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Medicine
FromWikipedia,thefreeencyclopedia

Medicine(BritishEnglish i /mdsn/AmericanEnglish
i
/mdsn/)isthescienceandpracticeofthediagnosis,
treatment,andpreventionofdisease.[1][2]Thewordmedicine
isderivedfromLatinmedicus,meaning"aphysician".[3][4]
Medicineencompassesavarietyofhealthcarepractices
evolvedtomaintainandrestorehealthbythepreventionand
treatmentofillness.Contemporarymedicineapplies
biomedicalsciences,biomedicalresearch,genetics,and
medicaltechnologytodiagnose,treat,andpreventinjuryand
disease,typicallythroughpharmaceuticalsorsurgery,but
alsothroughtherapiesasdiverseaspsychotherapy,external
splintsandtraction,medicaldevices,biologics,andionizing
radiation,amongstothers.[5]

Medicine

Aphysicianlistenstotheheartbeatofaboyusinga
stethoscopeinHelmand,Afghanistan

Specialist
Physician
Medicinehasexistedforthousandsofyears,duringmostof
whichitwasanart(anareaofskillandknowledge)
frequentlyhavingconnectionstothereligiousandphilosophicalbeliefsoflocalculture.Forexample,a
medicinemanwouldapplyherbsandsayprayersforhealing,oranancientphilosopherandphysicianwould
applybloodlettingaccordingtothetheoriesofhumorism.Inrecentcenturies,sincetheadventofmodern
science,mostmedicinehasbecomeacombinationofartandscience(bothbasicandapplied,underthe
umbrellaofmedicalscience).Whilestitchingtechniqueforsuturesisanartlearnedthroughpractice,the
knowledgeofwhathappensatthecellularandmolecularlevelinthetissuesbeingstitchedarisesthrough
science.

Prescientificformsofmedicinearenowknownastraditionalmedicineandfolkmedicine.Theyremain
commonlyusedwithorinsteadofscientificmedicineandarethuscalledalternativemedicine.Forexample,
evidenceontheeffectivenessofacupunctureis"variableandinconsistent"foranycondition,[6]butisgenerally
safewhendonebyanappropriatelytrainedpractitioner.[7]Incontrast,treatmentsoutsidetheboundsofsafety
andefficacyaretermedquackery.

Contents
1 Clinicalpractice
2 Institutions
2.1 Delivery
3 Branches
3.1 Basicsciences
3.2 Specialties
3.3 Interdisciplinaryfields
4 Educationandlegalcontrols
5 Medicalethics
6 History
6.1 Ancientworld
6.2 MiddleAges
6.3 Modern
7 Traditionalmedicine
8 Seealso
9 Notesandreferences
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9 Notesandreferences

Clinicalpractice
Medicalavailabilityandclinicalpracticevariesacrosstheworlddueto
regionaldifferencesincultureandtechnology.Modernscientific
medicineishighlydevelopedintheWesternworld,whileindeveloping
countriessuchaspartsofAfricaorAsia,thepopulationmayrelymore
heavilyontraditionalmedicinewithlimitedevidenceandefficacyand
norequiredformaltrainingforpractitioners.[8]Eveninthedeveloped
worldhowever,evidencebasedmedicineisnotuniversallyusedin
clinicalpracticeforexample,a2007surveyofliteraturereviewsfound
thatabout49%oftheinterventionslackedsufficientevidencetosupport
eitherbenefitorharm.[9]

TheDoctor,bySirLukeFildes
(1891)

Inmodernclinicalpractice,doctorspersonallyassesspatientsinorder
todiagnose,treat,andpreventdiseaseusingclinicaljudgment.The
doctorpatientrelationshiptypicallybeginsaninteractionwithanexaminationofthepatient'smedicalhistory
andmedicalrecord,followedbyamedicalinterview[10]andaphysicalexamination.Basicdiagnosticmedical
devices(e.g.stethoscope,tonguedepressor)aretypicallyused.Afterexaminationforsignsandinterviewing
forsymptoms,thedoctormayordermedicaltests(e.g.bloodtests),takeabiopsy,orprescribepharmaceutical
drugsorothertherapies.Differentialdiagnosismethodshelptoruleoutconditionsbasedontheinformation
provided.Duringtheencounter,properlyinformingthepatientofallrelevantfactsisanimportantpartofthe
relationshipandthedevelopmentoftrust.Themedicalencounteristhendocumentedinthemedicalrecord,
whichisalegaldocumentinmanyjurisdictions.[11]Followupsmaybeshorterbutfollowthesamegeneral
procedure,andspecialistsfollowasimilarprocess.Thediagnosisandtreatmentmaytakeonlyafewminutesor
afewweeksdependinguponthecomplexityoftheissue.
Thecomponentsofthemedicalinterview[10]andencounterare:
Chiefcomplaint(CC):thereasonforthecurrentmedicalvisit.Thesearethe'symptoms.'Theyareinthe
patient'sownwordsandarerecordedalongwiththedurationofeachone.Alsocalled'chiefconcern'or
'presentingcomplaint'.
Historyofpresentillness(HPI):thechronologicalorderofeventsofsymptomsandfurtherclarification
ofeachsymptom.Distinguishablefromhistoryofpreviousillness,oftencalledpastmedicalhistory
(PMH).MedicalhistorycomprisesHPIandPMH.
Currentactivity:occupation,hobbies,whatthepatientactuallydoes.
Medications(Rx):whatdrugsthepatienttakesincludingprescribed,overthecounter,andhome
remedies,aswellasalternativeandherbalmedicines/herbalremedies.Allergiesarealsorecorded.
Pastmedicalhistory(PMH/PMHx):concurrentmedicalproblems,pasthospitalizationsandoperations,
injuries,pastinfectiousdiseasesand/orvaccinations,historyofknownallergies.
Socialhistory(SH):birthplace,residences,maritalhistory,socialandeconomicstatus,habits(including
diet,medications,tobacco,alcohol).
Familyhistory(FH):listingofdiseasesinthefamilythatmayimpactthepatient.Afamilytreeis
sometimesused.
Reviewofsystems(ROS)orsystemsinquiry:asetofadditionalquestionstoask,whichmaybemissed
onHPI:ageneralenquiry(haveyounoticedanyweightloss,changeinsleepquality,fevers,lumpsand
bumps?etc.),followedbyquestionsonthebody'smainorgansystems(heart,lungs,digestivetract,
urinarytract,etc.).
Thephysicalexaminationistheexaminationofthepatientformedicalsignsofdisease,whichareobjective
andobservable,incontrasttosymptomswhicharevolunteeredbythepatientandnotnecessarilyobjectively
observable.[12]Thehealthcareproviderusesthesensesofsight,hearing,touch,andsometimessmell(e.g.,in
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infection,uremia,diabeticketoacidosis).Fouractionsarethebasisofphysicalexamination:inspection,
palpation(feel),percussion(taptodetermineresonancecharacteristics),andauscultation(listen),generallyin
thatorderalthoughauscultationoccurspriortopercussionandpalpationforabdominalassessments.[13]
Theclinicalexaminationinvolvesthestudyof:
Vitalsignsincludingheight,weight,bodytemperature,blood
pressure,pulse,respirationrate,andhemoglobinoxygen
saturation
Generalappearanceofthepatientandspecificindicatorsof
disease(nutritionalstatus,presenceofjaundice,palloror
clubbing)
Skin
Head,eye,ear,nose,andthroat(HEENT)
Cardiovascular(heartandbloodvessels)
Respiratory(largeairwaysandlungs)
Abdomenandrectum
Genitalia(andpregnancyifthepatientisorcouldbepregnant)
Musculoskeletal(includingspineandextremities)
Neurological(consciousness,awareness,brain,vision,cranial
nerves,spinalcordandperipheralnerves)
Psychiatric(orientation,mentalstate,evidenceofabnormal
perceptionorthought).
Itistolikelyfocusonareasofinteresthighlightedinthemedical
historyandmaynotincludeeverythinglistedabove.

