SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In the opinion of the natural sciences and medicine of the Romantic Era, Paracelsus represents a central step from the Middle Ages to modern times. Their interpretations of this perceived kindred spirit "not free from criticism" focus on metaphysical orientations, holistic approach to cosmology and anthropology, biochemical perspective, ethical dominance, immenent union of etiology, pathophenomenology and therapy.
Some recent historical celebrations of modern Italian nephrology offer the opportunity to write about the meaning of the history of medicine and nephrology. First of all, the question "what do we learn from history" is wrongly phrased. It is from trying to learn about history, from the effort required to achieve a historical and epistemological perspective, that we may learn how people as individuals or as a group solved the problems of meeting their common human needs. Medicine is itself an eminently historical endeavour. There is history in medicine as well as history of medicine. According to Paracelsus, the history of medicine is medical science and medical science is essential history in the widest sense of the word. The word "history" embraces the concepts of human nature, the world in which human nature is revealed and the thoughts guiding it through life. If the history of medicine and nephrology is observed in all aspects of their evolution, we can see how it had a beneficial role on the work of physicians by reminding them that, prior to the light of achievement, the discovery of all medical principles is preceded by errors and doubts. We report on nephrological debates, controversies and achievements and we call attention to the need to focus on the present through the involvement of medical historians in the analysis of contemporary health policy issues and clinical methodology.
Endocrinology was recognized as a new branch of biological science mainly as a result of events which took place between about 1890 and 1905, but ideas and discoveries dating from antiquity contributed to it also. Experiments supporting the concept of internal secretions by the testicles were described by Aristotle (4th c. B.C.) and by Hunter (18th c.) and Berthold (19th c.). In 1855 Bernard described glucose as an internal secretion of the liver and Addison reported the effects of adrenal disease in man. Adrenalectomy was fatal in animals. Goitre was known in antiquity and cretinism had been described by Paracelsus. Myxoedema was reported by Gull in 1873, and Kocher described cachexia strumipriva in 1883. In 1888 cretinism, myxoedema and cachexia strumipriva were attributed to thyroid insufficiency. In the 1890s Gley found that tetany after thyroidectomy was due to removal of the parathyroids. In 1884 Rehn proposed that toxic goitre was due to thyroid excess. In 1889 Brown-Séquard claimed that injections of testicular extract rejuvenated the elderly, and in 1893 he introduced organotherapy. In 1891 Murray treated myxoedema successfully with thyroid extract. In 1893 Oliver and Schäfer found that an adrenal extract raised the blood pressure, and soon adrenaline was extracted from the adrenal medulla. Adrenocortical deficiency was proposed as the cause of Addison's disease, and in 1896 Osler prepared an extract which relieved one patient. Diabetes mellitus, described in the first century, was usually fatal. Thirst and polyuria followed experimental pancreatectomy, and pancreatic lesions were found in some human diabetics. In the 19th century workers in France and Germany found that diabetes resulted from absence of an internal secretion by the islets of Langerhans and, in 1893, Laguesse described the function of the islets as "endocrine". In 1895 Beatson treated advanced breast cancer successfully by oöphorectomy. In 1895 Schäfer commended study of the internal secretions to physiologists. In 1902 Bayliss and Starling discovered secretin, a chemical messenger secreted by the intestinal mucosa. In 1905 Starling proposed the name "hormone" for this class of internal secretions. By then endocrinology had been launched as a new branch of science. The crucial events which led to the recognition of endocrinology as a new branch of biological science took place between about 1890 and 1905. Many ideas and discoveries dating from antiquity and apparently unrelated at first had, however, contributed to it. Most of the organs and tissues that form the endocrine system were recognized over 100 years ago.(ABSTRACT TRUNCATED AT 400 WORDS)
This paper aims to discuss the scientific evidence to answer the question in the title. After a brief mention of the fundamental toxicological principles of risk assessment (hazard, exposure, susceptibility, risk), the concepts of dose-response, dose-effect and threshold-dose are presented. The difference between adverse effects with and those without a threshold is highlighted, together with the corresponding methodologies used in risk assessment for the definition of the limit values, i.e. the No Observed Adverse Effect Level (NOAEL) and Safety Factor (SF) method and the Virtually Safe Dose (VSD) method. The two methods correspond to two different types of effect, i.e. deterministic and stochastic, and to two different shapes of the dose-response curve at low doses. The various possible meanings (semantic, toxicological and practical) of the terms "low doses" are discussed: a dose (or concentration) may be low because it does not cause measurable adverse effects (as from Paracelsus' aphorism) or because it is too low to be (analytically) measurable or because it is close to or within the "normal" values of a reference population or because it is well below the exposure limit(s). These various concepts are presented also in relation with the controversial concept of "moderate risk" introduced by a recent Italian legislation (D. Lgs 25/02) on the protection of the workers against chemical risk. It would not be appropriate to set a level of risk simply based on the dose (or the level of exposure) without considering the two other components of risk, i.e. hazard and susceptibility, whose estimation also needs a careful and competent evaluation by the occupational physician. For a thorough discussion of the "moderate risk" concept see a specific paper in these Proceedings. So, clinical, epidemiological and toxicological evidence indicates that in some individuals, groups of the population or circumstances, adverse effects can be observed or expected even at low doses, at which the large majority of the population shows no effect. This is due to a number of factors including toxicological interactions, immunoallergic mechanisms, metabolic hypersusceptibility, both genetic (polymorphism) and acquired (phenotype), preexisting traits or diseases, living habits, diet and others. The Authors conclude therefore that to ensure the protection of all the workers' health and safety, the clinical, toxicological and epidemiological expertise of the occupational physician appears to be fundamental and unreplacable.
