Medicine (Forensic Science)
Medicine is a social science that began with the earliest and even the smallest human social units. Tribes discovered ways to alleviate pain, stem blood flow, heal wounds, and cure common ailments through the judicious and often experimental use of local herbs. As tribal units grew in number, some members became specialized in these techniques and became the “healers” or “shamans” of their tribes. They were tasked with day-to-day healing and also with the transmission of medical information from one generation to the next.
The transition from tribal medicines to modern medical science is embedded in the growth of human civilization. The formal start of modern medicinal use is considered to have taken place in Mesopotamia, but ancient societies of tribes and other social units practiced the healing arts thousands of years prior to the civilizations of the ancient Near East. The formalization of medicine as a distinctive science undoubtedly dates first from the Egyptians and shortly thereafter from the Alexandrian Greeks, who acquired medical information from their conquest of India and Egypt and introduced it to civilizations of the Mediterranean.
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Early Egyptian and Indian Medicine (Forensic Science)
The Greeks learned much from the Egyptians, who, in turn, had learned from the civilizations of Mesopotamia. Ancient Egyptian physicians treated diseases in ways both physical and spiritual. They developed a basic understanding of anatomy and used this knowledge to perform surgeries more than forty-five centuries ago.
Ancient papyrus accounts reveal that Egyptians knew how the body worked and had a broad understanding of the heart, the pulse, blood, and breathing. These documents clearly show that the Egyptians knew about the spleen, heart, anus, and lungs and their functions. They also addressed female issues such as menstrual flow and birthing problems, and the records include a reference to the first known female physician, Peseshet, who lived and practiced in the Fourth Dynasty (c. 2613-c. 2494 b.c.e.). The first medical hospital, called “the Life,” was established in the Second Dynasty (c. 2775-c. 2687 b.c.e.), and by the Twelfth Dynasty (c. 1991-c. 1786 b.c.e.), Egyptian workers had pensions, medical insurance, and sick-leave benefits.
Physicians in the subcontinent of India in ancient times also demonstrated an understanding and knowledge of medicine and dentistry. A tradition called Ayurveda, now more than two thousand years old, encompassed religious beliefs important in healing as well as instruction in herbal practices that demonstrated the understanding of the concept of holistic...
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Ancient Greek, Roman, and Islamic Medicine (Forensic Science)
Hippocrates, considered the father of medicine, was born in Greece in about 460 b.c.e. He believed that observation and recording of patients’ symptoms were critical aspects of patient care. In the twenty-first century, Hippocrates is best remembered for his ultimate contribution to the growth of medicine, which is embodied in the Hippocratic oath.
The ancient Romans were a practical people, and their medicinal science emphasized public health and personal hygiene. Functional toilets, baths, water pumps, and a city sewage system improved health by making possible a constant supply of clean water. To prevent disease, the Romans embarked on a major program of draining marshes, which, they correctly believed, bred disease-carrying mosquitoes.
Among the major medical advancements made by ancient Islamic civilizations were contributions to the fields of anatomy, ophthalmology, pharmacology, pharmacy, physiology, and surgery. Islamic physicians set up universities and wrote many texts of their findings that were used in universities in the Middle East and Europe. The text De gradibus connected mathematics to medicine in its quantification of drug dosages. Many medical tools invented in ancient times by Islamic physicians are still in use in the twenty-first century; these include forceps, ligatures, surgical needles, the scalpel, the curette, the retractor, the surgical spoon, the...
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Medieval to Modern Medicine (Forensic Science)
Advances in medical science in Europe slowed during the Middle Ages, in part because of the Roman Catholic Church’s dominance over Europe. The Church pressed the idea that human illnesses were caused by sin and insisted that only repentance and redemption could alleviate pain and suffering. In the late Middle Ages, however, many universities were established, and students were encouraged to challenge traditional and folkloric beliefs. This enabled a resurgence of the medical field during the Renaissance that has continued to the present. A major part of this growth involved the discovery and application of techniques from the Muslim world and from India.
The transition of medicine into a modern science occurred over the course of the past two centuries with the recognition of disease causation as well as a revolution in thought concerning how patients are treated and how diseases can be prevented. Joseph Lister developed and used antiseptics during the late eighteenth century, and Louis Pasteur created a vaccine for rabies and developed the process now known as pasteurization, which made milk and wine safer to drink. Pasteur’s experiments demonstrated a causal link between microorganisms and diseases that led to the development of germ theory. Florence Nightingale introduced changes into medicine through her role as a nurse, focusing on alleviating patient suffering and mortality caused by lack of hygiene and...
