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

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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.