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History 291: Disease, Medicine, and History Fall 2017

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Jacob Steere-Williams

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Transcript of History 291: Disease, Medicine, and History Fall 2017

History 291: Disease, Medicine, and History
Professor: Jacob Steere-Williams, Ph.D.
College of Charleston
Fall 2018

(1.) Skills of Historians
-Reading Primary and Secondary Sources
-Critical Analysis/Thinking
-Arguing (Using Evidence/Providing Interpretations)
-History as "Epistemology"

(2) Sensitize You to Issues You Will Come Across the Rest of Your Lives
-Health is a Political/Cultural/Social/Economic PRIORITY
-Health Care Practitioners
-Health Care Consumers

(3) Improve Your Writing & Critical Reading
-Fewer Writing but More Reading
- Writing Assignments focused
Course Goals
America
as Medicine
Class/Race/
Age/Gender/
Lifestyle/Place
"Americanization"
Hygienic
Habits/
"Purity"
Public Health as Religion
Freedom/
Democracy/
Capitalism
Role of Gov't/
Regulating
Health Care
Medical
Geography
Medical
Racism
Political/
Cultural Notions
Antebellum Medicine as a "Cottage Industry"
-Self Policing
-Competence (Standard Curriculum)
-Exclusivity
-Education
The "GP"
Jacksonian America
1820- First edition of National Pharmacopeia
Practice
Theory & Geography

1. Purges Calomel (mercury)
2. Emetics
3. Bloodletting
4. Laudanum (opium)
& Alcohol
Bloodletting
"Scarcely any two cases of disease are to be treated exactly alike"
Class 3
"Medicine in the Early 19th c."
Threshold of Gentility
Benjamin Rush
and Physician's
MORAL
Character
Benjamin Rush (1746-1813)
What is a (Medical) Profession?
The Hippocratic Tradition and the Origins of Western Medicine
The Speckled Monster: Smallpox
Medical Education I:
Edinburgh and London
"Good subjects for the dissecting knife"
Why (some) American Medical Students
went to Europe

Edinburgh
?
(mid 18th-1820s +)
(Hunterian then)
Wm Cullen (1710-1790)
(1820-1860s)
St. Thomas' Hospital Theatre, circa 1822
Xavier Bichat
Why Edinburgh?
Why London?
Anatomy and Grave Robbing
Medical Education II: Why Paris?
Class 7 (Wednesday 4 September)

The 'Gaze' and the Paris Clinical Revolution
Medical Marketplace II- European Imports
Patent Medicines
Studying Germs
Studying Germs
The Bacteriological Revolution
The New Public Health and Immigration
Professional Authority: The Case of Typhoid Mary
American Progressivism and TB
Medical Marketplace I- Homegrown Radicals
New to the Hospital: X-rays and Twilight Sleep
The Rise of Social Medicine
Class 32 (Monday 4 November)

Medicine and Morals: Syphilis
Medicine and Morals: Polio
HIV/AIDS in Focus
(Wednesday 30 November)

"Vis Medacatrix Naturae" (The Healing Power of Nature)
Thomsonianism
Samuel Thomson (1769-1843)
Lobelia Inflata
Capsicum
Thomson as Entrepreneur
Grahamism
Sylvester Graham (1794-1851)
Morality, Stimulation,
Sexuality
Vegetarianism
The Abracadabra of the Nineteenth Century
Vincent Priessnitz, Hydropathy or the cold-water cure, 1842.
Hydropathy (Hydrotherapy)
-Similia Similibus Curantur (like cures like)
-infinitesimal doses
-Homeopathic preparations
-Homeopathy as the biggest challenge to Orthodox Physicians- WHY?
-Organization
-Efficacy in Therapy?
Medical Systems Compared- 1849
Take some calomel,
The more you take the better,
Mix it with a drop
Or two of cistern water.
Feed some to your dog
It will make him vomit,
And, may be, see stars
And perhaps a comet.
One in each half hour,
Take a rousing portion;
Say, a tumbler-full
If that suits your notion.
Should you chance to die,
As you're almost sure to,
You may safely swear,
That it did not cure you.
Orthodox
Homeopathy
Take a little rum,
The less you take the better;
Mix it with the lakes
of Werner and of Wetter.
Dip a spoonful out-
Mind you don't get groggy.
Pour it in the lake
Winnipisiogee.
Stir the mixture well,
Lest it prove inferior;
Then put half a drop
Into Lake Superior.
Every other day,
Take a drop in water;
YOu'll be better soon-
Or, at least, you ought to
Hydropathy
Take a linen sheet,
The bigger 'tis the better-
Wrap yourself up well
And plunge into the water.
Any water'll do
Croton sea, or cistern;
Each should make a choice
Of what best suits his notion.
When you're fairly soaked,
If you don't feel better,
Take a generous show'r bath,
And get a little wetter.
Touch no wine nor gin,
But gallons of cold water-
You'll be better soon,
If you ain't, you o'rt to
William Farr
Statistician- Compiler of Abstracts at the Registrar-General's Office

