History of Medicine & Health Humanities

Medical Council of Canada

• Formed in 1912.

Francis Bacon

• Known for advocating empiricism and observation to transform society.
• His work influenced how disease is conceived socially.
• Lived from 1561-1626.

William Harvey

• Discovered that the heart is a muscular pump (1578-1657).

Rene Descartes

• Proposed that humans and animals are organic machines (1596-1650).

Jean-Jacques Rousseau, John Locke, and Immanuel Kant

• Discovered laws of nature, suggesting science can uncover these laws.

William Cullen

• Developed nosology, a classification system for diseases.

The Humanities

• Study of history, philosophy, religion, languages, literature, arts, media, ethics, law, social sciences using historical or philosophical approaches, archaeology, and interdisciplinary studies.

Humanistic Education

• Aims to form compassionate, knowledgeable individuals who act in the world.

Roots of Medical and Health Humanities

• Emerged in the 1960s and early 1970s.

Response to Dehumanization of Medicine

• Medical and health humanities arose due to the "sins of modern medicine" (Edmund Pellegrino).

Pellegrino's 3 Elements of Medical Education

• Ethical issues and values in clinical decisions.
• Developing habits of critical self-examination.
• Educating physicians versus merely training them.

Role of Medical Humanities

• Serve as a bridge between science and experience.

George Engel

• Developed a biosocial model of medicine.
• Argued clinical medicine relied too heavily on biomedicine and needed to integrate psychological and social aspects into patient care.

Eric Cassell

• Stated in the early 1990s that "bodies feel pain but persons suffer".
• Disease affects the body and is understood via science.
• An individual's experience is understood via stories, such as considering disease in a family context.

Challenges Faced by Physicians in the 21st Century

• Increased use of technology in diagnostics.
• Reduction in narrative modes.
• Increased commercialization.

Key Qualities Developed by Medical Humanities

• Altruism.
• Empathy.
• Compassion.
• Ability to be reflective, interpretive, and reflexive.

Role of Moral Critique in Medical Humanities

• Recognizing privilege.
• Recognizing history.
• Becoming critical and self-critical.
• Recognizing medicine as a moral undertaking.

Model of Key Features of Medical Humanities

• Context.
• Experience.
• Conceptual and critical analysis.
• Formation.

Context in Medical Humanities

• Using various disciplines to understand the cultural and historical dimensions of medicine.
• Recognizing gender, race, class, age, and sexuality.

Experience in Medical Humanities

• Understanding what it means to be a patient, doctor, or a community affected by an epidemic.
• Understanding what it is to be affected by specific conditions (dying, cancer, etc.).

Conceptual and Critical Analysis in Medical Humanities

• Being reflexive and reflective.
• Asking questions and forming answers to key questions about disease, illness, healing, curing, health and the goals of medicine.

Formation in Medical Humanities

• Cultivating a professional identity.
• Developing resilience.
• Dealing with trauma.
• Physicians are not merely plumbers of the body.

William Osler

• Concerned about the human cost of scientific medicine (1849-1919).
• Canadian Professor of Medicine at Johns Hopkins University.
• Developed a model of medical education that is still common.

Medical Humanities vs Health Humanities

• Health humanities are broad; medical humanities are narrow, but not opposing.

Flux Art Exhibition

• Aims to bring understanding of the experience of head and neck cancer to people who have never had to live with it.
• Illustrates the health humanities in action.
• Knowledge gained flows to medicine, health, community, education, and the art world.
• Developed at the University of Alberta.

Medical Humanities vs. Health Humanities: Professions

• Medical humanities primarily involve doctors and sometimes nurses.
• Health humanities involve doctors, nurses, health professionals, and therapists.
• Medical humanities tend to binarize health, while health humanities are concerned with health at all stages of life.

Jenny Tillotson

• PhD in Printed textiles; fellow of the Royal society for the arts; sensory designer.
• Founder of eScent and Smart Second Skin.
• eScent commercializes personalized wearable fragrance products for connected garments and enhanced PPE in the wellness/healthcare/AI sector.

eScent

• Mixes fashion design, neuroscience, and artificial intelligence.
• Works to address health challenges outside clinical contexts.
• Brings together health and humanities to address a variety of factors.

Actions of the Health Humanities

• Democratize health care.
• Open health care to those outside clinical and hospital settings.
• Bring individuals into the health realm.
• Give legitimacy to health matters and developments outside institutions.
• Center health care around the community.
• Are interested in the whole person.
• Bridges bioscience with culture, community, and society.

Dr. Sam Guglani's Passage

• Medicine is scientific yet deals with humanity.
• Biomedical science options for treatment are combined with judgments (ethics, emotions, determining a patient's needs).
• Communication is prioritized.
• Variability of expectations and fears are key.
• It is a medical practice that has tension between science and the human position.

Ways History and Medicine Serve Us

• Examining medicine within historical contexts.
• Social historians + medical education, medical research, and medical practice.

