Hist Sci 212 Final UW Madison

Why are urban epidemics on the rise?

Rapid urbanization and population growth

innoculation

vaccines containing the virus within itself

Onesimus (D. 1770)

An African man who was kidnapped and taken to America, told Cotton Mather about his vaccination, who told the Royal Society

Edward Jenner (1749-1823)

Developed method for smallpox vaccine using cowpox prevention methods

Cholera

fecal contaminated water

Shows up in Europe ~1830, TERRIFYING disease, quick and painful death

1854 London epidemic

John Snow (1813-1858)

came up with the idea of contaminated water as a cause of cholera by mapping out the epidemic and tracing it to water pumps and wells

Ignaz Semmelweis (1818-1865)

Works at Vienna general hospital, notes high death rate of women following birth

Gets the idea of medical students contaminating the bodies(puerperal fever)

Institutes handwashing protocols, death rates drop

Joseph Lister (1827-1912)

Surgeon, works in Glasgow

Talks about putrifaction(infection)

Gets the idea of killing bacteria from Pasteur, made surgery way more survivable with aseptic technique

Antonie van Leeuwenhoek (1632-1723)

extremely skilled at creating optical lenses, he was the best of everyone

Friedrich Henle (1809-1885)

anatomical pathologist

On Miasmas and Contagions (1848), he thinks that there are living contagions and that it's associated with disease, and a specific disease(basically germ theory)

Louis Pasteur (1822-1895)

Chemist, starts in agriculture/fermentation

He makes the connection that a particular kind of yeast produces the right thing, he then makes up pasteurization

Works on diseases of animals and vaccines

Created anthrax vaccine for sheep, chicken cholera vaccine,

Got a lot of press for rabies vaccine research

Attenuated viruses to create vaccines

Vaccinated a German child, who lives, which has never happened before

Robert Koch (1843-1910)

Connected to idea of the living contagion, awarded Nobel for identifying tons of microorganisms that cause disease

Developed solid culture media

uses dyes for identification

Koch's Postulates

four things he uses to identify a microorganism

1. Found in all cases of disease

2. Isolated in pure culture

3. Capable of causing disease in new host

4. Re-isolated from new host

Regular medicine around 1800

regular means aligning with European styles of medicine

Doctors don't need training, a Wild West of physicians

No change in therapeutics

Training in the 19th Century

Apprenticeships are the main path to medicine

College of Philadelphia 1765 is the first real medical school

Rush Medical College 1837, schools are competing for students

Irregular vs Regular

irregular: nonconventional, barber surgeons apothecaries herbal medicine etc. more accessible to non-white non men

regular: university-trained doctors, mostly white men

Homeopathy

giving diluted quantities of the disease that is happening(like cures like), reaches height in 1880

American Medical Association (1847)

standardizing medicine

Sets a national agenda

Extremely powerful lobbying group

Purges irregulars

Does investigations

Elizabeth Blackwell (1821-1910)

The first women to get a medical degree in the US

Goes to the Geneva medical college

Opens the first women's hospital-> space where women can train

Mary Putnam Jacobi (1842-1906)

Part of the 1900s trend of women entering medicine

Female medical college of Pennsylvania

Interested in laboratory medicine, dissection, and scientific research

Early nursing

things happening at home from relatives or household staff

Urbanization raises the need for nurses

Early 19th century has volunteer charity nursing organizations

Mrs. Sarah Gamp

a caricature of a nurse; seen as old, ignorant, dirty, and drunk

Mary Seacole (1805-1861)

Learned medicine from her mother, born in Jamaica

Travels to the Crimea and opens a hospital there for wounded British soldiers during the Crimean War

Florence Nightingale (1820-1910)

Schooled in her youth, trained with a pastor

Started a mini nursing organization for women

Travels to the Crimea, provides sanitary methods for their Scutari hospital, keeps records of cause of death

Works with statistical methods to publish the data, big proprietor of sanitary practices

Gets a lot of press, opens a training school

US Civil War (1861-1865)

tons of disease, tons of destroyed infrastructure, beginning of US sanitary commission

Clara Barton (1812-1912)

