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Thursday, April 26, 2007
Blood
For other uses, see Blood (disambiguation).Blood is a highly specialized circulating tissue consisting of several types of cells suspended in a fluid medium known as plasma. The cellular constituents are: red blood cells (erythrocytes), which carry respiratory gases and give it its red color because they contain hemoglobin (an iron-containing protein that binds oxygen in the lungs and transports it to tissues in the body), white blood cells (leukocytes), which fight disease, and platelets (thrombocytes), cell fragments which play an important part in the clotting of the blood.
Medical terms related to blood often begin with hemo- or hemato- (BE: haemo- and haemato-) from the Greek word "haima" for "blood." Anatomically, blood is considered a connective tissue from both it
Medical terms related to blood often begin with hemo- or hemato- (BE: haemo- and haemato-) from the Greek word "haima" for "blood." Anatomically, blood is considered a connective tissue from both it
Functions
Supply of oxygen to tissues (bound to hemoglobin which is carried in red cells) Supply of nutrients such as glucose, amino acids and fatty acids (dissolved in the blood or bound to plasma proteins) Removal of waste such as carbon dioxide, urea and lactic acid Immunological functions, including circulation of white cells, and detection of foreign material by antibodies Coagulation, which is one part of the body's self-repair mechanism Messenger functions, including the transport of hormones and the signalling of tissue damage Regulation of body pH Regulation of core body temperature Hydraulic functions Problems with blood composition or circulation can lead to downstream tissue dysfunction. The term ischaemia refers to tissue which is inadequately perfused with blood.
The blood is circulated around the lungs and body by the pumping action of the heart. Additional return pressure may be generated by gravity and the actions of skeletal muscles. In mammals, blood is in equilibrium with lymph, which is continuously formed from blood (by capillary ultrafiltration) and returned to the blood (via the thoracic duct). The lymphatic circulation may be thought of as the "second circulation".
The blood is circulated around the lungs and body by the pumping action of the heart. Additional return pressure may be generated by gravity and the actions of skeletal muscles. In mammals, blood is in equilibrium with lymph, which is continuously formed from blood (by capillary ultrafiltration) and returned to the blood (via the thoracic duct). The lymphatic circulation may be thought of as the "second circulation".
Anatomy of mammalian blood
Blood is composed of several kinds of cells (occasionally called corpuscles); these formed elements of the blood constitute about 45% of whole blood by volume, mostly red blood cells. The other 55% is blood plasma, a fluid that is the blood's liquid medium, appearing yellow in color. The proportion of blood occupied by red blood cells is referred to as the hematocrit
The normal pH of human arterial blood is approximately 7.40 (normal range is 7.35-7.45), a weak alkaline solution. Blood that has a pH below 7.35 is considered overly acidic, while blood pH above 7.45 is too alkaline. Blood pH along with arterial carbon dioxide tension (PaCO2) and HCO3 readings are helpful in determining the acid-base balance of the body. The respiratory system and urinary system normally control the acid-base balance of blood as part of homeostasis. Blood is about 7% of the human body weight,[1] so the average adult has a blood volume of about 5 litres, of which 2.7-3 litres is plasma. Human blood density is around 1060 kg/m³.[2] The combined surface area of all the red cells in the human body would be roughly 2,000 times as great as the body's exterior surface.[citation needed]
The cells are:
The cells are:
Red blood cells or erythrocytes (96%)
In mammals, mature red blood cells lack a nucleus and organelles. They contain the blood's haemoglobin and distribute oxygen. The red blood cells (together with endothelial vessel cells and some other cells) are also marked by glycoproteins that define the different blood types.
White blood cells or leukocytes (3.0%)
White blood cells are part of the immune system; they destroy and remove old or aberrant cells and cellular debris, as well as attack infectious agents (pathogens) and foreign substances.
Platelets or thrombocytes (1.0%)
Platelets are responsible for blood clotting (coagulation). They change fibrinogen into fibrin. This fibrin creates a mesh onto which red blood cells collect and clot. This clot stops more blood from leaving the body and also helps to prevent bacteria from entering the body.
Blood plasma is essentially an aqueous solution containing 92% water, 8% blood plasma proteins, and trace amounts of other materials. Some components are:
Serum albumin
Blood clotting factors (to facilitate coagulation)
Immunoglobulins (antibodies)
Hormones
Carbon dioxide
Various other proteins
Various electrolytes (mainly sodium and chloride)
Together, plasma and cells form a non-Newtonian fluid whose flow properties are uniquely adapted to the architecture of the blood vessels.
The term serum refers to plasma from which the clotting proteins have been removed. Most of the protein remaining is albumin and immunoglobulins.
In mammals, mature red blood cells lack a nucleus and organelles. They contain the blood's haemoglobin and distribute oxygen. The red blood cells (together with endothelial vessel cells and some other cells) are also marked by glycoproteins that define the different blood types.
White blood cells or leukocytes (3.0%)
White blood cells are part of the immune system; they destroy and remove old or aberrant cells and cellular debris, as well as attack infectious agents (pathogens) and foreign substances.
Platelets or thrombocytes (1.0%)
Platelets are responsible for blood clotting (coagulation). They change fibrinogen into fibrin. This fibrin creates a mesh onto which red blood cells collect and clot. This clot stops more blood from leaving the body and also helps to prevent bacteria from entering the body.
Blood plasma is essentially an aqueous solution containing 92% water, 8% blood plasma proteins, and trace amounts of other materials. Some components are:
Serum albumin
Blood clotting factors (to facilitate coagulation)
Immunoglobulins (antibodies)
Hormones
Carbon dioxide
Various other proteins
Various electrolytes (mainly sodium and chloride)
Together, plasma and cells form a non-Newtonian fluid whose flow properties are uniquely adapted to the architecture of the blood vessels.
The term serum refers to plasma from which the clotting proteins have been removed. Most of the protein remaining is albumin and immunoglobulins.
