Medicine
Table of contents
This article is about medical science. For substances that treat patients, see drug, medication, and pharmacology.
In the context of the anthropology of religion, see medicine (shamanism) for objects with supernatural power and/or the supernatural power that such items possess.
Medicine is an area of human knowledge concerned with restoring health. It is, in the broadest sense of the term, the science and practice of the prevention and curing of human diseases, and other ailments of the human body or mind. However, it is often used only to refer to those matters dealt with by academically trained physicians and surgeons. There are many traditional and modern methods and schools of healing which are usually not considered to be part of medicine in a strict sense (see health science for an overview).
Medicine has two aspects: both as an area of knowledge (a science), and as an application of that knowledge (the medical professions). Evidence-based medicine is an attempt to link these two aspects through the use of the scientific method and techniques derived from safety engineering.
The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. It may therefore be difficult to distinguish clearly between the science and the profession.
History of medicine
Western medicine
Medicine is currently defined as the science of disease prevention, diagnosis, alleviation and cure. However the Greek pharmakos means both remedy and poison, indicating a more equivocal attitude in the past.
All human societies have medical beliefs – birth, death, disease and cure are explained in some manner. Historically, throughout the world illness has often been attributed to witchcraft and the will of the gods, ideas that still retain some power, even in ‘modern’ societies, with faith-healing and shrines still common.
As socities developed in Europe and Asia belief systems were replaced with a different natural system. The Greeks, from Hippocrates, developed a humoral medicine system where treatment was to restore the balance of humours within the body. Similar views were espoused in China and in India. From the ideas developed in Greece, through Galen until the Renaissance the main thrust of medicine was the maintenance of health by control of diet and hygiene.
Anatomical knowledge was limited and there were few surgical or other cures, doctors relied on a good relation with patients and dealt with minor ailments and soothing chronic conditions while epidemic diseases grew out of urbanization and domestication and then raged across the civilized world.
This idea of personalised medicine was challenged in Europe by the rise of experimental investigation, principally in dissection, examining bodies in a manner alien to other cultures. The work of individuals like Andreas Vesalius and William Harvey challenged accepted folklore with scientific evidence. Understanding and diagnosis improved but with little direct benefit to health.
Few effective drugs existed, beyond opium and quinine, folklore cures and almost or actually poisonous metal-based compounds were popular treatments, if useless. Medicine was aided in the 18th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology (Robert Koch, Louis Pasteur), and for the first time actual cures were developed for certain endemic infectious diseases.
However the decline in the most lethal diseases was more due to improvements in public health and nutrition than to medicine. It was not until the 20th century that there was a true breakthrough in medicine, with great advances in pharmacology and surgery. Modern western medicine, despite the hypochondria of western society, is uniquely effective and widespread compared with all other medical forms. It is notably secular and material, indifferent to ideas of the supernatural or the spirit and concentrating on the body to determine causes and cures.
The harsh scientific nature of modern medicine is the pinnacle of a very narrow concern, a particular aspect of the human condition has been exulted at the cost of considerable social disquiet, as evinced by anti-vivisectionism, eugenics, 18th and 19th century concerns about body-snatching and attacks at doctors for ‘playing god’ in the 20th century. And the capabilities of modern medicine have done little to improve the lot of poorer countries.
Ayurveda
Ayurveda, the Vedic system of medicine, views health as harmony between body, mind and spirit. Its two most famous texts belong to the schools of Charaka and Sushruta. According to Charaka, health and disease are not predetermined and life may be prolonged by human effort. Sushruta defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life.
Ayurveda speaks of eight branches:
- k?y?chikits? (internal medicine),
- shalyachikits? (surgery including anatomy),
- sh?l?kyachikits? (eye, ear, nose, and throat diseases),
- kaum?rabhritya (pediatrics),
- bh?tavidy? (psychiatry, or demonology), and
- agada tantra (toxicology),
- ras?yana (science of rejuvenation), and
- v?j?karana (the science of fertility).
Apart from learning these, the student of ?Ayurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis.
The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines.
At the closing of the initiation, the guru gave a solemn address to the students where the guru directed the students to a life of chastity, honesty, and vegetarianism. The student was to strive with all his being for the health of the sick. He was not to betray patients for his own advantage. He was to dress modestly and avoid strong drink. He was to be collected and self-controlled, measured in speech at all times. He was to constantly improve his knowledge and technical skill. In the home of the patient he was to be courteous and modest, directing all attention to the patient’s welfare.
He was not to divulge any knowledge about the patient and his family. If the patient was incurable, he was to keep this to himself if it was likely to harm the patient or others. The normal length of the student’s training appears to have been seven years. Before graduation, the student was to pass a test. But the physician was to continue to learn through texts, direct observation (pratyaksha), and through inference (anum?na). In addition, the vaidyas attended meetings where knowledge was exchanged. The doctors were also enjoined to gain knowledge of unusual remedies from hillsmen, herdsmen, and forest-dwellers.
Medical sciences and medical professions
Medicine has both its foundational sciences, and specialized branches dealing with particular organs or diseases. The foundational sciences of medicine frequently overlap with other areas of science (such as veterinary science, biology or chemistry).
