Florence Nightingale began working on hospital reform even before she founded her famous school of nursing; hospitals were dangerous places for nurses as well as patients, and they urgently needed ...fundamental reform. She continued to work on safer hospital design, location, and materials to the end of her working life, advising on plans for children's, general, military, and convalescent hospitals and workhouse infirmaries. Florence Nightingale and Hospital Reform, the final volume in the Collected Works of Florence Nightingale, includes her influential Notes on Hospitals, with its much-quoted musing on the need of a Hippocratic oath for hospitals—namely, that first they should do the sick no harm. Nightingale's anonymous articles on hospital design are printed here also, as are later encyclopedia entries on hospitals. Correspondence with architects, engineers, doctors, philanthropists, local notables, and politicians is included. The results of these letters, some with detailed critiques of hospital plans, can be seen initially in the great British examples of the new "pavilion" design—at St. Thomas', London (a civil hospital), at the Herbert Hospital (military), and later at many hospitals throughout the UK and internationally. Nightingale's insistence on keeping good statistics to track rates of mortality and hospital stays, and on using them to compare hospitals, can be seen as good advice for today, given the new versions of "hospital-acquired infections" she combatted.
This Viewpoint discusses regulation of nonprofit hospitals in a way that will advance their charitable purposes without eliminating their tax exemption status.
Spurred by ideals of individual liberty that took hold in the Western world in the late nineteenth century, psychiatrists and public officials sought to reinvent asylums as large-scale, totally ...designed institutions that offered a level of freedom and normality impossible in the outside world. This volume explores the “caged freedom” that this new psychiatric ethos represented by analyzing seven such buildings established in the Austro-Hungarian monarchy between the late 1890s and World War I.
In the last two decades of the Habsburg Empire, architects of asylums began to abandon traditional corridor-based plans in favor of looser formations of connected villas, echoing through design the urban- and freedom-oriented impulse of the progressive architecture of the time. Leslie Topp considers the paradoxical position of designs that promoted an illusion of freedom even as they exercised careful social and spatial control over patients. In addition to discussing the physical and social aspects of these institutions, Topp shows how the commissioned buildings were symptomatic of larger cultural changes and of the modern asylum’s straining against its ideological anchorage in a premodern past of “unenlightened” restraint on human liberty.
Working at the intersection of the history of architecture and the history of psychiatry, Freedom and the Cage broadens our understanding of the complexity and fluidity of modern architecture’s engagement with the state, with social and medical projects, and with mental health, psychiatry, and psychology.
InAmerican Catholic Hospitals, Barbra Mann Wall chronicles changes in Catholic hospitals during the twentieth century, many of which are emblematic of trends in the American healthcare system.
Wall ...explores the Church's struggle to safeguard its religious values. As hospital leaders reacted to increased political, economic, and societal secularization, they extended their religious principles in the areas of universal health care and adherence to the Ethical and Religious Values in Catholic Hospitals, leading to tensions between the Church, government, and society. The book also examines the power of women--as administrators, Catholic sisters wielded significant authority--as well as the gender disparity in these institutions which came to be run, for the most part, by men. Wall also situates these critical transformations within the context of the changing Church policy during the 1960s. She undertakes unprecedented analyses of the gendered politics of post-Second Vatican Council Catholic hospitals, as well as the effect of social movements on the practice of medicine.
Frederick R. Gabriel graduated from medical school in 1940, entered the US Army, and was assigned to the newly-created 39th Station Hospital. His letters from the Pacific theater—especially ...from Guadalcanal, Angaur, and Saipan—capture the everyday life of a soldier physician. His son, Michael P. Gabriel, a professional historian, has faithfully preserved, edited, and annotated that correspondence to add a new dimension to our understanding of the social history of World War II, which he presents here in  Physician Soldier: The South Pacific Letters of Captain Fred Gabriel from the 39th Station Hospital .  Like most wartime hospitals, the 39th Station Hospital was positioned in a rear area and saw limited direct action. And like most wartime hospitals, the 39th Station Hospital spent each day confronting the injuries and casualties of frontline combat. Gabriel supervised a ward and oversaw the unit’s laboratory, serving a hospital that provided care to four hundred patients at a time. Gabriel’s letters home capture this experience and more, providing a revealing look into day-to-day life in the Pacific theater. He discusses the training of medical officers and female nurses, recreational activities such as Bob Hope’s USO show, and even his thoughts on the death of FDR, the end of the war in Europe, and ultimately the horrors of the atomic bomb.
En 1573, la Corona española presentó a fray Dionisio de Sanctis para ocupar la sede episcopal cartagenera. Muy temprano, el prelado constató que no era él quien tenía el patronazgo del Hospital San ...Sebastián, sino el cabildo secular. Fue así como entabló un pleito en contra de la institución municipal para recuperar el gobierno del centro hospitalario. Utilizando el expediente del proceso, se presenta los pormenores del pleito y se analiza el discurso de la respuesta dada por el procurador general de la ciudad a la demanda del prelado. Con ello se busca dar cuenta del papel que jugaron los obispos en la fundación y gobierno de los hospitales coloniales y de algunos aspectos del funcionamiento de la justicia local. Se adopta como hipótesis que, con el recurso interpuesto, el mitrado buscaba que se le devolviera el patronazgo del hospital, tal y como lo habían ostentado sus antecesores.
BackgroundIn CLARITY, cladribine tablets (CT) significantly reduced relapse rates in patients with relapsing multiple sclerosis. CLARITY Extension (EXT) compared the effects of 2 years’ additional CT ...treatment vs no additional treatment.ObjectiveAssess efficacy of 2 courses of CT or placebo (PBO) in CLARITY and 2 additional courses of CT or PBO in EXT.MethodsPatients receiving PBO in CLARITY were assigned to CT3.5 mg/kg; those treated with CT (3.5 or 5.25 mg/kg) were re-randomised 2:1 to CT3.5 mg/kg or PBO. Annualised relapse rates (ARR) and proportions qualifying relapse free (RF) were compared for CLARITY vs EXT within the same treatment groups: CT3.5 mg/kg in CLARITY and PBO in EXT (n=98); CT3.5 mg/kg in CLARITY and CT3.5 mg/kg in EXT (n=186); CT5.25 mg/kg in CLARITY and CT3.5 mg/kg in EXT (n=186); PBO in CLARITY and CT3.5 mg/kg in EXT (n=244).ResultsNo significant differences in ARR for CLARITY vs EXT except for PBO in CLARITY and CT3.5 mg/kg in EXT (0.26 vs 0.10, p<0.0001). The proportion RF was similar between CLARITY vs EXT across groups and >70%, except for PBO in CLARITY and CT3.5 mg/kg in EXT (58.0% vs 79.6%, p<0.0001).ConclusionsClinical benefits were maintained in patients who received CT in CLARITY and PBO in EXT demonstrating durable efficacy.
PDF