As a science, medicine rests on and makes use of the same methods and principles as the physical sciences. One of these principles is that the observer is a person, and the object he observes is not. Chemists and physicists observe, for example, the characteristics of various elements and classify them as helium, lithium, uranium, and so forth. The classification serves the interests of the classifiers. The objects classified have no interests.
To understand the many conceptual, economic, and political problems that beset contemporary medical practice, that is, medicine as health care, we must distinguish between scientific medicine, whose objects of study are diseases that affect human beings, and clinical medicine, whose objects of study are persons, usually called "patients." Making this distinction does not imply that one is intellectually, morally, or practically better or more important than the other. Each enterprise has its own agenda and vocabulary.
· The aim of scientific medicine, an enterprise barely 150 years old, is to increase our understanding of the causes and cures of conditions scientifically defined as diseases. The aim of clinical medicine, which may be said to be as old as civilization, is to help persons regarded as sick recover their health.
· The practitioner of medical science seeks to understand disease. The practitioner of clinical medicine seeks to relieve dis-ease.
· Scientific medical knowledge is indifferent to individual or collective human well-being; it may be equally useful for biological warfare and the relief of human suffering. In contrast, the raison d'être of clinical medicine is the welfare of the patient.
... In the ancient world, disease was a gnostic concept, concerned with "spiritual truth," not with empirical evidence. In Biblical, Greek, and Roman accounts, disease is a holistic-theistic concept that precludes distinguishing between literal and metaphorical illnesses, between diseases of the body and diseases of the mind. There is no Latin word for our scientific concept of disease. When the Romans spoke of disease, they used the word "morbus"the root of the English words "morbid" and "morbidity"which also means disaster, fault, and vice; or the word "malum"the root of such English words as "malefactor" and "malevolent"which also means evil, harm, hardship, and punishment. The King James Version of the Scriptures uses the terms "murrain," "plague," and "pestilence," instead of the term "disease." The Revised Standard Version uses "plague" throughout. Accordingly, the act of healing entailed intermingling natural and supernatural means of influence, medical and religious methods of treating the body and the mind.
... Deluged by incessant advertising and propaganda about medical treatments, people forget that Christianity is not only a faith of redemption but also a faith of healing, of both body and soul. Unlike Abraham, Jesus is not only a prophet, he is also a healer, the Divine Physician, the Savior (der Heiland in German). For centuries, Christians regarded sickness as punishment for sin, curable by means of prayer, repentance, sacrifice, and the aspersion of holy water by a priest, the representative of an all-forgiving deity.
To be plague-stricken was to be smitten by God. This put people in a bind: They believed in the theological explanation of the "plague," at least in part, because they could not get at the natural, physical cause of it, and then they refrained from trying to get at the root of the evil because they thought the evil was brought on by the hand of God. Furthermore, everyday life was replete with proof of the efficacy of miraculous cures for illnesses of all kinds. Shrines with powers of healing dotted the Christian landscape. More than 5 million pilgrims a year still visit Lourdes, and, to this day, the Vatican's official procedure for sanctification depends on medical proof of the would-be saint's having performed at least two miraculous cures.
... In short, prior to the nineteenth century, neither physicians nor patients had a precise idea about what was and what was not a disease. Disease was simply a discomfort and a danger, often leading to death, to be avoided and relieved as best one could. ... As the taboo against treating the body slowly lifted, there arose a diverse corps of professional healers: barber surgeons performing operations; herbalists prescribing medicines derived from plants; and doctors of medicine relying mainly on purging the body of presumed toxic substances believed to be the causes of disease.
... The waning influence of religion and the waxing prestige of science were slow and gradual processes. In the sixteenth century, the Church began to authorize the dissection of executed felons. Although physicians participated in this enterprise, the true fathers of anatomy were the great Renaissance artists, especially Michelangelo and Leonardo da Vinci.
... Once the secrets of nature are revealed, they cannot be ignored. Physicians and lay persons alike began to view the body as a machine whose workings must be understood, rather than merely manipulated in the tradition of herbal empiricists. The stage was now set for the development of the scientific diagnosis of patients, both dead and alive. The diagnosis of live patients is a surprisingly recent development. The first diagnostic method, thoracic percussion, was discovered in 1756 by Leopold Auenbrugger (1722-1809), the son of an innkeeper in Graz, Austria. As a youngster, Auenbrugger learned to tap caskets of wine to determine the quantity of liquid in the container and applied the technique to the human chest. This simple but ingenious method led the famed French physician, René-Théophile-Hyacinthe Laennec (1781-1826) to hit on the idea of thoracic auscultation and, in 1816, to the invention of the stethoscope. Although standard thermometric values were developed in the seventeenth century, the systematic measurement of body temperature was introduced into medicine only in 1851. The development of an ever-growing array of diagnostic instruments and techniques followed quickly. Today, the practicing physician can diagnose many diseases in the living patient as objectively and almost as effectively as the pathologist can diagnose them at autopsy. The long-standing gap between antemortem (clinical) diagnosis and postmortem (autopsy) diagnosis has narrowed but has not disappeared. Despite modern diagnostic techniques, the postmortem examination of the cadaver remains an indispensable tool for scientific medicine and forensic pathology.
... Although the development of the modern, scientific concept of disease was a gradual process, the publication, in 1858, of Cellular Pathology as Based upon Physiological and Pathological History, by Rudolf Virchow (1821-1902), is generally accepted as signaling the birth of modern medicine as a profession based on empirical science. The study of pathology as the phenomenology of disease, combined with the study of bacteriology as the etiology of infectious disease, placed medicine as the study of bodily disease on the rock-solid foundation of modern science.
Thomas Szasz, Pharmacracy: Medicine and Politics in America (2001: xxiii-6)