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A Hospital of Their Own

Lisa Levenstein

in A Movement Without Marches: African American Women and the Politics of Poverty in Postwar Philadelphia

This chapter examines the publicly provided health care at Philadelphia General Hospital (PGH), which was of critical importance to poor African American women, who needed a safe and respectful place ... More

This chapter examines the publicly provided health care at Philadelphia General Hospital (PGH), which was of critical importance to poor African American women, who needed a safe and respectful place to care for their own and their children's medical needs. This hospital was the most successful institution in the city in terms of the quality of the services it provided and the loyalty it commanded from a wide range of citizens. As increasing numbers of African American women sought and received subsidized treatment at PGH, critics charged that its policies encouraged “illegitimacy” and irresponsible state expenditures. Yet these same policies played a vital role in encouraging and enabling working-class African American women to choose PGH over all of the other hospitals in the city and turn it into a place they called their own.Less

Maximalist Medicine at Walter Reed

in War's Waste: Rehabilitation in World War I America

This chapter reports that rehabilitation played a role in the shaping of the modern American hospital. Leo Mayer and other like-minded rehabilitation advocates supported state medicine rather than ... More

This chapter reports that rehabilitation played a role in the shaping of the modern American hospital. Leo Mayer and other like-minded rehabilitation advocates supported state medicine rather than state pensions. William Borden's most powerful argument for the creation of Walter Reed Hospital was that it would “reduce the pension list.” As Borden showed using the pension system numbers, additional medical services would cost the government less. In addition to the appliance shop, orthopedists at Walter Reed and Letterman General Hospitals supervised the construction of physiotherapy buildings, spaces outfitted for hydrotherapy, mechanotherapy, electrotherapy, massage, and exercise. The most crucial part of making these rehabilitation hospitals was the introduction of “curative workshops.” In general, rehabilitation hospitals such as Walter Reed and Letterman tried to decrease long-term involvement of the government in the veterans' everyday life through medicine.Less

Perspective: Actor Tristan Rogers on Changes in Soaps’ Industry, Audiences, and Texts

Abigail De Kosnik

in The Survival of Soap Opera: Transformations for a New Media Era

This chapter presents Rogers’ views about the many changes in soap operas during his stints on ABC’s General Hospital, in a role that has spanned almost three decades. Topics discussed include the ... More

This chapter presents Rogers’ views about the many changes in soap operas during his stints on ABC’s General Hospital, in a role that has spanned almost three decades. Topics discussed include the impact of the current economic crisis; the 1980s as the golden age of soaps; the advent of the Internet; and age as both the strength and the weakness of the daytime drama genre.Less

Medical Care, 1860–1900

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

During the latter part of the nineteenth century, few changes occurred in drug therapy and the treatment of nonsurgical disorders, which comprised the bulk of medical practice. Major improvements ... More

During the latter part of the nineteenth century, few changes occurred in drug therapy and the treatment of nonsurgical disorders, which comprised the bulk of medical practice. Major improvements occurred in the diagnosis and prevention of infectious diseases and in surgery, which was revolutionized by the discovery of anesthetics and antiseptic techniques. Dispensaries and hospitals continued to expand as providers of health care in urban areas, with dispensaries playing the larger role. Hospitals assumed a significant educational role. The number of physicians increased at a rate comparable to the growth in population in the latter part of the nineteenth century. The 55,055 physicians enumerated by the census in 1860 increased to 132,002 in 1900, about 175 physicians per 100,000 population at both dates. Medical schools graduated enough students to assure a reasonable supply of physicians in almost all towns and villages in the country, although urban areas continued to have more physicians per capita. The physician who began practice in a large city entered a highly competitive profession. He usually started by caring for the tenement population, perhaps augmenting his income by working as a dispensary or railroad physician or assisting another practitioner. His earnings were low and he had few regular patients. Eventually he found a neighborhood where he was able to attract enough patients to establish himself. Competition from other physicians and from pharmacists and dispensaries remained a problem throughout his career. A physician who chose a small town or rural area, where most of the population lived, had a different type of career. Rural families were poor and the physician’s services were low on their list of priorities. Professional relations reflected this fact. Established physicians often greeted the newcomer by sending him their nonpaying patients. Once the rural physician established a clientele, he had less difficulty keeping it than an urban physician. The stability of rural populations enabled him to retain the patronage of families from one generation to another. The rural physician worked longer hours than his urban counterpart and had to be more self-reliant because of the absence of specialists and hospitals. Less