Organizes field hospitals

Works with office of missing soldiers

Establishes the American Red Cross

Pennsylvania Hospital, Philadelphia (1751)

Ben Frank and Dr. Thomas Bond started with the goal of treating the sick poor, first hospital of its type, but not necessarily the first overall hospital in the Americas

Growth of Hospitals - Late 19th/Early 20th century

More people living in cities, more people need care

Towns building hospitals rather than churches building

Specific communities(ethnic/religious) making hospitals benefits both practitioners and people of those communities

Student/training physicians on the rise

Hospitals are expanding in size

Change in Audience - Late 19th/Early 20th century

Care is happening more in hospitals rather than in the home, which is causing worry in control of care and billing

This causes them to focus more on the money of the rich and takes away the focus on the poor

Amenities and modern fancy science to attract the rich

Surgery in Hospitals - Late 19th/Early 20th century

Lister's aseptic technique helps makes surgery more survivable, new anesthetics, safer and less painful

Nurses doing labor makes it easier

Surgery is becoming more central to medical care, more professional and on level with physicians

The X-Ray

Wilhelm Rontgen(1895), discovers x-rays can go through flesh to see bones

Big public interest and part of the spectacle

Very expensive to hospitals but it attracts paying customers because less painful

Johns Hopkins University and Hospital

Funding a hospital is very tough, rich women help but they make them require a bachelor's degree and to admit women

Abraham Flexner

Carnegie Foundation for the Advancement of Teaching

Works with AMA to make a standard medical school curriculum

Flexner Report(1910): admission requirements, facility size/training, endowment/tuition, labs, presence of a teaching hospital. Basically just hates on all schools but Hopkins

Makes it more elite and hard to get into medical school

United States Public Health Service (1912)

Merchant Marines need people to monitor them and disease control

Also municipal health departments being formed(food/water safety, outbreak of disease, etc.)

Tuberculosis(identified by Koch)

Extremely deadly

Allowed to find out how disease spread

Sanitoriums

Trudeau founded the Lake Saranac sanatorium for TB

The Tuskegee Institute

Civic minded women organize themself into a women's club that do civic service

Created a settlement house

Lillian Wald (1867-1940): Public Health Nurse

Henry street settlement, focused on the health of the community

Managing over 200 nurses, did political organizing as well

Sheppard-Towner 1921: act that helped with Maternal/Infant mortality

Early 20th Century Therapeutics

There's been a large change in recent years, therapeutics are becoming standardized, humoralism is falling even more out of favor

Because of laboratory research, invisible causes come into favor, also bringing invisible cures

Laboratory research is seen as the basis of the medical field, so therapeutics are wanted to go through them

Proprietary vs Ethical Medicine

"Proprietary" medication: concocted by a person and advertised, not really advocated

"Ethical" medication: approved by AMA, on US Pharmacopia, prescribed through a doctor, cemented as the better option by the amount of successes

Paul Ehrlich (1854-1915)

coined the term Magic Bullets

Magic bullets: laboratory research developed treatments that kill microorganisms without hurting the host

Does research with dyes(Koch), studies bacteria and the toxins they produce, discovers chemical immunity(features on membranes can attach to toxins, help immunity)

Researches treatment of protozoal diseases(malaria, sleeping sickness, etc.) using chemicals, develop a syphilis treatment using an arsenic compound called Salvarsan

Sulfonamides

first reliable antibiotics

Discovered by Gerhard Domagk

KL730(1935) has antimicrobial properties in mice, and it later takes off

Very effective against strep and staph bacteria, which are the most prominent in diseases

Alexander Fleming (1881-1955)

scottish, penticillin

Where fungus grows, staph does not. Discovers that it cures most gram positive and doesn't harm red blood cells

Difficult to isolate and come by

Mass production because of military need, Big Science

By 1930s, two scientists have collected enough to do a mouse trial, super successful

1941 first trial, super successful, 1942 trial in the US

By 1943, theres enough penticillin to treat all of the Allied troops

Rise of Food and Drug Administration (1930)

1906 Pure Food and Drug Act: banning mislabeling

1938 Food, Drug, and Cosmetics Act: ensures drug safety and prescription only basis

1951: Durham Humphrey Amendments: creates distinction between prescription and OTC

