Is Medicine an Art or Science - Essay Example

Was there a Laboratory revolution in Medicine from c.1850 why One question that always arises in every ones mind, when the word medicine is spelledis "Medicine an art or science". This debate can be rooted back to the ages, that saw the concept of medicine being sprouted. I personally believe that this question is the point from which the entire existing medical advancement and break through have branched out from. Men folks leap into future is fueled by his sense of appreciation of past. So in this assignment I have tried to outlay the medical history, working hard to cover all important events in nutshell. This assignment tries to unravel the point that ,was there a revolution in medicine, if so what , why and when The practice of medicine has been shaped through the years by advancement and refinement of existing techniques of that era. As per N.D Jewson the concept of sick man was found to disappear from medical cosmology in two related sense of period ,1770 to 1870. Medical cosmology is basically meta physical and attempts to circumscribe and define the universal nature of medical disease ( Althruser and Bailbar, 1970 ). Three distinct period in history of medicine are associated with three different places and three different thoughts of diagnosis. From middle age- 18th century BED SIDE Medicine ( BM ) was widely prevalent, then by 1794 to 1848 came the era of HOSPTIAL MEDICINE ( HM ). And from the time forward it was Laboratory Medicine ( LM ) that ruled the medical world. The Laboratories contribution to the medicine has been recently recognized by the historians as something more than addition of knowledge, but as an seat of medicine which helps clinicians to account what they observe in patient. Medicine in Ancient days The first medical diagnosis made by human race was based on observations made with eyes and ears by ancient physicians. The Greek attribute all diverse reactions and diseases to bodily fluid called humor. Ancient Egypt's and Mesopotamian clinicians made diagnosis and treatment based primarily on observation of clinical symptoms as palpitations, acultation, etc. Other less scientific diagnosis that was widely prevalent in that time was spiritual sacrifice of animal and examination of those animals organs, being correlating to the patient's stage. Aptly described as the father of medicine ,Hippocrates in 300 BC attributed all diseases to body fluids. Later Gallen ( AD 131 to 101 ) who is called as the founder of experimental physiology combines Hippocrates and Pythogras theorem, holding four elements earth, fire, water and air contributing to four elements blood, bile, phlegm and black bile. In the middle age, in Europe early Christians considered diseases sin or punishment and diagnosis were based on symptoms, pulse, excreta ( especially urine). The concept of uroscopy was introduced and testing of urine for all diseases was made mandatory. The 17th century saw the descriptive work of medicine, as the medical journals started evolving and there was more ground work done for diagnosis and therapy of diseases. Many inventions as blood circulation, microscope, uroscopy, gravimeter analysis, experiments on blood transfusion, and attempt to use pulse rate and temperature as health indicator were followed. 18th century was considered to be the golden age of medicine as text book of medicines and laboratory medicines evolved. Blood pressure measurement and heart beat measurement and coagulation concepts were established in this century. The 19th century saw the growth of sophistication in technology in labs, transformation of society, introduction of the concept of bacteriology, stethoscope, opthalmoscope, layrngoscope, x-ray, microscope, etc.( Starr, 1982). The three concepts in medicine At the beginning of medical cosmology, Bedside Medicine was widely predominant, mainly in the last 3rd of 18th century. The ideology was centered around University of Edinburg and in certain parts of England (Jewson, 1974). The BM treats patients as the patrons and physicians as practioners and the sick was perceived as personal and the concept of illness being psycho somatic. The major growth was in phenomenal nosology and specific pathology, though both were contradicting theories, thy were based on grouping of the symptoms his was the period dominated by the rich and higher class and lords, who as patients decided the doctors and only their interpretations guided the investigations. Thus earlier diagnosis was cumulation of physical observation , patient interpretations and doctors imagination. This was the period where the patient doctor relationship was cherished (Ackerchenet, 1967). As the medical individuals gained power the medical fraternity tend to cling together and among themselves and a high powered senior member in the circle was the one who allocated and gave access to the medical community. This marked the beginning of Hospital Medicine The medical group started exchanging the details and they felt their need to practice and the concept of hospital emerged as a common place for medical fraternity.. The relation ship earlier that was primary with the sick man slowly shifted towards other clinicians with the confusion being replaced by certainty. The