Medicine in the Early 20th Century Part 1
During the last decade of the 19th century and the beginning of the 20th century, the world witnessed many advances in the medical field, especially the integration of modern technology into diagnosis and treatment. Classical patient history taking and physical examination were met with new technologies to diagnose various medical conditions.
— ECG —
One of such examples of technological advancements in the medical field was the development of the electrocardiograph in the first decade of the 20th century. An electrocardiogram, or electrocardiography, is a recording of the electrical activity of the heart– an important indicator for heart health. Today’s ECG machines are portable and easy to use.(Parker) It was not the case back then. In 1910, Dutch physician Willem Einthoven used a string galvanometer to make the first functional electrocardiograph. He was awarded the Nobel Prize in Medicine in 1924 for his work on electrocardiography.(“EKG Machine”) However, the first machine was cumbersome and complicated to use. The machine occupied an entire room and the patients were required to put their hands and feed in saltwater in order to ensure a good electrical signal.(Parker) Despite the imperfections in the first ECG machine, it provided important knowledge about the patients without the involvement of invasive procedures. Its invention resulted in better treatment methods and prevention plans of cardiac complications. Until today, ECG remains a vital step in the initial evaluation of patients presenting with cardiac complaints. (AlGhatrif)
— The Surgical Revolution– Minimally Invasive Surgery —
Surgery has been an essential part in medicine since ancient times. The Surgical Revolution in the 20th century is highlighted with the emergence of minimally invasive surgery or MIS. Instead of making a large opening on the patient in order to operate on the targeting area, surgical site, surgeons performed keyhole surgeries, operating through small incisions miniature light source and imaging device.(Parker) In 1901, German surgeon Georg Kelling performed the world’s first keyhole surgery– a laparoscopy on the abdomen of a living dog. The same technique was later performed on two human patients. Kelling’s work laid the foundation for modern minimally invasive surgeries. Over the next few decades, technologies advanced rapidly. In the 1980s, high-quality miniature cameras and other imagers were widely used in surgical procedures such as gallbladder and kidney removal, tumor removal, and repair of hernias and heart defects.(Parker)
— Diabetes & Insulin —
In the pre-insulin era, patients with diabetes were advised to decrease sugar and starch intake and to follow calorie-restricted diets.(Quianzon) Ever since diabetes was first described in Ancient Egypt around 3500 BCE, doctors around the world have been trying to find a cure for this “sugar sickness”.(Bantinghouse) In the pre-insulin era, patients with diabetes were mainly given advice on diet modification.(Quianzon) In the late 19th century, the Allen Diet invented by two renowned diabetologists Frederick Allen and Elliot Joslin was the most popular. It was essentially a starvation diet, only allowing patients as few as 400 calories per day.(Bantinghous) In 1921, it all changed when Canadian orthopedic surgeon Frederick Banting and his assistant Charles Best derived hormone insulin from the pancreas of a dog and injected it into a rabbit, causing the rabbit’s blood sugar level to decrease. A year later, the insulin therapy was first used on human. Since then, many improvements were made in insulin therapy, making the effects last longer and more promising.(Parker)
— Battlefield Medicine —
While countless improvements in medicine were taking place around the world, World War Ⅰ and World War Ⅱ forced battlefield medicine to evolve in order to keep pace with the increasing casualties caused by new weaponries. The cruelty of modern warfare led to highly organized and advanced battlefield care systems that include mobile aid stations, emergency stations, mobile field hospitals and different types of medical personnels. Infection and blood lost were two major threats faced by wounded soldiers. Before the discovery of penicillin, sulfonamides were the primary antibiotics. Towards the end of World War Ⅱ, penicillin was widely used, decreasing battlefield death rate by almost two-thirds.
— Penicillin —
The Germ Theory, developed by the French microbiologist Louis Pasteur, and works of many other great scientists have laid the foundation for the discovery of penicillin and its application. In 1928, pharmacologist Alexander Fleming accidentally discovered penicillin and was able to culture and replicate its property of antibiosis (inhibition of bacterial growth). However, isolating penicillin took several decades and was not trialed until 1943. Its success drew interests from drug companies. Penicillin was subsequently produced in large quantities and supplied to soldiers at the frontline. (Parker) This article titled “How Being a Slob Helped Alexander Fleming Discover Penicillin” reveals the story behind the accidental discovery of the world’s first antibiotic.
In the next blog post, I will briefly share about my visit to a pharmaceutical company during spring break and will continue to look at medicine in the 20th century with a specific focus on the history of the pharmaceutical industry.
AlGhatrif, Majd, and Joseph Lindsay. “A brief review: history to understand fundamentals of electrocardiography.” Journal of community hospital internal medicine perspectives vol. 2,1 10.3402/jchimp.v2i1.14383. 30 Apr. 2012, doi:10.3402/jchimp.v2i1.14383
Bantinghouse. “Before Banting: Treatments for Diabetes in the Pre-Insulin Era.” Banting House, 29 July 2016, bantinghousenhsc.wordpress.com/2016/07/29/before-banting-treatments-for-diabetes-in-the-pre-insulin-era/. Accessed 11 Apr. 2019.
Blood for Britain Campaign. U.S. Army Medical Department, history.amedd.army.mil/booksdocs/wwii/blood/default.htm.
C. H. Best and F. G. Banting. Wikimedia Commons, commons.wikimedia.org/wiki/File:C._H._Best_and_F._G._Banting_ca._1924.png. Accessed 11 Apr. 2019.
Edan SE-1200 Express Basic 12-Channel ECG Machine. Tiger Medical, www.tigermedical.com/Products/12-Channel-ECG-Machine__EDASE-1200ExpressBasic-.aspx. Accessed 11 Apr. 2019.
“EKG Machine and ECG Machine Buyer’s Guide for Medical Professionals.” USA Medical and Surgical Supplies, 6 July 2018, www.usamedicalsurgical.com/blog/ekg-ecg-machine-buyers-guide/. Accessed 11 Apr. 2019.
Parker, Steve, editor. Medicine– the Definitive Illustrated History. New York, DK Publishing, 2016.
Quianzon, Celeste C, and Issam Cheikh. “History of insulin.” Journal of community hospital internal medicine perspectives vol. 2,2 10.3402/jchimp.v2i2.18701. 16 Jul. 2012, doi:10.3402/jchimp.v2i2.18701
Sir Alexander Fleming. 11 Mar. 1955. Time, time.com/4049403/alexander-fleming-history/. Accessed 11 Apr. 2019.
Type 1 vs Type 2 Diabetes. Today Health Tips, www.todayhealthtips.com/types-of-diabetes/. Accessed 11 Apr. 2019.
Vargesson, Neil. “Thalidomide-induced teratogenesis: history and mechanisms.” Birth defects research. Part C, Embryo today : reviews vol. 105,2 (2015): 140-56. doi:10.1002/bdrc.21096
Walsh, Robin. “A History of the Pharmaceutical Industry.” Pharmaphorum, 1 Oct. 2010, pharmaphorum.com/articles/a_history_of_the_pharmaceutical_industry/.