Medicine: Difference between revisions

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 the [[Royal 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 the [[Wikipedia:Royal College of Surgeons of England|Royal 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 a [[Faculty (teaching staff)|faculty]] of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the [[Wikipedia:Royal College of Anaesthetists|Royal 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).

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

[[File:Changing lives for girls and women every week (12330467294).jpg|thumb|[[Gynecologist]] Michel Akotionga of [[Ouagadougou]], [[Burkina Faso]]]]

* ''[[Aerospace medicine]]'' deals with medical problems related to flying and [[Human spaceflight|space travel]].

* ''[[Medical ethics]]'' deals with [[ethic]]al and [[moral]] principles that apply values and judgments to the practice of medicine.

* ''[[Biomedical Engineering]]'' is a field dealing with the application of [[engineering]] principles to medical practice.

* ''[[Evolutionary medicine]]'' is a perspective on medicine derived through applying [[Evolution|evolutionary theory]].

* ''[[Forensic medicine]]'' deals with medical questions in [[legal]] context, such as determination of the time and cause of death, type of weapon used to inflict trauma, reconstruction of the facial features using remains of deceased (skull) thus aiding identification.

* ''[[Hospital medicine]]'' is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called [[hospitalist]]s in the United States and [[Canada]]. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role.

* ''[[Medical humanities]]'' includes the [[humanities]] ([[literature]], [[philosophy]], [[ethics]], history and religion), [[social science]] ([[anthropology]], [[cultural studies]], [[psychology]], [[sociology]]), and the arts ([[literature]], theater, film, and [[visual arts]]) and their application to [[medical education]] and practice.

* ''[[Health informatics]]'' is a relatively recent field that deal with the application of computers and [[information technology]] to medicine.

* ''[[Sports medicine]]'' deals with the treatment and prevention and rehabilitation of sports/exercise injuries such as [[muscle spasm]]s, [[muscle tear]]s, injuries to ligaments (ligament tears or ruptures) and their repair in [[sportsperson|athletes]], [[amateur]] and [[professional]].

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 against [[charlatan]]s that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or [[Hippocratic]] Medicine, they are not intended to discourage different paradigms of health.

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 ethical [[dilemma]] 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 refuse [[blood transfusions]], considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

[[File:Imhotep-Louvre.JPG|thumb|left|upright|Statuette of ancient Egyptian physician [[Imhotep]], the first physician from antiquity known by name]]

[[Prehistoric medicine]] incorporated plants ([[herbalism]]), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests, [[shamans]], or [[medicine man|medicine men]]. Well-known spiritual systems include [[animism]] (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); and [[divination]] (magically obtaining the truth). The field of [[medical 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 from [[ancient Egyptian medicine]], [[Babylonian Medicine]], [[Ayurveda|Ayurvedic]] medicine (in the [[Indian subcontinent]]), [[classical Chinese medicine]] (predecessor to the modern [[traditional Chinese medicine]]), and [[ancient Greek medicine]] and [[Medicine in ancient Rome|Roman medicine]].

In Egypt, [[Imhotep]] (3rd millennium BCE) is the first physician in history known by name. The oldest [[Egyptian medical papyri|Egyptian medical text]] is the ''[[Kahun Gynaecological Papyrus]]'' from around 2000 BCE, which describes gynaecological diseases. The ''[[Edwin Smith Papyrus]]'' dating back to 1600 BCE is an early work on surgery, while the ''[[Ebers Papyrus]]'' dating back to 1500 BCE is akin to a textbook on medicine.

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

In India, the surgeon [[Sushruta]] described numerous surgical operations, including the earliest forms of [[plastic surgery]]. Earliest records of dedicated hospitals come from Mihintale in [[Sri Lanka]] where evidence of dedicated medicinal treatment facilities for patients are found.

[[File:HSAsclepiusKos retouched.jpg|thumb|upright=1.1|Mosaic on the floor of the [[Asclepieion]] of Kos, depicting [[Hippocrates]], with [[Wikipedia:Asklepius|Asklepius]] in the middle (2nd–3rd century)]]

In Greece, the [[Ancient Greek medicine|Greek physician]] [[Hippocrates]], the "father of modern medicine", laid the foundation for a rational approach to medicine. Hippocrates introduced the [[Hippocratic Oath]] for physicians, which is still relevant and in use today, and was the first to categorize illnesses as [[Acute (medical)|acute]], [[Chronic (medicine)|chronic]], [[Endemic (epidemiology)|endemic]] and epidemic, and use terms such as, "exacerbation, [[relapse]], resolution, crisis, [[paroxysm]], peak, and [[convalescence]]". The Greek physician [[Galen]] 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 the [[Western Roman Empire]] and the onset of the [[Wikipedia:Early Middle Ages|Early Middle Ages]], the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the [[:en:Eastern Roman Empire|Eastern Roman (Byzantine) Empire]].

