Notes on Chapter Four: The Reconstitution of the Hospital.

As Paul Starr examines the development of the hospitals in the United States, I came across a couple of thought-provoking points.

Heterogeneity within the Same Nation.
I found the detailed account of the how different types of hospitals became more popular in certain areas in the U.S. more than others very interesting. I guess it is the vastness of America that makes this possible. I personally struggle with the concept of heterogeneity of prevalent sources of institutional medicine within the same country because in Egypt most development occurred in the Nile Valley and in a few coastal cities-- mostly Alexandria. With homogenous ethnicities in Egypt, the state control was greater, just as Starr had predicted.

Surgical Practice and Hospital-based Medicine.
While it is common knowledge that the advent of antisepsis and aseptic techniques were behind revolutionizing surgical practice, I had previously failed to make the connection between the boom in the number of hospitals and their increasing focus on acute care (indeed, post-surgical care). This realization is important because it also sheds light on another phenomenon that occurred in Egypt with the increase in numbers and capacity of hospitals, surgeons became more and more influential in the medical circle --partially due to the fact that they had hospital admission privileges. They were instantaneously transformed in Egyptian society from mere ‘butchers’ or ‘barbers’ to the true healers in the medical profession: a surgeon performing an appendectomy weeds out and removes the source of pain; the patient is completely cured as opposed to someone consulting a physician who offers only temporary relief.
Surgery became the most coveted specialty, granting prestige and the most monetary benefits.