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45 - MEDICINE TODAY AND TOMMORROW

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45. MEDICINE TODAY AND TOMMORROW

MEDICINE is a paradox: it is ancient; yet ever new. Its practice is an art; yet that art must be grounded on solid foundations of science, of practicality, and of the needs of the patient. It is one of the most important fields of scientific discipline; yet in practice it must employ and apply essential knowledge gleaned from many other fields of science. Medicine’s practitioners have at their command the epitomization of knowledge and discovery gained over fifty centuries; yet, they face a great wall of unknown factors as formidable as any faced by their predecessors – challenging, baffling, yet urgently demanding solution because of needs of a humanity faced with speeded-up living processes that outdistance man’s ability to adjust.

In his primitive state, man tried to explain the rigors and uncertainties of his surroundings by imagining himself a toy of the gods. He sought relief by attempts to propitiate the unknown. Today, with tools of many sciences at hand, man seeks to grasp reality and to surround himself with the comforts and conveniences that he and his fellows have wrought, and to push on to new horizons. His knowledge and his skills give him visions of goals undreamed a few decades ago; and confidence to move boldly toward these objectives. This confidence bolsters him and carries him forward – until illness and distress strike him. Then, modern man reacts much in the same manner as did his ancestors: he seeks help, turning to man of religion and of medicine, reaching out for someone in whom he can have faith and who may be able to help restore his health and his confidence in himself.
Never before in the world’s history have its people had the advantage of medicines and medical services equal to those available today. The knowledge gained by countless generations of dedicated medical men is at the command of today’s physician, and through him, is brought to focus upon the needs of the individual patient at the bedside, in the laboratory, in the consultation room, and in the hospital.

During no period in history has man experienced such rapid and revolutionary advances in medicine and in opportunity for improved health as during the twentieth century; and the accelerated pace of scientific research holds promise of still greater advances in the years ahead.

As the twentieth century opened, the great gains of the nineteenth century were being consolidated and perfected: anesthesia and asepsis were becoming better understood, as were the medical potentials of x-rays. Together they combined to make possible tremendous advances in surgery. The field of biological medicines – vaccines to prevent diseases and antitoxins to combat them – was expanding rapidly. Chemotherapy, which had already developed basic analgesics such as aspirin and phenacetin, was on the verge of blossoming to full potential.

Early in the century, dependence on drugs or vegetable origin – largest source of medicines then available to practicing physicians – began to wane as scientific advances improved the whole field of drug therapy. While many valuable drugs still in use were originally derived from vegetable sources (ephedrine, reserpine), disappearance of many medicines of doubtful value was hastened by the contributions of chemotherapy. Given impetus by Ehrlich’s creation of the arsphenamines as specifics for syphilis, chemists brought forth a number of new classes of medicines – anesthetics, barbiturates, and antimalarials. However, research in chemotherapy did not hit its full stride until, about 1937, sulfanilamide and its chemical relatives entered the physician’s armamentarium. Following upon the sulfas came the antibiotics – an entirely new concept in development of drugs. Demonstration that hitherto deadly diseases could be treated successfully.

With these new medicines reestablished confidence in chemotherapy and initiated a tremendous advance in industrial medicinal and chemical research. Laboratories increased their scientific manpower by a hundredfold. There resulted a tremendous speedup of discovery and development of new compounds useful to medicine.

Meantime, research was bearing fruit in other areas. The use of hormones in medicine, first by employing thyroid extract, in 1891, for treatment of myxedema, followed by the discovery of epinephrine, first made available by Parke-Davis, which marketed its Adrenalin® brand in 1900, led to examination of other glandular functions. From one phase of this study came the theory that in 1921 led Banting and Best to the discovery of insulin, which prolonged and saved lives of millions of diabetics. From hormone research there also developed study of the complex chemistry of steroids, opening another new source of compounds useful to medicine.

The study of vitamin deficiencies got under way with the work of many men in many countries, encouraged by the findings of Eijkman and his associates in the Far East, of Casimir Funk, in 1911, and of Joseph Goldberger in 1914, in the United Stated. These scientific studies led not only to better understanding of causes and treatment of vitamin deficiencies, but to improved nutritional practices. New food products, and new methods of preparing and preserving natural vitamin content of foods, as well as fortification of foods with additives, have gone a long way in prevention of deficiency diseases that once plagued a large sector of the population. Pellagra, beriberi, and rickets have largely disappeared in world areas where preventive nutritional measures are understood and practiced.

Need for improved sulfa drugs stimulated chemists to make thousands of experiments with synthetic compounds, many of which led them to previously unexplored bypaths. Form these experiments came compounds that opened several new areas of endeavor. Promin® (sodium glucosulfone), the first synthetic drug to prove truly effective in arresting leprosy, resulted from the new intense interest in synthetic compounds. Out of research studies of sulfa derivatives have come a group of oral diuretic compounds; and of oral antidiabetic drugs that supplement and sometimes replace injections of insulin. Other areas of chemotherapeutic development include the psychic energizers; the tranquilizers; the antihistamines; the anticoagulants; and a group of compounds that hold promise of leading to control of certain types of tumors. Paralleling development of synthetic medicinal compounds has been that of improved insecticides. While new medicines can cure many insect-borne diseases, far more progress toward elimination of these problems, especially of malaria and of yellow fever, has been made through preventive measures. Spraying of swamplands, of huts and homes, and of individuals with DDT or compounds that developed from this field of research, has resulted in great savings economically in many world areas, as well as prevention of human misery and incapacitation. Research into use of recently discovered compounds in animal feeds has added to production and to improvement of meat and poultry food products. Improved agricultural fertilizers have increased yields and quality of food crops. All of these auxiliary results of scientific research have made indirect but important contributions to human health.

