医学

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医学
Marble statue of Asclephius on a pedestal, symbol of medicine in Western medicine
ギリシャ神話の医術の神アスクレーピオスの像、蛇が巻きついたアスクレピオスの杖を持つ
Specialist医学分野
Glossary医学用語

医学とは、患者をケアし、そのけが、病気、健康増進の診断、予後、予防、治療、緩和を管理する科学と実践である。医学は、病気の予防と治療によって健康を維持・回復するために発展した様々な医療行為を包含している。現代医学は、生物医学、生物医学研究、遺伝学、医療技術を応用して、傷病の診断、治療、予防を行う。一般的には医薬品の投与や外科手術を行うが、心理療法、外反、牽引、医療機器、生物製剤、電離放射線など様々な治療法がある。

医学は先史時代から行われており、そのほとんどの期間、医学は芸術（技術や知識の領域）であり、しばしばその土地の文化の宗教的・哲学的信念と結びついていた。例えば、呪術医が薬草を塗って治癒の祈りを捧げたり、古代の哲学者や医師が四体液説の理論に従って瀉血を施したりする。近代科学の出現以来、ここ数世紀、ほとんどの医学は芸術と科学（医学(medical science)の傘の下で、基礎と応用の両方）の組み合わせになっている。例えば、縫合糸を縫う技術は練習によって習得される芸術であるが、縫合される組織の細胞レベルや分子レベルで何が起こっているかという知識は科学によって生まれる。

現在では伝統医学や民間療法として知られる、科学的根拠のない医学は、代替医療と呼ばれている。安全性や有効性に懸念がある科学的医学以外の代替療法は、ヤブ医者と呼ばれる。

語源

医学(UK: /ˈmɛdsɪn/ (listen), US: /ˈmɛdɪsɪn/ (listen)) とは、病気の診断、予後、治療、予防に関する科学と実践のことである。"医学"の語源は、 ラテン語の medicusから来ており、医師を意味する。

臨床実習

植民地時代の医学を描いた油絵
ルーク・フィルデス卿作ドクター（1891年）
米国初の女性医師エリザベス・ブラックウェルはSUNYアップステートを卒業した（1847年）

文化や技術の地域差により、医薬品が入手可能な地域や臨床現場は世界各地で異なる。近代科学医学は西洋世界では高度に発達している一方、アフリカやアジアの一部のような発展途上国では、エビデンスや効能に乏しく、医療に正式な訓練を義務付けていない伝統医学に頼ることが多い。

先進国では、エビデンスに基づく医療は臨床で普遍的に用いられているわけではない、 例えば、2007年に行われた文献レビューの調査では、治療の約49％が、有益性または有害性のいずれかを裏付ける十分な証拠を欠いていた。

現代の臨床現場では、医師と医師助手は、臨床的判断を用いて病気を診断し、予後を予測し、治療し、予防するために、患者を個人的に評価する。医師と患者の関係は通常、患者の病歴とカルテの調査から始まり、問診と身体診察が続く。基本的な診断医療機器（聴診器、舌圧子など）が通常使用される。徴候を調べ、症状を問診した後、医師は医学的検査（血液検査など）を指示したり、生検を行ったり、医薬品やその他の治療法を処方したりする。鑑別診断法は、提供された情報に基づいて病態を除外するのに役立つ。診察の際、関連するすべての事実を患者に正しく伝えることは、患者との関係や信頼関係を築く上で重要なことである。この医療行為は、多くの法域で法的文書である医療記録に記録される。経過観察はより短時間で済むかもしれないが、一般的な手順は同じであり、専門医も同様のプロセスを踏む。診断と治療には、問題の複雑さに応じて、数分しかかからない場合もあれば、数週間かかる場合もある。

問診とカウンセリングは以下の通り:

  • 主訴(CC): 現在の受診の理由。これは症状である。患者自身の言葉で書かれ、それぞれの期間とともに記録される。'主訴(chief concern)'または1'主訴提示(presenting complaint)'とも呼ばれる。
  • 現病歴（History of present illness：HPI）：症状の時系列的な順序と、各症状の詳細な説明である。過去病歴（PMH）と呼ばれることもある。病歴はHPIとPMHからなる。
  • 現在の活動：職業、趣味、患者が実際に行っていること。
  • 医薬品(Rx)：処方薬、市販薬、家庭薬、代替薬や漢方薬など、患者が服用している薬物。アレルギーも記録する。
  • 過去の病歴（PMH/PMHx）：同時発生した医学的問題、過去の入院や手術、怪我、過去の感染症や予防接種、既知のアレルギー歴など。
  • 生活履歴（SH）：出生地、居住地、婚姻歴、社会的・経済的地位、習慣（食事、医薬品、タバコ、アルコールを含む）。
  • 家族歴（FH）：患者に影響を及ぼす可能性のある家族の疾患のリスト。家系図が用いられることもある。
  • システム・レビュー（ROS）またはシステム探求：質問すべき一連の追加質問、 一般的な問診（体重減少、睡眠の質の変化、発熱、しこりやこぶに気づいたか、など）に続いて、身体の主な臓器系（心臓、肺、消化管、尿路など）に関する問診を行う。

