Cynthia Connolly

Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labor Force

Contents:Acknowledgments List of AbbreviationsIntroduction. Immigration by the Numbers: Rethinking the Immigrant Medical ExperiencePart I. Numbers Large: Immigrant Medical Inspection as an Inclusionary Tool One. Immigrants and the New Industrial Economy Two. The Function of Medical Inspection: Restriction, Instruction, and Discipline of the Laboring Body Three. The Medical Gaze: Science in Industrial-Era AmericaPart II. Numbers Small: Immigrant Medical Inspection as an Exclusionary Tool Four. The Shape of the Line: Immigrant Medical Inspection from Coast to Coast Five. At the Borders of Science: Diagnostic Technology at the Intersection of Race, Class, Disease, and Industrial Citizenship Six. Drawing the Color Line: Radical Patterns of Medical Certification and ExclusionEpilogue. The End of the Line: Immigrant Medical Inspection after 1924Appendix. Note on Data Collection, Cleaning, Coding, and Analysis Notes Index

“Coming together, keeping together, working together”: Interdisciplinary to transdisciplinary research and nursing

To enhance clinical science and hasten the translation of research to practice so as to ultimately improve health, an increasing emphasis is being placed on transdisciplinary research. The purpose of this article is to describe the development of transdisciplinary clinical research in nursing, the current state of the science, potential threats to the discipline, and the promise of transdisciplinary research for nursing and for the health of the public. To successfully engage in transdisciplinary research, nurse scientists can use multiple strategies, including continuing to prepare researchers in rigorous pre-doctoral and postdoctoral training programs.

Histories of nursing: The power and the possibilities

This article challenges the dominant paradigm of understanding the history of nursing as only that of relative powerlessness. By moving away from the stance of educators deeply concerned about the inability of the profession to gain control over entrance requirements and into the realm of practice, we use examples from our own work to discuss alternate histories of power. We acknowledge historical circumstances of invisibility and gender biases. But we argue that when we look at the history of practice, we see as much evidence of strength, purpose, and successful political action. Finally, we call for an acknowledgement of the rich and complex nature of the many different histories we can tell in nursing. And we suggest that an admitted inability to advance in one area of the discipline has not meant an inability to move in others.

A Startling New Chemotherapeutic Agent: Pediatric Infectious Disease and the Introduction of Sulfonamides at Baltimore's Sydenham Hospital

Using pediatric patient records from Baltimore’s Sydenham Hospital, this article explores the adoption of sulfa drugs in pediatrics. It discusses how clinicians dealt with questions of dosing and side effects and the impact of the sulfonamides on two diagnoses in children: meningococcal meningitis and pneumonia. The care of infants and children with infectious diseases made demands on physicians and nurses that differed from those facing clinicians treating adult patients. The article demonstrates the need to distinguish between pediatric and adult medical history. It suggests that the new therapeutics demanded more intense bedside care and enhanced laboratory facilities, and as a result paved the way for the adoption of penicillin. Finally, it argues that patient records and the published medical literature must be examined together in order to gain a full understanding of how transformations in medical practice and therapeutics occur.

Nurses: the early twentieth century tuberculosis preventorium's "connecting link".

The service the public health nurse can render the preventorium and the tuberculous child is invaluable. She is the connecting link between the home and the institution; between the child and his physician; between the public and the tuberculous child in need of prevemorium care. Whether she works om from the institution or in the communi ty as the public health nurse, her responsibility and opportunity toward the wberculous child and rhe preventorium are alike .... 1

“Remarkable Improvement”: Sulfa Drugs and Pediatric Meningococcal Meningitis, 1937–1949

