Linking Public Health and Individual Medicine: The Health Policy Approach of Surgeon General Thomas Parran

Surgeon General Thomas Parran Jr was once viewed as a path-breaking leader, but his legacy is now highly contested. Scholars of national health insurance have viewed Parran as an impediment to government-backed insurance, and revelations about his role in the Tuskegee Study and in the Public Health Service's experiments in Guatemala have cast a shadow over his career. Surgeon General from 1936 to 1948, Parran led the Public Health Service during the development of key features of the modern American health system and was involved in critical debates over the role of the national government in health. I argue that Parran is best understood not as an opponent of insurance but as the proponent of an approach to health policy that sought to link public health and individual medicine. A pragmatic bureaucrat, Parran believed that effective policymaking required compromise with the American Medical Association.

The legendary Smiths and their Paris hospital

The Paris Hospital in Paris, Arkansas, provided high quality care during its existence from 1910 to 1971, offering a prepaid health care plan from 1920 to 1971. Three generations of Smith doctors were its nucleus, subsidizing the annual losses of the hospital and providing care to all, regardless of ability to pay. The hospital was a community unto itself for the nurses who lived, trained, and worked there. A unique family in the history of medicine in Arkansas, the Smith physicians were well trained, altruistic, compassionate, and conscientious, exemplifying the traditional values of twentieth century medical practice.

Humble beginnings: from Lalaura to the board rooms of Papua New Guinea--the story of Dr Evelyn Lavu

This article explores the life and professional achievements of Dr Evelyn Lavu, the Director of the Central Public Health Laboratory at Port Moresby General Hospital in Papua New Guinea (PNG). The article documents Dr Lavu's journey from the happy village in which she grew up to her internationally recognized status as a leading pathologist of the Pacific region. Never limited by her gender, Dr Lavu has served as an executive committee member of the Medical Society of Papua New Guinea. She has also served as the President of the Women Doctors' Association of PNG. Exploring the factors that have enabled Dr Lavu's achievements, the article documents her quiet tenacity and confidence.

The psychiatrist as administrator: the career of W.F. Theunissen in the Dutch East Indies

W. F. Theunissen (1882-1961) was a leading psychiatrist in the Dutch East Indies. He was the medical director of several large mental hospitals after which he became director of the Dutch East Indies Public Health Service. Theunissen was not known for his research into the causes of mental illness. Instead, he made his mark as an administrator greatly reducing the expenses of the Lawang mental hospital by expanding occupational therapy in new and innovative ways. His accomplishments earned him the position of director of the Indies Public Health Department, where he oversaw the decentralisation of health services and the development of public health initiatives.

Dame Josephine Barnes: distinguished gynaecologist and first woman president of the British Medical Association

In previous articles in this series, we have written about the great women pioneers who broke down the barriers which prohibited or limited their entry into the various branches of the healthcare professions and who then proved that they could compete, on equal terms, with their male counterparts. Included in the first among these, of course, was Florence Nightingale, who, in the Crimean war (1854-6) and afterwards introduced the 'modern' era of nursing training and put an end to the dirty, ignorant and often drunk women who had been delegated to look after the sick and injured in the hospital wards before her time.

From cure to custodianship of the insane poor in nineteenth-century Connecticut

Connecticut was the exception among the Northeastern and Middle Atlantic states in not founding a public institution for the insane until after the Civil War when it opened the Hospital for the Insane at Middletown in 1868, a facility previously neglected by scholars. The state had relied on the expedient of subsidizing the impoverished at the private Hartford Retreat for the Insane that overtaxed that institution and left hundreds untreated. Despite abundant evidence to the contrary, well meaning officials oversold the idea that the Middletown site would promote cures and be cost effective. A number of unanticipated consequences occurred that mirrored fundamental changes in nineteenth-century psychiatry. The new hospital swelled by 1900 to over 2,000 patients, the largest in New England. Custodianship at the monolithic hospital became the norm. The hegemony of monopoly capitalism legitimated the ruling idea that bigger institutions were better and was midwife to the birth of eugenic responses. Class based psychiatry--the few rich at the Retreat and the many poor at Middletown--was standard as it was in other aspects of the Gilded Age. Public policy toward the insane poor in Connecticut represents an outstanding example of the transition from antebellum romanticism to fin de siècle fatalism.

Bernard Schwartz, MD, PhD, Founding Chair of Ophthalmology, Tufts University School of Medicine, and Founding Editor of Survey of Ophthalmology

Bernard Schwartz, MD, PhD (1927-2007) was first and foremost a scholar. He was a teacher, serving as Professor of ophthalmology for many years at Tufts University; an administrator, chairing the department of ophthalmology for over 20 years; a clinician, practicing primarily in the field of glaucoma; a scientist with a broad interest in ophthalmic research; an historian, especially of medical history; and an editor, primarily of Survey of Ophthalmology. Throughout all of his activities, the central theme was always scholarship.

'These strangers within our gates': race, psychiatry and mental illness among black Americans at St Elizabeths Hospital in Washington, DC, 1900-40

During the early decades of the twentieth century, William Alanson White and the medical staff at St Elizabeths Hospital in Washington, DC, developed an ambitious programme for US psychiatry wherein the profession would dedicate itself to the reconstitution of mentally-fit and socially-productive American citizens. The racist assumptions beneath this programme led most physicians at the institution to expect little more than deference, dependence and common labour from their black patients, preventing them from comprehending the impact of substandard and racially-segregated care. Black men and women were acutely aware of the injustices they faced. When they rejected elements of the hospital's medical regimen, these patients were also rejecting a social vision that consigned them to the margins of US civic life.

Notable women in healthcare: Elizabeth Garrett-Anderson

Nowadays well over half the new graduates coming out of the medical schools in the United Kingdom are women. Women are found in the highest ranks in the profession and are well represented on the Councils of the Royal Colleges and the other medical institutions. Yet it was only during the second half of the 19th century that a handful of dedicated women invaded what was until then an entirely male profession. Perhaps the most prominent of these was Elizabeth Garrett-Anderson, the first female to graduate in medicine in the UK.

[Johann von Oppolzer (1808-1871) as director of the medical clinic at the university of Leipzig]

Johann von Oppolzer (1808-1871) is known as one of the most influential representatives of the "Vienna School of Medicine". However, little is known about Oppolzer's short but significant work at the Leipzig Medical School (from October, 1848 to March, 1850). Being not only an excellent physician and an outstanding teacher in the field of internal medicine, he was very open-minded with respect to new developments in medicine. This is shown by documents found in the archives of the university of Leipzig. In 1849, in opposition to the other members of the medical faculty, Oppolzer voted in favour of the establishment of a chair of pathological anatomy and a chair of physiological chemistry at the Leipzig Medical School.

[Habitus, capital and fields: the search for an acting head of the Hamburg Asylum Friedrichsberg in 1897]

In 1897 Hamburg was in search of an Oberarzt for the asylum Friedrichsberg who should function as the acting head of the head Wilhelm Reye (1833-1912). This search was part of the intended reformation of the outmoded psychiatric care in Hamburg. During this application procedure the Hamburg Physikus John Wahncau examined all possible candidates and applicants. The article explores the election process by using some sociological categories developed by Pierre Bourdieu (habitus, capital, field). The author argues that not only meritocratic attributes led to the choice of one candidate, but also his functional "fitting" into the field in Hamburg.