Pox Britannica: Smallpox Inoculation in Britain, 1721-1830

Inoculation has an important place in the history of medicine: not only was it the first form of preventive medicine but its history spans the so-called eighteenth century \u27medical revolution\u27. A study of the myriad of pamphlets, books and articles on the controversial practice casts new light on these fundamental changes in the medical profession and medical practice. Whereas historians have associated the abandonment of old humoural theories and individualised therapy in favour of standardised techniques with the emergence of new institutions in the second half of the century, inoculation suggests that changes began as early as the 1720s. Though inoculation was initially accompanied by a highly individualised preparation of diet and drugs, more routinised sequences of therapy appeared the 1740s and by the late 1760s all inoculated patients followed exactly the same preparative regimen. This in turn made possible the institutionalised provision of inoculation, first through the system of poor relief, later by dispensaries and charitable societies. In addition, debates over inoculation reveal the disintegration of the old professional order and the struggles of the physicians--whose authority was based in individualised practice--to retain their monopoly of inoculation and their status as authorities on the practice. By the 1770s, the intellectual and professional leadership of the profession passed to a new generation of practitioners. The thesis ends with an assessment of the impact of inoculation on population growth and finds that it was not widely practiced and had, at best, a marginal effect on mortality

Global assessment of aquatic Isoëtes species ecology

1. Isoetes are iconic but understudied wetland plants, despite having suffered severe losses globally mainly because of alterations in their habitats. We therefore provide the first global ecological assessment of aquatic Isoetes to identify their environmental requirements and to evaluate if taxonomically related species differ in their ecology. 2. The assessment resulted in an extensive new database on aquatic Isoetes, ecological niche analyses, and descriptive species accounts. We compiled a global database that includes all known environmental data collected from 1935 to 2023 regarding aquatic Isoetes. We then evaluated the environmental drivers of 16 species using 2,179 global records. Additionally, we used hypervolume analysis to quantify the ecological niches of the two species with the greatest number of records, finding significant differences and evidence that Isoetes echinospora occupies a wider ecological niche than Isoetes lacustris. 3. Fifty-nine species (30% of the c. 200 Isoetes species known today) were categorised as aquatic and were mainly reported in the Americas and northern Europe. About 38% of the aquatic species are threatened with extinction or are endemic to a small region, according to the International Union for Conservation of Nature's Red List in 2023. Many species were determined to be sensitive to certain water physical and chemical factors, generally preferring oligotrophic conditions such as low total phosphorus, moderate total nitrogen, moderate to low pH, and low conductivity. 4. This analysis includes ecological data in the assessment of rare/threatened aquatic plants globally. This new database and the ecological analyses completed defined the ecological requirements of several species and identified knowledge gaps, which can aid management actions and future research. 5. This paper highlights ecological significance and environmental sensitivities of aquatic Isoetes. The current level of knowledge is inadequate for a large proportion of known taxa. We affirm the extreme need to support global, collaborative initiatives on which to build future conservation strategies

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Power, policy and practice: the public response to public health in the Scottish city

About the book: Medicine is concerned with the most intimate aspects of private life. Yet it is also a focus for diverse forms of public organization and action. In this volume, an international team of scholars use the techniques of medical history to analyse the changing boundaries and constitution of the public sphere from early modernity to the present day. In a series of detailed historical case studies, contributors examine the role of various public institutions - both formal and informal, voluntary and statutory - in organizing and coordinating collective action on medical matters. In so doing, they challenge the determinism and fatalism of Habermas's overarching and functionalist account of the rise and fall of the public sphere. Of essential interest to historians and sociologists of medicine, this book will also be of value to historians of modern Britain, historical sociologists, and those engaged in studying the work of Jürgen Habermas

Evil necessaries and abominable erections: public conveniences and private interests in the Scottish city, 1830-70

This study of the provision of public conveniences in four large Scottish burghs explores the governance of public space. Conveniences were the responsibility of local government and were erected to bring moral and environmental order to city streets by providing a confined and private area for urination and defecation. Yet private citizens had an acknowledged right to demand the erection or removal of conveniences in order to bring the condition of public space into line with that of adjacent homes, businesses, and institutions. The burgh authorities therefore had to balance the interests of the wider population against those of individual residents and businessmen when attempting to introduce this sanitary reform

