Describe a pre-modern theory of disease

Be prepared to contrast/compare diagnosis or treatment in early America vs. in our own time

Benjamin Rush: quack or hero?

What is Foucault’s conception of “the gaze”and why is it a useful concept for historians of medicine?

How (and when) did Johns Hopkins, or the Flexner Report, or European models influence American medical education?

What was “Listerism” and why was it resisted by the American medical establishment?

Is vaccination a Constitutional use of the police power given to states? Discuss this question, using relevant legislation or court cases.

Medical researchers in the early to mid 20th century were on the forefront of scientific discovery, yet positioned themselves firmly against nationalized health care. Can you explain why physician organizations were on the one hand, futuristic in their work and on the other hand, so resistant to certain kinds of change?

Characterize treatment or the patient experience and outcomes at Willard; the institution was an example of why, exactly? I.e., place those experiences in wider context (medical, social, legal or other).

What is Paul Farmer’s contribution to the ethical dimensions of medicine and health care? Would you consider him he a modern Hippocrates, why or why not?

Provide a case study of the role of race in medicine or health care in America (possibilities: transfusions/blood banking, epidemics, “white man’s burden”)

What loopholes does the Affordable Care Act (aka Obamacare) close? Where, according to its critics, does the legislation fall short (or, conversely, go too far)?

Wed 4/17 – View Michael Moore’s film Sicko. Response Paper #3 due.

Mon 4/22 – How Did We Get Here? Reading: Stevens, “History and Health Policy in the US” (PDF on Blackboard)

In-class link: “Why is American Health Care So Ridiculously Expensive?” (The Atlantic 3/27/13)

Wed 4/24 – Costs: Economic, Social and Ethical. Reading and Listening: Farmer, “Pathologies of Power” (PDF on Blackboard) and LISTEN to and take notes on this October 2009 hour-long episode of the NPR program This American Life

Links we watched in class:
MRI Costs (Washington Post WonkTalk, March 2013)
Health Care System Overview (Khan Academy)
Journalist Steven Brill talks about his Time cover story on Medical Bills (March 2013)

Mon 4/29 – Health Care Reform, Law & Policy. Start by browsing this site: Healthcare.gov

Then read these:
Health Care Reform – Top 10 Pros/Cons on Procon.org
“The Case for Universal Health Care in the United States,” AMSA (American Medical Student Association), 2008
Robert A. Levy, “The Case Against President Obama’s Health Care Reform: A Primer for Nonlawyers,” Cato Institute White Paper, 2011 (12-page downloadable PDF)
“Fighting to Control the Word ‘Obamacare’” NYT 25 March 2012
“The ABCs of the Health Care Law and its Future,” NYT 2 April 2012

Note: there quite a number of polemical websites, you might want to look at a few, keeping in mind none of these are official or scholarly sources –

Obamacarefacts.com
Obamacareprosandcons.org
therepealpledge.com
HeritageFoundation.org’s content on Obamacare
CommonHealth: Reform and Reality (WBUR.org)
NYT: Multimedia content on the Affordable Care Act and the Supreme Court

Wed 5/1 – The HC Debate in Microcosm. See the “Debate” tab at the top of the course website. Prepare for the debate by taking, and supporting with evidence, a position in the health care debate. Due in class: Your Position Paper

Mon 5/6 – Wrap Up Day and Exam Prep. We will complete the Glossary in or before class, and work on developing the format for the final together.

Mon 5/13 – Final Exam 12:30 pm. Due at the final: Your Course Reflection Paper (prompt TBA)

Option 2: Our readings have uncovered tensions, concerns and conflicts when it comes to medical care in the period 1890-1950. Choosing examples from at least two different readings, consider some of these conflicts or unresolved issues – describe what was at stake, who took sides, and how the problems were either solved — or not.

Option 3: If you’re familiar with the New York Times Review of Books (and if not, you should be), you know that its essayists often compare two or more books on a related theme and offer insights on their scholarly or cultural contributions. In the style of such an essay, summarize or characterize the main argument of at least 2 of our readings from this unit, assess their content and provide a thoughtful/critical analysis of how well they convey the realities of health care, medicine, and illness in the American past.

