Historical text archives constitute a rich and diverse source of information, which is becoming increasingly readily accessible, due to large-scale digitisation efforts. However, it can be difficult for researchers to explore and search such large volumes of data in an efficient manner. Text mining (TM) methods can help, through their ability to recognise various types of semantic information automatically, e.g., instances of concepts (places, medical conditions, drugs, etc.), synonyms/variant forms of concepts, and relationships holding between concepts (which drugs are used to treat which medical conditions, etc.). TM analysis allows search systems to incorporate functionality such as automatic suggestions of synonyms of user-entered query terms, exploration of different concepts mentioned within search results or isolation of documents in which concepts are related in specific ways. However, applying TM methods to historical text can be challenging, according to differences and evolutions in vocabulary, terminology, language structure and style, compared to more modern text. In this article, we present our efforts to overcome the various challenges faced in the semantic analysis of published historical medical text dating back to the mid 19th century. Firstly, we used evidence from diverse historical medical documents from different periods to develop new resources that provide accounts of the multiple, evolving ways in which concepts, their variants and relationships amongst them may be expressed. These resources were employed to support the development of a modular processing pipeline of TM tools for the robust detection of semantic information in historical medical documents with varying characteristics. We applied the pipeline to two large-scale medical document archives covering wide temporal ranges as the basis for the development of a publicly accessible semantically-oriented search system. The novel resources are available for research purposes, while the processing pipeline and its modules may be used and configured within the Argo TM platform.
Objectives:To use the history of the Karnofsky Performance Scale as a case study illustrating the emergence of interest in the measurement and standardisation of quality of life; to understand the origins of current-day practices.Methods:Articles referring to the Karnofsky scale and quality of life measurements published from the 1940s to the 1990s were identified by searching databases and screening journals, and analysed using close-reading techniques. Secondary literature was consulted to understand the context in which articles were written.Results:The Karnofsky scale was devised for a different purpose than measuring quality of life: as a standardisation device that helped quantify effects of chemotherapeutic agents less easily measurable than survival time. Interest in measuring quality of life only emerged around 1970.Discussion:When quality of life measurements were increasingly widely discussed in the medical press from the late 1970s onwards, a consensus emerged that the Karnofsky scale was not a very good tool. More sophisticated approaches were developed, but Karnofsky continued to be used. I argue that the scale provided a quick and simple, approximate assessment of the ‘soft’ effects of treatment by physicians, overlapping but not identical with quality of life.
The rise of biomedicine is usually associated with the transformation of biological and medical research in the United States following the vast expansion of funding, both private and public, in the years after the Second World War. 1 Along with the other authors in this issue, we are interested in describing this phenomenon in national contexts other than the United States. Our discussion of biomedicine in Britain draws upon many of the same themes as our fellow authors and the existing literature on the US-the new role of the state as scientific entrepreneur; the relationship between experimental medicine and clinical services; and the growing institutionalization of associations between laboratory and clinic-to emphasize the clinical trial as a privileged form of therapeutic evaluation in the post-war years. In particular we are keen to stress that the randomized clinical, or controlled, trial (RCT) in Britain developed within a period of increasing centralization of state policy and planning for health services and medical research.The epistemological success of the RCT in demonstrating the value of the antituberculosis drug streptomycin elevated the technique to international prominence in the late 1940s. The 1948 trials of streptomycin conducted by the British Medical Research Council (MRC), along with similar trials in the United States, are usually recognized as the world's first randomized controlled trials. Indeed, the streptomycin trials, and the trials of PAS and isoniazid that followed in the early 1950s, did combine the statistical technique of randomization, with new organizational techniques, such as the division of specialist labour, and central review and data collection, across multiple sites of study. As Peter Keating and Alberto Cambrosio, Ilana Löwy, and Harry Marks have shown for the US, the success of the co-operative (that is, multi-centre) clinical trial was intimately related to the new role of the federal government, through
This paper explores the historical developments of admission registers of psychiatric asylums and hospitals in England and Wales between 1845 and 1950, with illustrative examples (principally from the archives of the Rainhill Asylum, UK). Standardized admission registers have been mandatory elements of the mental health legislative framework since 1845, and procedural changes illustrate the development from what, today, we would characterize as a predominantly psychosocial understanding of mental health problems towards primarily biomedical explanations. Over time, emphasis shifts from the social determinants of admission to an asylum to the diagnosis of an illness requiring treatment in hospital. We discuss the implications of this progressive historical diminution of the social determinants of mental health for current debates in mental health care.
One of the defining features of interwar medical debates in German-speaking countries was the remarkable popularity of holistic concepts among both experts and the lay public. Attacks on the allegedly too-mechanistic outlook of modern medicine were frequent and were often associated with calls to research and treat the constitution of patients rather than isolated causes of disease. This paper traces the rise of the new constitutional medicine, locating its roots in nineteenth-century medical science. The essay attempts to explain the increasingly antimechanistic outlook of promoters of constitutional medicine by relating it to the larger context of the politics of health in Weimar Germany, to concerns of medical practitioners over the rise of the welfare state and the popularity of nonlicensed healers, culminating in the widespread notion of a "crisis of medicine." Drawing on case studies of, among others, the Danzig surgeon Erwin Liek and the Vienna gynecologist Bernhard Aschner, the article distinguishes between rationalist and neoromantic constitutionalists and aims to demonstrate that antimechanism in constitutional medicine was related to neoromantic tendencies in art and other realms of society, while rationalists were concerned with making German men and women fit for war and the requirements of modern industry.
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