“What the Hell Does TIIC Mean?”: Online Content and the Struggle to Save the Soaps

Elana Levine

in The Survival of Soap Opera: Transformations for a New Media Era

This chapter presents an overview of the soaps’ range of online enterprises. It considers the fact that soap audiences have criticized many of these steps, demanding that writers, producers, and ... More

This chapter presents an overview of the soaps’ range of online enterprises. It considers the fact that soap audiences have criticized many of these steps, demanding that writers, producers, and networks better serve what fans see as the true nature of soaps. To examine these contentions, the chapter analyzes the character blogs of ABC Daytime. In particular, it examines the ways in which the blog of General Hospital (GH) character Robin Scorpio has served as a site of struggles between ABC Daytime executives, GH creative staff, and GH audiences. Such struggles offer insight into the tensions between daytime soaps and the audiences they are so desperate to maintain and grow, suggesting that the use of new media outlets in and of itself cannot save the genre.Less

Medical Care and Medical Education, 1825–1860

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

During the early nineteenth century, medical practice became professionalized and medical treatment standardized as medical school training became more popular and medical societies and journals ... More

During the early nineteenth century, medical practice became professionalized and medical treatment standardized as medical school training became more popular and medical societies and journals were organized. Dispensary and hospital care increased with the growth in urban populations. Medical students became dissatisfied with the theoretical training in medical schools and turned to private courses from individual physicians and clinical instruction at hospitals and dispensaries. By mid-century, private instruction had become almost as important as medical school training. Because little progress occurred in medical knowledge during the first half of the nineteenth century, the quality of medical care remained low, although it became more standardized due to the greater popularity of medical school training. Diagnosis continued to be unsystematic and superficial. The physical examination consisted of observing the patient’s pulse, skin color, manner of breathing, and the appearance of the urine. Physicians attributed many diseases to heredity and often attached as much credence to the patient’s emotions and surmises as the natural history of the illness. Although the invention of the stethoscope in France in 1819 led to the use of auscultation and percussion, the new diagnostic tools contributed little to medical care in the short run because more accurate diagnoses did not lead to better treatment. Few useful drugs existed in the materia medica and they were often misused. According to Dowling, the United States Pharmacopoeia of 1820 contained only 20 active drugs, including 3 specifics: quinine for malaria, mercury for syphilis, and ipecac for amebic dysentery. Alkaloid chemistry led to the isolation of morphine from opium in 1817 and quinine from cinchona bark in 1820. Morphine was prescribed with a casual indifference to its addictive properties and quinine was widely used in nonmalarial fevers, where it was ineffective and produced dangerous side effects. Strychnine, a poisonous alkaloid isolated in 1818, was popular as a tonic for decades, and colchine, another alkaloid discovered in 1819, was widely used for gout despite its harmful side effects. Purgatives and emetics remained the most widely used drugs, although mineral drugs replaced botanical ones among physicians trained in medical schools because their actions were more drastic and immediate. Less

From Daytime to Night Shift: Examining the ABC Daytime/Soapnet Primetime Spin-Off Experiment

Racquel Gonzales

in The Survival of Soap Opera: Transformations for a New Media Era

This chapter examines the development of General Hospital’s spin-off General Hospital: Night Shift (GH:NS) on SOAPnet. GH:NS experimented with the traditional U.S. soap serial format by airing once a ... More

This chapter examines the development of General Hospital’s spin-off General Hospital: Night Shift (GH:NS) on SOAPnet. GH:NS experimented with the traditional U.S. soap serial format by airing once a week for thirteen episodes in the first season and fourteen for the second. The ambitious goal for the producers of GH:NS was to gain new viewers, specifically the primetime cable audience, while testing the possible migration of daytime broadcast viewership to an original primetime series on SOAPnet. The chapter also considers the poor reception of the show’s first season compared with much stronger feedback for its second season.Less

