药用蜈蚣的生态习性与临床应用

生化分析显示,蜈蚣体内含有多种氨基酸、小分子肽、甾醇、脂肪酸等各类活性物质,这可能是医典所载其主治中风、破伤风、恶疮、肿瘤、癣、蛇咬等的药学基础。本文从古代、现代的中医药典籍、文献中总结了六个方面的临床应用,还较为系统全面地阐述了药用蜈蚣的栖息环境、行为与食性、繁殖与个体发育等方面的野外及人工环境下的生物学特性与生态行为表现,以资现代中医药建立医疗模式和药源基地参考。     

Experimental history and Herman Boerhaave’s chemistry of plants

In the early eighteenth century, chemistry became the main academic locus where, in Francis Bacon’s words, Experimenta lucifera were performed alongside Experimenta fructifera and where natural philosophy was coupled with natural history and ‘experimental history’ in the Baconian and Boyleian sense of an inventory and exploration of the extant operations of the arts and crafts. The Dutch social and political system and the institutional setting of the university of Leiden endorsed this empiricist, utilitarian orientation toward the sciences, which was forcefully propagated by one of the university’s most famous representatives in the first half of the eighteenth century, the professor of medicine, botany and chemistry Herman Boerhaave. Recent historical investigations on Boerhaave’s chemistry have provided important insights into Boerhaave’s religious background, his theoretical and philosophical goals, and his pedagogical agenda. But comparatively little attention has been paid to the chemical experiments presented in Boerhaave’s famous chemical textbook, the Elementa chemiae, and to the question of how these experiments relate not only to experimental philosophy but also to experimental history and natural history, and to contemporary utilitarianism. I argue in this essay that Boerhaave shared a strong commitment to Baconian utilitarianism and empiricism with many other European chemists around the middle of the eighteenth century, in particular to what Bacon designated ‘experimental history’ and I will provide evidence for this claim through a careful analysis of Boerhaave’s plant-chemical experiments presented in the Elementa chemiae.     

Classification, disease, and diagnosis

Classification shapes medicine and guides its practice. Understanding classification must be part of the quest to better understand the social context and implications of diagnosis. Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered. This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification. It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine. It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.     

Revisiting the Navajo way: lessons for contemporary healing

Given the paradox of the success of modern medical technology and the growing patient dissatisfaction with present-day medicine, critics have called for a reevaluation of contemporary medical practice. This paper offers a phenomenological analysis of traditional Navajo healers and their ceremonies to highlight key aspects of healing. A phenomenological view of medical practice takes into account three key features: the lifeworld, the lived body, and understanding. Because of their closeness to a phenomenological view, traditional Navajo mythology and healing practices offer insight into the healing process. Contemporary physicians can appreciate the phenomenological elements of Navajo healing ceremonies, including the Mountain Chant. Navajo healers help patients make sense of their illnesses and direct their lives accordingly, an outcome available to contemporary practitioners, who are also gifted with the benefits of new technologies. By examining scientific medicine, Navajo healing practices, and phenomenology as complementary disciplines, the authors provide the groundwork for reestablishing a more therapeutic view of health.     

The doctrine of specific etiology

Modern medicine is often said to have originated with nineteenth century germ theory, which attributed diseases to bacterial contagions. The success of this theory is often associated with an underlying principle referred to as the “doctrine of specific etiology”. This doctrine refers to specificity at the level of disease causation or etiology. While the importance of this doctrine is frequently emphasized in the philosophical, historical, and medical literature, these sources lack a clear account of the types of specificity that it involves and why exactly they matter. This paper argues that nineteenth century germ theory involves two types of specificity at the level of etiology. One type receives significant attention in the literature, but its influence on modern medicine has been misunderstood. A second type is present in this model, but it has been completely overlooked in the extant literature. My analysis clarifies how these types of specificity led to a novel conception of etiology that continues to figure in medicine today.     