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Medicine and Forensic Science (Forensic Science)
Forensic medicine, a branch of both health sciences and forensic sciences, is charged with determining and interpreting medical facts in legal cases. Forensic medicine is especially concerned with the areas of biology, pathology, and psychiatry that may be important in criminal and other court cases. It encompasses everything from the signing of birth and death certificates and negotiating insurance claims to performing autopsies and presenting expert medical testimony in courtroom trials. Because mainstream medicine, as taught in hospitals and medical schools, is such an established and accredited science, the testimony of forensic medical examiners is considered extremely credible evidence.
Forensic medicine also includes such common legal medicine procedures as paternity testing, determination of cause of death, psychological evaluation of suspects or witnesses, and DNA (deoxyribonucleic acid) analysis of crime scene materials and samples from suspects and victims. A forensic medical expert must know all about human anatomy and human capabilities related to body structure and abnormalities that might be caused by crimes or malpractice. Such knowledge plays a major role in crime scene reproduction, which may lead to indicative or exclusionary testimony.
Forensic pathology focuses on determination of the cause of death in legal cases; this area of specialty includes the study of the structural changes...
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Further Reading (Forensic Science)
Adelman, Howard C. Forensic Medicine. New York: Chelsea House, 2007. Brief work provides basic information on the applications of medicine in forensic science.
James, Stuart H., and Jon J. Nordby, eds. Forensic Science: An Introduction to Scientific and Investigative Techniques. 2d ed. Boca Raton, Fla.: CRC Press, 2005. General text devotes a section to the discussion of forensic pathology and related specialties, many of which involve medical training.
Payne-James, Jason, Anthony Busuttil, and William Smock, eds. Forensic Medicine: Clinical and Pathological Aspects. San Francisco: Greenwich Medical Media, 2003. Collection of essays by specialists in various disciplines is a useful reference source aimed at forensic pathologists and physicians as well as law-enforcement personnel.
Shepherd, Richard. Simpson’s Forensic Medicine. 12th ed. London: Arnold, 2003. Introductory textbook addresses the medical examination of both the living and the dead for purposes related to law enforcement and legal proceedings. Includes discussion of ethical issues.
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Medicine (Encyclopedia of Science and Religion)
Religion and medicine are twin traditions of healing. Although they have overlapped for most of their history, in the past three hundred years the two traditions have become separate and have often been in competition with one another. At the close of the twentieth century, serious consideration began to be given to reintegrating religion and medicine. In this discussion, a review of the historical connection between these two traditions will be offered. Research that has led to a possible rapprochement will be examined as will the implications for practicing clinicians.
There is a long historical tradition that connects religion and medicine. The first hospitals in western civilization for care of the sick in the general population, particularly for those unable to pay for their own care, were built by religious groups. In the fourth century, Basil, the Bishop of Caesarea established one of the earliest hospitals based upon the good Samaritan story in the Bible. This building was resurrected in present-day Turkey among almshouses and leper colonies. For the next thousand years, the church would build and staff most hospitals throughout the western world. Many early physicians, especially those in Europe during the Middle Ages and in the New England colonies of the United States during the seventeenth and eighteenth centuries, were also members of the clergy. In Europe, licenses to practice medicine were in fact controlled by the church and church-sponsored universities.
Similarly, the profession of nursing was to emerge out of the Christian church in the 1600s and 1700s with the Daughters of Charity of St. Vincent de Paul, an order of Catholic sisters devoted to the care of the sick. The Daughters of Charity also established the first nursing profession in the United States in Emmitsville, Maryland, in the early 1800s, modeled after nursing in France. Florence Nightingale (1788849), after receiving a "calling" from God, would later receive nurses training from the Daughters of Charity and the Protestant deaconesses (started up by Lutherans in Germany). After the Crimean War, Nightingale applied what she learned to a secular setting. Interestingly, though, up until the early 1900s, most hospitals in Europe and the United States continued to be staffed by nurses who were primarily from religious orders.
Beginning in the fifteenth century, the profession of medicine began to split away from the church, and the state took over the role of administering licenses to practice medicine. That separation would continue to widen until the early 1800s when it was nearly complete. For the last two hundred years, religion and medicine have been divided into separate healing disciplines, with very little overlap and very little communication between the two. However, since about the mid-1990s, especially in the United States, there has been active dialogue about bringing religion and medicine together once again. This movement has been highly controversial and has met with considerable resistance. A growing volume of research showing a connection between religion and health, however, has been breaking down the resistance.
Although the history reviewed above applies primarily to the Christian church, there has been similar interest in health and healing running through nearly all the major world religious traditions, including Judaism, Hinduism, Buddhism, Islam, and Chinese religions. Space does not allow for an adequate discussion of historical connections with medicine for each of these traditions, although resources that do so include Lawrence Sullivan's Healing and Restoring: Health and Medicine in the World's Religious Traditions (1989) and Caring and Curing: Health and Medicine in the Western Religious Traditions (1998) by Ronald Numbers and Darrel Amundsen.
