This article explores the rise and decline of tonsillectomy/adenoidectomy (T&A) in twentieth-century America. Between 1915 and the 1960s, T&A was the most frequently performed surgical procedure in the United States. Its rise was dependent on novel medical concepts, paradigms, and institutions that were in the process of reshaping the structure and practice of medicine. The driving force was the focal theory of infection, which assumed that circumscribed and confined infections could lead to systemic disease in any part of the body. The tonsils in particular were singled out as ";portals of infection," and therefore their removal became a legitimate therapy. Nevertheless, what kinds of evidence could prove that tonsils were portals of infection? How could the effectiveness of tonsillectomy be determined? An inherent difficulty was the absence of any consensus on the criteria that would be employed to judge its efficacy. Yet tonsillectomy persisted despite ambiguous supportive evidence. Although criticisms of the procedure were common by the 1930s, its decline did not begin until well after 1945 and involved debates over the nature of evidence, the significance of clinical experience in the validation of a particular therapy, and the role of competing medical specialties.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes new standards for the protection of private health information in the United States. The Privacy Rule, one of the specific regulatory provisions of the act, went into effect 14 April 2003 for covered health care providers, institutions, and businesses. The Privacy Rule directly affected medical archivists and their collections. It has significant implications for historians of health care, as well. The Privacy Rule is the first major regulation that protects the privacy of the deceased in perpetuity. It establishes requirements that researchers must satisfy in order to gain access to "individually identifiable health information"; held by HIPAA-protected institutions. While these requirements will burden historians in some cases, the Privacy Rule could open up opportunities for well-prepared historians to work with a more extensive range of twentieth-century documents.
This article examines the psychiatric screening of U.S. soldiers during the Second World War, established by psychiatrist Harry Stack Sullivan (1892-1949), as a key moment in the public application of clinical psychiatry, as well as a turning point in Sullivan's intellectual and professional career. After a brief look at the ideas and expectations Sullivan brought to the screening system, I discuss a major problem of the screening: the mismatch between the medical concept of disease prevention and the realities of the mass screening as a public policy. As a way to highlight this mismatch, I focus on Sullivan's failure to protect homosexual men from medical and social stigmatization by screening them out of the armed forces. Despite his liberal approach to the issue of homosexuality before the war, which he had created in his clinical practice, Sullivan was unable to persuade the military and the public of gay men's right to serve the nation. The examination of how his sympathetic view of homosexuality became circumscribed reveals not only the gap between clinical insights and public policy, but also how tentative views of homosexuality in public debate among liberal psychiatrists during the decade preceding the war contributed to the failure to make non-homophobic policy in the 1940s. This article shows that the relative conservatism in the politics of sexuality among liberal psychiatrists, as well as the intransigent conservatism as seen in homophobic tradition of the Army, contributed to the discriminatory screening criteria.
This article explores the profound impact of the thought of Claude Bernard (1813-78) and his philosophy of experimentalism elaborated in his masterwork An Introduction to the Study of Experimental Medicine. I argue that Bernard's far-ranging theoretical impact on medicine and biology marks the end of conventional vitalism and the elusive notion of a "vital force" as a legitimate scientific concept. His understanding of medicine is as epistemologically significant in its time as Newton's contribution was to the physical sciences in the seventeenth century. This essay treats Bernard's philosophical ambitions seriously, exploring his important, even central, role in the mental world of nineteenth-century France. This includes his influence on Henri Bergson (1859-1941) and other late-nineteenth century thinkers. The subtext of Bernard's experimental epistemology is also contrasted with a key idealist philosopher of the period, the German Arthur Schopenhauer (1788-1860), and placed in the context of the larger European philosophical sphere. In contrast to much of mid-nineteenth-century philosophy, Bernard, in creating the framework for experimental medicine, argued for an experimental approach in which a priori assumptions were to be strictly constrained. Bernard's thoughts on the nature of experiment put an end to "systems" in medicine, ironically by replacing all previous medical philosophies with the all-embracing "system" of experiment. And yet, while "vital forces" fade after Bernard, a form of vitalism still flourishes. Even in Bernard's own work, in the struggle with concepts like determinism, complexity, and causality, there is a realization of the unique character of living function in a kind of "physical vitalism."