Physiology of blood
Production and degradation
Blood cells are produced in the bone marrow; this process is termed hematopoiesis. The proteinaceous component (including clotting proteins) is produced overwhelmingly in the liver, while hormones are produced by the endocrine glands and the watery fraction is regulated by the hypothalamus and maintained by the kidney and indirectly by the gut.
Blood cells are degraded by the spleen and the Kupffer cells in the liver. The liver also clears some proteins, lipids and amino acids. The kidney actively secretes waste products into the urine. Erythrocytes usually live up to 120 days before they are systematically replaced by new erythrocytes created by the process of hematopoiesis.
Transport of oxygen
Further information: Oxygen transportation
Blood oxygenation is measured in several ways, but the most important measure is the hemoglobin (Hb) saturation percentage. This is a non-linear (sigmoidal) function of the partial pressure of oxygen. About 98.5% of the oxygen in a sample of arterial blood in a healthy human breathing air at normal pressure is chemically combined with the Hb. Only 1.5% is physically dissolved in the other blood liquids and not connected to Hb. The hemoglobin molecule is the primary transporter of oxygen in mammals and many other species (for exceptions, see below).
With the exception of pulmonary and umbilical arteries and their corresponding veins, arteries carry oxygenated blood away from the heart and deliver it to the body via arterioles and capillaries, where the oxygen is consumed; afterwards, venules and veins carry deoxygenated blood back to the heart.
Differences in infrared absorption between oxygenated and deoxygenated blood form the basis for realtime oxygen saturation measurement in hospitals and ambulances.
Under normal conditions in humans at rest, hemoglobin in blood leaving the lungs is about 98-99% saturated with oxygen. In a healthy adult at rest, deoxygenated blood returning to the lungs is still approximately 75% saturated.[3][4] Increased oxygen consumption during sustained exercise reduces the oxygen saturation of venous blood, which can reach less than 15% in a trained athlete; although breathing rate and blood flow increase to compensate, oxygen saturation in arterial blood can drop to 95% or less under these conditions.[5] Oxygen saturation this low is considered dangerous in an individual at rest (for instance, during surgery under anesthesia): "As a general rule, any condition which leads to a sustained mixed venous saturation of less than 50% will be poorly tolerated and a mixed venous saturation of less than 30% should be viewed as a medical emergency."[6]
A fetus, receiving oxygen via the placenta, is exposed to much lower oxygen pressures (about 20% of the level found in an adult's lungs) and so fetuses produce another form of hemoglobin with a much higher affinity for oxygen (hemoglobin F) in order to extract as much oxygen as possible from this sparse supply.[7]
Substances other than oxygen can bind to the hemoglobin; in some cases this can cause irreversible damage to the body. Carbon monoxide for example is extremely dangerous when absorbed into the blood. When combined with the hemoglobin, it irreversibly makes carboxyhemoglobin which reduces the volume of oxygen that can be carried in the blood. This can very quickly cause suffocation, as oxygen is vital to many organisms (including humans). This damage can occur when smoking a cigarette (or similar item) or in event of a fire. Thus carbon monoxide is considered far more dangerous than the actual fire itself because it reduces the oxygen carrying content of the blood.
Insects
In insects, the blood (more properly called hemolymph) is not involved in the transport of oxygen. (Openings called tracheae allow oxygen from the air to diffuse directly to the tissues). Insect blood moves nutrients to the tissues and removes waste products in an open system.
Small invertebrates
In some small invertebrates like insects, oxygen is simply dissolved in the plasma. Larger animals use respiratory proteins to increase the oxygen carrying capacity. Hemoglobin is the most common respiratory protein found in nature. Hemocyanin (blue) contains copper and is found in crustaceans and mollusks. It is thought that tunicates (sea squirts) might use vanabins (proteins containing vanadium) for respiratory pigment (bright green, blue, or orange).
In many invertebrates, these oxygen-carrying proteins are freely soluble in the blood; in vertebrates they are contained in specialized red blood cells, allowing for a higher concentration of respiratory pigments without increasing viscosity or damaging blood filtering organs like the kidneys.
Deep sea invertebrates
Giant tube worms have extraordinary hemoglobins that allow them to live in extraordinary environments. These hemoglobins also carry sulfides normally fatal in other animals.
Transport of carbon dioxide
When systemic arterial blood flows through capillaries, carbon dioxide diffuses from the tissues into the blood. Some carbon dioxide is dissolved in the blood. Some carbon dioxide reacts with hemoglobin and other proteins to form carbamino compounds. The remaining carbon dioxide is converted to bicarbonate and hydrogen ions through the action of RBC carbonic anhydrase. Most carbon dioxide is transported through the blood in the form of bicarbonate ions.
Transport of hydrogen ions
Some oxyhemoglobin loses oxygen and becomes deoxyhemoglobin. Deoxyhemoglobin has a much greater affinity for hydrogen ion (H+) than does oxyhemoglobin so it binds most of the hydrogen ions.
Thermoregulation
Blood circulation transports heat through the body, and adjustments to this flow are an important part of thermoregulation. Increasing blood flow to the surface (e.g. during warm weather or strenuous exercise) causes warmer skin, resulting in faster heat loss, while decreasing surface blood flow conserves heat.
Hydraulic functions
The restriction of blood flow can also be used in specialized tissues to cause engorgement resulting in an erection of that tissue. Examples of this would occur in a mammalian penis, clitoris or nipple.
Another example of a hydraulic function is the jumping spider, in which blood forced into the legs under pressure causes them to straighten for a powerful jump.
Color
In humans and other hemoglobin-using creatures, oxygenated blood is bright red. This is due to oxygenated iron in the red blood cells. Deoxygenated blood is a darker shade of red, which can be seen during blood donation and when venous blood samples are taken. However, due to skin pigments, blood vessel coverings and an optical effect caused by the way in which light penetrates through the skin, veins typically appear blue in color. This has led to a common misconception that venous blood is blue before it is exposed to air. Another reason for this misconception is that medical charts always show venous blood as blue in order to distinguish it from arterial blood which is depicted as red on the same chart.
