Modern medicine and modern science and technology do not only study things and phenomena, but also study the change and development process of things and phenomena and the relationship between things. From the science of “sorting materials” to a rigorous and comprehensive system.
Modern medicine has experienced the foundation laying in the 16th ~ 17th century, the systematic classification in the 18th century, the great development in the 19th century, and the close combination with modern science and technology in the 20th century.
The characteristics of medicine in the 20th century are: on the one hand, it develops to the micro, such as molecular biology; On the one hand, it is developing towards macro. In terms of macro development, it can be divided into two types: first, people realize that man himself is a whole; The second is to study man as a whole closely interacting with the natural environment and social environment.
Since the 20th century, the most outstanding achievement in basic medicine is the development of basic theory, which has effectively promoted clinical medicine and preventive medicine. Effective means to treat and prevent diseases began to appear in the 20th century. The main reason for the development of medicine in the 20th century is the progress of natural science. The interdisciplinary integration of various disciplines has become one of the characteristics of modern medicine.
The main achievements of medicine since the 20th century are as follows:
Advances in medical treatment. In the latter half of the 19th century, due to the progress of pharmacology, although there were some improvements in treatment, there was still nothing to do with most diseases, especially some infectious diseases with known etiology.
The invention of chemotherapy and antibiotics in the 20th century changed this situation. In 1908, German P. Ehrlich (1854 ~ 1915) and Japanese Qin Zuo Ba Lang (1873 ~ 1938) found that 606 could treat spirochete disease, creating the pioneer of chemotherapy. In 1935, g.j.p. domark (1895 ~ 1964) developed sulfonamides, which can treat diseases caused by a variety of bacteria.
In 1928, British A. Fleming (1881 ~ 1955) found that penicillin had bactericidal ability. After 1941, H.W. Flory (1898 ~ 1968) and E.B. chann (1906 ~ 1979) used penicillin in clinic. In 1944, American S.A. Waxman (1888~1973) found streptomycin to treat tuberculosis. Then new antibiotics appeared one after another. These specific therapies are epoch-making advances in the history of treatment.
In 1922, F.G. Banting (1891~1941) extracted insulin successfully, which can be used to treat diabetes.
In the second half of the 20th century, the continuous emergence of new drugs, including new antibiotics, has significantly improved the efficacy of some diseases. At the same time, treatment methods have also made significant progress, such as the application of combined chemotherapy from the treatment of leukemia to the treatment of some other tumors; Application of element diet and intravenous hypernutrition therapy in patients with severe weakness; Immunotherapy, etc.
These drugs and therapies make some chronic and refractory diseases change the prognosis and improve the curative effect. The continuous improvement of medical instruments such as electric defibrillation, artificial cardiac pacemaker and artificial respirator has significantly improved the treatment effect of some diseases.
② Development of diagnostic technology. W. C. roentgen discovered X-ray in 1895. By the beginning of the 20th century, X-ray diagnosis had become an important means of clinical medicine. It was first used to observe the state of bones. In 1906, the gastrointestinal movement was examined with the help of bismuth paste. Later, barium meal and lipiodol were used for X-ray radiography.
Since then, important advances in diagnostic techniques include ECG (1903), syphilis serum reaction (1906), cerebral angiography (1911), cardiac catheterization (1929) and EEG (1929). In the early 1950s, ultrasonic technology was applied to medicine. In the 1960s, optical fiber was used to make gastroscope in Japan. Now a variety of fiber-optic endoscopes have been applied in clinic. After the 1970s, small lesions can be found after the application of computer X-ray tomography (CT) and magnetic resonance imaging.
Laboratory diagnostic methods have also been developed, such as sensitive radioimmunoassay, which can determine the content of body components at microgram level. Other electronic instruments should also be used in clinical departments, such as cardiopulmonary monitor γ- Photography and electronic computers are also used in diagnostic systems.
Fetal hemophilia was diagnosed by amniotic fluid examination in 1960. Prenatal chromosome examination of genetic diseases was carried out in 1967. A method for measuring enzyme activity in amniotic fluid was found in 1968, which can be used to diagnose congenital metabolic defects. In the 1970s, alpha fetoprotein in amniotic fluid could be measured to diagnose fetal malformations, and prenatal diagnosis reached a new level.
