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essay代写-The rise of modern British hospitals

2019-10-21 | 来源:51Due教员组 | 类别:Essay代写范文

本篇essay代写- The rise of modern British hospitals讨论了近代英国医院的兴起。近代之前,英国的医院一词并不是指现代意义上的医院,而是主要指济贫、收容机构,所以当时的医院无疑是与贫穷和死亡联系在一起的。直到1819世纪,医院才成为救治中心、医学教学和临床研究的机构,成为救死扶伤的中心,并且随着自愿捐助医院的大规模建立,医院成为现代意义上的医院。至此,医院也建立了新型的医患关系,医生开始从从属地位转变为主导地位。本篇essay代写51due代写平台整理,供大家参考阅读。

modern British hospital,近代英国医院的兴起,essay代写,代写,paper代写

Before modern times, the word "hospital" did not refer to the hospital in the modern sense, but mainly referred to the poor and reception institutions. The so-called "hospitals" in the middle ages mainly included four kinds of institutions: leprosy hospitals, workhouses, boarding houses and clinics for the sick poor, so the hospitals were associated with poverty and death. It was not until the 18th and 19th centuries that the hospital became a center for treatment, medical teaching and clinical research, and a center for saving the dying and recovering the wounded. With the large-scale establishment of voluntary hospitals, the hospital became a hospital in the modern sense. Not only did this change allow doctors to treat more patients than in private practice, but also, importantly, new doctor-patient relationships were established in hospitals, and doctors began to shift from a subordinate position to a dominant one. Secondly, the rise of hospitals has brought about changes in the medical industry. Thirdly, the rise of hospitals is conducive to the development of medical teaching, which starts to transform from text teaching to experimental and clinical teaching. Finally, the rise of hospitals has led to improvements in care. This paper analyzes the changes brought by the rise of modern hospitals, in order to inspire people to understand the historical origin of today's doctor-patient relationship, medical teaching and nursing industry. Because "the history of hospital is the history of culture, society and medicine". The history of hospital is an important part of the social history of medicine. Foreign studies have been very in-depth and there are a lot of works. The role of hospitals in the development of modern medicine -- a sociological analysis published by Ivan waddington in the journal of sociology makes a wonderful analysis of the changes brought by the rise of hospitals. "Hospitals in history," by lindsey granshaw and Roy porter, explores the history of western hospitals. The research on the social history of western medical care in China has just started with few achievements. This article is intended to fill the gap in China's study of western medical history.

Hospitals in the modern sense began to be built on a large scale in the 18th and 19th centuries, when they were called voluntary hospitals. In the 18th century alone 36 hospitals were established in England, 29 in the provinces and seven in London. Hence the phrase "the 18th century was the century of hospitals". According to statistics, between 1700 and 1825, 154 hospitals or treatment centers were built in Britain. The number of general hospitals among voluntary hospitals increased the fastest, from 130 in 1861 to 385 in 1891. Specialist hospitals also grew rapidly, from 70 in 1861 to 160 in 1891. The rise of hospitals in the modern sense has brought about a series of changes.

In the doctor-patient relationship before modern times, the patient is in the dominant position. This is what happened when aristocrats and wealthy people were able to afford a doctor, so it's possible to say that aristocrats and wealthy people were at the mercy of a patient-doctor relationship, which is a kind of mobilization. Wealthy patients demand not only that their diseases be treated, but that doctors be very kind to them. They pay for the doctor's services, so it is the patient, not the doctor, who decides the treatment. Patients need to be cured, which requires doctors not to have doubts about their diagnosis, they need to make a diagnosis quickly, and the treatment can only be based on partial evidence or pure observation. So doctors are forced into a position of service or comfort in the presence of wealthy, powerful, critical, and poorly informed patients. In the late 17th century, Moliere mocked this "patronage system" in his book the man who thinks he is sick. He wrote that when dilfaris was asked in court if he wanted his own son to be a doctor, dilfaris replied: "frankly, I have never found the pleasure of practicing medicine among the rich. My experience is that practicing medicine among ordinary people is more rewarding. In the practice of medicine among ordinary people, you don't have to be so precise. You don't have to explain to anyone what you do. The worst thing about rich people is that when they get sick, they demand that you cure them immediately. Wealthy patients in the middle ages often signed contracts with doctors before receiving treatment, agreeing on what they hoped to achieve and how much they would be paid.

