A enfermagem em Portugal aos 40 anos do Serviço Nacional de Saúde / Nursing in Portugal in the National Health Service at 40

Resumo Retratamos a evolução da enfermagem em Portugal desde a criação do Serviço Nacional de Saúde (SNS) em 1979, focando sobre os efetivos, a formação, as condições de trabalho, a carreira, e a organização profissional. Utilizamos a literatura sobre a evolução do sector da saúde em Portugal, e fontes de dados estatísticos da Ordem dos Enfermeiros e do SNS. Nos últimos 40 anos, o número de enfermeiros aumentou de 233%, mas o rácio enfermeiro/médico só passou de 1.15 para 1.4. A maioria exerce funções nos hospitais, apesar dos repetidos compromissos políticos a favor da expansão dos cuidados de saúde primários. No SNS, 55% são funcionários públicos com contrato por tempo indeterminado; os outros detêm um contrato individual de trabalho de direito privado. O curso de licenciatura em enfermagem é oferecido em 20 escolas do sector público e 16 do sector privado. Em 2019, a carreira de enfermagem foi revista em 3 categorias: enfermeiro, enfermeiro especialista e enfermeiro gestor. Apesar de queixas em relação as condições de trabalho, a remuneração e ao progresso na carreira, os enfermeiros continuam moderadamente satisfeitos. O papel do enfermeiro, mudou pouco ao longo dos anos e há resistência por parte da Ordem dos Médicos à sua expansão.

Abstract We describe the development of nursing in Portugal since the creation of the National Health Service (SNS) in 1979, focusing on staff numbers, education, work conditions, career, and professional organization. We used the literature on the evolution of the Portuguese health sector and statistical data from the Nursing Council and the SNS. The number of nurses grew by 233% in the last 40 years, but the nurse/physician ratio only increased from 1.15 to 1.4. Most work in hospitals, despite repeated political commitments to expand primary health care. In the SNS, 55% are public servants, and the others are employed through private law contracts. The basic nursing course is currently offered in 20 public and 16 private institutions. In 2019, the career structure was revised and now comprises three categories: nurse, specialist nurse, nurse manager. Nurses remain moderately satisfied despite complaints about working conditions, remuneration, and lack of career progress. Nurses' role barely changed over the years, and the Medical Association is resisting to its expansion.

Trabajo, miserias y recompensas: Asistentes sociales, enfermeras y matronas en la construcción de la política sanitaria chilena a mediados del siglo XX / Work, miseries and rewards: Social workers, nurses and midwives in the construction of Chilean health policy in the mid-twentieth century

RESUMEN El artículo busca mostrar el aporte realizado por asistentes sociales, enfermeras y matronas a la exitosa política de salud pública de mediados del siglo XX en Chile, llevada a cabo por el Servicio Nacional de Salud en el marco de un modelo de desarrollo estatista y benefactor. Se han utilizado fuentes documentales de diverso tipo y testimonios de asistentes, enfermeras y matronas entrevistadas para la investigación. Las profesionales, encargadas fundamentalmente de tareas operativas y en contacto directo con la población usuaria del Servicio Nacional de Salud, fueron artífices de la instalación de una verdadera pedagogía sanitaria que cambió el patrón epidemiológico y trastocó la cultura de la población chilena, incidiendo en la valoración del autocuidado y la prevención. Como ejecutoras, sortearon las dificultades inherentes al trabajo burocratizado de los programas sociales pero, a la vez, recibieron gratificaciones diversas de tipo afectivo y altruista, que las hizo sentirse protagonistas de una construcción histórica.

ABSTRACT The article seeks to show the contribution made by social workers, nurses and midwives to the successful public health policy implemented in the mid-twentieth century in Chile by the National Health Service in the context of a statist and welfare development model. Documentary sources of different types and testimonies of social workers, nurses and midwives who were interviewed for this research were used. These professionals, mainly responsible for operational tasks and in close contact with the users of the National Health Service, were responsible for the establishment of a true health pedagogy that changed the epidemiological pattern and touched the culture of the Chilean population, influencing its estimation of self-care and prevention. As executors of the policy, they avoided the difficulties inherent to the bureaucratized work of social programs, gaining, at the same time, satisfaction at the affective and altruistic level, which made them feel like the protagonists of a historical process.

