It is practiced by medically trained healers with the aim of maintaining or restoring health . These are mostly doctors , but also members of other medical professions . For the medical field include not only human medicine , the dentistry , the veterinary (veterinary) and in a further understanding of the Phytomedicine (control of plant diseases and pests). In this comprehensive sense, medicine is the study of healthy and sick living beings .
The history of culture knows a large number of different medical teaching buildings, starting with the medical schools in European and Asian antiquity, up to the modern variety of scientific knowledge. Medicine also includes the application-oriented research of its representatives on the nature and function of the human and animal body in a healthy and sick state, with which it wants to improve its diagnoses and therapies. Since around 1845, (natural) scientific medicine has been making increasing use of the fundamentals developed by physics , chemistry , biology and psychology .
About the term medicine
In the European tradition
The word medicine is derived from the Latin medicina or ars medicina , “medical art” or “medicine”, from mederi , “to heal” - to Indo-European med- , “Heilkundiger”.
The art of healing (Latin also ars medicinae ) is rarely the Iatrik called (pronounced Iátrik , from the Greek substantivized adjective ἰατρική [τέχνη] , ancient Greek pronunciation iatrikḗ [téchnē] , "art of medicine" or "medical trade"; more common in compositions such as " iatrogenic "," Pediatrics "or" Psychiatry ").
With the North American Indians
The term “medicine” (as a médecine used by French trappers for the first time for the healing ceremonies of the shamans of the Plains Indians, who they equate with doctors ) is not used here in the sense of medicine or medicine , but in European- English usage denotes a “mysterious, transcendent Power behind all visible appearances ”. The Indian medical system of magical-animistic character, including all of pre-Columbian America, traces diseases back to violations of taboos, which lead to a disruption of harmony between man and his environment, and can be described as a form of shamanism . A shaman (as a healer or "medicine man") used various mind-altering methods, enabling a journey into heaven or the soul, for reconciliation with non-material powers and ritual actions in order to restore this harmony. Only in the course of time did it become apparent that Indian “medicine”, which however also includes medicine based on medicinal herbs and physical therapy methods in the narrower sense, goes far beyond medicine (see medicine bag or medicine wheel ) . Indian medicine is more reminiscent of Polynesian mana .
Medicine is a practice-oriented empirical science . The aim is to prevent diseases or their complications; the curation ( healing ) of curable diseases, or the palliation (alleviation) of complaints in incurable situations. The rehabilitation (restoration) of the physical and mental abilities of the patient is also a task of medicine. Doctors and non-medical therapists create treatment plans and monitor the course of treatment. In Germany, the Patient Rights Act in German Civil Code obliges the doctor or dentist to record in the patient file "all measures and their results that are essential from a professional point of view for current and future treatment, in particular the anamnesis, diagnoses, examinations, test results, findings, therapies and their effects , Interventions and their effects, consent and explanations. ”The obligation to record the entire medical history is also part of the professional regulations . All patient-related documents are subject to data protection . In everyday scientific findings with the results of are ideally history , diagnostic assessment and diagnosis and medical intuition and experience combined to meet the individual patient.
The personal patient-doctor relationship that always arises when someone with a health problem seeks help from a doctor is essential. According to medical historians, this relationship has fundamentally changed with the advent of modern medicine. The expert knowledge and the specialist authority of the uniformly trained doctors have elevated them to a dominant role that barbers , stone cutters , but also academic medical professionals of earlier times with their often unsuccessful disease theories did not have. The medical profession today has extensive power to define what constitutes illness and what medical and medical-political measures should be taken against it. On the other hand, civil society (in Germany since the late imperial era) has tried to reduce the paternalistic discretion of doctors, for example through the legal classification of medical interventions as bodily harm , first published in 1884 ( Richard Keßler ) , for which the patient's consent is essential. A deliberative performance is now expected from the therapist, whose specialist knowledge supports the patient's free decision-making power, not a substitute for it. The associated obligation to provide medical information is unchallenged; It is reflected in internationally valid documents such as the Declaration of Helsinki as well as in national criminal law and the professional codes of the medical professions .
Both doctors and other health professions use an analytical term for disease: disease as a functional disorder of the organism. On the basis of a contractual and trusting relationship, data on the medical history ( anamnesis ) can be collected and a thorough clinical examination can be carried out. Technical procedures for medical examinations using a laboratory , imaging processes such as x-rays and many other examination procedures such as the electrocardiogram supplement the information collected. It is part of the medical art to integrate the multitude of facts and observations for diagnosis . Successful therapy is only possible with a correct diagnosis . This analytical concept of illness in scientific medicine - also adopted by many alternative therapists - has largely replaced the ontological ideas of earlier centuries. Controversial borderline cases of the definition of illness are disabilities and mental illnesses , the definition of which has always been socially influenced.
