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The Inevitable Hour

A History of Caring for Dying Patients in America

Emily K. Abel

Publication Year: 2013

At the turn of the twentieth century, medicine’s imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, The Inevitable Hour demonstrates that professional attention and resources gradually were diverted from dying patients. Emily K. Abel challenges three myths about health care and dying in America. First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become dehumanized. Abel shows that hospitals resisted accepting dying patients and often worked hard to move them elsewhere. Poor, terminally ill patients, for example, were shipped from Bellevue Hospital in open boats across the East River to Blackwell’s Island, where they died in hovels, mostly without medical care. Some terminal patients were not forced to leave, yet long before the advent of feeding tubes and respirators, dying in a hospital was a profoundly dehumanizing experience. With technological advances, passage of the Social Security Act, and enactment of Medicare and Medicaid, almshouses slowly disappeared and conditions for dying patients improved—though, as Abel argues, the prejudices and approaches of the past are still with us. The problems that plagued nineteenth-century almshouses can be found in many nursing homes today, where residents often receive substandard treatment. A frank portrayal of the medical care of dying people past and present, The Inevitable Hour helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.

Published by: The Johns Hopkins University Press

Title Page, Copyright

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pp. 2-5


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pp. 6-7

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pp. vii-viii

Many people helped me write this book. My history writing group— Carla Bittel, Janet Farrell Brodie, Sharla Fett, Devra Weber, and Alice Wexler— read draft after draft, making generous yet sharp comments. Richard Abel, Lara Freidenfelds, Sandra Harding, Joanne Leslie, and Steven P. Wallace read individual chapters and provided extremely helpful recommendations. Jacqueline H. Wolf and ...

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pp. 1-7

“I had a very painful introduction to being a doctor,” recalled Katharine Sturgis. During her first weekend as an intern in 1935, “a little girl was brought in from the housing project across the street from the hospital; she was convulsing and was unconscious.” Sturgis’s distress stemmed partly from her failure to maintain professional distance. The patient “was just a little bit older, maybe a year older, than ...

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1 The Good Death at Home

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pp. 8-21

Death was never far from Mary Ann Webber’s mind as she sat by herself in her small Vermont farm house each evening. By the early 1860s, her five surviving children had grown and left home. Especially during the winter, when snow made roads impassable for months on end, she saw no one but Perley, her irascible and silent husband. Letters to and from her children represented virtually her sole ...

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2 Medical Professionals (Sometimes) Step In

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pp. 22-35

Medicine played a relatively minor role in nineteenth- century death and dying. Tuberculosis aside, most deaths arrived swiftly and suddenly, from accidents and especially from acute, infectious diseases, often before doctors arrived. The American Medical Association urged physicians not to abandon patients whose lives slowly ebbed from chronic, incurable disorders, but many continued to do so. Only the rare ...

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3 Cultivating Detachment, Sidetracking Care

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pp. 36-56

The growing faith in medical science during the late nineteenth and early twentieth centuries altered the meaning and experience of death in America. An accumulation of breakthroughs, including the isolation of the pathogens causing major infectious diseases and the development of dramatic new diagnostic technologies, both enhanced medicine’s efficacy and dazzled the public. Growing numbers of ...

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4 Institutionalizing the Incurable

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pp. 57-87

“Cancer is getting to be a common disease,” observed Minnie Patterson in a 1912 letter from her new home in Alaska to her Illinois family. “It seems there are always one or more afficted with it in this town or community.” A 90- year- old man buried the previous week had died from “the effects of cancer on his face.” A middle- aged woman recently had had “both breasts cut off, in two dfferent operations.” Although ...

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5 “All Our Dread and Apprehension”

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pp. 88-102

...“Weeks of shocked apprehension, anxiety, and strain,” wrote music composer Dorothy Smith Dushkin in her diary on December 6, 1959. Born in Chicago in 1903, Dorothy had graduated from Smith College in 1925 and five years later married David Dushkin, another musician, with whom she established a famous music school and summer camp. Now Amanda, the youngest of their four children and ...

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6 “Nothing More to Do”

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pp. 103-117

Death and dying increasingly moved into hospitals during the decades immediately following World War II. By 1960, 50 percent of deaths occurred in those facilities, and many patients who died elsewhere spent time in hospitals during the last year ...

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7 A Place to Die

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pp. 118-135

In the summer of 2000, archivists and a medical historian at Columbia University in New York rescued hundreds of Presbyterian Hospital patient files from the mil-lions contained in a large ware house slated for destruction. Searching through the salvaged files, I found forty- nine discussing cancer patients ...

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8 The Sacred and the Spiritual

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pp. 136-165

By the end of World War II, attitudes toward dying had changed considerably from the sentiments expressed by Mary Ann Webber when she wrote from her Vermont farm house to remind her children that “the seeds of death are within us” and urge them to “be prepared to meet the event with Christian fortitude.” We saw ...

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pp. 166-173

Although death is a universal human experience, the care of dying people tradition-ally has occupied a marginal place in medical history. Focusing on that topic reconfigures the field. This book demonstrates that most of the benefits from the transformation ...


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pp. 175-217


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pp. 219-226

E-ISBN-13: 9781421409207
E-ISBN-10: 1421409208
Print-ISBN-13: 9781421409191
Print-ISBN-10: 1421409194

Page Count: 240
Illustrations: 3 b&w illus.
Publication Year: 2013