【外科醫生與諾貝爾醫學獎】

 

J Invest Surg. 2006 Jul-Aug;19(4):211-8.

Nobel Laureate surgeons.

Toledo-Pereyra LH1.

Author information

 

Abstract

Eminent surgeons who received the Nobel Prize in Physiology or Medicine for their work and accomplishments are considered Nobel Laureate surgeons. There are nine such distinguished individuals who achieved this award. In chronological order, from earliest to latest, we encounter: 1. Theodor Kocher, 1909, thyroid gland pathology; 2. Allvar Gullstrand, 1911, dioptrics of the eye; 3. Alexis Carrel, 1912, vascular suture and organ transplant; 4. Robert Barany, 1914, vestibular system; 5. Frederick Banting, 1923, discovery of insulin; 6. Walter Hess, 1949, midbrain function; 7. Werner Forssmannn, 1956, cardiac catheterization; 8. Charles Huggins, 1966, hormones and cancer; 9. Joseph Murray, 1990, organ transplantation. These extraordinary Nobel Laureate surgeons had in common four significant qualities expressed by four letters, CDFI, representing commitment, determination, focus, and innovation. The examples of a sustained path of accomplishment and success set by these unique personalities serve as a vivid guide for future generations of surgeons.

 

 

 

外科醫生與諾貝爾醫學獎

江顯楨

 

每年十月，世人都在注意誰與誰上了諾貝爾的榮譽榜沒有？自從1901年有諾貝爾獎金以來，前後有一百八十六位醫學專家得過它的醫學生理獎；大多數得主是基礎醫學研究者，臨床科學家非常之少，在這其中隻有五個人是外科醫生。看到過去幾位在心胸外科領域的先驅者，應得諾貝爾獎而失之交臂，不禁為之惋惜。

備受尊敬的外科領導者

Dr. Theodor Kocher

瑞士的外科醫生悉奧多．柯克（Dr. Theodor Kocher, 1841-1917）任職伯恩（Bern）外科主任共四十五年，他是一般外科，胃腸外科，內分泌外科，泌尿科，婦科，神經外科，以及外傷醫學之權威，這些钜細靡遺的手術全部都包羅在他1892年出版的外科教科書裏。當時瑞士因缺碘而得甲狀腺腫瘤病患特多，1876年他是首位切除甲狀腺腫瘤者，經過許多實驗工作之後，數千個甲狀腺切除是當時做得最好，最為安全的手術。其技術高超，不像其他開刀者隻求快速，忽略細節而導致高死亡率與併發症。他也率先指出外科切除引起的“甲狀腺官能不足症”（Hypothyroidism）。他不僅是一位外科巨擘，傑出教授，從事研究的學者，也是一位虔誠於宗教，厚道待人，有修養的紳士。他為後代外科醫生立下典型，世界上沒有一個外科醫生不知道何謂Kocher's incision，Kocherization等術語。時至今日，大師聲譽之隆，如雷貫耳，在外科領域裏，備受尊敬。1909年柯克醫生因為研究甲狀腺的生理，病理以及對外科疾病所作的貢獻，獲得諾貝爾醫學獎。

移植試驗外科的先驅者

Dr. Alexis Carrel

法國裏昂（Lyons）的外科醫生阿勒西．卡瑞（Dr. Alexis Carrel, 1873-1944）是美國籍的法國人，他的成就大部分是1906年到1914年，當他在美國紐約洛克菲勒醫學研究院（Rockefeller Institute）做試驗外科研究員的那段時期。他1902年發表的“三角固定縫接技術”（triangulation technique）是標準的血管end-to-end兩端吻合法，至今仍然被外科醫生奉為圭臬。他的研究包括動物實驗：用人工培養母雞的一個胚體，竟然存活超過二十多年；成功地完成自體血管和器官的移植；以冷卻方式延長被分離過的血管或器官的壽命，使不壞死；1908年他將小狗心臟移植到大狗的頸內，發現被剝離神經的心臟仍有正常搏動的生理功能；1935年他與第一位飛越大西洋的英雄林白（Charles Lindbergh）合作，設計雛型的“人工心肺”機器；又與另一有名的法國外科醫生Dr. Tuffier合作，設計一種佩帶在醫生手指上的“瓣膜刀”儀器，可以進入心臟裏麵切開瓣膜。1912年卡瑞醫生因為研究血管吻合技術以及對器官移植外科所作的貢獻，獲得諾貝爾醫學獎。

三角固定縫接技術

把自己當天竺鼠的怪傑

佛斯曼的心臟導管步驟

德國的維納．佛斯曼醫生（Dr. Werner Forssmann, 1904-1979）從柏林醫學院畢業不久，1929年當他還是一位外科住院醫師時，在柏林附近的Eberswalde醫院，他把自己當作白老鼠做試驗。不顧上級醫生和教授的反對，他說服同事和一位護士，得到他們的合作，先把自己的左肘窩局部麻醉，切開前肘靜脈，然後順著血流方向插進一條導管，這條泌尿科用的“輸尿管導管”（ureteral catheter）又細又長。等到導管已經進入六十五公分時，外頭還吊著晃來晃去的一大截，他從容走到X光科，照了一張胸部X光。照片證明該導管已經進入他的右心房，這也證明整個心臟導管步驟是安全的。