The blood of horseshoe crabs is blue, which is a result of its high content in copper-based hemocyanin instead of the iron-based hemoglobin found, for example, in humans.
Blood cells are produced in the bone marrow; this process is termed hematopoiesis. The proteinaceous component (including clotting proteins) is produced overwhelmingly in the liver, while hormones are produced by the endocrine glands and the watery fraction is regulated by the hypothalamus and maintained by the kidney and indirectly by the gut.
Blood cells are degraded by the spleen and the Kupffer cells in the liver. The liver also clears some proteins, lipids and amino acids. The kidney actively secretes waste products into the urine. Erythrocytes usually live up to 120 days before they are systematically replaced by new erythrocytes created by the process of hematopoiesis.
Transport of oxygen
Further information: Oxygen transportation
Blood oxygenation is measured in several ways, but the most important measure is the hemoglobin (Hb) saturation percentage. This is a non-linear (sigmoidal) function of the partial pressure of oxygen. About 98.5% of the oxygen in a sample of arterial blood in a healthy human breathing air at normal pressure is chemically combined with the Hb. Only 1.5% is physically dissolved in the other blood liquids and not connected to Hb. The hemoglobin molecule is the primary transporter of oxygen in mammals and many other species (for exceptions, see below).
With the exception of pulmonary and umbilical arteries and their corresponding veins, arteries carry oxygenated blood away from the heart and deliver it to the body via arterioles and capillaries, where the oxygen is consumed; afterwards, venules and veins carry deoxygenated blood back to the heart.
Differences in infrared absorption between oxygenated and deoxygenated blood form the basis for realtime oxygen saturation measurement in hospitals and ambulances.
Under normal conditions in humans at rest, hemoglobin in blood leaving the lungs is about 98-99% saturated with oxygen. In a healthy adult at rest, deoxygenated blood returning to the lungs is still approximately 75% saturated.[3][4] Increased oxygen consumption during sustained exercise reduces the oxygen saturation of venous blood, which can reach less than 15% in a trained athlete; although breathing rate and blood flow increase to compensate, oxygen saturation in arterial blood can drop to 95% or less under these conditions.[5] Oxygen saturation this low is considered dangerous in an individual at rest (for instance, during surgery under anesthesia): "As a general rule, any condition which leads to a sustained mixed venous saturation of less than 50% will be poorly tolerated and a mixed venous saturation of less than 30% should be viewed as a medical emergency."[6]
A fetus, receiving oxygen via the placenta, is exposed to much lower oxygen pressures (about 20% of the level found in an adult's lungs) and so fetuses produce another form of hemoglobin with a much higher affinity for oxygen (hemoglobin F) in order to extract as much oxygen as possible from this sparse supply.[7]
Substances other than oxygen can bind to the hemoglobin; in some cases this can cause irreversible damage to the body. Carbon monoxide for example is extremely dangerous when absorbed into the blood. When combined with the hemoglobin, it irreversibly makes carboxyhemoglobin which reduces the volume of oxygen that can be carried in the blood. This can very quickly cause suffocation, as oxygen is vital to many organisms (including humans). This damage can occur when smoking a cigarette (or similar item) or in event of a fire. Thus carbon monoxide is considered far more dangerous than the actual fire itself because it reduces the oxygen carrying content of the blood.
Insects
In insects, the blood (more properly called hemolymph) is not involved in the transport of oxygen. (Openings called tracheae allow oxygen from the air to diffuse directly to the tissues). Insect blood moves nutrients to the tissues and removes waste products in an open system.
Small invertebrates
In some small invertebrates like insects, oxygen is simply dissolved in the plasma. Larger animals use respiratory proteins to increase the oxygen carrying capacity. Hemoglobin is the most common respiratory protein found in nature. Hemocyanin (blue) contains copper and is found in crustaceans and mollusks. It is thought that tunicates (sea squirts) might use vanabins (proteins containing vanadium) for respiratory pigment (bright green, blue, or orange).
In many invertebrates, these oxygen-carrying proteins are freely soluble in the blood; in vertebrates they are contained in specialized red blood cells, allowing for a higher concentration of respiratory pigments without increasing viscosity or damaging blood filtering organs like the kidneys.
Deep sea invertebrates
Giant tube worms have extraordinary hemoglobins that allow them to live in extraordinary environments. These hemoglobins also carry sulfides normally fatal in other animals.
Transport of carbon dioxide
When systemic arterial blood flows through capillaries, carbon dioxide diffuses from the tissues into the blood. Some carbon dioxide is dissolved in the blood. Some carbon dioxide reacts with hemoglobin and other proteins to form carbamino compounds. The remaining carbon dioxide is converted to bicarbonate and hydrogen ions through the action of RBC carbonic anhydrase. Most carbon dioxide is transported through the blood in the form of bicarbonate ions.
Transport of hydrogen ions
Some oxyhemoglobin loses oxygen and becomes deoxyhemoglobin. Deoxyhemoglobin has a much greater affinity for hydrogen ion (H+) than does oxyhemoglobin so it binds most of the hydrogen ions.
Thermoregulation
Blood circulation transports heat through the body, and adjustments to this flow are an important part of thermoregulation. Increasing blood flow to the surface (e.g. during warm weather or strenuous exercise) causes warmer skin, resulting in faster heat loss, while decreasing surface blood flow conserves heat.
Hydraulic functions
The restriction of blood flow can also be used in specialized tissues to cause engorgement resulting in an erection of that tissue. Examples of this would occur in a mammalian penis, clitoris or nipple.
Another example of a hydraulic function is the jumping spider, in which blood forced into the legs under pressure causes them to straighten for a powerful jump.
