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    Additional Readings

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    Mara Roxana Tamas

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    © All Rights Reserved
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    of 12
    SUPPLEMENTARY READINGS Disease — An Undefined Word The primitive man ascribed disease to the evil influences of the malignant devil, etc.), Magic and incantations, S ‘some religions believed that many diseases were sent as punishment The ancient tribes of Australia believed that disease was due to “Bone P separation of the soul from th The ancient Jews regarded The ancient Chinese medi he body.” disease as an expression of the wrath of God ne considered that disease was caused by the impré rerween two opposing forces, “Yin” and * Yang” and also amongst the five elem fire, water, wood and metal) of which the body was composed. ‘According to th (Ayurveda) the disease is viewed as the re of improper proportion of three hi tam and kaphah) Thales (6th century b.o.e.) declared that he primary cause of all things. This statement marks the beginning o Pythagoreans had a mathematical conception of health and disease. To them the ideal umber was the even number because it could be broken up into a pair of equal whole umbers signifying symmetry and harmony. Health was thus supposed to be related to an even and disease to an odd number. Hippocrates of Cos (460 b.0.¢.) held that the irregular proportion of the four humours (blood, phlegm, yellow bile and black bile) constituted disease. ‘Aristotle (384-322 b.0.e.) held that disease Wis the imbalanced com temperaments (biliary, sanguinary, phlegmatic and melancholic) and humours. In his Kulliyat-i-Quanoon, Avicenna describes disease as an abnormal state of the human body, because of which, directly or indirectly, occurs some disturbance in the function of the body. Fracastorius (1484-1543) explains the first scientific statement of the true nature of contagion, of infection and the germ theory of disease. Paracelsus (1491-1541) stated that all disease was the result of maladjustment of the three elements: sulphur, mercury and salt. Brown (1735-1788) explained that disease was the result Broussais (1772-1838) affirmed that gastro-enteritis cau n Virchow (1841-1902) developed a new theory of “cellular pathology”, i.e. alterations in the cells are the essential factor in disease. Schussler found that health was dependent on the twel Composed but the deficiency and excess of any ‘of them cons aa doctors submitted that disease was caused by irregular co yellow, white and purple). 1 fi a ological factors were responsible for disease. 10 the concept of disease was the balance ents (earth. It theory of Indian medicine umours called tridosha (vayu, Pil moisture (water) was U ¢ European philosophy position of four of stimulation or defect of stimulation. ed most of the trouble of human the view that tituted disease. mposition of four colours Bee stearcins claimed that psy¢ i : vevcontribution of the ae ee rand specific causes of such disease as ‘Tcognition of its causes. Bacteria as ENGLISH IN MEDICINE 276 rera were unmasked. The significance of end i¢ influence was soon recognized. T} ictors to the etiology of disease p is due to a great variet typhoid, tuberculosis, and chol PP nutritional deficiencies, of geneti ali social, occupational and economic fa ‘ ‘Modern pathologists consider that disease from malfunctioning and inorganic poisoning ‘Dorland’s Medical Dictionary defines disease as health: an illness, or @ sickness. More specifically a definite mor characteristic train of symptoms Tt may affect the whole body or a etiology, pathology and prognosis may be known or unknown ‘Stedman's Medical Dictionary describes disease thus: Morbu jmterruption or perversion of functions of any of the organs, a morbid tigsue or an abnormal state of the body as @ whole, continuing for a lon; in general any de Short Account of Chinese Medicine medicine properly begins with the legendar The father of Chinese medicine was air g We examined hundreds of herbs, and it is saig personally tasted 70 different poisons in one d i i ay. To him is ascribed 7 Herbal. The three-volume work enumerated 365 drugs. aT "Another eminent physician of the legendary period was Huan ‘ ig Ti (2689 He was clled ine yellow Emperor epee etibaic Nel Ching or Cla ae ‘Medicine, the oldest medical book known to man. ita Yang and Yin are ae Ea. ie saa forces of Yang and Yin (~ light and dark -. li = a ce ygeoaraied in man but are in complicated alam eae ae interior is Yin; the empty organs are Yan gate crue Beak seein ya, Yin within Yang A dise ae meet es and a when due to internal causes. Raaraieingert ee 4 lux in the body ; perfect harmony means heal. brings disease. The Chinese believed there are 12 main ducts carrying these vital forces, paired bilaterally, symmetrical and usually deeply im| me ae . eal lly deeply imbedded in the muscles. Some The history of formal Chinese extended from 2697 to 1122 b.o.