- Created by: holly6901
- Created on: 27-05-19 14:32
Modern understanding of disease
- Viruses could not be killed by antibiotics. This meant that a new treatment had to be found.
- Antiviral drugs can stop viruses from growing in the body, but they were not discovered until a lot later in the 1950s.
- Antibiotics kill bacteria, but antivirals only stop viruses from growing, they don't kill them. The body (and its immune system) must kill the virus.
- In 1892, Dmitry Ivanovsky stumbled upon tobacco mosaic virus in plants. He found that some microbes stayed even after all bacteria microbes were killed.
- Martinus Beijernick later called these microbes viruses.
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New diseases and treatments
- In 1953, Leroy Stevens discovered stem cells. These are cells which can renew themselves. In 2013, the first human liver was grown only using stem cells.
- In 1953, Francis Crick and James Watson from the University of Cambridge mapped out DNA structure. This allowed developments in gene therapy, genetic screening and genetic engineering. In the 1990s, the Human Genome Project was launched, this was designed to identify all 40,000 genes in the human body.
- In 1972, Geoffrey Hounsfield created CAT scanners, which could produce 3D images of the human body. In 1976, endoscope probes were developed which meant doctors could look inside human bodies. In 1987 MRI scanning was developed, this gave doctors a scan of a human body using magnets.
- From 1946 to 1969 free vaccines were made available in the UK. These were for diseases such as tuberculosis, diphtheria, tetanus, polio, measles and rubella.
- In the 1950s, Peter Medawar developed anti-histamine, which helps prevent allergies.
- In the 1970s, Patrick Steptoe discovered IVF fertility treatment to help pregnancy. In 1978, Louise Brown was the first IVF baby.
- Today, doctors cannot cure all infections and diseases.
- Viral infections like AIDS and some types of cancer cannot be completely cured.
- Today, lots of illnesses are created by the people themselves.
- Smoking cigarettes (tobacco) can cause cancer (usually lung cancer).
- Eating too much unhealthy food can lead to obesity, which is linked to diabetes and heart disease.
- Drinking excessive amounts of alcohol can lead to cirrhosis of the liver.
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Modern tools of diagnosis
- Rontgen discovered X-rays in 1895. This allowed us to scan bones. In 1972, Geoffrey Hounsfield created CAT scanners, which could produce 3D images of the human body using X-rays. In 1987 MRI scanning was developed, this gave doctors a scan of a human body using magnets and radio waves. They can also give an image of the human body.
- After blood groups were discovered in 1901, blood tests began to increase in popularity. Doctors today can use blood tests to examine a patient's level of cholesterol (measures risk of heart attack), a patient's DNA (genetic material) and some indicators of their risk of developing cancer.
- Doctors and patients can now monitor their blood pressure, heart rate and lots of other things. People suffering from diabetes need to measure their blood sugar levels to keep it at the right levels. Wearable technology like the Fitbit and Apple Watch help people to monitor their own health.
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- People knew that antibodies (found in the body) attacked different types of microbes. Because of this, they were called magic bullets. Paul Ehrlich decided to create magic bullets that behaved like antibodies using chemicals. Ehrlich argued that if certain dyes could stain bacteria, certain chemicals could also kill bacteria. This was the foundation of the idea of ‘chemotherapy’.
- Ehrlich found a dye (methylene blue) that killed malaria germs and he tried hundreds of compounds to kill the bacteria behind syphilis. He thought he had failed to find a dye to kill syphilis bacteria, but the 606th compound tried – Salvarsan 606 – worked. It was used on humans in 1911.
- This was the start of the modern pharmaceutical industry. However, the second magic bullet to treat a different disease (not syphilis) wasn’t discovered until 1935. The second golden bullet (prontosil) was found by Gerhard Domagk (worked for Bayer) in 1932. Prontosil is a red dye that contained sulphonamide. This killed the streptococcus microbe, but it also had bad side-effects and could damage the kidneys and liver.
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- Most alternative therapies are not backed up by statistics, observation or scientific research. Culturally, alternative medicine is different in the modern day because it is not mainstream or accepted practice. This is the opposite of medicine in the medieval era which was dominated by medicine from apothecaries etc. Alternative treatments today generally use natural herbs/plants or theories about the body to relieve pain and illness.
- Some of these treatments are more accepted and are available on the NHS. For example, acupuncture (put needles in certain points of someone’s body) and homoeopathy (treating people with weak solutions made of natural substances).
- There has been a trend towards ‘positive health’. This means that people focus on the prevention of disease and illness rather than curing it. This means a focus on prevention rather than cures. People are now more concerned with a healthy diet and regular exercise. This has been accompanied by a rise in screening, which checks people to make sure they are healthy and catches early signs of disease.
