The Rhesus Factor and Disease Prevention. Wellcome Witnesses to Twentieth Century Medicine. Volume 22

If the past is another country, then even quite recent events in medicine can appear to be from another world. In a time when parents are showing reluctance to vaccinate their children against now almost forgotten—yet only suppressed—infectious diseases, it is good to be reminded that it is not only transmissible diseases that have been all but eliminated by the practical application of medical science. In the period immediately after the second world war, 1.6 babies per 1000 births died from Rh haemolytic disease owing to blood group incompatibility between mother and fetus. A further unspecified number was damaged dreadfully by the kernicterus caused by the toxic levels of bilirubin generated by red cell destruction. In the baby boom years of the late 1940s, Rh haemolytic disease took a heavy toll and blighted the lives of many women who endured repeated episodes of fetal or perinatal death.

Figure 1.

Ed D T Zallen, D A Christie, E M Tansey

Wellcome Trust, £6 + p&p, pp 121 ISBN 0 85484 099 0 www.ucl.ac.uk/histmed/publications/wellcome-witnesses/witness22.html

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The introduction of blood transfusion, and then exchange blood transfusion, made an important contribution to those viable infants born with a chance of life. It was, however, the discovery and application of the use of human antibody against Rh D (anti-D) as a preventive measure that made the real impact, and reduced the deaths from Rh haemolytic disease from 1.2/1000 in the late 1960s to < 0.1/1000 in the early 1980s.

Lest we forget the contributions of those able to make such a difference, the Wellcome Trust Centre for the History of Medicine hosted a witness seminar on the Rhesus Factor and Disease Prevention on 3 June 2003.Witness Seminars bring together those individuals with first hand experience of the subject, supported by contemporaries with an interest in the area. Nearly 40 Witness Seminars have been held on a range of subjects from the development of monoclonal antibodies to the history of coronary disease. Transcripts are recorded, checked, and published with selections of still photographs taken at the time, together with references, brief biographical details, a glossary for non-specialists, and an index (see also BMJ 2002;325: 1119). As such, the Witness Seminar represents a real-time example of oral history.

Most of the main players in the prevention of Rh haemolytic disease who were still surviving and fit to attend gathered at the Wellcome Library in London. Those of us who were present as interested observers heard of a time when committed scientists and physicians worked together to find, develop, and implement solutions that led first to improved treatment for the sick new-borns, then to the saving of the unborn, until the condition itself was virtually eliminated in the United Kingdom by the introduction of the preventive use of anti-D.

Extensive contributions by two major figures from the Liverpool group (Professor John Woodrow and Professor Ronald Finn (obituary BMJ 2004;328: 1501)) led by Sir Cyril Clarke (obituary BMJ 2001;322: 367) provide a solid core to this volume that should be essential reading for all those involved in the care of mothers and children at risk of Rh haemolytic disease. Clarke's group worked on the causes of Rh haemolytic disease, developed theories for the mechanism of action of anti-D as a preventive, and completed the clinical trials that confirmed the efficacy of the approach—a paradigm for translational medicine.

The abiding memory from this event was of a few remarks that summed up all the privileges and pain of being a physician. Dr Archie Norman, long time consultant paediatrician in London, described his memories of the 1950s and his feelings on this matter. In an illuminating and moving contribution he told us, “I found that dealing with rhesus problems was emotional and stressful” and that “driving home in the early morning after an emergency exchange, and that feeling of elation that one has really done something for once. It was great.”