La Medicina Estatal en América Latina (1880-1930) / State-owned medicine in Latin America/1 (1880-1930)

Durante las últimas décadas del siglo XXI y las tres primeras de este siglo, en América Latina se registra la creación de órganos de sanidad de carácter nacional. La centralización de los servicios de sanidad se explicaría como parte de un proceso más amplio de transformación de la superestructura jurídico-política del Estado, transformación requerida para que esta correspondiera con la fase inicial de la implantación del capitalismo y realizada en los países de la América Latina por la burguesía surgida de la producción capitalista de materias primas y de productos alimenticios destinados al mercado exterior. El surgimiento de la medicina estatal fue posible también debido a los cambios que se habían operado en el campo médico como resultado de su vinculación con el proceso de producción capitalista y que la afecta en su conceptualización, en su práctica y en la forma como organiza sus actividades. Por lo tanto, el análisis de la medicina estatal en el período de 1880 a 1930 deberá iniciarse con una presentación breve de las formas de vinculación de la medicina en el capitalismo y su transformación conceptual y técnica. El segundo paso en la exposición, bajo el título de El surgimiento de la Medicina Estatal, trata sobre los factores que llevan a la creación de órganos estatales de sanidad, considerando a la sanidad, hasta cierto punto, como sinónimo de medicina estatal ya que la sanidad adquiere para el Estado una importancia mayor que otros tipos de prácticas médicas. El tercero y último capítulo se refiere a la forma como se desarrolló la medicina estatal, en el período considerado, finalizando con las transformaciones que se producen en el campo de la atención médica y que se han de desenvolver en todas sus posibilidades a partir de 1930. LA MEDICINA EN EL CAPITALISMO En el modo de producción capitalista la medicina se desplaza del espacio religioso y político, donde se encuentra en los modos de producción precapitalistas, para articularse con el proceso de producción económica. En este modo de producción el trabajador pierde el control y la propiedad de los medios de trabajo y tiene, en consecuencia, que vender su fuerza de trabajo para sobrevivir. Entonces, la región económica juega el papel dominante en la estructura social y, también, a éste se vincula la medicina, variando...(AU)

Gênese da atenção domiciliária no Brasil no início do século XX / Génesis de la atención domiciliaria en Brasil al inicio del siglo XX / Genesis of home care in Brazil at the start of the twentieth century

RESUMO Objetivo problematizar as condições de possibilidade para o aparecimento da atenção domiciliária no início do século XX no Brasil. Método estudo de inspiração genealógica sobre a atenção domiciliária. O material empírico foi constituído por dois documentos legais sobre o tema publicados no Diário Oficial. A análise documental utilizou as ferramentas analíticas poder, poder disciplinar e biopolítica, inspiradas em Foucault. Resultados foram elaboradas duas categorias: “Vigilância no domicílio: as enfermeiras visitadoras e a tuberculose” e “Registros: o aparelho político e econômico”. Considerações finais A tuberculose, a nova profissão das enfermeiras visitadoras, os registros produzidos pela vigilância e a análise minuciosa das cidades conferiram à atenção domiciliária um caráter de vigilância, inspeção e controle voltado a conduzir as condutas dos indivíduos.

RESUMEN Objetivo problematizar las condiciones de posibilidad para el aparecimiento de la atención domiciliaria al inicio del siglo XX. Método se trata de un estudio de inspiración genealógica sobre atención domiciliaria. El material empírico fue constituido por documentos legales sobre el tema, publicados en el Diario Oficial. El análisis documental utilizó las herramientas analíticas poder, poder disciplinar y biopolítica, inspiradas en Foucault. Resultados fueron elaboradas dos categorías analíticas, “vigilancia en el domicilio: enfermeras visitadoras y la tuberculosis” y “registros: aparato político y económico”. Consideraciones finales la tuberculosis, la nueva profesión de las enfermeras visitadoras, los registros producidos por la vigilancia, y el análisis minucioso de las ciudades configuran la atención domiciliaria con carácter de vigilancia, inspección y control para mejor conducir las conductas de individuos.