Lauded as one of the greatest developments of 20th-century medicine, the “wonder drug” penicillin reshaped the treatment of infectious diseases and altered patterns of mortality. As a result, the breakthrough that preceded penicillin—the development of the sulfonamides—is often overlooked.1,–,3 Using records from Sydenham Hospital, a municipal communicable disease institution in Baltimore, Maryland, in which nearly 75% of patients were children, we show the transformative role that sulfa drugs played in pediatric practice through a case study of meningococcal meningitis.4 Through the 19th and early 20th centuries, physicians observed patients ravaged by what they called “epidemic” or “cerebrospinal” meningitis. No matter how much mercury, opium, or arsenic they prescribed and no matter how many times they injected sterilizing agents into the dural space or drained infected cerebrospinal fluid via lumbar puncture, the disease proved fatal in nearly all cases.5,–,8 The first significant therapeutic breakthrough arrived when the Rockefeller Institutes Simon Flexner developed an intrathecally administered serum treatment. By the early 1920s, eminent Johns Hopkins pediatrician Kenneth Blackfan exulted that the serum lowered the mortality rate at the hospitals Harriett Lane Home from nearly 100% to 52%.9 Sydenham physicians used serum therapy with positive results. Their protocol, in which patients received meningococcus serum both intravenously and intrathecally, lowered the mortality rate to ∼30%.10 Although serum therapy saved Baltimore childrens lives, it proved challenging to administer, because it required numerous intravenous injections and lumbar punctures. It also … Address correspondence to Cynthia Connolly, PhD, RN, School of Nursing, University of Pennsylvania, 2017 Fagin Hall, Philadelphia, PA 19104. E-mail: cac1{at}nursing.upenn.edu

I am a trained nurse: the nursing identity of anarchist and radical Emma Goldman.

For more than a century, scholars have analyzed the many dimensions of Emma Goldman. Remembered as an agent of revolution, feminism, sexual freedom, anarchy, and atheism, Goldman’s motives, personality, and actions have generated an entire subgenre of historical scholarship. But although Goldman practiced nursing in New York City for ten years, one facet of her life that has been neglected is her nursing identity. Goldman’s autobiography, Living My Life, reveals the way her nursing experiences informed her evolving anarchist political philosophy and international activism. She valued nursing for many reasons—for the economic independence it offered, identity it provided, and sense of community and connectivity she believed it encouraged. Finally, for Goldman, nursing represented was a vehicle to understand people’s struggles and as a way of translating political philosophy into meaningful, practical solutions.

Penicillin's 70th Birthday

S eventy years ago a new medication that would transform the global treatment of infectious diseases—penicillin—was first produced in large enough quantities to treat many civilian patients. A December 31, 1944, New York Times editorial declared penicillin, “that most miraculous germ-killer,” the biggest medical story of the year, an opinion probably shared by the majority of nurses and the American public. Although Scottish biologist Alexander Fleming observed in 1928 that no bacteria could grow in the vicinity of the Penicillium notatum mold in culture, therapeutic results were not achieved until 1940, when Oxford University scientists Howard Florey and Ernst Chain prepared an extract and successfully treated mice they had infected with streptococci. Dorothy Hodgkin, a young English expert in X-ray crystallography, described the molecular structure of penicillin in 1945. 3 Producing large quantities of penicillin became a high priority during World War II, when the military controlled almost all supplies of the medication. Civilian access to penicillin was severely limited before 1945, despite growing interest among medical providers and public enthusiasm for the new “wonder drug.” According to Dowling, “By early 1942 enough penicillin had been produced by American companies to treat one patient, and a year later 100 patients had been treated.” Perhaps of special interest to nurses, the woman who made medical history in March 1942 when she became the first patient whose life was saved by penicillin, Anne Sheafe Miller, had been a 1931 graduate of the Columbia Presbyterian School of Nursing. Chester Keefer, then physician-in-chief at Massachusetts Memorial Hospitals, was appointed chairman of the National Research Council’s Committee on Chemotherapeutic and Other Agents, making him responsible for rationing the civilian distribution of the medication. Investigators received quantities of the drug only after petitioning Keefer, the “penicillin czar,” with a patient’s case history and bacteriologic findings. 6 An in-depth examination of the medical literature on the use of sulfonamides and penicillin in treating pediatric patients from 1937 to 1950—in journals including JAMA, the Journal of Pediatrics, and the American Journal of Diseases of Children—shows that the criteria Keefer used to decide who should receive penicillin during the war years had little to do with the severity of a person’s illness; rather, his concern was that the recipient have the “right” bacterial infection, meaning a bacterial type that commonly afflicted soldiers in the field and about which more data was needed with regard to dosing, excretion, and pharmacokinetics. In the early 1940s, pediatric patients were overrepresented among civilian recipients of experimental By Cynthia Connolly, PhD, RN, FAAN LOOKING BACK