Dr. Werner Forssmann

佛斯曼的原意是為了替“心臟復甦術”尋找可以直接注射藥物到心臟的安全之路，那時一般人包括醫生都相信任何管子隻要進入心臟，一定致人於死。雖然佛斯曼打破這迷信，他卻立刻被上司老闆撤職，據說佛斯曼自我實驗十七次，德國醫界對他“瘋狂”行為一致聲討。以後他又用狗繼續做心臟導管的研究，德國的心臟科醫界難以消受，至少有十年以上的時間，大家對他的重要發現不屑一顧。他失望之餘，改行泌尿外科。倒是後來美國醫界重視他的成就，紐約哥倫比亞大學的兩位心臟科教授Dr. Cournand和Dr. Richards重新啟發心臟導管研究，並做臨床實驗。佛斯曼醫生的創意和勇氣終於在二十七年後被肯定，1956年他與美國心臟內科醫生三人共同獲得的諾貝爾醫學獎。

性賀爾蒙的巧妙操作者

Dr. Charles Huggins

美國泌尿科醫生查理．赫金斯（Dr. Charles Huggins, 1901-1997）是芝加哥大學（University of Chicago）的外科教授，泌尿科及癌症專家。他首先研究正常公狗的前列腺，發現它的功能與成長，受男性賀爾蒙的刺激，也受女性賀爾蒙的抑製。由這觀察他大膽假設：人與狗的前列腺對性賀爾蒙的反應基本上可能一樣，他又假設前列腺的癌細胞可能還保留著些許正常細胞對賀爾蒙的反應。1941年他根據實驗，發表前列腺癌的“賀爾蒙療法”：也就是用“去勢”（castration）手術來免除男性賀爾蒙對癌的刺激，或用女性賀爾蒙來控製。許多末期的前列腺癌患者，癌細胞已經侵襲到附近正常組織或擴散到遠處器官，無法做腫瘤的外科切除，經過這種前所未聞的賀爾蒙療法，居然有一半以上的人病情好轉，原發腫瘤和轉移到遠處器官的腫瘤相繼變小，甚至消失無蹤。病入膏肓的患者反而日有起色，原來預計非常短暫的生命得以延長。更妙的是，他給的並非“化療”有毒之藥，亦非放射性物質，而是操作運用自然發生的賀爾蒙，既無毒性，又很少有副作用。1950年後赫金斯醫生也試用賀爾蒙療法於乳癌病人，基於癌細胞內荷爾蒙感受體分析所得的結論，如今“抗激情素”已經是乳癌必用之藥。賀爾蒙療法尤其對末期的乳癌病人，有解除痛苦和長期舒緩的效應。1966年赫金斯醫生因為研究前列腺癌，發展“賀爾蒙療法”以及外科療法，獲得諾貝爾醫學獎。

同卵雙胞間的腎臟移植

Dr. Joseph Murray

美國波士頓Brigham & Women's醫院約瑟夫．莫瑞醫生（Dr. Joseph Murray 1919-）是哈佛大學一般外科和整形外科的教授，他相信免疫學的障礙並不存在於同卵雙胞（identical twins）之間。他先發展狗的腎臟移植手術，然後在1954年的十二月，首次應用這技術到臨床，成功地替同卵雙胞的病人完成腎臟移植。有末期腎臟病衰竭的Richard是他第一個換腎的對象。為了確定他與Ronald是同卵雙胞，莫瑞醫生跑到波士頓警察局，去查詢求證他們的指紋圖案。正在翻閱警局記錄之時，消息泄漏，被跟蹤的記者發覺。這宗調查差點變成侵犯個人隱私的案件。幸好Richard對這意外，一直保持鎮靜。後來手術成功，腎臟功能恢復正常，他反而變成媒體寵兒。Richard與恢復室護士小姐結婚，並且成為兩個孩子的父親。他快樂活了八年，最後死於心肌梗塞。莫瑞醫生以後又繼續替幾對同卵雙胞的病人做腎臟移植，都很成功。遺憾的是，絕大多數患有末期腎臟衰竭者並非同卵雙胞，所以這些病人還得等一段長時間才能成為換腎手術的對象。為避免移植後的排斥反應，莫瑞醫生當初採用的是全身輻射（total body irradiation），有了新藥物azathioprin，血緣親戚之間的腎臟移植，或屍腎移植，才告成功。據說給腎者與受腎者的“移植抗原”如果匹配，成績最好。時至今日，免疫學研究突破，嶄新藥物陸續出現，各種器官的移植已經是大型教學醫院的常規外科手術。1990年莫瑞醫生因為對器官移植外科作出貢獻，獲得諾貝爾醫學獎。

