medical societies: by addressing a speech to one’s fellow members; by
donating an anatomical specimens; by offering a manuscript for publication (or by reviewing one); by taking up a role as an ‘expert’ in public
health; and by commemorating the work of one’s colleagues. Together,
these performances have shed new light on – what appears in hindsight
– a process of growing autonomy of the medical sciences, from its
emancipation from a broader learned culture at the turn of the nineteenth century to its institutionalization in specialized academic subdisciplines
Concepts of ‘balance’ have been central to modern politics, medicine and society.
Yet, while many health, environmental and social challenges are discussed
globally in terms of imbalances in biological, social and ecological systems,
strategies for addressing modern excesses and deficiencies have focused almost
exclusively on the agency of the individual. Balancing the Self explores the
diverse ways in which balanced and unbalanced selfhoods have been subject to
construction, intervention and challenge across the long twentieth century.
Through original chapters on subjects as varied as obesity control, fatigue and
the regulation of work, and the physiology of exploration in extreme conditions,
the volume analyses how concepts of balance and rhetorics of empowerment and
responsibility have historically been used for a variety of purposes, by a
diversity of political and social agencies. Historicising present-day concerns,
as well as uncovering the previously hidden interests of the past, this volume’s
wide-ranging discussions of health governance, subjectivity and balance will be
of interest to historians of medicine, sociologists, social policy analysts, and
social and political historians alike.
This book talks about late eighteenth- and early nineteenth-century English medical culture, a study of what it meant to be a doctor and how this changed over time. It presents a brief overview of the social, economic and cultural landscape of late eighteenth-century York. Medical culture and identity in late eighteenth-century York took shape within a social landscape shaped by the values of gentility, polite sociability and civic belonging. The book examines the role of intellectual liberality, demonstrating how public displays of polite and 'ornamental' learning were central to the performance of medico-gentility. It explores the incipient demise of this culture. Through a close reading of a scandal which enveloped the York Lunatic Asylum, it also explores the ways in which medical identities founded upon gentility and politeness were critically undermined by the political and social factionalism. The book looks at medical involvement in the provincial scientific movement, examining how local medical men positioned themselves relative to the so-called 'march of intellect', the cultural and ideological alignment between science and social reform. It continues this analysis in relation to the cholera epidemic of 1832 and other medico-political activities. The book considers how the professional dominion over healthcare was forged by the dual processes of inclusion and exclusion. It discusses the foundation of the Medical School in 1834 against the trial, in the same year, of a local salesman for James Morison's 'Universal Vegetable Medicine'.
as patient satisfaction, absence rates, agency spend, the number of
MRSA cases, patient mortality rates and staff health.
This new financial focus on the care of the health of nurses emphasises the need for managers to understand the links between health
and organisational performance and, as a result, to remodel their
provision of occupational welfare to include a much stronger preventative emphasis than in the past. Nurses, and other NHS employees, are to be supported to reduce their risk factor of disease by, for
example, losing weight, increasing exercise
, courageous, dedicated, motivated. 16 Yet alongside this conceptualisation a new type of athlete was emerging; muscle bound, fixated with winning; demonstrating a physique and ability unobtainable by the majority; state-sponsored, professional or shamateur. 17 By this period it was no longer tenable, as it had been in 1908, or even 1924, that a reasonably fit adult could approach the performance of an elite-level athlete. 18 Although it took another decade for some parts of the British sporting world to admit as much, by 1952 the athletic body was in some respects no
covering ideal facilities and staffing, the parameters of guidance expanded to encompass standards for care process and targets for therapeutic outcomes as concerns over clinical standards and professional accountability grew. Moreover, indicative of novel visions of professionalism that emphasised self-reflection and peer critique, the new documents covered not just disease management, but also the process of review; they aimed to structure care and audit, and to provide benchmarks against which performance (and by extension, professionals themselves) could be managed
attitude in a scientific debate, somewhere in-between respect for established authority
and an assertiveness driven by curiosity. No written rules existed for
presenting instruments, scientific drawings or patients to strengthen
one’s arguments, combining verbal skills with visual aids. Yet such performances were regulated as well, albeit by unwritten codes of conduct
rather than formal articles. To deliver a good speech, society members
had to meet the expectations of their audience – an effort which
required, besides moderation and mutual respect, a strong performative
his final minutes, Seekleham is joined at his bedside by a choir of ‘Decadents’, who sing ‘in praise of exhaustion, and disillusion, and failure, and emptiness, and weariness’. Individual singers explore themes of ‘decay’ and ‘decline’, with another reciting a ‘sombre poem’ on the subject of exhaustion. Finally, as the clock strikes midnight, they all join in an ‘Ode to the Spirit of Decadence’.
Before the performance ends, however, Seekleham has already succumbed to his fatigue, disappearing to make way for the
general practices were encouraged to operate as purchasers of certain hospital services (such as outpatient care), and new GP contracts introduced enhanced pay-for-performance elements. 2 Guidelines and medical audit were to play important roles in the new system. Although remaining under the control of professional bodies, these instruments would enhance professional accountability and provide standards against which care could be measured before payments were made. The earliest moves in this direction were made in relation to chronic disease, with diabetes a
introduced subtle changes to the prevailing consensus on diabetes management – for instance, developing primary preventive strategies and bringing professional management closer to performance management – even these innovations were closely tied to developments discussed in the preceding pages.
In concluding a book of ‘contemporary history’, it is tempting to bring the narrative up to date. In an earlier draft, this Epilogue surveyed the changes in diabetes care since the early 2000s, tracing the evolution of the QOF since 2004 and the growth of the