1900-modern

• What was different about the 20th century?

  - People finally understood what caused common diseases such as cholera and diphteria

  - First time period where doctors were working solely with solid scientific discoveries

  - Move towards laboratory medicine, with examination of samples.

  - Much of the progress in this period has relied on technology and government funding/intervention.
• Early advances in genetics

  - By 1900, a German scientist, Mendel had theorised that genes come in pairs, inherited from each parent.

  - Microscopes were not yet powerful enough to prove his theory

  - By 1951 scientists knew that characteristics were passed from parent to child. At King's College in London, Rosalind Franklin and Maurice Wilkins created the first X-Ray photographs of DNA.
• Crick and Watson

  - In 1953, James Watson and Francis Crick saw the x-rays provided by Franklin and built on this with new technology, using a technique called crystallography which uses radiation to take a higher power X-ray photograph.

  - They published their paper in April 1953 and understanding the shape of DNA was the launchpad for future discoveries: scientists could now look at its structure and identify the parts that caused hereditary disease.
• The Human Genome Project

  - Between 1990 and 2003, James Watson led a project to map the human genome (every gene in the human body)

  - It took 13 years and involved 18 teams of scientists from all over the world to decode and map the human genome.

  - Scientists have since used this blueprint of human DNA to look for mistakes or mismatches in people suffering from hereditary disease... the BRCA1 breast cancer gene being an example.
• What helped DNA be discovered?

  - Science and Technology: powerful microscope technique crystallography and later, the electron microscope

  - Key individuals: Franklin and Wilkins, Watson and Crick

  - Teamwork: Human Genome Project required collaboration from 18 teams all around the world// would not have been possible before computers as way too much information for any library!

  - Government (and industries funded Crick and Watson's work)
• Lifestyle factors

  - Throughout the twentieth century, we have gained better understanding of the impact lifestyle choices have on the body

  - Smoking: linked with high blood pressure, cancers, heart disease

  - Diet: Sugar and fat have a particularly negative impact, leading to type 2 diabetes etc.

  - Drinking too much can lead to liver diseases and kidney problems

  - Fashion for tanning has led to rise in skin cancer cases
• The impact of technology: Diagnosis

  Technology has had a huge impact in allowing us to diagnose and monitor disease. For example...

  - Blood tests can test for an enormous number of conditions

  - Blood pressure monitors help diagnose high and low blood pressure

  - Blood sugar monitoring allows people suffering from diabetes to check their blood sugar regularly

  - ECGs use electrical impulses to track heart activity
• Magic Bullets


  Definition: a chemical cure which would attack microbes in the body, leaving the body unharmed

  - First major breakthrough was made in the treatment for syphilis

  
  

  - Paul Ehrlich tested over 600 compounds initially but by 1907 still had not found a cure

  - In 1909, a Japanese scientist called Hata retested all the compounds and found that #606 cured syphilis. The drug was named Salvarsan 606 and was the first magic bullet.

  In 1932, Gerhard Domagk discovered prontosil was another which would cure blood poisoning.

  
  

  Magic bullets work similarly to antibiotics, but are created using chemicals, rather than microorganisms.
• Antibiotics: Fleming

  - Alexander Fleming was a British doctor with an interest in bacteriology

  - In 1928 Fleming left some petri dishes in the lab whilst he went on holiday

  - Upon his return, he discovered that mould had grown around some of the staphylococcus bacteria and appeared to be killing it off: penicillin

  - Fleming did not pursue funding on his chance discovery.
• Antibiotics: Florey and Chain

  - In 1939, Howard Florey and Ernst Chain received Fleming's original papers.

  - They tested the extracted penicillin on infected mice and set about growing as much as possible so they could start a human trial.

  - By 1941, there was enough penicillin to test on one person. The volunteer was a policeman, Albert Alexander, who had developed septicaemia - a bacterial infection - from a rose thorn cut. The penicillin worked and Albert began to recover, however they ran out of penicillin after five days, and Albert later died.

  - They needed to persuade the government to fund their research, but the last time they'd asked, they only received £25.
• Antibiotics: WW2

  - English factories were working flat out on the war effort during the Second World War (1939-45) and could not be used to mass-produce penicillin.

  - Florey went to America. The American government realised the potential of penicillin for treating wounded soldiers and made interest free loans to US companies to buy the expensive equipment needed for making it.

  - Soon British firms were also mass-producing penicillin, enough to treat the allied wounded on D-Day in 1944 - over 2.3 million doses.

  - After the war ended in 1945 penicillin began to be manufactured and gradually became an 'everyday life saver
• Liberal Government Reforms

  The Liberal Government were in power between 1905 and 1915

  - They introduced a series of health reforms including free school meals and the 1911 National Insurance Act.

