CHAPTER 2

THE WAR AGAINST DISEASE

第2章

与疾病的战争

In War

战争年代

The death rate for all diseases in the Army, including the overseas forces, has been reduced from 14.1 per thousand in the last war to 0.6 per thousand in this war.

包括海外部队在内的军队所有疾病的死亡率已从上次战争中的14.1%降至在这场战争中的0.6%。

Such ravaging diseases as yellow fever, dysentery, typhus, tetanus, pneumonia, and meningitis have been all but conquered by penicillin and the sulfa drugs, the insecticide DDT, better vaccines, and improved hygienic measures. Malaria has been controlled. There has been dramatic progress in surgery.

黄热病、痢疾、斑疹伤寒、破伤风、肺炎和脑膜炎等肆虐的疾病几乎都被青霉素和磺胺类药物、杀虫剂滴滴涕、更好的疫苗和改进的卫生措施所征服。疟疾得到了控制。外科手术取得了巨大进展。

The striking advances in medicine during the war have been possible only because we had a large backlog of scientific data accumulated through basic research in many scientific fields in the years before the war.

战争期间医学的惊人进步之所以成为可能，仅仅是因为我们在战前几年通过许多科学领域的基础研究积累了大量的科学数据。

In Peace

和平时期

In the last 40 years life expectancy in the United States has increased from 49 to 65 years largely as a consequence of the reduction in the death rates of infants and children; in the last 20 years the death rate from the diseases of childhood has been reduced 87 percent.

在过去40年中，美国的预期寿命从49岁增加到65岁，这主要是由于婴儿和儿童死亡率的降低；在过去20年中，儿童疾病的死亡率降低了87%。

Diabetes has been brought under control by insulin, pernicious anemia by liver extracts; and the once widespread deficiency diseases have been much reduced, even in the lowest income groups, by accessory food factors and improvement of diet. Notable advances have been made in the early diagnosis of cancer, and in the surgical and radiation treatment of the disease.

糖尿病通过胰岛素得到控制，肝脏提取物导致恶性贫血；曾经广泛存在的缺乏症即使在最低收入群体中，也会因辅助食物因素和饮食改善而减少。在癌症的早期诊断、手术和放射治疗方面取得了显著进展。

These results have been achieved through a great amount of basic research in medicine and the preclinical sciences, and by the dissemination of this new scientific knowledge through the physicians and medical services and public health agencies of the country. In this cooperative endeavour the pharmaceutical industry has played an important role, especially during the war. All of the medical and public health groups share credit for these achievements; they form interdependent members of a team.

这些结果是通过医学和临床前科学的大量基础研究，并通过医生、医疗服务和国家公共卫生机构传播新的科学知识。在这一合作努力中，制药工业发挥了重要作用，特别是在战争期间。所有的医疗和公共卫生团体都为这些成就获得殊荣；他们是团队中相互依存的成员。

Progress in combating disease depends upon an expanding body of new scientific knowledge.

抗击疾病的进展取决于不断扩大的新的科学知识。

Unsolved Problems

未解决的问题

As President Roosevelt observed, the annual deaths from one or two diseases are far in excess of the total number of American lives lost in battle during this war. A large fraction of these deaths in our civilian population cut short the useful lives of our citizens. This is our present position despite the fact that in the last three decades notable progress has been made in civilian medicine. The reduction in death rate from diseases of childhood has shifted the emphasis to the middle and old age groups, particularly to the malignant diseases and the degenerative processes prominent in later life. Cardiovascular disease, including chronic disease of the kidneys, arteriosclerosis, and cerebral hemorrhage, now account for 45 percent of the deaths in the United States. Second are the infectious diseases, and third is cancer. Added to these are many maladies (for example, the common cold, arthritis, asthma and hay fever, peptic ulcer) which, though infrequently fatal, cause incalculable disability.

