Medical Knowledge and Medical Practice: Geriatric Medicine in the 1950s

Abstract

This article examines the development of medical knowledge and practice with regard to sickness in old age in the early years of the National Health Service. It suggests that the creation of a speciality of geriatrics was inspired by the need to prevent hospital beds being blocked by long-stay patients. Thus, the efficient use of hospital provision required the diagnosis, treatment, and rehabilitation of elderly patients. The publication of medical texts on sickness in old age, provided the basis for a more interventionist approach to the care of sick, elderly people, but the development of geriatrics as a separate speciality was hindered by professional disputes over administrative responsibility, funding, private practice, and medical training. One key area of debate was whether sickness in old age was primarily a social rather than a medical problem. This needs to be considered with regard to the relationship between the hospital and the local community and the article examines the contribution of social and medical surveys of elderly people at home to the discourse on sickness and old age.

‘The geriatric hospital felt like a backwater’: aspects of older people’s nursing in Britain, 1955–1980

“…Goffman goes so far as to say that the, ‘contradiction between what the institution does and what its officials say it does, forms the basic context of the staff’s daily activity’ (Goffman 1961, p. 73) and certainly much of the work with older people in hospital was custodial in nature (Martin 1995, p. 446). One participant recalled her anxiety as a student nurse, of suddenly being aware of an old lady actually being a person, something which she did not think that the system expected:…”

“…If the hospitals controlled the movement of the nurses, it is difficult not to understand their position as part of the institution in a similar way to that of the patients. Moreover, the length of service of nurses on older adult wards was such that often they were part of the fabric of the wards; there are even references to ‘beds and nurses’ (Martin 1995, p. 448). Finally, it is clear from the literature and also from the oral history participants that both patients and staff alike undergo, ‘a process of mortification’, that is, a loss of self‐esteem and perhaps even social identity (Karmel 1969, p. 134).…”

Frail bodies: geriatric medicine and the constitution of the fourth age

“…Two reviews were undertaken. Firstly, informed by a close reading of published histories of old age and geriatric medicine (for example, Haber 1986, Martin 1995, Morley 2004, I undertook an electronic search of the content and titles of all articles published in the Lancet and BMJ between 1930 and 1990. Using the keywords 'frailty and elderly', 'chronic sickness and elderly' and 'infirm and elderly', I reviewed the abstracts that emerged and then read in full a sample of 20 relevant full articles for each journal in each category (for details see Table 1).…”

“…While the discourse of senescence made age a central concern in treating disease and directed the identification of disease to within the body itself, the welfare regime, from which geriatric medicine in the UK emerged, embedded the older body within a different biopolitical framework (Cooper 2008). By classifying and treating older bodies according to a unique expertise that enabled beds to be unblocked, 1 geriatric medicine established itself as a profession in 1948 in the UK at the same time as characterising older people as a class apart from the mainstream adult population (Martin 1995). For example, older bodies differed from other bodies in the presentation of disease, particularly in terms of an ambiguous boundary between normality and pathology generic to the patho-anatomical techniques noted above (Katz 1996).…”

Joint Planning across the Health/Social Services Boundary since 1946

“…Professional considerations have also encouraged this phenomenon. Hall and Bytheway have suggested, for example, that hospital doctors have sought to limit the definition of health care in line with the prevailing 'acute ideology' in medicine, and have thus tried to restrict entry to hospitals by controlling assessments of patients' needs (1 99 1 ; see also Martin, 1995).…”