Eknoyan Garabed
Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Semin Dial. 2012 Sep-Oct;25(5):550-9. doi: 10.1111/j.1525-139X.2012.01088.x. Epub 2012 Jun 8.
The Late Medieval Period was a decisive period in the history of medicine. It was then that medical education was integrated into the universities that were coming into existence and when medicine made its transition from a menial trade to a regulated profession with a statutory basis of learning and graduation. It was also then that the necessities of understanding the fabric of the body was realized; for the first time in history, the study of anatomy and of human dissection were incorporated into the medical curriculum. This was a defining change whose subsequent expansion and evolution would bring about the study of function (physiology) and changes in disease (pathology). Few advances were made in the study of the kidney, which was considered part of the venous circulation, whose function was subservient to that of nutrition in eliminating excess fluid. Uroscopy flourished and reached unrealistic levels of dominance in the diagnosis, treatment, and prognostication of any and all diseases, especially in the hands of quacks and charlatans. Alchemy, a mysterious pseudo-science, blossomed into a discipline that nurtured experimentation and laid the rudimentary foundations of scientific study, chemistry, and pharmacology. It was also then that surgery took form as a specialty that actually provided much of the medical care of the period including that of the principal diseases of the kidney, obstruction and calculi, and thereby laid the foundations of what in time would become urology.
中世纪晚期是医学史上的一个决定性时期。正是在这个时期,医学教育被纳入新兴的大学之中,医学也从一种卑微的行当转变为一门有法定学习和毕业基础的规范职业。也正是在这个时期,人们认识到了解人体结构的必要性;历史上第一次,解剖学和人体解剖学研究被纳入医学课程。这是一个具有决定性意义的变化,其后续的扩展和演变将带来对功能(生理学)和疾病变化(病理学)的研究。在肾脏研究方面进展甚微,当时肾脏被认为是静脉循环的一部分,其功能在排除多余液体方面从属于营养功能。尿液检查盛行,并在所有疾病的诊断、治疗和预后方面占据了不切实际的主导地位,尤其是在庸医和江湖骗子手中。炼金术,一门神秘的伪科学,发展成为一门孕育了实验并奠定了科学研究、化学和药理学基础的学科。也是在这个时期,外科学形成了一门专科,实际上提供了当时大部分的医疗服务,包括肾脏的主要疾病——梗阻和结石的治疗,从而奠定了后来成为泌尿外科的基础。