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This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.

During late 1951 and early 1952, married couple, social biologist Elaine Cumming and psychiatrist John Cumming, led a mental health education experiment in Indian Head, Saskatchewan. The study, which was intended to inform strategies toward deinstitutionalization, sought to determine if attitudes regarding mental illness could be changed through commonly used educational practices. It was shaped by the shared interests of powerful philanthropic, charitable, psychiatric, academic and governmental bodies to create healthier citizens and a stronger democratic nation through expert knowledge. However, in addition to the disappointing findings indicating that attitudes remained unchanged, the town appeared to close ranks against the research team. Nonetheless, the Cummings' later association with sociologists at Harvard University enabled them to interpret the results in a way that lent the study credibility and themselves legitimacy, thus opening the door to their careers as very successful researchers and policy-makers.

We analyze the cost of quality improvement in hospitals, dealing with two challenges. Hospital quality is multidimensional and hard to measure, while unobserved productivity may influence quality supply. We infer the quality of hospitals in Los Angeles from patient choices. We then incorporate ‘revealed quality’ into a cost function, instrumenting with hospital demand. We find that revealed quality differentiates hospitals, but is not strongly correlated with clinical quality. Revealed quality is quite costly, and tends to increase with hospital productivity. Thus, non-clinical aspects of the hospital experience (perhaps including patient amenities) play important roles in hospital demand, competition, and costs.

Until today, it is still unexplored, how modern (scientific) medicine in Western Germany could negotiate its social position in the public sphere and how it was represented in the media. This paper will contribute to the analysis of this problem by investigating all entries on "medicine" in the journal "Der Spiegel" during the period 1947 to 1955, when Western Germany was built up. It is possible to show that the journal was a market place where specific public spheres as e.g. physicians, patients or journalists could discuss medical topics. This way, on the one hand, "Der Spiegel" grasped contemporary notions on medicine and the medical market, which made itself felt in later years of Western Germany. On the other hand, the journal itself molded the discussions about a scientific medicine, which was to be not only innovative but also democratic.

Chagas disease is one of the main endemic illnesses in Latin America. Since 1969 up to the present, the treatment of chronic Chagas patients has been the object of a scientific-medical controversy mobilizing several bodies of knowledge and actors. The resolution of the controversy has direct effects on the health of patients; however, they have been systematically excluded of public debates. In this paper we identified and specified four different steps of the controversy, showing the different positions adopted by the actors implicated, analyzing their statements, the scientific knowledge mobilized during the debates and the consequences for the establishment of norms for the treatment. We conclude showing that what makes up the central issue of the controversy is not what the actors implicated explicitly state as it but the criteria (technical and cognitive) through which are measured and defined "illness" and "cure" states. This research is about a case study in Argentina.

As part of a larger e-health strategy, Canadian governments have invested millions in online health information services for the lay public. These services are intended to reduce demands on the primary health care system by encouraging greater individual responsibility for health and are often promoted using the language of personal empowerment. In this paper, we describe how lay searchers generally look for online health information and discuss the disempowering challenges they are likely to face in (a) locating Canadian government-sponsored health information sites and (b) finding useful information on these sites to address everyday health concerns. We conclude with several recommendations for policy changes.

Chronic pain (CP) is a stressful condition that severely impacts individuals' lives. Researchers have begun to explore the role of religion for CP patients, but the literature is scarce, especially for West European populations. Drawing from the transactional theory of stress, this study examined the associations between the religious meaning system and the life satisfaction for a group of CP patients who were members of a Flemish patients' association. To take into account the religious landscape of West European countries, the centrality of one's religious meaning system, rather than religious content, was the focus. Results from the questionnaires completed by 207 patients suggest that the centrality of a meaning system is an important factor in the promotion of life satisfaction for this group, above and beyond the influence of several control variables. Furthermore, the centrality of the religious meaning system moderated or buffered the detrimental influence of pain severity on life satisfaction.

After colonizing Korea, Japan invaded China, and subsequently initiated the Pacific War against the United States, Britain, and their allies. Towards the end of the war, U.S. warplanes dropped atomic bombs on Hiroshima and Nagasaki, which resulted in a large number of Koreans who lived in Hiroshima and Nagasaki suffering from the effects of the bombs. The objective of this paper is to examine the history of Korea atomic bomb victims who were caught in between the U.S., Japan, the Republic of Korea (South Korea) and the Democratic People's Republic of Korea (North Korea).

