History- 20th Century Medicine

Progressive

• Governments invest money in improving the health of soldiers and the people
• Doctors and Nurses can practise and make new discoveries as they battle to deal with high casualties and new types of injury or emergancy
• Research increases to solve medical problems or to give a country a pead over its rivals

Regressive

• Research is disrupted because doctors are needed to cope with casualties.

• Before WW1 blood transfusions were risky ignored by most surgeons until it saved many lives on the front line as techniques improved
• 1914- researchers noticed that sodium citrate prevents blood from clotting and a safe concentration was developed for use the following year
•  Citrated blood could be refrigerated for several days so it could be used on the front line and in 1917 the idea of blood transfusions was used regularly
• This led to faster transfusions as blood was avaliable straight away rather than taking fresh blood from doners
• Away from the front line fresh blood was still preferred, until 1920s where the first voluntary blood donation occurred, late 1930s the first blood bank appeared. 

• Men suffered terrible injuries. Some scars could be hidden or disguised however some had facial injuries. Often left unrecognizable, their return to life was traumatic
• The risk of such injury was high. Surgeon Harold Gillies was appalled by the number of facial wounds he saw in France, many caused by shrapnel.  In treating them he became convinced of the benefits and wanted a special hospital. In England, he persuaded the army to establish a purpose built site-Queen's hospital sideup was opened in 1917. Archibald McIndoe was drawn to the facility and was to become famous in the 2nd world war.
• New specialism emerged- using the living skin of a man to help construct his facial features, was not as a new technique, at the Queens hospital these surgical procedures were refined and improved
• Despite advances there were limits. Patients often cut short treatment because of pain, while basic elements could be restored for most disfigurement remained profound and permanent.

• 1941-1921 over 41,000 men lost at least one limb in the British Armed forces alone
• Servicemen were entitled free artificial limbs by 1915 existing of provisions were failing- couldn't produce limbs fast enough (cottage factory)
• lack of hospitals that would give out free limbs
• opened queen mary's hospital in Roehampton- a place for artificial limbs so production was better
• Despite the hospital giving out limbs, it was still a struggle
• Many people didn't get training in using their artificial limbs, this was under control after the war.
• By 1918 limb quality had improved, the metals were made of lighter alloys

• Stress and horror of war had severe effects on their minds known as shell shock. Today the condition is known as post traumatic stress disorder
• The diseases was gradually accepted as a condition it was almost certain that some 300 british servicemen were suffering from the condition
• lack of understanding about war neurosis is seen in the treatments given to some patients
• 1917 the approaches were more human, shellshock was noticed by some physcologists such as Charles Majers and W.H.Rivers
• Special units were set aside for neurosetheric patients, institutions like Gary Lackheat. Where Wilfred Own stayed, tratment was based around cognative therapy.
• Mental scars were long healing, 4 years after the war ended some 50,000 were receiving pensions on mental health.

• Government and Attitude- government realised that people needed help and that medicine and treatment should be free for all
• Communication and Education-Ideas were able to spread rapidly, more doctors were trained. Advertising was used to promote public health
• Money- Governments spent far more on research and care. So did companies hoping to make money from medicine
• Science- Rapid advances allowed doctors to make new discoveries
• Earlier discoveries- Doctors were able to build on the key scientific discoveries and methods of people such as Pasteur
• War- The 2 world wars encourages government spending research and development as doctor tried to find better ways to treat casualties.

Doctors- Doctors and surgeons were often unable to cure their patients. There were no antibodies to fight internal infection.

Life Expectancy- Life expectancy remaned below 50 years

Surgery- In surgery, Anaesthetics and antiseptics had taken much of the pain and danger out of operations, but problems of bleeding and infections remained. Appendix operations for example were still considered dangerous. 