Medical Care, 1900–1950

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

During the first half of the twentieth century, both mortality rates and the incidence of infectious diseases declined, due primarily to public health measures and a higher standard of living. ... More

During the first half of the twentieth century, both mortality rates and the incidence of infectious diseases declined, due primarily to public health measures and a higher standard of living. Developments in surgery and drug therapy improved medical care and increased the amount of specialization among physicians. On the other hand, fewer physicians were available to care for the sick because of a decline in the per capita number of medical school graduates. The urban poor continued to receive most of their care from outpatient departments in public and private hospitals, while a growing number of the middle classes became paying inpatients in private hospitals. Hospitals expanded their educational activities to include internships and residency programs. In the first half of the century, physicians became less accessible to much of the population. The number of physicians per capita decreased substantially from 1900 to 1930 and remained at that level until 1950. The greatest impact of this decline occurred in rural areas: between 1906 and 1923, communities of under 5,000 population experienced about a 25 percent reduction in the physician-population ratio, while cities of 50,000 or more experienced a decline of less than 8 percent. Young physicians especially preferred the cities. In 1906 in communities of fewer than 1,000 persons, the proportion of graduates from 1901 to 1905 who practiced in those communities exceeded the proportion of all physicians who practiced in those communities by a ratio of 1.17 to 1. By 1923 in the same size communities, the proportion of graduates of the classes of 1916 to 1920 who practiced there compared to the proportion of all physicians who practiced there dropped to a ratio of 0.58 to 1. Thus rural communities changed from locations preferred by younger physicians to locations avoided by them. The same ratio in cities of over 100,000 population increased from 0.99 to 1 in 1906 to 1.36 to 1 in 1923, which indicated the growing popularity of large cities for young physicians. Several factors accounted for the preference of physicians for towns and cities. Urban physicians earned more than rural ones and had greater opportunities to Specialize. Less

Between asylum and community: DGH psychiatric nurses at Withington General Hospital, 1971–91

Val Harrington

in Mental health nursing: The working lives of paid carers, 1800s-1900s

The post-war history of mental health services is dominated by the shift from the mental hospital to the community; with a corresponding shift within nursing from asylum nurse to community ... More

The post-war history of mental health services is dominated by the shift from the mental hospital to the community; with a corresponding shift within nursing from asylum nurse to community psychiatric nurse. Within this broad history, however, what is often overlooked is the role of the DGH psychiatric unit which, sited in the local district general hospital and espousing an acute, episodic model of mental illness, was explicitly designed to break down the isolation and stigma of mental health care, and to integrate mental health patients and services with their physical counterparts. This chapter focuses on the role and experiences of nurses in one such unit, Withington Psychiatric Unit in South Manchester, which opened amidst a fanfare of publicity and optimism in 1971. It draws on the oral testimonies of eight psychiatric nurses and a number of other staff, augmented by documentary evidence, including two postgraduate theses written within a few years of the unit opening. The chapter explores how nurses both contributed and adapted to their new environment, forging a new professional identity, far removed from that of the traditional asylum nurse.Less

Communicating with children when a parent is dying

Cynthia W Moore, Michele Pengelly, and Paula K Rauch

in Handbook of Communication in Oncology and Palliative Care

When a parent with dependent children is diagnosed with a life-threatening illness, it is common for a significant part of their distress to be associated with worries about their children. While ... More

When a parent with dependent children is diagnosed with a life-threatening illness, it is common for a significant part of their distress to be associated with worries about their children. While there are not yet data to support a particular approach, it is important to highlight lessons learned from existing initiatives. This chapter draws on the clinical experience from two different programmes: one an innovative programme spearheaded by nurses at a regional oncology centre in South Wales, and the other a parent-guidance programme offered by child psychologists and child psychiatrists at a major academic cancer centre in Boston, Massachusetts. In the Welsh programme, parents have an opportunity to spend quality time with their children, while facilitating play as a means of helping children express anxieties. At the Massachusetts General Hospital Cancer Center PACT (Parenting at a Challenging Time) programme, child psychiatrists and psychologists provide free guidance to parents with cancer about communication and children's coping.Less

