Attending the Sick

...Conflicts between physicians and patients existed in hospitals from the beginning...

...Patients in general were unhappy with this, and the belief among the poor that hospitals were places where people were used for scientific experimentation discouraged many from using them...

...Annual reports of the period refer again and again to sophisticated machines and instruments...

...Alternatively, he could have left them out altogether and confined his book to its superior historical narrative...

...Reviewed by Steven Kelman Professor of Public Policy, Harvard University...

...Hospitals also imposed strict behavior rules on patients...

...Rosenberg elaborates that basic story with many fascinating details...

...For instance, in contrasting the holistic notion of disease as caused by poor living habits with the more modern idea that sickness stems from chance encounters with germs, he appears to be suggesting that the "old-fashioned" view had more going for it than disdainful turnof-the-century germ-theory enthusiasts allowed...

...Whereas previously the major uses of surgery were to repair broken bones and to sew together deep gouges, the procedure could now deal with appendixes, gall bladders and other internal organs...

...It was only with the development of modern medicine that the hospital cast off its status as a dumping ground for the poor and moved into the mainstream of American society...

...The virtue of seriously ill people was thus placed into question simply by the fact of their illness...

...In the event they come off as undigested aperçus, detracting from an otherwise fine contribution...

...The Care of Strangers is excellent as social history...

...In the '20s surgical admissions outnumbered medical ones...

...The photographs illustrating these reports] often contained no human figures at all...

...He is especially good on relations among the benefactors who paid for the hospitals, the doctors who worked there and the unfortunate patients who came there when ill...

...Medical advancements were linked in the public's mind with the technological progress that electrification, the automobile and factory machinery represented...

...furniture, curtains, food...

...Around this time, the hospital further benefited from the growing stature of science in American society...

...Whatever the reason, it is surprising and noteworthy that institutions populated by people hardly considered of high standing enjoyed such a cachet...

...Swearing, cardplaying, drinking, and 'impertinence,'" Rosenberg reports, "were typical grounds for discharge in antebellum hospitals...

...The start of the 20th century saw the onset of a radical transformation, and by 1920 the hospital was already taking on the form it has today...

...it is a bit less successful as sociology...

...The general points the author seeks to draw from his well-told tale often seem intrusions into the text rather than fully developed arguments...

...The arrival of the middle and upper classes set the medical community to grappling with the new issue of accepting fees for hospital services that had until then been donated...

...Doctors wanted to do medical research on their charges (and to perform autopsies after they died...

...But Rosenberg never really makes his case in a sustained way (if indeed he is trying to make it...

...This solicitude about the patients' character, however, was ironically somewhat vitiated by the widespread view at the time that disease tended to be the result of dissolute living...

...Driving the change were the advances in surgery made possible by the development of antisepsis...

...Administrators emphasized the sophisticated equipment in operating rooms and laboratories as they appealed for funds, reassured private patients and impressed visiting committees...

...Even before the Civil War, an appointment as an attending physician was the profession's most important distinction, and hospital practice was avidly sought by young physicians hoping to enter the medical elite...

...Hospitals were generally places for the indigent who had nobody to look after them, or whose home surroundings were so bad as to discourage the body's ability to recover from disease...

...Rosenberg writes: "Early 20th century hospitals sought to capitalize on their image as temples of science...

...The hospital was from its very origins inextricably linked to the careers of successful and ambitious medical men," Rosenberg notes...

...Nor does he adequately discuss the social implications of putting the care of the sick in the hands of strangers instead of friends and relatives-a disappointment, considering the title...

...After all, we now know that individual lifestyles and choices do affect the likelihood of contracting certain kinds of diseases...

...Interestingly, hospitals were nevertheless prestigious places for doctors to practice (and learn) medicine...

...In the early days of American hospitals, their benefactors were concerned that they be institutions for the deserving and not the undeserving poor...

...Charles Rosenberg, a Professor of History and Sociology of Science at the University of Pennsylvania, has produced an instructive and highly readable account of how American hospitals evolved from the beginning of the 1800s to the period around World War I-in terms of the way they treated patients, the way doctors interacted with them, and the role they played in society...

...I, for one, wish Rosenberg had explored those and related themes at greater length...

...In the circumstances, people preferred to be cared for at home, in familiar surroundings with familiar people, if they possibly could...

...Perhaps the public nature and consequent visibility of the hospital accounted for its status, or perhaps the honor attached to charity and public service...

...Trustees frequently determined who would be admitted, often requiring testimonials from "respectable" people as to the moral worth of the prospective patient...

...author, "Making Public Policy" This book is social history at its richest and most satisfying...

...Administrators, meanwhile, began devoting attention to amenities-e.g...

...Prior to the rise of scientific medicine shortly before the turn of the century, there was relatively little doctors could do for the sick...

...Moreover, the fact that modern surgery could be done better in the hospital than at home eroded the traditional preference for home-based medical care among all except the poor...