Developments no less spectacular and important to the patients whom medical men serve have come from other fields.

Great improvements have been made in anesthetics, both injectable and inhalant types. Understanding of important of electrolyte balance in body fluids has made possible advances in surgery and has improved patients’ likehood of rapid recovery. Physicomedical developments, such as the artificial lung, the artificial kidney, and the artificial heart, have greatly extended the surgeon’s field of operation. Tissue banks, making possible such procedures as corneal transplants, replacement of arteries, of bones, and other parts of the body, have enabled medical men to restore to useful lives patients who otherwise would have been cripples. Recognition of importance of fractions of the blood, and of how to utilize these substances, extended lives of still another group of patients.

Bold explorations into brain surgery, better diagnosis of mental diseases, advances in psychiatry, and employment of tranquilizers and psychic energizers, all have contributed greatly to restoring afflicted persons to normalcy, and to reduction of population of mental care institutions.

Heart surgery – going far beyond procedures thought possible a decade or two ago – has corrected many lesions, congenital or chronic, and given chance of useful life to persons otherwise doomed to death or crippling. Mechanical developments, such as artificial heart valves, and electronic equipment that will stimulate or regulate performance of abnormal hearts, also have contributed tremendously to welfare and comfort of many people.

Application of new knowledge of radiation, and especially adaptation to medical use of products of the atomic age, have further extended lives of persons suffering from lesions beyond reach of surgery.

These developments of the twentieth century not only have revolutionized the therapeutic practice of the medical profession; they have had an impact upon the lives of every person in the civilized world:
Approximately a quarter century has been added to the life expectancy of persons born in the 1960’s as compared with those born in the 1900’s.

Millions of people are living today who would have died from infectious diseases under conditions existing during the first quarter of this century.

The death rate of mothers during childbirth has declined ninety per cent, and infant mortality has been greatly reduced during this century.

Deaths from influenza have been cut ninety per cent in twenty five years; deaths from tuberculosis and from rheumatic fever the down more than eighty per cent.

Due to extension of the work begun on vaccines and biological medicines just before the turn of the century, diphtheria and small-pox have nearly disappeared; typhoid and tetanus are seldom encountered in settled communities; and the threat of polio has been largely diminished.

Ninety per cent of the drugs which physicians prescribe today were unknown twenty-five years ago.
There have been many changes in the practice of medicine, too. Specialization has increased, with disciplines and boards to govern each group. While the old-style “family doctor” has largely disappeared, general practitioners have organized courses for postgraduate education that assure continuation of high standards of family care in neighborhoods and in smaller centers of population. Further – more, they are not allowing educators to overlook the future need for general physicians.
The rise of prepaid hospital, surgical, and medical care also has had its impact upon medical men and their patients. Further experience with these comparatively new services undoubtedly will solve their “growing pains” problems and bring about standards beneficial to all concerned.

As improved methods of medical care and better medicines have become available and the average life expectancy of people has been lengthened, new problems have arisen for patients, for physicians, for other health professions, and for research workers. Lowering of death rates from infectious diseases has resulted in more persons reaching the older age brackets, and consequent medical focus on groups of diseases that were not so frequently seen in the past. The degenerative diseases, particularly those affecting the circulatory system, mental processes, and various forms of cancer, now rank among the foremost afflictions demanding the skills of physicians, surgeons, and researchers.

In addition, psychosomatic considerations are demanding more and more of the attention of medical men, as their patients are affected by the pressures and stresses of modern working and living. To this may be added the concern which physicians share with sociologists and engineers for the sociopsychological aspects of the rising rate of accidental injuries, particularly those influenced by the hazards of man and rapid transportation.

Future research in the various scientific fields related to medicine may be expected to bring about breakthroughs in new areas that will be of benefit to the people of the world. Research having to do with preventive medicine, chemotherapy, antibiotics, and hormones show great future promise. The intensive search for agents – biological as well as chemical – effective against cancer undoubtedly will uncover means of combating various forms of this dread killer.

What will the space age, just ahead, mean to medicine? No one can tell – but in all likelihood, citizens of the twenty – first century will be able to look back upon medicine of our day with much of the same combination of superiority, humor and pity as that which we are likely to regard the practices and remedies of nineteenth – century physicians. However, it must be realized that such feelings of superiority or humor are not justified; we owe a great deal of gratitude to the physicians of the nineteenth century for the contributions which they made. Among these nineteenth – century for the contributions which they made. Among these nineteenth – century advances, one has only to consider recognition that germs are a cause of disease; advances in understanding of anatomy and of cellular pathology; discovery of the principles of anesthesia and of asepsis; of bacteriology, and of biological medicines; of physical devices, such as the ophthalmoscope, the otoscope, the stethoscope, and x-rays. Literally, physicians and scientist of today stand upon the shoulders of those stalwarts of yesterday. It seems certain that, as more scientific and technological advances are made, they will contribute, directly or indirectly, to products and procedures that will increase the effectiveness of the physician’s therapy, and extend the operative field of the surgeon.
Indeed, the future will bring changes in the practice of medicine and of surgery, in hospital care, in relationships with patients. A move sophisticated people will demand services in keeping with the advancing world. However, whatever the age of stage of world after their will be men and women, educated, experienced, dedicated and imbued with compassion, ready to offer help to persons who had their medical ministrations.

However highly placed or lowly may be the individual’s positives the future socioeconomic scheme – when his child cries out in the right racked with pain and fever, the first thought will be: “Call the doctor When he or she personally falls ill – age – old instincts of fear and a self-preservation will cut through the veneer of sophistication and turn the ailing one’s mind to the question that has been heard the centireus:

“Doctor, I’m sick. What can you do for me?