Doctoral Dissertation Improvement Grant: Sociocultural Factors Affecting Medical Constructs of the Consumptive in Nineteenth-Century Scotland

在Jane E.Buikstra博士的指导下，人类学研究生艾米·W·法恩巴赫将研究社会和文化因素如何塑造对疾病的理解和治疗。她将在苏格兰进行她的研究，苏格兰是现代西方医学思想发展的关键环境。范巴赫女士将使用19世纪的档案记录来调查人们对结核病(TB)的医学理解，以及对结核病患者的不同治疗。这项研究将包括19世纪在格拉斯哥、爱丁堡、邓迪及其周边地区运营的29家医疗机构的患者病历和其他文件。利用这一丰富的语料库，研究人员将解决两个主要的研究问题。首先，患者的社会类别和不断变化的结核病医学知识如何影响医生对这种疾病的看法？其次，在19世纪的苏格兰，医生用什么指标来诊断消费，这些指标的一致性如何？为了回答第一个问题，她将分析患者记录和医务人员之间的讨论录音，以确定医生是将男性和女性的结核病归因于不同的原因，还是以不同的方式对待工薪阶层和地位更高的结核病患者。对于第二个问题，研究人员将对病历中被诊断为结核病、消费等疾病的病例记录的临床指标进行卡方分析，以检验“消费”是有严格的临床定义，还是被较为宽松的诊断。在十九世纪，结核病影响了数量惊人的生命。尽管自20世纪中叶以来就有抗生素治疗，但即使在今天，这种疾病在世界范围内仍然很常见，很大程度上是因为许多患有这种疾病的人没有得到治疗。虽然众所周知，医生对结核病患者的态度可能会影响患者是否寻求并遵守医疗治疗，但这是如何发挥作用的，人们却知之甚少。本研究将有助于社会科学对影响医疗实践的非科学因素的理解。它还将通过研究结核病和结核病患者的历史根源，帮助澄清当代西方医学对结核病和结核病患者的假设。

Under the supervision of Dr. Jane E. Buikstra, anthropology graduate student Amy W. Farnbach will investigate how the understanding and treatment of disease is shaped by social and cultural factors. She will conduct her research in Scotland, a critical setting for the development of modern western medical ideas. Ms. Farnbach will use nineteenth-century archival records to investigate medical understanding of tuberculosis (TB), then known as consumption, and the variable treatment of TB patients. The study will include patient medical records and other documents from twenty-nine medical institutions operating during the nineteenth century in Glasgow, Edinburgh, Dundee, and their surrounding areas. Using this rich corpus of materials, the researcher will address two major research questions. First, how did patient social categories and changing medical knowledge of TB affect doctors' ideas about the disease? Second, what indicators did doctors use to diagnose consumption in nineteenth-century Scotland, and how consistent were those indicators? To address the first question, she will analyze patient records and recorded discussions among medical personnel to determine whether doctors attributed men's and women's TB to different causes, or approached working-class and higher-status TB patients differently. For the second question, the researcher will undertake chi-square analysis of the clinical indicators recorded in cases diagnosed as TB, consumption, and other diseases in patient records, to test whether "consumption" had a strict clinical definition or was more loosely diagnosed. During the nineteenth century, TB affected a staggering number of lives. Even today and despite antibiotic treatments available since the mid-twentieth century, the disease remains common worldwide in large part because many with the disease go untreated. While it is known doctors' attitudes toward TB patients are likely to affect whether patients seek and comply with medical treatment, how this works is poorly understood. This research will contribute to social science understanding of the non-scientific factors that affect medical practice. It also will help to clarify contemporary western medical assumptions about TB and TB patients by examining their historical roots.