③ Endocrinology. In 1901, adrenaline was isolated from Gaofeng ranggi. Soon, pancreatin was also extracted. Human beings began to understand the function of humoral regulation. Later, thyroxine, insulin and various sex hormones were isolated and purified successively. Adrenocortical hormone was extracted in the 1940s and thyrotropin releasing hormone was isolated from the 1950s to 1960s. In the 1960s, the second messenger theory was put forward to clarify the action mechanism of nitrogen-containing hormones and promote the development of endocrinology to the molecular field.
④ Nutrition. Before the 20th century, nutrition as a subject term rarely appeared in the literature. After entering the 20th century, nutrition has developed greatly. Firstly, the importance of protein in nutrition is becoming more and more clear. British biochemists f.g. Hopkins (1861 ~ 1947) and E. Wilcock studied at Cambridge University in 1906 and American biochemists T. Osborne and L.B. Mendel at Yale University in 1916.
They proved that some proteins have high nutritional value and others have incomplete nutritional value. In the 1930s, W. Ross of the United States spent five or six years figuring out the difference between essential and non essential amino acids. In 1938, he proved that human beings needed eight essential amino acids. The second is the successive discovery of vitamins, such as vitamin B1 (C. Fink, 1913); vitamin A (e. mccullem and M. Davis, 1913); vitamin D (o. Rosenheim, and t. Webster et al., 1926); vitamin C (A. St. jergie, 1928); vitamin B2 (R. Kuhn et al., 1933); vitamin E (H. Evans et al., 1936); vitamin B6 (S. lepkovsky et al., 1938) ; vitamin K (P.H. dum and D. fox, 1948), etc.
The third is the recognition of the important role of trace elements such as zinc, copper, manganese, cobalt, molybdenum and iodine in the second half of the 20th century. Due to the progress of nutritional knowledge, human beings have understood the causes of various nutrient deficiency diseases, so it is possible to take “fortified food” and other measures to prevent and control them, and make “complete parenteral nutrition” This treatment method first reported by S. duderek in 1968 can effectively save the lives of patients with severe malnutrition due to gastrointestinal dysfunction and other reasons.
⑤ Molecular biology. Molecular biology is to understand the essence of life phenomena by studying the structure and interaction of biological macromolecules (proteins, enzymes, nucleic acids, etc.). The research of molecular biology has promoted the development of molecular medicine and human understanding of “molecular diseases” In general, although the rise of molecular biology has not been long, its influence has gradually penetrated into various fields of biology and medicine, and some emerging disciplines have emerged, such as molecular genetics, molecular cytology, molecular pharmacology, molecular pathology, molecular immunology, etc. This will promote the development of medicine.
⑥ Medical genetics. Classical genetics made great progress in the early 20th century. Through family investigation, the genetic mode of many genetic diseases has been clarified. However, only after the rise of molecular biology, people can gradually explore the pathogenesis of genetic diseases at the genetic level. Later, Lu Xun confirmed that many diseases are defective functional proteins caused by gene defects (such as hemoglobin and various enzymes), and finally produce various corresponding symptoms (such as anemia and various metabolic disorders) At present, we can use the techniques of molecular genetics to diagnose whether the fetus has genetic diseases before delivery.
Molecular geneticists are also studying the possibility and ways of introducing normal genes into patients with genetic diseases. ⑦ immunology. After the 20th century, a series of preventive vaccines have been successfully developed, which has a significant effect on controlling many infectious diseases.
In the early 20th century, it has been found that antibodies against self tissues can be found in the human body. After the invention of immunofluorescence technology in 1942, it is possible to confirm the widespread existence of autoantibodies. In the middle of the 20th century, people found the phenomenon of immune tolerance and successfully induced the tolerance state in experimental animals, which led to the emergence of cell line selection theory. This makes people gradually realize that the role of immunity is not limited to anti infection , it can identify “self” and “non self”, so as to maintain the stability of the body.
Since then, the progress of immunology has emerged one after another. In the 1950s, it was found that the thymus is related to immunity, and the structure of immunoglobulin has been clarified; in the 1960s, the role of T cells and B cells was discovered, and the monoclonal antibody technology was born in the mid-1970s.
In 1974, N.K. Jenna put forward the theory of immune network. In terms of clinical application, immunological technology as a diagnostic method can be said to have started at the beginning of the century, but the most prominent contribution should be tissue and organ transplantation.
Immunology has now become one of the most important basic sciences affecting biology and medicine. In 1971, the world immunology society agreed that immunology should be separated from microbiology It includes: immunochemistry, immunobiology, immunogenetics, immunopathology, clinical immunology, tumor immunology and transplantation immunology.
