Before the Renaissance, there was little progress in clinical medicine. "There are many reasons for the lack of progress." "One of them must be that in those centuries, scholars only pursued the knowledge of God, not the knowledge of people. It was not until the Renaissance characterized by humanism that it began to change ... "Therefore, the main development in the last thousand years was actually mainly in the last five hundred years. The following is the main progress announced by NEJM in the form of topic outline.
Clarification of human anatomy and physiology
A remarkable first step in contemporary anatomy:16th century
Founder: Andreas Vesalius published his very important anatomical exposition in 1543. The attached illustrations (drawn by an unknown painter) provide a new standard for understanding human anatomy.
The Noteworthy First Step in Physiology:17th Century
Founder: William Harvey determined that blood circulation is a closed system, and the heart plays the role of a pump; After cardiac contraction, the artery fills to produce pulse; The right ventricle of the heart sends blood to the two lungs; The left ventricle transports blood to other parts of the body.
Other important people: Stephen hales (taking his blood pressure for the first time [on horseback]); Werner forssmann, Andre Kunand and Dickinson Richards (clinical application of cardiac catheterization); Robert Gross, Elliot Cutler, Charles Hefnagor and alfred blalock.
Discovery of cells and their basic structures
The noteworthy first step in cell biology:17th century
Founder: Antony van Leeuwenhoek, who brought the object close to his own lens (he was nearsighted), was able to see tiny "micro-animals" (probably bacteria and protozoa) for the first time, and thus found that tissues included complex internal structures.
Other important people: robert hooke (describing plant cells); Matthias Schleiden and Theodor Schwann (describing animal cells); Rudolf virchow, Ludwig Ashoff and Karl Rokitansky (their work in cell biology has led to a deeper understanding of the disease process).
The noticeable first step of subcellular biology: the 20th century.
Founder: Ernst Ruska made the first electron microscope in the early 1930s. From the initial device to the later advanced machine, the cell-rich subcellular structure became visible.
Other founders: George Paradi developed a method to separate subcellular components (such as mitochondria) in the 1950s. "The ingenious dance of different components of various cell types can finally be recognized."
Clarification of biochemistry
The first noticeable step in biochemistry:17th century
Founder: Thomas Willis began to think in 1659 that "the tragedy of every disease is caused by the power of some enzymes", which was exaggerated by some scientists, such as Antoine Lavoisier and Jonas Jakob Beerse.
Other important figures: Amadeo avogadro (the rule he proposed can calculate the atomic weight, determine the molecular structure and understand the enzyme reaction); Leonor Michaelis and Maud Menten (who discovered how to express enzymatic reactions in mathematical terms); Otto warburg (deducing the path of metabolism); And hans krebs (who discovered a pathway called the tricarboxylic acid cycle).
Other important discoveries: hormones and neurotransmitters; Information transmission path between cells (helpful to understand diseases, such as diabetes); The relationship between sodium and water and dehydration; The importance of potassium in the loss of body fluids in diarrhea.
Application of statistics in medicine
The noticeable first step of modern statistics:/kloc-the transition period of 0/7th century.
Founder: Pierre de Fermat and blaise pascal developed probability theory and used it to analyze accidental events. In London in the17th century, their idea of relative frequency was first applied to the mortality rate of plague.
Famous clinical trial: James Linde treated 12 septicemia passengers on board, and gave them preparations containing citrus juice or drugs recommended by doctors on board. The success of the preparation kit containing citrus juice led the British Admiral to instruct all sailors (who became members of the British Navy) to store lime juice, thus eliminating septicemia in the Royal Navy.
Other important figures in statistics: John Graunt (introducing the concept inferred from potential population and the sample describing life expectancy); C.F.Gauss (developed modern statistical reasoning); /kloc-Thomas Bayes, an English theologian in the 8th century (demonstrating how to apply probability to inductive reasoning); Sir ronald fisher (randomization principle, a method to avoid research bias); And Jerzy Neyman (estimation and testing theory).
The first noticeable step of modern epidemiology:19th century
Founder: John Snow proved that the spread of cholera came from polluted water by analyzing the disease incidence of people who used wide street pumping in Britain. In 1854, he stopped the spread of the disease by removing the pumping handle of the polluted well.
Other important people: Richard Doyle (who made a groundbreaking research on smoking among British doctors)
Development of anesthesia
The noticeable first step of modern anesthesia:19th century
Founder: 1799, humphry davy inhaled nitrous oxide when he had a toothache, thus discovering the anesthetic (analgesic) characteristics of nitrous oxide. He called it "laughing gas".
Other important people: dentist horace wells (1844 anesthetized patients with nitrous oxide for the first time); His former assistant William Morton demonstrated ether anesthesia at Massachusetts General Hospital. James young Simpson (chloroform anesthesia was used in women's delivery in 1847); There is Harold Griffith( 1942 introduces and routinely uses muscle relaxants in surgery).
Discover the relationship between microorganisms (bacteria) and diseases.
The first noticeable step to discover the relationship between microorganisms and diseases:19th century.
Founder: Louis Pasteur recognized bacteriology as a science. He proved that "all living things, including microorganisms, come from other living things"; He used heat treatment (flash pasteurization) to destroy microorganisms, which showed that inoculating attenuated Bacillus anthracis to sheep could protect sheep from getting sick, and found that rabies reagent could attenuate the virus; His immunization can prevent the little boy bitten by a mad dog from suffering the previous fatal results.
