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Trephination

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A Precolumbian Surgical technique where a hole is drilled into the skull to relieve brain swelling. Proof that neuro-surgery was being performed without anesthetics and that these patients could survive.

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Calculus of Suffering

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Pernick writes of the Calculus of Suffering in nineteenth C surgery when anesthetics were becoming prevalent. This concept addresses a problem of anesthetic surgery: Does relief from pain and suffering create more risk? Pre anesthetics doctors performed surgery as quickly as they could, but they could take all the time they needed with anesthesia and this conflicts with the held notions of what surgery is supposed to be.

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Anesthesia

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In 1846, Morton demonstrated that ether can make patients insensitive to pain. After this demonstration, anesthesia quickly revolutionizes surgery. Before, the patient suffering limited doctors abilities to perform surgery, but with anesthetics they could be more careful and less distracted by cries of pain.

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Antisepsis

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Concept that you can contrast infection. Becomes prevalent in late 19th C after Joseph Lister writes about using Pasteur's idea of carbolic acid to spray in the surgery room to decrease the high infection rates in surgery.

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asepsis

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Idea brought about by late 19th C american surgeon Agnew to create a sterile environment where infection isn't possible as oppose to having to use the harsh carbolic acid to destroy present bacteria. Helps create the surgiccal environment we know today: switch from theaters to rooms, surgeons have to wear gloves, nurses around to enforce these sterile practices

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Joseph Lister

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In 1867, writes On the Antiseptic Principle in the Practice of Surgery. Takes idea of using carbolic acid from Pasteur to spray in the surgical room to kill infectious pathogens. As the germ theory of disease spread, Lister's antisepsis idea followed and became a part of almost all surgical operations.

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Theodor Bilroth

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Austian surgeon in the 19th C that develops Anastomosis, cutting out cancerous portion of the stomach and putting the two sides together. Example of one of the first experimental operation in which the anatomy becomes a more malleable subject to test on.

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Charles and William Mayo

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Two surgeons who founded the Mayo clinic in 1883. They became known for their ever-growing proficiency of gull bladder removal surgery. Their hospital developed this efficiency and a better business model for other hospital in America. Start medical tourism-travel to a certain clinic for a specific operation.

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William Halstead

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American surgeon who organized the first surgical residency in the late 19th C. Advocate of Listerism, develops gloves for surgeons to wear to protect their hands from the effects of carbolic acid, but this has become standard protcol for every doctor today for it also benefits the patients. Also perform the racidal mastectomy, removing all lymphatic tissue in order to root out the cancer, including the pectoral muscle. Reflects the growing idea that disease can be localized and rooted out. Founds JHU as the Professor of surgery

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Spontaneous generation

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An idea held up until Pasteur's swan necked flask experiment that different forms of life could emerge from sources other than seeds, eggs, parents,...etc.Pasteur put broth in two of these flasks, left one open and microbes developed, sealing the other one prevented them from growing, proving that these microbes cannot just superficially arise

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Louis Pasteur

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A French founder of microbiology in the 19th C. Discovers that fermentation depends on which microbes are present during the process and infers from this that maybe different kinds of microbes could cause different kinds of pathological diseases. Isolates disease causing bacteria in silkworms as well as anthrax and rabies. Proves vaccinations of anthrax in sheep. Also disproves the theory of spontaneous generation to show that disease is not just a product of filth, if you can control where the animalcules get you can possibly control disease.

