20th Century Medicine January 1901 to

December 2000

ANTONIO T. PARONG JR., AB chem.,MD.,MHA.

PLTCI – COLLEGE OF MEDICINE
Bascaran Campus, Solano, Nueva Vizcaya
Philippines
 20th Century
 20th century began on 1 January 1901, and will end on 31 December 2000

 The 20th century period, the century from 1901 to 2000.

 It was the last century of the 2nd millennium and was marked by new models of
scientific understanding, unprecedented scopes of warfare, new modes of
communication that would operate at nearly instant speeds, and new forms of art
and entertainment. The Blue Marble, Earth as seen from Apollo 17 in December
1972.
 Sir Alexander Fleming

 (born Aug. 6, 1881, Lochfield, Ayr, Scotand.—died March 11, 1955, London, England.)
 Scottish bacteriologist., biologist and pharmacologist
 Conducted research on antibacterial substances that would be nontoxic to humans.
 In 1928 he inadvertently discovered penicillin (Penicillium notatum) when he
noticed that a mold contaminating a bacterial culture was inhibiting the bacteria’s
growth. This discovery changed the course of history, saving millions of lives

 The discovery of penicillin in 1928 marked the beginning of the antibiotic

revolution. Ernst Chain and Howard Florey purified the first penicillin, penicillin G,
in 1942 but became widely available outside the Allied military in 1945. This
marked the beginning of the antibiotic era.
the greatest discovery in terms of treating disease in
the 20th century?

 He shared a 1945 Nobel Prize with Ernst Boris Chain and Howard Walter Florey,
who both carried Fleming’s basic discovery further in isolating, purifying, testing,
and producing penicillin in quantity.
 Karl Landsteiner

 (June 14, 1868, Baden bei Wien, Austria - June 26, 1943, The Rockefeller University, New
York, United States
 Austrian American biologist, physician, pathologist and immunologist.
 He emigrated with his family to New York in 1923 at the age of fifty five for professional
opportunities, working for the Rockefeller Institute.

 Discovered human blood groups in 1901 and laid the foundation for the modern medical
practice of blood transfusion. Landsteiner discovered the ABO blood group system by
mixing the red cells and serum of each of his staff.
 Discovery of Rh factor, discovery of poliovirus
 Received the 1930 Nobel Prize in Medicine For his discovery of blood group
 Landsteiner's account of blood types brought a new tool to forensic science. For the first
time, forensic scientists could definitively compare blood evidence left at a crime scene to
the blood of a suspect\
 In 1930 A Nobel laureate for his discovery of human blood groups, Landsteiner continued
his research with colleagues on Rh factors, eventually making the blood transfusion an
even safer procedure.
 Karl Landsteiner

 Initially, Landsteiner recognized three different blood types: A, B, and C. The C-blood
type was later more commonly called type-O.
 In 1902, one of Landsteiner's students found a fourth blood type, AB, which
triggered a reaction if introduced into either A or B blood.

 Landsteiner identified three such antigens, which he labeled A, B, and C (later changed
to O). A fourth blood type, later named AB, was identified the following year (1902}
 In molecular history, type A appears to be the 'oldest' blood type, in the sense
that the mutations that gave rise to types O and B appear to stem from it.
Geneticists call this the wild-type or ancestral allele.

 Landsteiner also discovered other blood factors during his career: the M, N, and P
factors, which he identified in 1927 with Philip Levine, and the Rhesus (Rh) system, in
1940 with Alexander Wiener.

 His work permitted successful blood transfusion, and the saving of so many lives.
 Heinrich Hermann Robert Koch

 (December 11, 1843, Clausthal-Zellerfeld, Germany - May 27, 1910, Baden-Baden,

Germany)
 German physician and microbiologist.
 Awarded the Nobel Prize in Medicine in 1905, for his discovery of the tuberculosis
bacterium

 As the discoverer of the specific causative agents of deadly infectious diseases

including tuberculosis, cholera and anthrax,

 He is regarded as one of the main founders of modern bacteriology. Father of

Modern Bacteriology; father of microbiology and Nobel laureate
 He is regarded as one of the founders of modern bacteriology and has been
honored as the "father of bacteriology" and the "father of microbiology"
(together with Robert Koch; the latter epithet also attributed to Antonie van Leeuwenhoek).
Pasteur was responsible for disproving the doctrine of spontaneous
generation.
 Major Contributions of Robert Koch

 He investigated the anthrax disease cycle in 1876, and studied the bacteria that cause
tuberculosis in 1882 and cholera in 1883.