Historical Medical Milestones: 2600 BC

• Egyptian Imhotep describes the diagnosis and treatment of 200 diseases.

Historical Medical Milestones: 500 BC

• Alcmaeon of Croton distinguished veins from arteries.

Historical Medical Milestones: 460 BC

• Birth of Hippocrates, began the scientific study of medicine and prescribes a form of aspirin.

Historical Medical Milestones: 300 BC

• Diocles wrote the first known anatomy book.

Historical Medical Milestones: 280 BC

• Herophilus studies the nervous system.

Historical Medical Milestones: 130 AD

• Birth of Galen. Greek physician to gladiators and Roman emperors, he wrote numerous texts.

Historical Medical Milestones: 160 AD

• Pedanius Dioscorides wrote De Materia Medica.

Historical Medical Milestones: 910

• Persian physician Rhazes identifies smallpox.

Historical Medical Milestones: 1010

• Avicenna writes The Book of Healing and The Canon of Medicine.

Historical Medical Milestones: 1249

• Roger Bacon invents spectacles.

Historical Medical Milestones: 1489

• Leonardo da Vinci dissects corpses.

Historical Medical Milestones: 1543

• Vesalius publishes findings on human anatomy in De Fabrica Corporis Humani.

Historical Medical Milestones: 1590

• Zacharias Janssen invents the microscope.

Historical Medical Milestones: 1628

• William Harvey publishes research on blood vessels, arteries, and the heart.

Examples of History and Medicine Interlinking

• The development of medical knowledge.
• Medical language: Greek and Latin roots of a great many medical elements.
• The history of pandemics.

Susan Reverby and David Rosner

• Pioneered the new social history of medicine.
• Social historians wrote from a perspective that was sharply critical of the health care system, the authority of physicians, and the biomedical establishment.

Hippocrates

• (c. 460-377 BCE)
• Knowledge of thinking and work is recorded in about 60 texts.
• Valued observation, experience, and reason vs. supernatural explanations.
• Disease = disequilibrium; health = equilibrium.
• Restoring health = restoring equilibrium in body and with environment.
• Doctors should always act in the best interest of patients.

Hippocratic Oath

• Guides medical and health care today: rooted in 2500 year-old thinking.
• Privacy and confidentiality.
• Primacy of patient's welfare.
• Prohibition of sexual contact and exploitation of patients.

Galen

• Wrote about 350 medical texts in the Roman Empire.
• Influenced treatment modes for 1000 years.
• "Above all do no harm".

Middle Ages

• Characterized by the rise of Christianity.
• Some Christian values are incorporated into medicine.

Agape

• Love and care for the sick and needy.
• Religious hospitals are founded.

Renaissance

• With the printing press and greater literacy, more people read texts.
• More individually-validated knowledge was relied on.

18th Century

• Medicine was entirely unregulated.

John Gregory

• Created a new ethical context for medicine in the medical school at the University of Edinburgh (1724-1773).
• Revised Hippocratic Oath.

Revised Hippocratic Oath

• Stressed scientific practice as a moral obligation.

Thomas Percival

• He developed a code of conduct which influenced all later approaches to medical ethics in the UK and North America (1740-1804).
• The feelings and emotions of patients and the right to refuse treatment were key.

1847

• The American Medical Association adopted a code of ethics based on Percival's writing.
• The framework existed until the 1920s.

"The Doctor" Painting

• Painted by Sir Luke Fields, 1891.

Early Greek Medicine

• Primarily comprised traumatology and supernatural revelation.

Hippocrates' Prioritization

• Prioritized medical knowledge over wisdom of the gods.

Galen's Prioritization

• Roman (131-201).
• Textual medical knowledge; texts were a source for more than 1000 years.

Formalization of Medical Education

• Formalized with the founding of universities in Europe, Paris, Bologne, Oxford, Montpelier, Cambridge, Padua, Naples (1110-1224).
• Heavily text based vs practical experience.
• Experience was criticized over knowledge (e.g., surgeons were looked down upon).

Challenge to Tradition of Knowledge Over Experience

• Challenged with the arrival of the Renaissance.

Andreas Vesalius

• The Flemish doctor believed in hands-on learning ("seeing for oneself").
• Dissected bodies and produced knowledge of how bodies are put together.
• Wrote On the Fabric of the Human Body.

18th Century Medical Advancements

• Growth in education.
• Knowledge of disease and health, knowledge of academic subjects.
• The gap between theory and practice is closed.

Leader of Medical Education in 18th Century

• The University of Edinburgh.

Physicians Trained at German Universities

• 10,000 physicians were trained there between 1870 and 1914.

Abraham Flexner and the Carnegie Foundation

• Investigated medical schools in the US and Canada in the 20th century.
• Found these schools were of poor quality.
• Between 1910-1935, half of the medical schools closed.
• They wrote Medical Education in the United States and Canada.