The Medical Student

Sue Leaf

in A Love Affair with Birds: The Life of Thomas Sadler Roberts

This chapter examines Thomas Sadler Roberts’ medical education at the University of Pennsylvania in 1882, believing that natural history was not a gentlemanly vocation. Staying in Germantown where ... More

This chapter examines Thomas Sadler Roberts’ medical education at the University of Pennsylvania in 1882, believing that natural history was not a gentlemanly vocation. Staying in Germantown where his Aunt Cornelia Roberts’s family lived, Roberts was presented with an opportunity to put down a few roots in his father’s hometown by spending some time with his Quaker relatives. During his stay, Roberts showed his skill in memory. One noteworthy display of this skill was when he quoted a textbook verbatim on an oral exam. The rigors of medical school, however, led to Roberts neglecting his bird studies. His journals omitted anything about avian presence in Philadelphia. But his interest did not vanish entirely as during his second year, he accepted an invitation to become a member of the American Ornithologists’ Union. The chapter concludes by describing his residency at the Philadelphia General Hospital.Less

Medical Care and Medical Education, 1750–1825

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

Medical care at the end of the eighteenth century, like that in any period, was determined by the state of medical knowledge and the available types of treatment. Some useful knowledge existed, but ... More

Medical care at the end of the eighteenth century, like that in any period, was determined by the state of medical knowledge and the available types of treatment. Some useful knowledge existed, but most of medical practice was characterized by scientific ignorance and ineffective or harmful treatments based largely on tradition. The empirical nature of medical practice made apprenticeship the dominant form of medical education. Toward the end of the century medical schools were established to provide the theoretical part of the student’s education, while apprenticeship continued to provide the practical part. The scientifically valid aspects of medical science in the late eighteenth century comprised gross anatomy, physiology, pathology, and the materia medica. Gross anatomy, the study of those parts of the human organism visible to the naked eye, had benefitted from the long history of dissection to become the best developed of the medical sciences. This enabled surgeons to undertake a larger variety of operations with greater expertise. Physiology, the study of how anatomical structures function in life, had developed at a far slower pace. The greatest physiological discovery up to that time, the circulation of the blood, had been made at the beginning of the seventeenth century and was still considered novel almost two centuries later. Physiology was a popular area for theorizing, and the numerous physiologically based theories of disease were, as a physician wrote in 1836, “mere assumptions of unproved, and as time has demonstrated, unprovable facts, or downright imaginations.” Pathology at that time was concerned with pathological or morbid anatomy, the study of the changes in gross anatomical structures due to disease and their relationship to clinical symptoms. The field was in its infancy and contributed little to medicine and medical practice. Materia medica was the study of drugs and drug preparation and use. Late eighteenth century American physicians had available to them a substantial armamentarium of drugs. Estes studied the ledgers of one New Hampshire physician from 1751 to 1787 (3,701 patient visits), and another from 1785 to 1791 (1,161 patient visits), one Boston physician from 1782 to 1795 (1,454 patient visits), and another from 1784 to 1791 (779 patient visits). Less

The Evolution of the Fan Video and the Influence of YouTube on the Creative Decision-Making Process for Fans

Emma F. Webb

in The Survival of Soap Opera: Transformations for a New Media Era

This chapter examines the development of video production and editing practices among General Hospital (GH) fans in a study of how fans use YouTube to distribute historic soap opera content. It ... More

This chapter examines the development of video production and editing practices among General Hospital (GH) fans in a study of how fans use YouTube to distribute historic soap opera content. It suggests that many GH viewers enjoy watching and analyzing soaps online, and gravitate toward websites such as YouTube because of its ease of use and the ability to watch clips uploaded by other fans (a feature not available on any of the networks’ own sites). YouTube makes the soap opera watching experience significantly more flexible.Less

Hospitals and Health Care

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

The use of hospitals for medical care became more varied after 1950. More patients were admitted for a wide variety of conditions and more different types of treatments were provided. Many new ... More