Parallel and divergent landscapes: cultural encounters in the ethnographic space of Tuareg medicine

This essay explores the dialogue between the local quest for healing and the anthropological quest for healing knowledge, and local assessments of knowledge-power relationships in these processes. The context is medical discourse among the Tuareg of Niger Republic, West Africa, and my research experiences among these people. I examine local medical specialists and their traditional and changing practice in terms of how they perceive and respond to wider knowledge and power systems that impinge on local health care. Paramount in these systems are central state policies and medical anthropological research on healing, as these intersect in a postcolonial and post-separatist/rebellion setting. The essay analyzes parallels between the exchange of medicine and the exchange of knowledge and reflects upon how anthropological knowledge of African healing systems is constructed in an environment highly charged with power and danger--of political violence and economic crisis. The broader issue addressed here is how to give greater empowerment to local residents' voices in their "indigenous critique" of the medical anthropological project.     

The physicians and surgeons of Koper from the 14th to the 17th century

Koper stands out among Istrian towns of the nordeastern Adriatic coast for its highly advanced medicine. Communal service developed between the 13th and 15th century. Beside the hospital, almshouse and a quarantine, the city also boasted highly trained physicians, surgeons and barbers. Trade, crafts and navigation prospered and numerous town intellectuals established an academy whose most active members were medical doctors. The aim of this article is to give a chronological presentation of physicians related to Koper by their birth or work and of other scientists who contributed to the development of local medicine. These includes (about forty names) S. Santorio, Ser Benvenuto, P P. Vergerio, G. Nuzio, E Nuzio, P de Castaldi, I. de Albertis, L. Zarotti, B. Petronio, I. Bratti, Z. Zarotti, A.Valdera, G. Vergerio and C. Zarotti of whom some are well known. The author wishes to systematisize the bibliography, fill the gaps and show ways for further research in the archives and museums of Istria, Triest, Venice and Vienna.     

The next steps for genomic medicine: challenges and opportunities for the developing world

This is a historical moment on the path to genomic medicine - the point at which theory is about to be translated into practice. We have previously described human genome variation studies taking place in Mexico, India, Thailand, and South Africa. Such investments into science and technology will enable these countries to embark on the path to the medical and health applications of genomics, and to benefit economically. Here we provide a perspective on the challenges and opportunities facing these and other countries in the developing world as they begin to harness genomics for the benefit of their populations.     

What is an "organism"? On the occurrence of a new term and its conceptual transformations 1680-1850

The essay reconstructs the occurrence of the term "organism" and the transformations of its concept from around 1680 to the middle of the nineteenth century. The different sections refer to individual authors who used the word "organism" and situate its usage in specific historical contexts. After earlier uses of the word in medieval sources, the Latin word "organismus" appeared in 1684 in Stahl's medico-physiological writings. Around 1700, it can be found in French (organisme), English (organism), Italian (organismo) and later also in German (Organismus). During the eighteenth century, the word "organism" generally referred to a specific principle or form of order, often in opposition to the order of "mechanism," that could be applied to plants, animals or the entire world. At the end of the eighteenth century, the term became a generic name for individual living entities with inside-outside-interfaces and an inner "organization" of parts. From around 1830, the word "organism" replaced the expressions "organic" or "organized body" as a recurrent technical term in the emerging biological disciplines.     

Creating difficulties everywhere

In this essay we link the rationale for the medical humanities with radical hermeneutics, a move that infuses the medical humanities with incredulity and suspicion. This orientation is particularly important at this historical moment, when the evidence-based and competency blanket is threatening to overpower all aspects of medical education, including the medical humanities discourse itself. Radical hermeneutics works relentlessly against the final word on anything, and as such, it provides a critically provocative way of thinking about doctors, patients, illness, health, families, death--in short, the experience of being human. We use three literary examples to illustrate the complex, contradictory, perplexing, and disturbing questions related to a life in medicine: Rafael Campo's "Like a Prayer," Irvin Yalom's "Fat Lady," and Richard Selzer's "Brute."     