First Program of Medical Education in Canada

• Created in 1824 at the Montreal Medical Institution.
• Became the Faculty of Medicine at McGill University in 1829.

Medical Programs Founded By 1900

• U of T, Laval, Queen's University, Dalhousie University, University of Western Ontario, and the U of M medical programs were founded.

Medical School at the U of A

• Established in 1913.

Medical Schools Established By 1950

• U of S, University of Ottawa and UBC had all established medical schools.

Dramatic Increase in Scientific Knowledge

• Occurred during and after WWII.
• In the 1950s and early 1960s there was rapid expansion of the body of knowledge which created challenges to medical education.
• Most schools started introducing students to patients in the first year rather than the third.

Curricula in Medical Schools in the 50s and 60s

• Used an integrated or "systems" model.
• Basic and clinical features of systems were taught in integrated blocks.
• This approach helped students build a conceptual framework on which they could base their diagnosis and treatment.

Innovation at McMaster

• Problem-based learning approach.
• Small groups of students worked together to solve problems devised for them by the faculty and developed ability and self-reliance.

Universal Healthcare in Canada

• Established in 1970.

Committee on the Accreditation of Canadian Medical Schools

• Formed in 1979 as an independent body to examine and attest to the quality of educational programs in Canadian medical schools.

Understanding of Diseases

• Diseases are understood as constructions by various social groups.
• They are understood biomedically and socially and culturally.

Social Construction of Disease Theory

• A conceptual framework.
• Emphasizes cultural and historical aspects.
• Understood through the interaction in a social context.

Social Constructionism

• Examines how individuals and groups contribute to producing perceived social reality and knowledge.
• For disease: biological condition + social meaning of the condition.

Mitochondrial Disease

• Inherited, chronic illness that can be present at birth or develop later in life.
• First patient diagnosed in 1962.

Ancient Theory of Disease

• Natural + supernatural beliefs.
• The cult of Aesclepius and Hippocratic medicine co-exist.

Humoral Theory

• Dominates thinking about disease until the 1800s.
• 4 humors: yellow bile, blood, phlegm, black bile need to be in balance for health.
• Disease is understood as imbalance vs specific pathology.
• Hippocratic theory.

Galen in Rome

• Built on Hippocratic theory by supporting balance.
• Disease is also an imbalance.
• Health = living a healthy life is a moral life = long life free of disease.

Leprosy in the Middle Ages

• Thought to be disease in Leviticus 13-14 because of the symptoms.
• Thought to be a dirty disease so those with it were seen as impure and stigmatized.
• Mycobacterium leprae was discovered in 1874.

Bubonic Plague

• Thought to be a disease God created to punish people.
• It is caused by microorganism, Yersinia pestis that infects rodents.

Syphilis in the Renaissance

• It was deemed a humoral disease resulting from congenital factors, unhealthy environment or sinful behaviour.
• It is caused by a spirochete organism, Treponema pallidum.

Xavier Bichat

• Focused on tissue pathology = empiricism vs patient experience and description of symptoms (1771-1802).
• Treatment of disease vs care of patients.

Rudolf Virchow

• Stated smaller units; disease is at the cellular level (1821-1902).
• He launched the field of cellular pathology.

Louis Pasteur

• Theorized that microorganisms are responsible for disease (1822-1895).
• Developed vaccines.

Robert Koch

• Founder of bacteriology: discovered bacteria that caused tuberculosis, cholera and others (1843-1910).

The Electron Microscope

• Invented in the 1930s.
• Has the ability to detect viruses.
• Antibacterial medications like penicillin and antibiotics also invented in the 20th century.

John Snow

• Studied contagion (germ theory) vs miasma (bad air) for the understanding of Cholera.
• Solved by John Snow in 1854
• Started with the Broad Street pump outbreak of 1854 that killed many people in Soho.
• Used reasoning, graphs, etc to demonstrate the impact of dirty water.

John Snow's Discovery

• Showed the harmful effect of contaminated water in two nearly equivalent populations.
• Resulted in intervention strategies.
• His ideas and observations were published in his book On the Mode of Communication of Cholera (1855).

Eugenics

• A set of beliefs and practices that aim to improve the genetic quality of a human population.
• Sir Francis Galton (1822-1911) coined the term eugenics.
• Had significant impacts in Britain, the US and Canada, and Germany (WWII).

"Clearing the Plains" by James Daschuk

• Discusses smallpox outbreaks (1730s-1870s).
• Some First Nations simply ceased to exist as distinct groups.
• After the 1870s, FNs are moved to a reserve system; food was withheld for political reasons while Indigenous people were dying of starvation, other rights and mobility were restricted.

Overview of key figures and concepts in the history of medicine and the health humanities. Includes information on the Medical Council of Canada, Francis Bacon, William Harvey, Rene Descartes, and others. Also covers humanistic education and the roots of medical and health humanities.