Research on religion and health
The recent trend towards integration of religion and medicine has been stirred primarily by medical research demonstrating intimate and often complex relationships between religion and health. First, many patients indicate that religious beliefs and practices help them to cope with the stress of medical illness. In some areas of the United States, nearly ninety percent of hospitalized patients report that they use religious beliefs to at least a moderate degree to help them to cope. Nearly fifty percent of this group indicate that religion is the most important factor that enables them to cope with medical conditions and the stress they cause. Over one hundred studies have now documented the high prevalence of religious coping among persons with a variety of diseases ranging from diabetes, kidney disease, heart disease, cancer, arthritis, and cystic fibrosis, to more general conditions such as chronic pain.
There is also research demonstrating that persons who are religious end up coping better with physical health problems and disabling conditions. Of nearly one hundred studies conducted during the twentieth century on the relationship between religion and emotional well-being (happiness, life satisfaction, optimism, and hope), nearly eighty percent find that the religious person experiences significantly greater well-being. This is particularly true when populations of medically ill subjects have been studied. The religious are less likely to become depressed or anxious, and if they do develop these mental conditions, they recover more quickly. Suicide is less common among the more religious, as is marital dissatisfaction and divorce, and alcohol and drug use. Nearly 850 studies have now examined these associations, with between two-thirds and three-quarters of these finding that the religious person tends to be healthier and better able to cope with illness.
Of course, a number of studies also report that religion can be associated with worse mental health, more depression, and greater anxiety. This is particularly true for practitioners of religions that are repressive, controlling, and do not emphasize caring for self and others in a responsible way. Religion can be used to justify hatred, aggression, prejudice, and social exclusion. It may induce excessive guilt in situations where guilt is not healthy. Religion may also be used to replace professional psychiatric care for serious mental or emotional problems that require medication and biological therapies. In all of these ways, religion may do a disservice to mental health. In most cases, however, the emotional benefits of religious faith tend to outweigh the negative effects.
There is also a growing volume of research suggesting that religious belief and practices are related to healthier lifestyles, better overall physical health, and longer survival. Studies demonstrate stronger immune functioning among religious persons who are older, who are HIV positive or have AIDS, or have breast cancer. Death rates from coronary artery disease are lower among the more religious, even when health behaviors, diet, and social factors are taken into account. The same applies to mortality from all causes. Since 1990, over a dozen careful studies have demonstrated that the religious person lives longer than the person who is less religiously involved. In these studies, religion is measured by frequency of church attendance, private prayer and scripture study, meditation, and religious coping. Studies have not demonstrated that the broader aspect of religion called spirituality is associated with greater longevity. Spirituality is a broad concept, making it difficult to measure, whereas religious beliefs, practices, and commitment can be more easily assessed and quantified.
Why does religious belief and practice correlate with and predict greater physical health? The answer may lie in the mind-body relationship. There is growing evidence suggesting that emotions influence physiological processes. Psychological stress, anxiety, and depression have been related to impairments in immune functioning, delayed wound healing, and increased risk for cardiovascular morbidity. If religious beliefs and practices reduce emotional stress, counter anxiety, and prevent or facilitate recovery from depression, then religion may help to neutralize the health-impairing effects that these negative emotions have on physical health, and do so through known biological pathways. Mainstream scientists in the field of psychoneuroimmunology are beginning to explore these connections more seriously.
Since about 1980, people have become increasingly disillusioned with medical care that relies solely on high technology and focuses on the biology of disease, while neglecting the care of the whole person. That disillusionment has caused many patients to express a desire to have their spiritual and emotional needs met, as well as their physical needs. Between one-third and two-thirds of patients consistently indicate that they wish their physicians to address religious or spiritual needs in addition to medical needs, particularly when they experience serious medical problems or terminal illness.
Furthermore, there is research indicating that religious and spiritual beliefs impact medical decision making and may even affect compliance with medical treatment, making it essential for physicians to know about these beliefs. Some patients may use religion instead of traditional medical care to treat their illnesses. For example, they may decide to pray for their illnesses and stop taking their medications. There is also research showing that certain types of negative religious beliefs may adversely affect physical health and recovery from medical illness. Patients who feel punished or deserted by God, who question God's power and love, or who feel abandoned by their spiritual community, experience greater mortality and worse mental health outcomes.
Application to medical practice
The growing body of research on religion and health suggests at least the following four applications to medical practice in the West. First, in light of this research, some have argued that physicians should consider taking a spiritual history on patients with serious, terminal, or chronic medical illness. In the United States, only about one in ten physicians consistently addresses spiritual issues by taking a religious history, despite suggestions by a consensus panel of the American College of Physicians and American Society of Internal Medicine that such a history can be obtained by asking a few simple questions. Such questions include the following:
- Are religious beliefs a sense of comfort or a source of stress for the patient?
