medicine. A striking feature of warfare up to 1939 is that, with the exception of the Russo-Japanese war of 1904–5, in which battle casualties were extremely heavy, more service personnel were lost to disease and accidental injury than to hostile fire. In this, the Second World War was little different from previous conflicts, with over two-thirds of admissions to hospital, in both Allied and Axis forces, resulting from sickness and injury not sustained in military action. Among British troops in North Africa, for instance, the average number of admissions from sickness was 564 per thousand and the number of battle casualties only 60 per thousand. In north-west Europe the sickness/casualty ratio among British troops was less marked, with an average of 151 admissions per thousand due to disease against 37 per thousand from hostile fire. The incidence of disease among British troops was highest in the South-East Asia Command, with an admission rate of 1,118 per thousand from disease (mainly malaria) and 45 per thousand from wounds. But in all theatres the incidence of most diseases and battle casualties was lower than it had been in the First World War, and for the first time in the history of warfare more service personnel died as a result of wounds sustained in battle than from sickness and disease.

Health, hygiene, and preventive medicine

Table 1 shows dramatic reductions in the incidence of many infectious diseases among British troops in the Second World War as compared with previous conflicts. Note in particular the much lower incidence of diseases such as enteric fever and dysentery. The introduction of preventive inoculation and, since the South African Wars (1899–1902), greater recognition of the importance of sanitary discipline meant that military commanders were by 1939 equipped with the means to keep such diseases under control.

Medicine, Table 1: Major infectious diseases in the British Army during wartime, mean monthly incidence per 1,000 strength

Medicine, Table 2: Infectious diseases notified in France

The medical sciences

It is ironic that the exigencies of warfare have often produced scientific and technical innovations of great benefit to humankind. There can be few better illustrations of this than the development of penicillin during the Second World War. Until the early 1940s bacterial infections resulting from injury and disease were generally treated with sulphonamide drugs, useful in the treatment of pneumonia, for instance, but largely ineffective when employed against streptococcal infections. The limitations of sulphonamides, and their often unpleasant side-effects, spurred research into the development of new drugs on the principle of antagonism between various species of microbe. In 1939, at the Sir William Dunn School of Pathology in Oxford, Professor Howard Florey began an investigation of the anti-bacterial properties of various substances, including Penicillium notatum, first observed by Alexander Fleming ten years before. In May 1940 encouraging results were obtained by Florey and his team in connection with penicillin and streptococcal infections and by 1941 enough evidence had been collected to warrant clinical trials. The tests confirmed that even the most severe bacterial infections could be controlled by penicillin and that it had no harmful side-effects.

However, penicillin could be produced in only minute proportions under laboratory conditions and just one case of severe sepsis might require the processing of up to 2,000 litres (440 gallons) of medium. It seemed that the only way to obtain sufficient quantities of the drug was to enlist the help of industry. But since industrial capacity in the UK was already stretched to its limit, enquiries were made via the Rockefeller Foundation to find a suitable manufacturer in the USA. By 1942 sufficient quantities had been produced by American firms to allow the use of penicillin in the field and in the following year the drug was being used extensively in the treatment of wound infections in North Africa.

The refinement of sulphonamide preparations and later of penicillin had a significant bearing on surgery during the Second World War. Due to the high mobility of armies in the North African desert, it was difficult to operate on wounded men until they had been evacuated to base. Chemotherapy and antibiotics, combined with drainage of the wound and its immobilization, kept the patient relatively comfortable and his wound free from infection until a hospital was reached. More complex surgical procedures such as closure of the wound and skin grafting could take place only when an army's advance was steady and when air superiority ensured constant supplies. For the Allies, these conditions did not occur until the end of the war.

As in former conflicts, surgical techniques themselves evolved to meet the changing demands of warfare. Among the more important developments in 1939–45 were the use of proximal colostomy in cases of injury to the large intestine and improvements in the treatment of burns, such as the saline bath associated with the British doctor A. H. McIndoe. McIndoe's technique, which was not entirely new, involved the immersion of severe limb burns in a bath of flowing saline solution, after which would be applied sulphonamide (later penicillin) powder or cream, and the burns covered with a bandage dressing which was floated off in a subsequent bath. Great strides were also made in anaesthesia—which had progressed relatively slowly in peacetime—with the introduction of ‘closed-circuit’ or ‘local’ anesthesia and of new anaesthetics, given intravenously and orally. Local anaesthesia revolutionized thoracic surgery in the combat zone and paved the way for the inception of cardiac surgery after the war.

Wartime medical research illustrates the trend, evident since the First World War, for scientists to become directly involved in the solution of military problems. The Second World War accelerated this process, with scientists anticipating as well as providing for the needs of the military. One area in which they made an important contribution in this regard was in the field of ‘Services Personnel Research’, which concerned the safety and efficiency of the armed forces. In the UK, working under the auspices of the Medical Research Council, scientists considered means of protecting service personnel against noise, blast, and the vagaries of climate, and nowhere was such research more important than in the field of aviation medicine. High-altitude flying was a miserable and often perilous experience. Bomber crews were regularly subjected to temperatures of 30–50°F below zero and flight surgeons estimated that half of all crewmen suffered from the effects of oxygen starvation. Oxygen masks tended to freeze above 6,100 m. (20,000 ft.) and lack of oxygen made men far more susceptible to the cold. Amputations due to frostbite were alarmingly common.

Research into these problems involved close collaboration between British and American scientists. The newly-opened RAF Physiological Laboratory at Cambridge, for example, conducted experiments regarding oxygen installations for high altitude bombers of the US Army Air Forces. This work led to the development of the ‘economiser-and-mask’ system, a constant-flow apparatus which wasted no oxygen during expiration. At the same time, American scientists developed electrically heated body suits and gloves for high-altitude flying, though their use was restricted and the suits themselves prone to failure. Some progress in aviation medicine were also made in the USSR, but, despite a number of exchange visits organized between Soviet scientists and their counterparts in the West, scientific interchange was limited and the flow of information largely travelled West to East. In Germany, the Forschungsführung der Luftwaffe and other aviation research institutions achieved results which matched those of Allied scientists, except in the development of high-altitude oxygen equipment.

Collaboration between Commonwealth and American scientists also proved successful in the investigation of the cause and spread of serum hepatitis which came to be distinguished from the ‘infective’ form of the disease. Research into jaundice was stimulated by several severe epidemics among Allied troops in Europe and during the early stages of the North African campaign. However, such investigations proved difficult because of the unusually long incubation period of the disease. Considering these obstacles, the successful conclusion of hepatitis research was considered at the time to be one of the outstanding medical achievements of the war. Scientists in the UK and USA came to the conclusion that hepatitis was caused by a virus transmitted by contact with contaminated syringes. However, a vaccine against serum hepatitis was not developed until 1969.

Two less well-known aspects of medical science during the Second World War are those related to atomic and chemical weapons research. The development of isotopic tracers during the war was a by-product of the preparation of radioactive and stable isotopes in connection with work on the atomic bomb. The outbreak of war in Europe also led to the intensification of research into the medical effects of chemical weapons. Though they were never employed in the Second World War, their use was both feared and contemplated by Allied and Axis governments. Researchers at the British Experimental Station at Portonassessed the offensive and defensive capabilities of a range of weapons including mustard gas, phosgene, and chlorine, as used in the First World War, and several new compounds were developed between 1939 and 1945. In order to gain an accurate impression of the effects of these weapons, researchers at Porton were authorized to use human guinea-pigs for some experiments. Volunteers drawn from the Porton research team and from the three armed forces were exposed to mustard gas and various other compounds designed to incapacitate troops.

By this time it was known that hot and sweaty skin was especially sensitive to the effects of vesicants such as mustard gas, and the entry into the war of Japan in December 1941 raised the alarming prospect of these weapons being used in tropical climates. Since it was difficult to simulate such conditions at Porton, two new experimental stations were established: one in Queensland, Australia, the other in southern India. Both made use of human volunteers, many of whom, as at Porton, suffered burns and other severe injuries as a result of their participation. It is a matter of continuing controversy whether or not some volunteers for these experiments were misled or inadequately informed of their probable effects.

We can speak with more certainty, however, about medical experiments carried out in the German concentration camps. In war crimes trials conducted after the war, it was a common defence among camp doctors to plead that any medical experiments were conducted with volunteers, yet the testimony of those subjected to these experiments, together with official documentation, shows that the overwhelming majority were carried out on inmates against their will, and in many cases with the willing compliance of camp doctors. These experiments frequently concerned matters of military efficiency such those carried out at Dachau simulating high altitude flying and those involving exposure to extreme cold. In the case of the former, inmates were forced into decompression chambers, where the pressure was steadily lowered until most died in agony. At other camps such as Ravensbrück and Buchenwald the emphasis was on the artificial inducement of, and experimental inoculation against, diseases such as typhus, which had claimed more than 10,000 German lives on the Eastern Front in the winter of 1941–2 (see German–Soviet war). Nazi doctors also found time to pursue research aimed at ‘proving’ Aryan racial superiority. At Auschwitz, the ambitious Josef Mengele embarked on a study to find evidence for the supposed ‘physical degeneracy’ of Jews, and there he conducted his infamous experiments on twins and the causes of dual births. Other doctors took advantage of ‘human guinea-pigs’ among the inmates to complete university doctorates in medicine and genetics.

Casualty evacuation and treatment

Advances in medical science during the war did much to contribute to the recovery rates of sick and wounded service personnel. British casualties in north-western Europe were 25 times more likely to make a full recovery than their predecessors in the First World War, but this improvement was due as much to the more efficient organization of casualty services as it was to advances in medical science. The Allies learned much from defeats inflicted in the early stages of the war. An internal inquiry by the Royal Army Medical Corps in 1941 found its field units insufficiently mobile and not readily adapted to tactical changes on the battlefield. German casualty services were also found wanting during the invasion of the USSR in June 1941 (see BARBAROSSA). The severe Russian winter exposed all existing inadequacies and hindered the evacuation of sick and wounded by air and land. In this first winter of the war against Germany, the Soviets themselves suffered severe shortages of medical personnel and medical supplies.

In other combat theatres air transport was being used to better and better effect and, as the war progressed, the field medical units of the major combatants also became more mobile and more effective. In the Commonwealth armies, the process of on began with regimental stretcher bearers, who conveyed battle casualties to Regimental Aid Posts (RAP). These RAPs were usually makeshift structures such as a ruined cottage or a lean- to of bracken and branches. Next in line was the Casualty Clearing Post (CCP), equipped with a light ambulance and two trucks, around which the camp was constructed. Behind this lay the Advanced Dressing Station (ADS), a more permanent affair consisting of six or seven tents. The RAP and CCP were expected to respond almost immediately to an order to move, and the ADS at up to four hours' notice. After 1941, these units were assisted by several specialist formations such as the Field Dressing Station, which resuscitated casualties suffering from shock, and the Field Surgical Unit, a mobile team capable of being directed to any point on the battlefield.

Similar procedures for casualty treatment and evacuation were followed by all the major combatants. Every German infantry division had two medical companies, each of which provided one field hospital, two main dressing stations, and two casualty clearing stations to receive wounded from medical units in the field. In addition, all German medical companies were equipped with a motorized unit. Similarly, by the end of 1942, Soviet field medical units were accompanied by mobile specialist surgical and ophthalmic teams. In the US forces, special ‘Replacement Depots’ were created to receive, hold, and finally to assign service personnel from hospitals and convalescent centres to appropriate duties.

At the end of the war, Allied commanders were generally satisfied with the level of efficiency attained by their casualty services. At Iwo Jima, wounded US marines were quickly evacuated by air and sea, and, following the cessation of hostilities in Europe, Montgomery expressed his gratitude to the Allied medical personnel who had evacuated with the minimum of delay some 100,000 troops, greatly improving their chances of recovery.