Other important people: robert koch (the first person to isolate bacteria through pure culture, discover the cause of cholera reagent and tuberculosis, and distinguish non-pathogenic (benign) bacteria of pathogenic bacteria by his own standard [robert koch's Law]); There is also joseph lister (spray disinfection with carbolic acid, insisting on disinfection of hands, instruments and dressings with disinfectant to make them safer in major operations).
Heredity and genetic interpretation
A noteworthy first step in genetics:19th century
Founder: Gregor Mendel did an experiment and reported his conclusion on pea character separation in 1865. Mendel's work was ignored until William Bateson and others rediscovered it in 1902.
Other important figures: archibald Garaude (found that congenital metabolic defects are hereditary); Thomas Hunt Morgan (mapping the distribution of genes along homologous chromosomes); George beadle, Edward Tatum and Boris Froussis (think that the function of genes is enzymes); Thomas Avery, Colin mcleod, McLean Macatee (found that DNA is genetic material); Erwin chargaff (describing the main components of DNA and base pairing rules); Rosalind franklin (revealing the double helix model through the X-ray diffraction pattern of DNA); James watson, francis crick and maurice wilkins (double helix model); Jacques Monod and Fran?ois Jacob (DNA expressed by messenger RNA as protein); Frederick sanger and walter gilbert (who created the method of decoding DNA base sequence); David Baltimore and Harold Temin (discovered the reverse transcriptase that can convert RNA into DNA) >
Famous Sequence Study: On the train from Denver to Chicago on 1949, William Castle told linus pauling about sickle cell anemia. Pauling and his colleagues confirmed that the molecular result of mutation (sickle cell anemia) led to genetic diseases, and named it "molecular diseases" (this sickle mutation was later confirmed by Vernon Ingram to be caused by single molecule and single amino acid substitution).
Understanding of the immune system
The noteworthy first step in immunology:19th century
Founder: emil behring and Kitasato Shibasaburo discovered diphtheria antitoxin in 1890, and found antibodies in the process. Almost at the same time, Eli Mechnikov identified phagocytes, which can devour foreign particles and promote the cellular theory of immunology.
Other important people: john enders (live measles vaccine); Thomas weller, frederick robbins and Enders (polio vaccine); Albert Sabin (attenuated poliovirus); Jonas salk (inactivated vaccine); And Michael Heidelberg (laying the foundation for pneumococcal vaccine)
The first vaccine was produced by DNA (to prevent hepatitis) and was approved by FDA on 1986. In the new Millennium, "vaccines based on DNA sequences are likely to undergo revolutionary changes, and microbial antigens may be compiled."
The development of human image
The first noticeable step of human body image: the transitional period of the 20th century.
Founder: wilhelm konrad rontgen discovered X-rays in 1895, so he won the first physics Nobel Prize in 190 1 year.
The first stage: imaging can be divided into three stages. In the first stage, the goal is to develop imaging technology to explain the anatomical characteristics and functions of internal organs. In order to achieve this goal, in addition to radiation, ultrasonic and radiation tracers and contrast agents have been developed in the process of revealing previously invisible structures.
The second stage: describe the heart and blood vessels by angiography. Other new tools, including computed tomography (CT or CAT scanning) and magnetic resonance imaging (MRI), have very small resolution and can see very small structures all over the human body.
Stage 3: Now directly use imaging methods to guide the treatment. From long-term tumor treatment guidance to recent online minimally invasive surgery.
Discovery of antimicrobial agents
The noticeable first step in the discovery of antibacterial agents: the turn of the 20th century.
Founder: paul ehrlich discovered Asfan Namin (also known as "606", which he tried 606 times) for treating syphilis, and confirmed that this dye also has antibacterial activity.
Other important people: Gerhard Domagk (he found that the red dye azosulfamide can cure streptococcal infection and develop into sulfonamides); Alexander fleming (accidentally found mold, Penicillium, can inhibit staphylococcus bacteria); Howard Florey and Ernst Chain (purification of penicillin and its clinical application); Rene Dubos (a biological force in the soil found an antibiotic); And selman Wachsman (a systematic study of soil biology and antibiotics found streptomycin, the second most important antibiotic in clinic).
Development of molecular drug therapy
The noticeable first step of molecular drug therapy: at the turn of the 20th century.
Founder: When paul ehrlich experimented with the therapeutic potential of organic dyes, he named it "chemotherapy", which expanded the concept of "panacea" from infectious diseases to cancer.
Other important people: Thomas Beatson (ovariectomy for breast cancer patients); Charles Huggins (confirmed the value of orchiectomy for prostate cancer); Alfred gilman and Frederick Phillips (nitrogen mustard-mustard gas-was discovered in World War I to help treat lymphoma); Sidney Farber (introducing methotrexate to treat childhood leukemia); Barnett Rosenberg (discovery of anticancer drug cisplatin); And james black (whose work promoted the development of beta blockers).
The progressive revolution of molecular biology has made it possible to identify a large number of new potential drug targets, and genetic pharmacology has begun to explain the genetic variation of people's response to drugs.