I met my wife Anne who was a sociology student, and her influence together with activities associated with the student movement of the time opened up my interests amongst other things into the theatre, art, music, politics and philosophy.
 |
Throughout most of human history, limitations on food production, together with lack of medical knowledge, have placed limits on the size of populations. Diseases like the bubonic plague have actually reduced populations. In England the plague, known as the Black Death, was responsible for a drastic drop in the population in 1348 and for the lack of population growth in the seventeenth. In 1625 alone, 35,417 residents of London died of the plague. Smallpox and dysentery have had similar, though less dramatic, effects (Davis, 1992, Natural Disasters: The Black Plague: Wrigley, 1969, Population and History). Until relatively recently physicians were powerless either to check the progress of disease or to prolong life. In fact, they often did more harm than good---that is, their remedies were more harmful then the illnesses they were intended to cure. As Lewis Thomas (1979, The Medusa and the Snail) has stated: Bleeding, purging, cupping, the administration of infusions of every known plant, solutions of every known metal, every conceivable diet including total fasting, most of these based on the weirdest imaginings about the cause of the disease, concocted out of nothing but thin air---this was the heritage of medicine up until a little over a century ago. (p. 133) Thomas's point is that before the nineteenth century, when scientists finally began to understand the nature of disease, physicians based their treatments on folklore and superstition. In fact, with few exceptions, the practice of healing, like many other aspects of science, was closely linked to religion. In ancient Greece people who suffered from chronic illnesses and physical impairments would journey to the temple of Asclepius, the god of healing and medicine, in search of a cure. In medieval times pilgrims flocked to the cathedral at Lourdes in France as many still do today in the belief that they would thereby be cured of blindness, paralysis, or leprosy. Not until Louis Pasteur, Robert Koch, and other researchers developed the germ theory of disease did medicine become fully differentiated from religion. Their discoveries, together with progress in internal medicine, pathology, the use of anesthesia, and surgical techniques, led to the twentieth century concept of medicine as a scientific discipline (Cockerham, 2001, Medical Sociology, 8th ed.).
During the nineteenth century specific research resulted in the discovery of the causes of many diseases, but at first this progress led physicians to do less for their patients rather than more: They began to allow the body's natural healing processes to work and ceased to engage in damaging procedures like bloodletting. At the same time, they made major strides toward improving public health practices. They learned about hygiene, sterilization, and other basic principles of public health, especially the need to separate drinking water from wastewater. These innovations, which occurred before the development of more sophisticated drugs and medical technologies, contributed to a demographic revolution that is still underway in some parts of the world. Suddenly rates of infant mortality decreased dramatically, birth began to outnumber death, and life expectancy increased. This change resulted not from the highly sophisticated techniques of modern medicine but largely from the application of simple sanitation techniques and sterilization procedures (Rosner, 1995). In fact, these simple technologies have had such a marked effect on infant survival that the rate of infant mortality in a society is often used as a quick measure of its social and economic development. In sum, as medical science progressed toward greater understanding of the nature of disease and its prevention, new public health and maternal care practices contributed to rapid population growth. In the second half of the nineteenth century, such discoveries as antiseptics and anesthesia made possible other life-prolonging medical treatments. In analyzing the effects of these technologies, sociologists ask how people in different social classes gained access to them and how they can be more equitably distributed among the members of a society. The ways in which medical technologies have been institutionalized in hospitals and the medical profession are a central focus of sociological research on these questions. The Hospital: From Poorhouse to Healing Institution In the twentieth century the nature of medicine changed dramatically as scientific investigations expanded our knowledge of the causes and cures of disease. That knowledge led to the development of a vast array of technologies for the prevention and cure of many known illnesses, as well as the long-term care of terminally ill patients. Because the more complex of these technologies are applied in a hospital setting, it is worthwhile to consider the development of the hospital as the major social institution for the delivery of healthcare.
Historically, hospitals evolved through several stages, beginning as religious centers and eventually developing into centers of medical technology (Cockerham, 2001). The first hospitals were associated with the rise of Christianity; they were community centers for the care of the sick and the poor, providing not only limited medical care but also food, shelter, and prayer. During the Renaissance, hospitals were removed from the jurisdiction of the church and became public facilities. Because they offered food and shelter to the poor regardless of their health, they soon became crowded with invalids, the aged, orphans, and the mentally ill. The third phase in the development of hospitals began in the seventeenth century, when physicians gained influence over the care of patients in hospitals. Gradually the nonmedical tasks of hospitals disappeared, and the hospital took on its present role as an institution for medical care and research. The modern hospital began to emerge at the end of the nineteenth century as a result of the development of the science of medicine. Especially important were advances in bacteriology and increased knowledge of human physiology, along with the use of ether as an anesthetic. Because the new medical technologies were more complex and often more expensive than earlier forms of treatment, they were centralized in hospitals so that many physicians could use them. Physicians also began to refer patients of all social classes to hospitals, and those patients paid for the services provided to them there. In the United States the number of hospitals grew rapidly in the twentieth century from a few hundred at the turn of the century to more than 6,500 in the 1990s. Today hospitals play an important role in the control of medical practice and access to medical care. For example, doctors who want to practice in a particular hospital must be accepted by the hospital's medical board. Patients who want high-quality care in private hospitals must be able to pay the fees charged by those hospitals or have the necessary insurance coverage. And hospitals have a monopoly on advanced medical technologies, a fact that has had a major impact on the American healthcare system.  Medical sociology Paul Starr's 1982 study (The Social Transformation of American Medicine) of the evolution of healthcare institutions had a major impact on the healthcare reform movement of the 1990s. It is an excellent example of medical sociology. This relatively new field of study has emerged in response to the development of medicine as a major institution of modern societies. Many sociologists are employed by healthcare institutions, and some medical schools have established faculty positions for sociologists. these trends are further evidence of the increasing role of sociology in assessing the effects of technological change on other aspects of society. In recent years medical sociologists have faced a new and serious challenge: helping society cope with the ethical issues that arise as it becomes increasingly possible to prolong human life by artificial means. Procedures such as heart transplants are extremely expensive and cannot possibly be made available to all patients who need them. Are they to be limited to those who can pay for them? If not, how should the patients who will benefit from such procedures be chosen? Medical sociologists are often asked to conduct research that will affect decisions of this nature---a form of technology assessment (a form of policy research that examines short- and long-term consequences of the application of technology). *MAIN SOURCE: KORNBLUM, W., (2003), SOCIOLOGY IN A CHANGING WORLD, 6TH ED., PP. 659-662* end |
No comments:
Post a Comment