- Is the patient a member of a spiritual community and is this a source of support for the patient?
- Does the patient have any religious belief that may influence medical decisions or conflict with medical care?
- There any religious or spiritual needs present that need addressing?
Taking a spiritual history should be done in addition to (not instead of) competently and completely addressing the medical issues for which the patient seeks help from the physician. Thus, a spiritual history is most appropriate when there is more time in the schedule, such as during a new patient evaluation or during a hospital admission workup.
Second, if spiritual needs are identified when the spiritual history is taken, then the research suggests that addressing those needs should improve the health and coping capacity of the patient. This can be done in a couple of ways. The patient can be referred to a trained clergyperson or chaplain. Chaplains in the United States are required to undergo extensive training that prepares them to address such issues in the medical setting. Before a chaplain is certified in the Association of Professional Chaplains, he or she must complete four years of college, three years of divinity school, one to four years of clinical pastoral education, and must take written and oral examinations. Thus, chaplains are skilled professionals with much to offer in this area. Sometimes, however, patients do not wish to speak with a chaplain or clergyperson. In that case, if the patient already has a trusting relationship with the physician, then the physician may need to be prepared to address such issues, even if this involves only listening and showing respect and concern. Nearly two-thirds of the medical schools in the United States have elective or required courses on religion, spirituality, and medicine. In these courses, medical students are trained to take a spiritual history and to address spiritual issues in a sensitive and appropriate manner.
Third, in addition to taking a spiritual history and, if necessary, addressing spiritual issues, the physician may choose to support healthy religious beliefs or practices that the patient finds helpful in coping with illness. Physicians should not prescribe religion for patients who are not interested in religion. There may be benefits, however, in physicians learning about the religious beliefs and practices of their patients and supporting those beliefs that the patient finds helpful and that do not conflict with medical care. Even when religious beliefs conflict with medical care, the patient is likely to profit when the physician tries to understand those beliefs and keep open lines of communication about religious issues with the patient. By way of supporting religious practice, some physicians have decided to pray with their patients. This activity is highly controversial in the medical setting. Conditions for its appropriateness include that:
- A spiritual history has been taken and the physician knows about the religious background of the patient.
- Religion is important to the patient and is used in coping.
- The religious background of the patient and the physician are similar.
- Either the patient asks the physician to pray (i.e., patient initiates the prayer) or, if the physician initiates it, the physician is certain that the patient would appreciate this activity.
- The situation calls for prayer (i.e., a difficult, uncontrollable, or stressful situation, severe medical condition, or terminal illness).
Under such circumstances, it may be helpful for a physician and patient to engage in prayer together, enhancing the doctor-patient relationship by increasing trust.
Finally, the research suggests that new social arrangements for medical care may prove beneficial. For example, physicians might develop a communication network with local clergy, both to facilitate a referral base and to allow physicians to assess the community resources that are available to the patient. Religious communities often already provide volunteers to assist with homemaker services, rides to the doctor, respite for exhausted family members caring for the patient, and emotional support to the patient and the patient's family. Religious communities may also monitor the patient to ensure that the medical regimen is being followed and that medical problems are detected early and treatment is obtained promptly. Such a system works especially well when volunteers are appropriately trained and coordinated by a parish or congregational nurse registered nurse who is a member of and works professionally as a nurse within the congregation. A parish nurse can coordinate health programs within the congregation that involve screening for high blood pressure, diabetes, depression, and other diseases. A parish nurse can also provide spiritual care, communicate with physicians and nurses within the formal healthcare setting about the health condition of members of the congregation, train and mobilize volunteers within the religious community to meet the needs of sick members, and provide health education to keep healthy members well.
Religion and Western medicine are indeed coming closer and closer together. The research suggests that this is a positive trendood for the health of patients and for the maintenance of the health of the community. It is also arguably good for the profession of medicine in the West, which is truest to its most basic aims when its practices support the health of the patients in every dimension.
See also MIND-BODY THEORIES; PLACEBO EFFECT; SPIRITUALITY AND HEALTH; SPIRITUALITY AND FAITH HEALING
Carson, Verna Benner, and Koenig, Harold G. Parish Nursing: Stories of Service and Care. Radnor, Pa.: Templeton Foundation Press, 2002.
Koenig, Harold G. "Religion, Spirituality and Medicine: Application to Clinical Practice." Journal of the American Medical Association 284 (2000): 1708.
Koenig, Harold G; McCullough, Michael E.; and Larson, David B. Handbook of Religion and Health. New York: Oxford University Press, 2001.
Koenig, Harold G. Spirituality in Patient Care: Why, How, When, and What. Radnor, Pa.: Templeton Foundation Press, 2002.
