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St. Mary's Hospital Medical School: An Historical Anthology



AIMS AND OBJECTIVES: To challenge statements made about 'Careful Nursing' as a 'distinctive system' of nursing established by the Irish Sisters of Mercy, prior to Florence Nightingale, and which is said to have influenced her. BACKGROUND: Numerous publications have appeared claiming the emergence of a 'distinctive system' of nursing as 'Ireland's legacy to nursing', which, it is claimed, influenced Nightingale's system. One paper argues that the Irish system has its philosophical roots in Thomist philosophy. Several papers argue the ongoing relevance of the Irish system, not Nightingale's, for contemporary nursing theory and practice. Nightingale's influence on and legacy to Irish nursing are not acknowledged. DESIGN: A Discursive paper. METHODS: Archival and published sources were used to compare the nursing systems of Florence Nightingale and the Irish Sisters of Mercy, with particular attention to nursing during the Crimean War. RESULTS: Claims were challenged of a 'distinctive system' of nursing established by the Irish Sisters of Mercy in the early nineteenth century, and of its stated influence on the nursing system of Florence Nightingale. The contention of great medical satisfaction with the 'distinctive' system is refuted with data showing that the death rate at the Koulali Hospital, where the Irish sisters nursed, was the highest of all the British war hospitals during the Crimean War. Profound differences between the two systems are outlined. CONCLUSIONS: Claims for a 'distinctive' Irish system of nursing fail for lack of evidence. Nightingale's principles and methods, as they evolved over the first decade of her school's work, remain central to nursing theory and practice. RELEVANCE TO CLINICAL PRACTICE: Nightingale's insistence on respect for patients and high ethical standards remains relevant to practice no less so as specific practices change with advances in medical knowledge and practice.




St. Mary's hospital medical school: An historical anthology



OBJECTIVES: The first of two articles is to show how Florence Nightingale became a leading, effective hospital reformer. AIM: The aim of the first paper is to relate how Nightingale was influenced by the great defects in the war hospitals of the Crimean War (1854-1856) and how she learned the lessons from those defects to set a different course. The article shows how her famous Notes on Nursing is a positive treatment of the lessons learned, turning the sanitary defects, notably in ventilation, into chapters of the book. The importance of the pavilion model of hospital design is highlighted. There is coverage of the advances made by Semmelweis at the Vienna General Hospital. METHODS: This is a purely historical study drawing on the extensive publications by Nightingale, augmented by her (massive) surviving correspondence and notes. The search for archival materials was done for the publication of the 16-volume Collected Works of Florence Nightingale, written by the author of this article. The collected works was peer reviewed, and the research process succeeded in locating material in more than 200 archives worldwide.


The medical technology program was in full swing, and especially busy after a Blood Bank opened at Bender Laboratory and made its services available to the Albany chapter of the American Red Cross for collection of blood for the armed services. With 100 pints of blood collected each week as well as pathology tests for various area hospitals, there was plenty of work for the med tech students who spent their junior year at Bender lab.


During graduation ceremonies, Rudolph H. Blythe '31, Pharm.D., received an honorary Doctor of Science degree recognizing his pioneering work on the timed-release capsule, as did Donald Brodie, a nationally recognized hospital pharmacy administrator and educator, and William Helfand. An exhibit of Helfand's comprehensive collection of 19 th century pharmacy and medical poster art was exhibited that fall at the New York State Museum in honor of ACP's Centennial.


There were a number of important developments in addition to the seven crucial ones outlined above: the model of bedside teaching developed by Boerhaave at Leyden about 1700; the development of precision instruments such as the thermometer, microscope, ophthalmoscope, kymograph, and sphygmomanometer; and the discovery of the x-ray. The urban migration in Europe in the late 1700s and early 1800s, coupled with the development of the French hospital system, made available to physicians a concentration of human illness never seen before. The ascendance of the German and American university had a profound influence on medicine. Once again, the genius of William Osler wove all these threads into the fabric that established clinical diagnosis and medical education as it exists today.


Another vital development was the rise of the hospital; this did not occur until the nineteenth century. Greek physicians focused upon the individual sickbed. Libraries were the focus of medicine during the Middle Ages. The bedside was the center of attention during the seventeenth century, as Boerhaave taught in his 12-bed ward at Leyden. The nineteenth century was the century of the hospital. The tens of thousands of peasants who streamed into the capitals of Europe with the coming of the Industrial Revolution became sick with a host of acute infectious and chronic diseases. Tuberculosis and typhoid fever were especially prevalent, and attracted the interest of physicians and lay-people alike during this period. The émigrés from the farms to the cities were without urban roots or families, and consequently, when they became ill, the hospital was the only place to go. The wards of the overcrowded hospitals provided clinical material in unprecedented quantity to the physicians of the period. Physicians could apply for the type of cases they wanted to see. Whereas Boerhaave's clinic had 12 beds, Bouillaud boasted of having seen 25,000 cases in 5 years (Ackerknecht, 1968). In 1830 Paris had 30 hospitals containing 20,000 patients. The Hôtel-Dieu alone had 1000 beds. There were 5000 medical students. The political climate was favorable: Napoleon liked and encouraged physicians. Corvisart, the most influential physician of the period, was Napoleon's personal physician.


Germany's rise to scientific preeminence was made possible by the nature of the German university. There were 20 or more universities throughout the country, and nothing like them existed outside Germany. Science, including medicine, existed side by side with all other disciplines. By way of contrast, in England medicine was centered in the London hospital schools, separate from the universities. The organization of the German university was ideally suited for furthering scientific research, including medical research. The German university had freedom, flexible organization, well-provided laboratories, and a free-flowing spirit of inquiry, all of which allowed Germany to become the undisputed center of scientific medicine (Ludmerer, 1985). Germany had achieved preeminence in other areas: the social sciences, philosophy, linguistics, literary criticism. This was in startling contrast to the Germany of the eighteenth century, where higher learning was dominated by a philosophic system termed Naturphilosophie, a romantic philosophy of nature characterized by extensive speculations on the essence of life and disease.


Stoeckle and Billings have surveyed the history of the medical interview in the United States since the beginning of the twentieth century. Inferences about the history can be obtained from hospital records. Examples from Richard Cabot's Case Teaching in Medicine 1905 illustrate detailed histories, with one or two lines regarding the patient's social circumstances (Stoeckle and Billings, 1987). From 1900 to the 1940s in the United States, as well as elsewhere, there were no instructional texts on history taking. Teaching was by senior physicians acting as role models at the bedside. With rare exceptions, there were no verbatim accounts of the history, and students themselves were rarely if ever actually observed or critiqued doing a history. Didactic material on what to ask was found, albeit sparsely, in physical diagnosis texts and manuals on the physical examination. Questions given as examples were highly specific: "Have you ever had tuberculosis?" There was circumscribed attention to social circumstances.


The University of Pennsylvania medical school underwent similar reforms in 1877, followed closely by the University of Michigan. The reforms in these three schools set the stage for the most extraordinary development of all: the opening of the Johns Hopkins Medical School in 1893. This new medical school embodied astonishing innovations from its inception: strict admission requirements for students; two years of rigorous basic science training with plentiful laboratory experience; two years of clinical experience at the hospital bedside; a faculty chosen solely for their teaching and research ability; a view that research was one of its high priorities.


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