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medicine,the science and art of treating and preventing disease.
History of Medicine
Prehistoric skulls found in Europe and South America indicate that Neolithic man was already able to trephine, or remove disks of bone from, the skull successfully, but whether this delicate operation was performed to release evil spirits or as a surgical procedure is not known. Empirical medicine developed in ancient Egypt, and involved the use of many potent drugs still in use today, such as castor oil, senna, opium, colchicine, and mercury. In spite of their skill in embalming, however, the Egyptians had little knowledge of anatomy.
In Sumerian medicine the Laws of HammurabiHammurabi
, fl. 1792–1750 B.C., king of Babylonia. He founded an empire that was eventually destroyed by raids from Asia Minor. Hammurabi may have begun building the tower of Babel (Gen. 11.4), which can now be identified with the temple-tower in Babylon called Etemenanki.
..... Click the link for more information. established the first known code of medical ethics, and laid down a fee schedule for specific surgical procedures. In ancient Babylonia, every man considered himself a physician and, according to Herodotus, gave advice freely to the sick man who was willing to exhibit himself to passersby in the public square. The Mosaic Code of the Hebrews indicated concerns with social hygiene and prevention of disease by dietary restrictions and sanitary measures.
Although ancient Chinese medicine was also influenced adversely by the awe felt for the sanctity of the human body, the Nei Ching, attributed to the emperor Huang-Ti (2698–2598 B.C.), contains a reference to a theory of the circulation of the blood and the vital function of the heart that suggests familiarity with anatomy. In addition, accurate location of the proper points for the traditional Chinese practice of acupunctureacupuncture
, technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points. For thousands of years acupuncture has been used, along with herbal medicine, for pain relief and treatment of various
..... Click the link for more information. implies some familiarity with the nervous and vascular systems. The Chinese pharmacopoeia was the most extensive of all the older civilizations. The Hindus seem to have been familiar with many surgical procedures, demonstrating skill in such techniques as nose reconstruction (rhinoplasty) and cutting for removal of bladder stones.
In Greek medicine the impetus for the rational approach came largely from the speculations of the pre-Socratic philosophers and such philosopher-scientists as Pythagoras, Democritus, and Empedocles. HippocratesHippocrates
, c.460–c.370 B.C., Greek physician, recognized as the father of medicine. He is believed to have been born on the island of Cos, to have studied under his father, a physician, to have traveled for some time, perhaps studying in Athens, and to have then
..... Click the link for more information. , the father of Western medicine, taught the prevention of disease through a regimen of diet and exercise; he emphasized careful observation of the patient, the recuperative powers of nature, and a high standard of ethical conduct, as incorporated in the Hippocratic Oath. By the 4th cent. B.C., Aristotle had already stimulated interest in anatomy by his dissections of animals, and work in the 3d cent. B.C. on human anatomy and physiology was of such high quality that it was not equaled for fifteen hundred years.
The Romans advanced public health and sanitation through the construction of aqueducts, baths, sewers, and hospitals. The encyclopedic writings of GalenGalen
, c.130–c.200, physician and writer, b. Pergamum, of Greek parents. After study in Greece and Asia Minor and at Alexandria, he returned to Pergamum, where he served as physician to the gladiatorial school. He resided chiefly in Rome from c.162.
..... Click the link for more information. constitute a final synthesis of the medicine of the ancient world. Revered by Arabic and Western physicians alike, his concepts stood virtually unchallenged until the 16th cent. Unfortunately, his prolific researches on anatomy and physiology were not invariably accurate, and reliance on them impeded subsequent progress in anatomy.
The Middle Ages
With the destruction or neglect of the Roman sanitary facilities, there followed a series of local epidemics that culminated many centuries later in the great plagueplague,
any contagious, malignant, epidemic disease, in particular the bubonic plague and the black plague (or Black Death), both forms of the same infection. These acute febrile diseases are caused by Yersinia pestis (Pasteurella pestis
..... Click the link for more information. of the 14th cent. known as the Black Death. During the Middle Ages certain monastic libraries, notably those at Monte Cassino, Bobbio, and St. Gall, preserved a few ancient medical manuscripts, and Arab and Jewish physicians such as AvicennaAvicenna
, Arabic Ibn Sina, 980–1037, Islamic philosopher and physician, of Persian origin, b. near Bukhara. He was the most renowned philosopher of medieval Islam and the most influential name in medicine from 1100 to 1500.
..... Click the link for more information. and MaimonidesMaimonides
or Moses ben Maimon
, 1135–1204, Jewish scholar, physician, and philosopher, the most influential Jewish thinker of the Middle Ages, b. Córdoba, Spain, d. Cairo.
..... Click the link for more information. continued medical investigation.
The first real light on modern medicine in Europe came with the translation of many writings from the Arabic at Salerno, Italy, and through a continuing trade and cultural exchange with Byzantium. By the 13th cent. there were flourishing medical schools at Montpellier, Paris, Bologna and Padua, the latter being the site of production of the first accurate books on human anatomy. At Padua, VesaliusVesalius, Andreas
, 1514–64, Flemish anatomist. He made many discoveries in anatomy and became noted as professor of anatomy at the Univ. of Padua. There he produced his chief work, De humani corporis fabrica
..... Click the link for more information. proved that Galen had made anatomical mistakes. Prominent among those who pursued the new interest in experimental medicine were ParacelsusParacelsus, Philippus Aureolus
, 1493?–1541, Swiss physician and alchemist. His original name Theophrastus Bombastus von Hohenheim. He traveled widely, acquiring knowledge of alchemy, chemistry, and metallurgy, and although his egotism and his contempt for traditional
..... Click the link for more information. , Ambroise ParéParé, Ambroise
, c.1510–1590, French surgeon. Serving in the army, he revived the use of ligature instead of cautery with boiling oil and continued to devise and champion more humane treatments in medicine.
..... Click the link for more information. , and FabriciusFabricius
(Caius Fabricius Luscinus) , d. 250 B.C., Roman general and statesman, distinguished for simplicity of habit and probity in public life. He persuaded the Tarentines to abstain from war with Rome and, as consul (282 B.C.), defeated the Boii and the Etruscans.
..... Click the link for more information. , who discovered the valves of the veins.
The Birth of Modern Medicine
In the 17th cent. William HarveyHarvey, William,
1578–1657, English physician considered by many to have laid the foundation of modern medicine, b. Folkestone, studied at Cambridge, M.D. Univ. of Padua, 1602. Returning to London, he became a physician of St.
..... Click the link for more information. , using careful experimental methods, demonstrated the circulation of the blood, a concept that met with considerable early resistance. The introduction of quinine marked a triumph over malaria, one of the oldest plagues of mankind. The invention of the compound microscope led to the discovery of minute forms of life, and the discovery of the capillary system of the blood filled the final gap in Harvey's explanation of blood circulation.
In the 18th cent. the heart drug digitalis was introduced, scurvy was controlled, surgerysurgery,
branch of medicine concerned with the diagnosis and treatment of injuries and the excision and repair of pathological conditions by means of operative procedures (see also anesthesia; medicine; radiology).
..... Click the link for more information. was transformed into an experimental science, and reforms were instituted in mental institutions. In addition, Edward JennerJenner, Edward,
1749–1823, English physician; pupil of John Hunter. His invaluable experiments beginning in 1796 with the vaccination of eight-year-old James Phipps proved that cowpox provided immunity against smallpox.
..... Click the link for more information. introduced vaccinationvaccination,
means of producing immunity against pathogens, such as viruses and bacteria, by the introduction of an killed or weakened microorganism, a harmless piece of a microorganism, or the like to stimulate the body to produce antibodies against more dangerous forms.
..... Click the link for more information. to prevent smallpox, laying the groundwork for the science of immunization.
The 19th cent. saw the beginnings of modern medicine when PasteurPasteur, Louis
, 1822–95, French chemist. He taught at Dijon, Strasbourg, and Lille, and in Paris at the École normale supérieure and the Sorbonne (1867–89).
..... Click the link for more information. , KochKoch, Robert
, 1843–1910, German bacteriologist. He studied at Göttingen under Jacob Henle. As a country practitioner in Wollstein, Posen (now Wolsztyn, Poland), he devoted much time to microscopic studies of bacteria, for which he devised not only a method of
..... Click the link for more information. , EhrlichEhrlich, Paul
, 1854–1915, German bacteriologist. He directed (1896) an institute for serum research at Steglitz, near Berlin, that was transferred (1899) to Frankfurt-am-Main as the Institute for Experimental Therapy.
..... Click the link for more information. and SemmelweisSemmelweis, Ignaz Philipp
, 1818–65, Hungarian physician. He was a pioneer in employing asepsis. While on the staff of the general hospital in Vienna, he recognized the infectious nature of puerperal fever and insisted that attendants in obstetrical cases thoroughly
..... Click the link for more information. proved the relationships between germs and diseasedisease,
impairment of the normal state or functioning of the body as a whole or of any of its parts. Some diseases are acute, producing severe symptoms that terminate after a short time, e.g., pneumonia; others are chronic disorders, e.g.
..... Click the link for more information. . Other invaluable developments included the use of disinfection and the consequent improvement in medical, particularly obstetrical, care; the use of inoculation; the introduction of anesthetics in surgery (see anesthesiaanesthesia
[Gr.,=insensibility], loss of sensation, especially that of pain, induced by drugs, especially as a means of facilitating safe surgical procedures. Early modern medical anesthesia dates to experiments with nitrous oxide (laughing gas) by Sir Humphry Davy of England
..... Click the link for more information. ); and a revival of better public healthpublic health,
field of medicine and hygiene dealing with the prevention of disease and the promotion of health by government agencies. In the United States, public health authorities are engaged in many activities, including inspection of persons and goods entering the country
..... Click the link for more information. and sanitary measures. A significant decline in maternal and infant mortality followed.
Medicine in the 20th cent. received its impetus from Gerhard DomagkDomagk, Gerhard
, 1895–1964, German chemist and pathologist. A teacher successively at the universities of Greifswald and Münster, he became (1927) director of research at the I. G. Farbenindustrie laboratory at Wuppertal.
..... Click the link for more information. who discovered the first antibiotic, sulfanilamide, and the groundbreaking advancements in the use of penicillinpenicillin,
any of a group of chemically similar substances obtained from molds of the genus Penicillium that were the first antibiotic agents to be used successfully in the treatment of bacterial infections in humans.
