A History in 13 Steps

MEDICAL BREAK-
THROUGHS

The big steps that saved lives — from cowpox lymph in a country doctor's hand to messenger RNA folded by an algorithm. Two centuries of pushing back against death.

13 Slides1796 → 2021
Era Spanned225 years
Lives SavedHundreds of millions
02 / 13 — The First Vaccine

Jenner inoculates a boy with cowpox.

A country physician notices milkmaids don't catch smallpox. He tests a hunch on 8-year-old James Phipps — and invents immunology.

17·96
Edward Jenner — Berkeley, England
Smallpox vaccination — the first deliberate immunisation

Jenner inoculated a boy with material from a cowpox lesion, then exposed him to smallpox. The boy didn't get sick. The Latin word for cow, vacca, gave the procedure its name. Smallpox would go on to be the only human disease ever eradicated (1980).

300M+
Smallpox deaths in the
20th century alone
0
Cases since 1977
(the disease is gone)
VACCINE
A drop, an arm, an ideaImmunology begins
03 / 13 — Painless Surgery

Morton ends the screaming centuries.

Until October 1846, surgery meant being held down, awake, while a surgeon worked as fast as humanly possible.

18·46
William T. G. Morton — Massachusetts General Hospital
Ether anesthesia: the first public demonstration in the "Ether Dome"

Morton inhaled diethyl ether through a glass apparatus to a 20-year-old patient named Edward Abbott. Surgeon John Collins Warren removed a neck tumor in silence. Warren turned to the audience and said, "Gentlemen, this is no humbug." Within a year ether crossed the Atlantic.

21 Oct
1846 — "Ether Day"
at MGH, Boston
100%
Of modern surgery
built on this moment
Z ANESTHESIA
From horror to silenceEther Day
04 / 13 — Why Patients Died After Surgery

Two men kill the invisible killers.

Surgery was now painless — but post-operative infection killed roughly half of all surgical patients. Then a chemist in Paris and a surgeon in Glasgow connected the dots.

1861
Louis Pasteur — Paris

Germ Theory of Disease

Pasteur's swan-neck flask experiments showed microorganisms cause spoilage and disease — not "spontaneous generation" or bad air. He invented pasteurisation along the way and later developed vaccines for rabies and anthrax.

1867
Joseph Lister — Glasgow Royal

Antiseptic Surgery

Reading Pasteur, Lister sprayed carbolic acid in operating theatres and washed instruments. Surgical mortality at his hospital plunged. The mouthwash bearing his name (Listerine) is the small commercial echo.

50% → 15%
Surgical mortality drop after carbolic acid spray
1864
Year pasteurisation patented
Implications: hand-washing, hygiene, modern microbiology
05 / 13 — Seeing Through Skin

Röntgen finds the "X" rays.

Working in a darkened lab, the German physicist saw a barium-coated screen glow even with his cathode-ray tube covered. He had stumbled into the first medical imaging.

18·95
Wilhelm Conrad Röntgen — Würzburg, Germany
X-ray imaging — first non-invasive look inside the living body

On 8 November 1895 Röntgen photographed his wife Anna's hand: bones and wedding ring sharply visible through flesh. She reportedly gasped, "I have seen my death." Within weeks the technique was being used in clinics. The first Nobel Prize in Physics (1901) went to him.

15 min
Exposure for that
first hand image
3.6B
X-ray exams now
performed yearly
X-RAY
Bones through skinThe first medical scan
06 / 13 — A Forgotten Petri Dish

Fleming returns from holiday to a mouldy miracle.

A blue-green mould had killed the bacteria around it. Fleming named the substance penicillin. It would take Florey, Chain and a wartime crisis to mass-produce it.

19·28
Alexander Fleming → Florey & Chain (Oxford, 1940)
Penicillin — the antibiotic age begins

Fleming's accident sat in a journal for a decade. Then Howard Florey and Ernst Chain at Oxford figured out purification; American pharma scaled production for D-Day. Soldiers who would have died from infected wounds in WWI now survived. The trio shared the 1945 Nobel.

200M+
Lives saved by
penicillin alone
2.3M doses
Produced for Allied
troops by D-Day, 1944
PENICILLIUM
A clear ring of dead bacteriaThe first antibiotic
07 / 13 — The Secret of Life

A double helix on a scrap of paper.

In Cambridge, Watson and Crick built models. In London, Rosalind Franklin's X-ray diffraction "Photo 51" handed them the answer.

19·53
Watson, Crick, Franklin & Wilkins — Cambridge / King's College London
Structure of DNA: two anti-parallel strands, base pairs A-T and G-C

A one-page paper in Nature proposed a self-copying molecule. It birthed molecular biology, recombinant DNA, the Human Genome Project, CRISPR — and eventually the mRNA vaccines on slide 12. Franklin's contribution was for decades under-credited.

