1) The Ontological Theory of Disease

General Information

  • Anatomo-politics: Where anatomy and politics combine, like in the Murder Act of 1752.
  • Bio-politics: Where biology and politics combine, like with the Public Health Officers in France.

Michel Foucault explains that the nature of legitimate political power has changed in the modern age from the power to 'let live and make die' to the power to 'make live and let die'. He noted that medicine is crucially important to 'making live', i.e. enhancing the productivity of the political subject. In the modern age, questions about medicine are increasingly tied to questions of political order: anatomo-politics and bio-politics.

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Is there such a thing as 'disease'?

Is disease just one thing or a collection of things? E.g., heart disease and AIDS aren't caused by bacteria and viruses, but the flu is. So, disease can mean many things. Institutions to look after the sick were created in the 17th and 18th centuries.

  • Herbalists were particularly used by the poor.
  • Bone settlers (e.g. Mrs Sarah Mapp) were well-respected and had to know how skeletons worked to heal fractures and breaks.
  • Midwives were usually women and were needed by everyone. Although there was a fashion in the 18th century for male midwives.
  • Apothecaries had an informal apprenticeship and an open business.
  • Surgeons were only respected after they distanced themselves from the Company of Barbers and Surgeons and established the Royal College of Surgeons (1800), signalling a connection to royal power.
  • Physicians were the most respected. They belonged to the Royal College of Physicians in London, had medical degrees from Oxford or Cambridge, and dispensed tonics, emetics, expectorants, and were involved in blood-letting. A lot of their education involved philosophy.

Lay healers like herbalists, bone settlers and midwives had informal apprenticeships and worked in an open, unregulated market. The others had guilds and formal apprenticeships.

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Hospitals

Hospitals usually treated the poor and the doctors who worked in them didn't get paid. They usually worked there to build up a practice and gain experience. It allowed them to get their name known and reach the higher circle of doctors.

Hospitals were usually founded by religious orders and later sustained parish rates and donations. They were often feared by the poor, though, as they were full of disease and patients often caught a new ailment whilst in there.

Hospitals changed radically in this period.

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The Ontolgical Theory of Disease

The Ontological Theory of Disease or The Medicine of Species uses taxonomy (the classification of things like plants or diseases etc) by examining what makes up certain diseases to help identify what it is. To understand a disease's nature, observable things, however imperfect, must be compared and organised. So, symptoms were compared to understand the disease.

Carl Linneaus and François Bossier de Sauvages worked together to produce a medical text that was a methodical nosology for diseases, a classification system. Sauvages sent botanical specimens to Linneaus to study who then created the binomial nomenclature, the modern system of naming organisms.

Identifying characteristics of diseases required careful distinction between its essential and accidental characteristics, like different characteristics within the same species. e.g. hydrangeas can be either pink or blue depending on the soil. So, even though they're the same, they're also different. Patients were understood as different from one another. For example, one could have cholera while another with the same symptoms may only be phlegmatic. Attention had to be paid to the patient to not confuse the nosological picture.

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Continued

A good physician was supposed to facilitate disease rather than fight it and let nature take its course (vis medicatrix natura). Diseases were usually better healed in domestic environments as it allowed the physician to fully understand the characteristics of the patient. In a hospital, different species of diseases could mix and confuse the nosological picture. So, the true nature of disease could only be revealed in the properly functioning domestic environment.

Doctors saw themselves as equals to the patient. But, therapeutic nihilism, the passivity with respect to the progress of disease that distinguished the world of the learned physician, increasingly exposed physicians to the competition of lay and other healers.

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