CORE 3

Before

• the rapid industrial changes in the 19th century caused a new set of health problems for the working class
• science and tech also helped to create a better understanding of disease and some ways to prevent disease spreading
• the government became more involved in dealing with health and disease
• the standards of health care still depended upon the peoples ability to pay

After

• as the cost of the NHS continues to rise there is a great debate about the role of government and private health scehemes
• developments in science and tech have raised many peoples hopes of cures for many diseases and conditions
• also some ethical debates within medicine

• at the start of the 20th century photographs film and electricity, the bicycle and motor car, had all been invented
• many people continued to live and work in cramped and unhygienic conditions using oil lamps or gas lighting
• the average life expectancy in 1901 was 47
• Pasteurs germ theory led to a range of vaccinations being develped but there had been little progress in the search for a way to cure diseases
• most medicines were still herbal
• the 20th century was a story of huge improvements in the treatment of illness

Scientists in Europe find the way to develop chemical cures for illness

• Pasteurs germ theory in 1861 was an important breakthrough in understanding how disease was spread
• led to Kochs work in identifying the different microbes that cause disease
• the technique to prevent people from catching a disease was developed and applied to more and more diseases
• the government also began to intervene as they insisted that children were vaccinated

The Magic Bullet

• Emil Von Behring developed Kochs work to isolate the antitoxins used by the body to fight diptheria then found a way to inject them to cure the disease
• Paul Ehrlich set up his own research team to build on this work 
• he knew that antitoxins only attacked the diseased microbes
• he tried to combine a dye with other chemicals to find a cure for Syphilis, a 'magic bullet' that would only target the disease microbe and not harm the rest of the body
• in 1909 another doctor joined the research team found there had been a mistake, the 606th compound that they had dismissed was effective
• this treatment was the Salvarson 606

The Second Magic Bullet

• not until 1932 that the second magic bullet was found
• Gerhard Domagk discovered that a particular red dye was effective against some cases of blood poisoning
• developed the drug prontosil
• research showed that the key ingredient in Prontosil was sulphonamide and other drugs with this compoiund were developed that could cure pneumonia, scarlet fever, and meningitus

• at first treatment was injections
• developments in tech in the late 19th century allowed it to be possible to mass produce pills and the pharmaceutical industry grew quickly

• was a chemist working at St Marys Hospital in London
• 1928 noticed a culture of bacteria growing in a petri dish were being attacked and killed by an unknown mould in the same dish
• decided to research the killer mould
• discovered it was penicillin

• Howard Florey and Ernst Chain read about Flemings research and in 1939 set up a team including a range of specialists to develop Penicillin
• 1941 conducted a test on a patient, test showed penicillin acted like a miracle drug on people dying from infection
• only a small amount available and the patient died when it ran out
• Florey became determined to develop the mass production of penicillin
• florey refused to patent penicillin and believed it should be available to everyone so went to the USA to see if a pharmaceutical company would fund their research (UK were at war so couldnt)
• unsuccessful at first but in december 1941 USA entered war and government were prepared to fund mass production of penicillin

Early 20th century

• the women in the family were mainly responsible for treating most illnesses and caring for the sick 
• doctors were only used if the patient was really ill as they were expensive
• most illnesses were treated with patent medicines
• minor surgery was often done by a GP on a kitchen table
• anything serious would be done in a big hospital

Charitable Hospitals

• many hospitals offered only basic care for the sick rather than the range of treatments we now expect
• sanotoriums were built to provide a healthy diet, fresh air, and hygienic conditions for recovery
• effective fundraising was vital
• in 1912 Queen Alexandra started a national rose day selling roses to make money for hospitals

Improved access to health care

• by 1900 most cities had built infirmaries fever houses and asylums to care for the poor
• also local cottage hospitals, depended on charity for funds
• 1907 health visitors were expected to visit mothers and help them care properly for their new born babies
• 1911 national insueance act, working men their employers and the government all paid into a fund to cover doctors fees and medical costs

Improved standard of medical care

• nurses were trained within a hospital
• by 1900 doctors had to have a university medical degree and to be accepted by the General Medical Council
• doctors decided to either become a GP or a specialist
• 1902 midwives act; midwives had to be properly trained and registered 
• 1919- nursing act set up to enforce high standards of training for nurses

Increasing role for government

• the government began to take more responsibility for public health
• the change of attitude was reinforced when men who volunteered to fight in the army were declared unfit and turned away
• britain relied on their army, finding ways of improving health of the working class became an important issue and war was a factor speeding up these changes
• doctors could choose who to accept as their patients and could refuse treatment if they wasnt getting paid
• provision continued to be a mixture of people paying for private care, local authorities providing some support, and many hospitals relying on charity funding

