1900 - present: modern medicine

• Alexander Fleming (1881 - 1955)

  *discovered the first antibiotic, penicillin

  *sent to France during WWI to study soldiers' wounds and found that wounds infected with bacteria were not healed by chemical antiseptics

  *in 1928 when he went on holiday, he left a pile of petri dishes containing bacteria (in case he made a discovery by chance) and on his return, he noticed mould on one of the petri dishes and the bacteria around it had disappeared

  *upon closer inspection with a microscope, he saw that the mould was penicillin, which must have blown in through the open laboratory windows

  *took a very long time to make enough penicillin to use in his experiments. so he stopped his research
• penicillin


  *the first antibiotic

  *if diluted, it killed bacteria without harming living cells

  *Fleming made a list of the germs it killed

  *used to successfully treat another scientist's eye infection

  *discovered in 1872 by Lister and used by him in 1884 to treat a nurse who had an infected wound, but was never used again

  *didn't work on deeper infections
• Fleming's short term impact

  *development of the first effective antibiotic

  *penicillin becomes the first antibiotic

  *used in WW2 to treat Allied soldiers
• Fleming's long term impact

  *penicillin and other antibiotics are mass produced by the pharmaceutical industry

  *after WW2, the British government provided antibiotics free to anyone who needed them through the NHS

  *impact of antibiotics in modern medicine is very far reaching
• Howard Florey and Ernst Chain

  *purified penicillin, the first commercial antibiotic to save human lives

  *in 1938 they read Fleming's article on penicillin, saw potential in it and applied for funding from the British government- they only received £25

  *tested penicillin on mice and saw that it helped them recover from infection. but to treat a person they needed 3000 times the amount, so they began growing it wherever they could

  *by 1941, they had enough to test it on one person, a policeman who has developed blood poisoning from a small cut - he began to recover however the penicillin ran out in 5 days, so he died

  *proving that penicillin worked, they went to America in 1941 (when they entered WWII) for funding (as English factories were too busy making war supplies to help) - the government saw potential; for treating wounded soldiers and funded them

  - by 1944, there was enough penicillin to treat all the wounded Allied soldiers on D-Day, over 2.3 million doses
• impact of antibiotics


  *pharmaceutical companies paid researchers to discover and trial other antibiotics

  *general use began in 1950s: the NHS provided antibiotics free of charge after 1948

  *improved surgical outcome and survival rates from diseases like pneumonia, meningitis and similar infections

  *scientists and doctors communicated their research and scientific techniques to learn from each other and technological equipment were improved to enable this work

  *pharmaceutical companies compete in to make more effective drugs
• aspirin


  *comes from willow bark and had been used as a medicine for centuries, though no one knew why it worked

  *scientific development enabled scientists to identify how willow bark was beneficial, and it was then manufactured in large quantities

  *aspirin helped thin blood and could help repented blood clots from forming, hence reducing risk of heart attack
• discovery of DNA


  *until the 1950s, genetic diseases such as Alzheimer's disease, diabetes, Parkinson's disease and some forms of cancer were untreatable

  *the work of Rosalind Franklin enabled Crick and Watson to discover the structure of human DNA and how it passes from parents to their children

  *the discovery of DNA and how each part of it affects the human body has allowed scientists to find ways of treating specific genetic illnesses
• thalidomide


  * mild tranquilizer that taken to reduce morning sickness during pregnancy

  *was not fully tested and led to children being born with severely deformed limbs

  *usage was banned in 1961 worldwide and with further research, different forms have been found to help people with blood cancer and leprosy

  *impact has led to much more thorough testing of drugs before use
• antibiotic resistance


  *the evolution of populations of pathogenic bacteria that antibiotics are unable to kill due to overuse of antibiotics

  *in 2014, the World Health Organisation warned of a "post-antibiotic era" in which common infections could once again kill due to antibiotic ineffectiveness
• new diseases

  *in 1982, doctors recognised a new illness, AIDS, which destroys the body's immunity to other diseases, leaving those with the illness much more vulnerable to infections

  *transmitted through sexual fluids and blood and a cure or effective vaccine is yet to be discovered

  *in the 1990s, treatments such as HAART were introduced, high helped to improve long term survival rates
• alternative treatments


