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Cover image of Epidemics in Western Society Since 1600 - Audio

Epidemics in Western Society Since 1600 - Audio

Epidemics in Western Society Since 1600 - Audio

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21 - The Tuskegee Experiment

The Tuskegee Syphilis Study, carried out in Macon, Alabama, from 1932 to 1972, is a notorious episode in the checkered history of medical experimentation. In one of the most economically disadvantaged parts of the U.S., researchers deceived a group of 399 black male syphilitics into participating in a study with no therapeutic value. These "volunteers" were not treated as patients, but rather as experimental subjects, or walking cadavers. Even after the development of penicillin, the Tuskegee group was denied effective treatment. Despite regularly published scholarly articles, forty years passed before there was any protest in the medical community. The aftereffects of the study, along with the suffering of its victims, include a series of congressional investigations, the drafting of medical ethics guidelines, and the establishment of independent review boards.

51mins

30 Mar 2011

Rank #1

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19 - Tuberculosis (II): After Robert Koch

The cultural transition from the romantic era of consumption to the era of tuberculosis derived not only from the germ theory of disease and the triumph of contagionism over anticontagionism, but also from political considerations. Worries over population decline and growing working-class militancy were aggravated by what now appeared to be a social disease, or a disease of poverty. One of the strategies deployed against the disease was the sanatorium, an institution which was capable both of instructing patients in contagionism and in imposing a practical quarantine. Although the development of effective chemotherapy in the 1940s raised hopes that tuberculosis might be globally eradicated, these have unfortunately proven to be overly optimistic. Factors such as poverty and population displacement continue to favor the disease's spread today, particularly in the Third World.

49mins

30 Mar 2011

Rank #2

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20 - Pandemic Influenza

Reliable records of influenza, dating back to the 1700s, suggest a pattern of one major pandemic every century. Among the pandemics for which there is solid documentary evidence, the outbreak of 1918-1920 is by far the greatest. The so-called Spanish Lady caused somewhere between 25 and 100 million deaths worldwide. It is distinctive both for its high mortality rate, in comparison to other flu pandemics, and for its unusual demographic effect: whereas the flu typically targets the very young and old, the 1918-1920 epidemic struck adults in the prime of life. Without a cure for the disease, public health authorities today are in a position to learn from the successes and failures of the early-twentieth-century response.

50mins

30 Mar 2011

Rank #3

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18 - Tuberculosis (I): The Era of Consumption

An ancient disease, tuberculosis experienced a major upsurge in Western Europe in the nineteenth century, corresponding with increasing industrialization and urbanization. Poor air quality and cramped living conditions increased susceptibility to the disease. Tuberculosis also had a significant impact on European culture. In this respect, the modern career of the disease can be divided into two eras: the first associated with artistic romanticism and the idealized image of the beautiful and brilliant consumptive, the second, following the germ theory of disease, linking tuberculosis with social fears of poverty and contagion.

48mins

30 Mar 2011

Rank #4

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17 - Malaria (II): The Global Challenge

In the last decade of the nineteenth century, malariology emerged as the most prestigious and intellectually exciting field in the new discipline of tropical medicine. The disease's complexity and resistance to conventional public health strategies posed a major challenge to doctors and scientists. Plague measures and social hygiene had no effect in curbing malaria, and the disease proved difficult to classify. The case of Italy, and the malaria eradication program of 1900-1962, furnished a model for other efforts across the world. In evaluating the Italian campaign, it is important to distinguish between valuable lessons and warnings for future efforts, and in particular to account for the diversity of strategies responsible for its success.

46mins

30 Mar 2011

Rank #5

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16 - Malaria (I): The Case of Italy

Of all the diseases studied in this course, malaria has been responsible for the most human suffering. It has evolved alongside humans, and impacted human biology as well as civilization. In the former case, this impact is evident in genetic diseases like sickle-cell anemia which, while increasing vulnerability to a host of other illnesses, has the advantage of conferring substantial resistance to malaria. In social terms, malaria's debilitating sequelae have resulted in a reciprocal cycle of poverty and infection, low productivity and the desertion of profitable land weakening societies' ability to combat the disease and ultimately reinforcing a division between the global North (where malaria was eradicated following the Second World War) and the South, where the disease persists.

49mins

30 Mar 2011

Rank #6

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15 - Tropical Medicine as a Discipline

The sub-discipline of tropical medicine furnishes a clear example of the socially constructed character of medical knowledge. Tropical diseases first enter medical discourse as a unique conceptual field and topic for specialization at the end of the 19th century, and the heyday of tropical medicine - from the 1890s to the First World War - corresponds to the golden age of Western colonialism in Africa and Asia. This correspondence was not accidental; tropical medicine both gave practical aid to colonial powers faced with unfamiliar disease environments and furnished a deeply Eurocentric view of disease well-suited to the ideology of colonial expansion. As a consequence of this approach, little attention was given to the social factors of disease (work conditions, poverty, malnutrition), and the health of native populations was largely ignored. Subsequent periods of research in tropical medicine have, with decolonization and infusions of money from American foundations, been obliged to confront the consequences stemming from the discipline's formation as an instrument of colonial subjugation.

46mins

30 Mar 2011

Rank #7

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14 - The Germ Theory of Disease

Although the development of the germ theory of disease in the latter half of the nineteenth century marks a major revolution in medical science, comparable to the discoveries of Galileo in astronomy or Darwin in biology, it cannot be reduced to the heroic efforts of a single researcher or group of researchers. Rather, a number of conceptual, technological and institutional preconditions made the germ theory possible. Among these, contagionism, microscopy and hospital medicine all played a major role. The germ theory of disease facilitated a wide range of scientific advances, including the isolation of pathogens, the creation of vaccines and the introduction of antiseptics in surgery.

49mins

30 Mar 2011

Rank #8

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13 - Contagionism and Anticontagionism

The debate between contagionists and anticontagionists over the transmission of infectious diseases played a major role in nineteenth-century medical discourse. On the one side were those who believed that diseases could be spread by infected material, perhaps including people and inanimate objects, and on the other those who subscribed to the more venerable miasmatic theory. Although the contagionist view would be substantially vindicated by Robert Koch's germ theory of disease, it is important not to simply ignore the arguments put forward by the anticontagionists. Although these were based on science that has since been disproven, the concrete proposals put forward by scientists like Max von Pettenkofer marked a major step forward for public health policy. In particular, the anticontagionists' emphasis on the environmental factors of disease control continues to provide an important lesson.

49mins

30 Mar 2011

Rank #9

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12 - Syphilis: From the "Great Pox" to the Modern Version

There is a longstanding debate over the origins of syphilis, in which arguments over how the disease arrived in Europe have historically been linked to racist and xenophobic ideologies as well as to scientific and historical research. Whatever its provenance, the major syphilis epidemic of the late sixteenth and early seventeenth centuries spread in the train of war, alongside Charles VIII of France's armies. Syphilis was distinguished both by its catholicity, targeting kings as well as paupers, and its mode of transmission. The disease's evident contagiousness served both as grist for a religious interpretation, emphasizing asceticism and divine punishment, and as a major challenge to the humoral theory of disease.

49mins

30 Mar 2011

Rank #10