Look up template in Wiktionary, the free dictionary.

Template may mean:

• a stencil, pattern or overlay used in graphic arts (drawing, painting, etc.) and sewing to replicate letters, shapes or designs
• a pre-developed page layout in electronic or paper media used to make new pages with a similar design, pattern, or style
• Form letter, a predefined letter which retains its primary intent when individually customised with variable data or text.

Computer science and information technology[link]

• Template (file format), a standardized non-executable file type used by computer software as a pre-formatted example on which to base other files, especially documents
• Template (C++), a tool for generic programming especially in the C++ language
• Template metaprogramming, a programming technique used by a compiler to generate temporary source code
• Template method, an object-oriented design pattern
• Template processor, a system that combines a template with data to produce an output.
• Template (word processing), a standard document containing layout and styles used to configure word processing software
• Style sheet (web development) or master page on which you can globally edit and format graphic elements and text common to each page of a document
• Web template or web template system, a master page used to produce web pages
• A main document from which mail merge documents are created

Manufacturing[link]

• Mechanical template, used to cut and shape a product, such as:
  • a die (manufacturing)
  • a mold

Molecular genetics[link]

• a strand of DNA which sets the genetic sequence of new strands
• a strand of RNA which translates genes into proteins

Miscellaneous[link]

• Template (racing), a device used in car racing to ensure that the body of the race vehicle adheres to specifications

This disambiguation page lists articles associated with the same title. If an internal link led you here, you may wish to change the link to point directly to the intended article.

Statue of Asclepius, the Greek god of medicine, holding the symbolic Rod of Asclepius with its coiled serpent

Medicine is the field of applied science and the art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness in human beings.

Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication or surgery, but also through therapies as diverse as psychotherapy, external splints & traction, prostheses, biologics, ionizing radiation and others. The word medicine is derived from the Latin ars medicina, meaning the art of healing.^[1][2]

History[link]

Statuette of ancient Egyptian physician Imhotep, the first physician from antiquity known by name.

Prehistoric medicine incorporated plants (herbalism), animal parts and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (magically obtaining the truth). The field of medical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

An ancient Greek patient gets medical treatment: this aryballos (circa 480–470 BCE, now in Paris's Louvre Museum) probably contained healing oil

The Greek physician Hippocrates (ca. 460 BCE – ca. 370 BCE), considered the father of medicine.^[3][4]

Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has been called the "father of medicine"

Early records on medicine have been discovered from ancient Egyptian medicine, Babylonian medicine, Ayurvedic medicine (in the Indian subcontinent), classical Chinese medicine (predecessor to the modern traditional Chinese Medicine), and ancient Greek medicine and Roman medicine. The Egyptian Imhotep (3rd millennium BC) is the first physician in history known by name. Earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found.^[5][6] The Indian surgeon Sushruta described numerous surgical operations, including the earliest forms of plastic surgery.^{[7][dubious – discuss][8]}

The Greek physician Hippocrates, the "father of medicine",^[4][9] laid the foundation for a rational approach to medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence".^[10][11]

The Greek physician Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the Western Roman Empire and the onset of the Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.

Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the Byzantine Era, with the physician Asaph the Jew, and has since been tremendous.^[12]

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine".^[13][14] He wrote The Canon of Medicine, considered one of the most famous books in the history of medicine.^[15] Others include Abulcasis,^[16] Avenzoar,^[17] Ibn al-Nafis,^[18] and Averroes.^[19] Rhazes^[20] was one of first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine.^[21] The Islamic Bimaristan hospitals were an early example of public hospitals.^[22][23]

However, the fourteenth and fifteenth century Black Death was just as devastating to the Middle East as to Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East.^[24] In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey.

The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Vesalius improved upon or disproved some of the theories from the past.

Andreas Vesalius was an author of one of the most influential books on human anatomy, De humani corporis fabrica.^[25] French surgeon Ambroise Paré is considered as one of the fathers of surgery. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology.^[26] Partly based on the works by the Italian surgeon and anatomist Matteo Realdo Colombo the English physician William Harvey described the circulatory system.^[27] Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). It is said that the 17th century French physician Pierre Fauchard started dentistry science as we know it today, and he has been named "the father of modern dentistry".^[28]

Veterinary medicine was for the first time truly separated from human medicine in 1761, when the French veterinarian Claude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.

Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century (inspired by the method of inoculation earlier practiced in Asia), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900.

The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austria, doctors Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner and Otto Loewi made notable contributions. In the United Kingdom, Alexander Fleming, Joseph Lister, Francis Crick and Florence Nightingale are considered important. Spanish doctor Santiago Ramón y Cajal is considered the father of modern neuroscience.

From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet.

In the United States, William Williams Keen, William Coley, James D. Watson, Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan (Kitasato Shibasaburō), and France (Jean-Martin Charcot, Claude Bernard, Paul Broca and others did significant work). Russian Nikolai Korotkov also did significant work, as did Sir William Osler and Harvey Cushing.

As science and technology developed, medicine became more reliant upon medications. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids.^[29] Pharmacology developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc.). Vaccines were discovered by Edward Jenner and Louis Pasteur.

The first antibiotic was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes.

Pharmacology has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce side-effects. Genomics and knowledge of human genetics is having some influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology and genetics are influencing medical technology, practice and decision-making.

Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.^[30]

Clinical practice[link]

It has been suggested that Medical practice be merged into this article or section. (Discuss) Proposed since August 2011.

The Doctor, by Sir Luke Fildes (1891)

In clinical practice, doctors personally assess patients in order to diagnose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's medical history and medical record, followed a medical interview^[31] and a physical examination. Basic diagnostic medical devices (e.g. stethoscope, tongue depressor) are typically used. After examination for signs and interviewing for symptoms, the doctor may order medical tests (e.g. blood tests), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions.^[32] Followups may be shorter but follow the same general procedure.

The components of the medical interview^[31] and encounter are:

• Chief complaint (cc): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
• History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
• Current activity: occupation, hobbies, what the patient actually does.
• Medications (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
• Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
• Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
• Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.

• Review of systems (ROS) or systems inquiry: a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc.).

The physical examination is the examination of the patient looking for signs of disease ('Symptoms' are what the patient volunteers, 'Signs' are what the healthcare provider detects by examination). The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis). Taste has been made redundant by the availability of modern lab tests. Four actions are taught as the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen). This order may be modified depending on the main focus of the examination (e.g., a joint may be examined by simply "look, feel, move". Having this set order is an educational tool that encourages practitioners to be systematic in their approach and refrain from using tools such as the stethoscope before they have fully evaluated the other modalities).

The clinical examination involves study of:

• Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
• General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
• Skin
• Head, eye, ear, nose, and throat (HEENT)
• Cardiovascular (heart and blood vessels)
• Respiratory (large airways and lungs)
• Abdomen and rectum
• Genitalia (and pregnancy if the patient is or could be pregnant)
• Musculoskeletal (including spine and extremities)
• Neurological (consciousness, awareness, brain, vision, cranial nerves, spinal cord and peripheral nerves)
• Psychiatric (orientation, mental state, evidence of abnormal perception or thought).

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

Laboratory and imaging studies results may be obtained, if necessary.

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.

This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

Institutions[link]

The Hospital of Santa Maria della Scala, fresco by Domenico di Bartolo, 1441–1442

Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.

Advanced industrial countries (with the exception of the United States)^[33][34] and many developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.

Most tribal societies, and the United States,^[33][34] provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

Modern drug ampoules

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness,^[35] new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

Delivery[link]

Provision of medical care is classified into primary, secondary, and tertiary care categories.

Primary care medical services are provided by physicians, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics, nursing homes, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.

Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.

Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.

Branches[link]

Working together as an interdisciplinary team, many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses, emergency medical technicians and paramedics, laboratory scientists, pharmacists, physician assistants, physiotherapists, respiratory therapists, speech therapists, occupational therapists, radiographers, dietitians, and bioengineers.

The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while considered by some a separate discipline from medicine, is a medical field.

A patient admitted to hospital is usually under the care of a specific team based on their main presenting problem, e.g., the Cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments.

Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.

