Upgrade to remove ads
Only $2.99/month

history of modern medicine exam 1

Terms in this set (71)

Americas Healthcare
-largest industry in the US
-Taking total amount of money dividing by a population so that it does not debilitate a family or individual
-US per capita spending has topped 10K per person -US produce the bulk on medical innovations/research - spending on medical research
-Our culture influences our physical + mental health
American culture increases our stress and pressure on individuals (american dream)
-High rates of poverty- they dont receive proper health care
U.S. causes of death
-Heart disease + cancer are the leading causes of death
Overdoses - in opiates - heroin or prescription painkillers (oxy)
Our national health expenditure is increasing way more than gross domestic product or wages
american exceptionalism
-We have the right to be involved in foreign countries' affairs - we are "dif/better"
-Winning WWs + Civil War
-American culture- cant face death- stems from religious beliefs
-Leads into the way of high health care expenses
tensions in the history of medicine
-Simplicity vs. Complexity
-Theory vs. Practice
-Tradition vs. Science
-Heroic Intervention vs. -Natural Healing
-Holisitics vs. Specific
-Professionals vs. Everyone else
-General Practice vs. Specialization
-Curing Disease vs. Preventing Disease
-Men vs. Women
-Right vs. Privilege
disease transmission
-Droplet-sneezes - flu
Airborne- exhale/inhale- tuberculosis
Vector- malaria
Waterborne- infecting water supply- cholera
Sit and wait- living outside of a host for long periods of time- smallpox
greek and roman ancient medicine
-Seen as educated and the great thinkers
-Important to the development of modern medicine
-They took the first step towards science
-First to differentiate the real physical science world from the gods and their world
-father of medicine - Hippocrates (Hippocratic oath-goes against heroic medicine- no assisted suicides or abortions + do not pay for medical studies + surgery is not for doctors + no sexual abuse either men or women )
-humors
four humors
-Black bile, blood, phlegm, yellow bile
Adam and eve/christian belief
-Bible depiction- shows a woman's body as a mirror derivative of the male body
-This can be shown in michealangelo's work
-Christian way- diseases- suffering is a part of the life of a christian- a natural part of existence
medieval hospital
-Charitable institution for the poor
-Those who didnt have family, poor, travelers
-Radical transformation of hospitals during the civil war
medieval university
-Create the title of doctor
-teachings/learnings from islamic studies
medieval therepies
-Purged bodies- bloodletting + making you vomit
medieval surgery
-Removal of bladder stones
-Brain surgery
ring around the rosy
-Bubonic plague - rats - fleas
-Human to human transmission
-Europe did not recover until 150 yrs
-Did not disrupt social order
-Christians + pope- blamed sins
malaria
-Mal aria- bad airs- liquids in the streets
thomas Kuhn
-Normal science- in each time period in medicine
-Asks questions to abnormal results
New paradigm
-Destroyer of ancient writers + disrupted school of thoughts
-Thought diseases were caused by outside of the body not inside
-That there were many diseases not just one
-Believed in folk remedies- organ should look like plant that can cure the disease
-Revelations- he had a control over nature
intelligent/ mystical nonsense
-Still had an important influence
william Harvey
first to describe how the body was pumped through the blood system
-physician in 1600's
the knife man
-Surgery was quick, people die from shock, bleeding out, infection
-Gotta be tough to be a surgeon, military toughness, people are alive and in pain
-Training- not a lot of it, didn't really study anatomy, or basic principles of health, just knew about humors and ancient greek doctrines, surgeons could not do much
-A lot of amputations, infections,bullet wounds, gang green
-Infections so common doctors thought it was apart of healing
-Most common was treating venereal disease (with mercury)
-Hunter gives himself gonorrhea and syphilis by accident (he thinks they come from each other)