漫談外科醫生─科學家

由創意，經過實驗室，再到臨床應用，這是外科使命的思維模式。回溯上個世紀的醫學歷史，一些重要的發明或發展如：血庫的設立；“開心”手術的創始；休克，外傷及灼傷引發人體反應的了解；全麵靜脈營養的輸入；人工器官，器官移植，關節換置，微創手術的發明，都是一些極負創意的“外科醫生－科學家”（Surgeon-scientist）經過實驗室嘔心瀝血的研究，最後應用到臨床，改善病人的照顧。他們研究的創意來自病人；實驗室研究則是憑著恆心和勞力，而不單靠聰明睿智；最後臨床應用的成功，卻往往是始料未及的意外收穫，有時全靠運氣。有些醫生博士（MD/PhD）著手研究人體的方式簡化到分子層次，可惜的是，他們對較大的人體生理病理現象，興趣索然。人體的疾病畢竟是發生在器官係統的層次，譬如：血管痙攣，阻塞；器官缺血，壞死；乃至補償不全，休克等等，隻有保持著“整體概念”的臨床外科醫生才能理解，“簡化論者”難以置喙。外科醫生科學家在臨床治病時表露高度自信，當機立斷，劍及履及；做起科學研究一樣是審時度勢，大膽假設，小心求證。有人認為：二十世紀後半期，也就是說二次大戰後的五十年是外科醫生做科學研究的黃金時代，鼎盛已過，風光不再。但我相信：時空變化不應該影響或轉移外科的核心價值。看在今朝，他們仍栩栩如生；放眼未來，他們繼續領銜醫學科學的研究與臨床病人的照顧，也當可預料。

 

外科醫生與諾貝爾醫學獎（二）

江顯楨

 

　　翼報2006年十一月第28期刊登“外科醫生與諾貝爾醫學獎”一文，提到自從1901年以來，曾經獲得諾貝爾醫學生理獎的人，前後共有一百八十六位醫學專家，其中大多數是基礎醫學研究者，臨床科學家的確非常之少，臨床外科醫生在“一般外科”的領域裏有重大貢獻者，更是少之又少，算了算也就是上次介紹的那五位。事實上，廣義的外科醫生並不局限於一般外科，它應該包括眼科，耳鼻喉科，以及神經外科等外科係統的醫生。至於他們得獎的理由，固然都是劃時代的貢獻，但是與其說這些基礎醫學的發現與臨床外科的領域並無直接之關連，不如說這些發現與他們豐富的外科經驗相得益彰。甚至說，在一個內科與外科互相交匯錯綜複雜的領域裏，重要的突破影響了人們的注意力，因而對受獎者本身是否為外科醫生一事，已經不太關心或介意。在這個範疇裏，我們也看出諾貝爾獎對候選人的選擇有時並非公允，而這美中不足和偏差的做法也帶來日後莫大的爭議。為了忠實於這論題的報導，現在就介紹下麵另外五位諾貝爾醫學生理獎的得主，其中的前四位曾經是臨床外科的醫生。

 

Dr. Allvar Gullstrand

光學物理研究靈魂之窗

瑞典烏普薩拉（Uppsala）的沃華．郭思傳醫生（Dr. Allvar Gullstrand, 1862-1930）是烏普薩拉大學的首任眼科教授，也是物理與生理光學的教授。他早年的物理數學都是自學而成，他把這些基礎科學的方法後來應用到“光學圖像”（optic image）的新概念和眼睛的“光線折射”（dioptrics）理論。

郭思傳裂隙燈 Gullstrand slit lamp

他致力於眼睛結構與功能的研究，特別是角膜弧度“散光”的研究；利用鏡片矯正或改善白內障切除後之視力；對“檢眼鏡”（ophthalmoscope）的改善；和發明“郭思傳裂隙燈”（Gullstrand slit lamp）；後兩者成為研究眼睛詳細構造不可或缺的診斷工具。
郭思傳醫生並且把德國物理學家赫姆霍茲（H. von Helmholtz）的古典理論發揚光大，解釋肉眼裏的水晶體對不同遠近而來的光線可以有集焦的能力。這種調節機製就是水晶體凸透鏡麵的“適應”（accommodation），根據他的研究，其增幅可以達到動作的三分之二，另外三分之一則受限製於外囊而固定不變。1911年郭思傳醫生因為研究眼睛的光線折射理論，獲得諾貝爾醫學獎。由於他在瑞典科學院有過行政能力的表現，後來被選為該院諾貝爾物理委員會委員，並擔任過主席。

 

內耳前庭器與平衡機製

Dr. Robert Barany

奧地利維也納的羅伯．巴瑞尼醫生（Dr. Robert Barany, 1876-1936）畢業於醫學院後就對神經精神科深感興趣。在維也納作耳科醫生時，對人類內耳的生理及病理有深入之研究。他為一名有前庭器官疾病的人診斷治療，用不同溫度的沖洗液灌進病人的外耳道時，發現當注射液太冷時，病人出現眩暈（vertigo）和眼球自動震顫（nystagmus）的現象。當他改用比較溫暖的液體灌進，病人眼球震顫的方向正好與以前的相反。在一連串的試驗中，他觀察出三半規管內淋巴液對溫度冷降熱升的反應；而淋巴流動的方向提供前庭器官“本體感受”（proprioceptive）的信號。這些“熱反應”實驗導致後來耳科醫生對前庭器官疾病手術治療的可能性。他同時也對其他有控製平衡機製功能的小腦與肌肉進行研究。1914年巴瑞尼醫生因為研究內耳前庭器官的生理和病理，贏得諾貝爾醫學獎。
當時第一次世界大戰方殷，巴瑞尼醫生以平民身分跟隨奧地利陸軍，在前線照護頭部外傷的傷兵。諾貝爾醫學獎發表時，他們發現他被關禁在俄羅斯的俘虜營裏。經過瑞典卡爾王子親自代表紅十字會與俄羅斯交涉，1916年巴瑞尼醫生終於被釋放，並且能夠前往斯德哥爾摩，接受瑞典國王頒給他的諾貝爾獎。遺憾的是，同年他回維也納，受到同行學者們無情的詆毀，他失望之餘，乃轉往瑞典，在烏普薩拉大學（Uppsala University）任教耳科，一直到他去世，再也沒有回到自己的國家。