¢. who reigned about 2700 b.0.e. ‘the vertex of the head... pa aeiieibody: After a disease was diagnose Jet the evil air out and restore the prope! ‘em long, ‘a light mallet. The physician int en withdraws on expiration. The poi n and number of needles used deve! ————~~— SUPPLEMENTARY READIN ntil these have finished ins immobile Un megs ofthe FACE blister and Iter a sea ar ao ese were fascinated ty tumbers and used then sang The 365 drugs of See capa them a8 a framework for their bo Momber of days in a Year Pree TU unasesisys foc thacarh adie ee numeat vers of China Sa cs eat pre complicated, stem 8 based on the numb cid te fine elemen' of Yanga Yn, rode, er He, chosen tea Beiecaiyees prustmictions Re eoegfalittied, ‘ame and ducted, tre tet a fg bch, sei, ness, death and paring; fve ne and vated; fe kin safes and five spiritual resources Tau een ae mats Hedge undoubtedly was held back by the concept of he sacred anuunafurterstenghened by Confcis about 50}... Not sredness ofthe man body wi pdnteahorzing dissection of deed odie, was the fist legal a 113, a fhe fist easion was one of seat formality with judges, governors and erate ead Thas been stated that the Chinese anticipated Harvey’s discovery of eae \dance. few bousand years, and some historians pointed ‘0 STUNG 'CHIIY ad roar or EIST Es es which seem to bear this out are ali the blood is under the control of the heart the heart is in accord with the pulse. the heart regulates all the blood of the body. the blood current flows continuously in a circle and never stops Ceriainly the Chinese knew thatthe blood and the heart were closely related, They had no ) tue concept of circulation, however. 2 ig the Borderlands of the Mind Explo! Pe etuictassionaries were the first Europeans to report on acupuness But it was not until 1928 that a full and accurate account of acupuncture reached the West. In that year Set aeractiremrned fronn'China and published his first wesiiee Oe the subject Today several hundreds of European doctors combine the science and art of Western medicine with the ancient science and art of Chinese acupuncture. International ‘Congresses of Acupuncture are now convened. That a neddle stuck into the outsi the functioning of the liver is obvious appearances” but our theory, we shall be oo the claims of the acupuncturis muse, within our present frame of re ; This is possible because, eeea matter of empirical fact, the rims, rank and head a invisible "meridians" related in some way 1 the Ware orgs of be ody ins wil ‘meridians are located specially sensitive points. A needle inset : i affect the functioning ad ae dno the meridian on which the point aa ints the skilled acupuncturist reestabli de surface of the leg, a little below the knee should affect sly incredible. If our primary concert is to save, not the tempted to ignore the empirically established facts reas mere superstition and hocus-POCdS: Itcan’t ference, it makes no sense. ‘ta number of judiciously selected : ly selected point ‘irculation of energy and brings the patient back to health. ste scientific study of ancient ‘Scientific reasons can be given in support ee een a Min (2 braking) iS desirable. _ tiental theories like that of Yang (= ac ENGLISH IN MEDICINE 278 i arasympathic according to Prof, | , athic and the latter parasy ng The former poe the two leading to health, while eee ane © of Bs eave in China as in France, as well in ancient times as disease is true A “Complete” Physician “Medicine is the most empiric of arts, and the most scientip Humanism and the Physician, ¢ p A section of the Corpus Hippocraticum entitled “Of ie epidemics 1 practice of medicine “consists in three things: the patent, he disease, and the phy ‘The patient must combat the disease alone with the physician. According to this tradition, physicians vow “first to do good and not to do f celebrated summary of the practice of medicine is indicative of the accumulated ng and wisdom that a “complete” physician must strive to achieve empowerment, en and mastery of the discipline. A physician must be scientific. A physician must know about diseases in general and be able to classify diseases ac to their etiologies, symptoms and signs, pathophysiologies, and natural histories. $y. knowledge underlies a physician's diagnosis of a patient’s malady. This in turn faci assessment of the prognosis and the stages through which an illness will progress, from i onset, through various crises or turning points, to its sequelae or consequences. The accurse Of the diagnosis and certainty of the prognosis influence the effectiveness of any remedy 3 physician prescribes to achieve cure or palliation. : However, a physician must also be humanistic. Patients are never identical. A physician must know a patient as an individual, and al relevant circumstances of that individual’s life, as well as the particular characteristics of ti illness, must be discerned. The Hippocratic conception of a physician's work favours the practice of general medicine rather than divisive subspecialization, Spies individual all the knowledge and wisdom they have acquired artistry as te) stery, and subjectivity te cnt ts integra f : nae i i elemeat a jectivity i ee itroduces an organism, as