-Hunter turned surgeory into a scientific approach, questioned everything
-Think if you are the patient and you wouldn't want it done to you, don't do it to the patient
-Hunter very interested in pregnant, look into development of fetus
-War wounds- people try to make them big, hunter said bad idea and if the bullet hasn't done any major damage just leave it there and let nature heal it
-Dentistry- seemed unimportant, very bad teeth bc of sugar
-When hunter gets sick they treat him the way they treat everyone else, even though -Hunter knows it doesn't work
-Hunter spent time studying life, resurrecting friends, think things could come back from dead (hanging victims don't actually die) or life can be paused (frozen) and unfrozen
-Hunter starts to investigate evolution, comparative anatomy with animals, religious orthodox
death of charles II
-Drained 16 ounces of blood, cupping glasses on shoulders, burned him, teeth held open, gave him stuff to make him throw up and have diarrhea, blistering agents on his head, and red hot irons on him ( wound man medieval surgeon ad)
the eighteenth century- the enlightenment
-Patients purged and bled (unsuccessful)
-The humours still help dominance for most practitioners
-Whilst many scientific advances were made during the 17th century, physicians during the 18th century struggled to apply all this new knowledge to medicine
-Hunter in the knife man threw away all this information (he knew it was false)
-Hunter also made medicine an education process
-Medicine only moves forward with experiment - but there is an ethical issue because in order to experiment must torchered animals and some humans
-Modern example is kids with leukemia were experimented tested on because their disease was a life sentence a while ago (the children suffered and died, but now there's a cure)
-Medical sciences were not as advanced in scientific knowledge
-Because the body and functions were still a mystery
-Universities in Europe had their own versions of diseases in the body
-Caused more harm than good
-Doctor's didn't sterilize anything
-most illnesses and medicine were aided by the families and mothers in their house
the 19th century- making medicine modern
-We learned how to define a problem, attach it experimentally, and find a result
-What did we get from this?
-Specialization - people each got specific to a problem, many people working on many little problems
-Communication - must communicate your work, medical journals, publication, medical societies
-Organization - forming medical societies, scientific societies
-birth of modern hospital
20th century
research switched to hospitals
smallpox
-Extinct today
-Common childhood disease until late 16th century when it started killing a lot more people than in the past (more virulent)
-Fearful disease, caused panic, particularly cities
-People used to inject the smallpox fluid into other kids when one child had it
-The children who had been given the fluid got a mild case of smallpox and then never got it again (inoculated-treat (a person or animal) with a vaccine to produce immunity against a disease.)
-Was written up in royal society and then came back to be useful when smallpox came back again
-Worked most of the time but some still got sick and died, it became a political controversy in boston (why make people sick intentionally?)
-Until 1938 no one saw a virus, not until they had the microscope, they knew what a virus was but couldn't see it - those working with it were in the dark
-There was a smallpox outbreak in bethlehem in 1800's (they would burn tar in the streets thinking it would help)
edward jenner
-Trained with john hunter
-He made an interesting observation about smallpox
-He found that people working on farms (milk maids) didn't tend to get smallpox, because they had gotten a related disease called cowpox (a less dangerous disease)
-He said cowpox gives you immunity to smallpox (tested on man who he gave cowpox then smallpox and he didn't get smallpox)
-Vaccine - comes from spanish/latin word vacca for cow
-Approaches to pass vaccines?
