Unit 9 – History of Medicine 1600 - 1900
University of Bristol (UK)
The lecture is split into four main sections. The first section, ‘From Humors to Germs’, focuses on the long shift from the humoral system of medicine to the new ideas of germ theory in the nineteenth century. I emphasise that humoral theory was a theoretically satisfying account of health and illness in order to emphasise the perceived usefulness of the framework to practitioners. I go on to explain the long course of experimentation, especially in anatomy, that questioned the theoretical underpinning of humoral theory, before providing a very brief overview of the great changes in medical theory in the nineteenth century, which were encouraged by new discoveries and inventions.
The second section examines the changes in the doctor-patient relationship that occurred at the same time that the shift from humoral medicine was occurring. I emphasise that in the eighteenth century, patients had a lot of autonomy in making decisions over their care—in part due to the lack of effective therapeutics. Regular medicine thus offered a particular kind of service to patients, that emphasised their uniqueness, and proscribed individual cures to them. From the ninteenth century, as disease began to be understood anatomically and chemically doctors gained more power in the doctor-patient relationship, and so this relationship changed. Doctors now employed instruments such as the stethoscope to investigate the internal leisons of the patient, with their testimony becoming less important. As patients became ‘things’, what could be done with them changed too. I end the section by introducing the work of J. Marion Sims, who developed the surgical technique for the repair of vesicovaginal fistula by experimenting on enslaved women and calling for reflection on the doctor-patient relationship in that case.
The third section, ‘Professionalisation’, examines the changes in the medical profession in the nineteenth century, as it became more professionalised and specialised, especially through the example of nursing. The example of nursing provides ample room to discuss the historical role of women in medicine, especially in relation to the marginalisation of women in medicine through professionalisation, as well as the various campaigns to ensure that women could work in orthodox medicine.
The fourth section, ‘Public Health Measures and the Decline in Infectious Diseases’, focuses on the efforts at reducing infectious disease from a policy and public health standpoint. I begin the section by emphasising the poor state of health in Britain in the period, which was largely caused by industrialisation, before discussing different health measures that were developed in the nineteenth century. I discuss health measures undertaken at local level—such as hand washing by medical practitioners—and at national level—such as through policy and legal acts like the Public Health Act (1848). I then probematise this narrative by discussing the debate by historians over the causes of the decline in infectious diseases, emphasising the difficulty of assigning concrete causal factors to long-term statistical trends in health. In the final part of the section, I examine the public dissatisfaction with some of these public health measures, to emphasise the role of public activisim in changing healthcare policy as well as the potentially negative consequences of policy change intended to improve healthcare outcomes. The conclusion briefly summarises the main goals of the lecture for students and encourages them to think historically about their profession.