Medical Humanities - Week 2

Dr/Patient Relationship (chap 1) + constructing disease (chap 2)

whiggism

represent history of medicine as a triumphant, linear march of progress

presentism

bias in medical history —> evaluate past procedures, knowledge, and figures through modern lense and standards

relationships with doctors and patients always changing

there’s never been a single definition

hippocrates

460-377 BCE (pinacle of ancient Greek medicine)

Island of Cos/Asia Minor

lived during golden age of Greece

observation, diagnosis, prognosis

teaching done under sicamore tree

hippocratic corpus

collection of 60 diverse texts written by others

health is equilibrium, disease is disequilibrium (restoring balance)

hippocratic oath

moral values that guide/shape medicine

not much known about who wrote or followed it THEN but we follow it now

framework:

• privacy and confidentiality of patients

• no sexual contact/exploitation

• conceal truth from patients/promise cure

separated medicine from superstition

Galen

131-201 CE, Roman era, from pergamom (Turkey)

adopted/revised hippocrates legacy (not shy or humble) —> 350 texts = foundation for learned medicine

wrote 600 treatises, his writing influenced medicine for 1500 yrs.

“above all, do no harm”

father had a dream of Asclepius (your son needs to be a doc) “prince of medicine”

doctor to gladiators - he wasn’t the one making the cuts, just observing

• De Usu Parts (on the uses of the parts of the body)

treat quality with its opposite (believed in bloodletting)

christian era (early hospitals)

Roman emp. sanctioned Christianity 313 (by constantine)

Hippocratic+Galenic+Asclepius = 1 framework for medicine

AGAPE - obligation of love = communal obligation to care for the sick (caring/hospitality OVER curing)

church sponsored institutions (hospitals)

doctors in 2 categories - (women excluded)

1. trades people

2. clerical (elite) practitioners

learned by apprenticeship/went into family of other doctors

Hildegard of Bingen

1098-1179, woman, abbess of Rupertsberg (Germany)

practiced medicine and wrote medical texts

one of the first people to talk about veriditas (greenness, greening power of life, vitality, and growth—human bodily ability to heal)

significance of Florence

celebration of classical traditions of Greeks/Romans (purify European culture by returning to origins) —> bc of booming trade market/wealth

knowledge became more available bc/ of printing press (1440)

autopsy

seeing for ones self

Andreas Vesalius

(1514-1564) quirky/obnoxious man

center for medical learning now in ITALY (Renaissance)

critique on Galen’s anatomical findings (taken from animals, not humans)

ppl. were diehard followers of Galen so they wouldn’t budge on ideals and thought the BODY was wrong not the man/interpreter

BOOK: De Humani Corporis Fabrica Libri Septem (On the Fabric of the Human Body in Seven Books) — pictures on book are wood cuttings, not done by him

background of modern medical ethics in Britain

no regulations on who could be a doctor (if you could pay you could get one)

test subjects acquired from the lower class, often without consent

eventually shifted to whole person care (John Gregory, university of Edinburgh)

Thomas Percival

1740-1804

1st appearance of ‘Medical Ethics’ as a term (1803)

jumpstarted ethics: Dr. respects patient

American Medical Association creation…

1847

adopted code of ethics based on Thomas Percival’s writings, called “AMA code”

The Doctor

(1891) painting by Sir Luke Fields

Tate Museum, London

had child who died on christmas day

rise of university trained doctors and hospitals

no physician post-1925 would graduate from med. school without hospital training

new tech, trained staff —> hospitals became imp. in urban American life

Sir William Osler

professor of medicine at Johns Hopkins (1849-1919)

founded Johns Hopkins Historical club (brought humanities into medicine)

“good physician treats disease, great physician treats patient”

Francis W. Peabody wrote what…

the care of the Patient

“for the secret of the care of the patient is in caring for the patient”

beneficene

act of doing good, showing kindness, taking action to improv welfare of others

primum non nocere

first, do no harm

founding principle of medical ethics, obligation of doctor to avoid hurting patient

Hypochondriac

Amy Bennett - painting (small)

