Modern medicine experienced the foundation of 16 ~ 17 century, the systematic classification of 18 century and the great development of 19 century. The 20th century was closely combined with modern science and technology and developed into modern medicine. The characteristics of medicine in the 20th century are, on the one hand, microscopic development, such as molecular biology; On the one hand, it is macro development. From the macro-development, it can be divided into two types: first, people realize that people themselves are a whole; The second is to study people as a whole closely interacting with the natural environment and social environment. Since the 20th century, the most outstanding achievement of basic medicine is the development of basic theory, which has effectively promoted clinical medicine and preventive medicine. Effective means to treat and prevent diseases only 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 cross-integration of disciplines and specialties is one of the characteristics of modern medicine. The main achievements of medicine since the 20th century are as follows:
The progress of medical treatment. /kloc-in the second half of the 9th century, due to the progress of pharmacology, although there was some progress in treatment, there was still nothing to be done about most diseases, especially some infectious diseases with known causes. The invention of chemotherapy and antibiotics in the 20th century changed this situation. 1908, P. Ehrlich of Germany (1854 ~1915) and Kojiro Qinzuo of Japan (1873 ~ 1938) discovered that 606 could treat spirochetes. 1935 G.J.P Domagk (1895 ~ 1964) developed sulfonamides, which can cure many diseases caused by bacteria. 1928, British A. Fleming (1881~1955) discovered that penicillin has bactericidal ability. 194 1 year later, H.W. Flory (1898 ~ 65438) was in 1944, S.A. Wachsman (1888 ~/kloc-). Later, new antibiotics appeared one after another. These special effects therapies are epoch-making progress in the history of treatment.
1922 f.g. wanjin (1891~1941) successfully extracted insulin, which can be used to treat diabetes.
In the second half of the 20th century, the emergence of new drugs, including new antibiotics, significantly improved the efficacy of some diseases. At the same time, great progress has been made in treatment methods, such as the application of combined chemotherapy from leukemia to other tumors; Application of basic diet and intravenous hypernutrition therapy in patients with severe weakness: immunotherapy and so on. These drugs and therapies have changed the prognosis of some chronic and refractory diseases and improved the curative effect. The continuous improvement of medical devices such as defibrillation, artificial pacemakers and artificial respirators has significantly improved the therapeutic effect of some diseases. ② Development of diagnostic technology. X-ray was discovered by W.C. Roentgen in 1895, and X-ray diagnosis became an important means of clinical medicine in the early 20th century. At first, it was used to observe the state of bones. 1906 gastrointestinal movements were examined with bismuth paste, and then X-rays were taken with barium meal and iodized oil. Since then, important diagnostic techniques have been developed: electrocardiogram (1903), syphilis serum reaction (1906), cerebral angiography (191), cardiac catheterization (1929) and cardiac catheterization. In the early 1950s, ultrasonic technology was applied to medicine, and in the 1960s, Japan used optical fiber as gastroscope. At present, a variety of fiber optic endoscopes have been applied in clinic. After 1970s, the application of computerized X-ray tomography (CT) and magnetic resonance imaging technology can find tiny lesions.
Laboratory diagnostic methods have also been developed, such as sensitive radioimmunoassay, which can determine the content of body components at picogram level.
Other electronic instruments should also be used in clinical departments, such as heart and lung monitors, gamma-ray photography and electronic computers.
1960 amniotic fluid examination can diagnose fetal hemophilia, 1967 has carried out prenatal genetic disease chromosome examination, 1968 found that amniotic fluid enzyme activity determination method can be used to diagnose congenital metabolic defects. In 1970s, AFP in amniotic fluid can be determined to diagnose fetal malformation, and prenatal diagnosis has reached a new level.
③ Endocrinology. Adrenaline was separated from Takamine jūkichi in 190 1 year, and soon, secretin was also extracted, and human beings began to understand the function of regulating body fluids. After that, thyroxine, insulin and various sex hormones were separated and purified one after another. Adrenocortin was extracted in the 1940s, while thyrotropin-releasing hormone was isolated in the 1950s and 1960s. In 1960s, the second messenger theory was put forward to clarify the mechanism of action of nitrogen-containing hormones and promote the development of endocrinology to the molecular field.