正如罗斯福总统所观察到的那样，每年死于一两种疾病的人数远远超过了这场战争中美国人在战场上丧生的总人数。这些平民死亡中的很大一部分缩短了我国公民的有用生命。这是我们目前的立场，尽管在过去三十年中，民用医学取得了显著进展。儿童期疾病死亡率的降低已将重点转移到中老年群体，特别是恶性疾病和后期生活中突出的退化过程。心血管疾病，包括慢性肾脏疾病、动脉硬化和脑出血，目前占美国死亡人数的45%。其次是传染病，第三是癌症。除此之外，还有许多疾病（例如，普通感冒、关节炎、哮喘和花粉热、消化性溃疡），这些疾病虽然很少致命，但却会导致无法估量的残疾。

Another aspect of the changing emphasis is the increase of mental diseases. Approximately 7 million persons in the United States are mentally ill; more than one-third of the hospital beds are occupied by such persons, at a cost of $175 million a year. Each year 125,000 new mental cases are hospitalized.

重点变化的另一个方面是精神疾病的增加。美国约有700万人患有精神病；超过三分之一的医院床位被这些人占用，每年花费1.75亿美元。每年有125000名新的精神病患者住院治疗。

Notwithstanding great progress in prolonging the span of life and in relief of suffering, much illness remains for which adequate means of prevention and cure are not yet known. While additional physicians, hospitals, and health programs are needed, their full usefulness cannot be attained unless we enlarge our knowledge of the human organism and the nature of disease. Any extension of medical facilities must be accompanied by an expanded program of medical training and research.

尽管在延长寿命和减轻痛苦方面取得了巨大进展，但仍有许多疾病尚未得到充分的预防和治疗手段。虽然需要更多的医生、医院和健康项目，但除非我们扩大对人体和疾病本质的了解，否则无法充分发挥它们的作用。医疗设施的任何扩展都必须伴随着医疗培训和研究的扩展计划。

Broad and Basic Studies Needed

亟需全领域的基础研究

Discoveries pertinent to medical progress have often come from remote and unexpected sources, and it is certain that this will be true in the future. It is wholly probable that progress in the treatment of cardiovascular disease, renal disease, cancer, and similar refractory diseases will be made as the result of fundamental discoveries in subjects unrelated to those diseases, and perhaps entirely unexpected by the investigator. Further progress requires that the entire front of medicine and the underlying sciences of chemistry, physics, anatomy, biochemistry, physiology, pharmacology, bacteriology, pathology, parasitology, etc., be broadly developed.

与医学进展相关的发现往往来自遥远和意外的来源，可以肯定的是，这在未来将是真实的。心血管疾病、肾脏疾病、癌症和类似难治性疾病的治疗很可能会取得进展，这是与这些疾病无关的受试者的基本发现的结果，可能是研究人员完全意想不到的。进一步的进步要求医学的整个前沿以及化学、物理学、解剖学、生物化学、生理学、药理学、细菌学、病理学、寄生虫学等基础科学得到广泛发展。

Progress in the war against disease results from discoveries in remote and unexpected fields of medicine and the underlying sciences.

在与疾病的斗争中取得的进展源于医学和基础科学的偏远和意外领域的发现。

Coordinated Attack on Special Problem

特殊问题的协同攻关

Penicillin reached our troops in time to save countless lives because the Government coordinated and supported the program of research and development on the drug. The development moved from the early laboratory stage to large scale production and use in a fraction of the time it would have taken without such leadership. The search for better anti-malarials, which proceeded at a moderate tempo for many years, has been accelerated enormously by Government support during the war. Other examples can be cited in which medical progress has been similarly advanced. In achieving these results, the Government has provided over-all coordination and support; it has not dictated how the work should be done within any cooperating institution.

青霉素及时送达我们的军队，挽救了无数人的生命，因为政府协调并支持了该药物的研发计划。开发从早期的实验室阶段转向大规模生产和使用，只需很少的时间就可以完成。多年来，人们一直在以温和的速度寻求更好的抗疟疾药物，但在战争期间，政府的支持大大加快了这一进程。其他例子也可以列举，在这些例子中，医学进步也取得了类似的进展。为了取得这些成果，政府提供了全面的协调和支持，同时政府并没有对这些合作机构该如何开展具体工作指手画脚。

Discovery of new therapeutic agents and methods usually results from basic studies in medicine and the underlying sciences. The development of such materials and methods to the point at which they become available to medical practitioners requires teamwork involving the medical schools, the science departments of universities, Government and the pharmaceutical industry. Government initiative, support, and coordination can be very effective in this development phase.

新治疗剂和方法的发现通常来自于医学和基础科学研究。这种材料和方法的发展到可用于医疗的程度从业者需要医学院、大学科学系、政府和制药行业的团队合作。政府的倡议、支持和协调在这一发展阶段可能非常有效。

Government initiative and support for the development of newly discovered therapeutic materials and methods can reduce the time required to bring the benefits to the public.

