The Orifices -- Where Most of Medicine's Money Is Made

Since antiquity, physicians have used their senses to study and try to understand human health and disease. Sight, sound, touch, smell, and taste. For much of history and for most physician-clinicians today, those five senses, when used well, are enough. Listening to the patients' history remains the most important clinical tool. And, as Yogi Berra famously stated, "You can observe a lot by just watching."

But there are obvious limits, and good physicians have inquiring minds.

When I began medical school in 1953, my biochemistry professor, Dr Emmett B. Carmichael, told our entering class that doctors made most of their money at "the orifices." Natural anatomic orifices back then (and now) were the nostrils, the mouth, the ear canals, the urethra, the vagina, and the anus — openings that allowed the physician to take a look, palpate, and obtain a specimen or two in pursuit of a diagnosis. Many natural orifices have been used to mechanically access deeper regions.

Being a biochemist, the esteemed professor can be excused for not recognizing that the largest human organ, the skin, which is primarily subject to direct observation, could also become the largest human orifice.

Professor Carmichael may not have considered the potential of the hollow needle and syringe device (credited to Alexander Wood in Scotland, who invented it around 1850 to deliver medications into the body).