Smallpox: A Retrospect

Smallpox has been known as a disease of man since the earliest times. However, its severity increased greatly during the eighteenth century, stimulating physicians and others to find methods of protection against it. Variolation (the inoculation of smallpox material into the skin) was tried, and for a while found general approval, although its practice was not without danger. In 1796, Edward Jenner began his investigations into the use of cow-pox material (vaccination) as a prophylactic against smallpox, and later showed that vaccination could confer protection. Although vaccination centres were first set up in Canada early in the nineteenth century, the disease on occasion assumed epidemic proportions, such as occurred in Montreal in 1885. Sporadic outbreaks have occurred since then, including the recent case in Toronto. From the public health point of view, maintenance of a high level of immunity to smallpox throughout the general population is necessary if serious epidemics are to be avoided.     

Scars of experience: the art of moxibustion in Japanese Medicine and Society

Beliefs and practices surrounding moxibustion, a cautery technique used in Japan, are analyzed to demonstrate that the concept of holism is culture-bound and that the practice of East Asian medicine is often reductionistic.Pluralistic traditional medical belief systems of historical and contemporary Japan are discussed with reference to moxibustion. Moxa is used in popular family medicine, for ritual purification, as a technique to cure disease or as part of a holistic approach to healing; its symbolic meaning changes according to its usage and it serves to unite disparate medical beliefs.Socialization practices concerning attitudes towards illness reflect pluralistic values derived from traditional medical systems. One dominant set of values encourages patient and family responsibility during the healing process, adaptation to psychosocial relationships regarded as causal in disease occurrence and avoidance of verbal analysis of problems. These concepts, fundamental to East Asian medicine, cannot be readily adapted in the West as part of a holistic approach to health care.     

Differences and similarities in the regulation of medical practice between early modern Vienna and Osijek

This paper evaluates the regulation of medical practice from the sixteenth to the eighteenth centuries in two Habsburg cities, Vienna and Osijek, in the light of the spread of medical knowledge and practice from the centre to the periphery of the Habsburg Monarchy. Although both cities were part of the Habsburg Monarchy for much of the early modern period, there were more differences than similarities between them. This may be explained by appealing to a variety of factors, including geographical position, population structure, religion, government type, and professional organisations, all of which contributed to making medical practice very different in the two cities. The divergence occurred in spite of a central agenda for ensuring uniformity of medical practice throughout the Habsburg Monarchy. Although the legislation governing medical practice was the same in both cities, it was more strictly implemented in Vienna than in Osijek. In consequence, Osijek was the setting for some unique patterns of medical practice not to be found in the Habsburg capital.     

Botanists and Medical Herbalism in Montpellier

The article describes how the medical school in Montpellier, organized in 1498, responded to the development of the Jussiaean classification of plants. Though overshadowed by Paris in the eighteenth century as a center of medical and botanical training, botany as taught at Montpellier provided the impetus for the conversion of traditional herbalism into a biology-based medicine by the nineteenth century. In addition, the plant affinities and analogies underlying natural classification led to the conception of a viable theory of evolution, as Darwin acknowledged. The opposition to these advances, evident in the nineteenth century, remains alive today.     

'An adept in medicine': the Reverend Dr William Laing, nervous complaints and the commodification of spa water

This essay addresses mineral water as a medical, experimental and economic material. It focuses on the career of the Reverend Dr William Laing (1742-1812), a physician and cleric who wrote two pamphlets about the water of provincial spa located in Peterhead, a town on the north-east coast of Scotland. I begin by outlining his education and I then reconstruct the medical theory that guided his efforts to identify tonics in the well's water. Next, I explain why Laing and several other local inhabitants thought themselves to be authorities on the palliative power of the water and I close by showing how such effects were commodified by local entrepreneurs. Although I concentrate primarily upon Peterhead Spa, this study touches upon several issues relevant to the types of medical theory and chemical experimentation that were being used in provincial Scotland during the late eighteenth and early nineteenth centuries.     

