Medical Care and Professionalization PDF

Medical Care and Professionalization Mark Sholdice HS 2220 The 19th Century and Medical Practice societal shifts the rise of market society; the rise of mass society; the rise of the middle classes; the rise of the modern state; the “age of improvemen...

Medical Care and Professionalization Mark Sholdice HS 2220 The 19th Century and Medical Practice societal shifts the rise of market society; the rise of mass society; the rise of the middle classes; the rise of the modern state; the “age of improvement?” changes to the medical profession more doctors, increases in pay = decline of aristocratic patronage private practice in the early 19 th century low start-up costs, relatively low pay The Status of Doctors varied experiences, including: a small number of fashionable, famous, highly- paid doctors in cities lowly-paid doctors in rural areas and industrial slums respectability: reformers like Thomas Wakley (1795-1862) fought to raise social status of doctors by regulating profession and curtailing sidelines like medicine sales, rest-cure establishments, and abortions Regulation and Licensing France: Napoleon introduces direct state examination and licensing for doctors of medicine or surgery in 1803 Germany: at first, regulation by princely bureaucracies; after unification in 1871, Kurierfreiheit (freedom of healing) Britain: doctors regulated by royal colleges, not the state; competition from non-doctors US: Congress refuses to regulate doctors; different situation in each state  Admission of Women women excluded from professions and universities for most of 19th century some “women-only” medical colleges created after 1850 (e.g. Women's Medical College of Pennsylvania) Act of UK Parliament in 1876 finally empowered medical examining bodies to allow women to qualify; this led to entry rights nearly everywhere but exclusion continued in many places Harvard and Yale medical schools only open to women after 1945; parity in medical school entrance in Great Britain only achieved in 1996 Private Practice and Distribution private practice based on fee-for-service and patient-doctor relationship inequality of access doctors over-represented in wealthy towns solutions in Germany, state control means some doctors paid salaries and forced to practice in underserved areas in UK and US, no state intervention  Anaesthesia at first, alcohol (get drunk) and opium (get high before surgery)- (limited effects) Physician might be reluctant to perform surgical procedures due to pain gases and solvents developed in 19 th century nitrous oxide (laughing gas) –became widespread at parties, fairs, carbon dioxide Ether-became popular with rich people-one famous doctor used it to extract a tooth, however, causes issues with the lungs which results in vomiting Chloroform-a lot of debates against using this for labour pain- (used successfully by Queen Victoria in child birth)-because of this British women started to accept the use of this local anesthetics e.g. cocaine Coca using by Indigenous people by chewing Gain support against the medical community and Sigmund Freud loved it and wrote an essay about it Ignaz Semmelweis (1818-1865) doctor in at Vienna General Hospital in the 1840s; world’s largest maternity clinic noticed differing higher mortality rate in Wards One than in Ward Two (29 percent vs. 3 percent) Ward One births handled by medical students; midwifery students in Ward Two when he switched students between wards, mortality rates changed (medical students were coming from surgery and went straight into helping with birthing) ordered hand-washing with chlorinated water before delivery; mortality plummeted colleagues fought directive, Semmelweis quit and was admitted to a medical hospital Bacteria and Antisepsis some antisepsis used since ancient times (the Greeks used wine and vinegar), but no knowledge of bacteria Joseph Lister (1827-1912): created routine and effective form of antisepsis, making surgery safe. read Pasteur and understood that microbes in air caused infection developed use of carbolic acid as antisepsis to cleanse wounds before and after surgery Both the surgeon and medical assistance had to wear clean gowns Name started to be attached to sanitary products like Listerine Nursing nursing practice developed in religious orders in 19th century, nursing became a profession beginning in 1836, Friederike and Theodore Fliedner trained Lutheran women as secular “deaconesses” Florence Nightingale (1820-1910) developed secular nursing during Crimean War (1853-1856) her fame spread idea across the world,wanted to devote herself to serving human kind Specialization (I) Hippocratic ideal: doctor as a generalist but over 19th century, market competition and ideas of scientific progress pushed some doctors towards specialization conflict over qualifications and regulations for specializations hospitals also became specialized in London, UK: Royal Hospital for Disease of the Chest, St. Mark's Hospital for Diseases of the Colon and Rectum, the Royal National Orthopaedic Hospital, the Hospital for Sick Children, etc. Specialization (II) obstetrics: controversy, because “ungentlemanly” and not “pure” surgery in UK, Medical doctors could qualify without any obstetrical training until 1886; midwives regulated and licensed in 1902 pediatrics: development of children’s hospitals in German- and English- speaking countries orthopedics: interest in spinal deformities and correcting the musculoskeletal system