Medicine is a vast and ever-changing sea of ideas and practices, with each new wave refreshing how we care for our patients. What follows here is a collection of, in this author’s opinion, the five most inspiring innovations in the medical field across its history. There was no shortage of landmarks to choose from, but this list tries to deliver a snapshot of the achievements of physicians who have, arguably, accumulated less household fame than the Flemings and Listers of this world. And, to reflect the multifaceted nature of medicine, the subfields I touch upon include endocrinology, plastics, neurosurgery and reproductive medicine. Hopefully this list will be as entertaining and inspiring as it is informative!
The striking image of a physician’s stethoscope is so synonymous with medicine that you’d be forgiven for thinking them siblings, twins even. But the reality is that the stethoscope is a relatively new addition to the chest examination. This particular examination usually consists of a visual inspection, palpation, percussion and auscultation. Before the early nineteenth century, the first three components were very similar to how we conduct examinations today. However, auscultation used to involve pressing an ear directly against the patient’s chest. And this wasn’t great for hygiene; it was awkward for everyone involved; and it relied on the doctor having excellent hearing. The changes in the sounds of heart valves, air flow and blood flow are often imperceptible. To detect signs of pathology, it would be incredibly useful to amplify those sound for doctors. Enter the stethoscope.
The stethoscope was invented in 1816 by French doctor, Rene Laënnec to make it easier for him to listen to patients’ breathing and heart sounds. Without it, chest exams would involve pressing our ears against the patient’s chest. This would carry an infection risk as well as being potentially embarrassing for both doctor and patient! Over the centuries since its invention, the stethoscope has evolved from a paper tube into a swish binaural instrument, now a must-have piece of kit for every doctor and an expensive piece of kit for every medical student. Finally, due to its widespread use in the medical profession, the stethoscope has become an important symbol for medicine, on par with the rod of Asclepius.
Plastic surgery is often thought of as a modern specialty, possibly because the reconstruction of external organs seems a very advanced and difficult undertaking. However, we mustn’t underestimate the ingenuity of the ancients, lest we invent a new form of prejudice. Nevertheless, the first plastic surgeon that we know of was born a long time ago indeed. Known only as Sushruta, meaning ‘renowned’, he is widely touted as the founding father of surgery due to his numerous innovations in the field, and we could fill a whole other article with them. But, for now, I’ll focus on his invention of the rhinoplasty, the first known technique in plastic surgery. In a culture where nose amputations were a common punishment, rhinoplasty gave offenders a chance at a normal life.
Sushruta, the mysterious ancient Indian surgeon, invented rhinoplasty among many other surgical innovations in the 7th or 6th century BCE. From him, sprang the specialty of plastic surgery, which benefits victims of disfiguring trauma worldwide. His techniques are being referenced and modified even now, which is an incredible legacy.
Today, in-vitro fertilisation (IVF) is almost mainstream. It’s a topic taught in biology classes throughout the UK and it’s a now a tried and tested option for couples trying to conceive. As a relatively new technology, it’s rather astounding how established it’s become in such a short space of time. And the very idea of relocating the process of fertilisation outside the body is, at best, absurd! But because of this breakthrough, families have been formed that wouldn’t have otherwise. Lives have been lived and loved and lighting up their little corners of the world because humanity redefined what it is to be infertile.
In IVF, Patrick Steptoe and Robert Edwards pioneered a fertility technique that has allowed many couples to start families. While controversial in some circles, the process is incredibly successful for what really should still be science fiction!
The paradox of surgery is an elegant one, encapsulated perfectly in the procedure known as the corpus callosotomy. To apply a cut, to actually cause damage, to tissue should really be in malice because to damage is to hurt. But surgeons cut beneficently, they divide to make whole again and brazenly ignore the reign of Mother Nature. They’re the ones who buy the IKEA wardrobe and assemble it themselves – instructions be hanged. Those extra panels and screws weren’t needed anyway. Brains, obviously, are not wardrobes, but neurosurgery still represents humans decreeing that they are qualified and capable to edit this most complex of organs. A common palliative procedure for epileptic patients is to sever the connection between the two hemispheres, known as the corpus callosum, in an operation called the corpus callosostomy. Because of this intervention, many people with epilepsy have been able to better manage their conditions.
William van Wagenen and Robert Herren revolutionised the management of epilepsy by performing corpus callosostomies to limit the spread of seizures through the brain. The resulting research by Roger Sperry laid the foundations for later psychological theories about the relationships between brains structures and their functions – without these surgeries, we wouldn’t know that the brain hemispheres contribute different things to the tasks that the brain performs.
Genetic engineering is almost like an abstract, macroscopic viral infection. The human contagion impregnates an organism with the instructions to produce proteins beneficial for the human, and only the human. We essentially implant an idea and farm the organisms to bring the idea into reality. Such was the dawn of insulin’s mass-production: human recombinant insulin produced from E. Coli bacteria. No more would diabetic patients have to rely on animal pancreases, when human insulin was now ready to be shipped out everywhere. Management of diabetes was made easier and cheaper, and it opened the door for modified insulins with more useful half-lives and pharmacokinetic profiles.
David Goeddel and Dennis Kleid at the Genentech lab created the first bacteria-produced human insulin. This meant that diabetic patients could use their insulin without fear of an immune response to the drug. In addition, the genetic engineering techniques refined in this endeavour could be widely applied to other human-specific protein-based drugs. The potential that this innovation unleashed was immeasurable, and we’re still seeing its fruits today.
Each of these physicians and scientists, each in their own small way, helped to reshape the fabric of medical practice. Clinical examinations were never the same after Laënnec; recombinant human insulin fundamentally and forever changed the production of diabetes medication. These pioneers weren’t the first, and nor will they be the last to change how we treat our patients. Indeed, more humble individuals will come along and inspire us all with their vision and audacity. And that goes some way to explaining part of why this field and profession are so great.