ABSTRACT Objective to discuss the conditions that enabled home care at the beginning of the twentieth century. Method study of the genealogic inspiration on home care. The empirical material consisted of legal documents on the subject that were published in the Official Journal. The documents were studied using analytical tools, such as Power, Discipline and Biopolitics, which were inspired in Foucault. Results two analytical categories were established, “home inspection: visiting nurses and tuberculosis” and “records: political and economic apparatus”. Final considerations tuberculosis, the new profession of visiting nurses, inspection records and the detailed analysis of the cities grant home care a nature of surveillance, inspection and control to conduct the behaviour of individuals.

State Control of Medicine through Legislation and Revision of the Medical Law : Licensed and Unlicensed Medical Practices in the 1950s - 60s / 의사학

In the 1950s and 1960s, Korea overcame the aftermath of the war and laid the foundations for modernization of economy and professionalization of medicine. The National Medical Services Law, enacted in 1951 was the first medical law to be legislated since the establishment of the Republic of Korea. The law provided a medical system for the traditional Korean medical practitioners, activated opening of hospitals through report-only system and prohibition of interference in medical practice, and facilitated mobilization of the doctors by the government. The Medical Law, legislated in 1962 by the Park Jong-Hee administration contained practice license system, regular practice reporting system and practice designation, thereby strengthening the government control on the medical practitioners, inducing professionalism and high-quality of medical practitioners and abolished unlicensed medical practitioners such as acupuncturists, moxa cauterists and bone setters. The Medical Assistant Law of 1963 was introduced so that medical examination and assistance could be carried out under supervision of professional doctors. To reduce areas without healthcare system, region-specified medical practitioners got licensure and a community doctor system was organized. However, due to expensive medical fees in comparison to economic status and medical needs of patients, shortage of doctors, low accessibility to hospitals led to the prevalence of illegal medical practice by unlicensed practitioners. Absence of national budget or policy on the health care system and the American-style noninterference medical system were other factors causing the situation. Government, Korean Medical Associations and Korean Dental Association tried, without success, to exercise control over the unlicensed medical practice. President Park Jong-Hee had to introduce a special law concerning the health-care related crimes with life sentence as the highest penalty. While the government put modernization before social welfare, operated on a policy of state-controlled medical care system, and doctors achieved specialization system similar to that of the United States, the public had to suffer, being treated by unlicensed medical practitioners. Inevitably, the need for a national medical practitioner supply plan and a policy to support health service was raised.

Re-evaluation of the Medical Practice and the Medicine in the Later Half of the Chosun Dynasty / 의사학

The state-running medical institutions which had been instituted in the earlier period of the Chosun dynasty substantially downsized during the reconstructing process after the major wars with Japan and Qing dynasty. The downsizing was mainly due to the malfunctioning public financial system; but it was also due to the growth of the private medical market. The growth of the private medical market reoriented the focus of the public health system of the Chosun dynasty from providing treatment for every minor disease to providing the more efficient policy against epidemic. Hwal-in Seo (a temporary local public health center established for epidemic) became a new core of the dynasty's health policy under the phrase of "Ae Rye (saving the rituals)." As the changes of the dynasty's public health policy, the growing private medical market had been admitted into the public domain. Chosun government once had declared Sa Yak Gye (a private mutual-aid group for medicine) illegal and prohibited the private groups to be organized. Instead, with the policy change mentioned above, the government tried to support the private mutual-aid group for medicine while forbidding sales of fake medicine, restraining rise of price of medicine. Especially the Do go merchants often caused the sudden rise of price of medicine by bulk purchasing. Medical practice was reassessed as the period when it was considered as one of the lowest professions had been over. Although the Yangban class still refused to be a professional medical practitioner themselves, they also well understood the value of medicine as a field of study to save human and dismissed negative perception on medicine. Medicine as a field of study and medical practice, which had been underestimated under the ruling system influenced by the Song Confucianism and the status system of the Chosun dynasty, faced a new era. The whole society guaranteed more free practices of the medical practitioners and they were recognized for their works. With the change of social environment, the government officials gradually realized needs to discuss how they could educate and recruit medical practitioners to provide advanced medical treatment and what provisions they had to legislate to ensure the stable supply of the medicine. It is certain that the transformation developed in the medical environment and the changes of the public health policy up to 18th century Chosun dynasty accompanied the emergence of the commercial society. However, the overall social urge was still not enough to induce the actual law-making process. The change of the public health policy and the growth of the private medical market were surely the evidence of the transforming Chosun society; at the same time, they also revealed the immaturity of the medical environment which was not able to lead new health policies.

