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- Family medicine emerged from the fragmentation that occurred after the decline of the “general practitioner” and the rise of specialization in the first half of the twentieth century. Family medicine aimed to restore the deterioration of the patient–doctor relationship that resulted from the decline of general practice.
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Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world.
This chapter presents the origins of family medicine. Family medicine emerged from the fragmentation that occurred after the decline of the “general practitioner” and the rise of specialization in the first half of the twentieth century.
Family medicine began as a revolutionary movement with courageous leaders who had a compelling vision for the new specialty. Next came a growth era with the expansion of residency programs, medical school departments and community practices; organizationally adept, businesslike people managed family medicine’s prosperity.
- Robert B. Taylor
- 2006
Storylines of Family Medicine is a 12- part series of thematically linked mini- essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world.
- Overview
- Medicine in the 20th century
- Infectious diseases and chemotherapy
- Penicillin
- Antituberculous drugs
- Other antibiotics
The 20th century produced such a plethora of discoveries and advances that in some ways the face of medicine changed out of all recognition. In 1901 in the United Kingdom, for instance, the life expectancy at birth, a primary indicator of the effect of health care on mortality (but also reflecting the state of health education, housing, and nutrition), was 48 years for males and 51.6 years for females. After steady increases, by the 1980s the life expectancy had reached 71.4 years for males and 77.2 years for females. Other industrialized countries showed similar dramatic increases. By the 21st century the outlook had been so altered that, with the exception of oft-fatal diseases such as certain types of cancer, attention was focused on morbidity rather than mortality, and the emphasis changed from keeping people alive to keeping them fit.
The rapid progress of medicine in this era was reinforced by enormous improvements in communication between scientists throughout the world. Through publications, conferences, and—later—computers and electronic media, they freely exchanged ideas and reported on their endeavours. No longer was it common for an individual to work in isolation. Although specialization increased, teamwork became the norm. It consequently has become more difficult to ascribe medical accomplishments to particular individuals.
The 20th century produced such a plethora of discoveries and advances that in some ways the face of medicine changed out of all recognition. In 1901 in the United Kingdom, for instance, the life expectancy at birth, a primary indicator of the effect of health care on mortality (but also reflecting the state of health education, housing, and nutrition), was 48 years for males and 51.6 years for females. After steady increases, by the 1980s the life expectancy had reached 71.4 years for males and 77.2 years for females. Other industrialized countries showed similar dramatic increases. By the 21st century the outlook had been so altered that, with the exception of oft-fatal diseases such as certain types of cancer, attention was focused on morbidity rather than mortality, and the emphasis changed from keeping people alive to keeping them fit.
The rapid progress of medicine in this era was reinforced by enormous improvements in communication between scientists throughout the world. Through publications, conferences, and—later—computers and electronic media, they freely exchanged ideas and reported on their endeavours. No longer was it common for an individual to work in isolation. Although specialization increased, teamwork became the norm. It consequently has become more difficult to ascribe medical accomplishments to particular individuals.
In the 20th century, ongoing research concentrated on the nature of infectious diseases and their means of transmission. Increasing numbers of pathogenic organisms were discovered and classified. Some, such as the rickettsias, which cause diseases like typhus, are smaller than bacteria; some are larger, such as the protozoans that engender malaria and other tropical diseases. The smallest to be identified were the viruses, producers of many diseases, among them mumps, measles, German measles, and polio. In 1910 Peyton Rous showed that a virus could also cause a malignant tumour, a sarcoma in chickens.
There was still little to be done for the victims of most infectious organisms beyond drainage, poultices, and ointments, in the case of local infections, and rest and nourishment for severe diseases. The search for treatments was aimed at both vaccines and chemical remedies.
A dramatic episode in medical history occurred in 1928, when Alexander Fleming noticed the inhibitory action of a stray mold on a plate culture of staphylococcus bacteria in his laboratory at St. Mary’s Hospital, London. Many other bacteriologists must have made the observation, but none had realized the possible implications. The mold was a strain of Penicillium—P. notatum—which gave its name to the now-famous drug penicillin. In spite of his conviction that penicillin was a potent antibacterial agent, Fleming was unable to carry his work to fruition, mainly because the techniques to enable its isolation in sufficient quantities or in a sufficiently pure form to allow its use on patients had not been developed.
Ten years later Howard Florey, Ernst Chain, and their colleagues at Oxford University took up the problem again. They isolated penicillin in a form that was fairly pure (by standards then current) and demonstrated its potency and relative lack of toxicity. By then World War II had begun, and techniques to facilitate commercial production were developed in the United States. By 1944 adequate amounts were available to meet the extraordinary needs of wartime.
While penicillin was the most useful and the safest antibiotic, it suffered from certain disadvantages. The most important of these was that it was not active against Mycobacterium tuberculosis, the bacillus of tuberculosis. However, in 1944 Selman Waksman, Albert Schatz, and Elizabeth Bugie announced the discovery of streptomycin from cultures of ...
Penicillin is not effective over the entire field of microorganisms pathogenic to humans. During the 1950s the search for antibiotics to fill this gap resulted in a steady stream of them, some with a much wider antibacterial range than penicillin (the so-called broad-spectrum antibiotics) and some capable of coping with those microorganisms that are inherently resistant to penicillin or that have developed resistance through exposure to penicillin.
This tendency of microorganisms to develop resistance to penicillin at one time threatened to become almost as serious a problem as the development of resistance to streptomycin by the bacillus of tuberculosis. Fortunately, early appreciation of the problem by clinicians resulted in more discriminate use of penicillin. Scientists continued to look for means of obtaining new varieties of penicillin, and their researches produced the so-called semisynthetic antibiotics, some of which are active when taken by mouth and some of which are effective against microorganisms that have developed resistance to the earlier form of penicillin.
Although the term “family medicine” has been used intermittently over the past forty years or so, the first unified effort to make family medicine the preferred term came about as a result of the Future of Family Medicine (FFM) Project.
Nov 1, 2016 · Family medicine is relatively young as an organized medical discipline. While before the turn of the 20th century most physicians practised as generalists, the explosion of medical knowledge and therapies in the early 20th century led to the development of medical specialties.