StatueofAsclepius,theGreekgodof
medicine,holdingthesymbolicRod
ofAsclepiuswithitscoiledserpent

Thetreatmentplanmayincludeorderingadditionalmedicallaboratory
testsandmedicalimagingstudies,startingtherapy,referraltoa
specialist,orwatchfulobservation.Followupmaybeadvised.
Dependinguponthehealthinsuranceplanandthemanagedcaresystem,variousformsof"utilizationreview",
suchaspriorauthorizationoftests,mayplacebarriersonaccessingexpensiveservices.[14]
Themedicaldecisionmaking(MDM)processinvolvesanalysisandsynthesisofalltheabovedatatocomeup
withalistofpossiblediagnoses(thedifferentialdiagnoses),alongwithanideaofwhatneedstobedoneto
obtainadefinitivediagnosisthatwouldexplainthepatient'sproblem.
Onsubsequentvisits,theprocessmayberepeatedinanabbreviatedmannertoobtainanynewhistory,
symptoms,physicalfindings,andlaborimagingresultsorspecialistconsultations.

Institutions
Contemporarymedicineisingeneralconductedwithinhealthcaresystems.Legal,credentialingandfinancing
frameworksareestablishedbyindividualgovernments,augmentedonoccasionbyinternationalorganizations,
suchaschurches.Thecharacteristicsofanygivenhealthcaresystemhavesignificantimpactontheway
medicalcareisprovided.
Fromancienttimes,Christianemphasisonpracticalcharitygaverisetothedevelopmentofsystematicnursing
andhospitalsandtheCatholicChurchtodayremainsthelargestnongovernmentproviderofmedicalservices
intheworld.[15]Advancedindustrialcountries(withtheexceptionoftheUnitedStates)[16][17]andmany
developingcountriesprovidemedicalservicesthroughasystemofuniversalhealthcarethataimstoguarantee
careforallthroughasinglepayerhealthcaresystem,orcompulsoryprivateorcooperativehealthinsurance.
Thisisintendedtoensurethattheentirepopulationhasaccesstomedicalcareonthebasisofneedratherthan
abilitytopay.Deliverymaybeviaprivatemedicalpracticesorbystateownedhospitalsandclinics,orby
charities,mostcommonlybyacombinationofallthree.
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Mosttribalsocietiesprovidenoguaranteeofhealthcareforthe
populationasawhole.Insuchsocieties,healthcareisavailabletothose
thatcanaffordtopayforitorhaveselfinsuredit(eitherdirectlyoras
partofanemploymentcontract)orwhomaybecoveredbycare
financedbythegovernmentortribedirectly.
Transparencyofinformationisanotherfactordefiningadelivery
system.Accesstoinformationonconditions,treatments,quality,and
pricinggreatlyaffectsthechoicebypatients/consumersand,therefore,
theincentivesofmedicalprofessionals.WhiletheUShealthcaresystem
hascomeunderfireforlackofopenness,[18]newlegislationmay
encouragegreateropenness.Thereisaperceivedtensionbetweenthe
needfortransparencyontheonehandandsuchissuesaspatient
confidentialityandthepossibleexploitationofinformationfor
commercialgainontheother.

TheHospitalofSantaMariadella
Scala,frescobyDomenicodi
Bartolo,14411442

Delivery
Provisionofmedicalcareisclassifiedintoprimary,secondary,andtertiarycare
categories.
Primarycaremedicalservicesareprovidedbyphysicians,physicianassistants,
nursepractitioners,orotherhealthprofessionalswhohavefirstcontactwitha
patientseekingmedicaltreatmentorcare.Theseoccurinphysicianoffices,
clinics,nursinghomes,schools,homevisits,andotherplacesclosetopatients.
About90%ofmedicalvisitscanbetreatedbytheprimarycareprovider.These
includetreatmentofacuteandchronicillnesses,preventivecareandhealth
educationforallagesandbothsexes.

Moderndrugampoules

Secondarycaremedicalservicesareprovidedbymedicalspecialistsintheir
officesorclinicsoratlocalcommunityhospitalsforapatientreferredbya
primarycareproviderwhofirstdiagnosedortreatedthepatient.Referralsare
madeforthosepatientswhorequiredtheexpertiseorproceduresperformedby
specialists.Theseincludebothambulatorycareandinpatientservices,
emergencyrooms,intensivecaremedicine,surgeryservices,physicaltherapy,
laboranddelivery,endoscopyunits,diagnosticlaboratoryandmedicalimaging
services,hospicecenters,etc.Someprimarycareprovidersmayalsotakecare
ofhospitalizedpatientsanddeliverbabiesinasecondarycaresetting.
Tertiarycaremedicalservicesareprovidedbyspecialisthospitalsorregional
centersequippedwithdiagnosticandtreatmentfacilitiesnotgenerallyavailable
atlocalhospitals.Theseincludetraumacenters,burntreatmentcenters,
advancedneonatologyunitservices,organtransplants,highriskpregnancy,
radiationoncology,etc.
Modernmedicalcarealsodependsoninformationstilldeliveredinmany
healthcaresettingsonpaperrecords,butincreasinglynowadaysbyelectronic
means.