The Health Care in North Korea during the Period(1945-1948) between Liberation from Japanese Occupation and Establishment of North Korean Government / 의사학

This paper, mainly based on literature and documents from North Korea and Russia, described how health care system had been formulated during the period of between liberation from Japanese Occupation and formation of its own government in North Korea, which is so-called 'the Period of People's Democracy'. North Korea authorities, by themselves, address that their health care system is characterized by state medicine, universal free medical care, emphasis on preventive medicine, community(ho) doctors in charge, provisions of modern medical services in parallel with traditional ones, imposed high value on ideologies of medical personnel, and mass participation of health programs so on, taken rise since this period. Under North Korea's socialistic regime, authorities started to restructure health care system through national health care organizations and institutes, which partially provided medical service free. Also, they emphasized preventive medicine against 'capitalistic' treatment-oriented medicine, and community(ho) doctor in-charge was derived from this period. It showed that the mass participation on health program was equal hereafter and they had under bias toward more emphasis on ideology of medical personnel rather than their professionalism. The attempt to develop traditional medicine had been made during this period, however, much funding and support was not observed. In this period, it showed that a series of action to restructure health care system had been gradually carried out.

Antecedentes del Servicio Nacional de Salud: historia de debates y contradicciones: Chile: 1932-1952 / Background facts on the National Health Service: a tale of debate and contradictions: Chile 1932-1952

El trabajo es una investigación historiográfica acerca de los antecedentes de la creación del SNS. A partir de fuentes primarias y bibliográficas se hace un análisis del contexto político, social y sectorial del país, desde1932 hasta 1952. La investigación revela evidencias que permiten explicar la extraña cronología de la construcción de la reforma del régimen previsional y sanitario generado en la década de los años veinte y que culminó en 1952 con el SNS, así como los problemas políticos surgidos entre las fuerzas políticas protagonistas de la época y particularmente, al interior del Frente Popular. Se analizan los efectos teóricos de aquellas contradicciones en la conceptualización de la salud, que permiten comprender las fuertes y permanentes antinomias en las decisiones del Estado, prolongadas hasta el presente, entre la tendencia a la medicina social universalizada y la introducción de la medicina liberal en el propio régimen estatizado. El análisis incluye los factores de la larga espera desde 1941 hasta 1952. En este sentido, el trabajo destaca el rol principal de la Confederación de Trabajadores de Chile desde 1936. Su lucha social forzó en 1950 la apertura del debate del proyecto de ley que culminó en el Servicio Nacional de Salud. Se hace evidente que las transformaciones del sistema de salud fueron el resultado de complejas negociaciones, sujetas a la hegemonía del statu quo y al freno de la guerra fría, que produjeron acuerdos siempre imperfectos. El trabajo permite concluir que el régimen político chileno de la época no estaba maduro para realizar transformaciones profundas, sino para favorecer cambios graduales y negociados, bajo la hegemonía de los sectores conservadores del espectro político.

