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3 Cultivating Detachment, Sidetracking Care
- Johns Hopkins University Press
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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 dying patients sought care from physicians and hospitals, but as those providers gained increased confidence in their ability to avert mortality, concerns about the physical, emotional, and spiritual sufferings of people at the end of life receded into the background. The idealization of scientific rationality also helped to alter public attitudes about death. Emboldened by the new bacteriological knowledge, health officials launched widespread campaigns to convince the public that mortality resulted from human action rather than divine forces. Rather than winning praise, patients and relatives who accepted death as God’s will increasingly met criticism. Reorganizing the Health Care System Various health providers gained social legitimacy by allying themselves with scienti fic breakthroughs. Institutions revised surgical procedures to conform with discoveries about asepsis and installed X-ray machines and clinical laboratories, which publicity photographs prominently displayed. As hospitals increasingly converted themselves into major scientific enterprises, growing numbers of physicians sought to affiliate with them, participate in their governance, and fill their beds with patients . A nationwide survey conducted in 1909 found 4,359 hospitals with a total of 421,065 beds. So-called “regular” physicians capitalized on developments in laboratory science to assert their dominance over competing schools. They reorganized the American Medical Association by linking it more closely with local and state medical societc h a p t e r 3 Cultivating Detachment, Sidetracking Care Cultivating Detachment, Sidetracking Care 37 ies; by 1910, over half of all regular physicians had become members. That newly reconstituted body helped to launch a movement for the reform of medical education , leading to the closure of large numbers of inadequate schools as well as the upgrading of surviving ones. As a result, entry into medicine was restricted to those who had completed a standardized university curriculum based on the principles of scientific medicine. Although nurses never achieved equal power or prestige , they, too, sought professional status by donning the mantle of science. The first nursing schools opened in 1873, and their numbers grew rapidly, reaching 1,600 by the outbreak of World War I. As late as 1920, approximately three-fourths of the graduates worked in private duty, either in patient homes or hospital rooms. The “Fatal Mistake of Caring” “Inasmuch as all of our patients, as well as we ourselves, must die sooner or later,” wrote physician Alfred Worcester in 1929, “we might naturally suppose that the care of the dying would receive more attention.” Nevertheless, “in the onward progress of medical science it appears to have been sidetracked. Those who are interested only in the diseases of their patients find little that is noteworthy in their dying beyond the mere fact of fatality and the possible opportunity of verifying their diagnoses.” Other observers noted that discussions about care for the dying rarely appeared in medical schools, meetings, or journals. Although Worcester wrote little about nurses, their lack of attention to the care for patients at the end of life might have seemed even more surprising to him. Nurses typically had the primary responsibility for tending the dying, but their schools, conferences, and journals, too, rarely mentioned the needs of individuals close to death. A 1908 textbook entitled Practice of Medicine for Nurses, for example, included only the following brief paragraph, focusing on nursing tasks after the event had occurred: “In Case of Death, the nurse should first notify the physician if he happen to be not present. Then she should gently lead the family from the room in order to cleanse the body and put the room in order.” Despite the neglect of the dying in the curriculum of medical and nursing schools, both transmitted attitudes that significantly altered professionals’ relationship with that patient population. We saw that nineteenth-century medical beliefs had encouraged doctors to value personal ties both to alleviate stress and as a source of medical knowledge. Discovery of the bacteriologic causes of specific diseases encouraged medical educators to emphasize the importance of maintaining emotional distance from patients, not of developing intimate bonds with them. Biological reductionism rendered irrelevant the patient’s emotional and moral state, [54.242.191.214] Project...