 

主導揭開治糖尿的奧秘

Dr. Frederick Banting

加拿大多倫多外科醫生佛德瑞克．班亭（Dr. Frederick Banting, 1891-1941），在第一次世界大戰期間，他加入加拿大軍隊的醫療團前往法國，在一場戰役中受傷。1919年戰爭結束，班亭返回加拿大，在多倫多的病童醫院當骨科住院醫師，學成後他選擇在安大略倫敦開業骨科，同時也在西安大略大學及多倫多大學兼教解剖學和藥理學。在這之前，班亭早就對糖尿病之奧秘深感興趣。人們很早就瞭解胰臟除了有外分泌腺之外，胰臟中的許多胰島也就是朗格漢斯小島（Islets of Langerhans）還有內分泌賀爾蒙的功能。缺少後者血糖就高，繼而產生糖尿病。有人口服新鮮的胰臟或服用其榨出的精汁，想以此來治療糖尿病卻毫無結果，因為口服時，胰島的賀爾蒙被消化酵素分解掉。1921年班亭醫生在閱讀文獻時發現有一篇文章，提到結石阻塞胰管引起的病變：該胰臟裏的外分泌細胞皆呈萎縮，唯獨朗格漢斯小島則保持完整，所以這個病變並不觸發糖尿病。他忽然受到啟示：萎縮的胰臟既不再產生消化酵素，又不必擔心胰島會被破壞；如果能用這種胰臟的提取物，不經口服而改用注射，就一定能治糖尿病。於是在他腦海中立刻呈現出一個萃取胰島素的計畫。

班亭和貝斯特的實驗室

他向多倫多大學生理學係的麥克勞教授（John Macleod, 1876-1935）請求供給一個小實驗室，也請他介紹一位優秀的醫科學生貝斯特（Charles Best, 1899-1978）協助這個實驗研究。班亭和貝斯特把實驗狗隻的外分泌的胰管紮結，六至八週後取出胰臟，清除了萎縮的部分，再進行萃取有效物質的手續。一年之內，他們發展出初步純化胰臟萃取物的方法，並進行臨床試驗。發現這胰臟的萃取液可以降低糖尿病狗的高血糖，也改善了其他糖尿病的症狀。當班亭和貝斯特的實驗遇到瓶頸時，另外一位傑出的生化學家柯利普（James Collip, 1892-1965）也來相助。

John Macleod

James Collip

 

貝斯特

班亭和貝斯特純化胰臟萃取物的方法，成功地分離出胰島素（insulin），1923年十月，瑞典的卡洛琳研究院決定將該年的諾貝爾醫學生理獎頒給班亭及麥克勞兩人。班亭醫生得知消息後，馬上宣布將自己的獎金與貝斯特平分。稍晚，麥克勞教授也宣布將自己那一半的獎金與有謙遜性格的柯利普共享。一般醫學界則認為諾貝爾醫學生理獎沒給貝斯特是非常偏差的做法。

班亭和貝斯特

 

神經生理與心理之聯繫

Walter Hess

瑞士蘇黎世（Zurich）的華特．赫斯醫生（Dr. Walter Hess, 1881-1973）Walter Hess 1881~1973） 在大學畢業後就是執業眼科。他對控製血流和調節呼吸的中樞神經係統甚感興趣，1912年毅然決定要做生理學家。第一次世界大戰期間他前往德，法，英三國，受到幾位生理學大師的薰陶。1917年他回瑞士，被選為蘇黎世大學生理研究所所長。在實驗室裏他深入研究“間腦”（diencephalon），發現它有diencephalon），發現它有監管和控製內臟之活動，協調並自動糾正軀體之動作，區別並保持骨骼肌肉之張力等功能。他也詳細觀察並分析病人的神經症狀，認為發現間腦在這些過程中與前庭器官引起的行動有關聯。至於其他腦部的研究，他還指出前腦皮層的某些地方有控製視覺，口腔，咽喉地區的機能。赫斯醫生在動物實驗中偶爾見到間腦刺激與行為方式的關係，他因此提出“感情力”（psychic power）的理論，不久這成為“生物心理學”的主題。由於他在心理動機與腦組織表達功能之間所作的貢獻，心理學與生理學之間的鴻溝開始彌縫補合。他同時在一篇專刊裏總結其發現：以生理為基礎的重要臨床心身現象，得以處理；所謂“精神藥物”（psychotropic）的運作模式，得以了解；而行為的研究和中樞神經係統具體組織之間的緊密聯繫，也終於有了一些指導原則。為滿足先決條件的目標，後來的神經醫學家對腦部之探索不斷地擴大。1949年赫斯醫生因為對間腦的研究，莫尼茲醫生共同獲得諾貝爾醫學獎。

 

