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Medical Thinking

Medical Thinking: A Historical Preface

Copyright Date: 1982
Pages: 338
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  • Book Info
    Medical Thinking
    Book Description:

    Lester S. King, M.D., focuses on those aspects of medicine that remain constant through the centuries--the problems that doctors always face and the critical judgment needed to solve them. According to Dr. King, modern technological advances are really new ways of answering old questions, while the basic modes of medical thinking have not changed.

    Originally published in 1984.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-5568-1
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
    (pp. v-viii)
  3. Table of Contents
    (pp. ix-2)
  4. CHAPTER 1 Persistent Problems of Medicine
    (pp. 5-15)

    In 1928, when I entered medical school,our class was fully aware of the great ferment taking place in medicine. Insulin had only recently been discovered, and so had the curative value of liver in pernicious anemia. Endocrinology was emerging as an active discipline. The important role that electrolytes played in health and disease was receiving abundant study. Protein chemistry was making great progress, as was immunology. Surgical interventions were becoming more and more dramatic. By the time we graduated we were fully convinced that the medicine of our day was a truly scientific discipline and that it contrasted markedly...

  5. CHAPTER 2 Consumption: The Story of a Disease
    (pp. 16-70)

    Recently, when I lectured to medical studentson the history of tuberculosis, I asked the class how many were familiar with the disease called consumption. Only about a third of the students raised their hands—an interesting commentary on medical progress. Once a medical term of high repute, “consumption” gradually became outmoded and in the middle of the 19th century it gave way to the more precise concept, “tuberculosis.” The older nomenclature faded even from popular usage; it now sounds rather archaic, eliciting mostly a blank stare. In an earlier period, however, consumption was deemed a quite specific term with...

  6. CHAPTER 3 Signs and Symptoms
    (pp. 73-89)

    If we get away from any medical contextand consider terms in their popular or “ordinary” sense, there is nothing mysterious about a sign. Most people would think, perhaps, of a sign on the street corner, identifying the name of the street, or perhaps on the highway, telling us which exit to take. These are every day usages of the word.

    Let me ask a question, “When is a sign not a sign?” This is not an idle conundrum but a serious question whose answer has considerable import. Let me give the answer before offering any explanation. I maintain that...

  7. CHAPTER 4 Diagnosis
    (pp. 90-104)

    Diagnosis is central to the practice of medicine,for it identifies the disease from which the patient suffers. Much of medical education centers around the problem: how do you learn to make a diagnosis? One recent text gave this advice: the student should “begin, as in all scientific research, by marshalling all the facts, then proceeding with an unprejudiced analysis of facts, and end with a logical conclusion.”¹

    I would point out the similarity of this excellent advice to that which da Costa offered more than a century before (see p. 88). Da Costa indicated the following steps: discover the...

  8. CHAPTER 5 Classification
    (pp. 105-128)

    Diagnosis takes place when someone makes a choiceamong a series of classes. The series must have at least two members, but there is no upper limit. Then we have the problem: how do the classes get formed?

    Classification depends on the perception of similarity, and whenever we perceive a similarity we deal with a class. A red brick and a red flower may not have much in common, but they do share the quality that we recognize and call “red.” The important feature is not similarity-in-general but a similarity-in-at-least-one-particular, and this particular we call a “property.” In all classes...

  9. CHAPTER 6 Disease and Wealth
    (pp. 131-145)

    If I pose the question,“What is disease?” the answer will depend on whom I ask. There is the patient who has a disease, and the physician or healer who tries to cure him. There is also the scientist, who may or may not be a physician. In either case the scientist does not concern himself with the direct care of the patient but rather with the overall advancement of knowledge. The patient seeks relief, the physician tries to provide it, and the scientist seeks understanding.

    Disease is an abstract term. Ordinarily we define an abstraction by studying the...

  10. CHAPTER 7 The Clinical Entity and the Disease Entity
    (pp. 146-164)

    Two people are looking idly at the sky,watching the clouds. One says, “I see a castle, with a tower, and over there I can see a horse with a man astride, and I can just make out a helmet and a plume.” And as he watches, the wind freshens, and he says sadly, “The man has disappeared and the horse has turned into a hill, and the tower of the castle has collapsed.” He was drawing on his imagination, forming casual associations with evanescent shapes.

    The second man, looking at the sky, says, “This is a typical cumulonimbus cloud,...

