MEDS 280: the History of Medicine: a Doctor S Perspective

MEDS 280: The History of Medicine: A Doctor’s Perspective

FALL 2015 Weekday TBA 1 hour 50 minutes 2 units

INSTRUCTORS:  Peter Crookes, M.D., Professor of Surgery, Keck School of Medicine of USC  Guest Faculty from the Keck School of Medicine and Dornsife College of Letters, Arts and Science  Office Address: 1510 San Pablo Street Suite 514, Los Angeles, CA 90033  Office Phone: (323) 442 5831  Office hours by appointment: please contact: Shelley Staudenmeir

ADMINISTRATIVE ASSISTANT: Shelley Staudenmeir (323) 442 5831

Introduction and Purpose

The history of medicine has lessons for the future of medicine. This course will explore the role of medicine and surgery in society, whose ideas about health and disease have undergone enormous changes from antiquity to the present day.

Understanding where we have come from is an important aspect in directing where we are going in healthcare. Healthcare in this country is no longer the sole province of physicians, but has come to occupy a central position in the nation’s culture and priorities, and is of great relevance not just to medical, nursing and allied healthcare professionals, but also to public policy, the corporate world, economists and educators. Insights into how modern healthcare has developed will give much needed perspective into what it takes to promote change in the nation’s health, and will have a humanizing effect on healthcare practitioners such as physicians and nurses.

Course Requirements and Grades

 The principal textbook which outlines many of the key areas in the course is “The Greatest Benefit to Mankind” by Roy Porter (WW Norton & Co., 1999)  Periodic quizzes will be held throughout the course. These quizzes will form part of the assessment and will be included in the assessment of “Class attendance and participation.”  Course materials will include a selection of articles from the peer-reviewed medical literature. These required readings will be distributed one week before each relevant session.  The course will consist of one 110 minute meeting each week, which will involve a dynamic combination of lecture, videos, class discussion and special guests.  Prior to each class meeting, students will receive communication with material to read, listen to, and/or watch in preparation for the session. Students will be expected to be able to discuss the material during class.

1  After each meeting, students will receive an email with questions involving material from the session. These questions will not be graded, but will instead act as practice questions for the final examination.  Grading breakdown: Letter Grade 10% of the grade will be for attendance and participation 35% of the grade will be for the mid-term examination 55% of the grade will be for the final exam

Grading Scale: A 94-100 A- 90-93 B+ 87-89 B 83-86 B- 80-82 C+ 77-79 C 75-76 C- 74-70 D+ 69-67 D 66-64 D- 63-60 F 59-0

Examinations:

Exams will be multiple choice and/or short answer questions or short essays as appropriate and will cover didactic information provided within the class discussions and readings.

Class Sessions: 1 hour 50 minutes

Week 1 Medicine in antiquity and the classical age

Hippocrates, Galen, the 4 humors theory, philosophical concepts in the Ancient world and medieval times which precluded empirical observation (e.g. anatomy dissections). Influence of anatomists like Vesalius.

Week 2 Concepts of disease: the major causes of premature death and disability

Insight into infections, trauma (war) Malnutrition, and awareness of vitamins and other vital nutrients: concepts of life expectancy, risk of perinatal, maternal and infant mortality, and the evolution of health from concerns about premature mortality to the current awareness of the burden of chronic disease

Week 3 The fight against infections

2 Vaccination: Edward Jenner and the fight against smallpox, the elucidation of control over malaria and yellow fever. Discovery of microbiology and antisepsis. Discovery of Antibiotics. Application to the world's biggest killers (TB, Malaria, HIV)

Week 4 Extending human unaided observation: Microscope, X rays, endoscopy

Leeuwenhoek and the microscope, Virchow and the concept of cells and tissues, development of X rays (Wilhelm Conrad Roentgen), contrast radiology (WB Cannon) and CT Scanning. Development of endoscopy from Mikulicz in Austria to Basil Herschowitz in Michigan

Week 5 Surgery before and after anesthesia

Development of anesthesia (Humphrey Davy, Wells, Morton, Crawford Long). Development of Local Anesthesia: dramatic effect on practice of clinical and experimental surgery

Week 6 Major surgical figures

John Hunter: father of scientific Surgery. Theodor Billroth and his disciples. Halsted, Cushing and the development of surgical specialties. Harnessing technology, from Bovie to Laparoscopy

Week 7 Dramatic Milestones in Surgery and Medicine

Heart Surgery (Heart Lung Machine), Dialysis, The first Kidney Transplant, the first Heart Transplant, and the development of laparoscopic surgery. Analysis of why these advances were resisted (eg how the early laparoscopic surgery almost landed Dr Muhe in jail).

Week 8 Women's Health

Childbirth and its risks. Midwifery and Obstetrician in primitive and advanced societies. History of Obstetric Forceps (Chamberlen family), vacuum and Caesarean Section. How cultural norms impeded the treatment of women.

Week 9 Women in Medicine

Florence Nightingale and the power of statistical observation and rigorous training. Elizabeth Blackwell in USA and Elizabeth Garrett Anderson in England as pioneering women physicians. The transformation of Western medical practice brought about by the contribution of women.

Week 10 Cancer: understanding of what cancer is and how it leads to ill health and death.

3 Cancer development, environmental risk factors (Smoking, H Pylori, HCV, UV light, GE Reflux, HPV).

Week 11 Cancer Treatment

Radiation therapy (Marie Curie etc) and the develoment of chemotherapy from Nitrogen Mustard, Judah Folkman and anti-angiogenesis.

Week 12 Medicine and international politics.

Where medicine changed international relations: Sir Morrell Mackenzie and the crown prince of Germany, Anthony Eden negotiating Suez Canal treaty). How illness affected the function of influential politicians and rulers.

Week 13 The education of Physicians

Transformation from haphazard apprenticeship to structured and regulated training. Effect of the Flexner Report and its consequences for reformation medical schools. The development of Residency Training, From Billroth to Halsted and beyond.

Week 14 The force of personality.

Major figures whose forceful personality, drive, ambition and passion created major change despite ridicule and opposition: Semmelweiss, Christiaan Barnard, Sir William Osler, Thomas Starzl. Analysis of what it takes to introduce reform and how resistance can be overcome.

Week 15 Field trip TBA (notable historical archival collections in Huntington Library and old LAC USC .

FINAL FINAL EXAM 1 hours 50 minutes

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