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This paper considers insights for contemporary medical practice from an archival study of gratitude in letters exchanged between almoners at London's Brompton Hospital and patients treated at the Hospital's tuberculosis sanatorium in Frimley. In the era before the National Health Service, almoners were responsible for assessing the entitlement of patients to charitable treatment, but they also took on responsibility for aftercare and advising patients on all aspects of welfare. In addition, a major part of the work of almoners at the Brompton was to record the health and employment status of former sanatorium patients for medical research. Of over 6000 patients treated between 1905 and 1963 that were tracked for the purposes of Medical Research Council cohort studies, fewer than 6% were recorded as 'lost to follow-up'-a remarkable testimony to the success of the almoners' strategies for maintaining long-term patient engagement. A longitudinal narrative case study is presented with illustrative examples of types of gratitude extracted from a corpus of over 1500 correspondents' letters. Patients sent money, gifts and stamps in gratitude for treatment received and for the almoners' ongoing interest in their welfare. Textual analysis of letters from the almoner shows the semantic strategies that position gratitude as central to the personalisation of an institutional relationship. The Brompton letters are conceptualised as a Maussian gift-exchange ritual, in which communal ties are created, consolidated and extended through the performance of gratitude. This study implicates gratitude as central to the willingness of former patients to continue to engage with the Hospital, sometimes for decades after treatment. Suggestions are offered for how contemporary relational healthcare might be informed by this unique collection of patients' and almoners' voices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Context.—: Frederick Banting, Charles Best, J. Bertrand Collip, and J. J. R. Macleod contributed to the discovery of insulin in 1921-1922. Recent advances in anatomic pathology, experimental pathology, and clinical pathology were necessary for the research in Toronto, Ontario, Canada, to begin and to succeed., Objective.—: To explore the role of pathology and laboratory medicine in laying the foundation for the discovery of insulin., Design.—: Available primary and secondary historical sources were reviewed., Results.—: During a 3-decade period, pathologists, through autopsy pathology and experimental animal studies, were able to provide solid evidence that the pancreatic islets were the source of the internal secretion responsible for proper carbohydrate metabolism. Banting, a surgeon with no previous research experience, read about these studies in a case report with an extensive literature review by pathologist Moses Barron; this piqued Banting's interest and caused him to approach Macleod, a Toronto physiology professor, with an idea that initiated the research. Advances in clinical laboratory medicine, which allowed them to measure blood glucose levels using small blood volumes, were critical to their success., Conclusions.—: By 1921-1922, the pieces necessary to solve the puzzle were available. The primary reason that the time was ripe for the discovery was the contributions of pathologists and laboratory physicians in the preceding 3 decades. As the 100th anniversary approaches, our profession can take pride in its important contributions to the discovery of insulin, which is broadly recognized as one of the most important medical research advances of the 20th century., (© 2020 College of American Pathologists.)

Aim: To emphasize the role of history in shaping clinical nursing identity and opportunities, and encourage nurses' contribution to the story of contemporary clinical nursing., Approach: Drawing upon history frameworks and approaches to history research, greater engagement of clinical nurses in recording nursing history is canvassed. A basic framework for developing historical research from practice narratives is suggested as a feasible option., Outcomes: Topics identified: a) nurses' awareness of their history and nursing's professional standing; b) the importance of oral history in nursing development; and c) digital influences on history research and constructing historical narratives., Conclusion: Clinical nurses' stories contribute to historical research. All nurses are responsible for gathering and distributing contemporary local narratives on clinical nursing. Oral history research provides a framework for nurses to record and share stories., Implications: Recorded history can prevent nursing from being trivialized or misrepresented. Missing accounts of contemporary nursing create gaps in our narrative and risk future professional disempowerment., (© 2020 International Council of Nurses.)

I met Dan Callahan in 1986-when I came to pitch him. Coming from a sleek office setting near Boston, I was intrigued by The Hastings Center's higgledy-piggledy environment where so many smart people got to work in a relaxed, inviting atmosphere. I had noticed that the Center was producing a great deal of policy work on a wide range of topics but didn't seem to go further than publishing the highly valuable guidance developed under Dan Callahan's leadership. I ended my pitch, "Look, Dan, where Hastings gets bored and wants to go on to the next topic, my group in Boston gets interested." To my great pleasure, and despite his skepticism, Dan accepted the pitch. Beyond his generous responsiveness to unproven young people, Dan had many other virtues. For one, he was a boundary crosser., (© 2019 The Hastings Center.)

