Medicine in Modern Britain

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Medicine in the Early 20th Century

  • Home remedies continued to be used e.g. putting stockings around throats for mumps
  • Most couldn't afford doctors as there was no NHS yet
  • Life expectancy was low 
  • Before antibiotics, they had 'cure all' pills which didn't actually cure anything
  • Boots and Beechams were set up to manafacture drugs
  • Technology in the late-19th century meant that we could mass-produce pills. This led to a growth in the pharmaceutical industry
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Paul Ehrlich and his magic bullet

  • Was one of Emil Von Behring's students who discovered that the bodies of animals could produce natural chemicals (antitoxins) which could kill toxins produced by some germs
  • He wondered whether if man-made chemicals could be found that would work inside the body
  • Koch had used chemical dyes to stain microbes to see them better and discovered that some of the dyes killed the microbes. Ehrlich therefore set out for a dye that would kill microbes without harming the human body.
  • He wanted to find a cure for syphillis and infected rabbits with the disease. He then tested 605 dyes on the germ over 10 years. The 606th one worked. 
  • He named this 'magic bullet': Salvarsan 606. This discovery had nearly been missed as the 606th one had been tested and discarded as useless.
  • Hata, a Japanese assistant, was testing one of the discarded dyes and found that it did work. Ehrlich insisted that it was thoroughly tested and found that it did work.  
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Gerhard Domaghk

  • In 1932, he was working for a large German chemical firm and he discovered a red dye, called prontosil, which stopped the streptococcus microbe (this caused blood poisoning) multiplying in mice 
  • In 1935, French scientists discovered that it was one group of chemicals called sulphonamides. These were introduced as an injection before becoming a pill derived from coal tar
  • Domaghk had first used it to save the life of his daughter who had pricked her finger with a needle and had developed blood poisoning
  • Sulphonamides were later found to cure many other diseases, like pneumonia, scarlet fever, and meningitis. This discovery was helped by the invention of electron microscopes in 1931.
  • This project was funded by drug companies
  • They later discovered that there were more serious side-effects including liver and kidney damage.
  • The discovery of both magic bullets and sulphonamides showed that synthetic, targeted treatments for specific diseases were possible. Since Ehrlich's discovery, a huge pharmaceutical industry had grown, dedicated to the research and production of new treatments.
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DNA Discovery

  • In 1953, Crick and Watson discovered that DNA was a double helix and that it was present in all people and could pass on information to the next generation
  • Scientists knew about DNA before, but had never been able to identify it
  • A complete set of genes is called a genome and in 1990, the Human Genome Project was set uo and research teams from 18 countries took part to compile a map of human DNA
  • This project was funded by governments and drug companies and scientists analysed and recorded the data.
  • DNA discovery led to gene therapy, which will give people living with a disease a normal lifestyle
  • Genetic engineering means that parents can produce perfect children
  • Genetic screening can predict illnesses that people could get and recommend how to avoid them
  • This discovery could be potentially more important than the germ theory which had eradicated many diseases and increased life expectancy. The germ theory could not, however, prevent or offer cures to genetic diseases like cancer or heart disease. DNA helps to explain actual changes in the body itself. 
  • DNA can also be used in detecting crime due to the use of DNA fingerprinting.
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Penicillin - Alexander Fleming

  • Alexander Fleming had seen many people die in the war of septic wounds by staphylococcal bacteria when he was working in an army hospital in WW1
  • As he was searching for a cure for this, he came across the antisceptic substance in tears, lysozyme, in 1922. This only worked for some germs.
  • In 1928, he came to clean up some old culture dishes and found that a fungal spore had landed and grown on one of the dishes.
  • Fleming noticed that the colonies of staphylococci around the culture had stopped growing and this fungus was identified as Penicillium notatum. It produced a substance which killed bacteria and this substance became known as penicillin.
  • He found that the substance acted against anthrax and diptheria 
  • He published his findings in articles between 1929 and 1931, but nobody was willing to fund further research, so he was unable to take his work any further. The industrial production still needed to be developed.
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Penicillin - Florey and Chain