The relationship between doctors and patients can be observed from a contract signed between doctors and patients in 1316. "Announced to all the public records of readers: we learned Giovanni DE Anglio doctors began to treat the disease of aristocratic Bertholucio, plus, the doctor should undertake the following treatment for 50 florin gold: plus, the doctor to cure the disease of Western Europe, Poseidon road in the process of water, drugs and mixture, add varney doctors want to buy, in the next 40 days, Poseidon road Western Europe to recover gradually, to achieve the following effects: can part moving legs, feet, hands, can cure this hand clothing, shoes, washed by hand in be cured of your other hand. These effects must be achieved within 40 days. After this effect has been achieved, poseisio shall pay Dr. Cavani 25 gold pieces out of a total reward of 50 gold pieces, as well as the cost of the drugs used and needed to be used. Dr. Gaviani promised to treat and cure poseisio so that the sick side was as healthy as the healthy side, and that once he recovered, poseisio would pay the other part of the price agreed upon, namely, another 25 ducat. The rev. Santa Maria Maggiore, who witnessed the signing of this contract, received 50 gold pieces in exchange for the cure of poseisio. It looks like a commodity trade.

If the treatment fails to achieve the agreed effect, the doctors will not only receive no treatment fee, but also face a lawsuit. Not surprisingly, the kind of data we see today comes from lawsuits, because patients often Sue doctors for practicing illegally or cheating, and doctors in turn Sue patients for breaking their promises.

In this case, the patient's dominance is maximized and the technical doctor's authority is minimized. In fact, skill was not the criterion for doctors at that time. The physician was first required to be a gentleman, to be accepted by the circle of patients he served, the circle of the rich, and to be elegant and intelligent rather than skilled. It was said at the time, "a physician should have the qualities of a gentleman, which only a man of literary accomplishment can possess. A man in medicine must have a knowledge of the humanities, and it would be a stain on his profession if he could not give a lecture on history or philosophy.

Obviously, this situation is not conducive to medical research and innovation. First, because doctors are not judged on their skills, they have little incentive to do research. The rise of the physician before the 18th century was not due to any particular study, but rather to the kind of friends you made in your social circle. Secondly, research is a long-term process, which requires researchers to have suspended judgment and proceed with caution. Before the 18th century, patients demanded an immediate cure, which was usually impossible. Faced with such a situation, most doctors chose to attach themselves to a rich man. Therefore, a prominent feature of medicine before the 18th century was that doctors should be familiar with various diseases that patients might suffer from, that is, they must be general practitioners. This last point is perhaps the most important obstacle to research and innovation -- the unwillingness of wealthy patients to be treated as guinea guinea for new and sometimes dangerous technologies, and the ultimate veto power of patients, thus severely hampering progress and innovation in medical technology.

However, the doctor-patient relationship in hospitals is completely different. For the first time, doctors have become the dominator of doctor-patient relationship. Before the rise of voluntary hospitals, hospitals were not really treatment facilities, but reception and relief facilities. Poor hospital conditions - especially cross infections - are enough to deter those who can afford treatment because they prefer to be treated at home. Hospitals took in the homeless, without money and without care, so most of the patients were not only sick but also poor. "At that time, the patients in hospitals were mainly poor people. Out of 10,414 patients in 1861, only 157 were professionals, and half of them were local government officials, teachers or priests... Others are wage laborers, domestic workers or agricultural workers. There are 1,630 domestic helpers. Such patients are very humble and obedient in the hospital. Every hospital has very detailed rules, such as prohibiting patients from gambling, cursing, smoking, going out, stealing, adultery, and they have no say in their treatment. Some critics point out that patients have no place in hospitals. "Patients are very orderly and humble, and they know they have to follow the rules, follow the instructions of their doctors, and if they make a mistake they will be kicked out of the hospital," said Campbell Stewart. His words are more revealing when it comes to asking patients to agree to surgery. Before anesthesia, surgery was dangerous and extremely painful, he wrote. "patients have the right to choose surgery or to refuse surgery, but once a doctor recommends surgery, that means either having surgery or leaving the hospital." Because patients could no longer get care from anywhere else, they had virtually no choice but to receive the treatment recommended by their doctors. As can be seen from the words of Campbell Stewart, doctors were in a dominant position in the doctor-patient relationship in the hospital at this time.

