Friday, November 21, 2008

Top Ten Medical Advancements of the 20th Century

Top Ten Medical Advancements of the 20th Century

#10: Placebo controlled, randomized, blinded clinical trials

One of the first accounts of a clinical trial is from 1747 when a naval surgeon James Lind tested the effects of various remedies for scurvy and compared them to each other. Since then clinical studies have been gradually improved, either by adding control groups or making the study “blind,” that is the subject are unaware of which sample (experimental or placebo) they are receiving. Not until the 20th century, however, did scientists and doctors begin running clinical trials that were placebo control, randomized, and double blinded, where both the subjects and the experimenters don’t know which sample is being administered. These trials are far more accurate and revealing than most clinical trials of the 18th and 19th centuries because of the elimination of bias. This leap forward in our ability to research has helped create many life-saving drugs and treatments. 1

#9: Development of vitamin supplements

While vitamins were known to have existed before the 20th century, the only sources of vitamins were certain types of food. This is a problem for groups of people who live in conditions which limit the variety of the food they can eat. For example, crews on a ship would routinely develop scurvy due to Vitamin C deficiency. This was caused by a lack of fruit aboard the ship on especially long journeys. The British began bringing lemons and limes aboard on such journeys (hence the nickname “Limeys,”) and saw a decrease in the cases of scurvy at sea.

(Photo at left: Symptoms of scury from 2)

Another example of when change in diet was implemented to increase the ingestion of certain vitamins was in the Japanese Navy, where (during the 1880’s) low ranking sailors often only ate white rice regularly. This bland low-meat diet led to the development of beriberi, a condition described as severe lethargy caused by thiamine (Vitamin B1) deficiency. The Japanese realized this and changed the rations allotted to their sailors, drastically reducing the cases of beriberi among them.

Better understanding of vitamins and their role in human health can greatly reduce the occurrence of certain diseases, as demonstrated above. But in both cases new foods were required in order to fight the disease. What came about in the 20th century were vitamin supplements, the ability to concentrate certain vitamins into pill form. Vitamin supplements are a great tool in the fight against malnutrition and hunger worldwide. They do not spoil like most foods do, and they are mostly inexpensive to produce. While some people may only have white rice to eat, these debilitating diseases can still be prevented.

#8: Development and use of X-Rays

In 1895, Wilhelm Röntgen was experimenting with a new type of ray which he referred to as “X.” Little did he know that those rays would improve the lives and livelihoods of millions of people in the future. Röntgen discovered the medical application of X-rays when he photographed his wife’s hand, creating the first image of a human body part made by X-rays. The early tubes used to create the rays were very inefficient, but around 1920 a more efficient vacuum tube was invented, making way for wide spread use of X-rays for medical purposes. Today they are used to identify diseases mainly in bone, but also in soft tissue (pneumonia, lung cancer, kidney stones, etc.). 4

#7: Development of medical insulin for diabetics

Insulin was first isolated at the University of Toronto by Dr. Fredrick Banting 5. It had been known that the pancreas was involved in the disease diabetes since the late 19th century, but not until 1921 was it discovered that the hormone insulin could be used to treat type 1 diabetes. Until then such a diagnosis meant death for the patient. Banting and Charles H. Best made their patent on insulin available to all who could produce it in order to avoid prohibiting any production of this life-saving drug in any part of the world. That decision and their work have saved millions of lives all over the world and will save many more in the future. 6

(Photo at left: The Bronco’s quaterback Jay Cutler was diagnosed with Type 1 diabetes. Image from 7)

#6: Advancements in heart surgery.

Surgeons didn’t begin operating on the heart until the late 1800’s, and at that time success rates were very low. One of the first surgeons to operate on the heart had a 60% mortality rate after operating on over 100 patients. However, this was considered amazing by the standards of the time, since without the procedure they all would have probably died. These few successes led the way into the 20th century, where many new advances in heart treatment and surgery allowed people to live longer and fuller lives. Some of these advances include bypass surgery, heart transplants, and pacemakers. 8

#5: Development of immunosuppressive drugs and tissue typing.

When undergoing organ transplant, a patient’s tissue must be matched with the tissue of prospective donors in order to ensure the new tissue will not be rejected by the patient’s immune system. This problem may have prevented many transplant procedures from being studied, but the development of better tissue typing procedures made it possible to find appropriate donors faster and more accurately 9. Immunosuppressive drugs are also very important, since they further prevent the immune system from attacking new tissue, which sometimes happens even with close matches. The combination of these two methods has allowed many people to receive the new organs they need to survive without many complications. 10

#4: Advances in cancer treatment.

Chemotherapy – This treatment method arose from research into alternative uses of mustard gas during WWII. Doctors administered the drug intravenously to cancer patients and noted a temporary improvement in their condition. Since then research has found many forms of successful cancer treatment involving chemicals. 11

Radiotherapy – With the discovery of X-rays also came the discovery of a new but mysterious cancer treatment. Establishment of radiotherapy began in the early 20th century, and gradually improved through the years. CT scans improved the efficiency and effectiveness of radiotherapy dramatically in the 1970’s. 12

(Photo at right: A patient receiving radiotherapy treatment. Image from 13)

Immunotherapy – Our own immune systems are very powerful, and can be used through immunotherapy to combat cancer. In the 1920’s it was found that certain vaccines stimulate the immune system in such a way that it can fight certain types of cancer, depending on what vaccine is used. 14

These three cancer treatments have proved life saving for many cancer patients. The combination of two or all three of them often proves to be successful in putting cancer either into remission or killing it outright.