  11. CHAPTER 8 When, Where, and What Is the Disease?
    (pp. 165-184)

    Until about a half century ago the term “crisis” was commonly used in medicine. The word itself means a decision, a point of decisive change. At the crisis the patient would either pass the danger point and get well or he would get worse and die. A dramatic example of a crisis often occurred in lobar pneumonia, when the desperately sick patient could take a sudden turn for the better—or else for the worse. Similar turning points are seen in many febrile diseases. The layman might use the expression, “the fever broke”; the pathologist and immunologist can give a...

  12. CHAPTER 9 The Causes of Disease: I
    (pp. 187-203)

    One of the busiest words in Englishis the monosyllable “cause.” The word itself and the ideas behind it lurk almost everywhere—in everyday activities, in medicine, law, history, philosophy, sociology, economics, in virtually every intellectual and practical pursuit. However, the meaning and implications will vary according to context. Although we are here concerned primarily with medicine, we cannot study causation without briefly surveying some of the different meanings that we find in other disciplines.

    Let us look at a few examples. A minute cinder blew into your eye, and produced great pain, redness, and tearing. Rubbing the eye did...

  13. CHAPTER 10 The Causes of Disease: II
    (pp. 204-224)

    Popular usage constantly refers toone event asthecause of another. In this usage, however, the definite article implies something unique, when actually there is multiplicity. We see the fallacy if we look at the officers of a corporation. If there are ten vice-presidents, it would be wrong to call any one of themthevice-president. We can, however, achieve accuracy if we add further determinants. It is entirely correct to say, Mr. X. isthevice-president in charge of personnel.

    We find the same situation in regard to causes. To speak ofthecause suggests that there is...

  14. CHAPTER 11 Reflections on Blood-Letting
    (pp. 227-244)

    Today doctors candosomething for their patients. Of course, the older physicians prescribed vast quantities of drugs and performed various therapeutic indignities like bleeding and sweating, but—so runs a popular mythology—in the old days treatment led chiefly to disaster—unless the healing power of nature cured the patients in spite of the physicians.

    Blood-letting has become a symbol for whatever was bad in earlier medical practice. Everyone seems to know that George Washington died from excessive blood-lettings when he lay ill with a sore throat; and that Benjamin Rush, with fanatic intensity, almost exsanguinated his patients under...

  15. CHAPTER 12 What Is a Fact?
    (pp. 247-266)

    Medical students are inundated with facts. Each course in the curriculum has its Own huge text crammed with facts. The faculty emphasizes the sacredness of facts through the so-called truefalse or objective examination, where for every question there is a right answer and a wrong answer. The students get sensitized to all this and become uneasy if a lecturer makes a statement running counter to what the text declared or what some other lecturer has said. If facts do not hold still, where will the student find stability? Yet neither students nor faculty show much interest in the basic question,...

  16. CHAPTER 13 The Scientific Method, So-called
    (pp. 267-293)

    In 1593, in the duchy of Silesia,a boy of seven lost some of his milk teeth. Clearly, the mere event of itself held no significance, for all children lose their milk teeth. In this particular case, however, in the place of one tooth there grew back—so it was alleged—a new tooth of unique character, namely, one made of gold. This report attracted a great deal of attention. A learned physician in the University of Helmstad wrote, in 1595, that this event was partly natural and partly miraculous. God, he said, had sent the miracle “to comfort the...

  17. CHAPTER 14 “Scientific Niedicine”
    (pp. 294-310)

    Today, if we judge by advertisementsthat bombard us on all sides, anything that claims kinship with science has a special virtue that confers superiority. Among the advertisements that preach this gospel I would distinguish three types that actually illustrate three different aspects of science.

    One example would be an automobile repair shop that recommends its “scientific auto tune-up” This sounds attractive indeed, but we can only guess at what it means. The sign, I suggest, implies that the shop uses the latest technology, with the latest automated gadgets. These, supposedly, are tools of precision that eliminate guesswork and subjective...

    (pp. 311-318)

    Just as M. Jourdain was extremely surprisedto learn that he had been speaking prose all his life without knowing it, so too the modern physician might be equally surprised to learn that he constantly deals with philosophy. I do not mean formidable technical subjects like symbolic logic or epistemology but rather the familiar concepts that relate to everyday medical activities. Thus, physicians—and laymen too—speak of thehealthychild, anormalblood count, thesignsof pneumonia, thediagnosisof cancer, thecauseof malaria, the wonders of medicalscience. These and cognate topics I have discussed in...

  19. NOTES
    (pp. 319-330)
  20. INDEX
    (pp. 331-336)
  21. Back Matter
    (pp. 337-337)