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History 116- Spring 2014

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Jacob Steere-Williams

on 22 January 2016

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Transcript of History 116- Spring 2014

History 116- Epidemics and Revolutions
Professor: Jacob Steere-Williams, Ph.D.
Office: 310 Maybank Hall
Office Hours:
Telephone: (843) 953-3043
Email: steerewilliamsj@cofc.edu
Spring Semester 2013
Why Disease?
Why History?
Class Overview
Syllabus Walk through
Required Books
Prezi and OAKS
Two Essays (4-6 pages) which you will write outside of class. (20% each, 40% total)

Waring Archives Research and Paper (5% Archives + 15% Paper)

Comprehensive Final Examination (20%)

In-Class Reading Response Quizzes (2% Each, 10% Total- 7 altogether- count the top 5-
4% of extra credit available
)-in lieu of midterm

In-Class Participation and Attendance (10%)
Additional Readings on OAKS

Prezi "builds" as the semester moves
Honor Code
"forbids lying, cheating, attempted cheating, stealing, attempted stealing and plagiarism"
Early Foundations of Western Medicine
Hippocratic Corpus
"Airs, Waters, Places"
Humoral Pathology
-Collection of Texts

-Numerous Authors

-Centuries of Work

-Treatises wide-ranging
Excerpt from Plato's Protagoras

Socrates, in speaking to a man by chance named
wonders why the man exhibits excitement over the impending visit of a famous Sophist, Protagoras. In the dialogue, he reveals the existence of the physician, Hippocrates of Cos, the Asclepiad, implying that the latter’s fame as a physician and teacher had reached Athens during his lifetime:
“Tell me, Hippocrates, I said, as you are going to Protagoras, and will be paying your money to him, what is he to whom you are going? and what will he make of you? If, for example, you had thought of going to Hippocrates of Cos, the Asclepiad, and were about to give him your money, and someone had said to you: You are paying money to your namesake Hippocrates, O Hippocrates; tell me, what is he that you give him money? how would you have answered?”
“I should say, he replied, that I gave money to him as a physician.”
“And what will he make of you?”
“A physician, he said.
1. Should we develop the world’s public health infrastructure 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?

3. How can we make harmful organisms evolve towards being benign?
What is Disease?

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
Major Theoretical Model until end of 19th century
Medical Marketplace:

Drug Sellers
Sellers of Charms
Temple Healers
Hippocratic "School"
Practical Foundation

Prognosis (Px)

Diagnosis (Dx)

Therapy (Rx)
What is it about?
What does it tell us about medical theory?
What about therapeutics?
Overall impression?
Primary Source Analysis
Week 1

Week 2
Antecedents: The Hippocratic Paradigm & The Columbian Exchange

Thursday 9 January
Course Introduction:
Why Disease? Why History?
Tuesday 14 January
The Hippocratic Revolution & the Environmentalist Paradigm

Thursday 16 January
The Columbian Exchange: Smallpox and Indigenous Health in the Americas
Week 3
Disease & Democracy in the 18th century

Tuesday 21 January
'Fevered States': the 18th c. Enlightenment
Thursday 23 January
Yellow Fever, Quarantine, and the Young American Republic
Tuesday 28 January
Thursday 30 January
In-Class Work on Waring Projects
Week 5
Laissez-Faire & the Medical Marketplace of the early 19th century

Tuesday 4 February
Jacksonian Democracy & Heroic Medicine
Thursday 6 February
America in 1832: The Medical Marketplace
Tuesday 11 February
Europe in 1832: Poverty, Industrialization, Urbanization
Week 6
Industrial Revolution I: Poverty and Cholera

Thursday 13 February
Enter Cholera!
Week 7
Debating Germs: The 19th c. Tools of Sanitary Science

Tuesday 18 February
The mid 19th c. 'Sanitary Impulse': Anatomy, Microscopy, Vital Statistics, and Epidemiology
Week 8
The Industrial Revolution II: Tuberculosis

Tuesday 25 February
A Disease of Poverty- Tuberculosis
Wednesday 27 February
Saranac lake and the TB Sanatorium
Week 9
Immigration, Imperialism, & the rise of American Progressivism