Color
In humans and other hemoglobin-using creatures, oxygenated blood is bright red. This is due to oxygenated iron in the red blood cells. Deoxygenated blood is a darker shade of red, which can be seen during blood donation and when venous blood samples are taken. However, due to skin pigments, blood vessel coverings and an optical effect caused by the way in which light penetrates through the skin, veins typically appear blue in color. This has led to a common misconception that venous blood is blue before it is exposed to air. Another reason for this misconception is that medical charts always show venous blood as blue in order to distinguish it from arterial blood which is depicted as red on the same chart.
The blood of horseshoe crabs is blue, which is a result of its high content in copper-based hemocyanin instead of the iron-based hemoglobin found, for example, in humans.
History of Western medicine
History of Western medicine
The earliest type of medicine in most cultures was the use of plants (Herbalism) and animal parts. This was usually in concert with 'magic' of various kinds in which: animism (the notion of inanimate objects having spirits); spiritualism (here meaning an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (the supposed obtaining of truth by magic means), played a major role.
The practice of medicine developed gradually, and separately, in ancient Egypt, India, China, Greece, Persia and elsewhere. Medicine as it is practiced now developed largely in the late eighteenth century and early nineteenth century in England (William Harvey, seventeenth century), Germany (Rudolf Virchow) and France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific" medicine (where results are testable and repeatable) replaced early Western traditions of medicine, based on herbalism, the Greek "four humours" and other pre-modern theories.[citation needed] The focal points of development of clinical medicine shifted to the United Kingdom and the USA by the early 1900s (Canadian-born) Sir William Osler, Harvey Cushing). Possibly the major shift in medical thinking was the gradual rejection in the 1400s during the Black Death of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general - see Copernicus's rejection of Ptolemy's theories on astronomy). People like Vesalius led the way in improving upon or indeed rejecting the theories of great authorities from the past such as Galen, Hippocrates, and Avicenna/Ibn Sina, all of whose theories were in time almost totally discredited. Such new attitudes were also only made possible by the weakening of the Roman Catholic church's power in society, especially in the Republic of Venice.
Evidence-based medicine is a recent movement to establish the most effective algorithms of practice (ways of doing things) through the use of the scientific method and modern global information science by collating all the evidence and developing standard protocols which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment.
Drug ampoules
The practice of medicine developed gradually, and separately, in ancient Egypt, India, China, Greece, Persia and elsewhere. Medicine as it is practiced now developed largely in the late eighteenth century and early nineteenth century in England (William Harvey, seventeenth century), Germany (Rudolf Virchow) and France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific" medicine (where results are testable and repeatable) replaced early Western traditions of medicine, based on herbalism, the Greek "four humours" and other pre-modern theories.[citation needed] The focal points of development of clinical medicine shifted to the United Kingdom and the USA by the early 1900s (Canadian-born) Sir William Osler, Harvey Cushing). Possibly the major shift in medical thinking was the gradual rejection in the 1400s during the Black Death of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general - see Copernicus's rejection of Ptolemy's theories on astronomy). People like Vesalius led the way in improving upon or indeed rejecting the theories of great authorities from the past such as Galen, Hippocrates, and Avicenna/Ibn Sina, all of whose theories were in time almost totally discredited. Such new attitudes were also only made possible by the weakening of the Roman Catholic church's power in society, especially in the Republic of Venice.
Evidence-based medicine is a recent movement to establish the most effective algorithms of practice (ways of doing things) through the use of the scientific method and modern global information science by collating all the evidence and developing standard protocols which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment.
Drug ampoules
Genomics and knowledge of human genetics is already having some influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology and genetics are influencing medical practice and decision-making.
Pharmacology has developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc). The modern era began with Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics shortly thereafter around 1900. The first of these was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes. Throughout the twentieth century, major advances in the treatment of infectious diseases were observable in (Western) societies. The medical establishment is now developing drugs targeted towards one particular disease process. Thus drugs are being developed to minimise the side effects of prescribed drugs, to treat cancer, geriatric problems, long-term problems (such as high cholesterol), chronic diseases type 2 diabetes, lifestyle and degenerative diseases such as arthritis and Alzheimer's disease.
Pharmacology has developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc). The modern era began with Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics shortly thereafter around 1900. The first of these was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes. Throughout the twentieth century, major advances in the treatment of infectious diseases were observable in (Western) societies. The medical establishment is now developing drugs targeted towards one particular disease process. Thus drugs are being developed to minimise the side effects of prescribed drugs, to treat cancer, geriatric problems, long-term problems (such as high cholesterol), chronic diseases type 2 diabetes, lifestyle and degenerative diseases such as arthritis and Alzheimer's disease.
Physician
Physician
This article is about the term physician, one type of 'doctor'; for other uses of the word doctor see Doctor.The word physician should not be confused with physicist, which means a scientist in the area of physics.The word physician always applies to a person who practices some type of human biological medicine. Physicians are traditionally considered to be members of a learned profession, because of the extensive training requirements and also because of the occupation's special ethical and legal duties.
Etymology of the word physician
The word physician shares a common etymology with words such as physics & metaphysics, physical, physique, and physiognomy.The Classical Greek noun phusis and derived adjective phusikos meant "nature" and "natural". From this, amongst other derivatives came the Late Latin physicus, which meant a doctor of medicine. After the Norman Conquest, the word entered Middle English via Old French fisicien, as early as 1200. Originally, physician meant a practitioner of physic (pronounced with a hard C). This archaic noun had entered Middle English by 1300 (via Old French fisique). The noun physic meant the art or science of treatment with drugs or medications (as opposed to surgery), and was later used both as a verb and also to describe the medications themselves
Different meanings of the word physician
In modern English, the term physician is used in two ways, with relatively broad and narrow meanings respectively.This may be confusing, especially to non-physicians.Physician in the broad sense, usual in North America, now applies to any legally qualified practitioner of medicine. In the United States, the term physician is now commonly used to describe any medical doctor holding the Doctor of Medicine (M.D.), Doctor of Podiatric Medicine (D.P.M.) or Doctor of Osteopathic Medicine (D.O.) degree. The American Medical Association, established 1847, uses physician in this broad sense to describe all its members. See the article on Medicine for more information on what physicians (in this broad sense) do in practice.
