Introduction - Uppsala Monitoring Centre

1850, the Lauder-Brunton auriscope in 1862, followed by the discovery of X rays in
1895 expanded the diagnostic possibilities for physicians. The next year saw the
Riva-Rocci mercury sphygomometer, the forerunner of our present machine, come
onto the market. The new century started with the invention of the ECG in 1901 and
the gastroscope in 1932 (Walker, 1990). Blood dyscrasias could, in theory, have
been recognised after the discovery of the microscope by Leeuwenhoek in 1673
since he saw blood films in which absence of white cells would have been
noticeable, but it wasn’t until 1888 that aplastic anaemia was recognised and 1922
before agranulocytosis was discovered, so drug induced dyscrasias are a fairly new
phenomenon. Most of the early ‘doctors’ were untrained; others had served
apprenticeships of varying qualities. Only a few physicians were university trained.
In the UK prior to the mid 19th century physicians did not physically examine
patients, but did feel the pulse and examine the urine (Loudon, 1986). Only a few
physicians or healers would publish books. The translation of symptoms and signs
into their specific pathological causes only evolved as medical science advanced. It
can be difficult to translate old diagnoses into modern terms, e.g. cardiac
depression? cardiac failure. The first mention of individual variation in susceptibility
to drugs was in 49 BC and had not advanced much further by 1874. It wasn’t until
Pirquet recognised allergy in 1907 that real progress was made. Only those with
access to publications would be able to learn from distant experts, so that it would
require a certain level of education and wealth. It wasn’t until 1862, with a thesis on
drug induced skin reactions, that the diagnosis of ADRs was discussed. Liver
function tests were mentioned in 1916 in respect of salavarsan, but these were very
limited and it wasn’t until the 1970s that transaminases were used. The fact that a
particular advance had been published did not mean that its use immediately
became widespread. Some years might pass before the medical elite accepted a
new idea sufficiently to mention it in a standard textbook. It would take even longer
before new advances were used routinely in general practice. In 1960 few general
practices in the UK would have had an ECG.
4. Reporting
There would always have been reluctance for patients to report adverse events to
their healer/physician since there is an implication of blame. The side effects of a
drug might have been accepted as showing that the drug was working. The
salivation with mercury was taken as showing that the evil was being washed out
and therefore the dose was increased until the required amount of salivation was
occurring. People who accepted that human excrement dried and powdered and
then puffed into the eyes was a reasonable treatment for conjunctivitis might not
have been very discerning. Many of the writers comments have been whether the
drug was safe or could it kill, rather than mentioning temporary inconveniences.
When death was all about them patients may have been more stoical and accepted