Search Results

This chapter looks at the role of medical institutions and medical authority in the lives of young people with physical impairments. It illustrates change in the influence of health professions over non-medical decisions in people's lives, and change in medical and therapeutic regimes. The chapter examines the influence of health professionals, policies, and institutions on the life expectations and life pathways of three generations.

This chapter focuses on the death of Nathan Smith in 1829, which signified a great loss to the young Medical Institution of Yale College. His reputation as a clinician in conjunction with Benjamin Silliman's reputation as a scientist had been responsible for much of the school's initial success. Silliman now replaced Smith as the driving force behind the Medical Institution. From a pragmatic point of view, Smith had represented one-fifth of the medical faculty, holding the chairs in both medicine and surgery. To replace him Eli Ives was appointed professor of the theory and practice of medicine and Thomas Hubbard, a rural practitioner, became professor of surgery. William Tully took over Ives's former professorship of materia medica.

This chapter focuses on the experiences of African Americans as patients, medical students, and doctors from the end of the war through the early twentieth century. Faced with Jim Crow practices of exclusion from medical care and professional training, and in spite of limited resources, African American citizens had clear ideas about organizing their own medical care, establishing themselves as fundraisers and philanthropists who, by the end of the century, had founded medical institutions.

This essay, eschewing the use of meta-narratives such as Enlightenment, Romanticism or Industrialisation, examines in detail the role that the Watt family (James senior and his sons James junior and Gregory) played, first, in establishing the Medical Pneumatic Institution (MPI) in Bristol and, second, in securing the employment of the nineteen-year old Humphry Davy to be the Institution’s Superintendent. The radical physician Thomas Beddoes wanted to investigate, using an apparatus developed by Watt senior, the possible therapeutic effects of gases discovered during the eighteenth century. To facilitate developing pneumatic medicine Beddoes organised a national fund-raising campaign to establish the MPI. In doing this he was supported (including financially) by the Watt family and by others such as Tom Wedgwood. By the middle of 1798 sufficient funds had been obtained and Beddoes began looking for a Superintendent to run the MPI. Davies Giddy and Gregory Watt successfully recommended Davy to Beddoes, who appointed him in October 1798. Davy spent two and a half years at the MPI, during which he discovered the physiological effects of nitrous oxide and undertook his earliest electrical researches. Understanding the course of these events at the level of detail used here suggests the limited explanatory value of meta-narratives.

Throughout the rich history of the Yale University School of Medicine, several important themes have tended to recur. First and foremost among these themes has been the close relationship between the university and the medical school from its inception. Most medical schools in the United States were founded as private proprietary schools, which were subsequently subsumed by a university; Cooper Medical College, for example, became the Stanford University School of Medicine. The Medical Institution, in contrast, was founded by the Yale Corporation. As a result, the culture of Yale College fashioned the ethos of the medical school. Success in science was fostered from the beginning. Benjamin Silliman, who was appointed professor of chemistry and natural history in 1802, played a key role in the founding of the Medical Institution.

This book concludes with an understanding of the Yale University School of Medicine's fortunes at the time of its tercentenary, which will allow the story to be put in context. It is generally recognized as one of the world's great medical schools, but what, in particular, makes it a preeminent medical institution? With some understanding of Yale's history, can the medical school's future be divined? Its future is closely associated with both the university and the hospital, but there are strong outside determinants, too. The direction of healthcare in the United States and the evolution of biomedical science will profoundly affect the future of the school. The arrival of Robert W. Berliner, deputy director of the NIH, heralded an increased commitment to basic science, which catapulted the medical school into the top ranks of research-intensive medical institutions.

This chapter addresses California’s notorious sterilization program from the first half of the twentieth century. Looking at sterilization practices in three California medical institutions, it argues that decentralized decision making provides a better explanation of what happened in practice. This chapter shows that the cases of Stockton State Hospital, Sonoma State Home, and Agnews State Homes vividly illustrate the different varieties of sterilization practice that flourished within an institutional model that stressed the autonomy and the discretion of hospital superintendents. It suggests that the history of compulsory sterilization in California holds a complicated lesson for commentators on genetics in society.