Tommaso Bovio was a representative of North Italian non-academic medicine in the early modern period. His "dialogues", published in the second half of the 16th century, were written in the Italian vernacular and enjoyed a certain popularity also in Germany. Although Bovio used to exaggerate for rhetorical effect, his portrayal of patients, illness and treatments provides interesting insights into everyday urban life in his time. Sympathising with Paracelsus, Bovio propagated an image of empirics as humanitarians and fought for the recognition of his own practical knowledge and skills. Bovio was a most original figure in the medicine of the period of counter reformation. His writings exemplify the lively debate between the learned medical tradition and unorthodox reform.
The first description of diabetes dates back to the 3,500-year-old Ebers papyrus. Until the 16th century diabetes was traditionally thought of as a disease of the kidney and the liver. Paracelsus was the first to suspect an association between diabetes and an altered blood composition. Treatment and knowledge about the origin of diabetes have changed. For the patients, the 20th century has been most important. Their chance to survive increased with the introduction of insulin. Today, diabetology is based on the "best practice", on evidence-based medicine that focuses on the diabetic patients' quality of life.
The concepts of ferment and fermentation played an important, though heretofore neglected, role in 17th-century physiology. Though these notions can be found in ancient philosophy and medicine, as well as in medieval medicine, they became integral part of the chemical medicine that was advocated by Paracelsus and his school. Paracelsians made fermentation a central concept in their successful effort to give chemical foundation to medicine. Jean Baptiste van Helmont and Sylvius used the concepts of ferment and fermentation to explain a variety of physiological processes in human body. Corpuscular philosophers like Robert Boyle and Thomas Willis reinterpreted these notions in corpuscular terms and separated the concept of ferment from that of fermentation. In the second half of the seventeenth century, physiologist tried to explain fermentation by means of chemical reactions, as for instance acid -alkali, and ruled out the notion of ferment as superfluous to their investigations. At the end of hte seventeenth century fermentation attracted the interest of physicists like Johannes Bernoulli and Isaac Newton, who tried to explain fermentative processes in terms of matter and motion (Bernoulli) and short-range forces (Newton). George Ernst Stahl devoted a work to fermentation: the Zymotechnia. He explained fermentation as the outcome of the reactions of molecules formed of saline, oily and earthy corpuscles with particles of water. He saw fermentation as a mechanical process, i.e. as collision of different kinds of corpuscles.
Contemporary advancements in cardiothoracic and abdominal surgical procedures have been historically dependent on the development and adoption of controlled airway management, specifically endotracheal intubation, controlled positive-pressure ventilation, and the use of automatic positive-pressure mechanical ventilators. More than 400 years elapsed before the 16th Century theories of Paracelsus and the demonstrations of Vesalius were routinely adopted to solve the "pneumothorax problem" that prevented complicated or prolonged surgical procedures within the pleural cavity. Acceptance and implementation of controlled positive-pressure ventilation was impeded for decades by the inability to maintain and protect the airway. Consequently, emphasis on the development of mechanical ventilation was directed toward machinery that provided safer negative-pressure respiratory support. The introduction of curare into European anesthesia practice and the adoption of protective airway practices during the poliomyelitis epidemics led to routine use of controlled positive-pressure ventilation and construction of dependable machinery. Laboratory investigations, exploring complications from cardiothoracic surgery, brought about American acceptance and established controlled positive-pressure mechanical ventilation as an indispensable part of conventional intraoperative management.
