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Long and recurring illnesses have burdened sick people and their doctors since ancient times, but until recently the concept of “chronic disease” had limited significance. Even lingering diseases like tuberculosis, a leading cause of mortality, did not inspire dedicated public health activities until the later decades of the nineteenth century, when it became understood as a treatable infectious disease. Historian of medicine George Weisz analyzes why the idea of chronic disease assumed critical importance in the twentieth century and how it acquired new meaning as one of most serious problems facing national healthcare systems. Chronic Disease in the Twentieth Century challenges the conventional wisdom that the concept of chronic disease emerged because medicine’s ability to cure infectious disease led to changing patterns of disease. Instead, it suggests, the concept was constructed and has evolved to serve a variety of political and social purposes. How and why the concept developed differently in the United States, the United Kingdom, and France are central concerns of this work. In the United States, anxiety about chronic disease spread early in the twentieth century and was transformed in the 1950s and 1960s into a national crisis that helped shape healthcare reform. In the United Kingdom, the concept emerged only after World War II, was associated almost exclusively with proper medical care for the elderly population, and became closely linked to the development of geriatrics as a specialty. In France, the problems of elderly and infirm people were handled as technical and administrative matters until the 1950s and 1960s, when medical treatment of elderly people emerged as a subset of their wider social marginality. While an international consensus now exists regarding a chronic disease crisis that demands better forms of disease management, the different paths taken by these countries during the twentieth century continue to exert profound influence. This book seeks to explain why, among the innumerable problems faced by societies, some problems in some places become viewed as critical public issues that shape health policy.
Epistolary Medicine in the Renaissance
During the Renaissance, collections of letters both satisfied humanist enthusiasm for ancient literary forms and provided the flexibility of a format appropriate to many types of inquiry. The printed collections of medical letters by Giovanni Manardo of Ferrara and other physicians in early sixteenth-century Europe may thus be regarded as products of medical humanism. The letters of mid- and late sixteenth-century Italian and German physicians examined in Communities of Learned Experience by Nancy G. Siraisi also illustrate practices associated with the concepts of the Republic of Letters: open and relatively informal communication among a learned community and a liberal exchange of information and ideas. Additionally, such published medical correspondence may often have served to provide mutual reinforcement of professional reputation. Siraisi uses some of these collections to compare approaches to sharing medical knowledge across broad regions of Europe and within a city, with the goal of illuminating geographic differences as well as diversity within social, urban, courtly, and academic environments of medical learning and practice. The collections she has selected include essays on general medical topics addressed to colleagues or disciples, some advice for individual patients (usually written at the request of the patient’s doctor), and a strong dose of controversy.
The U.S. Government's Sex Education Campaign from World War I to the Internet
This history of the U.S. Public Health Service's efforts to educate Americans about sex makes clear why federally funded sex education has been haphazard, ad hoc, and often ineffectual. Since launching its first sex ed program during World War I, the Public Health Service has dominated federal sex education efforts. Alexandra M. Lord draws on medical research, news reports, the expansive records of the Public Health Service, and interviews with former surgeons general to examine these efforts, from early initiatives through the administration of George W. Bush. Giving equal voice to many groups in America—middle class, working class, black, white, urban, rural, Christian and non-Christian, scientist and theologian—Lord explores how federal officials struggled to create sex education programs that balanced cultural and public health concerns. She details how the Public Health Service left an indelible mark on federally and privately funded sex education programs through partnerships and initiatives with community organizations, public schools, foundations, corporations, and religious groups. In the process, Lord explains how tensions among these organizations and local, state, and federal officials often exacerbated existing controversies about sexual behavior. She also discusses why the Public Health Service's promotional tactics sometimes inadvertently fueled public fears about the federal government’s goals in promoting, or not promoting, sex education. This thoroughly documented and compelling history of the U.S. Public Health Service's involvement in sex education provides new insights into one of the most contested subjects in America.
The Politics of Public Health in Early Philadelphia
By the time William Penn was planning the colony that would come to be called Pennsylvania, with Philadelphia at its heart, Europeans on both sides of the ocean had long experience with the hazards of city life, disease the most terrifying among them. Drawing from those experiences, colonists hoped to create new urban forms that combined the commercial advantages of a seaport with the health benefits of the country. The Contagious City details how early Americans struggled to preserve their collective health against both the strange new perils of the colonial environment and the familiar dangers of the traditional city, through a period of profound transformation in both politics and medicine.
Philadelphia was the paramount example of this reforming tendency. Tracing the city's history from its founding on the banks of the Delaware River in 1682 to the yellow fever outbreak of 1793, Simon Finger emphasizes the importance of public health and population control in decisions made by the city's planners and leaders. He also shows that key figures in the city's history, including Benjamin Franklin and Benjamin Rush, brought their keen interest in science and medicine into the political sphere. Throughout his account, Finger makes clear that medicine and politics were inextricably linked, and that both undergirded the debates over such crucial concerns as the city's location, its urban plan, its immigration policy, and its creation of institutions of public safety. In framing the history of Philadelphia through the imperatives of public health, The Contagious City offers a bold new vision of the urban history of colonial America.
