Magic Bullets and Other Medical Milestones Quiz

Answer: Syphilis

During the 19th century, syphilis was widespread throughout Europe. Treatments, usually involving mercury or mercury-containing compounds, were painful, dangerous and often ineffective. After Salvarsan was introduced in 1910, it proved very effective in controlling the disease, and remained the standard treatment for syphilis until the discovery of antibiotics.

Answer: Ignaz Semmelweis

In Vienna in the 1840s there were two maternity clinics to serve poor women; the first was used to train medical students, and the second to train midwives. The first clinic had a much higher incidence of puerperal fever than the second. When a friend died from an infection after being accidentally cut by a scalpel during an autopsy, Semmelweis noticed his symptoms were similar to those of women who contracted puerperal fever. He then deduced that the the women in the first clinic were dying from the disease in greater numbers because medical students were carrying "cadaverous particles" on their hands from the autopsy room and infecting their patients.

When Semmelweis instructed the students to wash their hands in a mild chlorine solution after leaving the autopsy room, the incidence of puerperal fever among women at the first clinic plummeted from nearly 20% to less than 2%.

Semmelweis' ideas were not well received by his colleagues. Because the germ theory of disease was unknown, Semmelweis could not explain why hand washing worked, only demonstrate that it did. Some doctors resented the implication that their hands were unclean; others recognized that puerperal fever could be spread to patients, but thought the danger existed only if the corpse they had been dissecting had died of puerperal fever, not some other disease. Typical of his critics was Dr. Carl Edvard Marius Levy, head of Copenhagen's maternity hospital, who wrote: "It seems improbable that enough infective matter or vapor could be secluded around the fingernails to kill a patient."

Semmelweis became increasingly frustrated that his ideas were being rejected by his peers. He was aware that thousands of women were dying needlessly throughout Europe because the medical establishment refused to see the truth of his findings - so much for peer review! Semmelweis began acting strangely and in 1865 he was confined to a mental institution. He resisted confinement and was severely beaten by the guards. Two weeks later he died at age 47, of an infected wound.

Although his achievements were largely unappreciated during his lifetime, Semmelweis is now regarded as an important figure in the history of medicine.

Answer: Scurvy

It is estimated that over 2 million sailors died from scurvy between 1500 and 1800. It had long been known that fresh vegetables and fruit, especially citrus fruit, were effective treatments for scurvy. But in the days before refrigeration, fruit and fruit juices wouldn't keep very long before spoiling. Various extracts of fruit juices were tried, but Vitamin C is very heat sensitive, and also reacts with the copper tubing used in the distillation process, so most of the Vitamin C was lost in making them. Some thought that any acidic substance would combat scurvy, including dilute sulphuric acid. No wonder so many sailors died.

In 1747 James Lind conducted the first truly scientific experiments on the treatment of scurvy, showing that citrus fruits were effective against the disease, but other acids were not. But it was not until the 1790s that the British Fleet began acting on Lind's findings. Even then there were those who believed that scurvy was the result of eating tainted meat, not a nutritional deficit. So scurvy was still a problem well into the 20th century.

In 1927, Hungarian biochemist Szent-Györgyi isolated a compound called
hexuronic acid from the adrenal glands. He thought it was the agent that prevented scurvy, but was unable to prove it. In 1932, the American scientist Charles Glen King proved that hexuronic acid prevented scurvy in guinea pigs. Szent-Györgyi was later able to find the same substance in paprika peppers, and in 1934 sent some of it to British chemist Norman Haworth, who determined its chemical structure, and was able to produce it synthetically in the laboratory. Because the medical term for scurvy is "scorbutus," it was decided to rename the chemical "ascorbic acid." We know it as Vitamin C.

Today, scurvy is rare is western societies, because Vitamin C is regularly added to many of the foods we eat and the liquids we drink. Both Szent-Györgyi and Haworth won Nobel prizes for their work on Vitamin C.

Answer: Penicillin

Most of us know the story about how, in 1928, Alexander Fleming left a Petri dish containing a culture of Staphylococcus uncovered and it became contaminated with a mold called Penicillium notatum. Fleming noticed that the mold had killed the bacteria, and concluded that it was producing a substance that could be used as a disinfectant. He stopped studying it in 1931, but in 1934 again began trying to find a way to purify it and produce it in sufficient quantities to treat patients.

There were some early successes in treating eye infections and eventually other researchers began experimenting with the drug. It was WWII that provided the real incentive to begin producing penicillin on a massive scale. By 1945 the chemical structure of penicillin had been determined, and by 1957 synthetic penicillin was being produced.

