Main description:

Healthcare is very much dependent on the model of the patient that is assumed by healthcare providers. The current model derives from a chemical/mechanical view of the patient body. Simply put: we are healthy if all of our mechanical parts are working properly and if all of the chemicals in our body are in the right proportions and have the appropriate reactions. This view is based on philosophical accounts of the body that go back to Paracelsus, Descartes, Boyle and others. It became the central basis of medical practice only in the late 19th Century after several hundred years of research and professional politics.

The Mechanical Patient traces the intellectual development of the chemical/mechanical model of the patient and its implementation. This book names the problem that we have with the mechanical patient and prepares us to respond to its exaggerated place in our society. It provides a historical and conceptual background and explains how the chemical/mechanical model of health gained such a strong hold over our thinking and took the place of the earlier Galenic humoral model. It sketches a promising outline of a more humanized model for understanding health and calls for help to fully articulate it. In that way, it joins a growing movement to go beyond our current chemical/mechanical orientation.

Contents:

Contents

List of Figures ..................................................................... xi

List of Tables .....................................................................xiii

Acknowledgments ............................................................. xv

Author ................................................................................ xix

1 Introduction .............................................................1

2 Aristotle and a Good Life ........................................7

Aristotle (384-322 BC) ........................................................ 7

How Aristotle's Ideas Can Help Us Understand

More about Health .............................................................12

3 Galen's Four Humors: The First Medical Model ....15

Galen (AD 129-c.210) .......................................................16

4 The Renaissance and Roots of the Mechanical

Patient ....................................................................25

Paracelsus (1493-1541) .....................................................26

Francis Bacon (1561-1626) .............................................. 28

William Harvey (1578-1657) ..............................................31

Rene Descartes (1596-1650) .............................................32

Pierre-Simon Laplace (1749-1827)......................................35

5 Robert Boyle: The First Mechanical Patient ..........37

Robert Boyle (1627-1691) .................................................37

Boyle and Samuel Hartlib .................................................40

Boyle and George Starkey (1628-1665) ...........................43

Boyle and William Petty (1623-1687) ...............................45

Boyle and John Wilkins (1614-1672) .............................. 46

Boyle and Thomas Willis (1621-1675) .............................47

Boyle and Robert Hooke (1635-1703) ............................ 48

Boyle and Thomas Hobbes (1588-1679) .........................51

Boyle and Arthur Coga (1631-1691) ................................53

Boyle and John Locke (1632-1704) ..................................53

Boyle and Isaac Newton (1642-1727) ..............................55

6 The Story of Scurvy and the First Failed

Controlled Trial .....................................................59

George Anson, 1st Baron Anson (1697-1762) .................60

James Lind (1716-1794) ....................................................61

James Cook (1728-1779) .................................................. 64

John Pringle (1707-1782) ..................................................65

Sir Gilbert Blane (1749-1834) ...........................................66

Almroth Wright (1861-1947) .............................................69

Axel Holst (1860-1931) and Theodor Frolich

(1870-1947) ........................................................................70

Ancel Keys (1904-2004) ....................................................71

7 Surgery and the Mechanical Patient ......................73

John Hunter (1728-1793) ..................................................74

Fanny Burney (1772-1840) ...............................................75

Ignaz Semmelweis (1818-1865) ....................................... 77

Joseph Lister (1827-1912) .................................................81

Wilhelm Roentgen (1845-1923) ..........................................82

Abraham Flexner (1866-1959) ......................................... 84

The Mechanical Patient in the Modern Hospital ..............85

Nurses in the Modern Hospital ........................................ 86

Lili Elbe (1882-1931) .........................................................87

Christiaan Barnard (1922-2001) ....................................... 88

Surgical Techniques ...................................................... 90

PROMs ........................................................................... 90

8 Medicine and the Chemical Patient .......................93

Lady Mary Wortley Montagu (1689-1762) ........................93

Edward Jenner (1749-1823) ..............................................95

Louis Pasteur (1822-1895) ................................................ 96

Robert Koch (1843-1910), Ferdinand Cohn

(1829-1898), and Maurice Hilleman (1919-2005) ............. 98

Mary Mallon (Typhoid Mary) (1869-1938) ....................... 99

Charles Best (1899-1978), Sir Frederick Banting

(1891-1941), and James Collip (1892-1965) ..................101

The Tuskegee Syphilis Study (1932-1972) and Ethics ...101

Gerhard Domagk (1895-1964) ........................................102

Alexander Fleming (1881-1955), Howard Florey

(1898-1968), and Ernst Chain (1906-1979) ......................103

Henrietta Lacks (1920-1951) ...........................................104

Ali Maow Maalin (1954-2013) ..........................................106

Sam Wagstaff (1921-1987) and Robert Mapplethorpe

(1946-1989) .......................................................................106

WHO Atlas .......................................................................107

Brenda Zimmermann (1956-2014) .................................. 110

9 Genetics and the Return of Individualized

Medicine ..............................................................113

Charles Darwin (1809-1882) ........................................... 114

An Aside on the Evolution of Human Consciousness ... 115

Francis Galton (1822-1911) .............................................. 115

Wilhelm Beiglboeck (1905-1963), Karl Brandt

(1904-1948), and Josef Mengele (1911-1979) ................... 116

Rosalind Franklin (1920-1958), Francis Crick

(1916-2004), and James Watson (1928-) ......................... 118

Herbert Boyer (1936-) and Stanley Cohen (1935-) ......... 118

Charles DeLisi (1941-), Pete Domenici (1932-),

and Craig Venter (1946-) ................................................. 119

Angelina Jolie (1975-) ......................................................120

Emmanuelle Charpentier (1968-) and Jennifer

Doudna (1964-) ................................................................120

10 The Great Mortality Shift ....................................123

Edwin Chadwick (1800-1890) ........................................124

John Snow (1813-1858) ..................................................126

Joseph Bazalgette (1818-1891) .......................................127

John Simon (1816-1876) .................................................127

Aneurin Bevan (1897-1960) ............................................128

Rachel Carson (1907-1964) .............................................130

Thomas McKeown (1912-1988) ......................................131

Hubert Laframboise (1924-1991) and

Marc Lalonde (1929-) .......................................................132

11 Humanizing Health: The Social/Relational

Person ..................................................................139

The Great Chain of Being ............................................... 141

Voltaire (1694-1778), Rousseau (1712-1778),

Diderot (1713-1784), and Hume (1711-1776)...................142

The Enlightenment and Reform ..................................142

James Edward Oglethorpe (1696-1785) .........................143

Jeremy Bentham (1748-1832) and John Stuart Mill

(1806-1873) .......................................................................144

Richard Wilkinson (1943-) ..............................................146

Michael Marmot (1945-) .................................................. 147

Amartya Sen (1933-) ....................................................... 150

Thomas Piketty (1971-) ................................................... 151

Finding a More Human Model of Health .................... 151

Bibliography ............................................................... 157

Index ..........................................................................163