The Changing Practice of Medicine
(And things you wish you didn’t know)
HCMG 300, Fall 2014
October 6, 2014
Jen Early, Doctoral Candidate, MSHA, RN
Virginia Commonwealth University, Department of
Health Administration
1
Objectives
• Historical evolution of
the study of the human
body
• Overview of evolution of
medical education in US
in light of co-evolving
ethical issues
2
Historical Study of the Human Body1
• Medicine is the study of disease and its
treatments
• To study disease, physicians focus on
abnormalities of structure (i.e. anatomy) and
function (i.e. physiology)
• For a long time, structural (anatomical)
explanations of disease were considered
secondary to those of function (physiological)
3
Historical Study of the Human Body1
Ancient Egyptian physicians do
not appear to have used anatomy to
inform their theory of disease
Greek doctors were not especially interested in
anatomy
– Dissection of human bodies was
forbidden
– Funeral practices centered on
cremation
Few opportunities arose for examination of the
internal structures of humans
4
Historical Study of the Human Body1
• 300 B.C.—City of Alexandria permits dissection of
bodies of criminals, alive or dead
– Designed to horrify as much as instruct
• 129 A.D.—Galen, physician to the gladiators
– Wrote treatises devoted to human anatomy and deplored
the laws that forbade dissection
– Dissected animals
– May have taken advantage of the gaping wounds of
gladiators
– Created medical texts that were used for more than a
thousand years
5
Historical Study of the Human Body1
• Throughout the 13th to 16th century, dissection
became increasingly permitted by law in many
European countries
– Determining cause of death in cases of murder
and other situations
– Usually permissible to dissect criminals or other
low status individuals
• The rise of secular universities
– Christian tradition linked the body to sin, as did
learning about its inner workings (could
jeopardize salvation)
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Historical Study of the Human Body1
• Legal dissections were
ritualized and infrequent
• Professor sat high above
the scene, reading from a
Latin edition of Galen
• Demonstrators were
often non-literate barbers
who dissected in
conjunction with the
lesson
• Differences between the
cadaver and Galen’s text
were “imperfections” of
the criminal mortal
7
Why were barbers
demonstrating the
dissections?1,3
– Surgeons were part of the barber class in the 15th and 16th
century
– Derived income from shaving, cutting hair, pulling teeth, and
bloodletting
• Accidents were incidental
• Had the tools to cut
– Often illiterate and inferior in status to physicians
• Humble origins, were not permitted into learned placed (medical
colleges)
• Learned through apprenticeships until able to formally organize/join
“academic surgeons” of the long robe
8
History of the Barber Pole3
• Staff—for patient’s to grip, causing veins to stand out sharply off
arm
• Copious supply of linen bandages to clean up blood
• After the operation, bandages would be hung on staff, sometimes
for advertisement
• Barbers used to advertise their
services by displaying large jugs
of blood in the window4
• 1307-law passed in London—
”no barber shall be so rash or
bold as to exhibit blood in their
window”
• The brass pommel at the end
represents the containers in
which they used to store the
blood
9
Historical Study of the Human Body1
• Renaissance art
contributed to anatomy
and artists conducted
dissections
• Why didn’t physicians
value anatomical study?
– Anatomical structural
problems (except fractures
and dislocations) were
impossible to fix
10
Historical Study of the Human Body1
• 16th and 17th century—anatomists focus on
discovery and artistic portrayal of the human
form
• Not until early 17th century did scientists begin
to relate structure to disease—field of
physiology found application for new
anatomical research
• By the 18th century dissections become more
respectable—new philosophy of knowledge
emphasizes wisdom coming from observation
through the senses
11
Medical Education in Early America2
• No medical schools in colonial America
– Only a few University trained physicians in Europe
came to the colonies
– They trained other physicians in apprenticeships
– No testing or licensing, free to practice with no
regulation
– Physicians brought their own apprentices to hospitals
and encouraged other students to observe treatments
– Became so popular that the Philadelphia Hospital
began charging students a fee and formalized a
training program, others followed
12
Anatomy Goes Medical1
• Beginning of 19th century, dissection becomes
essential to medical training
• New problem: limited supply of bodies
• In urban areas,
unclaimed bodies
were automatically
given to medical
educators
• But this wasn’t
enough . . .
13
Anatomy Goes Medical1
Does anyone know what this is?
“Resurrection Man”
• New occupation
– AKA “body snatchers”
– Retrieved fresh corpses to use
as cadavers from cemeteries
– Or to avoid middle man costs,
students learned to harvest
corpses themselves
• Wealthy could afford one of
these
– “mortsafes”
– Or hired sentries to guard
family plots
14
Anatomy Goes Medical1
• Where medical schools
operated in close
proximity to graveyards,
the human body trade
was ruthlessly
competitive
• The inevitable
happened: murder for
the sale of corpses
• Unknown numbers of
disadvantaged people
may have been killed to
this end
• 1823: William Burke
and William Hare found
guilty of murdering at
least 16 people and
selling the corpses to
Robert Knox, anatomist
at leading medical
school in Edinburgh,
Scotland
15
Chris Baker5
• Officially the janitor
• Unofficially the MCV
campus resurrection man,
aka “anatomical man”
• Procured bodies and
cleaned bones
• “ruled the dissection room
and possessed
considerable knowledge of
human anatomy”6
• Took students to local
cemeteries to rob graves
• Dr. Bosher, anatomy
professor condoned this
activity
• Lived in the Egyptian
building
16
Medical Education in Early America2
• Flexner Report and Medical School Reforms
– Funded by the Carnegie foundation in 1905
– Examined medical school entrance requirements, size
and training of the faculty, endowment funds, quality
of laboratories, and the relationships between
medical schools and hospitals
– Searing indictment of most medical schools of the
time
• “disgrace” “plague spot”
• Recommended corrective measures
• Schools closed, others consolidated
17
Medical Education in Early America2
• Flexner Report and Medical School Reforms
– Dartmouth, Yale , and Columbia improved quality of
their programs
– Harvard and Johns Hopkins recognized as excellent
– Increased leverage of medical reformers
•
•
•
•
Licensing legislation was pursued more vigorously
Medical training became more standardized
Quality of laboratories and other facilities established
Most important: financial support for medical school from
foundations and wealthy individuals
18
Transition to Academic Medical/Health
Centers2
• Federal research grants of the 1950s and 60s
encouraged research-oriented medical schools
and their teaching hospitals to become the
country’s centers of scientific and technologic
advances
• Other professional health care programs were
added—nursing, pharmacy, dentistry, and
allied health
• The research agenda continues and new
ethical issues arise . . .
19
Distrust of Doctors and Hospitals
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References
1. Sultz, H. A., & Young, K. M. (2006). Health care, USA:
Understanding its organization and delivery. Jones &
Bartlett Learning.
2. Duffin, J. (2010). History of medicine: a scandalously short
introduction. University of Toronto Press.
3. http://www.tn.gov/regboards/barber/bpolehis.shtml
4. http://www.swide.com/art-culture/history/barber-shoppole-history/2013/09/29
5. http://wp.vcu.edu/richmondcemeteries/wpcontent/uploads/sites/1876/2012/09/Schmitz_ChrisBaker.
pdf
6. http://www.virginiamemory.com/blogs/out_of_the_box/2
010/10/27/chris-baker-cheerful-among-corpses/
7. http://www.reddit.com/r/HistoryPorn/comments/22uek4
/uva_school_of_medicine_cadaver_society_3rd_club/
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