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Wed 12 April
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Thu 13 April
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Fri 14 April
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Sat 15 April
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Saturday 15 April 2023 08.30 - 10.30
R-13 HEA13 Cross-comparative Perspectives in Health Care History
E45
Network: Health and Environment Chair: Maria Heidegger
Organizers: - Discussants: -
Sören Edvinsson, Johan Junkka & Erling Häggström Lundevaller & Lotta Vikström : Disability Risks in Past Populations: Sweden from the 1800s until 1959
While the determinants of diseases and epidemics have been considerably studied in contemporary and past populations, there is poor knowledge about disability in history and the risks for getting it. Similar to many illnesses, some of which can cause disabilities, disabilities increase with growing age and are more common in ... (Show more)
While the determinants of diseases and epidemics have been considerably studied in contemporary and past populations, there is poor knowledge about disability in history and the risks for getting it. Similar to many illnesses, some of which can cause disabilities, disabilities increase with growing age and are more common in elderly groups. This notion probably holds for past population as well, but it remains unknown whether also other groups experienced higher risks for disability depending on age or sex or type of work, for example, and changes in these risks over time and between groups. Our study aims to identify the disability risks in Swedish populations from the 1800s up until 1959. The results not only uncover differences over time, but also differentiate the risks by sex, age, occupational status and even disability types.
Our study makes use of micro data from parish registers digitized by the Demographic Data Base (DDB), Centre for Demographic and Ageing Research (CEDAR), Umeå University. In these registers, the ministers reported socio-demographic characteristics and events on all parishioners from birth until death, even on impairments (lyten) regarded as disabling at the time. Governed by Statistics Sweden, ministers were to report disabilities to inform national authorities about the health status in the population. Our data covers two study populations in Sweden, i.e. from the Sundsvall region in the 1800s and Västerbotten region 1900–1959. The former includes c. 36,500 individuals out of whom c. 550 had some kind of disability reported during their lifetime, while the 1900–1959 population includes c. 194,500 individuals out of whom c. 4,700 had disabilities similarly reported. We use Cox proportional regression models to estimate the disability risks (hazard ratios) over time by sex, age, occupational status and by disability types (sensory, physical, mental). This enables us identify disability risks associated with a) socio-demographic characteristics of individuals/groups (e.g. age, sex); b) their behavior (e.g. working life, lifestyle); c) their environment given the specific time-space context they lived in (e.g. agricultural, urban-industrial setting, 1800s, 1900s). As our data provide information on the individuals’ biological parents and their disabilities, we can even estimate risks due to genetic origin, as some disabilities are transferred across generations.
Our study is unique in showing long-term results on groups in populations that were at higher risk for disability than others in a society in change. Back in the 1800s, Sweden was one of the poorest countries in Europe predominated by agricultural production. From the late 1800s onwards, urban-industrial processes, rapid economic growth and improvements in public health care and service systems contributed to make Sweden internationally known as a modern welfare state in the latter part of the 1900s. In the early welfare era, however, disabled citizens were increasingly confined to institutions for treatment. That such societal concerns increased the risk for disability, or the labeling of it, we see evidence of in our data. (Show less)

Ceren Gülser Ilikan Rasimoglu : The Debates on Turkish Medicine and Medical Competency in the Early Republican Turkey
This study analyzes the debate that was set off following the sudden postoperative death of the minister of education, Mustafa Necati (1894-1929), two months after the proclamation of Latin scripts as replacement of the Arabic ones, and on the same day in which the schools of nations, designated primarily to ... (Show more)
This study analyzes the debate that was set off following the sudden postoperative death of the minister of education, Mustafa Necati (1894-1929), two months after the proclamation of Latin scripts as replacement of the Arabic ones, and on the same day in which the schools of nations, designated primarily to teach the adults to read and write in these scripts, were introduced to the service of the public. The death of the minister, causing deep sorrow and great surprise, provoked a vivid debate and problematization of the competency of a group of doctors in Ankara, the capital city of Turkey. This debate was reflected in the prominent newspapers of the period, and revealed the controversies between the columnists and doctors, which in turn revived major sensitivities of the republican elites in nation-building processes.
Based on the columns and news published on two newspapers, Cumhuriyet, the state-driven one, whose editor-in chief was Yunus Nadi, a prominent intellectual, and Vakit, owned by a deputee, Hakki Tarik (Us), and whose editor-in chief was Mehmet Asim (Us), his brother; the presentation focuses on two main aspects that this debate reveals: the professional identity formation of the doctors based on the sacrificial medical ethos; and the making of Ankara as a symbol of the new regime as opposed to Istanbul, the former capital of the Ottoman Empire.
The debate was sustained in three axes: Between the doctors and the columnists about the alleged malpractice of the doctors in Ankara, between Hakki Tarik / Mehmet Asim and Refik Saydam, the minister of health about the necessity of a faculty of medicine in the capital in addition to the existing one in Istanbul, and finally between the doctors within and outside the faculty of medicine about the assertion that the professors of the faulty neglected their duties at the expense of their private clinics. The presentation will argue that both the Istanbul and Ankara doctors referred to the idea of self-sacrifice, in both practice and education of medicine, which united them under one body of "Turkish medicine," as a response to the offenses. (Show less)