Money- The majority of families could not afford to go to a doctor

Housing- Many people were still living in unhealthy housing

Baby Mortality- In 1899 163 out of every 1000 babies born die before their 1st birthday

Magic Bullet- A chemical drug that kills the microbes causing a specific disease without harming the rest of the body

NHS- An organisation set up by the government in 1948 to give free health care to all

Consultant- A doctor specializing in a specific disease or part of the body, usually based in hospitals and seeing patients referred by a GP 

• A magic bullet was compared to antibodies that killed bacteria and nothing else
• Magic bullets were chemicals that killed certain bacteria
• The first magic bullet was Salverson 606 that killed syphilis bacteria
• The importance of Ehrlich's work is that it was the first time a chemical compound had been used to destroy bacteria 

First Magic Bullet:Salverson 606

1) Paul Ehrlich was part of Robert Koch's research team. Koch showed that certain dye sought out certain bacteria

2)Ehrlich spent hours staining bacteria and observing the effects of dye. He worked with Behring on diphtheria and was interested by the way in which the body created antibodies that only killed bacteria.

3)Ehrlich was convinced that a chemical could be found which might do the same

4)In 1905 he was looking for a magic bullet to treat syphilis. Instead of using dyes he experimented with a variety of chemical compounds based on arsenic.

5) Ehrlichs team tried 605 variations before they found one that worked. It was nearly missed but Sahashua Hata realised it killed syphilis 

6)The drug was name Salverson. It could kill not only microbes causing the disease but the patient as well.

2nd Magic Bulled: Prontosil

1)Research into the use of chemical compounds was interrupted by the 1st world war, but in the 1920s it started again.

2)In 1932, Gerhadt Domagk tried out Prontosil, a red dye. Domagk started a series of experiments using mice, the results were good.

3)Domagk got an oppourtunity to test Prontosil on his daughter. She was playing with her pet near medical equipment.

4)She developed blood poisoning. Domagk decided to risk giver her Prontosil, she recovered

5)Then next step was to find out what the active ingredients were in prontosil

6)French scientists found it was sulfonamide from coal tar. The discovery was made fast because of the invention of electron microscopes.

6)Soon major drug companies joined a race to discover cures based on sulfonamides

7)Within a few years druges were developed to cure and control scarlet fever, meningitus, gonorrhea and pneumonia 

Background Information: German Scientists in the fields of hematology, immunolgy and chemotherapy. Became interested in staining microscopic tissue substances.

Progressive

• Member of Koch's research
• Worked with Behring on diphtheria
• 1905, he was looking for a magic bullet to treat syphilis
• worked with chemical compounds instead of dyes.

Regressive

• It could not only kill microbes but patients as well
• had to do 605 variations before they found one that worked

Background Information: German pathologist and bacteriologist 

Progressive

• 1932, he tried out prontosil for his magic bullet
• gave his daughter prontosil when she had blood poisoning- she recovered.

Regressive

• didn't find out what active ingredient was

Background Information: Japanese bacteriologist who develped arsphenamine in 1909 in the labroatory of Paul Ehrlich

Progressive

• he noticed the 606th experiment for the salverson 606 worked

• Communication: Lack of communication meant Sanderson and Lister couldn't tell people about Penicillin
• Chance- The penicillin flew in through the window, however Fleming was researching it so it was individual genius aswell.
• Governments- Fleming didn't have enough money or government support, so nothing was done with his discovery for 10 years. During war government gave money to research penicillin
• Individuals: Early 1800s- John Sanderson found Penicillin but nobody found out because of lack of communication. 1880s Joseph Lister. 1928-Alexander Fleming rediscovered penicillin, he used communication so people knew about it. Florey&Chain- mass produced penicillin
• War- Second world war persuaded the government to fund further experiments with penicillin.

1928- Fleming discovers mould has killed germs

1929-Fleming writes articles about penicillin

1937-Florey and Chain begin research in Oxford on penicillin after reading article by Fleming

1940-Experiment with mice

1942- US and British governments co-operate to fund production of penicillin

1944 Enough penicillin to treat all the allied forces wounded in the D-Day invasion of europe

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Background: Florey was Professor of pathology; Chain was a biochemist at Oxford University. Ernest Chain found an article about Alexander Fleming's work and this prompted them to look at penicillin

Focus of research: Team bagan to investigate the anti-bacterial substances produced by mould. Chain worked on putryfying penicillin with E.Abraham and N.Hedley. A.D.Gardner and Jena Orr-Elving studied how penicillin reacted with other organisms. H.Florey and M.Jenning looked at penicillan on animals.

Support and Funding: Led a research team but received limited funding and went to the USA for more support.