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Robert Koch

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A german founder of microbiology in the late 19th C. Comes up with the doctrine of specificty after reading Pasteur's work. His postulate is that in every case of disease some microscopic organism can be isolated and infect an uninfected organism. Isolates causative agents of anthrax, turberculosis, and cholera

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Max von Pettenkoffer

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A bavarian scientist who, in 1892, set out to prove that the cause of cholera was indeed povertry and not the bacillus. Drinks a flask of the bacillus and survives to prove that just the germ can't be enough to cause these cholera epidemics. Sign that germ theory did not just immediately get accepted. It took time to convince everyone

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Paul Ehrlich

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A German bacteriologist in the late 19th century. Tries to develop a dye that can bind to an organic substance to kill the bacteria and not harm the host body, a concept known as the magic bullet. Kills syphillis with arsenic, an introduction to chemotherapy. Also comes up with the side-chain theory which has developed into a guiding principle of public health

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Biomedical model

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Develops along with the germ theory of disease throughout the 19th C. Offers etiology, but not therapeutics. Determining the cause of diseases is no longer a result of a negotiation between the doctor and the patient, but focuses on the physiology of the disease itself, not social or individual factors.

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specificity

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Late 19th C concept that developed as a result of the germ theory of disease. Idea that an individual disease can be tied to a cure. Behring is a pioneer of this concept, injects horses disease to get antitoxin and inject that into humans. This brings about the idea that a specific therapeutic agent can be developed in a lab to bring a cure to the public, and access to the specific cure can mediate life or death.

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magic bullets

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developed by Ehrlich in the late 19th C. Idea that if a compound could be made that selectively targeted a disease-causing organism, then a toxin for that organism could be delivered along with the agent of selectivity. Hence, a "magic bullet" would be created that killed only the organism targeted.

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Diptheria antitoxin

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Developed by Ehrlich and distributed to the public. One of the first biomedical interventions as a specific therapeutic. Something developed in a lab could be sent out to cure the public.

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healthy Carrier

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Idea embodied by Typhoid Mary. She carried Typhoid but did not have the symptoms and infected people wherever she went. Changes public health because you can be healthy but infect, has a strong impact on popular culture: begin to see association with germs and the marketing of goods.

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Mary Mallon

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Identified in the early 20th C as the first asymptomatic typhoid carrier. Wherever she went she infected those around her and as a result, was improsoned for her whole life. Infringement of her rights in the name of public health. abs have used germ theory to legitimate improving public health, but what are the consequences when you can be healthy but be a carrier?

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Mechanical objectivity

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Idea behind Ludwig's Kymograph, that a person (doctor) is not needed to determine that bodies processes, but a machine can be used to quantify and record the bodys' activities, and these results can be circulated

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Kymograph

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Developed by German physiologist Ludwig in the 1840s. Its a machine that records and quantifies the activities of living organisms. Idea that the body can write its own processes on paper without the mediation of a human.

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internal milieu

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phrased coined by Claude Bernard in the late 19th C to describe the extra-cellular fluid environment, and its physiological capacity to ensure protective stability for the tissues and organs of multicellular living organisms.Helps explain that in order to understand disease, you have to understand what's normal first.

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hyperglycemia

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Discovered by Claude Bernard, a pioneer of experimental medicine. He sees that the liver breaks down glycogen into glucose. Important discovery because Bernard used the method of creating a controlled arena in the lab to understand the normal processes in comparison to the diseased.

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chronic experiment

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As demonstrated by Pavlov's dog experiments in the late 19th C, chronic experiment required keeping the dogs healthy to live as norma of a life as they could. This contradicts most previous experiments where an animal undergoes vivisection during the experiment and dies

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Carl Ludwig

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A German scientist and student of Muller's in the latter half of the 19th C. developed the Kymograph, a machine which could quantify and record the activities of living organisms. Important because a doctor was no longer needed to get results, the machine could mediate the bodys' processes on paper.

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Hermann von Helmholz

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Late 19th C German physicist who develops a system of lenses to look into the eye to study the physics of perception. Studies the speed between which the eye visualizes something and when t is percieved. His lenses are tools of peering into the patient's body, which needs to be understood as a set of mechanical processes. Develops opthalmalscope to see structures in the eye

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Claude Bernard

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Does work in new field of experimental medicine to understand the chemistry of digestion. Believes in needing a hypothesis in order to carry out an experiment to figure out causal determinants. Creates controls to understand normal processes to be able to understand the disease. Helps with discoveries of hyperglycemia in diabetes.