..... Click the link for more information. . Further progress has been characterized by the rise of chemotherapychemotherapy
, treatment of disease with chemicals or drugs. One chemotherapeutic approach is the development of selectively toxic substances, i.e., substances that can destroy or inhibit infecting organisms or, as in cancer, malignant tissue, but do not damage normal host
..... Click the link for more information. , especially the use of new antibioticsantibiotic,
any of a variety of substances, usually obtained from microorganisms, that inhibit the growth of or destroy certain other microorganisms. Types of Antibiotics
..... Click the link for more information. ; increased understanding of the mechanisms of the immune system (see immunologyimmunology,
branch of medicine that studies the response of organisms to foreign substances, e.g., viruses, bacteria, and bacterial toxins (see immunity). Immunologists study the tissues and organs of the immune system (bone marrow, spleen, tonsils, thymus, lymphatic system),
..... Click the link for more information. ) and the increased prophylactic use of vaccinationvaccination,
means of producing immunity against pathogens, such as viruses and bacteria, by the introduction of an killed or weakened microorganism, a harmless piece of a microorganism, or the like to stimulate the body to produce antibodies against more dangerous forms.
..... Click the link for more information. ; utilization of knowledge of the endocrine system to treat diseases resulting from hormone imbalance, such as the use of insulin to treat diabetes; and increased understanding of nutrition and the role of vitaminsvitamin,
group of organic substances that are required in the diet of humans and animals for normal growth, maintenance of life, and normal reproduction. Vitamins act as catalysts; very often either the vitamins themselves are coenzymes, or they form integral parts of coenzymes.
..... Click the link for more information. in health.
In Mar., 1953, at the Univ. of Cambridge, England, Francis CrickCrick, Francis Harry Compton,
1916–2004, English scientist, grad. University College, London, and Caius College, Cambridge. Crick was trained as a physicist, and from 1940 to 1947 he served as a scientist in the admiralty, where he designed circuitry for naval mines.
..... Click the link for more information. , age 35, and James WatsonWatson, James Dewey,
1928–, American biologist and educator, b. Chicago, Ill., grad. Univ. of Chicago, 1947, Ph.D. Univ. of Indiana, 1950. With F. H. C. Crick he began (1951) research on the molecular structure of deoxyribonucleic acid (DNA) at the Cavendish Laboratory at
..... Click the link for more information. , age 24, announced "We have discovered the secret of life." Indeed, they had unraveled the chemical structure of the fundamental molecule of heredity, deoxyribonucleic acid (DNA), giving science and medicine the basis for molecular genetics and leading to a continuing revolution in modern medicine.
Much medical research is now directed toward such problems as cancercancer,
in medicine, common term for neoplasms, or tumors, that are malignant. Like benign tumors, malignant tumors do not respond to body mechanisms that limit cell growth.
..... Click the link for more information. , heart disease, AIDSAIDS
or acquired immunodeficiency syndrome,
fatal disease caused by a rapidly mutating retrovirus that attacks the immune system and leaves the victim vulnerable to infections, malignancies, and neurological disorders. It was first recognized as a disease in 1981.
..... Click the link for more information. , reemerging infectious diseases such as tuberculosistuberculosis
(TB), contagious, wasting disease caused by any of several mycobacteria. The most common form of the disease is tuberculosis of the lungs (pulmonary consumption, or phthisis), but the intestines, bones and joints, the skin, and the genitourinary, lymphatic, and
..... Click the link for more information. and dengue feverdengue fever
, acute infectious disease caused by four closely related viruses and transmitted by the bite of the female Aedes mosquito; it is also known as breakbone fever and bone-crusher disease.
..... Click the link for more information. , and organ transplantationtransplantation, medical,
surgical procedure by which a tissue or organ is removed and replaced by a corresponding part, usually from another part of the body or from another individual.
..... Click the link for more information. . Currently, the largest worldwide study is the Human Genome ProjectHuman Genome Project,
international scientific effort to map all of the genes on the 23 pairs of human chromosomes and, to sequence the 3.1 billion DNA base pairs that make up the chromosomes (see nucleic acid).
..... Click the link for more information. , which will identify all hereditary traits and body functions controlled by specific areas on the chromosomeschromosome
, structural carrier of hereditary characteristics, found in the nucleus of every cell and so named for its readiness to absorb dyes. The term chromosome
..... Click the link for more information. . Gene therapygene therapy,
the use of genes and the techniques of genetic engineering in the treatment of a genetic disorder or chronic disease. There are many techniques of gene therapy, all of them still in experimental stages.
..... Click the link for more information. , the replacement of faulty genes, offers possible abatement of hereditary diseases. Genetic engineeringgenetic engineering,
the use of various methods to manipulate the DNA (genetic material) of cells to change hereditary traits or produce biological products. The techniques include the use of hybridomas (hybrids of rapidly multiplying cancer cells and of cells that make a
..... Click the link for more information. has led to the development of important pharmaceutical products and the use of monoclonal antibodiesmonoclonal antibody,
an antibody that is mass produced in the laboratory from a single clone and that recognizes only one antigen. Monoclonal antibodies are typically made by fusing a normally short-lived, antibody-producing B cell (see immunity) to a fast-growing cell, such as
..... Click the link for more information. , offering promising new approaches to cancer treatment. The discovery of growth factors has opened up the possibility of growth and regeneration of nerve tissues.
With the surge of general and specialized medical knowledge, the educational requirements of the medical profession have increased. In addition to the four-year medical course and the general hospital internship required almost everywhere, additional years of study in a specialized field are usually required. Similar progress and increased requirements in education are reflected in ancillary professions such as nursing.
Modern Health Care Management
Modern medicine, characterized by growing specialization and a complex diagnostic and therapeutic technology, faces problems in the allocation of capital and personnel resources. Some authorities advocate an increase in the use of paramedical personnel to supervise the care of individuals with common, chronic, or terminal illnesses, leaving the physician in charge of treating curable disease. Others emphasize the physician's responsibility to help patients and families in the overall management of their health problems, many of which are thought to reflect the social ills of living in an urban, industrialized society.
In some countries, such as Great Britain, medical care is under government control and is available virtually without charge to all. In the United States, medical practice is characterized by a patchwork mixture of government and private control. The Kefauver-Harris amendments to the federal Food, Drug, and Cosmetic Act of 1962 empower the Food and Drug Administration to require stricter testing and licensing of new drugs. There have also been federal, state, and local programs for mass vaccination and other public health programs. The MedicareMedicare,
national health insurance program in the United States for persons aged 65 and over and the disabled. It was established in 1965 with passage of the Social Security Amendments and is now run by the Centers for Medicare and Medicaid Services.
..... Click the link for more information. program, enacted in 1965, provides subsidized hospital and nursing-home care for persons over 65 and, with the Hill-Burton Act, provides funds for state aid to the medically indigent (MedicaidMedicaid,
national health insurance program in the United States for low-income persons and persons with disabilities. It was established in 1965 with passage of the Social Security Amendments and is now run by the Centers for Medicare and Medicaid Services.
..... Click the link for more information. ).
A wide variety of private medical insurance plans are also available to those who can afford them, and many employers pay all or part of their employees' health insurance premiums. In addition, health maintenance organizationshealth maintenance organization
(HMO), type of prepaid medical service in which members pay a monthly or yearly fee for all health care, including hospitalization. The term "health maintenance organization" was coined by a health policy analyst, Dr.
..... Click the link for more information. (HMOs), or group practice plans, are designed to promote disease prevention and reduce medical expenditures.
See J. Walton et al., ed., The Oxford Companion to Medicine (2 vol., 1986); historical study by H. E. Sigerist (2 vol., 1951–61); studies by R. Hudson (1983), P. Starr (1983), D. Dutton (1988), E. Shorter (1991), and J. Duffin (2d ed., 2010); M. Bliss, The Making of Modern Medicine (2011).
a system of scientific knowledge and practical measures combined for the purpose of the diagnosis, treatment, and prevention of disease, the preservation and strengthening of health and of the capacity for work, and the prolongation of life. Modern medicine is the result of long historical development. The level of medicine has always been determined by the stage of development of the society, the socioeconomic system, the achievements of natural science and technology, and the general educational level. This article is primarily concerned with the development of medicine as a complex of scientific disciplines.
Medicine consists of three groups of disciplines: the biomedical, the clinical, and the medicosocial and hygienic.
Biomedical disciplines. The biomedical disciplines, which belong primarily to the various biological sciences, go beyond the framework of medicine. The group includes the morphological disciplines (anatomy, histology, and cytology), which deal with the structure of the human body at all levels—the organism as a whole, the organs and systems, and the molecular. Physiology, another biomedical discipline, investigates the functions of the body. Pathology, which deals with the origin, development, and course of morbid processes, is divided into pathological anatomy and pathophysiology. (Immunology and allergology are related to the pathological disciplines. The chemical and physical aspects of physiological and pathological processes are the concerns of biochemistry and biophysics.) The pathology group also includes pharmacology and toxicology, which deal with the effects of drugs and determine toxicity; microbiology (bacteriology and virology) and parasitology and helminthology, which deal with the causative agents of disease; and medical genetics, which investigates the phenomena of heredity and variability in relation to human pathology.
Clinical disciplines. The group of clinical disciplines, which deal with the treatment and prevention of human disease, is especially extensive and ramified. It includes internal medicine and its branches—cardiology, rheumatology, pulmonology, nephrology, gastroenterology, hematology, clinical endocrinology, and geriatrics. Other subdivisions of the clinical group include phthisiology, pediatrics, neuropathology and psychiatry; dermatology and venereology; health resort medicine, physical therapy, and exercise therapy; and medical radiology and roentgenology. Also among the clinical disciplines are stomatology; obstetrics and gynecology; surgery; traumatology and orthopedics; anesthesiology and resuscitation science; neurosurgery; oncology; urology; and otorhinolaryngology and ophthalmology. The criteria for establishing independent clinical disciplines vary. The chief considerations are localization of the diseases studied in a single organ or system of organs (for example, neuropathology and ophthalmology), age (for example, pediatrics), sex (obstetrics and gynecology), characteristics of the causative agent of the disease and nature of the pathological process (for example, phthisiology), and diagnostic and therapeutic methods (for example, roentgenology, surgery, and physical therapy). Each clinical discipline has branches concerned with methods of examining patients and with symptoms (for example, semiotics, which is becoming the basis for computerized methods of diagnosis).
Medicosocial and hygienic disciplines. The medicosocial and hygienic disciplines deal with the effect of the environment on the body and the methods of improving the health of the population. The group includes social hygiene and the organization of public health; general hygiene, pediatric and adolescent hygiene, communal hygiene, nutritional hygiene, radiation hygiene, and industrial hygiene; epidemiology and medical geography; and medical deontology.
The division of medicine as described is arbitrary. To some extent, all medical disciplines have social aspects. This is also true of such practical fields as military medicine, space medicine, sports medicine, and forensic medicine. Medical microbiology and parasitology are usually classified with the biomedical group, but they are also related to epidemiology. Since they provide the scientific basis for many preventive measures, they are often regarded in practice as medicosocial sciences. Many disciplines are intertwined (pediatric and adolescent hygiene and pediatrics, for example). The experimental method, which is characteristic of theoretical medicine (that is, the biomedical disciplines), is winning broader acceptance in clinical and hygienic medicine.
