Transcript LECTURE 2 - Student subdomain for University of Bath

LECTURE 2
THE HISTORY
OF DISEASE
Overview.
History of disease
epochs of disease
cross cultural and trans-historical
theories of disease
social constructionist arguments.
classifying medical systems
historical trajectory of the treatment of
disease.
The epochs of Disease. 1
Broadly 3 periods -characterized by
different ways of life and different disease
problems.
1. Pre-agricultural societyBefore organized argriculture, hunter
gatherer societies, Life short but healthy,
adult mortality linked to search for food
supplies, few infectious diseases.
population growth restricted by high
mortality. Life was short but comparatively
healthy (McKeown)
The epochs of Disease. 2
2. Agricultural SocietiesSedentary man; cultivation of crops ; domestication of animals. increasing numbers
of people together living together; poor hygiene; insufficient food.
Growth of large settled communities. Some advantages but costs outweigh
benefits.
Encourages spread of many diseases as opened up more to trade and
communication.
Also because build and live in more settled houses –encourages disease
transmission – attract vermin – rodents and mosquitoes. Eg influenza –
disease of civilization.
Refuse attracts wild animals – this is the means through which rat borne
bubonic plague is brought into human communities
Rise in instances of fecal-oral transmission –worms; dysentery etc
Insect borne disease
Domestication of animals and disease
Increased population density- important factor in the spread of disease.
four key factors in the spread and
increase in disease
So we have four key factors in the
spread and increase in disease .
1 Increased communication
2sendentarism
3. domestication of animals
4. population density
Globalisation of Disease.
William Mc Neil - 3 major events of
transportation:
Linking of China, India and
Mediterranean by sea and land in
Christian era
Spread of European seaborne
exploration in 15th century (brought
bubonic plague to Europe)
Mongol expansion to Europe
The epochs of Disease. 3
3. Modern Industrial societiesdecline in mortality from infectious diseases; little to do with
modern medicine according to McKeown. Rise in ‘Modern
diseases’ cancers, heart disease and strokes, diabetes etc
Modern illness non-communicable, chronic (longlasting)
and progressive.
a number of risk factors
linked to lifestyle.
avoidable but not ‘curable’
increasingly aging population
changes in conditions of life and industrialization.
Diseases of developing world.
The Classification of Medical
Systems 1
Dunn.
Distinguishes between systems according to the
geographical extent of their influence.
Local Medical Systems- Those confined to a small
geographical area.
eg. The !Kung of the Kalahari desert.
Regional medical Systems- Those that have wider
geographical influence, perhaps across an entire
continent.
eg. Ayurvedic Medicine found throughout the
Indian subcontinent.
Cosmopolitan Medical Systems- Those that are
exported and adopted worldwide.
eg. Western medicine (bio-medicine) and
homeopathy.
The Classification of Medical
Systems 2
Foster.
Focuses on the nature of belief systems and how they influence
medical discourse. Distinguishes between:Personalistic Systems- Those that interpret sickness
supernaturally. In these systems sickness is viewed as punishment
by a supernatural being or by an individual practising magic or
witchcraft. In these systems preists or shamans are required to
alleviate or cure symptoms.
Voodoo in Haiti.
Naturalistic Systems- Those that explain health and ill-health in
terms of a balance or imbalance in the basic elements of the body,
often called equilibrium theories. In these systems physicians or
herbalists with expert knowledge are required to restore health and
the bodies natural balance.
eg. Plato's 3 state model. Hippocrates' 'Four Humours. Chinese
Medicine 'Yin, Yang'.
The Classification of Medical
Systems 3
Leslie
Distinguishes between:
Mechanistic theories. - human body seen as
machine-like, illness a dysfunction or breakdown.
eg. Western Medicine.
Equilibrium theories- (Similar to Foster's
'Naturalistic Systems') illness a result of
disequilibrium or disharmony in the body. Health a
result of harmony or balance
eg. Chinese medicine.
