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23 Cards in this Set
- Front
- Back
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In the medical marketplace of C18, what were the three orders of regularly qualified practitioners?
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1. Physicians
The top, learned profession, classically-educated, Oxbrideg, Fellowship of RCoP. Practised internal medicine - didn't use hands 2. Surgeons Craft taught by apprenticeship. Some learned surgeons, esp. mainland Europe. Practised surgery - external, manual. Company of Surgeons (later RCoS) 3. Apothecaries Trade taught by shorter apprenticeship. Compounding and dispensing drugs - needed to know Latin, botany and chemistry. Worshipful Society of Apothecaries |
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What was the 'tripartite hierarchy', and was it relevant?
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The hierarchy of Physician -> Surgeon -> Apothecary. Became an increasingly irrelevant physicians' idealisation in C18. Surgeons were practising internal medicine too and apothecaries were prescribing in their own right. Much more open system than medicine today - people shopped around and took more personal responsibility for their own health
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What did C18 consultations entail?
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Biographical exploration of the patient's life - not just taking a history but a history of disease. No physical examination other than pulse and urine sample - examination was only in terms of what was appropriate for the patient, who was the physician's superior.
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What was the medicine of symptoms of C18?
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Symptoms as they appeared to the patient. The symptoms were the disease, and they were classified as such - nosologies. Disease believed to be general imbalance of the body, affected by constitution and lifestyle. One disease could progress and turn into another, and diseases could propagate around the body, as well as being unique to that particular patient
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What treatments were typical in C18?
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Heroic general remedies to restore equilibrium - remedies needed to produce visible effect so were quite powerful e.g. purging. Drugs to relieve pain e.g. opium. Surgery such as blood-letting. Advice on regimen e.g. where to live, what kind of exercise
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What sort of hospitals were there in C18?
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Endowed - live off investment from land e.g. Bart's, St Thomas'
Voluntary - funded by subscriptions of wealthy donors e.g. the London, St George's. Wave of such hospitals founded in provincial centres. Paternalistic charity for deserving poor. Lay governors in charge rather than doctors |
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How did changes in medicine begin to come about in the Enlightenment?
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- Pursuit of health chimed with Enlightenment ideals
- Sick trade boomed in consumerist society - New specialist hospitals as doctors colonised niches - Changes in education as monopoly of Oxbridge broken and thus the 39 articles no longer necessary, teaching in vernacular, dissection, walking wards, rise of anatomy |
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What were the differences between C18 medicine and C19 medicine?
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C18 - bedside, library medicine - reliance on book-learning, symptoms as they appeared to patients, "What is the matter with you?"
C19 - hospital/clinical medicine - organs and lesions, medical hierarchy, increased relations between physical and post-mortem examinations. "Where does it hurt?" |
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Michel Foucault
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Notable historian. Wrote "The Birth of the Clinic" (1963) in which he describes the clinical gaze and the consequences of social and political change.
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How did the French Revolution link to hospitals and medicine?
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Physicians, the old-regime and the prison-like hospitals epitomised what was wrong with the old system. The Hotel-Dieu received damning reports and there was a movement to abolish physicians and hospitals, under the belief that the Revolution would make people so healthy that they didn't need hospitals. In actuality, more hospitals were founded as a result of the Revolution. A committee of the national assembly dismantled the medical old regime, suppressing academies and suspending medical licenses (anyone could practise medicine for a small fee). Hospitals were nationalised and starved of funds. This led to medical chaos and military demands for surgeons on the battlefield meant that reform was called for.
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What were the three resources for medical reform in C19 France?
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1. Philosophy of ideology - Empiricism. Ideas not traced to senses are wrong (e.g. Divine right of kings). Doctors must learn from sickbed and not books
2. Rise of surgery and a surgical point of view (medical historian Owsei Temkin). Empirical orientation and rise of anatomy. Lectures at Royal College of Surgery 3. Medicine of epidemics and epizootics (Foucault). Start to think about spread of disease, localisation etc |
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Who said "Read little, see much, do much"?
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Antoine Francois de Fourcroy (leading author of the law which set out what would happen in the Paris hospitals)
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What were the reforms of December 1794 enacted by Antoine Fourcroy?
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- Medicine taught in the hospitals
- Full-time professors for medicine and surgery of equal status - Meritocracy rather than plutocracy of who could receive a medical education - Schools of Health (Paris, Montpellier and Strasbourg) - The citizen as a patient - receiving medical care became a right as part of one's entry into the bargain of being used for demonstrating/autopsy. As peasants came into treatment, doctors could do things they couldn't do with their social superiors |
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How did a new social organisation produce a new approach to disease in C19 hospitals?
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- Hospitals as places for investigating disease analogous to museums being founded at time
- Physical examination on ward more thorough - looking (clinical gaze, eyes free to roam), feeling (touching now allowed - palpitation), hitting, listening - learning from sounds - stethescope ("I view") - Pathological anatomy - correlate signs elicited in life with changes in organs post mortem - Statistics - find out common symptons, test the efficacy of treatments |
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Who said "Open up a few corpses?"
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Xavier Bichat
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How was Parisian medicine imported to other countries?
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Doctors from Britain, US etc. went to France to experience this kind of medicine. They took it home and adapted it to local traditions
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Name three types of history of public health
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1. Popular darkness-to-light progressive narrative
2. One concentrating on the central use of statistics e.g. mortality decline in Victorian times attributed to sewers and medical inventions but could also be due to economic growth resulting in overall better quality of life 3. Highly politicised - "public health" assumes a public and ties in notions of what it is to be a citizen. Many conflicts of C19 are between how broad/narrow public health should be |
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Theories of public health and disease
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- Individual vs 'Mass' medicine
Mercantilism (health of people = health of nation). French Revolution - rights and responsibilities of citizens - Preventative measures- social and cultural interventions e.g. Johan Peter Franck's "A complete system of medical police" - Theories of disease - miasma and contagion (competing ideas about transmission); environment and debility - Problems of civil liberties - how much role should the government have in preventing the spread of disease? |
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Theories of political and moral economy
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Adam Smith - self-interest, free market, 'natural prices'
Jeremy Bentham - utilitarianism, mass vs individual rights Thomas Malthus - exponential vs linear, inevitable famine Overall: poor as visible problem |
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Why was there such death in the cities of C19?
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- Industrial growth - more people flock there
- Epidemic disease e.g. cholera - Unprecedented growth - large demand for housing meant upkeep unnecessary as landlords feel no need to bother |
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Why was the existing 1601 Poor Law insufficient for the C19?
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It was parish led, so you only received relief from where you were born - not helpful for those who had migrated to the cities
Costs were increasing The loss of a wage earner meant poverty for the country The 1832 Reform Act gave the vote to a much larger section of the middle class - who weren't happy about the Poor Law taxes and so put pressure on politicians |
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What did Edwin Chadwick achieve?
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Lawyer. Led the 1832 Royal Commission on the Operation of the Poor Laws. Halved the Poor Law Bill in 1834 with his reforms - made workhouses central, made all relief indoor relief.
Also led 1839 Poor Law Commissiom, publishing his results in 1842 in which he said health was of economic importance, was environmentally caused and that we must seek technological solutions such as sewer systems |
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1848 Public Health Act
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General and Local boards of health, building sewers, street cleaning, clean water.
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