 He discovered bacteria such as the anthrax bacilli, tubercle bacilli and cholera bacilli.

 Koch observed the phenomenon of acquired immunity.

 He introduced solid media for culture of bacteria. Koch pioneered the use of agar as a
base for culture media. He developed the pour plate method and was the first to use
solid culture media for culture of bacteria.

 Koch also developed media suitable for growing bacteria isolated from the body.
Because of their similarity to body fluids, meat extracts and protein digests were used
as nutrient sources. The result was the development of nutrient broth and nutrient agar
media that are still in wide use today.
 Major Contributions of Robert Koch

 He also introduced methods for isolation of bacteria in pure culture

.
 He described hanging drop method for testing motility.

 He introduced staining techniques by using aniline dye.

 He invented the hot air oven and steam sterilizer, and also introduced methods to find
out the efficacy of antiseptics.

 Koch’s Phenomenon: Robert Koch observed that guinea pigs already infected with
tubercle bacilli developed a hypersensitivity reaction when injected with tubercle bacilli
or its protein. Since then, this observation was called as Koch’s phenomenon.

 The medical applications of biotechnology still heavily depend on the Koch’s principles
of affirming the causes of infectious diseases.

 Contribution to the Germ theory

 Germ theory of disease: The “one pathogen to one disease” paradigm was developed
based on the germ theory of disease that was formulated by Robert Koch the late 19th
century and shaped the development of diagnostic microbiology in medicine.

Contribution to the Germ theory

 Building on the early work of Louis Pasteur and the germ theory of disease, Robert
Koch established the basic scientific requirements used to demonstrate that each
specific disease is caused by a specific microorganism.

 The first direct demonstration of the role of bacteria in causing disease came from the
study of anthrax by the German physician.

 These requirements were based on Koch’s experiments with anthrax isolated from
diseased hosts, and are known as “Koch’s Postulates”.
The Experiment

 In the experiment, Koch injected healthy mice with a material from diseased
animals, and the mice became ill. After transferring anthrax by inoculation
through a series of 20 mice, he incubated a piece of spleen containing the
anthrax bacillus in beef serum. The bacilli grew, reproduced, and produced
spores. When the isolated bacilli or spores were injected into mice, anthrax
developed.

 During Koch’s studies on bacterial diseases, it became necessary to isolate

suspected bacterial pathogens. His criteria for proving the causal relationship
between a microorganism and a specific disease are known as Koch’s
postulates.
 Koch’s Postulates

Koch’s Postulates consist of the following four rules:

1. The microorganism must be identified in all individuals affected by the

disease, but not in healthy individuals.

2. The microorganism can be isolated from the diseased individual and grown
in culture.

3. When introduced into a healthy individual, the cultured microorganism

should cause disease.

4. The microorganism must then be re-isolated from the experimental host,

and found to be identical to the original microorganism.
 Sir Godfrey Newbold Hounsfield
 (born August 28, 1919, Newark, Nottinghamshire, England—died August 12, 2004,
Kingston upon Thames)
 in 1972 the first clinical test of CAT scanning was performed successfully.
 Godfrey Hounsfield, a biomedical engineer contributed enormously towards the
diagnosis of neurological and other disorders by virtue of his invention of the
computed axial tomography scan for which he was awarded the Nobel Prize in 1979.

 He was an English electrical engineer who shared the 1979 Nobel Prize for
Physiology or Medicine with Allan MacLeod Cormack for his part in developing the
diagnostic technique of of X-ray computed tomography: Computerized Axial
Tomography (CAT), or Computerized Tomography (CT), August 28, 1919, Sutton
on Trent, United Kingdom; Reconized “father of computed tomography”.