Ethical theories- health is a result of 'right living'
illness is a punishment for sin or wrong-doing.
eg. Magico-religious systems. Ndembu in Zambia.
The development of scientific
medicine EARLY HUMANS: (before
3000 B.C.)
Supernatural Belief Systems: magico-religious or
supernatural explanations of disease.
Causes of disease: by direct intervention of a god
or spirit, or through a sorcerer or through the
intrusion of some foreign object (spirit or demon or
something more tangible such as a stone or
pebble) into the body.
Cures: religious rituals (prayer, magic spells,
exorcism, dancing, sacrifices) or physical means
(sucking out, vomiting, bloodletting, skull
trepanation)
The first physicians were known as the shaman
(or the witch doctor or medicine man).
The development of scientific
medicine -THE EGYPTIAN
CIVILIZATION (3000 B.C.)
Egyptian physicians were specialists and
religious leaders. Each was devoted to a
different god. Diseases were associated
with their deity.
Egyptian medicine produced two
noteworthy documents: the Code of
Hammurabi which is possibly the first
codified set of guidelines regarding
responsibilities of physicians, and the
Ebers Papyrus, a type of medical textbook
summarizing extant medical knowledge.
The development of scientific
medicine -GREEK AND ROMAN
SOCIETIES: (2000 B.C.) 1
Apollo, the sun god, was also god of health and medicine.
Aesculapius, son of Apollo, was the Greek god of health.
Temples called "asklepieia" were created where priest-physicians
could practice.
Hippocrates: The Father of Medicine. (460-377 B.C.)
The principle of natural, rather than supernatural, explanations for
disease - humoral theory of disease: linked to the body in the
natural environment- early materialist notions. The natural elements
such as air, earth, fire, and water balance with the element in the
body such as blood (hot), phlegm (cold), yellow bile (dry), and black
bile (wet). A person is healthy when these four humors are in
balance and when the individual is in balance with the environment.
His writing - over 70 books, monographs, and essays - focusing on
the importance of observing disease progression and described his
own copious note taking of medical histories, symptoms, and
reactions to therapy when treating patients, also the notion of
treating the "whole patient," not just a particular organ or symptom.
The development of scientific
medicine -GREEK AND ROMAN
SOCIETIES: (2000 B.C.) 2
His teaching of human compassion and ethical standards Hippocratic Oath.
Asclepiades (a Greek physician)
Causes of disease: health and illness were determined by
the condition of the pores - either too open or too closed.
Cure: massage, diet (wine) and baths.
Roman households ministered to the sick in their own
families. They did not produce their own physicians in the
beginning.
Roman contributions to medicine: public health (pure water,
public baths, street cleanliness, and hospitals). Direct link
made here between hygiene and health.
The development of scientific
medicine -THE MEDIEVAL ERA:
(A.D. 500-1500)
Monastic Medicine: church controlled the medical practice Disease
and illness are beneficial in that they test one's faith and
commitment to God and the church. Despite this the earliest
hospitals developed in the monastic period.
Causes of disease: due to the punishment by God, possession by
the devil, or the result of witchcraft.
Private physicians represented a form of blasphemy in their efforts
to cure disease, no cure apart from religious intervention. Preist
responsible for this.
Arabic Medicine: Contrast- built hospitals and bestowed high
prestige on private physicians, and basically served as the link
between Greek medicine and Renaissance medicine.
Scholastic Medicine: medicine practice became the province of the
secular clergy, and universities began to plan a prominent role in
the education of physicians.
Two other occurrences during the period: there were numerous
devastating epidemics (e.g., Black Death) that made clear the total
helplessness of physicians to restrain disease.
The development of scientific
medicine -MEDICINE IN THE
RENAISSANCE: (15C - 16C)
Focuses on humanism: dignity of the
individual, the importance of this life,
and spiritual freedom.