History of clinical diagnosis starts with HIPPOCRATES and his school. History taking and inspection are fundamental diagnostic tools. later on feeling of the pulse, and observation of the tone of the voice are added. In GALEN's system examination findings serve to substantiate theoretical views. Since the time of AVINCENNA uroscopy gains special meaning. Urine examination and pulse control are the most important diagnostic tools for PARACELSUS. His name is connected with diagnosis, "ex juvantibus". Clinical examination obtains further impulses by VESALIUS and later MORGAGNI. In 1761 AUENBRUGGER discovers percussion, LAENNEC in 1819 auscultation. Measurement of arterial blood pressure (RIVA-ROCCI) develops to an important procedure since 1896. Microscopical examination becomes routine in the second half of the 19th century. The same applies to the bacteriological (KOCH, PASTEUR) and endoscopic examination. Discovery of X-rays by ROENTGEN in 1895 widens diagnosis considerably. Ultrasound sonography, computed tomography and magnetic resonance tomography stand at a temporary end of a long development of clinical diagnosis which is completed by the discussion of principal signs.
The explanation for the explosion of science in the 17th century lies in history and medical historiography. Without this approach, it becomes fantasy, accidents, or success stories. Sigerist grasped the essential interdependence of science and history, and had no need for devised reasons or speculation. He realized that once the dark night of the Middle Ages was over, the sciences arose with undreamt of force and accelerated development. The advances in astronomy, mathematics, mechanics, and experimental science benefitted a society developing in seafaring, manufacture, and trade in the 17th century. Sigerist's views make the scientific explosion understandable in human and social terms. He did not overlook the capabilities of some extraordinary individuals, such as Paracelsus (1493-1541), to shape the course of medicine, nor the importance of the mechanistic philosophy in the 17th century. Man makes history and science; hence, we find concurrent phenomena of history and science essentially interdependent. The spirit of experimental science of 17th century England was inspired by the new needs of commercial enterprise for more means of transportation and communication. Likewise, the interest in the mechanics of the pump for waterworks and for the drainage of swamps led Harvey to think of the heart as a pump, and to explain the circulation of the blood in terms of its functioning.
With students such as Hippocrates, Galen, Paracelsus, Sydenham, Herberden, Harvey, Cheyne, Boerhaave and Paŕe, the history of "The Gout" (L. gutta-drop), more than any other disorder, parallels the history of Western medicine. It also played important parts in modifying American and European culture and history. Such was the fear and honor it commanded in the last 3,000 years, that over a score of saints and holy men are credited with its cure. Long stated to be a disease of the upper class, at one time, it was considered so stylish that it was said that the only thing worse than having it was to be cured.
Henry E. Sigerist's paper on the history of dietetics covers the entire development of dietetics since the emergence of the human species. Originating in early man's food-seeking instinct, dietetics had become an empirical science by the time of the ancient Greeks. They stressed the dietetic treatment of illness and began to formulate numerous rules. Regimina sanitatis, manuals containing precise dietetic prescriptions for the maintenance of good health, were widely circulated in the Middle Ages. In addition to new impulses initiated by Paracelsus, the author emphasizes the clinical and experimental studies pursued, from the 17th to the 19th centuries, by such scientists as Thomas Sydenham, Justus von Liebig, Carl von Voit and Gustav von Bunge. The author concludes by pointing out that, despite enormous progress, more than one half of the world's population still suffers from malnutrition. For this reason, he regards the social application of dietetic findings as the most urgent task facing us in the future.
This article has reviewed a few of the major historic aspects of urine examination from ancient times to the twentieth century. It is a most fascinating history for it mirrored that of the history of medicine itself. The recognition of the importance of urine in diagnosis was made over 6000 years ago by several of the earliest civilizations, and a few of their clay tablets have been found that give us some insight into their observations and conclusions. However, the progress in analysis and its clinical significance was often slow and frequently littered with charlatanism. Visual inspection alone, and prognostication therefrom, was shown to be inadequate as a single means of diagnosis, and over 600 years ago Paracelsus, as well as others, began to reject ancient dogma and searched for new approaches to the analysis of urine by using chemical distillation techniques. Progress in anatomy and physiology, coupled with the understanding of organ function, provided a fertile field for the investigation of the composition of the urine and associating its chemical constituents with specific disease states. The advent of the microscope caused scientists to examine all body fluids, especially the urine, and to record their observations as an aid to diagnosis--the beginnings of medical microscopy. This century has also seen remarkable advances in the field of urinalysis: dipstick testing, the application of modern chemical and microscopic techniques to constituent analysis, automation, and, most recently, monoclonal antibody and recombinant gene technology to enhance and improve urine examination. In short, urinalysis, the first of all laboratory tests, began as and still remains a most valuable and highly important means of diagnosis in clinical medicine.
