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Creating the American Junkie

Addiction Research in the Classic Era of Narcotic Control

Caroline Jean Acker

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.

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Cultivating Health

Los Angeles Women and Public Health Reform

Jennifer Lisa Koslow

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.

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Customers and Patrons of the Mad-Trade

The Management of Lunacy in Eighteenth-Century London

Jonathan Andrews

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.

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Désinstitutionnalisation psychiatrique en Acadie, en Ontario francophone et au Québec, 1930-2013

L'isolement en asile, traitement grandement utilisé à la fin du XIXe siècle pour guérir la folie, a été remis en question au fur et à mesure que le XXe siècle passait. La conception des réseaux de santé, le développement des disciplines psychiatrique et psychologique dans l'après-guerre, la découverte des neuroleptiques au début des années 1950 et les contrecoups de la Révolution tranquille, accompagnés d'un vent de décléricalisation, ont mené à une révolution psychiatrique : la désinstitutionnalisation. Cet ouvrage expose les tenants et les aboutissants d'une première vague de désinstitutionnalisation qui a marqué les années 1960 et 1970 en contexte canadien-français (Québec, Ontario et Nouveau-Brunswick). Proposant une étude sociohistorique et une analyse critique de cette période charnière en santé mentale, les auteurs évaluent les conséquences des transferts sur la vie des patients sortis des asiles ainsi que le rôle des intervenants en matière d'accompagnement. Ils soulèvent également des pistes d'intervention entourant les nouveaux enjeux de la prise en charge des personnes souffrant de maladie mentale. Alliant criminologie, histoire, sociologie, travail social et sciences infirmières, -l'ouvrage traite autant de politiques d'hygiène mentale, de contrôle social, de médicaments psychotropes que de marginalisation des malades mentaux. Il met au jour un vaste patrimoine matériel et immatériel de la santé mentale au Canada.

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Death Is That Man Taking Names

Intersections of American Medicine, Law, and Culture

Robert A. Burt

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.

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Deliver Me from Pain

Anesthesia and Birth in America

Jacqueline H. Wolf

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.

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Diagnosis, Therapy, and Evidence

Conundrums in Modern American Medicine

Gerald N. Grob and Allan V. Horwitz

In Diagnosis, Therapy, and Evidence, Gerald N. Grob and Allan V. Horwitz employ historical and contemporary data and case studies, combining into one book a variety of medical and psychiatric conditions. They utilize case studies and examine tonsillectomy, cancer, heart disease, PTSD, anxiety, and depression, and identify differences between rhetoric and reality and the weaknesses in diagnosis and treatment.

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Disease and Discovery

A History of the Johns Hopkins School of Hygiene and Public Health, 1916–1939

Elizabeth Fee

At the end of the nineteenth century, public health was the province of part-time political appointees and volunteer groups of every variety. Public health officers were usually physicians, but they could also be sanitary engineers, lawyers, or chemists—there was little agreement about the skills and knowledge necessary for practice. In Disease and Discovery, Elizabeth Fee examines the conflicting ideas about public health’s proper subject and scope and its search for a coherent professional unity and identity. She draws on the debates and decisions surrounding the establishment of what was initially known as the Johns Hopkins School of Hygiene and Public Health, the first independent institution for public health research and education, to crystallize the fundamental questions of the field.

Many of the issues of public health education in the early twentieth century are still debated today. What is the proper relationship of public health to medicine? What is the relative importance of biomedical, environmental, and sociopolitical approaches to public health? Should schools of public health emphasize research skills over practical training? Should they provide advanced training and credentials for the few or simpler educational courses for the many?

Fee explores the many dimensions of these issues in the context of the founding of the Johns Hopkins school. She details the efforts to define the school’s structure and purpose, select faculty and students, and organize the curriculum, and she follows the school’s growth and adaptation to the changing social environment through the beginning of World War II. As Fee demonstrates, not simply in its formation but throughout its history the School of Hygiene served as a crucible for the forces shaping the public health profession as a whole.

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Disease Prevention as Social Change

The State, Society, and Public Health in the United States, France, Great Britain, and Canada

From mad-cow disease and E. coli-tainted spinach in the food supply to anthrax scares and fears of a bird flu pandemic, national health threats are a perennial fact of American life. Yet not all crises receive the level of attention they seem to merit. The marked contrast between the U.S. government’s rapid response to the anthrax outbreak of 2001 and years of federal inaction on the spread of AIDS among gay men and intravenous drug users underscores the influence of politics and public attitudes in shaping the nation’s response to health threats. In Disease Prevention as Social Change, sociologist Constance Nathanson argues that public health is inherently political, and explores the social struggles behind public health interventions by the governments of four industrialized democracies. Nathanson shows how public health policies emerge out of battles over power and ideology, in which social reformers clash with powerful interests, from dairy farmers to tobacco lobbyists to the Catholic Church. Comparing the history of four public health dilemmas—tuberculosis and infant mortality at the turn of the last century, and more recently smoking and AIDS—in the United States, France, Britain, and Canada, Nathanson examines the cultural and institutional factors that shaped reform movements and led each government to respond differently to the same health challenges. She finds that concentrated political power is no guarantee of government intervention in the public health domain. France, an archetypical strong state, has consistently been decades behind other industrialized countries in implementing public health measures, in part because political centralization has afforded little opportunity for the development of grassroots health reform movements. In contrast, less government centralization in America has led to unusually active citizen-based social movements that campaigned effectively to reduce infant mortality and restrict smoking. Public perceptions of health risks are also shaped by politics, not just science. Infant mortality crusades took off in the late nineteenth century not because of any sudden rise in infant mortality rates, but because of elite anxieties about the quantity and quality of working-class populations. Disease Prevention as Social Change also documents how culture and hierarchies of race, class, and gender have affected governmental action—and inaction—against particular diseases. Informed by extensive historical research and contemporary fieldwork, Disease Prevention as Social Change weaves compelling narratives of the political and social movements behind modern public health policies. By comparing the vastly different outcomes of these movements in different historical and cultural contexts, this path-breaking book advances our knowledge of the conditions in which social activists can succeed in battles over public health.

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Doctoring Freedom

The Politics of African American Medical Care

Gretchen Long

For enslaved and newly freed African Americans, attaining freedom and citizenship without health for themselves and their families would have been an empty victory. Even before emancipation, African Americans recognized that control of their bodies was a critical battleground in their struggle for autonomy, and they devised strategies to retain at least some of that control. In Doctoring Freedom, Gretchen Long tells the stories of African Americans who fought for access to both medical care and medical education, showing the important relationship between medical practice and political identity.

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