Option 4: How were prevailing ideas about sickness, health and the body changing from the 19th century to the 20th century? Discuss, using evidence from our readings or class discussions.

Reminder: no class Monday 4/15 (Patriot’s Day). On Wednesday 4/17 we will view the 2007 Michael Moore film (documentary, expose, provocateur) Sicko in class, as a way to kick off our final unit on the extensive, highly technology-based system of health care in the contemporary United States, and to begin thinking about some of the issues (economic, ethical, and ideological) in debates over health care now.

For Wednesday, April 3rd – your Disease Report papers are due, but also: please bring Rutkow’s book and be ready to talk about chapters 8 and 9.

Relevant links:

A (hilariously campy) British government 1964 film looking back on the 1940s discovery of penicillin

See Jack Gibbon’s heart-lung machine in action (BBC Four)

Hear Ronald Reagan in his 10 minute LP recording from the AMA’s “Operation Coffee Cup” 1961 lobbying effort (never mind the images, just listen to the recording)

Listen to the 1948 “Truth or Consequences” episode introducing the original “Jimmy” of the Jimmy Fund

Next week we’ll read a short, but gripping, historical and medical detective book delving into the abandoned suitcases of inmates (is that the right word?) at a big New York mental hospital in the 1920s-1950s. I think you’ll really enjoy reading it and considering its thought-provoking depiction of care for the mentally ill. Read chapters 1-6 of The Lives They Left Behind for Monday, April 8th and Chapters 7-Epilogue for Wednesday, April 10th. I’ll then hand out a prompt for the third response paper, due on Wed 4/17.

The story of how smallpox epidemics affected the public and the government control of medical treatment and prevention.

Smallpox created a sense of unity between diverse populations by bringing everyone down to the same level, which made them have to work together to find a cure.

I was struck by the violence surrounding smallpox, both of the disease itself and of the actions taken against it.

The evolution of the medical community and at times the government, deciding what is best for society with regards to smallpox.

Smallpox epidemics are moments in history where we learn the strengths and weaknesses of a community, broaden our medical horizons, and challenge previous thoughts, morals and laws.

The book depicts the history of an era from a different, yet influential point of view.

The story of how smallpox ravaged a nation and the government’s attempt to treat this unprecedented outbreak.

In an attempt to eradicate the awful disease of smallpox, Americans went against their fundamental principle of freedom, showing how fear can drive a nation.

In Michael Willrich’s book Pox, citizen are forced to get vaccinated or face legal repercussions, creating a government upheaval between those wanting and not wanting to be vaccinated.

This book shows the effect of a massive outbreak of disease can have on a society, civilians and leaders.

The book blurs the line between the public good and civil liberties.

I learned one of the most deadly and horrible diseases and the steps the government took to try to eradicate it.

Law, being of human design, is arbitrary in nature, whereas the concept of disease lies outside humanity’s sphere of understanding, yet we combat it, as we do with most things we deem to be inherently bad, even at the cost of our self-attributed rights under those laws.

Smallpox was of a time in history that is rarely touched upon, almost hidden, but out of it came the revolution and reminder of civil liberties that the people of the US hold today.

The development and growth of American health care primarily counted on smallpox, up until its cure, with its effects on physical health, medical growth, social problems and the rights of the government.

Social factors can sometimes carry more weight than medical or political; smallpox epidemics are an example of how fear drives people to take action in order to protect their loved ones and most sacred beliefs.

I learned to not underestimate the power of disease, people’s will, and the government, and also the extent to which people will go to fight for what they believe in.

Willrich illustrates how the ends justify the means in eradicating pox and how the government was seeking the greater good.

For Mon 3/11 – Read Pox Prologue and Chapter 1

For Wed 3/13 – Read Pox Chapters 2-3

Over spring break, read Pox Chapters 4-5 for Mon 3/25

Reminder: the Disease Project poster and presentation day is Wed 3/27 of the week we come back from break.