Did Dan Callahan know the calling he was displaying in his own work and offering to others in the special intellectual garden of The Hastings Center, which he cocreated, with Will Gaylin, and went on to prune and tend for nearly four decades? I would say, yes, he knew what he was about. Successful people usually have self-confidence and drive in abundance, but in Dan's case, there was something more profound and interesting at work. Having gone through the endnotes of his latest book one day, I asked him how he found time to read so widely. He said he had learned to be an efficient skimmer who could pull out the nuggets he valued from another's work because he had a few magnetic ideas from which he would brook no distraction., (© 2019 The Hastings Center.)

For more than eleven years, I worked with Dan Callahan as an editor, a liaison with journalists, and a sounding board for ideas. To Dan, every new writing project was a thrill, whether it was for the New Republic or a blog. He consumed a wide range of professional and scholarly literature, followed the news with the eye of a reporter, and called experts when he wanted to learn more about something he had read. The result was a volcanic bubbling of story ideas. If he didn't turn them into articles or books, I sometimes had the feeling that he might burst., (© 2019 The Hastings Center.)

As a student in bioethics, I knew that The Hastings Center and its founders were the height of excellence in this field, and therefore I found them both intimidating and intriguing. When I began working there, Dan Callahan was supportive of my endeavors to provide a venue for students and other young writers to express their views on bioethics. I started my own blog called Bioethx under 25 that featured short essays by anyone who wished to submit, generally individuals who had a genuine philosophical interest but were not yet at the level of pursuing a Ph.D. Dan's support of my project culminated in his sponsorship of the Daniel Callahan Young Writer's Prize, an essay contest run through the blog. This was one of the many ways he demonstrated that making theoretical contributions to bioethics should not be limited to a select few., (© 2019 The Hastings Center.)

The medical field often requires radiologic technologists to make complex decisions that affect patients, employers, and colleagues. Technologists must consider practice standards when making choices, and also must act ethically to protect patients' safety and respect their autonomy. To make the most informed and ethical decisions, technologists should know the history of medical ethics, as well as be familiar with philosophical tools and ethical codes that can guide them in their daily practice., (©2019 American Society of Radiologic Technologists.)

Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.

Objective:: To describe the circumstances that determine the creation of the Brazilian Association of Graduate Nurses of the Federal District Section and analyze its implications for the reorganization of the field of nursing., Method:: Qualitative, socio-historical, documentary study. The analysis generated the following category: Creation of a new group to guarantee unity: Brazilian Association of Graduate Nurses in the Federal District Section., Results:: The economic crisis resulting from the Second World War, the creation of the Paulista Association of Graduate Nurses and the increase in the number of Schools of Nursing in the country were decisive for the Brazilian Association of Graduate Nurses to reformulate its statute as to guarantee its unit., Final Considerations:: The creation of the Federal District Section consisted of one of the strategies of the Association to reorganize the field of nursing, in order to ensure the recognition of the profession by the society., Objetivos:: Descrever as circunstâncias que determinam a criação da Associação Brasileira de Enfermeiras Diplomadas Seção do Distrito Federal e analisar as implicações dessa criação para a reorganização do campo da enfermagem., Método:: Estudo qualitativo, sócio-histórico, documental. A análise gerou a seguinte categoria: Criação de um novo grupo para garantir a unidade: Associação Brasileira de Enfermeiras Diplomadas Seção do Distrito Federal., Resultados:: A crise econômica, decorrente da Segunda Guerra Mundial, a criação da Associação Paulista de Enfermeiras Diplomadas e o aumento do número de escolas de enfermagem no país foram determinantes para que a Associação Brasileira de Enfermeiras Diplomadas reformulasse seu estatuto, de modo a garantir sua unidade., Considerações Finais:: A criação da Seção do Distrito Federal consistiu em uma das estratégias da associação para reorganizar o campo da enfermagem, de modo a assegurar o reconhecimento da profissão pela sociedade.

