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1 Access to healthcare, 1880–1930

The late nineteenth and early twentieth centuries have often been described as a period of progress, when the poorer classes gained access to a whole range of medical services previously reserved for the wealthy. In the past, this opening up of care was largely attributed to the state. Across Europe, central and local governments created health insurance schemes and new welfare services to provide the poor with access to care, from general practitioners (GPs) to outpatient and hospital care,
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Learning outcomes

After studying this unit, you should be able to do the following:

  • describe the wide range of methods of promoting health, preventing disease and providing care that were available to patients of different social groups and classes;

  • be aware of the inequalities of services – in terms of both quality of care and access to different services – open to different social groups and classes;

  • assess the significance of the roles of central and local gov
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Acknowledgements

This unit was written by Dr Debbie Brunton

The material acknowledged below is Proprietary (see terms and conditions) and is used under licence.

The extracts adapted for OpenLearn appear in full in Medicine Transformed: Health, Disease and Society in Europe 1800–1930 (ed Deborah Brunton), published by Ma
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References

Adair, R., Forsythe, B. and Melling, J. (1997) ‘Migration, family structure and pauper lunacy in Victorian England: admissions to the Devon County Pauper Lunatic Asylum, 1845–1900’, Continuity and Change, vol.12, no.3, pp.373–401.
Adair, R., Forsythe, B. and Melling, J. (1998) ‘A danger to the public? Disposing of pauper lunatics in late-Victorian and Edwardian England: Plympton St Mary Union and the
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4.5 Section summary

This section has given some of the sense of how historians work – by developing explanations of historical events, which are in turn challenged by new research that re-examines these ideas. In the case of the nineteenth-century asylum, much of the research carried out since the 1980s is based on new sources and detailed case studies which test old explanations for the timing and causes of the growth of asylums. In part, this reflects a trend in other areas of medical history and in the broa
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4.4 Outside the asylum walls: limits to the primacy of the asylum as a solution

Although historians have written about the asylum as the only response to insanity, there was in fact a widely used alternative. Boarding-out, or ‘family care’ of the insane, offered a genuine alternative to asylumdom. The exact form of boarding-out differed from one national and regional context to another, but basically it supported patients within domestic and often rural settings, generally with guardians or relatives in single dwellings and cottages. The practice had long been
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4.2 Social factors in the growth of the asylum: industrialisation, urbanisation and migration

Many historians link the rise of the asylum with the huge social changes of the nineteenth century. Some link the rise to industrialisation and urbanisation, pointing to the fact that asylums grew up in industrial regions and large cities. Frank Rice, for example, argues that in Scotland the great majority of asylums grew up if not within urban centres, then at least servicing urbanised communities, in the central belt of Scotland (Author(s): The Open University

4.1 Introduction

In the nineteenth century, the asylum became – as never before – the accepted place for the care and treatment of insanity. Until that time, people suffering from mental disorders were mostly cared for at home. Of the few institutions that offered care, most were rather small. They were funded by a combination of fees charged to patients and charitable donations or subscriptions. From the early nineteenth century, the number of asylums increased all over Europe as governments accepted a r
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3.4 War and women in medicine

Until 1914, the number of women attending medical schools grew slowly (Figure 4). In Britain, even after the 1876 Enabling Act allowed medical examining boards to grant licences to women, universities could still legally exclude women from their medical schools. By
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3.3 The reasons for – and emergence of – women working in medicine

Why in the face of such resistance did women wish to become doctors at all? Until recently, many authors have argued that women pursued a medical career as a form of service and for altruistic reasons. Women doctors claimed to be serving the public (one of the features of a profession) by preserving the modesty of women patients and ending their suffering at the hands of male doctors who did not understand the female body. This idea of women being called to serve for the betterment of others
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3.1 Introduction

Women have always cared for the sick. They have nursed family members within the home and worked as nurses, healers and midwives within the community. In the eighteenth century, a few women worked as ‘doctresses’ and ‘surgeonesses’, having received some form of training similar to male practitioners. However, when formal medical training began to be developed in hospitals and medical schools in the early nineteenth century, women were not admitted. Thus they were excluded from the ran
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2.2 Unity and conflict

In the nineteenth century, licensing reform and developments in medical education brought a new unity to the profession. Students had a similar education, trained in large groups and developed a strong sense of allegiance to their institutions and to their teachers (see
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2.1 Introduction

In the late eighteenth and nineteenth centuries, fundamental and sweeping changes took place in medical training and practice. Apprenticeships, which were once the most common form of medical training, gradually disappeared, and a university education became the norm for all practitioners. Responsibility for licensing practitioners shifted from the old medical guilds and colleges to the state and then back into the hands of medical men. The last remnants of the division of practitioners into
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1.2 The laboratory in diagnosis

Different fields of laboratory research offered a range of new diagnostic techniques. Bacteriological research into the identity of disease-causing microorganisms provided practitioners with a new and accurate means of diagnosing cases of infectious disease. By the 1890s, specimens from patients suspected of suffering from tuberculosis or diphtheria were routinely cultured to confirm a diagnosis made on the basis of symptoms (Worboys, 2000, pp. 211–16, 252–7). Laboratory equipment used to
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1.1 Transforming practice

‘Laboratory medicine’ represented a fundamental shift away from the established view of the body and disease. Where hospital medicine saw disease as a collection of symptoms in life, which related to changes in body structure discovered at post-mortem examination, laboratory medicine sought to explain the structure of the body at the cellular level and to describe its function as a complex series of dynamic processes. Within this medical cosmology, the laboratory usurped the hospital as t
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3.2 Negative freedom

The concept of negative freedom centres on freedom from interference. This type of account of freedom is usually put forward in response to the following sort of question:

What is the area within which the subject – a person or group of persons – is or should be left to do or be what he is able to do or be, without interference by other persons?

(Berlin (1969), pp. 121–2; see, p. 155)


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3.1 Preamble

In a ground-breaking lecture, the philosopher and historian of ideas Isaiah Berlin (1909–97) argued that there are two basic types of freedom which have been defended by philosophers and political theorists: negative freedom and positive freedom. Within each category there is scope for quite a wide range of positions; but most theories of freedom fit quite comfortably into one category or the other.

Berlin's article is important for three reasons. First, it provides a us
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6.4 Recasting the Turkish identity

There was a similar ambivalence towards the Turks in music. The plots of eighteenth-century ‘Turkish’ operas had represented Turks as both unenlightened barbarians and enlightened humanitarians. Rameau’s The Courtly Indies (1735), for instance, encompasses four tales of love, the first of which, entitled The Generous Turk, is set in Turkey. It features a magnanimous pasha – a convention followed in two works both generally known as The Unexpected Encounter, Gluck
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6.1 Oriental literature

As part of this section you will be studying the material in a video, Eugene Delacroix: The Moroccan Journey. Before doing this, however, it will be useful to look at some of the factors that affected his treatment of the Oriental and the exotic in art. His choice of the Sardanapalus theme, for example, was probably the result of a complex web of cultural influences that acquired new significance in the context of French Romanticism. In many respects, Delacroix’s conception of the Or
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5.6.3 Honeymoons

Image 65 Photographer/Painter: Alfred Pettit, Keswick. Subject: Ben Naylor and his new wife Carrie, née Birchall, on their honeymooon in the Lake District, c.1880.<
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