Timio M
Dipartimento di Medicina Interna, Nefrologia e Dialisi, Ospedale S. Giovanni Battista, Foligno (PG), Italy.
G Ital Nefrol. 2003 Mar-Apr;20(2):176-83.
Medicine in the technological era acquired many of the characteristics that concurrently marked other fields. So, by adopting procedures based on information obtained with instruments and devices, medicine developed an approach to illness that transformed it into a special form of technology. The collective effect of instrumentation deserves consideration and offers the historian opportunities for interpreting the interaction between physician and his patients in other than scientific and technological terms. The very construction of instruments and devices depends on the Author's ideas assembled with the basic theories of the time. For instance, at the end of the nineteenth century, when medical instruments became essential, the bacterial origin of diseases revolutionised their construction and application. In this context, the invention and use of the microscope became an outstanding feature of the clinical approach by disclosing the cellular universe. The microscope had become crucial in locating some major causes of physical suffering and death in man, and was considered the pre-eminent diagnostic instrument in medicine. In the nephrological field, the microscope drew the physician into a universe of physical changes that were concealed to the naked eye. The microscope made possible the verification of some of Bright's brilliant ideas, something that helped physicians classify glomerulonephritis. Many nephrologists confessed "how few things are established in this subject (nephrology) and how many more difficulties are established, we have learned by experience with the microscope". The modesty of this claim is striking. In nephrology, as in other fields, the admission of ignorance proved to be the beginning of wisdom. This wisdom, based on the admission of ignorance and assembled through the commitment and ingenuity of the pioneers of the dialysis treatment, led to the treatment of end-stage renal disease and the guarantee of success. The technique of haemodialysis has been enriched by the new lexicon, which expresses different ways and ideas on the removal of the solute.
技术时代的医学具备了许多同时标志着其他领域的特征。因此，通过采用基于仪器和设备所获信息的程序，医学发展出一种对待疾病的方法，将其转变为一种特殊形式的技术。仪器使用的总体影响值得关注，也为历史学家提供了从科学技术之外的角度解读医生与患者互动的机会。仪器和设备的构造本身取决于作者结合当时基本理论所形成的想法。例如，在19世纪末，当医疗器械变得至关重要时，疾病的细菌起源彻底改变了它们的构造和应用。在这种背景下，显微镜的发明和使用通过揭示细胞世界成为临床方法的一个突出特征。显微镜对于确定人类身体痛苦和死亡的一些主要原因变得至关重要，并被视为医学上卓越的诊断工具。在肾脏病领域，显微镜将医生带入了一个肉眼无法察觉的身体变化的世界。显微镜使得验证布赖特的一些卓越观点成为可能，这有助于医生对肾小球肾炎进行分类。许多肾脏病学家承认“在这个学科（肾脏病学）中确定的事情是如此之少，而确立的困难却更多，我们通过显微镜的经验学到了这一点”。这种说法的谦逊令人瞩目。在肾脏病学以及其他领域，承认无知被证明是智慧的开端。这种基于承认无知并通过透析治疗先驱者的奉献和智慧积累起来的智慧，带来了终末期肾病的治疗并确保了成功。血液透析技术因新的术语而更加丰富，这些术语表达了关于溶质清除的不同方式和理念。