The Idea of a germ: [Essay review of] 'Spreading germs: disease theories and medical practice in Britain, 1865–1900' by Michael Worboys

Essay review - published without an abstract

Health and Wellness in the 19th Century

Medicine in the 19th century may strike us as primitive by today's standards, but widespread social change of the era brought about new ideas and practices in health and healing—all described in this engaging book. Exploring the history of medicine in the 19th century around the world, this book showcases the wide range of medical ideas, practices, institutions, and patient experiences, revealing how the exchanges of ideas and therapies between different systems of medicine resulted in patients enjoying a surprising degree of choice. The author offers a unique perspective that provides an introduction to 19th-century medicine on a global stage and places the advancement of medicine within the context of wider historical changes. Chapters examine areas of dramatic change, such as the development of surgery, as well as the fundamental continuities in the use of traditional forms of supernatural healing, covering western, Chinese, unani, ayurvedic, and folk medicine-based understandings of the body and disease. Additionally, the book describes how the culture of medicine reflected and responded to the challenges posed by urbanization, industrialization, and global movement

The Politics of Vaccination: Practice and Policy in England, Wales, Ireland and Scotland, 1800-1874

The introduction of public vaccination was among the greatest of public health triumphs. By the end of the nineteenth century, legislation framed and implemented by medical experts in Britain's government brought smallpox under control for the first time. The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800-1874, by historian Deborah Brunton, reveals the conflict that accompanied this success, and highlights how power differentials among government officials, medical experts, and general practitioners influenced vaccination policy across Great Britain. Brunton challenges the assumption that expert supervision was crucial, showing instead that local organization was pivotal to successful public vaccination. Throughout Britain, ordinary practitioners -- eager to enhance their professional status -- demanded the right to shape and supervise public vaccination. But their achievement depended on wider political considerations, and varied from country to country. In England and Wales, for instance, practitioners were defeated by a new band of medical experts who had established a power base within government. In Scotland, medical professionals contrived to keep most vaccination within the private sector, but local enthusiasm ensured very high levels of participation. Public vaccination was most successful in Ireland, where practitioners had limited influence over dispensary provision and smallpox was nearly eradicated, if briefly, in the 1860s. In The Politics of Vaccination, Brunton demonstrates that public vaccination was not simply a medical matter: it was a divisive political issue, with outcomes strongly influenced by competing partisan interests

Feasibility of Family Participation in a Delirium Prevention Program for the Older Hospitalized Adult

Objective . To examine the feasibility of family participation in a nurse-supported, multicomponent intervention program for delirium prevention in the older hospitalized adult. Background . Delirium is the leading complication of hospitalization for older adults and is associated with important consequences including increased morbidity and mortality, increased use of health care resources, and increased caregiver burden. The potential role that family caregivers could play in delirium prevention and how nurses could facilitate family participation has been largely unexplored. The Calgary Family Intervention Model (CFIM), operating on the assumptions of a family-centered care philosophy, provided a framework for understanding the feasibility of family participation in delirium prevention efforts. Methods . A descriptive exploratory design using a convenience sample of 15 family caregivers of older hospitalized adults at a large teaching hospital was used to address the research questions. For the Family Participation Delirium Prevention Program (FPDPP), family caregivers implemented five intervention protocols targeted toward four baseline risk factors for delirium and self-tracked daily intervention completion. Feasibility was based on rates of intervention completion, and consideration of the barriers and facilitators for participation based on older adults\u27 and family caregivers\u27 responses on discharge questionnaires and staff nurses\u27 responses on a questionnaire. Results . Intervention completion was highest for the orientation protocol (83.5%), followed by the vision protocol (81.5%), therapeutic activities protocol (76.9%), hearing protocol (73.6%), and early mobilization protocol (55.3%). Three themes emerged on the barriers and facilitators for family participation: therapeutic relationships, partnership, and environment. The barriers and facilitators were generally consistent with the concept of family-centered care as described in the CFIM. Conclusion . Based on the rates of intervention completion, it appears that the FPDPP is feasible for implementation in clinical practice. A remarkable level of agreement was found on the concept of the feasibility of family participation among older adult patients, family caregivers, and staff nurses with the common themes that emerged. Key to its successful implementation will be recognition and attention to the barriers and facilitators for participation. In addition, operating from a framework of family-centered care, nurses can advocate for environments that support family caregivers\u27 participation in a delirium prevention program