1999年医学博士外语真题试卷

Directions： For each numbered blank in the following passage there are four choices marked A, B, C and D listed below. Choose the best answer and mark your answer on the ANSWER SHEET.

The problem of caring for the weak and sick members of society has existed from the very earliest times. But the idea is a new one in the history of man.

The Greek, for instance, had_31_public institutions for the sick. Some of their doctors maintained surgeries where they could carry on their work, but they were very small, and only one patient could be treated_32_. The Romans, in times of war, established infirmaries,_33_were used to treat sick and injured soldiers. Later on, infirmaries were founded in the larger cities and were_34_out of public funds.

_35_, the Roman influence was responsible for the establishment of hospitals. 36 Christianity grew, the care of the sick became the duty of the Church. During the Middle Ages monasteries and convents provided most of the hospitals Monks and nuns were the nurses.

The custom of making pilgrimages to religious shrines also helped advance the_37_of hospitals. These pilgrimages were often long, and the travelers had to stop_38_at small inns along the road. These inns were called hospital, or guest houses, from the Latin word hopes, meaning a guest”. The inns connected with the monasteries_39_themselves to caring for travelers who were ill or lame or weary. In this way the name “hospital” became connected with_40_for the afflicted.

Since living conditions during the Middle Ages were not very comfortable or hygienic, the hospitals of those days were_41_clean or orderly. In fact, many_42_hospital would put two or more patients in the same bed!

During the seventeenth century, there was a general_43_living conditions. People began to feel that it was the duty of the state to care for its ailing citizens. But it wasn’t_44_the eighteenth century that public hospitals became general in the larger towns of England. Soon, the idea of public hospitals began to_45_and they appeared all over Europe.

Dear Board of Education:

On behalf of the residents of the townhouses located on Franklin Street near the proposed college along River Road, I want to protest the building of the college as it is presently planned. We oppose it because:

First, the college will block our view of the river. This is disturbing not only for aesthetic reasons; it will also decrease the value of our houses if we are ever to sell them.

Second, there are two high-rise apartment buildings to the south of us blocking sunlight from that direction during a good part of the day. If the college is built to the west of us that will decrease the amount of sunlight we get even more.
Third, parking will become even bigger problem than it already is. From what we understand, there are no provisions for parking for college staff and students. This will only compound a problem that is already a serious one for this neighborhood, lack of space for on-street parking.
Fourth, the proposed main entrance to the college is on Franklin Street, which is a very narrow street already overloaded with street traffic. Having the college entrance on this street will cause an increase in traffic and unnecessary dangers to the residents of both the townhouses and the high rise apartment buildings, many of whom are children.

If we have to accept the college being built in this location, we would like to suggest several changes to the plans. First, the college should create a parking area for college personnel, perhaps in the empty space on Chambers Street and West Street, so that our parking problems will not be in-creased. Second, the main entrance should be moved to either River Road or Chambers Street, thus relieving the amount of traffic on a residential street. Finally, the Board of Education should con-tribute to expanding and improving the park on River Road so that residents of the area have a pleasant and safe place to enjoy the view and the sunlight.

Thank you for your attention.

Sincerely,

Frank Hampton

As today’s bride walks down the aisle with her future husband, she has every excuse for being nervous. She is about to exchange vows of lifelong commitment; fidelity and mutual support. Yet all around her, she can see that many people do not and cannot live up to these vows. Her own marriage faces a one in three chance of divorce, if present trends continue.

Traditionally marriage in Britain is currently in a turmoil. Not only is the divorce rate rising, but the rate at which people marry is failing. Living together is more popular than ever before. The shape of the family is now no longer one man, one woman and their children. Instead, there are growing numbers of families which include step-patents, half sisters and brothers, or merely one lone parent coping on her own.
Compared with other countries, Britain is still conservative in its marriage patterns. In America, the divorce rate is even more startling. Two out of five marriages end in divorce. In Sweden living together is now more popular than marriage among couples in their early twenties and a similar pattern seems to be emerging in Denmark.

