The Rise and Fall of Modern Medicine Read Free

‘magic bullets’ that would alleviate their patients’ suffering and then, quite suddenly and without warning, they came cascading out of the research laboratories just as if medicinal chemists had hit the jackpot (as they had). Or again, in 1945,desirable objectives such as transplanting organs or curing cancer were rightly perceived as being unattainable, as there was simply no way of overcoming the biological problems of the rejection of foreign tissue or the selective destruction of cancer cells. But these and many other obstacles were surmounted. The past fifty years have been a unique period of prodigious intellectual ferment that, quite naturally, invite investigation.
    There is a problem, however, in knowing where to start. The scale of the therapeutic revolution has been so vast that any comprehensive history would necessarily run to several volumes. Decisions had to be made about not only what to include and what, regretfully, to leave out, but also how to go beyond a simple chronological account to illuminate themes of more general significance. The compromise I have chosen is illustrated opposite. This list of the major events of this period identifies twelve ‘definitive moments’ which are considered in depth in a prologue that is necessarily longer than is customary. The rationale of this selection is not of immediate concern but several themes are easy enough to identify, including the decline of infectious disease (sulphonamides, penicillin and childhood immunisation); the widening scope of surgery (the operating microscope, transplantation and hip replacements); major developments in the treatment of cancer, mental illness, heart disease and infertility; and improvements in diagnostic techniques (the endoscope and the CT scanner).
    Each of these events is a remarkable story of human endeavour in its own right, but when they are assembled together then, as with the dots of the pointillist, a coherent picture should begin to emerge. The value of such an historical perspective is not necessarily obvious. ‘Medicine pays almost exclusive homage to the shock of the new,’ writes the editor of The Lancet , Richard Horton. ‘We place constant emphasis on novelty . . . this is an era of the instantaneous and the immediate.’ 1 This preoccupation with ‘the new’ leaves little room for history, and indeed medicine has got by well enough with no sense of its immediate past at all. Perhaps the history of twentieth-century medicine is solely of academic interest, an intellectual pastime for retired doctors but of little practical importance?
    The Twelve Definitive Moments of Modern Medicine
* A ‘definitive’ moment
1935
Sulphonamides
1941
*Penicillin
‘Pap’ smear for cervical cancer
1944
Kidney dialysis
1946
General anaesthesia with curare
1947
Radiotherapy (the linear accelerator)
1948
Intraocular lens implant for cataracts
1949
*Cortisone
1950
*Smoking identified as the cause of lung cancer
Tuberculosis cured with streptomycin and PAS
1952
*The Copenhagen polio epidemic and the birth of intensive care
*Chlorpromazine in the treatment of schizophrenia
1954
The Zeiss operating microscope
1955
*Open-heart surgery
Polio vaccination
1956
Cardiopulmonary resuscitation
1957
Factor VIII for haemophilia
1959
The Hopkins endoscope
1960
Oral contraceptive pill
1961
Levodopa for Parkinson’s
*Charnley’s hip replacement
1963
*Kidney transplantation
1964
*Prevention of strokes
Coronary bypass graft
1967
First heart transplant
1969
Prenatal diagnosis of Down’s syndrome
1970
Neonatal intensive care
Cognitive therapy
1971
*Cure of childhood cancer
1973
CAT scanner
1978
*First test-tube baby
1979
Coronary angioplasty
1984
*Helicobacter as the cause of peptic ulcer
1987
Thrombolysis (clot-busting) for heart attacks
1996
Triple therapy for AIDS
1998
Viagra for the treatment of impotence
    Needless to say, I do not share this view, but rather, taking my cue from T.