Casualty evacuation and treatment at sea had also improved by the end of the war. In addition to sick bays on board fighting ships, several vessels were earmarked by the British and American governments immediately before the war for conversion into hospital ships. Hospital ships were of two kinds: those used by the navy as ‘floating general hospitals’ and those used to convey casualties from land theatres to hospitals in friendly ports. During 1939–45 a total of eleven hospital ships were in service with the Royal Navy, admitting a total of 93,142 patients. But the number of hospital ships was often insufficient, particularly in the later stages of the war in the Far East, giving rise to acrimonious disputes between the British Army and the Royal Navy over the allocation of these vessels. Following their entry into the war, American forces also felt the lack of hospital ships, but by the end of 1943 a number of large, specially-built, and well-equipped hospital vessels came into in service with the US Navy and altogether the US Army had 24 hospital ships (6 of them Liberty ships) and the US Navy 17.

Two features of casualty evacuation by sea are especially worthy of mention. One was the evacuation of the British Expeditionary Force from France in May 1940 when several hospital ships joined other vessels in picking up wounded troops from Dunkirk and other beaches under extremely hazardous conditions. Heavy shell-fire forced several hospital ships to return to England without completing their mission and two—Wakeful and Grafton—were sunk with the loss of many lives. The other was the use of specially-converted amphibians and landing craft during the Normandy landings in June 1944 (see OVERLORD) to carry wounded Allied personnel back to hospitals in the UK. Evacuation was somewhat slower than by ship—each crossing taking 26–30 hours—but a continuous shuttle service across the Channel meant that wounded men were evacuated from the beachhead without delay.

A vital component in the treatment of battle casualties in the Second World War was the development of more efficient forms of blood transfusion: many of the improvements in this field were a direct consequence of research conducted in the USA between 1939 and 1945. In December 1939, American scientists announced their discovery that unfiltered blood plasma was a useful substitute for whole blood in transfusion. It was impossible to dry whole blood without destroying the red cells, but plasma could be dried without damaging it and could therefore be stored and transported in all temperatures. The discovery of the rhesus factor in human blood by American scientists also had important implications for blood grouping and, ultimately, for the development of human genetics. But such developments were slow to reach the medical services of the Axis forces. Until 1943 the Germans relied upon a synthetic blood substitute called ‘Periston’, which most German medical officers interrogated by the Allies admitted was unsatisfactory. It was not until after the capture of dried blood serum from the British at Tobruk in June 1942 that natural blood substitutes were employed by German medical units.

Once a casualty had been removed from the battlefield, treatment took place in military hospitals or in military wings of civilian hospitals with a number of service personnel in attendance to maintain military discipline. In the UK, where it was expected that large numbers of civilian air-raid casualties would occur soon after the declaration of war, local authorities and the ministry of health were apprehensive about the requisitioning of hospitals for military use. The precedent of the Spanish Civil War suggested that estimates of high casualties among the civilian population were well founded, and the war cabinet accepted the ministry's suggestion that the army should relinquish its claim on 25 of the 29 general hospitals then under construction. But, though air-raid casualties were far from negligible, they did not occur in the numbers expected, reinforcing the argument of army commanders who had all along stressed the need for more hospital accommodation specifically for military use. Throughout the war, and afterwards, many remained critical of the inadequate hospital provision for military sick and wounded. The allocation of medical resources for civilian or military use was never adequately resolved, but in retrospect it seems unreasonable to have expected the government to have done anything other than plan for the worst of all eventualities. Few at the time disputed the civilian casualty ratio on which the ministry of health and the cabinet based their decision and, in the years leading up to the war, the prospect of a loss of civilian morale and social disorder as a result of air attack loomed large in the minds of all concerned.

While efficient planning enabled the UK to cope with its casualties of war, little could be done with regard to hospital provision in north-west Europe and other battle zones once conflict had begun. In western Germany, in 1945, hospitals were overflowing with sick and wounded from the Allied and German forces, as well as with civilians. On the Eastern Front the situation was even worse, though the expansion of hospital accommodation within the USSR during the war was an astonishing feat. At the beginning of 1941, hospital provisions for wounded Soviet troops were woefully inadequate: in five days, one 200-bed hospital near the front had to cope with more than 5,000 casualties. But by 1944 the Soviets had built more than 1,370 evacuation hospitals with some 664,595 beds, 75% more than in 1940.

Psychiatric medicine

Over one-third of medical discharges from the British and Commonwealth and American armed forces were the result, not of physical injury and sickness, but of psychiatric disorders, which also afflicted some deserters. More than half the psychiatric disorder cases were diagnosed as ‘anxiety neuroses’, stemming directly from combat stress (see Battle of the Pips for an example of this), or from a multiplicity of sources including separation from families and domestic problems. Other reasons given for psychiatric discharge, in descending order were ‘psychoses’, ‘mental deficiency’, and ‘psychopathic personality’. Though no major theoretical advances were made in military psychiatry during the Second World War, there were, in the Allied camp at least, significant developments in terms of the mechanism for dealing with psychiatric casualties and in the position of psychiatrists in relation to military administration as a whole.

As the Allied forces became more deeply embroiled in conflict, the value of psychiatrists in maintaining morale and in returning psychiatric casualties quickly to duty was increasingly recognized by officers in the field. During the Western Desert and the North African campaigns, individual army psychiatrists began to develop new methods of forward treatment for nervous exhaustion, and by 1944 these innovations had been incorporated into official procedures for dealing with psychiatric casualties in the Allied forces. Troops suffering from battle exhaustion were generally placed under sedation for 48 hours and removed to a therapeutic environment at a divisional centre. Thereafter, they underwent a period of rehabilitation in which military discipline was reimposed, before being returned to appropriate duties. In north-west Europe, official sources estimate that as many as 65% of British psychiatric casualties were returned to full combatant duty in less than a fortnight.

In the Axis forces there was no comparable system of treatment for battle exhaustion and other psychiatric disorders, though the German Army had a high incidence of psychiatric illness on the Eastern Front. In his book Hitler's Army (Oxford, 1991, p. 22) O. Bartov notes that during the Soviet counter-offensive in front of Moscow in December 1941 ‘Symptoms of mental attrition caused by fatigue, hunger, exposure, and anxiety’ became increasingly prevalent and that there were ‘numerous cases of physical and psychological breakdown caused by the wretched living conditions.’ The German High Command responded to this crisis after 1942 simply by tightening military discipline as the majority of German military psychiatrists had long insisted that stress breakdowns were military rather than medical problems, resulting from deficiencies in leadership and morale. Treatment generally amounted to indoctrination of the sick or, in extreme cases, electric shock therapy, and the military authorities reacted to all breaches of discipline, regardless of whether these resulted from psychiatric breakdown, with undiscriminating severity. By mid- 1944, 107,000 German soldiers had been tried for absence without leave, and a further 49,000 for disobedience. More than 7,000 were executed for desertion and subversion as against only 48 in the First World War. Suicides among German troops also increased markedly at the end of the Second World War, some 10,000 occurring among those undergoing treatment for battle neuroses.

The other important development in military psychiatry in the Allied camp was the introduction of psychological and intelligence testing. Acute manpower shortages in 1941, especially in the skilled trades, led Allied military authorities to consider a more efficient basis for the allocation of service personnel. Some means had also to be devised for detecting and disposing of the many ‘undesirable’ persons admitted to the armed forces through conscription. Intelligence, aptitude, and ‘character’ testing provided a rationale for such procedures and opened an avenue to academic psychologists hitherto marginalized by the military and academic establishments. Increasingly, military psychiatry came under the influence of men who saw themselves as social engineers. Whole regiments, such as the British Pioneer Corps, were formed to provide employment for men not considered suitable by virtue of ‘low intelligence’ or ‘inappropriate personality’ for the combatant or technical branches of the army. These tests continued to form the basis for personnel selection in the British Commonwealth and American armed forces after the war. In a slightly modified form, they were later introduced for candidates for the British civil service.

Post-war planning

Throughout the Second World War, Allied leaders gave much thought to the problem of reconstruction when victory was achieved. Planning for health administration and medical relief following the liberation of occupied countries began as early as 1941, when, at an inter-Allied conference in London, it was accepted in principle that these tasks should be the joint responsibility of the Allied nations. As a result, an Allied Post-War Requirements Committee was set up to estimate the immediate post-war needs of various countries under Axis occupation and its work paved the way for the formation of UNRRA in November 1943. In conjunction with Allied military authorities, civil governments, and voluntary organizations, UNRRA was empowered to co-ordinate and administer the provision of clothing, shelter, health services, and other forms of aid. The Health Division of UNRRA became one of its most important branches, and regional organizations were formed in Europe and the Far East.

In practice, however, the responsibility for health administration fell most heavily on the Civil Affairs Administrations of the liberating armies (see Allied Control Commissions and Allied Military Government of Occupied Territories). In the final years of the war, training centres were established by the Allied armies to school both service and civilian personnel in various aspects of public administration and to familiarize them with the social and economic conditions of occupied countries. However, it is unlikely that this training would have prepared relief workers for the scale of the problem they actually encountered in the liberated countries. In Germany, the British Army alone had responsibility for some 700 camps containing more than 750,000 displaced persons (see refugees). Typhoid, diphtheria, poliomyelitis, and other diseases were rife among the dispossessed, and de-lousing and other typhus control measures were instituted in all camps under Allied command. However, it was some time before the medical advances which had so markedly improved the lot of servicemen in the Second World War began to touch the lives of those who had been left destitute by five years of conflict and occupation.

Mark Harrison

Bibliography

Copp, T., and and McAndrew, W. , Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939–1945 (Montreal, 1990).
Green, F. H. K., and Covell, G. (eds.), Medical Research: Medical History of the Second World War (London, 1953).
Heaton, L. D. (ed.), United States Army Medical Department, 10 Vols. (Washington, DC, 1955–63).

Medicine

Religion and medicine are twin traditions of healing. Although they have overlapped for most of their history, in the past three hundred years the two traditions have become separate and have often been in competition with one another. At the close of the twentieth century, serious consideration began to be given to reintegrating religion and medicine. In this discussion, a review of the historical connection between these two traditions will be offered. Research that has led to a possible rapprochement will be examined as will the implications for practicing clinicians.

Historical background

There is a long historical tradition that connects religion and medicine. The first hospitals in western civilization for care of the sick in the general population, particularly for those unable to pay for their own care, were built by religious groups. In the fourth century, Basil, the Bishop of Caesarea established one of the earliest hospitals based upon the good Samaritan story in the Bible. This building was resurrected in present-day Turkey among almshouses and leper colonies. For the next thousand years, the church would build and staff most hospitals throughout the western world. Many early physicians, especially those in Europe during the Middle Ages and in the New England colonies of the United States during the seventeenth and eighteenth centuries, were also members of the clergy. In Europe, licenses to practice medicine were in fact controlled by the church and church-sponsored universities.

Similarly, the profession of nursing was to emerge out of the Christian church in the 1600s and 1700s with the Daughters of Charity of St. Vincent de Paul, an order of Catholic sisters devoted to the care of the sick. The Daughters of Charity also established the first nursing profession in the United States in Emmitsville, Maryland, in the early 1800s, modeled after nursing in France. Florence Nightingale (1788–1849), after receiving a "calling" from God, would later receive nurses training from the Daughters of Charity and the Protestant deaconesses (started up by Lutherans in Germany). After the Crimean War, Nightingale applied what she learned to a secular setting. Interestingly, though, up until the early 1900s, most hospitals in Europe and the United States continued to be staffed by nurses who were primarily from religious orders.