Tests: Used penicillin on 8 mice injected with lethal doses of streptococcal bacteria. Treated mice recovered, untreated died. Florey then tested the drugs on humans. 1941- Albert Alexander was given penicillan and within a day began to recover, he died because of too small a dose.

Next stage:At first, hospital bedpans and dairy churns were used to grow mould. Liquid containing penicillin was drained from the growing mould and filtered through parapets. But they needed large amounts required for test patients. 1843- mass production commenced.

Public Reaction: Florey&Chain's role is often played down and credit is given to Fleming for penicillin's discovery, while they are given the credit for its mass production.Florey explained his method to people in US

Background Information: Florey was a professor of pathology. Chain a biochemist. Florey was German and Chain was Australian.

Progressive

• discovered how to mass produce penicillin
• 1940 tested on mice, 1941 conducted a test on 10 patients- test showed penicillin was a miracle drug
• discovered drying the mould at low temperatures was the most successful method of purifying penicillin

Regressive

• didn't discover penicillin

Background Information: Scotish scientist, was a chemist working at St Mary's hospital in London.

Progressive

• found penicillin killing a culture of bacteria in a Petri dish
• Published his findings in 1929

Regressive

• He was unable to get funding to develop his work so he returned to his original research

• 1919: Nursing act, this set up the general nursing council to enforce high standards of training for nurses
• 1919: ministry of health was set up
• 1911: National insurance act, working men their employers and the government all paid into a fund to cover doctors' fees and medical costs if a worker became ill- only applied to certain groups of men
• death of 3,000 children from diptheria in 1938 led to a free vaccination programme
• 1900: doctors had to have a university medical degree and to be accepted by the general medical council
• by 19,000 most cities had built infirmaries, fever houses and asylums to care for the poor
• 1902: midwives act, midwives had to be properly trained and registered
• 1907: health visitors were introduced to visit mothers and help them care properly for their new babies

Although the government was taking an increased role in improving health of the nation, but the start of the second world war in 1939 there was still no national organisation offering the same level of care to everyone, and access to healthcare remained patchy.

Care for the Sick

• 1900-1947- Sick mainly cared for at home and treated by the woman of the family
• 1948(NHS)- People would see a doctor and get treatment at an early stage of an illness

Access to Doctor

• 1900-1947- Doctors had to be paid by the patient but many men were covered by schemes set up to pay a weekly amount to a sickness club or by national insurance
• 1948- Everyone is covered by the NHS no matter what gender, age or class

Type of Treatment

• 1900-1947- Simple remedies, many diseases still untreatable. Home remedies and patent medicines used.
• 1948- treatment was free until 1951. People could see doctors and get treatment at a early stage

Hospital Facilities 

• Local cottage hospitals staffed by local doctor, but no specialist expertise. Hospitals in towns and cities often had outpatients department which offered treatment.
• 1948- Ambulances. hospitals covered the whole country

Medical personnel

• 1900-1947- Trained doctors, general practitioners in local areas and hospitals. Women now trained as doctors although not many. Nurses trained. No ambulances and limited resources to diagnose or treat illness
• 1948- Now ambulances and emergency treatment. More women staff. GPs, opticians and dentists all free. Access to professional nursing care.

Other points

• 1900-1947- Dentists, opticians etc. all need to be paid. Good understandng of disease but limited understanding of genetic conditions
• 1948- could now access dentists and opticians through the NHS free. Better understanding of genetic conditions.

Second World War

• Working class children had been evacuated from cities to middle class households in the countryside. Many people were shocked by the poverty they saw and demanded something to be done. 
• A national Energency medical service was set up. It was controlled by the government and provided free treatment, blood transfusion and ambulance services
• The Beveridge Report in 1942 identified '5 giants' to be tackled after the war- plans were made for a NHS to tackle disease
• Clemet Attlee's labour party won a landslide election victory in 1945, defeating Winston Churchill. Labour had promised to implement the Beveridge Report.
• People had a more communal attitude. Soldiers had fought together and people at home had pulled together. They wanted this to continue.
• It was total war where the government had taken control of many areas. People realised that government had power to change things for the better.