sophisticated pean the entre endeavour because knowledge of heb e-currently, remains elementary. SUPPLEMENTARY READINGS 29 Decisions about patient care are often rendered prgnally even incorrect, information It is Sa cians co cope with this burden - After Mark D, Williams and Charl is of incomplete, and rudence a sera Prudence acquired by experience that enables B. Rodning (The Humanities in Medicine) Autopsy: A Tool for Diagnosis and for Education autopsy remains the touchstone of diagnosis” , acco : wpe Universi ‘of Connecticut Health ahi, Henge ia Henty Schneiderman, MD, nd Med. 1985; 77: 153-156) on (Schneiderman H., Gruhn J.J. But autopsy rates have declined precipitously in reo yg64 to ess than 5% today. Schneiderman and his soesgse tt Hiahe oe situation a “disaster” because autopsy is an invaluable and irreplaceable fool io os veal medicine and epidemiology but also for medical education, esdad “autopsies enable all physicians, both trainees and those who are more senior to check the accurary of their medical findings and the effects of their therapies,” Schmeiderman noted “There is no test as powerful as this, even in the age of MRI and CT. There is a high rate af discovery of unexpected diagnosis at autopsy, particularly by trainees. It helps them to inderstand that our profession is not only not omnipotent, but not omniscient,” he said “Iris also a potent reminder that patients are not immortal, so that one does not regard the decline and death of a patient as inevitably a medical failing, but as the nature of our species. ~ Eric H. Bernicker and colleagues at Baylor College of Medicine in Houston. Texas. evaluated the use of autopsies in an urban public teaching hospital during the AIDS era. Only 16% of patients who died in 1992 and 1993 had autopsies; however significant, unsuspected diagnoses were found in 35% of the 152 patients who had an autopsy. Infections, pulmonary emboli, and myocardial infarction were the most common diagnoses, is : fd more unsuspected findings than did uninfected patients, The authors concluded that valuable, tmanticipated information can frequently be obtained from autopsies in public hospitals. Reasons cited for the reluctance of physicians to order autopsies include the belief that technology has rendered them obsolete, pressure 10 cut OS! discomfort in approaching the family for autopsy permission, fear of litigation oF professional discredit due to unexpected findings, inadequate compensation for pathologists, and inability to perform = properly, A recent addition to the list is increasing concern a ae Fertecteely with the substantial number of patients who bartout drug-resistant clini nae ENGLISH IN MEDICINE Patients’ Rights raised many questions centering on p and hospitals, and relate to the general nd why. Diagnostic procedures hav questions concern both physici know what is happening to him or her a Efforts to develop lists of specific rights that the p: specific area of diagnosis and treatment. The lists touch on such matters as the pa to maintain privacy, his or her right to be informed of any surgical or other p performed, and the right to refuse treatment to the extent permitted by law, O; Rights” was issued by the American Hospital Association in 1973. It noted in part “Equitable and humane treatment at all times and under all circumstances j principle entails an obligation on the part of all those involved in the care recognize and to respect his individuality and his dignity. This means creating relationships founded on mutual acceptance and trust.” atient enjoys have gone far Like other statements on patients’ rights, the AHA list stressed informed consen meant the need on the part of the patient to be able to agree to medical and surgical treatm on the basis of complete, accurate information, Informed consent as a principle provid foundation for many other specific or general rights. These include : * * The right to considerate and respectful care The right to take part in planning for one’s own care The right to have records kept confidential The right to full explanation of the hospital bill Questions to Ask the Doctor ne ee some of the questions the patient may want to ask the doctor - Sa elie first ye or later. For example, most patients want to know the results aa paren pe lures. Patients may also ask about planned treatments, the risks a ae r failure with particular types of treatment may be hospitalized, Many other factors become of care or treat t, and the period of time far SUPPLEMENTARY READINGS 281 gnostic Tests and Patients’ Rights iat d procedures rn ingot rests and procedures ave been discussed, Many others could be listed Mage reason is tht as medical costs have risen in recent yeas, some persons have ecessity of various diagnostic tests, Consumer sestoned the necessity of various diagnostic ess, Consumer advocates have insisted thet sien some hospitals have been charged for tess that only increased their hospat by ations cases the tests were given in batteries, or sets oe Imarpe question that has come up: Did the patients actually understand all those tests and involved ? Tact what they involved