Koenig, Harold G., and Cohen, Harvey J. The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor. New York: Oxford University Press, 2002.
Lo, Bernard; Quill, Timothy; and Tulsky, James. "Discussing Palliative Care with Patients." Annals of Internal Medicine 130 (1999): 74449.
Mueller, Paul S.; Plevak, David J.; and Rummans, Teresa A. "Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice." Mayo Clinic Proceedings 76 (2001): 1225235.
Numbers, Ronald L., and Amundsen, Darrel W., eds. Caring and Curing: Health and Medicine in the Western Religious Traditions. Baltimore, Md.: Johns Hopkins University Press, 1998.
Sloan, Richrd P.; Bagiella, Emilia.; and Powell, T. "Religion, Spirituality, and Medicine." The Lancet 353 (1999): 66467.
Sloan, Richard P.; Bagiella, Emilia; VandeCreek, Larry.; et al. "Should Physicians Prescribe Religious Activities?" New England Journal of Medicine 342 (2000): 1913916.
Sullivan, Lawrence E. Healing and Restoring: Health and Medicine in the World's Religious Traditions. New York: Macmillan, 1989.
HAROLD G. KOENIG
Medicine (Encyclopedia of Food & Culture)
MEDICINE. Food plays both a causative and curative role in health and disease. Thus, its role in medicine may be as a risk factor for, protector against, or treatment of an illness. While too much food or exposure to certain foods can reduce someone's health, too little food or inadequate amounts of certain foods can be equally damaging. In the years before modern transportation, packaging, and refrigeration, medicine was primarily concerned with food deficiencies and food spoilage. The focus of medicine was on the identification of critical components of food and common pathogens and on the prevention of nutritional deficiencies and foodborne infections. The role of food in medicine has changed as food production, preservation, and preparation techniques have progressed. Today far more people in developed countries such as the United States suffer from excessive food consumption than from food deficiencies. In addition, certain components of food have been found to have therapeutic or protective properties when administered in levels greater than generally considered necessary. For instance, large quantities of vitamin A are used to treat acne, therapeutic quantities of vitamin E may be protective against heart disease, and extra fiber appears to reduce the risk of colon cancer. However, the problems of malnutrition or inadequate food intake and foodborne illness have not been eliminated. Undernutrition continues to plague developing nations, while the prevention and treatment of foodborne illness is a concern for all nations.
The Basics of Food and Health
Food is fundamental to support life. People get energy, water, and all of the building blocks for growth and proper bodily functioning from the foods they eat and the liquids they drink. The components of food necessary to life are termed "nutrients" and the study of the role of food in health is called nutrition. The goal of medicine is to ensure health, and because adequate nutrition is necessary to accomplish this, nutrition is a crucial component of medicine. Nutritional science combines food science and medical science. Nutrients include protein, fat, carbohydrates, fiber, thirteen vitamins, seventeen minerals, and more substances that are still being identified. The majority of nutrients essential to health are found in a variety of different foods. No one food is absolutely essential to support life. People with access to adequate amounts of food get all of the nutrients they need by eating a varied diet complete with fruits, vegetables, meat or meat alternatives, dairy foods, and grains. However, some people are not able to or do not choose to eat the full variety of foods available. These people may require special foods or supplements to meet their nutritional needs.
The Study of Food in Medicine
All branches of medicine, from pediatrics to geriatrics and from internal medicine to surgery, study food and its role in health and disease. Nutritional scientists in government, industry, and academia are constantly seeking to understand the role food plays in illness and well-being. Meanwhile health-care practitioners treat patients with nutritional plans and food supplements. Registered dietitians are health-care specialists who integrate food into medical treatmenthis is referred to as medical nutrition therapy.
The Role of Food in Maintaining Health
Although the presence of adequate nutrition does not ensure health, it is a significant contributor. The energy contributed by the protein, carbohydrates, and fat in food provides the fuel for every element of body functioning from breathing to thinking to fighting disease to running marathons. Adequate energy intake is crucial to promote proper growth and development as well as to maintain healthy functioning once one is fully grown. Food also provides the materials necessary to build healthy bone, muscle, skin, hair, etc. For example, bone is a complex matrix of calcium, phosphorus, and collagen fibers. A person's bone strength is directly related to their nutrient intake such that inadequate calcium intake is one of the primary reasons for bone disease such as osteoporosis. Nutrients are also necessary to support proper chemical and neurological functioning. For example, fat insulates nerve fibers such that they can conduct electrical signals along the length of the body. Meanwhile, those electrical signals are generated via channeling ions such as sodium, potassium, and calcium into and out of the nerve cells. Finally, the neurotransmitters released from the nerve cells are made from amino acids contributed largely from proteins in the diet. Thus, thinking and feeling are intricately connected to food.
