history of medicine in america

The History of Medicinein America

Brian Regal, PhDAssistant Professor for the History of Science,

Department of HistoryKean UniversityUnion, New Jersey USA

HIST 3323

• Medicalization vs. Demedicalization

Medicalization: doctors want to be central and important players in society, to gain respect and authority—scientific and technical medicine

Demedicalization: dissenters not wanting to be under control of mainstream medical profession: faith healers, folk remedies, do it yourself-alternative medicine

• Heroic Narrative of the history of medicine

History shows the progressive—ever improving—nature of western medicine: great doctors overcoming great odds to create great cures and discoveries. Medicine is important to the growth of western civilization.

Support the supremacy of academically/mainstream trained physicians against non-medical, alternative, folk practitioners

Chinese medicine and the origins of medical ethics and physician practice

Kung Fu-tse (Master Kung)

Known as

Confucius (551-476 BC)

Five classical Confucianelements applied to medical practice:

Ren (仁 , Humanity)Yi (義 , Righteousness)Li (禮 , Ritual)Zhi (智 , Knowledge)Xin (信 , Integrity)

Asclepiusmaybe the same as Egyptian Imhotep

daughters were:Hygeia (Hygiene)Panacea (cure all)

Hippocratic Oath

Hippocratic Oath

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability andmy judgment, the following Oath and agreement: To consider dear to me, asmy parents, him who taught me this art; to live in common with him and, ifnecessary, to share my goods with him; To look upon his children as my ownbrothers, to teach them this art.I will prescribe regimens for the good of my patients according to my ability

and my judgment and never do harm to anyone.I will not give a lethal drug to anyone if I am asked, nor will I advise such aplan; and similarly I will not give a woman a pessary to cause an abortion.But I will preserve the purity of my life and my arts.I will not cut for stone, even for patients in whom the disease is manifest;I will leave this operation to be performed by practitioners, specialists in this art.In every house where I come I will enter only for the good of my patients,keeping myself far from all intentional ill-doing and all seduction andespecially from the pleasures of love with women or with men, be they free orslaves. All that may come to my knowledge in the exercise of my profession orin daily commerce with men, which ought not to be spread abroad, I will keep secretand will never reveal.If I keep this oath faithfully, may I enjoy my life and practice my art, respected byall men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Doctors at work

Medical Grimoires

American almanacs

Medical Astrology book (2008)

Bad Doctor

‘The Regulars,- Allopath-Orthodox practitioners

• Samuel Hahnemann (1755-1843), regular MD, German

• similia similibus curantur -- “like cures like”

• later discovered same beneficial effects with minute doses --> law of infinitesimals, ritual dilutions

• drugs acted on some spiritual level, vital force

• popular among German immigrant doctors, educated patients

• many homeopaths also regular physicians

‘The Irregulars,-Homeopathic unorthodox practitioners

• Samuel Thomson(1769-1843), N.H., herbalist, farmer

‘The Irregulars,-Homeopathic unorthodox practitioners

James Still (1812-1882)Black Doctor of the Pines

• Self-taught• Herbalist• Sold medicines and saw

patients• Thomsonian influences

‘The Irregulars,-Homeopathic unorthodox practitioners

Nicholas Culpeper and his Herbal, 1652

Heroic Medicine – Benjamin Rush (1745-1813)

Medieval Bloodletting

Bleeding procedures and instruments

Heroic Medicine –Leeches

Heroic Medicine –Clyster enemas

London edition (first published in 1680)

New England edition (1821)

Mary Baker Eddy (1821-1910) and Christian Science

Eddy built her work on a Boston doctor named PHINEAS PARKHURST QUIMBY  (1802-1866) founder of New Thought

She called her book Science and Health – became the ‘bible’ of Christian Science

Mary Baker Eddy (1821-1910) and Christian Science

Eddy built her work on a Boston doctor named PHINEAS PARKHURST QUIMBY  (1802-1866) founder of New Thought

She called her book Science and Health – became the ‘bible’ of Christian Science

African American Doctors

James McCune Smith (1813-1865) first African American to receive a medicaldegree. Travelled to University of Glasgow, Scotland, graduated in 1837

African American Doctors

Rebecca Crumply (1831-1895) first African American woman awarded a medicaldegree in the United States. New England Female Medical College (now themedical school of Boston University) 1864

Fisrt Black owned hospital, Chicago, 1890s. Opened by Dr. Daniel Hale Williamswho also did the first open heart surgery on an emergency patient who hadbeen stabbed

The Gross Clinic (1875), Thomas Eakins

History of Psychology and Brian function

Phrenology: Franz Joseph Gall, Austrian argued language localised in the brain not global.

Psychology begins 1870s1879 Wilhelm Wundt opens first psychology school at Leipzig, Germany

Wundt inspires William James and Ivan Pavlov as well as B.F. Skinner’s behaviorism

Neuroscience: Paul Broca argues different parts of the brain do different things

Use of the microscope helps show brain function 1860s/70s while Camillo Golgi invents techniques for staining brain tissue to show individual neurons (1890s)

Franz Joseph Gall (1758 – 1828) pioneering German neurologist. His work washijacked and turned into Phrenology

Phrenology

Phrenology Almanac

Phrenology Almanac

Lorenzo Fowler (1811-1896) American proponent and popularizer of phrenology

Phrenology

Phineas Gage - after

Phineas Gage (1823-1860)September 13, 1848, Cavendish, VT.

