Just thirty-odd years ago, a HIV diagnosis was a death sentence. Advances in pharmaceuticals and in our understanding of the mechanisms of HIV infection mean that today it is a manageable, chronic disease on par with diabetes, hypertension, and cardiovascular disease. People with HIV are living longer, and a graph recently published by the Centers for Disease Control and Prevention (CDC) shows that in the United States the average age at death from HIV infection has dramatically increased since 1987. (1)
The Pacific broad tapeworm thrives in the guts of the sea lions that frolic in the waves of the Pacific Ocean, has been identified in the preserved poop of Peruvians mummified some five millennia ago, and is now making its way to seafood-loving Europeans through the briny conduits of the world-wide commercial fish trade.
Three scientists that developed treatments for debilitating parasitic infections were awarded the Nobel Prize in physiology or medicine today for their ground-breaking advancements in tropical medicine.
Infectious diseases have long been the companions of war and natural disaster. For those that barely escaped death in the calamities of antiquity, walking away with what appeared to be a light injury, the agony of a gangrenous wound or convulsive, back-breaking muscle spasms would deal an impending final blow. For centuries, a dreaded complication from an innocent blister or a bullet wound was the untreatable and catastrophic tetanus, caused by Clostridium tetani.
It is common knowledge that the discovery of penicillin in the laboratory of Alexander Fleming radically changed the world of medicine and public health, allowing us to treat and cure once intractable and deadly bacterial infections. Less well-known is the winding road from discovery, past numerous roadblocks including production limitations and the second World War, to widespread use. A decade and a half of limited access to the world’s first antibiotic came to an end in 1943, when a prolifically moldy cantaloupe was purchased from a grocery store in Peoria, Illinois. We would double down in our battle against infectious diseases less than a decade later, when two female scientists inspired by the humble discovery of penicillin would identify the first known antifungal agent in the mucky soil of a Virginia dairy farm.
Advancements in the medical sciences follow a well-trod path: observation of a problem, reasoned hypothesis and experimentation, and implementation of a solution. This course is governed by logic and, occasionally, reinforced by unorthodox thinking with the ultimate goal of improving the viability of man. An exception to this rule is the invention of the rubber glove. One of the most important breakthroughs in the practice of medicine was born not of careful problem-solving and the scientific process, but of a romantic gesture, a clinical schoolboy’s crush, an event which one observer described as “Venus [coming] to the aid of Aesculapius.”
Smallpox has haunted man for almost as long as we have been walking this earth. The variola virus that causes the deadly pox had been known to liquidate entire communities, towns, and cities since antiquity, stalking along trade routes and capitalizing upon human behavior and patterns of movement. Egyptian mummies unearthed from their tombs bear the pocked faces of fortunate survivors; Chinese emperors, Indian peasants, Russian Tzars, and Australian Aborigines – around the world, millions succumbed to virus in the centuries before the discovery of an effective vaccine.
The mother gazes at her naked, lethargic infant, wan with a pustular red rash dotting his chest. She’s dressed in the fashion of the day: a high-necked black blouse with leg-of-mutton sleeves, a heavy full-length skirt, a formless red feather jutting from her hat. She holds a white handkerchief to her distorted scarlet face, one arm hanging limply at her side, seemingly in despair over the lamentable circumstances that have brought her to this bare waiting room.
The Nuremberg Code was drafted in 1947 following the appalling revelations of human experimentation committed in Nazi concentration camps. The overarching goal of the Code was to establish a set of rules for the ethical conduct of research using human subjects, guaranteeing that the rights and welfare of such participants would be protected. Two important principles guide and define this Code: the concept of voluntary, informed consent and that no experiment shall be conducted in which “there is an a priori reason to believe that death or disabling injury will occur.”
It seems to have started, as many things medicinal do, with Hippocrates. We may not understand precisely why, some 2000 years ago, the great Greek physician chose to insert the bladder of a pig into a patient’s chest and then inflate this porcine balloon. But it may have had something to do with tuberculosis and with the phenomenon of “pulmonary collapse,” which has had a surprisingly long and fruitful run in the annals of medical history.