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- In 1952, surgeons successfully performed an organ (kidney) transplant. The first organ transplant in Britain was in 1960.
- In 1967, a South African surgeon called Christian Barnard successfully performed a heart transplant for the first time (but the patient only lived 2.5 weeks). The first heart transplant in Britain was in 1968.
- In 1986, a British woman called Davina Thompson becomes the first patient to successfully receive a heart, lung and liver transplant.
- Transplanted organs were often “rejected” by the body because the body’s immune system recognised that the body parts were not from that person.
- Immunosuppressant drugs can stop the body from rejecting transplanted organs.
- In 1970, a British scientist called Roy Caine developed a drug (immunosuppressant) which stopped the body rejecting transplanted organs. This was called cyclosporine.
- In 2006, the first partial face transplant was successfully performed. In 2008, the first full face transplant was successfully performed.
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- Henri Becquerel and Marie Curie discovered radiation in 1898.
- Since then, radiotherapy has been used to kill cancer cells. Radiotherapy targets cancer cells using gamma rays and X-rays.
- In World War 2, doctors found that some drugs could treat cancer. This is called chemotherapy.
- Some drugs like folic acid can stop cancer cells from growing.
- The latest treatments of cancer are called immuno-oncology.
- They involve using the body's immune system to attack cancer cells.
- White blood cells called T cells can target and kill the cancer cells.
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Improvements in surgery
- Anaesthetics were developed which enabled patients to remain unconscious for longer. This meant doctors could try more complicated procedures.
- In 1950, William Bigelow performed the first open-heart surgery. Anaesthetics made more complex surgery like this possible. In 1958, a pacemaker was fitted in the heart.
- Keyhole surgery was created. This means the surgeon could perform an operation through small incisions (cuts).
- Keyhole surgery needed improvements in the video so that tiny cameras could be put into the body to do surgery.
- Using miniature instruments and fibre-optic cameras, surgeons can perform operations which reconnected nerves and blood vessels together.
- Radiation therapy was advanced in the 20th century by Henri Becquerel and Marie Curie. This means the surgeon uses high-energy radiation on a patient with cancer.
- This helps surgeons kill cancer cells and reduce the size of tumours.
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Improvements in surgery
- X-ray machines were used to make surgery more effective. They could identify what was wrong with a patient before and during surgery to make it more effective.
- Laser surgery was first used in 1987 in eye surgery. Alongside eye surgery, lasers can also help treat skin conditions, remove ulcers, control bleeding and help remove blockages in arteries.
- A prosthetic limb is an artificial body part that can replace arms or legs. Pare had designed some prosthetic limbs but investments after the world wars improved the technology. In 1972, John Charnley made the first hip replacements and in 1984, skin grafts became widely available. In the 1990s, prosthetic limbs with microprocessors were released.
- Some surgeons now do robot-assisted surgery. The robot (machine) is controlled by the surgeon. This became more common after 2000. Robot-assisted surgery can make smaller cuts than surgery done by humans. This reduces the size of scars and the chance of infection.
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Advances in prevention
- If a high percentage of the population is vaccinated against a disease, then the spread of contagious disease is a lot slower. Vaccination is still very effective, even if not everyone is vaccinated. Vaccination campaigns can get enough people vaccinated for there to be herd immunity.
- The diptheria vaccine was introduced in 1942. Before then it killed around 3,500 children each year.
- Diptheria was a bacterial disease that could cause heart failure and paralysis.
- People feared that wartime conditions would make diptheria more common, so the government introduced and advertised the vaccination (in newspapers, radio and posters).
- Polio is caused by a virus and can cause paralysis. It attacks the body's nervous system and blood.
- Polio caused up to 750 deaths and thousands of disabilities each year.
- The polio vaccine was introduced in 1956 and a campaign to vaccinate everyone under 40 was launched.
- By 1980, polio had been almost eradicated in Britain.
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- The government tried to improve people's health choices in the second half of the 20th century.
- The Change4Life campaign was launched in 2009. It tried to improve people's diet and encourage exercise. Obesity has risen in the UK and it causes lots of health problems.
- The consumption of alcohol has risen in the last 50 years. The government's 2004 Drinkaware campaign aims to reduce drinking.
- These interventions are very different to the laissez-faire policies of UK governments 100-300 years ago.
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Booth and Rowntree
- In the 20th century, the government began to change their policy from ‘laissez faire’ to the creation of a welfare state. This was influenced by the reports of Charles Booth and Seebohm Rowntree.