  • In 1935, Florey and Chain at Oxford University saw Fleming's papers on penicillin. They believed that penicillin would be able to save lives and prevent pain. 
  • They developed a system of growing penicillin and they tested it on mice. When it was successful, they decided to try and get it to production.
  • They had to purify the penicillin before use
  • At the time, it was not financially feasible to mass produce the drug. It became widely available following the introduction of the USA into WW2 during 1941. The Americans were easily persuaded to develop and produce the drug to benefit Allied Servicemen.
  • In December 1941, US government began to give out grants to businesses that produce penicillin
  • By 1943, British businesses had also started to mass-produce the drug 
  • In 1945, 2 million doses were being given a month
  • After the war, the cost of penicillin fell and this made it more accessible for everyday use
  • In 1945, Florey, Chain and Fleming recieved the Nobel Prize. The discovery of penicillin is considered one of the most important breakthroughs in medical history.
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Fighting Cancer

  • The first successful treatment was radiotherapy. This was introduced after the discovery of radiation in 1869-98 by Antoine Henri Becquerel, Marie Curie and Pierre Curie. Radiotherapy involves killing cancer cells using targeted X-rays and gamma rays.
  • Chemotherapy is the treatment of cancer using drugs. This was discovered during WW2 when doctors found that nitrogen mustard could be used to reduce cancer tumours. 
  • Other drugs were later discovered, including a compound in folic acid that blocks the growth of cancer cells.
  • Since the late-1990s, targeted therapy has been used to fight cancer. This uses drugs to prevent cancer from spreading.
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The NHS

  • WW2 made people realise the health problems of the poor and air raids prompted the government to set up the Emergency Medical Service providing a centralised control of medical services and offered free treatment to air raid casualties.
  • In 1942, William Beveridge published a report calling for government provision of social security 'from the cradle to the grave'. This became a bestseller.
  • In 1945, the Labour Party was elected with a mandate to implement Beveridge's proposals, primarily by founding the National Health Service in 1948
  • Aneurin Bevan was the Minister for Health who introduced the NHS. He wanted the NHS to be free at the point of use and he set up a compulsory National Insurance to pay for it.
  • Bevan wooed doctors and dentists with a fixed payment for each registered patient. They were also allowed to continue treating private fee-paying patients. 
  • By 1948, nearly all hospitals and 92% of doctors had joined the NHS.
  • The NHS increased the number of people with access to healthcar and the number of doctors doubled between 1948 and 1973 to keep up with demand.
  • Today, it provides a range of health services of which are free anc accessible to everyone, including accident and emergency care, maternity care and major surgery.
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National Insurance Acts, 1911

  • The Boer War had highlighted the big issues with poor health when men could not pass the physical examinations
  • The liberal government began a number of reforms to improve the health of the nation
  • Children were supported by: free school meals, school nurses and trained midwives
  • The elderly were considered with the introduction of pensions
  • Slum areas and back-to-back houses were banned and soldiers returning from war were promised homes for heroes; by the 1930s, slum areas were cleared abd council houses were built.
  • The 1911 National Insurance Act helped to provide free medical health care and sickness benefits if workers were unable to work or faced unemployment. Workers, employers and the state paid into this.
  • The Great Depression of 1929 led to huge unemployment and the government cut back their NI contributions so child poverty increased. Over 3 million were unemployed and over 4 million National Insurance schemes had monies owing for the payments. 
  • The war also meant that the government had to provide free medical care with ambulances and hospitals due to casualties caused by the German bombings.
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NHS Achievements

  • Women's health was considered a priority and has continued to do so; women are now 4x more likely to go to a doctor than a man
  • Maternal mortality has been reducing since the development of sulphonamide drugs, but under the NHS, this came down more rapidly
  • It took away the worry for women as they now were able to afford healthcare as it was free, so they were less likely to lose a loved one
  • The NHS transformed the role of the family doctor. GPs increasingly work as part of teams offering a whole range of services
  • Improved the number of people with access to healthcare; the number of doctors doubled between 1948 and 1973
  • Today, the NHS provides a wide range of health services, including maternity care, pharmacies, dentists and mental health services
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New Technologies to Improve Diagnosis