Origin and development until the 16th century. Medicine and hygiene, in their rudimentary form, evolved from early man’s observations and experience and were consolidated in the customs and methods of treatment and protection against disease that made up folk medicine and hygiene. The use of natural phenomena (sun, water, and air) and empirically discovered drugs of plant and animal origin played a major role in the prevention and treatment of disease.
Diseases were originally regarded as something living, external and hostile to man, that penetrated the body and caused pathological conditions. Helpless before the forces of nature and having only a poor understanding of the environment, primitive man believed that diseases were caused by evil spirits settling in the body. This notion gave rise to the use of magical methods of treatment (incantations, exorcism, and prayer), which contained the rudiments of psychotherapy. Quackery, shamanism, and priestly and temple medicine developed.
The written monuments of the ancient East (Egyptian papyri, the Code of Hammurabi, and, in India, the Code of Manu and the Ayur-Veda) show that physicians’ activities, fees for treatment, and responsibility for doing harm to the sick were regulated by laws.
In addition to magical approaches to healing, physicians and priests used rational medical methods and folk remedies. Great importance was attached to diet, hygiene, massage, water treatments, and gymnastics. Surgical methods were also used, including craniotomy, and, in cases of difficult labor, cesarean section and embryotomy. Ancient Chinese medicine made use of more than 2,000 medicinal substances—especially ginseng, mercury, rhubarb root, and camphor. The unique technique of acupuncture is several thousand years old.
Extensive information on the medicine of the peoples who lived in the first century B.C. in the territories of what are now Middle Asia, Iran, Azerbaijan, and Afghanistan is contained in the Avesta (ninth century B.C. to third century A.D.), the holy book of the Zoroastrians. The first concepts of human anatomy and physiology took shape during this period. A great deal of attention was devoted to the prevention of disease (“an ounce of prevention is worth a pound of cure”). This emphasis gave rise to numerous hygienic instructions for eating, family life, and the treatment of pregnant women and nursing mothers, as well as to the prohibition against intoxicating beverages.
Ancient Greek medicine made use of the knowledge gained by the peoples of the ancient East. A tendency toward the differentiation of knowledge was reflected in the cults of the idolized physician Aesculapius (Asclepius) and his daughters Hygeia, the protectress of health, and Panacea, the patroness of healing. Treatment was given in temple “asclepions” and domestic facilities. The training of physicians followed the apprenticeship system. A distinction was made between household physicians, who cared for the nobility, and wandering physicians, who took care of tradesmen and craftsmen. In addition, there were public physicians, who treated poor citizens without charge and took measures against epidemics.
The Crotona school, which developed earlier than others, was named for Alcmaeon of Crotona (c. 500 B.C.), who developed a theory of the pathogenesis of disease on the basis of the idea that the body is a unity of opposites: health is harmony; disease is a disharmony in the body and its inherent properties. The Crotona school’s principle of treatment—“treat opposites with opposites”—became the basis of therapy in subsequent schools of medicine. Pathogenetic theory was elaborated by the Cnidian school (first half of the fifth century B.C.), which developed one of the variants of the humoral theory, which viewed disease as essentially a disturbance in the proper mixture of the body’s fluids by a particular external factor.
Other versions of the humoral theory had been propounded in the ancient East, but the doctrine was formulated most clearly by Hippocrates, whose influence determined the course of medicine for centuries. Hippocrates isolated medicine as a science from natural philosophy, turned observations at the sickbed into a strictly medical method of examination, and called attention to the importance of the way of life and role of the environment in the etiology of disease. In addition, through his theory of the main types of body build and temperament, he laid the ground-work for the individual approach to the diagnosis and treatment of the sick.
In the third century B.C., the Alexandrian physicians Herophilus and Erasistratus founded a science of the structure and functions of the human body. They introduced the first experimental proof that the brain is the organ of thought, they discovered the differences between sensory and motor nerves, and they described the meninges, gyri, and ventricles of the brain.
Galen, a native of Asia Minor who practiced in Pergamum and Rome, had a profound influence on the development of medicine. In the second century B.C. he summarized the available information on anatomy, physiology, pathology, pharmacology and pharmacognosy (galenicals), internal medicine, obstetrics, and hygiene. He introduced much that was new into each of these and attempted to fashion a scientific system of medicine. Galen was the first to perform vivisection on animals in order to study systematically the relation between the structure and functions of human organs and systems. He showed that a knowledge of anatomy and physiology is the scientific foundation for diagnosis, therapy, surgery, and hygiene. The teleological tendency of Galen’s works led the church to support them, in a somewhat modified form known as Galenism. Thus, Galen’s teachings dominated Western and Eastern medicine for centuries.
The elements of sanitation and public hygiene that were known all over the ancient world reached a high level in Rome, as is indicated by the ruins of aqueducts, sewers, and baths. The world’s first sanitation and military medical organizations and a municipal medical service were established in Rome. In addition, there was legislation on sanitation.
In the Byzantine Empire large hospitals for the civilian population were built during the same period. Devastating epidemics and wars led to the institution in Europe of quarantines and the establishment of monastery hospitals and lazarettos.
In the ancient Russian feudal state, folk medicine continued to develop along with monastery medicine. Popular books of home remedies contained a number of reasonable instructions for the treatment of diseases and everyday hygiene. Medicinal plants were described in herbals. The folk specialists included kostopravy (bonesetters), ochnye (eye doctors), kil’nye (hernia doctors), kamnesechentsy and kamchuzhnye (specialists in treating aches and pains and rheumatism), pochechuinye (specialists in treating hemorrhoids), chepuchinnye (specialists in treating venereal diseases), midwives, and child healers.
Eastern physicians played an important role in the history of medicine: al-Razi (known in Europe as Rhazes); ibn Sina (Avicenna), author of the Canon of Medicine, an encyclopedia of medical knowledge; Ismail al-Jurjani (12th century), who reflected the achievements of Khwarazmian medicine; and the Armenian physician M. Heratsi. The university medical schools founded in Europe in the 11th and 12th centuries were unable to promote the rapid progress of medicine, because they were under the influence of Scholasticism. This influence was felt less strongly in the universities of Salerno, Padua, Bologna, Kraków, Prague, and Montpelier. The Spanish physician Arnaldo de Vilanova (13th-14th centuries) and many others fought against the Scholastics and defended the right to knowledge based on experimentation.
The 16th to 19th centuries. During the Renaissance the Swissborn physician Paracelsus reexamined the past, criticizing Galenism and humoral pathology and advocating experimental knowledge. His work in alchemy led to the rise of a major field in medicine: iatrochemistry. Believing that chronic diseases are caused by a disruption of chemical transformations in digestion and assimilation, Paracelsus introduced a variety of chemical substances and mineral waters into medical practice. His most prominent follower was Jan B. van Helmont, who described the processes of fermentation in gastric digestion.
The founder of modern anatomy, A. Vesalius (16th century), questioned the authority of Galen and, on the basis of the systematic dissection of cadavers, described the structure and functions of the human body. The development and popularization of the scientific method of research by the materialist philosopher F. Bacon, as well as the development of mechanics, greatly influenced medicine. In 1628, W. Harvey described the circulation of the blood, thus laying the foundation for a new branch of knowledge: physiology. S. Santorio studied human metabolism using weights of his own construction and advanced the theory of solid pathology, according to which a pathological condition is the result of interference with the motion of the tiniest particles in the body. Together with J. Borelli and R. Descartes, Santorio opened the field of iatromechanics (iatrophysics). The invention of magnifying devices (microscopes) and the development of microscopy are a striking example of the effect of physics on medicine. In 1676, A. van Leeuwenhoek described live microscopic organisms, opening the new discipline of microbiology. Using a microscope, M. Malpighi described capillary circulation.
The most important events in practical medicine in the 16th century were the development of the theory of contagious diseases (G. Fracastoro) and the development of the principles of surgery (A. Paré).
The last stage of the descriptive period of medical history came in the 18th century, with the development of primary systematization. Numerous medical “systems” were elaborated in an attempt to explain the causes of disease and principles of treatment. The German physician G. Stahl advanced the theory of animism (from Latin anima, “soul”), according to which the pathological process is a series of movements made by the soul to remove harmful foreign substances from the body. Another German, F. Hoffmann, attempted to prove that life consists of motion and that mechanics is the source and governing force of all phenomena. The French physicians T. de Bordeu and P. J. Barthez advanced the theory of a “vital force,” or vitalism. L. Galvani and A. Volta investigated “animal electricity” and treatment by electric current. F. Mesmer, who was familiar with this work, developed a theory of “animal magnetism.” S. Hahnemann founded homeopathy. The Scotsman W. Cullen advanced the theory of “nerve pathology,” which was based on the primacy of the “nerve principle.” A student of Cullen, the British physician J. Brown, constructed a metaphysical system that declared impairment of excitability to be the main factor in the etiology of disease. Accordingly, the objective of therapy was to decrease or increase excitation. F. Broussais created the system of “physiological medicine,” which attributed the origin of disease to an excess or insufficiency of stomach irritation and used bloodletting as its principal method of treatment.
The advocates of knowledge based on experimentation opposed the supporters of speculative, metaphysical systems based on the absolutization of a given discovery or principle. Revealing a mistrust of “systems,” T. Sydenham and the Italian physician G. B. Montano called on physicians to investigate diseases by observing them carefully. The method of bedside observation was the basis of the clinical and pedagogical works of H. Boer-haave, C. Hufeland, S. G. Zybelin, and M. Ia. Mudrov. The philosopher physicians of the 17th and 18th centuries (H. Duroy, J. La Mettrie, and P. Cabanis and later, M. V. Lomonosov’s followers F. G. Politkovskii, K. I. Shchepin, and I. E. Diad’kovskii) used the achievements of natural science to criticize speculative systems and substantiate their materialist concepts of the body and disease.
The expansion of industrial production attracted attention to the study of occupational diseases. At the turn of the 18th century, B. Ramazzini began a study of occupational pathology and labor hygiene. In the second half of the 18th century and the first half of the 19th, J. Pringle and J. Lind in Great Britain and D. P. Sinopeus and A. G. Bakherakht in Russia laid the foundation of military and naval hygiene. J. Graunt and W. Petty (Great Britain) worked out statistical methods for investigating public health. Lomonosov and Zybelin thoroughly analyzed the reasons for high morbidity and mortality and the problems involved in protecting the health of the population. The Austrian physician J. P. Frank, who worked for several years in Russia, and the Hungarian physician Z. G. Huzty advanced the concept of a “medical police,” the first attempt to systematize and regulate the state’s sanitary inspection and public and personal hygiene. The relationship between the health of various population groups and their working and living conditions was established by numerous medicotopographic descriptions and statistical studies of sanitation made at the end of the 18th century and during the first half of the 19th in Russia, Germany, Great Britain, and a number of other countries.