Statistics crucial to public health and "Sanitary Movement"
Disease Theory around 1850
Contagion
(spread by personal contact)
Smallpox, Rabies, Syphilis?
Miasma
(Anticontagionism)
Cholera, Yellow Fever, Typhoid, TB, (most epidemic diseases)
Debt to
Hippocratic Humoralism
Predisposing Causes
Crucial
-Hierarchy of Causation
"All Smell is Disease"
The Usual Suspects
Joseph Lister (1827-1912)
Louis Pasteur (1822-1895)
Robert Koch (1843-1910)


-German Physician (Bavaria- Munich)
-Most sophisticated of Anti-contagionists
-Groundwater Theory-X-Y-Z
-1855 Treatise on Cholera
Political Manifestations:
Quarantine
=
Anticontagionism-

Liberal Freedom
Contagion- Absolutist- Gov't Control
John Snow (1813-1858)
Epidemic Cholera
Major Outbreaks- 1831-2, 1848-9
1853-4, 1866

-Major fear-
killed quickly
Unusual Symptoms
“a disease that could seize a British soldier in perfect health, reduce him six hours later to a whimpering infant unable to control the discharge from his bowels, and lay him out a corpse six hours after.”
-Pioneer Epidemiologist?
-Anesthesiologist
-Water-borne theory of cholera

(1)Metropolitan Water Companies Study
(2) Broad Street Pump Study
Scottish Surgeon (Glasgow Royal Infirmary)
Asepsis and Anti-sepsis
-Carbolic Acid Spray
-French Wine (Pasteur) Expectant Mothers (Semmelweis), Scottish Sewers (carbolic acid)
French Chemist/Microbiologist
-Fermentation/Spontaneous Generation
-Swan-neck flask experiments
-Anthrax + Rabies
1870-1880: General Practitioner & Health Officer in Wollenstein (East Prussia)

-1880-1885: Bacteriologist at Imperial Health Department

-1885-1891: Professor of Hygiene, University of Berlin

-1905: Nobel Prize
1877: Etiology of Anthrax
1882: Etiology of Tuberculosis
1884: Etiology of Cholera
Koch's Postulates
-Plausible Cause: Must be present in all cases
-Cannot be present incidentially
-Experimental Test:


(a) Isolate Organism
(b) Grow in Pure Culture
(c) Produce Disease in Healthy
(d) Recover from the inoculated case
Koch's Importance
1. Specific Formal Criteria for understanding disease
2. Development of standard techniques
3. Use of Pure Cultures
4. Staining techniques
5. Micro-photographs
6. Research Laboratories: Koch's Students
Problems?
-No identification of viruses
Not visible with light microscope
Not capable of culturing until tissues cultures introduced in 1930s
-No concept of Healthy Carriers
(until 1910s- we'll return to with the case of "Typhoid Mary"
-Artificiality of "Pure Culture"
Germ Hunters....
Find causal organism- create vaccine
Context = Smallpox Vaccination (arm-to-arm)
-Bacteriologists seemed to have new answer
Diphtheria- "Childhood's Deadly Scourge"
Pasteur (and his students):
-1879- Chicken cholera vaccine
-1881- Anthrax vaccine
-1883- Swine Erysipelas
-1885- Rabies (Read Hansen article!
)
"throat distemper" "morbus stranglatorius" "croup"
"malignant ulcerous sore throat" "angina maligna"
Diagnosis- Breakthrough = Wm Park + H. Biggs
Wm Park (1863-1939)
1893- New York City Health Department- bacteriological diagnosis of diphtheria mandatory for all suspected cases