-Arm to arm transition-inoculate one person and then pass it on to another - this caused syphilis to be passed on too
-Dry the fluid from cowpox on a thread and mail it to someone
-1880s had cowpox farming, herd of cattle kept just to keep cowpox virus alive
scurvy
-The short and rather unpleasant life of 18th century sailors
-Sailors had bad diet that lacked vitamin C
-Gums swell up, teeth fall out, joints start to not work right, and then you die
-Lacked vitamin C that is needed to keep collagen in body
-1400 of the 1900 men on a voyage to indonesia from england died, 1000 died from scurvy
-Sailing was a big part of the life back then, trading and stuff, fortune made on the ships
theories for scurvy
-Old fashion theory- scurvy caused by black bile, so they purged (throw up and diarrhea)
-New theory- caused by atmosphere, cold wet air that interfered with perspiration, solution was ventilation (they thought good clean fresh air is good for health, it is true but used wierd theory to get there)
-New theory- thought it was caused by improper acid base balance and could be solved by diet (on the right track)
-James lind (figured it out) - he found that citrus fruits and juices would cure and prevent scurvy- he fed oranges and lemons and they don't get scurvy, before their diet was salted meat and alcohol (he did not believe his result and prescribed ventilation)
-Concept of vitamins doesn't come up until 1910
site of medical innovation
-Middles ages - library of university, read the classic and ancient texts
-1500-1800 - individual sick bed, look at patients (diagnose)
-19th century - birth of modern hospital
-20th century - research switch to laboratories
France - hospital and patients
Germany - chemical laboratory
Sydenham's Hypothesis (1714)
-Nature in the production of disease is uniform and consistent so much so that for the same disease the symptoms are the same
-Essentially that disease can be diagnosed from their symptoms
more ideas of disease in 18th/19th century
-Believed diseases went through a cycle, and they would give a prognosis based on where they thought you were in the cycle
-Doctors usually just looked at patient, putting hand on patient was not acceptable (especially men verse women issues)
Also doctors thought touching was a craftsman thing and doctors were above that - they were upper class
-Bichat (1801) - taking patient history and listing symptoms get you nowhere, when they die then you examine them and figure it out
Percussion
two fingers on you and they would thump (get an acho)
Came from 1761 a guy said you can diagnose by thumping
Put ear on chest of patient to here the lungs - ethical problem can't touch people (head on ladies chest) - so developed the stethoscope
Ignaz Semmelweis.
hungarian doctor
-first to take about the idea of germs and washing hands
-could have saved the lives of many children and mothers but
-assistant professor at johns hopkins school of public health
-during a time when physicians were just starting to have scientific training no longer thinking of illness as an imbalance caused by bad air or evil spirits. (autopsy became more popular)
-discovered through child bed fever and how doctors would aid a mother giving birth after they did autopsies and then more of them got sick (said their was particles on the cadavers)
-told them to wash hands with chloride and it worked death rate declined (bit the doctors stopped listening to him)
cholera
-Had sudden dramatic and disgusting symptoms
-Not easy to transmit
-Bacteria in cholera must go through your stomach
50% mortality rate, but low infection rate
-Kills you fast
-Infection in the small intestines
-Transmission of disease in contaminated food
-Cholera was not a disease only of sinners, but the poor
-Cholera was a "poor man's plague"
-dirty streets especially in NYC
ways they thought cholera was transmitted
-Some thought it was unsanitary living conditions
-Some blamed sin and religion, punishment from god
-A lot thought caused by atmosphere
-If someone who was wealthy got cholera people thought they were breaking some kind of sin
-Saw it as an individual problem
new york during cholera
-Wasn't very helpful, only active during epidemic but didnt know how to work
-Quarantine
-Set up hospitals, in schools usually because no one wanted a cholera hospital on their property or near them
-Tried to set up laws to clean the city, people didn't listen
predisporition
-tendency to a condition or quality, usually based on the combined effects of genetic and environmental factors.
-Thought homesickness was fatal
manchester vs lowell
-The path of america is unique to any other country in the world
-America is different and unique, history means nothing, we are special
-Manchester, england full of working class who rioted, workers are savages, industrial system and cities turn people into savages
-Textile city lowell massachusetts, didn't want it to be like manchester, recruited farm women, women no threat to democracy because can't vote
immigrants and american exceptionalism
-Immigrants get sick the most, make problems in cities
-They don't fit in with american culture
-Mainly irish people
-Immigrants bring disease
-People like thinking of america as a refuge from europe for the oppressed (both immigrants and americans believe this)
-Believe immigrants will eventually turn into americans
where the other half live
-Poverty is the other half, not everyone living the american dream
-Americans blame the poor for all problems
-Dont fit into jefferson's idea of america
cleanliness
-individual solution to the social problem of cholera is to be clean
-cleanliness is a religious idea
-ben franklin air baths
-put babys in cages in the air
-cleanliness came out of the rising middle class- respectable if clean
air baths
-supported by Ben Franklin, early proponent of cleanliness and good health
-fresh air makes you health
-had children stay outside for long time
middle class and cleanliness
-cleanliness came out of rising middle class
-helped them be respectable neat and clean
civil war
-Modern warfare
-Creation of the red cross
-War is great for medical development
(WWII, penicillin and heart surgery)
-Registering prostitutes so that they would keep their troops healthier
-If they couldn't stop the sex/transfer of disease, they might as well try to regulate it
-Not eating well, not bathing often,
-Washington D.C. was lowlands along the potomac
swamp→ malaria, typhoid
-If all of your soldiers are sick, you can't fight at all
-After 2 years of service, only ⅓ of the unit is still fit to fight
-When a soldier got sick, injured, or slightly wounded....why not just send them home?