1962: Drug Efficacy Amendment: pharm companies have an obligation to demonstrate safety and that their drug does something before it goes to market

Between 1930-1970 more drugs become prescription

Diuril

first specific antihypertensive drug

Changed from diuretic to antihypertensive for marketing

American Gynecology

Enslaved women need a ton of medical reproductive care(environment)

18th century begins medical experimentation on enslaved people

James Marion Sims(1813-1883) established first hospital for slaves, operated on enslaved women, also exploited their labor for nursing care and domestic labor, sells hospital and opens the Women's Hospital in New York, experiments on poor Irish immigrants

Pellagra

a nutritional disorder that manifests as a skin disease

In 1912, 30,000 cases in the state of South Carolina alone, death rate 10%

Dr. Joseph Goldberg does experiments on 2 orphanages, adds nutrition to one place's diet and keeps the other the same. Repeats at a mental hospital for women

The Tuskegee Syphilis Study (1932-1972)

Oslo study: withholds treatment from 2000 patients

Medical scientists tend to think of black bodies as more susceptible to disease

Macon County, Alabama is very poor, so the USPHS decides to study there, recruit ~400 syphilitic men, ~200 without syphilis, track them throughout life, do autopsies when they die

Once penicillin comes around(1950s), the question of whether syphilis should be cured is answered, but they continue for another 20 years

Outright lying to people about what was happening in the study, did not give the treatment that they promised the individuals in the study(which lowered life expectancy)

A committee finds that they should have given penicillin when it came out, class action lawsuit is settled out of court

Tuskegee Syphilis Study Legacy Committee wants to gain reparations for all the damage caused

WWII and After

seen as a turning point in medical ethics

Nuremberg code(1947) for human experimentation, talks about consent/informed consent, tries to inform bioethics

Fernald State School: 1940s-1950s

School for kids with disabilities

Quaker Oats gave children food coated in radioactive isotopes disguised as a free breakfast

USPHS in Guatemala

Started at Terre Haute Prison, brought in infected sex workers, low success

John C. Cutler(head of USPHS) decides to give syphilis and gonorrhea to individuals(~1300) in Guatemala and not treat it

Darwinism

Charles Darwin publishes The Origin of Species (1859), popularizes theory of evolution and natural selection

Herbert Spencer- Progress, It's Laws and Conquests, influenced by darwinism

Competition and fitness are on the rise

Francis Galton (1822-1911)

Hereditary Genius (1869)

He wants to study families with geniuses

Coins the term Eugenics: the study of the agencies under social control which improve or impair the qualities of future generations

Progressive Era 1890s-1920s

Americans feel like old institutions can't keep up with the modern world

Social reform is on the rise, lot of optimism

Positive and Negative Eugenics

increasing and decreasing a trait respectively

A lot of contests at state fairs to promote positive eugenics

Negative eugenics means to get rid of unwanted things

Eugenics is rooted in agriculture and is familiar to rural people

Institutional Eugenics

American breeders association: wants to apply rural eugenics to people, publish the journal of heredity, became the American Genetics Association

1910s Eugenic record office is established, research and family pedigrees

The Jukes

1870s originally published, first multigenerational history of an American family, based in criminality, based on prison-guard word of mouth. Concludes that the Jukes are costly to everyone(institutions and medicine etc.)

Eugenics Laws

Marriage laws instituted waiting periods and medical certificates, outlawed interracial marriages

Immigration laws aligned with eugenic thinking, prohibiting people who were "likely to be a cost" USPHS and ERO ran public health at Ellis Island, 1917 congress includes people with disabilities, 1924 it further limits those people and also Eastern and Southern Europeans

By the time eugenics laws were stopped, ~63,00 people had been legally sterilized

Sterilization in Wisconsin

Compulsory sterilization law passed in 1913, first one happens in an asylum

Establishes a state eugenic board

~1800 sterilizations happened over the course of the law, were mostly of mentally deficient women

Buck V Bell, 1927

Emma Buck is a widowed mother of 3, works through charity and occasional prostitution, struggling a lot, daughter Carrie is taken away, she becomes pregnant

She is taken to the Virginia Colony for Epileptic and Feeble-Minded, her baby is given to her adoptive parents. In 1924 Virginia allowed forced sterilization of the feeble-minded.