The United States Patent Office of the 1850s offers a rare opportunity to analyze the early gendering of science. In its crowded rooms, would-be scientists shared a workplace with women earning equal pay for equal work. Scientific men worked as patent examiners, claiming this new occupation as scientific in opposition to those seeking to separate science and technology. At the same time, in an unprecedented and ultimately unsuccessful experiment, female clerks were hired to work alongside male clerks. This article examines the controversies surrounding these workers through the lens of manners and deportment. In the unique context of a workplace combining scientific men and working ladies, office behavior revealed the deep assumption that the emerging American scientist was male and middle class.

The Dutch physician Pieter Van Foreest (1520-97) included nine books of surgical observations among his large series of case-histories. Although he demanded that all physicians should have a knowledge of surgery, his writings show the limitations of his approach as well as the overlap between physicians and surgeons. Certain conditions were treated by both types of practitioner, but Foreest left invasive and manipulative side treatments to surgeons, while claiming the right as a physician to organise the overall treatment of the patient.

During the profession's first decades, social workers tried to improve their clients’ financial capability (FC). This article describes the methods used by early social workers who attempted to enhance the FC of their clients, based on contemporary descriptions of their practice. Social workers initially emphasized thrift, later adding more sophisticated consideration of the cost of foods, rent, and other necessities. Social work efforts were furthered by home economists, who served as specialists in nutrition, clothing, interior design, and other topics related to homemaking. Early home economists included specialists in nutrition and family budgeting; these specialists worked with social services agencies to provide a financial basis for family budgets and assisted clients with family budgeting. Some agencies engaged home economists as consultants and as direct providers of instruction on home budgets for clients. By the 1930s, however, social work interest in family budget problems focused on the psychological meaning of low income to the client, rather than in measures to increase client FC. Consequently, social workers’ active engagement with family budget issues—engagement that characterized earlier decades—faded. These early efforts can inform contemporary practice as social workers are once again concerned about improving their clients’ FC.

Two hundred years ago the occupational boundaries between different medical practitioners were blurred and unspecified, with many practicing in several fields. However the 1815 Apothecaries Act had a major impact on both the emerging pharmaceutical and dental professions. The 1878 and 1921 Dentists Acts enabled pharmacists who did some dentistry to continue practicing dentistry. Changes proposed by the British Dental Association (BDA) resulted in the formation of a Chemists Dental Association in 1910 to defend the interests of this group, which continued in existence until 1951. This paper explores the changing relationship between chemists and dentists from the early nineteenth century through to the early twenty-first century. Sources used include the published work of both dental and pharmaceutical historians, documentary sources, and quotations from oral history interviews.

The objective of this study was to reconstruct the professional identity of the practicante (male assistant in medicine and surgery) by analyzing three professional journals of this collective in Zaragoza (Aragón). The discourse of practicantes on their profession insists that they were the only assistants for physicians with technical qualities. This affirmation constituted a key element in shaping their identity, contributing in turn to establish the moral and social legitimization of practicantes and their professional authority. This was constructed in counterpoint to the profile, qualifications and gender identity of the other professional healthcare assistant, the nurse. Despite achieving a clear discourse on their professional identity and developing certain professional infrastructures through the work of institutions and key figures, practicantes were not able to consolidate a collective project of upward social mobility that would improve their status and enhance social recognition of the profession. This led to the construction of a group identity that was largely characterized by apathy, frustration and disunion, elements that eventually weakened the profession.

The U.S. healthcare system is changing and is becoming more patient-centered and technology-supported, with greater emphasis on population health outcomes and team-based care. The roles of healthcare providers are changing, and new healthcare roles are developing such as that of the patient advocate. This article reviews the history of this type of role, the changes that have taken place over time, the technological innovations in service delivery that further enable the role, and how the role could increasingly be developed in the future. Logical future extensions of the current typical patient advocate are the appearance of a virtual or avatar-driven care navigator, using telemedicine and related information technologies, as healthcare provision moves increasingly in a hybrid direction, with care being given both in-person and online.

