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A feminist historian of medicine recounts the efforts of early-20th-century women in science who spearheaded a research project detailing the history of medical women in the US. In 1925, the American Medical Women's National Assoc founded the Committee of the History of Medicine. Headed by Kate Hurd-Mead, who gave up a clinical practice to devote herself to research, the committee remained active until 1941, making the writing of history an important part of the political agenda of women physicians. It is contended that the fact their ambitious work has largely been ignored by male historians makes it historically & politically imperative to establish a history of feminist historians of science & medicine that acknowledges the symbolic & political roles played by feminist historians who documented feminine medical/scientific authority. It is suggested that reevaluating the historiographical project implemented by Hurd-Mead's committee within the historical context of a time when women were discouraged from becoming physicians places the experiences of these women at the core of the history of medicine. 26 References. J. Lindroth

The importance of reconciling status with interests in studying elites is illustrated through discussion of the meanings behind fledgling physicians' use of the term "crock" to refer to patients who are not really sick, & are viewed as not worthy of consideration. Because they cannot be cured, & therefore cannot contribute to the status of the physician, crocks are given low status. Professional interest thereby defines patient status. The tendency of elites to make informal categorizations that would be unacceptable if categorized formally is discussed. D. Generoli

Analyzes changes in the regulation of doctors in the UK during its transition from an imperial power to a European nation, drawing on personal experience as a lay member of the British General Medical Council. The council was created in 1858 & charged with registering medical practitioners. Traditionally, the General Medical Council has been reluctant to register foreign doctors who were not trained in UK-founded medical schools. However, during the 1960s, the National Health Service experienced a dearth of competent doctors, thus increasing the pressure on the council to register more foreign doctors. The admittance of more foreign doctors produced a reaction against supposedly lax registerial standards & eventually a return to the restrictive policy. This new policy was constituted in such a way as to privilege European doctors over "overseas" doctors to reduce tension between the UK & the European Community. Recently, greater integration with the European Community & the introduction of concerns outside the province of the council have further reduced its influence. 45 References. D. M. Smith

Reviews the status of the Belgian medical profession historically & changes to that position since the 1980s. The medical profession has traditionally enjoyed dominance in its field by virtue of several 1960s laws. The only weakness in the profession's dominance was its inability to control the growth of doctors, which became important in the 1980s & 1990s, as the national Health Insurance System sought to reduce the medical profession's autonomy through passage of new legislation. The profession has resisted this effort, but has been hampered by the high density of physicians, which adversely affects the average income & status of individual doctors & hinders the profession's ability to create a coherent oppositional voice. However, debates centered on the federalization of the Health Insurance System & the issue of financial responsibility for sickness funds have delayed any concerted effort to reduce the profession's autonomy. 19 References. D. M. Smith

Examines diagnoses of neonatal jaundice, arguing that it is a self-correcting, developmental feature of newborns, & its treatment as a pediatric disorder serves to disrupt maternal bonding & nursing. Dominant cultural expectations of medicine deem anything outside the biomedical definition of "normal" as an indication of pathology. Medical elements of neonatal jaundice are explained, & the history of its treatment is traced in relation to development of the subspecialty of neonatology. Difficulties involved in doing neonatal research to determine risk potentials are discussed, along with the tendency of many clinicians to treat all babies who fall within a "zone of suspicion," rather than chance one disastrous outcome. As a result, the added burden of exaggerated pathology is placed on the newborn period. It is contended that the practice of medicine lacks a cultural perspective, & neonatal jaundice is an example of a constructed condition where social, historical, & cultural factors have combined to create both a disease & a medical/legal dilemma for doctors & parents. 45 References. J. Lindroth

The nature & implications of the balance between work & family responsibilities among medical doctors in Russia were examined in a 1991/92 questionnaire survey of 207 female & 110 male doctors in Moscow. It is argued that the burdens of rapid economic & social change are more problematic for women in Russia who must perform dual roles as professionals & domestic servants. Although physicians were dissatisfied with their low wages & status, the majority depicted their work as purposeful & meaningful, but were unhappy with their overall lives. Women suffered disporportionately from various signs of fatigue & stress, & felt more strongly that their ability to cope with difficult situations had deteriorated, especially the 64% who were responsible for all or most domestic duties. Women's greatest concern was conflict between their professional & domestic obligations. Men were much more likely to succumb to excessive use of alcohol as a means of coping in stressful situations. 2 Tables. T. Sevier

Participant observation of three in vitro fertilization (IVF) cycles in metropolitan national health care clinics, 1990-1992, underpin a self-reflexive comparative case study of IVF procedures in Israel & Canada. Feminist critiques of infertility treatments as the epitome of male domination & a means to objectify women are discussed. IVF method & organization are detailed, noting that procedures in both countries were physician-dominated, highly technological, low in cost, & woman friendly. Israeli doctors were more patronizing, but also more personal & sympathetic, than their Canadian counterparts. Organizational & economic differences resulting from the smaller size & lower affluence of the Israeli clinic are described. A gender politics perspective suggests that the greater marginalization of women in Israeli society is reflected in uncritical acceptance of the control & dominance of male physicians. In contrast, Canada has more women on the medical staff, & paternalism is discouraged. How cultural differences are mirrored in clinic programs is explored. 48 References. J. Lindroth

