December 5, 2012 [CLINICAL MEDICINE]
Context and Considerations
If Hippocrates was still around in 19 century, he would find it unremarkable. Not much had
changed, and while new ideas had emerged, no new remedies or surgical techniques were
developed. By the 1800s, significant change starts to take place. Significant distancing that takes
place between doctor and patient in the 1800s is largely due to use of technology – the way doctors
are treating and interacting with patients began to change.
The Paris School
19 Century Paris becomes the world center for medicine. Some scholars argue that the Paris
School of Medicine marked the transition between the middle ages and the modern era.
When you think of the Paris School you want to think of a hospital-based medicine that relies on
radical empiricism as opposed to abstract theories.
No longer books and ancient schools but physical evaluation. The unofficial motto that said
something like “read little see a lot".
Technological instruments like stethoscopes allowed them to see. This was truly a conceptual
revolution = way thinking and practicing medicine. The rise of Paris Medicine in the first half of
the 19th century marked a transformation in medical knowledge to hospital medicine.
3 Cultural Factors that Influenced the Rise of the Paris School of Medicine
1. Philosophical Origins
John Locke. A symbol of the enlightenment and the questioning of authority; skepticism
(Locke in particular). Nobody is born with inherent beliefs. Because everything is new,
we respond to our environment. He promoted the idea that ideas and knowledge is not
innate and derrive from sense and impressions; 5 senses in medical evaluation.
Thomas Sydenham. A 17 Century British doctor who exemplified the above idea.
Father of English medicine, his practice was rooted in sensualism. He called for a rigorous
return to observation and abandonment theory. In addition, he didn’t fully reject humoral
medicine but a return to direct observation of the patient at the bedside. Turning away from
the written word, he was a radical.
Pierre Cabanis. A French physician who was also a physiologist and a medical
philosopher,he wastheadministrator of hospitalsin Paris. Hewas all about observingthe
patient using one’s senses and seeing what is in front of you. These men’s writing were
influential by helping to inspire French medicine.
2. French Revolution
Provides the opportunity to completely wipe the slate clean, bringing in a new standard of
medicine. With the French revolution we have a heightened sense of French nationalism.
People were fighting to be French, and this mentality trickles down to medical education:
medicine being taught in French.
Subtle changes largely because of revolution also emphasized meritocracy: it’s about your
own qualities and not your social status or who your father was. It creates competition for
medical school students, bringing innovation and stimulation, leading to technological December 5, 2012 [CLINICAL MEDICINE]
3. Institutional Origins
Hospitals already existed for a longtime, but not traditionally as a place of treatment (more
as safety nets). In the late 18 to 19 century, clientele of hospitals changed, largely
because of industrial revolution. More people admitting themselves and being admitted
into hospitals for different types of care. The increase in cities resulted in more people
crammed into smaller places: more people working in factories (unsanitary, terrible
regulation within the workforce for young children working), and large smoke stacks
outside of factories caused everything to be covered in ash and soot, including buildings
andthhe street. th
18 Century France already had almost 2000 small hospitals, and by the 19 Century, with
Paris becoming the great urban center of western culture, it becomes the greatest location
for great hospitals. Hospitals began dedicating themselves more to furthering scientific
knowledge than to actually treating people. For outsiders this becomes a major criticism –
the idea that patients are to be tested and not treated. But for medical students this is a great
thrill - greater opportunity for interaction with the patients.
Interest in Anatomy
Renewed emphasis on anatomy – the diagnostic techniques of percussion and such made it
possible to detect structural changes within the body. These types of technologies helped mark a
shift to doctors looking for signs in the body thanks to stethoscope. Autopsies began to be used to
corroborate what they were hearing during bedside medicine. Medical students under the Paris
School of Medicine were being told that they needed to understand the unseen - radical
empiricism (beyond what they can physically see). As porter notes in text, the shift bolstered the
idea that disease was a very different state from health. Now seeing that a patient who seems
healthy can actually be quite sick.as diseases are becoming more anatomical medicine had to move
in the same direction.
19 Century saw anatomy and dissection becoming more interesting, but also essential for medical
training. Practical problems arise with newfound emphasis on autopsies because they have a
limited supply of bodies. Academics, medical students and professors were not eager to see the
corpses of their loved ones opened up and displayed for testing. Also, legal problems with attaining
bodies: in this time with cities withlarge whore houses such as New Orleans, anyunclaimed bodies
within whore houses or hospitals were being given to medical schools (money to be made). We
start to see cadavers being retrieved from cemeteries, giving rise to grave robbers or resurrection
men (they essentially satisfied the growing need of bodies with the newly burried corpses of
private citizens,....in response the wealthy private citizens begin to errect mort safes or steel cages
that prevent bodies of loved ones being stolen). Cemeteries also becoming more guarded. Wealthy
families protecting their own, causing the public to become outrageously offended. Many began
attacking grave robbers as well as the recipients of these bodies in medical schools.
o Canadian example: Medical teacher named John Rolfe had a former student in Toronto
send body parts in whiskey barrels over the border to him. With this type of activitywe see
the emergence of murder for the sale of bodies. December 5, 2012 [CLINICAL MEDICINE]
Famous case from 1823 from Britain: William Burke and William Hare (Scotsmen) murdered at
least 16 people, sold the corpses to Robert Knox (an anatomist at the leading medical school in
Edinburgh). When they started out, they targeted the elderly residence of Burkes’ apartment
structure, but then moved on to the local prostitute. Only when Burke and Hare kidnapped a
well-known boy with intellectual disabilities that suspicion rose. A few days later the body of a
healthy women was reported missing, and the body was found in a lab – a clear connection being
made. Burke and Hare are charged with murder. Hare gets out of being sentenced by testifying
against his accomplice. He was hung and his body was dissected in public for hundreds of
on-lookers - also demonstrates the general distaste that public has for dissection. Knox was never
charged, but after his career was completelyin ruins. In Britain we start to seelegislation passed for
safe selling of bodies to medical schools.
1832 Anatomy Act passed in Britain for this sole purpose. France and Germany had enacted
similar legislation before.
In addition to advancements in anatomy with increased dissection came advancements in pathology
Jean Cruveilhier. Publishes a lavishly illustrated treatise with a new type of research called
pathological anatomy-if disease was anatomical then it could appear in a picture. One could now
drth disease. Once it was established, this generated a further shift in disease concepts. In the early
19 Century, doctors are realizing that patients not displaying all symptoms of disease might not
have all of them. Recognizing and linking specific disease with specific symptoms especially when
it comes to anatomy...
Microscope Improvement (1830’s)
Now we can see diseases in tissues. E.g. The ancient concept of inflammation characterized by
redness and swelling. In 1846, one physician discovers the link between the characteristics of
inflammation and leukemia.
Elegant technological innovationsarefurtherlinkingchanges tostructurewithillness. Still relevent
in medical practice today, we are now able to analyze disease on a microscopic level.
Women’s Medicine and Women in Medicine
Ever since prehistoric societies, the capacity of the female body to give birth has set it apart. Since
ancient times, statues to exaggerate secondary characteristic sexual purposes being valued. There
has always been a dichotomy between sexualization of women and the role of lifegivers. Talked a
bit about how bleeding and menstruation were seen – mystical but dangerous. Some societies used
menstruation as a curse.
o Dolls pointing to show symptoms so doctor didn’t have to touch you - doll