前額白質腦葉割除手術

Egas Moniz

葡萄牙裏斯本（Lisbon）的依葛．莫尼茲（Dr. Egas Moniz, 1874-1955）並不是莫尼茲醫生 （Egas Moniz, 1874~1955） 並不是外科醫生。他原先在法國波爾多（Bordeaux）和巴黎接受教育，畢業於葡萄牙哥英布拉（Coimbra）大學。1902年他是母校的教授。1911年他擔任裏斯本聖瑪麗亞醫院醫師，後來當裏斯本科學院主任和院長。他曾經是巴黎，馬德裏，倫敦，裏約熱內盧，美國，以及南美幾個國家的科學院院士。1903年他開始從政，擔任過葡萄牙議會副會長，葡萄牙駐西班牙大使，外交部長。1918年巴黎和會他是葡萄牙代表團主席。莫尼茲醫生在莫尼茲醫生在神經醫學的貢獻是：1935年發明“前額白質腦葉割除手術”（prefrontal leucotomy），以及1931年發明腦血管造影術。前者是用來治療精神分裂病患者的外科手術，他因此獲得1949年的諾貝爾醫學獎。後者則是用來診斷腦瘤，是當時最先進的影像診斷方法。據了解，絕大多數莫尼茲醫生的莫尼茲醫生病人，其腦葉割除手術其實都不是他本人做莫尼茲醫生自己做的，而是由他的神經外科同事Dr. Almeida Lima操刀。莫尼茲醫生後來被他的一個病人槍殺未死，竟從此癱瘓終身。他創始的手術也引起全世界的爭議和道德關切，部分的原因是，學習他的美國醫生把這“psychosurgery”略加修改為“ice pick lobotomy”，手術方法變得非常殘忍，而且濫用到極不道德的程度。美國國會接受聽證後終於立法禁止，世界各國也隨同禁止該手術。一般醫學界及社會人士認為諾貝爾醫學獎頒給莫尼茲醫生時所引述莫尼茲醫生所用的理由缺乏審慎，是有偏差錯誤的做法。

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Laureates

1901–1950

Year	Laureate[A]		Country[B]	Rationale[C]
1901		Emil Adolf von Behring	Germany	"for his work on serum therapy, especially its application against diphtheria, by which he has opened a new road in the domain of medical science and thereby placed in the hands of the physician a victorious weapon against illness and deaths"[10]
1902		Sir Ronald Ross	United Kingdom  India	"for his work on malaria, by which he has shown how it enters the organism and thereby has laid the foundation for successful research on this disease and methods of combating it"[11]
1903		Niels Ryberg Finsen	Denmark ( Faroe Islands)	"[for] his contribution to the treatment of diseases, especially lupus vulgaris, with concentrated light radiation, whereby he has opened a new avenue for medical science"[12]
1904		Ivan Petrovich Pavlov	Russia	"in recognition of his work on the physiology of digestion, through which knowledge on vital aspects of the subject has been transformed and enlarged"[13]
1905		Robert Koch	Germany	"for his investigations and discoveries in relation totuberculosis"[14]
1906		Camillo Golgi	Italy	"in recognition of their work on the structure of the nervous system"[15]
		Santiago Ramón y Cajal	Spain
1907		Charles Louis Alphonse Laveran	France	"in recognition of his work on the role played by protozoa in causing diseases"[16]
1908		Ilya Ilyich Mechnikov	Russia	"in recognition of their work on immunity"[17]
		Paul Ehrlich	Germany
1909		Emil Theodor Kocher	Switzerland	"for his work on the physiology, pathology and surgery of the thyroid gland"[18]
1910		Albrecht Kossel	Germany	"in recognition of the contributions to our knowledge of cell chemistry made through his work on proteins, including thenucleic substances"[19]
1911		Allvar Gullstrand	Sweden	"for his work on the dioptrics of the eye"[20]
1912		Alexis Carrel	France	"[for] his work on vascular suture and the transplantation ofblood vessels and organs"[21]
1913		Charles Richet	France	"[for] his work on anaphylaxis"[22]
1914		Robert Bárány	Austria-Hungary	"for his work on the physiology and pathology of thevestibular apparatus"[23]
1915	Not awarded
1916
1917
1918
1919		Jules Bordet	Belgium	"for his discoveries relating to immunity"[24]
1920		Schack August Steenberg Krogh	Denmark	"for his discovery of the capillary motor regulating mechanism"[25]
1921	Not awarded
1922		Archibald Vivian Hill	United Kingdom	"for his discovery relating to the production of heat in themuscle"[26]
		Otto Fritz Meyerhof	Germany	"for his discovery of the fixed relationship between the consumption of oxygen and the metabolism of lactic acid in the muscle"[26]
1923		SirFrederick Grant Banting	Canada	"for the discovery of insulin"[27]
		John James Rickard Macleod	United Kingdom
1924		Willem Einthoven	Netherlands	"for the discovery of the mechanism of theelectrocardiogram"[28]
1925	Not awarded
1926		Johannes Andreas Grib Fibiger	Denmark	"for his discovery of the Spiroptera carcinoma"[29]
1927		Julius Wagner-Jauregg	Austria	"for his discovery of the therapeutic value of malariainoculation in the treatment of dementia paralytica"[30]
1928		Charles Jules Henri Nicolle	France	"for his work on typhus"[31]
1929		Christiaan Eijkman	Netherlands	"for his discovery of the antineuritic vitamin"[32]
		SirFrederick Gowland Hopkins	United Kingdom	"for his discovery of the growth-stimulating vitamins"[32]
1930		Karl Landsteiner	Austria	"for his discovery of human blood groups"[33]
1931		Otto Heinrich Warburg	Germany	"for his discovery of the nature and mode of action of therespiratory enzyme"[34]
1932		Sir Charles Scott Sherrington	United Kingdom	"for their discoveries regarding the functions of neurons"[35]
		Edgar Douglas Adrian	United Kingdom
1933		Thomas Hunt Morgan	United States	"for his discoveries concerning the role played by thechromosome in heredity"[36]
1934		George Hoyt Whipple	United States	"for their discoveries concerning liver therapy in cases ofanaemia"[37]
		George Richards Minot	United States
		William Parry Murphy	United States
1935		Hans Spemann	Germany	"for his discovery of the organizer effect in embryonic development"[38]
1936		Sir Henry Hallett Dale	United Kingdom	"for their discoveries relating to chemical transmission of nerve impulses"[39]
		Otto Loewi	Austria  Germany
1937		Albert Szent-Györgyi von Nagyrapolt	Hungary	"for his discoveries in connection with the biological combustion processes, with special reference to vitamin Cand the catalysis of fumaric acid"[40]
1938		Corneille Jean François Heymans	Belgium	"for the discovery of the role played by the sinus and aortic mechanisms in the regulation of respiration"[41]
1939		Gerhard Domagk	Germany	"for the discovery of the antibacterial effects of prontosil"[42]
1940	Not awarded
1941
1942
1943		Carl Peter Henrik Dam	Denmark	"for his discovery of vitamin K"[43]
		Edward Adelbert Doisy	United States	"for his discovery of the chemical nature of vitamin K"[43]
1944		Joseph Erlanger	United States	"for their discoveries relating to the highly differentiated functions of single nerve fibres"[44]
		Herbert Spencer Gasser	United States
1945		SirAlexander Fleming	United Kingdom	"for the discovery of penicillin and its curative effect in various infectious diseases"[45]
		Sir Ernst Boris Chain	United Kingdom
		Howard Walter Florey	Australia
1946		Hermann Joseph Muller	United States	"for the discovery of the production of mutations by means of X-ray irradiation"[46]
1947		Carl Ferdinand Cori	United States	"for their discovery of the course of the catalytic conversion of glycogen"[47]
		Gerty Theresa Cori, née Radnitz	United States
		Bernardo Alberto Houssay	Argentina	"for his discovery of the part played by the hormone of theanterior pituitary lobe in the metabolism of sugar"[47]
1948		Paul Hermann Müller	Switzerland	"for his discovery of the high efficiency of DDT as a contactpoison against several arthropods"[48]
1949		Walter Rudolf Hess	Switzerland	"for his discovery of the functional organization of theinterbrain as a coordinator of the activities of the internal organs"[49]
		António Caetano Egas Moniz	Portugal	"for his discovery of the therapeutic value of leucotomy (lobotomy) in certain psychoses"[49]
1950		Philip Showalter Hench	United States	"for their discoveries relating to the hormones of theadrenal cortex, their structure and biological effects"[50]
		Edward Calvin Kendall	United States
		Tadeusz Reichstein	Switzerland  Poland