Examines the role of the medical audit & clinical budgeting in the hospital sector of the British National Health Service & their consequences for the medical autonomy of hospital doctors. Traditionally, doctors had great autonomy in the medical system because of state dependency. However, the recent introduction of new systems of resource management & quality control, some of which have been imported from the US, have significantly reduced doctor autonomy. While the National Health Service system has not been completely privatized, doctors have been forced to accept a new form of responsible autonomy entailing greater oversight of their actions. Doctors initially resisted the new system, but continued economic pressure eventually forced them to acquiesce to the new market-driven system. The issue raised by the ascendance of the market is not whether doctors will abide by the new system, but whether they will be any good at managing themselves within it. 83 References. D. M. Smith

Examines policy changes in the 1980s in the British National Health Service, highlighting the impact of these changes on general practitioners. These policy changes stressed the introduction of market principles into medical care accomplished through a shift toward primary care, an alteration of funding & allocation procedures, & an enhancement of patient rights. It is argued that these changes have increased opportunities for general practitioners to manage the scope of their work & control resources used to provide medical care. While remaining beyond day-to-day scrutiny, general practitioners have gained more freedom to make medical decisions & bargain with other service providers. Thus, the main consequence of the introduction of market principles has been to retract state supervision & allow market criteria to determine medical provision outcomes. 37 References. D. M. Smith

Examines the effects of 1970s welfare state policies in Finland & Norway designed to narrow inequalities in health care delivery, focusing on their implication for the gendered division of labor in medicine. Empirical literature demonstrates that one consequence of the new policies was the creation of new medical schools & the entrance of large numbers of women into the medical field. However, women have been concentrated in low-paying, low-status, primary care specialities. This gender segregation is taken to be a consequence of the profession's claim to have mastered medical uncertainty per its definition by a male ethic of rationality. Interview data gathered in 1987 from 31 women doctors in Finland reveal a discursive strategy manifested in a self-concept as a traditionally valued community doctor, a holistic perspective on their medical tasks, & a service-over-achievement orientation. Thus, women doctors have asserted medical uncertainty through appeal to this a female gaze that solidifies their professional power amid the prevailing division of labor. 1 Table, 57 References. D. M. Smith

Examines the controversial issue of female genital operations performed in various immigrant groups in Canada, drawing on 1995/96 in-depth interview data from 40 community workers, 15 immigrants from countries where the operations are common, 7 physicians, & 4 nurses. The three types of operations (excision, infibulation, & refibulation) are examined in their social contexts. The practice is based on the dominant belief that all aspects of a woman's body should be controlled by men or other family members. Various legal & educational strategies designed to eradicate the practice are discussed, along with the connection between Canadian foreign policy & female genital operations in African nations. Attention is called to the inconsistency of Western attitudes toward these operations in light of widespread acceptance of other surgical procedures related to female sexuality. Growing global awareness of the consequences of female genital operations is discussed, along with the emergence of campaigns against them led by women who underwent operations. 3 Figures, 43 References. J. Lindroth

Discusses primary health care reform in Spain to explore the influence of medical professionals in the state's attempts to reform the health care system. Both professional & private provider associations have worked through demonstrations, strikes, judicial appeals, & personal political connections to delay government control of medical services, & a large number of public physicians have chosen to remain outside the new network of care. Spain's autonomous regions have had varying results, with Navarra a high performer in the primary care field, & Galicia & Catalonia blocking policy implementation. The dangers of open confrontation with interest groups at the macropolitical level in the early stages of a reform effort were recognized. The government eliminated compulsory integration of doctors & did not force implementation by each region. Political visibility was reduced at the microlevel by narrowing the groups receiving selective negative incentives. On an institutional developmental level, the size & quality of public primary care manpower & infrastructure was progressively increased. The Spanish experience demonstrates circumstances where the federalist form of government faces difficulties in achieving welfare state development. 3 Tables, 1 Figure. L. A. Hoffman

Discusses the potential impact of various health care reforms on Los Angeles, CA. A number of circumstances distinguish the health care situation in Los Angeles from that of the rest of the country: disproportionately high level of uninsured residents, rapid growth of private & public managed care, a substantial surplus of hospital beds & specialist physicians, an underfunded county-operated health system in need of new facilities, a large legal immigration population in need of culturally & linguistically sensitive services, a large population of undocumented residents, & a 6-year economic recession & rise in unemployment. It is argued that health insurance reform, federalization of Medicaid, nonmandatory subsidies for the purchase of private health insurance, & voluntary medical savings accounts advocated by the US Congress would not have a substantial effect on Los Angeles's greatest problem, ie, its large number of uninsured residents. The recently defeated proposal by the Bill Clinton administration, with its emphasis on universal or nearly universal care, could have reduced this problem, but no solutions have been offered to the dilemma of undocumented persons. It is argued that the problem could be at least minimally handled through limited low-cost coverage for doctor visits, immunizations, & hospital stays. 5 Tables, 20 References. T. Sevier