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 Post subject: The Swiss San
PostPosted: 01 Sep 2017, 16:11 
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The Austrian San seems to be largely for TB treatment, although they also treat Mlle Lepattre's unspecified condition, but is it ever made clear exactly what the set-up in Switzerland is? Frank Peters specialises in treating arthritis, and, whilst we're never told exactly what Phil Graves and Eugen Courvoisier specialise in, it would be too much of a coincidence even by CS standards if both Hilary and Biddy were involved in lake-rescue incidents with TB specialists :lol:. It seems to be more of a general private hospital: Phil is called out to treat a smallpox case in Theodora , and Naomi's back problem is treated there in Trials. As the incidence of TB in the West declined, it'd make sense for them to treat other conditions there too, but it never seems to be very clear :roll: .

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 Post subject: Re: The Swiss San
PostPosted: 01 Sep 2017, 16:59 
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Mary Lou's and Grizel's back injuries are also treated there. It does make sense that they should develop a sideline in treating injuries of that type, since climbing and winter sports injuries were likely to be quite common. Less sense that Jack and the other doctors seem to turn their hand to everything, rather than having someone who is a specialist in spinal injuries/orthopaedics.

Nina Rutherford was taken there after she was involved in an accident.

They seem to have done obstetrics - Cecil is born there. Are we told where the Graves, Courvoisier and Rosomon babies are born?

And Kathie Ferrars had her appendix out.


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 Post subject: Re: The Swiss San
PostPosted: 01 Sep 2017, 17:19 
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A good amount of hospitals change their use over time. The hopital where I was born was originally a military hospital, built in the 1st World War. It stayed as a military hospital until after the Second World War, when it became a civilian hospital that also had a special unit, and research facilities, for juvenile arthritis. Maybe Phoebe Peters could have stayed there :D It also had a large training facility for midwifery in later years.

But yes, as TB cases were in decline, the San would have turned into something else - had to, or it would have closed down. Mind you, the amount of CS people that ended up needing medical treatment, maybe that would have been enough to keep it open......


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 Post subject: Re: The Swiss San
PostPosted: 01 Sep 2017, 18:00 
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The main hospital for the north of Scotland was originally built as a military hospital during World War 2. We also had a small hospital for TB/infectious diseases but this has long since closed.

The site of the Swiss San was a hotel which had closed down as tourism moved away from the platz. However, as people started to go abroad in greater numbers and Switzerland became well known as a tourist/winter sports centre, surely that would have attracted increasing numbers to the area and a general hospital would have been necessary?

I don't understand the lack of specialisation but that would have made it easier for EBD.


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 Post subject: Re: The Swiss San
PostPosted: 01 Sep 2017, 18:45 
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The Platz doesn't sound like an ideal location for a general hospital IMO, on an isolated mountain shelf. The clientele can't have been that large for the non-TB departments, as why would someone from say Interlaken go there when there was likely to have been the same sort of facilities in the city itself? It was fine when they were mainly catering for TB, where it's a suitable climate and they have people coming from all over Europe, but I can't see it surviving for long after the TB rates dropped, unless they focused more or less exclusively on treating climbing accidents and that sort of thing, but even that doesn't seem likely to be sustainable.

As for why Frank Peters ended up there when he was a rheumatologist, God knows. I hope their chalet had decent central heating or poor Phoebe would have had a hell of a time with her rheumatism during those Alpine winters. I think EBD just ended up forgetting that she'd initially made Frank a rheumatologist and in the Swiss books promoted him to be a specialist in everything, like Jack and Phil. :D

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 Post subject: Re: The Swiss San
PostPosted: 01 Sep 2017, 19:48 
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I don't think there is any need to worry about the heating in Swiss houses, even at that time. The house will have been well insulated, and draught-proofed and the heating will have been exemplary, whether central or not. Even the oldest of Czech houses have a form of double window that ensures heat stays in, even in the coldest weather. The Swiss were even better at it than the Czechs.

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 Post subject: Re: The Swiss San
PostPosted: 02 Sep 2017, 04:34 
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Hi,

A lot of their TB cases are referrals from the UK like Alex Rutherford, but as someone has said, they couldn't keep that up for long. So I always saw the Swiss San as specialising in TB but primarily being a general hospital looking after broken bones from skiing accidents etc

Though the question arises of what Jem's San specialised in, if anything. Wouldn't it have been easier for people like Alex to go to the Welsh San rather than Switzerland?

cheers,
Joyce

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 Post subject: Re: The Swiss San
PostPosted: 02 Sep 2017, 08:20 
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Switzerland was supposed to be better because of the Alpine air, and the Rutherfords were well able to afford it ... although Miss Bubb clearly wasn't, and it would have been a lot more sensible for her to have gone to the Welsh San. I know that people from this area (North West England) used to be sent to Wales for treatment for TB, but it was considered better to go to the Alps if you could. It wouldn't just have been about money: not everyone would have wanted to take the whole family abroad, or for the breadwinner to be able to leave their job.