Cost, as both oulsiders and members of the medical profession admit, has definite pecome a factor in medical care. An electrocardiogram may cost only (20 or [30- bury a betpputerized axial tomography (CAT) scan can cost [500 to [600 ‘Another reason Why questions about patients’ rights have been raised centres on the rarure of test batteries and the time available to doctors. The batteries can be complex, and the physician may often be short of time. He may find it difficult or impossible to explain very test he has ordered ~ and to do so in enough detail so that the patient knows what each feat requires and what it means in terms of discomfort, risk, and cost Hospital admission tests may be simple or complex. They may involve only “vital signs” tests of temperature, pulse rate, respiratory rate, and blood pressure. But they can include the ‘admission labs ~ screening tests done by automated machines. These tests may include a urinalysis (UA), a complete blood count (CBC), and serum chemistries - Simultaneous Multiple Analyzer tests of 12 (SMA-12) or 24 (SMA-24) factors. The SMA-12 would typically call for chemical analyses for calcium, inorganic phosphorus, glucose, and nine other body elements. Admission labs usually also include a test for syphilis, a chest X ray, and an EKG. The latter is often considered essential for patients over 40. Together, the admission labs tell the physician a number of important facts about the state of the patient's health. Literally dozens of other tests could be noted. All involve some degree of risk and discomfort for the patient. But for most admission tests, both risk and discomfort are minimal. When the patient agrees to undergo them in batteries, is his or her right of informed consent being violated? The Doctor’s Challenge ‘That question cannot be answered in a single word. The doctor faces a dilemma in nearly all cases. He or she has to ask how much information can and should be transmitted ~ and how ‘much the patient can absorb without becoming confused. eT He or she has also to ask what degree of risk is involved in any test or series of tests. Them the doctor has to weigh the advantages of having test readings against the involved in not having those test results. For a woman under.35, a teav for cancer suchas thelmamiagit administered regularly (annually). For an older woman o With some tests, the risk forthe patent is slight co virally Biven in batteries involve some risk, however minor. Does that m ‘ests in batteries increases the risk element significantly ? It ENGLISH IN MEDICINE 282 wave to do some “homework” to answer should spend time with pat ind prognoses The doctor may even bi thorities agree that doctors sl Aven) 10 clarify procedures, risks. 2 davised to talk to patients in a dire ient’s rights are protected ¢ or she needs to know Doctors are also a term. By such means the pat “The doctor also finds out what h (from The New Complete Medical and i vol, 3, edited by Richard J. W Telemedicine ‘Telemedicine has proliferated throughout much of the industrialized ‘of scientific, technologic, economic, and social factors. D high-capacity digital networks and improved switching technologies ha ‘many regions of North America. hardware and software have become fast, powerful, easy to use, anc ‘Compressible, high-resolution digital images can be enhanced and ma ‘availability of and access to health-related information has improved substan ‘Telemedicine has begun to take hold, almost 40 years after the first ex providing medical care at a distance demonstrated its feasibility. f emetic ues tecnoloy to deliver media services to the point of ned ni ions of telemedicine, a committee of specialists der. slentiin as “hese of electronic information and communication icsisiogtes eae dad suppor healthcare when distance separates the participants" fis capamsive definition afer considering atleast 10 ober Probably the mos in the report was that “telemedicine encompasses all of the he " ‘education, information eae services that can be transmitted over dista of eee eo complicated the discussion of telemedicine policy a oftechnologies, including telephone, radio, asin, ole saarieo faces ime, a5 with imerative video, or asynchrooots ee auditory verbal information, sill images, soc vt sobre Virtual reality interfaces have been introduced ie ons. These technologies may be applied i was spplications. Thess ees > applied in various ee ee ition, preventive medicine, public eal sewniple) fe resiatiens of telemedicine even encomps® access LINE, and continuing medical eves" and space-based (satellite) transmission in Part because its bandwidth or bie rate (the seul! the type of technology that may be elephone lines, are inexpensive but ack & SUPPLEMENTARY READINGS 283 4 with narrower bandwidths if data compression algorithms are also used smetimes too jerky a used, but the images Z 10 permit resolution of detail or subtle moveme: worst the early telemedicine programs used interactive video to bring ae voviders, and consultants Ciipetisnn ica, A989 eons the 30708,16letaescionaet ee medical

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