The success of penicillin in treating and preventing bacterial infections soon led to a search for other antibiotics. Today, there are dozens of different antibiotics available, and new ones are still being discovered. But penicillin is still one of the most widely used.

Answer: Ether

Dr. William T.G. Morton was a Boston dentist. He didn't discover ether, and wasn't the first to use it as an anesthetic. But he was definitely the man who popularized its use.

In 1844, Morton had briefly attended Harvard Medical School, where a professor named Charles T. Jackson supposedly taught him about the anesthetic qualities of ether. On September 30, 1846, Morton administered ether to a patient and painlessly extracted a tooth. Then, on October 16 of the same year, he gave a public demonstration of the benefits of ether at Massachusetts General Hospital, where a tumor was extracted from the neck of a young man. The news of his achievement spread rapidly, and by December ether was being used in Great Britain.

Morton tried, but failed, to patent his technique for administering ether. Almost immediately he was involved in disputes with other men, including Professor Jackson and Georgia surgeon Crawford Williamson Long, who claimed that they were the true discoverers of "anesthetic inhalation."

Before Morton's demonstration of ether, even minor surgical procedures involved excruciating pain. None of the vast strides that have been made in surgery over the past 160 years would have been possible without anesthesia. The world owes a debt to the memory of Dr. William T.G. Morton.

Answer: Smallpox

Many young people have never even heard of smallpox; they are not routinely vaccinated against it because it has been completely wiped out. But during the 20th century, smallpox is estimated to have killed between 300 and 500 million people. As late as 1967, two million people died of smallpox world wide.

Smallpox comes in various varieties, but they all involve the victim breaking out in a rash and developing skin lesions that are often filled pus. Smallpox is extremely contagious, and, depending on the strain of the disease involved, kills between 20% to nearly 100% of those infected.

For thousands of years, people had tried to prevent smallpox using inoculation. This involved deliberately infecting the patient with a mild strain of the disease. Unfortunately, up to 2% of the people receiving smallpox inoculations died. It was a risk many were not prepared to take.

In 1796, Dr. Richard Jenner observed that milkmaids in England very seldom developed smallpox, although they did come down with another disease called cowpox, which was rarely, if ever, fatal. Jenner deduced that the cowpox must somehow provide immunity against smallpox. He performed an experiment that would be unthinkable today. He scraped pus from the hands of a milkmaid named Sarah Nelmes, and then scraped it into the arms of his gardener's son, eight year-old James Phipps. Phipps developed a mild case of cowpox. After he had recovered, Jenner then injected him with smallpox. The boy did not develop any symptoms. He tried the experiment successfully on an additional 23 people.

It took over 40 years for the British government to outlaw smallpox inoculation and replace it with Jenner's cowpox vaccination. But in 1840 it outlawed live smallpox inoculation and began funding vaccination programs. Better vaccines were eventually developed, and by 1980, smallpox had been eradicated everywhere in the world.

Answer: Wilhelm Röntgen

Like many scientific discoveries, Röntgen stumbled upon X-rays almost by accident. In 1895, he was studying the radiation emitted from various types of vacuum tubes when he noticed that one one of them, called a Lenard's tube, caused a piece of cardboard painted with a chemical called barium platinocyanide to glow when it was placed close to the tube. He repeated the experiment using a device called a Hittorf-Crookes tube, which had much thicker glass walls, and observed the same effect. Röntgen believed he had discovered a new form of radiation which he called X-rays, the "X" standing for "unknown."

He soon discovered that the rays could expose a photographic plate, and on Decemeber 22, 1895, he took the first modern medical X-ray: a photograph of his wife's hand. On Decemeber 28, 1895, he submitted his first paper on the subject, "On a new kind of ray: A preliminary communication."

News of Röntgen's discovery spread rapidly; on February 14, 1896, X-rays were used for the first time in a surgical operation. Thomas Edison invented the fluoroscope, which could capture moving X-ray images, in 1896. By the 1970s, X-ray computed tomography (CT scan), which produces a three-dimensional image, was developed. X-rays are not without their problems; they are a form of ionizing radiation, and can be quite dangerous. Many early pioneers in the field were unaware of the dangers and died of cancers caused by exposure to X-rays. While tremendous strides have been made to reduce the dangers associated with X-rays, they are still a calculated risk. Some experts estimate that between 0.5 and 2% of cancers are actually caused by X-rays!

