BHMP – MEU

North Sumatera University

2013
Big Picture Bioethics
 Bioethics should be informed by
 Medicine
 Philosophy
 Medical sociology
 Medical anthropology
 Economics
 Political science
 History
Central questions in medicine
 Why is my patient sick?
 microbe / lesion
 lifestyle
 poverty
 SES and health
 politics

The history of medicine contains a vast tradition in

answering this question
History of Medicine
 History of disease
 History of civilization
 Epidemics (plague)
 Diseases of civilization (hypertension, obesity)
 History of human response to disease
 Herbal medicine (jamu)
 Healers
 Physicians
 History of medical knowledge; therapeutic
interventions
 History of the medical profession; medical care
I. History of Disease
 Improvement in health
 Nutrition
 Engineering
 Sewers
 Drinking water
 Food (nutrition, disease carriers)
 Conditions of work
 Living
 Medicine, physicians

 McKeown thesis
 Resource allocation
 How best to fight disease
 Medicine is not always the answer
II. Paradox of Medicine
1. SES and disease
 The poor carry the greatest disease burden

2. Health care: spending mostly on less serious diseases

of higher SES groups
II. Medicine / Pharmacy
 Trade, exchange, circulation
 Importance of Asia
 Arab and Chinese traders
 India
 China
 Indonesia
 Middle East
 A blending of traditions
 No East / West
 Jamu
 Bontius
 Rumphius
 Van Reede tot Drakensteyn
 Knowledge from the East taken
to the West
 Leyden: Boerhave
III. Medical
 Rudolf Virchow
response to disease
 Report on the Typhus
Epidemic in Upper Silesia,
1848
 Silesia: Polish inhabitants,
German control
 Recommendations:
Recommendations:
 Polish as official language
 Democratic self-government
 Separation of church and state
 Creation of agricultural cooperatives

 Birth of social medicine

1846
 Willem Bosch (founder of
Dokter Djawa school,
Batavia, 1851)
 1846, report of an epidemic
in central Java
 Poverty, forced cultivation
system
 Recommendation:
 Abolish culture system
 Train Indonesian physicians
 Trouble with governor-general
Turned to politics
• “I have the same responsibility towards the nation as I
have to my patients” 1851
The increase of Java’s population and the welfare of the Netherlands

• Public health
I made a special study of the STOVIA (the medical
school for the natives). After all, most of those
promoting the awakening of Asia were doctors, and
not lawyers as was the case in Europe. Perhaps the
movements for enlightenment in Europe were
motivated by the violation of people’s sense of justice.
In Asia the awakening was inflamed by the awareness
that society was sick and must be cured.

Pramoedya Ananta Toer, House of Glass [Vol. 4 or the

Buru Quartet], 1988.
 Tirto Adi Suryo
 Promise of modernity
 Western medicine, Western technology
 Method: journalism
 (Abdoel Moeis, Suwardi Suryaningrat)
 Soetomo
 Education
 Bank
 Unions
 Cipto Mangunkusumo
 Turn to politics
 Why?
 Plague eradication campaign
Malang
 Measures
 Against Indonesians
 No trouble for Belanda
 Medicine
 Disease
 Health
 Conditions of health
 Biological
 Social
 Political
 Conception of the good society
 Conception of the place of medicine in society
… more
 PERSEKIN: Perhimpunan Sejarah Kedoktoran
Indonesia (Indonesian Association of the History of
Medicine)
 2-5 July 2012: IAHA, Solo
 2-5 July 2012: HOMSEA (History of Medicine in SE
Asia), Solo