UNINFORMED CONSENT: MASS SCREENING FOR PROSTATE CANCER

While medicine may agree in principle that cancer screening requires informed consent, such consent is not, in fact, common practice. In the case of prostate‐cancer screening this means that men in large numbers undergo PSA testing with little understanding of its liabilities – in particular, that it may or may not decrease mortality, often detects cancer of questionable significance, and may lead to unnecessary surgery. Given that prostate cancer is known to be overtreated and that family history is a risk factor, it follows that a man diagnosed with prostate cancer, even if it is of no clinical significance, automatically promotes his son into the high‐risk category; and given that those so categorized are subject to heightened medical surveillance and that the more diligently medicine searches for prostate cancer the more likely it is to find it, it follows that the sons of men diagnosed as a result of PSA testing are at risk of being overdiagnosed (and overtreated) precisely because their father was. Twenty years into the PSA revolution, its generational consequences have not been discussed in the medical literature.     

The Oslerian Tradition and Changing Medical Education: A Reappraisal

Although only 21 of Sir William Osler''s 45 years in academic medicine were spent in US medical schools (1884 to 1905), he played a major role in shaping modern medical education in this country. The integration of scholarship with patient care, together with the science and art of medicine, was central to Osler''s teaching and writing throughout his career. A classic generalist and a charismatic clinical teacher, he taught by example and was as concerned with the ideals of medicine as with its science and knowledge.Many changes have reshaped the content, process and concerns of American medical education since Osler''s time. Subspecialization and balkanization of medical education and practice have become dominant. Many of the important issues in medicine today do not fit neatly into the domain of any of the established specialties or medical organizations. There is now an urgent need to promote generalist attitudes in medicine, and the Oslerian tradition has much to offer in approaching today''s problems in medical education and practice.     

Hempelian and Kuhnian approaches in the philosophy of medicine: the Semmelweis case

Semmelweis's investigations of puerperal fever are some of the most interesting in the history of medicine. This paper considers analysis of the Semmelweis case. It argues that this analysis is inadequate and needs to be supplemented by some Kuhnian ideas. Kuhn's notion of paradigm needs to be modified to apply to medicine in order to take account of the classification schemes involved in medical theorising. However with a suitable modification it provides an explanation of Semmelweis's failure which is argued to be superior to some of the external reasons often given. Despite this success in applying Kuhn's ideas to medicine, it is argued that these ideas must be further modified to take account of the fact that medicine is not a natural science but primarily a practice designed to prevent and cure diseases.     

The Biotechnical Embrace

This essay discusses three interpretiveconcepts that link bioscience and biotechnologyto society: the medical imaginary, thebiotechnical embrace, and the clinicalnarrative. Drawing on research carried out inthe United States and internationally on theculture and political economy of biomedicine,the essay examines these interpretive conceptsthrough examples from studies of patients,clinicians, scientists, and venture capitalistsengaged in the worlds of oncology and hightechnology medicine. These interpretiveconcepts contribute to an understanding of howthe affective dimensions of the experience of patients, clinicians and scientists invested inhigh technology medicine are fundamental tobioscience and biomedicine, and to thepolitical economy and culture of hope.     

Henry Ingersoll Bowditch and Oliver Wendell Holmes: stethoscopists and reformers

Two Bostonians, Henry Ingersoll Bowditch (1808-1892) and Oliver Wendell Holmes (1809-1894), went to Paris for advanced medical training and came home ardent disciples of Pierre Charles Alexandre Louis, leader of the French school that derived its eminence from expert auscultation and careful correlation of bedside and autopsy findings. Both Bowditch and Holmes became leaders in 19th-century American medicine. Bowditch, a successful practitioner and prolific medical writer, wrote the first important American text on physical examination and became our first specialist in pulmonary disease. He pioneered in the public health movement, was a charter member and later president of the American Medical Association, and was an abolitionist and an advocate for equal rights for women in medicine. Holmes left practice to become a medical educator. As Dean of Harvard Medical School, he tried unsuccessfully to admit white women and free black men to the school. Although his greatest fame came as a man of letters, Holmes considered himself first a physician and medical educator, and was justifiably proud of his definitive study, "The Contagiousness of Puerperal Fever" (1843). Today, Bowditch and Holmes are little appreciated as pioneers and reformers, but we remain in debt to them both.