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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?
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