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[1790 - 1850年实验药理学的发展]

[The development of experimental pharmacology 1790-1850].

作者信息

Bickel M H

机构信息

Universität Bern.

出版信息

Gesnerus Suppl. 2000;46:7-158.

Abstract
  1. The use of drugs goes back to the origins of mankind. In historical times oral drug-lore became codified empiric drug theory (materia medica) and ultimately, in the 19th century, experimental pharmacology. The initiator of experimental pharmacology as an independent medical discipline is Rudolf Buchheim (1820-1879). This study traces the pathways leading to Buchheim and identifies his predecessors between 1790 and 1850. The history of empirical pharmacology and its major theories in Antiquity, the Middle Ages, and early modern times is summarized. For the 18th century an overview is given on early attempts at experimental testing of drug effects and on the new therapeutic systems and medical sects. 2. Many authors have dealt with the grievances of pharmacology and therapy between 1790 and 1850, among them chief representatives of contemporary medicine like the French Fourcroy, Bichat, Pinel, Alibert, Magendie, and the Germans Schönlein, Mitscherlich, Wunderlich, Henle, and Oesterlen. Their criticisms are a means for a better understanding of the situation. They cover the following aspects. Pharmacology is distorted by speculations on the causes of drug action and confusion with regard to terminology and indications. Drug actions are being tested with inadequate methods. An increase in the number of drugs is mistaken for an increase in knowledge. The statement is made that pharmacology is the least developed of all medical subjects. The critics point out that only a more developed chemistry, physiology, and etiology will allow a scientific pharmacology. The drug theories of the medical sects are likewise rejected. Polypharmacy, composite drugs, and absurd formulas are regarded with contempt. Aggressive drug therapy is repudiated, but this easily results in avoidance of drugs and in therapeutic nihilism. 3. In 1799 Johann Christian Reil elaborated his principles for a future pharmacology. Reil establishes the rules for clinical experiments on which a scientific pharmacology should be based. His goal is to explain the actions of drugs which are the results of biochemical alterations. Even though Reil's program is a theoretical conception, it anticipates a situation that was to take shape half a century later. Also in 1799 Adolph Friedrich Nolde published detailed rules for the critical examination of drug actions in patients, including aspects like placebo, compliance, statistics, and several ethical rules. Reil's and Nolde's programmatic messages vanished in the emerging German medicine of "Naturphilosophie". 4. In the decades after 1800 medicine was at its zenith in the Paris School. It became a hospital medicine, based on anatomy and pathology. François Magendie was one of its representatives. He started out as a physician in 1808 and became a physiologist who soon surpassed his teachers Bichat and Richerand. Magendie's sole interest were facts, which had to be unravelled by experiments, mainly on animals. He created modern physiology based on the laws of physics and chemistry. Nevertheless, he remained an outsider among the Paris School. Bichat and other predecessors of Magendie had considered an experimental pharmacology based on physiology, however, they did not provide knowledge resulting from experiments. Magendie published his first experimental study of a pharmacological problem in 1809. From then on he studied the mechanism and site of action of drugs and used them at the same time as tools for the investigation of physiological processes. After Sertürner's isolation of morphine from opium the preparation of pure alkaloids became a specialty of French pharmacists and chemists. Magendie sought their collaboration from 1817 on, convinced that pharmacology and therapy must be based on both physiology and chemistry. In 1821 he published his Formulaire pour la préparation et l'emploi de plusieurs nouveaux médicamens which marks the beginning of modern pharmacology. It grew throughout eight editions up to 1835. (ABST
摘要
  1. 药物的使用可以追溯到人类起源之时。在历史时期,口头药物知识逐渐编纂成经验性药物理论(药物学),并最终在19世纪发展为实验药理学。实验药理学作为一门独立医学学科的开创者是鲁道夫·布赫海姆(1820 - 1879)。本研究追溯了通向布赫海姆的路径,并确定了他在1790年至1850年间的前辈。概述了古代、中世纪和近代早期经验药理学的历史及其主要理论。对于18世纪,介绍了药物作用实验测试的早期尝试以及新的治疗体系和医学流派。2. 许多作者论述了1790年至1850年间药理学和治疗学的弊病,其中包括当代医学的主要代表人物,如法国的富尔克鲁瓦、比沙、皮内尔、阿利贝尔、马让迪,以及德国的舍恩莱因、米切尔利希、温德利希、亨勒和厄斯特伦。他们的批评有助于更好地理解当时的情况。这些批评涵盖以下方面。药理学因对药物作用原因的推测以及术语和适应症的混淆而被扭曲。药物作用的测试方法不充分。药物数量的增加被误认为是知识的增长。有人指出药理学是所有医学学科中发展最不完善的。批评者指出,只有化学、生理学和病因学得到更充分发展,才会有科学的药理学。医学流派的药物理论同样遭到摒弃。复方药剂、复合药物和荒谬的配方受到轻视。激进的药物治疗被否定,但这很容易导致对药物的回避和治疗虚无主义。3. 1799年,约翰·克里斯蒂安·赖尔阐述了他对未来药理学的原则。赖尔确立了科学药理学应基于的临床实验规则。他的目标是解释作为生化改变结果的药物作用。尽管赖尔的计划是一个理论构想,但它预见了半个世纪后才会形成的一种局面。同样在1799年,阿道夫·弗里德里希·诺尔德发表了对患者药物作用批判性检验的详细规则,包括安慰剂、依从性、统计学等方面以及若干伦理规则。赖尔和诺尔德的纲领性信息在新兴的德国“自然哲学”医学中消失了。4. 1800年后的几十年里,巴黎学派的医学达到了鼎盛。它成为了基于解剖学和病理学的医院医学。弗朗索瓦·马让迪是其代表人物之一。他1808年开始行医,后来成为一名生理学家,很快超越了他的老师比沙和里歇兰。马让迪只对事实感兴趣,这些事实必须通过实验来揭示,主要是在动物身上。他基于物理和化学定律创建了现代生理学。然而,他在巴黎学派中仍是个局外人。比沙和马让迪的其他前辈曾考虑过基于生理学的实验药理学,然而,他们并未提供实验得出的知识。马让迪在1809年发表了他关于药理学问题的第一篇实验研究。从那时起,他研究药物的作用机制和部位,并同时将它们用作研究生理过程的工具。在塞尔图纳从鸦片中分离出吗啡后,纯生物碱的制备成为法国药剂师和化学家的专长。从1817年起,马让迪寻求他们的合作,坚信药理学和治疗学必须基于生理学和化学。1821年,他出版了《几种新药物的制备和使用配方》,这标志着现代药理学的开端。该书不断修订,到1835年共出了八版。(摘要)

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