Alan Bellows, “Undark and the Radium Girls,” Damn Interesting #241
Deborah Blum, “The Radium Girls,” Speakeasy Science 24 March 2011

There’s also a play based on their experiences, “These Shining Lives” (the photo is from a recent Minnesota production of the show).

See also this eyepopping post for more on the early 20th century fascination with radium and radiation in advertising and product names.

Luke Fildes, “The Doctor,” 1887

The first part of the unit will look like this -

Mon 2/18 – Reminder, no class – Presidents’ Day

Wed 2/20 – The Medical Gaze. Reading: Foucault, Birth of the Clinic (excerpts – as PDF on Blackboard). Bring the essay or take good notes on it and bring those. Remember to BRING a list of terms to class so we can begin our glossary together. The terms/concepts can come from Porter, Rutkow’s Intro/Ch1, Ulrich’s article, and Steele’s essay – or from anything we’ve brought up in class so far.

Mon 2/25 – Democratization of Healing. Reading: Rutkow, Ch 2. Your Diagnosis: History paper is due.

Further reading:
The “Ether Dome” original article from the Boston Medical and Surgical Journal, 1846

Wed 2/27 – Modern Medicine and Quackery. Reading: Rutkow, Ch 3-4. See also: The Quack Doctor blog.

Other links for Wed:
HarpWeek Cartoon, 1865 “The Hygiene of New York City”
Full text of Cathell’s book The Physician Himself (1886 edition) on Google Books
More on Garfield’s death: “The Doctors Who Killed a President” (New York Times Review of Books, 2011)

Mon 3/4 – Rise of Medical Professionalism. Reading: Rutkow, Ch 5-6. See also: The Flexner Report 100 Years Later (Yale J of Bio and Med, Sept 2011).

Response Paper #2 Prompt –
In his first 7 chapters, Rutkow has briskly marched his readers through a tour of medical progress (both forward and backward) and professionalization. In a 2-3 page response paper, choose and describe one debate, ideological conflict, or inflection point of change in American health care history. Reflect/respond on the impact and importance of this episode. Be sure to cite any direct quotations from the text. We will use your response papers as the basis of discussion on Wednesday, so preferably bring it as a printed hard copy paper.

Wed 3/6 – Progressive Era Challenges. Reading: Rutkow, Ch 7. Due in class: Response Paper #2.

* I rarely recommend Wikipedia entries, but the one on the gaze is actually pretty decent – maybe partly because it’s flagged as “too technical for most readers to understand.”

For each case study, the first class period will discuss the writings of a historian and give a general overview to the text, the time period, and the conclusions that scholars are able to draw from these sources. Then you’ll go to the original text and explore for yourself, and bring your findings, questions and conclusions to our second class discussion.

A page from Ballard’s diary

This week, we’ll be working with the diary of Martha Ballard, a midwife and healer skilled in the arts of household production in rural present-day Maine just after the American Revolution.

Mon 2/4 - read an essay about Ballard as a “social healer” by Laurel Thatcher Ulrich, which is an excerpt from her 1990 Pulitzer Prize-winning book, A Midwife’s Tale, titled “1787: Exceeding Dangerously Ill” (PDF on Blackboard)

Wed 2/6 - explore the diary itself at DoHistory.org

Mon 2/11 – UPDATE: No Class – Campus Closed due to snow removal. Read Volney Steele’s chapter from Bleed, Blister and Purge: A History of Medicine on the American Frontier, titled “Lewis and Clark: Keelboat Physicians” (PDF on Blackboard)

Wed 2/13 - we will explore the journals themselves at the Online Lewis and Clark Journals Project (University of Nebraska Lincoln)

Links we may use in class:

Biographical Sketch of Onesemius, medical pioneer and Cotton Mather’s Slave (W.E.B. DuBois Institute)
Harvard University’s “Contagion” Page on the Smallpox Epidemic of 1721 (Open Collections)
The Boston Smallpox Epidemic of 1775-1776 (BBC)
The Adams children being inoculated (HBO “John Adams” Miniseries)