Unravelling the 'tangled web': chemotherapy for tuberculosis in Britain, 1940-70 the William Bynum prize essay

The introduction and assimilation of chemotherapy to treat pulmonary tuberculosis (TB) during the mid-twentieth century appears at first sight to be a success story dominated by the use of streptomycin in a series of randomised clinical trials run under the auspices of the Medical Research Council (MRC). However, what this standard rhetoric overlooks is the complexity of TB chemotherapy, and the relationship between this and two other ways of treating the disease, bed rest and thoracic surgery. During the late 1940s and 1950s, these three treatment strands overlapped one another, and determining best practice from a plethora of prescribing choices was a difficult task. This article focuses on the clinical decision-making underpinning the evolution of successful treatment for TB using drugs alone. Fears over the risk of streptomycin-resistant organisms entering the community meant that, initially, the clinical application of streptomycin was limited. Combining it with other drugs lessened this risk, but even so the potential of chemotherapy as a curative option for TB was not immediately apparent. The MRC ran a series of clinical trials in the post-war period but not all of their recommendations were adopted by clinicians in the field. Rather, a range of different determinants, including the timing of trials, the time taken for results to emerge, and whether these results 'fitted' with individual experience all influenced the translation of trial results into clinical practice.

[Method of saving a sick person's strength in 19th century medical therapy]

Saving a sick person's strength through limiting physical exercise has been used since the early ages. Slowing down the pace of functioning of the human body was intended to cause the decrease in the body temperature, improve general feeling and accelerate the process of recovery. However, saving patient's strength as a therapeutic method had been described only three years before the end of the 19th century. It was presented by Seweryn Sterling in the publication Krytyka Lekarska (Medical Critique) in 1897, in article entitled Care of the Sick as a Therapeutic Agent. The author presents the most important concepts of the above therapeutic method.