culosis and pneumonia as would if 

 the mortality rate of 20 years ago 

 still preyailed. The death rate among 

 children between the ages of 5 and 

 14 from all causes combined was cut 

 57 percent between 1922 and 1942. 

 For eyery three children who die 

 under current conditions, more than 

 seyen would haye died if the death 

 rate of two decades ago had continued. 

 This reduction in the death rate in 

 childhood has shifted the emphasis 

 in medicine to the middle- and old- 

 age groups, and particularly to the 

 malignant diseases and the degenera- 

 tiye processes which are prominent in 

 the later decades of life. Cardioyas- 

 cular disease, including chronic dis- 

 ease of the kidneys, arteriosclerosis, 

 and cerebral hemorrhage, now ac- 

 counts for 45 percent of the deaths 

 in the United States. Second in im- 

 portance are the infectious diseases, 

 and third is cancer. Added to these 

 are many maladies (for example, the 

 common cold, arthritis, asthma and 

 hay feyer, peptic ulcer) which, 

 though infrequently fatal, cause in- 

 calculable disability. 



Another aspect of the changing 

 emphasis in clinical medicine is the 

 increasing incidence of mental dis- 

 ease. Approximately 7,000,000 per- 

 sons in the United States are men- 

 tally ill. More than one-third of the 

 hospital beds in this country are filled 

 with such persons at a cost of $175,- 

 000,000 annually. Each year nearly 

 125,000 mentally ill new patients are 

 hospitalized. 



In short, despite notable progress 

 in prolonging the span of human 

 life and in alleyiating suffering, ade- 

 quate methods of preyention and 

 cure are not yet ayailable for many 

 diseases. Additional hospitals, physi- 

 cians, and mechanisms for dispersing 

 knowledge, howeyer useful, cannot 



su])ply a complete solution. We sim- 

 ply do not know enough, and in- 

 creased facilities for medical care will 

 not supply the missing answers. The 

 basic task faced by medicine is con- 

 tinued exploration of the human 

 organism and the nature of disease. 

 This exploration has only begun. 



5. Importance of Fundamental 

 Research to the Progress of 

 Medicine 



Research in medicine may be car- 

 ried out eflfectiyely in two ways: 

 First, by a coordinated attack on a 

 particular disease; or second, by inde- 

 pendent studies of the fundamental 

 nature of the human body and its 

 physiological mechanisms, of the 

 nature of bacteria, yiruses, and other 

 agents of disease, and of the influence 

 of enyironment on both. An example 

 of the first method is the attack on 

 malaria carried out under the Army, 

 Nayy, Public Health Seryice, the 

 National Research Council, and the 

 Office of Scientific Research and De- 

 yelopment. The discoyery of peni- 

 cillin is an example of the second 

 method: Fleming noted that a com- 

 mon mold, Penicilliuvi notatum, in- 

 hibited the growth of a culture of 

 bacteria in which it appeared as a 

 contaminant. Thus an incidental ob- 

 servation in the course of studies un- 

 related to chemotherapy furnished 

 the basis for the ultimate deyelop- 

 ment of the most valuable chemo- 

 therapeutic agent known. 



Discoveries in medicine have often 

 come from the most remote and un- 

 expected fields of science in the past; 

 and it is probable that this will be 

 equally true in the future. It is not 

 unlikely that significant progress in 

 the treatment of cardiovascular dis- 

 ease, kidney disease, cancer, and other 



55 