4 nutrition. Before the 20th century, nutrition as a discipline term rarely appeared in the literature. After entering the 20th century, nutrition has made great progress. First of all, the importance of nutrition in protein is becoming more and more clear. The research of British biochemists F.G. Hopkins (186 1 ~ 1947) and E. Wilcock (1906) in Cambridge University and American biochemists T. Osborne and L. B. Mendel (19). In 1930s, it took American W Ross and others five or six years to figure out the difference between essential amino acids and non-essential amino acids. 1938 proved that human beings need eight essential amino acids. Second, the discovery of vitamins, such as vitamin B 1 (C. Fink,1913); Vitamin A (E. mccollum and M. Davies,1913); Vitamin D (O. rosenheim, and T. Webster et al.,1926); Vitamin C (A. Szentgyorgy,1928); Vitamin B2 (R. Kuhn et al.,1933); Vitamin e (H. Evans et al.,1936); Vitamin B6 (S. Lepkowski et al.,1938); Vitamin k (p.h.dam and d.fox, 1948), etc. Third, we recognize 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 nutrition knowledge, human beings have figured out the causes of various nutritional deficiencies, so it is possible to take measures such as "strengthening food" to prevent them; It makes "total parenteral nutrition" possible. This treatment was first reported by S. Dudrick in 1968, which can effectively save the lives of patients with severe malnutrition caused by digestive tract dysfunction.
⑤ Molecular biology. Molecular biology is to understand the nature of life phenomena by studying the structure and interaction of biological macromolecules (protein, enzymes, nucleic acids, etc.). The study of molecular biology has promoted the development of molecular medicine and human understanding of "molecular diseases". Generally speaking, although the rise of molecular biology is not long, its influence has gradually penetrated into various fields of biology and medicine, resulting in some emerging disciplines, such as molecular genetics, molecular cytology, molecular pharmacology, molecular pathology, molecular immunology and so on. This will promote the development of medicine.
⑥ Medical genetics. Classical genetics made great progress in the early 20th century, and many genetic diseases have been clarified through family investigation. But it is only after the rise of molecular biology that people can gradually explore the pathogenesis of genetic diseases at the genetic level. Later, it has been made clear that many diseases are caused by gene defects that lead to functional protein defects (such as hemoglobin and various enzymes), and finally various corresponding symptoms (such as anemia and various metabolic disorders) appear. At present, molecular genetics technology has been used for prenatal diagnosis of fetal genetic diseases. Molecular geneticists are still 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 were successfully developed and achieved remarkable results in controlling many infectious diseases.
At the beginning of the 20th century, it has been found that there are antibodies against self-organization in human body. 1942 after the invention of immunofluorescence technology, the widespread existence of autoantibodies was confirmed. In the mid-20th century, people discovered the phenomenon of immune tolerance and successfully induced tolerance in experimental animals, which led to the theory of cell line selection. This makes people gradually realize that the function of immunity is not limited to anti-infection, it can identify "self" and "non-self" to maintain the stability of the body.
Since then, the progress of immunology has emerged one after another. In 1950s, it was found that thymus was related to immunity, and the structure of immunoglobulin was also clarified. The role of T cells and B cells was discovered in the 1960s, and monoclonal antibody technology was born in the mid-1970s. 1974, N.K. Jena put forward the theory of immune network. In clinical application, immunology as a diagnostic method can be said to have started from the beginning of the century, but the most outstanding contribution should be tissue and organ transplantation. Immunology has become one of the most important basic sciences affecting biology and medicine. 197 1 year, the world immunology society unanimously agreed that immunology should be separated from microbiology and become an independent discipline. Include immunochemistry, immunobiology, immunogenetics, immunopathology, clinical immunology, tumor immunology and transplantation immunology.