This essay explores the significance that rehabilitation physicians and polio patients in the United States put on recovering the ability to walk. Polio often paralyzed or severely weakened the legs of those who contracted the disease. Regaining the ability to walk was thus a significant measure of recovery from the disease. However, walking meant more than the physical act itself. Regaining the ability to walk meant, in a symbolic sense, that one was no longer disabled, that one had again become normal. This attitude was shared by rehabilitation specialists and patients alike. This essay examines this attitude and the cultural values it embodied through a study of the efforts of selected polio survivors to learn to walk again and of the rehabilitation literature that held walking as an ideal. It also explores what happened when polio patients were unable to walk again because of the severity of their paralysis.

The São Pedro Hospice was inaugurated on June 29, 1884, and it wa the first psychiatric hospital in Rio Grande do Sul State and one of the first of Brazil, whose history was in a turning point, and it became correlated with the construction of the psychiatry then province. This article presents an abbreviation history of the institution until the decade of 1920, it analyzes the data of the internal population. Moreover, it deals with the medical practices of attendance inside the hospice, which were combined with the development of the "cure" of the subjects, the precepts of the science and the physical and cultural attributes, as well as the experiences of the inpatients' life.

This article explores the history of the San Juan de Dios Hospital in Cartagena de Indias, at the end of the 18th century. Its activities and evolution cannot be understood unless they are analyzed within the context of the Bourbon sanitary reforms. it was precisely at that time when these reforms were being implemented in Nueva Granada. One of the goals of the reforms was to improve the health of the population in order to discipline the vassals, to promote the growth of the workforce and to increase the Crown's wealth. The text reviews different aspects of the institution, and how it operated. It examines the budget, its expenses, and the dynamics of the hospital population and of its employees. In doing so, it intends to explain what the hospital offered to the city's various social groups.

This study investigates the staffing by physicians of the "Hospital Real" in the city of Granada in the 16th century, focusing on the selection processes that preceded their respective and successive appointments. The aim is to illustrate the determination shown by this class of professionals to claim this healthcare space and the academic and socio-cultural requirements that they had to meet in return. These included the possession of a university degree and the accreditation of reputable surgical experience and, to a lesser degree, "limpieza de sangre" (proof of Spanish Christian ancestry) and the title of physician awarded by the local court of the Inquisition.

Teeth cut across cultures. They transgress cultural boundaries but also define social boundaries. They provide information about what goes into the mouth, and what the mouth is appropriately used for. Scrutiny of teeth identified a new biomedical space to analyze pain, and created a new culture of medicine for such practices. This paper uses the evolution of dentistry since the 18th century to look at how our social and scientific understanding of teeth has shaped cultural attitudes about pain, politics, beauty and prophylaxis. It then raises questions about how these attitudes in turn create ethical contexts for the practice of dentistry around the world.

Patients' letters are among historical sources that have been recently put forward in the history of medicine in order to shed light on the perspective of the sick and explore the dynamics of therapeutic relationships. They enable historians to focus on the active participation, initiatives and strategies of lay people in the handling of their health and illness. Based on the analysis of letters written by patients to the Swiss physician Samuel-Auguste Tissot in the second part of the 18th Century, this paper deals with the relative autonomy that sick people are able to claim in the process of interpreting and explaining of their medical trajectories. It is argued that they possess a "narrative authority", which can be defined as the possibility to defend one's own point of view in the organisation of one's narrative, thanks to the interpretative latitude due to polyphony and plurality of meanings inherent in the intersubjective construction of the illness experience.

This article presents a unique document, a hitherto unpublished diary of a patient analysis with Freud in 1921. Conclusions on how Freud worked with patients at that period, particularly insofar as transference is concerned, are drawn.

The consultation letters of Lorenz Heister enable a specific patient-focused analysis. Heister was not only a famous physician of the early German Enlightenment, but a renowned surgeon as well. His double expertise gives his correspondence a unique character. The consultation letters addressed to him testify not only the well known phenomenon of "medicine-by-post", but also the less well known practice of "surgery-by-post". They allow us some insight into the different sensations and strategies of people who suffered from a malady which could call for surgical treatment. Patients' letters enable historians to compare the expression of fears, hopes and actions with those of their fellow-patients who sought in Heister not the surgeon, but the physician. Such a comparative approach suggests a series of issues, of which two are discussed here: representations of the patient's history of suffering (Patientenweg, and representations of the patient's body (Patientenkörper).