-Park's Culture Kit: Tube, Swab, Clear Instructions
-Physicians would send to NY Bacteriological Laboratory- (Herman Biggs in charge)
Herman Biggs (1859-1923)
The Laboratory Breakthrough
1883- Edward Klebs- First Described Bacillus Diphtheria
1884- F. Loeffler- First to grow in Pure Culture (Koch)
1888- Emil Roux and A. Yersin- Discover Diph. Toxin
1890- E. von Behring- First Immunized guinea pig with toxin
1890s- Paul Ehrlich- First use of Antitoxin in humans
Scrofula
Pott's Disease
Tenement Living- Jacob Riis "How the Other Half Lives" 1890
Consumption
Henry Livingstone Trudeau and the Saranac Lake Sanatorium
Saranac Lake = Model
Education + Change Personal Behavior
Surgical Solution?
Pneumothorax- collapse lung
Social Solution?
Anti-TB Associations- National and Local
“Cure sometimes, Relief Often, and Comfort Always”
Most of 19th century- TB = Multiple Diseases
1. Patients required to be outside "taking therapy" from 9-noon, 2-5 everyday
2. Patients must have no exercise
3. Solid, Substantial Diet- 4 Compulsory meals (goal about 4,000 calories/day)
4. Constant vigilance by staff- no alcohol, tobacco, sex, gambling, etc.
Koch- isolates mycobacterium tuberculosis in 1882
Technology in the Hospital
Henry Fisher- Pathology lab @ Penn. Hospital, c.1890s
Lab Technicians @ Penn Hospital, c.1920s
Nurse Anesthetist- Deana Murphy
1924- Residents and Interns- Penn Hospital
Figures from Penn & NY- 1900 and 1920
New Tools
Crowing Achievement = X-Rays
Wm Roentgen- German physicist @ Würzburg
1895- 1st Report on X-rays (tested his wife's hand)
Light passing an electrical current through a cathode-ray tube (Crookes tube)- produced new ray (radiation)
"I have seen my death"
New "Sanitary" equipment for Hospitals (marketing)
-Urinalysis
-Lighting equipment
"Beach Party a'la Roentgen"
X-Ray MANIA!
Wm Welch- Professor of Pathology
Wm Halstead- Professor of Surgery (also Harvey Cushing)
Wm Osler- Professor of Medicine
Wm Osler and the First group of Residents at Hopkins Hospital in 1890s
First Faculty @ Hopkins
Osler
Welch
Halstead
Johns Hopkins Medical School and Hospital
-Designer- John Shaw Billings- uses Nightingale model
New to Curriculum
-Co-ed from the beginning
-Prereqs- 4 year college degree, foreign language
-Less didactic training, more HANDS-On
-All students do laboratory training and Clinical Clerkship
-Length of study = 4 years of 9 month training
Pathology Department
Progressivism in late 19th early 20th c. America

-Increasing reliance on Science + Technology
-More willingness for state control (of some issues)
-Wealthy Industrialists = key image, not Farmers (Jacksonian ethos)
-Education a National Issue ( John Dewey's Progressive education, importance of Morril Land Grant Act)
Medical Professionalization Renewed

-1901- AMA revised
-1900-1920- AMA Membership increases tenfold
-Medical Schools = Gateways
-1906 Study- 160 Schools: 82 (A); 46 (B), 32 (C)
"Though medicine can be learned, it cannot be taught. Active participation- doing things- is therefore the fundamental note of medical teaching," Flexner, 1925
"The time has gone by when one mind can encompass all which has been ascertained in the medical sciences" Wm Welch, 1886.
1910 Flexner Report
-Flexner staff at Carnegie Foundation for the Advancement of Teaching (AMA asked them to do it)
-Flexner visited all 155 Schools
-Examining:
-School’s entrance requirements
Size and training of the faculty
Size of Endowment and tuition
Availability of a Teaching Hospital
Quality of Laboratories
All Along the Watchtower:







Abraham Flexner and the Standardization of the American Medical School
Watershed?
No- Changes already underway (half of the schools Flexner visited had annual incomes over $10,000
Yes- Exposed terrible conditions- pressured schools to improve
-Sensational- Muckraking Journalism
Actual # of Schools
Proposed # of Schools
Kelly
Why Disease? Why History?

1. Should the world’s public health infrastructure be based on the (apparent) success of those developed largely in the ‘West’ in the 20th c?

2. Why are some disease organisms more harmful than others? Can diseases be eradicated?
What is Disease?
Disease
"Paradigms"
Biomedicine

Diseases are specific living entities capable of reproduction inside of the body

Infectious and Chronic distinction

Treatment chemically complex- Surgical Intervention very common

Pharmaceutical development based on “scientific method”

Current buzz-words: “evidence-based medicine”
Current Disease Paradigm
Introductions
World’s Collide: the Biological Realty of the Columbian Exchange




Evolutionary Evidence

Geological Evidence

Geographical Evidence
"McNeil Hypothesis"
Historian Alfred Crosby
Alfred Crosby’s research

Use more tools than archival research:
Zoonotic Origins
Disease Exchange
Syphilis