  *other options available besides the proposed treatment

  *includes lifestyle remedies, such as getting enough sleep, eating healthily and exercising regularly

  *includes traditional remedies, such as acupunctures and herbal remedies
• x-rays

  *discovered in 1895 and were used before WWI to find internal injuries and broken bones

  *the need for x-ray technology was greater in WWI to not only locate broken bones but also find bullets and shrapnel inside soldiers in order to remove them from the body more easily

  *by 1916, all major British army hospitals were using x-rays and ambulances fitted with x-ray equipment wee being used close to the front lines
• improved antiseptic techniques


  *surgeons experimented with new ways to prevent infection in wounds during the first and second World War, as the dirty conditions of war left soldiers vulnerable to infection

  *cutting away infected flesh and soaking the wound in saline solution was found to be a life-saving short term solution in battle, though not ideal
• Karl Landsteiner


  *discovered that blood can be grouped into different types, A, B, AB and O in 1901

  *blood of one group cannot be mixed with blood of a different group

  *after this discovery, blood transfusions became possible
• blood transfusions


  *the introduction of blood, or blood products, or a blood substitute into a patient's circulation to restore blood volume to normal levels

  *the issue of blood clotting when storing/transporting blood was solved by adding sodium citrate to prevent clotting in 1914 and in 1915 blood was being bottled, stored in ice and kept in blood banks

  *in 1940 scientists discovered how to store blood cells and plasma separately, making it easier to store and transport
• Harold Gillies


  *developed new techniques for treating facial injuries WWI with plastic surgery

  *persuaded the army to set up a special hospital to repair severe facial injuries many soldiers suffered from

  *treated over 5000 soldiers by 1921

  *recognised as one f the first surgeons to go beyond simply considering patients' survival and health to treat their appearance and self-esteem
• Archibald McIndoe


  *cousin of Harold Gillies

  *did plastic surgery on hands and faces in WWII using new drugs like penicillin to prevent infection

  *helped patients psychologically to deal with great changes in their appearance and even helped some financially start life again as civilians
• plastic surgery


  *surgical specialty involved in repair, reconstruction, or improvement of body structures such as the skin that are damaged, missing, or misshapen
• broken bones


  *Army Leg Splint was used to deal with broken legs, as it would support the leg in traction while bones healed

  *in 1914, 80% of soldiers with a broken femur died but by 1916, 80% survived
• shell shock


  *psychological disturbance caused by prolonged exposure to active warfare

  *now known as PTSD

  *was not initially recognised by the army and 300 British and Empire soldiers were executed for cowardice or desertion, though later in war it was recognised and over 80000 soldiers were diagnosed as showing signs of it

  *army hospitals began to work with psychologists to use a combination of discussion, sports and crafts to provide therapy and support
• Helmuth Wesse


  *developed anaesthetics that could be injected into the look in the 1930s
• injected anaesthetics


  *invented by Helmuth Wesse

  *allowed doctors to control the dosage more precisely, making anaesthetics safer and permitting longer operations

  *effectiveness of local anaesthetics allow patients to have major surgeries even without going to sleep
• Marie Curie


  *when researching x-rays with her husband, Pierre, they noticed that the skin on their hands were burned by the material they were handling, leading to the discovery of radium

  *her research was the beginning of the modern treatment of cancer, with radium being used to diagnose and treat cancers

  *died of leukaemia, which was caused by the radioactive material she used in her research
• radio therapy and chemotherapy

  *radio therapy aims to kill cancer cells using beams of radiation that target them precisely

  *chemotherapy is used if cancer has developed so far that surgery and radiotherapy are not successful: it involves the use of particularly powerful chemicals to attack cancer cells, it can have significant side effects because healthy cells are killed too
• open heart surgery


  *surgical procedure in which the sternum is cut in half vertically to open the chest and expose the heart, its valves, or the arteries

  *enabled surgeons to repair parts of the heart while blood circulation is maintained
• transplant surgery


  *replaces a malfunctioning body part, tissue, or organ

  *first heart transplant was carried out in South Africa in 1967 (kidneys in 1954 and liver in 1963)