concept of specialties in medicine emerged. In HM the subject were called patients and practioners as clinicians. The diagnosis was made based on symptoms and classifications. So hospital medicine brought about the theory of observations to be made for considerable time and the importance of exchanging clinical ideas gained momentum. For eg. In the Glascow case in 1886, the patient Margaret speaks about the hospital environment and the modus operandi of Doctor Lister and his assistant where the patients food intake, quality and quantity was defined by the doctor. Earlier hospitals existed ase as charitable institutions with religious and communal priority. In later years it became more common to the human race (Turner, 1971). Centered around Prussia -German society Laboratory Medicine differed in being reversal methodology, where the medical persons were rewarded. LM celebrates the perception, decision and concrete scientific facts and data provided by research works. With this LM revolution medicine was known to be the field of knowledge. In LM person with advanced technical knowledge was rated high than person with personal reputation. LM started with the Germans thrust for medical power, their quest to show the world its academic excellence. So now, two entities in medical field started working hand in hand, the hostile working clinicians and practically working research worker. The LM states the place as lab, patient as cell, practioner as scientist, explaining the diseases as bio chemical process ( Elliot.P, 1973). Medical practioner's duty is to observe and study while the lab mans work is to measure and extrapolate from abstract. Now Sick man is considered as the object to be analyzed. With LM revolution both hospital and universities started having laboratories as a small unit within them. The LM Paved way for the clinician to get a quick grasp about the patient just by asseing treatment by sitting just inside his room (Elias.N, 1956). Hospital medicine Vs Laboratory medicine To get a more detail picture, the comparison and analysis between LM and HM becomes more important. Lets first see the conflicting ideologists between the historical medical people and then we could seep through them to get a strong hold of concrete facts. Carl Browning describes the art of medicine as a skill to deal with patients as an individuals, appraising his psychological makeup assessing its effects on lesions and thus the judgments. So an experienced clinician can make note on assumptive diagnosis but can reach to a conclusion only through laboratory methods. (Carl Browning, 1976). Lord Moyniban says medicine owes much to the method of observations, considering observations as a first act in scientific procedure and also as its last act. Experiments according to him play a necessary part in the intermediate stage but is through out subject to both initial direction and to final control. He foresees the role of clinician as to gather together and integrate the items of knowledge obtained from sources as himself, evidence, symptoms, environment, personality, etc. (Lord Moyniban, 1930). Prof. Noah Morris treats patients not as mere substance but in treating he takes observations, diagnosis and most important the man's psychology as a very essential point for treatment. (Noah Morris, 1944). Claude Bernard a pioneering French experimental physiologic strongly says clinical medicine and hospital wards are only mere entrance to scientific medicine but true sanctuary of medicine is laboratory, where we can seek a explanation of life in normal and pathological state by means of experimental analysis. (Claude Bernard, 1865). Thus it can be seen that there is a split of opinion favoring hospital medicine and laboratory medicine between Claude Bernard who loves laboratory and Lord Moynihan who believes in hospital medicine. Claude Bernard strongly attacks clinician, arguing hospital medicines has limitations as being historical, observational and descriptive rather not explanative. Now let us discuss about laboratory medicines in detail Laboratory medicines is a field where medical scientist attempts to establish the physical or chemical means of controlling the living system using carefully setup experiments and measuring their outcomes. where as hospital medicines focus mainly on observation and natural historical classification of diseases, by where it appears in the body. LM is about measuring the difference in chemical and cellular level in normal and disease state. Jewson's LM - Jewson argues that there is a major shift in medical authority increasingly from 1870 onwards as LM becomes dominant over HM. Now medical scientist and not clinicians are the ones making medical knowledge. They are the one who has accurate knowledge over the efficient lab methods and thus becomes the dominant partner in diagnosis and therapy. LM paved way for Professional scientific carrier structure that embodies research papers peer review and assessment. This model describes Doctor as a Scientist and Patient as Numerical or graphical representation. This type of medicines alienates patient from doctors, it considers sick person as cell complex and illness as bio chemical process. Here arise the questions of whether medicines is science or art and