Medical Treatments in Modern Britain (Edexcel GCSE History)

Approaches to Treatment in the 20th Century - Summary

Antibiotics - Ehrlich & Domagk

'Magic Bullets'

• By the 20th century, doctors understood the idea of antibodies

  • Medical professionals had discovered that vaccination worked by producing a reaction from the patient's immune system

  • Scientists believed the human body was capable of producing antibodies to other chemical compounds

• A 'magic bullet' was an early 20th-century concept. The idea was that one chemical treatment could attack harmful bacteria without hurting the rest of the body

Ehrlich and Syphilis

• Syphilis continued to be a problem in the 19th and 20th centuries

  • When Britain fought the Boer War (1880-1902) and World War One (1914-1918), it became clear that many young men had syphilis. The army could not conscript enough healthy men

  • Scientists needed to find an effective cure for syphilis. Medical professionals were still prescribing the mercury treatments of the 16th century

• Paul Ehrlich tested arsenic compounds to find a cure for syphilis

  • By 1907, Ehrlich had tested more than 600 versions of arsenic but had not found a cure

• In 1909, Japanese scientist Hata retested the arsenic compounds Ehrlich had experimented with

  • He discovered that compound 606 cured syphilis

  • He named the chemical cure Salvarsan 606

    • This became the world's first 'magic bullet'

Domagk and Antibiotics

• Scientist Gerhard Domagk discovered in 1932 that a red dye called Prontosil killed infections in mice

• Domagk did not know if this would cure bacterial infections in humans

  • He tested Prontosil on his daughter, who was dying from blood poisoning. Prontosil saved her life

  • Queen Charlotte's Maternity Hospital in London used Prontosil to treat puerperal fever

    • Death rates in puerperal fever dropped from 20% to 4.7%

• Domagk's and Ehrlich's success encouraged scientists to pursue the development of antibiotics

Fleming and Penicillin

Fleming's Discovery of Penicillin

• Fleming was a Scottish doctor working at St. Mary's Hospital in London

• Alexander Fleming:

  • Pioneered the use of Salvarsan 606 to treat syphilis

  • Worked in battlefield hospitals during World War One and saw men who died of syphilis infection

• During the 1920s, Fleming began to study a type of bacteria called Staphylococcus

• Staphylococcus was resistant to the 'magic bullets' available at the time

  • It is a deadly bacteria which can cause blood poisoning and toxic shock syndrome

• In 1928, Fleming accidentally discovered penicillin

  • Fleming went on a holiday, forgetting to clean a petri dish which contained the staphylococcus bacteria

  • On his return, Fleming noticed mould in the petri dish. This mould prevented staphylococcus from growing

    • Medieval people observed that mouldy bread had healing qualities. Fleming's examination demonstrated that mould could fight bacteria

    • Fleming published his findings in 1929

• Fleming didn't realise the potential impact of his discovery on humans

  • Scientists at the time were more interested in looking for chemical cures for disease. Germ Theory states that microbes are dangerous and they do not possess the ability to heal

  • His first experiment showed penicillin was ineffective when combined with blood

Florey and Chain and the Development of Penicillin

• Florey and Chain worked together at Oxford Medical School

  • Howard Florey was an Australian pathologist

  • Ernst Chain was a German biochemist who had escaped from Nazi Germany

• In 1939, during their study of antibiotics, Florey and Chain discovered Fleming's work on penicillin

  • Chain was able to grow mould and extract enough penicillin to run tests

• In 1940, they successfully tested penicillin on mice

  • Eight mice were infected with staphylococcus  

  • Four mice received penicillin while four mice did not receive treatment

  • The four mice without treatment died

  • Penicillin saved the other four mice

• Florey and Chain's research caught the attention of the British government

• At this time, Britain was fighting Germany in World War Two

  • In World War One, many soldiers died from their wounds becoming infected

  • The British government knew that the effective treatment of wounds could be the difference between winning or losing World War Two

  • Florey and Chain received £25 from the government to fund their research into penicillin

    • Today, this would be approximately £1100

• By 1941, penicillin was ready for human trial

  • Albert Alexander was a local policeman

    • He was in hospital suffering from septicaemia, a deadly blood poisoning

    • Alexander had developed the infection after scratching himself on a rose thorn

  • Albert took penicillin and showed signs of recovery. Florey and Chain ran out of their supply of penicillin

  • Despite Albert's death, the trial proved that penicillin worked on humans

Mass Production of Penicillin

• In July 1941, Florey flew to America to persuade pharmaceutical companies to mass-produce penicillin

  • Florey had approached British companies but, due to the Second World War, they did not have the time or resources to grow penicillin

  • Mass production of penicillin required growing the mould in beer vats

  • It was a slow process. After a year, the American companies had only produced enough penicillin for ten doses

• America recognised the potential of penicillin

  • The US government gave money to 21 pharmaceutical companies to produce the drug

  • British pharmaceutical companies began to mass-produce penicillin in 1943

• Towards the end of the Second World War, penicillin became vital

  • By 1945, the US Army had access to two million doses of penicillin per month

  • An estimated 50% of wounded soldiers survived their injuries because of penicillin

