Medicine

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Diagnosis, treatment, and prevention of illness
This article is about the science of healing. For medicaments, seeMedication. For other uses, seeMedicine (disambiguation).
Medicine
Marble statue of Asclephius on a pedestal, symbol of medicine in Western medicine
Statue ofAsclepius, theGreek god of medicine, holding the symbolicRod of Asclepius with its coiledserpent
SpecialistMedical specialty
GlossaryGlossary of medicine

Medicine is thescience[1] andpractice[2] of caring for a patient, managing thediagnosis,prognosis,prevention,treatment,palliation of theirinjury ordisease, andpromoting their health. Medicine encompasses a variety ofhealth care practices evolved to maintain and restorehealth by theprevention andtreatment ofillness. Contemporary medicine appliesbiomedical sciences,biomedical research,genetics, andmedical technology todiagnose, treat, and prevent injury and disease, typically throughpharmaceuticals orsurgery, but also through therapies as diverse aspsychotherapy,external splints and traction,medical devices,biologics, andionizing radiation, amongst others.[3]

Medicine has been practiced sinceprehistoric times, and for most of this time it was anart (an area of skill and knowledge), frequently having connections to thereligious andphilosophical beliefs of local culture. For example, amedicine man would applyherbs and sayprayers for healing, or an ancientphilosopher andphysician would applybloodletting according to the theories ofhumorism. In recent centuries, since theadvent of modern science, most medicine has become a combination ofart andscience (bothbasic andapplied, under theumbrella ofmedical science). For example, while stitching technique forsutures is an art learned through practice, the knowledge of what happens at thecellular andmolecular level in the tissues being stitched arises through science.

Prescientific forms of medicine, now known astraditional medicine orfolk medicine, remain commonly used in the absence of scientific medicine, and are thus calledalternative medicine. Alternative treatments outside of scientific medicine with safety and efficacy concerns are termedquackery.

Etymology

Medicine (UK:/ˈmɛdsɪn/ (listen),US:/ˈmɛdɪsɪn/ (listen)) is thescience and practice of thediagnosis,prognosis,treatment, andprevention ofdisease.[4][5] The word "medicine" is derived fromLatinmedicus, meaning "a physician".[6][7]

Clinical practice

Oil painting of medicine in the age of colonialism
The Doctor bySir Luke Fildes (1891)
Elizabeth Blackwell, the first female physician in the United States graduated fromSUNY Upstate (1847)

Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in theWestern world, while indeveloping countries such as parts of Africa or Asia, the population may rely more heavily ontraditional medicine with limited evidence and efficacy and no required formal training for practitioners.[8]

In thedeveloped world,evidence-based medicine is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm.[9]

In modern clinical practice,physicians andphysician assistants personally assess patients in order todiagnose,prognose, treat, and prevent disease using clinical judgment. Thedoctor-patient relationship typically begins an interaction with an examination of the patient'smedical history andmedical record, followed by a medical interview[10] and aphysical examination. Basic diagnosticmedical devices (e.g.stethoscope,tongue depressor) are typically used. After examination forsigns and interviewing forsymptoms, the doctor may ordermedical tests (e.g.blood tests), take abiopsy, or prescribepharmaceutical drugs or other therapies.Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions.[11] Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.

The components of the medical interview[10] and encounter are:

  • Chief complaint (CC): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'chief concern' or 'presenting complaint'.
  • History of presentillness (HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH).Medical history comprises HPI and PMH.
  • Current activity: occupation, hobbies, what the patient actually does.
  • Medications (Rx): what drugs the patient takes includingprescribed,over-the-counter, andhome remedies, as well as alternative andherbal medicines or remedies.Allergies are also recorded.
  • Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, pastinfectious diseases orvaccinations, history of known allergies.
  • Social history (SH): birthplace, residences, marital history, social and economic status, habits (includingdiet, medications,tobacco, alcohol).
  • Family history (FH): listing of diseases in the family that may impact the patient. Afamily tree is sometimes used.
  • Review of systems (ROS) orsystems inquiry: a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed anyweight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart,lungs,digestive tract,urinary tract, etc.).