Physician is still widely used in the older, narrow sense, especially outside North America. In this usage, a physician is a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This traditional meaning of physician still conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.[4] This older usage is at least six hundred years old in English; physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter OED, third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a phisician." [5] Henry VIII granted a charter to the Royal College of Physicians (London) in 1518, and granted the Company of Barber/Surgeons (ancestor of the Royal College of Surgeons) its separate charter in 1540. In the same year, the same English monarch established the Regius Professorship of Physic at Cambridge University [6]. Hence, in the 16th century, physic meant roughly what internal medicine does now.
These days, a specialist physician in this older, narrow sense would probably be described in the United States as a internist (a specialist in internal medicine). This narrow usage of physician is common in Britain, Ireland, Canada, Australia, Brazil, New Zealand, Japan, South Africa, India, Indonesia, Republic of China (Taiwan), Pakistan, Bangladesh, Sri Lanka, Zimbabwe and Hong Kong. In such places, the terms doctor or medical practitioner are prevalent, to describe any practitioner of medicine (whom a North American would likely call a physician, in the broad sense). For information on the work of specialist physicians in the older, narrow sense, see internal medicine, or else visit the web page What are Physicians? at The Royal Australian College of Physicians — the description given here applies fairly well throughout the Commonwealth of Nations.
On both sides of the Atlantic, the combined term Physician and Surgeon is a venerable way to describe either a General Practitioner, or else any medical practitioner irrespective of specialty.[1][4] This usage still shows the narrow meaning and the old difference between physician, as practitioner of physic, and surgeon. Some Americans may also consider those who hold the Doctor of Chiropractic Medicine (D.C.) or Doctor of Naturopathic Medicine (N.D.) degrees to be physicians, but, unlike M.D.s or D.O.s, neither are licensed to practice the full scope of medicine and neither are given the title Physician and Surgeon by United States medical boards.
Physician is still widely used in the older, narrow sense, especially outside North America. In this usage, a physician is a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This traditional meaning of physician still conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.[4] This older usage is at least six hundred years old in English; physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter OED, third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a phisician." [5] Henry VIII granted a charter to the Royal College of Physicians (London) in 1518, and granted the Company of Barber/Surgeons (ancestor of the Royal College of Surgeons) its separate charter in 1540. In the same year, the same English monarch established the Regius Professorship of Physic at Cambridge University [6]. Hence, in the 16th century, physic meant roughly what internal medicine does now.
These days, a specialist physician in this older, narrow sense would probably be described in the United States as a internist (a specialist in internal medicine). This narrow usage of physician is common in Britain, Ireland, Canada, Australia, Brazil, New Zealand, Japan, South Africa, India, Indonesia, Republic of China (Taiwan), Pakistan, Bangladesh, Sri Lanka, Zimbabwe and Hong Kong. In such places, the terms doctor or medical practitioner are prevalent, to describe any practitioner of medicine (whom a North American would likely call a physician, in the broad sense). For information on the work of specialist physicians in the older, narrow sense, see internal medicine, or else visit the web page What are Physicians? at The Royal Australian College of Physicians — the description given here applies fairly well throughout the Commonwealth of Nations.
On both sides of the Atlantic, the combined term Physician and Surgeon is a venerable way to describe either a General Practitioner, or else any medical practitioner irrespective of specialty.[1][4] This usage still shows the narrow meaning and the old difference between physician, as practitioner of physic, and surgeon. Some Americans may also consider those who hold the Doctor of Chiropractic Medicine (D.C.) or Doctor of Naturopathic Medicine (N.D.) degrees to be physicians, but, unlike M.D.s or D.O.s, neither are licensed to practice the full scope of medicine and neither are given the title Physician and Surgeon by United States medical boards.
Wednesday, April 25, 2007
Doctor Egypt
Just What the Doctor Ordered in Ancient Egypt
Then your physician would interrogate you, according to the Smith Papyrus, finding out about your general condition and symptoms, just as doctors do today, but probably a bit longer than the restricted fifteen minutes. The doctor might ask you if you had any enemies or did anything recently to incur anyone’s wrath. If you thought so, he might chant a spell to help rid the entity that was causing your cystitis. Or give you an amulet or healing charm to wear.
Then the doctor would examine you with a lot of hands-on observation, probing here, palpating there. He might ask for an urine sample to look at or test when he left your bedside. Finally, he would pronounce what he thought was wrong with you and what your treatment should be. In your case, it would not be surprising if the doctor ordered you to take the herb coriander, still used today for medicinal purposes by the Egyptian Copts. You would be instructed to make the leaves into a tea, which was known to soothe a variety of stomach and urinary ailments, including cystitis. Coriander seeds, in fact, were discovered in the tomb of Tutankhamun and in other ancient burial sites.
The ancient Egyptians were the prototype of the holistic health practitioner. They treated the whole person: physically, mentally, spiritually and even socially. Many of the medicinal herbs we use today were first used by the ancient Egyptians. Much of our knowledge of anatomy was handed down to us by these ancient healers from their experience with mummification. And the doctor back in ancient Egypt, although lacking in our high tech medical equipment, seemed to recognize a very important thing we may have forgotten: how important it is to listen to your patient.
By Ilene Springer
The place: Thebes. The time: Two thousand BC. You’re an Egyptian scribe, on assignment for an important vizier, preparing to take account of various supplies that have just come down (up) the Nile. And what do you have? A terrible, throbbing toothache. What’s the answer? Mashed garlic in a solution of equal parts of vinegar and water.
Or you’re an Egyptian wife preparing for a big banquet at your home. All is ready: the cooked geese, the fresh mango, the newly plucked lotus blossoms out of the pond. And what do you have? The start of a scratchy sore throat. What’s the answer? A rinse or gargle with garlic and water/vinegar.