Week 10
WWI and the Spanish Influenza in Focus

Week 11
Framing Non-Infectious Disease in the Early 20th century

Week 12
Shell-Shocked: Mental Health in WWII

Week 13
Disease, Human Rights, and Human Experimentation

Week 14

Week 15
Conclusions- Disease as a Force in History

Tuesday 11 March
Immigration and American Progressivism
Thursday 13 March
Disease and Imperialism: the case of Leprosy
Tuesday 18 March
World War and Influenza
Thursday 22 March
Film: Influenza, 1918- American Experience
Tuesday 25 March
Cancer and Risk Factor Epidemiology
Thursday 27 March
Inter-War Years: Mental Health in Focus

Tuesday 1 April
Film: The Snake Pit
Tuesday 8 April
Tuskegee- The Study
Thursday 10 April
Discussion on Tuskegee
Tuesday 15 April
Stigma and the Beginning of AIDS
Thursday 17 April
HIV/AIDS Discussion
Tuesday 22 April
Conclusions & Final Exam Study
History 116- Epidemics and Revolutions
Spring Semester 2013
College of Charleston
Professor Jacob Steere-Williams, Ph.D.

World’s Collide: the Biological Realty of the Columbian Exchange
Evolutionary Evidence

Geological Evidence

Geographical Evidence
Zoonotic Origins
Disease Exchange

English Sweats





Challenge to:
Medical Theory?
Disease Causation Models?
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
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 Legend
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
Disease and the Enlightenment
Andreas Vesalius
William Harvey
De Motu Cordis, 1628
Body as Machine
De motu animalium, 1680
Descartes, L’homme, 1630
Gersdorf, "Wound Man" ca. 1530
de Fabrica, 1543
1. Human autonomy is the means and end of Enlightenment
a. Enlightenment means that humans develop (become “mature”) through the use of their reason. Individuals can seek knowledge and use their own reason rather than be told how to think by the church or the state. Enlightenment means think for yourself!
b. The notion of human autonomy changes the relationship between individual freedom and the state. If individuals should be free to use their own reason and to think what they want, how much power should the state have over individuals’ lives? This becomes a key problem for Enlightenment ideologies.

2. The importance of reason
a. Freedom means being able to think rationally for yourself. Kant argues that humanity must abandon a life of unreason, of relying on superstition, faith, and blind obedience. Instead, we must order our lives according to reason.
b. Reason will lead us to the truth. We find truth through science rather than opinion or faith. Through scientific inquiry we can solve all the mysteries of the universe and reveal the solutions to all the problems people face.

3. Enlightenment is universal
All human beings possess the ability to be enlightened. In other words, humans are equal by nature. All humans are part of a “universal community” who share a single universal human nature. Differences among people are less important than their fundamental sameness.

4. Progress
Humanity is progressing from immaturity, superstition, and slavery to maturity, reason, and freedom. Human history is therefore the story of progress in the human condition.

5. Secularism
Religion and politics should be separated. There should be no official religion. Further, one’s method of worship should be a private matter.

6. The centrality of economics to politics
The social organization of production and distribution becomes a central problem for enlightenment ideologies. A society’s well-being depends on how its economy is structured.

7. The ideal of popular government
a. People are capable of ruling themselves. The aristocracy is not the only class that deserved to rule. The middle class, or bourgeoisie, should also play a part in politics.
b. Support for popular government developed into support for democracy in the nineteenth century. As a result, all ideologies today (except fascism and nazism) claim to be democratic.
Yellow Fever and the South
A most infectious pestilential and mortal distemper (the same which hath al ways been in one or more of his Majesty's American plantations, for eight or nine years last past) which from Barbados or Providence was brought in among us into Charles Town about the 28th or 29th of Aug. last past, and the decay of trade
and mutations of your Lordships public officers occasioned thereby. This Distemper from the time of its beginning aforesaid to the first day of November killed in Charles Town at least 160 persons. . . .Besides those that have died in Charles Town 10 or 11 have died in the country, all of which got the distemper and were infected in Charles Town went home to their families and died; and what is notable not one of their families was infected by them.
Report of Colonial Governor of Charles Town, 1700
"Yellow Jack"
"black vomit"
"Pestilential Fever"
Cholera in the 19th century
7 Cholera Pandemics
1899-1923 **
Cholera as Invading Army
Cholera vis-a-vis plague
"A Court for King Cholera" from Punch, 1840s
Morality and "Filth"

