Twentieth-century treatments: antibiotics and beyond
A Century of Medical Revolution
The twentieth century saw more advances in the treatment of disease than in any previous century combined. Three forces drove this transformation: the application of new scientific discoveries (such as radiation and antibiotics), the mobilisation of industrial-scale research and manufacturing during and after the Second World War, and the expansion of public healthcare. The result was that conditions which had been death sentences in 1900 became treatable or even curable by 1980.
Marie Curie and the Development of Radiation Treatment
Marie Curie was a Polish-French physicist and chemist who, working with her husband Pierre, conducted pioneering research on radioactivity in the 1890s and 1900s. She discovered two new elements — polonium (1898) and radium (1898) — and received two Nobel Prizes: in Physics (1903, shared with Pierre and Henri Becquerel) and in Chemistry (1911). Crucially for medicine, she recognised that radioactive substances could destroy living tissue. During the First World War, Curie developed mobile X-ray units — known as petites Curies — to assist battlefield surgeons. Her research on radiotherapy laid the foundation for treating tumours with targeted radiation. Today, radiotherapy remains a central treatment for many cancers.
Marie Curie discovered polonium and radium in 1898 and won Nobel Prizes in Physics (1903) and Chemistry (1911). Her research on radioactivity formed the foundation of radiotherapy, used to destroy cancer cells and still central to cancer treatment today.
Alexander Fleming and Penicillin, 1928
In September 1928, Alexander Fleming, a bacteriologist at St Mary’s Hospital in London, returned from holiday to find that one of his petri dishes of Staphylococcus bacteria had been contaminated by a mould. Around the mould — identified as Penicillium notatum — the bacteria had been killed. Fleming recognised that the mould was producing a substance lethal to bacteria. He named it penicillin and published his findings in 1929. However, Fleming could not isolate penicillin in sufficient quantities to make it a practical medicine, and the discovery languished for over a decade.
The decisive step in making penicillin a usable medicine came from Howard Florey and Ernst Boris Chain at Oxford University. In 1940, their team demonstrated that penicillin could cure bacterial infections in mice. In 1941, the first human trial took place: a police officer named Albert Alexander, dying from a severe blood infection, was treated with the available (very limited) supply of penicillin. He improved dramatically but died when the supply ran out before he was fully cured. This trial showed both the drug’s power and the problem of supply. The war provided the solution: the US government funded large-scale industrial production of penicillin, and by 1944 it was available in quantity for Allied troops. Fleming, Florey and Chain shared the Nobel Prize in Physiology or Medicine in 1945.
Fleming discovered penicillin in 1928 but could not purify it. Florey and Chain developed a process to extract and test it in 1940–1941. War funding enabled US mass production by 1944. The three shared the Nobel Prize in 1945. Penicillin became the first antibiotic in widespread clinical use, saving millions of lives.
Christiaan Barnard and Transplant Surgery, 1967
By the mid-twentieth century, surgery had advanced enough for surgeons to attempt transplanting organs from one human body to another. On 3 December 1967, Christiaan Barnard, a South African cardiac surgeon working at Groote Schuur Hospital in Cape Town, performed the first successful human heart transplant. The patient, Louis Washkansky, received the heart of a road accident victim. He survived for 18 days before dying of pneumonia. While the survival time was short, the operation demonstrated that transplantation of the human heart was possible. Subsequent improvements in anti-rejection drugs — particularly the development of immunosuppressants such as cyclosporin in the 1970s — made organ transplantation increasingly viable. Today, thousands of heart, kidney, liver and other transplants are performed successfully each year.
Cancer treatment advanced on multiple fronts in the late twentieth and early twenty-first centuries. Radiotherapy, building on Curie’s work, was refined to target tumours with increasing precision. Chemotherapy using cytotoxic drugs developed from the 1940s onwards. Keyhole surgery — using cameras and tiny instruments through small incisions rather than large open cuts — reduced recovery times dramatically. Genetic research, including the mapping of cancer genes, opened new avenues for targeted drug therapy. Stem cell therapy, still largely experimental at the time of writing, offered the prospect of regrowing damaged tissue.
Alongside these mainstream advances, alternative treatments — acupuncture, herbal medicine, homeopathy — retained and in some cases grew their popularity. Supporters argued that these approaches treated the whole person rather than just symptoms. Critics pointed to limited clinical evidence for their effectiveness. The coexistence of evidence-based medicine and alternative treatments is a feature of healthcare at the start of the twenty-first century, reflecting continuing diversity in how people understand and seek to address illness.