The benefits far outweigh the risk in most cases. X-rays were considered such an important discovery that Röntgen was awarded the very first Nobel Prize in Physics in 1901.

Answer: Blood typing

Interest in blood transfusions dates back to the Middle Ages or even beyond. Sometimes even animal blood was transfused into humans! But these early experiments were not very successful. The recipient of the blood often died, and no one knew why.

Enter Karl Landsteiner. Dr. Landsteiner was a physician and and a biologist. In 1901 he discovered that blood serum contains antibodies that cause red blood cells to agglutinate, or clump together, if the blood introduced is of a different type. Dr. Landsteiner discovered three types of blood, which he called A, B and C (we now call the latter O). The following year, group AB was discovered. As a result of Landsteiner's research, it was discovered that blood could safely be transfused between people of the same blood type. In 1940, he was also involved in research that identified the Rh factor, which resulted in blood types being further refined as Rh negative or Rh positive.

In 1930, Karl Landsteiner received the Nobel prize in Physiology or Medicine for his ground-breaking work on blood typing.

Answer: Frederick Banting

Diabetes was identified as a disease in ancient times, but its cause was not known until the late 19th century. The primary symptom is the presence of sugar in the urine. One of its most severe forms, juvenile diabetes, was a major cause of death in children.

In 1869, a young German student identified structures in the pancreas which are called "islets of Langerhans" after their discoverer. It was thought they might play a role in in the digestive process, but no one knew what it was. In 1889, it was discovered that dogs who had their pancreata surgically removed developed diabetes. In 1901, the American pathologist, Eugene Lindsay Opie, observed changes in the islets of Langerhans in patients suffering from diabetes mellitus, which led researchers to believe that these structures secreted some substance that prevented the disease. Experiments were done which showed that pancreatic extracts could be used to alleviate the symptoms of diabetes in dogs, but none of these extracts was suitable for use in humans.

In 1920, the Canadian scientist, Frederick Banting, speculated that the pancreas' own digestive enzymes might be breaking down the anti-diabetic factor in the extracts which had been tried. He developed a technique of tying off the arteries supplying blood to the pancreas in dogs; this resulted in atrophy of the organ, but left the islets of Langerhans intact. Along with his assistant, Charles Best, Banting was able to produce an extract containing enough insulin to keep a diabetic dog alive indefinitely.

Next, Banting began using the pancreata of fetal calves as a source of insulin. Since the organs of these unborn animals were not fully developed, it was easier to extract insulin from them, and the quantity obtained was much greater than could be produced by dogs. The first human trial was performed on January 11, 1922, but the patient suffered a severe reaction to the impurities in the insulin. A better extract was prepared, and a second trial on January 23, 1922 was successful. The patient, a boy named Leonard Thompson, who was near death when the experiment began, went on to live another 13 years.

In recognition of his discovery, Banting shared the Nobel Prize in Physiology or Medicine for 1923 with J.R.R. Macleod, his supervisor at the University of Toronto, where his research had taken place. Banting thought his assistant, Charles Best, was more deserving of recognition than Macleod, and shared his Nobel Prize money with Best.

The researchers never became rich from their discovery. All those involved believed that insulin was so important that drug companies should be able to produce it without paying royalties.

Frederick Banting died in a plane crash in 1941, at the age of 49. But his discovery has saved literally millions of lives.

Answer: Jonas Salk

Polio, or infantile paralysis, was one of the last serious communicable diseases conquered by medical science. It is caused by several strains of viruses which attack the nervous system. While most polio infections produce few if any symptoms, in about 1% of the cases there are serious complications, ranging from partial to total paralysis, or even death. As recently as 1952, there were 3,145 deaths in the United States from polio, and over 20,000 cases which resulted in some degree of paralysis.

The polio virus was identified by Karl Landsteiner as early as 1908, but it took nearly 50 years to develop an effective vaccine against the disease. Polish-American scientists Hilary Koprowski and Albert Sabin developed a vaccine in the early 1950s that used a live, but weakened, strain of the polio virus, and which was administered orally. About the same time, Jonas Salk developed a vaccine that used dead viruses, but which required a series of injections. There were advantages and disadvantages to both vaccines, but eventually the Salk vaccine proved to be more effective and posed less risk, and it is now used exclusively in the United States.

Today, polio has been virtually eliminated. In 2012, there were only 223 cases of polio worldwide, and these were limited to five countries: Nigeria, Niger, Chad, Pakistan, and Afghanistan.