#3: Advances in blood typing, banking, and transfusion.

Blood transfusion had been experimented with in both humans and animals since the 15th century, many attempts being fatal for both patient and donor. Distinct blood types were first noticed in the 19th century. But both these techniques were not adequately improved for wide-scale use until the early 20th century, when a method of blood banking was established. Separating the plasma from the blood cells allowed for longer storage time and reduced occurrence of reactions. These improvements in blood typing, banking, and transfusion technology save millions of lives in the U.S. alone every year, as 15 million units of blood are transfused annually. 15

#2: The development of antibiotics.

Antibiotics are a very important part of modern medicine. Anti-bacterial soap prevents the spread of bacterial disease, antibiotics turn would-be dangerous infections into a small rash that goes away in about a week, and post-operative infections are minimal due to sterilizing efforts in operating rooms at hospitals and in doctors’ offices. All of these benefits stem from the discovery of Penicillin by Alexander Fleming in the early 20th century. Since then, medical research into the antibacterial effects of certain compounds and substances has led to the ability to prevent most bacterial infection in both everyday life and in the hospital setting, and in the case where an infection does occur the proper antibiotic medicine can be used to combat the infection. 16

#1: Eradication of smallpox and vaccines for various diseases (polio, diptheria, tetanus, measles, mumps, rubella, chickenpox, flu, Hep. A & B)

Smallpox was a very deadly disease, one that killed millions upon millions of people worldwide throughout history. The first cases of it are thought to have been from near the beginning of history, about 10,000 BC in Egypt, Africa, and the Middle East. The disease had been prevalent in most of the world, spreading through trade, war, and migration. Spanish conquistadors spread the disease to the Americas, where millions were killed in several severe epidemics within the Aztec and Incan empires. People struggled for a cure or treatment, and eventually developed a treatment via inoculation in the 17th and 18th centuries. This, however, came with a risk of developing the actual disease rather than becoming immune. It wasn’t until Edward Jenner began vaccinating patients with cowpox about the turn of the 18th century that a safe and effective method of preventing smallpox was developed 17.

(Photo at left: A timeline of events leading to the erradication of smallpox. Image from 18 )

In the early to mid 20th century, the United States had successfully eradicated smallpox within its own borders. The last naturally occurring case in the U.S. was in 1949. This achievement led the World Health Organization to realize the eradication of smallpox was a real possibility worldwide. Through vigorous vaccination programs put on by the WHO and many nations independently, the last naturally occurring case of smallpox in the world occurred in 1977 in Somalia. Vaccinations save many lives and have improved life expectancy world wide dramatically. Combined with the lives saved by the eradication of smallpox, the development of safe and reliable vaccines has greatly improved human health in ways no one could have imagined previously. For this reason, it is #1 on our list of the top ten medical advances of the 20th century. 19


1. "Placebo." Wikipedia, The Free Encyclopedia. 20 Nov 2008, 11:29 UTC. 21 Nov 2008
3. "Vitamin." Wikipedia, The Free Encyclopedia. 20 Nov 2008, 17:35 UTC. 21 Nov 2008

4. "X-ray." Wikipedia, The Free Encyclopedia. 20 Nov 2008, 21:34 UTC. 21 Nov 2008

5. "The Discovery of Insulin - The History of Diabetes Treatment." Inventors. 20 Nov 2008

6. "A brief history of diabetes and insulin." Diabetes Information and Statistics. 16 May 2006. 20 Nov 2008

8. Stephenson, Larry. "History of Cardiac Surgery." Cardiac Surgery in the Adult. 20 Nov 2008

9. Velickovic, Zlatibor. "Brief history of Human Leukocyte Antigens - discovery and characterisation." 20 Nov 2008

10. "Immunosuppressive drug." Wikipedia, The Free Encyclopedia. 9 Nov 2008, 09:01 UTC. 21 Nov 2008

11. "Chemotherapy." Wikipedia, The Free Encyclopedia. 20 Nov 2008, 22:38 UTC. 21 Nov 2008

12. "Radiation therapy." Wikipedia, The Free Encyclopedia. 20 Nov 2008, 13:42 UTC. 21 Nov 2008

14. Park, John . "Immunotherapy Cancer Treatment." Cancer Supportive Care Programs National and International. 20 Nov 2008

15. "Blood transfusion." Wikipedia, The Free Encyclopedia. 18 Nov 2008, 13:30 UTC. 21 Nov 2008

16. "Penicillin." Wikipedia, The Free Encyclopedia. 20 Nov 2008, 01:53 UTC. 21 Nov 2008

17. Riedel, Stefan. "Edward Jenner and the history of smallpox and vaccination." 20 Nov 2008

19. "Vaccination schedule." Wikipedia, The Free Encyclopedia. 16 Oct 2008, 23:20 UTC. 21 Nov 2008

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