 In this technique, information obtained from X rays taken by scanners rotating

around the patient are combined by a computer to yield a high-resolution image of a
slice of the body.
 The first commercially available CT scanner was created by British engineer Godfrey
Hounsfield of EMI Laboratories in 1972.
Biggest medical breakthrough of the 20th century ( Source: MDLinx 2023 M3 USA
Corporation ).

 With the idea that modern healthcare is rooted in discoveries of the past, let's take a
look at seven major medical milestones of the 20th century.

 Antibiotics: 1929.
 In 1929, Sir Alexander Fleming, FRCS, of St. Mary's Hospital Medical School in
London, United Kingdom, shared his observation that the culture medium on which
a penicillium mold grew attacked certain types of bacteria. But chemists and
bacteriologists working separately were unable to isolate the active substance in the
mold ooze.

 In 1940, Oxford researcher Sir Howard Florey brought together a multidisciplinary

team who were finally able to isolate the drug penicillin.

 Funds from the Rockefeller Foundation in the United States, as well as the Medical
Research Council in the United Kingdom, helped support clinical testing and
laboratory scale production of the drug.
 Penicillin became widely popular in the years surrounding World War II—not only for
the treatment of battle wounds, but also for the treatment of syphilis. Moreover,
penicillin led to a surge in healthcare utilization in the post-war era.

 With the idea that modern healthcare is rooted in discoveries of the past, let's take a
look at seven major medical milestones of the 20th century.
• Intriguingly, in the years before the discovery and dissemination of penicillin,
infections took on a moral tenor:

• “Even more profound were the moral consequences of the use of the drugs,”
wrote Robert Bud, Science Museum, London, United Kingdom, in an article
published in BMJ. “Until the mid-1930s prevention rather than cure had been
the general means of control of most infections. Injunctions to the healthy
were complemented by a moral disdain for those who lapsed and then
succumbed to disease. The introduction of antibiotics in the 1940s converted
illness into a strictly technical problem. In richer countries the avoidance of
‘germs’ gradually ceased to be a duty.”
Biggest medical breakthrough of the 20th century
 Tissue culture: 1949

 American scientist John Enders PHD, Thomas Weller, MD and Frederick

Robbins, MD, announced in 1949 that they had grown poliovirus in cultured
human embryonic skin and muscle cells, thus taking tissue culture
mainstream. This discovery led to methods of measuring immunity to polio and
the Nobel Prize for the trio in 1953.

 The accessibility to tissue cultures resulted in a new era of virus discovery.

Interestingly, the development of tissue culture methods would have been
impossible without the discovery of antibiotics, which were used to limit
bacterial contamination.

. ...
Biggest medical breakthrough of the 20th century

 Risks of smoking: 1950.

 People sensed that smoking was bad for some time before research supported
these assumptions.
 For instance, Henry Ford decried smoking as immoral, and a generation of
Americans believed that it could stunt growth. But two landmark case-control
studies published in JAMA and the BMJ in 1950 triggered substantial interest
in the risks and harms of smoking.

 Further research was followed by a drop in the prevalence of smoking for the
first time, much to the chagrin of Big Tobacco, which was more than willing to
fight dirty—particularly through the use of false advertising campaigns—in
order to retain market share.

 Fortunately, as you may have noticed, smoking has now hit an all-time low
among US adults.
Biggest medical breakthrough of the 20th century

 Antipsychotics: 1952.

 Before the discovery of antipsychotics and other psychotropics, asylums of yore

housed stigmatized, dangerous, and mostly hopeless patients. Some of these
patients received psychoanalysis, but most didn’t. Instead, these patients were
treated as prisoners.

 By the 1940s, university researchers and drug manufacturers started exploring

psychopharmacology and developing new compounds to treat psychiatric illness.
• By 1926, for instance, acetylcholine was understood to be a
neurotransmitter.
• By 1937, antihistamines were identified, followed in 1943 by lysergic acid
diethylamide (LSD).
• Furthermore, insulin coma therapy, electroconvulsive therapy, and
leucotomy (ie, prefrontal lobotomy), as well as sedatives including
bromides, barbiturates, and paraldehyde, were being used to treat those
with mental illness.
 In 1950, chemist Paul Charpentier synthesized the drug 4560 RP, later called
chlorpromazine, which is a member of the phenothiazine group of antihistamines.
Based on the work of various luminaries, by 1954, chlorpromazine had been
administered in double-blind trials in Canada, the United Kingdom, and the United
States. However, psychoanalysts refused to accept the drug as a substitute for analytic
psychotherapy. Nevertheless, the drug’s effects were undeniable and, starting in 1956,
the number of inmates in UK asylums dropped substantially, with antipsychotics and
antidepressants subsequently becoming very popular.

