19th Century Medical Care and Professionalization

Medical Care and Professionalization

• Medical care experienced significant societal shifts in the 19th century, including the rise of market society, mass society, the middle classes, and the modern state ("the age of improvement").
• Medical practices changed with more doctors and increasing pay, leading to a decline in aristocratic patronage.
• Private practice became common in the early 19th century, characterized by low start-up costs and relatively low pay.

The Status of Doctors

• Doctors' experiences varied greatly, with a small number of high-paid doctors in cities, and a significant portion of poorly-compensated doctors in rural and industrial slums.
• Reformers like Thomas Wakley fought to improve the social standing of doctors by regulating the profession and curbing activities such as medicine sales and abortions.

Regulation and Licensing

• France introduced direct state examination and licensing for doctors in 1803.
• Germany initially regulated doctors through princely bureaucracies but transitioned to freedom of healing (Kurierfreiheit) after unification in 1871.
• British doctors were overseen by royal colleges, with competition arising from non-licensed practitioners.
• The US did not regulate doctors uniformly, with each state having different policies.

Admission of Women

• Women were largely excluded from professions and universities throughout most of the 19th century.
• Some "women-only" medical colleges emerged after 1850.
• The UK Parliament's 1876 Act empowered medical bodies to allow women to qualify, leading to wider entry into the profession but not everywhere.
• Harvard and Yale medical schools admitted women after 1945, and parity in Great Britain's medical schools wasn't achieved until 1996.

Private Practice and Distribution

• Private practice was largely based on fee-for-service arrangements and patient-doctor relationships.
• Inequality in access to healthcare was evident, with doctors concentrated in wealthier areas.
• Germany implemented state controls, forcing some doctors to practice in underserved areas and paying a set salary.
• The UK and US had no similar state intervention.

Anaesthesia

• Early anaesthesia relied on using alcohol and opium before surgery with limited effectiveness.
• Nitrous oxide (laughing gas) was developed and gained popularity, like carbon dioxide and ether.
• Chloroform was used, with debates about its application for labour pain.
• Cocaine, initially used by indigenous peoples by chewing, became accepted.

Ignaz Semmelweis

• Semmelweis, a doctor at Vienna General Hospital, observed significantly higher mortality rates in one ward than another.
• He hypothesized that medical students were spreading infection to the maternity ward, linking the increase in mortality to a lack of handwashing with chlorinated water before delivering infants.
• His colleagues resisted his findings.
• Semmelweis was admitted to a mental hospital.

Bacteria and Antisepsis

• The Greeks used wine and vinegar for antisepsis, but the idea of bacteria was unknown to them.
• Joseph Lister's understanding of Pasteur's work led to the development of a more effective form of antisepsis, using carbolic acid, to significantly improve surgical safety.
• The use of carbolic acid to disinfect surgical wounds and instruments contributed to improved surgery outcomes.
• Medical professionals started to wear clean gowns.

Nursing

• Nursing practice initially developed in religious orders.
• The 19th century saw the rise of secular nursing, with figures like Friederike and Theodore Fliedner training Lutheran women who became secular deaconesses.
• Florence Nightingale made significant contributions to nursing during the Crimean War and made the profession more recognised internationally.

Specialization (I) & (II)

• The Hippocratic ideal of a generalist doctor faced challenges due to heightened market competition and scientific progress.
• Some doctors specialized, leading to more and more specialized hospitals like Royal Hospital (London) for specific illnesses.
• Specialization also led to debate in areas such as obstetrics where doctors initially rejected the idea of specialising.
• Pediatrics, and orthopedic specializations developed along with child-oriented hospitals.

Explore the transformations in medical care during the 19th century, focusing on the rise of private practice and the changing status of doctors. Learn about the challenges faced by medical professionals and the efforts of reformers to enhance their societal standing through regulation and licensing. This quiz delves into historical shifts that shaped modern medical practices.