Cholera as God's Judgment
Medical Understanding
Cholera and Public Health
“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.”
Cholera,Race, and Colonialism
“Cholera burst forth in India where parents (in times of famine) sold children, and particularly in Bengal, where they ate (and drank the blood of) dogs, frogs, and serpents, and in Indonesia, where they smoke opium with tobacco, and when intoxicated, attack the first one they see.”
“The tendency to a fatal termination of disease increases in proportion to the poverty and ignorance of the individual.” –Bisset Hawkins
Arthur Hill Hassall
Fillipo Pacini
John Snow
Broad Street Study
Metropolitan Water Study
William Farr
Bacteria: Friend and Foe
Early Cholera bacteriology
"The White Plague"
Temple of Moloch (1914)
Thomas McKeown
(1912-1988)Physician- Chair of Social Medicine @ Birmingham (England)Series of Articles and Books between 1955 and 1975-
Subject: Modern Rise in World Population
Mortality (demographic) Transition
in late 19th c.Role of Public Health/Medicine/Physicians
Rising personal income? (Economic Growth)
Improved Diet?
Better Sanitation?
Personal Hygiene?
Public Health Activities?
Advancement in Medical Technology?
Nature of microorganisms themselves (changing virulence)?
Host resistance?
“I had a little bird,
Its name was Enza
I opened the window
And in-flu-enza”
1948- The Snake Pit
“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.”
Understanding Germs in the first half of the 20th century
-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
sin and disease = enemy
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
Smoking Ads
Smoking Denial
Gregor Mendel
-Inheritance of each trait is determined by “units” or “factors” that are passed on to descendents unchanged.

-An Individual inherits one such unit from each parent for each trait

-A Trait may not show up in an individual but can still be passed on to the next generation.
T.H. Morgan- 1910s-1920s
Showed that Genes, Strung on Chromosomes, are the units of heredity

Morgan first to really demonstrate the Mechanism for Mendelian heredity
Evolutionary "Modern" Synthesis of 1930s and 1940s
-one of a pair, or series, of alternative forms of a gene that occur at a given locus (location) in a chromosome.

-the number of offspring left by an individual, often compared with the average of the population or with some other standard, such as the number left by a particular genotype.

-a hereditary determinant of a specific biological function; a unit of inheritance (DNA) located in a fixed position on a chromosome.

-the genetic constitution (gene makeup) of a an organism.

-The observable characteristics of an organism.

-darkly staining nucleotide bodies that are observed in cells during division. Each chromosome carries a linear array of genes.

-a change in DNA at a particular locations in an organism. The term is used loosely to include point mutations involving a single gene change as well as a chromosomal changes.

-in biology, the occurrence of differences among individuals.

(plural: Taxa)-any named group of organisms.

-large evolutionary change ,usually in morphology; typically refers to the evolution of differences among populations that would warrant their placement in different genera or higher-level taxa.

-changes in a gene frequencies and trait distributions that occur within populations and species.

-the hypothesis that phenotypic changes in the parental generations can be passed on intact, to the next generation.

-for sexual species, a group of interbreeding individuals and their offspring; for asexual species, a group of individuals living in the same area.

Natural Selection
-a difference, on average, between the survival or fecundity of individuals with certain phenotypes compared to individuals with other phenotypes.
Darwin's original four postulates on the theory of evolution through natural selection are:

Individuals within species are variable.

Some of these variations are passed on to offspring.

In every generation, more offspring are produced than can survive.