Beginning in the fifteenth century, the profession of medicine began to split away from the church, and the state took over the role of administering licenses to practice medicine. That separation would continue to widen until the early 1800s when it was nearly complete. For the last two hundred years, religion and medicine have been divided into separate healing disciplines, with very little overlap and very little communication between the two. However, since about the mid-1990s, especially in the United States, there has been active dialogue about bringing religion and medicine together once again. This movement has been highly controversial and has met with considerable resistance. A growing volume of research showing a connection between religion and health, however, has been breaking down the resistance.

Although the history reviewed above applies primarily to the Christian church, there has been similar interest in health and healing running through nearly all the major world religious traditions, including Judaism, Hinduism, Buddhism, Islam, and Chinese religions. Space does not allow for an adequate discussion of historical connections with medicine for each of these traditions, although resources that do so include Lawrence Sullivan's Healing and Restoring: Health and Medicine in the World's Religious Traditions (1989) and Caring and Curing: Health and Medicine in the Western Religious Traditions (1998) by Ronald Numbers and Darrel Amundsen.

Research on religion and health

The recent trend towards integration of religion and medicine has been stirred primarily by medical research demonstrating intimate and often complex relationships between religion and health. First, many patients indicate that religious beliefs and practices help them to cope with the stress of medical illness. In some areas of the United States, nearly ninety percent of hospitalized patients report that they use religious beliefs to at least a moderate degree to help them to cope. Nearly fifty percent of this group indicate that religion is the most important factor that enables them to cope with medical conditions and the stress they cause. Over one hundred studies have now documented the high prevalence of religious coping among persons with a variety of diseases ranging from diabetes, kidney disease, heart disease, cancer, arthritis, and cystic fibrosis, to more general conditions such as chronic pain.

There is also research demonstrating that persons who are religious end up coping better with physical health problems and disabling conditions. Of nearly one hundred studies conducted during the twentieth century on the relationship between religion and emotional well-being (happiness, life satisfaction, optimism, and hope), nearly eighty percent find that the religious person experiences significantly greater well-being. This is particularly true when populations of medically ill subjects have been studied. The religious are less likely to become depressed or anxious, and if they do develop these mental conditions, they recover more quickly. Suicide is less common among the more religious, as is marital dissatisfaction and divorce, and alcohol and drug use. Nearly 850 studies have now examined these associations, with between two-thirds and three-quarters of these finding that the religious person tends to be healthier and better able to cope with illness.

Of course, a number of studies also report that religion can be associated with worse mental health, more depression, and greater anxiety. This is particularly true for practitioners of religions that are repressive, controlling, and do not emphasize caring for self and others in a responsible way. Religion can be used to justify hatred, aggression, prejudice, and social exclusion. It may induce excessive guilt in situations where guilt is not healthy. Religion may also be used to replace professional psychiatric care for serious mental or emotional problems that require medication and biological therapies. In all of these ways, religion may do a disservice to mental health. In most cases, however, the emotional benefits of religious faith tend to outweigh the negative effects.

There is also a growing volume of research suggesting that religious belief and practices are related to healthier lifestyles, better overall physical health, and longer survival. Studies demonstrate stronger immune functioning among religious persons who are older, who are HIV positive or have AIDS, or have breast cancer. Death rates from coronary artery disease are lower among the more religious, even when health behaviors, diet, and social factors are taken into account. The same applies to mortality from all causes. Since 1990, over a dozen careful studies have demonstrated that the religious person lives longer than the person who is less religiously involved. In these studies, religion is measured by frequency of church attendance, private prayer and scripture study, meditation, and religious coping. Studies have not demonstrated that the broader aspect of religion called spirituality is associated with greater longevity. Spirituality is a broad concept, making it difficult to measure, whereas religious beliefs, practices, and commitment can be more easily assessed and quantified.

Why does religious belief and practice correlate with and predict greater physical health? The answer may lie in the mind-body relationship. There is growing evidence suggesting that emotions influence physiological processes. Psychological stress, anxiety, and depression have been related to impairments in immune functioning, delayed wound healing, and increased risk for cardiovascular morbidity. If religious beliefs and practices reduce emotional stress, counter anxiety, and prevent or facilitate recovery from depression, then religion may help to neutralize the health-impairing effects that these negative emotions have on physical health, and do so through known biological pathways. Mainstream scientists in the field of psychoneuroimmunology are beginning to explore these connections more seriously.

Since about 1980, people have become increasingly disillusioned with medical care that relies solely on high technology and focuses on the biology of disease, while neglecting the care of the whole person. That disillusionment has caused many patients to express a desire to have their spiritual and emotional needs met, as well as their physical needs. Between one-third and two-thirds of patients consistently indicate that they wish their physicians to address religious or spiritual needs in addition to medical needs, particularly when they experience serious medical problems or terminal illness.

Furthermore, there is research indicating that religious and spiritual beliefs impact medical decision making and may even affect compliance with medical treatment, making it essential for physicians to know about these beliefs. Some patients may use religion instead of traditional medical care to treat their illnesses. For example, they may decide to pray for their illnesses and stop taking their medications. There is also research showing that certain types of negative religious beliefs may adversely affect physical health and recovery from medical illness. Patients who feel punished or deserted by God, who question God's power and love, or who feel abandoned by their spiritual community, experience greater mortality and worse mental health outcomes.

Application to medical practice

The growing body of research on religion and health suggests at least the following four applications to medical practice in the West. First, in light of this research, some have argued that physicians should consider taking a spiritual history on patients with serious, terminal, or chronic medical illness. In the United States, only about one in ten physicians consistently addresses spiritual issues by taking a religious history, despite suggestions by a consensus panel of the American College of Physicians and American Society of Internal Medicine that such a history can be obtained by asking a few simple questions. Such questions include the following:

1. Are religious beliefs a sense of comfort or a source of stress for the patient?
2. Is the patient a member of a spiritual community and is this a source of support for the patient?
3. Does the patient have any religious belief that may influence medical decisions or conflict with medical care?
4. There any religious or spiritual needs present that need addressing?

Taking a spiritual history should be done in addition to (not instead of) competently and completely addressing the medical issues for which the patient seeks help from the physician. Thus, a spiritual history is most appropriate when there is more time in the schedule, such as during a new patient evaluation or during a hospital admission workup.

Second, if spiritual needs are identified when the spiritual history is taken, then the research suggests that addressing those needs should improve the health and coping capacity of the patient. This can be done in a couple of ways. The patient can be referred to a trained clergyperson or chaplain. Chaplains in the United States are required to undergo extensive training that prepares them to address such issues in the medical setting. Before a chaplain is certified in the Association of Professional Chaplains, he or she must complete four years of college, three years of divinity school, one to four years of clinical pastoral education, and must take written and oral examinations. Thus, chaplains are skilled professionals with much to offer in this area. Sometimes, however, patients do not wish to speak with a chaplain or clergyperson. In that case, if the patient already has a trusting relationship with the physician, then the physician may need to be prepared to address such issues, even if this involves only listening and showing respect and concern. Nearly two-thirds of the medical schools in the United States have elective or required courses on religion, spirituality, and medicine. In these courses, medical students are trained to take a spiritual history and to address spiritual issues in a sensitive and appropriate manner.

Third, in addition to taking a spiritual history and, if necessary, addressing spiritual issues, the physician may choose to support healthy religious beliefs or practices that the patient finds helpful in coping with illness. Physicians should not prescribe religion for patients who are not interested in religion. There may be benefits, however, in physicians learning about the religious beliefs and practices of their patients and supporting those beliefs that the patient finds helpful and that do not conflict with medical care. Even when religious beliefs conflict with medical care, the patient is likely to profit when the physician tries to understand those beliefs and keep open lines of communication about religious issues with the patient. By way of supporting religious practice, some physicians have decided to pray with their patients. This activity is highly controversial in the medical setting. Conditions for its appropriateness include that:

1. A spiritual history has been taken and the physician knows about the religious background of the patient.
2. Religion is important to the patient and is used in coping.
3. The religious background of the patient and the physician are similar.
4. Either the patient asks the physician to pray (i.e., patient initiates the prayer) or, if the physician initiates it, the physician is certain that the patient would appreciate this activity.
5. The situation calls for prayer (i.e., a difficult, uncontrollable, or stressful situation, severe medical condition, or terminal illness).

Under such circumstances, it may be helpful for a physician and patient to engage in prayer together, enhancing the doctor-patient relationship by increasing trust.

Finally, the research suggests that new social arrangements for medical care may prove beneficial. For example, physicians might develop a communication network with local clergy, both to facilitate a referral base and to allow physicians to assess the community resources that are available to the patient. Religious communities often already provide volunteers to assist with homemaker services, rides to the doctor, respite for exhausted family members caring for the patient, and emotional support to the patient and the patient's family. Religious communities may also monitor the patient to ensure that the medical regimen is being followed and that medical problems are detected early and treatment is obtained promptly. Such a system works especially well when volunteers are appropriately trained and coordinated by a parish or congregational nurse—a registered nurse who is a member of and works professionally as a nurse within the congregation. A parish nurse can coordinate health programs within the congregation that involve screening for high blood pressure, diabetes, depression, and other diseases. A parish nurse can also provide spiritual care, communicate with physicians and nurses within the formal healthcare setting about the health condition of members of the congregation, train and mobilize volunteers within the religious community to meet the needs of sick members, and provide health education to keep healthy members well.

Religion and Western medicine are indeed coming closer and closer together. The research suggests that this is a positive trend—good for the health of patients and for the maintenance of the health of the community. It is also arguably good for the profession of medicine in the West, which is truest to its most basic aims when its practices support the health of the patients in every dimension.

See also Mind-body Theories; Placebo Effect; Spirituality and Health; Spirituality and Faith Healing

Bibliography

carson, verna benner, and koenig, harold g. parish nursing: stories of service and care. radnor, pa.: templeton foundation press, 2002.

koenig, harold g. "religion, spirituality and medicine: application to clinical practice." journal of the american medical association 284 (2000): 1708.

koenig, harold g; mccullough, michael e.; and larson, david b. handbook of religion and health. new york: oxford university press, 2001.

koenig, harold g. spirituality in patient care: why, how, when, and what. radnor, pa.: templeton foundation press, 2002.

koenig, harold g., and cohen, harvey j. the link between religion and health: psychoneuroimmunology and the faith factor. new york: oxford university press, 2002.

lo, bernard; quill, timothy; and tulsky, james. "discussing palliative care with patients." annals of internal medicine 130 (1999): 744–749.

mueller, paul s.; plevak, david j.; and rummans, teresa a. "religious involvement, spirituality, and medicine: implications for clinical practice." mayo clinic proceedings 76 (2001): 1225–1235.

numbers, ronald l., and amundsen, darrel w., eds. caring and curing: health and medicine in the western religious traditions. baltimore, md.: johns hopkins university press, 1998.

sloan, richrd p.; bagiella, emilia.; and powell, t. "religion, spirituality, and medicine." the lancet 353 (1999): 664–667.

sloan, richard p.; bagiella, emilia; vandecreek, larry.; et al. "should physicians prescribe religious activities?" new england journal of medicine 342 (2000): 1913–1916.

sullivan, lawrence e. healing and restoring: health and medicine in the world's religious traditions. new york: macmillan, 1989.

harold g. koenig

MEDICINE

MEDICINE. Food plays both a causative and curative role in health and disease. Thus, its role in medicine may be as a risk factor for, protector against, or treatment of an illness. While too much food or exposure to certain foods can reduce someone's health, too little food or inadequate amounts of certain foods can be equally damaging. In the years before modern transportation, packaging, and refrigeration, medicine was primarily concerned with food deficiencies and food spoilage. The focus of medicine was on the identification of critical components of food and common pathogens and on the prevention of nutritional deficiencies and foodborne infections. The role of food in medicine has changed as food production, preservation, and preparation techniques have progressed. Today far more people in developed countries such as the United States suffer from excessive food consumption than from food deficiencies. In addition, certain components of food have been found to have therapeutic or protective properties when administered in levels greater than generally considered necessary. For instance, large quantities of vitamin A are used to treat acne, therapeutic quantities of vitamin E may be protective against heart disease, and extra fiber appears to reduce the risk of colon cancer. However, the problems of malnutrition or inadequate food intake and foodborne illness have not been eliminated. Undernutrition continues to plague developing nations, while the prevention and treatment of foodborne illness is a concern for all nations.