In a prospective study 73 patients on maintenance digitalis treatment at the Paracelsus Institute, Bad Hall, were clinically examined and the dosage of the drug was adjusted according to cardiac symptoms. The clinical effects were correlated to digoxin concentrations measured on the day following admission to hospital and on the 21st day of treatment. The following practical conclusions were reached: 1. More than 50% of the patients were underdigitalized. 2. There is often no indication for digitalis therapy in patients with a low daily maintenance digoxin dosage and normal renal funciton. 3. The usual recommended maintenance dosage of digoxin provides serum digoxin levels in the lower region of the therapeutic range. 4. Patients with symptoms of decompensation taking an average dosage of digoxin need more digitalis. There is generally no danger of toxicity when the dosage is increased. 5. The serum digoxin concentration in patients with slightly reduced renal function lies in the upper region of the therapeutic range with usual doses of digoxin.
Intensely myopic patients in the Eye Department of the Paracelsus-Institute in Bad Hall (Upper Austria) were subjected to visual acuity tests whereby the conditions of examination were held constant (optotype-projector, panoramic visual range, exactly defined break-off criteria). Results showed that 33% of the patients, who had completed combined iodine treatments and ophthalmo-iontophoresis, showed an improvement in visual acuity of 3 or more optotypes, corresponding to an average increase thereof of 0,13 from the initial visual power. Side effects of intense myopia (dilatation tension and degenerative changes at the posterior eye pole) should thus be regarded as an indication of the successful application of the combined balneotherapy, mineral water treatment and eye-cure in Bad Hall.
The phenomena of epilepsy have been known for at least 3000 years, the earliest recorded account being in an Akkadian text called the Sakikku (written around 1067-1046 BC). Over nearly all the subsequent centuries the popular belief has been that epilepsy is a disorder of supernatural origin, and to some extent such ideas have carried over into medical thought. In Western civilisation, the long dominant belief was that epilepsy was due to possession by a devil or a demon, an interpretation given authoritative support by the miracle story of the cure of the epileptic child which is recorded in all three synoptic Gospels. However, there have been many other interpretations e.g. epilepsy as a consequence of wrong doing or of lunar or magical influences. Such ideas began to die out only in the past 200 years. From Hippocrates (c. 400 BC) onwards, there has been a continuing line of thought that considered epilepsy a medical condition due to natural causes. The hypotheses concerning its pathogenesis have ranged from excess phlegm in the brain, through boiling up of the vital spirits in the brain (Paracelsus), explosion of the animal spirits in the centre of the brain (Willis), heightened reflex activity at a spinal (Marshall Hall) or medullary level (Brown Séquard), to Hughlings Jackson's notion of an occasional, an excessive, and a disorderly discharge' in part of the cerebral cortex. Among thinking men, epileptology in the past century has proved largely to be a matter of exploring the ramifications of Jackson's concepts.
On the occasion of closing the research department of the Paracelsus Institute in the iodine salt spa, Bad Hall, the results of more than 30 years' research work in this institute are summarized. This work concerned the therapeutic effects of iodine on circulatory illnesses, especially hypertension, bronchitis and degenerative eye diseases. Controlled studies in patients showed significant cure effects of the iodine springs. Other studies demonstrated an influence of iodine on peripheral blood vessels, blood viscosity, connective tissue and vision and demonstrated the scavenger function of iodine, too. The different therapeutic forms of iodine administration (baths, sprays, iontophoresis, drinking cures) are described and the potential side effects of a cure in an iodine spa, notably temporary hypothyroidism, are mentioned.
In addition to starlike cells, friable pigment and thready remnants of the pupillary membrane, also radial retroiridal pigmentlines which were found on the peripheral anterior capsula of the lens were interpreted to be remnants of the "tunica vasculosa retroiridalis (membrana capsulopupillaris). They seemed to be very rare. An examination of the patients from the Eye-department of the Paracelsus-Institut in Bad Hall/Upper-Austria, showed that "radial retroiridal pigmentlines" could be found in 5% of all examinated patients. In a control examination of 1108 children and juveniles we could see a high proportion of usually described remnants of the pupillary membrane also, but in no case did we find "radial retroiridal pigmentlines". Therefore these pigmentlines do not appear to be hereditary remnants of the pupillary membrane. They seem to be changes of the senium. These pigmentlines which may be caused by a constant friction of the iris on the anterior surface of the lens, we would like to call "Pigmentschleifspuren".