Sairey Gamps, feminine nurses and greedy monopolists: discourses of gender and professional identity in the Lancet and the British Medical Journal, 1886-1902

The British debate over midwife registration in the late 19th and early 20th centuries was highly gendered. Focusing on the period between the 1886 Medical Act and the 1902 Midwives Act, this article uses the content from the Lancet and the British Medical Journal, the two main general medical publications of the time, to explore the complex ways that gender works through other categories such as class and race to create professional identity. Specifically this article demonstrates how man-midwives used gendered language to help create identities for themselves, female midwives, and other rivals in order to legitimize their own professional identity and practice and to delegitimize the professional identities of their competition.

Quest for professionalism: a biography of the North American Medical and Surgical Journal (1826-31)

This is the biography of a deceased medical journal, the North American Medical and Surgical Journal, born in 1826 in Philadelphia. It was a publication of the Philadelphia Chapter of the Kappa Lambda Society. In the prospectus of the North American Medical and Surgical Journal the promoters observed that a well-conducted journal would achieve the object of elevating the medical profession to its legitimate rank which up to that time had been the recipient of low public opinion. The Journal hoped to inculcate 'a higher standard of excellence not merely in the professional or ministrative but also in the ethical relations and duties of physicians'. After several successful and productive years it passed into history in October 1831, the victim of financial difficulty.

'Often there is a good deal to be done, but socially rather than medically': the psychiatric social worker as social therapist, 1945-70

Seeking to align psychiatric practice with general medicine following the inauguration of the National Health Service, psychiatric hospitals in post-war Britain deployed new treatments designed to induce somatic change, such as ECT, leucotomy and sedatives. Advocates of these treatments, often grouped together under the term 'physical therapies', expressed relief that the social problems encountered by patients could now be interpreted as symptomatic of underlying biological malfunction rather than as a cause of disorder that required treatment. Drawing on the British Journal of Psychiatric Social Work, this article analyses the critique articulated by psychiatric social workers based within hospitals who sought to facilitate the social reintegration of patients following treatment. It explores the development of 'psychiatric social treatment', an approach devised by psychiatric social workers to meet the needs of people with enduring mental health problems in hospital and community settings that sought to alleviate distress and improve social functioning by changing an individual's social environment and interpersonal relationships. 'Physical' and 'social' models of psychiatric treatment, this article argues, contested not only the aetiology of mental illness but also the nature of care, treatment and cure.

Does ownership matter for the provision of professionalized services? Hip operations at publicly and privately owned clinics in Denmark

In terms of clinical procedures (to take the example used in this article, hip operations), both public and private organizations provide highly professionalized services. For this service type, our knowledge about ownership differences is sparse. To begin to fill this gap, we investigate how the ownership of hip clinics affects professional behaviour, treatment quality and patient satisfaction. The comparison of private and public hip clinics is based on data from the Danish Hip Arthroplasty Register and the Danish Central Patient Register combined with 20 semi-structured interviews. We find that private clinics employ stronger individual financial incentives and try harder to increase the income/costs ratio than do public clinics. Private clinics optimize non-clinical factors such as waiting time much more than public clinics and have fewer complication-prone patients than public clinics. However, the clinical procedures are very similar in the two types of clinics. Private clinics do not achieve better clinical results, but patient satisfaction is nevertheless higher with private clinics. The implication is that ownership matters for highly professionalized services, but professionalism neutralizes some – but not all – ownership differences.

Amateur knowledge: public art and citizen science

The science studies literatures on amateurs and citizen science have remained largely unconnected despite similarities between the two categories. The essay connects amateur knowledge and citizen science through examples from public art. Through an analysis of the use of the term "amateur" by contemporary artists working to engage the public in critiques of science, connections in the ideals of democratic knowledge making by amateurs and citizen scientists are further explored.

A Lipskian analysis of child protection failures from Victoria Climbié to "Baby P": a street-level re-evaluation of joined-up governance

This paper explores the issue of joined-up governance by considering child protection failures, firstly, the case of Victoria Climbié who was killed by her guardians despite being known as an at risk child by various public agencies. The seeming inability of the child protection system to prevent Victoria Climbié's death resulted in a public inquiry under the chairmanship of Lord Laming. The Laming report of 2003 looked, in part, to the lack of joined-up working between agencies to explain this failure to intervene and made a number of recommendations to improve joined-up governance. Using evidence from detailed testimonies given by key personnel during the Laming Inquiry, the argument of this paper is that we cannot focus exclusively on formal structures or decision-making processes but must also consider the normal, daily and informal routines of professional workers. These very same routines may inadvertently culminate in the sort of systemic failures that lead to child protection tragedies. Analysis of the micro-world inhabited by professional workers would benefit most, it is argued here, from the policy-based concept of street-level bureaucracy developed by Michael Lipsky some 30 years ago. The latter half of the paper considers child protection failures that emerged after the Laming-inspired reforms. In particular, the case of ‘Baby P’ highlights, once again, how the working practices of street-level professionals, rather than a lack of joined-up systems, may possibly complement an analysis of, and help us to explain, failures in the child protection system. A Lipskian analysis generally offers, although there are some caveats, only pessimistic conclusions about the prospects of governing authorities being able to avoid future child protection disasters. These conclusions are not wholeheartedly accepted. There exists a glimmer of optimism because street-level bureaucrats still remain accountable, but not necessarily in terms of top-down relations of authority rather, in terms of interpersonal forms of accountability – accountability to professionals and citizen consumers of services.