The Basics of Food and Health

Food is fundamental to support life. People get energy, water, and all of the building blocks for growth and proper bodily functioning from the foods they eat and the liquids they drink. The components of food necessary to life are termed "nutrients" and the study of the role of food in health is called nutrition. The goal of medicine is to ensure health, and because adequate nutrition is necessary to accomplish this, nutrition is a crucial component of medicine. Nutritional science combines food science and medical science. Nutrients include protein, fat, carbohydrates, fiber, thirteen vitamins, seventeen minerals, and more substances that are still being identified. The majority of nutrients essential to health are found in a variety of different foods. No one food is absolutely essential to support life. People with access to adequate amounts of food get all of the nutrients they need by eating a varied diet complete with fruits, vegetables, meat or meat alternatives, dairy foods, and grains. However, some people are not able to or do not choose to eat the full variety of foods available. These people may require special foods or supplements to meet their nutritional needs.

The Study of Food in Medicine

All branches of medicine, from pediatrics to geriatrics and from internal medicine to surgery, study food and its role in health and disease. Nutritional scientists in government, industry, and academia are constantly seeking to understand the role food plays in illness and well-being. Meanwhile health-care practitioners treat patients with nutritional plans and food supplements. Registered dietitians are health-care specialists who integrate food into medical treatment—this is referred to as medical nutrition therapy.

The Role of Food in Maintaining Health

Although the presence of adequate nutrition does not ensure health, it is a significant contributor. The energy contributed by the protein, carbohydrates, and fat in food provides the fuel for every element of body functioning from breathing to thinking to fighting disease to running marathons. Adequate energy intake is crucial to promote proper growth and development as well as to maintain healthy functioning once one is fully grown. Food also provides the materials necessary to build healthy bone, muscle, skin, hair, etc. For example, bone is a complex matrix of calcium, phosphorus, and collagen fibers. A person's bone strength is directly related to their nutrient intake such that inadequate calcium intake is one of the primary reasons for bone disease such as osteoporosis. Nutrients are also necessary to support proper chemical and neurological functioning. For example, fat insulates nerve fibers such that they can conduct electrical signals along the length of the body. Meanwhile, those electrical signals are generated via channeling ions such as sodium, potassium, and calcium into and out of the nerve cells. Finally, the neurotransmitters released from the nerve cells are made from amino acids contributed largely from proteins in the diet. Thus, thinking and feeling are intricately connected to food.

Food for Those Who Can't Feed Themselves

Food is generally eaten, or drunk, and swallowed. However, many people cannot obtain adequate nutritional levels by conventional ways of ingesting food. In the past, these people would suffer and die from malnutrition. Modern nutritional medicine offers people several alternatives to conventional chewing and swallowing of food so that those who cannot do so will not die. Liquid solutions have been manufactured by pharmaceutical companies that are easier to digest than solid food and provide 100 percent of nutritional needs. People who can drink but not eat rely on these formulas just as babies who cannot breast feed rely on baby formula to meet their nutritional needs. People who cannot consume anything orally are fed via a tube inserted into the stomach or intestines. Finally, those whose gastrointestinal tracts cannot absorb even liquids are fed intravenously with solutions that provide 100 percent of human nutritional needs.

Examples of Food as a Cause of Disease

Food allergies and intolerances are common medical reasons for eliminating specific foods from one's diet. An allergy is an immune response to proteins in food that the body identifies as foreign. The most common food allergies include those to peanuts, tree nuts, shellfish, milk, soy, corn, wheat, and eggs. Most allergies appear in childhood and require complete elimination of the offending food if the symptoms are to be eradicated. Childhood food allergies may persist for a lifetime or may resolve a few years after getting rid of the offending food. Symptoms of allergies may include rashes and other skin irritations, gastrointestinal inflammation and bleeding, and respiratory distress, which may even involve arrest of breathing.

Food intolerances are not allergies but rather uncomfortable reactions to food that are not generally considered life threatening. One well-known example is lactose intolerance. Lactose is the carbohydrate in milk and other dairy products. The body requires a specific enzyme if lactose is to be absorbed. As people age their bodies may make less of the enzyme necessary to break down lactose and as a result they may experience gastrointestinal distress, including such symptoms as gas or diarrhea, when they consume milk products containing lactose. Most people with lactose intolerance can tolerate dairy products if they accompany their meal with a lactase enzyme pill or if they consume dairy products pretreated with lactase enzyme. Thus, food technology allows people with intolerances to tolerate the offending foods but avoidance is the only option for people with food allergies.

In countries such as the United States where food is abundant, some of the greatest medical risks result from overeating rather than insufficient eating. For example, an excess intake of energy in the form of food leads to an increased risk of obesity. Obesity increases one's risk of cardiovascular disease, cancer, diabetes, and obstructive pulmonary disease—among the most common and most deadly diseases today. Medical practitioners have tried to determine how much food is adequate to support healthy living. People who consume too much food and become obese may seek medical treatment to lose weight and treat diseases resulting from obesity. Treatments may include nutritional therapy, exercise programs, drug therapy, or surgery. Foodborne illness results from eating contaminated food. Foodborne illness can be caused by parasites, bacteria, viruses, toxins, or other pathogens that are harmful to humans. Food is not the direct cause but rather the carrier of the problematic agent. The effects of foodborne illness can range from flulike symptoms to death depending on the type of pathogen and the amount of exposure. Foodborne illnesses are generally prevented by appropriate growing, harvesting, packaging, preparation, cooking, and storage of food. However, many countries lack the technology and resources necessary to accomplish this. Thus, assuring food safety continues to be an area of international concern.

Food as a Treatment

Food is not only necessary to sustain health but it can also help ill people regain health. Although the common advice to "feed a fever" may sound like folklore it is actually based in scientific evidence. A rise in body temperature is required in order to fight disease. People with a fever also require extra energy if they are to have adequate energy to maintain their strength while they battle illness. Likewise, the immune system uses a wide range of nutrients to combat intruders. All infectious diseases result in increased need for nutrition to strengthen the immune system as if fights against invading viruses or bacteria. People who suffer from diseases such as cancer, cystic fibrosis, and acquired immunodeficiency syndrome (AIDS) generally require extraordinarily large amounts of nutrients to battle their disease. Likewise, young children who are ill require extra food to ensure that they have adequate nutrition to ensure normal growth and development. Food is crucial in combating both minor and major illnesses.

Many specific nutrients defend against disease. Calcium, a mineral found mainly in dairy products, is critical in the promotion of bone health and protection against osteoporosis. Fluoride, now added as a supplement to most water supplies, is crucial to tooth development. Iron is most commonly found in meats and protects against anemia. Folic acid prevents neural tube defects such as spina bifida in developing fetuses and has recently been found to protect against cardiovascular disease. In fact, almost every vitamin and mineral is known to be critical to one or more life processes. Nutritional specialists and medical practitioners are constantly studying the role each nutrient plays in protecting the body and investigating further possible cures.

See also Dietetics ; Digestion ; Disease: Metabolic Diseases ; Enteral and Parenteral Nutrition ; Health and Disease ; Hunger, Physiology of ; Immune System Regulation and Nutrients ; Intestinal Flora ; Microbiology ; Nutrient-Drug Interactions ; Nutrients ; Nutrition ; Nutritionists ; Safety, Food.

BIBLIOGRAPHY

Duyff, Roberta Larson. The American Dietetic Association's Complete Food and Nutrition Guide. New York: Wiley, 1998.

Mahan, Kathleen L., and Marian Arlin, eds. Krause's Food, Nutrition and Diet Therapy. 10th ed. Philadelphia: W.B. Saunders; Harcourt Brace Jovanovich, 2000.

Margen, Sheldon, and the editors of the University of California at Berkeley Wellness Letter. The Wellness Encyclopedia of Food and Nutrition: How to Buy, Store, and Prepare Every Variety of Fresh Food. New York: Health Letter Associates, 1992.

Nelson, Jennifer K., Karen E. Moxness, Michael D. Jensen, and Clifford F. Gastineau. Mayo Clinic Diet Manual: A Handbook of Nutrition Practice,. 7th ed. St. Louis: Mosby, 1994.

Pennington, Jean A.T., Anna De Planter Bowes, and Helen N. Church. Church's Food Values of Portions Commonly Used. 17th ed. Philadelphia: Lippincott, Williams & Wilkins, 1998.

Zeman, Frances J., and Denise Ney. Applications in Medical Nutrition Therapy. 2nd ed. Englewood Cliffs, N.J.: Prentice Hall, 1995.

Jessica Rae Donze

medicine has been practised in Ireland for thousands of years, but the modern Irish medical system is essentially a product of the post‐1700 period.

It is not easy to describe Irish medicine during the pre‐Christian era reliably, as the main sources available are myths and sagas. The Celtic pantheon of gods included a doctor or leech (liagh) called Dian Cecht, who cured by means of therapeutic herbs and magic. The Irish sagas refer to leeches on numerous occasions. In the most famous of the Ulster Cycle of sagas, the Táin Bó Cuailnge, the hostile armies of Ulster and Connacht were both accompanied by leeches. Conchobar mac Nessae, king of Ulster, had his own personal leech, Fingin Faithliaig, who was in charge of the Ulster medical corps. But a leech's job had its peculiar dangers: one warrior in the Táin, informed by a succession of leeches that his wounds were mortal, killed each in turn before Fingin was able to pacify him.

Even for the medieval period (ad 500 to 1500) literary sources, such as annals and law tracts, are still major sources of information on Irish medicine. The Irish annals mention a variety of disorders, including plague, leprosy, smallpox, tuberculosis, ague (malaria), dysentery, pneumonia, gout, colic, palsy, erysipelas, paralysis, epilepsy, cancer, and flux (diarrhoea). Some of these diseases, like bubonic plague and smallpox, struck Ireland as major epidemics, creating widespread panic and disorder. Such outbreaks were seen as visitations of God, rather than as medical disasters, and from the 8th century the church sought to counter them by circulating holy relics through affected areas.

Doctors did, however, play a significant role in the treatment of wounds and injuries and of endemic diseases. Irish chieftains employed doctors as honoured members of their households. Often such doctors came from medical families, as medicine was largely a hereditary occupation. Leech books compiled over generations by medical families, such as the O'Hickeys, the O'Lees, and the O'Shiels, and mainly surviving from the late medieval period, are vital sources for the early history of Irish medicine. These show that Irish doctors were well aware of developments in European medicine, while they continued to practise their own treatments.

As important as leech books in understanding medicine in medieval Gaelic Ireland are legal tracts, setting out patients' rights and dictating the fees doctors could charge. Patients could be treated at home, in a doctor's house, or, in the case of a wound, in the house of the person who had inflicted the injury. The doctor's house had to be well ventilated and have access to a plentiful supply of fresh water. Medical fees varied according to the rank of the patient, but if the patient did not recover then the doctor could be fined.

