ABSTRACT
Mckeown (1971a: 6–7) has identified six aspects of the traditional medical task: the diagnosis or identification of disease, the pathology or understanding of disease, the prevention of disease, the cure of disease, the estimation of the prognosis or anticipation of the probable results of disease, and the palliation or alleviation of the effects of disease. Considering these aspects historically he points out that although several diseases were recognized more or less precisely at an earlier date, the reliable identification of disease really began in the nineteenth century. Second, in spite of earlier advances in related sciences such as anatomy and physiology, an accurate understanding of disease processes was also delayed until the nineteenth century. This later understanding, of course, owed much to the recognition of the bacteriological origins of infections. Third, although some reforms were anticipated earlier, effective preventive measures did not begin until the control of the environment and its effects promoted by individuals such as Edwin Chadwick and Sir John Simon in the middle of the nineteenth century. Such measures were not related to prevention vis-ci-vis the individual and, with the single exception of vaccination against smallpox, this latter type of effort was not possible until after 1900. Effective treatment and cure was also delayed until the twentieth century. Indeed, although some useful drugs were introduced much earlier (for example, mercury, iron, quinine, and digitalis) the circumstances and manner of their use, and the limited grasp of their mode of action suggest that they must have been relatively ineffective. On the surgical side, before the discovery of anaesthesia, operations were mainly for cataracts, amputations, incisions for abscesses, lithotomy, and trephining of the skull. Even after the introduction of anaesthesia results were poor until aseptic techniques became widely used. With regard to prognosis Mckeown suggests that predictions even today remain largely a matter of clinical impression usually not submitted to scrutiny. The systematic calculation of prognosis, based on medical evidence, is still a science in its infancy. Finally, if relief of both physical and mental suffering are included under palliation, Mckeown argues that this is certainly the oldest and was, at least until the development of other aspects, the most important medical task.
