Head injury in heroes of the Civil War and its lasting influence.

The Civil War era was an age-defining period in the history of the United States of America, the effects of which are still seen in the nation today. In this era, the issue of head injury pervaded society. From the president of the United States, Abraham Lincoln, to the officers and soldiers of the Union and Confederate armies, and to the population at large, head injury and its ramifications gripped the nation. This article focuses on 3 individuals: Major General John Sedgwick, First Lieutenant Alonzo Cushing, and Harriet Tubman, as examples of the impact that head injury had during this era. These 3 individuals were chosen for this article because of their lasting legacies, contributions to society, and interesting connections to one another.

Free medical clinics: helping indigent patients and dealing with emerging health care needs.

An innovative movement of free medical clinics, which began in the 1960s, has helped indigent people without access to traditional health care. In this article, the author relates his experiences at three free clinics. Aside from the delivery of good care to deserving people, these clinics also had an impact on other relevant issues in medicine: The first of these clinics became involved with a chronic illness that affected medical research, the second provided another venue for medical teaching, and the third increased volunteerism, especially among senior clinicians. These secondary features are the focus of this article. The first clinic, created in a time of troubling social change, cared for many young people with infections, probably including some who were part of an evolving epidemic that was only later recognized as HIV/AIDS. The second clinic began when the traditional hospital and outpatient clinic settings for teaching medical students-both in their preclinical years and during clerkship rotations-were not conducive to learning the skills of interviewing and physical examination of cooperative patients. The more informal, less frenetic pace of a free clinic appealed to students and some residents as a place to build clinical skills. The new Liaison Committee on Medical Education standard to provide student service learning may formalize the use of free clinics in medical schools. The third clinic, like any of the 1,200 or more free clinics in the United States, cares for indigent people who have no access to established health care. The free clinic movement, which can provide some of the needed care, relies on volunteer physicians, many of whom are older and retired clinicians, who find that their contribution to free clinic care can be both useful to the patients and most rewarding to themselves.

Exploitation and enrichment: the paradox of medical experimentation.

Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the "unethical" experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical research.

Harriet Tubman's last work: the Harriet Tubman Home for Aged and Indigent Negroes.

This article focuses on the important contributions the venerable Harriet Tubman made to the field of housing for older persons and other populations at risk. It uses an historical approach to document the importance of early housing and self-help initiatives in the African American community. It embraces Harriet Tubman and other early housers for their good works and acknowledges them as contributors to the rich legacy of community social work practice and its sage principles of empowerment and self-help. The article presents a nexus between the current housing status of older Blacks and the double jeopardy status imposed by historical discrimination.

George Armstrong MD (1719-1789) and his dispensary for the infant poor.

George Armstrong published one of the first textbooks on children's diseases in 1767 and two years later opened in London the first dispensary/hospital in the world for sick children. He introduced clinical teaching and may be regarded as the founder of paediatrics and child health in Great Britain.

Advocacy and community: the social roles of physicians in the last 1000 years. Part I.

Over the last 1000 years, the practice of medicine in the Western world has been shaped by extraordinary transformations -- in the organizational structures of healthcare delivery, the changing concepts of disease and illness, and the ethical and social issues posed to a growing and diversified profession. Some critical aspects that characterize contemporary Western medicine -- as professionally defined, highly organized and regulated, and scientifically and technologically based -- have emerged only within the last 200 years. For most of its history, medicine was practiced without these distinctions -- but precursors to many current tensions can be traced back to Hippocratic times. In the last millennium, medicine developed in tandem with emerging political ideologies and social structures, and the roles of physicians evolved to respond to the needs of individual patients, the profession, and society at large. As medicine became increasingly effective, it was harnessed into the political objectives of promoting social cohesion and productivity. Professional regulation and social mechanisms for the equitable distribution of healthcare became significant considerations for the profession and society. In this brief 3-part history, we will trace the major organizational, conceptual, and political changes that, together, by the year 2000, created a profession with responsibilities of advocacy for individual patients in concert with attention to the needs and demands of all the individuals in the larger community.

Dispensaries in counties Armagh and Down in the pre-Famine years.

This paper traces the development of dispensaries in the counties of Armagh and Down in the decades prior to the Great Famine. It examines the number and distribution of dispensaries and discusses their management, finance and daily administration. The role of dispensary doctors, their conditions of employment and the diseases which they treated are also considered.