Newark Beth Israel and the Jewish Hospital in America
Addiction Research in the Classic Era of Narcotic Control
Heroin was only one drug among many that worried Progressive Era anti-vice reformers, but by the mid-twentieth century, heroin addiction came to symbolize irredeemable deviance. Creating the American Junkie examines how psychiatristsand psychologists produced a construction of opiate addicts as deviants with inherently flawed personalities caught in the grip of a dependency from which few would ever escape. Their portrayal of the tough urban addict helped bolster the federal government's policy of drug prohibition and created a social context that made the life of the American heroin addict, or junkie, more, not less, precarious in the wake of Progressive Era reforms. Weaving together the accounts of addicts and researchers, Acker examines how the construction of addiction in the early twentieth century was strongly influenced by the professional concerns of psychiatrists seeking to increase their medical authority; by the disciplinary ambitions of pharmacologists to build a drug development infrastructure; and by the American Medical Association's campaign to reduce prescriptions of opiates and to absolve physicians in private practice from the necessity of treating difficult addicts as patients. In contrast, early sociological studies of heroin addicts formed a basis for criticizing the criminalization of addiction. By 1940, Acker concludes, a particular configuration of ideas about opiate addiction was firmly in place and remained essentially stable until the enormous demographic changes in drug use of the 1960s and 1970s prompted changes in the understanding of addiction—and in public policy.
Los Angeles Women and Public Health Reform
Cultivating Health, an interdisciplinary chronicle, details women's impact on remaking health policy, despite the absence of government support. Jennifer Lisa Koslow explores community nursing, housing reform, milk sanitation, childbirth, and the campaign against venereal disease in late nineteenth and early twentieth century Los Angeles. She demonstrates how women implemented health care reform and civic programs and highlights women's home health care, urban policy-changing accomplishments, and pays tribute to what would become the model for similar service-based systems in other American centers.
The Management of Lunacy in Eighteenth-Century London
This book is a lively commentary on the eighteenth-century mad-business, its practitioners, its patients (or "customers"), and its patrons, viewed through the unique lens of the private case book kept by the most famous mad-doctor in Augustan England, Dr. John Monro (1715-1791). Monro's case book, comprising the doctor's jottings on patients he saw in the course of his private practice--patients drawn from a great variety of social strata--offers an extraordinary window into the subterranean world of the mad-trade in eighteenth-century London.
The volume concludes with a complete edition of the case book itself, transcribed in full with editorial annotations by the authors. In the fragmented stories Monro's case book provides, Andrews and Scull find a poignant underworld of human psychological distress, some of it strange and some quite familiar. They place these "cases" in a real world where John Monro and othersuccessful doctors were practicing, not to say inventing, the diagnosis and treatment of madness.
Intersections of American Medicine, Law, and Culture
The American culture of death changed radically in the 1970s. For terminal illnesses, hidden decisions by physicians were rejected in favor of rational self-control by patients asserting their "right to die"—initially by refusing medical treatment and more recently by physician-assisted suicide. This new claim rested on two seemingly irrefutable propositions: first, that death can be a positive good for individuals whose suffering has become intolerable; and second, that death is an inevitable and therefore morally neutral biological event. Death Is That Man Taking Names suggests, however, that a contrary attitude persists in our culture—that death is inherently evil, not just in practical but also in moral terms. The new ethos of rational self-control cannot refute but can only unsuccessfully try to suppress this contrary attitude. The inevitable failure of this suppressive effort provokes ambivalence and clouds rational judgment in many people's minds and paradoxically leads to inflictions of terrible suffering on terminally ill people.
Judicial reforms in the 1970s of abortion and capital punishment were driven by similarly high valuations of rationality and public decision-making—rejecting physician control over abortion in favor of individual self-control by pregnant women and subjecting unsupervised jury decisions for capital punishment to supposed rationally guided supervision by judges. These reforms also attempt to suppress persistently ambivalent attitudes toward death, and are therefore prone to inflicting unjustified suffering on pregnant women and death-sentenced prisoners.
In this profound and subtle account of psychological and social forces underlying American cultural attitudes toward death, Robert A. Burt maintains that unacknowledged ambivalence is likely to undermine the beneficent goals of post-1970s reforms and harm the very people these changes were intended to help.
Anesthesia and Birth in America
Despite today's historically low maternal and infant mortality rates in the United States, labor continues to evoke fear among American women. Rather than embrace the natural childbirth methods promoted in the 1970s, most women welcome epidural anesthesia and even Cesarean deliveries. In Deliver Me from Pain, Jacqueline H. Wolf asks how a treatment such as obstetric anesthesia, even when it historically posed serious risk to mothers and newborns, paradoxically came to assuage women's anxiety about birth. Each chapter begins with the story of a birth, dramatically illustrating the unique practices of the era being examined. Deliver Me from Pain covers the development and use of anesthesia from ether and chloroform in the mid-nineteenth century; to amnesiacs, barbiturates, narcotics, opioids, tranquilizers, saddle blocks, spinals, and gas during the mid-twentieth century; to epidural anesthesia today. Labor pain is not merely a physiological response, but a phenomenon that mothers and physicians perceive through a historical, social, and cultural lens. Wolf examines these influences and argues that medical and lay views of labor pain and the concomitant acceptance of obstetric anesthesia have had a ripple effect, creating the conditions for acceptance of other, often unnecessary, and sometimes risky obstetric treatments: forceps, the chemical induction and augmentation of labor, episiotomy, electronic fetal monitoring, and Cesarean section. As American women make decisions about anesthesia today, Deliver Me from Pain offers them insight into how women made this choice in the past and why each generation of mothers has made dramatically different decisions.