Consulting by letter was fairly common practice among the educated, upper classes of early modern Europe. Surviving letters of consultation written by patients, relatives or friends count among the most valuable source for the analysis of pre-modern experiences of disease and the body. This essay gives a brief overview of the various types of consultation letters and related documents which resulted from this practice before tracing the historical development of epistolary consultations from the late Middle Ages through the heyday medical correspondence in the 18th c. before its decline in the 19th c. It presents "experience", "self-fashioning" and "discourse" as three particularly fruitful levels of analysis on which patients' letters can be used within the wider framework of a cultural history of medicine. These three levels of analysis, or three distinct approaches, enable historians to access a greater awareness of the ways in which the experience of illness and the body is culturally framed with an analysis of the performative effects of patients' narratives and the influence of medical discourse among the wider society.

Based on the letters sent by French patients to Hahnemann and his wife (or written about them), this essay focuses on the behaviour of patients towards treatment rather than on their representations and interpretations of illness and health. Despite the fact that we don't know exactly who the authors of these letters were, it is clear that they all hope to obtain some of Hahnemann's medicines. The well-known demand for medicine at the beginning of the 19th Century was reinforced by the mystery surrounding homeopathic remedies and the specific way they were made available. Relying on theories which lent an important role to the nerves and the patient's character to explain the origins of sickness, patients hoped that Hahnemann and his new doctrine would be able to change both their life and their psychical characteristics. One can conclude that for the authors of such letters, writing about illness could be a means to construct new behaviour patterns and new attitudes towards health and sickness, rather than an illustration of existing medical, social and literary models.

Analysing the contents of letters exchanged by patients in the 18th century, this chapter aims to demonstrate the capacity of such sources to offer both contextual information on medical practices and first hand information on patient strategies to retrieve and maintain their health. The letter is sometimes closer to the events than other texts and hence, more precise. Series of letters sent by the same author to different addressees can be used to reveal something of the meaning construed around patients' choices. Letters sent over long distances reveal variations in medical practices in different spatial contexts. In short, the letter, as a historical document, is an important key to lay medical culture.

Letters represent the most important type of source where patients of the early modern period record their feelings, thoughts and behaviour. It is therefore crucial to put them into context and identify the author's reasons for writing. Consultation letters written to physicians can be distinguished from family letters or letters exchanged between members of the Republic of Letters. The way patients write about their illness is largely determined by the main reason for the letter. Family members want, for instance, to inform their relatives about the general situation of the household. News about the state of health of family and kin is an essential part of such accounts. Though usually sparse in detail, information about health is offered regularly in order to free addressees from uncertainty. Among learned men, accounts of sickness are mostly brief and described as "inconveniences", as distractions from the pursuit of learning. Neither in family letters nor in learned correspondence should superficial descriptions of illness be considered as a sign of superficial relationships.

It was common practice between the 16th and the 18th c. to submit a clinical case to a physician whose renown and prestige were generally acknowledged even outside academic circles. Patients could normally gain access to Antonio Vallisneri, who was then a famous physician, through their own physician. Vallisneri was regularly engaged in writing consultations and sending them by post, an activity which gave way to a peculiar kind of writing both in style and language level. The patient and his illness are the object of minute descriptions in order to secure an effective therapy. One of the best therapies, nevertheless, seems to be the written communication itself, written by the physician for the patient, which possibly reassured the patient that the best possible therapeutic measures were being taken in order help to retrieve his or her health.

The author examines the course of 17 analyses, as conducted by Freud, on the basis of a new source, Freud's patient notebooks. All analysands (five women, 12 men) were or were to become members of a psychoanalytic society. Their treatments were marked by a relatively short duration (all of them less than a year) and a very high number of hours per week (generally six). The total number of hours ranged between nine and about 250. Compared to the present conditions, both the duration and the number of hours per week show a great historical change has taken place. The author discusses this change as well as some other characteristics, e.g. the customary extra-analytical contact between Freud and his analysands. In an appendix, treatment profiles of all 17 analyses are given, summarizing their duration, the total number of hours, numerous of hours per week and number of hours in each month of treatment.

