Medical Sociology Chapter 2

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.

Germ theory.

4000 and 3000 BC

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.

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.

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.

Egyptian engineer, architect, scribe, priest and builder of the tombs and possibly a physician who lived in the 2600 BC

Imhotep. A deified figure in Egypt.

Possibly the first codified set of guidelines regarding responsibilites of physicians.

A Babylonian King who lived from 1728 to 1686 BC.

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.

Greek. The substantial contribution of the Greeks medicine is consistent with their contributions to philosophy, art, theater, sculpture, government, and other areas.

God of Health and medicine and believed to be the inventor of the healing art.

Son of Apollo and such a brilliant healer that by the eighth century he was considered the Greek god of health.

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.

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.

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 Hippocraticum3. His teaching of human compassion and ethical standards as illustrated in the Hippocratic Oath.

Compiled by Hippocrates, more than 70 books monographs, and essays covering a variety of aspects of medicine. Medical histories, symptoms, and reactions to therapy.

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.

753 BC

Medicine did not flourish in Rome, Greek physicians began filtering into Rome.

Man given credit for being the first important writer in Latin, prohibited all in his family from using the Greek physicians

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.

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.

Galen. Extensive contributions to anatomy He dissected monkeys and pigs and studies skeletons of criminals.

The foremost medical experimentalist until the 1600s.

Belief that certain vital spirits circulated throughout the body.

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.

The of the Western Roman Empire AD 500 to AD 1500.

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.

Early Christian Church where medical practices was controlled.

Extremely hostile to physicians because of 2 reasons.

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.

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.

The second half of the Medieval Era is referred to the time of this.

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.

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.

15th and 16th century.

Rebirth in the arts and philosophy, scientific endeavor, technological advancement, and medicine.

Stressed the dignity of the individual, the importance of this life (and not solely the afterlife), and spiritual freedom.

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.

Englishman demonstrated that blood circulates throughout the body in an action stimulated by the heart. The most important physiological advancement in the century.

Held that God revealed medical truth to humans through revelation. Criticized the humoral theory and searched for specific pharmacological remedies.

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.

Francis Bacon and Rene Descartes

Argued for "natural" explanations for events that could be understood through systematic observation and experimentation.

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.

British country doctor, discovered vaccination of cowpox to prevent smallpox immunity.

Italian physician and professor of anatomy developed the anatomical concept of disease.

That diseases could be traced to disturbances in certain organs.

That diseases could be traced to particular pathology r disturbance in individual organs.

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.

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.

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.

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.

2nd half of the 19th century focused on this.

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.

Invented of the microscope.

Louis Pasteur a french chemist now called the Father of Modern Medicine. Generally accepted theory in 1881.

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.

1880s considerable progress in surgery occurred due to 3 essential advancements.1. an understanding of he localized nature of disease2. an ability to control the patient's pain in the surgical process3. an ability to prevent would infection

discovered by Sir Joseph Lister (1827-1912)

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.

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.

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.

Due to an outbreak of scurvy and other diseases, only 50 of the 102 arrivals survived he first 3 months.

Malaria, dysentery, typhoid fever, influenza, smallpox, scarlet fever, yellow fever, and tuberculosis.

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.

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.

Primarily made their living by providing drugs and medical preparations, they also gave medical advice, dressed wounds, and even performed amputations.

The first comprehensive hospital in the US built in 1751.

The first formalized medical school.

Home medicinal healing remedies. This was supported by an ideology that individuals and families were capable of providing for the ill.

Considered as the world's finest medical school. By the end of the century 4 other medical schools were established.

1. Pennsylvania2. Columbia3. Harvard4.

Dartmouth

The most famous American physician of the Revolution Era. He was as singer of the declaration of independence.

Physician of Edinburgh practicing in Danville Kentucky wa the first to do a ovariotomy. He removed a tumor of 22 pounds from the ovaries.

Experience with a young accidental gunshot victim led to experiments on digestion.

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.

1. The fact that family medicine was preferred by many2. 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 care4. The fact that many people offered themselves as physicians

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.

Founded by Samuel Thompson

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.

1. The Civil War2. Medical Advancements3.

The Organization of Professional Medicine (The AMA or American Medical Association)

1/3 from battle and 2/3 from diseases. Smallpox, typhoid, yellow fever, pneumonia, scarlet fever and infection from surgical procedures.

Patients would bite bullets or a piece of wood during surgery as a distraction.

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.

Discovered X-Raya and their diagnostic utility in the 1890s.

1920s and 1940s

Discovered in 1921

Discovered in 1928

Discovered to kill bacteria in 1940s.

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.

1. Promotion of the science and art of medicine2. Betterment of public health3.

Standardization of requirement for medical degrees4. Development of an internal system of licensing and regulation5. Development of a code of medical ethics

1. Discovery of the Germ Theory of disease2. The AMA was envtually successful in achieve on e of its key goals MEDICAL LICENSURE REQUIREMENTS.3.

The 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.

Prepare national standards of medical schools.

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.

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.

Manifested in the "awe and respect from the general public and legislators" that allows medicine to set its own conditions of practice

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.