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Politics
Published in Alan Bleakley, Medical Education, Politics and Social Justice, 2020
Modern medical education begins with Abraham Flexner’s 1910 report on North American and Canadian medical schools and 1912 report on European medical schools. Flexner discovered that the majority of for-profit medical schools, run as businesses, were severely under-resourced and educationally naïve. As a result, many schools were closed rather than given resources to improve them, and these included schools that recruited women and African Americans (Hodges 2005). Perhaps as an unintended consequence, medical education was predominately white and male for over half a century after Flexner’s report. Flexner also introduced a standard model of two years of laboratory-based dissection and science, followed by two or three years of largely hospital-based clinical experience. Downstream hospitalism became privileged over upstream primary and community care. Hospitalism, with its dress codes, ceremonies and intensivity or acute focus, was seen as sexier than community-based medicine and chronic care.
Practising on principle: Joseph Lister and the germ theories of disease
Published in Christopher Lawrence, Medical Theory, Surgical Practice, 2018
Christopher Lawrence, Richard Dixey
Also in 1870 Lister detailed his operative results over a five-year period, and described how his methods had, he said, converted ‘some of the most unhealthy [hospital wards] in the kingdom into models of healthiness’. Again, he made the claim that wound management had cleared the hospital of fevers. Antiseptic treatment, he said, had reduced the incidence of pyaemia, erysipelas and hospital gangrene because it reduced ‘emanations from foul discharges … the great source of mischief in a surgical hospital’. Lister considered every other contributory cause as minor. He ridiculed the idea of what was known as ‘hospitalism’. Everything, he said, was of ‘trifling consequence’ compared to ‘emanations from sores’ and ‘putrid exhalations’. What these exhalations were and how they acted Lister did not indicate. That Lister considered revolutionising therapy was central to salvaging the great hospitals as the locus of medical excellence and the seat of medical education is evident in his view that substituting ‘cast-iron cottages’ for hospitals was expensive, interfered with patient supervision ‘and with the teaching of students at the bedside’.62
The Fight for Antisepsis
Published in A.J. Youngson, The Scientific Revolution in Victorian Medicine, 2018
Fresh trouble arose a few years later, again partly due to Lister’s uncompromising attitude. In 1873 John Wood, Professor of Surgery at King’s College, London, gave the address in surgery to the annual meeting of the BMA and devoted about one quarter of his time to the antiseptic system. The system, he said, had been originally developed by Lemaire in 1860, and he himself had recently experimented with various antiseptic substances and dressings, with and without ‘the elaborate attempts to exclude the unpurified atmospheric air which Lister deems essential’. He had obtained, he said, good results both with Listerian and un-Listerian methods when the hospital was free of pyaemia and similar diseases, but when these diseases became present results deteriorated whatever the method used. His conclusions echoed the hospitalism debate: I believe that cases of recovery frequently occur under other methods, or no methods, and that at least as much depends upon the age and reparative power of the patient, the amount of blood poison formed or absorbed, and the general condition of the atmosphere, as upon any system of treatment whatever.37
Racialized Bodies and the Violence of the Setting
Published in Studies in Gender and Sexuality, 2019
“Passionate attachments” (Butler, 1997) to power are formed through the setting; while most psychoanalysts locate these attachments in dyadic, infant–caregiver relations, Butler (1997) argues for their generalizability to social processes. What the concept of passionate attachments does not quite capture, however, is that attachment is just as much a capacity as it is an inborn system. An infant must be capacitated enough by care to form an attachment. Part of that capacitation requires a caregiver who can hold a coherent image of the child and its needs in mind. Without that coherence, the capacity for attachment is compromised. As Spitz’s (1945) “hospitalism” shows, orphans not tended to regularly by the same caregiver can deteriorate into a kind of nonbeing or psychic death, where they are no longer capable of attaching to others, much less an image of themselves in the other’s eyes. Racialization can have similar long-term effects. If racialized bodies form the phantomatic setting that holds a White imaginary in place, apathy and resignation thus become a reasonable option when those bodies register how the care they provide is not—and may never be—reciprocated.
Atypical antipsychotics in the treatment of patients with a dual diagnosis of schizophrenia spectrum disorders and substance use disorders: the results of a randomized comparative study
Published in Journal of Addictive Diseases, 2021
V. Yu. Skryabin, M. A. Vinnikova, E. V. Ezhkova, M. S. Titkov, R. A. Bulatova
Patients with a dual diagnosis are characterized by the following clinical and dynamic peculiarities of the clinical picture: 1) early social disadaptation, as evidenced by low numbers of employed individuals (20%) and high numbers of single and unmarried persons (80%); 2) trend to develop “hospitalism,” possibly associated with frequent relapses and poor quality of remissions, as evidenced by high hospitalization rates during one year (42%); 3) the development of substance use disorder at an early age: 21.2 ± 1.9 years; 4) the most frequent motivation for initiation of substance use is the so-called “experiment” (according to patients, “the scientific method of use,” i.e. not for euphoria, but to study the effect of psychoactive substance on the brain − 39.9%), or “the desire to calm down or raise the mood” (i.e., for the correction of mental state − 35.7%); 5) unusual motivation to involve in the use of psychoactive substances – to “join the company” (7.1%); 6) predominance of highly progressive course of substance use disorder (62%), the prevalence of drug misuse (62%); 7) predominance of psychopathological symptoms in the structure of withdrawal syndrome (subthreshold depressive mood, mood swings, self-incriminating ideas and suspiciousness reaching the paranoia level − 68%); 8) predominance of the ideational component in the structure of craving (52%); 9) the pattern of drug use is chaotic, with more than 2 substances (66.7%); the most frequent combinations of substances in patients with a dual diagnosis are combinations of psychoactive substances with cholinolytics, such as alcohol, psychostimulants, cholinolytics (22.2%), alcohol, opioids, cholinolytics (15.2%), and psychostimulants and cholinolytics (12.4%). Opioids were the most commonly used psychoactive substances among the patients from the main groups (52 patients, 57.8%), followed by alcohol (21 patients, 23.3%), and synthetic cathinones (17 individuals, 18.9%). In the control group, in most cases patients used opioids (heroin, street methadone) (133 patients, 75.6%) and psychostimulants (43 individuals, 24.4%).