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249 - Week 9 – Lecture 1 - the Modern Medical Profession.docx

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HIST 249
Faith Wallis

Week 9 – Lecture 1 – 29/10/2013 History 249 – Health and the Healer in the Western World Continuation of Modern Medicine 2 – Laboratory Medicine & the Modern Medical Profession The Laboratory Revolution = central to the Claude Bernard assignment - a period in time around the late 1800s when, alongside the bedside as a place where important knowledge is produced, there is the laboratory▯experimental physiology w. the French school (Claude Bernard as leader – summarised his approach the importance of his approach w. regards to medicine) ▯producing knowledge by entering the laboratory w. a model of something that occurs in nature (experimental model) and trying to discover the conditions for certain phenomena w. scientific determinism (if one controls the scientific conditions, then the phenomena will occur always in the way that is expected – there is no probability within the situation) o different outcomes = either the law is incorrect or there is a problem with the method Numerical methods = give a certain therapy or preventive measure to a group of patients thus making this the only variable; compare the results numerically thus ending up with probabilities and percentages  population based - these approaches are not wholly compatible at all - can actually, in principle, distinguish 3 ways of producing knowledge: 1 – traditional, clinical knowledge as the doctor sees and experiences something and then is done repeatedly, 2 – experimental science, do an experience where there is a variable often in the body of the animal and something happens = then find the law which governs this natural phenomenon; deterministic knowledge is the outcome; 3 – counting and creation of probabilities also have the laboratory sciences esp. the use of the laboratory to determine the causes of infectious disease – originally done by Louis Pasteur, then Koch’s Postulates in order to express the conditions that have to be fulfilled in order to prove that a particular microorganism causes a specific disease as he determines the etiology/causes by finding the microorganism in the host organism every time in order for them to have the disease, then one takes the organism from the animal or human that has the disease and culture this outside the host organism until it reaches a pure culture thus proving that what is taken from the patient is actually a living being since it can propagate (if it was just a chemical one couldn’t culture it) and then give it to another healthy animal and that animal has to get the disease hence establishing a cause-effect relationship and a specific one between these microorganism and diagnosis next step = how can one explain immunity? Two models – Ehrlich and humoral immunity as immunity is located in the body’s fluids and the serum (there are protein molecules called antibodies in the serum and fit like a key into a lock into bacteria thus eliminating it) OR Metchnikoff’s parallel way of explaining immunity with cellular immunity = in the cells that immunity resides as cells were discovered that ‘eat’bacteria Final element that enters the puzzle of infectious disease is how contagion can happen  how can a contagious disease be transferred from one subject to another if there is no direct contact; discovery of vectors explains this - they are intermediaries to transmit the disease e.g. lice covered rats with plague, mosquitoes with malaria, lice in typhus = breakthrough is that mosquitoes caused yellow fever ▯ with the glamorisation of the new medical sciences, mosquitoes’ role had been suspected o 1891 – Carlos Finley = the theory was that a (particular kind of) mosquito bite transmitted yellow fever from one individual to another; virus was only isolated in 1927  whenAmericans engaged with Cuba with the Spanish-American War there was much yellow fever and thus they wished to beat it  Walter Reed = head of commission of the US government  tested Finley’s theory by capturing mosquitoes that had bitten those with yellow fever and induced those mosquitoes to bite healthy subjects = these healthy subjects did get yellow fever • One of them, named Jesse Lazear, died of Yellow Fever as a result of this experiment alongside those of the Cuban Civil Service  The discovery is depicted in a series of hagiographic paintings known as ‘great moments in the history of medicine’ somewhat story-telling as doctor’s are depicted as saints • Jesse Lazear is almost martyred within the painting = glorification and glamorisation of modern medicine in these images from the 1930s and 1940s 4 – Biochemistry; last chapter in the laboratory revolution of the 19thC - opened a new way for understanding disease; therapeutic impact was more preventive rather then curative o how to cure infectious disease? Kill the bacteria before it has contact with humans = principle of pasteurisation though it is not possible to pasteurise a whole patient.  How to kill a microorganism when it is within the patient’s body? • The area of organic chemistry or biochemistry comes in o Organic chemistry = chemistry that occurs within living beings based on the fundamental elements e.g. carbon, oxygen  Original belief that chemical and organic medicine were incompatible because of analysis and synthesis - Person responsible for chemical analysis of organic chemistry = Justus von Liebig = invented apparatus that could take the carbon dioxide from organic substances  possible to split up the substances and show organic elements like carbon o Hundreds of substances were analysed in this way = bridges organic and unorganic - Opposite of this = Friedrich Wöhler; synthesised for the first time an organic substance of urea from inorganic elements = able to find a technique to put together the building block elements of urea o Had an impact on biochemistry by the end of the 19thC = chemical components in the old botanical drugs started to be isolated e.g. morphine in 1806 from the opium poppy  End of the 19thC = action of morphine could be understood and it could be recreated in the laboratory Impact of this is demonstrated in Ehrlich’s work  began his work when the German chemical industry was developing