In 1994 the head of the information department of the Amsterdam Medical Centre (AMC) and Professor Urbanus, then chairman of the board of directors of this academic hospital, came up with the idea about a written history of the AMC. After some fund raising Annet Mooij, a freelance historian who lives in Amsterdam and wrote a Ph. D. about venereal diseases, was asked to write a book about the AMC and its predecessors, patient care and medical teaching and training at the University of Amsterdam. The book, entitled 'De polsslag van de stad Amsterdam' was published in Dutch in 1999 and an English translation appeared in 2002.
Amsterdam as pars pro toto for Dutch medical historyThis book deserves attention, as it fills a gap in the Dutch history of public health and health care. As a matter of fact, we are in need of an overview of Dutch medical history. Professor J.K. van der Korst wrote a short synthesis ten years ago, but his book has been sold out already for a long time and you can even hardly find it in the second hand circuit., The book was not appreciated by everyone, some experts thought that it was too much centred on doctors. A lot of publications have appeared since then, so the need for an overview has increased considerably. Doctors of Amsterdam deals with Amsterdam, of course, but it gives the reader much more, as the author preferred a broader view on medical history and added a lot of general medical history. Amsterdam, can be considered as a pars pro toto as important developments in the Netherlands often started in Amsterdam and with some exceptions medical innovations very often spread from there into the country. When the Dutch Association for the advancement of Medicine was founded in 1849, Ramaer -who took the initiative- came from Zutphen, a provincial town in the eastern province of Gelderland, but almost from the beginning the doctors from Amsterdam took the lead and according to the statutes the association's secretary had to live in Amsterdam. After 1945, however, the situation changed: Amsterdam became a part of the mainstream of medical history. From now on all innovations came from across the Atlantic and medical research became an international affair.
Tremendous expansionMooij's book covers more than the title promised, but she omitted some important parts of the health system. Patient care has been restricted to hospital care in the three main hospitals: the Inner Hospital, which is the oldest, the Wilhelmina Hospital and the AMC. The hospital of the Free University and the connected medical training, which started in 1950 have been omitted either. General practice, especially for the period after 1900, midwifery and preventive care were excluded. The author acknowledges that she did not write from the patient's perspective, although leading researchers have been stressing the importance of that view the last decade. I would like to comment that there is a wide gap between this wish and reality, as a tremendous lot of research in archives needs to be done yet and a lot of interviews have to been taken before we can write that history. The cause of these restrictions may haven been the wish of AMC that ordered, financed and coached the whole project.
If you want to prevent that a huge mass of facts has a bewildering effect on the reader, theories are necessary and clarifying. Mooij used the theory of the sociologist Terence Johnson who presented a sequence of three stages: client control until about 1880, colleague control between 1880 and 1975, followed by third party control after 1975. Another line is integration of patient care, training and research, who came together in the AMC when it was officially opened in 1984. These three elements of good health care had been separate until then in Amsterdam, as laboratories, university and hospitals had their own location. All these little worlds merged into the AMC and after a difficult period full of conflicts the AMC seems to function quite well nowadays.
The book consists of five parts that have subdivided in 15 chapters. Part 1 deals with the period 1650-1730 when Amsterdam was a prospering and powerful city with a lot of physicians and even more surgeons. Part 2 entitled 'Dark days and Enlightenment' deals with the period 1730-1815 followed by the more promising period 1813-1880 in part 3. Things really changed in a short period (1880-1945) and deserved a separate part 4 entitled 'Independence gained'. Part 5 is entitled 'Expansion and Circumscription' and deals with the period 1945 until 1999. The health care system expanded tremendously, the state intervened from ca. 1980 and the control of hospitals was taken over by a new class of professional managers.
Real change around 1880Before 1865 the medical market was relatively free despite the existence of guilds until 1808 and some regulation of the city government. Fierce competition caused frequent personal conflicts and the wealthy patient could order what he liked. The decline of the Amsterdam economy had some nasty consequences: creation of monopolies, strife and privatisation of medical training. The Roonhuysian lever, a tool used at complicated deliveries, was an extremely profitable and successful attempt to create a medical monopoly. Mooij made a special study in the numerous spectatorial magazines, that were very popular in Dutch society in the eighteenth century and are suitable as a source of patient's beliefs and attitudes. The author is rather pessimistic about the results of the movement of hygienists in the middle of the nineteenth century.
The real change took place around 1880. Municipal government took the lead and after a long discussion the construction of a new hospital outside the old city finally started in 1890. It grew into the largest hospital in the Netherlands with 1.700 beds in 1919. Between 1880 and 1945 the social status and the power of the physicians increased and the professors of Amsterdam University behaved like prima donna's on the stage watched with admiration by very dependent patients. Some surgeons could cut away from the body what they liked and doctors became Divine Providence (p. 305-306). After 1945 the status of physicians, especially of the GP's declined, and the patient started claiming. Annet Mooij pays much attention to women in medicine and to demand for medical care. In her final observations she gives a interesting philosophical view on medical history, seen from the year 1999 backwards.
Some critical notesI would have started this book in the Middle Ages instead of 1637. The creation of the Collegium Medicum Pharmaceuticum in 1637 after a disastrous attack of the plague, was not so new as it seems to be, as physicians already had some supervisory powers in the sixteenth century. A lot of interesting documents are to be found in the three volume source publication by Mr. J.G. van Dillen that covers the period 1500-1672.
The last fifteen years of the book are rather superficial and I missed some developments that should not have been omitted like medicalisation of society, the rise of a claim culture, life inside the hospital's walls and the rise of insurance medicine from 1880 onwards. I can recommend this book to everybody without hesitation, because the author has succeeded in giving a truthful and entertaining survey of Amsterdam medical history seen against the background of Dutch medical history. It has been a very good idea to translate it in English, so not only Dutch and Flemish people, but also people from other countries can read about Dutch medical historiography.
Annet Mooij provided her book with notes, a bibliography, a list of archival sources and people interviewed by her and a mixed index, so the result is a well accessible book.