I'd think that the Welsh San also moved into other areas of treatment. It must have been doing that already, if Frank Peters was working there before moving to Switzerland.

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 Post subject: Re: The Swiss San
PostPosted: 02 Sep 2017, 09:00 
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Alison H wrote:
Switzerland was supposed to be better because of the Alpine air, and the Rutherfords were well able to afford it ... although Miss Bubb clearly wasn't, and it would have been a lot more sensible for her to have gone to the Welsh San.

Miss Bubb doesn't actually go to Switzerland for San treatment. She goes there because she realises that the air is more beneficial for her and only ends up in the San when she doesn't look after herself properly. Stupid woman. Of course she could (and possibly should) have gone to Wales but would she have wanted to be so close to the place of her more disastrous career moments? :lol:
In any case she is really only a plot device and as a reader it is good to have loose ends tied up even with characters that we are not supposed to be very sympathetic to. Half of what EBD writes about the San doesn't make logical sense but the San is part of the CS world and we have to accept her descriptions. She is very unrealistic at times, I agree, but she was writing for a schoolgirl audience.


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 Post subject: Re: The Swiss San
PostPosted: 02 Sep 2017, 20:27 
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They must have been doing a lot of important research and trials at the Sonnalpe, because bigwig doctors from Austria, Britain, Germany and elsewhere were always visiting, but I can't remember that ever happening in Switzerland. (Or maybe we just don't hear about it because they didn't stay at Freudesheim, word that they were likely to be jumped on by a badly-behaved dog having reached their ears in advance :lol: .)

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 Post subject: Re: The Swiss San
PostPosted: 04 Sep 2017, 13:22 
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One of my colleagues spent most of her childhood in a hospital in the Alps being treated for Asthma, and I know some of the sanatoria switched over to offering more general care for people with allergies and breathing problems.

My personal belief is that the San turned into a specialist centre for mountaineering and injury rehabilitation. The sort of place you went after life-changing injuries and relearnt not just how to walk but how to climb again


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 Post subject: Re: The Swiss San
PostPosted: 05 Sep 2017, 00:48 
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I can't see the San becoming a general hospital because of it's location. It's ideal for a TB hospital - altitude, and fresh air, and out in the countryside - but it's too inaccessible for other uses. Unless a patient came from the Platz, it would make more sense to go to town, because otherwise they'd likely have to go down from their mountain shelf and then back up again, because of the geography of mountain roads.

From a general medicine perspective, I could see at most having a local clinic with a GP and maybe a nurse, who could handle the usual run of doctor stuff, and maybe set simple breaks, operate for appendicitis and deliver babies. Anything serious would be sent down by ambulance.

I suspect EBD assumed that doctors could easily switch from being TB doctors to other specialities (operating on Naomi and fixing her back, for example), or from general practice to TB work (like Laurie). I'm not sure how true that would have been, as medicine has become increasingly specialized with time. At the beginning of the series, it maybe makes sense that Jack would come out as a general junior doctor, and learn TB work on the job, but maybe not so much that Laurie, a GP, would be hired for speciality work without further training.

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 Post subject: Re: The Swiss San
PostPosted: 06 Sep 2017, 23:28 
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jennifer wrote:
I suspect EBD assumed that doctors could easily switch from being TB doctors to other specialities (operating on Naomi and fixing her back, for example),...

Expertise in back surgery would have been critical at a TB hospital, given how common it was in treatment of the consequences of spinal tuberculosis. "Tubercular hip" and related ailments would likewise have called for orthopods, so it always made sense to me that the San doctors were fully competent in bones as well as lungs. That's something I think would have been common knowledge in the twenties and thirties, when EBD started the series and my family was still losing members to the disease. However, the San doctors did seem to include better than GP skills in many other areas, e.g. Dr. Peters' cutting edge rheumatology. Maybe it's just that patients with TB were likely to have other problems as well? I know there's some evidence for increased TB susceptibility among those with rheumatoid arthritis, but that may be a modern phenomenon linked to steroid treatments of the arthritis.

My guess is that the post-TB San, because of its location, would have become less a surgery center than an upscale locale for long-term rehab of conditions requiring extensive physical/occupational therapy. Patients and their families would demand a full medical staff and enough distractions to keep them as cheerful as possible under the circumstances.

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