Medical Sociology Chapter 2

Medical Sociology Chapter 2

Germ Theory
Many diseases can be traced to specific causes such as bacteria, viruses, parasites, and genetic impairments. Chief credit for discover of this is Louis Pasteur formulation of the germ theory of disease in the 1860s and 1870s.
Louis Pasteur
Germ theory.
First for of writing appeared between
4000 and 3000 BC
Supernatural Explanation of Disease
(Magico-religious)
Diseases were caused either by direct intervention of a god or spirit or through a sorcerer (a mortal in control of supernatural forces) or through the intrusion of some foreign object in the body. This “object” might have been a spirit or demon or even something more tangible such as a stone or pebble.
Skull trephination
Using sharpened stones to drill or carve a hole in the skull. Exact purpose of trephination is unknown, but many believe it was done to release evil spirits. The first surgical technique.
Shaman
Specialists such as religious figures served as intermediaries with the gods. Typically highly revered, much feared who often provided effective medical care. Prayer and incantation, ritualistic dancing, and sacrifices used to get attention of the gods.
Imhotep “Historical Father of Medicine”
Egyptian engineer, architect, scribe, priest and builder of the tombs and possibly a physician who lived in the 2600 BC
Historical Father of Medicine
Imhotep. A deified figure in Egypt.
Code of Hammurabi
Possibly the first codified set of guidelines regarding responsibilites of physicians.
Hammurabi
A Babylonian King who lived from 1728 to 1686 BC.
Ebers Papyrus
A type of medical texbook summarizing extant knowledge about several disease categories that offered tips on diagnosis, prognosis, and therapeutic measures, including over 800 specific prescriptions.
Most remarkable of civilizations of the last 2,000 years
Greek. The substantial contribution of the Greeks medicine is consistent with their contributions to philosophy, art, theater, sculpture, government, and other areas.
Apollo, the sun god
God of Health and medicine and believed to be the inventor of the healing art.
Aesculapius
Son of Apollo and such a brilliant healer that by the eighth century he was considered the Greek god of health.
Asklepieia
Greek temples which were created where priest-physicians practiced the healing ceremony of incubation or “temple seep”. Patients who came to the temple would purify themselves (bathe), fast, read about the cures of former patients, and make offerings to Aesculapius.
Hippocrates of fCos
The father of Medicine. Born in Cos, was educated, became a successful and much beloved physician, and was an esteemed teacher. He is best known for 3 contributions. Empirical Medicine.
3 Contributions of Hippocrates