A storyboard showing the discovery and development of penicillin

Factors Which Enabled the Development of Penicillin

• Institutions

  • The US government funded Florey and Chain's research

  • The British government invested in medical research for the first time

• Technology

  • The use of beer vats and milk churns to mass-produce penicillin

• Attitudes in society

  • The Second World War motivated the government to discover a treatment that prevented soldiers from dying from infection

  • The urgency for penicillin to be available meant that thorough medical trials were not considered necessary

• Science

  • Scientists were able to observe how penicillin mould killed staphylococcus

  • The scientific team at Oxford worked together to test and produce penicillin

• Individuals

  • Alexander Fleming discovered penicillin

  • Florey and Chain proved the impact penicillin could have on infections in humans

  • Florey persuaded American pharmaceutical companies to mass-produce penicillin

  • Florey refused to patent penicillin, believing it should be readily available to all

Modern Development of Antibiotics

• Penicillin inspired scientists to research other moulds and fungi for their antibiotic abilities

  • Selman Wakston discovered Streptomycin in 1943. This was effective against tuberculosis

  • Dorothy Hodgkin mapped the chemical structure of penicillin in 1945. This allowed other scientists to create synthetic antibiotics which were adapted to treat different bacteria

    • John C. Sheehan created the first chemical copy of penicillin in 1957

• Science and technology impacted the development of antibiotics

  • Antibiotics were distributed in capsule form. This is an easier method to administer medicine

  • Those with serious infections have antibiotics administered by hypodermic needles. This allows an accurate dose of medicine to be placed directly into a patient's bloodstream

  • Drug trials ensured that new antibiotics worked and had limited side effects

• In the 21st century, some bacteria have become resistant to penicillin

  • Penicillin-resistant strains of bacteria emerged in 1942

  • When antibiotics became readily available in the 1950s, doctors prescribed them too often

    • Antibiotics only work for bacterial infections yet they were being offered to patients with viruses

  • A government report in 2018 discovered that GPs in England incorrectly prescribed 20% of patients with antibiotics 

  • Bacteria like MRSA are a danger to public health

  • MRSA is resistant to some antibiotics mainly penicillin. It can still be treated with other antibiotics

Modern Surgery - Transplants, Transfusions & Keyhole Surgery

• An extensive range of operations are now available to patients

  • For example, people in modern Britain have access to operations like hip replacements and organ transplants

• Surgery in modern times is much safer

  • Modern surgery has methods to cope with the three major problems of surgery:

    • Blood loss

    • Pain

    • Infection.

• The contributions of Lister and Simpson resolved the issue of pain and infection. Blood transfusions combated blood loss in the mid-20th century

• Surgeons are now able to complete deeper, more complex operations like brain surgery

New Surgical Technology

Medical Care: The Impact of the NHS

• The Liberal Party won the 1906 general election. They passed a series of reforms which attempted to improve medical care:

• In 1907, children received free medical inspections in school

• The National Insurance Act of 1911 provided health insurance for male workers earning under £160 per year. The Act entitled eligible workers to 25 weeks of sick pay

• In 1912, school-aged children became entitled to free medical treatments 

• Many people still did not receive the medical treatment that they needed

  • The provision of healthcare depended on each local authority

  • National Insurance did not cover women or a worker's family

  • Areas outside of London and the South East of England did not have enough hospitals. Built in the 19th century, the available hospitals required updating 

  • People still had to pay for doctors. As a result, many continued to rely on purchasing herbal treatments like Beechams from pharmacies

Structure of the NHS

• The Labour government under Aneurin Bevan launched the NHS (the National Health Service) in 1948

• It provided free care for everyone

  • Workers funded the NHS through their National Insurance payments. The government continue to apply this tax

• The government used the existing provision of hospitals and medical services and took them under their control

A flowchart showing the structure of the NHS

The Impact of the NHS

The Extent of Change in Care & Treatment

Improved Access to Care

• In 1919, the government established the Ministry of Health

  • This showed a desire by the government to ensure a good standard of healthcare across Britain

• The NHS gave free healthcare to all

  • People were no longer turned away for being unable to pay for treatment

• The role of hospitals transformed

  • Before, hospitals provided facilities for the elderly to rest 

    • People questioned where the elderly would go if they had no family to care for them

  • Now, hospitals are only for the treatment of disease

Improvements to Treatments

• Deaths by infectious diseases fell significantly

  • In 1900, 25% of all deaths were the result of infectious diseases

  • By 1990, this percentage had fallen to less than 1%

• Chemical treatments were available

  • At the start of the 20th century, people relied on herbal remedies

  • After 1945, a range of 'magic bullets' were available to treat a variety of illnesses

Issues with Treatments

• It is difficult to make vaccines for viruses

  • There is a new flu vaccine every year because there are lots of variant of the disease

  • Microbes can evolve to become resistant to certain treatments

    • An example of this is newer strains of COVID-19

• Newer or more complex diseases sometimes do not respond to treatment

  • Scientists can take many years to develop successful treatments. There are few specialised medical cures for diseases with many variations like cancer

• Lifestyle factors have caused diseases like heart disease to increase

  • Scientists do not fully understand the impact of all lifestyle choices on public health