material, which can be used not only in tracing the history of the practice of pharmacy, but also for illuminating the social, political and economic context in which health care has been delivered during the course of the twentieth century. A wide range of accounts of the lives and work activities of pharmaceutical chemists now exists. Some of these are written, others have been recorded, and extracts from a number of these recordings have been published. The purpose of this paper is to describe and review the material currently available in relation to pharmacy in Great Britain.
{"title":"'I remember it well': oral history in the history of pharmacy.","authors":"Stuart Anderson","doi":"10.1093/SHM/10.2.331","DOIUrl":"https://doi.org/10.1093/SHM/10.2.331","url":null,"abstract":"The reminiscences and personal testimony of retired pharmaceutical chemists provide a rich and valuable source of historical material, which can be used not only in tracing the history of the practice of pharmacy, but also for illuminating the social, political and economic context in which health care has been delivered during the course of the twentieth century. A wide range of accounts of the lives and work activities of pharmaceutical chemists now exists. Some of these are written, others have been recorded, and extracts from a number of these recordings have been published. The purpose of this paper is to describe and review the material currently available in relation to pharmacy in Great Britain.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79371160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.
{"title":"Other than healing: medical practitioners and the business of life assurance during the nineteenth and early twentieth centuries.","authors":"M. Dupree","doi":"10.1093/SHM/10.1.79","DOIUrl":"https://doi.org/10.1093/SHM/10.1.79","url":null,"abstract":"The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75758471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper replies to the comments made by James C. Riley. It provides a defence of the assumptions adopted in 'Physician, heal thyself' (Social History of Medicine, 9(1996), 1-30) to estimate the average duration of work-preventing sickness experienced by members of the medical profession in England in the 1860s as well as offering some new estimates. It also provides further criticisms of Riley's contention that although the rate of mortality declined in England between the 1860s and 1890s that of morbidity increased, which is based on surveys of friendly society members. In doing so it reiterates the warning given by Jacques Bertillon in 1892 concerning the use of friendly society surveys for the measurement of variations and trends in morbidity patterns by age.
本文对James C. Riley的评论进行了回复。它为“医生，治愈你自己”(医学社会史，9(1996)，1-30)中采用的假设提供了辩护，以估计19世纪60年代英国医疗专业人员经历的工作预防疾病的平均持续时间，并提供了一些新的估计。它还对莱利的论点提出了进一步的批评，莱利认为，尽管英国的死亡率在19世纪60年代到90年代之间有所下降，但发病率却有所上升，这是基于对友好社会成员的调查。在这样做的过程中，它重申了雅克·贝蒂隆在1892年提出的关于使用友好社会调查来衡量年龄发病率模式的变化和趋势的警告。
{"title":"'Sickness is a baffling matter'. A reply to James C. Riley.","authors":"R. Woods","doi":"10.1093/shm/10.1.157","DOIUrl":"https://doi.org/10.1093/shm/10.1.157","url":null,"abstract":"This paper replies to the comments made by James C. Riley. It provides a defence of the assumptions adopted in 'Physician, heal thyself' (Social History of Medicine, 9(1996), 1-30) to estimate the average duration of work-preventing sickness experienced by members of the medical profession in England in the 1860s as well as offering some new estimates. It also provides further criticisms of Riley's contention that although the rate of mortality declined in England between the 1860s and 1890s that of morbidity increased, which is based on surveys of friendly society members. In doing so it reiterates the warning given by Jacques Bertillon in 1892 concerning the use of friendly society surveys for the measurement of variations and trends in morbidity patterns by age.","PeriodicalId":68213,"journal":{"name":"医疗社会史研究","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90934707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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