The primary medical professions are those of physicians and surgeons. Both professions have many specializations and subspecializations. Dentistry and clinical psychology are separate from medicine in a strict sense, but are both medical fields by the wider definition of the term.
There are also many allied health professions (AHPs): pharmacy, physiotherapy, speech and language therapy, occupational therapy, dietetics and bioengineering.
Basic, supplementary and related sciences
Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology 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.
Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
Cytology is the microscopic study of individual cells.
Embryology is the study of the early development of organisms.
Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
Genetics is the study of genes, and their role in biological inheritance.
Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and histochemistry.
Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
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 to epidemiology and evidence-based medicine.
Neuroscience is a comprehensive term for those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain.
Nursing is the diagnosis and treatment of human responses to health and illness. Professional midwifery is a branch of nursing.
Pharmacology is the study of drugs and their actions.
Physiology is the study of the normal functioning of the body.
Toxicology is the study of hazardous effects of drugs and poisons.
Diagnostic and imaging specialties
Clinical microbiology is concerned with the in vitro diagnosis of pathogens such as bacteria, fungi, and protozoa.
Anatomical pathology — Biochemical pathology — Forensic Pathology
Radiology is concerned with imaging of the human body, e.g. by x-ray, x-ray computed tomography, ultra sonography and nuclear magnetic resonance tomography.
Interventional radiology
Nuclear Medicine In nuclear medicine, radioactive substances are used for in vivo and in vitro diagnostics. Another field of nuclear medicine is radiation therapy, i.e. the therapeutic use of radioactive substances as well as other sources of ionizing radiation.
Disciplines of clinical medicine
Anesthesiology is the clinical discipline concerned with providing anesthesia as well as the field of research associated with it.
Dermatology is concerned with the skin and its diseases.
Emergency Medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
General practice or family medicine or primary care
Internal medicine is concerned with diseases of inner organs and systemic dieseases, i.e. such that affect the body as a whole. There are several subdisciplines of internal medicine:
- Cardiology is concerned with the heart and cardiovascular system and their diseases.
- Gastroenterology is concerned with the organs of digestion.
- Endocrinology is concerned with the endocrine system, i.e. endocrine glands and hormones.
- Haematology or hematology is concerned with the blood and its diseases.
- Infectiology is concerned with the study, diagnosis and treatment of infectious diseases.
- Nephrology is concerned with diseases of the kidneys.
- Oncology is devoted to the study, diagnosis and treatment of cancer and other malignant diseases.
- Pulmonology is concerned with with diseases of the lungs.
- Rheumatology is devoted to the diagnosis and treatment of rheumatic diseases.
Neurology is concerned with the diagnosis and treatment of nervous system diseases.
Obstetrics and Gynecology (OB/GYN)
Ophthalmology deals with the diseases of the eye and their treatment.
Otolaryngology or otorhinolaryngology or ENT (ear-nose-throat) medicine is a branch of medicine that specialises in the diagnosis and treatment of ear, nose and throat disorders.
Pediatrics or paediatrics is devoted to the care of infants and children.
Preventive Medicine
Community Health Care — Occupational Medicine
Psychiatry is a branch of medicine that studies and treats mental and emotional disorders.
Psychotherapy
Surgical specialties
There are many medical disciplines that employ operative treatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
General surgery
Abdominal surgery — Vascular surgery — Endoscopic surgery or Minimally invasive surgery — Laparoscopic surgery (keyhole surgery)
Cardiothoracic surgery is the surgical specialty that is concerned with the organs of the chest, including the lungs, the heart, and major blood vessels.
Neurosurgery is concerned with the operative tratment of diseases of the nervous system.
Maxillofacial surgery — Oral surgery
Orthopedic surgery — Trauma surgery or Traumatology
Pediatric surgery
Plastic surgery includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appearance after traumatic or operative mutilation).
Transfusion medicine is concerned with the transfusion of blood and blood components.
Urology focuses on the urinary tracts of males and females, and on the male reproductive system.
Teaching of medicine
Medical training is long and grueling, involving several years of university study followed by several more years of residential practice at a hospital. Most medical students spend some time as an intern — a medical apprenticeship — supervised by other doctors. Entry to a medical degree in some countries (e.g. the United States) requires the completion of another degree first, while in other countries (e.g. Australia — though it is moving towards the American model) medical training can be commenced immediately after secondary education.
The name of the medical degree gained at the end varies: some countries (e.g. the US) call it ‘Doctor of Medicine’ (abbreviated ‘M.D.’), while others (e.g. Australia, Pakistan) call it ‘Bachelor of Medicine/Bachelor of Surgery (Chirurgie)’ (a double degree, frequently abbreviated ‘M.B.B.S’ or ‘M.B.B.Ch.’). In either case graduates of a medical degree may call themselves doctor. In many countries, a doctorate of medicine is not a PhD which requires original research, but is like a doctorate in law (J.D.) or theology (Th.D.).
A graduate can then enter general practice and become a general practitioner; or they can specialise in any one of a number of medical fields, and become a specialist; or they can become a surgeon. No matter what they choose, even more training is involved.
