The Formation of the Swiss Hospital System (1840–1960) : An Analysis of Surgeon-Modernisers in the Canton of Vaud

This book offers an analysis of the formation of contemporary hospital systems between the mid-19th century and the mid-20th century. Based on extensive archival material and a broad international literature review, it focuses on the case of the canton of Vaud, Switzerland, and uses a triple approach that discusses technological innovations, hospital management, and health policy. This research is a major contribution to the history of medicine which gives a unique overview of the formation of contemporary hospital systems. Preface to the English Edition Contents List of Figures List of Tables 1 Introduction 1 Influence of the Social History of Medicine 2 Medicine as a Sociotechnical System 3 The Business History of Medicine and Hospitals 4 The Interest of the Swiss Case 2 Surgeons of the Canton of Vaud in the Nineteenth and Twentieth Centuries 1 Introduction 2 The Surgeons of the Canton of Vaud Through the Nineteenth Century (1800–1880): Surgery as a Craft Surgery at the Cantonal Hospital Until the Mid-1870s The Changes of the 1870s and 1880s 3 The Industrial Revolution in Surgery in the Canton of Vaud: César Roux and the German School (1880–1930) The Model: Theodor Kocher and the German Surgical School The Production of Surgical Equipment: A Product of the German School Roux in Lausanne: German Surgery and Radical-Democratic Networks Professional Recognition Political Commitment: The Strength of Radical-Democratic Networks Teaching Surgery in the Faculty of Medicine Teaching Gynaecology The Development of Orthopaedics The Radiology Laboratory The Surgical Policlinic Empowerment of Non-clinical Chairs: Operative Medicine and Occupational Health Roux's Disciples Chiefs of Clinics Interns Vocational Training at the Roux School: Predominance of Practice and Rational Organisation of Work The Creation of a New Surgical Clinic The Importance of War Surgery in the Training of Surgeons Training of Healthcare Personnel The Deaconesses of Saint-Loup: Obedient Supervisors The Surgeons of Vaud and the La Source Nursing School 4 The American Model: Decker and Saegesser (1930–1960) Medical Plethora and the Birth of Specialist Titles The Beginnings of Research Support The Surgical Department Under Decker: The Emergence of Teamwork and Surgical Specialties (1936–1957) Neurosurgery The Beginnings of Cardiovascular Surgery Hand Surgery The New Surgical Clinic of the Cantonal Hospital: “Science in the Service of Humanity” After Decker, the Consecration of Team Surgery 5 Conclusion 3 Management and Organisation at the Cantonal Hospital of Lausanne 1 Introduction 2 The Cantonal Hospital Before the New Buildings of 1883 A Hospital that Focuses on the Sick (1806–1870) The Hospital as a Service of the Cantonal Administration The Crisis of the 1870s and the Construction of the New Hospital in 1883 The Old Hospital Is Encumbered The Introduction of the German Model (1883) Financing the Cantonal Hospital (1850–1883) Strengthening Administrative Authority 3 The Integration of the Cantonal Hospital into the Faculty of Medicine (1883–1914) Empowerment of Hospital Management At the Head of the Hospital: Directors from the Public Administration A New Financial System: The Hospital Creates Its Own Resources Organisation of the Various Hospital Services The Impact of the Faculty of Medicine Subcontracting of Some Clinics to Private Philanthropic Institutions Attempted Centralisation (1910–1920) 4 Privatisation and Rationalisation (1920–1950) Strengthening the Administrative Control New Competition from Private Clinics Reorganisation of La Source Opening of the Cecil Clinic Hospital Financing: The Affirmation of a New Management System Boarders in Common Rooms Replace Wealthy Clientele Radiology: A Profitable Innovation Private Sector Intervention in Hospital Infrastructure Development Development of Hospital Services Strengthening Links with Private Specialist Hospitals Special Funds for Clinics: A Step Towards the Privatisation of Hospital Services? Cancer Research: A Private Initiative Conclusion Rationalisations Veska: “Simplifying, Saving and Improving Everything That Can Be Done in the Operation of a Hospital” Rationalisation of the Pharmacy Service When the Interests of the Hospital Meet Those of the Doctors: The End of Free Ambulatory Consultations (1944–1950) Reorganisation of the Accounting Department (1938–1941) Conclusion 5 The Cantonal Hospital in the 1950s: The Return of the State The Resources of the Cantonal Hospital in the 1950s Development of Hospital Equipment: The End of Partnerships with the Private Sector 6 Conclusion 4 The Transformation of Regional Hospitals 1 Introduction 2 Local Infirmaries: A Fruit of the Protestant Revival (1840–1900) The First Infirmaries: Homes for the Indigent Sick A Minimal Medical Service Unstable Balance of Finances Administrative Organisation Original Funding from Private Sources An Unstable Financial Balance After the Construction of New Buildings Between Philanthropy and Medicine: Lausanne’s Specialised Hospitals Conclusion 3 The Development of Hospital Surgery and Its Consequences (1900–1960) The Arrival of Modernising Surgeons An Example of Modernisation: The Aigle Hospital Internal Reorganisation of Hospitals Empowerment of Medical Services Working Alongside the Doctors, the Deaconesses (1880–1930) Appointment of Resident Doctors and Lay Nurses (1930–1950) Architectural Uniformity of Regional Hospitals Improvement of the Medico-Technical Infrastructure 4 Administrative and Financial Reorganisation (1900–1960) Professionalisation and Secularisation of Administrative Departments The Limits of the Philanthropic Financial System The Financial Impact of New Construction The Crisis of Philanthropy Pensions for the Sick: The State, Insurance and Private Clients Late Intervention by Municipalities Some Examples of Hospital Management The Financial Difficulties of Peripheral Establishments Following the Modernisation of Their Equipment: The Case of Aubonne Hospital The Transformation of Rural Town Hospitals: The Case of Broye Hospital Modernisation of an Urban Hospital: The Case of the Montreux Hospital Conclusion 5 Building a Hospital Policy 1 Introduction 2 The Beginnings of a Statewide Hospital Policy: The 1875 Law on Infirmaries and Its Consequences The Department of the Interior Organisation of the Department of the Interior (1845–1914) The Health and Hospices Council Between 1885 and 1914 The Public Relief Service: Financial Aspects The Cantonal Hospital Becomes Too Small: The Beginnings of a Statewide Hospital Policy The Financial Importance of Public Support for Local Infirmaries The Formation of a Private Hospital Lobby 3 Attempts to Reorganise the Hospital System During the Inter-War Period The Demand for the Centralisation of Investments in Lausanne Warnings About the Hospitalisation of the Chronically Ill in the 1920s Prof. Decker's Questioning of the Cantonal Hospital Regional Hospitals’ Opposition to the Cantonal Policy The Structuring of the Lobby: The Association of Vaud Infirmaries (1930–1947) 4 The Implementation of a New Hospital Plan (1945–1966) The Affirmation of the State in Public Health Guaranteeing the Hospitalisation of Patients The 1953 Convention for the Hospitalisation of Indigents The Forel Motion on Hospital Conditions (1953) The Joint Commission for the Rationalisation of Hospitalisation (1954–1960) The 1966 Hospital Plan: A Guarantee for the Widespread Development of the System The Hospital Advisory Commission (1959–1961) The Working Group for the Establishment of the Hospital Building Programme (1959–1966) The 1966 Hospital Plan 5 Conclusion 6 Conclusion References