The Making of Hygienic Modernity in Meiji Japan, 1868~1905 / 의사학

This article is based on conceptual and methodological understanding of hygienic modernity in the nineteenthcentury Western countries: one is the concept of modern hygiene in the context of modern state and the other is methodological relation of modern hygiene to scientific theory of germ. While modern state calls for the institutionalization of medical police as an administrative tool for consolidating the governmentality what Michel Foucault calls, scientific 'invention' of germ may be considered as 'logical, philosophical and historiographical.' Furthermore, the Meiji medicine men preferred Koch's to Pasteur's laboratory framework, not because the former was scientific than the latter but because Koch's programs were more compatible with imperial needs. The objective of this paper is to investigate four ways in which hygienic modernity had been established in Meiji Japan; (i) how Meiji imperialists perceived and managed to control Japanese hygienic condition, (ii) how Meijileading doctors learned about the German modern system of hygiene to consolidate Meiji empire; (iii) how modern germ theory functioned as the formation of imperial bodies in Meiji period; and (iv) how modern military hygiene contributed to Japanese defeat of Russia. Although I try to contend that modern hygiene was adopted as one of the most significant strategies for intensifying and extending the Meiji empire, this paper has some limits in not identifying how Japanese perception of infectious diseases were culturally adaptive to sciencebased hygienic programs the Meiji administrators had installed.

A Study of Treatise on Medicine by King Sejo / 의사학

This paper explores historical backgrounds and contents of Treatise on Medicine written by King Sejo (r.1455-1468) including his views on traditional medicine and pharmacy in the early Chosen period. The Treatise declared by King Sejo in 1463 has been considered as an important and unique manual of medicine because it was the exclusive example written by the king of Chosen. It was the King Sejo's era when the medical milieu in both social and medical aspects was highly encouraged thanks to the previous achievements by King Sejong the Great (r.1418-1450). King Sejo, in particular, who was much interested in practical learning called 'Miscellaneous Studies' emphasized on court medicine. His writing can be understood in such historical frame. Another reason why he wrote the Treatise can be said that he felt necessary for establishing the medical ethic codes for inefficient court medicine-officials. In personal background, he tried to find available remedies since he had been suffered from some chronic diseases. The contents of the Treatise can be broadly fallen to the clinical and ethical aspects, In the former one, the Treatise focuses on treatment without hesitation through the sharp and exact diagnosis by medical doctors. In the latter one, eight categories of medical doctors are discussed according to their moral degrees, sim'eui, sik'eui, yak'eui, hon'eui, kwang'eui, mang'eui, sa'eui, and sal'eui. Finally, musim'ji-eui was supplemented. Among them, sal'eui, medicine-official laking both medical ability and ethical attitude, was classified as the lowest degree, sim'eui, medicine-official sincerely making his all efforts for patients, was thought to be a paragon of medical morality. In conclusion, the Treatise on Medicine by King Sejo played an important role as a manual for the principle of medical practice and for the instruction to enhance ethical attitude among medicine-officials.

Emperor Akbar as a healer and his eminent physicians.

Akbar, however, was himself considered to be a healer to be healer by his miraculous powers. The court physician was one of the top-most officers of the court. Hakim Humam was such a physician who was one of the nine jewels (nauratnas) of Akbar. In 1581, Akbar curtailed the powers of Sadr (or Sadr-i-Jahan, the chief Justice and Administrator of the Empire) and he divided the empire in six zones with a Sadr in charge of each. Out of these six Sadrs, five were his physicians who were Hakim Abul Fath, Shaikh Fayzi, Hakim Humam, Hakim Ali, Hakim Ain-ul-Mulk. Tobacco was introduced either in 1604 or in 1605. Hakim Abul Fath opposed its circulation but Akbar permitted it. It was Abul Fath who found out a remedy for counteracting the pernicious effects of tobacco on health. His opinion was that if the smoke of tobacco passed through water the harmful effects would be minimised. So hukka was invented by him.

The Tughlaqs and medicine.

Muhammed Tughlaq established hospitals. A versatile scholar, Muhammed used to sit by the patients and watch the symptoms of extra ordinary diseases. His successor Firoz Tughlaq established a hospital where patients used to get free medical help and also food and drinks. This hospital was open to all. Though Firoz was known for his bigotry, we find no discrimination made between muslims and non-muslims in case of patients in this hospital. Firoz invented an eye-ointment in which, skin of black snake was used. It cured many kinds of eye diseases. This fact supports the Ayurvedic theory of and prescriptions for curing blindness with the ointment prepared with the flesh of cobras. Firoz himself was a good bone-setter.

The terms Khalisa and dar-bahara in Jahangir's dastur -ul- amal and his physicians.