Although this is happening on a smaller scale in Britain, it has not yet become such a marked trend. But if we do follow the America and Scandinavian patterns, the future will see many more couples living together before marriage—and even more divorce.

Interestingly enough, it is women rather than men who get a divorce in the courts. Seven out of ten divorces are granted to the wife. Divorce, of course, only reflects the legal winding up of a marriage which may have effectively broken up long before. The partner who petitions for divorce may not be the partner who broke up the marriage. Women usually have more to gain from the courts in the way of alimony rights to the home, and child maintenance. But there is also a fascinating disproportion in one of the grounds that the sexes choose for divorce. The grounds of unreasonable or cruel behaviors are overwhelmingly chosen by ten times more women than men. Does this mean that women will put up with less than they used to?

Knowledge about sickness, death and other misfortunes is colored by perceptions of the body and how it functions, the place of the individual in the social order, and the cosmological forces that affect human beings. Many studies of local knowledge systems emphasize the “exotic” causes to which chronic conditions and disabilities are attributed. Witches, spirits or pollution resulting from improper behaviour may be regarded as the causes of mental or physical impairment. Such cultural explanations are ways of putting disability in context, of making sense of it in relation to social conflicts, moral lapses and the influence of unseen powers. They help people to understand an individual’ s condition in terms of the whole life situation.

Identifying causes is often a first step towards treatment. In many health cosmologies, dealing with the reason for a condition holds out the hope of a permanent cure. Dealing merely with symptoms may only give temporary relief until another disaster strikes; the underlying social and moral problems remain. Eliminating pollution, counteracting witchcraft or making offerings to spirits are efforts to tackle the powers responsible for problems and thus to solve them once and for an.

Of course, it often happens that a person with a disability does not improve when measures of these kinds have been adopted. Other causes may then be sought until the affected family accepts that the condition cannot be changed. It is this point that people in East Africa begin to speak of the “work of God”, unalterable by the efforts of humans. The difference between misfortunes which can be dispelled and the workings of fate which cannot be changed only becomes evident over time.

In contrast rehabilitation programmes are based on the cultural belief that disability can be diminished through constant effort, training, individual adjustment and, to some extent, environmental adaptation. The goal is improved function, not cure. The individual is the Object of long terra special attention. Here technical aids and training are the key, rather than attempts to eliminate the wider social and moral causes of the problem. Rehabilitation officers complain that families are insufficiently committed to such extended efforts over months and years, and that they are disappointed when there is no immediate improvement. There is a cultural gap but the problem is not necessarily that people trapped by traditional beliefs about disability. Culture is a matter of experience and most people in developing countries have little experience of the results of effective rehabilitation programmes. Consequently there is little commitment and confidence until the value of programmes has been demonstrated.

In all cultures, the people with special knowledge and powers to deal with suffering and death also have special obligations. In their respective societies, healers and health professionals have thus always been subject to a wide variety of written and unwritten rules.

For more than a millennium in the Western medical tradition, the Hippocratic oath has encapsulated some of the principles that ate still seen as essential for good practice in the health professions. And for almost 50 years now, the World Health Organization has set technical and ethical standards and proposed guidelines and codes of good practice in virtually all areas of health, as mandated by its Constitution. The Organization also contributes to the harmonization of legislation and terminology, and fosters the dissemination and exchange of information on these subjects.

Ethics today is a matter of lively public interest. This reflects a strong desire to assert some measure of control over the current proliferation of new biomedical and information technology. People want the benefits of science and technology,but they also want democratic: control over their own lives and societies. Hence the concern among the general public is to be consulted, to ensure that science and technology are harnessed to protect rather than endanger human dignity, health, well being and diversity.

Genetics, for example, offers the hope of therapies for previously incurable diseases but it also holds the risk of eugenics. Screening is a valuable tool for prevention and care, but may also lead to discrimination and breaches of confidentiality.