1951–2000

Year	Laureate[A]		Country[B]	Rationale[C]
1951		Max Theiler	South Africa	"for his discoveries concerning yellow fever and how to combat it"[51]
1952		Selman Abraham Waksman	United States	"for his discovery of streptomycin, the first antibioticeffective against tuberculosis"[52]
1953		Sir Hans Adolf Krebs	United Kingdom	"for his discovery of the citric acid cycle"[53]
		Fritz Albert Lipmann	United States	"for his discovery of co-enzyme A and its importance for intermediary metabolism"[53]
1954		John Franklin Enders	United States	"for their discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue"[54]
		Frederick Chapman Robbins	United States
		Thomas Huckle Weller	United States
1955		Axel Hugo Theodor Theorell	Sweden	"for his discoveries concerning the nature and mode of action of oxidation enzymes"[55]
1956		André Frédéric Cournand	United States	"for their discoveries concerning heart catheterization and pathological changes in the circulatory system"[56]
		Werner Forssmann	West Germany
		Dickinson W. Richards	United States
1957		Daniel Bovet	Italy	"for his discoveries relating to synthetic compounds that inhibit the action of certain body substances, and especially their action on the vascular system and the skeletal muscles"[57]
1958		George Wells Beadle	United States	"for their discovery that genes act by regulating definite chemical events"[58]
		Edward Lawrie Tatum	United States
		Joshua Lederberg	United States	"for his discoveries concerning genetic recombination and the organization of the genetic material of bacteria"[58]
1959		Arthur Kornberg	United States	"for their discovery of the mechanisms in the biological synthesis of ribonucleic acid and deoxyribonucleic acid"[59]
		Severo Ochoa	United States  Spain
1960		Sir Frank Macfarlane Burnet	Australia	"for discovery of acquired immunological tolerance"[60]
		Sir Peter Brian Medawar	Brazil  United Kingdom
1961		Georg von Békésy	United States	"for his discoveries of the physical mechanism of stimulation within the cochlea"[61]
1962		Francis Harry Compton Crick	United Kingdom	"for their discoveries concerning the molecular structure ofnucleic acids and its significance for information transfer in living material"[62]
		James Dewey Watson	United States
		Maurice Hugh Frederick Wilkins	New Zealand  United Kingdom
1963		Sir John Carew Eccles	Australia	"for their discoveries concerning the ionic mechanisms involved in excitation and inhibition in the peripheral and central portions of the nerve cell membrane"[63]
		Sir Alan Lloyd Hodgkin	United Kingdom
		Sir Andrew Fielding Huxley	United Kingdom
1964		Konrad Bloch	United States	"for their discoveries concerning the mechanism and regulation of the cholesterol and fatty acid metabolism"[64]
		Feodor Lynen	West Germany
1965		François Jacob	France	"for their discoveries concerning genetic control of enzymeand virus synthesis"[65]
		André Lwoff	France
		Jacques Monod	France
1966		Peyton Rous	United States	"for his discovery of tumour-inducing viruses"[66]
		Charles Brenton Huggins	United States	"for his discoveries concerning hormonal treatment ofprostatic cancer"[66]
1967		Ragnar Granit	Finland  Sweden	"for their discoveries concerning the primary physiological and chemical visual processes in the eye"[67]
		Haldan Keffer Hartline	United States
		George Wald	United States
1968		Robert W. Holley	United States	"for their interpretation of the genetic code and its function in protein synthesis"[68]
		Har Gobind Khorana	India  United States[69]
		Marshall W. Nirenberg	United States
1969		Max Delbrück	United States	"for their discoveries concerning the replication mechanism and the genetic structure of viruses"[70]
		Alfred D. Hershey	United States
		Salvador E. Luria	Italy  United States
1970		Julius Axelrod	United States	"for their discoveries concerning the humoral transmittors in the nerve terminals and the mechanism for their storage, release and inactivation"[71]
		Ulf von Euler	Sweden
		Sir Bernard Katz	United Kingdom
1971		Earl W. Sutherland, Jr.	United States	"for his discoveries concerning the mechanisms of the action of hormones"[72]
1972		Gerald M. Edelman	United States	"for their discoveries concerning the chemical structure ofantibodies"[73]
		Rodney R. Porter	United Kingdom
1973		Karl von Frisch	West Germany	"for their discoveries concerning organization and elicitation of individual and social behaviour patterns"[74]
		Konrad Lorenz	Austria
		Nikolaas Tinbergen	Netherlands
1974		Albert Claude	Belgium	"for their discoveries concerning the structural and functional organization of the cell"[75]