synthetic dies for textiles in place of old plant-based dies; atoms were being altered in the molecules - scientists began to use these synthetic dies in order to stain tissues for the work with microscopes - certain dies of these synthetic states had an affinity for certain kinds of cells as they absorbed the dye and stood out - 1904 – certain kind of dye had an affinity for the microorganism that caused sleeping sickness and actually destroyed trypanosome o led him t consider that there might be other chemicals that not only had an affinity but actively destroy other microorganisms o principle of modern chemotheraphy = find a specific chemical key for a biological lock which will destroy the microorganism/bacteria etc. without damaging the host = notion of a ‘magic bullet’ o also 1905 = the ‘magic bullet’of Salvarsan for syphilis  1905 – the bacterial agent that caused syphilis was discovered and Ehrlich synthesised from arsenic, Salvarsan which could be used to treat the disease = ‘chemical key which fitted the syphilis lock and then destroyed it’ = medicine of choice pre-antibiotics = for the first time there is information on disease that permanently displaces the old model of epidemics that had proliferated since the time of Hippocrates - clear that disease was spread through contagion – necessary to stop the vector contagion or immunise a person against the contagious agent - laboratory medicine revolutionised the profession between the period of 1830-1930 (?) o body is not just a structure but a dynamic system and health is the result of complex, integrated physiological processes o the addition of laboratory medicine now produced knowledge for medicine that had an impact on the way the doctors’professional position was negotiated – the medical profession benefited from being able to offer new cures as their place within society became more important and prestigious LECTURE 2 – THE MAKING OFAMODERN MEDICAL PROFESSION - medical profession is typical of modern times for many reasons idea of a profession is rather old - 12thC = classic professio▯ theology, law and medicine o all had a curriculum (canon of knowledge) exams etc. – all based on university education - professional medicine/learned physicians were part of this university tradition o medical pluralism meant there were multiple sources for medical services o no dominance of the ‘medical profession’and there no monopoly of one occupational group o often centred in an urban context also whilst women healers were usually excluded from the guilds and the universities medical pluralism changes over the period since there was an ideology and programme that would ensure a monopoly of medical practice the process of professionalization occurred between roughly 1840-90 – process of how medicine become a profession in the modern sense - possible to see that there were several related aspects of this process: fundamental changes in training and practice in the th th late 18 /19 C o apprenticeship was replaced by university training for becoming a medical practitioners = required o licensing removed from the authority of the guilds and colleges to first the state and then partially back into the hands of medical men but with different levels of state involvement depending on nation o collective identity as a single occupation – all belonged to one profession o differentiation was thus directing against irregular healers and unorthodox practitioners e.g. those using herbal remedies = idea of modern professionalism is based on that of medicine Textbook  tests the idea of professionalization and compares it to medicine - modern professions have specific characteristics: o body of highly specialised knowledge: medicine = history of body and disease as documented by formal qualification o professional unity with a strong ethos of public service = competition between doctors is not characteristics, but often instead there is cooperation in the interest of the patient o monopoly of practice = only members of the medical profession can call themselves doctors and act as doctors o professional autonomy = only doctors can judge if other doctors are competent because of the special knowledge they have o high social status – income and social respect 1 – Highly specialised knowledge - normally acquired in schools – the case early on for learned physicians but it took longer for other practitioners - surgery and medicine merged (this is important!) = the professions of medicine and occupational groups merged, but also the knowledge did  situation where physicians and surgeons went to the same school e.g. Ecole de la Santé in France whilst there were other national institutions, usually associated with hospitals - university degree becomes increasingly the precondition for being a doctor – by 1890 this is pretty much an international standard = there was a move towards higher standards of education for medical practitioners o occurred because there were too many physicians and thus physicians wanted to narrow the field – medical students and the physicians thus attempted to make the state introduce higher standards thus lessening the number of physicians o also wanted a good training for successful practice (Brunton?!) o those whom also had an historical interest in better practice = the government: desirous of highly educated doctors since they wished to minimise the societal effects of sick people  the government wished to protect and also wanted doctors for the military o broader education reforms created a context also = standards for training in medical areas became higher as more formal training became introduced in all aspects of ‘professions’ - knowledge that doctors acquired was also becoming increasingly esoteric and specialised e.g. use of the stethoscope and ECG o in the 18thC under the regime of the patronage system there was much shared knowledge between doctors and their patients whom had the same level of education o this changed with hospital medicine and even more with laboratory medicine since the knowledge that comes from laboratory medicine was not even available to the medical practitioners themselves  the types of medicine as described by Jewson intersects with the theory of professionalization of medicine 2 –Professional Unity (e.g
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