Professor Peter Vinten-Johansen
Tara Dosumu-Birr, teaching assistant

American and European Health Care Since 1800

HST/LBS 425 is designed as an introduction to the intellectual and cultural history of medicine, health, and disease. This historical approach features socio-cultural interpretations of ideas — in this course, medical knowledge developed over several centuries within what is often termed a western worldview, particularly in the United States and the United Kingdom. We will focus on the following themes:

         1. Historical continuities and changes in four medical/health care perspectives (humoral, biomedical, alternative, and evolutionary).
         2. Interactions among lay persons and professionals in selected medical-practice sectors.
         3. Biological and socio-cultural constructions of disease, illness, and health.
         4. “Anthropological strangeness” and its application to health beliefs and systems.
         5. Comparisons of selected health care systems and managed care in North American and Western Europe.
         6. Case studies of conflicts between notions of personal liberty and social justice in public health.

Our substantive course objective is that all students will demonstrate increasing understanding of these six course themes as they emerge in course readings, mini-lectures, and class discussions.

Required Reading

The following paperback texts are available at local booksellers:

 DEFOE, D. Journal of the Plague Year (1722; Penguin, 1986)
 HILLERMAN, T.  Sacred Clowns (Harper, 1993)
 JONES, J. H.  Bad Blood, 2nd ed.  (Free Press, 1992)
 LEAVITT, J. W.   Typhoid Mary (Random, 1996)
 NESSE, R. & G. WILLIAMS Why We Get Sick (Random, 1994)
 ROSENBERG, C. Cholera Years (Chicago, 1987)
 ROTHMAN, S. Living in the Shadow of Death (Johns Hopkins, 1995)
 RYAN, F. Virus X (Little, Brown, 1998)
 SEALE, C. & S. PATTISON Medical Knowledge: Doubt and Certainty, 2nd ed.
         (Open University, 1994)

In lieu of a costly course-pack, we are placing selected items on the course internet site, http://coursesa.matrix.msu.edu/~hst425.  Please note that all internet items noted in the schedule of assignments are required reading, unless you receive instructions to the contrary; readings still under copyright can only be accessed via a password.

Honors Option

Read two plays by Molière: “A Doctor in Spite of Himself,” and “The Imaginary Invalid.” Write a 5-7 page essay in which you compare (includes similarities and differences) concepts of health and disease in Molière’s plays and Defoe’s Journal of the Plague Year; essay is due no later than 4:45 p.m. on 25 April 2003. All who intend to complete an Honors Option in this course must inform the instructor, in writing, by 26 February 2003. We will then arrange at least one meeting outside of normal class hours to discuss the plays and essay expectations. Please note: one does not have to be a member of the Honors College to pursue an Honors Option in a course.

General Course Expectations

Students are expected to prepare all readings assignments in the attached “Schedule” in advance of the listed class meeting. Critical reading worksheets are assigned for most texts (including the internet readings). Worksheets are designed to focus your attention on the authors’ arguments — basic information about the past, how something may have happened, and why it may have historical significance. Worksheet assignments are usually made on Wednesdays for the following week. We will distinguish, in advance, between passages you should read with care, since they will be featured in class and on the worksheets, versus passages you only need to scan for major themes.

HST/LBS 425 is not a conventional lecture class. Most class meetings will include mini-lectures, but normally extensive periods of time is used for discussion involving either the entire class or small groups. Each student is placed in a “basic group” of four or five. Everyone is responsible for preparing all required reading, although individuals may sometimes have primary responsibility for reading a portion of an assignment that others in your group will only scan. Everyone has collective responsibilities to the basic group and to the learning community composed of all class participants. Consequently, attendance in HST/LBS 425 is “an essential and intrinsic element of the educative process” (Academic Programs, General Information —  “Attendance”). Timely completion and discussion of critical reading worksheets and writing exercises directly affect your preparation and participation mark (50% of the preliminary course mark; see below). Since “attendance is necessary to the achievement of . . . course objectives” in this course, it constitutes “a valid consideration in determining the student’s grade” (Ibid.) according to university policy.