Objectives: To determine the percentage of pharmacists portrayed in a positive, negative, or neutral light in films and television shows available in the United States from January 1970 to July 2013. Secondary objectives were to evaluate pharmacist characters as heroes, villains, or victims; assess pharmacist characters' demographics; and determine the presence of pharmacist characters in medical-themed television shows., Design: Retrospective, observational, descriptive study., Setting: A review of available U.S. film and television from January 1970 to July 2013 at an academic institution., Participants: 214 television episodes or films that contained at least one pharmacist portrayal., Intervention: Electronic inquiries requesting submissions of known pharmacist portrayals were distributed to pharmacy professionals in national and state-affiliated pharmacy organizations and to faculty, staff, and students at the University of South Carolina. Electronic databases and search engines (Internet Movie Database [IMDb], Bing, and Google) were consulted and used to further research possible pharmacist portrayals. The study investigators developed an algorithm incorporating social norms, common pharmacist practices, and viewer perceptions to determine positive, negative, or neutral status for each pharmacist portrayal., Main Outcome Measures: Year and genre of media, demographics of identified pharmacist characters, portrayal status of identified pharmacist characters, and number of pharmacist characters and appearances per each television show reviewed., Results: In the films and television shows reviewed, there were 231 pharmacist portrayals, with 160 unique pharmacist characters. Of the 231 portrayals, 145 (63%) were negative, 30 (13%) were positive, and 56 (24%) were neutral. Of the 160 unique characters, 121 (76%) were male, 120 (75%) were Caucasian, and 86 (54%) were younger than 50 years old. The name of the character was provided for 70 (44%) of the pharmacists portrayed., Conclusion: The portrayal of pharmacists in U.S. film and television is primarily negative. Pharmacists and pharmacy organizations are encouraged to be vocal proponents of the profession and educate trainees on the importance of an enhanced public perception.

Hospitalists work in 90% of US hospitals with over 200 beds. With over 48,000 practicing hospitalists nationwide, the field of hospital medicine has grown rapidly in its 20 years of existence. Obstetrics and gynecology (OBGYN) hospitalists are uncovering similar drivers for their growth. Obstetricians cannot be in both the hospital and the office at the same time, they face an increased acuity of hospitalized patients demanding a full time presence, and hospitals are searching for physicians aligned with their goals. OBGYN hospitalists are at a similar point today at which hospital medicine was in the late 1990s., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The lives of the first women doctors in Britain have been well studied by historians, as have the many debates about the right of women to train and practice as doctors. Yet the relationship between these women and their most obvious comparators and competitors-the newly professionalized hospital nurses-has not been explored. This article makes use of a wide range of sources to explore the ways in which the first lady doctors created "clear water" between themselves and the nurses with whom they worked and trained. In doing so, it reveals an identity that may seem at odds with some of the clichés of Victorian femininity, namely that of the intelligent and ambitious lady doctor.

Adulterated and counterfeit drugs were pouring into the U.S. Providing poor medicines was a growing business, and the market was growing with the rapid expansion of the country itself. There seemed to be little that could be done to slow or stop it. The sophistication of the adulterations was superior to available tests, standards were lacking, and there were few trained pharmacists or physicians who could apply them. There were no laws that would prohibit the importation of these products nor limit their sale once ashore. This was the situation when a small group of New York pharmacists took it upon themselves to convince other health professionals and legislators that there was a problem and devised a solution that would establish patient safety as the core value of the emerging profession of pharmacy.

The three pieces in this section introduce the Festschrift celebrating the works and influence of Omega: Journal of Death and Dying's founding editor, Robert Kastenbaum. Robert Fulton, an early Associate Editor of the Journal begins with some personal reflections on Kastenbaum. Klass and Doka then describe the nature of the Festschrift. A closing coda by Robert Kastenbaum's wife, Beatrice Kastenbaum, reminds us of the person behind the work.

The article considers the main directions of formation of professional competence of pharmacist in XIX--early XX centuries. The study revealed six directions: development of normative documents to determine requirements to different aspects of pharmaceutical activities; establishment of requirements to professional education of pharmacists; organization of public control of activities of pharmaceutical organizations and pharmaceutical personnel, development of system of penalties for established infringements of laws and regulations concerning pharmacies; introduction of conduct listings; development of opinion of pharmaceutical community concerning the necessity of top level of education of pharmaceutical personnel and its public responsibility.

This article examines the professional roots of the hospital almoner, a position which has been widely neglected in medical history. The first almoner was Miss Mary Stewart, a former Charity Organization Society employee, appointed at the Royal Free Hospital of central London in 1895. The Royal Free was a charitable hospital which offered free medical treatment to patients considered morally deserving but unable to afford medical care elsewhere. The role expected of Stewart was to means test patients in order to ensure that only those deemed "appropriate" received free medical treatment, and to establish the extent to which the hospital was being abused by those who could afford to contribute toward their medical care. While in office, Stewart continually reshaped the role of almoner. She fashioned the position into that of a medical social worker and undertook such duties as referring patients to other means of medical and charitable assistance, visiting patients' homes, and training almoners for positions at other voluntary hospitals. Through the examination of Mary Stewart's Almoners Report Book, this article considers the circumstances of her appointment, the role she performed, and the findings of her investigations.