The role of hospital heterogeneity in measuring marginal returns to medical care: a reply to Barreca, Guldi, Lindo, and Waddell

In Almond et al. (2010), we describe how marginal returns to medical care can be estimated by comparing patients on either side of diagnostic thresholds. Our application examines at-risk newborns near the very low birth weight threshold at 1500 g. We estimate large discontinuities in medical care and mortality at this threshold, with effects concentrated at “low-quality” hospitals. Although our preferred estimates retain newborns near the threshold, when they are excluded the estimated marginal returns decline, although they remain large. In low-quality hospitals, our estimates are similar in magnitude regardless of whether these newborns are included or excluded.

The strange case of the Freudian case history: the role of long case histories in the development of psychoanalysis

Sigmund Freud's five long case histories have been the focus of seemingly endless fascination and criticism. This article examines how the long case-history genre developed and its impact on the professionalization of psychoanalysis. It argues that the long case histories, using a distinctive form that highlighted the peculiarities of psychoanalytic theory, served as exemplars in the discipline. In doing so, the article extends John Forrester's work on "thinking in cases" to show the practical implications of that style of reasoning. The article illustrates how the form disappeared once the theoretical basis of the movement was set. The genre never became institutionalized, although the content of the five long case histories did, because of Freud's accepted role as theoretician of psychoanalysis.

The role of governmentality in the establishment, maintenance and demise of professional jurisdictions: the case of geriatric medicine

This paper examines the professionalising of geriatric medicine in the UK roughly between the 1940s and the 1970s and locates it in terms of the broader context of the relationship between the professions and the state. It looks at how this relationship shaped geriatric medicine's professional jurisdiction, including the discourses of expertise on the one hand and the constituting of the 'subjects' of such expertise on the other. In contrast to other sociological approaches to the professions, which highlight the negative impact of state encroachment on professional territory, this paper contends that without the backing of the Ministry of Health the specialty may never have established itself in the face of prolonged opposition from rival specialists. However, such support was predicated on the specialty's highlighting particular legitimating discourses and practices at the expense of others, and in framing this in terms of specific policy concerns around an ageing population. Whilst this imprinted the profession with the stamp of governmentality, it also contributed to the broader problematising of old age in the twentieth century. The paper concludes by considering the legacy of this context of professionalisation for the profession today.

Students as resurrectionists--A multimodal humanities project in anatomy putting ethics and professionalism in historical context

Because medical students have many different learning styles, the authors, medical students at Mayo Clinic, College of Medicine researched the history of anatomical specimen procurement, reviewing topic-related film, academic literature, and novels, to write, direct, and perform a dramatization based on Robert Louis Stevenson's The Body-Snatcher. Into this performance, they incorporated dance, painting, instrumental and vocal performance, and creative writing. In preparation for the performance, each actor researched an aspect of the history of anatomy. These micro-research projects were presented in a lecture before the play. Not intended to be a research study, this descriptive article discusses how student research and ethics discussions became a theatrical production. This addition to classroom and laboratory learning addresses the deep emotional response experienced by some students and provides an avenue to understand and express these feelings. This enhanced multimodal approach to"holistic learning" could be applied to any topic in the medical school curriculum, thoroughly adding to the didactics with history, humanities, and team dynamics.

The "cradle of glass": incubators for infants in late nineteenth-century France

This article examines the development of the incubator for premature infants in fin-de-siècle France. During a period of widespread anxiety in France regarding infant mortality and its implications for population growth, physicians in Paris developed and widely promoted the lifesaving technology. This article explores the ways in which the incubator reflected new scientific and symbolic approaches to creating hygienic spaces as well as how it reflected new scientific and symbolic approaches to the traditionally feminine project of infant care. By creating such an isolating and protective milieu around premature infants—an entirely new population of patients—the incubator, I argue, heralded a renegotiation of the boundary between motherhood and medical authority.

Eyes on the prize: reflections on the impact of the evolving digital ecology on the librarian as expert intermediary and knowledge coach, 1969-2009

OBJECTIVE

The 2009 Janet Doe Lecture reflects on the continuing value and increasing return on investment of librarian-mediated services in the constantly evolving digital ecology and complex knowledge environment of the health sciences.