  *dependancy on technical skill and many other discoveries: before transplants could work, scientists had to first discover drugs to stop the patients body from rejecting replacement organs
• keyhole surgery


  *medical operation in which a very small hole is made in a person's body to reach the organ or tissue inside

  *done so to avoid large incisions

  *possible because of miniaturisation: all the surgeon's tools are inside a small instrument called an endoscope, which is controlled by the surgeon from outside using miniature cameras, fibre-optic cables and computers
• scanning machines


  *CT scanners use x-rays to produce 3D images of internal bodily structures

  *magnetic resonance imagining (MRI) uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain

  *ultrasound scanners convert high-frequency sound waves to images of internal body parts
• problems of poverty

  *malnutrition from a lack of protein and other nutrients needed for good health

  *limited access to adequate sanitation facilities and clean drinking water

  *high infant death rates

  *38% of potential recruits for the Boer War were unfit to serve on medical grounds - the need for a strong army was an incentive for the government to improve public health
• Seebohm Rowntree (1871 - 1954)

  *in 1901 he published a study of living conditions in York, showing that more than 25% of people were living in poverty and it was seriously harming their health

  *his report deeply influenced people within the Liberal government that came into power in 1906
• Charles Booth (1840 - 1916)

  *businessman who paid for research into poverty in East London between 1889 and 1903 and spent weeks living in the area himself

  *discovered that 35% of people were living in poverty (far more than had been claimed)

  *argued that government should take responsibility for caring for people in poverty

  *one of his suggestions was an old-age pension
• David Lloyd George (1863 - 1945)


  *Chancellor of Exchequer in the Liberal government

  *increased taxes paid by the rich to pay for the Liberal reforms
• the Liberal social reforms (1906 - 1914)

  *1906: free school meals for school children

  *1907: free medical checks for school children and all births had to be reported to the local Medical Officer and a health visitor then visited each mother to make sure she knew how to protect her baby's health

  *1908: old-age pensions introduced for people over 70 who did not have enough money to live on

  *1909: new laws enforced higher standards of house building

  *1911: National Insurance Act provided help for sick people

  *1912: clinics set up to provide free medical treatment for children in school
• National Health Insurance Act of 2011

  *gave workers medical help and sick pay if they could not work through illness

  *made workers, their employer and the government pay into a sickness fund and when workers fell ill and unable to work, they received money for 26 weeks and free medical care

  *until then, workers who fell ill either had to work despite being sick or not work and get no pay, which usually meant that they could not afford medical help

  *only covered people in work, not their families, so most women and all children were excluded as well as unemployed people, older people and anyone will chronic illnesses
• Housing Act of 1919

  *passed immediately after WWI

  *any poor people had fought in the army for years, and the government felt that it owed them a better life in return for their sacrifices

  *they were promised "homes fit for heroes"

  *local councils were ordered to provide decent, low-cost housing

  *about 250,000 new homes were built.
• WWII's impact on health

  *death of 400000 soldiers and 60000 civilians

  *evacuation of one million children from British cities to the countryside

  *food shortages and rationing resulted in healthier diets for poorer people as vegetables were more prevalent in diets

  *government took measures to improve public health, such as encouraging healthy diets, regular exercise, and immunisations with vaccines
• William Beveridge (1879 - 1963)

  *British civil servant who produced a famous report in 1942, which suggested the setting up of a national health service
• Beveridge Report (1942)


  *government report published in November 1942, officially entitled Social Insurance and Allied Services, which was influential in the founding of the welfare state in the UK

  *it was drafted by the Liberal economist William Beveridge, who proposed widespread reforms to the system of social welfare to address what he identified as five "Giant Evils" in society: squalor, ignorance, want, idleness, and disease

  *published in the midst of World War II, the report promised rewards for everyone's sacrifices

  *spelled out a "cradle-to grace" welfare state, recommending a national health service and universal national insurance

  *overwhelmingly popular with the public (600000 copies were sold), it formed the basis for the post-war reforms known as the Welfare State, which include the expansion of National Insurance and the creation of the National Health Service
• a national health service

  *free to everyone and paid for from taxes

  *doctors, nurses and other medical workers would become government employees instead of charging sick people to pay their wages