The main branches of medicine are:

• Basic sciences of medicine; this is what every physician is educated in, and some return to in biomedical research.
• Medical specialties
• Interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.

Basic sciences[link]

• Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
• Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
• Biomechanics is the study of the structure and function of biological systems by means of the methods of Mechanics.
• Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine.
• Biophysics is an interdisciplinary science that uses the methods of physics and physical chemistry to study biological systems.
• Cytology is the microscopic study of individual cells.
  

  

  Louis Pasteur in his laboratory, 1885
• Embryology is the study of the early development of organisms.
• Endocrinology is the study of hormones and their effect throughout the body of animals.
• Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
• Genetics is the study of genes, and their role in biological inheritance.
• Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and immunohistochemistry.
• Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
• Medical physics is the study of the applications of physics principles in medicine.
• Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
• Molecular biology is the study of molecular underpinnings of the process of replication, transcription and translation of the genetic material.
• Neuroscience includes those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain and spinal cord. Some related clinical specialties include neurology, neurosurgery and psychiatry.
• Nutrition science (theoretical focus) and dietetics (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition, and neoplastic diseases.
• Pathology as a science is the study of disease—the causes, course, progression and resolution thereof.
• Pharmacology is the study of drugs and their actions.
• Photobiology is the study of the interactions between non-ionizing radiation and living organisms.
• Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
• Radiobiology is the study of the interactions between ionizing radiation and living organisms.
• Toxicology is the study of hazardous effects of drugs and poisons.

Specialties[link]

In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities will have their own body or college (collectively known as the Royal Colleges, although currently not all use the term "Royal"), which have their own entrance exam. The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (e.g., emergency departments), which leads to the desire to form a unifying body of doctors and thence the prestige of administering their own exam.

Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery." "Medicine" refers to the practice of non-operative medicine, and most subspecialties in this area require preliminary training in "Internal Medicine". In the UK, this would traditionally have been evidenced by obtaining the MRCP (An exam allowing Membership of the Royal College of Physicians or the equivalent college in Scotland or Ireland). "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." (In the UK: Membership of the Royal College of Surgeons of England (MRCS).)There are some specialties of medicine that at the present time do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above – for example anaesthesia developed first as a faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the Royal College of Anaesthetists and membership of the college is by sitting the FRCA (Fellowship of the Royal College of Anesthetists).

Surgery[link]

Surgeons in an operating room

Surgical specialties employ operative treatment. In addition, surgeons must decide when an operation is necessary, and also treat many non-surgical issues, particularly in the surgical intensive care unit (SICU), where a variety of critical issues arise. Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. Surgery has many sub-specialties, including general surgery, cardiovascular surgery, colorectal surgery, neurosurgery, maxillofacial surgery, oncologic surgery, orthopedic surgery, otolaryngology, plastic surgery, podiatric surgery, transplant surgery, trauma surgery, urology, vascular surgery, and pediatric surgery. In some centers, anesthesiology is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such as ophthalmology and dermatology, but are not considered surgical sub-specialties per se.

Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time consuming.

'Medicine' as a specialty[link]

Internal medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases, either of one particular organ system or of the body as a whole. According to some sources, an emphasis on internal structures is implied.^[36] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth nations, such specialists are often called physicians.^[37] These terms, internist or physician (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.

Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys.^[38]

In the Commonwealth of Nations and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of Primary care.

There are many subspecialities (or subdisciplines) of internal medicine:

Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on Medical education and Physician for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one to three year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the USA. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.

Diagnostic specialties[link]

• Clinical laboratory sciences are the clinical diagnostic services that apply laboratory techniques to diagnosis and management of patients. In the United States, these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services. Subspecialties include Transfusion medicine, Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology and Clinical immunology.
• Pathology as a medical specialty is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in evidence-based medicine. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearrangements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology.
• Radiology is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
• Nuclear medicine is concerned with studying human organ systems by administering radiolabelled substances (radiopharmaceuticals) to the body, which can then be imaged outside the body by a gamma camera or a PET scanner. Each radiopharmaceutical consists of two parts: a tracer that is specific for the function under study (e.g., neurotransmitter pathway, metabolic pathway, blood flow, or other), and a radionuclide (usually either a gamma-emitter or a positron emitter). There is a degree of overlap between nuclear medicine and radiology, as evidenced by the emergence of combined devices such as the PET/CT scanner.
• Clinical neurophysiology is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include Electroencephalography, Electromyography, Evoked potential, Nerve conduction study and Polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.