NursesinKokopo,EastNew
Britain,PapuaNewGuinea

Inlowincomecountries,modernhealthcareisoftentooexpensivefortheaverageperson.International
healthcarepolicyresearchershaveadvocatedthat"userfees"beremovedintheseareastoensureaccess,
althoughevenafterremoval,significantcostsandbarriersremain.[19]

Branches
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Workingtogetherasaninterdisciplinaryteam,manyhighlytrainedhealthprofessionalsbesidesmedical
practitionersareinvolvedinthedeliveryofmodernhealthcare.Examplesinclude:nurses,emergencymedical
techniciansandparamedics,laboratoryscientists,pharmacists,podiatrists,physiotherapists,respiratory
therapists,speechtherapists,occupationaltherapists,radiographers,dietitians,andbioengineers,surgeons,
surgeon'sassistant,surgicaltechnologist.
Thescopeandsciencesunderpinninghumanmedicineoverlapmanyotherfields.Dentistry,whileconsidered
bysomeaseparatedisciplinefrommedicine,isamedicalfield.
Apatientadmittedtothehospitalisusuallyunderthecareofaspecificteambasedontheirmainpresenting
problem,e.g.,theCardiologyteam,whothenmayinteractwithotherspecialties,e.g.,surgical,radiology,to
helpdiagnoseortreatthemainproblemoranysubsequentcomplications/developments.
Physicianshavemanyspecializationsandsubspecializationsintocertainbranchesofmedicine,whicharelisted
below.Therearevariationsfromcountrytocountryregardingwhichspecialtiescertainsubspecialtiesarein.
Themainbranchesofmedicineare:
Basicsciencesofmedicinethisiswhateveryphysicianiseducatedin,andsomereturntoinbiomedical
research
Medicalspecialties
Interdisciplinaryfields,wheredifferentmedicalspecialtiesaremixedtofunctionincertainoccasions.

Basicsciences
Anatomyisthestudyofthephysicalstructureoforganisms.Incontrasttomacroscopicorgrossanatomy,
cytologyandhistologyareconcernedwithmicroscopicstructures.
Biochemistryisthestudyofthechemistrytakingplaceinlivingorganisms,especiallythestructureand
functionoftheirchemicalcomponents.
Biomechanicsisthestudyofthestructureandfunctionofbiologicalsystemsbymeansofthemethodsof
Mechanics.
Biostatisticsistheapplicationofstatisticstobiologicalfieldsinthebroadestsense.Aknowledgeof
biostatisticsisessentialintheplanning,evaluation,andinterpretationofmedicalresearch.Itisalso
fundamentaltoepidemiologyandevidencebasedmedicine.
Biophysicsisaninterdisciplinarysciencethatusesthemethodsofphysicsandphysicalchemistryto
studybiologicalsystems.
Cytologyisthemicroscopicstudyofindividualcells.
Embryologyisthestudyoftheearlydevelopmentoforganisms.
Endocrinologyisthestudyofhormonesandtheireffect
throughoutthebodyofanimals.
Epidemiologyisthestudyofthedemographicsofdisease
processes,andincludes,butisnotlimitedto,thestudyof
epidemics.
Geneticsisthestudyofgenes,andtheirroleinbiological
inheritance.
Histologyisthestudyofthestructuresofbiologicaltissuesby
lightmicroscopy,electronmicroscopyand
immunohistochemistry.
Immunologyisthestudyoftheimmunesystem,whichincludes
theinnateandadaptiveimmunesysteminhumans,forexample.
Medicalphysicsisthestudyoftheapplicationsofphysics
principlesinmedicine.
Microbiologyisthestudyofmicroorganisms,includingprotozoa,
LouisPasteurinhislaboratory,1885
bacteria,fungi,andviruses.
Molecularbiologyisthestudyofmolecularunderpinningsofthe
processofreplication,transcriptionandtranslationofthegeneticmaterial.
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Neuroscienceincludesthosedisciplinesofsciencethatarerelatedtothestudyofthenervoussystem.A
mainfocusofneuroscienceisthebiologyandphysiologyofthehumanbrainandspinalcord.Some
relatedclinicalspecialtiesincludeneurology,neurosurgeryandpsychiatry.
Nutritionscience(theoreticalfocus)anddietetics(practicalfocus)isthestudyoftherelationshipoffood
anddrinktohealthanddisease,especiallyindetermininganoptimaldiet.Medicalnutritiontherapyis
donebydietitiansandisprescribedfordiabetes,cardiovasculardiseases,weightandeatingdisorders,
allergies,malnutrition,andneoplasticdiseases.
Pathologyasascienceisthestudyofdiseasethecauses,course,progressionandresolutionthereof.
Pharmacologyisthestudyofdrugsandtheiractions.
Photobiologyisthestudyoftheinteractionsbetweennonionizingradiationandlivingorganisms.
Physiologyisthestudyofthenormalfunctioningofthebodyandtheunderlyingregulatorymechanisms.
Radiobiologyisthestudyoftheinteractionsbetweenionizingradiationandlivingorganisms.
Toxicologyisthestudyofhazardouseffectsofdrugsandpoisons.

Specialties
Inthebroadestmeaningof"medicine",therearemanydifferentspecialties.IntheUK,mostspecialitieshave
theirownbodyorcollege,whichhaveitsownentranceexamination.ThesearecollectivelyknownastheRoyal
Colleges,althoughnotallcurrentlyusetheterm"Royal".Thedevelopmentofaspecialityisoftendrivenby
newtechnology(suchasthedevelopmentofeffectiveanaesthetics)orwaysofworking(suchasemergency
departments)thenewspecialtyleadstotheformationofaunifyingbodyofdoctorsandtheprestigeof
administeringtheirownexamination.
Withinmedicalcircles,specialitiesusuallyfitintooneoftwobroadcategories:"Medicine"and"Surgery."
"Medicine"referstothepracticeofnonoperativemedicine,andmostofitssubspecialtiesrequirepreliminary
traininginInternalMedicine.IntheUK,thiswastraditionallyevidencedbypassingtheexaminationforthe
MembershipoftheRoyalCollegeofPhysicians(MRCP)ortheequivalentcollegeinScotlandorIreland.
"Surgery"referstothepracticeofoperativemedicine,andmostsubspecialtiesinthisarearequirepreliminary
traininginGeneralSurgery,whichintheUKleadstomembershipoftheRoyalCollegeofSurgeonsofEngland
(MRCS).Atpresent,somespecialtiesofmedicinedonotfiteasilyintoeitherofthesecategories,suchas
radiology,pathology,oranesthesia.Mostofthesehavebranchedfromoneorotherofthetwocampsabovefor
exampleanaesthesiadevelopedfirstasafacultyoftheRoyalCollegeofSurgeons(forwhichMRCS/FRCS
wouldhavebeenrequired)beforebecomingtheRoyalCollegeofAnaesthetistsandmembershipofthecollege
isattainedbysittingfortheexaminationoftheFellowshipoftheRoyalCollegeofAnesthetists(FRCA).
Surgicalspecialty
Surgeryisanancientmedicalspecialtythatusesoperativemanualand
instrumentaltechniquesonapatienttoinvestigateand/ortreata
pathologicalconditionsuchasdiseaseorinjury,tohelpimprovebodily
functionorappearanceortorepairunwantedrupturedareas(for
example,aperforatedeardrum).Surgeonsmustalsomanagepre
operative,postoperative,andpotentialsurgicalcandidatesonthe
hospitalwards.Surgeryhasmanysubspecialties,includinggeneral
surgery,ophthalmicsurgery,cardiovascularsurgery,colorectal
surgery,neurosurgery,oralandmaxillofacialsurgery,oncologic
Surgeonsinanoperatingroom
surgery,orthopedicsurgery,otolaryngology,plasticsurgery,podiatric
surgery,transplantsurgery,traumasurgery,urology,vascularsurgery,
andpediatricsurgery.Insomecenters,anesthesiologyispartofthedivisionofsurgery(forhistoricaland
logisticalreasons),althoughitisnotasurgicaldiscipline.Othermedicalspecialtiesmayemploysurgical
procedures,suchasophthalmologyanddermatology,butarenotconsideredsurgicalsubspecialtiesperse.
SurgicaltrainingintheU.S.requiresaminimumoffiveyearsofresidencyaftermedicalschool.Sub
specialtiesofsurgeryoftenrequiresevenormoreyears.Inaddition,fellowshipscanlastanadditionaloneto
threeyears.Becausepostresidencyfellowshipscanbecompetitive,manytraineesdevotetwoadditionalyears
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toresearch.Thusinsomecasessurgicaltrainingwillnotfinishuntilmorethanadecadeaftermedicalschool.
Furthermore,surgicaltrainingcanbeverydifficultandtimeconsuming.
Internalspecialty
Internalmedicineisthemedicalspecialtydealingwiththeprevention,diagnosis,andtreatmentofadult
diseases.Accordingtosomesources,anemphasisoninternalstructuresisimplied.[20]InNorthAmerica,
specialistsininternalmedicinearecommonlycalled"internists."Elsewhere,especiallyinCommonwealth
nations,suchspecialistsareoftencalledphysicians.[21]Theseterms,internistorphysician(inthenarrowsense,
commonoutsideNorthAmerica),generallyexcludepractitionersofgynecologyandobstetrics,pathology,
psychiatry,andespeciallysurgeryanditssubspecialities.
Becausetheirpatientsareoftenseriouslyillorrequirecomplexinvestigations,internistsdomuchoftheirwork
inhospitals.Formerly,manyinternistswerenotsubspecializedsuchgeneralphysicianswouldseeany
complexnonsurgicalproblemthisstyleofpracticehasbecomemuchlesscommon.Inmodernurbanpractice,
mostinternistsaresubspecialists:thatis,theygenerallylimittheirmedicalpracticetoproblemsofoneorgan
systemortooneparticularareaofmedicalknowledge.Forexample,gastroenterologistsandnephrologists
specializerespectivelyindiseasesofthegutandthekidneys.[22]
IntheCommonwealthofNationsandsomeothercountries,specialistpediatriciansandgeriatriciansarealso
describedasspecialistphysicians(orinternists)whohavesubspecializedbyageofpatientratherthanbyorgan
system.Elsewhere,especiallyinNorthAmerica,generalpediatricsisoftenaformofPrimarycare.
Therearemanysubspecialities(orsubdisciplines)ofinternalmedicine:
Angiology/Vascular
Medicine
Cardiology
Criticalcaremedicine
Endocrinology
Gastroenterology
Geriatrics
Hematology

