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History of Medicine Week Two Notes

by: Annita Kasabyan

History of Medicine Week Two Notes History 3D

Marketplace > University of California - Los Angeles > History > History 3D > History of Medicine Week Two Notes
Annita Kasabyan
GPA 3.577

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These notes cover week two's lecture. good luck!
History of Medicine
Dr. Robert Frank
Class Notes
medicine, history, 3d, Robert, frank
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This 6 page Class Notes was uploaded by Annita Kasabyan on Wednesday April 6, 2016. The Class Notes belongs to History 3D at University of California - Los Angeles taught by Dr. Robert Frank in Spring 2016. Since its upload, it has received 62 views. For similar materials see History of Medicine in History at University of California - Los Angeles.


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Date Created: 04/06/16
History of Medicine Week Two Lecture Notes 1. Paris Hospitals, the lesion, and Physical Diagnosis a. 18  Century (1780s­1820s) Legacy i. Disease and diagnosis 1. Diseases were whole inside the body; occupied the whole body 2. Any particular change on the outside of the body was a  manifestation of the disease 3. Common therapeutic agents: alcohol, opium (calm down your  nerves) 4. Looked for certain kinds of key phenomena; didn’t have to look  very closely at patient to diagnose ii. Med Education 1. Took place in two ways a. Universities: learned medicine; good training in Latin and  Greek (focus on texts written by Latin and Greek  philosophers b. Practical medicine: apprenticeship (14 years old) to a  surgeon or apothecary; very private, constricted learning;  mentors did not have a very strong sense of anatomy iii. Hospitals – Origins 1. Very old as institutions (beginning in the late Roman Empire) 2. Thousands of years ago, best hospitals were found in places such  as Baghdad, Cairo, Damascus 3. Medieval hospitals were religious and care institutions 4. Hospitals were run by orders of monks, sisters, nuns; provide a  place of refuge 5. All were welcome, provided hospitality th iv. Hospitals – 18  Century 1. Beginning 1720s in England, which was Protestant, groups of men  began to feel the poor were not being well treated in society;  groups of philanthropists founded small scale hospitals that would  be supported by voluntary charity; provided the poor with  medicine, surgical care, recovery a. Presence of medical personnel was very light b. One physician for the entire hospital; his job was to admit  patients, set out the course about how they would be  treated, and would go back to his priority patients – those  who could afford it 2. Pennsylvania hospital was first hospital developed in the colonies v. Anatomy – Origins 1. In the history of cultures in the world, the practice of anatomical  dissection was an exception rather than the rule; medical  practitioners did not learn anatomy 2. There were anatomists in Antiquity; they would dissect animals  (apes, pigs) and assume humans were similar 3. Revived and reinvented in the 1540s; Renaissance interest on the  human body a. Book published by Andreas Vesalius on Anatomy i. Human dissection b. Anatomical knowledge grew, but was not deployed in  medical education vi. Anatomic Pathology 1. What do body parts look like when they are infected by disease? 2. Maldeveloped until the mid­18  century 3. 1761­ Morgagni (spent 50 years writing his book); emphasized that pathology was manifested in the organ b. Medical Reform i. Social and political revolutions 1. 1789 – political system in French monarchy was abolished due to  the French Revolution 2. 1792 – French Revolution was in the midst of completely  abolishing old institutions – among those were institutions that  educated Medicine ii. War and new medical education 1. After that, a lot of wars, physicians needed a. Needed to change the way of teaching (get rid of lectures) b. More hands on experience, less reading, more doing 2. Both theoretically trained and practically competent iii. Links to reformed hospitals 1. Better education ­> better hospitals 2. Criticisms of old hospitals a. Not enough beds b. No privacy, sanitation 3. Reorganized hospitals; proclaimed that every citizen had a right to  medical care 4. Decentralize, categorize illnesses and cases and separate them into  different hospitals and wards 5. Organize medical education based upon the hospitals 6. Access to medical school based on ability to perform well on  certain exams iv. Hospitals as museums of disease 1. A medical student walks into a ward and can understand a disease  as something that takes place in many stages, affecting many  people v. Frequency of autopsy 1. Essential for the faculty to have a much better understanding of the disease, and allow students to really understand the disease c. Lesion and Physical Diagnosis i. Bichat and tissues 1. born in 1771; fanatical dissector; carried out 3­4 autopsies a day;  family couldn’t object an autopsy 2. emphasize that organs are composed of various tissues; 22  different kinds of tissue in the human body 3. in many important cases, the tissue itself is the subject of  pathology within the organ 4. distinguished that the heart is composed of three parts:  pericardium, myocardium, and endocardium a. you can have one part infected, but other two parts stay  untouched ii. Auenbrugger and Percussion 1. Old technique based upon the principle that if you create a sound  on a part of body, how it sounds will depend on the structure  underneath 2. Auenbrugger published in 1761 – not very popular iii. Corvisart and the Heart 1. Used percussion method to outline the shape of the heart iv. Bayle and TB 1. Obsessed with post­mortems 2. Phthisis (pulmonary TB); performed multiple autopsies and came  to the conclusion that the key feature was a small rice­shaped  object in lungs called tubercles that gradually caused cavities in the lungs that caused erosions