Other major specialties[link]

The followings are some major medical specialties that do not directly fit into any of the above mentioned groups.

• Anesthesiology (also known as anaesthetics): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also served the same function in the labor & delivery ward, and some are specialized in critical medicine.
• Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine.
• Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
• Family medicine, family practice, general practice or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency room coverage, inpatient care, and nursing home care.
• Obstetrics and gynecology (often abbreviated as OB/GYN (American English) or Obs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
• Medical Genetics is concerned with the diagnosis and management of hereditary disorders.
• Neurology is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
• Ophthalmology exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy.
• Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
• Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
• Psychiatry is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
• Preventive medicine is the branch of medicine concerned with preventing disease.
  • Community health or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.
  • Occupational medicine's principal role is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
  • Aerospace medicine deals with medical problems related to flying and space travel.

Interdisciplinary fields[link]

Some interdisciplinary sub-specialties of medicine include:

• Addiction medicine deals with the treatment of addiction.
• Medical ethics deals with ethical and moral principles that apply values and judgments to the practice of medicine.
• Biomedical Engineering is a field dealing with the application of engineering principles to medical practice.
• Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
• Conservation medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology.
• Disaster medicine deals with medical aspects of emergency preparedness, disaster mitigation and management.
• Diving medicine (or hyperbaric medicine) is the prevention and treatment of diving-related problems.
• Evolutionary medicine is a perspective on medicine derived through applying evolutionary theory.
• Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death.
• Gender-based medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
• Hospice and Palliative Medicine is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
• Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the USA and Canada. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role.
• Laser medicine involves the use of lasers in the diagnostics and/or treatment of various conditions.
• Medical humanities includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.
• Medical informatics, medical computer science, medical information and eHealth are relatively recent fields that deal with the application of computers and information technology to medicine.
• Nosology is the classification of diseases for various purposes.
• Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems.
• Pain management (also called pain medicine, or algiatry) is the medical discipline concerned with the relief of pain.
• Pharmacogenomics is a form of individualized medicine.
• Sexual medicine is concerned with diagnosing, assessing and treating all disorders related to sexuality.
• Sports medicine deals with the treatment and preventive care of athletes, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.
• Therapeutics is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health.^[39]
• Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
• Urgent care focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency room.
• Veterinary medicine; veterinarians apply similar techniques as physicians to the care of animals.
• Wilderness medicine entails the practice of medicine in the wild, where conventional medical facilities may not be available.
• Many other health science fields, e.g. dietetics

Education[link]

Painted by Toulouse-Lautrec in the year of his own death: an examination in the Paris faculty of medicine, 1901

Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by a period of supervised practice or internship, and/or residency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research.

Many regulatory authorities require continuing medical education, since knowledge, techniques and medical technology continue to evolve at a rapid rate.

Medical ethics[link]

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are:

• autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
• beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
• justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
• non-maleficence - "first, do no harm" (primum non nocere).
• respect for persons - the patient (and the person treating the patient) have the right to be treated with dignity.
• truthfulness and honesty - the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials and Tuskegee syphilis experiment.

Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

Legal controls[link]

In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health.

Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.

Criticism of modern medicine[link]

The Catholic social theorist Ivan Illich subjected contemporary western medicine to detailed attack in his Medical Nemesis, first published in 1975. He argued that the medicalization in recent decades of so many of life's vicissitudes — birth and death, for example — frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced industrial society. He was the first to introduce to a wider public the notion of iatrogenesis.^[40] Others have since voiced similar views, but none so trenchantly, perhaps, as Illich.^[41]

Through the course of the twentieth century, healthcare providers focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendant loss of patient-focused care, known as the medical model of health, led to criticisms that medicine was neglecting a holistic model.^{[citation needed]} The inability of modern medicine to properly address some common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, some, notably acupuncture for some conditions and certain herbs, are backed by evidence.^[42]

