THE TWENTIETH CENTURY

The twentieth century was a period of revolutionary in­dustry in the science and politics of health. Concerns about the care of infants and children and the spread of in­fectious disease became prevailing themes in public and political arenas alike. It was during this time that private duty and public health nursing emerged as the means of delivering health care to people in their homes and in their communities. Social service agencies like the Henry Street Settlement in New York, founded by Lillian Wald, sent nurses into tenements to care for the sick.⁵ The place­ment of nurses in schools began in New York City in 1902 at the urging of Wald, who offered to supply a Henry Street nurse for 1 month without charge.⁵ Efforts to broaden the delivery of health care from the city to rural areas also were initiated during the early 1900s. The American Red Cross, which was reorganized and granted a new charter by Con­gress in 1905, established a nursing service for the rural poor that eventually expanded to serve the small town poor as well.⁵

Scientific discoveries and innovations abounded in the twentieth century. In the early 1900s, German bacteriologist Paul Ehrlich (1854-1915) theorized that certain substances could act as "magic bullets," attacking disease-causing microbes but leaving the rest of the body undamaged. In 1910, he introduced his discovery: using the arsenic com­pound Salvarsan, he had found an effective weapon against syphilis. Through his work, Ehrlich launched the science of chemotherapy.

 

 

The operating room. With the advent of anesthesia, knowledge of how mi­crobes cause disease, and availability of incandescent lighting in the operat­ing room, surgery became an option for treating disease. Rubber gloves had not yet been invented and the surgical team worked with bare hands to per­form surgery. (Hahnemann Hospital, Chicago, IL. Courtesy Bette Clemons, Phoenix, AZ)

 

The first antibiotic was discovered in 1928 by English bacteriologist Sir Alexander Fleming (1881-1955). As he studied the relationship between bacteria and the mold Penicillium, he discovered its ability to kill staphylococci. However, it was not until the 1940s that later researchers, who were searching for substances produced by one micro­organism that might kill other microorganisms, produced penicillin as a clinically useful antibiotic.

By the 1930s, innovative researchers had produced a cornucopia of new drugs that could be used to treat many of the most common illnesses that left their victims either severely disabled or dead. The medical community now had at its disposal medications such as digoxin to treat heart failure; sulfa drugs, which produced near-miraculous cures for infections such as scarlet fever; and insulin to treat diabetes.

At the turn of the century, social service agencies like Henry Street Settlement in New York sent nurses into tenements to care for the sick. (Schorr T.M., Kennedy S.M. [1999]. 100 years of American nursing [p. 12]. Philadelphia: Lippincott Williams & Wilkins)

With the discovery of insulin, a once-fatal disease known from antiquity no longer carried a death sentence. Working together, Canadian physician Sir Frederick Bant­ing (1891-1941) and physiologist Charles Best (1899-1978) isolated insulin from the pancreas of a dog in 1921. The extract, when given to diabetic dogs, restored their health. In January 1922, they successfully treated a young boy dying of diabetes with their pancreatic extracts. Although still incurable, it became possible to live with diabetes.

One disease that remained not only incurable but un-treatable through much of the twentieth century was tu­berculosis. With no cure or preventive vaccine forthcoming, efforts at the turn of the century were dedicated to con­trolling the spread of tuberculosis. It was then that an alliance between organized medicine and the public re­sulted in the formation of voluntary local organizations to battle the disease. These organizations focused on educa­tion to counteract the fear of tuberculosis; at the same time, they warned against the disease. In 1904, the local organizations joined together to form a national organi­zation, the National Association for the Study and Preven­tion of Tuberculosis. In 1918, the name was changed to the National Tuberculosis Association, which was renamed the American Lung Association in 1973.⁶

The national and local tuberculosis associations played a vital role in educating the public by running campaigns urging people to have skin tests and chest x-rays as a means of diagnosing tuberculosis. Once tuberculosis was diagnosed, an individual was likely to be sent to a sanato­rium or tuberculosis hospital. There, good nourishment

fresh air, and bed rest were prescribed in the belief that if the body's natural defenses were strengthened, they would be able to overcome the tuberculosis bacillus. For almost half a century, this would be the prevailing treatment. It was not until 1945, with the introduction of chemother­apy, that streptomycin was used to treat tuberculosis.

Outbreaks of poliomyelitis, which had increased in the early decades of the 1900s, served as the impetus for the work of American microbiologist Jonas Salk (1914-1995). At its peak, the virus was claiming 50,000 victims annually in the United States.³ Test trials of Salk's vaccine with in­activated virus began in 1953, and it proved to prevent the development of polio. By 1955, the massive testing was complete, and the vaccine was quickly put into wide use.

Surgical techniques also flourished during this time. A single technical innovation was responsible for open­ing up the last surgical frontier—the heart. Up to this time, the heart had been out of bounds; surgeons did not have the means to take over the function of the heart for long enough to get inside and operate.⁷ American sur­geon John Gibbon (1903-1973) addressed this problem when he developed the heart-lung machine. Dramatic advances followed its successful use in 1953—probably none more so than the first successful heart transplantation performed in 1967 by South African surgeon Christiaan Barnard (1922-2001).

For centuries, the inheritance of traits had been ex­plained in religious or philosophical terms. Although Eng­lish naturalist Charles Darwin's (1809-1882) work dispelled long-held beliefs about inherited traits, it was Austrian bo-

 

A tuberculosis skin testing clinic. (Schorr T.M., Kennedy S.M. [1999]. 100years of American nursing [p. 49]. Philadelphia: Lippincott Williams & Wilkins)

 

 

which used negative pressure to draw air into the lungs, was used to provide ventilatory support for persons with "bulbar polio." (Schorr T.M., Kennedy S.M. [1999]. 100years of Amer­ican nursing [p. 91]. Philadelphia: Lippincott Williams & Wilkins)

tanist Gregor Mendel's (1822-1884) revolutionary theories on the segregation of traits, largely ignored until 1902, that laid the groundwork for establishing the chromosome as the structural unit of heredity. Many other scientists and re­searchers contributed to the storehouse of genetic knowl­edge. With the work by American geneticist James Watson (1928-) and British biophysicists Francis Crick (1916-) and Maurice Wilkins (1916-) in the early 1950s, which estab­lished the double-helical structure of DNA, the way to in­vestigating and understanding our genetic heritage was opened.

It is difficult, if not impossible, to single out all the landmark events of the twentieth century that contributed to the health of humankind. Among the other notable achievements are the development of kidney dialysis, oral contraceptives, transplant surgery, the computed axial tomography (CAT) scanner, and coronary angioplasty.

Not all of the important advances in modern medicine are as dramatic as open-heart surgery. Often, they are the re­sult of dogged work by many people and yield results only after a number of years, and then they frequently go un­heralded. For example, vaccination programs, control of in­fectious diseases through improvements in sanitation of water and waste disposal, safer and healthier foods free from microbial contamination, identification of health risks from behaviors such as smoking, and improved prenatal care all have saved many lives in the twentieth century.