History of medicine
MEDICINE is a paradox: it is ancient; yet ever new. Its practice is an art; yet that art must be grounded on solid foundations of science, of practicality, and of the needs of the patient. It is one of the most important fields of scientific discipline; yet in practice it must employ and apply essential knowledge gleaned from many other fields of science. Medicine’s practitioners have at their command the epitomization of knowledge and discovery gained over fifty centuries; yet, they face a great wall of unknown factors as formidable as any faced by their predecessors – challenging, baffling, yet urgently demanding solution because of needs of a humanity faced with speeded-up living processes that outdistance man’s ability to adjust.
Never before in the world’s history have its people had the advantage of medicines and medical services equal to those available today. The knowledge gained by countless generations of dedicated medical men is at the command of today’s physician, and through him, is brought to focus upon the needs of the individual patient at the bedside, in the laboratory, in the consultation room, and in the hospital.
During no period in history has man experienced such rapid and revolutionary advances in medicine and in opportunity for improved health as during the twentieth century; and the accelerated pace of scientific research holds promise of still greater advances in the years ahead.
As the twentieth century opened, the great gains of the nineteenth century were being consolidated and perfected: anesthesia and asepsis were becoming better understood, as were the medical potentials of x-rays. Together they combined to make possible tremendous advances in surgery. The field of biological medicines – vaccines to prevent diseases and antitoxins to combat them – was expanding rapidly. Chemotherapy was on the verge of blossoming to full potential.
Early in the century, dependence on drugs or vegetable origin – largest source of medicines then available to practicing physicians – began to wane as scientific advances improved the whole field of drug therapy. While many valuable drugs still in use were originally derived from vegetable sources (ephedrine, reserpine), disappearance of many medicines of doubtful value was hastened by the contributions of chemotherapy. Given impetus by Ehrlich’s creation of the arsphenamines as specifics for syphilis, chemists brought forth a number of new classes of medicines – anesthetics, barbiturates, and antimalarials. However, research in chemotherapy did not hit its full stride until, about 1937, sulfanilamide and its chemical relatives entered the physician’s armamentarium. Following upon the sulfas came the antibiotics – an entirely new concept in development of drugs. Demonstration that hitherto deadly diseases could be treated successfully.
With these new medicines reestablished confidence in chemotherapy and initiated a tremendous advance in industrial medicinal and chemical research. Laboratories increased their scientific manpower by a hundredfold. There resulted a tremendous speedup of discovery and development of new compounds useful to medicine.
Bold explorations into brain surgery, better diagnosis of mental diseases, advances in psychiatry, and employment of tranquilizers and psychic energizers, all have contributed greatly to restoring afflicted persons to normalcy, and to reduction of population of mental care institutions.
Heart surgery – going far beyond procedures thought possible a decade or two ago – has corrected many lesions, congenital or chronic, and given chance of useful life to persons otherwise doomed to death or crippling. Mechanical developments, such as artificial heart valves, and electronic equipment that will stimulate or regulate performance of abnormal hearts, also have contributed tremendously to welfare and comfort of many people.
Application of new knowledge of radiation, and especially adaptation to medical use of products of the atomic age, have further extended lives of persons suffering from lesions beyond reach of surgery.
These developments of the twentieth century not only have revolutionized the therapeutic practice of the medical profession, but they have had an impact upon the lives of every person in the civilized world. Due to extension of the work begun on vaccines and biological medicines just before the turn of the century, diphtheria and small-pox have nearly disappeared; typhoid and tetanus are seldom encountered in settled communities; and the threat of polio has been largely diminished.
Ninety per cent of the drugs which physicians prescribe today were unknown twenty-five years ago. There have been many changes in the practice of medicine, too. Specialization has increased, with disciplines and boards to govern each group. While the old-style “family doctor” has largely disappeared, general practitioners have organized courses for postgraduate education that assure continuation of high standards of family care in neighborhoods and in smaller centers of population.
The rise of prepaid hospital, surgical, and medical care also has had its impact upon medical men and their patients. Further experience with these comparatively new services undoubtedly will solve their “growing pains” problems and bring about standards beneficial to all concerned.
As improved methods of medical care and better medicines have become available and the average life expectancy of people has been lengthened, new problems have arisen for patients, for physicians, for other health professions, and for research workers. Lowering of death rates from infectious diseases has resulted in more persons reaching the older age brackets, and consequent medical focus on groups of diseases that were not so frequently seen in the past. The degenerative diseases, particularly those affecting the circulatory system, mental processes, and various forms of cancer, now rank among the foremost afflictions demanding the skills of physicians, surgeons, and researchers.
In addition, psychosomatic considerations are demanding more and more of the attentions of medical men, as their patients are affected by the pressures and stresses of modern working and living. To this may be added the concern which physicians share with sociologists and engineers for the socio psychological aspects of the rising rate of accidental injuries, particularly those influenced by the hazards of man and rapid transportation.
Future research in the various scientific fields related to medicine may be expected to bring about breakthroughs in new areas that will be of benefit to the people of the world. Research having to do with preventive medicine, chemotherapy, antibiotics, and hormones show great future promise. The intensive search for agents – biological as well as chemical – effective against cancer undoubtedly will uncover means of combating various forms of this dread killer.
As we ride valiantly into the twenty first century we owe a great deal of gratitude to the physicians of the nineteenth century for the contributions which they made. Among these nineteenth – century advances, one has only to consider recognition that germs are a cause of disease; advances in understanding of anatomy and of cellular pathology; discovery of the principles of anesthesia and of asepsis; of bacteriology, and of biological medicines; of physical devices, such as the ophthalmoscope, the otoscope, the stethoscope, and x-rays. Literally, physicians and scientist of today stand upon the shoulders of those stalwarts of yesterday. It seems certain that, as more scientific and technological advances are made, they will contribute, directly or indirectly, to products and procedures that will increase the effectiveness of the physician’s therapy, and extend the operative field of the surgeon.
The twenty first century has opened great horizons with a vast repertoire of infrastructure, facilities, human abilities, education, knowledge and technology that has helped make patient care that much important and treatment of complicated diseases that much more easy.