Medical errors and overmedication are also the focus of complaints and negative coverage. Practitioners of human factors engineering believe that there is much that medicine may usefully gain by emulating concepts in aviation safety, where it is recognized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Clinical versus statistical, algorithmic diagnostic methods were famously examined in psychiatric practice in a 1954 book by Paul E. Meehl, which found statistical methods superior.^[43] A 2000 meta-analysis comparing these methods in both psychology and medicine found that statistical or "mechanical" diagnostic methods were, in general, although not always, superior.^[43]

Disparities in quality of care given are often an additional cause of controversy.^[44] For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study.^[45] Rural poor African-American men were used in a study of syphilis that denied them basic medical care.

Honors and awards[link]

The highest honor awarded in medicine is the Nobel Prize in Medicine, awarded since 1901 by the Nobel Assembly at Karolinska Institutet.

Patron saints[link]

There are a number of patron saints for physicians, the most important of whom are Saint Luke the Evangelist the physician and disciple of Christ, Saints Cosmas and Damian (3rd-century physicians from Syria), and Saint Pantaleon (4th-century physician from Nicomedia). Archangel Raphael is also considered a patron saint of physicians. In India and in Hinduism, Dhanavantari, a form of Lord Vishnu and "Vaidyanatha" meaning 'Lord of Medicine', a form of Lord Shiva are the patron dieties of medicine.

The patron saints for surgeons are Saint Luke the Evangelist, the physician and disciple of Christ, Saints Cosmas and Damian (3rd-century physicians from Syria), Saint Quentin (3rd-century saint from France), Saint Foillan (7th-century saint from Ireland), and Saint Roch (14th-century saint from France).

See also[link]

Medicine portal

References[link]

External links[link]

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The National Anti-Vivisection Society (NAVS) is a national, not-for-profit animal welfare organization based in London whose purpose is to eliminate product testing, education and biomedical research on animals.

It was the world’s first organisation campaigning against animal experiments having been founded in 1875 by Miss Frances Power Cobbe, a humanitarian who published many leaflets and articles opposing animal experiments, and gathered the support of many notable people.

In 2009 the NAVS and its animal and environmental group, Animal Defenders International, are now leading the lobbying on the revision of the European Directive on animal experiments, seeking the first ban on the use of primates in research. 55% of the European Parliament has voted to end the use of primates in research, but the pharmaceutical industry has launched a gigantic lobbying effort. Arguments by the pro-vivisectionists have included that a ban on primates would send research abroad and that jobs would be lost.

History[link]

The NAVS of the UK is the world’s first anti-vivisection organization, founded in 1875 by Miss Frances Power Cobbe and Toni Doran, a humanitarian who published many leaflets and articles opposing animal experiments, and gathered many notable people of the day to support our cause. Early supporters of the NAVS included Queen Victoria and Lord Shaftesbury. Many of the social reformers of the day, working for children's rights and women's rights, supported the aims of the NAVS.

The Society was formed on 2 December 1875 in Victoria Street, London, under the name of the Victoria Street Society. At the time there were about 300 experiments on animals each year. Public opposition to vivisection led the Government to appoint the First Royal Commission on Vivisection in July 1875; it reported its findings on 8 January 1876, recommending that special legislation be enacted to control vivisection. This led to the Cruelty to Animals Act 1876, which reached the statute book on 15 August 1876. This Act remained in force for 110 years, until it was replaced by the Animals (Scientific Procedures) Act 1986.

The Cruelty to Animals Act 1876 legalised vivisection, as well as providing total secrecy to the vivisectors and to the laboratories, with no public accountability. The Home Office awarded licences to vivisectors in secret, the locations of laboratories were secret. No access was allowed, for any reason - whether Member of Parliament, media, public, or local authority - all were barred. And so, the numbers of animals used as well as the number of licences awarded rose year on year for a century, protected by successive governments and a silent scientific community.

However, opposition to vivisection also increased, and the Victoria Street Society grew in strength and influence and after a few years changed its name to the National Anti-Vivisection Society (6 October 1897).