Survival and reproduction are not random: The individuals that survive and go on to reproduce, or who reproduce the most, are those with the most favorable variations. They are naturally selected.
Charles Darwin
"Origin of Species"
DNA- Watson and Crick
James Watson
Francis Crick
Rosa Franklin
Watson on TED talking about discovery
Thursday 3 April
The 'Nazi Doctors'
1941: Ancel Keys
-Advisor to U.S. Dept. of Defense
-1st K-ration:
-28 ounces
-3,200 calories
1944- Starvation Experiment at University of Minnesota

-36 Conscientious Objectors in study
(before 1964 "Helsinki Declaration")
Seven Countries Study- Began in 1957
Touch and Children
Sexual Mores
Waring Archives
Thursday 20 February
Koch, Pasteur, and the Rise of Bacteriology
New Diseases challenge:

-Medical Theory and Medical Therapy

-Disease causation models:

-Endemic Disease that went epidemic?
-Unitary Disease that evolved?
-Imported Disease?
Morbus Gallicus (The French Disease): Syphilis and New Diseases in 16th and 17th c. Europe
early 16th c.
woodcut of syphilis treatment
16th c. Spanish physician Oviedo-
and the Commercialization of Guaicam Tea
Girolamo Fractastoro
16th c. Italian professor medicine at Padua (best medical school at the time)
-"fomite" theory of disease
-How does Fracastoro sort through medical and religious causes for syphilis?
-Does he associated sex or gender to the disease?
-What does he suggest for cures?
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
18th century Mercantilism and the Seven Years War (1756-1763).
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"
Philadelphia 1793
Medical Controversy
Rush + Heroic Practitioners
Cause = Miasma- Cargo/Coffee
Cure = Bloodletting, Purging

Currie + College of Physicians
Cause = Haitian Refugees
Cure = Palliative Care/diet,teas, wine, rest (healing power of body)
What is Civic Responsibility/Public Health?
-Role of Gov't
March 4th, 1829- Andrew Jackson's inauguration party
Jacksonian Democracy
“Andrew Jackson was the most roaring, rollicking, game-cocking, horse-racing, card-playing, mischievous fellow that every lived in Salisbury.”
laissez faire:
simple, frugal, and unobtrusive gov’t

Generally opposed Gov’t spending and Gov’t favoritism

Against Gov’t measures to only aid the rich, privileged-Strict

Separation of Church and State
Benjamin Rush and Heroic Medicine
Samuel Thomson and Thomsoniansim
Alexis de Tocqueville- said that above all the American was a “man of action”
(1745-1813): b. Philadelphia, Educated @ Princeton & Edinburgh (Scotland) & London & Paris
Professor of Medicine at College of Philadelphia
Abolitionist (against slavery)
Pro Women's rights, Educational Reform

Early American Medicine as
"Cottage Industry"
No uniformity of practice
Lots of Competition

ALL AMERICAN DOCTORS = General Practitioners

-Biggest recommendation to young aspiring doctors?

-Establish a small farm

-Bloodletting Key- Long History- Rich Theoretical justification- Supports medical theory from antiquity- and makes patients ‘at ease’ (we’ll talk more on this later)
European Doctors
“Therapeutic Skepticism”
Social/Cultural Understanding
Medical/Public Health Understanding
Cholera, Science, and Public Health: The Sanitary Impulse
Immigration, Quarantine, and American Progressivism
Argument Today:
Quarantine = public health tool for scapegoating immigrants
Ellis Island Inspection and Quarantine Station
Inspection Gathering Room
Eye and Skin Examinations
Old v. New Immigrants
Assimilation, Americanization, Acculturation
III. Why do Aliens Come?

10. Name the principal causes of immigration. The principal classes.

11. What American ideals have the greatest attractive power? What opportunities?

12. Give some typical instances of immigrants' stories. * Would you have wished to come under the same circumstances?

13. What other forces stimulate immigration to the United States? What agencies?

IV. What Should be our Attitude toward Aliens, and What is our Individual Responsibility for Them?

14. * What is the Christian attitude toward these newcomers? How can we remove prejudice?

15. * What is our personal responsibility as Christians in improving the condition of aliens?
1881-1884: 3 million new 1885-1898: 6 million new 1898-1920: 15 million new
Eastern and Southern Europe:-Russia, Poland, Austria-Hungary, Bulgaria, Greece, Italy, Portugal, Romania, Serbia, Spain, Turkey
Northern Europe:-England, Ireland, Scotland, Wales, Belgium, Denmark, France, Germany, Netherlands, Sweden, Switzerland)
mid 19th c. and before
late 19th early 20th c.
"Our things were taken away, our friends separated from us; a man came to inspect us, as if to ascertain our full value; strange looking people driving us about like dumb animals helpless and unresisting; children we could not see crying in a way that suggested terrible things; ourselves driven into a little room where a great kettle was boiling on a little stove; our clothes taken off, our bodies rubbed with a slippery substance that might be any bad thing; a shower of warm water let down on us; without warning we are forced to pick up our clothes from among all the others, with the steam blinding us; we choke, cough, entreat the women to give us time...those gendarmes and nurses always shouted their commands at us from a distance, as fearful of our touch as if we had been lepers... our last place of detention turned out to be a prison, 'Quarantine' they called it... several hundred of us were herded in half a dozen compartments... with never a sign of the free world beyond our barred windows; with anxiety and longing and home sickness in our hearts... the fortnight in quaratine was not an episode; it was an epoch, divisible into ears, periods, events