Lobotomy

Manipulate the frontal lobe of the brain, this area controls emotion

1890: Friederich Gouz does work on dog brains, found them much tamer after manipulating them

1892: Gottlieb Burkhardt did the first such limited operations on a human at the Swiss Insane Asylum

1935: Yale University, Carlyle Jacobson lobotomizes chimps to calm them down

Antonio Moniz, Lisbon Medical School, first modern operations on humans and lectures on the subjectLater, a former patient, outraged at what had been done to him shot Moniz to death.

1936: American Walter Freeman starts the lobotomy craze in the US

Lobotomy - theory

Lobotomy - practice

Howard Dully, 1960, 12 years old

Early antiseptic work

1500s a ‘miasma’ (poison air) causes infection

19th century – British surgical pioneer John Hunter showed how subcutaneous wounds – under the skin– did not get infected while surface wounds open to the air did

You must cover wounds immediately!

Collodion wraps: a syrupy and explosive material seals wounds and protects them

George Tichnor (US civil war) used alcohol to clean wounds and found less infection

Ignaz Semmelwies (Hungarian doctor) used chlorine to was hands of doctors in 1860s and found dramatic drop in death of post birth mothers

Joseph Lister (1827-1912)

British surgeon, Glasgow Infirmary

-clean wounds-Sterilize equipment-Remove germs

-Suggested Carbolic Acid (which had been usedde-stinkify the sewer system

Spray it on everyone as you work

Oliver Wendell Holmes Sr. (1809-1894)

American (Boston) medical reformer and poet- academically trained but critical of the mainstream profession- must improve hygiene at hospitals

Anti-quack, anti-homeopathy

Early proponent of the belief that doctors unconsciously infected their patients with their dirty hands

1846: Holmes coins the term ‘antiseptic’ (against putrification) in a letter to Boston dentist William Morton

Antiseptic, carbolic acid

Antiseptic, carbolic acid

Thomas Bartholin. De nivis usu medico observationes variae (1661)

Earliest discussion of anesthesia.Chapter XXII of this historically importantbook makes the first known mention of theuse of mixtures of ice and snow for freezingto produce surgical anesthesia . . .The treatise on snow crystals, byBartholin's younger brother, Erasmus, is theearliest publication on crystallography,and preceded Boyle on gems (1672)by eleven years.

William Morton, First use of ether/anesthetic for surgery, 1846

Anesthetic

William Morton (1853)

A compendium of testimonies, hearings, investigations, etc., both favorable and unfavorableto Morton's claim, including reprints of the 1852Majority and Minority Committee Reports, the lattersupplemented by adverse marginal notes. Theappendix contains testimony relating to thecompeting claim by Horace Wells.

Horace Wells (1815-1848)

1844: Wells had been a partner briefly with Morton and had showed Morton nitrous oxide (which he had already experimented with). 1845 his demo at Mass General Hospital was a disaster. He left dentistry and the country. Returned and became addicted, ended up committing suicide in1848.

Crawford Long (1815-1878)

Used nitrous oxide (laughing gas) to remove a tumor from a friend’s neck on March 30, 1842

Anesthetic, ether and nitrous oxide

Clara Barton (1821-1912)

Patent Medicines

Patent Medicines

Patent Medicines

Patent Medicines

Eugenics

Eugenics: from the Greek for good breedingFirst developed by Francis Galton in the UK then picked up on by Americans

Madison Grant (1865-1937)

Johnson Act 1925

Blood is all – biological relations dictateBehavior, future development and nothingCan change it, therefore medical/socialamelioration programs are a waste of money

Public health

Sanitary reform comes in three phases

1.1840-1890 clean up the environment2.1890-1910 Bacteriology – go after germs3.1910-present clean up people

Conservative response: keep poor and working class people down, they spread Disease – employ eugenics

Giving the poor and working class health benefits only renders them dependent and leeches upon the state and the healthy (well off) body politic

Liberal Response: health care makes the country a better, stronger, and moreEconomically viable place

Public health, 1870s

Public health dispensary, 1870s

Public health, sanitation, NYC 1895

Public health, sanitation, NYC 1898

Public health

Public health, Venereal disease, 1940s

Public health, Venereal disease, 1940s

Bad hospital

Bellevue Hospital

Bad hospital

19th century hospital, Mass General, 1847

19th century hospital

The Agnew Clinic (1880)

1930 hospital

Red Cross nurses, WWI

Modern hospital

Surgery/Amputation kits

Surgery/Amputation

Surgery/Amputation kits

Civil War Surgery part 1

Civil War Surgery part 2

Civil War medicine

Skull with bullet hole, 1893 (stereoscopic photo)

Medical school dissection

US Army lab tech, field station, Korea 1952

Reconstructive surgery, 1917

Monstrous Births

Monstrous Births

Monstrous Births

The Tocci Brothers

The Tocci Brothers

Conjoined twins, Chang & Eng and the Hilton Sisters

Early 19th century birth training model

Aristotle’s Masterpiece

Aristotle’s Masterpiece (1821)

Aristotle’s Masterpiece (1821)

Abortion

First anti-abortion laws in America – after 4 months – 1820s

Many doctors and the AMA pushed for completely outlawing abortion by 1900

1873: Comstock Law outlawed sale of birth control devices includingprophylactics and ‘pornography’

Susan B. Anthony was an anti-abortion advocate

1938: government case against Margaret Sanger overturned the ComstockLaw

1973: Roe versus Wade makes abortion legal

Abortion Instructions

Abortion in the textbook

Pro choice argument

Pro Life argument