Lec 6- Plagues

1. Do no harm to the patient
2. Keep patient confidentiality
3. Do not administer a poison, if asked do not give women instrument to procure an abortion
4. avoid in property corruption or seduction
5. Don’t perform surgery, leave it to surgeons

- as a result of the Nuremberg trials

1. Voluntary consent (free of forcing, well informed) of a patient
- Hippocratic oath spoke more to value system of the doctor
- this is more focused on the patients rights
- because of experiments during wartimes
2. Any experiment that is conducted must yield fruitful results
3. The experiment/treatment must be based on animal experimentation
- divide in value of animals vs. human life
4. Avoid all physical and mental injury
5. Avoid death or disabling injury
6. The degree of risk shouldn’t be greater than the important of the experiment
- how do you measure this?
7. Must put into place proper preparation to protect the subject
8. Experiment to be conducted only by scientifically qualified persons
9. Subject must be free to end treatment/experiment at any time
10. The doctor or scientist in charge must terminate if believed it could harm the patient / subject

- as a result of Nuremberg code person is given much autonomy as the doctor or scientist
- One issue: the political, social, economic, cultural content of the research
- Need social justice agenda when doing experimentation
- Economic imbalance: those people may be more willing

- herbs in the beak were thought to protect doctor from getting plague
- cut down on smell of infected bodies

a widely prevalent and rapidly spreading infection
- sudden outbreak of infection

epidemic that becomes very wide spread and infects large numbers
- region, country, world

degrees of infection that always present in a population but in a low grade

effects all classes in the same way
- doctors cant find cures, they lose divine power: so does god
- people lose faith

- might not understand true nature because busy blaming who’s fault it is
- blame on sins

- ex: sinners, jews caused the plague, Africans, Mexicans for the swine
- ALL of these people are:
- minorities
- lower in social class
- migrants or foreigners
- coming from the outside
- the plague is never from within but from the outside
- Ex: sars from asia, H1N1= Mexican flu, AIDs= Africa

4. When there is evidence of a plague, societies attempt to deal with plague by geographical or legal controls over populations

5. Social conditions create or exacerbate the spread of infection. Social determinates of health

people will be seen as innocent or guilty
ex: gonorrhea: babies= innocent, prostitutes= guilty
- HC workers will often respond negatively comparing these situations

- we in the west concerned with:
influenza
new outbreaks
STI
Scarry diseases: maybe 1 person will get sick
In reality: malaria kills way more people

1. The plague of Athens 430BC
2. The bubonic plague → the great dying, the black death 1347-1352

- large # of deaths → including ruler

- symptoms were the appearance of buboes (armpit and groin, would swell and skin turned black and would die)
- blamed on ships coming to Europe from Asia
- constellation of Aquarius
- priests to corrupt
- jews, strangers etc. witches

Actual Cause
- fleas would infect rats, and jumped unto humans → bacterium
- *speculation

birth to plague Tractate (literature about the plague)
- famous: the decameron
- 10 stories about the plague a record

1 third of European population dies
- despite quarantine efforts
- -comes from French word 40 days
- person would no longer infect
- Ripple effects
o Breakdown of divine
o Medical profession
o Decline in agriculture
o Massive decline in economy

- Leprosy
- Cholera
- Typhus
- Small pox
- Tuber sclerosis
- Influenza

- all themes the same, but one more
- people act differently when it is related to sex or sexuality

- moral meaning of plagues eventually got neutralized when not of sexual origin
- BUT when they are, it stays at top of concern
- “different” more deviant infection

- Syphilis
- Chancroid
- Gonorrhea

caused by Treponema pallidum
- attacks mucous membranes
- 1. First stage-→ sore chancre → genitals, small and heals quick
- 2. Second Stage→ rash, hands and feet, fever, muscle aches
- if untreated: 3. Third stage: lateral pahse → dormant →can take years
- brain, nerve, eyes, ears, joints, paralysis, dementia, death
Congenital Syphilis
- passed on to children→ miscarriage, still bitch
- developmentally delayed: all over rash, damage to eyes, brains, teeth, ears

Neisseria gonorrhoea
- loves mucous membranes
- discharge of pus from genitals
- burning while urination
- if untreated causes :infection that leads to infertility
- put silver nitrate in infants eyes
- incase of asymptomatic

- mucous membranes
- 1st sign: ulcer or sore on genitals, swollen lymph glands, can rupture, very painful
- not congenital

= contagious, need fast treatment
- thought to be from outside
- Spanish pox
- French decease
- African lethargy

1. Associated first with prostitutes, immigrants, minorities
2. Mediate contagion: can be transmitted though inanimate object
3. Diagnosis and treatment were shaky
4. constant concern about the effect of VD on the family, nation and race

no cure→ treatments intense

- based on laws that attempted to prevent contagious diseases in cattle
- try ot prevent VD from spreading by arresting prostitutes:
o any women suspects
o no proof
o she would be confined
o forced into gynological exam
o quarantine, treated,
o men were free
o nobody thought men had diseases
Irony: Diagnosis and treatment shaky. Many people are asymptomatic

medical, legal, moral

1500: animal intestines, fine linen, sheep
1800s invention of rubber
1920s invention of latex
Condoms also associated with prostitutes
- negative views
- not easy, uncomfortable, cleaned and reused

Medical Treatments → mercury→ apply or swallow
- Sulpha drugs

1940’s Penicillin = Cure
- Penicillin in 1920’s → effective against wounds
- VD clears up = cure

social hygiene

- religious, leaders, doctors, politicians, encouraged to preach abstinence
WI and WII very popular campaigns
- do you want soldiers to get infected?

typhoid mary