The national legal and financial framework for the practice of medicine is represented by the respective health system of a state. During the Middle Ages, churches and communes with hospitals and employed doctors provided a rudimentary form of medical care. After the emergence of the powerful nation states, they initially took control of the health professions and passed licensing regulations and fee regulations . In 1852 Prussia abolished the traditional division of the medical profession between surgeons and doctors and closed the surgeon schools . At the instigation of liberal circles, including Rudolph Virchow , the first trade regulations of the German Empire (1871) allowed therapy freedom even for non-licensed practitioners, which was retained with the Heilpraktikergesetz (1939) , which is still valid today .
Under Otto von Bismarck's chancellorship , Germany set up the world's first general social security system, including statutory health insurance for all employees and their relatives, which today comprises 90% of the population. The resident doctors organized themselves against the initially overpowering administration ( Hartmannbund , 1900) and enforced today's self-administration in doctors' strikes , according to which the statutory health insurance physicians are solely responsible for ensuring outpatient health care and receive total remuneration for this (emergency ordinance, 1931). After reunification, the common outpatient departments in the GDR were also closed or converted into medical practices. The health authorities play no role in health care outside of disasters. In-patient medicine in hospitals , on the other hand, remained largely in the hands of the state. German hospitals conclude supply contracts with health insurers and also receive investment subsidies from tax revenues, so they have dual financing that is completely separate from the health insurance system . Numerous reforms of health legislation have tried to prevent the threatened double supply with expensive infrastructure (such as large medical devices ). Other industrialized countries have developed other solutions. There are developed nations with national, tax-financed health systems (like the National Health Service in Great Britain) or with largely unregulated supplier markets (like the health system in the United States ). In other European countries there are regulated markets with a strong public sector; For example, in Germany's health system, the public sector bears around 80 percent of total health care expenditure through statutory health insurance and state hospital grants .
With the increase in doctors and clinics, the improved technical possibilities and demographic change , the health care system became more expensive, against which numerous health reforms were implemented. These not only stipulate the scope of services and payment, but increasingly also regulate the specific service provision and quality control. Society is intensively debating the rationalization introduced in this way (increased efficiency), implicit and explicit rationing (performance limitation), and the equitable distribution that has been achieved .
A common classification of medical care distinguishes three sectors:
- The primary health care (English primary care , "family medicine") is used by medical practices , general hospital outpatient borne and other public outpatient facilities. Around 90 percent of acute and chronic health problems are to be treated at this cost-effective and comprehensive level.
- The secondary care (English secondary care , "Facharztmedizin") consists of resident and employed specialists of all disciplines as well as other specialists who work on referral from the primary physician. The specialist treatment takes place on an outpatient or inpatient basis (after admission to a hospital). Within this sector, emergency rooms, intensive care units, operating theaters, laboratory and X-ray diagnostics, and physical therapy are held.
- The tertiary care ( tertiary care , maximum care) is based on providing specialized clinics and centers that larger regions or several cities with especially expensive and complex services, such as accident and burn hospitals , cancer centers , transplant hospitals and neonatal centers.
This can be used to create measurable indicators relevant to the health system, such as the density of doctors (doctors per 1,000 inhabitants) or the density of hospital beds (hospital beds per 1,000 inhabitants). Cities that are at the fore here in Germany are Heidelberg and Regensburg .
Spectrum of medicine
The variety of areas and sub-areas as well as the increase in knowledge have led to a breakdown of medicine into a large number of subject areas and sub-specializations. Scientific (or scientific) medicine is based on the natural sciences ( biology , chemistry , physics ), especially human biology , anatomy , biochemistry , physiology , supplemented by psychology and social sciences (see medical sociology , epidemiology , health reporting and health economics ). In German medical studies , these subjects are summarized as a preclinical in the first section. Clinical subjects deal with patient treatment itself. They include the traditional subjects of internal medicine and surgery , gynecology and obstetrics , and, since around 1800, paediatrics . More recent specializations are, for example, ophthalmology , ear, nose and throat medicine , pulmonology , social medicine and psychiatry . In the 20th century, technology-oriented subjects such as radiology and radiation therapy , and subject areas with integrative demands such as geriatrics and palliative medicine emerged . These medical specialties also include sub-specializations such as pediatric cardiology , neuroradiology , addiction medicine and many others, the content of which is codified, for example in Germany, in the model training regulations of the German Medical Association .
Added to this are the areas of responsibility of the other health professions , such as physiotherapy , speech therapy , medical-technical assistance , medical assistance , which, like the medical profession , have achieved a high degree of specialization and professionalization . Nursing in particular has meanwhile developed from purely charitable assistance to an academic science and independent support for health care.