Garlic was an important healing agent to the ancient Egyptians just as it still is today to the modern Coptic Egyptians and to people in all Mediterranean countries. In fact, you could think of garlic as the aspirin of the ancient Egypt.
Or you’re an Egyptian wife preparing for a big banquet at your home. All is ready: the cooked geese, the fresh mango, the newly plucked lotus blossoms out of the pond. And what do you have? The start of a scratchy sore throat. What’s the answer? A rinse or gargle with garlic and water/vinegar.
Garlic was an important healing agent to the ancient Egyptians just as it still is today to the modern Coptic Egyptians and to people in all Mediterranean countries. In fact, you could think of garlic as the aspirin of the ancient Egypt.
Medical advances in ancient times
The Egyptians can claim credit for yet another achievement that influences us today: one of the first populations to have practicing physicians. Doctors in Egypt usually went through years of hard training at temple schools in the Various arts of interrogating the patient, inspection or examination, palpation and treatment.
We cannot talk about ancient Egyptian medicine without speaking of the world’s earliest recorded physician, Imhotep, the prime minister of Zoser’s reign (founder of the Third Dynasty) and also chief architect of the first pyramid at Saqqara. He was renown as a great healer, and centuries after his death he was worshipped as a god of medicine. Today, a statue of Imhotep stands in the Hall of Immortals at the International College of Surgeons in Chicago. Peseshet was the first known female physician in the world, practicing during the Fourth Dynasty. Says Sameh M. Arab, MD, Associate Professor of Cardiology, Alexandria University in Egypt, "Peseshet was titled Lady Overseer of the Lady Physicians and supervised a corps of ladies who were qualified physicians, not midwives. She graduated midwives at the periankh (medical school) of Sais."
The Egyptians started practicing medicine very early, around 4000 BC, during what is known as the Badarian times--before Egypt was a united nation. For example, evidence from this time period suggests that the green eye paint, malachite, was used to prevent a certain parasitic eye disease.
Egyptian medical practitioners knew a lot about the human body without the modern advantages of X-rays and CAT scans. Their knowledge came primarily through the process of mummification in which they removed and examined different parts of the body after death. They knew about the various fluids of the brain, the exact location of the heart and that the arteries were hollow and that blood circulated throughout the body.
But the Egyptian physicians were also excellent observers of their patients. They knew by the way an individual moved if he was suffering from a dislocated vertebrae. They knew that the urine of a pregnant woman germinated certain grains more rapidly than urine from a non-pregnant woman, according to Dr. Arab.
There were also specialists. There is archaeological evidence of an early dentist’s skill from the Fourth Dynasty. The mandible of the poor suffering patient was found in which a modern day-like process was used to drain an abscess under the first molar. From tombstones, we also learn about physicians who call themselves palace eye physician, palace stomach bowel physician and even guardian of the anus, according to Professor Hamed A. Ead of the University of Cairo, Giza. There were also physicians who dealt with the medical conditions of women’s fertility, pregnancy and contraception.
Written proof
The main sources for our knowledge of ancient Egyptian medicine comes primarily from seven papyri that date from the Twelfth Dynasty to the Twentieth (2000 to 1090 BC). But these archives themselves reveal a much earlier practice of medicine back to the Old Kingdom.
Egyptian medical practitioners knew a lot about the human body without the modern advantages of X-rays and CAT scans. Their knowledge came primarily through the process of mummification in which they removed and examined different parts of the body after death. They knew about the various fluids of the brain, the exact location of the heart and that the arteries were hollow and that blood circulated throughout the body.
But the Egyptian physicians were also excellent observers of their patients. They knew by the way an individual moved if he was suffering from a dislocated vertebrae. They knew that the urine of a pregnant woman germinated certain grains more rapidly than urine from a non-pregnant woman, according to Dr. Arab.
There were also specialists. There is archaeological evidence of an early dentist’s skill from the Fourth Dynasty. The mandible of the poor suffering patient was found in which a modern day-like process was used to drain an abscess under the first molar. From tombstones, we also learn about physicians who call themselves palace eye physician, palace stomach bowel physician and even guardian of the anus, according to Professor Hamed A. Ead of the University of Cairo, Giza. There were also physicians who dealt with the medical conditions of women’s fertility, pregnancy and contraception.
Written proof
The main sources for our knowledge of ancient Egyptian medicine comes primarily from seven papyri that date from the Twelfth Dynasty to the Twentieth (2000 to 1090 BC). But these archives themselves reveal a much earlier practice of medicine back to the Old Kingdom.
The most famous of the papyri are the Smith Papyrus and the Elders, named after their discoverers and interpreters. The Elbers roll is over 20 meters long and 30 centimeters high. It contains 877 recipes concerning a whole host of diseases and symptoms, including that of the eye, skin, head and face; surgical procedures; diseases of women and even comments on housekeeping. Spells are recommended in only twelve cases and in the remainder, the therapy seems quite appropriate to the condition. The Elbers Papyrus is virtually a medical treatise on all known medical interventions at the time, one of the earliest ever written, over 36 centuries ago!
The Edwin Smith Papyrus much shorter and is actually a copy of a much older document dating back to probably the Old Kingdom. The most important part is the ancient author’s addition of a whole series of glossaries which explain obsolete terms used when the papyrus was first written. The Smith Papyrus also discusses actual cases dealing with wounds, each concentrated in different regions of the body---the head, throat and neck, sternum, and spinal column.
The ‘office visit’ in ancient Egypt
Let’s say you’re a citizen of ancient Egypt and suffering from cystitis, a recurring, very painful type of urinary tract condition. What happens with the doctor? Probably the doctor would make a home visit if you could afford it. The first thing he might do is examine your pulse, although it was never really clear what information the ancient Egyptians learned from this procedure.