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Ivan Pavlov

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Late 19th C early 20th CRussian scientist who experimented on the gastric function in dogs. Uses the dog as a lab technology to get precise measurement over long periods of time. Coins chronic experiments in contrast to usual animal experiments in which the animal dies. Uses surgery to make their internal processes visible.

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Francis Peabody

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Humane clinician of the late 19th early 20 centuries. celebrated as the caring physician who believed that character of the research was reflceted by the character of the researcher. Need to have high minded individuals conduct research instead of the desensitized view that had come to predominate the view of a lab researcher.

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vivisection

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surgery on live animals mostly for experimental purposes. Gives great knowledge on the body processes, however in most of these experiments the animal will die. Idea of sacrficing the animal becomes vocal in the early 20th C and brings up question of who is regulation the ethics of medical research.

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technological determinism

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the idea that technological advancements drive the transformation of medicine. For example, the hospital becoming the central institution of public health infrastructure was driven by the fact that technologies such as the x ray machines were stored in hospitals.

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medical gaze

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Foucault coined the term "medical gaze" to denote the dehumanizing medical separation of the patient's body from the patient's person (identity). Beginning in the late 19th century, patient doctor interactions were depersonlized with new technologies that allowed doctors to diagnose with much less patient input.

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total institution

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a setting in which people are isolated from the rest of society and controlled by an administrative staff that is reflected in the transformation of hospitals in the late 19th C. Heirarchical staff is implemented as opposed to informal nursing charges.

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semi-private room

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A room that is shared with at least one other patient. Part of the transformation of hospitals in the late 19th century away from wards. Rooms further decrease infection.

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Wilhelm Roentgen

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German physicist who discovered x-rays in 1895. Beginning of radiation therapy. Way for doctors to see inside a patient as oppose to relying on their explanation

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the block model

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One of the many designs of hospitals that came out to represent hospitals as symbols of modernity

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renee Laennec

answer

developed the stethoscope in the early 19th C as a tool to amplify the sounds of a patients heart. THis technology allowed doctors to better diagnose their patients with these observations

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opthalmoscope

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Tool made my Helmholtz in the late 19th century used to see structures in the eye. Part of the transformation of diagnostic technologies.

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otoscope

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tool invented in the mid 19th C to look into the ear. allowed doctors to peer inside their patients to observe the bodys' activities

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laryngoscope

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medical insturment invented int he early 19th C to look at the vocal folds and glottis of a patient. Part of the transofmration of technologies that allow doctors to peer inside the patients bodily activities

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fluoroscopy

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radiographic technique in which x-rays are directed through the body to a flurorescent screen that displays continuous motion image of internal structures. Developed by Roentgen in the late 19th C that allows doctors to make better observations.

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erving goffman

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20th century write and sociologist that wrote about total institutions: a setting in which people are isolated from the rest of the society and controlled by an administrative staff. Reflects onto the managing tranformation of late 19th C hospitals

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reductionism

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concept of 19th century contemporary with germ theory of disease that you can reduce specific material at play. In biomedicine, take the concept of mechanistic disease and boil it down to microbes.

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cellular pathology

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Concept that you start with cells and then work towards tissue. Can describe inflammed tissue by the cells that makeup that tissue and how those are growing. For example, realize inflammation is mediated though kinds of white blood cells.

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side-chain theory

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A theory developed by Ehrlich in the late 19th C that some people have immunity to a disease and others don't and looking into someone's serum could give you a history of what they have and have been exposed to. Becomes a guiding principle in public health

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hemacytometer

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grid-like device created in the late 19th C to measure blood cell count. Represents idea that these careful observation can produce quantitative data to cure disease

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chlorosis

answer

A disease characterized by the greenish tint the skin gets when one has this disease. WIth new technologies and tests developed in the 1890s, this disease recieved a different name based on these discoveries: anemia. Proof that advanced technology has helped better our classification of diseases

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molecular disease

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Product of reductionism in early 20th C: disease can come from mutated molecules as opposed to just pathogenic cells. Linus Pauling has taken Virchow's theory one step further: identification of sickle cell is a molecular disease.

