The business of ethics: gender, medicine, and the professional codification of the American Physiotherapy Association, 1918-1935

The history of codes of ethics in health care has almost exclusively been told as a story of how medical doctors developed their own professional principles of conduct. Yet telling the history of medical ethics solely from the physicians' perspective neglects not only the numerous allied health care workers who developed their own codes of ethics in tandem with the medical profession, but also the role that gender played in the writing of such professional creeds. By focusing on the predominantly female organization of the American Physiotherapy Association (APA) and its 1935 "Code of Ethics and Discipline," I demonstrate how these women used their creed to at once curry favor from and challenge the authority of the medical profession. Through their Code, APA therapists engaged in a dynamic dialogue with the male physicians of the American Medical Association (AMA) in the name of professional survival. I conclude that, contrary to historians and philosophers who contend that professional women have historically operated under a gender-specific ethic of care, the physiotherapists avoided rhetoric construed as feminine and instead created a "business-like" creed in which they spoke solely about their relationship with physicians and remained silent on the matter of patient care.     

Boekbesprekings/Book reviews

Abstract

The departure point of this article is the postmodern critique of my book, The Dead Will Arise. The object of the article is not however to defend either the book itself or the 'constructionist’ school of historiography to which it apparently belongs. The first part of the article seeks to clarify the epistemological basis on which constructionist historians claim the right to engage with and interpret the past. In the process of doing so, it establishes a conceptual framework capable of defining relevance in the context of post-democratic South African historiography. It argues that historians have a duty to prioritise the ‘scars’ and ‘pitfalls’ of South African history failing which they become mere lapdogs, decorative but irrelevant. It is further argued that, although historians have the right to study whatever they choose, there is something intrinsically wrong with institutional mechanisms which produce nothing but lapdogs, and that university history departments need to take more of a lead.     

陈黻宸的史学“四独”“五史”论

在挖掘中国传统史学的精华和吸收消化西方史学思想的基础上,陈黻宸糅合中西,提出了自己的"四独""五史"的史学思想。这些史学思想中既有对史家的要求,也包括了对读史之人的要求,其中处处透露着陈黻宸对史学性质的认识和"新史学"的影像。     

"Confinement of the higher orders": the social role of private lunatic asylums in Ireland, C. 1820-60

The period 1820-60 marked an era of transition and diversity in Ireland that rapidly transformed the face of Irish society. Inextricably linked with these processes was the expansion of Ireland's private asylum system. This system diverged from its British counterpart both in the socioeconomic cohort it served and in the role it played within the mental health-care system as a whole. The implementation of the 1842 Private Asylums (Ireland) Act, the first legislative measure geared exclusively toward the system, highlighted the growing importance of private care in Ireland as well as providing for the licensing and regulation of these institutions for the first time. To date, historians of Irish medicine have focused almost exclusively on the pauper insane. This article aims to shift this emphasis toward other categories of the Irish insane through exploration of the Irish private asylum system, its growth throughout the period, and the social profile of private patients. I shall also interrogate the trade in lunacy model through exploration of financial considerations, discharge and recovery rates, and conditions of care and argue that while Irish private institutions were a lucrative business venture, the quality of care upheld was apparently high. Finally, I shall argue that Irish private asylums catered primarily for the upper classes and briefly explore alternative provisional measures for other non-pauper sectors of society.     

The dearth of the clinic: lead,air, and agency in twentieth-century America

By surveying myriad ways that twentieth-century American experts and nonexperts grappled with the health implications of aerial exposures to lead or substances that may have contained lead, this paper urges medical historians' attention toward environments-workplaces, homes and the outdoors-and their extrabodily ontology. Health histories framed around dust, toxins, fumes, and pollution rather than around particular diseases challenge long-accepted narratives, such as Hibbert Hill's old generalization about a "New Public Health" shift from "the environment to the individual." Greater environmental focus can also advance "bottom-up" health history. Pushing the gaze of twentieth-century medical and public health historians beyond hospitals, "public health" departments, clinically confirmable disease, and "patient" roles, it draws historians' attention to health-related realms in which laypeople often claimed greater knowledge and competence.     