Other

• People were promised land fit for heroes after World War One but instead faced a depression. They were determined things would be different this time.
• By the mid-20th century, there was much more acceptance about the government being involved with peoples lives
• Significant medical breakthroughs meant that much more could be done for the sick
• It was a total war where the government had taken control of many areas. People realised that government had power to changes things for the better.
• The role of the individual Aneurin Bevan- allowed doctors to earn a salary and use NHS hospitals to create private patients

Doctors

• Paramedics are now trained to assess a patient and take action whenever possible
• Had to qualify and then register with the general medical council
• training take 7 years- includes taking a university degree, spending time in hospitals, becoming a GP or working with a consultant.

Nurses

• They receive practical training working on a range of wards and specialised situations
• Must be registered with nursing and midwifery council
• must past further exams before they can administer drugs or chemotherapy
• must hold a degree or diploma in nursing (3 years) 

1953- Crick and Watson discovered the structure of DNA

1)1990- The human Genome project, led by Watson, set out to map the location of every single one of the 30,000-35,000 genes in the 23 chromosomes in every cell of the body

2)The project involved hundreds of scientists working in 18 different teams. The first draft was produced in 2000.

3)Scientists have identified certain genes that pass on specific hereditary conditions

The consequences of the discovery:

There are new techniques for skin grafts, better production of insulin for diabetics and better vaccines.

There has been further research to develop techniques to alter faulty genes with the body and prevent genetic illnesses from developing

There is a better understanding of conditions such as down's syndrome and leukemia and whether people are more likely to develop certain forms of cancer.

The discovery has  been made that stem cells can transform into various types of cells used around the body- which offers a chance of replacing faulty cells with healthy ones.

Understanding DNA could lead to:

Gene Therapy- using genes from healthy people to cure the sick. Research has shown that certain diseases e.g. cystic fibrosis are caused by a single abnormal gene. 

Customized drugs- creating drugs to cure one person particular health problem. Drug treatments of the future could be developed to deal with a particular gene in a particular person. These 'custom drugs' would be less haphazard than at present where the same drug is given to millions of different people regardless of their genetic make up.

Genetic Engineering- creating new varieties of plants and animals.

Genetic Screening or Testing- identifying the illnesses people could suffer from and preventing them. 

Research Teams- Crick and Watson knew more about genetics. They also involved Rosalind Franklin and Maurice Wilkins, who were experts in x-ray photography, and other colleagues at Cambridge University. The Human Genome Project was a very complex operation, with research teams in 18 countries, each working on a different part of human DNA. Without large teams, this simply could not be done. 

Technology- Electron microscopes and x ray photography in the 1950s. In the 1990s, computers and the internet allowed scientists in the human genome project to exchange and process huge amounts of information.

Scientific Developments- At each stage of work on DNA, scientists built on new knowledge in other types of science e.g. genetics and biochemistry. For hundreds of years scientists knew that some illnesses can be inherited. In the 19th century Mendal showed that characteristics could be passed from one generation to the next. Scientists using improved microscopes also discovered how cells in the body were able to build on this earlier work. Crick, Watson and others were able to build on this earlier work. 

Funding from Government&Industry- This kind of detailed scientific research is very expensive, uses complex equipment, employs highly skilled people and takes a lot of time. Money came from two sources-government and industry

Communication- In the human genome project, began in 1990, hundreds of scientists worked in 18 research teams in different countries; USA, Britain, Japan, France and Canada. Communication of huge amounts of information was possible through computers and the internet.

Individual Genius- Rosalind Franklin too the first xray photograph of DNA in 1951. Crick and Watson discovered the structure of DNA in 1953

1896: Walter Cannon (America) used a barium meal with x-rays to track the passage of food through the digestive system.

1910: Henry Dale (Britain) discovered the chemical histamine, which is produced by the body during an allergic reaction. This allowed him to understand allergic response and surgical shock.

1921: Frederick Banting and Charles Best discovered insulin, which breaks down sugar in the bloodstream. Thus he found the cause of diabetes.

1923: Edgar Allen (America) discovered oestrogen (the hormone that powers femaleness). In 1935 Ernst Laqueur isolated testosterone, the hormone that creates maleness.

1931: The invention of the electron microscope allowed doctors to see bacteria and viruses for the first time.

