PUBLIC HEALTH IN THE SPACE AGE

Medicine and public health in the space age will work in closer partnership. Both will draw more widely from the behavioral sciences. More spectacular conquests in space will come before man learns much more about man himself and his interrelationships with his fellow man. The past century has been the era of the biological and physical scientist; we are now entering the century of the psychological man. There is a fusion of the sciences—biological, physical and social—in medical research, teaching and service.One is apt to think of public health as a specialty of medicine. Equally valid is the concept that medicine is a specialty of public health, which draws from more of the basic sciences.Epidemiology is concerned with noninfectious conditions and is moving into the epidemiology of health. The spectacular gains in life-saving in this country during the past half century are unrepeatable phenomena. The major gains in the future must come in the older ages.     

I.M. Sechenov's creative development of ideas in aviation and space medicine

Research carried outby the great Russian scholar I. M. Sechenov has significantly contributed to development of aviation physiology, medicine and psychology. His fundamental works consisted of discovery of the constancy of alveolar air composition theory, study of interactions of analyzers systems in solving the problem of human spatial orientation under flight conditions, development of a nervous theory of fatigue. Creative development of ideas by I. M. Sechenov allowed enhancing the efficiency of performing and safety of aviation and space flights.     

The contribution of academician Leon Abgarovich Orbeli and his school to the development of physiology of extreme conditions

The paper is devoted to the role of Academician L. A. Orbeli and his school in foundation and development of extreme physiology. The works of L. A. Orbeli, his pupils and collaborators contributed to the advancement of key theoretical and applied aspects of hyperbaric physiology, flights in stratosphere, aviation physiology and medicine, space physiology and radiobiology.     

The problem of estimation of the organism adaptable opportunities under stressful influences

The human organism testing in conditions of modern scientific and technical progress constant stressful influences (industrial, social, psycho-emotional) was carried out for continuous adaptation to the environment: changing of the level of functioning of separate systems and a corresponding tension of regulatory mechanisms occurred. In the article, theoretical bases and methodology of studying the adaptable capacities of the organism are considered. The prenosological diagnostics was used for studying functional conditions on the verge of norm and pathology. The heart rate variability analysis was used based on mathematical model of functional conditions. Concrete technologies and results of evaluation of the adaptation capacities of the organism in space and aviation medicine are presented as well as in applied physiology.     

Conscientious objection in healthcare: How much discretionary space best supports good medicine?

Daniel Sulmasy has recently argued that good medicine depends on physicians having a wide discretionary space in which they can act on their consciences. The only constraints Sulmasy believes we should place on physicians’ discretionary space are those defined by a form of tolerance he derives from Locke, whereby people can publicly act in accordance with their personal religious and moral beliefs as long as their actions are not destructive to society. Sulmasy also claims that those who would reject physicians’ right to conscientious objection eliminate discretionary space, thus undermining good medicine and unnecessarily limiting religious freedom. I argue that, although Sulmasy is correct that some discretionary space is necessary for good medicine, he is wrong in thinking that proscribing conscientious objection entails eliminating discretionary space. I illustrate this using Julian Savulescu and Udo Schuklenk’s system for restricting conscientious objections as a counter‐example. I then argue that a narrow discretionary space constrained by professional ideals will promote good medicine better than Sulmasy’s wider discretionary space constrained by his conception of tolerance. Sulmasy’s version of discretionary space would have us tolerate actions that are at odds with aspects of good medicine, including aspects that Sulmasy himself explicitly values, such as fiduciary duty. Therefore, if we want the degree of religious freedom in the public sphere that Sulmasy favours then we must decide whether it is worth the cost to the healthcare system.     

Depression, Constraint, and the Liver: (Dis)assembling the Treatment of Emotion-Related Disorders in Chinese Medicine

Traditional Chinese medicine (TCM) is today practiced worldwide, rivaling biomedicine in terms of its globalization. One of the most common TCM diagnoses is “Liver qi constraint,” which, in turn, is commonly treated by an herbal formula dating back to the 10th century. In everyday TCM practice, biomedical disease categories such as depression or anxiety and popular disease categories such as stress are often conflated with the Chinese medical notion of constraint. Medical anthropologists, meanwhile, argue that constraint reveals to us a distinctive aesthetics of constructing body/persons in Chinese culture, while psychologists seek to define constraint as a distinctive psychiatric disorder distinctive from depression and anxiety. All of these actors agree in defining constraint as a concept dating back two thousand years to the very origins of Chinese medicine. This article disassembles the articulations by means of which these different facts about constraint are constructed. It shows how ideas about constraint as a disorder caused by the penetration of external pathogens into the body were gradually transformed from the eleventh century onward into constraint as an emotion-related disorder, while treatment strategies were adjusted to match perceptions about body/self that developed among the gentry elite of southeast China in late imperial China.     

