Introduction In Medicine And History Of Medicine Lecture 7 PDF

INTRODUCTION IN MEDICINEAND HISTOEY OF MEDICINE LECTURE 7. HISTORY OF TECHNICAL KNOWLEDGE AND PRACTICE ON LEADING DISEASES CHRONOLOGIC OVERVIEW OF TECHNICAL KNOWLEDGE DEVELOPMENT– MANNER OF DISEASES TREATMENT AND MONITORING ANTIC MEDICINE  In Antic period, medicine was viewed as synthesis...

INTRODUCTION IN MEDICINEAND HISTOEY OF MEDICINE LECTURE 7. HISTORY OF TECHNICAL KNOWLEDGE AND PRACTICE ON LEADING DISEASES CHRONOLOGIC OVERVIEW OF TECHNICAL KNOWLEDGE DEVELOPMENT– MANNER OF DISEASES TREATMENT AND MONITORING ANTIC MEDICINE  In Antic period, medicine was viewed as synthesis of knowledge and contemplation, science and philosophy.  Founder of Antic medicine, Hippocrates, distinguished two notions in medical work: - technical and - contemplative  He named “techne” the technical work– where knowledge and application of such knowledge are pointed out.  He named “ars” the contemplative work – where knowledge and contemplation, science and philosophy are pointed out. SUCCESSFUL PHYSICIAN  «For one who wants to do surgery it is necessary to practice during surgeries, as practice is the best teacher for a hand; if one deals with hidden and severe diseases, techne does not help, contemplation should be used to help.  Modern physician is the one who knows his job (knows rules and has skills to apply them) and who is, on top of that, capable of philosophical thinking, who is an artist capable of theoretical generalization.» Hippocrates EXAMINATION OF A PATIENT  Hippocrates’ clinical work is based on developed examination plan, disease diagnosis, disease course and outcome forecast and treatment. All of this is made next to patient’s bed.  Examination starts by taking medical history «anamnesis». It continues by physical examination, to identify patient’s condition, «status praesens», relaying on “facts and wise judgment”. As of today the term «facies hippocratica» is used to define a look just before death.  Taking medical history and status praesens is today also an integral part of any physical examination. DIAGNOSTIC THINKING USING SENSES  In physical examination and diagnosis, Hippocrates focused on using five senses.  Hippocrates followers in next centuries improved that method.  Skoda was biggest artist in that. In mid 19th century he focused on inspection, palpation, percussion, auscultation and diagnostic thinking. LABORTORY DIAGNOSTICS  Scientific progress, particularly of microbiology, physics and chemistry, was putting aside direct use of senses. By getting number of laboratory information, examination of patient moves from his bed to laboratory.  This way of work leaves physician’s senses and thinking without practicing, thus they are not sharpened any more and reducing physician’s experience and power of observation, meaning that his intuition disappears.  Such way of work produces physician expert, equipped by treasury of knowledge, but powerless and unproductive thinker, unable to use his treasury of knowledge and apply it in any particular case. LABORATORY RESULTS DO NOT GIVE READY MADE DIAGNOSIS  Laboratory results present only broader and deeper, indirect product of senses, and only support physician’s work, but do not produce ready made diagnosis.  They are just signs to be understood and interpreted, and that can be done only by thinking and making conclusions by physician.  Work which is not based on thinking, direct intuitive learning and in which physician does not apply sharp critical consideration of all the received laboratory results, is not in line with Hippocrates’ understanding of physician’s work. According to Hippocrates, physician must be equally expert and thinker. PATIENT’S PSYCHOLOGICAL CONDITION OBSERVATION  In earliest centuries of history of medicine “soul was handed over tacitly to doctors of theology, while body to doctors of medicine”.  Such situation was maintained for centuries, although long time ago close relation was observed between person’s live tissues and his spiritual features and requirements. This was formulated in the expression «Mens sana in corpore sano».  Psychosomatic medicine proved that soul also affects person’s live tissues, not only causing their reflexes but also keeps them. ??? (Stress and duration of life) GENERAL LOOK AT DISEASE IS REPLACED BY NARROW SPECIALIST ONE  Biological terms “constitution”, “predisposition”, “inclination”, “heredity” are known since long ago. However, over time they have been increasingly less used in practical medicine.  