 “Without the discovery of drugs such as chlorpromazine we might still have the
miserable confinements … a world of desperate remedies,” wrote psychiatrist
Trevor Turner, Homerton Hospital, London, United Kingdom, in an article published
in BMJ. “Then the attendant's role was akin to a zookeeper's: feeding, scrubbing,
and forcibly treating hundreds of ‘demented’ patients. The psychiatric workforce
was largely cut off from surgical and physician colleagues, was of poor quality, and
was readily mocked.”
Biggest medical breakthrough of the 20th century

 DNA: 1953.
 As late as 1952, geneticists didn’t know how DNA worked. All of this changed with the
1953 discovery of the double helix by James Watson, PhD, and Francis Crick, PhD.
 Their discovery of DNA’s structure was rooted in Gregor Mendel's theory on the
principles of single gene inheritance in 1866, as well as Sir Archibald Garrod's
elucidation of the inheritance pattern of alkaptonuria in 1923.

 Drs. Watson and Crick, as well as Maurice Wilkins, PhD, were honored with the Nobel
Prize for Physiology or Medicine in 1962 for their discovery. But in the eyes of many,
the prestige of this award will be forever tinged by sexism. In addition to Dr. Wilkins,
Rosalind Franklin, PhD, helped produce x-ray diffraction images instrumental to the
deduction of Drs. Watson and Crick that DNA is a three-dimensional helix. These
images were shared with Drs. Crick and Watson without her permission, and she
wasn’t credited in any way. Although Nobel Prizes can only be bestowed on living
scientists—and Dr. Franklin died from ovarian cancer in 1958, possibly due to her
work with x-rays—many feel that she never got her due recognition.
Biggest medical breakthrough of the 20th century

 DNA: 1953.

 On a more positive note, however, in January 2004, Chicago Medical School (North
Chicago, IL) announced its intention to change its name to the Rosalind Franklin
University of Medicine and Science.

 Immunology: 1958.
 The field of immunology came into its own with the discovery of histocompatibility
(HLA) antigens in 1958 by French researcher Jean Dausset, MD.

 The immune system utilizes the pattern of HLA antigens on the surface of cells as a
sort of unique biological barcode. When unrecognized by the body, HLA antigens
on a foreign cell results in the creation of antibodies and other substances by the
host to attack and destroy.
Biggest medical breakthrough of the 20th century

 Oral rehydration therapy: 1960s–1970s.

 As every physician knows, cholera kills by means of copious fluid loss in the
form of diarrhea. Before the advent of oral rehydration therapy, healthcare
facilities in India and West Bengal lacked the intravenous solution needed to
rehydrate all patients infected with cholera.

 Both American and Indian researchers worked to hammer out the formulation
and successful administration of oral rehydration therapy in the 1960s and 1970s.

 Of note, the discovery that glucose enhances the absorption of sodium and water
across the intestinal brush-border membrane without causing morphological
changes in the gut epithelium of patients with cholera was key to the successful
development of oral rehydration therapy.
Biggest medical breakthrough of the 20th century

 Oral rehydration therapy: 1960s–1970s.

 Based on this work, a successful rehydration solution was implemented. In the

early 1970s, thousands of starving Bangladeshi refugees sought asylum in
refugee camps. The fear was that a cholera epidemic would ensue. Indeed, 30%
of patients who contracted cholera in these camps died within a few days.

 It was there that Dilip Mahalanabis, MD, Johns Hopkins Center for Medical
Research and Training, Calcutta, West Bengal, India, successfully used an oral
rehydration solution that replaced the water and electrolytes lost in vomiting and
diarrhea. His formulation reduced mortality in the camps to less than 1%.