The use of hospitals for medical care became more varied after 1950. More patients were admitted for a wide variety of conditions and more different types of treatments were provided. Many new technologies were adopted that have raised costs considerably. Hospitals employed more residents, foreign medical graduates, and nurses. Between 1946 and 1983, hospitals grew both in size and importance in the health care system. The number of short-term nonfederal hospitals increased by only one-third, but the number of beds and the average daily census doubled and the number of admissions increased 2.6 times, while the U.S. population grew by only two-thirds. Much of the additional use was for nonsurgical care. During the 1928–1943 period, 74 percent of all hospital admissions were surgical. This declined to 60 percent between 1956 and 1968 and to 50 percent between 1975 and 1981. Outpatient care grew even more rapidly than inpatient care, with the number of hospital outpatients doubling between 1965 and 1983. The hospital system has become dominated by large hospitals, practically all of which have affiliated with medical schools. In 1983, the 18 percent of nonfederal short-term hospitals that had 300 or more beds admitted 50 percent of the patients, carried out 59 percent of the surgery, and had 55 percent of the outpatient visits and 61 percent of the births. They employed 72 percent of all physicians and dentists employed in hospitals and 90 percent of all medical and dental residents. At least 60 percent of them had nurseries for premature infants, hemodialysis units, radiation therapy or isotype facilities, computerized tomograhy (CT) scanners, and cardiac catheterization facilities, and almost one-half had open-heart surgery facilities. Most also offered types of care not traditionally associated with hospitals. Practically all of them provided social work services and physical therapy, at least 75 percent provided occupational and speech therapy, and 40 percent provided outpatient psychiatric care. On the other hand, fewer than one-third provided family planning, home care, or hospice services, or partial hospitalization for psychiatric patients. The expanding services of nonfederal short-term general hospitals has led to the employment of larger numbers of workers. Less

Naturphilosophie and Physiology

John H. Zammito

in The Gestation of German Biology: Philosophy and Physiology from Stahl to Schelling

Schelling’s Naturphilosophie provided a powerful theoretical support system for the innovations in physiology that established biology as a special science in the early nineteenth century. He clearly ... More

Schelling’s Naturphilosophie provided a powerful theoretical support system for the innovations in physiology that established biology as a special science in the early nineteenth century. He clearly undertook – and was taken to be undertaking – a supercession of Kant’s philosophy of science in order to open the way for the “daring adventure of reason” necessary to create an empirical science of biology as a historical-developmental understanding of life forms. This chapter demonstrates the problematic relation of Kant to empirical physiology and medicine in this period and why the latter community of inquiry turned from him to Schelling. The crucial advocacy of Henrik Steffens marks this transition. Then the chapter explores Schelling’s engagement with Brownian medicine at the Bamberg General Hospital and then the University of Würzburg, culminating in the key journal Jahrbücher der Medizin als Wissenschaft. It concludes with a consideration of Ignaz Döllinger as a key mediator between the eighteenth-century gestation of biology, culminating in its embrace of Naturphilosophie, and the early nineteenth-century figures recognized as eminently engaged in a special science of biology, like Karl Ernst von Baer.Less

1899: The Instituto Médico Nacional

Alexander S. Dawson

in Peyote Effect: From the Inquisition to the War on Drugs

While research on peyote accelerated in the United States, United Kingdom, and Germany during the last decade of the nineteenth century, Mexican scientists remained largely ignorant of the properties ... More

While research on peyote accelerated in the United States, United Kingdom, and Germany during the last decade of the nineteenth century, Mexican scientists remained largely ignorant of the properties of the cactus. This changed when Mexico’s Instituto Médico Nacional (IMN) sponsored a series of peyote studies at the turn of the century. In part, those studies relied on historical accounts and reports from government agents working in regions where indigenous peyotists lived. In part, they entailed experiments, first with a variety of animals and then with patients in the Hospital General de San Andrés in Mexico City. In contrast to their counterparts elsewhere, Mexican researchers lacked the capacity to extract mescaline from peyote, and they depended on solutions made from whole peyote buttons for their research. They were also much less inclined to experiment on themselves than researchers elsewhere, and they were more interested in the corporeal effects of peyote than its capacity to affect states of consciousness. In particular, they attempted to demonstrate peyote’s potential to be used as a heart tonic. Their work was ultimately undone by Mexico’s 1910 Revolution, which resulted in the closing of the IMN in 1915.Less

