What happened was that at the beginning of the era, in 1936, on a very small grant from the Rockefeller Foundation, a group of investigators searching for a cure for puerperal fever revealed to the world the antibacterial powers of sulfanilamide. Osler could not have anticipated the coming successes in curing the terminal infections associated with these incurable, or chronic, diseases that were to be introduced by a new era of medical research-the era of the clinical trial. Secondary terminal infections carry off many patients with incurable disease. There is truth in the paradoxical statement that persons rarely die of the disease with which they suffer. The health situation regarding modern man's chronic diseases and disabilities immediately before that period was well described by Osler in 1904 in his famous textbook, The Principles and Practice of Medicine, and the same description was still present in the 1935 edition revised by McCrae ( Osler, 1935): The beginning of this historical period coincided with the introduction of the systematic clinical trial and of the sulfonamides in 19.
I am going to talk about a particular chapter in the history of disease, a chapter characterized by the surprising fact that the net effect of successful technical innovations used in disease control has been to raise the prevalence of certain diseases and disabilities by prolonging their average duration. I would like to begin by taking you back to the years preceding the Second World War, because the problem I wish to discuss must be seen as a historical process if it is to be understood.
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