A Berlin for Historians

On his death in 1997 Isaiah Berlin was widely hailed as a leading philosopher of political liberalism. This article takes the position that Berlin's philosophical views, particularly those on freedom and cultural pluralism, can also be construed as a valuable guide for historians working in the present, "postmodernist" climate of debate. It further argues that Berlin's character and career, the subjects already of considerable critical inquiry, lend added authority to these views. The focus is on three lengthy essays on history written by Berlin in the 1950s, one of which was first published in the first issue of this journal. The article concludes, following Berlin, that it is the responsibility of historians, as historians, to recognize the often incommensurate plurality of ultimate values to which their fellow human beings historically have subscribed and to judge, as judge they sometimes must, with that recognition fully in mind. If the result of these as well as the other choices that they make is a plurality of histories, of contending subjects, approaches, methods, and outcomes, that is only to be expected, indeed welcomed. It is freedom in practice, and infinitely preferable as such to any known alternative.     

"In need of care and attention" Local authorities and the implementation of the Scottish NHS Act, 1948–1960

Abstract

This article looks at the influence and reaction of Scottish local authorities in the implementation of the NHS (Scotland) Act, 1947. It examines the implementation of the Act through local authorities and the problems encountered in co-ordinating the NHS. Furthermore, it considers the problems encountered through the lack of clear dividing lines of responsibility between the three administrative areas of the NHS. It proposes that local authorities were seen as service providers within the NHS and were unable to assert any influence over the implementation of the NHS, apart from within their own health service sphere. The implementation of the Scottish NHS Act was full of inconsistencies and problems and was not as smooth as many historians would argue. The impact on patient care was the provision of an uneven service throughout Scotland.     

PATIENT CASE RECORDS IN MEDICAL AND FAMILY HISTORY: EXAMINING THE RECORDS OF THE ROYAL FREE HOSPITAL

Abstract

The purpose of this article is to highlight the value and potential of patient case records as an historical source. Previous histories of the hospital (and of other healthcare providers more generally) have neglected to consider the patient. This is partly as a result of the ‘history from above’ approach of past histories which have focused on the founders and medical staff of such institutions and never on the people who were treated. During the early 1990s Porter called for the patient to be brought into the focus of medical history, and Risse and Warner drew attention to patient case records as a means of doing so. In the near twenty years which has passed since, however, patient records have still not been utilized by historians and the patient remains largely absent from history. By using the project ‘Royal Free Hospital Patient Case Records’ as a working example, this article will illustrate the benefits of using these records as a source as to patient identity, experience of medical treatment, use of the medical market, and life-cycle of individual, family, and community ill-health. The type of information the historian can extract from patient case records will be discussed and the example sampling method explained. The wider use and potential of patient records in history will then be considered and some practical advice given to help prepare historians to use such records to fill the void that is the history of the patient.     

A History of Normative Theory in Americanist Archaeology

Efforts in the 1960s to demonstrate the value of the new archaeology involved showing that the competing culture-history paradigm was inferior. One allegedly weak plank in that paradigm had to do with how culture historians viewed culture—as a set of ideas transmitted in the form of ideal norms or mental templates. Lewis Binford referred to this view as normative theory. In archaeology that view was manifest in the equation of artifact types with prehistoric norms—an equation that, according to Binford, the culture historians had made so that they could track the flow of ideas through time and thus write culture history. Culture historians regularly subscribed to cultural transmission as the theoretical backdrop for their artifact-based chronometers such as seriation and the direct historical approach, but with few exceptions they perceived only a weak relationship between norms and artifact types. It was not until 1960, in a paper by James Gifford, that what Binford labeled as normative theory appeared in anything approaching a complete form. Ironically, the first applications of normative theory were products of the new archaeologists, not the culture historians.     

The State and the Left in modern France

French historians have recently begun to pursue the historyof left-wing politics in a manner which suggests that the Marxistframe of reference has begun to disappear, even in this fieldof history. The eminent historian and public intellectual PierreRosanvallon is leading the way in the field of political andintellectual history, through his sustained examination of theState and the ongoing debate about French democracy. The connectionbetween history and current political discourse is important,and it is significant that historians are attempting to revisecommon perceptions of the evolution of French political institutions.Wide areas of new research have been opened out and this articlehopes to offer some reflections on how these new approachesto French political history may be used in future research.     

