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Week 6 Notes

by: Hannah Millirons

Week 6 Notes AMST 203

Hannah Millirons

GPA 3.25

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About this Document

These notes include my notes on #5 & #8 in L & N & also my notes from the class lecture and the discussion section.
Medicine in America
Robert J. Scholnick
Class Notes
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This 7 page Class Notes was uploaded by Hannah Millirons on Friday October 7, 2016. The Class Notes belongs to AMST 203 at College of William and Mary taught by Robert J. Scholnick in Fall 2016. Since its upload, it has received 52 views. For similar materials see Medicine in America in American Studies at College of William and Mary.


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Date Created: 10/07/16
Hannah Millirons Medicine in America October 3, 2016 Week 6 Notes Highlight = Chapter/Reading Name            Highlight = Section Name           Highlight = Key Term  #5 L & N: Warner  Medical Therapeutics and the Principle of Specificity o Disease was viewed as systemic imbalance in early to mid­19  century  o Therapy to modify system’s imbalance was normally depleting overexcited  patient and stimulating exhausted patient   Until the 1840s, it was always thought the patient was overexcited and the  treatment for this was bloodletting, purging (vomiting), making them eat  little to no food  Physician was in control, which was important  o Principle of Specificity: Treatment was determined and administered based on the individual’s characteristics (age, gender, ethnicity, social class, morals) and not so much the symptoms/diagnosis  Medical therapeutics was the only category of medicine that specificity  applied to o Physicians thought that environmental forces could turn one disease into another  and one disease could have different forms  Disease was fluid, not fixed  Patients with the same disease/symptoms could be treated differently  People in the city received different treatment than those in the  country did   White patients received different treatment than black patients did  Physicians used local knowledge of patients in their area  Therapeutic Change  o Patients that were hospitalized got less aggressive treatment than those in private  practice did  o Depletion practices became less prescribed as time went on and when they were  prescribed, they were used in less aggressive doses  Since they were less frequent, stimulation treatments rose   Alcohol, iron compounds, and quinine were commonly prescribed o Once physicians started doubting their medical practices, they started going down  the natural route o Physicians recognized that in physiology, chemistry, and anatomy, the practice  and understanding was universal and there was a large degree of certainty, but for  therapeutic treatment, the complete opposite was true  Experimental Therapeutics and the Dissipation of Gloom  o Physiological Method: experiments in the physiology lab would produce  physiological processes in health and disease as well as the actions of treatments   This would help the physician figure out what the patient’s symptoms  were and what adjustments should be to their body in order to treat them o Crucial new research in the physiology lab would show what treatments to use,  not just explain therapeutic behavior o Rationalism regained sovereignty over therapeutics  This got rid of the pessimism previously associated with therapeutic  treatments o Illnesses stopped being seen as systemic imbalances in the body’s natural state  and more as symptoms that could be analyzed in isolation  o Physicians stopped using the term “natural” and started using the term “normal”  o Therapeutic attention drifted from viewing physiological processes as indicators  of disarray to being meaningful on their own  Because of this, treatment started being aimed towards restoring the vital  signs to their normal state  o Case histories became shorter once the focus shifted away from the patient’s  cultural background and towards chemical and instrumental analyses of their  condition   Case records became more concise, but were less able to evoke a sense of  the patient’s humanity  o Therapeutists started breaking down the body into sections and systems, which  allowed them to assess and treat each individually   This lowered the number of treatment prescribed to each patient decreased rapidly  o Medicine moved more towards standardization  From Specificity to Universalism  o Medical therapeutics was elevated to being universal by using experimental  science  Universal rules made therapeutic medicine simple and certain o Physicians stopped treating the individual based on their history and started  treating them based on their symptoms in comparison with normal physiological  characteristics o The new medical ethos increased the hospital’s importance as a source of medical therapeutic knowledge o The lab simultaneously found new ways to support therapeutic legitimacy while  using ideals of experimental science   The Appeal of Experimental Science  o New therapies emerged, but they were few and failed to give clinicians the  therapeutic control that they were promised  The physicians who really believed that therapeutics would make it big  were basing their hope on future relevance and not actual results  #8 L&N: Numbers & Warner  The Basic Sciences o 19  century American physicians attributed their low scientific output to their  immature country o Before the 19  century, research was not performed by the students, but was left  up to individual initiative or scientific academies  o In the US, most med schools were solely proprietary, which means they were run  for prestige and profit, and were run by ill­equipped local practitioners   Almost all med schools used tuition as their main source of income and  this was split up between professors   This almost guaranteed mediocrity of the education because high  standards would have would have weeded out some of the high  paying customers o Most med students didn’t know how to read or write and didn’t go to college  Students normally left just as dumb as they came in  o Independence in the medical sciences didn’t come until American med schools  freed themselves from dependence on student fees and acquired endowments  This raised their admission standards and gave professors the time and  facilities to complete their scientific work  o Most med school professors made their living by being a practicing physician o As long as American med schools remained business ordeals, they had very little  chance of getting government and philanthropic funding   The Clinical Sciences o Americans thought highly of European medical facilities, but they usually  believed that certain stuff in the US demanded only American responses to  disease and thought European practices were suspect and sometimes even  irrelevant