Lots of them wouldn't come back
-When the war starts, all of the young men thought that they were going to be heros → romantic notion on military service and war
United States Sanitary Commission
-Bandages, making socks, food drives, shipping it to the front lines for the soldiers to use
-Lots of young women end up volunteering to go with the army
-Lots of them became nurses
-made in civil war
nurses in civil war
-Nurses saw their roles as like mothers
-Called the soldiers boys
Like it is their sons
-Doesn't turn up as many noses
-Respectable Women wore hoop skirts (Working as a nurse couldn't wear hoop skirts)
-Dorothea Dix (Superintendent of army nurses)
cholera 1866
-last outbreak of cholera they create a metropolitan board of health in New York City that is given a lot of power
it is created by a new york state legislator (not the city of New York)
Tammidy hall ran the city
-The 1st time an american community organized itself to conquer an epidemic. The tools and concepts of an urban industrial society were beginning to be used in solving this new society's problems
-Disinfectant was a standard medical approach to disease but no one has a clear idea of what it is they are disinfecting against
-Only 1/10 the amount of deaths this time then past outbreaks
-Started having an idea of the germ theory
-No effective approach to any kind of medicine
-Enforced cleaning up the streets, old fashion idea from the first two outbreaks
-Started to believe it wasn't just the poor that is affected because they sinned
-Movement away from nasty medicines, especially to soldiers
-How to prevent a disease from spreading - quarantine - best but also most difficult one to enforce
-They know it is spread through bodily fluid but cant figure out if it is chemical or biological
-Believe infection was spread through the air, so wanted hospitals with good ventilation
problem board in NYC confronts in cholera outbreak
-Political problem - democrats fight board because republicans made it - said the board it only there for the rich
-Mean to immigrants - mostly irish - irish were dirty
-Quarantine is hard to enforce and do - nasty procedure - put sign on door and no on is allowed in or out wait until they all die
-Constitutional problem - government doesn't have the right to interfere with private property
Parisian hospital medicine
Hospitals had existed before, but their numbers increased prodigiously as the Industrial Revolution fostered rapid urbanization. Regue had to be found for the tens of thousands of young peasants,.. Who were streaking into the growing cities. All too often they fell victims to typhoid fever or tuberculosis, diseases which as a result are found to be in the center of the clinical interests of the period. The crowded hospitals offered unprecedented material for clinical observations-and for autopsies.
