"There are three factors: the disease, the patient, the physician.
The physician is the servant of the art. The patient
must cooperate with the physician in combating the disease."
Hippocrates, Epidemics, I, 11 (ca. 400 B.C.)
ombating the disease," said our venerable Father of Medicine close to 400 years B.C. (1), and today we say: "kill the virus," "arrest the growth," "eradicate the infection," "conquer cancer." "Senator Kennedy is bravely battling brain cancer," said the newscaster.
For our everyday number 1 national medical problem: pain, we have painkillers, mild and strong, and an entire medical specialty dedicated to it, Pain Medicine. The current president of the American Pain Foundation examines the issue in his book The War on Pain: How Breakthroughs in the New Field of Pain Medicine are Turning the Tide Against Suffering. For the war on (illicit) drugs we have a designated "drug czar" with unlimited powers! And, if the enemy is of an infectious nature, our "drug armamentarium" is second to none; yet, we must always "remain alert." Cancer is an enemy that is constantly on the prowlthere are "victims" every hour of the day and support groups for "survivors."
Make no mistake, we are all susceptible to "attack" or "accident." An appendicitis attack is best to have in childhood, a time also propitious for the respiratory wheezing sounds of early onset asthmatic attacks. Epileptic attacks may present at any time, whereas a heart attack is more common in mid-life. Attack, attack, attack, attack! The annual death rate due to auto accidents on our nation's highways is, actually, far below the annual death rate for vascular accidents in our internal circulatory routes, be they cerebrovascular or coronaryour worse enemies, bar none.
A closer look at the original Hippocratic Epidemics, translated from the Greek into English, reveals a penchant for drama, suspense and action.
A facial palsy (paralysis) can "strike" at any time and a "stroke" is what happens when blood supply to a part of the brain is cut off. For new and emerging diseases we have a "containment plan." And guess who is at the head of our national defense against these latter enemiesnone other than the highest-ranking commanderThe Surgeon General of the USA.
If these lexical developments were of recent vintage, we would all agree that they are an understandable extension of our honorable national military history and ever-present state of readiness. However, as we look far back, we find that wars were very common in Ancient Greece. The Greeks lived in small city-states like Athens, Sparta, Corinth and Thebes, that were always at war with each other over their borders (3). Their fights, which we have seen recreated in modern movies, were fought in lines or arrays of military soldiers called phalanxes, thus our anatomical phalanges, the bones of the fingers or toes. A closer look at the original Hippocratic Epidemics, translated from the Greek into English (1), reveals a penchant for drama, suspense and action. "Ardent fevers"as perceived by touch, no thermometer availableended, in old Greek terminology, "by lysis"a gradual abatementor "by crisis"a sudden turning point, often attended by rigors, paroxysms, convulsions and fears that "seized" the patients, thus our "seizures" today. The ominous development of phrenitis (no longer in use), an inflammation of the brain, ended many lives and left us with the prefix 'phren' from whence comes frenetic and frenzy as well as schizophrenia, the mind-splitting disease.
"Consumption," an apt name for the withering effects of tuberculosis, a disease so named after a tubercle-shaped bacillus was discovered to be the causative agent, but not before another original Hippocratic term, "phthisis" or wasting away, persisted for centuries. Phthisis took the lives of important figures in history, real or fictional. To wit, René Laennec, the inventor of the first stethoscope died of it in 1816, and so did the celebrated composer Fredrick Chopin in 1849 as well as Mimi, the heroine in Puccini's opera La Boheme, and so many others (4). Black phthisis is the name given to the lesions of pulmonary anthracosis of coal miners who inhale black coal dust for years. Phthisis is also used today in ophthalmology to designate the end result of chronic inflammation, retinal detachment or old ocular trauma that progressively shrivels the affected eye to look like a raisinphthisis bulbi.
The beginnings of our own American style allopathic medicine started at the turn of the twentieth century. Allopathy, from the Greek..allos ~ contrary to, against, and pathos ~ disease, a combination that gives us a hint of things to come. In 1910, the American Medical Association tasked the Carnegie Foundation with conducting a thorough study of the status of American medicine and drafting appropriate recommendations for education, training and conduct of the practice of medicine. The resulting document, called The Flexner Report (5), outlines the basic educational requirements that still stand today.
Alongside the medical educational norms Flexner also provided a theoretical basis for scientific medicine along the following premises:
• All diseases are organic in origin caused by etiologic agents or mechanisms (known or unknown)
• The patient's role is entirely passive.
• Use of any necessary treatment to restore normality (known as health).
Get the picture? Or, better, the mandate! An entirely passive recipient of disease stands to suffer, possibly die, unless literally torn away from the organic enemy intruder. Tie that to another Hippocratic saying: "Life is short and the art (.. of medicine) is long, opportunity is fleeting, experience delusive, judgment difficult" (6). A more sophisticated German physician, Dr. Samuel Hahnemann, starts his Organon of Medicine (7), a lifelong collection of annotations from 1810 to 1842, with this very first dictum: "The physician's highest calling and only mission is to restore the sick to health, to "cure," as it is called."
Everybody agrees. To cure is the aim, and the faster the better. Easy to conceive, often difficult to attain. Nevertheless, as a nation, we keep constant pressure on the enemy, literally. Emergency Medicine is now a well-defined specialty using the military concept of triage throughout the land. Dialing 911 anywhere in the nation sets off a 24-hr alarm system to which dedicated first responders (fire-rescue-police) meet the enemy anywhere, treat on the spot and through a nationally coordinated system of levels of carefrom dispensaries to emergency rooms, to trauma centers and burn unitsdeliver patients via ground, water or air transport, to the closest treatment facility that can provide the required level of care. Time is the metric for success.
A development from the Korean Warour MASH (Mobile Army Surgical Hospitals) units, led the international community in the skills of emergency care of sick and wounded in a battlefield. Today, observers from all over the world visit our present 212th Combat Support Hospital (CSH) in Iraq (8) (9), a conversion from our last MASH unit to this first of a kind battlefield hospital. This unit is supported by medical evacuation helicopters for nearby, in-country transport as well as enormous flying surgical centers with several fully staffed operating rooms, performing major surgery over the clouds while en route to US military hospitals in the European theater.
Truly amazing. A product of our inherent medical antipathy against the enemy. Hippocrates would be pleased.
(1) Epidemics. http://classics.mit.edu/Hippocrates/epidemics.html
(2) Fishman, Scott M., MD The War on Pain: How Breakthroughs in the New Field of Pain Medicine are Turning the Tide Against Suffering. Harper Collins, New York, NY ISBN 0-06-019297-6
(4) Caduceus Newsletter, Summer 2004, Glossarium.. 'phthysis'
(5) Flexner, A. Medical Education in the United States and Canada, Bulletin No. 4, Carnegie Foundation for the Advancement of Teaching, 1910
(6) Caduceus Newsletter, Spring 2004, Rosdolski, M., History of Medicine,
(7) Hahnemann, S. Organon of Medicine. B. Jain Publishers (P) Ltd New Delhi -10 055 latest edition.1921.