History of Science 2220 Chapter Notes - Chapter 4: Current Science, Heredity, Tuberculosis
2 May 2018
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Chapter Four: History of Pathology
Pathology as a System of Medical Knowledge
• Medicine is an applied technology or an art that makes extensive use of science.
• Medicine’s claims to being scientific are anchored in pathology as the study of disease.
o Pathology, derives from the Greek words for ‘suffering’ and ‘theory about,’ is literally the
study of suffering.
o Its meaning represents material knowledge about disease.
• Pathology is a system of knowledge used to draw conclusions about illness.
o Validated by current science and philosophy
Functions of Pathology
1. Used to
explain
suffering to account for why and how humans are subject to pain and death.
a. Illness demands a ‘logical’ explanation, rooted either in the cultural and spiritual ideas of sin
and blame or in the more material and ‘scientific’ ideas of structure, function, heredity
(genetic inheritances), contagion, and risk.
2. Used to
identify
or label the ailment from which a person suffers: the process of diagnosis.
a. Doctors use signs that point – just like signs on the highway – to the diagnosis or prognosis.
b. Good clinical skills convert symptoms into signs. A physical examination yields more signs.
Signs are not simply the product of observation; they also contain knowledge.
i. Ex. the subjective symptom of squeezing chest pain becomes an objective sign of heart
disease with the addition of medical knowledge.
c. About identifying which is ‘abnormal’ or sick, and the ‘normal’
i. The line between normal and abnormal is conditioned by culture, religion, economics,
race, class, gender, and other social and biological factors. Phenomena once thought
to be ‘abnormal,’ or ‘diseased,’ are now considered variants of normal.
ii. Ex. visceroptosis (the drooping gut syndrome) and homosexuality
3. Used to
predict
outcomes.
a. In some cultures, especially in antiquity, accurate prognosis was at least as important as the
ability to diagnose or cure. Based on a few reliable signs relating to an individual, medical
prediction resembled priestly divination: ‘You will die on the seventh day.’
b. Prognosis is still an important function of pathology, but it is now based in statistics, derived
from the experience of a cohort, defined by age, sex, diagnosis, and extent of lesion.
4. Used to
justify
treatments.
a. Most treatments were discovered through observation rather than reasoning (i.e.,
empirically)
5. Used to
prove
the reasonableness of an explanation, a diagnosis, or a course of action.
a. Ex. Post-mortem examination
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Disease vs Illness
Subjective aspects of being sick – pain, fever, swelling, vomiting, diarrhea, deformity, injury, loss of
weight, loss of blood, loss of function, loss of life.
- ‘Illness’ designates individual suffering
o Exists as the real suffering felt by a person
- ‘disease’ pertains to ideas about the illness
o Exists as a theory constructed to explain the illness, its presumed cause, and its target
- Medical knowledge = the ability to recognize and respond to the disease.
o Main focus is constructing, recognizing, and treating disease.
Disease concepts are ‘built’ from observations of many individual sufferings of a similar nature.
- Take into account the patient, the illness, and the presumed cause, but they are also influenced
by the observer/doctor.
- Diseases are given characteristics (symptoms), names (diagnoses), life expectancies (course),
anticipated outcomes (prognoses), and recommended treatments.
- A cause is implied in the concept constructed for a disease even when the cause is unknown.
Organismic - diseases are bad, discontinuous, and affect individuals.
- Individuals turn to medicine to get rid of diseases
- Medical education aims at how to recognize, cure, and prevent disease.
The ‘medical model’: addresses the patient as target of the disease, but offers little to explain the
causes.
Ontological - theory that holds that the causes of disease come from outside the patient, that diseases
vary one from another, and that they exist separate from the patient
- emphasizes the idea of disease as a separate ‘being,’ or entity.
o Ex. A medical practitioner will be concerned with what the patient has
Physiological - theory that holds that the causes of disease emerge from inside the patient, that patients
vary, and that diseases do not exist separate from patients
- This perspective emphasises who or what the patient is
Historical Overview of Pathology
Supernatural Causes of Disease
The professional healer or priest does not concentrate on symptoms but looks widely for signs to
determine why the deity has sent the affliction.
o The patient’s subjective opinion about the causes of the illness are given serious
consideration, including the possibility that the disease may have moral, spiritual, or
pedagogic functions.
- Treatment is the maintenance or restoration of integrity – righting wrongs, keeping faith.
- Diseases sometimes construed as punishments include AIDS, eating disorders, and the effects
of drugs, smoking, and alcohol.
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Document Summary
Signs are not simply the product of observation; they also contain knowledge. Phenomena once thought to be abnormal," or diseased," are now considered variants of normal. Ex. visceroptosis (the drooping gut syndrome) and homosexuality: used to predict outcomes, in some cultures, especially in antiquity, accurate prognosis was at least as important as the ability to diagnose or cure. Subjective aspects of being sick pain, fever, swelling, vomiting, diarrhea, deformity, injury, loss of weight, loss of blood, loss of function, loss of life. Illness" designates individual suffering: exists as the real suffering felt by a person. Disease" pertains to ideas about the illness: exists as a theory constructed to explain the illness, its presumed cause, and its target. Medical knowledge = the ability to recognize and respond to the disease: main focus is constructing, recognizing, and treating disease. Disease concepts are built" from observations of many individual sufferings of a similar nature.
