Week 4 Discussion Board
First, let’s take a look at the context of the time (1850’s to the 1930’s)
America is becoming an industrialized nation. More people are leaving the farming lifestyle (agrarian) and moving to towns and cities to work in factories. Industrialist realize that providing health care for employees makes them better employees (loyalty-health wise-production wise). Physicians gain some status by contracting with employers or proving health care through private practice (on a fee-for-service payment model).
However, during this time period there were major advances in medicine for physicians, surgeons, and nurses through war! (This is not a celebration of war, only the reality that war has always advanced medicine).
Crimean War (fought in and around the Balkan Peninsula in Southeast Europe)
Although the U.S. was not involved in the Crimean War, the lessons learned by our British cousins were well communicated to U.S. physicians and medical societies:
The Crimean War was the first time the world saw modern technologies in action and the utter devastation they caused:
- Exploding naval shelling. Larger and heavier bombs (shells) that could travel greater distances and exploded on impact. Imagine the injuries that this new technology caused.
- The ability to move larger numbers of troops around the battlefield at a reduced time caused an exponential increase in casualties.
- Battle field communications improved, which also contributed to larger numbers of casualties.
The British Army lost 22,000 soldiers. However, on 17% died on the battle field. The rest died from wound infection, unsanitary conditions, and being ill prepared for harsh winters. War is often the cause of huge leaps in medical technology. An experimental environment caused by desperate needs starts the observation-invent/or try something new-then see what the outcome cycle.
Here’s what British doctors (and a nurse named Florence Nightingale) learned:
- Surgeons started washing their hands before surgery. Germ theory remember?
- The first antiseptic was applied to wounds. Regular wound cleaning and the application of an antiseptic saved thousands of lives.
- Hospitals started using clean linen, beds, and hospital gowns, preventing infections from the hospital environment.
- Chloroform was introduced as anesthesia, and opium derivates were used to control pain.
- Ammonia was used to keep things clean.
- The roots of the nursing profession started after Florence Nightingale witnessed how bad medical care was during the Crimean War.
Civil War (1861-1865)
The American Civil War brought many new inventions to medical practice. Once again, war technology had improved and new weapons caused new types of injuries. Here’s an illustration of the new types of bullets, which caused a lot of damage in the Civil War:
How about this: Dr. Gatlin was a doctor that wanted to see the end of all wars. He figured if he could invent a weapon that caused so much devastation, nobody would want to go to war. He invented the Gatlin Gun, which was the first machine gun-a gun that could shoot many bullets without reloading-and kill many of the enemy. Dr. Gatlin had no idea that his invention would be improved upon and be a devastating factor in World War I.
Surgeons, a type of physician specializing in performing surgery, gained enormous authority during the Civil War because removing bullets, fixing fractures, and performing amputations was the most common type of medical care from the battlefield.
Civil War advances in Medicine:
- A highly organized system of ambulances with first-aid trained stretcher bearers.
- Using “Triage” (the French word for “sort”) to designate wounded soldiers as 1) beyond help, 2) surgical case, and 3) slightly wounded. This system allowed surgical cases to get to a surgeon first, and the slightly wounded to wait their turn for care. It also designated those that would likely not benefit from the care of a surgeon so the surgeon’s time could be spent on surgical cases.
- Medical care was moved closer to the battle field with “field dressing stations” and “field hospitals.” General hospitals were used for rehabilitation and recuperation. During the Civil War, general hospitals became a place of healing (instead of dying) with a remarkable death rate of only 9%.
- Surgeons saw so many patients that they started specializing: Orthopedic medicine (took over for the bone setter, especially when fixing a fracture require surgery); Plastic surgery (surgery to bring back functions like breathing and eating due to battlefield disfiguring); Neurosurgery (there were more people saved when a surgeon went into the brain to remove bullets and shrapnel from bombs); Prosthetics (badly managed limbs, complex fractures, and missing parts caused surgeons to perform many limb amputations-these missing parts needed a prosthetic). All of these advances in medicine during the Civil War are still around today in military medicine as well as civilian medicine.
- Nursing in America was advanced through the nursing work of Dorethea Dix and Clara Barton.
Outside of the Civil War, American physicians were making great strides in establishing their profession. Two major factors happened during this time period:
- Consensus: Medical societies (including the American Medical Association) were agreeing on higher standards for medical schools, the authority of physicians over lay healers and apothecaries, and that physicians needed a licensing process to prove that they had the education and experience to be practicing medicine in the US. Consensus among American physicians was the first step in establishing their authority and raising their status.
- Legitimacy: Setting the medical license aside, many Civil War veterans that benefited from ta surgeon and the advances in medicine brought their respect and admiration for the physician home with them. Society started placing these “miracle workers” on a pedestal-a step toward legitimizing the physician profession.
World War I
The war to end all wars used the lessons learned from the Crimean War and American Civil War to bring the best possible medical care to the fronts of war. New weapons included poisonous/toxic gas, bombs from aircraft, heavier and long-distance artillery, and the machine gun (thanks Dr. Gatlin1).
Advances in medicine, which further legitimized the position of the physician, included:
- New and better working antiseptics
- New and better working anesthesia (nitrous oxide)
- Opening a wound to clean it our before repair and bandaging
- Motorized ambulances
- X-ray
- Thomas splint
The Thomas splint exemplifies the technological advances during World War I. Before the Thomas splint, 80% of soldiers suffering a femur fracture (thigh bone) died from their injuries because the sharp ends of broken bones would lacerate the big blood vessels hidden deep in the thigh-they would bleed to death. The Thomas splint was used to pull the broken bone ends apart and stabilize the whole leg for the ambulance ride to the field dressing station or field hospital. Using the Thomas splint during World War I brought the percentage of soldiers with femur fractures to 80% that would live.
Discussion Board Questions: Answer two (2) questions and respond to one (1) classmate’s posting.
Question 1:
Between the 1850’s and 1930’s, physicians gained authority and status. What is one condition or event that led to this? Starr mentions many conditions or events that led to physicians gaining authority and status, just post one (Consult the Starr textbook, Chapter 3).
Question 2:
Due to the litigious nature of medicine, physicians often order more tests (lab, X-ray, CT, MRI, EKG, etc.) than the standards of care suggest. This is sometimes referred to as “defensive medicine.” Additionally, a significant amount of a physician’s income is used to pay malpractice/liability insurance. If health care reform initiatives considered capping or limiting the physician’s liability to keep health care costs down, how could it be done?
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