  • Blood tests (1930s) use blood samples to test for many conditions without the need for intrusive diagnosis methods
  • Blood Sugar Monitoring (1960s) allows people who suffer from diabetes to check their blood sugar levels regularly to ensure that they can manage their condition
  • X-Rays (1890s) help to see inside of the body without cutting into it. They have been used since the start of the 20th century to help diagnose problems e.g. broken bones
  • MRI Scans (1970s) use magnets and radio waves to create an internal image of the body. These are better suited to diagnosing soft tissue injuries e.g. ligament damage
  • CT Scans (1970s) are more advanced x-rays to diagnose tumours and other growths 
  • Ultrasounds (1940s) use sound waves to build a picture of the inside of your body. Helpful in diagnosing gall stones and kidney stones
  • ECGs (1900s) use electrical impulses to track heart activity
  • Endoscopes (1900s) use a camera on the end of a stick to see inside of the body. Mostly used for digestive problems.
  • Blood Pressure Monitors (1880s) help to diagnose high and low blood pressure
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Keyhole Surgery and Robot-Assisted Surgery

  • Keyhole surgery is a technique developed in the 1980s, which makes surgery less invasive and leaves patients with smaller scars 
  • An endoscope is put through a small hole so the surgeon can see inside the body and other surgical instruments are put through even smaller cuts in the skin. 
  • This can be used for investigating the causes of pain  or infertility and can also be used for vasectomies, removing cysts, mending hernias and other minor operations. 
  • Robot-assisted surgery has improved precision
  • The first surgical robot was introduced in 1985, but this form of surgery only became qidely used after 2000 with the launch of the da Vinci system 
  • This type of surgery allows surgeons to make smaller cuts meaning less scarring, less infection and quicker healing. 
  • Is important for things like brain surgery
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Transplants

  • In 1905, the first successful transplant of the cornea was performed. During WW1, surgeons developed techniques for skin transplantation
  • The first complete organ to be transplanted was the kidney. Liver, lungs, pancreas and bone marrow followed.
  • The first successful heart transplant was carried out by South African surgeon, Christiaan Barnard, in 1967. The patient only survived for 18 days.
  • The success of early transplants were limited because doctors lacked effective immunosuppressants - drugs to stop the immune system attacking the organ
  • Since the 1970s, researchers have developed increasingly effective immunosuppressants, making transplants safer and more likely to be successful
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Blood Transfusions

  • This idea was known from the 17th century, but they were rarely successful because the blood often clotted.
  • In 1900, Karl Landsteiner discovered blood groups. Certain blood groups can't be mixed as the blood would clot, clogging blood vessels. He found that transfusions were safe as long as the patient's blood matched the blood donor's
  • In 1914, during WW1, doctors found that sodium citrate stopped blood clotting while stored outside of body. 
  • In 1917, this discovery was vital when the first ever blood bank was set up at the Battle of Cambrai
  • In 1946, the British National Blood Transfusion Service was set up
  • Blood transfusions helped to prevent the death of someone by allowing a sugeon to replace the blood lost during surgery
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Lifestyle Campaigns

  • In the 20th century, doctors showed a link between lifestyle and disease.
  • In 1952, a Great Smog caused by coal fires resulted in 4000 deaths in London. It showed the dangers of air pollution, which can cause breathing conditions, like asthma.
  • The government passed laws to limit air pollution
  • An increase in less active lifestyles led to an increase in obesity. In 2009, the government launched the Change4Life campaig, with the aim of improving diets and promoting daily exercise
  • Excessive alcohold intake has linked to multiple diseases, like liver cirrhosis. Alcohol intake rose between 1950 and 2004, but has since fallen. The government introduced the Drinkaware campaign in 2004, and the logo appears on many alcohol advertisements.
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Lung Cancer

  • This was rare in 1900, but more common in the 1940s. Today, about 20% of cancer deaths are due to lung cancer. About 43500 people are diagnosed each year.
  • Scientists estimate that there around 90% of lung cancer cases are linked to smoking. This became popular in WW1
  • In 1950, the link between smoking and lung cancer was proven by Richard Doll and Austin Bradford Hill
  • X-Rays and CT Scans are used to diagnose lung cancer. They also now use bronchoscopy, which involves put a thin tube into the lungs to take a sample of the cells, requiring a local anaesthetic. 
  • It can be treated using surgery to remove affected cells and then radiotherapy or chemotherapy.
  • In 1965, cigarette adverts were banned from TV. In 1971, tobacco companies had to put a health warning on cigarette packets.
  • In recent years, there has been a ban on smoking in public places (England - 2007)
  • In March 2015, Parliament passed a law requiring all cigarette companies to use plain packaging on cigarette boxes. 
  • The percentage of men smoking has dropped from 65% to 20% from 1948 to 2010.
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