J. Duffin, 78 Barrie St., 613-533-6580
Classes: Monday 1 to 2:30 and Wednesday 11:30 to 1 pm
Office hours: Mon 2:30 to 4:00 and Wed 5 to 6 pm Or by appointment
Medical ideas have always focused on how to identify disease, treat it, and predict its outcome. The definition of normal and abnormal is the business of medical epistemology; yet the parameters, evidence, and definitions of this activity have changed through time in concert with social, philosophical, and technical change. This course provides an overview of the history of medical ideas, by focusing on a wide selection of primary sources about diseases and about philosophy of knowledge, from Homer to this year's Globe & Mail. Students read short passages written by philosophers, historians, physicians, writers, and journalists to discover the theoretical underpinnings of the construction of medical knowledge.
To become familiar with some major writers in philosophy and history of medicine.
Š the philosophical and intellectual underpinnings of medical knowledge
Š the concept and utility of theory.
Š how the business of medical epistemology is the construction of disease.
Š how diseases are/have been/can be empirically, constructed socially, scientifically, and theoretically.
Š how and why changes occur/have occurred in dominant theories of disease.
Š the historical context of health care and the origins of the medical model in the late twentieth century.
To be able to use the theories of disease as tools in the analysis of primary sources.
Classes will be discussions based on prior reading of texts. Regular preparation of "focus notes" on disease concepts will facilitate learning (see p. 2).
REQUIRED primary source texts
Photocopied readings course pack (CP) available at Campus Bookstore
RECOMMENDED secondary source texts (available in library and bookstore)
Jacalyn Duffin, History of Medicine: A Scandalously Short Introduction, 2nd ed., U of Toronto Press, 2010. (hereinafter Duffin, 2010)
Jacalyn Duffin, Lovers and Livers: Disease Concepts in History, U of Toronto Press, 2005. (hereinafter Duffin, 2005) – especially Chapter 1.
Three in-class Tests (5 + 15 +15 = 35%):
Sep 29 (5%); Oct 25 (15 %) and Nov 10 (15%)
To be marked by TA. All complaints to Duffin.
- may include short answer, matching, multiple choice, or fill in the blank
- may invite identification and discussion of texts studied in class and their relationship
- may invite short definitions and discussion of a choice of key concepts to the course
- may invite an analysis of an “unseen” text not discussed in class
- may invite analysis of an image
Essay proposal Due 1 Nov. (5%) 1 page (max). To be marked by Duffin.
Outline of essay indicating topic, proposed method of analysis, and a few preliminary sources (ie bibliography both primary and secondary sources). You do NOT have to have done the work yet, but you need a topic and you need to have identified some sources for future reading.
Essay Due 29 Nov. (30 %) 5 to 10 p. (max.), printed on paper, double spaced, 12 pt font!!
To be marked by Duffin and mostly TA
See further information on website: How to write an essay for Phil 201:
Lateness Penalty for Essay 1 mark per day up to ten days, then zero.
Exam Date to be announced (30%) Old exams are available.
"Focus note" suggested format for PHIL 201 classes re. any disease concept
Try to write one of these for each class based on the assigned texts according to the headings below. If a disease is mentioned, think about it in the following ways:
Cause: was there any? was it important?
Characteristics and nature: were there any characteristics? what? were they important?were there types of disease? (classification)
Symptoms and signs: What were they, if any?
Diagnosis: names of disease. relationship to characteristics? Was it important?
Prognosis: predicted outcome of disease. Was it important?
Treatment: did the nature of the disease define a route of therapy?
Theories: general questions: was disease bad? or good?
individual? or collective?
discontinuous? or always present?
did it come from inside? or outside the sufferer?
This focus note task is a way of organizing your thoughts and will help you to deal with (and dispense with) terms that may be neither familiar nor important so that you can focus on the notions that are relevant for the discussion.
Words to understand (there will be others along the way)
disease - illness
symptom - sign - nosology
diagnosis - prognosis
specificity - sensitivity
mechanism - vitalism
induction - deduction
causes - Aristotle's four types; Paracelsus 5 types
Disease theories to know:
ontological theory - vs - physiological theory
organismic theory - vs - non-organismic (ecological?) theory
CLUES: Article by Risse (in Handout) for late in course offers a useful overview of some of the concepts to be discussed in class.
See also Duffin, History, 2010, Chapter 4; and Duffin, Lovers, 2005, Chapter 1
Week 1a-Sep. 13: Introduction to concepts of disease - the Disease Game.
Even if we have never seen someone with a certain disease, we have ideas about it. Where do these ideas come from? How do they operate in our society? Are there any features common to all diseases?