In 1969 NAVS formed the International Association against Painful Experiments on Animals (IAAPEA).^[1]

Founder Miss Frances Power Cobbe[link]

From the outset the Victoria Street Society had demanded the total abolition of vivisection and whilst this has always been, and remains the prime objective of the NAVS, at a Council meeting on 9 February 1898 the following resolution was passed:-

The resolution was carried by 29 votes to 23. Miss Cobbe did not approve of this as she did not want the Society to promote any measure short of abolition. As a result, after the Resolution was passed, Miss Cobbe left the NAVS and formed the British Union for the Abolition of Vivisection to demand total and immediate abolition of animal experiments. This resolution of 1898 has remained the policy of the NAVS until this day.

Brown Dog affair[link]

In 1906, a statue was erected in Battersea Park of the small brown terrier dog, one of the animals which featured in the journals of the undercover investigators, as he was vivisected at the University of London. The inscription on the statue reads:

The statue became the target of animal researchers and London University medical students; students rioted at the site; anti-vivisectionists defended their statue; the elderly Frances Power Cobbe was attacked in her office. After years of conflict, the statue mysteriously disappeared in 1910.

The NAVS and others erected a new statue with the same inscription in 1985, again in Battersea Park, where it remains today.

Second Royal Commission on Vivisection[link]

In 1906 the Government appointed the Second Royal Commission on Vivisection. This Second Royal Commission heard a great deal of evidence from the NAVS and other interested parties. It published its findings in 1912, recommending an increase in the numbers of Home Office Inspectors; further limitations with regard to the use of curare (paralysing drug which does not deaden pain, but can heighten it); stricter provisions as to the definition and practice of pithing; additional restrictions regulating the painless destruction of animals which show signs of suffering after experimentation; a change in the method of selecting, and in the constitution of, the advisory body of the Secretary of State*; and keeping of special records by vivisectors. (*This body, under the new 1986 Animals (Scientific Procedures) Act, is called the Animal Procedures Committee).

This was a long way from abolition; it did not deal with the issue of secrecy and public accountability; it left the vivisection community protected from outside control and scrutiny. Although each successive Home Secretary attached ‘pain conditions’ to all experiments, the ‘conditions’ were so worded that they afforded no protection to the animals whatsoever.

The NAVS strongly believes and can demonstrate that there are good scientific arguments against the use of animals in research, not least because of the misleading results from animal experiments, due to species differences. Thus, for animal research to be abolished would, in fact, be in the public interest. However, to pursue such a case would be prohibitively expensive.

In 1963, with animal experiments running into millions each year and a public deprived of information on the issue, the Government set up a ‘Departmental Committee on Experiments on Living Animals’ to consider the use of animals in research, and whether any changes in legislation were necessary. In 1965 the Littlewood Committee, as it was known, published 83 recommendations, and although none of the recommendations were designed to bring an end to animal experiments, no legislation was passed to put any of them into effect anyway.

Throughout the 20th Century, the NAVS lobbied government and drafted various Bills against a seemingly unstoppable rise in animal experiments ‘reaching almost 6 million per year in the UK by the 1970s’. When the trade in monkeys for use in vaccine tests devastated India’s population of rhesus macaques, NAVS representatives went to India and successfully lobbied for a ban on the export of these animals, which was introduced in 1978.

In 1973, the NAVS, now based in Harley Street, London, sought a new strategy and founded the Lord Dowding Fund for Humane Research. The Fund was named after Lord Dowding, the Air Chief Marshal and Battle of Britain WW2 hero. After the war, Lord Dowding became President of the NAVS and in the House of Lords made many impassioned speeches on animal experiments. His wife Lady Dowding was also an NAVS Council member (later becoming President after her husband’s death).

This new strategy was to make positive steps to replace the use of animals in research, and to show that animal research is not necessary for medical and scientific progress. The Lord Dowding Fund continues to be responsible for ground breaking medical and scientific research that does not involve animals. Tens of thousands of animals have been saved, through the introduction of techniques and technology funded by the Lord Dowding Fund for Humane Research.