-Mary Antin, 1894
"a place where filth diseases sprout naturally among the hordes that bring the germs with them from across the sea and whose first instinct is to hide their sick lest the authorities carry them off to be slaughtered."
Jacob Riis, writing on Jewish Lowe East Side in "How the Other Half Lives"
In-Class Documentary
Telford Taylor
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
Syphilis to Old World
Smallpox to New World
Indigenous Americans
& Smallpox
Europeans & Smallpox
Week 4
Waring Archives Visit & Project on Yellow Fever

The Doctor/Patient Relationship
A Profession?

Educational Standards
Ethics (Hippocratic Oath)
Common Ideological Basis
Write down the following:
Three things you learned from Airs, Waters, Places
Two questions you still have after reading it
One impression that makes this reading relevant today
Newtonian Mathematics
Francesco Torti's 'Lignum Febrium' or Fever Tree
Emanuel Kant: Was ist Aufklarung? (What is Enlightenment)? 1784
Who are the guardians, and how do they keep people immature?
Do we have contemporary versions of 'the guardians'?
Why are people kept immature (self-imposed from larger structural forces) and how is immaturity defined in relation to political engagement?
What is the role of freedom, and how does Kant define freedom?
According to Kant, what is the central difference between the public and private use of reason? for example, what does he say a scholar should obey to a soldier or pastor?
Where does rationalism fit into Kant's argument?
Explain what Kant means when he says, "do we presently live in an enlightened age?" the answer is 'no', but we do live in an age of enlightenment"
Enlightenment Science
Conceptualizing the Environment
Conceptualizing the Body
"Fever" as a Nosological Category
Swedish Botanist Karl Linnaeus
Binomial nomenclature
Genus and Species name
Way to categorize the natural world
Built from John Locke's idea of 'tabula rasa'
Miasma & Contagion
Robert Hooke's 'Micrographia
Rene Descartes
Public Health in the Enlightenment
Cameralism (esp. in Germany)
Concept of 'medizinische polizei' (medical police)
'Science' of Governmental Administration
Johann Peter Frank & Wilhelm Rau
-Clothing, Housing, Public Safety, Medical Education, Vaccination, Hospitals, Dispensaries, Poor Houses, Schools
Fever = Constellation of Diseases

George Fordyce:
"A fever is a disease which no knowledge of the structure of the human body, as fa as it is at present known, no knowledge of the properties of the fluids, as far as they have hitherto been investigated, no knowledge of the action of the moving parts, as far as they have hitherto been observed, could give the smallest ground of supposition, tat this disease could ever have existed. In showing its history, therefore, observation of the disease is to be entriely adhered to, without any reasoning why, or how any thing in it takes place, or without any theory, as it has been called."
Anton van Leeuwenhoek
Context of Colonialism, Slavery, and Ecology
Big Questions to Consider
BUT: who was excluded?

Native Americans
1830 Indian Removal Act
African Americans
Vis Medicatrix Naturae
Botanical Medicine-

(Lobelia inflata)

-1822 New Guide to Health (1822)

Central Beliefs:

-Medicines need to be Botanically-based (not that controversial)

-Local material medica need to replace mineral and plant drugs of Europe-
His eventual list of botanicals focused on 70 widely available in most places.