Most of our knowledge of ancient [[Hebrew medicine]] during the [[:en:1st millennium BC|1st millennium BC]] comes from the [[Wikipedia:Torah|Torah]], i.e. the Five Books of [[Moses]], which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the [[Wikipedia:Byzantine Era|Byzantine Era]], with the physician [[Wikipedia:Asaph the Jew|Asaph the Jew]].

[[File:Al-Risalah al-Dhahabiah.JPG|thumb|left|A manuscript of ''[[Wikipedia:Al-Risalah al-Dhahabiah|Al-Risalah al-Dhahabiah]]'' by [[Wikipedia:Ali al-Ridha|Ali al-Ridha]], the eighth Imam of [[Twelver|Shia Muslims]]. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to [[Wikipedia:al-Ma'mun|al-Ma'mun]]."]]

Although the concept of [[uroscopy]] 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 of [[Theophilus 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.

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into [[Wikipedia:Arabic|Arabic]], and [[Islamic medicine|Islamic physicians]] engaged in some significant medical research. Notable Islamic medical pioneers include the [[:en:Persians|Persian]] [[Wikipedia:polymath|polymath]], [[Wikipedia:Avicenna|Avicenna]], who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote ''[[Wikipedia:The Canon of Medicine|The Canon of Medicine]]'' which became a standard medical text at many medieval European [[:en:University|universities]], considered one of the most famous books in the history of medicine. Others include [[:en:Abu al-Qasim al-Zahrawi|Abulcasis]], [[Wikipedia:Ibn Zuhr|Avenzoar|Ibn Zuhr|Avenzoar]], [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], and [[Wikipedia:Averroes|Averroes]]. Persian  physician [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]] was one of the first to question the Greek theory of [[Wikipedia:humorism|humorism]], which nevertheless remained influential in both medieval Western and medieval [[Islamic medicine]]. Some volumes of [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]]'s work ''Al-Mansuri'', namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of [[pediatrics]], and a pioneer of [[ophthalmology]]. For example, he was the first to recognize the reaction of the eye's pupil to light. The Persian [[Wikipedia:Bimaristan|Bimaristan]] hospitals were an early example of [[Wikipedia:public hospital|public hospital]]s.

However, the fourteenth and fifteenth century [[Wikipedia:Black Death|Black 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. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including [[Wikipedia:Gabriele Falloppio|Gabriele Falloppio]] and [[Wikipedia:William Harvey|William Harvey]].

The major shift in medical thinking was the gradual rejection, especially during the [[Wikipedia:Black Death|Black 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 – see [[:en:Nicolaus Copernicus|Copernicus]]'s rejection of [[Wikipedia:Ptolemy|Ptolemy]]'s theories on astronomy). Physicians like [[Vesalius]] improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were [[Wikipedia:Materia Medica|Materia Medica]] and [[Wikipedia:Pharmacopoeia|Pharmacopoeia]].

Modern scientific [[biomedical research]] (where results are testable and [[reproducible]]) began to replace early Western traditions based on herbalism, the Greek "[[Wikipedia:humorism|four humours|humorism|four humours]]" and other such pre-modern notions. The modern era really began with [[Wikipedia:Edward Jenner|Edward Jenner]]'s discovery of the [[smallpox vaccine]] at the end of the 18th century (inspired by the method of [[inoculation]] earlier practiced in Asia), [[Wikipedia:Robert Koch|Robert Koch]]'s discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of [[antibiotic]]s around 1900.

The post-18th century [[modernity]] period brought more groundbreaking researchers from Europe. From [[Wikipedia:Germany|Germany]] and Austria, doctors [[Wikipedia:Rudolf Virchow|Rudolf Virchow]], [[Wikipedia:Wilhelm Conrad Röntgen|Wilhelm Conrad Röntgen]], [[Wikipedia:Karl Landsteiner|Karl Landsteiner]] and [[Wikipedia:Otto Loewi|Otto Loewi]] made notable contributions. In the [[Wikipedia:United Kingdom|United Kingdom]], [[Wikipedia:Alexander Fleming|Alexander Fleming]], [[:en:Joseph Lister, 1st Baron Lister|Joseph Lister]], [[Wikipedia:Francis Crick|Francis Crick]] and [[Wikipedia:Florence Nightingale|Florence Nightingale]] are considered important. [[:en:Spain|Spanish]] doctor [[Wikipedia:Santiago Ramón y Cajal|Santiago Ramón y Cajal]] is considered the father of modern [[neuroscience]].