  - National Insurance Act provided free health care for some workers, but excluded key groups such as women and children.
• The Beveridge Report


  - The first half of the twentieth century saw increasing demand for effective public health provision.

  - Two factors behind this: democracy (more voters demanding change)

  - World War Two: free health care in the war was very effective and evacuation highlighted horrendous living conditions of inner city poor.

  - William Beveridge was a civil servant who wrote The Beveridge Report in 1942 which recommended the setting up of a National Health Service

  - 600,000 copies were sold - people queued up in the streets to buy it.
• NHS: Early Years

  - NHS was introduced on July 5th 1948.

  - Aimed to provide medical care for the entire population of Britain and was paid for through National Insurance contributions.

  - Initial problems included 19th century hospitals in desperate need of renovation, more hospitals in London and the South East than elsewhere and many GPS not providing a satisfactory srevice

  - Gradually, the government became more involved, introducing a GPs charter in 1966 and building hospitals across the whole country.
• NHS: 21st century


  - Hospitals have become increasingly high tech, with the development of new machinery to treat the body.

  - Examples include advanced x-rays, smaller and cheaper machines such as dialysis and robotic prosthetic limbs

  
  

  Government are also much more 'active' in in running of the NHS - increasing funding, setting up organ donor scheme etc.
• 21st century surgery

  Developments in 21st century include:

  - Microsurgery (first kidney transplant was in 1956, lung transplant in 1963) - this was made possible by microsurgery which reattaches tiny nerve endings and blood vessels

  - Laparoscopic (keyhole) surgery - Tiny cameras and narrow surgical instruments are used so that surgeons can operate through tiny incisions some distance away from the area being operated on - less traumatic and faster healing time.
• Why did the government abandon Laissez Faire?

  Two main reasons:

  1) Increased understanding of disease means that the government knows it will have an impact and their intervention will change things

  2) Increased understanding of the methods of prevention: Increased understanding naturally leads to more effective methods of prevention being introduced e.g. compulsory vaccination campaigns, passing laws and communicating health risks.
• Prevention: Compulsory Vaccination Campaigns

  Many compulsory vaccinations have been launched in the 20th century. For example...

  - Diphtheria in 1942

  - Tetanus in 1961

  - Measles in 1968 ... leading to successful eradication of these diseases in many cases.
• Prevention: Clean Air Acts

  - Government has passed two Clean Air Acts of 1956 and 1968 which were triggered by bad episodes of smog in London.

  - Introduced a number of measures to reduce air pollution (e.g. smoke control areas in some towns and cities and relocating power stations away from cities)
• Prevention: Communicating Health Risks

  Government lifestyle campaigns have successfully communicated health risks. For example...

  - Advertising campaigns warn against dangers of binge drinking, recreational drug use and unprotected sex

  - Events such as Stoptober encourage people to stop smoking for a month

  - Initiatives such as Change4Life encourage people to get healthy in many different ways e.g. sugar swap, couch to five k.
• Lung Cancer in the 21st C: Causes

  Lung cancer is the second most common cause of cancer in the UK - affects mostly people over the age of 40,

  - 85% of cases are in people who do, or have, smoked.

  - Chemicals in the air such as radon gas are sometimes to blame.

  - Rise in cases of lung cancer coinciding with aggressive advertising for cigarettes dating from WW1.
• Lung Cancer: Science and Technology in Diagnosis


  - Lung cancer is hard to detect because it's usually very advanced by the time it's detected as patients mistake their symptoms for other diseases.

  - CT scans are often used to help create a detailed picture of the inside of the body (using dye) and help to show up tumours

  - Bronchoscopes are also used - this involves passing a tube into a patient's lung and collecting a sample of cells for testing.
• Lung Cancer in the 21st C: Treatment

  - Transplants: replacing a diseased lung with a healthy, donor lung - raises ethical concerns

  - Radiotherapy: Radiowaves are aimed at the tumour trying to shrink it or inhibit growth.

  - Chemotherapy: Patients are injected with many different drugs in the aim of shrinking the tumour.
• Lung Cancer in the 21st C: Prevention

  Government have passed many measures to either force or influence people to stop smoking.

  - In 2007 they banned smoking in all workplaces

  - In 2015 this ban was extended to cars carrying children under 18

  - Tobacco products are increasingly taxes and advertising of products was banned in 1965.

  - Increasingly, the gov release anti smoking campaigns with stark health messages.

  - From 2012, all cigarette packaging displayed warning messages and discouraging images.