1917: The Year the Nobel Prize Stalled

What You’ll Learn

This article explores why 1917, the year the Nobel Prize was suspended, marked a pivotal turning point in 20th-century medicine. You'll understand how the changes of that year reshaped the global medical landscape, and how those shifts continue to influence the differences we see in national healthcare systems today.

The Year the Game Changed

1917 is a year that can be considered the true beginning of the 20th century. Three significant events occurred during this year:

1. The Russian Revolution (February and October): A 500-year-old dynasty collapses, and the world's first socialist state is born.
2. U.S. Entry into World War I (April 6): A nation outside of Europe becomes a decisive force in the European war.
3. First Use of Mustard Gas (July): Chemical warfare enters a new phase.

From a Nobel Prize perspective, this year is the year in which the very foundation of the recognition system changed. Prior to 1917, the Nobel Prize was essentially a recognition game within the academic circles of Western Europe (Germany, France, Britain, Italy, and Scandinavia). After 1917, this map underwent a fundamental restructuring. The United States emerged as a new center of global science, and Russia began its own separate trajectory of socialist science.

Using a computer science analogy, this is like a distributed system where a leader node fails and a completely different architecture of cluster emerges. While the surface-level system (the Nobel Prize) is down, the underlying topology of the global knowledge infrastructure is being reconfigured.

The Landscape of the Era: The Year Three Worlds Were Born

The Russian Revolution had a decisive impact on medical history. From the beginning, the Soviet regime established the principle of state management of healthcare. This included free medical care, a network of regional comprehensive clinics, and a focus on preventative medicine. This system was later formalized as the Semashko model, becoming the standard for countries within the Soviet sphere of influence. One of the roots of the continental European public healthcare system we know today lies here.

U.S. Entry into World War I transformed American medicine in the opposite direction. By deploying a large contingent of medical personnel to the European front for the first time, the United States recognized the need to standardize its medical practices internationally. This impetus laid the foundation for the global rise of American medicine in the 1930s. Johns Hopkins, Harvard, and the Rockefeller Institute began their journey to become the new centers of global medicine.

Mustard gas represented a new stage in chemical warfare. While chlorine gas and phosgene caused acute lung damage, mustard gas was a persistent toxin that caused burns to the skin, eyes, and respiratory tract. Soldiers did not die immediately but suffered a painful death over several days or were left with lifelong disabilities. Interestingly, a side effect was observed: exposure to mustard gas reduced the white blood cell count in those exposed. This observation would become the seed for the first chemotherapy treatment (nitrogen mustard) 20 years later. This is where the dark narrative of a war weapon evolving into a cancer treatment begins.

In the context of Korean history, 1917 was the year when the Japanese colonial administration erased the last vestiges of the Gwangmu Reform in Korea. The schools, hospitals, and administrative organizations of the Daehan Empire were completely reorganized into the Japanese colonial system. While the world was undergoing a transformation, Korea was losing its own national system. The gap created during this period would remain as a development challenge for Korean society for the next 100 years.

Science Didn't Stop

The Seeds of the Soviet Healthcare System

Immediately after the revolution, the Soviet government appointed Nikolai Semashko as the first People's Commissar of Health. The principles he established were radical but clear:

• Free healthcare access for all citizens
• Emphasis on preventative medicine
• State management of doctors and hospitals
• Regional hierarchical organization (local clinics → regional hospitals → central hospitals)

This system began to be implemented in practice within the Soviet Union's extreme resource scarcity. The results were interesting: the Soviet Union achieved remarkable progress in indicators such as increased life expectancy and control of infectious diseases. Of course, there were also dark sides, including restrictions on individual freedoms and repression of dissenting doctors.

The strengths and weaknesses of this system became the subject of ideological debate for the next half-century. However, the very fact that the concept of viewing healthcare as a public good rather than a commodity was first demonstrated on a national scale in this year cannot be denied. Today's British NHS, the social insurance healthcare systems of France, Germany, and the Nordic countries, and even the American Affordable Care Act, are all descendants of this idea.

Acceleration of Specialization in American Medicine

Following U.S. entry into World War I, American medicine underwent a rapid self-reform. The Flexner Report of 1910 had already begun the complete reorganization of American medical schools, but World War I accelerated this reform significantly.

Key changes:

• Establishment of professional certification: System of certifying specialists in surgery, internal medicine, pediatrics, etc.
• Intern/resident training: Standardized training programs based in hospitals.
• Science-based education: Laboratory training became an essential component of clinical education.

During this period, American medicine shifted from a European-style apprenticeship training to a standardized, military-school-style training system. Using a computer science analogy, during this period, American medicine was refactored from a collection of custom systems with different interfaces to a microservices architecture with standardized APIs. It was on this infrastructure that the global dominance of American medicine in the latter half of the 20th century became possible.

Standardization of Clinical Practice

As American doctors worked alongside their European colleagues on the front lines, the need for international clinical standards became critical. Previously, treatment methods varied from country to country, and even from hospital to hospital. In order to treat trench warfare casualties with a multinational team, a common protocol was needed.

This need became the seed of international medical standards. It can also be argued that the WHO (established in 1948), has its origins in the clinical protocols developed in the trenches during this period.

Connections

The trends of 1917 were connected to the following developments:

• 1929 Nobel Prize in Chemistry, Harden and Euler-Chelpin: Research on fermentation chemistry. The fact that early Soviet biochemistry continued along a separate path from the West is due to the events of 1917.
• The surge in American Nobel Prizes in the 1930s: 1933, Morgan (fruit fly genetics), 1934, Whipple, Minot, and Murphy, etc. From this period, American laureates became on par with European laureates.
• Nitrogen mustard chemotherapy in the 1940s: Goodman and Gilman at Yale University developed the first chemotherapy drug from mustard gas byproducts.

Using a computer science analogy, 1917 is the year when two new nodes joined the distributed system and completely re-executed the leader election algorithm. While the previous leader (Western Europe) remained powerful, the emergence of the United States and the Soviet Union as new nodes meant that the global knowledge landscape for the next half-century was determined by the interaction of these three nodes.

However, this analogy has its limitations: leader election in software is rule-based, but the changes in the global knowledge landscape were achieved at the cost of human death, ideological conflict, and cultural resistance. The millions who died in the Russian Revolution and the millions who died in the trenches – it is these people who made the global knowledge landscape what it is today, and that is a heavy thought.

Summary of the 1917 Global Knowledge Landscape Restructuring: The system shifted from a Western Europe-centered system to a Western Europe, United States, and Soviet Union tripolar system. The Nobel Prize was suspended, but the knowledge infrastructure of the future was newly established in that year.

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