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clinicopathological conference

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Originated in late 19th ealry 20th century. A formal discussion of a Pt's clinical, radiologic, and lab data, usually in front of a large group of junior and senior colleagues. Publish cases and discuss what could have been done differently.

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rudolf virchow

answer

A german scientist in the 19th C known as the father of modern pathology as well as a prominent figure in the founding of social medicine. Wants to uncover deterministic laws that guide pathology in everyone. Makes headway in discoveries of blood clots

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Richard C Cabot

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A late 19th early 20th C american physician who advanced clinical hematology. Previously known as chlorosis, anemia gained its new title from new technologies and test and Cabot, like Virchow, believed you could subdivide this disease. However, Cabot stated that the specifities did not matter because the same treatment was used in the long run. Believed that the role of being able to see disease correlates to the ritualized practice of medicine

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James Herrick

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a late 19th early 20th c american physician who is credited with discovering the sickle cell shaped red blood cells that characterize sickle cell anemia. ALso helps make headway in heart attack causes. Example of the idea of the blood lab in that you can locate disease in the hospital without the patient being dead.

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Linus Pauling

answer

AN american scientists in the 1940s that develosp reductionism even further than Virchow. Pauling conceptualized disease at the molecular level

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specialization

answer

Medical specialization developed throughout the 19th century. Doctors limited their studies to a specific type of disease, body part, or life stage in order to divide and conquer the medical field.

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standardization

answer

implementation in the early 20 C of policies and guidelines to standardize and unite laboratory tests as the need for them grew larger across America

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gatekeeping

answer

A primary-care provider who coordinates patient care and provides referrals. Part of the transformation of hospitals as a center of the public health structure

question

The flexner report

answer

-written in 1910 by abraham Flexner The Report called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to the protocols of mainstream science in their teaching and research. Many American medical schools fell short of the standard advocated in the Flexner Report, and subsequent to its publication, nearly half of such schools merged or were closed outright.

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Charles eliot

answer

After becoming the president of Harvard in 1869, he reduced the number of required courses at the college while adding electives that allowed students to learn more in the areas of modern languages and the sciences, such as biology, chemistry and geology.

question

Henry Bigelow

answer

surgeon at Harvard in the 19th cenurty. Vocal antivivsectionist and wrote an article that detailed the discovery of ether as an anesthetic

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William Osler

answer

founder and first professor of medicine at the Johns Hopkins University in late 19th C. JHU raised medical education standards to begin the move to the high standards that medical schools hold today. Advocated bedside teaching of inspection, palpation, auscultation, and contemplation

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W.H Welch

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Founds and becomes first Professor of Pathology at Johns Hopkins University in the late 19th C

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antivivisectionists

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object to the procedure, though many of our most important medical discoveries were made through vivisection. Advertise the implcation that human vivisection will soon be taking place. Adhere to the idea of the desensitized doctors

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eugenics

answer

the science of improving genetic qualities by selective breeding (especially as applied to human mating). Proves that racism and prejudice can get encoded into what is considered science.

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Tuskegee Syphillis study

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A study that began in 1930 to observe the effects of untreated syphilis on black men in which they told the research subjects they were recieving free health care from the U.S government. Study only ends because the story is leaked to journalists. Reveals the power differentials between the researcher and his subject and potential for exploitation associated with medical research.

question

eunice rivers

answer

An African American nurse involve in the Tuskegee study. Was aware of what was going on the trials and was under much criticism for not reporting the scandal

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Nuremberg code

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the code stating that certain types of medical experiments on human beings be kept within reasonably well-defined bounds that observe basic principles of moral, ethical, and legal concepts. Result's from Hitler's eugenics movement that contributed to racial differentiation

question

helsinki report

answer

In 1963, a set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association (WMA). Have to respect the research subjects right to make informed decisions about participating

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belmont report

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In part prompted by the tuskegee scandal, a report written in 1978 to address informed consent by research subject, and assessment of risks and benefits. Making a protocol to ensure no more unethical science will be performed

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historical epistemology

answer

ALso, known as the theory of knowledge. How do we know what we know and what we consider to be valuable knowledge. In the context of medicine, where is medical knowledge made?