In addition to this state-sanctioned and controlled medicine, there is a large number of alternative or complementary medicine offers, which by definition are not taught at medical universities. Depending on their social status, some of these doctrines and methods can nevertheless be subject to a certain standardization and academization (by private law associations and schools) and included in the state health financing; in Germany, for example, the special healing methods homeopathy , herbal medicine , anthroposophic medicine and acupuncture . Osteopathy is similarly broadly anchored in the USA . Many complementary methods (dietetics, order therapy , naturopathy ) are recognized by large parts of the medical profession; others (traditional medical systems, folk medicine ) at least from many doctors. Countless unsecured methods and procedures are on the edge of the spectrum and are only used by individual practitioners; some are considered dangerous for the patient (e.g. Clark therapy , Germanic New Medicine ). In the USA and Germany, attempts to combine university medicine and complementary medicine are also referred to as integrative medicine .
Due to the lack of theory, medicine can only be described as a science to a limited extent. The approach of evidence-based medicine tries to remedy this by aligning clinical decision-making with scientific findings, i.e. forms of therapy are only accepted if their effectiveness has been proven by clinical studies . However, most clinical trials are wrong and useless. So far, this progress has not changed anything in the fundamental trial-and-error process of basic medical research. Nevertheless, medicine, together with the natural sciences , forms a cornerstone of research and financing in today's scientific landscape , especially at universities , which can also partly explain its high reputation among the general public. This recently became clear as part of the Excellence Initiative.
In ancient times, different medical systems developed in the advanced cultures of China, India, and the Mediterranean, which have often been changed and mixed and also play a major role in Western alternative medicine . The traditional Chinese medicine came about in the second millennium BC from simple demons and ancestral healing cults; in the post-Confucian era it differentiated itself from the natural philosophical system of dual and elementary correspondences that still exists today . Practical medicine dates from around 300 BC. The pharmacology was founded with the work of Tao Hongjing , the acupuncture with the anonymous work Huángdì Nèijīng (Inner Classic of the Yellow Prince). In modern times, under the influence of the communist government and the increasing western reception, the techniques were perfected and standardized, but the original magical doctrine of demons was abandoned.
The Ayurveda -Medicine India was also v to 500th Defined from the older, magical-theistic beliefs. Theoretically, it is based on a theory of temperament combined with a physiology of equilibrium of the vital energies of air, bile and phlegm, practically on nutrition and meditation exercises. The first written references to this can already be found in Arthashastra ; extensive textbooks come from Sushruta , Charaka and Vagbhata . Even yoga is used for medical treatment.
Western medicine, which is widespread worldwide today, is rooted in the medicine of ancient Egypt, Greece and Rome . Historians divide ancient medicine into four phases. The first, theurgic-magical medicine treated the sick in temples and tried to trigger divine healing miracles. Its end is associated with the life of Hippocrates of Kos (around 460 to 370 BC), when medicine tried to differentiate itself from philosophy. Hippocrates was namesake, but certainly not the only origin of a new natural philosophy based on the theory of elements and humoral pathology , which made medical action independent of the direct influence of deities. The Hippocratic practice of diagnosis , therapy and prognosis is still common today; the Hippocratic case descriptions are considered to be the origin of today's scientific medicine. In the Hellenistic phase that followed, other medical schools developed in addition to the Hippocratic one, such as empiricists , methodologists or pneumatics . Finally, the Greco-Roman phase followed, characterized by outstanding authors such as Celsus , Dioskur and Galen . Their anatomical, pharmacological and surgical works determined not only those of Hippocrates until the Enlightenment, medical thought in the West .
In the Byzantine era , the ancient models were handed down and supplemented by pulse theory and urine examination . Islamic scholars adopted the medical traditions and developed schools of botany , dietetics, and surgery , including the outstanding work of Avicenna . The classical authors, mostly in Islamic translation and compilation, remained the core component of Western medicine until the 16th century. The most influential medical school was in Salerno . New contributions to monastic medicine in the Middle Ages were astrological and theological components as well as the doctrine of signatures , according to which medicinal plants can be recognized by their external properties - an idea that was only taken up again in a similar form by homeopathy much later.
The term medicine originally comes from the Medicini , who first dissected a corpse in Bologna in 1302 and did this regularly from 1306 onwards. After centuries of stagnation, the medical profession broke away from ancient models in the Renaissance . The anatomist Andreas Vesalius was the symbol and model of a new type of scholar who wrote based on his own point of view and endured contradictions to Hippocrates and Galen. At the same time, Ambroise Paré revolutionized surgery, and Paracelsus rejected the Hippocratic doctrine of the juices in his iatrochemistry . The age of scientific medicine began in the 17th century with the experiments of Francis Bacon and continues to this day. The disease theories were not yet established as they are today; It was not until the 19th century that pathology finally asserted itself against competing doctrines such as humoral pathology or Hufeland's life force .