Reasons for it being set up

• government became concerned about the inequalities of health care
• the bombing raids in WW2 caused many casualties so a national emergency service was set up
• some new hospitals and 1000 operating theatres were built
• hospitals provided a free service
• blood transfusion was created
• an ambulance service was set up

NHS 1948

Taxes were used to pay for a wide range of care offered to people including

• the right to see a GP
• treatment by dentists and opticians
• health care for pregnant women and young children
• ambulances and emergency treatment
• health care for the elderly

• previously only those covered by the national insurance system could see a GP free of charge
• non working women, and children were not covered
• the cost of the doctors visit and the medicine would often make people delay seeking treatment until they were seriously ill
• through the NHS people could see their doctor and get treatment at an early stage of an illness and therefore had more chance of recovery
• at first all treatments were entirely free
• the expense of running the NHS was soon much higher than expected and prescription charges were introduced in 1951

Costs

• the cost of the NHS is now a major problem for the government
• this is because people are living longer so need more treatment
• new drugs can help many conditions but costs are high
• treatment is more complex
• equipment is expensive
• staff costs are high because of increased training and wages

long waiting lists for treatment developed meaning some conditions deteriorated before getting treatment

changes in the way GPs have been funded means few now run an emergency or weekend service

there is discussion as to whether the NHS should continue in its current form

• at the start of the 20th century doctors had to qualify and then register with the general medical council 
• they could then set up a practise anywhere and accept the patients they wanted
• many opened practises in middle or upper class areas
• some were set up in poorer areas and were willing to treat people who paid through a local sickness club
• as knowledge of disease increased many doctors in hospitals specialised more than previously
• GPs also became more conscious on the knowledge to update their knowledge

Doctors

• training now takes 7 years
• a degree
• spending time in hospitals
• becoming a GP then developing into a specialist area

Nurses

• degree or diploma in nursing
• must be registered with nursing and midwifery council
• recieve practical training working on a range of wards
• must pass further exams before adminstrating drugs or chemotherapy

• study of genetics began in the 19th century when Mendel showed how characteristics can be passed down from one generation to the next
• during the 20th century scientists could take photographs of human cells through two improvements in tech; electron microscopes and x-rays
• it became known that each cell in the body contains DNA which is the set of codes controlling the genes that decide eyes and hair colour etc
• if scientists could work out how these genetic codes fitted together in a DNA strand, they might be able to identify which genes were responsible for inherited conditions
• Francis Crick and James Watson worked together to investigate the structure of DNA, their work also made use of X-ray crystallogrophy by Maurice Wilkins and Rosalind Franklin at Kings college hospital in London
• it was one of Franklins photographs that suggested that genes were arranged in a double helix structure

• scientific research has led to chemical treatment of disease, antibiotics, more vaccines, a better understanding of genetics, development of treatments

Blood Transfusion

• 1901 Karl Landsteiner discovered there were 4 blood groups and transfusions were only successful if the donor and patients blood group was the same
• the discovery meant people who die from losing a lot of blood could now be kept alive
• people with blood disorders could recieve treatment
• the only problem- blood could not be stored so the donor and patient had to be together for the transfusion
• in 1915 it was discovered that adding sodium citrate prevented blood from clotting but caused blood cells to deteriorate
• 1916 new scientific techniques made it possible to store blood longer

Problems of Science and Tech

• many companies produce different versions of the same product
• although each drug is tested before licensed, there can be problems such as un-foreseen side effects
• a lot of debate about whether scientists play god (embryo screening etc)

• an aid to research; x rays etc
• an aid to diagnosis or monitoring of illness; scans, endoscopes
• an aid to treatment; pacemakers, drips
• an aid for people to monitor their own health; diabetes etc

Change

• the first world war gave an added urgency to the search to find a way to store blood because it would save injured soldiers who needed transfusions
• change happens at different speeds
• one breakthrough can lead to several others in a very short space of time
• discoveries can take a long time to have an effect on the treatment people recieve

Change and Progress

• when antibiotics were discovered it was thought that all type of infection had been conquered
• some types of bacteria have become resistant to these drugs
• the NHS insist on new standards of hygiene due to superbugs such as MRSA

• acupuncture
• herbal and natural remedies
• some people feel they are less likely to have dangerous effects because they do not use mass produced chemicals