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What the Doctor Ordered: Social Impacts of New Medical Knowledge 

The advance of modern medicine and public health comes at the cost of the fields becoming depersonalized with their increasing use of statistics and microbiology.

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James Burke ...
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The advance of modern medicine and public health comes at the cost of the fields becoming depersonalized with their increasing use of statistics and microbiology.

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30 April 1985 (UK)  »

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James Burke: And then Farr got a break. A local well started killing people.
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Aesculapian Authority.
29 October 2012 | by (Deming, New Mexico, USA) – See all my reviews

An historical description of how medicine changed in Europe from the application of nonsense on a one-to-one basis, to the impersonal and ubiquitous standard of measurement that it's become today. Everything is routinized. Universalism prevails. (I have my Medicare number somewhere in my wallet, probably next to my Social Security card.) Of all the episodes of this outstanding series, I think this is my favorite.

For one thing, I find it funnier than most. Here is James Burke describing how the development of anesthesia increased the death rate. (!) Ether is discovered. Surgeons had previously used invasive techniques -- surgery, probes, amputations, and what not -- sparingly. Why? Because "that HURT." Then, with a wide grin of demonic irony, Burke holds up a bottle of ether and says to the camera, "But not with anesthetic." Now surgeons could slice and dice patients at will, stick things into their orifices, painlessly. They could dig in with their unwashed hands and fingers. The patient was in no position to object or cry out because he was unconscious. But until Lister -- and for some time after -- the practitioners had no idea of what germs were, and the patient stood a good chance of dying.

Another reason is that this episode doesn't flit around quite as much as some of the others. It's almost a case study of the effects, identification, and finally the measures taken to prevent cholera. Cholera was one of those ill-understood infectious diseases of the 19th century that tended to wipe out millions of people, as it did in India. Read (or see) Charles Dickens' story, "Our Mutual Friend," for a vivid portrait of those who made a living picking garbage out of the Thames. "Mudlarks," as they were called.

The pathogen that produces cholera is found in drinking water and is passed on through human feces or things like, well, hands or laundry, that have become contaminated. It doesn't come from smelly air, as everyone thought in the 1840s. In London, it came from the Thames, into which raw sewage was flushed and which contaminated some nearby wells providing drinking water.

Cholera came to be controlled not by treatment but by measures taken in the area of epidemiology and public health. The death rate dropped when someone built a series of sewers that pumped human waste well out to sea instead of into local rivers. It was about thirty years ago that two kids fished a watermelon out of the Hudson River and came down with cholera. It wouldn't happen today because of pollution control. Today they catch sturgeon in the Hudson.

That single narrative thread -- the increasing understanding of cholera -- is really important. I used to show this film in a class on -- I think it was Social Problems or Medical Sociology. In any case, the central notion of cholera was something that students could hang onto. It provided a kind of handle that, usually, other episodes didn't. And, let's face it, getting sick and receiving medical treatment is something that concerns everyone, because we're all going to go through it, so it's a lot more personal that knowing why the planets maintain the orbits that they do.


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