身体診察とは、客観的で観察可能な疾患の医学的徴候があるかどうかを調べることであり、患者が自発的に訴え、必ずしも客観的に観察できない症状とは対照的である。医療従事者は、視覚、聴覚、触覚、時には嗅覚（感染症、尿毒症、糖尿病性ケトアシドーシスなど）を用いる。身体診察の基本は、検査、触診（触る）、打診（叩いて共鳴特性を調べる）、聴診（聞く）の4つの行為であり、一般的にはこの順番であるが、腹部の評価では打診と触診の前に聴診が行われる。

臨床検査では以下のことを調べる：

病歴の中で強調された関心分野に焦点を当てることになると思われ、上記のすべてが含まれるとは限らない。

治療計画には、臨床検査や画像検査の追加、治療の開始、専門医への紹介、経過観察などが含まれる。経過観察が勧められることもある。健康保険制度やマネージドケア制度によっては、検査の事前承認など様々な形態の "利用審査"が、高額なサービスへのアクセスを阻むこともある。

医療上の意思決定（MDM）プロセスでは、上記のすべてのデータを分析・統合して、可能性のある診断（鑑別診断）のリストを作成し、患者の問題を説明する確定診断を得るために何をすべきかを考える。

その後の診察では、新たな病歴、症状、身体所見、検査や画像診断の結果、専門医の診察などを得るために、このプロセスを省略した形で繰り返すこともある。

施設

古代の病院を描いたフレスコ画
サンタ・マリア・デッラ・スカラ病院、ドメニコ・ディ・バルトロによるフレスコ画、1441-1442年

現代の医療は、一般的に医療制度の中で行われている。法律、資格認定、資金調達の枠組みは各国政府によって確立され、時には教会などの国際組織によって補強されることもある。どのような医療制度であっても、その医薬品が医療のあり方に大きな影響を与える。

古来、キリスト教が実践的な慈善を重視した結果、組織的な看護や病院が発展し、今日でもカトリック教会が世界最大の非政府医療サービス提供者である。先進工業国（米国を除く）と多くの発展途上国は、国民皆保険制度を通じて医療サービスを提供している。この制度は、一人払いの医療制度、あるいは強制加入の民間医療保険や協同組合医療保険を通じて、すべての人に医療を保証することを目的としている。これは、支払い能力よりも必要性に基づいて、全国民が医療を受けられるようにすることを目的としている。医薬品は、民間の診療所、国営の病院や診療所、慈善団体によって提供されるが、最も一般的なのは、これら3つの組み合わせである。

ほとんどの部族社会では、国民全体に対する医療の保証はない。そのような社会では、医療費を支払う余裕のある人や、（直接または雇用契約の一部として）自己保険に加入している人、あるいは政府や部族が直接資金援助する医療でカバーされている人が、医療を受けることができる。

さまざまなサイズのガラス瓶のコレクション
最新の薬物アンプル

情報の透明性は、医療提供システムを定義するもうひとつの要素である。病態、医薬品、品質、価格に関する情報へのアクセスは、患者・消費者の選択、ひいては医療従事者のインセンティブに大きく影響する。米国の医療制度は、開放性が欠如しているとして非難を浴びているが、新しい法律が開放性の拡大を促すかもしれない。一方では透明性の必要性、他方では患者の守秘義務や商業的利益のための情報搾取の可能性といった問題との間に緊張関係があると認識されている。

医療でケアを提供する医療専門家は、医者、看護師、理学療法士、心理学者など複数の職種から構成されている。これらの専門職は、それぞれ独自の倫理基準、専門教育、組織を持っている。医療専門職は社会学的観点から概念化されてきた。

引渡し

「Health care/ja」、「clinic/ja」、「hospital/ja」、および「hospice/ja」も参照

医療の提供は、一次医療、二次医療、三次医療に分類される。

看護師3人の写真
パプアニューギニア東部ニューブリテン州ココポの看護師たち

一次医療サービスは、医師、医師助手、看護師、または医療やケアを求める患者と最初に接触するその他の医療専門家によって提供される。これらは、医院、診療所、ナーシングホーム、学校、訪問診療など、患者の身近な場所で行われる。医療機関の受診の約90％は、一次医療提供者によって治療される。これには、急性および慢性疾患の治療、予防ケア、すべての年齢および男女を対象とした健康教育が含まれる。

