02/16/2015

Last Wednesday
Medical education, changes that took place late 18th, early 19th
Century
Laboratories, equipment, technology, lengthening of medical school
curriculum all of which cost money
o Rockefeller institute in NYC
Philanthropy
o Carnegie hired Abraham someone to write a study
o Johns Hopkins founded an institution in Baltimore
o Rise of capitalism in the USA, monopolies with railroads, etc.
o Morality: if you made a lot of money, rather than use it for
your own personal wealth, they should also do something to
help the public and give back.
Good publicity (John D. Rockefeller)
With the help of Rockefeller, we see the rise of the teaching
hospital, laboratories, research, depth of the medical field
(University of Michigan)
Healthcare
Birth of large hospitals in London, England
St. Barths hospital, founded 1123 (?)
o Survived the great fire of 1666
High technology blitz of WWII
Voluntary hospitals, funded by charity of people of the community
If you gave money to the hospital, you held some control in the
hospital
o Contributors would overrule the physicians over hospital
affairs
Difference between hospital and almshouse
o Hospital was very selective about who they accepted
o Life in the hospital was brutal, dead bodies everywhere
Tight control over who could get in and get out for visits
almost like a jail
Tension between trustees and physicials

Religious hospitals
o Mount Sinai hospital 1852
Florence Nightingale
o Often dubbed Mother of nursing
o Went to Kremlin War
o Came back, spent the rest of her life in bed
o Opposed Germ Theory
Thought disease was what one deserved for living a
corrupt, unhealthy life
o 1873: 178, 1909: 4359; hospitals really took off in the US
o They get bigger as well
o Hospitals start to become structured
Lots of women and children, upper class people in hospitals
o People who can afford to pay
o Shift in hospital acceptance (from prostitutes to nobles)
Adding machines drive accounting, to add up money coming into
hospitals and other hospital finances
Cost accounting
Industrialization of healthcare
o The nurses all look the same reminiscent of factory
workers; impersonal vibe, to the detriment of the patient

Monday, Feb 23
Hospital Records:
Short case records, hand written urine exam results, overall not
very organized or professional
Huge transition heart disease
Setting: England 1768

o William Heberden Medical Transactions papers

Most notable for his paper about the disorder of the
breast.
His commentaries were his magnum opus.
o Dr. Anonymous
Early 20th century:
o Patient walks in to hospital with dental pains
o First use of microscope
Sir Thomas Lewis
Separate space designated to study the heart Heart Station
o Equipped with director and office
o Heart specific machines
o Leads on the chest mild breakthrough
o Frank Wilson early 1920s-1950s; started his work after he
returned from WWII

Exam
Terms
Image - interpretation
Essay
o Short Answer Qs (1-2 sentences):
Robert Koch Proposed germ theory
Carnegie Foundation, Carnegie himself
Flexner Report (?)
Vesical Vaginal fistula experiments, J. Sims, worked
on slaves
Stethoscope - Lamec
o Essay Exam Qs:
What is disease, how do people conceptualize disease?

Role of war in the development of medicine.

William Beaumont
French Revolution med schools closed bc it
wasnt deemed important. After people got
injured during war, they realized med schools
were necessary and they reopened.
Describe two examples of relationship between doctors
and patients.
Beaumont and St. Martin
Transfer of power between physician and
patient
Sims and slaves
Opens up debate between ethics and
medicine
The process and development of the germ theory.
Started with experiments by Pasteur, Koch
Worked on developing vaccines
Koch worked towards finding a cure for
tuberculosis, cholera
Developed postulates
How/why?
Changing role of hospitals (19th-20th Century)
Earlier religious institution
(Go through slides)
Almshouse vs. Hospital; morals
Class rich wouldnt go to hospitals, they could
afford a physician to visit them at home; hospitals
were a place for the poorer
Contributors to the hospitals held more power in
the institutions than physicians
How could one become a doctor in the 19th Century;
medical education
Johns Hopkins med school curriculum became
more developed and structured
Flexner Report
In the old days, becoming a doctor required
basically no schooling at all to become one, you
merely had to apprentice a physician
Role of Nurses

Changes/challenges of childbirth
Slavery and medicine
Development of Technology
How medicine has been portrayed in art

Brush up on TB