History of Medicine: Key Figures & Concepts

Medical Council of Canada

• Formed in 1912.

Francis Bacon

• Known for advocating empiricism and observation to transform society which would change how disease is conceived socially.
• Lived from 1561 to 1626.

William Harvey

• Discovered that the heart is a muscular pump in 1578-1657

Rene Descartes

• Discovered that humans and animals are organic machines in 1596-1650

Jean-Jacques Rousseau, John Locke and Immanuel Kant

• Discovered laws of nature and that science can discover these laws.

William Cullen

• Developed nosology, a classification system for diseases.

Humanities Defined

• Encompasses the study of history, philosophy, religion, languages, literature, fine arts, performing arts, media studies, cultural studies, ethics, jurisprudence, and social sciences using historical or philosophical approaches.
• Includes archaeology and interdisciplinary approaches.

Humanistic Education

• Aims to cultivate compassionate, knowledgeable individuals who actively engage in the world.

Origins of Medical and Health Humanities

• Emerged in the 1960s and early 1970s.

Response to Dehumanization

• Medical and health humanities arose in response to the dehumanization of medicine.
• Edmund Pellegrino recognized this issue.

Pellegrino's 3 Elements of Medical Education

• Ethical issues and values in clinical decisions.
• Development of critical self-examination habits for self-awareness.
• Educating physicians as opposed to merely training them.

Medical Humanities as a Bridge

• Serves as a bridge between science and experience.

George Engel

• Developed a biosocial model of medicine.
• Believed that clinical medicine relied too much 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 through science.
• The experience of the individual is understood through stories.

Challenges for Physicians in the 21st Century

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

Qualities Developed by the Medical Humanities

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

Moral Critique in Medical Humanities

• Recognizing privilege.
• Recognizing history.
• Becoming critical and self-critical.
• Acknowledging that medicine is a moral undertaking.

Model of Key Features of Medical Humanities

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

Context in MHs

• Using disciplines to understand medicine's cultural and historical dimensions.
• Recognizing gender, race, class, age, and sexuality.

Experience in MHs

• Understanding the perspectives of patients, doctors, and communities affected by epidemics.
• Understanding the impact of specific conditions such as dying or cancer.

Conceptual and Critical Analysis in MHs

• Being reflexive and reflective.
• Asking questions and forming answers to key questions, such as the differences between disease and illness, healing and curing, the definition of health, and the goals of medicine.

Formation in MHs

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

William Osler

• Concerned about the human cost of scientific medicine.
• Developed a model of medical education that is still common.

Medical 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.
• The knowledge gained flows to medicine, health, community, education, and the art world.
• Developed at the University of Alberta.

Medical Humanities vs. Health Humanities

• MHs include primarily doctors, sometimes nurses
• HHs include doctors, nurses, health professionals and therapists
• MHs tend to BINARIZE health (one is healthy, one is sick), but we might actually be more concerned with our health at all stages of our lives, not just when we have a diagnosable disease.

Jenny Tillotson

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

eScent

• Mixes fashion design, neuroscience, and artificial intelligence.
• Works to address health challenges in ways that are outside clinical contexts.
• Brings together health and humanities to address various factors.

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.
• Centre health care around community.
• Are interested in the whole person.
• Bridges bioscience with culture, community and society.

Dr. Sam Guglani's Passage

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

How History and Medicine Serve Us

• We can examine medicine within historical contexts going back millennia.
• Social historians + medical education, medical research, and medical practice.

Historical Timeline of Medicine

• 2600 BC: Egyptian Imhotep describes the diagnosis and treatment of 200 diseases.
• 500 BC: Alcmaeon of Croton distinguished veins from arteries.
• 460 BC: Birth of Hippocrates, the Greek father of medicine begins the scientific study of medicine and prescribes a form of aspirin.
• 300 BC: Diocles wrote the first known anatomy book.
• 280 BC: Herophilus studies the nervous system.
• 130 AD: Birth of Galen, a Greek physician to gladiators and Roman emperors, who wrote numerous texts.
• 160 AD: Pedanius Dioscorides writes De Materia Medica.
• 910: Persian physician Rhazes identifies smallpox.
• 1010: Avicenna writes The Book of Healing and The Canon of Medicine.
• 1249: Roger Bacon invents spectacles.
• 1489: Leonardo da Vinci dissects corpses.
• 1543: Vesalius publishes findings on human anatomy in De Fabrica Corporis Humani.
• 1590: Zacharias Janssen invents the microscope.
• 1628: William Harvey publishes An Anatomical Study of the Motion of the Heart and the Blood in Animals, forming the basis for future research on blood vessels, arteries, and the heart.

Interlinks Between History and Medicine

• The development of medical knowledge.
• Medical language with Greek and Latin roots.
• The history of pandemics.