After his accession Jahangir passed twelve orders (dastur-ul-amal). According to the tenth order hospitals were to be built in all the big cities and physicians were to be appointed and expenditure for this purpose were to be made from "Khalisa" establishment. The term 'Khalisa' has been translated as royal treasury by scholars. But according to the Encyclopaedia of Islam the term means crown land. Jahangir's yearly income from his crown-land was fifty crores of rupees. So he in all probability ordered money to be spent from his personal fund. According to the fifth order, Jahangir forbade manufacture and sale of dar-bahara (rice-spirit). It has been suggested that probably the right term was 'dil-bahara' (exhilarating drink) because Jahanir the emperor would know title of rice-spirit a cheap drink meant for poor people. But in the history of the fourth year of his reign Jahangir says that he forbade the sale of bhang and buza (rice-spirit) in the market as those were injurious for health and he gave stringent orders for the abolition of gambling. So Jahangir was anxious for the physical and moral health of his subjects.

Dawn of Ayurveda during the reign of Nizam VII of Hyderabad.

Mir Osman Ali Khan Bahadur, the Nizam VII ruled the Hyderabad State for about 38 years. In those days Ayurveda was flourishing in the state due to efforts of many Ayurvedic physicians, scholastic teachers, distinguished patrons and well-wishes who worked together with devotional spirit to make Ayurveda available to the people of the state to provide care for the diseases. Nizam Ayurveda Vaidya Sangh started Nizam Ayurvedic college and Nizam Ayurvedic Sadar Dawakhana in Hyderabad city under their management in the year 1934 as a private institution, which was inaugurated in the same year by Azam Jah Bahadur, the Prince of Berar. Consequent upon the inauguration, the Nizam Government accorded sanction of an amount of Rs. 200/- per month for Ayurveda. Thus the seed of Ayurveda was sown during the reign of Nizam VII in the Hyderabad state.

Todaramalla.

Todaramalla was a famous physician, scholar, statesman, Finance and Revenue Minister in the court of Akbar. One of the oldest commentary namely 'Manojna' was written by him on Ashtanga Hridaya. He was patriot of Ayurveda and author of 23 series of works in the form of an encyclopedia called 'Todarananda'. Ayurveda saukhyam is one among the Todarananda. The biography of Todaramalla has been presented here.

Aurangzeb's belief in divine help for cure of diseases.

Aurangzeb had employed the most learned and experienced physicians for himself, for the members of his palace and for his courtiers. During his reign many hospitals were established in the capital as well as in the other cities. The reign of Aurangzeb was note-worthy for the composition and compilation of medical texts. So we can say that Aurangzeb had a very scientific attitude towards the problems of health. We find, at the same time, that he attached great importance to virtuous deeds and divine help for cure of diseases.

Historia de la medicina estatal en Uruguay: 1724-1930 / History of state medicine in Uruguay: 1724-1930

Se analiza la importancia de un enfoque histórico global, que sin descartar los acontecimientos y las biografías, busque su articulación con los aspectos económicos, políticos, sociales más relevantes (macrohistoria). Con este enfoque globalizador se describe y analiza desde la fundación de Montevideo en 1724 hasta 1930-40, la participación del Estado en la Medicina. Se describen cuatro períodos: 1) desde la fundación hasta fin del siglo XVIII, dentro de un Estado monárquico y una estructura económica precapitalista, la participación en la atención médica es meramente normativa (Protomedicato). 2) En la primera mitad del siglo XIX, se logra la independencia política, se crea un Estado liberal oligárquico que mantiene una función meramente normativa (Juntas, Consejos). 3) En la segunda mitad del siglo XIX se consolida el Uruguay moderno y capitalista, liberal y mercantil, con un Estado que sigue siendo oligárquico y mantiene funciones normativas. Aparece la Universidad, como institución estatal que monopoliza la formación e investigación médica. 4) Con el inicio del siglo, el Estado liberal y democrático asume funciones asistenciales directas y extiende sus atribuciones normativas. Coincide con la revolución industrial y la consolidación del paradigma médico científico y clínico y la medicalización de la sociedad civil