For Patients of Moderate Means

For Patients of Moderate Means: A Social History of the Voluntary Public General Hospital in Canada, 1890-1950

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    For Patients of Moderate Means
    Book Description:

    The Great Depression, however, finally exhausted the average patient's ability to pay and engendered a national health-care crisis. A public hospital insurance scheme was first achieved in Saskatchewan in 1947 and nationally in 1957. Universal accessibility without fear of the financial consequences of hospitalization reflected concern for both the medical health of Canadians unable to pay for hospital care, and the economic health of the paying ‘patient of moderate means' threatened with medical pauperization. It also provided the resources necessary to address the modern epidemic of lifestyle diseases and to accommodate the demands of the post-war therapeutic revolution. Employing the historical records of selected individual hospitals, reports and data from all levels of government, a wide range of professional medical, nursing, hospital, and public health journals, and the international historiography of hospital history, David and Rosemary Gagan describe and account for the invention, rise, decline, and rebirth of the modern Canadian hospital between 1890 and 1950. They pay particular attention to the evolving interdependence of doctors and hospitals in the struggle to legitimate the social and cultural authority of scientific medicine, the evolution of hospital-based nursing, and the experiences of patients.

    eISBN: 978-0-7735-7058-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-2)
    D.P.G. and R.P.G.
  4. History and the Hospital
    (pp. 3-12)

    In the last twenty-five years, historians have substantially remapped the landscape of Canadian social history. Their inquiries have identified in particular the high ground of change and continuity in the social history of late nineteenth- and early twentieth-century Canada: the role of industrialization, immigration, and urbanization in redefining the essential context of social experience; the emergence of the working class; the changing role of the family in society; the reinterpretation of childhood and adolescence and their association with formal education; the successes and failures of movements of social and moral reform; the impact of first-wave feminism; the interplay of religion,...

  5. 1 Hospital Fever
    (pp. 13-41)

    The nineteenth-century general hospital was a medically marginal but socially essential agency of voluntary charity. Sustained by private benevolence and government grants, the hospital provided indoor, largely custodial, care for sick indigents. Their dependent and submissive relationship with hospitals characterized them as inmates, not patients, the subjects equally of medical and public curiosity and of social stigmatization, because they both required and accepted confinement in an institution, and the care of strangers, that no “respectable” citizen would endure. Hospitals were associated with the most repugnant circumstances of disease and death. Respectable Canadians received medical treatment, and convalesced, at home in...

  6. 2 A Factory for the Production of Health
    (pp. 42-70)

    As the demand for hospitalization escalated, boards of established hospitals scrambled to provide greater patient accessibility. Communities without public hospitals struggled to acquire them. In both cases the pressures were similar. Medical specialism in general, and surgery in particular, sources of the new hospitalism, required up-to-date facilities, equipment, diagnostic services, and standards of care consistent with their therapeutic mission. The middle and upper classes, whose newly discovered willingness to enter hospital when sick had launched the revolution, and whose ability to pay for care and treatment had largely financed it, demanded, as one hospital’s publicity put it, “All the Comforts...

  7. 3 For “Patients of Moderate Means”
    (pp. 71-97)

    The hospital standardization movement in the early 1920s was the culmination of a quarter century of intense institutional development driven by the interplay of patient demand, scientific and technological innovation, professional self-interest, and social utilitarianism. Standardization was intended to signal the triumph of scientific health care – and the demise of the Victorian charitable hospital – by giving accredited hospitals an objectively verifiable stamp of approval for their organizational efficiency, professional accountability, and medical authority. What remained unresolved was the question of how to sustain, and more widely disseminate, the new standard in the face of the growing dependence of health, in...

  8. 4 Camp Followers of the Army of Science
    (pp. 98-128)

    The emergence and subsequent development of the modern Canadian hospital were influenced by many forces, not least of which were the interactions of governors, administrators, doctors, nurses, and patients whose respective experiences reflected evolving hospital culture. The role of the medical profession, as it pursued its own path from its status as a marginalized trade in the nineteenth century to being respected as a profession at the leading edge of basic and applied science by the middle of the twentieth century, was particularly critical. General hospitals began to develop their modern form when “scientific” medicine, the political and economic interests...

  9. 5 “Better, Brighter and Kinder Nurses”
    (pp. 129-157)

    Modern hospital care is synonymous with the presence of the professional nurse as principal caregiver and as the intermediary between physician and patient. Since the 1880s nursing science has been inseparable from the purpose and the promise of hospital-centred medical science. Yet, hospitals were not always essential to nursing as a career except for their monopoly over recruitment into and training for the profession, a monopoly that they constantly exploited to their own advantage. Before World War One, private nursing in the home or the hospital, not hospital ward duty, was by choice or necessity the business of approximately two-thirds...

  10. 6 Mrs Jones and Mr Grant
    (pp. 158-179)

    The purpose of the hospital is to heal the sick. How well hospitals succeed in producing health is the ultimate test of their efficiency. But there are no reliable measurements of hospitals’ success in the early twentieth century. Hospital boards filled annual reports with detailed tables on income, expenditures, admissions and discharges, surgical procedures performed, hospital morbidity and mortality, the duration of patient stays, the demographic characteristics of patient populations, and the numbers of student nurses trained. These same data were then retailed in annual provincial government reports that comparatively assessed hospital productivity relative to capacity, income, and operating costs...

  11. Health Care Déjà Vu
    (pp. 180-188)

    In the interval between Mackenzie King’s first abortive postwar attempt to introduce national health insurance and the promulgation, in 1957, of the federal government’sHospital Insurance and Diagnostic Services Act, Canada’s inventory of general hospitals grew by 58 per cent. The number of patient days provided annually by these 750 hospitals increased by two-thirds; but the cost of providing them leapt by 185 per cent, while yearly total general hospital expenditures increased by nearly 400 per cent. In the hospital insurance scheme’s first year of operation under provincial legislation, hospital expenditures nationally were inflated by 30 per cent.¹ A decade...

  12. Appendices
    (pp. 189-206)
  13. Notes
    (pp. 207-242)
  14. Bibliography
    (pp. 243-258)
  15. Index
    (pp. 259-268)