In terms of treatments, early Irish doctors made extensive use of herbs, baths, cupping, bleeding, and sweating. Leech books often contain long lists of herbs, with descriptions of their medicinal properties and of the correct modes of preparing and administering them. Doctors carried cupping horns and probes intended to clear and clean wounds. Herbal baths and sweating houses were also employed extensively in cases of fever or skin diseases.

In the 16th and 17th centuries, with the decline of Gaelic power, Irish medicine underwent major changes. Increasing numbers of would‐be doctors began to seek training in formal medical schools. Catholic students were largely to be found in medical schools attached to universities, such as Paris, Montpellier, Reims, Louvain, Padua, and Bologna, while Irish Protestants favoured Oxford, Cambridge, Leiden, and, from the early 18th century, Edinburgh. Not until the 19th century did Irish students patronize Irish medical schools in any large numbers.

Irish doctors, whether trained in England or on the Continent, soon felt the need of a body to represent their interests and regulate the practice of medicine. In 1654 Dr John Stearne (1624–69) established a fraternity of physicians, which received royal charters in 1667 and 1692, transforming it into the present Royal College of Physicians in Ireland. The 1692 charter stipulated that no one could practise physic in Ireland who was not a licentiate or fellow of the college, and it gave the college power to supervise surgeons, apothecaries, and midwives (see childbirth).

The surgeons and apothecaries had already been organized before the setting up of the College of Physicians. In 1577 the Guild of Dublin Barber‐Surgeons received a royal charter and in 1687 a further charter added apothecaries and wigmakers to the guild. But, by the 18th century, many surgeons were unhappy with their lowly status and with attempts by the physicians to control them. They therefore began to organize themselves into separate companies. This trend culminated with the granting of a royal charter to the Irish College of Surgeons in 1784.

The creation of the two colleges, which both sought to ensure that practitioners were adequately trained, helped raise the quality and status of Irish medicine. At the same time the establishment of voluntary and state hospitals in Irish cities and towns during the 18th century gave doctors greatly increased opportunities to practise their profession.

By the early 19th century there was a recognized Irish school of medicine centred on Dublin, competing for prestige with the medical establishments of London and Edinburgh. The Irish school was particularly strong in fields like mid‐wifery and anatomy. The Rotunda hospital pioneered with regard to the former, while the College of Surgeons set high standards in the teaching of the latter. Large numbers of Irishmen served in the British army and navy: the advent of the Napoleonic wars brought a great demand for military and naval surgeons, which stimulated the teaching of anatomy and surgery in Dublin.

A number of Dublin surgeons made significant contributions to medicine during the early and mid‐19th century. James Macartney (1770–1843) pioneered the teaching of pathology and revitalized the medical school at Trinity College, Dublin; Abraham Colles (1773–1843) identified a common fracture of the wrist (Colles's fracture); Arthur Jacob (1790–1874), a pioneer of ophthalmology, described the neutral layer of the retina (Jacob's membrane); William Wallace (1791–1837) was the first to establish the contagious nature of secondary syphilis; Robert Adams (1793–1875) recognized the significance of disorders in cardiac rhythms; Francis Rynd (1801–61) gave the first hypodermic injection in 1844; and Sir William Wilde was a pioneer in ear surgery.

Dublin‐based physicians also made major contributions to medicine. John Cheyne (1777–1836) made important studies of the fever epidemic of 1817–19; Robert Graves (1796–1853) identified exophthalmic goitre (Graves's disease) and published an influential collection of clinical lectures in 1843; William Stokes (1804–78) wrote the first book in English on the stethoscope and described Cheyne–Stokes respiration (intermittent breathing which usually indicates the approach of death) and Stokes–Adams syndrome (a slowed pulse with fainting attacks); Sir Dominic Corrigan (1802–80) first recognized the signs of incompetence in the aortic valves.

Yet, despite the considerable achievements of Irish medicine and the existence of a network of hospitals, infirmaries, and dispensaries throughout the country, far more people died of disease during the Famine of the late 1840s than succumbed to hunger. Typhus, relapsing fever, dysentery, and smallpox reached epidemic proportions and were followed by a cholera epidemic in 1848–9. A series of Fever Acts were passed and a Central Board of Health set up in 1847 charged with establishing fever hospitals throughout the country. But these efforts were to little avail. It has been estimated that there were 2,600 doctors in Ireland in the late 1840s, some 380 of whom died in the three years 1845–7, two‐thirds of them succumbing to fever and dysentery.

A Medical Act of 1858 established a council which was responsible for compiling and policing a register of practitioners. Despite protests, women were excluded from the register and it was not until 1876 that an act was passed to remove restrictions on medical education based on sex. In 1877 the College of Physicians licensed its first woman practitioner, although women were not eligible for fellowships in the college until 1924. The College of Surgeons opened its medical school to women in 1885 and elected its first female fellow in 1893. The Royal University agreed in principle to admit women students in 1882, but women did not begin studying medicine in Belfast until 1889, in Cork until 1892, and at Cecilia Street medical school in Dublin until 1896. Trinity College, Dublin, took even longer, not admitting women medical students until 1904.

The Famine had highlighted the inadequacies of public health in Ireland, but these inadequacies remained obvious well into the 20th century. In 1878 a major Public Health Act was passed. The act's comprehensive provisions relating to sanitation, water, food, housing, offensive trades, markets, and infectious diseases were, however, largely permissive. Many town councils and rural boards of guardians, who were charged with enforcing the act, were more concerned with keeping down the rates; and dispensary doctors, who were empowered under the act to control infectious diseases, were already underpaid and often overworked.

Poor living conditions, particularly in towns and cities, were at the root of Ireland's dismal public health record. In Dublin during the 1880s 17 per cent of infants died before reaching the age of 1 year, while in Belfast the figure was 15 per cent. (In the 1980s in Belfast only 1 per cent of infants died.) During the 1880s, similarly, 30 per cent of deaths in Belfast were due to infectious diseases, half being due to tuberculosis. The comparable figure in the 1980s was 0.5 percent.

In 1925 the Irish Free State appointed county medical officers, charged solely with promoting public health measures, and many of the provisions of the 1878 act were at last made compulsory. Even so tuberculosis, and maternal and infant mortality, remained alarmingly high throughout the 1930s and 1940s. The controversial Health Acts of 1947 and 1953, which were opposed by the medical profession and the Catholic church, who feared a state‐controlled health service, finally introduced more effective disease prevention measures. In Northern Ireland a Public Health Act of 1946 transferred powers from boards of guardians to county and borough health authorities, which opened the way for more rigorous enforcement of public health regulations.

Bibliography

Barrington, R. , Health, Medicine and Politics in Ireland, 1900–70 (1987)
Fleetwood, J. F. , The History of Medicine in Ireland (2nd edn., 1983)
Jones, G., and Malcolm, E. (eds.), Medicine, Disease and the State in Ireland, 1650–1940 (1999)

Elizabeth Malcolm

Medicine

HISTORY OF MEDICINE

MEDICINE TODAY

BIBLIOGRAPHY

In its broadest sense, medicine denotes ideas relating to diagnoses, causes, and cures of illness, as well as the practice of restoring and maintaining health, and the substances used in the treatment of disease. Medicine is both a domain of knowledge and the application of that knowledge. Medical ideas and practices as well as the social institutions relating to health compose a medical system. Medical systems include ways of classifying disease (cancer, a cold, soul loss, and spirit possession), health specialists (doctors, herbalists, and shamans), and therapies to end illness (pharmaceuticals, meditation, acupuncture, and divination).

Western medicine, or biomedicine, is currently the most widespread medical system, but thousands of others exist throughout the world. Although each tradition is different, diagnosis and treatment often consist of both magical and herbal components. For instance, many societies believe that ill health can be attributed to supernatural forces, which can be meted out by spirits, gods, ancestors, sorcerers, or witches. These forces are capable of causing both the body and the soul to become ill. To combat disease, patients and healers can also invoke magical substances, rituals, or supernatural beings. Another common method of healing is herbalism, using plants to treat illness. An immense variety of plant species are employed as remedies and include decongestants, pain relievers, and antiseptics. Plants in the Americas have been used to derive important drugs including aspirin, quinine, and novocaine. Although nonbiomedical traditions were once regarded as ineffective and superstitious, they are now acknowledged as providing new sources of medicinal plants as well as information regarding the social lives, environments, and experiences of humans.

Medical ideas and practices both constitute and are constituted by social and cultural beliefs and concerns. Arthur Kleinman notes that medicine is a cultural system “of symbolic meanings anchored in particular arrangements of social institutions and patterns of interpersonal interactions” (1990, p. 24). Illness dialogues, diagnoses, and treatments can express ideas regarding religion, morality, power, politics, identity, economics, and gender. Consequently, social scientists are able to examine medical systems and their components as one method of understanding societal norms, attitudes, and practices. For instance, in The Birth of the Clinic (1973) Michel Foucault examines what he calls the “clinical gaze,” to show how medicine is linked to power. In AIDS and Accusation (1992) Paul Farmer explores how AIDS dialogues in the United States and Haiti reflect attitudes of colonialism, capitalism, and poverty. Social science research regarding the conceptions and use of medicine can focus on both local environments and global ones.

HISTORY OF MEDICINE

The purposeful treatment of illness has probably occurred throughout the entire span of human existence. However, without written records, it is impossible to know for certain what the earliest types of medical treatment were. The first written evidence of medical knowledge, including lists of symptoms, diagnoses, and treatments, comes from Mesopotamia and Egypt, dating to more than four thousand years ago. In ancient Mesopotamia 250 vegetable and 120 mineral drugs were documented (Magner 1992, p. 19). But it is ancient Egypt that can claim both the first real physician known by name, Imhotep (c. 2980 BCE), and later, the first formalized medical system, which included medical schools, medical insurance, sick leave, and registered physicians of both sexes. The ancient Mesopotamian and the Egyptian medical systems also incorporated magical remedies. These were the first of a number of codified medical traditions that developed around the world.

The ancient medical systems of India and China were developed later than those of Mesopotamia and Egypt but they are still practiced today. In India, Ayurveda (the science of life) was intended to maintain health, not simply treat disease. Ayurvedic practitioners believe that health is the result of the balance of three doshas (elemental manifestations in the physical body) that govern body processes. Magner notes that ancient texts list more than one thousand diseases and almost one thousand drugs, and describe advanced surgical procedures including cesarean section, amputation, lithotomy, cauterization, tonsillectomy, and plastic surgery (p. 43). Like Ayurveda, traditional Chinese medicine also views disease as the result of an imbalance in the body, which is composed of yin and yang elements. Doctors often made diagnoses by studying the pulses of patients and were aware that the heart was responsible for circulating blood long before Europeans were. Chinese medicine employs a variety of treatments including more than five thousand medicinal herbs (such as ginseng), acupuncture (inserting needles into the body at specific points), and moxibustion (applying a burning tinder to the skin).

In classical Greece, Hippocrates (460–361 BCE), sometimes called the “Father of Medicine,” wrote that health was the result of a balance between the four humors (basic bodily fluids) of phlegm, yellow bile, black bile, and blood. During the Roman Empire the humoral approach was used by many physicians, including Galen (130–200 CE). His writings were used as important medical texts throughout Rome, the Islamic world, and Europe for centuries. Islamic doctors further embraced and modified the Greek tradition and spread it from Spain to India. The medical writings of the doctor and philosopher Ibn Sina (Avicenna, 980–1037) became standard texts throughout the Arab conquests and Medieval Europe. In Europe it was not until the scientific revolution of the sixteenth and seventeenth centuries that the Greco-Islamic tradition was fully abandoned.