The development of clinical medicine in the second half of the 18th century and the early 19th was promoted by the invention of new, objective methods of examining the sick. These methods included percussion (L. Auenbrugger, J. N. Corvisart, and Ia. O. Sapolovich, a Russian), auscultation (R. Laennec and J. Skoda), palpation, endoscopy, and laboratory diagnosis. The comparison of clinical observations with autopsies—a method used by G. Morgagni, M. F. X. Bichat, M. Baillie (Great Britain), R. Virchow, K. Rokitansky, J. Skoda, N. I. Pirogov, and A. I. Polunin—led to the development of pathological anatomy and histology, which made it possible to determine the site and physical substrate of many diseases.
The use of the experimental method to study normal and impaired functions had an exceptional influence on the development of medicine in many countries. The Czech J. Prohaska, E. O. Mukhin, and the English physiologist M. Hall investigated the body’s reactions to causative agents of disease and provided highly detailed descriptions of reflex acts. C. Bell and F. Magendie demonstrated experimentally that the anterior roots of the spinal cord are centrifugal and motor and that the posterior roots are centripetal and sensory. The English surgeon J. Hunter is considered the founder of experimental pathology. The combining of pathologicoanatomical and experimental methods of investigation and the thorough study of human anatomy and physiology helped create a scientific anatomical and physiological foundation for surgery.
The conditions for theoretical generalization in medicine were created by advances in physics, chemistry, and biology around the turn of the 19th century, including the discovery of the role of oxygen in combustion and respiration, the law of the conservation and conversion of energy, and the first synthesis of organic substances (first half of the 19th century), which undermined the views associated with vitalism. J. von Liebig’s balanced diet theory also contributed to the rise of theoretical generalization in medicine, as did study of the chemical processes in living organisms, which led to the development of biochemistry.
The greatest advance in the 19th century was the cell theory of the structure of living organisms (J. Purkinje, M. J. Schleiden, and T. Schwann). This development enabled R. Virchow to formulate his theory of cellular pathology, according to which disease is a purely local process that consists esssentially of morphological changes in the cellular elements. Consequently, the most important task of medicine is to determine the “seat of the disease.” This approach had a beneficial effect at the time. Disease was linked to certain changes in the structure of cells and organs, the concept of cell degeneration was advanced, and many forms of tumors and other diseases were described. However, Virchow and especially his students and followers insisted on the universality of the phenomena they had discovered. As a result, the animal organism came to be regarded as a federation of “cell states,” and all human pathology was reduced to cell pathology.
Many of Virchow’s contemporaries not only rejected this theory but also criticized its principles and regarded anatomical localization, at a time when it appeared to be an unshakable theory, as too limited. Advances in the theory of evolution (Darwinism) encouraged a synthetic approach in scientific thought that would reflect the complex relations between the organism and the environment. The acknowledgment of the kinship between man and animals led physicians to make wider use of experiments on animals to elucidate the phenomena of human sickness and health. In the mid-19th century, C. Bernard developed experimental medicine, which combines physiology, pathology, and therapy. With his many investigations of the effects on the organism of drugs and poisons, Bernard laid the foundation for experimental pharmacology and toxicology.
In Germany, J. Müller’s school investigated the physiology of the sense organs, the digestive system, and the blood. H. Helmholtz’ research helped establish ophthalmology, the study of eye diseases, as a discipline independent of general surgery. The Czech physiologist J. Czermak perfected the laryngoscope and founded laryngology. A. Politzer and his student R. Barany (Austria) founded otology and ear surgery.
In the first half of the 19th century the works of Mukhin, P. A. Zagorskii, Diad’kovskii, A. M. Filomafitskii, and I. T. Glebov laid the theoretical and experimental foundation for the development of the physiological approach in Russian medicine. However, the approach did not flower until the second half of the 19th century and the early 20th.
I. M. Sechenov’s Brain Reflexes (1863) had a decisive effect in shaping the materialist outlook of Russian physiologists and physicians. Physiology and nervizm (the concept of the preeminence of the nervous system in regulating physiological functions) were most fully and systematically applied in clinical medicine by S. P. Botkin, who profoundly influenced I. P. Pavlov. Sechenov’s many students and ideological followers elaborated the progressive principles of materialist physiology in various medical disciplines. N. E. Vvedenskii, A. F. Samoilov, and M. N. Shaternikov worked in normal physiology; V. V. Pashutin, in pathophysiology; N. P. Kravkov, in experimental pharmacology; and G. V. Khlopin, in hygiene. Vvedenskii’s and A. A. Ukhtomskii’s fundamental discoveries in the physiology of the nervous system (the phenomena of dominance and parabiosis and the relationship between excitation and inhibition) stimulated experimentation, especially in neurophysiology.
The differentiation of medical knowledge was accompanied by the creation of an integrative discipline, general pathology, which studies the patterns of origin and development of pathological processes. Initially, the principal methods of general pathology were clinical observation, the description of symptoms, and the systematization and generalization of practical medical experience. But because of advances in pathological anatomy, general pathology began in the first half of the 19th century to emphasize pathomorphology. The most prominent representative of pathomorphology was A. I. Polunin, who organized the first independent department of general pathology at Moscow University (1869). This line of research was advanced by S. M. Luk’ianov and K. A. L. Aschoff, aided by newly developed histological, biochemical, and experimental methods. The clinical anatomical approach of the Moscow school of pathological anatomists (M. N. Nikiforov, A. I. Abrikosov, and I. V. Davydovskii) made an original contribution to the field. The St. Petersburg (M. N. Rudnev) and Kiev schools of pathologists chose to focus on experimental pathomorphology. V. V. Pashutin organized a department of general pathology emphasizing experimental physiology at the University of Kazan (1874) and the St. Petersburg Medical and Surgical Academy (1879) and founded the first scientific school of pathophysiologists. This subsequently became the dominant approach in most departments of general pathology in Russia. As a result, general pathology came to be known as pathophysiology. The experimental pathologist J. Cohnheim later adopted an analogous approach in Germany.
E. Metchnikoff substantiated the concept of inflammation as a tissue’s adaptive reaction to irritation. He developed the principles of comparative pathology and was the first to emphasize the general biological approach in medicine, which led to the discovery of significant patterns and mechanisms of adaptability of the organism to pathological conditions, aging, and so forth.
Many Russian pathologists pursued the clinical experimental line of research. For example, A. B. Fokht’s school made a major contribution to the study of the body’s reserves and compensatory adaptations to pathology of the lymphatic, endocrine, and urinary systems and, especially, the cardiovascular system. They devised experimental models of disturbances of coronary circulation and studied the significance of interoception in the origin of these disturbances.
Advances in physiology led to an emphasis on physiological function in clinical medicine. Many Russian physicians subscribed to anthropathology rather than organopathology—that is, they studied the patient as a whole organism. In addition, they formulated the principles of “functional thought” and functional pathology and recognized the importance of individuality in the development of most diseases. Physicians began to speak not only of diagnosing the disease but also of diagnosing the patient. The new attitude gave rise to individualized therapy, or “treatment of the patient.”
Botkin, the leading Russian clinician of the second half of the 19th century, sought to develop methods of examining, observing, and treating patients that were based on the natural sciences. In the 1870’s he discovered that functional changes in the heart were often disproportionate to anatomical changes; he concluded that these changes depend on the central nervous apparatus and, through it, on environmental conditions. This knowledge contributed to the development of the functional approach in medicine. Believing that a physician’s observations should be confirmed by experiment and that pathological findings should be related to physiological data, Botkin organized a laboratory in 1861 at the clinic of the St. Petersburg Medical and Surgical Academy. There, the close relationship between physiology and medicine was recognized in practice. (Botkin directed the laboratory until 1878; he was succeeded by Pavlov, who served as director for ten years.)
G. A. Zakhar’in, a contemporary of Botkin, perfected a method of inquiry that consisted in a careful study of the working and living conditions of the patient in order to determine the causes of disease and the ways of preventing illness and to “comprehend the connection between all phenomena of the given pathological case” (anamnesis). Zakhar’in’s lectures were translated into German, English, and French as a model of keen clinical observation, medical thinking, and comprehensive therapy.
A. A. Ostroumov looked for the causes of human disease in the environment and linked the solution of the problem of disease to clinical medicine’s use of advances in the biological sciences. He paid special attention to functional diagnosis and proposed a plan for the functional examination of the individual organs and of the body as a whole. Like Mudrov and Zakhar’in, he championed prevention as an important part of medicine. Botkin, Zakhar’in, Ostroumov, and such foreign clinicians as the German internist L. Traube characteristically emphasized the clinical physiological approach to research. Like Bernard, they believed that the experimental method could “replace authority with scientific criteria.”
New branches of study grew out of internal medicine in the middle and late 19th century. For example, with the establishment of medical school departments and clinics, pediatrics, which previously had been a branch of general medical practice, took shape as a scientific discipline. (The first pediatrics department in Europe was established by N. A. Tol’skii at Moscow University in 1866.) N. F. Filatov, who developed clinical physiology, and N. P. Gundobin, who brought together a large group of physicians to make a thorough study of the anatomical and physiological characteristics of the child’s body, were active as researchers and teachers in the second half of the 19th century and the early 20th. The Gundobin group included J. Bokai (Hungary; childhood diseases) and A. Czerny (Czechoslovakia and Germany; nutrition and metabolism in children). Neuropathology and psychiatry emerged as scientific disciplines independent of general clinical medicine, owing to progress in the study of the anatomy and physiology of the nervous system, as well as to the clinical work of P. Pinel, J. M. Charcot, H. Maudslay, I. M. Balinskii, A. Ia. Kozhevnikov, S. S. Korsakov, E. Krepelin, and E. Bleuler.
Until the second half of the 19th century, there were only hypotheses concerning the causes of infectious diseases. In the 18th century, D. S. Samoilovich demonstrated that plague is a contagious disease, and he elaborated its epidemiological principles. Mukhin, Mudrov, and especially Diad’kovskii correctly interpreted the causes of the spread of cholera. The search for a safe and effective means of preventing smallpox led E. Jenner to the discovery and use of the first vaccine (1796), which subsequently made possible the radical control of the disease by vaccination. In the 19th century, N. I. Pirogov suggested that the suppurative complications of wounds are caused by live pathogens and proposed a system of preventive measures. I. Semmel-weiss found that puerperal fever is caused by transfer of the infectious principle from the instruments and hands of doctors to patients. He introduced the practice of disinfection and succeeded in sharply reducing the death rate among parturient women.
