Thomas Sydenham (1624-89)stated “As for anatomy, my butcher can dissect a joint full and well; no youngman … you must go to the bedside, it is there alone that you can learn disease” (Dobson, 2013, p.63) This means that the relationshipbetween the doctor and the patient is extremely important because if thepatient’s opinion isn’t taken into consideration then that will have a negativeimpact on the medical treatment of the patient. Therefore, the ‘Patient knowsbest’ approach is when the doctors treat a patient based on what the patientknows about their symptoms. They treated the symptoms instead of the cause.
This evolved into the 18thand 19th centuries as more research was being carried out anddoctors had more knowledge but still nowhere near as today, this was the timewhere doctors and patients had very little knowledge on disease and illness.For example, they believed that illness was caused by bad smells, also known as’Miasma’. (Fielding et al 2017, p.1) During this time the ‘Patient Knows Best’approach was used in the medical treatments of patients because the patientcame in with symptoms and the doctors would treat them based on their symptoms beinggiven, without needing evidence. This resulted in miss-diagnosis and medicalerrors. To summarise, the ‘Patientknows best’ approach effected medical treatment because the majority ofpatients were upper class and had more authority because they were wealthy, thedoctors acted in a way that was aimed at pleasing the patient rather thanactually helping them.
The doctors felt like they did not need to physicallyexamine the patient but to just listen to what they had to say instead, theytreated the symptoms of the patient rather than the cause. Most of the doctorsfelt like they had to compete with each other to please the patient because oftheir patient’s social status. The patients were paying to see a doctor,therefore they had no respect for the professionals.
Also, there were nolegislations in these times for people to purchase medication freely so peopletended feel responsible and in control of their own health. (R. Kaba, P.Sooriakumaran (2007) ‘The Evolution of the Doctor-Patient Relationship’ Doctor-patient relationship from 1700 topresent day p.59)In these times, the fourhumours were the basis of treating illness and these were known to the patientand the doctors.
If a patient was showing any of the following humours thenthey knew that they needed to be treated. The four humours consisted of blackbile, yellow bile, phlegm and blood. However, being able to see doctors was aluxury for the privileged and wealthy, so the poor and middle-class people ofthe community had to resort to quakes, barber surgeons and home remediesbecause they couldn’t afford to see a qualified doctor. To save money, they hadto self-diagnose or rely on people that were not as sanitary or had littleknowledge on the subject which was why the death rate in the 18thand 19th centuries were so high and people were dying a lot youngerthan they are today because of the lack of knowledge and the way in which thedoctors and the patients had the same amount of knowledge.Dissection has changed the wayin which modern medicine is led over time. For example in the 15th-17thcentury’s cadaveric dissection was the most popular method. The advantages ofthis method includes that it was able to teach medical students about the humananatomy through practical demonstration.
However, these demonstrations werestarting to become public, therefore breeching any ethical barriers such aspatient confidentiality. In 1543, Andreas Vesalius (with the help GemmaPhrysius) dissected stolen bodies from graveyards and snatched the bodies ofcriminals that had been hung. He proceeded to conduct a public dissection,where he donated the skeleton to Basel University so that medical studentscould learn about the human anatomy. The advantages include that he provided informationand resources for medical students and that he was able to identify where mainorgans such as the heart, lungs and liver were. On the other hand, thedisadvantages include that the way in which he was doing this was unethical andhe had no respect for the bodies that he was taking. In those times, there wereno laws or legislations in place for the respect of bodies and patientconfidentiality so people did not have the same reaction as people would today.From Vesalius, anatomy theatres were becoming more popular and more people werecarrying out public dissections.
(Dobson, 2013, p.31) Another case includes the WilliamBurke and Hare murders in Edinburgh which happened in 1827-1828. (Johnson, B,2017 p.1)These two men would steal bodies from graves and sell them to medicalschools so that they could use them to dissect and learn.
The more recent thebody was buried, the more money it was worth. When there were a shortage ofbodies, they would then resort to murder. They murdered at least sixteenpeople. These murders then led to the Anatomy Act 1832. Due to this Act,anatomy lecturers, medical students and doctors were allowed greater access tobodies and it also allowed bodies to be legally donated to medical science. Thisprotected graves from body snatchers because that was now illegal. (Brine, R.
2009. p.1)During this time, surgeons andhospital based professionals did not require many qualifications or training,as dissection was being further discovered and more research into the humananatomy was being carried out, this was about to change. In 1822, summercourses were no longer accepted as a qualification to be able to be acceptedinto the Royal College of Surgeons.
(McLachlan, J. and Patten, D. 2006. p.243) Dissectiondid not need to be in a clean environment and the surgeons often did not weargloves or any protective clothing/equipment because in those times, they hadlittle knowledge on the subject.