In 1628 William Harvey (1578–1657) challenged the Galenic tradition when he published what was then an unorthodox idea: that the pumping heart moved a continuous flow of blood through the body. Almost one hundred years later the Turkish and African practice of purposefully exposing individuals to mild strains of smallpox to achieve inoculation caught the attention of Europeans and Americans, leading to the development of the first vaccine. Nonetheless, it was not until the nineteenth century that advances in chemistry and medical technology led to the discovery of microbial sources of disease and their cures. This allowed researchers to isolate, treat, and create vaccines for diseases such as tuberculosis, tetanus, cholera, and rabies. The introduction of general anesthesia (1840s) and antisepsis (1870s) precipitated the growth of surgery and hospitals, but it was not until the twentieth century that significant advances were made.

MEDICINE TODAY

The product of a specific historic and cultural past, bio-medicine is currently used around the globe. The biomedical system includes professional, scientific, educational, legal, financial, and ethical frameworks. Biomedicine can be characterized by a number of features. One is its almost exclusive use of science and technology to fight disease. Unlike many other traditions, biomedicine views disease as caused by only natural factors. Supernatural or magical sources of illness or treatments are absent. Most biomedical treatments involve the use of synthesized pharmaceuticals and some require hospitalization. Furthermore, the physical body, not the soul, is considered to be the only locus of illness. Given its early history, biomedical practitioners often have a tendency to look for and find a single cause of an illness (such as a microbe) and then to treat it with a single cure (such as antibiotics). Deborah Gordon (1988) notes that the scientific approach of biomedicine is not only a way to treat illness; it is also a way of conceptualizing the world.

The focus of biomedicine is illness and not health, which is often defined as the absence of disease. Critics charge that because biomedicine almost exclusively treats the body and disease, it lacks a holistic approach to well-being that engages with the social individual. Patients who feel that biomedicine is not meeting their needs have a number of other therapeutic options from which to choose. In developed counties such as the United States, complementary and alternative medicines are widely used. In 1998 Eisenberg et al. estimated that number of visits to alternative medicine practitioners exceeded the total number of consultations with primary care physicians in the United States. These therapies, which include herbalism, meditation, yoga, massage, acupuncture, aromatherapy, and chiropractic medicine, are used either in conjunction with, or as a substitute for, biomedical treatment. They are often provided by nonlicensed healers and can incorporate religious or non-Western traditions.

Throughout much of the world, the majority of medical consultations are still with traditional healers and not biomedical personnel. Nevertheless, indigenous and local healing traditions are often used in conjunction with bio-medicine. For instance, in India and China, Ayurveda and traditional Chinese medicine, respectively, continue to play important roles in the public health care systems alongside biomedicine. Magner notes that in the 1960s acupuncture anesthesia was used in 60 percent of all surgeries in China (1992, p. 59). Australian Aboriginal people have the choice of going to a biomedical clinic, using local plants as remedies, or consulting local healers to cure spiritual sickness. In Africa herbalists and diviners, as well as doctors and nurses, are regularly consulted. Throughout our history, humans have employed a variety of techniques to treat illness, and this process continues today.

SEE ALSO AIDS; AIDS/HIV in Developing Countries, Impact of; Anthropology, Medical; Disease; Magic; Medicaid; Medicare; Medicine, Socialized; Public Health

BIBLIOGRAPHY

Eisenberg, David, Rodger Davis, Susan Ettner, et al. 1998. Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-Up National Survey. Journal of the American Medical Association 280 (18): 1569–1575.

Farmer, Paul. 1992. AIDS and Accusation. Berkeley: University of California Press.

Foucault, Michel. 1973. The Birth of the Clinic: An Archaeology of Medical Perception. London: Routledge.

Gordon, Deborah. 1988. Tenacious Assumptions in Western Medicine. In Biomedicine Examined, ed. Margaret Lock and Deborah Gordon, 19–56. Dordrecht, Netherlands: Kluwer Academic Publishers.

Kleinman, Arthur. 1980. Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry. Berkeley: University of California Press.

Magner, Lois. 1992. A History of Medicine. New York: Marcel Dekker.

Eirik J. Saethre

Medicine

Medicine is one of the branches of the health sciences. It deals with restoring and maintaining health, but is also used in determining the causes of death. It is a practical science that applies knowledge from biology, chemistry, and physics to treat diseases. Biological knowledge is derived from anatomy, biochemistry, physiology , histology, epidemiology , microbiology, genetics, toxicology , pathology , and many other disciplines. Biology forms the basis for understanding how the human body works and interacts with its environment. An understanding of chemistry is required to determine the interactions between different drugs, to detect chemicals in the body, and design drugs for treatment. Physics has an impact on understanding how the body works and on understanding how the various instruments and equipment are used in diagnosis and treatment. The need to understand interactions between all of these areas makes medicine one of the most complex scientific disciplines.

In its early days medicine was not based on science. Many aspects of it were considered forms of magic, encompassing everything from disease causes to treatments. This was because the disease process was not understood. There was no knowledge of infectious agents (such as bacteria and viruses). Therefore, unless the cause of a disease was obvious and visible, sickness was considered a punishment from gods or an interference of an evil spirit. As a result, some treatments were logical, while others were irrational and often involved magic incantations and spells.

The practice of medicine goes back to at least 3000 b.c., when the first written medical records appeared in Mesopotamia. Babylonian medical texts provided the first anatomical descriptions and an early code of conduct for doctors. Their understanding of diseases was very basic; they recognized trauma and food poisoning , but a lot of the illnesses were still a mystery. Despite advances in anatomy and surgery, ancient Egyptians, as the Babylonians before them, still believed in supernatural causes for many illnesses.

The scientific basis of medicine was laid down by Hippocrates, who rejected magical causes of diseases. He believed in medical examination and keeping detailed records of a disease history. His influence on medicine is present even today, in form of the "Hippocratic Oath," which all new doctors have to take. It sets out ethical guidelines for doctors.

The importance of clinical examination of the patient was made even more important by Claudius Galen, another Greek physician. He worked extensively on anatomy and experimented with live animals.

Great advances in all areas of medicine, especially in epidemiology and hygiene, took place in the middle ages. Avicenna, a Persian physician, was the first to recognize the contagious nature of tuberculosis. In his many works, he gave important advice to surgeons, especially on cancer treatment and advanced use of oral anesthetics (painkillers). Another great advancement of the times was the use of silk thread for stitching wounds, developed by Abul Qasim al-Zahrawi.

A number of scientific discoveries, starting from the late 1800s with the work of E. Jenner, L. Pasteur, R. Koch, A. Flemming and others, established that microbes are the cause of infectious disease; these diseases can be prevented by vaccinations; and there are drugs that can kill the infectious agents (microbes). These findings shaped modern western medicine.

Furthermore, discoveries in physics, such as x rays, ultrasounds, magnetic resonance, and lasers, led to the development of equipment that allows quicker and better diagnosis, as well as easier and safer surgical procedures.

As a result of these scientific and technological changes, the knowledge that medical students have to acquire is immense. Therefore, all doctors learn the same basics but later they have to specialize in narrower areas in order to be highly skilled and able to effectively treat all of the diseases of a particular organ or tissue.

There are doctors specializing in various areas of medicine, such as emergency medicine, intensive care medicine, internal medicine, pediatrics, surgery, neurology, obstetrics, and others. While obstetrics is a relatively narrow area, dealing with childbirth and female health, surgery or internal medicine is further subdivided into sub specializations. Some of those subspecialties are hematology (blood and its diseases), cardiology (heart and cardiovascular system), oncology (cancer), ophthalmology (eyes), orthopedic surgery (mostly skeletal system), or neurosurgery (brain). On the other hand, pediatrics deals with childhood diseases and most of the specialties and subspecialties have their pediatric equivalent. Some doctors specialize in narrow medical fields, while others specialize in areas requiring wide medical knowledge such as sport, aerospace, or forensic medicine.

The most important doctor for the majority of the population is the family doctor (or general practitioner, GP). It is the GP who makes the first examination and keeps a record of the medical history of the patient. He or she also makes an assessment if more tests are required before a diagnosis can be made or if a referral to a specialist is required.

The process of determining the cause of a disease and prescribing treatment is quite complex. It consists of clinical examination, diagnosis, and treatment.

Clinical examination can consist of a number of different aspects, including visual, pathological, toxicological, and genetic analysis. Visual examination addresses the general symptoms: a patient's appearance, heart rate etc. Pathological analysis is often required to identify any non-obvious cause of disease. The tests can include blood or urine analysis, electrocardiogram (ECG), ultrasound, computed tomography (CT) scan, biopsy, histology of removed tissues, or bacteriological analysis of body fluids . Most people have blood and urine tests during their lives. Toxicological analysis is usually carried out on blood, but can be done on tissue samples (bones or hair) and can detect alcohol, certain drugs, toxic metals, and other compounds (for example dioxins). Genetic testing is not usually required for the majority of patients, but in cases of inherited diseases, or genetic predisposition, they can be carried out. Often it is not just the adults that undergo this procedure. Amniotic fluid surrounding the embryo can be tested to determine if a child will develop a life-threatening disease.

Diagnosis is based on the combination of all of the examinations that have been performed and the accumulated knowledge of the doctor. Depending on the illness, it can be quick and simple or time consuming and difficult.

Treatment is the ultimate result of a visit to the doctor. It can include prescription of drugs, surgery, or special diet. Any treatment can be simple or complex depending on the illness.

Not all doctors treat patients. Pathologists study disease processes. They analyze clinical tests and base their diagnosis on the results. They can work with isolated tissues and samples, or, in the case of forensic pathologists, the deceased. Pathological analysis is very important in the diagnosis of an illness in the case of regular pathology and in determining a cause of death in forensic pathology. Forensic pathology is a part of a forensic medicine, a branch of medicine answering questions important to the law.

Forensic medicine is important in determining the cause of death, time of death , and identification of the remains. This allows doctors to determine the cause of death as accident, suicide, or murder . A forensic pathologist describes the state of the body (decomposition if any), and subsequently examines the body for a cause of death, but also notes any abnormalities found on the surface or in the tissues. The surface of the body is initially checked for the presence of trauma injuries (bruises, broken bones), cuts or stab wounds, thermal injuries (burns), firearm injuries (gunshot wounds), or defensive wounds . An internal examination of the body is carried out on organs or isolated tissues (histology). It might reveal presence of water in lungs (drowning), or asphyxia (lack of oxygen).

The analysis of a corpse is often carried out in the same way as for normal patients using x rays, toxicology, and genetics. Forensic medicine requires great attention to detail and a wide medical knowledge, especially in the areas of anatomy and physiology.

Modern western medicine is not the only existing medical system. There is also traditional medicine and complementary or alternative medicine. Traditional medicine includes folk and indigenous practices. The best known and most widely accepted areas are Chinese medicine and western herbal medicine. Complementary medicine uses non-invasive and non-pharmaceutical methods. Examples of alternative treatments include yoga, chiropractic or osteopathic manipulation, or various massage methods, as well as many others.

The first written evidence of Chinese medicine comes from 1766 b.c. The philosophy of medicine and methods used by Chinese doctors differed widely from those of the ancient Mediterranean and current modern medicine. The Chinese have based their medicine on a philosophy of yin and yang, and on The Five Elements (metal, wood, water, fire, and earth). A healthy person would have a harmonious mix of these elements. Among the practices developed in Chinese medicine are acupuncture, moxibustion (a technique that involves the use of heat, through burning specific herbs, to facilitate healing), and traditional herbal medicines. A physical examination with a doctor can include detailed interview, pulse taking, breath analysis, and tongue inspection. Some of the traditional Chinese treatments are quite widely accepted by modern western medicine, for example acupuncture.

