Last Unit: The American Health Care System

by Prof. Hangen - April 2nd, 2014

April 2 – Poster and Presentation “Conference Day” on your Disease Projects

Video we watched in class:

April 9 – (virtual class) Supremacy, and Hubris? Reading: Rutkow Ch 8-10. Disease Report is due (please email it). For a brief time in the mid-20th century, things looked very promising for the eradication of major transmissible diseases and for steady progress on extending the human lifespan. Science and medicine seemed to have triumphed over ignorance and disease. Were we fooling ourselves?? See, for example:

A (hilariously campy) British government 1964 film looking back on the 1940s discovery of penicillin and Jack Gibbon’s heart-lung machine in action (BBC Four)

April 16 – (virtual class) The American System (pre-Obamacare). Viewing: screen the 2007 film Sicko in its entirety (allow 2 hours), and read Stevens, “Health Care and Policy in the US” (PDF).
journal-cJournal Prompt #6. By class time on Wednesday, April 16, please post a 500-word journal response on Blackboard answering why there was so much resistance to a national health care system in the US, when it was adopted in so many other developed nations in the 20th century? Also, by the 2000s, what were the major failings of the health care system as highlighted by Michael Moore in his film? What did he think needed to be fixed? What accounts for the sense of urgency in Sicko?

April 23 (virtual class) Health Care System and Costs
. Reading/listening/viewing: Read “Why is American Health Care So Ridiculously Expensive” in The Atlantic of March 2013 (and check out a few of the graphs that are linked to in the story), and also listen to / take notes on the 1-hour “More is Less” episode of the public radio program This American Life, which originally aired in October 2009. You might also appreciate October’s cover story in MIT Technology Review, A Tale of Two Drugs.” And watch these two overviews of the American health care system:

journal-cJournal Prompt #7. By class time on Wednesday, April 23, please post a 500-word journal response about the current — and coming — changes in the US health care system. How does this look from your perspective as a health care provider?

Our last class will be a debate in person on April 30th, and preparing for the final exam. The instructions and resources are now posted under the “Debate” tab, above.

Discussion Questions for Part II of Pox (March 26)

by Prof. Hangen - March 19th, 2014

Use these questions to guide your 500-word journal entry due on Blackboard by March 26th, the date of our next “virtual class.” You DO NOT have to answer all questions!

4. “War is Health.”
At the beginning of the 20th century, how was military and American imperial expansion related to the origins, development and transformation of the “sanitary campaigns” in places that the US military had occupied? What were some of the legacies or achievements of those campaigns; at what cost were they achieved?
Of what causes did the majority of soldiers die during the War of 1898?

5. Stable and Lab
(see p. 171) In the fall of 1901, vaccination regulation was controversial. A few months later it was federal law. What happened?
Describe the process of vaccine manufacture in the early 1900s under the direction of the state boards of health. (How does it compare with today, by the way?)
What were some of the problems with this process, and what were the effects of tainted vaccine?
Why is the Biologics Control Act important?

6. Politics of Tight Spaces
Why were immigrants MORE likely than native-born Americans to be vaccinated at this time?
(see p. 240) Which powers of the state were especially contested when it came to vaccination?

7. The Antivaccinationists
Who was included under the anti-vaccinationist umbrella, and to what other causes and movements was the antivaccination movement connected?
(see p. 271) What were the dueling concepts of liberty at odds in the struggle over vaccination?
What lesson would you draw from the story of Immanuel Pfeiffer?

8. Speaking Law to Power
What was radical, unexpected, or significant about the court case Commonwealth v. Jacobson? (see p. 299) What was the core legal question in the case?
(see p. 308) How did the anti-vaccinationists understand compulsory vaccination as a fundamentally different public health measure?
(see p. 334-335) What have been some of the uses of the Jacobson ruling in the years since?

What did you learn from this book about how “police power” is important in medical history?
How does this book illustrate or connect to some of the principles or themes of the Progressive Era that we discussed in class?

Smallpox in America, Part I for Wed Mar 12 (in person)

by Prof. Hangen - March 8th, 2014

As we agreed, please read up through Chapter 3 of Willrich’s book Pox: An American History.