Hematology
Pulmonology/Pneumology/Respir
Hepatology
medicine
Infectiousdisease
Rheumatology
Nephrology
SportsMedicine
Neurology
Oncology
Pediatrics
Pulmonology/Pneumology/Respirology/chest

Trainingininternalmedicine(asopposedtosurgicaltraining),variesconsiderablyacrosstheworld:seethe
articlesonMedicaleducationandPhysicianformoredetails.InNorthAmerica,itrequiresatleastthreeyears
ofresidencytrainingaftermedicalschool,whichcanthenbefollowedbyaonetothreeyearfellowshipinthe
subspecialtieslistedabove.Ingeneral,residentworkhoursinmedicinearelessthanthoseinsurgery,averaging
about60hoursperweekintheUSA.ThisdifferencedoesnotapplyintheUKwherealldoctorsarenow
requiredbylawtoworklessthan48hoursperweekonaverage.
Diagnosticspecialties
Clinicallaboratorysciencesaretheclinicaldiagnosticservicesthatapplylaboratorytechniquesto
diagnosisandmanagementofpatients.IntheUnitedStates,theseservicesaresupervisedbya
pathologist.Thepersonnelthatworkinthesemedicallaboratorydepartmentsaretechnicallytrainedstaff
whodonotholdmedicaldegrees,butwhousuallyholdanundergraduatemedicaltechnologydegree,
whoactuallyperformthetests,assays,andproceduresneededforprovidingthespecificservices.
Subspecialtiesincludetransfusionmedicine,cellularpathology,clinicalchemistry,hematology,clinical
microbiologyandclinicalimmunology.
Pathologyasamedicalspecialtyisthebranchofmedicinethatdealswiththestudyofdiseasesandthe
morphologic,physiologicchangesproducedbythem.Asadiagnosticspecialty,pathologycanbe
consideredthebasisofmodernscientificmedicalknowledgeandplaysalargeroleinevidencebased
medicine.Manymodernmoleculartestssuchasflowcytometry,polymerasechainreaction(PCR),
immunohistochemistry,cytogenetics,generearrangementsstudiesandfluorescentinsituhybridization
(FISH)fallwithintheterritoryofpathology.
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Diagnosticradiologyisconcernedwithimagingofthebody,e.g.byxrays,xraycomputedtomography,
ultrasonography,andnuclearmagneticresonancetomography.Interventionalradiologistscanaccess
areasinthebodyunderimagingforaninterventionordiagnosticsampling.
Nuclearmedicineisconcernedwithstudyinghumanorgansystemsbyadministeringradiolabelled
substances(radiopharmaceuticals)tothebody,whichcanthenbeimagedoutsidethebodybyagamma
cameraoraPETscanner.Eachradiopharmaceuticalconsistsoftwoparts:atracerthatisspecificforthe
functionunderstudy(e.g.,neurotransmitterpathway,metabolicpathway,bloodflow,orother),anda
radionuclide(usuallyeitheragammaemitterorapositronemitter).Thereisadegreeofoverlapbetween
nuclearmedicineandradiology,asevidencedbytheemergenceofcombineddevicessuchasthePET/CT
scanner.
Clinicalneurophysiologyisconcernedwithtestingthephysiologyorfunctionofthecentraland
peripheralaspectsofthenervoussystem.Thesekindsoftestscanbedividedintorecordingsof:(1)
spontaneousorcontinuouslyrunningelectricalactivity,or(2)stimulusevokedresponses.Subspecialties
includeelectroencephalography,electromyography,evokedpotential,nerveconductionstudyand
polysomnography.Sometimesthesetestsareperformedbytechswithoutamedicaldegree,butthe
interpretationofthesetestsisdonebyamedicalprofessional.
Othermajorspecialties
Thefollowingsaresomemajormedicalspecialtiesthatdonotdirectlyfitintoanyoftheabovementioned
groups.
Anesthesiology(alsoknownasanaesthetics):concernedwiththeperioperativemanagementofthe
surgicalpatient.Theanesthesiologist'sroleduringsurgeryistopreventderangementinthevitalorgans'
(i.e.brain,heart,kidneys)functionsandpostoperativepain.Outsideoftheoperatingroom,the
anesthesiologyphysicianalsoservesthesamefunctioninthelabor&deliveryward,andsomeare
specializedincriticalmedicine.
Dermatologyisconcernedwiththeskinanditsdiseases.IntheUK,dermatologyisasubspecialtyof
generalmedicine.
Emergencymedicineisconcernedwiththediagnosisandtreatmentofacuteorlifethreatening
conditions,includingtrauma,surgical,medical,pediatric,andpsychiatricemergencies.
Familymedicine,familypractice,generalpracticeorprimarycareis,inmanycountries,thefirstport
ofcallforpatientswithnonemergencymedicalproblems.Familyphysiciansoftenprovideservices
acrossabroadrangeofsettingsincludingofficebasedpractices,emergencyroomcoverage,inpatient
care,andnursinghomecare.
Obstetricsandgynecology(oftenabbreviatedasOB/GYN
(AmericanEnglish)orObs&Gynae(BritishEnglish))are
concernedrespectivelywithchildbirthandthefemale
reproductiveandassociatedorgans.Reproductivemedicineand
fertilitymedicinearegenerallypracticedbygynecological
specialists.
Medicalgeneticsisconcernedwiththediagnosisand
managementofhereditarydisorders.
Neurologyisconcernedwithdiseasesofthenervoussystem.In
theUK,neurologyisasubspecialtyofgeneralmedicine.
GynecologistMichelAkotiongaof
Ophthalmologyisexclusivelyconcernedwiththeeyeandocular
Ouagadougou,BurkinaFaso
adnexa,combiningconservativeandsurgicaltherapy.
Pediatrics(AE)orpaediatrics(BE)isdevotedtothecareof
infants,children,andadolescents.Likeinternalmedicine,therearemanypediatricsubspecialtiesfor
specificageranges,organsystems,diseaseclasses,andsitesofcaredelivery.
Pharmaceuticalmedicineisthemedicalscientificdisciplineconcernedwiththediscovery,development,
evaluation,registration,monitoringandmedicalaspectsofmarketingofmedicinesforthebenefitof
patientsandpublichealth.
Physicalmedicineandrehabilitation(orphysiatry)isconcernedwithfunctionalimprovementafter
injury,illness,orcongenitaldisorders.
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Podiatricmedicineisthestudyof,diagnosis,andmedical&surgicaltreatmentofdisordersofthefoot,
ankle,lowerlimb,hipandlowerback.
Psychiatryisthebranchofmedicineconcernedwiththebiopsychosocialstudyoftheetiology,
diagnosis,treatmentandpreventionofcognitive,perceptual,emotionalandbehavioraldisorders.Related
nonmedicalfieldsincludepsychotherapyandclinicalpsychology.
Preventivemedicineisthebranchofmedicineconcernedwithpreventingdisease.
Communityhealthorpublichealthisanaspectofhealthservicesconcernedwiththreatstothe
overallhealthofacommunitybasedonpopulationhealthanalysis.