o  Conditions in American hospitals was deplorable   Even physicians were disgusted at and embarrassed about how low their  quality was o Once they started using anesthesia for surgery, things got somewhat better and  Americans were not as embarrassed  Class Lecture Notes  Yellow Wallpaper o The mentally ill woman is speaking  She sees women inside of the wallpaper and tries to free them by scraping  away the wallpaper to let them out o She pushes back against John (her husband) and starts writing, which helps her  exercise her brain o Her impulse in the story is to free herself from being imprisoned by her husband o The physician and husband fail to understand what is going on in the woman’s  mind  o Gilman uses this story to show that everyone has these psychological qualities   Profession requires ethics, licensing, education, and finances  Flexner report 1910 (Starr) o AMA was disturbed by inferior medical schools and wanted to improve American medical education o Hired Abraham Flexner to go to medical schools in US under the pretense that he  was interested in giving them money for research o Medical schools showed him around and he reported about their quality of lab  rooms, dissection rooms, and education o Divided schools   C: schools serving African Americans; schools that were terrible and  irredeemable; underfunded and could not compete with the other schools  and did not have a chance  B: within the means of transforming into a good school  A: Johns Hopkins, Penn, Harvard, Michigan; important med schools that  were on the way to exemplifying a wonderful medical education  o Emphasized science in the first two years and then focused on practice after that  o Since medical schools had to upgrade, it cost them a lot of money and the students had to pay for it  Tuition was raised and med school became something available to only  middle or upper class  o AMA wanted to reduce the number of physicians so they could control the supply o Running and going to a medical school became more expensive, so it was harder  for people to get into it/run it  Johns Hopkins Medical School (1893) o Had profound impact on American medical education o Started with money from wealthy women who wanted other women to have  access to med school o Required 4 years of undergrad study to get in   Had a rigorous 4­year curriculum and then an internship afterwards o Hopkins hospital o Founded as a graduate institution o Grant for women to be allowed into this school   William Osler (1849­1919) o Canadian who taught at Penn and one of four who founded Hopkins o Integrated teaching of medicine with actually seeing patients o Medicine was learned in the classroom and not by the bedside  He changed the curriculum from just reading books to actually practicing  medicine with real patients o Set the model for medical education and what it meant to be a physician who  combined science and concern for patient o Hero of American medical education and medicine in general   Charles William Eliot (1834­1926) o Chemist who went to Harvard o Went to Europe to investigate European education o Harvard’s president in 1869 and was president for 40 years o Medical school was based on proprietary mode and Eliot wanted to stray away  from this so that the courses could be more rigorous  o Brought Harvard into the research realm by writing a letter to dean of med school  to suggest reforms  3­year course sequence   Exams  Familiarity with dissections o Reform of medical education is credited to him o Tension with the past president of Harvard  Rockefellers o Jr. established CW o Sr. established University of Chicago & Rockefeller University in NY  Bonner article o American medicine at Hopkins found a new way of educating physicians  Expensive, but the best in the world  Transformation in American life from 1870­1920 o Bacteriology and germ theory o Transportation  Cars allowed physicians to make more home visits  They also allowed patients to get to the doctor easier and faster o In 1870, roughly 200 hospitals in US and in 1920, roughly 6,000  Ether was used to put people to sleep during surgery o Concepts of thinking about the body o Licensing  AMA (1847) rose educational standards, kept charlatans out of medical  field, and pushed for licensing of physicians by the state  Driving force behind the Flexner Report  Created examining boards that were responsible for licensing/examining  physicians  Made exams required  Excluded substandard med school  Demanded a code of ethics  Alabama: examining board  Missouri: passed registration laws in 1883  Andrew Taylor Still o Body is mechanical  o Set up first osteopathic practice in Kirksville, Missouri   Christian Science o Started by Mary Baker Eddy  Believe that illness stems from the mind and traditional medicine could  not cure it  Believed that a Christian scientist was the only person who could help the  sick person overcome their illness  Eclectics o Inherited ideas of Samuel Thompson o Wooster Beach (1794­1868)  Disliked conventional medicine and rejected Thomsonians   Wanted to find a way to use natural substances to heal   Supreme court urged medical sects to agree on educational standards o Licensing grew  Field of physiology o Claude Bernard (1813­1878)  Introduction to the Study of Experimental Medicine   Important in developing American ethics   Vivisection  Dissection of live animals in order to see how their internal  processed worked o Suggested that animals have similar anatomy to humans o Used vivisection to discover how human internal processes  worked   Louis Pasteur o Pasteurization: heating up liquid in order to kill the bacteria in it o Understanding of disease caused by microorganisms  o Argued case for germ theory  Before germ theory, there was the miasmic theory  Disease was in the atmosphere and caused breakdown somehow  Applied germ theory to every day life o Was convinced that living organisms causes putrification and disease o Developed anthrax and a vaccine for it  o Developed rabies vaccine  Robert Koch (1843­1910) o Father of bacteriology o Physician that discovered anthrax disease cycle with the help of Pasteur’s work o Responsible for understanding and treating TB and Cholera o Received Noble Prize for medicine and physiology in 1905  Technologies that changed the face of American medicine o Transportation was more readily available, which made it easier for people to get  the care that they needed much faster than before o Telephones allowed patients to get in contact with their physicians from home  instead of having to go all the way to them  o Pathology  Germ theory helped understand what microorganisms were and how they  caused diseases   Medicine becomes an actual profession in this time period  Doctors are able to get the infrastructure that they didn’t previously have o Research ability o Transportation o Support from other physicians


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