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Architecture, asylum and community in twentieth-century mental health care
Sarah Chaney and Jennifer Walke

This chapter explores the value and relevance of a combined academic and public engagement approach to the history of medicine. The authors consider a specific mental health project at the Bethlem Museum of the Mind, in the context of a longer tradition of service user involvement in mental health research and museology. It is argued that the project’s approach presented a unique opportunity for mental health education and the reduction of stigma. These elements of the project informed the historical focus, resulting in a more inclusive history than in many institutional histories of psychiatry, focusing on the importance of space, place and architecture in twentieth-century psychiatry. The chapter concludes that community engagement within a museum setting enriches the history of medicine as a discipline and vice versa.

in Communicating the history of medicine
A disrupted digression on productive disorder, disorderly pleasure, allegorical properties and scatter
Michael Sappol

This ‘chapter’ mixes up genres, registers and media – through essayistic reflection, polemic, hyperdiscourse, historical narrative, autobiography and cut-up. The foray into experimentation is justified, because the formulaic article and historical exhibition are imprisoned in a habitus that conditions us to feel discomfort with deviations. And that raises issues of practice and audience: what conditions produce the habitus; what current audiences are conditioned to expect; what new practices might raise new and different audiences and a new and different scholarship. Notwithstanding its intellectual achievements, current scholarship is often stale and undermining. This piece models an alternative by calling conventional forms into question. It implies that (a) historical consciousness is a necessary condition for the well functioning of a democratic society, and therefore (b) we need a culture of historical consciousness based on a pleasurable history-for-history’s sake, a practice that exceeds, or is unyoked from, any instrumental purpose. And therefore opposes the utilitarian economism that currently governs medical history and everything else.

in Communicating the history of medicine
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Physician-publics, citizen-audiences and a half-century of health-care debates in Canada
Sasha Mullally and Greg Marchildon

This chapter examines five decades of historical writing on, and myth-making about, the origins of Medicare, Canada’s public health-care system. It examines interpretations of the 1962 doctors’ strike in Saskatchewan, and its reception and uptake among physician and citizen audiences. Within the medical profession, academic and professional elites have vied to capture attention from Canadian citizen-audiences. A pro-Medicare consensus, emergent in the 1960s and 1970s, was replaced in the early 2000s by a newly polarized view, critical of public health care, which reinterprets the history of the strike action as a form of justified public protest.

in Communicating the history of medicine
Representations, address and assumptions about influence
Elisabet Björklund

Sex education films have historically raised much concern due to their combining a controversial subject with a medium believed to have a particularly great influence on its audiences. In this chapter, the role of medicine in the relationship between sex education films and their audiences is explored, using a number of Swedish films from different time periods as examples. The chapter demonstrates that a medical perspective was significant in this relationship, both regarding the context in which audiences viewed the films, and regarding representations and educational address. Reflections are also made concerning the audiences of historical research on sex education films today.

in Communicating the history of medicine
The historian’s dilemmas in a time of health-care reform
Beatrix Hoffman

This chapter examines ways in which historians of medicine can reach the wider public and have an impact on policy debates. Using the US Affordable Care Act as a case study, it describes how historians have engaged in correcting health policy falsehoods, disseminating historical research to a wider audience, cautiously applying the lessons of history to policy, and even direct advocacy. It ends by cautioning that historical research and publication must still be valued for their own sakes, apart from its ‘impact’ outside the academy.

in Communicating the history of medicine
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Nursing on the Crimean War battlefields

This book is a study of nursing in the five Crimean War armies. It sets military nursing into the wider transnational context, and studies the political and economic as well as the cultural and military factors which impacted the early development of modern nursing. In the Ottoman army there was no nursing corps as such, so doctors gave whatever nursing care their soldiers received. In the other four armies three systems of nursing developed: government-directed, doctor-directed, and religious sisterhood-directed. Government-directed nursing, the system in which Nightingale worked, was the most difficult to apply and placed the most constraints on the nursing superintendent. Religious sisters were highly successful, as were the trained French and Sardinian soldier nurses who reported to them, but the most innovative and productive military nursing developed in a doctor-directed nursing service, that of the Russians. There the director of nursing was a brilliant, internationally renowned Russian surgeon, Nikolai Ivanovitch Pirogov. As well as giving his nurses a wide scope of practice, he placed them in charge of hospital administration. Nursing under direct fire for most of the siege of Sevastopol, the Russian nurses met the challenges brilliantly. The book concludes that French and Sardinian soldier nurses, the Daughters of Charity, and Russian nurses provided the best nursing because they worked on the battlefields where they could save the most lives, while British nurses remained confined in base hospitals.