Food for Those Who Can't Feed Themselves
Food is generally eaten, or drunk, and swallowed. However, many people cannot obtain adequate nutritional levels by conventional ways of ingesting food. In the past, these people would suffer and die from malnutrition. Modern nutritional medicine offers people several alternatives to conventional chewing and swallowing of food so that those who cannot do so will not die. Liquid solutions have been manufactured by pharmaceutical companies that are easier to digest than solid food and provide 100 percent of nutritional needs. People who can drink but not eat rely on these formulas just as babies who cannot breast feed rely on baby formula to meet their nutritional needs. People who cannot consume anything orally are fed via a tube inserted into the stomach or intestines. Finally, those whose gastrointestinal tracts cannot absorb even liquids are fed intravenously with solutions that provide 100 percent of human nutritional needs.
Examples of Food as a Cause of Disease
Food allergies and intolerances are common medical reasons for eliminating specific foods from one's diet. An allergy is an immune response to proteins in food that the body identifies as foreign. The most common food allergies include those to peanuts, tree nuts, shellfish, milk, soy, corn, wheat, and eggs. Most allergies appear in childhood and require complete elimination of the offending food if the symptoms are to be eradicated. Childhood food allergies may persist for a lifetime or may resolve a few years after getting rid of the offending food. Symptoms of allergies may include rashes and other skin irritations, gastrointestinal inflammation and bleeding, and respiratory distress, which may even involve arrest of breathing.
Food intolerances are not allergies but rather uncomfortable reactions to food that are not generally considered life threatening. One well-known example is lactose intolerance. Lactose is the carbohydrate in milk and other dairy products. The body requires a specific enzyme if lactose is to be absorbed. As people age their bodies may make less of the enzyme necessary to break down lactose and as a result they may experience gastrointestinal distress, including such symptoms as gas or diarrhea, when they consume milk products containing lactose. Most people with lactose intolerance can tolerate dairy products if they accompany their meal with a lactase enzyme pill or if they consume dairy products pretreated with lactase enzyme. Thus, food technology allows people with intolerances to tolerate the offending foods but avoidance is the only option for people with food allergies.
In countries such as the United States where food is abundant, some of the greatest medical risks result from overeating rather than insufficient eating. For example, an excess intake of energy in the form of food leads to an increased risk of obesity. Obesity increases one's risk of cardiovascular disease, cancer, diabetes, and obstructive pulmonary diseasemong the most common and most deadly diseases today. Medical practitioners have tried to determine how much food is adequate to support healthy living. People who consume too much food and become obese may seek medical treatment to lose weight and treat diseases resulting from obesity. Treatments may include nutritional therapy, exercise programs, drug therapy, or surgery. Foodborne illness results from eating contaminated food. Foodborne illness can be caused by parasites, bacteria, viruses, toxins, or other pathogens that are harmful to humans. Food is not the direct cause but rather the carrier of the problematic agent. The effects of foodborne illness can range from flulike symptoms to death depending on the type of pathogen and the amount of exposure. Foodborne illnesses are generally prevented by appropriate growing, harvesting, packaging, preparation, cooking, and storage of food. However, many countries lack the technology and resources necessary to accomplish this. Thus, assuring food safety continues to be an area of international concern.
Food as a Treatment
Food is not only necessary to sustain health but it can also help ill people regain health. Although the common advice to "feed a fever" may sound like folklore it is actually based in scientific evidence. A rise in body temperature is required in order to fight disease. People with a fever also require extra energy if they are to have adequate energy to maintain their strength while they battle illness. Likewise, the immune system uses a wide range of nutrients to combat intruders. All infectious diseases result in increased need for nutrition to strengthen the immune system as if fights against invading viruses or bacteria. People who suffer from diseases such as cancer, cystic fibrosis, and acquired immunodeficiency syndrome (AIDS) generally require extraordinarily large amounts of nutrients to battle their disease. Likewise, young children who are ill require extra food to ensure that they have adequate nutrition to ensure normal growth and development. Food is crucial in combating both minor and major illnesses.
Many specific nutrients defend against disease. Calcium, a mineral found mainly in dairy products, is critical in the promotion of bone health and protection against osteoporosis. Fluoride, now added as a supplement to most water supplies, is crucial to tooth development. Iron is most commonly found in meats and protects against anemia. Folic acid prevents neural tube defects such as spina bifida in developing fetuses and has recently been found to protect against cardiovascular disease. In fact, almost every vitamin and mineral is known to be critical to one or more life processes. Nutritional specialists and medical practitioners are constantly studying the role each nutrient plays in protecting the body and investigating further possible cures.
See also Dietetics; Digestion; Disease: Metabolic Diseases; Enteral and Parenteral Nutrition; Health and Disease; Hunger, Physiology of; Immune System Regulation and Nutrients; Intestinal Flora; Microbiology; Nutrient-Drug Interactions; Nutrients; Nutrition; Nutritionists; Safety, Food.