Thephysical examination is the examination of the patient formedical signs of disease, which are objective and observable, in contrast to symptoms that are volunteered by the patient and not necessarily objectively observable.[12] The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection,uremia,diabetic ketoacidosis). Four actions are the basis of physical examination:inspection,palpation (feel),percussion (tap to determine resonance characteristics), andauscultation (listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments.[13]

The clinical examination involves the study of:[14]

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

The treatment plan may include ordering additionalmedical laboratory tests andmedical imaging studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon thehealth insurance plan and themanaged care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services.[15]

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (thedifferential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

Institutions

Color fresco of an ancient hospital setting
The Hospital ofSanta Maria della Scala, fresco byDomenico di Bartolo, 1441–1442

Contemporary medicine is in general conducted withinhealth care systems. Legal,credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.

From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and theCatholic Church today remains the largest non-government provider of medical services in the world.[16] Advanced industrial countries (with the exception of theUnited States)[17][18] and manydeveloping countries provide medical services through a system ofuniversal health care that aims to guarantee care for all through asingle-payer health care system, or compulsory private or co-operativehealth insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.

Mosttribal societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

collection of glass bottles of different sizes
Modern drugampoules

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness,[19] new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

Thehealth professionals who provide care in medicine comprise multipleprofessions such asmedics,nurses,physio therapists, andpsychologists. These professions will have their ownethical standards, professional education, and bodies. The medical profession have been conceptualized from asociological perspective.[20]

Delivery

See also:Health care,clinic,hospital, andhospice

Provision of medical care is classified into primary, secondary, and tertiary care categories.[21]

Primary care medical services are provided byphysicians,physician assistants,nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care.[22] These occur in physician offices,clinics,nursing homes, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses,preventive care andhealth education for all ages and both sexes.

Secondary care medical services are provided bymedical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient.[23] Referrals are made for those patients who required the expertise or procedures performed by specialists. These include bothambulatory care andinpatient services,Emergency departments,intensive care medicine, surgery services,physical therapy,labor and delivery,endoscopy units, diagnosticlaboratory andmedical imaging services,hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These includetrauma centers,burn treatment centers, advancedneonatology unit services,organ transplants, high-risk pregnancy,radiationoncology, etc.

Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays byelectronic means.

In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain.[24]

Separation of prescribing and dispensing is a practice in medicine and pharmacy in which thephysician who provides amedical prescription is independent from thepharmacist who provides theprescription drug. In theWestern world there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.[25]

Branches

Drawing byMarguerite Martyn (1918) of a visiting nurse in St. Louis, Missouri, with medicine and babies

Working together as aninterdisciplinary team, many highly trainedhealth professionals besides medical practitioners are involved in the delivery of modern health care. Examples include:nurses,emergency medical technicians and paramedics, laboratory scientists,pharmacists,podiatrists,physiotherapists,respiratory therapists,speech therapists,occupational therapists, radiographers,dietitians, andbioengineers,medical physicists,surgeons,surgeon's assistant,surgical technologist.

The scope and sciences underpinning human medicine overlap many other fields. A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e.g., the cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments.

Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.

The main branches of medicine are:

Basic sciences

  • Anatomy is the study of the physical structure oforganisms. In contrast tomacroscopic orgross anatomy,cytology andhistology are concerned with microscopic structures.
  • Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
  • Biomechanics is the study of the structure and function of biological systems by means of the methods ofMechanics.
  • Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental toepidemiology and evidence-based medicine.
  • Biophysics is an interdisciplinary science that uses the methods ofphysics andphysical chemistry to study biological systems.
  • Cytology is the microscopic study of individualcells.
Louis Pasteur, as portrayed in his laboratory, 1885 byAlbert Edelfelt

Specialties

Main article:Medical specialty

In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which has its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (such as emergency departments); the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination.

Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of theRoyal College of Physicians (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of theRoyal College of Surgeons of England (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above; for example anaesthesia developed first as afaculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming theRoyal College of Anaesthetists and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).

Surgical specialty

Main article:Surgery
Surgeons in anoperating room

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat apathological condition such asdisease orinjury, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example,a perforated ear drum). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. In some centers,anesthesiology is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such asophthalmology anddermatology, but are not considered surgical sub-specialties per se.

Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming.

Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training:[26]

Other surgical specialties within medicine with their own individual residency training:

Internal medicine specialty

Main article:Internal medicine

Internal medicine is themedical specialty dealing with the prevention, diagnosis, and treatment of adult diseases.[27] According to some sources, an emphasis on internal structures is implied.[28] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially inCommonwealth nations, such specialists are often calledphysicians.[29] These terms,internist orphysician (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.

Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; suchgeneral physicians would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example,gastroenterologists andnephrologists specialize respectively in diseases of the gut and the kidneys.[30]

In theCommonwealth of Nations and some other countries, specialistpediatricians andgeriatricians are also described asspecialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form ofprimary care.

There are many subspecialities (or subdisciplines) ofinternal medicine:

Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles onmedical education andphysician for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one- to three-year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the US. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.

Diagnostic specialties

Other major specialties

The following are some major medical specialties that do not directly fit into any of the above-mentioned groups:

  • Anesthesiology (also known asanaesthetics): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also serves the same function in the labor and delivery ward, and some are specialized in critical medicine.
  • Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, includingtrauma, surgical, medical, pediatric, and psychiatric emergencies.
  • Family medicine,family practice,general practice orprimary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency department coverage, inpatient care, and nursing home care.

Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

Education and legal controls

Main articles:Medical education andMedical license
Medical students learning about stitches

Medical education and training varies around the world. It typically involves entry level education at a universitymedical school, followed by a period of supervised practice orinternship, orresidency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research. In Canada and the United States of America, aDoctor of Medicine degree, often abbreviated M.D., or aDoctor of Osteopathic Medicine degree, often abbreviated as D.O. and unique to the United States, must be completed in and delivered from a recognized university.

Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities requirecontinuing medical education. Medical practitioners upgrade their knowledge in various ways, includingmedical journals, seminars, conferences, and online programs. A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched athttp://data.medobjectives.marian.edu/.[32]

Headquarters of theOrganización Médica Colegial de España, which regulates the medical profession in Spain

In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard againstcharlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, orHippocratic Medicine, they are not intended to discourage different paradigms of health.

In the European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification.The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC.

Doctors who are negligent or intentionally harmful in their care of patients can face charges ofmedical malpractice and be subject to civil, criminal, or professional sanctions.

Medical ethics

Main article:Medical ethics
A 12th-centuryByzantine manuscript of theHippocratic Oath

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are:

  • autonomy – the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
  • beneficence – a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
  • justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
  • non-maleficence – "first, do no harm" (primum non-nocere).
  • respect for persons – the patient (and the person treating the patient) have the right to be treated with dignity.
  • truthfulness andhonesty – the concept ofinformed consent has increased in importance since the historical events of theDoctors' Trial of the Nuremberg trials,Tuskegee syphilis experiment, and others.

Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethicaldilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuseblood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

History

Main article:History of medicine
For a chronological guide, seeTimeline of medicine and medical technology.
Statuette of ancient Egyptian physicianImhotep, the first physician from antiquity known by name

Ancient world

Prehistoric medicine incorporated plants (herbalism), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests,shamans, ormedicine men. Well-known spiritual systems includeanimism (the notion of inanimate objects having spirits),spiritualism (an appeal to gods or communion with ancestor spirits);shamanism (the vesting of an individual with mystic powers); anddivination (magically obtaining the truth). The field ofmedical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

Early records on medicine have been discovered fromancient Egyptian medicine,Babylonian Medicine,Ayurvedic medicine (in theIndian subcontinent),classical Chinese medicine (predecessor to the moderntraditional Chinese medicine), andancient Greek medicine andRoman medicine.

