History of medicine in 20th century

Introduction: History of medicine in 20th century. The 20th century produced such a plethora of findings and advances that, in some ways, the face of medicine transformed beyond all recognition.

For example, in Britain in 1901, life expectancy at birth was a primary indicator of the effect of health care on mortality (but also reflecting health education, housing, and nutritional status); for men, it was 48 years and 51.6 years, respectively year for women.

After a steady increase, by the 1980s, life expectancy reached 71.4 years for men and 77.2 years for women. Other industrialized countries showed similarly dramatic increases. 

By the 21st century, the approach had changed so much that, except for certain fatal diseases such as cancer, the focus was on disease rather than mortality, and the emphasis shifted from keeping people alive to keeping them fit.

Tremendous communication improvements between scientists worldwide fueled the rapid development of medicine during this period. Through magazines, conferences, and—later—computer and electronic media, they freely traded ideas and reported their efforts.

It is no longer common for an individual to work in isolation. Although expertise increased, teamwork became the norm. As a result, it has become more challenging to attribute medical breakthroughs to specific individuals.

History of medicine in 20th century

The golden age of the history of medicine in the 20th century

In the first half of the 20th century, and especially during the 1950s, physicians considered the Golden Age of Medicine due to rapid advances in surgical techniques, the development of antimicrobials and other drugs, and the declaration of polio in 1955.

With the vaccine’s success (a pivotal moment that excited the public), this vision of a golden age, combined with other notable scientific achievements, seemed entirely justified.

The Golden Age is generally considered golden due to technological advancements. While many promissory notes have been written on the technical aspects of precision (personalized) medicine (i.e., the so-called ‘omics’ revolution and the predictive ability and clinical relevance of microbiome science), their full potential still rests on the physician’s delivery.

Thus, the technical aspects of 21st-century personalized medicine cannot be abstracted from the contextual complexities of lifestyle (and its psychosocial factors) and the individual’s environment and total life experiences.

Lifestyle Medicine, Planetary Health

The importance of lifestyle as a general theme—diet, exercise, sleep, mental ‘hygiene,’ and exposure to climate—has resonated in most medical systems throughout recorded history.

In the latter half of the 20th century, researchers and policymakers began to use the term ‘lifestyle’ to refer to health and disease.

For example, in 1979, the United States (US) Surgeon General’s Report on Health Promotion and Disease Prevention (Healthy People) estimated that half of all deaths were caused by lifestyle, while environmental factors (especially air pollution) were assessed. It accounts for another 20 per cent of annual deaths. 

Fourteen years later, US government scientist J. Michael McGuinness and colleague William Fogg published their landmark study. Again, smoking, dietary choices, lack of physical activity, and excess alcohol were the main contributors to the annual burden of mortality and chronic disease. 

Lifestyle medicine, which focuses on planetary health, is a modern necessity in all fields of medicine/health professions (to define lifestyle medicine and planetary health).

Because physicians are highly trusted by society, clinicians have multiple opportunities to educate and advocate for lifestyle factors that promote health at all scales.

Differences in lifestyle counselling are perhaps most remarkable during pregnancy. Clinicians are not providing complete lifestyle guidance during prenatal visits.

Lifestyle medicine involves more than just asking about smoking during pregnancy. Instead, it means following specific referral-based medical guidelines and supporting and following smoking cessation care. 

On this score, opportunities are lost, and efficiency is low in providing adequate smoking cessation care to pregnant women. Indeed, practical approaches in lifestyle medicine cannot be equated to simple check-off boxes that advise patients to “eat less fat and cholesterol” and “exercise more.” 

This background becomes even more disturbing when viewed through the prism of planetary health. Because physicians hold society’s trust, medical schools must educate their students about lifestyle realities and the health of people, places, and the planet.

Infectious diseases and chemotherapy

In the 20th century, ongoing research focused on the nature of infectious diseases and their means of transmission. Many pathogenic organisms, such as rickettsias, were discovered and classified, which cause diseases such as typhus, smaller than bacteria.

Some are large, such as the protozoans that cause malaria and other tropical diseases. The smallest identified were viruses, the causative agents of many diseases, including mumps, measles, German measles, and polio. In 1910, Peyton Rous showed that the virus could also cause a malignant tumor, sarcoma, in chickens.