⑧ The development of surgical discipline. At the beginning of the 20th century, K. landsteiner discovered blood type, and transfused blood safely by matching blood. Local anesthesia was also used at this time. Muscle relaxants were used clinically in the 1940s, and later antibacterial drugs were used in surgery. All these have solved the basic problems of surgical treatment.
Since then, various professions in the field of surgery have become independent. Such as brain surgery, cardiovascular surgery, orthopedics, digestive surgery and plastic surgery.
Modern neurosurgery only began in the 20th century and has developed rapidly since the 1960s. Computerized X-ray imaging was a great progress in diagnostic technology in 1970s, which improved the diagnostic rate of many intracranial diseases, especially cerebral hemorrhage and intracranial tumors. In some neurosurgical centers, CT and magnetic resonance imaging have replaced other comparative examinations. The development of microsurgery technology has expanded the field of surgery, improved the success rate of complex intracranial lesions, and given some diseases that could not be operated in the past a chance to be treated. Significant progress has been made in the surgical treatment of cerebrovascular diseases. The operative mortality of cerebral aneurysms decreased from 50 ~ 80% to about 3%. The success of extracranial-intracranial artery anastomosis has opened up a new way to treat ischemic cerebrovascular disease. Some progress has also been made in the treatment of glioma, especially malignant glioma, and severe craniocerebral injury. Microsurgical technology has developed rapidly, and peripheral nerve repair is the most widely used. With the development of microvascular anastomosis technology, transplantation and replantation have reached a new level. This also makes the free transplantation of living bones a reality. Microsurgical technique has also pushed the replantation of severed limbs, especially severed fingers, to a new height.
Pet-name ruby organ transplantation and artificial organs. 19 13 A Karel put forward the idea of ex vivo, culture and organ transplantation. 1933 corneal transplantation was successful, and 1954 kidney transplantation between twin brothers was successful for the first time. Since then, with the progress of immunology, liver transplantation (T.E. Staats, 1963), lung transplantation (J.D. Hardy, 1963) and pancreas transplantation (C.W. Lelehai, 1966) have been completed successively. Bone marrow transplantation has also made great achievements. Dentists are also experimenting with transplanting children's tooth embryos into adults' gums to produce new teeth.
Since the 1940s, modern science and technology have directly entered the medical field. Medicine has been integrated with biology, chemistry, electronics, mathematics, mechanics, polymer chemistry and engineering, and biomedical engineering has emerged. Various artificial organs are one of its achievements.
From 65438 to 0945, after two years of research and application, Dutch W.J. kolff successfully treated acute renal failure for the first time. Later, he began to develop artificial hearts in the United States; 1962, Starr successfully replaced mitral valve with artificial spherical valve; The clinical application of artificial heart-lung machine and artificial hypothermia in 1950s made open-heart surgery under cardiopulmonary bypass possible. 1982, American doctors implanted "Jarvik -7" artificial heart into a 6 1 year-old heart patient, which made this field enter 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 and artificial senses. In 1960s, laser was used in clinic. 1960 the first laser was first used in ophthalmology.
Participate in psychiatry. At the beginning of the 20th century, German E. Kraepelien (1856 ~1926) introduced the classification methods of mental diseases through books and lectures, and expounded the significance of early-onset dementia, which provided one of the scientific bases for mental diseases.
S Floyd (1856 ~ 1939) founded the theory of "psychoanalysis", holding that mental function affects potential consciousness, and sexual instinct has an important relationship with this function.
Before 1930, there were few effective psychiatric treatments. For example, 19 18 used plasmodium inoculation to treat paralytic dementia. In 1930s, insulin shock therapy and electroconvulsive therapy were applied in clinic one after another, which became the two main treatments for mental illness before chemotherapy.
Chlorpromazine was synthesized by 1950, and 1952 p. DeLay was successfully applied to mental patients. Later, the efficacy of reserpine was discovered, so psychiatric treatment entered the stage of chemotherapy.
In the second half of the 20th century, psychosomatic medicine, behavioral medicine and other disciplines to explore the relationship between psychology and health and disease appeared one after another.