of arteries, etc 3. Started finding these tubercles elsewhere (spine, intestines);  created the unitary concept of TB – defined by the presence of  tubercles (can be found in places other than the lungs) v. Laennec and Auscultation 1. Put ear against chest or back of patient and try to determine what is going on in the chest based on what you hear 2. Developed stethoscope ­ better able to hear with rather than using  ear 3. Created mental picture of the lung and its structure and conducted  autopsies to confirm  vi. New teaching 1. More personal than just a lecture 2. Skills of physical diagnosis cannot be communicated by any other  way than getting up close and personal with the patients 2. Dimensions of disease: clinic plus lab a. New frameworks from pathology i. Mature Paris: Louis and numbers 1. Increased interest in statistics 2. Louis was in his early 30s at the time a. Very critical of the individual case method; did not clarify  numerical relationships b. “statistics are the only basis of medical studies” 3. Most famous for applying his method using numbers to traditional  areas of medicine such as bloodletting and pneumonia a. In a series of experiments, concluded that bloodletting can  be deleterious 4. Expansion of the Paris message to other colonies ii. Vienna: path research 1. 1830­1850s: built a new hospital; taught Paris methods; one large  hospital so that patients can go to different sections of one hospital  to be treated rather than have to travel to different hospitals 2. Rokitansky began to teach physical diagnosis. Objects of  investigation iii. Reformer/revolutionary – Virchow 1. Served as a military doctor 2. At 24, gave a series of medical lectures; said that the whole way  that Germany practiced medicine was wrong; it had to be  reorganized 3. Clinical observations ought to include chemical methods 4. Believed that animal experiments were the way to understand  pathology 5. Need to know microscopic pathology, not just macroscopic 6. Political difficulties: revolutions in 1848; transfer political power  from established elites to academic societies iv. Institutes – Wurzburg and Berlin 1. Virchow became popular in Wurzburg and then returned back to  Berlin 2. Virchow brought lab and morgues from basement to their own  wing in a hospital v. Lab training/Exams 1. Incorporated mind, sight, and practicality to exams and training 2. Students  had to know how to use the microscope and provide  microscopic slides vi. Instruments for clinic b. Microscopes and Cells i. Old microscopes: faulty 1. Invented in 1610 2. Spherical abrasion (light passes through lens and rays from the  edges come to focus before rays from the center) 3. Chromatic abrasion (different wavelengths come to focus at  different times) 4. These created problems with the sight ii. 1830s improvement 1. Combined both lenses  2. Anatomists looked at tissues up close and discovered that tissues  are made up of smaller units iii. Schwann and cell theory 1838 1. These small units are made of a membrane and contain a small  center, the nucleus iv. “free­cell formation” 1. Transitional concept; not fully right 2. Cells just arose from the fluid in the body v. Training and clinical application 1. Sudden enthusiasm about microscopy 2. Affordable microscopes; many courses offered to students to learn  how to use a microscope c. Virchow’s pathology i. Thrombus and embolus 1. Observed that in many circumstances, particularly in the elderly,  there was clot formation 2. People at first did not think blood clots were a problem, did not  think it was mobile 3. Virchow argued that parts of a thrombus (blood clot) can detach  and spread to narrower vessels and creates an embolus which leads to problems such as myocardium infraction ii. Leukemia 1. Sick young woman; blood was lighter than usual; unusually large  number of white blood cells discovered, making the blood whiter iii. Collab with Kolliker 1. Early 1850s – Virchow and Kolliker started doing systematic  investigation of cell types 2. Concluded that cells divide and form new cells iv. Omnis Cellula E Cellula 1. “every cell from a cell” v. Cellular pathology (Virchow) 1. Invited back to berlin 2. Lectured on cellular pathology 3. Collected evidence to prove that large number of diseases that  looked like diseases of the tissue are actually diseases at the  cellular level 4. First time thinking of a disease as a cellular phenomena vi. Cell and tumors 1. Began studying diseases that gave rise to tumors 2. The key characteristic of cancerous tumors consist of a  homogeneous population of cells 3. Tumor consists of uncontrolled cellular growth d. Instruments into clinic i. Old and new ideas of heat 1. Early 18  century: belief that heat was natural, but not considered  very important th 2. Late 18  century: Celsius and Fahrenheit scale became widely  adopted 3. Previously thought that heat was generated in the lungs, and then  dithributed from there 4. 19  century: heat is generated in the tissue; body heat is the sum of all the metabolic processes occurring in the body ii. Thermometry: first attempts 1. Tried too much for precision 2. Techniques would take too long iii. Wunderlich and clinical science 1. Did an enormous series of thermometric measurements 2. Professor of clinical medicine 3. Accumulated data from 25,000 patients iv. Principles of thermometry 1. the human body temperature for a given individual is constant 2. temperature is the nest indication of deviations 3. there is a daily cycle of different body temperature v. Diseases and fever charts 1. Majority of diseases cause elevations in temperature 2. What is the numerical magnitude of change in temperature? 3. Looked for patterns in the change in temperature during a course  of an illness 4. Distinguished 30 different disease in which he can identify the  temperature pattern throughout the course of the disease 5. Graphed the numbers and examined the data (innovative at the  time)


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