Over time, biological importance of body juices, humor theory and integrity of organism, was reduced in favor of narrowminded importance of body cells and parts of organism. This made specialist practice dominating over general practice in physician’s profession. ??? CONSTITUTION AND CHARACTER RELATION – BIOLOGICAL CONDITION  German physician and professor Zimssen, said in his lecture delivered in 1890 the following: «I think that modern therapy pays too little attention to person’s general constitution, taken as a whole and his individuality. Prescribing our therapy, particularly for local disorder, we cannot achieve best possible results». THERAPY Over centuries, therapy was fluctuating between two opposite principles:  Hippocrates’ passive therapy, oriented towards strengthening organism itself by life-style, diet and preventive measures, accepted also by some of more recent period physicians (Seidenheim, Skoda) and  Active poly-pharmaceutical therapy THERAPIA MAGNA STERILISANS  By end 19th century, times of progress in microbiology, there was an idea among physicians to invent and start using antiseptics to fight microorganisms in the organism, substances which would eliminated causes of disease, but not harm organism itself.  A substance ‘stovarsol’ was discovered, which produced antiseptic effect against syphilis, reccurenss, tripanosoma and protozoa..  Domination of such chemical therapy was short, as starting 1935 they were carved out by sulphoamides (salvarsan to treat syphilis) MICRO-THERAPY AND OTHER THERAPY  During the World War II, thanks to US large pharmaceutical industry and earlier penicillin discovery by Alexander Fleming in 1923, sulphamide therapy started losing its importance in favor of micro-therapy. (Chain and Follay were the first to start treating policeman which severe throat infection accompanied by fever; they administered penicillin and patients condition improved, since they did not have enough penicillin, they extracted it from patient’s urine, however after a month there was no more penicillin and the patient eventually died).  Insulin discovered by Banting and Best in 1921 – basis of hormonal therapy  In 1920 Benneth introduced D vitamin to treat rachitis  Today, pharmaceutical industry has available many synthetic substances, but also the ones produced on herbal base (digitalis, cytostatics) NEO-HIPPOCRATES MEDICINE  New directions of theoretical medicine and overambitious active therapy contributed to revival of basic thoughts of Hippocrates and faith in healing power of nature, complemented and strengthened by appropriate life style. This new directions is knows as «neohippocratism». Neo-Hippocrates medicine relies on:  Hippocrates’ humoral theory,  Hippocrates’ naturalistic and biological principle of healing power of organism itself (vis medicatrix naturae)  Therapeutic principle of «contraria contraris curantur» (opposite is treated by opposite – aleophaty – fever is healed by cooling down),  Antic theory on tempers and corresponding bodily juices ALIGNING OLD WITH NEW SCIENTIFIC LEGACY  Neohippocrites medicine, by adopting principles of the founder of medicine, aligns such old principles with new scientific legacy: immunology and antigen and anti-body theory, vaccines and sero-therapy, science on enzims and ferments, hormones and vitamins, as well as homeopathic medicine and its principle on infinitezimalnim doses and «similia similibus curantur» principle (similar is treated by similar– homeopathy – administering low doses of micro-organisms induces immune response of the organism). ALIGNIG OLD WITH NEW SCIENTIFIC LEGACY  Neohippocrates medicine emphasizes mutual integrity of humoral and cellular theory, as bodily juices are products of bodily cells and as cells do not affect functions and processes in the organism directly, bt through their juices which are circulating throughout organism via blood circulation system. MODERN MEDICINE – SCIENCE ON HEALTH  Lion professor Pierre Delloar said that future medicine would be science on health  It would promote preventive measures aimed to protect health. It would focus on promoting healthy life styles – healthy diet, physical activity, alcohol-, tobacco- and psychotropic substances-free life. CONTRADICTIONS IN MEDICINE ARE YET TO BE RESOLVED  Modern medicine identifies its problems and reveals its internal contradictions, which old and go back all the way to first medical schools at Kos and Knid.  Resolution of these contradictions must be in line with principles of medicine and requirements of society.