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Moral economy of science

answer

scientists value objectivity, but definition of objectivity has changed over time. In the early 19th C objectivity had to do with the trustworthiness of the person making the objective claim, but it has evolved to trust technology and its sound data

question

council on pharmacy and chemistry

answer

created by the AMA in the early 20th C to mediate what should be seen as good medicine and what should not. THis group of elite medical practitioners sets standards for drug manufacturing and advertising

question

evidence-based medicine

answer

medical care based on the latest and most accurate clinical research. As the definition of objectivity rationality evolved to rely less on the trustworthiness of the doctor and more on raw data, the need for evidence based medicine followed

question

phase IV trials

answer

One method of the state regulating clinical trials. In Phase 4 trials, postmarketing studies delineate additional information, including the treatment's risks, benefits, and optimal use. Try and distribute medicine to larger population to gain more market but can backfire (Vioxx)

question

Jonas Salk

answer

Developed the polio vaccine in 1952. Says doing a randomized trial is a bad idea because he is sure that it works. But these trials were an important development in biomedical therapeutics because it makes us ask how we reconcile the opposition of clinician and researcher

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A. Bradford Hill

answer

20th century english epidemiologist who pioneered the idea of the randomized clinical trial which is widely used today. Randomized trials allows for variable to be equally distributed across the population. Also did a study to link lung cancer with smoking.

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sham surgery

answer

Same idea of a placebo sugar pill but with surgery. Open up research subject but don't give actual operation. severely critiqued as unethical and brings up the question of any placebo being unethical. why is surgery more unethical than a pill?

question

Epidemiologic transition

answer

A graph showing the 3 eras of dieases: first of famine and pestilence, second there are still spikes but less frequent, and third is the plateau of chronic diseases. Development that shows the changing burden of disease as infectious disease receded in importance

question

risk society

answer

a term developed in the 1980s to describe the manner in which modern society organizes in response to risk of disease. Have adds for surveillance of health

question

louis dublin

answer

Early 20th century statictician at metlife insurance. Ran stats that allowed many insurance companies to not insure blacks and white women. THese stats became important not only to insurance companies but society in general

question

Ernst Boas

answer

early 20th century physician who helped link early heart disease in America with strep and improper diet, activity, cholesterol, and blood pressure

question

commitee on chronic disease

answer

20th C committee that shows that the English and Welsh population have a a decrease in mortality from infection and and more chronic disease cases. Reflect the epidemiologic transition and the shifting burden of disease to looking at risk factors

question

1964 surgeon general's report

answer

Cigarette smoking is a "health hazard of sufficient importance to the US to require remedial action" In 1965 cigarette companies have to put a warning on their boxes. Government increasing intervention to promote public health

question

public health millennialism

answer

Resurgence of infectious disease, ongoing problem of cigarette consumption, and obesity problems could lead to an end in the improvment of public health

question

diseases of civilization

answer

diseases that increase in frequency as countries become more developed and people live longer. Leads to a shift in perception of disease as preventative and under risk management

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medicalization

answer

process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. e.g hospitals

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sick role

answer

concept created by Parsons in the 50s in which he describes the rights and obligations of the sick in society.

question

paternalism

answer

Idea in pre 1960s that Doctor knows best and then he can make the decisions that are best for you. Embodied in fact that doctors would not tell patientsexplicitly if they had cancer. It was their choice to determine if the patient was ready to hear that

question

egalitarianism

answer

Post 1960s that patients had a right to know if they were sick or not. They were seen more as consumers to make their own decisions as oppose to ill informed victims

question

pinkwashing

answer

Term for breast cancer awareness marketing

question

one-step procedure

answer

a surgical biopsy is performed, maybe even a mastectomy for women with suspicious lesions as a preventative measure

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