Medicine would Never have been the same without them!

The Doctor Who Drank Infectious Broth, Gave Himself an Ulcer, and Solved a Medical Mystery!

In 1910 an article was published in the Lancet stating “acid gastritis” or “hyperchlorhydria” as the sole cause for Duodenal Ulcer (1). Therefore, in order to treat duodenal ulcer, truncal vagotomy or antrectomy (cut off the bottom of the stomach and reconnect to the intestine) was considered as the only treatment available for about seven decades.

Marshall while he was in the third year of his internal medicine training, in 1981; worked on a project with Dr. Robin Warren, the hospital pathologist, who was seeing some bacteria on biopsies of all ulcer and stomach cancer patients for two years, which were all identical. Microbiologists had no dogma to overcome about the causes of gastritis and peptic ulcers but the wider medical community remained hard to convince.

Dr Marshall had a patient with gastritis. He got the bacteria and cultured them, then worked out which antibiotics could kill patient’s infection in the lab (in that case, bismuth plus metronidazole). He treated the patient and did an endoscopy to make sure his infection was gone.

The same year, in an act born to some extent of frustration, Marshall deliberately infected himself by drinking a solution swimming with the bacterium, as part of a successful and widely reported experiment to prove Koch’s postulates. But many clinicians still remained unmoved. It wasn’t until the early 1990s that the evidence of Marshall and Warren became impossible to ignore, at which point pharmaceutical development and clinical practice underwent a shift towards eradication of H. pylori to treat ulcers.

For their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease, the Nobel Prize in Physiology or Medicine 2005 was awarded jointly to Barry J. Marshall and J. Robin Warren (2).

Medical Imaging Technology (CT Scan, MRI) and Non-Interventional Visualization of Body!

One of the England engineer Godfrey Hounsfield came up with an idea that instead of taking x-ray from just one angle, if taken from all angles around one could determine something covered inside the box.

He then set to work constructing a computer that could take input from X-rays at various angles to create an image of the object in “slices”. In 1979 Cormack A.M and Hounsfield G.N were jointly awarded the Nobel Prize in Physiology or Medicine for the development of computer assisted tomography (CAT), popularly known as CT Scan these days.

But it came with great bane of radiation hazard! Continuous efforts were being done in advancement of imaging technology where the principle of Nuclear Magnetic Resonance (Felix Bloch and Edward Purcell, 1946 NP1952) originated but was not kept in clinical practice yet.

Up until 1970s MRI was being used just for chemical and physical analysis of molecules. Early detection of internal neoplasm was greatly hampered during those days because of increased permeability of many tumors to x-rays. A study found different biological responses among Tumor cells and Normal cells when resonated magnetically within magnetic field (3).

Finally, the mankind was able to scan human anatomy without a drop of radiation using a different principle than that of CT scan. Instead of x-rays field used in CT Scan, MRI used Magnetic field to resonate the protons present in fats and water in human body and using complex algorithms transcribed into the series of images of scanned section.

In recognition of this contribution to mankind, the Nobel Prize in Physiology or Medicine of 2003
was awarded jointly to Paul C. Lauterbur and Sir Peter Mansfield “for their discoveries concerning magnetic resonance imaging (MRI).”

Project 523; Artemisinin yielding ancient Herbs and Nobel Prize

According to a recent WHO report, 97 countries have ongoing malaria transmission, and an estimated 3.4 billion people are at risk of malaria, of whom ~1.2 billion are at high risk (4). What if the secret of modern medicine is hidden within the ancient herbs?

It was early 1970s in china (period when scientific research was strictly prohibited). In response to a request from the Vietnam government for help on malaria treatment, the Chinese government launched a secret operation called 523 Project during their Cultural Revolution.

Professor Youyou Tu (an 84-year-old, female scientist) joined the project; she searched more than 2,000 recipes and compiled 640 recipes used for the treatment of fever written ~1700 years ago. Professor Tu suddenly realized that high temperature could be the cause of instability in antimalarial activity they experienced. She decided to use ether, replacing ethanol, to extract the active ingredients from the plant leaves.

Professor Tu was the person who discovered an efficient method for extracting the active ingredient from the A. annua plant (5) (the plant which the world was witnessing for years and yet was left unnoticed!) For her discoveries concerning a novel therapy against Malaria, Prof Youyou Tu shared Nobel Prize for Medicine and Physiology in 2015.

References

• SOME POINTS IN THE DIAGNOSIS AND TREATMENT OF CHRONIC DUODENAL ULCER. Moynihan, B.G.A. 4610, 1912, The Lancet, Vol. 179, pp. 9-12.
• Nobel Prize winners Robin Warren and Barry Marshall. The Lancet . 9495, s.l. : Elsevier Ltd., 10 22, 2005, The Lancet , Vol. 366, p. 1429.
• Tumor Detection by Nuclear Magnetic Resonance. Damadian, Raymond. Mar 19, 1971, Science, pp. 1151-1153.
• World Health Organization. World Malaria Report 2014. s.l. : WHO , 2014. p. 3. 978 92 4 156483 0 .
• The discovery of artemisinin and the Nobel Prize in Physiology or Medicine. SU Xin-Zhuan, MILLER Louis H. 11, s.l. : Springer , 10 16, 2015, SCIENCE CHINA Life Sciences, Vol. 58, pp. 1175–1179.

Karun Bhattarai
Medical Student
BPKIHS Dharan