The slides we looked at in class:

290 BackgroundPOX Progressivism

Some discussion questions to guide your reading and thinking:

  • Consider the subtitle. How is this an “American history”? Is it, in some way, a history of America itself? Or of the era? Is this a “history of disease” book in the same way as the one you are reading for the Disease project? Where does Willrich locate the story – in the sick people, or the researchers, or the law, or somewhere else? Why does he begin the story in 1900, when smallpox is a very old disease?
  • How do race and gender intersect with the story of smallpox outbreaks at the turn of the 20th century?
  • One of Willrich’s claims is that smallpox “sparked one of the most important civil liberties struggles of the twentieth century” (14). This is a surprising claim; why?
  • Explain the difference between smallpox variolation and vaccination.
  • Why didn’t the US go the route of compulsory vaccination laws, as in other developed industrial nations at the time?
  • How did communities, states and the federal government respond to “mild type” smallpox? Was Middlesboro, Kentucky, typical? What cultural factors made fighting smallpox in the South more challenging in these years?
  • Describe the work of health inspectors like Wertenbaker – what did they do, and not do? What kind of authority (moral, legal, jurisdictional) did they have?
  • What can you learn from these chapters about IDEAS of health and sickness at the time, or about the development of the American health care system?

Meet the Civil War Nurse – Wed Mar 5 (in person)

by Prof. Hangen - February 28th, 2014

I look forward to our in-person meeting this week, especially as I’m eager to hear your responses to our reading. Do bring the Rutkow book with you so we can review the recent chapters we’ve read (Chapters 5-7), but we will probably spend most of our time talking about a remarkable account of being a Civil War nurse in Washington D.C. written by Louisa May Alcott (author of Little Women) in 1863, titled “Hospital Sketches.” It’s slightly fictionalized; she calls herself “Tribulation Periwinkle” and disguises some of the other names, but the place and her experiences were very real.

First, some background information: click here to see her muster roll card in the collection of the National Archives, and click here to learn a little about the formidable woman who was in charge of the volunteer nursing corps, Dorothea Dix.

Next, read Alcott’s narrative itself; it’s divided into 6 chapters and should be a fairly quick read. I’ll link here to two versions (same words, take your pick): plain-text online or a digitized original book (just the first 91 pages; the rest is a different book). Take good notes for our discussion of what she did (and didn’t do) as a nurse, her training (such as it was), and the hospital conditions and medical practices.

journal-cJournal Prompt #4. By class time on Wednesday, March 5th, please post a 500-word journal response on Blackboard that addresses some or all of these questions (these will be the basis for our in-class discussion as well, so you might want to bring your journal entry as a printed paper to serve as notes for our discussion):

What can Alcott’s narrative tell us about nursing in the 19th century?
What does it reveal about IDEAS of health and sickness at that time?
What can a document like this NOT tell us? What questions might it leave unanswered or unresolved?
If you were Nurse Periwinkle’s supervisor or colleague, how would you assess her nursing skills and performance?
According to Rutkow, the era in which Alcott was working as a volunteer nurse was prior to the emergence of “modern medicine” and professional authority. Does her account seem, in your professional opinion, to be completely foreign to your own experiences or are there some similarities that may have surprised you?

For Feb 26 (virtual class)

by Prof. Hangen - February 21st, 2014

Topic: Modern Medicine, Quackery, and Health in the Victorian Age

Due on Feb 26: your Diagnosis: History paper. Please submit it to me by 8 pm on Wed 2/26 as an email attachment, preferably as a Word document (to see a sample APA paper as a formatting example, click here). For our “virtual class” this week, please continue reading in Rutkow’s book, chapters 5-7 on Scientific Advancement, Professional Authority, and Challenges of Success. History-wise, that will bring us up into the 1930s, which is helpful background when we read Pox later this semester.

One of the things Rutkow talks about is the rise of (and later efforts to contain and control) medical entrepreneurs and “quacks.” Take a look at one or more of the sites on the list below and spend some time exploring them for more about quackery and oddball cures in the 19th century (some in England, some in the U.S.) Enjoy!

The Quack Doctor (a blog of historical cures, medicines, and devices)
Victorian Quack Cures (image gallery by the London Telegraph)
Balm of America: Patent Medicine Collection (Smithsonian Institution)
Patent Medicine: Cures and Quacks (PDF – Pilgrim Hall Museum)
The Medicine Show (Legends of America)
Patent Medicines and Miracle Cures (New York Bar Association)

Please leave a comment about which site(s) you visited and what you found interesting, using the comment box at the foot of this post. Instead of a formal journal entry this week, please contribute definitions to the existing glossary entries on Blackboard, and add at least 3 terms of your own, with definitions. These can be drawn from Rutkow’s book or from any of our readings or documents to date. Remember, each definition should always establish the historical context for the term (time period? place?), because meanings and discourses are always historically constructed (as we learned from Foucault).