becoming a doctor in this time
-doctors professional status is not high - praised scientific advancement but not seen as high status
-Becoming a doctor was easy
-No government regulation of medical profession
-Created a medical association to control this
medicine in america after civil war
Coming out oc civil war medicine in america made a lot of progress
But doctors professional status is not high - praised scientific advancement but not seen as high status
Becoming a doctor was easy
No government regulation of medical profession
Created a medical association to control this
disinfectants USSC publication 2864
-Used acid to clean wounds
-Bromine most prompt antiseptic
-Carbolic acid
-Included the word virus but they don't know what it means, they had a different definition
-Thought yellow fever and malaria went away with frost
-Didn't realize it was cold that killed misquitos, thought just cold ended disease
-All of this came up with watching and working with patients
-Did it without germ theory of disease
joseph lister
-Observation - setting fractures, fixing broken bones, noticed patients with open fractures usually got infections and those with closed did not
-Realized there is some external agent think it is coming from the air
-He thought it was oxygen like rusting of iron
-He thinks bacteria in the air are landing on the flesh and causing infection (big step to germ theory)
-He uses carbolic acid to try to combat this idea
-After a while nurses came up with a process to clean hands that included a lot of acids and stuff bad for hands and skin - soon they came up with using gloves - but hard to convince because thought lost some motion of hands during surgery
development of the germ theory
-There was a lot of guessing about what could be happening
-Nobody can really see viruses until electron microscope in 1930s
-1953 finally explains what viruses are with Watson and Crick
-Mix of science and technology
-louis pastuer
-leibigs laboratory
-the microscope
-Using chemistry to make dyes to stain
louis pasteur
-saw himself as a technologist more than a scientist, stumbles in to being a scientist
(What kills silkworms
What is killing chicken)
-Is disease just chemistry
-Or are living things involved in this somehow
-Fungi could cause disease in silkworms
-Germs come from
-Very catholic and conservative
-Bias towards living things
-He is a practical chemist and very interested in the french economy
Cheese, milk
-Heat it up to a certain temperature to kill bacteria → pasteurization
-Came up with rabies vaccination
-Created a strain of rabies virus that is not that virulent so that he can use it to make a vaccination
-14 shots in the stomach
Liebigs laboratory
-Germans start making major developments in scientific research
-Liebig invents the modern research laboratory
-Building with a bunch of equipment and tables in them and having a bunch of students doing research in there
-Start doing chemistry
-Elements and molecules had been discovered → finally starting to make sense to people --Determined the essential components of food
-Studied breast milk
-Notion of you can't study life with chemistry
Proved that this was wrong
LaVoisier
-chemistry of combustion
-What is the relationship between chemistry and biology
-All biology is just sophisticated chemistry?
-Vitalism: Living things are different?
-Boils down to fundamental question, what is life?
the microscopre
-Robert Hook
Homunculus
-The sperm
-Has a tiny little completely formed person in the sperm
-The woman basically only contributed nutrition to the tiny little person in the sperm
understanding the diagnosis of disease
Looking for Disease Origins
Body
When you were sick, your body was sick→ four humor theory
Bleeding, purging,
1858→ Grey's Anatomy
Importance of autopsy
Organs
Tissues
Cells
Cancer is a cellular disease
Major breakthrough in starting to know that cancer is caused by uncontrolled cell division
tuberculosis
-killed more people in the 19th century than any other disease
-Die slowly
-Isolate bacteria that cause tuberculosis
-Uses staining technology
How do germs make you sick? Why do bacteria in your body make you sick?
-Germans think biology is chemistry
They believe bacteria make you sick by poisoning you, which is true, many diseases are caused by toxins
anesthesia
-start with Humphrey Davy
Discovered nitrous oxide made people loopy
Used as a party drug
-halstead really created it
john hopkins hospital
American universities had been to train undergraduates
University was a place that does research
Hospital founded in 1889 and medical school opened in 1893
How did the school get established? Had the money from john hopkins but used it all so then needed a donor, funding from mary elizabeth garrit had to have a bachelor's degree before going to medical school, medical education before this was a joke could go to lecture for 6 weeks and become one, anyone could call themself a doctor, four more years of graduate school to call yourself a doctor, standard we have today
Education their was really disorganized, had to teach themself, hands on, teachers wouldn't show up