二次医療サービスは、最初に診断や治療を行った一次医療提供者から紹介された患者に対して、専門医がオフィスや診療所、または地域のコミュニティ病院で提供するものである。紹介は、専門医の専門知識や処置が必要な患者に対して行われる。これには、外来診療と入院診療の両方、救急部、集中治療部、手術部、理学療法部、分娩部、内視鏡検査部、診断検査部、画像診断部、ホスピスセンターなどが含まれる。一次医療の提供者の中には、入院患者の世話や分娩を二次医療の場で行う場合もある。

三次医療サービスは、地域の病院では一般的に利用できない診断・治療設備を備えた専門病院や地域センターによって提供される。これには、外傷センター、火傷治療センター、高度新生児科、臓器移植、ハイリスク妊娠、放射線腫瘍学などが含まれる。

現代の医療は情報にも依存しており、多くの医療現場ではいまだに紙の記録で提供されているが、最近では電子的手段によるものも増えている。

低所得国では、近代的な医療は一般人には高すぎることが多い。国際的な医療政策研究者たちは、このような地域では、アクセスを確保するために利用料を撤廃するよう提唱しているが、撤廃された後でも、かなりのコストと障壁が残っている。

処方と調剤の分離とは、処方箋を出す医師が、処方薬を提供する薬剤師から独立している医療・薬局における慣行である。欧米諸国では、薬剤師を医師から切り離す伝統が何世紀も続いている。アジア諸国では、医師も薬物を提供するのが伝統的である。

分科

ミズーリ州セントルイスの訪問看護婦と薬と赤ん坊を描いたマルグリット・マーティンの絵（1918年）

学際的なチームとして協力し合いながら、医療従事者以外にも多くの高度な訓練を受けた医療専門家が、現代医療の提供に携わっている。例えば、看護師、救急救命士と救急医療隊員、検査技師、薬剤師、足病医、理学療法士、呼吸療法士、言語聴覚士、作業療法士、放射線技師、栄養士、生物工学者、医学物理学者、外科医、外科医助手、外科技師などである。

人間の医学を支える範囲と科学は、他の多くの分野と重複している。病院に入院した患者は通常、主な問題点に基づいて特定のチーム、例えば循環器科チームのケアを受けるが、その後、主な問題点やその後の合併症・進展の診断や治療のために、他の専門分野、例えば外科や放射線科と連携することがある。

医師には多くの専門分野があり、以下に挙げるような特定の医学分野に特化したサブスペシャリゼーションがある。特定のサブスペシャリティがどの専門分野であるかについては、国によって違いがある。

医学の主な分野は以下の通りである：

基礎科学

  • 解剖学は、生物の物理的構造を研究する学問である。巨視的または肉眼的解剖学とは対照的に、細胞学と組織学は微視的構造を扱う。
  • 生化学は、生体内で起こる化学、特に化学成分の構造と機能を研究する学問である。
  • バイオメカニクスとは、力学の手法を用いて生体システムの構造と機能を研究する学問である。
  • 生物統計学は、広義の生物学分野への統計学の応用である。生物統計学の知識は、医学研究の計画、評価、解釈に不可欠である。また、疫学やエビデンスに基づく医療においても基礎となる。
  • 生物物理学は、物理学と物理化学の手法を用いて生物システムを研究する学際的な科学である。
  • 細胞学は、個々の細胞の顕微鏡的研究である。
ルイ・パスツール、1985年、アルバート・エーデルフェルト作、彼の研究室にて

専門分野

詳細は「診療科」を参照

広義の「医学」にはさまざまな専門分野がある。英国では、ほとんどの専門分野に独自の団体や大学があり、独自の入学試験を行っている。これらは総称してロイヤル・カレッジ（Royal Colleges）と呼ばれるが、現在、すべてのカレッジが「ロイヤル」という言葉を使用しているわけではない。専門分野の発展は、新しい技術（効果的な麻酔法の開発など）や仕事の方法（救急診療科など）によって推進されることが多い。新しい専門分野は、医師の統一組織の形成や、独自の試験を実施する威信につながる。

医学界では、専門医は通常2つのカテゴリーに大別される： 「医学」と「外科学」である。「医学」は手術以外の医療行為を指し、その下位専門科のほとんどは、内科の予備訓練を必要とする。英国では伝統的に、王立医師協会（MRCP）の会員資格試験、またはスコットランドやアイルラ ンドではそれに相当する大学の会員資格試験に合格することで証明されてい た。「外科」 は手術医学の実践を指し、この分野のほとんどのサブ スペシャリティは、一般外科の予備訓練が必要であり、 英国では英国王立外科学会（Royal College of Surgeons of England：MRCS）の会員資格につながる。現在、医学の中には、放射線学、病理学、麻酔学な ど、これらのカテゴリーのどちらにも当てはまりにくい 専門分野もある。たとえば麻酔科は、王立麻酔科医学会となる前に、まず王立外科医学会（MRCS/FRCSが必要だった）の学部として発展し、王立麻酔科医学会（FRCA）の会員になるには、王立麻酔科医学会（FRCA）の試験を受ける必要がある。

Surgical specialty

Main article: Surgery
Surgeons in an operating room

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as disease or injury, 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 as ophthalmology and dermatology, 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:

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

Internal medicine specialty

Main article: Internal medicine

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 nations, such specialists are often called physicians. 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.