The 20th century was ultimately marked by an enormous increase in knowledge and, as a result, a differentiation between numerous medical disciplines, such as bacteriology , hygiene , anesthesiology , social medicine and psychiatry . At the same time, the industrialized countries increasingly gained supervisory functions over the health care system , and in some cases a national health system was established, such as the NHS in England. Medicine under National Socialism formed a distortion and disgrace of state surveillance . The current end point of the development is evidence-based medicine and the comprehensive introduction of quality management systems in all areas of patient care.
- Apparatus medicine
- List of specialist libraries, virtual specialist libraries and special collections - medicine
- William DePrez Inlow: Medicine: its nature and definition . In: Bulletin of the History of Medicine 19, 1946, pp. 249-273.
- Wolfgang U. Eckart : History of medicine. 6th edition. Springer, Berlin 2009, ISBN 978-3-540-79215-4
- Roy Porter : Cambridge illustrated history. Medicine. 4th edition. Cambridge University Press, Cambridge 2009, ISBN 978-0-521-00252-3
- Stefan Schulz, Klaus Steigleder, et al. (Ed.): History, theory and ethics of medicine. Suhrkamp, Frankfurt / M. 2006, ISBN 978-3-518-29391-1
- Huldrych MF Koelbing: Medicine. In: Historical Lexicon of Switzerland .
- Literature on the subject of medicine in the catalog of the German National Library
Papers, specials, projects
- Specialized information center: German Central Library for Medicine, Cologne
- Medical Center for Quality in Medicine (ÄZQ)
- BioMedCentral (English) - Open Access Project
- Extensive link collection of the University Library Essen on medical topics ( Memento from February 15, 2008 in the Internet Archive )
Medical search engines
- PubMed : Database of the National Library of Medicine (USA, English) website
- Medpilot : Search engine of the German Central Library for Medicine - Homepage
- Deutsches Ärzteblatt - Homepage
- British Medical Journal - Homepage (English)
- The Lancet - Homepage (English)
- The New England Journal of Medicine - Homepage (English)
- Axel W. Bauer : Medicine, natural science (1850-1900). In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 938-942, here: p. 938.
- Friedrich Kluge : Etymological dictionary of the German language. De Gruyter, Berlin 1975, p. 470.
- Rudolf Laux: Ars medicinae. An early medieval compendium of medicine. In: Kyklos. Volume 3, 1930, pp. 417-434.
- Duden German universal dictionary . Verlag Bibliographisches Institut & FA Brockhaus AG, 5th edition, Mannheim 2003 online version
- Norbert Kohnen: Medicine Man. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 956 f .; here: p. 956.
- Doris Schwarzmann-Schafhauser: Indian Medicine, North American. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 665.
- Doris Schwarzmann-Schafhauser (2005), p. 665.
- Norbert Kohnen: Medicine Man. 2005, p. 956.
- Regional Atlas Germany Indicators of the subject area "Health and Social Services " , at www-genesis.destatis.de
- cf. Wirtschaftswoche, No. 49, 2014, city ranking, p. 28
- See also Robert Jütte : History of Alternative Medicine. From folk medicine to today's unconventional therapies. CH Beck Verlag, Munich 1996, ISBN 3-406-40495-2 , pp. 27–32 ( “Naturopathy” versus “scientific” medicine (1850–1880) ) and pp. 32–42 ( “Kurpfuscherei” versus “conventional medicine”) (1880-1932) )
- Joachim Müller-Jung: "Integrative Medicine" in FAZ October 11, 2011
- John Ioannidis : Why Most Published Research Findings Are False . In: PLoS Medicine . tape 2 , no. 8 , March 19, 2017, p. e124 , doi : 10.1371 / journal.pmed.0020124 , PMID 16060722 , PMC 1182327 (free full text).
- John Ioannidi's Why most clinical research is not useful. , PLoS medicine 13.6 (2016)
- Jutta Kollesch , Diethard Nickel : Ancient healing art. Selected texts from the medical writings of the Greeks and Romans. Philipp Reclam jun., Leipzig 1979 (= Reclams Universal Library. Volume 771); 6th edition ibid 1989, ISBN 3-379-00411-1 , p. 14.
- Max Pohlenz : Hippokrates and the foundation of scientific medicine. Berlin 1938.
- Gill Davies, The Illustrated Timeline of Medicine , 2011, p. 49