1. The principle of natural, rather than supernatural, explanations for disease.

2. His writings. One of the most important sets of medical writings ever collated is the Corpus Hippocraticum

3. His teaching of human compassion and ethical standards as illustrated in the Hippocratic Oath.

Corpus Hippocraticum
Compiled by Hippocrates, more than 70 books monographs, and essays covering a variety of aspects of medicine. Medical histories, symptoms, and reactions to therapy.
Hippocratic Oath
Expresses reciprocal commitments made by physicians and their primary obligation of the physician. The second portion of the oath is a brief summary of ethical guidelines. Some of the pledges for example, against doing abortion, cutting for stone, and facilitating a suicide.
Rome founded in what year
753 BC
Roman Medicine
Medicine did not flourish in Rome, Greek physicians began filtering into Rome.
Cato the Censor (234-149 BC)
Man given credit for being the first important writer in Latin, prohibited all in his family from using the Greek physicians
Asclepiades
Greek physician who believed that health and illness were determined by the condition of the pores. If the pores were too open or too closed, illness resulted. He influenced Julius Caesar to decree in 46 BC that Greek slave-doctors were free and citizens.
Roman Contributions to Medicine
Public Health. Unsanitary conditions contributed to the spread of disease, the government constructed a system of aqueducts to obtain pure water, built an elaborate system of public baths, passed ordinances requiring street cleanliness, and established a system of hospitals to tend to the sick.
“Father of Experimental Physiology”
Galen. Extensive contributions to anatomy He dissected monkeys and pigs and studies skeletons of criminals. The foremost medical experimentalist until the 1600s.
Pneuma
Belief that certain vital spirits circulated throughout the body.
End of the Western Roman Empire
AD 476 when the conquest of Europe by the barbarians was completed. In the East, the Byzantine Empire survived and became a center of civilization. AD 500 – AD 1500 is referred to as the Medieval Era.
Medieval Era
The of the Western Roman Empire AD 500 to AD 1500.
Monastic Medicine
Medical practice in the first half of the Medieval Era. This medicine was based in the monastery. Medical practice was officially controlled by the Church in Byzantium.
Church in Byzantium
Early Christian Church where medical practices was controlled. Extremely hostile to physicians because of 2 reasons.
2 reasons for hostility towards physicians by Church of Byzantium
1. Disease and illness are beneficial in that they test one’s faith and commitment to God and the church.
2. All illnesses occur as a punishment by God, possession by the devil, or the result of witchcraft.
Mohammed
Founded the commonwealth of Islan in 622. During the next 100 years, his followers conquered almost half of the world known at that time. By 1000 the Arab Empire extended from Spain to India.
Scholastic Medicine
The second half of the Medieval Era is referred to the time of this.
Council of Clermont
In 1130 a proclamation forbade monks from practicing medicine because it was too disruptive to the peace and order of monastic sequestration. Medical practice became the province of the secular clergy and universities began to play a big role in the education of physicians.
Black Death
Bubonic Plague caught hold in Europe in the 1340’s and killed an estimated 43 million people in 20 years. This made clear of physicians to restrain disease. The earliest hospitals developed in the monastic period.
The Renaissance
15th and 16th century. Rebirth in the arts and philosophy, scientific endeavor, technological advancement, and medicine.
Humanism
Stressed the dignity of the individual, the importance of this life (and not solely the afterlife), and spiritual freedom.
Andreas Versalius
Contradicted Galen’s ideas but was shut down and career as anatomist was finished due to his refutations. In 1628 William Harvey demonstrated that Andreas was right to refute.
William Harvey
Englishman demonstrated that blood circulates throughout the body in an action stimulated by the heart. The most important physiological advancement in the century.
Paracelsus 1493-1541
Held that God revealed medical truth to humans through revelation. Criticized the humoral theory and searched for specific pharmacological remedies.
17th century key event
The development of modern science. The scientific revolution replaced previous concepts with new ideas of matter and its properties. Revolution stimulated by several scientist philosophers of the century.
Scientist philosophers that stimulated the Scientific revolution of the 17th century
Francis Bacon and Rene Descartes
Francis Bacon
Argued for “natural” explanations for events that could be understood through systematic observation and experimentation.
Rene Descartes
Invented analytical geometry and, through his work on momentum, vision, reflex actions, and a mind-body duality, laid the basis for a science of physiology.
Edward Jenner (1749-1823)
British country doctor, discovered vaccination of cowpox to prevent smallpox immunity.
Battista Morgagani (1682-1771)
Italian physician and professor of anatomy developed the anatomical concept of disease. That diseases could be traced to disturbances in certain organs.
Anatomical concept of disease
That diseases could be traced to particular pathology r disturbance in individual organs.
18th century
Age of Enlightenment is marked by efforts to collate the advancements of the preceding century and further refine knowledge in all fields including medicine. Time of rapid growth.
Industrialization in 19th century
Began in England and spread to the rest of Europe and the US. The development of large industries with many jobs. The world was not ready for the consequences of the urbanization, cities overcrowded and unsanitary which produced very bad living environments.
Hospital Medicine
1st half of the 19th century known mostly for the importance of physicians and medical researchers attached to clinical observation, whereas medicine in middle ages was centered in monasteries and in the Renaissance on individual sickbed. In the 19th century it was centered on the hospital for the first time.
Hospitals
Have existed for centuries but have increased rapidly in number in the 1800s as a result of the massive number of people migrating into the newly developing cities.
Laboratory Medicine
2nd half of the 19th century focused on this.
Discovery of the Cell
Rudolf Virchow pinpointed the cell as the basic physiological matter and understood that disease begins with some alteration in the normally functioning, healthy cell. Effective treatment depends on restoring the cel to normality.
Leeuwenhoek 1675
Invented of the microscope.
Germ theory of disease
Louis Pasteur a french chemist now called the Father of Modern Medicine. Generally accepted theory in 1881.
Father of Modern Medicine