政府对开发新发现的治疗材料和方法的倡议和支持可以尽早惠及民众，减少大家等待时间。

Action is Necessary

行动的必要性

The primary place for medical research is in the medical schools and universities. In some cases coordinated direct attack on special problems may be made by teams of investigators, supplementing similar attacks carried on by the Army, Navy, Public Health Service, and other organizations. Apart from teaching, however, the primary obligation of the medical schools and universities is to continue the traditional function of such institutions, namely, to provide the individual worker with an opportunity for free, untrammeled study of nature, in the directions and by the methods suggested by his interests, curiosity, and imagination. The history of medical science teaches clearly the supreme importance of affording the prepared mind complete freedom for the exercise of initiative. It is the special province of the medical schools and universities to foster medical research in this way—a duty which cannot be shifted to government agencies, industrial organizations, or to any other institutions.

医学研究的主要场所是医学院和大学。在某些情况下，调查小组可以对特殊问题进行协调直接攻克，以补充陆军、海军、公共卫生服务和其他组织进行的类似攻关。然而，除了医学院和大学的首要任务是继续这些机构的传统职能，即为个体工作者提供一个自由、不受限制地研究自然的机会，按照其兴趣、好奇心和想象力所建议的方向和方法。医学历史清楚地告诉我们，给予准备好的大脑完全自由以行使主动权是极其重要的。以这种方式促进医学研究是医学院和大学的特殊职责，这一职责不能转移给政府机构、产业组织或任何其他机构。

Where clinical investigations of the human body are required, the medical schools are in a unique position, because of their close relationship to teaching hospitals, to integrate such investigations with the work of the departments of preclinical science, and to impart new knowledge to physicians in training. At the same time, the teaching hospitals are especially

well qualified to carry on medical research because of their close connection with the medical schools, on which they depend for staff and supervision.

如果需要对人体进行临床调查，由于学校与教学医院的密切关系，学校处于独特的地位，可以将此类调查与临床前科学部门的工作相结合，并在培训中向医生传授新知识。同时，教学实践医院尤其有资格开展医学研究，因为它们与医学院有着密切的联系，依靠医学院的工作人员和监督。

Between World War I and World War II the United States overtook all other nations in medical research and assumed a position of world leadership. To a considerable extent this progress reflected the liberal financial support from university endowment income, gifts from individuals, and foundation grants in the 20’s. The growth of research departments in medical schools has been very uneven, however, and in consequence most of the important work has been done in a few large schools. This should be corrected by building up the weaker institutions, especially in regions which now have no strong medical research activities.

在第一次世界大战和第二次世界大战之间，美国超越了所有其他国家，在医学研究方面取得了领先地位。至这一进展在很大程度上反映了20年代来自大学捐赠收入、个人捐赠。然而，医学院研究部门的发展非常不平衡，因此，大多数重要工作都在少数几所大学校完成。这应该通过建立小型机构来弥补，特别是在目前没有强大医学研究活动的地区。

The traditional sources of support for medical research, largely endowment income, foundation grants, and private donations, are diminishing, and there is no immediate prospect of a change in this trend. Meanwhile, research costs have steadily risen. More elaborate and expensive equipment is required, supplies are more costly, and the wages of assistants are higher. Industry is only to a limited extent a source of funds for basic medical research.

医学研究的传统支持来源，主要是捐赠收入、基金会赠款和私人捐赠正在减少这种趋势不会立即改变。同时，研究成本已经稳步上升。需要更精细和昂贵的设备，用品更昂贵，助理的工资也更高。产业只是基础医学研究的有限资金来源。

It is clear that if we are to maintain the progress in medicine which has marked the last 25 years, the Government should extend financial support to basic medical research in the medical schools and in the universities, through grants both for research and for fellowships. The amount which can be effectively spent in the first year should not exceed 5 million dollars. After a program is under way perhaps 20 million dollars a year can be spent effectively.

很明显，如果我们要保持过去25年来在医学方面取得的进展，政府应该通过研究和研究金赠款提供财政支持医学院和大学的基础医学研究。第一年可以有效使用的金额不应超过500万美元。在一个项目实施后，每年的有效花费或可达到2000万美元。