the debate between HM and LM. Laboratories have four different functions which reflect those four aspects of new authority of lab scientist, medical advance, accurate, efficient method, new resource and dominant in diagnosis. And these different functions often means 4 different types of Labs - research ( individual ), teaching ( universities and med schools), diagnostic testing ( hospitals, centers ) and development of new therapies ( industries ). By 1870 teaching and research function separated and researches started being done in research lab in universities and pharmaceutical industrial labs. Jewson on LM is widely abstract as he sees LM as mere successor to HM and does not look at the impact of LM on clinics and how they do interact to produce the hybrid of working knowledge. The invention of Lister's microscope marks the birth of laboratory medicines. Microscope by mid century was giving new eye to medicine. Earlier as with HM what were talked as tissues and organs now got deeper in laboratory as schwann itself, treating cell as the basic unit of life .Diverting the level of analysis and location of the diseases to cell was brought about by microscope. So while supporters argued that microscopic analysis of tissue is more accurate diagnosis, opposition felt threatened that medical authority shifts from clinician to new group of medical workers the pathologist. Thus the lab revolution - microscope was seen as a materialist and reductionism, reducing body to an object which completely opposed bed side medicines. Many advances were made in various fields after this era as in experimental physiology Justus Von Lie big saw organism as a serious of physio chemical system producing hear by combustion, Johannes Muller professor of physiology and anatomy standardized microscopic methodology and animal experimentation, Karl Vogt found brain too secretes as other cells and Claude Bernard pioneered drug receptors proving that body can synthesize its own chemicals. In bacteriology Germ theories emerged as Germany Vs France, Paster Vs Koch. Thus micro organisms were found as the cause of lesion and every instance of disease, where the Germs could be extracted and grown in pure culture. Thus establishing diphtheria, typhoid, pneumonia, Leprosy, Plague and syphilis. In Pharmacology Paul Ehrlich found the magic bullet - drug that can strike at the root cause of all diseases. In the laboratory and surgery Joseph Lister introduced carbolic acid and concept of asepsis. In the Laboratory and public health the concept of epidemiology was widely spread and epidemiologist came into limelight. In laboratory and clinic new instrument and tests were introduced as thermometer spimograph, kymograph, EKG and bio chemical tests on, urine and blood and bacteriologic diagnosis, came into routine. Thus 1928 to 1929 the London debate was reported in MRC as "is science a art or medicine", further fuelling the battle of laboratory and clinic. As a conclusion it would not have been easy for LM to win over clinical medicine as there might have been struggle for authority as the elite clinicians then entreched with power wouln't have just given up medicine to lab scientist. There had been war of words as we saw. But over all it has to be a team work with different type of medical worker working together their roles blending and new trends being evolved. But the questions remains thus LM makes clinical medicines more alienated from patient. Let anything be the outcome of this question, but the fact that there was a laboratory revolution and that has made medicine reliable, safe to be looked up by commoners giving the status to the doctors as one next to god. The laboratory revolution fertilized the soil above which today's entire specialties in medicines, up front techniques and reduction in mortality rate and increase in average human lifespan has been achieved Bibliography 1. Ackerchenet.E.W., OP.G.T 1967. (3) 2. Althusser.L and Bailbar.E. Reading Capital, New left book London, 1970, PP 25 to 8. (1) 3. Carl Browning, 1976., 'Equipment for calling of medicine', Hon, Pres Address to Southern medical society (Glasgow), 24/1/46, GMJ, 1946. (5) 4. Claude Bernard, 1865., 'Introduction to the study of experimental medicine', PP 145 to 47, 1927 edition, New York Maxmillan. (6) 5. Elias.N, 1956., problem of involvement and detachment., # VII 226 to 252. (5) 6. Elliot.P, 1973., professional ideology and social situation., the sociology review, vol 2, #2, PP 211 to 28. (4) 7. Jewson.N.D. The disappearance of sick man from medical cosmology 1770 to 1870. 225 to 245. (1) 8. Jewson.N.D, 1974. Medical knowledge and patronage system in 18th century England, Sociology, Vol 8, #3, September 1974, PP 369 to 80. (3) 9. Lord Moyniban, 1930., 'The science of Medicine' an address delivered at the opening of the Banting research institute of the University of Toronto, Lancet, 11th October 1930, PP 779 to 85. (5) 10. Noah Morris, 1944., 'The history of Therapeutic' proceeding of Royal philosophies society of Glasgow, PP 13 to 34. (5) 11. Starr.P, 1982. The social transformation of American medicine, New York (3) 12. Turner.R.S. The growth of professional research in Prussia, 1818 to 1848., historical study in Physical science, Vol 3,1971, PP 137 to 82. (4) Read More