Promoting productivity in the National Health Service, 1950 to 1966

In the 1950s, the Ministry of Health, supported by interested groups outside government, recognised the political importance of productive efficiency. For leadership, organisational models and techniques the Ministry looked to the movement for industrial productivity. The NHS was receptive, but private-sector approaches were modified and dampened as they were imported. NHS management was to be the provider of technical expertise, but the deployment of this expertise was limited by clinical autonomy and de-coupling from financial incentives. This article casts new light on the history of productivity policy, NHS management and the moving frontier between state and civil society.     

Cases of hydatid disease in medieval Iceland

Eight individuals with calcified cysts preserved in the thorax and abdomen, one of which had a maximum diameter of 17–20 cm, were recovered during recent excavations at Skriðuklaustur, a medieval monastic site which also functioned as a hospital during its operation from AD 1493–1554 in Eastern Iceland. Hydatid cysts are the result of parasitic infection by Echinococci commonly in the liver and lungs of the accidental human host. Echinococcus granulosus was likely introduced to Iceland soon after the settlement period (9th century AD) and became endemic around AD1200 when dogs were introduced from Germany. It has since been eradicated in Iceland due to an extensive educational literature programme and government controls implemented since the mid‐1800s. Reviews of the palaeopathological literature mentioning calcified shell fragments indicated hydatism to be the most logical aetiology. The eight individuals in question were buried in close proximity to one another. This may indicate that this particular ailment (sullaveiki) had its own classification during the medieval period in Iceland and perhaps even a distinct treatment if not in life, at least in death. Copyright © 2010 John Wiley & Sons, Ltd.     

Voluntarism, municipalism and welfare: the geography of hospital utilization in England in 1938

This paper provides a comprehensive analysis of the pattern of hospital utilization (rather than provision) in England prior to the establishment of the NHS, showing the extent to which the probability of obtaining hospital treatment was a function of residence. Access to hospital care depended on the vigour of voluntarism and the political priorities of local governments. The pattern of voluntary hospital utilization is shown to have been markedly unequal, but the effect of municipal provision was to reduce disparities in access to services. The paper demonstrates variations in hospital utilization and discusses contemporary assessments of the situation. This work contributes to debates about the efficacy of non-profit forms of welfare delivery; it provides a novel British study to complement American work in this field. It also raises questions about the contemporary vogue for partnerships in health care delivery between the public and private sectors, arguing that such proposals rest on an optimistic view of history.     

Book reviews

Abstract

This paper explores the decision-making process for heritage management at the monastic community of Mount Athos, a World Heritage Site in Northern Greece, in relation to the concept of living religious heritage and the pursuit to balance the heritage values of both the experts (heritage professionals) and the non-experts. The function and impact of a specific heritage agency — KEDAK (Centre for the Preservation of Athonite Heritage) — designed to establish the decision-making power of the Athonite monasteries will be critically discussed. A range of interesting compromising solutions and some challenges and problems raised by the function of this agency will serve as the background for examining the extent to which different perceptions on heritage management can coexist, particularly when heritage professionals find themselves on the bottom of a top-down decision-making process.     

医院可达性评价与规划——以江苏省仪征市为例

医院作为公共服务设施的一个重要组成部分,为居民提供了必不可少的医疗机会,其空间分布以及可达性的优劣,直接影响到居民能接触到医院的机会和方便程度。把可达性的概念引入到医院规划中,利用Mapinfo公司的控件MapX和Borland公司的可视化编程语言Delphi,开发了基于时间最短的路径选择信息系统,生成了医院可达性的等时线图和医院服务范围图,通过该系统可直观的看到区域内任何一点到达同一级医院所花费的最短时间以及通过的路径。以江苏省仪征市的医院为例,运用该系统对医院的可达性进行了评价,并提出了医院的规划方案。     

近代广州医院时空分布研究

广州近代医院,历经百余年的发展,呈现为初生、迅速、衰落和恢复四个发展阶段,形成以老城为核心区向周围墨渍式递减、五大优势地段呈面状、城外西关和东关呈点散状的选址空间格局。不同类型医院的生长、选址亦具有清晰的时空界线。这种时空分布特征是多种机制因素综合作用的结果。近代医院的生长和配置,使广州居民医疗生态大为改观,但总量供应不足、空间配置不合理等缺陷亦非常明显。     

Martin Waldseemüller's Death Date

ABSTRACT

The subject of this article is the first extant topographical engraving of Meteora, the second largest monastic complex in Greece and one of the most spectacular landscapes in the world. This late eighteenth-century print combined cartographic principles with techniques traditionally used in Byzantine painting, which situates it within a broader vernacular Greek cartographic tradition. It can also be considered a mental map of the region as envisaged by eighteenth century monks, as well as a tool for advertising the region and its monasteries at a time of political and financial distress. As with any map, the engraving simultaneously concealed and revealed, masking difficult terrestrial conditions while showing pathways to heaven.     

Founding Years of Clinical Neurology in Berlin Until 1933

During the so-called “Gründerjahre” or “founding years” in Berlin it became necessary to build new hospitals because of the rapid growth of population. As a result, several infirmaries, asylums for the insane and institutions for epileptics were built between 1877 and 1912. The new building of the University Neuropsychiatric Clinic (“Nervenklinik”) of the Charité was opened in 1905 according to plans made by Friedrich Jolly (1844–1904), the physician who named myasthenia gravis pseudoparalytica. A “Neurological Central Station”, under the direction of Oskar and Cecil Vogt, in existence since 1898, was a research center dedicated more to morphology. There the study of the structure of the cerebral cortex by Korbinian Brodmann (1868–1925) and research into basal ganglia diseases by the Vogts began. The Kaiser-Wilhelm Institute for Cerebral Research, which moved into a new building in 1931, also had its origin here. Hermann Oppenheim (1858–1919) promoted independent clinical neurology, as did his younger contemporary, Max Lewandowsky (1876–1918), who was already advising physician for neurology at the Berlin-Friedrichshain Hospital. Hugo Liepmann (1863–1925), the creator of apraxia theory, worked at the asylums for the insane in Dalldorf (Berlin-Wittenau) and Berlin-Herzberge. In 1911, the first neurological unit was established in the large hospital in Berlin-Buch under the direction of Otto Maas. Not until after World War I were further neurological hospital units founded, under the direction of Paul Schuster (1867–1940), Kurt Goldstein (1878–1965), Kurt Löwenstein (died in 1953) and Friedrich Heinrich Lewy (1885–1950). These Jewish physicians, as well as C.E. Benda and Otto Maas, had to leave their posts in 1933 and emigrate. The clinical institutions and scientific achievements of these pioneers of independent clinical neurology will be presented up to the point of its violent dissolution.