The Edwin Smith Papyrus much shorter and is actually a copy of a much older document dating back to probably the Old Kingdom. The most important part is the ancient author’s addition of a whole series of glossaries which explain obsolete terms used when the papyrus was first written. The Smith Papyrus also discusses actual cases dealing with wounds, each concentrated in different regions of the body---the head, throat and neck, sternum, and spinal column.
The ‘office visit’ in ancient Egypt
Let’s say you’re a citizen of ancient Egypt and suffering from cystitis, a recurring, very painful type of urinary tract condition. What happens with the doctor? Probably the doctor would make a home visit if you could afford it. The first thing he might do is examine your pulse, although it was never really clear what information the ancient Egyptians learned from this procedure.
A Relief of What is Thought to be Surgical Instruments
Then your physician would interrogate you, according to the Smith Papyrus, finding out about your general condition and symptoms, just as doctors do today, but probably a bit longer than the restricted fifteen minutes. The doctor might ask you if you had any enemies or did anything recently to incur anyone’s wrath. If you thought so, he might chant a spell to help rid the entity that was causing your cystitis. Or give you an amulet or healing charm to wear.
Then the doctor would examine you with a lot of hands-on observation, probing here, palpating there. He might ask for an urine sample to look at or test when he left your bedside. Finally, he would pronounce what he thought was wrong with you and what your treatment should be. In your case, it would not be surprising if the doctor ordered you to take the herb coriander, still used today for medicinal purposes by the Egyptian Copts. You would be instructed to make the leaves into a tea, which was known to soothe a variety of stomach and urinary ailments, including cystitis. Coriander seeds, in fact, were discovered in the tomb of Tutankhamun and in other ancient burial sites.
The ancient Egyptians were the prototype of the holistic health practitioner. They treated the whole person: physically, mentally, spiritually and even socially. Many of the medicinal herbs we use today were first used by the ancient Egyptians. Much of our knowledge of anatomy was handed down to us by these ancient healers from their experience with mummification. And the doctor back in ancient Egypt, although lacking in our high tech medical equipment, seemed to recognize a very important thing we may have forgotten: how important it is to listen to your patient.
Doctor Egypt
Just What the Doctor Ordered in Ancient Egypt
Then your physician would interrogate you, according to the Smith Papyrus, finding out about your general condition and symptoms, just as doctors do today, but probably a bit longer than the restricted fifteen minutes. The doctor might ask you if you had any enemies or did anything recently to incur anyone’s wrath. If you thought so, he might chant a spell to help rid the entity that was causing your cystitis. Or give you an amulet or healing charm to wear.
Then the doctor would examine you with a lot of hands-on observation, probing here, palpating there. He might ask for an urine sample to look at or test when he left your bedside. Finally, he would pronounce what he thought was wrong with you and what your treatment should be. In your case, it would not be surprising if the doctor ordered you to take the herb coriander, still used today for medicinal purposes by the Egyptian Copts. You would be instructed to make the leaves into a tea, which was known to soothe a variety of stomach and urinary ailments, including cystitis. Coriander seeds, in fact, were discovered in the tomb of Tutankhamun and in other ancient burial sites.
The ancient Egyptians were the prototype of the holistic health practitioner. They treated the whole person: physically, mentally, spiritually and even socially. Many of the medicinal herbs we use today were first used by the ancient Egyptians. Much of our knowledge of anatomy was handed down to us by these ancient healers from their experience with mummification. And the doctor back in ancient Egypt, although lacking in our high tech medical equipment, seemed to recognize a very important thing we may have forgotten: how important it is to listen to your patient.
By Ilene Springer
The place: Thebes. The time: Two thousand BC. You’re an Egyptian scribe, on assignment for an important vizier, preparing to take account of various supplies that have just come down (up) the Nile. And what do you have? A terrible, throbbing toothache. What’s the answer? Mashed garlic in a solution of equal parts of vinegar and water.
Or you’re an Egyptian wife preparing for a big banquet at your home. All is ready: the cooked geese, the fresh mango, the newly plucked lotus blossoms out of the pond. And what do you have? The start of a scratchy sore throat. What’s the answer? A rinse or gargle with garlic and water/vinegar.
Garlic was an important healing agent to the ancient Egyptians just as it still is today to the modern Coptic Egyptians and to people in all Mediterranean countries. In fact, you could think of garlic as the aspirin of the ancient Egypt.
Or you’re an Egyptian wife preparing for a big banquet at your home. All is ready: the cooked geese, the fresh mango, the newly plucked lotus blossoms out of the pond. And what do you have? The start of a scratchy sore throat. What’s the answer? A rinse or gargle with garlic and water/vinegar.
Garlic was an important healing agent to the ancient Egyptians just as it still is today to the modern Coptic Egyptians and to people in all Mediterranean countries. In fact, you could think of garlic as the aspirin of the ancient Egypt.
Medical advances in ancient times
The Egyptians can claim credit for yet another achievement that influences us today: one of the first populations to have practicing physicians. Doctors in Egypt usually went through years of hard training at temple schools in the Various arts of interrogating the patient, inspection or examination, palpation and treatment.
We cannot talk about ancient Egyptian medicine without speaking of the world’s earliest recorded physician, Imhotep, the prime minister of Zoser’s reign (founder of the Third Dynasty) and also chief architect of the first pyramid at Saqqara. He was renown as a great healer, and centuries after his death he was worshipped as a god of medicine. Today, a statue of Imhotep stands in the Hall of Immortals at the International College of Surgeons in Chicago. Peseshet was the first known female physician in the world, practicing during the Fourth Dynasty. Says Sameh M. Arab, MD, Associate Professor of Cardiology, Alexandria University in Egypt, "Peseshet was titled Lady Overseer of the Lady Physicians and supervised a corps of ladies who were qualified physicians, not midwives. She graduated midwives at the periankh (medical school) of Sais."
The Egyptians started practicing medicine very early, around 4000 BC, during what is known as the Badarian times--before Egypt was a united nation. For example, evidence from this time period suggests that the green eye paint, malachite, was used to prevent a certain parasitic eye disease.
