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Lecture 16 : History Of Medicine(2) Overview CURATIVE / THERAPEUTIC MEDICINE Medicinal drugs Other developments PREVENTIVE MEDICINE Vaccines PUBLIC HEALTH MEDICINE Yellow Fever in Cuba / USA Malaria in US STATE HEALTH SYSTEMS GLOBAL Medicinal Drugs • Antitoxins – e.g. diphtheria 1890. Also used for botulism, dysentery, gas gangrene, and tetanus. • Chemical. Paul Erhlich – Salvarsan, 1910. Effective against syphilis. • Gerhard Domagk – Suphonamides, 1932. From red dye Prontosil. Effective against Streptococcal infections. • Biological. Alexander Fleming – Penicillin, 1928 / 1941. Toxin produced by Penicillium notatum. Effective against syphilis, gonorrhoea, bacterial pneumonia, meningitis, puerperal fever, septicaemia, and a host of childhood infections. • Streptomycin, 1944. Cultivated from a soil organism Streptomyces griseus. Effective against TB. Major Antibiotics Antibiotic Date of Discovery Microbe Penicillin 1929-40 Penicillium notatum Streptomycin 1944 Streptomyces griseus Chloramphenicol 1947 Streptomyces venezuelae Chlortetracycline 1948 Streptomyces aureofaciens Cephalosporin C, N & P 1948 Cephalosporium sp. Neomycin 1949 Streptomyces fradiae Oxytetracycline 1950 Streptomyces rimosus Nystatin 1950 Streptomyces noursei Erythromycin 1952 Streptomyces erythreus Novobiocin 1955 Streptomyces spheroides Vancomycin 1956 Streptomyces orientalis Kanamycin 1957 Streptomyces kanatnyceticus Fusidic acid 1960 Fusidium coccineum Lincomycin 1962 Streptomyces lincolnensis Gentamicin 1963 Micromonospora purpurea Antibiotics • By 1965 more than 25,000 different antibiotics had been developed, many of which were 100 per cent effective against specific bacteria. Other Advances In Therapeutic Medicine • Endocrinology : insulin for diabetes, cortisone for rheumatoid arthritis, and sex hormones for birth control. • Medical technology : X-rays, CT scans (computerised tomograpgraphy) and MRI scans (magnetic resonance imagery) and ultrasound. • Surgery : improved anaesthetics, methods to reduce shock, blood transfusions, organ transplants, keyhole surgery. Preventive Medicine - Vaccines • Bacterial vaccines : diphtheria (1890) and tetanus (1892) using antitoxin, typhoid (1897) using dead bacteria, diphtheria (1913) and BCG (1921) using attenuated strains, diphtheria (1923) and tetanus (1930) using toxoids. • Viral vaccines: yellow fever (1930s), influenza (1945), Salk (1954), Sabin (1960), measles (1960s) and rubella (1960s). Preventive Medicine - Vectors • Patrick Manson – mosquito vector for elephantiasis (1876). • Ronald Ross – Anpheles mosquito for malaria (1898) after Alphonse Laveran identified Plasmodium as the agent (1880). • Carlos Juan Finlay – Aedes mosquito for yellow fever (1881), confirmed by Walter Reed (1900). Public Health Medicine • Curative / therapeutic can be conducted for profit by individuals. • Preventive medicine is non-profit making and therefore usually requires some form of social intervention in the public interest. • Came to the fore in the late 19th century. The Yellow Fever Campaigns • Cuba, 1901. Yellow fever eliminated in Havana in 3 months. • New Orleans, 1905. Epidemic killed 452 people. Citizens raised $250,000 for campaign. Last outbreak in North America. US Malaria Campaigns • Ithaca, 1905-1908. Malaria eliminated after draining wetlands and pouring oil on water bodies. • Rockefeller foundation launched major campaign in southern US cities in 1922. Urban areas cleared, but rural areas still problematic. • Upsurge after flooding in 1927, caused by deforestation and soil erosion. • Tennessee Valley Authority set up 1933. 150,000 cases of malaria, 5,000 deaths per year. 65% carried Plasmodium. Tennessee Valley Authority • Malaria rates initially increased (as expected). • TVA cleared vegetation around the water line of the resevoirs, and flushed the mosquito breeding grounds by raising and lowering water levels. • Swamps drained. Canals built to speed up water flow. • By 1940s malaria rates declined to 50,000 cases and 6,000 deaths per year. • DDT spraying introduced in 1943. Malaria elimintated by 1952. • DDT spraying extended to rest of the South at end of WWII. Co-ordinating body became the Centers for Disease Control, based in Atlanta. State Interventions • State subsidised health systems now the norm. • Mass / routine vaccination campaigns e.g. the BCG; the DPT (diphtheria, pertussis and tetanus, plus polio, influenza, hepatitis B) 6-in-1; and MMR (measles, mumps and rubella) 3-in-ones, plus others. • Screening programs (e.g. school check-ups, smear tests, etc.). • Hospitals are mostly funded by the state. WHO Campaigns • World Health Organization set up 1948. • Global campaign against malaria met with mixed results. • Smallpos campaign begun in 1965 eliminated smallpox by 1977.