Ulrika Lagerlöf Nilsson : The Eternal Question of Older People’s Right to Health and Care. The Emergence, Development and Restriction of Geriatric Care in Sweden during the 20th Century
According to a forecast by the UN, the global population aged 60 or over is growing faster than all younger age groups. Within that large age-stratum the group of frail older people in greatest need of care and health care, is growing the fastest. At the same time, geriatrics is ... (Show more)
According to a forecast by the UN, the global population aged 60 or over is growing faster than all younger age groups. Within that large age-stratum the group of frail older people in greatest need of care and health care, is growing the fastest. At the same time, geriatrics is a low priority medical specialty challenged by lack of resources and fewer medical professionals willing to work in the field. Moreover, although investments in health care and the care of older people can save money on a macro-economic level, geriatrics is today exposed to rationalization attempts.
Sweden has long been presented as the ideal welfare state where a high taxation successfully has generated guaranteed health care, not least in the late stages of life. In the light of geriatric care being renegotiated and even threatened by rationalizations, we must ask ourselves how such a development became possible. To understand the present discourse’s low recognition of the societal gains associated with investments in geriatric care, it is essential to explore under which conditions this medical specialty came about.
Why did it last until the late 1960s before geriatrics became a medical specialty in Sweden? To what extent was the development in Sweden affected by the one that had occurred much earlier in US and UK where geriatric as a medical specialty was founded during the 1940s? What was seen as beneficial respectively troublesome in honoring geriatrics in Sweden the status of a medical specialty? One basic assumption is that the historically strong societal view of ageing as something normal (not sick) always risks becoming the restricting basis for which health care resources should be added to the group of patients framed by geriatrics. In addition, this paper will discuss a possible struggle within the medical profession to set and control boundaries of already established medical specialties. To increase our understanding for the present’s ethical, social and economy challenges of geriatrics, we need to go back in time to see how these were dealt with when the specialty was founded. (Show less)

Helene Laurent, Anu Huttunen : Trapped in Hospital. The Life Course of Refugee Psychiatric Patients in Finland after WWII
The war in Ukraine has again lifted in the forefront the hardships of civilian population during a military conflict. The most vulnerable groups in the society are usually the hardest hit. It is known that during WWII in Finland the mortality of psychiatric hospital patients doubled, mostly due to evacuations, ... (Show more)
The war in Ukraine has again lifted in the forefront the hardships of civilian population during a military conflict. The most vulnerable groups in the society are usually the hardest hit. It is known that during WWII in Finland the mortality of psychiatric hospital patients doubled, mostly due to evacuations, crowding, infectious disease but also due to actual hunger.
This paper examines the life history of psychiatric patients who were placed in the Rauha psychiatric hospital as refugees from the ceded parts of Finland during and after WWII. It is part of an ongoing research project, which examines the fate of psychiatric patients in Finland during and after WWII.
Finland lost 11 % of its surface area in the peace treaty in 1940 and over 400 000 Karelian refugees had to be resettled. The fate of the psychiatric patients of the ceded areas was sealed with a well-meaning legislation in 1940, according to which the state took over the hospital fees, but also decreed where the patients should be treated.
Most of the refugee psychiatric patients were placed in Rauha hospital, situated close to the eastern border. The Karelians were usually resettled to the south-western regions of the country and thus the contacts within the family were easily severed. The solution was very likely meant to be a provisional one, to solve a problem in a crisis and to secure the treatment of the patients who couldn’t fend for themselves. However, as an unintended consequence of the legislation, the relocation of the psychiatric patients closer to their families became impossible. It was mostly due to the resentment of the municipalities being reluctant to take responsibility of the costs as well as to the stigma attached to the psychiatric diseases. Thus, the refugee patients stayed in the Rauha hospital until their death. Their initial number was approximately 300, most of them suffering from chronic schizophrenia. The number decreased slowly due to the deaths of the patients, the last one passing away in 2016. Several of the patients had been in institutional care for more than 70 years.
This paper analyzes the life and hospital care of the longest surviving 50 patients with a help of their hospital records: their initial cause for entering the hospital, their social background, treatment and the development of their disease. The study is complemented with interviews of hospital personnel as well as of family members of the patients. The research material gives a rich perspective to the past: the changes in psychiatric care, both medical treatment as well as the attitudes towards the psychiatric patients over a time span of more than 80 years. The fate of these patients mirrors the vulnerability of psychiatric patients in a time of crisis, which is especially true in the world of today. (Show less)

Katharina Rowold : 'The Nursing Had Taken So Much Out of My Constitution': Breastfeeding and Maternal and Infant Health in Late-Nineteenth-Century Britain
In 1863, Frederica Orlebar recorded in her diary that she weaned her baby after a prolonged period of feeling faint and weak. On the last day of nursing, she wrote that her son 'was as fat & well looking as any baby needs to be, & everyone said it was ... (Show more)
In 1863, Frederica Orlebar recorded in her diary that she weaned her baby after a prolonged period of feeling faint and weak. On the last day of nursing, she wrote that her son 'was as fat & well looking as any baby needs to be, & everyone said it was my doing!' This paper will explore conceptualisations of the relationship between breastfeeding and maternal and infant health in the second half of the nineteenth century in Britain. While bottle-feeding and the employment of wet nurses were not uncommon among well-to-do mothers for much of the second half of the nineteenth century, these methods of infant feeding were mostly discouraged, on different grounds, in the medical and advice literature. Victorian medical opinion associated maternal breastfeeding with babies and mothers' health. Breastfeeding put the maternal and infant body in an interdependent relationship, which was understood to lead to the well-being of both. And yet, it was thought by doctors and mothers alike that this interdependence could, under certain circumstances, have adverse consequences. Women could not always withstand the demands that breastfeeding placed on their bodies or minds, putting their health at risk. Moreover, mothers could not always produce milk of wholesome quality and quantity, meaning that nursing could be harmful to babies. Over the course of the second half of the nineteenth century, these ideas on the benefits and dangers of breastfeeding for mothers and babies altered with the development of new understandings particularly of infant illness, and this paper discusses how physicians and mothers interpreted and negotiated ideas on the relationship between breastfeeding and maternal and infant health in this period. (Show less)



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