"A physician does not need to have had a disease to know all its components, but it sharpens the perception ... one acquires a deeper understanding of the difference that exists between giving and receiving". Marcel Thibault, 2004.

All researchers agree that individuals can become intoxicated by and dependent on alcohol, tobacco, and other psychoactive drugs. But they have disagreed over whether, and to what extent, drug pathologies comprise a unitary medical problem. Most critically, does addiction have a biological common denominator? Consensus on this question has shifted back and forth. In the late nineteenth and early twentieth centuries, physicians often studied and treated various drug addictions together, working under the "inebriety" paradigm. By the mid-twentieth century the inebriety paradigm had collapsed. Tobacco and alcohol had split off, both in the medical research community and in western popular culture. This article argues that neuroscientific, genetic, epidemiological, and historical evidence helped to reunify the addiction field in the late twentieth century. A new unifying paradigm emerged, variously called chemical dependency, substance abuse, or simply ATOD -- alcohol, tobacco, and other drugs.

Subjectivity and objectivity are central dimensions or perspectives in medicine. During modern times, the "history of the disease" (objectivity) has more and more re-placed the "history of the patient" (subjectivity). But if medicine wants to be human, the physician's and patient's subjectivity and ethics cannot be ignored. During the Middle Ages, the concepts of health and disease are seen from a transcendental point of view, subjectivity was given an objective or spiritual meaning. Processes of secularization, naturalization and individualization deeply influenced medicine in Modern Times. The positivist 19th century laid the foundations of successful scientific medicine; the concept of disease became objective, the length and the quality of life were increased, at the same time, however, medicine witnessed anthropological losses. The 20th century stressed anew the patient's subjectivity and ethics against the scientific objectivity. Integrating psychology and sociology is a similar initiative in this anthropological perspective. The anthropological and ethical permeation of medicine is essential. Disease is not just a physical phenomenon, it is also a psychic, social, and spiritual one. Medical science behaving as human medicine should always and above all see the ill and suffering person.

The open psychiatric service established in Paris by Edoward Toulouse was meant to provide early, active psychiatric treatment to mildly afflicted individuals without subjecting them to legal commitment. Psychiatric reformers also hoped that the service would help to raise the status of psychiatry by typing their specialty's fate to laboratory science and hospital medicine. This article traces the genesis of open psychiatric services in interwar France and survey the debates they engendered within the French psychiatric community. It highlights the role of World War I in the implementation of open services and in the creation of a pool of patients who required assistance.

Nineteenth-century Ireland was colonized and strictly controlled from Britain. In this highly regulated society, reports of the Inspectorate of Lunacy in Ireland were used to express an official medical view on cirminal lunacy. This view was based on experiences gained in the Central Criminal Lunatic Asylum for Ireland, opened at Dundrum in 1820. This paper will examine some of the ideas expressed in these reports, including views on the treatment of criminal lunatics, on their potential for dangerous behaviour, and on emigration as a form of after-care.

Routine distribution of alcoholic beverages to mental hospital patients would be a fanciful prospect today, yet in the formative decades of lunatic asylums, beer was standard issue. A staple item in the supposedly healthy Victorian asylum diet, beer also served as inducement for patient labour. Around the mid-1880s, this commodity was abolished throughout Britain's mental institutions. This paper explores the factors that combined to condemn the beer barrel to asylum history, and, in particular, how this small comfort for immates fell foul of the medicalization of the asylum and of the professional project of psychiatry.

This paper examines patients' demography at Ohji Brain Hospital, a prosperous private psychiatric hospital in Tokyo, from 1926 to 1945. Increase and decrease in the number of resident patients, new admissions and deaths are discussed, based on a database compiled from the patients' admission register. Particular attention is paid to the length of stay. The changing pattern of the distribution of the length of stay is examined in the light of new therapeutics and different expectations held by the clients.

In so-called "euthanasia" operations, Nazis murdered patients with psychiatric or hereditary diseases in large numbers. Psychiatric patients in Germany were sent to six institutions, where they were deprived of their lives in gas chambers. In his sermon delivered on 3rd August, 1941, at St Lambert's Church in Münster, Bishop von Galen of Münster intensely condemned this cruel operation in public. Quoting the fifth commandment, "Thou shall not kill", he said it was sinful to kill innocent people on account of their unproductiveness. By the influence of this brave sermon, Hitler had to order the closure of the institutions, though the "euthanasia" operation itself was secretly continued.