中华文明探源 国家学术工程十年

中华文明探源工程是继"夏商周断代工程"之后,又一项由国家支持的多学科结合、研究中国古代历史与文化的重大科研项目,由科技部立项、国家文物局牵头组织,两大权威考古科研机构联合多个国家级及省级科研机构,数百位考古学、历史文献学、天文学,古文字学、体质人类学,科学测年、古植物古动物、古环境、冶金史、化学成分分析、古人类食谱分析、遥感和遗址的物理探测、天文学、科技史、计算机科学领域的学者联合攻关,让最新的考古学研究成果成为判断中华文明是否有五千年历史的根据,     

Deaf people in Hitler's Europe: conducting oral history interviews with deaf Holocaust survivors

Deaf people living in Europe between 1933 and 1945 were mistreated, forcibly sterilized, incarcerated, and murdered by the Nazis. Their stories have been overlooked or underappreciated because of the complexities of communication and the difficulties historians face gaining access to those communities. This article describes the challenges faced by two United States historians when they interviewed deaf Holocaust survivors in Budapest, Hungary and during a conference, "Deaf People in Hitler's Europe," co-sponsored by the United States Holocaust Memorial Museum and Gallaudet University. It also raises general questions of adapting methodologies to facilitate "oral" history interviews for deaf informants.     

Governors,Provincial Administration,and Local Self-Government in Late Imperial Russia

After long neglect in the Soviet period, the study of Russia's provincial governors and local institutions of self-government is attracting new interest among contemporary historians, who struggle with questions that preoccupied their late imperial predecessors.     

"That Food of the Memory which Gives the Clue to Profitable Research": Oral history as a source for local, regional, and family history in the nineteenth and early twentieth century

Numerous local, regional and family historians in the nineteenthand early twentieth century collected oral narrations and conductedinterviews as a form to document information that otherwisemight have never been preserved. Family historians, in particular,not only practiced interviewing relatives for family histories,but also encouraged the practice in how-to-do manuals amongtheir peers. While advocating the practice, family historiansalso reflected about the value of "traditionary evidence" collectedthrough interviews and other means. These reflections by familyhistorians mirrored the discussions about the value of traditionsand memories as historical sources among several professionalhistorians at the time. These reflections were shaped by a modernizedunderstanding of tradition, which combined a reverential approachto the authoritarian element of tradition with a critical approachquestioning the validity of tradition. In this context, oralhistory was both a tool to negotiate the value of traditionand a mirror to the contemporary understanding of tradition.     

“Deliver Me From This Indignity!”: Cottage Hospitals,Localism and NHS Healthcare in Central England, 1948-1978

Victorian and Edwardian cottage hospitals, compared to infirmaries and workhouse institutions, have been neglected by social historians. Yet, they provided an infrastructure dedicated to localism and healthcare for the aged under the new National Health Service (NHS) after World War Two. This article focuses on two renowned Midlands cottage hospitals built in mid-Northamptonshire at Pitsford. In their patient case-histories we can engage with: dignity standards, medical regime, ward designs, staffing levels, budget provisions, and patient voices. These popular institutions had a well-deserved reputation for delivering high-quality geriatric medicine from 1948 to 1978. Human vignettes detailing the physical indignities of ageing nonetheless proliferate in the records. The longevity of these basic issues was to prove to be a recurring tension in NHS financial planning. Budget models lacked enough funds for aged patients to receive ‘stable’ bedside care. Instead, NHS accountants allocated resources to ensure the future ‘sustainability’ of the system itself. A new paradigm highlights the inherent financial contradictions and empty political promises that those needing geriatric care often experienced, and still do. Throughout, the rediscovered cottage hospital records contain important historical lessons for the present impasse about how to define, deliver and secure dignity for elderly patients in today’s NHS.     

