[an error occurred while processing this directive]
BBC News
watch One-Minute World News
Last Updated: Monday, 6 October, 2003, 23:15 GMT 00:15 UK
How The Lancet made medical history
By Martin Hutchinson
BBC News Online staff

Picture courtesy of Mary Evans Picture Library
Historic moment: First blood transfusion
Today, there are hundreds of medical journals covering every nook and cranny of medical practice.

The vast medical research community collectively churns out a small rainforest each year detailing major breakthroughs, minutiae and every point in between.

The Lancet, published in London, remains one of the most prestigious - and still attracts some of the most important announcements in medical science.

When scientists traced the origins of the recent Sars outbreak, they communicated it urgently through the pages of the Lancet.

In the unbroken 180 years since it was first published by doctor, coroner and MP Thomas Wakley, it has become one of the most important - and most reliable sources of medical and social history around.

He saw the journal as a way of opening things up, cleaning out the wound
Dr Ruth Richardson, historian

Now that history has been compiled in electronic form for the first time. Every edition, and every article in The Lancet has been digitised and made available to researchers.

The Lancet may now be part of the aristocracy of medical journals - but in 1823, it had a distinctly radical slant.

Its very name represented a sharp instrument used to puncture a boil - Wakley saw much of the medical establishment as fundamentally corrupt, tolerating both nepotism and incompetence.

Dr Ruth Richardson, a medical and social historian, said: "He saw the journal as a way of opening things up, cleaning out the wound."

In his preface to the very first edition, Wakley wrote: "We shall be assailed by much interested opposition.

"We hope that the age of 'mental delusion' has passed, and that mystery and concealment will no longer be encouraged."

He said that the weaknesses of "ignorant practictioners" could be exposed if doctors took more trouble to learn more about their subject.

Scandal maker

Within a few years, the Lancet set itself directly at a scandal which might have otherwise gone unreported.

World War I troops suffered from "shell shock"
One of the most eminent surgeons of the day, Sir Astley Cooper, had a son who had also risen to the rank of surgeon at Guy's Hospital in London.

However, when the son bungled a relatively simple operation, and the patient died, the Lancet launched a furious campaign against nepotism.

Likewise, after the Crimean War, the journal revealed that while Florence Nightingale's "modern" hygienic nursing methods had been adopted by private hospitals, many workhouse hospitals remained filthy and in disrepair.

A Lancet campaign prompted government action.

We hope that the age of 'mental delusion' has passed, and that mystery and concealment will no longer be encouraged
Thomas Wakley, 1823
Dr Richardson said: "As a result of the Lancet, an inquiry was launched, followed by a huge hospital building programme.

"The Lancet did not just influence medical practice, but also medical politics. It really is a very important journal."

But it is the medical milestones which regularly pop up on the pages of the journal which reinforce its importance.

Blood to blood

Within a few years of its creation, it was telling readers about the first ever blood transfusion technique, pioneered by Dr James Blundell.

The "Gravitator" was rudimentary, but laid the principles for a process that has saved countless lives since.

In 1867, Dr Joseph Lister used the Lancet to publicise his new "antiseptic" to treat abcesses - another huge lifesaver.

Warnings over thalidomide appeared in the Lancet
Within the pages of the Lancet are countless medical firsts - such as the first caesarean section performed under general anaesthetic, and the first use of intravenous fluids to keep cholera victims alive.

In the 20th century, there are yet more - the use of penicillin in patients, the first naming of "foetal alcohol syndrome", and the announcement of the world's first test tube baby, Louise Brown.

Alongside these are some of medicine's darkest moments - including the discovery that thalidomide, a drug given to pregnant women to ease morning sickness, was in fact causing deformities in the unborn child.

Traumatic stress

In 1918, Dr William Rivers wrote in the journal of a new phenomenon: "shell shock", diagnosed in soldiers returning from the horrors of the Great War.

His observations led on directly to the modern diagnosis of post traumatic stress disorder.

Lancet volumes
Leafing through old volumes is hard work
"It is as if the process of repression keeps the painful memories or thoughts under a kind of pressure during the day - accumulating such energy by night that they race through the mind with abnormal speed and violence when the patient is wakeful, or take the most vivid and painful forms when expressed by the imagery of dreams," he wrote.

Doctors contributing to the Lancet offered insights into some of the most notorious moments of history.

An autopsy report into one of the victims of Jack the Ripper describes in awful detail how the woman's womb had been removed with surgical precision by the killer.

And just as doctors rail against media coverage today, it criticises the "sensational fiction" which has grown up around the case.

The language may be arcane in places, but Dr Richardson says that, in certain ways, little has changed since Thomas Wakley published the first Lancet in 1823.

"We are still in the dark about so many things," she said.

"Perhaps in a century's time scientists will look back at today's research on cancer in our journals and think exactly the same as we do looking back at these old Lancets."

And while most medicine has moved on since the 1800s, she said there might still be nuggets that could help modern researchers.

"Ideas would come up and never be revisited - for example, it was 100 years after it was first suggested that doctors found the link between puerperal fever and blood poisoning.

"Perhaps there are some ideas in these journals, about BSE, about cancer, which might have some relevance today.

"And researchers won't now have to plough through three-inch thick volumes looking at close type columns to find them."


The BBC is not responsible for the content of external internet sites


News Front Page | Africa | Americas | Asia-Pacific | Europe | Middle East | South Asia
UK | Business | Entertainment | Science/Nature | Technology | Health
Have Your Say | In Pictures | Week at a Glance | Country Profiles | In Depth | Programmes
Americas Africa Europe Middle East South Asia Asia Pacific