		Christian de Duve	Belgium
		George E. Palade	Romania
1975		David Baltimore	United States	"for their discoveries concerning the interaction betweentumour viruses and the genetic material of the cell"[76]
		Renato Dulbecco	Italy  United States
		Howard Martin Temin	United States
1976		Baruch S. Blumberg	United States	"for their discoveries concerning new mechanisms for the origin and dissemination of infectious diseases"[77]
		D. Carleton Gajdusek	United States
1977		Roger Guillemin	United States	"for their discoveries concerning the peptide hormoneproduction of the brain"[78]
		Andrew V. Schally	Canada  Poland United States
		Rosalyn Yalow	United States	"for the development of radioimmunoassays of peptide hormones"[78]
1978		Werner Arber	Switzerland	"for the discovery of restriction enzymes and their application to problems of molecular genetics"[79]
		Daniel Nathans	United States
		Hamilton O. Smith	United States
1979		Allan M. Cormack	South Africa	"for the development of computer assisted tomography"[80]
		Sir Godfrey N. Hounsfield	United Kingdom
1980		Baruj Benacerraf	Venezuela	"for their discoveries concerning genetically determinedstructures on the cell surface that regulate immunological reactions"[81]
		Jean Dausset	France
		George D. Snell	United States
1981		Roger W. Sperry	United States	"for his discoveries concerning the functional specialization of the cerebral hemispheres"[82]
		David H. Hubel	Canada	"for their discoveries concerning information processing in the visual system"[82]
		Torsten N. Wiesel	Sweden
1982		Sune K. Bergström	Sweden	"for their discoveries concerning prostaglandins and related biologically active substances"[83]
		Bengt I. Samuelsson	Sweden
		Sir John R. Vane	United Kingdom
1983		Barbara McClintock	United States	"for her discovery of mobile genetic elements"[84]
1984		Niels K. Jerne	Denmark	"for theories concerning the specificity in development and control of the immune system and the discovery of the principle for production of monoclonal antibodies"[85]
		Georges J.F. Köhler	West Germany
		César Milstein	Argentina  United Kingdom
1985		Michael S. Brown	United States	"for their discoveries concerning the regulation ofcholesterol metabolism"[86]
		Joseph L. Goldstein	United States
1986		Stanley Cohen	United States	"for their discoveries of growth factors"[87]
		Rita Levi-Montalcini	Italy
1987		Susumu Tonegawa	Japan	"for his discovery of the genetic principle for generation ofantibody diversity"[88]
1988		Sir James W. Black	United Kingdom	"for their discoveries of important principles for drug treatment"[89]
		Gertrude B. Elion	United States
		George H. Hitchings	United States
1989		J. Michael Bishop	United States	"for their discovery of the cellular origin of retroviraloncogenes"[90]
		Harold E. Varmus	United States
1990		Joseph E. Murray	United States	"for their discoveries concerning organ and cell transplantation in the treatment of human disease"[91]
		E. Donnall Thomas	United States
1991		Erwin Neher	Germany	"for their discoveries concerning the function of single ion channels in cells"[92]
		Bert Sakmann	Germany
1992		Edmond H. Fischer	Switzerland  United States	"for their discoveries concerning reversible proteinphosphorylation as a biological regulatory mechanism"[93]
		Edwin G. Krebs	United States
1993		Sir Richard J. Roberts	United Kingdom	"for their discoveries of split genes"[94]
		Phillip A. Sharp	United States
1994		Alfred G. Gilman	United States	"for their discovery of G-proteins and the role of these proteins in signal transduction in cells"[95]
		Martin Rodbell	United States
1995		Edward B. Lewis	United States	"for their discoveries concerning the genetic control of early embryonic development"[96]
		Christiane Nüsslein-Volhard	Germany
		Eric F. Wieschaus	United States
1996		Peter C. Doherty	Australia	"for their discoveries concerning the specificity of the cell mediated immune defence"[97]
		Rolf M. Zinkernagel	Switzerland
1997		Stanley B. Prusiner	United States	"for his discovery of Prions - a new biological principle of infection"[98]
1998		Robert F. Furchgott	United States	"for their discoveries concerning nitric oxide as a signalling molecule in the cardiovascular system"[99]
		Louis J. Ignarro	United States
		Ferid Murad	United States
1999		Günter Blobel	Germany  United States	"for the discovery that proteins have intrinsic signals that govern their transport and localization in the cell"[100]
2000		Arvid Carlsson	Sweden	"for their discoveries concerning signal transduction in thenervous system"[101]
		Paul Greengard	United States
		Eric R. Kandel	United States