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; such general 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 and nephrologists specialize respectively in diseases of the gut and the kidneys.

In the Commonwealth of Nations and some other countries, specialist pediatricians and geriatricians are also described as specialist 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 of primary care.

There are many subspecialities (or subdisciplines) of internal medicine:

Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on medical education and physician 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 as anaesthetics): 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, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
  • Family medicine, family practice, general practice or primary 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.
Gynecologist Michel Akotionga of Ouagadougou, Burkina Faso

Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

Education and legal controls

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

Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by a period of supervised practice or internship, or residency. 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, a Doctor of Medicine degree, often abbreviated M.D., or a Doctor 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 require continuing medical education. Medical practitioners upgrade their knowledge in various ways, including medical 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 at http://data.medobjectives.marian.edu/.

Headquarters of the Organización 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 against charlatans 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.

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 of medical malpractice and be subject to civil, criminal, or professional sanctions.

Medical ethics

Main article: Medical ethics
A 12th-century Byzantine manuscript of the Hippocratic 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 and honesty – the concept of informed consent has increased in importance since the historical events of the Doctors' 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 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.

History

Main article: History of medicine
Statuette of ancient Egyptian physician Imhotep, 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, or 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, Ayurvedic medicine (in the Indian subcontinent), classical Chinese medicine (predecessor to the modern traditional Chinese medicine), and ancient Greek medicine and Roman medicine.

In Egypt, Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldest 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.

Mosaic on the floor of the Asclepieion of Kos, depicting Hippocrates, with Asklepius in the middle (2nd–3rd century)

In Greece, the 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, chronic, 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 Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.

Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC comes from the 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 Byzantine Era, with the physician Asaph the Jew.

Middle Ages

A manuscript of Al-Risalah al-Dhahabiah by Ali al-Ridha, the eighth Imam of Shia Muslims. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to al-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 the Byzantine Empire.

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 Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote The Canon of Medicine which became a standard medical text at many medieval European universities, considered one of the most famous books in the history of medicine. Others include Abulcasis, Avenzoar|Ibn Zuhr|Avenzoar, Ibn al-Nafis, and Averroes. Persian physician Rhazes was one of the first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine. Some volumes of 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 Bimaristan hospitals were an early example of public hospitals.

In Europe, Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historian Geoffrey Blainey likened the activities 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. The Benedictine 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 great Abbey of Cluny. The Church also established a network of cathedral schools and universities where medicine was studied. The Schola Medica Salernitana in Salerno, looking to the learning of Greek and Arab physicians, grew to be the finest medical school in Medieval Europe.

Siena's Santa 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 century 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 Gabriele Falloppio and William Harvey.

The major shift in medical thinking was the gradual rejection, especially during the 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 Copernicus's rejection of 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 Materia Medica and Pharmacopoeia.

Andreas Vesalius was the author of De humani corporis fabrica, an important book on human anatomy. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology. Independently from Ibn al-Nafis, Michael Servetus rediscovered the pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by Renaldus Columbus and Andrea 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".

Modern

Paul-Louis Simond injecting a plague vaccine in Karachi, 1898

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

Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours|humorism|four humours" and other such pre-modern notions. The modern era really began with 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), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900.

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

From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet.

Others that did significant work include William 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); and Harvey Cushing (United States).

As science and technology developed, medicine became more reliant upon medications. 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. Pharmacology developed in part from herbalism and some drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc.). Vaccines were discovered by Edward Jenner and Louis Pasteur.

The first antibiotic was arsphenamine (Salvarsan) discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by German chemists originally from azo dyes.

Packaging of cardiac medicine at the Star pharmaceutical factory in Tampere, Finland in 1953.

Pharmacology has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce side-effects. Genomics and knowledge of human genetics and human evolution is having increasingly significant influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology, evolution, and genetics are influencing medical technology, practice and decision-making.

Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information 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. The Cochrane 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.

Quality, efficiency, and access

Evidence-based medicine, prevention of medical error (and other "iatrogenesis"), and avoidance of unnecessary 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 but population health metrics lag similar nations.

Globally, many developing countries lack access to care and access to medicines. As of 2015, most wealthy developed countries provide health care to all citizens, with a few exceptions such as the United States where lack of health insurance coverage may limit access.

See also

Main articles: Outline of medicine, Outline of health, and Glossary of medicine
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