TB or notTB?

On 28 October 1948 a paper describing the outcome of the Medical Research Council trial of streptomycin in tuberculosis (TB) appeared in the British Medical Journal. The results were striking. Out of 55 patient treated with streptomycin only four died. On the other hand, of 52 control patients 14 died. Looked at in terms of patients who showed ‘considerable improvement’ the results were even more impressive: 28 in the streptomycin group and only 4 in the control group. Streptomycin had been shown to be an effective remedy against one of mankind's biggest killers and was, in due course, enrolled in the fight against the disease.

However, it is not for its successful conclusion that this trial is now chiefly remembered but for various innovations in design, including the application of randomisation. This trial is regarded as the first modern randomised clinical trial (RCT). As the paper put it, ‘Determination of whether a patient would be treated by streptomycin and bed-rest (S case) or by bed-rest alone (C case) was made by reference to a statistical series based on random sampling numbers drawn up for each sex at each centre by Professor Bradford Hill; the details of the series were unknown to any of the investigators or to the co-ordinator and were contained in a set of sealed envelopes, each bearing on the outside only the name of the hospital and a number.’