- Booth investigated living conditions in London in his 1889 report “Life about Labour of the People in London” He discovered that 30% of the London population lived in poverty, despite having jobs. Some wages were so low that people couldn’t afford to live. He showed that poverty was linked to the nation’s high death rate. He highlighted that there was a poverty life-cycle. This meant that people’s economic status could fluctuate during their life.
- Rowntree was a factory owner in York. He investigated the living conditions in York in 1901. Rowntree invented the term ‘poverty line’. This meant the minimum amount of money a person needed to earn to stay out of poverty. He estimated that at 28% of the city’s population, at some point in their life, were below the poverty line.
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The Boer war
- The Boer War was fought between Britain and the Boers (Dutch settlers) in South Africa. In 1899, when it started, over a third of volunteers to join the army were unfit for service. Lots of people had illnesses that were linked to poverty and poor living conditions. A governmental committee discovered that many men were unfit for service because they led unhealthy lives.
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Liberal social reforms
- Politicians were also anxious to improve public health as they feared it was causing a decline in Britain’s industrial power. For example, Germany had greater industrial strength and had passed social reforms to help workers.
- In 1906, they provided free school meals for poor children.
- In 1907, medical service for school children was established. This gave children free inspections and later free treatment.
- In 1908 the government passed the Children and Young Person’s Act. This meant that children were protected in the eyes of the law against parental neglect and abuse.
- In 1908, Old Age Pensions were introduced for the elderly, supported by taxes.
- In 1909, the first job centres (labour exchanges) were created.
- In 1911, The National Insurance Act was introduced. This provided unemployment benefits, free medical treatment and sick pay.
- These reforms improved the living conditions of the poor, the unemployed, the elderly and the young.
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Social changes after WWI
- When children were evacuated to the countryside, more people realised the differences in living standards between people in different areas.
- Some evacuated children were in a very unhealthy state.
- The need to raise large armies made the government aware of the problems created for society by an unhealthy workforce.
- The government realised the importance of having a healthy population. David Lloyd George wanted to have ‘homes fit for heroes’.
- After the First World War, overcrowded housing was banned.
- In 1918, it became compulsory for local councils to provide health visits and support for pregnant women.
- In 1919, councils started to build housing for poor families.
- In 1919, a Ministry for Health was set up. This looked after sanitation, healthcare and the training of doctors and nurses.
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- In 1919, a Ministry for Health was set up.
- This looked after sanitation, healthcare and the training of doctors and nurses.
- In 1934, the Free School Milk Act meant children could have free milk in schools. This was critical as Britain was hit by the Great Depression.
- Evacuated children in the Second World War triggered outrage as people saw how unhealthy they were.
- Almost 1 million homes were built by the Labour government between 1945 and 1952. The New Towns Act of 1946 created whole new towns (like Milton Keynes and Telford) close to large cities.
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The Beveridge Report and the welfare state
- The report claimed that everyone had a right to be free of the ‘five giants’: disease, want, ignorance, idleness and squalor.
- It highlighted that people’s quality of life needed to improve and suggested that the government should be responsible for this.
- The report suggested that welfare should be available to everyone in need. It should be paid for by tax payers, non-means tested (available to everyone) and compulsory for everyone.
- The government’s involvement in improving public health and social security is called the welfare state.
- The welfare state was implemented by the Labour Party led by Clement Attlee in 1945.
- The welfare state included a health service that was “free at the point of delivery”, a weekly allowance for families to look after their children and a ‘benefits’ system to give financial help to the very poor.
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- In 1946, the New Towns Act was set up to plan new towns.
- In 1956, the Clean Air Act established smokeless zones in cities.
- In 1980, the Black Report said that there were still inequalities in health between the rich and poor.
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- There was not unanimous support for the NHS. Doctors did not want to be employed by the government. This public good meant that doctors could lose some of their income. Bevan promised to pay doctors a salary and allowed them to continue working privately as well.
- Lots of Conservatives disliked the NHS, but it was too popular to abolish (get rid of).
- The cost of the NHS has increased dramatically in the last 70 years. The original plan was to pay for the NHS through National Insurance contributions. But this only covered 10% of costs. In 1948, the NHS budget was estimated to be £15 billion. In 2015/2016, the NHS budget was estimated to be £116.4 billion.
- The NHS has been relatively successful. Child mortality rates have fallen (and maternity services are likely to have helped this). New and improved hospitals have better facilities. Vaccinations provided under the NHS have got rid of diseases like tuberculosis. Healthcare and affordability of treatment are a lot better in Britain relative to the United States.
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- Today, drugs are very expensive. Medicine lets people live longer, but older people on average need the NHS more. This increases the cost of the NHS.
