Hopsital Medicine Flashcards
What existed in the Middle Ages?
Many small hospitals - both for the sick and those in need (the poor)
What was the first specialised institution?
Leporosias in the Middle Ages; care as much spiritual as physical
E.g. St Mary Magdalene, Hampshire
At least 320 established between C11th and C14th (Many destroyed by Henry VIII’s Dissolution of the Monasteries - religious influence on medicine)
Also affected by Black Death - increasing fear of contagion
What was leprosy believed to be in the Middle Ages
Punishment from God; because sufferers were enduring purgatory on earth, they were believed to be closer to God; thus helping them became desirable
Name some early hospitals
St Barthlomew’s 1123
St Thomas’, early C12th
To care for sick poor
What functions did early hospitals have?
Polticial, religious, and socioeconomic functions - for patients, doctors and patrons
What does Waddington argue that early hospitals did?
‘helped enforce traditional social hierarchies…social rather than medical needs’ – elite used them to maintain their prestige and that of their towns
How many new hospitals were established in C18th London?
5
Why did demand for hospitals increase in the C18th
Demands of industrialisation and urbanisation
TB and typhoid common in cities
Increasing geographic mobility reduced family care
How were hospitals founded in C18th?
Sometimes by laymen
Usually charitably funded, by religious or political groups
Admission to hospitals C18th
‘Admission ticket’ system - need for benefactor, moral basis
Middle and upper classes NOT treated in hospitals but at home
Care provided for free, but with strict rules and work for patient
When did creation of specialist hospitals begin?
Mid-C18th - e.g. smallpox hosptials. Usually created by medical men, not laymen
When did dispensaries begin to be made?
1770s - worked alongside hospitals
Who suggests that hospital medicine arose out of revoutionary Paris?
Ackernecht - 1789-99 French Revolution
What does Fissell suggest changed patient/practitioner relationships?
Diagnosis within hospitals
What did hospital medicine provide?
Opportunity for statistics, experimentation, medical research
Reflected change from individualised to popular medicine (emphasis on what works for the majority)
Place of teaching for doctors (impact on professionalisation)
How did the rise in surgery aid the rise of the hospital?
Need for specialised spaces - e.g. operating theatres, anesthetic, pre and post surgery care
What increased the surgery success rate?
Antisepsis and asepsis; reduced hospital fever thus popularising hospitals
Specialised conditions in hospital also helped increase success rates
When did hospitals begin to have dedicated laboratories?
1850s
When did X-Rays begin to be included in hospitals?
1895
What happened to funding in the 1870s?
Increasing number of patients paid for themselves; insurance schemes and work/society schemes
Hospitals began to lose their charity status - increasing popularity
However this meant patient had arguably more autonomy
When was the first Cottage Hospital founded?
1859 in Surrey - patients paid for treatment, often small and rural; became more popular as middle/upper class sought hospital treatment
How many specialist institutions were in London alone by the 1860s
66 in London alone - trend towards specialisation; reflects specialisation of knowledge (depth?)
Who established a nursing school and when?
1860s Florence Nightingale
1893 Nightingale Pledge
When did Laennec invent the stethoscope?
1819
What did Louis do in 1828?
Used numerical method to invalidate the curative properties of bloodletting (proving Broussais wrong)
Beginning tradition of peer-review in medicine?
What did the Emergency Hospital Service during WW2 do?
Pooled UK hospital resources together in regions; precursor to NHS
When was the NHS implemented?
Plans from 1942, implemented 1948
What does Foucault identify?
The growth of the medical case in doctor/patient relationships - aided by hospital environment
Ackernecht - the Paris Hospital
Explores philosophy of Paris medicine: empirical observation, physical examination, autopsies, statistics, surgery
Bynham - influences of hospital medicine
1) used for statistics/public health
2) theoretical shaping of other disciplines (anatomy, physiology, etc)
3) influence on laboratory medicine
What does Fourcroy identify as the 3 revolutions of the Revolutionary Assembly’s Paris Medicine?
1) training in medicine AND surgery
2) intensely practical training
3) need for larger scale to elucidate diagnostic categories
What is a key tension in medicine?
Professional unity vs specialisation
especially with increasing knowledge areas = increasing specialisation
What were Paris Medicine’s four cardinal dimensions of physical diagnoses?
Inspection Palpation Percussion Ascultation All systematised - reliability, objectivity
What was the main Paris diagnostic change?
From reliance on subjective symptoms to objective signs
What did John Bellers argue in the C18th
‘Every Able Industrious Labourer, that is capable to have Children, who so Untimely Dies, may be accounted Two Hundred Pound Loss to the Kingdom’
Mercantilist interest to medicine
What does Bynham call Revolutionary Paris medicine?
‘evolution rather than revolution’
What established a pathological-clinical correlation?
Morgagni - On The Seats and Causes of Diseases, 1761
Laennec routinely followed patients to the morgue - establishing correlation between sign and presentation
What can the growth of localism be seen as?
An expression of surgical thinking/influence in medicine
What problem was faced in mid-C19th
Therapeutic nihilism - fear that some people would always be sick (like Durkheim - social fact?), expresison of conservative thought
However new medical developments in later C19th reversed this; re-emerging in modernity?
What does Foucault identify in hospital medicine
Need to remove patient from the interaction between doctor and disease
‘A doctor supported and justified by an institution’
Stethoscope as authorisation of ‘moral distance’