This chapter examines the life and writings of Superintendent John M Galt, and argues that the experience of heading an asylum in the United States South and the example of slaves hiring out prompted institutional innovation. Galt was the only American Superintendent to publicly endorse total non-restraint, reject racial segregation, and promote the cottage system of outpatient care. By showing that slavery provided the impetus for cost-saving initiatives that also maximized patients’ rights, this chapter connects the history of psychiatry with recent scholarship on slavery and modernity. Shunned by his peers in the Association of Medical Superintendents of American Institutions for the Insane, Galt tried to establish a transnational network with superintendents in Brazil and Russia, two societies that were also shaped by systems of coercive labor.

This chapter looks at the transformation of asylum care that was initiated by the Civil War. At the Eastern Lunatic Asylum, the biggest change came after the suicide of Superintendent John M. Galt during Union occupation of Eastern Virginia. Ultimately, Galt’s death created opportunities for his professional rivals in the Association of Medical Superintendents of American Institutions for the Insane to end his experiments with outpatient care and to insist upon the creation of segregated institutions for black and white patients. In the interim, the asylum was run by a series of Union doctors and civilians with the aid of former staff, including enslaved attendants. Operating during wartime was especially difficult for enslaved staff because their legal status was in limbo, and they were liable to seizure by raiding Confederates. Wartime shortages further compounded these challenges.

In 1856, by establishing herself as physician, marrying George Ott and then moving to Madison, Wisconsin, the newly renamed Mrs. Dr. Anna B. Ott transformed herself. Instead of a local doctor’s wife, instead of an impugned divorcee, Anna became a successful physician and property owner. Very quickly, however, the Ott marriage became very violent and Anna twice attempted to divorce George. This chapter places Ott’s early career in the context of women’s property laws, understandings of marital violence, the growing power of and challenges to institutions for the insane, and the activism of suffragists and women such as Elizabeth Packard.

This chapter examines how illness is dispersed over people, relationships, and technologies by focusing on the case of a Delhi boy named Swapan, who is suffering from madness. It describes what happens to a young person whose madness unsettles the family to the extent that the neighbors and wider kin become implicated, taking sides and finding temporary respite in what the outside world has to offer. The chapter begins with an overview of psychopathology and the challenge it presents to narrative theories of the self. It then considers modernity in relation to the failure of medical institutions, the politics of family, and the devaluation of its nonproductive members, along with the lure of the modern in such forms as the ability to speak in English. It also explains what the story of Swapan and his family struggling to deal with mental illness and unstable financial conditions tells us about madness in the context of urban poverty.

The purpose of this chapter is to evaluate TEDIUM. Evaluation is similar to correctness in that both are always with respect to some external criteria. what criteria should be used for evaluating an environment that develops and maintains software applications using a new paradigm? Clearly, the criteria of the old paradigm (e.g., lines of code, measures of complexity, effort distributed among phases) are irrelevant. In the early days of medical computing, Barnett playfully suggested the following three criteria for evaluating automated medical systems: . . . will people use it? will people pay for it? will people steal it? . . . At the time, the answers to first two questions frequently were negative, and Barnett’s pragmatic approach was intended to prod the field from theory to practice. TEDIUM is used and paid for, but its techniques have not been transported to other environments (i.e., it has not yet been stolen). I console myself by observing that a lack of recognition need not imply an absence of value. The transfer of ideas often is a product of the marketplace, where acceptance depends more on perception than on quantification. As we have seen throughout this book, there can be vast differences between what we care about and what is measurable. Real projects tend to be large, difficult to structure for comparative studies, and highly dependent on local conditions. In contrast, toy studies are easy to control and analyze, but they seldom scale up or have much creditability. How then should I evaluate TEDIUM? I have tried a number of strategies. I have analyzed small projects in detail, I have reported on standard problems comparing TEDIUM data with published results, I have presented and interpreted summary data taken from large projects, I have extracted evaluation criteria from other sources, and I have examined how TEDIUM alters the software process. All of this was summed up in TEDIUM and the Software Process (1990a).