The massive use of laxatives, emetics and blood-letting in pre-modern medicine has often intrigued historians. Why did generations of prominent and often quite empirically minded physicians resort to methods which, in hindsight, were usually much more likely to do harm than good? And why did the patients not rebel?Based on patients' personal documents and, in particular, on the letter consultations many of them wrote ot renowned early modern physicians, this essay traces, how the sick and their relatives experienced and responded to this kind of treatment. These sources provide ample evidence, first of al, that early modern lay-men not only accepted evacuative treatment with laxatives and the like but often explicitly demanded it. To them these methods seemed plausible and indispensable in the light of their notions of disease causation. For diseases were generally though to result no so much from an imbalance of humours or qualities (as is often believed) but from a specific, impure, morbific matter which had to be expelled. And patients frequently felt better or even totally cured immediately after taking a drastic laxative. In hindsight, we may attribute this to a placebo effect or the self-limiting nature of most disease episodes. But in the patients' experience the efficacy of evacuative treatment was thus constantly reconfirmed. Indeed, the very physical perception of curative effects was already shaped by their deeply embodied belief in the predominantly humoural nature of human physiology and pathology, increasing the likelihood of placebo effects from treatment that occasioned a marked, clearing visible evacuation. Therapeutic failure, on the other hand, was a common experience, too, but it could easily be explained on a case to the case basis, as a result of divine will or, more commonly, of the physician's incompetence. Presumably he had not chose the right evacuative treatment or drug, which was adequate in the specific case and another physician with a slightly different approach might well have more luck. The beneficial effects of evacuative treatment as such, however, were not called into question. Treatment with laxatives, emetics and blood-letting thus became obsolete very gradually only, in the nineteenth century, when new, more solidistic body concepts started to prevail also among the population.

Cancer had often been linked with unhappy emotions in the past, but this association entered a new phase in the middle of the 20th century as a result of research in the field of psychosomatic medicine conducted in the United States during the 1950s. There researchers focused particularly upon cancer in women, and were strongly influenced by the prevailing psychoanalytic orthodoxy surrounding the nature of femininity and normal female sexuality. The results of these studies, which appeared in the Journal Psychosomatic Medicine, confirmed the personality-cancer link out but were rife with erroneous assumptions and faulty methodologies. They were widely publicized, nonetheless, and were instrumental in promoting the association between repression and cancer, especially in women. Despite criticism, their influence was manifest in psycho-oncological research in many countries during the decades which followed and popular notions of the "cancer personality."

Hospital monographs frequently describe the buildings and the leading staff but rarely the patients. However, the 1980s and 1990s called attention to the importance of the perspective of patients of the past. The chapter reports an examination of the quality and extent of information retrieved through a systematic search of patient records from the Copenhagen General Hospital, extending back to 1855. The charts illuminated the social conditions of the patients in addition to their illnesses and the treatments characteristic of the day. Analyzing the state of medical practice revealed in the records, the author tested whether hospitals in reality were no more than gateways to the afterlife. Comparisons among hospitals showed the extent to which treatments varied across institutions. Correlations between the evidence of the patient charts and the ideals of the professional literature at the time revealed the differences between theory and practice. The records yielded important insights into the daily lives of patients admitted 150 years ago. They generally were younger and of lower social class. For reasons of poor hygiene, poor housing, and poor nutrition, they fell victim to the classical diseases of the crowded urban environment, including lung, skin and venereal diseases. Of these, tuberculosis killed most patients admitted to hospital.

This is the narrative of a patient made before, during and after being incarcerated in an agricultural colony in the Peruvian Amazon. In a vivid style, it narrates the decay of the body, the stigma and the compulsive segregation, as well as the hope for a better life. It is the perspective of a patient, something that is difficult to find when researching the history of health. The original publication was possible thanks to the German physician Maxime H. Kuczynski-Godard and thanks to the Institute of Social Medicine of the University of San Marcos that was directed by the professor of hygiene Carlos Enrique Paz-Soldán. We have used this publication for this transcription. Kuczynski-Godard was a German medical doctor that arrived in Peru in the mid 1930s and organized valuable activities in the Peruvian jungle as a part of an effort, which eventually failed, of the Peruvian State to colonize, or really to "civilize" the Amazon.