Medical replacements
for heart, lungs, liver, pancreas, and other important organs become routinely
feasible. For your convenience, the diseases are arranged in alphabetic
sequence and thus the order in which they are presented has nothing to do with
I heir frequency or seriousness. In this part of our book we tell you about a number
of diseases-some potential killers, others disablers, some just nuisances. You
may be puzzled by our approach and by use of some words new to you in
discussions about your health. For example, you will find mentioned scenario,
also primary, secondary, and even tertiary prevention of disease.
We use the word scenario because it conveys the idea of the
dynamic picture the physician can foresee for the course of a disease after he
completes his questioning to understand the patient's symptoms, his physical
examination, and his study of x-ray and laboratory reports. Sometimes, there
can be no valid scenario until the physician sees the patient in several return
visits. For example, two patients may have high blood pressure.
Mr. One has a
pressure reading of 164 over 98; so does Mr. Two. But in subsequent
measurements of blood pressure, Mr. One's has settled down to 150 over 86
whereas Mr. Two's has gone to 190 over 110. Mr. One has no signs and symptoms,
whereas Mr. Two shows a small hemorrhage in his retina and slight enlargement
of the heart.
The physician will see very different scenarios or possible
future courses for these two patients, and his preventive treatments will be
much more active for Mr. Two than for Mr. One. By primary prevention, we mean
measures that can be used to prevent a disease completely. A good example would
be the use of the Sabin vaccine to keep polio from developing. By secondary
prevention, we mean the use of measures to keep a disease that is already
present from progressing.
For example, for a patient with a definite ulcer of
the duodenum, the physician can foresee and wants to avoid a scenario in which
hemorrhage, perforation, or scarring and obstruction may take place; so he
institutes diet and medical therapy as part of a secondary prevention program.
We may be the first to employ the word tertiary for preventive medicine.
Our concept is that
when every type of secondary prevention may fail, there is still a chance of
providing new health for the patient in a special way-that is, by giving him a
new organ to replace the destroyed organ. For that, however, the patient's
general health must not become so undermined that the new organ would be of
little use.
For example, suppose every effort has failed to stop the ravages of
nephritis (Bright's disease); the kidneys have failed; the patient is in uremic
poisoning. If the physician institutes tertiary preventive measures at this
time to avoid damage to the heart and brain and eyes, then at a suitable time
he can save the patient with a kidney transplant. In the future, this type of
tertiary prevention may become very common as transplants or mechanical