Andreas Vesalius and Paracelsus
both attacked Galen's anatomy.
Medical specialization: physicians,
surgeons, barber surgeons and
apothecaries.
The development of scientific
medicine -MEDICINE FROM 1600
TO 1900:
Focusing on science, observation, and experimentation.
William Harvey's confirmation of the circulation of blood in
the 17C body comes to be viewed as a machine.
In the 17C, scientific medicines were met with skepticism,
medicine superstitions were still common, some physicians
focused on the physician-patient relationship and on the
body's self-healing capacity, and in this way, maintained the
Hippocratic tradition.
In the 18C: Development of a modern concept of pathology:
Giovanni Battista Morgagni's anatomical concept of disease
- diseases could be traced to a particular pathology or
disturbance in individual organs.
The emergence of public health (sanitary conditions and
water supplies) and preventive medicine (using cowpox
vaccine to prevent smallpox by Edward Jenner).
The development of scientific
medicine -19C: industrialization,
migration and urbanization:
The emergence of Hospital medicine and laboratory
medicine.
Early part of century a diversity of beliefs many still believe
disease caused by Miasma- airborne poisonous gas from
sewers and cesspits which infects wounds or lungs. Later
part of century diversity of belief contained by growing
development of a scientific bio-medical model resting on a
number of major developments (influence of Cartesianism,
mechanism, duality) more about this week after next.
Discovery of the cell by Rudolf Virchow: disease begins
with some alteration in the normally functioning, healthy
cell. Effective treatment depends on restoring the cell to
normality. He also emphasized on the importance of
environmental influences (social class, occupation, social
networks) on health and illness, and referred to medicine
as a "social science" and as the "science of man".
(Virchow).
Germ Theory and the Doctrine of
Specific Aetiology
The germ theory of disease by Louis Pasteur in
1850’s (the Father of Modern Medicine) I will
discuss this in more detail the week after next.
1880’s Robert Koch elaborates Pasteurs germ
theory- into ‘Doctrine of specifc aetiology’ each
disease caused by particular micro organism.
Progress in surgery: an understanding of the
localized nature of disease, an ability to control
patient's pain in the surgical process, and an
ability to prevent wound infection.
The Role of Medicine in the
decline of disease.
Food and Agriculture.
Perhaps improvements medicine not as
central as you might think (Mc Keown).
Improvements to agriculture around 17th
century
important in improving diet.
New crops
new agricultural techniques
Better nutrition - greater immunity
relationship between levels of immunity
and poverty
The Role of Medicine in the
decline of disease.
Hygiene and drinking water.
From mid 19th century improvements
in hygiene
purification of water and sewage
disposal.
From 1900 improvement in quality of
milk was very important
New sterilization techniques (Does
this contradict Mc Keown?)
The Role of Medicine in the
decline of disease.
Birth Rates.
decline in the birth rate.
Sex education and contraception
(McKeown) - pre-modern society (and contemporary
developing societies) out of new born children, on average,
23% died before their first birthday, 56% (Check these
figures) by age 6
In technologically advanced society more than 95% survive
to adult life.
Average life expectancy in Sierra Leone currently 34.
Infant death rates fell dramatically from mid 19th century
(Mc Keown) - since the mid 19th century, 40% decline in
mortality from airborne diseases, 21% decline from water
and food borne diseases, 13% from other infections, and the
remainder (26%) from non-infective conditions.
Conclusion.
Different periods characterized by different
material conditions.
Different material conditions give rise to
different kinds of disease.
Disease interpreted differently in different
contexts.
Does this mean health, illness and disease
are cultural constructs?
Mc Keown contradicts ‘common sense
assumptions about role of medicine in
decline of disease.
Next week
The development of modern medicine
and the hospital;
public health, the bureaucratization,
rationalization and ‘technologization’
of medicine and health care.
Home work- read the hand out on
Weberian
models
of
Bureaucratization and see how we
might apply this to health care.