An important stage in the history of medicine was inaugurated by the work of L. Pasteur, who discovered the microbial nature of infectious diseases. Based on his research, J. Lister proposed the antiseptic method of treating wounds, which helped to reduce considerably the number of complications with wounds and surgical interventions. The discoveries of R. Koch and his school led to the spread of the etiological approach in medicine. Koch’s method of sterilization by live steam was transferred to surgical practice from the laboratory and contributed to the development of asepsis. Progress was made in microbiology and epidemiology in many countries, and the causative agents and transmitters of various infectious diseases were discovered: malaria (C. L. A. Laveran, 1880, and R. Ross, 1893-97), yellow fever (C. J. Finlay, 1881), and typhus and relapsing fever (the German scientist O. Obermeier, 1868; G. N. Minkh and O. O. Mochutkovskii, 1874-78).
The progress in microbiology was so striking that the second half of the 19th century became known in the history of medicine as the bacteriological era, the period in which the role of microorganisms in human pathology was discovered. But the fascination with bacteriology also had a darker side, manifested in monocausalism, an approach that greatly exaggerated the role of bacterial pathogens in the etiology and pathogenesis of disease and that, as a result, came into constant conflict with medical practice. Many prominent men of medicine, especially clinicians and hygienists, sharply criticized the underestimation of the role of environmental (including social) conditions in the etiology of disease.
Metchnikoff’s work led to the study of the role of the body itself in the infectious process and to the elucidation of the factors responsible for immunity to disease. The Russian scientist’s chief contribution was his theory of immunity, in which he attributed a major role to phagocytosis. Most of the leading Russian microbiologists and epidemiologists at the turn of the 20th century (D. K. Zabolotnyi, N. F. Gamaleia, L. A. Tarasevich, G. N. Gabrichevskii, and A. M. Bezredka) were trained, as was Metchnikoff, at the Pasteur Institute in Paris. The German scientists E. von Behring and P. Ehrlich elaborated the humoral and chemical theory of immunity and laid the ground-work for serology, the study of the properties of blood serum. Their research drew attention to the role of humoral factors in the body’s vital processes.
Advances in the natural sciences were responsible for the use of experimental methods of research in hygiene and for the organization of departments and laboratories of hygiene during the second half of the 19th century. The work of M. von Pettenkofer and C. W. Prausnitz (Germany), E. Parkes (Great Britain), E. Fleury (France), A. P. Dobroslavin, and F. F. Erisman laid the scientific foundation for hygiene and completed the transition from general description to the precise quantitative and qualitative study of the influence on human health of various environmental factors, using physical, chemical, and other research methods.
The German hygienists M. Rubner and C. Fliigge laid the scientific foundation for the hygienic evaluation of air, water, soil, housing, and clothing. Hygienic standards for nutrition were given physiological substantiation by Rubner and K. Voit. Considerable progress was made in labor hygiene and occupational pathology.
The industrial revolution, the growth of cities, and the bourgeois revolutions at the end of the 18th century and during the first half of the 19th stimulated the study of social problems in medicine and gave rise to social hygiene. The data that had accumulated by the mid-19th century indicated that the health of working people (particularly of the working class) was dependent on working and living conditions, and attempts were made to provide a scientific basis for public health measures. The terms “social hygiene” and “social medicine” were proposed. The German physicians Virchow, S. Neumann, and R. Leubuscher suggested that medicine was a social science. In Great Britain representatives of public health services and factory inspection (S. Smith, J. Simon, E. Greenhow) looked into the working and living conditions and diet of workers and substantiated the need for public health legislation (1848, 1875). K. Marx and F. Engels used the results of health inspections in their criticism of capitalism and in justification of their conclusion that capitalist exploitation has a destructive effect on the health of the proletariat.
Social medicine developed in Russia during the second half of the 19th century. Its principal forums were the journals Moskovskaia meditsinskaia gazeta (Moscow Medical Gazette), Sovremennaia meditsina (Modern Medicine), Arkhiv sudebnoi meditsiny i obshchestvennoi gigieny (Archives of Forensic Medicine and Public Hygiene), Zdorov’e (Health), and Vrach (The Physician). The N. I. Pirogov Society of Russian Physicians, the Russian Public Health Society, and physicians’ societies in St. Petersburg, Moscow, Kazan, and Kharkov played a major role in promoting social medicine.
Zemstvo (district and provincial assembly) medicine and the zemstvo sanitary inspection organization were a distinctive phenomenon: a unique example of organized medical services under capitalism for the rural population. The health officers I. I. Molleson, V. O. Portugalov, E. A. Osipov, P. I. Kurkin, M. S. Uvarov, N. I. Teziakov, P. F. Kudriavtsev, and A. I. Shingarev made comprehensive statistical studies of the health of the peasants and agricultural workers. Similar studies of factory workers were conducted by F. F. Erisman, A. V. Pogozhev, E. M. Dement’ev, V. A. Levitskii, and S. M. Bogoslovskii.
Russian social physicians collected data that testified to the unhygienic living conditions of the working masses and to the high morbidity and mortality of the population. Their work was cited by V. I. Lenin as a grave indictment of autocracy and capitalist relations.
The 20th century. Diagnosis and treatment were enriched and improved by the rapid development of the natural sciences and by technological progress at the turn of the 20th century. The discovery of X rays by W. K. Roentgen (1895-97) led to the development of roentgenology. The possibilities of X-ray diagnosis were broadened by the use of contrast substances, methods of sectional roentgenography (tomography), mass roentgenography (fluoroscopy), and methods based on the use of advances in radioelectronics (television roentgenography, roentgenocinematography, roentgenoelectrokymography, and medical electroroentgenography, for example).
The discovery of natural radioactivity and subsequent research in nuclear physics gave rise to radiobiology, which deals with the effects of ionizing radiation on living organisms. The Russian pathophysiologist E. S. London experimented with autoradiography in 1904 and published the first monograph on radiobiology in 1911. Continued research led to the development of radiation hygiene and to the use of radioactive isotopes for diagnostic and therapeutic purposes; these, in turn, made possible the use of tagged atoms. Radium and radioactive preparations began to be used effectively for therapy.
A profound technological revolution is taking place in medicine. The introduction of electronics has had enormous significance. Fundamentally new methods of recording the functional activities of organs and systems make use of a variety of receiving, transmitting, and recording devices. Data on cardiac activity and other functions can be received even from outer space. There are devices, such as the artificial kidney and the heart-lung machine, which perform the work of organs (during surgery, for example). Electric stimulation helps regulate the rhythm of the ailing heart and empty the urinary bladder. Electron microscopy, combined with the technique of preparing tissue sections less than 0.02 microns thick, has permitted magnification to tens of thousands of times the actual size. The use of electronics has been accompanied by the development of quantitative methods for the precise and objective monitoring of biological processes.
A great deal of progress is being made in medical cybernetics. The programming of the distinctive symptoms of various diseases and the use of computers for diagnosis have become especially important. Automatic systems have been created for controlling anesthesia, respiration, and blood pressure during operations. Controllable prostheses are available. Notable progress has been made in physics and polymer chemistry. New technology is having an enormous influence on medical science and practice.
An important result of technological progress has been the emergence of new branches of medicine. For example, the development of aviation early in the 20th century gave rise to aviation medicine, whose founders included N. A. Rynin in Russia and E. Koschel in Germany. Manned space flights have led to the development of space medicine.
Chemistry and physical chemistry have had a substantial effect on the development of medicine. New chemical and physicochemical methods of research have been created and applied. Advances have been made in the study of the chemical basis of the life processes. Early in the 20th century, I. C. Bang (Sweden) devised methods of identifying a variety of substances in small quantities of a given substrate under study (for example, blood and serum). These methods broadened diagnostic capacities.
Research on the chemical interpretation of pathological conditions has shown that a variety of diseases are caused by the impairment of certain chemical conversions in the metabolic chain. After it was found that changes in hemoglobin structure result in sickle-cell anemia (L. Pauling, 1949), data were obtained showing that in some cases a molecular basis of diseases is manifested in defective amino acid molecules. Study of the mechanisms regulating metabolism at various levels made new therapeutic methods possible.
Genetics, which established the laws and mechanisms of heredity and variability, has greatly influenced medicine. The study of hereditary diseases and disorders gave rise to medical genetics, which helped to elucidate the interaction of heredity and environmental factors and showed that environmental conditions can stimulate or suppress hereditary predisposition to disease. Methods were developed for the rapid diagnosis, prediction, and treatment of a number of hereditary diseases and disorders, and a consultation service was offered to the people. There are new possibilities in research in the genetics of microorganisms (including viruses) and in biochemical and molecular genetics.
In the 20th century immunology outgrew the classical immunity theory. Gradually, immunology concerned itself with questions of pathology, genetics, embryology, transplantation, and oncology. In 1898-99, J. Bordet and N. N. Chistovich, coworkers of Metchnikoff, established that the introduction into the body of foreign erythrocytes and serum proteins stimulates antibody formation. This discovery marked the beginning of the development of noninfectious immunology. Subsequent study of cytotoxic antibodies became the basis of immunopathology, which deals with the many diseases caused by impairment of immunological mechanisms. K. Landsteiner’s discovery of the laws of isohemagglutination (1900-01) and J. Jansky’s discovery of the four human blood groups (1907) led to the use of blood transfusions and the development of the theory of tissue isoantigens. Study of the laws of inheritance of antigens and other immunity factors gave rise to the field of immunogenetics. The study of embryogenesis demonstrated the importance of immunity phenomena in tissue differentiation.
In the 1940’s scientists found that the rejection of foreign tissue after a transplant is due to immunological mechanisms. During the 1950’s research led to the discovery of immunological tolerance. (Organisms developing from embryos exposed to certain antigens lose their ability after birth to react to those antigens and to reject them by forming antibodies.) This discovery opened up the possibility of overcoming immunological intolerance in tissue and organ transplants. Other advances of the 1950’s included tumor immunology, radiation immunology, immunohematology, immunodiagnosis, preventive immunology, and immunotherapy.
Research on various kinds of distorted reactions to foreign substances was closely associated with the study of immunological processes. The discovery of anaphylaxis by the French scientist C. Richet (1902) and the discovery of serum anaphylaxis and anaphylactic shock by the French bacteriologist N. M. Arthus and the Russian pathologist G. P. Sakharov (1903-05) laid the groundwork for the study of allergies. The Austrian pediatrician C. F. Pirquet introduced the term “allergy” and in 1907 suggested that the allergic skin reaction to tuberculin could be used as a diagnostic test for tuberculosis. N. N. Sirotinin discovered the general patterns of the development of allergic reactions, and M. A. Skvortsov described their morphology.