Carol Helmstadter

This chapter describes the decentralized and inefficient administration of the British army medical department. The department was a civilian, rather than a military department, which meant the doctors had no authority over their patients and orderlies and could only make recommendations to the military High Command. The position of hospital nurses in the British hierarchical class structure placed them at the very bottom; they were very much looked down upon, while their social behavior sometimes merited censure. This made it especially difficult to introduce them into army hospitals. The ideology of the domestic and public spheres in Victorian society, and how this affected the lady nurses, is explored in the chapter. Furthermore, it explains how Nightingale, who saw her government-directed mission to the East as a mystical religious commitment, was placed under severe political constraints. She had to accept women whom she considered unqualified, and 25 percent of the nurses had to be Roman Catholic at a time when anti-Catholicism was rampant. The chapter also describes the impossible situation of the orderlies, who were the principal nurses.

in Beyond Nightingale
Carol Helmstadter

The British government established two hospitals in Turkey, in Smyrna and Renkioi. Civilian, rather than army doctors directed the hospitals and the nursing. The doctors ran the hospitals on the model of the civilian hospitals they had worked in at home. Two secular ladies, Henrietta LeMesurier at Smyrna and Maria Parkes at Renkioi, neither of whom had any experience in clinical nursing, became outstanding lady superintendents. Both did extremely well, with a good deal less firing of nurses compared to Nightingale and her lady superintendents. The Smyrna hospital was housed in a dilapidated building very similar to the Barrack Hospital but the Renkioi hospital was purpose-built, designed by Isambard Brunel, and incorporated all the latest features that the sanitarians demanded. In the Renkioi hospital, with the exception of Lady Superintendent Maria Parkes who was the sister of the director of the hospital, the lady nurses were paid. Ladies were no longer volunteering unless they were paid, a major shift in the Victorian concept of the domestic sphere. At the same time the doctors’ belief in women’s mission impeded innovation in nursing in these hospitals.

in Beyond Nightingale
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Transcending the limitations of gender
Carol Helmstadter

The highly politicized government-imposed system of nursing was the hardest to apply; Florence Nightingale faced the greatest challenge of any of the nursing directors and did well under the circumstances. As a whole, the religious nursing sisterhoods consistently provided the best nursing, but it was doctor-directed nursing in Russia that developed the most innovative and efficient system. The Crimean War demonstrated that nursing was becoming a knowledge-based practice. The barely literate British working-class nurses were aware of this and demanded recognition of their expertise and body of knowledge, but a persistent theme in the story of nurses is the way the upper classes looked down on them and what they considered their menial and repulsive domestic service. The most outstanding feature of the war’s nursing experience was the transnational humanitarianism of nurses who came from all classes and such different cultural backgrounds. Despite all the restrictions and obstacles these men and women faced, all managed to relieve some of the sufferings of their patients. However, the nursing services which were most successful, the Russian, French, and Piedmont-Sardinian, were those in which the nurses transcended gendered constructions, and their competencies rather than their sex determined their roles.

in Beyond Nightingale
Carol Helmstadter

As professionally trained nurses, the Daughters of Charity had a long tradition of managing French military base hospitals, which they did extremely effectively; their patients took a very positive view of their work. The French medical department functioned very efficiently at the beginning of the war because it included professionally trained soldier nurses as well as canteen ladies, who were essentially sutlers and entrepreneurs but who also gave care on the battlefield. The trained soldier nurses were excellent but the doctors always complained there were not enough of them. Furthermore, these nurses could not advance beyond the level of non-commissioned officer. The French had solved the problem of land transport for the wounded and sick with their muleteers, but the medical department’s administrative arrangements were unsatisfactory. It reported to the commissariat which did not consider the care of the sick and wounded a high priority. In a good example of transnationalism, the Piedmont-Sardinians modeled their army on the French and similarly had trained male soldier nurses. Their nursing system was somewhat better because their soldier nurses could become officers and their Daughters of Charity worked on the battlefield. They had an outstanding leader in the Countess Cordero.

in Beyond Nightingale