Affinities, Associations, and Projects of Charity

Alison Forrestal

in Vincent de Paul, the Lazarist Mission, and French Catholic Reform

Chapter 10 assesses the ways in which de Paul carried his preference for communal performance of Christian acts of piety and morality into associations that he did not found, promote, or run himself, ... More

Chapter 10 assesses the ways in which de Paul carried his preference for communal performance of Christian acts of piety and morality into associations that he did not found, promote, or run himself, so that he acted uniquely as a point of connection between three of them: the Lazarists, the Ladies of Charity of the Hôtel-Dieu hospital in Paris, and the influential Company of the Holy Sacrament. It uses three case studies to expose his interconnectedness, and his ability to capitalize on his relationship with each group in projects of charitable welfare: the provision of aid to war-torn regions of north-east France, the foundation of a galley hospital in Marseille, and the establishment of the General Hospital in Paris.Less

That Handmaiden Business

Lisa Yarger

in Lovie: The Story of a Southern Midwife and an Unlikely Friendship

This chapter discusses Lovie Shelton’s nursing training at Norfolk General Hospital (through the U.S. Cadet Nurse Corps) and early nursing experiences in the 1940s, when delivery room nurses were ... More

This chapter discusses Lovie Shelton’s nursing training at Norfolk General Hospital (through the U.S. Cadet Nurse Corps) and early nursing experiences in the 1940s, when delivery room nurses were little more than handmaidens to the doctors (often instructed, for example, to hold a laboring woman’s legs together to keep her from delivering before the doctor’s arrival). The chapter not only takes readers on an interesting historical side trip, but gives them a benchmark for gauging the significance of Lovie’s later career as a nurse-midwife attending home births by herself. The chapter also describes the highly routinized, medicalized hospital births at the time Lovie was in training and how birth in the U.S. arrived at this point. After graduation, Lovie worked for a country doctor and sometimes found herself attending deliveries of babies all on her own in homes. Wanting more training, she enrolled in the public health nursing program at the University of North Carolina at Chapel Hill, where she learned about nurse-midwives from visiting lecturer Laura Blackburn, a public health nurse-midwife employed by the state board of health in South Carolina. Lovie “caught on fire” to become a nurse-midwife herself.Less

Medical Education, 1900–1950: General Trends and Basic Medical Sciences

William G. Rothstein

in American Medical Schools and the Practice of Medicine: A History

During the first half of the twentieth century, American medical education underwent drastic changes. Greater costs of operation and the requirements of licensing agencies forced many medical ... More

During the first half of the twentieth century, American medical education underwent drastic changes. Greater costs of operation and the requirements of licensing agencies forced many medical schools to close and most of the others to affiliate with universities. The surviving medical schools were able to raise their admission and graduation requirements, which was also made possible by the rise in the general educational level of the population. The growth of the basic medical sciences led to the development of a new kind of faculty member whose career was confined to the medical school. During the first half of the twentieth century, the educational level of the population rose significantly. The proportion of the 17-year-old population with high school educations increased from 6.3 percent in 1900 to 16.3 percent in 1920, 28.8 percent in 1930, and 49.0 percent in 1940. The number of bachelors’ degrees conferred per 100 persons 23 years old increased from 1.9 in 1900 to 2.6 in 1920, 5.7 in 1930, and 8.1 in 1940. Between 1910 and 1940, the number of college undergraduates more than tripled. Because the number of medical students did not increase, medical schools were able to raise their admission standards. At the same time, many new professions competed with medicine for students. Between 1900 and 1940, dentistry, engineering, chemistry, accounting, and college teaching, among others, grew significantly faster than the traditional professions of medicine, law, and the clergy. Graduate education also became an alternative to professional training. Between 1900 and 1940, the number of masters’ and doctors’ degrees awarded, excluding medicine and other first professional degrees, increased from 1,965 to 30,021, or from 6.7 to 13.9 percent of all degrees awarded. Colleges and universities decentralized their organizational structure to deal with the increasingly technical and specialized content of academic disciplines. They established academic departments that consisted of faculty members who shared a common body of knowledge and taught the same or related courses. Departments were given the responsibility of supervising their faculty members, recruiting new faculty, and operating the department’s academic program. By 1950, departments existed in most of the sciences, social sciences, and humanities. Less