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LECTURE 11 Clinical medicine in the 20th century

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  1. LECTURE 11Clinical medicine in the 20th century

  2. Clinical medicine in the 20th century • The development of the internal medicine • The development of surgery • The beginning of new medical disciplines

  3. Clinical medicine in the 20th century • It’s dominated by holist conception in which the body is in charge of the neural-endocrinologist system. • The heart diseases will be treated separated with the support of radiography, electrocardiography, echography and radioimmunology. • The electrocardiography has been introduced in 1903; in 1904 has been discovered the autonomic neural system of conducting the heart by Ludwing Aschoff. • Karl Albert Ludwig Aschoff (January 10, 1866 – June 24, 1942) was a German physician and pathologist. He is considered to be one of the most influential pathologists of the early 20th century and is regarded as the most important German pathologist after Rudolf Virchow.

  4. Aschoff was especially interested in the pathology and pathophysiology of the heart. He discovered nodules in the myocardium present during rheumatic fever, the so-called Aschoff bodies. Aschoff's reputation attracted students from all over the world, among them Sunao Tawara. Together they discovered and described the atrioventricular node (AV node, Aschoff-Tawara node). Numerous travels abroad, to England, Canada, Japan, and the US led to many research connections, whereas the trips to Japan proved to be especially productive. In the early 20th century, 23 of 26 Japanese pathological institutes were headed by students of Aschoff. • In 1907 Arthur Keith and Martin Flach revolutionized the knowledge of the mecanism of the appearing the heart diseases. • An important step was the exploring of the heart’s cavities using the method of catheterization of the large vessels. • The year 1947 marks the moment of the left heart’s catheterization. The procedure was made by H.A. Zimmemann, R.W. Scott and N.A. Eeckler.

  5. Clinical medicine in the 20th century • The French physician Felix Moutier introduces gastroscopy and the German Rudolf Schindler is considered the father of gastro-endoscopy. • The most spectacular discovery of the 20th century was the nephrology. • Among the Romanian personalities of the century I shall mention: • Nicolae Klinderu (1835 – 1902) publishes various works about aorta’s aneurism, meningitis and the lesions of the spinal cord in Addison disease. • Ion Nanu Muscel (1862-1938) introduces the radio-diagnosis and other laboratory investigations. • Daniel Danielopolu (1884 – 1955) is precursor of bio-cybernetics . • Nicolae Gheorghe Lupu (1885 – 1966) is concerned with hematology, nephrology and hepatology.

  6. Clinical medicine in the 20th century • Iuliu Hatieganu (1885 – 1959) individualizes new clinical forms of septic hepatitis and introduces the cytology of the duodenal liquid. • Endocrinology gains an outstanding development together with the discovery and isolation of the certain hormones: • adrenaline (1901 – Takamine and Aldrich) • ocitocine (1906 – Dale) • tyroxine ( 1914 – Kendall) • pancratine and insulin (N. Paulescu, Banting and Best – 1922) • the growth hormone (1922 – Long and Evans)

  7. Clinical medicine in the 20th century • An outstanding figure of the Romanian School of Medicine in the endocrinological field was Constantin I. Parhon (1874 – 1969) who makes investigations on the ovary, thyroid, parathyorids, hypothisis and their importance in histo and organogenesis. • Constantin Ion Parhon (October 15, 1874—August 9, 1969) was a Romanian neuropsychiatrist and endocrinologist. • In 1909, he co-authored with the first book on endocrinology, Secreţiile Interne ("Internal Secretions"). Later on, he published a Handbook of Endocrinology, co-written with M. Goldstein and (3 volumes, 1945-1949). Parhon published over 400 titles, and was known for his encyclopaedic knowledge. Besides the afore-mentioned works, some of his other well-known works are Old Age and Its Treatment (1948), The Age Biology (1955), and Selected Works (5 volumes, 1954-1962).