If you can't figure it out on your own gotta leave don't belong their, reproduction of themselves
Connection between hospital and civil war, organized along same was as civil war hospital because first person to head hospital was civil war surgeon
Named experimental laboratory after john hunter - medicine is an experimental science
surgery
problems keeping people from doing a lot of surgery that halstead tackled
Still introducing germs into interior of body, infection still a big problem
Halstead makes rubber gloves
He said their needs to be no germs at all completely clean, no germs on people in room
Cleanliness big problem
Suturing
Use silver thread
Slower approach, dont do it as fast as your can
Know where all the arteries are, clamp them all off, tedious but safer so dont bleed out
Now we give people do transfusion, halstead did it once but they dont understand differnt types of blood
Halstead a lot of his times working on dogs
Clean, limit blood loss, dont kill tissue, dont experiment on humans - all ideas o modern surgery/medicine
Colon surgery, explode not sutured well enough, colon explode
Breast cancer- women wait a really long time before going in - radical vasectomy, took out everything, most women were doomed because the cancer already spread to so many places
Hernia surgery, world famous
evolution of hospitals
=Hospitals were controlled by doctors, not administrators
-Doctors weren't paid
-178 hospitals in 1910
-Very small hospitals
80 beds
-Attitude of the 19th century→ "Danger of hospitals"
-Originally, caring for the sick stays in the family
-Ultimate unite in society
-Civil war shows that hospitals could provide medicine
-Hospitals in the north were pretty good
-Middle class gets into hospitals through insurance
-Hospitals would set up outside and give care to the community
-To deal with people with common problems
-Keep them out of hospitals
-Competing with private physicians
-Private practitioners
-See medicine as a business
-Visiting nurses
(Would visit houses where people don't show up to work/school for a long period of time
Taking healthcare to people
Taking care of families)
-rich can pay extra for nice care and poor can get free care but get risky experiments tested on them
-Moves away from the idea of it being the family to take care of the sick
1876- views thought that hospitals would let people get away from responsibilities + weakens family= weakens society
-Roms for poor patients and rich ones and the middle class is left out
Poor went for free and got experimented on
Rick paid for nice rooms
Middle class couldn't afford the nice rooms and didn't want to hurt their pride going for free
ethical problems with medicine
-Letting nature take its course
-Harming more than doing helping
-Religion & medicine
-Medicine is an experimental science
-Experiments on animals & human beings
Thomas Kuhn
-"The Structure of Scientific Revolutions"
-Theory: How science really works
miasma theory
-diseases (cholera, chlamydia, black death) were all called by miasma.
-Noxious form of bad air
-Theory in the 18 century
Given up by scientists and physicians after 1880
-Replaced by the germ theory of disease
-Specific germs caused diseases
disease was a consequence of sin
-Summary: The disease gets the people who are unwise, people who drink too much alcohol, and drug users
-Disease, especially cholera was a punishment coming from God's own hand
peoples understanding of disease
-miasma theory
-disease was a consequence of sin
treatments for disease
-cholera: If one wanted to rid themselves of Cholera (Give food to the hungry
Clothe the naked
Remove the filth from the the homes of the poor )
They must "lend a hand"
Alternative methods that Doctors used:
-Cupping
-Purging
-Bleeding
-Sweating
evolution of surgery/sanitation
-William Halsted-professor of surgery at Johns Hopkins
-Founding father of modern American surgery
-Well versed in in human physiology and anatomy
-Introduced new methods to control hemorrhaging
-Ardent medical researcher
-Explored new methods to operate on hernias, thyroid glands, gall bladders, and ducts
-New procedures in intestinal sutures
-Trained surgeons
-Had proper training now
-Changed the approach of modern medicine
-Unrefined reputation to a more precise manner that emphasized controlled blood loss and minimized tissue damage
-Showed that he had good background in physiological/anatomical knowledge
-Slow/methodical surgeon
-Careful not to disrupt any area of the patient's body that was in close proximity to the operating area
evolution of sanitation
-Introduced new preventative methods that significantly reduced bodily infections
-Introduced Through many invasive surgery techniques
-Main concern was the prevention of infection through sterilization of all medical equipment
-Design & use of surgical gloves
-New procedures for handling tissues/organs→ Minimized trauma and infection
-Taught that bodily tissues that are damaged during surgery are more susceptible to infection
evolution of learning the human body
-Surgeon: John Hunter
-Expert in anatomy
-Dissected animals to learn more about the body
-Related it to the human body
YOU MIGHT ALSO LIKE...