Fifteen of the most important milestones on the road to modern medicine are identified today by the British Medical Journal. They range from vaccines to computers to the pill - and the journal is calling for readers to vote on which was the most significant. The 15 have been shortlisted from more than 100 nominated discoveries since the BMJ was launched in 1840. Anyone can log on to www.bmj.com and cast a vote.
1 Anaesthesia
Revolutionised surgery. By the end of the 19th century, anaesthesia had become a symbol for the wider humanitarian movement. It remains the most vivid example of medicine's capacity to diminish human suffering.
2 Antibiotics
The first "wonder drugs". Alexander Fleming reported on penicillin's potential to kill bacteria in 1929. Cheap mass production was achieved in the US during the second world war, allowing soldiers to be protected from wound infections but also sexually transmitted diseases. Antibiotics transformed healthcare.
3 Chlorpromazine
Breakthrough drug for schizophrenia, which helped close the asylums. Pierre Deniker, who ran the first trial on psychotic patients, published in 1952, wrote that "aggressiveness and delusive conditions of schizophrenia improved", and contact with patients was re-established.
4 Computers
Computers have allowed decoding of the genome and permitted doctors to see the body and its functions in three dimensions. Computers could help us transcend boundaries to achieve good health, whoever or wherever we are.
5 DNA
The nature of the infectious agent causing Sars was published within weeks, thanks to DNA testing. Newborn babies are now screened for genetic diseases and all patients for surgery have their blood group analysed, after the discovery of the structure of DNA by Watson and Crick in the 1950s. It has also made possible genetically targeted drugs.
6 Evidence-based medicine
The term was coined in 1991 as result of the recognition that pulling together all the information on a topic leads to more valid results than a single study and that bias - deliberate or not - pervades many clinical trials.
7 Germ theory
Realisation that germs carried on the hands of doctors could transmit lethal infections to women in labour by Ignaz Semmelweis in Vienna in 1847 became the accepted germ theory of disease. At the end of the 19th century, infection caused 30% of deaths. By the end of the 20th century it caused less than 4%.
8 Imaging
Identifying that the passage of electricity though rarefied gases produced x-rays won Wilhelm Roentgen the first Nobel prize for physics in 1901. X-rays proved invaluable for diagnosis and soon became therapeutic tools as well, in cancer and palliative medicine.
9 Magic bullets
The discovery of monoclonal antibodies which the immune system will not reject has led to dramatic new treatments for disease. Over a million people have been treated for rheumatoid arthritis, with a spectacular reduction of symptoms. They have helped reduce organ transplant rejection and these "magic bullets" target radioactive treatment for cancer precisely to the tumour.
10 Oral rehydration
Children in poor countries are faced with episodes of diarrhoea about three times a year. Simple, cheap and easily prepared oral rehydration therapy, which combines salt and sugar with clean water, saves millions of lives.
11 The pill
The oral contraceptive brought about a social as well as a medical revolution and had huge benefits for women. It was the first potent drug to be taken by millions of healthy people and the active ingredient is virtually unchanged.
12 Risks of smoking
Two landmark studies in the 1950s led to a growing body of evidence about the harmful effects of tobacco, and a gradual decline in the numbers of people smoking and dying of tobacco-related disease.
13 Sanitation
First came the industrial revolution, then urbanisation, and by the 1800s infectious diseases were rampant. Cholera outbreaks turned attention to urban water systems and modern sanitation was born. By the beginning of the 20th century death rates rates fell.
14 Vaccines
Louis Pasteur's unveiling of the rabies vaccine in 1885 paved the way for every other vaccine. The discovery has saved millions of lives.
15 Tissue culture
The invention of laboratory-reared tissue cultures has played a role in 18 out of the last 52 Nobel prizes for medicine. Tissue culture provided a medium on which to grow viruses for experimentation, test drugs, and grow skin culture.