English Sweats

Typhus

Scurvy

Malaria

Smallpox

Challenge to:
Medical Theory?
Disease Causation Models?
Therapeutics?
Columbus: 1: 1492-93; 2: 1493-96; 3: 1498-50; 4: 1502-04 (to Caribbean)



John Cabot: 1497-98 (to Newfoundland, NS)



Vasco Da Gama: 1497-99 (Around Africa to India)



Cortez: 1517-1521 (Mexico, Aztec Empire)



Pizzaro: 1524-1533: (Perus, Inca Empire)



Magellan: 1519-1521: (circumnavigation)
“All their science consists of a knowledge of a few simple laxatives, or astringents, hot or cold applications, leaving the rest to luck, nothing more.”
-Jesuit Missionary Pierre Biard
“They have commonly coniurers or jugglers which use strange gestures, and often contrary to nature in their enchantments: For they be very familiar with devils, of whom they enquire what their enemies do, or other such things. They shave all their heads saving their crest which they wear as others do, and fasten a small black bird above one of their ears as a badge of their office. They wear nothing but a skin which hangs down from their girdle, and covers their privities. They wear a bag by their side as is expressed in the figure. The Inhabitants give great credit unto their speech, which oftentimes they find to be true.”
Smallpox and Ecological Imperialism
New Diseases challenge:

-Medical Theory and Medical Therapy

-Disease causation models:

-Endemic Disease that went epidemic?
-Unitary Disease that evolved?
-Imported Disease?
1763- British General Lord Amherst @ Fort Pitt



“Could it not be contrived to send the small pox among the disaffected tribes of Indians? We must on this occasion use every strategem in our power to reduce them.” …

“I will try to inoculate them with some blankets that may fall in their hands, and take care not to get the disease myself”
Germ Warfare: the Smallpox Blanket Ledgend
News came to Britain in early 18th about
Turkish “Smallpox Parties” with live viruses

Edward Jenner’s Discovery (1749-1823)

Country Doctor: Dairy-maids and Cowpox

Arm to Arm Inoculation with Cowpox
Anti-Smallpox Vaccination in 18th and early 19th c. America and Europe
Cotton Mather and the campaign for inoculation
Early American (18th c.) Fears of Inoculation
1. "Tampering with God's Plan"
2. Connection to Cowpox
3. Quarantine Question
Smallpox Inoculation and the American Revolution in the 18th c.
The London Times (October1, 1774)

Wanted,a man between 20 and30 years of age, to be a footman and under butler in a great family;he must be of the Church of England and have had the smallpox in the natural way.Also a woman,middle-aged to, wait upon a young lady of great fashion and fortune:the woman must be of the Church of England, have had the smallpox in the natural way, very sober,steady,and well-behaved and understand dress,getting up lace and fine linen,and doing all things necessary or a young lady that goes into all public places and keeps the best company
"The Speckled Monster"
British Hierarchy v. American GP
Heroic Therapy
William Buchan's (1769) 'Domestic Medicine'

142 editions
First 1/3 of book on general (Hippocratic) preservation of health
3/4 of the book on specific ills
preface:

I did not intend [it] would become a Piece of Furniture, as it were, in the House of every Peasant. Nineteen out of twenty will probably never know of its Existence. Many may be unable to read, and still more unable to understand it, plain and simple as it is. I have principally calculated it for the Perusal of intelligent and charitable Persons who live in the Country; and show seem to have, as it were, a Call from Providence, to assist their less intelligent poor Neighbors with their Advice."
Burke and Hare- 1828 Edinburgh
Edinburgh
mid 18th-1820s
London
mid 18th-20th c.
Paris
1820s-late 19th c.
Germany
1860s-early 20th c.
(mid 18th to early 20th c.
"Old Spasm"
"First Lines of the Practice of Physic" (1778)
Hunterian
today
Up the close and down the stair,
In the house with Burke and Hare.
Burke's the butcher, Hare's the thief,
Knox, the boy who buys the beef.

19th-century Children's rhyme.
"Ontological" v. "Physiological"
Pathological Anatomy
Rene Laennec
Technologies of Diagnosis
Pierre Louis
Vital Statistics- Numerical Method
At least 1000 Americans went to Paris
“Parisian Polish”
Structural Conditions
Opening up' of France after Napoleonic Wars (1790s-1815- Battle of Waterloo)
Wartime Training Schools:
Ecole Polytechnique
Ecole de Sante
Centralized medical treatment
Paris Clinics: 7 General Hospitals, 5 Specialist Hospitals

