Contenu du sommaire

Pierre Royer : Medicine and Society. A sociology of medicine is gradually emerging that suits the needs of sociologists and doctors. Some examples of this are given in certain areas of research: collective images of medicine and health, attempts at a socioeconomic interpretation of pathogenic factors, the problems of migrating or transplanted populations. In the future, responsible organizations should favor psycho-socio-medical research on the same par as biomedical research.

François Steudler: The Hospital, the Medical Profession and Hospital Policies. By placing the hospital in a historical dimension and highlighting those factors involved in its transformations as well as the way its functions have developed and diversified, the author is trying to show how the nature of relationships between the medical corps, the administration and financial organizations are being modified. Until around 1850, the hospital principally had the job of lodging persons and exercising social control. The medical corps was not very integrated therein. Between 1830 and 1940, the hospital became a complex organization. Technology and special disciplines have developed. The role of the administration has grown. However, the medical corps has conserved a large degree of professional autonomy. At present, the hospital has become a technical system. The importance of health problems leads to a rationalizing logic, especially on the part of government and administration. This logic aims at associating the medical corps, which becomes more and more integrated within the institution, with major administrative decisions. Until quite recently, this corps only had a consultative role in such matters.

Claudine Herzlich : Types of Patients and Hospital Procedures. This study grew out of the observation of two hospital wards, Medicine and Surgery, at the Paris Assistance Publique. The author analyzes the development of medical practices at the hospital as well as the procedures for admitting different kinds of patients. In particular, the article brings to light the relation between medical specialization and: 1) selectivity in the recruitment of patients who happen to fall into two categories; 2) the strategy of relationships between the doctor, the hospital and the entire medical profession.

Antoinette Chauvenet : Ideologies and Professional Classifications of Hospital Doctors. The industrialization of hospital medical practices creates a dependence of the doctors on the technical system and between doctors of different specialized areas. This division of medical labor engenders situations where power is not equal. Attempts at administrative rationalization tend to institutionalize these situations. The increasing reference to biological disciplines and the high esteem accorded to them are limited to the ideological level. The fact that clinicians continually dominate others is assured by the hospital's technical system which directly reflects power relationships within the medical corps. These relationships exclude any outside ? administrative or political ? mediation.

Jean Duhart and Jacqueline Chartron-Brassard : Nursing Care Prescribed by Doctors and Hospital Reform. This article is part of a national research project concerning nursing problems in French hospitals. The analysis of nurses' work has pointed out a lack of correspondence between the formal structure of nursing care and those practices brought to bear on the patient. Part of actual practices are thus located outside of definition of such duties. This difference does not signify a simply dysfunctioning of hospital care, rather it very much derives from the contradiction of actual nursing practices with the social relationships between nurses and doctors. By institutionally maintaining these relationships and the division of labor resulting from them, the hospital reform now in progress ? although containing many positive points ? is one of the factors which mask and reproduce this contradiction.

Roland Pressat: High Death Rates: Biological and Social Factors. Whereas relative social equality used to exist in the face of death, major differences appeared between various groups within the population during the 19th Century Industrial Revolution in Europe. In spite of medical and economic progress, this inequality has not disappeared. We can undoubtedly demonstrate the harmful effects of certain behaviors, e.g., the abusive use of tobacco, and the consequences of different attitudes that individuals have with regard to sickness. Nevertheless, the deep causal origins are still not very clear. French statistics on social mortality lead the observer to look into the tie between work and lifespan. Society does not draw any conclusions about this inequality; at least, it has not adopted appropriate social measures which would sufficiently attenuate the effects.

Robert Castel: New Frontiers of Mental Health Medicine. This study deals with the sociological significance of moving psychiatric practices out of the asylum into the community. After measuring the extent of this change through a thematic and critical analysis of recent publications in French, this article then discusses proposed interpretations. Contrary to the sociology of organizations which tends to treat the development of psychiatric structures in isolation, the author proposes recentering this problem area on a rigorous study of populations under care. Recent difficulties have arisen because new categories of patients have appeared. Not only their psychopathological but also their social, professional, geographic, demographic, etc., characteristics differ from those of former asylum inmates.