A new approach to practicing medicine is the development of integrative medicine. It combines the modern western practices with alternative treatments. It only accepts methods for which there is scientific evidence for safety and effectiveness. Acupuncture, herbal treatment, music, and massage therapy are just some of the accepted treatments. The aim of this approach is not to just treat the illness, but to provide support to patients and induce their general well-being.

see also Autopsy; Epidemiology; Pathology.

medicine the science and art of treating and preventing disease.

History of Medicine

Ancient Times

Prehistoric skulls found in Europe and South America indicate that Neolithic man was already able to trephine, or remove disks of bone from, the skull successfully, but whether this delicate operation was performed to release evil spirits or as a surgical procedure is not known. Empirical medicine developed in ancient Egypt, and involved the use of many potent drugs still in use today, such as castor oil, senna, opium, colchicine, and mercury. In spite of their skill in embalming, however, the Egyptians had little knowledge of anatomy.

In Sumerian medicine the Laws of Hammurabi established the first known code of medical ethics, and laid down a fee schedule for specific surgical procedures. In ancient Babylonia, every man considered himself a physician and, according to Herodotus, gave advice freely to the sick man who was willing to exhibit himself to passersby in the public square. The Mosaic Code of the Hebrews indicated concerns with social hygiene and prevention of disease by dietary restrictions and sanitary measures.

Although ancient Chinese medicine was also influenced adversely by the awe felt for the sanctity of the human body, the Nei Ching, attributed to the emperor Huang-Ti (2698–2598 BC), contains a reference to a theory of the circulation of the blood and the vital function of the heart that suggests familiarity with anatomy. In addition, accurate location of the proper points for the traditional Chinese practice of acupuncture implies some familiarity with the nervous and vascular systems. The Chinese pharmacopoeia was the most extensive of all the older civilizations. The Hindus seem to have been familiar with many surgical procedures, demonstrating skill in such techniques as nose reconstruction (rhinoplasty) and cutting for removal of bladder stones.

In Greek medicine the impetus for the rational approach came largely from the speculations of the pre-Socratic philosophers and such philosopher-scientists as Pythagoras, Democritus, and Empedocles. Hippocrates , the father of Western medicine, taught the prevention of disease through a regimen of diet and exercise; he emphasized careful observation of the patient, the recuperative powers of nature, and a high standard of ethical conduct, as incorporated in the Hippocratic Oath. By the 4th cent. BC, Aristotle had already stimulated interest in anatomy by his dissections of animals, and work in the 3d cent. BC on human anatomy and physiology was of such high quality that it was not equaled for fifteen hundred years.

The Romans advanced public health and sanitation through the construction of aqueducts, baths, sewers, and hospitals. The encyclopedic writings of Galen constitute a final synthesis of the medicine of the ancient world. Revered by Arabic and Western physicians alike, his concepts stood virtually unchallenged until the 16th cent. Unfortunately, his prolific researches on anatomy and physiology were not invariably accurate, and reliance on them impeded subsequent progress in anatomy.

The Middle Ages

With the destruction or neglect of the Roman sanitary facilities, there followed a series of local epidemics that culminated many centuries later in the great plague of the 14th cent. known as the Black Death. During the Middle Ages certain monastic libraries, notably those at Monte Cassino, Bobbio, and St. Gall, preserved a few ancient medical manuscripts, and Arab and Jewish physicians such as Avicenna and Maimonides continued medical investigation.

The first real light on modern medicine in Europe came with the translation of many writings from the Arabic at Salerno, Italy, and through a continuing trade and cultural exchange with Byzantium. By the 13th cent. there were flourishing medical schools at Montpellier, Paris, Bologna and Padua, the latter being the site of production of the first accurate books on human anatomy. At Padua, Vesalius proved that Galen had made anatomical mistakes. Prominent among those who pursued the new interest in experimental medicine were Paracelsus , Ambroise Paré , and Fabricius , who discovered the valves of the veins.

The Birth of Modern Medicine

In the 17th cent. William Harvey , using careful experimental methods, demonstrated the circulation of the blood, a concept that met with considerable early resistance. The introduction of quinine marked a triumph over malaria, one of the oldest plagues of mankind. The invention of the compound microscope led to the discovery of minute forms of life, and the discovery of the capillary system of the blood filled the final gap in Harvey's explanation of blood circulation.

In the 18th cent. the heart drug digitalis was introduced, scurvy was controlled, surgery was transformed into an experimental science, and reforms were instituted in mental institutions. In addition, Edward Jenner introduced vaccination to prevent smallpox, laying the groundwork for the science of immunization.

The 19th cent. saw the beginnings of modern medicine when Pasteur , Koch , Ehrlich and Semmelweis proved the relationships between germs and disease . Other invaluable developments included the use of disinfection and the consequent improvement in medical, particularly obstetrical, care; the use of inoculation; the introduction of anesthetics in surgery (see anesthesia ); and a revival of better public health and sanitary measures. A significant decline in maternal and infant mortality followed.

Modern Medicine

Medicine in the 20th cent. received its impetus from Gerhard Domagk who discovered the first antibiotic, sulfanilamide, and the groundbreaking advancements in the use of penicillin . Further progress has been characterized by the rise of chemotherapy , especially the use of new antibiotics ; increased understanding of the mechanisms of the immune system (see immunology ) and the increased prophylactic use of vaccination ; utilization of knowledge of the endocrine system to treat diseases resulting from hormone imbalance, such as the use of insulin to treat diabetes; and increased understanding of nutrition and the role of vitamins in health.

In Mar., 1953, at the Univ. of Cambridge, England, Francis Crick , age 35, and James Watson , age 24, announced "We have discovered the secret of life." Indeed, they had unraveled the chemical structure of the fundamental molecule of heredity, deoxyribonucleic acid (DNA), giving science and medicine the basis for molecular genetics and leading to a continuing revolution in modern medicine.

Much medical research is now directed toward such problems as cancer , heart disease, AIDS , reemerging infectious diseases such as tuberculosis and dengue fever , and organ transplantation . Currently, the largest worldwide study is the Human Genome Project , which will identify all hereditary traits and body functions controlled by specific areas on the chromosomes . Gene therapy , the replacement of faulty genes, offers possible abatement of hereditary diseases. Genetic engineering has led to the development of important pharmaceutical products and the use of monoclonal antibodies , offering promising new approaches to cancer treatment. The discovery of growth factors has opened up the possibility of growth and regeneration of nerve tissues.

With the surge of general and specialized medical knowledge, the educational requirements of the medical profession have increased. In addition to the four-year medical course and the general hospital internship required almost everywhere, additional years of study in a specialized field are usually required. Similar progress and increased requirements in education are reflected in ancillary professions such as nursing.

Modern Health Care Management

Modern medicine, characterized by growing specialization and a complex diagnostic and therapeutic technology, faces problems in the allocation of capital and personnel resources. Some authorities advocate an increase in the use of paramedical personnel to supervise the care of individuals with common, chronic, or terminal illnesses, leaving the physician in charge of treating curable disease. Others emphasize the physician's responsibility to help patients and families in the overall management of their health problems, many of which are thought to reflect the social ills of living in an urban, industrialized society.

In some countries, such as Great Britain, medical care is under government control and is available virtually without charge to all. In the United States, medical practice is characterized by a patchwork mixture of government and private control. The Kefauver-Harris amendments to the federal Food, Drug, and Cosmetic Act of 1962 empower the Food and Drug Administration to require stricter testing and licensing of new drugs. There have also been federal, state, and local programs for mass vaccination and other public health programs. The Medicare program, enacted in 1965, provides subsidized hospital and nursing-home care for persons over 65 and, with the Hill-Burton Act, provides funds for state aid to the medically indigent ( Medicaid ).

A wide variety of private medical insurance plans are also available to those who can afford them, and many employers pay all or part of their employees' health insurance premiums. In addition, health maintenance organizations (HMOs), or group practice plans, are designed to promote disease prevention and reduce medical expenditures.

Bibliography

See J. Walton et al., ed., The Oxford Companion to Medicine (2 vol., 1986); historical study by H. E. Sigerist (2 vol., 1951–61); studies by R. Hudson (1983), P. Starr (1983), D. Dutton (1988), E. Shorter (1991), and J. Duffin (2d ed., 2010); M. Bliss, The Making of Modern Medicine (2011).

Medicine

Traditionally, space medicine has tackled medical problems associated with the space environment. Increasingly, however, space medicine also encompasses research conducted aboard space stations and vehicles. Medical research conducted in microgravity is making significant contributions to the understanding of the molecular structure of living things—a key to the development of new disease-fighting drugs. The scope of biological molecules includes proteins, polysaccharides and other carbohydrates, lipids and nucleic acids of biological origin, and those expressed in plant, animal, fungal, or bacteria systems. The precise structure of proteins and some other biologic molecules can be determined by diffracting X rays off crystalline forms of these molecules to create a visual image of the molecular structure. Determining the structure of these macromolecules —which allow living organisms to function—is essential to the design of new, more effective drugs against infectious diseases and other afflictions, such as AIDS, heart disease, cancer, diabetes, sickle-cell anemia, hepatitis, and rheumatoid arthritis.

Medical Advances from Space Research

Space-based crystal growth facilitates the study of how macromolecules work in the human body, which has important implications for medicine. For example, through protein crystal growth research, scientists have made an important step toward developing a treatment for respiratory syncytial virus—a life-threatening virus that causes pneumonia and severe upper respiratory infection in infants and young children. Investigators have determined the structure of a potentially important antibody to the virus, allowing scientists to understand key interactions between the antibody and the virus, thus, facilitating development of treatments. Factor D protein crystals have also been grown in space, leading to development of a drug that may aid patients recovering from heart surgery by inhibiting the body's inflammatory responses. Experiments in protein crystallization research have also yielded detailed structural data on proteins associated with Chagas' disease, a deadly illness that afflicts more than 20 million people in Latin America and parts of the United States.

Medical research in space has likewise yielded precise images of insulin proteins—mapped from space-grown crystals—which can aid the development of new insulin treatments for diabetes. Such treatments would greatly improve the quality of life of insulin-dependent diabetics by reducing the number of injections they require. In addition, a space-based study of the HIV protease-inhibitor complex has resulted in improved resolution of the protein's structure, which has important implications for designing new drugs for AIDS therapies. Microgravity research has also provided insight into an enzyme called neuraminidase, which is a target for the treatment and prevention of the flu. Meanwhile, influenza protein crystals grown aboard several space shuttle flights have had a significant impact on the progress for a flu medicine. As a result, several potent inhibitors of viral influenza (types A and B) have been developed. Medical research in space has also provided insight into fundamental physiologic processes in the human body. A protein crystal growth study conducted during a space shuttle flight shed new light on antithrombin—a protein that controls coagulation of blood.

Research on the International Space Station

Equipped with a dedicated research laboratory, the International Space Station (ISS) will support longer-duration experiments in a more research-friendly, acceleration-free, dedicated laboratory than the space shuttle can allow. Onboard ISS, astronauts and cosmonauts will use the Microgravity Science Glovebox to support investigations and demonstrations in all of the microgravity research disciplines. When it is sealed, the Glovebox serves as a single level of containment by providing a physical barrier. A planned protein crystal growth facility will be used to expose a pure protein solution to a substrate, which draws the liquid out of the protein solution, leaving crystallized proteins behind.

Plans for the ISS also call for a "bioreactor" onboard that will be used in experiments to grow cells and tissues in a controlled environment. On Earth, bioreactors have to rotate to allow cell growth in three dimensions, very similar to the way cells grow naturally within an organism. However, this works only up to a certain sample size because the larger the sample gets, the faster the bioreactor has to spin to keep the cells suspended. In the microgravity environment of the International Space Station, the cells will remain suspended on their own because there is virtually no gravity to cause sedimentation. As a result, samples can be grown larger and be kept alive for longer periods.

