Having a baby in January 2000 is very different from having a baby in January 1900. Back then, there were no early pregnancy tests to know in a moment that a baby was coming, and no blood tests or amniocentesis or prenatal ultrasounds to know that the baby was okay.
The months leading up to a baby’s birth are usually a time for both hopes and fears. As the 1900’s began, maternal mortality was appallingly high. The figures varied considerably around the globe, but the statistics were expressed as the numbers of women who died per 1,000 births. The tragic danger of a mother’s dying in the first minutes of her baby’s life was real and present. Over the last 100 years, this risk has plummeted by more than one hundred eighty times, or 99.4%, and maternal mortality – now rare in developed countries – is reported per 100,000 births.
After a baby was born, and mother and baby had made it safely through the newborn period, keeping them safe from disease was an uncertain task. Infectious diseases, such as smallpox and polio, ran unchecked. The germ theory of infection was new and not yet completely accepted. Bacteria and viruses were only beginning to be understood. No vaccines were routinely available to prevent diseases. The ideas of antisepsis were only sporadically applied. Rubber gloves were first introduced in surgery by William Halstead in 1890 – to protect his nurse’s hands!
The great American surgeon, William Halstead was in love with his chief surgical nurse, Caroline Hampton. She, however, had sensitive hands. Halstead asked the Goodyear Rubber Company to manufacture gloves of thin rubber for her. This helped her hands – and also happened to decrease the incidence of postoperative infections. A new chapter in surgery was opened. (And, on June 4, 1890, Caroline Hampton married William Halstead).
Accurate diagnosis was a challenge, especially of children too young to describe their symptoms. There were no MRI’s, or CT scans, or ultrasounds to clarify the situation. The plain X-ray was discovered in 1895, and was not yet well understood. This technique seemed completely safe, though, so early X-ray workers were unprotected during frequent large exposures and often developed cancers.
If an accurate diagnosis of leukemia or other childhood cancer was made, it would be a death sentence. Without insulin, diabetes, too, was a fatal illness (insulin was discovered in 1922). Aerosols weren’t available to treat asthma. The 20th century would see thousands of medicines invented, but at the turn of the century, before antibiotics, even simple bacterial infections could be fatal.
And surgery was a risky affair. As the century progressed, safer operative techniques allowed more complex operations. In 1902, the successful appendectomy of King Edward VII was major news – because appendicitis had hitherto often been fatal. Now complex operations, microsurgery, and even organ transplantation no longer seem like miracles.
Even so, there was no way of knowing how much oxygen was getting to a sleeping child’s brain during surgery until Nellcor’s pulsoximeter (the little red light that tapes to the finger) slashed the risk of anesthesia in the 1980’s. And surgery continued to progress. As the 20th century drew to a close, even computerized, robotically performed microsurgery was becoming a reality.
A mother in labor in 1900 could scarcely have dreamt of the advances this century would hold. Aspirin, produced at the very end of the 19th century by Bayer, was the hot new technology. DNA, the building block of life, was unimagined. We can scarcely imagine where healthcare will be when the next century rolls around.
The randomized trial, one of the great advances in the history of knowledge, had its roots in the 1920’s. Because of this method of evaluating truth, medical advances will continue to accelerate, making treatments and preventive measures more targeted and less harsh.
More exciting to me is the trend toward making these advances (and health knowledge) less centralized and more accessible. A century ago, health knowledge was guarded closely in the hands of a few professionals. The Internet is already changing that, but fundamental change is still needed. Let me give you a glaring example: it is the dawn of the 21st century, at least half a million women each year still die from pregnancy-related causes – but 99% of these tragic deaths take place in developing countries. In no other statistic is the gap between developed and developing countries so wide. I look forward to our global community taking up the challenge to tear down the barriers and put the tools for good health in everyone’s reach.