Besides drainage, poultices, and ointments for the victims of most infectious organisms, much still needed to be done in cases of local infection and rest and nourishment for acute diseases—the search for cures aimed at both vaccines and chemotherapy.

Discoveries of medicine

A dramatic event in medical history occurred in 1928 when Alexander Fleming observed in his laboratory at St. Mary’s Hospital, London, the inhibition of a stray mold on a plate culture of Staphylococcus bacteria.

Many other germologists must have made the observation, but none realized the potential implications. The mold was a strain of Penicillium-P—Notatum – which gave its name to the now-famous drug penicillin.

Despite his belief that penicillin was a powerful antibacterial agent, Fleming needed help to complete his work, mainly because he could not isolate it in sufficient quantities or pure enough form to use it on patients. He was permitting techniques that still needed to be developed. 

Ten years later, Howard Florey, Ernst Chain, and their colleagues at Oxford University repeated the problem. They isolated penicillin in a relatively pure form (by standards than current) and demonstrated its relative lack of potency and toxicity.

World War II began, and techniques were developed to facilitate commercial production in America. By 1944, sufficient quantities were available to meet the extraordinary needs of wartime.

For more than 30 years, some of the greatest minds in physiology have searched for the cause of diabetes mellitus. In 1889, German physicians Joseph von Meiring and Oskar Minkowski showed that the removal of the pancreas in dogs caused the disease.

In 1901, American pathologist Eugene Lindsay Opie described degenerative changes in clusters of pancreatic cells known as the islets of Langerhans, thus confirming the link between the dysfunction of these cells and diabetes.

Sharpey-Schafer concluded that the islets of Langerhans secrete a substance that regulates carbohydrate metabolism. The breakthrough event in endocrinology in the early 20th century was the discovery of this substance, insulin.

Insulin later became available in various forms, but synthesis on a commercial scale was not easily achieved, and the only source of the hormone was the pancreas of animals.

Moreover, one of its helpful disadvantages was that it had to be given by injection. As a result, there was an intense search for some alternative substance that would be active when taken orally.

Various preparations—oral hypoglycemic agents, as they are known—appeared to be somewhat effective in controlling diabetes. Still, evidence indicated that they were of value only in relatively mild cases of the disease.

However, by the early 1980s, certain strains of bacteria had been genetically modified to produce human insulin. Later, a form of human insulin was created using recombinant DNA technology.

Human insulin was available in a form that acted rapidly but temporarily (short-acting insulin) and in a biochemically modified form designed to prolong its action for up to 24 hours (long-acting insulin).

In nutrition, a significant development of the 20th century was the discovery and appreciation of the importance of “dietary factors” or vitamins to health.

Various workers have shown that animals do not thrive on artificial diets that contain all the right amounts of protein, fat, and carbohydrates. He even suggested that natural foods must contain some unknown ingredient essential for developing and maintaining health.

However, only some progress was made in the field once the classic experiments of the English biologist Frederick Gowland Hopkins were published in 1912.

First described by Edward Jenner in the 18th century, vaccination programs prevent deaths and severe illnesses from diseases such as yellow fever, poliomyelitis, measles, mumps, and rubella. They merely became common in the 20th century. In 1980, the World Health Organization declared that deadly smallpox. The virus was gone entirely.

Doctors can now use various techniques to examine their patients’ bodies. X-rays were the first invented by Roentgen, but advanced computer technology now allows surgeons to plan operations and radiologists to target tumours with precision.

Ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET), and computed tomography (CT) scans are all part of a doctor’s diagnostic armoury.

Conclusion: History of medicine in 20th century

The 20th century was a period of remarkable transformation in medicine, characterized by rapid technological advancements, a better understanding of diseases, and the development of new treatments. These changes significantly improved life expectancy and quality of life worldwide.

Sadly, it was not all good news for medicine in the 20th century. Many diseases can be controlled and treated, but it costs money. In places like Africa, South America, and Asia, levels of health care are lower than in Western countries.

Diseases like HIV/AIDS, Cholera, Tuberculosis, Pneumonia, and malaria remain significant killers in these regions.

The foundations laid during this century continue to influence medical practice and research in the 21st century, guiding the ongoing quest for better health outcomes and innovations in healthcare. The challenge of medicine in the 21st century is to provide high-quality health care for all.

Also read: History of medicine in 19th century; History of Medicine in Japan; History of medicine in India