Asclepius

believed to be an actual man (medical god of medicine)

asclepian temples! > ppl would make pilgrimages to these medieval sites, hoping for healing dream (healing snakes present)

symbol = staff with a snake

sacred snakes = non venomous, whispered secret of healing in asclepius’s ear

belief that disease was because of divine visitation

daughters of asclepius

Hygeia = health/where our word hygeine comes from

Panacea = cure all (mortar + pestal)

miasmatic theory/miasma

disease from poisonous swamp vapors (major theory before germ theory)

miasma - bad air, punishment from God

leprosy

‘hansen’s disease’ / bibilical disease

disappeared around 1300

people affected = considered disgusting/offensive to God

caused by mycrobacterium leprae

Leprosariums in Louisiana and Hawaii

bubonic plague

‘black death’ rodent disease, microorganism infects rats

1347, Europe, ~20 million people killed (1/3-1/2 population killed)

3 types

bubo

swelling in neck, groin, or armpit

Paracelsus

Swiss, “father of toxicology” // alchemist, 1493-1542

actual name: Theophrastus Bombast von Hohenheim

humoral theory (proposed chemical substances), cure by similitude

medication = poison

syphilis

known as ‘the pox’ or ‘the great pox’ (not smallpox), early 1500s

killed 980,000 indigenous people (when columbus got to the new world, he also brought it back to europe)

syph = sexually transmitted disease (spirochete org. treponema pallidum

demiurge

fundamental idea of creation/monotheism

architect who built the perfect machine of the body

an artisan-like creator, a subordinate god, or a shaping force responsible for fashioning and organizing the physical universe

lancet

surgical tool used for centuries (often bloodletting)

more modern finger pricking version

scientific revolution + enlightenment

empirical data + power of human reason

careful repeated observation = new knowledge (Francis Bacon)

William Harvey + book by him

English! 1578-1657 (using quantitative methods for one of the first times)

proved heart func. as a muscular pump

De Motu Cordis - (1600s) of the motion of the heart, overturned Galen ideals

Nosology

William Cullen developed disease classification/naming (treating disease as real entities w/their own distinctive signs)

Giovanni Battista Morgagni

1660-1723

On the seats and causes of disease investigated through anatomy - (De Sedibus et causes morborum oer anatomen ind.) = based on 700 autopsies

“symptoms are the cries of suffering organs”

“Ubi Est Morbus” - where is the disease

CLINICAL OBSERVATION (transition from looking at natural (person to person) to normal (statistical)

Rudolf Virchow

GERMAN! 1821-1902

“think microscopically”

“every cell from a cell” - omnis cellula a cellula

cell theory of disease (expert w/ the microscope)

Edward Jenner

developed vaccines for smallpox

Louis Pasteur

microorganisms cause disease (pasteurization solves a lot of problems)

“chance favors a prepared mind”

Robert Koch

discovered bacteria causing TB, cholera, etc.

humoral theory

4 distinct bodily fluids in charge of health, disease, and temperament

disease understood as disequilibrium, an imbalance

to restore balance: purge or strengthen

blood

air

hot + moist

sanguine (optimistic/cheerful)

spring

childhood

liver + heart

phlegm

water

cold + moist

phlegmatic (calm/cool/collected - not easily upset)

winter

old age

brain + lungs

yellow bile

fire

hot + dry

choleric (extremely irritable/angered)

summer

young adulthood

gall bladder

black bile

earth

cold + dry

melancholic

autumn

middle age

spleen

tuberculosis

known as phthisis, consumption, white death

epilepsy

sacred disease

hippocrates believed it wasn’t any more special than any other disease

alexander flemming discovered what, when?

penecillin, 1928

scottish scientist

his life (1881-1955)

epidemiologic transition

1900—>2006 avg. age of death 41—>78

decline in deaths from infectious diseases, gave rise to an aging population (aka chronic/degenerative diseases)

late 1950s drug cos are mass prod. antibiotics/drugs (1940 first antibiotic dev. for use)

medicalization

transforms human problems into diseases/disorders and brings them under the jurisdiction of medical diagnosis/treatment

ex) childbirth, menopause

diagnosis req. before help is received

first medical school

university of pennsylvania

then…

• kings college (aka columbia uni)

• harvard med school

• johns hopkins

Giovanni Boccaccio

commentaries about black dearth

quarantine

comes from word for 40 days (comes from venice)

3 types of bubonic plauge and what they were associated with

3 types (yersinia pestis)

-bubonic (lymph)

-septicemic (bloodstream)

• pneumonic (lungs)