SETTING

The interrelationship of knowledge, decision making based on knowledge, technology used to access and retrieve knowledge, and the important linkage roles of expert librarian intermediaries is examined.

METHODOLOGY

Professional experiences from 1969 to 2009, occurring during a time of unprecedented changes in the digital ecology of librarianship, are the base on which the evolving role and value of librarians as knowledge coaches and expert intermediaries are examined.

CONCLUSION

Librarian-mediated services linking knowledge and critical decision making in health care have become more valuable than ever as technology continues to reshape an increasingly complex knowledge environment.

[Scientific training and professional practice in Vicente Cervantes Mendo's Spain.]

Vicente Cervantes Mendo (Ledrada, Salamanca, 1758 - México, 1829) was a famous Spanish Mexican scientists; he is today heritage of Spain and Mexico. As a continuation of two recent articles on his life at Spain, the present study deals with his scientific formation at madrid, as pharmacist and as botanist, as well as on his professional activity. Two documents of Casimiro Gómez Ortega, principal professor of the Real Jardín Botánico de Madrid, dated in 1786 and related with the "Real Expedición Botánica a Nueva España (1787-1803)," have served to establish conclusions which clarify the subjects studied and correct mistakes.

[The professionalization of nursing in Argentina: political and institutional disputes during Peronism.]

This paper discusses the professionalization of nurses in Argentina during Peron's administration (1946-1955). We will focus on two nursing schools during such period: Escuela de Engermas de la Secretaría de Salud Pública (1947) and Escuela de Enfermeras "7 de mayo" member of Fundación Eva Perón (1950). We will analyze the institutional disputes over budgetary positions in the context of greater government intervention in public health issues.

The professional and the scientist in nineteenth-century America

In nineteenth-century America, there was no such person as a "professional scientist". There were professionals and there were scientists, but they were very different. Professionals were men of science who engaged in commercial relations with private enterprises and took fees for their services. Scientists were men of science who rejected such commercial work and feared the corrupting influences of cash and capitalism. Professionals portrayed themselves as active and useful members of an entrepreneurial polity, while scientists styled themselves as crusading reformers, promoters of a purer science and a more research-oriented university. It was this new ideology, embodied in these new institutions, that spurred these reformers to adopt a special name for themselves--"scientists". One object of this essay, then, is to explain the peculiar Gilded Age, American origins of that ubiquitous term. A larger goal is to explore the different social roles of the professional and the scientist. By attending to the particular vocabulary employed at the time, this essay tries to make clear why a "professional scientist" would have been a contradiction in terms for both the professional and the scientist in nineteenth-century America.

[In the heart of Brazil, a healthy capital--the participation of doctors and sanitarists in the construction of Brasília (1956-1960)]

Projected as an expression of the daring and modernity of an age, Brasília could not overlook planning that considered the conditions where it would be located in the interior of Brazil. Constructed in a region historically associated with isolation, poverty and diseases, the new capital required the participation of doctors and sanitarists from the very beginning of construction to ensure healthy conditions. Seeing the opportunity to expand their sphere of action, until then restricted to the interior, doctors from Goiás stood out in this process, highlighted by concerns of the profession manifested in the periodical published by its association and their extensive mobility and modern practice, contradicting the common conceptions regarding doctors in the interior.

Cookery, diet and district nursing in late nineteenth-century London

While health education in late nineteenth-century Britain could be beneficial for every household, it was particularly so where district nurses understood family circumstances and adapted knowledge to individual needs. During this period sick room cookery training and lectures on hygiene and dietetics became standard for nurses--especially following the reforms of Matron Eva Lückes at the London Hospital. Because understanding about health was not widespread in society, due to the living conditions and poverty of so many patients, and because doctors had few opportunities to convey such knowledge, the active support of nurses in the community proved to be essential for translating professional knowledge into words commonly understood. By demonstrating cooking and other health-related skills in the homes of the poor, nurses played an important part in improving the nation's health.

[Masters of Ireneusz Wierzejewski]

Authors described the figures of outstanding German orthopaedists and the influence they exerted on the development of Polish orthopaedics. Their biggest achievements for the European and global orthopaedic are clarified. The particular attention was devoted to these luminaries of German orthopaedics at whom Ireneusz Wierzejewski, author of modern Polish orthopaedics, began studies, undertook the clinical practice as well as developed his professional interests.

[Famous figures of the Poznań orthopaedics of the period of the occupation and post-war years. Coryphees of Polish orthopaedics]

In this article author presents, from a perspective of own memories is portraying persons which he met in his professional activity. They participated in forming the orthopaedics in Poznań and different nooks of Poland. He resembles their, often very dramatic, fates and the influence they had on Polish medicine reviving after the II world war. With the special attention he is reminding one of most well-known and valued celebrities of the Polish orthopaedics professor Wiktor Dega.