The Dialectical Method in the Psychology of Memory

The modern science of psychology grew out of the empirical psychology of the 19th century, construing itself as the complete negation of the latter. As such it contains two quite distinct basic tendencies: one away from the idealism of empirical psychology, the other away from its metaphysical mode of thought. These two tendencies are now a part of virtually all of progressive European psychology (1), and also reflect two problems posed by modern Russian psychology.     

Regenerative medicine's historical roots in regeneration, transplantation, and translation

Regenerative medicine is not new; it has not sprung anew out of stem cell science as has often been suggested. There is a rich history of study of regeneration, of development, and of the ways in which understanding regeneration advances study of development and also has practical and medical applications. This paper explores the history of regenerative medicine, starting especially with T.H. Morgan in 1901 and carrying through the history of transplantation research in the 20th century, to an emphasis on translational medicine in the late 20th century.     

Space Medicine—A Review of Current Concepts

Space medicine deals with the branch of research involved with the adaptation of humans to the unique environment of space. More than 100 people have traveled in space. The day will come when some human beings will spend all their time in space. Medical problems encountered in space, such as motion sickness, negative nitrogen and calcium balance, anemia and radiation exposure, are issues that already affect medical practice outside aerospace medicine.     

Moral medicine: Symbolic content in 19th century Shaker therapeutics

This paper presents an analysis of the symbolic meanings implicit in an ostensibly empirical therapeutic system. The Shakers, a celibate communal religious order founded in New York State in the mid 1770s, were practitioners of botanic medicine, as were many other Americans in the nineteenth century. This study analyzes the therapeutic properties of the herbs they produced (such as diuretic, stimulant, narcotic, emetic, astringent), using a classification scheme based on the location of the botanical substance's effect vis-à-vis body boundaries and surfaces. The Shakers' beliefs about the therapeutic properties of their herbs are compared with similar analyses of the properties given by two contemporary nineteenth century New England proponents of herbal medicine, botanist Constantine Rafinesque and sectarian practitioner Samuel Thomson. The comparison shows systematic variation in emphasis given to herbs which regulate internal body processes, or act through the openings of the body or on its surface. In this context Shaker medicine can be characterized as quickening, internal, and purifying in its effects on body processes, effects which are highly consistent with Shaker religious beliefs in active, physical worship, selflessness and spiritual purification by confession.     

Tropical medicine for the 21st century.

The specialty of tropical medicine originated from the needs of the colonial era and is removed from many of the health care requirements of tropical countries today. Tropical medicine concentrates on parasitic diseases of warm climates, although other infections and diseases related to poverty rather than climate dominate medicine in developing countries challenged by population pressure, civil strife, and migration. In the new century, tropical medicine would best be absorbed into the specialty of infectious diseases, which should incorporate parasitic diseases, travel medicine, and sexually transmitted diseases. Pressing questions for health care and research in developing countries concern the provision of appropriate services for problems such as HIV/AIDS, tuberculosis, sexually transmitted diseases, and injuries. The question of how to provide appropriate clinical care in resource poor settings for the major causes of morbidity and premature mortality has been neglected by donors, academic institutions, and traditional tropical medicine.     

Plant identification credibility in ethnobotany: a closer look at Polish ethnographic studies

In Italy, malaria was an endemic disease that was eradicated by the mid-20th century. This paper evaluates the prophylactic and therapeutic remedies used by folk medicine to cure malaria in Calabria (southern Italy). The data has been collected by analysing works of physicians, ethnographers, folklorists and specialists of the study of Calabrian history between the end of the 19th century and the 20th century. The data collected have allowed us to describe the most common cures used by the Calabrian people to treat malaria and the most evident symptoms of this disease, such as intermittent fever, hepato-spleenomegaly, asthenia and dropsy. This approach uncovered a heterogeneous corpus of empirical, magical and religious remedies, which the authors have investigated as evidences of past "expert medicine" and to verify their real effectiveness in the treatment of malaria.     

A spirit of scientific rigour: Koch's postulates in twentieth-century medicine

This article explores one of a citation classics in medical literature—Koch's postulates. It analyses their creation in the nineteenth century and their popularity in the twentieth century. As a genre of historiography, references to the postulates are anecdotes. In referring to a historical event that never happened, such references serve to remind their audiences of a tradition of experimental medicine that supposedly originated with Robert Koch.     