3.2B
Base pairs in the
human genome
2003
Year the genome was
fully sequenced
DNA
Two strands, four lettersThe code of life
08 / 13 — Iron Lungs Empty Out

Salk's vaccine ends the summer terror.

Mid-century parents feared polio more than any other disease. Pools closed. Children appeared in newsreels in iron lungs. Then a Pittsburgh lab made a vaccine.

19·54
Jonas Salk → Albert Sabin (oral version, 1961)
Inactivated polio vaccine — first mass childhood immunisation campaign in the US

Salk's 1954 trial was the largest medical experiment in history: 1.8 million "Polio Pioneers." Asked who owned the patent, Salk replied: "There is no patent. Could you patent the sun?" Wild polio is now confined to two countries.

99.9%
Reduction in wild
polio cases since 1988
$0
Salk's earnings
from the patent
NEAR ERADICATION
From 350,000 cases (1988)To a few dozen today
09 / 13 — A Heart Borrowed

Barnard transplants a beating heart.

A 9-hour operation in Cape Town moved the heart of a young woman killed in a car crash into the chest of a 53-year-old grocer.

19·67
Christiaan Barnard — Groote Schuur Hospital, Cape Town
First successful human-to-human heart transplant

Patient Louis Washkansky lived 18 days; he died of pneumonia, not rejection. The world's press camped outside the hospital. Within years, surgeons everywhere were transplanting hearts, kidneys, livers and lungs. Cyclosporine (1983) made long-term survival routine.

3 Dec 1967
Date of the first
heart transplant
~150,000
Solid-organ transplants
now done globally each year
TRANSPLANTATION
A new beatThe transplant era
10 / 13 — Conception, Re-engineered

Louise Brown — the world's first IVF baby.

Born 25 July 1978 in Oldham, England, weighing 5 lb 12 oz. The egg had been fertilised in a glass dish in a Cambridge lab.

19·78
Robert Edwards & Patrick Steptoe — UK
In-vitro fertilisation: the start of assisted reproduction

Edwards spent two decades being denied research funding. The Catholic Church condemned the experiment. The headlines screamed "test-tube baby." Today IVF is mundane medicine. Edwards received the Nobel Prize in 2010 — Steptoe had died, ineligible posthumously.

12M+
People born via IVF
since Louise Brown
1 in 60
Babies in developed
countries (and rising)
IVF
A glass dish, a new familyReproductive medicine
11 / 13 — Death Sentence to Chronic Condition

Antiretrovirals turn HIV treatable.

In the early '80s, a positive HIV test meant a death within years. By the mid-'90s a triple-drug cocktail rewrote the obituary pages.

19871996
AZT (1987) → HAART triple therapy (1996)
Highly Active Antiretroviral Therapy: HIV becomes a chronic disease

David Ho's combination therapy reduced HIV in the blood to undetectable levels. Within a couple of years US AIDS deaths halved. Today a person with HIV on treatment has near-normal life expectancy and cannot transmit the virus (U=U).

21M+
Lives saved by
antiretroviral therapy
U = U
Undetectable equals
untransmittable
TRIPLE THERAPY
Three drugs, one daily pillHIV becomes chronic
12 / 13 — From Sequence to Shoulder in 11 Months

mRNA vaccines, designed in a weekend.

SARS-CoV-2's genome was published 11 January 2020. Moderna's vaccine sequence was finalised 48 hours later. The first US arms were jabbed on 14 December 2020.

20·20-21
Karikó & Weissman (decades of mRNA work) → Pfizer/BioNTech, Moderna
First widely-deployed mRNA vaccines — and a new platform for medicine

Katalin Karikó and Drew Weissman spent the 1990s and 2000s figuring out how to get synthetic mRNA past the immune system. Their 2005 paper was the seed. In a pandemic year that work paid off — and won them the 2023 Nobel Prize. The platform is now being aimed at flu, RSV, cancer.

~14M
Lives saved by COVID
vaccines in year one
11 mo
From genome publication
to first authorised shot
mRNA
A line of code, a vaccineThe platform era
13 / 13 — Where to Go Next

Two centuries, one direction.

Each breakthrough multiplied lifespan and shrank suffering. Global life expectancy in 1800: about 30. In 2024: about 73. The line keeps climbing.

Medicine is the only profession that labours incessantly to destroy the reason for its own existence.
— JAMES BRYCE

Further Reading

  • Siddhartha Mukherjee — The Emperor of All Maladies (2010); The Gene (2016)
  • Roy Porter — The Greatest Benefit to Mankind: A Medical History (1997)
  • Lindsey Fitzharris — The Butchering Art (Lister, 2017)
  • David Quammen — The Tangled Tree (molecular biology, 2018)
  • WHO & CDC reports on smallpox & polio eradication
  • Walter Isaacson — The Code Breaker (Doudna & CRISPR, 2021)
MEDICAL BREAKTHROUGHS
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