Hotel-Dieu, La Charite, la Pitie, Neckar
skin, venereal diseases, sick children, women in childbirth, elderly, incurables, odd surgical cases, tumors, cancers, and eye problems.
What was novel?
“Parisian Polish”
Patients received free healthcare
BUT- had no rights
Physicians in charge
All had Faculty and Hospital Appointments
Hospital Organization Crucial
Patients Grouped into Wards

EMPIRICISM- OBSERVATION- EXPERIMENT
What Defined Paris Medicine?
Skepticism of Heroic Medicine
Researching Disease = #1
Unification of medicine + surgery
“the hospitals of those great cities were very extensive and filled with persons labouring under great varieties of diseases; but they were from the very dregs of society, a class whose constitutions have been depraved by intemperance and want, and modified by vice, habit and climate until they possess no analogy in constitution or disease to any class in our own country.” (Charles Caldwell)
“the climates of London and Paris were entirely different from our own; the diet and habits of the people altogether different; and that these with other circumstances so modified the constitutions of the people and the character of the diseases, as to make the latter totally different from the diseases of this country.” (A. Louisville)
Any Problems with Paris Medicine?
French Medical Science praised
BUT French therapeutics lagged
Character and morality of French/Parisian life
Scientific 'gaze' too dangerous
Experiential Knowledge
Change from Symptom-based pathology to Organ (tissue) -based pathology
Mediate Auscultation
Stethoscope
"the gaze"
"a small army of followers"
medical statistics
research on the effects of bloodletting
"everyday, at twelve o'clock, there is a distribution o them among all the classes of students. Every instructor has a small building for his own use, in which are ten or fifteen tables of cast iron. The human body may thus be viewed in every stage of dissection, and I may add, decomposition. By perambulating the several buildings, the various parts of the human organism, the nerves, muscles, and blood-vessels may be easily examined, and studied. Here, the assiduous student may be seen, with his soiled blouse, and his head bedecked with a fantastic cap. In one hand he holds a scalpel, in the other a treatise on antomy."
4,000 corpses annually!
“open up a few corpses”
1833- over 41 mission leeches were imported into France
"Therapeutic Skepticism"
"vis medicatrix naturae"
"methode expectante"
External Symptom
Internal Lesion
Dissection+Diagnostic Technologies
Thomsonianism and Grahamism
Temperance
Healing = Restoring Heat
Homeopathy & Hydropathy
Homeopathy
Samuel Hahneman
Mesmerism and Phrenology also (smaller) contenders
Enter Cholera
19th c. Disease Theory as seen through the satirical press
Cartoons from 'Punch' in 1840s and 1850s
Cholera Politics
Debating Cholera
Medical Understanding
Early Use of Anesthetic Agents
Ether
Nitrous Oxide
Joseph Priestley 1772
Humphrey Davy 1800
Chloroform
Laughing Gas Parties and Ether Frolics
Anesthetics enter Surgery
Crawford W. Long- Georgia Physician
1842- used ether on James Venable- excised a small tumor
Results not published until 1849 in Southern Medical and Surgical Journal
Horace Wells- Connecticut dentist
1844- Used ether to have John Riggs (partner) extract his own tooth
W.T. G. Morton- Wells' partner in Connecticut
Turned his attention to ether
Experimented on animals
First inhalation device
1st Public Demonstration (successful) of ether for surgery- Mass. General Hospital- October 1846
John C. Warren's Official Report:

On October 17th, the patient being preapred for the operation, the apparatus was applied to his mouth by Dr. Morton for about three minutes, at the end of which tiem he sank into a state of insensibility. I immediately made an incision abut 3 inches long through the skin of the neck, and began a dissection among important nerves and blood vessels without any expression of pain on the part of the patient. soon after he began to speak incoherently, and appeared to be in an agitated state during the remainder of the operation. Being asked immediately afterwards whether he had suffered much, he said that he had felt as if his neck had been scratched; but subsequently, when inquired of by me, his statement was, that he did not experience pain at the time, although aware that the operation was proceeding."
Refining the Technique
Enter Lord Lister
1867 'A Report on Antisepsis'

