Until the end of the 19th century, the physician had only the use of the senses for the diagnosis of diseases. Since the possibilities of surgery were limited and knowledge of medicines was still precarious, the physician could only restrict action to the Hippocratic precept: “to cure sometimes, to relieve often, and to comfort always.”
With the discovery of X-rays, which made it possible to understand the anatomy and pathology of organs, and with the string galvanometer, the origin of the electrocardiograph used to detect cardiac disorders, medicine entered its technical stage.
To this must be added the contribution of the physical and chemical sciences to biology. Theoretical and practical acquisitions, along with the constant refinement of experimental technique, gave rise to biophysics and biochemistry, which make it possible to understand vital phenomena, to investigate them with the rigor used in the exact sciences, and to analyze life in its physical and chemical aspects.
These investigations placed at the physician’s disposal a large number of tests and reactions for the diagnosis of functional alterations. Progress in the fields of biochemistry and biophysics has been so extraordinary that today any well-equipped biochemical analysis laboratory is capable not only of studying the physical and chemical characteristics of urine and blood, but also of carrying out a set of tests of capital importance for the differential diagnosis of diseases.
In certain centers, it is even possible to determine the genetic structure of cells, the chemical constitution of pathological hemoglobins, the electrical activity of the brain, intracardiac pressures, and other phenomena.
The medical act, understood as the strict physician-patient relationship, is replaced by the confrontation of the sick person with an organized system that depersonalizes the individual and turns them into “the case” or merely into a registration number. The patient often does not know the name of the physicians who assist them, and sometimes is not even aware of their existence, given the structure and organization of large healthcare centers.
This technical evolution, as a logical consequence, forgets that beyond the disease there is a human person who seeks security, support and understanding. Such dehumanization and depersonalization of the medical act led to the creation of an intellectual movement that began with the pathophysiologist Ludolf von Krehl (1861–1937). In response to technocratization and scientism, he affirmed the thesis that medicine is a craft of humanity and for humanity.
For von Krehl and his followers, the physician forms, together with the patient, an existential unit that cannot be replaced by the patient’s confrontation with the coldness of examinations and functional tests.
This neo-Hippocratic movement, which places the patient at the center of the medical act, is extremely important when one considers the foreseeable modifications that the biological sciences may undergo in the next hundred years. These include the use of electronic devices with transistors to replace organs, the doubling of average life expectancy, the disappearance of diseases caused by biological agents, control of diseases of genetic origin, the neutralization and cure of malignant tumors and degenerative diseases, and the use of machines for automatic diagnosis.
Despite the technical organization of medicine and the changes that diagnosis and treatment will undergo, the physician, as a member of medical units, must reconsider their position before the sick human being. The physician will acquire great powers over disease and, consequently, over life. This will require the formation of a very strict sense of morality and responsibility toward the individual, based on practicing the art with conscience and dignity; making the health and life of the sick the first concern; maintaining the honor and traditions of the medical profession; allowing no considerations of religion, nationality, race, party or class to come between duty and the patient; having absolute respect for human life from the moment of conception; never using medical knowledge, even under threat, against the laws of humanity; and devoting life to the service of humanity, as established by the Hippocratic oath, the highest ethical invocation of physicians.
Ionizing Radiation
Following the discovery of X-rays by Röntgen in 1895 and of radium by the Curies in 1898, ionizing radiation began to be used for therapeutic purposes. These radiations are capable of passing through tissues and acting in depth, producing either a regulating or resolving effect on inflammatory processes, or a destructive effect on the cells of certain organs and on tumor cells.
The biological effect of these radiations, regardless of their energy and source, results from the combination of three different effects: direct, indirect and constitutional. The disintegration of an atomic nucleus by Hahn in 1939 made it possible to obtain artificial radioisotopes, such as Co60, Cs137, P32, Au198, Mn54, Y151, and others.
There is a constant effort to obtain new elements that concentrate their activity on specific cells, that is, that have a specific effect.
Psychotherapy
Beginning in the 20th century, with Freud’s contributions to the understanding of psychic processes, psychotherapy began to be used as a therapeutic method. According to Seguín, psychological procedures are as follows:
- The emotional relationship. Throughout the “medical act,” a relationship is established between the patient and the physician. The patient seeks help and tries to have the physician free them from the “anguish” of their illness. The patient sees the professional as a protector, which allows the physician to use that relationship for therapeutic purposes.
- Catharsis. This is the process of releasing a repressed emotion or experience by reliving it through words, emotions or actions. This produces in the patient a decrease in psychological tension, establishing an affective bond with the person in whom they trust. Upon discovering that someone is concerned with their problems, the patient gains self-confidence and begins to objectify them.
- Comprehension. By speaking, the patient clarifies the meaning of things, establishing relationships between psychological phenomena that were previously unrelated. In this way, unconscious psychic contents emerge into consciousness, allowing the patient to connect and link psychological events.
- Working through. The term means “working through something.” It is the continuous and repeated use of the other three methods, at different moments and from different points of view, in order to produce new experiences and resolve the patient’s problems.