Week 1b-Sep. 15: Disease as supernatural: Write focus notes on the diseases described in Homer and in the Book of Job. Is one aspect of the disease description more important than others? Are there any of these ideas pertinent to diseases in our society? What is the meaning of the rules set out in Leviticus? What do they tell us about disease?
Homer, Iliad (CP)
Bible, Old Testament, Leviticus, Exodus, Deuteronomy, Job (CP)
Duffin, 2010, 69-71
Week 2a-Sep. 20: Disease as natural and/or imbalance: Write a focus note on Hippocrates' "Sacred disease." How does the description of this disease differ from that in Homer and in Job? What is a sign? a symptom? What is the difference between illness and disease? How can a disease be "physiological"?
Hippocrates, Oath, Aphorisms, Prognostic, Cases (CP)
Hippocrates, Sacred disease (CP)
Schema of four humours (CP)
Potter, on Hippocratic theory (CP)
Duffin, 2010, 40-45, 71-73
Week 2b-Sep. 22: The plague of Athens. From Thucydides’s account write a focus note on the plague of Athens. Was this disease new? What might Plato (born c. 429 BC) have said about this disease, if he had witnessed it? How can a disease be "new" according to Plutarch?
Plutarch, Table-Talk, Moralia (CP)
Plato, Symposium, Timaeus, Republic (CP)
Thucydides, "Plague of Athens" (CP)
Duffin, 2010, 163-64
Week 3a-Sep. 27: Disease, the soul and purpose. Think about the significance of "purpose" in these writings. What does "teleology" mean? What are the types of causes in Aristotle's writings. Try to think of examples of these causes in terms of disease. What is soul for these writers? Why do you think the writings of Galen and Aristotle were favoured by the Christian church?
Galen, cases (CP)
Galen, On the Natural Faculties (CP)
Aristotle, "On Respiration," Animals, Metaphysics, On the Soul (CP)
Duffin, 2010, 40-45, 102-4
Week 3b-Sep. 29: Illness as Christian suffering. Write a focus note on the disease described by Hildegard. What are the implications of Abelard's statements for disease? What does this mean for medicine? Who was Luke? What concepts of disease are operating in the New Testament readings?
Bible, New Testament, Matthew, Luke, Corinthians (CP)
Abelard, Introduc. ad Theologiam III (CP)
Hildegard von Bingen, cited by C. Singer (CP)
Test #1 -a short in-class quiz (5%)
Week 4a-Oct. 4: The Black Death. What are some of the historical implications of the Black Death? Write a focus note on the Black Death from an historical perspective. What is happening in the reading from Boccaccio? Why?
map (CP) and paragraph from Hudson, Disease and Its Control (CP)
Nohl Plague readings from (CP)
Boccaccio, Decameron (CP)
Duffin, 2010, 164-8
Week 4b-Oct. 6: Syphilis, contagium vivum, and anatomy. Write a focus note on syphilis based on Fracastor's account. What is the significance of living contagion? Compare the title pages and human figures of pre-and post Vesalian anatomies. What is the significance of Vesalius' work for medicine?
Fracastor, De Contagione and the French Disease (CP)
Duffin, 2010, 20-32, 168-72
Week 5a-Oct. 11: Thanksgiving
Week 5b-Oct. 13: Ontology: Disease, a being (ens) from the outside: What was new about Paracelsus? What does "ontology" mean? How can diseases be entities? What are the "ens" of Paracelsus?
Paracelsus, selections from Clendening and Jacobi (CP)
Duffin, 2010, 106-7
Week 6a-Oct. 18: Physics, chemistry, and the body. What are the meanings of "mechanism" and "vitalism" and how do they differ? Which applies to Harvey? What are the implications of the reading from Descartes, Hoffman, and Stahl with regard to disease?
Descartes, Discourse on Method and Meditations (CP)
Harvey, De motu cordis (CP)
Newton, Principia mathematica (CP)
Hoffman, Fundamenta medicina (CP)
Stahl, cited by J. Roger (CP)
Duffin, 2010, 45-50
Week 6b-Oct. 20: Classification of Disease: Symptoms, Nosology, and Sensualism. How did Locke and Hobbes believe knowledge is obtained?How did Cullen and Pinel apply this to their classification of diseases? What was the purpose and the meaning of the disease classification tables?
Sydenham on gout (CP)
Hobbes, Leviathan (CP)
Locke, Essay Concerning Human Understanding (CP)
Cullen, First Lines and Nosologia methodica(CP)
Pinel, Nosographie philosophique (CP)
Duffin, 2010, 73-76
Week 7a-Oct. 25: In Class Test #2 (15%) DUFFIN AWAY at Yale
Week 7b-Oct. 27 Positive medicine: Disease as localised physical lesion. What is Comte's agenda? How does the work of Auenbrugger and Laennec relate to it? How does it compare with the concerns of Sydenham? Write a focus note on tuberculosis according to Laennec. What is positivism?
