the evolution of modern medicine(现代医药的演变)-第48节
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initiated in the practice of surgery； which； it is not too much to say； has
proved one of the greatest boons ever conferred upon humanity。 It had
long been recognized that； now and again； a wound healed without the
formation of pus； that is； without suppuration； but both spontaneous and
operative wounds were almost invariably associated with that process； and；
moreover； they frequently became putrid； as it was then called；infected；
as we should say；the general system became involved and the patient
died of blood poisoning。 So common was this； particularly in old； ill…
equipped hospitals； that many surgeons feared to operate； and the general
mortality in all surgical cases was very high。 Believing that it was from
outside that the germs came which caused the decomposition of wounds；
just as from the atmosphere the sugar solution got the germs which caused
the fermentation； a young surgeon in Glasgow； Joseph Lister； applied the
principles of Pasteur's experiments to their treatment。 From Lister's
original paper＇*＇ I quote the following： 〃Turning now to the question how
the atmosphere produces decomposition of organic substances； we find
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that a flood of light has been thrown upon this most important subject by
the philosophic researches of M。 Pasteur； who has demonstrated by
thoroughly convincing evidence that it is not to its oxygen or to any of its
gaseous constituents that the air owes this property； but to minute particles
suspended in it； which are the germs of various low forms of life； long
since revealed by the microscope； and regarded as merely accidental
concomitants of putrescence； but now shown by Pasteur to be its essential
cause； resolving the complex organic compounds into substances of
simpler chemical constitution； just as the yeast…plant converts sugar into
alcohol and carbonic acid。〃 From these beginnings modern surgery took
its rise； and the whole subject of wound infection； not only in relation to
surgical diseases； but to child…bed fever； forms now one of the most
brilliant chapters in the history of preventive medicine。
＇*＇ Lancet； March 16； 1867。 ＇Cf。 Camac： Epoch…making Contributions；
etc。； 1909； p。 7。Ed。＇
With the new technique and experimental methods； the discovery of
the specific germs of many of the more important acute infections
followed each other with bewildering rapidity： typhoid fever； diphtheria；
cholera； tetanus； plague； pneumonia； gonorrhoea and； most important of
all； tuberculosis。 It is not too much to say that the demonstration by Koch
of the 〃bacillus tuberculosis〃 （1882） is； in its far…reaching results； one of
the most momentous discoveries ever made。
Of almost equal value have been the researches upon the protozoan
forms of animal life； as causes of disease。 As early as 1873； spirilla were
demonstrated in relapsing fever。 Laveran proved the association of
haematozoa with malaria in 1880。 In the same year； Griffith Evans
discovered trypanosomes in a disease of horses and cattle in India； and the
same type of parasite was found in the sleeping sickness。 Amoebae were
demonstrated in one form of dysentery； and in other tropical diseases
protozoa were discovered； so that we were really prepared for the
announcement in 1905； by Schaudinn； of the discovery of a protozoan
parasite in syphilis。 Just fifty years had passed since Pasteur had sent in his
paper on 〃Lactic Acid Fermentation〃 to the Lille Scientific Societyhalf a
century in which more had been done to determine the true nature of
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disease than in all the time that had passed since Hippocrates。 Celsus
makes the oft…quoted remark that to determine the cause of a disease often
leads to the remedy；＇*＇ and it is the possibility of removing the cause that
gives such importance to the new researches on disease。
＇*＇ 〃Et causae quoque estimatio saepe morbum solvit；〃 Celsus； Lib。 I；
Prefatio。Ed。
INTERNAL SECRETIONS
ONE of the greatest contributions of the nineteenth century to
scientific medicine was the discovery of the internal secretions of organs。
The basic work on the subject was done by Claude Bernard； a pupil of the
great Magendie； whose saying it is well to remember〃When entering a
laboratory one should leave theories in the cloakroom。〃 More than any
other man of his generation； Claude Bernard appreciated the importance of
experiment in practical medicine。 For him the experimental physician was
the physician of the future a view well borne out by the influence his
epoch…making work has had on the treatment of disease。 His studies on the
glycogenic functions of the liver opened the way for the modern fruitful
researches on the internal secretions of the various glands。 About the same
time that Bernard was developing the laboratory side of the problem；
Addison； a physician to Guy's Hospital； in 1855； pointed out the relation
of a remarkable group of symptoms to disease of the suprarenal glands；
small bodies situated above the kidneys； the importance of which had not
been previously recognized。 With the loss of the function of these glands
by disease； the body was deprived of something formed by them which
was essential to its proper working。 Then； in the last third of the century；
came in rapid succession the demonstration of the relations of the pancreas
to diabetes； of the vital importance of the thyroid gland and of the pituitary
body。 Perhaps no more striking illustration of the value of experimental
medicine has ever been given than that afforded by the studies upon those
glands。
The thyroid body； situated in the neck and the enlargement of which is
called goitre； secretes substances which pass into the blood； and which are
necessary for the growth of the body in childhood； for the development of
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the mind and for the nutrition of the tissues of the skin。 If； following an
infectious disease； a child has wasting of this gland； or if； living in a
certain district； it has a large goitre； normal development does not take
place； and the child does not grow in mind or body and becomes what is
called a cretin。 More than thisif in adult life the gland is completely
removed； or if it wastes； a somewhat similar condition is produced； and
the patient in time loses his mental powers and becomes fat and flabby
myxedematous。 It has been shown experimentally in various ways that the
necessary elements of the secretion can be furnished by feeding with the
gland or its extracts； and that the cretinoid or myxedematous conditions
could thus be cured or prevented。
Experimental work has also demonstrated the functions of the
suprarenal glands and explained the symptoms of Addison's disease； and
chemists have even succeeded in making synthetically the active principle
adrenalin。
There is perhaps no more fascinating story in the history of science
than that of the discovery of these so…called ductless glands。 Part of its
special interest is due to the fact that clinicians； surgeons； experimental
physiologists； pathologists and chemists have all combined in splendid
teamwork to win the victory。 No such miracles have ever before been
wrought by physicians as those which we see in connection with the
internal secretion of the thyroid gland。 The myth of bringing the dead back
to life has been associated with the names of many great healers since the
incident of Empedocles and Pantheia； but nowadays the dead in mind and
the deformed in body may be restored by the touch of the magic wand of
science。 The
