Abstract
It is probably true to say that few medical people find the history of their discipline to be in any way interesting-made up, as it is, of strange ideas about humours, bile and so on. The extent to which medicine lagged behind other sciences seems incomprehensible-the discovery of something as basic as the circulation of the blood was made at the same time as Isaac Newton's work on differential calculus and the laws governing the movements of the planets, and when Einstein published his theory of relativity, doctors still treated many ill-nesses by blood-letting.
The Wellcome Trust Centre for the History of Medicine is shifting the historic focus to the second half of the 20th century, when medicine finally did get its act together, in its series of books ‘Wellcome Witnesses to Twentieth Century Medicine’. With 40 volumes published over the last 13 years, the series covers major medical advances of the period, such as antibiotics, neonatal intensive care, NMRI scans, and organ transplantation. This one, on the history of cervical cancer screening, is the first of the series to deal with screening.
The approach is for Wellcome to hold a half-day round-table discussion as a source of material, inviting experts in the topic who saw an advance happen (hence ‘Wellcome Witnesses’). Essentially they are left free to reminisce. About 30 such experts were invited to attend this one, half accepted.
Surprisingly, the book takes the form of a transcript of the conversation, edited only lightly. As a result it contains many phrases that look out of place to people accustomed to reading scientific treatises-‘Good afternoon everyone’ ‘Can I make one comment here?’, ‘Lionel is absolutely right’, T think we will probably touch on this later on’, ‘I wish Lutz was here’, ‘Is there anything we can learn from other countries?’ and so on. Also, while the half-day session had a chairman who attempted to structure the discussion, conversations always wander and contain many repetitions and irrelevant comments, and this one is no exception. These problems, and the lack of any subheadings in 80 pages of text, make it difficult to read the book and take in the information. The editors of this series would probably defend their approach by arguing that leaving the text in the form of a direct transcript of the conversation lends an immediacy and authenticity to the account of ‘history in the making’ and conveys a sense of T was there’-in other words, that the volumes are, primarily, important historical records, and add a valuable collective oral source to the historical record. There is some truth in this. Many readers, nonetheless, will probably wish that a single author had rewritten the material as structured prose. Had this been done, the text would be only about half as long, and significantly easier to read.
The book starts with Dr George Papanicolaou's development of his famour smear, which sadly took place not in his native Greece but in the United States, where it was first introduced into practice in the 1940s. It proceeds to tell the story of the development of cervical cytology as an effective screening test, of its widespread use in the UK as early as the 1950s, and of the development of a national cervical screening programme in the UK in 1988, which effectively solved the problem in those early years that younger women, who rarely developed the disease, had the screening test (opportunistically, because they saw doctors), whereas older women who did get the disease were not screened (because they saw doctors less commonly). The book also describes the development of cytology as a pathological discipline and a medical specialty, and the impact of colposcopy, against a background of changing attitudes to sexual behaviour, and of the ultimate success of the screening programme in reducing cervical cancer mortality. The book goes on to describe the discovery of the viral cause of cervical cancer, the gradual acceptance of this, the detection of HPV16 and 18 and the need, to date only partially fulfilled, to incorporate these into the screening test. Finally, the development of the HPV vaccine is outlined.
Overall, as the Introduction states, ‘The volume gives fascinating insights into the science, serendipity and dogged commitment of a generation of clinicians, virologists, cytologists, epidemiologists and public health specialists in establishing cervical screening as a sensitive, specific, and effective tool to reduce cancer mortality’. The book also has many photographs of the great and the good who played their part in this understanding of cervical cancer and its prevention.
Unusually for a book review, people who wish to read the book do not need to purchase it: all the volumes in this series are freely available online at www.ucl.ac.uk/histmed, following the links to publications/ Wellcome Witnesses to Twentieth Century Medicine.