The author provides a brief overview of the papers given at the Schafer Symposium in October 2012 by the following six presenters: Henry Schwartz, Richard Fritsch, Rosemary Balsam, Lucy LaFarge, Michael Feldman, and Jay Greenberg. He also highlights some important ongoing themes in Schafer's writing, including theory-about which Schafer takes a unique position-history, and ideas from other disciplines. Schafer prefers continuing explorations over arriving at conclusions, the author notes, and believes that students should remain faithful to their mentors' thinking-until it is time for them to move beyond it., (© 2013 The Psychoanalytic Quarterly, Inc.)

The author discusses some of the characteristics of Roy Schafer's contributions to psychoanalysis that he finds most valuable, such as his openness to uncertainty, his anti-reductive view of analytic constructions, his unique formulation of the analyst's role, and his close attention to how the patient engenders particular emotional reactions in the analyst. The author also presents a clinical vignette illustrating the value of the analyst's tolerance of uncertainty in the face of the patient's push for interpretations, explanations, and reassurance., (© 2013 The Psychoanalytic Quarterly, Inc.)

The forensic pathologist has always had a central role in the identification of the dead in every day practice, in accidents, and in disasters involving hundreds or thousands of victims. This role has changed in recent years, as advances in forensic odontology, genetics and anthropology have improved the chances of identifying victims beyond recognition. According to the Interpol DVI Guide, fingerprints, dental examination and DNA are the primary identifiers, and this has given new emphasis to the role of the forensic pathologist as the leader of a multidisciplinary team of experts in a disaster situation, based on his or her qualifications and the experience gained from doing the same work in the everyday situation of an institute of forensic medicine.

Scholars researching and writing on the roles of pastor-caregivers in predominantly black congregations have done so using models originally designed to examine the roles of pastor-caregivers in primarily white churches. This study offers a revised model based on the historical development and present reality of black churches that more closely matches the historical and present roles of the black pastor who can trace his or her roots back to African spiritual traditions.

The British debate over midwife registration in the late 19th and early 20th centuries was highly gendered. Focusing on the period between the 1886 Medical Act and the 1902 Midwives Act, this article uses the content from the Lancet and the British Medical Journal, the two main general medical publications of the time, to explore the complex ways that gender works through other categories such as class and race to create professional identity. Specifically this article demonstrates how man-midwives used gendered language to help create identities for themselves, female midwives, and other rivals in order to legitimize their own professional identity and practice and to delegitimize the professional identities of their competition.

This is the biography of a deceased medical journal, the North American Medical and Surgical Journal, born in 1826 in Philadelphia. It was a publication of the Philadelphia Chapter of the Kappa Lambda Society. In the prospectus of the North American Medical and Surgical Journal the promoters observed that a well-conducted journal would achieve the object of elevating the medical profession to its legitimate rank which up to that time had been the recipient of low public opinion. The Journal hoped to inculcate 'a higher standard of excellence not merely in the professional or ministrative but also in the ethical relations and duties of physicians'. After several successful and productive years it passed into history in October 1831, the victim of financial difficulty.

Seeking to align psychiatric practice with general medicine following the inauguration of the National Health Service, psychiatric hospitals in post-war Britain deployed new treatments designed to induce somatic change, such as ECT, leucotomy and sedatives. Advocates of these treatments, often grouped together under the term 'physical therapies', expressed relief that the social problems encountered by patients could now be interpreted as symptomatic of underlying biological malfunction rather than as a cause of disorder that required treatment. Drawing on the British Journal of Psychiatric Social Work, this article analyses the critique articulated by psychiatric social workers based within hospitals who sought to facilitate the social reintegration of patients following treatment. It explores the development of 'psychiatric social treatment', an approach devised by psychiatric social workers to meet the needs of people with enduring mental health problems in hospital and community settings that sought to alleviate distress and improve social functioning by changing an individual's social environment and interpersonal relationships. 'Physical' and 'social' models of psychiatric treatment, this article argues, contested not only the aetiology of mental illness but also the nature of care, treatment and cure.