Interdisciplinaryfields
Someinterdisciplinarysubspecialtiesofmedicineinclude:
Aerospacemedicinedealswithmedicalproblemsrelatedtoflyingandspacetravel.
Addictionmedicinedealswiththetreatmentofaddiction.
Medicalethicsdealswithethicalandmoralprinciplesthatapplyvaluesandjudgmentstothepracticeof
medicine.
BiomedicalEngineeringisafielddealingwiththeapplicationofengineeringprinciplestomedical
practice.
Clinicalpharmacologyisconcernedwithhowsystemsoftherapeuticsinteractwithpatients.
Conservationmedicinestudiestherelationshipbetweenhumanandanimalhealth,andenvironmental
conditions.Alsoknownasecologicalmedicine,environmentalmedicine,ormedicalgeology.
Disastermedicinedealswithmedicalaspectsofemergencypreparedness,disastermitigationand
management.
Divingmedicine(orhyperbaricmedicine)isthepreventionandtreatmentofdivingrelatedproblems.
Evolutionarymedicineisaperspectiveonmedicinederivedthroughapplyingevolutionarytheory.
Forensicmedicinedealswithmedicalquestionsinlegalcontext,suchasdeterminationofthetimeand
causeofdeath,typeofweaponusedtoinflicttrauma,reconstructionofthefacialfeaturesusingremains
ofdeceased(skull)thusaidingidentification.
Genderbasedmedicinestudiesthebiologicalandphysiologicaldifferencesbetweenthehumansexes
andhowthataffectsdifferencesindisease.
HospiceandPalliativeMedicineisarelativelymodernbranchofclinicalmedicinethatdealswithpain
andsymptomreliefandemotionalsupportinpatientswithterminalillnessesincludingcancerandheart
failure.
Hospitalmedicineisthegeneralmedicalcareofhospitalizedpatients.Physicianswhoseprimary
professionalfocusishospitalmedicinearecalledhospitalistsintheUSAandCanada.ThetermMost
ResponsiblePhysician(MRP)orattendingphysicianisalsousedinterchangeablytodescribethisrole.
Lasermedicineinvolvestheuseoflasersinthediagnosticsand/ortreatmentofvariousconditions.
Medicalhumanitiesincludesthehumanities(literature,philosophy,ethics,historyandreligion),social
science(anthropology,culturalstudies,psychology,sociology),andthearts(literature,theater,film,and
visualarts)andtheirapplicationtomedicaleducationandpractice.
Healthinformaticsisarelativelyrecentfieldthatdealwiththeapplicationofcomputersandinformation
technologytomedicine.
Nosologyistheclassificationofdiseasesforvariouspurposes.
Nosokineticsisthescience/subjectofmeasuringandmodellingtheprocessofcareinhealthandsocial
caresystems.
Occupationalmedicine'sprincipalroleistheprovisionofhealthadvicetoorganizationsandindividuals
toensurethatthehigheststandardsofhealthandsafetyatworkcanbeachievedandmaintained.
Painmanagement(alsocalledpainmedicine,oralgiatry)isthemedicaldisciplineconcernedwiththe
reliefofpain.
Pharmacogenomicsisaformofindividualizedmedicine.
Podiatricmedicineisthestudyof,diagnosis,andmedicaltreatmentofdisordersofthefoot,ankle,lower
limb,hipandlowerback.
Sexualmedicineisconcernedwithdiagnosing,assessingandtreatingalldisordersrelatedtosexuality.
Sportsmedicinedealswiththetreatmentandpreventionandrehabilitationofsports/exerciseinjuries
suchasmusclespasms,muscletears,injuriestoligaments(ligamenttearsorruptures)andtheirrepairin
athletes,amateurandprofessional.
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Therapeuticsisthefield,morecommonlyreferencedinearlierperiodsofhistory,ofthevariousremedies
thatcanbeusedtotreatdiseaseandpromotehealth.[23]
Travelmedicineoremporiatricsdealswithhealthproblemsofinternationaltravelersortravelersacross
highlydifferentenvironments.
Tropicalmedicinedealswiththepreventionandtreatmentoftropicaldiseases.Itisstudiedseparatelyin
temperateclimateswherethosediseasesarequiteunfamiliartomedicalpractitionersandtheirlocal
clinicalneeds.
Urgentcarefocusesondeliveryofunscheduled,walkincareoutsideofthehospitalemergency
departmentforinjuriesandillnessesthatarenotsevereenoughtorequirecareinanemergency
department.Insomejurisdictionsthisfunctioniscombinedwiththeemergencyroom.
Veterinarymedicineveterinariansapplysimilartechniquesasphysicianstothecareofanimals.
Wildernessmedicineentailsthepracticeofmedicineinthewild,whereconventionalmedicalfacilities
maynotbeavailable.
Manyotherhealthsciencefields,e.g.dietetics

