Quote of the Week

Millennium Hoopla
I know that there has been a lot of hoopla about the new millennium and the hundred best of this and that during the past century, but I heard a good presentation of an editorial at a recent meeting of my Journal Club and I thought I would comment on it in The Web Letter. The Editorial that was discussed, from the Jan. 6th 2000 issue of The New England Journal of Medicine, outlined advances in medicine during the past millennium took notes so that I could summarize it. The authors stated that the developments selected were not isolated occurrences but rather pathways that accumulated knowledge in certain fields and they tried to restrict it to Clinical Medicine. The authors introduced the Editorial by stating that nothing very significant occurred until the Renaissance. They further stated that this was due to scholars only being interested in the knowledge of God rather than man. Most of these advances occurred in the 19th and 20th centuries and they predicted that the pace of discovery would continue and escalate in the next millennium.

I will list the Editors choices in outline form and briefly name some important contributors in each field of advancement:

Human Anatomy and Physiology:
In 1543 Andreas Vesalius (1514-1564) wrote Seven Volumes on the Structure of the Human Body. This anatomical work is recognized as one of the most important in medicine. William Harvey (1578-1657) described the circulation of blood and its relation to the heart.

Cells and their Substructure
This was facilitated by Anton van Leeuwenhoek's (1632-1723) invention of the microscope. Cellular biology was influenced by Rudolf Virchow, Ludwig Aschof, and Carl Rokitansky. Ernst Russia invented the electron microscope in the early 1930's.

Study of the Chemistry of Life
Thomas Willis in 1659 was a pioneer and this was carried on by scientists such as Antoine Lavoisier, Jons Berzilius, and Louis Pasteur. In this past century important contributors were Otto Warburg (1883-1970) and Hans Krebs (1900-1981).

Using Statistics in Medicine
This started clinical trials and biostatistics, which have been greatly supported by computer technology.

After many failures by other individuals experimenting with nitrous oxide and other agents, William Morton demonstrated ether anesthesia at the Massachusetts General Hospital on Oct. 16, 1846. Modern anesthesia was started by the introduction of muscle relaxants in 1942.

Microbes and Disease
Louis Pasteur (1822-1895) was a giant in this field as was Robert Koch (1843-1910) who discovered the cause of tuberculosis. Antisepsis in surgery started by Joseph Lister (1827-1912) and this together with anesthesia ushered in the era of modern surgery.

Inheritance and Genetics
Many advances occurred from the time of Charles Darwin up to the present and will occur in the future. This is the current hot topic in clinical medicine.

The Immune System
The science of Immunology was probably started by Edward Jenner (1749-1823) when he used fluid from cowpox lesions to vaccinate against smallpox. This likewise is currently a popular segment of clinical medicine.

Body Imaging
Wilhelm Konrad Rontgen (1845-1923) discovered X-rays in 1895.This opened the field of medical imaging and it has come a long way since then. It includes ultrasound, magnetic resonance imaging (MRI), and many other techniques utilizing radio nucleotides.

Anitmicrobial Agents
In 1928 Sir Alexander Fleming discovered Penicillin. This has been listed by various authorities as the most important medical event of the 20th century. It started the Pharmaceutical Industry by stimulating research, development, and production.

Molecular Pharmacotherapy
This understanding has enabled many advances in drug therapy to occur. Cardiac drugs, cholesterol-lowering drugs, chemotherapeutic drugs for cancer are just a few and this list will grow in the future as we learn how to target drugs for diseases at a cellular and molecular level.

In our discussion at the Journal Club one of the participants suggested that Laenec's invention of the stethoscope should have been mentioned. To that I might add technical discoveries such as the heart-lung machine that enables surgeons to perform open heart surgery, the artificial kidney, and mechanical ventilators. You could go on and on.

Medical science has come a long way in a comparatively short time. The exciting aspect of this is that in the words of Al Jolson "You ain't heard nothin' yet, folks!" (Asa Yoelson, 1886-1950 in the film The Jazz Singer, July 1927)

"The Future, like the Mississippi, it just keeps rolling along. Let it roll. Let it roll on full flood, inexorable, irrestible, benignant, to broader lands and better days.""
     - Winston Churchill (1874-1965), British statesman. Referring to co-operation with the US. Speech, House of Commons, 20 Aug. 1940.

Take care until next time,
RJT, Editor.

To ask questions or submit comments, please fill out and submit the contact form.

     Caffeine Consumption