In Egypt,Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldestEgyptian medical text is theKahun Gynaecological Papyrus from around 2000 BCE, which describes gynaecological diseases. TheEdwin Smith Papyrus dating back to 1600 BCE is an early work on surgery, while theEbers Papyrus dating back to 1500 BCE is akin to a textbook on medicine.[33]

In China, archaeological evidence of medicine in Chinese dates back to theBronze AgeShang Dynasty, based on seeds for herbalism and tools presumed to have been used for surgery.[34] TheHuangdi Neijing, the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.[35]

In India, the surgeonSushruta described numerous surgical operations, including the earliest forms ofplastic surgery.[36][dubious –discuss][37] Earliest records of dedicated hospitals come from Mihintale inSri Lanka where evidence of dedicated medicinal treatment facilities for patients are found.[38][39]

Mosaic on the floor of theAsclepieion of Kos, depictingHippocrates, withAsklepius in the middle (2nd–3rd century)

In Greece, theGreek physicianHippocrates, the "father of modern medicine",[40][41] laid the foundation for a rational approach to medicine. Hippocrates introduced theHippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses asacute,chronic,endemic and epidemic, and use terms such as, "exacerbation,relapse, resolution, crisis,paroxysm, peak, andconvalescence".[42][43] The Greek physicianGalen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of theWestern Roman Empire and the onset of theEarly Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in theEastern Roman (Byzantine) Empire.

Most of our knowledge of ancientHebrew medicine during the1st millennium BC comes from theTorah, i.e. the Five Books ofMoses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in theByzantine Era, with the physicianAsaph the Jew.[44]

Middle Ages

A manuscript ofAl-Risalah al-Dhahabiah byAli al-Ridha, the eighth Imam ofShia Muslims. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, toal-Ma'mun."

The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in theByzantine Empire.[45]

Although the concept ofuroscopy was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such ofTheophilus Protospatharius that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe.[46]

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated intoArabic, andIslamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include thePersianpolymath,Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine".[47] He wroteThe Canon of Medicine which became a standard medical text at many medieval Europeanuniversities,[48] considered one of the most famous books in the history of medicine.[49] Others includeAbulcasis,[50]Avenzoar,[51]Ibn al-Nafis,[52] andAverroes.[53] Persian physicianRhazes[54] was one of the first to question the Greek theory ofhumorism, which nevertheless remained influential in both medieval Western and medievalIslamic medicine.[55] Some volumes ofRhazes's workAl-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities.[56] Additionally, he has been described as a doctor's doctor,[57] the father ofpediatrics,[54][58] and a pioneer ofophthalmology. For example, he was the first to recognize the reaction of the eye's pupil to light.[58] The PersianBimaristan hospitals were an early example ofpublic hospitals.[59][60]

In Europe,Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historianGeoffrey Blainey likened theactivities of the Catholic Church in health care during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. TheBenedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the greatAbbey of Cluny. The Church also established a network ofcathedral schools and universities where medicine was studied. TheSchola Medica Salernitana in Salerno, looking to the learning ofGreek andArab physicians, grew to be the finest medical school in Medieval Europe.[61]

Siena'sSanta Maria della Scala Hospital, one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities to revive the study of sciences, drawing on the learning of Greek and Arab physicians in the study of medicine.

However, the fourteenth and fifteenth centuryBlack Death devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East.[62] In the early modern period, important early figures in medicine and anatomy emerged in Europe, includingGabriele Falloppio andWilliam Harvey.