At the beginning of the 20th century, Ehrlich demonstrated the possibility of synthesizing drugs capable of acting on the causative agents of disease, thereby initiating the study of chemotherapy. In 1928, A. Fleming found that one of the species of mold fungi releases the antibacterial substance penicillin. In 1939-40, H. Florey and E. Chain developed a technique for obtaining stable penicillin, learned how to concentrate it, and started its industrial production. This initiated a new approach to the control of microorganisms: antibiotic therapy. In the USSR penicillin was first synthesized by Z. V. Ermol’eva in 1942. In the same year, G. F. Gauze developed the new antibiotic gramicidin. S. Waksman (USA) obtained streptomycin in 1944. Many antibiotics, with various spectra of antimicrobial action, have been isolated in the years since.
The science of vitamins (vitaminology), a 20th-century phenomenon, has also made marked progress. Scientists have found that all vitamins participate in the function of various enzyme systems. The pathogenesis of many avitaminoses has been elucidated, and ways of preventing avitaminoses have been developed.
The science of endocrinology, which was established at the end of the 19th century by C. Brown-Séquard, has become an independent medical discipline. The discovery of insulin has revolutionized the treatment of diabetes mellitus, and the discovery of the female sex hormones has played an important role in the development of endocrinology and gynecology. The isolation in 1936 of a hormonal substance from the adrenal glands (later called cortisone) and the synthesis in 1954 of the more effective prednisolone and other hormones led to the therapeutic use of the corticosteroids.
Modern endocrinology no longer limits itself to the study of the pathology of the endocrine glands. It also concerns itself with the hormonal therapy of nonendocrine diseases and with the hormonal regulation of functions in healthy and sick persons. The work of H. Selye, author of the stress theory and the concept of the general adaptation syndrome, has made a number of contributions to the development of endocrinology and hormonal therapy.
Chemotherapy, hormonal therapy, and the development and use of agents capable of acting on the central nervous system have altered clinical medicine and enabled physicians to intervene actively in the course of diseases.
Among the disciplines emerging from internal medicine, cardiology is particularly important. Clinical experimental research (in the USSR, by D. D. Pletnev) has contributed to the development of this field. The rapid growth of cardiology is due largely to the work of J. Mackenzie (Great Britain), who published a classical study on diseases of the heart in 1908; L. H. Vaquez, a prominent French cardiologist of the early 20th century; and P. White (USA). At the beginning of the 20th century, V. M. Kernig, V. P. Obraztsov, and N. D. Strazhesko and, subsequently, J. B. Herrick (USA) gave a classical description of the clinical symptoms of myocardial infarction. M. V. Ianovskii’s theory of the “peripheral (arterial) heart” drew attention to the significance of the vascular aspect of the circulatory system. S. S. Khalatov and N. N. Anichkov advanced the cholesterol theory to account for atherosclerosis. Modern cardiology is a comprehensive discipline, embracing not only internal medicine but also surgery, physiology, and biochemistry.
Another new and comprehensive discipline is hematology, the study of the blood. The important stages in its history are associated with the development of new methods of examination, such as bone marrow puncture (M. I. Arinkin; USSR, 1927) and the use of radioisotopes (L. Lajtha; Great Britain, 1952). Cultivation of hematopoietic tissue enabled A. A. Maksimov to develop the unitary theory of hematopoiesis, according to which a lymphocyte-like cell is the precursor of all forms of blood cells. This theory has been confirmed by recent morphological studies on stem cells. A major practical achievement of hematology is the treatment of pernicious anemia with raw liver (W. P. Murphy and G. R. Minot; USA, 1926) and vitamin B12. Another is combined cytostatic therapy of leukemia. Hematology is among the clinical disciplines that make extensive use of methods of the natural sciences (mathematics, genetics).
Surgery has developed rapidly in a number of directions. The steadily increasing scale of warfare gave rise to military field surgery, and the increase in traumatism led to the development of traumatology and orthopedics. V. P. Filatov’s work in plastic surgery won universal recognition. The work of H. W. Cushing, W. Penfield, A. L. Polenov, and N. N. Burdenko promoted the development of neurosurgery. The development of surgical methods of treating diseases of the genitourinary system by S. P. Fedorov in Russia led to the establishment of urology as an independent branch of medicine.
Between 1923 and 1930, A. V. Vishnevskii developed a method of local anesthesia with Novocain. Continued improvements made anesthetics safer and more effective. Anesthesiology became an independent specialty in the second quarter of the 20th century. The use of curare preparations (muscle relaxants) and the development of hypothermia, which was tested experimentally and then introduced into clinical practice by H. M. Laborit and P. Huguenard (France, 1949-54), helped improve the methods of anesthesia.
Modern techniques of anesthesia and antibacterial therapy have made heart and lung surgery possible. In 1925, S. S. Briukhonenko constructed an apparatus for extracorporeal blood circulation that was used successfully to revive animals from clinical death. It was also used in experimental heart surgery. Present-day models of this apparatus are used for open-heart surgery. Owing to advances in cardiac surgery, the foundation for which was laid by H. Souttar, R. Brock (Great Britain), C. Bailey, and D. Harken (USA) in the late 1940’s, the traditionally “therapeutic” group of congenital and rheumatic heart defects are now regarded as surgical diseases. The development of cardiac surgery in the USSR is associated with the names of A. N. Bakulev, P. A. Kupriianov, B. V. Petrovskii, A. A. Vishnevskii, and E. N. Meshalkin. Thoracic surgery is continuing to make progress. The most outstanding thoracic surgeons in the USSR have included I. I. Grekov, S. I. Spasokukotskii, A. V. Martynov, S. S. ludin, and A. G. Savinykh.
In the USSR, oncology was founded in the early 20th century by N. N. Petrov and P. A. Gertsen. In 1903 the French scientist A. Borrel proposed the viral theory of cancer. F. Rous (USA) discovered fowl sarcoma virus in 1911. In 1945, L. A. Zil’ber proposed the virogenetic theory, according to which a tumor virus acts as a transforming agent that alters the genetic material in cells. The theory is gaining increasing recognition.
Microbiology has developed very rapidly. In 1921, A. Calmette and C. Guerin proposed a tuberculosis vaccine. The method of specific prevention of infectious diseases with vaccines and serums has become a decisive factor in the control of diseases such as diphtheria and poliomyelitis. Research by D. K. Zabolotnyi and V. Khavkin on the epidemiology of plague, cholera, anthrax, and typhoid and the development of the theory of leptospiroses and rickettsial diseases have become the scientific foundation for the struggle against infectious diseases. Virology came into being as a result of D. I. Ivanovskii’s discovery in 1892 of filterable viruses and the subsequent studies of M. Beyerinck. In the 1960’s, attention was again focused on mycoplasmas, which are specifically linked to atypical pneumonias in man. The studies of E. I. Martsinovskii, E. N. Pavlovskii, and K. I. Skriabin were the basis for the natural focus theory of transmissible diseases and for the control of parasitic diseases, as well as for the development of methods of extermination of sources of infection and methods of anthelmintic treatment. L. V. Gromashevskii’s theories regarding the mechanisms governing the transmission of infection have played an important part in the development of epidemiology.
Scientific and technological progress, socioeconomic changes, and advances in medicine have brought about substantial changes in the health of the population, as well as reduced death rates. Infectious and parasitic diseases, which once were widespread and the main cause of death, accounted for only 1-3 percent of the deaths at the beginning of the 1970’s. Extremely dangerous epidemic diseases (for example, plague and smallpox) have been eradicated, and the incidence of childhood diseases has been reduced markedly in the economically developed countries. There is still a pressing need to control influenza, infectious hepatitis, and other viral diseases, which cause high sick rates and do tremendous damage to individual health and the economy.
Cardiovascular diseases have become the main cause of death in the economically developed countries, constituting 40 to 60 percent of the mortality at the beginning of the 1970’s, with 300-600 or more cases per 100,000 population. They are also the main cause of disability and strike the age groups most valuable to society. Ischemic heart disease (coronary insufficiency), hypertension, and vascular disorders of the central nervous system, which account for 80-85 percent of all deaths from cardiovascular diseases, have become particularly significant. The factors that increase the risk of their occurrence are stress, smoking, insufficient physical activity, overeating, and abuse of alcohol. This suggests that the diseases are social in origin and that they are associated with the life-style of economically developed countries.
However, there is no question that progress has been made in the diagnosis and treatment of cardiovascular diseases. For example, the chances of a person recovering from myocardial infarction and returning to work have tripled in the last 30 years. The control of cardiovascular diseases requires large-scale and systematic state, social, and medical measures (the organization of reasonable working conditions, nutrition, rest, and mass forms of physical culture; the creation of an optimum “psychological climate”; the detection of persons suffering from the diseases; prompt outpatient and hospital treatment; and job placement).
Malignant neoplasms are a serious problem. The mortality from cancer in most of the economically developed countries has increased two to three times in the last 50 years and since 1937 has been second only to cardiovascular diseases (16-23 percent). Every year, at least 2 million people worldwide die of cancer. This increase is ascribed, in particular, to pollution of the atmosphere and the continuing spread of smoking. The nature of malignant growth has not been completely elucidated, and much has yet to be learned about the mechanisms of action of carcinogens, the blastomogenic effect of radiation, tumorigenic viruses, and the body’s defense mechanisms. According to data of the US National Cancer Institute (1971), one in three cancer patients can be saved (in 1930, one in five). The perfection of diagnostic and surgical methods, the availability of powerful machines for radiotherapy, and the use of radioisotopes have contributed to the improved results of treatment. Combination therapy (surgery, radiation, and chemotherapy) has been the most effective. In the USSR, cancer research is directed by the Institute of Experimental and Clinical Oncology of the Academy of Medical Sciences of the USSR (founded by N. N. Blokhin), where chemical carcinogenesis (L. M. Shabad) and other problems are under active study. The USSR and the USA have conducted joint research in oncology since 1972. According to many scientists, the problem of treating cancer can be solved in the 20th century.
An important problem in contemporary medicine is the increased incidence of nervous and mental disorders, which in some capitalist countries are called the number one health problem. At least 6-8 percent of the population is affected. Some 10 percent of all Americans suffer from psychoses or neuroses. At the end of the 1960’s and early 1970’s there were at least 65-70 million mental patients all over the world requiring hospital treatment. Alcoholism and other forms of addiction are a national disaster in many countries. The development of highspeed transportation, the intensification of labor, and excessive nervous and mental fatigue are increasing the incidence of traumatism.