Egyptian medical practitioners knew a lot about the human body without the modern advantages of X-rays and CAT scans. Their knowledge came primarily through the process of mummification in which they removed and examined different parts of the body after death. They knew about the various fluids of the brain, the exact location of the heart and that the arteries were hollow and that blood circulated throughout the body.
But the Egyptian physicians were also excellent observers of their patients. They knew by the way an individual moved if he was suffering from a dislocated vertebrae. They knew that the urine of a pregnant woman germinated certain grains more rapidly than urine from a non-pregnant woman, according to Dr. Arab.
There were also specialists. There is archaeological evidence of an early dentist’s skill from the Fourth Dynasty. The mandible of the poor suffering patient was found in which a modern day-like process was used to drain an abscess under the first molar. From tombstones, we also learn about physicians who call themselves palace eye physician, palace stomach bowel physician and even guardian of the anus, according to Professor Hamed A. Ead of the University of Cairo, Giza. There were also physicians who dealt with the medical conditions of women’s fertility, pregnancy and contraception.
Written proof
The main sources for our knowledge of ancient Egyptian medicine comes primarily from seven papyri that date from the Twelfth Dynasty to the Twentieth (2000 to 1090 BC). But these archives themselves reveal a much earlier practice of medicine back to the Old Kingdom.
Egyptian medical practitioners knew a lot about the human body without the modern advantages of X-rays and CAT scans. Their knowledge came primarily through the process of mummification in which they removed and examined different parts of the body after death. They knew about the various fluids of the brain, the exact location of the heart and that the arteries were hollow and that blood circulated throughout the body.
But the Egyptian physicians were also excellent observers of their patients. They knew by the way an individual moved if he was suffering from a dislocated vertebrae. They knew that the urine of a pregnant woman germinated certain grains more rapidly than urine from a non-pregnant woman, according to Dr. Arab.
There were also specialists. There is archaeological evidence of an early dentist’s skill from the Fourth Dynasty. The mandible of the poor suffering patient was found in which a modern day-like process was used to drain an abscess under the first molar. From tombstones, we also learn about physicians who call themselves palace eye physician, palace stomach bowel physician and even guardian of the anus, according to Professor Hamed A. Ead of the University of Cairo, Giza. There were also physicians who dealt with the medical conditions of women’s fertility, pregnancy and contraception.
Written proof
The main sources for our knowledge of ancient Egyptian medicine comes primarily from seven papyri that date from the Twelfth Dynasty to the Twentieth (2000 to 1090 BC). But these archives themselves reveal a much earlier practice of medicine back to the Old Kingdom.
The most famous of the papyri are the Smith Papyrus and the Elders, named after their discoverers and interpreters. The Elbers roll is over 20 meters long and 30 centimeters high. It contains 877 recipes concerning a whole host of diseases and symptoms, including that of the eye, skin, head and face; surgical procedures; diseases of women and even comments on housekeeping. Spells are recommended in only twelve cases and in the remainder, the therapy seems quite appropriate to the condition. The Elbers Papyrus is virtually a medical treatise on all known medical interventions at the time, one of the earliest ever written, over 36 centuries ago!
The Edwin Smith Papyrus much shorter and is actually a copy of a much older document dating back to probably the Old Kingdom. The most important part is the ancient author’s addition of a whole series of glossaries which explain obsolete terms used when the papyrus was first written. The Smith Papyrus also discusses actual cases dealing with wounds, each concentrated in different regions of the body---the head, throat and neck, sternum, and spinal column.
The ‘office visit’ in ancient Egypt
Let’s say you’re a citizen of ancient Egypt and suffering from cystitis, a recurring, very painful type of urinary tract condition. What happens with the doctor? Probably the doctor would make a home visit if you could afford it. The first thing he might do is examine your pulse, although it was never really clear what information the ancient Egyptians learned from this procedure.
The Edwin Smith Papyrus much shorter and is actually a copy of a much older document dating back to probably the Old Kingdom. The most important part is the ancient author’s addition of a whole series of glossaries which explain obsolete terms used when the papyrus was first written. The Smith Papyrus also discusses actual cases dealing with wounds, each concentrated in different regions of the body---the head, throat and neck, sternum, and spinal column.
The ‘office visit’ in ancient Egypt
Let’s say you’re a citizen of ancient Egypt and suffering from cystitis, a recurring, very painful type of urinary tract condition. What happens with the doctor? Probably the doctor would make a home visit if you could afford it. The first thing he might do is examine your pulse, although it was never really clear what information the ancient Egyptians learned from this procedure.
A Relief of What is Thought to be Surgical Instruments
Then your physician would interrogate you, according to the Smith Papyrus, finding out about your general condition and symptoms, just as doctors do today, but probably a bit longer than the restricted fifteen minutes. The doctor might ask you if you had any enemies or did anything recently to incur anyone’s wrath. If you thought so, he might chant a spell to help rid the entity that was causing your cystitis. Or give you an amulet or healing charm to wear.
Then the doctor would examine you with a lot of hands-on observation, probing here, palpating there. He might ask for an urine sample to look at or test when he left your bedside. Finally, he would pronounce what he thought was wrong with you and what your treatment should be. In your case, it would not be surprising if the doctor ordered you to take the herb coriander, still used today for medicinal purposes by the Egyptian Copts. You would be instructed to make the leaves into a tea, which was known to soothe a variety of stomach and urinary ailments, including cystitis. Coriander seeds, in fact, were discovered in the tomb of Tutankhamun and in other ancient burial sites.
The ancient Egyptians were the prototype of the holistic health practitioner. They treated the whole person: physically, mentally, spiritually and even socially. Many of the medicinal herbs we use today were first used by the ancient Egyptians. Much of our knowledge of anatomy was handed down to us by these ancient healers from their experience with mummification. And the doctor back in ancient Egypt, although lacking in our high tech medical equipment, seemed to recognize a very important thing we may have forgotten: how important it is to listen to your patient.
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