1951: The Mexican company Syntex developed norethisterone, which prevents ovulation - leading to production of the first contraceptive pills.

1953: Francis Crick and James Watson (Britain) discovered DNA.

1953: Leroy Stevens (America) discovered stem cells.

1970s: Patrick Steptoe (Britain) developed IVF fertility treatment; in 1978 Louise Brown became the first 'test-tube' baby.

1970s: Endoscopes - fibre optic cables with a light source - enabled doctors to 'see' inside the body.

1972: Geoffrey Hounsfield (Britain) invented the CAT scanner, which uses x-ray images from a number of angles to build up a 3D image of the inside of the body.

1980s: MRI scans were developed to monitor the electrical activity of the brain.

1986: In the Visible Human project undertaken in the US, the bodies of two criminals (a male and a female) were frozen, cut into 1mm slices, stained, photographed and stored as 3-d images on the internet.

1990s: The Human Genome project undertaken in the US mapped all the genes in the human body - 40,000 of them. Humans share their gene make-up with much of the natural world, leading scientists to joke that because of the genes we share, human beings are 60 per cent banana! In 1997 Scottish researchers bred Dolly, the first cloned sheep.

2002: Gunther von Hagens (Germany) performed live dissections on TV

1. There was a great explosion of scientific understanding and technological innovation.
2. Many societies became hugely rich, though wealth was still unequally shared.
3. There was considerable urbanisation (explosive growth of cities).
4. Communications technology made the world seem smaller and more cosmopolitan. This allowed medical ideas to spread rapidly, but also allowed diseases such as SARS to spread.
5. There was more time for leisure, less time spent on work.
6. People became less religious - so more inclined to look for medical solutions even to spiritual and psychological problems.
7. Many societies were democratic, and thought the duty of the state was to care for its citizens - hence demands for a welfare state.
8. American military and economic power, and American values, were dominant.
9. Stress due to terrorism, the undermining of traditional values and the rapid pace of life took a great toll on people's general health.
10. Wars, epidemics and famines killed more people in the 20th century than they had in the whole of the rest of history.

The discovery of vitamins allowed doctors to prescribe vitamin supplements, which cured beriberi, rickets, pernicious anaemia and pellagra.

In 1921 Banting and Best developed insulin. They could not cure diabetes, but they were able to alleviate its results. Today, doctors use hormone treatments to correct thyroid problems, help children grow, improve sexual performance and shrink cancers.

In 1932, the German scientist Gerhard Domagk discovered that a coal tar product (a sulphonamide called prontosil) killed streptococci bacteria. Other sulphonamides were discovered which could cure pneumonia, meningitis and acne.

During the Second World War, Florey and Chain learned how to mass-produce penicillin - discovered (by chance) in 1928 by the Scottish bacteriologist Alexander Fleming - the first antibiotic. Now, doctors could effectively cure acute infectious disease (although misuse of antibiotics has led to the development of drug-resistant strains of killer diseases such as TB and the MRSA hospital superbug).

The work of Peter Medawar (1950s: Britain) on immuno-suppressants led to the development of anti-histamine, which prevents allergies and operative shock.

After the 1950s, doctors (through contraception) were able to prevent pregnancy, and after the 1970s (through IVF) to help childless women become pregnant (although side effects of the contraceptive pill are thromboses, migraine and jaundice). In 2005, a 66-year-old Romanian woman gave birth to twins.

In the 1950s, doctors used the drug thalidomide to treat morning sickness during pregnancy. It caused terrible deformities in babies, but today is used in the treatment of AIDS, leprosy and some cancers.

In 1952, the Danish surgeon Christian Hamburger used large doses of hormones and surgical operations to change the sex of George Jorgenson, an American army vet, who returned to the US as Christine.

In 1954, Joseph Salk (America) discovered a polio vaccine, which helped eradicate polio from the western world in the 20th century, and which may make it extinct worldwide early in the 21st century.

Doctors started using technology - such as incubators and pacemakers - to help patients. In 2002, American surgeons implanted electrodes connected to a miniature computer into the visual cortex of a blind man. Using a video camera mounted on his glasses, he was able to 'see' well enough to drive a car.