⑧ The development of surgery. At the beginning of the 20th century, K. Landsteiner discovered the blood type and made blood transfusion safe through blood matching. At this time, he also began to apply local anesthesia. In the 1940s, muscle relaxants were used clinically, and then antibiotics were used in surgery. These solved the basic problems of surgical treatment.
Since then, various specialties in the field of surgery have been independent, such as brain surgery, cardiovascular surgery, orthopedics, digestive surgery, plastic surgery and so on.
Modern neurosurgery began in the 20th century and has made rapid progress since the 1960s. Computer X-ray imaging is a major progress in diagnostic technology in the 1970s, which improves the diagnostic rate of many intracranial diseases, especially intracerebral hemorrhage and intracranial tumors. In some neurosurgery centers, CT and magnetic resonance have replaced other contrast examinations. The development of microsurgery technology has expanded the field of surgery , it improves the success rate of surgery for complex intracranial lesions, and gives the opportunity to treat some diseases that could not be operated in the past.
The surgical treatment of cerebrovascular diseases has made outstanding progress. The surgical mortality of cerebral aneurysms has been reduced from 50 ~ 80% to about 3%. The success of extracranial intracranial artery anastomosis has opened up a new way for the treatment of ischemic cerebrovascular diseases In particular, there has been some progress in the treatment of malignant glioma and severe craniocerebral injury.
Microsurgical technology has developed rapidly, and the most commonly used is peripheral nerve repair. The development of microvascular anastomosis technology has brought the transplantation and replantation surgery to a new level. It also makes the free transplantation of living bone a reality. Microsurgical technology has also promoted the replantation of severed limbs, especially severed fingers Level.
⑨ Organ transplantation and artificial organs. In 1913, a. Carrell put forward the idea of organ removal, culture and transplantation. In 1933, allogeneic corneal transplantation was successful, and in 1954, twin brother kidney transplantation was first successful. Later, with the progress of immunology, liver transplantation (T.E. statzer, 1963), lung transplantation (J.D. Hardy, 1963) and pancreas transplantation (C.W. lillehigh, 1966) In 1967, South African surgeon C. Barnard performed the first heart transplantation. Bone marrow transplantation has also made great achievements. Dentists are also experimenting with transplanting children’s tooth germs into adult gums to produce new teeth.
Since the 1940s, modern science and technology has directly entered the medical field. Medicine has been integrated with biology, chemistry, electronics, mathematics, mechanics, polymer chemistry and engineering. Biomedical engineering has emerged, and various artificial organs are one of its achievements.
In 1945, after two years of research and application, the Dutch W.J. kolf first succeeded in using artificial kidney in the treatment of acute renal failure; later, he began to develop artificial heart in the United States; in 1962, Starr successfully replaced mitral valve with artificial spherical valve; in the 1950s, the clinical application of artificial cardiopulmonary machine and artificial hypothermia enabled open heart surgery under cardiopulmonary bypass. In 1982, the United States Chinese doctors implanted a “Jarvik-7” artificial heart into a 61 year old heart patient, bringing this field to a new stage.
In the late 1950s, biomedical engineering became an independent discipline. In addition to artificial organs, it also studied artificial joints, artificial limbs, artificial senses, etc. in the 1960s, lasers were used in clinic. In 1960, the first laser was first used in ophthalmology.
⑩ Psychiatry. At the beginning of the 20th century, e. kreppelin (1856 ~ 1926) in Germany introduced the classification of psychosis by means of works and lectures, and clarified the significance of early-onset dementia, so as to make psychosis one of the scientific foundations.
Freud (1856 ~ 1939) in Vienna created the theory of “psychoanalysis”, which holds that the spiritual function affects the potential consciousness, and the sexual instinct has an important relationship with this function.
Before 1930, there were few effective psychotherapy. For example, Plasmodium inoculation was used to treat paralytic dementia in 1918. In the 1930s, insulin shock therapy and electroconvulsive therapy were successively applied in clinic, which became the two major psychotherapy methods before the application of chemical therapy.
Chlorpromazine was synthesized in 1950 and successfully used in psychiatric patients by P. delay in 1952. Later, reserpine was discovered In the second half of the 20th century, disciplines that discussed the relationship between psychology, health and disease, such as psychosomatic medicine and behavioral medicine, appeared one after another.