Case goes to the Supreme Court, 8 to 1 decision to uphold forced sterilization

Eugenic Sterilization Outside of the Law

In the south, women(mostly women of color) experienced forced or coerced sterilization whenever they went to the hospital ~60% of women entering the hospital

Puerto Rico had an intense sterilization project, ~1/3 of Puerto Rican women had been sterilized, nonconsensual

Indian health services, 40-50% of Indian women being sterilized

19th Century Asylums

Heroic treatments(corporal punishment, humoral treatments, extreme confinement)

Pinel and the Tukes

Pinel works in Paris asylum, William Tuke worked in York, both knew someone who was hospitalized for melancholia and died, which encouraged them to work in mental healthcare, Tuke starts a retreat

- They both like "moral therapy" aimed at treating a person's mind rather than the body, both wanted to reduce the extremity of heroic treatments and increase normality

Dorothea Dix (1802-1887)

Lead the union nursing corp in the Civil War

Unitarian faith pushes her to moral therapy, visits the Tuke retreat

Travels to asylums, jails, alms houses, etc. to inspect conditions and see how people are being treated, writes to the state of Massachusetts

She says they need to create a hospital system rather than a confinement system, and she wants to separate criminals and the mentally ill

Does similar things in other states, she makes a huge plan but it gets vetoed, establishes 1 federal mental hospital

Government Hospital for the Insane/St. Elizabeths

First federal mental health hospital, emblematic of the reform going on in the 19th century

Following the Kirkbride plan, big popular plan for mental health institutions, restrictive for size though

Overburdened hospitals lead to

Mental Hygiene Movement

Optimism in the potential to revolutionize the field

Clifford Beers (1876-1943) - on again off again mental hospital patient, gets people to care about the mental hygiene movement because of his book A Mind that Found Itself, he got in contact with Adolf Meyer and Thomas W. Salmon and later founded the committee

National Committee for Mental Hygiene (1909)

Adolf Meyer

Thomas W. Salmon

Everyone in the reform movement was involved

Gets a boost around WWI because they were screening soldiers before they left for shellshock(PTSD)

Psychopathic Institutions

Associated with courts/existing institutions

Acutely ill people would go to curb the "infection"

William A. White (1870-1937)

American Psychiatric Association

American Psychoanalytic Association

National Committee for Mental Hygiene

Built up staff at St. Elizabeths, thought of psychopathology/psychiatry as a medical science

National Healthcare:

Started in Europe, Germany was the first one to have a national healthcare plan.

American Association of Labor Legislation

wanted to pass for medical benefits for family and death benefits, but didn't pass in the legislature.

Employer organization started to buy medical insurance plans

Red Scare: didn't want worker medical insurance

Great Depression:

October 29, 1929

10 million unemployed people

People can't afford to go to hospital so hospital admission rates are dropping

Government intervention: gave money to people to get people working and to get the economy to work again

Social Security Act (1935)

Private Insurance:

Starts to rise in the 1930s

Due to the great depression and because costs are rising

Hospital Plans:

Main type of service plans

Hospitals wanted a stable source of income and patients and so they started a service plan

You pay monthly fee and when you get hospitalized the hospitals will give you the service

The AMA did not like that because you could only get the benefits at the places you were paying your fee at

But the American Hospital Association (AHA) liked it and helped promote it

Baylor University Hospital: some Justin guy who later took over BUH started a non profit where teachers in the school district could pay a monthly fee and then get some number of hospitalization days for free

Blue Cross becomes the central service plan provider. Blue Cross is hospital centered — plans for the hospital

AMA started Blue Shield for specific physician plans

Kaiser Permanente and the Rise of Managed Care:

The first managed care system

Garfield is a California MD who established a small hospital targeted at labor who were doing labor work

He started charging worked 5 cents a day to cover the costs of running a hospital

All these labors worked for Kaiser Permanente

During WW2, he got a ship building contract. Kaiser decided to work with Garfield to come up with hospital plans.

