Maligned by the public and manipulated by politicians, today's city hospitals often cannot keep pace with the rising costs of medical technology. But while the urban landscape decays around them and city officials debate their continued existence, these institutions provide primary care for many of the nation's poor, and technically advanced care for some. They also serve as training grounds for many health professionals. How city hospitals have progressed so far, only to face such an uncertain future, is the subject of this clearly written and meticulously researched history.
Drawing on his personal experience as a physician and administrator, Harry F. Dowling shows that many problems facing city hospitals in the 1980s can be traced to their bleak beginnings as adjuncts to the poorhouse. Occasionally they provided satisfactory custodial care for the indigent sick, along with medical treatment comparable to the best private hospitals; more often their wards were scantily staffed with incompetent, careless attendants and characterized by filth, overcrowding, and epidemics that turned hospitals into death houses. Dr. Dowling describes how the gradual affiliation of city hospitals with medical schools, as well as the professionalization of nursing and administration, brought about the transition from almshouse to modern medical center. But by the 1960s deteriorating buildings and dwindling budgets again raised questions about the city hospital's role in today's medical establishment.
This book discusses a number of issues that will have a direct bearing on the future viability of these hospitals. Of particular significance will be their willingness to respond creatively to the needs of the surrounding community through emphasis on preventive medicine, family services, and care of the chronically ill.
Cleansing the City: Sanitary Geographies in Victorian Londonexplores not only the challenges faced by reformers as they strove toclean up an increasingly filthy city but the resistance to their efforts.Beginning in the 1830s, reform-minded citizens, under the banner of sanitaryimprovement, plunged into London’s dark and dirty spaces and returned withthe material they needed to promote public health legislation and magnificentprojects of sanitary engineering. Sanitary reform, however, was not alwaysmet with unqualified enthusiasm. While some improvements, such as slumclearances, the development of sewerage, and the embankment of the Thames,may have made London a cleaner place to live, these projects also destroyedand reshaped the built environment, and in doing so, altered the meanings andexperiences of the city.
From the novels of Charles Dickens and George Gissing to anonymous magazinearticles and pamphlets, resistance to reform found expression in the nostalgicappreciation of a threatened urban landscape and anxiety about domestic autonomyin an era of networked sanitary services. Cleansing the City emphasizes the disruptions and disorientation occasioned by purification—a process we are generally inclined to see as positive. By recovering these sometimes oppositional, sometimes ambivalent responses, Michelle Allen elevates a significant undercurrent of Victorian thought into the mainstream and thus provides insight into the contested nature of sanitary modernization.
Health and Community Design is a comprehensive examination of how the built environment encourages or discourages physical activity, drawing together insights from a range of research on the relationships between urban form and public health. It provides important information about the factors that influence decisions about physical activity and modes of travel, and about how land use patterns can be changed to help overcome barriers to physical activity. Chapters examine:
Between 1850 and 1900, Milwaukee’s rapid population growth also gave rise to high death rates, infectious diseases, crowded housing, filthy streets, inadequate water supplies, and incredible stench. The Healthiest City shows how a coalition of reform groups brought about community education and municipal action to achieve for Milwaukee the title of “the healthiest city” by the 1930s. This highly praised book reminds us that cutting funds and regulations for preserving public health results in inconvenience, illness, and even death.
“A major work. . . . Leavitt focuses on three illustrative issues—smallpox, garbage, and milk, representing the larger areas of infectious disease, sanitation, and food control.”—Norman Gevitz, Journal of the American Medical Association
“Leavitt’s research provides additional evidence . . . that improvements in sanitation, living conditions, and diet contributed more to the overall decline in mortality rates than advances in medical practice. . . . A solid contribution to the history of urban reform politics and public health.”—Jo Ann Carrigan, Journal of American History
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