- The question today is, who should pay for which treatments and how can enough money be raised to pay for all the treatments needed?
- To deal with these questions, the National Institute for Health and Care Excellence (NICE) have a metric called a Quality Adjusted Life Year (QALY) valuing life at £30,000 per year. This metric helps to compare where money should be spent.
- Preventative health care is often cheaper than medical treatments. Campaigns encouraging healthy eating & discouraging smoking and drinking have been introduced.
- The healthy eating campaign promotes eating five portions of fruit and vegetables every day. In 2005, tobacco advertising became legally banned.
- Things like cancer screening are preventative measures that try to find people vulnerable to cancer or in the early stages so that treatment is more cost-effective and people get less ill.
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Progress in 20th century
- Revolutionary ideas can diffuse slowly. Fleming’s discovery was not recognised for many years.
- However, the printing press allowed his publications to be read more widely and they reached Florey and Chain.
- Inoculation was first brought to the UK by Lady Montagu who observed it in Turkey. Discoveries from France (Pasteur) and Koch (Germany) spread faster because of improvements in communication.
- The US government funded the initial mass production of penicillin.
- The improvements in living standards in the UK only really came from government action.
- Mandatory reforms in the form of the 1875 Second Public Health Act and the Welfare State seem to have had the largest impact on living conditions.
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Progress in 20th century
- Chain and Florey received funding to mass produce penicillin partly because of World War Two.
- The World Wars meant that a lot of people needed plastic surgery and prosthetic limbs.
- Blood transfusions were needed on the battlefield.
- The Boer War made Parliament realise that a malnourished population was not in their interests.
- Individuals like Louis Pasteur, Robert Koch, Alexander Fleming, Sir William Beveridge and Seebohm Rowntree all had impacts on society larger than you would expect from one individual.
- Science involves the objective observation of outcomes, but it also requires building upon the knowledge of previous scientists.
- Blood transfusions needed an understanding of blood groups, which relied on the discoveries of William Harvey around circulation
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- Fleming discovered penicillin because he left bacteria out in his laboratory.
- Lots of people only discovered the unhealthy state of British children because of evacuation in the war.
- The Liberal Party was influenced by the launch of the Labour Party in 1900 as it pushed through its reforms at the start of the 20th century.
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- In 1922, Fleming found that lysozyme, an enzyme in tears killed some bacteria.
- In 1928, he accidentally left out some Staphylococcus bacteria in his laboratory. Mould grew on one of the plates with the bacteria and this stopped the mould from growing.
- This mould was a fungus called Penicillin. Fleming called it a natural antiseptic (it is actually an antibiotic).
- He published his research in 1929, but this was not recognised immediately.
- Howard Florey and Ernst Chain read Fleming’s article. They experimented on mice at the University of Oxford and then tested penicillin on humans.
- It worked, but the doctors did not produce much penicillin.
- The scientists had to find a way to mass produce penicillin.
- In 1939, the British government would not fund the project because they were too focused on the war and chemicals companies were producing explosives.
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- In the Second World War, lots of soldiers got infected wounds.
- The USA government funded the team and then Britain in 1943 began to mass produce penicillin.
- Fleming, Florey and Chain won the Nobel Prize in 1945 for their discovery of penicillin.
- In 1945, Margaret Hutchinson Rousseau developed the technology to produce penicillin on a large scale. It is estimated that 15% of injured US and British soldiers would have died if they did not have penicillin.
- After the war, chemical companies began to sell penicillin to the general public as an antibiotic. The cost of producing penicillin fell as more was produced.
- Following this, other antibiotics were also developed. This included streptomycin (1944) for tuberculosis and tetracycline (1953) for skin infections.
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- 36,000 people in the UK die from lung cancer each year.
- Scientists think that 89% of lung cancer cases are "preventable" and these are usually linked to smoking tobacco (cigarettes).
- Smoking became very popular in the First World War.
- Doll and Hill found a link between smoking tobacco and cases of lung cancer in 1950. Scientific research (often funded by governments) helped to find this link.
- X-rays and CT scans can create images of people's lungs to help diagnose lung cancer.
- Modern cancer treatments like chemotherapy and radiotherapy can treat lung cancer, as well as surgery (taking out tumours or a lung).
- The Royal College of Physicians recommended stopping tobacco companies from advertising in 1962.
- TV adverts were banned in the UK in 1965.
- Health warnings were put on cigarette packets in 1971.
- In England, smoking in public places was banned in 2007.
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- 19% of men and 15% of women still smoke today, despite these campaigns and scientific advances.
- Although smoking is less common, attitudes in society have not shifted completely. This may be because of complex social factors, as well as the addictive nature of cigarettes.
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