The protection and improvement of the environment have become acute social and political problems. Pollution of the water, air, and soil and disruption of the ecological balance in the biosphere are adversely affecting human health. For example, more than 3,000 cases of diseases caused by environmental pollution were officially reported in Japan in March 1971. An especially serious problem is the poisoning of drinking water and soil by toxic industrial wastes. Nature’s self-restorative processes have been outstripped in several areas of the planet by the haphazard use of natural resources and by pollution of the atmosphere. The processes of spontaneous environmental renewal have been undermined, and substances dangerous to man are accumulating. The struggle to improve the environment and protect nature is now being waged on an international scale.
The altered pattern of pathology is closely related to demographic changes, which in the economically developed countries are marked by a declining birthrate (approximately 15-18 per 1,000 inhabitants), relative stabilization of the general and child mortalities (9-12 per 1,000 and 15-25 per 1,000 live births, respectively), and high average life expectancy (69-73 years). The population is “aging”; that is, the percentage of persons 60 years of age and older is increasing (to as much as 15-18 percent of the total in some countries).
Most of the developing countries still exhibit the epidemic type of pathology and the traditional demographic processes, which are marked by high birthrates, high general and child mortalities, a rapid succession of generations, and high morbidity and mortality from infectious and parasitic diseases.
In a number of foreign countries the change in pathology and the universal attention paid to the “diseases of civilization” have helped disseminate a number of theories linking the causes of disease with hereditary and constitutional inadequacies that prevent human beings from adapting to the environment, as well as with the influence on human behavior of eroticism and the subconscious. Psychoanalysis, a technique developed by S. Freud, finds the explanation for neuroses in suppressed sexual desires. Freud’s more recent followers see the essence of disease in certain socially determined changes in the unconscious, the “deep-seated forces” of the patient’s personality that secondarily bring about changes in the activity of organs and systems and all observable external manifestations of disease (the German and American neo-Freudians K. Horney, E. Fromm, W. Riese, and R. Dessauer, and the psychosomaticists F. Alexander and F. Danberg).
Medicine in the capitalist countries is characterized by a conflict between general idealistic concepts, on the one hand, and the concrete achievements of medical science, public health practice, and the materialistic approach of most naturalists and medical men to concrete research, on the other. Particular patterns observed in many studies are elevated to the rank of fundamental laws of the development of pathological phenomena, and these laws are either not formulated at all or are presented unilaterally (for example, molecular pathology). Such biomedical conceptions as neo-Malthusianism, eugenics, and the theory of the “vicious circle of poverty and disease” are often used as the theoretical basis for population and public health policy in the capitalist states.
According to widespread bourgeois ideas of social maladaptation, the same inevitable changes are taking place in the people’s health in all industrial countries, regardless of socioeconomic or political organization, as a result of certain factors associated with scientific and technological progress. Advocates of these views usually start with the notion that there is a growing disparity between social conditions (the rhythms of modern life in industrial society) and the biological cycles and rhythms of the body’s vital activities that have evolved over thousands of years. An important argument in these theories is the numerical similarity of the indexes of social health (demographic phenomena, the prevalence of certain diseases) in the various economically developed countries. The authors of the theories disregard the fact that the socialist states are superior in the rate of improvement of social health and that there are no sharp fluctuations in the indexes of the health of social groups and classes.
The supporters of neo-Freudianism, psychosomatics, neoHippocratism, and a number of other schools of foreign medicine elaborate these ideas to a greater or lesser degree and attempt to prove that social adaptation and “human relations” are capable of regulating social conflicts in modern society and reducing the incidence of disease and the number of accidents. Social phenomena are treated as biological and psychological phenomena, reflecting the class character of many bourgeois theories of medicine and public health.
In addition to scientific problems, modern medicine is confronted more sharply than ever before with ethical questions concerning the relation between physician and patient, the limits of allowable intervention (for example, the effects of psychotropic drugs), and the donation of organs for transplants. The danger of forgetting the ethical side of medicine is demonstrated, for example, by such well-known facts as the inhuman experimentation on human beings in fascist Germany and the participation of physicians in preparations for bacteriological warfare.
The Great October Socialist Revolution and socialist construction opened new possibilities for the development of medicine and public health. Protection of the people’s health became a major function of the state. An extensive network of medical establishments and schools was established. Formulated in the early years of the Soviet power, the principles of organizing public health were based on Marxist views (developed by Lenin) concerning the social conditionality of public health and the task of building a socialist state that manifests its concern for the health of the working people through socioeconomic and medical measures.
Medical science was provided with a material and technical basis. The State Institute of Public Health (1920) became the prototype for the more extensive mergers of medical research institutes that were to take place. The Gorky All-Union Institute of Experimental Medicine was organized in 1932 as a comprehensive establishment whose duty it was to integrate the natural sciences (in particular, experimental biology and medicine). Advances in medical science and Soviet public health (791,000 hospital beds and 155,000 physicians in 1940, compared to 207,000 hospital beds and 23,000 physicians in 1913) resulted in significant changes in the people’s health. Many epidemic diseases were eradicated, and general mortality declined to 18.3 per 1,000 inhabitants (30.2 in 1913).
The war against fascist Germany required the creation of a scientifically sound system of medical care for the sick and wounded. The efficiency of the army’s medical service made it possible for 72.3 percent of the wounded and more than 90 percent of the sick to return to active duty. Epidemics were prevented for the first time in the history of mass warfare, and the sanitary aftereffects of the war were eliminated with relative speed. The results of this work were summed up in the collective, multivolume publication The Experience of Soviet Medicine in the Great Patriotic War, 1941-1945.
The Academy of Medical Sciences of the USSR was founded in 1944, despite wartime difficulties. The academy unified the leading medical research institutes and directed work on medical problems. The scale of scientific research in medicine was widened considerably after the war. In 1972, 55,122 scientists (including 5,783 doctors of science and 32,845 candidates of medical and pharmaceutical science) were conducting research in more than 350 research organizations and more than 100 medical and pharmaceutical institutes, as well as in university medical departments and institutes for the advanced training of physicians. There were 731,800 physicians in 1972 (more than a fourth of the world total, and an average of 29.4 physicians per 10,000 inhabitants). The number of hospital beds increased to 2,793,000 in 1972. Compared with 1913, general mortality had declined almost fourfold by 1972, and child mortality more than tenfold. The average life expectancy had increased from 32 to 70 years.
Relying on the methodology of dialectical materialism, theoretical medicine made progress in the struggle against both the mechanistic and the idealistic concepts of the causality and mechanisms of development of disease. Attempts were made as early as the 1920’s to reexamine the general theories of disease, etiology, and pathogenesis (A. A. Bogomolets, G. P. Sakharov). The study of causality in medicine led to the conclusion that a distinction must be made between the main cause (without which disease in its qualitative specificity cannot develop) and conditions that cannot themselves cause disease but that contribute to its development and influence its course and outcome.
The relationship between specific and nonspecific mechanisms in the development of disease acquired particular significance in connection with the theory of standard nerve dystrophies advanced in the 1930’s by A. D. Speranskii, who regarded it as a modern theory of medicine. However, the notion that the nervous system plays an organizational role in the pathological process was justly criticized. Attempts were made in the 1950’s to universalize the patterns discovered by K. M. Bykov and his co-workers in their studies on the connections between the cerebral cortex and the viscera.
Many studies revealed that it was unsound practice to construct a theory of disease grounded in particular phenomena (for example, the role of the endocrine, autonomic, or other systems in the development of disease and in recovery). At its present stage of development, medical science in the USSR looks upon disease as a multifaceted impairment of the regulation of functions, embracing various levels of the nervous, endocrine, connective-tissue, and other physiological systems (including the molecular). The fertility of the principles elaborated by Pavlov and his school is particularly in evidence here.
Although it acknowledges the tremendous importance of internal factors such as heredity, constitution, and reactivity, Soviet medical science believes that the actual source of disease must be sought in the unfavorable effect exerted by environmental factors—physiological, biological, and social. Moreover, it believes that the effect of the diverse causes of diseases depends on working and living conditions, the character of socioeconomic relations, and the condition of the body itself, which reacts actively, and not passively, to external influences.
Studies by Soviet physiologists (P. K. Anokhin, E. A. Asratian, S. I. Beritashvili, L. A. Orbeli, and V. N. Chernigovskii) greatly influenced the development of theories of medicine. The physiological approach became the leading trend in Soviet theoretical medicine and was also applied in various clinical disciplines. Thus, physiologists joined clinicians in creative research. For example, G. F. Lang and his school developed the concept that hypertension is a neurosis of the vasomotor centers. Neuropathologists and psychiatrists (V. M. Bekhterev) used a theory of higher nervous activity to explain the pathogenesis of neuroses and several psychoses. The materialistic reflex theory, which established the relationship between the conscious mind and the environment, had a decisive effect on the development of Russian psychiatry, which acquired a distinctly physiological tone in the USSR.
In the USSR and other socialist countries medicine is distinguished by its emphasis on prevention. With the advent of free, highly skilled medical care accessible to all the people, prevention acquired state significance and became the basis for the protection of the people’s health by the state and society. In the USSR and, later, in the other socialist countries, the solution of public health problems became closely associated with the transformation of the environment. The forms of prevention are varied. General health measures are taken to protect nature and to improve the environment and working and living conditions. Health legislation, hygienic standards, and antiepidemic measures are enforced. A network of disease prevention facilities has been organized, and rest homes, sanatoriums, children’s homes, boarding schools, and day care centers have been established. Mass medical checkups are provided. Regular visits to the clinic are the most important method of combining prevention and treatment. The implementation of preventive measures produced significant results in the fight against various social diseases, including venereal diseases and tuberculosis.
An emphasis on prevention is also characteristic of the clinical approach to internal diseases in the USSR and is manifested by an interest in the study of premorbid states (M. P. Konchalovskii), the thorough analysis of the social factor in the etiology of disease, the study of the work prognosis, and the maintenance of a close relationship between clinical medicine and public health practice. This approach has become dominant in pediatrics (A. A. Kisel’, G. N. Speranskii), obstetrics, and gynecology and has found expression in a state system for the protection of mothers and children. Another manifestation of the preventive approach was the creation of a network of health resorts and the elaboration of the principles of social health-resort medicine, which originated in the USSR. N. A. Semashko, Z. P. Solov’ev, and A. V. Mol’kov are the founders of social hygiene in the USSR. Drawing on the Marxist view that social conditions are a major factor in the origin and prevention of disease, they worked out the theoretical foundation of the Soviet health system and outlined social measures for protecting and restoring the health of the people. Health education, the work of the Union of Red Cross and Red Crescent Societies of the USSR, cooperative councils, and the public councils of medical establishments also make valuable contributions to the prevention of disease.