Educationandlegalcontrols
Medicaleducationandtrainingvariesaroundtheworld.Ittypically
involvesentryleveleducationatauniversitymedicalschool,followed
byaperiodofsupervisedpracticeorinternship,and/orresidency.This
canbefollowedbypostgraduatevocationaltraining.Avarietyof
teachingmethodshavebeenemployedinmedicaleducation,stillitselfa
focusofactiveresearch.InCanadaandtheUnitedStatesofAmerica,a
DoctorofMedicinedegree,oftenabbreviatedM.D.,oraDoctorof
OsteopathicMedicinedegree,oftenabbreviatedasD.O.anduniqueto
theUnitedStates,mustbecompletedinanddeliveredfroma
recognizeduniversity.

Medicalstudentslearningabout
stitches

Sinceknowledge,techniques,andmedicaltechnologycontinueto
evolveatarapidrate,manyregulatoryauthoritiesrequirecontinuingmedicaleducation.Medicalpractitioners
upgradetheirknowledgeinvariousways,includingmedicaljournals,seminars,conferences,andonline
programs.
Inmostcountries,itisalegalrequirementforamedicaldoctortobe
licensedorregistered.Ingeneral,thisentailsamedicaldegreefroma
universityandaccreditationbyamedicalboardoranequivalent
nationalorganization,whichmayasktheapplicanttopassexams.This
restrictstheconsiderablelegalauthorityofthemedicalprofessionto
physiciansthataretrainedandqualifiedbynationalstandards.Itisalso
intendedasanassurancetopatientsandasasafeguardagainst
charlatansthatpracticeinadequatemedicineforpersonalgain.While
thelawsgenerallyrequiremedicaldoctorstobetrainedin"evidence
based",Western,orHippocraticMedicine,theyarenotintendedto
discouragedifferentparadigmsofhealth.

HeadquartersoftheOrganizacin
MdicaColegialdeEspaa,which
regulatesthemedicalprofessionin
Spain

IntheEuropeanUnion,theprofessionofdoctorofmedicineis
regulated.Aprofessionissaidtoberegulatedwhenaccessandexercise
issubjecttothepossessionofaspecificprofessionalqualification.The
regulatedprofessionsdatabasecontainsalistofregulatedprofessions
fordoctorofmedicineintheEUmemberstates,EEAcountriesand
Switzerland.ThislistiscoveredbytheDirective2005/36/EC.

Doctorswhoarenegligentorintentionallyharmfulintheircareof
patientscanfacechargesofmedicalmalpracticeandbesubjecttocivil,criminal,orprofessionalsanctions.
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Medicalethics
Medicalethicsisasystemofmoralprinciplesthatapplyvaluesandjudgments
tothepracticeofmedicine.Asascholarlydiscipline,medicalethics
encompassesitspracticalapplicationinclinicalsettingsaswellasworkonits
history,philosophy,theology,andsociology.Sixofthevaluesthatcommonly
applytomedicalethicsdiscussionsare:
autonomythepatienthastherighttorefuseorchoosetheirtreatment.
(Voluntasaegrotisupremalex.)
beneficenceapractitionershouldactinthebestinterestofthepatient.
(Salusaegrotisupremalex.)
justiceconcernsthedistributionofscarcehealthresources,andthe
decisionofwhogetswhattreatment(fairnessandequality).
nonmaleficence"first,donoharm"(primumnonnocere).
respectforpersonsthepatient(andthepersontreatingthepatient)have
therighttobetreatedwithdignity.
truthfulnessandhonestytheconceptofinformedconsenthasincreased
inimportancesincethehistoricaleventsoftheDoctors'Trialofthe
Nurembergtrials,Tuskegeesyphilisexperiment,andothers.

A12thcenturyByzantine
manuscriptofthe
HippocraticOath

Valuessuchasthesedonotgiveanswersastohowtohandleaparticularsituation,butprovideauseful
frameworkforunderstandingconflicts.Whenmoralvaluesareinconflict,theresultmaybeanethicaldilemma
orcrisis.Sometimes,nogoodsolutiontoadilemmainmedicalethicsexists,andoccasionally,thevaluesofthe
medicalcommunity(i.e.,thehospitalanditsstaff)conflictwiththevaluesoftheindividualpatient,family,or
largernonmedicalcommunity.Conflictscanalsoarisebetweenhealthcareproviders,oramongfamily
members.Forexample,somearguethattheprinciplesofautonomyandbeneficenceclashwhenpatientsrefuse
bloodtransfusions,consideringthemlifesavingandtruthtellingwasnotemphasizedtoalargeextentbefore
theHIVera.

History
Ancientworld
Prehistoricmedicineincorporatedplants(herbalism),animalparts,and
minerals.Inmanycasesthesematerialswereusedrituallyasmagical
substancesbypriests,shamans,ormedicinemen.Wellknownspiritual
systemsincludeanimism(thenotionofinanimateobjectshaving
spirits),spiritualism(anappealtogodsorcommunionwithancestor
spirits)shamanism(thevestingofanindividualwithmysticpowers)
anddivination(magicallyobtainingthetruth).Thefieldofmedical
anthropologyexaminesthewaysinwhichcultureandsocietyare
organizedaroundorimpactedbyissuesofhealth,healthcareand
relatedissues.

StatuetteofancientEgyptian
physicianImhotep,thefirstphysician
fromantiquityknownbyname.

EarlyrecordsonmedicinehavebeendiscoveredfromancientEgyptian
medicine,BabylonianMedicine,Ayurvedicmedicine(intheIndian
subcontinent),classicalChinesemedicine(predecessortothemodern
traditionalChineseMedicine),andancientGreekmedicineandRoman
medicine.

