21st October 2016

Old medicine, new medicine

When I was a lad, times were hard. But we were happy.

How many times have you heard these lines and not just from Monty Python’s amazingly well observed Yorkshiremen sketch? Well, dear reader, sad to say, but times truly were hard. 

Without the medical and social pioneers of the last 200 years, times would be hard now; in fact it is doubtful that any of us would be alive today without the men and women who drove medical discovery forward and continue to do so. What has been achieved has been truly amazing, and something that justifies celebration.

Until Louis Pasteur, a mere 150 years ago, we didn’t even know about microbes. Now, with the work of innovative researchers and physicians, we can cure and hold back diseases that even a few years ago would have proved rapidly fatal.  We even use viral vectors to insert genes into defective genomes to cure hyper-rare disease. How brilliant is that?

But let’s take a little trip back in time (cue wavy lines and spooky music) to the streets of a city in Victorian times. Let’s not dwell too long on where this city is; it could be New York, Paris, Berlin, Glasgow or London.  I’d prefer it to be Manchester, Liverpool, Newcastle or Leeds, but sadly my editor doesn’t know what lies beyond Cambridge.

Anyway, I shall wipe the chip from my shoulder (but not with a saveloy), and return to the subject: the fantastic and inspiring medical advances of the last 200 years. But bear with me, it isn’t all science.

In 1850 we faced many grim health challenges; malnutrition and poor sanitation were responsible for a whole plethora of endemic diseases. Living in an overcrowded city, a Victorian child faced measles, mumps, diphtheria, scarlet fever, whooping cough, polio, smallpox and influenza. Their parents had probably survived exposure to one or more of these diseases, but as adults they faced not only the ever-present risk of industrial accident, or death during child birth, but also cholera, typhoid, tetanus and tuberculosis.  Is it any wonder gin was so popular?

So, dear reader, yes, life was hard. Probably harder than we can imagine…

So, what were the big advances? Well, vaccination has probably saved more of the planet’s population than any other advance; then there’s Lister and his disinfectants, Curie and her X-rays, Nightingale and her professional nursing, and Bayer and his aspirin. But there were other major advances in the 19th Century, and some unsung heroes (and heroines) that you may never know of. 

As well as the medical and scientific heroes, there were political heroes too.  In 1875, Richard Cross (Home Secretary) brought in the Public Health Act. From 1876, the vigorous Chief Medical Officer, John Simon, spent the next 20 years successfully diverting public money to make cities safer and more sanitary. In the UK, these two men probably did more for the health of a nation, through politics and the implementation of proper social policy, than a whole lake of disinfectant could ever do. Perhaps, in modern times, we should reflect on how powerful, well designed, and aggressively implemented health and social policy can change people’s lives.

The 20th century saw continued advances in health, but, sad to say, this was often driven by the dreadful wars our grandparents lived through. I think we’d all agree that Fleming’s penicillin was a pretty big advance, and it saved many a soldier (on the Allied side anyway). Later in the century there was organ transplantation, social medicine, the wonderful National Health Service, and the realisation that inhaling smoke from dried tobacco leaves soaked in pesticide residue did not have health benefits, but could kill you. Even the Australians got in on the act with the discovery of H. pylori, and the subsequent massive reduction in gastric ulcers. 

In essence, medicine advanced, health policy got better and the population became healthier.  The statistics say it all really: in 1850 the death rate was 20.8 per thousand; in 2014 it was 9.

We’ve come a long way. Medicine works; science works; and when we really think about it, politics has worked too.

We need to maintain this amazing momentum, take care of our own health, spread the benefits to poorer communities around the world, and ensure that we encourage our doctors and politicians to work together, to the betterment of us all.