If you find yourself short of preparation time for a forthcoming class, your first priority should be a special assignment if you have one. Your entire group suffers if you are unprepared or absent. In addition, at least scan everything else that is due, returning to it at a later for a thorough read when you have more time. You will be a more informed participant if you have an overview of the entire assignment instead of having preparing only a portion of it with care. It is especially important in HST/LBS 425 not to skip class if you are unable to fully prepare an assignment. Someone’s notes can never reconstruct what happened in a course that incorporates as much discussion and group work as this one. If you find yourself in a situation where your preparation is incomplete, please inform the instructor before class begins. I only need to know that you will not be a full participant for the entire meeting — not why.

Satisfactory performance in HST/LBS 425 will require considerable preparation time. The university minimum for scheduled, average, outside-of-class preparation for any course is "two hours of study per contact hour" (Academic Programs, General Information — “Credits”).  Since this is a 400-level course, my assumption when I formulated reading and writing assignments was that you would spend, on average, at least three hours of preparation for every credit-hour, or approximately twelve hours per week.

HST/LBS 425 is designed to meet the university’s Tier-II writing requirement, which involves training in writing and revising typical of a particular discipline. Everyone will write (a) two historical essays in which you analyze common readings previously discussed in class — specific topics will be selected by the instructor; (b) a “skeletal essay” revision of the first essay; and (c), a skeletal essay on the evolutionary medicine unit. There will also be writing exercises during the preparatory phases for all four essays. Structurally these essays should conform to the following expectations for a “classical” historical essay: (1) an opening thesis-paragraph that begins with the assigned historical question, contains definitions and context necessary to clarify the question, and ends with a thesis statement — your interpretation of the texts with respect to the assigned question; (2) a logically organized and fully substantiated argument in support of your thesis; and (3) a concluding paragraph in which you recapitulate your argument. Grading criteria for the essays are attached to the syllabus.

Figuring the Preliminary Course Mark

50% for Preparation and Participation (P&P). Every student begins with a P&P mark of 4.0. To maintain this portion of the course mark, you must:

         1. Attend class in a regular and timely manner. You cannot participate unless you are present. Every student has one personal “cut,” if you need it. Additional absences reduce the P&P mark by 0.3 each. Three tardies/early departures equal one absence.

         2. Prepare assigned critical reading worksheets and writing exercises in advance of class and hand them in on time. Unless instructed otherwise, place all worksheets and exercises in your basic group folder before leaving class. The instructor will mark the exercises on a ?/?-minus system and return them to the group folders for you to retrieve at the next meeting. A ? means, in my judgment, that your work reflects sufficient preparation of the assignment for you to make constructive contributions to class discussion; a ?-minus means either that the preparation seems inadequate for constructive contributions or that you misunderstood what was expected. Any ?- worksheet should be redone and resubmitted within a week. Place revised work, with the ?-minus version attached, in the group folder. Missing worksheets or writing exercises, as well as unconverted  ?-minuses on worksheets and writing exercises, reduce your P&P mark by 0.2, each. Unless an agreement is worked out with me in advance, worksheets you complete more than a week after the due date should be placed in your processfolio for possible partial credit, which I will determine at the end of the semester.

         3. Maintain an organized processfolio of all reading worksheets and notes, writing exercises, and essays and essay drafts. Organize reading worksheets by authors. Keep writing exercises and essays separate from reading worksheets. Please bring your processfolio to all class meetings. Around mid-semester, you will receive a check-list of items that should be in your processfolios. Processfolios are due on April 25, the last day of classes. During the final review of the processfolios, I will assign a quality adjustment (between minus 1.0 and plus 1.0) to the preliminary P&P mark (using 1 and 2 above), based on the thoroughness of the items submitted during the semester, and your timeliness, or lack thereof, in submitting them.