-Hospitalism
Continuing Problems in Surgery
St. Thomas' Operating Theatre (London)
Surgical kit, ca. mid 19th c.
Enter Semmelweiss
Ignaz Semmelweiss (1818-1865)
Hungarian Physician/Surgeon
Director of the Maternity Clinic @ Vienna General Hospital
‘Childbed Fever’
HAND-WASHING!
“the saviour of mothers”
Max Von Pettenkofer (1818-1901)
Success of Labortaory Bacteriology around 1900?
“Except for a few diseases or except for very indirect effects, the cleansing of streets, alleys, and back yards, of dwellings and stables, the regulation of offensive trades, and the prevention of nuisances generally, have, so far as we can see, no effect on the general health, nor any value in the prevention of specific diseases.” (Chapin, 1910 page 32)
"The filth theory of the origin of disease is dead"
Some vaccines: Diphtheria, rabies, smallpox
Surgical success: Gall bladder, Tonsillectomy
Bacteriological tests: Widal test (Typhoid), Wm Park culture kit (Diphtheria), Wasserman test (Syphilis- in 1906)
-Identification of causal organisms of bacteria (viruses not until 1930s
Basis of "New" Public Health
-From Environmental-based theories to Individual-based theories
-Knowledge of the Individual Crucial
-Identification + Isolation + Disinfection
-Combination of Epidemiology and Bacteriology
“Bacteriology has been called the handmaid of epidemiology, but it is rather an equal partner’ (Charles Chapin, 1928)
Disease PREVENTION
Indirect:
Water, Food (Milk), Flies, Soil (Epidemiologically proven)

Direct:
personal behaviors- coughing, spitting, saliva, sputum (Bacteriologically proven)
Charles V. Chapin
Health Officer for Providence, R.I. from 1884-1932
1906- “The Fetich of Disinfection” read at the AMA Meeting

1910- The Sources and Modes of Infection (academic book- standard textbook in public health)

1917- How to Avoid Infection (popular book based on 1910 book)
Prevention Strategies center on Individuals:
*Immigrants, Children, and the Poor

1. Infant Milk Depots

2. School Hygiene Movement

3. Rockefeller Foundation & Imperial Health
Federal Government Gets involved with funding major initiatives in 1930s

1935- Child Health Services
1938- Venereal Disease Control
1944- Tuberculosis
1947- Mental Health
1947- Industrial Hygiene
1947- Dental Health
1909- U.S. Public Health Service- Bulletin 56
Detailed 500 outbreaks of milk-borne disease from 1880-1907
Early Forerunners:
Early Modern Guilds
19th c. Workers Compensation Laws
Friendly Societies
Private + Independent
European Beginnings + America in the Discussion
Germany
First System of Social Insurance as a National Program
Unification of Germany in
1871
(
Bismarck
's 'Realpolitik'
Marx
& Origins of German Socialism
1883: Health Insurance of Workers Law
1884: Accident Insurance Law
Old Age and Invalidity Insurance Law
1911: National Insurance Code
"Call it socialism or whatever you like. It is the same to me."
Bismarck, 1881
System Compulsory for Lower Income Workers
Financed by the Employer, Employee, and State
Benefits = Income-based
1891: 11.5 Million workers insured out of total pop of 50 Million
1911: Expanded system to White-collar workers
Widely seen as successful
England
Long history of Friendly Societies and Commercial Insurance Companies
Eg. Funeral Benefit
Eg. Union Provident Sick Society
1870-75: Parliament issued Royal Commission
1875: Rival State-Run Insurance System (Burial and Retirement Benefits- Voluntary not Compulsory)
David Lloyd George visit to Germany in 1908
British National Insurance Act, 1911
1911 Act:
Compulsory Health Insurance to 12.4 Million Workers
Compulsory for Manual Workers (30% of pop) and anyone who made less than £160/year
Employers, Employees, and State all paid in
Benefits uniform, not income-based like Germany
DLG
1914-1920- AALL (American Association for Labor Legislation) promoted a model state bill for employment-based sickness insurance
Interested Parties:
Labor Groups (Am. Fed. of Labor)
AMA (Growing more powerful)
Insurance Companies
Sheppard-Towner Act- 1921
1934-35: Social Security toyed with more extensive health coverage
1937- Blue Cross
1939- Blue Shield
1940-50: New Dealers again crusade
1946: Hill-Burton Act- Hospitals get Fed $$
1965: Medicare and Medicaid
America
By mid 1910s calls for health insurance already labelled as 'socialist' and European:
'a dangerous device, invented in Germany, announced by the German emperor from the throne the same year he started plotting and preparing to conquer the world."
“This poster warned that even the perfect girl-next-door could not be trusted. In contrast to the cigarette-smoking, heavily made-up women in posters warning against exposure to prostitutes, this poster features an apparently average and conservatively dressed woman who might also pose a threat. Featured in the poster is the warning to all servicemen that “She May Look Clean–But pick-ups, good-time girls and prostitutes” could be possible carriers of infection.”
Syphilis:
-late 19th c. pathological and bacteriological studies- symptoms can reappear

-Discovery of congenital syphilis- can be transmitted to unborn child

-1905: Organism identified and isolated- "Spirochete"

-1906: Wasserman Test

-1910: Salvarsan: Arsenic derivative: need series of injections, had side effects, expensive