Pioneers of the New Social History of Medicine

• Susan Reverby and David Rosner.
• Trained as social historians, they were sharply critical of the health care system, the authority of physicians, and the biomedical establishment

Hippocrates

• Knowledge of his 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 the body and with the 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.
• Covers privacy and confidentiality.
• The primacy of patient's welfare.
• Prohibition of sexual contact and exploitation of patients.
• Some qualities have been dropped over the millennia, such as the prohibition of surgical interventions.

Galen

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

Middle Ages

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

18th Century

• Medicine was entirely unregulated.

John Gregory

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

Revised Hippocratic Oath

• Stressed scientific practice as a moral obligation.

Thomas Percival

• (1740-1804)
• Influenced by John Gregory, he wrote Medical Ethics (1803); he developed a code of conduct which influenced all later approaches to medical ethics in the UK and North America.
• 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.

Sir Luke Fields

• Painted "The Doctor" in 1891.

Early Greek Medicine

• Comprised traumatology and supernatural revelation.

Hippocrates

• Prioritized medical knowledge over wisdom of the gods.

Galen

• (131-201)
• Prioritized textual medical knowledge; his texts were a source for more than 1000 years.

Formalized Medical Education

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

Challenging Tradition

• 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").
• He dissected bodies and produced knowledge of how bodies are put together.
• Wrote On the Fabric of the Human Body.

18th Century

• Growth in education and knowledge of disease and health, also knowledge of academic subjects (physiology, chemistry, botany, pathology, anatomy, therapeutics).
• Gap between theory and practice is closed.

University of Edinburgh

• The leader of medical education in the 18th century.

German Universities

• Trained 10,000 physicians between 1870 and 1914.

Abraham Flexner and the Carnegie Foundation

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

Montreal Medical Institution

• In 1824, became the Faculty of Medicine at McGill University in 1829.
• First program of medical education in Canada.

By 1900

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

University of Alberta

• Medical school established in 1913.

By 1950

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

Scientific Knowledge Increase

• 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.

Integrated/Systems Model

• The basic and clinical features of such systems as the cardiovascular, musculoskeletal, etc, were taught in integrated blocks.
• Students learned the basic science of the system alongside its clinical features, diagnosis and management.
• 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, collecting/integrating information to solve problems designed by faculty.
• Led to development of ability and self-reliance.

Canada

• Universal healthcare began 1970.

Committee on Accreditation of Canadian Medical Schools

• Formed in 1979 (independent body).
• Prior in 1934 accredited by US body called the Liaison Committee on Medical Education.
• Examine and attest to the quality of educational programs in Canadian medical schools.

Understanding Diseases

• They are understood biomedically and socially and culturally.
• As constructions by various social groups (sometimes contradictory).

Social Construction of Disease Theory

• Emphasizes cultural and historical aspects of phenomena understood commonly as exclusively natural.
• A conceptual framework.
• Understood through 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

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

Ancient Theory of Disease

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

Humoral Theory

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

Galen

• Health = living a healthy life is a moral life = long life free of disease.
• Built on Hippocratic theory by supporting balance. -Disease is also an imbalance: if a patient is too hot, the prescription is cooling.

Leprosy

• Thought to be disease in Leviticus 13-14 because of the symptoms.
• Only in 1874 was an infectious microorganism discovered: mycobacterium leprae.
• Common disease in the Middle Ages.
• Thought to be a dirty disease and stigmatized.

Bubonic Plague

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

Syphilis

• Deemed a humoral disease resulting from congenital factors, unhealthy environment or sinful behavior.
• Know now it is caused by a spirochete organism, Treponema pallidum.

Xavier Bichat

• Tissue pathology = empiricism vs patient experience and description of symptoms.
• Treatment of disease vs care of patients.
• Lived 1771-1802.

Rudolf Virchow

• Launched the field of cellular pathology.
• Smaller units; disease is at the cellular level.
• Lived 1821-1902.

Louis Pasteur

• Microorganisms are responsible for disease.
• Vaccines can be developed.
• Lived 1822-1895.

Robert Koch

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

Electron Microscope Developed

• Developed in the 1930s.
• Ability to detect viruses.
• Antibacterial medications like penicillin, antibiotics also invented in the 20th century.

John Snow

• Contagion (germ theory) vs miasma (bad air) informed how cholera was understood.
• Solved in 1854 with the broad street pump outbreak.
• Used reasoning, graphs, etc to demonstrate the impact of dirty water.

John Snow's Discovery

• The "grand experiment" which compared London neighbourhoods receiving water from two different companies: one Thames river water and the other sources in central London where the water was contaminated.
• 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

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

James Daschuk

• 1730s-1870s, small pox outbreaks.
• 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.
• Discusses in Clearing the Plains
• Dewdney: "policy of reward and punishment".
• Basquia, Peopamaw and Cowanitwo Cree simply ceased to exist as distinct groups.

Overview of key figures and concepts in the history of medicine, including the Medical Council, Bacon's empiricism, Harvey's discovery of the heart as a pump, and the definition of humanities. Also covers the role of philosophy and science in understanding the human body.