2001–current

Year	Laureate[A]		Country[B]	Rationale[C]
2001		Leland H. Hartwell	United States	"for their discoveries of key regulators of the cell cycle"[102]
		Sir Tim Hunt	United Kingdom
		Sir Paul M. Nurse	United Kingdom
2002		Sydney Brenner	South Africa	"for their discoveries concerning 'genetic regulation of organ development and programmed cell death'"[103]
		H. Robert Horvitz	United States
		Sir John E. Sulston	United Kingdom
2003		Paul Lauterbur	United States	"for their discoveries concerning magnetic resonance imaging"[104]
		Sir Peter Mansfield	United Kingdom
2004		Richard Axel	United States	"for their discoveries of odorant receptors and the organization of the olfactory system"[105]
		Linda B. Buck	United States
2005		Barry J. Marshall	Australia	"for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease"[106]
		J. Robin Warren	Australia
2006		Andrew Z. Fire	United States	"for their discovery of RNA interference - gene silencing by double-stranded RNA"[107]
		Craig C. Mello	United States
2007		Mario R. Capecchi	United States	"for their discoveries of principles for introducing specific gene modifications in mice by the use of embryonic stem cells."[108]
		Sir Martin J. Evans	United Kingdom
		Oliver Smithies	United States
2008		Harald zur Hausen	Germany	"for his discovery of human papilloma viruses causingcervical cancer"[109]
		Françoise Barré-Sinoussi	France	"for their discovery of human immunodeficiency virus"[109]
		Luc Montagnier	France
2009		Elizabeth H. Blackburn	United States  Australia	"for the discovery of how chromosomes are protected bytelomeres and the enzyme telomerase"[110]
		Carol W. Greider	United States
		Jack W. Szostak	United States
2010		Sir Robert G. Edwards	United Kingdom	"for the development of in vitro fertilization"[111]
2011		Bruce A. Beutler	United States	"for their discoveries concerning the activation of innate immunity"[112]
		Jules A. Hoffmann	France
		Ralph M. Steinman	Canada	"for his discovery of the dendritic cell and its role inadaptive immunity"[112] (awarded posthumously)[113][114]
2012		Sir John B. Gurdon	United Kingdom	"for the discovery that mature cells can be reprogrammedto become pluripotent"[115]
		Shinya Yamanaka	Japan
2013		James E. Rothman	United States	"for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells"[5]
		Randy W. Schekman	United States
		Thomas C. Südhof	United States  Germany
2014		John O'Keefe	United States  United Kingdom	"for their discoveries of cells that constitute a positioning system in the brain"
		May-Britt Moser	Norway
		Edvard I. Moser	Norway
2015		William C. Campbell	Ireland  United States	"for their discoveries concerning a novel therapy against infections caused by roundworm parasites"[116]
		Satoshi ?mura	Japan
		Tu Youyou	China	"for her discoveries concerning a novel therapy againstMalaria"[116]
2016		Yoshinori Ohsumi	Japan	"for his discoveries of mechanisms for autophagy"[117]
2017		Jeffrey C. Hall	United States	"for their discoveries of molecular mechanisms controlling the circadian rhythm"[118]
		Michael Rosbash	United States
		Michael W. Young	United States

Notes

^ A. The form and spelling of the names in the name column is according to nobelprize.org, the official website of the Nobel Foundation. Alternative spellings and name forms, where they exist, are given at the articles linked from this column. Where available, an image of each Nobel laureate is provided. For the official pictures provided by the Nobel Foundation, see the pages for each Nobel laureate at nobelprize.org.

^ B. The information in the country column is according to nobelprize.org, the official website of the Nobel Foundation. This information may not necessarily reflect the recipient's birthplace or citizenship.

^ C. The citation for each award is quoted (not always in full) from nobelprize.org, the official website of the Nobel Foundation. The links in this column are to articles (or sections of articles) on the history and areas of physiology and medicine for which the awards were presented. The links are intended only as a guide and explanation. For a full account of the work done by each Nobel laureate, please see the biography articles linked from the name column.

References