Duyff, Roberta Larson. The American Dietetic Association's Complete Food and Nutrition Guide. New York: Wiley, 1998.
Mahan, Kathleen L., and Marian Arlin, eds. Krause's Food, Nutrition and Diet Therapy. 10th ed. Philadelphia: W.B. Saunders; Harcourt Brace Jovanovich, 2000.
Margen, Sheldon, and the editors of the University of California at Berkeley Wellness Letter. The Wellness Encyclopedia of Food and Nutrition: How to Buy, Store, and Prepare Every Variety of Fresh Food. New York: Health Letter Associates, 1992.
Nelson, Jennifer K., Karen E. Moxness, Michael D. Jensen, and Clifford F. Gastineau. Mayo Clinic Diet Manual: A Handbook of Nutrition Practice,. 7th ed. St. Louis: Mosby, 1994.
Pennington, Jean A.T., Anna De Planter Bowes, and Helen N. Church. Church's Food Values of Portions Commonly Used. 17th ed. Philadelphia: Lippincott, Williams & Wilkins, 1998.
Zeman, Frances J., and Denise Ney. Applications in Medical Nutrition Therapy. 2nd ed. Englewood Cliffs, N.J.: Prentice Hall, 1995.
Jessica Rae Donze
Medicine (World of Forensic Science)
Medicine is one of the branches of the health sciences. It deals with restoring and maintaining health, but is also used in determining the causes of death. It is a practical science that applies knowledge from biology, chemistry, and physics to treat diseases. Biological knowledge is derived from anatomy, biochemistry, physiology, histology, epidemiology, microbiology, genetics, toxicology, pathology, and many other disciplines. Biology forms the basis for understanding how the human body works and interacts with its environment. An understanding of chemistry is required to determine the interactions between different drugs, to detect chemicals in the body, and design drugs for treatment. Physics has an impact on understanding how the body works and on understanding how the various instruments and equipment are used in diagnosis and treatment. The need to understand interactions between all of these areas makes medicine one of the most complex scientific disciplines.
In its early days medicine was not based on science. Many aspects of it were considered forms of magic, encompassing everything from disease causes to treatments. This was because the disease process was not understood. There was no knowledge of infectious agents (such as bacteria and viruses). Therefore, unless the cause of a disease was obvious and visible, sickness was considered a punishment from gods or an interference of an evil spirit. As a result, some treatments were logical, while others were irrational and often involved magic incantations and spells.
The practice of medicine goes back to at least 3000 B.C., when the first written medical records appeared in Mesopotamia. Babylonian medical texts provided the first anatomical descriptions and an early code of conduct for doctors. Their understanding of diseases was very basic; they recognized trauma and food poisoning, but a lot of the illnesses were still a mystery. Despite advances in anatomy and surgery, ancient Egyptians, as the Babylonians before them, still believed in supernatural causes for many illnesses.
The scientific basis of medicine was laid down by Hippocrates, who rejected magical causes of diseases. He believed in medical examination and keeping detailed records of a disease history. His influence on medicine is present even today, in form of the "Hippocratic Oath," which all new doctors have to take. It sets out ethical guidelines for doctors.
The importance of clinical examination of the patient was made even more important by Claudius Galen, another Greek physician. He worked extensively on anatomy and experimented with live animals.
Great advances in all areas of medicine, especially in epidemiology and hygiene, took place in the middle ages. Avicenna, a Persian physician, was the first to recognize the contagious nature of tuberculosis. In his many works, he gave important advice to surgeons, especially on cancer treatment and advanced use of oral anesthetics (painkillers). Another great advancement of the times was the use of silk thread for stitching wounds, developed by Abul Qasim al-Zahrawi.
A number of scientific discoveries, starting from the late 1800s with the work of E. Jenner, L. Pasteur, R. Koch, A. Flemming and others, established that microbes are the cause of infectious disease; these diseases can be prevented by vaccinations; and there are drugs that can kill the infectious agents (microbes). These findings shaped modern western medicine.
Furthermore, discoveries in physics, such as x rays, ultrasounds, magnetic resonance, and lasers, led to the development of equipment that allows quicker and better diagnosis, as well as easier and safer surgical procedures.
As a result of these scientific and technological changes, the knowledge that medical students have to acquire is immense. Therefore, all doctors learn the same basics but later they have to specialize in narrower areas in order to be highly skilled and able to effectively treat all of the diseases of a particular organ or tissue.