With these cells and tissues, new medicines in the fight against AIDS, cancer, and diabetes can be safely tested, without harming animal or human test subjects, and long-term exposure to microgravity and its effects on human bones, muscles, cartilage, and immunity can be studied effectively. Bioreactor research will also be valuable in the study of potential cartilage and liver tissue transplantation.

see also Careers in Space Medicine (volume 1); Crystal Growth (volume 3); International Space Station (volumes 1 and 3); Made in Space (volume 1).

John F. Kross

Bibliography

Oberg, James E. The New Race for Space. Harrisburg, PA: Stackpole Books, 1984.

O'Rangers, Eleanor A. "Basics of Space Medicine and Physiology: Space Motion Sickness." Ad Astra 13, no. 4 (2001):10-11.

Woodard, Daniel, and Alcestis R. Oberg, eds. The Case for Mars. San Diego, CA: American Astronautical Society, 1984.

Internet Resources

Marshall Space Flight Center. "NASA Research Helps Map Protein Structures: Key in the Development of New Disease-Fighting Drugs." <http://www.msfc.nasa.gov/news/background/facts/pcg.htm>.

Microgravity Research Program Office. Marshall Space Flight Center. <http://microgravity.nasa.gov/ISSLAB.html>.

NASA Biotechnology Program: Protein Crystal Growth. Marshall Space Flight Center.<http://microgravity.msfc.nasa.gov/pcgBiot.html>.

medicine

The practice of medicine in the early Renaissance was still bound by the study of the ancient Greek doctors and writers, in particular Hippocrates, Dioscorides, and the second-century physician Galen. The writings of Galen were the accepted teaching in universities and sanctioned by the Catholic Church, which held control through the universities over the training of professional doctors. Galen's own anatomical knowledge was limited, however, by a prohibition on human dissection, a practice still banned by the medieval church. Thus the limitations of Galen's knowledge persisted for a thousand years within Europe, even as the church held his teachings to be infallible.

A new approach to knowledge and investigation of science bloomed in the Renaissance. Old methods and treatments came under question. The German philosopher Paracelsus was the son of a physician, and one of the most important figures of Renaissance medicine. He believed that sickness resulted from imbalances of essential minerals and chemicals in the body, and prescribed medicines meant to correct these imbalances. He also investigated the action of poisons, and hit upon the idea that a toxic substance, when applied in a limited dose, can cure the body of illness. Paracelsus applied his theories to the treatment of miners, who seemed to have several dangerous illnesses in common that resulted from their occupation and not from the state of their bodily humors (fluids) or their souls.

In the generation of Paracelsus, new treatments for sickness and injuries were developed, which bypassed many of the old superstitions of the medieval age. The French surgeon Ambroise Pare developed the use of ligatures to close battlefield wounds, a method intended to deter infection and avoid the complications caused by sealing wounds with burning irons. Pare set down his findings in Method of Treating Wounds Inflicted by Arquebuses and other Guns, which after its publication in 1545 became a standard medical textbook for military doctors. For the majority of the population, however, medical practice still held to medieval traditions, and spiritual healing was still the most commonplace approach to sickness. Barber/surgeons set bones, pulled teeth, carried out bloodlettings, and performed amputations of infected limbs. Ordinary medical doctors still relied on the philosophy of the four humors of the body (blood, phlegm, yellow bile, and black bile) to diagnose illness and prescribe treatment. Apothecaries and herbalists offered a wide range of plant and animal products to apply or to ingest, mixtures designed to heal disease through their sheer repulsiveness.

The discovery of new land in the Western Hemisphere and Asia also had an important impact on Renaissance medicine, bringing new treatments and medicines to Europe. University professors and doctors put dissection and the new microscope to work to explore the human body, while artists such as Leonardo da Vinci undertook their own investigations in order to render the human body as realistically as possible. The first translation of Galen's work On Anatomical Procedures into Latin was accomplished in 1531 by Johannes Guinter. In this book Galen recommends human dissection, a stand that promoted the practice by doctors and scientists in the late Renaissance. A new age of investigation was opened up, led by anatomists such as Andreas Vesalius, a professor of surgery at the University of Padua, the academic center of medicine in the Renaissance. Vesalius was the first to practice public dissection before students on human corpses. His book On the Structure of the Human Body, first published in 1543, offered detailed and accurate anatomical drawings. These investigations culminated in the discovery of the circulation of the blood by William Harvey, an English doctor who published On the Motion of the Heart and Blood in Animals in 1628.

See Also: Paracelsus

436. Medicine (See also Healing.)

1. Acesis daughter of Asclepius; name means ‘healing remedy.’ [Gk. Myth.: Kravitz, 37]
2. Angitia goddess of healing. [Rom. Myth.: Kravitz, 24]
3. Antony, St. invoked against venereal diseases and erysipelas (St. Antony’s fire). [Christian Hagiog.: Daniel, 28–29]
4. Apollo (Phoebus ) patron of medicine. [Gk. Myth.: Kravitz, 28]
5. Asclepius (Aesculapius ) god of healing. [Gk. Myth.: Kravitz, 37]
6. Benassis, Dr. devotes himself to the poor and miserable inhabitants of a remote village. [Fr. Lit.: Balzac The Country Doctor ; Magill II, 185]
7. Bull, George ignorant physician who cannot prevent an epidemic. [Am. Lit.: Cozzens The Last Adam Haydn & Fuller, 409]
8. caduceus snake-entwined staff; emblem of medical profession. [Gk. Myth.: Kravitz, 49]
9. Carmenta goddess of healing. [Gk. Myth.: Kravitz, 53]
10. Cosmas, St. and St. Damian patron saints; brothers, practiced medicine without charge. [Christian Hagiog.: Attwater, 94]
11. Diver, Dick failed psychiatrist becomes a small-town general practitioner. [Am. Lit.: Tender Is the Night ]
12. Ferguson, George young surgeon who goes to Vienna to become better qualified for a hospital job. [Am. Lit.: Kingsley Men in White ; Haydn & Fuller, 183]
13. Hippocrates (c. 460–c. 360 B.C.) Greek physician and “Father of Medicine.” [Gk. Hist.: NCE, 1246]
14. Hippocratic oath ethical code of medicine. [Western Culture: EB, 11: 827]
15. Iaso Asclepius’s daughter; personification of his healing power. [Gk. Myth.: Kravitz, 37]
16. Mayo Clinic voluntary association of more than 500 physicians in Rochester, Minnesota. [Am. Hist.: EB, 11: 723]
17. Mitchell, Parris studies medicine in the U.S. and abroad, returns as a physician at an insane asylum. [Am. Lit.: King’s Row ; Magill I, 478]
18. Paean physician to the gods. [Gk. Myth.: Espy, 29]
19. Panacea daughter of Greek god of healing. [Gk. Myth.: Kravitz, 37]
20. Prince, Nan becomes a successful physician like her foster father. [Am. Lit.: Jewett A Country Doctor ; Magill II, 183]
21. Rieux, Dr. Bernard works unceasingly to relieve victims of a deadly epidemic. [Fr. Lit.: Camus The Plague ]
22. Roch, St. (also St. Rock ) invoked against infectious diseases; especially in the 15th century, against plague. [Christian Hagiog.: Daniel, 198]
23. Vitus, St. invoked against epilepsy and chorea (St. Vitus’s dance). [Christian Hagiog.: Attwater, 338]
24. Watson, Dr. John H. Sherlock Holmes’s chronicler who had a medical practice. [Br. Lit.: Arthur Conan Doyle Sherlock Holmes ]
25. Welby, Marcus avuncular doctor of impeccable ethics. [Am. TV: “Marcus Welby, M.D.” in Terrace, II, 66]

medicine. For over 2,000 years the Buddhist monastic order (Saṃgha) has been closely involved with the treatment of the sick. Several centuries before Christ, Buddhist monks were developing treatments for many kinds of medical conditions and played a significant role in the development of traditional Indian medicine (Āyurveda). Medical expertise was required as a means to securing the healthy physical constitution necessary to withstand the rigours of the monastic life. Treatments were given in the monasteries, and the medical practices that were institutionalized as part of the monastic rules (Vinaya) provide some of the earliest codifications of Indian medical knowledge. In the Vinaya, the Buddha counsels monks to care for one another in the following terms: ‘You, O monks, have neither a father nor a mother who could nurse you. If, O monks, you do not nurse one another, who, then, will nurse you? Whoever, O monks, would nurse me, he should nurse the sick.’ As monasteries grew, hospices and infirmaries supported by the laity increasingly formed part of the structure, and medicine became integrated into the curricula of the major monastic universities. The great Buddhist monarch Aśoka states in his second Rock Edict that he has made medical provision for both men and animals, and that he has imported and planted medicinal herbs, along with roots and fruits. In modern times Buddhist monks continue to practise traditional medicine from a range of cultures as well as Western medicine.

med·i·cine / ˈmedisən/ • n. 1. the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery). 2. a compound or preparation used for the treatment or prevention of disease, esp. a drug or drugs taken by mouth: give her some medicine | your doctor will be able to prescribe medicines. ∎  such substances collectively: an aid convoy loaded with food and medicine. 3. (among North American Indians and some other peoples) a spell, charm, or fetish believed to have healing, protective, or other power: Fleur was murdering him by use of bad medicine. PHRASES: give someone a dose (or taste) of their own medicine give someone the same bad treatment that they have given to others: tired of his humiliation of me, I decided to give him a taste of his own medicine. take one's medicine submit to something disagreeable such as punishment. ORIGIN: Middle English: via Old French from Latin medicina, from medicus ‘physician.’

medicine Practice of the prevention, diagnosis and treatment of disease or injury; the term also applies to any agent used in the treatment of disease. Medicine has been practised since ancient times, but the dawn of modern Western medicine coincided with accurate anatomical and physiological observations first made in the 17th century. By the 19th century, practical diagnostic procedures had been developed for many diseases; bacteria had been discovered and research undertaken for the production of immunizing serums in attempts to eradicate disease. The great developments of the 20th century included the discovery of penicillin and insulin, chemotherapy (the treatment of various diseases with specific chemical agents), new surgical procedures including organ transplants, and sophisticated diagnostic devices such as radioactive tracer and scanners. Alternative medicine, such as osteopathy, homeopathy, or acupuncture, some of which are hundreds of years old, is becoming increasingly popular, and some therapies are being accepted within conventional medicine.

medicine (med-sin) n.
1. the science or practice of the diagnosis, treatment, and prevention of disease.

2. the science or practice of nonsurgical methods of treating disease.

3. any drug or preparation used for the treatment or prevention of disease, particularly a preparation that is taken by mouth.

MEDICINE.

This entry includes four subentries:

Medicine: see HEALING.

medicine •assassin • Yeltsin • sasine •Solzhenitsyn • rebbetzin •biomedicine, medicine •ceresin •ricin, Terramycin •tocsin, toxin •Wisconsin • oxytocin • niacin •moccasin • characin • Capuchin •Latin, satin •plantain • captain •marten, martin •cretin •pecten, pectin •Quentin •clandestine, destine, intestine •sit-in • quintain • bulletin • chitin •Austen, Mostyn •fountain, mountain •gluten, highfalutin, Rasputin •Dustin, Justin •biotin • legatine • gelatin • keratin •certain, Curtin •Kirsten • Gethin • lecithin • Bleddyn •Gavin, ravin, ravine, savin, spavin •Alvin, Calvin •Marvin •Bevin, Kevin, levin, Previn, replevin •kelvin, Melvin •riboflavin • covin • Mervyn