Comte, Positive Philosophy (CP)
Auenbrugger, Inventum Novum(CP)
Laennec, Treatise on Diseases (CP)
Duffin 50-56, 76-81, 221-230
Week 8a-Nov 1: ESSAY PROPOSAL DUE (5%) Duffin will mark
Disease as numbers: Write focus notes on tuberculosis according to Louis, cholera according to Snow, and childbed fever according to Semmelweis. What are the advantages (if any) of statistics for diagnosis, prognosis, and individual illness? Can you think of a non-organismic view of any modern disease?
Louis, On Phthisis (CP)
Snow, On the Broad Street Pump (CP)
Semmelweis, On Childbed Fever (CP)
Carter, On Semmelweis (CP)
Duffin, 2010, 173-77, 290-92
Week 8b-Nov. 3: The Birth (and Proliferation) of the Clinic. Write a focus note on tuberculosis according to Koch. What are the implications of the germ theory for the ontological view of disease? How did Pasteur believe rabies could be prevented? What are the implications of immunity for the physiological view of disease?
Foucault, Birth of the Clinic (CP)
Duffin, 2010, 81-87, 112-14
Week 9a-Nov. 8: Disease resistance, disease label, the internal sign. What is reductionism? Write a focus note on syphilis according to the Wasserman test. What are the advantages of such a test for diagnosis? for the individual patient? What is meant by a false positive and a false negative sign? "specificity" and "sensitivity"? How do specificity and sensitivity enter into the significance of lab tests?
Shaw, Doctors' Dilemma (CP)
Fleck, Genesis and Development of a Scientific Fact (CP)
On the Wasserman test, Stedman's dictionary (CP)
Week 9b-Nov.10: TEST #3 (15%) in-class DUFFIN AWAY at McMaster
Week 10a-Nov. 15: Disease from within, physiology strikes back. Write a focus note on trisomy 21 according to Lejeune. What are the advantages of his discovery? Are there any disadvantages? How do statistics relate to Dausset's work? What are its implications for the physiological view of disease?
J. Lejeune, 21 Trisomy (CP)
J. Dausset, HLA and Disease (CP)
Duffin, 2010, 88-92
Week 10b-Nov. 17: Disease as ecology and the social construction. Can disease been defined in populations? How do we "create" or "construct" diseases? Apply the theory of social construction (Duffin) to the essay ‘Osteodensosis’ (Duffin). Analyze the images and claims in the drug advertisements. Try to apply the course concepts to the diseases described.
Dubos, Man Adapting (CP)
Duffin, on social construction and ‘Osteodensosis’ (CP)
Duffin, 2010, 168-73, 398-99, 408-13
Week 11a-Nov. 22: Concepts of Disease. How did Cousins recover from his illness? What are the implications for concepts of disease? What are endorphins? How do they relate to mechanistic and vitalistic concepts of life and disease? Risse offers an overview of some of the concepts already discussed.
Cousins, Anatomy of an Illness (CP)
on the word Hormone (CP)
Wikipedia on endorphins (CP)
Risse, “Health and Disease a History of the Concepts” (CP)
Duffin, 2010, 88-97
Week 11b-Nov. 24: Cancer and Disease Concepts. Read 4 of the 6 below. Write focus notes on cancer according to each of the different authors in today's readings. Try to delineate which theories of disease are operating. ie how do these different views of cancer relate to each other and to the course? Are they all the same? Are there any throwbacks to ancient theories?
Sontag, Illness as Metaphor (CP)
Harrison's textbook on cancer of the ovary and testis (CP)
Gotthard Booth, Cancer Epidemic (CP)
Trillin, “Of dragons and garden peas” (CP)
BC Cancer Control on Simonton Method (CP)
*Distribution of readings for week 12a
Week 12a-Nov 29: ESSAY DUE
AIDS and Disease Concepts
MMWR 1981: "Pneumocystis" and "Kaposi's sarcoma" (CP)
Barbara Amiel in Maclean’s magazine (CP)
Random readings selected by individual students in week 12a
Duffin, 2010, 187-90
*Class will consist of presentation and discussion of students' focus notes of the above and the readings distributed in class 11b.
Week 12b-Dec. 1: Review. Bring your questions and problems to class.
Reviewing for exam?
See Risse in (CP), Duffin, History, 2010, Chap. 4, 65-97; Duffin, Lovers, 2005, Chapter 1