There are doctors specializing in various areas of medicine, such as emergency medicine, intensive care medicine, internal medicine, pediatrics, surgery, neurology, obstetrics, and others. While obstetrics is a relatively narrow area, dealing with childbirth and female health, surgery or internal medicine is further subdivided into sub specializations. Some of those subspecialties are hematology (blood and its diseases), cardiology (heart and cardiovascular system), oncology (cancer), ophthalmology (eyes), orthopedic surgery (mostly skeletal system), or neurosurgery (brain). On the other hand, pediatrics deals with childhood diseases and most of the specialties and subspecialties have their pediatric equivalent. Some doctors specialize in narrow medical fields, while others specialize in areas requiring wide medical knowledge such as sport, aerospace, or forensic medicine.
The most important doctor for the majority of the population is the family doctor (or general practitioner, GP). It is the GP who makes the first examination and keeps a record of the medical history of the patient. He or she also makes an assessment if more tests are required before a diagnosis can be made or if a referral to a specialist is required.
The process of determining the cause of a disease and prescribing treatment is quite complex. It consists of clinical examination, diagnosis, and treatment.
Clinical examination can consist of a number of different aspects, including visual, pathological, toxicological, and genetic analysis. Visual examination addresses the general symptoms: a patient's appearance, heart rate etc. Pathological analysis is often required to identify any non-obvious cause of disease. The tests can include blood or urine analysis, electrocardiogram (ECG), ultrasound, computed tomography (CT) scan, biopsy, histology of removed tissues, or bacteriological analysis of body fluids. Most people have blood and urine tests during their lives. Toxicological analysis is usually carried out on blood, but can be done on tissue samples (bones or hair) and can detect alcohol, certain drugs, toxic metals, and other compounds (for example dioxins). Genetic testing is not usually required for the majority of patients, but in cases of inherited diseases, or genetic predisposition, they can be carried out. Often it is not just the adults that undergo this procedure. Amniotic fluid surrounding the embryo can be tested to determine if a child will develop a life-threatening disease.
Diagnosis is based on the combination of all of the examinations that have been performed and the accumulated knowledge of the doctor. Depending on the illness, it can be quick and simple or time consuming and difficult.
Treatment is the ultimate result of a visit to the doctor. It can include prescription of drugs, surgery,
Not all doctors treat patients. Pathologists study disease processes. They analyze clinical tests and base their diagnosis on the results. They can work with isolated tissues and samples, or, in the case of forensic pathologists, the deceased. Pathological analysis is very important in the diagnosis of an illness in the case of regular pathology and in determining a cause of death in forensic pathology. Forensic pathology is a part of a forensic medicine, a branch of medicine answering questions important to the law.
Forensic medicine is important in determining the cause of death, time of death, and identification of the remains. This allows doctors to determine the cause of death as accident, suicide, or murder. A forensic pathologist describes the state of the body (decomposition if any), and subsequently examines the body for a cause of death, but also notes any abnormalities found on the surface or in the tissues. The surface of the body is initially checked for the presence of trauma injuries (bruises, broken bones), cuts or stab wounds, thermal injuries (burns), firearm injuries (gunshot wounds), or defensive wounds. An internal examination of the body is carried out on organs or isolated tissues (histology). It might reveal presence of water in lungs (drowning), or asphyxia (lack of oxygen).
The analysis of a corpse is often carried out in the same way as for normal patients using x rays, toxicology, and genetics. Forensic medicine requires great attention to detail and a wide medical knowledge, especially in the areas of anatomy and physiology.
Modern western medicine is not the only existing medical system. There is also traditional medicine and complementary or alternative medicine. Traditional medicine includes folk and indigenous practices. The best known and most widely accepted areas are Chinese medicine and western herbal medicine. Complementary medicine uses non-invasive and non-pharmaceutical methods. Examples of alternative treatments include yoga, chiropractic or osteopathic manipulation, or various massage methods, as well as many others.
The first written evidence of Chinese medicine comes from 1766 B.C. The philosophy of medicine and methods used by Chinese doctors differed widely from those of the ancient Mediterranean and current modern medicine. The Chinese have based their medicine on a philosophy of yin and yang, and on The Five Elements (metal, wood, water, fire, and earth). A healthy person would have a harmonious mix of these elements. Among the practices developed in Chinese medicine are acupuncture, moxibustion (a technique that involves the use of heat, through burning specific herbs, to facilitate healing), and traditional herbal medicines. A physical examination with a doctor can include detailed interview, pulse taking, breath analysis, and tongue inspection. Some of the traditional Chinese treatments are quite widely accepted by modern western medicine, for example acupuncture.
A new approach to practicing medicine is the development of integrative medicine. It combines the modern western practices with alternative treatments. It only accepts methods for which there is scientific evidence for safety and effectiveness. Acupuncture, herbal treatment, music, and massage therapy are just some of the accepted treatments. The aim of this approach is not to just treat the illness, but to provide support to patients and induce their general well-being.
SEE ALSO Autopsy; Epidemiology; Pathology.