25% for the two, 5-page historical essays, marked according to the attached grading criteria. An improvement factor will be used, if possible, in determining this mark; that is, if the mark on the second essay is higher, it will constitute 25% of the course mark. Otherwise, the first essay counts 10%, the second 15%.

15% for the skeletal essay revision of the 1st historical essay, including a thesis paragraph, one substantiating paragraph, and topic sentences with “clustered evidence” for rest of substantiation. A comprehensive revision is expected, not just a minor “repair” job. This skeletal essay is marked according to the attached grading criteria.

10% for a combined critical reading-interpretive writing project on the evolutionary medicine unit. The instructor will evaluate the worksheets; the teaching assistant will evaluate the writing exercises.

Figuring the Final Course Mark

An out-of-class assignment (to be distributed the week of 14 April) on Tony Hillerman’s novel, Sacred Clowns, is due at the beginning of our scheduled final examination period on Monday 28 April, 5:45 - 7:45. We will evaluate your work on this assignment to determine if your preliminary course mark should remain the same or be adjusted, either up or down, no more than 0.5.

Office Hours

Peter Vinten-Johansen
328 Morrill Hall
Tuesdays, 4 – 5:15, and by appointment
353-9417 (Morrill Hall)
332-3316 (home)

Tara Dosumu-Birr
328 Morrill Hall
Wednesdays, 11:45 – 1:45, and by appointment
353-9417 (Morrill Hall)
339-6532 (home)

Grading Criteria for Historical Essays

The grading criteria reflect how well you accomplish the expected format for interpretive, historical essays:  (1) an opening thesis paragraph containing an historical question, relevant historical context and definitions, and a thesis statement containing declarative (WHAT happened)  and explanatory (WHY significant) components that answer the initial question; (2) substantiating paragraphs that offer a logical explication of your thesis statement via use of complete topic sentences and analysis of supporting evidence; and (3) a concluding paragraph in which you recapitulate your thesis. Citations should be parenthetical--(author, page)--for all quotations and paraphrases. Attach a bibliographical list of all works cited in your essay.

Few essays fall entirely within one grade rubric.  Therefore, the final mark is often a composite of strengths and weaknesses from several rubrics.

        4.0   Thesis paragraph conforms to all expectations.  Substantiating paragraphs reflect a logical progression of the argument, including effective topic sentences. Sufficient evidence to substantiate the thesis statement. Proper use of syntax, grammar, and diction throughout the essay. No/very few proofreading errors.

        3.5 Thesis paragraph conforms to all expectations except that one component of the thesis statement is incomplete. Substantiation falls between expectations for a 3.0 and a 4.0.

        3.0   All four elements of the thesis paragraph are present. Thesis contains declarative and explanatory components, but both are either incomplete or unclear. Substantiating paragraphs have topic sentences with analytical potential (make connections to thesis statement and include causal explanations). Use of short quotations is the norm, but inconsistent. Promising but incomplete analysis of quotes and paraphrases; that is, the essay lacks evidence to fully explain the meaning and significance of the thesis statement. Stylistic problems, if any, do not obscure the argument. Proofreading errors may be present, but infrequent.

        2.5 All four elements of the thesis paragraph are present, but the thesis statement lacks one component. Substantiation falls between expectations for a 2.0 and a 3.0. Quotations present but generally unexplained and/or overuse of paraphrasing.

        2.0   Thesis paragraph contains a statement of intent rather than a thesis statement. Open-ended or vague topic sentences. Unclear or problematical organization of substantiating paragraphs. Majority of potential evidence is in the form of paraphrasing from assigned texts. Very little/no explanation of evidence. Stylistic problems occasionally obscure intended meaning.

        1.0  Paper on a topic drawn from the required course reading, but it doesn’t follow expectations for interpretive historical essays. Summation dominates paper. Stylistic problems often obscure intended meaning. No apparent proofreading.