Louis Pasteur discovered the specific bacteria involved in anthrax and chicken cholera and with several of his pupils identified other disease-causing bacteria and developed effective vaccinations against them.
Progress in Surgery
1880s considerable progress in surgery occurred due to 3 essential advancements.
1. an understanding of he localized nature of disease
2. an ability to control the patient’s pain in the surgical process
3. an ability to prevent would infection
asepsis
discovered by Sir Joseph Lister (1827-1912)
Native Americans
Relied mostly on supernatural explanations for disease and illness. Diagnosis of disease and illness and treatment were often assigned to separate individuals. Medicine man treated the sick.
Medicine Man
Man assigned to treat the sick and would intercede with gods and it was hoped drive off evil spirits. Common ailments treated: fractures, dislocations and wounds.
Early colonists
Jamestown settlers in 1607 were afraid of indians and selected a homesite up high with bad food supply and bad water. Six months later 60 of 100 died from dietary disorders or other diseases, similar happened to Plymouth Colony in Massachusetts.
Plymouth Colony in Massachusetts
Due to an outbreak of scurvy and other diseases, only 50 of the 102 arrivals survived he first 3 months.
Primary killers during the colonial years
Malaria, dysentery, typhoid fever, influenza, smallpox, scarlet fever, yellow fever, and tuberculosis.
Colonists brought with them from Europe several contagious diseases
Measles, smallpox, and mumps that had been unknown in the Americas. Native Americans very susceptible to them died in outbreaks. 90% of Native Americans died in this process.
Reverand Thomas Thatcher of the Old south church in boston
The first significant figure in American Medicine. The only known medical work published in American in 1600s. Wrote many books on anatomy and therapeutic medicine.
Apothecaries (1600s)
Primarily made their living by providing drugs and medical preparations, they also gave medical advice, dressed wounds, and even performed amputations.
Pennsylvania Hospital in Philadelphia
The first comprehensive hospital in the US built in 1751.
College of Pennsylvania
The first formalized medical school.
Domestic Medicine
Home medicinal healing remedies. This was supported by an ideology that individuals and families were capable of providing for the ill.
University of Edinburgh
Considered as the world’s finest medical school. By the end of the century 4 other medical schools were established.
1. Pennsylvania
2. Columbia
3. Harvard
4. Dartmouth
Benjamin Rush (1745-1813)
The most famous American physician of the Revolution Era. He was as singer of the declaration of independence.
Ephraim McDowell (1771-1830)
Physician of Edinburgh practicing in Danville Kentucky wa the first to do a ovariotomy. He removed a tumor of 22 pounds from the ovaries.
William Beaumont (1785-1870)
Experience with a young accidental gunshot victim led to experiments on digestion.
Daniel Drake (1785-1870)
Wrote about the influence on health of physical and social environmental factors (climate, diet, ethnicity, lifestyle, and occupation), encouraged collaboration among physicians and was a strong proponent of physician licensure.
Reasons why physicians were poorly paid
1. The fact that family medicine was preferred by many
2. The difficult in seeing a substantial number of patients in a day (people lived far apart, no good transportation)
3. The inability of many patients to pay for care
4. The fact that many people offered themselves as physicians
Samuel Thompson (1769-1843)
Thomosonianism: “every man his own physician”. He believed that disease resulted form insufficient heat and could be countered by measure that would restore natural heat.
Thomosoninism
Founded by Samuel Thompson
Homeopathy
Founded by Samuel Hahnemann (1755-1843) who viewed that disease is primarily of the spirit. Homeopaths believed that disease could be cured by drugs that produces the same symptoms when given to a healthy person.
3 major events that professionalized medicine
1. The Civil War
2. Medical Advancements
3. The Organization of Professional Medicine (The AMA or American Medical Association)
Major killers during the Civil War
1/3 from battle and 2/3 from diseases. Smallpox, typhoid, yellow fever, pneumonia, scarlet fever and infection from surgical procedures.
Bite the Bullet Expression
Patients would bite bullets or a piece of wood during surgery as a distraction.
Profesional Nursing
Began during the Civil War as a means to assist in the treatment of wounded soldiers. The ambulance corps was initiated to move the wounded form the battlefield to field hospitals.
Wilhelm Roentgen (1845-1923)
Discovered X-Raya and their diagnostic utility in the 1890s.
Eras of peak pharmacological success
1920s and 1940s
Insulin
Discovered in 1921
Vitamin C & Vaccine for Yellow Fever
Discovered in 1928
Penicillin
Discovered to kill bacteria in 1940s.
American Medical Association (1847)
On may 5, 1847, 250 physicians representing many of these medical societies and some medical schools met in Philadelphia to establish a national medical society.
Chief Goals of the AMA
1. Promotion of the science and art of medicine
2. Betterment of public health
3. Standardization of requirement for medical degrees
4. Development of an internal system of licensing and regulation
5. Development of a code of medical ethics
3 events strengthened the position of the AMA
1. Discovery of the Germ Theory of disease
2. The AMA was envtually successful in achieve on e of its key goals MEDICAL LICENSURE REQUIREMENTS.
3. The Flexner Report
Flexner Report
Abraham Flexner hired to conduct a comprehensive study of all the medical schools in the US and Canada. From 400 it was reduced to 31 and medical education would be subject to formal regulation.
Council of Medical Education (CME)
Prepare national standards of medical schools.
Great Trade of 1910
The AMA was given a near exclusive right to regulate the medical profession. With the power of knowledge supplied by the germ theory of disease and the organizational legitimacy provided by the states and federal government.
Paul Starr
The Social Transformation of American Medicine (1982). Won pulitzer prize for his work. Describes the rise of medical authority in America as medicine was transformed from a relatively weak occupation to a powerful and prestigious profession. Relationship between advancement of science and the professionalization of medicine.
Cultural Authority of Meidicine
Manifested in the “awe and respect from the general public and legislators” that allows medicine to set its own conditions of practice
Vicente Navarro
Marxist scolar disagrees with Starr and says that Ascendancy of medical authority occurred not because people willed it and not because they were persuaded it was in their interests, but because it served the interest of powerful societal groups. These groups determine what options are provided for society and ignore value and preferences that they judge not to be in their interest.
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