Organ transplants can save lives but they also raise difficult issues such as accessibility, cultural resistance and commercialization. Technology which prolongs life also prolongs the dying process.

These are not just theoretical matters. They concern the professional ethics of all those involved—scientists, health workers, economists and politicians alike. They also, of course, concern us all because they deeply affect our lives and relationships.

The issues raised will not be settled by a list of abstract principles or by medical judgment alone. Ethical dilemmas arise in concrete situations which are shaped by biomedical culture. They require careful consideration of both what is desirable and what is possible. For example, how do we balance individual with social needs? How do we ensure that quality of care is reconciled with equity and is not used as a pretext to serve the interests of the few7 If the development of technology is driven by market forces, what happens to the principle of health for all? How do we ensure that research and health development take into account the needs of the poor and provide them with effective health care and services?

There is a permanent steel arch across Main Street bearing a neon sign which reads WELCOME TO RENO THE BIGGEST LITFLE CITY IN THE WORLD.

Iris a quiet little town. We can see through our windshield almost to the end of Main Street, a dozen blocks away. Everything is sharp to the eye at this altitude, the sky is immaculate, and the morning jazz coming from the dashboard is perky. It is a clean town. The great gambling palaces are modernistic, battleship grey, and all their neon signs are lit in the sunshine. The traffic lights change and our vehicle moves cautiously ahead. But a block on we are halted by a policeman who steps off the sidewalk, he stops a truck coming the other way, and escorts an old lady slowly across the street. She goes into the sedate hank and trust company next to which is an elegant women’s clothing store and next to that a store with “Craps” in gold letters on its windows. Some stores feature “Horse Betting”, others “Casino”, and others “Wedding Rings”. In this momentary halt a loud buzzing draws our attention. A gambling emporium on the left, glistening inside, is broadcasting the buzzing noise into the street and flashing a sign over the sidewalk which says “jackpot”, indicating that some where within a customer has struck the full count.

The policeman, who wears gold-framed eyeglasses, waves us on, but a woman steps up to the side window of our vehicle. She is carrying a three-month-old baby on her arm, and a suitcase.

The woman: “Am I headed fight for the courthouse, Mister?”

Driver’s voice: “Straight on one block and then two left.”

The woman: “Thank you kindly. It’s awfully confusing here.”

Driver’s voice: “It sure is, ma’am.”

She steps back to the sidewalk. There is a rural pathos in her eyes an uprooted quality in the intense mistrust with which she walks. She is thin, and her polka-dot dress is too large. She is clutching the baby and the suitcase, as though she were continuously counting them.

The men set off in silence. Pedro walked with his dog a few paces behind the boys. When neighbors saw them walking along in this formation they would say that Pedro looked like a veritable patron striding behind his peons. Yet there were mornings when Pedro talked to the boys in the course of their two-hour walk to the fields, giving advice or telling, what work had to be done. The boys, however, spoke only in answer to a question. Out of their father’s earshot they would joke about their sweet hearts ox visits to the saloons of Cuahnahuac. But this morning they moved silently down the road.

It was still barely light. All around them, just beyond the far edges of the fields, the blue-green slopes of the pine-covered mountains rose through the morning mist, Pedro and Ricardo were headed for the mountain slope cornfield which they had cleared the year before. This was communal land belonging to the municipality which consisted of seven villages; anyone could work it. New clearings had to be made every two or three years, for heavy rains washed the top soil away. To acquire new fields Pedro and his sons burned the brush and weeds, cut down young trees, and built new stone fences. The boys worked well; they had the largest mountain clearing in Azteca. But the crops could supply enough corn and beans for only three or four months. So Pedro had to try other means of earning a living as well-making rope from maguey fiber, selling plums, hiring out his sons as farm-hands. One thing he would not do to earn money was to make charcoal for sale, as so many of his neighbors did. This practice, he knew, was wasteful of the precious oak and pine forests and ultimately ruined land. He had been one of the leaders in the struggle for the preservation of the communal forest lands. So he made charcoal only once a year and only for the use of his family.