-Disease diminished vitality in the body (human body like the mechanical operation of a steam engine)

-Disease always means you’re losing heat-Disease was always caused by the same thing- losing heat

Thomson thought regular physicians (Rush)- bleeding, mineral poisons- accelerated disease by further cooling the body. (Fever was a sign that heat was escaping- inside cold, outside hot- need to reverse it)

Thomson went from travelling itinerant to wealthy businessman
Hierarchy of Medical Practice
University-trained Physicians
1832 Anatomy Acts
Burke & Hare in Edinburgh

Burke and Hare- 1828 Edinburgh
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.
(Hunterian then)
St. Thomas' Hospital Theatre, circa 1822
medical institutions
Xavier Bichat
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

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
"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
Paris Clinical Revolution
Reorganization following French Revolution (by Napoleon)
Industrialization + Poverty
Industrialization- The Results of Laissez-faire

• Mid 19th century life expectancies in England:
Gentry = 55 Farmer = 37 Laborer = 25
: Gentry = 35 Farmer = 22 Laborer = 15

English Cities with 100,000:

• 1800- Zero
• 1840- 5
• 1890- 23

Some Statistics:
Poverty and the New Poor law
“the bore, the fanatic, and the prig”
Edwin Chadwick-
1834 New Poor law
Workhouse Test
Principle of Less Eligibility
Thomas Malthus
“prophet of Doom and Gloom”
19th century overcrowded society- demand for food is going to be much greater than supply.

Idea that population increases geometrically (2,4,8,16,32, 64)
while foodstuffs only at arithmetic rate (2,4,6,8,10)

Follower of Jeremy Bentham
Poor Law & Workhouses
Essay Revisions
Global Comments:
Tense & Tone
Follow Directions (citations, sources)
Revisions due Thursday Feb. 27th in class paper copies.
The Germ Theory: The Science
Medical Chemistry
Louis Pasteur (1822-1895)
French Chemist/Microbiologist
-Fermentation/Spontaneous Generation
-Swan-neck flask experiments
-Anthrax + Rabies
Robert Koch (1843-1910)
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
-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"

-German Physician (Bavaria- Munich)
-Most sophisticated of Anti-contagionists
-Groundwater Theory-X-Y-Z
-1855 Treatise on Cholera
Max Von Pettenkofer (1818-1901)
Scottish Surgeon (Glasgow Royal Infirmary)
Asepsis and Anti-sepsis
-Carbolic Acid Spray
-French Wine, Expectant Mothers, Scottish Sewers, & Surgery)
Joseph Lister (1827-1912)
1867 'A Report on Antisepsis'
Pott's Disease
Tenement Living- Jacob Riis "How the Other Half Lives" 1890
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
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
A Diagnostic Problem
A Social Problem
A Public Health Solution
A Surgical Solution
A Social Solution
Immigration Through Ellis Island Documentary
-start around 15:00
1963- Iranian Documentary on Leprosy
'The House is Black'
2013 British Documentary on
Leprosy in India
1959 Documentary (by U.S. Missionary Society)
'The Happy City' about Leper Colony in Burma
19th/20th c. Mortality Transition
(Spanish) Influenza- 1918-1919
Context of WWI
Brief History of Smoking
Late 19th c. boom
19th c. Traditional
20th c. popularity
Smoking & Health
Mental Health in the First half of the 20th c
1946 National Mental Health Act
Life Magazine' "Bedlam, 1946"
19th century Asylums
Freud & Psychoanalysis
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.
Eugenics in first half of 20th c
Americans actually led the way
Nazi Eugenicists learned from Americans
World War II, Women, and Venereal Disease
“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.”
Scientific Story of Development
WWII- US takes VD to be Serious Problem
Alexander Fleming- 1928-29 Discovered Penicillin- Not Manufactured until 1940s- in Peoria Illinois
1905: Discovery of Spirochette (Organism for syphilis)
1906: Wasserman Test
1910: Salvarsan (Paul Ehrlich)
1913 Neurological effects (Hideyo Noguchi)
1928-9: Discovery of Penicillin
1946: Beginning of widespread use of Penicillin
1918: Division of Venereal Disease part of USPHS
Thomas Parran: US Surgeon General from 1936-1948
1938: Venereal Disease Control Act
1946: Creation of Communicable Disease Center (CDC)
Parran's creative use of new media:
popular magazines
radio shows
The Moral Soldier
The Moral Society
VD and Film
Chastity, Maniliness, and Military Strength
Full transcript