As we move into the new millennium it is becoming increasingly clear that the biomedical sciences are entering the most exciting phase of their development. Paradoxically, medical practice is also passing through a phase of increasing uncertainty, in both industrial and developing countries. Industrial countries have not been able to solve the problem of the spiraling costs of health care resulting from technological development, public expectations, and—in particular—the rapidly increasing size of their elderly populations. The people of many developing countries are still living in dire poverty with dysfunctional health care systems and extremely limited access to basic medical care.
Against this complex background, this chapter examines the role of science and technology for disease control in the past and present and assesses the potential of the remarkable developments in the basic biomedical sciences for global health care.
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Medicine Before the 20th Century
From the earliest documentary evidence surviving from the ancient civilizations of Babylonia, China, Egypt, and India, it is clear that longevity, disease, and death are among humanity's oldest preoccupations. From ancient times to the Renaissance, knowledge of the living world changed little, the distinction between animate and inanimate objects was blurred, and speculations about living things were based on prevailing ideas about the nature of matter.
Advances in science and philosophy throughout the 16th and 17th centuries led to equally momentous changes in medical sciences. The elegant anatomical dissections of Andreas Vesalius swept away centuries of misconceptions about the relationship between structure and function of the human body; the work of Isaac Newton, Robert Boyle, and Robert Hooke disposed of the basic Aristotelian elements of earth, air, fire, and water; and Hooke, through his development of the microscope, showed a hitherto invisible world to explore. In 1628, William Harvey described the circulation of the blood, a discovery that, because it was based on careful experiments and measurement, signaled the beginnings of modern scientific medicine.
After steady progress during the 18th century, the biological and medical sciences began to advance at a remarkable rate during the 19th century, which saw the genuine beginnings of modern scientific medicine. Charles Darwin changed the whole course of biological thinking, and Gregor Mendel laid the ground for the new science of genetics, which was used later to describe how Darwinian evolution came about. Louis Pasteur and Robert Koch founded modern microbiology, and Claude Bernard and his followers enunciated the seminal principle of the constancy of the internal environment of the body, a notion that profoundly influenced the development of physiology and biochemistry. With the birth of cell theory, modern pathology was established. These advances in the biological sciences were accompanied by practical developments at the bedside, including the invention of the stethoscope and an instrument for measuring blood pressure, the first use of x-rays, the development of anesthesia, and early attempts at the classification of psychiatric disease as well as a more humane approach to its management. The early development of the use of statistics for analyzing data obtained in medical practice also occurred in the 19th century, and the slow evolution of public health and preventive medicine began.
Significant advances in public health occurred on both sides of the Atlantic. After the cholera epidemics of the mid 19th century, public health boards were established in many European and American cities. The Public Health Act, passed in the United Kingdom in 1848, provided for the improvement of streets, construction of drains and sewers, collection of refuse, and procurement of clean domestic water supplies. Equally important, the first attempts were made to record basic health statistics. For example, the first recorded figures for the United States showed that life expectancy at birth for those who lived in Massachusetts in 1870 was 43 years; the number of deaths per 1,000 live births in the same population was 188. At the same time, because it was becoming increasingly clear that communicable diseases were greatly depleting the workforce required to generate the potential rewards of colonization, considerable efforts were channeled into controlling infectious diseases, particularly hookworm and malaria, in many countries under colonial domination.
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