InEgypt,Imhotep(3rdmillenniumBC)isthefirstphysicianinhistory
knownbyname.TheoldestEgyptianmedicaltextistheKahun
GynaecologicalPapyrusfromaround2000BCE,whichdescribesgynaecologicaldiseases.TheEdwinSmith
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Papyrusdatingbackto1600BCEisanearlyworkonsurgery,whiletheEbersPapyrusdatingbackto1500
BCEisakintoatextbookonmedicine.[24]
InChina,archaeologicalevidenceofmedicineinChinesedatesbacktotheBronzeAgeShangDynasty,based
onseedsforherbalismandtoolspresumedtohavebeenusedforsurgery.[25]TheHuangdiNeijing,the
progenitorofChinesemedicine,isamedicaltextwrittenbeginninginthe2ndcenturyBCEandcompiledin
the3rdcentury.[26]
InIndia,thesurgeonSushrutadescribednumeroussurgicaloperations,includingtheearliestformsofplastic
surgery.[27][28][29]EarliestrecordsofdedicatedhospitalscomefromMihintaleinSriLankawhereevidenceof
dedicatedmedicinaltreatmentfacilitiesforpatientsarefound.[30][31]
InGreece,theGreekphysicianHippocrates,the"fatherofwesternmedicine",[32][33]laidthefoundationfora
rationalapproachtomedicine.HippocratesintroducedtheHippocraticOathforphysicians,whichisstill
relevantandinusetoday,andwasthefirsttocategorizeillnessesasacute,chronic,endemicandepidemic,and
usetermssuchas,"exacerbation,relapse,resolution,crisis,paroxysm,peak,andconvalescence".[34][35]The
GreekphysicianGalenwasalsooneofthegreatestsurgeonsoftheancientworldandperformedmany
audaciousoperations,includingbrainandeyesurgeries.AfterthefalloftheWesternRomanEmpireandthe
onsetoftheEarlyMiddleAges,theGreektraditionofmedicinewentintodeclineinWesternEurope,although
itcontinueduninterruptedintheEasternRoman(Byzantine)Empire.
MostofourknowledgeofancientHebrewmedicineduringthe1stmillenniumBCcomesfromtheTorah,
i.e.theFiveBooksofMoses,whichcontainvarioushealthrelatedlawsandrituals.TheHebrewcontributionto
thedevelopmentofmodernmedicinestartedintheByzantineEra,withthephysicianAsaphtheJew.[36]

MiddleAges
After750CE,theMuslimworldhadtheworksofHippocrates,GalenandSushrutatranslatedintoArabic,and
Islamicphysiciansengagedinsomesignificantmedicalresearch.NotableIslamicmedicalpioneersincludethe
Persianpolymath,Avicenna,who,alongwithImhotepandHippocrates,hasalsobeencalledthe"fatherof
medicine".[37]HewroteTheCanonofMedicine,consideredoneofthemostfamousbooksinthehistoryof
medicine.[38]OthersincludeAbulcasis,[39]Avenzoar,[40]IbnalNafis,[41]andAverroes.[42]Rhazes[43]wasone
ofthefirsttoquestiontheGreektheoryofhumorism,whichneverthelessremainedinfluentialinbothmedieval
WesternandmedievalIslamicmedicine.[44]AlRisalahalDhahabiahbyAlialRidha,theeighthImamofShia
Muslims,isreveredasthemostpreciousIslamicliteratureintheScienceofMedicine.[45]TheIslamic
Bimaristanhospitalswereanearlyexampleofpublichospitals.[46][47]
InEurope,Charlemagnedecreedthatahospitalshouldbeattachedtoeachcathedralandmonasteryandthe
historianGeoffreyBlaineylikenedtheactivitiesoftheCatholicChurchinhealthcareduringtheMiddleAges
toanearlyversionofawelfarestate:"Itconductedhospitalsfortheoldandorphanagesfortheyounghospices
forthesickofallagesplacesforthelepersandhostelsorinnswherepilgrimscouldbuyacheapbedand
meal".Itsuppliedfoodtothepopulationduringfamineanddistributedfoodtothepoor.Thiswelfaresystem
thechurchfundedthroughcollectingtaxesonalargescaleandpossessinglargefarmlandsandestates.The
Benedictineorderwasnotedforsettinguphospitalsandinfirmariesintheirmonasteries,growingmedical
herbsandbecomingthechiefmedicalcaregiversoftheirdistricts,asatthegreatAbbeyofCluny.TheChurch
alsoestablishedanetworkofcathedralschoolsanduniversitieswheremedicinewasstudied.TheSchola
MedicaSalernitanainSalerno,lookingtothelearningofGreekandArabphysicians,grewtobethefinest
medicalschoolinMedievalEurope.[48]
However,thefourteenthandfifteenthcenturyBlackDeathdevastatedboththeMiddleEastandEurope,andit
hasevenbeenarguedthatWesternEuropewasgenerallymoreeffectiveinrecoveringfromthepandemicthan
theMiddleEast.[49]Intheearlymodernperiod,importantearlyfiguresinmedicineandanatomyemergedin
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Europe,includingGabriele
FalloppioandWilliamHarvey.

AmanuscriptofAlRisalahal
DhahabiahbyAlialRidha,the
eighthImamofShiaMuslims.The
textsays:"Goldendissertationin
medicinewhichissentbyImamAli
ibnMusaalRidha,peacebeupon
him,toalMa'mun."

Themajorshiftinmedical
thinkingwasthegradual
rejection,especiallyduringthe
BlackDeathinthe14thand15th
centuries,ofwhatmaybecalled
the'traditionalauthority'
PanoramaofSiena'sSantaMaria
approachtoscienceand
dellaScalaHospital,oneofEurope's
medicine.Thiswasthenotion
oldesthospitals.DuringtheMiddle
thatbecausesomeprominent
Ages,theCatholicChurchestablished
personinthepastsaid
universitieswhichrevivedthestudy
somethingmustbeso,thenthat
ofsciencesdrawingonthelearning
wasthewayitwas,andanything
ofGreekandArabphysiciansinthe
oneobservedtothecontrarywas
studyofmedicine.
ananomaly(whichwas
paralleledbyasimilarshiftin
EuropeansocietyingeneralseeCopernicus'srejectionofPtolemy's
theoriesonastronomy).PhysicianslikeVesaliusimproveduponor
disprovedsomeofthetheoriesfromthepast.Themaintomesusedboth
bymedicinestudentsandexpertphysicianswereMateriaMedicaand
Pharmacopoeia.

AndreasVesaliuswastheauthorofDehumanicorporisfabrica,an
importantbookonhumananatomy.[50]Bacteriaandmicroorganisms
werefirstobservedwithamicroscopebyAntonievanLeeuwenhoekin
1676,initiatingthescientificfieldmicrobiology.[51]Independentlyfrom
IbnalNafis,MichaelServetusrediscoveredthepulmonarycirculation,
butthisdiscoverydidnotreachthepublicbecauseitwaswrittendownforthefirsttimeinthe"Manuscriptof
Paris"[52]in1546,andlaterpublishedinthetheologicalworkforwhichhepaidwithhislifein1553.Laterthis
wasdescribedbyRenaldusColumbusandAndreaCesalpino.HermanBoerhaaveissometimesreferredtoasa
"fatherofphysiology"duetohisexemplaryteachinginLeidenandtextbook'Institutionesmedicae'(1708).
PierreFauchardhasbeencalled"thefatherofmoderndentistry".[53]

Modern
Veterinarymedicinewas,forthefirsttime,trulyseparatedfromhuman
medicinein1761,whentheFrenchveterinarianClaudeBourgelat
foundedtheworld'sfirstveterinaryschoolinLyon,France.Beforethis,
medicaldoctorstreatedbothhumansandotheranimals.