-Did work- killed the spirochete

BUT- Disease Still Stigmatized
Early 20th c. Social Hygiene Movement

1905: Am. Society of Sanitary and Moral Prophylaxis
1910: American Social Hygiene Association
Prince Albert Morrow, MD
1904 "Social Diseases and Marriage"
-VD a Moral Problem
WWII- US takes VD to be Serious Problem
Alexander Fleming- 1928-29 Discovered Penicillin- Not Manufactured until 1940s- in Peoria Illinois
Children
1994
1987
Sexual Mores
1990
2000s
1990
1989
1988
2000s
Transmission
1987
Identity
1989
1986
1983
2010
Medical Theory
Disease
Public Health
Medicine before the 19th c.
http://www.nbc.com/saturday-night-live/video/theodoric-of-york/n8661
16th-17th c. revival of anatomy
Antiquity & Greek foundations
Andreas Vesalius: de Fabrica (1543)
Microcosm/Macrocosm
Disease = idopathic
Materialistic pathology
The Body = Black Box
William Harvey: de motu Cordi (1628)
Fever
High Infant and Maternal Mortality
Threat of Infectious Disease
Higher Mortality of the Poor
?
Treating the individual or
Treating the disease?
http://well.blogs.nytimes.com/2014/01/06/when-doctors-google-their-patients-2/?_r=0
And when I must resign my breath,
Pray let me die a natural death.
And bid the world a long farewell,
Without one dose of Calomel.

—The Granite Songster; Comprising
the Songs of the Hutchinson Family, 1847 [1]
start at 21 mins

Studying Germs II: Microscopy
17th c. origins & 18th c. classification
Robert Hooke and the Royal Society
Gentlemanly microscopy (related to botany, zoology, what was then called 'Natural History')
Scientific microscopy (related to public health & the body)
Arthur Hill Hassall
"Monster Soup"
Darwin's 'Origin of Species' = 1859
According to the present system of London Water Supply, a portion of the inhabitants of the metropolis are made to consume, in one form or another, a portion of their own excrement, and, moreover, to pay for the privilege.
cabinets of curiosity AND
"gentlemanly science"
Rudolph Virchow
infusoria & animalcules
Eugenics & Family Medicine
War and Medicne
Smoking Ads
Smoking Denial
Brief History of Smoking
Late 19th c. boom
19th c. Traditional
Cigar
Cigarette
20th c. popularity
Smoking & Health
Telford Taylor
Buchenwald
Nuremberg Trial:
Medical Science on Trial
International Military Tribunal
Nov. 20 1945 onwards
Nazi Doctors tried Dec. 9th 1946 to Aug. 20th 1947
Four Courts:
-Crimes against Peace
-War Crimes
-Crimes Against Humanity
-Conspiracy to Commit these Crimes
“Nature is cruel; therefore we are also entitled to be cruel. When I send the flower of German youth into the steel hail of the next war without feeling the slightest regret over the precious German blood that is being spilled, should I not also have the right to eliminate millions of an inferior race that multiplies like vermin?” —Adolf Hitler
3 Main Areas of Nazi Medical Research
1. Research Aimed at Improving the survival and rescue of German troops

2. Testing of Medical Procedures and Pharmaceuticals

3. Experiments sought to confirm Nazi Racial Ideology
Dr. Fritz Klein,
"Of course I am a doctor and want to preserve life, and out of respect for human life, I would remove a gangrenous appendix from a diseased body. the Jew is the gangrenous appendix in the body of mankind."
Culminated in Nuremberg Code
1946- first regulation of human experimentation
OPENING STATEMENT OF THE PROSECUTION BY BRIGADIER GENERAL TELFORD TAYLOR, 9 DECEMBER 1946
[EXCERPTS FROM TRIALS OF WAR CRIMINALS BEFORE THE NUREMBERG MILITARY TRIBUNALS UNDER CONTROL COUNCIL LAW NO. 10. NUREMBERG, OCTOBER 1946 - APRIL 1949. WASHINGTON D.C.: U.S. G.P.O, 1949-1953.]
The defendants in this case are charged with murders, tortures, and other atrocities committed in the name of medical science. The victims of these crimes are numbered in the hundreds of thousands. A handful only are still alive; a few of the survivors will appear in this courtroom. But most of these miserable victims were slaughtered outright or died in the course of the tortures to which they were subjected.

