Five research papers that revolutionised health

First edition of Phil Trans Roy Soc Image copyright SPL
Image caption The world's first scientific journal with its founders Viscount Brouncker, King Charles II and Francis Bacon

You are unlikely to find The Lancet, Thorax or the Journal of the American Medical Association in your doctor's waiting room, but their contents have more impact on your health than the usual lifestyle magazines.

Such journals, where papers are reviewed by other scientists in the same field - are where researchers set out their findings about how diseases occur, which drugs save lives or what surgical procedure is best.

The first scientific journal - Philosophical Transactions - was published 350 years ago this month. It is still produced now - along with thousands of others.

Here are five of the many papers that have transformed medical practice - and people's lives - over the centuries.


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Image caption An 1873 engraving of smallpox vaccination

In the 18th Century smallpox was a major killer.

The idea of inoculating people to protect them from developing the disease was brought to Britain in 1721 by Lady Mary Wortley Montagu, the wife of the British ambassador to Constantinople in Turkey.

When a smallpox epidemic threatened Britain she asked her doctor to inoculate her daughter. Royal physicians took up the idea, and doctors around the country followed suit.

But the treatment was controversial - people thought it was going to give them the disease.

Sir James Jurin, editor of Philosophical Transactions, collected reports from around the UK.

His research, published in the journal in 1723, found people were much more likely to die from smallpox than from inoculation.

The findings were also published in pamphlets, and were important in persuading the public of the value of inoculation.


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Image caption Joseph Lister and an antiseptic spray device from the late 1800s

Patients who went into hospital up until the late 19th Century only had a 50/50 chance of coming out alive.

Surgeons didn't wash their hands between patients and believed illnesses were passed on through the air.

Joseph Lister knew carbolic acid was used to disinfect sewage. In 1867, he published a paper in the British Medical Journal in which he explained how he had used carbolic acid to treat patients with serious bone fractures.

The acid, he wrote, "appears to exercise a peculiarly destructive influence upon low forms of life".

Lister described washing wounds with the acid to destroy "septic germs". He then wrapped the wound in an antiseptic paste, made of carbonate of lime, carbolic acid and linseed oil, and the bone healed without infection.

But his research was not immediately accepted in his home country. Colleagues did not believe that bacteria existed because they could not see them, and his theory was first accepted in Europe and the US.


Image caption Smoking was once seen as both fashionable and good for health

In the late 1940s doctors noted a big rise in the number of deaths from lung cancer in the UK, Australia, Canada, US, Turkey and Japan since the end of World War One.

There were two potential culprits that had changed over the 20th Century - industrial pollution and smoking.

Richard Doll was the British statistician working for the Medical Research Council who published a ground-breaking paper in the British Medical Journal in 1950 that concluded there was "a real association between carcinoma of the lung and smoking".

He looked at the incidence of smoking and lung cancer in a large number of patients and compared their experience with people who had different cancers - what scientists call a control group.

His findings led him to give up smoking.

But despite many subsequent studies that have supported the connection, the tobacco industry has not accepted the research.


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Image caption Helicobacter pylori bacteria in the stomach causes ulcers

Ulcers had been thought to be down to stress, personality, smoking, or genetics, and the only treatment was drugs to neutralise the acid.

But during the 1980s, two Australian researchers, Robin Warren and Barry Marshall, started to investigate another cause.

By the middle of 1982 they identified a bacterium called Helicobacter pylori (H.pylori) as the culprit, but peers thought living things could not survive the acidic conditions of the stomach.

Later - when they won a Nobel prize - Barry Marshall said: "No amount of logical reasoning could budge what people knew in their hearts to be true. Ulcers were caused by stress, bad diet, smoking, alcohol and susceptible genes. A bacterial cause was preposterous."

In frustration he decided to experiment on himself. He drank a broth containing H.pylori, and as he had expected, became ill.

After 10 days of vomiting and bad breath, he asked a colleague to look inside his stomach with an endoscope where he found the bacteria, as well as other symptoms which would lead to ulcers.

H.pylori had been proved to be the cause of ulcers. The researchers' paper was published in the Lancet in June 1984.

Warren and Marshall were awarded the Nobel Prize for Medicine in 2005.

Ulcers are now cured with a short course of antibiotics.


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Image caption Charles Best and Sir Frederick Banting co-discovered the hormone insulin

In January 1922, 14-year-old Leonard Thompson was in hospital in Toronto seriously ill with Type 1 diabetes.

The only treatment available was starving the body of sugar, so he was very thin and expected to die. But he was lucky enough to be in the first recipient of insulin extracted from cows, given by Frederick Banting.

He had an allergic reaction to the first injection but the second, of a purer extract, had dramatic positive effects and he lived for another 13 years.

Doctors had known there was something wrong with the way the pancreas worked in type 1 diabetes that led to a build up of sugar in the blood.

But until the work of Banting and others, they could not find a way of extracting the substance that we now know as insulin.

An account of the work was published in the Canadian Medical Journal just two months after Leonard's first treatment.

Banting, and a colleague John McLeod, were awarded the Nobel Prize for Medicine or Physiology in 1923.

Millions of lives have since been saved by the discovery of insulin.

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