The major shift in medical thinking was the gradual rejection, especially during theBlack Death in the 14th and 15th centuries, of what may be called the "traditional authority" approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – seeCopernicus's rejection ofPtolemy's theories on astronomy). Physicians likeVesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians wereMateria Medica andPharmacopoeia.

Andreas Vesalius was the author ofDe humani corporis fabrica, an important book onhuman anatomy.[63] Bacteria and microorganisms were first observed with a microscope byAntonie van Leeuwenhoek in 1676, initiating the scientific fieldmicrobiology.[64] Independently fromIbn al-Nafis,Michael Servetus rediscovered thepulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris"[65] in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described byRenaldus Columbus andAndrea Cesalpino.Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708).Pierre Fauchard has been called "the father of modern dentistry".[66]

Modern

Paul-Louis Simond injecting a plague vaccine inKarachi, 1898

Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarianClaude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.

Modern scientificbiomedical research (where results are testable andreproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began withEdward Jenner's discovery of thesmallpox vaccine at the end of the 18th century (inspired by the method ofinoculation earlier practiced in Asia),Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery ofantibiotics around 1900.

The post-18th centurymodernity period brought more groundbreaking researchers from Europe. FromGermany and Austria, doctorsRudolf Virchow,Wilhelm Conrad Röntgen,Karl Landsteiner andOtto Loewi made notable contributions. In theUnited Kingdom,Alexander Fleming,Joseph Lister,Francis Crick andFlorence Nightingale are considered important.Spanish doctorSantiago Ramón y Cajal is considered the father of modernneuroscience.

From New Zealand and Australia cameMaurice Wilkins,Howard Florey, andFrank Macfarlane Burnet.

Others that did significant work includeWilliam Williams Keen,William Coley,James D. Watson (United States);Salvador Luria (Italy);Alexandre Yersin (Switzerland);Kitasato Shibasaburō (Japan);Jean-Martin Charcot,Claude Bernard,Paul Broca (France);Adolfo Lutz (Brazil);Nikolai Korotkov (Russia);Sir William Osler (Canada); andHarvey Cushing (United States).

File:Alexander Fleming.jpg
Alexander Fleming's discovery of penicillin in September 1928 marks the start of modern antibiotics.

As science and technology developed, medicine became more reliant uponmedications. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids.[67]Pharmacology developed in part fromherbalism and some drugs are still derived from plants (atropine,ephedrine,warfarin,aspirin,digoxin,vinca alkaloids,[68]taxol,hyoscine, etc.).[69]Vaccines were discovered byEdward Jenner andLouis Pasteur.

The first antibiotic wasarsphenamine (Salvarsan) discovered byPaul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class ofantibiotics was thesulfa drugs, derived by German chemists originally fromazo dyes.

Packaging ofcardiac medicine at the Star pharmaceutical factory inTampere,Finland in 1953.

Pharmacology has become increasingly sophisticated; modernbiotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduceside-effects.Genomics and knowledge ofhuman genetics andhuman evolution is having increasingly significant influence on medicine, as the causativegenes of most monogenicgenetic disorders have now been identified, and the development of techniques inmolecular biology,evolution, andgenetics are influencing medical technology, practice and decision-making.

Evidence-based medicine is a contemporary movement to establish the most effectivealgorithms of practice (ways of doing things) through the use ofsystematic reviews andmeta-analysis. The movement is facilitated by modern globalinformation science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. TheCochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.[70]

Quality, efficiency, and access

Evidence-based medicine, prevention ofmedical error (and other "iatrogenesis"), and avoidance ofunnecessary health care are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly butpopulation health metrics lag similar nations.[71]

Globally, manydeveloping countries lack access to care andaccess to medicines.[72] As of 2015, most wealthy developed countries providehealth care to all citizens, with a few exceptions such as the United States where lack ofhealth insurance coverage may limit access.[73]

See also

Justapedia supports:
Further information:Outline of medicine,Outline of health, andGlossary of medicine

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