Beginnings of Public Health: Dispensaries
This chapter started with a section on dispensaries. I actually didn't know these existed -- they began in the late 18th century and were "medical soup kitchens," aka provided free medical care. Physicians worked their either to gain experience or used it as places to teach medical students. Some private practitioners opposed the growth of dispensaries because it "took away" paying patients. Although, it is not known if this "dispensary abuse" was as widespread as private doctors claimed, most likely it seems to me that most patients were actually poor individuals who couldn't pay for health services.
Unfortunately, some dispensaries did abuse their patients. Many patients were forced to wait hours in crowded rooms for services only to be met with grumpy physicians who offered quick, haphazard care. Besides this controversy, a majority of controversy surrounding dispensaries came from two types of doctors: affluent doctors who wanted no limits on dispensary use to use for teaching and "economically insecure" physicians who thought dispensaries took away paying patients.
In the end, dispensaries faded away due to varying reasons.
Health Departments
The next part of this chapter centers around Health Departments. Around the beginning of the 20th century, a major change occurred in public health. Public health individuals began to change focus from environmental factors to individual factors that effected health. Health departments were created because they provided venues individuals could research different factors that effected individual health and venues to treat individual health factors.
The first local and state health departments began post-Civil War when there was proliferation of epidemics of yellow fever and cholera. Besides the creation of the National Board of Health in 1879, which was later disbanded, public health has mostly been run by state or local governments. Health departments offered many innovations to medicine. First, diagnostic bacteriological laboratories were created. These labs provided physicians with tools that accurately diagnosed several diseases. Second, these labs created "serums" that could be used as cures to certain diseases. Unfortunately, many private physicians and chemists were against distribution of serums because it allowed for "unfair competition with private businesses." In the end, health departments stopped advertising and selling serums, but did distribute them to doctors for patients.
School health services also popularized at this time. Bacteriology proved that individuals could be treated for contagious diseases and could be taught to prevent spreading such diseases. Thus, different schools began hiring health investigators to identify sick children and offer treatment. Later on, nurses were utilized. Eventually, these health programs became a permanent part of schools.
"Dirt"
Starr goes on to discuss the changed view of "dirt" in Public Health. Before the 20th century, there were broad, general ways of dealing with dirt and how it effected disease. Large scale fumigations, etc. were popular. Slowly, as more information about how diseases are spread, etc. more narrow techniques or interventions were employed. Charles V. Chapin, health commissioner in Providence, RI, headed this innovative movement. Chapin supported using such techniques as washing hands, effectively "removing adenoids," etc. to help prevent disease.
The Three Phases of Public Health
This innovation was identified as the third phase in public health by C.E.A. Winslow: the first phase was from 1840-90, when there was widespread "empirical environmental sanitation;" the second phase was from 1890-1910, when bacteriology first surfaced and emphasis on isolation and disinfection was popular; finally, this "new public health" emphasized 'education in personal hygiene and the use of the physician as a real force in prevention;"
Thus, at this time, there was also an icnrease in individual health examinations. Physicians began focusing more on finding diseases early or finding ways to prevent them altogether. Insurance companies even stated that there was a reduction in mortality rates due to preventive examinations. Some campaigns were even launched to support exams, such as "Have a Health Examination on Your Birthday."
Health Centers
The final section of this chapter focuses on the "prevention of health centers." The health center movement started in the 1910's. At this time, many public health heads wanted to create health centers where all types of services would be provided: labs, x-rays, medical exams, etc. Hermann Biggs, one supporter, stated these centers could even solve the problems concerned with the lack of physicians in rural areas. Although, many physician societies opposed the creation of such centers. They believed that too much power would be given to Health Boards and not to physicians. Thus, health centers never really came into existence.
Although, as Starr states, this vehement support to withdraw government intervention is popular throughout many American professional fields. "It was a cardinal principle in America that the state should not compete with private business." More specifically to medicine, one NC county supervisor said, "You had to promise that you were going to do no curative medicine at all before you could set up a country health department." -- In other words, physicians wanted to make sure these dept centers would not take away their work.
The Golden Age
Starr concludes this chapter by stating that, despite such controversies, this time seems to be the "golden age" of public health history. There was a constant snowball of discoveries in the field at this time ranging from bacteriology, to creation of health departments. On a less optimistic note, this time also proved that public health would always be "relegated to a secondary status: less preestigious than clinical medicine, less amply financed, and blocked from assuming the higher level functions of coordination and direction that might have developed had it not been banished from medical care."
My Thoughts & Questions
After reading this ending note, I wanted to actually see what the differences in public health and medicine are. I found the following website: Public Health vs. Medicine from the Stony Brook University Medical Center website.
One interesting difference
- Public Health: Biologic sciences central, stimulated by major threats to health of populations; move between laboratory and field
- Medicine: Biologic sciences central, stimulated by need of patients;move between laboratory and bedside
But, the reason I use this example is the difference in which members of each field "move between." Public health is between the lab and field, while medicine is between the lab and bedside. Perhaps, one reason why public health is always "secondary" because public health individuals do not directly work with the patient. Of course, public health researchers have provided a multitude of preventive means for people, but, in the end, it is always the doctor patients go to to treat illnesses. The aid doctors provides give immediate, visible results, while public health individuals provide more long term aid. This small difference may make a world of difference.
But, this is just a thought. Many people appreciate both physicians and public health individuals for their work. Unfortunately, in life there is always competition for who or what will be "first."
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