In 1979, the NAVS established World Day for Laboratory Animals (also referred to as Lab Animal Day) on April 24 - Lord Dowding’s birthday. This international day of commemoration is recognised by the United Nations, and is now marked annually by anti-vivisectionists on every continent.

London and Provincial Anti-Vivisection Society[link]

In 1957 the London and Provincial Anti-Vivisection Society (LPAVS) became part of the NAVS. An active member of the LPAVS was Norah Elam who had been a member (possibly even founding member) from its very beginnings around 1900. Elam was a prominent suffragette who was part of the Pankhurst inner circle from late 1912 to 1917 (under the name Dacre Fox).

During 1916/1917 Elam obtained work as supervisor of a typewriting pool at the Medical Research Council (MRC), gaining a wealth of information she was to use later in articles published under the auspices of the LPAVS during 1934 and 1935. In March 1921 Elam advertised in The Times and chaired a public meeting of LPAVS to discuss 'The Dog's Bill' (Bill to prohibit the vivisection of Dogs) that was being debated in Parliament at that time. The meeting was held at Aeolian Hall in London and as Chair, Elam read out 20 letters from Members of Parliament in support of the bill, and stated that, 'A large majority of the public were strongly in favour of the measure, and she felt sure that victory would be theirs if a determined effort were made, especially if women made proper use of their new political power'.^[2]

In 1932 the MRC had produced a paper called 'Vitamins, A Survey of Present Knowledge'. Elam's 1934 response was entitled 'The Vitamin Survey, A Reply' and was a critical appraisal of that survey and its results. This was followed in 1935 by 'The Medical Research Council, What it is and how it works'. The second paper was based on the same arguments about MRC research practices and remits as the first paper, but distilled and argued more cogently on a broader front. Elam's argument was that 'powerful vested interests' had managed to 'entrench' themselves behind 'State-aided research', and had managed to make themselves unaccountable; the public were unable to influence the decisions about what research should be undertaken, and it operated like a closed shop, only answerable to itself. Elam also argued that the research involved the cruel and inhumane use of animals, and that any thinking person had to question how and why research and results based on animal models could safely be extrapolated to humans. Finally, she complained that animal experimentation was doubly cruel because of the unnecessary repetition of experiments to replicate or prove the same point, which in many cases she argued could have been arrived at by simple, common sense. These papers were widely distributed and copies could be found in libraries throughout the UK.^[2]

Modern movement[link]

After years of lobbying, in 1983, the Government announced it would replace the 1876 Act and published a White Paper. The NAVS was bitterly disappointed with the weakness of the proposals. However, the Society decided to take a very reasonable approach to the issue, realising that abolition was not achievable. Thus, together with other UK groups such as BUAV, Animal Aid and the Scottish Society, a list of key experiments and purposes was forged that should be banned under new legislation.

The coalition of groups of which NAVS was part, called for a ban on the use of animals in tests for cosmetics, tobacco, alcohol products; warfare experiments; psychological and behavioural tests; a ban on the Median lethal dose and Draize eye irritancy tests, as well as other measures in relation to the administration of the legislation (such as reform of the Home Secretary’s Advisory Committee). After a hard fought campaign, the Animals (Scientific Procedures) Act received Royal Assent on 20 May 1986.

It would not be until the late 1990s that a change of Government brought in bans on the use of animals for cosmetics research and a ban on the use of great apes would start the process of change. These were followed by the UK's Freedom of Information Act, which permitted wider public scrutiny of some scientific procedures.

In 1990 the fast-expanding Society had long outgrown its premises in Harley Street, and so moved to larger premises in Goldhawk Road, London. After 17 years, the shape of its campaigning had changed to meet the changes of the new millennium; so in 2006 NAVS moved to Millbank Tower, London, where it remains today.

Mission[link]

NAVS claim is that they strive to educate researchers, physicians, manufacturers, teachers and government leaders in the discovery of new, humane methods that will save millions of animals each year and still give our children a safer, healthier and happier future.

See also[link]

• Women and animal advocacy

References[link]

External links[link]

• National Anti-Vivisection Society website
• International Association Against Painful Experiments on Animals website

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