HIST 249 Lecture Notes - Lecture 13: Passive Immunity, Fowl Cholera, Rudolf Virchow
Modern Medicine 2 : The Laboratory Revolution
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Textbook Reading:
• Deborah Brunton, “The Rise of Laboratory Medicine”
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Recap:
• Turning point in the history of medicine
• Important topic of the origins of clinical medicine
• Physical examination of the patient - find out what's wrong inside of the patient
• This approach could only happen in the hospital in the early 19th century
• Paris
• Paris school of medicine
• French revolution
• Represents a particular kind of setting/context of medicine that made it possible to
develop this approach
• Need access to the patient while he/she is alive
• Dead patient - dissections in order to correlate signs & symptoms
• Hospitals in the Paris school - lots and lots of patients
• Arriving at generalizations by looking at all these patients
• Definition of disease - disease is the focus that each patient happens to be a case of, focus
is no longer just on 1 patient (different than individualized medicine)
• Counting for things - Treatment results
• Also possible within the new context in hospital medicine & the Paris school
• Important
• Foundation of modern clinical medicine as we know it
• Going to a doctor - don’t just tell him/her a story, they do an examination on you
• Stethoscope
• Diagnostic optimism
• Doctors - quite sure about diagnosing disease, new kinds of disease
• Tuberculous - what is found inside the patient
• Therapy - not much change
• Main change - people didn’t know why they did certain things for treatment
• Old theoretical basis was gone
• Had not been replaced by something that was useful for treatment
• Cant learn very much from this for the treatment of disease
• People using the Stethoscope in different ways
• 'Coneil lenac' - traditional treatment
• 'Bousea' - bloodletting, industrial
• Scientific credibility of the Paris school - diagnostic & classification in the Paris school
• Gave them a new certainty in terms of what disease is
• Not for treatment
• In order to approach the topic of treatment, need to also approach the question of
causation
• What is disease caused by? What does it come from?
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• This question was addressed later in laboratory medicine
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Laboratory medicine:
• 19th century
• Transformation of medical knowledge
• Way of doing medicine by science
• Science - replaces scholarship
• Middle ages - doctor authority on claims to understand what's going on in the body,
based on learning
• 19th century - authority of science was replaced from the of medical authority
• Shift from the clinic to the lab
• Most reliable
• New knowledge
• Always laboratory in the direct views of disease
• Tests on what diseases were
• Primitive lab tests - last time
• Identifying tuberculous
• People who worked in the lab - not doctors, but scientists
• Could be both - Louis Pasto
• Someone who makes their income being a scientist
• Experimental science
• Subject phenomenon to experiments, intervene
• Looking at the laboratory revolution
• Research lab
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Physiology
• How this crossed with pathology in France
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Microscopy
- cell theory
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Bacteriology
- germ theory - causation of disease
• Biochemistry based on germ theory -
• nature is separate from the human
• Anatomical body - micro level
• What counts as knowledge - experimental in physiology
• Knowledge & the profession
• Source of knowledge in lab medicine is no longer the doctor, but lab scientist
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Physiology meets pathology:
• Replaced pathological science
• Focuses on functions rather than structures
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Continuity of normal and pathological
• Experimental physiology French style
• Normal - new in western medicine, natural for Galen & Hippocrates
• Disease = contra natural
• Normal & abnormal - replaced natural & contra natural
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3
• Physiology = the functions of the body, health, disease
• All diseases - arises from disturbances to physiology
• Pathology - physiology gone wrong
• What in physiology causes disease?
• Control life phenomenon in the lab, can also control in a clinical setting & cure
disease
• Absorption of food/nutrients
• Main activity of a body - growing
• Does the food become part of the body?
• Worked on this topic with experimental animals, not patients
• Who stand in for humans in the lab
• To study the properties of drugs / structure of the body of the living animal
• Cut a nerve & register what happens
• Intervene
• Don’t just observe the animal - need to intervene
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Francois Magendie
• "Medicine is nothing but the physiology of the sick man"
• A lab researcher
• Animal experimentation
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Claude Bernard
• One of the most important figures in medicine
• France
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Homeostasis
- living bodies are programmed to maintain a constant internal
environment
• Sweating when you are hot
• Secretion of substances within the body - glucose in the blood if there wasn’t
enough
• Bodies resistant to alternations in the program was disease
• Disease is the body which is upsetting internal milieu
• Intervention into a living body
• Using an animal
• Under controlled conditions
• Cut a nerve, take out an organ, observe, record
• If successful - this reveals a particular function of the body
• Experimenter can turn this body function on & off at free will
• Bernard - Certain & reliable knowledge in experimental physiology - ability to
control body functions on active intervention, not passive observation
• Determinism
• Nature is determined through its law, no room for chance
• Not about probability, personal experience
• It is about determinism
• Control of body functions in the lab
• Of diseases in the clinic
• Book - introduction to the study of experimental medicine (1865)
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