The most important consequence of this new doctor-patient relationship is that inpatients, unlike wealthy patients, can neither demand treatment nor criticize the attitude of the doctor. When the requirements of patients conflict with the professional judgment of doctors, doctors can ignore the requirements of patients for the first time, make diagnosis according to their own experience or knowledge, and decide how to treat patients instead of following the opinions of patients. The patient has no right to require immediate assistance on being cured, so the doctor can wait for observation and make a cured judgment. Doctors are no longer the servants of the rich, so the focus of medicine has shifted from the treatment of illness, which is most important to patients, to the diagnosis and analysis of disease.

Hospitals are also where patients are most vulnerable to new treatments. In private practice, not only do patients refuse new treatments, but if they fail, doctors lose wealthy patients. In a hospital, not only is it impossible for a patient to refuse, but if the trial fails, it will not affect the individual physician.

As the hospital becomes the center of medical teaching, it also brings about the change of its own professional structure. Since the middle ages, there have been three classes of medical practitioners: physicians, surgeons, and pharmacists. People usually say "internal medicine", "surgical technique" and "pharmacist business". Physicians are considered to be among the elite of society and medicine, with college degrees, deep knowledge of medicine, and a sense of mannerism rather than skill in diagnosing patients. Then there were the surgeons, who were then seen as a craft, as a manual rather than an intellectual labor. Pharmacists are at the bottom of the heap, considered to be businessmen rather than medical practitioners.

There are strict boundaries between industries that cannot be crossed. A physician cannot be a surgeon, a pharmacist, or sell medicine to patients. Members of the society of physicians can only serve as pure physicians to examine patients, diagnose diseases, and prescribe medicines, and pharmacists are responsible for filling prescriptions. At that time, only graduates from Oxford and Cambridge universities were eligible for membership in the association of physicians. The special educational background, the Shared life and study experience in Oxford or Cambridge, and the membership of internal medicine association make the physicians in London a unique social group. Their charters maintained the distinction between physicians and other practitioners, and strictly limited their expansion for their own benefit. Members of the society of physicians lived primarily in London, serving the royal and noble families. All this made the royal society of physicians the most powerful and powerful organization of physicians.

Although in practice, surgical medicine is as old as internal medicine, but until the early modern times, the system and nature of surgery and internal medicine are completely different, so the status of surgeons is lower than that of physicians. Surgical medicine is characterized by the use of incision, surgery, etc., to deal with external body discomfort, such as burns, gunshot wounds, knife wounds, etc. Surgeons perform operations, engage fractures, and treat injuries, skin diseases, and gynecological diseases. Many surgeries required speed, dexterity, strength, and skill even after the invention of anesthetics, so the work of the surgeon was considered primarily manual, and the surgeon was regarded as a kind of craftsman, on an equal level with the barber. Moreover, the most important difference between surgeons and physicians is the way they are taught. Unlike physicians and surgeons, who do not receive a college education, they learn their craft through apprenticeships, which are typically seven years, like traditional craftsmen. Their training is practical and technical, not theoretical or classical like that of physicians, so their social status cannot be compared with that of physicians.

Pharmacists are the lowest ranked, in the third tier of the medical profession. Before 1617, pharmacists belonged to the London grocer's association. In this year, they obtained the royal charter and established a separate association of pharmacists, whose rights and functions were limited by the royal charter like those of other trade associations, and they were responsible for the supply, preparation and sale of medicines in London. At that time, they were not medical practitioners, but drugmakers, who filled the prescriptions of the physicians.

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