Perkins B B
Soc Hist Med. 1997 Dec;10(3):419-35. doi: 10.1093/shm/10.3.419.
This paper focuses on structural development of institution-based medical specialism in the USA in the first third of the twentieth century. It examines organizational ideas of key reformers and specialty leaders and it examines corresponding characteristics of the institutions they built. The structural characteristics which they incorporated into medical care embodied forms of economic organization of the time. Leaders (variously) explained their reform activities in terms of scientific, professional, and/or economic development of medicine. The first section describes a form of specialization within academic medical centres as a vertical functional division of labour which divided medical work into procedures performed by a range of personnel. This division of labour and its required management changed the work of doctors and nurses and required a multiplication of 'auxiliary' hospital staff, as shown in the second section. The final section demonstrates how the departmental structure within academic medical centres provided a necessary institutional framework for vertical specialism. The literature has emphasized the fact that an industrial model was only partly implemented in medical care at the time. Nevertheless, the (industrial) characteristics identified had a significant impact on fundamental structures of twentieth-century medicine.
本文聚焦于20世纪前三分之一时期美国基于机构的医学专科的结构发展。它考察了关键改革者和专科领导者的组织理念，并审视了他们所建立机构的相应特征。他们纳入医疗护理的结构特征体现了当时的经济组织形式。领导者们（以不同方式）从医学的科学、专业和/或经济发展角度解释了他们的改革活动。第一部分描述了学术医疗中心内一种专业化形式，即垂直职能分工，这种分工将医疗工作分为由一系列人员执行的程序。如第二部分所示，这种劳动分工及其所需管理改变了医生和护士的工作，并要求增加“辅助”医院工作人员。最后一部分展示了学术医疗中心内的部门结构如何为垂直专业化提供了必要的制度框架。文献强调了这样一个事实，即当时工业模式在医疗护理中只是部分得到实施。然而，所确定的（工业）特征对20世纪医学的基本结构产生了重大影响。
