The best tools for predicting the location of the next medical breakthrough are a blindfold, a few pins and a map. Plenty of innovations do emanate from elite hospitals and universities, but history also throws up surprises from unlikely places.
In the UK, Lancashire has proved a rich seam. Burnley was the starting point both for the specialism of cardiology and research in general practice through James Mackenzie's work as a GP over 30 years in the town.
If you were to guess the birthplace of the modern artificial hip replacement, a former TB hospital at Wrightington near Wigan would not be the obvious candidate. But this was where John Charnley successfully demonstrated the operation in 1961.
Teflon initially proved problematic as a coating for the hip joint and Charnley was cautious in his outlook: 'Objectives must be reasonable. Neither surgeons nor engineers will ever make an artificial hip-joint which will last 30 years and at some time in this period enable the patient to play football'.
In vitro fertilisation (IVF) was the subject of much research in July 1978 but very few, least of all the media, would have believed the first birth, Louise Brown, to parents Lesley and Peter, would be at Oldham and District General Hospital.
Perhaps the unlikeliest breakthrough venue was a garden shed in Aberdeen. Surgeon Alexander Ogston was interested in examining the properties of pus from abscesses in his operations. Armed with a £50 grant from the British Medical Association, and knowledge of antiseptics and germ theory from Lister and Pasteur, he equipped the shed with a camera and a Zeiss microscope. His medical chums also brought in samples. Eventually, Ogston saw microbes which looked like a golden bunch of grapes which inspired the name staphylococcus aureus provided by the professor of Greek, William Geddes.
Other breakthroughs come in quick succession. The notion in 1936 that a small town in south Wales would inspire one of the most popular medical novels and a National Health Service for the United Kingdom would have been judged at the raving end of lunacy.
Both were grounded in experiences of the Tredegar Workmen's Medical Aid Society. A J Cronin had worked there as a doctor before diagnosis of a chronic duodenal ulcer sent him off with his family to a cottage at Dalchenna Farm near Inveraray to see if he could make a new career as a writer.
was an instant success in 1937 and broke all records in America for publisher Little Brown – even outselling its previous blockbuster All Quiet on the Western Front
. Hollywood loved it and within a year released a film with King Vidor as director and Robert Donat, Rosalind Russell, Ralph Richardson, and Rex Harrison in leading roles. Workers paid contributions to the Medical Aid Society and in return received free care for themselves and their families. Aneurin Bevan was elected to its management committee in April 1926 and later drew on it as a model for the National Health Service – to 'Tredegarise' the rest of Britain.
Non-medical breakthroughs also leave a legacy – in this case, a crash landing in Clifden, County Galway, where Alcock and Brown touched down to win the Daily Mail's
prize for the first transatlantic air crossing. This was in 1919 during the influenza epidemic where virus spread had been part mitigated by the slow speed of shipping. Within 50 years, it became jet-propelled and thousands of daily transcontinental flights now mean a virus or bacterium could be in Wuhan one day and Warsaw or Washington the next.
Some breakthroughs don't get noticed at all. World leaders meeting in the opulence of Davos to decide on distributing millions of stockpiled COVID-19 vaccines are clearly unaware of the contributions made by 180 patients from the slums of Madras (now Chennai).
The British Medical Research Council conducted a series of landmark controlled trials across Africa and Asia to find the best chemotherapy regimens for tuberculosis in poorer countries. More affluent Bangalore (now Bengaluru) was offered as a location but rejected – if it worked in the direst conditions of Madras, it would work anywhere.
The Madras trial involved nurses, doctors, and health visitors to compare the effectiveness of treatment at home against treatment in expensive sanatoria. The work to keep tabs on patients was tough and unrelenting and back in the office, the heat was stifling. Thousands of statistical cards had to be sorted manually without the benefit of fans which would have blown them all away. Published in 1959, the trial demonstrated that if closely supervised, people recovered just as well from home treatment as those in sanatoria. Further studies followed.
The lesson for the entire world was that TB sanatoria were no longer needed. As a result, billions of dollars were wiped off the health budgets of affluent countries. In Britain, it provided the NHS with its largest ever boost in beds. Davos had to reinvent itself as a luxury conference venue.
Looking forward still requires the blindfold, pins and map. But looking back, it sometimes helps to take the blindfold off.
Chris Holme is a former
Herald reporter and Reuters Foundation fellow in medical journalism. He now runs the History Company