An active interface between medical science and aeronautical technology: the physiological investigations for the XC-35.

Although the advantages of flight at high altitude were early recognized, so also were the physiological problems standing in the way of its realization. The idea of surmounting such problems by means of a pressurized cabin was advocated as early as 1909, while the first attempt to translate the concept into actuality occurred in 1921. Neither it nor several successive attempts enjoyed any real success until a project launched by the U. S. Air Corps in 1935 produced a breakthrough aircraft designated the XC-35. The major reason for the favorable termination of that venture was the thoroughness of the engineering involved. But it is equally notable that this was the first instance in the age of powered flight where there was an active collaboration between the scientists and engineers, a rather curious circumstance in view of the fact that the achievement of altitude record-setting balloon flights in the nineteenth century had owed a great deal to an interconnection of aeronauts and scientists' laboratories. This paper focuses on the physiological investigations which informed the XC-35 engineers while at the same time bringing into being a new aeromedical laboratory taking the first small step toward turning aeromedicine into space medicine.     

Intensive care ethics in evolution

The ethics of treating the seriously and critically ill have not been static throughout the ages. Twentieth century medicine has inherited from the nineteenth century a science which places an inappropriate weight on diagnosis over prognosis and management, combined with a seventeenth century duty to prolong life. However other earlier ethical traditions, both Hippocratic and Christian, respected both the limitations of medicine and emphasised the importance of prognosis. This paper outlines some of the historical precedents for the treatment of the critically ill, and also how the current paradigm limits clinical practice and causes ethical tensions. An understanding that other paradigms have been ethically acceptable in the past allows wider consideration and acceptance of alternatives for the future. However future alternatives will also have to address the role of technology, given its importance in this area of medicine.     

Intensive Care Ethics in Evolution

The ethics of treating the seriously and critically ill have not been static throughout the ages. Twentieth century medicine has inherited from the nineteenth century a science which places an inappropriate weight on diagnosis over prognosis and management, combined with a seventeenth century duty to prolong life. However other earlier ethical traditions, both Hippocratic and Christian, respected both the limitations of medicine and emphasised the importance of prognosis. This paper outlines some of the historical precedents for the treatment of the critically ill, and also how the current paradigm limits clinical practice and causes ethical tensions. An understanding that other paradigms have been ethically acceptable in the past allows wider consideration and acceptance of alternatives for the future. However future alternatives will also have to address the role of technology, given its importance in this area of medicine.     

"Decisions and Dispositions": Socializing Spatial Archaeology

Concerns with spatial dimensions and social inference have long histories in archaeology. However, the two histories are not always conjoined. This article considers changing understandings of space in archaeology in the last half century, and the variable nature of what "social" has denoted and connoted during that same span. The review highlights recurring calls for a social archaeology, and the degree to which, in such instances, social inference has been expressed in spatial terms, especially as these have recognized people's "decisions and dispositions" as shaping the archaeological record. Life histories of place receive special attention as ways of discerning the existence and social impact of such decisions and dispositions. These life histories constitute an arena in which archaeologists from diverse theoretical perspectives can offer complementary insights. Moreover, they exemplify ways in which social and spatial inferences in archaeology contribute to wider understanding of human experience. [Keywords: archaeology, social, space, place, life history]     

A complex experimental assessment for objective description of hierarchical psychophysiological behavior as human regulatory phenotype

For the objective and valid identification of different human regulatory phenotypes it should be useful to analyze the behavior of different regulatory subsystems (Anochin 1976) in one multivariate design. Therefore in a DARA supported project a fully computerized and reliable laboratory assessment was developed and tested. We used a set of electrophysiological parameters that should indicate the activity of different functional regulation systems on different "behavioral levels". Skin conductance, skin temperature and voice pitch were used as indicators of sympathico-parasympathical activity. Breathing, heart rate variability and bloodpressure should indicate cardiovascular activity and electromyogram and mimic variablity were thought as indicators of locomotional external behavioral activity. To identify physiological reactions which are influenced by emotional stress we used voice stress measures. Even in the field of aviation and space medicine there exist data about the correlation of voice pitch with emotional excitation (Hecker et. al. 1968, Williams et.al. 1969, Friedrich, Vaic 1978, Vaic et.al. 1981,1982, Griffin, Williams 1987). In our former study (MOSAIC-study, Johannes 1990) the voice pitch and its variation range correlated with perceived emotional excitation but were independent of real bloodpressure variations. Two different types of pitch reaction to this experimental design were correlated to psychological personality scales and assigned subjects to "sensitizers" and "suppressors".