Theory and Practice from the Medieval to the Modern
Laurinda Abreu and Sally Sheard Introduction
I look to the abolition of all hospitals. But it is no use to talk about the year 2000. — Florence Nightingale to Sir Henry Bonham Carter, 1867 Nightingale’s faith in the progress of health and society was naïve. The millennium arrived, and we still placed hospitals at the heart of most national healthcare systems. She would have applauded the World Health Organisation’s Alma Ata declaration in 1978, which aimed to re-balance healthcare towards primary health care – a more ef ficient and equitable use of resources – but this has not yet come to pass. Hospitals continue to dominate, to suck the majority of funds from national healthcare budg- ets. This might seem an unnecessarily negative or cynical attitude, but it resonates with expert opinion accumulated since Nightingale’s time. The late nineteenth century witnessed a sea-change in attitudes to hospitals. The impact of scientific advances, especially through the development of anaesthesia and antisepsis, new imaging techniques and pharmaceutical treatments have contributed to improvements in the capacity of hospitals to treat patients, not just to care for them. But we still lack a sensible justi- fication for devoting such a large proportion of scarce financial resources to these expensive physical, social and economic constructions. This book, in which the majority of the chapters were initially pre- sented at the International Network for the History of Hospitals confer- ence, held in Lisbon and Évora, Portugal in April 2011, is focused on the enduring tensions between theory and practice, between expectations and experiences. It...
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