Exam 1 review (lecture 2)

Young nation years (1776-1865)/19th century (1800s)

Healthcare values & practices

Urban vs Rural health

Self reliance

Many theories of disease causation:

Contagion:

Supernatural cause:

Proper personal behavior:

Miasma:

Humoral (Humoral Theory):

• Contagion: being near others with illnesses

• Supernatural cause: God/religion

• Proper personal behavior: smoking/drinking/etc

• Miasma: environment

• Humoral (Humoral Theory): imbalance of the humors = disease

  • The body contains a mix of four humors (fluids): black bile, yellow bile, blood, and phlegm

  • To restore health: purging, blister, bleed, bloodletting, leeches

Major medical discovery:

Other medications used were:

Late 1800s:

anesthesia

Other medications used were calomel, rhubarb, opium, medicinal alcohol, quinine

Late 1800s: ether, cocaine, aspirin, codeine, iodine

Quackery:

Quackery: term to denote patent medicines deemed to be dangerous and/or fraudulent in their claims

Typical patent or quack medicines were marketed in colorful distinctive bottles.

Transformation of the hospital

Transformation of the hospital

• Increase in hospital construction (late 1800s post civil war)

• New types of hospitals: tuberculosis sanatorium, children, mental

• Improvements: lighting, ventilation, supplies and instruments

• More hospitals overall

Transition from healing arts to

science of medicine

Practicioners

orthodox vs sectarian

Practicioners

Types of “physicians”

Heroic medicine:

Heroic medicine: draconian medical practices in the 18th/19th centuries that included bleeding, blistering, purging, and the use of mercury/arsenic-based medicines

Sectarian medicine:

• Thromsonianism:

• Hydropathy:

• Homeopathy:

• Electicism:

• Temperance:

• Kellogg/Graham:

Sectarian medicine:

• Thromsonianism: botanical medicine

• Hydropathy: water therapy

• Homeopathy: use of plants, minerals or animals in “infinitesimal” (very small) doses to stimulate body’s own defenses

• Electicism: combination of therapies above

• Temperance: movement for no alcohol

• Kellogg’s corn flakes/Graham crackers

Financing

Financing

• Some insurance towards the end of the 1800s

• Covered accident and/or sickness

• Wasn’t like todays insurance, as most people didnt have insurance

Government involvement

Government involvement

• Similar to colonial times

• Lack of legislation regulating patent medicines, wasn’t addressed til Pure Food and Drug Act (1906) due to quackery, making sure everything in bottles was safe and accurate.

Early 20th century (1900-1945)

Healthcare values & practices -> boom of the medical sciences

Flexner report (1910):

More drugs:

• WWI -

• 1920-30s:

• Antibiotcs and sulfa drugs were…

Healthcare values & practices -> boom of the medical sciences

Flexner report (1910): evaluation of 157 med schools in US and 8 in Canada based on different criteria

More drugs

• WWI - epinephrine

• 1920-30s: insulin, antibiotics, and sulfa drugs

• Antibiotcs and sulfa drugs were the first drugs to bring real improvement in morbidity (decreased the number of days sick)

Practicioners (early 20th century)

• Heroic medicine was …

Practicioners (early 20th century)

• Heroic medicine was rejected

• Sought private, paying patients from the middle to upper classes

Finance early 20th century

Finance early 20th century

• More insurance

• Private insurance plans, bluecross - hospitals, blue shield plans (1930) - physicians

Government involvement (don’t worry about years, just know these were in the Early 20th century)

• Increased role of …

• Federal government:

• Legislations:

Government involvement (don’t worry about years, just know these were in the Early 20th century)

• Increased role of government policy making at the local, state, and federal level

• Federal government: US Public health service

• Legislations:

  • Pure food and drug act, Sheppard towner maternity, infacy act, national cancer act

• National institues of health (NIH), veterans administration (VA)

America since 1940

Healthcare values and practices

WWII had a…

Hill-Burton Act of 1946:

America since 1940

Healthcare values and practices

WWII had a medical aftermath, as there were international medical consequences. There were new trends related to healthcare, new patterns of disease, and advancements to prolong lifespan.

Hill-Burton Act of 1946: Hospital boom

Federal funding for assisting in construction of new hospitals/health centers

America since 1940 Practicioners: changes in …

Practicioners: changes in demographics

Financing since 1940

Financing since 1940

• Most people finally get health insurance

• Growth of private plans (Blue Cross, Blue Shield)

• Medicare/Medicaid

• Health Maintainence Organization (HMO) act -> prepaid healthcare and managed care, essentially healthcare for employees

Government involvement since 1940

• Health Insurance Portability and Accountability Act (HIPAA) -> privacy

• Obamacare -> tried for universal healthcare coverage

Health: definition

Health: state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.

Health demographic trends*

Most important trends throughout the 20th century were

Health demographic trends*

Most important trends throughout the 20th century were

1. Decline in infant mortality rate

2. Increase in life expectancy

3. Changes in causes of death and disease (1900s was infectious diseases, 2000s are chronic diseases)

Healthcare system developed for acute disease (fix/leave, not chronic)

21st century focus on health promotion and disease prevention

Health demographic factors*

Health demographic factors*

1. Changes in standard of living/lifestyle

2. Advances in public health measures

3. Progress in medical practice, including therapeutic interventions in treatment of patients