Infection, contagion, and public health in late medieval and early modern German imperial towns

From today's point of view, the concepts of "miasma" and "contagion" appear to be two mutually exclusive perceptions of the spread of epidemic diseases, and quite a number of historians have tried to discuss the history of public health and epidemic diseases in terms of a progression from the miasmic to the contagionist concept. More detailed local studies, however, indicate how extremely misleading it may be to separate such medical concepts and ideas from their actual historical context. The article presented here, based on local studies in late medieval and early modern imperial towns in southern Germany, demonstrates to what extent the inhabitants of these towns had notions of both "miasma" and "contagion." Furthermore, a contextual analysis of language shows that they did not see a necessity to strictly distinguish between these different concepts relating to the spread of diseases. Tracing the meaning of "infection" and "contagion," we find that these terms were used in connection with various diseases, and that a change in the use of the expressions does not necessarily imply a change of the corresponding notion. Moreover, a coexistence of differing perceptions cannot--as some historians have suggested--be attributed to a divergence between the academic medicine and the popular ideas of that period. A survey of measures and actions in the public health sector indicates that a coexistence of--from our point of view--inconsistent concepts helped the authorities as well as the individuals to find means of defense and consolation during all those crises caused by epidemic diseases--crises that occurred very frequently in these towns during the late medieval and early modern periods. As the article demonstrates, the interaction during such crises reveals the continuity of ancient rituals and concepts as well as the adoption of new insights resulting from changes in the economical, political, scientific, religious, and social structures.     

Comparison and Beyond

The merits of the comparative approach to history are undeniable. Comparison helps to identify questions, and to clarify profiles of single cases. It is indispensable for causal explanations and their criticism. Comparison helps to make the "climate" of historical research less provincial. Still, comparative historians remain in a minority. Many cherished principles of the historical discipline — proximity to the sources, context, and continuity — are sometimes in tension with the comparative approach. More recently, new transnational approaches — entangled histories, histoire croisée –challenge comparative historians in a new and interesting way. But histoire comparée and histoire croisée can be compatible and need each other.     

THE CONTINUING MODESTY OF HISTORY

The critique of conventional historical writing has been emergent for a century—it is not the work of a few—and it has immense practical implications for Western society, perhaps especially in English‐speaking countries. Involved are such issues as the decline of representation, the nature of causality, the definitions of identity or time or system, to name only a few. Conventional historians are quite right to consider this a challenge to everything they assume in order to do their work. The challenge is, why do that particular work at all? Understandably, historians have consolidated, especially in North America where empiricism and the English language prevail. But even there, and certainly elsewhere, and given the changes in knowledge and social order during the past century at least, the critique of conventional historical method is unavoidable. Too bad historians aren't doing more to help this effort, and by historians I don't mean the most of us who think constantly in terms of historical causality as we learned it from the nineteenth century and our teachers; by “historians” I mean the experts who continue to teach the young. A major roadblock to creative discussion is the fact that problems such as those just mentioned all exceed disciplinary boundaries, so investigation that does not follow suit cannot grasp the problem, much less respond to it creatively. Of course everyone is “for” interdisciplinary work, but most professional organizations, publications, and institutions do not encourage it, despite lip service to the contrary. Interdisciplinary work involves more than the splicing activity that is all too familiar in academic curricula. Crossing out of one's realm of “expertise” requires a kind of humility that does not always sort well with the kind of expertise fostered by professional organizations, publications, and institutions. And even the willing have trouble with the heady atmosphere outside the professional bubble. In such conditions key terms (“language,”“discourse,”“relativism,”“modernity,”“postmodernity,”“time,”“difference”) are pushed here and pushed there without gaining the focus that would lead to currency until finally the ostensible field of play resembles a gigantic traffic jam like the one that opens the film Fellini Roma. Discussion of these issues leads in the end to Borges and his story, ‘The Modesty of History,” from which the title of this essay is borrowed.     

清代史馆制度的特点

和前代相比,清代史馆制度有自身的特点。顺康时期,清朝官方就形成了以常开、例开史馆为主干,以阅时而开、特开史馆为辅助的史馆格局,这种史馆格局既具有稳定性,又具有灵活性,功能完善,相得益彰,在清廷的政治运作中发挥了重要作用。清代帝王对史馆修史的干预更加全面,皇帝亲自确定修史项目,对史书修纂的内容进行全面指导,时常过问史馆的管理,并形成了史书修纂次第进呈御览的制度,一切仰承圣裁,保证了帝王意志在史馆内的贯彻执行。清代史馆还具有鲜明的民族特色,官方以制度化的方式规定了史馆内满汉纂修官的员额和比例,保证满人参与修史。清代史无专官,但史馆从组建、管理到史官选任、资料征集等,都有一整套严格而又灵活的运作机制。