There was a huge growth in people with private insurance between 1945 and 1950 (went from about 22% to about 50-ish%)

But there were also some critiques of managed care

Veterans Care:

Government offered pension before

The War Risk Insurance Act started in 1914 and had amendments in the 1917s. The amendment added medical care costs and that the federal government will provide medical aid for soldiers who were honorably discharged

Medicare and Medicaid:

Started in 1965

Medicare is compulsory and for the elderly

Medicaid is for the poor people

Both pay providers for services

Affordable Care Act (2010):

Added accountability measures for hospitals

Created mandates- both individual and employer mandates.

They also added that people could not refuse care due to pre-existing issues.

FRAMINGHAM STUDY, 1948

Growing concern of heart disease

1948 National Heart Act created National Heart Institute

USHPS + NHI did Framingham, studys atherosclerotic cardiovascular disease(artery clogging disease)

~5200 people between 32-60, every 2 years they do tests and answer questionnaire, track them over the course of their lives

In 1971 they add the offspring cohort, to study their kids, and in 2001 they add the third generation, and in the mid 90s they added the omni cohorts to expand the diversity of the original cohorts

Caused the first drug specifically targeted to one race, very big deal in heart research

Becomes the gold standard of epidemiological research

Diet-Heart Hypothesis

Ancel Keys in the first person in the States to link high cholesterol and heart disease

Begins the buisness and professional men's study in 1947, following 500 healthy men for 15 years to see their risk factos

Links the blood pressure, body weight, and high cholesteral toheart disease

Hypothesizes high-fat diets are linked with more heart disease, to confirm he starts the Seven Countries study in 1957, compares men from 7 different countries diets and cholesterals and rates of heart disease

His ideas caught on in large and by the 1950's were well-accepted by most heart researchers

Cholesterol: "A Target Awaiting It's Magic Bullet"

Identified in 1932, has roles in many biological processes

Cannot be controlled effectively, difficult to determine normal/healthy level

National Cholesterol Education Program, trying to reduce cholesterol over 300, then reduced the number to have 25% of adults in the high-risk zone, which led AHA to do the Know Your Number campaign to increase awareness

Statins- home tests for testing and treating high cholesterol, helpful for clinical research to connect high cholesterol and heart disease. They did Phase-5 trials(post marketing trials) to come up with more therapeutic indications for competitions between patents

Based on the phase V trials, there were new guidelines for high cholesterol

Risk Calculators

Online tests where you can input info and then they can prescribe you Statins if it thinks you need it

Treatment flowcharts guide decision making as well

National Cancer Institute

Established in an act in 1937, opens in 1939, independent research institute under USPHS

Public Health Service act(1944) happens and NCI moves to the NIH

Cancer Chemotherapy National Service Center(1955) clinical and laboratory research to treat cancer, find more than a dozen chemotherpic agents, specific success in childhood leukemia

Cancer is still a big public health issue and very scary

The War on Cancer - Richard Nixon

Pressure on the government to expand cancer research

National Cancer Act(1971) Nixon declares war on cancer, gives the director of the NCI direct access to the president, gives NCI power to develop national cancer plan, created cancer centers around the country

Naive because cancer itself is incurable, but very effective for research

NIH Revitalization Amendments(1993) specifically expands research breast and prostate cancers

Risk Factors

Early detection and risk management are huge parts of preventing deaths from cancer

Over the course of the 20th century the idea of breast cancer spread so far that every woman saw herself as an eventual break cancer patient

Risk calculators came into affect as well

Makes people feel they have more control or responsibility over their risk than is reasonable

Incidence rate = how many diagnosis, mortality is how many deaths

Cascinoma in situ, abnormal cell growth in duct stays in duct, argument on whether it's a risk factor or precancer or pathological entity

Research has identified 4 types of genetic breast cancer, which has disrupted the idea of a risk timeline applying to everyone

Mammograms

a cornerstone of early detection

Early clinical trials in the 60's, reduced BC mortality by 25%

Low rates of women in the 80's, late 80's it was added to medicare which raised the rates

False positives and negatives became a large issue in younger women

Awareness Campaigns

Pink everywhere. The goal is to get more women to get mammograms

Pinkwashing and carcinogens being within the products being used to increase awareness