The practice of modern medicine

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In peacetime most of the intermediate medical units exist only in skeleton form; the active units are at the battalion and hospital level. When physicians join the medical corps, they may join with specialist qualifications, or they may obtain such qualifications while in the army. A feature of army medicine is promotion to administrative positions. The commanding officer of a hospital and the medical officer at headquarters may have no contacts with actual patients.

Although medical officers in peacetime have some choice of the kind of work they will do, they are in a chain of command and are subject to military discipline. When dealing with patients, however, they are in a special position; they cannot be ordered by a superior officer to give some treatment or take other action that they believe is wrong. Medical officers also do not bear or use arms unless their patients are being attacked.

Naval and air force medicine. Naval medical services are run on lines similar to those of the army. Junior medical officers are attached to ships or to shore stations and deal with most cases of sickness in their units. When at sea. medical officers have an exceptional degree of responsibility in that they work alone, unless they are on a very large ship. In peacetime, only the larger ships carry a medical officer; in wartime, destroyers and other small craft may also carry medical officers. Serious cases go to either a shore-based hospital or a hospital ship.

Flying has many medical repercussions. Cold, lack of oxygen, and changes of direction at high speed all have important effects on bodily and mental functions. Armies and air forces may share the same medical services.

A developing field is aerospace medicine. This involves medical problems that were not experienced before space-flight, for the main reason that humans in space are not under the influence of gravity, a condition that has profound physiological effects.

CLINICAL RESEARCH

The remarkable developments in medicine that have been brought about in the 20th century, especially since World War II, have been based on research either in the basic sciences related to medicine or in the clinical field. Advances in the use of radiation, nuclear energy, and space research have played an important part in this progress. Some laypersons often think of research as taking place only in sophisticated laboratories or highly specialized institutions where work is devoted to scientific advances that may or may not be applicable to medical practice. This notion, however, ignores the clinical research that takes place on a day-to-day basis in hospitals and doctors' offices.

Historical notes. Although the most spectacular changes in the medical scene during the 20lh century, and the most widely heralded, have been the development of potent drugs and elaborate operations, another striking change has been the abandonment of most of the remedies of the past. In the mid-19th century, persons ill with numerous maladies were starved (partially or completely), bled, purged, cupped (by applying a tight-fitting vessel filled with steam to some part and then cooling the vessel), and rested, perhaps for months or even years. Much more recently they were prescribed various restricted diets and were routinely kept in bed for weeks after abdominal operations, for many weeks or months when their hearts were thought to be affected, and for many months or years with tuberculosis. The abandonment of these measures may not be though of as involving research, but the physician who first encouraged persons who had peptic ulcers to eat normally (rather than to live on the customary bland foods) and the physician who first got his patients out of bed a week or two after they had had minor coronary thrombosis (rather than insisting on a minimum of six weeks of strict bed rest) were as much doing research as is the physician who first tries out a new drug on a patient. This research, by observing what happens when remedies are abandoned, has been of inestimable value, and the need for it has not passed.

: 11/11/2009