PaulLouisSimondinjectingaplague
vaccineinKarachi,1898

Modernscientificbiomedicalresearch(whereresultsaretestableand
reproducible)begantoreplaceearlyWesterntraditionsbasedon
herbalism,theGreek"fourhumours"andothersuchpremodern
notions.ThemodernerareallybeganwithEdwardJenner'sdiscoveryof
thesmallpoxvaccineattheendofthe18thcentury(inspiredbythe
methodofinoculationearlierpracticedinAsia),RobertKoch's
discoveriesaround1880ofthetransmissionofdiseasebybacteria,and
thenthediscoveryofantibioticsaround1900.

Thepost18thcenturymodernityperiodbroughtmoregroundbreakingresearchersfromEurope.From
GermanyandAustria,doctorsRudolfVirchow,WilhelmConradRntgen,KarlLandsteinerandOttoLoewi
madenotablecontributions.IntheUnitedKingdom,AlexanderFleming,JosephLister,FrancisCrickand
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FlorenceNightingaleareconsideredimportant.SpanishdoctorSantiagoRamnyCajalisconsideredthefather
ofmodernneuroscience.
FromNewZealandandAustraliacameMauriceWilkins,HowardFlorey,andFrankMacfarlaneBurnet.
IntheUnitedStates,WilliamWilliamsKeen,WilliamColey,JamesD.Watson,Italy(SalvadorLuria),
Switzerland(AlexandreYersin),Japan(KitasatoShibasabur),andFrance(JeanMartinCharcot,Claude
Bernard,PaulBroca)andothersdidsignificantwork.RussianNikolaiKorotkovalsodidsignificantwork,as
didSirWilliamOslerandHarveyCushing.
Asscienceandtechnologydeveloped,medicinebecamemorereliant
uponmedications.ThroughouthistoryandinEuroperightuntilthelate
18thcentury,notonlyanimalandplantproductswereusedasmedicine,
butalsohumanbodypartsandfluids.[54]Pharmacologydevelopedin
partfromherbalismandsomedrugsarestillderivedfromplants
(atropine,ephedrine,warfarin,aspirin,digoxin,vincaalkaloids,taxol,
hyoscine,etc.).[55]VaccineswerediscoveredbyEdwardJennerand
LouisPasteur.
Thefirstantibioticwasarsphenamine(Salvarsan)discoveredbyPaul
Ehrlichin1908afterheobservedthatbacteriatookuptoxicdyesthat
humancellsdidnot.Thefirstmajorclassofantibioticswasthesulfa
drugs,derivedbyGermanchemistsoriginallyfromazodyes.

AlexanderFleming'sdiscoveryof
penicillininSeptember1928marks
thestartofmodernantibiotics.

Pharmacologyhasbecomeincreasinglysophisticatedmodernbiotechnologyallowsdrugstargetedtowards
specificphysiologicalprocessestobedeveloped,sometimesdesignedforcompatibilitywiththebodytoreduce
sideeffects.Genomicsandknowledgeofhumangeneticsishavingsomeinfluenceonmedicine,asthe
causativegenesofmostmonogenicgeneticdisordershavenowbeenidentified,andthedevelopmentof
techniquesinmolecularbiologyandgeneticsareinfluencingmedicaltechnology,practiceanddecision
making.
Evidencebasedmedicineisacontemporarymovementtoestablishthemosteffectivealgorithmsofpractice
(waysofdoingthings)throughtheuseofsystematicreviewsandmetaanalysis.Themovementisfacilitatedby
modernglobalinformationscience,whichallowsasmuchoftheavailableevidenceaspossibletobecollected
andanalyzedaccordingtostandardprotocolsthatarethendisseminatedtohealthcareproviders.TheCochrane
Collaborationleadsthismovement.A2001reviewof160Cochranesystematicreviewsrevealedthat,
accordingtotworeaders,21.3%ofthereviewsconcludedinsufficientevidence,20%concludedevidenceofno
effect,and22.5%concludedpositiveeffect.[56]

Traditionalmedicine
Traditionalmedicine(alsoknownasindigenousorfolkmedicine)comprisesknowledgesystemsthat
developedovergenerationswithinvarioussocietiesbeforetheeraofmodernmedicine.TheWorldHealth
Organization(WHO)definestraditionalmedicineas"thesumtotaloftheknowledge,skills,andpractices
basedonthetheories,beliefs,andexperiencesindigenoustodifferentcultures,whetherexplicableornot,used
inthemaintenanceofhealthaswellasintheprevention,diagnosis,improvementortreatmentofphysicaland
mentalillness."[57]
InsomeAsianandAfricancountries,upto80%ofthepopulationreliesontraditionalmedicinefortheir
primaryhealthcareneeds.Whenadoptedoutsideofitstraditionalculture,traditionalmedicineisoftencalled
alternativemedicine.[57]PracticesknownastraditionalmedicinesincludeAyurveda,Siddhamedicine,Unani,
ancientIranianmedicine,Irani,Islamicmedicine,traditionalChinesemedicine,traditionalKoreanmedicine,
acupuncture,Muti,If,andtraditionalAfricanmedicine.
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TheWHOnoteshoweverthat"inappropriateuseoftraditionalmedicinesorpracticescanhavenegativeor
dangerouseffects"andthat"furtherresearchisneededtoascertaintheefficacyandsafety"ofseveralofthe
practicesandmedicinalplantsusedbytraditionalmedicinesystems.[57]Thelinebetweenalternativemedicine
andquackeryisacontentioussubject.
Traditionalmedicinemayincludeformalizedaspectsoffolkmedicine,thatistosaylongstandingremedies
passedonandpractisedbylaypeople.Folkmedicineconsistsofthehealingpracticesandideasofbody
physiologyandhealthpreservationknowntosomeinaculture,transmittedinformallyasgeneralknowledge,
andpracticedorappliedbyanyoneintheculturehavingpriorexperience.[58]Folkmedicinemayalsobe
referredtoastraditionalmedicine,alternativemedicine,indigenousmedicine,ornaturalmedicine.Theseterms
areoftenconsideredinterchangeable,eventhoughsomeauthorsmaypreferoneortheotherbecauseofcertain
overtonestheymaybewillingtohighlight.Infact,outofthesetermsperhapsonlyindigenousmedicineand
traditionalmedicinehavethesamemeaningasfolkmedicine,whiletheothersshouldbeunderstoodratherina
modernormodernizedcontext.[59]

Seealso
Listofcausesofdeathbyrate
Listofdisorders
Listofimportantpublicationsinmedicine
Listsofdiseases
Medicalencyclopedia
Medicalequipment
Medicalcoding
Medicalbilling
Medicalliterature
Medicalpsychology
Medicalsociology
Philosophyofhealthcare

Notesandreferences
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ww.etymonline.com/index.php?term=medicine))Cf.mederi"toheal",etym."knowthebestcoursefor,"fromPIE
base*med"tomeasure,limit.Cf.Greekmedos"counsel,plan",Avestanvimad"physician"
4."Medicine"(http://www.etymonline.com/index.php?term=medicine)OnlineEtymologyDictionary
5."Dictionary,medicine".Retrieved2Dec2013.
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