For the most part they are nameless dead. To their murderers, these wretched people were not individuals at all. They came in wholesale lots and were treated worse than animals. They were 200 Jews in good physical condition, 50 gypsies, 500 tubercular Poles, or 1,000 Russians. The victims of these crimes are numbered among the anonymous millions who met death at the hands of the Nazis and whose fate is a hideous blot on the page of modern history.
Context
Eugenics in first half of 20th c
Americans actually led the way
Nazi Eugenicists learned from Americans
WWI Turning Point
Medicine and the State
Doctors as "Gatekeepers"
WWII and Experimentation
Shellshock & War Neuroses
Ancel Keys Nutrition Studies
Nazi Doctors Experiments
medical testing of recruits
Cancer
http://www.history.com/topics/chinese-exclusion-act/videos
Ellis Island Medical Inspection
"a loathsome or dangerous disease or mental deficiency"
10 million from 1910-1914
Taxonomies?
1995
Blame
Activism
Management ($)
Global?
Professionalization: Women and Medicine
"a blank wall of social and professional antagonism"
Elizabeth Blackwell (1821-1910)
-First woman to earn M.D.
(Geneva Medical College)
-Zealous moral reformer
-Women especially apt for medicine: moral + sensitive
Geneva Medical College (Seneca Lake, NY)
I had not the slightest idea of the commotion created by my appearance as a medical student in the little town. Very slowly I perceived that a doctor's wife at the table avoided any communication with me, and that as I walked backwards and forwards to college the ladies stopped to stare at me, as at a curious animal. I afterwards found that I had so shocked Geneva propriety that the theory was fully established either that I was a bad woman, whose designs would gradually become evident, or that, being insane, an outbreak of insanity would soon be apparent."
Elizabeth Blackwell- shortly after starting at Geneva Medical College
Blackwell after an anatomy class
A trying day, and I feel almost worn out, though it was encouraging too, and in some measure a triumph; but 'tis a terrible ordeal! That dissection was just as much as I could bear. Some of the students blushed, some were hysterical, not one could keep in a smile ... My delicacy was certainly shocked, and yet the exhibition was in some sense ludicrous. I had to pinch my hand till the blood nearly came ... Dr. Webster, who had perhaps the most trying position, behaved admirably." (Diary, Nov. 22, 1847)
After Geneva?
la maternité (Paris 'lying-in' clinic)
St. Barts, London
Mary Putnam Jacobi (1842-1906)
-MD from Women's College of Penn
-120 Scientific articles, 9 books
-Professor at Women's Medical College (Blackwell's School)
“immersion in technical studies is like arsenic eating- once begun, you must go on, and at a continually increasing dose” (Jacobi, to mother)
Female Medical College, Penn
Two kinds of 19th c. feminism:

1. Feminism and morality (Blackwell)
2. Professionalism and science (Jacobi)
James Miranda Barry (Margaret Bulkley)
(1795-1865)- successful- Scottish-trained surgeon
"Every woman is born a doctor. Men have to study to become one." Dr. Ella Flagg Young
Women, Childbirth,
and the rise of Obstetrics
Childbirth as a social (domestic) event
"Gossips"
Men enter the birthing chamber
William Smellie- (18th c. Scottish surgeon/man midwife)
"Science" takes over the birthing experience
BUT- Women chose!
Obstetrics Kit
Forceps
Blunt Hooks
Arrow Perforator
Cranioclast
-Fanny Longfellow,
“I never was better or got through a confinement so comfortably… I feel proud to be the pioneer to less suffering for poor, weak womankind. This is certainly the greatest blessing of this age, and I am glad to have lived at the time of its coming.”
"Your death has entered into you" (Cotton Mather)
"Thirty years ago the practice of midwifery was principally in the hands of experienced women, who had no difficulty, but the doctors have now got most of the practice into their own hands... These young, inexperienced doctors... have little knowledge, except what they get from books, and their practice is to try experiments.... The midwife's prace was one dollar; when the doctors began to practice midwifery in the country rural areas, their price was three dollars, but they soon after raised it to five: now they charge twelve to twenty."- Samuel Thomson

In October 2010, Joe Palca introduced a segment of National Public Radio’s “Science Friday” in the following manner:

Over 600 people died of cholera in London during the outbreak of 1854, and it was a pretty mysterious disease back then. The prevailing medical theory of the day blamed it on contaminated vapors, but the English physician, John Snow, had his own theory. To prove it he mapped out the cholera deaths during the outbreak, and he noticed that many of the deaths were concentrated around one particular water pump on Broad Street. Snow recommended disabling the pump; and sure enough, the outbreak was contained, so they knew it had something to do with water.

Salk v. Sabin (David v. Goliath)
National Foundation for Infantile Paralysis (March of Dimes)
-Basil O'Connor
Media Campaigns
1954 human trials
Full transcript