Evolution of Therapy

 

Some Moments in the Evolution of Therapy

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In the foreground, Galen and Hippocrates debate a therapeutic dilemma, while in the background apprentices collect ingredient necessary to ensure the efficacy and the infinitely complex medication – theriac.

Paracelsus in the 16th century, made balsams from herbs by putrefaction and distillation, and as such, obtained a number of essential oils including the quintessence – Lilium Paracelsi.

Early pharmacotherapeutic remedies, sometimes multiple but often bizarre, had a rather dubious success when it came to treating medical diseases.

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The development of a rational therapeutic strategy depended upon the identification of active principals in herbal remedies – belladonna, and mandragora.

Cinchona derived from Peruvian bark made its appearance in European drug markets during the 17th century. Thomas Sydenham was one of the first to use it as a specific for fevers.

The development of Homeopathy during the 19th century by Samuel Hahnemann achieved widespread popularity. His theory was not significantly different to that of Paracelsus.

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Paul Ehrlich deserves the credit for initiating the concept of the chemical target of pathogenic agents. His concept allowed for a targeted drug reality to develop.

In 1973, a team of scientists led by Sir James Black, produced the first clinical H2-receptor antagonist, cimetidine, thereby ushering in the age of acid suppressive medication and therapy.

Proton pump inhibitors that irreversibly target the acid-secreting proton pump in the stomach were developed from 1977-1981, and helped revolutionize acid therapy.

Some Moments in the Evolution of Gastro-Esophageal Therapy

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Theodore Billroth and colleagues, Rydygier and Eiselsberg, attempted to treat acid diseases (e.g. obstructions) by performing gastro- or esophagectomies (1881).

Ismar Boas (top) and Karl Ewald (bottom) were the founders of modern Gastroenterology. They wrote the first textbooks, established the first journal and performed gastric function tests.

Bertram Sippy devised a complex dietary regimen of bland food that included hourly feedings of milk to relieve dyspeptic symptoms and treat acid-related diseases.

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Andre Latarjet recognizing the role of vagal nerves in the regulation of acid secretion sought in 1923 to show that their resection resulted in a resolution of acid diseases.

Rudolf Nissen in 1956 described his operation – a gastroplication – for the treatment of reflux esophagitis. One of his patient’s who declined the procedure was Albert Einstein.

The evolution of gastro-esophageal therapy has coincided with that of therapy per se, and has included herbal, medical, surgical and ultimately pharmacological intervention.

 

 

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