The emphasis on prevention and the state and social character of medicine, public health planning, and other principles put into practice in the USSR and other socialist countries are gaining international recognition. At the initiative of the USSR delegation, the Twenty-third World Health Assembly (1970) adopted a resolution recommending the following as the most effective principles for constructing and developing national health systems: the “proclamation of the responsibility of the state and society in protecting the health of the people,” the creation of “a single national plan” (for the public health system), the “carrying out of public and private preventive measures,” and the provision of “qualified free medical care” to the entire population. A new stage in the implementation of state measures to improve the working and living conditions of the Soviet people was marked by the Legislative Principles of the USSR and the Union Republics on Public Health (1970). Protection of the people’s health is regarded not only as a concern of medical personnel and state medical agencies but also as a legal obligation of every person.
Medicine still faces the important tasks of studying the nature of cardiovascular diseases and malignant tumors and the ways of preventing and treating them and of investigating aspects of the molecular biology of viruses, the chemotherapy and prevention of viral infections, and immunology. It is very important that medicine take into account the steadily increasing effect of environmental factors and scientific and technological progress on the health and work capacity of the people, foresee the aftereffects of these influences, and devise scientifically sound measures for improving the environment.
The growing importance of medicine and public health as a branch of the economy and of the widening sphere of human activity has also been manifested in international relations. For example, the USSR has signed agreements with the USA, France, and other countries (1971-73) regarding environmental protection, as well as joint research in cardiology and oncology and various current problems in medicine. Soviet scientists and physicians are active in international scientific societies, associations, and medical journals and in specialized agencies of the United Nations (especially the World Health Organization). International medical congresses, conferences, and symposia held in the USSR promote scientific cooperation.
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Kielanowski, T. Propedevtika meditsiny. Moscow, 1968. (Translated from Polish.)
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ludin, T. I. Ocherki istorii otechestvennoi psikhiatrii. Moscow, 1951.
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IU. P. LISITSYN, IU. A. SHILINIS, A. D. ADO, and P. E. ZABLUDOVSKII; B. V. PETROVSKII editor in chief
What does it mean when you dream about medicine?
Giving or receiving medicine in a dream is a very powerful experience. It is a cure to problems known and sometimes unknown. This is a very spiritual symbol of “healing guides” attending to the dreamer during sleep.
healthcare ITFollowing is a summary of common terms found in documentation related to information technology (IT) in the healthcare field.
CCOW - (Clinical Context Object Workgroup) See CCOW.
CCD - (Continuity of Care Document) See CCR.
CCR - (Continuity of Care Record) See CCR.
CDA - (Clinical Document Architecture) See CDA.
CDRH - (Center for Devices and Radiological Health) See CDRH.
CDSS - (Clinical Decision Support System) See CDSS.
CMS - (Context Management Standard) See CCOW.
CPOE - (Computerized Prescriber Order Entry) See CPOE.
e-detailing (Electronic Detailing) See e-detailing.
e-prescribing (Electronic Prescribing) See e-prescribing.
EMR - (Electronic Medical Record) See EMR.
EHR - (Electronic Health Record) See EHR.
PHR - (Personal Health Record) See PHR.
HAN - (Health Alert Network) See HAN.
HIE - (Health Information Exchange) See HIE.
HIMSS - (Health Information and Management Systems Society) See HIMSS.
HIPAA - (Health Insurance Portability and Accountability Act of 1996) See HIPAA.
HIT - (Health Information Technology) See HIT.
HITECH - (Health Information Technology for Economic and Clinical Health Act) See HITECH.
HITSP - (Healthcare Information Technology Standards Panel) See HITSP.
HL7 - (Health Level 7) See HL7.
Hospital Compare - A U.S. government website for finding hospitals and their track record. See Hospital Compare.
ICD - (International Classification of Diseases and Related Health Problems) See ICD.
LOINC - (Logical Observation Identifiers Names and Codes) See LOINC.
meaningful use - Meeting requirements for EHR use. See meaningful use.
NHIN - (Nationwide Health Information Network) See NHIN.
NQF - (National Quality Forum) See NQF.
PCEHR - (Personally Controlled Electronic Health Records) The Australian standard for electronic health records. Individuals have control over who can see the information.
SNOMED CT - (Systematized Nomenclature Of Medicine Clinical Terms) See SNOMED CT.
SRE - (Serious Reportable Event) See SRE.
RHIO - (Regional Health Information Organization) See HIE.
telehealth - Remote diagnostic/remedial procedures. See telehealth.
telemedicine - Remote medicine. See telemedicine.
telesurgery - Remote surgery. See telesurgery.
UMLS - (Unified Medical Language System) See UMLS.
VLER - (Virtual Lifetime Electronic Record) See VLER.
AHIC - American Health Information Community
ARRA - American Recovery and Reinvestment Act of 2009
CAH - Critical Access Hospital
CAHPS - Consumer Assessment of Healthcare Providers and Systems
CCHIT - Certification Commission for Health Information Technology
CCN - CMS Certification Numbers
CDC - Centers for Disease Control and Prevention
CFR - Code of Federal Regulations
CGD - Certification Guidance Document
CHIME - College of Healthcare Information Management Executives
CHIP - Children's Health Insurance Program
CHIPRA - Children's Health Insurance Program Reauthorization Act of 2009
CMS - Centers for Medicare and Medicaid Services
CMS-0033-P - CMS Electronic Health Record (EHR) Incentive Program
CY - Calendar Year
EP - Eligible Professionals
EPO - Exclusive Provider Organization
FACA - Federal Advisory Committee Act
FFP - Federal Financial Participation
FFS - Fee-For-Service (Medicare program)
FFY - Federal Fiscal Year
FQHC - Federally Qualified Health Center
FTE - Full-Time Equivalent
FY - Fiscal Year
GIPSE - Geocoded Interoperable Population Summary Exchange Accountability Act of 1996
HEDIS - Healthcare Effectiveness Data and Information Set
HHS - Department of Health and Human Services
HMO - Health Maintenance Organization
HOS - Health Outcomes Survey
HPSA - Health Professional Shortage Area
HRSA - Health Resource Services Administration
IAPD - Implementation Advanced Planning Document
IHS - Indian Health Services
IPA - Independent Practice Association
MA - Medicare Advantage
MAC - Medicare Administrative Contractor
MCO - Managed Care Organization
MITA - Medicaid Information Technology Architecture
MMIS - Medicaid Management Information Systems
MSA - Medical Savings Account
NCPDP - National Council for Prescription Drug Programs
NCQA - National Committee for Quality Assurance
NCVHS - National Committee on Vital and Health Statistics
NLM - National Library of Medicine
NPI - National Provider Identifier
OCR - Office for Civil Rights
OIG - Office of Inspector General
OMB - Office of Management and Budget
ONC - Office of the National Coordinator for Health Information Technology
ONC ACB - ONC Authorized Certification Body
ONC ATCB - ONC Authorized Testing and Certification Body
OPM - Office of Personnel Management
PAHP - Prepaid Ambulatory Health Plan
PAPD - Planning Advanced Planning Document
PFFS - Private Fee-For-Service
PIHP - Prepaid Inpatient Health Plan
PHO - Physician Hospital Organization
PHS - Public Health Service
PHSA - Public Health Service Act
POS - Place of Service
PPO - Preferred Provider Organization
PQRI - Physician Quality Reporting Initiative
PSO - Provider Sponsored Organization
RFA - Regulatory Flexibility Act
RHC - Rural Health Clinic
RIA - Regulatory Impact Analysis
RPPO - Regional Preferred Provider Organization
SHARP - Strategic Health IT Advanced Research Projects Program
SMHP - State Medicaid Health Information Technology Plan
SSA - Social Security Act
TIN - Tax Identification Number
UCUM - Unified Code for Units of Measure
UNII - Unique Ingredient Identifier
medical conditionsThere are several harmful reactions when using computers and mobile devices for extended periods. See carpal tunnel syndrome, mouse elbow, computer hunch, smartphone pinky, computer vision syndrome, RSI, tech neck, electromagnetic hypersensitivity, dry eyes, thumb culture and deep vein thrombosis.
robotic surgeryUsing robots in the operating room to assist the surgeon in performing surgery. The surgeon views the patient via a terminal and manipulates robotic surgical instruments via a control panel. Views of the organs being worked on are transmitted from tiny cameras inserted into the body.
Such robots are considerably less invasive than normal operating room procedures because the instruments can be inserted into much smaller incisions in the human body. This type of "laparoscopic" surgery means less pain and less scarring, and patients recover much faster.
Since the patient and surgeon are separated by an electronic console, it also enables "telesurgery," which allows the surgeon to perform the operation in a remote location. See telesurgery.
|A Robotic Surgery|
|A University of Mississippi Medical Center physician is performing a robotic surgery. (Image courtesy and copyright of the University of Mississippi Medical Center.)|
telehealthAn umbrella term for remote diagnostic and remedial procedures in the medical field as well as accident prevention systems. Telehealth also encompasses video meetings in lieu of physical doctor visits. Such meetings can be among medical professionals discussing a case, as well as an appointment between doctor and patient.
Telehealth in 2020
Since the beginning of the COVID-19 pandemic, millions of people have visited their doctors online for the first time. It is highly likely that telehealth visits will continue long after the pandemic because it provides a convenient way to have a medical consultation. See PERS, teleradiology, telemedicine and telesurgery.
telemedicine("long distance" medicine) Telemedicine refers to any diagnosis or medical procedure performed via a video call. The term was first used in the mid-1990s between rural healthcare facilities and medical centers, whereby a specialist monitors the patient remotely and takes cues from the general practitioner or nurse who is actually examining the patient. A patient's blood can be placed under a microscope in the remote facility and transmitted for examination.
Telemedicine Has Become Mainstream
Throughout the COVID-19 pandemic, telemedicine has flourished in place of routine doctor visits as well as a way to help determine if a patient's symptoms are likely due to the virus. See telehealth, telesurgery and robotic surgery.
|The Friendly Rollabout Engineered for Doctors was one of the first telemedicine units that helped specialists collaborate worldwide. The handheld camera (top right) was used for close-ups. (Image courtesy of VTEL Corporation.)|
telesurgeryA medical technology that allows a surgeon to operate long distance. Also called "telepresence surgery," by combining advances in imaging, video, robotics and sensors, the system gives doctors the full sensory experience of hands-on surgery. The surgeon performs the operation sitting at a console that displays a high-resolution image of the patient. See telemedicine, 3D surgery, telepresence and robotic surgery.
|With early work funded by DARPA and NIH, SRI International became involved with telesurgery in the early 1980s. These images from the late 1990s show the surgeon operating remotely while being assisted by a doctor who does not have the same skill level. (Images courtesy of SRI International.)|
|With early work funded by DARPA and NIH, SRI International became involved with telesurgery in the early 1980s. These images from the late 1990s show the surgeon operating remotely while being assisted by a doctor who does not have the same skill level. (Images courtesy of SRI International.)|