Dermatologists in the Wild West, 1870-1900: The early pioneers from the Mississippi River to the Pacific Coast.

During the Wild West era of American history (approximately 1870-1900), at least 53 dermatologists settled between the Mississippi River and the Pacific Coast. In 1870, two dermatologists began their practice in the city of St Louis, Missouri (William Augustus Hardaway and Solomon Claiborne Martin, Sr) and one dermatologist started his practice in San Francisco, California (George J. Bucknall). By 1900, 50 more dermatologists had settled in 19 cities located in the American West (Tables 1,2). There, they established practices, initiated academic programs, and pioneered dermatology as a medical specialty in the western United States. This contribution provides brief biographic profiles of these early western American dermatologists. It also presents several dermatology-related vignettes from the Wild West that involved such colorful personalities as Doc Holiday, Calamity Jane, and Sister Mary Joseph. From these beginnings, 150 years ago, the specialty of dermatology would further spread and develop across the American West during the 20th century.

Laryngology in Art: The Portrait of Dr Wilhelm Mayer-Hermann.

Otto Dix's portrait of the laryngologist Dr Wilhelm Mayer-Hermann represents a shining example of Neue Sachlichkeit, or New Objectivity, offering a return to unsentimental reality and a focus on the objective world, as opposed to the more abstract and idealistic tendencies of expressionism. However, precious little is known about the subject of the portrait. This article examines the portrait and attempts to shed light on the life and career of the Dr Wilhelm Mayer-Hermann.

Fighting for business: the limits of professional cooperation among American doctors during the First World War.

The American medical profession participated extensively in preparedness and mobilization for the First World War, with more than one in five doctors voluntarily enlisting in various branches of the Army and Navy Medical Corps. Medical officers were widely valorized for suspending their civilian careers and for sacrificing their professional income while in service. Because of the meager commissions that medical officers received by comparison with fees many doctors earned in established private medical practices, scores of county medical societies implemented organizational solutions to this business problem, with the hopes of removing a significant disincentive to enlistment. In these "practice protection plans," a civilian doctor promised to take care of the patients of a military doctor, to forward a portion of the fees collected thereby to the family of the military doctor, and to refer these patients to the military doctor upon his return. Despite initial enthusiasm and promotion, these plans ultimately failed to achieve their objectives, leading some medical officers to accuse civilian doctors of being opportunistic, unpatriotic "slackers." This episode reveals the limits of professional cooperation in American medicine at the time and the need to explain organizational failures in the grand narrative of professionalization during the "Golden Age" of American medicine.

Once upon a time--starting up a dental practice in the 1980s.

A description of how a dentist could establish a practice in the UK in the 1980s.

Medical tourism: reverse subsidy for the elite.

The medical tourism sector in India has attracted global attention, given its phenomenal growth in the past decade. India is second only to Thailand in the number of medical tourists that it attracts every year. Estimates indicate that the medical tourism market in India could grow from $310 million in 2005 to $2 billion by 2012. These figures are significant when contrasted with India's overall health care expenditure - $10 billion in the public sector and $50 billion in the private sector. Factors that have contributed to this growth include the relative proficiency in English among health care providers and the cost effectiveness of medical procedures in India. Generally, most procedures in Indian hospitals cost a quarter (or less) of what they would cost in developed countries. The expansion of medical tourism has also been fueled by the growth of the private medical sector in India, a consequence of the neglect of public health by the government. India has one of the poorest records in the world regarding public financing and provisioning of health care. A growing driver of medical tourism is the attraction of facilities in India that offer access to assisted reproductive care technologies. Ironically, this is in sharp contrast with the acute neglect of the health care needs of Indian women. The Indian government is vigorously promoting medical tourism by providing tax concessions and by creating an environment enabling it to thrive. However, there is a distinct disjunction between the neglect of the health care needs of ordinary Indians and public policy that today subsidizes the health care of wealthy foreigners.

[Town physician or physician in a town? Three early modern physicians and their understanding of their municipal function]. / Stadtarzt oder Arzt in der Stadt? Drei Arzte der Frühen Neuzeit und ihr Verständnis des städtischen Amtes.

The institution of the town physician has been up to now discussed mostly on the limited scale of regional studies. In this article three early modern period town physicians are compared regarding their own understanding of their office. Their individual approach towards medical practice is examined on a broader spatio-temporal range within the context of medicalization, which was an integral part of the development of early modern territorial states. This comparison shows that beyond contemporary normative concepts town physicians also claimed particular roles within their social context. By achieving these, they often broadened or even transgressed the assumed delineation of the function subscribed to town physicians.

Tuberculosis management by private practitioners in Mumbai, India: has anything changed in two decades?

SETTING: Mumbai, India. A study conducted in Mumbai two decades ago revealed the extent of inappropriate tuberculosis (TB) management practices of private practitioners. Over the years, India's national TB programme has made significant progress in TB control. Efforts to engage private practitioners have also been made with several successful documented public-private mix initiatives in place. OBJECTIVE: To study prescribing practices of private practitioners in the treatment of tuberculosis, two decades after a similar study conducted in the same geographical area revealed dismal results. METHODS: Survey questionnaire administered to practicing general practitioners attending a continuing medical education programme. RESULTS: The participating practitioners had never been approached or oriented by the local TB programme. Only 6 of the 106 respondents wrote a prescription with a correct drug regimen. 106 doctors prescribed 63 different drug regimens. There was tendency to over treat with more drugs for longer durations. Only 3 of the 106 respondents could write an appropriate prescription for treatment of multidrug-resistant TB. CONCLUSIONS: With a vast majority of private practitioners unable to provide a correct prescription for treating TB and not approached by the national TB programme, little seems to have changed over the years. Strategies to control TB through public sector health services will have little impact if inappropriate management of TB patients in private clinics continues unabated. Large scale implementation of public-private mix approaches should be a top priority for the programme. Ignoring the private sector could worsen the epidemic of multidrug-resistant and extensively drug-resistant forms of TB.