HIST 249 Lecture Notes - Lecture 25: Phlegm, Stethoscope, Henrietta Lacks
~~ What it All Means?
** NO readings **
• History of Medicine Change & Continuity
• What its all about is - change
• Change across time
• Change --> In medical concepts (how does the body work? What causes disease?)
• Difference of how Hippocrates sees the body than how we do
• Or even 18th century people (nerves, fibers, tension, relaxation)
• Today's vision - transforms in 19th century because of physiology
• Chemical series of reactions, the brain
• Change in what causes disease
• Still understand there are environmental diseases but not in the same way as we
used to…
• Content of medicine
• What we know
• Change --> In what counts as knowledge (accumulated wisdom? First hand experience?
Structured experimentation)
• Moving away from hot/cold explanation of disease --> accumulated experience @
the bedside --> a clear & scientific understanding of processes that you cant see
because they are inside the body and can only be seen through reasoning
• Modern medicine - 3 modes of knowledge
• Clinical experience (doctor, accumulated experience in 1 person)
• Experimental science (specific & deterministic knowledge - Bernard & laws of
nature in lab)
• Counting (results from this are probability - RTC, evidence based medicine, rival
knowledge)
• Change --> institutions (care, teaching, regulation)
• Obvious change
• Vast change
• The hospital - all purpose shelter, charitable care --> taken over by doctors
themselves
• Hospital change - technology change, society changes (sometimes completely non-
medical reasons)
• WWI - huge difference for how British people understood hospitals
• All people from all social classes were hospitalized
• Therefore being hospitalized was not a mark of shame
• But this took a long time
• Social barriers
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2
• Hospital --> nice example of tension of change & continuity
• Another good example is the university - story of continuity
• Medicine enters in the 13th century & it is still being taught in universities
• Regulation - medical professions in Canada replicate self regulation
• Weight of state of regulation is far greater now than it was in the past…
• Change --> technology & our relationship with it
• Most obvious points
• Surgery
• X-ray
• Technology itself as changed
• And our relationship with it
• Our expectations of technology when we visit a doctor
• Availability
• How it influences the patient/doctor relationship
• What it can do for disease
• Drug therapy - as a technology
• Machines
• Also includes surgery
• All falls under this
• Diagnostic technology --> similar to assignment #2 (stethoscope)
• Transforms the relationship b/t the doctor & the patient
• Not about patient saying their symptoms - its about the sounds the doctor
hears
• Also shape what's happening
• Change --> professions
• Religious profession
• 19th century - professionalization
• Change --> responsibility to society
• Working in the interest of the patient & in the interest of society
• This opens up other tensions
• Change --> relationship to state or local authorities
• State protecting society against elicit practice
• State recognized you as an elicit practitioner
• (EX) Public health insurance in Canada - also changed the medical profession
• Cant have change without continuity
• Not just a transformation over night
• Is complicated
• Continuity is a complicated process
• Prof switch - Galen isn't just cut out
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