Advice for dementia carers: A critique of the literature.

Although hundreds of advice manuals for dementia carers have been published, most have serious limitations. They emphasize the various problems family members experience without noting the social and political context within which caring unfolds. As a result, they eschew structural reforms in favor of individual solutions, including self-care. The manuals also encourage carers to detach emotionally from people with dementia by viewing them in terms of their disease. In addition, the books hew so closely to the medical model of dementia that they ignore newer perspectives. Narratives by people with dementia provide a critical corrective. Those works argue that the disproportionate attention directed toward carers has eclipsed the perspective of people with dementia, that people remain individuals despite a dementia diagnosis, that issues of stigma and discrimination shape the experience of living with dementia, that more emphasis should be placed on promoting the autonomy of people with dementia, that they are entitled to reasonable accommodations, and that they should have more opportunities for growth. I have reviewed the policies detailed in the guide and have no competing interests.

"Modern medical science and the divine providence of god": rethinking the place of religion in postwar U.S. medical history.

Drawing on a large cache of letters to John and Frances Gunther after the death of their son as well as memoirs and fiction by bereaved parents, this essay challenges the assumptions of secularization that infuse histories of twentieth-century American medicine. Many parents who experienced the death of children during the postwar period relied heavily on religion to help make sense of the tragedies medicine could not prevent. Parental accounts included expression of belief in divine intervention and the power of prayer, gratitude for God's role in minimizing suffering, confidence in the existence of an afterlife, and acceptance of the will of God. Historians seeking to understand how parents and families understood both the delivery of medical care and the cultural authority of medical science must integrate an understanding of religious experiences and faith into their work.

"In the last stages of irremediable disease": American hospitals and dying patients before World War II.

After a brief discussion of early- and mid-nineteenth-century hospitals, this article focuses on the years between 1880 and 1939, when those facilities underwent a major transformation and the proportion of hospital deaths steadily increased. During both periods, private hospitals refused admission to many seriously ill people and discharged others when death approached. City hospitals dumped poor patients with advanced disease on chronic care facilities and especially on almshouses. With each transfer, the quality of care sharply declined. And trips from one institution to another often inflicted additional suffering; some accelerated death.

The rise and fall of celiac disease in the United States.

Because celiac disease is greatly under-diagnosed in the United States, a common assumption is that U.S. doctors and researchers always have considered the condition extremely rare. However, the disorder captured widespread medical attention at the beginning of the twentieth century. Luther Emmett Holt, a leading pediatrician, encouraged three other doctors to investigate the condition. Two helped to associate celiac disease with elite medical institutions. The third linked it to the marketing efforts of the United Fruit Company. Interest in celiac declined after 1965, partly as a result of the decreased concern with nutrition and nutritional disorders.

"Only the best class of immigration": public health policy toward Mexicans and Filipinos in Los Angeles, 1910-1940.

Public health officials contributed to the early 20th-century campaign against Mexicans and Filipinos in Los Angeles. In 1914, the newly established city and county health departments confronted the overwhelming task of building a public health infrastructure for a rapidly growing population spread over a large area. However, for several years public health reports focused almost exclusively on the various infectious diseases associated with Mexican immigrants. Although the segregation of Mexicans was illegal in California until 1935, county officials established separate clinics for Whites and Mexicans during the 1920s. With assistance from state officials, local health authorities participated actively in efforts to restrict Mexican immigration throughout the 1920s and to expel both Mexicans and Filipinos during the 1930s.

From exclusion to expulsion: Mexicans and tuberculosis in Los Angeles, 1914-1940.

Even before the influx of Mexicans, public health officials in Los Angeles constructed very sick and very poor tubercular people as an illegitimate presence who not only endangered others but also represented weakness and failure and imposed intolerable economic burdens. The identification of tuberculosis with Mexicans during the 1920s hardened the perception that they did not belong in Los Angeles. Because Mexicans lived and worked in dangerous surroundings, it is likely that they bore a very high burden of tuberculosis. Contemporary statistics, however, tell us less about the prevalence of disease than about the attitudes of health officials. Most were convinced that Mexicans had an innate susceptibility to tuberculosis. Concerns about the cost of supporting tubercular Mexicans figured prominently in efforts to restrict their immigration in the 1920s, and in the deportation and repatriation drives of the 1930s.