Hopsital Medicine

Question 1

What existed in the Middle Ages?

Answer 1

Many small hospitals - both for the sick and those in need (the poor)

Question 2

What was the first specialised institution?

Answer 2

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

Question 3

What was leprosy believed to be in the Middle Ages

Answer 3

Punishment from God; because sufferers were enduring purgatory on earth, they were believed to be closer to God; thus helping them became desirable

Question 4

Name some early hospitals

Answer 4

St Barthlomew’s 1123
St Thomas’, early C12th
To care for sick poor

Question 5

What functions did early hospitals have?

Answer 5

Polticial, religious, and socioeconomic functions - for patients, doctors and patrons

Question 6

What does Waddington argue that early hospitals did?

Answer 6

‘helped enforce traditional social hierarchies…social rather than medical needs’ – elite used them to maintain their prestige and that of their towns

Question 7

How many new hospitals were established in C18th London?

Answer 7

5

Question 8

Why did demand for hospitals increase in the C18th

Answer 8

Demands of industrialisation and urbanisation
TB and typhoid common in cities
Increasing geographic mobility reduced family care

Question 9

How were hospitals founded in C18th?

Answer 9

Sometimes by laymen

Usually charitably funded, by religious or political groups

Question 10

Admission to hospitals C18th

Answer 10

‘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

Question 11

When did creation of specialist hospitals begin?

Answer 11

Mid-C18th - e.g. smallpox hosptials. Usually created by medical men, not laymen

Question 12

When did dispensaries begin to be made?

Answer 12

1770s - worked alongside hospitals

Question 13

Who suggests that hospital medicine arose out of revoutionary Paris?

Answer 13

Ackernecht - 1789-99 French Revolution

Question 14

What does Fissell suggest changed patient/practitioner relationships?

Answer 14

Diagnosis within hospitals

Question 15

What did hospital medicine provide?

Answer 15

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)

Question 16

How did the rise in surgery aid the rise of the hospital?

Answer 16

Need for specialised spaces - e.g. operating theatres, anesthetic, pre and post surgery care

Question 17

What increased the surgery success rate?

Answer 17

Antisepsis and asepsis; reduced hospital fever thus popularising hospitals
Specialised conditions in hospital also helped increase success rates

Question 18

When did hospitals begin to have dedicated laboratories?

Answer 18

1850s

Question 19

When did X-Rays begin to be included in hospitals?

Answer 19

1895

Question 20

What happened to funding in the 1870s?

Answer 20

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

Question 21

When was the first Cottage Hospital founded?

Answer 21

1859 in Surrey - patients paid for treatment, often small and rural; became more popular as middle/upper class sought hospital treatment

Question 22

How many specialist institutions were in London alone by the 1860s

Answer 22

66 in London alone - trend towards specialisation; reflects specialisation of knowledge (depth?)

Question 23

Who established a nursing school and when?

Answer 23

1860s Florence Nightingale

1893 Nightingale Pledge

Question 24

When did Laennec invent the stethoscope?

Answer 24

1819

Question 25

What did Louis do in 1828?

Answer 25

Used numerical method to invalidate the curative properties of bloodletting (proving Broussais wrong)
Beginning tradition of peer-review in medicine?

Question 26

What did the Emergency Hospital Service during WW2 do?

Answer 26

Pooled UK hospital resources together in regions; precursor to NHS

Question 27

When was the NHS implemented?

Answer 27

Plans from 1942, implemented 1948

Question 28

What does Foucault identify?

Answer 28

The growth of the medical case in doctor/patient relationships - aided by hospital environment

Question 29

Ackernecht - the Paris Hospital

Answer 29

Explores philosophy of Paris medicine: empirical observation, physical examination, autopsies, statistics, surgery

Question 30

Bynham - influences of hospital medicine

Answer 30

1) used for statistics/public health
2) theoretical shaping of other disciplines (anatomy, physiology, etc)
3) influence on laboratory medicine

Question 31

What does Fourcroy identify as the 3 revolutions of the Revolutionary Assembly’s Paris Medicine?

Answer 31

1) training in medicine AND surgery
2) intensely practical training
3) need for larger scale to elucidate diagnostic categories

Question 32

What is a key tension in medicine?

Answer 32

Professional unity vs specialisation

especially with increasing knowledge areas = increasing specialisation

Question 33

What were Paris Medicine’s four cardinal dimensions of physical diagnoses?

Answer 33

Inspection
Palpation
Percussion
Ascultation
All systematised - reliability, objectivity

Question 34

What was the main Paris diagnostic change?

Answer 34

From reliance on subjective symptoms to objective signs

Question 35

What did John Bellers argue in the C18th

Answer 35

‘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

Question 36

What does Bynham call Revolutionary Paris medicine?

Answer 36

‘evolution rather than revolution’

Question 37

What established a pathological-clinical correlation?

Answer 37

Morgagni - On The Seats and Causes of Diseases, 1761

Laennec routinely followed patients to the morgue - establishing correlation between sign and presentation

Question 38

What can the growth of localism be seen as?

Answer 38

An expression of surgical thinking/influence in medicine

Question 39

What problem was faced in mid-C19th

Answer 39

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?

Question 40

What does Foucault identify in hospital medicine

Answer 40

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’